Kwa Heri from Eldoret

It’s Thursday night. This will be my last post from Eldoret.

I’ve said (most of) my goodbyes, I am (mostly) packed, and I feel (mostly) ready to go home.

There’s a certain feeling I have that I’ve left some things undone, some things unsaid. But, I suppose that’s probably normal.

It's so strange...how at the beginning two months seems like forever; an eternity to be away from your home, your family, and everything familiar. But sitting here tonight, looking behind me at the amazing and terrible things that have happened... it seems like just yesterday I was looking up at the stars in Eldoret and thinking how I felt so terribly far from home. But now this is home, and the heartbreak I had 8 weeks ago at leaving is revisiting me, in a different way.

We’re leaving from IU house at 2:00 tomorrow, to catch our 3:00 flight to Nairobi. Nairobi to Amsterdam at 10:15. Amsterdam to Boston at 8 ish. Boston to Indy at 1 ish. Then at 4pm I'll get to see Michael's smiling face after 2 long months.

The Blog will probably continue to be updated for awhile, as I post my hundreds of pictures and some stories about readjusting, as well as my final paper (or at least part of it) for the rotation. After that, who knows? Maybe it will sit in cyberspace for a few years, until my next trip to Africa.

Kwa heri, Afrika, na asante sana.

Marafiki

…”Friends” in Kiswahili. One of the 3 major commandments given to us before coming to Kenya was “dignify relationships.” I’d like to share a little about some of the wonderful friends and relationships I’ve encountered here. I’ve learned something from every single person mentioned, and clearly my life would have been different, less rich, if the following people had never been a part of it.

Priti. Probably best to start with my roommate, as she figures prominently into most of my stories about MTRH, Eldoret, and Kenya. I didn’t know Priti that well before coming to Africa, but I was very lucky that she was the other student drawn out of the hat at the same time as me. She’s a very fun and silly person, and often adds lightness to my often too-seriousness. She’s going into internal medicine – she hates developmental milestones and I hate COPD and CHF; so medically we make a well rounded pair. In addition, we share a lot of the same views on life, the world, and med school and we’ve had many late-night discussions about these various topics. We both come from rather different backgrounds (Priti being a first-generation Hindu American whose parents are from India) so we bring different perspectives to any issue. Most importantly, she loves to shop. Between being there for each other through various illnesses, mood swings, and work frustrations, I think I’ve made a friend for life.

Dayna. The 3rd of the 3 IUSOM seniors here during my time, I regrettably only got to spend one month in Kenya with Dayna. But, what a fun month it was. Dayna was a lifeline to Priti and I when we first got here – not knowing our way around town at all, anything about the hospital, how much things should cost, where the good shops, groceries, banks, etc were in Eldoret. It would have been infinitely harder to move into the hostel if Dayna had not already been here. I really admired Dayna’s strength: soon after she arrived in Eldoret she found out that her mother had a serious medical condition. Being close to her mom, it was hard for her to not rush home, but she stayed and made the most of her time here. Dayna spent her 2nd month doing OB/GYN – her future career – and we could always count on her for a wide variety of stories from the delivery rooms and ORs: funny, bizarre, sad, tragic. We miss Dayna a lot now, only a small part of that being because she had a vast library of “Scrubs” episodes on her laptop. There is no better way to unwind from a frustrating day than watching your chosen profession get parodied relentlessly.

Venus. Oh Venus. The only ‘blonde’ Chinese girl I’ve ever met. Venus is a girl with a heart of solid gold, with such a sweet and innocent disposition that you can’t help but like her immediately (Think Tiff, but a Chinese Canadian). Venus is a business major at U of Toronto, and she spent her 10 weeks here working with the Family Preservation Initiative (FPI) arm of AMPATH. FPI works on issues like food security, small loans to private businesses and families, etc. Venus’ real passion while she was here, though, was playing with the kids at Sally Test. She used her camp-counselor persona to come up with absolutely brilliant arts and crafts to do with the kids. They all loved her. When she left, they made her a poster with all of their handprints on it. Being such a sweet person, Venus had a hard time saying no, and consequently gave her phone number out to just about everyone in Eldoret. By the end of the time here, she didn’t even answer her own phone anymore, as more likely than not it was some random guy calling with another marriage proposal. She was often subject to incessant teasing by the group – especially Sonak (since she left, Sonak has been on an earnest hunt for the “new Venus”), but she always took it well, and she knew that we all loved her.

Laurein. A 6th year medical student from Holland, I met Laurein on my first night in Eldoret when she came to dinner with us. I have no idea how she got hooked up with our group, as she didn’t know any of us at the time. That first night, I just remember being jet-lagged and exhausted, and thinking “who is this crazy Dutch girl who’s yakking my ear off?” Verbosity aside, it didn’t take long for me to love Laurein. She has a refreshingly European way of saying exactly what she’s thinking, and she can tell some of the funniest stories I have ever heard. Very outgoing and gregarious, she throws herself into whatever she is doing with gusto, whether it’s her studies, her patient care, or her friendships. Because of her work ethic, she has become essentially tri-lingual; applying the same fortitude in her Kiswahili lessons. On her way to becoming an international health worker in Doctors Without Borders, Laurein is currently starting a month-long rotation in rural healthcare in Kapenguria, Kenya, the she finish up her 4 month stay in Africa with a month of OB/GYN in Cape Town, South Africa. The thought of four months in Africa does not phase her, despite not knowing anyone in any of her destinations. Her ability to make friends wherever she goes is one of her strongest assets, and I believe she is going to do a huge amount of good in her medical career.

Abby. A social work student from Indianapolis, Abby will be spending 13 weeks in Eldoret, working with Sarah Ellen to improve and really get off the ground the rape/sexual assault center at MTRH. Her passion for women’s advocacy is very inspiring, despite the horrible, HORRIBLE things she sees every single day. Instead of letting the countless tragedies make her emotionally paralyzed, she uses these patients to drive her work and remind her of her purpose. I admire that so much. She actually reminds me a lot of Laura, which is part of the reason I like her so much. (And, it turns out that she actually lived on the same street in Chicago as Laura and Daniel for basically the same stretch of years. Uncanny, no?) In addition, she’s a very good basketball player, and it’s always amusing to watch her school Sonak at hoops. Her OCD-esque quirks and dry sense of humor have made her a real joy to have on trips.

Natalie. A senior medical student from University of Utah, I wasn’t quite sure what to make of Natalie at first. After only a short time; however, she really grew on me. We really only spent about 3 weeks together in Kenya, but it was 3 intense weeks, as they included the rafting trip to Uganda and she was our next door neighbor in the hostel. Natalie has a work ethic that I really admire, going back to the wards almost every afternoon to do procedures, check up on labs, or admit patients. She basically talked me into interviewing at the peds program in Salt Lake, and it will be great to see her again when I go out there.

Angela. A 3rd year peds resident from IU. Angela was one of my residents when I did my 3rd year inpatient peds rotation, and she was a lot of fun. She was also one of the night-float residents when I did NICU at Methodist, so when I found out one month of our time in Kenya overlapped, I was very excited. As one of the other NICU residents said “Angela could have fun at the bottom of a well.” I think that’s true. We’ve enjoyed quite a few fun and crazy moments courtesy of Angela in the past 4 weeks, including rafting on the Nile together and staying in the same hotel at Masai Mara. Not only is she extremely fun, she’s also extremely smart, and she has taken on the care of the children in the wards as a personal mission. Many days she has gone over and above the call of duty or expectation to find an inhaler for a kid that really needed it, made sure a dehydrated baby got enough fluids, or found a way to get an antibiotic that was out of stock.

Sonak. One of the smartest, if not /the/ smartest guy I’ve ever met. Sonak is 26, has his PharmD, did 2 years of residency in infectious disease, got his MPH (masters of public health) and is now a fully salaried professor through Purdue pharmacy school. Oh yes, and he’s on a tenure track. And ALSO, he worked for a year in Kisumu before getting his job in Eldoret. He got here the day before Priti and I did. Sonak was hired on for at least 5 years (but probably more) to rev up the pharmacy student exchange program that had sort of gotten into a rut. And he has really thrown his full energy at the job. His head is practically bursting with new, innovative ideas for AMPATH funding and HIV/AIDS research. (The 2 latest ones being global Wii tournaments with a buy-in that goes to AMPATH, and his most recent brainchild: Drinking and Dancing for Drugs. This involves a bi-monthly dance party at his house, where he will sell at-cost liquor and beer for a huge markup, and give the money to the Pharmacy program for emergency and out of stock drugs. After it gets off the ground in Kenya, he wants to live-link all of the cities in the ASANTE consortium, as well as sell t-shirts and other merchandise). His energy really does seem endless, and he is a constant source of information about all things related to international health. And to top it all off, he is an honest to goodness nice guy. He’s so patient about driving the girls around town to go shopping or run various other errands, especially when it’s raining. Whenever any of us are sick or has a problem, he’s so good about following up with us to make sure we’re ok. (Even Dr. Mamlin said – “that Sonak, he’s so cute. What a nice guy.”) And, really, he’s a lot of fun. He has a pool table in his house which is almost always in use, and he just recently acquired a 46-inch flat screen TV for his wall – sports viewing and all 3 seasons of “The Office” being the primary objectives. He also regales us with his lofty plans of building a fully-stocked bar in his house, in addition to a water cooler so he can be fully “self-sufficient” and not have to rely on IU house for anything. His role models are Paul Farmer and Joe Mamlin, and despite his young age he’s well on his way to being on par with those men; Sonak is going to do great things – things on a global scale to improve the health of developing nations, I am absolutely sure of it. I consider the newly-arrived pharmacy students very lucky to have such an energetic and optimistic teacher, but I think I may be a little bit luckier to have him as my friend.

