Back in the USA

Thank you for all of your thoughts, prayers, and support to help us travel to Kenya and arrive back safely in the United States. We had an amazing journey, met some amazing people, and formed great friendships. I know we all feel incredibly blessed to have been a part of this experience. Thanks for following our blog along the way. In the coming weeks, I'll be making more updates that includes stories with pictures to tell you a little more about our month long journey in Kenya.

For now, I want to let you all know that we're safe at home and making the weird transition back to running, potable water with electricity and all the conveniences of home. Most of us agreed that we could have stayed another month, but by the time we made it 20 hours into our journey home...we were ready to be in our beds at our own houses!

Thanks again for your support. If you want to hear more about our journey in person, I want to invite you to our SHIP post-Kenya meeting this upcoming Thursday from noon until 1PM at LSU Health in the 3rd floor testing center. Hope to see you there!

Friday Clinic

I woke up with the idyllic rooster call and sunshine peeped through the window of my mud hut. It was Friday and just one more clinic day stood between me and a relaxing weekend. I stepped outside, took a deep breath of fresh Kenyan air and I saw Paulette sitting near my hut, enjoying her breakfast.

“Don’t look to your right,” she says.

“Okay, I won’t…. why?”  My curiosity got the best of me.

“They’re slaughtering a cow right outside your hut.”

Aside from my rough start to the morning, I was excited to experience another day of clinic outside of Bungoma, Kenya. Dr. Keith Scott announced to us that some of us needed to leave for clinic early. I volunteered and piled into a vehicle with the other early birds and we took off for clinic which was located one hour away.

Our final destination was a small mud-building with a tin roof. We found out that it was the village’s church. A lady and a gaggle of small children meandered out of the church to see what was going on. As we poured out of the vehicle, some of the little kids acted a bit terrified of us. I even heard some of them crying. I guess they don’t see wzungu, whites, very often.

We checked out the building and realized it was just too small for our clinic and there was no shade outside so we couldn’t work outdoors, either.  Some of the locals told us of a better location just a little way down the dirt road. I grabbed my belongings and Marcy helped me pass candy out to the children as we headed to our next location.

A man led us to a green yard with a nice house and a canopy of trees. We were told that this house belonged to the pastor of the church.  We began setting up our clinic stations and the pharmacy.  I found a nice shady patch, grabbed a translator and was ready to get clinic started.

My first patient was a 3 year old boy. I recognized him as one of the children from the small church. He had a patch of impetigo on his upper lip.  His little nose was running onto the impetigo and he had flies crawling on his face. I grabbed wet wipes, Hibiclens and triple antibiotic ointment and got to work. The little boy stood there, quietly, while I scrubbed his face. I even cleaned the parts of his face that weren’t affected since I didn’t want flies to walk over the impetigo. When I was done, I gave him some candy and toys and sent him on his way.

My next few patients were a smattering of the usual: osteoarthritis, GERD, untreated hypertension. A mom brought in a 5 year old girl for tinea capitis (tinea = ring worm, capitis = of the head). The little girl’s younger brother was so scared of me that he buried his face in his mom’s chest and wouldn’t even look at me. I tried to offer him some candy so that he might not be afraid, but he was hanging on to his mom for dear life.

The LSU medical team began wrapping up clinic a bit earlier than usual since many people were leaving for the United States the next day and needed to pack. Right when I was about to start getting my things together, a mother walks up with her four young children. My translator, Ellah, who is also a Kenyan physician, gave me a pleading look that said, “Please don’t leave me!”, so I asked Mary Katherine and Mama Joyce if it was okay for me to stay behind. They said it was fine, and thus began the most overwhelming afternoon of my life.

Once all of the LSU wzungu left the clinic, the only medically trained people left were Ellah and Edward (Kenyan physicians), Karen (Kenyan nurse) and myself. Ellah eventually found another interpreter for me so that she could start her own clinic station and we could get through the patients more efficiently.

