Ordinarily we would not get into a car with a complete stranger, especially given that we have no idea where we are being taken. Nor would we agree to rendezvous with a man we met over the internet and let him take us to his house in the notoriously dangerous city of Nairobi, Kenya. Today, however, we completely ignore mother?s advice and climb into the tattered car of Alex Kilele Ndolo. We leave the hotel and pass by the uniformed guard as he swings open the heavy iron gates that create a protective fortress for our hotel. Outside the tranquility and luxury of The Palancia Suites is a world unlike our own. Homes, apartments, businesses and even the kindergartens are secured behind large cement block walls topped with barbed wire or electric fencing.
?We are so happy to have you visit us that we will be slaughtering a goat in your honor,? are the first words our host speaks to us. Director of the Kilele Foundation, Alex has teamed up with us to celebrate LIVESTRONG Day 2010. Ordinarily we would be leading an indoor cycling marathon in Los Angeles, raising money to provide support for people living with cancer, but this year the anniversary of Lance Armstrong?s testicular cancer diagnosis falls on our arrival to Nairobi, Kenya before we embark on a safari to see the great migration. Were it not for our LIVESTRONG mentor, Steve Bartolucci, finding this Kenyan event, we would be sipping cocktails on the patio of our fine hotel instead of sitting in the back seat of a car wondering if we should feel proud of our charitable spirit or embarrassed by our foolishness and naivety for leaving the safety of our hotel.
A forty minute drive over dirt roads covers us with a fine red dust. Our lungs burn from black exhaust billowing from vehicles zigzagging in and out of traffic, everyone jockeying for a better position on roads that have no lanes. Ineffective policemen stand motionless in the middle of the street watching in a daze as cars drive over makeshift sidewalks, jut onto the opposite side of the road and demand that pedestrians take responsibility for avoiding being hit.
A large padlock hangs open from a rusted massive metal gate that belies the tiny cement block house that it completely shelters. Thirty or so members of the Kilele Foundation greet us as if we were celebrities. Visitors from the USA don?t venture outside their luxury hotels, making us highly honored guests. Cameras are not too common either and the children are eager to have their picture taken and immediately see it on the LCD screen. I take photos of the yellow themed center table with yellow roses and handmade gifts for us bearing the LIVESTRONG name. I can?t resist taking a photo of the family goat tied to the wall.
We arrived loaded with 100 pounds of LIVESTRONG bracelets and shirts, school supplies and clothing. Men, women, children and even toddlers are excited to don their yellow bracelets, despite not knowing their global significance. We educate them that the bracelets are the key to starting the dialogue about cancer. This stimulates a discussion of cancer being a topic few in Kenya ever talk about. The fear that cancer is contagious keeps its victims silent. Awareness of cancer throughout the country is scarce. Knowledge of risk factors, preventative screenings and recognition of the signs and symptoms of cancer leave the majority of cancer victims diagnosed at advanced stages. The least informed citizens are the least likely to be able to afford the medicines; medicines that often don?t exist in government facilities.
A natural societal separation of men on one side, women on the other evolves. Stan speaks to the men about his 35 years of surviving Hodgkin’s. Looks of amazement flood their faces as they gaze upon this medical miracle never before seen in their lifetime. The feeling of hope is palpable as each man contemplates the possibility of life after cancer. The men are curious and want to know how Stan knew he had cancer, what type of treatment he had, how he paid for it and if he was cured.
Our conversations are interrupted for a formal welcome from Alex and his wife, Nzembi and the announcement of the slaughter of the goat. Apparently I blocked from my short term memory the promise of a goat and mistook dinner for a family pet. Watching the slaughter is an honor and much to my surprise, is done right there on the dirt patio over a piece of plywood. Despite my commitment to honor the traditions of other cultures I cannot bear to witness this and regret my earlier denial of vegetarianism.
?Cancer, you die from it, no?? is the first question I am asked. Women listen attentively, but are too shy to ask questions. Cathy Inguru, a project manager for African Food Security and Environmental Program, interviews me as if she has a telepathic connection into the minds of the guests. Speaking for them she extracts information from me that I take for granted as basic knowledge. ?Are there different cancers?? ?Can someone live long after having cancer?? ?How do they treat cancer?? ?There is no cure for cancer, right?? said more as a statement of fact than a question. The queries come with an eagerness to learn about a disease that is just recently gaining awareness in this impoverished country.
