Umbrella Falls

Today we met up with some some friends at "Sizzlers" (indian/kenyan restaurant owned by our friend's uncle here). Great samosas and very good ice cream (a rarity here). After lunch we went on a brief trip outside of Eldoret to Umbrella Falls. It was pretty neat because the falls were very secluded and it did not appear they were very well-traveled. The falls are named for the sweeping rock canopy which comprises the falls and this allows one to walk behind the waterfall. It was pretty immense and neat to walk behind and around the waterfall.

Out and About in Eldoret

This weekend was all about Eldoret. Friday night a big group of the pharmacy and medical students went out to eat at "Klique". Supposedly their pizza is really good and that is something that I have been missing here since it is such a huge part of my diet at home. Unfortunately upon arrival we were informed that the ovens were broken that evening. We were all pretty bummed but we stayed anyway for some drinks and dinner. I had a chicken kiev which was actually really good. The food in general in kenya is not the best quality nor the most flavorful so it was nice to enjoy a pretty decent meal (and only for 350 kenyan shillings which is about US $4.5o). Afterward we went to a rendezvous with our preceptor and a few others who were already at a local bar called "Wagon Wheel". A live Luhya band was playing and they were pretty good. From what I could tell it was contemporary african music - very beat driven and pretty repetitive. Good band though complete with drums, bass, two guitars, keys, and vocals. Some of my friends and I went to dance by the stage and it wasn't long before we were coaxed on stage to dance (Ashley was more than coaxed, she was literally picked up by a kenyan and placed on stage!). It was fun though I am sure we were quite a spectacle.

The following day I relaxed by the pool a little bit and read (The Fountainhead - almost done, I don't want it to end!). In the evening, we arranged to meet up with some friends from work and go out again in Eldoret. We started out at a local watering hole called "bliss" which offered super cheap Tuskers (kenyan beer) for 70 kenyan shillings (about 90 cents US). We then went to grab some dinner at Will's pub at which point the lights went out (luckily just after we received our meals). So, we ate by candlelight. We then proceeded to a club called "Places". The power was still out and when we walked in it we were greeted with a bar in complete silence. I am not sure if it was that quiet before we arrived or it became quiet once the patrons saw us, but I was reminded of the scene from "Animal House" where the guys go into the soul club and the music stops playing and everyone just looks at them in silence. It was strange and very funny. So, we took a seat, and talked over some Tuskers in the dark. Intermittently the lights would flicker on only to fail again. Eventually the power came back or they fixed their generator and we were able to dance.

It was a relaxing weekend and it was nice being able to sleep later than 6 AM (something I haven't been able to do since I arrived here). We may go into town sometime during the late afternoon one day this week - I'll try to take some pictures...

Safari!

The safari was surreal. Of course, all my previous experiences with these wild animals were in the setting of a zoo. It seemed strange to see them living in the wild. It really almost seemed fake. But, I could not deny what I was seeing - a cheetah mother with her cubs, a leopard climbing a tree to feast on the antelope he had killed earlier in the day, elephants and giraffes grazing in the grasslands. We also saw hyenas, zebras, hippos, gazelle, water buffalo, warthog (which looked exactly like pumba from the Lion King), wildebeest, and lions. I was (and still am) awestruck by the immense natural beauty of the masai mara and the animals living within it.

Food Poisoning

Apparently my problems on rounds on Wednesday and Thursday with feeling faint, dizzy, and nauseated were not entirely my own fault but the fault of a pathogen I ingested. On Thursday, after leaving the hospital about 1.5 hours into rounds I went home and had diarrhea, vomited, and laid in bed for twenty hours straight. I was really in dire straights - I was bloated, had stomach pain, shallow breathing, and was febrile. I thought it might be attributed to the bat cave I visited the weekend prior (and perhaps a bat bite that I didn't realize I had). I ended up keeping liquids down at after 7 pm that night and the next morning I felt a lot better besides having a very stiff neck from my unnecessarily large pillow. It was lucky I was better because this weekend we went to the Masai Mara!

Life on the Wards

Brief background info on my rotation:

Basically I go in at about 7:30 AM and work up as many of my patients as I can. I look at new admissions to our ward, any new labs for our current patients, and other status changes overnight. At 9:00 I round with the medical team. This includes writing orders for all new medications for the patients, adjusting doses, making therapy recomendations, and generally optimizing their medication therapy. Rounds so far have usually lasted between 3.5 to 4.5 hours depending on the team and our patient load (24 beds, up to two patients per bed - average census is about 35). Then at 1 pm I grab some lunch back at the IU house and go back to the hospital in the afternoon to present my patients to my preceptor (Sonak) and follow-up on anything else that needs to be done with my patients.

