June 24, 2006 

Hi Everyone, 

Most of us have arrived in Nairobi safely and on time.  We are still waiting for Emily who was delayed in Detroit and Amy who arrives on Monday.  The trip was long but uneventful.  After we managed to get our 16 bags to the hotel and in our rooms, we all had a snack and pretty much went straight to bed.  The baby is doing great; he is sleeping better than mom. 

Today we will do some tourist activities – visit the Kenya National Museum and the Kazuri bead factory.  I am dragging the team to an Ethiopian restaurant for lunch and hopefully some authentic Kenyan food for dinner.  I’ll make adventurous eaters out of these students by the end of the trip!  We’ll pick up Emily from the airport tonight.

Tomorrow we head to Kisumu.  That will be about a 7 hour drive on some relatively bumpy roads but it is fairly scenic, with a stop at the rift valley.

Introducing you to the US team this year, we have 4 first year students: Shawn, Tim, Kim & Abby.  They vary quite a bit in travel experience.  Emily is a 4^th year OMM fellow.  Amy is a DO/Ph.D. student who plans to do her dissertation work on the impact of orphan hood on growth and development.  She was in Kenya with me two years ago.  Of course, we have Jaja, my research assistant who is originally from Kenya and has been working with me since 2002.  This year we also have Andrew, my six year old son.  Everyone has been given Luo names by Jaja.  Shawn is Ooko, Tim is Omondi, Kim is Akyini, Abby is Adhiambo, Andrew is Odhiambo, Emily is A and Amy was names Awuor 2 years ago. 

I will send periodic emails to update everyone about our experience.  I hope to have the students send occasional emails as well.  From past experience, I know that the students greatly appreciate hearing from home.  So, please keep the emails coming so people don’t get too home sick. 

Gillian

June 27, 2006

Dear friends and family,

I am happy to let you all know that I made it to my destination safely.  The flight to Nairobi, Kenya was a very long one, but I was thankful that we had two layovers or else the flight would have been even longer.  The first layover was in St. Paul, Minnesota and it was so much fun because we had 7 hours until our connecting flight into Amsterdam.  So what did we do those seven hours? We put all of our stuff into 2 lockers at the airport and went to the Great Mall of America (I think that’s the name of the mall).  It was my first time there and it was so nice. I was tempted to buy a bunch of stuff there but I didn’t because 1… I’m not rich and 2, I didn’t need anything. 

Already I am maturing on this trip realizing how much I already have that is unnecessary.  I did, however, buy a book form Barnes and Noble called “STIFF” about the contributions of human cadavers to medicine in mankind. I haven’t finished it yet but it’s really good you should check it out.

After the mall we went back to the airport and flew into Amsterdam whose airport is like nothing I have ever seen.  They sell diamonds, Hugo Boss clothing, Prada, anything you can think of.  Shawn, one of the guys on the trip with us bought some chocolate and it was amazing. He says it’s better than Godiva but I’m not sure about that… it was pretty close though.  After eating chocolate and walking all over the airport just to find a sweatshirt, we were off to the motherland!

We arrived in Nairobi around 10:30 Thursday evening and we had over 20 bags between the 7 of us. Some of it Dr. Ice had to pay extra for because they weighed over 70 pounds and others were ok. It was very difficult packing all of the medical equipment and getting all of the t-shirts and other donated items onto the flight, but we made it happen.  We were lucky none of our bags were lost or stolen and we didn’t have any difficulty getting it onto the vehicles from the airport to a hotel in Nairobi, so it was all good.  I think it has a lot to do with knowing people too. Dr. Ice has been doing research in Kenya for 6 years now and everyone that has helped us at the hotels, traveling from city to city and so on, has been extremely helpful.

We were in Nairobi for 2 days, and it was awesome. It is so different from when I went to Ghana because Nairobi is a large growing city and is very industrialized.  There are concrete roads and almost everyone drives here, so that took some getting use to.  The hotel we stayed in was very nice, equivalent to a hotel in the states. We had hot water, electricity, a TV; it almost did not feel like I was in Africa at all. The fruit here is fabulous. I love the bananas here. They are about half the size of US bananas and taste twice as good; very sweet.  I’ve had passion fruit, pineapple, papaya, chapati (similar to pita bread but much sweeter and softer) and some things that I would have never tried if I was not in a different country. The dengu here is really good with rice; it’s similar to lentils but green and smaller in size.

Now to some of my favorite moments in Kenya (sorry it took me so long to get to this point).  We went out dancing the last night in Nairobi and I had so much fun. I love to dance and it was even more fun being at this particular place because there was live music with a drummer, a person playing a horn and also a guitar.  I have been playing the drum I got from Ghana the last few weeks before I arrived here and I had that feeling again, the feeling I had the first time I played my drum in Ghana – like I could do anything.  I feel so connected to the people and the culture here, like I’m at home.  I do not feel out of place at all and I thank God everyday for the opportunity to even be here this summer.  I am blessed to be able to see where my people come from its awesome, there’s no other word that could describe it. We danced and danced and it was so much fun because the people dance in groups.  I was surprised how many men there were out dancing.  I danced in a group with Tim (one of my classmates) and 2 Kenyan guys that are going to be working with us this summer as translators, Jared and Danish.  At some point I was off in my own world and found myself dancing with a Kenyan woman and we were all over the place having a great time. The guys left me on the dance floor and had to come back and get me when it was time to go.  We were having such a good time and my Kenyan lady friend introduced me to some of the people she came with. It was a very memorable experience - my first night out on the town dancing with the Kenyans.  I learned a few moves too so I’ll have to show those off when I get back home.

The next day we had a long, bumpy 8 hr drive from Nairrobi to Kisumu. When I say bumpy, I mean bumpy I almost hit my head on the ceiling of the van a few times. It was a mess, but it kept me awake most of the time so I could see how the people around me really live.  We saw really poverty – slums, grass huts and cardboard homes full of people working hard to make ends meet.  People were on the side of the roads selling oranges and potatoes, convincing others they needed to buy their product so they could survive.  It was truly a harsh reality but we all needed to see it.  We were living it up in Nairobi and only a few miles outside of the city, we saw what was real for the majority of the people living in Africa.  What I saw that day was very similar to what I saw in Ghana, so I was no completely surprised, but it came as a shock to some of my classmates who were traveling with us. I was glad we could all talk about what we saw and debrief when we finally made it to Kisumu.

