I'm not crying, I just got pepper in my eye.

I’m currently sitting in the airport in Mombasa, Kenya, waiting to board the first of 4 planes to get me back to Indianapolis.  I really can’t believe 2 months have already gone by!  A full reflection post may happen in the future (or talk to me in person!) but I at least want to get another post in about my last 2 weeks.  Author's note-The majority of this post was written on an airplane with nothing but time, so I went on a few tangents.  I apologize for its extreme length!  Headings have been provided again for your convenience :)

“PROBABLY the best rafting in the world…”

I back-loaded my weekend excursions, which ended up making for an action-packed finale to my time in Kenya.  Another perk: Just as I was getting rundown by “the system” and/or “the man,” I was able take a few breaks from it all.  The weekend following our fabulous safari at the Maasai Mara, a group of 14 of us headed over to Jinja, Uganda to white water raft THE NILE!  WHAT?!  You can

Cruising on the Nile!

 DO that?!  Yes!  (And if you are ever in the area, you should!)  Kelvin helped us plan a fabulous weekend and it ended up being a HUGE success.  The drive took about 8 hours which included a long stop at the border into Uganda.  More stamps in my no-longer-empty passport!  We did have to purchase a $50 visa to enter the country, but it was totally worth it.  We stayed at a campsite overlooking the Nile, complete with an outdoor bar and neighboring delicious chapatti stands.  Friday evening we went on the “Sunset Cruise,” aka booze cruise, on the river.  Basically, we hung out on a double-decker pontoon boat as it motored around our little bay area of the Nile…+/- choice beverages and singing along to the classic American bar playlist.  I have a host of hilarious pictures and videos from the cruise and the evening that followed!  Of course, several in our party weren’t quite 100% the following morning, but it was all in good fun. :)

As for the rafting—SO MUCH FUN!!  The culture on the Nile is to find a group of like-minded rafters (either “wild” or “mild”) and then hang on!  I unsurprisingly found myself with the wild chunk of our party, although I will admit to a little anxiety.  My previous rafting experiences (The New and The Gauley in West Virginia) were a blast, but I never fared well if/when I fell out of the boat.  For the “wild” Nile rafters, it’s not a matter of IF but HOW MANY TIMES you will fall out of the boat!  The guides know exactly where to send you for flips, and if you aren’t flipping on your own they will flip the boat for you!  The first 2 falls were a little rough, made more ominous by the rain and thunder surrounding us, but once I learned how to override my underwater-panic-reflex, I also was asking for more flips!  Our guide, Alex, quite enjoyed flipping Team Kabina (the Ugandan word for buttocks, the only Ugandan word our boat could come up with so we ran with it).  Multiple times our heads would pop up around the overturned raft to find our guide playing air guitar on top of it!  There was one extended rapid where our boat flipped 3 times!  I made it back into the boat for the second flip, but was in a rescue boat for flip 3, which can be blamed on Shyamal quickly shifting the boat’s balance on a surf by prematurely cheering its success.  Hilarious to watch unfold from the safety of my rescue boat.  The sun eventually came out, we had a delicious lunch of crackers and pineapple while floating through the currents, and save the few expected scrapes, bruises, and in my case a broken toenail (which I have coined my SchisToe, for you medical people) we all survived.  I might not have time to load pictures with this post, so see facebook for a good one of me falling out of the boat!

The following morning, 3 brave souls in our party bungee jumped over the Nile as well.  I was extremely tempted to join them, especially once I saw that it was off of a seemingly well-constructed platform and not so terribly high that you couldn’t survive the fall into the water if something DID go wrong, but of course I had promised both my mom and my sister that I would not bungee jump while on this trip.  They couldn’t talk me out of rafting, but I do agree that bungee jumping might be best left to more regulated locations.  One day I will pull another skydiving maneuver and just show my family the video after I’ve already survived the jump.  It’s better to ask for forgiveness than permission, right? ;)

Kwa’heri Eldoret



Dodgeball Thursdays.

The last 2 weeks in Eldoret were filled with the usual work, didactics, dodgeball, dinners, etc.  By the end of my 2 months I was functioning more as an Intern.  I tried to follow all of our patients and help with as many procedures as possible.  I was still very frustrated by the system in the hospital, but the majority of my frustrations have transitioned to the corruption within the government.  I just keep thinking about this huge AMPATH program and all of these people involved who give hugely of themselves.  I love the Kenyan culture and people, and it would be great if their government would help them out a bit more.

I moved back into my old room at IU House for the last week, this time with my Hostel roommate, so that the new February-March students could enjoy the Hostel living.  Moving back to IU House did literally and figuratively distance me from my new Kenyan friends, but it ended up leading to a smooth transition back to Americanized luxuries.  They eased me in, I had a 6 week dip into the Kenyan culture and lifestyle, and then I eased back out.  The very last week I made sure to do all of my favorite things one more time.  All-out karaoke Tuesday, dinners at our favorite restaurants, one last chocolate Tusky muffin, last-minute souvenir shopping, a Wazungu Palooza party in the Hostel, and of course the many goodbyes to my new friends and new home away from home.  I expected some of the goodbyes to be difficult, but there were several which were unexpectedly emotional.  Michael, the security guard at IU House, who called me Mamma Jessica for 2 months, pulled me aside for a goodbye blessing.  Sarah, my roommate for 2 months, only got a half goodbye because I started getting misty-eyed.  Shadi, one of the abandoned kids at MTRH who I visited daily, and if I were in a place to adopt the paperwork would be in the mail, didn’t even get a goodbye!  I stopped by Sally Test to see him one last time and could feel the lump in my throat before I even found him.  I spotted him in the playground being pushed around on a tricycle and decided that it was better that he continue having fun than some blubbering mazungu come in and ruin the party for everyone.  Shadi is another kiddo who has a whole backstory that I don’t believe I fully shared on this blog, except maybe the part about him biting me on day 2, but I’d be happy to tell you in person.  He is so bright and so many people love him that I am confident he will have a happy ending to his story, but it is hard to leave without knowing.  Blah, emotions, I’m now sniffling on an airplane surrounded by sleeping Germans somewhere over Egypt, haha.  Thankfully, many of the goodbyes were made easier by the fact that I will see them again!  A big chunk of the wazungu are from IU, at least for another couple months, and Kelvin and 2 of the Kenyan pharmacy crew will be spending some time in Indiana in April!  Yay!

