Archive for April 2009

Back on the Home Server Show Podcast   Leave a comment

This week, Dave McCabe (host of the Home Server Show podcast) and I caught up a bit by Skype to discuss some of the latest home server news.  We did a little recording and you can hear our conversation on show number 41 by clicking below.  I’m not sure how many podcasts have been recorded from Kenya, but it can’t be many. 

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Posted April 26, 2009 by chrislux in Technology

MTRH NICU   Leave a comment

Moi Teaching and Referral Hospital Neonatal Intensive Care Unit

Impressions and Thoughts

When a baby is born that is in need of special medical attention, they are admitted to the NICU.  In the states, the sick neonate is placed in a crib or incubator and attached to series of tubes and wires.  Temperature, respiratory rate, fluid balance, heart monitoring, and weight are analyzed on a constant basis.  A fleet of doctors, nurses, technicians and students pore over the data and assess the wellbeing of the child.  It is an intense environment that must seem as alien to the new parents as the world appears to the newborn.

The NICU I walked into in Eldoret this week bore little resemblance to what was just described.  After changing into hospital scrubs and donning communal slippers we entered the first of several rooms.  We were greeted with a wall of heat.  The babies were placed nude in a row of plastic bassinettes on wireframe stands lined with a black mattress covered with a hospital sheet.  There were no wires, no monitors, no tubes.  Some of the babies had a fine plastic oxygen line fixed to their nose at one end and spliced together with other lines leading to a lone O2 tank.  The heat was produced by a series of rusted electric coil heaters haphazardly placed on the floor.  Metal bowls of water were placed in front of the heaters to provide humidity.  Why heat a room in a cinderblock building just miles from the equator?  It dawns on us that the room itself is functioning as a giant incubator.  Body temperature; 98.6 degrees.  Necessity breeds innovation.

There is no relief from the heat in the next room.  This room harbors some of the sickest babies in the hospital.  Some are awaiting surgery they may never get.  Some lay blindfolded under the hum of a fluorescent bili-light to combat their jaundice.  One baby was born with externalized intestines with little chance of survival.  There is a single nurse assigned to each of these intensive rooms.  There are no monitors.  The nurses’ charting consists primarily of paper cards where weight and temperature are listed and little else.  Inevitably, the power fails leaving us temporarily in the dark until the large diesel generator belches to life outside the NICU window.

The final room is larger and houses the healthiest newborns still requiring some degree of medical attention.  The plastic bassinettes line the walls, each one containing a naked baby.  In the center of the room is a pair of rough hewn wooden benches where the mothers congregate.  The women are clothed in hospital gowns tied at the waist.  Most sit with their breasts exposed.  (Breast feeding is by far better accepted in Kenya than the states and it is not uncommon to see a woman breastfeed in a restaurant.)  The hospital has some interesting rules about when a baby should be allowed to breastfeed.  Before starting breastfeeding, many mothers are told to cup feed their infants.  These women sit on the benches and use their hands to massage milk into small containers.  They then hold their babies at arm’s length in blankets pouring the milk from the containers into the babies’ mouths.  It is shocking that more of them do not aspirate milk into their lungs.

Dr. Lemons, director of neonatal medicine at Riley Hospital in Indianapolis, arrived at the hospital this week.  He has been instrumental in arranging the funding to make the MTRH NICU a reality and continue to improve the conditions here.  The hospital administration elected to post a framed picture of Dr. Lemons in each NICU room whereas the rest of the rooms in the hospital display a portrait of Kenyan president Mwai Kibaki.  The morning Dr. Lemons arrived, the unit was swarming with doctors (called consultants and usually hard to find on the wards).  A blue ribbon was hung from the NICU doors for Dr. Lemons to cut.  As he entered the ward, he noticed his portraits.  He was obviously uncomfortable with the celebrity attention he was receiving.  With him were two Riley NICU nurses here for their first visit; both trying to conceal their surprise at the state of the ward.  Their job will be to assess the conditions in the MTRH NICU and determine areas in need of improvement.  They have one week.

