Monday and Tuesday - Week 3

            Monday was a pretty slow day. We arrived at the hospital around 9 am to start our glucose screening research. We were only approved to do the testing on the AIDs Relief patients so our population isn’t so random. It took us about 4 hours just to collect data on only 8 patients. In the afternoon, we wandered around the hospital looking for doctors or residents we knew to follow, but we really couldn’t find anyone. One of our resident friends in the women’s ward gave us a lecture about malaria, typhoid, and cholera. I had to take notes on what he was saying because I was afraid I would fall asleep right in front of him if I didn’t! We saw a few patients in MCH (maternal and child health) outpatient. One 11 month old baby was so malnourished that he only weighed 0.2 kg over his birth weight, which was 4.1 kg. When we finished up at the hospital, we went to the little market near the hospital and bought a mango, a pineapple, and some orange juice. We had wanted to make pizza for dinner again, but unfortunately our pizza crust already started to mold!

            Today was a much busier day. We began our day with the pediatric team and went on rounds with them. We saw one girl with cryptococcal meningitis. She was admitted on Friday, but the course of treatment for this type of infection will require her to stay in the hospital for at least a week and a half more. Another child was severely hypothermic and had been admitted to the hospital with a temperature of 30 degrees Celsius (about 86 F). Since being in the hospital, her temperature has raised and the team will probably be able to discharge her soon. We saw several other patients with interesting histories, but not anything worth sharing. I think it was just interesting because it was something different. After rounds, we took tea with the peds team. We asked the residents if they knew of any surgeons who wouldn’t mind us watching a surgery and I think they will be able to work something out for us. When we finished our tea, we went to the AIDs Relief clinic to see if there were any patients we could do our glucose screening on. It was actually really busy when we arrived there and since the nurses were still off taking tea, Neeli and I took vitals for all the patients waiting and screened those who consented and were over 18. Even with these patients, we have only gathered data for 13 patients total. I’m hoping we are able to get all 30 before we leave on Friday! We left the hospital for lunch around 1:20. When we were on our way back to the hospital after finishing lunch, we ran into Dr. Keiser and Caley. For those who don’t know, Dr. Keiser is an infections disease doctor at UTMB and is responsible for running the Kenya elective. Caley also works for UTMB as the Global Health Director. We chatted with them for a while and gave them a quick tour of our house before walking to the hospital together. We checked the AIDs Relief clinic to see if any new patients had come since we were last there, but there were none. While we were there, Dr. Mireille asked us to walk one of the patients over to casualty because she needed to be admitted to the hospital. She was a little 3 year old who was having difficulty breathing. I felt so bad for her because she started crying hysterically every time the nurse tried to put on the nasal canula. I don’t think I would like it very much either. We saw another patient in casualty with tachypnea and difficutly breathing; we found out later that he probably has pericardial TB. It’s crazy – TB is on the top of almost every differential diagnosis at Kijabe Hospital. After a while we ran into Isaac, one of the Kenyan residents we have made friends with. He told us that we should be able to see a surgery on Thursday or Friday. He also said that he would give us a call tomorrow if there happened to be a c-section. We saw a cardiac ultrasound and a few more patients before leaving the hospital for the day.

            Around 6:15, we left our house to walk over to where Dr. Keiser and Caley were staying to have dinner. We didn’t get very far from our house, however, when Grace stopped us and said that she wanted to leave some of her things at our house for us to look at later. She would come back in the morning to pick them up and we could buy anything we wanted then. I think it’s funny how trusting she is! For dinner, Dr. Keiser made spaghetti and for dessert, we ate the pineapple that Neeli and I had brought over. We had a good time chatting with Dr. Keiser and Caley about our experiences at Kijabe so far. Dr. Keiser told us some stories from when he was in medical school – much crazier than anything we have seen in Kenya!

            Tomorrow is a Kenyan holiday so I’m not exactly sure what we will be doing. I know that the AIDs Relief clinic will be closed, but we may still go to the hospital to see a delivery or c-section. I guess we will see!

Hell’s Gate and House of Hope

            On Friday morning we got to the hospital at 8am. We were headed toward the AIDs Relief clinic to attend CME when we ran into Jane, one of the clinic’s administrators. She quickly turned us around and told us – no, we needed to go to chapel. So we went to chapel, which was pretty much just like it was the day before except this time the kitchen staff performed a song instead of the doctors. After chapel, we went to the clinic and waited for a while until everyone was ready for the CME lecture. It was a quick one about electrolyte imbalance and I actually found it very informative. In medical school, I sometimes feel like I am supposed to know things that I’ve never actually been taught about. I guess those things are supposed to be my own “learning issues.” At the end of the lecture, the AIDs Relief staff said goodbye to one of its members who would be leaving the team for another position. This went on for quite a while because almost everyone was asked to say something about this person.

            After CME, we went up to the women’s ward and followed around Dr. Shirley and his team. We saw two new patients, but the rest were the same as the previous days. One of the new patients had actually been transferred from ICU. She had suffered a hemorrhagic stroke and they were having a really hard time controlling her blood pressure, which was running in the 200s/100s. By noon I was really itching to leave the hospital because I was excited to go to Hell’s Gate.

