04 February 2011

Kenya: Gone on Safari

Work's finished and it's time for safari!  Please take in the last official post of our trip.

The last few days were spent finishing up at the hospital and the clinic in the village.  Rounds, treating malaria in the clinic, and watching the clinic's new reception being built were the main events of note.  We even had dinner last night at Brenda's, prepared by her two sisters and mother - boy was it amazing.  Daniela, Brenda's 2 year-old daughter, even has her English up to speed.  We'd ask her "How are you?"  She responds, "I'm fine."  (Those are the most commonly known phrases by the kids here.)  We've definitely explored Kenyan and Indian food to the fullest, and I actually look forward to some Indian food when I return home.  Never thought I'd say that.

It is difficult to capture all the appreciation we have for your support and prayers throughout this trip.  Through your donations we purchased and gave out all our children's multivitamins, handed out toothpaste and toothbrushes to those who needed them, re-stocked about 18 different medications (antibiotics, phenergan suspension for nausea/vomiting, children's tylenol, etc.), handed out glasses and gave reading glasses to the Tenwek hospital crew, left a number of medications from home for emergency use only, gave coloring books, crayons, workbooks, pens and lollipops to roughly 150 kids, and even purchased cooking supplies for one of Brendas' mothers.  Their smiles showed their appreciation, but from us we say "thank you" for your open hearts.  We truly cannot thank you enough - what an honor and a blessing.

This has been an invaluable learning opportunity for me, as a repeat trip to a developing country, challenging my patience and shaping my attitudes.  There are so many projects here, intended to serve the population in poverty, where the ball is actually being dropped:  there is still a huge need for reliable transportation (well-maintained vehicles and smooth roads), the effective distribution of bed nets to those who truly need them, closer access to clean drinking water, and an increased emphasis on the prevention of the spread of HIV.  For the failures, there are plenty of successes as well:  motorbikes now fill the roads getting citizens to and from their destinations quicker, internet access has exploded keeping people better informed on current events and public health measures, anti-retroviral medications are available to those mothers who deliver in the hospital to try to prevent vertical transmission of HIV, and more community health workers are devoting their work-week to improving the health of Kenyans.  There are plenty to build on.  One of the most valuable lessons revolves around respecting what you don't know.  We don't know everything.  Especially when we don't live in the community we're serving.  And a clear and open mind with respect to this can bring one closer to success.

There is a plethora of projects going on here, and the main need for improvement is in the coordination between them.  Filling in the small holes.  Connecting the dots.  Adding the last few small pieces to the puzzle.  And I hope to help with that. 

The true soldiers and "saints," really, in all this, are Josh, Brenda, and Aduda.  Josh, the Bonyo's Kenya Mission #1 here in Kisumu, who ensures the clinic operates smoothly for those in and around Masara.  Brenda, the social / community health worker who gives her time to educating pregnant mothers and young schoolgirls on STI's among other public health measures.  (And let's not forget her father, "Papa Joshua," the clinical officer who offers his experience and charisma to her endeavors.)  Aduda, the former salesman, who believes so strongly in preventing HIV spread and educating those living with TB and AIDS, that he travels by public transport to the villages for surprise home visits to ensure compliance.  I have learned from their actions, and can only hope to support their work further in the future.

In the end, I've learned that the health of all peoples boils down to education.  If you don't understand that germs are on your hands, even if they don't look soiled, you will not prevent the spread of many diseases, especially diarrheal illness.  If you don't understand proper baby-feeding techniques, then you'll continue to feed fresh cow's milk directly to your newborn which can be harsh on their young gut (yes, this happens).  If you don't understand that forcing baby teeth to fall out with nails (yes, as in "hammer-and-nails" - this happens too), then infections will continue to hurt young children.  Expanding the public health educational efforts, and simply expanding the number of children able to complete secondary school, will drastically improve health in this area. 

Finally, what I take from this particular trip is the desire to use all the many little luxuries I've been blessed with, that built the foundation of my knowledge, to strive with extra effort to reach my full potential.  Most children here can't even focus enough in school due only to hunger.  How can I not take advantage of all I have, to do my absolute best?!  It would be a disgrace. 

In the end, my buddy Dan, the manager of the Milimani Resort Hotel, our home for the last three weeks who says, "We live like lions."  They wander throughout the day, with no intentional direction.  But, when an antelope comes along, they eat.

There is no need for plans.  When the antelope comes, you'll be there.

The finale from Mom:

Hi all!  This will probably be our last post as we leave for the Masai Mara and safari early in the morning.  We said goodbye to all our friends at the clinic after seeing several more patients (all with malaria).  I presented our blessed shell to the social worker, Brenda, and we both got a little teary.  She has been such a wonder for this village bringing lots of programs which I think will have a great impact.  It has been a profound and moving experience to be here and I'm sure this will be with me the rest of my life.  There is such great need here (in my eyes) and I hope to be sharing some of our ideas for continued support of this village.  Each day in the village for most people is about surviving and basic needs.  We've been so warmly welcomed and Josh, our host, has taken good care of us.  I feel blessed to have made this journey and especially to have this bonding time with Travis.  He's a very good traveling partner as you won't be surprised to hear.  He's good at keeping his cool when I'm losing mine and getting frustrated.

Last night we had the honor having dinner with Brenda and her family which included her mom, dad, 2 sisters and 2 yr old daughter.  We had such wonderful Kenya dishes such as beef stew with rice, kale and spinach, roasted potatoes, tomato/red onion/cabbage salad, fried chicken abd chipati bread.  Quite fabulous!  And as if this wasn't enough, Brenda's mom presented me with some gorgeous Aftican fabric of yellow and purple.  I'd worn my new African-made dress with zebras which Brenda had helped me have made so her mom knew how much I love the fabrics here. That was an incredibly generous gift and I was quite moved.

Today, we've been taking care of last minute business and we took Josh to lunch.  He's been such a great resource this whole trip.  Tonight, we're having dinner at Dan (hotel onsite manager) and Stella's and we're very excited about that.  Got lots of packing to do and decisions about what I'll leave behind since I need lots of room for gifts, etc.  Ha! I'm thrilled about the safari and can't wait to see all the many animals there.  I miss you all so much and look forward to seeing you soon. Many thanks again for all of your love and support!


Asante sana for all  your prayers and support.  We can't wait to share in person when we return.

02 February 2011

Kenya: The Kakamega Forest + Democracy Now?

So, apparently almost the entire Arab world has decided in the last few weeks, that after an average of 25 - 30 years of autocratic rule, they want democracy.  Now.  In the three weeks leading up to my first trip to Morocco.  What timing!  How selfish.  With uprisings spreading to Yemen, Jordan, Algeria, and now rumors of Libya and even Nigeria being next, I figured it would be smart to change my vacation plans.  With the help of God (it could only be) and Nikki the kind Delta agent, my flight from Nairobi will now head to Lisbon, and then home after nine days of Portuguese espresso, nightlife, and port.  

But we are still one long week from being done here in Kenya.  My time with Dr. Allibhoy came to an end today, after a busy set of rounds.  We continue to see cases that are only seen in textbooks back home.  Today, a patient with cryptococcal meningitis was readmitted, our patient status post thoracentesis is still improving, and a post-MI patient appears to be doing well on day 1.  Dr. Allibhoy gave an excellent talk today on the latest in Acute STEMI management.  Here in Kisumu there is no cath lab, so no PCI can take place - thus, they use fibrinolytics.  I don't think I've seen fibrinolytics used for MI in my training in the U.S., so it's interesting to see that used here, and safely.  I've only seen it given in suspected embolic stroke.  Dr. Allibhoy does an excellent job of keeping up with the latest in Cardiology, collecting journal articles and attending annual meetings in Europe.  

I'm continually referred to as "Dr. Travis from U.S.," but out in the village I answer to Giles, Charles, Jarvis, or Trevor.  The "Tr" sound doesn't mesh well with native Kiswahili tongues, but I appreciate the efforts.

Yesterday's visit to Kakamega was beautiful and a refreshing break from the polluted air and busy streets of the city.  Mom's details will be below, and will hopefully include the amazing 8 - 10-foot python that had wandered into the local village and was beaten to death by a swarm of villagers, and then taken to be skinned by the Kenyan Wildlife folks.  It was the only snake, dead or alive, we saw yesterday, even though the forest has 27 species of snakes (25? poisonous per the guide).  We saw plenty of red-tail and Colobus monkeys swinging from the trees, and great views of the falls and land surrounding.