Posted April 25, 2009 by chrislux in Travel

Birthdays in Kenya (WARNING: GRAPHIC CONTENT)   2 comments

Sunday, April 12, 2009
River House, Eldoret, Kenya

Word had gotten around the IU House that two of our friends (Colin and Francesca) had birthdays coming up, so a party was planned for Sunday, April 12.  I enlisted the help of Simon and Benson to help plan an event down at River House.  They informed me that there are two birthday traditions here in Kenya; 1) Pour as much water and/or beer on the birthday boy/girl and 2) Prepare a goat or sheep for the celebration.  After clearing the birthday animal sacrifice with Colin and Francesca, I gave Benson the go ahead to start searching the local villages for a good candidate for dinner.

In the meantime, Bethany and I decided it would be fun to make a piñata for a little entertainment during the party.  Neither of us having made a piñata before, we googled the directions and modified them to fit our resources in Kenya.  We tied a balloon and a surgical glove together and realized that we were going to be making a rooster.  Our plaster consisted of flour and water which was remarkably similar to the ugali mentioned in a previous post.  After several rounds of plaster and yarn for structural support, we hung our creation out to dry in the back of house 5.

 

Next, we went on a bit of a nature walk to find local plants and flowers to decorate our creation.  We found a cluster of spiral seed pods for the tail, pink and orange flower petals for the crest and beak, palm fronds for the feathers, and yellow bush tomatoes for the eyes.  We even fashioned an official whacking stick from a bamboo pole.  The final decoration happened while I was in Nakuru.  With the help of Allison and Greg, the results were fairly spectacular.

 

The day of the party came and Benson and I went to pick up the goat he had purchased for 3,500 shillings (about $40).  Naomi, a long term resident of the IU house, volunteered to drive us to the village where our dinner was waiting.  Our purchase was tied to a bush on the side of the hill.  I noticed that the ‘goat’ looked awfully wooly.  “Benson”, I said, “is that goat a goat or a sheep?”.  “A ram”, he replied.  Apparently, for birthday celebrations, either will do.  You can’t be too choosy during the rainy season because farmers need to breed the next generation.  We drove back to the IU House with the ram quietly sleeping in the back.

CAUTION: Continue reading only if you are comfortable reading and seeing the ram being prepared for dinner.

  

At around 2:30, we gathered at the River House to start preparing the ram for dinner.  Colin, as the birthday, boy was offered the job of killing the ram, but he asked me to do the job for him.  I had never slaughtered a large animal before (just lots of lab mice), but felt comfortable giving it a try.  Benson held the ram with feet tied and head laid over a metal basin and I was handed a newly sharpened blade.  I took hold of the ram’s head and with a quick series of forceful cuts, the job was done.  Some people in the crowd could not watch.  One person became momentarily angry at the site of dying animal.  Most just watched and seemed glad not to be me.  Benson and his friend Nicholas continued to prepare the ram for cooking.  The muscle, we would keep for our dinner.  The head and limbs went to the guards to make soup.  The viscera went to the cooks who cook them for their families as a delicacy.  There was little or no waste.  I think it was a good experience for us to see where our food comes from.

While the meat was being prepared, we gathered to break the piñata.  It was stronger than we anticipated and it took seven people hitting it to finally break it open.  The contents of our rooster were all local items; packets of roasted peanuts from Mary (a woman who sells them on the side of the road on the way to the hospital), some local candies called ‘happy sweets’, several Safaricom top-up cards (cell phone minutes), and a hand full of government issued condoms (maybe you have to be here to find that funny).  We played volleyball, drank tuskers and coke, ate our roasted ram and had a fun birthday party for Colin and Francesca.

