Happy World TB Day!!

Wow what a day!! The TB team and the Kenyan Medical Students' Association put together some phenomenal events today to spread the word about TB.

The day started with a parade through town. Dressed in t-shirts and TB bandannas, and carrying signs and banners, our chants did not go unnoticed!




We even ran into William Ruto (yes one of the politicians called to the ICC) and Najib Balala (the minister of tourism), and they spoke to the crowd!


Once we returned to the hospital, there were speeches, certificates awarded, and a skit. The skit was my favorite part because I was convinced to play a Kenyan witch doctor.




It was incredible to see everyone come together and get excited about such an important (and often neglected) global health issue. As with anything, I think that it is easy for Kenyans (or anyone) to fall into a daily routine and lose some of the motivation to constantly try to improve and change a difficult system. Let's hope this will encourage everyone to work a bit harder to STOP TB!!

Denial

I have been telling myself since January that I am only at the halfway point of my year in Kenya, and suddenly today when I looked at a calendar I realized that I'm only here for 3.5 more months. Aaah...how did this happen??
The weeks keep flying by, and I find myself making mental notes of what I need/want to accomplish/see/experience/eat before I have to return to the states. All of the things that I kept saying "oh I'll do that later" have turned into "oh wow...I better do that NOW".

Anyway, here is a small preview of some of the things I would like to do in my final months here:

Work
1) Now that the child contact register has been up and running, I'm working to get the second part of the project started which will hopefully continue into next year. The purpose of the project is to implement a 'child tracker' which is an individual who will be in charge of helping to get the exposed children identified by the register into care for TB screening and HIV testing. More details to come in a project update post in the next few weeks!
2) Hopefully we will be able to do a few more TB sensitization talks and screenings at the Tumaini Children's Drop In Center before I leave and create a schedule to continue the screenings in the future. We are also hoping to extend the screening to the street children who do not come to the center but this might be more of a challenge.

Exploring
1) The longtermers are planning a backpacking/hiking weekend through the Cherengani Hills in late April/early May!
2) Umbrella falls is only 30 minutes away and somehow I still have not made it there...it's definitely on the list...

Eating
1) I want to learn how to make Kenyan chapati, ugali and mokimo!
2) Although the restaurant scene in Eldoret isn't exactly topping the charts on yelp, I have had some of the best Indian food that I have ever tasted here. I plan to get my fill of mango lassis and malai kofta.
3) I will be planting again for the rainy season: beans, spinach, beets, parsley and dill are on the list. I'm hoping to introduce my Kenyan colleagues to borscht. :)

Other
1) Continue blogging (it's getting harder and harder to keep up!)
2) Take more pictures

I was able to do a bit of the last one this weekend at Tumaini Outreach...

on the way to the soccer field


a cow and Eldoret town in the background


jump rope with the kids


some of my (many) favorites

Rafting on the Nile

On Friday, 13 of us headed to Jinja, Uganda to take on the Nile. The Nile has many class 5/class 6 rapids. Usually in other parts of the world people are unable to raft 5/6 rapids successfully because it is often too shallow and too dangerous. The Nile is deep though so flipping onto rocks is not as much of a concern.

Anyway, many of us were still a bit apprehensive so we asked for a 'no flip' boat. Many of the guides will flip boats on purpose for added thrill, but since drowning wasn't really on our agendas, we opted for the 'mild' experience.

We started the trip with some safety training - learning how to get down, what to do if we flip, and how to get back into the boat safely.


Then we were off! Starting the day off with a class 5!

The nice thing about the Nile is that there are calm pools of water between the rapids so we actually spent a lot of time lounging in the raft and swimming where the guide told us it was safe. (the crocodiles also like the calm areas!)

