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?

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. Many diseases that could be treated in the developed world lead to death in developing and resource poor countries.

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 layed 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 nothing. 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 and I.

We called for help. "I need the bag mask stat." The nurse leisurely walked out of the room. "Why is she not running?" I thought. A minute later she brings me a mask for the tanked oxygen. "No bring me the resuscitation kit." Again she leisurely waked out.

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 had the intern and medical student check pulse and listen for breath 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.

"I think we should let the mother sit with her baby for a bit." I said hesitantly. The doctor 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 arm 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. I was still shaking as I debriefed with the medical student. At that point I was no longer mad at the nurse who didn't run or the pediatrician who decided to leave or the interns for not helping. 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.

Sunday, January 31, 2016

The Expat IU Family

IU House in Eldoret is home to a small city of expats within Western Kenya. It's electric fence and high cement walls separate it from the rest of Eldoret. Behind these walls is a neighborhood of large houses separated by their own gates and fences. I live here, sourrounded by other expats who have ventured to Kenya to change the world. 

Eldoret is a small city with almost anything you can think of. Nakumatt, a Walmart like grocery store, night clubs, resurants, gyms, even a basement movie theater. For a small city there is always traffic and congestion. Hundreds, even thousands of Kenyans clog sidewalks and road. Motorcycle taxis called pike-piki's and small van-buses called matatus drive crazily through the congested streets. Vehicles turn up the red dust on the road and big trucks release black exhast into the air. At every corner kenyan sales people yell their wares and welders and builders bang hammers creating a cacophony of sounds. 

A kilometer away from this hustle and busel lies IU House with its high concrete walls and electric fences. Within its gates lies a quiet neighborhood of global health activists and academic scholars. Neighbors wave and greet each other as they walk by. Evenings are filled with basketball games, movie nights, bbqs and wine and cheese socials. Games of trivia mix with intellectual conversations of how we are going to save the world. 

Each morning groups of doctors and medical students leave the protected gates to walk the 15 minutes to the local government hospital. Each evening we walk back trading stories, often sad, with our collegues. Doctors, pHd students, agriculturalists, pharmacists, entrepreneurs, business men and women, medical students and teachers sit together over coffee trading ideas. 

IU house is a unique community. We all want to be here and we all want to make a difference. We are not paid well but here money is not our obsession. We enjoy talking about our projects and we strive to inspire each other in the process. We have built a family, an IU family, different from the families you know. It's a family where mentors sit with their students and pharmacists and doctors work side by side. Surgeons and horticulturalist trade tips and we all put on tennis shoes on Friday and play an intense game of football (soccer) with the street boys. 

It's been a breath of fresh air from the mundane and ridged structure and hierarchy of medical school. Here doctors teach students how to show compassion, working in Kenya teaches us how to be culturally sensitive and we all work together to learn something new each day, even if it's not in your field of interest. We all love what we do. It can be sad and frustrating sometimes, but we sleep well knowing that we are doing something that will hopefully make Kenya and the world a better place to live. 

Saturday, January 23, 2016

Future Neurosurgeon

Yesterday I met an inspiring 10 year old girl named Grace (name changed for confidentiality). She was sitting alone in the waiting area of AMPATH pediatric HIV clinic. She was very focused reading a small paperback book she held in her hands as she waited to see the doctor. I sat down next to her. "What are you reading?" I asked her.

She began to explain the story to me excitedly. Her English was perfect and the book she was reading was far beyond her level. I complimented her English and she sat up straighter smiling proudly. I asked her what she wanted to be when she grew-up.

"Neurosurgeon!" she proclaimed confidently. When I asked her why she told me how she wanted to help children without money. She wanted to provide care for free so that children who are sick can grow up healthy.

Despite attending an underfunded public school she was getting excellent marks in school and national exams. She hopes that next year she will be chosen to receive a scholarship to attend an all girls boarding school.

We began to read the story book together, alternating who was reading out-loud. She read eagerly until her mother called her into the doctors office. I saved the book as she saw the doctor. When she came back out we began to read again.

The book was about an impoverished boy who helped his mother with the garden and his younger sister. His only clean pair of clothes was his school uniform. He loved to read books and go to school.

One Saturday his mother left for the day and he was put in charge of his little sister. His sister woke up with a fever and proceeded to have a seizure. Scared the brother fashioned a basket onto the back of a bicycle and rode 15km to the clinic.

