Under African Skies

HIV in America

2008-08-28T19:41:00.000-07:00

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

2008-08-27T18:45:00.000-07:00

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

2008-08-10T19:35:00.000-07:00

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

2008-07-18T08:01:00.000-07:00

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

2008-07-17T09:59:00.000-07:00

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

2008-07-17T09:47:00.000-07:00

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

2008-07-16T06:44:00.000-07:00

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.

Happy Birthday, MOM!!

2008-07-16T06:42:00.000-07:00

Pictures are of Baby Moses and Lauren and I in Sally Test Center.

Monday, July 14, 2008

Today is my mom’s birthday! Happy Birthday, MOM!! I love you…

This is our last week in Eldoret. I cannot believe time has gone by so quickly. I was in the pediatric ward again. Baby Moses was excited to see me and cried when I left him at Sally Test. I felt like a mom leaving her kid at daycare. Rounds were longer than usual since the med students were back rounding. They had a week off due to examinations. Our afternoon patient discussions were replaced by an aminoglycoside dosing discussion. I had to struggle to stay awake for it. We had special guests at dinner. We invited Kenyan med students to eat with us. Bromwell, the med student who took us to church, came along with 5 of his friends. It was great talking with them about the differences between Kenya and America. They asked us the usual question I am asked about 10 times a day: Are you going to vote for Obama? All the Kenyans love Obama since his father was Kenyan. I have had multiple people tell me they are Obama’s cousin. I always reply with, “Well, I am Bush’s cousin.” They also asked if it was true that Americans eat cake when the doctors round on patients. I thought that was an odd perception. After dinner and tea, we took the med students to Sonak’s house to show them the video games. Many of them had never played a video game in their life. We played Rock Band first. Somehow, I am always sucked into being the singer…It was hilarious watching Kenyans try to play the video games. We also played Mario Kart which was equally hilarious.

Happy Birthday, Claudia!

2008-07-13T11:22:00.001-07:00

Sunday, July 13, 2008

Today is my older sister’s birthday. She lives in Germany so we are almost on the same time zone. It is comforting to know I am not the only person in my family on this side of the world. Abby and I woke up and celebrated Claudia’s birthday by making one of her favs for breakfast…eggs in a basket! We made them for anyone who wanted them. The best was when Naomi, Kenyan daughter of the cook, poured syrup on hers! She thought it was French toast…We then helped the girls clean the kitchen and wash dishes. We had fun singing to the music on the radio. It was all American R&B hits. I think we have heard Boyz to Men more here than I ever did in America. After cleaning, Abby, Alex and I watched Pride and Prejudice.

Sammy, a guard at the IU compound, invited us to his home for chi, Kenyan tea. We took another matatu ride to a similar neighborhood as Tony’s. He is a bodybuilder/guard. Sammy is a former Mr. Kenya like Javen, the driver. We had Marie cookies with the tea…which are Africa’s version of Maria cookies. Sammy told us his lifelong dream is to get the opportunity to move to America and be an aerobics’ instructor. He currently holds classes at the IU compound for the Americans who stay here.

Muzungu Parade

2008-07-13T10:25:00.000-07:00

Saturday, July 12, 2008

We were invited to Kenyan Tony’s house for lunch. We got to ride a matatu with other Kenyans to his neighborhood. I was amazed when we walking down the dirt patht to his home. Trash piles lined the path with chicken and pigs rumaging through them. Children were running out of their homes to look at the muzungu (name for white people) parade. A group of girls in their green school uniforms came up to us and shook everyone's hands. They were so excited to touch muzungus. I have realized this is how celebrities must feel. Everyone stares and shouts at us when we walk down the street. We cannot go anywhere without getting something yelled at us or having street kids follow us.

Tony's home consisted of a small living room, kitchen and 1 bedroom which is the fourth row of rooms in a building. Tony and his wife Lucy prepared a true Kikuyu meal. Kikuyu is Tony’s tribe. Kikuyu was also the tribe in the biggest danger during the post-election violence. Tony taught us how to prepare chapatti which are thicker versions of tortillas. We listened to his favorite music….American rock. I was laughing when Stained, Fuel, Nickelback, and Linkin Park were playing. We spent 6 hours at his home talking and playing with his 9 month son, Ethan.

