Wednesday, May 11, 2016

What is Body Safety Education?

I arrived in Kenya eleven months ago. I am only a month away from my return to the USA. I am a bit sad that I will be leaving but I am hoping to leave a positive change here in Kenya since Kenya has made such a positive change on me. Kenya has taught me so much. I have learned about new cultural practices and traditions. I am nervous I will return to the USA and greet everyone in a room with handshakes and cheek kisses. I have learned a good amount of Kiswahili to the point that words like "sawa" (ok), "pole" (sorry), "asante" (thanks) and "sasa" (whats up) are integrated into my vocabulary. USA get ready to hear a mzungu speaking random words of kiswahili.

In addition Kenya has taught me so much about medicine. I have been working with AMPATH Clinic on a project helping children living with HIV. I have learned the resilience of these children and the dedication of the people supporting them. Kenya is such a beautiful country with so many kind and generous people. I have made life-long friends here and I hope come back and visit soon.

Kenya also taught me how to manage a research project and work with a team to meet our goals. Six months ago one of our research assistants brought to my attention a handful of cases of sexual abuse of children at his clinic. He was asking for help and guidance and we saw an opportunity to fill a gap.

One in three girls and one in five boys experience sexual abuse before the age of 18 based on a survey in 2010 in Kenya (1). Unfortunately sexuality is a taboo subject in Kenya and there is a large amount of stigma that surrounds children who have been sexually abused and their families. Rarely children in Kenya receive education about how to keep their private parts safe and prevent inappropriate touches. For many educators and healthcare providers its hard or embarrassing to talk about these topics of sexuality.

Thanks Maria Schlatter (Mom) for the book illustrations
In the hopes to fill in this educational gap my team developed a culturally friendly book that would educate children about private parts, good and bad touches and what to do if they experience inappropriate touches. At the same time the book help healthcare providers and educators feel more comfortable about this topic. In addition it helps raise awareness in the community about the importance of educating and supporting our children.

Thanks Maria Schlatter (Mom) for the book illustrations
After a four month study we have finally ready to bring this book to the community. Surveys of study participants have created a list of where we can send these books. This includes orphanages, schools, churches, mosques, village elders, community outreach events and more. In the hopes to get these books out we hope to print a thousand books, but we need all the help we can get. 

Please visit: to donate!  Thanks so much for all your help.

(1) UNICEF, CDC, Together for the Girls, Kenya Vision 2030, (2010) Violence Against Children in Kenya Findings from a 2010 National Survey. 

Tuesday, March 29, 2016

So Many Monkeys!

I arrived In Kakamega forest Easter Sunday. Kakamega rainforest resides in Western Kenya, less than two hours from either Kisumu or Eldoret. It's abundant wildlife and activities makes it a great weekend getaway.

Kakamega has many places to stay for any budget. If you are interested in saving money you can stay in the Isecheno Keep bandas between $6-9 depending on your residence status in Kenya. The Isecheno Blue Shoulder Lodge which is approximately $5 for a dorm-style lodging. If you are interested in higher end accommodations Rondo, a Christian retreat offers room and board for $60 a night.

On a smaller budget my friend Kris and I decided to stay in the bandas for 700KSH ($7) a night for residents. We also packed food and snacks to minimize costs. When we arrived to kakamega forest ranger station we paid park entrance ($4 for residents) and were given a small tour of the area. Next we were shown where we were going to be sleeping.

Our banda was a large thatched roofed house with cement walls. It has a small covered porch for sitting. Inside were two bedrooms, each with two beds and a mosquito net. Inside the thatched roof was lined with spider webs and probably many other bugs. The bed was a small twin sized mattress with a small slope in the middle from overuse. The pillows were thin and the chicken wire over the windows to keep out the monkeys was mended with rope. Despite the place not being very appealing it was a roof over our head, something soft to sleep on and only $7.

The banda was in a compound with five other similar bandas, an office, outdoor toilets and a large covered sitting area. The compound was surrounded by large trees  and a green lawn. The thatched roof bandas fit perfectly with the surrounding forest. On the compound resided a group of seven German volunteers and a lone German traveler. Once Kris started speaking in German it felt like I was in Germany rather than Kenya. Everyone was very nice from the other group and helped us navigate around the area.