At the clinic he met a female doctor. He had never seen a woman doctor before so he admired her greatly. The friendly female doctor praised his love for his sister and the courage he showed by bringing her to the clinic. The doctor treated his sister and encouraged the young boy to keep working hard and dreaming big. He was so swept away by the doctor's encouragement that he rode home proud and smiling. His sister was feeling much better when they arrived home.

Grace's mother came out of the doctors office and sat down next to us. She watch us as we took turns reading the book. Finally the girl had to leave. Her mother shook my hand and thanked me in Kiswahili.

I said bye to Grace and I told her to keep dreaming and working hard so that she can one day be a neurosurgeon. I smiled as she walked out of the clinic. I wonder if she knows she has HIV, many caregivers do not tell their children out of fear. With medications children with HIV can live long and successful lives. I hope one day I will see her pass me in the halls of the hospital with her white coat flutter behind her on the way to the operating room to save a child's life.

Visit AMPATH website to learn more:

Thursday, December 31, 2015

Adventures in Istanbul

I arrived in Turkey exhasted after a 17 hour layover in Saudi Arabia. Other than my first night at World House Hostel, I had nothing else planned. I took th metro from the airport to the hostel. The metro is very easy, maps are placed through out the stations and trains. Stations are announced in Turkish and English. Everyone I asked for help were very enthusiastic to help, even if they didn't speak English. 

Immediately as always I met a new friend at the hostel. He was from Turkey and was visiting a friend in Istanbul. He invited me to join and how can I say no? Within a couple minutes of arriving to the hostel I was heading out again.

 Istanbul is the largest city in Turkey with over million residents. It's divided into many different districs, which each have their own atmosphere. World House Hostel is located near Galata Tower in Taskim. Taskim is very busy and boast some of the best nightlife in Istanbul. The Main Street in Taskim is packed with people in the evenings. Small windy streets fork from the main road. These streets are packed with restaurants, bars and cafes. 

My new friend and I headed out for a beer, then a Turkish coffee followed by dinner with a view of Galata Tower. Friday and Saturday are the most popular nights to go out in Istanbul, but there is always a party happening in Taskim. After dinner we happened upon a small bar with a live Turkish rock cover band. 

The next morning we headed out to try some of the famous foods of Turkey. We traveled to Ortakoy for waffles and kumpir. We sat at a small restaurant near the water under the bridge and enjoyed kumpir, which is a large baked potato packed with various items, including cheese, salad, veggies, sausage, and toppings. After a filling kumpir we found some space for a Turkish waffle. This is no ordinary waffle, this a is a waffle topped with chocolate, white chocolate, Carmel, bananas, kiwi, strawberry, and nuts. Both kumpir and waffles are a must try in Istanbul. 

After lunch I visited a Turksih Bath or hamam. Here I undressed to my bathing suite bottoms, entered an extremely hot room, poured water over myself, entered the hottest sauna of my life for about 30 seconds until I gave up and then rested on a heated rock. I waited until a large naked Turkish lady entered the room and beckoned me to a smaller room to clean me. She proceeded to bark orders in Turkish, which I struggled to understand. She scrubbed me with a scratchy cloth all over, removing way more dead skin than I thought I even had. Then she poured bowels of water over me removing the skin. Next she had me lay down on a stone slab and she covered me with bubbles. I felt a bit like a child in a bubble bath. She rubbed me all over shouting at me in Turksih when she wanted me to change positions. Again she threw water over me, removing the bubbles, she finished by washing my hair and then sent me back to the large hot room. I finished the Turkish bath experience with an apple tea. The whole experience costs 60 Turkish Lira ($20 USD) at Aga Hamam on Taskim. 

After the bath I met another friend and we three headed out for dinner and drinks. Our Turkish friend lead us down a windy street, into a noisy bar, up a flight of stairs, into a small elevator and out onto a rooftop patio for dinner. We tried a dish of fried Hamsi (anchovies) and Doganay (fermented turnip juice). The Hamsi were very good but I was not a fan of the fermented turnip juice. 

We then proceeded to dessert in one of the small Turkish bakeries along Istiklal street. We tried ekmek kadayifi, a Turkish bread pudding bathed in sugary syrup served with a dollop of thick cream and we tried kabak tatlisi, butternut squash covered with syrup and pistachio pieces. After dessert we headed to a small club to dance to Turkish and Arabic music. 