I'll leave you with a quick commentary on top of all this pro-Democracy anti-autocratic unrest in northern Africa and the middle East.  The sentiment down here is of course the same as the U.S. - Democracy = good.  No other way about it.  But how about when Democracy elects leaders that will not be friendly to the U.S?  This is what will likely happen in Egypt.  Then what?  Will the country then be unfriendly to tourists from the West?  From what I hear, the Muslim Brotherhood (majority in Egypt) is not similar to the majority of other Muslims around the world, and continue to represent an extremist view.  But they are who will ascend to power in Egypt.  At first, President Obama wanted to have "talks" with Egypt, but now the word from the State Department is for a transition to begin "now."  How is our country's leadership handling this?  Shall we bomb the hell out of northern Sudan to set them straight?  Or hold diplomatic talks with Egypt?  What's the course?  Is President Obama being too weak, or being smart?  In all honesty, the main thing about an Obama presidency that made me hopeful was his anticipated ability to work with international leaders and bolster the view of Americans around the globe.  Is he doing enough right now?  Of course, it depends who you read, and it's fascinating:

You can either read the caution-provoking article about Obama being the one who will be remembered as "the one who lost Turkey, Lebanon and Egypt."   Or, you may want to read support of Obama supporting Democracy, and practicing what he preaches.
Oh, and Josh still doesn't have the truck.
The better version from Mom:

Hello all!  Yesterday we took a trek through the Kakamega Forrest.  It's about 1.5 hours each way and our driver, Mark, had to drive like he was on an obstacle course on some of the journey as the pot holes are deep, wide and plentiful.  We made it and boy was it spectacular!  We began our 3.5 hour trek (about 10 miles) with our guide, Rachel, who was wearing sturdy leather-soled flip flops.  Our lst stop was to look at a 10 ft. dead python the villagers were skinning.  OMG!  I could not get close but Trav took a couple of pictures.  As we entered the forest, we saw a troop of blue-tailed, red-tailed, and white-tailed monkeys which was quite exciting.  It's the lst time I've seen monkeys in their natural habitat.  Rachel then told us of all the animals/reptiles there--27 species of snakes, 10 of them being poisonous (I went blank after that--ha).  Thankfully, we didn't see any.  We did see lots of monkeys as well as a breathtaking, beyond words overlook of the whole valley and some waterfalls.  Pictures can't capture the awesome beauty of this part of Kenya. We had the perfect day as it was overcast and nice and cool. There were fewer people around and I noticed that the whole area (forest and villages) was pristine with hardly any litter.  They seemed dedicated to caring for the area which was heartening. The kids were excited to see the mzungus and to have their picture taken.

We returned and boy were our feet tired.  After a lovely dinner of spaghetti and garden salad at the mzungu hangout, the Green Garden, we made our way home via tuk tuk since it was after dark.  Trav then began to try and change his trip plans. Instead of Morocco (with politcal unrest nearby), he will go to Portugal.  The communication system here is archaic and extremely slow.  After about 2 hours of trying to communicate with KLM about his desire to change his flights, the call was disconnected and we were about out of phone time.  So very frustrating to say the least.  We decided to call it a night and try again today.  I'm happy to announce that he was able to work out all the changes! And, we'll be on the same flight to Amsterdam so I'm pleased about that.

Today, I took it easy while Trav did hospital rounds.  I began to talk with Dan, the on-site manager of the hotel about differences in here and the U.S. Here people are very connected to family.  If a brother has a financial need, the family (which is usually large) helps thus making it near impossible to save for the future.  On the other hand, the family is a built-in safety net.  Dan has several other businesses so that he can earn extra.  He has driven us a couple of times into town and has helped Trav get some music CDs (which excites T).

It has rained a little bit and there are thunderclouds in the area so we may get more.  We're heading back to the clinic tomorrow even though the truck is still at the police dept.  I guess Josh will find another vehicle.  We only have 2 more days in Kisumu and are trying to fit in many things.  Sat. we leave for safari.  Awesome.

Love to you all!

Asante sana.

31 January 2011

Kenya: Our visit with Grandma Sarah...on the Equator

Today, we try a different format - Mom goes first:

I know we just blogged yday but it was before our amazing afternoon and I just had to write more.  Josh, our host/driver picked us up about 1 and we headed NW to the equator which is only recognized by a metal marker on the side of the road. It's up in the mtns so a little cooler but not by much.  Afterwards, we asked if we might visit President Obama's Grandma, Sarah Obama, who we understood entertained visitors and we heard was relatively nearby.  After several calls, it was determined that Grandma was home (she's often away doing ambassador-type work) so we headed out and 1.5 hours later, after several stops for directions, we found ourselves outside her compound. There was a Kenyan policeman at the gate and he pointed to a visiting schedule which was M-Sat. with no hrs on Sun.  Josh did a great job of convincing the guard that we'd come all this way and soon a young lady came walking down to greet us.  The guard looked at our passport copies, we signed a guest log (the 2 people who had last visited were from Iceland!) and then we were all led to a shady clearing under some big trees where Grandma was seated visiting with a couple of men from the village.  The men soon left and we had a PRIVATE audience with her. There were many chairs around and she told us through our interpreter that she has many visitors--up to 200 in a day.  She loved talking and shared with us many stories for about 30 minutes.  What a gracious hostess and so welcoming on her day off for which we were most grateful. I expressed my admiration for the President and she was pleased. She'd last seen him when she attended the inauguration.  She ended our conversation asking for prayers for him.  I'm still floating from this awesome experience despite the long, hot drive on many dirt roads.  It was well worth it!

Last night we had dinner at a new Indian restaurant which was quite good and we tried another Indian restaurant for lunch today. We've gotten a little adventurous with our food choices!

This morning began in a wonderful way!  Dr. Allibhoy's wife, Nuni, invited me to a pranic healing meditation group with about 7 other women.  It began and ended with a series of exercises.  The meditation itself was led by a CD with an American teacher, John Coe (not sure I'm spelling this right) with beginning prayers and positive thoughts from Nuni and ending prayers by her as well. I found it very moving and energizing.  Many thanks to Nuni for inviting me to this.  I now feel calm and ready for whatever is next.

Just before lunch, I picked up my tailored outfits, made from fabric purchased at the market.  I can't wait to show them off at home!

Much love to you all. Know that I miss you very much and can't wait to show you all my pictures and tell you many more stories.


Our truck is still impounded with the police.  Josh has his driver's license back, but he needs to produce the log book of repairs done...to get the truck back...to get it repaired up to par...to pass inspection...to get an inspection sticker so we can finally have our own vehicle again.

No worries.  That couldn't prevent what has thus far been Mom's favorite day in Africa.
Josh managed to rent a smooth-riding four-door sedan to take us to the Equator yesterday afternoon.  The one-hour trip ended with us pulling off on the side of the road.  "We're here!"  Mom was expecting a colorful Tourist Welcome Center, or at least a giant "You're at the Equator" sign, but the modest metal globe-shaped sign with "Equator" painted brightly on the side (under the acknowledgment of the Lions' Club sponsorship) was all that was there.  We stood in both the Northern and Southern hemispheres at the same time, snapped some photos, and decided to head on.

Josh called Philip, who called another friend, who called someone else to confirm She was home.  Standing in the checkout line at the Nakumatt last week we'd heard a woman from Minnesota blab about meeting "Grandma Sarah," and after asking around, we heard she received visitors - frequently numbering over 200 per day.  She indeed was home, so we headed further out.  We found our turn-off, asked for directions, went down a dirt road, asked for more directions, turned, and asked again.  Everyone knew where to point us, and as Josh always assures us, we found our way.