A five minute walk down the road, by the green house, across the main road was a small wooden shack called the canteen. This run-down building was where you could order lunch and dinner. Its small menu boasted local favorites such as ugali, matoke, and sukuma wiki. The prices are a bit more than what you find in the cities but still reasonable.

Kris and I decided on dinner, matoke, cabbage and beans, and placed our order. Since there are only two cooks and food perpetration take many hours, they recommend you place your orders hours in advance. Our bill ended up being only 200 KSH ($2) for both of us.

After ordering dinner around 2pm we set off on our first hike. Limited on money we decided on the short hike for 500KSH ($5) and the sunrise hike for 1200KSH ($12). This is the priciest part of the whole trip, but they are worth it. Ask fro Abraham as a guide, he is fantastic and very knowledgeable. He is a avid birder, so if you like learning about the different bird species he is the one to hire.

We walked out into the forest stopping every 5-10 minutes for a story. He explained to us about the medicinal properties of the plants and the history of the forest. His eyes were excellent, he was able to spot birds and animals and name them in seconds. He had a pair of binoculars which he was lent us to see birds and monkeys that were far off.

As we walked monkeys jumped through the branches over our heads. Cricket and bird calls filled the forest with sounds. Soon we arrived to a clearing. He explained to us that these islands of grasslands within the forest were shrinking as the rain forest swallowed them up. We climbed to the top of a watch tower which was missing quite a few steps. A the top we met another group consisting of two American's from Oregon. We sat at the top talking and looking out at the monkeys jumping through the trees.

We headed back down and back to our banda. We sat on our porch talking and listening to the sounds of the rainforest. At eight we headed over to  the shack for dinner. Despite order only matoke (stewed green bananas) beans, and cabbage we still had food left. We said goodnight to the other group of volunteers and headed to bed early.

The next morning we awoke at 5am to head out to the sunrise hike. The sunrise hike is a 4km walk down the road and up a large hill. This hill, due to its volcanic rock composition, was clear of trees. It was the highest hill in the forest and therefore offered an amazing view of the sunrise. We hiked in the dark with our torches and finally reached the top.

The two American's from Oregon were sitting at the top. We handed out the five PB&J sandwiches we had made and we ate as we enjoyed the sunrise over the rainforest. After sunrise we headed down the mountain and stopped at a cave. The cave was 50 meters long and was filled with bats and crickets. If you are afraid of bats or creepy crawlies this cave is not good for you.

After the cave we hiked home. At home we enjoyed another peanut-butter and jelly sandwich under the covered sitting area and took tea with the Germans as we talked. After lunch we went exploring. We found a small trail leading into the forest and began walking. We made markers at each fork to lead us back. The trail began getting narrower and narrower, until we reached a point when we were ducking under trees and jumping over logs.

 Finally we turned around and headed back to camp. On the way we were surrounded by monkeys. Close enough that you could reach out and touch them. We watched them as they played in the trees, running over the thatched roofs, running around our feet. Small babies clinging to their mother's bellies as the monkeys swung from branch to branch. After several minutes of watching we meet with our ride back to Eldoret.

Over all Kakamega was very relaxing. The forest was beautiful and green. The hikes were leisurely and not very strenuous. The forest was warm and humid, but not too hot. The nights were chilly, perfect for a sweater. Overall I would go back and visit. Its a great weekend trip that won't break the bank.

Thursday, March 17, 2016

Hold On - Rafting the Nile, Uganda

On Friday I headed to Jinja with my roommates. We left at 2pm in the hopes that we would arrive our our campsite in Jinja before dark. Unfortunately things did not go as we planned.

Crossing the boarder is simple and take only 30 minutes usually if you have all the documentation you need. Unfortunately our taxi driver forgot his log book .Of course you can't cross the boarder without the logbook. Already three hours from our home there was no turning back. So to get across we bribed the guard to let us go, but that was almost two ours after we had pulled into the boarder control office.

