Kenya Flag Pie. A Peek in to the eye project…

Alone, in the corner of the simple, clay home, Mama Wangari stares wide eyed as though doing so will somehow allow her to see. A Kenyan grandmother of three, she has been blind for years and consequently has become increasingly isolated.

Six weeks ago, Joel, a community health care worker examined her using a mobile phone. Today he is back.

Joel has used the specially adapted smartphone, the same one he uses to examine people with, to guide him to Mama Wangari’s home. Much like using Google Maps to navigate around town, it works perfectly well in a remote Kenyan village. Along with neighbouring patients found to be blind, they are brought to the eye clinic in town to be assessed and treated.

Like most patients in the eye clinic she is wearing her best clothes. It is rare for most people attending the clinic to have seen a doctor before. She is clearly struggling to navigate; with assistance we get her sat in position to be examined. As I peer down at the magnified view of her eyes I witness a familiar sight. Her pupils are not clear and black but a cream white. No light can penetrate through them for me to see the back of her eyes. No light penetrates through them for her to see. She is blind.

Her pupils are white due to a change in the natural lens of the eye. The lens sits just behind the coloured iris and is visible through the pupil. It helps focus images on the retina at the back of the eye. Normally it is crystal clear and light effortlessly passes through it being diverted on its path to a clear point of focus. With age the lens commonly starts to mist, initially an off yellow it eventually becomes impenetrable by light. We call this “cataract”.

For you and I, as soon as we start to experience a change in our vision, we have several options: we could see our local optician, family doctor or local eye clinic. What would happen if none of those options existed?

I pull back from the machine through which the finest details of her eyes are visible and feel a mix of sadness and excitement. Sad because she has suffered unnecessarily, but excited knowing something can now be done.

Through incredible advancements in the field of ophthalmology (eye medicine and surgery) it has become not only possible, but also commonplace to be able to remove someone’s cataract and replace it with a tailor made, clear, artificial lens and fully restore their sight. What’s more, it can be done in minutes for just a few pounds. It is wonderful to be part of a speciality where the most frequent causes of blindness can be cured or prevented. Tragically, despite centuries of progress it remains that those most in need are least likely to ever receive it.

80% of all blindness can be prevented or cured

90% of blind people live in low-income countries

A lack of trained human resources, lack of equipment, and poor infrastructure contribute to this tragedy. In the UK we have one ophthalmologist per 20,000 people, in Africa it is on average, one or two per million. Most diagnostic equipment is expensive, large and immobile, so either does not exist in African Eye Hospitals or is not suitable to be moved. Poor roads, no roads and infrequent availability of electricity all add up to those who live beyond the end of the road going silently blind.

In Kenya, we are trialing a new system based on an adapted smartphone. Healthcare workers wearing solar powered rucksacks (no need for mains power or a generator) go door to door in remote locations. They check vision and take pictures of the lens and inside the eye. The data is sent to specialists to diagnose the cause of poor vision, effectively putting the expert in the patient’s home without leaving the hospital. The GPS function of the phone makes it possible to search for people in any given area by any parameter, such as “blind” from “cataract”. The red pins drop on the map showing where they live and their contact details. Transport is arranged from the hospital and treatment is provided.

Her eyes open, wide eyed like the first time she was examined, only this time the light penetrates her clear artificial lens that sits where her cataract once occupied. Her retina is stimulated by uninterrupted views. Her smile is so wide it looks as though she is not only seeing for the first time in years but smiling also for the first time in a very long while. She looks up holding the healthcare workers hand, “take me home quickly” she demands. He asks why the rush? Mama Wangari responds, “I have never seen the faces of my grandchildren”

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Recipe – Kenya Pie

Ingredients

250g strong white flour
250g wholemeal flour
7g dried yeast
10g salt
340g water

Pie filling
Red
2 red peppers
Pinch of cayenne pepper
Salt and pepper to season
Olive oil

Green
See sikumu wiki recipe

Black
Large aubergine, peeled and cubed

Handful of pitted black olives

2 Cloves of garlic

Method

Make the bread dough as in the pie recipe

Red
Roast red ingredients then blend

Green as per recipe

Black
Sauté the aubergine with olive oil and garlic then add to the olives and blend.

For each colour aim to have dry ingredients by roasting sufficiently or dabbing with kitchen town.

Layer the colours in a muffin tin to make small pies then bake at 220°C for 15-20 minutes.

Enjoy in Kenya with some great Kenyan people 😉

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George and Jack fundraising! Heroes! 