We arrived to find the place fenced in, with an iron gate at the end of the dirt driveway.  The sign said visitors Monday - Saturday only, but after some smooth talking, Josh convinced the one guard to let us disturb her day of rest.  We signed in the log book under a couple from Iceland from the previous day and walked up the dirt path.  We found Grandma Obama sitting with two other gentlemen under a giant tree to shade the circle of about 20 wooden chairs.  The two men left, and Mom, Josh, and I were the only three in her company.  She spoke only Luo/Kiswahili so Josh translated well.  She described how "our President" came from a "bad" background and pointed to the graves (and headstones) of President Obama's father and grandfather about 30 yards to our left outside the circle of chairs.  She joked about her trip to the Inauguration and the giant size of our country.  She described some of her projects, including smart farming and sponsoring about 20 orphans through secondary school.  On the way out, Mom had to / asked to / was honored to use her restroom, before the two-hour ride home.  Ha!

Mom was beaming the entire way home.  What a day.

This morning's rounds with Dr. Allibhoy proceeded as usual.  He's a busy man, taking care of complex tropical medicine cases, patiently describing diagnoses and prognoses to families in multiple languages.  He is assisted by some of the in-house "residents," but his status as an Attending leaves him with much of the work and definitely the responsibility.  Today's interesting cases included 1) a patient with acute renal failure, likely from HIV and not the malaria as originally thought, 2) an intra-cranial hemorrhage in a young woman with left-sided hemiparesis who will need to be transferred to Nairobi for MRI technology and neurosurgical consultation and 3) miliary TB.  The x-ray on the latter isn't something to be learned in "real life" back in the U.S. - it's only in textbooks.  She's on four-drug therapy, clinically stable.

The uprisings and political demonstrations north of us look to be spreading.  First Tunisia, now Egypt, Algeria, and Yemen.  Our local paper today states Egypt blocked Facebook and Twitter, because of their use in spreading the word organizing protests and the crazy ideas of democracy.  But the proxy servers circumvented these blocks.  So they just decided to cut out the entire internet.  Egypt cut off from the rest of the world - unimaginable.  Al Jazeera confirmed a lot of this, saying roughly 90% of people are without internet service now - including schools, hospitals, and banks.  The media company is also having its radio and TV broadcasts blocked at the moment.  A "mega protest" is apparently planned for tomorrow in Cairo.

Libya is apparently next.  And maybe even Syria.  In light of this news, my chances for planned R&R in Morocco next week are starting to look slim.  We're paying close attention to the reports, so we shall see...

Asante sana.

30 January 2011

Kenya: Lake Victoria and Global Politics

After working the first 9 of 10 days here, we took the weekend off.  

Thursday night, we had a feast prepared by Dr. Allibhoy's wife, made up of traditional Indian and Kenyan food.  We hadn't eaten lunch and ate ourselves sick.  I rarely eat Indian food, but this was unreal.  

Friday we did some shopping in one of the markets and we made out well.  Our bargaining skills are now razor sharp.  Dinner that night was out at Kiboko Bay, a hotel on Lake Victoria.  We watched a brilliant sunset that cannot be captured in photos.  Dan (the manager of our own hotel, and new friend) and his wife Stella joined us for dinner and our conversation consisted mostly of, what else, politics.  The vast majority of Kenyans are extremely well educated on their own politics, and that of the rest of the world.  It's fascinating to hear their perspective and learn from their historical knowledge.  If only the majority of Americans were that engaged.

That night at dinner we also met some girls from George Washington, completing their MPH's.  They're here on a 4-month internship - we learned about their projects and solicited their photographic skills at sunset.

Friday and Saturday night, I was out enjoying Tuskers and the beats of Bongo, Congolese, and Kenyan/Luo music.  Friday night was with Dan, Stella, the MPH girls, and Brenda.  Of course there was more political debate once the Tusker was flowing - but mostly for the sport of it - learning from others' views.  Saturday, Josh and Aduda were added to our group after another phenomenal pizza dinner and sunset drink atop the Imperial Hotel.  Conversation with Aduda was pretty intense - he's very sharp when it comes to sociopolitical history and regarding the current uprisings in Tunisia and Egypt.  Not only are the educated young professionals here knowledgeable, but they're passionate - especially after four 500-mL Tuskers!  He offers a historical perspective unlike any other.

If you're not paying attention to what's going on in Tunisia and now Egypt, check out the BBC or Al Jazeera perspective.  Many are watching closely, and learning from it, here.  With social media and internet spreading the news fast, the "lower" (or, poorer) classes are exposed to what's out there - i.e. luxuries of the middle class, uprisings against autocracy - and want a fair shot for themselves.  Can you blame them?

OK, as if it's not hot enough here in the city, we're headed to stand on the equator...

The more colorful version from Mom:

Hi from Kisumu where it continues to be very hot. I think I left off with my excitement about our invitation to Dr. Allibhoy's home for dinner.  His wife, Nuni, and Dr. A were such gracious hosts and they have a lovely home. Nuni had prepared a tableful of wonderfully delicious dishes. My favorite was samosas (a triangular shaped pastry with chicken and other spices--sort of like a egg roll only much better!) which you bite into, squeeze a little fresh lime juice on and top with a bit of homemade yogurt with cucumber and corriander.  We also had cassava (like potatoes), another homemade yogurt, chips masala, fish, eggplant, tomatoes (roasted), chapati bread which I ate with a dish of maize, beans and other spices.  I wish I could remember the names of these yummy dishes.  Nuni told me the ingredients for many of these dishes so I'm hoping I can prepare them when I get back but I'm guessing that they will not taste as delicious as they were here.  As if this wasn't enough, for dessert we had homemade ice cream in the shape of a rose along with pirforoles (like cream puffs with chocolate drizzles). Nuni is quite creative and presented me with a homemade gift set of quilted hot pads and coaster tops to cover bottles.  I look forward to using them and showing you all as I can't adequately find the words to describe them. And each time I use them I will fondly remember the Allibhoys and their wonderful hospitality.It was a magnificent evening and Trav and I were deeply honored to have such a nice mean with such kind and welcoming folks.

I took Fri., Sat. and today off just relaxing and being a tourist. Fri., after Trav finished at the hospital, we had quite a lot of fun going to a local market.  We bought lots of gifts and a few treats for ourselves. It was quite exciting seeing all the African-made items and doing some bargaining.  Fri. evening was another spectacular sunset--this time at Lake Victoria. We had drinks and watched this incredible event trying to capture it in photos but alas they don't do it justice. We stayed for dinner and were joined by Dan and his wife, Stella. Dan is the onsite manager of our hotel and is so very nice.  We thoroughly enjoyed their company.  It was definitely a mzungu haven. In fact, we met 4 delightful young ladies who are from GW in D.C. 3 of whom are here working on projects for their masters in Public Health and 1 is pursuing her PhD.  They will be here for 4 months.  After dinner, "Mama" got dropped off at the hotel (way fine with me) and they all went to take in the night life.

Sat. we had a leisurely day.  We tried a new place for lunch called the Green Garden restaurant, mentioned in our Lonely Planet guide as good for mzungus and sure enough, there were quite a few there, including an older lady from San Antonio.  We shared a margarita pizza and each had a green salad with lots of veggies.  In the evening, we returned to the Imperial Hotel for another sunset and were joined there by 2 of the young ladies we'd met the night before. We had lively political conversations as Trav was the only Republican among us. I'm thrilled to see so many young people interested in the world and the future.  It warms my heart.  Plus, they were lots of fun. After dinner, same drill as night before with "Mama" getting dropped off.

Today, Josh will take us to the equator (about an hour away) providing he can get a car (as you recall the truck is at the police station and we hope will be ready tomorrow).  We've also heard that President Obama's grandma, Sarah, lives nearby and receives visitors and we are hopeful for a visit with her sometime. Wouldn't that be something?  We're also hopeful that we can get to the Kakamega Forrest one day.  We will go to Masara a couple of more days and then leave on Sat. for the Masai Mara for 2 days of safari and then to Lake Nakuru for 1 more 1/2 day of Safari on our way back into Nairobi from where we each fly. Trav will continue to Morocco for 10 days. It seems like a lot to fit in but we will try our hardest.

Am getting a little homesick for my sweet family and friends.  I'm already dreaming (literally, thanks to anti-malaria meds) of a hot shower and my favorite foods.  Again, many thanks to you all for your support and continued prayers.

Asante sana.

27 January 2011

Kenya: The Car Inspection

After a lot of Gatorade-powder-enhanced hydration, chicken masala, and chips masala last night, we were back on the horse this morning.

