Endurance...

My endurance is waning, not for working, just things like laundry, ironing, Patient tracking, EBM and H & P assignments and... well..... blogging. Sorry but I feel like here towards the end it's more important to spend my very precious, because there is so little of it, free time doing what I think is truly important. For example studying for the PANCE which I am now officially registered for! And reviewing anatomy and procedures for my current rotation... which I am LOVING!! Yesterday I helped do the most fantastic I & D in the OR. A patients ventral hernia mesh had gotten infected ( for the 3rd time ) so we opened up her belly and drained.... wait for it.... 3 Liters of PUSS!!! It was gross and foul smelling and AWESOME!! I loved it!

Out of Africa!!

Wooo Hoooo! I made it! I'm now safely back on American soil, and have never been more thankful to be a citizen of the USA than I am today on this beautiful 4th of July.

I now reside in the pleasant little town of Ashland OR, where the weather is warm and the people are too! I just finished my first week at the clinic and am gearing up for week 2, but it's late and I'm tired so off to bed I go. I'll catch up with a review of my days here sometime this week. Until then.... remember to eat lot's of fiber, your colon will thank you :)

Week 4

On Sunday Le, Tammy and I decided to go for an adventure with George (Alice the Anesthesitis’s “brother”. Actually I just realized I haven’t talked about Alice yet so allow me this tangent to tell you a little about her. She is fantastic and I love her!! Alice is a Clinical Officer, Kenya’s equivalent to a PA, who did further training to perform anesthesia and has been working at St. Josephs for 5 years and Homa bay district hospital for 1 year, she is extremely busy. She lives next to our house in the hospital compound and was one of the first people to welcome us when we first arrived at the house. She has been extremely helpful both at the hospital and with cultural issues here in country. Last week she invited us over for a glass of wine and her favorite soap opera, which she is obsessed with! While we enjoyed a wonderfully cold glass of South African white wine, we met her “brother” George, cousin veronica and actual brother Jeffrey (who also works at the hospital in maternity and is amazing with mothers in labor, fun to work with and in general another one of my favorite people) George and Alice talked about some places they thought we might enjoy visiting that are nearby. Thim leech, Ruma national park and Gogo falls and we made arrangements to go with George the following Sunday to visit one or two. In short Alice is one of my favorite people here and meeting/spending time with her has been another highlight of the trip). Now to continue with my story….

So George helped us arrange to rent a matatu for the day and accompanied us on a trip to Kisii which is famous for its soap stone carvings and then on to Ruma National park, which is home to elephants, giraffe’s and many other animals. The trip was, which I’ve grown accustom to, difficult from the beginning. The drivers of the matatu decided that the price of driving all the way to Kisii and then to Roma (which are in opposite directions) was too far for the previously agreed upon price of 8,000ksh (94$) so we had to negotiate a new deal which included paying for the petrol. After some haggaling we agreed upon 11,500ksh (135$) for the whole day rental of the matatu. We spent 1hr ½ in Kisii looking through the many shops and buying up beautiful souvenir bowls, chess sets and vases. After our shopping spree we piled back into the matatu and headed to Ruma. We stopped in a small town to pick up some lunch, well the drivers picked up lunch we had packed snacks. Lunch for the drivers consisted of a loaf of bread and a pouch of milk (no cartons here). We shared our peanut butter Cliff bar with the drivers. It was pretty amusing to watch them take such a small bite at first and then gobble up the rest of it. As we pulled into town we noticed a long line of people in the street, as we got closer we saw the line was made up of children in uniforms all marching together. George explained to us the scouts were having a parade. Girls scouts, Boy scouts, Eagle scouts, Brownies there must have been 80-100 kids marching down the street. Then George told us he was a scout and we compared scouts in the states to the traditions of scouts here in Kenya.

The drive to Ruma was filled with sweeping green hillsides dotted with farms, tin and grass hut roofs and some unbelievable views of the entire valley. After 2hrs of driving we finally reached our destination. Unfortunately we had been told the entrance fee was 200ksh, turns out that is the price for Kenya residents, the non-resident price is $20 USD!! We offered to pay the student price of 10$USD but apparently that only applies to students under the age of 23. And I realize one of Kenya’s primary draws for tourists is their parks and wildlife, so I understand the price. Unfortunately we are here as volunteers to help people in the area and I think with as many missionaries and volunteers as they get, it would be reasonable to also have a lower price for people who are here to work, not here on vacation with a ton of money to spend. So the fee would have made our trip a grand total of 65$ just for Ruma… After much deliberation and many failed attempts to negotiate with the park official, we decided it was just too expensive and turned around.

