Wednesday, April 15, 2009

On being very white

So I’m white. Or at least really pale-skinned. Which tends to almost look a little iridescent in the equatorial sun. And fortunately, due to SPF 30 sunblock and hats, I haven’t turned pink. But I do stand out in a crowd of Kenyans…

In fact there’s a word in Swahili for Caucasians: “Mzungu”. I think its pretty similar to “Gringo” en espanol, but with a little less overtone of slang and insult. According to our Lonely Planet travel guide, 0.1% of Kenya’s population is “European”, which I take as Caucasian. Which surprised me as this country was a British colony up until 1963, but I sure haven’t seen too many white folks that aren’t associated with the IU-Kenya/AMPATH programs.

We hear the word mzungu fairly often when walking around, whether its people talking about us, or trying to get our attention. Like “mzungu… taxi!”. And while we certainly have drawn a lot of attention for simply having a lighter skin tone, it has nearly always been good natured.

Little kids, especially in rural areas, are pretty fascinated by us. Allison and I have often repeated the phrase “Howareyou Howareyou Howareyou” that we heard from a group of kids a few weeks ago when we were slowly driving through a small town.

And even in Eldoret this past weekend, a friendly gentleman on a crowded downtown street corner singled me out and shook my hand for probably 15-20 seconds as I was walking, greeting me in English and trying to convince me that to be strong, I needed to eat snakes. I’m guessing he doesn’t pass on that kind of advice to any old Kenyan on the street. And no, I haven’t eaten any snakes here. At least that I’m aware of…

But as a caucasian protestant heterosexual male in the United States, I don’t often find myself in situations where I’m representing a minority group as far as your check the box diversity categories go. And for whatever reason, I’ve been more aware of the fact that “I ain’t from around here” more here in Kenya than I have when previously traveling abroad.

So its been an interesting 6 weeks being mzungu.

Saturday, April 11, 2009

Lake Baringo

Sorry for the lack of posts recently—I think we’re at the natural “we’ve been here for several weeks, not much new to report on”. We are spending the Easter weekend in Eldoret so it should be pretty low key. Last weekend we did travel to Lake Baringo, one of the Rift Valley fresh water lakes. It is most notable for the variety of birds that can be found there. We had a good time, saw tons of birds as well as a few hippos and crocs. No sign of the elusive hiphopopotamus though. It was pretty hot there and we were glad there was a pool to relax in. We now *really* appreciate the weather in Eldoret.


Sunday, March 29, 2009

IU House

We had a low key weekend staying in Eldoret which was highlighted by exploring town and doing a bit of shopping and a hiking adventure to Umbrella Falls which was about 30 minutes outside of town.
So here’s the long overdue blog entry about where we’re staying. The IU house is actually a small compound of 8 two story buildings. It is about a 15 minute walk from the hospital. There are common areas on lower floors and 4 apartments each of the upper floors. It is gated and guarded, and the neighborhood is also gated and guarded. This does tend to insulate us from Kenyan culture, but not worrying about security seems to be a justified priority for the medical exchange program. There are also 4 ‘guard dogs’ who actually mostly lay around.
Our room is the Blue Swallow room in building 1, which also houses a library and 1 of the two washing machines on the compound. Our room is like a good sized college dorm room – it’s best feature is the windows that allow breezes to blow through. Our bathroom is outside our room, but we haven’t had to share it with anyone. The bathroom is luxurious by Kenyan standards with toilet paper, toilet seat, toilet that flushes, and hot water for the shower (it has a sink too). We’ve been doing a couple of loads of laundry per week and it gets dried on a clothesline in the hot Kenya sun. Other staff are around for housekeeping, administrative, and other maintance type duties.
Meals are provided Sunday dinner through Friday lunch and the kitchen/pantry are available during the rest of the time. There are full-time cooks who also live in the compound. A typical meal is white rice, baked chicken, curried mung beans and fruit salad. There are other vegetables sometimes, and there is also cake sometimes (delicious), but rice is a constant. The food is good, though after a month, somewhat monotonous. However, our western-geared meals have more variety than the local fare. The Kenyan culinary tradition is based on ugali (cornmeal dish), sukuma wiki (stewed kale), and some type of meat. Chipati is also commonly found – it is like a wheat tortilla. We miss Dr. Pepper, ice cubes, and cold milk but it will be an adjustment to have to cook for ourselves again when we go home.
The IU house functions as a hotel of sorts, not just IU associated people are housed here. If you’re a westerner who is associated with health care in the Eldoret area, there is a good chance you’ll spend time at the IU House. There has been somewhat of a revolving door of other guests. Some people are staying here for months longer than us, while others stay days to weeks. Other medical schools, most notably Brown, also have a partnership with Moi University in a similar type of exchange as IU. Purdue sends pharmacy students here regularly too. It seems that any western person who has heard of AMPATH, is associated with MTRH, or is just involved in healthcare seems to be able to arrange for housing at the IU house. Meal time has allowed us to meet new faces and find out their roles.

