HIV in America

I am currently at University of Louisville Hospital completing an ambulatory care rotation. I was slated to complete an oncology (cancer) rotation this month but my preceptor is on maternity leave. I came in on Monday and was told to meet with a man named Jessie Morgan. He handed me a test when I first walked in and told me to complete it. I was intimidated by this but when I started the exam I realized most questions were HIV/AIDS and anticoagulation questions. I was pretty comfortable with these questions since I was in Kenya but I was confused what this had to do with cancer. I found out quickly that this was not going to be an oncology rotation. My calendar showed I was in the anticoagulation clinic Monday, Wednesday and Friday and in the HIV clinic Tuesday, Wednesday, Thursday and Friday. I was quite upset about not having an oncology rotation this month but hopefully I will be rescheduled to have one later this year.

This rotation is staking up to be a very busy and challenging rotation. I am on the rotation with Phillip Simpson who is another student from Purdue University. We work on everything together and it is fun being able to share the experience with another student. We see patients all day and assist in their anticoagulation care or HIV regimens. We also have 2 major presentations and various projects we need to work on.

We have already seen many interesting patients in both clinics. I have seen many patients cry because they suffer from depression or because they feel hopeless. I have seen a patient tear up because he could not bear the thought of having to swallow another pill. All of these patients face the reality of having to be on medication for the rest of their lives and it is up to me to help them cope with this harsh truth and embrace it as a new lifestyle. I met a patient today named Maria who only spoke Swahili. I got excited when I heard we were in need for a Swahili translator. Everyone was in an uproar and not a single person looked to the patient to acknowledge she was there. I immediately went to the patient and said Jambo, habari yako? (Hello, how are you?) Jina langu ni Maria. (My name is Maria). She then became excited because not only was I speaking Swahili to her, but her name was also Maria. I was not able to communicate further with her since my swahili is very limited but I hope I touched her life a little by that small gesture.

Floyd Memorial Hospital

I am back! Sorry about the delay in writing, it has been crazy these past 5 weeks.

My first rotation back from Kenya was at Floyd Memorial Hospital (pictured here at the left) in New Albany, Indiana. This is just across the Ohio River so it was only a 20 minute drive from my apartment in Louisville, KY. The rotation was an impatient Adult Medicine rotation. Floyd Memorial Hospital is a gorgeous facility. I felt like an intern in Grey's Anatomy when I was walking down the large corridor surrounded by glass windows. It also contributed to my reverse culture shock I experienced after returning from Africa.


I was able to follow patients in the Intensive Care Unit (ICU), Palliative Care Unit (PCU), Cardiovascular Care Unit (CVCU), Surgical impatients (SIPS) and Medical impatients (MIPS). I was on a different floor everyday so it never got boring. So you are probably thinking, what the heck does a pharmacist do on an impatient floor. Well, we would review the medications of the patients, calculate the dose of antibiotics using the pateint's renal function, calculate proper protocols for patients on tube feeds and any other medication issue. I was able to perform all these tasks and by the end of the rotation I was writing in patient charts and making recommendations.

I was also able to spend a day in the ER and saw various of patients. There were minor car accident victims, drug-addicts, and a woman who was mentally challenged. I was shadowing a nurse and I found out quickly why I chose pharmacy and not nursing! Just watching them draw blood made me queasy. The real shocker was when I was in the cath lab. This is where they check for clots in major arteries by threading a long wire (called a catheter) through the femoral artery in the groin up to the heart and injecting with contrast dye. They inserted about 10 different wires before they found the right size wire to fit through the gentleman's valve in his heart. There was blood pouring out of the large hole in his leg and I had to excuse myself to the restroom because I thought I was going to hit the ground.

Lamu & Nairobi

Back by popular demand! I had many people ask me to continue updating them on my rotations and life. The stories may not be as interesting as they were in Africa but I will try my best to keep you on the edge of your seat. Here is an update on how our final week in Africa played out and what I have been doing in America since my return.

Lamu Island

We flew to Lamu town and got to take a dhow to Lamu island. We could feel the difference in climate the second we stepped off the airplane. It felt sticky and hot, similar to Florida in the summer. The island was very different than everyone expected. Dirty was the first word that comes to mind. There are no motorized vehicles so the only mode of transportation is by donkey...

There is a large Muslim population on the island. So we were woken up every morning at 5am by prayers that are broadcast to the whole island via loud speaker. The women wore full burkas ( you could only see their eyes). I was reading "A Thousand Splendid Suns" while I was in Lamu and I felt the descriptions of Afghanistan and the lives the women lead in their culture were similar to Lamu.

We had issues with our hotel because we did not have any hot water and there were insects everywhere! I had ants in my bed the first night and two mosquitoes spent the night hanging out inside my mosquito net with me! I heard them buzzing in my ear all night long but I assumed they were flies...when I awoke and saw they were mosquitoes, I killed them and there were small drops of blood that came out of them...my blood probably! Nights were rough in this town...the donkeys would bray all night....there wasn't any power after 9pm.