Finally arriving at our campsite Jinja, Uganda

Finally we crossed onto the Uganda side. Now its the easy part.... wrong. Of course after filling out proper paperwork we were hassled by a man who was adamant we paid him for services that he had not provided. After a few curse words he left angry that we did not pay, but not without sabotaging our entrance to Uganda. The guard who had witnessed our quarrel told us we needed to purchase $60 insurance for year insurance (but we were only staying two days). We handed him $2 to let us pass through the gate into Uganda. Of course he wanted more. We bumped it up to $5 and he let us pass through the gate.

Already dark we drove carefully to Jinja in the hope not to be pulled over. We arrived in Jinja at close to midnight. We were exhausted and hungry. Of course the kitchen at the campsite was closed. We ordered rolexes (chapati stuffed with egg and veggies) from a local shop. We headed to bed only to wake up six ours later for rafting.

We went with Nalubale rafting company. They are one of the highest rated rafting companies in Uganda. They offered us a sweat deal for a full day rafting trip which included a guide, lunch and pictures of the whole experience.

I have been rafting a handful of times so I was excited for this class V rapid down the Nile. We started of the trip practicing some safety skills. What to do if the raft flips, what to do if you fall in. It was important that we practiced because the first rapid was a class V waterfall.

As we perched on the top of the rapid watching the safety boat and then a kayak flip over we were all a bit nervous.

We inched closer. Paddling swiftly to get to the perfect path down the waterfall. Of course as we edged closer to the edge we got stuck on a massive rock. We all paddled hard trying to dislodge ourselves. We felt the pull of gravity as the front of the raft tilted down. I was sitting right in the front. Everyone on the raft was screaming and yelling.

All of a sudden the boat tilted forward and became vertical as it slid down into the churning water below. We all held on for dear life as the raft slammed into the water below. The impact was so hard our raft penetrated the water and we all flew every which way.

When we surfaced again everyone was still on the raft. We had survived.

This was just the first in a series of class III, IV and V rapids. The eight hour day of rafting was full of adventure. We would jump out and lounge in the river enjoying the cool crocodile infested water as we floated down the Nile, the longest river in the world. Flips off the boat. Enjoying spraying each other with out paddles. Holding onto the safety kayakers as they dragged us around the river.

We had lunch on the edge of the river. It was a satisfying salami wrap, pasta, carrot cake and fresh fruit. After lunch we ran the last four rapids before washing up on the shore of the island campsite we stayed at that night.

It was a perfect day with all my friends.

Monday, March 14, 2016

Where can you find hairy lemons? - Camping on the Nile

After a long day of white water rafting down waterfalls we washed up on shore of Hairy Lemon Island Lodge. Hairy Lemon is situated on a forested island in the middle of the Nile River in Uganda. This small island hosts an eco-friendly camping, cabins, glamping and hostels. With a fully stocked bar, board games, and volleyball court in the middle of the river, its a perfect place to relax and have fun with friends.

The island is very quiet and quite small but has lots of hidden treasures. If you love being active, play a round of Nile River volleyball or go for a kayak outing. If you want to sit back and relax, have a drink at the bar or recline in the hidden natural Jacuzzi. Its the best of both worlds.

Within the cost of lodging you receive three meals and chai (tea). For dinner we had soup with home-cooked warm bread, tender beef stew over rice, cooked cabbage, mixed veggies and baked butternut squash. For lunch we were packed veggie pizza, cookies and mango juice, breakfast was eggs, warm bread, bacon, fresh fruit and muffins. Fresh cookies and chai are served at 4pm each day.

We arrived to the island straight from white water rafting and received a quick tour of the island. We got settled into the dorm room and then headed to the volley ball court in the middle of a small river going through the resort. We played a competitive game of volleyball.

After dinner inhabitants of the island gathered around a bonfire and roasted marshmallows on long skewers. I have not had a marshmallow for over a year. They are so hard to find in Kenya, but sure enough Hairy Lemon had them. We were given complimentary Hairy Lemon signature shots to get the mood started. We joined in deep conversations and played board games on the large family tables.

The next morning I woke for the sunrise. As I sat on the beach watching the sun rise over the green forested sides of the Nile I heard monkeys swinging from the trees over my head. Red tailed monkeys play through the trees day and night at the resort. That's why its important to clean up all your food remnants before you go to bed.

