Reflections on Kenya

Sunset back home

     I've been home for two weeks now, which hardly seems possible. In one sense, it seems like I was just in Kenya yesterday, but in another sense, it feels like my trip was ages ago, or even just a dream that didn't really happen. Of course, the 1,047 pictures and videos help deny that last idea, but they don't change the feeling of surreality. It probably doesn't help that I sort of hit the ground running. I definitely had a day or so of adjustment, but since then it's been a lot of unpacking, application finishing, arranging to shadow PAs, and going to weddings (the last bit was certainly the most fun).

     Now that I've been back for a bit I'd thought I'd write up just a few last reflections on Kenya, mostly ones I thought up on the long drive (7.5 hours) from Migori to the Kenyatta Airport in Nairobi. 

     First, some random tidbits:

La b and pharmacy waiting area

1. I never mentioned it before, but people were a bit obsessed with Obama over  there. It probably didn't help that Migori is not that far from the area Obama's family comes from. In fact, many random people in Migori claimed to Obama's brother, father, cousin, or other assorted family member. 
2. The patients in the hospital formed their own community. Often you'd enter a room and all the patients and their family members would just be chatting up a storm, or they wouldn't even be in room. Instead they would be outside relaxing in the sun, or washing their laundry or children.
3. I sort of fell in love with Kenyan soap operas. They were so, so bad. Everything about them, from the acting to the writing to the cinematography, was just atrocious. The thing is though, they were so bad, they were good. They were also constantly playing on the hospital tv by the lab so I could just sit at reception and listen to them. You didn't even have to see them to die of laughter.
4. I started to judge people based on their blood. This may seem absurd, and it is, but after a while you start to be able to tell some things about a patient just by looking at their blood. Most of the lab techs could just look at a tube and tell that the hemoglobin was low, and once the tubes were centrifuged, you could tell even more.

That's a chunk of fat and/or cholesterol

Fatty blood -probably drawn after a meal

Normal blood

Low hemoglobin... and everything else

Hemolysis

      Secondly, here are a few cases from the hospital, good and bad:

Two girls on the hospital swing set

1. The mother whose first two children had developed fevers shortly after birth and had died within 24 hours, but whose third baby survived and did well.
2. The 5-year-old girl who was hit by a pikipiki and responded to pain, but never actually woke up. Her family was finally able to come up with enough money to send her to Kisii for a CT scan, but by then she'd already been unconscious for over a week and we feared any damage detected would be irreparable.
3. The hemophiliac boy who had to come to the hospital after a tooth extraction. He ended up being just fine, but the dental students were pretty concerned.
4. Multiple cases of machete attacks. One man almost lost his nose, and a 20-year-old boy who had been stabbed in the back was the first person I ever gave an injection to. 
5. The three triplets who were born far too soon. Two died right away but we had so much hope for the third one, despite the defective incubator. He died on the second day. 
6. So many AIDS deaths. It seemed like the majority of the deaths in the hospital were attributed to AIDS, and those were always hard to see. It's incredibly frustrating to know that, no matter what you do, you will probably lose the battle for a patient's life, even to a simple illness, because their immune system is basically gone. 
7. Two cases of bee stings. We discovered that swarms of bees would occasionally appear and if you didn't get out of the way fast enough, there was a good chance you'd end up in the hospital. Luckily I never encountered such a swarm, and the two cases I saw did just fine.

     Third, I noticed three things on the trip to Nairobi that told me I'd been in rural Kenya for a while:

1. I was surprised to have a seat belt.
2. I was delighted to discover toilet paper in the bathroom of the restaurant where we stopped for lunch.
3. I was shocked to see so many Mzungus in the airport.

     There are definitely things I appreciate more being home. My family had Umpqua ice cream (quite possibly the best in the world) waiting for me when I arrived, and that is certainly a point in America's favor. I also appreciate having privacy again, since that can be kind of difficult when there's fifteen people in the house and the windows to every room are always open. There are also things I missed. The other day I went grocery shopping and was so excited to see so much variety but I was bitterly disappointed when I saw the mangoes. Now I remember why I never liked mangoes in the U.S. They're just not ripe or good-looking, and they will never be as good as the ones from the street vendors in Migori.    