Our guide did a phenomenal job keeping our boat upright. However, I wanted to experience the thrill of flipping one time so I switched to our other group boat for the last rapid. We went over a class 5 and suddenly we were all flying out of the boat. I managed to hold on to the raft for a bit but then the raft ended up bouncing again so I found myself surrounded by waves, taking every opportunity to get a good breath before the next wave took me under. This only lasted about 10 seconds until I was in a calm pool of water and grabbing onto a safety kayak, but of course if felt like much longer. It was scary but definitely one of the most amazing things I have ever done!!

We all made it back safely sans crocodile bites or schistosomiasis (well at least so far!) :)

The next morning we celebrated with a famous Ugandan breakfast...egg, tomato, onions, and avocado wrapped in chapati!! (chapati is similar to indian naan or a thick crepe) YUM


More pictures

One year ago...

I was interviewing for the FICRS program in Bethesda! Wow time flies.

If you are at the interviews and have specific questions about the Eldoret site, please feel free to contact me at Szkwarkd at gmail.com. Good luck to all of the finalists!

Mountain Biking in Iten

This weekend a group of us headed to the Iten High Altitude Training Center. Runners from all around the world come to Iten to train so the facilities are amazing. Luckily, they also let normal people in to relax, mingle with the runners, and use their equipment/facilities.

We decided to rent mountain bikes from the center in the morning and headed for Bugar Forest.

Making our way towards the valley...


Huts in the distance...


Ngooooombe! (cows)


Kids and dogs chasing us...I think they could probably run faster than I can bike!

What can you carry on your bicycle?

This is a post I have been planning since September, but I've been waiting to complete my photo collection.

I am constantly amazed by the items that people manage to carry on their bicycles in Kenya. Most of the items below would not fit in the trunk of my toyota!! However, one lesson I have learned this year is that if a person only has limited resources and money, he/she manages to improvise in fantastic ways to become as efficient as possible.

Soooo here we go!

Grass for thatching


A table, a bucket and a few bags of goods


A child (where is his helmet???)


Sugarcane


bundles of wood


And my favorite....
A bicycle!

A need for affordable primary care

I received a phone call this morning that a patient with pulmonary TB brought her children in to be screened for TB. One of the main objectives of my child contact register project is to get patients to bring their exposed kids in for screening so the fact that someone actually did was great news. However, I encountered a bigger problem when I arrived at the clinic - mom and kids were HIV negative. Why on earth would this possibly be an issue? The original mission of AMPATH was to provide affordable healthcare and support to HIV infected individuals in western Kenya. The organization has succeeded with this and currently manages >160,000 HIV infected individuals and counting. In other words, if you have HIV in Eldoret, your clinic visits, medications, lab studies, and imagining is free. So a child exposed to TB in the home who is HIV infected can see his/her clinician and be sent for a chest x-ray for free (a savings of approx 6 dollars).

What about if your child is HIV negative? Well prepare to wait in a long line at either the sick child Emergency Room or the Pediatric Acute care (only open 2 mornings a week) to have a clinician see the child for a fee. Then the clinician will probably send the child for a chest x-ray so it will be necessary to pay 400KSH for the test. To put things into perspective, a 30 minute bus ride costs 20KSH and a lunch costs 80KSH so these medical costs add up quickly.

Fortunately, this issue is well known, and AMPATH has just started shifting to a primary care model to incorporate HIV negative patients. It will be interesting to see if a test like a chest x-ray will get waived for a HIV negative child who has been exposed to pulmonary TB at home.

In the meantime, I feel a bit torn. Of course I want the clinical officers to encourage pulmonary TB patients to bring their children in for screening if they are symptomatic. Isn't a chest x-ray a small price to pay if your child's life is at risk? Conversely though, if they can't afford the suggested screening, what are the emotional consequences of telling a parent their kid might be very sick but they can't do anything about it due to financial constraints?

I couldn't answer this question today so when the mom told me she could only pay for one x-ray, I contributed the rest to get the second. Luckily, both kids were TB free and mom (and I) are relieved. Here's to hoping that a more sustainable solution is on the horizon!