Sujal

Sujal Parikh, one of my friends from the Fogarty program, passed away this week after a horrible motorcycle accident in Uganda. I had just heard from him Friday evening prior to the accident regarding our plans to travel together with some other Fogarty students in November.

Suj was one of the most inspirational individuals I have ever met. Each day after our orientation sessions, he would be in the hotel lobby on his computer working on multiple global health projects or engaged in intellectual discussions with other students and physicians. He had already been working in Uganda for many years and was a tireless activist for human rights around the world.

Suj - Although you may not physically be with us anymore, your spirit remains and you will continue to inspire us all. You will not only be missed by the people who have met you, but also by the hundreds of individuals globally who have and would have been greatly impacted by your work. I hope that we can all aspire to lead our lives the way you described on your facebook page:
Risk more than others think is safe,
Care more than others think is wise,
Dream more than others think is practical,
Expect more than others think is possible.
-Claude Bissel

Sujal's blog

Cough Monitors

When people ask me what I'm doing in Kenya, my one line answer for my main project is usually the following: I am implementing a cough monitor in the PMTCT clinic to screen HIV+ pregnant mothers for TB. I was under the impression that this was a clear way to describe what I am doing. Apparently, I was completely wrong. After about 4 weeks in Kenya, another student innocently admitted to me that she imagined a cough monitor to be a machine - a baby monitor type of device that could somehow listen for cough. She was not the only one because when I told this story to others I received more shocked looks and comments. "Wait so the cough monitor isn't a machine?" "It's a person???" "Oh I thought it was a robot!!"

So to clarify, a cough monitor is a trained PERSON who is assigned to a ward or a clinic. His/her sole purpose is to survey patients for TB risk and TB disease. The cough monitor asks each patient 6 questions that can help determine if the patient is at risk for having active pulmonary TB (cough, household contacts etc). Depending on the patient's answers, the cough monitor collects a sputum sample from the patient to test for TB disease. The sample is sent to the TB lab and results are back the same day. The best part? TB screening AND treatment are FREE!

Two of my favorite short termers and I really got a kick out of the cough monitor robot idea, and we spent some time discussing what this robot would do if a cough monitor was actually robotic. They made me this wonderful present before they left Kenya!!



















Meet Neil the Cough Monitor
Features:
1) Large diameter straw in right breast pocket for easy sputum collection
2) Sputum results back in seconds
3) Culture and drug sensitivity capabilities with siren and light warning for XDR cases
4) User friendly conveyer belt tongue depressor distributes appropriate medications immediately to patient (combo pill available for intensive phase treatment! Limited supply of MDR treatment included!)
5) Large left eye xray device takes a chest xray in minutes

**Deluxe addition with lumbar puncture feature coming soon! Don't let any TB cases get past your cough monitor!

A Kenyan Wedding

My Kenyan roommate from the July Fogarty orientation in Washington, DC got married on Saturday, and she invited me to Nairobi for the event. The wedding was beautiful and incorporated both Western and Kenyan traditions. The ceremony was like any other Christian one in the States. The bridal party walked down the aisle, followed by the bride and her parents. Vows were exchanged, rings were carefully placed, and prayers were said. Even the pastor's sermon felt very familiar except for the one part when he went on about the key to a healthy marriage is to understand that the woman is the subordinate and the man is the captain of the ship. This touches on some interesting cultural differences that will have to be a separate blog post in the future.












Many of the women were dressed in traditional Kenyan clothing and I couldn't get enough of the different patterns and designs.












A 3 hour reception followed the ceremony. It took place outside the church and there were several large tents set up with a center table displaying the cakes (yes there was more than one!).

























After we ate, the bridal party came back from taking pictures, and they were escorted to the reception by a bongo quartet and many singing and dancing guests.











Then came the speeches. Each parent shared their blessings with the bride and groom, and the grandfathers provided their words of wisdom to the guests.

This was followed by more dancing and singing at which point I decided to give African dancing a try!

























All in all, another fabulous weekend in Kenya!

As always, additional pictures are here

Important Lessons

I realized that I made my first significant mistake in my research this week. In my initial observations of the patient flow in the PMTCT clinic, I talked to the wrong people and was mislead to believe that all HIV + patients go through the antenatal clinic first for their initial visits. To make a long story short, they recently changed the patient flow and now all HIV+ patients have all of their antenatal clinic visits in the place I was originally supposed to implement a cough monitor! My implementation in the antenatal clinic would have worked great 6 months ago before the transition, however, now I am back to square one.

Luckily, it is only week 2 of our screening, and I'll be able to use the data collected to do a comparison study later sooo hakuna matata.

Anyway, my mentor wrote me a great email in response to my mistake:

Welcome to Kenya and OR (operations research) work in the developing world.

Lessons learned:

1.) Talk to everyone.

2.) Talk to everyone again.

3.) Talk to the heads and talk to the people in the trenches

4.) Walk the walk- meaning follow on the ground where you think the patients will be

5.) The most important lesson- ANYTHING THAT CAN GO WRONG WILL GO WRONG.

I am finding the challenges of conducting operations research in an entirely different culture and resource poor healthcare system to be the aspects I enjoy most about this work. There are moments that I feel like an undercover investigator attempting to unravel and understand the intricate nuances of what at times seems like an alternate universe. The environment causes me to slow down in my conversations and analyze phrases and facial expressions that I would never think twice about in the states. And, the moment I think that I have successfully figured out the system, it seems to transform right before my eyes as it did earlier this week!

The Kenyan response to my frustration? They smile and in unison respond "haraka haraka haina baraka, kwa hivyo polepole ndiyo mwendo" which means "hurrying has no blessing, going slowly is the way" I can feel my anxious American-programmed brain retaliating already! I can only hope that I get to a point this year when this approach feels more natural to me....

Kakamega

A group of people from the IU compound headed to Kakamega National Park this weekend. It is only a 1.5 hour drive from Eldoret.

View Larger Map

I was excited because it is the first tropical rainforest I have ever visited, and it's a bird and butterfly watcher's haven.
We arrived on Saturday and went on an afternoon hike to the Yala river.
























This is a black and white casqued hornbill and can only be found in equatorial central and western Africa.














One of many butterflies













On Sunday morning, we woke up at 5am and went on a sunrise hike.
The view of the canopy was absolutely gorgeous.












We relaxed for the rest of the day on the hotel grounds. I have been experimenting more with the manual features on my camera and photo editing. Below are some pictures I took on the hotel grounds.




































For more pictures, please go to the picture albums page.

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’?