Frustration & Opportunity

The past two weeks have been an absolutely hectic blur. I have been struggling to find time to write a blog the past two weeks, but I think this is coming at a good time, as, up until now, I have been working in tandem with one of the clinical pharmacists here, while this weekend serves as the transition into my independent role as the sole pharmacist for my rounding team at MTRH. 

Frustration.

That would be the word that sums up so much of the aura that envelops me at Moi on a daily basis. Frustration with the constant disorganization--hours are spent on a daily basis tracking down information that would readily be available back home. Frustration with the lack of resources available--medication availability changes day-to-day, resulting in the status of patients' wellbeing remaining stagnant or deteriorating in some cases solely due to external factors. Frustration with the inability to entirely trust the word of the healthcare personnel--tasks/medication administration records are checked off only to be discovered that they were never completed upon talking to the patients myself. Frustration with the apparent lack of concern--suffering and death are so commonplace here that it appears as though everyone has become desensitized to the reality of what it means to the Loved ones left to fend off the void left in their lives as a result of the loss.

Opportunity.

On Day 1 of being here, the lead clinical pharmacist told us that we will get eaten away with frustration over the course of our time here and that, rather than letting it lead us down a path of cynicism and detachment, we should let it be one our greatest motivating factors while here. Prior to experiencing the hospital firsthand, this forewarning did not hold much weight for me because I had nothing with which to associate it. However, over the past two weeks, it has been a constant murmur in the back of my mind as I attempt to not be downtrodden by the environment within which I am finding myself. All of these frustrations truly do lead to increased opportunities to learn, grow, and impact the care of individuals in a way that pharmacists traditionally cannot have in most settings back home. 

To give you an idea of what exactly my roles and responsibilities are here, let’s do a run through of the typical day/week for myself and the other pharmacy students here with me. Each morning we wake up around 5:30am to get ready, eat breakfast, finish researching patient-specific topics, and make the 15-minute walk to the hospital by 7am. For the following two hours, we make adjustments to the drug availability list so we have a better idea of what medications we have at our disposal, rewrite T sheets (Treatment sheets—the patient’s list of medications paired with their instructions as well as instructions for nursing on how to administer IV medications to reduce adverse events), confirm that patients received all of their medications the previous day as well as that morning as frequently as they were supposed to receive them (I am not sure this has ever happened), check vitals of the patients for whom I am caring directly, and review T sheets for medication issues to discuss with the doctor during rounds. When rounds finally start at 9am, we spend the next few hours going walking around to each patient’s bed, receiving daily updates on their statuses as well as receiving the results of the labs and tests that were conducted the day prior. The doctor discusses his plan while providing teaching to the med students. The pharmacist’s role during rounds can vary slightly depending on the doctor leading rounds; however, in my case, the doctor on my team seemingly holds the discretion and opinion of pharmacists in high regard. For that reason, I am able to make a variety of medication-related recommendations as well as recommend a variety of labs that are necessary to monitor for adverse effects. Occasionally, we are even able to contribute to directing diagnosing, as we spend a large amount of time reading patient charts and tend to be more familiar with the patients’ stories and statuses than the Kenyan med students. Once rounds end, we spend the next hour or two completing additions to T sheets and following up on pertinent patient issues. Around 1pm, we walk back to our compound for lunch, relax briefly while also researching patient-related topics if necessary as we do not have internet access at the hospital, and finally head back to the hospital to follow up on additional issues the rest of the afternoon until about 6-6:30pm when we walk home for the evening. The 7am to 6:30pm workday lines up with dawn and dusk, as we are not allowed to walk outside of the compound when it is not daylight. When we arrive home for the evening, we eat dinner and then spend the majority of the rest of the evening researching and studying in order to improve our ability to care for the patients present on the wards before heading to bed around 10-11pm.