I still had to examine and manage the mom and her four children that arrived at my station. The first child I examined was an 8-year-old boy who had a history of complex partial seizures ever since he had meningitis when he was 2 years old. We cannot treat chronic seizure disorders from our clinics since we cannot follow-up with our patients, so I explained to the mother that she needed to take her son to a hospital or clinic so that he could be treated and followed for his disorder. As good measure, I decided to listen to the boy’s heart. I was startled when I heard a systolic murmur. It was loud and clear. Panic ran through me: I could hear Dr. Kiel’s voice in my head, asking me what might be causing this boy’s heart murmur. Unfortunately, my mind was blank. I also didn’t have any American doctors to consult anymore since they had long since left clinic. I started to get more history on the boy including his activity levels and any history of syncope. I felt horrible that there was nothing I could do for him at clinic (even if the American doctors were still there), and I knew that if we were in the US, we’d get an echocardiogram on this patient to find the cause of the murmur. Unfortunately, we were not in the US and this family had very little money. So I told the mom that she needed to have a doctor listen to his heart when they take him to get his seizure disorder worked up.

Next, I listened to the boy’s younger sister. The mom said the little girl had a history of asthma-like symptoms. As I was listening to her lungs, the little girl laughed a lot. I was glad that a child was not terrified of me for once.  Her lungs sounded great, which made me happy since I didn’t want to add any more problems to this mother’s load.

The next sibling, was a baby over a year old. Her lungs sounded terrible. I could hear wheezes and mucus all over her lung fields. The baby didn’t look toxic, which was a good sign. I discussed the case with Ellah and she suggested we give the baby amoxicillin and a shot of rocephin to cover most causes of pneumonia in a patient her age. I ran to the pharmacy and Karen helped me mix up the amoxil. I started looking around the table for the rocephin, but I could not find any sterile water or glucose to mix with the rocephin in order for us to administer it intramuscularly. That meant the baby would only get amoxicillin. We had also run out of albuterol and all other inhaled medications meaning we couldn’t offer the baby any immediate breathing relief.  The best we could do was crush up some salbutamol and mix it in water to give the baby. It wasn’t anything I’d do in the US, but I was desperate to make her feel better and keep her out of the hospital.

At this point, many other patients had arrived and registered to be seen by a doctor. I think they may have been telling this woman things in Swahili because she told me that she wanted to withdraw the fourth child from being seen. I made sure she got a refund for that child. The mom grabbed her children and left quickly after I educated her on warning signs that the baby might be experiencing a respiratory emergency. Even if the baby did need to go to the hospital, I am not sure the mom would be able to find transportation there.

The rest of the afternoon was a bit of a blur. I knew I had to see many patients and I had to see them quickly. I also had to depend on my brain, my books and my stethoscope (my otoscope and ophthalmoscope ran out of batteries earlier).  I also did not have my attending doctors to consult when I was not sure of what to do. Luckily, most of my patients were pretty much complaining of musculoskeletal problems, GERD, headaches and other very common ailments that I could manage.

One older woman had a very deformed ankle that she came to clinic for.  She told me (okay, she told the interpreter who then told me) that she had broken a bone in her leg last year and was in the hospital for 3 months while it set. It was obvious that the bone was not set correctly as it was now grossly deformed. The woman was in so much pain and could no longer work due to her leg. I asked Ellah what this woman’s options were in Kenya. Ellah said that all we could do was treat her pain. If we were in the US, this lady would be having orthopedic surgery. It made me so frustrated that there was not more we could do for this woman.

The three of us somehow managed to see all of the patients. Ellah congratulated me on my hard work and I told her that I was worried I did not do a great job. She told me that we were not only treating the patients physically, but also psychologically since we listen to their problems and we show them that we care about what they need.

I thanked Ellah for her kind words and felt a little bit better about my afternoon. Mama Joyce thanked me repeatedly and told me that I was very brave for staying at clinic without the rest of the LSU team.  I finally felt like I actually may have made a larger contribution than I initially realized and felt good about the work I did. I heard thunder in the distance and was glad clinic was over so we wouldn’t have to be in the rain. A single rain drop fell on the side of my face. I wiped it off with my hand.

