My New Place

Sorry it's taken me a while to post these pictures!

I moved into my mentor's house almost two weeks ago. It's the servant's quarters of an amazing house right up the street from the Indiana University compound where I had my first room.

My new room...


















The wonderful kitchen which means I can cook again!!


















The living room...












And my favorite...my garden! The rocks indicate where I planted last weekend. I have two rows of lettuce, two rows of carrots, and two rows of swiss chard. I'm growing tomatoes and cilantro inside until the plants are big enough to transport outside.

Grateful

There are days that I feel selfish living here. Although I have been working as much as possible to help implement TB screening in the antenatal clinic, I still feel like I gain so much more than I am giving. Most of the Kenyans that I interact with daily are living on only several dollars a day. Yet they seem to live each day full of energy and without many complaints. It’s a great attitude, and I have been trying to adopt it as my own while living here. Fortunately, it’s not difficult to do since this way of thinking is sort of necessary if you want to emotionally survive here.

When I was walking to meet the field coordinator last week, I was trying to think of things that I might complain about/think about in the states vs things that I might complain about/think about here. I thought that this would help me realize if living here has changed my outlook on life at all. Here is what I came up with:

In the US: Ugh this traffic light is taking forever. I’m not going to be able to stop for coffee on the way to work.

In Kenya: I hope that it’s not too muddy on the way to town. I really want to get there in under 40 minutes.

In the US: Oh man. I left my umbrella in the car. And I just dried my hair this morning.

In Kenya: Hmm. I wish I had covered the open blisters on my feet. This muddy rainwater that I’ve been walking through for the past 20 minutes might not be that clean.

In the US: Why is the hot water off in my apartment complex? If it’s not back by this evening I am definitely calling to complain.

In Kenya: If I run before I shower, the lukewarm water actually feels hot!

In the US: Ugh. The jalapeno monterey jack cheese isn’t on sale today at Wegmans!

In Kenya: Oh damn. Nakumatt doesn’t have any cheese left.

I hope that I will be able to maintain this mindset when I return to the states, and think less about the relatively little, insignificant things in life. I feel so lucky to have been born in the US where my family provided me with great food, shelter, healthcare, and a fantastic education. It’s difficult to realize and appreciate these things at home when the norm where we grew up is the above. However, living in Kenya highlights these disparities for me daily, and my feelings of guilt and selfishness lead me to wonder what my responsibilities are as an American and future physician to help those less fortunate across the globe. Do we have a social and moral obligation to close the gap between the Western and developing worlds? Or do we leave poverty and suffering from curable diseases as Kenyans put it ‘in the hands of God’?

First Field Visit

Today I headed to the field with one of our field coordinators who oversees the cough monitors working in the rural areas. We went to Tambach, which is about 45 minutes outside of Eldoret in the Kerio Valley.














One of the most important jobs of the cough monitors is to do sensitization talks. Typically, the cough monitor will target large groups of people like prisoners or students. The goal is to educate as many people as possible about TB and encourage them to get screened (for free!) if they have TB like symptoms usually including cough, fever, and night sweats.

We started off at the Tambach prison. The prisoners were very interested in what we had to say, asked great questions, and expressed their gratitude for our willingness to educate them. One man summed it up perfectly,"you have given us information and information is power. Nowe we have the power to keep ourselves health."




























Then we started our trek to a primary school in a nearby village. We walked up the side of the valley for about 1.5 hours. As we climbed, the valley came into view and I couldn't stop saying "ooo maridadi sana (so beautiful)". I don't know if these pictures capture the beauty of the landscape, but hopefully you can get a good idea.




























Our next stop was a primary school. We arrived while the students were still at lunch. While we were waiting for everyone to get there, I decided to play soccer with the kids who were already there. And by soccer I mean the kids would kick me their ball made of paper, foil and rope, and I would try to kick it back and they would laugh hysterically. Children from the rural areas in Africa are fascinated by Wazungu (white foreigners). They surrounded me, and started shooting questions at me to see if they could stump me. I did fine on the first few...what is the capital of your country? What is the highest mountain in the world and what country is it in? Then failed miserably on what is the deepest lake in America? If anyone knows, please post your answer in the comments section. I need to be prepared for next time!














The primary school talk was definitely my favorite one.
My talk went something like this:
"Who here is going to eat dinner tonight?" (all hands go up)
"And who here is going to eat dinner with their parents, brothers and sisters?" (again all hands go up)
"OK then. My assignment for you tonight is to teach your families everything you learned today about TB. As Willy said, Kenya is #5 in Africa on the list of countries with the most TB cases. YOU have the power to change that!"














We took an interesting shortcut down the mountain through corn fields, and again, I could not get enough of the scenery!














When we approached the secondary school where we would be speaking to children and their parents, I started to race some of the children playing in the school yard. What I did not realize was that there were about 150 kids waiting for us to arrive and once they saw me running they all charged at me excitedly. The talk here went well and the parents seemed very itnerested to learn more about TB!

Lake Nakuru

After 4 weeks of being in Eldoret, I decided that it would be a good idea to get out of town for the weekend. Some of my short term friends are leaving soon so I joined them on one of their last trips.

We headed to Lake Nakuru...

View Larger Map

We found a hotel that was supposed to be 'a 15 minute drive from the park entrance'. Well after getting lost a bit in town, our safari driver finally figured out where we needed to go. It turned out that we were actually about an hour from the entrance in the middle of nowhere.

Not too shabby for the middle of nowhere though!

























Some animal highlights....





























































On Sunday morning, a few of us went on a guided bike ride near our hotel. This is my favorite picture from the weekend...













And on the way home we stopped at the equator!

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