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!

A Case of the Monday's...

Today was our first Monday in the wards. We did rounds as usual, but there were two consultants (like attending physicians in America) on our team, so all the Kenyan medical students came. This always makes for challenges with hearing and being involved in patient care. I don't think any of our patients passed away over the weekend, but when I was back in the wards in the afternoon, I saw a cart going by. I will find out tomorrow who passed away, and hopefully we can determine the reason. Tomorrow it will be a smaller team because the consultants will not be there.

I think I expected to be able to be directly involved in patient care on day one, but I didn't realize how much personal adjustment it would take first. Everything about the hospital is overwhelming, but I am starting to grasp the system and identify the pharmacists' roles. Each day gets better, and I build a little more confidence after each experience with the help of Will, Messai, the Kenyan pharmacists, and the Kenyan and American medical students and physicians.

I was walking outside this afternoon, and I saw a small boy in a patient uniform, probably no more than six years old sitting on the ground. He looked sad, and I had a couple extra cookies in my pocket, so I gave them to him. He looked up at me without smiling, but I smiled and offered him the cookies. A few minutes later I walked by and he was still sitting expressionless on the sidewalk holding the cookies in his hands. I looked more closely at him and realized that he had sores around his mouth. I wonder if he was unable to eat them because of pain or if he was just saving them for later. If it is too painful to eat, I feel like I was just torturing him. All I can do is keep trying to help though.

Daily food update: We had taco's for dinner! They were great! We have fruit salad at every meal, and that has definitely become one of my staples. I had another good facial expression when I tried to make hot chocolate and realized after taking a sip that it was unsweetened chocolate- just a tad bitter! Nothing a little milk and sugar can't fix though.

Anyway, not much else is new. Tomorrow will be another day of rounds, and tomorrow evening I may attend a Kenyan aerobics class and/or Karaoke night in town- updates to come!
Love to all in the US!

Sunday at the IU House

Today was another relaxing day at the IU House. I slept until about 11am (I'm finally starting to feel caught up on sleep), and then a big group of us walked to The Oasis for lunch. Even a walk is tiring- the elevation really makes you work for each breath! We had burgers, fries, and milkshakes-YUM! The fries were very similar to American fries; the other stuff was a little different, but still very good- although Will said my face was pretty hilarious after I took the first bite of my burger. Still working on my poker face... I really don't mind the food, it just takes some adjustment.

I never really thought about food at home. I mean, if there was something I didn't like, there was always an alternative. I don't ever remember going hungry, and I have a new appreciation for food and what I have been provided. If you don't eat here, you do go hungry. Many patients in the hospital don't get fed, and when they do it is a piece of bread and some tea. I don't think I will ever complain about hospital food in the US. You can see what hunger is on TV or be told what it is like from someone else, but until you see it first hand, it is difficult to truly grasp the concept.

Later this afternoon, we had our second Swahili lesson and learned numbers, which are much more difficult than words and phrases. Tomorrow we will learn pharmacy terminology to help us at work. We ate dinner with everyone at 6:30. It was a big group tonight because a lot of high schoolers on a mission trip just arrived. Dr. Joe Mamlin was also there- he started the AMPATH Clinic and oversees many of the medical programs. He is responsible for many of the advancements that have been made here.

He told a story about how he handles the situations in downtown Eldoret when kids come up and ask for money. He buys loaves of bread from a market and hands the bread out, and the kids literally jump for joy and clap. I guess I have been reflecting on hunger a lot today, but Dr. Mamlin's story was touching.

After dinner, Will, Messai, and I had a study session to help prepare for rounds this week. The disease states and treatments are very complex! We have seen HIV, Malaria, Meningitis, collapsed lungs, cancer, Tuberculosis, and others. So there will be lots of studying and learning this week, and I am excited for the time when I feel comfortable making recommendations and contributing more to patient care. All of this will come with time, and the medical students are a great help. The Kenyan doctors can diagnose someone just by looking at them, and in the US we use many tests to confirm diagnoses. It is impressive how they use their resources. I have also enjoyed working with the medical students from IU- we have met lots of wonderful people this weekend!

Anyway, I am off to bed. Big week ahead- first full work week!
Keep me updated on news at home :) I miss everyone!
Love to all in the US!

The Eldoret Experience

It has been a relaxing and fun weekend. We decided not to go to Nakuru this weekend and stayed in town to get settled in and meet some of the people around here. We have made many Kenyan friends- they are great!

Last night we went to a Chinese restaurant that is frequently dined in by the IU House residents. It was very good, and I'm sure we will go there more. I had chili shrimp- probably one of the best shrimp dishes I've had! Following dinner, we went to a local club called Places. It was actually pretty similar to an American club- there was a bar, dancing, etc. The Kenyans are amazing dancers! I am glad we went with our Kenyan friends- they introduced us to more people, showed us around, etc.

Today, Messai and I slept until about 12:30pm- I think we needed the rest! We studied a little bit so we can be more prepared for rounds and presentations next week, and we also went on a run. The elvation definitely takes a toll on your lungs! The air feels "thinner," so even a small workout is pretty tiring. We ran by some local farms and schools, and a few children ran up to us and said "we'll run with you!" They ran along side us talking for a couple minutes and it was a highlight of the run. We thought we would get lost, but we made it and were pretty proud! Tonight we went to dinner at a club called Klique, and had pizza. It was actually pretty good, and there is a lounge where we could enjoy a Tusker (Tusker = Kenyan beer). We also went here with a Kenyan friend who likes to play basketball with Will. He is a med student and showed us where he lives- it is actually similar to American dorms. I love learning about the Kenyan culture and sharing some American culture as well. Our Kenyan friends are very up to date with the news in the US- in fact they may do a better job than I do keeping up on current events.

