Jambo! I'm writing this post from IU house while drinking a
Tusker. This week has been unbelievable. There is so much I want to
document in this blog, so I apologize if it is lengthy. But you'll
want to at least scroll down to see the photos!
There are 4 ward teams at the pediatric hospital at Moi
University: Tumaini ('Hope' in Swahili) 1 and 2 and Upendo ('Love'
in Swahili) 1 and 2. I am on Upendo 2 Team. My first day was
post admission, and the experience was a bit overwhelming. The
rounding team is 10-15 strong, represented by medicine, nursing,
pharmacy, nutrition, social work, etc. I certainly stand out
wherever I go in Eldoret. I am one of the only "Mzungus" (white
person) in a town of roughly 750,000. Also I seem to be the tallest
person in the hospital. The pediatric hospital recently opened and
is state-of-the-art for this region; however, here I find myself in
a room the size of your average living room, where there are 12
patients and their families in beds with no barriers. Single beds
are often occupied by two patients and their parents. Children with
malaria, HIV, tuberculosis, cancer….all in the same room.
This is the initial shock. I was expecting it, but there is no
way to prepare. Most of these children should be in an intensive
care unit, hooked up to monitors, receiving a myriad of medicines
and personalized attention. And the barriers become clear quickly:
the only CT scanner is down, the medication isn't available, the
parents can't afford a test. The list goes on and on. I felt
About the medical team. I am ashamed that I assumed beforehand
that my education would be superior to the education at Moi
University. I thought I would be teaching my medical student
counterparts about everything I've learned with the
state-of-the-art learning resources I've had access to in the
states. I couldn't have been more wrong. The students are
brilliant. They are teaching me things I should already know or
have forgotten. Granted, this is my first hospital rotation since I
took Emergency Medicine six months ago. Taking light electives
during interview season really made me rusty.
Medical students at Moi University take six years of medical
school, with clinical rotations starting in the third year. I am
most impressed with their knowledge of therapy doses. This has been
one of my weaknesses, but they are very adept at recommending
specific doses, which is even more difficult in pediatrics since
doses are weight-based.
I am also awed by the thoroughness of their history-taking.
Since many labs and imaging are not possible, every piece of
information gleaned from the patient's history is valuable. I am
learning to ask questions I would have never considered: Do you
live in town or in the country? Is your kitchen inside or outside?
What fuel source do you use? Where do you get drinking water?
Do you boil or treat your water? Is your toilet inside or outside?
How many rooms does your house have? Do the rooms have windows?
I am glad to have faced these initial challenges. One of the
reasons I came here was to be exposed to a different culture and
healthcare system. This was not supposed to be easy. Much of what I
have learned does not apply here. I came because I think that all
health is global health. All human lives matter. And though Kenya
is distant from Indiana, the health here affects us. Perhaps some
we won't fully realize the connection for a number of years. The
world is becoming increasingly connected, and you only have to look
at recent headlines concerning Ebola and Zika Virus to see how
"those diseases over there" become a problem for our local
The other reason I came was to try to help, even if in a limited
way. It's good to say after a week I definitely feel like a
valuable member of the team. I have taken leadership over the
management of multiple patients. Team members are often very
interested in learning how we treat patients in the USA even if
such treatments do not exist in Kenya. I have taught fourth year
students about physical exam skills. And I have been handing
out those stickers and Pokemon cards that I've had stuffed in my
white coat pockets along with my pulse oximeter, stethoscope,
reference books, etc.
I must mention a couple other experiences last week. The Dean of
the IU School of Medicine, Chair of Surgery, Chair of Medicine, and
other IU faculty visited last week. On Wednesday, there was a
banquet celebrating the AMPATH consortium and the partnership with
Moi University. It was incredible night. There have been many key
players in the success of this partnership, but none more than Dr.
Mamlin (he prefers to be called Joe). He moved here from Indiana to
dedicate his life to fighting the HIV epidemic in Kenya. The
details are described in the book, "Walking Together, Walking Far"
by Fran Quigley. I got to spend a day with Joe in the AMPATH clinic
in Turbo, and small town 45 minutes away. Joe is something
else. We know he's at least 80, but he still dedicates his life to
serving his patients. I found myself at ground zero of the fight
against HIV, sitting next to Joe behind his desk as patient after
patient came through the door. I saw Joe take money out of his
wallet for the patients who couldn't afford transportation to their
next location. I saw him crack jokes with his patients in fluent
Swahili. He translated for me while I filled out antiretroviral and
opportunistic infection prophylaxis prescriptions with a big grin
on my face. I saw him be one of the coolest physicians I've
We spent last weekend at Lake Nakuru Park. It's about a three
hour drive from here, and the eight of us had a great time crossing
the Equator in our large safari van. The diversity of life and
scenery was astounding. I can only compare it the first time diving
in a coral reef (my first experience was in Grand Cayman, an
undergraduate IU Study Abroad Trip). I was in a landscape I have
never seen before. The lions were a highlight, of course. This
country is a treasure with so much to offer, and I keep chuckling
to myself when I think that I sacrificed a vacation month to be
Upendo 2 Team rounding the
Heading to the Turbo HIV Clinic,
squeezed together in the back of Joe's car.
I fit right in, don't you think?
slightly delayed by traffic while driving to Lake Nakuru
Lion sighted! I captured this
photo by placing binoculars in front of my iPhone.