At night, we prepared a Kenyan meal for ourselves with the help of the cooks’ daughters, Naomi and Leah. They are fun girls who know how to cook and dance! I got to make the meat…and yes I burned it but it still tasted good

TGIF: Happy Birthday, Mercy!

2008-07-13T10:04:00.000-07:00

Friday, July 11, 2008

Ward rounds were non-existent…the doctors were busy examining med students so we did not round on patients. To pass time, Abby (IU med student on my team) and I took Baby Moses to the Sally Test Center to play with the abandoned babies and children in the hospital. We got Moses a bath, picked out boy clothes for him since he has been wearing a Barbie sweater, and played games with him. Moses looked much better today and we were able to get him to interact with us. I also got to hold and feed Reuben, a 6 week old abandoned baby. His mother was a patient at MTRH but left Reuben on a bench because she did not want him since he has HIV. At lunch, we treated Mercy for her Birthday. She came and ate at the IU house which they served gooey, warm chocolate cake and spaghetti!! After lunch, we headed to the Imani Workshop to pick up bags we special ordered. Javen, Mr Kenya himself, drove us since the African rains have been unforgiving the last few days. We also went into town so Tony could get his hair cut at the Indian barber. It was quite the spectacle having 3 white girls in a men’s Indian barbershop. I had my first scary experience in Kenya…when we were walking in town, two men walked into me and tried to pick-pocket me. Thank goodness I never put anything in my pockets but it was scary because they had me pinned. Katie said she was scared when she saw the guys come up to me and Tony was ready to fight the men. I was pretty upset afterwards but I am happy they were not successful in getting anything from me.

Beatrice

2008-07-10T21:41:00.000-07:00

This picture shows a typical load of people in a Prado. My three favorite Kenyans are in this picture: (From Left to Right) Nicholas, Tony and Mercy. Alex, Katie and Andre are in the back...

Thursday, July 10, 2008

I was in the pediatric wards again today. We admitted new patients in our ward so I was pretty overwhelmed with the new patients. Paul is a patient I will never forget. His jaw is 3x the normal size due to Burkitt’s lymphoma and misdiagnosis. Tumors in this type of cancer can present in the jaw and disrupt teeth and move them around. Many dentists mistake it for periodontal disease and abscesses. In Paul’s case, his dentist pulled out 5 adult teeth before realizing there were no abscesses. He also has an enlarged spleen and a large tumor on his hip bone that you can actually see since he is so skinny. Baby Moses is still around but he was not in a good mood today.

Lauren and I took a trip into town after afternoon patient discussions. We went to the bakery to pick up a cake for Mercy’s birthday (Kenyan pharmacy student). The people at the bakery sold us a vanilla cake with NO ICING. Lauren and I thought we could go to any supermarket to pick up icing…not in Africa. You have to make it yourself. So we picked up powdered sugar instead. We headed to the ATM to get shillings for our Lamu Island trip in 2 weeks. You have to make multiple trips to the ATM since they only allow a certain amount to be withdrawn each day. I can take out 20,000 shillings at one time (about $320). Then we headed to the cultural shop to look at African souvenirs. I bought a beautiful wooden elephant. As we were walking home from town, the sky threatened rain and it looked like we were going to be caught in a torrential downpour. Then I saw a white face in a car about to pull out into the street. It was Nicole, the girl who goes to Baylor. We asked if they had room for us in the car, and when we got into the car…the rain came down so hard. We were lucky to have run into the Toyota Corona…yup Corona…

Once at home, we watched The Lion King…it is pretty accurate on how the Serengeti plains look.

Dinner was held at Beatrice’s house tonight. All the pharmacy students were invited to her home for a traditional Kenyan meal. She had chapati, ugali, sikumu wiki (green veggies similar to kale) meat, and of course fruit salad. Lauren, Katie and I made the icing for the cake at Beatrice’s house. We iced the cake and sang Happy Birthday to Mercy. We were all proud of our homemade icing.

Mario Kart Champion at Kitale Clinic

2008-07-10T12:54:00.001-07:00

This picture was taken at the rally we went to on Saturday.

Wednesday, July 9, 2008

An update for Wednesday since the internet did not work yesterday.

