tag:blogger.com,1999:blog-27328103131335602432024-03-19T06:10:16.810-05:00Life's ResidencyWelcome to Life's Residency: Where the worlds of health policy, travel, politics, and global health converge, and the education is constant.Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.comBlogger33125tag:blogger.com,1999:blog-2732810313133560243.post-10907152577832821392017-07-19T14:58:00.003-05:002017-07-19T15:01:42.027-05:00The Pace of American Medical Training<div class="MsoNormal">
<a href="https://web.ics.purdue.edu/~drkelly/DFWKenyonAddress2005.pdf" target="_blank">In his commencement address at Kenyon College in 2005</a>, the
late author David Foster Wallace told the story of two young fish swimming
along. They pass an older fish swimming the other way who greets them: “Morning
boys. How’s the water?” As they swim on, one of the younger fish responds to
the other, “What the hell is water?” <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Feeling and appreciating your body of water takes experience,
maturity, and occasionally someone else making you aware of your daily
surroundings. It was not until a few years into my career as a Family Medicine
physician that I realized the furious pace at which American physicians learn
to swim, insulated in a system that operates in stark contrast to that of other
countries around the world.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
--<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i>What kind of young physicians is our system creating?</i><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Six months into my first year of residency, I was on a rotation
with an energetic Orthopedic Surgeon. Our residents looked forward to our time with
him. Residency training is a time for young physicians to drink from a fire
hose of information during long work hours, learning not just clinical medicine
but also the business of healthcare. As we stood outside the exam room
preparing to see the next patient, the topic of medical malpractice came up. He
stated, “Every time I walk into a patient room, I see the patient in front of
me, the insurance representative on the right, and the malpractice lawyer to
the left.” <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
At morning report following nights on call in the hospital,
we would present each admitted patient to our Attending Physician who taught us
clinical pearls and also regaled us with stories regarding malpractice cases
that had arisen from similar situations. He helped us refine our documentation
and ensure our trail of charting and medical care would back us up in the event
of a lawsuit. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Several times faculty physicians reinforced my plan to order
studies to ensure a life-threatening condition was ruled-out. Many could have
been reliably excluded with physical exam signs or patient risk factors, but I
had been trained to rely on technology to definitively prove my clinical hunch.
I have never been the subject of a medical malpractice lawsuit, but I practice
as if I have.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
So each month, I gathered nuggets of information from my professors
regarding medical business practice, detailed documentation, and using
technology to prove diagnoses. These lessons all slowly seeped deep into my
practice habits. And, much like an older brother repeating a parents’ teachings
to a younger impressionable sibling, I taught these to junior residents and
medical students. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Then came several stints in a rural health center in Kenya and
a <a href="https://www.lshtm.ac.uk/study/courses/short-courses/DTMH-east-africa" target="_blank">three-month course in tropical medicine put on by the London School ofHygiene and Tropical Medicine</a> in Tanzania and Uganda. My classmates were from
the United Kingdom, Australia, Germany, Tanzania, Uganda, and even Botswana,
among other countries. Out of the 57 young physician students from around the
world, I was the only American. Through work in the resource-limited health
center in Kenya and a subsequent year of teaching medicine in East Africa, and
discussions with my tropical medicine classmates, I started to see my water
more clearly.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Fear of medical malpractice lawsuits and defensive medicine
are unique American system attributes. The private fee-for-service system
without a firm foundation of public care is an American trait. Patient cost
sharing having no basis on the actual cost of care makes the US health sector
unlike any other. Mountains of educational debt following medical school are
only found in the American system. The large pay increase that first year as an
independently practicing physician after postgraduate training is a massive
incentive only present Stateside.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i>How do these elements affect healthcare delivery in one of
the strongest economies on the planet? <o:p></o:p></i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In the documentary film <a href="http://www.escapefiremovie.com/" target="_blank">Escape Fire</a>, former Centers for Medicare
and Medicaid Services Administrator Donald Berwick says he does not blame
anyone in the American system for doing what they are doing. Hospitals fill
hospital beds because they are incentivized to do so. Physicians enter
lucrative sub-specialties at times partially motivated by the need to pay off
educational debt, and many go straight through medical school and residency eager
to absolve that debt. <a href="https://members.aamc.org/eweb/upload/2016_Debt_Fact_Card.pdf" target="_blank">Seventy-six per-cent of American physicians graduate medicalschool with an average of almost $190,000 of educational debt</a>. Can we blame them for
sometimes seeking more profitable specialties and blazing straight through
training? I finished training as quickly as possible at the age of 29 with just
over $200,000 in debt and no savings, and then entered practice in the fee-for-service
system. And the path of least resistance was to follow the volume-based carrots
laid out by my predecessors. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The lessons of older physicians are percolating down to
breed younger physicians with similar attitudes. And that should be concerning.
What were once young idealistic physicians, are now caregivers entering a
post-Affordable Care Act system with the same views as a physician who was
raised in the fee-for-service scheme.<span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i>How do we incentivize young physicians to enter the right
mix of specialties and shape them to serve an aging population in a changing
system?</i><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We must start by addressing the cost of medical education.
Without the heavy debt burden, financial incentives lose their power. Next,
improve the pay during postgraduate training, while encouraging, through
funding or built-in time away from the home institution, extended breaks in
training if the physician so chooses. This time away could be used for
international rotations, administrative or policy placements, or exploring research
opportunities that interest them. For example, young British physicians take
months, sometimes years, away from their postgraduate medical education to work
with non-governmental organizations (NGOs) or in academic settings in
low-income countries. During this time out of their comfort zone, physicians
have more time for self-reflection while pursuing personal interests. This may
very well extend the length of training, but without debt creating the race to
finish, this would be less bothersome to young physicians. In fact, many young
physicians start out craving these seemingly extracurricular experiences, but
there is currently little time or support for what would be key to a physicians’
personal and professional growth.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
When the system of education changes to encourage outside
perspective gathering experiences, our system may well end up with physicians
whose incentives better align with the most important healthcare player of all:
the patient. That physician will be more confident in her physical exam skills
rather than relying on technology, which will in turn lower costs in the most
expensive healthcare system in the world. That physician will be more in tune
with herself and the need to care for herself before caring for others, thus
lowering chances for burnout and improving longevity. That physician will be
more empathetic to patient needs, leading to higher quality care.<o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
-- <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
One must smell poverty to recognize the stench of
inequality. You have to be confronted with true hopelessness to detect
suffering. You must feel, at some point, uncomfortable to identify
vulnerability.</div>
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Learning medicine takes years of study, sacrifice, and
repetitive pattern recognition. Caring for another human takes a self-awareness
that requires an intimate full sensory appreciation of your surroundings. And only
with these skills sharpened, can the leaders of our health system take that
vital swim alongside their patient.<span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><span style="mso-spacerun: yes;"> </span><o:p></o:p></div>
Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com0tag:blogger.com,1999:blog-2732810313133560243.post-62979147030111562242016-10-06T04:37:00.001-05:002016-10-06T04:37:18.064-05:00How the Republicans Effectively Pushed Away this Texan<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;">In 2002, I became President of a small minority group at my
liberal arts university: our chapter of the College Republicans. I had come of
political age during the exciting time of a Texas Governor being elected to the
highest office. George W. Bush was a successful governor who met regularly with
Democrats and accomplished much of his agenda for our great state. I was proud
to be a Texan, and being a conservative meant reasonably limiting government
and encouraging innovation and private enterprise. <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Georgia, Times New Roman, serif;">But September 11, 2001 came and impacted our generation and changed
our country forever. Conservatives and Republicans somehow progressively lost
touch with the majority of Americans and continued in power by playing the game
well enough – dividing Americans through social stances and then courting and securing
their extreme base.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Limited government was the principle, until it came to women
making decisions about their bodies or about people being able to marry whoever
they love. Compromise gave way to obstructionism, solely based on party lines.
Leadership meant sound bites to appease the far right or to ensure support by a
small transient Tea Party force. Enacting policy no longer required facts based
on evidence or science, because fact is no longer something to be proven or
disproven but rather something to be heated, molded, and pointed in the desired
direction by a think tank or a lobbyist to fit a narrative. <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Georgia, Times New Roman, serif;">That was just the tip of an apparently growing ice berg in
the face of the overwhelming evidence pointing towards the existence climate
change. That ice block was swelling and hardening to buoy the candidacy of
Donald Trump. Rising inequality has left many Americans feeling left out and Trump
successfully harnessed this sentiment and crafted it into a message of
xenophobia, insulation, and hatred. <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Georgia, Times New Roman, serif;">The Republicans had the opportunity to squash his candidacy.
At one point there were 15 other primary candidates, and I’m sure others on
deck, and the party leadership could have found a way to ensure Trump was not
their man. But, they did nothing, or not enough. And thus, they deserve any
landslide coming their way. In fact, deep Republican losses all the way down
the ballot may be what is necessary to ensure the Republican leadership hears
the message loud enough to force an honest look in the mirror to inspire change.
A Democratic landslide victory could even make way for a brand new, ideally
centrist, third party or a completely rebranded Republican party.<o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><a href="http://www.nytimes.com/2016/03/24/upshot/lasting-damage-for-gop-young-voters-reject-donald-trump.html" target="_blank">Some argue</a> that the Trump candidacy will damage the
Republican party for at least a generation. Whatever the case, to win back any
semblance of a diverse or young coalition of support, multiple transplants, far
beyond a makeover, will be necessary. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">--<o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Yesterday, I entered the beautiful and secure US Embassy
complex in Kampala to take the Foreign Service Officer Test, and I thought
about how our next President will guide and protect our interests around the
world. Following the test, I went home and completed my absentee ballot and,
for the first time since I was old enough to vote for President, did not vote for
the Republican candidate. In an increasingly more complex world, the last thing
we need is a President Trump. </span><o:p></o:p></div>
Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com0tag:blogger.com,1999:blog-2732810313133560243.post-77088764265774284972016-10-06T04:19:00.001-05:002016-10-06T04:37:28.711-05:00Recognizing Mom<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;">We live in a world where girls still drop out of school
early to fulfill work demands at home or due to inadequate hygiene products. We
live in a world where women do not enjoy rights equal to those of men and a
world where, in parts, females kneel when greeting males or other “superiors.” And
in this world where women work back-breakingly hard, many times without warranted
respect or appropriate appreciation, financial or otherwise, the <a href="http://csw.fsu.edu/articles/fsu-college-social-work-celebrates-distinguished-alumni-student-scholars/" target="_blank">Florida State University’s College of Social Work has recognized my mother for her contributions to the field of Social Work</a>.<o:p></o:p></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Her impact on the field that merits an award of this type came
at the same time as she was actively influencing the lives of the three men in
her family. She designed a schedule to ensure she was present to pick me up
after school, help with homework, drive me to tennis lessons, and make dinner. And
when it came time to apply to university, she advised on applications and
encouraged my broad search. While I did not follow her one piece of advice
based on her one regret – “study abroad!” – her experience and the way she
prioritized education has set me on a unique and fulfilling path.</span><br />
<span style="font-family: Georgia, Times New Roman, serif;"><br /></span></div>
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Name="Message Header"/>
<w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Salutation"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Date"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text First Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Heading"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Body Text Indent 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Block Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Hyperlink"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="FollowedHyperlink"/>
<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Document Map"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Plain Text"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="E-mail Signature"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Top of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Bottom of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal (Web)"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Acronym"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Cite"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Code"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Definition"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Keyboard"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Preformatted"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Sample"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Typewriter"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Variable"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal Table"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation subject"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="No List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Contemporary"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Elegant"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Professional"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Balloon Text"/>
<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Theme"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 9"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" QFormat="true"
Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" QFormat="true"
Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 5"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 5"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 5"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 5"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 5"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 6"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 6"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 6"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 6"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 6"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="46" Name="List Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 3"/>
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<span style="font-family: Georgia, Times New Roman, serif;">There is no prize big enough to honor my mother for all she
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<span style="font-family: Georgia, Times New Roman, serif;">Travis</span><br />
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<o:p></o:p></div>
Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com0tag:blogger.com,1999:blog-2732810313133560243.post-68440843508999738782016-08-21T03:05:00.000-05:002016-08-21T03:12:14.388-05:00Why We're Here<!--[if gte mso 9]><xml>
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It’s circumcision season here in Mbale. We occasionally
approach celebratory processions of men and children of all ages pumping handheld
tree branches in the air, trotting to the beat of chants and drums along the
roads just outside of town. The 18 year-old of honor is in the middle of the parade
covered in mud, on the way to his public transition into manhood. If he flinches or falls to the ground it will be the subject of gossip for years to come. The
circumcisions occur in eastern Uganda during every even year, but two weeks ago
was a ceremonial day marking a spike in the procedure, following a month-long festival
at the cultural grounds. A local colleague described it: “If all year was the
regular season, this month is the Champions League.” Our minivan matatu crawls
slowly, splitting through the middle of the groups that continue uninterrupted around
us like a school of fish. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i>How did I get here? <o:p></o:p></i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Multiple short-term stints in a health center in Kenya, a
diploma course in tropical medicine and hygiene, and a four-month job teaching
in a new postgraduate residency (MMed) program in central Kenya have all been strides
on my persistent search for where my professional experience and academic
interests meet a need. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Fortunately, during my Masters in Public Health a professor
pointed me towards <a href="http://seedglobalhealth.org/" target="_blank">Seed Global Health</a>. Seed, <a href="http://m.wcvb.com/chronicle/chronicles-gamechangers-vanessa-kerry-sows-seeds-of-change/41235206" target="_blank">founded by Dr. Vanessa Kerry</a>,
sparked the <a href="https://www.peacecorps.gov/volunteer/is-peace-corps-right-for-me/global-health-service-partnership/" target="_blank">Global Health Service Partnership (GHSP)</a>. This is a new
public-private partnership with the United States Peace Corps and the
<a href="http://www.pepfar.gov/" target="_blank">President’s Emergency Plan for AIDS Relief (PEPFAR)</a>, a groundbreaking US
governmental program put into place by President George W. Bush and reauthorized
by President Obama which now funds half of all HIV/AIDS testing and care around
the world. The GHSP places physicians, nurses, and midwives in faculty posts at
29 different universities alongside local lecturer peers to help train the
future health workers of Uganda, Tanzania, Malawi and now Swaziland and Liberia,
for one academic year. There were roughly 30 GHSP volunteers sent in each of the
first three cohorts and there are 59 new volunteers serving in this fourth
iteration. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In my struggles to stomach the inequalities of access to
basic necessities that promote health in areas of extreme poverty, the seemingly
simple answer of how I, a Family Medicine physician, could contribute to the
solution has proved more challenging than expected. Considering my skills and
experience thus far, what is the proper way to have a sustainable impact? <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Enter GHSP. Instead of delivering healthcare, GHSP health
workers, upon request from the host government and university, are partnering
with faculty to assist the public systems in teaching, and thus scaling up,
their future human resources for health (HRH). There are numerous
non-governmental organizations (NGOs) working on many critical projects in
low-resource areas, some better coordinated with like-minded NGOs and host
country priorities than others. GHSP is inherently aligned with US governmental
positions and initiatives, augmented by the conferred experience and reputation
(largely positive) of the Peace Corps. Financial stressors born mostly from the
burden of educational debt are a reality for young American health workers, and
thus one of Seed’s major yet simple innovations is to essentially remove this
barrier through generous loan forgiveness during each year of service. Given my
policy interest, this opportunity could not be a better fit. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i>What am I doing here?<o:p></o:p></i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
School started as scheduled this week at Busitema University’s
Faculty of Health Sciences despite the nearly three-week <a href="http://allafrica.com/stories/201608180115.html" target="_blank">non-teaching staff strike affecting all public universities in Uganda</a>. This is the fourth year of the
medical school’s existence and thus the first year (first week!) we have
students on clinical rotations at Mbale Regional Referral Hospital, <a href="http://www.health.go.ug/affiliated-institutions/hospitals" target="_blank">one of 14 regional hospitals in Uganda</a>. Within the Internal Medicine department, we have started
with 13 students on a five-week rotation, and we have been working on taking a
patient history and basic physical exam skills. Our first week has been busy
with some bedside teaching, a few board room tutorials, a discussion regarding
tuberculosis after a visit to TB clinic, and an end-of-week practical assessment
of their general exam skills. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
On Tuesday a group of four students and I saw an end-stage
AIDS patient who had recently fled South Sudan to stay with her family here in town. Her brother at her
bedside claimed she did not know of her HIV diagnosis. The students and I
adjourned to the board room for a lively ethical debate first on if she truly
was unaware of her diagnosis and secondly the “if” and “how” of communicating
to her the true diagnosis given her anticipated limited life expectancy. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<i>Why am I here?<o:p></o:p></i></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Day 1 of orientation in Washington, DC, ended with happy
hour on the Washington Harbour waterfront. I was privileged to meet Aaron
Williams, the most recent former Director of the Peace Corps and current Seed
board member, who originally worked with Dr. Kerry to establish the GHSP. He told
me that creating the GHSP was one of the most significant accomplishments of
his career, right up there with working with Nelson Mandela. <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Day 2 of orientation ended with Dr. Kerry closing our day at
4:45 p.m. “You are totally free to leave, but if you can hang out about 20 more
minutes, Dad wants to stop by.” The surprise visit by our Secretary of State
John Kerry complete with an informal 10-minute speech on the history of the
Peace Corps, the legislation that gave birth to PEPFAR, and the health
implications of diplomacy, to a room of about 75 left us in awe. To motivate
our year ahead, he left us with a quote from Nelson Mandela: <i>“It always seems impossible until it’s
done.” </i><o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
In 2014 I visited Robben Island where Mandela was held
captive for 17 years, where our group was led through the maximum security
prison by a tour guide who was himself a former political prisoner there in the
1980s. On my way out, I bought a postcard that I displayed on my bathroom
mirror throughout 2015 as a reminder of the goal ahead. The card quoted Nelson
Mandela: <i>“Overcoming poverty is not a
gesture of charity. It is an act of justice. It is the protection of a
fundamental human right, the right to dignity and a decent life.”</i> <o:p></o:p></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The reinforcing guideposts featuring Nelson Mandela have
provided powerful reassurance that this new step on the Path is right and
quickly feeling familiar.<br />
<br />
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVavpTYoG1NPD-y9cRVeCb-_5v5Tw5lz5oqkooIt02JnRTMvGaOIIvsYkOArNtbuzMFAgxbv3rjEjs8UyDM2TjfnBKafnzT-EUdK_czTEbnYl-xO2Zqq84oCHA9Ld5F-upo9gH9ng2U7Ib/s1600/IMG_2530.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiVavpTYoG1NPD-y9cRVeCb-_5v5Tw5lz5oqkooIt02JnRTMvGaOIIvsYkOArNtbuzMFAgxbv3rjEjs8UyDM2TjfnBKafnzT-EUdK_czTEbnYl-xO2Zqq84oCHA9Ld5F-upo9gH9ng2U7Ib/s320/IMG_2530.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">The view from my office.</td></tr>
</tbody></table>
<o:p></o:p></div>
<!--EndFragment-->Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com0tag:blogger.com,1999:blog-2732810313133560243.post-42201022043098172062016-06-04T00:45:00.000-05:002016-06-04T02:00:18.608-05:00Porch Time<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJTOpxaQsPm9K6MT8veEbjWo-79yjmIUGiXWDV8w0y9qxjN7oQI6vmSsHcdRh7atwFHbNGRQVTYJ7v2lWIh2Rhg_HMrYzJTFSs9b-70l8muI2y07dsuUIzH2wJcglG5_j023Du_6Cjiv_W/s1600/IMG_0402.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiJTOpxaQsPm9K6MT8veEbjWo-79yjmIUGiXWDV8w0y9qxjN7oQI6vmSsHcdRh7atwFHbNGRQVTYJ7v2lWIh2Rhg_HMrYzJTFSs9b-70l8muI2y07dsuUIzH2wJcglG5_j023Du_6Cjiv_W/s320/IMG_0402.JPG" width="240" /></a></div>
<div class="MsoNormal">
<span style="font-family: "georgia"; font-size: 11.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia"; font-size: 11.0pt;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia"; font-size: 11.0pt;">I will
never be exactly here again. Have you ever thought: “I will never forget <i style="mso-bidi-font-style: normal;">this”</i>? A lesson learned. An experience
at work. A funny joke. A feeling. The name of the dish in a region you visited.
