Sunday, November 30, 2014

Gobble! Gobble!

Well like my birthday, this Thanksgiving was certainly one I will remember for a long time!

We all took the day off from our internships, after having quite a long conversation about what Thanksgiving was and what it stood for. Eventually, our friends accepted that this was a big deal in America and were happy to give us a break to celebrate our holiday.

The morning was spent relaxing, and running a few errands, then the early afternoon is when the real fun started! We all trekked over to Mwangi and Frances’ place for our good ole American Thanksgiving. Frances had been working on the food for a few days and we had a huge feast! There were two great turkeys, stuffing, mashed potatoes, sweet potatoes, corn bread, deviled eggs, cranberry sauce, and gravy! In addition to this we had a few Kenyan additions such as chapatti. We enjoyed an afternoon and evening filled with great company, catching up about our colleagues internships, and most of all a fantastic dinner which was also Sammy (our great taxi driver and friend) and Sabina’s (our wonderful orientation assistant and friend) first Thanksgiving!

We even continued the tradition of going around the table and saying what we were thankful for, to make this blog post more than the bare bones it is I want to say what I am thankful for:

Opportunities and Memories.

I am thankful for the opportunity of spending this semester in Kenya, thankful for the opportunity to meet so many wonderful people here, thankful for everybody back home (and across the US) supporting me, thankful for every opportunity I have had.

On the other side of these opportunities are memories.

The memories of my University of Nairobi classes, my internship in Kibera, the time spent exploring Nairobi, the excursions we’ve taken to Kitengela Glass, Nyumbani Village, Mt. Longonot, Paradise Lost, Hell’s Gate, The African Heritage House, Kisumu (Rural Week in Seme), and now Maasai Mara for Safari. These memories are incredibly special. Even if I end up working or living here for a bit of time, these memories stand apart. They are special and will always have a special place in my heart.

I am thankful for so many things, but this semester has put all that in perspective for me.

Saturday, November 22, 2014

Update: A Feeling of Helplessness

Friends and Family,

This is an update on the young girl I talked about my in my previous post: A Feeling of Helplessness.

I have been informed that she made it to the hospital in time, the Doctor was able to meet her, and she was started on oxygen immediately.

She is alive, and on the road to recovery.

We learned she was diagnosed with meningitis, and was in the final stages of it when we saw her. On Wednesday she was able to breathe on her own again, but she was not eating. They hoped she would begin eating to build her strength back up and get her out of the hospital sooner rather than later.

Thank you to everyone who read my blog, sent kind words, and prayed for the situation. Your support made this all much easier for me to handle.

Now, I must wrap my head around how this child nearly died from a disease that is completely preventable through a vaccine most of us in the United States get.

While I can say that this is one of the hardest experiences I have had, it has given me more energy for my passion of Public Health than any other experience I've had.

Tuesday, November 18, 2014

A Feeling of Helplessness

Note: This post is long but it’s incredibly important to me so I ask you read it in its entirety.

This past week I started interning full time, which means I am dropped at the Makina Clinic in the morning and picked in the afternoon. Spending the day either at the Clinic, or more common moving around Kibera participating in campaigns, or meeting with partner organizations. Nonetheless, I have spent much more time at the clinic than I have in this semester. Last week was nothing crazy in terms of the patients: cuts, burns, etc. This week was much different.

Before I dive into the real meat of this blog post I want to provide some context to the ‘clinic’. The clinic is a tiny space, with a small waiting room, a consultation room, a storage room, and a pharmacy. The floor is uneven, the walls are half-painted, and the doors hang crooked. It is in Makina, which is a part of Kibera. The power frequently goes out, and the few lights can be run off of a generator. The doctor’s office features a small table for examination and procedure, and another small table for consultations. The supplies are stored in cabinets barely hanging on the wall. The clinic operates 24 hours, with a doctor always on call. Overnight and early morning, the lab and storage rooms are locked tight but the lobby is always ‘open’ and the consultation room is always open. It is a clinic, but is not what we imagine a clinic to be.

This week started off interesting with a scenario I am still grappling with, and may or may not blog about. In essence, I witnessed a pure clash between culture and medicine, in a clinic setting, which tore me apart. While culture is important, in a ‘clinic’ medicine should come first. I fully support cultural sensitivity in medicine, but there is a time and place and there was an incident Monday where the lines were too blurred.

Tuesday (today) is what this post is about. I ask that you bear with me, and read what follows.

We arrived at the clinic our normal time, but when we walked into the waiting room I noticed the other doors locked. I also noticed that neither the doctor, nor anyone else was around. Except for about six people gathered in the room. When my colleague and I stepped in they cleared a path to a woman sitting on the bench holding a girl who I estimate to be about 9 years of age. It became clear to me that when we stepped in one of the people was performing some form of CPR. As they cleared a path and stared at us, I looked at the girl.

