Friday, Nov. 4, 2005
Goosebumps. That was the sensation I felt after receiving the e-mail about the SHARE Kenya program; it was the sensation I felt at the Kenya orientation meeting at Cuyahoga Hospital, and it was the sensation I felt today during the Kenyan fundraiser at Akron City Hospital.
Even before that first email, I felt drawn to Africa. I've always wanted to travel outside the United States and have always wanted to feel the immediate difference I can make in someone's life. I am pleased and honored to be a part of such an amazing program, especially during the 10th anniversary trip.
Honestly, I've never had so many emotions in my entire life: the fear of leaving my family, the drive to help people and the realization that I have no clue what to expect. Despite all these emotions, I know I am ready to go, ready to make a difference. I cannot wait for the trip's subtleties to unravel.
Wednesday, Nov. 23, 2005
Not what I expected. One of the billboards in Nairobi, the capital, shows the rapper Nelly, and everything is written in English. I expected to feel more "foreign," more out of place. They even have a Kenyan MTV with almost all American music. I was hoping that Kisumu, where we were headed, wasn't so influenced.
From Nairobi, we took a bus to Kisumu, near the northwest Kenyan border. Even just outside of Nairobi, all the buildings grew smaller, metal shanties became more common and poverty began to encompass us. Butcher shops hung entire skinned lambs in the window without refrigeration on a 95°F day. We drove through the gorgeous Great Rift Valley and while we were taking pictures, we were approached by many Kenyan vendors, whom Bonyo told us to ignore. We saw baboons sitting on the side?and in the middle?of the road.
After eight hours of the bumpiest ride I've ever been on, we finally arrived at the Milimani Resort Hotel, where we will stay this month. At the hotel's amazing Kenyan buffet dinner, we were told we will divide tomorrow: those who want to visit the hospital and those who want to break up the supplies, while the medical students will all be visiting the hospital. So, goodnight, and until tomorrow night, God bless.
Thursday, Nov. 24, 2005
Oimore: Good evening
Ero kamano: Thank you
Today was a day of learning. I'm starting to learn Kenyan phrases from my interpreter, Fred, and I want to learn two a day. I also learned the difference money makes for health care in Kenya. A small group of us toured two hospitals. The first was a provincial, government-funded hospital and the second a private, pay-first hospital.
Two things stuck out about the first. One: the unsanitary conditions. There were broken windows, doors wide open, and flies on and around the patients. The hospital had 350 beds and 440 inpatients, and yes, that means more than one patient to a bed. Instead of hospital gowns, patients wore their own clothes, which they dried, along with bed sheets, by hanging them outside.
The second was the severity of certain disease processes. For the first time I saw someone with Burkitt's Lymphoma, an extremely rare form of cancer that affects the white blood cells, which protect our bodies from infection. The cancer responds amazingly to therapy, but the treatment is costly. The boy was probably eight or nine, and his face completely, permanently disfigured. This little boy will never be able to walk through a room without being stared at. It brought tears to my eyes.
The second hospital was a private, pay-first hospital. Only after you paid would they determine when, where and by whom you would receive treatment. The wait at the private hospital was five to ten minutes, while at the general hospital it was four to six hours, even for urgent patients.
This clinic was spotless; only the best. It even had a CT machine (computerized tomography machine) of which there are only three in Kenya. But, again, to use it, patients had to pay first. Also, I noticed something that the provincial hospital didn't have: mosquito nets. So, cancer patients could come to get cured, instead of contracting malaria on top of their condition.
The difference disgusted me. I realize that in the United States there are differences between people with and without money. And yes, pro-athletes and celebrities do have access to "new medical advances" that probably won't reach the public for a while, but overall, our healthcare system treats the majority of people on the same level. I just keep on thinking how I hope to God none of us gets sick here.
?Oh yeah, and Happy Thanksgiving.
Saturday, Nov. 26, 2005
A nindo ma ber: I slept well
Ma ber: I'm well
First day of clinic. They wouldn't let us into the rooms at the clinic. Neither did they leave us benches outside to see patients on, as they had promised. So, we made do with what we had, setting up our clinic outside. We each had an interpreter, but posing questions that could be understood and translated was difficult.
My first patient was a little girl with high fevers, chills and a cough that increased at night. My instinct was upper respiratory infection?flu, cold or even pneumonia?but I had to ask questions for malaria, sickle cell, exposure to mosquitoes and other things that would never come up at home. Then, when her temperature showed up as 103.7 °F, I checked her lungs and found them clear. I consulted the attending physician, and he told me to treat her for malaria. No testing, nothing. Sure, it's highly probable that the problem was malaria and all she needed was medication, but what if she had a parasite or another protozoal infection I could have treated, but missed? My discomfort turned to straight fear. Hopefully during the month I'll become more comfortable with this, but as for now, I'm going to read and study as much as I can so I can rely more on physical diagnosis and history and feel better about the answers I get. Until then, oriti (goodbye).
Sunday, Nov. 27, 2005
Today we all traveled to the Kenyan rainforest, Kakamega. It took two hours with 13 people in the back of each truck, but the scenery made it worth the ride. We could see Lake Victoria in the distance as we drove up the hill and the sounds of singing from the churches added to the serenity.