The Watering hole

             We met up with our driver around 12:45 and set off for Hell’s Gate. On our way there, we got the see Lake Naivasha and Mt. Longoknot. We also saw the town of Naivasha, which is much bigger than Kijabe or any of the other towns I have seen. We passed some very nice resorts and several flower farms. The flower farms are like their own little villages because they provide housing and schools for the workers and their families. We arrived at Hell’s Gate National Park at about 2pm and when we went to buy our tickets, the man working the booth said, “Welcome to Hell.” The park is really cool. You have the option of walking, biking, or driving through it. We opted to drive since we came with a driver. Our driver, Benson, was also our tour guide. His van was actually really great for the park. He popped up the roof so we could stand up and look out and get a really good view while still in the car. Almost immediately we saw some gazelles, and as we kept driving we saw tons of zebras and warthogs. We stopped and got out of the car at one of the watering holes where there were several giraffes, zebras, and warthogs. The giraffes look so funny when they are drinking water. We were actually able to get pretty close to them and they didn’t do anything – just stared at us. Hell’s Gate looked a lot more like what I thought Africa would look like. Benson told us that it was the site Disney artists used to model the landscape in The Lion King after. We continued driving until we reached a picnic area. Here, Benson parked the car and we got out for a little hike. We definitely didn’t realize what kind of hike we were in for. I was wearing Toms and Neeli had on converses. Not exactly the best shoes for hiking. We were basically shimmying up and down huge boulders to make our way down into the gorge. I really enjoyed the hike and I even managed to make it through without falling once! Poor Neeli wasn’t so lucky though. She fell twice! But don’t worry – she didn’t get hurt and was laughing on the way down. After about an hour and a half of hiking, we arrived back at the picnic site. At the picnic site there is a sign that says “beware of baboons.” We saw a few at the picnic site, but as we were leaving, we saw a ton of them just outside the site. On our way out of Hell’s Gate, we saw all the same animals that we saw before, plus some African buffalo.

            From there we headed to House of Hope. House of Hope is an orphanage outside of Nairobi that 5 other UTMB students have been working at. They have their own school and a small clinic there. I was told that there are 127 orphans who live at House of Hope and about 170 children who attend school there. While driving through Nairobi, we got stuck in terrible traffic again. They really need to discontinue the old round-abouts here. You literally sit without moving for 15-20 minutes at a time! We were stuck in Nairobi for 2 miserable hours worth of traffic. We finally got out of traffic and arrived at House of Hope at almost 9pm. Friday was Michael’s birthday, so earlier that day the UTMB crew at House of Hope went to the Masai market to buy two goats to roast for dinner. They slaughtered them and everything – I’m glad we missed out on that part! We were introduced to everyone and then joined in on the feast. We ate ugali with the goat. Ugali kind of looks like mashed potatoes, but it is actually made out of corn flour and has a pretty bland taste. After we ate, we went to play with the kids. As soon as we walked over to where they were, they were shouting our names and grabbing our hands. By the end of the night, some of the little girls were already trying to teach me African dance moves.

            Saturday morning we got up early for breakfast. We had sweet potatoes, some fried African bread, and fried eggs. We also drank chai with breakfast, at 10 am, at 4 pm, and after dinner. The chai is the milky tea stuff that I don’t really care for at Kijabe, but I actually think I don’t like it there because the smell of it is so strong mixed with the smells of body odor, sweat, and sick, coughing patients. They are very religious about tea time at House of Hope. After breakfast, we spent some time at the clinic. There were only a few patients, one of whom had a positive malaria smear. The others weren’t anything too exciting to mention. The rest of the day we pretty much just relaxed. Lauren gave us a tour of the compound. We saw where they keep the farm animals and where they grow all their vegetables and such. Later on in the afternoon, we went to the roof of one of the buildings to lay out in the sun. After that we went to do arts and crafts with the kids before tea time at 4. Their craft was to cut pictures that they liked out of the newspaper and glue them to a poster board. It was funny because they would pick like car advertisements, pictures of political leaders, and other really random things to glue on the board. Before dinner, we learned how to make chipati. Chipati looks like a tortilla, but it has a different taste and texture. It is much more complicated to make it than I would have thought! I’m hoping I can remember how to make it so that everyone can try it back home. After dinner, we went back up to the roof to watch the stars and listen to music before watching the Barcelona-Manchester game. It didn’t start until 9:45 in Kenya so we only made it to a little bit past half-time before we were all dozing off.

            Sunday, we had breakfast at 8, and in between breakfast and church we practiced the song “Lean on Me” to sing at the kids Big Sunday Revival later that day. Church lasted for 3 1/2 hours. A little bit longer than I am used to, especially since we couldn’t understand the majority of what was being sang/said. Also, the entire service was run by the children this Sunday. We even got to listen to a 9 year old preacher! To our surprise, we were called up to sing our song during church. We weren’t ready and most of us hadn’t brought our copy of the words, so it wasn’t that great of a performance. They said they liked it anyway though. After the service, we all ate lunch together before breaking for a few hours. At 3pm, the revival picked up again and the kids started to sing, dance, and do skits. While I was sitting watching the performances, I had at least seven kids around me playing with my hair, my watch, or my camera. They love to have their photo taken. Around 5 we left the revival to grab an early dinner with Benson (House of Hope’s doctor) and the UTMB group before leaving for Kijabe. It was kind of scary driving in the dark, but we made it home safe and sound!

*I tried adding pictures, but our internet is too slow. I'll have to share later!

Thursday

             So today was a pretty uneventful day. We got up early to attend a CME lecture by one of the doctors we shadow, but when we got to the hospital a little bit before 7am, no one was in the conference room. We thought that maybe no one was there yet, but we could hear Dr. Shirley’s voice coming from the room next door. It sounded like he hadn’t just started his lecture, but was somewhere in the middle of it. After waiting a few minutes, we decided to stick our heads in and see if it was where we were supposed to be. Well, we were definitely wrong. No one even said anything to us when we stuck our heads in. A few minutes later, Dr. Mireille showed up and did the same thing. Apparently there had been some miscommunication concerning where the lecture would be and who would be attending. I have learned that you really can’t count on anything going exactly as planned before 8am in Kenya.

            At 7:45 we went to chapel. This week is spiritual emphasis week at Kijabe Hospital. At the beginning of chapel, we sang songs and at the end of each song, the chorus was sung in Swahili. I obviously couldn’t join in, but it sounded cool!  