Hao & Robert. Hao is a pediatrician, Robert is a medicine/pediatrics doc. It was a strange and new experience, being friends with my attendings, though not at all an unpleasant one. Before coming to Kenya to be the IU medical team leaders for a year, Hao and Robert spent quite a few years living on a Navajo reservation in America, providing medical care for the tribe. Right after getting married, they took a year off of medical school to do malaria research in Peru. Romantic way to spend your first year of marriage, eh? At first glance, it seems as though they have lived very exotic lives, but when it comes down to it they are very nice, very normal people raising 3 kids, trying to have as normal a life as possible while doing what they really love. I think they are very inspiring, and I certainly look to them as role models for having a family and practicing medicine – practicing international medicine at that.

Benson. A former street kid taken under the Mamlins’ wing, Benson serves as an invaluable asset to the American students in Eldoret. He shows us around town, goes out with us, takes us to the safe places, and makes sure we all get home ok with reliable taxis. A very fun and very nice guy, he’s in the process of finishing up his primary schooling so he can go to pharmacy school in Nairobi. I am amazed that, after years of revolving-door friendships, he still takes the time to get to know us all personally.

Joy. A 4th year medical student on my pediatric team from day 1. I was very intimidated by Joy at first, but after I got to know her, she became by far the best Kenyan friend I’ve made here. She possessing a very quirky sense of humor and the most uncanny way of imitating our Consultants that have earned us reprimands on rounds more than once. Aptly named, I have never once seen her looking down about anything or say anything negative about anyone. She checked on me when I was sick, and after we weren’t on the same team anymore, would send me random text messages to see how I was doing. Through our many and various discussions, I was pleased and surprised to find out how much we had in common, despite growing up on opposite sides of the world and in very different circumstances. I appreciate the way that Joy just seems to get me; understanding exactly who I am the way a lifelong friend would. I’m sure it’s very ignorant of me, but I did not expect to make friends in Kenya the way that I did. Perhaps a part of me figured ‘aside from working in medicine, what else could we possibly have in common?’. Clearly Joy (and the rest of my Kenyan friends) proved that ignorant notion wrong. I would not have loved Kenya nearly as much as I did (do) if it hadn’t been for Joy’s friendship, and I will miss her very much. She aspires to complete her residency in the U.S., and I sincerely hope that she does.

Ben. A 6th year student on my pediatric team. Nicknamed “The Professor” because he always has an answer for everything (usually the right answer) and he always has a lot to say about everything as well. Ben is one of the few non-traditional students at MTRH – he’s 38 (though he doesn’t look a day over 25) and worked for several years as a clinical officer before starting med school. He’s married and has 2 kids, and since he lives at the hostel during the week, his idea of a good time on the weekend is going home to see his family. Ben is very down to earth, very knowledgeable, and very good with his patients. He wants to be a pediatrician, and I know he will be an excellent one.

Allan. Also a student from my pediatric team, a 4th year. Allan was the student who sort of guided me through the first few very confusing weeks on the wards. He helped me with admissions, found the patients/parents who spoke English, and kept me updated on the ever-changing class schedule so I could go to lectures. Along with Joy and Ben, Allan really helped me feel like a part of the team and less like an outsider.

Wycliffe. The faithful Kiswahili tutor. How many times over the years has he heard muzungus butchering his native language? Too many to count, I’m sure. Still, he soldiers on with us in his infinite patience. Always very encouraging, even with the smallest of accomplishments, never laughing at me but allowing me to laugh at myself. (And my mastery of the Kiswahilli language is indeed, quite laughable). One of many IU House Kenyan regulars who witnesses the revolving door of our community, he still manages to never forget a face or a name. If I’m ever back in Eldoret, I’d like Wycliffe and Kiswahili to give me another chance.

At lunch on Tuesday, Hao asked Priti and I what our favorite part of the experience had been. I didn’t even have to think before answering “the people.” The hospital has been educational, the trips have been amazing, but none of it would have meant half as much if it hadn’t been for the people there around me. I hope that in coming to that realization, I have fulfilled the purpose of the program. I hope that by making this experience about the people, it will mean much more, and stay with me much longer than just ‘these 2 months I spent in Kenya once.’

Sleeping and Reading

That’s what I’ve been up to for the past 2 days. More sleeping than reading, really, as I’m still battling this cold/flu thing. Not the best way to spend my last week in Eldoret.

Today was not the best day. Even though I’m technically on vacation, I went to rounds in the newborn unit (basically the NICU) with Hao, as it’s something I’d wanted to see and hadn’t yet had the chance. First off, I got terribly lost, and every time I asked anyone where the newborn unit was, they looked at me as if I was speaking a foreign language (which I very well could have been). I finally met up with Hao, and she took me to the unit – which I never would have found by myself. There was a small ante-chamber type area, where we had to take off our shoes and put on these slipper-type sandal things, as well as leave our gear and coats, to minimize the germs entering the unit. As soon as we opened the door into the actual unit, a wave of heat nearly knocked me down. Since they don’t have individual incubators, the small 3 room unit is packed to the brim with at least 25 space heaters on full blast. Great for the babies. Bad for the adults. I was in there for all of 3 minutes before I was sweating profusely. Between being sick and it being about 100 degrees in the teeny tiny unit, not to mention there were about a dozen of us all crammed together, I was not much of a champ during rounds today. I had to leave every 10 minutes or so to go sit down in the antechamber area and drink some water, lest I end up losing consciousness. It’s the first time that heat alone has made me feel like I was going to pass out.
And then Laurein came by the unit to say goodbye. So that was hard. She was crying, I was crying – a big cry-fest. So I eventually wander back into rounds with my eyes wet and red, my nose dripping, completely sweaty, and Hao just looks at me and says “are you ok?” Uh…yeah. Great. Never better. I managed to rally somewhat and made it through the last 30 minutes of rounds without leaving (or fainting!). Overall the morning was not my most shining moment.

After rounds Priti and I had our de-briefing lunch with Hao, to talk about the program, what we liked, what we didn’t like. Hao had some really nice things to say; that she appreciated our attitudes during the whole experience and that we were able to be so flexible. Some people rolling through IU house these 2 months have had nothing but negative things to say about the wards and the experience, so I appreciated that she separated us from that group. We also ended up eating with some of the Kenyan Registrars, including my favorite peds regirstrar, Julia. Julia, and most of the other registrars, have been to the US (or will go at some point) for 6 months to train. Juila was at IU during the horrible snowstorm(s) this winter, and hearing her stories of this experience are always quite entertaining. She is an incredibly intelligent person, and in the course of these 2 months, I’ve learned many many things from her – both medical and about life in general. She’s also very passionate about her work and her country. One day a few weeks ago, I asked her if she ever considered moving to the US. She said yes, she did, but when she thought about it she decided the children of Kenya needed her much more than the children in the US. American kids, she said, will always have doctors to care for them, but not so for the children of Kenya. Her only qualm is that her son would have more opportunities in America, and that’s something she struggles with. Seems like working moms struggle with a lot of the same things, no matter where they live.

During the course of our lunch, a downpour started (by the way, the rainy season is not over yet) and continued for a good 90 minutes. So, we all sat around the table chatting about anything and everything. I really enjoyed listening to the Kenyans’ stories about growing up, going to school, and now working in Kenya. They reminisced about the ‘good old days’ when they shared one or two room houses with their large families, not owning anything, being too poor to own shoes, etc. While it may sound terrible, they universally said that they remember those days with fondness; the days when life was simple. To hear those attitudes was amazing, and it was also amazing to think about how this group of people had risen from such poverty to become physicians. It makes me look like I was born with a silver spoon in my mouth. I guess, compared to them, I was. Priti and I also discussed our time in Kenya with the Kenyans, and they were happy and somewhat surprised when we told them we didn’t want to leave, and we would really miss being here.

It continued to rain and rain and ran and rain and RAIN (rainy season is still ON, did I mention?), so Priti and I decided to brave the 10 minute walk back to the hostel with only 1 small umbrella between us. We may as well of not had had it, for all the good it did us. By the time we got back to our room, we were thoroughly soaked and cold, and generally cranky in disposition. Napping being the best thing to do on a cold rainy day, I decided that was the best thing to do. Being my 4th nap in 2 days, I felt somewhat guilty being so lazy, but I really am trying not to bring the African gleeb back to Indiana. Also, I’ve been trying to use this downtime to rest up for my new elective that starts on Monday, as well as have some time to reflect on everything that’s happened. I’m trying to anticipate the various difficulties I will have in becoming an American again, in order to ease the transition. Still, though, I know it’s going to be hard. I know that many well-meaning people will ask “How was Africa?” and how can even BEGIN to answer that question? A short ‘fine’ or ‘good’ or even ‘great’ will not even begin to justify the experience, while attempting a more thorough explanation will just frustrate me, because I never can really, fully, explain it all.

I think the hardest part will be helping people understand how Africa has changed /me/. That I am not the same person I was when I left 2 short months ago; that the experiences and the people here have changed so much about how I look at the world, medicine, and just human beings in general. I am a part of Kenya now, and it is a part of me, but how can I fully convey that to everyone who was not here with me? This is something that I’ve wanted to do for the last 4 years, and now that it’s almost over – is that just it? Is it just over? I hope not, and I don’t think so. We’ve joked about Kenya reunions after we all get back to Indy, and the closer I get to leaving, the more I see how much we may all need that. Just to be with people who saw what I saw, who understand the beauty and the horror and the sorrow and the joy of Kenya without having to explain. It’s not that I don’t want the people in my life to understand, it’s just that I don’t know how I could ever convey it all.

