Safari Njema

And last but certainly not least, I ended my time in East Africa with an amazing vacation! My parents and my friend Jolene from medical school joined me for a whirlwind of two safaris and a trip to Zanzibar.

My parents and I went to Amboseli National Park in southern Kenya, known for its elephants and amazing views of Mt. Kilamanjaro. Then Jolene joined us and we all went to the Maasai Mara, Kenya's most famous national park where the annual wildebeest migration takes place. And then Jo & I bid my parents farewell and ended our trip with a few days on the beach on the spice island of Zanzibar.

Here are a few of my favorite pictures from our trip...

A giraffe running alongside our car:

A huge herd of elephants crossing the road right in front of our jeep:

The classic elephant with Kilamanjaro in the background:

A mom and baby elephant crossing the road together:

The view of the Mara River from our camp in Maasai Mara:

A pair of cheetahs on the prowl:

A lion relaxing after a hard day of killing wildebeest and some vultures enjoying the leftovers:

The lion king:

A smorgasbord of other wildlife, including the elusive black rhino which we found after searching for 2 days:

And finally, relaxing on the beach in Zanzibar:

It was the perfect end to a wonderful experience. Hope you enjoyed the blog!

Kwaherini,
Ammu

Nyumbani means Home

After leaving Kisii, Noela and I had a week in Nairobi to wrap up our project and do final presentations at the University of Nairobi and the Kenya Medical Research Institute (KEMRI). And during that week, Noela and I also had the chance to visit Nyumbani, a home for children with HIV/AIDS who have been orphaned or abandoned.

The home was founded in 1992 by a physician who was also a Jesuit priest and today its executive director is a friend of Noela's so we were lucky enough to get a tour. I wasn't really sure what to expect when we arrived. HIV is one of those global health issues that has so much publicity and funding swirling around it that in theory there should be plenty of resources to treat and care for these vulnerable children. But I had just come from Kisii, where there were several women and children with HIV who were not getting medical care due to financial and social barriers.

Thankfully, that was not the case at Nyumbani. We were greeted by a sea of smiling faces, both from the children and the staff who take care of them. The children's home tries to create a domestic feeling by having individual houses, each with its own "den mother" who lives with and cares for up to 14 children, varying in age from infants to pre-teens. The older kids (teenagers) have boarding school style dorms where they live so they can have some more independence.

We also got to tour the amazingly state-of-the-art infectious disease laboratory that Nyumbani runs on its complex. They do all the medical care and testing for the children on-site. And their lab is so good that even large hospitals like Kenyatta National Hospital send HIV-related testing to them. It was a really impressive example of what is possible when adequate resource are put to good use.

Here are a few pictures of me & Noela with the kids. They are absolutely ADORABLE!

They were also strangely fascinated with my hair:

For more information about Nyumbani and how you can help, check out http://www.nyumbani.org/

~Ammu

Kitale & Kakamega

It seems as though no friendship in Kenya gets an official stamp of approval until you have visited your friend's home. Not just their house, but their real home, where their family lives. So it was almost a given that I would go and visit Jackie's home in Kitale and Noela's home in Kakamega while I was in Kisii.

Kitale is a small town northwest of Kisii near Mount Elgon, an extinct volcano on the border with Uganda. Jackie's grew up on her family's farm in a village near Kitale and her parents still live there. She and her husband have a farm of their own in a village called Kiminini just outside Kitale. This was our destination when Noela and I set out early one Saturday morning.

We started out from Kisii at 8am and went to the matatu station. Matatus, as I mentioned earlier, are 14 seat minivans that criss-cross the Kenyan roadways and are the most common form of transportation available. They're cheap and efficient but they have a lot of quirks. First off, there is no set schedule and they won't leave the station until they're full. There's heavy competition between matatu companies to fill their vans and they're not afraid to play dirty. This includes grabbing passengers' luggage and holding it hostage and hiring fake passengers to sit in their matatus to trick people into thinking that the van is almost full and ready to leave.