Mombasa Raha!

Shyamal convinced the IUSM crew to join him in his hometown of Mombasa, Kenya for our last weekend in the country.  Thank goodness, because it was another weekend of new experiences and crazy fun!  We decided to take a 12 hour overnight bus to the coastal city of Mombasa to save money, which ended up being quite the experience, as you can imagine.  The glimpse into another side of Kenya was nothing like the warm and welcoming atmosphere I was surrounded with while in Eldoret!  Before we even left the bus station a random passenger threw a fit about Natalie taking a picture.  I found myself in the (un)lucky position of having an empty seat next to me since one of our friends backed out, and I was repeatedly harassed from other passengers wanting the seat.  The gentleman behind me and I had a tense conversation, which lead to uneasy rest and repeatedly checking that my belongings were still present.  We quickly realized that we needed more friends on the bus, which was successfully accomplished during our dinner break, so we were able to relax more for the remainder of the trip.  Then there was the driving!  I seriously thought I was on

 The Night Train from Harry Potter.  There was a moment when we somehow squeezed between another bus and a mutatu that I was sure would scrape off the sides of our ride.  In the end, we made it to Mombasa just fine and did end up saving a lot of money, so I’m happy for the experience, haha. 

We stayed at the very swank Reef Beach Resort for a super-discounted price.  We again ran into several people who were less hospitable than my previous blanket-assumption of Kenyan culture, but overall we had a fabulous time.  Shyamal made sure to show us the sites (the tusks, Fort Jesus, Old Town, the lighthouse, delicious street food, etc) and a great time at the amazing club scene.  Friday night we “took it easy” and only stayed out until 3am.  Saturday we took a tiny canoe/outrigger out to the reef for some amazing snorkeling.  We were told it would be an hour of snorkeling, but only 1 application of sunscreen and 4 hours later we finally made our way back to our little boat.  4 hours snorkeling + equator + doxycycline – sunscreen = painful sunburns for everyone, even Shyamal.  (“When non-white people get white people problems, it’s a big deal.”)  That night we went to an amazing resort bar on the beach with pool tables, dancing and THE BEACH right there!  Clubs in Mombasa don’t necessarily have a closing-time, so we hung

Sunrise on the beach of the Indian Ocean!

out there all night so that we could watch the sunrise over the Indian Ocean the following morning at 7am.  A few people took naps on the couches, but the majority of us used the opportunity to dance, request our favorite Kenyan songs, dance, take a little dip in the Indian ocean, and dance.  SO much fun!  I have already mentioned this, but I will really miss the club scene in Kenya!  Unfortunately the sunrise was covered by clouds, but we tried.  Later that day, our wake-up call at 2pm came from a man on the beach letting us know that our CAMELS were ready.  Yes, we all rode camels on the beach!  So awesome!  We took it easy the last

night in Mombasa and spent our last day poolside with fruity drinks and football.  Natalie and I did some last-last minute shopping on the beach and had fun talking their crazy muzungu pricing down.  “We lived in Eldoret for 2 months—we don’t want muzungu prices!”  “I can get the same thing from my friend for 100 shillings.”  It’s amazing what a little Kiswahili and dropping the fact that you worked in Eldoret for 2 months will get you here, particularly in respect.

Heading home

I now find myself on a giant plane heading towards Amsterdam, currently somewhere over Egypt.  My time in Kenya, at least for round 1, is officially over.  I am so so grateful to have had this experience and am genuinely proud of myself for completing it.  I was talking with Joe in the Nairobi airport tonight about how this was the longest he had ever been outside of Indiana, which got me thinking…and the realization struck me that I haven’t been outside of Indiana for more than 1 week at a time!  Is that even possible?!  Indiana has always been my home base, it has provided my undergraduate and medical educations, and I can’t think of a trip longer than 1 week that I have ever taken IN MY LIFE.  What was I thinking signing up for 2 months in Kenya?!  There are several moments in my life where I look back and think, “dang Gina, I can’t believe you did that,” and this is obviously one of them.  You know what else is great about this realization?  It’s that I don’t mind that I still call Indiana home.  I am so blessed to be able to say that I have loved my life, my education, my friends, I love having my family close by, and I wouldn’t change a thing.  I am very much looking forward to my 3 year residency within the borders of Indiana.  Perhaps a fellowship will finally pull me away, but for now I will continue growing my deep roots into the Indiana soil. 

I'm wearing the Indianapolis flag while cruising on the Nile.
REPRESENT!

