It's been a good couple of weeks

So an update from my last post ... it looks like Joyce from Kenya is being considered for the Gift of Life program at Riley Hospital where they will fix heart defects for children from other countries (and provide for the expenses). We're also working on getting a plastic surgeon involved to repair her cleft lip/palate at the same time. I'm really excited because it should hopefully happen while I'm still working at Riley so I should get to see her while she's in Indy.

In other news, I've told a lot of people, but maybe not everyone, but I'm going to be moving to Denver in June to start a Genetics/Metabolism fellowship at The Children's Hospital which I'm excited about. Given the poor state of the market right now I put my house on the market when I left for Kenya and I just sold it last week! Not only that but 3 other units a lot like mine were on the market before mine was but mine sold first! I credit it all to watching a whole lot of HGTV and learning how to "stage" my house :) I didn't make as much money as I would have liked but I'm not going to have to bring any money to closing and will make a little bit of money when the mortgage is paid off. In this market, I look at that as a big plus. I'll be moving in with a fellow resident who has a spare bedroom for the rest of residency.

Finally this week, I traveled to Strasburg, PA (which is near Harrisburg) to meet with a group of researchers that I've been collaborating with on a genetics project involving the Amish community. The area that I visited in Pennsylvania is in Amish country out there as well. I stayed in this adorable bed and breakfaast which even had a fireplace in the bedroom I stayed in. I've decided that will be a must in my dream home someday so that I can get ready in the morning with a fire going :) I've been working with this group via email for the last 1.5 years so it was great to finally meet with them in person. Not only that but they had some great news ... they've identified the gene that causes the new syndrome we've described in this population! It's a big victory and I think the things we've learned about this syndrome are going to impact the types of treatment and screening we choose immediately. I love genetics but one of my biggest dislikes is how esoteric it often is but I feel like with this project we may actually be able to make a different in the quality of life for these families. Now it will be a whole lot more work writing this up and submitting it to a journal. I'm also going to get to present this work as a poster at the American College of Medical Genetics conference in Tampa, FL in March.

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!