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30th January 2006

Kenya continued…

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Hi Everybody!

First of all, thank you, thank you, thank you for all of your congratulations! They made me smile. I was glad to have a few of you express regret that I was moving across the country—otherwise, I would have thought that you were just overjoyed to get rid of me! To answer a few of the questions, yes, I did want to go to Milwaukee, it was my first choice (and I was overjoyed to find out that I was theirs), they are a great program, and as nervous as I am to leave, I don’t regret for one minute ranking them first. It’s going to be a good thing for me.

I realized this weekend, that while I have been emailing and updating in terms of my match stuff, I really haven’t written about being in Kenya for a while. Part of that’s due to the fact that I came down with the “Nature’s revenge” and spent much of last week, feeling like I couldn’t sit for long periods to even email. But Cipro is magic and I’m doing much better now.

Lake Nakuru last weekend was amazing. It’s a small park that’s actually completely fenced in because the city, Nakuru, is honestly only a few kilometers away. It surrounds a soda lake that is home to hundreds and hundreds of flamingos. I have pictures that look like it’s of a pink sunset—no, it’s the flamingos in the distance. We went on 3 game drives. The first day was rainy and cold and there weren’t a lot of animals out, but the other two were packed with animals, like white rhinos, giraffes, buffalo, jackals, warthogs, etc. Didn’t see any cats, no lions or cheetahs, but we did hear the lion and went out looking for them, but they stayed hidden. There’s only one pride of lions in the park—apparently a few months ago, a lion killed a guard and so they poisoned all of the lions. I couldn’t believe it; they didn’t even try to move them to a different park or anything. So, we were bummed about that—I think Rachel is still bitter. I don’t know if the parks down in South Africa even have lions, so I might miss seeing them. It’s quite a different experience doing a safari, because I don’t know about you, but when I see wilderness, I always want to get out and explore and I couldn’t do it. Frustrating. But I was good, although I was really tempted to get out and become bait to lure the lions out. 😉

I took some amazing pictures, which I’ll try to attach or upload to a website. Unfortunately, the battery to my camera completely died, which has definitely put a damper on my budding photographer career. Luckily, it happened last weekend and not later, and I got it added to the list of things that the other medical student’s husband is going to bring with him. He supposedly left this morning (your time), and Karin reportedly dropped it off, so hopefully all is well that way. I did buy a disposable camera, but they are very expensive here and without a zoom, so my pictures aren’t as awesome.

We have every weekend off (very very nice!), so this weekend’s trip was to the Kakamega Forest, about an hour and a half south from here, very close to the equator. It’s a rainforest, that is actually the most western part of the Congo, which I found fascinating. Once upon a time, it was populated with elephants and lions and leopards (oh my!), but they’ve either migrated to other areas or have been poached so it’s rather safe (still has snakes). We stayed at a gorgeous little lodge that had been built by some Catholic monastery as a retreat and it was truly beautiful, surrounded trees and exotic birds and monkeys. I would have like to stay there all day, just soaking in the sun and peace and quiet, but the others had different ideas. So the first day, we went on a 3 hour hike up a volcano… and then right back down, which completely wiped me out. Yesterday, we did a four and a half hour hike to the Yala River, which actually flows into Lake Victoria—which also wiped me out. Don’t get me wrong—yes, I’m out of shape and have these bone problems that make hiking more difficult and painful on a baseline level, but I usually don’t complain too much if there seems to be a purpose to the hikes. But in both cases, we stayed at the goal for mere minutes once I got there (of course, since I was struggling, I was at the back), barely enough time for me to catch my breath and cool down, much less appreciate the scenery. Plus the trails were rather slippery in parts, with hidden branches and roots and I spent more time staring down at my feet— I twisted both ankles, the left one twice, thudded down on my knee wrong several times, almost slipped off the trail into a ravine once (and that was the second “walk” which was for all purposes easier. We won’t talk about the straight down slide that we did yesterday down the volcano.)—than I ever got to look up. So I missed most of the monkeys and birds, precisely the reason that we were hiking. Last summer, Mom, Dad and I went on a good long hike in the mountains of Idaho/Oregon, and it had some challenging parts to it, so by the end, I was exhausted—but once we got to the water and the rapids and that gorgeous, crystal blue pool, we stopped and thoroughly enjoyed it, making it all worth it. All in all, this was rather disappointing, and instead of feeling proud of my accomplishments (the volcano was huge, people, with absolutely no trees), I was cranky and exhausted and just weary. I had to hold back a hysterical snort when Rachel stated that our trip had been “very relaxing”; our definitions are very, very different! The bed was, however, the most comfortable thing I’ve slept on since coming to Kenya.

The area was beautiful with wild banana trees and more varieties of flowers than I’ve ever seen. And I did see all four varieties of monkeys—plus baboons! So I guess I should stop complaining. Every muscle of my legs hurts today. With every movement, I’m reminded of the numerous anatomy lessons and remembering which muscle attaches where. Ouch.