This trip has given me a huge appreciation for how big AND how small the world is, and how accessible it can be.  I will continue to take advantage of international medicine opportunities, and depending on where I land for residency, could definitely see myself back in Kenya.  However, I would love the opportunity to see more, learn more, and help more wherever the destination may be!  For now, I will be forced to quickly adjust back to my “old life”…where I have to use utensils, punctuality actually matters, I don’t have to ask for my drink to be cold, 2 grown men holding hands is an unnusual sight, toilets/toilet seats/toilet paper are provided, a pothole is worthy of a phone call to my political representative, and where I blend in with the crowd.  ((sigh))

*          *          *

I imagine this will be my final post on JessDoesKenya.  Thanks to everyone who read it, whether or not I actually knew you were reading it.  It has given me the excuse I needed to document my experiences.  As always, please feel free to comment or email me with any feedback or questions!  Also, check out my youtube channel, as I will momentarily be posting additional videos -- JessDoesKenya VIDEOS!  Jessica karaoke, Hostel Cribs episode, and more! See you back in Indiana!  Who’s up for Qdoba?! J

Holy Crap! Crap! Tours.

Warning: This is a vent-session.  If you would like to zoom to the interesting safari part, head to the bottom of the post!

As expected, working on the adult side is very different from the pediatric side of MTRH.  We admit every other day, as opposed to every 4th day, which results in a census consistently in the 30s.  These patients are often very complex and very sick, and are far less resilient than the children.  Result--we loose a lot of them.  The first patient we lost that hit me hard was a 19 year old with terrible endocarditis.  We thought he had turned a corner, but 2 days later I was watching his blanketed body get wheeled through the wards.  There was another day that I went to try to "admit" a new patient after rounds, but found I couldn't communicate with him or his caretaker.  This happens fairly often, so I mentioned it to my intern and we decided to see him after lunch.  By the time I was back on the wards, he had passed.  That one really bothers me...I went to see him within a couple hours of his passing.  I did nothing.  I can take a step back and realize that I wouldn't have been able to do anything about his passing, but that's all the "blablabla" and not the experience...of.....essentially ignoring a dying human.  This makes me sound pretty terrible, doesn't it?  Stuff like that happens all the time here.  I just thought I wouldn't be involved when it does.

OK, so a lot of those were sick patients who essentially came to the hospital to die.  At the end of the day, what is really getting to me is the system.  MTRH has a 6-bed ICU, so patients that would certainly qualify for ventilation, cardiac telemetry, etc etc in the US all end up on the wards.  We have to deal with everything.  Oncology.  Neurology.  Cardiology.  All on the wards, all being managed by a team which consists of 1 Kenyan resident, an intern, a PA, and a group of medical students.  On top of that, the resources are severely limited.  We run out of gloves, tape, even paper on a regular basis.  Good luck finding sterile gloves.  The lab frequently runs out of reagents, and therefore can't complete our lab requests.  Imagine Wishard not giving you creatinine values for a week.  The next week, they can't get you LFTs.  One night the hospital ran out of oxygen.  Oxygen!  One medicine team lost 6 patients that night.  Then there is also the culture of never being in a hurry...which is great outside of the hospital, but when people are dying in front of you...a little hurry goes a long way.

I knew what I was signing up for.  This is a "resource limited" setting, and MTRH is doing the best it can.  ...or is it?  I'm realizing just how damaging the corruption in the Kenyan government is.  Exhibit A: one Kenyan politician is spending 3 billion kshillings ($37 million) on helicopters for the upcoming election.  I don't know about you, but there might be a better way to spend that money.  Like on OXYGEN for your HOSPITAL.  Cue Indiana University, who walks a fine line between functioning in the system yet also providing much needed resources (currently still largely only available for HIV+ AMPATH patients).  We are here to learn and to help, and hopefully to encourage change in the system.  Leading by example, if you will.  Of course, I wonder if "the system" will keep breaking down and expect IU to pick up the slack.  That isn't the goal of this partnership, but it could easily head that direction.  And of course, this has me thinking a lot about health care systems in general.  I used to badmouth "rationed care" where patients have to wait weeks to months for their tests/surgeries/whatever.  Considering where I am now, where certain resources just aren't available and/or affordable, I may have to change my stance.  Yes, it has been a very interesting, very eye-opening, and in the day-to-day, very frustrating experience.



Maasai Mara Safari!

After 6 weeks without a day off, and beginning to feel particularly rundown, I decided it was time for a little tourism--Safari at the Maasai Mara!  It was amaaaazing!  We had SO much fun and saw some incredible WILD wildlife.  On our very first "game drive" our Maasai guide said he had heard of the location for some cheetahs.  Cheetahs are difficult to spot, so we flew by a ton of other interesting things in search of them.  Zebras, elephants, even an entire pride of lions (which was crazy because I wanted to stop for everything!  I had just gotten there!) but it quickly paid off and we found the cheetahs!  That's pretty much how the whole safari went.  If we were hunting for something in particular, we found it.  If we were just driving home after a successful day, we stumbled upon some new and amazing animal find.  We definitely had luck on our side, and it made for a very successful and exciting safari!  The elusive leopard, check.  The camouflaged cheetah, triple check.  "I'm surprised we haven't seen--oh, there they are!"  The hunt for the rhinoceros, our missing piece of "the big 5" was especially exciting.  We were slowly and quietly searching around a huge new area of the mara when we ran into another safari van who had spotted the rhino up ahead.  He gave us detailed directions on how to find him.  The closer we got, the more excited the other passing vans were to tell us the news.  Eventually we were racing to reach him before he disappeared into the bush.  The last van was our friend Max, who only slightly slowed down to yell at us in swahili to "hurry! hurry!".  It was so exhilarating!  Especially because we eventually DID find him, and spent the next hour watching a wild rhinoceros chill in his natural habitat.  Having successfully checked "The big 5" off our list, (lion, elephant, buffalo, leopard, rhino) we asked our Maasai guide what else there was to see.  He responded with, "Only the smaller animals, like mongoose and jackals."  What did we find later that day?  2 giant groups of mongoose, and I'll claim credit for spotting the 3 jackals on an adjacent path!  On our last morning drive we had no particular plan, but ended up catching a caracal cat cross our path--an animal that our Maasai guide had only seen once before in his life!  (See the wikipedia page for just how rare spotting this cat is.)  We also paid a visit to our guide's village, which was a really cool experience.  We danced with them, watched them make fire, hung out in one of their tiny houses, and bought a ton of souvenirs. 