Today, I was Kitale, a town an hour from Eldoret, in an AMPATH clinic. This clinic serves all HIV/AIDS patients in the area. All AMPATH patients get free medication to keep patients adherent to their antiretroviral medication. I worked in the pharmacy with Moses, Robert and Gladwell. They all knew Lisa Caudell and the group she came with in May. They were excited when they found out I knew her…they all say HI. I could not believe how we counted medication using our hands (no counting trays in Africa) into brown envelopes that we wrote the sig on. For example, Septrin 960mg 1 x 1. This means take 1 tablet of Septrin once a day (moja mara moja in Swahili). My hands and black pants were covered in white powder from counting out the Septrin tablets. Septrin is Bactrim which is used to prophylaxes against PCP and toxoplasmosis; infections AIDS patients are susceptible to getting with their weak immune system. It broke my heart to see girls my age come in with two children to get ARVs. They have HIV, their children have HIV, they will never know life without having to take at least three medications throughout the day. One story that really affected me was this four year old girl who was HIV positive because she was raped. I felt like her eyes poured out her pain.

After falling asleep on the hour drive back to Eldoret, I came home to everyone playing Mario Kart. Katie, Rahki (Sonak’s girlfriend), Lauren, and Tony all played in the first round of races with the overall winner playing the winner from the second group of Sonak, Alex, Benson (Former street kid who now works for AMPATH pharmacy) and me. Tony won the first group. I did terrible in the first race…I got 11^th out of 12 cars but then I won the next game. The third race I got around 6^th place putting me tied for first in our group with Sonak. Sonak, our preceptor, is an extremely competitive person who gets super frustrated when he doesn’t win. So it was intense going into the last race with it meaning a chance to play Tony in the championship round. I ended up holding off Sonak to win our initial first round! Then came the true test…racing the champ from the fist group, Tony. At first it looked dismal; I was in 12^th place with Tony in 2^nd place. Then, I somehow was able to catch up to Tony and pass him in the final seconds of the race. The whole room was screaming and laughing, they could not believe I came back to win it. Tony was shocked, I don’t think he said anything for 20 minutes which is strange for him. Sonak was also fuming at this point and demanded a re-match versus just me. So we were racing then the power went out…oh how I love Africa. He was so upset…

Dinner was at a local Indian food restaurant, surprise surprise. However, I met a new girl, Nicole, who arrived today. She is from Indiana but goes to school at Baylor in Texas. She is the opposite of me.

Baby Moses

2008-07-10T03:39:00.000-07:00

Tuesday, July8 2008

The internet has been down for 3 days so here is an update for Tuesday. Wednesday's update will come later....

Day 2 in the pediatric ward was a lot of fun. I am able to interact with many of my patients by giving high fives and playing peek-a-boo. It makes my day when I am able to get them to smile. Staying in a hospital cannot be fun for these children so any bit of happiness or laughter makes me feel like I am making a small difference. One of my patients has the most precious smile. Everything I do seem to make him laugh. Another patient of mine is named Moses. He was an abandoned baby found in a basket, hence the name Moses. We are not sure how old he is but we approximate around 18 months. He had severe malnutrition but now we are assessing other issues he may have. He smiles and laughs when we play with him but he never responds to clapping, singing or us calling his name. We sent him to get a hearing test and sadly he is deaf in both ears. I was devastated by the news. This probably means it will be harder for him to be adopted and he may not get proper care in an orphanage.

On a lighter note, we have been invited to two homes. Kenyans are very giving people even if they do not have much. Beatrice, the head pharmacist at AMPATH, invited us to dinner on Thursday night. Tony (another Tony, not Purdue Tony) a pharmacy technician in the MTRH pharmacy and oncology clinic, invited us to his home on Saturday. I have been working with him on my oncology project and he is also working on conducting a study to determine the incidence of Non-Hodgkin’s Lymphoma in three Kenyan regions.

Night-time at the IU compound is spent by the fireplace in House 1. We have been working on our projects and listening to music. Tonight, Katie made yummy chocolate chip cookies! I got to review my chemo regimens with Mary Ann, the oncologist from Brown University.