It was a bird dropping. 

- Allison Cormier

February 8, 2013

WHITE WATER RAFTING/DEATH FLASHES BEFORE OUR EYES

            White Water Rafting on the Nile - sounds fun. Adventurous. Life changing. Peaceful even. It all started out pretty positive.  We missed the 16foot waterfall and ironically, it was all downhill from there.  Olow, our Ugandan native raft guide, led us on the “wild side” of the first rapid where we were flipped immediately in what we thought would be the time of our lives.  While previously flipping sounded fun and adventurous, it was in actuality death defying and terrifying.  Chancy, picture this, is being bobbed like an apple, trapped like a rat under the raft.  While she says she was under for a whole minute, it was probably more like 10-20 seconds.  She looked like a wet rag doll when we pulled her limp body back into the safety of the raft.  White as a ghost.  Silent as a monk.  Chancy’s silence was an ominous sign. She was pretty ter-ri-fied.  I had also been under the raft but pulled myself out from it and was tossed about as we rode the rest of the rapids out.  Thankfully, Olow was by my side to calm the panic attack that was happening.  These rapids were like nothing I’ve ever seen.  Honestly, after that first flip, Chancy and I considered switching to the safe raft. (Thankfully, we didn’t because in hindsight we had a great time and live to tell about it). 

            The second rapid we debated for about 30 minutes whether to take “the chicken line” (as Olow so detestably called it), the class 4 rapid or the class 5 rapid.  Well after much debate and trepidation, we requested the class 4.  Kyla, in her bossy little cute self, says says “LETS DO THE FIVE!!!” and pokes her oar at Chancy and stares her down saying “Chancy?” Chancy, not fully recovered from vomiting the Nile says - “No, Kyla.  I don’t wanna die again.”  Little did Kyla know, I was right behind Chancy shaking my head and wanting to go on a raft called “Kindergarten” – wishing it actually existed. We think we make it through.  We hear cheers and applause from the other 1% rafters in the background.  Well whatdya know? We flip again on the last rapid.  It’s another rollercoaster of death.  “PADDLES FORWARDS TEAMS, PADDLES FORWARDS! PADDLE HARD! PADDLE HARD! HOLD, HOLD!” …and we’re in the water again.  Meanwhile, while we are sucking on the Nile like fish, the other rafts went down the class 5 and came out dry and smiling.  That’s when we nicknamed ourselves “the unlucky 99%” because obviously we were not in the thriving 1%.  We got dragged throughout the water like ragdolls, pulled back into the boat, and we are exhausted, defeated, whipped.  We realize after we get back in the boat that Matt has ripped his pants from Kingdom Come. He was concerned that people saw more than they bargained for – Marcy assured him that everyone definitely did. We have met our match.  Chancy has now lost her left contact and cannot see. She was walking around like a pirate. I guess it was better that way – ignorance is bliss.

            We paddle to the next rapid where we have to walk around it on land since it’s a class 6.  (Yes, they have even more terrifying rapids than what we experienced). So as we are paddling to land, Olow is just a screaming at us to “PADDLE HARD, TEAM! PADDLE HARD! HARDER, HARDER!” Obviously I think we are headed straight for the class 6 and I am paddling my little heart out by this time.  The thought of a class 6 makes me sweat even now.  I’m freaking out.  I can hear it in the background calling me to my death.

            We reach land.  We get to walk near the class 6.  It’s terrible.  It’s as long as a football field and as scary as walking into a gladiator ring where you know you have a 50/50 chance of dying.  I won’t even get too close to it in fear of falling in. 

            We have one more rapid before lunch.  I’m the last to get back in the boat.  My hands are trembling.  We are immediately launched into the end of the class 6 rapid where it turns into a class 5.  We make it through!  This one was called “grave.” Surprise.  Surprise.  We rename ourselves the 1% due to our new found success.  Kyla is over there on the other side of the raft rowing like a champ.  She needs a 10 ft clearance just to get her stroke in.   