I really want to write about all of the other hilarious things that happened because I remember laughing so hard for so long that I couldn't fully laugh anymore...but it has all blurred into the awesome safari that it was.  I DO remember referencing and/or singing "Only in Kenya!" an exorbitant amount, much to the annoyance of 2 of our safarimates, haha.  (Please reference my first blogpost for a link to the video.)  Cynthia also kept saying "Holy crap!" when we would see something awesome, which was often, which played into our obsession with that video.  (Holy crap! Lions! Tours.  Again, please see video for further understanding.)  And then there was just the fun of trying to stay standing upright while driving on the bumpy mara roads!  Bah, it was an amazing 4 days.  I would LOVE to post more pictures, but my internet is being particularly slow.  However, I have posted a few videos onto my snazzy youtube channel, if you are interested! 

Link to my youtube channel here!



Tomorrow I leave for white water rafting on the NILE!  I've definitely reverted back to my tourist-self, but it is a much needed break from the wards.  And I'm having a blast :)  Then one more week of work, a last weekend having fun somewhere in Kenya, and then I head back to the US.  It has FLOWN by!

As always, thanks for reading!  Comments/questions/life updates are encouraged!

Over the half-way hump :(

I have exactly 3 weeks left in Kenya. :( I have met so many great people, and just keep meeting more and more!  Just yesterday I was brushing my teeth next to a complete stranger, and by the time we were done, she had invited me to her room for coffee.  That's just how people are here.  My sometimes awkward tendency to say hi to random people solely because we made eye-contact is completely embraced here, and I love it.  I often get asked if I'm homesick...and I can honestly say that I'm not.  For the girl who hasn't lived outside of a 100-mile radius of the home she grew up in, it's somewhat surprising.  Watching home-videos of my 6-month old nephew does make me want all the details of life back home, but I've never had the thought that I wish I were back in Indiana rather than where I am!

I am starting my second week on one of the Men's Medicine wards.  The adult service is significantly busier and with more complicated patients than the pediatric ward.  Rounding lasts from 9am - 1pm without fail.  Luckily, I have a great team.  My registrar does useful teaching in an un-intimidating way.  We have a visiting resident from the UK, with whom I have developed a sign-language of sorts to know when he needs my pulse ox vs. BP cuff vs. hand sanitizer.  We have another outgoing and overworked intern who happens to be from Malaysia.  Today we welcomed a visiting medical student from Sweden to the team!  It turns out that Moi provides quite the international work environment!  Of course, the Kenyan medical students on the team were very welcoming to me.  I feel like I am forming bonds with them much quicker than I did in the beginning.  This week we restarted with a new batch of students, who seem equally friendly and awesome.

Since Mount Elgon over 2 weeks ago, I have stayed here in Eldoret.  It has been nice to feel like I live here rather than feel like a tourist.  I have kept myself plenty busy with work, exploring town, and random fun activities we come up with.  I think I'll try the bullet format again to give you a snapshot of the stuff I've been up to, and to help me remember in the future :)

• Eldoret nightlife = awesome!  Tuesday night Karaoke was so much fun.  Kenyans seem to take karaoke pretty seriously and usually sing slow power ballads.  We stuck to the American tradition of trashy pop songs.  A friend of mine and I sang "My Humps" by Fergie...it seemed quite inappropriate once I was reminded of the lyrics, but the crowd seemed to enjoy it!  On the weekends, we have gone to to the new Club Samba and Spree several times.  Clubs here are similar to those in the US, but the people make it so much more fun!  It's more about the dancing than the drinking.  Guys always outnumber girls on the dance floor, and eventually the entire CLUB becomes the dance floor!  There is always a fun mix of American and African music.  I will seriously miss this dance scene back home.
• I have visited a couple places for children here in Eldoret.  Neema House is a home and primary school for children infected or affected by HIV.  There are 40+ kids living there, most of which are <10 yrs old.  At least I had Sarah for support, but we were basically attacked for 2 hours, haha.  My favorite game was the "nap time" game, but mostly I played a lot of soccer.  Tumaini is a center for "street children" to drop in and get support in a variety of ways.  Shyamal and I attempted to teach them how to frisbee.  We ended up playing an ultimate-soccer-frisbee game, which was a huge hit.
• One of our random nights out deserves a bullet point.  The details are fuzzy on whether or not we were actually invited, but we got the whole group dressed up and crashed an Indian wedding!  Shyamal, the brown Brown University medical student (it's too perfect that I can't stop myself) acted as our tour guide through the temple and delicious buffet dinner.  Afterwards we strolled through a new part of town and stumbled upon a bar with pool tables and 2 very friendly gentlemen.  They had a hard time keeping track of our names, and didn't seem to notice that we kept changing them throughout the night.  Josh and I were apparently siblings, and eventually went by the names Michael and Janet Jackson.  When Kelly/Sally/Nancy tried to go by Hannah Montana, my drink almost came out my nose.  It was a very random, very fun night out!
• I attended a Kenyan Church service with 2 of my new friends here.  It was very different, yet was fundamentally the same.  Basically, it was smaller, longer, and louder than most US services!  The prayer morphed into worship, and then morphed back to prayer, etc.  It was difficult for an outsider to follow, but at times was very powerful.  There were many pearls from the message which I hope will stay with me.  Of course, everyone was very welcoming and even "honored" to have me attend!