Thus far, I have felt the full spectrum of emotions while working here—entirely overwhelmed, underprepared, utterly devastated, proud, etc. Several of my patients have passed away (20% of patients who enter MTRH for care ultimately pass away during admission), one of which left me paralyzed briefly after attempting to get him in stable condition before failing. Another patient that has been in the hospital with acute renal failure as a result of an unidentified etiology had a hypertensive emergency this past Friday, who I, with the help of other clinicians available, was able to get in stable condition prior to the start of the weekend, a moment which has been my proudest up to this point, as continuous blood pressure monitoring was impossible due to the lack of availability of a bed in the cardiac care unit. For that reason, I spent the next few hours administering a potent anti-hypertensive medication while monitoring blood pressure and other vitals myself manually on a continuous basis. Again, one of the greatest frustrations as well as most rewarding aspects is the lack of resources available—resources in terms of medications and items as well as in terms of personnel. After rounds the vast majority of the Kenyan doctors and med students leave the hospital, and the pharmacists and pharmacy students, the few American med students and doctors, and an occasional Kenyan doctor are left at the helm of patient care for the entire adult wards at MTRH. For this reason, we are left to pick take care of all that happens post-rounds, allowing us the opportunity to do much more than would typically be asked of us back home while additionally contributing to the stress as there are a variety of circumstances that arise that would best be handled by an interdisciplinary healthcare team that has been following the patient all along rather than by a few individuals who may or may not be familiar with the patient’s history as all of the patients in the adult wards are split up between 8 healthcare teams.

Frustration and opportunity. Those are the two conflicting and somehow synergistic themes that have characterized my brief amount of experience within MTRH. Nothing about this has been easy up to this point; however, I am finding myself growing more and more familiar with the hospital and its procedures, which is making the responsibilities and roles I am filling relatively less overwhelming. I have a long way to go, but I am pleased with where I have come even in the past two weeks.

When in Africa…Hell’s Gate and Lake Naivasha

Our second weekend, we decided to use our time to visit a couple incredible locations named Hell’s Gate and Lake Naivasha.

Hell’s Gate is a national park measuring 26 square miles within the Rift Valley. It contains all kinds of wildlife free to roam across the land including giraffes, wildebeest, warthogs, zebra, baboons, smaller monkeys, rock and tree hylax, and several species of gazelle. One of the most absolute amazing things we had the opportunity to experience while we were there was riding bikes 6 km from the entrance of the park to the entrance of the gorge through which we were ultimately going to hike, wade, and climb. It was an incredibly surreal experience to ride alongside all of the aforementioned animals and literally be within 20-40 feet of some of them while they were grazing in large herds without any fences or barriers between us. We were even able to ride right up to a watering hole where two giraffes were drinking as well as witness two zebras fighting over territory. When we finally reached the entrance of the gorge, we found small monkeys scurrying all across the rocks and trees that essentially behaved like the squirrels of West Lafayette in that they were rummaging for any trace of food and entirely unafraid of being in close proximity to humans. The hike that we took through the gorge was an absolute blast. It was so incredible how gaping parts of it were with the height of its walls dwarfing us in every single picture. All along its base, there were signs indicating flash flood warnings and emergency exits to the top, as we were told that the entire cavernous rift can fill extremely quickly with rushing water that has taken with it many visitors in the past. One of the most enjoyable aspects of the gorge was the amount of rugged climbing and scaling that was involved—with one part requiring taking our shoes off to scale the side of a wall before descending into a shallow area of water while other parts required us to essentially find our way farther along the gorge by ascending walls using whatever foot- and handholds we could find up semi-vertical walls. On our way back to the entrance of the park, we were fortunate enough to be nearing sunset, as the fading light was exploding against the foliage and cliffs causing them to glow brilliantly, which was a perfectly flawless ending to the day.

The next day, we took a short boat ride on Lake Naivasha, which measures 53 square miles, in the chilly morning air, during which we were greeted by a couple families of hippos, several crocodiles, and a variety of colorful and unique birds as well as several animals grazing along the coast such as giraffe, waterbuck, camels, warthogs, and gazelle. 

We have definitely been blessed with wonderful weekend experiences thus far, and I expect that Kenya will continue to amaze us moving forward!

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When in Africa…Kruger Farm and Kerio View

In order to maximize our time here and get to experience some unique African adventures in between long work weeks, we’re looking forward to spending our weekends taking trips to nearby locations. Our first weekend, we decided to use our Saturday to visit a couple of awesome locations that we had heard about: Kruger Farm and Kerio View.