Tomorrow begins a new round of farewells – we’re having lunch with some of our Kenyan team-mates and friends, then it’s our last Wednesday night dinner out with IU house. I suppose it’s appropriate that it’s at the same restaurant I had my very first IU house dinner.

I know this seems all tears and melodrama, but it’s really not so terrible. Goodbyes are hard, but I will keep in touch with the friends I’ve made here (Kenyan, Dutch, American, et al), and I’m not saying goodbye to Kenya forever…more like… see you later, or until next time…

Masai Mara

Acacia in the Sunset

Me and Elephants

Well, I suppose I can allow myself to leave Kenya now, as I saw both a lion and a giraffe thisweekend…in addition to SO many other animals. What a fantastic safari.

Nine girls – 5 pharmacy girls, me, Priti, Abby, and Laurein – left bright and early on Friday morning. It was a long drive to Masai Mara, about 7 hours in total. Luckily I was able to sleep for most of the drive, despite the constant bouncing of the van. When I woke up, we were in Maasai Land, and it was beautiful. It was completely different than any part of Africa I’ve yet seen. It looked exactly like the picture I (and many people, probably) have in my head of what Africa looks like. Bright sun, clear blue sky, and the brown-green of the savannah grassland stretching out to the distant mountains as far as the eye can see.

I should explain more about Masai Mara. The Masai Mara National Reserve is about 1500 square kilometers of grassland that is essentially the northern extension of the Serengeti Plains of Tanzania. It is located in the south of Kenya, on the Kenya-Tanzania border. Its name comes from the famous Maasai tribe (more about the Maasai later) that resides in the area and the Mara River that flows through southern Kenya. Basically, Masai Mara is to Kenya as the Serengeti is to Tanzania – it is the most famous safari destination in the country.

The drive through Maasi Land was beautiful. The Maasai are one of the few tribes in Kenya who live largely in traditional ways, shunning modernization and city life, so I really felt like I was in Africa. We saw numerous Maasai along the way, traditionally dressed in their bright red shukas and elaborate jewelry, both men and women. The Maasi are a nomadic, cattle herding tribe, and we saw many, many people out in the fields with large herd of cattle, in their traditional Maasai dress. It was just fantastic.

Just outside the entrance to the park, our driver Erick let us browse at a ‘cultural’ gift shop for a few minutes. This place was like the Eldoret Cultural Shop (our favorite store here) on steroids. It was a very large tin building packed (I mean packed) with anything and everything, including masks, soapstone carvings, spears, Maasai shukas, and of course: tourists. The prices for everything were inflated at least 200 percent, if not more. Having lived in Kenya for some time, we just laughed at the outrageous prices they were asking. But, as the majority of their customers fly into Nairobi then come straight south for Safari, they really have no idea how much things should cost. I think they were making pretty good money there. We ended up stopping there again today on our way home, and a few of us bought some things after we haggled them way down to a more reasonable price. I bought a really pretty batik canvas painting of the plains with giraffes and elephants around an acacia tree.

After the shop and after entering the gate to the actual reserve, the road quality dwindled from bad to worse to an adventure in its own right. Our hotel was a 45 minute drive from the gate – 45 minutes on bad roads. But, this was offset by the gobs and gobs of wildlife we saw on the way in, mostly zebras, various types of antelopes, and wildebeest. The other good thing about the long drive was that it meant our hotel was smack dab in the middle of the park.

We finally arrived at our hotel the Fig Tree, which was quite lovely. We had just enough time to check into our cabins – also very nice with real bathrooms and hot showers – and eat a quick lunch before going on our first game drive. Being as this was our first drive, everything was new and exciting, and being as we are 9 girls, pretty much everything we saw was squeal-worthy. After a lot of zebras, antelope, and wildebeest, and even a few warthogs, we came across some lions. I must say, it was pretty exciting. There were 6 or 7 other safari vans gathered around, taking pictures, but the lions – a male and a female – just lay calmly in the grass. Clearly they are very acclimated to humans. Now, this blog is G-rated, but let me just say that it is apparently the lions’ mating season, which we got to witness...several times. Erick told us that lions will mate 300 times a week. Hmm… no wonder we saw so many lions this weekend. After spending at least an hour looking at our first lions, we drove onward. We came across 3 elephants feeding, and they were beautiful. Thirty minutes and at least 2 dozen pictures later, we found some more lions – 2 young males and a female. These lions were just sleeping, so our pictures were not that exciting, though I got a really cute picture of one of the males rolled onto his back with his legs in the air – reminded me so much of Fred. The term “Big Cat” is not a misnomer; they purr, play, and generally act just like my two Big Cats at home.

By this time it was getting dark, so we headed back to the camp. Just outside the entrance, we came across a very young male lion hanging out in the bushes. He was not as used to us as the others, he acted very skittish, but I got a nice picture of him peeking out from behind a bush. After a delicious dinner and a hot shower, it was time to call it a night.Saturday was an early morning; we left at 6:15 for our first game drive. We left a little earlier than most of the other vehicles, which was nice, in that we got to sort of lead the pack and see animals before dozens of roaring engines scared them off. Almost as soon as we pulled out, we saw 2 lions – a male and a female again – prowling across the plain. The male was absolutely HUGE, weighing at least 150 pounds I’d guess, with a big full beautiful mane. They really didn’t give two hoots about us, and we were able to get so close it was unbelievable. Erick said it looked like they were hunting their breakfast – and indeed there was a very large herd of various grazers nearby (all of them looking alert and nervous). But, very soon there was a bevy of safari vehicles following the lions, so I think our chances of seeing a kill were minimal. We moved on, and soon came to a mamma giraffe and her baby. I was so excited! They were just beautiful. They moved so gracefully. Clearly they were very skittish, and we couldn’t get terribly close, but I got some fantastic pictures of them anyway. Pretty soon all of the late-start safari-ers roared up behind us, and the giraffes ran off.

The other highlight of the morning was finding a large pride of female lions lazing about on some rocks, and one of them had 2 little lion cubs! They were so cute. Much squealing was heard from our vehicle. Again, they reminded me so much of little kittens they way they played and jumped about. They didn’t give their mother a moment’s peace. In fact, she kept getting up and moving a little farther off, and they’d bound along right behind her and jump on her as soon as she plopped down – biting her ears, batting at her tail, etc. It was just too cute for words. After the lion pride we found another herd of elephants – 5 or so. Even though we were seasoned elephant viewers, having seen them for the 2nd time after all, they were still just stunning. We really saw so much wildlife in the morning, in addition to the mentioned we saw quite a few hyenas (most of them collared for some sort of research/conservation project), numerous zebras and antelopes, warthogs, jackals, meerkats (running along side the van – those things can move!), baboons, a tortoise, and dozens of beautiful birds. The morning drive provided some great pictures with the sun rising over the mountains, and many hot air balloons. Apparently sunrise hot air balloon safaris are quite popular, quite spectacular, and quite romantic. And also quite expensive. We all decided it’s definitely something we will do someday, when we find a rich gentleman to foot the bill. I’ve got the gentleman; now all he needs to do is win the lottery. Or publish his first novel.

After about 3 hours of driving, we headed back to camp for a fabulous breakfast, after which 5 of us decided to do the Maasai village walk. I’d heard mixed reviews of the village walk; some people had said it was a wonderful experience, while others said it was just one long sales pitch for various Maasai goods. I decided to go, not expecting a true cultural experience but hoping I would enjoy it anyway. The fee to enter the village was 1500 kSH, which bought us a personal Maasai guide, a tour of a Maasai hut, traditional dances by both men and women, and the right to take as many pictures as we wanted. Apparently it’s very culturally insensitive to photograph the Maasai (which is a shame because they are so beautiful). Unless you’ve paid for the privilege, I suppose.

At any rate, Jeremiah, the son of the village chief and our guide, started off by telling us a little bit about the Maasai people, that they are primarily nomadic cattle herders, etc. Their villages are really quite small – 10-12 small mud huts built in a circle with an open common area in the middle. The houses are surrounded by a fence of sorts made from sticks and bush. In the morning the cattle are driven out to graze, and at night they are driven back into the circle, and the fence completed. This is to protect the cattle from predators, though Jeremiah said it’s not uncommon for lions to jump over the fence and eat cattle. When this happens, the men of the village must find the lion and kill it, otherwise it will learn how easily it can get food at night. With cattle being the Maasai’s primary means of existence, that would be a disaster. It is illegal to kill lions in Kenya, but the Maasai are allowed because they are recognized as a self-governing tribe by the government – as long as they remain in the government-appointed lands. Jeremiah also told us that in order to be eligible for marriage, a young Maasai man must first single-handedly kill a male lion. While that is certainly a traditional Maasai practice, I had heard that it was largely obsolete now, so who knows. I guess it makes a nice story for the muzungus. Jeremiah is actually getting married next month, he said, to a Maasai woman he met in school. He said that since they are both educated, they are allowed to make the decision to marry themselves, and sort of ask their families’ permission, though it is not strictly needed.

We learned so many things about traditional Maasai culture, and it was very interesting. Traditionally, Maasai women shave their heads, while the men grow their hair long. However, if a woman is educated, she is allowed to grow her hair long. We saw one woman with long hair (or “big hair” as Jeremiah called it), she was the local school teacher. Also, at the age of 18 Maasai will typically start to put spacers in their earlobes to create the long dangling skin that is often decorated with colorful beads or earrings. But again, if the person (man or woman) has had an education, they can forego that practice. Jeremiah also told us about the Maasai shukas: bright colorful cloths worn by men, always in shades of red. The Maasai adopted the color red many years ago as a way of identifying each other in battles with other tribes. As a nomadic tribe, a village will pack up and leave every 5 years or so and start a new village elsewhere. The main impetus behind their continued nomadic lifestyle is the search for the best cattle grazing land.