• The Superbowl!  Natalie, our resident party-planner, talked a local bar into opening for us at 2am for the game!  Hawaiian pizza and Little Manning for the win at 4am in Kenya = epic.  Of course there were the hilarious hiccups, like how the workers set up the projector for the game but the sound was bass fishing, and how the "Please replace the light bulb" warning blocked our view of the score the whole game, haha.  Just little reminders that I was actually watching the game in Kenya!  Otherwise, I felt very at home with all of the downtown Indy shots!

The most important change that has happened over the last couple weeks is my ability to make connections with my Kenyan colleagues.  The first month, it seemed that the US crew spent a lot of time together getting to know each other.  We did fun Kenyan things, but mainly as a giant group of foreigners.  However, now that I am more comfortable, (and perhaps now that they are more comfortable?), I feel like I am forming true friendships.  My church invitation came from a friend on my pediatric team, who just stopped by my room to invite me for porridge!  She loved that I had never had porridge before.  (Fyi, it's like drinking a warm apple pie!)  I guess part of me asumed that the Kenyan medical students wouldn't take a huge interest in the next batch of IU students since so many of us rotate here.  I think (1) that belief is mainly false, and (2) we started at the beginning of a new school year for them, so we are almost like the FIRST batch of IU students.  It was a bit of a slow start because of it, but I do think my timing is great for meeting people and making friends.  I am already excited by the possibility of some of them rotating through IU in the future!

Bittersweet

Wednesday evening, February 1st.  In my cave (Sarah and I switched bunks).

I just got back from the hospital.  Not because I'm a superstar medical student who likes to go in at night to admit patients, like my roommate, but because I had locked myself out of our room and I needed to track down a set of keys.  Keys in hand, I decided to do another sweep of the pediatric ward.  (I switched to Medicine (adults) this week, and have been periodically visiting the kids and patients on the pediatric side throughout the week...I can't let go of them!)  Bittersweet: My favorite family is gone.  I have mentioned them to a lot of you, and the kids made it into a picture on my last post.  This family has defined my experience thus-far, so I think it's time I share a little more of their/my/our story.

Week 2, when I switched to a new pediatric team, I was still trying to figure out how to be helpful.  The strategy I employed was to pick up the sickest patients and do everything I could to make sure they had the best care possible.  Jo was one of those kids.  The 3 year old malnourished boy looked near-death when I picked him up as a patient.  He was on oxygen, his skin was pealing off, he couldn't keep feeds down and he couldn't hold his head up.  The initial perks of this patient were (1) the very friendly mom who spoke a good amount of english, and (2) her healthy 9 month old boy who was an adorable package of giggles and smiles.  It was after few days of checking up on them that the mom told me her whole story, which was briefly touched upon in my last post.  Basically, she was run out of her house and was only able to take 3 of the 4 children with her.  She returned 2 years later to find her son severely malnourished.  She had to leave 2 of her children in the care of neighbors while she essentially lived in the hospital with her youngest and her very sick 3 year old.  Jo had a very long, hard road to recovery.  After initial improvement, he began to decline.  Cue MY entrance, the enthusiastic muzungu come to save the day--only to realize that there was very little I could do to reverse the damage of chronic malnutrition.  What I could do was keep the mom hopeful and keep the little brother smiling.  So that's what I did.  With some additional medications, mom's dedicated care, a little prayer and a lot of God's grace, little Jo started to perk up.  He came off oxygen.  He started making eye contact with those humongous brown eyes.  Eventually, he started to reach out for a daily mazungu handshake.  The morning that I saw him sitting upright and feeding himself porridge, I knew he would make it.

There are so many side stories to my experience with this family that I don't know where to start.  Watching Jo transform into himself was amazing.  That first smile he showed me, man, I about ran down the hall shouting with excitement!  Finally seeing LIFE behind those big brown eyes!  His smile got bigger and brighter as he continued to improve.  Eventually, he would smile so big that I could see the two dimples high on each cheek.  It wasn't until my last visit with them that I heard him laugh.  (I had to look away to allow the insta-mist in my eyes to resolve before I continued my play-session.)  And then there was Jay, the little brother.  He was so joyful!  Always smiling and laughing so hard that he would loose his balance and collapse onto the bed.  However, it seemed that as Jo was making a turn for the better, Jay started loosing his energy.  He eventually developed a cough and began spiking fevers.  He was "admitted" and treated for, you guessed it, hospital-acquired pneumonia and tuberculosis.  Turns out that if you stay in a hospital long enough, you will get sick.  Shocker.  He quickly turned around and returned to his joyful self, but not before adding a good chunk to the bill.

Priority #1: Get all members of the family healthy.  Check.  Priority #2: Get all members HOME!  Difficult.  Frustrating.  Lead to my first breakdown during this experience.  I went with the mom to go speak to social work to figure out the plan for discharge (payment, timing, transportation, whatever).  The always brave-faced mom broke down into tears as she pleaded with the social worker to allow her to leave the hospital, that she couldn't afford the bill, that her children were getting sick and her OTHER children needed her.  I learned that there would be a "committee meeting" to decide upon her case.  I offered to attend this meeting and speak on behalf of the family, but the social worker seemed confused and eventually responded with, "They will just ask you to pay the bill."  I held back my own tears as I wound through the hospital and back across the street to my tiny hostel room.  We had done everything medically correct, but the social red-tape was preventing the final step.  I made a plan to go over the social worker's head the following day, if necessary, while in the back of my mind I calculated how much money it would cost to get this family reunited and back home to Uganda.  The following day, we were all pleasantly surprised when the decision was reached that the bill would be waived in total.  That was my last official day on pediatrics.  It was the day the family gave me an orange and I became the afternoon entertainment for my firm as I repeatedly squirted myself trying to peal and eat it.  It would still be several days before the family was allowed to leave the hospital, which is why I continued to visit.  When I went to see them this evening, I found an unfamiliar child in their bed.  Good news.