Friday, March 27, 2009

(yawn)

Last night I woke up at 2am to watch the Purdue-UConn mens basketball NCAA Tourney game. I was joined by the two Purdue PharmD students here who are big PU athletics fans (one ran cross country and track at Purdue and the other played in the Boiler Brass pep band). We quietly watched our overmatched Boilers keep it respectable for much of the game. And at 4:30am local time we trudged back to bed after a loss, serenaded by the early rooster crows…

But they were in the Sweet Sixteen and won the Big Ten Tournament, and next year promises to be a strong season as they don’t graduate much production (which assumes no other key players with eligibility leave the program).

There’s always next year…

I sure sound like a Purdue fan, eh?

Tuesday, March 24, 2009

Nakuru

This past weekend we went on our first real safari, to Lake Nakuru National Park. It’s a soda lake in the central Rift Valley that attracts flamingos, pelicans, and storks. It also had a variety of landscapes, with rocky cliffs, yellow acacia forests, and open savannah plains. And a huge variety of wildlife living in it! Without listing every animal we saw, the highlights were rhinos, giraffes, water buffalos, zebras, impalas, gazelles, baboons, and warthogs… no really, this wasn’t the entire list! The only animals in the park that we didn’t see were lions and leopards. Hopefully we’ll see the cats sometime later…

We went on game drives Saturday evening, Sunday early morning, and Sunday late morning. Seeing the animals starting their day just before the sunrise was absolutely beautiful. And there were SO many animals in the park--every now and then I had to remind myself that this was real life (within the confines of a national park). Its just so different seeing these animals in their actual setting instead of in a zoo exhibit.

We took hundreds of pictures. Yikes! We promise not to make anybody look at all of them—we’ll just show off some of the favorites!


Monday, March 23, 2009

Match/March Madness

Last Thursday was a fun day here in Eldoret. For the 11 fourth-year medical students, it was their Match Day, which is the day they find out which residency program they will start at this summer. It’s a big deal for the students, and at least the IU Med School turns it into a big celebration. But the med students here weren’t home for the big shindig… So Allison, Bethany, and another resident here from Ohio State put together a party to announce the matches. The three residents went online to find the residency matches, and then the IU House crew gathered together for the matches to be announced and to celebrate. They had an amazing chocolate cake baked for the event, which we’re still savoring… It was fun to see the students so excited about the next step in their training. And I’ll admit, it was also awfully nice to reflect on Allison’s residency almost being over!

And of course, Thursday is when March Madness began back in the States. After not having much internet access last week, we furiously made our bracket picks on Thursday before the games started... And Sonak, the Purdue pharmacy professor here, has a satellite dish, so several of us went to his place after our Match Day Party and watched some of the opening round broadcast. Which had portions of the Purdue-Northen Iowa game CBS feed, including the start and finish of Purdue’s victory. Boiler Up!

Friday, March 20, 2009

kids

Since we have internet access in our room this morning, I’m going a little crazy with uploading photos… gotta get them posted while I can! Allison painted fingernails/toenails at the hospital earlier this week which was very popular. She took pictures of several of the kids, printed them on a color printer back here at the IU house, and gave copies to the kids/families the next day. It was a huge hit, and she’ll do it again as new patients rotate through.

The picture of Allison holding the baby is of Sheba, one of the abandoned kids. Rumor has it she’ll be adopted out shortly--Yay! Though we’ll all miss her--she’s an adorable kid. And the picture of the little girl in the pink dress is a particularly good one of one the patients in the ward who got painted nails. Click on the pictures to view the full size images:

Photo Caption Contest Results

Thanks for the responses- Allison and I got a kick out of all of them!