On a happier note, I saw ZEBRA - tons and tons of zebra grazing and roaming around only a few short yards from our van. I got pictures I’ll have to download when I get back to the states because the internet is so slow here, but you will all get to see :)  it is one thing to see animals in the zoo, but here, in their natural habitat to see zebra was so exciting. I am really in Africa!

I apologize for making this email so long and boring, but I did want to share with you what we’ve done so far.  We have only been here a few days but the experience has been phenomenal and I can’t wait to see what happens in the upcoming weeks, especially when we start seeing patients and working with all of the people that live in the villages.  I haven’t received any marriage proposals yet, so no jewelry at this time, hahaha, but I will let you all know what happens.

Talk to you soon,

Kim Jackson

June 28, 2006

We are slowly settling in at the Imperial hotel.  We have three apartments and two rooms.  The apartments are great – they have a large bedroom, bathroom, large living room and a good size kitchen.  They are extremely comfortable, even air conditioned! As we having been running around and trying to get organized we have yet to make dinner but we fix our own breakfast every morning.  The hotel is basically downtown, so it is easy to get around.

All students have now arrived.  Amy flew into Kisumu this morning.  The students seem to be adjusting to their surroundings etc.  I’ve been taking them on a culinary tour of Kisumu and so far everyone has managed to find food that they can eat and has been willing to try the local cuisine – including a whole fish, which was a milestone for some.  Yesterday, several of them went to a local outdoor market to buy produce and generally explored the town.  Emily’s travel skills have come in handy as she helps the others to negotiate their way around.

We have been trying to organize our equipment and supplies.  Of course, we have already had problems.  Unfortunately, Shawn’s machine to examine cholesterol and glucose is not working.  He is in the process of trying to get a new one shipped from the US.  Somehow, my actical reader (the thing that connects the activity monitors to the computer) is missing.  I am trying to get that shipped from the US because without it, I cannot contact an essential part of the project.  Hopefully, we can get both things through customs more easily than last year.

Yesterday, I went to Ahero to conduct interviews for 2 new fieldworkers.  We had 9 people show up for the interview.  They were all very nice but two candidates stood out based on their education and experience.  Last year’s team met us at the Pastoral center and it was nice to see everyone.  Everyone was excited to meet the “young American”, who has been the hit everywhere we go. 

Today, I continue to work on getting things set up and two of the students will rotate with Dr. Allibhoy at Aga Khan Hospital.

The World Cup has been a central part of the day here.  Of course, it is on everywhere here and the students and Jaja often schedule meals etc. around where and when the games are on. 

So, everything is going well overall. 

Gillian

July 2, 2006

We’ve now been in Kisumu for a week.  Everyone is adjusting well to their surroundings and getting to know each other.  The students took turns rotating with Dr. Allibhoy at the Aga Khan hospital this week.  They saw everything from HIV/AIDS to malaria to typical diseases of modernization (diabetes, hypertension).  I used Tuesday to get the field supplies and computer programs together.  The students also helped with the tedious tasks of labeling and collating forms etc.  On Wednesday, Thursday and Friday, we trained and retrained everyone. 

On Friday the women prepared all of the foods that are likely to be eaten by the elders.  As each item was prepared, they weighed all the ingredients and after the dishes were prepared, they weighed them in the various containers.  Now when someone reports that they ate a bowl full of green grams, we will know the weight and contents of the green grams which allows us to calculate the calories, protein and fat.  Afterward, we all ate a feast of chicken, tilapia, ugali, beef stew, green grams, chapati, kale, mixed local greens, cabbage, rice, sweet potato, matoke and pudding (fruit salad).  We also had porridge for breakfast. 

Saturday we went to Busia, which is the border town in Uganda to shop for fabric.  As usual there were lots of great fabrics and I look forward to seeing what everyone has made.  The ride was long as we had to stop at about 7 security check points.  There seems to be more check points but we are also frequently stopped because we are riding in a mini van that is typically used for a matatu (bus).  One guy stopped us and opened the side door just so he could tell me that he went to LSU for a year.  When we returned to Kisumu we went to the lake to have huge tilapia.  Everyone enjoyed it and on a dare from Jaja, Shawn “cleared” a whole fried tilapia, eyes, brains, gills and all.  We were all impressed and Kim took lots of photos to document the event.  Amy and Emily ate the eyes too but couldn’t bring themselves to eat the brain.  Everyone watched football last night and I gather they played cards in the lounge after Andrew and I went to bed.

Shawn received his new machine yesterday.  He made Tim plug it in for him this time.  So far it seems to work.  We may want to kill a black chicken to avoid chira, just in case.  I am still waiting for my equipment but it is on its way.  I am having trouble with another piece of equipment but haven’t had much luck resolving that issue yet.

Andrew continues to draw attention.  People call out Toto or baby everywhere we go.  The boda boda (bike taxi) drivers always want to give us a ride and I ask them if they are crazy.  He won’t lack for attention in the field.  Lina, his baby sitter, is great with him as are all the field assistants and medical students.  The main issues in the field will be settling him down for naps and keeping him out of the sun.  He is so fascinated by his surroundings that he has trouble going to sleep.  We will have to lather him up with sunscreen constantly and make sure he stays in the shade. Has a few teeth still threatening to come in but otherwise he is doing well.

We have started digging one of the water wells.  The communities who are receiving the wells are very excited.  I wasn’t able to see the digging but it was interesting to watch on video.  We met with the director of the water group that is doing the drilling.  They receive funds from various NGOs to place water wells.  After the wells are installed, they will train three people from each community for five days to make sure that they develop plans for maintenance and upkeep.  They try to emphasize that this is one-time assistance and it is up to them to make sure that they can sustain the well and pump. 

Most of the uniforms have been made as well.  Unfortunately about 200 children were unable to be located – they’ve either died, moved or are just unable to be found.  Unfortunately, we have some adults who are trying to get other children to lie about their name so that they can get uniforms.  We are taking a few different steps to avoid that. 

Tomorrow is the big day, the beginning of data collection.  The first day is always chaotic. 

