I the day rotating through the general and trauma surgery wards. I have not [yet] shadowed surgeons in the US, so I am unfortunately able to com First thing in the morning, I was most surprised to see several policemen (armed with machine guns) surrounding a young child with a severely swollen abdomen and several bruises on his face. I later learned that he had been abused by his mother, and would be taken to a shelter after surgery.
One surgery had to be rescheduled because the hospital was low on potassium solution. The surgeons informed me that this occurs at least twice a month. Orthopedics allowed me to see engineering meet medicine, and I was amazed by the level of creativity surgeons must possess in the "simplest" of fractures. Leg braces were stabilized by actual weights (i.e. standardized hunks of metal) hung at calculated angles. One individual has the job of conducting these calculations; to be qualified for his job, he had to complete a one-year certificate program after high school.
One patient was leaking fecal matter and fluids through an abdominal tear. Surgeons repaired the tear, created a stoma until the point of surgery heals completely, and told the patient to come back in 3 weeks.
Another was brought for a post-surgical follow-up. He had been born without an anal opening. Surgeons created the opening, but he had to return every day for a period of three months so the anus could be dilated with a standardized piece of metal. There were four additional patients throughout the day who needed this procedure. The last was unable to pay for future visits, so the surgeon gave her the instrument to take home and do at home. This woman was more comfortable in my native tongue of Hindi, so I discussed with her the importance of continuing to use the instrument even if it makes the child uncomfortable--the anal opening would clinch shut and another surgery would be necessary without daily perturbation.
At the end of the day, we booked the operating theather for three patients. One had a worsening aganglionic megacolon and would undergo a colectomy. Another had hypospadias and needed surgery due to fertility issues. The third had an ascended testicle due to a sports injury and required immediate intervention.
My time in Kenya so far has been a flurry of emotions. I have witnessed grave medical consequences of ignoring symptoms, as well as severe repercussions of being malnourished and impoverished. I'm looking forward to being back on US soil within a week or so and reflecting on my trip. Unfortunately, I will be without internet for the rest of my time here.
Friday, December 31, 2010
Thursday, December 30, 2010
12/30
I spent the day at Kenyatta Hospital. I arrived at 7 AM, and was in grand rounds with the doctors of internal medicine until 1:30 PM--there are so many beds! I was astounded by the prevalence of end-stage disease. Many do not have the means to seek treatment until their symptoms unbearably worsen, and this leads to a much more grim prognosis when attention is finally received. Many patients did not have beds and were on floor mats or hallway chairs. It was not uncommon to move "less serious" cases to the hallway or floor after a more exigent case was admitted.
One particularly disappointing case was a mother who had to be released because there was no one to take care of her child. The child went to school too far from the hospital to stay with her there, and the doctors therefore gave the mother a series of vaccines and medications for self-administration at home. There were far too many patients for doctors to take the time to explain the importance of taking the treatment, so I spoke to the mother and ensured her understanding of instructions.
The cases themselves, unsurprisingly, are similar to diseases seen in US hospitals. The cultural differences and overall logistics were remarkably different, however. For one, patients' shirts are marked with their record number because wristbands are not available. It was also acceptable for doctors to sit on patients' beds as they diagnosed them, and many doctors had their personal cell phones go off in the middle of rounds that they were able to attend to without repercussions. Patients were often not completely informed of their treatment regimen, likely due to cultural differences with regard to the position of healer in Kenyan society.
The lack of attention to mental health was astounding, although largely expected from my background research. A psychiatrist was not paged for a suicidal patient ("they are as crazy as their patients," according to the ward matron), but instead an internal medicine doctor cracked jokes with him for a few minutes to "cheer him up." No references were made to his suicide attempt, and there was not attempt to understand his background or address his mental health. He was discharged rather quickly and without any major observation period.
I ended my day at 5:30 PM because I wanted to be home before sundown. Experiencing the wards at one of the busiest hospitals in Africa was unforgettable.
One particularly disappointing case was a mother who had to be released because there was no one to take care of her child. The child went to school too far from the hospital to stay with her there, and the doctors therefore gave the mother a series of vaccines and medications for self-administration at home. There were far too many patients for doctors to take the time to explain the importance of taking the treatment, so I spoke to the mother and ensured her understanding of instructions.
The cases themselves, unsurprisingly, are similar to diseases seen in US hospitals. The cultural differences and overall logistics were remarkably different, however. For one, patients' shirts are marked with their record number because wristbands are not available. It was also acceptable for doctors to sit on patients' beds as they diagnosed them, and many doctors had their personal cell phones go off in the middle of rounds that they were able to attend to without repercussions. Patients were often not completely informed of their treatment regimen, likely due to cultural differences with regard to the position of healer in Kenyan society.
The lack of attention to mental health was astounding, although largely expected from my background research. A psychiatrist was not paged for a suicidal patient ("they are as crazy as their patients," according to the ward matron), but instead an internal medicine doctor cracked jokes with him for a few minutes to "cheer him up." No references were made to his suicide attempt, and there was not attempt to understand his background or address his mental health. He was discharged rather quickly and without any major observation period.
I ended my day at 5:30 PM because I wanted to be home before sundown. Experiencing the wards at one of the busiest hospitals in Africa was unforgettable.
Tuesday, December 28, 2010
12/28
Many of the schoolchildren in the area near Ushirika do not have a place to gather. They are wandering streets every moment that they're not in school (which is mandatory only until 8th grade), and I wanted to do a little to change that. I went to a market and bought several reference books appropriate for primary school (1-8), as well as crayons and coloring books to keep the little ones entertained. There is an open space where children often gathered, and I got a bookshelf to place these books on.
In my work with kids I have always stressed the importance of reading for pleasure, and I therefore got several storybooks. Reading encourages imagination as well as original thought, and hones important skills indispensible to a productive life. To ignite their passion, I had storytime where I read a picturebook to them as they closed their eyes. When they opened them, I had them draw what they think is happening.
To engage the older children, I got several boardgames. Ludo is common here (takes as long as monopoly), and I got many sets of pieces and die.
In the second part of my day, I went to Kenyatta National Hospital. It is the largest hospital in Kenya and is considered to have the best doctors. It is also the busiest, and the wait time can exceed weeks for non-urgent matters. People often die while waiting to see a doctor.
I was unprepared for the sheer volume of patients I witnessed. Ushirika is very busy, but this was at a different level. There is standing room only throughout the (gigantic) hospital. Patients in the wards are on the floor because there are not enough beds. Weights are used in orthopedics to stabilize the patient. The average wait time upon admission to the emergency room is about 12 hours, even for more serious cases. If you think the ER TV shows on Discovery Health are exciting, the cases in this hospital were multiplied by a magnitude of 10.
Three patients I saw stood out to me in a manner that I will likely never forget. A gunshot victim with stab wounds was in the waiting room, bleeding profusely, for several minutes until hospital staff could take care of him. Another patient had been hit by a bus and his cranium had sunk in. A third patient is in the middle of the admittance floor screaming while throwing her legs in the air. I went over and thought it was a psychiatric issue. When I returned about 10 minutes later, there were giant (approx 4 in) rashes on both of her legs. When I informed the doctor about how quickly her symptoms were progressing, she was admitted. I unfortunately had to leave--there are safety issues in being out at night--before I learned the outcome.
I will return to Kenyatta at 8 AM tomorrow and will be able to scrub into trauma surgery. I have never witnessed a surgery before, and am looking forward to just being in the room!
In my work with kids I have always stressed the importance of reading for pleasure, and I therefore got several storybooks. Reading encourages imagination as well as original thought, and hones important skills indispensible to a productive life. To ignite their passion, I had storytime where I read a picturebook to them as they closed their eyes. When they opened them, I had them draw what they think is happening.
To engage the older children, I got several boardgames. Ludo is common here (takes as long as monopoly), and I got many sets of pieces and die.
In the second part of my day, I went to Kenyatta National Hospital. It is the largest hospital in Kenya and is considered to have the best doctors. It is also the busiest, and the wait time can exceed weeks for non-urgent matters. People often die while waiting to see a doctor.
I was unprepared for the sheer volume of patients I witnessed. Ushirika is very busy, but this was at a different level. There is standing room only throughout the (gigantic) hospital. Patients in the wards are on the floor because there are not enough beds. Weights are used in orthopedics to stabilize the patient. The average wait time upon admission to the emergency room is about 12 hours, even for more serious cases. If you think the ER TV shows on Discovery Health are exciting, the cases in this hospital were multiplied by a magnitude of 10.
Three patients I saw stood out to me in a manner that I will likely never forget. A gunshot victim with stab wounds was in the waiting room, bleeding profusely, for several minutes until hospital staff could take care of him. Another patient had been hit by a bus and his cranium had sunk in. A third patient is in the middle of the admittance floor screaming while throwing her legs in the air. I went over and thought it was a psychiatric issue. When I returned about 10 minutes later, there were giant (approx 4 in) rashes on both of her legs. When I informed the doctor about how quickly her symptoms were progressing, she was admitted. I unfortunately had to leave--there are safety issues in being out at night--before I learned the outcome.
I will return to Kenyatta at 8 AM tomorrow and will be able to scrub into trauma surgery. I have never witnessed a surgery before, and am looking forward to just being in the room!
Monday, December 27, 2010
12/27
Since I am staying in Nairobi, I have limited healthcare-related experience with rural Kenya (and my tourist experience is limited to the town of Nakuru and my safari). This changed today!
Mashavu is an orgnaization attempting to establish "telemedicine" in rural areas. These areas often lack health professionals and instruments, so technology is being implemented for providing these people with the care they deserve. Videoconferencing allows villagers to connect with doctors in Nairobi, Kisumu, and Mombassa. They are working with donors now to ensure a sustainable method of providing supplies to these villages. Transportation is usually the hindrance, so ensuring a constant pipeline is critical to the project's success.
I met with Dr. Manu Chandaria. As you can see by clicking on his name, his list of accomplishments, memberships, and chairmanships is unparalleled in quality and quantity. What struck me more, though, is the generosity in his heart. He has set up the Chandaria foundation, one with branches in over 40 countries. Some of his work focuses on giving free education to children who are unable to afford high school. He has also hired people in various countries to go to a small village, live there, and report back to him on what the most pressing needs are. He is also very well-connected to the business and political atmosphere worldwide. These connections are, of course, indispensable for someone wishing to collect funds for charity work. The passion and ferocity with which he continues his work at the age of 81 serves as an inspiration for me, and I hope you can find some personal meaning through what he does. I am not at liberty to post his email, but if you find it and contact him he usually responds within 24 hours with a personal message.
Mashavu is an orgnaization attempting to establish "telemedicine" in rural areas. These areas often lack health professionals and instruments, so technology is being implemented for providing these people with the care they deserve. Videoconferencing allows villagers to connect with doctors in Nairobi, Kisumu, and Mombassa. They are working with donors now to ensure a sustainable method of providing supplies to these villages. Transportation is usually the hindrance, so ensuring a constant pipeline is critical to the project's success.