But I gotta say that Sasha's response (the first one) seemed to resonate with several of us here. The picture of the nurse just seemed more pinup than gentle reminder to be quiet. And of course quiet wouldn't be the first word I'd use to describe the waiting area where the sign is posted...

Tuesday, March 17, 2009

Obama Mania

EDIT: The picture below is of a woven banner that appeared in the IU House dining room not long after we arrived. Our Swahili tutor said it says "Congratulations President Obama Kenyans wish you good luck" in Swahili.



Hi All,

We haven’t had much internet access since last Friday… which has been frustrating only because the internet access was pretty consistent initially! Anyway, my quick thoughts for you for today is about how big President Obama is here.

We had heard from Allison’s colleagues that last November, the day after President Obama won the US Presidential election, a national holiday was declared in Kenya to celebrate.

Since we’ve been here, we’ve seen lots of Obama stickers, banners, etc. In fact, last week Kenya declared the village where Obama’s father is from as a protected national heritage site, presumably for tourism-related reasons.

But just this morning… I went to an early lecture at the hospital about HIV and related opportunistic infections, and spent the next 3 or 4 hrs at the Sally Test Center in the hospital which looks after a few orphaned/abandoned kids as well as being the play center of sorts for kids in the pediatric ward who are well enough to get out of bed and play. While playing with a few Tonka-style dump trucks with three boys, I lined them up and used my Swahili lesson from yesterday as pointed to them in order and counted to four… their eyes lit up and they grabbed every toy truck they could find so we could count to eleven together in Swahili. Good thing there weren’t 20 of them as I forgot the word for 20! Anyway, we went back to playing with trucks, and a little later I heard one of the boys behind me saying “American” over and over until it registered with me he was talking to me… after I turned around, he said (I’m guessing the only other English word he knew) “Obama” over and over, with some word that was kinda like either magnificent or marvelous. Absolutely cracked me up. Perhaps it isn’t as ugly being an American overseas these days!

And the rest of my morning at the Center was remembering how to play familar board games with a couple of the staff members. They have several games, but so many are missing directions. So I played Sorry, Uno Spin, Bingo, and Chinese Checkers. All while Allison was going through rounds… It was a pretty fun morning!

Thursday, March 12, 2009

Photo Caption Contest


Hey All, Allison said I needed to post something to lighten the mood up a bit, so here's our first Kenyan Photo Caption Contest. Maybe its just a sly ploy for reader interaction, but whatever...

This is a photo of a sign posted in the hospital. I'd love for you to guess the caption, which I've trimmed off. After we all enjoy each others guesses in the comments for this entry (ploy for reader interaction), I'll post the uncropped pic.

And just so you know, Allison's day at the hospital today was much better than yesterday...

baby

a baby died :( 6 weeks old, HIV+, difficulty breathing, needed O2, sats never >90, poor perfusion, lethargic. did get some antibiotics and oxygen. fluids slow in coming, slow in infusing, didn’t get in fast enough. stopped breathing, lost pulse, chest compressions, didn’t have right bag and mask x2, 3rd bag and mask ok but no O2 hooked into it, gave epi x1, nothing. a baby died :(

Tuesday, March 10, 2009

mtrh


from allison...
the pediatric ward-firm i’m on - upendo (means love) - has about 12 beds for general peds and 8ish for oncology patients. with the ability to double patients up in beds, that leads to the potential for >40 patients! there are 2 pediatric wards with 2 firms/teams per ward. that being said, the day before my team was admitting, the general peds ward had 7 patients one day, that same day i also rounded with oncology and i think there were about 13.

i’m glad we had been somewhat oriented by people who had been before about what to expect about what the hospital was like, what resources there were, etc. so i guess i didn’t feel as shocked or frustrated as i could have. an asthmatic ordered for breathing treatments every 4 hours had received 2 in the past 24h. there are only certain medicines available, there are only certain tests that are possible, and each is somewhat carefully considered before being ordered. then there is the likely hood that the medicines will be given, tests will be done, and if the patient’s family can afford it, all to be considered. i’m still trying to figure out where i fall in the team’s care of these patients. on one hand i’m about to be done with my residency, on the other i’ve never taken care of patients with some of the diagnoses these kids have and don’t really know the system here at all.