The rest of the week at St. Joe’s was pretty normal filled with the mundane, spiked with a few exhilarating, yet sad incidents. I rounded on the Medical ward with Dr. Megori, who is a great teacher and it was interesting to compare treatment plans, which most of the time were very similar. I got to see an AIDS patient with a classic manifestation of Kaposi Sarcoma and was shocked to see her CD4 count was literally 1! I had a few patients die, but unfortunately they were immunosuppressed and circling the drain, there was nothing more anyone could have done. Tammy and Alice had a very tough case this week, a small child of around 2yrs was brought in with severe burns over the face and upper extremities, after a successful resuscitation and careful management, she later died due to resources. Unfortunately the hospital doesn’t have an ICU for patients that need that high a level of care. What worse is that even if they did the child’s family doesn’t have the money to pay for it. One of the saddest things I’ve seen is the grandmother and mother of the child paced and wailed outside the hospital gates for 2 days mourning the loss of the child, but also begging for money to pay the hospital debt to release the body for a burial in the family plot.

On Wednesday we drove up to Homa Bay district hospital, where we toured the facility and participated in rounds. The district hospital is a government run hospital and the difference between it and St. Joe's is striking. The district hospital is larger, with more patients and worse pathology than St. Joe's. They are severely understaffed ( 2 nurses for 26 patients in the surgical ward I rounded on) and the drug supply is unpredictable. It is a teaching hospital though so the Doktari I rounded with (Dr. Elisa) had 12 clinical officer student with him, so he was an excellent teacher! After rounds we met with the principle and administrator of the CO school next to the hospital. After our tour of the school we drove down to Lake Victoria and had lunch at a hotel right on the lake!

We finished off the week in Bware where we were scheduled to meet with the BBEKAS group and BUCHWA. We arrived at Bware primary school as the venue for the meeting; however as with just about every meeting in Kenya there is the 2 hour window of when the meeting actually takes place. So we played with the children until the other headmasters arrived. Tammy organized a football game and Heather and I walked around talking with the kids. We met a teacher conducting a small group of children singing in the corner of the soccer field and the children sang the most beautiful little song for us. In speaking with the teacher we learned the group was actually practicing for a competition next week. It turns out they had already won 2 other competitions and were scheduled to compete at the provincial level, if they win they will go onto the national competition and winning there means the opportunity to sing for the President of Kenya!

Later we met with the headmasters of the primary schools and presented them with a form to track the health of their students over time. We also outlined implementation time line and the logistics of completing each step. We also met with the BUCHWA group and gave a presentation on female cancers, diabetes, hypertension and stroke. As well as conducted a workshop on taking blood pressures. We also toured the Bware dispensary and inventoried the items we brought as a donation.

Only 12 days left, 4 days at St. Joseph’s, 1 day in Bware, 1 day of travel to Mombasa, 4 days in Mombasa! 1 day of travel back to Nairobi and on Friday June 24^th we leave Kenya.

Pictures yeay!!

WEEK 3

This week we said goodbye to our new friends Cheryl and Lauren from Michigan. They are an amazing mother, daughter duo who joined us the first two weeks and it was pretty sad to see them go after everything we had experienced together. So we all went out to dinner at the Bliss Hotel, where we had a few cold beers, lot’s of laughs and a few tears, as they climbed into the taxi.
On Wednesday we got up early all 5 of us squeezed into a car with no seat belts and only 4 seats for an hour and half bumpy ride on our way to Kopanga dispensary. We’ve grown accustom to squeezing more people and bags into a car than we ever thought possible, however this was our first experience with a LENGTHY car ride down a road that would be for ATV’s and motorcross only in the states. When we finally reached the clinic, we were dropped off on the side of the road and tramped our way through a field of cows and goats to the clinic.