The next morning exhasted we walked down to old city to stroll through the famous historical sites, including Hagia Sophia and the Sultan Ahmed Mosque (blue mosque). Near the spice market we had Balik ekmek (fish sandwiches) served straight from boats lining the Golden Horn near the Galata Bridge. After dessert we enjoyed Lokma (fried balls covered in syrup) from small carts near the bridge. 

We three boarded a boat and headed over what they call the Asian side of Istanbul. On this side it's a totally different feel. The touristy hustle and bustle of the European side was replaced with a more local and calm atmosphere. We walked through narrow windy streets admiring unique coffee shops on every cornered. We walked back along the water stopping for Turkish coffee and apple tea at Kemal'in Yeri a small cafe perched on the cliff overhanging the Sea of Marmara.

For dinner we strolled the windy streets to meet up with some friends at Ciya Resturant. Here we had a plethora of Turkish cuisine. We enjoyed a plate of mixed appetizers including domas (stuffed mwine leaves), hummus, cacick (yogurt and cucumber) and many more. For dinner we started off with a lahmancun, which is ground meat, onions and spices on a thin circular bread. You top it with cilantro, tomatoes and onions, roll it into a burrito like shape and eat it. At this point I was full but the main meal was yet to come. Lamb kebabs were delivered to our table with salad, bread and rice. We washed this down with Ayran (thin yogurt drink). For dessert we shared a large thin square pastry stuffed with pistachio paste. 

I took the ferry back to Taskim just in time to board my bus to Goreme, Cappadocia. Overall I loved Istanbul, it was very westernized yet had many reminders of its past. The city is very young and fashionable with many restaurants and bars catering to the large young population. The food is amazing and diverse. Turkey is fairly cheap, hostels range from $8-15 a night and a meal can cost between 3-30TL ($1-10). My favorite part were the countless coffee shops which offered wifi and amazing coffee and treats. I can definitely see myself living in Istanbul someday. My adventures in Turkey will continue. Stay tuned to hear about Cappadocia and Pamukkale. 

Wednesday, December 2, 2015

Breathing Underwater

After an adventurous first couple days in Zanzibar I headed to Nungwi at the north tip of the island for diving. Nungwi boasts touristy beaches, five-star hotels and restaurants that line the beach. Busier and more touristy than Paje, Nungwi also is home to many dive companies and some of the most beautiful dive sites on Zanzibar.

I arrived to my guest house at Highland Bungalows in the early afternoon. Highland bungalows are a good 8-10 minute walk to the beach but it’s one of the cheapest in town.  For $20 a night you can have your own room and $30 a night for a double room. My friend Christian who had accompanied me from Paje joined me to find the best and cheapest dive company. We were recommended Spanish Dancer Divers, and after emailing them, acquired a 10% discount on all our dives.

We met up with our friend Amber, who we also met in Paje, and had dinner at Mama Mia balcony, overlooking the ocean. Thanksgiving Day, we woke up early and set off for Mnemba Atoll, one of the most famous dive sites in Zanzibar. With a slow boat the trip can take over an hour, but Spanish Dancer Divers speed boat got us there in 30 minutes. We strapped on our BCD’s and tested our equipment and took one large step out of the boat into the turquoise water.

The visibility was amazing as we descended under the water. We enjoyed many creatures including eels, Spanish dancers, many colorful fish, and beautiful coral. After a successful dive we headed back to our boat for snacks and our waiting period. We again descended down into the water to enjoy wide array of fish and coral before headed back to the boat. I was a bit disappointed that we did not see any larger animals but it was still amazing to be swimming with so many colorful fish.

For thanksgiving dinner Amber, Christian and I ate at Bracka Restaurant, located right on the sand. We choose a table nearest to the water and enjoyed cocktails and the sunset as the restaurant set out the daily catch. Earlier we had been told that Bracka had some of the best seafood in town. Before dinner they set out their catch of the day for customers to see and choose. I, of course could not choose only one because they all looked so good, so I choose the mixed seafood platter (assorted seafood’s, fries, salad and a house cocktail) for 25,000 TSH ($12.50 USD) and was able to try, prawns, lobster, tuna, snapper, squid and octopus. They were all amazing but the prawns were my favorite.

