Leap Year

Hello!

Turns out I've gotten even worse at updating my blog. Good thing it's a leap year so I get an extra day, right? Let the updates begin!

Last time I checked in was 2/16. So let's start with 2/17. Another lovely day in Eldoret, highlighted mostly by a really cool fireside chat and discussion about the 2007-08 post-election violence. If you have not gathered from my previous posts, I find Joe Mamlin to be a fascinating man and could listen to him tell stories for days on end. Joe, his wife Sarah Ellen and Francis, one of the many Kenyans closely tied to IU House, told their stories and talked about the implications of tribalism in Kenya. Despite the central theme of the discussion, I think it's safe to say we all left House 1, the home of Fireside Chat, with a lot of hope for the future of this country and the relations of its people going forward. Sitting around talking about difficult social issues and asking probing questions is not something we often do in medicine (at least in the US). I have come to relish Wednesday evenings at IU House- not only because Wednesday means catered food from some fantastic Eldoret restaurants- but because it gives us a chance to think about things we don't often confront. It's a refreshing mental exercise.

Last weekend, 2/19-21, was really boring. A group of 13 of us- five IU students and two residents, two Brown students, three Toronto students and one Georgetown resident- set out on Friday afternoon for Lake Naivasha, about three hours south of Eldoret. On Saturday we hiked up to and around the rim of Mount Longonot, a volcanic crater near the lake. The hike was roughly 10k and a bit more challenging than our guides told us ahead of time, but also incredible. One poor woman (from another party) sprained her ankle on the way down. Lucky for her, there were 12 doctors/soon-to-be doctors with first-aid kits in their backpacks (not me specifically- I'm not that responsible) immediately behind her who gave her a cooling pack and ibuprofen, then quickly orchestrated a mad dash to the cars below for an Ace bandage and helped carry her down to meet a vehicle driving up.

In the afternoon we took a pleasant and relaxing boat ride across Lake Naivasha to Crescent Island, which you may know as the set of the movie Out of Africa, a tortuously long film about Meryl Streep falling in love with Robert Redford and getting syphilis. Despite Meryl's STD history, the island is quite remarkable. It is home to hippos, zebras, giraffes, antelopes, waterbucks, numerous birds, and lots of other species that roam around freely. Humans too are encouraged to walk amongst the animals, as we did.

On Sunday we went to Hell's Gate National Park and rode bikes (look out- warthogs crossing the road!) to a gorge that we then hiked into. Apparently "the real pride rock" from Lion King is somewhere near this area but I'm still confused as to how people keep assigning the term "real" to a cartoon.

So anyway, super boring weekend. Don't know why I mentioned it.

Last week was pretty interesting on the wards because of exam week for the students. In the US, we occasionally have practical clinical skills exams where we examine fake patients who are just actors with no real complaints or physical findings. We basically pretend to do the physical exam and are told what one would find if this patient truly had X and use our gathered history and physical to proceed. Here at MTRH, the entire ward is available for testing. So when I showed up to round on Thursday, half our patients were hurriedly being examined by anxious fourth years, nervously listening intently to heart sounds that would actually be test material. The student then presents his/her patient to two attendings ("consultants") who proceed to grill the student until he/she gets a question incorrect. It's basically oral board exams and a clinical skills assessment in one. My sixth year colleagues, Dennis and Sheila, shared with me their respective exam horror stories from their fourth year while we were on call one night and I vowed then and there to never complain about an American medical exam again. Dennis' surgery exam ended when one particularly picky surgeon asked him what the dimensions of a full bladder are (for the record, I'm pretty sure that isn't a real fact. If it is, Dennis still does not know the correct answer).

Once again, Fireside Chat was a fantastic night. Last week's discussion was a special edition "Humanities Night," which happens biannually, usually in conjunction with a visit from Dr. Peter Kussin, an intensivist from Duke who is one of the more interesting people I've ever met. Humanities Night is a Dr. Kussin-driven effort to delve into our non-medical skills and show off some of our more creative endeavors. We have an amazingly talented group of musicians, poets, writers, artists and thinkers here. Again, wildly refreshing.

After witnessing a week of exam mayhem (which is exhausting enough to watch- I can only imagine participating) we spent Saturday at a retreat center in the Kakamega rainforest, about two hours from Eldoret. It was an amazing setting. Highlight of the weekend was the sunrise hike we did Sunday morning and being able to watch the sun come up from a hilltop high above the rest of the rainforest. Can't really ask for much more.

Today we all switched to our new rotations. I have moved on to pediatrics (the land of small patients who can't tell you what's bothering them). We have said goodbye to fellow IU student Adam, as well as the two Brown students, but will be gaining another IU student, two more from Brown and a few more from Mt. Sinai by the end of the week.

Not much else to report. I hope you used your leap day wisely!

"As you get older, it isn't so much death that you fear but the failure to live."