This is a real mango

These just can never measure up.

 

     Now that I'm back from Kenya it feels like the real work for preparing for PA school is beginning. My first applications are due Sep. 1, so right now I'm running around trying to finish those, since it was quite tricky to take care of some things while I was abroad. This means getting in some last minute shadowing, polishing essays, updating my resume, making sure all my information is accurate, as well as preparing for the possibility that I won't be accepted this cycle. To prepare for that possibility, as well as help me get a job, I'll be taking an accelerated EMT course this fall, as well as a genetics course. Trying to organize those classes while in Kenya was ridiculously difficult and thankfully my wonderful parents were willing to call the school for me and help sort everything out because email was just not cutting it. 

     For anyone who is interested, I am going to keep this blog going to chronicle my entire journey to PA school, providing tips on what works, when to do what, things to avoid, and the like. I can't guarantee pictures of babies or wild animals, but hopefully it will be an interesting journey and will be helpful to anyone thinking about PA programs themselves.

Last Thoughts

As I prepare to leave tomorrow morning to begin my journey home, I have a few final thoughts on my time here.

Random Thoughts 

With Wesley, the baby whose delivery I watched
and helped with

• One of the other students hit the nail on the head when they said that driving in Kenya is like live-action Mario Kart. There are obstacles that come out of nowhere (cars, cows, children), people driver faster than they should, lanes don't really exist, and cars pretty much play chicken when they pass. I'd say it's a miracle people don't hit each other, but I saw too many motor and pikipiki accident cases in the hospitals to know that's not true.
• I realized on safari that the first day Geoffrey taught me Swahili, the first verbs he taught me were the most important ones (for me): kula (to eat), lala (to sleep), and soma (to read).
• There were so many great and interesting things that I saw at the hospital, but the natural birth was probably my favorite. I'd been waiting the entire trip to see one and I'm so glad I managed to see one on Friday. It was just the midwife, mother and I and it was awesome. I even got to wrap up the new baby boy and hold him up the mother was ready. :D 

With Geoffrey in the lab

Things I'll Miss 

• Being able to do all the medical things I can do here, but not in the U.S... yet.
• All my friends at the hospital, especially the guys in the lab and Bobby in the pharmacy. I have some of the greatest conversations with them just waiting for patients to show up.
• Being able to just buy a delicious mango from a street vendor for 40 cents and scoop it out with a spoon for dessert that night.
• Seeing so many different kinds of animals.
• My friends in the program, and not just the other students. I'm really going to miss Helen and Judy.
• So much sunshine.
• Kenyan soap operas -They were always on in the hospital waiting room, and even in the house sometimes, and they were just so completely ridiculous. The acting, writing, and plot were always atrocious, the kind that's so bad it's good. The best were the Spanish soap operas that were dubbed into English. You could just listen to them playing in the background and start laughing.
• Helen's donuts -we sometimes called them "crack donuts" because they sort of became addicting. They're not quite Marty's, but close when they're hot.
• Walking by all the street vendors, especially the ones selling fruits or fabrics.
• Mirror dancing -one of the best parts of going to the club was watching the Migori guys dance with themselves in the mirror. Absolutely hilarious. 
• The funny English typos we see on signs all the time.

Thing I Won't Miss  

Harry, our friend who lives in the house and eats insects

• Being stared, whistled, or yelled at every time I go out.
• All the relationship questions that are usually the first or second thing people ask me. E.g. "Are you married? Why aren't you married? When will you marry? How many kids do you have? Exactly how many children will you have? When will you have children?" And, of course, the inevitable, "do you want to marry/have kids with an African?"
• Pillows that are just an inch thick.
• Slow internet -this is especially a problem when one is trying to finish their CASPA application, like me.
• The almost daily power outages -considering our computer here is a desktop one that doesn't have battery power, these power outages often strike right in the middle of a long email or photo upload and you lose everything.
• Feeling like people just see me as a big money sign, forcing me to haggle for good prices and mistrust most people I meet.

