Jack, Bob, and Smith

This was my last week rounding in the adult wards. It has again presented challenges, but I have been determined to make this last week the best week. I have still been experiencing difficulty in gaining trust from the leading Kenyan physician on my team, but I decided if I couldn't gain her trust, I would gain the trust of the patients and nurses. It turns out that this may have made more of a difference than anything.

I'll tell you the stories of Jack, Bob, and Smith (names changed for privacy)...

It started with Jack. Jack is a mentally retarded 18 year-old boy, and he came in having convulsions and also developed sores around his mouth. For some reason, I was always drawn to spending extra time on his care; I think this was because either one or both of his parents were always sitting with him. I just did simple things like checking his treatment sheet ("T-sheet") to make sure medications were being give (which I did with all patients) and talking to his parents to make sure they understood what was going on and seeing if they had any questions. When we did tie-die for our craft day at the Sally Test day care center, I made a tie-die shirt for him. Jack could never speak, but his parents were really grateful. He improved after a long time in the hospital, and one afternoon his mom came up and hugged me and said "We're going home!" I was so happy to see them take Brinda out of the hospital where he could be loved by the rest of his family.

On to Bob... Bob is an extremely ill patient with HIV, cryptococcal meningitis, and tuberculosis- quite a load of diseases. He has been a challenging case since he arrived in the hospital, and his wife is also always there with him. It seems like his wife is there during the day, and another family member comes to spend the night with him. I think this is one of the reasons Bob has held on this long and is fighting for life.

I again would always check on Bob and talk to his wife (sometimes with a translator) to see if they needed anything. One of the physicians told me that he had not been taking his ARV's (HIV medications) for an entire week because he was out. This is not acceptable- the nurses should be making sure that they are taking their ARV's, even though the patient usually keeps them at their bedside and it is ultimately their responsibility. Compliance is vital with HIV treatment- even missing one dose puts them at an increased risk of deadly infections, and their disease can take a turn for the worst. I immediately went and got him a prescription and filled it in the pharmacy. I brought them to his wife, and she was so grateful. She gave him his medications every day, but she just didn't know how to get more and no one else bothered to help her or explain it to her.

A couple days later, she showed me that he was also out of tuberculosis (TB) medications. I wasn't sure how to get these refilled, as patients usually go through a clinic, but one of the nurses explained it to me. She discouraged me from going to get the medication myself because the patients need to learn how to get them and use the system. I understood this, so I brought Bob's wife with me to get him some more medications. I took her to the TB clinic, and told the doctors there about her situation. She had to wait some time to be seen, but she eventually was successful. I went back in the afternoon to make sure she was successful, and she showed me the medication and was not given enough to last for 2 weeks (the usual amount given during the initial treatment phase). I then went back and got her the correct amount and explained what to do when she runs out again.

Yesterday, the team noticed that Bob was in severe respiratory distress- his oxygen saturation was in the 80% range, and he was not yet on oxygen. He had indeed taken a turn for the worst. This lack of oxygen is deadly and can cause a lot of brain and other organ damage. After much persistence, we finally found some oxygen for Bob. I went back multiple times to see if he had improved, and he had not. I started talking to his wife, and she said that he had not been making urine for the past couple of days. This is a sign of acute renal (kidney) failure, and can be life threatening- definitely a contributing factor to his condition. She said she forgot to mention it to anyone else (nurses, doctors, etc). First of all, it is not her responsibility to monitor fluid "ins and outs." That is what we as health care professionals are there for. Secondly, I don't think she forgot to mention it, but she has not been treated with compassion, so maybe she was just afraid that nothing would be done or she would be scolded. I immediately told one of the physicians on my team (who actually did scold her a little for not mentioning this sooner), and she fixed his catheter and increased the amount of fluids being given. He started passing urine through the catheter, and hopefully today he will have improved a little. I really appreciated this physician's sense of urgency and persistence in correcting this problem. She did a great job.

I will be going back to the hospital today (Saturday) to deliver food to one of our extremely wasted HIV patients. He is so skinny, I couldn't even describe it without you seeing it first hand. He had a relative there, and I asked if he would be able to eat. He said yes, and that this patient was a fighter. Later that day, I brought him some leftovers from our lunch (eggplant casserole, chicken, rice, vegetables- lots of protein). He was awake, and his face lit up when I handed him the food. He immediately started eating, and I think he ate the whole container of food. He then fell asleep, satisfied maybe for the first time in a long time. Sonak said that sometimes food can save these patients faster than medication, and you can see them gain weight and literally come back to life. I will bring more food over the weekend, and hopefully he will keep fighting.

After I gave out the food, another patient (Smith) in this same cube (area of beds) came up to Bob's wife and gave her his empty TB medication container. (All of these patients have been in the same area.) She looked at me (along with every other patient in that cube) and said "We all love you because you help us and understand our problems." She then handed me the other patients medication, and Nicholas just looked at me. I smiled, told them I would be right back, and went to get another month's supply of this patient's medications.

Let me pause and give you a little background on Smith. He has what is called an empyema. He has an infection in his pleural cavity (the area where your lungs are), and pus has been building up inside of him. We put in a chest tube (literally a tube that goes straight into the side of his chest) to drain the pus. Within 48 hours, we had drained 6 Liters of pus (imagine three 2-liter bottles of pop). The chest tube is still there; Smith asked me if we could take it out so he could go home- the fact that he asked this is an improvement, considering he could not talk or move due tot he pain before the chest tube. I had to explain that his tube would not be removed for a few days because if we take it out, more fluid will build up and he'll be in the same spot he was a few days prior. I told him to relax and rest, and he smiled and accepted this news. I wish he could go home too, but I definitely don't want him to have to come back a second time.

