Joyce - please help!

Made it safely home! Ironically, the journey from Nairobi to Indianapolis, while long, went pretty smoothly. It was only in Davenport, Iowa where I ran into a hitch! On the drive from Indy to Ames (to spend Christmas with my parents), there was some inclement weather and icy roads. After passing multiple accidents and seeing about 5 ambulances pass me on the interstate, I decided to stop in Davenport and get a hotel rather than ending up upside down on the side of the road somewhere. I picked a hotel near the mall and got some much needed Christmas shopping done while killing time and got home without too much drama the next day. It is good to be back!

One part of my trip to Kenya that I haven't written about yet is my experience with a patient on our medical team at Moi Teaching and Referral Hospital. The little girl above is an approximately 16 month old girl with a cleft lip and cleft palate (obviously) who was in the hospital for failure to thrive (failure to grow and gain weight appropriately). Despite hospitalization for 3 months, she continues to not grow. This could have been due to any number of reasons including her cleft lip and palate. The hospital staff was not equipped to perform the intensive feeding that she would require to get enough calories. While we were there, however, we noticed she seemed to sweat a lot with her feedings (that's not normal) and suspected a heart defect. We obtained an echocardiogram and yes, she has a ventricular septal defect which means she has a hole between the two lower chambers of her heart. She will not be able to grow adequately and eventually, her heart will fail because of the size of this defect. Her only solution is a surgical intervention to correct this. This will be difficult because the funding to perform this surgery does not exist under the current medical system in Kenya.

So now you know, her medical background. Joyce is a beautiful, happy little girl who was, unfortunately, abandoned at the hospital because her mother didn't feel she had the ability or resources to care for her. Joyce plays peek-a-boo, is desperately trying to crawl but doesn't have the strength since she is the size of a one month old, mimicks sounds (her favorite "word" is "gooley, gooley, gooley, gooley," loves the mobiles that hang over her crib and in general is pretty much one of the sweetest children I have ever encountered. One of the medical students and his wife (Don & Crystal) who were there during my time in Kenya pretty much fell in love with this adorable little girl (okay, I did too). They are spear-heading a fundraising effort to provide this life-saving surgery for Joyce. They have set up a Paypal account at the following address for people to contribute.

https://www.paypal.com/cgi-bin/webscr?cmd=_s-xclick&hosted_button_id=1675225

If you have a few extra dollars to donate during this Christmas season, that would be wonderful. I assure you that all funds will be going directly to medical expenses or travel expenses related to Joyce receiving this surgery. We are still working on whether she would get this surgery in Nairobi or perhaps travel to the United States. As events progress, I will continue to provide updates on this blog. And if you have any other questions, please let me know!

A great weekend and looking ahead ...

This weekend, we went to Masai Mara which is a national game reserve and the best place to safari in Kenya. The Mara is a approxmiately 500 square miles of open land where animals such as lions, leopards, elephants, many variety of antelope, hyenas, warthogs, hippos etc all reside. We saw literally hundreds of elephants and unlike our previous safari saw far more than two lions. One of the highlights was watching a group of five lionesses stalk and attempt to kill a poor warthog. It was fascinating how they worked together though spread out across a field and used strategy to try to prevent the warthog escape. Amazingly, the warthog managed to get away though we all thought he was a goner. I've always heard that warthogs are incredibly stupid though obviously the lions (and we) had underestimated this one.

As this week winds down, we're getting ready to leave Eldoret and spend a few days at the beach in an area south of Mombasa called Tiwi Beach (on the Indian Ocean). I'm excited to begin the journey home as well. Don't get me wrong, every day with temperatures in the 70s is great but I have to admit I love the seasons and am looking forward to it actually feeling like the holiday season. I'm also anxious to get back to Ames for Christmas for the first time in 3 years. This has been quite an experience. Its made me very grateful that I've had this opportunity to be here and I know its something I'll reflect upon for a very long time. Perhaps I may even return here if I feel there is something more than I can offer. Who knows?

Brave .... or Stupid ...?