            Lunch: The pathway to lunch is up the hill where they have prepared a feast of chipatees (a fried flat bread), and a spread much like make your own tacos.  They have passionfruit juice at the end.  Once I got my glass,  I noticed there was dirt floating around in it.  I figured if the rapid didn’t kill me, this surely couldn’t.  I drank 2 glasses.  I looked over and everyone seemed to be having a great lunch.  Chancy looked a little road hard and hung up wet, but the break was really nice. 

            Back to the water: We somehow make it through the next series of rapids without flipping.  Making it through is so fun and exciting.  We ride the waves instead of drowning in them. 

            We knew it was too good to last.  At the very end, we flip yet again.  By this time, we’re used to it, or as used to it as we could get.  He asked us if we wanted to go big or go home.  We wanted to go home. Olow told us the last one is like 50/50. Half a chance we could flip, half a chance we won’t.  Stirling later says he was sending out positive energy that we would make it.  Well I was in the back of the raft countering that with my negative, pessimistic energy.  I knew it wasn’t  50/50, but more like 99/1 and that we were on the 99% of that .  It was over and under for us.  I’ve got my eyes closed the whole time until I open them and realize we are a good 10 feet perpendicular to the rapids. I hear Jason coming in hot above me and chancy.  He is literally catapulted off the raft, leaping over us, 10 feet in the air, stride in a runners sprint.  We’re hitting the water, and he’s not even gotten wet yet.  We rode the rest of the rapid out and stayed in the water for a good ways just floating until we got to the end. At this time, Andrew decided to be our tour guide and pointed out some interesting wild life on the river banks. Without his narration – our peaceful floating would not have been the same.  

            At the end, they cooked us kabobs and had cold beer for us.  They put together a slide show of each of the different groups’ pictures.  I’m not being biased when I say all of the groups are smiling and waving in their pictures while our group has the look of utter terror as we plunge to our death.  Kudos to Stirling, Matt, Jason and Andrew who went along with us and our nervousness.  (but in all honesty, I think they used us as a scapegoat because they too were terrified deep down inside).  It was a great day! If I was asked again to go the next day, I would say absolutely not.  But in a year, I might consider riding the rapids again.

Still Alive - Hannah Scott and Chancy Gulotta

A Second Home

From Thursday (we're trying to catch up now that we have internet!!):

For the first time since we have arrived in Kenya, I slept pretty soundly through the night. I only woke up once around 3 AM when it had begun to storm around. I’m hoping by next week, I’ll be able to sleep a full night even with any combination of animal sounds, monsoons, or people pumping water before dawn. It’s troublesome getting up before the sun because really – what can you do? I am also developing a personal vendetta against the rooster outside who insists on crowing every 5-6 minutes starting at 4:37 AM and the geckos that sound like a broken beeper that doesn’t turn off.

We ate our breakfasts and had our morning disease presentation in the gazebo this morning. It was a little muggy and cloudy outside, but the temperature is still quite nice. The gazebo is actually more like a giant hut, replete with giant thatched roof, concrete floors, and mismatched furniture. We all huddle together around the table and eat our PB & banana sandwiches and drink chai.  A few people have brought some mini speakers so we tend to have music playing the background at times, which also kind of brings a little bit of the US to our African experience.

Clinic today was in a village called Masango. It was “near” in Africa terms, which means over one hour away. On the drive over, Masango seems to be a more developed and populated area than some of the other places we have been. There were lots of shops and gas stations along the way. The roads were generally well-paved and we saw lots of schools (with playgrounds!). Wherever we seem to go, people – 99% of the time hordes of children – come running out to wave at us and yell, “Muzungu!” (def: foreigner) or “How are you!” (not an actual question; usually said in lieu of hello). I feel as my arms will fall off, but I cannot in good conscience, willingly not wave back to a child.

