On Kenyan Time

Being the youngest “physician in training” on the trip, I found myself scared and overwhelmed…to say the least… before embarking on this journey.  Now having it almost come to an end, I thought it would be appropriate to mention a few of the incredible lessons I’ve learned from this life altering opportunity.

 Coming from a bustling State Hospital in the US where any laboratory test or consult could be obtained with a click or call, life in Kenya may seem to come to a staggering halt.  While in the mobile clinics, our texts, combined knowledge and experience from the upper level physicians, and most importantly, the history and physical exam guided our diagnosis and treatment.   So a question or two for all the budding doctors out there, “What is the appropriate regimen of treatment for Typhoid fever? For cutaneous Leishmaniasis?” Well if you’re like me, I had to look it up, and not to mention ask about a million other questions to help sort through the many differential diagnoses that exist in the tropics.  So, lesson number one would have to be, don’t be afraid to not know something, as this will invariably be the case.   And don’t be afraid to ask for help. As Dr. Hodges says, common things are still common, even though we’ve gotten to see several rare diseases that one may never see in the US.

In what seems to be the lack of rush to do anything, we’ve found ourselves engrossed in conversations about the community and the struggles they face.  You see the importance of a handshake, of asking “Habari” (how are you) and in taking time to make each patient feel welcome.  The Kenyan people are such gracious hosts.  In two separate mobile clinics, several of the community women cooked all day to provide a meal for our team in thanks for providing medical care for their community. In a country where food is precious and a nutritious meal often hard to come by, such a gesture was incredibly powerful. 

For many, we are the first “mzungus” they’ve seen, so even the smallest gestures speak volumes.  The children here are both curious and sometimes afraid, but you can always get a smile with a quick game of tag, or soccer, which they LOVE to play. The bottom line is that these children hunger for an out-pouring of love and affection.  Being in Kenya has helped me to understand the importance of the unspoken word and gesture as equally important in the care of the patient as the medicine we provide.

Finally, I’d say the lesson I’ve learned best is to be confident in myself and the rest of the medical team.  That regardless of age or experience, the greatest satisfaction has been merging the didactic knowledge learned in the first years of training with clinical experience to serve the community competently and compassionately.  One case particularly comes to mind.  A young boy about 5 years old came to clinic with a peculiar rash that had begun on the face and had descended to the arms and trunk.  The rash was fine and popular and did not appear to be in the distribution of scabies or a tinea corporis infection. The rash did not have any varying levels of healing. No other siblings were affected.  The child also complained of a stuffy, runny nose, and inflamed red eyes.  Because rashes are so prevalent here as the result of fungal and bacterial infections, and bites, at first it appeared theses may be two separate entities. Getting the whole team involved, with further questioning it was discovered that the child had been febrile the week before. On Physical Examination, findings were generally unremarkable except for the stuffy nose, papular rash that had begun on the face, then descended to the arms and trunk, and prominent posterior auricular lymphadenopathy.  In consulting with the attending and texts, we felt confident that this was a case of Rubella, a viral infection we don’t see anymore in the US because of the MMR vaccine given twice before children reach school age. We reassured the family and offered conservative management of the symptoms.  Practicing medicine is an incredible profession, and I’ve felt incredibly blessed to have this opportunity to sharpen my skills here.

-Hannah Bauer

We’re Winning!