So far everyone is healthy and seems to be adjusting well. 

Gillian

Sunday, July 02, 2006

Kisumu, Kenya   1:30 PM

Dear Friends,

The days here have been very exciting.  Before I came to Kenya, I could count on my hands how many soccer games I’ve watched on TV. Now, the World Cup Games are on and every bar, restaurant and lounge I walk by, the games are on.  This year was the first time in history Ghana made it to the World Cup so it is a very big deal here. Unfortunately, Ghana is out, along with the US, and it was a very sad day here when Ghana lost. Last night, Brasil lost to France (1-0) and I was in complete shock. I really wanted Brasil to win the whole thing, so today I am wearing my Brasil soccer jersey I got in Amsterdam in solidarity of my team not making it to the semi-finals.  As I walked into town to check email, several of the people in town showed sympathy saying, “I’m so sorry your team lost.” I appreciate that, they take the game very seriously here. 

Other than the World Cup games I haven’t watched very much TV here. Every now and then I’ll flip through the 10 channels we get and Desperate Housewives will be on and a few other American movies. I was excited to learn Grey’s Anatomy comes on every Wednesday night at 8pm so I’ll have to check that out since it’s my favorite show. They are probably all episodes I’ve already seen, but I’ll flip to it when I go through Grey’s withdrawals. I am so surprised at how up to date the TV shows and movies are in Kenya.

On Wednesday, Abby and I spent the entire day working in the hospital with Dr. Allibhoy.  I found this experience to be very rewarding, and I was excited to see so many illnesses I would seldom or never see in the states.  I cannot even tell you how many HIV/AIDS patients I saw, tuberculosis, hypertension, sickle cell crisis, dysphagia (difficulty swallowing), opportunistic infections varicella zoster (chickenpox in a child and adult), and one case of a diabetic foot ulcer.  I could spend hours talking about everything I saw in this one day of shadowing Dr. Allibhoy, but I won’t right now… what I will say is that international medicine is awesome. Illnesses I read about in a textbook came to life for me in the hours I spent in clinic.

Many of the patients I saw when we went on rounds in the morning, visiting patient after patient, checking their medications and so forth.  Later in the morning and in the afternoon, we spent time in Dr. Allibhoy’s office where patients would come in and get physical exams done or pick up medication.  I was surprised how many people came into the office to pick up HIV cocktails of protease inhibitors and non reverse transcriptase inhibitors.  HIV medication is very expensive, but there are some people here that can afford it; some people by looking at them I never would have imagined were infected.  Most were men wearing a ring (but I’m not sure if they were actually married), well-dressed, wearing gold, diamonds, sometimes a suit with nice leather shoes.  Dr. Allibhoy said they come to his office to pick up medication because everything done there is confidential, as opposed to local pharmacies. 

The case I saw of a diabetic foot ulcer was hilarious.  This patient was hanging out in the clinic, with his foot hanging off of the bed covered in gauze, oozing clear fluid onto the floor. He was reading a newspaper and actually seemed annoyed that we stopped by to check on his foot and change the dressing (gauze) on it.  He was walking around on it and was asking when he could get back to work.  He figured since he wasn’t in any pain, it wasn’t a big deal.  In my opinion, he’s lucky to still have his foot. Often times, diabetic neuropathy gets so bad to the point where the foot or even the leg below the knee has to be amputated. His ulcer was caught early, and I saw that Dr. Allibhoy is a true advocate for preventative medicine, something all physicians should do.

This past Friday, we all went to a town called Ahero, which means love in the Dholuo (Luo) tribal language.  Ahero is where we pick up the fieldworkers before we meet with the Luo elders at various villages and sites.  The fieldworkers will translate for us as we do history and physical exams on the elders, and help explain to them what we will be doing with them there when we take blood pressure, height and weight measurements, and blood samples to measure glucose, cholesterol and hemoglobin levels.  All of this data will be entered into palm pilots as part of the Kenyan Grandparents Study. All of the Luo elders participating are grandparents, but we will be comparing the results of the caregivers versus the non-caregivers of orphaned children as a result of the HIV/AIDS epidemic.

I was explaining this to one of my roommates and she asked me why this is important.  At the time, I didn’t have a definitive answer.  Since I have been here and have actually worked with these people, I have come to realize the severity of the epidemic.  If the grandparents do not take care of these children, who will? What will happen to the population if parents die of AIDS and there are no grandparents to take care of the children? Who will educate them about this disease? That is why this is important.  It is crucial that the grandparents be able to take care of themselves and remain healthy for the sake of their grandchildren.  I am hoping that we will be a positive force to assist in maintaining good health in the elderly Kenyan population.

When we were in Ahero, we practiced doing all of the blood work and my clinical skills improved so much.  At school, I volunteered doing finger pricks and taking blood pressure, and I was really slow. It took forever just to get the blood pressure cuff on properly. In Ahero, working with the people I was able to do it more efficiently.  It didn’t take me as long to set up each station and collect blood samples. I was quick, but accurate without making mistakes.  It was a good feeling; I’m really on my way to becoming a doctor. Practice makes all the difference.

Later on that day, the fieldworkers cooked a huge feast - it was sooooo good. We had chapatti, tilapia, sweet potatoes, dengu, chicken, kale, greens and ugali. Brenda made this wonderful pudding (what we call fruit salad in the states) with fresh pineapple, papaya, mango, avocado, passion fruit, and banana - it was to die for. It was like Thanksgiving, we ate and ate and ate and it was amazing. We had such good fellowship, eating together and getting to know the fieldworkers was a lot of fun.  I helped wash dishes and it took a long time, since nearly 20 of us ate, but it was a good time.

I have been eating like a rhino since I got here the food is so good. I never would have tried any of this if I was in the states.  We eat a lot of fish here, mostly tilapia. I said I would never eat a fish that was looking at me, but I have several times already.  They cook the fish whole, with the head on and everything. It really is an experience.  Jaja, one of the faculty/staff at Ohio University that came with us is Kenyan, and he always offers us a beer if we can eat the whole fish with the eyeballs, brain, and so on. So far, Amy and Shawn have done it; but I can’t do it. I’m not ready for that yet so he can keep his beer. I don’t drink beer anyway, so maybe when he offers something better I’ll be up to the challenge.