The beach was interesting in Lamu because it was a disappearing beach. The tides were so dramatic that the beach disappeared every evening around 6 pm. The beach wasn't the best ever but it was nice to be one of the only people out there. We also swam to the sand bar which was another beach in the middle of the ocean. We went exploring around the island one day and saw huge crabs and blue jellyfish.

Our fishing trip was unique to say the least. There were no fishing poles...just the line. When I was fishing I felt I had a bite, when I was pulling in the line it sliced through my finger. I had a deep cut and lost the fish! Only Alex caught a fish out of everyone in our group.

We spent one last day in Africa in Nairobi, the capital of Kenya. Our last day we went to a baby elephant sancuary. They take care of orphaned baby elephants. I was really excited to be able to touch one (even though it left a nasty stain on my favorite jeans!) We then went to the market. I told people I was Mexican so they wouldn't charge me as much money. The market vendors sell wooden elephants, cap buffalo, rhinos, hippos, etc. We also went to Carnivore, a Brazilian-type restaurant. Among the regular pork ribs and lamb were some exotic meat such as crocodile and ostrich. The meal was a great final meal in Africa.

We headed to the Nairobi airport about 5 hours in advance to begin our 30 hour + travel experience back to America.

Ta ta for now

We will be departing for Lamu Island in the morning. There will be limited computer access since we are turning our laptops in as I type. If you need to get a hold of me the numbers you can use are as follows:

011 254 710 311 903

011 254 710 184 716

Fabrics and Textiles

Photo 1: Julius, one of my patients, with his tie-dye shirt.
Photo 2: All the patients who participated in Sally Test Center craft day.

We had our last case conference this morning. We learned about organophosphate poisoning from Andre and Joyce. Ward rounds were in the smelly men’s side again with Lagat.

The real fun came when we had Sally Test Center craft day! We went to the center in the hospital for children to play during the day. Katie had the great idea to make tie-dye t-shirts for the children. I made sure to get Julius (one of my favorite patients) and Baby Moses a shirt. Baby Moses was being crabby today so thankfully I got him to take a nap while we helped the other kids dye their shirts. Rono, the Kenyan pharmacy student, stenciled Julius’s name on his shirt. It was so rewarding seeing the smiles on all the kids faces. Some were in wheelchairs, some on crutches, most with IV lines in their little hands. No matter their state, they all had smiles.

A lot of the kids were going crazy over our digital cameras. They took mine and I had a lot of pictures of people without heads since the kids were too short to take pictures of full adults.

I got to meet Patricia and Franklin today, too. My friend Kelly Gregory sponsored Franklin. The money she gave helped him get uniforms for school, tuition and food. Patricia told me how there isn’t a day that goes by without thinking about Kelly and her selfless gift.

Hapo Sawa...Hapo Vippy

Lauren, Tony and I in the back of a matatu!

Wednesday, July 16, 2008

Hapo Sawa means “That is good” in Swahili. It is the name of our favorite song from Africa. Sonak burned a CD with 8.5 hours of African music for us!

I was back on the men’s wards today. I was bummed at first to be leaving pediatrics but I got excited when I found out my favorite registar, Lagat, was on the men’s team. He was happy to see me too and said, Ahhh, Maria, back by popular demand! Today was rough being back in the adult wards. The smell is 10x worse than the children’s side. Men are smelly to begin with…try having some not shower for 2 weeks then use the side of their bed as the bathroom.

We got our evaluations from Sonak today. He actually likes our group and had great things to say about all of us. It was nice to hear that he appreciated all our hard work.

For dinner, we went to the Indian restaurant for the last time! THANK GOODNESS : )

Pharming Pharmacists

Tuesday, July 15, 2008

Today, I worked on a farm! Lauren, Tony and I went to the Annex farm to experience one of the many initiatives AMPATH provides for their patients. There are five farms, three with irrigation systems, in the surrounding area. The farms provide employment for HIV positive patients. The food is also given to the patients. This initiative also provides free food to patients.

I thinned cabbage, hoed spinach beds, and cleaned up carrot beds. Apparently, when I was hunched over doing all this work, I managed to expose my back because I have a beautiful red strip across my back which hinders sleeping comfortably. We were served maize, beans and carrots for lunch. The mixture was very fitting for the work we had just done. After eating, we laid out in the grass which was quite relaxing, it was great being able to breathe fresh air and not be in the stuffy hospital.

After a much needed nap, we ate dinner by candlelight since the power was out. Andre, IU med student, lit his firework he has had since the Fourth of July. It was pretty much a glorified sparkler. The power eventually came back on but the internet did not…

We played Mario Kart again tonight but I was backstabbed by Tony when he chose Mario as his character before me. I was quite upset and I did not perform to my known greatness.