Last Song

Well this is it. My final blog post from my time here in Kenya. 24 hours from now I will be on a plane to Nairobi to hop on a plane to Amsterdam to hop on a plane to NYC to hop on a plane to Chicago. It seems so surreal, I can't believe I've been here two months. I've met so many incredible people. I've learned a lot, both about medicine and about myself. I can truthfully say I will be a better person and better pharmacist for this experience, regardless of where I end up.

The last couple of days have been incredible. Sad, but incredible. All of our Kenyan friends have been wishing us goodbye, asking us for contact information, and all the while making us promise we'll come back someday. I definitely wouldn't mind. Last night, our preceptors had us over to their house to play Rock Band and enjoy each other's company. It was a lot of fun. If there is one thing I have gained from this rotation, it is a vast amount of respect for people (such as my preceptors) that choose a career in global health. There is so much frustration with the reward, and I'm sure it becomes very disheartening at times. However, it is these people who give me hope that a day may come where top-rate medicine is no longer a privilege of those with means, but a right to all. I've seen it happening, even in my only two months here.

Today we went to the wards just to rewrite the treatment sheets one last time. After that, we stuck around IU House working on various things and tying up loose ends. At the end of the day, one of the peers here took us out for a drink as a sendoff from Kenya. I know I keep coming back to it, but the people here are really what have made the experience so rewarding. The Americans, the Kenyans, we've met Dutch, Scottish, Canadian, Indian, you name it. Everyone is here because they want to help, and it's an incredible thing to be able to witness.

So as my time draws to a close here, I find myself very content with my time here in Eldoret. I'm not extremely excited to leave, but neither am I wanting to stay. I am simply ready. Ready to take what I have learned here back to the U.S. and apply it. Ready to get back to the people I love and care about. And so, with a heavy heart I leave Kenya behind… for now. Until next time, Kenya. Hakuna matata.

"By the time the fool has learned the game, the players have dispersed." ~ Ashanti proverb

Imagine

Every Thursday evening here, many of us at IU House gather for what we call "fireside chats." The topic of these chats can be just about anything: we have spoken of Kenyan culture, research ethics, the children of Tumaini, and have even watched "The Lion King." This past week, however, I particularly enjoyed our evening. The topic was "Humanities," with the idea being everyone bringing something outside of medicine that they enjoy or do or that is important to them and sharing it with the group. It was really nice getting to see a different side of all the awesome people that I have gotten to know for the last 2-7 weeks (depending on how long they've been here).

Some spoke of their family: their parents, brothers, sisters, nephews, pets. Many pictures were passed around the room, and I got to look at a lot of people's adorable dogs. It made me miss Vito, I can't wait to see him on Saturday. I can't wait to see all of my family.

Some spoke of hobbies. We have a new student from IU from Ontario who talked about hockey; stereotypes exist for a reason, but he showed us a commercial aired in Canada prior to the last Winter Olympics that gave me chills. It reminded me how much I miss sports. In case anyone was wondering, one of the reasons the Colts haven't won a game yet is because I haven't been able to watch the games. Don't worry, Chuck, I'll be back for next weekend. You're just gonna have to find a way to beat the Jags on your own today--and please do, for crying out loud. It's a division game.

We had one of the more senior members of our group talk about his loves of poetry as well as fencing. He read us a poem written by a famous poet/pediatrician, and then showed us a short clip of a fencing match on YouTube. He explained the different weapons and how each one is used for a very different style of fencing, and he spoke about some of his experiences with the sport. I couldn't help but feel like fencing was a poetic sport as I watched the video; perhaps that's why he particularly enjoys them both.

One of our med students from Brown showed us videos of two of her unique talents: an ethnic dance of which I can't particularly remember the name, and hula hooping. One of my Purdue classmates talked about his love of woodworking and showed us some pictures of one of his pieces. Another fellow Boiler played us a recording on his phone of a song he wrote on guitar. One more classmate is really into film editing and is actually somewhat of a Facebook sensation; he shared some of his work with us and even showed us a video he made for AMPATH.

Another Brown student and myself spoke of ways that we like to take a break from reality for a little while. He talked of his love of fantasy novels, which I related to very much and we exchanged some book recommendations when the evening was over. Anyone who knows me well knows that I have a deep-seated passion for movies. I shared a few short clips from some of my favorite films: the wedding scene from "The Godfather" and the scene from "Billy Madison" where he is informed that his answer to the question about the Industrial Revolution is less than satisfactory. Lastly, I showed one of my favorite movie scenes of all time: Robin Williams' park bench monologue from "Good Will Hunting." I plan on watching several Robin Williams movies when I get home for obvious reasons; he will be missed.

