K'la first look and contact info

Since I'm at a cafe that seems to have decently fast internet, I thought I would try uploading a few pictures. These first three are of apartment (view from my patio, bedroom, living room):





These two are from my walk to work:




And these last two are of IDI and Mulago Hospital:




Also, while calling any of you seems to be more of an impossible task than I'd anticipated, you can all easily get in touch with me, and for free! (That's right, FREE. Be amazed.) If you download Skype, and look for 'melas15' (my Skype username), you can call me any time, and even if I'm not at my computer the call will forward to my Ugandan cell phone. I tried it with my dad a few days ago and it worked beautifully. Again, free for you, cheap and happy for me, give it a shot sometime. Otherwise, if making phone calls from a computer is weirding you out, you can call me directly (with a calling card) on my mobile: +256-77-984-9519

More soon. Love, me.

What's the dilly, yo

Ki kati, people (that’s Luganda, for ‘Yo’). I’ve gotten more than a few ‘What? You’re in Uganda right now?? Why???’ emails, so now that I’ve got a somewhat reliable albeit slow internet connection at work and can update this blog regularly, I thought I should at least give some background on what I’m doing here this year.

The NIH Fogarty International Center, now about 40 years old, supports global health research by providing US and international investigators with grants to the tune of over $60 million each year. One of its programs is the Fogarty International Clinical Research Scholars program, or FICRS. Since 2004, each year the FICRS program has offered 20-30 US graduate-level students in the health professions the opportunity to train at NIH-funded research centers in resource-limited settings in 20 or so countries. This year, I am, lucky enough to be one of those students. I am working at the Infectious Diseases Institute (IDI) in Kampala, Uganda, an NGO that provides clinical care and antiretroviral therapy (ART) at the clinic, trains health professionals from all over the continent, and conducts research into HIV and related infectious diseases. As far as I know, it is unique in this triple focus. (For those who don’t know, Uganda has had relative success in controlling the AIDS epidemic through coordinated clinical care, and as such places such as the IDI have had the luxury of being able to focus on research and training rather than in establishing effective health systems. If you want to read more about that, try these links:
- http://www.who.int/inf-new/aids2.htm
- http://en.wikipedia.org/wiki/HIV/AIDS_in_Uganda
- http://www.avert.org/aidsuganda.htm

So anyway, the bottom line is that I will be here for a year doing HIV/AIDS clinical research. My principle investigator (PI) Yuka Manabe, who I’ll talk about at length a bit later in this blog, has a background in tuberculosis basic science research at Johns Hopkins, where she has been a faculty member for 10 years or so. She has a special interest in something called IRIS, immune reconstitution inflammatory syndrome. What is IRIS? Say you have HIV and you live in the developing world, and you are started on ART. There is a 10-25% chance that in the first 3 months of being on therapy, you will actually get worse. Why? If you have advanced HIV, your immune system stinks. If you start on ART, you get it back. But when you reboot your immune system by starting ART, suddenly your body mounts an inflammatory response against all the different pathogens with which you were likely infected when you were severely immunosuppressed. In other words, you were actually TOO sick to show that you had TB or Cryptococcal meningitis when you were immunosuppressed, but now that you’re on ART you actually HAVE all these things and are suffering clinically. Why do IRIS research? To figure out whether preventive screening is effective, how to prophylax against it, whether IRIS interferes with other comorbid conditions…you name it and it needs to be characterized.
- http://en.wikipedia.org/wiki/Immune_reconstitution_inflammatory_syndrome

If you actually read all that, I’m very impressed. It’s complicated and probably a bit boring to read about. But there it is. And here I am.

So yeah, I arrived in Uganda five days ago and will spend the next 10 months here, based out of Kampala but spending a good chunk of time out in the boonies of Western Uganda to work on a big PEPFAR study. Check out this map if you want to see where I’ll be working, small villages called Kibaale and Kiboga are (pronounced Chee-ball-eh and Chee-bo-gah):
- http://www.ugandamission.net/aboutug/image/ugmap.jpg

To start at the very beginning, I’ll just pay brief lip-service to the events of the last month or two leading up to my arrival in Kampala.

