Last Week in Kenya

The Day of the African Child

My time here in Kenya is coming to a close. Part of me is sad, because I have really enjoyed my time here and have learned so much. I have also met some great people and built some awesome friendships. I have to admit I am ready to leave, I am pretty darn ready to see my husband. The last few days I have missed him even more, maybe it is because I will see him so soon.

There was a large group of people that went white water rafting but I decided to stay around Eldoret for my last weekend. It has been a very relaxing weekend. Last night we cooked a great meal which included grilling out :) Today I played soccer for several hours with a large group of Kenyans and few Americans. It was great, but they ran circles around us.

I am done rounding on the wards. I am going to spend this week visiting several different clinics. On Monday I am going to the adult Oncology clinic, Tuesday Cardiology clinic, and Wednesday diabetes clinic. I am looking forward to the clinic environment and a break from the wards.

This past Saturday was The Day of the African Child. It is a day to honor the children and bring attention to the huge problem of homeless children in Eldoret. I joined a parade of street children that went through town and then watched some of the program. It was a fun event but sad to see hundreds of street children.

XDR-TB

Extreme Drug Resistant Tuberculosis

Did you know that 1 in 3 people in the world are infected with tuberculosis? I have come to believe in this statistic as we currently have 7 patients on my ward alone with active TB. Multiple patients have pulmonary (lung) TB and we also have two patients with TB meningitis. I have discovered that TB is on par with HIV in Africa.

We had a fireside chat (there is no fire, but we sit around and discuss an interesting topic) tonight about XDR TB. The distinction of XDR TB is drug resistance to INH, rifampacin, quinolone, and an injectable agent. The thing about TB is that you need to treat with 4-5 drugs to cure the disease. If you are resistant to >4 drugs there is a very low probability of survival. The mortality rate for XDR TB is 50-80%.

The moral issue comes in what do you do with a patient who has XDR TB?? There was a patient that was hospitalized at Moi University for 9 months with XDR TB. She was brought against her will to the hospital and placed in isolation to undergo her treatment. Her family lived 3 hours away and was unable to afford the trip to visit her. She died in isolation after 9 months of therapy.

This situation at first appears shocking and inhumane but you have to think about public health. What if there is an outbreak of XDR TB? It would be devastating. What do you do with these people?

The testing for XDR TB is not readily available in Kenya. So it is highly likely there are many people out there with resistance. If the testing does become available what are we going to do when we find these patients?

If you have any comments on this issue I would love to here them. I don't think there is a right answer to this difficult problem. I think one thing we focus on is PREVENTION! We have to prevent patients from getting TB/XDR TB in the first place.

Interesting Case

We had a 16 year old boy that came in with severe neck pain/stiffness and high fevers. It was assumed he had meningitis and he underwent a lumbar puncture and was started on antibiotics. He continued to decline over the next several days, as his pain worsened and his fevers persisted.

On rounds one day the American medical student took his blood pressure and it was 120/10. She thought she was messing something up so she asked me to take it. I got a reading of 120/0. This is not normal! The lower number should be 40-60 mmHg. The difference between the top and bottom number (systolic and diastolic blood pressure) is called the pulse pressure. This guy had a huge pulse pressure of 120 mmHg.

We quickly moved to a cardiovascular exam, as there are only a few things that can cause such a blood pressure. Just placing your hand on the patient's chest you could feel a thrill (buzzing sensation) of a heart murmur. You could hold your stethoscope off the chest and here a murmur. He had the loudest murmur I think I have ever heard.

On further examination we found that he had all the classic findings of severe aortic regurgitation. He had the pistol shot pulses, dancing carotids, bobbing head, and tender splenomegaly. We ordered a stat echo and found that he had severe aortic valve disease with aortic stenosis and regurgitation. He was also in heart failure secondary to his valvular disease.

Looking back through the chart multiple people had written: Cardiac examination normal with no murmurs. It made me realize how in medicine we can get fixed on a diagnosis and forget to look for anything else. This guy's heart disease was obvious once you took the time to listen, but everyone thought he had meningitis so no one really paid any attention to his heart.

We think the patient has an infection on his heart valve and is throwing small emoli (clots) all over his body. Unfortunately, there is very little to do for people in Kenya with valvular disease. There is no open heart surgery in Eldoret. It is very unlikely that this young boy will survive for very long. We are trying to aggressively treat any infection that might be present to help his odds of survival.

