Saturday, July 31, 2010

My trip is nearing it's end and like I expected, this blog has been woefully neglected. Old habits die-hard. Without question, my time in Kenya has been amazing. Over the past two and a half months I have had the opportunity to be a part of some remarkable experiences. I have been in a mini-van with 25 other living entities (19 adults, 4 adolescents, 2 babies, and a chicken) flying down the highway at 60 mphs with a man hanging out the open sliding side door yelling, “Welcome to Kenya!” I have been to a bullfight in Kakamega (not the Spanish kind, but a soccer field full of bulls fighting each other while the viewers do their best not to get trampled) and a butterfly farm in an ancient rainforest. I swam in the warm waters of the Indian Ocean and then travelled 400 miles by bus through some of the most beautiful scenery I have ever seen. I spent 6 weeks with 6 incredible students and and like Nikki said, got to fulfill all of my National Geographic dreams when we spent three spectacular days in the Masai Mara.

For the past month, I have been staying with a family in a rural area near the Tanzanian border. Four days a week I go to St. Joseph’s Mission Hospital in Migori and on Tuesdays I have been trying to show the teachers at the locals schools how to use Microsoft Word and sign-up for Facebook accounts. At night and on the weekends I play with Jeska, the families’ youngest daughter (the older 3 are away at boarding school) and read about all the things I see at the hospital.

Of all my time at the hospital, this past week was hardest. I have been there on and off for over two months now and have been surrounded by death and dying the whole time. This week however, was the first time that I'd actually been there when someone died. On Thursday evening I watched a young 21 year-old boy name Alfred succumb to late stage typhoid. The immediate cause of death was a severe stomach infection due to significant perforations in his small intestines. I’d been attending to the boy and communicating with his family since his admission the previous afternoon. When he finally took his last gasping breadth, his father and I were sitting at his bedside talking about why we couldn’t take him in to the operating theater and agreeing that all that we could do was leave the situation in God’s hand. When Alfred stopped breathing a few minutes later, it was heartbreaking to watch the family break into wailing tears. The boy’s mother and younger brother were inconsolable and Charles, his father, seemed to be lost. The boy had been in another hospital for 10 days before being brought to St. Joseph’s, and it was during that time that the disease progressed to a point in which nothing could be done. I have never felt so paralyzed and frustrated in my life.

After he died and the family had time to mourn over his body, the nurse and I removed his hospital gowns and put him in the white linen suit that mark the patients headed for the morgue. As we manipulated his lifeless body out of his hospital gown, I was overcome by the feeling that surely there must be a better way to treat the dead. In an open ward surrounded by 9 other patients and their visiting families it seemed like the most undignified thing we could have done. Nevertheless, we lifted him onto a metal table and wheeled him to morgue accompanied by his father. After we situated his body, the father expressed his gratitude for the care I had shown his son. I immediately started to cry and apologized for not being able to do more.

I saw Charles the next day when he came back to pick up the body and he invited me to the funeral which will take place next Saturday. I told him that I would very much like to attend but that I would be leaving the country the day before. We talked for a few more minutes before he headed for home and I went back to check on the progress of a laboring mother.

As frustrating and draining as the experience was, I feel very blessed to be becoming part of a profession that has the opportunity to help and support patients and their families as they navigate these difficult and painful times. It feels like a real gift.

I couldn’t have imagined a better way to spend my summer. I have seen things I never imagined I would, and I am as excited to start medical school this fall. I have also extended my family halfway across the world and know that when I leave I will immediately start thinking about when I can return.

Having said that, I am ready to come home. I miss my friends and family dearly and I really want to eat some sushi. I will see you soon. I’m bringing the mustache with me.

Saturday, June 26, 2010

This is what happens when you leave me……

…I make fantastic style choices. The rest of the gang left Kenya on Wednesday. It hasn’t fully set-in that I will be here for another six weeks by myself but I certainly already miss my travel companions. I couldn’t have asked for better people to share this experience with and I will be forever grateful that they made me feel like I was part of the group from day one.