June: End of 3rd year & Leaving NoHo/Baystate
Quite an end to the year. For those of you who don’t know, I was living out in Western Massachusetts for the past year, working at Baystate Medical Center in Springfield. It was an incredible experience—Baystate is a fantastic hospital and health system, and their self-proclaimed emphasis on medical education rather than research made it an ideal environment for medical students. I felt so comfortable and happy there by the end of the year that it was harder to leave than I had thought it would be. The same can be said for Northampton, where I was living. My apartment, the first 1-bedroom I’ve ever lived in and probably the last for a while, and the town itself were so charming. I had a great time there and miss it quite a bit already. My lovely parents came to help me with the Herculean task of packing up the apartment and moving my whole life into storage. It wasn’t fun and I was a sad, crabby girl, but my parents were unfailingly patient with me. I couldn’t have made it through that time without them! After the move, I had about a week of hanging out in Boston through July 4th, hanging out with friends and trying to prepare myself for what was coming the next week…

July: Fogarty Orientation @ the NIH & Nashville
I’ll say in advance that many of my friends from Fogarty have written extensively on our two-week session in Bethesda, so I’ll refer you to their blogs if you’re looking for more detail about the experience (look at the links section in the section on the right side of this page). From my end, I arrived in DC July 5th more than a bit trepidatious and wondering what I’d gotten myself into. While on an intellectual level I knew that this would be a once-in-a-lifetime experience that I was lucky to have, I missed my life and my friends in Massachusetts already, and I worried whether I would love the program as much as previous Fogarties had promised me I would. Of course, all of my worrying was for naught (and was pretty dumb, I’ll be the first to admit it).

The orientation was indeed an incredible way to start the year. Getting to know all the other 32 Fogarty scholars and our 32 international counterparts or “twins” (scholars from the countries where we’re going with whom we’ll be partnering on our research projects), as well as 25 post-doctoral level Fogarty fellows (read: geniuses) was awe-inspiring and fun. They are a motivated and accomplished group, not to mention some of the nicest and most adventurous people you’ll ever meet. It was a normative experience as well—all of us in this program have felt an inexplicable tug towards global health for a long time and have been trying to explain it to graduate school admissions committees or advisors or friends and relatives all along, and finally finding a room full of colleagues and mentors who not only understand this drive but have excelled in their careers in this field already felt like coming home. It’s a great network to be a part of. The program administrators, from the NIH Fogarty International Center itself, from Vanderbilt University (the group that manages the FICRS program) and from the Association of American Medical Colleges made us feel welcome and special as they guided us through a couple of weeks of research presentations (e.g. New Immunodiagnostic Techniques in TB), basic topics in global health (e.g. emerging neglected diseases), inspirational talks by world-renowned leaders in global health (e.g. Tony Fauci on how he ended up where he is now), and presentations by various NIH institute directors (the head of NIMH telling us about the global burden of mental health diseases, the research that is needed and that we could do in the next year). We learned a lot, partied a lot, and generally exhausted ourselves. It was fantastic.

While I was in DC, I also got to spend time with my family and some close friends, which was a special treat. My mom and dad live in DC (though my mom had to trek down from her vacation home in downeast Maine), and my sister Julie and aunt Sandra flew in from California for my dad’s birthday celebration and to say goodbye to me. One of my best friends in the whole world from growing up in DC, Hannah, also lives in DC, and I got to see her several times as well (more than in the last year or two, probably!). It was lovely to see them all, and sad to leave them.

We Fogarty scholars split up after the two week orientation for an additional mini-orientation at our US partner sites. Mine was at Vanderbilt in Nashville. A relaxing few days of meeting administrators, touring the campus and hospital, and taking in the music scene on the strip capped off the trip. I’d never been to Nashville before but I will definitely be back. Fun fun fun.

