Rescue Center

Yesterday Hao took Priti and I to the Eldoret Rescue Center – the camp/school/home for the street kids of Eldoret. This is the place founded by the German missionary who rescued Frances, Mwangi, and Benson from the streets (see “Eldoret Street Kids” post). He has since moved to Nakuru and the center’s operations taken over by a Kenyan group (funding from Kenya? Germany? America? It’s not really clear).

The experience at the center was very interesting. We went for the afternoon to do checkups with the kids. Since we had a limited amount of time yesterday, we tried to see the kids who had the most urgent medical needs. The staff at the Rescue Center tried to triage the kids for us from most to least sick. We saw a lot of kids with chronic cough, most of them with simple URIs/colds from persistently damp conditions and little in the way of clothing. Unfortunately not much we could do for them, though it’s standard practice to prescribe antibiotics for colds in Kenya. We saw one boy with a horrible ear infection, one boy with costochondritis, one boy with chronic dermatitis. I saw Elvis, an 8 year old little boy who was dropped off at the Center 2 days ago by his mom. His legs were covered in deep gashes and he had a big laceration on his scalp. Apparently his mom had been beating him. The injuries on his legs really looked more like burns to me, but he said they were from being hit with something (a cane? Bat? The translator didn’t understand the word he was using). He had the sweetest face and the saddest eyes. All I really wanted to do was give him a big hug, and all I could think of was that line from The Green Mile, where Big John says that he’s tired, tired of people being ugly to each other. There’s not much we could do for his wounds, as the Rescue Center doesn’t have wound care supplies, so we just told him and the Center supervisors to keep them clean, dry, and covered as much as possible. His physical wounds will heal, but his psychological wounds…who knows?

As sad as it was to see children in such desperate situations, I really, really, really, really enjoyed the afternoon. I actually felt useful, QUITE useful, in that we were diagnosing mainly colds, aches and pains, and a few open wounds. This is stuff I actually know how to treat. I want to go back. We really only scratched the surface of the need there. We saw about 25 patients in our 2 ½ hours, which was only about half of the ones that were picked out to be seen. Which wasn’t nearly all of the boys, and we didn’t even see ANY of the girls at all. There is a full time nurse on staff at the Rescue Center, but she is very limited in the resources that she has available to her, and the staff there today were so appreciative that we had come. Hao wanted to go back in 2 weeks, but when she saw that Priti and I were so enthusiastic about it, she considered maybe going back next week.

I discussed the Rescue Center with Sarah Ellen Mamlin at dinner last night, and she had quite a bit of insightful and helpful input. IU used to do consistent weekly or bi-weekly clinics at the Rescue Center, but that fizzled out once AMPATH really got going and IU diverted more of its resources there. Which is fine, but I think (and Sarah Ellen wholeheartedly agrees) that IU has not really tapped the resources it has in its residents and students. I think the Rescue Center would be an ideal project for them. The residents that come here are senior-level residents with plenty of experience, and a lot of the stuff we would see the students would be able to diagnose and manage. And again, it would make the students and residents feel very useful. I know our medical directors are very busy, which is part of the reason that the Rescue Center clinic fell by the wayside, but this is something that I don’t think necessarily needs full-time staffing by an attending physician. Except in the unusual or rare cases, I think we underlings would do a fine job. The clinic is something that Sarah Ellen would really like to see started again, and I’m hoping I can sort of help out with that implementation in my remaining weeks here. We would have to find out how to get certain resources that we need, like medications and supplies, etc. Another big part would clearly have to be HIV testing, but Sarah Ellen thought we could work out something with AMPATH to get the tests for free or at greatly reduced price. I’ll have to talk to my friendly neighborhood pharmacist (as Sonak likes to call himself) about that one. Really I just see so much potential here to do something really, really good for a lot of children; children who’ve never really had anyone care about them. And apart from finding funds to make the program sustainable, it really wouldn’t be that hard.

I’m pretty bummed that this visit took place so late into my time here, as this is something I could get totally involved in.

The morning was interesting too. Wednesdays I spend in Module 4, the pediatric clinic at AMPATH. We saw a few patients early on, but then spent most of our time with Sophia. Sophia is a 12 year old little girl, not really sure how long ago she was diagnosed with HIV. She was started on antiretrovirals in the middle of July sometime, then was seen in clinic about 2 weeks ago with complaints of generalized body swelling. I talked to Hao about Sophia, and it turns out that Hao actually saw here when she was in in August. At that time, she had “mild facial swelling.” Well today, this poor girl. Her face was swollen she could barely open her eyes, and she had so much fluid in her legs that her skin was pulled taught. When I pushed on them to check for pitting edema, fluid actually oozed from her skin. Since being here 2 weeks ago, she has gained 5 kilograms (over 10 pounds) of fluid. When someone has this much fluid retention, it’s due to either a cardiac problem, a liver problem, or a kidney problem. Her heart sounded fine, and her chest xray was normal. On exam, her liver was not enlarged, and all of her liver labs came back normal. Her stepmom did say that she’s had some decreased urine output, but her kidney labs were all normal, and her electrolytes were normal. A time when you actually want something to be abnormal so you know the diagnosis and how to treat it. So Victor, the clinical officer, called one of the consultants – the consultant that saw her 2 weeks ago. She said that it’s probably due to one of the antiretrovirals that got started in July, so we should take her off of them completely and see her again in a few weeks. Victor looked quite dubious when he got off of the phone, and asked me what I thought we should do. I said, admit her. So, we did. Sophia also has a huge mass on her tongue that is most likely Kaposi’s Sarcoma (KS) – a type of malignancy that HIV patients get frequently; and is actually an AIDS-defining illness. She also had multiple nodules of likely KS around her ear. So not only was her face completely swollen, it was also very bumpy. This poor girl was not at all comfortable. Even though the other team was admitting tonight, hopefully she’ll come to our ward because she’ll need chemo for her KS.

So the big trip in the works for this weekend is to Uganda for white water rafting on the Nile. Which, as totally awesome as that sounds, I’m thinking about not going. Though I finally admitted this to Mike tonight, and he told me I had to go. And, as I definitely do everything Mike tells me…
My main concerns are these: It’s expensive. Though really, probably my only chance to ever do something like this. Really my only chance to do it, as they’re damming this part of the Nile in a few weeks, so the company that does the rafting will have to locate elsewhere. Another concern is of course, safety. Not that I’m a total nervous Nellie, but it is generally better to do these types of things when easy evacuation and trauma ERs are in ready supply. But, I found out today that you can choose an “easy” “medium” or “hard” raft in terms of rapids. IF I go (IF IF IF) I will be on the easy raft. The other thing is that I’ve been white water rafting several times in America, and while it’s been fun, it’s not like the most amazing thing I’ve ever done. (Though I did enjoy my first trip, as I was on the same raft as a boy that I liked very very much…) I’d rather spend the money on Masai Mara next weekend (which WILL be one of the most amazing things I’ve ever done), plus I always thought this would be something that Mike and I would do together, so that’s kind of a bummer. Really, I just keep going around and around about it, and I haven’t decided yet. It /would/ be a lot of fun, and definitely a once in a lifetime experience. My deadline for decision is Thursday morning.

I’ll keep everyone updated.



*And here is the update* Since writing this post I have decided to go to Uganda this weekend. Prayers much appreciated.