And then you can’t recall it. This time is different though. It will never
escape me.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia"; font-size: 11.0pt;">For
memories to stick with me they must be imprinted with an image or a song, some
other stimulus or sensation accompanying the event. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia"; font-size: 11.0pt;">--<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia"; font-size: 11.0pt;">My Porch
in Chogoria has hosted some of my most meaningful moments during the last four
months. These were headlined by much desired quiet time for contemplation - about
my place in life and the current navigation along my professional and personal
Path. My Porch also convened pleasant discussions regarding unpleasant
realities of work here. And a few heart-wrenching conversations. And provided
the setting for texting back to Texas, in silence except for the wind-blown
trees or the slowly dropping rain or the high-pitched laughter from my neighbor
above that forces a smile. My Porch has adapted to serve as brainstorming
incubator, peaceful meditation station, and banter bench, depending on what the
occasion required.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia"; font-size: 11.0pt;">--<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1dKIVxhLFBFilkR5qBlCK-ZuKpSGd0_wCuJ7Yb2euYzPq6tp_SEcAOTj2sP3-KuQo2zxVY_82cez3cdYMmSYpGSR4ZlDjVg2moIMJXigEOIVNRi5dZQXK0Mcl4JxizcWdnMxyyhixbEHZ/s1600/IMG_1593.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="180" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj1dKIVxhLFBFilkR5qBlCK-ZuKpSGd0_wCuJ7Yb2euYzPq6tp_SEcAOTj2sP3-KuQo2zxVY_82cez3cdYMmSYpGSR4ZlDjVg2moIMJXigEOIVNRi5dZQXK0Mcl4JxizcWdnMxyyhixbEHZ/s320/IMG_1593.JPG" width="320" /></a><span style="font-family: "georgia"; font-size: 11.0pt;">I had an
upper-level resident during medical school who used to take me on “social
rounds” late at night in the hospital. Things would be quiet, patients would be
tucked in, and we had a chance to breathe. Instead of sleeping, we would go
visit our favorite night nurses and the women keeping the cafeteria afloat
during the midnight hours. In my residency years, we made sure to catch the
July 4<sup>th</sup> fireworks from the top floor of our hospital. While in my
last couple weeks in Chogoria, I’ve visited the lab technician to let him show
off the GeneXpert machine. I have had more time to talk with the Palliative
Care staff who contributed to my last lecture on end of life care, and the clinic
nurses as, thanks to added consultant manpower, I have been mostly in the
outpatient clinic precepting residents and Medical Officer interns during my
final month. I visited my friend and neighbor, the new dentist from Nairobi,
for a quick consult in the Dental Unit. And I finally went out to a village
primary school for the day with the public health team of <a href="http://villagehopecore.org/" target="_blank">Village HopeCore International</a>, a local NGO that brings microenterprise and various health
services to most of the county. Social rounds ought to be employed in every
setting as they build the links that make teamwork feel like fun.<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia"; font-size: 11.0pt;"><br />
My time here, like every place I go, has been colored by the relationships
formed. It started with the welcome by Leonard and then a note on my door from
Mrs. Ritchie within the first hour of arrival. Dr. Ritchie, the program
director, and Mrs. Ritchie have hosted me for meals and short bits of guidance.
The Webbers and Brothertons have provided me the home away from home, complete
with younger siblings, family meals, and deep manversations when necessary.
Anne, a new friend and the managing director of HopeCore, helped me acquire
comforts like a fan and a water filter, and the NGO and expat crew built in small
social evenings at the right intervals. The residents, Drs. Boaz and Yulu, characterized
simply by their continual acts of selfless service enhanced by refreshing enthusiasm,
have made the work rewarding and an absolute pleasure.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia"; font-size: 11.0pt;">A groggy
patient mistook me for an angel, and my interns have told me I look tired,
energetic, or dehydrated, depending on the morning. The Safari café selling chapati
still comments on the color of my skin and the Lenana waiters know I like my
take away coffee black. The newspaper salesman finds me some mornings and I pay
with exact change, then I hand off the paper to my clinic nurses so they can be
up on current events too. The people in the villages along the tarmac road
stare, laugh, and wave during my runs along the hills (my final run I was
joined by the rugby-playing carwash owner), and the motorbike drivers still
smile in disbelief when I decline the ride. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia"; font-size: 11.0pt;">Community
can be built even during a short time and is found where it is sought. It is
these connections that give an experience its true value.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia"; font-size: 11.0pt;">--<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-o_b28hBUgfxpMY4ftzt2AXzhceDP2tJrwBXWV9XMzyOYcLY8kPwH_EJdG_kRQ8FScAsp5tgCpnRW9Tg5drkn4LNwuxVFYvqIynniF8u3a6icEv4SNsmF_D2ZxtraCYyUwpea6XGXbbf1/s1600/IMG_1596.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-o_b28hBUgfxpMY4ftzt2AXzhceDP2tJrwBXWV9XMzyOYcLY8kPwH_EJdG_kRQ8FScAsp5tgCpnRW9Tg5drkn4LNwuxVFYvqIynniF8u3a6icEv4SNsmF_D2ZxtraCYyUwpea6XGXbbf1/s320/IMG_1596.JPG" width="320" /></a></div>
<div class="MsoNormal">
<span style="font-family: "georgia"; font-size: 11.0pt;">Proper
Porch Time is required then, to sort through all the daily occurrences here in
Chogoria. Coffee amidst the still morning on the Porch fuels inspiration and
energy. Home-cooked dinners over sunset allow the days’ events to be processed,
the emotions to bubble up, and the lessons to seep in. The Porch is a place of familiar
comfort. Porch Time is carved out of the day, with a meal designed like a
banquet specifically for this Time, structured to center myself or arranged to
bring people together. You do not need an invitation to the Porch, because you
are already welcome. <i style="mso-bidi-font-style: normal;">Karibu</i>. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia"; font-size: 11.0pt;">Occasionally,
there are welcomed disruptions from the few neighbors walking past, shouting a
short greeting of “Hello, <i style="mso-bidi-font-style: normal;">Daktari</i>” or
“Good evening to you” that jerk me out of the daydream and back onto my Porch
in Chogoria. “May I approach the sacred Porch?” my neighbor Hawa, the dentist,
asked on my last night, opening chat to deepen a new friendship just before my
departure.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia"; font-size: 11.0pt;">Perhaps I learned its significance from Swing Time, coined by my parents and their
neighbors-turned-life-long-friends, in the front yard of our family home they lived
in from when I was 12 years-old until age 29. The sacred Time spent in this
safe place is meant to be focused, not on work, but rather on dedicated time to digest life and celebrate it with those you trust and love most. This
special Time has been transported to other geographic locations, and thus can
be reproduced with the right attitude and mental space. It is in fact the most
important Time, as it clears the way to carefully consider your current place,
show gratitude for it, and interpret what meaningful result it will yield.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia"; font-size: 11.0pt;">--<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia"; font-size: 11.0pt;">Will I
remember <i style="mso-bidi-font-style: normal;">this</i>? Complete with the
unique smells and competing sounds of singing school girls and birds, the
memories will flood back in, perhaps triggered by a song heard or an image
seen, without consciously requesting it. I’ll be right back on my Porch –
giving thanks for this incredibly formative four months. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia"; font-size: 11.0pt;">A
conflicting deep emotion emerges from the collision of a sentimental heart
saying goodbye and the searching soul eagerly anticipating moving on. There is
always that next step. And it is here and it is exciting! But when the emotion
becomes too much, or the list of tasks grows too long, or the slower pace frustratingly
turns to boredom, or the steps need reflection, I will clean off my chair,
adjust my table, prepare a meal, brew the coffee, and sit out on my Porch. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia"; font-size: 11.0pt;"><br /></span></div>
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="E-mail Signature"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Top of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Bottom of Form"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal (Web)"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Acronym"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Address"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Cite"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Code"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Definition"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Keyboard"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Preformatted"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Sample"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Typewriter"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="HTML Variable"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Normal Table"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="annotation subject"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="No List"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Outline List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Simple 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Classic 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Colorful 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Columns 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Grid 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table List 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table 3D effects 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Contemporary"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Elegant"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Professional"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Subtle 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Web 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Balloon Text"/>
<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Table Theme"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 1"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 2"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 3"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 4"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 5"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 6"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 7"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="Note Level 9"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Placeholder Text"/>
<w:LsdException Locked="false" Priority="1" QFormat="true" Name="No Spacing"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 1"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 1"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 1"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 1"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
<w:LsdException Locked="false" Priority="34" QFormat="true"
Name="List Paragraph"/>
<w:LsdException Locked="false" Priority="29" QFormat="true" Name="Quote"/>
<w:LsdException Locked="false" Priority="30" QFormat="true"
Name="Intense Quote"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 1"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 1"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 1"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 1"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 1"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 1"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 1"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 2"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 2"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 2"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 2"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 2"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 2"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 2"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 2"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 2"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 2"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 2"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 2"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 2"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 2"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 3"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 3"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 3"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 3"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 3"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 3"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 3"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 3"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 3"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 3"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 3"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 3"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 3"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 4"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 4"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 4"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 4"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 4"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 4"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 4"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 4"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 4"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 4"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 4"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 4"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 4"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 5"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 5"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 5"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 5"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 5"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 5"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 5"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 5"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 5"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 5"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
Name="Subtle Emphasis"/>
<w:LsdException Locked="false" Priority="21" QFormat="true"
Name="Intense Emphasis"/>
<w:LsdException Locked="false" Priority="31" QFormat="true"
Name="Subtle Reference"/>
<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
<w:LsdException Locked="false" Priority="41" Name="Plain Table 1"/>
<w:LsdException Locked="false" Priority="42" Name="Plain Table 2"/>
<w:LsdException Locked="false" Priority="43" Name="Plain Table 3"/>
<w:LsdException Locked="false" Priority="44" Name="Plain Table 4"/>
<w:LsdException Locked="false" Priority="45" Name="Plain Table 5"/>
<w:LsdException Locked="false" Priority="40" Name="Grid Table Light"/>
<w:LsdException Locked="false" Priority="46" Name="Grid Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="Grid Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="Grid Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 5"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 5"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 5"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 5"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 5"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="46"
Name="Grid Table 1 Light Accent 6"/>
<w:LsdException Locked="false" Priority="47" Name="Grid Table 2 Accent 6"/>
<w:LsdException Locked="false" Priority="48" Name="Grid Table 3 Accent 6"/>
<w:LsdException Locked="false" Priority="49" Name="Grid Table 4 Accent 6"/>
<w:LsdException Locked="false" Priority="50" Name="Grid Table 5 Dark Accent 6"/>
<w:LsdException Locked="false" Priority="51"
Name="Grid Table 6 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="52"
Name="Grid Table 7 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="46" Name="List Table 1 Light"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark"/>
<w:LsdException Locked="false" Priority="51" Name="List Table 6 Colorful"/>
<w:LsdException Locked="false" Priority="52" Name="List Table 7 Colorful"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 1"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 1"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 1"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 1"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 1"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 1"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 2"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 2"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 2"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 2"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 2"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 2"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 3"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 3"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 3"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 3"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 3"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 3"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 4"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 4"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 4"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 4"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 4"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 4"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 5"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 5"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 5"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 5"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 5"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="52"
Name="List Table 7 Colorful Accent 5"/>
<w:LsdException Locked="false" Priority="46"
Name="List Table 1 Light Accent 6"/>
<w:LsdException Locked="false" Priority="47" Name="List Table 2 Accent 6"/>
<w:LsdException Locked="false" Priority="48" Name="List Table 3 Accent 6"/>
<w:LsdException Locked="false" Priority="49" Name="List Table 4 Accent 6"/>
<w:LsdException Locked="false" Priority="50" Name="List Table 5 Dark Accent 6"/>
<w:LsdException Locked="false" Priority="51"
Name="List Table 6 Colorful Accent 6"/>
<w:LsdException Locked="false" Priority="52"
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Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com1Chogoria, Kenya-0.2279535 37.630678200000034-0.243832 37.610508200000034 -0.212075 37.650848200000034tag:blogger.com,1999:blog-2732810313133560243.post-42021969943690211502016-05-26T04:33:00.002-05:002016-05-26T04:39:24.001-05:00The Future Built on Primary Care<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxP6qXJ-lLcH-pfG63yJ3Ad0zjgWG00MJF5TZALhBNb-RQ1LtjMmyz1Al3eISIVK8et9DA1PZLWR4RVfLxkk2ij2vYXdZM_H_kbn_ZYDk_ERuc6PgIPJecq78Xp5Pc6Vdb0ecfWs8VwsTj/s1600/IMG_1470.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxP6qXJ-lLcH-pfG63yJ3Ad0zjgWG00MJF5TZALhBNb-RQ1LtjMmyz1Al3eISIVK8et9DA1PZLWR4RVfLxkk2ij2vYXdZM_H_kbn_ZYDk_ERuc6PgIPJecq78Xp5Pc6Vdb0ecfWs8VwsTj/s320/IMG_1470.JPG" width="320" /></a></div>
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<span style="font-family: "georgia" , "times new roman" , serif;">Last night we arrived home from Nairobi after attending the
<a href="http://www.primafamed.ugent.be/" target="_blank">2016 Primafamed meeting</a> on Family Medicine’s contribution to <a href="http://www.un.org/sustainabledevelopment/health/" target="_blank">Sustainable Development Goal 3, also known as the main health goal</a> (one of 17 SDGs). This
brought together Family Medicine leaders and advocates from around the continent
to share ideas on the current state of and future plans for the growth of
Family Medicine throughout sub-Saharan Africa (SSA). Boaz, one of our
residents, and I enjoyed meeting a lot of the academic “celebrities” of Family
Medicine this weekend. When you are widely published in a field, your nametag
will get frequent glances! <o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSO1348dpEHmSHQMzpMHo3_sW0zVsw0aNMqCWsjMeOW9LMUz35f8LiIMQObSZA9tfoJXS4Mbes54SsNr_m-epyafFbSk9fyhWQEKKr-uhkD8xr-2GBpnmzSauwC_8pmKuSidbDzXjo2Nom/s1600/IMG_1507.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhSO1348dpEHmSHQMzpMHo3_sW0zVsw0aNMqCWsjMeOW9LMUz35f8LiIMQObSZA9tfoJXS4Mbes54SsNr_m-epyafFbSk9fyhWQEKKr-uhkD8xr-2GBpnmzSauwC_8pmKuSidbDzXjo2Nom/s320/IMG_1507.JPG" width="320" /></a></div>
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<span style="font-family: "georgia" , "times new roman" , serif;">Reflective of the broader reach of the Sustainable
Development Goals to include climate change, human rights, and equity, this
weekend we discussed the importance of expanding primary health care (PHC) across
SSA and improving its quality while honing the message of the function of
Family Medicine as the “expert generalist.” The <a href="http://apps.who.int/iris/bitstream/10665/200009/1/9789241565110_eng.pdf?ua=1" target="_blank">emergence of the SDGs from the Millennium Development Goals (MDGs)</a> has required a maturation process or perhaps
an improvement in the measurement of success, especially when it comes to
healthcare delivery. The SDGs call for lofty goals such as ending the HIV/AIDS
epidemic while imploring countries to achieve Universal Health Coverage. While
many argue the merits and scope of the SDGs, <a href="http://healthaffairs.org/blog/2016/03/16/the-mdg-to-sdg-transition-implications-for-health-care-systems/" target="_blank">along with the importance of other relevant factors necessary for success</a>, SDG #3 will benefit greatly from this
renewed focus on primary care. <o:p></o:p></span></div>
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<span style="font-family: "georgia" , "times new roman" , serif;">Family physicians appear appropriately trained and
positioned to lead the teams to deliver the first point of healthcare, especially
in low-resource settings. <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690145/" target="_blank">We know from American research that sufficient access to primary care leads to improved health outcomes, reduced health disparities,and lower costs</a>. <o:p></o:p></span></div>
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<span style="font-family: "georgia" , "times new roman" , serif;"><i style="mso-bidi-font-style: normal;">So, if we have this
body of evidence formulating over the past two decades, why then were <a href="http://www.aafp.org/medical-school-residency/program-directors/nrmp.html" target="_blank">only 14.5% of the available residency (postgraduate) positions in the most recent match of US physicians in primary care, with just 11.7% of the total in Family Medicine</a>?
And why do many SSA countries have such difficulty finding interested
applicants for postgraduate training in Family Medicine?</i> <o:p></o:p></span></div>
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<span style="font-family: "georgia" , "times new roman" , serif;">We discussed many factors this weekend that I tagged as “push”
and “pull” factors, fashioned after the described influences on brain drain.
The “push” or input factors occur during medical school. Is the curriculum in
Family Medicine strong and longitudinal, are there preceptors to serve as
strong role models and supportive Deans, and does the student get a good sense
of what primary care truly looks like in the community? The “pull” factors
occur after post-graduate training, which is largely dependent upon an
encouraging Ministry of Health creating a favorable regulatory environment and
tempting practice atmosphere. Is there a career path for that fully-trained
Family physician and how attractive is that path?<i style="mso-bidi-font-style: normal;"> <o:p></o:p></i></span></div>
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<span style="font-family: "georgia" , "times new roman" , serif;">Ultimately, recruitment depends on the appeal of the
specialty. <i style="mso-bidi-font-style: normal;"><o:p></o:p></i></span></div>
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<span style="font-family: "georgia" , "times new roman" , serif;">The distinctive feature of primary care is the focus on the
whole patient. This requires an understanding of their whole situation,
including elements like their community, nutrition, access to weapons, and family
dynamic. This appreciation comes from continuity, truly knowing a patient, and
results in higher satisfaction for patients in addition to the prevention of
disease. I have seen it in Austin in the diabetic truck driver who lost 40
pounds in six months, stopped smoking, and then no longer required medications
to lower his blood sugar. And I have seen it in Chogoria where thorough
education surrounding a new hypertension diagnosis and proper blood pressure management
and monitoring will likely stave off a stroke, and resultant disability, for
many years. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
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<span style="font-family: "georgia" , "times new roman" , serif;">A society requires productive citizens to develop. <a href="http://www.huffingtonpost.com/vanessa-kerry/the-health-requisite-for_b_9215294.html" target="_blank">To be productive, citizens must have health</a>. To live in a state of health, people must
have access to safe water, nutrition, and sanitation along with basic primary
healthcare.<o:p></o:p></span></div>
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<span style="font-family: "georgia" , "times new roman" , serif;">The individual and structural problems may differ throughout
the world, but the solution, with many practical local adaptations, remains the
same. A system built on a strong foundation of primary care reaches vulnerable
populations, effectively manages the bulk of their disease burden, and has the
potential to efficiently blaze the trail to success with all SDGs, not just #3,
by 2030. While it is impossible to accurately quantify the societal return on
investment, the time to redirect efforts to implement strong primary care
systems is now. <o:p></o:p></span></div>
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<span style="font-family: "georgia" , "times new roman" , serif;">--<o:p></o:p></span></div>
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<span style="font-family: "georgia" , "times new roman" , serif;">Arguably my favorite part of conferences is the networking. But
the aim is not merely social. Informal interactions amongst colleagues is important
to build in supervisory support in the clinic, create networks for research,
and to learn what others are doing to energize your current efforts at your
home institution or to inspire improvement. Most importantly perhaps, in a
young and growing field, it is nice to simply connect with others in the region
just like you. Young professionals can hear from wiser ones through war stories
shared over dinner and seasoned veterans can impart their knowledge on the next
generation of leaders in their craft.<o:p></o:p></span></div>
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<span style="font-family: "georgia" , "times new roman" , serif;">Before returning back to Chogoria, we stopped to get some food for take away on the road. The residents’ appreciation of their free lunch took me back to the many free dinners and lunches I have been thankful to share with mentors in Texas. “It’s just what your consultants are supposed to do for you. It’s part of it!” I explained. Teaching and mentoring is fun, but it’s the shared meals that solidify the special bonds among physicians at all stages.</span></div>
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<!--EndFragment--><br />
<div class="separator" style="clear: both; text-align: center;">
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<span style="font-family: "georgia" , "times new roman" , serif;"><br /></span><o:p></o:p></div>
Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com0tag:blogger.com,1999:blog-2732810313133560243.post-75864000979888678932016-04-26T07:31:00.001-05:002016-04-26T07:38:30.032-05:00Teachers and Mental Health: The Worthless Currency of Words<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdCQ4dGSoXYKIEK9fObWybaBmpwDcD-lXo-VaVP9C5xLnV6uuobg9pd2mevEmz6GzAW3eUCRSjK7aF1HnwZRdTHqISVJuZQ9194jYOExk8NZ-hSDm7CWrQzstPXnlbUAPrE9d2HfbTIb6A/s1600/IMG_0402.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgdCQ4dGSoXYKIEK9fObWybaBmpwDcD-lXo-VaVP9C5xLnV6uuobg9pd2mevEmz6GzAW3eUCRSjK7aF1HnwZRdTHqISVJuZQ9194jYOExk8NZ-hSDm7CWrQzstPXnlbUAPrE9d2HfbTIb6A/s320/IMG_0402.JPG" width="240" /></a></div>
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<span style="font-family: "georgia";"><br /></span></div>
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<span style="font-family: "georgia";">My Friday morning started as
usual, sitting on my porch reading over coffee, catching up on the latest in
the US presidential primaries. It had been a busy but great couple of weeks of
teaching and learning, to be capped off with the Medicine team leading Journal
Club at 8 a.m. So I set off a bit earlier to ensure I was at the board room on
time. As I walked onto the hospital grounds, I noticed two of my three medical
officer interns (who were supposed to be presenting) were standing outside the medical
ward. I figured that was a bad sign. I asked why they were not preparing for
the start of Journal Club and they informed me the third intern would present
for us while they took care of two unstable patients. <o:p></o:p></span></div>
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<span style="font-family: "georgia";"><br /></span></div>
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<span style="font-family: "georgia";">I sat down in the board
room and before the first Powerpoint slide I got a call on my little Nokia. “Dr.