When we entered the village the women performed traditional songs and dances for us for about a half an hour. I got some great pictures as well as a short video. After that Jeremiah took us into one of the huts, made completely of sticks and sealed over every inch with cow dung. We sat inside for awhile, saw where the Maasai slept, ate, and cooked in the home. It was pretty cool. We also saw the “calf pen” that every home has. Calves are kept in the pen, which is inside the actual house, at night, both to protect them from predators and to prevent them from nursing at night, so the cows can be milked in the morning.

After exiting the house, the Maasai men performed their traditional songs and dances. One of them involved a competition to see who could jump the highest. The winner gets the right to court (or maybe marry?) whatever woman they are fighting over. They really could jump quite high. Whichever young man has killed a lion gets to wear a tall hat made out of the lion’s mane. One man was wearing one, and the group danced around, taking turns putting the hat on each of us. I got a picture of myself in the lion mane hat, and I must say I look quite ridiculous.

Then the fun began as we were ushered into a smaller fenced-in circle adjoining the village, which was the “Maasai market.” We circled around tables and tables full of beaded jewelry, soapstone plates and carvings, gourds…pretty much everything. I ended up buying a Maasai shuka. I probably paid a little too much for it, but I think it was worth it. Overall the experience was rather touristy, but it was still enjoyable. It was at least nice to learn about the traditional Maasai culture, even if that’s not exactly how some of them live anymore. I mostly enjoyed seeing the traditional Maasai dress, on both the men and the women. It was so beautiful. The Maasai, especially the men, are extremely tall and thin. Their physique combined with the bright reds of their shukas and their piles of jewelry on every appendage was quite striking. They just look so…African.

Lonely Planet Kenya actually has some interesting information on the Maasai:

From “History:”
…Although control of the coast was largely sewn up, the interior, especially the Rift Valley and the Aberdare Highlands, was largely impregnable to outsiders due to the fearsome Maasai and other warlike tribes. A few explorers braved the Maasai heartland – including Gustav Fischer, a German whose party was virtually annihilated at Hell’s Gate in 1882 – but most attempts to enter the Rift Valley were doomed to failure.

The united front of the Maasai began to crack in the late 19th century, following a brutal civil war between the Ilmaasai and the Iloikop groups and the simultaneous arrival of rinderpest (a cattle disease), cholera, smallpox, and famine. Because of this, the British government was able to negotiate a treaty with Olonana (known today as Lenana), the laibon (chief or spiritual leader) of the Maasai, allowing them to march the Mombasa-Uganda railway line right through the heart of Maasai grazing lands. On one level, the Maasai were just accepting the inevitable – their end-of-the-world myth spoke of an ‘iron snake’ that would one day crawl across their land. Ironically, this once-crucial line now has just two passenger services, a far cry from its conception as the pride of East Africa.

With the completion of the railway, the headquarters of the colonial administration was moved from Mombasa to the cooler small settlement of Nairobi, and white settlers began to occupy the fertile highlands north of Nairobi. Their interests clashed with those of the Maasai, prompting the colonial authorities to pressure Olonana into restricting the Maasai to two reserves, one on either side of the new railway. However, the white settlers soon wanted the northern reserve as well and in 1910 and 1911, the Maasai who lived there were forced to treck south, despite Olonana’s objections.

From “Tribes of Kenya:”
For many, the Maasai are the definitive symbol of ‘tribal’ Kenya. With a reputation (often exaggerated) as fierce warriors, and a proud demeanor, the tribe has largely managed to stay outside the mainstream of development in Kenya and maintains large cattle herds along the Tanzanian border.

The Maasai first migrated to central Kenya from current-day Sudan, but in the late 19th century were decimated by famine and disease, and their cattle herds plagued by rinderpest. The British gazetted the Masai Mara National Reserve in the early 1960s, displacing the Maasai, and they slowly continued to annex more and more Maasai land. Re-settlement programs have met with limited success as the Massai scorn agriculture and land ownership.

Maasai women are famous for wearing vast plate-like bead necklaces, while men typically wear a red-checked shuka (Maasai blanket) and carry a distinctive ball-ended club. Blood and milk are the mainstay of the Maasai diet, supplemented by a drink called mursik, made from milk fermented with cow’s urine and ashes, which has been shown to lower cholesterol.

At around the age of 14, males become el-moran (warriors) and build a small livestock camp (manyatta) after their circumcision ceremony, where they will live alone for up to eight years, before returning to the village to marry. Morans traditionally dye their hair red with ochre and fat. Female genital mutilation is common among the Maasai, despite the best efforts of various human rights groups.

Tourism provides an income to some, either through being guides and camp guards (askaris), selling everyday items (gourds, necklaces, clubs, and spears), dancing or simply posing for photographs. However, the benefits are not widespread. In recent years, many Maasai have moved to the cities or coastal resorts, becoming doormen for restaurants and hotels.

“The Hard Sell:”
A common complaint among travelers, particularly in The Mara, is that the Maasai can be incredibly hard-nosed in business, and ‘cultural’ visits to villages often become high-pressured sales ventures the moment you arrive.

While it would be unfair to generalize, it’s certainly true that some Maasai, especially in high-density tourist areas, will treat you purely as a cash cow. Favorite techniques include dropping wares in your lap and refusing to take them back; coming into campsites to offer dances at non-negotiable rates; and charging for absolutely everything, from camping to crossing their land. While this behavior isn’t limited to Maasai, their aggressive and utterly unapologetic attitude upsets more travelers than day-to-day hassle elsewhere.

If you feel you’re being taken for a ride, Maasai or otherwise, stand up for yourself. Or, ask yourself this: If your people had been consistently dispossessed for over a century and were now subjected to constant streams of gawping foreigners with seemingly bottomless pockets, wouldn’t you do the same?

I think this is all very interesting. The weekend for me turned out to be as much about the animals and the safari as it was about the Maasai culture: their land, their traditions, and their history. I was surprised how much their story (and really the story of most of the tribes of Kenya) resembles that of the Native Americans back home. It seems we white people are capable of some pretty terrible things. Not that it helps to dwell on the past, but the question becomes, if we can’t undo what has already been done, how can you attempt to right the wrongs? I don’t know the answer, but surely there must be one. Surely there has to be a way for the Maasai to teach me about their culture, their real culture, in a respectful and authentic way. And surely there has to be a way for them to preserve what is native and important to them without selling their cultural identity to the highest bidder? I don’t know if going on the village walk was a help or a hurt. I learned about the traditions of a group of people wholly different than myself, and I definitely gained a new respect and knowledge of where they came from. But at the same time, was my presence there only perpetuating the problem of cultural tourism by confirming to them that their cultural identity could be sold for a price? I don’t know.

And then there’s the whole other issue I was re-confronted with this weekend (the first time being Baringo/Bagoria) of staying in absolute fantastic luxury while surrounded by some of the most destitute people in the world. I know I wasn’t the only one troubled by this, as we had several discussions about it in our group. Is it right? Is it wrong? Is it both? We never came to a consensus. Maybe we shouldn’t worry about it and just hope that the money we’re throwing around is doing some good for the people who need it the most. I just don’t know.

Maybe the answer to all of these troubling questions is not a matter of money or technology, or ‘westernizing’ people who wouldn’t necessarily benefit from it… maybe the answer just lies in an understanding. An understanding between people of different colors, races, cultures, and backgrounds. A learning that this is where you come from and this is where I come from; and neither one is better or worse, we’re just…different. An exchange of ideas. I highlight that because of this: from the very first meeting I went to about the IU-Kenya program, clear back in the first months of first year – we were told that was the emphasis of the program. The primary goal being an exchange: Of knowledge. Of ideas. Of experience. Of Understanding. I don’t think that I fully grasped that concept until now, 3 years after that first meeting, 7 weeks into my stay in Kenya. It’s still a powerful concept to try to wrap my mind around.

But I digress…(verbosely, it would seem)…

After the Maasai village walk, which I did enjoy very much, we drove back to the Fig Tree for lunch and chillin’ at the pool time. After a few hours of that, it was time for our afternoon game drive. We ventured into the less wildlife-populous places, having seen most of the big game, and now looking for the much more elusive cheetahs, leopards, and rhinos. We didn’t see any of the those, but a nice addition to our list of wildlife was some hippos. We actually saw them in 2 different places along the river. The first place was nice, nothing terrifically special, having seen hippos twice before. (I sound like such an animal snob). The second place we saw them, there were quite a few more. There was one especially large male who was being an absolute bully, and we got to see some pretty cool hippo fighting action. (As Abby dryly said: I would say those are some hungry, hungry hippos). On our evening drive we also saw some more elephants (see picture above). There were 7 in this herd (people here always tell us that elephants travel in 7s…though I’ve never heard that before), including 2 small little baby elephants who were just too cute. We parked the van and they plodded slowly by us, just yards in front of the vehicle. The neat thing about this herd was that they walked in a perfectly straight line across the plain, which I thought was just a circus trick (though they didn’t hang on trunks-to-tails, which probably is just a circus trick). I got some great pictures of the line of 7 elephants. We also saw several ostriches, as well as the elusive Eland – the largest antelope. The picture will make a nice compliment to the one I took of the dik-dik – the smallest antelope – at Lake Bagoria.

The ride back to the hotel showed us one of the most outstandingly beautiful sunsets I’ve seen in my life (of which many pictures were taken). Leisurely dinner and a hot shower were again the order of the night, as wake up call for this morning was even earlier.