End of July/August: Boards & Goodbyes
I flew back to Boston after orientation(s) to wrap things up before I left. I had, in a fit of ambition, decided to take Step 2 of my USMLEs prior to taking off for the year, but finding the time or motivation to study was harder than I had anticipated. Anyway, I squeezed in study time in between fun with friends, loaded up on toiletries and flip-flops, and got ready to go. Where I had been nervous and morose about leaving before the training in DC, afterwards I was energized and excited to start my adventures. Though there were many tears and difficult goodbyes, I left Boston feeling ready to move forward and grateful for every minute I’d had with my friends and family, not only in the months leading up to my departure, but in the 3 years I had with the Tufts class of 2010 (best class ever).

My father would be proud of the amount of context I just laid out. Have to do some work now, but in my next post I’ll actually start talking about life in Uganda, I swears.

Backstreet's back, oh yeah.

It's been a long time since I called myself a blogger, and I have to say it feels good to be back. I will try to do my best at posting bits and pieces to give you a taste of what life is like in Uganda. Just wanted to get this up and running--a huge accomplishment for a day in East Africa! I'll post more tomorrow, hopefully after having overcome the white whale of a challenge of having money, a phone, internet, and food all at the same time.

To come: quick recap of the last 6 weeks!

Hakuna Matata

Friday, July 13, 2007

Awesome, I’m only one month behind! I think the day-by-day reports will have to get shaved down a bit, no? Here we go.

Voi: In the Beginning

Looking back and remembering my first bus ride down to Voi, I wish I could have seen the look on my face when we finally arrived. Stunned/having received a board to the back of the skull would probably best have described my impression. Understandably so: Voi is practically a frontier town, coated with the red dust that blows all around, six blocks from one end to the other of the “central business district” with the main through-way as the only paved road, and not a mzungu in sight. Before I left Nairobi, my friend Laura had said she was sure there would be a video store in town. I wasn’t even sure there were toilets (I later would find out that technically yes, there are toilets in Voi, but whoever invented the “Eastern” toilet ought to be shot. Toilet my ass [so to speak]. Squatting over a whole in the ground with no toilet paper in sight makes Miriam a sad girl.)

Those first few days when Mkaya was there were spent meeting people from the hospital and local HIV/AIDS public health program—contacts that would be important for me later—and looking for a place for me to stay. We stayed with Mkaya’s sister and her husband and then with his parents for the next two. Since Emily and Julius live in a town roughly 20 minutes west of Voi in the Taita hills, and the Mwamburis Sr live in Wundanyi, the headquarters of the Taita-Taveta district set high up in the hills another 25 minutes or so past Mwatate, I got my first real experience with the roads in Kenya and the distances people routinely travel by foot and by matatu. Never, ever, ever again will I complain about the roads in the US. Never. Take the worst road you can imagine (potholes a few feet deep and wide, washboard when driving, mud, narrow, no signs anywhere—ever—for anything, be it a curve or a town or a 75% grade) and that’s the best road in the district. Seriously.

Needless to say, everyone even distantly related to Mkaya is a saint. Having since seen Mkaya's sister often in town and gone back to stay at her house, I am so grateful that they are close by! I always feel better just remembering that. The people I met at the hospital were also welcoming and lovely, and they seemed excited for me to be there to help out. Everyone spoke Kitaita or Kiswahili most of the time but assured me that they would be happy to speak in English when I was around. (Aside: it is still amazing to me that even the poorest people in the most rural areas of Kenya that I have visited usually speak 3-4 languages.)

I’m not usually such a skittish person, but I was flat out panicked for those first few days. I think Mkaya could sense it, and he tried his very best to reassure me and make sure that I was settled and well-connected before he left. Nonetheless, the thought of being left by myself in this tiny little town where everyone stared at me with gaping jaws no matter where I went scared me. By the end of the first day I had set my internal countdown: only 7 more weeks in Kenya…The days before he left were punctuated with the small natural disasters that I have come to recognize as my trademark bad luck: my digital camera left on the bus from Nairobi (apparently it miraculously showed up on the bus hours later when the driver threatened to take the remaining passengers to police station), flat tires, bad weather, misplaced keys, cell phones, and money, and downed servers at the cyber café. I fretted at the thought of what would happen once Mkaya left, and visions of malaria danced in my head (it is endemic in this area).