Things I'm Looking Forward To

Christian, Judy, Andrew G. and I in Maasai Mara

• Being able to just pick up my phone and call friends and family, or, for that matter, just get in a car and see many of them face to face.
• Eating vegetables other than cooked cabbage and sukuma wiki.
• Chocolate! I really craved it the first week or so. There is chocolate here, but I've found most of the chocolate bars here to be too sweet even for my taste, so I had to settle for chocolate cookies. 
• Being able to call different schools and people because I had been trying to arrange for more shadowing hours and to take a class this fall, and it has been almost impossible to do via email. 
• The new Classic Crime cd -I was a backer for their Kickstarter project which means I get to download their new album 2 weeks early which is awesome, but that also means that every time I've checked my email this week I've been reminded that the download is ready, I just can't download and listen to it here because I didn't bring my laptop. 
• Being able to read or lay outside without ten or more children pouncing on me.
• Listening to music other than Hip-Hop, R&B, and Rap -I like songs and artists from all these genres, but for an entire month this is almost the only kind of music that has been played here and I'm ready for a break. 

Swahili Word of the Post

kwaheri -goodbye 

Inevitable -Life at St. Joseph's

The file room... yeah.

     I’ve been meaning to do a post on the hospital, and it seems like I better do it now since I’m leaving so soon. There have also been a lot of things that have come to feel like they’re inevitable over here, and since most of them relate to the hospital, it’s a 2 in 1 post! It’s also long, so be warned.

     It is inevitable that someone’s phone will go off in the hospital. I don’t just mean some patient is talking to their family in the hallway. No, the doctor will be in the middle of an examination and the patient will answer their phone, or the doctor will. Granted, if a doctor gets called in the middle of rounds they generally ignore the call or tell the caller to try again in 10 minutes, but still, it happens all the time. Even in the middle of the morning meeting, the phones never stop. Surgeries aren’t exempt either. If you’re not scrubbed in and the surgeon’s phone goes off, you get to answer it. It’s crazy. Also, it’s not like the phones are on vibrate or silent. Every time someone gets a call or a message, the music is blaring. Oy vey.

Gold star to anyone who can identify this test,
A+ if you also know the result of the bottom row.

     Whether or not it’s actually inevitable, I think most of us are pretty sure we’re going to come home with at least tuberculosis (TB), if not also malaria, typhoid or HIV. We see so many patients with each of these diseases each day. Every time I see a TB patient, I think of the special rooms we have for such patients in the U.S., rooms that only allow air to enter and purify any air before it leaves. At St. Joseph’s, TB patients are just in the big rooms with all the other patients, quite possibly passing on the disease to everyone else. If I come back with anything, I’m guessing it’ll be TB. However, we did have a recent HIV scare when one of the guys got blood into his eyes during a surgery (the patient was negative for HIV and hepatitis when we retested her blood, but my friend decided to start post-exposure prophylaxis just in case) and there was a student who went home with malaria a month ago.

Patients can pay with cows if they don't have the money.

     The reality though is that most of us students will go home without a serious illness. That doesn’t mean though that we’re not going to get sick. It’s sort of become a rule that everyone will get sick while they’re in Kenya; the only question is just how bad it’s going to be. So far I’ve been lucky and have only had to deal with allergies and a sinus infection (though the dusty safari trip seems to have made it a bit worse). It’s certainly not pleasant, but it’s better than the stomach bug other people have had. A girl who was here before me had to go to the hospital every night for an IV. Having to go to the hospital for treatment is possibly our greatest fear here. St. Joseph’s is leagues ahead of the other hospitals near us, but none of us want to be patients. Thanks to a recent Harry Potter craze in the house Alex came up with our new motto for St. Joseph’s: “you could get sick, or worse, admitted.”

Filling out discharges in pediatrics

     Speaking of jokes, sickness and St. Joseph’s, it became a joke amongst us students that it didn’t really matter what the symptoms were, a pediatric patient always had “complicated malaria.” Of course that wasn’t true, but we heard Dr. Atonga say it so often that it felt like it was.