Now, when I brought more TB medicine for Bob, he looked up and said "God bless you" with a huge smile. At this point, I knew that all this extra work of hunting down medications and staying at the hospital late was worth it. I finally gained the trust of the patients, and they were not afraid to ask for help. I saw the difference that could be made with a little bit of extra effort and persistence. Through these experiences, I learned that you can try to prove what you know to physicians all day long, but in the end it is the patients that matter. There is no way of knowing how long Barnabas would have gone without passing urine if his wife had not told me. The patients and their relatives are the ones that provide the most useful information, and you have the potential to directly impact their care by listening and going the extra mile.

This pretty much wraps up my time in the hospital here. Next week I will be spending a day at Sally Test, working on my research project, and I might spend a day on the AMPATH farm doing some manual labor (Ok, you can stop laughing now). Some days I have felt like I never want to leave here, and some days I have just wanted to come home. Kenya will always have a special place in my heart, and I hope to come back as a pharmacist, see how the program has developed, and try to help as much as possible. I am so grateful for this opportunity and for everything that Sonak, other students, and the patients have taught me. I have gained new perspectives and appreciations for the little things in life, and the things that I have seen and learned will always be with me.

Hospital Updates

Recently, I spent a couple of weeks rounding in the pediatric ward. There is a pediatrician from Brown University here now (Marisa), so I was able to round with her, and I learned a lot. We learned about pediatrics in school, but I don’t feel too familiar with the medication regimens, as they are very different from adult medications. Marisa was able to teach me a great deal about the medical conditions and special considerations in children.

Since she just arrived in Eldoret, I also was able to learn about how to integrate yourself into a new situation. When I first arrived here, I really had no idea how to do this; I did my best, but I found it very difficult to gain trust and respect from the Kenyan physicians. Marisa was excellent at this, and I think it’s because she did a lot of listening during her first two weeks. There are so many times when you want to chime in and make suggestions, going off of how things are done in the US. Marisa refrained from doing this and just listened and learned about how the Kenyan system works. She eventually started asking questions and speaking up more, and after less than a month she is an integral part of her rounding team.

Some of the things I saw in the wards were heartbreaking, but as much sadness as there is, there is just as much hope. There is one child who looks about 8 years old, and she also looks about 9 months pregnant. She has severe malnutrition and possibly a malignancy in her abdomen, but she is extremely skinny and wasted other than her belly. It is very sad because it is even difficult for her to walk. There is another patient in the oncology unit that has a malignancy that has misshapen her face so badly that she hardly looks human. She has masses on/above both of her eyes and on the rest of her head/face. I want to go sit with her sometimes, but she is very shy and scared, and I can understand why. There are not many good treatment options for this type of cancer, and the prognosis is not good. Today, I went into the pediatric oncology ward to say hello to all my friends, and this girl was sitting up and smiling at me. She has the most beautiful smile I’ve seen. Her teeth are literally perfect, and her face lit up when I offered her candy and talked to her. She then was able to go home, and I hope for the best for her-I will always have a special place for her in my heart. Another similar case has a malignancy of the eye and had to have one of his eyes removed. He still walks around smiling and takes my lollipops, and at that I am amazed. I am starting to believe that these children are angels. They have endured so much, yet they bring hope to others, when they could so easily lose hope for themselves.

It is also inspiring to see the parents. The parents may not be able to provide food every day for their children, but they will recruit friends and family to pay for hospital bills or a chest x-ray that goes for about $10. Many of the children have acquired HIV through mother transmission, and these children display some very serious disease states and are at an extremely high risk of infection. The hospital is pretty much a second home for them. One good thing is that children under 6 cannot transmit tuberculosis due to their physiology and sputum production; this at least prevents the spread of one more disease in young children.

During my time in peds, I learned a lot regarding drug therapy, but I also learned and grew emotionally and personally. There is a lot to be learned from children, and they are very good at helping you put some perspective into your life.

After a couple weeks in pediatrics, I decided I would return to the adult wards to finish up the rotation. I initially had some challenges with my rounding team as they doubt the impacct that pharmacy can have, but I have learned a lot about the Kenyan systems and culture, so I am looking forward to working for a couple more weeks with my original team and trying to help as much as possible.

Just like the first day of this rotation, on my first day back in the adult wards, one of our patients passed away. It is always sad, but when the patients are so ill, I am almost grateful that they are in a better place and out of pain. That said, it also hurts and frustrates me when so many of these deaths are preventable (or would be in the US, anyway).

The biggest challenge this week has been making sure that patients are receiving medications from the nurses. The nurses are responsible for administration, and it seems like it does not always get done, or it at least does not always get documented that it was done. Many of these drugs are critical to life, and for some reason that seems difficult for nurses to grasp. No one has been able to figure out what the attitude or mental outlook of the nurses is. When I talk to them, I try to get them to see the impact that they can have- if they give the medication, they can save this patient’s life.

