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.

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.

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.

Rural Week Post 3: The Survey

One of the coolest experiences of my rural experience was conducting the research for my Community Diagnosis Survey, a field exercise attached to my Community Health Class. Recently, I had read I got from the American Public Health Association, titled “Conducting Health Research with Native American Communities”. This book is a collection of stories from researchers, many with the Indian Health Service, who have conducted research in the American Indian and Alaska Native Populations. The book talks a great deal about this idea of being an outsider conducting research, not providing direct services. I always knew that this would help frame my experience in the community, but I never thought about how much it would always be in the back of my mind.

To conduct my 11-page questionnaire, I was equipped with my papers, my pencils, and most importantly my guide and translator. This guide would be guiding me through the community and translating my questions and the answers. Usually the surveys went well but there were a few issues that arose:

·      First, it was obvious that on many occasions we were given answers that would please us, but were not in practice. The biggest example of this was a question about hand-washing and when people wash their hands. People knew how to answer, but I know that they did not wash their hands every time they claimed to. They were looking to give us the right answers, and not necessarily what was in practice.

·      Similar to this would be when we would ask a question regarding a pit-latrine or waste-disposal and would receive one answer then would ask to see it and see a completely different situation, again we were given answers they thought we were looking for not the truth.

One of my favorite stories from this experience was when I was sitting in a house, made of mud and straw, interviewing the head of household. It came to the point where I was asking about recent illness in the household. They explained the youngest child, 1.5 years old, was having an unknown leg pain. As I walked through my questions there was a bit of commotion and before I knew it there was a naked baby being dangled in my face while all the family members were talking and pointing out where the leg pain was. I just looked at the leg, jotted a note, and then said thanks. It was this moment that made me feel like a real public health official. A professional conducting real research, not just a student with a field study attachment.

This field study experience was one-of-a-kind. Something few other students have the opportunity to do, and an experience that will stick with me forever.

I learned so much about conducting this type of research, being an outsider, and most of all how to truly assess the needs of the community. Over the next few weeks, I will be producing an extensive report analyzing the findings and eventually making recommendations. Due to the nature of this project and to protect the community this report will not be released publicly, just to the faculty at the University of Nairobi School of Public Health and hopefully back to the community.

Throughout all of this I learned many things including: the importance of being with community members, the value of knowing about the community before, and most importantly the need for this concept presented to me in the book I referenced earlier: Community Based Participatory Research (CBPR).

This idea is just as it sounds: the community you are researching should have participation in the research. Either by having community members conduct the research, or empowering the community members to make changes per the recommendations you create. CBPR is an idea that seems straightforward, but as I discovered it is often hard and challenging because some community members may not understand what you are doing, or how to carry out the recommendations. Becoming known in the community, and being friendly to those you meet is invaluable to conducting the research.

In Public Health and Epidemiology there is this idea of Shoe-Leather Epidemiology, meaning the old-fashioned detective work wearing out your shoes because you are walking the streets. While my research in Seme will not solve any mysteries it was my first taste of shoe-leather epidemiology and I don’t think I’ve ever felt as happy as I did conducting that research (except maybe the Polio campaign – but that’s another blog post!).

I always thought I found my passion, but now I confirmed that