My friend Jen and I were walking around in downtown Eldoret today doing some shopping. Downtown Eldoret is one of these incredibly busy places where the sidewalks (that's a term applied loosely) are packed shoulder to shoulder. People walk up and down the streets as well and there are no such things as traffic lights or cross walks. Well, actually, that's not entirely true, there are traffic lights, they're just more decorative and non-functional. At some point in the near past, they installed traffic lights at several busy corners in town. Apparently, people decided that "red" meant "speed up" or just ignored them all together so after about a day, they were shut off and have been decorating the landscape ever since. Anyways, so Jen and I are standing in the middle of the street, having crossed half of it, waiting for a break in traffic. We're standing with half a dozen other people and I'm positioned just a little behind her. Suddenly, I glance over and notice the guy right next to her is oh so casually unzipping her purse. Unfortunately for him, the only thing in the pocket he would have obtained was her chapstick. However, I didn't know that either, so I proceed to lean over and shove the guy away from her. Hmmm, maybe not the smartest thing in the world but it was effective. The funny thing is, after I shoved him, he shifted over about 6 inches, but still had to wait to cross the street with the rest of us. He just sort of looked away and pretended it hadn't happened. I think he would have started whistling if it had been a t.v. show. Only in Kenya, I guess!

AMPATH clinic

Above you can see both the hospital and the neighboring clinic where I spent the day out in the Teso area. I have to admit I find the outside of buildings much more beautiful here than the inside. Because the climate is so temperate, there are amazing displays of flowers and plant life around every building no matter how rudimentary. I think the Kenyan people take a certain amount of pride in their landscaping as well judging by how beautiful everything is.

The clinic itself was interesting. I was paired up with a "medical officer" who is an individual that has completed medical school in Kenya and done a one year general internship and is now out practicing general medicine. In this case, its a woman who is working for AMPATH (Academic Model for the Prevention and Treatment of HIV) who goes out and sees HIV positive patients and HIV at risk children. Its amazing because she is clearly the most senior and the most educated person out there and she goes out to this place probably once every couple of weeks. She struck me as very bright with a good foundation but hasn't had the resources or guidance to do a super thorough job. But she's honestly doing the best with she can with what she has to work with. She's actually interested in doing and internal medicine residency in the U.S. and I think it would be great if she could. What was cool about today is we started talking about some of her patients and I was actually able to offer some suggestions about evaluation and treatment that she seemed to appreciate. It reinforces how great it is to always have people to bounce ideas off of at home. The other neat part is you could tell that the people in this rural clinic ARE trying ... and are instituting this continuing medical education a couple times a month just trying to educate each other about basic medical issues. Today they were discussing asthma which is probably one of the few subjects that I feel like I could walk into a room and discuss basic diagnosis and treatment without too much preparation. We see a lot more of it in the United States than they do here but it can still be a problem. The background preparation that this medical officer had done to educate the people there was pretty much right on and I was able to add a few practical tips since we see so much of it in the U.S. The treatment they were able to do previously is very out of date as to the current thinking (1st line there was IV "adrenaline" or epinephrine) so we were able to brainstorm ways for them to be able to incorporate current treatment regimens in this rural place, including modifying a water bottle to make a "spacer" in order to better administer inhaled medicines to children and elderly adults when nebulizer machines aren't available due to lack of machines or lack of electricity. (Actual spacers dispensed in the U.S. cost ~ $50 a piece which is FAR beyond the cost reasonable for people here).

Just to give you an idea of cost of living, the average household makes about 35000 Kenyan shillings a year which is about the equivalent of $470. You can see why we Americans are rich here ... I can tell you I've withdrawn more than that already from my bank account to cover the cost of travel and other incidentals in the almost 4 weeks i've been here.

On the News

Well, I'm not on the news (they filmed the spots a couple months ago) but the IU-Kenya partnership is being profiled by one of the Indianapolis news stations. There are about 5 articles and they're continuing to post video clips. It's definitely one of those stories designed to tug at the heart strings but there is some good video of where i'm spending my days! The clip that profiles the medical students shows the Upendo wards where my team is based, and the orphans they show are still the same ones that I see every day.