Thank you boys!

Baked mandazi, Nakuru – a town on the brink…

We regularly revisit the fundamental question of why are we opening a bakery? We aim to have a sustainable business whose profits we can put into eye care for those in the local population who cannot afford it.  However, the vision is wider than just this and we want the bakery to encourage health on all levels.

In the UK £7m is spent by the government each year promoting healthy eating

In the UK £700m is spent by the food and drink industry promoting unhealthy food per year

Nakuru is a town on the brink. On the brink of great success and growth and on the brink of an epidemic of food related diseases. If we only pursue profit margins for an apparently noble cause  we will soon find ourselves compromising on the quality of our products and having many other long-term negative consequences. We could make more profit by using lower quality ingredients, however it is exactly this compromise that rules the food and drinks industry which in turn rule our eating behaviours. Combined with reduced physical activity that comes with more and more people moving in to sedentary jobs and lifestyles has brought us close to an explosion in diabetes and related diseases, a pandemic across the world.

Diabetes, heart disease, and stroke are all together termed as Non Communicable Diseases (NCD), in other words, diseases you don’t catch off one another, ironically we do “catch” our lifestyle choices from one another and our environment.   80% of people living with diabetes are in middle and low income countries such as Kenya, Type II is preventable and can be well controlled with services for all the complications such as having a regular eye examinations.  Half a million people are blind due to diabetic retinopathy, one million have amputations a year due to nerve damage and many have serious kidney problems. Unfortunately most African countries don’t have the infrastructure to support and preserve health for this growing population of patients.  Just the simple fact that very few people have access to a fridge means that its difficult to store insulin (A diabetic treatment) at home.  To complicate the issue diabetes also increases risk of TB and using Antiretrovirals (HIV/AIDS medication) increases diabetes risk, the peak age of onset is between 20 and 40 years in low and middle income countries consequently and not surprisingly the disease burden (disability, death and loss family wage earner) is much higher than in wealthier countries.

The problems with highly refined, processed foods are the hidden fats and sugars. The fats increase the likely hood of obesity and leads to diabetes and damages heart vessels. Processed food are bulked out with many refined carbohydrates which are very quickly converted into high levels of sugar in the blood stream.  Fats and sugars make the food sweet, last longer in the home and far cheaper to produce. If you are on a limited budget, low-cost is the only affordable option.

Unfortunately the effects of a more processed diet and lower levels of physical activity are damaging the world over, but the burden of this is higher in countries like Kenya.  If we can provide delicious, healthier alternatives to currently available food, maybe, just maybe we could have a small effect on the direction we are headed.

We are aiming to have two ranges from Jamii Bakery. The speciality high end bakery products appealing to those with disposable income and a Jamii basics range; a cost neutral, healthier alternative to Kenyan staples. One of which is the mandazi, eaten everywhere from road side stalls, a triangular shaped donut fried in  lot of low-cost oil.

Heathy food will not be eaten just because it is healthier. It needs to be familiar, similar in price and better tasting if there is any hope of them being accepted in the community. This bake was all about trying to do just that.  Rather than the oil rich mandazi I tried to make mango filled baked ones. The mango (very cheap and plentiful when in season) is to add a little flavour that is lacking from not using any oil. I heated the mango with a little cardamon and piped a blob inside each one. Amongst our team at least, they went down really well.

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Chef Sam cooks on the Jiko as Bryan gives education on diabetes and high blood pressure

Recipe – Baked Mango filled Mandazi

Admittedly I used the mix the Kenyans used.  The ingredients say white wheat flour, sugar, edible oil (!) baking powder, flour improver’s.  We were a little busy packing so I didn’t get the chance to make and compare my own version with rapeseed oil (a healthier oil which is farmed locally) but actually I very much wanted to make them this way so that the only difference is the cooking method and mango addition.

Ingredients:

500g mandazi mix (Give me a little time and I will have a recipe for use in a UK kitchen!)

