Where Are We Runnin'?

So as many of you may or may not know, one of the many things that I am trying to keep up with while here in Kenya is running. I am training for the Monumental Marathon which I will be running in on November 1 with some of my esteemed colleagues in Purdue University Dance Marathon Alumni (PUDMA) to raise money for Riley Hospital--shameless plug, if you'd like to donate, go to http://donate.rileykids.org/site/TR/ThirdParty/ThirdParty?px=1296614&pg=personal&fr_id=1490. Anywhoozer, living at the IU Compound there are certain rules, not the least of which is that we are not allowed to leave while it is dark, neither in the morning nor evening. As you can imagine, seeing as I get to the hospital around 7 am and typically don't leave until 5:30 or 6 pm and dinner is served at 6:30 pm, this makes it pretty difficult to work in my runs. My running schedule involves running on Tuesdays, Wednesdays, and Thursdays; I run my long distances on Sundays. I've been keeping up as best I can, but there's definitely times when it slips through the cracks. Aaaaaand cue today's story.

This past weekend we went to Lakes Baringo and Bagoria, which I have yet to blog about--don't worry, it's coming soon to a computer near you. We got home later than I expected on Sunday, and this particular Sunday I was scheduled to run a half-marathon, or 13.1 miles. Technically, I could have ran it on the small roads that connect all the houses in the compound where IU House is located (it's gated with security guards), but seeing as one lap on such streets is a little over a third of a mile, I didn't much care for the idea of running approximately 39 diminutive laps in the dark. So, the next day--this past Monday, August 25--I made sure to eat a quick lunch so that I could get back to the hospital earlier than usual, cram in some work and leave the hospital by 4 pm. I walked back to the house quickly changed, and embarked upon my journey. I hadn't done much running outside of the compound yet, let alone a half-marathon's worth of mileage, but I'd asked a few regular runners at IU House and they gave me some tips on routes. I decided to keep it simple: take a road straight out five miles, take it straight back another five, and then run the last 5K within the IU Compound. And so I strut through the gate and began my escapade.

It was absolutely wonderful. There was a medium-light rain going with a thunderstorm off in the distance, and I was at one with the run. The first couple miles were rough, going uphill and on the poor dirt Kenyan roads. Once I hit around 2.5 miles, though, I was in the zone. Music blaring in my ears, smiling at Kenyans driving their cows and running home to escape the deluge falling on their heads. The road I was on T'ed off a couple times, but I still felt confident in my ability to find my way back. There were some land markers I felt sure I could remember. I really, really wish I'd had a GoPro on during that run. That first five miles especially was one of the most serene experiences I've ever had in my life. I couldn't help but feel like I was truly experiencing Africa the way it was supposed to be. I ran by hardworking Kenyans tilling their fields. Nothing but green green green all around me. I ran by Kenyan women walking home balancing massive bags of who-knows-what on their heads--yes, that apparently is a real thing. The best part is all the smiles I got as I ran by, and the encouragement I would get. I was the crazy mzungu running in the storm, and they loved it. To all my friends who are runners, if you ever have the opportunity to take a good, long run in Africa, and you know you'll be safe, just trust me that you absolutely have to do it. I heard Siri tell me I hit the five mile marker, and turned around to return home. That was right around where things got a little muddy--both figuratively and literally.

Remember how I said my route T'ed off a couple times? Well, I missed my first turn. Next thing I knew I was running through massive fields of mud that I most definitely did not remember running through on the way out. Before I knew it, I was good and lost. When I say lost, bear in mind I wasn't completely without bearings; I had a good idea of the direction of IU House, but in Kenya country roads don't exactly just go straight. They tend to careen off in directions you don't want them to and slither like snakes until your heading straight onto someone's farm. I looked at my clock. I'd run about 5.5 miles and it was about 5:30 Kenyan time, and according to my phone earlier the sun was due to set at about 6:45. Best of all, my Kenyan phone--you know, the one that can call people who can rescue me--was dead. After mulling over my options, I realized my only choice was to keep going and head in the direction I knew I needed to go. Panic hadn't quite set in yet; after all, I had an hour to run what I though was approximately 4.5 miles--not exactly a difficult pace for me to keep up. I just had to get back before dark, because I knew three things: if I didn't, Katie Harsh, the responsible one in our Purdue group here, would kill me. And if Katie didn't, Monica Miller, my professor at Purdue who prepared us for Kenya and told me specifically not to do anything stupid, would. And if Monica didn't, my mom would, and she would most definitely succeed.