Once we dropped Jeanette off at the airport, Barasa and I returned to downtown Nairobi and spent the night in a small hotel where we ate fried chicken and French fries on our beds while we watched the world cup. We spent a good portion of the next day walking around the Nairobi second-hand markets searching for vintage neckties before we hoped on a bus and went to Kawangware to pick-up his laptop. As we stepped on board, Don Williams “I’ve been loved by the best” emanated soothingly from the remarkably crisp speakers and I knew we’d picked the right one. I asked the conductor what the name of the mix was and he said it was a few years old (back when they used to burn audio files onto CDRs rather than the MP3s that they now load on to DVDs) and that I wouldn’t be able to find it anywhere. He said I could copy it when I returned to Nairobi and I took down his email and phone number. Meanwhile, Barasa had moved to the front of the bus and was in deep conversation with the driver. When we got to our stop the music halted abruptly and I watched Barasa exit with that devilish grin that graces his face so often. Once outside he just laughed and handed me the CD. He said he paid the driver 100 ksh and then dropped some knowledge about knowing what you want and not worrying about what other people think as you go after it. God I love that guy.

And that’s the story of how I got Kenya’s Country Mix 3. At least I have the conductors address so I can mail it back to him before I leave. Anyway, there’s nothing quite like cruising through the slums of Nairobi listening to John Denver’s “Country Road” thinking about home, hoping what I'm doing here is making some small difference, and thanking God for all the blessings I've received.

Thursday, June 17, 2010

The Crew (I couldn't have asked for better people!)

Habari! My name is Jami Strapple and I am from Hawai’i. Here in Kenya, I have been called “the lady from the waters”. I think I am called this because people cannot remember my name or pronounce it. I am here in beautiful Kenya along with my wonderful classmates from Pacific University PA program class of 2010. We have been looking forward to this unforgettable opportunity and experience for 1 year and it has finally come.

I was born and raised in Kailua, Hawai’i in a quiet, little beach town where everyone rides bike around town and to the beach, hangs out at the beach and goes for morning beach walks. I have two happily married parents and a dear younger sister. I have a warm hearted, loveable boyfriend in Hawai’i named Kamaka who has been by my side every minute through this journey through PA school. Love him! I have one poi dog (many mixed breeds) named Ziggy. I enjoy anything water related: surfing, canoe paddling, kayaking, boogie boarding, swimming. There is something magical and mystical about being in the ocean. That is one thing that I can say that I miss the most right now, the ocean. I love sushi and bubble tea!!!!

Being in Kenya has been eye-opening and life-changing. There have been so many different emotions everyday! It is hard to explain. I think my classmates know what I mean. I have learned so much about the people, culture, language, land, food, and tropical medicine. The people here are overwhelmingly friendly and I have never felt so welcomed and cared for since being here in Kenya! In fact, let me share an experience J-dub and I had with a lady from the hospital (keep in mind we had only met her 2 days prior). She approached us with the earnest handshake, hugged us and told us how much she wanted us to stay in Kenya forever, work here and that we should buy a piece of land, build a house and live in Kenya forever. Super nice!!! This made me feel so happy inside. I will take each and every one of those experiences with me home and hold them deep down in my heart.

We are headed back to Portland, Oregon next week, graduate in 6 weeks, take the PANCE (PA national certification exam), find a job and settle into our lives which have been on hold for the past 26 months. I can’t wait!!!! I plan to head back to “the waters” to work and live. Until next time….Aloha!

My name is Jessica Wright, I’m 32 years old. I live in Portland, Oregon and I’m in my final couple of months of a Pacific University’s Physician Assistant program. I grew up in Oregon but spent a good portion of my adult years in California. I live with my girlfriend and several cats (of course) and I love rainbows and ponies. My collegiate background is in biopsychology and mental health, however, I’m hoping to only use those skills to subtly influence people, not to use them as my professional focus. In all seriousness my professional goals are to help a lot of people, particularly old people and buy some nice skirts. I’m hoping that upon graduation I’ll be able to land a hospitalist position, or potentially a general surgery position. I have thoroughly enjoyed Kenya and the comparison to our medical system has been eye opening. The people of Kenya are like no other I have ever met. They are truly the most kind and welcoming people. The culture and the land are amazing and I will truly miss these things as well as the culture.