Mkaya left on a midnight bus to Nairobi on Monday, June 18th. Tuesday I spent doing…nothing. No, seriously. I was supposed to meet the HIV/AIDS guy (Innocent Mjomba) in the morning to travel with him to some of the local clinics and dispensaries, but he first called to tell me that he would be delayed by 3 or 4 hours, and then that the public health vehicle he used needed repair and would not be ready until Thursday. I had not yet learned about Kenyan “time” and had sat waiting patiently in my hotel room for the first few hours and then at the cyber, thinking that I should be ready at the drop of the hat to rush out the door, jump into said 4x4 vehicle, and zip off to save the people of this cheerful, developing country from the scourge of HIV. Ha ha.

By the time I found out he wasn’t coming after all, I had spent a few hours at the cyber trying to arrange some way to get out of town that coming weekend. I was also looking for something to do for my birthday the next day. I was gloomy and sulky and BORED. As I was leaving the cyber, I met Khadija, the woman who owns the cyber and the stationery shop next-door. She was very friendly and sympathetic, and rather than smacking me and telling me to “Snap out of it!” a la Moonstruck as I deserved, she told me about nice people in town that I would surely meet and befriend. When she asked what I was going to do for my birthday, I told her that I would probably go to Voi Wildlife Lodge, a safari lodge just outside the entrance to Tsavo East, to swim and have a nice meal and just relax. She agreed that this was a good idea.

After a quick walk through town (it usually takes about 10-15 minutes to walk at Kenyan pace from end to end…Kenyan means slow, by the way), I went back to my guest house. Oasis Guest House (‘Oasis’ is pronounced to rhyme with Onassis otherwise no one knows what you’re talking about) is clean and charming, and the people there are, of course, extremely friendly and welcoming. I went into my room that night, lay down on my bed to read and freak out some more around 7 PM…and got out of bed at 9 AM the next day, my birthday.

To be continued...

M

Ndiyo, Natoka Amerika

Thursday, June 28, 2007

Goodness time has really started to fly! Now that I’m 3 weeks behind on updates, I’ll see what I can do in the next few hours…

June 9th & 10th
My first real weekend in Nairobi was full of fun little trips as well as some quality time with Laura.

Maasai Markets: Touching Is Free
The rains had started in earnest in Nairobi. Were they late? Right on time? In classic Kenyan fashion, no one could ever agree, but in any case every day of my last week started hot and sunny, clouded over by 3 or 4, and then poured rain for an hour or two in the evening. That weekend was no exception, but fortunately I got to enjoy each day without the rain. Saturday I had brunch with Laura and her brother-in-law and niece (Harper is always the cutest 18 month-old in a 100 km radius, no question) and then headed down to the Maasai market in downtown Nairobi to start shopping for the 200 items my father had requested I bring back to fill the sadly neglected and empty house on Jocelyn St. Right…

My first time at the market was akin to walking into a smorgasbord or all-you-can-eat buffet at Holiday Inn or something. There was every possible variety of beaded or carved or printed object or bracelet or wall hanging or pair of salad tongs you ever could have imagined. As a SWF (or SMF, more precisely—Single Mzungu Female), I instantly attracted a coterie of suitors who started that chant that followed me around the entire market. “Hey seesta! Seesta! To look is free, eh? Looking is free? Here, touch! TOUCH!!! TOUCHING IS FREE!!!” Ruth started laughing so hard at the look on my face, which you could approximate by smacking yourself in the back of the head with a board (optional). I started cracking up too when it became so predictable. We would finally shake off one horde of persistent merchants, have 2 seconds of peace browsing, and then whatever sleepy salesperson was sitting on the mat of wares we happened to be looking at would do a double-take at me and the start in with the, “Touching is free!!! And the price is *almost* free!” Ruth liked asking why it wasn’t just free, if it was “almost” free. They tried the, “You name a price, eh? Any price, seesta!” and she would come right back with, “One Shilling!” After much moaning, and “Seesta, you are KEELING MEE!” we would finally take off, me still in fits of giggles. It was so much fun.

