The Medical MacGyver

I am the 99 cent Jr. Bacon Cheeseburger

2012-01-14T07:44:00.000+03:00

A few days ago, I got fed up with people reposting photos from the "We are the 99 percent" tumblr. While some of these stories have merit (mainly those with hopeful messages), the vast majority are sob stories meant to get attention.

Let's review

1) Almost all pictures are taken in front of a computer screen, in a living space with electricity, and with some kind of digital camera.
2) Nearly everyone claims to be destitute despite this. So much so, that they can't pay their medical bills or student loans
3)If you don't think you can pay off your student loans, don't take the gamble of going to college. You don't HAVE to have a crappy job to act as some cog in society, I can carry out my own pizza.
4)The whole movement reminds me of the "I am 99x" advertisements from 10 years ago
I am 99x
5)It reminds me more of actual destitute people who for decades have allowed themselves to be photographed for western photographers as a plea for help

I created this satire as a response you can share on your own facebook walls. Please share it with as many people as possible.

Falling from the Sky Addendum

2010-05-19T17:36:00.006+03:00

I'm sure some of you may have had a hard time believing the largest airport in the entire country could be completely blacked out for hours-that's why I shot this movie as I drank my last Tasty tusker before the coolers warmed up. As you may know, I shot hours and hours worth of video while I was in Kenya last October-so you get the complete experience, I will be uploading some of them here for you! Keep checking back!

As a side note, while I was travelling around between Nairobi and Maseno I took Jetlink airways. While I lived, for future travellers, this may not be a good idea. Be sure to check out the video below which inexplicably is dubbed with Sarah Mclachlan techno and matrix references between plane crash footage.

Learning Swahili the Hard Way

"Ok children, if you want to talk in class I need you to raise your hand like this...(SNAP!) OH MY GOD! SOMEBODY HELP ME! DON'T FEED IT TO THE CLASS HAMSTER!!!!!"

"Haha Mwalimu wetu aliaga dunia kwa ukoma!"

Out teacher died of leprosy

Pints of Pus (A guide to become an overnight viral video superstar)

2010-02-14T21:24:00.008+03:00

If you have read my posts about Samson and the witch doctor, you know I was dealing with some serious abscesses over in Africa. Nothing compared to the massive incision and drainage of a leg that we performed while over in Kenya. The story was a 12 year old girl was playing field hockey (like ice hockey, but without canadians and the players have more teeth) when she was kicked hard in the side of her leg. Like many of us, she shrugged it off and continued on with her life. Unfortunately, she developed a big pool of blood in the area she was kicked called a hematoma. The hematoma bleed lateral compartment of her right leg and over time, it swelled up, causing pain so severe she was unable to walk. When Dr. Hardison and I saw her she would scream and cry anytime her leg was touched. We knew we were going to have to check it out internally. We brought her to the operating room and gave her ketamine to anesthetize her and opened up the lateral portion of her leg. What followed had to be seen to believed-thankfully I had my camera in the OR and began shooting video right away. Thick blood mixed with pus began pouring out of the wound at such a fast rate it was quickly covering the table and falling to the floor. We grabbed a metal basin nearby and put her foot over it as we explored the hollowed out cavity with our probes and foreceps and pulled out long clots. I didn't think it would ever end as we quickly filled up the metal basin with I would say 3/4 of a liter of blood and pus (if not more) and packed her incision with iodine soaked gauze packing. The next day we removed the packing and cleaned out her wound a little more at the bedside-but after that she didn't have any more drainage and felt well enough to go home!

I think my most memorible incision and drainage was the one I did by myself without Dr. Hardison-and it was definitely the one I would have felt much more comfortable with someone watching over me just in case. This was a small 5-6 year old boy with AIDS and numerous complications. One of his many complications were nearly a dozen abscesses on his neck which Dr. Hardison asked me to individually incise and drain and pack. Once again, the boy was brought to the operating room and given ketamine to anesthesize him. I watched the boy's chest heave in and out-his neck moving up and down with every breath. I took the scalpal blade in my hand and knew I was going to have to make sure I was very careful of any movement and his variations in breathing. One small error and this boy would have a cricothyrotomy or worse. I elected to hold the scalpal blade with my fingertips for better control as I meticulously opened each one and drained them all without incident. Before he left to go home, I was able to finally get a smile out of him.

By now many of you are probably wondering how what I have said will make you a viral video superstar. A few months ago, I was uploading videos of my trip to youtube for later use in this blog. Well, I uploaded the incision and drainage surgery of that child's leg. Yes, I did say in the description that this was a medical procedure done under sedation uploaded for learning purposes, and yes, there are hundreds if not thousands of actual surgery videos to watch on youtube if you are so inclined. Perhaps I should have titled it something other than "EXTREME PUS DRAINAGE" but I figured no one was going to watch it anyway. Well within a few days, my video has 30,000 views! I scratch my head why and then I see on the comments section "congrats, you made the front page of www.popthatzit.com" (not to be confused with pimplepoppers.com or the boilandblackheadblog.com). If there is one thing I have learned in life, it's that there is a fetish for everything-and some people really like to see enormous zits pop. Pimples are just the gateway to bigger pus payoffs-large incision and drainages, sandfly removals, the list goes on and on. Who can say if "pus porn" is addicting, but based on the numbers I was saw on my youtube video-I would say it is. The comments on the video (you can see them here) are hillarious. Some people expressed 2 girls, 1 cup-like nausea and vommiting from the video. In the end, youtube ended my fun by pulling the videos and giving me a warning that if I post anything like that again I will be BANNED FROM YOUTUBE! Thankfully, the more progressive folks at vimeo have not pulled the video, so you can still check it out. I do warn you before watching these videos-it is a very graphic procedure so if you are easily disgusted by blood or pus-do NOT WATCH THIS VIDEO.

Incision and drainage 2 from dan ketterer on Vimeo.

Leg Incision and drainage and exploration from dan ketterer on Vimeo.

More Swahili Translations

Try this rope swing Jimmy, it's super fun and it takes you right over acid crocodile lake! There you go, you got it....AAAGHHHHHHH!

Kamba ilikatika alipokuwa akibembea

The rope cut as he was swinging

Betsy Ross's husband's style of parenting

Alimwumiza mtoto kwa sindano kubwa

He injured the child with a big needle

Sunday Bloody Sunday

2010-01-04T04:09:00.008+03:00

How did you ring in the 2010? Was it a champagne toast? Watching the ball drop on TV in a warm toasty home? I was on 30 hour ICU call on New Year's Eve at the Regional Medical Center here in Memphis. The Med does not have nearly as many "Code Blue" emergencies at the other hospitals, but before started my shift I got this strange feeling that there would be one that night...right around midnight.
Sure enough, the only code of the night comes as the skeleton crew (made up of 4 residents-no interns strangely) gets ready to ring in the new year. The person who coded was a very sick individual and his numerous medical problems stacked against his chances of living as we injected him with medications to restart his heart and each of us cycled the CPR roles. I felt that sickening feeling as the bent and cracked as the CPR was done. I ended being the one that got to call his wife right before midnight to say her husband was dead.

As we helped the staff clean the poor man up for his wife, who was on her way-we started the paperwork and I believe we all felt the exact same way. A strange sense of solidarity that came from the fact that we were all upper levels and experiencing a new year like few else would. The moment was not marred by the recent death, we felt connected in that moment though. I tried to get a picture of all of us with my camera phone but the other residents didn't like the idea considering what just occurred. I then thought to myself-I must have taken 1000 or more pictures in Kenya but I have almost no pictures of my fellow residents and I've been here a year and a half already! It may be the reason you take more pictures at Disneyworld than you do of your co-workers-one is exotic and the other mundane and routine-but in moments like the one I experienced at midnight I realized just the opposite was true.

It's amazing how much memory is like a sieve over time when you don't take those pictures to remind you. Of course, I didn't have my camera with me at all times with me nor did I have a 24 hour documentary crew (it wasn't in the budget-they spent the money on something called medicine instead) so I couldn't capture everything that happened. Despite my nimble fingers, there were just some things I couldn't get to that were so important to cover and I kept reminding myself I would have to come back to cover it. One of these things was the Bloody Sunday which already I feel has become a victim to my poor memory. Pieces of it have broken apart from what I thought was an impossible to forget experience. The same thing happens with my comedy-so many amazing jokes and skits lost because of poor memory or thrown away post it notes.

Tonight I am again on 30 hour call and I decided to get some sleep early in case it was going to be another long night. I had the strangest dreams/omens, not really pertaining to Kenya but haunting and none the less would soon be forgotten unless I posted it here. In my dream I am cruising through what I think is Las Vegas and noticing that many of the big hotels are modeled after famous buildings around the world (Luxor, New York, New York, etc) and I sort of laughed that instead of so many people being able to personally see the real amazing sites in person that Las Vegas was their sort of cheap alternative to world travel. As I drive through I am amazed that they have a replica of the Eiffel Tower in Vegas (I actually didn't know that there really was one before this dream-but it turns out there is here). Yes, you can see all the magnificent knock offs of famous world structures in Vegas if you are so inclined. Once I get to my destination, I am somewhat surprised to see many people that were at one time significant were waiting for me-only except I can no longer remember their name. The sky is blood red as the sun goes down and I am struck with an intense pain. My vision gets blurry but I try to keep it together but I can't remember anyone's name of the people around me to ask for help. These are not your trivial acquaintances either-but current and former girlfriends and other really meaningful people I am surrounded by but cannot remember their name. At this time I am in a building with big glass panes for walls and as I look out at the blood red sky I see 2 black clouds in the shapes of claws, one on each side of the building that I am in drawing closer. As my vision blurs and I wake up, I feel the cold black claws of death envelope me in their grasp.

After waking up, I knew before I forgot it as well I had to post about the bloody Sunday I experienced while in Kenya. I remember walking from the guest house to the hospital and rather than being greeted with the calm quiet and maybe the occasional monkey-there was chaos. Ambulances were scattered over the lawn families outside crying and moaning. This was not the quiet hospital I was so used to waking up to. I am able to piece together the pieces of the story-the major one being there was a big car accident on the main road going to the hospital. An entire family was travelling in a private car when they were struck from the side with a packed speeding matatu (van cabs). Cars in Kenya tend to lack many of the safety features that we are so used to, airbags being one of them. A husband was driving and his wife in the passenger seat and the kids in the back. The car was struck as it pulled out-the matatu smashing into the driver's side killing the dad and at least 1 of the kids in the back. The wife was relatively unscathed except for a few cuts wailed in her room in disbelief of what was happening. Her children had to be transported to the provisional government hospital. Several people in the matatu were also injured or killed as well and they were all brought to our sleepy hospital-overwhelming what little staff there was. We ended up transferring them as quickly as we could to better equipped facilities-with no ICU; there was not much we could do.