With Josh driving, we picked up Brenda's father ("Papa Joshua"), a clinical officer, who was to help with today's educational session at the clinic.  Today's trip down the Jomo Kenyatta Highway was a little different than the others.  Things were smooth sailing en route to Ahero from Kisumu until we noticed a lot of people walking along the side of the road.  We were asked to pull over by a few police officers standing on the side of the road, accompanied by a military officer and an "inspector."  This was a random crack-down on car inspection stickers, but the machine gun on the military man felt normal.  Josh is the perfect "Number One" to have here in Kenya, and I think the stickers usually aren't enforced, but today, the "2008" inspection sticker on our windshield was just a little too out-of-date for the Inspector and the Police.  Josh continues to refuse to pay bribes, which I would agree with (he knows best), so the Inspector took Josh's driver's license and KEYS to the truck and said he needed to go to Kisumu and pay for a new temporary sticker and then eventually get the truck "inspected," I guess.  No ticket.  No warning.  No opportunity to drive the truck back to the city and get the truck inspected properly.  

Word of the crack-down had spread, so no matatus were driving through this section of highway - I assume their stickers weren't even as up-to-date as ours, if they had one at all.  So the plan was for Josh to walk back towards Kisumu, in hopes of finding a matatu to give him a ride just up the road...and we (Mom, Papa Joshua, and me) would walk towards Ahero in hopes of finding the same.  That was the only option...

...Until Momma Bias got pissed.  Mom's been known to score a few free pizzas in her day, from Mr. Gatti's delivery drivers who showed up about 90 seconds past the time they promised:  "WHAT ARE YOU GONNA DO TO MAKE ME HAPPY?!"  Not pleased.  Well, apparently, the Inspector standing next to the Police officer with the giant baton and the military officer with the automatic weapon did not deter her.  She was NOT going to walk.  So, she approaches the inspector, "Look, Mom's tired and it's hot, something else can't be done here?"  I'm honestly not sure the exact quote, because I was standing back, paralyzed in shock.  So, they pull over one of the giant charter buses, Papa Joshua and the Inspector ask them to take us on, and they agree.

So, we make it to Ahero for about $1, and then broker a deal with a car for about $8.  This was still the expensive "mzungu price."  We are already haggling kings, so when the first truck said "1000 shillings" ($12), we said "forget it," and walked on.

At clinic, I saw about 7 patients.  Annette told me to bring all these anti-allergy eye drops (which aren't cheap) and I hadn't seen a single case yet, so I was beginning to wonder.  I saw 3 cases today, and I'm hoping the drops help.  It's amazing the irritation caused by the smoke and dust in the air.  

Brenda's 9-o'clock educational session began about 10:50 after Papa Joshua and we arrived.  They teach about preventing the spread of HIV to their unborn children among other basic public health teaching.  At the end of the session, they passed out toothbrushes and toothpaste, along with bed nets to all the mothers (about 24) in attendance.  Mom sat in the entire session while I was seeing patients, and her details are below.

The most uplifting experience of the trip came after we left clinic and headed to the community hospital in the neighboring village.  We found our mother - the one who delivered her baby in the village yesterday - sitting up, smiling, with a little more energy, breast-feeding her baby.  Baby clinically looked good.  We dropped off supplies for the mom - juice, flour, cooking oil, rice, beans, maize, infant formula, multivitamins with iron, soap, and a bed net - which Brenda helped us pick out and buy yesterday for about $30.  Your (and our) prayers were surely answered.

Her bill was going to be 2500 shillings (about $32), but we talked them down to a little less than 1000 shillings - $12.  $12.  $12 for a one-night hospital stay, 1 liter of IV fluids, a couple doses of metronidazole, dinner for the mother, and gloves and towels used for what took place in the "labour room."  Yes, we have an itemized receipt.  Money well spent.  One, or maybe you'd say two, patients helped.  Thank you for your prayers and contributions.

Being amongst extreme poverty in such a way gives me this conflicting feeling.  One instinct tells me that as soon as possible, I want to go to Disney World, or on a cruise, where every desire is catered to.  Everything is sparkling clean, and whatever you could imagine wanting is available.  Yet, we're also pulled to go home and conserve as much as possible - spending money only on essential priorities.  Conserve water.  Do without luxuries, take care of the basics, and contribute to those who truly are in NEED.

It also makes want to improve my Texas gentleman etiquette.  The southern hospitality courtesy.  There is a glaring lack of that here.  If I can walk ahead of you and cut you off, I do.  Women work and they work hard - planting and harvesting rice fields, walk to fetch water, take care of children and the household, and bring home the money.  This is true for most regions here.  Here, men ride shotgun.  

Mom's version:
Hello all!  I'm back and ready to report a day that was most interesting!  I've recovered from my sunburn and am well hydrated again.

Josh picked us up and as we were driving toward the clinic, we suddenly saw lots of people walking. Josh said, "Oh no, inspection".  And sure enough there were police and military men who pulled us over.  They asked for his license and noticed his inspection sticker was outdated.  He tried to reason with them but before I knew it, we were asked to get out of the truck, the keys and his license were taken away by the inspector and Josh was told to return to Kisumu to purchase a temporary sticker.  The truck would remain behind (although we later learned it was taken to the police station) and Josh would have to find his own way back and we would have to find our own way to the clinic. Fortunately, the social worker's father was going with us to the clinic and he was our interpreter.  I wasn't sure whether to cry or what.  I remained calm and went up to the inspector and said we were doctors and needed to get to the clinic and could Josh take us there and then return to Kisumu.  The inspector said "no" but when I made my plea that "Mama was old and couldn't walk", he must have felt a little bad cause he beckoned a large bus (like a Greyhound) and they took us all to Ahero (5 miles or so) for 100 shillings (about a $1).  Then we had to find another way to get from Ahero to Masara (about 10 miles).  A "nice" man offered to take us for 1000 shillings but Trav said, "no mzungu price--that's embarrassing" and started off as if we'd walk.  Thankfully, Joshua, our interpreter, found us a saloon car (a toyota 4 dr sedan) for 700 shillings and we were off arriving 1.5 hrs after we'd left. But seriously, what an adventure!  I had my hat, lots of water, and my sunscreen so was more prepared.

We arrived to a hearty welcome by Brenda, the Social Worker. She had invited 20 pregnant women to a training and her dad, a clinical officer (like a PA) was going to be the instructor for much of the time. It was to start at 9 but didn't get rolling til almost 11 (surprise--ha). Anyway, he began by having the women form a circle and have everyone introduce themselves (all in Kiswahili, of course) and tell their name, how far they were in pregnancy, marital status, # of children delivered and # alive as well as their village.  Many came from far away.  There were women pregnant for the lst time ranging to 11th time (this woman had 7 live children).  It was really a psychoeducation group where they could learn but also support each other and know that they weren't alone in their issues.  They learned about antenatal care, going to the clinic for testing for HIV, STDs, and malaria (most were afraid of learning about test results so didn't want to go), newborn care, breastfeeding and substitute feedings (diluting cows milk with water).  Joshua was quite entertaining and there was lots of laughter and the women loosened up and began to talk and ask questions.  He kept their attention and it truly appeared that they were learning many things for the lst time. By the time the training ended, there were 23 women, 6 babies and 2 community aide workers. At the end (after 4 hrs), they received insecticide-treated mosquito nets (bed nets from the Ministry of Health), toothpaste and toothbrushes (thanks to donations we brought), water and a special nutritious porridge.

Travis saw several patients during the training time and we left the clinic in yet another vehicle to head back to the hospital where the woman and baby we'd dropped off yday were recovering. I'm pleased to report that both mother and baby (a boy) looked 100% better. I'd feared they wouldn't live (thanks for all your prayers!).  People are tough here--you have to be.  It's truly survival of the fittest in it's rawest form.  Travis paid the bill at the hospital (about $12) and we delivered goods that Trav and the social worker had purchased yday. This included maize, flour, rice, stuff for porridge, baby clothes, formula (in case breastfeeding wasn't possible) and other stuff I can't remember.  Mom was most grateful and was going to rtn home today.

It's now about 4:45 and we're going to get back to the hotel to get ready for dinner with Dr. Allibhoy and his wife at 7:30. I'm really looking forward to this as the lunch I ate that his wife prepared for us earlier in our visit was quite good.  It will be interesting to see their lifestyle.