The physical exam findings here are absolutely amazing...you just have to look for them!

Rough Day

So today was probably my worst day in Kenya. I am not sure why it was so bad, but everything seemed to bother me today. I think it was just an overwhelming feeling of helplessness that just overtook me today.

My day started with me arriving on the ward at 9am and no one was there. I waited for about 20 minutes and then decided to start rounding without my interns. I was then yelled at by a Kenyan attending because I "talked to loud." It was pretty awful and I felt he was definately picking out the one white person on the ward. The problem is that I am the American visitor and I can't keep anyone accountable. I just want to shake them and tell them to "work" - to show some interest in the patients, to read about the patients, and fight for the patients. I don't think I am in a place to say these things and I don't think they would listen to me even if I did say something.

On rounds I would try and ask people to help by going to find labs or X-Rays and they all just stand there and stare at me. I have to select a specific person to do the task and even then it does not get done 80% of the time. Nothing gets done on the wards. It feels like we do nothing for these patients. Part of me feels like the patients might be better off not coming to the hospital. At least they would be at home surrounded by their family.

Early in our rounds a patient died, we suspect from disseminated TB. It just made me think about the giant disease burden we are fighting against here. TB and HIV are claiming the lives of so many Kenyans. These diseases are so awful because they are slow, debiliating disease that slowly take lives.

I am sorry this is a depressing blog post but I want to be honest and keep you up to date on the emotional lability of Mackenzie :) Please keep me in your prayers that I would be able to see God's hand working in Kenya.

Lake Baringo and Lake Bagoria

Flamingos!!!






The geysers of Lake Bagoria with flamingos in the background.






Sunset






The gang: Ryan, Felip, Nick, Darion, Elizabeth, Shashona, Beth, Me, and Shephali.




Our boat tour around the island.

Lake Baringo and Lake Bagoria

This was our accommodations - a tent with running water, a flush toilet, and a warm shower.

The African fish eagle, a beautiful bird that posed very nicely for this picture.


Goliath Heron


The sunrise from our tent!

I am sure you have all been impressed by my weekend adventures but I think this past weekend was my favorite. Nine of us from IU house took a trip to Lake Baringo and Bagoria and stayed at a placed called Island Camp. We had to take a 20 minute boat ride to the island and we stayed in these tents that had running water, toilets, and showers. Our tent over-looked Lake Baringo and I was able to sit up in my bed and watch the sunrise over the lake (did I mention they brought me hot chocolate in bed at 6 am for the sunrise).

Our time at the camp included all our meals, and the food was amazing. The first night I had tilapia which was caught in lake. The second night we had an all you can eat meat cookout with goat, lamb, chicken, beef, fish, and pork. I really enjoyed the food - just in case you couldn't tell.

We went on a boat ride around the island and saw crocodiles, hippos, lizards, and tons of amazing birds. We also took a boat ride to an island to watch the sunset and they provided us with drinks. It was acutally very romantic - the only thing missing was Ivan :)

On Sunday we drove about an hour to Lake Bagoria which is located in an extremely dry area. The lake is alkaline and does not support any animals except thousands of flamingos. The only problem at Bagoria was that it was extremely hot and it is the home of the hot springs and geysers. So I was sweating profusely as we walked around on top on the steaming soil and rocks.

Overall this was an awesome weekend. It was an amazing place, absolutely breath taking. The best part of the whole weekend was the people. The group we went with was awesome and we all had so much fun together.

Cooking in Eldoret

Lentil soup! It actually tasted just like the lentil soup Ivan and I make at home.


Enjoying our homemade dinner!

I love to cook and you all probably know that I am a picky eater with my strong dislike for both onions and tomatoes. It makes eating here a bit challenging. I have a lot of peanut butter and jelly sandwiches - my favorite back up meal.

I did have a chance to cook here last weekend. I made the Lupov's famous lentil soup and it was delicious. I was a happy camper! My friend Beth made Butternut Sqaush Curry and we also had cooked green beans and pineapple. It was a great meal.

My other cooking endeavour was making homemade chocolate chip/chunk cookies. It was a bit challenging as the brown sugar was a large hard square rock and I had to chip off pieces with a knife. I also discovered that you cannot set the oven temperature, the lady told me to turn it about half-way and that should work. I had to watch the cookies very closely. The end result -- DELICIOUS!! They were a huge hit and they were gone very quickly. I already have multiple request to make more, a few people even bought me some more chocolate bars.