Another injury I saw that day was one I had never seen before, but considering the risk factors for getting this injury, I was more surprised I had never seen it before. The patient was a college student at Maseno University across the street-pretty and young, receiving blood transfusions. I asked Francis the clinical officer what had happened. Apparently, she was having sex and the man was so well endowed that he actually punctured through the posterior part of her vagina (the posterior fornix for those medicos out there). She was now had an open cavity into her peritoneum and was bleeding into it-not good. We ended up boarded her onto the ambulance with the car accident victims and transporting her to Kisumu.
I am scratching my head now for other things that happened that day to later cause me to label that day as "Sunday Bloody Sunday" but I cannot remember now. Was there another death or injury I am forgetting about? The fragile nature of memory had caused that day to now be fragmented where I once thought it was bulletproof. Thankfully, I have this journal, and thousands of pictures to help me remember Francis, Samson, Lynette, and Dr. Hardison and all those who mean so much to me, that I will not lose them in that red sky.

I will post some more swahili translations once I get home

St. Mary's Presentation

2009-12-17T17:53:00.004+03:00

UPDATE 1/3/10 Parts 3 and 4 have finally been uploaded-now you can see the conference in it's almost entirety!

This entry is currently incomplete-part 3 hasn't been edited yet but I wanted to put up parts 1 and 2 in the meantime-youtube still may be converting them so the quality will be much better this afternoon. Many of you requested seeing the video feed from the Kenya talk I gave at St. Mary's last weekend. Double click on the videos to go to the youtube page-I left a pretty good description in the part 1 video (which you will see on the right side of the page).

Part 1

Part 2

Part 3

Part 4

Stinging in the rain

2009-12-04T16:36:00.001+03:00

Another interesting phenomenon occurs when there is damage the cervical spinal cord at levels C3,C4, and C5. Instead of chorea like dancing this time causing spontanous diaphragmatic impulses resulting in unintelligible but patterned sounds to be bellowed out without consistant tone or pitch but with some sort of underlying repition. This medical condition was initially discovered by Japanese researches and named after the Japanese word meaning "to sing" which is "karaoke"

Here are some affected patients

While I was in Kenya-I suffered from an unfortunate Panga injury to my cervical spine-causing spasms of the nerves which innervate my diaphragm forcing me to have recurring belches that resemble something like singing. My condition seemed to be triggered by humidity because whenever it would rain-I would sing! (Gene Kelly suffered from a similar condition). So when I felt it come on, I would try to sing traditional African songs until the spasms stopped. Since few people here know these traditional African songs, I don't expect you to recognize them but have fun watching me sufffer!

Caucasian Chorea Compilation

2009-12-03T00:43:00.009+03:00

Medicine and dance have always been intertwined like two tango partners. Since the drawn of medicine with the ancient greeks, diseases have been described by actions they may create. One such disease described by the greeks is "chorea", in which the victim uncontrollably performs dance like movements. Chorea is a sign of many organic brain diseases (as opposed to inorganic brain diseases which use pesticides and exploit farmers)such as Huntington's disease.

Once someone's brain is damaged so severely, the body becomes unable to control itself and random nerve firings trigger sometimes violent muscle jerks. When analyzed closely, these jerks can sometimes be patterned and actually resemble a dance-which is why "chorea" is the greek word for "dance". What I am trying to say is that every one of us has the capability to become a dancer-provided we suffer an inordinate amount of brain damage. This may be why alcoholics are often regarded as the finest dancers.

Therefore it should come as a surprise to no one that part of my medical mission was to honor my medical forefathers and show the Kenyans some of the hottest dance moves on the planet. While there Westerns that came to Kenya with the goal of treating a village for malaria, or help infants with HIV, but just as important as this is to teach children the pure joy that comes from learning a complex dance that reaches deep into your soul and dig through those years of oppression, hunger and death and rise to the surface the joy and harmony that can be expressed though dance. It was with this goal in mind that I chose to teach the children of Kenya the Stanky Legg.

Link to official video
http://www.youtube.com/watch?v=H0TpyCU6iv4

David and Helen, my two fellow medical missionaries I was living with, are far more skilled at dancing than I'll ever be. I remember one night David and I were both sitting at the dining table with our laptops out and listening to music. David's music selection on his computer was radically different than what I listen to-namely it was the dreaded "adult contemporary" music. David lets it slip that he still dances quite a bit and Helen asks for a sample. David puts on some Calypso music on through his tinny laptop speakers and they danced right there in the dining room. I'm not a dancing expert, but it looked pretty good and seemed to be a compilation of several white people dances: ballroom, latin, and square (only missing were the chicken dance, electric slide, and macarena).

After Helen and David danced for a while, they tried to get me involved as well. All the dances they had done pretty much were for 2 people so what could we do? Helen suggested doing some indian-esque dancing, David also having some slumdog millionaire sounding songs on his computer. Helen explained:

"To do Indian Dancing you need to lift one knee up and pretend you are going to high five it while keeping your upper body straight". Yes, that's all there is to Indian dancing. So the three got on the dining room dance floor, I handed the camera to Helen our housekeeper and we filmed this monstrosity-(remixed by DJ Vaggy!) The stupid hats were inspired by Helen-not alcohol.

Look for the follow up to Caucasian Chorea Compilation very soon where I show you what happens when you have cervical spinal cord dysfunction!

Not like he was going to raise you anyway...

Baba yangu alikufa ajalini

My dad died in the accident

Revisionist History-Little Orphan Annieshequa

2009-11-23T01:51:00.005+03:00

Little Orphan Annieshequa was the most adored entry I have done so far. How can you resist those adorable orphans smiling, singing, and admiring the rims of the land rover? So much of the experience could not possibly be put in words, which is why you get another revisionist history.

I took so much video that my camera battery-which had a full charge-was dead by the time I left. Here I was expecting a dark, dank shack filled with orphans in potato sacks requesting more porridge (I may have been thinking of Oliver Twist or Employee appreciation day at the Nike Factory). Winding though those precarious narrow dirt roads on a bright sunny day- we reached the church to find 40 or so orphans circled around a shade tree singing in perfect 2 part harmonies. I quickly brought out my camera and filmed the traditional Africa Spiritual "Ride that choo-choo Pirate Jesus".

Two days ago I was talking with my colleague Carlos and Dr. Steinhauer-all of us having spent a month or more in Maseno about their inherent singing ability.

Dr. Steinhauer said

"In church, they would go into perfect 4 part harmonies without any instruction-it like they just knew".

The ability of the Africans far exceeded that of any Caucasian. I know this because I went to church on Moi day, which is a national holiday. All the Africans were absent, so it was just white people trying to sing. Worse still, there were percussion instruments (drums, tambourine, etc) that white people without rhythm should NOT USE! "He has made me glad" sounded as cheerful as a funeral, but you be the judge.

Compare this to our swahili service

When I went to go help out at the Orphan program with David-we saw that Kindergarten through second grade kids were being taught basic math skills on chalkboards outside. David and I could do basic math with the help of our cell phones, so we volunteered our skills to teach these kids. We were whisked away and brought into an actual public school and told we should teach them something. I brought out my digital camera and David and I just winged it for that whole class. David and I (especially me) really wanted to know what the kids would do to improve the country. I really wanted to hear someone say "rise up against government corruption", but I am not sure that idea would be tolerated in a public school. If you watch the videos, one child said exactly that. Eventually, it became a lecture about teaching kids about HIV/AIDS-it was amazing. I took the time to upload all these videos in hopes that someone will watch them-and as an added incentive, within one of the videos is a code-first one to email me the code will win a prize from
Kenya!

It's thanksgiving today, I hope everyone is with the people you care about today. I know I appreciate what I have so much more now.

Revisionist History-26+2 (the birthday post)

2009-11-21T00:12:00.003+03:00

It's time again for some more revisionist history-this time for my birthday entry (a.k.a. 26+2)

DID YOU KNOW?!?

That many of the titles for my posts are song titles or references to songs that are relevant to the themes of the post? I did this there because I want you to explore deeper into this project, and part of the way I do this is through these cryptic messages. If there is something you don't quite understand why I put in there-google it! You will be happier to discover it yourself! This particular entry was a reference to "fourty six & two" from Tool-a complex song about changing one self, its lyrics very much relevant to this post. Look around though, you might find some more surprises I hid for you.

As with all of the videos I post on here, if you double click them-you will be taken to the youtube site where you can then click the "HD" button in the video toolbar to watch these in widescreen HD!

The first video I am putting up is one I debated with myself about putting up. In my entry, I talk about going to the Maseno Club and that Helen and David as my present each said 3 things they really liked about me. Yes, 6 total nice things about me. Here they attempt to do the impossible I didn't say in the entry what these things were, but I did film it as it happened in real time from a 1st person view perspective. This is the video below.

This next video is at my super special birthday dinner as Helen, David, and Emmah sing me happy birthday. Blowing out the candles was probably a bad idea though since we then lost electricity and that was the only thing keeping the room lit. Sing along if you know the words!

I come up with a birthday comedy routine so funny that Steve Martin parodied it 30 years ago-it's THAT good!

The case of the patient with the new leg

2009-11-20T23:07:00.010+03:00

While I was in Africa, I encountered numerous medical problems I had never experienced in the states-some of which I will document here in the coming days. The case of the patient with the new leg is a little different though. Let's start with a picture.

This wound is about 3-4 cm across and was draining foul smelling discharge. The patient had been seen at other hospitals for this in other villages and they thought he had a skin abscess and would heal over time with some antibiotics. The abscess wasn't healing though and it had been going on for a few months so they were brought to the Maseno Mission outpatient clinic.
He was seen by Francis, one of our clinic officers and admitted to be started on antibiotics. We x-rayed his leg and found this.

That's his femur on the right-and that's not normal.

Here's a normal right femur for comparison

Notice on the normal femur it is thin and rod-like and has a demarkation between the outer bone (compact bone) and inner bone (spongy bone)? That's all missing on the xray of the patient I saw.

This condition is called chronic osteomyelitis in the United States and it's very very common. We see numerous elderly patients, generally with diabetes or peripheral vascular disease. It is a very hard to treat illness and antibiotics are given over several months and it's not always possible to eradicate it. Many times, amputation is the only way to control it. It's caused by a bacteria (usually staph aureus, but other bacteria can cause it too. Over time, the infection in the bone causes an influx of inflammatory cells that can kill the bone (or necrotize) as they try to kill off the infection. Sometimes even new bone is made as is in the case of the patient above-his body trying to make up for the dead bone made the strange shaped leg you see above.

The real shocker comes when you see what this patient looked like though.

This was not old person with diabetes, or decubitus ulcers, or paralysis.

This was a happy, smiling 4 year old boy!

He probably had trauma to that leg some time before and the infection was never properly handled and continued to worsen-killing off his bone and causing him bone pain. Eventually the infection even formed a sinus tract (the "abscess") to his skin. Amazingly enough, the boy walked with relatively little dysfunction. We ended up treating him with a few days of antibiotics and after his fever went down, sent him home with several months of antibiotic pills. He was one of the happiest patients I had though-where other kids his age were very shy or would cry when a white coat would come by-he would always smile for me. I really hope he gets better and doesn't have to have his leg amputated.

