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!

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.