After some minor shenanigans, our matatu finally set off for Kisumu at around 8:45am. It was a really bumpy ride because most of the matatu drivers get paid for speed rather than how well they treat the vehicles. In Kisumu we switched to a bus which took us through Kakamega and up to Kitale. The bus ride was full of entertainment, like a woman who carried on chickens wearing plastic bags for diapers and a guy selling herbal medicines whose sales pitch claimed that his cream would cure "asthma, arthritis, bone cancer, baldness" and about 20 other ailments!

The bus trip was pretty grueling and we arrived in Kitale 6 hours later, grungy and exhausted. But Jackie was waiting for us at the station, and welcomed us into her lovely home with hot tea and snacks. We spent the weekend stuffing ourselves with food from her farm, especially maize and mango smoothies. We also visited her family's other farms and went to Kitale to visit the museum. Here are a few pictures from our trip...

This is Noela, Jackie, Jackie's husband Patrick, and Patrick's brother David at their farm:

This is me & Noela with Patrick:

This is a hilarious sign at the Kitale museum next to their snake exhibit:

These are some adorable kids at the church in Kiminini who wanted me to take their picture:

The following weekend, Noela and I ventured out again - this time to Kakamega to visit Noela's family. Kakamega is about halfway between Kisii and Kitale, and you might remember it from my earlier post about the Kakamega Rainforest. Noela's mom and most of her seven (that's right 7!) siblings live there.

We hung out with Noela's nephews and watched the Smurf movie, which they were crazy about although they kept calling the smurfs "smoothies". =) And stuffing ourselves with lots of tea and delicious food was happily a recurring theme.

Here I am with Noela and her family:

This is the stream where they collect water for their house. It's about a half a mile away.

This is the beautiful countryside around their home:

After these wonderful weekend trips it was time to head back to Kisii and wrap up our project! More on that next time. Kwaherini,

Ammu

Moraa & Kwamboka's Exchange Transfusion

Sorry for the long delay in posting to the blog. We've gotten really busy with our research project in the past few weeks. So, now that you've gotten and introduction to Nairobi and Kisii, I thought it would be good to share a little bit about my experiences in the hospital here and about the project that Noela and I are working on...

On our first day at the KEMRI-UW office in Kisii, we were told that we needed to have Kisii names for when we went out into the local villages to meet with community health workers and traditional healers. Noela said that she had already been given a Kisii name by one of her friends from the area - "Kwamboka" - which means someone who has crossed over rough waters to arrive where they are today. But I was still name-less. Luckily, Peter, one of the office staff, came up with a name for me - "Moraa" - which means always happy & smiling.

Armed with our new names, we set out to see the hospital and brainstorm about our research project. We got a tour of the hospital wards and met some of the nursing staff. Kisii's hospital is a Level 5 facility, which means that it is supposed to be a referral hospital for the Kisii District and just one level below the national Level 6 referral hospitals - Kenyatta in Nairobi and Moi in Eldoret.

However, Kisii Level 5 has no pediatric ventilators or ventilators for newborns. It actually has no pediatric or neonatal ICU. There is only one certified pediatrician on staff, who is supposed to supervise the care of the entire pediatric ward and newborn unit. She works with several medical officers and clinical officers -- mid-level health care workers who have some general medical training but have not gone to medical school or completed a residency. These MOs & COs provide the majority of the care to the children who are admitted to Kisii Level 5, and actually to most patients admitted to government health facilities all over Kenya. There is a critical shortage of qualified medical providers in Kenya - both doctors and nurses.

On the day we arrived in Kisii, the pediatrician was away in Nairobi for a meeting. That meant that Noela and I were the most highly trained pediatricians at the hospital. The pediatrician had communicated with our mentor in Kisii - Jackie - that there was a newborn recently admitted who was very sick.

Baby E. was a 10 day old girl who had been born at home and whose mom had not gotten any prenatal care. Her mom brought her to the hospital because she had developed jaundice. Once she was admitted it was also clear that she had a serious infection (sepsis) and probably meningitis. But the jaundice was the most concerning issue because it was not responding to the phototherapy that been used for the past 3 days.

