Tutaonana

This is my final post for now. I am typing this on my fourth and final flight back to Indianapolis.  33 hours of travel time so far, and only 3 hours of sleep (I don't sleep well on planes).  This veil of drowsiness about me coupled with scenes from the 6 films I saw on the last two flights intruding into my conscience make it rather difficult to think at the moment.  There is only one constant thought, echoing over and over: "Now what?"  Might take just a bit more sleep before I can start to unravel the answer to that question...so I'll come back to it and the end.  I'll start by recapping the last week.

Lake Naivasha, a fresh water lake nestled in the Great Rift Valley, is an incredible place.  We woke up early Saturday morning and hiked up Mount Longonot, a dormant volcano nestled near the lake.  Our fearless guides, Mugo and Joseph, led us 3 km up to the top, 7 km around the crater to a maximum altitude of 2780 meters, and 3 km back down.  It was the most strenuous and perilous hike I've ever experienced.  It was also among the most beautiful. The ashy dirt path was very narrow and often steep enough to require climbing on your hands and knees, deciding whether to lean left towards the deep crater or right towards the edge of the mountain.  The 50 plus group of 10 year old children on a field trip running around us provided a bit of extra motivation.  6 hours later, after helping assist a woman with a sprained ankle down paths as previously mentioned, we were back in the vans.

Immediately after, we grabbed lifejackets and hopped aboard boats to Crescent Island in the middle of the lake.  We spotted quite a few hippos on the way.  Crescent Island is remarkable because we walked through the savannah, amongst the wildlife.  We found ourselves walking alongside giraffes and surrounded by zebras.  The setting sun created silhouettes of acacia trees outlined in front of Mount Longonot.

Sunday morning, we went to Hell's Gate National Park.  We biked through the park to the gorge, passing towering cliffs, bounding impala, and all the other fauna we've come to love.  Then we descended into the Ol-Njorowa Gorge which is fed from hot springs - the stream flowing through it is incredibly warm to the touch.  The gorge is a stunning and surreal environment, enhanced by the opportunity to spend time in locations such as "The Devil's Bedroom".

I have digressed much into our touristy ventures because I want to illustrate how beautiful, unique, and exciting Kenya is.  For us, the weekend trips create an opportunity reset before going back to another week on the wards.  Although throughout this particular weekend, I kept in touch with the intern on my pediatric team.  My 3-month old with a neck mass was supposed to finally have a biopsy performed after a month of waiting. It didn't happen.  He was supposed to get a tracheostomy so he could breathe better. It didn't happen. Not for lack of ENT surgeons willing to do the operation, but for lack of a pediatric ventilator.  MTRH has a catchment area of at least 20 million people.  And they have 5 or 6 ventilators in the ICU depending on which ones are functional.  There are only adult ventilators.  My heart is heavy as this patient, along with many others who I cared for and befriended, are still in that hospital.  It is terrible to leave Kenya, knowing these infants and children are still in the hospital, most of them waiting for some test or trapped in a purgatory where they cannot afford to pay the medical bill so they cannot leave, thus their bill grows and grows.

One of my personal missions this trip was to spend some time with ophthalmology at MTRH.  After many attempts, I finally got my chance this week.  I joined clinic on Monday. Before the first patients arrived, I was surprised to see 15 5th year medical students on the service.  They have a required 3 week rotation in ophthalmology.  I never received any formal training in ophthalmology other than the electives I've taken this past year.  Before the patients arrived, the students gathered in a conference room and one presented on uveitis.  The students were all engaged in the presentation, and I could see that learning from peers works very well in this training model.  When the patients arrived, they all sat on a single long bench in a narrow room, while students sat next to them and asked questions and performed basic visual assessments.  When it came time to present the patients, students lead the patients back into the conference room and the entire team heard the history and exam findings and was part of the discussion of the diagnosis, plan, and reasoning for each patient.  The cases were all age-related cataracts and trauma.

I had to leave clinic on Monday afternoon to give a Sally Test Talk, a medical student presentation and discussion of a health topic with parents of pediatric patients.  I chose to discuss HIV.  I was certainly hesitant to discuss HIV, as it is an incredibly complex topic both medically and socially.  However, I knew previous presenters had been asked about HIV repeatedly following their presentations on different topics. I thought if I was going to be asked about HIV, I might as well be prepared.  I started my presentation by tackling the biggest issue: stigma.  There is still a prevalent perception that individuals with HIV are dirty or immoral. Also that they are doomed to die soon regardless of any treatment.  I told them that many individuals contract HIV from partners who do not disclose or know their HIV status.  If a woman is diagnosed with HIV and takes her antiretroviral medicines (ARV) to keep her viral load down , she can still go to school, she can have sex with her spouse, she can give birth and breastfeed her child, she can live a long and happy live.  I was overjoyed to see women nodding in agreement when a translator said my words in Swahili. I also told counseled them on how to disclose to a child that they or the child has HIV.  It was a terrific discussion, and I am very thankful to the wonderful translator who did a terrific job connecting with the parents. I found out later she has HIV.

Tuesday morning I was in the ophthalmology "operating theatre". I do not want to disclose too many details of what I saw.  Firstly, I have not started my formal ophthalmology training yet and do not understand a lot of what I saw.  Secondly, resources are limited in this medical care and training institution and should not undermine the quality of care given in light of these circumstances.  I saw 3 corneal laceration repairs and 2 cataract extractions.  I learned a lot, and I hope to continue to keep in touch with the ophthalmologists I met as I continue my training.

Wednesday and Thursday were my final two days on the pediatric wards at Shoe 4 Africa.  Previously I wanted to focus on learning medicine - my primary objective.  Now, I figured I'd focus on giving some medicine before I go, so I brought my guitar to the hospital both days.  The Child Life specialists led me into each ward room in the hospital.  I sang "Jambo Bwana" with the children in each room.  I played "Mombasa" by Tommy Emmanuel.  We sang "Peace Like A River".  It was incredible, and you know what the difference playing music with kids in the hospital versus playing music with orphans outside the hospital? Absolutely nothing!  They all sang and danced.

Thursday afternoon, we went to Iten - where the Olympic long distance runners train. At Kerio View, we looked down on the beauty of the Rift Valley.  It was the best lasting final image for my final day in Africa.  We watched rain falling in the valley, and it swept up along the cliffs and we felt the drops splashing welcomingly on our faces.  On the flight to Nairobi, I looked down and saw the sparkling waters of Lake Naivasha, outlining Crescent Island.  This morning I watched the sun rise over the Indianapolis skyline.
 
What now? This is a marathon, not a sprint. I need to maintain the connections I've made with all the wonderful people I've met at MTRH and at AMPATH.
  I will emulate the hard work and compassion I've witnessed in Kenya and into my own practice of medicine, starting with next month where I'll be working in the ICU of the county hospital.  My thoughts still turn to the children waiting in the hospital, and I will not forget them and will continue to work to bring them home. I was there for one month thus far, but a part of me is there for life, rooted in the red earth. Tutaonana - see you later!

 

Tutaonana 1

Group photo at the peak of Longonot Volcano: Indiana, Brown, Toronto, Chicago and Kenya

Tutaonana 2

Crescent Island. Photo credit: Sandra Huynh

Tutaonana 3

Hell's Gate.

Tutaonana 4

Group photo in the ophthalmology operating theatre.

Tutaonana 5

Music with children on my final day in Shoe 4 Africa pediatric hospital.

Tutaonana 6

Rain sweeps through the Great Rift Valley.

Posted at 03:54

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