Check out the link below and follow the links to the segment called "Compassion for Kenya"
www.wthr.com

Equator, Nakuru and Street Kids

Kenya lies right on the equator and we passed from the north side to the south side on our way from Eldoret to Nakuru this past weekend. You can see me with my friend Jen who's also a Pediatrics resident from Indiana. After making this stop we proceeded the rest of the way to the city of Nakuru which is the 4th largest in Kenya. We stayed in the city but next to the city is Lake Nakuru National Park which is a great place to go on safari. I saw many animals - rhinos, waterbuck, giraffe, baboons, hyenas and even a couple of lions among many others.

The safari was a lot of fun but one of the most interesting things about this past weekend was actually the time spent talking with individual we hired to drive us to Nakuru and then through the park. He’s one of the employees of the IU house and is from Kenya. In most large Kenyan cities, Eldoret included, there is a group of homeless kids and young adults that are called “Street Kids.” You see them everywhere in busy areas of town and they usually approach you begging for food or money. Kenya doesn't have the established social system with shelters and support for homeless children that we see in the United States, so this is a rampant problem. What was so interesting this weekend was our driver, Francis, used to be a Street Kid after both his parents died when he was 1o years old. He lived for 4 years on the streets in Eldoret. He said Street Kids usually find enough food by eating spoiled food and going through the trash but when they ask for money will often just use it to by drugs. Francis was able to move beyond this past and is now a productive member of society, married with a couple of kids. I think a lot of this was in part because Dr. Joe Mamlin (basically the founder of the program I'm involved with here in Kenya) gave him a chance and allowed him to work for him. Now in fact, Francis actually has taken in two street kids whom he supports in addition to his wife and own children. It was so fascinating watching him interact with these kids as they came up and begged him for money knowing that he was in the same situation earlier in his life. Also amazing to think about what he has overcome and how much different his life is now. Plus, he was an incredibly nice guy, who, without a lot of education had a lot of inciteful and intelligent things to say about the Kenyan education system, health care, government, and culture. I really feel like the most valuable part of the weekend was not the safari but really meeting and learning from this incredible guy!

My Heart Will Go On ...

and on and on and on! What I really mean is that Kenyans have this unending love of Celine Dion! Can't really explain it but all I know is that I heard pretty much an entire Celine Dion album at full volume on the streets of Nakuru at about 2 in the morning and continue to hear her songs at regular intervals. Who knew?

Will update more soon (internet access has been a little tricky lately).

Remember fording the river on Oregon Trail?

We drove yesterday through the countryside to spend the day and night at Lake Baringo in the Rift Valley. Lake Baringo is a fresh-water lake known for its population of hippopotamuses (hippopotami?). We were staying at a sort of camping resort where there were tents set up on an island for visitors to come use. Really, it was more like a hotel. Yesterday we got a ton of rain at Lake Baringo which was a little disappointing but had a nice relaxing day anyways. Interestingly, the Rift Valley has a river that winds through it and it routinely floods and dries up as it drains into Lake Baringo. On the way to the resort, we had to drive our van through this area of flooding on the road where the water was moving fast and was probably 1-2 feet deep. The above was taken by me reaching my camera out of the passenger side window (steering wheels are on the right in Kenya) However today, since we had gotten so much rain throughout the day before, we were questioning if we may even be trapped! We were in communication with our driver who was watching the level of the water earlier in the day and matatus (Kenyan word for big passenger vans) were not able to make it across. Finally mid afternoon, the driver said, let’s just give it a chance to see if we can make it, otherwise we’d probably be trapped for a few more days especially if it continued to rain! So, we were all pretty nervous about this wondering if our matatu may get washed away in the current with us in it. Some of my fellow passengers even went so far as to get out their utility knives in case we needed to crack the windows to escape. The back of a ten passenger van is not the easiest thing to get out of even in good circumstances. Needless to say since I’m posting this, I made it without too much difficulty and I think we entertained the 30 or so Kenyans loitering around this crossing watching people attempt to get across. We even got a round of applause at the end :)

