Hello from Kampala! I know this may be a bit confusing because I am supposed to be in Kenya, and Kampala has always been, and still is, in Uganda, but I have come across the border for a few days over the festive break.

Since I wrote last, I am now at 92 anaesthetists met and mentored, and about 60 hospitals visited. I have spent a lot of time creating a 45 page “common themes” document from my field notes which is a kind of thematic analysis of the barriers to practice implementation that I am seeing. It is helping me put on paper all of the things that are buzzing around my head. The visits have continued to be interesting and informative and I have met some wonderful people doing inspiring things in their settings, and encountered others who I hope have benefited from a bit of mentoring and direction.

A major issue in Kenya has been a national strike affecting initially doctors, but also nurses, clinical officers, and other staff, which in-turn affected all the government hospitals across the country. It stemmed from an agreement signed by the government three years ago, promising pay increase and promotions, working condition changes etc. It was supposed to be implemented over two years, but a failure to achieve any of it three years down the line has led to this mass strike. The industrial action had a detrimental effect on my data collection, as well as my ability to clinically assess the course candidates and visit the hospitals.

This is nothing compared with the widespread suffering across Kenya with no one to treat patients. Hospitals emptied as patients moved to private or mission hospitals, but only if they could afford them. There is a huge swathe of patients however who cannot afford alternative care, and have been prematurely discharged home. The newspapers are full of patients who have delivered babies outside the hospital, or people who have died from lack of medical attention. You may have heard about the petrol tanker tragedy at Naivasha that killed and injured dozens; those that survived had no hospitals to go to except mission hospitals. When I was taken on a walking tour of one of the hospitals, the doors were literally barred, and the wards were desolate and empty except for one poor soul on traction who could not be removed by his family, or maybe did not have family to move him. I cannot imagine what it is like to have a chronic condition, or be heavily pregnant, and not know where you will be able to access healthcare.

My last set of visits have been in the central area, on the other side of Mt Kenya from Nanyuki and Nyeri where I was before, visiting Embu, Meru and up to Isiolo. This region is stunning, and I remain continually surprised by the micro-climate nature of the country. With a slight change of altitude one day, I am conducting interviews surrounded by the hot and dusty flat dry plains of Isiolo, with beautiful views across the mountains in the distance, then a half hour drive up the foot hills of Mount Kenya and it is cold, and I am shivering in an operating theatre. It is truly bizarre!

My boyfriend also came to visit recently and we went on a safari, did boat rides, and other “must do” things that I had saved for us to do together. Although we were busy and moving around a lot, we had such an amazing experience of the touristic side of Kenya – we were truly blessed with the animals we saw at the Masai Mara; including the big five! We saw a lesser-spotted leopard (still spotty just very rarely seen), lions enjoying a wildebeest kill, and 2 of the only 8 remaining black rhinos in the park – a very special siting.

Goodness knows how many wildebeest there were before the great migration to the Tanzanian side because there were still thousands left for us to ogle, as well as giraffes, elephants, hippos, crocodiles, every sort of antelope imaginable, and exceptionally; a Pangolin. A “whaty-what?” I hear you say – a Pangolin! A very rare and endangered scaly mammal often mistaken for an Armadillo that can roll up into an armoured ball to fend off attack. I know this because I googled it! You know you are seeing something exceptional when your seasoned and experienced game driver gets excited and cannot tell you what it is. Apparently they have been hunted to near extinction for their meat. We were privileged to see the white Rhino at Lake Nakuru as well.

I think highlights were the viewpoints at Lake Nakuru very early in the morning, our hikes through the Hells Gate National Park rock formations, and an incredible climb up to Mount Longonot crater - not for the faint-hearted but so well worth the exhaustion for absolutely unbelievable views. We spent my birthday at Karura Forest on the outskirts of Nairobi enjoying a beautiful brunch and a tropical storm!

It is the time of year to count your blessings – and there have just been so many! I am thankful to have had so many blessings in 2016, for wonderful family, friends and boyfriend who have been so supportive and encouraging during this Kenyan adventure. I am also thankful for the health and safety I have enjoyed since being here, the eye-poppingly incredible sights and sounds (and smells) I have encountered in Kenya, and so many wonderful, thought-provoking (and often amusing) experiences of a different culture and country. Finally, I am thankful for the wonderful and varied jobs I have had this year and how much I have learnt – about medicine and myself!

I have now returned to Kenya for my final clinical stint prior to ending this adventure. A New Year’s resolution for me is to not lose the habit of counting my blessings. I do wish you all a happy, wonderful 2017.