For those of you that just read about J. Dubs (aka. Jessica Wright), I just want you to let you know that in real life, she is one of the wittiest of people that I know. She’s the comic relief of our group, and can dance like you wouldn’t believe. I’m Michelle, hailing from Corvallis, Oregon. Here, I’m known as Michelle Obama, or just Obama for short. Having Obama as President has really gotten us quite far. I was born in San Jose, CA and I’ve got two wonderful parents and one older brother who I love dearly. I too, am classmates with J. dubs. There are six of us from Pacific University, here for our ninth (of ten) rotations before we graduate this August. It is really hard to believe how close we are to graduating. PA school has been quite a ride, and we’ve been looking forward to this time in Kenya for one year. Being here in Kenya has been more than I could have ever imagined. We’ve seen manifestations of diseases we’ve only read about, and become more astute in the art of tropical medicine. I definitely heart Kenya. Traveling has and always will be a part of my life. It’s the kind of experience that always exceeds whatever expectation you had -- the people have been more gracious and genuine, the country has been more beautiful, and the food has been amazing. I couldn’t have asked for better travel buddies, and J. biddle has been a great addition to our group. Though we only have a few weeks left, I know J.biddle will try and retro-chronologically keep you updated on what I have failed to do with my family and friends. Cheers!

adding to the pot here…

I am still figuring out biddle, so I will freely write about myself instead in a shameless act of self-promotion. my name is nikki mcleod (yeah, I know the punch line) and am part of the kenya 2010 crew from born in delaWHERE? (biden is my homeboy), raised on a boat in the chesapeake bay (I sure know my crabs), transplanted to new hampshire (it’s like old hampshire but new), then to tahoe (keep it blue) for a few years of ski, climbing, and world travel related hedonism before settling down back in new hampshire with the love of my life, only to recently find myself back on the left coast for grad school. i’m really good at run on sentences and inappropriate punctuation, laughing at irony, drinking tea, and napping. the list of things i’m no good would dwarf the magna carta.

i have 3 boys, ben, liam, and camper- who truly are the most amazingly weird and fun creations ever. we like to ride bikes around pdx and picnic at the neighborhood beach, go to the park for some crazy see saw action, and share a pint of beer (the adults, not the kids…i mean as liberal as i think i might be, i would not share a beer. with anyone. period.) and chess on sundays at the pub 3 blocks down. It’s a good life….one that I finally plan on really participating in after graduation. august 14th.

in the meantime, am just reveling in traveling like i mean it. to a crazy place in a fantastic time (woot woot obama and world cup) and soaking up experiences like there’s no tomorrow. an escape from my norm, but a place I find nostalgically comfy. good times with good peeps. fo sho.

Jambo Sana! Joshua now on the keyboard.

Sugarcane by the meter and our own perpetual group of under 7 yr olds constantly in tow. These children free to roam, or come and go as they please find something supremely interesting in all of our movements and activities. Finally one of them gets the nerve up to approach us - sticky little hand extended for a hand shake…. Once the others see the exchange of handshake and smile they all converge.

I am shooting from the hip here blogosphere world.

A few weekends ago – walking between homes in our rural Kenyan community –Bware- with members of the Buchwa women community heath workers who have identified those in the community with medical needs and acted as guides and translators. I visited 24 patients in one day seeing everything you could ever imagine… . These rolling hills of dark red earth spotted with single-track trails, mud huts, brick houses, and fields of corn, sugarcane, pineapple, beans, peanuts and rogue goats, chickens with chicks in tow and cows that are elated in their escape – long rope in tow tied to one of the front hoofs. Small children 1/3 the size of their cows keeping them in line with a small branch in one hand and a piece of sugar cane in the other.

Babies tied to mothers backs in bright colored fabric that makes the small faces that peek out over these improvised slings irresistible.

What a time for an American to visit Kenya : we have a Kenyan man in the president’s office. Obama is the default conversation piece that can bring any of us together with our hosts. Saying “my vote helped put Obama in office” wins the hearts of any Kenyan.

My only question – why no hammock culture here?

On a final note I was one of 12 people in a run of the mill Toyota station wagon today. 2 full sized people in the drivers seat – let the imagination figure out the rest.

A bit about myself, to help frame this conversation and blog– sparing the diapers to degree timeline, I will give the last 10 years. Once I completed my undergrad degree I began seasonal work in the Frank Church Wilderness (Idaho) and Northern Italy. Summers were spent guiding 7-day river expeditions on the Middlefork of the Salmon River; the other 8 months living with an Italian family I befriended while studying abroad. Happily studying medicine now with some of the most genuine people I have ever been with.