The cherry on top of the evening was one of the new IU students teaching us origami; it might have taken some time and frustration, but I'll be darned if I didn't successfully make a crane. It might not have been the best in the room, but hey, it was recognizable.

Sometimes it's good to take a break, even for only a short time. I was grateful for such an opportunity, particularly as it afforded me the chance to take a closer look at the human side of my colleagues as opposed to the all-business side.

"Where there are many, nothing goes wrong." ~ Swahili proverb

Good Day

Yesterday (17/9), my classmate Ryan and I were given the opportunity to participate in a program called "BIGPIC." I'm still not sure what it stands for, but basically it is a outreach program managed by pharmacists to help patients in rural villages handle their chronic illnesses (mainly diabetes and hypertension). It also helps them set up and manage their own micro-finance infrastructure. They form a group that meets once a week to twice a month. In addition to supporting each other, they also have a shared reserve of money that they can buy shares in or withdraw from to pay for their medications/clinic visits. They are allowed to withdraw up to three times the amount they have put in. When they borrow though, they have to pay interest, and the interest rolls over and accrues from month to month. They also have to pay small fees if they miss meetings (paying more for unexcused absences), are late for meetings, etc. At the end of the year, everyone is given a share of the interest/fees that have added up according to how many shares they've bought. They are limited to a certain amount of shares that they can buy per month. It's pretty incredible how each village manages it all on their own and how they come together to support each other as they succeed or struggle in managing their blood pressures and blood sugars.

As students, Ryan and my main purpose was to assist in the screening of patients: we took their blood pressures and weighed them. We also got to assist the pharmacist in charge that day in adjusting blood pressure medications and insulin dosing. For our day we got to go to two different villages in the Sinoko (sp?) area in Webuye, Kenya. It was really neat to get out of the hospital and experience a real Kenyan village. I particularly enjoyed the first village, where we made friends with a young girl and boy who couldn't have been older than 4 and 3 years old. The little girl would make a face at me, and when I made it back at her she would laugh and laugh; it was one of the most adorable sounds I've ever heard. Ryan also made a cool paper airplane that they both really liked. I would throw it and they would chase it down, laughing as the wind carried to-and-fro. When we were finished, the village gave us each a soda and asked us to pray with them. I was expecting a quick 30 second rant in Swahili that I didn't understand, but was pleasantly surprised when one man and several of the women began to sing. Their voices were beautiful, and the gentleman closed the prayer with some kind words in Swahili--I'm assuming they were kind. Technically, I suppose they could have been threatening to murder us in sing-song, but the melody just didn't strike me as having that kind of tone.

It was a very peaceful day. Even though we didn't get back to IU House until about 6:45 pm, it was completely worth it to meet these amazing people. In comparison to the urbanized America I'm used to, they live such simple lives and they are some of the happiest folk I've ever met.

In the words of Ice Cube: "What can I say? Today was a good day."

"Unity is strength, division is weakness." ~ Swahili proverb

The Lazy Song

This weekend we opted for a very relaxing trip to the Rondo Retreat House in Kakamega Forest, about 2.5 hours outside of Eldoret. It was just what we needed. There wasn't any wifi there, so I apologize if anyone was trying to contact me this weekend. We stayed in this nice little cottage with a couple of new IU Med students and a new friend we met at the hospital from Holland. It was a blast. We did about a 3.5 hour hike through the forest when we got there on Saturday to the Yala River and back. When we got back we showered up and relaxed a bit. I did some reading on the front porch and we even played some euchre, which I had not played in far too long. Before you ask the rhetorical question, of course my partner and I won best of three (although we did get slaughtered 10-0 in the first game). Dinner was delicious and I had the best mango juice I have ever had in my life. If there is one thing I'm going to miss when I return to the United States, it's the fruit and juices here. I have become a passion fruit juice fanatic, and the fruit everywhere here is so fresh and juicy it's amazing. I bought a mango from the market this past week, and it was one of the most delicious things I've ever tasted…

Sorry, friends, got a little sidetracked. Anyway after dinner we played more euchre, I read some more, and then went to bed. This morning we woke up to leave for our hike at 5:30. Our guide took us to a tall hill overlooking the entire forest where we could watch the sunrise. It was a sight I won't soon forget, and definitely worth waking up at 5 on a Sunday. After that our cab driver, Max, taught us how to play a Kenyan card game. Long story short, it's a Kenyan version of Uno. It was a lot of fun. All in all, just a nice relaxing weekend to prepare us for our final full week at the hospital. It was exactly what I needed.

