Week 3

The Goat (Sheep) Game....

Occasionally, the IU med students play a basketball game against the Kenyan med students. I'm not quite sure how the tradition started, but for the past few games, there have been two prizes at stake: 1) bragging rights; and 2) a goat.

This year, Phil went to town with Benson, one of the guys who works/lives at the IU house. They were supposed to buy a goat, but for some reason they ended up coming home with a fat sheep. I'll leave it to you to read more about it on Phil's blog (uvmster.blogspot.com), but we all heard it was a great time.

The game was played on a Friday night before we left for Kakamega rainforest. Our team looked very strong at first; we clearly had a skill advantage, and we were able to move the ball around easily and get some good outside shots. Unfortunately, the altitude and the athletic prowess of the Kenyans caught up with our team in the second half. The game ended up going into overtime, wherein the conditioned Kenyan athletes blew our team away. Thankfully for us, they agreed to share the sheep with us on Monday night after we got back from the weekend trip.

Don and one of the Kenyan med students, grilling up some sheep meat.

I'll spare you the gruesome details of the skinning and slaughtering in the lawn in front of one of the houses at the IU House compound (we have photos if you really want to see them). Don's dad is a vet, so he has lots of experience with animals and some with slaughtering. He helped the very skilled Kenyan med students with the slaughtering, skinning, and preparing of the meat. In the end, it turned out to be quite a party, with lawn games going on during the meat preparation. Everyone was happy with the result. The meat was a bit sinewy, but it tasted great!

Keith, one of our basketball players, enjoying his freshly-cooked dinner.

Medicine wards....

Last week was the third and last week on the medicine wards. Although some of the same frustrations I wrote about last week carried through, I did have some very interesting patients and even a couple who improved and by now (I hope) ought to be out of the hospital. For you meddies, I had a case of toxic epidermal necrolysis (TEN), the first I'd ever seen. Very, very sad. I had one patient in particular, with cryptococcal meningitis, who showed significant improvement over the course of the week. I was also able to spend a fair amount of time doing procedures, which is always enjoyable. My meningitis patient required what we call "therapeutic taps," which means doing a lumbar puncture (insertion of a needle through the back to drain fluid away from around the spinal cord and brain) every 2-3 days to relieve the increased pressure around the brain that results from the infection. We call it therapeutic because most lumbar punctures are done for diagnostic purposes (to detect what type of infection may be present, or to look for evidence of bleeding), but this tap is done to ameliorate the headache that arises when the pressure of fluid around the brain gets to be too high. It's a pretty great procedure, as it provides virtually instant relief of symptoms that are not really controllable by standard pain medications. I had done 5-6 lumbar punctures before coming over here, and I easily doubled that number over the last two weeks.

AMPATH....

Yesterday I transitioned off of the medical wards and started a week of AMPATH experiences. As I wrote about below, AMPATH is the institution associated with IU and Moi that is responsible for the treatment of HIV+ patients here in Western Kenya. We've been hearing more and more about the progress that the program has made since its inception. It's great to finally spend a week looking at how it functions. Yesterday several of us traveled out to one of the farms associated with AMPATH, where food is grown to provide to HIV+ patients and their families who are starting their treatment regimens. They grow a wide variety of crops, including leafy greens, onions, carrots, watermelons, etc.

I met a White Sox fan at the farm. Boo!

All of the food is given away until the newly diagnosed HIV+ patients regain enough health to participate in the workforce again. The goal is to eventually build up the farming with some cash crops (like sweet peppers) such that it will be a self-sustaining entity without any dependence on foreign aid. (The farming initiative is almost entirely paid for by USAID, the United States Agency for International Development, which gave AMPATH a $20 million grant recently to do this type of infrastructure building.) Obviously, the goal is to eventually make all of the services provided completely independent of donors, and the farm is a big step in that direction.

Crystal, myself, and Nadine, along with the farm workers we spent the morning with. They taught us how they fertilize beds for planting. We helped hoe and fertilize soil, and we planted some watermelon and tomato plants.