I met with Dr. Manu Chandaria. As you can see by clicking on his name, his list of accomplishments, memberships, and chairmanships is unparalleled in quality and quantity. What struck me more, though, is the generosity in his heart. He has set up the Chandaria foundation, one with branches in over 40 countries. Some of his work focuses on giving free education to children who are unable to afford high school. He has also hired people in various countries to go to a small village, live there, and report back to him on what the most pressing needs are. He is also very well-connected to the business and political atmosphere worldwide. These connections are, of course, indispensable for someone wishing to collect funds for charity work. The passion and ferocity with which he continues his work at the age of 81 serves as an inspiration for me, and I hope you can find some personal meaning through what he does. I am not at liberty to post his email, but if you find it and contact him he usually responds within 24 hours with a personal message.
Sunday, December 26, 2010
12/26
I spent the 24, 25, and most of the 26 in the Masai Mara. Specifically, I was in one of the national parks for a 3-day safari!
The drive from Nairobi took approximately 5 hours in one direction. I arrived at my accommodations late on the 24th (a tent). After dropping my belongings, I went on my first game drive. The vehicle was a revamped matatu: the roof opened up allowing passengers to stand and observe the animals.
I saw many wild beasts on within the first few hours alone. The most exhilarating included a cheetah, a leopard, giraffes, lions elephants, vultures (feasting on their find), water buffalo, and even a snake (that I later learned is very poisonous to humans. Nigerians often kill the type we encountered on sight)--all from a few meters away!
As someone who has not been camping, it was particularly tough to adjust to the tents. A bit of discomfort is expected, however, on a budget safari. The unique thing about our campsite is that the Masai people are in the area. They guarded it at night and could be seen everywhere. I was excited to interact with them, but my enthusiasm was quickly disbanded with my first encounter.
I was lost within the campsite and asked one of the men to take me to my tent. He asked me for my age, which seemed initially irrelevant, and I was impressed by his wonderful English. After I disclosed some personal information to a stranger I'd just met, he explained that he went and killed a lion within the mara at the age of fifteen--as a rite of passage into manhood. Impressed, I asked him about the history of his ceremony and the hierarchy within Masai society. My enthusiasm dwindled when he pulled out a sharp tooth-like figure on a cheap plastic chain and put it around my neck. He informed me that this was the tooth of a lion that he had killed--the very first one that marked his entrance into manhood. I observed the specimen. It was clearly not a lion's tooth. It was far too polished, clean, and artificial to have ever belonged on an animal. Playing along, I said it was my honor to accept his gift. At this point, he became bewildered and said that he would sell it to me for 10,000 shillings (100 dollars is 8,000 shillings). By this time we had arrived at my tent, so I thanked him for showing me the way and requested that he not put a price on his childhood memories.
I did not see him again for the duration I was at the camp. Overall, the safari was a wonderful experience in seeing animals in their true habitat. My tourguide was wonderful, and though the matatu transportation was a bit bumpy, I had a great time!
The drive from Nairobi took approximately 5 hours in one direction. I arrived at my accommodations late on the 24th (a tent). After dropping my belongings, I went on my first game drive. The vehicle was a revamped matatu: the roof opened up allowing passengers to stand and observe the animals.
I saw many wild beasts on within the first few hours alone. The most exhilarating included a cheetah, a leopard, giraffes, lions elephants, vultures (feasting on their find), water buffalo, and even a snake (that I later learned is very poisonous to humans. Nigerians often kill the type we encountered on sight)--all from a few meters away!
As someone who has not been camping, it was particularly tough to adjust to the tents. A bit of discomfort is expected, however, on a budget safari. The unique thing about our campsite is that the Masai people are in the area. They guarded it at night and could be seen everywhere. I was excited to interact with them, but my enthusiasm was quickly disbanded with my first encounter.
I was lost within the campsite and asked one of the men to take me to my tent. He asked me for my age, which seemed initially irrelevant, and I was impressed by his wonderful English. After I disclosed some personal information to a stranger I'd just met, he explained that he went and killed a lion within the mara at the age of fifteen--as a rite of passage into manhood. Impressed, I asked him about the history of his ceremony and the hierarchy within Masai society. My enthusiasm dwindled when he pulled out a sharp tooth-like figure on a cheap plastic chain and put it around my neck. He informed me that this was the tooth of a lion that he had killed--the very first one that marked his entrance into manhood. I observed the specimen. It was clearly not a lion's tooth. It was far too polished, clean, and artificial to have ever belonged on an animal. Playing along, I said it was my honor to accept his gift. At this point, he became bewildered and said that he would sell it to me for 10,000 shillings (100 dollars is 8,000 shillings). By this time we had arrived at my tent, so I thanked him for showing me the way and requested that he not put a price on his childhood memories.
I did not see him again for the duration I was at the camp. Overall, the safari was a wonderful experience in seeing animals in their true habitat. My tourguide was wonderful, and though the matatu transportation was a bit bumpy, I had a great time!
Thursday, December 23, 2010
12/23
From my excursion yesterday, I realized to important things:
1) The importance of food whilst taking HIV medication.
2) The formation of cliques: HIV-positive members remove themselves from society because of the pressure they face from HIV-negative members.
Finding one patient that had gone AWOL after her HIV diagnosis had taken hours, so I devised a method of attracting large numbers of people to an education seminar focusing on what to do after being diagnosed with HIV. Disspelling myths was my first objective (i.e. it's not a curse from god) after having people show up, followed by the importance of hygiene and proper nutrition. Thirdly, I stressed the need to follow up with a healthcare provider either at a free clinic or large hospital.
Early in the day, people were simply not willing to talk. They had no reason to trust what I had to say (with help from a translator). To establish a sense of trust, I decided to provide what many needed most: food and a place for non-judgmental, open discussion. The first part was easy: I bought large quantities of beef stew and bread. The latter, however, was tricky to chew through. After much thought, I decided the best way to create a "safe zone" was to only allow HIV-positive people to come in. I assumed that there would be no fear in sharing experiences and knowledge among a group of people going through a common difficult experience, and I was right! Over 200 mothers showed up to listen to me (again, with help from a translator).
Since many are still within childbearing age, I stressed the importance of seeking care for the infant to prevent mother-child transmission. Many don't realize that medication is available to prevent HIV from afflicting the child, and had previously automatically assumed that the child automatically contracts HIV.
This was a very personally-rewarding day, and epitomizes my reasons for coming to Kibera in the first place. Knowledge is power.
1) The importance of food whilst taking HIV medication.
2) The formation of cliques: HIV-positive members remove themselves from society because of the pressure they face from HIV-negative members.
Finding one patient that had gone AWOL after her HIV diagnosis had taken hours, so I devised a method of attracting large numbers of people to an education seminar focusing on what to do after being diagnosed with HIV. Disspelling myths was my first objective (i.e. it's not a curse from god) after having people show up, followed by the importance of hygiene and proper nutrition. Thirdly, I stressed the need to follow up with a healthcare provider either at a free clinic or large hospital.
Early in the day, people were simply not willing to talk. They had no reason to trust what I had to say (with help from a translator). To establish a sense of trust, I decided to provide what many needed most: food and a place for non-judgmental, open discussion. The first part was easy: I bought large quantities of beef stew and bread. The latter, however, was tricky to chew through. After much thought, I decided the best way to create a "safe zone" was to only allow HIV-positive people to come in. I assumed that there would be no fear in sharing experiences and knowledge among a group of people going through a common difficult experience, and I was right! Over 200 mothers showed up to listen to me (again, with help from a translator).
Since many are still within childbearing age, I stressed the importance of seeking care for the infant to prevent mother-child transmission. Many don't realize that medication is available to prevent HIV from afflicting the child, and had previously automatically assumed that the child automatically contracts HIV.
This was a very personally-rewarding day, and epitomizes my reasons for coming to Kibera in the first place. Knowledge is power.
Wednesday, December 22, 2010
12/22
I encountered many barriers and challenges today in counseling patients with HIV/AIDS.
For one, most are aware of their HIV status. It is not uncommon to ask someone "are you HIV positive or negative," nor is it considered impolite. People often go with their parents or other elders in their family to get tested. The flipside to this transparency-laden coin is that cliques form based on HIV status. The positives do not associate with the negatives, sort of like a class struggle found in most areas. Once a colleague, friend, or neighbor finds out that Suzy has HIV, they inform Suzy's employer. If Suzy has children, teachers are told. The children are removed from school until parents can prove that they are not positive as well. Employers (illegally) fire affected individuals.
It's easy to realize that this wreaks psychological havoc on people's lives, and creates a void that counseling can help occupy. The children I encountered were particularly emotionally bruised. It was important to convince them to still go to school and stay with their education.
Many individuals, once they are tested positive for HIV, do not ever come back to the clinic. They think that no one will look at them, and consider themselves banished form society. Antiretrovirals (ARVs) do not help if they are sitting unused on the shelf, and I realized it is important to follow-up with patients who had not come back since their diagnosis and make them cognizant of the resources that are available. This proved to be difficult work. We had only the name and last known address, so much detective work had to be done. After asking around and finding the patient, it was even more difficult to convince them to seek help.
As people found out that someone from the US was visiting, they flocked to where I was trying to find the AWOL Ushirika patient. This is when I learned that even though ARVs were given to those who needed the medication, food was out of stock. MSF Belgium provides much of the food to this area, but it is often stolen by corrupt managers and sold in black markets. The amount of corruption continues to astound me--I saw a truck marked "donations from the british people" unload a stack of books at a drop-off point. A day later, these books were on sale by a street vendor. Few things infuriate me more than stealing from the sick and hungry, and I was disappointed to have seen this side of Kibera.
Without food, the ARVs do more harm than good and actually shorten one's lifespan compared to if one had not been taking any medication. People stop taking the medication because they do not have food, and you can assume the downward spiral in health this ultimately creates. Instead of donating food, I hope a wealthy individual can purchase large amounts of land outside of the city limits, employ the people of Kibera to tend to it, and use the food to feed people taking ARVs. Many ideas have been tried to remedy the situation, but corruption ultimately outdoes people's goodwill. Seeing people laden with disease unable to take medication because they're also starving has a profound impact on my overall mentality.
For one, most are aware of their HIV status. It is not uncommon to ask someone "are you HIV positive or negative," nor is it considered impolite. People often go with their parents or other elders in their family to get tested. The flipside to this transparency-laden coin is that cliques form based on HIV status. The positives do not associate with the negatives, sort of like a class struggle found in most areas. Once a colleague, friend, or neighbor finds out that Suzy has HIV, they inform Suzy's employer. If Suzy has children, teachers are told. The children are removed from school until parents can prove that they are not positive as well. Employers (illegally) fire affected individuals.