The next morning we woke up even earlier and Christian and I walked out to the beach to enjoy the sunrise.  If you don’t know me yet, I hate waking up early, so I almost fell asleep multiple times on the beach. As the sun rose the sky turned into a pastel of colors. We then headed back to the guest house for a quick nap and then we set off again for another two dives. Today we did two local dives. I again we strapped on the BCD and back-flipped of the boat into the water.

The first local site was Magic Reef, we spotted many animals including baby sharks, eels, rock lobsters, colorful fish and beautiful corals. The current was very strong as we swam, we swan hard fighting against the current and I began feeling a bit queasy. I have heard many stories of people throwing up into their regulators and attracting all kinds of fish. I did not want that to happen to me so I swam along trying not to exert myself. I of course was still at over a half tank but I wanted to hold out as long as I could so I didn’t cut short the dive for the others in the group. Luckily one of the guys already was at a quarter tank, so we headed up. I was so glad to be out of the water.  

I decided to sit the next dive out, but after the divers went into the water I decided to attempt snorkeling. I put on my flippers, mask and snorkel and swam out into the water. I followed the three divers on the surface until I began to spot jellyfish swimming around me.  Of course I got a bit nervous and headed back to the boat to check. The captain of the boat said the translucent jellyfish were harmless, and the stings were very mild, but if I saw a pink or blue one to swim away fast.

I went back out and snorkeled with the clear jellyfish until the divers came up. I felt much better after swimming around. When we arrived back to shore we had a quick bite to eat and headed home for a nap. For dinner we visited LangiLangi Beach Bungalow Restaurant and ate on the deck hanging over the ocean. Almost all restaurants have an amazing view and the prices are reasonable between 10,000 – 25,000 ($5 - $12.50) for amazing seafood, pizza, pasta and more.

The next morning we woke up early and enjoyed pancake breakfast at our guest house before heading off in a shared taxi to Stone Town. Overall Nungwi was amazing. In contrast to Paje, it was filled with tourists and restaurants catered to Muzungus. We were hassled more by the beach boys and Masai men who tried to sell us everything from tours and handcrafts to weed and sex. The diving was good but it’s a hit or miss if you are going to see large animals. The prices were a bit higher than Paje, but still reasonable for backpackers.


Friday, November 27, 2015

Chasing Dolphins

I arrived in Zanzibar Monday morning during a torrential downpour. I waited longingly staring out of the airport doors for the rain to stop. Over and over taxi drivers asked me to take their taxi. "No dala-dala in the rain" they persisted but I was sure I would find one. I ran out in as the rain began to subdue. Asking every fifty feet for directions to the dala-dala stop. Finally I arrived at a small covered area with people waiting. At the stop waited a small van-bus calling for stone town. I asked if they went to Darajani market. He nodded and I jumped in and handed him 2000 Tanzanian shillings (TSH). As we drove we picked up a bunch more people. Finally we reached the buselling market. I jumped off and headed for the ATM.

Zanzibar is a Tanzanian island. You can travel there by air or boat from Dar Salama. The island is 3 hours from north to south and one hour across. Also known as the spice islands, this island boasts world famous diving, international kite surfing competitions and gorgeous beaches. Although this island can be expensive for most tourists it has affordable options for the backpackers too, especially in low season. 

Traveling around Zanzibar is easy. There are many options including dala-dalas, mini-buses, piki-piki (motorcycles) and taxis. Dala-dalas are by far the cheapest transportation. Many say they are uncomfortable, confusing and slow, but I found them none of the above. After getting money at an ATM (which you can only do in Stone Town) I looked for dala-dala 309 that would take me to Paje. A nice gentleman took me to the dala-dala, and he didn't even ask for money. I jumped on and waited for the vehicle to fill. 

Dala-dala is a large flat bed truck with a roof. It's open on all sides to let the fresh air in, and has emergency tarps that roll down during the rain. In the bed of the truck there are benches that line the sides. The roof is not high enough to stand so you much bend over and crawl your way to an empty seat. In the middle between people's feet is a storage area. For locals they carry anything from old car parts to fish. Many flies buzz around especially as a new passenger enters and disturbs them. The Dala-dalas drive fast and are only about 30 minutes slower than a taxi. They stop once and a while to pick up a new person or item, but speed off even before that person can sit down. They fill up quick requiring people to squish together or even sit on the luggage in the middle. Overall they are a great budget option for the backpacker who doesn't have much luggage and wants to enjoy the scenery. 