rounds are in english generally and the med school is taught in english, but most of the patients don’t speak english. they mostly speak swahili, or sometimes some other tribal language. i haven’t come across it, but others have had patients who no one can communicate with very well due to a language barrier.

medical education in kenya is lengthy. medical students start straight out of high school and it is 6 years. more than a dozen 4th and 6th years come to round with our team (equivalent to 3rd and 4th years in US). there is a 4th year student from IU on my team too. after med school an internship is required which consists of continuing training in essentially all different aspects of medicine for 1 year. there is an intern on our team. after this they are a medical officer (physican) and are assigned to a post by the government for several years. after this if more specialized training is desired they become ‘registrars’ which is similar to residents in the US. there is a 1st year pediatric registrar on my team who i work most closely with. then there are “consultants” who usually (50/50) come to round with the team – they are the staff or attending physicians. but not in the same way as in the US at all. they can be different people every day of the week. they help teach mainly and offer suggestions about diagnoses and treatments. but it is really the interns and registrars who do the work and make the decisions. there are others on the team as well – nurse, nursing student, clinical officer intern (PA or NP like), nutritionist, etc – which makes for quite a herd.

i hope i will be able to help the interns and registrars more in ‘working patients up,’ and i anticipate i will be able to work more in teaching the medical students (kenyan) too. we’ll see. i have been the most senior person a few days so far and didn’t have to make any big decisions, but I was looked to for recommendations/ guidance. we did end up starting an asthmatic on an inhaled steroid, something i’m much more comfortable with…

Kakamega!


Greetings all… this past weekend we were part of a group of 12 that went to Kakamega Forest Reserve, which according to the Lonely Plant travel guide, “This superb small slab of virgin tropical rainforest is the only Kenyan vestige of the unique and once mighty Guineo-Congolian forest ecosystem”. Whew, I couldn’t have said that better. Anyway, our group, all from the IU House, hired a minibus (matatu) to take us on the approx 2 hr trip to the rainforest. We were a little crammed into the minibus as there were only 11 pasenger seats. Though it made for a good chance to get to know people better! Probably half the trip was on reasonably smooth asphalt with frequent potholes, the other half was on exceptionally potholed asphalt or dirt roads with a few smooth sections. Our driver was very adept at swerving to miss more potholes than he hit—regardless of which lane (or shoulder!) the bus was in. And we only had 1 flat tire to deal with.

We stayed at Rondo Retreat, which was a very nice facility with cabins scattered throughout its extensive, gardened grounds, and a small central dining room where tasty meals were served. We met up with a guide at the hotel who took us on three hike/walks over Saturday evening and Sunday morning. Some highlights included seeing a couple types of gigantic birds (great blue turaco and the casqued hornbill), the sunrise hike which started at 5:30am and lots of tropical foliage. It didn’t even rain on us in the rainforest. Yay! But the highlight was all of the monkeys we saw. Allison was going so crazy with our new camera and its zoom lens that I decided to call her the monkey hunter! Above is a picture of a colubus monkey. We safely returned Sunday evening tired and a bit sore from all the hiking. A hot shower back at the IU House felt SO good…

Friday, March 6, 2009

internet access again

So no updates since the Thursday breakfast blog until now as our internet service was unavailable for a little more than a day…


  • Wednesday afternoon (Mar 4), Allison, Bethany, and I walked into downtown Eldoret. We stopped in Nakumat (the closest thing to a Wal Mart around here) and a stop by the Barclays bank ATM.

    The town was hopping for sure… lots of people out and about, and we left just before the full end of day rush of people to buses. Its kind of a mad mix of people and vehicles milling about. The many butcher shops with the sides of beef on display in the front window (sometimes covered with flies) certainly made an impression… mental note: make sure I only eat well done meat here! But what stuck with me most was the street children. It sounds like many (most?) of them are orphans, and they were just hanging out, being walked over/around by people. And apparently substance abuse (sniffing glue) is a huge problem among them. Some were quite aggressive in begging from the obvious foreigners.

