24th September. 20-22 ops.

Tony is doing an awkward palatal fistula in a 6 yr old girl who had lip and palate surgery elsewhere. Kaan, the Masai Clinical Officer for Anaesthetics in Kimilili has told me a disturbing story about Lifebox training in Eldoret in April/May this year. A colleague went to Eldoret for Lifebox training, with the promise of an oximeter to take away at the end of the course. In reality he came away with a Lifebox kit with self-inflating bag, laryngoscope and a selection of tubes, but no pulse oximeter. The boss in Eldoret with its excellent facilities had kept the oximeter. This is not the way that Lifebox set out its stall. It doesn't always work as planned. It's a new charity with a great purpose. How it achieves that purpose without intervening power-play by senior national doctors at the expense of the Medical and Clinical Officers ability to care safely for patients, is a matter that needs individual decisions, and international Standard Operating Procedures.

The afternoon list is in full swing; the third and last patient on the list. Another 6 year old girl. I wonder what schooling opportunities have been lost by her so far because of her facial disfigurement? "I'll be jiggered!" Is a phrase sometimes heard in the UK. This girl has jiggers. She obviously doesn't wear shoes, and the jiggers have caused eruptions on the soles of her feet. It is a significant cause of morbidity, and there was a UK student here last week doing a Masters dissertation on the Public Health response to jigger infestations. Eight schools in Bungoma province shut down last week because of jiggers. I remember going to a shoe shop in Covent Garden with Naomi and Sue, where each pair of shoes sold raised money for another foot problem common in Ethiopia caused by a particular crystal type of rock surface they walk on. And we take shoes for granted.

We plan three 7 kg children tomorrow, and then two double lip & palate patients on the Friday.. Those patients count as two operations each with Smile Train. The last week we won't do any more palates, so we start doing the 4+ kg patients with their lips at about three months of age for their cleft lip repairs. We could possibly take a couple more cleft lip patients if they arrive soon.

Last night after the afternoon rain, there was more rain at midnight and at 0600hrs. A tractor had broken down in Becky's lane when she returned home so she parked by the Guesthouse. Her Landrover front passenger door lock fails to function so the passenger has to hold the door shut! Maurice was filling the vehicle tank with petrol, so I set out early and walked a mile before I was picked up. It was muddy!

Ann and Anne-Marie busy themselves making up porridge to bring to the hospital for 0800 feeds. They have a blender in theatre to take out the lumps. It needs to boil for ten minutes before cooling down. It is popular with the patients and parents. The volume required as the palate operations have taken place has risen to 9 litres for today, which are brought here in recycled cooking oil 3litre plastic containers.