Greetings from beautiful Kenya! My name is Jeanette Nelson. I am also a PA student at Pacific University. The men in my life (hubby Matt and sons Ian and Grady) are currently residing in Salt Lake City, Utah while I am off globe-trotting. I have always had a desire to come to Kenya to do medical volunteer work and I consider myself very fortunate to be here with such a great group of people. This has been one of the most amazing experiences of my life. I have had so much fun getting to meet with people in their homes, play Frisbee and jump rope with school children, sing and dance with the locals, laugh with my friends and the hospital staff and watch the beautiful Kenyan sunsets as each day comes to a close. The people here frequently tell us not to forget them; I don’t think that will be a problem.

Wednesday, June 16, 2010

Quick Musings

Sitting on my bed while the rest of the crew does their evaluations at the hospital with Dr. Agullo. It’s hard to believe that the first half of my trip is almost over. Tomorrow is our last day at the hospital and we have seen some truly amazing things. Josh R., Nikki and I spent the majority of the morning walking around the hospital taking photos and playing with the children in the pediatrics ward. Josh R. made balloons of out gloves and we all had a great time laughing and throwing them up in the air. As much fun as it was it’s hard to fully extract oneself from the reality that most of the 40 or so children are very, very sick. I keep thinking
back to our first week in the hospital when Michelle and I observed a surgery in which Dr. Agullo removed 100 cm of necrotic intestine from an 8 year-old boy whose bowels were so full of round worms that their weight caused his intestines to wrap around themselves and cut off the blood supply. This was an extreme case but certainly not unique. Just before we went in for the procedure one of the nurses showed us a jar of 240 worms they’d pulled from the belly of a different boy the week before. That aside, it was a pleasure to play with the children out in the halls without having the cloud of disease hang over us the way it seems to do at the bedside. I’ve got to run to the hospital to meet the folks so we can head into to town and do a few things before we leave. I’ll write again soon and include a short write-up from each of the other students. Hope everyone back home is doing well.

Tuesday, June 8, 2010

Tuesday June 8, 2010

This is the 21st day of our trip and the first time I am finally sitting down to give an update. I’ll try my best to give a short but informative synopsis of the first three weeks but I know that I my attempt will fall short. This experience has been incredible and there is no way I will be able to convey the richness of the past days by trying to describe them from memory. I will start with today and work backwards with the intention of beginning with what is most fresh and in the process jump-start my memory in reverse.

We’re currently in Migori doing rotations at St. Joseph’s Mission Hospital and staying at the guesthouse down the road. For breakfast this morning we had the same thing we do every morning: a hard-boiled egg, sausage, three slices of tomato, toast and tea. Today was the first day Michelle wouldn’t take one of the extra sausages. If you’d been with us for previous breakfasts' you’d understand the magnitude of this event. Needless to say, some variety would be nice.

After breakfast we went to the hospital and met Dr. Agullo in his office. We heard the hospital statistics for the previous day and reviewed the cases of the three patients who died, two of whom were children. It is not uncommon for children to be brought to the hospital after they have been very sick for a number of days. Part of this is due to the financial situation of many of the families and part of it has to do with subsistence farmers not appreciating the severity of their children’s sickness until it is too late. Both of the children died within 24 hours of being admitted. Severe anemia as a complication of severe malaria was implicated in both. Although it was agreed that nothing could have been done to save the children, Dr. Agullo was concerned that the staff did not respond fast enough when the condition of one child worsened during the early morning. “Let us not lose children because we are not responding fast enough,” he said.

After the meeting we went to x-ray room to watch a hysterosalpinogram in which fluorescent dye was is to visualize the uterus and fallopian tubes. The patient was a woman who could not conceive. Once on the examination table, Dr. Agullo asked her how long she had been married (5 years), how many children she had (none), and whether or not her husband had a “co-wife” (he did not). After that we all headed to our prospective wards.