It's easy to realize that this wreaks psychological havoc on people's lives, and creates a void that counseling can help occupy. The children I encountered were particularly emotionally bruised. It was important to convince them to still go to school and stay with their education.
Many individuals, once they are tested positive for HIV, do not ever come back to the clinic. They think that no one will look at them, and consider themselves banished form society. Antiretrovirals (ARVs) do not help if they are sitting unused on the shelf, and I realized it is important to follow-up with patients who had not come back since their diagnosis and make them cognizant of the resources that are available. This proved to be difficult work. We had only the name and last known address, so much detective work had to be done. After asking around and finding the patient, it was even more difficult to convince them to seek help.
As people found out that someone from the US was visiting, they flocked to where I was trying to find the AWOL Ushirika patient. This is when I learned that even though ARVs were given to those who needed the medication, food was out of stock. MSF Belgium provides much of the food to this area, but it is often stolen by corrupt managers and sold in black markets. The amount of corruption continues to astound me--I saw a truck marked "donations from the british people" unload a stack of books at a drop-off point. A day later, these books were on sale by a street vendor. Few things infuriate me more than stealing from the sick and hungry, and I was disappointed to have seen this side of Kibera.
Without food, the ARVs do more harm than good and actually shorten one's lifespan compared to if one had not been taking any medication. People stop taking the medication because they do not have food, and you can assume the downward spiral in health this ultimately creates. Instead of donating food, I hope a wealthy individual can purchase large amounts of land outside of the city limits, employ the people of Kibera to tend to it, and use the food to feed people taking ARVs. Many ideas have been tried to remedy the situation, but corruption ultimately outdoes people's goodwill. Seeing people laden with disease unable to take medication because they're also starving has a profound impact on my overall mentality.
Tuesday, December 21, 2010
12/21
I spent most of today in the CWC, or Child Welfare Center (i.e. pediatrics). I have worked considerable hours in a pediatric office near my home, and the differences were simply astonishing.
Due to the volume of patients, weight is used as the primary indicator of health. Vaccination history is always checked, but most steps traditionally found in well baby checks are nonexistent (i.e. Babinski reflex testing or charting head circumference/vital signs). Mothers brought their own towels (used when the child is placed on the weighing scale) because the clinic did not have any reusable methods of maintaining sanitary conditions. There are also no stethescopes, so the clinical health officer listened to the baby with her ears.
One particularly troublesome case was a child with diahrhea. The mother stopped giving the child water because she was concerned that the child would have more watery stool. The child had not grown in the last 3 months, and we were finally able to determine the reason for asking series of questions about diet and sleeping habits.
In the Ob/Gyn area of matters, I learned that many women do not bring in their newborns to get vaccinated after delivering at home. I created large signs encouraging vaccination and placed them at "hang-out" places around Kibera.
Due to the volume of patients, weight is used as the primary indicator of health. Vaccination history is always checked, but most steps traditionally found in well baby checks are nonexistent (i.e. Babinski reflex testing or charting head circumference/vital signs). Mothers brought their own towels (used when the child is placed on the weighing scale) because the clinic did not have any reusable methods of maintaining sanitary conditions. There are also no stethescopes, so the clinical health officer listened to the baby with her ears.
One particularly troublesome case was a child with diahrhea. The mother stopped giving the child water because she was concerned that the child would have more watery stool. The child had not grown in the last 3 months, and we were finally able to determine the reason for asking series of questions about diet and sleeping habits.
In the Ob/Gyn area of matters, I learned that many women do not bring in their newborns to get vaccinated after delivering at home. I created large signs encouraging vaccination and placed them at "hang-out" places around Kibera.
Monday, December 20, 2010
12/20
One patient today had been removed from her home in Kibera. She has recently been diagnosed as HIV-positive, and had finally decided to tell her partner. He had been drinking for the past few days, became very hot-tempered, and kicked her out of the house. She is scared to go back, and was mad at us for convincing her to tell him.
This was not an uncommon situation today, as we had 3 other patients with similar stories. The healthcare professionals were too busy diagnosing and treating a whole slew of patients to attend to these 4 broken families, so I decided to take these patients on my own. I first asked the mothers to send their kids to friends' homes so they don't have to be exposed to the discussion I planned on having. I then went to the local grocery chain (Nakumat) and got juice and crackers for the families. I think food is something that unites and resolves differences, and I wanted to establish a sense of trust with the family by showing that I am willing to dedicate my resources to them.
After comforting the women and engaging them with infants in the clinic, I went with Peter to meet the husbands. 2 were mildly intoxicated, and were particularly challenging to deal with. I offered my apple juice, which they drank thinking it was beer. I first just told them I am in Kenya to meet with people, and had a particular interest in their lives. I did not mention the familial situation to not alienate them before making any progress. After chatting for about two hours, they sobered up almost completely. I asked them to come with me and took them to Ushirika.
Behind closed doors, I had an honest discussion. We had been laughing like old friends for a bit of time, so they listened to my thoughts and were very open to discourse. I did not address their drinking behavior directly, but talked about what I have seen alcohol do to families. After they were interested in my stories, I addressed alcohol objectively by providing them with statistics and ill health impacts.
I then shifted my attention to HIV. Unsurprisingly, HIV and alcohol are closely linked in Kibera. Parituclarly during the holidays, revelry leads to unsavory amounts of intoxication and unprotected intercourse. With an already high prevalence of HIV in the slum population, it becomes clear how the disease spreads like wildfire. As I explained a variation of this to the families, the men were not happy. Tribal culture, which I have described in previous posts to be very prominent in modern Kenyan society, came to the forefront of these men's minds and they told me that I was wrong. HIV is not a virus, they claimed, and is instead a method used by god to punished unfaithful women. We went around in circles, and I had to explain my stance in different ways after paying for dinner, but everyone was satisfied well into the night. I was not able to convince the men to go to rehab, or "devil's play" as they liked to call it, but they agreed to be tested and keep their family together in their time of greatest need.
This was not an uncommon situation today, as we had 3 other patients with similar stories. The healthcare professionals were too busy diagnosing and treating a whole slew of patients to attend to these 4 broken families, so I decided to take these patients on my own. I first asked the mothers to send their kids to friends' homes so they don't have to be exposed to the discussion I planned on having. I then went to the local grocery chain (Nakumat) and got juice and crackers for the families. I think food is something that unites and resolves differences, and I wanted to establish a sense of trust with the family by showing that I am willing to dedicate my resources to them.
After comforting the women and engaging them with infants in the clinic, I went with Peter to meet the husbands. 2 were mildly intoxicated, and were particularly challenging to deal with. I offered my apple juice, which they drank thinking it was beer. I first just told them I am in Kenya to meet with people, and had a particular interest in their lives. I did not mention the familial situation to not alienate them before making any progress. After chatting for about two hours, they sobered up almost completely. I asked them to come with me and took them to Ushirika.
Behind closed doors, I had an honest discussion. We had been laughing like old friends for a bit of time, so they listened to my thoughts and were very open to discourse. I did not address their drinking behavior directly, but talked about what I have seen alcohol do to families. After they were interested in my stories, I addressed alcohol objectively by providing them with statistics and ill health impacts.
I then shifted my attention to HIV. Unsurprisingly, HIV and alcohol are closely linked in Kibera. Parituclarly during the holidays, revelry leads to unsavory amounts of intoxication and unprotected intercourse. With an already high prevalence of HIV in the slum population, it becomes clear how the disease spreads like wildfire. As I explained a variation of this to the families, the men were not happy. Tribal culture, which I have described in previous posts to be very prominent in modern Kenyan society, came to the forefront of these men's minds and they told me that I was wrong. HIV is not a virus, they claimed, and is instead a method used by god to punished unfaithful women. We went around in circles, and I had to explain my stance in different ways after paying for dinner, but everyone was satisfied well into the night. I was not able to convince the men to go to rehab, or "devil's play" as they liked to call it, but they agreed to be tested and keep their family together in their time of greatest need.
Sunday, December 19, 2010
12/19
One of my greatest challenges today was witnessing someone being refused care due to the clinic's short supply of a particular medication. People must register with the Ministry of Health to a particular location, and once that is chosen, they may only good to that provider for healthcare. Changing providers involves a lot of paperwork, and many people simply do not want to put in the work. An HIV-positive mother came in requesting albuterol for herself and 2 of her children. The clinic was low on this particular medication, so the clinical health officer (equivalent to a physician assistant) told the patient that she would have to go to her original hospital for care. Unfortunately, this hospital is over 3 hours away. The mother also insisted on not doing the paperwork, because "that stupid Ministry is useless so why should I give them my information?"
I worked with this family to go sign the appropriate papers. This took hours, and I was not surprised that people simply do not want to go through this process.
I went on a homecare visit because one patient had not come in for her monthly after a 3 week grace period even with an extremely low CD4 count. After considerable effort in finding her, I learned that she was not going due to fear of being seen by her neighbors. It took several talks with those nearby and her before she was willing to come to the clinic to get follow-up tests and medication. When this woman came to the clinic, she continued denying that she has HIV and requested us to find what is truly causing her ailment. "You guys have the wrong virus," she told us. It was difficult to help her past the "denial" stage of grief, and we now see her every day.
I then bought some raw materials to make purses for mothers who have no means of working. I have a very high awareness on the sustainability of my work, and it is my hope that the purses will be sold in markets to help pay for food.
I worked with this family to go sign the appropriate papers. This took hours, and I was not surprised that people simply do not want to go through this process.
I went on a homecare visit because one patient had not come in for her monthly after a 3 week grace period even with an extremely low CD4 count. After considerable effort in finding her, I learned that she was not going due to fear of being seen by her neighbors. It took several talks with those nearby and her before she was willing to come to the clinic to get follow-up tests and medication. When this woman came to the clinic, she continued denying that she has HIV and requested us to find what is truly causing her ailment. "You guys have the wrong virus," she told us. It was difficult to help her past the "denial" stage of grief, and we now see her every day.
I then bought some raw materials to make purses for mothers who have no means of working. I have a very high awareness on the sustainability of my work, and it is my hope that the purses will be sold in markets to help pay for food.
Saturday, December 18, 2010
12/18
My host family had to attend a wedding, and I was graciously invited to accompany them! The ceremony took place in Nakaru, which is about a 3 hour drive from our location in Nairobi. We used my host's car, split the cost of gas (3600 ksh total) and the driver (2000 ksh). I also signed up for a 3-day safari in the Masai Mara at a cost of 28,000 ksh. As it is on the cheap end of safaris, I will be camping in a tent for two nights and will have an open-roof car to see the animals and the Masai people.My safari, which means journey in Swahili, will start at 7 AM on the 24th.