The next step to try to prevent the jaundice from leading to permanent brain damage was to do an exchange transfusion. For the non-medical folks that's a special type of blood transfusion where a baby's entire blood volume is removed and replaced with fresh donor blood. Replacing the baby's blood helps reduce the level of bilirubin, the chemical that causes brain damage in jaundice.

Obviously, it's not a procedure you do every day. It can be very dangerous and can even kill a baby. It has to be done under sterile conditions and you need to monitor the baby very closely and check lab tests frequently. I was pretty apprehensive about attempting to do this procedure because the newborn unit had no electronic monitors and I didn't think they could set up a truly sterile area for us to do the transfusion. The unit is chronically overcrowded and they usually have 2 or 3 babies in each crib, and up to 4 under each phototherapy light.

But it turned out I didn't have to worry because we didn't even get that far. First of all, the blood bank didn't have enough blood for the transfusion. And secondly, we were never even able to check the baby's bilirubin level to confirm if it was high enough to cause brain damage and thus worth the risk of doing the procedure. Why were we not able to do this basic lab test? Because the machine in the lab was broken and kept giving us the wrong results.

So in the end, we just continued to treat the baby with phototherapy and antibiotics. Her jaundice eventually improved, but over the next couple of weeks we watched her develop the signs of brain damage from her initial severe jaundice. She started to have episodes where she stopped breathing. And then one day, we came in morning and heard that she had passed away overnight. It was really heartbreaking to watch because it should have been prevented. If her mom had delivered at a hospital and gotten good prenatal care & health education, if she had brought the baby to a doctor just a couple of days sooner, if the hospital had a working laboratory and a functional blood bank, if the newborn unit had monitors and enough space and staff....if any of those things were true, Baby E. could have lived.

Baby E.'s story inspired us to focus on newborn babies for our research project. We decided to look at neonatal infections and how the outcomes differ between babies who are born at home and those who are born in a hospital. So far we have interviewed and surveyed health care workers, community health workers, traditional birth attendants, and mothers about their knowledge of neonatal infections and proper newborn care. We're also investigating the outcomes for newborns admitted to Kisii Level 5 with infections based on where the baby was delivered. Hopefully we'll end up with some useful results!

Ammu

A Birthday Surprise

A couple of days after our arrival in Kisii it was my 30th birthday. I wasn't quite sure what to expect since Noela and I had just settled into our rooms at the St. Vincent Center and we had only met the staff at the UW-KEMRI office in Kisii the day before. But the day was full of surprises.

In the morning, I awoke to find a birthday card and small present from Noela waiting just outside my room. The cook at St. Vincent's made me an extra spicy Spanish omelet for breakfast. And then Jackie, our dynamic powerhouse of a project mentor at UW-KEMRI, arranged a lovely surprise party at lunch with the rest of the office staff. There was of course lots of sweet milky tea, but also popcorn, spicy chips, cookies, fruit, and even samosas. They sang me "Happy Birthday" and presented me with a ridiculously large card with a bald eagle on it (not sure if that was intentionally America-themed).

But the very best surprise of all came in the evening. The day before, Jackie had suggested that Noela and I go on a trip over the weekend to do some "experience sharing" and work on our research project proposal. She said that the Kakamega Rainforest, which is about 3 hours northwest of Kisii via the town of Kisumu, would be the perfect place for us to get away from it all. This struck me as pretty amusing because I had just "gotten away" from Seattle to Nairobi 5 days ago and then got away from Nairobi to Kisii a mere 24 hours ago. But Jackie's enthusiasm is infectious, and Noela & I were up for anything, so off we went!

We set off in the afternoon in one of the hospital's 4x4 jeeps down the very long and bumpy road through Kisumu to Kakamega. In Kakamega, we were met by Dr. Nyongesa, the Director of Public Health for Kisii, who is one of the senior staff at the hospital. His home is in Kakamega and he very kindly gave us a ride into the forest to our final destination.

After several miles driving down dirt roads filled with gaping potholes heading further and further away from civilization, I was beginning to get a little worried about what we would find at the end of the road. I mentally prepared myself for a weekend spent in a tent with a dirt floor, lots of mosquitos, and no running water.