Kijabe's Chapel

After chapel we did rounds and saw most of the same patients we saw the day before. One patient had actually been discharged, but because her family could not pay her hospital bill, she was still in her bed. After rounds we had tea with Dr. Shirley. He told us about how national health insurance in Kenya is only equivalent to about $8 a year, but that hardly anyone purchases it. He also told us how some patients are abandoned by their families when their hospital bills get too high for them to pay. At that point the hospital must absorb the fees. It’s really sad especially since Kijabe Hospital is one of the nicer hospitals around with a relatively wealthier patient population.

The only other interesting thing from today was that the power went out twice during my shower tonight. That was fun. Luckily it came back on pretty quickly both times. We are used to the lights flickering, but they usually don’t go all the way out!

Tomorrow, we will only be in the hospital until noon and in the afternoon we will be taking a little trip to Hell’s Gate National Park. It is near Kijabe and from there we will head to House of Hope to meet up with our friends for the weekend.  

Time flies!

            I can’t believe it, but we are already half-way through with our time here at Kijabe. Today was a pretty good day. We started the day off by searching for the medical director, Dr. Achieng, because we were told she wanted to meet with us at 8:30. After we finally found her, she told us that we would be able to do our metabolic syndrome screening research as a small pilot project on about 20 or 30 patients. Although we expected to be able to do it on 200-300 patients, we are happy to at least get something out of it. I think we will be starting either tomorrow or next Monday. Once we finished talking with Dr. Achieng, we went to the women’s ward for rounds with Dr. Mireille and Dr. Shirley. We saw one woman who came in to have surgery for a ventral hernia, but had suffered complications and is now in a comma like state. Her wound had broken open and was also most likely infected. I also saw a patient with an aspergillus lung infection, listened to the galloping heart beat of another patient, and saw several others with less interesting findings. One patient had become delirious during her stay in the hospital and could be heard moaning and screaming throughout the hospital.

            At 1pm we went to conference and had lunch during it. I ate mostly potatoes and cabbage. I tried the beef stew, but it was pretty unappetizing this time. After lunch we went home to take a bathroom break. None of the bathrooms in the hospital have any toilet paper. Our maid was there doing our laundry and dishes for us – OK, I guess we aren’t suffering too much while we are here! Our maid also showed us how to turn on the oven!! Yay! We made pizza for dinner and it was pretty good!

            We spent the afternoon in the AIDs Relief clinic seeing patients with Mwaura. One patient had a lipoma on his back and Mwaura joked with him saying that it only needed to be removed if his wife couldn’t stand it. The other patient we saw was an HIV positive patient with a CD4 count of only 14. That is extremely low and she is susceptible to practically any and all opportunistic infections. They were worried she might have cryptococcal meningitis so Mwaura did a lumbar puncture to get some CSF. This time the LP was successful and 3 little vials of CSF were obtained.

            We got home around 5 pm and got a visit from Grace and Beatrice. Grace sells beaded jewelry, stone figurines, and other souvenirs. Beatrice sold us some english muffins. It’s nice when you don’t even need to leave your front door to do some shopping! While we made our pizza we watched Modern Family that we had been streaming all day so that the whole episode could load. And that’s about it for today!

Week 2 – Satellite Clinics

           This week has been pretty uneventful so far. Yesterday, Monday, I went to Githunguri again. When I got to the hospital a little after 7 am it was practically empty. There were no nurses around even though there was a patient on a bed in casualty (the ER). I waited around a little while, checked the AIDs Relief office which was still locked, and then decided to walk back to my house to grab my camera. Finally, around 7:40 the driver showed up and we could leave for Githunguri. I’m starting to think I should just add about 30 minutes to whatever time I am told to meet. I was much more relaxed on the car ride there since I knew what to expect this time. I think I am starting to get used to the crazy way Kenyans drive! After arriving at the clinic, we all got settled in and started to see patients. I saw one patient with a healing herpes zoster infection. It was spread all across his ribcage and looked like it must have been very painful at one time. Another patient I saw was a 17 year old HIV positive boy with healing chicken pox lesions. (I’m glad these two cases were in the healing stage when I saw them!) We saw several more patients, most of whom just needed refills of their ARVs. The doctor I was with would start the appointment by asking the patient if they had missed any of their meds and if they had attended their support group. Then she would ask if they were having any symptoms such as fever, cough, headache, etc. Since HIV patients have such diminished immune systems, they are very prone to getting opportunistic infections. There are also side effects associated with some of the meds so we also screen for any of those during the session. The doctor then does a quick physical exam and finishes by writing the patient’s prescription.

Tea fields

 Two of the patients we saw were orphans, taken care of by older siblings. One of these two was a little boy around 8 years old who had come with his older sister. The doctor I was with decided that it was time for him to begin to be “disclosed” to. During disclosure counseling sessions, patients are told that they are HIV positive and what impact this has on their life. For this boy, the counselor told the older sister that she needed to figure out what her brother does know about his medications and what ideas he has about HIV. He told the sister that children often have negative feelings toward HIV positive people because they are taught in school that it is a moral failing to be HIV positive. He also explained that disclosing this information to her brother was a process and would take time. It surprised me to see that the stigma of HIV/AIDs is still such an issue in a country where it is a fairly prevalent problem. I even learned that children on HIV treatment are often told they are taking anti-TB meds. 