This is a place of many interesting contrasts. There are "car washes" (using dirty water) all along the roadway and yet everything else is so littered.  Many are starving in the villages yet there's a cell tower in the middle as many have cell phones.  I don't think I'll ever really understand but I do know that I'm incredibly grateful for all that we have available to us in the states.

I'll sign off for now.  Love to you all!!!!


P.S. Josh is still at the police station.  Without the truck.

Asante sana!  Much love.

26 January 2011

Kenya: OB.

Good evening from Kenya.  It's been a draining day - Mom has already been dropped at the hotel for a cold shower and a cold drink of water.  (Thus, no special addendum from her today.)  The heat zapped our energy, and the days' events cost us a bit emotionally as well.  I hate melodrama, but I'll keep you posted on what we're seeing.

Yesterday, I rounded again with Dr. Allibhoy.  The ICU only had one occupant, recently extubated but with active TB and sepsis.  The wards with similar cases as the last time - cryptococcal meningitis, cerebral malaria, CVA (stroke), and active TB.  One of the tell-tale signs of active TB, with treatment started even before the sputum has been cultured, is a pleural effusion.  Fluid fills outside the lungs and compresses them, making it difficult to breathe.  I observed the Resident Radiologist (really, the Attending) perform a therapeutic thoracentesis, with a sample sent to the laboratory.  The pain tolerance of the majority of people here is unbelievably high.  This patient followed everything her physician requested (needle in her back and all) and even thanked him afterwards for relieving her "breathlessness."

The rest of the morning was spent in the Emergency Department.  We saw a few rashes, abdominal pain, follow-ups with lab results, typhoid, and malaria.  All stable, thanks to God, so no true emergencies - sounds familiar. 

Then, in the afternoon, I took a matatu out for home visits with Aduda.  Remember, the guy working for the PEPFAR-funded project?!  It's actually AIDS relief funded by Catholic Relief Services.  We walked for three hours finding three separate patients.  One was a 20-something year-old male on anti-TB therapy.  Aduda's visits ensure compliance and refer those to the sub-district hospital who are having difficulty.  He documents everything well and reports back.  His social sciences training, and then work as a retail salesman, make him perfect for this work - just trust me.  We then saw a 20-something year old woman on anti-TB therapy, but in the final stages of AIDS.  In the last month, she and her baby were dropped off by the husband at her mother's house in this village - and he left.  The baby died of AIDS last week.  The mother appears weeks, if not days, from death.  Thus, Aduda encouraged her to get to the hospital the following day - hopefully his NGO will send a ride out to scoop her up, but AGAIN we see transportation is a HUGE issue.  Aduda has no car/truck/motorcycle of his own - but what if he had one? - one that costs roughly $8,000.  She may not survive either way, but his outreach could touch more people in one day, and perhaps eventually save others.

Finally, we found the last patient - a mother with twin babies.  There is a big push to educate HIV-positive pregnant mothers to deliver in the hospital to get anti-retrovirals during labor to decrease the risk of transmission to the baby.  Many still deliver in the village, the traditional method.  This mother though, delivered in the hospital, got her ARV's, her babies got their dosages of meds for 18 months, and now, at the age of 2 years BOTH twins are HIV-negative.  This is not a movie, but after seeing the spectrum of successes and failures in this one afternoon, it sure as hell felt like it.

Last night's dinner was the most Westernized we've had - it was Mom's favorite.  We sat outside by candlelight, after finding our "luxury guesthouse" restaurant down a dusty dirt road.  We were served wine, chapati bread with beans (mixed with salsa) which was awesome, boiled chicken, a salad, and tomato soup.  Our walk home in the dark afterwards (there are no streetlights) was a bit of a heart-pumping experience, with motorcycles and bicycles whizzing by, but it was only a little less than two blocks away - it would have been a shame to blow 50 cents on that short ride home. 

Today was "outreach" day at the clinic.  Mercy, one of the other young community health workers, Brenda, Mom and I headed out further in the village.  We walked door to door (they'd organized which homes we'd visit), asking if the infants or toddlers were home, if they had their clinic cards, and made sure their immunizations were up to date.  Talk about a home visit!  SURPRISE!  SHOT TIME!  Our updates today included Diphtheria, Pertussis, Tetanus, Meales, and Vitman A (supplemented every 6 months until the age of 5).  We had lollies for the kids afterwards to cheer them up, and multivitamins and  toothbrushes/toothpaste to leave behind.  Many of the grandmothers and mothers however have not seen these childproofed bottles of vitamins, and so it takes a lot to teach them to compress the cap, then turn, and then it opens.  So, you could drop off a million bottles of vitamins, but unless you open it first, pierce the top foil, then show them how to open it several times, the kid won't take a single one. 

The trek was almost three hours long, and of course this was the day Mom failed to apply sunscreen prior to heading out.  She didn't even bring her embarrassing wide-brimmed hat.  (In all fairness, we were not warned this was outreach day.)  Oh, on side note: she brought ONE t-shirt on her first trip to sub-Saharan Africa.  Brilliant!  Luckily, she's bought three more from our favority kiosk/street vendor.  OK, so the trek was long, Mom and I both got burnt, and ran out of water quickly.  We ended at the Irrigation Scheme on the river.  This was NOT working when I was her in 2007, yet 2 pumps are now working, thanks to financing from the German government, and two more are being built thanks to the Finnish.  It flows 10 kilometers downhill from the site of the pump, helping to water the rice fields and cows (I think). 

Then, we made the final visit of the day.  Brenda received a call yesterday that one of her HIV-positive pregnant women was sent home from the hospital - she'd tried to deliver there but was not in active labor so she was sent home.  This morning however, Brenda was notified that she'd delivered in the village (with a midwife) around 03:00 and was feeling weak, still bleeding, and not doing well.  We got in the truck, and drove to find this woman in the neighboring village.  She looked weak, baby looked OK, so we loaded them up and took her to the nearest community hospital.  The GP helped stopped some of the bleeding and we got her fluids running.  She'd been unable to hold down fluids since delivering and was likely very dehydrated.  Of course, this story doesn't include all the details, but they aren't necessary.  Pray for the baby and Mom tonight.  The hospital was able to get a dose of ARV meds out to the baby this morning, so there is a chance baby will not be positive.  But, transporting Mom to the hospital was another story - again, transportation was the issue.

It's embarrassing to try to put some of this in words.  There are times we are left feeling powerless, but other days I feel like only a tiny amount of time/effort/money could put into place the tiny pieces of the puzzle necessary to bring some of these projects the successes they seek.

OK - I'm headed home to check on my own mother, but overall we are doing well.  Enjoy your warm shower, your mattress, your iced drink, your immediate medical care, your loved ones and friends, and all of God's many little blessings tonight.   

Asante sana.

24 January 2011

Kenya + George W. Bush

Yes, that's right my R friends, I finally found someone here in Kisumu who likes George W. Bush!  It was a dark and stormy night...well, just dark, and we slammed a wonderful pizza dinner.  Mom and I actually started with a beautiful sunset view from atop the Imperial Hotel.  We could see mountains to the north and Lake Victoria to the west.  Our small set of appetizers included beef and chicken sandwiches with chips masala - our new favorite dish.  Chips masala are basically french fries smothered in spices similar to curry.  Taken with tomato sauce (Ketchup), they're amazing after a long day.

For dinner we headed to the Grill House.  A hawaiian pizza, more chips masala, and another cold Tusker later, Brenda showed up and got her dinner.  Mom was tired from another long day, and it was a big Saturday night here in Kisumu, so Brenda took me out after dropping Mom at our hotel...

The night started at a bar called Quorum - a simple two-storied place, with blaring Congolese and Bongo music, full-blast ceiling fans, and about 90% men.  I had some Hunter's Choice (Kenyan scotch) and a Coca-cola, while she continued to down Smirnoff Ice Black - her go-to drink apparently.  Each time I wanted to say something to the waiter, she would teach me the term/request in Kiswahili, I'd say it, and he'd smile big.  