I set off running, and a mile quickly passed by. And then another mile. pretty soon I was on mile 7.5, and still hadn't a clue where I was. I was still relatively calm, all things considered--running has that amazing effect on people--but I'd be lying if I said a minimal amount of worry wasn't starting to sink in. I said a few prayers, asking the big man upstairs for a little help. About 5 minutes later, or the beginning of mile 9, the most incredible thing happened. I saw someone running a bit ahead of me, and he had to stop every so often to, what appeared from a distance to be, tie his shoe. I eventually caught up to him and discovered it was a Kenyan boy no older than 13 years old. Once I caught up, he flashed me the biggest smile and just started running with me. Every once in a while he would have to stop momentarily to reach down because, as I now noticed up close, the toe of his right shoe had a massive whole to the point where his foot would slowly slip out of his shoe. No matter, he would just pull it back on and keep running. I can't describe the feeling of having this young boy run with me, a complete stranger, as though we had been running together for years. I decided to just try and live completely in that moment for a while, so we ran for a good three quarters of a mile before I finally spoke. "Do you speak English?" He nodded. "What's your name?" "Kiprono." (key-PRAWN-oh). "Nice to meet you." We ran for another minute or so. "Do you know how to get to Boma's Inn?" "I don't understand." Strike one--I would have easily known how to get home from Boma's Inn. "Do you know where Nandi Road is?" His face lit up with excitement and he took off in the direction we were already running. Sure enough, he got me back to a paved road, which was DEFINITELY a good sign. I still had no idea where I was, but I knew which way down that road I needed to go. We ran for another half mile or so before he looked at me and said, "You keep running this way. I go that way." He could have been messing with me--not unlike other parts of the world, Kenyans greatly enjoy making fools of Americans--but I believed him. Partially because I had to, but also because I felt somehow connected to this kid. As he took off to my right, I couldn't help feel a little sad. I would never forget my mile and a half run with Kiprono.

As I kept running, I started to pass a gas station. There were some boda-boda's parked there (motorcycle taxis), so I walked up to one of them. It was about 6:15 at this point, and I'd already run 9.25 miles. "Want a ride into town?" he asked. I actually half-considered it. You see, another rule of IU House is to NEVER ride on a boda-boda; quite frankly, though, I would much rather risk riding a boda-boda if it meant not being subject to the streets of Eldoret after dark. Still, I figured I should ask first: "Do you know how to get to Boma's Inn?" "Sure!" he said. "Just keep going down this road and you'll see signs that you can follow right to it." My heart leapt for joy; I was going to make it. "About how far would you say that sign is?" "I'd say about 4 kilometers." For those of you who don't know, that's about another two miles. I sighed, but there was nothing for it. I kept going. Suffice it to say, I made it back to the IU Complex safely, and to my mother and Monica if you're reading this: I did, in fact make it before dark--by about 20 minutes. 11.83 miles when I got back and finished within the gates, aka 1.83 miles out of the way of where I'd intended on running.

It was definitely worrisome at times, but it was my most amazing experience in Kenya to date. The people here were so kind, and I feel eternally bonded to Kiprono. I don't know if he feels the same or not; I'd like to think he does, though. Rest assured though, friends: I shan't run further than I know for sure I can return safely again, and I will most positively have a fully charged phone.

"If you want to go fast, go alone. If you want to go far, go together." ~ African proverb

Highway to Hell

So this post is about a week and a half overdue, but a couple weekends ago (16/8 and 17/8) we went to Lake Naivasha and Hell's Gate.