Hard Lessons in Swahili

Actually this was true for this patient-but why it was in a translation book for kids is anyone's guess

Ana mguu mmoja mfupi kuliko mwingine

He has one short leg than the other

Revisionist History-Red Ribbon Revival

2009-11-18T06:58:00.006+03:00

Oh man, did I take a bunch of pictures and video on that day I went on my walk with Praxidis. Read the story of the red ribbon revival below then check out these pictures and videos. The videos are in glorious 720p HD as well!

This was the quail farmer I was so interested in

The average household of those we visited-this one contained 5 people

The matatu ride on the way back

And as always-watch out for the white dude with the panga-he's had one Tusker too many!

Hard lessons in swahili

Next time we'll try antibiotics instead of enemas and Sprite

Kiljana aliyekuwa na niumonia aliaga dunia

The boy who had pneumonia died

The Ballad of Tom

2009-11-18T06:03:00.010+03:00

Whoever said beauty is only skin deep has never had Toxic Epidermal Necrolysis.

While I was in Kenya, I actually saw 2 patients with a rare illness called Toxic Epidermal Necrolysis or TEN for short. TEN is basically a very severe allergic reaction causing the physical equivalent of a whole body burn. Skin can just come right off in huge thick sheets. TEN even involves the mucus membranes of the individual-their mouth and eyes ulcerated and bleeding-it is truly a terrible disease. Let's say you are fortunate enough to live in an industrialized nation with access to a burn unit-even then you have a 1 in 3 chance of dying from this disease. We of course had nothing even close to an ICU let alone a burn unit. We had just discharged a patient a few days before with TEN who had managed to hold on for several days. The allergic reaction removes a good portion of what protects your body from infection and keeps your fluids and electrolytes inside you. People that die from TEN often develop overwhelming infection or severe electrolyte imbalances and require a good deal of care to give them the best chance of living.

This is Tom.

Seeing someone like Tom come in with such severe disease I knew would be a death sentence-we couldn't even keep the flies from eating his dead flesh, how would we keep him from getting infected. Tom didn't talk to us, and his family did the talking for us-apparently he had been sick and received some antibiotics (penicillin is notorious for causing TEN) and then 2 weeks later had severe burns all over his body practically overnight. While we were taking care of Tom, I learned that the patient that we had sent home with TEN died in her house within a few days and Tom looked much worse. You would pull back his blanket and his skin flakes would create a cloud of dust in the air so that you were terrified to inhale but you kept Tom covered so he would not develop hypothermia.

Every day I would show up in the morning expecting Tom to be dead-but we did wound care as best as we could and gave antibiotics. I remember one day Dr. Hardison coming in and without gloves pulling napkin sized pieces of skin from his leg-showing everyone he was growing new skin underneath. I couldn't believe it when Dr. Hardison said that Tom was well enough to go home-not going home to die like our last patient with TEN. Even with our limited resources and with a disease that kills >50% of patients when they come to a place with low resources like our hospital we still saved him. Look at the after pictures below

It usually wasn't the patients like Tom that ended up dying right away though. Even with a relatively low patient load, I saw a good share of death that month. There were a few that stand out in particular though. I saw one man in the clinic that was there with his brother who had fallen ill in the last few days. He was febrile and apparently had a seizure earlier that day. When I saw him, he had reduced mental status. I also found out that this young man (around 24 or so) was a heavy Changaa drinker (moonshine) and had stopped drinking a few days ago. I admitted him and gave him scheduled valium for what I thought were withdrawal seizures. Within 2 hours of me admitting him, he had a seizure and died. I remember walking in the ward to see if he made it up ok and the sheet was over his head, his brother that was just there with him at his bedside-I tried to think of something to say but was too overwhelmed myself and figured my words would be useless in this situation-so I said nothing. Another patient later was admitted overnight for seizure disorder which Dr. Hardison believed was pseudoseizures because of the truly bizarre way she was behaving ended up also suddenly seizing and dying on us-these were young kids-early 20s at best. I'm used to death being all around me and I accept it as just a part of life we all must face and embrace at the right time-but the people that were dying in front of me had no past medical problems-it was like the helicopter accident in the Twilight Zone movie that killed the actors, life just snuffed like the candlelight and just the smoke remains close to the cold wick until it gathers itself up toward the heavens.

Hard Lessons in Swahili

I will trade you that black pen for a black eye-that's what girls get for trying to learn!

Alivunja kalamu yake ya wino ("ya wino" is actually part of the translation!)

He crushed her fountain pen

Lessons from Space

2009-11-10T07:25:00.004+03:00

With the windows down it was like God was whispering the idea in my ear

Engine off, parked on the side of the street, still in my scrubs and white coat I sat in my car with the driver side window down. The sun was rapidly dying below the horizon behind my head-yet I wouldn’t have to be locked inside tonight. I had time to think as I always did, but now I had the capacity to do something I hadn’t before-anything. You only really know how free you are to do something until you are powerless to do anything. I equate my time there to being in a vacuum-away from everything you know and everything that worries you. I guess it’s like being in space or solitary confinement. When you don’t have this aching nag of reality, you have a lot of time to think about what really matters.

When I came back, I felt like an astronaut coming out the space capsule and immediately being hosed down in case he picked up a bad case of Martian herpes from the green skinned women you would see an old issue of “Amazing Stories”. I had no stronger desire than to take a really long, hot, non-bucket shower. I looked at my arms covered in a raised, spotted rash and wonder if I got that alien pox from Africa as the steaming hot water ran over me. I thought back to the last leg of my trip as I came back from Amsterdam-after what happened when I wrote “Falling from the Sky”

The flight to America from Amsterdam was uneventful and I was awake the entire flight over the pond watching “Harry potter and the half blood prince”, “Star Trek”, and “Terminator: Salvation” before touching down in Detroit for a massive layover. Going through customs I thought about the 2 foot machete in my bag as I went though customs.

“Do you have any plants, vegetables, fruits, food from where you are coming from”

I shook my head no, and said I brought some beer and before I could even tell them about my 2 foot knife they said go ahead and I rapidly progressed through customs. I sat in the Detroit airport for 4 hours awaiting my next plane-putting the finishing touches on the “Pastasafarian entry” while CNN looped it’s news stories in the background-one of which being a big health festival in Kakamega, Kenya (about 3 hours to the north) where folks were being tested for HIV, shown how to purify water, and use mosquito nets.

Seeing Bethany at my gate at Memphis was the best thing ever though-she had wanted to surprise me (she bought the ticket right when I left) but she told me about it a little earlier. She could only overnight before she had to go back but it was amazing having her back in my arms, I missed her so much.

Before I knew it, I was back on wards and had my ward team of my own. Even at the MED, which I remember thinking was “dumpy” as I started as an intern last year was looking glamorous by comparison-daily labs could be ordered on patients. it’s so easy to go back to fixing the numbers, but at the same time in the back of your head you think back to the people in Africa who do fine without the aggressive micromanagement of western medicine.

Those first few jet lagged days hit me hard-I didn’t know which side was up. I couldn’t believe how many people in my program read my blog and I am still not entirely sure how it got around to everyone. Desi, the resident who is going to be there this month found the blog helpful though.

So I find myself back in the car, engine off, windows down, sun rapidly dropping below the horizon behind my head when I grab my phone. I texted old friends and called those who I hadn’t been in touch as quickly as I could. Life is too short to lose those who are close to you-that’s what you learn in the vacuum.

Hard lessons in Swahili-The Kenyan Government-cause every 2nd grader should be a responsible voter!

Cause it's easier than counting hanging chads

Chama chake cha kisiasa kilifungwa wiki jana

His political party was banned last week

Cause the tough issues like universal health care take the backseat to being able to make Toll-house cookies

Kila mplga kura alihongwa kwa kilo ya sukari

Each voter was bribed with a kilo of sugar

Because the new constitution will tell us when we need to write new constitutions!

Tulitake katiba mpya kwa sasa

We needed a new constitution by new

Tons of Pics and New content!

2009-11-06T14:45:00.003+03:00

I thought it would take a day or 2 to get over the jet lag-not quite. While I planned on doing a big update yesterday evening, I actually fell asleep at my desk at 6:30pm and ended up sleeping until 5am. I am still wiped. I did manage to upload some of the safari pics in the meantime and there will be SEVERAL more entries coming-and I will even load the video of Helen and David saying the 3 things they appreciate the most about me and even teaching the Kenyan kids the stanky leg.
For now, enjoy some safari pics!

Safari Pics and videos and journey home

Falling from the sky

2009-11-04T05:04:00.002+03:00

Then there was complete blackness...

In my hand, a bottle of Amarula liquor, and I'm about to purchase it at the Duty Free Shop at the airport. I had just haggled with the register girl because she was offering me a bad exchange rate for my shillings. As I was handing over the money-blackout. The entire airport is covered in a shroud of darkness. The chatter outside the store now absolute dead silence as everyone pulls their belongings to their side and wait for the backup generator to kick on or the power to go back on.

And they wait...

I had enough time to walk out of the store, find my video camera and record the complete blackness. Then the lights kicked on again, but just the emergency lights. All the stores closing hours abruptly came and the doors shut. Then after 10 minutes, the emergency lights blacked out. Apparently the backup .generator ran out of gas. The only light coming from the rapidly falling sun as it was settling on the horizon and again silence. Now-nearly an hour after the lights first went out-only the emergency lights are on. Jomo Kenyatta Airport-despite being the largest and highest traffic airport in Kenya is about 1/3 the size of the airport in Memphis, TN (which is a small airport by US standards). The airport in Kisumu on the other hand was a single runway, had 1 gate, and you had to walk to your plane-the entire airport terminal was smaller than our house in Cumming, GA and this is in a major city (Kisumu being the 3^rd largest city in Kenya).

The emergency lights then went out again...

Now that the sun is down, the only light is from traveller's laptops and the runway lights. It's truly eerie. I have shot video of this darkness, it's strange-most of the people here are white and non-English speaking. In the dark I hear French, Dutch, and a mash-up of dialects but no clear English can be heard. No power means no air conditioning (just like all of Africa), the sweat of the day odor lingers on those around me-the air is stagnant with it. At least the overpriced Tusker at the airport is still cold, it may be my last one for awhile-one of a short list of things I will miss here. Around me I hear whisperings, apparently all of Nairobi is in blackness and they sure as hell don't have emergency generators in many places.

I guess it was only fitting on my last day here that this should happen. Good thing I leaved my shaker flashlight in my checked bag. The emergency lights now being off for a 10 minutes with no sign of coming on. Overhead, a pleasant little chime and a female announces (in swahili then english) that a certain plane have arrived at the gate. Too bad no one can see where their gate is anymore, but since there is only 14 gates (that's lucky 13 more than all the other airports in Kenya) you might have a chance feeling blindly for the chest of the ticket agent at a gate-at least that's what I did.

That wasn't the only surprise to happen at a gate.