After breakfast we put on our bathing suits and headed to the natural Jacuzzi for a swim. To get there you must either ask the owner for directions or have someone show you. To find it you must hike from the beach around the far side of the island, under a mangrove tunnel, along a shallow stream up to a shaded area with a small waterfall. Here you can sit in the pool as the waterfall creates a vortex in the pool. Its a bit dangerous. If you get swept by the current it can carry you down the small waterfall and over some dangerous looking rocks.

At the end of our stay we took a short boat ride back to shore to meet up with our driver to head back to Kenya. Overall Hairy Lemon was wonderful. It seemed like a hidden piece of paradise. The island has poor cell reception, no internet, compost toilets and natural cold showers. Its vegetarian and vegan friendly and great for any age. With many things to do around the island you can spend days here escaping the hustle and bustle of Kenya's and Uganda's big cities.

PS: There are no hairy lemons on the island its names after where the couple who owns the resort met. 

Saturday, March 5, 2016

Rift Valley Exploring

Today I visited Samich Resort on the rift valley. Samich is a high end restaurant and hotel located on the edge of the rift valley in Western Kenya. It’s a day trip from Eldoret. The resort is hidden behind a huge gate on a 4km dirt road off of the main road. 

When we arrived we started off on the “Nature Trail” which descends into the rift valley. The trail is well maintained but very steep. Almost every part of the trail is a perfect photo opportunity of the rift valley. After about 30 minutes you arrive to a small banda/hut with an amazing view. This is a great place for a snack or lunch. 

There are more trails that descend further. We continued a bit more then turned around. The hike down is not too hard, but going up is steeper and much more exhausting. Once you reach the top you can enjoy a cold drink and lunch at the restaurant. The view from the restaurant is also beautiful. There are many shaded tables to choose from. 

Monday, February 22, 2016

Road Trip to Wote

Wote is a small rural town in Makueni County in Eastern Kenya. Its a two hour drive east of Nairobi and a seven hour drive from Edoret the town I live. Its also home to one of my close friends here in Eldoret, Dr Musa. My friend was very excited for me to meet her mother and brother so I joined them on an exciting and unforgettable roadtrip to Wote. 

The first part of the trip is the standard Eldoret to Nairobi highway. We stopped at Kikopey a famous roadside dining experience. Kikopey is known for its wide selection of nyama choma. They thrown almost anything on the grill. Chicken, cow, goat, intestine, kidneys, liver you name it. There are many stalls to choose from. Each of them offer samples. Hanging in the window are carcass of cows and goats. Its a bit overwhelming for a recovering vegetarian. 

After a satisfying meal we smashed back into the small car and headed to Wote. On the way to Wote we stopped in Machakos to pick up a card for Dr Musa's brother. It was just before the national exams for primary school children. Its ceremonial to give them an over-sized card and school supplies before exams. Dr Musa also decided to pick up a pair of shoes.

We headed off to Wote, or at least in the direction we thought Wote was in. We drove about two hours through the arid terrain, passing many small rural towns. Finally our driver, Vinny, realized we were not anywhere near Wote. We stopped in one of the small towns and asked a gentleman which direction Wote was. He shook his head, its about three hours the opposite direction. We had to head back to Machakos and then take a different road. 

The Shortcut
We were already late and three more hours on the road seemed long. There has to be a short cut. I opened google maps and found Wote. Sure enough there was a road that took a more direct path to Wote from where we were. Determined we set off for this shortcut. 

The shortcut happened to be a dirt road (rough road) that took us through the hilly dry terrain. All of a sudden we heard a pop and the car began to lean to one side. We all hopped out of the car to find one of our wheels had blown out. The view was beautiful so I decided to take a small hike up while we decided what to do. 

Where our tire popped
A piki-piki drove by and told us there was a town only around the corner. We drove with the flat tire a couple minutes to a small town that had to be a population of 50. We stopped near a shop under the shade of a small tree and let Vinny change the spare tire. At the same time Musa and I went off in search for a cold drinks for the three of us.

Of course it was dangerous to drive without a spare so we asked around for someone who could mend the tire. There was nothing in this town so we headed on our way hoping the next town would have more services. 