We finally agreed that I would just leave her with a list of things I wanted and she would come bargain for it herself in the absence of a SMF whose very presence tended to jack the prices by 200-300%. Another example of how very generous and kind Auntie is!

Once it started raining we retreated home to Hurlingham. Ruth indulged my snacky appetite with pancakes while we watched ‘Deal Or No Deal’ (I am 100% hooked now) and then made me some traditional seasoned, cooked banana dish, which was delicious. I don’t remember now if I mentioned that one of auntie's cousins/nephews was staying with us. He is about 14 and a sweet, studious young man. He helped me learn some key Kiswahili phrases during the week that he stayed with us (‘I smell chapattis!’ ‘No, it’s not ME that is smelling like chapattis!’ ‘Thank you, but I’m married’ and ‘May I please take your picture?’) and seemed delighted to spend a week away from the extremely strict boarding school where he works his little tail off. That Saturday night, he was doing still MORE HW (he had spent most of the days during the work doing HW for hours and hours) and being distracted by the soaps that Maggie and Ruth were watching. Finally, he looked at me with big brown eyes and asked me if I would help him with his Maths.

Now, significant figures and I have a long and storied history, so the problems in and of themselves were not troubling. It was fun to teach him the concept since he is so bright and picked it all up very quickly. What was troubling was the VOLUME of work he had to do. We’re talking 30+ HW problems of the EXACT same thing over and over: please write the number 68,139 using a) one significant figure, b) two SFs, c) three SFs, and d) four SFs. He was fretting that he wouldn’t finish all of it in time to go back to school the next day. What happens if you don’t finish, I asked? Either he would get suspended and sent home to do 40x as much work as before and receive a penalty on his exams, or…wait for it…he would have to dig up a tree stump. I don’t know, but I found this so distressing! Here was this sweet, smart, curious, hard-working kid who had been so intrigued by my laptop (it had a touchpad!! He had never seen one before) and taught himself ‘Chess’ on it as well as by my iPod (‘This Is Why I’m Hot’ is his favorite song so he listened to it over and over and over…and over again) who totally charmed me, and the thought of this puny, adorable kid having to dig up a tree stump because he had taken 2 hours to learn how knights move in chess rather than figuring out .00075612398914 to 7 ½ significant figures broke my heart.

Okay enough. That was Saturday.

I know what you’re thinking. At this rate, how will she ever fill in 3 whole weeks? No worries, folks. My activity level tapered off dramatically after about June 10th….

Safari Sevens
I spent most of Sunday at a rugby tournament with Laura called Tusker Safari Sevens. She and I had both thought it would be fun to go, and so it was. Any sport where they sell beer by the six-pack has gotta have some great fan action, and sevens rugby is so fast that especially if you’ve had a Tusker or two, time just flies! We picked our way through the muddy stands to the side where you could sit about a row or two off the field. The action was fantastic, and I basked in the sun with my friend, my beer, and my camera, diligently photographing the single hottest member of every rugby side with my digital zoom at full tilt. Good times. #3 from Morocco, #8 from Zimbabwe, and #5 from Wales: we should hook up.

Tennis
As many of you know, I am not only a tennis nut but a tennis nerd. I buy DVDs of tennis matches, babble to anyone who will listen about great players and great matches, and generally wear my tennis heart on my sleeve. So to everyone that had the misfortune of seeing me during those few days of June when Roland Garros was building up to its final days and I had NO IDEA WHAT WAS GOING ON because no one in Kenya gives a rat’s ass about Kenya, I’m really sorry. I was admittedly frantic to find out what was going on. That Sunday night, as I tried to determine whether it was Federer or Nadal who won the French Open over the course of FOUR HOURS—count them, four—and then sulked when I found out that Fed had lost to that stupid punk kid again, I remembered the lengths I had gone to throughout the week to find out what had been happening in the tourney: I had texted people to make them look up results, stayed up till 2 to watch the ticker on CNN or Al Jazeera, checked the internet everywhere I could…pathetic. Ah well. As I write this we are on Day 5 of Wimbledon. Not only am I watching the ‘Live Scoreboard’ like any faithful tennis devotee thousands of miles from tennis’s greatest Grand Slam, I am trying to figure out somewhere with satellite sports TV to check myself into next weekend for Finals. W-O-W.