I arrived the New Teddy Place in Paje a bit exhausted but I wanted to make the most out of my trip so I bargained for a kite surfing lesson. I paid a bit less than $20 per hour for lesson and equipment form a shop in front of Teddy's on the beach. I learned how to control the kite on land and water for two hours and then headed to dinner at Teddy's. Kite surfing was much more difficult than expected. 

New Teddy's is a backpacker hub on the south east coast of Zanzibar. With dorms for $15 a night, you can't beat the price anywhere else. It's right on the beach and they help you organize cheap tours around the area. I instantly made new friends and began exploring the area.

Paje beach is rated the most beautiful beach in Zanzibar, and I definitely agree. The sand is whiter than snow and finer than flour. The water is a turquoise blue and as clear as crystal. Small fishing boats bob up and down on the waves and Masai men dressed in traditional outfits wander up and down the beaches bugging every tourist they come across. Although there is not much shade small thatched umbrellas are scattered along the beach, make sure to apply and re-apply sunscreen over and over through the day. The beach during low season is almost empty. 

The tide at Paje is drastic. At times it looks like there is no water at all and other times it's almost up to the umbrellas. Watch out for sea urchins as you walk, they are not fun to step on. At night there are bonfires along the beach just a five minute walk from New Teddys as well as some hopping bars at night. 

My new friends and I decided to go to The Rock restaurant, a 10 minute drive north or Paje. We organized a taxi that would take us north, wait for us while we had drinks, and then take us to a place a bit cheaper for food for only $20. The Rock is beautiful. It's a small restaurant on a rock surrounded by water. It's important to go during high tide so that you can enjoy the boat ride. Prices are all in US dollar and rage between $18-55 for a meal, $7 for cocktails and $8 for dessert. We decided to instead order two bottles of wine as it was cheaper than ordering by the glass. We enjoyed the view and talked for hours. 

On the way back to New Teddys we stopped at a small food stall in Paje town. It was 2000TSH or $1 USD for chips (fries) and a small salad. You can also get chicken, beef skewers, and octopus for not much more than the chips. We ate on the side of the road and headed home for some sleep. 

The next morning I decided to swim with dolphins. I paid 40,000TSH or $20USD, which included an hour taxi ride, boat ride and snorkel gear. Although I heard mixed opinions on the excursion I wanted to see it for myself. I hopped on a boat and speeded off to where the Dolphins where swimming. Three boats where already there with 2-6 snorkelers on each boat. Although it was amazing being less than a foot away from these beautiful animals it was also a bit saddening that they had been made a tourist destination. 

As the Dolphins disappeared into the deep water all the snorkelers climbed back on the boat and looked for where they would pop out next. When we saw them jump from the water further ahead the boat captains rushed off to that location and all at once snorkelers rolled off the boats in the water. Over and over this happened. Although the Dolphins did not look scared, they were definitely annoyed. Overall I felt a little bad for the Dolphins. I would only recommend this tour if they limited it to one boat. There were 5-6 boats when I went and this is low season, I can't even imagine how overwhelming it can be for those animals during high season. After this interesting excursion I began my journey to Nwungi for some scuba diving. 

Monday, November 2, 2015

Holiday Blues Abroad

Halloween came and went in Kenya, I even forgot it was a holiday until my housemate reminded me. For most people, holidays are excuses to be with family or party with friends. I loved to wake up Christmas morning and run down in pajamas to tear wrapping paper off new toys and write little messages on valentines cards for all my friends in school. It was a Halloween tradition to spend hours in the thrift shops devising a unique costume for the various Halloween parties. Watching fireworks on 4th of July, turkey on thanksgiving, midnight kiss on new years eve, all of these are traditions are coveted by many in the states and around the world.

Halloween in Kenya
Many travelers know that these special holiday's are often the toughest days to be away from home. A couple years ago I would never have thought I would spend a Christmas away from home. It was an annual tradition to fly home from wherever I was to spend time with my family and friends. Last year I decided to take a trip to Israel and Jordan over Christmas. On Christmas eve I stood outside of nativity church listening to midnight mass and spent Christmas day riding a bus over the Israel-Jordan border.