Kopanga dispensary is a small mission clinic founded by the United Methodist Church in Washington state, around 1yr ago. The staff consists of a few nurses and nurse aids as well as a lab tech and an administrator. We were given the grand tour by the head nurse, who treats children under 5, the whole place consists of a labor room, a counseling/adult patient room, a Maternal Child Health room, a lab room, an observation room with four beds and a pharmacy room (the labor room and observation room are pretty large probably 15ft x 10ft, the other rooms are about 5ft x 7ft). The clinic takes 50 Kenyan shillings (ksh) for children under 5, 100ksh for children 6-13 and 200ksh for everyone 14 and older. This covers their evaluation, any lab tests and any medications prescribed. After our tour we each split off with a nurse to see some patients for a few hours and then were invited across the grounds to the guest house where we had tea and some lunch, which was prepared by a wonderful mother daughter team.

After lunch we decided since we were so close to the border of Tanzania we couldn’t possibly leave without venturing across. So we piled back into the car and journeyed down another bumpy red dirt road winding through the country side, passing small collections of mud huts with grass roofs and small children running alongside the car yelling “Msungu! Msungu!” and waving furiously. ( I just realized this is the first time I’ve mentioned this phrase and I have to apologize for this huge oversight, as this is one of the first words we learned because it means “white person” and everywhere… I mean EVERYWHERE we go, we hear it) So after about 30 minutes of driving we arrive at the border town where Mr. Barasa greeted the border guard, who looked like just everyone else except he had on a nice polo with the Kenyan flag embroidered on the upper left chest. After a few minutes Barasa got back into the car and we continued on into what Barasa called “no mans land” apparently there is a small section of land that doesn’t really belong to either country?? So after a few minutes we crossed over a small creek which we were told is the actual border, before arriving at the border town in Tanzania! We all quickly riffled through our bags to pull out our cameras to capture the moment and the signs, for proof of our entry when Mr. Barasa’s eyes bugged and “no, no, no, no.. it’s not like Kenya, no pictures”! Stunned we all shoved the cameras back in our bags and Barasa got out to speak with the border guard to see if we could enter the country. As he came back to the car smiling he says “ yes, it’s alright we can come in and we don’t have to pay to get back out” despite our mild shock and confusion at the prospect of having escaped a fee we didn’t know even existed we rolled along through the town.
On the side of the road towards the end of town a sign for the police station came into view and a stern looking gentleman in a khaki uniform with a rifle slung over his shoulder, glared at our car as we tried to turn around. He watched the car intently as the driver executed a 20 point turn, when the car was positioned exactly horizontal in the middle of the driveway he began to slowly stroll towards us. Small pangs of panic began to surge through me, Mr. Barasa jumped out of the car and greeted the man, who continued to look stern and glare at the car full of msungu’s. After only a few words exchanged the two strode up to the car and I prepared for the third degree. The guard, still stern with every step, stopped directly in front of my window, grabbed the door and busted out a wide toothy grin and a deep booming baritone said “You are welcome!” So our stay in Tanzania was brief but pleasant.

MASAI MARA!!! – Early Friday morning we left for our safari on the Masai Mara. We were told we would be taking a short cut to save time and get to the mara early, so we were all for it. It was the bumpiest most ridiculous ride, 10x worse and longer than the trip to kopanga! Thankfully we were in a van, but I really felt like I was going to rupture my spleen it was so rough. The holes and ditches on these roads are more along the lines of ravines, I seriously thought the car was going to bottom out, tip over, or break an axle! Finally we reached the Mara and before we got into the gates we saw water buffalo and zebras! Not even a mile past the gate and we saw elephants and were only a few feet from a herd of giraffe! It was amazing being so close to such magnificent animals in the wild. As our day came to a close we watched the sunset next to a pride of lionesses lazily napping next to a stand of trees.
Our accommodations in the tented camp were beyond expectation and just to put it in perspective, it was the BEST shower we’ve had since we arrived in Kenya! The food was delicious and a giant beer was only 200ksh. We were up early and out to watch the sunrise over the Mara, water buffalo, zebra, ostrich, topi, impala and tomi gazelle were all out grazing in the crisp morning air. We saw a lioness and four cubs cruise across the plains into some brush. Later in the morning we went back to the tent, packed up our things, took one last phenomenal shower and made our way down to the Masai village. The Masai are native people who still live in the traditional style on the Mara, houses made out of cow dung and all. The chief's son Peter was our guide and explained some of their cultural practices with us. Later the men and women danced and sang and we bought a few souvenirs from them. Tammy traded a headlamp for a necklace and Le traded her watch for a carved club. On our way out of the park we luckily happen across a cheetah resting beneath an acacia tree. She was beautiful and smaller than I had expected. This trip was definitely a high point of the rotation, don’t get me wrong I love the medicine but this was spectacular!!!