But when we finally arrived at the Rondo Retreat Center, we were greeted by this:

We stayed in this enchanting cottage for the whole weekend. After putting our bags away, we were served late afternoon tea and chocolate cake in the cozy parlor in front of the fire. The entire place was frozen in time from the British colonial era, and somehow perfectly preserved in the middle of the Kakamega Rainforest. It started off as a sawmill in the 1940s, became an orphanage for awhile, and now caters to eco-tourism. And as we met several of the other guests over the course of the weekend, we discovered that nearly every person was an ex-pat or visiting physician taking refuge from the hectic atmosphere of Nairobi, Eldoret, or Mombasa.

Above is a photo of Noela & me taken by our nature guide Job after our early morning hike into the jungle and up to the top of this hill where we had panoramic views of the surrounding rainforest. It was absolutely lovely and we were lucky enough to see all 3 types of monkeys that populate the area: colobus, blue and red-tailed. Here's a photo of the black & white colobus monkeys:

After our hike, we got to work on our research project and came up with our proposal by the end of the weekend. More on that in the next post. Tutaonana!

Some Pictures

Here are a few pictures from our trip from Nairobi to Kisii through the Rift Valley and then of Kisii itself. It's a very lush, verdantly green area up in the hills.

The Road to Kisii

Today we set off for Kisii, which is about 350 km to the west of Nairobi. George and I left Nairobi in the morning after my apartment at Gemina Court was inspected to make sure I didn’t abscond with any of their (mismatched) silverware. Then we stopped in Limuru, a small town covered in fog up in the hills, to pick up Noela and we were on our way.

As we headed down the hills on the highway with breathtaking views of the Rift Valley, we hit a road block. Or more precisely, a long line of cars and trucks stopped on the two lane highway that George said was most likely caused by an accident. He said sometimes it can take hours to clear the road when these happen. It seemed like our trip was off to an unfortunate start.

But then, George noticed a dirt road leading off the main highway up into the hills on the right. Calling it a road is quite generous. It was more like a clearing where the dirt had been flattened so that the rocks and potholes were more visible to the naked eye. A half-dozen 4-wheel drive safari tourist vehicles roared confidently up this road. They were followed by a couple of matatus (more about these later) and then a small minivan. And finally George, our intrepid driver, decided to go off-roading in a car that has the equivalent size and horsepower of a Toyota Prius.

Our long line of vehicles made its way slowly up the road, with continuous jarring bumps and dips. At one point about 15 minutes in, we came across a huge pothole where it looked like the road had caved in. The safari vehicles cleared it easily. The matatus, on the other hand, had to give up and turn around. Matatus are small passenger vans that seem to be the most common form of transportation used by Kenyans, especially when traveling long distances. They typically hold about 14 people, but their engines are not very powerful.

After the matatus gave up, I was pretty dubious about whether we could make it. But George expertly navigated our way across. It felt like we had just successfully forded the river on the Oregon Trail. =) That gaping pothole ended up being the first of many, but George managed to get us safely across all of them. After about an hour, we finally ended up getting spit out back on the highway several kilometers north of where we needed to take the exit for Kisii. I’ve never been happier to see a paved road!

The rest of the journey was thankfully quite uneventful, and we made it to Kisii in the late afternoon. I thought I was the only one who was nervous during our off-road adventure, but when I asked Noela about it later she said she was holding her breath the entire time. I have to say it was definitely a bonding experience. More about our adventures in Kisii next time!

 
~Ammu
 
(Note: I wrote this post 4 days ago but didn't have any internet access to post it till now.)

Bibimbap and BLTs

After 2 days in Nairobi, I'm starting to feel pretty settled in here. With a constant infusion of caffeine on my flight from Amsterdam to Nairobi, I managed to stay awake till 11pm Kenyan time (1pm PST) on my first night here and completely flip my circadian rhythms. I'm staying at a comfortable apartment with some truly excellent 70's decor -- there's shiny wood paneling and a velvet headboard on the bed!