We left at 5:50 this morning for our last game drive. I’m glad we left so early, as we enjoyed an equally fantastic sunrise over the plains, the backdrop for which was distant mountains and soaring hot air balloons. It felt pretty much like paradise. Abby said the animals were taking their day of rest this morning, which I had to agree with, as we didn’t see too many. We saw a few lions lying around, just a few antelope, but not too much else. The great, GREAT find of the morning by Erick was a herd (pack?) of giraffes feeding on some trees in the distance. There were about 6 or 7. We couldn’t see them that well, as they were pretty far off the safari path. Well, Erick just turned our safari van off the path and drove us across the grass right up to the grove of trees. The conservationist in me cringes, knowing that there are safari paths and protected grassland for a good reason; but the giraffe lover in me says it was one of the most amazing things I’ve ever seen and I got some fantastic pictures.

After the giraffes’ breakfast, we continued to look for rhinos, leopards, and cheetahs without success. The rhinos I didn’t really think we would see. There are only about 25 in the entire 1500 square kilometers of the park, and Erick said in all of last year doing game drives he only ever saw 2. Contrary to popular belief, it is rhinos, and not elephants, that are by far the most endangered species in Kenya. They were hunted to very near extinction in the 1960s and 70s. The cheetahs and leopards were not to be seen either, though I thought we might get lucky, but it was not meant to be. The other thing we had hoped to see was the tail end of the Great Migration – the migration of literally millions of wildebeest and zebras from the Serengeti to Masai Mara in search of more fertile grasslands. This typically happens in August every year, and then the animals head back to Tanzania around November. We did see the end result of the migration – thousands of wildebeest and zebras grazing in large herds all over the plains – though it was a little too late to get that infamous ‘fording the river’ picture that is on every nature show ever made. That, and the place where they cross the Mara River is about 70 kilometers away from where we were. I do think that would be a spectacular sight to see someday, but perhaps better appreciated from an aerial view.

We did end our last drive on a fun note, right at the end we saw a family of warthogs eating by the road, including 4 little baby warthogs, who were so cute in their own ugly little way. While mom and dad went about the important business of eating, the babies decided they were going to play head-butt and pick on the runt. It was quite adorable. Even that, at the end of the weekend, elicited girly squealing from the van.

Despite the relative lack of game sighting, I thought this morning’s drive might have been the best. One of the IU people here before us said that 2 days at Masai Mara was enough, because by the end you just get so sick of seeing the same animals over and over again, and it’s not nearly as exciting. While I agree that bouncing around in a safari van for hours at a time does get old, I don’t know how anyone could ever tire of looking at the African savannah – animals or no animals. It was quite brisk this morning, so most of the girls huddled in the van while we were driving around. It was cold, but I couldn’t help but stand and look out the top as we drove through the plains, seeing a full panoramic view of Masai Mara, seeing the sun rise, the mountains, the balloons, zebras grazing in the distance…seeing Africa just as I always dreamed it would look like. It was so beautiful.

I got some absolutely fantastic pictures this weekend, both of the landscape and the wildlife. As I was telling Mom when I talked to her, I think this is something that everyone should do if they can at some point in their lives. Seeing these animals in a zoo is absolutely nothing like seeing them in their natural habitat. In fact, I think after this weekend seeing these animals in a zoo might make me a little sad. Again, it’s really one of those things that cannot be captured on film – though I did try, I took over 500 pictures in the last 3 days alone! Amy (pharmacy student) said it best: “If one (picture) is good, then 10 must be better!”

After a quick breakfast and some last-minute camp photos, we packed up and headed back to Eldoret. Of course, the ride back was not nearly as exciting, as we had no safari to look forward to, plus we’d just spent the entire weekend in a car. The trip back took about 8 hours – 8 rather uncomfortable and hot hours, though there were some highlights. While driving through the Nandi hills we passed through a very long stretch of tea farms that were quite picturesque. The tea leaves are a very bright green, which makes a beautiful contrast between the more muted earth tones of the surrounding farms and hills. We had more fun in attempting to take pictures out the window of a bouncing van than actually getting the pictures.

About 3 hours from Eldoret, it started to rain. (I should say that last Thursday was an exciting day for us, as it was the 3rd straight day without any rain, at which point the rainy season was declared officially over. Huzzah! Just in time for me to leave! As it turns out, it did rain quite a bit in Eldoret today, so there goes that celebration.) After about 10 minutes of driving in the downpour…guess what song came on the radio… “Africa” by Toto. We totally cranked up the volume and enjoyed one of the greatest 80s songs ever written, especially singing “I bless the rains down in Africa” over the rain pounding down on the roof. Of all the fantastic memories of this trip to Africa, that one will stay right near the top.

Finally, though, we were back in Eldoret, just in time for dinner at IU house and some down time and TV at Sonak’s house. The real highlight after such an amazing weekend is that I don’t have to work tomorrow, as it is the start of my week off. The real lowlight is that I am definitely getting sick. Three of the girls started this weekend with a viral/flu type thing that’s been sweeping IU house (pretty much everyone has been sick) so I guess it was inevitable that I would get it after being in such close quarters with them for 3 days. Oh well, I suppose it’s better to be sick and be able to lie in my bed all day if I have to than to have to go to work. I do have a lot of things I want to get done this week though, and being sick is surely not on my list.

The other real bummer about tomorrow – much worse than being sick – is that Laurein leaves for her month of rural health care in Kapenguria tomorrow. As someone I met the first day I was here and have seen almost every day since for 2 months (not to mention all the trips we’ve done together), I consider her a very good friend and I will miss her a lot. Just the first in a long series of goodbyes I will have to make this week, most of which will be very hard. I am trying to offset the sorrow of goodbye with the joy of hello I will get to have when I see Mike, my four-legged kids, and the rest of my family and friends again.

Not that I want to end this post on a negative note. I had an absolutely fantastic weekend – surely the best trip I’ve taken in Kenya; maybe even the best trip I’ve ever taken period (If only Mike had been there). I did love Kakamega quite a bit, but I think that Masai Mara was better, because that belly-flipping feeling of ‘Oh my goodness, I’m actually in Africa’ didn’t leave for the whole weekend. Absolutely something that I want the people I love to see someday, and I hope that I’ll be able to be there when they do.

Last Week at Work

In honor of the 2 funny emails I got from my parents regarding Ms. Ozzie, here is a picture of the dog at the campsite in Uganda who looks like Ozzie's twin brother.

(Note: This post and the following are new. The previous one was typed this weekend, but just posted now due to internet issues.)

Hard to believe. And it's been a doozy.

Yesterday morning, the very first patient we rounded on was a new one, admitted overnight. A 29 year old woman named Lucy. Lucy was HIV-positive, but the primary reason she was admitted was severe heart failure. The mitral valve in her heart was severely, severely stenosed (tightened, or strictured), probably due to rheumatic heart disease, which affects many children in Kenya. The disease affects the heart in such a way that children develop heart failure slowly, over many years. If not treated with valve replacement(s), most people die in their teens and 20's. At any rate, we gathered around her bed, and this poor woman looked so bad. She was gasping for breath, and each breath she took was clearly very hard work. She was moaning and crying, kept asking for water, but the registrar said that most of what she was saying was gibberish. She had been on oxygen overnight, but the tank had run out, and we were waiting on a new one to be brought over. We checked her oxygen saturation, which was 70% -- not good. The plan we formulated was to get her back on oxygen and load her up with morphine; basically paliative care, as there was not much else we could do for her.

Because of her severe valve stenosis, she had a pretty classic heart murmur, which the registrar wanted us to listen to. I was the last student to listen, and I heard the murmur, or at least I thought I did. As soon as I started listening, her heart rate started dropping and dropping and dropping, and within a few seconds it wasn't there anymore... I stood up and looked at Rhonda, my resident, and I said "Umm.... I think she's dead." The Kenyan registrar asked me what made me say that, and I said "She doesn't have a heartbeat anymore." He listened, and sure enough, no heartbeat, no pulse, no respirations, and we declared her dead. It would have been more sad if it hadn't been such a bizarre, surreal moment. First she was alive and there, and then she.... wasn't. And then the team just moved on to the next bed. It was so strange.

I think this second death was easier than the first, partly because it wasn't the first, and partly because there really was nothing else we could have done for her. She was suffering so much that death was a blessed relief for her. That's one thing that Kenyans really have on Americans -- the understanding that there truly are things that are worse than death.

My patient Rebecca is doing better, her swelling is much much improved, though she still has a lot of edema and can't walk due to newly-formed ulcers on her legs. She had an ekg that showed significant bradycardia (slow heart rate) and a strange heart block/arrhythmia. Her echo showed that her aortic root is severely dilated and is resulting in her aortic valve malfunctioning. She is such a sweet lady, I really like her a lot. She has assumed that since I know swahili greetings and greet her every morning that I am fluent in the language. After I greet her she starts speaking to me in rapid swahili, and all I can do is stand there and nod, say uh-huh, and then later ask the registrar or the intern what she said. I'm afraid that she's not going to do well though, her heart is very bad. If she were in the US she would need a very extensive and involved cardiac surgery. That's just not a possibility for her here.

I admitted a woman named Jennifer on last Thursday night. She's 27 and was referred from AMPATH clinic for severe persistent anemia. There was a note from the clinic that day in her chart, but when I asked her about being an AMPATH patient, she straight out told me that she was not a patient at AMPATH. So, I just let that one go. She's gotten several blood transfusions, though we're not sure what exactly is causing her anemia. It's possible that it's a side effect of her HIV meds, though she was taken off of the one that usually causes anemia a few months ago. It's also possible that it's due to the virus itself, though her other cell lines are normal, and you would expect to see all of them decreased. She also has a pleural effusion (fluid in her lung) that /I/ got to put a needle in and drain yesterday. It was cool! She also is a very sweet lady, though very reserved. She has several scars on her face that look like burns, but when asked about them she pretends she doesn't know what we're talking about.