When we arrived to our destination site, we were in one little building so many of us had to set up tables and chairs outside. Shortly after arriving, this wizened old lady named Judith came inside. She said hello to all of us as she clasped our hands individually and kissed them, thanking God and us for being there today. She is a tiny little lady with a huge smile and some missing teeth, but so much energy and sweetness. She brought out a drum and rounded up some children to sing a welcome song for us. Both she and Ann, one of our favorite translators, led the song. It was a wonderful opening to the day.

Kenyans are some of the most welcoming people I have encountered in the world. In many different cities and villages all over we have met people who have tried their hardest to make Kenya a second home to us, whether it was at the hotel outside of Nairobi or here at Icodei. They have gone out of their way to make our weeks here as comfortable as possible, whether it is cooking us meat, when meat is quite a luxury, or whether it is putting a light bulb in our room so that we can see in the dark.  Bishop Ruben and Mama Betty have truly become surrogate parents to us all!

As has been the case, surprisingly enough, we encountered lots of chronic diseases today, like reflux and angina. Lots of back pain. I remember taking a course in college where we read an article issued by WHO about the changing face of disease in developing countries – and how chronic diseases that we associate with the Western world are rising in incidence and even sometimes surpass classic tropical diseases. There are a lot of people who smoke and eat a lot more unhealthy foods (yay intercontinental trade), so a lot of what we are seeing are patients with problems very similar to what we see back in Louisiana. One patient of note that I saw today was a lady presenting with left sided burning and tingling pain that apparently started one year before when she had neck surgery. It seems like the surgeons must have injured a nerve at the time, but no one has seen or treated her pain. Unfortunately, we are limited with what medicines we have and had to give her the name of an affordable medicine that she could hopefully find at the local chemist (pharmacy). This is what seems to be the most frustrating aspect of this trip: knowing all the resources we have in the world to diagnose disease and the medicines to treat them, but then operating in a resource-scare area, with only my brain and stethoscope to try to figure it all out. That’s a battle in itself. 

- Monika Kumar

Little Girl Blessed

Tuesday Clinic

The first time we met Blessed we thought she was dead. Her mother brought her into clinic and sat down on the bench next to our group and patiently waited her turn. Her seven-week-old baby, Blessed, was wrapped in numerous layers on her lap. She patiently waved over our translator, Ellah a Kenyan physician who was helping translate for us. Ellah calmly looks over to us and states, “It’s an emergency.” Side note: all Kenyans seem to speak impossibly soft and are difficult for loud Americans to hear.

After Ellah states that it’s an emergency, we come over and see this tiny infant looking blankly into the air. After a few agonizing seconds, she blinks. Feeling her forehead, she is burning up. Dr. Walter Scott, a pediatrician was called over. He states that she is having a seizure and feeling her head quickly determines it’s a febrile seizure.  While we spend time worrying about how to stop the seizure, he’s worrying about the cause of the seizure. Her mother begins to unwrap the multiple layers that surround the child, which seems to grow smaller the more clothing/blankets she takes off. Finally, we see her thin body and are able to examine her. Her pulse is racing and she is using accessory muscles to breath. Wheezing is heard over her chest. She probably has pneumonia and needs more than we are able to give her. Dr. Scott immediately orders a shot of antibiotics to give to her before we transport her to the hospital.

            The shot is brought over and her leg looks too small to give a shot. It is so thin. Blessed’s mother states that she has been feeling like this for one month and has been seen and treated at the local hospital without improvement. She couldn’t afford to go back. Three of us got into the van to bring her to the local hospital while Ellah stayed behind but called the hospital and told them to expect us.

            We arrived at the hospital and men with guns opened the gates to the parking lot. We got off the bus and followed our translator to a room full of five women who were completely confused by our presence. The nurses here are on strike.  Evidently, a different civil service group goes on strike every week according to the locals. We then go to the ER check in and jump to the front of the line. Robert was there and said he had just gotten off the phone with Ellah and was waiting for us. He briefly looked at the child, did an exam, and spoke with the mother (Lillian) and decided to admit the child for work up and treatment for possible pneumonia. We tried to pay ahead of time but we told to wait until discharge. Robert was told numerous times to take good care of Lillian and baby Blessed and that we would pay.