Travis, please come, we have a code in the male ward.” <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia";">The interns were running a
code, doing chest compressions on a very sick patient. He had Diabetes that was
poorly controlled. Well, it was not controlled at all – he had never taken his
medication. He had now been admitted with extremely high blood sugars and a
foot in which he had lost sensation giving rise to a deep wound causing a
severe system-wide infection. The code went a little over 30 minutes with a few
rounds of adrenaline, potassium, bag-valve-mask ventilation to help the patient
breathe, and intravenous fluids running into both arms. His random blood
glucose was now just above the normal range. We had finally controlled his
sugar, but his anticipated amputation had not occurred soon enough. He passed
away and we de-briefed on how we performed in the code. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia";">Valuable lessons can
usually be learned after a poor outcome. But that outcome has to be identified
before one can know the sequence of events that led to the teachable moment. A
frustration when working in a low-resource setting is that we many times do not
end up with a firm diagnosis. Autopsies are extremely rare (I have not heard of
one done in the last three months). Laboratory investigations can be
unreliable. So, without a definitive answer, we are left to clinical patterns
and team deliberations to decide the lessons learned, or what was missed, following
a difficult case. <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "georgia";">“This ward is so discouraging.”
One of my favorite senior nurses was down after another death. <o:p></o:p></span></div>
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<span style="font-family: "georgia";"><br /></span></div>
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<span style="font-family: "georgia";">We returned for the finale
of Journal Club, where the entire room discussed the (largely detrimental) <a href="http://www.nejm.org/doi/full/10.1056/NEJMoa1509024?af=R&rss=currentIssue" target="_blank">useof steroids in HIV-associated Cryptococcal meningitis</a>. As our team left, we
reviewed the previous call night and our plan for rounds that morning. We arrived
back onto the male ward and the same nurse notified us that our previous
patient’s neighbor had passed. The patient in the bed right next the patient we
coded had died while we were out at Journal Club, and because of his poor prognosis
due to metastatic prostate cancer, there were no plans for resuscitation.<o:p></o:p></span></div>
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<span style="font-family: "georgia";">Rough start to this
Friday!<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "georgia";">One early traumatic death.
One expected, seemingly peaceful death. <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "georgia";">--<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia";">Teaching is not easy. It
requires patience and organization. Preparing a quality lecture takes time.
Arriving at a plan for any clinical scenario takes guiding a young physician
without taking the reigns. This is one skill I have been taking time to develop
while here, and it is an effort that has given me a renewed respect for teacher
friends and my professor father. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia";">Two weeks ago I gave a
lecture on depression. With infectious threats under better control,
non-communicable diseases are on the rise. Mental health issues are commonly
underlying forces driving patient behavior and many times they manifest in
physical signs. Perhaps our diabetic was not compliant because he did not
believe he had the disease or did not understand the diagnosis or was down
about managing a chronic illness for which he could not afford the long-term
treatment. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia";">The recent <a href="https://www.nlm.nih.gov/medlineplus/news/fullstory_158462.html" target="_blank">announcement ofincreasing suicide rates in the US</a> alongside recent writings of the <a href="http://www.aljazeera.com/indepth/features/2016/04/taboo-mental-illness-kenya-160406093345546.html" target="_blank">stigmaassociated with mental health issues in Kenya</a>, in addition to my experience in
managing chronic depression and anxiety among other diagnoses, made me think it
was an appropriate and timely topic to discuss with the residents. Poorly
controlled mental health diagnoses lead to poor compliance with treatment
regimens, decreased productivity at work, increased absenteeism, and an overall
lower quality of life. No matter the label you put on the patient, there are
always psychological issues that could be better addressed to improve their
lives. But our society and our employers sometimes ignore their importance. One
need to look no further than daily current events such as the <a href="http://www.forbes.com/sites/davidkroll/2016/03/13/germanwings-pilot-took-5-drugs-ordered-to-psychiatric-hospital-2-weeks-before-murder-suicide-crash/#5cf0f6a2d120" target="_blank">Germanwings pilotwho flew a plane directly into the ground</a> or the multiple shootings across the
US each month to realize one major thing: we are not adequately addressing
mental health issues worldwide.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "georgia";">Teaching about depression
in an area that does not typically focus on mental health issues gives rise to
interesting discussion. The overall goal is to simply have the residents be
aware of mental issues surrounding each case so that discussions with the
patient and their families may address some potential barriers to care beyond
the hospital. <o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: "georgia";">--<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia";">In the US at least, we do
not value teachers near as much as we should. American society rewards certain
types of business and entertainment, but fails to invest in some of the most critical
vocations or professions. And our healthcare system fails to direct resources
towards issues sometimes difficult to address, such as mental health.<o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia";">So many people say how
important mental health or primary care is, and they say how important teachers
are, but <i style="mso-bidi-font-style: normal;">words</i> do not incentivize
sharp students to become and remain teachers and they do not pay off the
massive educational debt of primary care physicians or psychiatrists and they
do not form the necessary teams to manage the ignored despair that affects
almost everyone, worldwide, on a daily basis. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia";">--<o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia";"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia";">This morning before leaving a patient’s room on the private ward, he asked us to sign the Guest Book. “Like a hotel?!,” I asked confused. He was blind, due to poor diabetic control, and this teacher (more educated than our average patient) wanted to be sure he had a log of those health workers who had cared for him. What an excellent idea, I thought, as the three of us signed before exiting.</span></div>
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Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com1tag:blogger.com,1999:blog-2732810313133560243.post-89764518559537378242016-03-29T10:44:00.004-05:002016-03-29T10:44:52.630-05:00Meeting Joe Black<div class="MsoNormal">
<span style="font-family: Georgia;">The timeliness of watching
Meet Joe Black early in the Easter week experienced here in Chogoria became
apparent only late Sunday evening. Joe Black, played by a young frosty-tipped
Brad Pitt, is perhaps the most attractive physical embodiment of Death ever
created. He comes to get a taste of life the best way possible: alongside
wealthy media mogul Bill Parrish (Anthony Hopkins) who is approaching the
celebration of his 65<sup>th</sup>, and apparently last, year. A bit naïve to
the daily jargon of life, Mr. Black at one point interrupts a board meeting of Parrish’s
company when a board member mentions the certainty of death and taxes. “<i style="mso-bidi-font-style: normal;">Death</i> and taxes?” he asks, appearing
confused and offended. <o:p></o:p></span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia;">This week, the inevitability
of physical death and the promise of life beyond death were juxtaposed in a way
that leaves one pondering most proximately what awaits the deceased after life’s
most final event.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Georgia;">--<o:p></o:p></span></div>
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<span style="font-family: Georgia;">The transition from old
class of Medical Officer (MO) Interns to new class of MOIs came rapidly.
Highlighted by wrapping up Advanced Cardiac Life Support (ACLS) training and a pot-luck
goat roast funded by the hospital Wednesday night complete with speeches from
much of the medical staff, the outgoing MOIs were done with their Intern year
and headed out to work in various posts around the country. The new MOIs were
now on their own, running each of the inpatient services and independently taking
care of patients in the outpatient clinic.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia;">The week after their ACLS
training, a new MOI and one of our residents led a resuscitative success with a
young poorly controlled hypertensive patient. She was shocked once and after
some chest compressions and correcting her potassium level, she was alive.
Depending on the etiology, resuscitations commonly end with death. And this
past week saw a couple of attempts to revive extremely sick patients that ended
poorly.<o:p></o:p></span></div>
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<br /></div>
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<span style="font-family: Georgia;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Georgia;">We showed up for rounds
Thursday morning to find one of the two MOIs on our service missing. She had
gone for a break after spending four of the early morning hours attempting to
resuscitate, and eventually losing, two newly admitted patients. One
transferred from another hospital down the road, another with severe lower
gastrointestinal bleeding. Neither lived to be seen by our staff in the
morning. The fellow MOI covered for his teammate. “She is not in a good
emotional state, so she went to the house.” I was glad the MOI had made the
wise decision to take a break to regroup after a rough morning. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia;">She returned an hour
later. No matter how she felt, a busy medical ward needed to be cared for and
she was their primary physician. The last couple weeks our ward has had many
interesting guests including the rare case of malaria, some brittle diabetics, an
older man celebrating his discharge on the same day as his neighbor’s (“The two
old men are going home!”), and the police officer who was visited on the ward
by his four colleagues wielding a baton, an automatic rifle, and a newspaper.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia;">Towards the end of rounds,
the five-member family of our latest death appeared requesting to speak with
the MOI. The head sister (nurse) in charge on the ward motioned for me to
accompany her and the MOI in the discussion. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia;">What do you say to someone
who has had a family member recently pass away? What if you were the one
entrusted with keeping them alive? <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia;">Many family members here
in our area drop off their family members toward the end of life when they
sense they cannot provide proper care for their loved one. We then do our best
to control their pain and keep them comfortable, managing complications of advancing
cancerous masses, bladder obstructions, severe systemic infections, and
decreased oral intake. There is no Do-Not-Resuscitate (DNR) order here, so the
attempts to revive, and their extent, are decided many times unilaterally by
the MOI on call.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia;">The MOI conducted the
family meeting in a mixture of Kiswahili and English. She explained in detail
the state in which the patient came in, the resuscitation attempt including who
was present and what was achieved, and eventually when the elderly gentleman
died. The nurse answered practical questions about morgue costs and how they
could pay the hospital bill when they eventually took the patient for burial.
The patient’s daughter knew death was imminent, she said. “I just didn’t think
it would be this morning.” They thanked us and went to view their patriarch one
last time. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia;">The MOI admitted afterwards
that she had never broken the news of a death to a family. So we debriefed,
talking mostly about what she had done well and then what she could improve on
for the next time. Remain objective, but show empathy. Discuss details in plain
language, but only as much to be complete and adequately informative. Was my
approach molded within the American system appropriate for this community? My
MOI and I came to a few conclusions. Discussing death is never easy and always
different depending on the circumstances and the family. <o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRztcbg2j0pMSfLN90N-cPtF6KUOoP8jnMdCjeUTqAx7ZjEo8rIw0AuD2ktmSkghYT1JR77nn3y1QFlXl-YIg1XRyhQMfC8zco9mNSMR2AQu0UP1YTaCOIFguJILf9-mHOWu6pphwVSQ9S/s1600/IMG_0414.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="200" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjRztcbg2j0pMSfLN90N-cPtF6KUOoP8jnMdCjeUTqAx7ZjEo8rIw0AuD2ktmSkghYT1JR77nn3y1QFlXl-YIg1XRyhQMfC8zco9mNSMR2AQu0UP1YTaCOIFguJILf9-mHOWu6pphwVSQ9S/s200/IMG_0414.JPG" width="150" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgr08WV75ZNndT4h0ZqSVplg1UAQTpRrLcJS8HKTuzY-pz1lilxyoyKstHrg2n4EQ6NAENRSltwALglczdGNEj6fyzd5Je52wNAlCO4rjMHz7LRM4A5jeBFacaz5jbKedNOnY0eSmD6LTYM/s1600/IMG_0421.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em; text-align: center;"><br /></a><span style="font-family: Georgia;"></span></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgr08WV75ZNndT4h0ZqSVplg1UAQTpRrLcJS8HKTuzY-pz1lilxyoyKstHrg2n4EQ6NAENRSltwALglczdGNEj6fyzd5Je52wNAlCO4rjMHz7LRM4A5jeBFacaz5jbKedNOnY0eSmD6LTYM/s1600/IMG_0421.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em; text-align: center;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgr08WV75ZNndT4h0ZqSVplg1UAQTpRrLcJS8HKTuzY-pz1lilxyoyKstHrg2n4EQ6NAENRSltwALglczdGNEj6fyzd5Je52wNAlCO4rjMHz7LRM4A5jeBFacaz5jbKedNOnY0eSmD6LTYM/s200/IMG_0421.JPG" width="200" /></a><span style="font-family: Georgia;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Georgia;"><br /></span></div>
Then came Easter Sunday.
We started with a service here at our campus Presbyterian 9 a.m. English
service followed by a group lunch with a few missionary families. It was
another beautiful day full of good food and an Easter egg hunt. <span style="font-family: Georgia;">But the
resident was late.</span><br />
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Georgia;">He was called in to assist
with the deteriorating patient we had dealt with for a week-and-half. She had
just given birth to a healthy baby three weeks prior. Originally diagnosed 10
days ago as septic shock due to her low blood pressures and spiking fevers, a
poor condition due to wide-spread infection, and treated with intravenous
hydration and several powerful antibiotics, she was not improving. Further
investigation with a bedside echocardiogram revealed a heart that was almost
not contracting at all and a massive blood clot left by the stagnant blood in
her left ventricle. Postpartum, or peripartum, cardiomyopathy was the new
diagnosis and we prepared to transfer her to a higher level of care. Our
hospital is usually the referral hospital for several smaller facilities
nearby, but now we needed help. Before she could be transferred however, she
passed away early Sunday afternoon. Her three-week-old infant laid wrapped on
the nearby twin bed in the private room with grandmother sitting next to the
baby.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia;">--<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia;">No matter how inevitable,
no matter the medical training in objectivity, death hurts. Seeing a death that
leaves a healthy three-week-old without her mother begs the obvious question of
“Why?” <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia;">Following the death of a
patient, the discussion many times revolves around justifying both to ourselves
and the family that we did “everything we could.” But had we in these cases?
Did we have sufficient knowledge, medications, specialists, technology to “do
everything?” No way. Had she given birth in my hometown of Austin, her chances
of survival would have greatly increased. We could take comfort in knowing we
did all that was possible within the constraints of our local system. But considering
all the resources available on this planet, we had not truly “done everything.”