  

Posted April 21, 2009 by chrislux in Travel

Easter Weekend Safari   Leave a comment

Easter was a long weekend here in Kenya.  With things fairly quiet in the clinic, some of us decided to go on a bit of a safari to Lakes Nakuru and Naivasha.  We hired a driver who we all call Taxi Max who would be our guide and he arrived in his beat up land rover early on Friday Morning.  In addition to myself were Manika, Kalpana, Anita, and Justa.  This was my first introduction to the Kenyan highway system.  While there are short stretches of semi intact pavement, the vast majority of the roads are a mixture of large rocks imbedded in red dirt or asphalt in such disrepair that some drivers resort to driving in the dirt to the side of the road.  Even going as slow as 30 KPH, we were still being thrown around the land rover for most of the ride.

Along the road to Nakuru, we passed over the Equator.

Lake Nakuru is a beautiful nature preserve run by the Kenyan Wildlife Service.  Quickly after paying our admission fees and entering the park, we were stopped by a pair of park rangers.  After a brief discussion with our driver, the rangers demanded our entry cards and receipt.  Then they drove off without returning our cards.  This was likely a scam on their part to illegally sell entry passes from paying customers outside the park and pocket money.  It is a sad truth that you have to be on your guard for this kind of scheme in Kenya.

We saw an amazing array of animals in the park.  The following are just a small sample of the many pictures I took in Lake Nakuru Park.

   

After a quiet night’s sleep in the Lake Nakuru Lodge, we went for a final morning game drive by the lake and up to Baboon Point.  We had a spectacular view of the lake and park from the point.  As we drove out of the park, we found a tortoise in the middle of the road, so we helped him back into the woods.

From Nakuru, we drove towards Nairobi to Lake Naivasha.  We had a nice lunch at Fisherman’s Camp during an afternoon rainstorm while Colobus monkeys played in the trees.  When the rain cleared, we hired a motor boat to take us out to a small island where you can walk with herds of zebras and wildebeests.  The island is actually now a peninsula since the booming flower industry around the lake has drawn down the level of the lake enough to form a land bridge to the island.  Max decided it would be a good idea to ‘help’ the wildebeests with their daily migration across the island by chasing the herd.  As we walked around the island, the clouds began to break and a series of rainbows appeared on the horizon.  On the boat ride back to the camp, we passed by the region of the lake where hippos like to spend the day.  There were 30-40 hippos including several babies that kept diving out of sight.  We learned that the babies will actually dive under their mothers to nurse.

  

When we returned to the camp that night, we found that our banda (cabin) had been sold to a group of drunken partiers.  The manager decided to put us in the staff quarters in a triple bunk bed.  I was able to practice my bargaining skills (a must have in Kenya) to drive the price way down the next morning.  Our last adventure was to a gorge known as Hell’s Gate.  The gorge was full of obstacles that we had to climb over and down which made for an exciting walk.  Lining the walls of the gorge are natural hot springs that give the gorge it’s name.  Nearly halfway down the gorge, we started to hear thunder and feel drops of rain.  I suggested that we leave immediately and any resistance from the group vanished when a Masai guide leading another group rounded the corner, pointed to the top of the gorge and simply said “GO!”  We just made it out when sheets of rain began crashing down on us.  I hate to think what it would have been like at the bottom of the gorge.

The rain continued on the drive back to Eldoret and turned into a thick fog that made travel a bit precarious, but we made it home just fine thanks to Max.  All in all, we had a wonderful trip.

Posted April 14, 2009 by chrislux in Travel

Sometimes, when there’s nothing to do…   1 comment

Saturday, April 4th, 2009
IU House, Eldoret, Kenya

Late last night, I was invited to go on a trip to Mt. Elgon to a nature preserve with a big group of people from the house.  As tempting as that sounded, I was still feeling jetlagged and frankly not sure I was looking for a hike up a mountain side just yet.  I went to bed expecting a nice relaxing weekend with nothing to do.  Sometimes, when there’s nothing to do, amazing things happen.

I started the morning taking my camera around the IU House grounds to try and capture some images of this beautiful place.  I’m not sure the pictures do it justice.  When you look at them, you have to imagine a warm breeze blowing through the leaves, the call of exotic birds all around and the smell of red clay and flowers newly opened with the onset of the rainy season.

