Zebra

Preview to Masai Mara

Masai Mara: Hilarious photo of zebras staring at a sleeping lion either too scared to move or wondering if he's going to come hunting after them. In my personal opinion, this particular group of zebras may not have been the sharpest in the migration.

Moi University Medical Student Hostel

Finally some photos of the hostel! I have to take pictures of the bathroom tho. No comment on these, you can feel free to form your own opinions. Honestly though, I love living there bed bugs and communal bathrooms and all. Hanging out with the Kenyan medical students has been a great experience and it feels like there is always something going on. It's like being a freshman in the dorms again!

Street Children's Parade

This past weekend, instead of going white water rafting in Uganda like many others in the group, I decided to spend the weekend hanging out in Eldoret to get to know the city a bit better. Friday some of us went out for Indian food at a restaurant in town that was excellent. I have to say that Indian food in Kenya is definitely better than places in the US (except my mom's house of course!).

After, I headed back to the hostel, and met some more Kenyan medical students. My roommate Soshana wanted to go into town to pick up some food but somehow they talked us into going out to a club with them. The club is called Spree and I have to say that it is a really fun place. They play mixture of hip-hop, dance, pop, and popular Kenyan dance music. The Kenyan medical students definitely know how to have fun around here, and I would say that they go out more than us in the US.

One of the coolest things that I have done in Eldoret so far is the Street Children's Parade that I went to on Saturday. We met up with a group of people that was a combination of many street children, people who work with them, and other local groups that walked from the town hall of Eldoret to a children rescue center that was approximately a 45-minute walk away. The entire way I talked to a girl named Faith who lives at a boarding school that takes in children who have nowhere else to go and provides them with a safe place to live and an education. She was very sweet and was one of the students presenting at the program they had at the rescue center.

I thought it was a great experience overall, but they were many many street children who came which is not a happy sight. There are various social programs set up in Eldoret, but they don't provide them with as stable of a home that children need to grow up unfortunately.

That night, I had dinner at IU house that a bunch of us put together, but to be honest I mostly played with Dr. Stone's baby Gavin who is ridiculously adorable :)

Hope everyone is well! Love from Kenya

Don't Let the Bed Bugs Bite!

On Monday, we moved from the amazing IU House to the MUSOM Student Hostel. I was actually excited about getting to know some of the medical students on my team better and living there would give me the opportunity to go into the hospital during the evening to help admit patients and to check up on some of the ones that I follow.

That night actually was an interesting experience. Getting acclimated to a room that is about 5 feet by 7 feet that two people have to live in is something very different from what we experience in the US. Also, the communal bathrooms.... they are something else I guess. The one on the second floor is the one I went to first and I became very worried about the rest of my time there, but I soon found out from some of the other students that the the bathroom on the fourth floor is much better. And trust me, after seeing the standing brown water and smelling the 2nd floor bathroom three doors away, I don't mind the 3 flights of stairs multiple times a day. I truly am excited about living there though. I've already gotten to know some of the medical students and I hung out with one of the 4th year students (= MS2) for an hour in her room.

Well, right before falling asleep, Sashana (2nd year Slemenda Scholar and my roommate) told me that she saw two little bugs in her bed that are "longer than they are wide." At this point, I had been studying on my bed for the past hour so I decided that it was late and I was going to sleep in that bed regardless. Needless to say, I woke up with bites on my legs from presumed bed bugs. So they moved us back to IU House while they fumigate our room with something that is illegal in the US. Luckily, I didn't unpack anything so I don't have to boil/throw away all my clothes.

I am definitely having culture shock on the wards. More so than outside of the hospital. Things just work very different here and I'm still getting used to some (no pretty much all) of the intricacies of maneuvering the medical system at Moi. I have also seen some interesting cases that I never thought I would see outside of my pathology book. This includes multiple cases of miliary TB, rheumatic heart disease, TB meningitis, aortic insufficiency with infective endocarditis, and possible neuroleptic malignant syndrome (and so much more that I can't even think of right now). I will try to post some interesting cases/physical findings as I come across them but i will have to wait until I find a way to black out eyes in videos/pictures.

Dr. Mackenzie Lupov using a mercury blood pressure cuff :) (Her blog that is much more informative than mine: http://mackenzielupov.blogspot.com/)

Eldoret, Kenya

So I’ve been meaning to post in my blog ever since I got to Kenya, but unfortunately, the internet hasn’t been working so I’ve been saving up a lot of stuff to post.