A few nights ago I talked with Dr. Ice about how I am adjusting to Kenya and what it’s like for me to be here. I am the only black student in the group and I really like being in Kenya.  I feel at home and so comfortable in my own skin. It makes me happy to see so many people around that look like ME.  Everyday I see black faces of all complexions, people with natural hair, braids, or sometimes weave, beautiful colorful garments, it’s a real treat to be here, to see so many people of which I have common ancestry. 

At times, it is also difficult for me being in Kenya. We are staying in a really nice hotel with a TV, hot water, electricity and a pool.  Sometimes, it doesn’t feel like I’m in Africa at all, until I step outside and see the people and everything that’s going on around me. When I stayed in Ghana, I was in the villages living with the people, and we had none of the things I just listed, so every now and then I need a reality check. The other day Abby and I were walking back to our hotel from the market and a little boy, maybe around 10 or so, followed us several meters back to the hotel with his hands out, asking us for money. As we walked by a number of people, some would say (specifically to me), “Sister, help your brother!”  I didn’t know what to do. All I could say way that I was sorry, and I kept walking.

When we made it back to the hotel I was so filled with emotion, wondering if I had done the right thing. Should I have given the boy money? Would it have helped? I couldn’t stop thinking about it; even now it still haunts me. I thought back to when something similar happened to me in Ghana.  I gave someone money and several other people saw me and started asking me to give them something too. I was overwhelmed and couldn’t hear anything but the needs of the people encircling me.  I didn’t have enough to give everyone, and even though they think I’m rich, I am not. The money I am living off of here would not be anything in the states, and I don’t think they really understand that.  But why should they, they are trying to survive. So I keep all these thoughts in my mind and on my heart, and pour them into my journal where I can go back and revisit what I have seen and experienced.

Yesterday, we went to Uganda. This makes the third African country I’ve been to. We weren’t there for very long but it was a lot of fun. We got fabric to makes dresses and other accessories, so I am excited to see how the final product will look.  When we went to Uganda, I noticed a lot of HIV/AIDS prevention billboards and signs that said “Medecins sans frontiers.” It’s been a while since I’ve taken French, but I figured out the many billboards were addressing Doctors Without Borders, which is kind of like Peace Corps with physicians that provide medical care in countries that need it the most. I have been interested in Doctors Without Borders for a long time, so it was really cool to be in a place where this program serves people. It was like I had a revelation.  Speaking of revelation…

This morning I attempted to find a church to go to since I didn’t go last week. I had no idea what was going on; where a church was, how to get there, what time it started, etc. I made my way down to the front desk where they told me about a church within walking distance, but it had already started.  Jaja and a few others said they would go with me, so we’ll go next Sunday for sure. I am looking forward to it; I’m interested to see how people worship here.

My experience here so far has been a combination of good, sad, frustrating, exciting and other emotions I can’t put into words, but I am enjoying it none-the-less.  Thank you so much for taking out the time to read what was on my heart to write. Take care and God Bless,

Kim

PS - Thanks for writing me back it means a lot to me! I am not always able to write every person back, but I do read your emails and I appreciate it :) Someone asked me about the comment I made about jewelry and marriage proposals in my last email… When I was in Ghana, I was proposed to almost every day and the men would offer me jewelry and goats and all kinds of stuff to marry me. I would kindly tell them I could not accept their offerings, but they gave them to me anyway. Well, the jewelry at least; they kept the goats.  A lot of men propose to American women so they can come back with them to the states.  In a nutshell, I came back from Ghana with lots and lots of jewelry, what I like to call engagement jewelry. The experience here has been different, so that’s cool. I’m having a great time.  Amy is sitting next to me making jokes about me writing 10 more pages after I already finished the email, so I will let you go now…  :)

July 7, 2006

First week of data collection

So we finally started data collection.  As usual the first few days are rough as we work out the kinks and get into a routine.  The students are doing well overall.  For those of you new to my updates, let me give you the general set up.  We arrive to the site, a school or church, hopefully around 8am.  We set up the site, sometimes inside a building but often under some trees.  We bring big “polythin” (plastic) sheets to provide privacy for the physical and osteopathic exams.  The rest of us are in the open.  The elders have been waiting for us when we arrive.  First Jaja goes through the consent process with everyone.  Then after they have consented they go to a station.  The stations include: blood (finger sticks for glucose, hemoglobin and cholesterol testing), 24-hour recall (the elders are asked what they ate over the last 24 hours using various containers to estimate the amount of food), OMM (a basic osteopathic examination, looking for the greatest area of chronic pain), anthropometrics/blood pressure (body measurements), history (clinical history interview), interview (asking everything from the children in the homestead, income, stress), physical exam (a complete physical and some wound care if necessary).  There is no particular order, what ever station is available.  

On Monday we were at Kakola.  The people were happy to see us again and happy to get the photos that I brought.  Two elders have died since last year but everyone else looked more or less the same.  One lady had a bad wound last year and she was happy to show us that she had completely healed.  We had a couple of wounds to clean this year, one from a participant and one from someone in the community.  They were both minor cuts that became infected and rather large.  The woman from the community was missing basically all of her skin on the top of her foot.  She had been treated with antibiotics and it looked like it was going through the healing process.  Shawn and Amy cleaned that up.

On Tuesday we went to Ayucha, this is a site in Awasi which is a bit further than Ahero, where all the fieldworkers are based (also Dr. Bonyo’s home area).  The elders were generally poorly nourished and in poor health at Ayucha.  There were several people with infections as they were loosing their teeth.  One lady had BP of 224/110.  She complained of being stressed out because she was alone and had an orphan to care for.  We tried to get the chief to help with getting her medicine and we paid for some immediate medicine.  It is unlikely that she will have help beyond this but I guess we can hope.  We have a new clinical officer this year since Dr. Hongo was unavailable this year.  Joshua Owour started with us on Tuesday.  He is going to be working at the SHARE Kenya clinic once it is finished.  He and Emily were really backed up but I think they were trying to treat everyone.  It must be hard when you are used to treating people to try to shift gears to health research, where they are trying to locate the deficits but not treat them.  We do send people to the clinic if they have an urgent health problem but even if we were a medical mission, we would not be able to help people for chronic problems.  Emily kept saying, well, in the US, I know that we would do this….  I can understand the frustration.  I too struggle when I see people who are not only undernourished but in chronic energy deficiency, with BMIs under 16.  We saw many people like that on Tuesday; I only used the adult cuff for 2 people out of 22.  I want to give them extra food but then what do they do tomorrow. 