I also admitted a patient on Monday night, a 19 year old girl named Sheila. She's also HIV positive. She was admitted for meningitis. When I saw her she looked very, very sick. She could hardly move and she had a very high temperature. She was only being treated for bacterial meningitis, but no coverage for cryptococcal meningitis(a fungal meningitis that immunosuppressed patients often get). I talked to a couple of the pharmacy students who were still there, and we got her started on meds for that too. She got a lumbar puncture (spinal tap) and we're still waiting to see what exactly is wrong with her. She still looks sick, though she is looking much better now. She is classified as an HIV orphan -- her father died of HIV and her HIV positive mother abandoned her and her siblings. It's so sad. Again, she is a very sweet girl (I seem to get all the nice patients).

Things are FINALLY worked out for Masai Mara this weekend. Nine of us are leaving at 6am Friday morning, will get to the reserve to eat lunch, then afternoon game drive. We'll do a total of 5 or 6 game drives in the 3 days and I am SO excited. I told Mike I'm not leaving Kenya until I see a giraffe and a lion, so he better hope that works out for me.

Since we're leaving on Friday, that means that tomorrow is actually my last day of work on the wards, as we get our last week in Kenya off as vacation. It's so hard to believe that I'll be leaving in a little over a week. On one hand the 8 weeks have just flown by, but on the other hand it seems like an entire lifetime ago that I was in the U.S. As much as I'm looking forward to seeing my family and friends again, I know it's going to be very hard to attempt resuming normal life in Indiana. Aside from missing my family, I've been very, very happy in Kenya. Aside from my family, what do I need that I have in the US that I don't have in Kenya? Absolutely nothing. In many ways, I even have more in Kenya than I do in the U.S. Life here seems much more fulfilling in many ways, because I don't have to deal with distractions of TV, media, celebrities, and the overall superficial selfishness that pervades American culture. Here the focus is more on relationships and understanding another's point of view. Certainly in Kenya I've made friends -- good friends -- that I would never have made in the U.S. Here, people understand the value of one another, because life is so fleeting and so difficult, and it can be over at any time.

And here, I've gotten to see first-hand the amazing work of the Mamlins and the AMPATH program, and I've seen with my own eyes the countless lives that they have changed. But that's for another post.

I'm so excited to go home, but I'm also so very sad to leave. I have come to love Kenya, and I know I will miss it terribly. I also know, without a doubt, that I will be back.

My Hair is Braided!!!

And it looks great!

And it only took FIFTEEN hours! But... I'd say it was worth it. I took a bunch of pictures of the process as well as the finished product, and I'll attempt to post them once they're loaded onto the computer.

The only major downfall is that my head is at least 1-2 pounds heavier than it was before, so I may have to start doing some neck strengthening exercises.

While sitting at IU house all day yesterday, we had a bit of excitement. I'll see if I can describe it accurately. Imagine the IU house compound is basically a large rectangle surrounded by a wall on all sides. On the 2 long sides of the rectangle, surrounding the perimeter, are the houses of the compound. Down the middle of the rectangle, going the long way, the compound is divided into 2 smaller rectangles by a hedge/fence. The fence has 2 gates in it, so we can walk back and forth between the 2 sections of the compound. Between the houses and the hedge is all cement -- driveways for accessing the various houses.

Well, it rained yesterday. (Shocking, I know). It was an absolute downpour for an hour or so. When it rains like this, water starts to collect in the driveways and pool there, as the driveways don't really run downhill and there's no drainage system. Essentially, IU house compound becomes a lake. This has happened a few times before, and not surprisingly it happened again yesterday. But, even after it stopped raining, there was still water pouring into the compound from somewhere. It turned out that the river just down the road had overflowed due to all the rain, and it was backing up into IU house. The water flowing through the gate(s) actually looked like a river, as it was gushing through and splashing all around. The water came all the way up onto the sidewalks and started coming into the houses. Shawn told us if it got worse we'd all have to start moving furniture. I took a bunch of pictures, as it was just unbelievable. It really looked like the houses had been moved into the middle of a river. Robert and Hao had their kids out playing in the water, which was SO cute, especially the baby who was wearing a shirt, teeny galoshes, and no pants. The water came up to his waist! Everyone was wading around, taking pictures. Hatari (one of the dogs) was playing the how fast can I run through the water and splash the other dogs game. Petite and Jack were not amused. It was quite the sight to see. Shawn said that it was the most water he's ever seen at IU house in his decade or so of living here.

I'm getting very excited about Masai Mara this weekend. I hope it will live up to the high expectations I have for it in my mind. The planning is turning out to be a nightmare, as it seems all planning for trips here does, but it will be worked out and we'll still have a great time.

The People in My Life

Because I love this baby so much, here's another picture of Diana and me at Sally Test.

I'd like to start saying Welcome to My Blog to North Church! I really started this whole thing for Mike and my parents to know that I was still safe and well, etc, but apparently a little birdy revealed its existence to Ms Lela...and well, you know the rest of the story... :)

Since the Thursday night incident at MTRH, things have gotten better. I'm still bummed about it, but I'm trying not to think of it too much, or at least not dwell on it. This has been helped in large part to due to the people in my life, especially the residents here who listened sympathetically to the story, then shared their stories of First Deaths. They didn't tell me to get over it, just listened and said "that really sucks." They also didn't say that it gets any better, because I know that's not true, but apparently it does get easier, which is something to look forward to.

Of course Mike was very supportive as well (he is required to be) and I got the most amazing email from Emily that nearly made me cry. Not from grief, but from appreciation that I have such a wonderful friend who knows exactly what to say to make me feel better.

It had actually been a rather hard week for all of the teams at the hospital, so all of us IU house people went out last night to Places (a local club) with some of our Dutch friends, and we had A LOT of fun. I think we all just needed to blow off some steam, which we did quite heartily. We made a rule not to talk about medicine or the hospital at all, which was great, as I got to know Priti and Natalie better. It's nice to find out you have things in common with people other than just medicine. It was also fun because the 4th and 6th year Kenyan students just finished their end of rotation exams this week, so they were all out celebrating as well. One of the things I really love about Eldoret is the wide variety of friends I've been able to make in the last 6 weeks.

This morning Priti and I went about the serious business of gift shopping with much gusto. I spent a lot of money, bought a lot of stuff, and I'm ALMOST finished with shopping. I even bought my hair -- the hair that Christabel will use tomorrow when she's braiding mine! I'm pretty excited. We're starting at 8:30 and she thinks it will take 12-13 hours. I'm pretty sure that I'll look like a real Kenyan when it's done, and no one will be able to tell otherwise :).

Tonight the plan is to watch movies on Sonak's newly-delivered 46 inch plasma screen HD TV. Clearlythis will be a hardship, but I suspect we'll make it through somehow.

Kwa Herini!

The First One

The First One.

I suppose I shouldn’t be surprised that it happened in Kenya.

I went back to the hospital this afternoon with Kelly and Amy (2 pharmacy students) to admit some patients and follow up on some labs, etc.

I had just gotten done admitting when Kelly asked me if we could check an oxygen saturation on an asthmatic patient of ours who is in severe respiratory distress. We finally tracked down the pulse ox machine, and got her sats at 92%, which isn’t too bad considering how distressed she looks.
We were getting ready to leave when a nurse came up and asked us to check the sats on another patient – someone on the other firm’s team, not my team. We went over there and were not able to get a reading on the machine despite trying for 5 minutes or so. The nurse told us the patient was 55, HIV+ and currently on treatment for PCP (a type of severe pneumonia that immunocompromised patients get). She was on an oxygen mask, and her bed was in the middle of the cube because she was in the process of getting transferred to the ICU.
All of a sudden the woman stops breathing, and we can’t find a pulse. So the nurse asks us to get the intern. I run over to my intern, who’s admitting a patient, and he points across the room and says – “that’s the intern on call tonight.” Very nice. So I go up to this guy, tell him there’s a patient (of HIS, mind you) that has no pulse and he says “ok” goes about his business and doesn’t come with me. So the nurses are looking at me to do something, they wheel the bed back into its corner, and I started doing chest compressions.

As soon as the intern walked by and saw me doing chest compressions, he dashed off to get a bag mask and came running back.

We did CPR for about 15 or 20 minutes – me doing chest compressions, the intern giving breaths and Kelly pushing the drugs. After countless rounds of CPR and 2 rounds of drugs, the intern was ok with declaring her.

So, I wrote the death certification. And after it was all over, I cried. A lot.

The first patient I’ve been with when they died, and I don’t even know her name. When I was in the NICU in June, we had 2 babies die, but by the time I got there the pulse and respirations were already gone, and resuscitation was already underway. These babies were intubated and sedated as well – from the moment of their births in fact – so I suppose as a defense mechanism I never really thought of them as /alive./ Today, this patient, was the first time I have been with someone as they crossed that mysterious and universal boundary between life and death. I’m sure it won’t be the last.

I guess the one small silver lining of this cloud is that I was really able to remain calm during the whole ordeal. If I thought about the fact that it was me (a medical student) and Kelly (a pharmacy student) in charge of the resuscitation from the beginning, I probably would have had a panic attack.

All of our CPR and ACLS classes seemed so excessive until now – you learn so many different algorithms and what to do in a code situation, but I was surprised how much of it came back to me – the endless cycles of 15 compressions to 2 breaths, give epi and atropine, check pulse, check breathing, repeat. You have to become a robot in those situations, or I think you’ll just go mad.