<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia;">Life is precious and
perhaps work in medicine offers a close-up yet lopsided view of just how
quickly life can change.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: Georgia;">Following the grand
birthday celebration at the end of the movie and after Parrish has accepted his
long, fulfilling life is over, Joe Black and Bill Parrish disappear over the
bridge to his death. How peaceful. That romantic depiction of life and its end
can occasionally be disrupted. Shaken by a lack of control and confronted with
physical death, there must be something beyond that bridge, beyond the mother
leaving her infant, that offers hope. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: Georgia;"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: Georgia;">There is so much we can affect in modern medicine, but sometimes death comes. I choose to think Death came as Brad Pitt here in Chogoria. Perhaps I was just too blinded by the circumstances to even see him.</span></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<br /></div>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuWCcUgkcG91vcbOSEOK__K_evrFSlZQz_a1whMmYyHbHC0yZWDOpYXaKilT16ELA-J8DIbvzu1a-KP8V4lQ0KiNoynEpk36beV3DMJVNfN7FBY6rObe3d3oTJDqLTc73JE4FpYPArvQAB/s1600/IMG_0299.JPG" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjuWCcUgkcG91vcbOSEOK__K_evrFSlZQz_a1whMmYyHbHC0yZWDOpYXaKilT16ELA-J8DIbvzu1a-KP8V4lQ0KiNoynEpk36beV3DMJVNfN7FBY6rObe3d3oTJDqLTc73JE4FpYPArvQAB/s320/IMG_0299.JPG" width="320" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Sunset over Lake Victoria</td></tr>
</tbody></table>
<div class="MsoNormal">
<br /></div>
Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com3Chogoria, Kenya-0.2279535 37.630678200000034-0.243832 37.610508200000034 -0.212075 37.650848200000034tag:blogger.com,1999:blog-2732810313133560243.post-61492468708269938342016-03-08T13:01:00.000-06:002016-03-08T13:11:09.273-06:00"Nice Times"<div class="MsoNormal">
<span style="font-family: "georgia";">It was blazing hot. The
ice in my drink made the cup sweat. I looked up across the horizon. Blue salt
water ahead with the pool in my periphery. This was the life. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg239D0tNURgKnMlD2fzZAQRS-ftP6DrQFwdTh-5rRoTjF8Y5W8olG3AQmWeTyKhrt6Z87VjQu5mkExOCDuTXIP-nvvxA-s1Y0eFCia3M-AFnqHWhgbDVpZYPNQ5ianFRlI2V3ea-o71AgI/s1600/IMG_0210.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="213" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg239D0tNURgKnMlD2fzZAQRS-ftP6DrQFwdTh-5rRoTjF8Y5W8olG3AQmWeTyKhrt6Z87VjQu5mkExOCDuTXIP-nvvxA-s1Y0eFCia3M-AFnqHWhgbDVpZYPNQ5ianFRlI2V3ea-o71AgI/s320/IMG_0210.JPG" width="320" /></a><span style="font-family: "georgia";">Just then, the front my
head started to pound. I looked up at the pots of dinner being served on the Maasai-cloth-covered
picnic table in our hut. I was wearing all the clothes in my bag and it was only
the first night of our three-day climb up Mount Kenya. It was actually near
freezing. And this city boy from Texas was ill prepared, clutching the one-liter
thick plastic water bottle of recently boiled water. The views were incredible
and the company of our six-trekker group assembled by the doctor from New
Zealand made the hikes pass quickly. But the cold nighttime weather in a setting
slightly outside of my comfort zone had me daydreaming. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia";">I have been guilty of
daydreaming before. I’ve even been called out by good friends when they have caught
me distracted. So in this first month away, I have been extra careful to
consciously ensure I’m present. “In the moment,” some call it. But I am not
convinced that is always so easy, or absolutely necessary.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUqzw9SGI-kxzoJRYSqSNwjZAZ76AjhadTDd-oSY8qVE5aEvAL2UPruBQetpReRpWq_hCRt8r2plkz8hq9wnLnkqqP-RaBfY1yEqa6o9QibZULasdNh0VSxH2ld7O3Uc9T1_0nkCk6-RO5/s1600/IMG_3938.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em; text-align: center;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgUqzw9SGI-kxzoJRYSqSNwjZAZ76AjhadTDd-oSY8qVE5aEvAL2UPruBQetpReRpWq_hCRt8r2plkz8hq9wnLnkqqP-RaBfY1yEqa6o9QibZULasdNh0VSxH2ld7O3Uc9T1_0nkCk6-RO5/s200/IMG_3938.JPG" width="200" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjA2QJGJBTpbhnxdcaaq17hd_lI1lbhY-Eru84tc1r3gyEjkffKftYlz-8C4spWEJLkdVhTYGwl7aGMrC7lJ3jvLF5ibtnqcUjj1qSEUMXVD7kc0zxJuB8gqgZTwwdZ98Y-IVxoDbl_QanY/s1600/IMG_3941.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjA2QJGJBTpbhnxdcaaq17hd_lI1lbhY-Eru84tc1r3gyEjkffKftYlz-8C4spWEJLkdVhTYGwl7aGMrC7lJ3jvLF5ibtnqcUjj1qSEUMXVD7kc0zxJuB8gqgZTwwdZ98Y-IVxoDbl_QanY/s200/IMG_3941.JPG" width="200" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhChEnJyw-XdW0jqJtINwm0Ai_KzoHZyGaFujAxCF1DHTDuAcqhhIuBGXkz3TkigYrkeoqsKVERpcSkeWwWg4B4pDslq6EwJ5ugfUmUFE6Nf4pagoQuCMD7dz9WQKcJJvG0xZB9EhUTmEml/s1600/IMG_3948.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"></a></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhChEnJyw-XdW0jqJtINwm0Ai_KzoHZyGaFujAxCF1DHTDuAcqhhIuBGXkz3TkigYrkeoqsKVERpcSkeWwWg4B4pDslq6EwJ5ugfUmUFE6Nf4pagoQuCMD7dz9WQKcJJvG0xZB9EhUTmEml/s1600/IMG_3948.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhChEnJyw-XdW0jqJtINwm0Ai_KzoHZyGaFujAxCF1DHTDuAcqhhIuBGXkz3TkigYrkeoqsKVERpcSkeWwWg4B4pDslq6EwJ5ugfUmUFE6Nf4pagoQuCMD7dz9WQKcJJvG0xZB9EhUTmEml/s200/IMG_3948.JPG" width="200" /></a></div>
<br />
<div class="MsoNormal">
<span style="font-family: "georgia";">--</span><br />
<span style="font-family: "georgia";"><br /></span>
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9xkYn88xgGIFnya0pBHBP_F9V5EFPKnbYv660rlHP9Yy2KOc2fUw1mZZImj6bEOJu0hgYkzGRzD2KMgG1AP_wqEwyqjpfnPxeFCciUPVBGOeP37a_IZm716HFWARH2YocCVWAIE28Owp_/s1600/IMG_3967.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEj9xkYn88xgGIFnya0pBHBP_F9V5EFPKnbYv660rlHP9Yy2KOc2fUw1mZZImj6bEOJu0hgYkzGRzD2KMgG1AP_wqEwyqjpfnPxeFCciUPVBGOeP37a_IZm716HFWARH2YocCVWAIE28Owp_/s200/IMG_3967.JPG" width="200" /></a><span style="font-family: "georgia";">The excursion to Mt. Kenya
was something I had considered prior to coming to Chogoria, so when the group
effort had already been coordinated, I decided to take my first trip out of
town. We traveled by matatu to Tumutumu to be hosted the night before by a young
Pediatrician and her husband from the UK. They fueled us up with chapati and
vegetables before the climb. The following morning, we had a proper cappuccino en
route to stock up on snacks at the Nakumatt supermarket in Nanyuki before
entering the park. It is a beautiful but challenging climb, with the second day
requiring an 8-hour, 10-mile, steadily uphill trek. That day left me feeling
lousy (perhaps with a bit of the 13,000-foot altitude contributing) at base
camp, so I decided against summiting the next morning. Many say Mt. Kenya is
tougher than Mt. Kilimanjaro and I now know why.</span></div>
<div class="separator" style="clear: both; text-align: center;">
</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYnNBk8SoGOYRGcaX7GTWFKE_ZOmKhJSNvbx1FKiQqGlurFffVHJGQ3oTVJ8efiwAqbeL61FV_kRe5kJuumclFXdsPmqaXQDBmwk6ixAS936AVGcTEOo-wRoiDtvieR8AXHvDqol0DTyQI/s1600/IMG_4008.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhYnNBk8SoGOYRGcaX7GTWFKE_ZOmKhJSNvbx1FKiQqGlurFffVHJGQ3oTVJ8efiwAqbeL61FV_kRe5kJuumclFXdsPmqaXQDBmwk6ixAS936AVGcTEOo-wRoiDtvieR8AXHvDqol0DTyQI/s200/IMG_4008.JPG" width="200" /></a><span style="font-family: "georgia";">Following the descent, we
were delivered by our guides to a freezing cold shower at Camel Camp, where our
final night’s accommodation was in pastoral huts amongst roaming (you guessed
it) camels. The following 18 hours replenished the depleted calorie stores and allowed
us to soak up the luxuries of the bigger Nanyuki town. Pedicures for the girls,
haircut and Irish pub for the boys, a late lunch at <a href="https://www.tripadvisor.co.uk/Restaurant_Review-g612348-d1145982-Reviews-Trout_Tree-Nanyuki_Rift_Valley_Province.html" target="_blank">Trout Tree</a>, and last but
surely not least, the infamous brunch feast at the <a href="http://www.fairmont.com/mount-kenya-safari/" target="_blank">Mt. Kenya Safari Club</a>. Three
thousand shillings ($30), all you can eat buffet including fresh fruit, smoked
salmon, multiple cheeses, grilled tomatoes, made-to-order omelettes, sweet
breads, cappuccinos, all with a view of the mountain and the colorful hotel
grounds. We stocked up with provisions at Nakumatt once more on our way out of
town to ensure some comforts made it back to Chogoria.<o:p></o:p></span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8sG0UMYYDWZ_HS5_rHsWOxqnCfoAPB5CrcNaxbWlpyPYSc7RQHa0mpOSOrjiTTLHh_cDx_anEpndZMb_CVeYYbH0nqJ4xpKmWxa-crBh7NSQYPc0-cmTTGUdgZlde30wf4PJq45P-Dvmz/s1600/IMG_4015.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><br /></a></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8sG0UMYYDWZ_HS5_rHsWOxqnCfoAPB5CrcNaxbWlpyPYSc7RQHa0mpOSOrjiTTLHh_cDx_anEpndZMb_CVeYYbH0nqJ4xpKmWxa-crBh7NSQYPc0-cmTTGUdgZlde30wf4PJq45P-Dvmz/s1600/IMG_4015.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi8sG0UMYYDWZ_HS5_rHsWOxqnCfoAPB5CrcNaxbWlpyPYSc7RQHa0mpOSOrjiTTLHh_cDx_anEpndZMb_CVeYYbH0nqJ4xpKmWxa-crBh7NSQYPc0-cmTTGUdgZlde30wf4PJq45P-Dvmz/s200/IMG_4015.JPG" width="200" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxePu0BrZQlRB2QqGTuuM033dRP7sdahnDzV1QyPhP4etBBiW65FBPPKzQ1CLz8dBHXHLQR41pxeykZA_BWqrSU7cADSpHALabmT-RrLE0YS7670xkcrpOxIOL3-nM37rndGh2iaDipn0Z/s1600/IMG_4013.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em; text-align: center;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgxePu0BrZQlRB2QqGTuuM033dRP7sdahnDzV1QyPhP4etBBiW65FBPPKzQ1CLz8dBHXHLQR41pxeykZA_BWqrSU7cADSpHALabmT-RrLE0YS7670xkcrpOxIOL3-nM37rndGh2iaDipn0Z/s200/IMG_4013.JPG" width="200" /></a><span style="font-family: "georgia";"><o:p> </o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia";"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia";"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia";"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia";"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia";"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia";"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia";"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia";"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia";">--</span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia";">On the walk home from work
the following evening, a man stopped the car on his way out of the hospital’s
housing compound. I was with one of the three new physicians from Michigan, in
town for a one-month residency rotation. The man stuck his hand out the driver
window. “My son – I just dropped him off. He will work at the hospital.” The
former camp counselor (and chief resident) came out in me: “Excellent! We’ll
take good care of him,” as I shook his hand. The new interns had arrived.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia";">Medical Officers (MO) are
those who have just graduated medical school. The MO Interns are those doing
their one year of government-assigned rotating training. We have 10 just
starting and roughly that many moving on, overlapping for three weeks. The new
ones are energetic, ready to learn and serve. The old ones are drained and
quick to draw up the call schedule for the new interns, suggesting starting
them the day after they arrived in Chogoria. Fortunately, the rookies got a
short introduction to the electronic medical record and a tour before being
thrown in. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPXDM3haeOto1X-MDT4XrmHYKRfr39QZ1hQ34l1_L9u5410SQrI-MX7d67hTZD0ymLWa9EcllnMz0VHILDGRsl4yLhs2Kc10Nvs6RYjalYPve84uQ5MUmNU2aTcyASi6MyIT5GkPBVXg32/s1600/IMG_0250.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em; text-align: center;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjPXDM3haeOto1X-MDT4XrmHYKRfr39QZ1hQ34l1_L9u5410SQrI-MX7d67hTZD0ymLWa9EcllnMz0VHILDGRsl4yLhs2Kc10Nvs6RYjalYPve84uQ5MUmNU2aTcyASi6MyIT5GkPBVXg32/s200/IMG_0250.JPG" width="200" /></a><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDYnvaPQhm-HELJFentSVCbg59kCmAgS_yEtiKqvnGV5gxJ-rO8x06x2mjBX4OiNA6guWD7VUvtUE-2UvkonE5FERE4shk2K9OiZ2pS-hWVEjedjjUeZ7lB2XPn9G5EnWU3oy4cLRCeUiV/s1600/IMG_0245.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="150" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhDYnvaPQhm-HELJFentSVCbg59kCmAgS_yEtiKqvnGV5gxJ-rO8x06x2mjBX4OiNA6guWD7VUvtUE-2UvkonE5FERE4shk2K9OiZ2pS-hWVEjedjjUeZ7lB2XPn9G5EnWU3oy4cLRCeUiV/s200/IMG_0245.JPG" width="200" /></a><span style="font-family: "georgia";">This week we have them out
for an Advanced Cardiac Life Support (ACLS) class. This has proven popular with
a couple other (higher-ranking, technically) MOs already at the hospital who
have sat in on some sessions. Our two residents have been active in teaching the
course alongside the Michigan physicians, one of the new young American missionary
physicians, and me. Dr. Ritchie, the program director, put in great effort to schedule
this course, coordinate the teaching schedule, and block time away for the new
interns.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia";">Anyone who has completed or
worked in a residency program can tell you: blocking time off for interns can
be a surprisingly high hurdle requiring crisis-level diplomacy. If new interns
are out, that means old interns, or others, have to work. This ACLS training
and the call coverage debate brought back fond memories of residency. These
days for the course can be lighter, less stressful, and afford rare time for
the intern class to build camaraderie all together. Internship and Residency
can be trying on many levels, but the support of your classmates makes it
tolerable. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia";">Socially, the interns appear
to be settling in well, having perfect attendance at the regular Friday night
Pizza Night and a strong presence at the Sunday brunch hosted by the Michigan
crew despite some of the interns being on call. There is nothing like free food
to attract young physicians, no matter where you live.<o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia";">Adapting to the role of
attending, or “consultant,” has been enjoyable. In morning lectures, residents
and interns get called on, while consultants offer advice based on experience.
On rounds or in clinic, younger physicians practice medicine and deliver direct
care, consultants offer suggestions, guide discussion, and occasionally dive
deeper into topics questioned. The expanded opportunities for research and
teaching are a welcome shift in daily duties. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
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<span style="font-family: "georgia";">--</span></div>
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<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia";">Living in the moment,
enjoying your present, can be a challenge. Slowing down and just being here in
Chogoria has taken an unpredictably difficult adjustment from my life in
Austin. The daydreaming and living in the future got me here. So, I find it
hard to believe that it is all bad as sometimes living in the present requires
context. Keeping your vision or your inspiration in focus, I have realized, holds
up the backdrop. The present is the main show.</span></div>
<br />
<div class="MsoNormal">
<span style="font-family: "georgia";">Every time my housekeeper
Catherine leaves my place, she thanks me and says goodbye. “Nice times,” she’ll
say as she departs. Surely the meaning of that does not perfectly translate,
but I cannot stop repeating that aloud to myself. “Nice times.” Nice times,
indeed. <o:p></o:p></span></div>
Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com1tag:blogger.com,1999:blog-2732810313133560243.post-62970334585597982862016-02-14T09:36:00.000-06:002016-02-14T09:39:57.201-06:00The Chogoria Pattern<div class="MsoNormal">
<span style="font-family: "georgia";">“We are out of vitamin
K?...and streptomycin?” “Yes, but her family can go try to find it at a
pharmacy in Nairobi.” The Intern called Mugao, our team’s nucleus, explained
the stock-out. “You know, they say that in places without many facilities, God
works harder.”<o:p></o:p></span></div>
<div class="MsoNormal">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiODSQQkhdRU9ecSiarPosWg1dgI-dbSMqCEuUoAMn36492TmgiV8lNrpw7BnHnFpNK2S8vhDadcj39ynf5GlikqykQvHwc2DQu2GdtvH84D0J8GGBqh3IG0YkNJpw6b8VpcT-rSnMxOrtZ/s1600/IMG_0160.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiODSQQkhdRU9ecSiarPosWg1dgI-dbSMqCEuUoAMn36492TmgiV8lNrpw7BnHnFpNK2S8vhDadcj39ynf5GlikqykQvHwc2DQu2GdtvH84D0J8GGBqh3IG0YkNJpw6b8VpcT-rSnMxOrtZ/s320/IMG_0160.JPG" width="240" /></a></div>
<br />
<div class="MsoNormal">
<span style="font-family: "georgia";">It is amazing how quickly
life circumstances can change in two weeks. I was dropped at my flat on the
PCEA Chogoria Hospital grounds just 12 days ago. It was mid-afternoon and I
needed to plan for dinner. That requires cooking. Which requires utensils. And
a stove. And food. All of which require shopping. You get the point.<o:p></o:p></span></div>
<div class="MsoNormal">
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMVbaBhcM5xQw5G62IcjMjja6ppCGNTrl2fmWDGvdGf93ijH4wOMSKHunqges2iswG5rHdq0xrAx5w33VuvTNqpbCjDX9-Tr-_nWdpQRACBNaJ-_YMiyIMlj9A7jHbJDj9BNWy54cBLSMa/s1600/IMG_0147.JPG" imageanchor="1" style="clear: left; float: left; margin-bottom: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhMVbaBhcM5xQw5G62IcjMjja6ppCGNTrl2fmWDGvdGf93ijH4wOMSKHunqges2iswG5rHdq0xrAx5w33VuvTNqpbCjDX9-Tr-_nWdpQRACBNaJ-_YMiyIMlj9A7jHbJDj9BNWy54cBLSMa/s320/IMG_0147.JPG" width="320" /></a></div>
<div class="MsoNormal">
<span style="font-family: "georgia";">Meticulous planning simply
cannot prepare you for some things. Fortunately, my transition into life in
Chogoria has been eased by the guidance and generosity of many key people.
Leonard, the hospital staffer who does the work of three people, along with his
staff that look after housing, helped fix leaks and ensure my kitchen was
equipped with essentials like plates, bowls, and a coffee cup. The Webbers, a
long-term missionary family with three of the cutest kids under the age of
five, recently in from Uganda, welcomed me with dinner last weekend and a tense
game of Ticket to Ride. The three international NGO staff have helped with
critical local intel and sorting out a water filter. After multiple failed shopping
attempts in Nairobi by others, Dr. Yulu (one of the residents) returned from
Meru a hero yesterday with a modem to get me online at my flat! And finally,
Mrs. Ritchie, our program director’s wife, the physical therapist, homeschool
teacher, and mother of six, greeted me within an hour of arrival and helped me
with everything from my first two dinners to a coffee pot to key introductions
around town to a block of cheddar cheese.</span></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjsxL55FA3xzmAPQMKe-O8peVavrpSox_rvRd2eUFUgDbEjbVz6JKzKamWexDO1ZWbDgmp-QjcDptfBsN1d2tEDBhUpO4GGYU3x4_lT8wFe5c3IgnjD1Cit3KKlIIlvMfSHamiuA_VJba4I/s1600/IMG_0137.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><br /></a></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaqIcAJnNnHTxAgQLWGAjHVSUDf8_PcYzSG0Ur9xN6OxVd5e_y9OlSyZDW3KWSsMx4rDpHR3fcwX_0TD9pIHUf4mrhvqoBAG4GCg_4aJ_yZs-EJcjdEyJVKpxFsxaWu7otcIX96nsv3sM4/s1600/IMG_0139.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhaqIcAJnNnHTxAgQLWGAjHVSUDf8_PcYzSG0Ur9xN6OxVd5e_y9OlSyZDW3KWSsMx4rDpHR3fcwX_0TD9pIHUf4mrhvqoBAG4GCg_4aJ_yZs-EJcjdEyJVKpxFsxaWu7otcIX96nsv3sM4/s320/IMG_0139.JPG" width="240" /></a><span style="font-family: "georgia";">My flat was renovated and
painted in anticipation of my arrival. I am getting into the routine of buying
fresh vegetables and fruits in the markets, finding zucchini, green peppers,
tomatoes, mango, and apples, and cooking in the evenings. My new housekeeper
came Friday and worked especially hard on the first deep clean. She is also helping
me with washing and chopping vegetables in addition to laundry. She laughed at
my lack of cleaning supplies, but is helping me provision to this end. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia";"><br /></span></div>
<div class="MsoNormal">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGWwTjRIDRp60YXMiwPvX4TGu5tKeCwpP7hnyDWr8hRgkhnv4IU-lbSN-oHLb51Mita5msJzyXxfUNi_XtQZTgHWtjKqzFxtiHGbo8BevN2kRgBmH4vxDdL315MmlBf7787nE7qReugmg2/s1600/IMG_0149.JPG" imageanchor="1" style="display: inline; margin-left: 1em; margin-right: 1em; text-align: center;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgGWwTjRIDRp60YXMiwPvX4TGu5tKeCwpP7hnyDWr8hRgkhnv4IU-lbSN-oHLb51Mita5msJzyXxfUNi_XtQZTgHWtjKqzFxtiHGbo8BevN2kRgBmH4vxDdL315MmlBf7787nE7qReugmg2/s320/IMG_0149.JPG" width="320" /></a></div>
</div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgANnxc9lbtStG-yLANAGPsJ7hXpo20t2ecMLIifVL-Y1muWYPqIAaikrrTN7Q3cR9pZ24nGbqRu5de64Tp8g5wuJ2pMnpGNyGOf78iy1swlfFOZmjjikFQZjREjUnRCzaCSpKCM690rAdS/s1600/IMG_0166.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgANnxc9lbtStG-yLANAGPsJ7hXpo20t2ecMLIifVL-Y1muWYPqIAaikrrTN7Q3cR9pZ24nGbqRu5de64Tp8g5wuJ2pMnpGNyGOf78iy1swlfFOZmjjikFQZjREjUnRCzaCSpKCM690rAdS/s320/IMG_0166.JPG" width="320" /></a><span style="font-family: "georgia";">News of the drug stock-out
came during rounds in the adult female medical ward. The day starts with
breakfast and coffee on my back porch, enhanced by the daily sounds of over a
hundred serenading secondary school girl voices coming from their four-story
complex just over the hedge at 7:30 a.m.<span style="mso-spacerun: yes;">
</span>Then, lecture at 8 a.m. with all Interns, clinical officers (CO),
residents, and consultants. After my introduction on Day 1, we hit rounds.