    The ones we saw seemed SO young (though pediatricians Allison and Bethany said they could be older than they look due to poor nutrition)… Dr. Mamlin said 15 years ago the city’s street children were almost all taken care of by a shelter, and the hospital chipped in with health care. But the city shut down the shelter to provide those services itself, and at this point there are no services for the street kids.

    We heeded the advice to keep walking past them so as not to be overwhelmed, but it was really, really tough to do so. I’m still processing it all… It was slightly comforting that Bethany mentioned on Thursday afternoon that she got stuck journaling as she was struggling with writing about the street kids.

  • On Thursday afternoon (Mar 5), I joined Allison, Bethany, and the this week’s other new arrivals for a tour of the Moi University Teaching and Referral Hospital. While Allison and Bethany had worked in the Pediatric ward for two mornings prior to the tour, they hadn’t seen the whole hospital complex. And I hadn’t even been there yet! I’d almost call it a small campus as the various buildings are spread out a bit, connected by metal roofed open air walkways. Some items that stuck out to me were:

    This hospital is associated with one of two medical schools in Kenya (the other is in the capitol city, Nairobi). Moi is the referral hospital for all of western Kenya… what put things in perspective for a medical layman like me was that the hospital’s five ICU beds are the *only* ICU beds in western Kenya. The IU connection is very apparent throughout the campus facility wise, most so in the large 4 story AMPATH building that houses four HIV/AIDS clinics and serves as the hub for the 20 or so rural clinics in the region that focus on testing/treatment/prevention of HIV/AIDS, and sound like are expanding to provide more primary care services.

    The IU-Kenya program works with patients who come to the public side of the hospital, and would be people with no insurance and limited means (sustenance faming and maybe earning a little more than $1 US a day when day labor type jobs are available). Guards/security are posted around the site that aren’t there to prevent folks from coming in—they prevent patients from leaving without paying!

    After the tour, Bethany, Allison, and I spent a little while in the Sally Test Center in the hospital, which cares for several orphaned and abandoned children. I’m sure I’ll be spending more time there, and will write about it more later.

Thursday, March 5, 2009

Broadened (breakfast) horizons


Allison is at the hospital this morning for rounds, her 2nd day working in the pediatrics wards. I’m going to join her when she goes back to the hospital after lunch. In the mean time, having free time this morning and being well rested and all, I figured I’d dump another blog post.

So I’m a fan of breakfast. Back home its usually coffee, OJ, and cold cereal. Cold OJ, and cold cereal with cold milk. Yes, I’m emphasizing the word “cold”. And this is my morning meal routine at least 6 days a week back home…

Cold isn’t part of breakfast here at the IU house. Milk and juice are served from room temperature cartons that only say refrigerate after opening. Which I’m sure is quite fine, but I couldn’t deal with the thought of cereal without cold milk, so I looked elsewhere.

I grabbed a banana (really fresh and tasty!) and toast with peanut butter/jam. And warm OJ (which was fine) and some good strong coffee. And after looking at what everybody else was trying, I tried this lovely concoction called “Nutella” on a biscuit. It’s a kind of chocolately peanut butter-like spread that apparently is based on hazelnuts. Maybe the Coco Puffs of toast spreads?!? Somebody said its hugely popular in Europe, though Allison said she’s seen it in the grocery store back home. I’m not sure it’s a typical Kenyan breakfast item, but it’s a little more international than Cinnamon Toast Crunch! What I do know is that I’ll be trying it with banana slices on toast tomorrow morning.

So there’s your random entry about breakfast. Seems very blog-like to me.

our friend, the sandman

hooray! last night we were able to sleep at night, all night!

Wednesday, March 4, 2009

Globetrotters

Hello all from the IU House in Eldoret, Kenya. We’ve actually been here for right at 1 day now.

Our travel to Kenya went smoothly, though the Indianpolis to Nairobi portion (through Chicago and London) ended up being 26-27 solid hours in either an airport or on a plane. Yuck! Even in coach, British Airways was pretty comfortable. Service was excellent, food was decent, and each seat had its own small video monitor choosing which movie(s) you wanted to watch. On both long flights we got a in 2-3 hr nap…

Though everything went according to plan and on schedule, the most bizarre travel story involves our car ride from the Nairobi airport to the hotel we stayed at. We had a driver waiting for us with a sign “Dr. Allison and Dr. Bethany”. Which is good and all… until it became quite apparent that he wasn’t expecting to have to haul so much cargo! His car was something like a 4 door Corolla—small. And between Allison/Bethany/myself, we had 2 med school trunks, 3 big suitcases, 2 small/medium suitcases, 3 backpacks, and a duffel bag. Needless to say, we and our bags were really crammed into the car, but we made it!