We left early Saturday morning and made the five hour van ride to the place we were staying, Camp Crescent at Lake Naivasha (named after the crescent crane). This time, we had some new additions to the group! Two IU Med School residents and one from Brown. They were a fun, welcome addition to our posse, and I know that Katie was certainly excited to not be the only female in attendance. The place we stayed was incredible. My classmates called it "glamping", or glamourous camping. I had never heard the phrase before and played along because I wanted to be cool like everyone else, but in reality I didn't much care for it. Despite my distaste for the attached colloquialism, our "tents" were the bees knees. Here's a couple pictures below:

So we dropped off our bags in our tents and clambered back into the van to head to Hell's Gate. Hell's Gate is a national park established in 1984 just south of Lake Naivasha, and is named because of the narrow break between the cliffs according to its Wikipedia page. We arrived at the gate and paid our entry fee. Because I was an ignoramus and forgot my pupil pass back at IU House, I had to pay a little more than everyone else, but it was totally worth every penny… or shilling, rather. First things first, some of our classmates rode bikes a ways along a path while a couple others and I rode in the safari van behind on the way to the start of the hike. Bikes were in limited supply, and seeing as I was already paying extra I figured I'd jump on a grenade for the good of my friends--it had everything to do with my selflessness and nothing to do with trying to save money. I swear. This was our first real safari experience: we saw pumbas (warthogs), zebras, giraffes, water buffalo, Eland and Thompson gazelle, and antelope. It was awesome. At one point we even got to watch two zebras fighting for dominance or territory or maybe because there was some kind of dibs-related misunderstanding on a particularly delicious looking blade of grass. Regardless of their source of disgruntlement, it was highly entertaining to watch. Aside from the wildlife, the scenery was absolutely breathtaking. Cliffs, plateaus, trees; there is land untouched by man in America to a degree, but nothing that I've seen even comes close to what Africa is like. Square miles upon square miles (miles^4?) of seemingly infinite plants and mountains and animals. It is quite a sight to see.

Finally, we arrived at the entrance to our hike. There were a bunch of monkeys crawling around everywhere. There were some other tourists there handing them banana peels and they were running around like crazy. Katie referred to them as "the squirrels of Africa," which I thought was apropos. After playing watching the monkey's mess around for a bit, we began our hike.

Our hike through the canyons was one of my favorite activities we've done since being here. It involved a lot of climbing, jumping from rock to rock, taking off your shoes and wading through some knee-deep water--it felt like being a kid, and I loved every minute of it. I did some climbing that would have made my mom nervous but it was so exhilarating. Not to mention getting to observe the awesome canyon, the views, and even the Devil's Bedroom where all the baboons sleep. Unfortunately they weren't there, so no baboon-sightings. Still, it was awesome.

When it was all said and done we went back to the glampsite (ugh), ate dinner, and pretty much all passed out. We woke up the next morning, packed up our things, checked out, and hopped on a couple boats to take a quick one-hour tour of Lake Naivasha. It's home to a bunch of different birds and hippopotamuses… hippopotami? Whatever, you get it, hippos. We kept our distance obviously; for those of you who don't know, hippos are extremely territorial and considered the most dangerous animal in Kenya. Still, we got lots of pictures and had lots of fun. I'm not gonna lie, I'm getting sick of writing this post so I'll play you out with some pics and talk to you all later.

"A friend is someone you share the path with." ~ African proverb

If You Want to Sing Out, Sing Out

I realize I haven't blogged in a while, so I'm going to try to knock out a formidable amount in the next hour and a half or so. First, I'll talk about how being at the hospital has been for the last couple of weeks.

Where do I begin. This is shaping up to be one of the most frustrating but rewarding experiences I will probably ever have in my career. Let's start with the aggravating aspects first and then we can move on to the rewarding tidbits.

First, let me preface the following statements and say that what is done at this hospital is nothing short of miraculous. It is like any other hospital in that it comes with risks, but as I have noted in previous posts we do the best we can (and probably then some) in the environment we're in with the budget and commodities we are afforded. That said, there are some particulars that we have to overcome on a daily basis that can certainly become a source of irritation and aggravation; however, like our awesome preceptor tells us every week, it's good to get frustrated. Frustration can fuel you and make you a better learner and in the future a better practitioner. He reminds us continuously: if we ever stop getting frustrated with these things, it could mean we've stopped caring, and the biggest victims in that case aren't us--it's the patients.