There are usually roughly 50 adult inpatients on the medicine service, and thus
they have split into two teams, each led by a Medical Officer (MO) Intern. One
team has a Physician Assistant from the States, Derek (father Webber), and Dr.
Ikunda the CMO of the hospital. My team has the Burundian Dr. Boaz, one of the
two Family Medicine residents, and me as the consultant (attending). Rounding
on roughly 25 patients can take until 12:30 or 1 p.m., but rounding on the
entire 56-patient service, as my team did last Saturday, can take longer
despite the earlier start. Supposedly our service is a bit busier this week
thanks to transfers from the public hospital down the road in Chuka where the
<a href="http://www.the-star.co.ke/news/2016/02/11/tharaka-nithi-patients-moved-as-nurses-strike_c1292571" target="_blank">nurses have been on strike since Monday</a>.<o:p></o:p></span></div>
<div class="MsoNormal">
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<div class="MsoNormal">
<span style="font-family: "georgia";">Our service has patients
with pulmonary tuberculosis (TB), AIDS, cryptococcal meningitis, extrapulmonary
TB including meningitis and pericarditis, uncontrolled diabetes or
hypertension, congestive heart failure, rheumatic heart disease, nephrotic
syndrome, and substance abuse including a suicide attempt with pesticide. It
feels like our team averages one or two deaths per day. This occurs without the flurry
of a Code Blue, without commotion. The patient is physically gone from their
bed the following morning. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAeRw3_q1_Wd6z3krCn0BV3Kg89rFkW8b4L3vHhK-7yUc750Z1qk3EbZBLA_QeAt11r1l0TpGXhLzyMS9yPuii8bXXVBNL9wyqDkR94F27T_RdlB3VkkTAh6U6FIW91u6cOaJ0usZ5tbm6/s1600/IMG_0144.JPG" imageanchor="1" style="clear: right; float: right; margin-bottom: 1em; margin-left: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiAeRw3_q1_Wd6z3krCn0BV3Kg89rFkW8b4L3vHhK-7yUc750Z1qk3EbZBLA_QeAt11r1l0TpGXhLzyMS9yPuii8bXXVBNL9wyqDkR94F27T_RdlB3VkkTAh6U6FIW91u6cOaJ0usZ5tbm6/s320/IMG_0144.JPG" width="320" /></a><a href="http://www.thelancet.com/series/faith-based-health-care" style="font-family: Georgia;" target="_blank">Depending on the source you read</a><span style="font-family: "georgia";">, faith-based health providers (FBHPs) provide anywhere from 20% -
50% of healthcare in sub-Saharan Africa. </span><a href="http://www.pceachogoriahospital.org/" style="font-family: Georgia;" target="_blank">PCEA Chogoria Hospital</a><span style="font-family: "georgia";"> is a 300-bed hospital
founded in 1922 founded by Scottish missionaries. It is a faith-based health
facility which accepts the </span><a href="http://www.nhif.or.ke/healthinsurance/" style="font-family: Georgia;" target="_blank">Kenyan National Health Insurance Fund (NHIF)</a><span style="font-family: "georgia";"> for
both in- and out-patient care, although the newly implemented outpatient coverage of $1 per month per patient does not
even cover the costs of a chest X-ray ($5). The insurance fund pays roughly $22
per night in the hospital, but the patients pay out of pocket for specialized
imaging like ultrasounds ($12), CT scans ($80 - $100) or medications not found
in our pharmacy. Of course, the hospital accepts cash as well, and the very
basic inpatient costs start at about $5 to cover linens and food, which is
usually porridge. If the patient cannot pay their bill on discharge, they are
kept in-house until they can, increasing their debt to the hospital. <o:p></o:p></span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiN8DRHCLjU-EVcV0m_k2c1jq53SEX_c9I60adyrBKuwNM1yBq6DFNLc1X1WTvrKjHUiT-7zfcAiLNc62V2mSQQHqDT2lxO4afViKlV8ESgh6wYa6c5b_1_5T4E6r5kEBjfhG-m388FO8J-/s1600/IMG_0158.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiN8DRHCLjU-EVcV0m_k2c1jq53SEX_c9I60adyrBKuwNM1yBq6DFNLc1X1WTvrKjHUiT-7zfcAiLNc62V2mSQQHqDT2lxO4afViKlV8ESgh6wYa6c5b_1_5T4E6r5kEBjfhG-m388FO8J-/s320/IMG_0158.JPG" width="320" /></a></div>
<div class="MsoNormal">
<span style="font-family: "georgia";"><br /></span></div>
<div class="MsoNormal">
<span style="font-family: "georgia";">The afternoons are usually
devoted to clinic time or reserved for teaching sessions with the residents. More
time will be spent in the outpatient setting in the coming weeks, now that we
have a rhythm with the inpatient service. Traditionally though, these MOs on
the inpatient medicine service only see their consultant roughly weekly, so
they are used to the autonomy. Our Intern has been here at the hospital for almost
a year and is strong, but we will exchange his class of interns for a new one
in the next couple months, depending on government postings. <span style="mso-spacerun: yes;"> </span><o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<span style="font-family: "georgia";">The evening ends with
cooking dinner, reading, and usually more nighttime singing coming from the secondary
school. <o:p></o:p></span></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisBiOt2KB4INixJx-YEiV3co_dWBxfcI8mwOmm0U46OuNeT6WOfvA3y_kIo8P5Rxd-4DUO2X5jQaP6jqGKs-_8wDKJBIjPjvtGzJOxFe07CFRgqZud8ldH0XTPGY4SDL1A1YNw0j3HrQR8/s1600/IMG_0142.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEisBiOt2KB4INixJx-YEiV3co_dWBxfcI8mwOmm0U46OuNeT6WOfvA3y_kIo8P5Rxd-4DUO2X5jQaP6jqGKs-_8wDKJBIjPjvtGzJOxFe07CFRgqZud8ldH0XTPGY4SDL1A1YNw0j3HrQR8/s320/IMG_0142.JPG" width="320" /></a></div>
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<div class="MsoNormal">
<span style="font-family: "georgia";">Early in the week, one of
our 60 year-old patients on the female ward began complaining of bilateral leg
numbness and weakness just as her discharge was imminent. She was closest to
the entrance and near the middle of the 32-bed female ward. The curtains to
separate patients are typically not drawn. Dr. Boaz asked in Kiswahili if she
had been up walking around at all and she said indeed she had. Her two
neighbors on her row laughed out loud! The patient smiled. “Really, how far did
you walk?,” he asked. Our patient, busted, pointed to the other side of the
small ward. The other patients and our team all laughed along.</span><br />
<span style="font-family: "georgia";"><br /></span></div>
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<w:LsdException Locked="false" Priority="9" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="heading 8"/>
<w:LsdException Locked="false" Priority="9" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
Name="index 8"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" Priority="39" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="35" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="10" QFormat="true" Name="Title"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="1" SemiHidden="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="11" QFormat="true" Name="Subtitle"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="22" QFormat="true" Name="Strong"/>
<w:LsdException Locked="false" Priority="20" QFormat="true" Name="Emphasis"/>
<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" SemiHidden="true" UnhideWhenUsed="true"
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<w:LsdException Locked="false" Priority="39" Name="Table Grid"/>
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<w:LsdException Locked="false" Priority="60" Name="Light Shading"/>
<w:LsdException Locked="false" Priority="61" Name="Light List"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1"/>
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<w:LsdException Locked="false" Priority="65" Name="Medium List 1"/>
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<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1"/>
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<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3"/>
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<w:LsdException Locked="false" Priority="71" Name="Colorful Shading"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 1"/>
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<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 1"/>
<w:LsdException Locked="false" SemiHidden="true" Name="Revision"/>
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<w:LsdException Locked="false" Priority="30" QFormat="true"
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<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 1"/>
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<w:LsdException Locked="false" Priority="61" Name="Light List Accent 3"/>
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<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 4"/>
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<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 5"/>
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<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 5"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 5"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 5"/>
<w:LsdException Locked="false" Priority="60" Name="Light Shading Accent 6"/>
<w:LsdException Locked="false" Priority="61" Name="Light List Accent 6"/>
<w:LsdException Locked="false" Priority="62" Name="Light Grid Accent 6"/>
<w:LsdException Locked="false" Priority="63" Name="Medium Shading 1 Accent 6"/>
<w:LsdException Locked="false" Priority="64" Name="Medium Shading 2 Accent 6"/>
<w:LsdException Locked="false" Priority="65" Name="Medium List 1 Accent 6"/>
<w:LsdException Locked="false" Priority="66" Name="Medium List 2 Accent 6"/>
<w:LsdException Locked="false" Priority="67" Name="Medium Grid 1 Accent 6"/>
<w:LsdException Locked="false" Priority="68" Name="Medium Grid 2 Accent 6"/>
<w:LsdException Locked="false" Priority="69" Name="Medium Grid 3 Accent 6"/>
<w:LsdException Locked="false" Priority="70" Name="Dark List Accent 6"/>
<w:LsdException Locked="false" Priority="71" Name="Colorful Shading Accent 6"/>
<w:LsdException Locked="false" Priority="72" Name="Colorful List Accent 6"/>
<w:LsdException Locked="false" Priority="73" Name="Colorful Grid Accent 6"/>
<w:LsdException Locked="false" Priority="19" QFormat="true"
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<w:LsdException Locked="false" Priority="21" QFormat="true"
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<w:LsdException Locked="false" Priority="31" QFormat="true"
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<w:LsdException Locked="false" Priority="32" QFormat="true"
Name="Intense Reference"/>
<w:LsdException Locked="false" Priority="33" QFormat="true" Name="Book Title"/>
<w:LsdException Locked="false" Priority="37" SemiHidden="true"
UnhideWhenUsed="true" Name="Bibliography"/>
<w:LsdException Locked="false" Priority="39" SemiHidden="true"
UnhideWhenUsed="true" QFormat="true" Name="TOC Heading"/>
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<div class="MsoNormal">
<span style="font-family: "georgia";">In medicine, we are taught
to recognize patterns. And just as you get used to hearing all the stories that
neatly fit into a particular diagnosis, someone says something that just does
not sound right. Alarm bells are raised and the search for disease begins.
After two weeks in Chogoria, my daily home and work routines, and the pattern
of seeing incredibly ill patients, has all started to feel familiar. But one
thing that is hard to simply accept is the vast difference between the
pharmaceutical, imaging, funding, and health worker resources available here
and those found in higher income countries needed to protect privacy and afford
this community sufficient health care to thrive. For now, we will welcome the distraction
of mid-rounds laughter along with the patient innocently lying about her walking
effort. <o:p></o:p></span></div>
Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com2Chogoria, Kenya-0.2279535 37.630678200000034-0.243832 37.610508200000034 -0.212075 37.650848200000034tag:blogger.com,1999:blog-2732810313133560243.post-36302035358123778482015-12-24T09:25:00.001-06:002015-12-24T09:25:27.387-06:00Alternative Gifts
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During this holiday season, and as 2015 comes to a close,
many are searching for meaningful “alternative” gifts to give. While my expertise is in
healthcare, let me suggest a few reputable organizations that are doing good in
my hometown and around the world.</div>
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<o:p></o:p></div>
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<br /></div>
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<i>Austin</i><o:p></o:p></div>
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<br /></div>
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<a href="http://www.getupproject.org/for-donors/4586121740" target="_blank">Hope Medical Clinic</a> offers healthcare to political refugees
settled in Austin through the United Nations’ resettlement program.
Unfortunately, their initial health coverage in the form of Medicaid lasts only
eight months. Then, most of these refugees from Bhutan, Nepal, and Iraq are
left uninsured, yet needing the same preventive, chronic, women’s, physical
therapy, and dental care that we all need. Hope runs purely on volunteer
support and is a way to help refugees here in our own backyard.<o:p></o:p></div>
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<br /></div>
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The <a href="http://www.austinprepaccessproject.org/you-can-help1.html" target="_blank">Austin PrEP Access Project</a> evaluates patients for
Truvada, to be taken as Pre-Exposure Prophylaxis against HIV. High-risk
patients are evaluated by volunteer medical providers and monitored through
regular blood draws funded by private donors. PrEP has proven <a href="http://www.nytimes.com/2015/09/03/health/insurer-says-clients-on-daily-pill-have-stayed-hiv-free.html" target="_blank">wildly successfulin lowering HIV incidence in San Francisco</a>, saving lives and saving costs for
the local community.<o:p></o:p></div>
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<br /></div>
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<i>Global</i><o:p></o:p></div>
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<br /></div>
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Samaritan’s Purse through its World Medical Mission funds
short-term medical missionaries in settings requesting assistance around the
world. This faith-based organization places physicians, dentists, and other
personnel and supplies into resource-poor settings. I will be teaching as
volunteer faculty at PCEA Chogoria Hospital’s new Family Medicine residency
program through Kabarak University from February through June 2016. Samaritan’s
Purse’s World Medical Mission is assisting in coordinating my documentation,
travel, and funding. <a href="http://www.samaritanspurse.org/medical/wmm-doctors/" target="_blank">Follow this link, search for my name</a>, and be assured your tax-deductible
funds will go to essentials such as travel, food, visas, and my Kenyan medical
license. <o:p></o:p></div>
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<a href="https://www.medictomedic.org.uk/help-us/donate/packages" target="_blank">Medic to Medic</a> funds education for physicians in low-income
areas. The US has 2.5 physicians per 1,000 people; Malawi has less than 0.1
physicians per 1,000. This is a sustainable way to fund the education of health
workers where they are needed most. You could fund a medical student’s tuition
and all supplies for just $750 per year. A close UK-based physician friend of
mine is an organizational leader.<o:p></o:p></div>
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<a href="http://seedglobalhealth.org/" target="_blank">SEED Global Health</a> is a public-private partnership with the
US Peace Corps designed to place American physicians and nurses in medical/nursing
school and residency training settings as faculty to assist in educating
physicians, nurses, and clinical officers in low-income countries. Being a
uniquely American NGO, this organization funds some educational debt repayment
for each year of service. I will be teaching with SEED from July 2016 through
June 2017.<o:p></o:p></div>
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In my opinion, these three global options all represent
sustainable steps towards universal health coverage in some of the poorest
areas on the globe. Please join me in supporting these servant organizations.
Have a wonderful holiday season and a Happy New Year!<o:p></o:p></div>
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<!--EndFragment-->Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com1tag:blogger.com,1999:blog-2732810313133560243.post-68954395873765942242014-10-26T05:52:00.000-05:002014-10-26T05:52:20.464-05:00A World of Difference<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBwXxRxNsFHT_oQ16zIwh7jZo_NeDC3lHuedt_q0TNKtiAQWldvuQzRaqE2a6cVvlwIbND6_Jzwjr1aPNYlFvR7dSn7PyPFAvADwzT4LpliumijzH66szAhyphenhyphenNDIihBP3bWBo8P5hokgVTh/s1600/IMG_0983.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgBwXxRxNsFHT_oQ16zIwh7jZo_NeDC3lHuedt_q0TNKtiAQWldvuQzRaqE2a6cVvlwIbND6_Jzwjr1aPNYlFvR7dSn7PyPFAvADwzT4LpliumijzH66szAhyphenhyphenNDIihBP3bWBo8P5hokgVTh/s1600/IMG_0983.jpg" height="320" width="240" /></a></div>
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“You should try the cheese and chocolate,” she said. “Cheese
and chocolate?!” A confused facial expression accompanied my response. The local
Stone Town woman smiled warmly under her ornate hijab and instilled confidence
in this <i style="mso-bidi-font-style: normal;">Zanzibar pizza</i> chef – she was
a regular. I couldn’t decide between the savory tomato, meat, and cheese or the
sweet nutella, chocolate, and banana. She’d made my decision for me. “Don’t
worry,” she said as she walked off with her pizza in hand, “you’ll try it
anyway - this one’s on me.” </div>
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The first few times I traveled in sub-Saharan Africa, it was
only natural to be confronted with how different this was from my world. There
were people living in conditions like I’d never seen, receiving healthcare in
clinics and hospitals considered substandard in Texas, and those with cultural
practices and beliefs that seemed so odd. I was confronted with these
differences each day, smelling the air, hearing the sounds, feeling the heat,
stomaching the tastes. But following a more prolonged stay, becoming more
comfortable with the setting, and after wading past the differences, I’ve started
to appreciate all of the similarities. Why is the focus so frequently on our
differences?</div>
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In American politics, we focus on what distinguishes one
candidate from another, bringing us to the polarized place in which we find
ourselves. In religion, one hears the call to prayer and sees the dress and
thinks about the divergence of Muslims from Christians. In healthcare,
physicians are trained to observe or judge patients based on differences in
culture, gender, generation, or sexual preferences. And in current events, the
media highlights the many challenges our dissimilarities have brought us.
Perhaps if our global village started to focus on our similarities, our mutual
reliance on a healthy economy and environment, and our collective desire for
basic necessities, we would avoid much of the needless conflict we see
ourselves in today.</div>
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When Ebola first set foot in the U.S., we were already 8 months
and about 4,000 cases into the current epidemic. It was already 10 times larger
than any prior Ebola outbreak. And then the West took notice. We were different
from Liberians, until we were in the same boat. Ebola was a world away, until
prevalent international travel put us on the same globe. Then we started a
furious search for a drug or a vaccine. Lower resource countries don’t have the
market power to create the demand to inspire solutions to many tropical
diseases. Instead we wait for vocal advocates such as Bill Gates, Bill Clinton,
or Margaret Chan to push donors into these arenas to find an answer. </div>
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The silver lining of this experience with Ebola ought to be
a resurgence of civil debate on how we spend our abundant resources, with
renewed focus on the societal good.</div>
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The last two weeks I spent learning predominantly about
Palliative Care and HIV/AIDS care in Uganda. Our week at Hospice Africa Uganda
involved learning about the expansion of oral liquid morphine access for pain
control in terminally ill patients, followed by home visits to those receiving
home hospice services. Our home visits involved two women dying of cervical
cancer, dealing with pelvic pain and urinary incontinence. They simply wanted
pain relief and urinary care to die with dignity and in peace. Much like patients in the U.S. </div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjx9l8osHRanc0sl2sbeQ6GEeDHESgkMoEwPNYTd_IVTCNsKM0m-ZG2N_PtNwBOUYLYyU3_bPa7pJd8aCQqoWzNgwSKPnunIcV7HjcyZLUfBjNSyudzij0xqLZTTGbv0h5VTRmTATnLik2z/s1600/IMG_1038.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjx9l8osHRanc0sl2sbeQ6GEeDHESgkMoEwPNYTd_IVTCNsKM0m-ZG2N_PtNwBOUYLYyU3_bPa7pJd8aCQqoWzNgwSKPnunIcV7HjcyZLUfBjNSyudzij0xqLZTTGbv0h5VTRmTATnLik2z/s1600/IMG_1038.jpg" height="320" width="240" /></a></div>
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These patients many times get confused by difficult drug
regimens, despite only having ibuprofen and morphine for pain control. Primary
care doctors, nurses, and clinical officers at times are not trained to refer
to Palliative Care at the appropriate time. There is also a shortage in these
providers to competently prescribe this powerful drug, which lowers the amount
of patients who can benefit from it. And Hospice Africa Uganda is on the brink
of a severe funding shortage, with 70% of their funding coming from external
donors, much of that being cut in the near future, leaving inadequate funding
from the government to keep the service up and running as it is now. They are
the only producer of oral liquid morphine for all of Uganda. All of this – poor
funding, health worker shortages, patient education challenges – we deal with
in the U.S.</div>
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The HIV/AIDS epidemic is showing signs of improvement. The
number of new cases each year is dipping, but due to a lack of functioning
health facilities and a severe shortage of health workers, many are still
diagnosed late, dying of largely preventable causes. Mulago Hospital, the
national referral hospital for Uganda is overcrowded and under-staffed, but
still the best place to handle complex cases. There, we rounded on patients
with advanced lymphoma, visceral leishmaniasis, advanced lung cancer, and
toxoplasmosis. The chemotherapy or proper treatment is largely unavailable or
too expensive, and thus these patients rely on family to take them home and
care for them, without the help of the public health system. Despite seeing
this for a couple months now, it doesn’t make it easier. In the U.S., we too still
have many without basic health insurance and poor access to primary care
services, thus they present late in their disease, which can lead to worse
morbidity or even mortality, and is more costly on society. </div>
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When I return home from traveling and studying this time,
I’m sure I’ll be asked about the differences. But in addition to telling of these,
I plan to speak of the many similarities, and how we are in this together.