Michelle and I accompanied Dr. Agullo to maternity while Jamie and Jessica went to outpatient. Joshua and Nikki rounded on the medical ward and Jeanette was in pediatrics. We first checked on a woman who had been in the hospital for three days with a pregnancy that was two weeks overdue and a delivery that was not progressing. When Dr. Agullo found that she was no more dilated than she was the night before, he ordered an emergency c-section. Despite mild concerns, the baby’s heartbeat was loud and regular.

We also checked on an Indian woman who had given birth during the night. It was really neat to see a large Indian family in the maternity ward of a Kenyan hospital excitedly chatting with Dr. Agullo in fluent Swahili. With two American medical students in the room, it was certainly a cool international moment.

While they prepared the surgical theater for the cesarean, we continued on our rounds and found a young woman who was admitted late the previous afternoon due to an infection she acquired after the home abortion of her 5-month old fetus. We later found out from one of the nurses that abortions are illegal in Kenya. The woman was in severe pain and was resistant to even the lightest touch. Dr. Agullo called for an investigatory laparotomy. We finished rounding and Michelle and I wrote the discharge notes while Dr. Agullo went back to his office.

The notes done, we rushed over to the theater and changed into our scrubs. Michelle scrubbed in while I got my camera ready for the first c-section either one of us had seen. Dr. Agullo finally arrived and the procedure began without incident. As soon as the uterus was opened and the baby was visible, it was clear that this was not going to be the happy occasion we had all hoped for. It was immediately clear that the baby was slightly blue and as he was pulled out we could see that the umbilical cord was wrapped around his neck. Feces were covering the lower half of its body, an indication of traumatic labor, and the were no signs of movement or breathing. The anesthetists tried to resuscitate the baby while Michelle and Dr. Agullo closed the incision. Their attempts were unsuccessful. The baby was placed on the scale and then wrapped in a blanket and removed from the room. It weighed 4.2 kg. I didn’t end up taking many pictures; it didn’t feel like the right time.

When the procedure was over the three of us returned to Dr. Agullo’s office to see outpatients during the 30 minutes it would take the surgical staff to prepare the room for the laparotomy. During that time we saw the woman whom we imaged earlier in the morning and the husband of the woman we had just operated on. The first woman turned out to have an abnormally shaped uterus with two uterine cavities instead of one. On film, it looked like a compressed cartoon heart. Only the left lobe had an associated fallopian tube and ovary. Agullo suggested uterine reconstructive surgery and the woman left the office like most of the patients we’ve see in Kenyan, without affect. The would-be father was more engaged in the interaction with Agullo, perhaps because he spoke better English, but was nevertheless stoic in his response. He thanked Dr. Agullo for all of his work and left.

At 1:00 pm we returned to the operating theater (without lunch) for the exploratory laparoscopy and I scrubbed in. When we got into the room, we found that Nikki and Joshua were already there and that Joshua had already scrubbed-in and gloved-up. Joshua addressed the situation in characteristic fashion by replying to my inquiry about who should assist by saying, “as far as I am concerned, the more the merrier.” The operation went well but on gross examination nothing abnormal was found that could be causing the woman’s pain. At the end of the operation, Dr. Agullo returned to his office and left Joshua to place the last few sutures. It was pretty cool and somewhat nerve-racking to be at the table without a physician. In the end, Joshua did a great job and we both left the room happy.

The four of us returned to the guesthouse and ate rice, greens, and eggs for lunch. I did some laundry and Jamie, Jessica, Michelle, and I returned to the hospital at four to attend a weekly mass for the staff and any sick patients wishing to attend. When attendance was found to be wanting, the priest decided to postpone the service until next week. We stopped at the canteen for a ginger soda and headed back to the house for some rest and relaxation. I read a few chapters in “The Lost Art of Healing,” a book that Tina gave me as a graduation present and listened to some music that Justin put on my iPod. We ate dinner, watched Anchorman, and now I am finishing up this first post. I am not sure I like how it is turning out, heavy on the narrative and lacking in my impressions and feelings about what has been going on. Hopefully if I keep this up I can strike a balance between the two. As far as the synopsis goes, I guess it will have to wait. You will have to be patient not knowing who any of the people are that I referenced. I will try to describe them too when I have the change. For now you should know that everyone on this trip is great. I could not have asked for a better arrangement or a better group of people and students to be travelling with. Anyway, it’s getting late and we have to be at the hospital by 8 am tomorrow morning.