Written by Deepika Parmar, MD, PGY-2 at Kaiser Permanente Oakland Pediatrics Program while on Global Health…
Posted by Kate Pettit, MD (a second year Ob/Gyn resident from Kaiser Permanente, San Francisco serving a global health elective at The Matibabu Foundation in Ugenya, Kenya).
The first day I arrived in Kenya was a blur. I was lost somewhere between the traffic, grilled cheese, and noise of Nairobi and the bumpy roads, gorgeous landscape and peaceful quiet of Ukwala. When I finally reached my “home” in Kenya, I was met by an incredibly kind family, who offered me a room in their home, lots of green vegetables and wonderful stories. I was exhausted and Lucy led me to a friendly room with a bright blue mosquito net and old World Cup soccer pictures and articles taped to the walls. I had always wanted one of those four-poster princess beds as a little girl and I smiled, the blue net draping from the ceiling was pretty close.
I woke up the next day to what sounded like 55 roosters crowing outside my window. It had been pretty dark when I had finally arrived at the house, so I hadn’t appreciated the fact that there was an amazing virtual farm right outside my window. I peaked out and saw chickens, cows, and some goats, all making their morning rounds. I padded to the bathroom and met Lucy just outside. She gave me a bathroom tour and had just brought warm water for me to bathe. I took my big bucket of water and my small bucket to dump said water on my head and managed to keep most of the water from seeping out the door, quite an accomplishment for my first inside bucket shower. In the next couple days, I would sneak in to shower and just use cold water because it would wake me up faster and I didn’t want to waste the family’s warm water. I am from Washington and I used to swim in Puget Sound, so a bucket of cold water on my head was something that felt like home.
I sat down for breakfast the first day to one of the most delightful traditions in Kenya – amazing hot tea. It is a mixture of sweetness and warm milk and spiced tea that tastes good any time of day, from the breakfast table to the middle of a busy clinic. It is always offered and thankfully, no one ever lets you decline. I have tried to recreate it after returning to the U.S., and sadly, have not come close.
After breakfast, I walked down the road to clinic. Each of the children I passed screamed “Mzungu” followed by “how are you” with different intonations. Mzungu refers to people of European descent and the children will repeat it incessantly every time they spot you and “how are you” is something that is yelled almost like a cheer. When you respond, “fine, how are you,” they will often run away and giggle. I never tired of this exchange, no matter how many times it happened each day.
When I arrived at the Matibabu clinic, I was again met with kindness. I spent the first day working with one of the clinical officers, learning the ways of the clinic. She was great in taking time to explain each of the patients’ cases as I could not follow the Swahili or Luo words flowing back and forth. There were definite recurring themes – malaria, diarrheal illnesses, and often, all of this in the context of HIV.
The next several days in clinic, I began to work on my own with a translator with the clinical officer available for questions. I found myself seeing patients that brought me back to the tropical diseases of medical school. One child came in with a diffuse rash and a fever. The rash was somewhat unusual. I started the exam with how I had seen the Kenyan clinical officers starting, but first looking at the baby’s eyes. Right away, I noticed they were red and weeping. I looked again up at his rash. Then I had one of those “aha medical school moments” when somehow something you have read once upon a time springs up for you from some deep part of your brain. Cough, coryza, and conjunctivitis – the three C’s of measles. I quickly asked the mom to wait one moment and I would be right back. I walked out of the small clinic room to ask one of the clinical officers to confirm the diagnoses and they were of course unimpressed, having seen this many times before. I on the other hand was initially nervous (I stupidly first thought I would contract it from him, but then remember the M of MMR vaccine) and then fascinated. The little boy left with just pain medicine and a very strong mother to carry him all the way home.
My second week in Kenya was spent in Siaya, a small town about an hour from Ukwala, where the district hospital was located. This was the only hospital in the area and many patients traveled from far away even while they were very sick. The stories from Siaya were countless, but more than anything, I remember faces. I remember Sarah, with her gentle whispers in English and with such a bad pelvic infection that surgery left her with no chance of childbearing. Yet, she walked the day after her surgery to get some tea with her adopted mother like nothing had happened. I remember Jane who was only 30 years old and had a mass that was likely advanced cervical cancer, found too late. Her hematocrit was only 15, so low we could not even operate to take a biopsy and still, when we walked by, she would smile and wave out the window. I remember Susan, who had had polio and also had HIV and could not walk without support and needed a friend’s bicycle rack to travel more than 20 feet. She waited all day for her appointment and even translated for others in line at clinic. I left each day incredibly impressed with the strength of these women, both physically and emotionally. I was in awe.
At the end of my trip, I traveled back on the same bumpy roads upon which I had come with a sense of patience, appreciation and hope that will stay with me for a long time to come.
** All names of patients have been changed for privacy.