Radio and fan -two things I'm pretty sure you
don't usually see in an American OR.

     Something else I heard often, albeit before I left home, was how shocking Third World countries are. Now that I’ve been here almost a month, I’m not sure if being shocked is inevitable (though perhaps I was just so prepared to be shocked that not much has shocked me yet). However, while being shocked may not be inevitable, I feel like becoming frustrated and angry is. This is especially true in the hospital. There have been quite a few times when we’ve wanted to order a CT scan or an MRI for a patient, only to remember that the nearest CT machine is an hour away and there is no MRI machine anywhere close. Other times we’re waiting on a test to diagnose a patient, only to be told that the reagents are out of stock. Other times, you just get angry. For example, an extremely ill little girl was brought in, but despite being dehydrated and anemic, no IV was started until the second day when two medical students from Poland and some of the Medics to Africa students started it themselves. The girl’s veins were so small by that point that it was almost impossible to get the necessary blood samples for testing. Another common source of anger is the Clinical Officers (CO) who work at night. A CO is sort of like a Kenyan PA in that they function as a doctor, but they have only three years of training. Most of the “doctors” at St. Joseph’s are actually COs and most of them, like Dr. Atonga, seem to be pretty good. The two female COs who give reports in the morning though seem to know very little. Despite never having attended medical school (though she plans to next year), Alice the anesthesiologist often puts these two to shame and calls them out whenever their methods of treatment seem wrong or inadequate, which happens more than I’d like. Once Alice questioned their treatment of a patient who died. The COs may not have necessarily caused the patient’s death (heart attack), but they treated it incorrectly, using the wrong dosages of medications. The COs never answered Alice’s questions. They just started laughing. I think a language barrier played a role since Alice was speaking English and the two COs never seem comfortable speaking it, but whatever the case, the response was pretty infuriating. 

Ready to give injections in Maternity

     The language barrier is another inevitable part of life at St. Joseph’s. Every Kenyan is bilingual, if not trilingual, by adulthood. People first learn their tribal language (Dhoulo is the one in Migori) and then Swahili, the trade language. Most also speak English, which is taught in school, but most is not everyone. The staff members at the hospital mostly speak English well, but many of the patients, including the patient whose wound I dressed everyday, speak almost no English. I’ve learned some Kiswahili (the Kenyan dialect of Swahili) since coming here, and that usually helps a bit. However, I think I’ve confused a few people because I can greet them in Kiswahili and ask them how their pain is, but if they try to say other things to me, I’m totally lost.

Fibroids removed from one woman's uterus

     Being lost is nothing special at St. Joseph’s. The last inevitable thing about being a student here is that at some point (actually at many points) you will be asked to do something and have no idea how to do it. Filling out discharge papers were particularly frustrating for me at first. The good thing is, if you ask for help, the people at the hospital are usually more than willing. Even in the middle of surgery, Dr. Agullo’s a pretty good teacher, and if you show effort on rounds, he’ll push you to learn more and do more than you expected. Really in almost any department of the hospital, if you show initiative and want to learn something, someone will be willing to teach you, whether it’s tests in the lab, how to give injections, or even how to feel the position of the baby in the womb. It’s something I’ll miss about St. Joseph’s, though working here has made me more excited to work in a U.S. hospital one day.

T.I.A.

Andrew V., Christian and I were quite excited to
finally be in Maasai Mara

     In the movie Blood Diamond, as an explanation for why messed up things are happening, the character Danny Archer responds with "T.I.A. -This is Africa!" Occasionally we students in the program here have used the phrase when something happened that just seemed so out of place to our Western sensibilities. And, sometimes, something so beautiful appears that you can only say, "this is Africa." Each version of this phrase could have been used on my safari this last weekend. 