In the next town we found a tire repair place. Dr Musa and I decided to take a tour of the town while the tire was being fixed. We wandered through the dry town. It was very hot and their was barely any shade. Donkeys walked around carrying buckets of water and milk from place to place. Ladies sold clothing and vegetables from small wooden stalls. A woman sat with her baby under the shade of a building. Drawn to babies, I walked over and started playing with the baby boy. The mom got up from the seat, handed me her baby and walked off without a word. 

I sat down on the chair with the baby on my lap. I was hoping she did not just leave me with her baby forever. At one point a man from a nearby shop came out and took my picture with the baby. He ran back into his shop. Minutes later he came back out with a printed picture with a "pintrest" style boarder. 

The man fixing the tire finally gave up. He said the puncture was too big to fix. I sat for couple more minutes, I was getting worried the mother would not comeback. Soon I saw her in a shop across the way. I carried the baby over to her. I thanked her for letting me play with her son and gave her the picture of me and him to the mom as a keepsake. 

We headed off again towards Wote, still without a spare tire. As we drove we heard another bang and I looked back to see the trunk of the car bouncing up and down. We stopped again hoping that nothing had fallen out of the trunk. Turns out the piece that hold the trunk shut had fallen off with all the shaking. Vinny had a rope which he tied around the trunk to keep it from opening. We then continued. 

Finally about 3 hours later we finally found Wote. We met at a small restaurant, entirely too late for dinner. Despite all the bad luck we made it and Dr Musa's family was very excited to see us. 

Wednesday, February 17, 2016

Beware Scammers

Many people are cheated out of money everyday. People steal for many reasons, but stealing is never good and never justified. Stealing occurs due to inequal distribution of wealth and often promotes inequal distribution of wealth. We often hear of the Robinhood of robbers, stealing from the rich and giving to the poor, but this glorified form of robbing is no more justified than the others. Rather in a perfect society those with funds should give to those who have nothing.

These children would jump in the photo in Peru then demand to be paid.

Today I sat in my office as a man came by asking for money for a prosthesis. He hobbled in with a cane and handed us a paper with a letter from the university promising a prosthetic leg if he could collect the funds. I gave him 100 KSH. Most had warned that many of these individuals will ask for money for one thing and spend it on another. On the other hand if we always see the worst in every situation, then the ones who need help will never be helped. 

Sometimes when I take the street children out for dinner or give them a goodie bag I am warned that they often have ill intentions. I usually don't give cash, if one asks me I will usually stop and buy corn or a snack on the roadside and give that to them. I wold often carry stickers in India and hand those to the street children. Street children in India don't benefit from the money you hand them, they often must give the money to the adult they work for. 

Today I recieved a text which said that someone had sent me money through MPESA (a phone linked debit account). Then I recieved a call from a frantic man asking for me to send it back, that he accidentally sent me the money. Not sure what to do I consulted a Kenyan friend. We realized it was a scam. I reported him to the company immediately. 

Scams are easy to miss, especially when you are traveling in a foreign land. Often parks with no entrance fees will ask for entry from tourists. "Genuine" souvenirs, such as the coins sold at Petra kiosks and Kashmir scarves sold in the markets of India are often fake. Street children in Kenya fill empty phone bodies with mud and sell them to passerby's for hard to resist deals. Electronic shops in Chinatown, San Fransisco will give you the specs and price for better electronics but sell you last years model. Combi's (similar to matatus or small vans used as buses) in Peru would charge double or even triple of my friends who did not speak Spanish or the bus boy's would return incorrect change. 

Careful consideration, checking what you are being sold, learning "how much?" And the numbers in another language, and consultation with a local might help you avoid these scams. In the end karma always wins. 

Be careful and travel safe. 

Thursday, February 11, 2016

Smiles Make My Day Better

Rotating through the pediatric hospital can be taxing. When a child is admitted they are usually very sick. My morning starts early, checking on my patients before major ward rounds with the attending doctor. 

Wandering the hallway today I met a girl named Judy (name changed for protection). She looked like one of those children on the ads raising money for kids in Africa. Her legs are as small as broomsticks her cheeks and eyes sunken in. She was wearing a princess dress covered in dirt. She smelled of urine. Her hair was tangled and falling out. She barely could walk to the play room. She is being treated for malnutrition. Slowly she is is being introduced to a high calorie diet. Everyone seemed to be avoiding her so I sat down and I handed her my phone to play a game of candy crush. She pressed her little fingers on the touch screen and smiled. 