I am always amazed in 3rd world countries at the intersection of poverty and the modern world (globalization as some of the other people I’m with seem to call it). We drove past huts made of plywood or mud probably about the size of my living room or smaller with no glass in their windows, certainly with no indoor plumbing and their inhabitants standing outside watching us drive by while talking on their cell phones. Practically every other commercial building is painted lime green (for safari.com) or hot pink (for zain) representing competing cell phone companies in the area despite that they also don’t have the basic things we would expect to be able to run a business. We drove through the mountains and tiny villages and would still see Coke machines. Many times children would be walking down the side of the road up in the mountains wearing dirty, battered sweatshirts displaying American brand names such as GAP or MUDD jeans. I can only imagine these were acquired as people back in the U.S. cast them off as donations and somehow, these ended up in rural western Kenya. We also drove past a training center where many of the Kenyan runners train to compete professionally. These areas look no less impoverished and no more modern than anything else I’ve seen here yet turns out some of the best athletes in the world. One of the best things about running is that it really doesn’t take any special equipment. The Kenyans happen to have the unique combination of a temperate climate, a high altitude and some inborn talent and they are world-class athletes.

I am particularly struck here by the weird divide that I feel between my experience here and what Kenya is actually like. Indiana University has carved out its own little piece of the world here. Its built a compound where things are very comfortable with modern amenities including wireless internet! The buildings themselves are maintained by a full staff. They have a host of people hired to clean bathrooms, prepare meals, make sure we always have safe drinking water available and even transport us around town if we need it. When you factor in that my mom is accessing my bank account and actually paying my bills for me (thanks mom!) in the U.S, my life is even easier here than in the U.S., since most of my basic needs are taken care. It certainly hasn’t been anything close to “roughing” it. And so the existence I live here is one more akin to a boarding school or my freshman year at college. And is completely unlike the way the average Kenyan lives. I have this strange feeling I’m cheating or something. Though I have to say it is a little bit of a relief. I was worried that it would be so unlike my normal life that I might be miserable. I just feel so rich being here. Since I’m a pretty economical person I don’t like wasting money and have been known to pinch pennies on a regular basis. For instance, I haven’t been letting people help me with my luggage here because I don’t want to have to tip them. But then I see how people live here and start feeling maybe I should just do it because I obviously have so much more than they do.

Greetings from the Sausage Tree

Well , made it to Kenya with relatively few problems. We missed our flight to Eldoret because we went to the wrong airport in Nairobi but caught the next one later in the day without any issues other than spending a long boring day in the Nairobi airport. We arrived in Eldoret yesterday pretty tired. We’re staying at a compound here called the IU House which is like a pretty nice dorm actually. Jen and I are sharing a medium sized room (named the “Sausage Tree” and have our own bathroom right outside the door (hot shower and everything though the water pressure is low). We had our initial orientation and spent the morning at the hospital today but then have had the afternoon off to get ourselves settled. Honestly, even just the morning made me exhausted. I think it’s a combination of the jet lag, the altitude and being in a new place and situation.

One thing I’ve been struck by here is the rampant discussion of Obama. As the election happened last night (Kenya time) multiple people stayed up through the night to watch the election results come in on CNN. I asked one of the Kenyans watching the election results what would be the benefit for Kenyans if Obama was elected and he answered, “we’d get a national holiday.” And he was right, Kenyans today are so happy that they have actually declared tomorrow a national holiday. That’s right, election of someone not actually from Kenya, not in their country has had that effect. One of the other Kenyans thought that it would be easier for Kenyans to get VISAs into the U.S. I’m not so sure that will be the case but I didn’t tell him that. People are so excited, there is even a reggae type song getting a lot of radio play called “Barack Obama.” If you’re into that sort of thing, you should google it and check it out, it’s pretty funny. The irony of this whole situation is the people of this country seem to be so proud that both a Kenyan and an African American is going to be president of the united states. However, if you look at the record, you see that Obama’s Kenyan father abandoned his family leaving a single white American lady and her white parents to raise him in the United States. So essentially, other than some sperm donation, how much did Kenya really have to do with him??? Just some thoughts (that I’ve kept to myself while here) …