Christmas in Bethlehem
These days make being abroad feel a bit more lonely than usual especially if the country you are in does not celebrate that holiday. Browsing through Facebook or Skyping your family can cause you to be even more homesick and nostalgic around the holidays.

So what is the solution for these Traveler Holiday Blues? Not sure if there is a specific solution. It seems that everyone I have met traveling over the holidays have had various reactions and solutions. Here are a few suggestions:

1. It Gets Better: I have found the more holidays you are abroad the easier it is to get over the Traveler Holiday Blues. The first Christmas, Halloween or birthday abroad can be rough, but it gets easier from there.

Visiting my Grandma
2. Everyday is a Holiday: I have also found that when your home from a long trip, any day can be a holiday. Gift giving does not have to be on birthdays or Christmas but can be whenever you are home. Have a big turkey dinner with family on your visit home or hand out postcards to friends as often as you like.

3. Bring the Holiday With You: Teach others around you about the special day, many are interested to learn about your countries traditions and celebrations. You can think about all the memories associated with that holiday in a positive way.

Sole from Argentina baking cake for Christmas in California
4. Stay off Facebook: The last think you need is to see all your friends and family having a good time while you are sitting alone in a long distance bus ride. Scrolling through pictures of happy families sitting around a holiday meal or wearing fantastic costumes can make you think more about what your missing.

25th birthday in Argentina
5. Surround Yourself With New Friends: Hostels are filled with others also suffering from Holiday Blues, bring a little of that holiday with you and celebrate with you new found wanderlust friends. Go out to a special restaurant, hit up the local night club to dance, or sing some traditional songs.

In conclusion holidays are a time to celebrate wherever you are, but why not celebrate all the other days of the year too. Remember not to beat yourself up for missing a holiday with your family and friends but rather celebrate whatever you are doing wherever you are. Who knows it might be the best day of your life.

Christmas Day meal in Jordan

Monday, October 19, 2015

Getting Drunk in Kenya - Cheap Beer Goggles

As you know I am in Kenya doing a global health scholar year between my third and fourth year of medical school (I found out recently that people call me a tweener). I am working with HIV infected children. One of my projects is to come up with peer group topic agendas with our amazing pediatric counselors at AMPATH. We are discussing topics like depression, coping skills, hygiene, safe sex, children's rights, and so many more. 

One of the topics one of the counselors came up with was alcohol and drug abuse, which is a very common problem in Kenya. In Eldoret, where I work, a study of college student found that the is a lifetime prevalence of alcohol use was 51.9%.(1) Traffic accidents are a major problem in Kenya, and drinking has been linked to the increasing rates of traffic accidents. A survey in Eldoret hospitals assessed blood alcohol levels of individuals involved in traffic accidents 23.4% had positive blood alcohol concentrations and 12.2% were intoxicated.(2) It has been shown that those who drink and use illicit drugs have been found to have a higher risk of acquiring HIV. (3)

Due to its prevalence the counselors were inspired to educate kids and teens about alcohol and drug abuse. Many institutions in the states use beer goggles that mimic being intoxicated. These googles cost about $100, which is very steep especially in a resource poor place like Kenya. I decided to improvise and make these goggles at almost no cost. Here is what you need:

1. Toilet paper/paper towel cardboard cylinder 
2. Clear plastic bags
3. Scissors/knife
4. staples, or tape, or rubber bands

1. Cut a toilet paper cardboard cylinder in half. 
2. Cut the plastic bags into 3' X 3' squares. 
3. Fasten the plastic bag to one end of the cut cylinder with tape, staples or a rubberband

Hold them over your eyes and enjoy. Have the kids navigate an obstacle course holding the glasses over their eyes. 

1. Atwoli L, Mungla PA, Ndung’u MN, Kinoti KC, Ogot EM: Prevalence of substances use among college students in Eldoret, western Kenya. BMC Psychiatry 2011, 11:34.
2. Odero W. Alcohol-related road traffic injuries in Eldoret Kenya. East Afr Med J. 1998;75(12):708–711.
3. Mugisha F. & Zulu E. M. (2004) The influence of alcohol, drugs and substance abuse on sexual relationships and perception of risk to HIV infection among adolescents in the informal settlements of NairobiJournal of Youth Studies 7, 279–293