I think Courtney and I might have saved a small child! This is highly exciting for many reasons. The problem with medical TV shows is that it makes you think that being a doctor is running around saving people on the brink of death; that after one, giant, heroic measure they are all cured and you celebrate with tearful eyes, everyone gives hugs all around, and the curtain comes down. The truth is that  a large portion of medicine is a very drawn out process, recoveries are slow, paperwork is extensive, and they usually ride off on a wheelchair into a rehab center rather than a white horse into a sunset. So to be able to see a quick and huge improvement in someone because of something you did is an awesome feeling, especially for med students still so new in our career.  We were having clinic in our typical mudhut with tin roof and Courtney and I were in the back room. A mother came in carrying a toddler…a toddler that when you looked at them your brain sent a danger message; this child looked very ill. She was lying listlessly in her mother’s arms with her head just lolling loosely.  She had no appetite, vomiting and diarrhea, and fevers. Her mom said she had been treated multiple times for malaria and she would get better for a small amount of time before becoming very ill again. We went over to examine her and the first thing you noticed when you touched her was that this child was hot. Her temperature was above 39 degrees Celsius (above 102 for us Yanks).  But what was REALLY concerning was that when you tried to sit the kid up she still kept her head kind of leaning back. And when you tried to bend her head forward, it didn’t really bend. If you tried to force it, she cried. This is about when Courtney’s eyes got REAL big and both our little medical student brains exploded. For those not in the medical lingo know, a rigid neck is one of the first medical scary signs they ever teach you in medical school. It is a classic sign of meningitis, which is infection of the coverings of your brain. That qualifies as a bad thing. It kills people even in the States and even if you are a previously healthy adult. This was a probably chronically ill and malnourished child. The rest of her exam was actually pretty normal; nothing leaking out of her ears or oozed on the back of the throat and no rashes anywhere. She was very pale but she didn’t seem too dehydrated. The most concerning thing about the rest of it was that she didn’t fight. If you have ever tried to stick anything in a toddler’s ear, then you know you are fighting an uphill, loud, angry battle. In contrast, this child flailed its hand a little bit weakly. We went and conferred with our big, full-fledged doctor for help deciding on a battle plan. In the U.S. the child would be admitted for many days with IV drugs.  Here the hospital is a place to be avoided at all costs, where children are crammed side by side into a long room with nothing separating them from their neighbor and with little treatment available.  We gave the child a full gram of Ceftriaxone (one of the more powerful antibiotics and a meningitis staple) via 2 shots in the butt. She cried a pretty good bit on the shots, which was a good sign. We also treated for malaria. It sounded as though this kid had a chronic case that requires more extensive, longer treatment. Malaria is not something you want to miss in a child this sick, especially under the age of 5. If it doesn’t kill them, which is unlikely, there is a good chance it will do permanent brain damage. So she got another shot in the thigh for super malaria treatment.  Then we had her mom stay and give her rehydration salts on the lawn in front of the clinic so we could see how she was looking in a bit and to make sure she got some fluids in her. A lot of times it isn’t the illness that kills people so much as it is things like dehydration. Dr. Hodges helped the mom give 1 tsp of  water with rehydration salts in it every 1-2 minutes.  After about 1-2 hours the child looked moderately better and we decided we could probably get by without sending her to the hospital. Instead we gave the mother money to take the bus back to our home base clinic the next morning so we could see her before driving off to our next mobile clinic locale. When the mom brought the child in the next day she said that baby had seemed to do better for most of the evening but had started looking ill and vomited again that morning. So we repeated all the shots. This child will never trust white people. Ever. We then gave the mom enough meds to get through the weekend and enough money to come back and see us again 2 days from then on Monday.  On Monday the child was doing much better. The mom said there were no more fevers, no more vomiting, nothing.  The child was of course crying because by that time she had figured out that white people= butt shots but she looked much better.  We gave her enough antibiotic for another 10 days or so and enough malaria medicine for a total of 10 days. Normal malaria treatment is about 3 days but since we were thinking chronic, relapsing malaria we needed to treat longer. So we are going to chalk this one up in the win pile and have a group hug.

-Erin Barnes

Thoughts from a first-timer...

As the first resident doctor to accompany S.H.I.P. to Kenya, I can honestly say that this journey has been AMAZING, truly an eye-opening, humbling, and educational experience!  In only a week, we have seen so much tropical medicine that I can hardly keep track of all diseases that are “new” to me.  I actually saw my first case of Rubella, a disease that practically never occurs in the U.S. now because of childhood vaccinations.  I’ve also seen cases of Leishmaniasis, Schistosomiasis, Brucellosis, Malaria, and Typhod fever  - all of which are so RARE in the U.S. as we have basic needs of shelter, running water, electricity (for refrigeration), accessible medical care and even shoes!  Every day as we move to another community, I am again in awe of the poverty surrounding this Southwestern Kenya village and the vast need for help.  So, tonight as we start another week, I am so thankful for this opportunity! 

- Ellie Hudnall

Micro-enterprise Development

This week in MDP (micro-enterprise development program):

Mon Feb 5- I was able to meet with one of my groups from last year, Ngairwe Vijana youth group, to follow up on their group projects. I was excited to see that they were having a lot of success in their honey project and were able to even expand their hives from 9 to 13 within just one year. It was also interesting to see that their mushroom project had progressed. When I visited last year they had not yet begun the mushroom project, but had high expectations for it to be come a high revenue product. Unfortunately, the demand for this type of mushroom (oyster mushrooms) was less than projected, but it has only been about a month since they have begun selling this new product. The time and capital investment is very high for these mushrooms, so I plan to assist the group by developing a marketing plan to help increase sales on this project.

Tue Feb 6- Van broke down and was not able to visit any groups.

Wed Feb 7- the other MDP volunteers and I took a nice field trip to a group in Bungoma town who have greatly benefited from the skills and knowledge that previous MDP volunteers had provided them. They began just 3 years ago manufacturing and selling small quantities of cleaning products and hand soaps. Today their business has grown to a Ltd. (limited company, similar to our LLC), attained certification from the Kenyan Economic Bureau of Standards, been able to hire 17 employees, and secure contracts to sell to hospitals and schools throughout the region. They have also expanded into different product lines, like hand creams, and have plans to soon grow even more. It was very exciting and encouraging to hear about and see this small group have such success in such a short period of time. I can only hope that I will be able come back in a few years and see that some of the groups I have worked with have also achieved this type of success.