Jo and his classic reaching hand.
My usual handshake became tickle-fingers during
my last visit, which is how I got him to laugh.
Looks like he's saving his orange for later.



Week 3 and Mount Elgon

Tuesday, January 24th, sitting on my bunk bed.

I have been in Eldoret just over 3 weeks now, and my love for Kenya keeps growing.  I have had so many positive interactions and one-of-a-kind experiences that they are already blurring into the life-changing trip I knew this would be.  I really should be journaling on a daily basis, but the occasional blog-post is better than nothing.  Those of you who catch me on gchat get to hear some of the finer details, and I appreciate you letting me tell my stories!



Bry is one of my favorite patients! Unfortunately, he was
readmitted a few days after discharge onto a different team,
but he ran down the hall to find me!

 Week 3:  I finally had my bearings on the ward and was able to function (almost) as a Kenyan medical student.  My pediatric team welcomed a medical student from Holland and she and I quickly became friends as I showed her the ropes.  (Hey, Meike!)  To add more flair to our Kenyan team, the intern on my team is Indian and went through British schooling of some sort.  Quite the international group!  We had several long discussions comparing our cultures, education, politics (I kept pretty quiet during the politics part of the conversation, haha), etc.  It was a pretty cool environment.  I also really began to bond with our long-term patients.  And then I have a lot of love for the abandoned kids who now call MTRH home.  I have spent more than my fair share of time playing with them during our typically slow afternoons on the wards.  I could go on and on about each of them.  I took my camera to the ward a few days ago and surprised the kids with prints of the pictures today--it was a madhouse!  They LOVE cameras and pictures, and of course promptly began fighting over the prints.  Woops!  I'll just have to take my camera back to take pictures of the kiddos I missed on round 1 :)

 

LOVE these kids!  The patient is the one on my lap, and the
other kiddo is his little brother, who is upset that big bro
is getting all of the attention.  Such a cute family!

There is a 3 year old boy who has been in the hospital since mid-December for malnutrition who I "picked up" as a patient.  Fortunately, the mother speaks a fair amount of English, so when I was floundering around the wards, I tended to spend extra time with them.  The mother told me the whole terrible story about how she was run out of her house and was only able to take 3 of her 4 children, leaving the youngest behind.  She was able to return 2 years later but found her son severely malnourished.  I was very worried about the little guy, but long-story-short he pulled through and was discharged yesterday!  Of course, there is the tiny problem of the giant bill that she can't pay, but at least her family is healthy and about to be reunited.  I LOVE bringing smiles to these kid's faces, especially the 3 year old because it meant he was feeling better.  One of my conversations with the mother was particularly poignant--she asked, "Is it true, that in the US, you don't know your neighbor?"  I fumbled around trying to explain that one.  She went into detail about how neighbors help each other in Kenya, care for each other's children, share food,  protect each other, etc.  And then she responded with, "You won't help your neighbor, but you will help Kenya?"  ......yeah.  This family will definitely stay with me.


Mount Elgon: This past weekend 6 of us decided to take on Mount Elgon.  Joe Mamlin, the brain behind AMPATH who has lived in Eldoret for the last 13 years, endorsed it as his favorite thing to do. We HAD to check it out!  The whole trip ended up being a blast.  I was either laughing so hard I almost peed my pants or speechless over the beauty of nature at every turn.  For those of you on facebook, I have a new profile picture from the trip!  Also, here is a link to a video I uploaded to youtube, in case pictures just aren't enough:  Video Link!

The highlights, in bullet form this time!  :)

• Driver showing up an hour late in a MUTATU to drive us up a mountain.  A mutatu is an 11-seat rear-wheel drive van.  We knew it would be an interesting trip.
• Noticing that Micah, our fearless leader on the trip, speaks in a hybrid british accent when talking to Kenyans.  "Fraaaancis, is this the co-ffee plaaant?"  It was super noticeable from then on, and hilarious.
• Josh trying to point out the plant that smelled good out of the thousands of different plants we were driving by.  "No...wait....THAT ONE!"
• Needing to get out of the mutatu so our drivers and guide could push it up a particularly steep incline.  I'm surprised it only happened once.

• The hike!  Amazing.  Over each hill was a new landscape with new plants and spectacular views of the mountain.  See the video above for a decent representation.  Unfortunately, we were informed that it would only take 2 hours to get to the top, which was false.  Josh and Micah, the guys that were ahead of me at the time of video production, did actually eventually make it to the top, but we definitely ran out of daylight for the drive back down the moutain.  A little scary.  Us girls got tired of waiting for them so we started heading back on our own. I kept referencing those shows where hikers get lost and almost die right before getting rescued, and "This is how it happens!" became a tag-line for our long, unguided hike in the wilderness of Kenya.  We left a few signs for the boys so they would know we were ok, stopped for a yoga break, and eventually they caught up to us.
• Watching the boys fix the flat tire we got on the drive back down the moutain.  Of course the jack didn't work, so they had to lift our mutatu with their manly muscles.
• The overnight stay in the "guest house." We lost power for a while and lost water for the majority of the evening.  No shower for Jessica = gross.  We did manage to pull together a delicious meal of left-over Indian food and watch a movie on a computer, though.
• THE STARS!  Arguably my favorite part of this trip because it was RIDICULOUS!  Everyone in our group agreed that it was the most impressive display of stars that any of us had seen, and we are a well traveled group!  Joe took some pictures with a 30-second shutter, so I will be stealing those in an attempt to hang on to the beauty.  When I went to sleep that night, I just opened the window and looked up.