   

One of the guards was sitting at the gate with his dog Jack and suggested I go visit River House at the end of the road (also a part of IU).  River House is gorgeous.  There are large glass doors with iron accents open so that the wind blows the white curtains through the rooms.  There is a small pool to the side of the house and beautiful landscaping all around.  Thinking I was alone in the house, I walked into the kitchen and startled Elizabeth who was preparing a meal.  I apologized for ‘sneaking’ around and she told me the lunch she was making was for a group of shelter children who would be coming to swim this afternoon.  She also said she needed a lifeguard.  More on that later…

I said goodbye to Elizabeth and made my way back to the hospital to see if I could find Emily and her grandmother.  Grandmother was sitting alone on the edge of Emily’s bed.  Emily was outside playing.  Through an interpreter, I learned that she likely had been suffering from Grand Mal seizures for the last 3 years for which she had not been receiving any treatment.  The pills she needed cost less than a penny a day.  I wrote a long note detailing her symptoms and with the Kenyan intern, made sure that her discharge papers included her much needed seizure medication.  I met with Emily and her grandmother back at her bed and made sure they knew how to take her medication.  Emily was discharged.  We are all hopeful that she begins to see some relief from her affliction.

So, I went back to River House to report for lifeguard duty.  When I got there, the kids were just getting into the pool and Colin (who had mostly gotten over his food poisoning) showed up to help as well.  It wasn’t long before we joined them in the pool.  We taught them how to play Marco Polo and followed that up with a game of Sharks and Minnows.  The kids had a blast and it was a nice treat to soak in a cold pool for an hour or so.

We headed back up to the IU house where two of the locals (Simon and Lea) were planning to cook dinner.  Traditional ugali and beef stew.  Mary, Ashley and I pitched in.  Ugali is very simple; boil water, pour in corn flour, stir until it’s done.  It was a lot of work, but the final product was delicious and it was fun to make it with people who grew up eating it.

After dinner, Ashley, Simon, Kelvin and I decided to take a taxi to town for some live music.  We headed to the Sesia Club at the Eldoret Wagon Hotel.  The sign read “Your fun and cheers hub”.  This was going to be great.  The band was called Ja’mnazi.  They are a Kenyan cover band playing traditional music from all cultures in the country.  There was a large dance floor flanked by tables where people sat drinking Tusker Beer.  The dance floor was always full of people in mostly western style dress, mostly inebriated, and dancing in a style that makes even me look like I know what I’m doing.   It wasn’t long before other friends from the IU House (Benson, Victor, and some others) joined up with us.  We listened to music and danced until 1 in the morning.  It was a great time. (Apparently, you cannot take pictures in clubs in Kenya, so you’ll have to picture it for yourselves.

Posted April 6, 2009 by chrislux in Travel

Rounding With The Pediatrics Team   2 comments

Friday, April 3rd, 2009
Moi University Hospital

Today was my first full day in the clinic, and it was also my first chance to be on rounds with the pediatric team.  Bethany and I met up with Dr. Chitanga who is the team registrar (their version of a resident) next to the first line of patient cots.  We were also accompanied by 2-3 Kenyan medical students.  The registrar called for the first patient to be presented and a nervous student stepped forward with her notes in her visibly trembling hands.  She quietly and deliberately read through her notes while presenting her patient.  After a fumbling through a few questions from Dr. Chitanga, she ducked back into the crowd clearly relieved to be out of the spotlight.  I am told this is the result of the British system of medical education.  You are taught largely by being told what you are doing wrong rather than being given constructive feedback.  There is a clear demarcation between the ranks that does not tend to exist to the same extreme in the American system.