Today, Nadine and I will be headed up the road to the Imani Workshop. This is a place that employs HIV+ individuals and gives them an opportunity to re-enter into the workforce. Gaining employment after receiving a status of HIV+ is not easy here. 10 years ago, patients would have been thrown out of their villages and left for dead after receiving the diagnosis. But since that time, and largely due to the education efforts made through AMPATH/IU/Moi, which depend on community leaders and patients speaking to tribal councils and local villages, attitudes have begun to shift tremendously. When Dr. Mamlin first proposed the idea of setting up an AMPATH clinic/hospital that would be labeled as such, many critics laughed in his face and said that under no circumstances would any Kenyan willingly go to such a place and identify themselves so publicly with HIV. Now this clinic serves 13,000 patients who come on a daily basis for checkups and medications. The credit for this change should be given mostly to the patients themselves, who do almost all of the talking when AMPATH leaders go to visit outlying villages to try to educate and change the stigma surround the disease. There's still lots of work to be done, and the stigma is still more severe here than in the US, but progress is certainly being made.

I digress. The Imani Workshop is one of the institutions that provides labor for HIV+ patients. They fashion souvenirs, purses, bags, and many other products to be sold at market. The funds from this endeavor then go to pay the laborers so that they can become independent. The excess profit on top goes back to AMPATH to help pay for anti-HIV medications. Again, another part of creating sustainable development.

Tomorrow, Nadine and I will have the chance to travel with one of the Kenyan doctors to some of the outlying clinics. It will be a two day trip, as we'll stay overnight Wednesday night in a hotel in one of the rural centers. It should be a great experience!

Rafting the Nile....

So this weekend, we took another fairly long trip. 14 of us loaded up into two vans and headed west to the border with Uganda. For various reasons, including a strike by the Kenyan truck drivers, computer malfunction at Ugandan immigration control, and bad weather, the drive took almost 8 hours, but we did finally make it across and to a campsite near the source of the Nile. The campsite was fairly spartan, but we each had our own bunk beds in rooms that held six people, and there was a large bar/cook-to-order restaurant area. We were welcomed by the on-site directors, a young Scotsman and a young Australian (I love it that adventure travel around the world always, somehow, involves Ozzies), who gave us the intro for the weekend. Afterwards, we pretty much proceeded directly to bed in anticipation of the next day.

On Saturday, we awoke to perfect weather. The sun was already shining, and you could see the Nile bending through the lush, green land just below where the restaurant overlooked a steep embankment of about 50 feet. We all loaded up into trucks and headed up the road, where we ate breakfast and received our instructions, gathered up helmets and lifevests and oars, and got back into the truck to head to the water. Once there, we divided up with the other rafters (there were maybe 50 people total). Our boat consisted of me, Keith, Andy, Kim and Pearlie (two medicine residents from Lehigh Valley), Melissa (one of the pharmacy students), and Sarah (an OB/Gyn resident from University of Toronto). Our guide was a very chill guy named Elias, from Tasmania, who had only recently come to Africa after leading tours for some time in Australia.

So I've been rafting several times before. I spent a week with my family rafting lazily down the Green river in Colorado and Utah. I've rafted in West Virginia. And two summers ago I rafted on the Indus high up in the Himalayas. None of these experiences compared with rafting Class 5s on the Nile. The volume of water is simply incredible, and it's difficult to describe the force with which it rocks your boat.

To begin the day, we practiced flipping the boat, what to do when you're sucked down in an eddy, and how to avoid hurting your fellow rafters with your oar. All good tips.

I don't know if I can do justice to the rafting itself, but we have a video that I'll try to post if I can rip it off of the DVD. It gives you a much better idea of what it was like, and you get to see us being flipped out of the raft and sometimes, inexplicably, holding on when we should've flipped! This was the first time I've really been pulled underwater by a current, which is totally disorienting. You can't tell which way is up or down, and all you can do is hold on to your life jacket, hold your breath, and try not to panic. By the time you rise up you feel like gasping for air, even though you've really only been down for maybe 10 seconds. Such a rush!

Anyway, it was a fanastic weekend. Unfortunately, I don't have any photos to share, but the video is, I hope, pending.

Thanks for reading, and thanks for your comments! Hope all's well wherever you may be.