On Wednesday, we had a patient who was bleeding out of the mouth. He was not really vomiting, but he was losing a lot of blood, and we think he had a severe GI bleed. IV omeprazole was ordered, but that was not in stock, so we ordered IV ranitidine. I knew that this would probably not completely stop the problem, but it may help with the vomiting. I asked the nurse if they would give it soon, and she said she would when we finished rounding. I came back after lunch, and the medication was still not given. How can you not give a patient medication when he is bleeding profusely out of the mouth? I found the treatment sheet where documentation occurs, and started to look for the nurse in that area when I heard a women screaming and people holding her and trying to walk her out of the hospital. I looked over, and this very patient had just passed away. There was a knot so big in my stomach that I wanted to vomit. I’m not saying that his medication would have saved him, but there is no excuse to not give a medication. I was so upset by the lack of urgency regarding this patient.

I walked into rounds the next morning, and the curtains were closed around yet another patient, indicating that he had just passed away. This week was very difficult, and I saw a lot of death. This increased my motivation (to say the least) to make sure that medications were being given. We started an antibiotic for one patient with possible cellulitis, and I noticed that it wasn’t given. I asked the nurse and she said the pharmacy didn’t have any. That was interesting considering that a few other patients showed documentation from the same nurse of receiving the same antibiotic that day. I went to the pharmacy and brought the medication to her myself and she promised to give it. Thankfully, when I checked this afternoon, the patient had received the medication.

Will has experienced similar challenges and has ended up giving medications to patients himself. It is a lot of work, but it is comforting when you know for a fact that patients are receiving medications as opposed to feeling like it’s always a guessing game.

Messai had a patient with an INR of 8 (this means that she was at a very high risk of internal bleeding because her blood was essentially “too thin”). To treat this, we can administer Vitamin K to increase the clotting factors. We were trying to avoid giving this vitamin K IV because it can cause an anaphylactic allergic reaction if given too quickly. Luckily, the IV formulation can also be given by mouth. We administered the vitamin K to the patient orally, but it must have tasted awful because within 30 seconds she had vomited it up. We discussed with the nurse and decided that it should be given IV very slowly, but for some reason we had a lot of difficulty. The nurse resisted administering the medication, and it took so many tries to place an IV line in this patient that she began crying. I don’t think anyone would like to be poked 7 times with needles in your hands to try and place an IV. When Messai returned to rounds the next morning, the vitamin K was never given. This patient went an entire day and night with a huge risk of bleeding.

These are a few of the challenges that we have faced recently. It is easy to lose hope and get frustrated, but you have to keep a vision of the future in your head and heart. By helping one patient, you are making steps to helping more. Together, Will, Messai, and I are learning how to overcome many challenges to patient care and taking on a lot of responsibilities ourselves instead of always trusting others to do it. We are not trying to step on nurses toes or anything, but we are doing what is necessary to save lives. Patient care has come a long way, and I know it will continue to improve as long as people persist and put their heart into patient care.

4th of July Celebration!

The 4th of July is one of my favorite holidays! I love how spirited and proud of the US everyone is- and we always have the best party back home! I was thinking of everyone, and I tried to bring the celebration to Kenya with a flag t-shirt and Mr. Muether's mac & cheese recipe. It was cloudy and looked like rain the whole day, but thankfully it held off for the most part. We had a great time down at the River House, which is part of the IU House that has a pool, volleyball area, and nice yard for games.

Someone started singing the National Anthem, and everyone stood and joined in, and I looked around and they were all standing facing me and using my shirt as the American Flag. It was pretty funny! Ohhh say can you seeeeeeee...

American flag candles and candy! Now that's spirit!

We had lots of food at the barbeque (it was a pot luck, so everyone brought something- sausage, hot dogs, veggies, dessert etc), and the mac & cheese (front center in the picture) and baked mostaccoli that I made was definitely the favorite dish! I was so excited! When I was bringing back the empty dish to the kitchen, someone actually stopped me and asked if they could scrape the side of the bowl- no joke. It was awesome, so props to Mr. Muether for the great recipe. I wanted to make a Flag cake, but the resources for that are kind of limited. I'm sure Hanna did an amazing job with the Flag cake at home, though :)

Croquet time!

It was a pretty low-key evening after the barbeque. People played croquet, which also reminded me of home. We helped clean up and played cards, and then pretty much went to bed. I'm sorry I couldn't skype with everyone at home- I was really looking forward to it, but of course the internet failed when I needed it the most. It is up and running this morning, so hopefully it will work throughout the day.

I hope everyone had a wonderful 4th of July! Go USA!

Love to all back home :)

The 4th of July flower- I loved this!

Lots of new stuff

First of all- HAPPY 4TH OF JULY! I know everyone will be celebrating at home today, and we are going to try and celebrate ourselves with a little barbecue. I am thinking of everyone at home and wishing I could see the fireworks!

The internet has been very difficult this past week, so get ready for a long read with lots of updates... The past week has been pretty exciting.

Kario View and Kakamega Rainforest

Kario View overlooking the Rift Valley

Last weekend was full of adventures! On Friday afternoon, Will, Messai, Mei (psychiatric pharmacist), and I left for a place called Kario View. We had about a 45 minute drive to the top of a hill and once we reached the top, we could overlook the entire Rift Valley. (The Rift Valley is a region in Kenya, and Eldoret is included.) It was quite a site, to say the least. We stopped at a viewing area for some relaxation and photo taking, and then proceeded to the Kario View Hotel. We enjoyed a meal in the hotel restaurant while overlooking the Rift Valley. The scenery here literally takes your breath away, and it is easy to clear your mind of all other thoughts and simply enjoy the moment. I have heard many people say “Welcome to Kenya… Stress-free Kenya.” At first, I didn’t really understand this, but that saying gained a lot of meaning at the top of Kario View.