Whether we plan to bring the current Ebola outbreak to an end, or to control
tropical ailments with basic public health efforts, or plan to alleviate
poverty in any setting, it may just be in our interest to focus on how similar
we are, rather than taking the easier route of considering us all so different.
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My cheese and chocolate pizza was ready around the time my
friends caught up to me circulating the nighttime food market on the water’s
edge. We each tried a bite and she was right - it was a hit. So we ordered three
more to finish off our dinner. </div>
Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com3tag:blogger.com,1999:blog-2732810313133560243.post-22437013435879953472014-10-09T03:08:00.001-05:002014-10-09T03:08:10.165-05:00Morning<div>Morning view for coffee and Al Jazeera, WSJ, and Health Affairs reading.</div><div><br></div><br><div class="separator" style="clear: both;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_D4I-ujL0tgpjPwj7H_fXxKQas45VXOLHwViMBVPeoei69YSWchMD7R6QPZWG3zTuJaHDuy_XB1e9AJK6HinAPcxU4N_-rPsErmbe4aUWKPAOKWywz2sp9chX-MXRJJIl1SXfC4hc2AaN/s640/blogger-image-154380431.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEh_D4I-ujL0tgpjPwj7H_fXxKQas45VXOLHwViMBVPeoei69YSWchMD7R6QPZWG3zTuJaHDuy_XB1e9AJK6HinAPcxU4N_-rPsErmbe4aUWKPAOKWywz2sp9chX-MXRJJIl1SXfC4hc2AaN/s640/blogger-image-154380431.jpg"></a></div>Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com0tag:blogger.com,1999:blog-2732810313133560243.post-52071211121028414002014-09-16T14:18:00.000-05:002014-09-16T14:18:20.486-05:00Pemba!<div class="MsoNormal">
<span style="font-family: Georgia, Times New Roman, serif;">The aroma of Zanzibar spices and fresh vegetables is filling
our dining area as May prepares our curry meal for dinner. She’s one of my classmates
from Australia who has, through her offer to cook dinner, become even more
popular this evening – each of us has peeked into the kitchen one-by-one to
half-sincerely offer to help, but more so to check in to ensure our spot at her
dinner table. Tonight is the first night we have had a long rain, providing a
calm evening for our hostel to dine together and catch up.</span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Malaria was the major theme of the second week. Our main
professor practiced as an Infectious Disease physician and studied Malaria for
over four decades. He retired just three weeks prior to joining us for his week
of lectures. Most fascinating, he was part of studying the malaria vaccine. It
was particularly eye opening to hear him, the academic, the expert, point first
to the importance of access to basic healthcare, existing medicines, and public
health infrastructure, before more advanced studies on new treatments or
vaccines that are either too expensive to be rolled out any time soon or not
even very effective. </span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">The middle of the week, instead of exploring three cases
in-depth, we rounded rapid fire on about 8 cases within 2 hours.<span style="mso-spacerun: yes;"> </span>Case 1: Tuberculosis. Poorly treated
the first time, and concern for a multi-drug resistant case, perhaps with an
overlying cancer. Case 2: Lymphoma, but we could not investigate further due to
lack of pathologist. And even then, there is no access to even basic
chemotherapy here at this regional referral hospital. Or an Oncologist. Case 3:
Acute onset lower extremity neuropathic symptoms. No MRI machine. No X-rays
completed yet due to cost.</span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">You get the idea. It can be gut-wrenching and it’s simply
not fair.</span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Today was a full day of presentations, hearing about each
small group’s one-week (week 3) rural placement. One group studied palliative
care and end-of-life beliefs amongst Maasai villagers, another studied malaria
rapid diagnostic test use amongst physicians and traditional healers, and
another focused on battling malnutrition. </span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">My group traveled to Pemba, the northern of the two major
islands that make up Zanzibar. We spent the opening weekend at the apparently
infamous “Biederman’s Farm.” The farm excursion was a 2.5-hour bumpy dirt ride
from Tanga, and came with fresh cold milk and cheese that we think was properly
pasteurized. Mr. Biederman has lived there for 50 years, following an initial
placement on the Tanzanian coast by his engineering firm. His property is
dotted with barrels of mosquito larva-eating fish that Dr. Albert Schweitzer
reportedly introduced to him (?) and swore by as protection from malaria. We
spent hours swimming in the incredible warm water of the Indian Ocean, where
the stressors of real life back home finally washed away. Some take a few days
to really relax on vacation; I took about 12 days to be fully on board here.</span></div>
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The following day we flew to Pemba on a 14-seat plane. A couple cold beers at
the airport treated the pre-flight anxiety. The safety demonstration was two
sentences. The 20-minute flight ended safely and we were eventually delivered
to our destination – the Public Health Laboratory (PHL) guesthouse. Zanzibar is
largely Islamic as evidenced by the more conservatively dressed women and the
0445 calls to prayer.</span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">The PHL was originally started by an Italian NGO but is now
well integrated into the Zanzibar Ministry of Health (MOH) and its public
health campaigns. Zanzibar is actually its own “country,” depending on who you
speak to, and is part of the United Republic of Tanzania, but its Ministry of
Health functions autonomously.</span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Health spending in Zanzibar reaches $13 per person per year,
versus $3600 and $8600 in the UK and US respectively. Stop and think about
that. I didn’t accidentally add or omit zeros. </span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Our hosts provided lectures on schistosomiasis, water
quality, the Zanzibar health system structure, and sanitation, and then we set
out on field trips to see some water quality measurements and latrine
construction in action. In the evening, we ate our home-cooked meal, played Mafia,
and watched the British TV favorites of The Inbetweeners and Fawlty Towers. I
had forgotten about Mafia, played when I was younger, but when 11 physicians from
different countries are put in a dry guesthouse with little else nearby to do,
Mafia proves quite entertaining.</span></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRI57CdMcPEILMKkuhRFrnYU5hhcwpGFy9G89LsThSw1-aIdRBGghPmmHXkG-dOl4m7PGuIpApSzXotn_nAn7awzaBL9D-SLcSbZD0_jpb5WmccV4dq1YdY1C1gNsofJbbf9iwBWqKdu4S/s1600/IMG_0664.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><span style="font-family: Georgia, Times New Roman, serif;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiRI57CdMcPEILMKkuhRFrnYU5hhcwpGFy9G89LsThSw1-aIdRBGghPmmHXkG-dOl4m7PGuIpApSzXotn_nAn7awzaBL9D-SLcSbZD0_jpb5WmccV4dq1YdY1C1gNsofJbbf9iwBWqKdu4S/s1600/IMG_0664.jpg" height="320" width="240" /></span></a></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Thursday evening ended with a lavish thank you dinner for
our hosts at a nice hotel. We mixed with another group of consultants and
funders in town from the UK and US here to assess the <a href="https://www.youtube.com/watch?v=KjowOftJMjM" target="_blank">Millennium Village on Pemba</a>. Our hosts were actually key leaders in the implementation of the
village, selected as one of the poorest in the world. Some of our hosts sat at
the consultant table for political purposes while others chose to sit with us
to avoid the formal chat. 2015 will be the final year of the Millennium
Villages Project and it is when the Millennium Development Goals will
essentially “expire.” The Pemba village appears to be on track and the funders
seemed pleased with the results in this penultimate year.</span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">And then came Friday night. Friday we flew another short
flight across to Unguja (the main island of Zanzibar) to join forces with two
of the other small groups. After completing our write up of our project on
shistosomiasis, and traveling hours longer than expected, we arrived after dark
at the guesthouses on the beach of northeast Unguja. We threw down our bags and
walked 10 minutes down the beach to join the others at happy hour – and you
would have thought we were heroes returned from battle! Clapping, hugs, kisses,
high-fives! I think we surprised ourselves by how happy we all were to be reunited.</span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">It has always struck me how quickly people can become close and build relationships. During times of stress, people seem to need each other. And when the group starts off with baseline commonalities, they start from an advanced position due to an existing high level of trust. Fraternity pledgeship. Residency training. Summer camp. Whatever the experience, it’s a powerful pull that is difficult to put into words and it’s exhilarating to be in the middle of it.</span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">We spent the final night on the beach taking in the clear
view of the stars and rising moon celebrating our classmate’s birthday. After
blowing out her candles on the dry chocolate birthday cake, she wondered aloud:
“I wondered today if this might be the best birthday I’ve ever had. And I think
it is.”</span></div>
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<span style="font-family: Georgia, Times New Roman, serif;">Dinner is ready. Thankfully, I’ve contributed some wine and a
chocolate bar for dessert.</span></div>
Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com2tag:blogger.com,1999:blog-2732810313133560243.post-10219349665109366292014-08-31T12:19:00.000-05:002014-08-31T12:19:31.824-05:00From the base of Kilimanjaro<div class="MsoNormal">
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxWHJWpw5oC1lVfK4nvsdpYhQQVNcrO_4rH6nIR5M6E8csgyi3r7PFsG61hrH16UIPfOLqt2akxnmOZQDqa0j3fE9AbjoTUVVMbUFWIYnKficTeyzTwqoqVLahk_xWyAdmAeFtWcvUm1ZU/s1600/IMG_0420.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjxWHJWpw5oC1lVfK4nvsdpYhQQVNcrO_4rH6nIR5M6E8csgyi3r7PFsG61hrH16UIPfOLqt2akxnmOZQDqa0j3fE9AbjoTUVVMbUFWIYnKficTeyzTwqoqVLahk_xWyAdmAeFtWcvUm1ZU/s1600/IMG_0420.jpg" height="320" width="240" /></a></div>
<br />
<br />
Energized by the 2.5-hour church service at the Anglican
Church here in Moshi this morning, I figured it was time to check in. I arrived in Moshi
(Tanzania) last weekend, but my delayed checked bag stayed behind a few nights in Nairobi at
the international airport. Following some local advocacy by our course administrator, a handful of patient
phone calls to London, Nairobi, and Dar es Salaam, and a few clean shirt
changes thanks to our course director, my bag arrived at Kilimanjaro
International Airport for pick-up Tuesday evening.</div>
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<br /></div>
<div class="MsoNormal">
We are now one week into the <a href="http://www.lshtm.ac.uk/study/cpd/eadtmh.html" target="_blank">East African Diploma inTropical Medicine and Hygiene put on by the London School of Hygiene andTropical Medicine (LSHTM)</a>. 58 physicians are attending the three-month course.
Roughly one-third are from the UK, 8 are from Australia, and the rest represent
places such as Ireland, Botswana, Scotland, Austria, Denmark, Canada, Portugal,
Uganda, Tanzania, with yours truly being the sole American representative. </div>
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Our course began Monday morning with brief introductions,
registration, the passing out of our heavy textbook, Principles of Medicine in
Africa, distribution of some bicycle helmets (in case we decide to hop on the back of a motorcycle as
transportation instead of a taxi), and safety warnings. The first week
focused on Epidemiology, where we reviewed the basics of epidemiological study
design, had a review of biostatistics, and went in depth into the original
outbreak of Ebola in the DRC. A timely topic, we thought... Our lecturer was a
well-known epidemiologist and Infectious Disease (ID) specialist from LSHTM.
She made a potentially dry topic interesting, and is (like many of our
lecturers), an author of chapters in our reference textbook. </div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrrl43vHpRQ43yZoq-aFZkoofujAqluP-e7Fn3w8MIZdkSwq0TqiseQY7HuHsIldzLSedJ538tDqXG8jRtMJ6RO9MM9t-Fa5cgCK6Ygx6tIPzphJ1Ftdc4vM4nuZl6G-X8Ok8JOGYpdTcc/s1600/IMG_0435.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrrl43vHpRQ43yZoq-aFZkoofujAqluP-e7Fn3w8MIZdkSwq0TqiseQY7HuHsIldzLSedJ538tDqXG8jRtMJ6RO9MM9t-Fa5cgCK6Ygx6tIPzphJ1Ftdc4vM4nuZl6G-X8Ok8JOGYpdTcc/s1600/IMG_0435.jpg" height="320" width="240" /></a></div>
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The mornings were spent in lecture, and the afternoons were
spent in group Swahili lessons and clinical rounds. I rounded at Kilimanjaro
Christian Medical Center (KCMC, our home-base in Moshi), with our small group
of seven. Our Attending was an ID specialist from Cape Town who conducted
bedside rounds. First, we saw a case of an HIV-positive woman with a
Co-trimoxazole (Bactrim) induced dermatologic drug reaction. Unfortunately this
could have been avoided as at the time she started the medication for PCP
prophylaxis, it was not yet indicated. Our second patient was battling chronic
schistosomiasis with resulting splenomegaly and esophageal varices. These
patients end up severely anemic from GI bleeds and have a fairly poor prognosis.
Lastly, we saw a patient with a history of TB, currently struggling with an
exacerbation of chronic interstitial lung disease from his years of work in the
tanzanite mines. My second day of rounds, we went off site to a smaller
district hospital, where we saw four pediatric patients with viral
gastroenteritis, rickets, tonsillitis and severe malaria respectively. Our
Attending this day, was a local Moshi-based physician who claims he has an
allergic reaction any time he travels too far out of the Moshi area.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbq7BogVXoEeMXOXCwvVA6MfD4TYVE7iSBVKInxRsOcIaNGYJqeW1P_Y1hVI9HIHC40szJEs__oHmPKyvSJZP1Cyeo81naqlnV8sx9KzFC8IVNYOSYGcySpcJDCDCsmVf3Q3XDY8fk1_RE/s1600/IMG_0432.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgbq7BogVXoEeMXOXCwvVA6MfD4TYVE7iSBVKInxRsOcIaNGYJqeW1P_Y1hVI9HIHC40szJEs__oHmPKyvSJZP1Cyeo81naqlnV8sx9KzFC8IVNYOSYGcySpcJDCDCsmVf3Q3XDY8fk1_RE/s1600/IMG_0432.jpg" height="320" width="240" /></a></div>
<br /></div>
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In these settings, there is very limited access to
laboratory tests or imaging, so most of our diagnosis was based on clinical
examination and physical signs. Even though this is a tertiary referral
hospital, there is no pathologist on site most of the year to read biopsies.
