06 February 2017

we made a little human!

Three and a half years ago, Ashley and I announced that we were quitting our jobs and moving to Tanzania to live and work among poor and marginalized communities as Maryknoll Lay Missioners. Most everyone thought we were total cray-cray, and rightfully so. 

We said that we were setting out to embrace the unknown road ahead with a spirit of adventure, and friends and family assured us we were likely in for quite the adventure. But who knew this adventure would include welcoming a little human into the world? 

Meet Fiona Henning Leen - she's awesome!

Miss Fiona was born 23 January 2017 at 9:21 AM in Nairobi, Kenya, East Africa weighing 7 lbs 5 oz (3.31 kg) and measuring 19.4 inches (49.2 cm) in length. The story of her birth is a traumatic adventure all in itself best told in a dimly lit bar with a glass of Scotch whisky in one hand and a cigar in the other, but hey, we all made it! Yay for #LittleLeen2017!

Giving birth to Fiona and raising her is just the latest installment in a long line of wild adventures Ashley and I have had together these past three and a half years in Tanzania. You know, like...

No doubt being parents will be our wildest adventure yet. Ashley has spent every moment these past two weeks trying to keep Fiona alive, and I have spent every moment trying to keep Ashley alive. Turns out these little people are a lot of work. Guess that's why God made them so darn adorable otherwise we'd all just return them to the store after about 48 hours. But not so with Fiona; we've decided to keep her around for a while. 


Are you an expat expecting a child in East Africa and wondering what to do? Read on!

Ignoring the bit about the birth of our daughter being a traumatic adventure, Ashley and I would like to offer some suggestions and tips for couples trying to wrap their brains around a safe delivery in a hospital in East Africa. (Know that the "trauma" really had nothing to do with the doctor or hospital we used in Kenya.) We live in Mwanza, Tanzania but decided to go to Nairobi, Kenya for the birth given the vastly superior quality of healthcare in Nairobi compared to Mwanza. If you are living outside Nairobi like we were, consider arriving four weeks before the due date and expect to remain in Nairobi about four weeks after the birth of your child in order to collect various documents (see below). Here are our suggestions for childbirth in Nairobi, Kenya:

Recommended obstetrician

Dr. Maria B. Carvalho
Phone: +254 20 366 2728 / +254 733 623 909 / +254 20 3662726
Email: drmariacarvalhoakuh@gmail.com
Address: 3rd Parkland Avenue, Off Limuru Road, Doctor's Plaza, Room 310

Dr. Carvalho is a wonderful Consultant Obstetrician and Gynecologist and seems to be the go-to OB/GYN for expats in Nairobi. From the first appointment, Dr. Carvalho instantly made us feel good about the decision to use her for the birth of our first child. She was also available for questions on WhatsApp, which was great so that we did not always have to wait for an appointment to ask her something, especially since we do not even live in the same country. 

Recommended hospital

Phone: +254 20 366 2000 
Email: akuh.nairobi@aku.edu
Address: 3rd Parkland Avenue, Off Limuru Road

We found this hospital to be pretty much on par with the quality of care, modern facilities and equipment, cleanliness, and staff competency that we would expect in the United States. If you decide to give birth here, you can choose between the main maternity ward or the Princess Zahra Pavilion. The main maternity ward offers private labor and delivery rooms and then semi-private or private post delivery rooms, while the Pavilion offers private labor and delivery rooms and only private post delivery rooms. Both options offer you the same level of care and quality of facilities, but the Pavilion has the better food menu, like apple pie. Seriously. 

Recommended childbirth class instructor

Imelda Masinde
Phone: +254 722 315 711

Imelda will come to your home and provide private Lamaze childbirth classes. She charged KES 7,000 per three hour session, and we did two sessions or a total of six hours. Topics covered include: labor, delivery, delivery interventions, after birth, breastfeeding, and infant care. Imelda can also be hired as midwife and doula to be present at the actual birth, but we didn't do this. 

Alternate childbirth class instructor

Lucy Muchiri
Phone: +254 717 616 160 / +254 706 674 002 / +254 788 307 050
Practice: Eve's Mama

We did not use Lucy because we could not get the timing and cost to work for us, but she comes highly recommended so we wanted to share her contact information. Lucy conducts a set five session Lamaze childbirth classes (will not do less than five sessions) for three hours each and charges KES 20,000 if you go to her practice or KES 25,000 and she'll come to your home and do it in private. Lucy can also be hired as a midwife and doula for the birth of your child.

Recommended pediatrician

Dr. Sidney Nesbitt
Phone: +254 722 519 863 / +254 733 668 517
Email: reception@muthaigapediatrics.co.ke
Practice: Muthaiga Pediatrics
Address: Gertrude’s Children’s Hospital, Doctor’s Plaza, South Wing, Room S2

Dr. Nesbitt visited us each day in the hospital following the birth to check on Fiona's progress. He is very competent and caring and helps put you at ease. His practice is not far from The Aga Khan University Hospital Nairobi, and Dr. Nesbitt and Dr. Carvalho know each other very well, so using the two of them made things quite simple. Dr. Nesbitt's practice more or less follows the child immunizations guidelines as put out by the CDC, which is nice if you are an American and wanting to follow that schedule without any pushback. 