"Peace is costly, but it is worth the expense." ~ Kenyan proverb

Bittersweet Symphony

This week has been very bittersweet. It's had some sweet moments, and it's had some bitter moments. That's why I'm saying it's been bittersweet.

Bitter:

• A patient of mine that I've been following for a week and a half died over the weekend. Whenever a patient dies, you can't help but run through anything more you could have done in your head.
• I was in the Anticoagulation Clinic adjusting patients' warfarin regimens. Several patients didn't speak much English, so I had to have a translator. I was actually enjoying it quite a bit. However, toward the end, I did a couple patients by myself since they could speak English. What I didn't know is that warfarin tablets' colors are different strengths here than they are in America, and as a result I dispensed a patient a lower weekly dose than what they needed. Fortunately, I discovered my mistake and we were able to give the patient a call. Still though, I felt pretty dumb. Thank goodness their INR was high (3.8), or I would have been crazy worried about them having a stroke. I'm still a little nervous, to be honest.
• I did quite a number on my ankle playing dodgeball on Thursday. I rolled it pretty good, and it did not feel pleasant.
• I had to write this post twice because the first time I finished it, it wouldn't post and it didn't save what I had typed.
• We had to say goodbye to a few of the people we've met here. That's one of the strangest, best, worst parts of being here in Kenya: you meet a lot of new people, from all different walks of life, who come and go on a semi-regular basis. It's strange to think that in less than two weeks we'll become some of the goers and have to wish Eldoret, IU House, and our new friends TTFN.
• Still not having much time to run. Starting to get nervous about the marathon I'm running in about a month and a half.

Sweet:

• I have a new registrar, new consulting, and new Kenyan medical students on my team, and they are all fantastic. The registrar and consulting are great in particular, both as clinicians as well as teachers. I especially like that they are always open to my questions and suggestions. If they disagree with a suggestion, they don't make me feel unintelligent; they simply explain their reasoning behind why they think their plan is better for the patient and educate me in the process.
• Even though I hurt myself doing it, I enjoyed playing dodgeball.
• WE WATCHED THE LION KING.
• A few of us took some time to explore the streets of Eldoret a little more in depth than we've gotten to thus far. I have been wanting to do this since we got here--to just delve right into the culture and experience Kenya firsthand. It was very interesting; we got a lot of strange looks, and a lot of people trying to sell us things. I was sorely tempted to buy a pair of American Flag Toms, but I told the vendor flat out I would not pay above 1500 shillings and he couldn't budge from 1700. Sometimes you win, sometimes you lose. Still though, it was fun bartering and being in town.
• We finally got to visit Tumaini Drop In Center for street kids. Tumaini means "hope" in Swahili, and that is precisely what it's founder and operator intends for it to be to street kids across Eldoret. The idea is to provide a place where they can come, play safely, seek refuge from the streets for a little while, and even make crafts and other things to sell in order to make money to fund the shelter/buy food for themselves. It wasn't what I was expecting though; There weren't very many children when I visited, only a handful of older boys in their mid teens. There were, however, some 12, 13, and 14 year olds hanging out just off the premises. You see, it is very common for street kids to huff glue--they put it in the bottom of a plastic water bottle and constantly breathe it in through their mouth or nostrils. These boys were doing just that, and they have been informed they are not allowed at the center when they are huffing. It was extremely depressing seeing kids so young so obviously high on inhalants, but I am still putting Tumaini in the "sweet" column. They've come a long way from where they started, and they are currently finishing building a new center on a donated piece of land where 5-20 children can play, learn in a classroom, and even sleep once they get the beds. Speaking of which, that is the one item that their budget simply couldn't cover, and we were told they require a meager $1,000 to purchase the beds necessary for their anticipated inhabitants. If you are interested in helping fund this amazing cause to any degree, please feel free to email me (rjrivelli@gmail.com) and I will find a way to get you in touch with the right people.

Well, there you have it: my bittersweet week. I am really starting to (seemingly and hopefully) find my stride in the hospital and enjoy Kenya even more thoroughly than I have been of late. However, I am quite excited at the prospect of being home in 12 short days!