• Cave exploring.  The next morning, we used flashlights to go deep into caves and annoy thousands of bats.  I will attempt to post a video because my pictures didn't turn out.  They were super loud and occasionally flew a little too close for comfort!  Oh yeah, and Sarah came down with some terrible allergy/altitude sickness and couldn't even get into the second cave because the guano was so overwhelming.  I tried not to think about it.
• Waterfall shower!  There was a giant waterfall that we all eventually played in.  It was gorgeous, but the water was ice-cold and stung your skin because it was so huge!  Still worth it, particularly in my state of filth at the time.

So my "highlights" just ended up being a really detailed account of the weekend, haha.  Thanks for reading and/or lookng at my pictures :)  Now everyone go out and enjoy some cheezits for me!  I miss them!

2 weeks in...really!?

Saturday, January 14th.  Happy Birthday, Dadio!

Somehow I have seamlessly transitioned from the "I can't believe I'm actually in Kenya" belief to "How has it already been 2 weeks?!"  Seriously, how am I already 25% through my time here?  I'm so glad I'm here for 2 months because if this was the half-way point, I'd be really sad and I think missing out on a lot of the great stuff--like feeling at home here, and making real friends, and experiencing as much as I can.  Every day is still new and presents different challenges, but I've finally hit my stride.  I think the delay was partly because Eldoret, IU House, and MTRH were slow to get going following the holidays.  New people were still trickling in, the schedule of events was questionable, the medical students hadn't started yet, and I was stuck at IU House knowing that I was going to move at some unknown date in the near future.  And then there is the Jessica-has-no-idea-what-she-is-doing delay :)  At any rate, this second week here was filled with lectures, games, dinners, presentations, and meeting a whole lot of new people.  It's nice to have a routine back.  Yeah, I think that's a big part of it.  Guess I learned that about myself!  This post ended up getting rather long, so here are some handy headings so you may pick and choose what you want to know!

Wards
My wards experience is slowly but surely improving each day.  Switching to a new team this week did set me back a bit.  There were an awkward first few days because I couldn't tell who was a medical student and who was a nursing student, clinical officer, nutrition student, etc etc.  My team is literally 30 people.  I am not exaggerating.  I counted twice.  Imagine 30 people in white coats crowded around your bed, which you happen to be sharing with another sick kid and his or her mom.  It gets pretty claustrophobic, hot, smelly, and impossible to hear.  Kenyans think that the level Americans speak is disrespectfully loud, so to me everyone is walking around whispering!  Also, the bubble of personal space does not exist here...or at least you must sacrifice your bubble for the opportunity to hear.  The team I'm on thoroughly enjoys pimping which also makes that not-hearing thing a problem.  Half of the time I can't hear the questions, and the other half of the time I don't know the answers anyway, haha.  I am reviewing/learning a lot when I CAN hear, and I have started strategically choosing which beds I should push to the front, and which ones I will hang back.  Next week we will be acquiring at least 1 more student, which will change the way we will divide patients (yet again).  There is still a lot to learn on the wards, but I feel like I know the system now.  AND now that I have internet, I can actually study for the pimping sessions.  I'm thinking week 3 will be another giant leap in the right direction.

Sarah and I share a "front door" and triangle-shaped
entrance with the boys, who have a mirror-image room.
You can see our desk, situated between the wall and
our bunkbeds.  Our closet is 2 feet beyond the beds.
1 person at a time! :)

Hostel
The time finally came when Sarah, Josh, Micah and I moved from the pristine landscaping, prepared meals, and warm showers of IU House over to the Medical Student Hostel.  There is still a security gate, Brooke ;)  That is about the only luxury we have left.  The rooms can only be described as "comically small."  Sarah and I are sharing a room with bunk beds, 1 desk, 1 closet, and enough room for 1 person to stand, if the door is closed.  We share a paper-thin wall with Josh and Micah, which has been great as we settle in to this new location with new hilarious experiences at every turn. There is a "mess hall" cafeteria, which serves up huge portions of traditional Kenyan foods such as beans, rice, ugali and chapati for 30 shillings (not even 50 cents) at lunch, but apparently we are on our own for breakfast and dinner.  All of that is actually great--I love having home base across from the hospital, and being surrounded by our Kenyan colleagues will be great as I get to know them better.  The main pitfall: Sarah and I are living on a boys' floor and must walk up 4 flights of stairs to get to a girls' floor with a girls' restroom.  Oooh the restrooms!  Toilets without seats, which may or may not flush.  Cold water only out of waste-high faucets.  No toilet paper.  No soap.  Did I mention I have to walk up 4 flights of stairs to even get there?  Haha.  It just adds to the experience and comedy of it all! 

The Fun Stuff!
So the wards are a challenge, my living situation is less than ideal, but I am still having SO much fun!  The people here are amazing.  Us out-of-towners are having a great time getting to know each other and our new surroundings.  People that sign up for experiences like this, whether for a few weeks or a few years, are generally pretty interesting and fun people.  And then we get to surround ourselves with this amazing Kenyan culture!  For the vast majority, Kenyans are very welcoming of Wazungo (the plural of mazungu, thanks Kevin!).  They start every interaction with "Hi, how are you? How is your day?" even if all I need are directions to the restroom.  And then I often get a personal guide TO the restroom to make sure I found it!  Anyone I have met thus far now treats me as a good friend, even if my our interaction was ducking each others' dodgeballs.  The security guard at IU House greets me with a huge smile and a double-hand handshake every time he sees me, saying "Hey mamma! Welcome back to your home!"  Here's a shocker (note sarcasm): there is something different here.  A relaxed feel that I don't see in the US, even in the heart of Midwestern Hospitality.  (I've heard it theorized that it is because of the fabulous weather...?)  It does make time-sensitive activities a little frustrating, such as working in the hospital, but outside of the hospital I have adjusted to the feel.  Perhaps we are being treated better because we are foreigners...regardless, I quite enjoy it.  Of course there are those who try to take advantage of Mazungu, but I can hardly blame them.  We are spending a huge amount of money to get here and take our fancy site-seeing trips.  They know we have money.  It's hard to argue when the starting price of a watch is $5.