The wards have been difficult this past week, partially because of my little illness. And the mouse that infests the nurses station. And the never ending suffering and needless death. But it’s been really good as well. I’ve worked several times with the neuro resident, doing neuro consults, which I love. We’ve seen some very interesting pathology. I also worked one day in the HIV/AIDS clinic, where I got to do all of the physical exams. By myself. I diagnosed tuberculosis, PCP and kapowsi’s sarcoma—it was awesome and scary (to think I’m going to be doing that all of the time in just a few months!). It was wonderful to see all of the good that is being down—only a few years ago, it was difficult to get a person in to be tested for HIV, much less get the drugs that they needed because of the stigmas and the costs. But now, they’ve set up several clinics all over, where patients can get the drugs for cheap—and these people are taking the meds and getting better. We saw patients who had CD4 counts (that’s the white blood cell that the HIV virus attacks. Normal ranges are in the 800-1000 range) below 100—one lady had a count of 6. I couldn’t believe it—and who were pretty sick, but we started them on medication and within a few months, it would pop up to 250-300. It was great to see the people who weren’t coming into the hospital and doing good on their meds. It was refreshing to see that not every person in Kenya is at death’s door.

We’ve had several patients die this week too. The most heartbreaking was a 15-year-old, who’s liver and kidneys just suddenly stopped working—and because of the lack of proper tests (no such thing as a CT scan of the abdomen or most blood panels), we don’t really know why. She could have survived if we had been able to dialyze her, but it cost too much and would require a transfer to Nairobi. She died in the night. Next to her is a patient with almost the same exact problem—only she’s a little older and the failure is not as complete—and she’s quite upset now, having watched the girl die and us not being any closer to figuring out what’s wrong. We’ve ordered an ultrasound of the abdomen three times now and it hasn’t been done yet. We don’t have any crisis workers or grief counselors here to help with the emotional side of things. It can be very frustrating all around at times.

I changed clinical teams this morning. I will be working on the men’s side with Leigh Anna and Dr. Granger from Utah. It’s going to be a good change, I think. Still frustrating in the fact that we don’t make much of a difference, but I think the teaching will be better and it will be good to have a different population perspective. So far we’ve had a patient with leprosy, kapowsi’s sarcoma of the feet, hepatocellular carcinoma, and three patients in comas. It’s going to be an interesting time.

I do love the people here. The people who impress me the most are the family members of our patients, who come in every day, bathe them, feed them, sit by them, take care of all of these basic needs that back home would be taken care of by the nurse. There’s worry in their eyes, and yet they never ask what the prognosis is—they just do what is needed. And while most of the women are still reserved and quiet, the children more than make up for it. On our drive back from the forest yesterday, the streets were filled with children who all waved and yelled “jambo” as we passed and everybody’s sweet with my very hesitant Swahili. I’ve been “accosted” once in Eldoret, where one guy was running his hands up and own my arm saying that it was “so soft” and then dragged me towards a bus (matatu), but it was pretty benign. And no mention of my red hair. *pouts* I thought I was supposed to be hailed as a demigod or something!

On Friday, we went out to dinner with the two fourth year medical students from Kenya who are coming to Utah for a rotation. The two girls seem very bright and very nice and we are trying our hardest to make the transistion as smooth as possible. They’ll be coming in March. I’ve also ran into the medical student who lived with Chris for a month last year—he’s offered to take me to meet his family but they unfortunately live too far away. It’s too bad—I might have come home with several cows offered for payment of marriage. 😉

I know that my first emails, I mentioned that I felt that some of the people here at the IU house have been more distant and hard to get to know. Most of those people have no left—the turnover rate is quite astonishing, and it’s a very diverse group that’s here now. In addition to the residents from IU, Brown and Utah (I think the other schools are all gone now), we have several older physicians—a Heme-onc doctor, a pediatrician who specializes in infectious diseases—and their wives staying here, a bunch of people who are working with the Amanti project, which is a project that allows people with AIDS to work on crafts and sell them, so that they can support their families, and a half dozen more that I have no idea what they do. The residents who are left are some of the warmest, fun people to hang with, and I’ve really enjoyed working with them. We’ve remarked several times that a lot of this feels like summer camp—people from all over getting together, participating in activities and late night chats, and then leaving with the promises to write (or in our case to send all of the pictures that everybody took, so we can get the best looking ones).

I’ve been taking Swahili lessons! I think I told you all that, but I’ve been taking 1-2 lessons a week. We just started learning medical phrases! So far, we’ve really only been learning phrases, rather than how the grammar works (and I haven’t been able to puzzle it out), and while I’ve learned phrases to ask where it hurts and such, I haven’t really learned the responses, so I’ve a ways more to go. It is a lovely language though, and I love the vowels—extremely simple!

I don’t know how much you all have heard about what’s going on in Kenya/Africa right now, but I do suggest that you look up BBC-Africa online, if you have time and or interest—most American newspapers don’t mention what’s going on here. Last week, one of the buildings in Nairobi collapsed, trapping about 200 construction workers, and worse, wives and children who were coming to feed the workers for lunch. It’s been a big deal here, in all of the newspapers and we’ve all been closely following the developments. There’s also a huge drought and famine in the North that is causing a lot of problems throughout the country—distress and political unease. Everything is stable right now, but the people are really looking for the rainy season as a hope to bring an end to the suffering.

Well, I’m headed back to the hospital. We have six LPs and a thoracentesis to do today.

This entry was posted on Monday, January 30th, 2006 at 10:00 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

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