Charles (changed) is a boy with Burketts who wanders the wards. When I wave he smiles despite the huge mass on his cheek. He is a normal boy of 12 and wonders why he has to be in a place with such sick children. Burketts has a 60-90% survival rate in the states. But in our hospital chemo is expensive and his dad just can't afford the treatment. When I pass him in the hallway we high-five. 

Faith (also changed) is a small girl with HIV, she is so weak she can barely lift her head off the bed, but evey time I walk by her bed she reaches her arm out to greet me. When I walk away she waves bye. We greet each other and wave bye about 10 times a day. She loves being ticked and loves funny faces. 

Mary (changed) is a girl with epilepsy. She is on so many anti-seizure drugs that she seems intoxicated. She falls side to side as her mom props her up. She hit me today when I placed her IV. Despite that I got it on the first try. She smiles now when I walk by. 

A boy without a name was found left for dead on the street. He lays in a cage, isolated from everyone. He has cerebral palsy. His only form of communication is screaming. Every couple of hours he screams. All the staff walk by him seaming not to notice. I opened the cage the other day and held his hand. He stopped screaming. He just wants love and that's all I have to give. 

Wednesday, February 10, 2016

Upendo Ward

Upendo means love in Swahili. It's a fitting name for the ward that I am currently rotating in at Moi Teaching and Referral Hospital (MTRH). Upendo Ward is on the 2nd floor (3rd floor in american standards) of the Shoe 4 Africa Children's Hospital. This huge building is the newest on the MTRH compound. Bright yellow and blue accents contrast with its plain concrete sides. The building is simple. All concrete, no elevator but plenty of windows.

When you walk into Upendo or any of the other wards you first notice uniformed nurses and people in white coats walking around slipping into corridors to either side. Despite being one of the largest buildings on the campus it still has too few beds for the patients. As you turn into one of the "cubes" or rooms for the patients you notice many people standing, sitting or laying down. Each "cube" has 12 beds. Each bed is resident to two children and their caregivers. Often four or five people will share a bed.

Other than the large number of people you will see large metal oxygen cylinders, most split for two children sharing one tank. This provides poor oxygen delivery to both children but there is no other way as oxygen tanks are hard to come by. Fluids and blood bags hang from poles suspended from either side of the patients beds and personal belongings are strewn about the floors.

Children cry in pain as their caregivers try to comfort them. To your right is a boy with cerebral palsy, left to die on the streets of Eldoret. He cries for food so often that you wonder how he could be so malnourished.

Children with blue lips and fingers gasp for air as their mothers cradle them. Another girl with a huge abdominal mass sits coloring a paper. A boy with hemophilia rolls by you on a rusty old wheelchair. Children lay unresponsive on beds as their bodies try to fight brain and blood infections. Mothers fan their children who are febrile from malaria. A boy with a mass on the side of his face wanders in and out of the room. A girl barely able to see stares out the window from her bed.

A girl grunts as she takes her last breaths, her mom wailing, but she is pallative, so all we can do is calm the mother. Other caregivers come over to offer condolences and kind words. In the next door room a priest yells loudly over a girl in her bed as she convulses ... now she is cured.

Its a sight I never see in the states. Its a scene attributed to poverty and corruption. A scene that could be prevented had resources been divided equally. Often I am frustrated at the doctors and nurses that they don't do more, but what can they do? Nurses work tirelessly day and night administering medications, food, cleaning patients, hanging bags, checking vitals, bedside blood sugars and comforting caregivers. One intern covers over 50 patients all night while the residents and consultants (attendings) moonlight at private hospitals to make a living.

Illnesses such as pneumonia and anemia that can be treated successfully elsewhere lead to death because we lack oxygen and enough blood. Everyday we see children suffering or dying due to congenital heart diseases that are treated at birth in the states. Children die of type I diabetes because they have no access to daily insulin while at home or the tests that would check for metabolic disorders are not provided where they live.