For the past couple of weeks, the Moi interns and some of the registrars have been on strike. Moi is partially a government funded hospital, and apparently the federal government allocated a certain amount of money to the county to be spent on health care. The county government, which has never been in charge of the health care budget before, mismanaged the funding and as a result the interns and some registrars have not been paid for the past five months. The county government claims that the federal government should pay them, and visa versa. I can't say I blame the strikers; they have living expenses. Some are close to losing their homes, others have mouths to feed. Unfortunately, it's the poor patients that can't afford to leave and go to a private hospital that suffer in this instance. You see, when I say they're on strike, it literally means they don't come to work. It would be one thing if they were construction workers like my dad; traffic signals wouldn't get installed, roads wouldn't be paved, etc. Nobody unrelated to the issue really suffers. But these men and women are doctors and pharmacists. How it relates to us Purdue people is that we have to work a tiny bit harder to pick up the slack. I could care less about working harder. I just know that as a result our patients probably aren't receiving the level of care they could be if these men and women came back. It's a difficult situation, and hopefully it gets resolved soon. We still have doctors who are paid by the hospital, not the government, that come in, but there is talk of even more of them joining the strikers. Here's hoping it doesn't come to that.

Frustration number two: disorganization. If there is one word to describe the most irritating aspect of working at Moi compared to hospitals in the U.S., it is disorganization. Understandably, when you're using paper records instead of electronic ones, it's going to be a little more chaotic at times--I expected that. What I did not expect is what feels to me like what has become an acceptable culture of complete lack of organization when it comes to patient files and treatment monitoring sheets. I've looked into it a bit and talked to some of the "long-termers" here about it. According to them, many people--IU, Purdue, long-termers, and students alike--have attempted to implement any number of primitive filing, storage, organizing systems with all of the paper records here at Moi. Some have been met with initial success, but it always regresses into this haphazard, anarchic comedy of errors--sans the humor. I know my classmates and I have discussed this ad nauseam, particularly as it pertains to their treatment sheets. Remember those really important pieces of paper that have all the medications each patient is supposed to be taking? Some days we'll come into the hospital and, according to their T-sheets, our patients haven't received their medications. It'll usually turn out that the nurses just forgot to tick off that they gave them; to be fair, the nurses here (not unlike in America, but I would say definitely worse so) are overworked and under-appreciated. Some days they are responsible for administering medications for up to twenty patients at up to six different times a day, and they don't have any of the nice Alaris infusion pumps we have in the U.S. Still though, it's frustrating for us because then we have to track down the nurse responsible for our cube, ask them if they gave patients their meds that morning, and then believe them when they say they did--which while true most of the time is not true all of the time.

Those are the two main frustrations, so I'll move on from the more irksome facets of Moi and talk about the most rewarding part: the patients. There's success stories and not-so success stories. I've had a patient die because he was transferred to the wards from the ICU before he should have been because there's so many patients who need a bed there. I've had a patient die from DKA (diabetic ketoacidosis: it means his blood sugars were way too high) possibly simply because he needed potassium and we just didn't have any in the hospital at the time. For every patient that I lose or simply have to watch suffer--such as an HIV+ patient who's been here since before I have and has disseminated Kaposi's sarcoma--I try hard to find one that brightens my day. I usually don't have to look very far; many of the patients here are so grateful for the care they are receiving. When I talk to them, they could care less that I'm switching one of their HIV meds because it has an interaction with one of their TB drugs. I mean hopefully they listen (and I think most of them do), but more than that they're just excited that someone at the hospital is talking to them and treating them like a human being. Whether you believe in God or not, when someone says "God bless you" and you can hear the sincerity in their voice, is there truly any higher praise or gratitude? I don't know, maybe, but nothing reassures me more that what I'm doing here is making a difference than the guileless words and ways that a patient will occasionally use to display his appreciation for things that in my experience people in America simply feel entitled to receive. The patients are what keep me waking up at 5:45/6 every morning, and I'm honored to represent Purdue and get to help them, in whatever minute fashions I can muster.

Well there's a rant for you. Until next time!

"However long the night, the dawn will break." ~ African proverb

Shiftwork

I apologize for not posting more this week. This has been our first week actually rounding with our teams on the wards, and it basically keeps me busy from about 5:45 in the morning when I wake up until about 9 or 10 pm when I stop studying. By that time I just wanna curl up in bed, watch an episode or two of Community or West Wing on Netflix (praise God for Hola) to let my brain veg out for a bit, and then pass out like nobody's business.