The hotel we stayed at in Nairobi was very nice, it would have been a good place to enjoy a lazy morning, but we weren’t there even 7 hrs. A good shower and a bed sure was welcome! Though we could only sleep a few hrs until we were wide awake in bed 2 hrs before the alarm was going to sound. Curses—jet lag!

I was a little leery about our intra-Kenya flight from Nairobi to Eldoret, but the “Jetlink" flight really was a jet! It was a small Canadair regional jet that made for a smooth 30 minute flight. And the 1 hr delay gave me a chance to meet and visit with a Christian missionary named Mark Grossman who is from the states but has been in Kenya for 15 years. Real nice guy, and it was interesting to get his view on issues in Kenya (HIV/AIDS, the awful post election violence a year ago, the Christian church, etc) from somebody who has been in the Kenyan culture for a long time but isn’t of it.

The suprise about the regional jet service was there is a 20 kg limit for checked luggage per person that we weren’t warned about beforehand. Allison and I together were 29 kgs over, so our per-kilo heavy bag fee came to 1450 Kenyan shillings (about $20 US). Fortunately we changed some money in the airport the night before so we had no problems.

Our room at the IU house is quite comfortable, its very much like a university dorm room. I’ll describe more about it in a later post.

And yes, our body clocks are still way off. You’d think when you’re tired and its dark out you would be able to sleep. But we both woke up at 3 or 3:30am and couldn’t sleep. We got to listen to dogs barking and roosters crowing. Until we turned on the iPod in an attempt to lull us to sleep. Oh well, hopefully tonight we’ll get in a better block of sleep.

Sunday, March 1, 2009

leaving tomorrow


So we're about 12 hrs away from leaving for the airport. Our flight schedule has us leaving Indy at 1pm EST and after going through Chicago and London, arriving in Nairobi, Kenya at 9pm Kenya time... which is 1pm Indy time. 24 hrs of flying or sitting in an airport. ugh.


Anyway, we'll get back to finishing packing, but I wanted to test uploading a picture from home. This is our dog, Lucy, who Allison's parents are so kindly looking after during our adventure. Packing is a little easier with her not jamming her nose in everything, but things are also more quiet!

Tuesday, February 17, 2009

The IU-Kenya program

So the driver for our trip is the IU-Kenya partnership, which links Indiana University School of Medicine (IUSM) and Moi Teaching and Referral Hospital in Eldoret, Kenya. The partnership started in 1989 as an exchange of teaching physicians and medical residents and students. A decade later the partnership expanded in response to the explosion of HIV/AIDS in East Africa program: the AMPATH program (Academic Model Providing Access to Healthcare) was created. AMPATH focuses on prevention and treatment of HIV/AIDS, with a large system of rural clinics.

We’ll be learning a lot more about it on our trip. For those who want more info, which is much better presented than my attempt at summarizing it, check out:
http://www.iukenya.org/
In addition, an Indy TV station ran a series about the partnership last fall, so if you REALLY want to get even more, go to http://www.wthr.com/ and search the site with keyword “Kenya”.

So that’s some context for the trip (and for those who work with me at Lilly—we don’t have a monopoly on acronyms!). Allison is a third year pediatric resident at IUSM, so she’ll be working with a Kenyan counterpart in the Moi Hospital. One of Allison’s colleagues, Bethany, is going at the same time as well. And I was graciously granted a leave of absence from work to join Allison on the adventure.

So that’s blog entry #2. I imagine I’ll post at least one more before our departure on March 1st.

Monday, February 16, 2009

wow... a blog

Hi All,
So other than periodically checking the blogs of a few friends, I never thought I'd be joining the "blogosphere", if thats even the correct term at this point. But, as Allison and I leave in 2 weeks for Kenya, we thought this would be a convenient trip diary of sorts for people back home to check occasionally.

More to come on where we're going and why...
Greg