As I was sitting outside the security scan at the entrance to the airport, trying to redistribute the weight of my carry on luggage and my checked bag so I wouldn't go over limit, I thought back to the 2 foot machete in my checked bag and looked at a large sign above the metal detector. A circle slash was over a pocketknife, but also over knives, forks, and yes even spoons. Apparently, Al Queda's newest strategy is to pull your eyes out with melon ballers from williams-sonoma before vigorously brushing your teeth to death. There's no way in hell my pangaa is going to make it through. I watch as the bag goes through security and the color xray shows the huge blade. The security screener looks at me and says "you have a pangaa in your bag?"

"Yeah, but that's ok right?"

"Yes, the main problem is you have a container of aerosol (my bug spray), you have to remove that from your carry on please."

Unbelievable. After I leave the security screen I walk away, and actually rearrange the stuff in my check bag-meaning I could have grabbed the pangaa at that moment and put it on my carry on-that's scary. It looks like though at each gate they have an additional security screen like at Schipol in Amsterdam to prevent this from happening.

The last thing I want to do is create an incident that keeps me here, which reminds me of something that happened 4 hours ago.

My cervical spine bounces back and forth like a metronome as we tear ass down the dirt roads leaving from the masai mara. The dirt road is marred with beach ball sized pit holes and sudden dips that rocket my head into the ceiling despite wearing my seat belt. The entire ride feels like you are riding a jackhammer. The safari in the park was also in this vehicle and the roads were just as perilous, but we were driving at most 15 miles an hour so while it was jarring it wasn't this bad. The non-existent shocks become glaringly apparent at about 25 mph. I look at my watch, it's a 6 hour drive back to Nairobi and only about 15% of the way is paved. Our tour guide said we would make it back by 4pm, but that was before I was familiar with the concept of "African time"-meaning when someone gives you a time to meet, you should probably be happy if it happens within 1-3 hours of when it was originally scheduled. More than anything, this is the #1 complaint I get from all the folks I talk to from industrialized nations. Several hours into the jarring ride, we stop for lunch and wait on "African time" for another tour van to show up so we can swap passengers. Tired of waiting, I scope out my environment and spot a bunch of kids playing with loose strands of barbed wire. I go up to the group of kids and ask what they are doing but none of them understand English. I snap a few pictures of them, which draws a crowd of kids. These kids were beggers, which I quickly found out as their english speaking leader asked me for money. Looking at my watch and thinking about that I will be leaving Africa in a matter of hours, one thing was still left unaccomplished-teach the children of Africa the "Stanky Leg". Perhaps because they thought I would give them money, they actually did do the Stanky Leg and I was able to record it, too bad they were wrong about me giving them money. Eventually, another van shows up and we pick up 2 sweedish girls. I thought I was a real trouper being here in Kenya for a month-turns out of all the people I met on Safari I had been here the least amount of time. No one was really on vacation, and apparently Europeans actually pay to volunteer when they go to third world countries. How much do they pay? Upwards of 1-2 thousand US dollars to pour porridge for orphans! Before you think "well, it helps the orphans" think again-the money goes into the agency that arranges the volunteering. These two Swedes were also coming from Safari in the Masai Mara and were spending time volunteering in Ngong in an orphanage. While they were on Safari, they reached the Mara river and at this point the tour groups are actually allowed to leave their van and check out the hippos and crocodiles. However, since hippos kill more Africans per year than any other animal, you are only allowed to get near the river with a KWS (Kenyan Wildlife Service) employee, who just so happens to carry an assault rifle with bayonet. Well, our Swedes were given a private tour by a KWS when in the forest he turns to them and says "I will take one of you, only one of you will return to Sweden". The girls of course thought he was joking so he asks "does my gun make you afraid?" It was then they realize he isn't kidding and they head to the safety of their tour van pronto. I managed to get a video of them telling this whole account. Turns out that our added speed on that bumpy trail got us back into Nairobi by 4:30, much better than my Africa time expectations.

From Nairobi I boarded a bus to the airport. A taxicab ride to the airport would be about 1700-2000 KSH but the bus was only 50 KSH, a real bargain and since I had time, I took the bus here. Turns out the buses, like the matatu van transports, won't budge until EVERY seat is filled, so I sat in the back row of the bus, the window to my right and a mother and her pooping child nuzzled up to me on my left. There was no breathing room to reach into my pocket to get my camera, and I doubt I could have gotten good shots through the dirty window, but what I saw was amazing. Like the rest of Kenya, trash was strewn in the streets, but the bus ride marked the first time I saw a particular animal: the pig. As we were crossing a bridge, several pigs were under the bridge sorting through the garbage piled up near the stream below. Not once this month, was pork ever on a menu nor could it be found in the grocery stores. Turns out that Kenyans are not high on the hog-preferring goat, lamb, beef or chicken and it doesn't seem to be due to religious reasons because only a small amount of Kenyans are of the Islamic faith. (Future edit-I discovered a few hours later on the plane sitting next to a couple that spends 4 months a year running a theological college in Eldoret that pork is available in certain geographic regions of Kenya).

Have you been in deep in an urban city and seen those vans that are covered with ads and graphics for rap stars and their upcoming albums? Kenya's matatus (crowded van taxis) are generally decked out with one of two different designs: pictures of Jesus and bible quotes or pictures of gangster rappers and popular mass murders. Other matatus will have clothing brands painted all over it (Sean John etc) despite clearly they are not being paid for the advertisement. Most of the matatus I saw in Nairobi even had names on stickers on the driver's window adding a lot of personality to each vehicle. Nairobi in general had a lot of personality and about 2 square blocks of actual money (which is where the Hilton is located)-the rest is abject poverty and a heavy population density just like the rest of Kenya. Many of the smaller storefronts are painted in safaricom or Orange ads just like in the smaller towns (turns out the small businesses get their place painted free if they agree to have it painted like an ad-which is why so many of the buildings here are neon pink (Zain telecom), Orange and white (Orange telecom) or Bright green (safaricom).

So now I look at the dark skies in the gate for my plane, a fat englishman in safari gear is talking about the "Scheduled power rationing" and that all of Nairobi should be dark right now. Getting to the airport early turned out to be a punishment considering how incredibly hot it is. There's no moonlight, no starlight here, but thankfully the backup generators are powering the runway. Hopefully the air traffic control will see the planes on the runway (unlike when I came here) and we will leave on time.

Future edit #2-of course we didn't leave on time, but the delay was only about 45 minutes. I'm now sitting at my gate at Schipol in Amsterdam as people file in to go to Detroit. Immediately after leaving the plane I felt a rush of cold air and wonder what cold weather will feel like again. Amsterdam's airport is a lot like Ikea-everything is shapely, clean, and technology is being sold at every store. Unlike Ikea, their prices are through the roof, especially since it's about 1.6 dollars to a Euro. Kenya was the same way when it came to buying tech-the latest tech was either unavailable or ridiculously expensive compared to US prices. Kenyans find workarounds though, particularly when it comes to cell phones. There are no cell phone plans as far as I could tell, it was all pay as you go. The cheapest phones like the one I used could be had for $10 US. Remember those cellphones you used 5 years ago? The ones right after the starcom and right before your Razr? The one you lost, either you thought you left it at the gym or it fell out of your pocket at the movie theater, well it ended up in Kenya. The majority of people are using 5 year old unlocked phones while Nokia phones cater to the mid and high range. I remember coming here on the 5^th of Oct and thinking that Amsterdam has the best sunrises I've ever seen, well Kenya has the best sunsets in both the literal and metaphorical way. See you all soon!

Painful Lessons in Swahilil-Triple Threat

I didn't forget that the last entry didn't have any Swahili and that I've had radio silence the last few days-here's your reward

Thankfully his kidneys had good health insurance so that they could remove the cancerous person growing around them.

Alifanyiwa upasuaju kutolewa figo

"He was operated to be removed his kidney"

Melanoma's a bitch, but so is being thrown in an incinerator during your country's latest genocide

Ngozi yake ya rangi ya hudhurungi iligeuka na kuwa nyeusi

"Her brown skin became black"

If you keep running and take performance enhancing drugs, sometimes you'll grow an extra toe or two.

Alijikwaa kidole cha mguu akikimbia

"He trippled his toe while running"

White people on Safari - Adventures of the PaStafarian

2009-11-02T23:13:00.003+03:00

I don’t have internet access right now to check out the website “Stuff White people like” but if I did, I would make sure “Safari” is on the list. While I am at it, I would go ahead and add “Mission work” to that list-you’ll see why.

Getting your flight time changed in Kenya is surprisingly permissive-many of the domestic carriers allow you to change your flight at least one time. I was originally scheduled to leave Kenya Nov 1^st but got a Safari arranged thanks to Bethany’s hard work. She ended up calling Jetlink around 4 times before giving up in frustration because she clearly did not sound like a Daniel. When I called, I swear it was procedure to put a pillowcase over the phone receiver then talk through a Kazoo. There was no clarity to the calls and their English was terrible. After several calls I received the same answer, I needed to pay an additional $11 to change my flight because my “flight class” was sold out (BTW, there’s no first class, everything is economy on these small jets or prop planes). She was unable to accept the payment differential over the phone or online, I would have to go to the airport to get my ticket changed-which was about a 30 min drive away. I was lucky enough to hitch a ride there on an ambulance going to Kisumu where my ticket was changed out in less than 5 minutes with no additional fee. While waiting the 2 hours for the ambulance to come back, I talked with the pilots and the flight crew of Jetlink about world and Kenyan politics and history until my ride showed up.

The next day, I said goodbye to everyone at the hospital and headed to the Kisumu airport to get to Nairobi to pick up my safari group the next day. I stayed at an interesting hostel which had you sleeping in a tent in the garden of the owner’s house. A lot of people really like this place but as I was going to find out in the next few days-sleeping in a tent kind of sucks. It gets REALLY cold in Kenya at night around 1-2 am when the temp drops into the 50s and tents don’t insulate as well as I thought. I woke up to visible breath in my tent and shivering and curled in the fetal position to stay warm. After a basic breakfast, a driver from my tour group showed up to take me to the Safari offices in downtown Nairobi. While in those offices, I met the first of the 4 passengers that would be joining me-Charlotte from the UK. She had been in Africa for 2 months now, going through Tanzania, Rowanda, Uganda, Zanzibar, and Kenya. Most of the white people I would meet on Safari were from the UK. She dressed a little too fashionably for a tent safari-wearing designer sunglasses and fashion. She was the biggest complainer on the trip and would whine about standard African things like the concept of “African time” and that white people are going to get ripped off-wah wah. Several times during the Safari she told the driver to pull over so she could pee behind the van. The driver isn’t supposed to let people out of the van, but she would ask enough he would do it anyway. I think the driver had long ago devised a way to handle this annoyance-he installed a mirror on the back of his van that angled straight down so all the passengers still on the van could watch the girls pee behind the van-after seeing that 500^th zebra, this was actually a pretty good source of entertainment.