Kruger Farm is a 3500 acre piece of private land that hosts tourists on a 2-3 hour guided hike on an adventure trying to locate the 15 giraffes that roam their property. The most incredible part is that the giraffes are in fact free to roam a massive plot of land (as evidenced by the several miles we hiked across hills and plains trying to locate them) rather than within a cage that prevents them from acting as they normally would in the wild. When we were finally able to follow the tracks and signs of their presence, it wasn’t much longer before we were slowly approaching one that was feeding on leaves from the top of trees. We were able to walk with 25-30 feet of most of them before they wanted to increase the distance, and at one point we were even surrounded on all sides by 7 or 8 giraffes. The pinnacle of the experience came right before we began our hike back to the entrance of the farm, at which time one of the giraffes began charging at us and stopped 15-20 feet away, shaking its head at us, and allowing us to get the best pictures we had gotten of our entire time there. It was an absolutely surreal experience.

Kerio View is an area that professional/Olympic athletes often visit for large chunks of time throughout the year to participate in high altitude training. We didn’t get to see much of the training grounds, but we visited the Kerio View restaurant for lunch, which had incredible food and an unfathomable view that isn’t remotely done justice by the pictures I was able to collect. One wall of the entire restaurant is completely made up of glass panels and all of the dining tables are located adjacent to the windows, providing the most incredible view you could ever have during a meal. Furthermore, all of the landscaping as well as the unique stone work, art, and architecture throughout the property were amazing, which added to the feeling of being at a resort for a brief period. On a side note, although the food was extraordinary, it only added up to about $17.50, which definitely made it taste that much better.

What made the trip even more wonderful was our driver (Ken) over the course of the day who participated in all of the activities with us. He added quite a bit of dialogue regarding some of the Kenyan culture and politics, various bits of information dealing with some of the sights we were seeing, and was even open about his personal life, which was a nice change of pace, contrasting the typical closed-off nature of an individual’s family life in Kenya.

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First Impressions

Eldoret is the 5th largest city in Kenya. 

Prior to my arrival, this simple sentence in and of itself led me to have some conflicting ideas of the personality the city would bear. On the one hand, it being the 5th largest city within a country gave me images of a major metropolitan area with bustling streets and buildings several stories tall, modeling something remotely similar to a relatively medium to large city within the US. However, it being a major city within the country of Kenya led me to believe, perhaps ignorantly, that it would have characteristics of a purely 3rd-world country to the likes of the rural areas of Honduras that I have visited, the cities of Haiti that I have heard so much about, or the commercials on TV that I have seen time and time again requesting monetary support of children in Africa whose families’ can not afford schooling, food, or medical care. Truthfully, solely based on a first impression—a bird’s eye view—without having a thorough understanding of their culture and perspectives, it seems to be a mixture of both contrasting qualities I originally visualized. The streets are in fact swamped with cars, separated by less than a foot on all sides as they chaotically scramble to reach their destination with frequent short honks and flashing headlights, left unassisted by their complete lack of street/stop lights. The buildings are indeed several stories tall with shops and businesses pouring out of every small opening with some shops paralleling groceries and stores like Target and Kroger. The vast majority of the population in Eldoret are dressed quite nicely with suits and nice slacks paired with a button up shirt being the norm for men, regardless of age. Nevertheless, the lack of street gutters on most roads leaves standing water along the edges of most roads, the shops and buildings are not dressed with the fancy, clean-cut veneers we are so accustomed to seeing in the US, and the mud, dirt, and dust circulating constantly through the air and plastered to every inch of the road, sidewalks, and buildings make up permanent garnishment across the city in combination with the endless amount of litter generously distributed across the city. Even the hospital with/in which I will be working, though it is the 2nd largest hospital in the country, has its share of uncleanliness. Today, while in the wards, mice were seen scurrying among the personnel and patients, and the smell has been less than appealing, though bearable over time and with the help of mints and hard candy. 

There are, additionally, many other aspects of the hospital that would send most Americans running for the hills, likely even those considered severely financially strained who would have no other option. The wards in which I will be spending the vast majority of my time do not resemble the hospital rooms and beds back home. Essentially, the adult wards stretch down two hallways, which open up to 12 “cubes”, each of which contains 8 beds side-by-side that typically carry more than 1 person due to limited space and a large need. Most of these patients, by US standards, would be considered critically ill, seemingly coming to the hospital when left with no other choice as a last ditch effort. In the US, nurses caring for critically ill patients would generally only be held responsible for caring for 2-3 individuals at a time due to the constant, demanding attention and care required. However, in the adult wards at Moi Teaching and Referral Hospital (MTRH), each nurse is responsible for the care of up to 20-25 patients at a time. Due to the sharing of large rooms and the openness across the wards, the majority of patients within the cubes can see everything happening even in multiple cubes, just like the patient that began seizing my first day in the hospital and, unfortunately, the wailing of a woman mourning over the lifeless body of a Loved one, which was the case today. 