I asked the intern yesterday, after we finished seeing a patient with a congenital heart disease, "What will we do next?" He shrugged and replied. "Nothing." In reality we do a lot with what we have, and if all else fails, we just provide love. Isn't that the most powerful medicine anyways?

The Intern and I

Tuesday, February 9, 2016

Another Angel in Heaven

A baby boy died in my arms today. He took his last breaths as I propped him up on the bed. Death is all too familiar in the wards in Kenya, but not for me. Many diseases that could be treated in the developed world lead to death in developing and resource-limited countries such as Kenya.

Yesterday I began my pediatric ward week at Moi Teaching and Referral Hospital in Eldoret, one of the largest public hospitals in Kenya. I was excited and a bit nervous to start. It has been over 8 months since I last did any clinical work. The first day was rough, we had lots of very sick patients. Slowly we went through the patients deliberating over what our assessments and plans would be. Congenital heart disease, pediatric heart failure, hemophilia, respiratory distress, sepsis, infective endocarditis, rheumatic heart disease, malaria, meningitis, severe anemia, and burketts lymphoma to name a few.

I spent the day trying to help the interns take blood and check on the patients. I went home exhausted. In the morning I arrived on the pediatric floor. I was notified that two of our patients had passed away overnight. I felt terrible but this was not an uncommon occurrence in the Kenyan healthcare system.

It was an admission day today, which means any new pediatric patient comes to our ward. As soon as rounds were over we received our first two patients. One of the Kenyan medical students and I took the most urgent case. A baby boy who was having trouble breathing. Anemia was the suspected cause from the emergency room. When I first saw him laying in his mothers arms his body was limp, he was agonally breathing and his eyes were rolled back. Immediately I knew something was wrong. The mother was crying and I knew she knew something was wrong too.

We laid the baby down to examine him. His pupils were nonreactive, his breathing shallow, and his body limp. When I tried to stimulate the baby with a sternal rub, no response. I sat him up hoping he would have less difficulty breathing but nothing changed. His breaths were sporadic. I knew that we needed to start resuscitation now but it was just the medial student. I looked around but the medical student and I were the only ones in the room.

We called for help from a nurse in the hallway. "I need the bag mask stat." The nurse walked out of the room. A minute later she brings me a mask for the tanked oxygen. I was a bit frustrated about the communication barrier and the urgency of this situation. "No bring me the resuscitation kit." Again she went to find the kit.

Frustrated I called over a physician on the palliative care team from the states. "Can you help me with chest compressions?" I asked desperately. Finally the mask came. We started resuscitation. I tried to get a seal over the babies face, the bag was so large and the baby so small.

"Would you like me to give epinephrine?" asked the nurse. "Yes" I replied frustrated on why she was asking me, I am just a medical student. I had the medical student check pulse and listen for breaths and heart sounds. Still no pulse.

My hands were shaking as I held the bag mask. Then I realized I was leading a code. I was sweating and shaking. The mother was crying on the bed next to me. 5 minutes went by, then ten, then fifteen. Finally I looked up at the doctor across from me. We knew it was futile at this point.

I realized that I needed to end the resuscitation measures that I had initiated, but it was so hard. As a medical student my goal is to preserve life. I did not want to pull the mask from the babies face or tell the team to stop. But at the same time its Kenya and even if we did get a pulse and we could ventilate properly, there are no ventilators to maintain breathing and no ICU beds available.

"I think we should let the mother sit with her baby for a bit." I said hesitantly. The doctor across from me nodded in agreement. I stopped the resuscitation. I turned to the mother, I wanted to cry but I had to stay strong. I could feel my eyes welling up. I sat next to mom and I put my hand on her back. I don't speak much Swahili, I just said "Pole." Which means sorry. I gave her a tissue and I sat with her for a half an hour. I prayed with her and brought her something to drink.

I was pretty distraught and felt terrible afterwards. Could it have been my fault? I was still shaking as I debriefed with the medical student. At that point I was no longer mad at the nurse for bringing me the wrong mask or the interns for not being around. They know better how the system works in Kenyan hospitals. Lack of resources would have prevented this baby from surviving even if resuscitation would have been possible. At this point I was just sad. How can such a young life be taken from us?

RIP baby boy. I hope you are in a better place now.