How to get a birth certificate in Kenya

Are you about to become a father in Kenya? Then read on, because this section is for you. If you follow the typical hospital-to-government process for obtaining a birth certificate in Kenya, expect it to take at least four weeks. If you follow the below steps, expect it to take just a few hours. This process has been vetted by multiple fathers over the course of a few years. Hopefully it will work for you when your time comes.
  1. Within a couple of hours after your child is born, ask the attending nurse or midwife how to obtain the official hospital birth notification slip. For those giving birth at The Aga Khan University Hospital Nairobi, you fill out some information in a notebook at the nursing station. Tell them you plan to bring the slip yourself to City Hall the next day so it is urgent you get the slip as soon as possible. I followed up a bit later and was handed the official hospital birth notification slip, which is pink with a green carbon copy, including an upper and lower half and also a third pink-only piece. All of step #1 took about one hour, with 99% of that time waiting back in the room with Ashley and our newborn for the slip to be ready.
  2. Bring the official hospital birth notification slip to the medical records office in the hospital, and have both spouse's passports and your certificate of marriage on you just in case. At The Aga Khan University Hospital Nairobi, the medical records office is located up a stairwell near  the Mother and Child Clinic. Hit the buzzer at the gate and someone will let you in. Head to the right where you will see a bunch of people sitting at desks, and explain that you plan to obtain the child's birth certificate yourself at City Hall, and that you need a letter from the hospital requesting an expedited birth certificate. In our case, I told them we live in Tanzania and urgently needed to return (which is true). After five minutes, I was handed this letter, complete with stamp and signature, along with the official hospital birth notification slip. All of step #2 took about 15 minutes. Easy peasy lemon squeezy. 
  3. If your child is born in the morning or afternoon, try to get steps #1 and #2 done that same day. That's because you'll want to do step #3 and step #4 early in the morning to make things go as quickly as possible. Now that you have the official hospital birth notification slip and accompanying letter from the hospital stating you are personally obtaining the birth certificate and must do so urgently (normally the hospital would file the papers with the government on your behalf, but that can take ages), head to City Hall in the heart of Nairobi. Even if you have a car, I suggest hiring a taxi because parking in downtown Nairobi is a circus. I recommend a taxi driver named Maina, who speaks both English and Swahili. His mobile phone number is +254 720 513 204 and his license plate is KBB 957 R. Maina waited around for me for all of step #3 and step #4 and charged KES 2,000. Because Nairobi traffic is some of the worst in the world, and because things at City Hall get crazy busy, aim to arrive at City Hall right when it opens at 8 AM. When you walk in the gate, head for the staircase to your right and go to the British third floor (American fourth floor). Go to a room in the 320's. I say 320's because according to different stories the exact room seems to change each year. Tell the person why you are there and present the letter from the hospital and the official hospital birth notification slip. After reviewing your documents, the worker will stamp the official hospital birth notification slip and direct you to the Cashier's Office back on the ground floor to pay KES 500. This office is right in the middle of City Hall when you are standing on the ground floor outside. When you walk in this office, it's a bit of a zoo, but head to the counter immediately to your left, present your documents, and then you'll be handed an invoice and directed to a particular window number to complete payment in cash. You'll be given an official receipt. Now go outside the City Hall main gate where there is a small photocopy shop, and pay KES 40 for a photocopy of the official hospital birth notification slip, and then head back to the room in the 320's to once again present all of your documents along with the photocopy and the receipt confirming payment. If I remember correctly, the worker will stamp your official hospital birth notification slip again and keep the upper and lower portions but send you away with the third pink-only piece I mentioned in step #1. All of step #3 took me 45 minutes, not including time driving in the taxi. 
  4. With all of the documents, get back in the taxi and head to the Bishop Garden House on Bishop Road near the Social Security House and Prison Headquarters. When you walk in, the room is set-up with a long L-shape counter. Head for the corner or elbow of the L where you'll find a security guard blocking a door. Tell him you are there to see Mr. Lukano, or if Mr. Lukano is absent, ask to see his assistant or secretary. Just act like you know what you are doing and that you belong. You'll then be directed through the door and back to a glass cubicle. Tell Mr. Lukano's secretary that you are there to see Mr. Lukano, and she should let you into his office. Tell Mr. Lukano you are there to urgently collect your child's birth certificate. He will agree by writing so on one of your documents that you came with, and then he'll tell you to go back out to his secretary. Tell her why you are there, and she'll hand you a form to fill out. One question on the form asks for the maiden name of the child's mother, but I was directed by a friend to write the married name as they may ask to check the names against the passports you have on you, but if the name you put on the form differs from the passport, it will just complicate things. Also tell the secretary how many copies you'd like of the birth certificate. Since I don't plan to be in Nairobi always, I paid for five copies at KES 50 per copy. Be sure to carefully proofread the birth certificate for mistakes, especially spelling errors. (Fiona was spelled Riona on the first draft.) And with that, you have your child's Kenyan birth certificate!  All of step #4 took me 45 minutes, not including time driving in the taxi.  