Every morning, my trusty driver George comes to pick me up and take me to orientation activities. Yesterday, I met my project partner Noela Makotsi for the first time. She's very down to earth and funny. I think we're going to get along really well. She has just finished her first year of pediatric residency at the University of Nairobi, but since the Kenyan medical system is quite different from the U.S., she worked for 6 years as a general physician after completing medical school before she could even start the residency program. The more I learn about medical education in Kenya, the more grateful I am for the system we have in the U.S.

Noela and I did the orientation together and are now the proud (temporary) owners of 2 laptops and a satellite phone. Several of the meetings that had been set up for us didn't actually take place because the people we were supposed to meet were in other meetings or, in one case, not even in the country. But in my experience, that's just the way things go sometimes in global health settings.

One site I was disappointed to miss was Kenyatta National Hospital (KNH), which is the largest public hospital in Kenya and the site of the pediatric residency program. Unfortunately, the pediatric residents and all the other sub-specialty residents are on strike as of yesterday to protest their working conditions and lack of adequate compensation (or really any compensation) for the hours they work. No one is sure how long the strike will last but it has already ground the hospital to a standstill. I'm hoping that we can visit KNH when we get back from Kisii.

We did get to visit Gertrude Children's Hospital, which is the only private children's hospital in Nairobi. John Kamenwa, one of the pediatric residents who did a project in Kisii last year, took us on a tour of Gertrude's. It's a well-funded facility with specialty clinics, a surgical unit, multiple inpatient wards, a child development center and even a 4-bed intensive care unit with ventilators. The patients all have private rooms where a parent can stay with them and the nurse-to-patient ratio seems similar to what we have in the U.S. This is a hospital where ex-pats and wealthy Kenyans bring their children, and you have to pay cash or have private insurance to be treated there. The down payment for admission to the ICU is 500,000 Kenyan shillings which is about $6000.

Both John & Noela drew several comparisons between Gertrude's and KNH during our tour. The pediatric ward at KNH has an average of 100-150 patients with only 2 nurses to care for all of them. The babies are often housed 4 to a single bed and children are 2-3 to a bed. Their mothers sleep on the floor under the beds or have to find their own accommodations. In the pediatric ICU at KNH there only 2 ventilators and 1 CPAP machine. But as a public government-funded hospital, KNH has to treat all patients regardless of their ability to pay. Although, patient's families are still required to pay for some medications and other treatments and they may not let you take your child home until you settle your bill!

All of this has given me a lot to think about. Having this wide a gap in quality of care between the wealthy and the poor in Nairobi is unsettling enough. But I think when we go to Kisii, we will be confronted with even wider disparities and even fewer resources to try to bridge the gap.

But to end on a lighter note and go back to the title of my post....I have yet to eat any Kenyan food in Kenya. On my first day, I had a BLT+avocado sandwich for lunch at Java House (Kenya's answer to Starbucks) and then, I wandered into the Happy Love restaurant which is next door to my apartment and discovered that it was run by a Korean family! So I had some delicious bibimbap for dinner. I've also been drinking plenty of Kenyan tea, which is quite light on the tea and heavy on the milk & sugar.

Tomorrow, Noela and I will leave for Kisii to begin work on our project. Our trip is going to take us through the Rift Valley so I'll try to take some pictures and post them here. Until next time, kwaherini!

Ammu

The Adventure Begins!

Hi all,

I am writing this from the Amsterdam airport waiting to board my flight to Nairobi. For those of you who don't know, I'm going to be spending the next 2 months in Kenya working on a pediatric global health project. I'll be starting off in Nairobi for a week of orientation. And then my project parter and I will be heading to the town of Kisii in Nyanza province in southwestern Kenya to work with the local health care providers at the Kisii Level 5 District Hospital and the community it serves.

My partner, Noela, is a Kenyan pediatric resident just starting her 2nd year. We're going to be spending a lot of time together over the next 8 weeks, so here's to hoping we get along! =)

I'm not sure how reliable the internet is going to be during this trip, but I'll try to post regularly. And I'd love to hear from all of you while I'm gone! Wish me luck as I embark on this new adventure...

Ammu