Nevertheless, the hospital and its committed staff are thoroughly and undeniably impressive. This is not to say that there is not some amount of dysfunction and despair that naturally comes along with the objective of providing sustainable, accessible, and exceptional health care in an extremely resource-constrained environment. However, in spite of this—and perhaps due to the frustration of the situation which appears to drive the passion of prominent individuals within the system—MTRH and AMPATH have made tremendous strides and continue to do so to no end. It has absolutely floored me witnessing the amount of diligent work the leaders put in day in and day out in pursuit of the primary goals of improving patient care in all facets, attempting to create a model that may be mirrored in other parts of the world while also training individuals, Kenyans and foreigners alike, both, most importantly, building up the country while also sending out proficient clinicians to other parts of the world in grave need of ingenuity, passion, sound training, and experience. Even the beautiful characteristics of the Kenyan culture is made evident on a daily basis in the way family members of each patient are constantly present, not only caring for and comforting their Loved ones but also reaching out and extending Love and solace to those patients without family and friends to support them in their struggle. 

Obviously, there are many things I have yet to see and experience during my extremely short stay in Eldoret thus far, which drastically inhibits my ability to reflect as deeply as I hope to do as the end of the trip ultimately approaches; however, my first impressions of the city and the hospital have allowed me to enjoy the beginning of this experience even more thoroughly and have served as encouragement to look forward to developing relationships with Kenyan and foreign clinicians alike, gaining further insight into the personality and strength of Kenyan patients and caregivers, and maturing myself, both professionally and personally, as a result of the cumulative experience by which I will be utterly affected.

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I've only taken a couple pictures so far, but that should change soon. The first is the picture of the building in which I will be living for the duration of my stay in Eldoret. The following two pictures are just a couple shots of the downtown area today. Those two pictures are characteristic of what Eldoret looks like while the majority of the city is working and at school. In the evening and on weekends, I have been told that it is impossible to walk along the sidewalk without being shoulder to shoulder in a massive, congested crowd.

Finally made it to Eldoret!

Two 9-hour flights, 1 night in a presidential suite, another brief flight and taxi ride to Eldoret, Kenya, and now it’s time for the work to begin!

Traveling wasn’t nearly as rough as what I expected--with the fear of losing luggage along the way or being held at customs because of forgetting to bring along proof of receiving a very important vaccine… Let’s just say I had a few internal meltdowns before deciding it was all going to work out one way or another. I’m mainly sorry for stressing out my parents so much by trying to get them to email me a scanned copy of what I was missing (You two are INCREDIBLE!). I had an excellent conversation with a woman on the flight from Amsterdam to Nairobi, who is volunteering at an orphanage in Kenya through the 12th of August. In all my stress and worry about travel and coming to Kenya, her spirit definitely aided in my process of finding an even better perspective regarding the trip as a whole, as she continuously travels to Haiti as well as a host of African countries to help in whatever way she can even after contracting Malaria and experiencing her share of hardships in the process. It was wonderful to meet someone so passionate about life and so willing to allow God to lead her--even across oceans (Praying for you, Sandra!).

Once we arrived in Nairobi and made it through customs, we finally arrived at our hotel around 11:30pm. After waiting a few extra minutes for one of the rooms to be ready, the hotel staff apologized for the wait and led us up to the 8th floor, pushed open a pair of double doors, and there we were standing in the Presidential Suite at no extra cost—not a bad upgrade! Undoubtedly, I will never step into another hotel room that would even come close to rivaling it. A couple living rooms, 2 bathrooms, a sauna/steam room, a massive jacuzzi bathtub, a small kitchen, an enormous king-sized bed, 4 large, flatscreen TVs, a walk-in closet bigger than my bedroom back home, and windows lining walls from the floor to the ceiling in several of the rooms. All for our enjoyment for the next 4 hours until we had to wake up at 4am to catch a ride back to the airport for our final flight to Eldoret. It’s too bad that we had to sleep through it all, but the shower was fantastic, the beds were comfortable, and it was an awfully nice welcoming to Kenya!