Clinic in Githunguri

 Later in the day, I saw an attempted lumbar puncture. For some reason I felt really uncomfortable about it. The tools they use are wrapped up with “sterile” blankets. The doctor had the patient sit on the examination table rather than lie down. She estimated the L4/L5 intervertebral space, cleaned the skin, and went for it. I don’t really know much about doing lumbar punctures except the level that it should be done at, but I always thought it needed to be a precise procedure with just one shot to get it right. The doctor I was with, however, hit bone on her first attempt, and after several other attempts, gave up and said that it was a dry tap. With each attempt, I kept getting more and more nervous that she would hit a nerve and the patient wouldn’t be able to walk out of the exam room! Luckily, the patient was fine, but I felt bad since she had waited all day to have the procedure done, only to have no CSF obtained. 

We finished seeing patients around 3 pm and headed back to Kijabe soon after. On the ride back, close to Kijabe, I saw a ton of monkeys on the side of the road. They weren’t bothered by our presence at all – I guess they are used to being around people. The driver stopped and even backed up so I could take a few pictures of them. Most of the monkeys were like the ones Neeli and I had seen the day before, but some were black with long white hair runs along their back (I think they were colobus monkeys). Later that night, Peter, one of the local artists, came to our house and showed us all of his carvings. It was fun to do a little in home shopping. Peter’s carvings are a bit pricy and he isn’t much of a bargainer, but I still managed to buy two things. The carvings were all amazing. He even had some medically themed carvings. There was one carving of a patient with club feet before surgery and another of the same patient after surgery.

We messed with our oven again that night with no luck. We even asked our neighbors to come over and look at it, but they also did not know how to turn it on. Day 2 of the oven challenge and we failed again!

More monkeys!

 Today, Tuesday, I went to a different satellite clinic in the town of Njabini (pronounced jabini, the “n” is silent apparently). The road to Njabini was not as bumpy as the road to Githunguri, which I was very appreciative of. From Njabini, you can see the Aberdare mountain range, but the town itself is actually made up of fairly flat land. In Kijabe, you can see far into the distance because of its elevation compared to the surrounding land. When we arrived, Maura, one of the COs in the AIDs Relief program, gave me a tour of the clinic. After my tour, we went to take some tea and bread. First, I had some of the milky tea that I’m not too crazy about. Some time later, another canister was brought in with water based tea in it. I actually really liked this tea, but it could have been because it is closer to what I am used to! When we finished our tea, we went back to the clinic to see the patients. After seeing one patient with Maura, he asked me if I was comfortable with seeing patients on my own. I said sure, why not – as long as he would check my work after I was done. It took a while for him to get any of the patients to admit that they could speak English, but three eventually did. I think I did pretty well with them, but they were all healthy so it wasn’t too much of a challenge to begin with. 

Clinic in Njabini

 The rest of the day was pretty uneventful. On our way back to Kijabe, we stopped at restaurant (they often call restaurants hotels here) for somosas, meat pies, chipati, and bone soup. The bone soup was pretty awful and I only took one sip of it. I also tried a somosa, which is deep fried, triangle shaped dough filled with beef and onions. As soon as I ate it I started to worry that I would get a tape worm or something from eating meat from a random restaurant in the middle of Kenya. So far I feel fine, but we will see. When I got home I took a nap until Neeli got back from her satellite clinic. We went on our usual walk; no monkey sightings this time. We stopped by the hospital to play with this little boy who we always see in the playground right outside of the pediatric ward. I’m sure he didn’t understand much of what we said to him, but we pushed him on the swing for a while and I think he really enjoyed it. We also dropped by the apartment of our UTMB resident friend. We chatted for a while and he showed us how he lights his gas oven. However, when we got home we realized our oven is different than his and we still couldn’t figure it out. This is getting pathetic. Hopefully tomorrow we will be able to get a hold of the housing manager so we can finally figure this out!

Neeli and Kevin

Weekend in Nairobi!

            On Friday, Neeli and I went to the hospital in the morning to participate in rounds. We couldn’t find the doctor we are supposed to follow so we decided to ask one of the interns from Seattle if we could follow him for a while. He said it would be no problem at all and added jokingly that it would be great if we could figure out what was wrong with is patients for him. This is when we reminded him that we have only finished one year of medical school. His name is Kelly and he’s probably almost 7 feet tall with long hair that he keeps in a pony tail. The cause of illness in most of Kelly’s patients still hadn’t quite been pinned down. One of the patients was thought to have a disease called Black Water Fever, which we learned was a form of malaria so severe that it caused renal failure. We also saw a patient with congestive heart failure, COPD, and inactive leprosy sores. When Kelly examined this patient, he measured the patient’s JVP. Hmm, so maybe POM (Practice of Medicine) is helpful? I thought this was funny because we had learned that JVP was rarely measured anymore, but I guess when you are in a 3^rd world country you have to rely on cheaper (in this case free!) and more basic examination tools. Another patient was thought to either have pulmonary TB that spread to his cerebellum or primary lung cancer with a metastasis to the cerebellum. Before moving on with his case, they would need to biopsy the mass in his lung. Kelly was a great teacher. He explained everything very well and even went over chest x-rays and CT brain scans with us. Once we finished rounding with Kelly, we found Dr. Mirielle and began rounding with her. Dr. Mirielle is from Madagascar so she too kind of sticks out from the majority of the crowd at Kijabe Hospital. She too is a great teacher and truly cares for her patients. We saw one of the patients that I had seen my first day at the hospital. This patient is HIV positive, has Karposi’s sarcoma, neurosyphilis, TB, and a resolving herpes zoster infection. The herpes zoster infection (which affects the nervous system) was so bad that it had caused the patient to become paralyzed from the hips down. This not only means that she could no longer walk, but that she also could not control her bladder/bowel movements. Dr. Mirielle explained that since the infection had resolved her strength was starting to return, but since she is incontinent she is not able to benefit from physical therapy. When she would wet herself, the therapists would just send her back to the ward. Dr. Mirielle tried to find an adult diaper for her, she was told the hospital did not have any and the patient’s family had no money to buy them. It’s so heartbreaking to me that this woman’s only option is to sit in her own filth until one of the nurses can clean her.