Today at the hospital was interesting to say the least … there are about 48-60 Pediatric patients in 8 bed wards with beds being about 2 feet apart. There are no monitors, minimal medical equipment and disorganized or absent charting. The intern and the resident pretty much run things with attending physicians showing up a day at a time or not at all. I’ve been assigned to a team with a Kenyan intern (someone who’s had 6 years of medical school after highschool), a Kenyan Resident (someone who’s had training up through Intern year, then practiced for a number of years but is back to specialize), and a 4th year medical student from IU who seems vastly more knowledgeable than the Kenyan Intern. I did feel like the Kenyan resident was pretty competent, however. We cover 12-15 patients on our team. After we were done rounding today, one of the babies on the other unit stopped breathing and required some basic resuscitation. As we watched the infant required bag mask ventilation, became minimally responsive and started having some extensor posturing. The infant started breathing on her own again but with shallow breaths. They have minimal ICU beds here and really only intubate people that they feel very confident will be able to come off the ventilator because, culturally, they don’t withdraw support once they’ve given it. I believe this infant probably is septic, if not encephalitic (blood stream infection and infection in the brain) but so little was able to be done for her. We left her in a state such that I will be surprised if she lives until tomorrow. Its just such a different system and I’ve been encouraged by both people who have gone and people who work here currently to watch and observe initially and then try to contribute as I understand the system better. But ultimately, this system functions with or without us and there are many, many limitation which will not change by my presence here. I have to look at it as anything I can contribute with my limited knowledge is a bonus but not get too involved in taking ultimate responsibility. I sure have a lot of thinking and learning to do and will try to update this once per week to tell you what I’ve seen!

Floods, concert

To all the people who have asked, I appreciate your concern, but my area of Indianapolis is fine. I haven't personally experienced any flooding which is more on the south side of Indianapolis. There have, however been some patients transferred to our hospitals because there hospitals have been flooded. Actually, though I'm mostly saddened by all the flooding that's going on in Eastern Iowa and have a hard time seeing all the places I went to college and med school experiencing so much damage. Some of the pictures have been really unbelievable!

Tonight I went to see Jack Johnson, one of my favorite singers, in concert. I've seen him once before about 5 years ago and he lived up to everything I remembered. It's just a really laid back show and he sounds every bit as good in person as he does on CDs only he added in some new music and some fun improvisation. It reminded me of the concert I saw years ago with all my friends from med school and I wish they could have been there to see him again! One very cool part at the end was that he announced that all proceeds of the concert were being donated to the Red Cross because of all the flooding in Indianapolis.

Storm

There was a severe storm with some high winds, hails, and apparently some tornadoes the other night. I was at the hospital which wasn't really affected during the storm but the next day I was trying to drive home and found this tree blocking my way home. It's amazing to me that this gi-normous tree managed to split in two and fall over where just a block away, yard signs were still in place. Fortunately, there wasn't much damage in general but I thought this was pretty impressive!

Travels

It's been a great month for traveling for me! After a busy Neonatal Intensive Care month in April (hence, no blogging) I'm now on my elective in Dermatology which includes a week of vacation. Additionally, earlier in the month, I was able to attend the Pediatric Academic Societies conference in Hawaii where I presented a poster of a project I completed earlier this year. I spent a couple days at the conference and ... a couple days not at the conference :) Those days I spent snorkeling, relaxing on the beach, hiking up Diamond Head and not really working too hard.

Then, this past week I spent 6 days in New York City where my friend Cari got married in Manhattan. It was the first time in NYC for me and it was a busy few days since I was in the wedding but I did happen across some of the famous things and places such as the Statue of Liberty, Times Square, Herald Square, Empire State Building, Central Park, Madison Square Garden among other things. One of the neat things for me since I read a lot and have seen a lot of shows and movies based in New York City, I now have at least a basic knowledge of the geography and layout of the city and neighborhoods. Otherwise, I spent the time with about 6 friend from med school, many of whom I haven't seen since I graduated so that was great too.