            We haven’t been able to get back to the hospital to check on baby Blessed and pay the hospital bill, but Mama Joyce, the medical coordinator here, has been in contact with Lillian. We hope to check up on them soon and see the progress Blessed has made. This is just one example of the times when you feel like you really made a difference. We hope to have many more in our remaining 2 weeks of clinic. 

Anna Craig

Learning to Improvise

Our first day in clinic was Tuesday outside of Bungoma, Kenya. Our bus ride was only about 30 minutes to this particular clinic where we ended up seeing 138 patients!! Our medical team right now consists of 19 medical students, 1 cRNA, and 2 attending physicians. We work in teams of 2 medical students + a translator. Once we see a patient and develop a plan, we will present it to our attending…just as we do in the States. 

Although we see tropical diseases that we would rarely, if ever, see in the U.S., we still see back pain, constipation, ear infections, pneumonia, etc that we see back home. The consensus is that we’ve learned a tremendous amount about medicine, each other, and ourselves in just one week.

As you can imagine, treating patients in a Developing country requires a fair amount of improvisation. We have all had some frustrating moments with patients when we want to do so much more…in the U.S. we would send them for a much needed surgery. But we’ll blog more about those cases later!

On Tuesday, I happened to be seated closest to the door, which made my lap the perfect target for a mother to place her seizing child. I was working with Ashley that day and we were already seeing another patient, so it took me by surprise when I suddenly had a small child in my lap who was convulsing. I took the 4-yr-old Kenyan girl to the front of our clinic where we have the medications and where I could have a few more experienced hands/eyes on deck.  I kept her in my lap, but tried to keep her on her side while we administered medical care. She stopped seizing within about 30 seconds. Her temperature was 104.0 and we began to hunt for the source of the infection. She had coarse breath sounds and was moving very little air. Although we would have loved to admit her to the hospital and give her a full work-up, our resources were limited. We administered IV antibiotics, gave her acetaminophen, watched her for a while, sent her home with antibiotics and begged her mother to take her to the Bungoma District Hospital.  In these situations we always wish we could do more, wish we had more equipment with us to provide better medical care. Each year we think of ways to improve what we’re doing in Kenya. Ways we can set up a Global Health program with our friends at Icodei that will change medicine in Kenya. We’ve got a long way to go, but we certainly are trying!

It’s not just clinic tables/equipment that require improvisation. After my patient with the febrile seizures was treated, I required a new pair of pants. (At the end of her seizure, she released her bowels on my scrub bottoms).  No one thought to bring an extra pair of pants, but fortunately Matt H. allowed me to use his jacket as a skirt. Fun times. Pictures to come!

Mary Katherine

When In Kenya

[Sorry for the late blogging..we are all safe and at our Kenyan home! We just had some Internet issues. Safaricom was down for two days...but we're up!]

When in Kenya, do as the Kenyans. Which, apparently, involves getting temporarily locked up for speeding. On our drive across Kenya this Monday, our driver was caught speeding. After a long stop at a police station and a collection of 5,000 Kenyan shillings from the group, our driver was permitted to let his passengers (us) off at a nearby restaurant. We enjoyed the break from our vehicles for about an hour, then another hour when we really began to wonder where our driver was. So, Dr. Scott, Stacy and I decided it would be prudent to go to the police station to check on things. Outside the front gate of the police station it ironically read "Corruption Free Zone." Ha!

After some exploration of the police station, we finally found our driver...locked up in a very scary prison. I wish we had a picture of this place! Jimmy, our driver, was non-chalant about the whole experience and told us he would be released in about 30 minutes. He was...and after a VERY long drive we made it to Reuben and Mama Betty around 9:30PM. They had a very nice reception of food and chai tea for us!! It's good to be back!

