Tenwek Hospital is located in the heart of Kipsigis land--about 85% of our patients come from this particular tribe. Kenya has about 40 tribes living within its borders, relatively peacfully, although as we all know there have been inter-tribal conflicts (as evidenced by the post election violence several years ago). More and more, the younger generations of Kenyans are starting to identify themselves as Kenyan instead of a particular tribe. But one tribe still stands rather separate from the others, keeping to the "old ways." It's the tribe that comes to mind when you think of a "traditional" African--the Maasai tribe. Maasais are a group of people who live in southern Kenya and northern Tanzania, in the midst of some of the best game viewing in the world. They are herders and hunters, with large herds of cows and goats traversing the countryside. And their dress is dramatic, too--red blankets over their shoulders, dangling earlobes, walking sticks, beautiful beadwork.
What I have come to find most dramatic about Maasai, though, is their courage and high pain threshold. They are known as a warrior tribe, and they are, as well as stoic. All of us have taken care of a variety of Maasai here at Tenwek (somewhere close to 10% of our patient population) and we've found that you have to figure Maasai-ness into your physical exam. For example, earlier this week I rounded on a young Maasai lady on the OB ward. She had come in with some pain, severe anemia, and a 12 wk pregnancy with vomiting. The diagnosis seemed a likely anemia in pregnancy with hyperemesis (a more severe form of the typical morning sickness of pregnancy). We decided to get an ultrasound to check the viability of the pregnancy and found...a ruptured ectopic (a pregnancy had implanted in her tube and grown too large, breaking the tube open and spilling over a liter of blood into her belly). Yikes! How did we MISS that, you ask? Well, despite having an incredibly painful process going on inside of her, she was sitting up in bed, walking around normally, and barely flinched when I pushed on her belly. After the surgery, a nurse called to ask for some pain medication for her and I joked, "Pain meds? She's Maasai! She doesn't need pain meds!"
Jason has a great story about a Maasai Moran, which means a warrior, in training. He was out in the bush and got disemboweled--a spear cut open his belly causing his intestines to spill out. EIGHTEEN HOURS LATER he walked into Tenwek holding his intestines in his arms. These people are tough.
They also have a distinctive body habitus, tending to be quite thin and fit. I have seen some large Maasai women, but no overweight Maasai women. One morning an intern was presenting a patient during morning report and was asked the question, is the patient wasted? (meaning, do they look thin and gaunt likely due to a chronic illness or HIV) The intern paused,thought for a moment, and replied, "She is somehow Maasai." Ah, said the audience. Everyone undertood what he meant.
In summary, it has been fascinating to work and live among different groups of Kenyans. We have learned so much about the differences between them, and have developed a great amount of respect for what our patients go through. Upon our return to the US, though, I think we might have to readjust our expectations of our patients' pain thresholds and appropriate body sizes. . .