Misconceptions

This has been a busy week! I have been observing in the PMTCT and antenatal clinics this week to figure out where we should implement our cough monitor. I made some interesting discoveries about how patients flow through the system, and I think that we will be able to get started in a few weeks.

While at the clinic, I had a conversation with two of the HIV+ patients that has been on my mind a lot.

Patient: Where are you from?
Me: America
Patient: Wow, I wish that I was allowed to travel there.
Me: Allowed? Why wouldn't you be allowed?
Patient: My friend told me that now that I am HIV + I will never be allowed to leave the country.

(later on in the conversation)
Patient: I am so scared to have a relationship with a man ever again.
Me: How come?
Patient: My friend told me that if I sleep with another man and he has a different type of HIV, our types can mix and I will die immediately.

(and a bit later...)
Patient: Everything I do now is for my son. I live every day thinking that I am going to die tomorrow, and I desperately want to see my son grow up and support him so that he can go further in school than I did.

The stigma against HIV and all of it's associated diseases (TB being a major one) is unbelievable here. It leads to many misconceptions that prevent people from seeking testing and treatment. The above patient travels 3.5 hours one way to come to the AMPATH clinic because she is scared of being seen in her hometown by friends or relatives. Despite being enrolled in the HIV care program, she worries about dying every day. She is only 27 years old. This is a reality that I cannot even begin to imagine. I hope that with time and education the stigma will eventually fade one day as it has somewhat in the states. However, I wish that there was something more that I could do to help expedite this process so that more young women could stop living their lives in fear.

A Trip to the Market

I have really enjoyed spending the weekends in Eldoret. It gives me time to explore the downtown area and catch up on my cooking! This weekend, several students and I ventured into the market to buy ingredients for a Saturday evening feast.

This is Simon. All of the longterm people say that he is the best veggie guy in the market. I already like him because he gives us free bananas whenever we come to his stand.














Beans, rice, and lentils














Walking downtown














My finished product. Stuffed peppers with rice, sausage, and onions...and of course topped with lots of cheese!

A Case from the Peds Ward

This is an estimated 12 month old who was abandoned by a water tower. She has hydrocephalus, and her head is the size of a basketball. Since she has likely had this for months now, her brain was unable to develop properly which you can see below in the head CT. This is another little girl who would have done well in the states with proper treatment and surgery. Since she has no family, the Sally Test center workers visit her daily. She will receive 'palliative care' for the duration of her stay at the hospital which here only means a bed, fluids, and clean clothes.



















Here is a normal scan for comparison (the one on the right is normal):







www.seattlechildrens.org

Productive Week!

Sorry for not posting yesterday! I have a feeling that I might only be posting 2-3 times a week once I get settled because my work is definitely going to be keeping me busy. (and that is a great thing because I am loving it)

This week I have been working with the cough monitors in order to learn exactly what their function is. You might be asking - what the heck is a cough monitor?

My mentor implemented 'cough monitors' in Eldoret in order to help identify active tuberculosis cases. The cough monitors are trained, and then assigned to a location either in the hospital or in the community. They administer a 6 question survey to assess whether or not a patient needs to get a sputum smear. Every patient in the hospital is screened with the survey within 24 hours of admission, and patients in the community are provided educational pamphlets to encourage them to get screened (for free!) if they are experiencing symptoms of TB.

Today was my best day yet in Kenya. I went out into the community with Nyakoa, an Eldoret cough monitor, to visit a patient with active TB infection and hand out pamphlets in several crowded areas in town. The patient that we visited lived in the 'slum' part of town. It was a difficult reminder of how many people in Eldoret are still living in absolutely unacceptable conditions. The houses are made out of mud and covered with an unstable piece of metal. Each house is about 15 x 15 feet and they are arranged right next to each other in long rows. I was swarmed by about 10 kids before our meeting ended - they were all under the age of 6 and barefoot. Of course I had urges to scoop them up and bring them home for christmas, but of course this would not be the sustainable option for improving global health.

After our visit, we headed to the slaughterhouse to talk to the workers. One man attempted to scare me away by waving 4 cow hooves at me, but otherwise the pamphlet distribution went smoothly.
Then we were off to Kennit, which is one of the largest factories in Kenya. It produces sweaters and blankets for a large portion of East Africa as well as exports to Germany, Italy and Great Britain. The director offered to give us a tour and I happily accepted.

Here are some pictures: (sorry that these are blurry! I was trying to be discreet and could not steady my camera well in the process)














Women sewing sleeves to sweater bodies.















This is the 'sorting room'. The two women in back sort through the yarn to grade it. The lower grade sweaters are sold for less in the markets and the higher grade sweaters go to the better stores in Kenya and get exported out.















Cough monitor at work! This motorcycle taxi driver is getting a slip to get his free screening at the district hospital this afternoon.

Moi Teaching and Referral Hospital

I thought that I would give you a glimpse of what my walk to and from the hospital looks like. The compound is about a 10 minute walk from the hospital.















Many African hospitals are several buildings connected by long covered walkways. It doesn't really get cold here so keeping everything open helps to keep everything ventilated.

Walking Together, Walking Far

The Academic Model Providing Access to Healthcare (AMPATH) is Kenya's most comprehensive initiative to fight HIV. This model was made possible through a partnership that was started in 1990 between Indiana University and Moi University. It is one of the most successful HIV control systems in sub-saharan Africa, and I feel fortunate that I will be surrounded by the people who established it during my research year.

If you are at all interested in global health, Kenya, or AMPATH, I recommend that you read Walking Together, Walking Far. It describes the creation of the partnership, and perhaps will inspire you to establish your own collaboration in another developing country someday. :)

Physical Exam Finding of the Day

This is an 18 year old male who came in complaining of shortness of breath and peripheral edema. His echo showed textbook Tetralogy of Fallot (yes it's crazy that he's 18 with this and still living!). This case was one of my favorites from the male ward. The patient had been admitted several times to different hospitals and not once did a doctor explain to mom what was wrong. She thought that her son had a lung problem! She had no idea that his heart was involved. She seemed well educated because her English was fantastic, and when I sat down with her to draw out a diagram of her son's defect she was using terms like deoxygenated blood as if they were part of her every day vocabulary. Why hadn't anyone taken the time to educate this woman about her son's condition and prognosis?

More often than not, patients and family members here have little insight into what is happening inside their own or their loved one's bodies. It seems that they completely leave their fate in the hands of their doctors or God - never even questioning when a crucial test is postponed over the weekend or when the intern only has time to do a quick, mediocre exam. This is vastly different from the U.S where patients at times seem to drift towards the other detrimental extreme - demanding unnecessary tests or taking unapproved supplements.

Anyway, the best part of this case was that this patient was used during the medical student practical exams. According to one of the test takers, the mom was so excited that she knew her son's diagnosis that she ended up explaining to each examinee the 4 components of tetralogy and completely giving away the answers to the practical. Let's just say that the attending physicians were not at all pleased. :)

Below you can see the significant clubbing that typically indicates chronic lung or heart disease.