Giraffe Centre

            We finished at the hospital around 1 pm so we went back to our house to take a nap before heading to Nairobi for the weekend. Our driver arrived at 4:30, but we did not reach the apartments we would be staying in until 8:40! It takes about an hour to get to Nairobi from Kijabe and we stopped on the way to buy groceries to make dinner later. We did our best to buy the ingredients to make pizza. After foolishly asking if there was any pepperoni in the store, we decided to go with lamb sausage as the topping for the pizza since one from our group doesn’t eat beef and another is allergic to chicken. Once we left Westgate (the mall with Kenya’s version of Wal-mart – Nakumatt), we got stuck in the worst traffic I have ever seen. We would literally go for 15 minutes without moving an inch! When we finally did move, all the cars would lurch forward at once to fill every available space on the road. Even though we were pretty close to the apartments, it took us about an hour to get to them. It was great to see everyone from House of Hope once we finally arrived. We traded stories of what we had seen at our respective sites while preparing dinner. The rest of the night we enjoyed watching some TV and just chatting with each other.

Trevor and a giraffe

            Around 10 am Saturday morning we left the apartments to take full advantage of our day in Nairobi. We grabbed lunch at Nairobi Coffee House while we figured out our plan of action for the day. After lunch, we went to the Giraffe Centre first. It is made up of about 104 acres of land with 8 giraffes and a few warthogs here and there. There is a feeding area right when you walk into the centre and the giraffes are only feet away. They stand at the edge of the fence where visitors can feed them little pellets of food. It is so fun to feed them! They have super long tongues that feel like sand paper and when you hold out a pellet, they wrap their tongue around it. They are also a lot bigger up close than I thought they would be. JR even let one of them lick him – 3 times! Once we left the Giraffe Centre, we walked down this trail intended for bird watching. We never saw many birds, but it was still a nice walk! Trevor thought he found some cool eggs, but when I came over to see them, I laughed at him because they were actually giraffe droppings. From there we went to another park with crocodiles, turtles, ostriches, a giraffe, and a camel. Sounds like a random assortment of animals, but the park was mainly geared toward crocodiles. When I first saw the crocodiles, I didn’t even think they looked real. Our tour guide proved they were by poking them with a long bamboo stick. First they would hiss without even moving a muscle. Once they had been provoked enough they would snap their jaws shut which made a funny popping noise. One of the crocodiles was 47 years old! We also saw teenage crocs and baby crocs. The guide picked up one of the baby crocs for us to get a close look. Then he let each of us hold it ourselves.

JR and a baby croc

I didn’t even want to touch it at first, but after some convincing, I had the thing around my neck! After spending some time with the crocs, we saw some turtles. One was around 20 years old and the other was 50 years old. The guide also let us hold these. Just as Toug was reaching for the older (and much bigger) turtle, it started peeing everywhere! Soon after the smaller one did the same thing. It was pretty funny to see – probably because I wasn’t the one in the path of the urine stream! The giraffe at this park was a different kind of giraffe than the ones we had seen at the Giraffe Centre. It was smaller and its spots looked a little different. Once we made our way through the park we headed back to the city to do some shopping at the Masai Market. This was a pretty nerve racking experience, but I found it a little bit exhilarating at the same time. As soon as we entered the market, we were swarmed by brokers. The brokers try to break up your group and force you toward products they are promoting. They also bring items to you and tell you that you need whatever item it is, and when you say no, they just keep badgering you. There were a lot of really cool items in the market – Masai blankets, carved masks and animal figurines, paintings, tons of beaded jewelry, and other little trinkets. I managed to buy 5 things for 1,000 shillings (which is about $10). I was pretty pleased with my bargaining skills! For dinner, we went to Carnivore, one of the top 50 restaurants in the world! It is basically like Fogo de Chao plus some exotic additions like ostrich, crocodile, and camel. The food was really great, especially after Neeli and I had been eating fruit and bread all week!  For dessert, I had pineapple pie with vanilla ice cream – so amazing! After dinner, we went back to our apartments and spent the rest of the night there. 

The 50 year old turtle!

Dinner at Carnivore - Michael, Neeli, Me, Trevor

            On Sunday, our driver came to pick us up around 1:30. On our way back to Kijabe, Neeli and I stopped at Nakumatt to pick up some groceries for the week. We still hadn’t eaten lunch so we grabbed croissant ham and cheese sandwiches at Dorman’s on our way out. Dorman’s is basically Kenya’s version of Starbucks. After we arrived in Kijabe, we unpacked our things and decided to take a walk around the compound since the weather was so nice. We always see tons of beautiful, exotic flowers and birds, but this time we also so some monkeys! The first one we saw was sitting on top of some trash cans rummaging through the trash. At first we thought I thought it was a bird, and then a cat, until I finally realized it was a monkey! Right when we saw it, we both kind of freaked out a little because we thought it might come after us. Neither of us had our cameras with us, but we decided we should go get them and try to snap a picture of the monkey. When we got back, the monkey wasn’t there of course, so we just continued our walk. Then, we noticed a ton of monkeys in this low lying area with tons of ivy and trees. There were probably over 20 of them and we stayed watching them for at least 30 minutes. Later that night we attempted to use our oven, but unfortunately we couldn’t find the pilot light to get it started. We spent over 30 minutes and used about 15 matches, but never figured it out. I think we’re going to have to get our neighbors help on this one! So that was our weekend in a nutshell!        