     The trip did not quite get off on the right foot, and car trouble seemed to dog us the whole time. To get to Maasai Mara we first had to take a car to Narok (normally a 3-4 hour drive), and then switch to our Land Rover for the safari and drive another 2 1/2 hours to the lodge. The problems began right away when our first driver showed up 40 minutes late. Then we got lost along the way and the drive took 4 1/2 hours. Considering there were four of us crammed into the back of a rather small car and at least one of us had needed a bathroom since the first hour, the extra time spent driving was not a pleasant surprise. We finally arrived in Narok at 2pm (2 hours late) and after a quick lunch, we were finally en route to Maasai Mara in what was, by far, the comfiest and coolest looking safari vehicle we saw during the trip. Apparently it's high season right now, what with the wildebeest migration, so our program couldn't get us one of the normal vans. Instead, we four students (myself and three boys) and Judy our house mother got a private jeep and a Maasai named Mike as our driver. Rats. ;) 

One of the two male lions we saw

One of the many monkeys at our lodge

     Because of our delays, we didn't have too much time to get into the park before it closed at 6pm, but I'm so glad we did. After hours spent cramped and uncomfortable, and then another two on some of the bumpiest roads I've experienced (though Mike sort of made it like a Disneyland ride since he was constantly swerving onto smaller roads in order to find a better path), it was heavenly to stand up in the car with the wind whipping my hair, the sun setting over the hills, and animals seemingly everywhere we looked. We were barely inside the park when we saw gazelles, impalas, and the resident herd of wildebeest. We had just spotted elephants when the call came over the walkie-talkie that another van had seen a leopard. We raced over as quickly as possible, scaring a herd of zebras along the way, only to discover that the leopard had already slunk away into the bush. Undeterred, we decided to keep looking. We never did see a leopard, but that evening we did see a buffalo, a warthog, ilans, taupis, and some rather interesting birds. An hour later we started to head back when we got another call. It was a bit late, but Mike turned us around anyway and soon we found ourselves staring at an adult male lion. A few minutes later we discovered that he was really one of two brothers, and the other one was lazily sprawled in the grass just a little bit away. We were ridiculously close to them, but the lions didn't seem to care. All in all it was worth the detour. Plus, we discovered that it was rather handy to have a Maasai as a driver. Although we reached the gate 45 minutes after the park was closed, we didn't have to pay a fine because the park is still considered Maasai land and thus Maasai can kind of be out there however long they want. 

Giraffes, one of my favorites in the park.

     As fun as it had been to be out in the park, it was nice to get back to the lodge. We were all rather bruised already from standing up in the Land Rover and being thrown around at every bump and we knew we had a long day coming up. After a hot shower and a good dinner, we were ready to head to bed. Then some of the Maasai who worked at the lodge announced that they were going to demonstrate some of their traditional dances. We decided to check it out. When they got to the fourth dance, the one performed at weddings, they started asking audience members to join in. Andrew G. was one of their first targets. It was highly entertaining to watch him try to dance along and I'd just finished telling Judy that she was next when suddenly a Maasai was standing in front of yours truly. Yeah, it happened. I danced and had fun, though I was quite glad when I could sit down again. 

The boys all wrapped up in their blankets

     The next morning we got up bright and early to set out on our whole day safari.  First Mike stopped at his village so we could buy Maasai blankets and wrap up (Maasai Mara is the only place in Kenya where I've been remotely cold, and it's at 6000 ft), and then we headed into the park. We didn't get very far however. Shortly after passing the gate, our battery died. Luckily we weren't far from help, so forty minutes later we were on our way again. Soon enough we found some elephants just chilling and eating. A bit later we came upon a bunch of giraffes. Most of them were quite young, though there was one real adult with them. I was pretty excited because I rather like giraffes, and the Swahili word for giraffe, Twiga, is one of my favorites. After the giraffes there weren't many animals for a while, but I'd finally mastered the method of standing up in the Land Rover without been bashed into the side every second, so I was feeling like Queen of the Safari. 