We arrived to IU House, where we’ll be staying in Eldoret, around 8am this morning, and it has been a very fantastic experience so far. We only had a few items to cross off our list for today, so we have had a chance to ease into the new environment and give our bodies a chance to get over the jet lag. It is definitely a new world here. In some ways, the sights I have seen have paralleled some of my expectations, while other aspects have been unexpected. I’m excited to dive deeper into the culture and have a chance to talk with some more of the locals. Although we have received quite a few stares and glares (as outside of the compound, I have yet to see a single light-skinned person out of the thousands we have been surrounded by in town), the few Kenyans I have talked to have been exceedingly congenial and a pleasure to be around. Hopefully I’ll be able to post some pictures on here soon of IU House and Eldoret to give you a better idea of what it’s like here than a wordy description would attempt to do.

Most days, IU House supplies/prepares breakfast, lunch, and dinner for us on the compound. However, every Wednesday night, IU House treats us to dinner at a nearby restaurant, so tonight we had the opportunity to join a lot of the residents here at an italian restaurant named Mamma Mia’s just down the street. Let’s just say that food was completely overflowing, and, although it’s definitely not the italian I’m used to back home, it was delicious. Plates kept pouring out of the kitchen with all kinds of dishes: some kind of creamy salad with pineapple, carrots, and a few other ingredients, meat balls (maybe lamb?), potatoes smothered in some kind of sauce, pizza, beef/mushroom stroganoff, mashed potatoes, rice, and dough balls filled with herbs and cheese. It’s fair to say that I’m definitely not going to starve here.

Tomorrow will be our first glimpse into the program we’ll be working for/with over the duration of our time here, and I am incredibly excited to begin learning and growing both clinically and personally. 

I hope you have a wonderful night! 

Last Night Stateside

Tonight marks the last that I will spend on this side of the Atlantic Ocean for the next 8 weeks. The feelings that are surging through me are of both excitement and apprehension over the uncertainty of what is to follow. Excitement for the new culture, sights, food, people, and experiences that are sure to overwhelm my senses. Uncertainty over the distance between myself and those I Love without the tangible affection to which I am so accustomed as well as the fear of falling short of the expectations that will be placed upon me in a harsh environment away from the comfort and encouragement of home. It pangs me to say that, unfortunately, the fear of suffering has occupied my waking thoughts much more than the sense of wonder reminiscent of the childlike curiosity inside me. In these last hours I come back to one book that I will be rereading at the start of this journey, The Alchemist by Paulo Coelho, specifically this quote:

“Tell your heart that the fear of suffering is worse than the suffering itself. And that no heart has ever suffered when it goes in search of its dreams, because every second of the search is a second's encounter with God and with eternity.” 

― Paulo Coelho,  The Alchemist

At this point, this trip is inevitable. Eight weeks spent abroad and apart from the hearts of home is inevitable. Long days and nights outside of my comfort zone are inevitable. Stress and loneliness are surely inevitable. 

And so is God’s presence through every minute and every moment of every day. The piercing reality that the stress, struggle, and disappointment that I will face could never be any less God-filled than the most peaceful life of contentment that I could ever experience on this side of the world in the comfort of the shoes I have walked in all my life. The eye-opening realization that God’s truest intention may be in fact to stretch my heart in directions that make me uncomfortable, that break me down and break my heart for the purpose of building me up into the form that He created me to be. 

For the past decade, I have felt my heart being pulled toward serving the underserved, and I have offhandedly and mindlessly dreamed of doing so outside of the United States, somewhere I would have no roots to tie me down and neither habits nor routines to prevent my attitudes and perspectives from opening wide. And here is that opportunity, hours away from being realized. I pray that God would grant me Himself—not just His peace, but every gift that He would offer me—in every situation, in every encounter, in every experience that would bring me to my knees in desperation as well as in thanksgiving for the joys of this world. I pray that I find the confidence within myself and in His grace that is within me to live entirely in the present so that I may constantly grow and move forward toward the finish line he has set for me. Always forward—daima mbele.