The wedding allowed me to interact with the Kenyan people to a much higher degree than before. I was blown away by the friendliness and acceptance. I had believed that the drive through the highway would be nerve-wrecking, but people tend to yield to others as they attempt to overtake and are forced to return to their original lane.
On the way to the wedding, we stopped at Lake Elementite in the Rift Valley area. The US issued a travel advisory to the area within the past few days in light of post-election violence prosecution, but I did not encounter a single problem. Lake Elementite was marked by plenty of wild flamingos and awe-inspiring scenery marked by deep valleys and tall hills. It is 8,000 ft in the air, and I needed a sweatshirt to be comfortable.
We went to Lake Nakuru Nat'l Park as well. After standing in line for admission, we learned that entering into the park for Kenyans was 300 ksh (< 4 dollars), but all non-Kenyans were charged $60. The driver informed me that he could easily get me a Kenyan ID for less than 2 dollars, but I did not want to risk deportation. Out of principle (cheating foreigners in this highway robbing scheme), I did not pay for admission to the park and simply went to the wedding. There were plenty of monkeys and baboons outside, as well as some flamingos and a rhinoceros. A few local children tagged along with me, so I bought them lunch. They used copious amounts of salt (something that needs to quickly be eliminated from any healthful diet), and packed much of their meal for dinner. There were no tables left in the diner, and instead of waiting for one to open the waitress merely packed us next to a group of people already eating; they were not pleased.
At the wedding itself, I learned a lot about Kenyan tribal culture. The Kikuyu are the most common, and are traditionally farmers and businesspeople (i.e. trade). This particular wedding was a marriage between two Kikuyus, but I learned that inter-tribal marriage is often an issue. While the recent marked increase in inter-tribe marriages has decreased violence among the various groups, there is a dilution of culture and increase in homogeneity. The issues surrounding various tribes seems, upon a cursory glance, very similar to the caste system in India (what history books don't tell you here is that even though the Indian caste system has been ruled illegal, it is still in place).
The Luo have a practice where if the husband dies, the wife is married off to the next older brother. Furthermore, the corpse spends the night in the home. Cremation has now become commonplace due to land shortages and thus high burial costs, but the Luo tend to mourn for weeks. The Luhya have similar burial practices. The Kisii and Somalis practice FGM (female genital mutilation, i.e. female circumcision). This is often done at the age of 11 or 12, a few years before the girls are married off (15). Although FGM is now illegal in Kenya, it is still frequently practiced in rural areas. The tribes mentioned here (except for the Kikuyu) have a rule where the woman is no longer entitled to her father's property after marriage.
I learned that high school is not required schooling, and as such the gov't is not required to provide this level of schooling to all inhabitants. Nancy, my host, is working on creating a NGO that will bridge the gap between high-achieving students and affordable post-primary education. She hopes to have the program running by the end of next year.
On the way back to Nairobi, we were stopped by the police for a random check. They ensure everyone stops with the use of tire spikes that are about 6''--much longer than the American counterpart. The cop went through the entirety of my backpack, asked to see my passport, and asked a series of questions about what I was doing in Kenya, how long I'd been here, and when I planned to go back. Nancy later informed me that he was just trying to find an excuse to ask for a bribe. Nancy works for the gov't, and after she told the cop that she is a "public servant" the cop said "you may now leave." Nancy also said that if a cop ever gives trouble for a legitimate reason, it is best to ask "what do you want," a phrase nationally understood as a willingness to give bribes.
The mefloquine I've been taking to prevent malaria has been having side-effects. I get very dizzy at times, and my dreams are rather strange/traumatizing. Doxycycline has fewer, less significant symptoms, but must be taken everyday due to its short half-life.
The wedding allowed me to interact with the Kenyan people to a much higher degree than before. I was blown away by the friendliness and acceptance. I had believed that the drive through the highway would be nerve-wrecking, but people tend to yield to others as they attempt to overtake and are forced to return to their original lane.
On the way to the wedding, we stopped at Lake Elementite in the Rift Valley area. The US issued a travel advisory to the area within the past few days in light of post-election violence prosecution, but I did not encounter a single problem. Lake Elementite was marked by plenty of wild flamingos and awe-inspiring scenery marked by deep valleys and tall hills. It is 8,000 ft in the air, and I needed a sweatshirt to be comfortable.
We went to Lake Nakuru Nat'l Park as well. After standing in line for admission, we learned that entering into the park for Kenyans was 300 ksh (< 4 dollars), but all non-Kenyans were charged $60. The driver informed me that he could easily get me a Kenyan ID for less than 2 dollars, but I did not want to risk deportation. Out of principle (cheating foreigners in this highway robbing scheme), I did not pay for admission to the park and simply went to the wedding. There were plenty of monkeys and baboons outside, as well as some flamingos and a rhinoceros. A few local children tagged along with me, so I bought them lunch. They used copious amounts of salt (something that needs to quickly be eliminated from any healthful diet), and packed much of their meal for dinner. There were no tables left in the diner, and instead of waiting for one to open the waitress merely packed us next to a group of people already eating; they were not pleased.
At the wedding itself, I learned a lot about Kenyan tribal culture. The Kikuyu are the most common, and are traditionally farmers and businesspeople (i.e. trade). This particular wedding was a marriage between two Kikuyus, but I learned that inter-tribal marriage is often an issue. While the recent marked increase in inter-tribe marriages has decreased violence among the various groups, there is a dilution of culture and increase in homogeneity. The issues surrounding various tribes seems, upon a cursory glance, very similar to the caste system in India (what history books don't tell you here is that even though the Indian caste system has been ruled illegal, it is still in place).
The Luo have a practice where if the husband dies, the wife is married off to the next older brother. Furthermore, the corpse spends the night in the home. Cremation has now become commonplace due to land shortages and thus high burial costs, but the Luo tend to mourn for weeks. The Luhya have similar burial practices. The Kisii and Somalis practice FGM (female genital mutilation, i.e. female circumcision). This is often done at the age of 11 or 12, a few years before the girls are married off (15). Although FGM is now illegal in Kenya, it is still frequently practiced in rural areas. The tribes mentioned here (except for the Kikuyu) have a rule where the woman is no longer entitled to her father's property after marriage.
I learned that high school is not required schooling, and as such the gov't is not required to provide this level of schooling to all inhabitants. Nancy, my host, is working on creating a NGO that will bridge the gap between high-achieving students and affordable post-primary education. She hopes to have the program running by the end of next year.
On the way back to Nairobi, we were stopped by the police for a random check. They ensure everyone stops with the use of tire spikes that are about 6''--much longer than the American counterpart. The cop went through the entirety of my backpack, asked to see my passport, and asked a series of questions about what I was doing in Kenya, how long I'd been here, and when I planned to go back. Nancy later informed me that he was just trying to find an excuse to ask for a bribe. Nancy works for the gov't, and after she told the cop that she is a "public servant" the cop said "you may now leave." Nancy also said that if a cop ever gives trouble for a legitimate reason, it is best to ask "what do you want," a phrase nationally understood as a willingness to give bribes.
The mefloquine I've been taking to prevent malaria has been having side-effects. I get very dizzy at times, and my dreams are rather strange/traumatizing. Doxycycline has fewer, less significant symptoms, but must be taken everyday due to its short half-life.
Friday, December 17, 2010
12/17
Peter Gachanja picked me up this morning to head to the clinic. Since it is a Friday and Fridays are slow, we had time to visit Peter's dwelling within Kibera. I mention his last name because Peter is, in fact, a celebrity. He was featured in National Geographic's December 2005 issue about Africa. Peter remarked that this was the first time Nat Geo turned from discussion animals and their environment to people, and was highly impressed. Peter works as a film producer now. He had not received any formal training, but has learned to shoot films and take wonderful photographs. If you are in Nairobi, Peter would be glad to give you a tour of Kibera. Please email me for his mobile number.
Although I had walked into Kibera yesterday, this was my first time actually walking in between the houses and walking through the slums. There is a beautiful forest in the background, Ngong Forest. Once again, Kenya appears to be a land of stark contrasts. There is a busy market. Peter's house is very lavish inside, with leather couches, speakers, and a TV. I also met his wife.
I encountered my first "flying toilet." As I mentioned in an earlier post, people defecate into a plastic bag and fling it as far as they can. The government has installed 3 bathrooms in Kibera to decrease the occurrence of this, but 3 bathrooms are obviously insufficient for about a million people.
There are giant pockets of waste where people throw away large garbage. Much filth is intermixed between the homes and is on the road, but this was a full-fledged dumb. Ushirika burns its garbage to prevent the transmission of disease into the community, which will ultimately then find its way back to Ushirika.
I then worked with the CHOs. They oversee general patients (non VMC--voluntary male circumcision--and non CCC (HIV)). One woman had a spontaneous abortion within the last 24 hrs, and a speculum was inserted into her genitalia to take a blood sample from the walls. While everyone would leave the room as the patient undresses in the US, this was not the case here. This was also the first procedure of its kind that I witnessed here.
I then witnessed my first circumcision in the VCS. As a male, I can admit that it is a truly traumatizing experience. Patients receive counseling, and the procedure is free (it decreases HIV and STI transmission rates). Circumcision is a right of passage in some subcultures. The doctor informed me that one particular village he is familiar with has all 12 y.o. boys line up at the bank of a river every August, and a communal knife is used to circumcize everyone (with no anesthetic). I grimaced at the thought of this, but understood the cultural significance. My stomach was extremely squeamish after this procedure, and I become nauseous just thinking about it. I have seen baby circumcision videos on Youtube, but this did not come close to comparison.
Another patient had severe asthma. For one, there were no dosage cups available for cough suppressant. Secondly. she was given epi IV. This is done in the states only after someone has died, as it is an extreme measure. However, there are no resources such as albuterol or nebulizer, so drastic measures must be taken. Theopylline is also used, which has nasty side-effects and is therefore not used in the US.
The doctor trained at Nairobi medical school, and as part of his training he worked in the rural area for 3 months. He told us that although many people do not know their HIV status, there is NO stigma when it comes to getting checked and sharing the status. People are open about their status. It is, however, considered shameful to go buy contraceptive or things that allow one to practice safer intercourse. For this reason, even though there is lots of education and awareness surrounding HIV, people have the wrong attitude. They choose to engage in risky behavior even after understanding the risks either because they think they are immune to the problems, or because they feel that they have no other choice. This contrasts severely with the US, where HIV status is very hush-hush and obtaining contraceptives is very open,, especially at university health centers.
There is also a shortage of doctors in rural areas. Doctors that work for government hospitals have private practice in order to "keep up with the lifestyle that is expected of us," according to the doctor. People do not want to go to rural areas because they are unable to make much money, and "people start wondering what is going on." I saw many similarities between this overall thinking and the US; it allows me to appreciate the importance of rural education programs.