     After a brief pit stop at a super nice lodge we were en route to the Mara River to see the Wildebeest migration, the one USA Today named one of the "new" wonders of the world. We weren't quite done with the car trouble yet though. At 11:40am, our drive shaft, what the Kenyans called the "propeller," broke. We ended up sitting in the middle of nowhere for 3 hours until another car came to take us to the river. During this time we were pretty much confined to the inside and roof of the Land Rover because visitors aren't allowed to exit their vehicles inside Maasai Mara. We got a little break though when another car from the Maasai company stopped to help us around 1pm. The driver had brought us a new drive shaft and started to help repair it, but they hadn't been there ten minutes before one of the six girls in the car started complaining that they had wasted too much time already and they wanted to see the animals. The driver had no choice but to go... only he didn't, because their battery was dead. In the end our cars switched batteries since our car wasn't going anywhere anyways, and the girls would not stop complaining. Even when the battery was switched, the other car needed a bit of a jump start, hence the picture above. You may notice the six girls from the other car just watching, while the other driver, the boy from their car, the two Andrews, and I push their car until it starts. On the plus side, we got a chance to stretch our legs and the complaining which had started in our car earlier vanished after such clear evidence of how unattractive complaining makes someone. 

Shy hippo in the Mara River

The border between Tanzania and Kenya

     Eventually another car came to pick us up and we finally made it to the Mara River. Along the way we started passing hundreds and hundreds of wildebeest, all the ones who had already made the crossing from the Serenghetti in Tanzania to Maasai Mara. It was astounding to see so many. It wasn't until later that we actually saw the crossing though. First we went to see hippos and crocs at the river. There's a point where at least five hippo families all live. Most of the time they're submerged, which made it difficult to get a good picture, but quite a few surfaced to say hi (loudly) to us. While we walked along the bank (we were along to go on a "Jungle Walk" with a ranger there), we also saw a couple massive crocs, one of which had snagged a wildebeest earlier. We also saw some feisty baboons and an awesome pink and blue lizard. It was getting late and we were starting to head back from the Tanzania/Kenya border when we got the call that some of the wildebeest were crossing the Sundry, one of the offshoots of the Mara River.

Wildebeest crossing the right way

     We raced to the river because no wildebeest had crossed at all that day. Getting close we passed a huge group of wildebeest that had just made the crossing and we thought we'd missed everything. Some wildebeest were still waiting to cross though and we got to see the whole process. After watching it, we began to think that the "wonder" of the migration was that the animals managed to get anywhere. Many of them just stood on the side of the river waiting for who knows what (some had been there for days or weeks) despite the fact that this part of the river was shallow and crocodile free. Then, when some wildebeest finally started to cross, they crossed the wrong way and went back to Tanzania. When some decided to cross the right way, they ran into the other group and they all stopped for a drink in the middle. It was actually pretty funny. 

     It was really starting to get late now, so we began the long trip back. We were all pretty tired, but we kept our eyes peeled for any more animals. We still hadn't seen all of the Big 5 (Elephant, Rhinoceros, Leopard, Buffalo, and Lion -chosen by how dangerous they are, not how popular), though seeing all of them is pretty rare. In the end, there were not many animals to see. There were some ostriches and more wildebeest, but not much else... at least, not until we were almost out. Then we found a whole herd of elephants, including one that apparently quite friendly and enjoyed eating real close to the road. It was a good way to end the evening.

Andrew G. jumping with the Maasai

        We weren't able to go in the park again the next morning. Instead, we went to the Maasai village. We got to walk around the village and see how they live. The boys even got to participate in one of the traditional dances: the jumping competition that is usually used to win the hand of the chief's daughter. After being walked through all the different aspects of Maasai life, we visited their market and then waved goodbye to main park. The ride back seemed much shorter, and soon we were at the far border of Maasai Mara. Mike was afraid that the border guards would try to scam more money out of us (it often seems to be the Kenyan way), but he talked to them (actually I think he told them that we were missionaries) and soon we were on our way and back in Narok. Another uncomfortable taxi ride later and we were back in good ol' Migori. 


Swahili Words of the Post -the animals we wanted to see but didn't
Chui -leopard
Duma -cheetah
Kifaru -rhino
Fisi -hyena