During the nearly 6 hour drive to the Masai Mara we get 3 other travelers-Teresa a German tourist, and Simon and Elisa a couple of aid workers working for an NGO. The road to Masai mara is relatively unpaved and filled with tons of dips in the dirt roads but we made it there ok. Along the way, it’s just desert like savannah with the occasional massive herds of cattle being let by a man or boy in the characteristic red masai cloth. Around 4 pm we arrive at our tent camp. The tents were a bit odd-they were tents with 2 twin beds in them, but attached to the back is a bathroom! After throwing down our things we headed off on an evening game drive in the park. We oohed and ahhed and the herds of zebras, giraffes, warthogs, impalas etc. The safari van has a pop-up top so you can stand in the van and take pictures and videos. We did about 12 hours of driving around the park over 3 days-it takes several hours to get from one end of the park to the other it is so massive. I took about 300 pictures and videos which was basically all that you could do (and watch girls pee behind the van). A few things about the safari really stick out in my mind.

-Being 10 feet from lions

-Seeing about 25 hippos in the Mara river and a 95 year old 18 ft crocodile.

-Watching thousands of Wildebeest migrate across the planes (they weren’t doing the legendary crossing of the Mara river while I was there though).

-Seeing a male ostrich doing a mating dance for a female ostrich

-Watching 2 lions eat a huge buffalo

-Watching 2 cheetahs tear apart a gazelle

-Watching huge flocks of vultures tear apart wildebeest corpses

-Seeing wildebeest body parts hanging from a tree after a leopard put it there for an afternoon snack.

Notice a theme in the last few things? After you see the same animals over and over again, the tour groups (which are mostly westerners and from industrialized nations) demand BLOOD! You might be plodding along at a 10-15 miles an hour when you hear something in swahili come over the CB radio and your driver starts tearing ass through the park. “There’s been a kill!”, he would announce and I could see Charlotte salivate-it was really the only thing on safari that excited her. You can usually identify the kills from half a mile away because 8-12 safari vans will be mere feet from the carnage white people with expensive SLR cameras and designer safari gear oohing and ahhing as entrails are ripped out from a poor herbivore. The bleached white skeletons of the animals looking almost as if they had been placed there for added effect by park rangers they were so intact and clean. One thing I didn’t see was any mating-which is odd considering at times I was looking at herd of hundreds or even thousands of buffaloes and wildebeest-I certainly expected at least some of them to be doing it. I mean, if you put thousands of people in a single place, I would expect at least a few of them to be doing it-as I type this CNN is airing right now that 300,000 people were at Atlanta’s pride parade and certainly plenty of people there were doing it (although likely different end objectives)! The evening and afternoon safaris were filled with awesome sights and the weather was relatively cool with some occasional rain. On the final day, we did a morning safari at dawn which was a complete wash-barely any animals were seen.

The food was all included in our package and every night they cooked great dinner and even better breakfasts! The biggest issue was the tents-the first night there I woke up at 2am and started freaking out. The only power to the tent camp is from a generator which they only ran about 2-3 hours a day and not at all after dark. When the sun went down, it was complete blackness outside and inside the tent. There’s no locking or security and while I was at the wildebeest, one group of backpackers told me that they had their tent slashed open and their luggage stolen. In the complete blackness in the strange land of the masai mara I got really anxious especially because people were walking around outside my tent. The other issue was I wouldn’t sleep for more than an hour at a time before I would wake up scratching all over my skin. So many nights in Kenya I would wake up over and over with the sensation of being covered in bugs but this was the real deal. By Sunday morning, my arms were covered in petchial rashes that is either from bug bites while I was asleep-the other option is I have a rickettsial infection like rocky mountain spotted fever and will soon be dead. Somatisizing my symptoms on Sunday, I got nauseous and threw up during the morning safari but I think it was because of my doxycycline-all and all safari was pretty cool but I can’t see doing it longer than 3 days-we were all pretty bored. I had met folks that were doing 30 day safaris all around africa. In 3 days, we saw everything you wanted to see except a rhino, 30 days would really suck and it’s expensive as hell. Maybe one of the most interesting parts of the safari was actually meeting and talking to the people who were on them. If you are a white person that is in Africa for a period of time, more than likely it’s to do mission work or charity work. I should write a book about it called “If it ain’t Hell, it ain’t worth visiting”. Simon, Charlotte, and Elisa were all working for charity organizations and it was hard to have a good conversation with my group because they have all traveled around the world-mainly backpacking through affordable 3^rd world hellholes. You should see their eyes light up talking about having to experience firsthand such extreme poverty (before taking advantage of favorable exchange rates to eat like kings wherever they go). I just couldn’t relate to the stories of rural vietnam (everyone in my group had traveled there but me-wtf!)-totally bizarre. This entry picks up in “Falling from the sky” check it out!

Hard Lessons in Swahili-

How are you supposed to give the middle finger when this happens?

Mtoto aliyezaliwa alikuwa na vidole sita

The born baby had six fingers

Revisionist History

2009-10-30T05:01:00.003+03:00

It’s been 22 days since I first got here and freaked out after my IPOD touch went missing. On that day I thought I could stay here maybe 2 weeks at most. As the power went out for days at a time, as I woke up over and over in the middle of the night covered with the little bugs that make it through the mosquito net-I wondered how I was going to make it. Humor and lots of emails from the US is what helped me make it. I never realized how much of an impact the blog would have - so many people I don’t even know have contacted me to say they have been reading it and wishing me luck. To be honest with you, I felt more like a documentarian here than a doctor. I just had to soak in and understand what was going on around me so I didn’t go completely bonkers.

On 10-29, at 8am east coast time I will be on a flight back to Nairobi where I will be staying at a tent hostel called the Wildebeest. From there I leave Nairobi for the Massai Mara which is, in many native Kenyans opinions the most beautiful part of Kenya. It’s filled with lions, elephants, hippos, rhinos , giraffes and everything you can want-all getting killed and eaten-and I will capture it all in glorious 1080p high-def. Picture Planet Earth but with my goofy commentary as a wildebeest is chewed up by lions.

After that, I return back to the US, but the fun and the life of the Kenya blog WILL NOT STOP THEN! I literally have a list of topics to cover still on my computer! Also, remember how I said I would be arrested if I brought a camera to Kisumu? I went ahead and did it anyway and went to all the same places I went last time, taking over 100 photos while dodging bullets like Neo. These photos will be used to enhance already existing entries.

Also I have shot HOURS of awesome videos. Want to see a Vervet monkey dance? Want to see me teach the Orphans to sing? Want to see me teach a whole class of 8^th graders about HIV and anarchy? Want to see actual improv comedy monologues I made while I waited at the airport? Wait until I get back! I have over 17gb of pics and videos to sort through and edit and upload to streaming video sites and you’ll see it FIRST on the Medical MacGuyver blog. I almost feel bad at how little of the story is just in the text - you have to have the pics and videos to get the whole thing and it’s coming! Keep the blog bookmarked and check it frequently.

I’m going to have radio silence while I am on safari, but will be back in Memphis Nov 2^nd. Want to know the first thing I do when I get back to the states? I guess you’ll have to keep checking the blog!

Oh yeah, and you’ll get more swahili translations!

Hard lessons in Swahili-Thumper get away from that man in the white apron! NOOOOOOO!

Nyama ya sungura ni nyororo na tamu

Rabbit meat is tender and sweet (that rhymes!)

Red Ribbon Revival

2009-10-30T03:14:00.008+03:00

Yesterday was a really special day for me. I got to go on home visits to HIV patients with the CCC (comprehensive care center). Maseno Mission hospital is the cornerstone of HIV awareness, prevention, and treatment within a 25 KM radius. What this organization does it truly remarkable considering how prevalent HIV is here. The CCC has a daily clinic where they take care of just HIV patients and get them to understand and take their medications. For those that are known to have HIV but aren’t doing well or perhaps haven’t shown up for their appointments, the workers go on house calls. Many of these workers walk all day to get to these places to check on their patients - it’s just like how medicine was practiced in the old days.

My guide on my long hike yesterday has a truly amazing story. Her name is Praxidis and she herself has HIV and Tuberculosis. Around the year 2000, she became very ill but rather than go to the doctor, she basically gave up on her life and prepared to die. She thought she was infertile and couldn’t have children. She turned to God for guidance and she was told that she had a purpose to be alive.

So, she went to the hospital and was tested for HIV in 2003. She was positive and was suffering from numerous complications related to her HIV. She found Dr. Hardison at Maseno Mission hospital as she was in end stage AIDS. This was before the CCCs existence. Dr. Hardison took her in and found antiretrovirals for her to take and over time, she practically came back from the dead. As she got on antiretrovirals she also got another big surprise - a pregnancy. She was scared like many here that her baby was doomed to have HIV, but Dr. Hardison helped her through this and gave her and the baby the best chance of making it through the pregnancy safe. Sure enough, both of her 2 children she has are HIV free.

She considers herself so blessed to be alive, she has dedicated her whole life around giving those who have given up hope like she once did, a second chance to turn their life around. This is why she walks 15 miles or more to visit HIV patients in their homes that have thrown in the towel. She has an infectious optimism and indestructible faith and she knows it’s her mission from God to spread it like wildfire . Even with her currently struggling with pulmonary tuberculosis and having already failed first line therapy, she still does these long hikes into the country to share her message of hope and faith.

I approached her the day before yesterday and told her I wanted to go on the hike to do the home visits with her. The CCC nurses looked at me and my spare tire and laughed. “It’s going to be a long way and it’s going to be hot”. I laughed right back at them and told them I can do it. The next day I geared up like Rambo for the hike - bringing water, snacks, sunblock, and most importantly – toilet paper (there’re no bathrooms where we are going). I tried to dress as inconspicuously as possible to not draw attention to myself... do you think I was successful?

We started our hike to Luwanda town - a much larger town than Maseno located several miles away. Along the way, she told me how she adopted a blind, neglected HIV positive child named Sophie (who I have helped take of while she was in the hospital) and now Sophie is doing well in her school for the blind. She said the education of her 3 children is her top priority because if something happened to her, they would have no one to take care of them. She wanted to fuel them up with as much education as possible so they could be successful if something terrible would happen.

Along the way, we passed under this banner for a good ole’ fashion tent revival. As I look up at it and snap the above picture, she turns to me and asks me “Are you a Christian?” I nervously laugh and tell her “well, I grew up catholic...”. She saw right through it like scotch tape, “well, are you now?” I replied with a negative and braced myself for her preaching, but she didn’t criticize me and when I stated some of the reasons I don’t agree with religion (namely the money-making nature), she agreed completely. She told me she had seen the prophet coming to speak several years ago and that was his message, that the churches have become too focused on the money and not the message. You could even take home a DVD of the sermon, available for sale on site :)

We proceed to enter Luanda town, which is a stark contrast from Maseno. The shops of Maseno are shacks composed of tree branches and tin roofs - the shops of Luanda town are made of concrete and you can actually walk into these buildings. There were paved roads and tons of road traffic and just many more people buzzing around everywhere. Praxidis was practically a celebrity here, as we move through the crowd, she’s pointing to people and telling me they are her clients (meaning they are HIV positive) - let’s see you try to get away with that in the US. As we go through the markets, we meet with another aid worker who comes with Praxidis and helps her find the locations of her clients. She also was wearing an ironic T-shirt, so I got her picture.