Although I had walked into Kibera yesterday, this was my first time actually walking in between the houses and walking through the slums. There is a beautiful forest in the background, Ngong Forest. Once again, Kenya appears to be a land of stark contrasts. There is a busy market. Peter's house is very lavish inside, with leather couches, speakers, and a TV. I also met his wife.
I encountered my first "flying toilet." As I mentioned in an earlier post, people defecate into a plastic bag and fling it as far as they can. The government has installed 3 bathrooms in Kibera to decrease the occurrence of this, but 3 bathrooms are obviously insufficient for about a million people.
There are giant pockets of waste where people throw away large garbage. Much filth is intermixed between the homes and is on the road, but this was a full-fledged dumb. Ushirika burns its garbage to prevent the transmission of disease into the community, which will ultimately then find its way back to Ushirika.
I then worked with the CHOs. They oversee general patients (non VMC--voluntary male circumcision--and non CCC (HIV)). One woman had a spontaneous abortion within the last 24 hrs, and a speculum was inserted into her genitalia to take a blood sample from the walls. While everyone would leave the room as the patient undresses in the US, this was not the case here. This was also the first procedure of its kind that I witnessed here.
I then witnessed my first circumcision in the VCS. As a male, I can admit that it is a truly traumatizing experience. Patients receive counseling, and the procedure is free (it decreases HIV and STI transmission rates). Circumcision is a right of passage in some subcultures. The doctor informed me that one particular village he is familiar with has all 12 y.o. boys line up at the bank of a river every August, and a communal knife is used to circumcize everyone (with no anesthetic). I grimaced at the thought of this, but understood the cultural significance. My stomach was extremely squeamish after this procedure, and I become nauseous just thinking about it. I have seen baby circumcision videos on Youtube, but this did not come close to comparison.
Another patient had severe asthma. For one, there were no dosage cups available for cough suppressant. Secondly. she was given epi IV. This is done in the states only after someone has died, as it is an extreme measure. However, there are no resources such as albuterol or nebulizer, so drastic measures must be taken. Theopylline is also used, which has nasty side-effects and is therefore not used in the US.
The doctor trained at Nairobi medical school, and as part of his training he worked in the rural area for 3 months. He told us that although many people do not know their HIV status, there is NO stigma when it comes to getting checked and sharing the status. People are open about their status. It is, however, considered shameful to go buy contraceptive or things that allow one to practice safer intercourse. For this reason, even though there is lots of education and awareness surrounding HIV, people have the wrong attitude. They choose to engage in risky behavior even after understanding the risks either because they think they are immune to the problems, or because they feel that they have no other choice. This contrasts severely with the US, where HIV status is very hush-hush and obtaining contraceptives is very open,, especially at university health centers.
There is also a shortage of doctors in rural areas. Doctors that work for government hospitals have private practice in order to "keep up with the lifestyle that is expected of us," according to the doctor. People do not want to go to rural areas because they are unable to make much money, and "people start wondering what is going on." I saw many similarities between this overall thinking and the US; it allows me to appreciate the importance of rural education programs.
Thursday, December 16, 2010
12/16
I woke up at 4 AM, once again, due to the rooster. I spent my morning packing for my new accommodation, showered, and had a breakfast of toast and marmalade.
Even though I had only been there for a day, it was tough to say goodbye to the generous hosts. They are very nice people who went to great lengths to ensure our comfort, and they had grown on me. Leisel and I were taken my matatu to Jamburi Estate, where we will be staying for the rest of the time here.
I was blown away by this facility. It is a gated community located 10 minutes (by foot) from the slums of Kibera. I was taken to my room in the apartment complex. The apartment I was staying with belongs with Nancy, who has graciously offered me her space for the next few weeks. She works for a financial company and is a graduate of the University of Alabama-Birmingham. It is interesting to live with someone who is a "modern Kenyan," as opposed to a traditional one. It is rude to refuse food, so before I would stay up even when tired to eat with the host family and take food just to be polite. With Nancy, however, I can just be honest! Her apartment is beautifully luxurious. It has a speaker system, western toilet, and a hot water shower. I also have a very spacious room to myself, with plenty of closet/storage space. Liesel is staying in a different apartment downstairs.
I dropped off my suitecase in Nancy's apartmet, and said goodbye to the other volunteers. They will be going to their assignments, and it will be difficult to reconvene. Liesel and I were then taken to Kibera, and the Ushirika Medical Clinic. I was blown away at the stark difference between where I was ten minutes ago, in a gated community, and then later after crossing a set of railroad tracks: in the largest slum in Africa. The slum stretches for about 8 km according to Peter, and he says that although estimates are around 800k inhabitants he thinks there are closer to 1.6 million.
I was quick to get started in Ushirika. The outside appears freshly painted. The main clinic walls are made of wood, whereas additions (maternity ward, VMC--which I'll get to in a inute--, etc. are made of corrugated metal). We were given a tour of the facilities. The pharmacy is well-stocked with ARVs (antiretrovirals, i.e. HIV treatment) and other medication. I was amazed at how complete this was for an impoverished area, and discovered that most of the funding comes from donors. World Bank and Global TB Drug Foundation supply most of the TB medication. PEPVAR, a medical mission set up by George W and Global Health Initiative, set up by Obama, supply most other medications. Additional aid comes from US Aid and IMPACT. As someone who has seen what they are doing for the community first-hand, I highly urge you to donate to these organizations.
I was introduced to the nutritionist, who works closely with the counselor to educate patients on their diet. This is done based on a CBC (complete blood count), which provides vital information about blood chemistry. The laboratory was also well-stocked given the area, but severely malnourished compared to its western counterpart. It is able to do CBCs, glucose, prenancy testing, urinalysis, and stool analysis. CD4 counts (used as an indicator of T cell activity in HIV. 800-1400 is considered normal. <350 requires specific medication, and <200 indicates full-blown AIDS) as well as thyroid/liver/kidney panels must be sent out to other testing facilities. While these are usually available within 24 hours in the US, the results take 3 weeks to get back on average.
Most of the medical care is given by a clinic health officer, who is the equivalent of a PA in the states. A medical doctor is there to oversee the facility, and is in charge of the CCC (Comprehensive Care Clinic), which is exclusively for HIV patients). Keep in mind that although I refer to these centers and departments, it is generally a small room in some area of the overall facility.
The maternity ward has 6 beds and keeps patients for about 2 days after delivery. However, most prefer to give birth at home and bring their child for appropriate immunizations afterward. There is a large amount of counseling given to the mother for appropriate treatment of the child.
After the tour, I became involved with day to day operations. HIPAA guidelines require that persons not directly involved with medical care do not take notes, and I am therefore reciting this information from memory. Therefore, some points may not be accurate and are highly influenced by my perception of events (more than most other things). Everything was observed and conducted with patient permission and under professional supervision. I recognize that HIPAA does not apply outside of the US of A, but I consider it my ethical responsibility here to treat these people with the highest professional standards and utmost respect, and I therefore applied western medical ethics to my work here. With that disclaimer having been said, here we go!
I started the day in the CCC:
Patient 1: 23 y.o male with HIV and TB coinfection. CD4, pregnancy, and liver tests were ordered. Baselines should have been taken, but the blood pressure monitor was broken. Stethescopes are terrible in quality, and heart rhythm abnormalities are therefore hard to detect. There is only one weight machine for the entire facility, so patients have to leave the room in the middle of the exam to get their weight. There is unfortunately a refusal of treatment of issue--the patient simply would not speak to the doctor. The patient is also forgetting to take medication every day, and has greater issues with taking it on the same time. Counseling instilled in him that missing medication is very bad, and he therefore now just stops taking medicine when he misses a dose due to fears of side effects. The doctor spent over an hour working with him to get him to take his medication on time.
I am amazed at the amount of time spent with each patient. I first thought that the first was an exception due to severe complications, but 45 mins seems to be the standard amount of time. This is a stark contrast to the US, where 15 mins is standard and a maximum of 30 is reserved for rare conditions.
I was also shocked that the doctor spent time counseling, in addition to reinforced discussion with the counselor. This may, in part, be due to the place of the doctor in Kenya society. People are willing to listen, and patients rarely ask questions of the medical professional. There is no such thing as a second opinion in this society, and the doctor's word is taken with the highest authority. This is very different from the states, where doctors are frequently mistrusted, and second opinion is commonplace. I personally see the value in questioning every belief that is presented to me, so it is interesting to see this culture.
Chest X-Rays are free at Kenya Medical Institute for TB patients who are referred from the doctor at Ushirika. The bus fare is 20 shillings, but people who can not afford that can walk there from the clinic in about an hour.
As loose as the sense of time is for the Kenyan people, I was fascinated by a method used to encourage attendance. Patients who adhere to their regimen by attending the clinic when they are supposed to and take all medication on time, they are given a longer dosage. To clarify: patients are initially given a two-week supply of ARVs. Later, they are moved to 3 week and 4 week regimens, or even longer with perfect behavior. Reward training and behavioral psychology was cleverly applied in the clinic.
Explaining to the patients the importance of taking medicine at the right time was difficult to do. They come up with every excuse in the book on why they did not take their medication. It is also hard to keep patients. After receiving ARVs, many disappear because they feel better almost instantly. They often return after several months, however, when they realize they need long-term care.
Another patient had been coughing for 3 days (HIV status is positive). The doctor was concerned about a possible TB infection, but the patient was ultimately diagnosed with an upper respiratory tract infection (URTI). Since it is caused by viruses, antibiotics were not given. This is different from the states, where antibiotics are often prescribed anyway to prevent to advance of other opportunistic infections.
It has been very interesting to see that most of the conditions are a more advanced form of disease that is caught early in the US. People here do not go to the clinic until it becomes serious and hardly bearable. Additionally, since there is very little medical technology, doctors must connect to their patients at a deeper level and understand things without expensive tests. When a patient complained of chest pain, the doctor asked a series of questions to rule out serious possibilities such as an infarct; in the US, the patient would have quickly been hooked up to several monitors and EKGs would be conducted. Enough resources simply do not exist, and the doctors have a much tougher job as a result.
The prescriptions were written on specific paper, and it was an eye-opening experience to watch the doctor split up the carbon copy sheet from the original sheet--allowing him to give twice as many prescriptions as he would have been able to if he'd use the paper as directed. The extent to which every resource is used and waste is eliminated amazes me.
Throughout the day, I observed counseling regarding STIs, pregnancy, HIV, and circumcision. Studies have indicated that circumcized males have a much lower risk of contracting and spreading HIV/STIs, and the procedure is done free of charge at Ushirika (the gov't provides funds for this).
At every visit, patients are counseled with specific regards to the incident that brings them to the clinic.
Although TB drugs are free to the patient, we ran into some registration issues. Ushirika's reserves started dwindling, and we therefore had to limit people from the medication. There is a registration system for healthcare where one must register with a particular hospital that one wishes to receive care from (close to where one lives). Many people have moved and not updated this registration, and we therefore had to refuse treatment. They were, however, encouraged to register properly and come back for help. It was disheartening to experience.