 

Leap Day 1

Leap Day 2

Leap Day 3

Leap Day 4

Leap Day 5

 

Posted at 08:05

Maria, Mother of Jesus

Lessons learned in the past nine days:

  1. I'm really bad at keeping up a regularly updated blog.

  2. Forgiveness is truly divine. We had a patient on our team last week who was poisoned by a "friend." Apparently, she forgave her so-called friend before she was even discharged. I'm sure they'll have a great time reminiscing about that in the future …

  3. "HIV positive" is not to be said out loud, especially in a space where others can hear. I made the mistake of asking how long a patient had been HIV positive and the fourth year Moi student translating for me shot me a bit of a look and later explained that the correct term is ISS (immune-suppressed). Luckily it wasn't a huge deal.

On to other things! It's funny to me how quickly I've adapted to being on the wards. Last week I had to go to the new cardiac care unit, which is a very nice part of the hospital. It's quiet and not at all crowded; patients each have their own hospital beds; there are monitors and crash carts and all kinds of fancy equipment. Essentially, it looks like a standard American hospital ward. I was surprised, however, to find that it felt so weird to be there after getting used to the chaos of the general medicine wards. Returning to "The Wards"- teeming with patients, nurses, social workers, medical students, pharmacists, residents, even cockroaches-was almost a relief. I can't say I will ever be totally comfortable there but it's oddly come to be my "new normal." My team-thanks to Friday afternoon lunch and drinks last week-has officially bonded. Of course, there are daily frustrations, like taking an entire week to obtain a chest X-Ray for a very sick patient. That can be taxing and sometimes overwhelming. But I've also come to enjoy seeing some of the ingenuity of my Kenyan colleagues. Things like actually calculating how much hypertonic saline is needed to correct a sodium level (in the US, one has the luxury of checking serum chemistries every few hours) and controlling the rate of an IV drip by adjusting the length of the wire hanging the bag from the ceiling. Real science at work!

It's funny how in the US, we often romanticize physical diagnosis skills. Stories of professors diagnosing neurosyphillis after simply observing a patient's limp are legendary. Much of my nerdy medical excitement for this rotation was getting the chance to really hone my physical exam skills. And while this is (thankfully) happening and I do still hold these skills in high regard, I am also realizing how annoying it is to not have a CT scanner to back up your suspicions. Last week we had a patient with severe anemia-to the point that her conjunctivae where white. But you still cannot safely transfuse blood products in a non-emergent setting without doing a type and cross, which at MTHR can take days to get back.

On to more fun things!

On Friday we visited the Tumaini Center-a really neat shelter/rehab center for street youth in Eldoret that currently houses 14 boys who are former street youth (https://tumainieldoret.wordpress.com/childrens-drop-in-center/). Friday afternoons are reserved for soccer and often times, a group from IU House will go out to play with them. I would describe my own soccer skills by saying that it's clear I have spent a sizeable chunk of my life on a soccer pitch, but I am certainly nothing to write home about. I simply enjoy playing whenever I have the chance. In the past few years, however, I have often found myself playing soccer with a group of non-American, non-English speaking males who initially find my enthusiasm for the sport cute at best. The notion of an actually athletic and coordinated female does not always occur to them. And while the Tumaini boys have been primed by some of the more long-term soccer-playing female pharmacy students, I could tell they were still a little hesitant about my ability to not totally fail on the field. But as this story arc always goes, it took 15 minutes of me playing with solid mediocrity before a boy remarked to my friend on the sideline, "Maria is good! Is she training for something?" As much as my pro-Title IX, feminist self hates the double standard, I always find it amusing to be accepted onto a field full of males not by actually playing well, but just by not being the absolute worst player ever.

Weekend fun:

Saturday we went to Umbrella Falls, a waterfall near Eldoret that actually generates enough waterpower to provide half the city's electricity.  It was quite a serene and beautiful spot.

Falls

On Sunday we hosted "Blood Croquet" at IU House and invited many of our Kenyan medical student friends. As it turns out, none of us actually know how to play croquet but we didn't let that stop us. We essentially set up a putt-putt course throughout the yards, gutter system and gardens of the IU House compound. I'm sure our version is much more entertaining than real croquet. When everyone got tired of croquet, we moved on to a game called "Head's Up" where someone puts a word on his/her forehead and the rest of the group tries to get them to guess that word. We encountered a cultural exchange moment when the word "ping pong" came up. Many of the Kenyans immediately went the route of trying to describe the skull of a baby born with Rickets, which will be so weakened by the calcium deficiency that pushing on it is reminiscent of a ping pong ball. That's a bit more morbid than table tennis …

In lighter news, I've grown accustomed to being greeted at the main gate of IU House by the guard, Michael, who refers to me as "Mother of Jesus." All of you who see me on a regular basis in the US, please plan accordingly.

I'll finish with a short anecdote about the ever-impressive Joe Mamlin. Last week, the US ambassador to Kenya visited Eldoret and met with Dr. Mamlin at 10am on Friday. He and I sat down for lunch after the meeting and he went on to say that while he appreciated meeting the ambassador, he was ultimately disappointed to have to miss his 9am-11am HIV clinic. I responded by saying that important people want to know him. In his true humble form, he replied simply, "Nobody needs to know me … they should all just meet Sarah Ellen." (Sarah Ellen is his equally as impressive wife.)