Kids Korner

2008-07-07T13:14:00.001-07:00

I started my first day on the pediatrics ward. I really enjoy seeing the children even though it is tough to see them suffering. Pediatrics is really interesting because your patients have a greater chance of recovering than geriatric patients but if they do not recover it is so much more devastating. The biggest issue with pediatric patients here in Kenya is malnutrition. Today I saw over 6 cases of Kwashiorkor and Marasmus. Kwashiorkor is what many people think of in sick African children. It is a lack of protein in the diet and leads to the swollen stomach. Marasmus is caloric malnutrition across the board. One of my girl patients was not getting fed at home because she had 2 younger brothers who were given priority during feeding time. Another patient has a cleft palate and was not able to feed properly. The worst part of the day was when I saw Holly, an IU med student, performing CPR on a one year old boy who coded. She tried for 20 minutes to resuscitate the patient but she was not successful. I had to turn my head when she had to tell the mother. It broke my heart to see the mom’s face. She was devastated. I think this would be the hardest aspect of pediatrics.

Green Mountains...Red Earth

2008-07-06T10:41:00.000-07:00

Contrary to popular belief, Africa is not all desert or plains. The area surrounding Eldoret is lush, green with large trees and beautiful flowers. I cannot get over how green the mountains and valleys are in this area. The earth is a bright red color which is impossible to get out of khaki pants.

We were given an opportunity to join Joe Mamlin at a village an hour away at a rally for HIV/AIDS awareness. Professor Mamlin is the person who started the entire IU-Moi University partnership and is the mastermind behind the care for thousands of Kenyans. He has amazing stories of the post-election violence.

One story was about Javen, a Kenyan who was hired to be Sarah Ellen’s driver (Sarah Ellen is Joe Mamlin’s wife). Javen was also crowned Mr. Kenya last year in the bodybuilding category so he is a large man. Joe Mamlin was told about a Brown med student who was back in Kenya visting her family for Christmas. She was in danger in her village due to her tribal background. At 3am the next day, Javen set out to her village even though the roads were deemed impassable due to fallen debris on the roads and road blocks. Javen had to move trees from the roads and lie to rebels at roadblocks to get to her village. He was able to get her out of her village and onto an airplane back to the states 1 day before everyone and everything in her village was burned to the ground.

I got to experience a Kenyan church service. We went with a med student to church Saturday night. It was a great experience even though it was a 3 hour service. It was nice to see that even though we live in very different cultures and countries…we share the same beliefs. We got to meet 2 Kenyan medical students who had just returned from medical exchange with Indiana University in Indianapolis. They told us their perception of America. It was hilarious to hear them say we eat chicken all the time. They were in awe over how disciplined our drivers are and how clean we keep our streets. In Kenya, there are no rules on the roads for drivers or passengers (I have not worn a seat belt since I have been here), pedestrians DO NOT have the right of way (be certain you look the correct way when you cross the street since they drive on the opposite side of the road) and there are no anti-littering laws. Trash lines all the streets and gutters.

Happy Fourth of July!!

2008-07-04T07:05:00.002-07:00

Its Independence Day!! It definitely does not feel the same being in Africa but we had somewhat of a traditional American meal for lunch. They had cheeseburgers, hotdogs, potato salad, coleslaw, beans, potato chips, MAYONASE, yellow mustard, Heinz catsup, vanilla ice cream with hot fudge and CHOCOLATE CHIP COOKIES!! This was quite an exciting break from rice and Indian food. In the morning I had the opportunity to attend the Diabetes Clinic with Sonak and Mercy (Kenyan pharmacy student). I enjoyed the close patient contact and how much input the pharmacists have in their care.

An update on the rest of the week…

The wards have been lively with screaming men this week. I have changed sides to the men’s ward and it has been quite interesting. I was switched to the ward where the intern was beaten up. Currently, we do not have an intern and we have some crazy patients. I am not a fan of the consultant (attendee) who came on Monday. He was an arrogant man who smelled worse than the patients. Our registrar (resident) is really nice and I am starting to warm up to him. I feel a bit more overwhelmed on this side for some reason but I am glad to be challenged. We had 3 patients yelling in the wards making it next to impossible to hear what is going on. One of the patients swears British men captured and killed his tribal leader. Andre (IU Med student) and Tony are on the team who round on that patient and the patient believes they were the murders of his tribal leader. This is the first time I have felt truly nervous in Kenya. The patient is hostile and is only held back from attacking us by his caregiver who I believe is his brother. My team was rounding near his bed on Wednesday and he became agitated when he saw my white skin. Thank goodness for his caregiver, otherwise one of us would have been attacked by now. Another patient who is quite vocal is a male who thinks he was cursed. He rants about various things in Swahili but he is harmless physically. Also, one of our patients has been ill psychologically and he claims that he and I have been classmates for a long time. In addition to the madness of the patients, a branch from a tree crashed into the windows in the wards and glass went shattering all over the patients.