On Wednesday, we started to get into a groove.  We were at Kore, a site well into the interior.  When I drive to these places I often wonder how people find the place or give directions – take a right at the homestead with the big tree in front and a left at the choo with made of brick?   Anyway, we were two fieldworkers short – one who is pregnant had to be sent to the hospital for malaria.  The other had to go to oversee the survey for one of our water sites.  Two areas are very rocky and we are not sure where or if water can be tapped.  Even though we were short, we managed to work at a much faster pace.  The elders were again, happy to see us, they say, “you’ve come back, erokamano”.  I remembered the malnutrition from this site and we saw it again but overall people seemed relatively healthy.  We had to take one lady to the clinic because she had CHF with some kind of acute lung infection. 

Thursday we went to Dr. Bonyo’s home area, Masara.  It was good to see old friends that I’ve been working with for 4 years now.  I was sad to hear that my old friend Elekia died in February.  He had to be close to 100.  He was a sweetheart.  The day overall was good, we were working well together.  As far as health was concerned it was a “crapshoot” as Emily said.  Some people were fine others were very ill.  We sent one man to the hospital for a chest x-ray.  He had been previously diagnosed with TB but was having symptoms again. I gather SHARE Kenya told him to get an x-ray but he didn’t.  So we sent him to the hospital with some money for an x-ray.  Hopefully, he will follow through this time.  He is also extremely undernourished and has been for as long as I’ve been doing this research.  Another man was so undernourished that his temples were sinking in.  His total cholesterol was less than 100 and his blood pressure was 86/56.  We gave him extra food and water and sent him home with extra bread for what it is worth.  He also likely had TB.  We sent him to the clinic for a sputum culture.  I don’t know that he will go or if he will spend the money on food.   I guess, either way we’ll help him. Another man had high blood pressure and complained of blood in his stool and urine.  He needs to go to the hospital for a work up and medicine – I guess SHARE Kenya told him the same thing.  Finally, there was a grandmother who had a blood pressure of 224/112. Obviously, there is nothing we could do for her.  Tim and Shawn noted today that at each site there seems to be a common osteopathic problem.  Knees at one place, backs in another.  The only explanation that I can come up with is some kind of common farming practice but we haven’t been able to find an association previously. 

Friday we were at Kamswha South.  Overall the day went well.  People were generally in good health or had chronic problems for which we could do nothing.  They were generally well nourished.  I think everyone was relieved for the week to be over as it has been intense.  The girls went to the tailor with their fabrics when we got back to Kisumu. 

There are still challenges with the research.  The cholesterol machine (Shawn’s machine) was giving us some trouble.  It is hard for the students to get enough blood to fill the capillary tubes.  People’s hands are so calloused from years of farm work.  Then when they get enough blood the machine acts up – too much sun, too much heat, or just general chira.  The hemocue can be finicky as well.  The heart rate monitors with the GPS haven’t really been working.  On Tuesday I got the reader for my acticals and got excited to begin those on Wednesday, however, I don’t have the correct connection on my new computer.  Note to self: don’t get a new laptop 2 days before leaving the country.  I bought 10 new palms.  All of the chargers have died and several of the palms are hard to use.  A couple have just died completely.  So, equipment continues to be an issue.  I think there is a paper on non-field friendly equipment in this. 

Andrew has been in the field with us.  Lena watches him as I work and I take breaks to feed him or calm him down if his teeth are bothering him or he just needs mom.  He has been getting used to the routine though.  We bring a little bed with a tent over it that I borrowed from a friend.  He always has 20 or so people looking after him as the field workers like to give him attention.  The grandmothers love to see him too.  They call him toto and laugh when we tell them that his name is Odhiambo.  He laughs when they talk to him in Dholuo.  I had an interesting experience breastfeeding him while conducting a clinical history but the grandma heard him crying and told me to feed him.  When he started crying, she told me that he was young to have teeth coming in.  I guess after 10 children, she knows how to read them!  I was worried about traveling the bumpy roads with him but he loves them.  As soon as we start bouncing around, he drifts off to sleep. 

Today the students went to the Kakamega forest.  Amy and I stayed in town to get some work down.  I hope to be able to locate a connector for the actical.

Gillian

July 15, 2006

This week data collection went fairly well.  We continue to have equipment problems, palms, anthropometer, acticals, and scale.  Shawn’s machine is working well however.  The students seem to be getting the hang of the finger sticks and all of the team is working faster and better.  We added a new Kenyan to the team, Leticia.  Now we have three pregnant ladies on the team.  There was a bit of controversy as Leticia rode in the van after the rest of the team made her cry in the truck.  We had to have one of Jaja’s famous morning pep talks.  Everyone aired their grievances and it seems like people are working better together.  The organization is better this year.  We have a three member organizing team – Awili, Danish and Brenda.  Having a woman seems to help balance things a bit.   For the most part the sites are well organized as are the uniforms.

We began distributing uniforms last week.  The students seem pleased with getting the uniforms, although they are very shy.  They come and shake my hand and say thank you, erokamano or asante very quietly.  Then they go hang out with their peers and talk very animatedly and seem excited.  Most of their uniforms are in pretty bad shape so it must be nice to have a nice new uniform.  There were several sites that we don’t seem to have orphan lists for.  I am not sure what happened but we are trying to get lists so we can have the uniforms made before we leave.  I think there will be about 600 uniforms – many of the children from last year have either died, moved away or are otherwise unavailable.  The water well at the first site is finished.  They began drilling at the second site.  The third planned site had to be eliminated because of the geology of the area.  It would have cost about 1 million shillings (more than $14,000 US) to drill at the site.  We are trying to locate another appropriate site.  Unfortunately the places that need the water the most are the ones that are too difficult to drill.  The water is costing more than expected so I am not getting shoes for students this year.  Perhaps we will focus on shoes next year.  It is certainly a great need.