Mother-child HIV transmission is carefully monitored. Counseling plays a large role in this, as many mothers are not aware that they can pass it to the child. Others think that there is nothing medicine can do to prevent transmission (the drug HATT is provided to the child after 6 months of age to prevent).
Another issue we faced was that people were not disclosing their HIV status to their partners, and were taking drugs in great secrecy. It is troubling from a public health standpoint, but we work with the counselors to get them to tell their respective spouses.
Documentation is very important here. Many patients transfer out to other hospitals because they move and Ushirika is no longer convenient, and the doctor often makes letters. This takes a lot of the clinic time, and I see the value of EMRs (electronic medical records). While this is quickly becoming a reality in the states (especially with the recent influx of ER scribes), Kenya remains far behind in a standardized place for care. Miscommunication can often result in poor or incomplete care: one woman had been mugged and lost all her medical documentation. HIV and TB tests had to be repeated and she will lose several weeks, as she could not remember for how long she was taking what medications.
While this is small, I noticed that medical doctor's handwriting is very neat here. This could be because he/she is forced to write notes to other clinicians, but it served as a stark contrast from the US, where MDs are notorious for illegible penmanship.
At the end of the day, after seeing approximately 15 patients (keep in mind that these visits are extraordinarily long), we had someone come in with a CD4 count of 28. It had dipped as low as 15 a few months ago.
Stay tuned for more on this patient, the overall work of CHOs (clinical health officers, or PAs), and the VCC (Voluntary Circumcision Center). As you can likely infer from the length of this post, my first day at the clinic was extremely ebusy, eye-opening, shocking, and full of contemplation.
Even though I had only been there for a day, it was tough to say goodbye to the generous hosts. They are very nice people who went to great lengths to ensure our comfort, and they had grown on me. Leisel and I were taken my matatu to Jamburi Estate, where we will be staying for the rest of the time here.
I was blown away by this facility. It is a gated community located 10 minutes (by foot) from the slums of Kibera. I was taken to my room in the apartment complex. The apartment I was staying with belongs with Nancy, who has graciously offered me her space for the next few weeks. She works for a financial company and is a graduate of the University of Alabama-Birmingham. It is interesting to live with someone who is a "modern Kenyan," as opposed to a traditional one. It is rude to refuse food, so before I would stay up even when tired to eat with the host family and take food just to be polite. With Nancy, however, I can just be honest! Her apartment is beautifully luxurious. It has a speaker system, western toilet, and a hot water shower. I also have a very spacious room to myself, with plenty of closet/storage space. Liesel is staying in a different apartment downstairs.
I dropped off my suitecase in Nancy's apartmet, and said goodbye to the other volunteers. They will be going to their assignments, and it will be difficult to reconvene. Liesel and I were then taken to Kibera, and the Ushirika Medical Clinic. I was blown away at the stark difference between where I was ten minutes ago, in a gated community, and then later after crossing a set of railroad tracks: in the largest slum in Africa. The slum stretches for about 8 km according to Peter, and he says that although estimates are around 800k inhabitants he thinks there are closer to 1.6 million.
I was quick to get started in Ushirika. The outside appears freshly painted. The main clinic walls are made of wood, whereas additions (maternity ward, VMC--which I'll get to in a inute--, etc. are made of corrugated metal). We were given a tour of the facilities. The pharmacy is well-stocked with ARVs (antiretrovirals, i.e. HIV treatment) and other medication. I was amazed at how complete this was for an impoverished area, and discovered that most of the funding comes from donors. World Bank and Global TB Drug Foundation supply most of the TB medication. PEPVAR, a medical mission set up by George W and Global Health Initiative, set up by Obama, supply most other medications. Additional aid comes from US Aid and IMPACT. As someone who has seen what they are doing for the community first-hand, I highly urge you to donate to these organizations.
I was introduced to the nutritionist, who works closely with the counselor to educate patients on their diet. This is done based on a CBC (complete blood count), which provides vital information about blood chemistry. The laboratory was also well-stocked given the area, but severely malnourished compared to its western counterpart. It is able to do CBCs, glucose, prenancy testing, urinalysis, and stool analysis. CD4 counts (used as an indicator of T cell activity in HIV. 800-1400 is considered normal. <350 requires specific medication, and <200 indicates full-blown AIDS) as well as thyroid/liver/kidney panels must be sent out to other testing facilities. While these are usually available within 24 hours in the US, the results take 3 weeks to get back on average.
Most of the medical care is given by a clinic health officer, who is the equivalent of a PA in the states. A medical doctor is there to oversee the facility, and is in charge of the CCC (Comprehensive Care Clinic), which is exclusively for HIV patients). Keep in mind that although I refer to these centers and departments, it is generally a small room in some area of the overall facility.
The maternity ward has 6 beds and keeps patients for about 2 days after delivery. However, most prefer to give birth at home and bring their child for appropriate immunizations afterward. There is a large amount of counseling given to the mother for appropriate treatment of the child.
After the tour, I became involved with day to day operations. HIPAA guidelines require that persons not directly involved with medical care do not take notes, and I am therefore reciting this information from memory. Therefore, some points may not be accurate and are highly influenced by my perception of events (more than most other things). Everything was observed and conducted with patient permission and under professional supervision. I recognize that HIPAA does not apply outside of the US of A, but I consider it my ethical responsibility here to treat these people with the highest professional standards and utmost respect, and I therefore applied western medical ethics to my work here. With that disclaimer having been said, here we go!
I started the day in the CCC:
Patient 1: 23 y.o male with HIV and TB coinfection. CD4, pregnancy, and liver tests were ordered. Baselines should have been taken, but the blood pressure monitor was broken. Stethescopes are terrible in quality, and heart rhythm abnormalities are therefore hard to detect. There is only one weight machine for the entire facility, so patients have to leave the room in the middle of the exam to get their weight. There is unfortunately a refusal of treatment of issue--the patient simply would not speak to the doctor. The patient is also forgetting to take medication every day, and has greater issues with taking it on the same time. Counseling instilled in him that missing medication is very bad, and he therefore now just stops taking medicine when he misses a dose due to fears of side effects. The doctor spent over an hour working with him to get him to take his medication on time.
I am amazed at the amount of time spent with each patient. I first thought that the first was an exception due to severe complications, but 45 mins seems to be the standard amount of time. This is a stark contrast to the US, where 15 mins is standard and a maximum of 30 is reserved for rare conditions.
I was also shocked that the doctor spent time counseling, in addition to reinforced discussion with the counselor. This may, in part, be due to the place of the doctor in Kenya society. People are willing to listen, and patients rarely ask questions of the medical professional. There is no such thing as a second opinion in this society, and the doctor's word is taken with the highest authority. This is very different from the states, where doctors are frequently mistrusted, and second opinion is commonplace. I personally see the value in questioning every belief that is presented to me, so it is interesting to see this culture.
Chest X-Rays are free at Kenya Medical Institute for TB patients who are referred from the doctor at Ushirika. The bus fare is 20 shillings, but people who can not afford that can walk there from the clinic in about an hour.
As loose as the sense of time is for the Kenyan people, I was fascinated by a method used to encourage attendance. Patients who adhere to their regimen by attending the clinic when they are supposed to and take all medication on time, they are given a longer dosage. To clarify: patients are initially given a two-week supply of ARVs. Later, they are moved to 3 week and 4 week regimens, or even longer with perfect behavior. Reward training and behavioral psychology was cleverly applied in the clinic.
Explaining to the patients the importance of taking medicine at the right time was difficult to do. They come up with every excuse in the book on why they did not take their medication. It is also hard to keep patients. After receiving ARVs, many disappear because they feel better almost instantly. They often return after several months, however, when they realize they need long-term care.
Another patient had been coughing for 3 days (HIV status is positive). The doctor was concerned about a possible TB infection, but the patient was ultimately diagnosed with an upper respiratory tract infection (URTI). Since it is caused by viruses, antibiotics were not given. This is different from the states, where antibiotics are often prescribed anyway to prevent to advance of other opportunistic infections.
It has been very interesting to see that most of the conditions are a more advanced form of disease that is caught early in the US. People here do not go to the clinic until it becomes serious and hardly bearable. Additionally, since there is very little medical technology, doctors must connect to their patients at a deeper level and understand things without expensive tests. When a patient complained of chest pain, the doctor asked a series of questions to rule out serious possibilities such as an infarct; in the US, the patient would have quickly been hooked up to several monitors and EKGs would be conducted. Enough resources simply do not exist, and the doctors have a much tougher job as a result.
The prescriptions were written on specific paper, and it was an eye-opening experience to watch the doctor split up the carbon copy sheet from the original sheet--allowing him to give twice as many prescriptions as he would have been able to if he'd use the paper as directed. The extent to which every resource is used and waste is eliminated amazes me.
Throughout the day, I observed counseling regarding STIs, pregnancy, HIV, and circumcision. Studies have indicated that circumcized males have a much lower risk of contracting and spreading HIV/STIs, and the procedure is done free of charge at Ushirika (the gov't provides funds for this).
At every visit, patients are counseled with specific regards to the incident that brings them to the clinic.
Although TB drugs are free to the patient, we ran into some registration issues. Ushirika's reserves started dwindling, and we therefore had to limit people from the medication. There is a registration system for healthcare where one must register with a particular hospital that one wishes to receive care from (close to where one lives). Many people have moved and not updated this registration, and we therefore had to refuse treatment. They were, however, encouraged to register properly and come back for help. It was disheartening to experience.
Mother-child HIV transmission is carefully monitored. Counseling plays a large role in this, as many mothers are not aware that they can pass it to the child. Others think that there is nothing medicine can do to prevent transmission (the drug HATT is provided to the child after 6 months of age to prevent).
Another issue we faced was that people were not disclosing their HIV status to their partners, and were taking drugs in great secrecy. It is troubling from a public health standpoint, but we work with the counselors to get them to tell their respective spouses.
Documentation is very important here. Many patients transfer out to other hospitals because they move and Ushirika is no longer convenient, and the doctor often makes letters. This takes a lot of the clinic time, and I see the value of EMRs (electronic medical records). While this is quickly becoming a reality in the states (especially with the recent influx of ER scribes), Kenya remains far behind in a standardized place for care. Miscommunication can often result in poor or incomplete care: one woman had been mugged and lost all her medical documentation. HIV and TB tests had to be repeated and she will lose several weeks, as she could not remember for how long she was taking what medications.
While this is small, I noticed that medical doctor's handwriting is very neat here. This could be because he/she is forced to write notes to other clinicians, but it served as a stark contrast from the US, where MDs are notorious for illegible penmanship.