There is a CT scanner, but it has been broken for three years. The machine to
do a complete blood count is broken – and there is no back-up. These local
Attendings are unbelievably impressive with what they can deduce from just a
physical exam, whereas in the States we have come to rely on more costly
measures to nail down a diagnosis in nearly every case.</div>
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Socially, or what our course director affectionately calls the “Hidden Curriculum,” things are ticking along quite nicely. Most of my classmates
are in the middle of their specialty training and many have a wide variety of
experience. A common thread however, is that they have almost all had an
“elective” experience working in a developing area, and are currently taking,
or have already taken, a year off in the middle of their post-graduate training
to travel and learn more about healthcare in different settings. That’s in
stark contrast to American docs who are in such a hurry to complete residency
training for a variety of reasons. More on that later. I have enjoyed getting to know my classmates and lecturers,
slowly adding in one or two at a time, hearing about their travels, their training,
and their feelings on the system within which they work.</div>
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<br /></div>
<div class="MsoNormal">
Our lodging is decent, and Thursday night we had a meal
cooked at our hostel (our group is staying in one of four places around town)
for $5 per person. A few from the other hostels came by, and half the group
hung around on my hostel’s terrace ("Terrace Thursdays" we've dubbed it) for a few Kilimanjaros (beer) and some
Konyagi (the local spirit). </div>
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<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJI8lhPGSPmqmr1SRYg2Owmmil6WSdTFvv2TMwUWhHzSHhVRoKJRGjm7WJSqwu7f7DJPlx1H8BE-KsYJTLSiyxFM9OXP7AJuHJuGhAAm9y2bxKOSOBOEbfnWmNuKfGftvrUc9lF8DTxoGq/s1600/IMG_0424.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhJI8lhPGSPmqmr1SRYg2Owmmil6WSdTFvv2TMwUWhHzSHhVRoKJRGjm7WJSqwu7f7DJPlx1H8BE-KsYJTLSiyxFM9OXP7AJuHJuGhAAm9y2bxKOSOBOEbfnWmNuKfGftvrUc9lF8DTxoGq/s1600/IMG_0424.jpg" height="320" width="240" /></a></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkHO5Q8vRkRZO8bTTN0dXAb9G1MnNwXQ49LmHvgtkbcZ07YTNN3VrF2HB47BilZAu6g-RjhOlswK3p-CU-RF539ivu4Rf_hDQJn7A1zFB3CTT0VygObYd_JRcdai8RJn1rmSZnqSDlTH8a/s1600/IMG_0427.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgkHO5Q8vRkRZO8bTTN0dXAb9G1MnNwXQ49LmHvgtkbcZ07YTNN3VrF2HB47BilZAu6g-RjhOlswK3p-CU-RF539ivu4Rf_hDQJn7A1zFB3CTT0VygObYd_JRcdai8RJn1rmSZnqSDlTH8a/s1600/IMG_0427.jpg" height="320" width="240" /></a></div>
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<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgyAdn3SsoXQLE4L-mx6BHWCoScLPaxrByVzFqIbqyWlyVSyUPMaLqWQtFxUllWcv9RisOxkKb6Ze4LdZ93sdek3kvHILH1hxdyBM7r5pZSHR1rfsxY3UnpdoE1efWP5fdJZlWRpuehteY9/s1600/IMG_0428.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgyAdn3SsoXQLE4L-mx6BHWCoScLPaxrByVzFqIbqyWlyVSyUPMaLqWQtFxUllWcv9RisOxkKb6Ze4LdZ93sdek3kvHILH1hxdyBM7r5pZSHR1rfsxY3UnpdoE1efWP5fdJZlWRpuehteY9/s1600/IMG_0428.jpg" height="320" width="240" /></a></div>
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Most of the group went on safari or to stay a night
at the Ngorongoro crater this weekend, but Micah, my new Irish friend, and I went out to
Honey Badger Lodge for some relaxation poolside. An Epidemiology professor
associated with the LSHTM based here in Moshi owns the Lodge.</div>
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<br /></div>
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<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFzUmqmSGLBNeBZ0dzvvXpzDP4YXXiPnvwLStLBw4dI_n6amQrYStvn2p1Ww-_5p2l-fihir13pmo9nVGtVm2QGqI_SRqXM_l-3ajIw460owDYpSTDtrTUq-2SSCiIo1GJHrEPUMM46nE8/s1600/IMG_0442.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgFzUmqmSGLBNeBZ0dzvvXpzDP4YXXiPnvwLStLBw4dI_n6amQrYStvn2p1Ww-_5p2l-fihir13pmo9nVGtVm2QGqI_SRqXM_l-3ajIw460owDYpSTDtrTUq-2SSCiIo1GJHrEPUMM46nE8/s1600/IMG_0442.jpg" height="320" width="240" /></a></div>
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<div class="MsoNormal">
We are now preparing our reading for next week’s topic –
Malaria. The end of next week we will travel in six small groups to our
one-week rural placements to learn about different community-level health
services or projects. I’ll be headed out to Pemba, the northern island of the
Zanzibar region, and most of us are eagerly anticipating the week away.</div>
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<div class="MsoNormal">
The first week was busy, but it is about to end with our hostel’s
cook serving a homemade meal. What a blessing to be here – when your Sunday
evening sunset looks like this, it’s easy to be reassured you are exactly where you
should be.</div>
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<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiuk6_lk-GiqoIpNPMOT4j9pRF-EZbZe4r_znXo_O13IV19n0Z6jBvNs8t_uk7XyZc4rS-HJRVaTeMfdO02NwZMmBKE6vZcEyRLOWoyw37d3_XGF5nwT7Ais13cM1aZzNEIFe_hazvXLDi/s1600/IMG_0451.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjiuk6_lk-GiqoIpNPMOT4j9pRF-EZbZe4r_znXo_O13IV19n0Z6jBvNs8t_uk7XyZc4rS-HJRVaTeMfdO02NwZMmBKE6vZcEyRLOWoyw37d3_XGF5nwT7Ais13cM1aZzNEIFe_hazvXLDi/s1600/IMG_0451.jpg" height="320" width="240" /></a></div>
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Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com1tag:blogger.com,1999:blog-2732810313133560243.post-36339148671495013082014-08-22T16:14:00.001-05:002014-08-22T16:14:39.796-05:00Kwaherini!4 months. 1 bag.<br><br><div class="separator" style="clear: both;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYF_cPZqGH5a2dWib4I4DLYsYyVH4jvyVGcclJZF9GM0RQTdn_SLv7uTPdu48aZRPNA4ri9DVARI7nq6GZ0paIedcPNNE73ObzCcL2xbyHYrbWtc8HgN0KB81GWFnqZvtvoh2ocywX36lL/s640/blogger-image-755680852.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgYF_cPZqGH5a2dWib4I4DLYsYyVH4jvyVGcclJZF9GM0RQTdn_SLv7uTPdu48aZRPNA4ri9DVARI7nq6GZ0paIedcPNNE73ObzCcL2xbyHYrbWtc8HgN0KB81GWFnqZvtvoh2ocywX36lL/s640/blogger-image-755680852.jpg"></a></div>Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com0tag:blogger.com,1999:blog-2732810313133560243.post-83727243394410275642013-04-21T19:38:00.001-05:002014-06-29T18:18:19.074-05:00In Defense of Backpacking: Is free WiFi killing the backpacking experience?<!--[if gte mso 9]><xml>
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<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">“So where y’all from?”</i></b><span style="mso-spacerun: yes;">
</span>That one simple phrase is the only thing necessary to spark an instant friendship
under the hostel roof.<span style="mso-spacerun: yes;"> </span>Backpackers
share many of the same traits – the spirit for adventure, a desire to see new
parts of the world, simple travel needs, being trusting enough to share quarters with
complete strangers, and the goal to do so in a cost conscious manner.<span style="mso-spacerun: yes;"> </span>Sharing a bathroom with a friend or a
sibling is hard enough for most.<span style="mso-spacerun: yes;">
</span>Sharing a bathroom with someone who doesn’t speak your language is a
completely different experience.<span style="mso-spacerun: yes;"> </span></div>
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<div class="MsoNormal">
After a couple solo trips around the end of my time at university,
there were so many elements of backpacking to which I’d become addicted.<span style="mso-spacerun: yes;"> </span>Traveling solo had a certain air of
freedom that, combined with cheap hostel rates, allowed for versatile travel
plans.<span style="mso-spacerun: yes;"> </span>Thus far, my whole life had
been meticulously planned from my educational and career path to my tennis
training.<span style="mso-spacerun: yes;"> </span>Traveling with only my
backpack was freeing, and began my desire for a new plan to have no
plan.</div>
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<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-Zr-w-FJtzwkPShEJXUdmVb4ART1V9mUoHq6KeXc2thGnQ3Ixtq-QGAY0XIAP8-IfG9ybyoEDHgjTj6-_rzcllKGUWwZ8xyasv_wSaaEvGyjQBVzDYSc-0FAt_-J9EBk-DdM7jK-X6Mfr/s1600/IMG_3340.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEg-Zr-w-FJtzwkPShEJXUdmVb4ART1V9mUoHq6KeXc2thGnQ3Ixtq-QGAY0XIAP8-IfG9ybyoEDHgjTj6-_rzcllKGUWwZ8xyasv_wSaaEvGyjQBVzDYSc-0FAt_-J9EBk-DdM7jK-X6Mfr/s320/IMG_3340.jpg" height="320" width="240" /></a></div>
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<div class="MsoNormal">
Arriving at the hostel dorm is the best part.<span style="mso-spacerun: yes;"> </span>After a brief check-in, I throw my
bag on my assigned bed and start introducing myself around.<span style="mso-spacerun: yes;"> </span><b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">“So, where y’all from?”</i></b><span style="mso-spacerun: yes;"> </span>In the hostel, we are all on the same
team – traveling solo or in small groups, far from home, eager to explore, and
celebrating life on a budget.<span style="mso-spacerun: yes;"> </span>You
know that you and your dorm-mates already have many things in common, so after
the simple “where y’all from?” you can skip right to “what’s the plan for
tonight?!”</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The common area of the hostel is a place for sharing a
cheap beer in the evening, hearing stories from the day’s sightseeing, and
formulating the plan for dinner and dancing that night.<span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAgTteM41lBomsVinJ4_JXYb4RmTOBq_KU2XKwjuCKbPndp1aVSAiybZKC3xsZzm_QPImmjIBBRel-6WLgdRWPO4tSuqvTSRdOgfegHWLCGSr1i4ut7076mtCjdBWOVQtW5VnM_2zJQuxd/s1600/IMG_2935.JPG" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjAgTteM41lBomsVinJ4_JXYb4RmTOBq_KU2XKwjuCKbPndp1aVSAiybZKC3xsZzm_QPImmjIBBRel-6WLgdRWPO4tSuqvTSRdOgfegHWLCGSr1i4ut7076mtCjdBWOVQtW5VnM_2zJQuxd/s320/IMG_2935.JPG" height="240" width="320" /></a></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;"><br /></i></b></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">“So, where you from?”</i></b><span style="mso-spacerun: yes;">
</span>To be able to get this icebreaker off your lips, there must be someone
ready to receive it.<span style="mso-spacerun: yes;"> </span>This takes
eye contact.<span style="mso-spacerun: yes;"> </span>The hostel of 2013
however has unintentionally put a barrier in place to prevent this:<span style="mso-spacerun: yes;"> </span>Free WiFi.<span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Is WiFi killing the backpacking experience?<span style="mso-spacerun: yes;"> </span>And is it eroding the ability for
people to interact in the simplest yet most meaningful way possible -
face-to-face conversation?<span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Last month, I stayed in a giant hostel in Budapest I
affectionately called the Disney World of hostels.<span style="mso-spacerun: yes;"> </span>They’d literally thought of everything.<span style="mso-spacerun: yes;"> </span>It was clearly built by backpackers.<span style="mso-spacerun: yes;"> </span>The entire hostel was cleaned twice
daily.<span style="mso-spacerun: yes;"> </span>A hot breakfast was
included.<span style="mso-spacerun: yes;"> </span>They even had a small
shelf on the wall near the head of each bunk bed with an outlet to set down
your watch and charge your phone!<span style="mso-spacerun: yes;">
</span>Most importantly there was a bar downstairs that was lively every
evening complete with a pool table, Palinka tastings, beer deals, and a free
drink on the evening you checked in.<span style="mso-spacerun: yes;">
</span>I also stayed in a hostel in Istanbul a few days later that was a dump
comparatively, yet still sufficient.<span style="mso-spacerun: yes;">
</span>And both places had the same thing in common:<span style="mso-spacerun: yes;"> </span>Free WiFi.<span style="mso-spacerun: yes;"> </span>Both
places I dropped my bag down, settled in, and came down to the lobby to find my
new hostel-mates in the lobby glued to their iPads and iPhones, ear buds
in.<span style="mso-spacerun: yes;"> </span>There was even one Australian
Face-timing loudly with someone back home on his laptop.<span style="mso-spacerun: yes;"> </span>No one looked up to acknowledge their
new arrival – me.<span style="mso-spacerun: yes;"> </span>So I sat, opened
my bottle of wine, read my book and hung out.<span style="mso-spacerun: yes;"> </span>Everyone else read news, sifted through Facebook posts, and
listened to music from their devices - everything they could have done back
home.<span style="mso-spacerun: yes;"> </span>They were so focused on
their electronic task that there was no looking up to appreciate the current
moment, take in the scenery, or make a new friend.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Rewind 9 years.<span style="mso-spacerun: yes;">
</span>It’s 2003 and I’m backpacking for the first time ever, in Fiji.<span style="mso-spacerun: yes;"> </span>I stayed in hostels in the Colo-i-Suva
National Park and on Beachcomber Island, the latter a backpacker’s paradise
where the dorm had 100 bunk beds under one roof, wide open to the ocean breeze
entering freely on all sides.<span style="mso-spacerun: yes;"> </span>Each
evening after exploring during the day, I’d clean up in the dorm and go settle
in the lobby or main bar area for a drink, and I’d do the only thing left to do
– meet the rest of the folks staying there for the night.<span style="mso-spacerun: yes;"> </span>There was no WiFi.<span style="mso-spacerun: yes;"> </span>Both of these places didn’t even have
Internet access.<span style="mso-spacerun: yes;"> </span>Placing a call
back home required a pre-paid calling card.<span style="mso-spacerun: yes;"> </span>Thus, there were numerous steps (read barriers) necessary to
connect back to the “real world.”<span style="mso-spacerun: yes;">
</span>Instead I was forced to participate in the present.<span style="mso-spacerun: yes;"> </span>Thank God for that.<span style="mso-spacerun: yes;"> </span>I met two generous Swedish
couples.<span style="mso-spacerun: yes;"> </span>I watched some rowdy
South Africans fail miserably at limbo.<span style="mso-spacerun: yes;">
</span>And I took in one of the best evenings of my life – a Christmas Eve
complete with free boxed Chardonnay and a game of musical chairs with 11
strangers.<span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirm4FtNcEHfr9k07NejNqOCd0-5yexD6bc0wakwW8esWrJVL08nvanjIJcmdvIu9iou7a3Ej_REO8CNIRHivPP449IPde6kYBJSN52svMkPJCppzgA5itQfsMbf6CVrx2TcdfrgMMWa_Uy/s1600/195863_504188680067_4512_n.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEirm4FtNcEHfr9k07NejNqOCd0-5yexD6bc0wakwW8esWrJVL08nvanjIJcmdvIu9iou7a3Ej_REO8CNIRHivPP449IPde6kYBJSN52svMkPJCppzgA5itQfsMbf6CVrx2TcdfrgMMWa_Uy/s320/195863_504188680067_4512_n.jpg" height="213" width="320" /></a></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Six months later I found myself hopping through Europe over
5 weeks.<span style="mso-spacerun: yes;"> </span>I visited with friends I
met in Fiji and crashed in hostels when I was without a host.<span style="mso-spacerun: yes;"> </span>To use Internet then I could walk to
the Internet café, but that cost me a few Euros, which was a tough decision
when that could have been put towards a cold beer instead.<span style="mso-spacerun: yes;"> </span>The fact that energy was required to go
find an Internet café was a barrier to my decision to connect and I only
e-mailed my family and friends as much as was essential to let them know I was
alive and well.<span style="mso-spacerun: yes;"> </span>I was aware of my
surroundings.<span style="mso-spacerun: yes;"> </span>And my
blessings.<span style="mso-spacerun: yes;"> </span>And I was immersed in
the moment.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Now we find ourselves in the age of 24-hour news outlets and
second-by-second Twitter updates.<span style="mso-spacerun: yes;">
</span>We in the States have slowly become comfortable with constant
stimulation, whether that is by TV, music, Facebook, or text messaging, and we
almost can’t live without it.<span style="mso-spacerun: yes;"> </span>I
see so much anxiety and attention deficit disorder and I have to think our
constant need for connectedness, and our inability to occasionally “check out”
from the stressors of daily life, is playing a role in this.<span style="mso-spacerun: yes;"> </span>For if you are used to constant visual
or auditory stimulation and then all of a sudden you have none, and are stuck
with a still view of the ocean or find yourself seated in a somewhat quiet
lobby or restaurant or bar, what would your natural reflex be?<span style="mso-spacerun: yes;"> </span>To worry?<span style="mso-spacerun: yes;"> </span>To reach back for your standard level of stimulation?</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
This is precisely why I am choosing to make a concerted
effort to resist the new norm.<span style="mso-spacerun: yes;">
</span>And, at the risk of sounding like (or posing as) a backpacking elder, I
am calling all backpackers to do the same.<span style="mso-spacerun: yes;"> </span>Whether you’re away for a year or a week, old or young,
beginner or veteran, let’s return backpacking to its roots and keep the spirit
alive.<span style="mso-spacerun: yes;"> </span>Do it for your health, or
your sanity.<span style="mso-spacerun: yes;"> </span>But most importantly,
do it in the spirit of building new connections around the world.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
My home life is very well planned, with a fairly steady
routine that relies greatly on the Internet and electronics.<span style="mso-spacerun: yes;"> </span>But when I travel, I travel to get
away.<span style="mso-spacerun: yes;"> </span>To escape my daily
routine.<span style="mso-spacerun: yes;"> </span>To experience something
new and meet new people.<span style="mso-spacerun: yes;"> </span>To rest
my brain, take a deep breath, pray, and reflect on how blessed I am
and my current position in life.<span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
If I am constantly being told what’s happening on my iPhone
I fear I won’t be able to see for myself what is going on right in front of
me.<span style="mso-spacerun: yes;"> </span>So it takes a conscious effort
to stay off the iPhone, put it deep away in my bag and only use it for
essential communication.<span style="mso-spacerun: yes;"> </span>But it’s going
to take a community effort to renew our vows to each other to travel for the
original reason we were intrigued by the journey in the first place.<span style="mso-spacerun: yes;"> </span>Perhaps you wanted to take in a kava
ceremony in Fiji.<span style="mso-spacerun: yes;"> </span>Maybe you wanted
to reach the top of the Eiffel Tower.<span style="mso-spacerun: yes;">
</span>You likely wanted to meet someone from a different culture and hopefully
share a meal with your new mate.<span style="mso-spacerun: yes;">
</span>Maybe this is another vacation away from your daily work or a necessary
venture far from your comfort zone.<span style="mso-spacerun: yes;">
</span>Whatever your inspiration for crossing international borders or flying
across oceans, your iPhone or iPad will not be necessary for you to accomplish
your end goal.<span style="mso-spacerun: yes;"> </span>And they’ll be
waiting for you back home – trust me.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
So, disconnect.<span style="mso-spacerun: yes;">
</span>Turn off.<span style="mso-spacerun: yes;"> </span>Be present and
soak in the moment.<span style="mso-spacerun: yes;"> </span>And the next
evening you’re in the hostel lobby or bar, decline the free WiFi and look
up.<span style="mso-spacerun: yes;"> </span>Our eyes will be able to meet
and my friendly Texan face will be smiling to greet you:<span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
<b style="mso-bidi-font-weight: normal;"><i style="mso-bidi-font-style: normal;">“So, where you from?”</i></b><span style="mso-spacerun: yes;"> And w</span>e’re already friends.</div>
<!--EndFragment-->Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com1tag:blogger.com,1999:blog-2732810313133560243.post-10255824090528804562012-12-19T18:03:00.000-06:002014-06-29T21:04:57.280-05:00Kili and Me<div class="MsoNormal">
When two men arm wrestle, they do so to prove themselves to
a woman.<span style="mso-spacerun: yes;"> </span>When a man does pull-ups,
he does them to prove himself to another man.<span style="mso-spacerun: yes;"> </span>I travel solo to prove myself to myself.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Despite the “are you SURE you want to do this?!” questions
from family and friends, I’d been brought to Moshi, one of two towns at the
base of Mount Kilimanjaro, encouraged along by Michael Crichton’s autobiography
“Travels.”<span style="mso-spacerun: yes;"> </span>The descent into
Kilimanjaro International Airport ended with the sight of the equatorial
snow-capped mountain I’d read so much about and that stunned stomach
feeling:<span style="mso-spacerun: yes;"> </span>Will I stand up
there?<span style="mso-spacerun: yes;"> </span>Can I do this?<span style="mso-spacerun: yes;"> </span>I was sick of talking about it;<span style="mso-spacerun: yes;"> </span>the prep, the planning, the hype.<span style="mso-spacerun: yes;"> </span>I was ready to do it.<span style="mso-spacerun: yes;"> </span>My backpack was a confusing mix of my
North Face jacket and wool socks at the bottom, with t-shirts, shorts, and
sunscreen at the top to prepare for the mixture of climates on Kilimanjaro. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Zara Tours’ warm hospitality got me from the airport to the
hotel, and I’d arrived at the briefing that afternoon.<span style="mso-spacerun: yes;"> </span>Our guide talked us through the six-day
trek.<span style="mso-spacerun: yes;"> </span>I’d been introduced to
Meghan, the American I’d been partnered up with for the hike – a fortuitous
meeting given our similar interests of health policy and public health in
developing countries. Going up Kilimanjaro alone has its risks, and going up
with a partner allows for splitting the guides’, porters’, and cooks’
tips.<span style="mso-spacerun: yes;"> </span>My pairing with Meghan
proved in many ways that God was surely driving.<span style="mso-spacerun: yes;"> </span>The staff kept telling me I would meet “him” and that “he”
would be at the briefing, but sure enough Meghan’s gender was simply lost in
translation – she was a she.<span style="mso-spacerun: yes;"> </span>Our
guide went by many names, but his buddies called him Sikuu.<span style="mso-spacerun: yes;"> </span>With his broken English yet calm
demeanor he confidently talked us through our plan for the next five days,
assuring us of his Kilimanjaro experience.<span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
That night, Meghan and I became acquainted over dinner and
our conversation attracted a Dutch gentleman, just off the mountain.<span style="mso-spacerun: yes;"> </span>He handed off his left-over Paracetamol
(Tylenol) to be used as needed for pain.<span style="mso-spacerun: yes;">
</span>“You can do it!,” he encouraged us.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I slept well, awoke with excitement, and took pictures of
the white peak from the bottom from the last time.<span style="mso-spacerun: yes;"> </span>We ate a big breakfast and I gathered my rented pants and
gear – in true med student fashion, I’d arrived with only scrub pants.<span style="mso-spacerun: yes;"> </span>We then made several stops - grabbing
one-liter bottled waters and chocolate, both trek essentials - along the way to
the entrance gate. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The Trek</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Our arrival at the front gate was pretty unimpressive to the
hired crew.<span style="mso-spacerun: yes;"> </span>We had Sikuu (our
guide), his assistant guide, six porters, and two cooks - all for the two of
us.<span style="mso-spacerun: yes;"> </span>They set off ahead of us
carrying stacks of plastic chairs, tents, and other heavy gear.<span style="mso-spacerun: yes;"> </span>Their shoes were torn; some went
without socks.<span style="mso-spacerun: yes;"> </span>“Pole sana.”<span style="mso-spacerun: yes;"> </span>Or “I’m sorry for your work,” we’d
mumble as they took off ahead of us.<span style="mso-spacerun: yes;">
</span>We stuck with Sikuu.<span style="mso-spacerun: yes;"> </span>“Pole,
pole.”<span style="mso-spacerun: yes;"> </span>Slowly, slowly.<span style="mso-spacerun: yes;"> </span>“Acclimatize,” Sikuu would say,
explaining our slow steady pace.<span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
At the end of Day 1, we set up camp with about 40
others.<span style="mso-spacerun: yes;"> </span>Even though we had told
Sikuu that we’d be willing to share a tent, the crew brought us each our
own.<span style="mso-spacerun: yes;"> </span>I suited up with my cold
weather gear - hat, coat, gloves.<span style="mso-spacerun: yes;">
</span>The father-son duo from Colorado who passed the football around in
shorts and t-shirts had a hell of a laugh at this.<span style="mso-spacerun: yes;"> </span>It was only night one, and I was preparing for
hibernation.<span style="mso-spacerun: yes;"> </span>Sikuu brought us
boiled drinking water, and the dining tent was prepared for dinner.<span style="mso-spacerun: yes;"> </span>Every night included tea and chocolate
to mix with our boiled drinking water and options ranging from chicken
(usually) to some form of boiled egg or fruit, and bread with jam.<span style="mso-spacerun: yes;"> </span>The Nestle hot chocolate mix was my
dessert. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Days 2 - 4 took us from dirt terrain to a more lush, green,
and humid environment.<span style="mso-spacerun: yes;"> </span>We were
under large trees, mysterious giant plants, as we walked over rocky terrain and
across trickling streams pulled downhill.<span style="mso-spacerun: yes;">
</span>Sikuu kept our pace steady, stopping only for him to smoke and for us to
pee.<span style="mso-spacerun: yes;"> </span>Michael Crichton summited
when he was smoking a half-pack per day, so surely Sikuu could handle it!<span style="mso-spacerun: yes;"> </span>The higher altitudes have lower partial
pressure of oxygen and the body’s increased respiratory rate requires increased
hydration.<span style="mso-spacerun: yes;"> </span>The combination of the
necessary 4 – 5 liters of drinking water per day plus the acetazolamide
diuretic that we took to prevent altitude sickness contributed to our frequent
bathroom stops.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
Each night I took flak for my added winter warmth.<span style="mso-spacerun: yes;"> </span>On Night #3 however the analysis was
