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!

Culture Shock and Awe

January 3, 2012. IU House. Eldoret, Kenya.

The last 3 days have been so new to me that each moment is a new adventure!  Exciting and exhausting.  I feel pretty well adjusted to the time change, and I could easily zonk out right now and it isn’t even 9pm.  Quick(ish) rundown…

New Year’s Day—I was actually looking forward to sitting by the pool with my Kindle (Catching Fire, so addicting) but my Turkish friend had other ideas.  We spent most of the afternoon attempting to chat about medical school and his business.  Somehow he was unable to pick up on my social cues that I really just wanted to relax.  He did help me navigate the hotel lunch options, however, which was helpful.  Eventually Eddie came back to pick me up and I made my way back to the Nairobi airport for the final leg of my journey.  My last plane felt like an 18-passenger van with wings and propellers, but it got me to my final destination safely.  That evening a few of us new arrivals tried to order pizzas to be delivered to IU House, but 2 hours later we were notified that they had run out of cheese and the cook left…no pizza for us.  Only in Kenya J

1/2/12—My first full day in Eldoret was easily filled.  I took my first Swahili lesson: Jambo! Habari gani? Jina langu ni Jessica. Ninatoka nchi ya America.  Then I went to Kruger Farm with the other 2 new arrivals.  Krugar Farm is a giant farm with a small reserve where 12 rescued wild giraffe live.  We went on a hike up and around this giant hill/small mountain to try to get close to the giraffes, but they were not in a friendly mood that day.  We did see some other wildlife, but the most impressive thing was our guide spider-monkeying up a tree to locate the giraffes for us!  Then we stopped by Kerio View for a relaxing drink with a fabulous view over the Rift Valley.  And I suppose I should mention that doxycycline (my malaria prophylaxis) makes you extremely sun-sensitive, and I underestimated this.  I was immediately a victim. 



Kruger Farm

  

I see you!  But you see me, and then you start walking away.  Bummer.



Look, it's me at Kerio View!  I'm actually here! :)

Also, IU House is a temporary location for me, but it is super nice.  I have my own room with essentially my own bathroom, which has hot running water!  So what if there is zero water pressure and the room is so small that my showerhead dumps onto the toilet, it’s a whole lot nicer than where I’m moving to in a few days.  Driving through town was definitely an experience as well.  Traffic signs are apparently optional, people are walking everywhere, and the cars/mopeds/donkey-pulled-carts have no problem coming within inches of each other.  Oh yes, and just outside of the bustle you may run into a stray cow or sheep.  The town is actually quite large with a lot of shops, so once I realize what I forgot to pack (enough sunscreen, perhaps) I should be able to find it somewhere.



My current home away from home!
House 3 of the 8 houses at "IU House," each with several rooms.



1/3/12—My first day in the Moi Teaching and Referral Hospital.  I don’t even know how to describe how I felt.  I wasn’t nervous, I wasn’t excited…I guess the best way to put it was that I was “open.”  That sounds so lame, but it’s the best I can do with my limited vocabulary.  This was probably partly because I have just been through so many brand-spanking-new things in the last 5 days that this was just the next thing!  I really didn’t know what to expect so I had set no expectations.  During the tour, I was a sponge trying desperately to absorb as much knowledge and information as I could.  For those of you in med school—you know that routine of the first day of a new rotation?  You get the quick tour, run-down of your expectations, introduced to a few people, and then are thrown in?  It was like that but x 1000.  Information overload!  Not only is it a new hospital to get to know, it’s a completely new culture.  I have to learn where I fit into the system while just getting to know the system itself!  Trying to do both of those things at the same time makes life confusing, so these first few days promise to be hectic.  Where is the patient?  Found him…now how do I talk to him?  Does this count as pallor?  Where is his chart?  Ok, found it…now what do these abbreviations mean?  I should probably order an antibiotic…how do I do that?  Do we even have that antibiotic available?  Around and around we go!  There were fleeting moments where I felt like I had a handle on things, but mostly I just realized I have A LOT to learn.  Everyone has been extremely welcoming and helpful, but I’m still a small fish in a brand new ocean.

The highlight of the day actually came when Sarah and I (the MS4 from Brown) couldn’t find our team in the afternoon, so we decided to check out the Sally Test Center.  Basically, it’s a big play area for kids who are generally healthy but are stuck in the hospital for one reason or another.  (Children are sometimes abandoned due to their family’s inability to pay the hospital bill or are possibly orphaned.)  It’s a sad predicament, but the kids are so much fun!  Kenyan children love Muzungus (their word for white people) and I spent the afternoon pushing tricycles, stealing hats, and realizing that you don’t have to speak the same language to communicate, particularly with a child.  But I taught them the word “bike” anyway.

And now it is time for sleep.  I will post this once I have more reliable internet.  Fingers crossed for tomorrow!  Oh and don't worry, these play-by-play posts are done, haha.  Looks like I need to be spending more time studying and learning Swahili than fighting with the internet and attempting to load pictures...although I may have even better internet once I move into the Hostel, we'll see.  I'll keep you posted either way!  Questions, comments, and life updates are encouraged! :)