I am looking forward to getting to know more Kenyans and residents at the IU House. Everyone has been very friendly, and I know there are more great experiences to come. Messai and I might try to go to a Kenyan church tomorrow morning, or at least some time before we leave here. Will discovered where Obama's Grandmother lives, and we may be able to go talk to her some time as well. Every day we find out about another adventure we can pursue, but we also learned taht staying in Eldoret provides many adventures in itself!

More to come soon. Love to all in the US!

Habari?

Messai and Me at the Eldoret Airport
Welcome to Eldoret! We saw this right when we got off the plane :)

"Habari?" This is the most common greeting in Eldoret, along with "Jambo." "Habari" means "how are you?" and "Jambo" means "Hello." The past couple days have been very intense, scary, exciting, overwhelming, and pretty much every other emotion you can think of. After a long journey from the US to Amsterdam to Nairobi to Eldoret, I am glad to finally be settled in the IU House.

The IU House is a gated community comprised of about eight houses. I am sharing a room with Messai, and I'm really happy that we are roomates and can share our experiences with each other. When we first arrived yesterday, Sonak (our preceptor) picked us up from the Eldoret Airport and gave us a tour of the IU House followed by a tour of the AMPATH Clilnic as well as the hospital ("Wards"). It was pretty overwhelming to see the conditions of the hospital and the patients we would be treating. I am starting to think of a new definition of "sick."

Later that evening, everyone from the IU House (currently about 40 people, will be 70 in July) went to a Kenyan restaurant for dinner. It was definitely a cultural experience, but needless to say I went home hungry- good thing I followed advice and stocked up on granola bars! It was great to interact with the other IU House residents, but the food will take some adjustment. We were served chicken that had burnt feathers on the outside and organs still remaining on the inside and goat meat, which I imagine is similar to chewing leather. I may not have eaten very much, but I was able to embrace the experience and laugh about it with Will, Messai, and the Kenyans. They were laughing at our confusion and watching us trying to pull the chicken wings apart with our fingers, as is custom for them.

Lunches are served at the IU House and have so far been very good. The bananas are amazing, and I am excited to try some other fruits. I have yet to try Tusker (the Kenyan beer), but we may open one tonight to celebrate making it through our first day of work.

This morning, we were thrown right into the medical teams and rounded on the Wards at 9am. On our team, there were about 25 people, including an Attending Physician (aka Consultant), Residents (aka Registrars), Interns, and Pharmacists and Pharmacy students. On this very first day, the very first patient that we saw passed away right in front of us. With the number of people on the team, it was difficult to hear what was being said. I was just looking at the patient, and it dawned on me that his chest was not moving and he wasn't breathing. Without any reaction at all, the Kenyan physician ordered the cart to be brought in so the patient could be taken to the morgue. I kind of lost it and had to step outside for a few minutes. A couple of the med students comforted me and said they reacted the same way the first time they stared death in the face. A simple case of gastroenteritis that could have been treated in the US resulted in death to the patient here.

Even yesterday before we began the hospital tour, the first thing we saw was a person beeing wheeled away on a cart to the morgue. Other people warned me, but I don't think anyone could have prepared me for the amount of death I would see. The mortality rate at the hospital is about 25%, and there are very few days where all patients have survived through the previous night. This is due to lack of medication, lack of service, sanitary conditions, and multiple other factors.

Needless to say, the rounds experience was a little traumatic. I think this will get better with time. I will become more accustomed to the conditions, sights, and smells. I cannot describe the smell other than a combination of body odor, bodily secretions, and another component that I have yet to figure out.

I am not saying all these things to sound negative. I am grateful for the experience to be here and help others; I am just processing some of my own challenges as well. I know I am where I am supposed to be right now, and I am eager to help as best I can. I plan on ending many days with a short visit to the Sally Test Center, which is a Day Care Center for children. There is nothing better than going in to see the smiling faces of the children or holding a baby. The kids have been through more by the age of 4 or 5 than most people go through in a lifetime. They make each day worth it, and I'm sure they will provide some good stories!

Alright, time for me to head out to Nakuma- the Walmart of Kenya!

More stories to come soon- I may be going on an adventure to Nikuru this weekend (a game hunt/safari)- and we will do the BIG safari in July, as it is the time for the Wildebeest migration!

Love to all in the US!

Arriving in Nairobi

I am blogging from the hotel in Nairobi! I made it! Now I get one night of rest at the hotel (which is very near the US Embassy), then the last flight (only one hour long) from Nairobi to Eldoret tomorrow morning. My computer battery is almost dead, so I will have to fill everyone in on the journeys of our flights tomorrow. Everything went smoothly and we are safe!

Taking Off!

In just a few hours I will be in the air heading to Kenya! My final destination is Eldoret (see map). There is lots to do this morning- finish packing, make sure I have all the paperwork in order, etc. I can't believe the day is finally here! I am excited and have some butterflies, but I know it will be an amazing experience. Getting there is the hardest part!

Thank you (Asante sana- swahili, the main language) again to all my friends and family. Your love and support is what will get me through my time in Africa. I will be thinking of each of you every day.

Well, I better get everything organized and ready to go. Talk to you from Kenya!