A Ukrainian Easter in Kenya

One of the long termers and her 4 children love Easter and they had asked me last December if I could introduce them to Ukrainian Easter egg making. I brought the supplies back from the states in January and earlier this week we had a wonderful arts and crafts afternoon!

I have not made Ukrainian Easter eggs since middle school and wow did this bring me back. Everything from holding the stylus over the candle to the smell of the beeswax made me remember the many years of Ukrainian school, Ukrainian girlscouts, and Ukrainian church. It also made me feel grateful for the traditions, language, and sense of community my family instilled in me so early on (often against my will!!).

Here are some pictures of the finished products!

my egg...I was and never will be very artistic :)


My friend's egg...isn't it beautiful?? I told her that Ukrainian Babchias everwhere would be thrilled with this.


All of our creations.


Happy Easter!!

TB Screening at Tumaini

On Monday, we conducted our third TB screening at the Tumaini Children's Drop-In Center. Two kids died last fall from what was thought to be TB related causes so the center collaborated with the TB Projects Office to organize TB screening.

This is how the screening works:
Two cough monitors who are assigned to the Eldoret community come to Tumaini and lead a sensitization talk about TB. The children usually ask questions after the talk regarding TB symptoms and transmission.
Then the cough monitors are stationed in a private room so that children can meet with them individually. They are asked a 6 question questionnaire (eg Have you been coughing for more than 2 weeks? etc) and the cough monitor can then decide if the child is at risk and needs to provide a sputum sample.

Here are some pictures from past screenings...

Talking about TB after the morning assembly


One of the cough monitors screening a child


Another cough monitor doing screening


Entertainment while waiting to be screened

Chai Break

At around 10:30am at AMPATH, workers drop everything to have an obligatory chai (tea) and snack break.
Waiting room with 40 patients? Sorry, we are having chai!
Need to quickly pick up something? Yup, you'll have to wait until after chai!

8 months ago the chai phenomenon made me crazy. And I mean, rip my hair out of my head, CRAZY.
How can you leave all of those patients in the hallway while you all take a 30 minute tea break 1.5 hours before the 1hr lunch break?? Where is the sense of responsibility?
I sometimes asked...did you know that in the US we sometimes miss lunch completely or just eat on the run if we have a lot of patients??? (blank stares and jaw drops followed)

Fast forward 8 months later and wow have things changed. I LOVE chai break! I have come to respect this tasty and relaxing cultural tradition. The Kenyan chai is made with lots of milk and way too much sugar...just enough to give you an extra energy boost until lunch. Pair it with a mandazi (a sort of donut) or a beef samosa and life is perfect.

Yes, there are still some workers who choose to have a chai break that's just a little too long (eg when a chai break runs right into the lunch hour...). However, I think that some Americans could definitely benefit from a chai break - or maybe a proper 1 hour lunch break - on a regular basis. It's good for the brain to just stop for a few minutes, sip some sugary goodness, and reflect on the day! Here's to bringing chai break back to the states with me!!

My chai and samosa yesterday in the office. My desk is the one directly behind the thermoses.

Interesting Signs

This is another post I have been working on throughout the year. Hopefully you will enjoy it as much as the 'What can you carry on your bicycle?' post!

I find the signs and store names in Kenya to be very entertaining. Here are some of my favorites...

Mama Margaret Shop


This is one of many Jesus shops - Who knew he had so many shops in Kenya?


Victorious Butchery - because they victoriously slaughtered the meat?


Delicious Hotel


Redeemed Gospel Church - what did the gospel church look like prior to redemption?


God's Blessing Salon - I hope you have God's blessing before we cut your hair?


Precious Salon


This was posted in a bar...what are you supposed to be doing if you can't idle in a bar?


Corruption free zone? In Kenya? Hmmm...perhaps I've become too cynical.


Chipsy - The superior yellow cooking fat...


Medical Signs

5 causes of diarrhea...feces, flies, fingers, fluids, food


Resuscitation. Cost: FREE...Waiting time: 5 minutes hmm...anyone else see a problem with this?


And my favorite...
Don't spit, wash your hand. This is posted at Cool Stream - the AMPATH restaurant. I laugh every time. Do people often spit prior to entering a restaurant? Do they usually spit into a sink when they see one? And am I only supposed to wash one hand? Which one should I wash???

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