1 cup of water to form a firm dough

1 beaten egg to glaze

1 mango, cut, boiled with a pinch of cardamon

Method:

1. Mix the mandazi mix and flour then knead a little into a firm soft dough. Leave in a covered ball for 30mins.

2. Divide into 4 and roll out each then cut into 4 quarters about 1cm thick each

3. Place on a floured tray or non-stick baking sheet and bake for 12-15mins at 180C

4. Once cooked cool on a tea towel or wire tray and make a small hole in the mandazi with a teaspoon handle then pipe a blob of mango puree into the middle

Bonfire Cakes in the Mau Forest with a film crew…

Today we have Reuters film crew joining us in the field to make a short news documentary. We have done our best to be organised and have cleared it with the village chiefs, patients and the Ministry of Health to ensure everyone is on board.  Reuters have a very wide appeal and their footage is picked up all over the world so we wanted to facilitate the visit as best we could. We are a little late leaving our meeting point in town (we have a two and a half hour drive ahead of us in to the depths of the Mau Forest), just as I’m about to jump in the bus to set off I get a phone call from Madeleine. “Do you have the house keys?” I feel my back pocket and they are all there. Oops. Kat has spares but is already on her way to the forest. Quick on my feet I tell Madeleine where another hidden spare is kept in the flat. She stays on the phone and runs to get it from our bedroom. I hear it in the lock ( a smug look on my face at this point – what a good husband I am). “You’re not going to believe this” Madeleine says with a substantial hint of panic in her voice. “The key works to lock the door but not open it!”

Madeleine and Lucas are locked in the flat and I’m not due back for 14 hours. The smug look no longer on my face I run to the roadside and see a man sat on a revving motorbike about to pull out of the junction. Before he has chance to say anything I jump on the back and ask him to take me to my home as quickly as possible. He was in fact a motorbike taxi and this is what they do all day but I like to sound a little more dangerous and heroic than I actually am. Within less than ten minutes I’ve managed to unlock the flat, give Madeleine the keys and receive a confused look from Lucas who has no idea what is going on. “Daddy not working?”

With the early morning excitement behind us I was hopeful that everything else would run smoothly. We eventually arrived (two of the team vomited on route from car sickness, nothing a bit of tarmac could have prevented) and set up. The film crew were excellent, they manoeuvred around us and silently collected footage. Everyone was self conscious but doing their best to remain natural. My first patient of the day sat down at the slit lamp to be examined, I tapped on the power, in the way I have been for months and always grateful to have such a good machine after the saga of getting the project started over a year ago. For the first time EVER, it didn’t work. The power came on and there was no light. Oh dear. After ten minutes of tinkering and checking all the connections I have it working again. The crew see me getting back in position to examine someone and move over to start filming. This time, I flick the switch and it works! Less than a second later, it goes dark again, this time the power fails and the rain starts to crash down on the corrugated iron roof and leaks through the holes. Although this kind of happening is not unusual, the timing wasn’t great. The crew soon picked up on why using Peek would overcome so many of the barriers that are faced when trying to deliver eye care in an environment where the usual infrastructure doesn’t exist.

Eventually the long day is complete and we head home one the long journey back to Nakuru, more vomiting on the way back too…

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Finally its complete, we have the 54 page document ….the business plan for Jamii Bakery, my head is full of break-even analyses and marketing strategies with location, location, location whizzing around my head.  We all worked hard on this, although very much aware of the fluid nature of this plan and the need for it to constantly evolve it has been important to get it all down on paper.  We have a generous Kenyan donor for the land and the building for the bakery and have been patiently waiting for the parcel of land to process to begin building. However the process of buying land in Kenya has many hurdles, checks and steps to ensure a “clean” piece. Fortunately our friend on the case is meticulous and has been through the many checks necessary on multiple occasions before.  After planning out the dates for the remaining clusters we have until the beginning of April 2014 living in Kenya.  Although we will be coming back on short term visits to Kenya, we want to get things going before we leave,  however we don’t want to unwisely rush things or cut corners but to be as efficient as possible with the time remaining.  The ongoing land processing and advise from our visiting bakery consultant has led us to think of other ways to launch Jamii Bakery.  Our plans now are to start smaller with a central simple bakery and no cafe, we plan to open booths in target population areas, one by one offering a selection of baked goods, fresh fruit smoothies, Kenyan tea and proper coffee.  We plan to commence the pilot outreach healthy living workshops in December. These will provide education on eating and lifestyle choices accompanied by a practical lesson in baking using a charcoal stove (Jiko). More on this later…

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Recipe -Banana Choc and Marshmallow Bonfire Cakes

These cakes, like fireworks are full of surprises. You bight through the sweet marshmallow and the smell instantly makes you think of bonfires. Next you hit a soft banana cake with a hidden piece of melted chocolate in the centre. The taste being like chocolate filled bananas roasted on the BBQ or open fire. A real treat but not too often!