It's hard to see, but there is a monkey sitting on a stump in the middle of the picture

Road to Githunguri

            Well, good news – no spider in my bed this morning! Today was my first day to go to one of Kijabe’s satellite clinics and since they are about an hour or so car ride away, we are supposed to leave around 7am. I arrived at the designated meeting spot at 6:50. I wanted to be early so that I wouldn’t get left! Before leaving for Kenya, Dr. Keiser warned us that the people here don’t really follow schedules strictly (I’m not sure if they follow anything strictly) and he was right. I waited for about 40 minutes before the driver arrived and we finally left for Githunguri. After I got in the car and buckled up, I realized that no one else from the hospital had gotten in the car. I asked the driver if we would be picking more people up and he said we would. Well, we definitely picked up more people on our way there. All along the roads and highways there are people standing around and every now and then we would pull over and one of them would get in the car. It seemed so random to me, but I guess the driver knew who to pick up. This probably sounds pretty sketchy, but apparently it’s normal here. We dropped some of the people we had picked up at another Kijabe satellite clinic before arriving at Githunguri.

            Now I have to talk a little about the roads and driving in Kenya. The road from the highway to Kijabe is narrow, winding, and filled with potholes. To warn other cars or people when they are coming, the drivers flash the headlights and honk the horns. Needless to say, I was pretty uneasy the entire car ride. Once we got on the highway, the road was smoother, but there are still no lines or shoulder lanes. The cars constantly are passing each other even though each direction is just one lane wide. There are also mules, lamb, cows, and other farm animals along the highway. The mules are often tied down to a peg in the ground and stretch as far as they can to reach for grass to graze on. It’s pretty funny to see. When we got off the highway toward the direction of Githunguri, the roads were again full of potholes. The drivers zigzag all over the road trying to avoid the potholes, and not very successfully in my opinion. Keep in mind that these roads are two-way. It seems like the roads used to be paved, but have never been repaired. Even though I was stressed about the road, the countryside was really beautiful. You can see for a very long way and the hills are covered with different crops. I saw several tea farms too. Tea is very big here. Everyone breaks for tea time as some point during the day no matter what is going on. I had some my first day here and I’m not a big fan. They boil milk and then add the tea leaves. It tastes ok, but has a weird smell to it.

            Once we got to Githunguri I was able to relax some. Of course right when I got there I needed to use the restroom. Unfortunately for me, there were no restrooms and I had my first encounter with a latrine! If anyone doesn’t know, it’s like an outhouse with just a hole in the ground. So that was an experience in itself. While in the clinic, I watched the COs (basically the Kenyan version of a physician assistant) talk with patients and discuss their health and ART meds. One of the women working with me went through each of the different ARVs with me and told me about their side effects. They monitor for these as well as any signs of opportunistic infections. In triage, I got practice taking BP, respiration, pulse, etc. I also learned how to fill out some paperwork and order tests (woo.. fun!). After we had seen all the patients we had to wait a while for the driver. The women I was with took this opportunity to do some shopping and take me to see a real, open air Kenyan market. The market was huge. There was one section for food and another for clothes. The stands were made out of wood poles, burlap to hold the food, and old tarps to cover the top. I don’t think I’ve ever been stared at more in my life than at the Kenyan market. It made me nervous, but everything was ok. The fruit and veggies looked great and very fresh. One of the women insisted on buying me bananas even though I declined her offer. She said that you can’t come to the market and leave without them. The ride back to Kijabe was pretty uneventful, just bumpy. When I got back to the house, Neeli and I went on a walk. We decided we need to meet more of our neighbors so we can have something else to do after the work day is over.

The bananas from the market!

Kijabe Hospital

            Even though I’ve only had two days of experience at the hospital so far, I feel like I’ve learned so much. I know that I am in Africa and all, but it amazes me how disorganized, dirty, and lacking in modern day conveniences the hospital is. There are no electronic records and all of the paper records look like they’ve been tossed on the floor and walked over a couple of times. They are tinged with dirt and wrinkly. The patient files get thrown haphazardly into file cabinets, lab results go missing, and there is practically no sense of patient confidentiality. There is always African music playing in the background and strong smells of body odor, sweat, tea, urine, and just sickness in general.

Home for the next few weeks

The air is especially heavy in the women’s ward where I spent Monday morning. Here the women are very sick. In just one hour I saw Pott’s disease, TB meningitis, and a complicated case of HIV+, TB, Karposi’s sarcoma, neurosyphilis, and Varicella zoster. I heard about these during this past year, but maybe now that I’ve seen them in real life I’ll actually remember them! Later that day and for the rest of the day, I joined up with the pediatric team and followed around a 4^th year UTMB student. She has been great! She always answers my questions and makes sure I get to see anything really interesting. While in peds I saw several children with ponseti serial casting for clubbed feet – there’s even a whole ward for children with hydrocephalus. Some of the children are still happy despite their condition. One little boy, paralyzed from the waist down due to spina bifida, grinned every time we came near his bed. Most of the time though, my heart is breaking for these children. I saw one baby just a few weeks old seize for over an hour until it finally got the meds it needed. Another little girl about five years old had just been diagnosed with neuroblastoma with metastases to several locations in her body. I was there while the team broke the news to the mother. Even though the mother did not cry, I could tell she was very upset, and understandably so. I’m not quite sure she understood everything she was being told or how serious the situation was.  Anything the doctor told her had to be translated into Swahili. They told her that chemotherapy was not available at Kijabe so there was no reason for them to stay there. They also explained that they could take the girl to Nairobi, but that they could be refused treatment there since even the best treatment in the world may not save her.

