TB team field visit!

My mentor and her fellow are back in Kenya for a few weeks so I was able to join them on a field visit last Wednesday and Thursday to Port Victoria, Mukhobola, and Khunyango.

The main purpose of the trip was to work out the logistics to conduct lot quality assurance sampling to evaluate primary drug resistance in new TB patients. In Kenya, when patients are diagnosed with TB (via sputum microscopy) they are started on a drug regimen without knowing if they already have any primary drug resistance. If they are still smear positive after 2-3 months of treatment, their sputum is sent for culture and drug sensitivity testing and their regimen is altered accordingly.
This differs from the states where TB patients receive culture and drug sensitivity testing immediately so that they can be placed on a drug regimen specific to their drug resistance pattern. As a result, primary drug resistance is not well known in Kenya so this project will actually identify this information.

We started out at Khunyango and I was really impressed with how organized the TB clinic and register seemed to be. I think that some of my recent frustrations with the child contact register project have stemmed from the fact that the TB clinic and register in Eldoret are less organized. When you have a large patient volume and many different personnel working in TB clinic, it becomes more difficult to keep the system running smoothly. It's an even bigger challenge to implement a new project into this type of system! I'm very excited because my mentor suggested that I try implementing the child contact register at Khunyango in the next few weeks. I think that the register will help them identify more cases of pediatric TB, but it will also be a completely different experience for me to implement in a much smaller, rural setting.




Outside the TB clinic...


Waiting area...


The next day we started off at Port Victoria. The clinic is right next to lake Victoria and the drive was absolutely beautiful. One of the interesting challenges at this clinic is that there are patients who travel 5 hours by boat from one of the islands, and most of them stop coming to their appointments since the travel is long, expensive and they usually need to stay in Port Victoria overnight. Could you imagine if you had to travel 5 hours by boat to go see a doctor?? I would stop coming to my appointments too!

The drive...


AMPATH clinic...






The TB projects office team with the Port Victoria cough monitors


Our last stop was Mukhobola, which is another village near the lake. After the clinic visit, we went to see a TB patient at her home to discuss some important issues (sorry for being vague...just don't feel it's appropriate to share the details on a blog). The patient is part of the Luhya tribe and the set up of her household was fascinating. The male of the household is buried at the center of the compound surrounded by all of his wives' huts. Their sons then build homes with their wives outside their mother's hut and then they are eventually buried in the center of their small compounds. It's a tightly knit community where you definitely know all of your neighbors!




The lab


The patient visit (you can see the grave of the male head of household in the center under the tree)

I am so glad that I got to go into the field! It's rejuvenating to be out in the rural areas and witness the impact that the small community clinics have in these regions.

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!