That's it for now! Enjoy the snow. I'll continue to suffer through the 80 degrees and sunny weather in Eldoret.

Cheers,

Maria

Posted at 10:46

Greetings from Eldoret

Where to begin…I arrived last Tuesday evening along with my classmates Whitney, Adam, and Jess. We joined up with two fourth-year  Brown students, Mayuree and Caitlin, who will be here through February, and Becky, another IU student. (You'll notice there aren't many males around.)

My first impression of IU House is that it is summer camp for physicians. This is most certainly an oversimplified view of a much more complex program, but the camaraderie and spirit at the house elicits a certain charm that I find incredibly compelling. We happened to arrive at IU House at a time when many of the "big wigs" from IU, including the Dean of the medical school and chairs of Medicine and General Surgery, were visiting AMPATH. One day at lunch, I happened to be chatting with a fellow student, chomping away on one of the many delicious meals provided by the talented cooks here, when a man who introduced himself as "Pat" sat down and began casually conversing with us. I only realized later that indeed this was Dr. Patrick Loehrer, director of the IU Simon Cancer Center and quite the accomplished physician. First names and easy conversation are simply part of the culture at IU House. Later that night, Dr. Loehrer walked into the dining room to find a group of us---med students, residents and attendings---all reading or checking email on our computers, and declared, "Well I found Nerd Hall!" I chose not to point out the irony to him.

I am dividing my two months in Eldoret into one month of adult Internal Medicine and one of Pediatrics. I started on Internal Medicine wards on Thursday morning as part of Firm 3. In theory, each firm is assigned to one "cube" of eight beds on either the men's or the women's ward. In most hospitals in the US, this would imply eight patients. However, at MTRH, this is not the case. There is no shortage of patients being admitted to MTRH, and often patients share a bed, lying head to toe (my friends at home seem to have no concept of this outside of the grandparents in the original Willy Wonka film).

two to a bed

Adding to the overcrowded nature of the wards is the billing system of Kenyan hospitals. Instead of going home and being sent a bill post-discharge, Kenyan patients are required to pay before leaving the hospital, so much so that the guards at the hospital gates are more concerned with who is coming out than in (like the man who checks your Costco receipt … only it's your health and not a 12lb bag of gummy bears). This then creates the phenomenon of "discharge-ins"---patients who have technically been discharged but cannot leave the hospital until their families have raised enough money to pay their bill. Certainly, despite all of the warning, "overwhelming" does not even begin to characterize my first impression of the sight (and smells) of the wards. What I found to be most shocking was not necessarily the overall appearance of the hospital but the details instead. For example, date of birth for many of my firm's patients is simply a year. No month, no date. Think about how weird it would be to never know the exact day you were born (and to not be able to look it up on Facebook!). I personally have yet to spend one of my 28 birthdays not celebrating, with at least a piece of dessert, the simple fact that I am alive. A group of friends and I recently put together a 2016 calendar with photos from a New Year's trip and in addition to things like National Peanut Butter Day, the one thing we were sure to include was each person's birthday. It seems so trivial and unimportant when you have the luxury of forcing your friends and family to meet you at a bar and buy you drinks once a year, but we actually make a big deal out of it. For many of the MTRH patients, this just isn't a part of life.

But I was also surprised and impressed by a number of positive things as well. My firm, to begin with, is phenomenal. Seth, our third year Kenyan registrar (roughly equivalent to a fourth year resident in the US), appears to have memorized every medical text ever published. The sixth year Kenyan medical students (roughly those at my level of MS4 in the US) make me look like an idiot 75% of the time. All the students, interns and residents are more than capable of taking vital signs, starting IVs and changing lines, things we unfortunately rarely do in the US. This past week I saw and read for the first time in my life a CT scan that was printed on something that I only know as "old timey X-Ray paper." I've heard more real heart murmurs in eight hours on the wards than I did my entire third year of medical school.

After leaving the wards on Friday, the seven of us students as well as Kirsten, an OB-Gyn resident from the University of Toronto, took off for a safari in Lake Nakuru National Park for the weekend with our trusty guide Peter. After 12 hours of game drives, approximately 45 gallons of sunscreen and a combined 6,758 mosquito bites among us, we were able to see lions, hyenas, lots of zebra and water buffalo (who thought you could ever get bored of seeing zebra walk right next to your car?), warthogs, giraffes (my favorite!), lots of different birds, rhinos, impala and water bucks. It was quite lovely. We spent our evenings drinking Tusker (the official unofficial Kenyan beer), watching acrobatics shows, and trying to get the songs from The Lion King unstuck from our heads. We also learned that one can approximate a zoom lens camera by holding up the camera of an iPhone to the viewing end of a pair of binoculars, in case anyone was wondering.

That's about it for week one. Keep on keepin' on, friends.

Posted at 00:00

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