During, I asked the nurse if she had any family around. The nurse said “yes, a daughter.” I asked both so we could tell someone and keep them away at the same time. It really hit me afterwards, as they looked for her daughter, that this was a life, a human life. Someone’s mother. And we couldn’t bring her back.
I don’t know, I guess you can try to make sense of it all, or do as the Kenyan’s do and just accept that death is a part of every life. Maybe it’s a little bit of both. Or maybe, we all have to find our own path to understanding the horrible things that happen in this world, and we have to find a way to do that without becoming emotionally crippled for all our lives.

I think today was the beginning of my path to that place…wherever it is…

Still raining

and how. More like MONSOONING. Speaking of lots of water, there's apparently a typhoon headed directly for Mombasa, so Priti and I will NOT be going there this weekend. That and the planning was becoming quite the nightmare, as we'd have to ride to Nairobi on some random bus, then take a train from Nairobi to Mombasa. And you can't buy train tickets until you're at the station, at which point, if the train is full, you have to wait for 2 to 3 more days until the NEXT train to Mombasa... so... maybe next time, eh?

We may attempt to take a day trip to Umbrella Falls, or we may end up staying around town for the weekend, which would be fine with me also. Then next weekend Masai Mara! Can anyone tell how excited I am???

We found out today that Diana is being taken to Neema House, the local orphanage for HIV+ children and orphans due to HIV. It's run by a Kenyan couple whom Sarah Ellen knows very well. It's a great place for her, and I'm so excited that she'll have a nice place to live, with loving a parents and lots of siblings to play with. The sad part is that she's probably going there today, so I went to Sally Test and took a bazillion more pictures and even a 60 second video of her scooting around on a truck. SO cute.

On Doctoring

My first few days on the adult wards have been rather interesting.

I admitted my first adult patient last night. Rebecca, 57, came in florid congestive heart failure, with generalized severe body swelling, difficulty breathing, chest pain, and palpitations; all getting worse over the last 2 months. I actually saw some orderlies wheeling in this woman on a stretcher earlier in the day, and I just thought, "I bet she's coming to our ward." And sure enough, she was my patient. This poor woman could barely breathe, even on an oxygen mask, and her face was so swollen and edematous that she couldn't open her eyes. We got her on some Lasix though, and some cardiac meds, and already this morning she's off of her oxygen and can sit up in bed without huffing and puffing.

The other thing Rebecca told me was that she's had this cough productive of bloody sputum for the past month or so, and her roommate is currently being treated for TB. Great. She told me this AFTER I was all up in her face examining her, without my N-95 mask on. Oh well. Robert says that in the 25 or so years since IU's been here, only 2 people have converted to TB positive after returning to the states. So that's good. Yet one more reason I enjoy peds so much more -- it's very difficult to catch TB from a child.

At any rate, I got Rebecca admitted. Then Priti, who was also admitting last night, asked me to help her with her patient. A 3 month old little girl with diarrhea and vomiting for some time, as well as fevers and decreased feeding. Priti told me she looked bad and I was like "ok, just one sec." I walked over to the peds side and this baby looked bad bad BAD. The first real case of 'severe' dehydration I've seen yet. Her eyes were sunken, fontanelles sunken, very dry mucous membranes, breathing fast, fast heart rate, extremely pale, with a glazed over look in her eyes. I think she was only an hour or two away from coma and death. Seriously, this baby looked terrible. Obviously the first thing she needed was fluids, and they were written for and she had an IV in place, so we couldn't figure out why she hadn't gotten any fluids. We finally found a nurse who would actually talk to us, and she said that actually the IV was not in good position, they had tried fluids, and it had just infiltrated. After expressing the need for a new IV as NOW as possible, the nurses tried for 30 minutes or so to get an IV into the baby. They had no success, which is not surprising considering how small and dehydrated she was. They asked us if we wanted to try, which I was not really jumping at the chance to do. The intern on call last night was busy with crashing babies in the new born unit, so in order to buy some time we put an NG tube in the baby and gave her some fluids that way. Though really not the most efficient way of rehydrating someone, it was a temporary fix until the intern could get to the ward and get an IV in. Today she was doing a little better, but the team is still not quite sure what's wrong with her: malaria vs sepsis vs meningitis -- so she's being treated for everything. She's also HIV positive and severely underweight, which will do her no favors in terms of getting better.

We waited around on the wards until the NG was in and the fluids running, and in the meantime we played with Diana and her new crib-mate Gideon. Gideon is not technically abandoned, but his mom is currently being treated on the psychiatric ward, so he's hanging out on Ward 4 for now. Diana stays up way to late at night (it was about 9 when we were there) and is such a stinker she doesn't let Gideon sleep either. She was obviously very tired, as she was being an absolute terror -- screaming when we played with her and screaming when we put her down -- but there's really no one to put her to bed, so how can she know when it's time for her to sleep? I eventually gave her my pen and a piece of paper, and she calmed down and started drawing, allowing Gideon to fall asleep (he was quite fussy as well) and Blessing, who's in the next crib over. We even helped out the nurses by feeding Blessing and changing all 3 babies, which I think they really appreciated.

I've come to realize over the past few weeks that the hardest thing for me when I leave will be leaving the Sally Test kids, especially the abandoned ones. It's so easy to get attached (#1 rule of pediatrics being not to get attached), but I don't really think of them as patients, as they are for the most part healthy. Every day I look forward to rounds being over, partially because rounds can be extremely painful, but mostly because I can go to Sally Test and see Diana, Kevin, Phillip, and the other babies. If on my last day in Eldoret, someone handed me any of the 3 of them (or all 3 of them) and said "take them with you" I'm pretty sure I would. Especially Diana -- she is an absolutely precious baby. Although we learned today that it is illegal to immigrate to the US if you are HIV+, which applies to HIV+ children being adopted in as well. I was appalled to learn this. I guess I'll just have to sneak in Diana. As hard as it is for me, it's really even worse for the kids, who have already been abandoned by the people who should love them most, and now their time at MTRH and later in an orphanage will see a whole slew of people who come in and out of their lives -- loving them dearly and then leaving them again. It's a hard thing for a little one to understand. It's a hard thing for ME to understand, how someone could ever leave their child.

But, I suppose I should just enjoy the time I do have with them, and hope that some way the love of strangers will be enough for them, though I somehow doubt it.

I went to the Rescue Center again today, with Priti, Hao, Rhonda (4th year med/peds resident from IU who came last week) and Jeremy (pharmacy student). Again, it was so great. Since it FINALLY stopped raining for a few hours, we got a tour of the compound, which was nice. We learned a little bit more about the Center: the funding comes from a collaboration of churches in Eldoret, and though it's not a lot of money, it does pay for some full-time staff including the nurse, as well as the dorms, the meals, and the uniforms for the school-aged kids. When the kids first come in they get 1-2 weeks of counseling and catch-up education (longer if needed) then if they show that they are going to stick around for awhile, the school-aged kids go to primary (elementary) school. While primary school is free, secondary school is not, so the older kids either have to find sponsors in Eldoret or abroad or they have to work odd jobs in order to go to school. As you might imagine, the cost is prohibitive so some, so not a lot of the street kids end up finishing school.

At any rate it was nice to learn about the facilites and the demographics of the kids that live there. There are about 150 kids at the Center at any one time, though they do tend to come and go. Quite a few of the 'older' girls (12 and up) tend to come in with their own babies, though there was only one girl there today with an infant. We talked about the logistics of HIV testing for the kids -- something that is completely necessary, as well as some other nuts and bolts things. It was a great visit. Most of the girls we saw today were quite healthy. There was one little girl about 10 who was hit in the arm with the blunt end of an axe some time ago, and now her arm is very contractured and painful. We tried to see if we could bring her to the hospital today for an XRAY, but a lot of the staff are out sick so there was no one to accompany her. They promised they would take her in tomorrow. There was also a little girl with daily headaches and blurred vision, with difficulty seeing the board in school. She really needs glasses which seems like such a simple thing. But here, nothing is really simple. She needs transportation and a chaparone to the ophthamology clinic. If/when she can get that, she needs to have the money to pay for the visit, which is only about 100 shillings, and any one of us would have paid it, but the really expensive thing is the glasses -- 3,000 shillings and up. And then she'd need yearly exams and new prescriptions, and kids tend to break expensive things anyway... so.... But, we're going to have her go to the clinic and just go from there. Certainly we can't let her go without glasses, as that's no way to live.

Jeremy got a list of the meds that are available at the Center (not very long) and he's going to look into how to get more. I think we'll try to start with the basics: anti-fungals for tinea (which ALL of the kids seem to have), de-worming medicines, some basic antibiotics, things like that. The other thing that the center could really, really use is a car, but I think that's a bigger project that will come some time down the road.

Today was a really good day, despite the continuing rain. Priti and I are currently making plans for a long weekend on the coast in Mombasa, then it's on to Masai Mara next weekend! The weekend after that, I'll be home. It's very hard to believe.

Uganda

Sorry for the relative delay in posting. After getting back from Uganda yesterday I was exhausted, and the electricity has been out at IU house for awhile.

So, on to Uganda. Wait, first I should say that I watched "The Last King of Scotland" for the first time last week -- about the life of Ugandan dictator Idi Amin. This was not a good thing to do just before traveling to Uganda, but I went anyway. Everyone made it back without any major mishaps on the river, so that's a good thing. We left on Friday around noon (which is really 1:30 KT by the time we picked up people at 3 different locations, stopped at the bank, etc). There was quite a large group of us that went -- 5 IU people, 3 Utah people, 4 pharmacy people, 4 dutch people, and our Kenyan friend Ken. We filled 2 cars. The drive from Eldoret to Uganda was on a fairly nice road, so that part of the drive wasn't bad at all. When we got to the border, we first had to fill out paperwork on the Kenyan side to leave Kenya, got our passports stamped, etc. Then we drove across a bridge (that belonged to Kenya? Uganda? No man's land? Kenganda?) to the Ugandan side of the border, where we had to fill out more paperwork to enter Uganda, get our passports stamped again, and pay an entry fee. Which apparently used to be 30 dollars, 20 dollars for students, but last weekend they changed it to a flat 50 dollars for everyone. Great timing, eh.