"Being happy is better than being king." ~ African proverb

Don't Go Chasing Waterfalls

So last weekend we kinda just hung out here at the complex, but on Sunday we took a trip to a place about 40 minutes away called Umbrella Falls. As the name implies, it was about a 1-2 hour hike that centered around a waterfall. Eldoret has two turbines that harness the power of the water to generate electricity. It was absolutely awesome. I really enjoy hiking, especially challenging ones, and this was most certainly a challenging one at that. Anyone who knows me well knows that I love doing stunts that may or may not put my body slightly in harm's way and definitely would make my mother furious--I think that comes partially from my dad. The point being, it takes a fair amount for me to even really get nervous. This hike wasn't particularly physically challenging, but being a waterfall there were some fairly frictionless rocks that we had to step on. Eventually though, we reached our destination: we were behind the waterfall. It was a short, quick hike but I relished every second of it. I hope you enjoy the pictures. In case you wonder, the reason that the water may appear brown is because Eldoret is wrapping up its rain season; the rain washes a lot of the soil into the river that pours over the waterfall, thus the soily, brownish tinge. Still breathtaking nonetheless!

"The surface of the water is beautiful, but it is no good to sleep on." ~ Ghanian proverb

Home

So I'm attempting to write this so that it gives you an idea of where I tended to be at in the middle of the week for the last couple of weeks. With that in mind, just pretend that you're reading it this past Wednesday or so…

I'd be lying to you if I said I haven't hit a bit of a wall lately. Being in Africa has been nothing short of an amazing experience. It has opened my eyes to so many things. However, it isn't all safari-ing and hikes and other "insert tourist activity here"-ing. The hours are long, and after a while it's starting to get to me. Don't misunderstand: I knew what I signed up for, and I knew it wasn't going to be easy. It's also not as though I don't very much enjoy what I'm doing here. It's pretty awesome to be able to make a difference to the degree we can here. I have patients who I've really connected with, and I've been able to learn from some of the brightest minds in global health and some of the finest doctors and medical students that programs like Indiana University, Duke University, and Brown University have to offer. At the same time though, weekends are really the only rest time our brains get, and Monday mornings keep getting tougher and tougher with each passing week.

I am to be a pharmacist, possibly a future clinician. Even if I don't go into clinical practice and choose to pursue a career in community pharmacy, I have still sworn an oath to protect my patients to the best of my ability. Part of this is being a lifelong learner, and it's one of the reasons I chose a career in a medicinal field--who on earth ever wants to stop learning? There is but one answer, in my opinion: the fool who thinks he is ever done. I truly do enjoy being challenged on a daily basis, and here in Eldoret challenges come in no short supply. Each day comes with something new, and something new turns into something to study, whether it be a drug or disease state. I love learning, but the brain is a like a muscle. You can't flex it for too long without relaxing it, or it will sprain. Usually my time to let my brain relax is my runs, but I haven't even really had the time for those lately (which is starting to make me nervous considering I'm scheduled to run my first ever Marathon on November 1). I have started setting aside 30-60 minutes each night for recreational reading right before bed, though, which is helping.

Long story short, I'm beginning to feel the pangs of longing to return back to the good ol' U.S. of A. I'm very blessed to be here with classmates and people who help keep me grounded, a couple of whom also share my emotions. I still maintain that this clinical rotation is providing me with experiences and skills that I would not be able to get anywhere else. If anything, my time here has certainly given me a greater appreciation for what the amazing people in the global health field do; I'm only here for two months, but there are many folks here who have dedicated their entire lives to this cause. I think that I will be content with my two months.

As I have said many times, it's been amazing, humbling, inspiring, and difficult so far. I'm sure that when September 25 rolls around, there will be a part of me that will be sad to go; there will always be a part of me that will want to come back. There will also be a part, however, that is more than ready to return home, and that voice is already starting to creep into the back of my mind. Do not despair for me though, dear friends and family! I am still loving being here and wouldn't trade my time in Kenya for all of King Midas' silver. It just gets a little mentally taxing at times, and as the one currently helping you procrastinate all the tasks that you should actually be doing, I feel I would be doing you an egregious disservice if I didn't present you with all the facets of my journey. Besides, the next two and a half weeks will be gone in the blink of an eye, and I'll have a cheesy gordita crunch in each hand laughing about how retrospectively melodramatic this post sounds before I know it. I just need to buckle down, work hard for a couple more weeks, and be patient. After all, being here and doing what I'm doing is the opportunity of a lifetime. Before I spend too much time feeling sorry for myself and wishing my remaining time in Kenya away, I need to focus on taking all that I can from it while I can. Nothing gold can stay.

"A patient man will eat ripe fruit." ~ African proverb