Yesterday was a lot better at MTRH (Moi Teaching and Referring Hospital). Still fairly overwhelming, but I am starting to get more organized and have begun to figure out the controlled chaos that is the Amani Ward. Thankfully, I am here for another six weeks and will be that much more effective as I gain more experience. I have already learned a lot here and the Kenyans are learning from me as well. One of the Kenyan students on his clinical rotations was not sure how to instruct patients on the use of albuterol inhalers. So, this came up when we were getting ready to discharge a patient with asthma who had never been instructed how to use her inhaler. I explained the proper technique, and Stephen translated for me in Swahili. This is meant to be an exchange; although I am learning a great deal, it is with the hopes that the Kenyans will learn at least as much or hopefully more from me.

Before our rotation, we were warned that it is not uncommon for students to faint during rounds. The combination of the sights, sounds, and especially the smells (a combination of the usual hospital/nursing home smell in addition to body odor, stool, and wet dog) can be quite abrasive. Today, all of my senses were working against me and I had to take a break a number of times to get some fresh air and keep from fainting.

Wednesday nights we go out to eat in downtown Eldoret - tonight it was Indian food (delicious!). Poverty is certainly a problem and Kenya is unlike any place I have ever been. On the way out of the restaurant some children were begging us for money and being pretty adament about it. It is sad because I could see the glue on their upper lip which means that they would have likely used the money to buy more glue for sniffing. Certainly, when I return to the states I will have some reverse culture shock because of what I have seen here. It is impressive and sad how few resources the Kenyans have.

Kakamega Rainforest

Yesterday we left early in the morning for a trip to Kakamega Rainforest - the only rainforest in Kenya. Most of the ride was very bumpy with massive potholes. As we passed through villages, all of the the children would yell "mazunga" (a term of endearment basically meaning "whitey"). It is very rare for the people in this area to see caucasians and for many it may be the first time.

We stayed at little homes on the grounds of the rainforest and saw some red-tailed monkeys jumping from the trees when we arrived. Kakamega is home primarily to monkeys, birds, other small animals and butterflies. 70% of all of Kenya's butterflies reside at Kakamega; one is called the map butterfly that has wings which resemble the African continent. We also saw a few Blue Turacos which are huge brilliant blue birds with what looks like a crop of black curly hair on their head.

We went on a walk in the evening with a tour guide. He took us into a bat cave which I have never been in before. It was pitch black, musty, wet, and mud/bat guano covered the floor and walls. It wasn't too scary until Ashley started screaming and freaking out. Her and Isabel ran out of the cave screaming wildly which disturbed the bats and they started flying around. Luckily I don't think I was bitten! After the bat cave, we climbed to a high vantage point to watch the sunset - it was nice but I liked the moon rising in the early nighttime sky even more (see picture with tour guide).

This weekend went by quick and I need to start preparing for rounds tomorrow!

First Impressions

I landed at Nairobi airport at about 10 pm local time on Tuesday after 24 hours of traveling. Thankfully, the driver was there to meet me and take me to the hotel where my friends had already arrived a short while earlier. We stopped at a checkpoint/tollbooth as we left the airport which was staffed with guards holding fully automatic weapons. It was a bit intimidating. The next morning we took a quick flight from Nairobi to Eldoret. We gave our driver an already arranged fee for his services and the plane tickets and he disappeared with our passports for about 5 minutes. Perhaps we were a bit too trusting, but he returned with our check-in information and we were on our way! The flight took place during sunrise and it made the African topograpy even more dramatic and foreign. The Eldoret airport was very interesting - it was not a completley inclosed stucture and had a partially open roof and trees within it. We met our preceptor (Sonak) and he took us to our quarters for the next 8 weeks and on a tour of the hospital. It was all a blur as we were very tired and were introduced to so many people.

Yesterday and today I rounded with the medical team on the woman's ward. There were two people on most beds (twin-size beds) and we rounded on about 40 patients. It was very challenging as Kenyans are very soft-spoken and we rounded with 16 people on the first day (only about 8 today). It was cramped quarters and I could hear almost nothing. Today it was a bit easier as I was paired with a Kenyan pharmacy technician who could help translate and teach me some things about the hospital's system of charting and medication administration.. This will be a very challenging rotation both academically and emotionally. It is very difficult as the hospital in general is very disorganized and their resources are so limited. Once I become better acclimated I will be able to have a huge impact as pharmacy students can write orders for medications and tests. I hope I can help the patients here, the organization, and learn a great deal in the process.