I’ve currently in Eldoret, Kenya doing a medical student exchange program through the IU-Kenya program. (Link: http://www.iukenya.org/mission.html ) Essentially, I’m here for 2 months working on the inpatient wards at Moi University School of Medicine (MUSOM) and working with the Kenyan medical students. I’m going to be living at the MUSOM student hostel (I moved in and then moved out because of something unfortunate that I will go into shortly).

So much has happened; honestly I don’t know where to begin. This is what I get for procrastinating as usual.

The first week, I pretty much spent traveling around with my parents, which was a lot of fun. Amazingly, we didn't fight to much, but I would say that after 5 days of safaris I felt very exhausted. I might try to do some catch-up posts on that, but mostly, I will just post some pictures.

I got to Eldoret and found out that I would be staying at the IU house until all of the medical students got here so that we could all move over together. Now that I've been to the hostel, I will make sure to give you some great photos of the way that the students in Kenya live... definitely very different from us.

Today was a bad day for me, but rather than starting my blog with a depressing story, I think I'm going to think about it overnight and get back to it.

So instead, I'll leave you with a cute picture of baby lions:

La Brigada

Today was our first day of medical brigades, and according to Dr. Sevilla, it was the healthiest community that we will encounter during this week. This is mostly d/t the fact that they are only a 45 minute drive to the closest “city.” Many of the communities that we will be visiting are much more secluded with an even decreased access to health care in comparison.

Driving up the mountain, one of the most poignant pictures is of the garbage dump covered in scavengers, both human and vulture picking through the discards of the larger towns below in hopes of finding valuables. The smell of course assaults you, but I feel that the continual presence of this is a much more memorable image. Although, many have tried to move the “basurero” away from the small town, much of the efforts have been met with pure apathy.

In the town, fortunately, many of the other public health efforts have been successful. The majority of the residents of the town have chimneys instead of stoves so that the smoke of their cooking fires billows outside rather than into their homes and their lungs. The improvement in the health of these families has been substantial as they have seen a dramatic decrease in morbidities such as asthma and COPD. Additionally, there has been a significant decrease in the carbon monoxide poisoning seen.

One patient I had sticks to my mind tonight. She was an 80-year-old woman who came in due to a cough that she had had for years and pain in her bones (“dolor de los huesos.”) With her simply attempting to walk in, it was obvious that something was very wrong. Her protuberant belly preceded her as she was guided toward our small little station in the loud classroom. The cough she had had for years, but what bothered her most was the pain in her bones. As much as I attempted to redirect her toward her cough she had for years or her history of ovarian cancer, my attempts were futile as she continually insisted that the other brigade had checked her out and she was “fine.” Soon enough, as much as I attempted to speak to her and offer some sort of treatment for her bone pain in hopes of delving deeper into the root of her problems (recurrent ovarian cancer? Carcinomatous TB?), she left. Even now, I am left with the question of what could I have done differently and how has the discontinuity of care between the multiple brigade groups entering this community has affected the long-term outcome of her health. It is completely unclear to me why they decided that she was "fine," and what sort of tools they used. Did they ultrasound her belly? Did they perform a PPD? Sometimes, you feel like there is only so much you can do.... and it makes you feel a little small.

Honduras

Going to Honduras for my Family Medicine Rotation through the ENLACE program! 1 week brigade and 3 weeks in Tegucigalpa! Can't wait :)

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New Summer Plans!

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Brigadas! (Tropical Medicine Community Trips)

Today has been the best clinical week in my opinion. We're traveling with the public health teams here in Puerto Escondido to outlying communities to learn about the programs that are being undertaken in Oaxaca to reduce the numbers of Malaria and Dengue. Since the program was started in 1999, the number of malaria cases in this region has gone down from 20,000 to 250. Seriously remarkable!

Mexico has one of the most extensive public health programs in the world. In this state alone of Oaxaca, they employ more than 3000 workers not including the administration and coordination officers.

We followed officers who work with the initiative called Patio Limpio. In this program, the officers visit every house in the state to assess the cleanliness of the area to prevent tropical disease carried by arthropod vectors. This includes dengue (Aedes aegyptis - mosquito), malaria (Anopheles vivax - mosquito), and Chagas disease (triatomes).

