Ups and Downs

One more picture! This one is of me at the Crying Stone on the way back from Kakamega.

It's been a relative blogging dry spell (really only 3 days), but I've been unbelievably busy lately. I didn't /really/ want to be as busy in Kenya as I am at home -- I was looking forward to it as a sort of vacation. But, alas. I had 2 presentations to give on Monday, and the pediatric student lectures have really revved up now -- we usually have 3 or 4 on a given afternoon. I don't necessarily make it to /all/ of them, though I do try to make most. If I did go to morning rounds, afternoon lectures, and admit patients at night, I would never have time for laundry, reading, going to the bank, etc. You know, normal life. I don't know HOW the Kenyan medical students do it -- as they are required to be at all lectures and have read on the topic ahead of time. Joy, one of the Kenyan students on my team (who I like a WHOLE lot) told me she hasn't done laundry in 4 weeks. Too many things to do and not enough time -- yet another thing about medicine that I've found is universal.

Dayna left on Monday. It's kinda weird that she's not here. When Priti and I first got here, we thought we would be sharing a room at the hostel, then when Dayna left one of us could move into her room. I may have told this story already, but about a week ago, Shawn the IU house administrator told me that actually two Utah students were coming as soon as Dayna left, and would be moving into the hostel. Two girls. Ok, I guess that's fine. Well, Shawn called us early Monday morning to say that -- whoops -- the 2 students from Utah were actually a male and a female, so they would each be taking one of the hostel rooms and Priti and I would be moving back to IU house. Oh and by the way be ready to move at lunchtime today. Sure, no problem. Let's frantically pack all of our stuff and try to round in the morning. So... we were set to go, when Shawn called us yet again in the afternoon to say, hey, it makes more sense to have Natalie (new Utah student) move into the empty room, Teanu (new Utah student) stay at IU house, and Priti and I just stay put. (That was my EXACT thought when he called us that morning at 7, but I wasn't about to complain about moving back to warm showers, big rooms, and internet access). In the end it's probably for the best, because when we go back to admit at night it's much easier to walk across the street than to take a taxi from IU house to MTRH and back again. It's also nice to live with the other students, especially since we know many of them now and have made friends. Plus, it's weird to try to make yourself part of a team and live as a Kenyan medical student if the place you actually live is much better than where they do.

I spent today in "Module 4" -- ie the pediatric AMPATH clinic on MTRH campus. (Nothing to do with HIV/AIDS is actually called that here, as I've learned. People use a lot of euphemisms like "exposed" "seropositive" "ISS positive" "DCT positive" "been to room 54/Module 4, etc." Which I think is too bad. Because if healthcare professionals can't even say HIV/AIDS, how can they expect their patients to? A good example of the stigma that AMPATH is still fighting to eradicate). The clinic was pretty fun. Most of the kids were healthy little people, who I got to play with while the clinical officer and the mother spoke in Swahili. I was surprised that so many of the children aged 11 to 14 or so came by themselves. Many of them were orphans who lived with their "aunties" (could be a relative or just caretaker) who had to work or take care of their own 5 children. I just cannot fathom children having the presence of mind to keep clinic appointments, get there by themselves, and then communicate in a mature way with the CO. Not to mention have the presence of mind to self-administer something as complex as antiretroviral therapy and the various prophylactic drugs that they're on. Yet, I saw many examples of it today. I suppose that growing up hard makes you grow up fast. And of course, it was nice to get out of the wards today. It can honestly be such a depressing place.

Right now we are taking care of two abandoned little boys -- brothers, ages 3 and 5. The history is a little fuzzy, but apparently the landlord (or possibly a neighbor?) of the house the boys lived in heard them crying off and on for a few days. Eventually he went over to the house, looked in a window, and found them locked inside. He broke in, and no one else was home. Who knows how long they had been in there by themselves? They were taken to a childrens' social services type place, then immediately to MTRH for de-worming, nutrition, not to mention treatment for some sort of TERRIBLE skin rash/infection they have on their hands and feet. The Kenyans keep calling it "chiggers" but I'm thinking it's something else. It looks really bad. A few days ago, we found out their names: Philip and Kevin. So, I immediately took to them even more than I had already. Since coming and getting adequate food and water, Phillip the 5 year old has turned into a real crazy kid. He's constantly climbing out of the crib that he and his brother share and running all over the ward like a maniac, "rounding" with us, stealing things out of our pockets, trying to be goofy to get us to laugh -- which often works. He's actually really funny, and very smart too, and he likes to spend time playing with the other kids in Sally Test. Kevin, the little one, is a different story. He's the saddest little boy I've ever seen. He never gets out of the crib unless someone takes him out. Most of the time he just sits in the crib, staring with the saddest face I've ever seen. No matter how we try, we can't get him to smile. When he's in Sally Test, he just sits there with the same slumped posture and defeated face, watching the other kids play but never joining in. It's the saddest thing. Who knows what kids can remember, especially at such a young age, but being abandoned by your parents clearly has a profound and lasting psychological effect.

We also have Enock, a 5 year old boy with Burkitt's Lymphoma (VERY common here -- a cancer caused by the EBV virus [same virus that causes mono]). He was diagnosed in January, got some chemo but was then lost to follow up like so many of our patients. When he came back he had horrible disease, which this time did not respond to treatment. Now he's just getting palliative care, which includes morphine and low-dose chemo. The chemo is making him so ill, so a bunch of us are pushing to send him home with generous amounts of morphine, but for some reason he's still here. Everyone really likes Enock, because he's always in Sally Test, attempting to play and smile, even though he's the sickest kid there by far.

I've been here for 4 weeks -- halfway done already. It's so hard to believe. Though I will be so excited to get back to my family and friends, I can see already that I'm going to miss Kenya, despite its many problems. For sure I will be back someday.