The Rift Valley in Kenya

Enjoying the view of the Rift Valley

While we were at the restaurant, a group of school children arrived on a field trip. Met and I really wanted to talk with them and take pictures, so we asked their teacher if that was ok. She agreed, and we all went outside and took pictures with the class. They loved it! They thought our cameras were fascinating and loved seeing themselves on the camera afterwards. I thanked the teacher, Edna, and agreed to send her a copy of the photos we took. It was extraordinary to immediately be embraced by the class and spend a few minutes with them. I hope we gave them a good memory, as they greatly enhanced the Kario View experience for me.

The class and me at Kario View Hotel- what a great group!

They wanted to take more pictures- I love this one!

We went back to the IU House on Friday night and left for Kakamega Rainforest with a group of ten people on Saturday morning. We knew we were going to a rainforest and that we were probably going to hike, but we didn’t know what this entailed. We ended up hiking a total of 10 hours (3 on Saturday and 7 on Sunday) and probably about 9-10miles (up and down some major hills and through a cave)…

We arrived at Rondo Retreat Center around noon and were pleasantly surprised by our accommodations. Our group was assigned two cottages that each had a lovely porch and a view of the trees where monkeys were playing. We enjoyed the scenery for a few minutes and headed to the dining room for lunch. Lunch was wonderful! It was some kind of vegetable-sausage mix with rice and ice cream for dessert! Following lunch, we went on a three-hour hike and saw a variety of monkeys, including Colobus monkeys, Red tailed monkeys, and Blue monkeys. We also learned about some unique plant species that are found nowhere else in the world.

Our lovely cottage where we stayed during our Kakamega Rainforest excursion.

Tea and cake was served at our cottages at 4pm. I could definitely get used to afternoon tea. There is a tea plantation directly adjacent to Rondo Retreat, so the tea was as fresh as it gets. We did make friends with a domestic cat during tea, however. Feeding the cat milk was perhaps not the wisest idea. The cat never left our side for the remainder of our stay. At one point I was reading a book, and it jumped on my lap. When we were playing cards later that night, the cat tried to get through the window. Even when we left for the sunrise hike the following morning, the cat was following us!

A view of the sunrise after our long hike up the hill. It was definitely worth getting up early! What a sight!

A view of the canopy of the rainforest, with a layer of fog over it in the early morning. It's very mysterious, and you can only imagine what is underneath within the rain forest.

A group picture after our sunrise hike

Speaking of sunrise hike, this was definitely the highlight of the trip. We met our guide at 5:30am; it was pitch black outside and the stars were still out. (The stars are incredible, by the way- especially on a clear night.) We began our journey to the top of a hill where we would be able to overlook the entire rainforest and watch the sunrise. At first, I thought that we were all crazy- images of Blairwitch-type scenarios filled my head as we hiked through a pitch black forest full of monkeys, snakes, leopards, and other potentially dangerous creatures. We each had flashlights, but those didn’t always help us avoid the holes or puddles in our path. As it started getting lighter, we turned around and could start to see the canopy of the rainforest. This was motivation to make it to the top- what a beautiful sight. Before we reached the top, our guide wanted to show us the bat cave. I’m not really scared of bats, so I thought this would be exciting and adventurous. Turns out it was a little too adventurous- our guide stopped in the middle of the cave and told us to shine our lights on the wall. The wall was literally moving- yeah. He called the insects on the wall “crickets.” Well, I have never seen a cricket like this in my whole life; they were definitely more like spiders (although he laughed at me when I assured him that those were not crickets). After that, I just tried to go to my “happy place” (I imagined being in a shopping mall with a mocha in one hand and a shopping bag in the other) and hoped to make it out of the cave without any “creatures” on me. Seriously, this experience was similar to when a pharmacist tried to tell me that cockroaches are friendly and that we can coexist with them- not so much.

(My discomfort with bugs gives the Kenyans something to laugh about, and I think I actually am gaining more of an appreciation for all creatures and “nature” type things. The Kenyans see a purpose for everything- every animal, every plant, and every insect. This perspective helps me to appreciate the little things, and I find myself “stopping to smell the roses” more often than I used to at home.)

Back to the cave adventure- after we made it out, we continued on our journey up the hill. This hill was very steep, and to say that we were all out of breath would be an understatement. We were at an even higher elevation at Kakamega, and our lungs definitely felt it. When we got to the top and turned around to look at the view, we experienced a different kind of breathlessness. It was literally breathtaking. You could hear the noises of the rainforest (monkeys, exotic birds, etc) along with the sound of drums of local people going to church. The scene changed every few minutes as the sun rose higher into the sky. We could barely see Mt. Elgon from a distance, which is a famous mountain in Kenya. I could imagine us hiking underneath the canopy that I was looking at. The rainforest is a pretty mysterious place, and it’s fun to imagine what is going on in the depths where no one is hiking or disturbing the peace.

After enjoying the sunrise, we went back to Rondo for breakfast and then departed for a longer four-hour hike. This hike was even more physically challenging than climbing up the hill, but I learned a lot. I think the guide enjoyed a few of my questions and reactions as well. I asked what kind of predators monkeys have, and he gave a horrifying explanation of how large birds swoop down, kill monkeys, and take them to some place where they eat their intestines and leave the rest of the carcass for some other animal to finish. I think our entire group was silent for a few minutes and tried to pretend that we didn’t know that.

