Been here a week

Well, I've spent a week in Kenya. In many ways it seems longer than that, as so much has happened. In other ways it seems like it flew by, and I think that the next 7 will as well.

I'm slowly getting more used to the wards, and getting more integrated into the team. The Registrar even asked me a few questions today! I went back to the hospital yesterday afternoon to help the team give our heme/onc patients chemo. That was an interesting experience. We got a big box of meds from the pharmacy, and we took them into the procedure room, where the interns proceeded to mix, measure, and dose the meds themselves. Now, understand that in America, chemo drugs (being highly toxic) are strictly regulated, mixed by trained pharmacists under strict body protection by suits, masks, and eye shields, and the doses are calculated and measured very precisely. None of us being oncologists, yesterday we read many of the package inserts to figure out the dosing, then calculated the actual doses on a phone calculator. Moreover, it was a very crowded room with needles everywhere, and our only protective equipment was latex gloves. Again, I don't want to sound like I'm criticizing the Kenyan way of doing things, as they really do the best with what they have. I just find the differences between here and the US very striking.

So after mixing our chemo drugs, it was time to administer. One little boy, who's not as sick as the others, came to the procedure room to get his intrathecal (in the spine) chemo. No pain meds or anything, just a big needle in his back. He didn't even flinch. (One thing I've certainly noticed -- the patients here are extremely tough, especially the kids). The other 3 kids who got chemo yesterday we did at the bedside. Two of the boys IVs' were blocked, so they needed another stick before they got their drugs. The process of actually giving was a little hocus-pocus as well -- you can't generally give these drugs in one big bolus, in fact the US they're usually given via a pump for a constant small infusion of drugs over a certain amount of time. But here, there are no pumps obviously, so the interns just injected slowly, guessing at the rate by trying to keep the rate of IV fluids going in about the same. The worst part about the whole thing was that these drugs burn going in, and after about the 2nd or 3rd syringe, the kids started getting really sick and vomiting. It was awful. It was the first time I've almost cried in the hospital. In a way, it's great that we can offer chemo to these kids for a chance at palliation or even a cure, but in a way it made me feel like we were just torturing these children.

Last night was the big IU house dinner, we went to an Indian restaurant, which was quite good. They brought us out plates and plates of food, and when they took away my plate I was full. But then they brought out BIGGER plates and new utensils. I asked Sonak if there was more, and he informed me that the first "course" was just the appetizers! Good Heavens. The IU people go out as a group every Wednesday, and they cook dinner for the students at IU house on Thursdays, so I won't be eating beans, rice, and ugali for /every/ meal.

This weekend 5 of us are planning a trip to Kakamega -- a rainforest reserve about 2 hours from Eldoret. We'll be camping for one night, and going on 3 guided tours of the forest while we're there. I'm pretty excited about it. I'm sure I'll have a lot to say about it when we get back.

Keep sending your emails (or start, if you haven't sent any! ;)), I like to hear from home.