I'm going to try a new thing where I upload my pictures to some web albums and I'll include a link here so you can take a look if you'd like. Most of the pictures of people, less of the sites ...

New York: http://picasaweb.google.com/njlohr/NewYorkCityMay2008?authkey=vC3JajR8FWs

Hawaii: http://picasaweb.google.com/njlohr/HawaiiMay2008?authkey=wIAAK0OwUxk

St. Lucia

It's been a long time since I updated this but I think maybe I was just waiting for something fun to report. Well, I found it! My friend Karla got married in St. Lucia the weekend before last and I was lucky enough to get to go! It was one of the most fun 3 days I've had in a long while. Some highlights included the amazing villa I shared with a few others at the top of one of the Piton mountains, the rehearsal dinner that was really a "cruise" on the pirate ship from the Pirates of Caribbean, and of course the beautiful wedding and reception on the beach. It was a small group and everyone was so welcoming including all of her husband's family who I hadn't met before so that made it really amazing too. Above pictures are the view from the balcony of my villa including a plunge/infinity pool, the group picture on the beach after the wedding including a rainbow in the upper left part of the picture over the resort and finally a little goofing off during the dance at the reception.

Otherwise I'm on a month in the ER which explains the few days off I had since we do mostly shift work. It's going fine and I'm liking it better than I did last year. Not too much else new to report but I'm eagerly awaiting spring and more importantly spring-like weather.

Happy New Year!

I must apologize for my hiatus from blogging for the past month. You all know how Decembers can be and this one was no exception. I hope that you all had Happy Holidays. I thought of many of you over the past few weeks and lamented that I didn't send cards out but my goal next year is to do that! If you're reading this, please keep sending the Christmas cards my way because I love hearing from everyone!

For the month of December I was working in the Pediatric Intensive Care Unit taking care of some pretty sick kids. I enjoyed the challenges related to treating very complicated illnesses and children but stressed out a little bit over the on-call problems which tended to be more in depth and serious than my previous months. I learned a ton, however, and by the end of the month felt a whole lot more confident about managing complicated medical problems. Overall, I liked it better than a lot of months I've been on. Not enough to want to take care of intensive care patients for the rest of my life, but it sort of reaffirmed my interest in taking care of sick (vs. well) children. It will be nice to take care of sick kids but to know that if they get really out of control, there's a place to send them where they can be managed (i.e. an intensive care unit).

After working all month, I finally got back to Iowa for Christmas on Dec. 30! My parents were generous enough to hold off on most of their Christmas until I got back and that's where I still am enjoying both a holiday break and a week of vacation at the same time.

The part of my month not spent working was nice too. I did some gift exchanges with some friends from Indy and even got out to our Christmas Holiday party and to see the play, A Christmas Carol which is done by the local theater every year.

Finally, some New Year's resolutions! I hope that by putting them on here, you all can periodically check in on me and see if I'm actually following them.

1. Exercise, eat well, yada, yada, yada. Okay, no originality here but it's always a good thought after the holidays, right?
2. Continue my new budget! I started it about 4 months ago and have had some ups and downs with it. The first couple months went great, but the second couple months got significantly side-tracked when I had that little hit and run experience I talked about earlier. Turns out the police can't/won't do anything more and since the damage was at my deductible + the cost of a rental car when I got my car fixed, the whole $600 fell to my expenses. I guess the good news is, if I hadn't been doing the budget, I would have been in a whole lot worse shape. Anyways, so aside from that setback it's going well. And last night, I finally put the whole thing to an Excel spreadsheet so I'm going to be able to keep track of things more accurately!
3. Umm, get Christmas cards out next year!
4. Try to focus less on myself, and more on other people. I feel like in residency, it's really easy to get wrapped up in everything that's going on in my life and forget to give my tine and attention to other people, which is really what's most important. So in short, be less selfish.

there you have it, that's my last month in a nut shell. Drop me a line if you get a chance!