She was gasping for air, her eyes were rolling back in her head, she was limp, and there was a clear gurgling noise and a visible liquid in her mouth. My first thought was she was having a seizure, but I quickly realized this was not the case.

The others in the clinic (family members and a motorcycle driver who transported her) looked at me. They pointed at the sick girl. Then pointed at me. Then widened their eyes as if they were saying “do something”. It became clear to me they thought we were medical professionals, which is not the case.

I had my colleague locate our supervisor and guide Eric, who would find the doctor, as I looked for newspaper to put down on the examination table (the only paper they have to cover the table).

Even after we stated we were finding the doctor, they wanted us to do something.

I didn’t know what was happening, I only knew this young girl was unable to breathe. Liquid was coming up and we needed to make sure that she did not choke.

Hearing the gurgling sound, I knew she was not only unable to breathe but that liquid was coming up from her lungs and was already filling her throat.

Just as we were about to bring the girl to the exam room (I couldn’t find anything to put down, but it didn’t matter. This girl needed to lie on her side, not be held), the doctor walked in.

He put her in the table, and lifted her shirt.

It was clear she was malnourished, and her lungs were working harder than I have ever seen lungs work.

Her body was fighting to keep her breathing. She was unresponsive, her eyes rolling, and her lungs filled with fluid.

The mother reported the girl has a history of asthma. The doctor immediately referred this girl to Kenyatta National Hospital, the highest hospital in all of Nairobi.

His quick examination made him realize we didn’t have the equipment to do anything. He instructed the family to take her there immediately. He also provided the phone number of a doctor there who knows the Makina clinic. The family was to call the doctor as soon as they arrived, to ensure this girl could get the treatment she needed.

They left quickly.

That’s when I began talking to the doctor about possible causes. He had no idea, but it is clear that indoor air pollution and her asthma played a significant role in the severity of the situation.

This is when the heartbreaking news came from him: he said if she didn’t get help soon she would not make it. He estimated that if they could not get there within an hour, and have her lungs cleared within two hours (closer to an hour and half) she would not survive.

Her body was working on overdrive to get the little air through. He didn’t think it could keep that up much longer, especially given her young age.

We didn’t hear anything throughout the day, but we have placed a few calls and anticipate hearing either tonight or tomorrow if she made it.

I can’t help but think of the possibility she did not make it. To have that happen would be devastating. Knowing that I was one of the last individuals to see her in her last moments.

I knew this would be something I would encounter in public health and medicine; I just didn’t anticipate it coming when I was 19 years old, on a typical Tuesday morning, in a clinic in Kenya, with a 9 year-old girl, and most shocking of all the family right there and thinking I could be one to save her.

I can only pray that she makes it through.

Today was the most helpless I have ever felt.

Watching this girl struggle to breath.

Watching this girl struggle to live.

Seeing the hope in the family’s eyes when I walked in, thinking that I would be able to save her.

They were helpless, I was their hope, and I was helpless.

I did what was within my knowledge and means, but it didn’t feel like enough.

I am not giving up my dream of being a doctor, and this just proved to me that I will not let anyone or anything stand in the way of that dream.

I never want to feel as helpless as I did today.

This is one of the hardest days of my life. I can’t help but think of this girl and the look the family gave me. I am praying, and I ask you to pray as well, that this girl makes it. I will not give up working to find the result of her case. I will let you know as soon as I hear.

Sunday, November 16, 2014

Day Trip to Hell's Gate!

We took a trip to Hell's Gate on Saturday :-) here are the pictures for those who follow my blog, but not Facebook.

Click Here

Polio Campaign!

Back at my internship after Rural Week, I had one of the best experiences of my life. I was able to participate in a polio campaign with the Ministry of Health. This was a five-day campaign, all over Kenya but I was attached for two days, to two teams, in Kibera. The biggest slum in East Africa. The first day, I was attached to team 12. We started our long day by journeying through alleyways, homes, streets, and just about any opening we could find. Searching, and searching, and searching for children. When we encountered kids, younger than 5, we would give them a high-five to check their pinky to see if they had been vaccinated during this campaign. If not, a vaccine was administered followed by Vitamin A, a mark on their left pinky, then we were off. Looking for children anywhere and everywhere. One of the team 12 members knew what she was doing. I saw her spot a clothesline, I didn’t think much of it but she noticed there were baby-clothes on it. She knocked on every door in the area until she found the one child living in that area. The child was unvaccinated. Had she not have made the connection to the clothesline, we would have missed that house.

After checking an area, the door would be marked with a designation representing the round, team, and number of children found.