At the end of the day, after seeing approximately 15 patients (keep in mind that these visits are extraordinarily long), we had someone come in with a CD4 count of 28. It had dipped as low as 15 a few months ago.
Stay tuned for more on this patient, the overall work of CHOs (clinical health officers, or PAs), and the VCC (Voluntary Circumcision Center). As you can likely infer from the length of this post, my first day at the clinic was extremely ebusy, eye-opening, shocking, and full of contemplation.
Wednesday, December 15, 2010
12/15
Because of a rooster in the chicken coup, I was up at 4 AM. I had stayed up for most of the 30 hours beforehand (to avoid as much jetlag as possible), but the rooster unfortunately greatly offset my intended sleeping schedule and I was initiated into "farmer schedule."
The start of orientation marked my first experience with aforementioned Kenyan time. We were supposed to be picked up by a program representative at 7h30. I had toast and marmalade for breakfast at 7h00, and was ready by 7h15 (not wanting to be tardy on the first day). All the volunteers did exactly the same, but the program representative did not show up until 10h00! After he picked us up, we were taken via private matatu to a hotel conference room. Here, we discussed the program, Kenyan culture, Swahili, and other general information for several hours.
I learned that Kenyans simply don't like change. While this was evident through my experience in talking with people who live in poverty and the stories I'd heard about residents of Kibera, the program coordinators further explained that we should not be adamant about pushing our own agendas at our volunteering locations.
As I talked to parents of schoolchildren, I was flabbergasted by the price of (government, public) schooling. Although a recently passed law decreed that education must be free, parents are required to "buy a desk." This often costs 10k+ shillings. Other incidental costs include books and uniforms. Everything totals to approximately 20k/year. Furthermore, child abuse is common in schools and we were instructed to not say anything or deportation would become a reality.
We had lunch at the hotel, and at this point I realized how much starch there is in the Kenyan diet. Copious amounts of salt are also used. I believe that both of these forms of nutrition should be eliminated as much as possible from any diet, but obesity remains low in Kenya. This is likely due to the heavy reliance on walking (cars are for the rich), as well as the hot climate.
One person who worked at an orphanage shared her story of giving the kids many presents, toys, and other items (pens, paper, etc.). There was a flood one evening, and all of the bags containing kids' belongings were destroyed. As the volunteer opened them to dispose of things and salvage as much as possible, she uncovered a hoard of objects. Hundreds of pencils and crayons were littered across the floor. She described that kids would often say they did not have something or that they lost something that was merely given the day before. As people who have always had little, they like to save things and not use them. She had trouble adjusting emotionally to denying their requests for more supplies.
I went to downtown Nairobi for the first time. While this has the population of a big city, it does not have much of a Chicago or NYC feel: the buildings are not very tall. Internet cafes (such as the one I'm typing from right now) dotted the landscape. Nakumat is a national grocery chain much like Target, and I spent 830 KSH (shillings) on water and hand sanitizer (the latter of which is much cheaper in the States). I was also shocked at the number of people carrying machine guns. I was able to furtively snap a picture of one such group. I later learned that guns are illegal, but often overlooked by law enforcement.
As Kenya is on the equator, the intensity of the sun was something I am not used to. It is very different from even the sun in India--it is significantly more intense. I also experienced the stark contrast between day Nairobi and night Nairobi. I had arrived well into the night, and greatly feared my safety. But the day calmed my worries and I started looking forward to truly enjoying my stay. The other volunteers bought souvenirs at the local shops, and it was enjoyable seeing shopowners inflate the price of something by 1000% upon seeing foreigners, but bargaining was extremely easy with experienced veterans of the art on the team.
This was also the day that people who had incited violence during the Kenyan elections in 2007 were disclosed to the public. It turned out to be government minsters! I was shocked to see that people such as the minister of education would engage in such unethical behavior, but I came to terms with it when I saw a "bureau of corruption" and a very long line outside. Photography was not allowed, as it is a government building, but it would have been a picture worth framing.
I wanted to register with the embassy, but learned that after bombings they had moved into several hours north to a an area that is not easily accessible. I am hoping to not run into serious trouble while I am here.
Tomorrow, I will be taken to my permanent accommodation near Kibera and will also start work in the clinic.
The start of orientation marked my first experience with aforementioned Kenyan time. We were supposed to be picked up by a program representative at 7h30. I had toast and marmalade for breakfast at 7h00, and was ready by 7h15 (not wanting to be tardy on the first day). All the volunteers did exactly the same, but the program representative did not show up until 10h00! After he picked us up, we were taken via private matatu to a hotel conference room. Here, we discussed the program, Kenyan culture, Swahili, and other general information for several hours.
I learned that Kenyans simply don't like change. While this was evident through my experience in talking with people who live in poverty and the stories I'd heard about residents of Kibera, the program coordinators further explained that we should not be adamant about pushing our own agendas at our volunteering locations.
As I talked to parents of schoolchildren, I was flabbergasted by the price of (government, public) schooling. Although a recently passed law decreed that education must be free, parents are required to "buy a desk." This often costs 10k+ shillings. Other incidental costs include books and uniforms. Everything totals to approximately 20k/year. Furthermore, child abuse is common in schools and we were instructed to not say anything or deportation would become a reality.
We had lunch at the hotel, and at this point I realized how much starch there is in the Kenyan diet. Copious amounts of salt are also used. I believe that both of these forms of nutrition should be eliminated as much as possible from any diet, but obesity remains low in Kenya. This is likely due to the heavy reliance on walking (cars are for the rich), as well as the hot climate.
One person who worked at an orphanage shared her story of giving the kids many presents, toys, and other items (pens, paper, etc.). There was a flood one evening, and all of the bags containing kids' belongings were destroyed. As the volunteer opened them to dispose of things and salvage as much as possible, she uncovered a hoard of objects. Hundreds of pencils and crayons were littered across the floor. She described that kids would often say they did not have something or that they lost something that was merely given the day before. As people who have always had little, they like to save things and not use them. She had trouble adjusting emotionally to denying their requests for more supplies.
I went to downtown Nairobi for the first time. While this has the population of a big city, it does not have much of a Chicago or NYC feel: the buildings are not very tall. Internet cafes (such as the one I'm typing from right now) dotted the landscape. Nakumat is a national grocery chain much like Target, and I spent 830 KSH (shillings) on water and hand sanitizer (the latter of which is much cheaper in the States). I was also shocked at the number of people carrying machine guns. I was able to furtively snap a picture of one such group. I later learned that guns are illegal, but often overlooked by law enforcement.
As Kenya is on the equator, the intensity of the sun was something I am not used to. It is very different from even the sun in India--it is significantly more intense. I also experienced the stark contrast between day Nairobi and night Nairobi. I had arrived well into the night, and greatly feared my safety. But the day calmed my worries and I started looking forward to truly enjoying my stay. The other volunteers bought souvenirs at the local shops, and it was enjoyable seeing shopowners inflate the price of something by 1000% upon seeing foreigners, but bargaining was extremely easy with experienced veterans of the art on the team.
This was also the day that people who had incited violence during the Kenyan elections in 2007 were disclosed to the public. It turned out to be government minsters! I was shocked to see that people such as the minister of education would engage in such unethical behavior, but I came to terms with it when I saw a "bureau of corruption" and a very long line outside. Photography was not allowed, as it is a government building, but it would have been a picture worth framing.
I wanted to register with the embassy, but learned that after bombings they had moved into several hours north to a an area that is not easily accessible. I am hoping to not run into serious trouble while I am here.
Tomorrow, I will be taken to my permanent accommodation near Kibera and will also start work in the clinic.
Tuesday, December 14, 2010
12/14
As an aviation aficionado, I can't help but comment on Turkish Airlines' fleet. The flight from O'Hare to Ataturk (Istanbul) used an A340-300. The four engines were significantly quieter inside the cabin than the B747 counterpart.
Istanbul has a very European approach to security, as my carry-on was searched at the gate right before boarding my flight to Kenya, which was a B737-800. Both of these planes are a testament to the advanced TK fleet. I fortunately received the exit row on this flight and was able to spread out my legs, but was still unable to sleep. The flight itself was very choppy, even though the skies were clear and there were not any cold fronts moving in. I'm unsure if this is due to the equipment or pilot skill (not using autopilot).
Clearing customs at Jomo Kenyatta took less than five minutes. They took a picture, scanned my passport, and fingerprinted all ten fingers. I had to wait about an hour for my baggage to get through turnstile. It is not able to handle a high load of bags, so people had to move their bags onto the floor before others could be unloaded.
After converting 40 USD into Kenyan Shillings, I was met by a man named Jonathan.Since it was approximately 3 AM, the roads were deserted and we had a 30 minute drive in a matatu to my temporary (2 day) accommodation. Jonathan informed me that he has visited neighboring countries like Somalia and Tanzania, but has never left West Africa.
The house itself was in a poor part of town. At 4 AM it was particularly deserted, and I genuinely feared my safety. I had to stand outside for approximately 45 mins because my host family was asleep and not answering the phone. We were able to wake up neighbors who had the key and let me into their house. At this point, Jon left and it was likely the last time I'd ever see him. I was taken to a small room with a bed smaller than I and asked to sleep until sunrise (Kenyans are a very sun-based society: the city comes to life and dies with the position of the sun). I could not sleep, so I walked around the area (within the fence).
Around 6 AM I met the host family. Bea is a student at Nairobi University studying to become an auditor with a bachelors in commerce. Her sister, Bridgette, has a 14-month old child named Gasper. She sells cloth at a streetside market. Their father, George, is in real estate and likely owns the surrounding land. People who have built their homes probably pay him rent (I am uncertain because he never confirmed this, and I found it rude to ask, but it seemed that way from the way he described the area). George's wife is in Ohio with their child, who is going to University of Ohio.
My roommate was a 14 year old boy named Anthony. He spoke great English, and enjoys playing GTA San Andreas in his spare time on the PS2.
I met other volunteers. Carla is from Australia and will be working at an orphanage in the rural town of Nyeri. Georgina, from London, as well as Shannon, from Canada are working together in a 200-person orphanage close to Nairobi. Mother-daughter pair Bonnie and Madison are also working at an orphanage. Working with me at Ushirika Medical Clicnic is Liesel, who is from Washington state.
I went to the city to purchase a SIM card for my cell phone, which ran 100 shillings (1 USD is 80 shillings). I bought "top off," or calling and texting credit, of 300 shillings.
I was able to play with the neighbors' kids, who love the expression "How are you?" when they see a foreigner. I thought I would not stand out due to my dark complexion, but people picked me out quite easily. It was interesting to note the difference in raising children between America and here. While kids in America often whine or throw toys for attention, the kids here have a very high sense of independence. When they want to be picked up, which is very rare, they simply look up and raise their eyebrows. There is very little parental care, as parents have many other worries. People only do what is absolutely necessary. There is a very carefree sense of time that is based around the sun. "Kenyan time" is a phenomenon one must be here to experience.