When we arrived, we took a guided tour through the rainforest and learned that twenty-two types of poisonous snakes, six different monkeys and countless insects live within. Our guide showed us a tree that forms deep pockets (about eight feet deep) as it grows, allowing for birds and animals to keep hydrated during the dry season. The tree is thought to be "magic." If you're lost in the woods, the story goes, simply wash yourself in that water then you will find your way. He also showed us a plant that produces latex-like material used to close wounds. As it happened, a nurse in our group, Patty, had just fallen. She asked if she could try it and the guide gathered a couple of different plants to make a compound. So, we dressed her wound, hiked around looking at monkeys, climbed to a viewpoint, explored a bat cave and left for home.
I still can't get over the beauty of this place, simple as it is. Maybe the simplicity is the beauty of it. One thing that was apparent on day one: our U.S. society takes too much for granted. It's amazing what these people don't have and don't seem to miss. Meanwhile our "modern equipment" does our work while we sit around and eat 4,000 calories a day.
Monday, Nov. 28, 2005
Diche ma ber: good job
It's our second day of clinic, in Masara. This is Dr. Bonyo's village, so we knew we would be welcome. I volunteered to do wound care. When we arrived to the clinic, around 30 children were waiting to greet us.
Today was full of wounds, and I even got to pull a tooth. As we were loading the trucks to leave, I saw a Kenyan family washing their clothes in rice paddy fields. I was amazed that they decided to wash their clothes in such brown water when there's a clean-water well about a mile away. I kept thinking about the parasites they were getting all over their clothes. Then, I saw two little naked boys jump in the same brown, stagnant water and realized why so many children end up with parasites here.
Still, the day was a blessing overall. Thank the Lord today was better. I'm looking forward to tomorrow.
Friday, Dec. 2, 2005
It's been a crazy couple of days. I'm finally getting accustomed to not having labs and back-up, and I've seen so much: a six year-old girl with AIDS, a woman with leprosy, a million cases of malaria, lymphatic filariasis (elephantiasis), and typhoid fever.
In the village of Awasi I saw a lady who was about 70 years old and coughing constantly. She reportedly had been coughing up blood for about two years. She suffered lost weight, decreased appetite, bad fevers and night sweats. I automatically thought tuberculosis, so I asked her if she had ever had tuberculosis, or if anyone she knew had. She answered no to both questions. When I examined her, her lungs sounded horrible, so I decided to send her for a chest x-ray at the nearest equipped hospital. Then I asked if she had a medical book (medical records that hospitals give patients to keep, rather than tracking that information in the hospital). She did, and she handed it to me. After about five minutes of handwriting interpretation (the doctors write in English, which the patients typically don't understand), I realized that not only did this lady have pre-diagnosed tuberculosis, but she had already taken three rounds of anti-tuberculosis drugs, which hadn't worked.
It is hard not having labs and tests to back up my suspicions. It's also hard not to become frustrated with the patients' lack of education, and the general lack of materials, resources and communication. Still, I believe we're making a real contribution to the Kenyan people. Better to come see the Americans for free than to need money up front (which they don't have) to end up waiting in a hospital, getting more sick before they get better.
Friday, Dec. 9, 2005
In the clinic, a man told me that in the past they had catheterized him. He was having trouble starting and stopping his stream, and had a little bit of pain. He also had severe abdominal pain and a huge abdominal mass. Maybe prostate cancer or a bladder cancer? I consulted attending physician Dr. Bowling (from the University of North Texas Health Science Center at Fort Worth), and we decided to try to catheterize him. Right away a humongous stream came out, and after awhile, the entire mass went down. We decided to leave the catheter in him, showed him how to use it, and set him up with an appointment for a doctor at the hospital. He left completely happy. It was the first time I got to immediately see joy in someone's eyes because of what I did.
Funny, while I was seeing patients and catheterizing this man, I didn't even know that a birth going on. The young Kenyan said she had been in labor for almost 24 hours, and the baby was born before I even knew it was happening. It amazed me I could miss that, but I'm excited that I was able to be so dedicated and focused on my patients.
After clinic, we had the annual SHARE banquet with our translators and local helpers. Translators Hezron and Fred did a comedy skit that sent all the Kenyans rolling, although most of us "mzungus" (white people) couldn't understand it. One translator, Victoria, sang, and another, Lorraine, made a speech to thank us all for coming to help their country. She said we would never understand what a difference we had made in these people's lives.
Also, the food was delicious. I ate the tilapia, which they serve de-scaled but otherwise whole. The first time I ordered tilapia, I ate only three bites, shocked by the whole fish on my plate. Then, Debbie Meyer (administrator and assistant professor of geriatrics) from OU-COM, showed me how to filet it off of the bones. I joked that my goal for this trip was to learn how to filet and eat a whole fish. Today I did just that. Then I cut off the head and enjoyed an amazing meal.
Friday, Dec. 16, 2005
Rhea (Richardson, fourth-year OU-COM student) was talking with Brenda, one of the translators, whose father is a doctor. Right now he's laid off, which I couldn't believe. With the state of health care, I assumed there was a shortage of physicians and that they would use all the help they could get. Instead, the country can't pay for healthcare, and neither can the people. So for every so many patients, there's a qualified physician who's unemployed.
One of the translator's sisters, Mercy, is a nurse. She's hoping to come to the United States because as a nurse in Kenya, she only makes 550 shillings a month (around $8.00). It's not enough to pay her bills and rent each month without help from her father.
Thursday, Jan. 12, 2006
I wish I could get across how amazing and how different it was to be in Africa. Today, I went online for an hour viewing blogs and internet notes people have written about their trips to Africa. Even without knowing them, I feel such a connection.
Although most of us will probably not keep in touch a significant amount, I will always have an unspoken bond with the people I went to Kenya with. And I do feel honored that I am able to be home again.