Gone Fishing

2008-07-02T12:15:00.000-07:00

I received sad news yesterday. My grandfather, John Thompson, passed away Tuesday night. He is in heaven either golfing or fishing right now. I wish I could be home to be with my family during this time. Grandpa will be missed here but he is with God and finally at peace. I will miss you, Grandpa!

Maasai Mara

2008-07-01T04:48:00.000-07:00

Safari time! This weekend we journeyed to the Maasai Mara in southwestern Kenya to hunt for animals. We left on Friday morning at 5 am since it is an 8 hour drive. Our drive was the craziest since our time in Kenya. The roads are so atrocious everyone was car sick for the first 2 hours of the drive. Alex, Tony and I get the least motion sick so we were in the back but I think we all felt a bit ill. The bumps are felt 10x worse in the very back of a matatu so we fly up on every bump. I hit my head on the window probably over 10 times this drive. When we started getting closer to the park the landscape changed dramatically. The lush, green mountains gave way to the yellow plains many of us think of Africa. We saw zebra and gazelle when we got to the edge of the park. We drove for an hour in the brush…I have no clue how the driver knew where he was going. There are no signs, no roads just random trails that he followed.

We stayed at the Fig Tree Lodge which was amazing. It looked like an oasis in the middle of Africa. The rooms were tents which made the experience fun. The back of the tent opened to a bathroom which was an established structure. The bathrooms were luxurious and we were able to have the best shower since coming to Africa. We were warned to zipper our tents up when we leave to keep the monkeys and baboons out. Apparently, the Canadian girls who traveled with us did not heed this warning…their tent was broken into by monkeys who ate the Metamucil out of their first aid kit and a banana.

During our weekend, we had 3 game drives. We saw Vervet Monkeys, a spotted hyena, one male lion, 5 female lions, 5 lion cubs, an African elephant, a cheetah, Burchell’s Zebra, warthogs, 2 Hippos, giraffe, Cape Buffalo, Topi, Grant’s gazelles, springbok, Thomson’s Gazelles, impala, Kirk’s dikdik, and Oryx. The highlights were the Hippos, Elephant and Lions. I could not believe we saw a male lion as close as we did….I was getting nervous but apparently the elephant are much more likely to charge and attack the matatu than a lion. Words cannot describe the scenery at the Maasai Mara. I took some photos but even those cannot give justice to the beauty of the Serengeti Plains.

We also got the opportunity to visit a Maasai village. The Maasai warriors decked out in their traditional red robes danced for us then were our tour guides through the village. The huts are made out of cow dung…yup cow dung! And we were calling them mud huts all this time. There are 2 rooms in the huts. One for calves of the cows and the other for the people. There are 2 beds made out of sticks and only small holes for ventilation. Their diet consists of meat (mostly from cows, goats, and sheep), cow blood, and milk. The men made Alex and Tony dance and jump with them. It was quite the sight…

Happy Birthday, Tony!

On Saturday, it was Tony’s birthday…we got to see the Lions on this day so he was super excited. In addition to 2 game drives Tony got another extra surprise. The Maasai warriors came and did their traditional dance in his honor with a birthday cake! The cake even said HAPPY BIRTHDAY TONY! It was hilarious…I don’t think I have laughed that hard in a long time.

I bless the rains down in Africa

2008-06-26T07:32:00.002-07:00

I was back on rounds with my awesome team. Sadly, I found out I will be changing teams next week. I will be going to the men’s wards with Alex Fohl. We are packing tonight for our safari at the Masai Mara this weekend!! We are getting Friday off to travel. Another 8 to 10 hour matatu ride! I cannot wait to listen to Africa by Toto while we are driving across Kenya. Lauren is getting annoyed by Tony and I singing it all the time. I at least sing other lines than, I bless the rains down in Africa....Tony ONLY sings that part but I laugh so hard at Lauren's face. She almost punched Tony in the face today for singing it...ok gonna take some time to do the things we never had....

Wednesday, June 25: Oncology Clinic

2008-06-26T07:32:00.001-07:00

The picture is the sunset in Uganda on our way to white water rafting.