from a crew of four girls my age from Seattle.<span style="mso-spacerun: yes;"> </span>One was a vet and they were all entertaining at every
stop.<span style="mso-spacerun: yes;"> </span>Our socializing was
interrupted that particular evening by the sight of guards who were armed with
semiautomatic weapons supposedly in place to fend off any large animals that
walked around at this altitude.<span style="mso-spacerun: yes;"> </span>Soon,
we would be too high up for any animal life.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
On Night #4, we arrived at base camp - Barafu Huts – about
15,000 feet above sea level.<span style="mso-spacerun: yes;"> </span>We
signed in, just as we had each evening at camp, but this time, excitement
filled the air.<span style="mso-spacerun: yes;"> </span>Exiting the
sign-in hut, we looked out at the blue sky above the clouds.<span style="mso-spacerun: yes;"> </span>This was our last stop before the
attempted summit.<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
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<br /></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
I still had no symptoms from the altitude (I got
this!).<span style="mso-spacerun: yes;"> </span>Sikuu laid out the plan,
and we tried to get some sleep before our nighttime summit.<span style="mso-spacerun: yes;"> </span>Each day brought about 5 hours of
walking, and at the end of each day I would ask Sikuu:<span style="mso-spacerun: yes;"> </span>“Hey Sikuu?”<span style="mso-spacerun: yes;"> </span>“Ndiyo Bwana?” (Yes, my friend?) “Was today harder than the
Summit Day?”<span style="mso-spacerun: yes;"> </span>“Not,” he would
reply.<span style="mso-spacerun: yes;"> </span>I’d heard plenty about the
summit day; soon it would be go time.<span style="mso-spacerun: yes;">
</span>I dozed off early, comforted by the hum of the porters, relaxing and
sharing stories during card games played by the dim light that emerged from the
door-flaps of their tents.</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
The Assault</div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We awoke about midnight and layered up - two t-shirts, two long-sleeve
t-shirts, one wind/water-proof fleece, my thick North Face jacket, two pairs of
wool socks, and one digital camera tucked inside a couple of layers in hopes it
wouldn’t freeze before the peak shot.<span style="mso-spacerun: yes;">
</span>We began our assault, led only by our headlamps and Sikuu’s voice.<span style="mso-spacerun: yes;"> </span>After about an hour, Sikuu stopped off
to vomit.<span style="mso-spacerun: yes;"> </span>Our assistant guide took
over.<span style="mso-spacerun: yes;"> </span>Sikuu caught back up,
announcing his return with a term we’d learned on the trek:<span style="mso-spacerun: yes;"> </span>“Puke and rally!”<span style="mso-spacerun: yes;"> </span>Meghan started to feel her head hurt
and a little nausea, but we kept plugging.<span style="mso-spacerun: yes;"> </span>One foot in front of the other.<span style="mso-spacerun: yes;"> </span>Pole, pole.<span style="mso-spacerun: yes;"> </span>My
weight was increasingly on my walking sticks, from my grip down to the ground,
transferred away from my legs.<span style="mso-spacerun: yes;"> </span>I
walked without thinking. </div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We reached Stella Point.<span style="mso-spacerun: yes;"> </span>We had walked 4 hours.<span style="mso-spacerun: yes;">
</span>The world was still pitch black, and the wind was whipping.<span style="mso-spacerun: yes;"> </span>I began to wonder if I could even
accomplish this bathroom break with the multiple layers and temperatures surely
approaching zero.<span style="mso-spacerun: yes;"> </span>Sikuu handed us
each a Dairy Milk chocolate bar that hit the spot, and we pounded more
water.<span style="mso-spacerun: yes;"> </span>We prolonged our break, as
we were beating the sunrise.<span style="mso-spacerun: yes;"> </span></div>
<div class="MsoNormal">
<br /></div>
<div class="MsoNormal">
We pressed upward.<span style="mso-spacerun: yes;">
</span>We had another hour of walking, but only 300 meters in altitude,
left.<span style="mso-spacerun: yes;"> </span>My weight almost entirely
landed on my arms and walking poles, my gait had turned to a slow methodical
shuffle, brushing the ash ground with a slow rhythm.<span style="mso-spacerun: yes;"> </span>“Giant steps are what you take walking on the moon,” Sting
and The Police began to sing in my head.<span style="mso-spacerun: yes;">
</span>We came across two headlamps, one seated, one standing. <span style="mso-spacerun: yes;"> </span>The trekker vomited, I think, and his
guide comforted him.<span style="mso-spacerun: yes;"> </span>I think that
if I had sat then, I wouldn’t have made it.<span style="mso-spacerun: yes;"> </span>We shuffled on, and a bit of light broke over the horizon to
the left.<span style="mso-spacerun: yes;"> </span>The hill became slightly
more steep and curved up to the right and I saw Sikuu bolt up a little
faster.<span style="mso-spacerun: yes;"> </span>“Kuche Kuche!<span style="mso-spacerun: yes;"> </span>We don’t need no trouble!<span style="mso-spacerun: yes;"> </span>No more trouble!”<span style="mso-spacerun: yes;"> </span>He shouted.<span style="mso-spacerun: yes;"> </span>“Huh?!”<span style="mso-spacerun: yes;"> </span>I
wasn’t thinking straight, but I knew what it meant:<span style="mso-spacerun: yes;"> </span>We were here.<span style="mso-spacerun: yes;">
</span>We did it.<span style="mso-spacerun: yes;"> </span>To compare my
feeling to a hangover would glorify the day after drinking.<span style="mso-spacerun: yes;"> </span>The vice-grip headache affected me, but
the emptiness of mind didn’t allow me to acknowledge the pain.<span style="mso-spacerun: yes;"> </span>A few tears rolled down my cheek.<span style="mso-spacerun: yes;"> </span>I’m not sure how, but Meghan and I
withdrew our cameras and got solo and team shots in front of the sign at the
summit.<span style="mso-spacerun: yes;"> </span>The sun illuminated our
surroundings.<span style="mso-spacerun: yes;"> </span>A giant glacier
reflected the entire color spectrum of the sunlight to our right.<span style="mso-spacerun: yes;"> </span>A giant canyon revealed to the
left.<span style="mso-spacerun: yes;"> </span>A glacier!<span style="mso-spacerun: yes;"> </span>On the Equator!</div>
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Then the Seattle girls arrived.<span style="mso-spacerun: yes;"> </span>I had a brief burst of energy.<span style="mso-spacerun: yes;"> </span>“Hey Seattle!<span style="mso-spacerun: yes;">
</span>How’s it going?!”<span style="mso-spacerun: yes;"> </span>Blank
stares all around.<span style="mso-spacerun: yes;"> </span>One may have
cracked a smile.<span style="mso-spacerun: yes;"> </span>“Just another
warm summer day in Seattle huh?!”<span style="mso-spacerun: yes;">
</span>No response.<span style="mso-spacerun: yes;"> </span>“Was it worth
it?!”<span style="mso-spacerun: yes;"> </span>Their looks said it
all.<span style="mso-spacerun: yes;"> </span>It was an unbelievable accomplishment
on Day #5 of this adventure, and we had done it.</div>
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<br /></div>
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Meghan and I were trekkers number three and four to reach
the summit, 19,340 feet above sea level, on December 19, 2007.</div>
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<br /></div>
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The Celebration</div>
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After about 20 minutes at the peak, we headed down.<span style="mso-spacerun: yes;"> </span>We walked past the seated trekker, still vomiting, and then
slid down the scree as if on skis, racing past single-file lines of hikers
still focused on the summit.<span style="mso-spacerun: yes;"> </span>Our
arrival back at base camp was welcomed by my favorite porter: “Congratulation,”
he said with a big hug.<span style="mso-spacerun: yes;"> </span>After a
quick snack and change of clothes we packed up to head down the mountain.<span style="mso-spacerun: yes;"> </span>It was only 06:45 in the morning after
all.<span style="mso-spacerun: yes;"> </span>The camp for the last night
was just three hours from the bottom, and with showers calling our name, we
made the decision to reach the bottom that night.<span style="mso-spacerun: yes;"> </span>On our final hour of walking, it began to pour down
rain.<span style="mso-spacerun: yes;"> </span>And after a dry five days,
and seven solid hours of pounding on my knees, rainwater had never felt better.</div>
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Twelve hours of sleep, one big dinner, and a full day of
shopping in Moshi had us all ready the next evening for the celebration night
out.<span style="mso-spacerun: yes;"> </span>Sikuu and our assistant guide
joined the two of us for a night on the town.<span style="mso-spacerun: yes;"> </span>Our main drink for the night?<span style="mso-spacerun: yes;"> </span>Whiskey and Coca-Cola.<span style="mso-spacerun: yes;">
</span>We had, after all, conquered the Machame Route, dubbed the “Coca-Cola
Route,” and we were now familiar with Kili.<span style="mso-spacerun: yes;"> </span></div>
Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com0Moshi, Tanzania-3.3348833 37.3403806-3.4616958 37.179019100000005 -3.2080708 37.5017421tag:blogger.com,1999:blog-2732810313133560243.post-36061711947221734222011-02-04T06:10:00.001-06:002011-02-04T06:20:27.276-06:00Kenya: Gone on Safari<span style="font-family: Georgia, "Times New Roman", serif;">Work's finished and it's time for safari! Please take in the last official post of our trip.</span><br />
<br />
<span style="font-family: Georgia, "Times New Roman", serif;">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.</span><br />
<br />
<span style="font-family: Georgia, "Times New Roman", serif;">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.</span><br />
<br />
<span style="font-family: Georgia, "Times New Roman", serif;">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.</span><br />
<br />
<span style="font-family: Georgia, "Times New Roman", serif;">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. </span><br />
<span style="font-family: Georgia;"></span><br />
<br />
<span style="font-family: Georgia, "Times New Roman", serif;">The true soldiers and "saints," really, in all this, are Josh, Brenda, and Aduda. Josh, the <a href="http://www.bonyoskenyamission.org/">Bonyo's Kenya Mission</a> #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.</span><br />
<br />
<span style="font-family: Georgia, "Times New Roman", serif;">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. </span><br />
<br />
<span style="font-family: Georgia, "Times New Roman", serif;">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. </span><br />
<br />
<span style="font-family: Georgia, "Times New Roman", serif;">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.</span><br />
<br />
<span style="font-family: Georgia, "Times New Roman", serif;">There is no need for plans. When the antelope comes, you'll be there.</span><br />
<br />
<span style="font-family: Georgia, "Times New Roman", serif;">The finale from Mom:</span><br />
<br />
<span style="font-family: Georgia, "Times New Roman", serif;">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.</span><br />
<br />
<span style="font-family: Georgia, "Times New Roman", serif;">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.</span><br />
<br />
<span style="font-family: Georgia, "Times New Roman", serif;">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!</span><br />
<br />
<span style="font-family: Georgia, "Times New Roman", serif;">-----</span><br />
<br />
<span style="font-family: Georgia, "Times New Roman", serif;">Asante sana for all your prayers and support. We can't wait to share in person when we return.</span>Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com1tag:blogger.com,1999:blog-2732810313133560243.post-21017064472567508022011-02-02T07:13:00.002-06:002011-02-02T07:23:38.948-06:00Kenya: The Kakamega Forest + Democracy Now?<div style="font-family: Georgia,"Times New Roman",serif;">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. </div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">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. </div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">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.</div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">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.</div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">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:</div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
You can either read the caution-provoking article about <a href="http://english.aljazeera.net/news/middleeast/2011/01/201113177145613.html">Obama being the one who will be remembered as "the one who lost Turkey, Lebanon and Egypt.</a>" Or, you may want to read support of <a href="http://www.bbc.co.uk/blogs/thereporters/markmardell/2011/02/obama_gets_tough_on_egypts_wea.html">Obama supporting Democracy, and practicing what he preaches</a>.</div><div style="font-family: Georgia,"Times New Roman",serif;"> </div><div style="font-family: Georgia,"Times New Roman",serif;">Oh, and Josh still doesn't have the truck.<br />
</div><div style="font-family: Georgia,"Times New Roman",serif;"></div><div style="font-family: Georgia,"Times New Roman",serif;">The better version from Mom:</div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">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.<br />
<br />
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.<br />
<br />
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).<br />
<br />
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.<br />
<br />
Love to you all!</div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">----</div><div style="font-family: Georgia,"Times New Roman",serif;"></div><span style="font-family: Georgia,"Times New Roman",serif;">Asante sana.</span>Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com0tag:blogger.com,1999:blog-2732810313133560243.post-87117911120475596012011-01-31T04:53:00.008-06:002011-01-31T06:02:30.368-06:00Kenya: Our visit with Grandma Sarah...on the Equator<div style="font-family: Georgia,'Times New Roman',serif;">Today, we try a different format - Mom goes first:<br />
<br />
</div><div style="font-family: Georgia,'Times New Roman',serif;"></div><div style="font-family: Georgia,'Times New Roman',serif;">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!<br />
<br />
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!<br />
<br />
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.</div><div style="font-family: Georgia,'Times New Roman',serif;"></div><div style="font-family: Georgia,'Times New Roman',serif;"><br />
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!<br />
<br />
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.</div><div style="font-family: Georgia,'Times New Roman',serif;"><br />
</div><div style="font-family: Georgia,'Times New Roman',serif;">-----</div><div style="font-family: Georgia,'Times New Roman',serif;"><br />
</div><div style="font-family: Georgia,'Times New Roman',serif;"></div><div style="font-family: Georgia,'Times New Roman',serif;">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.</div><div style="font-family: Georgia,'Times New Roman',serif;"><br />
</div><div style="font-family: Georgia,'Times New Roman',serif;">No worries. That couldn't prevent what has thus far been Mom's favorite day in Africa.</div><div style="font-family: Georgia,'Times New Roman',serif;"></div><div style="font-family: Georgia,'Times New Roman',serif;">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.</div><div style="font-family: Georgia,'Times New Roman',serif;"><br />
</div><div style="font-family: Georgia,'Times New Roman',serif;">Josh called Philip, who called another friend, who called someone else to confirm <i>She</i> 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.<br />
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</div><div style="font-family: Georgia,'Times New Roman',serif;"></div><div style="font-family: Georgia,'Times New Roman',serif;">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!</div><div style="font-family: Georgia,'Times New Roman',serif;"><br />
</div><div style="font-family: Georgia,'Times New Roman',serif;">Mom was beaming the entire way home. What a day.</div><div style="font-family: Georgia,'Times New Roman',serif;"><br />
</div><div style="font-family: Georgia,'Times New Roman',serif;">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.<br />
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</div><div style="font-family: Georgia,'Times New Roman',serif;"></div><div style="font-family: Georgia,'Times New Roman',serif;">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.</div><div style="font-family: Georgia,'Times New Roman',serif;"><br />
</div><div style="font-family: Georgia,'Times New Roman',serif;">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...</div><div style="font-family: Georgia,'Times New Roman',serif;"><br />
</div><div style="font-family: Georgia,'Times New Roman',serif;">Asante sana. </div><br />
<span id="goog_449621201"></span><span id="goog_449621202"></span>Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com1tag:blogger.com,1999:blog-2732810313133560243.post-76184202124520000032011-01-30T03:09:00.003-06:002011-01-30T03:18:12.488-06:00Kenya: Lake Victoria and Global Politics<div style="font-family: Georgia,"Times New Roman",serif;">After working the first 9 of 10 days here, we took the weekend off. </div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">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. </div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">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.</div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">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. </div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">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.</div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">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?</div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">OK, as if it's not hot enough here in the city, we're headed to stand on the equator... </div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">The more colorful version from Mom:</div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.</div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">------</div><div style="font-family: Georgia,"Times New Roman",serif;"></div><span style="font-family: Georgia,"Times New Roman",serif;">Asante sana.</span>Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com0tag:blogger.com,1999:blog-2732810313133560243.post-9534504292479280502011-01-27T08:01:00.000-06:002011-01-27T08:01:11.455-06:00Kenya: The Car Inspection<div style="font-family: Georgia,"Times New Roman",serif;">After a lot of Gatorade-powder-enhanced hydration, chicken masala, and chips masala last night, we were back on the horse this morning.</div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">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. </div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">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...</div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">...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.</div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">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.</div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">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. </div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">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.</div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">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.</div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">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.</div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">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.</div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">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. </div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">Mom's version:</div><div style="font-family: Georgia,"Times New Roman",serif;"> </div><div style="font-family: Georgia,"Times New Roman",serif;">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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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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.<br />
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I'll sign off for now. Love to you all!!!!</div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">-------</div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">P.S. Josh is still at the police station. Without the truck. </div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;">Asante sana! Much love.<br />
</div>Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com2tag:blogger.com,1999:blog-2732810313133560243.post-10781888200191082072011-01-26T08:54:00.000-06:002011-01-26T08:54:18.928-06:00Kenya: OB.<span style="font-family: Georgia, "Times New Roman", serif;">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.</span><br />
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<span style="font-family: Georgia, "Times New Roman", serif;">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."</span><br />
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<span style="font-family: Georgia, "Times New Roman", serif;">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. </span><br />
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<span style="font-family: Georgia, "Times New Roman", serif;">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.</span><br />
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<span style="font-family: Georgia, "Times New Roman", serif;">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.</span><br />
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<span style="font-family: Georgia, "Times New Roman", serif;">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. </span><br />
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<span style="font-family: Georgia, "Times New Roman", serif;">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. </span><br />
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<span style="font-family: Georgia, "Times New Roman", serif;">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). </span><br />
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<span style="font-family: Georgia, "Times New Roman", serif;">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.</span><br />
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<span style="font-family: Georgia, "Times New Roman", serif;">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.</span><br />
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<span style="font-family: Georgia, "Times New Roman", serif;">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. </span><br />
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<span style="font-family: Georgia, "Times New Roman", serif;">Asante sana.</span>Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com0tag:blogger.com,1999:blog-2732810313133560243.post-68860656533072304022011-01-24T08:51:00.000-06:002011-01-24T08:51:48.555-06:00Kenya + George W. Bush<div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;">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.</span></div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;">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...</span></div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;">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. </span></div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;">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...</span></div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;">...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 (<a href="http://www.pepfar.gov/">President's Emergency Plan for AIDS Relief</a>) - 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.</span></div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;">"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.</span></div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;">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 <a href="http://www.mcc.gov/">Millennium Challenge Corporation</a> . 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. </span></div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;">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. </span></div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;">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! </span></div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;">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.</span></div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;">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.</span></div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;">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.</span></div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;">Again, it's amazing all of the many services that are down here - but there's more to be done.</span></div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;">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.</span></div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
</div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;">More from Mom: </span></div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;"><br />
</span></div><div style="font-family: Georgia,"Times New Roman",serif;"><span style="font-size: small;">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.<br />
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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.</span> <span style="font-size: small;"><br />
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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.</span> <span style="font-size: small;"><br />
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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!</span> </div><div style="font-family: Georgia,"Times New Roman",serif;"><br />
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</span></div><span style="font-size: small;"><span style="font-family: Georgia,"Times New Roman",serif;">Asante sana for your support and prayers. Much love.</span></span>Gaujothttp://www.blogger.com/profile/16530444046752140192noreply@blogger.com1