I figured for this post I'll just give you a general overview of what a day is like for me here. I wake up at 5:45, brush my teethes--never letting the water run, just like Barney taught me--and get dressed. The other Purdue students and I eat breakfast at IU House before departing for the roughly mile-long walk to the hospital (called Moi Teaching and Referral Hospital, or MTRH for those who didn't know). Once we get there, we put our things in a room where they'll be safe and head to the wards. The wards here are like nothing I've ever experienced or most likely ever will again in my career. They smell pretty bad, although not quite as terrible as I expected based on what we were told. We work in the adult wards only, which due to the conservative nature of Kenya and lack of private rooms of any kind is divided into men's and women's sides. I am one of the students on the men's side. Each ward is divided into six little alcoves, or "cubes" where they stuff 8 beds to a cube with just enough room for a team of doctors, med students, and clinical pharmacists to maneuver from bed to bed. There are no doors separating anyone, and beds typically have two, and--when business is unfortunately good--three patients in them. Most of you reading my blog aren't in the health care field, and I'm still pretty confident you figured out on your own that this is not the most ideal environment for treating sick people. We do what we can with what we have, though, and I continue to be impressed with how well we do given our disadvantages we're working with. Anyways, sorry for my tangent, back to the schedule (pronounced 'shed-yule' in my head as I type).

We get to the wards by about 7:15, and our first task is to locate our team's treatment sheets, or "T-sheets." As you can imagine, this hospital doesn't have enough computers to establish electronic medical records for patients, so it's done old school with good old lumber pounded down into paper thin… paper. As pharmacists, we are the ones responsible for maintaining these T-sheets (one for each patient), monitoring what medications our patients are on, making sure that doses are appropriate given their kidney function, liver function, electrolyte levels, or disease, and that the nurses administer them as scheduled. In summation, it's pretty much our job to make sure the patient is receiving the treatment they need while suffering as few adverse reactions as possible to their medications. On Mondays, Wednesdays, and Fridays we rewrite the T-sheets so that nurses don't run out of room to document administration. On Tuesdays and Thursdays, we have morning report at 8 o'clock. After rewriting T-sheets or morning report, we check up on our team's patients, make sure that they are actually getting their medications--sadly, with paper records and, to be frank, disorganization and the hectic nature of the hospital, it's not uncommon for this to slip through the cracks--and that they are doing well.

At 9 o'clock--or sometimes 9:15/9:30 if your team operates on what we at IU House call "Kenyan time"--we begin rounds with the doctors and med students. We, the pharmacy students, round with the team and carry all of our patients' T-sheets with us as we go. The med students present their patient to the registrar (the equivalent of an American third or fourth year medical resident) or consulting (in America, the attending). Sometimes, as some of us in this group as well as the previous group have found out, we don't even have a registrar or consulting and it's just us and the med students. Occasionally a question will come up--usually by one of the superior doctors--about what the patient is currently taking. We have the T-sheets and are in charge of the patients medications, so this is part of where our role comes into play. We answer said questions, and we also will often have questions of our own. For example, the most common question I have been asking so far is, "What are we treating with ceftriaxone (an antibiotic)?" It seems like every patient here gets put on ceftriaxone, regardless of the reason they are admitted. Admittedly, this is slightly understandable given how rampant infectious disease tends to be in this part of the world. However, as the pharmacists in this setting one of our jobs is to make sure our patients aren't on medications that they don't need. After all, every dose received has to be paid for, and each medication brings risk of side effects and adverse events. Sometimes we bring up ideas that the doctors don't necessarily agree with; sometimes we bring up something they do. Most of the time for sure, though, they seem very appreciative of our help and at least receptive toward our recommendations.