I had a nice change of pace today; I was able to observe the oncology clinic in AMPATH. They have an oncology clinic once a week and administer chemotherapy. I loved how they had a pastor come do a bible reading and discussion for the first hour. I wish I knew Swahili so I could follow along. It is sad to think that this is something we could never do in America since people would complain about it infringing on their beliefs. I think the extra spiritual healing is just as important as physical healing. The cancer treatment in Kenya is pretty primitive. I was talking with oncologists from Brown University who said the clinic reminded them of cancer therapy in the US in the 60s. I got to see a patient with Kaposi’s Sarcoma for the first time. Also, I was served tea, chapati and a samosa since I was a special guest. I actually enjoy the tea since it is made with milk and not water. After lunch, I sat in on the oncology conference call because I am completing a project with streamlining chemotherapy in the hospital. It’s a daunting task but I am excited to have a project that can have an effect on many patient lives. Since I was at oncology clinic, I missed the uproar in the wards. One of the interns was beaten up by family members of a patient that had passed away. The intern was trying to resuscitate the patient but he passed away. The family held the intern down and beat him up. Once this happened, the other intern went on strike demanding security guards in the wards. I saw the interns returning to the wards in the afternoon so hopefully they resolved the security issues.

June 23, 2008

2008-06-26T07:32:00.000-07:00

Monday

Back to reality from the African adventure of the weekend…we were back on rounds at the hospital. I had a special guest on my team, the Dean of IU Med School, he rounded with my consultant. I enjoyed having another American on my team and having a fellow westerner agree with my recommendations. He taught me a lot on rounds and I am thankful I had the opportunity to learn from him.

Impressive Indeed....MEAT...BEEF...MEAF

2008-06-23T13:42:00.002-07:00

Friday June 20, 2008

Ward rounds were Dr. Lagat (resident) and me only! It is scary being one of two people ensuring the care of over twenty patients. The patient I counseled a few days earlier told me she was feeling better and hoped to go home soon. It was rewarding to hear she was doing well and made me feel as if maybe I am making a difference. After rounds we headed back to the IU compound to load into a matatu, an 11 passenger van/bus, and headed for Jinja, Uganda, for our white water rafting (WWR) trip. We were told it was a 5-6 hour drive by bus….8 hours later we made it to our destination. On our way, we were stopped at the border for over an hour trying to get Uganda shillings for a visa. They took American cash but not Kenyan shillings…very strange considering they border Kenya and not America. Once we crossed the border, we saw baboons on the road. Our driver pulled over and allowed us take pictures. One baboon had a baby in its arms…super cute! The baboons were all over the road, it was a hilarious sight. When we finally got to Jinja, we saw something we had not seen in weeks…white people or muzungus. There was an outside bar filled with tons of muzungus. It was very strange to us since we had looked at the tiny towns and huts for the last 8 hours. It is just crazy to think how differently the Africans live than those muzungus in that bar….It felt like a scene out of a movie. At the “resort” we ate dinner and I got to experience the famous Lake Victoria tilapia. It was the best fish I ever eaten. At dinner I met Alex, a Kenyan who studied undergrad at Texas Southern and is now at IU Med School. It was fun to talk to another fellow “Texan” for a while. After dinner, we found out a group pretended to be our IU group and took our rooms at the resort. The resort had to pay for us to stay at a nicer resort down the street for the mix-up. Katie, Lauren, Andre and I all stayed in a “house” with 2 beds downstairs and 1 bed upstairs. It was awkward since you could look into the toilet and shower stalls from the staircase up to Andre’s room…Needless to say, none of us showered even though we should have after being a matatu for 8 hours.

