TB in the news

Preventing tuberculosis deaths in India: newyorker.com

This is an interesting article about TB that was recently published in The New Yorker. It addresses some of the political issues between public and private healthcare providers that often impede patient care in low-resource settings.

Feel free to leave comments! I would love to hear your thoughts :)

Kendu Bay and Mount Homa

After several weekends in Eldoret, several of us decided that it was time for a much needed weekend getaway. We headed to Kendu bay, a small town on the shore of Lake Victoria.

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We spent the first day relaxing, reading, and eating...












We woke up early to watch the sunrise...












And on Sunday we headed out to climb Mount Homa!





































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TB Quick Facts and Frustrations

Tuberculosis is a complicated disease, and when you throw it in with HIV, pregnancy, or different populations (peds vs adult) it transforms into an even more complex entity. This week was the first time that I experienced that feeling you get when you realize you are starting to become comfortable with a subject you are studying. The vocabulary is familiar, the explanations in each article or book start to follow a certain pattern, and what has or has not been studied starts to become apparent.

Some interesting facts about TB...(I am going to keep this basic since some of you have mentioned that the medical stuff on the blog has been a bit confusing/boring...sorry!)

1) 1 out of 3 people are infected with TB globally!! Infection does not mean that a person has active disease, but they have been exposed and now the bacteria is hanging out waiting for a good moment to make the person sick (active disease).

2) Approximately 1 out of 10 of these infected people will develop active disease in his/her lifetime.

3) In the HIV+ population, approximately 1 out of 10 infected people will develop active disease PER YEAR.


Young children with HIV are particularly at risk to develop severe active TB disease. Luckily, there is a drug (isoniazid) that can be given to an HIV+ child who has been exposed to TB for a period of time that significantly decreases the development of active disease AND mortality. For one child, it costs approximately 15 USD for the entire treatment duration.

You're probably thinking, "well that's great!"

This is where my frustration comes in...

Unfortunately, in many low-resource settings, implementation of isoniazid preventive therapy delivery has not occurred! The reasons range from politics to lack of education. However, the bottom line is that the literature demonstrates the positive impact this preventive measure could have on communities burdened with TB (particularly HIV+ children), and yet implementation is crawling. This makes me CRAZY, and it reinforces the need for individuals in medicine and public health to shift their focus to implementation/operations research in order to close the gap between the scientific literature and healthcare delivery!

Happy (belated) Halloween!

Halloween has and always will be one of my favorite holidays. Some of the longtermers' children live in Kenya, and desperately needed to get their fill of trick or treating. I immediately volunteered to help organize the festivities. I also found a great outfit at the market to be Pippi Longstocking so I was excited to celebrate!

Highlights

Trick or treat...

















Bobbing for apples...

















Carved watermelons (couldn't find pumpkins in Eldoret!)...












The Halloween Planning Committee

Composting

I've spent the past few weekends in Eldoret, and finally got to spend some quality time in my garden. Since I will be able to grow vegetables year round here, my goal is to grow enough so that I barely need to buy any veggies at the market. So of course if I will be gardening all year, I need some great soil to work with! Furthermore, most garbage is burned in Kenya so I'm also trying to contribute as little waste as possible to the burning pit polluting the air in the backyard. According to the US Environmental Protection Agency, burning 10 pounds of trash in a backyard bin produces as much air pollution as a well controlled incinerator burning 400,000 pounds of trash a day!

So here's what I did...

I bought a laundry basket type container and poked additional holes into the bottom to permit good air flow. (I had to get some help with this!!)






























I read that layering the compost can help speed up the process so I started with a layer of dry grass and leaves...













Then added a few scoops of cow manure and dirt...
Then came the compost material from my kitchen bin!












I picked a dark spot so that the compost won't dry out. It's also my attempt to keep the dog out of it but unfortunately that's been a bit tough...













There is a misconception out there that a compost bin will lead to rodents and insects inside the home and in the garden. This is totally false as long as you know what can and cannot be composted.

Here is a list!

Things that you can compost
-coffee grounds, tea, tea bags
-fruits and vegetables
-egg shells (but not the eggs)
-cardboard, newspaper shreddings
-paper
-wood chips, toothpicks, matches
-hair and fur
-leaves, grass
-animal manure

Things that you should not compost
-meat, fish, poultry, or egg scraps
-dairy products

I wish I knew more about this in the past! Even if you live in an apartment, it's possible to set up a small compost in the kitchen or on a balcony and use the soil for indoor plants or contribute to your apartment complexes landscaping. Here is an article for anyone interested in building one indoors http://planetgreen.discovery.com/home-garden/apartment-compost-guide.html

World Spirometry Day

October 14, 2010 was World Spirometry Day, and the clinicians from the chest clinic organized free spirometry screening outside the hospital. Spirometry is a tool used to measure lung function and can be useful in diagnosing various lung conditions like chronic obstructive pulmonary disease, asthma, pulmonary fibrosis etc.

Curious Kenyans gathered to see why people were exhaling aggressively into machines, and the brave individuals stepped into line. Most seemed a bit apprehensive, and I realized that culturally, it is not the norm to actively seek out problems in your body. One of my coworkers explained, "If I don't feel sick and I don't look sick, why should I go look for a problem? It will only ruin my spirit."

The idea of annual physicals is a foreign concept here, and preventable diseases are often identified in late stages when interventions are unfortunately futile. Preventive medicine has been a hot topic recently, and whether or not it is cost-effective to shift the healthcare focus to prevention in the US is controversial. In Kenya and in other low-resource settings, not only are basic preventive care services not readily available, but education is lacking to get individuals to proactively seek out these services. My coworker further confirmed this when he explained that his girlfriend (and many of her friends) refuse to go for cervical screening, and if something is wrong, she/they will go when the pain is severe enough.

I think that it is great that health services like spirometry and cervical screening are being introduced here. However, a tremendous need still remains for better education within the community about these services in order to encourage more individuals to proactively use them. I hope that I can remember this in the future since it's so easy to assume what people do or do not know about their own health!

Mashujaa (Hero's) Day

Yesterday was Mashujaa (Hero's) day in Kenya, the first official Hero's day since the new constitution was instituted in late August. Hero's day used to be called Kenyatta day in honor of Kenyan's first President, Jomo Kenyatta, but now the Kenyan's decided that it would be nice to celebrate all of their heroes on this day.

The longtermers and I decided to celebrate with a day hike in Kerio Valley.













This was my second visit to this beautiful region (the first was my Tambach field visit). We started with a steep decent into the valley, weaving in and out of cornfields and dodging cows and goats.












After about 1.5 hours, we reached a road that connected us to a trail that followed a river back up the mountain.












(That's Chai, one of the longtermer's dogs, attempting to cross the river!)

After a long climb, we suddenly stopped and our guide pointed to a small steep trail that must have been about a 75 degree downward drop. We made it down by sliding on our knees and grabbing on to whatever roots we could find.

It was well worth it because at the bottom was a gorgeous waterfall!


















We jumped right in!












Group shot


















We found this little guy on the way back...












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