The grandparents that we meet continue to be interesting.  Many of them complain of being “tuo” but often the people who complain the most are the most healthy.  I wonder if people are afraid to say that they are ok because they fear they won’t be seen or if there is a cultural component that I don’t understand.  Maybe they are just tired.  There is a great mix of people, from those who are extremely undernourished to those who are so heavy that they are developing the diseases of modernization (e.g. diabetes, hypertension etc.).  Some sites people are in better shape than others.  Generally those sites that are closer to town have people in better shape, presumably because they are closer to the market and healthcare facilities.  I was happy to see that one man who had a BMI of 16 last year and was passing out during the physical had gained weight and looked good.  He was very excited to see me again.  We’ve seen several wasted men with probable HIV and/or TB.  I don’t remember seeing quite as many people with HIV in previous years.  Yesterday, we had a lady who had a BMI of 13.6!  She showed no signs of illness other than her extreme undernourishment.  I had to take a break after seeing her – I felt disappointed, frustrated and helpless.  So many of the elders who are undernourished have cholesterol of less than 100.  We have had a few people with cholesterol over 200.  Several people have HDLs under 40.  Glucose has largely been low, a few people are diabetic.  One man had a glucose of 350, fasting!  He knew that he had diabetes but was unable to afford to see a doctor, let alone treatment.  We see a lot of low hemoglobin levels.  Blood pressure is all over the map.  Many people have very low blood pressure, we see a lot of pre-hypertension and then we have people with crazy high blood pressure.  One woman this week had a blood pressure of 240/142!  She is a caregiver of three orphans and is undernourished.  She talked about being extremely stressed out as she couldn’t feed the children what they were used to eating.  It is amazing that she hasn’t stroked out.  I gave her some money for food and sent her home with some bread but this obviously doesn’t really help her.  Joshua and Emily give most people Tylenol or Ibuprofen.  They get a 7 day supply so I don’t think it does anyone any particular good.  I think it makes them feel better when they feel helpless to help people.  We purchased antibiotics in bulk this week because it was getting difficult and expensive to send people with active infections to the clinic.  We purchased 1000 sulfa-based antibiotics and 1000 amoxicillin for about $18. 

Probably the most amazing case that we saw this week was yesterday.  Shawn was doing an OMM assessment on a woman who said that she had head pain from an accident 25 years ago.  She said that it bled daily.  Shawn asked her to take off her wrap and there was a huge gaping wound with a mass.  He went to grab gloves and Emily & Joshua and came back to find a pool of blood on the floor.  The best we can understand is that she had it closed at the time of the accident and at some point it opened back up.  Apparently you could see all the way down to the skull.  They cleaned it, packed it and wrapped it.  I gave her funds to go to the provincial hospital to see a surgeon.  It will be interesting to see what they do because Emily thought it couldn’t be closed without a graft.  Amazingly she seemed to be doing fairly well.  Her hemoglobin was 5.5 mg/dl and her blood pressure was 180/90.  I did her history and she complained only of a little fatigue and pain on the opposite side of the head.  I couldn’t get over how well she was doing. 

Overall the students are doing well, some ups and downs and the usual group dynamics. We all had a nice night out at Kay’s restaurant last night.  Tonight we are going to Brenda, Joshua & Lena’s house and the students are going dancing with the fieldworkers.  Email seems to be harder than usual so if you don’t get responses from them be understanding but keep emailing because homesickness crops up occasionally. 

Andrew continues to do well. He and Lena have gotten into a routine with a nice morning nap.  He seems to be thriving with all of the attention he gets from everyone. 

Gillian

Challenging week

This week has brought us many challenges.  The week began with a call from one of my fieldworkers to ask permission to be with his sick sister in Mombasa.  When I arrived in Ahero I was told by the team that he had lied to me and he was really visiting his girlfriend in Nairobi.  She had flown in from Canada – some team members encouraged him to talk to me but he chose to lie.  It was very disappointing because I have worked with him a long time and he has taken advantage of my generosity.  Based on other information, I now believe that he has taken advantage of me for a long time and has probably given me false receipts to get money as well.

When we arrived at Ahero, I also discovered that the water drilling at the second and third water sites had not begun.  Apparently, they were waiting for some funds but neglected to tell us.  So we had to send Jaja back to town from a very distant site to make the payment and get the water started.  They still haven’t started at one site and they are trying to extract more money from us.  This is why I prefer not to do capital projects.  There are always problems if you can’t be at the site and overseeing the project at all times.

At the field sites we also had some issues.  Joshua and Emily continue to provide people with pain killers (Tylenol and Ibuprofen) and antibiotics.  I think they feel a bit helpless to treat people, particularly when we see people who would be classified as being in hypertensive crisis.  We seem to be seeing more people with extreme blood pressures this year.  Anyway, on Monday a man came and began the study but he was too sick to continue – why he was enrolled I am not sure.  So I was asked to give him funds to go to the hospital in Kisumu.  He probably had CHF and some kind of lung infection.  It places me in a difficult situation when people request funds for such problems because it is difficult to refuse someone who is gravely ill, yet I give them funds – sometimes they use them for treatment and sometimes they don’t.  If they do get treatment, it is a temporary fix for a chronic problem.  Am I really helping them – probably not.  When I received the receipts from the family, they included a receipt for the grocery store, they purchased toilet paper, soap and some other supplies.  We also found out that the lady who had the large head wound to whom we gave funds to go to Kisumu for treatment, never went to the hospital.  I finally had to put an end to funds for sending people for treatment.  There is no budget for this and I am not convinced that we are actually helping people in most cases.  The health problems here are enormous and it is way beyond my capacity or SHARE Kenya’s capacity to solve them.  I think both projects help and hopefully will lead to assistance from groups with greater capacity but it can be overwhelming and it is easy to feel helpless.  Obviously, the greatest problem here is poverty and there is no easy fix to that.  Although people are told that this is research and that we are not providing treatment, they are still eager to participate.  People are disappointed when they are turned away because even the health information sheets that we provide them with their blood pressure, blood test results and physical exam findings are valued.  At most sites, I measure blood pressure and weight and the students test glucose levels for those who don’t participate in the study.  This seems to be enough to please people.  I suppose information is helpful too.