It was also interesting to note that most people who live in desolate conditions here have no desire to leave the area/country. They are perfectly content with their way of life. The Kenyan gov't, for example, started a program to relocate a handful of people form the slums of Kibera (where I will be working) to gov't housing. After a few months, these people went back to slums. They did not want to pay electric and water bills, as before they would just join wires together and have what they needed. They also left behind the close-knit group of friends and markets. Simply stated, the impoverished class is very happy with their status quo--something that continues to astonish me.
There is a chicken coup within the premises. As Americans flock to Whole Foods to buy cagefree eggs advertised as containing high amounts of Omega fatty acids, I had the option of eating cagefree "farm" eggs every morning (though I did not because I don't like boiled eggs).
I also learned about an internal conflict in Cambodia. A group of rebels killed almost every professional in the area, to a point where the country had 14 doctors left. A doctor from MSF started a series of clinics to train locals and provide medical care to the population. I do not know the veracity of this nor the "real story," but I definitely plan to research it in detail upon my return and see if there's anything I can do.
I start orientation tomorrow
Istanbul has a very European approach to security, as my carry-on was searched at the gate right before boarding my flight to Kenya, which was a B737-800. Both of these planes are a testament to the advanced TK fleet. I fortunately received the exit row on this flight and was able to spread out my legs, but was still unable to sleep. The flight itself was very choppy, even though the skies were clear and there were not any cold fronts moving in. I'm unsure if this is due to the equipment or pilot skill (not using autopilot).
Clearing customs at Jomo Kenyatta took less than five minutes. They took a picture, scanned my passport, and fingerprinted all ten fingers. I had to wait about an hour for my baggage to get through turnstile. It is not able to handle a high load of bags, so people had to move their bags onto the floor before others could be unloaded.
After converting 40 USD into Kenyan Shillings, I was met by a man named Jonathan.Since it was approximately 3 AM, the roads were deserted and we had a 30 minute drive in a matatu to my temporary (2 day) accommodation. Jonathan informed me that he has visited neighboring countries like Somalia and Tanzania, but has never left West Africa.
The house itself was in a poor part of town. At 4 AM it was particularly deserted, and I genuinely feared my safety. I had to stand outside for approximately 45 mins because my host family was asleep and not answering the phone. We were able to wake up neighbors who had the key and let me into their house. At this point, Jon left and it was likely the last time I'd ever see him. I was taken to a small room with a bed smaller than I and asked to sleep until sunrise (Kenyans are a very sun-based society: the city comes to life and dies with the position of the sun). I could not sleep, so I walked around the area (within the fence).
Around 6 AM I met the host family. Bea is a student at Nairobi University studying to become an auditor with a bachelors in commerce. Her sister, Bridgette, has a 14-month old child named Gasper. She sells cloth at a streetside market. Their father, George, is in real estate and likely owns the surrounding land. People who have built their homes probably pay him rent (I am uncertain because he never confirmed this, and I found it rude to ask, but it seemed that way from the way he described the area). George's wife is in Ohio with their child, who is going to University of Ohio.
My roommate was a 14 year old boy named Anthony. He spoke great English, and enjoys playing GTA San Andreas in his spare time on the PS2.
I met other volunteers. Carla is from Australia and will be working at an orphanage in the rural town of Nyeri. Georgina, from London, as well as Shannon, from Canada are working together in a 200-person orphanage close to Nairobi. Mother-daughter pair Bonnie and Madison are also working at an orphanage. Working with me at Ushirika Medical Clicnic is Liesel, who is from Washington state.
I went to the city to purchase a SIM card for my cell phone, which ran 100 shillings (1 USD is 80 shillings). I bought "top off," or calling and texting credit, of 300 shillings.
I was able to play with the neighbors' kids, who love the expression "How are you?" when they see a foreigner. I thought I would not stand out due to my dark complexion, but people picked me out quite easily. It was interesting to note the difference in raising children between America and here. While kids in America often whine or throw toys for attention, the kids here have a very high sense of independence. When they want to be picked up, which is very rare, they simply look up and raise their eyebrows. There is very little parental care, as parents have many other worries. People only do what is absolutely necessary. There is a very carefree sense of time that is based around the sun. "Kenyan time" is a phenomenon one must be here to experience.
It was also interesting to note that most people who live in desolate conditions here have no desire to leave the area/country. They are perfectly content with their way of life. The Kenyan gov't, for example, started a program to relocate a handful of people form the slums of Kibera (where I will be working) to gov't housing. After a few months, these people went back to slums. They did not want to pay electric and water bills, as before they would just join wires together and have what they needed. They also left behind the close-knit group of friends and markets. Simply stated, the impoverished class is very happy with their status quo--something that continues to astonish me.
There is a chicken coup within the premises. As Americans flock to Whole Foods to buy cagefree eggs advertised as containing high amounts of Omega fatty acids, I had the option of eating cagefree "farm" eggs every morning (though I did not because I don't like boiled eggs).
I also learned about an internal conflict in Cambodia. A group of rebels killed almost every professional in the area, to a point where the country had 14 doctors left. A doctor from MSF started a series of clinics to train locals and provide medical care to the population. I do not know the veracity of this nor the "real story," but I definitely plan to research it in detail upon my return and see if there's anything I can do.
I start orientation tomorrow
Saturday, December 11, 2010
Preparation and Perspective
In addition to personal belongings, I have packed items that I will be donating to the medical clinic and surrounding villagers. These include vitamins, calcium tablets, scabies medicines, easy to read medical guides, antifungal cream, first aid teaching materials, antibacterial soap, toothpaste, handkerchiefs, painkillers, cough medicine, and hand sanitizer. I also have some funds to buy mosquito nets upon arrival to give to the locals. My items will have a small impact at best, but disease is rampant in the slums and it is my hope to prevent at least some of its advance.
Personal preparation is requiring more forethought and planning than trips I have taken in the past, as I will be staying with a host family and will have limited access to running water and electricity. Stringent TSA regulations make this difficult, and I will have to buy most of my personal care supplies overseas.
Although I am excited to be contributing as much as I can to the Kibera slums and the clinic, I am going in with a firm sense of my overall role. As a temporary visitor to a place with decades of rich history (Kibera started when Nubian soldiers were given plots of land there in exchange for fine service in WW1), there is a limit to what I can do and the change I can bring. As disheartening as that seems, I remain optimistic at the personal change I will indubitably undergo. Personal development can serve as the catalyst for future activity, and I look forward to applying gained perspective to present and future activities.
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Friday, December 10, 2010
Trip Background
A bit over 48 hours now remain before I leave for Kenya! If you are like countless others who I have informed about my upcoming trip, you are wondering what I will be doing there. Here's a brief summary.
I will be volunteering at the Ushrika Medical Cinic, located in the slums of Kibera, Nairobi. Ushrika started in the community with a focus on hygiene and sanitation. A 1994 donation by a Médicos Sin Fronteras (Doctors without Borders, Spain) participant supported the formation of the clinic.
Kibera is located 5 km from Nairobi's center. It is among the poorest slums in the world; most inhabitants lack access to running water and electricity. Some sources also state that it is the largest slum in Africa--with UN population estimates ranging from 350,000 to over 1 million people. "Flying toilets" are used due to the lack of a sewage system, and the slums are thus a breeding ground for disease. There are several construction projects attempting to get off the ground (forgive the pun), but problems include theft of building materials, lack of a solid foundation (much of the ground is refuse), and the geographical topography (few homes have vehicle access, meaning that building supplies must be carried by hand).
My responsibilities at the clinic will be clinical in nature; there will be copious exposure to patients, facilities, staff, and the overall treatment system. I will assist in the VCT (HIV Voluntary Counseling and Testing) clinic, as the locals refer to them, by providing HIV education and counseling. TB education will also be a focus.
Within the hospital, I will assist in the maternity ward with deliveries. I will also vaccinate children, provide nutrition/health counseling, and observe surgeries.
I have extensive experience with the healthcare system in the United States at both public and private hospital settings, and it will be useful comparing the level and extent of care given with available resources. There are significantly less legal regulations in Kenya, and I will therefore be able to provide as much medical care as I feel comfortable with (under the supervision of hospital staff, of course).
While differences in healthcare are bound to astound me, I am also expecting a sort of "medical culture" shock. I am particularly interested in how involved the patient remains while making critical treatment decisions. Occidental values champion autonomy, and the patient therefore communicates directly with the physician in critical decision-making. Many cultures are more family-oriented, and serious news is often told to the eldest member of the family in the room, who is then expected to "break the news" to others. While this would spell lawsuit in the States, it is a cultural norm in many cultures. The Kenyan view of patient autonomy particularly interests me, but I have certainly not discounted other opportunities for cultural self-advancement.
I will be volunteering at the Ushrika Medical Cinic, located in the slums of Kibera, Nairobi. Ushrika started in the community with a focus on hygiene and sanitation. A 1994 donation by a Médicos Sin Fronteras (Doctors without Borders, Spain) participant supported the formation of the clinic.
Kibera is located 5 km from Nairobi's center. It is among the poorest slums in the world; most inhabitants lack access to running water and electricity. Some sources also state that it is the largest slum in Africa--with UN population estimates ranging from 350,000 to over 1 million people. "Flying toilets" are used due to the lack of a sewage system, and the slums are thus a breeding ground for disease. There are several construction projects attempting to get off the ground (forgive the pun), but problems include theft of building materials, lack of a solid foundation (much of the ground is refuse), and the geographical topography (few homes have vehicle access, meaning that building supplies must be carried by hand).
My responsibilities at the clinic will be clinical in nature; there will be copious exposure to patients, facilities, staff, and the overall treatment system. I will assist in the VCT (HIV Voluntary Counseling and Testing) clinic, as the locals refer to them, by providing HIV education and counseling. TB education will also be a focus.
Within the hospital, I will assist in the maternity ward with deliveries. I will also vaccinate children, provide nutrition/health counseling, and observe surgeries.
I have extensive experience with the healthcare system in the United States at both public and private hospital settings, and it will be useful comparing the level and extent of care given with available resources. There are significantly less legal regulations in Kenya, and I will therefore be able to provide as much medical care as I feel comfortable with (under the supervision of hospital staff, of course).
While differences in healthcare are bound to astound me, I am also expecting a sort of "medical culture" shock. I am particularly interested in how involved the patient remains while making critical treatment decisions. Occidental values champion autonomy, and the patient therefore communicates directly with the physician in critical decision-making. Many cultures are more family-oriented, and serious news is often told to the eldest member of the family in the room, who is then expected to "break the news" to others. While this would spell lawsuit in the States, it is a cultural norm in many cultures. The Kenyan view of patient autonomy particularly interests me, but I have certainly not discounted other opportunities for cultural self-advancement.
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