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.