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.

The ICU

Some of you may be aware of my dislike for the Intensive Care Unit (ICU) in the States. I am not a big fan of the high intensity with multiple patients on the brink of death. I have discovered that I probably wouldn't mind the ICU here - it is NOT high intensity.


I had my first real encounter with the ICU team this week when I wanted them to come see a patient on our team. The patient arrived on our team around 10 AM as we were going about our morning rounds. We stopped to assess the new patient because he looked quite sick. After a quick examination we found that his extremities were cold, he had no peripheral pulses, and we were unable to get a blood pressure or oxygen saturation. He was on oxygen and was clearly having difficulty with his breathing.

It was clear that this patient was not adequately perfusing his organs and he would quickly die if we did not get him to the ICU with some type of pressor support. On rounds we discussed this and the plan was to call the ICU and cardiology to come see him. After we saw the patient I noticed that no one was calling the ICU or cardiology. I asked my intern and he said he would call after rounds (rounds are an average of 3 hours long). I told him the patient wouldn't survive that long, so I called both consults myself.

I was pleasantly surprised when cardiology showed up 20 minutes later to see the patient. They agreed that he needed to be transfered but thought it might be too late to help him. I continued to wait for the ICU team to arrive. The patient died at 1pm and the ICU team showed up to see him around 3pm.

I was extremely frustrated with this but I learned that the ICU works a bit differently here. They take all the consults they recieve and go around seeing the patients. They may have 1-2 beds available so they try to find the patients they feel might have a chance at surviving. The others they turn down and the patients remain on the wards to be managed.

I guess my patient did not fit into their "possible recovery" category as he was unable to survive long enough for them to come see him. There is absolutely no urgency here in patient care.

The Street Children of Eldoret

There is a large population of street children living in Eldoret. The total number is unknown because they are very difficult to track, but the estimation is over 2,000 children. Some of the children live on the streets during the day and go home at night but many live completely on the street with no home to return to at night. These children are often forced to leave their homes because of lack of food or violence toward them in the home. On the streets they can make their own money and have freedom from those who may harm them at home. They form communities on the streets with the older children assuming leadership over the younger children. The age range is broad with some of the younger children being 4-5 years old. Many of the older children living the streets are killed by police.

On Saturday morning several of us went to an outreach for the street children. The outreach is put on by Tumanini House (with means Hope in Swahilli). This home is a day center for the street children where they can come and shower, eat, and participate in different types of education. The people at Tumanini are working hard to help the children find a way to get off the streets by teaching them a trade and getting them back into schools.

There is a huge problem with substance abuse among the street children. Nearly all of the children are addicted to sniffing glue. It was hard to watch as we played soccer with them on Saturday because as they played they would have the glue bottle in their mouth sniffing.

It was a neat experience but overwhelming to see the needs of these children. Tumanini is definetly a place that is trying to make a difference in their lives. If you want to read more about the Tumanini center check out their website: www.tumaninicenter.org.

Neema House

Neema house is a home for children located in Eldoret, only a five minute drive from where I am living. Yesterday afternoon I had the opportunity to spend several hours playing with the children. It was so much fun!

Neema house is home to 39 children at this time, 29 of them are HIV positive. It was started by an amazing couple who wanted to provide a home for abandoned children. They have also built a primary school on their property for the children to attend. It is a amazing place and I am eager to go back and play with the kids some more. I think I will stop by on Saturday for a few hours! I am sure to have more adorable pictures :)

Pellagra

Sorry if my pictures gross you out, but I wanted to share this amazing case with you. This man has a disease called Pellagra. Pellagra is caused by a deficiency in Vitamin B3 (Niacin). Patients with pellagra usually have a diet that is rich in unprocessed corn. It can also occur in alcoholics due to malnutrition. The treatment is very simple, you just have to give the patients a vitamin. Ofcourse we ran out of oral Vitamin B Complex today in the hospital so my patient has not been recieving his mediations.

If Pellagra is left untreated it will result in progressive dementia and ultimately death. Pellagra is a very preventable and treatable disease.

Lack of Supervision

The day to day routine at the hospital is alway different depending on who shows up. Some days we have a huge crowd with 10 medical students, two interns, 1 registrar, 1 attending, and myself. Other days it has been only me and the intern rounding on 50 patients. It is actually more fun and interesting the fewer number of people because it allows me to be more involved in patient care.

Today I was a little more involved in patient care than I prefered. Last month the intern I worked with was awesome. She knew what she was doing and just asked me for my opinion on certain issues. We have two new interns this week, one who is very strong and one who is extremely weak. Somehow today about half way through the rounds the registrar and good intern had to go to a meeting and I was instructed to "take over rounds." It was me, the weak intern, and 2 third year medical students. Talk about overhwelming. We had at least 40 patients on our service, about 10 of them were new admissions from the night before.

In the first 15 minutes of being the "attending" on my rounds today we had 4 patient that were completely unresponsive and one man with an acute abdomen. One unresponsive patient has cryptococcal meningitis and was actively seizing during rounds. Another man was in clear respiratory distress with an oxygen saturation of 68% (normal is 98%). Another patient I am concerned has TB meningitis (which I have seen twice in my life). The guy with the acute abdomen had severe rebound tenderness, guarding, and peritoneal signs.

I felt very helpless and overwhelmed today, but I was definately participating in patient care. None of the patients died during rounds or before I left for the day, which I thought was an accomplishment. I know I am getting use to the wards but I would prefer a little more supervision.