Moving on. Ambitiously, let’s try:

June 11th-14th
I spent much of this week catching up on emails, paying bills, and chatting with the few of you I found on GChat thanks the Laura’s laptop and the free wireless at a neighborhood coffee shop. I also visited another Maasai Market with Ruth to shop for the best prices and goods, had a few nice dinners out—one with Laura at a fantastic ex-pat Italian restaurant and one with some Canadians who I met randomly and with whom I spent an evening swapping dumb movie quotes and eating lasagna and salad…heavenly!—that I have since dreamed about, tried to avoid the locusts that swarmed Nairobi and penetrated even the movie theater where I went to see Ocean’s 13 (loved it by the way. But do you think it’s significant that one of the 10 plagues came to Nairobi while I was there? I personally think so…yuck those things are awful), visited some wildlife parks and just missed having a nice Kenyan husband. Here are some highlights.

‘Ur the kind of lady I dream. Ur fantastic.’
In one short day in Nairobi, I garnered three proposals. After that day, I learned how to say ‘Asante, nadhani nina mimba’, which means, ‘Thank you, but I think I’m pregnant.

The first two were at the Maasai Market, where one man told me he loved me and wanted to marry me while the other just showed me with his hand motions in the air what kind of women he liked and offered to let me come home with him. The third came in the form of a note that was slipped to me while I was sitting in a booth at the wireless coffee house. Part of the note is shown above, but it was also replete with two phone numbers, some doodles, and the aforementioned proposal. Never again will I claim that I am not a lucky girl. I don’t know how I managed to resist these tempting offers, but here I am, Mom and Babbo, toute seule.

Marilyn and Flic
Two days before I left Nairobi, I rendezvoused with Marilyn at her hotel. It was so lovely to see her!! For all who are wondering, Flic was improving rapidly last I heard, having been stepped down from the ICU and de-intubated. Marilyn herself seemed to be holding up very well. Strong as a rock as always, keeping her family posted, staying with Flic as much as possible, asking the medical team lots of questions and getting thorough answers, and staying positive yet patient. I felt right at home with her again when I saw her and was so pleased to here that things were progressing in a good direction. I believe they will be flying home to Melbourne at the beginning of July. I’m sorry I won’t be able to see them again before they go, but I am 100% sure that we will all meet again and under much happier circumstances. Seeing Marilyn again brought things full circle for me after my few weeks in Nairobi and left me feeling ready to move on to another phase of my trip. If she is reading this, I would again like to say how truly happy I am to have met and connected with her, and that I wish her and her family all the best, especially in the coming months of Flic’s recovery!

Ellies and Twiga
I spent all of the day before I left Nairobi at various Nairobi wildlife parks. I can’t even describe what it felt like to touch a baby elephant for the first time or get kissed by a giraffe so I think I will just post a few pictures. (I am running out of steam now after hours and hours in this internet café!) Suffice it to say that that was one of the happiest days of my trip so far. Since then, I have fallen back on animal ogling to buoy my spirits when I am feeling down. I really think that these are some of the most glorious and graceful creatures on the planet, and I can’t imagine anyone wanting to kill or harm them in anyway. Now that I am officially a sucker/foster mother for the elephant orphans at the David Sheldrick Wildlife Trust, I encourage everyone to be like me and fork over money to preserve the elephants and rhinos that are being preyed upon for their valuable body parts.

www.sheldrickwildlifetrust.org

My orphan’s name is Lempaute. She is the littlest one and a total pistol. I am obsessed.