Along with learning about animals, our guide was extremely knowledgeable about the plant life and various uses for certain plant species. He knew the scientific and common names for all plants- really amazing! Many plants had medicinal purposes (e.g. healing painful/red eyes, improving lactation, healing digestion problems, etc). One plant even had a historical use as nail polish! This definitely caught my attention, and Smith (our guide) demonstrated the nail polish on Will, which was hilarious. Will had a neon orange pinky nail for a while after that. This “nail polish” was used by women before marriage many years ago. This was of course my favorite plant.

Our Kakamega adventure was exciting and memorable. We got to learn about some of the nature in Kenya and get a 10 mile work out in one weekend!

A Week in Kenyan Psychiatry

This week I have been working with Mei, a clinical psychiatric pharmacist from New Jersey. I am doing a research project with her, so I have enjoyed getting to know her and learn from her as well as the Kenyan psychiatry team. The psych ward is separate from the rest of the hospital. There is a fenced in yard-like area where patients can hang out and a separate sleeping area. The patients are not allowed to leave, and most of them have very tattered and worn clothes. The most common disease states seem to be schizophrenia and bipolar disorder, which are both managed with olanzapine (Zyprexa®) and maybe carbamazepine (Tegretol®).

When Mei and I first walked into the psychiatric “ward,” the patients pretty much descended upon us. One of them thought I was God, and another thought I was Obama. No joke. Most of them were extremely friendly and welcomed us to Kenya. A few patients asked if I could bring them home with me or buy them a plane ticket to America.

After chatting for a few minutes, we began rounds. In the psych ward, rounds did not consist of visiting various beds, but rather all the doctors and students gathered in one room and patients came in one by one to be interviewed and assessed. The physician (Dr. Atwoli) that was in charge did an excellent job teaching and explaining how to go about making diagnoses of mental disorders.

One patient claimed that she was on her way back from working in Sudan as a Queen Police, and her grandfather owns an oil refining company and has a computer that can predict the future. Another patient believed that he was Adam and that the Bible was written about him and all people came from him. Someone else said that God speaks to her and gives her direction and she is a prophetess; she speaks to others and sings and teaches them. These are all known as grandiose ideas, and they are very real to patients. Many of the patients would get quite upset if you argued or challenged their powers or positions. These are mainly characteristics of bipolar disorder (specifically manic episodes).

We saw a different kind of patient that would simply sit quietly with a single fixed facial expression. Many of these patients heard voices; some heard God, others heard Islamic figures that were dictating his religion. The person who heard Islamic voices wore a towel over his head and applied other practices. The expressionless face is known as a “flat affect” and is common in psychotic disorders (as opposed to mood disorders) like schizophrenia.

I enjoyed learning about these mental disorders, and I wish that there were more medications available for mental health. It is vastly undertreated and almost neglected in this setting. The biggest problem is a lack of resources, but the need is definitely there.

A Day with Dr. Joe Mamlin

On Wednesday, I was able to go to Mosoriot Clinic (a rural outpatient clinic). I bet you are wondering who Dr. Mamlin is- he is the person who started the entire AMPATH program. He originally came to Kenya to help develop medical schools, and his ideas progressed into the massive life-saving center that it is today. He has given himself to Africa and to the people here. I was amazed at his interaction with patients and his generosity. Patient and other health care professionals respect him, and he shows great humility when he practices. He is never condescending but considers the patients and other team members equal or even more important than himself. His generosity ranges from financial to medical to emotional. He has a couple of adopted Kenyan sons, and I have enjoyed getting to know them as well.

The Mosoriot Clinic was made of typical offices like doctor’s offices. Since it is in a rural area, many patients have to travel long distances to get to their appointment. Travel can by tiring and expensive, so Dr. Mamlin offers travel assistance and encourages the patients to come to their appointments. I was very impressed at the number of patients that are willing to pay to receive treatment from this local AMPATH site.

The target population is people with HIV, but it is not limited. I was able to see patients walking, smiling, and healthy that were originally brought into the clinic in a sack and taken for dead. With the correct HIV therapy and nutritional support, patients can live many years and be happy and healthy. I saw another patient who unfortunately lost her vision, but she survived Karposis Sarcoma of the mouth (a very serious mouth cancer secondary to HIV) though chemotherapy and is successfully being treated with antiretroviral therapy for HIV. Seeing this progression in patients and seeing patients who are walking and healthy was inspiring and encouraging.

The hospitals are just filled with sadness sometimes, so I felt refreshed and uplifted after seeing this clinic. There is a kitchen at the clinic where the staff is invited to eat. I was invited to eat lunch there, and I got to experience a very traditional Kenyan meal. It consisted of Ughali (corn flower and water), greens (kales), and some type of meat. I was able to eat it, but it was definitely different, and I think the rest of the staff enjoyed watching me eating their food. I definitely heard a few chuckles in the room.

After clinic, Mei and I went on a little shopping trip in downtown Eldoret. There is a souvenir shop where Sonak is very well known, and they owner, Robert, expects his students to come each time they are here. I found some amazing souvenirs and enjoyed learning about some of the Kenyan artwork. It was definitley a successful shopping excursion!

Dodgeball and Rock Band

On Thursday, everyone went over to Sonaks and played a brutal game of dodgeball. This game was not for the weak or weary! It was actually quite a workout, and I think we all came out with a few bruises, but it was a great time. One of our guards played with us, and he had the most powerful throw out of anyone. Too bad I was on the other team! Actually though, we won most of the games thanks to Sonak.