As we neared to end of rounding on our patients nearly an hour later, an additional 10 or so Kenyan medical students wandered onto the wards.  Surprisingly, the registrar only made a small comment about the ‘late-comers’ but did not seem bothered.  Today was an admitting day for our team which meant that any new pediatric cases came directly to us; it would be busy.  Before the first patients began to arrive, I took a minute to track down ‘Emily’s’ chart.  There was little in it of any specific use, but the doctors seemed to believe that she suffered from hysteria and was not having seizures at all.  She would likely be sent home without further treatment.  I found Emily lying on her cot with another headache.  “I don’t feel well today,” she muttered.  The only way to confirm her seizure activity without and EEG (electro-encephalogram) was to ask her grandmother to describe what she sees when Emily has ‘fits’.  It is very hard to fake such descriptions.  “Grandmother has gone to market to work today,” said Emily.  “Will you come tomorrow and see her then?”  “Of course.” She answered me with a big smile.  I returned to the team and helped admit patients for the rest of the afternoon.

When a group of us arrived home after dinner, our friend Stephanie was standing in the driveway with a blanket in hand.  She and Collin had recently gone to Nairobi to complete security documents for their residency programs awaiting them in the states.  Unfortunately, they came down with food poisoning while there so the extra bunks in my room are now a makeshift convalescent ward for them.  I’ll likely stay in another room to let them recover.  Another eventful day.  The first of many I’m sure.

Posted April 4, 2009 by chrislux in Travel

First Day in Eldoret   1 comment

Leaving Nairobi for Eldoret, we switched to a small prop plane.  We flew at cloud level so our view shifted between towering clouds and green landscapes below.  As night came, the rain began to fall gently on the plane and we shortly landed on the dark landing strip in Eldoret.  A cab driver met me at the airport and we began a bumpy ride through the night streets.  There are no lines on the roads and driving tends to be a freeform mess of trucks, ‘matatus’ which are public vans, cyclers and pedestrians.  The rain didn’t seem to bother anyone and I later learned was the end of a long drought so the precipitation was very welcome.

When we arrived at the gates of the IU House, Sarah Ellen Mamlin was waiting for me.  Sarah Ellen is the wife of Dr. Joe Mamlin and co-directs the program here in Kenya.  We walked around the compound in the dark and she introduced me to some of the staff.  My room door was labeled with a painting of a flower called a ‘red hot fire poker’ that the Mamlin’s son had painted.  The room was furnished with a desk and two mosquito net draped bunk beds.  I had no roommates the first night.  As I lay down to go to bed, the skies opened up and gentle thunder quickly lulled me to sleep.

I woke to the sounds of two deaf carpenters who work on the property and walked around the quiet grounds.  Most of the people had gone to the hospital already and I was to meet up with them at lunch time.  I took a walk into town along the red dirt roads passing countless women with babies tied to their backs, a man in a suit herding cattle, and a vast array of other activities.  Bethany, a third year pediatrics resident, met up with me and gave me a tour of Moi Hospital.

The hospital is a bit hard to describe and I will have to add pictures in the near future.   Moi Hospital is a series of connected buildings packed with patients and their families.  There are no proper rooms, but rather general areas full of cots often with patients having to share a ‘bed’.  The hospital is open air so there are a great deal of flies, but there is a nice breeze so things don’t smell as bad as they could.  When we arrived, there was a choir singing on the balcony for an art show run by the women of AMPATH.  It was a nice soundtrack for the tour and the song is still stuck in my head.

After the tour, I went to spend a little time with the children in the hospital who were joined in the play room.  As the kids moved to play a little musical chairs, a little girl name Emily (made up name) stayed behind and lay quietly in the corner.  I sat with her and asked why she wasn’t playing with the others.  Emily told me that she was having one of what have become frequent headaches.  In talking with her more, I learned that she has HIV and possibly a seizure disorder.  While the other children played, Emily and I talked about her family and she taught me a few words of Swahili.  As I got up to go, she tugged at my sleeve and said she wanted to show me where she stayed so I could find her tomorrow.  She led to a small bed in the corner of the hospital near a window.  She pointed to her bed and showed me where her grandmother sits when she comes to visit.  I look forward to learning more about her on rounds tomorrow.

Posted April 2, 2009 by chrislux in Travel