There are no national cancer registries in Kenya, leaving the truth unknown just how much havoc this devastating disease wreaks on this country of 39 million people. Estimates suggest cancer kills 50 people each day in Kenya, a country where 45.9% of the population live in poverty and have little or no access to health care, resulting in an average life expectancy of 53 years. By contrast about 1,500 people in USA die each day from cancer, but in a population of over 310 million. Average life expectancy in the United States is 77.8 years.
Dinner is prepared by a team of women, slicing, dicing and chopping in a well choreographed symphony. In lieu of assisting with the cooking I am handed a baby to tend to. As the children await dinner they play with the school supplies we brought. Colorful stickers and rulers are the favored gifts, followed by colored pencils and paper, which keep the grateful children entertained for the duration of the evening. Even the adults are eager to receive a gift of a ruler.
Food and water in a foreign land is always a concern for any traveler. Adding to our anxiety is eating a home cooked meal in a home with dirt floors, a hole in the floor for a toilet and no electricity. We step over the goat head as we make our way to the buffet table. ?As long as the goat is cooked well we are okay, aren?t we?? I whisper to Stan. ?We know the meat is fresh!? he responds, providing me no reassurance that we are safe to eat.
As we pick our way across our plates we exchange stories of cancer. Unfortunately the stories from Kenya do not have the happy endings that many survivors from the United States tell. Most stories begin with the person never having heard of cancer or having only a vague notion of what it is. The middle of each tale includes the lack of medicine available, and even if chemotherapy or radiation can be obtained in a hospital or clinic, only a tiny minority can afford to pay. No insurance and a government that does little to provide medical treatment for cancer patients means the end of almost every cancer story is death.
Money is not the only obstacle to treatment, a dearth of medical specialists adds to the burden. Only 4,500 physicians practice in Kenya, a mere 1 doctor per 10,000 people. In comparison the USA has 26 physicians per 10,000. Of those 4,500 doctors six oncologists, four radiation oncologists and four pediatric oncologists serve the estimated 80,000 Kenyan?s diagnosed with cancer each year. There are no trained surgical oncologists in the country. Only one public health facility with three machines exists in the county to provide radiotherapy services to just 3,800 patients fortunate enough to receive care each year. Lack of funds, properly trained medical personnel and the necessary diagnostic and treatment resources sends 51% of the physicians leaving Kenya to practice in other countries where the opportunity to save lives is a reality.
A bright yellow cake in honor of LIVESTRONG Kenya is lit with candles. Stan and Alex make a silent wish, no doubt each wishing to bring help to the Kenyan?s dying of cancer. They cut the cake together and feed one another a bite like a wedding couple vowing to take care of one another for the rest of their lives. Indeed this is what Alex is hoping for with his foundation.
Safely returned to our hotel we leave the next day for the African bush. Part animal watching, part spreading the word about LIVESTRONG. We give bracelets to our guides and rangers, camp staff and managers and fellow safari guests we meet from all over the world. The yellow bracelet is not recognized by anyone we meet in Kenya. Everywhere we go in this country cancer is viewed as a death sentence. Hope of survival is a foreign concept. Cancer, for many people is an alien word. Masai villagers have never even heard of cancer. They repeat ?can-sir? several times as my guide interprets for them in their native Ma language. According to the Masai I met they don?t have ?can-sir? in their villages. The idea of seeing a doctor is confusing to them. They look at me puzzled when they tell me that when women get sick they are treated with herbs and trees. Before we leave one another we exchange bracelets, beads and bones exchanged for yellow rubber.
Despite the pessimistic outlook for Kenyans, Alex Ndolo has a smile that stretches across his face. A victim of a poor health care system himself, the ravages of polio in childhood don?t get in his way. In fact, Alex never mentions himself; he is only interested in helping others. His dreams go beyond cancer. He wants to provide clean drinking water, prevent HIV/AIDS, educate young girls about pregnancy, provide wheelchairs for those that cannot walk, train villagers in a trade that will allow them to support their families, and feed hungry Kenyans. The idea that he is just one man trying to save an entire country does not enter his mind. He has added the fight against cancer to his crusade and hopes that we bring his message back to the United States so his countrymen do not have to die just because they had the misfortune of being born in a country that is barely picking a fight with cancer.
Learn more about The Kilele Foundation at www.kilelefoundationkenya.org
-Susan Ashley, Ph.D. and Stan Steinberg, D.C.