Quorum's scene wasn't enough, so we tuk-tuk'ed it (jet-ski / tricycle / golf-cart mash-up) over to Tumeez.  Yes, Annette, TUMEEZ!  We paid an extra $2.50 or so to get upstairs and boy was it worth it.  There were more Congolese, Bongo, and Kenyan jams, mixed with an occasional Rihanna #1 from 2008.  They even played the one Bongo song I knew - "Cinderella" by Ali Kiba - requested in Dustin's honor!  I ordered a Bond 7 (Whiskey) with Coca-cola, and they served me my own probably 16-oz. bottle of Bond 7 with a glass bottle of Coca-cola - the typical method.  We enjoyed the music, danced a little to ourselves, and then...

...Then, we met Aduda.  Within about 5 minutes he dropped the terms "PEPFAR" and "George W. Bush" and I knew we were going to get along.  He works doing monitoring of a PEPFAR-funded project (President's Emergency Plan for AIDS Relief) - he goes out to houses, "surprises" the inhabitants and makes sure they are taking their "ARV's" (HAART, or Anti-Retroviral Therapy) for their HIV/AIDS and/or their anti-TB meds.  So, he never exactly said he "liked" W., but he was definitely proud of the work he's doing, and proud of the fact that it was funded by PEPFAR, started by Bush.  I probably shouted "Texas" about 5 - 10 times within the next 10 minutes, but I'm not sure anyone else noticed on account of the loud music.  I'm hoping to ride out with Aduda at some point in the next few days to observe his work-day.  It is absolutely amazing the work being done around here - there is more collaboration that needs to be done though.  If Brenda didn't know him, she did now, and it was good they met.

"Moto" was Aduda's buddy.  He was dubbed "Moto," by me of course because it means "Fire," because he seemed to be impressing all the women around him.  "Moto's" game was alcohol-enhanced.  His eyes appeared heavy by about midnight, and then 30 minutes later a near brawl started by Moto almost got him kicked out of Tumeez.  Brenda and I avoided the crossfire and left soon thereafter.

Currently reading The White Man's Burden by William Easterly and it is blowing my mind.  It is quite the polar opposite of Jeffrey Sach's End of Poverty, which I read after my first trip to Kenya/Tanzania.  Easterly talks a lot about the "Planners" and bureaucrats who are trying to do the glamorous of ending extreme poverty for the 1 billion (of Earth's 6 billion people) who live on less than $1 per day, versus the "Searchers" who are finding small projects, accomplishing them, and listening to feedback from those they serve, constantly (and accurately) evaluating their successes and failures.  No matter the side of the political aisle you're on, each president starting with Clinton has stuck his neck out for the developing world.  Clinton once negotiated the price of Anti-retrovirals down to about 1/5th their previous cost to developing countries.  Bush doubled the amount of aid given by the U.S., and even began attempts to give primarily to responsible (or not-as-corrupt) governments though the Millennium Challenge Corporation .  But Easterly has brought attention to the imperfections of Bush's "big push" - PEPFAR actually spends on expensive ARV's and doesn't focus enough on prevention of spread (which is MUCH cheaper - condoms cost less!).  That's already more than you asked for, but reading this book, mixed with conversations with Brenda, rounding on sick hospital patients, long days, hot sun, and Bond 7, made my chat with Aduda one of the most stimulating conversations I've had in my entire life.

The Bond 7, Hunter's Choice, and late night did not stop us from attending church the next morning.  We were picked up at 6 a.m. and arrived at 07:18 for a 7-a.m. service that ended up getting started around 07:37.  We made it in plenty of time!  The 2-hour service started with procession from outside, starting with the kids, followed by the choir of older women.  The music was unreal.  The keyboard in the background helped, but it was essentially a-capella - the sound forces tears out of your eyes.  It was an emotional experience for the both of us, but taking in all the sights, smells, and now sounds for Mom really moved her.  Tom, Dr. Bonyo's step-brother and also teacher in the church, invited us up to introduce ourselves.  Two other guys introduced themselves and had the crowd roaring laughing - it was a tough act to follow!  We said our sincere thanks, Ero komano.  

We returned home to a long nap up until dinner.  Dinner was an American-style pizza (found!) with some spinach and a salad.  Finally, a salad for Mom!  

This morning, we were back at it at the clinic.  We saw about 14 today - the word was out since church on Sunday.  We treated probably half of those for malaria, confirmed by the Rapid Diagnostic Tests we found in our own pharmacy.  Malaria is typically treated clinically (based on symptoms) out in rural areas, but the more scientific method is to use a peripheral blood smear.  If that's not available, these rapid tests are available.  No test is perfect, but after a negative control on one of our hosts, the rest have been positive.  There were a few others - some with backache, PID, arthritis, diarrhea and the like.  You would have backache too if you were 60 years-old, stooped over at a 90-degree angle in 90-degree heat, harvesting in the rice fields all day!  They don't seem to take time to drink water either, so I push them to drink plenty of water and take Ibuprofen only as needed.

Mom proved to be a worthy assistant today, but I fear my frustrations with our "clinic flow," or lack thereof, might have made me appear less than appreciative.  I think I fixed the clinic flow for the better, and my attitude toward Mom was nothing a fat plate of chips masala can't fix.

Also at the clinic today was a crew from Tenwek - a German-funded Eye Hospital - to pick up 40 patients identified last month as clients who could benefit from their ophthalmologic services.  Only about 15 showed up.  Tenwek has surgeons who fix mainly cataracts and trachoma.  The cataracts they fix for the equivalent of $36, and some they do cheaper I think.  The crew also helped with optometry and refractive services while at our clinic today.  Mom even gave them a bag-full of reading glasses that we'd brought and they were very appreciative.  They loaded their patients up on a bus and headed out - to return with them on Wednesday after helping ALL of our patients they took.

Again, it's amazing all of the many services that are down here - but there's more to be done.

So, who knows what tomorrow will bring - the plan is constantly changing.  We are getting used to "Kenyan time," with Josh (our unbelievable host) being the only one truly on time - he and we now call it "Josh time" just so we are clear when to actually pay close attention to our watches.

More from Mom: 

My editor tells me to shorten my posts. Yesterday (Sun.) was an emotional day. We started off at 6:30 a.m. for church service in Masara at a Catholic church.  The service was quite moving. It began with the choir processing in singing so beautifully I was almost in tears.  How can these people who live in such poverty be joyful and so spirit-filled?  Women and men are segregated with women and children in front and men (and visitors) in back. The church is a school during the week and is open-air but quite cool that early in the morning. Near the end of the 2 hr service, Trav and I, as well as 2 visitors, were asked to come to the front and speak. We were welcomed and we got to express our gratitude for being able to worship with them. Their faces were smiling and radiant.  We are all one in the spirit yet such radically different living conditions.

The excitement and shock have worn off and I was a bit teary yday realizing that THIS IS REAL!  What can I do to help?  Trav wisely counseled that we control what we can and do little things that can make a difference to one person at a time.  Afternoon spent napping at hotel and sitting out by the pool reading. While at the pool, a beautiful woman and her son (Obama, age 1) and dtr, (Tana, age 3) sat by me. The girl reached for my hand and smiled and examined my hand.  Very sweet.  Dinner was at the 711 Italian Restaurant and Pizzeria. I got the most delicious mixed greens salad with lots of veggies, sauteed spinach and T had a chicken pizza.

Today we went out to the clinic where word had gotten out that we were coming. We saw 14 patients, mostly kids needing malaria treatment.  I spent much of my time running to the "pharmacy" for medications.  There was a group there from an eye clinic (3 hrs away) picking up about 12 people for eye surgery (cataracts, retinal, prosthetic eye).  Many of the eyeglasses I collected were sent with them as their need was quite great.  I included an eyeglass repair kit and was told this was "an answer to prayer". Something so simple yet so needed.

We came back to town and Brenda, the Social Worker and I were dropped off at her tailors.  I was measured for a couple of skirts and a blouse.  They will be ready by Sat. and the total cost is about $27. Amazing!  We're now at a shopping area and will do a little gift-buying as well as get more goodies for the kids.  Trav made a run by the pharmacy here to get much needed meds for the clinic. We'll chill at the hotel for dinner and relax. Tomorrow, we'll return to the hospital for more learning and rounds.  There was some talk with our driver, Josh, about going to the equator and Lake Victoria on Sunday. Can you believe this?  WOW. That's all for today.  Love to you all and take a moment today to count your many blessings.  We have such abundance in the states!


Asante sana for your support and prayers.  Much love.

22 January 2011

Kenya: Rounds and Asian Food

The last 48 hours have been extremely busy.