Later that night we went over to Sonaks and tested our musical abilities with Rock Band. It was a blast! We all had a chance to play the guitar, drums, and sing- yeah- the singing part wasn't so great for me, but it was still fun. A nice night at the IU House :)

Friday Adventures

We always have Friday afternoons off, and this past Friday we decided to take a trip to the Imani Workshop. The Imani Workshop is a place for HIV+ women where they can work and make crafts, etc. We got a tour of all the different craft stations, and it is truly an amazing place. The crafts range from making beads (either out of magazine pages or clay) and jewelry to making paper out of papyrus that turns into journals, cards, bookmarks, etc. There is also a sewing station where they make blankets, bags, clothes, etc. Imani is such a great place because the people are able to have a sense of accomplishment and make thier own profit. It also serves as a support network, as the women can talk and share their struggles and successes with each other.

Our tour guide modeling the jewelry made out of Oprah magazine pages. They use Oprah magazine because it is very colorful and has a good texture to make beads out of. How creative!

We normally go out to eat on Friday, Saturday, and Sunday, but we decided to cook on Friday. We made pizza! We bought some plane tomato paste because that's really all that was available, so we had to do some work to spice that up, but it turned out just like American pizza sauce! Will is mainly responsible for that. We bought dough, mozerella cheese, and were set to go. We definitely stuffed ourselves- that is probably the most full I've been since I've been here.

There were lots of other people also cooking in the kitchen, so we got to help them prepare a Kenyan meal as well. We helped make ughali (a mixture of corn flower and water) and chapati (similar to soft tortilla shells). It was a lot of fun!

My attempt at making chipati. So fun!

Will making Ughali- this takes a lot of strength! It's very difficult to stir!

Aside from the pizza, we got to witness the common practice of Kenyans eating the flying termites that come out after a big rain. They catch them, pull the wings off, and eat them- they even sell them at the local markets! I don't think I will be brave enough to try that one, but apparently they are full of protein!

Benson is one of our best Kenyan friends, and here he is demonstrating the nutritious value of the flying termites that come out after the rain.

Last night, one of our Kenyan pharmacists took us out in Eldoret! We went to a couple bars/clubs (The Black Ball and Spree) and got to experience more Kenyan dancing- they are so good! It was really fun to get to meet more people in a social setting- I'm glad we stayed in Eldoret this weekend because we got to hang out with a lot of people here and get to know them better.

And today... the 4th of July!

I have been working on blogging and cooking all morning. We are having a 4th of July barbeque, and I am bringing Mr. Muether's mac & cheese recipe, and also some baked mostaccoli with our leftover pizza sauce. Updates to come on our little party! I couldn't find the resources to make a flag cake, but I am sporting an American Flag t-shirt just like we always do at home!

More pictures and updates to come- love to all in the US!

Week 3 Update

Greetings! It has been a busy third week here in Eldoret. Our preceptor, Sonak, returned from South Africa and brought with him his girlfriend and colleague (both pharmacists). There are now three pharmacy students, three American pharmacists, and three Kenyan pharmacists; one student to two pharmacists is a pretty good ratio- what an amazing opportunity to learn from so many professionals and resources!

It has been a pretty typical week in the wards. Some days we have 25 people rounding on patients, and some days we have 5 people rounding. There is something to be learned during both types of situations, but I must say that it is easier to communicate within a smaller team. I have made a new habit of ending every day in the pediatric ward. After work or when I need a break, I go over to ped's and find a child or baby and talk to them or hold them. Sometimes in the adult ward I feel hopeless and powerless. The situation itself and conditions are so overwhelming that it is difficult to focus on how you can medically help the patients. Some things don't seem so complicated in pediatrics, though. I do not have to speak Swahili to comfort a crying baby. I simply hold them and smile. They are friendly, positive, and stronger than most adults. I could have had the worst day in the world, and their smiles turn it around every time. I have made friends with one particular baby who cries a lot, and another child who often holds the baby. The older child's name is David, and I bring him cookies every day. This morning when I was walking to the hospital, he saw me and came running up to me. I forgot the cookies, but I brought them back after lunch and found him. He's very quiet but I enjoy seeing him every day.

We had a patient discussion this afternoon with the pharmacists, and much of our discussion revolved around malnutrition. I cannot describe the appearance of a wasting patient, but they really do look subhuman. I'm sure most people have seen commercials or Internet pictures of people wasting away to nothing, and the pictures are not exaggerated at all. There are nutritionists at the hospital, but it doesn't always take a nutritionist to know that a patient needs protein, so Sonak gave us permission to do "Banana rounds." We can bring leftover food, bananas, etc. back from lunch and feed the patients in the afternoon. Will has a particular patient who is extremely wasted; he brought the patient bananas and water today, and when we checked on him later, he was eating and drinking. These experiences are helping us to think "outside the box," as something as simple as food may be much more important than medication. Health care professionals have a variety of roles beyond their specialties, and they are all important aspects of patient care.

Aside from medicine, we have also experienced some more Kenyan culture this week at Karaoke! We went with one of our Kenyan friends, Waf, to Karaoke on Tuesday night- what a blast! All of the karaoke songs were in English, and it was so funny to hear them in Kenyan accents. The styles ranged from Celine Dion to pop to rap. Will and I performed the theme song from Fresh Prince of Belaire- a classic!

Waf and Will at Spree for Karaoke night on Tuesday! This may become a weekly event...