Time-wise, rounds varies a lot depending on how many patients your team is following, how much time your consulting or registrar spends on each patient, whether your team admitted new patients the night before, etc. Once they are over, the team disperses: consultings often have jobs in the private sector to go attend to, registrars and med students have patients to follow up on and notes to write--don't forget about that whole paper records thing--and we take the T-sheets back to the counter near the nursing station, finalize any dosing on newly added medications, and take them to the pharmacy so that patients can be charged for their medications before they are set to be administered at 2 pm. Once that's finished, we typically have some follow up of our own to do on our patients. Sometimes that's checking a patient's electrolyte levels to make sure their medications aren't pushing them into toxic ranges. Sometimes that's walking to over to the anticoagulation clinic or the AMPATH clinic (HIV clinic) to refer a patient or check up on what HIV medications a patient in the wards is taking. This varies day by day and can take anywhere from 15 minutes to a couple hours. Once we've completed following up on our patients needs, we return to the wards and write up our own reports on each patient so that we can discuss them with our preceptors (on-site teachers) throughout the week. This sounds boring and uneventful, but it can actually become a challenging, often times frustrating endeavor. You see, the worst feeling in the wards is relinquishing those T-sheets to any human being besides yourself. Once you do that, there is no telling where they will end up. Once you get used to it, you can usually narrow down the possibilities to three or four places, but there is no guarantee that you'll be able to find them. As difficult to find as the T-sheets are, finding a specific patient's medical record is comparable to finding a good parking spot at Purdue without a parking pass. Once we find our patients' files, we work up our reports until 1-1:30, occasionally answering a med student's question or following up on something new for a patient. We walk back to IU House for lunch, and then we typically get back to the hospital between 2-2:30. From there, we either have T-sheet review with our preceptors, or we continue to work up patient reports, advise med students when asked, and keep checking on our patients until anywhere from 5-6 pm. We go home, thankfully eat, and then study any topics or treatment guidelines that our preceptors asked us to that day until 9 or 10 pm.

There's some variation, but that's a typical weekday for me. Well marafiki ("friends" in Swahili) we're getting up early tomorrow with some of the IU Med students to go to Hell's Gate! I haven't looked much into what it has in store for us, but I hear there's animals, hiking, and even the rock that Pride Rock from The Lion King was inspired by! Obviously you can expect a post and pictures from this adventure Sunday or Monday depending on how tired I am. Kwaheri! (Goodbye!)

"You learn how to cut down trees by cutting them down." ~ Bateke proverb

New Perspective

Jambo, friends!

So this weekend was our first opportunity to get to leave IU House and explore the wonders Kenya has to offer. We decided to take it easy for our first weekend and go to a couple places within an hour of where we're staying.

The first place that we went to was Kruger Farms, which is a 3,500 acre plot that houses free-roaming giraffes, impala, gazelles, and anteaters to name a few attractions. The entry fee was 500 Kenyan shillings apiece (a little under $6)--in many aspects, that's the way things go in Kenya. $1 is about 84-88 KSH depending on where you get it, so minus a few commodities our money goes fairly far here. We were led by a guide and did a lot of walking; en route to the giraffes we saw a herd of impala as well as a wild chameleon, which all but thankfully one of us walked right past. Finally our guide located the giraffes and we got as close as we dared, which couldn't have been more than 10-15 feet. It was pretty cool; our guide informed us that you can tell the males from the females because the males have a fairly significant protrusion in the middle of their forehead, whereas the females typically have no more than a bump. At one point there was one running toward us and we thought it was charging, but it stopped about 10 feet away to eat some of the leaves off of a nearby tree. It goes without saying, it was pretty cool, despite the fact that I had to go to the bathroom for about an hour and twenty minutes of it--but who was counting?

Our next destination was Kerio View. Kerio is a world famous part of Eldoret where athletes come from all over the world to do high altitude training. When I say high altitude I mean high high. You'll see in the pictures below. Kerio View refers to a fantastic high point where you can see miles and miles of Kenya; in fact you can see two points where the land sort of drops off. One of my classmates and I commented on how awesome it would be to just hang-glide off of the ledge, and our taxi driver for the day, Ken--who was awesome--informed us that a lot of tourists do paraglide off of the cliff. He made sure to let us know that it's mostly South Africans, Europeans, Australians, and Americans that do it though, or "the crazy people" as he referred to them. He told us Kenyans "are too scared" and "know better." He was a pretty funny guy. We took a bunch of pictures, but pictures really don't do this view justice. It is one of the most incredible scenes I've ever viewed. One thing I really like doing wherever I go--I don't travel often though, which is why my Facebook isn't really full of them--is take pictures of me doing a handstand. I think the last one I took was in Pensacola on my spring break trip back in 2009. I decided to take one at Kerio View which you see below. It's a pretty sweet picture, as it includes both drop-offs I spoke of as well as a rainbow in the background: you could actually look out and see the parts of Kenya where it was raining from where we were.