Kijabe Hospital

Today (Tuesday), I began my day with no running water and a spider in my bed!  Once I killed the spider, I headed off to the wards again. We were reviewing a patient’s chart when a resident pulled Neeli and I aside to show us what he described as “the worst bedsore” he’d ever seen. I’m not even sure you can call what we saw a bedsore. Apparently, the man had suffered a gunshot wound and is now on palliative care. This sore was so bad that the head of his femur was actually protruding through his flesh. Not only was this gruesome to see, but I can’t even imagine the pain he must be in. After morning rounds, Neeli and I went to the HIV clinic. This is a clinic within the hospital that runs a program called HIV Relief to provide ART (anti-retroviral treatment) for free as long as they maintain the program by keeping up with their drugs and appointments. Here we just followed around one of the doctors and watched him with the patients. I think the saddest part is that so many babies have to be started on ART because their moms are HIV+ and many of those babies who receive treatment will still contract HIV despite treatment. One other interesting thing I saw today was a baby with myelomeningocele. This basically looks like a large tumor on the baby’s back, but the mass actually contains part of the spinal cord and its coverings in it. It is pretty serious and not something you see too often in the US. After we left the hospital for the day, Neeli and I went for a walk around Kijabe. We walked over to Rift Valley Academy which we decided must be where all the doctors and their families live. It is almost like a city within a city. We wanted to check it out because we had heard there is a gym to exercise at there. Once we got there, though, we decided it was enough of a work out just walking there! It took about 30 minutes and I’m still not acclimated to the elevation yet!    

Neeli and some kids we met on our walk!

Oh and I forgot to mention before – in Kenya, the part of the hospital where surgeries are done is called the Theatre and the ER is referred to as Casualty. I just thought that was kind of funny. Anyway – ‘til tomorrow!

Arriving in Kenya

            Once we met up with our drivers we piled our luggage into one of the cars and all of us except Trevor rode in the other car. When he went to get in the car, he accidentally tried to get into the driver’s seat. So we learned pretty quickly that they drive on the wrong side of the road here! Don’t worry – Trevor made it to the apartments we would be staying in for the night in one piece! Not even 5 minutes outside of the airport we spotted a herd of zebras! We were so excited that our driver slowed down so we could see them and we just kept yelling “yay, zebras!!” So touristy I know! Haha. I was pretty nervous the entire ride to our apartments/hotel (not quite sure what to call them). In Kenya the street lines seem to be merely suggestions and no one stops for red lights! People constantly weave in and out of traffic too. 

View of Rift Valley

            The place we stayed was very nice. There were three apartments for us so that we each had our own bedroom and bathroom! We were used to cramming 5 of us into a single room in the hostels we had been staying in. When we got there, dinner was waiting for us. The next morning, we went to church. Jonathan (our UTMB Kenyan contact) had warned us that church would be like a rock concert and he was right! The church was called Mavuno (Swahili for harvest) Church and as we got out of our cars, the congregation was singing Dynamite by Taio Cruz. I think the words had been changed to Christian lyrics, but still! Even though the service was held under a big tent, they still had a projection screen, microphones, speakers, lights, and most other modern conveniences you would find in any auditorium. After a couple more songs (one of them in Swahili), a man and a women came on stage and did a sort of stand up comedy gig. They made jokes about old jingles and advertisements. Of course we had no idea about most of what they were talking about. This went on for quite a while until the pastor came up to preach. His sermon was about using entertainment for Godly purposes. It was actually pretty interesting. Toward the end (almost 2 hours later… I was struggling to stay awake), an African music artist, who I’m guessing is pretty famous here, did a little interview with the pastor. When the service was finally over, we grabbed lunch nearby. However, it took forever to get there because the traffic getting out of the church parking lot was crazy (and when I say parking lot I mean the gravel area behind the tent). Something I noticed that is interesting is that whenever you park anywhere in Kenya you are given a plastic card type thing that you have to return when you leave. Apparently it is for security reasons. Anyway, after lunch we left to go to our three locations. Before heading to Kijabe, our driver took Neeli and I to the mall in Nairobi (Westgate) so we could buy a modem and a few groceries. It was actually a pretty nice mall. We got our groceries at a store called Nakumatt which is pretty much like Kenya’s Wal-Mart. The drive to Kijabe was really beautiful and we stopped when we were almost there to look over the Rift Valley. When we arrived at Kijabe Hospital, it took a while for us to figure out where to go and who to talk to. There was a mix up with our housing, but we were able to stay at a complex right across from the hospital called the sitaplex for the night. It surprisingly nice and we even had hot showers in the morning!

            Monday was our orientation day. We went up to the front of the hospital and asked the security guards to call the contacts we had been given. We were directed to the medical education part of the hospital. There we met a woman who gave us a tour of the hospital and introduced us to everyone we ran into. We finally found someone who knew what to do with us and the rest of the day we followed around physicians in the HIV Relief clinic. It was a good day but also very tiring. After we finished at the clinic, we had to move to our permanent residence for the duration of our stay. Our new place is in a doctor’s house (apparently not here for the time being) and we are sharing it with a resident from Seattle who has been here for the past few weeks. She will be leaving on Thursday and we will then have the place to ourselves!

There's a ton more to write about, but I'm still catching up.. I'll post again tomorrow!

Guten Tag, Hallo, and Jambo!

So we officially arrived in Kenya after spending a week in Munich and Amsterdam at about 8 pm Saturday night. The visa line, with only about 30 or so people in it, took over an hour to get through! Luckily our drivers, who had been waiting with UTMB signs since 7 pm, were still waiting for us outside of customs! 

(Just FYI, We = Me, Neeli, Pooja, Trevor, JR, Lauren, Michael, and Rachel)

 

Before going into details about Kenya, I’ll share a little about what we did in Munich and Amsterdam.

