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!