When we participate in excursions and events like karaoke, one cannot forget about the transportation. Each time we ride in a taxi we are taking somewhat of a risk, and each ride makes for a good story. There are really now rules or laws for drivers or pedestrians. It's kind of like driving a boat where you all just look out for each other and are aware of your surroundings. We have had a couple of instances where our taxi broke down. For some reason, some of the cab drivers do not like to keep a full tank of gas, or even 1/4 tank of gas, so we think he ran out of gas. The driver always claims that there is some kind of mysterious problem with his car, though. Anyway, this afternoon we were driving home from a store, and the car broke down... again. Will had to get out and help the driver push it to a mechanic- Messai and I were a little nervous but just laughing in the back seat. Messai got a hilarious picture of Will- I guess he got his workout for the day!

Well, it's bed time for me. I am getting up early to run tomorrow, go to the hospital, and then we are going to Kario View for the afternoon. It is a park type area with a beautiful view of a valley, so we are excited for a little relaxation and sight seeing. Saturday we will be leaving for Kakamega Rain forest where we can see various species of plants, snakes, birds, insects, and go on a sunrise hike. We may also go on a medicinal hike to see what types of plants are used for medicinal purposes- Updates to come when I return.

Hope all is well at home. Love to all in the US!

P.S. I am still working on downloading more pictures and posting a link... I haven't forgotten :)

The Equator and Nakuru

What a weekend! We traveled to Nakuru for a safari and had some great adventures!

Our journey began on Friday afternoon when our Van came to pick us up at the IU House. A total of five of us went, and we had a 10 passenger van, so we had plenty of room. We departed around 12:30 in the afternoon. I sat in the very back, so I was lucky enough to experience the true bumpiness of some of the Kenyan roads- imagine some of the Illinois roads, turn them into dirt/gravel, and multiply it by about 1,000. Quite a ride! You have to weave back and forth to try and miss the potholes- it's almost like a game.

Our van- This one was private, but public vans like this are known as Matatus.

It was about a three hour journey to Nakuru, and we were all sleeping, when Will calmly said, "Hey we just passed the equator," like it was no big deal! Two of the girls with us, Andrea and Brittany, started screaming saying "You have to go back! You have to go back! We'll pay for more time!" It was hilarious! Salem, our driver, was quite the trooper and took us back and let us look at the souvenir shop too. I think he might have been a little startled and probably thought we were insane. We were right on the equator- in the middle of the world! I kept wanting to run back and forth- it was really cool! We didn't even know we were going to pass it on our way to Nakuru, so it was a great surprise! Plus I was happy to take advantage of my first shopping opportunity at the souvenir shop.
The official sign of The Equator! Right in the center of the world...

The three Purdue Pharmacy students ON the equator! (Messai, Will, Mallory)

This was the sign on the other side of the road when you're going the opposite direction (from south to north)- I think the north to south sign was cooler.

After enjoying our time at the Equator, we continued on our journey to Nakuru. We arrived a little late, so we missed our afternoon game drive (when you see the animals), but we took a long drive (6 hours) on Saturday. We stayed at the Lion Hill hotel, and made good friends with the receptionist, Esther. When we got to the hotel, she upgraded us to the suite! We had our own little house with two bedrooms and a common living room as well as a porch where they kindly lit a fire for us in the evening after dinner. Will, Messai, and I shared one of the rooms, and it only had two beds, so they said they would have another bed in the room by the time we got back from dinner. Well, they did have a bed in the room, but they pushed all three beds together as close as possible in order to fit in the mosquito net (see picture). You can imagine our reaction when we walked in the room; we all just stopped and started cracking up! We felt like little kids- and of course I was in the middle bed- definitely a good story.

This is our suite! See the fire place on the left, and two rooms connected by the living area in the middle. We were definitely grateful for the upgrade!

Our three beds all pushed together- too funny! At least we didn't get any mosquito bites!

There was a traditional dance show at 7pm, so we watched that before dinner. We even danced with the Kenyans during one of the songs! They tried to teach us one of their dances, and I think this was probably pretty hilarious for them, considering our dance skills. The music and dancing was really amazing though, and I enjoyed learning about a different culture that has a deep appreciation for art and music.

The Traditional Dancing at the Lion Hill hotel.

More traditional dancing...

My attempt at the traditional dancing- it was pretty fun and definitely freeing- I can see why dancing is so popular! I know it was pretty funny for everyone else too!

Following the dance, we enjoyed a buffet dinner with lots of desserts! Sweets are not a large part of the Kenyan diet, so we all binged on anything sweet we could find. After we were stuffed, we went back to our suite and sat outside by the fire. It was very relaxing, but we were always on the lookout for wild animals or glowing eyes in the bushes, considering we were in the middle of a national park with wild animals. It almost felt like Jurrasic Park.

We woke up the next morning and ate a wonderful breakfast and began our 6 hour game drive at 7am. Early morning is the best time to see the animals because they are out and about since it is cool outside. At first we saw water buck, impalas, gazelles, and other deer-like animals. They were really interesting! We also saw baboons and warthogs, which were one of my favorites. Whenever I saw one, I thought "hakuna matata," which is a Swahili phrase meaning "no problem" and is actually said here!

Later in the morning, we were driving by some open fields with impalas, zebras, etc. Our driver, Peter, noticed some vultures in the trees and he told us that the lion was near and the vultures were waiting for the kill. We then started an exciting lion hunt and even did a little off-roading to see some carcases up close. Some vultures and other birds were feeding on the left-overs, but there wasn't much left at all. We didn't see the lion on this drive, but we actually saw it on a tree on our way into the park. This was an accidental viewing, but it was great! We were so glad to see it, and apparently it's not too common to get a glimpse of the lions at this park.

