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.