From Luanda town square, we proceed to get away from the paved roads and head into the sweeping country surrounding the town. There I see some of the most beautiful landscapes I have seen since I have been to Kenya. Under the clear blue sky, the rows of maize went on forever, herds of cattle mulched on the rolling hills cut by the now mostly dormant railroad. It was a breathtaking sight.

As we went house to house visiting the CCC patients who were either too sick to make it or have stopped becoming compliant, one thing really struck me. Most of these houses are the same - poured concrete with a roof made of stick supports and tin. Not a single house was wired for electricity or had running water. As we continued on our tour of the countryside, the houses stayed relatively the same, but the situations worsened. Toward the end, we went to a household where a woman was breastfeeding her baby.

Praxidis explained her story. She has 4 kids, 3 of them in the 4th grade (the older ones keep failing and repeating the grade). Her husband is gone during the day and only sometimes shows up at night - she has no idea where he goes. He does not help her raise the children. He refuses to be tested for HIV or wear condoms (which is a common occurrence here in Kenya, many of the men chose to remain on the down low). Her children have no food and are going to school hungry. She is breastfeeding her baby longer than the recommended 6 months for HIV patients because her baby has no other food - even though it might mean the baby may get HIV. Her tin roof was filled with holes which allow the rains to flood her small home. The small concrete house is probably 15x10 feet and house 5 people - 6 when her husband comes home. How can someone like this escape their situation when the odds are so stacked against them?

Undaunted, we went from house to house, at each place checking their HIV and TB medication to make sure they were taking it right and setting up appointments at the CCC clinic for those that needed closer follow up. After talking to the quail farmer (I talk about him in the food entry), we went to another house in the rural country. I learned something really interesting there. It seems that nzungu (white people) are considered good luck in the area where I am in... but in more rural places like where we were going, white people have NEVER been seen, so the children freak out. When we went to one house, I found this out first hand, all of the children started screaming and crying and ran/crawled away at top speed! I have a few pictures of this below.

Also, on the way back we came across a primary school (recognizable because the kids where wearing the typical blue and yellow school uniforms). As I came by I hear the usual “nzungu!” cry and they all ran up to the barbed wire fence to take a look at me. Recognizing the opportunity I missed while I was at the Orphan program, I tried to teach them to dance as quickly as I could. I instructed them to put one foot out and bend it at the knee. At the same time, lean back and move that extended foot like you are putting out a cigarette. In the US, this dance is known as the “stanky leg” and it was my goal to teach the children of Kenya this dance. I guess they didn’t know English though because not a single one of the 30+ kids followed my instructions through the fence - bummer-mission failed.

We hiked the whole countryside, coming across the quail farmer I talk about in the food entry. Once I feel like Praxidis and I are close enough, I ask her about Changaa and Bhang (moonshine and marijuana). She tells me that cannabis is grown in neighboring Uganda where it is less restricted and shipped here. Some folks in Luanda town grow it as well. The threat of police keeps it relatively low scale, but there is a small population of Rastafarians here. As we were leaving one client's house and I was talking about Bhang and how lots of people in the US use it, I hear reggae music in this distance and see the small shop where it is coming from. Praxidis’s friend walks up to the shop and I keep my distance, I ask Praxidis “what’s she doing?” She replies “she is seeing if they have Bhang they can show you”. I flip out completely, I don’t want to get arrested in Kenya - I’d never leave. Thankfully, they didn’t have any left but they showed us where we could get some down the street.

Are you ready for the real shocker? Guess how much a joint costs in Kenya-5 shillings! That’s less than 7 cents a joint! You can buy 15 joints for 1 US dollar. All you potheads should add on an additional ticket from Amsterdam to Kenya because bhang and changaa use isn’t heavily policed and you can smoke your brains out with maximum savings!

As we were going to Luanda town, I knew I had to get some money to pay for my rent here this month, so I found an ATM (there’s only 1 bank in the whole big town it seems). At least I felt comfortable getting money when the guards outside the ATM are carrying assault rifles. Walking back was extremely nerve racking carrying all this money, I did manage to get some obama gum but I also needed a way to protect myself. So, I did what any cautious citizen would do, I bought a pangaa (machete). Unfortunately, it comes in an unsharpened state, but Praxidis bought it with my money so I wouldn’t get charged the Nzungu (whitey or honkey) price. That’s a big reason of why I couldn’t live here, I would regularly get charged 4-5x more than everyone else since the prices are negotiable.

On the way back, it started to rain, so we got a matatu. In Kenya, there are 3 modes of public transport. Matatus are vans that you can (and regularly do) cram 10-15 people in that drive like a bat out of hell down the roads. There’re boda bodas which are bicycle taxis (you sit on the seat over the rear wheel and try to balance. Then there’s the piki piki which are motorcycle taxis. There’re no helmet laws here, so few people use a helmet on these bumpy dirt roads. Worse still, I have regularly seen entire families of 4 (which baby in the mother’s arms or sandwiched on the seat) on a single motorcycle. Considering the number of motorcycle accidents we see, if I could change 1 thing in Kenya, it would be to enforce helmet laws and maximum number of passenger laws.

Anyway, we took a matatu back and when we got in, they were blasting reggae music which made me wonder if they had some bhang or perhaps used it all before we got on. We hung on for dear life as they sped down the road and brought us closer to the hospital. As we walked back to the hospital, Praxidis showed me where the people in my village get changaa. About 200 yards from where we were walking, there was a banana plantation and several young men walking toward it carrying a sofa on their heads. “Those men are going to drink Changaa” she said “and they are bringing a sofa so they don’t have to stand”. She explained that the Changaa stand is hidden in the fields so that bystanders can not see what’s happening, but it’s common knowledge where to find them. Twenty shillings gets you 15 ML portion in a special commemorative Changaa shot glass (which I swear I saw for sale on QVC). It only takes about 2 doses until you are drunk and a few more until you are dead. We kept our distance from these guys, especially considering I was carrying a year’s salary in my pocket - Praxidis said the changaa boys regularly rob people.

As we made it back to the hospital, the rains picked up and I said bye to Praxidis and let her know more UT folks would be coming soon. The next day she helped me make a short video to let UT students know they are appreciated here and thanked me for my help. It was truly an amazing experience. I am in a time crunch, so no swahili translation in this entry, but look for double the swahili lessons in the next blog! I’m off to masai mara!

Beer Reviewed Article

2009-10-29T03:49:00.004+03:00

Back on my birthday, I took this photo representing several of the Kenyan beers available here. I have tried nearly all of them and just wanted to say a few words about each of them in case you are at your favorite beer importer and need a recommendation. If you are one of those quitting “recovering alcoholics” I also have soda recommendations for you at the end... pansy.

More lagers than in a Canadian forest

So apparently Kenyans like the lagers, because all of them except the Guinness are lagers. The only one I don’t have pictured here is Whitecap, which is also a lager (and a good one at that), so porter lovers, black beer afficionados, wheat beer lovers, etc you are out of luck. Also, if you drink lite beer, you are out of luck (see food entry)

Allsopps

The cheapest of the batch pictured above also happens to be the one that tastes like Budweiser. This is not a compliment-it was the most watered down and my friends agreed.

Pilsner

Along with white cap are the oldest beers in Kenya although Pilsner is not anything to write home about, white cap has a better flavor overall and is available in a white and a dark lager.

Summit

Better than the Pilsner and Allsopps. I sat on the porch and drank this after a hard day, then went with David and climbed the mountain behind the house. It provided much more buzz than the other 2 and the flavor was much more smooth without aftertaste or being watered down.

Tusker

The most popular beer in Kenya and in my opinion-one of the best beers I’ve ever had. What makes this beer so good is that sugar and cornstarch are used in the brew as well as barley and hops. This beer is what kept me from pulling a Patrick after my IPOD was stolen.

Tusker malt-

Costs the same as regular tusker but you get 200ml less?!? The reason for its price increase is that it doesn’t have sugar or cornstarch. The flavor is excellent and a little bit stronger than regular Tusker, but I prefer the extra 200ml.

Guinness foreign extra

This ain’t your mama’s Guinness. I first had this in Dublin in January and enjoyed it greatly before the crushing disappointment of finding out it’s only available in Africa. Now that I am here, I really enjoyed this super-strength 6.5% alcohol version of Guinness. The flavor is much less peat-like than American Guinness, it has a darker head and can get you buzzed rather quickly.

Sodas

Only available in glass bottles in 300ml, 500ml, and 1L sizes (although you can get the bigger 2L in plastic in the grocery store). One way to get murdered in Kenya is if you walk off with your beer or soda bottle because each bottle is returned for a deposit by the seller. If you want to take home a bottle of beer, a bottle-fee is added to the price (I have been charged between 20-50 shillings for this-which may be as much as the drink) and it is refunded when you return the bottle.

The other day I was explaining the concept of the soda fountain and free refills to a Kenya native and they couldn’t really understand it-there are no soda fountains here and sure as hell no free refills.

Also, Pepsi has little to no presence here in Kenya and the market is saturated with Coke products. Top sellers are Fanta and regular coca-cola. It’s made with real sugar instead of high fructose corn syrup which is why many argue it tastes better here-but it also could be because a coke is like a birthday present to Kenyans and most can not afford to get it unless it is a special treat. Coke also makes a few other brands here in Kenya that aren’t available in the US. One is Krest bitter lemon-which is exactly as it says, a slightly tart lemon soda that is excellent. Stoney is even better, a ginger beer with a heavy amount of ginger-a very unique and excellent taste for sure.

Hard lessons in Swahili-Sounds like he had a “hard” time crossing the street!

Jogoo alikanyagwa na dereva wa lori

The cock was hit down by a motorist

The Good, the Bad, and the Ugali

2009-10-29T03:00:00.008+03:00

“Let’s go out and get some Kenyan food tonight!” is probably not a phrase you have ever heard in your life. Kenyan food doesn’t have a large presence in America as far as I know. The funny thing is Ethiopian food is relatively common in America, and when a Kenyan wants to say someone looks starved, they say they look like an Ethiopian. So I am going to take you on a visual safari of a few of the basic Kenyan staples and since I’ve eaten all of these-I’ll let you know how they taste.

Ugali
Hands down the most commonly consumed food in this area and probably Kenya. Technically it is a super-thick bland porridge made from cornmeal. It reminds me of the clay mixture I used to make with cornstarch when I was a kid. Ugali is eaten with your hands and usually eaten with stews - the Ugali can soak up the gravy of the stew

Sikuma Wiki
The greens seen on the plate above are Sikuma Wiki, a local green commonly eaten as part of a traditional Kenyan meal. The flavor and texture is strange, it is a boiled green similar to mustard greens but it has a texture like a firm wet paper and a flavor similar to Kale. The other type of commonly eaten green is Cowpees (which said in Swahili sounds like you maybe got the wrong kind of milk). Cowpees has more of the flavor and texture of spinach and is boiled.