Although the cases of malaria have decreased in the region, dengue is becoming more prevalent (ick). A. aegyptis likes to stick around the house so the cleanliness and lack of stagnant water is a huge deterrent to keeping these bugs away.

Monday - stayed at the Jurisdicción de Puerto Escondido to see the malaria laboratory that they have there. The lab techs identify the cases of malaria with microscopes using slides sent in by volunteers in the community. Each community has a "notificante." When someone is sick or has symptoms that could indicate malaria, they visit the notificate who takes a blood sample which is then sent to the lab to verify whether or not it was malaria. The interesting this is that the notificante gives a precautionary dose of chloroquine as soon as the symptoms are suspicious and when the case is verified, the full dosage is given. They taught is how to identify malaria using the microscope and showed us the various stages of the parasite's life cycle. Not going to lie, it was kind of nice because the lab was air conditioned and it was the first time that I had been in air-conditioning while in Puerto Escondido.

Tuesday - One of the community workers took us to a small town called Tometal to show us a house that had cases of both dengue and malaria. They had also seen the bugs that transmit Chagas in their home, but luckily no one had been infected. The reason that I like this week is that we get the chance to talk to the people in the communities to ask them what they think of the program and the services available to them. The officer who took us out into the country was really nice and decide to give us a mini-tour. He took us to buy watermelon where I got a bunch of mangoes for free because there are so many that they can't get rid of them and don't eat them... (no way!!!) anyways, he also took us to see some iguanas or something (random) and to a point that is a great lookout over Puerto and has some religious memorials.

Wednesday - We went to learn about how they educate people on the Patio Limpio program. We went to a couple of houses with some of the officers here in Puerto. It was interesting because in the first house we went to we found A. aegyptis larva inside of a water feeder for one of their roosters that they forgot was there. There were also some in the water tank that they use to conserve water. In many parts of Oaxaca, they only get water one day a week. Therefore, people save it in tanks. Well, of course this is the perfect breeding ground for mosquitoes if it isn't kept clean or treated. They rate each of the houses according to how well they follow the plan. When they find a house that has problems they always return within one to one and a half months to check up on how well they are following the suggestions. They don't tell people when they're going to return because they want them to do it all the time and not only when the health officers come. Afterwards, we went out into the country again because after there has a been a case of dengue or malaria they spray insecticide as a ring around the house so that those mosquitoes that carry the disease can't spread. They told me that they used to spray everything but it wasn't working very well which is when they decided to start community capacity building programs instead. Pretty awesome! Especially because the newer programs that involve the community have been much more effective.

Thursday - Today was a very awesome day. We went out to meet a woman that is the health capacitor of her small town of 120 people. She gets together with the women of the community to set up programs for the health of the families. It's amazing that in her town there have been no cases of malaria or dengue and none of the children are malnourished (not so in Puerto Escondido). She was a very cool lady and explained how she works to set things up for the community. While we were in the community, people were amazed that we had come from the US to their small farms pretty much in the middle of nowhere. We were like local celebrities. We got free bananas from the store (the best I've EVER had btw) and Aureliana made us a delicious lunch of chicken soup•. very, very fresh chicken soup!

Montezuma's Revenge

Montezuma's Revenge is what is referred to by tourist's who visit México and experience stomach problems. The name is derived from Montezume III the ruler of the Aztez empire that was defeated by the Spanish conquitador Cortés.

Well, for the past 3 days, I've been feeling pretty cruddy. Haven't really done much other than lay around and feel nauseated. I'm starting to feel a little better right now so I think I'm going to go to the beach to hang out for a little while, but will probably take a taxi to get there.

Sigh... it stinks being sick.

Rave

Went to an all night dance party last night... it was amazing. Amazing DJ, everyone dancing on the beach under the stars, fire spinners... what more could you ask for??? The atmosphere was so accepting and fun that no one had any inhibitions to dance. It was great to dance without worrying about all the people around you. I hope there's another one this week so we can go again and stay until dawn.

Mercado, un Rodeo, una Roca Blanca, y un Incendio

Yesterday, we got up early in the morning to go to the market because Becky was leaving that afternoon and wanted to do some last-minute shopping. Rebecca and I went with Lori and Becky's host mom and sister. It was a lot of fun checking out the local market for all of the great food and handicrafts etc. One cool thing is that we went to two small stores next to the market to buy café and chocolate. I got some homemade chocolate that is very tasty and very very dark. It's great!