Yesterday morning started with Dr. Allibhoy picking me up at 07:15.  We headed to the hospital and hit rounds.  His training is in Family Medicine but also in Cardiology, as here, FM can serve as a springboard to that further subspecialization.  Rounds were very similar to that in the U.S:  walking rounds, with a crew of about 10 - 15.  We started in the open-air ICU, seeing all four patients (capacity).  All four were HIV-positive, with three of them having CD4 counts less than 50.  Three were intubated with active TB.  One had arrested (died/coded) on his presentation to the ER, but had been resuscitated by the nursing staff.  Each patient was on a different antibiotic regimen for different empirical reasons, most on four or more.  Dr. Allibhoy has a wide-range of experience, admitting all kinds of patients for over 25 years at this hospital.  He's actually the "resident doctor," meaning he's one of the primary admitting doctors here at the Aga Khan Hospital, the private hospital.

We then started to accumulate the crowd for rounds further down the hall in the wards.  We amassed four from the Nutrition Department, one Physiologist (Physical Therapist), one counselor, and one physician-in-training.  The physician-in-training was essentially serving as an Intern/Resident, but she she is simply gaining experience before heading on to Residency next year.  Each ward (room) had about four - six beds, one flat-screen TV with the British Premier League on, and was served by about three nurses.  The nurses would help on rounds, giving Dr. Allibhoy the run-down of what'd happened the night before.  The nutritionists would give input, the counselor (her badge said she was from the Pathology Department) would get assignments, and the physician-in-training would keep tabs of her assignments to complete after rounds.  We hit two other wards seeing everything from alcohol withdrawal, an upper GI bleed, cryptococcal meningitis, and dehydration from diarrhea.  We last went to the isolation room, with two patients being treated for active TB.  One with a classic x-ray to learn from.

So, Dr. Allibhoy had rounded on roughly 15 patients by 09:00 and then we headed to clinic where he proceeded to see about 20 - 30 before we stopped for lunch at 13:30.  He saw hypertention, diabetes, prior strokes, prior heart attacks (treated here with thrombolytics, as they don't have capabilities to cath and stent people here in Kisumu), and bronchitis.  This guy is busy.

We saw two interesting patients here.  The first needed a CT of the head, his son was told the price of the CT (full price, no co-pay), he was asked if they could afford it, he said they could, and then went on for the CT (about $90).  The second older woman needed to be admitted for further work-up and observation - she definitely needed to stay in the hospital THAT NIGHT, but the son had to go to the family and round up the money to pay before she could be admitted.  Again, this is the private hospital, but still pretty sobering seeing patients actually take into account the full price of services (VERY different from the U.S.).  Plus, there are no EMTALA laws here, demanding they admit the sick elderly woman if she can't pay...

Mom showed up to the hospital at 09:00 at met up with the counselor, and was able to see some patients with her, even helping to counsel the alcoholic along with her.  More on that down below I'm sure.  

What an eye-opening day at the hospital.

The lunch-hour of course didn't start until we were greeted by the friendly pharmaceutical rep from Nairobi.  He comes out every six - eight weeks and brought with him some ads for an Omeprazole patented drug (the new fancy pill coating, of course) and the Augmentin-alike, with different names.  He didn't bring a free lunch for the staff though, so Mom let him know that's how to do it next time.  GREAT - my own mother enabling these drug reps.  How wonderful.

The evening ended with me attending a lecture at the hospital given by a Critical Care doc (Intensivist) from Nairobi - he'd trained in New Orleans and Toronoto, and gave us the run-down on Hospital Acquired Infections.  This was mostly stuff beaten into my head throughout residency, and this hospital is working on their protocols to prevent HAI's such as UTI's and VAP's.  I introduced myself afterwards, and we talked about the Family Medicine program they're starting at Aga Khan University in Nairobi! 

I finally scooped Mom up in a tuk-tuk to head out for "oriental" (NOT the preferred nomenclature, but the name of the restaurant) food, which was amazing and the only restaurant recommended by my Attending.  The power was only out for about 5 minutes of the meal, and ended with a quick tuk-tuk ride home.

This morning we headed back out to the clinic in Masara.  We saw only a few patients, seeing a tooth abscess (a.k.a. osteomyelitis of the jaw) to be fixed on Monday at the Aga Khan Hospital by a surgeon from the public hospital, but I gave him some Clindamycin and Ibuprofen to help in the mean-time.  We also helped a young woman requesting a Depo-Medrol injection.  Yes, the clinic does an amazing job with Family Planning services, providing Depo-Medrol injections for less than $1 and OCP's for those who so desire.  The clinic is also offering Diphtheria, Hepatitis B, Hib, Tetanus, Measles, and Polio vaccines to children and mothers - free of charge thanks to the government.  Unbelievable the range of services this clinic has grown to provide to the area.

This morning also brought our first intro to Brenda, the community health worker / social worker / counselor that Dr. Bonyo's crew has come to know in the last few months.  She described some amazing projects, educating the local secondary school about Sexually Transmitted Infections (STI's) and stressing to the currently pregnant HIV-positive mothers (about 17 in the area) the importance of getting to the hospital for their delivery, along with taking the HAART during the pregnancy.  At the hospital they apparently get AZT orally during labor in an attempt to prevent transmission to the baby.  The delivery at the district hospital in Ahero, if they actually go for the delivery, costs the equivalent of about $5, and Brenda says she'll even pay if they need her to!  Compare THAT to costs in the U.S!

The most striking new project she has working revolves around keeping teenage girls in school.  Many, due to the embarrassing experience of having a period with no sanitary towels (pads), simply skip school for that one week each month.  Because of this, many are held back, and then simply drop out of school.  From what I've read, educated women make smarter decisions regarding numbers of kids they have, protection used during sexual intercourse, and of course, and have more resources to work and provide for themselves (thus, not relying on their men for support).  They don't have pads due mostly to cost, and this seems like a small way that rich-country folk like us can help out.  More on that over the next couple weeks, I'm sure.

The clinic experience today also allowed Mom to hand out more coloring books and lolli-pops to the kids.  One of the ladies older than Mom (yes, older than Mom!) was even reading (yes, reading!) her own coloring book!  It's for her grandchild...  Overall, the kids are loving the coloring, and not to worry all you haters, we've got toothpaste and toothbrushes for after their done enjoying their lollies.  One of the little 1.5-year-olds at the clinic, who happened to be running around naked today, starts yelling crying when I simply make eye-contact with him.  I rounded the corner this afternoon, and he was walking towards me, we met eyes, and he ran off screaming.  Not sure what it is about this mzungu...

This afternoon Brenda helped us buy Mom some cloth at the market for skirts/blouses (I guess) and those will get tailored sometime this week.  Tonight, we plan to hit up the Imperial Hotel for a sunset Tusker, and then dinner with Josh and Brenda - then hopefully a little dancing to some Bongo + Luo jams.  Poa Vipi!

These few days have sparked a lot of thought - how humbling.

More from Mom:

Yesterday, Trav and I spent much of the day at the Aga Khan hospital (private). I made rounds with the psychological counselor (aka social worker) and we saw 3 patients.  The lst man was awaiting test results to determine if he had AIDS.  The counselor would find out the results and be the one to tell him that afternoon.  The 2nd patient was a man admitted for alcoholic withdrawal and she asked me to lead the session.  I was surprised but went for it.  I learned that there are very few social services available for alcoholics--no AA or rehab programs (at least not in Kisumu; apparently there is AA in Nairobi).  The young man seemed motivated to be sober so we talked about ways he could achieve that including finding a "sponsor" (new concept to counselor) who could support his sobriety.  I won't go into details here but it's amazing how interested the counselor was in seeing me work with patients. Plus she asked me to document our meeting with this patient in the chart which would never happen in the U.S. Trav and I were both given free access to the hospital not required to wear nametags or sign in.  When Trav tried to take a picture of the outside of the hospital, a security guard said that wasn't allowed.  Security is very important here. Anyway, back to my story. We next met everyone in her dept. which is the Pathology Dept/Lab which was interesting.  While in an area where the counselor's purse was stored, I met a woman who had given blood.  After introducing myself and she heard what I did, she stated that she was a college teacher and there was a social work program there and would I come and do a lecture.  I agreed and we exchanged names and phone numbers.  And then to tea--which is served here with milk. Tea is grown locally and quite delicious.  I met even more folks and then we saw our last patient a woman with stage 4 cervival cancer.  This will not be treated and she was awaiting a bed in a hospice.  She also has AIDS which many patients do.  She was depressed and again the counselor wanted me to talk with her.  The counselor has not had a lot of formal training so was quite eager to learn.  I'm hoping to meet a trained social worker and work out a field placement for a Social Work student from UT. 