At the border, as soon as our cars pulled up to the customs areas, we were immediately surrounded by loads of people trying to sell us thousands of things. Bananas, chapati, samosas, cokes, you name it, they were trying to sell it to us. Most of the vendors were kids. After saying no to their bananas, then their cokes, then their chapati, then their samosas (all of them offered them in that exact order, it was like they had a script), then they would start asking us to give them things. Pens and books were popular items to beg for, and when we said no to those, they would ask for footballs, soccer balls, and then drop the whole charade and just ask for money. One thing I will say is that they were quite persistent. They were somewhat disarming in that they were children (dirty, clearly poor children at that), but when you get down to it they were really quite manipulative and knew exactly what they were doing. I had a conversation with a little boy no older than 6 or 7 that went like this:

Little Boy: Can I ask you a question?
MO: Sure.
LB: Are you from America?
MO: Yes.
LB: I heard that your president eats children. Is that true?
MO: Uh... I don't think that's true.
LB: So George Bush doesn't eat children?
MO: I really don't think he does.
LB: Ok.

As hilariously funny as it was, I'm pretty sure that someone (American or otherwise) taught him to say that. And in thinking that's something most American's will find amusing/true he probably hoped I would buy something from him because I found him so funny.

At any rate, the drive from Eldoret to Uganda was only about 2 hours, so the bulk of our 6 hour drive was in Uganda. The scenery was of course, completely amazing, similar to Kenya, but a little flatter I think. I thought it was going to be a great remaining 4 hours, in that the road was by far the best I've yet been on in Africa. But, that was short lived as I should have expected, and we soon started passing ominous signs announcing "Jinja road restoration project, 5 km." And then we happened upon one of the worst roads I've yet been on in Africa (thought NOT worse than the road to and from Kakamega -- that one still wins the grand prize). It was a bouncy 4 hours, and I was quite sore afterwards, though I did manage to protect my cranium a little better than on the last trip. Due the road construction, we had to drive multiple detours on our way, and ended up driving through lots of little villages. Though this meant a longer overall drive, I don't think I'll ever get tired of seeing the various African homes and shops and the people that live and work in them. My favorite thing was this hut -- literally a small, one room hut with an enourmous (HUGE) satellite dish by the front door. The dish was actually larger than the house. I would have liked to see the TV it was connected to. I tried to take a picture, but... bumpy roads...

We got to our campsite in Jinja a little before dark. The site sits on a huge hill overlooking the Nile, so of course the first thing we did was take a ton of pictures of the Nile. Which really, looks like a river. A very LARGE river, mind you, but still a river. But I thought it was exciting, I won't deny it. We got our stuff moved into our rooms -- a large dorm-style room with bunk beds, one for boys and one for girls, got some dinner at the camp restaurant, then hung out at the bar for a little while before turning in to rest up for our big trip on Saturday.

On Saturday morning we were loaded into a large flat bed truck (really quite like a cattle truck) and driven the 15 minutes or so to the main rafting office. There they served us all breakfast (In addition to the 17 of us, there were various other groups doing the rafting trip -- about 60 people in total) and we got to watch a video of some previous rafting trips. Really I think it would have been better not to show us this BEFORE the trip, but no one punked out after seeing it, so I guess that's good. After breakfast, a brief introduction, and picking up our life jackets and helmets, we were loaded back on to the cattle trucks and driven another 15 minutes to the rafting drop site, where we were put into rafts of 7 people.

I was on a raft with Priti, Abby, Ken, Jeremy (pharmacy student), and 2 Dutch girls -- Gwen and Kirsten. Our guide's name was Paolo. After getting into the boat we went over basic rowing, commands, and some safety stuff in a smooth part of the river. Paolo tossed us out so we could learn how to float (not that difficult with a life jacket on) with our feet first and he flipped the raft so we would know what it was like to be under the raft. Well this is all well and good when you're floating lazily down calm water, but it's so much different once you're actually in the rapids.

Soon we came to our first rapid -- a class 5. (Rapids are graded from 1-6, with 1 being hardly more than a dip and 6 being suicidal). About 12 different times I thought we had flipped or were going to flip, but we managed to stay upright. Actually, our boat did very well before lunch, only tipping once, and even then only the people on the left side fell out. After about 3 hours of rafting, we had lunch on the boat, then geared up for the afternoon. Our boat's luck was quite different in the afternoon -- we got dumped at every single rapid. The very first rapid after lunch was called Jaws, and while it was "only" a grade 3, if you hit it just right, it will rocket you out of the boat. Of course we hit it just right, and all of us were immediately sucked down into this churning vortex of water. Now, Paolo had told us that we might get caught in some "minor whirlpools" and if that happend to remain calm and wait for it to spit us out, as we'd waste more oxygen by struggling. We were all stuck in this "minor" whirlpool, and we'd break the surface with only enough time to see the same panicked look mirrored on 6 other faces before getting sucked back down into the water. In reality it probably lasted no more than 30 seconds or so, but it seemed like much, much longer than that. Of all the rapids in the 7 hour trip, it was the only one where I really started to think.... hmm.... am I going to drown???? Eventually, FINALLLY, we got spit out of the rapid, found our boat, our guide, and our fellow rafters, and climbed back in. Quite shaken. We were glad our first falling into the water experience was not a grade 5 rapid, though we would experience that joy soon enough.

Our boat got dumped at least 5 or 6 more times after that, though thankfully the other times I popped immediately up to the surface. One time was even directly over an 8 foot waterfall, even though Paolo told us we wouldn't flip -- we flipped, and we were the only boat that did so. On the course of our 30 km trip down the Nile, we went through 5 grade 5s, 5 grade 4s, 3 grade 3s, a dozen or so 1s and 2s, and we even got to see 3 grade 6s. As in look at only, as you have to be certified (certifiable?) to raft a grade 6. One of the 6s was named "the dead Dutchman" -- I'll let everyone figure that one out for themselves. Needless to say our Dutch counterparts wanted to steer very clear of that rapid. The last 6 was followed immediately by the last rapid we rafted, a grade 5 called "The Bad Place." The rapid was such that it spanned the entire width of the river, so we had to get out and walk around the 6 part to where the 5 began. In the meantime we got to watch to of our Kayaking safety guides raft down the 6. And Holy. Goodness. It was absoutely insane. The 2nd kayaker got stuck upside down in a rapid, so had to kick off the kayak. Down the rapids flew the kayak, and we watched in horror as the water just tossed this guy around and around before he flew down the river, yards and yards away. We found out later that he broke his arm in the process.

After finishing the last rapid, we all hiked (barefoot, mind you) up a huge hill to where the trucks were waiting, and had a long, cold ride back to the campsite. We ate dinner, then got to watch the video of our trip that the company had been filming all day. It was actually quite shocking to watch people getting dumped and tossed about like rag dolls by the river (especially our boat!) and to think... WHY did I just do that??. But, I did by a copy of the DVD so my family can be as mortally terrified as I was :).

I have been white water rafting in the US a couple times, but this was a different experience altogether. The Nile is just so... HUGE, and we've gotten so much rain lateley that the rapids were.... well.... rapid, and just unbelievably enormous walls of water. Coming straight at you, on either side, behind you. But, the company did a very good job. The guides were all very experienced, the equipment in good condition. There was one boat with the most experienced guide by himself -- his job was to go to the bottom of the rapid ahead of everyone else and wait there with the safety equipment (including antivenom for the Nile snakes -- something I'm glad I found out about afterwards). Then the Kayakers would go down the rapid -- about 15 in all-- and every time I fell out of the boat there was at least 1 if not 2 waiting right there for me when I popped back up. But still, at times a rather harrowing experience. I'm so glad that I decided to go, but I don't know if it's something I would ever do again.

It was another early night on Saturday, being exhausted and quite sunburned, then we left about 10 on Sunday morning to commence the bumpy road back to Kenya. We had to do customs in reverse -- check out of Uganda, and back into Kenya, and tell the same children no to the same things they wanted us to buy. Needless to say, after getting rocketed out of a boat a half dozen times, then pulling myself back in, then a long, bumpy ride back to Kenya, I am rather sore today, though I still maintain it's worth the experience I had.

Today was my first day on the adult wards. Priti and I switched for the last 2 weeks we'll be working, just to get the experience of the other side while we're here. I definitely don't like it as much as I like peds (which further confirms my decision to go into peds), though it is interesting, and I'll never see this sort of pathology again, I'm sure. But, I made sure to spend time in Sally Test today playing with my friends; especially Diana and Kevin. Diana and I played a fun game of take-off-my-nametag-and-put-it-on-Diana-then-take-it-off-Diana-and-put-it-back-on-me that lasted for about 30 minutes. And when I walked in Kevin was actually laughing and squealing at the top of his lungs. He looked SO happy, and it was adorable. His walking is much better in just these few short days, and he's getting around very well all by himself now.

Other than that, really just planning on studying for the rest of the rainy afternoon (my boards coming up much sooner than I would like). And yes, it is still raining. Though I am assured by multiple Kenyans every day that the rain will be over "soon." No one can seem to say how soon, though. I think even the weather runs on Kenyan time.

Kwa herini!