We were pretty much zombies by the time we arrived in Munich at 8 am local time. From the airport we took the train to HBF (the central station) just a street over from Wombat’s hostel where we would be staying for the next couple of days. Check in wasn’t until 3 pm so we stored our luggage at the hostel and decided to explore the city / find some good German food to eat while we waited! We stopped at a restaurant called Café Mozart a few blocks away. The food was amazing! Almost everyone else in our group ordered Wiener Schnitzel, but Pooja and I decided to go with a dish called Kasespaetzle. I had no idea what to expect seeing as my knowledge of German food is pretty limited, but it ended up being delicious! It kind of reminded me of macaroni and cheese except the pasta was spaetzle and it had onions in it too. After lunch and a beer we went for a stroll. Ironically our hostel was located near a German medical school! Just can’t get away from school haha. Later that day (after very much needed nap) we decided to try to find Marienplatz. Walking it took about 30 minutes to get there. Unfortunately we didn’t figure out the subway system until day 3 – oops. We had an awesome dinner at a traditional German restaurant. I ordered their “famous” sausage with a side of sauerkraut. Our waitress was super nice so we obviously had to get a picture with her! Once we finished dinner we headed to Hofbrauhaus. I’m pretty sure we took the most indirect way possible, but we finally stumbled upon it! Yay! Liter beers! Hofbrauhaus was a lot different than I expected, but at the same time exactly what you would expect a German beer garden to be like. It was huge! There was a band playing folk music dressed in those green overalls. Anyone know what those are called? The rest of the night consisted of “prosting” (German for cheers!) and singing the Texas fight song! When we got back to our hostel, Pooja introduced us to an Indian snack called batagotagotchia (I have no idea if I’m even near the correct spelling of that word haha). It was super spicy and I think she enjoyed watching us practically cry from the heat! The spiciness still didn’t stop us from having it every night we got back to our hostel!

Me, JR, Rachel, Michael, and Lauren

            The next day we did more exploring around the city. We visited a couple more cathedrals and went up to the top of the tower of St. Peter’s Cathedral. Even though we almost passed out from the trek up, we had a great view of the city that made it all worth it. It’s funny to me how churches that are centuries old are found nestled among modern coffeehouses and clothing shops. While we were walking around we noticed that a lot of the people in Munich snack on ice cream cones while out and about. This aspect of the culture in Munich was very easy for me to adapt to! : ) That night we went to back to Hofbrauhaus for dinner and another night of prosting and German folk music – not to mention the wombar back at our hostel!

            The next morning we woke up early to visit Dachau concentration camp. Dachau was the first concentration camp established and all others were later modeled after it. It’s also interesting to know that the city of Dachau used to be a royal city in medieval times. It was very sad but amazing experience. I definitely recommend that everyone who visits Munich go visit to Dachau. Our guide, Gordi, gave us some history while we toured. It was a very pretty day while we were there which made it hard to imagine the cruelty and suffering that went on there. Even though much of the camp had been destroyed at some point or another, some of the buildings had been rebuilt to provide an example of the prisoner living quarters. When the camp was first established, a prisoner could be killed for not being clean enough, but by 1945, the camp was so overcrowded that filth would pile up more than a meter high. They crammed over 500 prisoners into dorms that were made to hold only 50 people. Once we got back from Dachau, we met up with Flo, a friend of a friend (Allison!) from Berlin. Later we went to BMW world which was really cool. It was located right next to the Olympic stadium in a very pretty part of town. We grabbed dinner at a really random place, but the food ended up being amazing!

Flo, Trevor, and JR

            The next day, our last day in Munich, we visited the Dutch Museum. Even though it is in the process of remodeling, it is an amazing museum. It is basically a huge science museum with different exhibits on electricity, ships and navigation, planes, oil and gas, optics, physics – it would takes days to see the entire thing. Once we left the museum, Flo had to catch his plane back to Berlin. We were very sad to see our friend and translator go! After he left, we took the train to the Modern Museum of Art. There were some interesting things there, but I’m really not that into modern art. I did manage to set off an alarm though! I didn’t touch a painting or anything like that, but I guess I got a little bit closer than allowed! I wasn’t the only one to set off an alarm because we heard it going off again somewhere else later on. The museum was dead quiet. I felt like we were being loud just whispering to each other. There were some strange exhibits – one, called “Deadly and Brutal,” was a series of hand-painted film posters from Ghana that supposedly had nothing to do with the content of the movie.

            That night we took a train from Munich to Amsterdam. Before leaving for Europe, we each bought a ticket for one spot in a 6 person couchette. The ticket was in German and growing up in the US, none of us had any experience with riding overnight trains so we thought the couchettes might be first come first serve. We quickly found out that wasn’t the case after a nice German woman showed us our place number. Unfortunately we were not all in the same couchette, but some of us ended up together. Only Pooja was by herself, but I asked the man in my couchette if he would mind switching with her and he said no problem! I actually slept pretty well (minus the crazy loud alarm going off in the middle of the night – never figured out why) and when I woke up, I was in Amsterdam!  

  

            So I realized I said I would share a little about Europe and I ended up sharing a lot! I’ll make Amsterdam quick – we were only there for two days! Once we got off the train it took us a couple hours to figure out the tram system and how to get to our hostel. It was a pretty nice hostel, just very small. We stayed in the museum district so it was a pretty nice area to be in as well. After getting settled and showering, we had lunch and wandered around the city. I think the buildings in Amsterdam are beautiful. Many of the buildings are painted plum which is one of my favorite colors! We passed a ton of cheese stores while walking around the city so we decided to stop and have wine and cheese at a little café. That night we went to a piano bar in Lancaster Place that was really fun. The piano man even knew the song “Don’t stop believing!” Our second day we went on a canal cruise, walked by the Anne Frank Museum, and visited the Van Gogh Museum. I loved the Van Gogh Museum – I didn’t realize how many of his works I am familiar with. That night we had Indonesian food which is apparently really big there. It was sooo good and I am definitely going to look for some Indonesian food in Houston when I get back in town! Early the next morning we left for the airport to head to Kenya – and that’s where I’ll pick up with the next post!