We left for Kruger farms around 9:15 am and got back to IU House around 5:30 pm or so. The ride to both locations and back cost about 5000 shillings total, so about $10 for each of us. Incorporating the cost of lunch, I'd say there's not a lot of places in the U.S. where you can have a day this awesome for less than $50.

Well, I start rounding in the wards tomorrow; I have to up bright and early at 6 am to get to the hospital by 7, so it's kwaheri for now.

"Anyone who sees beauty and does not look at it will soon be poor." ~ Yoruba proverb

Blackbird

So I've already seen and heard a lot over the past couple of days.

Yesterday (7/8) was my first opportunity to visit the hospital that I will be working at for the next 7 weeks. To say that this place is incredible doesn't begin to do it justice. The programs that they have in place, from their mother-baby hospital (a partner of Riley Hospital, by the way) to their anticoagulation clinic, even their property is astounding. Anyone not familiar with hospitals and how they operate would probably be shocked and likely disgusted by the conditions here, but the costs of running a hospital the likes of which we are used to in the United States are tremendous. What they have managed to do here at AMPATH in such a "resource-constrained setting"--as they refer to it in their published research--is truly a testament to the willpower of people who share an unrivaled vision of global health care. Mind you, it's not a pretty hospital. The wards are less than sanitary, the funds are less than exuberant, and the patients are very, very sick. Fortunately, through the combined efforts of Kenyans and Americans alike, they are receiving care the likes of which still can't be found in a very large portion of the world.

Today (8/8) was our first opportunity to really get our feet wet in the wards. We will start rounding with the medical teams on Monday, but for now we are familiarizing ourselves with the medication records that are kept for patients here as well as our role on the team. I will be assigned to a team of medical interns, registrars (residents), and a consulting (attending) physician. As a team, we follow a share of the patients here and make sure they are on the most effective, appropriate treatment we can provide. I will have a lot of responsibility: I will be in charge of monitoring the medications they are prescribed, making sure that they are receiving them by communicating with the nursing staff, keeping accurate records of such activity, and making recommendations for optimal medication. If it sounds a little overwhelming, I assure you that it is; I am nervous but hopeful that I will rise to the occasion for the sake of my patients.

We also got to explore the town a little more in depth today. During our lunch break we walked around the city; it was crazy busy, people walking everywhere, covering the sidewalks selling goods and services. Even though I felt it was hot, it is rain season and considered chilly by the Kenyans who walk around in sweaters, jackets, and jeans. Shops are stuffed into buildings wherever they can fit. I purchased an umbrella since I didn't think to pack one and like I said it's rain season here. One of our preceptors and the Purdue Global Health resident showed us around town and gave us tips on where to find good souvenirs, how to bargain for them properly, and where to find specific things we may need throughout the rotation. It was a lot of walking; a classmate of mine with a Fitbit would later inform us we walked approximately 6 miles or so! But this was my first experience really sinking into a completely different culture. It was truly another world, and I am attempting to soak up as much as I can.

Lastly, today was my first experience with some of the hardships that I will face at the hospital. I don't know any patients yet, but while we were busy rewriting out medication record forms in the wards, I heard a woman begin to cry coming from the men's wards (wards are separated by gender). I have witnessed a lot of crying in my lifetime, but nothing has come close to the audible pain and agony that was emanating from this woman. I walked over to see what was going on, and I found her, completely inconsolable, sobbing onto a blanket covering what I can only speculate to be her now dead spouse or brother. Bear in mind: there are no single rooms in this hospital. There are wards that are divided into open cubes, which each have about 10 beds in them--usually with more than one patient in them lying head to toe--with no doors and a narrow path that connect them together. A curtain was pulled on one side of the bed, but that was all the privacy she was afforded--not that it mattered. Oblivious to the world around her, her anguished howls echoed through the entire hospital for what felt to me like an eternity. I will probably never forget it as long as I live.

Happy times and sad times alike are surely in store, but one thing is certain: I will come out all the better for it.

"The best time to plant a tree is twenty years ago. The second best time is now." ~ African proverb

Welcome to the Jungle

Greetings from Eldoret!

Three flights, one crazy hotel stay, and several time zones later (FYI, we are 7 hours ahead of EST), we have arrived. The flights themselves were pretty unremarkable. We got through security and customs without any hiccups, and, obviously, our plane did not crash--I've never flown before, but I'm told this is a good thing.