Back to the carcases... we were driving up to a certain carcass, and we all got our cameras ready as we got closer. We were anxiously awaiting to get a glimpse, but as we got closer, a massive swarm of flies invaded the van. I cannot begin to describe this, but the flies were so dense that we were blinded. You could hardly see! Needless to say, we didn't catch this on camera, but we were closing the windows and covering up trying to survive the fly attack! As soon as Peter got us out of there we started laughing, but wow- that was gross!

We also went to Flamingo Hill where there were literally thousands of flamingos in this lake. It was a beautiful sight, and I couldn't wait to get there. When we arrived, however, we discovered that flamingos don't smell very good. We were able to get out of the safari vehicle and walk around by the flamingos. It was such a neat experience and a beautiful sight to see a sea of pink. We took some pictures, enjoyed the scenery, and were on our way again. As we were driving away, we saw a hyena prey on a flamingo. We stopped and watched it devour the flamingo. I don't mean to be graphic, but it was quite a site- just like the discovery channel!

As we proceeded on our drive, we saw rhinos, elephants, and more animals mentioned previously. We got within 10 feet of a giraffe and probably within 15 feet of a white rhino. They are truly amazing creatures, and I felt surprisingly safe. I think the animals were used to people coming through, and they respected the cars just like we respected (or feared) them.

I am going to make an online photo album and post the link on the blog, since I took about 450 pictures during these adventures! I will try to get these up soon so you can see the wildlife!

Off to bed for now. It was a great weekend- a nice little African vacation :)

Love to all in the US!

Orphans and Vulnerable Children (OVC)

Today was a very special day. I had the opportunity to work with the Orphans and Vulnerable Children program (OVC) associated with AMPATH. OVC helps orphans and struggling families to get back on their feet by providing food as well as teaching skills such as how to raise and sell chickens/eggs, farm, manage money, etc. The projects are sustainable and help the families make their own living again. OVC also places children in schools and childrens' homes if needed.

I was able to work with Elizabeth, one of the administrators of OVC. We went "on the field" (to families' homes) with a Kenyan social worker and a Kenyan community health worker. The community health worker is responsible for identifying the families and/or children that may be potential candidates for OVC. Then, the social worker and Elizabeth go visit the family and assess the living situation.

Now, when Elizabeth told me that we would be doing "field work," I did not take this literally. However, after hiking through cornfields, forest, rivers, rocks, and trees, I realized that she was quite serious. After a short hike, we arrived at a small hut with a family outside. The grandfather greeted us, and everyone, including the children, shook our hands. (This is customary in Kenya and it is considered rude if you do not shake hands.) The grandfather pointed at my hair and laughed- I don't know if he has never seen blond hair before or if I was just having a bad hair day. Anyway, we sat and talked to the family for a few minutes and the children sat quietly and played with each other. Their clothes would not even be considered rags by American standards, but they were happy, clean, and did not appear malnourished. Their home consisted of a single circular hut made with dirt, clay, manure, and sticks/hay (I forgot the real name) for the roof. The inside was completely bare except for some more clothes/blankets hanging inside and a stove made of the same material as the hut. The stove was like a miniature cave where a fire would be started, and the rock above it would get hot where a pot could be placed for food. I remember standing in the hut and looking around me; I was seeing everything first-hand, yet I could not comprehend someone living in these conditions for years- and happily! It was truly amazing.

Back outside the hut, I gave the children one of the dolls I brought that were made by the Libertyville High School swim team. When I offered it to them, the oldest boy was scared at first. Eventually, he approached me and accepted the doll. His siblings all gathered around and they examined it and played with it. They were so happy, and the oldest boy held the doll so tightly. As we finished our visit and I was walking away from the hut, I looked back and the mother was holding the doll showing all her children who had gathered around and were touching it with huge smiles on their faces. I wish I had brought more dolls with me on this visit, but the joy that they showed with even one was truly touching. I hope that the doll can bring them comfort on rainy nights like tonight or stimulate their imagination when they are playing during the day.

I was also able to visit Brook of Faith school during my OVC visit. Children live at this school and attend classes with each other. It is a beautiful little school, and they are currently trying to fund a soccer field. These children are fed three times a day, and they have the potential for a successful future through this community support.

The surrounding lands were beautiful. I remember all the hills and rocks that we saw during the drive. Remember the big rock on the movie The Lion King? Where they sang The Circle of Life? (I know you remember this Hanna!) There was a rock just like that here! It was just like the movie- I didn't have my camera, but watch the Lion King and you'll see :)

The entire experience felt like a dream. You can see these types of conditions on TV or hear about them, but it is completely different seeing it first hand. I am trying to grasp everything I saw today. Elizabeth told me that you can't solve poverty, but you can help a family make the best out of their current situation. Education is a powerful tool, and school for these orphans is their big chance for a way out of poverty. Children are strong and positive, and when I walked by they would all smile, wave, and giggle.

I hope the best for them, and I hope to be able to help more families during my time here. We are so blessed, and I will definitely think twice before I complain about not sleeping well or food or studying too much whatever. What a great thing to take joy in what you have and in the people around you! Today was both challenging and rewarding, and I will remember it always.

More soon.
Hope all is well at home!
Love to all in the US!