I fell asleep after getting back which was great to rest during the middle of the day. I took a much deserved siesta. That evening, I went with Lori and her host mom and sister to a Mayan wedding that they had heard about that was happening on the beach. It started one hour after they had said (of course) but it was pretty cool to see the beginning of it. The "novios" came in on a boat from the ocean and they were dressed in their wedding clothes which were beautiful. They did some prayers where they prayed to the Houses of the North, East, South, and West.

Suddenly, Marie Carmen decided that we should leave because of the dinner. It's a good thing we did because when we climbed back up from the beach there was a big fire with trucks and everything! It was pretty scary, but I wasn't so scared to not be able to snap some pictures. The brush around Playa Manzanillo is pretty dry, so I wasn't really that surprised that it was on fire. I'm glad that we left when we did though, because it could have been much scarier.

That night, Rebecca and I decided to go to the Rodeo which came to town. We didn't know that the tickets were going to be pretty expensive (well not really but $15 is a lot in Mexico!) but we found out that the rodeo was very long and that there was a concert afterwards by a pretty famous Cumbia band called La Apuesta. We really enjoyed it and I saw my first rodeo in Mexico and the first one that I remember clearly.

The next day we just relaxed around Puerto Escondido, and in the afternoon we went to a place called Roca Blanca that is another beach that is nearby. It was beautiful! Rebecca and I climbed some rocks to be able to get to a deserted beach on the other side which was awesome. Climbing over the rocks was kind of scary thought because I went on the water side which was dumb because the waves kept splashing into me. We just spent time with the family and enjoyed a nice time on the beach. Unfortunately, as soon as the sun began to set, the mosquitoes came out and in about 3 minutes gave me a ton of bites on my ankles :(

Urgencias

Thursday and Friday I spent my time in the Sala de Urgencias (or the Emergency Room). I mostly shadowed the two interns that work there. They were both really nice; it was pretty cool to see how a smaller community emergency room works after working at the one by my house (in Munster, Indiana).

Thursday was pretty chill. It really wasn't that busy. The stuff that we saw was mostly stuff that you see on a normal basis in Mexico. Pregnancy, accidents, infections, etc. One thing that I saw that was pretty interesting was a woman came in with a relatively large mass in her breast. They weren't sure if it was a cyst or a tumor, but they won't know what it is until they do either a biopsy or an X-ray. Other than that there were a couple of women in labor, a bladder infection, and a broken leg.

Friday was VERY busy. First, I saw a woman who came in with labor pains whose baby had his umbilical cord wrapped around his head. They were examining her when suddenly an ambulance came in.

Two small brothers had been poisoned by what, they didn't know. I had never seen this before. It was very devastating to see two young boys so incredibly sick. I can't even fathom what the mother was going through to have both of her sons obviously struggling to even breathe. They were screaming in terror and pain, having trouble breathing, and salivating. They immediately took the smaller boy to the trauma room because he was in much worse condition, but the older boy (and by older I mean three years old) was simply taken to a regular emergency room bed without a monitor or anything like that.

I stayed with the older boy pretty much the entire time. He was absolute terrified (for obvious reason) and kept trying to remove his NG tube which could not have been comfortable at all. In some ways, they were not prepared for such an emergency. For example, the intern gave him the NG three different times because of various issues. There was also sanitation problems with not everyone wearing gloves all the time. Also, it kind of felt like there were too many doctors in the room. (Three attendings + two residents + two interns + many nurses), but overall, they did a good job. The boys were stabilized when I left. Mostly, I was just there to help with holding the young boys legs, making sure he got enough oxygen, talking to him to help calm him down, things like that. Pretty simple, but every little bit helps.

One of the residents was really great. When I told her that I was a student, she explained everything that was going on and when through the basic steps of doing a basic pediatric examination. She was from DF (Mexico City or Districto Federal) doing her four months of service at a rural hosp ital that is required of all residents in Mexico. I can tell that I am understand more Spanish all of the time, but it was very hard for me at times because people would ask me for stuff, but I wouldn't know what it was. Although I speak pretty fluently, there are many vocab words that I still need to learn especially medical ones. I learned that the hard way.

Oh, also here are some pictures of the hospital. I made sure that the faces of all the patients were covered or not visible in the pictures to maintain privacy although there aren't any laws that are actually enforced of the type in Mexico. I also made sure to ask consent first.