Maasai Mara

Old male lion, as seen from a safari van.

Weekends....

Since Friday was a holiday (Moi Day), we had our first extended weekend to travel outside of Eldoret and explore more of Kenya. To this end, a group of us signed up for a trip to the Maasai Mara. Mara is the name of the river that runs through this part of the Serengeti, and the Maasai are the native people who live in the southernmost portions of Kenya. They are a tribe of semi-nomadic character with very distinctive, brightly-colored dress. Their males carry large spears. They are a monotheistic, patriarchal people who subsist mostly on the food and trade provided by their herds of cattle, sheep, and goats. Interestingly, one of their religious beliefs is that God provided cattle for them to live; they therefore believe that all cattle on Earth belong to them. Needless to say, this can be awkward when they try to claim ownership over their non-Maasai neighbors' cows! They share many similarities with American Indians, as they had their land reduced in a piecemeal fashion by Westerners (the British colonial government) in the early part of the 1900s, and they now live mostly on reserve lands in southern Kenya and northern Tanzania.

Our trip involved hiring a driver (Hassan, who often drives for the IU House) to take us into the park to a lodge. The drive took about eight hours over variable roads, with the final hour or two consisting of mixed dirt and paved road with jarring bumps throughout. We also descended quite a bit in altitude from the 7000 ft elevation of Eldoret. As we went down, the temperature rose and the vegetation changed, from the lush greens around Eldoret to the more open expanses of browns and golds that is stereotypical of African plain regions.

Left to right in the van: Phil, me, Crystal and Don Zimmer, Nadine, Andy

On arrival at the park gates, our jeep/van was stormed by Maasai women selling various wares, including hand bracelets, painted wooden masks, and small spear tips. We all successfully avoided purchasing anything, except for Keith who bought a mask.

After proceeding through the gates, we started to really see some of the wildlife in the park, including tommies (small gazelle-like animals), zebras, and a few wildebeests. We proceeded immediately to the lodge where we were staying, as our first true "safari" wouldn't occur until later in the afternoon.

Andy, Keith, Phil, me, and Don outside one of the "tents"

The lodge itself is basically a 5-star hotel. We had requested the next step down in accommodations, but given that it was holiday weekend, they were all booked. This was a plus for us, because we got bumped up without any increase in price. Our rooms were semi-permanent "tents," complete with hardwood floors, marble bathrooms, hot water, and electricity. The lodge itself has a large restaurant area with an all-you-can-eat buffet for every meal (we definitely took advantage...I think most of us gained five pounds over the weekend!). Additionally, there was a meeting area/bar with a huge fireplace, an outdoor pool, a lawn for yard games, and a pond with a walkway overtop.

Nadine loves giraffes

Without being too long-winded, it was basically a Western-style paradise in the middle of the African plains.

As seen from the van

On safari, we had the chance to see basically every animal you'd want. We got up close to lions on several occasions, both male and female. We saw gazelles, tommies, topis (smaller deer-like animals with small straight horns), wildebeests, zebras, hyenas, warthogs, jackals, and plenty of birds, hawks, and vultures. We went to an area where hippos wade to see a pack of them cooling off. We saw a cheetah on the prowl. And on the last morning, best of all, we saw a leopard lounging out by a bush, with a half-eaten topi hanging from a tree next to it. Straight from a Discovery channel documentary.

Don, on the lookout

I'm sure I'll have this feeling on future weekend trips as well, but we all couldn't help but notice and be somewhat bothered by the stark contrast of our weekend life compared to the weekday life we see for our patients in Eldoret. The extravagance of wealthy Western vacationing stood in stark relief next to the abject poverty and poor health of our patients. We all felt somewhat guilty while out on safari, knowing that we were living a kind of life that only the richest people in the world can enjoy, while there were patients dying back in our hospital for lack of those same resources. Obviously, there is no real way to palliate this feeling except to do your best to fight against those disparities as you are able. I would like to think that our work here would count as part of that fight, and that we will take those sentiments of guilt and anger back to the States with us, where the same kind of disparities exist, if only in somewhat smaller magnitudes. And if there is a lesson to be learned from observing doctors like Joe Mamlin, it is that the best way to address disparities is help build and strengthen sustainable institutions that can address problems in a systemic fashion. Such is the lesson of AMPATH.

Hyenas, finishing off a wildebeest (we thought) carcass

Despite these misgivings, we did enjoy ourselves thoroughly. The wildlife we saw was incredible, and I felt privileged to have seen these animals in a truly wild setting.

Excited to see a lion, about 15 ft away

Give credit where credit's due....

I neglected to mention last week that we've been compiling photos on my computer, so some of the pictures you see may be mine, but many of them were actually taken by Keith, Andy, or Nadine.

Back to rounds....

I think we're all starting to settle in to our roles here. The last couple of days of rounding last week felt less foreign, and this morning I've begun to interact more with my Kenyan colleagues (up until now, I've basically stood and watched during rounds, trying to understand the way the system here functions). Each day is a new learning experience, not only with regard to general medical fund of knowledge (manifestations of tuberculosis...complications of HIV...typical reactions to antiretroviral/anti-HIV drugs...treatment of organophosphate poisoning...treatment of prostate cancer...diagnosis and treatment of UTIs), but also with respect to procedures (IV placement, lumbar punctures, chest tube placement and removal, abscess drainage) and health care system function (what antibiotics are available here...what is the cost of text X or treatment Y...do you start empiric treatment without an absolute diagnosis because more testing would financially ruin a patient...who follows up on lab tests...who hangs IV bags...etc, etc, etc). The differences are sometimes rather nuanced. I'm sure by the end of two months I'll have only begun to appreciate some of the more obvious ones. One of my US attendings who helped establish the program here, Dr. Einterz, once told me that it took him almost a year before he felt comfortable enough with the system here to take total charge of his patients' care.

That's it for now. I'm headed back up to "clerk" (admit) patients this afternoon, so we'll see how the week goes!

Kwa Heri....

Swahili for "good-bye" or "go with blessings."