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