PS. - I just waited 30 minutes for 4 pictures to upload and when it reached 100% it failed, so no pictures tonight, sorry

Pictures

I couldn't upload pic's this time but I was able to load them on the other blog I'm doing here it is http://kenyamay2011trip.blogspot.com/

Kenya week 2:

Unfortunately our preceptor was unable to join us due to a family emergency, but lucky for us a member of the group Safe Passage to Motherhood (who were here 2 weeks before us working in Bware helping educate women about pregnancy, labor and delivery in an effort to decrease maternal/infant mortality) Lelinda (or Le ) volunteered to stay on with our group for another 2 weeks. Le is a clinical psychologist and her experience with the community as well as her specialty has been invaluable to us in the last week. We are all extremely grateful for her willingness to stay and help us process our experiences here in country.

Migori – The town itself is probably a medium sized town for Africa as it has a level 4 hospital (St. Joseph’s) and the main street has 2 supermarkets, 3 hardware stores and countless other shops. There are open market type of stands all over the side of the road and down side streets. It’s relatively safe to walk around the main street in town during the day, just be sure to keep your passport wallet on a string tucked safely inside your shirt and not wearing anything that looks valuable is a good idea. We always walk together in at least a pair but the larger the group the better. Last night some of the students from Medics to Africa program (they are staying in the hospital guest house further up the road) went out to a disco (night club) but we decided to stay in. Most of the time when you’re walking through town people are friendly and everyone greets you with “habari” (hello, how are things) to which you respond “mzuri or salama” (good, perfect) and they are big fans of the handshake! You shake hands with everyone, everytime you see them and the better you know them the longer the handshake is.

St. Joseph’s Mission Hospital – In a word… AMAZING… there are so many things about this place that are both inspiring and tragic. The people here are so welcoming and friendly; full of such love and kindness at times it overwhelms my heart to see how selflessly everyone here at the hospital gives to the point of exhaustion. The resources have made me cringe so many times I’m almost in a constant state of shock. At the same time they do their very best with the limited equipment and supplies they do have. The most significant thing about the hospital that stands out for me is how much death there is, for a hospital this size the number of patients that die every day is astounding. Most of the problem is that people wait so long before coming in, because of money or transportation, by the time they actually come in it’s nearly impossible to save them.

Bware – A quiet farming community just outside of Migori. We visited Bware primary school and the kids were absolutely adorable and so excited for the books, pencils, crayons, paper, erasers and other supplies we brought. By far the biggest hit was the football (soccer ball) we brought, they went crazy for that. Then we met with the Buchwa and BBEKAS ( Buchwa is the community health aids group that is made up of mostly women from the Bware community and BBEKAS, an acronym for all the primary schools in the area, is the headmasters from each school) had a meeting during which they gave us some information about the issues the community and the schools are facing and the things we could address while we are here.

After lunch we were taken to meet our host family, all three of us are staying with Alex and Lucy and their 2 daughters Angela (who is making me a skirt) and their 5 grandchildren Whitney, Willis, Vincent, Sharon and Wayne. We left our bags there and walked up the street with Le to visit the family she has been homestaying with. Marselline Koskei and her husband own 10 acres, their daughter Annett took us on a tour of their farm where they grow; bananas, mango, papaya, avocado, pineapple (Heather got to pick a fresh pineapple which we will enjoy tomorrow) soya (soy beans), ground nuts (peanuts), kale, maze (corn), napear grass (for the cows to eat), and cassava. After that we walked back down to Alex and Lucy’s where we enjoyed dinner and some entertainment provided by the children and then us as we tried to remember the Kiswahili words to the head, shoulders, knees and toes song. Then the two girls braided my hair, before we turned in for the night. The next day Le met us in the morning and we walked up the street to a neighbor’s house where a group of monkeys live in the nearby trees. Unfortunately we were too late in the day for monkey spotting, but the view from the top of the hill was breathtaking. When we got back to the house the children were all waiting to play with us Tammy played some football with the kids, the girls showed me how to weave grass and then Heather and I turned a jump rope for the girls and learned some Kenyan jumprope games. All in all it was a VERY good week.

This upcoming week we will be going on Safari Friday and Saturday so next time I should have some pics of the animals.