On Tuesday, we arrived at the site with no uniforms for the students.  Apparently, the school was not on the list of pupils.  This is the third or fourth time this has happened.  At every site, I’ve asked, “are there any more sites without uniforms?” and they always tell me no and then we get to the site and I’m told there is no list.  I don’t understand where the communication problem was but it sent me over the edge.  After a long discussion, I found that there were 3 additional sites with no uniforms so I have arranged to get those students measured.  So we are adding about 300 students.  At one of the sites, they gave us a list of 130 students.  There is just no way that that many children are total orphans so we suspect that the community is being dishonest.  Again, I am sure that all students need assistance – the poverty here is staggering regardless of orphan status but it is beyond my capacity to help everyone.  Unfortunately, people here see us as being overwhelmingly wealthy with endless capacity to help.  On a more positive note, the students who receive the uniforms are always very grateful.  In most cases, their current uniforms are tattered.  They are shy around us but it is fun to watch them get very excited trying on or showing off their uniforms.

At the site on Tuesday, the headmaster, who has diabetes came to request medication.  When I told him that we weren’t treating people and we don’t have meds for diabetes, he went away.  Then he came back to ask for information on diet.  We gave him a diet sheet and he complained that it wasn’t diabetes specific.  He went away and then came back to ask for a book on nutrition.  Then he came back to ask for money for the school building.  I told him that we don’t have funds for that and that compared to other schools – this place was in pretty good shape.  The building was cement as opposed to mud as we’ve seen elsewhere and the students looked like they were in pretty good shape.  The site was in the sugar cane area and relatively speaking people are better off.  The elders also were in decent shape – of course developing diseases of modernization.

On Monday I finally received a replacement part for my activity monitors.  I was still unable to use it with my computer but luckily I was able to use Jaja’s computer and we have at least started collecting data. 

On Thursday, we went to the “Opinion Leader’s” place.  I’ve been coming to this site for three years and it was good to see old friends.  People at this site are generally in ok health but many are malnourished.  One lady has a large mass on her throat that has grown over the years.  It has gotten to the point where it is likely to block her airway completely at night.  Joshua asked the opinion leader to encourage the area MP to assist her to get some treatment – don’t know if that will happen.  We had a 95 year old participant, who was in pretty good shape except for hearing loss.  There was an old man who used to be a rather famous dancer.  He participated in the dances during the celebration of independence and also performed all over Nyanza province.  He treated us to many dances – it was great.  He was tiny – a BMI of 15 – I think his arm circumference was about 15 cm but he was in good health overall, no complaints.   I guess all that dancing kept him healthy.  Joshua told us that he used to dance in town and all the children in the area would follow him home.  At the end of the day, when parents were looking for their children, they would find them at his house where he would be performing for them.  After we worked, we were danced over to our first water pump site.  It was fun – they sang songs of praise and then I got to try out the water pump.  Afterwards we were treated to a great feast.  They gave me the following “gratitude message”:

“We, the Ongongo Self Help Project members and the entire community, do appreciate the heartfelt for your third visit to the community with great joy.  Sir, apart from the provision of proper healthcare to the community, we are most grateful for the support of hand pump water which will help the entire community.  May God bless you for this kind aid.  Although the entire community received the aid in a joyful mood, we only wish to request for a power generator that can supply water to huge tanks.  Otherwise this remains future plans for the group.  Thank you.  Long live Dr. Ice.  Long live USA.” 

This was read to me and was also followed with requests for other assistance. It was nice to be appreciated but also it would be nice to just get a thank you and leave it at that.  I wonder if the help that we provide just makes people more dependent and does it help in the long run?

Friday, we went to Kisumu rural, where Jaja’s family live.  People were generally in good health but had very high blood pressures.  It is interesting the blood pressure situation here – we see many people who have tremendously high blood pressure – particularly diastolic BP, which usually declines with age.   You expect it in people who are overweight but when you see a BP of 240/140 in a person with a BMI of 16, what do you do?  The heart rate monitors are giving us some crazy data as well.  Several people have heart rates up to 250 when they are probably sleeping.  Even among our fieldworkers, who are generally young, the blood pressure is high.  I wonder if there is a genetic component or some other underlying disease process that is affecting the heart.  Many people have low HDL cholesterol as well.  Then we saw a man who was 101 who, besides hearing difficulties and slightly high blood pressure, was in great shape! 

Unfortunately, on Friday one of our fieldworkers was ill.  He didn’t inform us until late in the day.  We rushed him to the hospital where he waited for 2 hours to be treated for an urgent situation.  We were frustrated because in the US, he would have been treated immediately.  He collapsed in the hallway, writhing in pain before he was finally given pain medication.   He was taken home late last night but had to be taken back to the hospital for surgery this morning.  This is the second fieldworker who came to work very sick.  I don’t know why they come instead of getting the treatment they need.  Perhaps they are worried about loosing their jobs or coming up with the funds for treatment.  On Monday, I’ll have to have a talk with the group. 

So the US field team is doing well.  Everyone is healthy and they seem to be enjoying and learning a lot from their experiences.  Andrew is doing well.  The fieldworkers say he is fat.  This is funny given that he is in the 25^th percentile at home.  They also say he is cheeky.  One more week left and then we are on safari and on our way home.

Gillian

July 22, 2006

9:01am Kisumu, Kenya

Dear Friends and Family,

This past week was our last full week of working in the field with the Luo elders. Most of the time, I do clinical histories with a translator and this particular week has been very exciting.  So many of the elders I have talked with have tried to hook me up with their grandsons so I would stay in Kenya, a few wanted me to take them back with me to the states. I kindly replied that I couldn’t, but they would still mention it throughout the day when I would see them. I should have asked hem how much cattle I was worth, then maybe I would have considered it – just kidding!

As I mentioned, this week was pretty exciting as far as the elders trying to marry me off to someone. However, I think my favorite day this past week was Thursday.  If I had to come up with a theme for this day I would say it was dancing in the field, because that is exactly what I did.  It all started with a very thin, loud-talking man we met early in the day.  I was at the blood station working when I heard a very loud voice talking.  I looked over and saw a very thin older man wearing lots of beaded jewelry that probably weighed more than he did, using his hands to talk and making all kinds of noise.  I thought he was upset or yelling at Jaja during the consent process.  Come to find out, that is how he talks, very lively and full of energy.