Thurs Feb 8- myself along with 2 other MDP volunteers visited a group in a very poor village near Kabula called Family Care. Family care group consists of 15 very smart, hard working, and eager members. They have been in business together for only one year, but have big plans and great ideas for the future. They currently own one sewing machine, which they use to tailor school uniforms for 4 different primary and secondary schools in the area. They are seeking advice on how to attain a loan to purchase 3 more machines to increase this business. They also are planning to expand into agriculture by planting and harvesting rice, passion fruits, and ribena (a flower which is boiled to make a delicious, fruity juice).  They were extremely organized, well thought out, and motivated. I feel that they have great potential to expand and grow successfully.  We used today to gather information about each of the project’s costs, product timeline, and sales to compile an appropriate business plan for the group. They will hopefully be able to use these recommendations and business plan to attain the loan they need to build and grow each of the projects.

-Aimee Berniard

Too Hot To Handle

On our third day of clinic we arrived at that day's village the see dozens of children scattering at the sight of us. We would be working in the church that day, and the classroom was next to it. We started handing out Dum Dums (the universal peace offering) to frightened and not so frightened children. A few burst into tears as soon as you looked at them. Most were excited to see mzungus (white people) up close. Soon they were showing each other their tongues to see what color the suckers had turned them. They were also swapping Dum Dums to taste the different flavors. Quite amusing to watch.

The church was an impressive sight. Nicely manicured lawns with flowers beds, windows with glass, and real pews with kneelers! The village obviously took pride in their place of worship. The kids we saw, however, were really sick and malnourished. And there's one that I'll remember for a very long, long, long time.

He was a one year old male (though much smaller than my niece was at six months old) whose mother brought him in for a burn he received the day before from chai tea. The first thing you noticed while examining him was his right hand. Picture a latex glove that's been blown up and tied off to amuse a pediatric patient. That's what his hand looked like. The skin on his entire palm had blistered but hadn't burst yet. The his mother removed the wrap that was covering his lower body. His entire right leg, right buttocks and genitals had been burned by the tea. Luckily the burns were only second degree at the worst, but the skin had already started to slough and he was at risk for infection. We covered him in silver sulfadiazine (something I don't remember having last year and wondered when we would use it this year) and dressed him in gauze and ace bandages. We instructed the mother that he needed to be brought to the hospital within the next couple of days and gave them paracetamol for pain and oral rehydration salts to prevent dehydration. If all goes well, he should recover nicely, as long as he stays away from the chai tea pot.

--Courtney Rome

Mission Update

Just Like Last year we are having a bit of trouble getting our communications up and running, however in the next couple of days everything should be taken care of.

Thus far we have had two days in clinic and seen upwards of 130 patients.
Without going into to much detail tonight, since we are still having some communication issues,
the range of disease thus far have been what we expected. Malaria, Typhoid, Skin and Soft Tissue Infections.

The more notable cases (pictures to follow shortly) have been Tertiary Syphilis, cutaneous leishmaniasis,  and a very strange growth of 22 years that we suspect to be a tetratoma ( you will have to see the pictures).

Everyone is still doing well and adapting fast to the slow life in Kenya. Please check back tomorrow much more and pictures will be posted.

-Matt Berniard

Upward and Onward

This being our first post in Kenya, first and foremost we would like everyone at home following to know we are safe and sound. Allow me to sum up the trip so far. We packed the van and departed shreveport Friday January 28, 2011. Overnight in Houston at the home of Tom and Trudy Rafferty who we would like to thank very much for their hospitality and the ride to the airport. We boarded our Emirates airline flight to from Houston to Dubai.  16 hours on a plane sounds like a long time on paper, well try actually doing it. However, it went as best as can be expected. Emirates airlines reputation lives up to the hype. Over 150 movies on demand. Food on Demand. It helped to make the 16 Hours bearable.

We had quick 3 hour layover in Dubai and bordered a 5 Hour flight to Nairobi. After immigration, we picked up our bags and headed to customs, expecting some hassle. However, customs was no problem whatsoever. They didn't need any "samples" to be analyzed this year. We were met by some familiar faces , Sammy who was our driver last year was ready and waiting to take us to our Hotel.

We are overnighting tonight at the Sankara Hotel in Nairobi. The hotel is extremely nice however, they don't call it Nairobbery for nothing. We booked the Hotel at $159 a night, however when we showed up the unmentioned taxes and fees added up to $199 a night. After the best shower on earth and a good meal, its time for bed. 7 Hours of driving tomorrow and on to our home and friends in Bungoma. More to come the Mission really starts tomorrow.

Before I sign off for tonight, I want to genuinely extend my thanks to everyone that makes our work possible. Everyone that supports our organization wether it be by time, work or financially, know we couldn't do this without you.

A very special thanks to our accompanying attending physicians Dr. Keith Scott and Dr. Lisa Hodges, we couldn't do anything without you.