The first few days....

Hi all,

If you're on this website, you know I decided to do a fourth-year med school elective in Eldoret, Kenya, which is in the western Rift Valley area of the country. The elective is two months in duration, so I'll be over here from October 1 until the end of November (sadly, just after Thanksgiving!). The Internet has been good to us so far, so I've elected to communicate with you all mostly by blog. If it goes down...well...my posts will become more intermittent, but I'll do the best I can.

My primary traveling partners are Keith Earley, Nadine Wakim, and Andy Shriner. We're all fourth-year medical students. We're all, for the most part, pretty laid back people who are interested in the world outside of what we know. So far we've traveled well together, and I'm excited to spend the next couple of months with them.

First, some background

Indiana University started sending physicians to Kenya about 20 years ago. Dr./Prof/Godfather Joe Mamlin is the director of all things IU here. In about 1990, shortly after he arrived, the Kenyan government decided to open its second teaching hospital (the other is in Nairobi). This hospital would be named after Kenya's second president, and would be called the Moi Teaching and Referral Hospital. Since its inception, the school has been tangled up with IU, as faculty and residents have gone between the two. Later, students started the exchange as well.

Shortly after the inception of the new medical school here and its partnership with IU, the physicians here were faced with a rising epidemic: HIV/AIDS. It became a primary goal of the school here to treat and prevent this terrible infection, especially in this part of the world where access to the latest antiretrovirals and other medications may be limited. Out of these efforts, Dr. Mamlin and his Kenyan colleagues developed what is now known as AMPATH: The Academic Model for Prevention and Treatment of HIV. This program serves roughly 60,000 HIV-infected individuals in the area. It has also garnered significant international attention due to its focus on sustainable development of local resources and infrastructure. This attention resulted in Dr. Mamlin being nominated twice in recent years for the Nobel Prize.

Those are the basics of the setup here. Now, I'll put up some excerpts of emails I sent to my family on the way here.

Traveling...with a stop-over in London

So we made it safely to London. Things have been well here. We got in early yesterday, took a nap, got some fish and chips, walked around quite a bit and saw some of the city, including the London Eye, Big Ben, the Houses of Parliament, Westminster from the outside, and the Millennium Bridge (kinda the usual, touristy-type stuff that most people see). Today we slept in a bit, then took the tube down to the Globe where we caught a 2 pm showing of 'The Merry Wives of Windsor'. Although it was freezing cold and we had the worst seats there, it was hilarious and definitely worth doing. Afterwards, we walked over to the Tower Bridge, then we tubed it up to Oxford Street to do some window shopping (except for Nadine, who did some real shopping). Then we walked around aimlessly until we found a nice little bistro-type restaurant to eat at. I got some DELICIOUS mussels in a cream sauce followed by some vegetarian lasagna with a glass of white wine. Finally, we worked our way back to the hostel to get some internet time and some sleep.

Side note: we're staying at a hostel called Generator near King's Cross. Apparently it's capacity is about 800 raucous twenty-something travelers. Ever try to sleep to the sound of drunk Germans doing karaoke to 80s Madonna? Well, it's an experience, let me tell you.

Tomorrow, we're going to take a trip to the British Museum (one of my favs--the Elgin marbles and all) and Buckingham Palace before heading to the airport. We have a red-eye tomorrow evening down to Nairobi, followed by a flight Sunday afternoon into Eldoret, where we'll be picked up by the team leaders from the IU House. Then the trip really starts.

So, all in all, things go well. I may or may not start blogging next week, it depends on the internet situation in the hostels and how busy we are on the wards.

After arriving in Africa....

We made it to Kenya!

Things are good so far. We had a good but brief day in london yesterday, then took a red-eye down here from london. Great flight, virgin atlantic, so we each had our own LCD with tons of TV/movies. I watched Don't Mess with the Zohan, which was only marginally funny, then slept for about 5 hours and watched some Entourage. Good flight overall.

Getting into Nairobi was pretty awesome. The earth is all dark tan and clay, looks very stereotypical of Africa, with sparsely located trees. Nice breeze though today, in the mid 60s, very comfortable. Ate at a nice restaurant outside at the airport (had fried tilapia with chipatli, which is basically like nan, or Indian flat bread, and a Coke classic). Then waited around for the flight to Eldoret. Eldoret is MUCH greener, and more elevated (7000 ft or so). The temp was high 50s or so here, maybe low 60s. You'd be really interested to see it.... Dirt roads, with dirt paths worn next to the roads where people walk so they don't get run over. Already saw a cart pulled by goats. Sweet.

The IU house is VERY nice. Like a little piece of America. Hot water, Internet, clean rooms, tasty food. Everything you could want. Great people. One of the pharm directors is this young dude who has a flat screen with satellite in his room and he invites the med students over on sundays to watch football games. Crazy!

After the first day on the wards....

On waking today, we headed down to the cafeteria for some toast, coffee, and juice. Afterwards, we all gathered up, left the IU compound, and walked the 15 minutes or so down the road to the MTRH complex. Here we got a quick tour of the hospital grounds, followed by assignment to a team. Everyone does three weeks of adult medicine, three weeks of pediatrics, one week of work with the AMPATH clinics, and one week off at the end to travel. I started today on adult medicine.

The team is composed of about 10-14 people, depending on the day. Here's the hierarchy:

Consultant: This is the person we'd call either an attending or staff in the US. They have the final call on any decision. They only round with us about 2 days a week, and the days they are there are considered "formal" rounds. Haven't experienced this yet, as our consultant wasn't in today.

Registrar: This is the Kenyan version of resident, although they're a bit more advanced than US residents (they've already done an internship and practiced general medicine for three years before pursuing "registrar" training). Our registrar is in her third year, which basically makes her a PGY6 or so in the US (like most graduating fellows or a senior neurosurgery resident).

Clinical officers: Basically a nurse practitioner or physician assistant in the US. Haven't met one of these yet, they run the clinics mostly.

Intern: Recently graduated medical students. They run the show for each team. The make everything happen. (For those of you in medicine, they have Q2 call for basically a year. That's how hard they work.)

Medical student: Can be anywhere from 4th to 6th year, because they start right out of high school and complete med school in 6 years, where as we do college and then med school for a total of eight years. They basically cut out the goofing off and the random British literature classes that we take to be "well-rounded" in the US, and instead focus immediately on their primary career.

In addition to these folks, we have a Purdue Doctor of Pharmacy student on each team, along with a Kenyan pharmacist. My team also has a US resident, Phil, who's here for a month from Brown. Today, Phil and our Kenyan registrar ran the service. Lots of great teaching, lots of great cases. The HIV infection rate among the inpatients is ~50%, so we deal with lots of AIDS-related illness. As a corollary to the high HIV rate, there is also an extremely high rate of tuberculosis infection. By the end of the two months, I'm sure I'll have seen as much TB as I will in the rest of my career in the US.

In general, the wards are clean and efficiently run, at least more so than I had imagined. The beds are spaced about four feet apart in bays with open windows. Some beds are shared with two patients to a bed. Today was cool and there was a nice breeze blowing in the windows, so the heat and smells weren't too bad, but I've heard they can simply be suffocating at times (many med students have passed out during rounds, apparently). Today was a great introduction to the system, with plenty of challenges to come, I'm sure.

Tomorrow, my team admits patients (each team admits every other day). So, that'll be when I really start to dig in and learn about the sources, manifestations, treatments, and consequences of disease here. Should be good!

That's all for now....

Thanks for reading this ridiculously long initial post. I can pretty much guarantee they'll be quite a bit shorter from now on. After all, brevity is the soul of wit.

Cheers.