Other fruits/veggies
Certain crops we are used to getting in America are grown here but must pass several tests. Since electricity and thus refrigeration are not in most homes, the fruits/veggies must be hardy or be so plentiful that they can be sold and consumed quickly. Common produce include roma tomatoes-the most hardy tomato from a spoil point because it contains the least amount of water inside! Small purple onions, greens, dried maize, potatoes, avocados (which are only about 15-20 cents US here) bananas, and rarely pineapples (which are expensive). Maize dominates all the above and is the main crop along with red beans in this area. Red beans and maize stew is a common food used to feed massive amounts of people (it’s what we ate at the orphan program). Rice is also used here, but doesn’t grow in the region and is shipped from outside.

There’s chapati in my mouth and everyone’s invited!
One of my favorite foods Emmah our housekeeper makes is Chapati and lentils. Chapati is a type of fried flatbread with a somewhat oily texture and outstanding flavor. When covered with her lentil stew it’s absolutely dynamite. Chapatis are commonly eaten everywhere here, usually with boiled red or kidney beans to help soak up the gravy. Emmah’s recipe for chapatis is the following (makes 2 chapatis, so you will probably want to triple this recipe).
1 cup flour
¼ tsp salt
1/3 cup water
Mix the flour with salt and add water to make the dough-flatten the dough and spread oil on each side. Then roll the dough and cut into round flat pieces and pan fry them.

Meats (besides people)

Cows, chickens, and goats are found EVERYWHERE in Kenya. Many of the tribes in Kenya when they arrived here were herders of cattle - the Masai tribe being the most famous of them for stealing other tribe’s cattle and living on the blood of cows. Here herds of cows are seen walking down the side of the road and are often chomping on the grass a few feet from my front door. The hospital uses its native cows and chickens for an ever present source of milk and eggs. When you do need meat, you can do what we do and go to the Nakumatt (aka wal-mart) and get some meat, but only the white folks and rich people do that. The meat at the Nakumatt is prepackaged just like the kind you get in the store - the only difference is some of the meat - particularly chicken is MUCH smaller than the drumsticks you are used to getting at KFC and with far less meat. Score one for steroids and growth hormone injections! The majority of people end up getting their meat from roadside butchers (which I took plenty of pictures of). These small tin shacks usually have a hanging cow carcass hanging on a hook in front of you and the price is per kilo (about $1.40 US a pound). You tell the butcher how much you want and he brings out his trusty Panga (machete) and will cut off a piece of the cow-tendon, bone, and sinew and wrap it in newspaper. Small fish are also brought in from lake victoria and sold at market. Other meats besides goat, beef, and chicken are eaten as well.

While on our home visits today we came across a strange sight in the fields - a long flexible pole containing several wicker cages, each containing a quail. These poles were scattered in a roughly square shape and on the ground were a series of traps. I interviewed the land owner and he traps quails by using the calls of the caged quails to lure more quail into his area. Because quail do no fly very well, they walk on the ground to see what’s up and get stuck in the wooden traps on the ground. The farmer then sells the quails in the market for meat at 30 shillings each (about 40 cents US each).

There are not many restaurants that I have seen. Most of the small shops don’t have the capacity to be restaurants, so instead you might by some fried dough at one stand and some juice at another stand. The majority cook on their own, so eating out is a luxury in this economy. I have yet to see a single fast food restaurant since coming to Africa (although I have been in the sleepier part of Kenya).

Diet Nothing!
For somewhat obvious reasons, commercial foods you get in the supermarket actually have extra fats and calories over their American counterparts. Today, after 1 month, I finally found the only diet soda - Coke Light - which actually has about 70 calories! Foods are heavy in starch and calories and many things are corn (or maize) based because it grows well in this climate. Despite this, there are relatively few fat people here. The other day we had a patient that was 1 MU (or Memphis Unit-which is around 250 pounds, the average Memphis resident weight). The entire staff, including American Dr. Hardison, was scoffing at how fat this woman was and how could she let herself get like this. I have yet to this day, to find a man here that weighs as much as I (and I am not really that big), and have been declaring myself “the fattest man in western Kenya”.

British Invasion
Less than 50 years ago, this land was still the property of the Queen of England and they imported many of their customs, some of which still hold true today. At 10am, anyone that can afford to stops working and enjoys a hot cup of tea. Chai tea is the order of the day (which is tea with milk) and the tea field of Kenya are on the Western Province where I am located, so while I usually don’t like hot tea, the tea here is delicious and enjoyed by everyone.

Sweets
Most of the sweets in the area I am in are usually single biscuits or pieces of gum or candy. Most people are unable to afford the big tub of cookie dough or funfetti frosting you scarf while watching Julia Roberts movies by yourself on Friday night. Rather, many places sell single pieces of gum or small non-chocolate candies (chocolate melts too easily). After much searching, today I found the legendary “Obama gum” the gum with pictures of Obama all over it - available in Obama Orange and Obama Strawberry. Yesterday, while I was in Kisumu and talking with Ruth, a sarcastic worker at St. Philips theological college, about Obama and how so many people here claim to be related to Obama or be their neighbors or friends. When I asked her if she was related to Obama, she said “No, but I know what he tastes like.” I can only hope she was talking about the gum.

Breakfast
For me, breakfast is the same each day and includes the spread above, which is essentially black coffee and corn flakes every day. There’s also the dreaded wheatabix, which are whole wheat bricks resembling plywood and with similar flavor and consistency. There’s also bread and margarine with so much fat in it that it can be stored at room temperature without separating.

I left the supa-loaf out on the counter one day and it attracted a supa-fly
Look for another post about the drinks of Kenya!

Hard lessons in swahili-Where do babies come from?

Mayai yaliangua vifaranga sita

The eggs hatched into six children

Your Questions Answered

2009-10-28T19:49:00.002+03:00

I asked for your questions about my Kenya trip and the response from both of you was overwhelming! I will take the time to selectively answer some of your questions - mainly the ones that do not implicate me in an international incident.

Have you learned things from a medical perspective that you would never have learned anywhere other than Kenya?

How to treat Malaria - nearly every patient is tested for it and almost all are positive. You have to deal with a high grade of ambiguity here, we only have an old xray machine and rudimentary ultrasound - preventative medicine is a bust here, but diabetes is rare and hypertension is much less common here. GI cancers are ridiculously common though.

Can you summarize the last month in one sentence? In one word? In one smell?

How truthful do you think you have been in your blog?

Are you calling me a liar? Sometimes when something is too strange to be true, it probably is. The material in my blog is very much true as experienced by me or read in good trustworthy sources.

What was your most difficult case?

I’ve seen some things here I probably won’t see in the US, but every case is difficult because of the cultural differences in medicine between here and the US - most folks here can’t afford to go to the doctor until it’s too late.

Are they using solar or wind to at least charge the smaller appliances like phones, flashlights etc?

Hahahahahaha, you realize that transistor radios are high tech here? Solar and wind technology isn’t used at all and the roadsides all pretty much have trash on the side of the roads. Since most people don’t even have electricity or running water, I feel they are a little away from that technology.

Are the Swahili translations for real? Are those all really from a kids book?

All of my translations from the same 40 page swahili kids book and I have only posted about 40% of the funny ones. I have the publisher info if you would like to get me a copy-you would be my hero.

and then the biggest question: Would you go back?

That’s the hardest question for me to answer. Folks are incredibly friendly, the landscape is beautiful, and the US dollar goes a long way in western kenya. Having to be locked in at night to avoid being murdered, being a constant novelty because I am white, being covered with bugs at night, fear of getting a disease or hurt and not having the facilities to treat it are all very real fears though. The fact that many of your patients are dying of problems that can be treated in the US is very hard. I would love to explore other parts of Kenya – especially Mombassa, but I probably wouldn’t do another medical mission trip here. I would probably go to a spanish speaking country next time - probably in South America.

Panga+Changaa+Bhang=instant murderer

2009-10-27T17:16:00.003+03:00

This morning as I was getting ready for rounds, I ran into one of my favorite clinical officers: Francis who was on duty last night. I asked him what came in overnight and he said, “It was a night of Panga attacks - 3 different people came in with Panga injuries”. Now when you think of Panga attacks, you are probably thinking “aren’t they adorable and just eat bamboo?” Turns out that Pangas aren’t cuddly oversized bears, it’s the Swahili word for “machete”.

You see, the Kenyans appreciate a well manicured lawn like we do in the US, but the terrain is far too rocky and unpredictable to use a lawn mower (not like anyone could afford it anyway). The solution? People use what’s called “slashers” which are these hockey stick like blades (I have a video I will upload when I come back) and use a sweeping U-shaped movement with their arms to cut the grass. A Panga is used for the more stubborn jobs and cutting your veggies, so Pangas are sold in most stores and a LOT of people carry them on the their person.

If Kenya had a national celebrity other than Obama, it would be Changaa. Changaa has achieved a counter-culture rock star status like Marijuana has back at home. Everyone knows about it, knows where to get it, and many drink it despite it being illegal. I wish there was a way I could accurately describe what is in Changaa, but the truth is it is brewed differently everywhere in Kenya. Changaa is Kenyan moonshine, and as potent as rocket fuel and much more hazardous to your health. The main ingredient is whatever is on hand than can be fermented - in this area millet is used in the brewing of Changaa. From there, the ingredients can vary but often include formaldehyde and methanol (which is why Changaa is notorious for killing entire rooms of people or rendering them blind).

If the stuff is so dangerous, you may wonder why people drink it. The average employed Kenyan makes about 80 shillings a day, with some making as little as 50 shillings. One bottle of Tusker beer costs 100 shillings and it might take a few days pay to get you wasted. Changaa is so potent that a minuscule 1 or 2 shots will have most Kenyans doing the Pink Elephant walk and several doses of Changaa can be bought for 20 shillings or less. I have often asked folks here “where can I get some Changaa?”, and despite knowing where I can get it, the hospital employees are reluctant to tell me because they think I will get a bad batch with extra formaldehyde and die. It took a lot of asking until I found someone who either detested me or was annoyed with me asking so much that she told me where to get it. With its illegal status, as you can imagine there is no Changaa store, and in my area it is sold in a stand in the woods where they are not easily found. It’s like the lemonade stand from hell, where for 20 shillings (about a quarter in US money) you can get absolutely messed up out of your mind. Yesterday as I was walking through town, I noticed Sean Paul music being blasted in a house and when I walked by and showed my approval, the group of guys invited me in for Changaa and probably a good raping - I politely declined.

In my last entry, I talked a little bit about the death customs here, and this entry incorporates another one that involves Pangas and Changaa. Apparently, the members of the Luhya tribe practice a burial custom where they bury the deceased at night. During this funeral, heavy amounts of Changaa are consumed and there is almost no artificial light in this country and moon and starlight are similarly non-existent here - it’s that pitch black. It’s not uncommon with the couple of folks I interviewed about this to get drunk and settle your differences with the other funeral guests with Pangas - hacking them into pieces in complete darkness where witnesses despite being right near you may not get a good look at what’s happening.