 

Ingredients:

Banana cake:

3 medium eggs

160g light muscovado sugar

250g grated butternut squash

1 tbsp vanilla extract

50g white rice flour or plain white flour

100g ground almonds or 100g ground cashew nuts

2 tsp baking powder

Pinch salt

150g chopped banana

12 chunks plain chocolate

 

Marshmallow icing:

6 egg whites

300g sugar

½ tsp cream tartar

2tsp vanilla extract

 

Topping:

Popping candy or grated crystallized ginger or other crunch or spice

 

Method:

1. Pre-heat the oven to 180°C.  Prepare the muffin cases.
2. Whisk the eggs, sugar until four times its volume, then beat in the grated butternut squash and vanilla extract.
3. Whisk in the dry ingredients followed by the chopped banana.
4. Fill each muffin case with mixture then just before baking place a chunk of chocolate on the top of each one.
5. Bake for 15-20mins.
6. Whilst in the oven make the marshmallow icing.  Place the egg whites, sugar and cream of tartar in the bowl of an electric mixer over a simmering pan of water.  Whisk constantly until the sugar is dissolved for 4-5 minutes.
7. Remove from the simmering pan and whisk for a further 5 minutes.  It should be very stiff and is now ready to pipe.
8. When the cakes are removed from the oven, let them cool on a wire rack then pipe the icing and finish with a sprinkle of your topping.  I guess if you would like to go one step further for bonfire night this would be the time to get the blow torch out and toast the tops.  Unfortunately we don’t have one in our Kenyan home!

Registering today’s patients in the Mau Forest

Patiently waiting before the rains come

Reuters film crew

 

As some of you know we have just landed back in the UK but with the recent craziness we are a little behind on the blogs but we will catch up soon!

Lucas “Why is it dark? Its raining in England” (!)

 

Kenyan-Italian cured ham and cheese bread twirl

“I do it on my own” Lucas is so excited as he plunges in to the pool with his two green arm bands hugging his little arms. He turns around and around somehow kicks his way across the pool!  We are in Malindi on the Kenyan coast, we had been told this place was beautiful and it sure meets up to expectations. This place is famous for the fresh fish, (Nakuru has a very limited range of fish, we can only find frozen tailapia or nile perch), however the day before we headed back to UK in July, Andrew became very sick after eating a fish curry and has been somewhat scarred by the experience. We were soon over it with the amazing variety of fresh fish, nice cheese, crispy pizzas and ice cream. Even the bread was at a much higher standard than in Nakuru. The Italian influence on the coast is certainly one we have been grateful for.

Our holiday home was overlooking the beach with direct access and Kat was much braver than us swimming in the sea every morning and facing the stinging jelly fish which stung her on three consecutive days.  Andrew and I stuck to a sweaty beach runs followed by a cool dip in the pool and fresh fruits salad washed down with a bucket of coffee every morning. At 2000m lower altitude than Nakuru the temperature is much hotter and the wildlife very different. Lucas had endless fun spotting  geckos, big big lizards and huge spiders. There were countless  TukTuks so Lucas was in his element getting a TukTuk to town for an ice cream (accompanied of course).

It was a much needed break with great friends that really came at the right time as we were all on the brink of exhaustion. We have been working hard at the business plan which is now eventually finished…well all 54 pages of the first complete draft , John has been very helpful in pushing this forward, exploring each element of the bakery business and has also encouraged us to think about the timescales and what is achievable before we move back to the UK and its long-term sustainability and growth.

These twirls were inspired by the local Kenyan-Italian deli that had cured hams and cheeses – delicious!

Recipe – Kenyan-Italian cured ham and cheese bread twirl

 

Ingredients:

500g white bread flour
10g salt
7g yeast
340g water
Tbsp olive oil
Sprinkle cayenne pepper
150g 1cm cubed cheese
10 strips cured ham

Method:

1.Mix flour, salt, yeast and water.  Knead for 8minutes until smooth dough.
2. Leave to prove for 1.5 hours, then knock back and leave to prove for another hour.
3. Roll out on a floured surface about 40cm x 25cm. With your fingers spread the olive oil all over the dough, sprinkle over the cayenne pepper as desired followed by covering with the cured ham strips and sprinkled chopped cheese.
5.Roll up firmly from the longer side and seal the dough with a little water.
6.Cut onto slices about 3cm wide, place on a floured or non-stick tray and leave to prove for about 60-90mins until the dough does not spring back when you poke your finger in it. This process is improved if you place in a plastic bag. Egg wSh the tops before placing in the oven.
7.Bake at 220°C for about 15mins until a little colour. These ate very yummy warm and we made a veggie version with skinned garlic aubergine cubes.