Eventually, he made his way to where I was working so I could get a finger prick from him. I learned at that point that he was about 70 years old and was/is a dancer. He had two large teeth, one at the top of each side of his gums which made a very scary gap, and he would smile about 2 inches from my face as he shook my hand. He was very thin; maybe he weighed about 80 pounds or so, but had the energy of a 5 year old. I was scared at first but the man was very friendly; I just didn’t know at the time what to say to him or how to respond to this “close encounter.” So I shook his hand and said hello, introducing myself.  Not sure of what to say next, I commented on how much I liked his colorful and festive jewelry.  He got excited, and smiled the wide toothless smile that I’ll never forget, and I quickly retrieved the sample so he could move on to the next station.

From afar off, I heard a voice say something in Luo followed by hearty laughter. It was Jaja, telling this old toothless man that I also am a dancer.  Why he felt the need to share this information I’m not sure, but the next thing I knew, he was dancing before my very eyes, grabbing my hand to join him.  I was in shock and all I could do was laugh.  We all got a pretty good laugh in at this old man, but what I found to be the most interesting was how he walked with a cane for support, but was swinging it around when he danced. His energy was never-ending and quite entertaining.  If we had elders like this in the states geriatrics would be a completely different ball game.

When I was done working, I was not surprised to see the same man outside dancing and singing alone.  Dr. Ice had the video camera and documented all of it; it was hilarious!  Jaja dragged me out there and I ended up dancing with the energetic elder, clapping my hands and swaying my hips.  We sort of marched around for a bit and I wrapped it up by saying ‘erokamano’ (thank you).  It was a lot of fun but it seemed surreal, dancing and carrying on in the workplace.  I appreciate the elder being there and dancing with me.  There is such a concern here that the traditional dances will be lost because the younger generation doesn’t want to carry it on.  Many of them listen to hip hop and have conformed to pop culture, rather than trying to learn the traditional tribal dances.  It is truly unfortunate.   I wish I did know specifically in Africa where my ancestors are from. I would love to have a native tongue and do traditional dances from Africa. I can’t understand why anyone would want to deny that.  At the same time, I am glad I am getting a taste of it now. When would I have an experience like this again? 

Later in the afternoon I did physical exams with Emily and Joshua, the clinical officer, and learned a lot about tropical ulcers.  I saw a woman with a huge mass at the back of her throat. We think it was a lymphoma because it was growing over a significant period of time, but we would need more lab tests and probably a biopsy of the tissue to be sure. Unfortunately, we couldn’t do any of that right there in the field so we encouraged her to see a physician in town and we would provide transportation there. I’m not sure what came of that woman, but I hope she is better.

Many of the elders we saw were underweight but there was one case we saw earlier in the week that I thought was kind of funny.  Joshua was explaining to me how polygamy works in Kenya; a man may have two or three wives and everyone gets fed but him.  That was the exact situation for a man we had seen earlier this week. An elder we saw had two wives and ten children with each wife.  Everyone was happy and healthy but this man was seriously malnourished. So we asked him, what is going on? Why are you not getting enough to eat? Sadly, he replied that his wives didn’t feed him. It’s sad, but I found a hint of humor in it. That was not the reason for malnutrition that I was looking for, but once again I am reminded that we are not in the states.  There are social and cultural factors involved here. Joshua explained to me later that polygamy isn’t always the best way to go.  The first wife will say, “Let your other wife take care of you!” and the second wife feels the same way, leaving the husband alone and hungry. Joshua then smiled a smile that told me he was thankful for his ONE wife and how well she takes care of him.

Thursday afternoon when we were all finished with a productive day of work, a woman came back to the field site singing and dancing, ready to take us to a place to eat a meal cooked from the heart. There were about 25 of us: Dr. Ice, medical students, Joshua, the fieldworkers and several of the elders. We all followed her with singing and clapping about 30 yards to a nice building where we would eat.  Chicken, ugali, beef, fish, greens, potatoes, vegetable rice, chipati and other foods were laid out in a huge spread before us. A feast was prepared for us and we ate so well! It is such a good feeling to enjoy a satisfying meal after working such a long day. 

After we ate, they gave speeches sharing their gratitude and appreciation for all of the work Dr. Ice has done in their community.  I found it to be so heart warming; it was clear to me that there were words that could not even be translated to express how thankful they are. The speeches may not have been eloquent but they were so rich in love; it truly was from the heart.  Dr. Ice gave a speech also, thanking them for the wonderful meal and their hospitality.  She briefly shared again what the Kenyan Grandparents Study is, and how her hope is to bring more help to the communities from the government to provide better care for the elders and HIV/AIDS orphans.  We all had a good time together, and it was revealed to me that every intention in the room was good. 

On Saturday, I woke up early excited for the day’s events. The medical students (me, Tim, Shawn, Abby, Emily and Amy) met in the hotel lobby and all six of us squeezed (literally squeezed) into a cab to go to Lake Victoria to Hippo’s point.  Fortunately the cab ride wasn’t too long but as soon as the driver opened the door for me to get out I almost hit the ground.  It was quite a sight… but we had a good time.  All six of us, including the two men rowing the boat, went out on the lake and saw hippos swimming around and splashing, it was so cool. I wanted to get closer but when I remembered how much of a tasty breakfast I would make, I calmed down and used more zoom action on my camera to take some photos. It was a lot of fun, I haven’t been on a boat in years.

On Lake Victoria, it was interesting to see people doing everyday activities.  When we were on the boat we saw two women next to each other, one was bathing and the other was washing dishes.  Further down were men fishing with three or four hand-made fishing poles.  The people get so much use out of this lake; it’s a good way to be resourceful.

The weekend is always fun for me.  It is always a good way to wrap up the week and enjoy doing something new.  We didn’t go out dancing, but I saw hippos so I’m satisfied! This coming Wednesday will be our last day working in the field. It went by so fast it doesn’t even feel like we’ve spent 3 weeks in the field, but I know we did.  I am looking forward to the week ahead; I know there will be many more stories to share.

Take care,

Kim