Here we go!

Hi friends!

Well, we're finally off! We left Shreveport on Friday morning for Houston and we all managed to get there, on the plane, and all the way to Dubai in one piece! What a miracle! Currently, we are 21 strong and we're staying in a pretty nice hotel in Dubai tonight thanks to the very accommodating Emirates airline! Tomorrow, we'll be picking up a special donor, Stacy Cason, and together the 22 of us will finish our journey to Nairobi and on to Bungoma! We are all very pumped about this year and the work we are going to do.

We look forward to updating this blog with interesting stories and maybe even some pictures as we experience Kenya and make a small difference to these communities!

Ashley

Packing Meds & Baking Cupcakes

S.H.I.P. members have not only been very busy packing our bags with enough supplies to last for 4 weeks, but also we've been busy pre-packing medications for our traveling clinics. Each year we keep record of how much medication we use in clinic every day. Last year we used over 8,000 Ibuprofen and needed more! The picture below shows your our Ibuprofen collection for this year (over 10,000 tablets). Ashley and I sat down to pre-package some of those bottles into 30-day supplies.

Another huge task for S.H.I.P. is raising funds for our mission trip to Kenya. With 25 medical students and doctors traveling with us to Kenya, our budget exceeded $67,000 this year. Believe it or not, our school bake sales raise a substantial amount of money for our trip. We hosted a Safari/Mardi Gras-themed Bake Sale yesterday and brought in $1,013.30!!

Thank you for all of your support in helping us get to Kenya. We've all had incredibly supportive family, friends, and colleagues who have made this possible. We will try to update our blog frequently throughout the trip! Stay tuned!

Mary Katherine Baker

New Years Update

Happy New Year everyone! We have only 18 days left until we leave for Kenya! How exciting! Financially, we are very close to our goal, but we still need about $2000 more to finish it off. Please visit the indiegogo fundraising site that one of our physicians, Dr. Scott, has set up to help us finish off our fundraising! http://www.indiegogo.com/LSU-for-Kenya/x/2065208

We also have a garage sale coming up on Sat, Jan 12th from 7am - 3pm in south Bossier (1920 Alison Ave).  Please come out and support us if you're in town!

Flights are booked, medications are ordered, and we're nearly ready to go! Please continue to follow us as we head to Kenya this February! We will be sharing stories that touch us and experiences that will shape our lives!

Thank you for all your support!

November Update

Hey guys,

We are well on our way to Kenya! It's only 2 months away now!!! We have raised a lot of money, but we still need a good bit more to show up, somehow...

We've got quite a few fundraisers out there and in the works right now. We're raffling a gorgeous framed Candice Alexander medical fleur-de-lis print for $10/ticket. The drawing will be held on Friday Dec 14th! We also have our last bake sale of the semester planned for Dec 10th. We're having a vitamin drive to collect vitamin donations going on now through Jan 18th to help reduce the cost of the meds we purchase for Kenya. And we've got lots more brewing to bring in those last few dollars: garage sale, jambalaya sale, movie night, and a silent auction!!

I would like to take a minute to say a big THANK YOU to the Cason Foundation for donating $60,000 to our Kenyan partner ICODEI so that they could purchase 2 more vehicles for their farm! This will enable them to do more of the vital work that is helping their community every single day. Also, thanks to all our friends and family who have donated to our cause.

until next time,
Team Kenya 2013

It's planning time!

We are deep in the planning stage of the trip! We've nearly finalized our list of attendees. Next we will be booking flights and making travel and transportation arrangements. Our fundraising goal based on our current numbers is about $70,000! That's a LOT of money! For those of you who have already donated, THANK YOU SO MUCH! You make this trip possible. You allow us to serve and bring life-saving medications to nearly 1,000 desolate rural Kenyans. If you haven't donated but would like to, please visit our website www.shipcares.org to donate! Please follow our blog as we post updates. Then, follow us during the month of February as we travel to Kenya!

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