Francis relayed a story to me that a friend of his was walking along the dirt road that leads to the Maseno Hospital (the same road I took my awesome sunset shots with Helen and David in my birthday post) around dusk/darkness. He was carrying a drum of cooking oil on his head (it is true that many people carry heavy objects by balancing it on their head). It started to rain, so the man took his jacket and placed it over his head and the cooking oil and continued walking down the road. Out of nowhere, someone jumps out from behind him and swings his Panga down on his head-splitting the jacket and the drum of cooking oil and what he initially thought were his brains running out of his head was the cooking oil the Panga buried in the drum.

If Changaa and Pangas weren’t bad enough, there’s one more thing to add into the equation that is guaranteed to make you into a homicidal maniac-and that’s Bhang. Like Changaa, Bhang is illegal but everyone knows where it grows and where to get it. Bhang is cannabis sativa (also known as Mary Jane, wacky tobacci, the sticky, bud, weed or marijuana for you drug fiends out there) and many folks I talked to believed that alone they can have some substantial effects-but when mixed Bhang, Changaa and Pangas turn even the most well behaved Christian into a lunatic death machine. I think the local churches have been buying up all the old copies of Reefer Madness and showing them like a documentary here if this is what the natives believe.

I find myself paralleling much of what e see here into what I have experienced in Memphis since I have been there. Mixing moonshine and machetes may seem like a relatively bad idea, but in Memphis in the past year, it has been made legal to conceal carry firearms into bars! I’m not sure if it has passed yet, but there were resolutions also being made to make it legal to carry firearms into churches. Sure, when I am particularly moved by a service, I can sometimes feel the Holy Spirit loosening the holster and removing the safety so I can squeeze off a few rounds of praise over my head and right into the Lord’s face. In all seriousness though - recently a doctor was murdered at a church in the US because he performed abortions. Having weapons available where people are emotional or inebriated is a bad idea, whether it be at church, a bar, or at drunken funeral in the dark. Rather than going to extremes and outright banning these things, I think it should be mandated that everyone be required to carry a drum of cooking oil on their heads. After all, an ounce of prevention is worth... something (I can’t remember the rest of the saying-I got a Panga haircut today).

Hard lessons in Swahili-this is what happens when you mix Changaa and Pangas

Pua yake ilikatwa na wezi

His nose was cut by thugs.

The Dirigible and the Dirge-less

2009-10-27T03:38:00.008+03:00

What follows here is the tale of 2 deaths that occurred within a day of each other-rather than focus on how they died, I want to focus on what happened after they did and the contrast between them.

Every morning that I have been here I awake at the same time - almost to the minute. I don’t have an alarm clock or any time telling device at my bedside to help accomplish this either. The curtains in my room might as well be made of paper mache for their light filtering ability (and remember, besides water going straight down the toilet-dawn and dusk are at essentially the same time year-round. Rather than a lame radio DJ waking me up, I have the crow of the rooster-which acts like an alarm clock with a broken snooze button-I get my revenge on Saturdays. Greasy, delicious revenge with a side of mashed potatoes is on the menu!

Which reminds me, every day here is either a cow, chicken, or monkey day-meaning you will see a lot of one of these three any particular day Many of the hospital staff live in the houses within the hospital compound, and the entire hospital is single story and open air. This means that some stray animals can get in the ward, most notably-Ward Kitty. Monkeys are usually kept at bay by putting the patient’s leftover meals in buckets on stands outside-which acts as an effective garbage disposal as the monkeys dive in and chow down. Being here for several weeks, you get used to a very limited assortment of sounds-the crow of the rooster, the squeeking vervet monkeys, the mooing of a cow. Imagine my surprise when I heard drums, guitars, cymbals, and what sounded like the type of repetitive chanting you would hear at soccer game just outside the hospital while we were rounding. My curiosity was high, but rounds were lasting forever and I couldn’t go outside the gate and see what was happening in the street. It sounded like a parade, and I thought it could be that as this happened on 10-19, the day prior to Kenyatta day. Every time it sounded like the parade had faded though, it would come back minutes later. When I couldn’t take it anymore, I ran out of the ward, up to the house to get my new camcorder and ran out the gate to see just what was going on.

What I witnessed is hard to describe in words, hell even the video I shot of the event doesn’t do it justice. Maybe the picture below can help you imagine what it was like.

It looked just like this, except with darker skins, shirts, no turbans, and not in a cave-but otherwise the same thing.

What was outside was a group of mostly men and children and they were dancing/parading in the street and playing percussion, guitars, and other instruments and singing this one very uplifting verse over and over again. As I approached them, I wondered how they would take a Nzungu (whitey) with a video camera filming them. It was one of those things that could either be really good or bad, but as I approached the mob they gathered around me and since no one was speaking English and they were dancing furiously, I wasn’t sure what my presence meant. As they went by me, a child grabbed my pant leg and pointed ahead like she wanted me to join the parade. Turns out this parade is a Luo tribe tradition-during the formal funeral service, the parade served to guard the funeral that was ongoing on the hospital grounds.

Next to the morgue in the hospital, there was a funeral service being held around a white wooden casket. Thirty or so mourners were near the casket, but back about 40 feet on a balcony overlooking the service were probably 50 or so schoolchildren. The deceased was either an employee at Maseno School or a student-regardless, there was a mob of people for this funeral both inside and outside the hospital. After the service, the gate to the hospital was opened and the parade ran inside to help load the body into a MASSIVE Maseno School bus-which the whole crowd boarded-with people hanging off the side and on the roof like an Indian Train. One person on the parade route told me I had to go on the bus to where they were burying this person. I refused but he kept insisting, I had to tell him over and over again that the patients needed me and I couldn’t just grab onto the side of the bus and ride like everyone else. Later that evening, I talked with David and Helen about the experience-Helen and David learned when they were on home visits for HIV patients that a white person at a funeral or visiting just after someone dies is considered good luck.

This is Anne

Anne is one of the many patients of the Comprehensive Care Clinic (CCC) branch of the hospital that deals exclusively with HIV patients. Helen and David met Anne on their home visits which the CCC does weekly to check on their HIV patients without any way to make it to Maseno Hospitial. This involves the workers of the CCC walking miles on end to see these patients. I tried to go with the CCC this past friday on their home visits, but the distance was so far they were going to have to take a Peki Peki (a motorcycle taxi) and if I went with, they would charge a lot more because I am white-so I didn’t go. When Helen and David met Anne in her home, her family was preparing for her to die. She was extremely malnourished and cachetic-skin taunt against her protruding bones. The CCC employee told her she needs to be admitted to the hospital immediately. Her family was not oblivious to the situation-they stated they didn’t have enough money to pay for the hospital visit, so they were going to let her die at home.

I need to interject something very striking about health care in Kenya. There is a feeling of duty to pay for medical services here completely unlike the US. If you are sick in the US, you go to the hospital regardless if you can pay or not-but not in Kenya. We actually keep patients until they can pay their bills-and charge them daily until their bill is paid-this is standard practice at all hospitals here in Kenya-even the government hospitals.

Back to Anne’s story, David and Helen tell me about this woman at dinner and how her family was going to let her die at home because they couldn’t afford hospitalization. Imagine my shock when 2 days later-she’s here in our hospital on the wards. She was unable to swallow anything and when we did the chest x-ray she had milliary tuberculosis all through her lungs.

We put an NG tube down her and began feeding her aggressively to help gain back some of her strength and started her on anti-TB medications. Then something amazing happened, despite her wasted state and constantly frantic appearance (she didn’t talk), over the next 2 days she started to look better-she was getting plenty of calories. We have pulled folks with advanced AIDS from the brink, would this be another one saved just in time?

It turned out that it was not meant to be.

She died on the 3^rd day in the hospital, we tried hard to give her the best chance...but we lost her. Worse still, there was now a 5000 shilling hospital bill-converting this into US dollars-this came out to be around $66 US. Her family walked out from their home over 6 miles away and talked to me and Helen. They didn’t have enough money to pay the bill (as we already knew) and they wanted to know what they should do because the hospital wasn’t going to let them have her body for burial until they did pay. We as doctors (or more specifically volunteers-even Dr. Hardison is an unpaid volunteer) have no control over the finance department of the hospital and unfortunately the financial department was closed because she died on a Sunday. The family had to walk all the way back the next day.

In Kenya, there are no cemeteries. When you die, you are typically buried on the family land. If Anne’s family did manage to pay their bill and get Anne out of the morgue-she was going to be carried back to home-not in a huge Maseno school bus with scores of people-but carried overhead, 6 miles, back to her family’s land to be laid to rest where she was born-I didn’t see the family the next day-I don’t know if the bill was paid so they could take the body-I just hope she is finally able to get some rest in heaven.

Painful Lessons in Swahili

I have to side with Sade on this one-Yams are stronger than pride-c’mon, eat through the shame!

Alijivunia kula viazi vikuu

He was too proud to eat yams.

They had to make another death binder just for me

Revenge of the Witch Doctor’s Curse

2009-10-27T03:29:00.003+03:00

Remember before I was telling you about Samson, the boy whose head I drained of about 400 mL of pus after he went to a witch doctor to get his headache cured.

To this day, we don’t know what happened when he went to the witch doctor and they cut on his head. When he left the hospital over a week ago, he looked great and felt great. I was surprised to see him back in the wards after an overnight admission. The report done by the clinical officer (which is a medical personnel that is trained to function like a M.D.) was not clear as far as the reason for admission. It turns out since Samson left, he has had 3 grand mal seizures for the first time in his life. When we looked at him yesterday, we saw papilledema in his eyes which means he has some increased intracranial pressure and was pressing on his optic nerves. In layman’s terms, he has something compressing is brain causing him to have seizures.

We stressed to the parents that he needed to go to Kisumu to get a CT scan (which is about 20-30 miles away) and they refused. Today poor Samson was seeing double and we were not going to let him sit around here without a diagnosis. We wrote transfer papers and discharged him, but it’s up to the parents now to bring him to the hospital. Dr. Hardison and I talked about this afterwards. Apparently it’s not uncommon for the family to say they will bring the patient to a higher level of care facility but end up taking them home. If Samson doesn’t get a CT and figure out what’s going on and get intervention, he could continue to have worsening seizures, lose his vision, or worse. We have no idea what the witch doctor did to Samson or what those 3 incisions on his head were from, but I pray he is able to undo the curse put on him.

Kenya Q+A

2009-10-24T14:16:00.002+03:00

Greetings everyone! It’s my last full week here in Kenya so I wanted to open it up to a question and answer session about Kenya! The cybercafe is closed on Sunday, so it will be a few days before I answer the questions, but I will get to it and I will post the best questions right here in the blog! I miss you all and remember, feel free to call me (I am 7 hours ahead of those on the east coast). The best way seems to be skype (google voice’s quality was bad)-my number here is 0714 831 451 Please call me sometime, it would be great to hear from you!
Painful lessons in Swahili-the double entendre
Aliandaa mchuzi ulionoga

He prepared a tantalising sauce