Okay I think I will stop here before I get into what happened when I left Nairobi. To sum it all up, I spent two lovely weeks with some really wonderful people who took great care of me and made me feel right at home. I can’t wait to go back and spend tome with all of them, though I threatened never to speak to any of them ever again if they didn’t come visit me in Voi. I finally felt more sure of myself and independent when I left, being better able to navigate the city and its suburbs but no less shocked by people’s (death-wish) driving style and the congestion of the city. There was much that I hadn’t gotten to see or experience in Nairobi, but by June 14th I was so fixated on how nervous I was to go to Voi and how little time Mkaya would have to chaperone me (only 4 days!) that I could only look forward.

On that cliffhanger, off I go for now.

Missing everyone but soaking it all in here like chicken curry on chapatis—
Miriam

Catching up

Thursday, June 21st, 2007

Many of you have pointed out that after an initial prolific stint as a blogger, I deserted my fan-base to stuff myself with chapatis and chai until I was oily and milky in the face. I am sorry for the radio silence and the precipitous decline in my ability to respond to emails in the last two weeks. My laptop is (unsurprisingly) on the fritz right now—my power cord shorted out about a week after I got here—and as such I am trying to snatch bits of time here and there to write down everything that’s been happening. That being said, there’s nothing like productivity to beget productivity, so since today was my first really productive day in a long time, it seemed an appropriate time to start filling in the last two weeks.

Quick overview: when last I wrote, I still had another week left in Nairobi while I was waiting for Mkaya to arrive and shepherd me down to Voi. I was considering going on a brief safari or something to fill up the time, but I ended up having to wait around in case I needed to be at any more meetings at the University of Nairobi (I didn’t) or if I would end up having a good enough time in Nairobi that I wouldn’t want to leave (I did!). I finally left Nairobi on a bus with Mkaya last Friday the 15th and arrived in Voi that afternoon, where we made a quick stop at the hospital to introduce ourselves around, and then spent the weekend visiting with different members of his family and generally taking it easy until Monday. When that important day came, we met with a few more key people, found me a place to live in Voi, and packed him off on the midnight train to Georgia/midnight bus to Nairobi. I sulked for the first day after he left, celebrated my birthday on the second day, and finally got to work on the third day, today, June 21st. Okay, now for the real, Miriam-ified verbose version…

Friday, June 8th
I don’t think I will ever forget this day because it was my first experience with a) matatus, b) Kenyatta National Hospital, and c) finally getting to check my email and post on my blog!

Matatus are every bit as smelly and deathtrap-resembling as you might think they are. As everyone always seems to say about everything in Nairobi, “You should have seen them 5 years ago!” Apparently the 14 passenger limit (everyone now HAS to have a seat equipped with a never-used seatbelt) changed everything. Just noticed that I don’t have a picture of one, or (what would be best) a video from the inside showing the absolutely BUMPING music that blares in your ear, something which I will have to remedy. These babies are so tricked out, frequent (one comes every 15 seconds or so almost anywhere you are), and CHEAP (a ride costs only 20-40 shillings depending on the time of day) that it’s not surprising how popular they are, despite problems with Mungiki, the drivers’ apparent death wishes, and the constant shifting and asses in your face as people get in and out. Anyway, in true mzungu style, I was mostly so petrified of getting my bag ripped off while alighting that I mostly avoided them except when I was with Ruth. I rode in 4 that day, and maybe one or two others over the course of the next week, and that was it for me and mats.

KNH, as the public hospital in Nairobi is called, is vaguely akin to Bellevue in size, patient population, and array of patient maladies seen every day, but having recently visited Bellevue when I was interviewing at NYU Med, I can safely say that that’s about all these two hospitals have in common. There’s no way to capture in words the sights and smells of KNH. Even two weeks later, there are so many images swimming in my head that I can’t make much sense of it. So many people warned me about the conditions there before I went that I didn’t react as strongly as I thought I might. Instead I was just in a kind of daze as the whole thing kind of washed over me. Bullet points might work best here:

- Burns ward where many of the patients had burns on >50% of their bodies, and most of those induced by spouses during arguments or when sleeping
- Orthopedics ward where patients were three to a bed or sitting/lying on the floor, and the doc I was with recognized a few of the guys as having been her patient when she rotated through that ward six months previously!
- Hydrocephalus: I’ve never seen it in the States, and in one ward on one of the 10 floors of the hospital, I saw at least 15 kids with hooorrible cases of hydrocephalus
- Hand-washing: I certainly never did it or had an opportunity to in the 2-3 hours I was there.
- Speaking of the 10th floor: I guess a lot of patients jump from there.
- 50-60% mortality rate at the hospital
- Babies: often when it’s busy there are 3 in a single incubator. Because appropriate temperatures have to be compromised, it’s not uncommon for one baby to die PER HOUR in the nursery.
- There are patients that have been in the hospital for YEARS. Mkaya told me about one guy in Neurology that had been there for 13 years. Residents would go to the ward just to see him. The doc I was shadowing told me about a baby she had helped deliver from a mom who was in a coma. That was 2 years ago. No one has ever come for Nancy (as the hospital staff named her) or her mother in that time.

I have lists of other stuff, but I think you all get the point. My head was swimming after I left and I have thought about it often since. A common theme that I have observed in lots of medical facilities here in Kenya and that the 5th year student I was shadowing at KNH mentioned to me is this: these medical professionals, every bit as well trained as doctors in the US--if not more so because of their vast and early experience--have the frustrating job of seeing these patients, recognizing their diseases for what they really are, and being unable to properly treat them. Whether because of time and workload constraints (everyone at KNH is beyond overwhelmed) or because their patients finally turn up too late to do anything or because of insufficient resources...whatever the reason, there is a disconnect between diagnosis and treatment. Both the doctors and the patients suffer as a result. While mostly we think of the patients as the sad victims of this "system", from the other side I think how disheartening that must be as a doctor! And yet they cope.

Back to the light stuff. That night we just made toasted sandwiches for dinner at the house (grilled cheese with the best tomatoes ever! What more could Miriam ask for??) and watched TV. I needed to unwind.

More soon…

Missing everyone and warily scratching at my potentially malaria-inducing mosquito bites,
M

Vitu vingi

Friday, June 8th, 2007

Random things I have jotted down in my notebook to blog about:

- Signs I’ve seen – faves so far are definitely:

• “Beware of Children and Warthogs” – at the Nairobi Safari Walk as you’re entering the parking lot.

• “Coffins for Sale” – the first thing you see when you drive onto the Life Sciences campus of the University of Nairobi is the mortuary, which while set down a bit off the road behind a copse of trees is literally circled by kites—the bird of prey, not the festive paper thing on a string—and adorned with signs like “Coffins for Sale” and “Cheap Coffins”. A step off from Tufts…


- Brands/advertising:

• “Biddy” margarine is advertised with a jingle to the tune of “Hypnotize” by Notorious B.I.G. Really? Really. And I thought “It’s Crumb-believable!” was the worst jingle ever… “Biddy biddy biddy/ is trans fat free/ Good for you and the whole family”

• “Kobil” – Jamie Galen, this bud’s for you. Remember the “kala”? The Kenyan gala? Á la Mobil, welcome to the Kenyan petrol stations, “Kobil”.


- Food

• Avocadoes: they grow on trees in people’s yards here. There’s a tub of them in the pantry at Ruth’s house. People eat them for dessert, breakfast, anything. Fresh every day for pennies. Amy, I think you would die!

• Tea: everyone has it at least 4 times a day. 10 AM sharp is a definite. I hope I bring this tradition home with me.

• Chapatis: made fresh here at Ruth’s every day. Breakfast is white tea, a couple chapatis, fresh-squeezed OJ, and a banana. As in the US, it is my favorite meal.

• Samosas: also home-made. Whatever, EVERYTHING is home-made and very good.

• Boar Sausage Pizza: ordered it with Laura last weekend from Pizza Inn. Let’s just leave it at that.


More soon! Hooray for working internet!!!

M