How to transmit U.S. citizenship to your baby and get his/her passport and social security

If you are an American giving birth in Kenya, then you'll also need to go through the most prolonged step of all all: applying for your child's Consular Report of Birth Abroad (CRBA), U.S. Passport, and Social Security Card. You should consult the U.S. Embassy in Kenya for the specific requirements as things may change from year to year, but basically you'll need to amass an incredible collection of documentation to prove that you and/or your spouse are U.S. citizens, are actually the couple who created this little person, and that you are eligible to transmit U.S. citizenship to your child - it is not necessarily automatic.

The main challenge is you need to make an appointment with the U.S. Embassy in Kenya to apply for the aforementioned documents, but appointments are generally booked at least six weeks out and you cannot book your appointment without the full name and date of birth of your child. My suggestion for those who, like us, do not actually live in Kenya is to immediately email the U.S. Embassy in Kenya once your child is born requesting an urgent appointment stating you must return to your country of residence right away. Despite requesting this appointment within one hour of our daughter's birth, it still took multiple emails and daily phone calls to the embassy for the next week in order to finally secure an appointment, which was set for two weeks after our daughter was born. From the date of your appointment, the embassy tells you it takes two to four weeks for your application to be processed and documents received. Note that the CRBA and passport will be sent directly to the U.S. Embassy in Kenya, while the Social Security Card will be mailed to a U.S. address of your choosing.

Regarding the day of the appointment, we arrived at the entrance to the Consular Section of the U.S. Embassy 45 minutes prior to the time of our appointment, and were surprised to find quite a line of people waiting to get in despite the fact it was before 6:30 AM. After moving through several security checkpoints, you finally are inside and waiting for your number to be called. Shortly thereafter we were called to a window to present the CRBA, passport and social security applications, along with both parents' passports, certificate of marriage, child's birth certificate, and child's passport photos. Then we paid $205 (USD, KES or credit card) with the cashier and were told to wait for our name to be called for the actual interview. (Note that your child and both spouses must be present.) Despite being the first people present for an American Citizen Services (ACS) appointment that day, we were not called for our interview until two hours after our scheduled appointment time. With that said, the "interview" could not have been more simple. We raised our right hands, said the information we provided is true to the best of our knowledge, signed the CRBA and passport applications in front of the officer, and that was it. Despite all of the information and evidence the embassy website says you must bring, not a thing was asked of us besides our passports, certificate of marriage, child's birth certificate, and child's passport photos. The embassy promises to notify you via email once the documents are ready for pick-up, which should be within two to four weeks after your appointment date.

Thankfully, it only took seven business days from the day of our appointment for both the CRBA and passport to arrive. I received an email from the U.S. Embassy in Kenya saying the passport was ready for pick-up, but in fact both documents were waiting for me upon arrival. You can only collect passports (and with it the CRBA) Monday - Wednesday from 1 PM - 3 PM. I received the email on a Tuesday and the next day I had our daughter's CRBA and passport in my hands. Bring the green slip with attached receipt you were handed on the day of your appointment in order to collect the CRBA and passport, and also have your personal passport with you in order to gain entrance to the Consular section to pick-up these documents. And with that, your child is a full-fledged American citizen and can travel internationally with you!

How to get an "entry" stamp in your child's new passport from Kenya Immigration

I have heard from several people that if you pick-up your child's passport and go to leave the country of Kenya, particularly if doing so by border crossing in a car, you may get hassled and even prevented from exiting Kenya since your child's new passport does not contain a stamp indicating when he or she entered Kenya. Of course this is silly since he or she was born in Kenya, but to avoid hassle, you can visit Kenya Immigration in Nairobi and get an "entry" stamp at no charge.

To do this, you need to visit the Nyayo House on Posta Road in the heart of Nairobi, not far from City Hall where you went for the child's birth certificate. Aim to get there when it opens at 8 AM to avoid the added stress of long lines, and consider taking a taxi even if you have your own car to skip dealing with the chaos of parking.

When you get to the Nyayo House, enter the main gate and immediately turn left and walk around the left side of the building. You will see a large sign hanging off the left side of the building that says something like "Foreign Residents." Walk up the steps and you will come to an electronic kiosk machine where you must take a number in order to be served. There are many prompts to choose from on this kiosk, but I clicked "Registration." After five minutes, my number was called and I proceed to the window and explained to the worker my child was born in Nairobi but we live in Tanzania and have just obtained the child's passport and that I have heard we need an entry stamp in order to exit Kenya. The worker instantly directed me to Room G-18 where I shared the same story with the worker in that room, who acted like this was a common request, and at once placed an entry stamp in our daughter's passport. No charge. No hassle. Very easy.


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