The second day, I was attached to team 8. I knew one of the team members already and this made it quite fun. While the day started in a very similar way, except it was much muddier. We trekked and trekked, but the most heart-wrenching experience was when we stumbled upon a small hallways, where we found over ten children unvaccinated. We only encountered one run-in with a father who did not want his child to be vaccinated. The Community Health Workers fought with him and eventually won. The child was vaccinated. What was heart-wrenching about this experience was we found the area from a little girl playing outside. When she saw us approach she ran inside and attempted to lock the door. She was probably only 3 or 4 years old. When we made it in the hallway we heard a moaning and screaming from the room she was in. The Community Health Workers decided they needed to see what was going on, so they forced the door open to find this small child alone with who was presumably her brother, not much older but special needs. He was locked in the house all day, with no help or contact. This was heart-wrenching but there was nothing we could do.

This entire experience was incredibly. I met tons of kids, and I can’t imagine the impact on health that we had during this campaign.

The whole time I kept thinking to myself: this is exactly like a movie. What we were doing was exactly like the videos from the early polio campaigns in India. I felt like a true public health official, and couldn’t believe I was participating in such a campaign. More of that shoe-leather public health I talked about earlier, and I loved every minute of it. This is the impact that I want to have, and this on-the-ground action is incredibly eye opening and inspiring.

The opportunities I have had here are unmatched by anything else. I love Public Health.

Rural Week Post 5: The Feelings Back Home

The feelings of culture shock did not end with returning to Nairobi, in fact they really only intensified. We were all exhausted, both physically and mentally, and were all facing his feeling of “Wow. Did that really happen?” During the week time moved so slow, but when we returned the week flew by. This was also the point in our semester where our schedules shifted. We are interning full time now, and done with classes. We are facing the remained of our semester and the amount is incredibly tangible. We always looked at rural week as this experience that was so far away, but it happened. It was done.

All of this was incredibly overwhelming. Incredibly. I talked to many friends here about these feelings that are hard to capture in words, but it was a combination of being sad because our days are numbered and this desire to not go home. We are comfortable here now, and now we have an incredibly limited number of weekends remaining. While talking it out with friends, it really was my mom who made my attitude change. I want to share something she sent me, because of how important it was:

“Going home doesn't make it less special, it gives you needed perspective to make good decisions. Feel the feelings and enjoy the moments. Then step back and think about what you can do once you further your education.”

Incredible advice, that help me overcome that post-rural week hump.

Photos from my week click here.

Rural Week Post 4: The Culture Shock

It almost should go without saying that I experience some culture shock being in the community. I want to share with you some of the most significant pieces of this culture shock:
  • First, because we were in such a rural area few of the community members had urban experiences. This means they were not familiar with white people, or mzungus. Everywhere I went I would hear “mzungu! Mzungu!” people waving, smiling, wanting a handshake, or wanting to hear me speak English. I have talked briefly about this on my blog before but this was a whole new level. I was expecting some of this but to the extent that it happened was nothing I could imagine. At first it was funny, being a celebrity. But it quickly got very old. I couldn’t go anywhere, or even be in the yard of my house without being hollered at and people wanting to see me, hear me, and greet me. This was one of the emotionally taxing things I have ever encountered, and it was frustrating during the survey to not be able to have it take four times as long to get somewhere to have to stop and greet everyone.
  • Another piece of culture shock, was the amount of food I was expected to eat. I don’t usually eat three big meals a day, but this week I did. Every time I would finish a serving I was given more. And more. And more. This in combination with my malaria medicine, meant there were times where I felt physically sick from the amount of food. Part of this food situation was because I was a visitor. They wanted to make sure I was well fed and impressed. Both of which were true.
  • Taking a bath. In the latrine, with my flashlight and a bucket of water. Nuff said.
  • The last major piece of culture shock that I want to discuss is my role as a man in the house. I expected the gender roles to be significant, but I never thought they would be as strong as they were. I would try to go help cook and was immediately dismissed to go back to the house. I would try to help clean up and the dishes would be taken out of my hands. I wanted to become a member of the family, and it wasn’t feeling like I was. Until I realized that I had. I had become a male member of the family. Victor, the father, would come home and sit. Everything was brought to him. He didn’t have to do anything. I, being an adult male, was in the same situation. I had become a member of the family. Just not in the role I had wanted. I learned a lot about these gender dynamics, but I didn’t learn what I wanted to (like making chai, but I am learning now!). I was not comfortable with these dynamics, but it was part of the experience.

The first few days were not easy. In fact they are some of the hardest days I’ve ever had. But near the end of the week, I was getting more and more comfortable. I knew my way around, I knew what to do, and I was connecting with the family. By then it was time to get picked and go back to Kiboko for a night before journeying back to Nairobi. I enjoyed a nice photoshoot with my family, and then walked to the school to be picked. I bid my father goodbye, and was done with one of the most memorable weeks of my life.