This weekend there were a couple trips planned, but all of us med students stuck around Eldoret.  I've been enjoying some of the regular events, including Wednesday night group dinner outings, Thursday evening dodgeball, Saturday morning cricket (I'm terrible, but it was fun!), and tomorrow I will attempt to keep up during an afternoon soccer match!  And if/when I fail, I can always blame the altitude :)  Last night a few of us went out to Spree, a club here in Eldoret, and had a blast!  Kelvin took excellent care of us, including the traditional dance-floor rescues, and made sure we met other great people while we were there.  We will definitely be going back for their karaoke Tuesdays!  I have done quite a bit more exploring of town and can now confidently dodge people and traffic with the best of them.  I have yet to purchase any souvenirs, but have my eye on several.  If anyone has any requests, I'd be happy to hunt it down while I'm here!

At Spree with my new friend Kelvin and my old friend Josh!

Here's to the next 6 weeks being even better than the first 2!  Cheers!

Wards and 1st Weekend Fun!

Sunday evening, January 8, 2012

After one week in Eldoret, I’d like to say that I’m all settled…but that isn’t quite the case.  I do feel very comfortable here at IU House, but I will be moving into the Hostel in the next few days.  I will miss this giant room and private bathroom with hot running water!  I can now navigate MTRH (the hospital) as well as the hustle and bustle of town, but have yet to do either completely on my own.  I will be moving to a new pediatric team tomorrow; one where I will be the only non-Kenyan.  Hopefully we will have an Intern and possibly even medical students, which will help define my role on the team.  It has been easy to float along the other team without taking any real responsibility…a nice way to ease into this new environment, but I’m ready for the real deal to start.  I think. J I hope everyone is as welcoming and helpful on my new team as my old one!

My reaction to the wards thus far: Mixed.  The registrars (residents) have been great and seem to know their stuff and I have been impressed with the team’s ability to take care of the high volume / wide variety pediatric ward.  However, it is impossible to miss the limitations of this system.  The consultants (attendings) are focused on teaching instead of patient care, and are not a daily presence.  We must work within a limited and ever-changing formulary.  Even if we order a medication, there is no guarantee that it will be given.  Ordering any kind of test or study is a big question mark.  Will the patient have the money to pay for it?  Will the supplies be available?  Will it get done today?  And for the love, WHEN will the results get back to us?!  That might be the most frustrating part.  I am very Americanized in my medical training in that I am used to basing many treatment decisions on these tests.  I realize that.  I would love to get away from that.  I think I will be forced to get away from that through this experience.  I could vent about how this imperfect system is less perfect than our imperfect system, but I’m here to learn and help and not to criticize.  (No promises that it doesn’t come out in the paper I have to write at the end, though, haha.)  In all reality, I’m working on the public ward in an excellent referral hospital in Kenya—the “SuperWomWom” Wishard of Western Kenya, if you will—so this is likely as good as it gets!  And from hearing other 3^rd world medicine stories from fellow IU House residents, it’s pretty darn good.

Now, for fun part: WEEKEND RECAP!!  I will be working Mon-Fri during these two months, leaving my weekends free and clear for adventures.  This weekend I jumped in with a group going to Naivasha, Kenya.  We spent Saturday at Hell’s Gate, which is a giant open park where you mountain bike through the wildlife. For a lot of it, there are huge beautiful rock cliffs along either side of the path.  We saw zebras, gazelles, antelopes, water buffalo, adorable little warthogs, giraffes, and baboons!  All around us!  At the end of the park is a gorge for more hiking and exploring.  Our hired guide showed us the hot springs (actually hot!  I need to look up how that works) and supposedly where the devil lives.  We took a picture in his bedroom, and maybe stole rocks from it for good measure. J

At the equator!

Hell's Gate bike path--we went to the Gorge.

That night we were exhausted from our rather strenuous biking and hiking, and stayed the night in the very swank Naivasha Country Club.  Really, it was unnecessarily swank, particularly for my first weekend when I wasn’t desperate for a hot shower.  In fact, we couldn’t even figure out how to get our shower working so I ended up taking a hybrid shower/bath, haha.  The following morning we got up early to head to Crescent Island.  This is the island where they filmed “Out of Africa,” I’ve been told.  Apparently us Americans brought in a bunch of animals for the movie and then left them there.  Typical.  But it ended up being this gorgeous oasis surrounded by crystal blue waters with mountains in the distance.  Literally breathtaking.  We were able to walk among the animals (no predators, same as in Hell’s Gate) and for some reason it had a completely different feel.  The scenery was spectacular, and off in the distance you could see groups of all different kinds of animals, often intermingled.  Who knew that wildebeest and zebras could be buds?  We found a particularly friendly and photogenic group of giraffe, and spent quite a bit of time with them.  Then we stumbled upon a group of hippos on the ride home.  It was ridiculously amazing.  The pictures don’t do it justice.  I feel like it could very well be the highlight of my trip, and I’m just getting started!

 

Again, internet is an issue.  I’m actually finishing up this blog on Monday night from my hostel bed so I will stop here.  The hostel experience deserves a blog post of its own!  I was talked into getting up at 4am to watch the BCS championship game, and my team is on call, so tomorrow will be a long one.  Better get to sleep.  As always, questions/comments/updates are encouraged!