So first, Nairobi: it is the capital city, and where we flew into from Amsterdam at about 9:10 or so last night. Between getting our visas, exchanging money, and getting through customs, we still didn't end up making it to our hotel until about midnight. Nairobi International Airport was much less modernistic than O'Hare or Amsterdam to say the least. The floors were cement, and if not for the advertisements and swahili greetings on walls I might have mistaken it for a parking garage. What it really reminded me of was the Metro in Washington D.C. Even the security was much more lax than I anticipated, despite the fact that we would occasionally walk by a military man with an assault rifle cradled in his arms. Our drive to the hotel was interesting. I, along with a couple of my colleagues, was slipping in and out of consciousness, exhausted both from our long flights as well as the prospect of having to be back at the airport in about 5 hours. There wasn't much to see during the drive anyway; it was midnight on a Tuesday night, not exactly hoppin'. The hotel we stayed at was unbelievable. I roomed with two of my classmates on the second floor, but our other two classmates struck gold. The hotel staff felt bad because they had to wait for their room to be prepared--they maybe waited ten minutes tops, by the way--and so they were upgraded to the presidential suite on the eighth floor. It was the most lavish room I've ever been in. It had a living room, a dining room, a walk-in closet, four flat screens throughout, and the bathroom was complete with standing shower, jacuzzi, and a sauna. What a shame we would only be there for about 4.5 hours and desperately needed sleep.

At approximately 7:30 am Kenya time we arrived in Eldoret. We received a ride to the IU House where we will be staying for the next two months. I'll briefly describe the two aspects of Eldoret that have stuck out to me most so far:

- Green: everything is growing, it is abundant with trees and bushes and flowers and the grass and all of it. There is also a lot of mud, which can be attributed to the fact that we are here during the rain season.
- Traffic: I couldn't possibly drive anywhere in Kenya, or I would be at risk for cardiovascular events. Bicyclists, motorcycles, pedestrians, matatus (taxi-vans that you do not want to take unless you have a fetish for getting robbed and/or risking your life), cars, runners--imagine all of these, and then imagine them imagining they are literally the only ones on the roads and that they can do whatever they want. That is Kenyan traffic, not to mention that they bought into Europe's ridiculous drive-on-the-wrong-side-of-the-road mantra.

Well I'm still exhausted from flying and barely sleeping, so I plan on turning in early tonight before we get a tour of AMPATH tomorrow and dip our toes into the pharmacy at the hospital. If you ever want clarifications on something or if there's a topic you're curious about, feel free to comment on these posts and I'll do what I can to bring it up in my next one. Kwaheri for now!

"To get lost is to learn the way." ~ African proverb

Ready, Set, Let's Roll

Three days until I leave for Kenya and I can't begin to describe the whirlwind of emotions I'm experiencing. I'm excited, obviously. I've never been outside of the country, and I've never even flown before. It will be amazing to finally get to experience a different part of the world, especially one so rich in culture and history as Africa. On the other hand, I know that there are difficult days ahead as well; Africa is no picnic from a medical standpoint. I will be tested to the limits of my capacity, and I only hope that I will rise to the occasion--not just for the purpose of representing myself and Purdue well, but for the sake of my patients.

It will no doubt be one of the most difficult, rewarding experiences of my life. I'm not really the type to get homesick--I never really have--but 8 weeks is a long time to be away from those I love. Namely Taco Bell and Colts football. I will also really miss, in no particular order of importance: my girlfriend, my family, my friends, Purdue, golfing, La Hacienda, and not having to worry about getting ebola.

It's impossible to explain how strange it is to think that this will be the first time in 18 years that I will not be walking into a classroom come mid-May. I'm sure it's the same way for the rest of my classmates, but it will be especially weird considering I will be halfway across the world.

The plan is to name each post after a song that I feel represents the theme of my day, and end each post with an African proverb. Bear in mind that I will have found most of these proverbs on the internet, so they may in fact be hokum.

I will try to post at least once every other day as time permits while I am over there, but please forgive me if I am unable to post a few days in a row. It either means I have been busy or kidnapped and waiting for my dad to go all Liam Neeson from "Taken" on the continent of Africa.

"Traveling is learning." ~ Kenyan proverb