After rounds, I connected with Trav and the Dr. he'd been with all morning and we were served lunch made by the dr's wife in the dr's office as he doesn't have time to get out.  It was quite delicious--some type of sandwich with chicken and spices that had been fried and then we had little rice cake type cups which we filled with Kasava (like scalloped potatoes).  After a 30 minute break, the dr. was ready to return to work and I returned to our hotel and proceeded to fall into a deep sleep for 2 hours.  Jet lag is catching up with me I think.  Trav returned early but then went back to the hospital for a lecture at 7.  He was home by 8:30 and we headed out to an Asian restaurant where I had hot and sour vegetable soup with vegetable fried rice.  The electricity went off for a few minutes which made dining interesting but it was restored and all went well.  We went back to the hotel and both fell asleep early as we were to be ready at 8 a.m. this morning to return to the clinic.

We arrived at the clinic about 9:30 or so and I spent the morning with Brenda, the social worker connected with the clinic.  She is starting a lot of very needed projects.  She's had 2 years of education which included social work, project management, community development and public health.  She works with orphans (getting sponsors for their educations and other needs), pregnant women who have AIDS trying to convince them to deliver their babies in a hospital so that the baby can be treated and not get AIDS hopefully (clinic pays for the deliveries) and with new mothers helping them learn about breastfeeding.  Many mothers have AIDS and need special encouragement and instruction for breastfeeding.  She was very enthusiastic and engaging and is only 24 yrs old.  She grew up in Kisumu and just began working with the Bonyo clinic this year.  She has some big goals and will send me more information as her program unfolds.  Oh, she also does lots of family planning and STD counseling.  After talking with her, I spent much of my time playing with the children since there is no school on Sat. for primary age kids.  We'd brought lollies and they were quite excited about this.  We left the clinic about 2 and were dropped off at a market accompanied by Brenda.  She helped me pick out some fabrics that her tailor will use to sew some skirts and a blouse or 2.  We then walked through a huge market through a big downtown park to another shopping area and that's where we are now! It was great to get some exercise.  Tonight we're going to meet some folks for drinks at sunset at the Imperial Hotel.  Now that sounds like a grand plan to me!!  Lots of love to you all!  All is well with us here.  We are sleeping and eating well.


Asante sana for all your support and prayers.  Much love.

20 January 2011

Kenya: Clinic Day 1

Jambo!  Greetings from Kisumu.  We arrived on time to Nairobi smoothly two nights ago and were greeted at the airport by our host, Josh (essentially Dr. Bonyo's Number One here).  On our way out of the airport, a zebra darted across the road - Mom's first big surprise here in Africa.

The following morning we headed to Kisumu via a 7-hour Matatu ride.  The road was much smoother than I remembered in 2007 - still a 2-lane paved road, but with much fewer potholes.  We caught an amazing view of the great Rift Valley and arrived in Kisumu in time for a walk to the Safaricom store to buy a mobile phone and the Nakumatt to stock up on some South African wine and Bond 7 (whiskey).  Then, carrying 3 5-liter bottles of water and our new alcohol stores, we enjoyed Mom's first tuk-tuk ride home.  

We are staying at the Milimani Resort Hotel and are well taken care of by Jackie and Dan, among others.  Our dinner last night included chicken curry and chicken masala with potatoes (of course) and a fruit cup.  Mom's been surprisingly adventurous with her diet and socializing with everyone...  

After sleeping a full 10 hours and Josh jump-starting the battery to the Bonyo clinic truck, we headed out to the clinic today for our first day there.  We spent only about 4 hours out there due to the late afternoon rains, but we treated malaria, chronic cough, acute gastroenteritis, dehydration, and chronic severe osteoarthritis.  Jeanine and Mercy are the full-time nurses at the clinic, and have already taught me a good deal of tropical medicine and about their local practices.  For the last elderly patient with arthritis, we gave her a steroid injection in her right knee to alleviate some of her pain (sorry Dr. Bones, I stole some of your supply for this! - I owe you one).  Our last patient of the day, had to be referred to the hospital - the little boy appeared lethargic and dehydrated after just a day of gastroenteritis.  He highlighted the fact that even a mild gastroenteritis can be extremely complicated by malnutrition.  The boy and his grandmother were transported to the district hospital in Ahero via motorcycle - "we" (Dr. Bonyo's NGO) paid for the ride.

The motorcycle ride was a little less than the equivalent of $1.  Each clinic visit can cost anywhere between $1.50 - $3.00, depending on the age of the patient and the services provided.  These "user fees" are the subject of pretty significant controversy regarding the delivery of healthcare in developing areas.  Some argue they shouldn't be levied on those already in extreme poverty in order to meet basic humanitarian goals, yet others argue for "user fees" in order to preserve quality healthcare in their areas, properly allocate services to those in need, and pay for necessary medications.  The clinic regularly buys anti-malaria medications and antibiotics from the local wholesale pharmacy, and these are not free.  Obviously, the cost of medications is included in the total price of the clinic visit.

Transportation seems to have changed a lot as well.  There are many more motorcycles for transport in the rural areas out near the village of Masara, and again the roads seem much smoother.  Of course, matatus and tuk-tuks are still prevalent.  There are still the semi-trucks that are over-loaded and traveling at 5 mph that need to be passed by faster cars and matatus - we've already seen two over-turned semi-trucks with contents spilled all over the side of the road, yet luckily with no obvious injuries. 

Socially, we've been a bit held back by our jet lag, but we hope to get out for dinner tonight.  My limited Kiswahili skills have come back slowly, with my vocabulary consisting of only fragmented phrases:  Hello, yes, no, thank you, thank you very much, how are you?, good, very good, and please.  After further lessons with Josh and Tom (Dr. Bonyo's step-brother), I hope to expand my Kiswahili to longer sentences and perhaps learn to be able to floss some pick-up lines.  I'll keep you posted.

Josh has been an amazing host, introducing us around to his friends, his little nephews, and even his mother.  He showed us his digs and his mother's shop as well.  Not only do we owe him for the priceless hosting duties, but we also owe him 3000 shillings for not having enough cash for the matatu ride yesterday.  Woops.

Tomorrow, I plan to work with Dr. Allibhoy at the local Aga Khan Hospital.  I'm not sure what that will entail, but we plan to meet up with him tonight to learn more.  Mom hopes to meet up with any social services folks they have working at the hospital and with Brenda, the social worker for Dr. Bonyo's NGO here.

Since I can't capture all the thoughts and feelings of my travel companion (Mom), she wanted to say a little something:

Jambo (which means hello in Kiswahili).  Trav and I just finished our lst clinic day and it was quite amazing.  The clinic has 2 nurses and we saw about 4 patients today including 2 children who each had dehydration and gastroenteritis--both very common here.  We also saw an elderly lady who needed an cortisone injection in her knee which Travis did so well that the woman said he did a better job than the doctor she'd seen before.  How about that?  We unpacked both our extra bags of supplies - the coloring books and stickers have already been popular with the kids.  Our nurse Jeanine already asked for one of our pairs of reading glasses, and we anticipate using many more.  It is quite sobering to see the incredible poverty here.  Most people live in a hut made of cow dung and mud with a corrigated iron type roof which makes it very hot.  Water pumped from the village authorized pump is not drinkable but most people don't take the time to purify it and drink it anyway.  We saw countless people using ponds of very dirty water to wash clothes and bathe.  Most people get around on bikes or motorbikes and there are very poor roads with lots of pot holes and only 2 narrow lanes  plus they drive on the left side of the road.  This makes getting around quite exciting (we have a driver thankfully).  I'm feeling well and the food has been pretty good.  We're sleeping well and everyone is very welcoming.  Oriti (good bye) for now.  

Asante sana for all your support and prayers.  Please be in touch.  Much love from Kisumu.