Saturday, June 21, 2008

We started the day being loaded onto an open bed truck to be driven to the WWR place. We were served breakfast (chapati, ndizi and hard boiled eggs) chapatti = thicker tortillas, ndizi = bananas. We were then fitted for life vests and helmets. Katie’s life vest looked like a sack of potatoes on her back…super safe. We then drove 45 minutes to the landing place to cast off in our rafts. My boat had Andre (IU Med student), Henry (IU med student), Alex (Kenyan/Texan/IU med student), Tony (Diego) and Lauren (Lo) with Tabani as our fearless leader (guide). We also had a kayaker follow us, his name was Wicked Virus…Andre, Tony and I were left side…strong side. We learned the basics and then attacked Class 4 and 5 rapids! Our first rapid went well without any flipping…then we hit the rapid called Fifty-fifty (tony’s favorite name). It is called fifty/fifty because regardless of form or experience…only 50% of rafts make it through without flipping. We were slammed and flipped over the second we hit that rapid. I remember the way the wave hit my face…it was amazing power. It seemed to take a while to find the surface and we were carried through the entire rapid until I was able to grab onto a kayaker named Joseph. I saw Tony and Lauren so I knew the others were OK. Tabani came to rescue me and he threw me into the raft with such force then he screamed..Paddle forward!!! I said “YES SIR” then we paddled to get the others. I pulled Lauren and Henry into the boat. It was funny because Lauren said, HELLO MARIA when I pulled her in and then everyone cheered and said Whoa, Maria when I pulled Henry in…it was hilarious. I laughed so hard…When we would paddle, we had a hard time keeping in sync so we would chant “STROKE” to keep pace. We probably said STROKE 55,000 times that day. We started getting hungry near the end so we changed to chanting the word MEAT and then BEEF because we were looking forward to the BBQ at the end. Our group was hardcore and wanted to be the first down the rapids to watch the other boats flip….Lunch on the River Nile was amazing. All we had was pineapple and glucose biscuits but they were delicious. I had never had such fresh pineapple in my life. The last rapid was downstream a Class 6 rapid so we had to get out and walk around the class 6 area along a cliff…barefoot! And I was complaining about climbing that other mountain in flip-flops! So the last rapid started off in the middle of a class 5 rapid. It was intense but the adrenaline rush was amazing. We rafted from 10am until 5pm. It was a full day and we were all sore afterwards. At night we hung out at the bar and tried the local brew called NILE SPECIAL. It was good and we watched a video us rafting. The DVD was amazing and we all are going to get copies to show off for eternity.

Sunday June 22, 2008

We drove back to Eldoret, it only took 6 hours this time but Tony and I were in the very back of the van and got to feel the full effects of the wonderful African roads. Uganda’s roads are much worse than the Kenyan roads so we were airborne for most of the trip. We laughed so hard because it is so ridiculous driving down those roads. There are no laws or signs…you just pray you don’t hit another van head on! We got used to it after a while and slept for most of the trip.

Malaria, Typhoid, and AIDS....OH MY

2008-06-17T13:36:00.000-07:00

Today was my second day of flying solo on the wards and today was especially scary since we did not have any attendees on our team to guide us. It was one intern, 4 med students and me. We were coming up with regimens and writing prescriptions for our patients. This would NEVER fly in America…NEVER. We would be sued by so many people. I am learning a lot and cannot wait until I am a real pharmacist with complete confidence in my knowledge. I was able to counsel a patient on their medication today. She spoke English and I needed to explain to her why we were changing her medication. It made my heart hurt when she told me she was having trouble swallowing her pills and she had back pain that made it impossible to get out of bed. I hate not being able to do more for my patients.

Under African Skies

2008-06-16T20:18:00.001-07:00

The internet has been out for 3 days….TIA. TIA means: This is Africa. I learned this from the movie Blood Diamond. I have written everything that has happened in this blog passage.

Friday
As I wrote about earlier, I drank Kenyan box milk! I put it in the refrigerator overnight and it is not bad cold. Our group had our first major mistake of the rotation. We assumed we needed to be at the hospital at 9am but the calendar read 8 am...thankfully, Alex, Katie and I were going to the hospital early to catch up on work so we were only 15 minutes late. I think we let Sonak down but he told us later in the day that it was water under the bridge and to not let it happen again. At 9am, we had rounds as usual. I was able to contribute more today and I was able to write prescriptions for a patient who was being discharged. In Kenya, pharmacists in their last year of training are considered “doctors” so they say, “Doctor, what medication do I give this patient?” I laugh when they call me doctor…I also get nervous when I am the person writing the discharge meds. I am the last check here, no one looking over my shoulder or holding my hand. I am proud of myself because I was able to catch a critical error. We had an HIV + patient on ARVs (anti-retroviral medications) who was diagnosed with TB. When you add TB medication, it interacts with certain ARVs and I was able to tell the doctor that we needed to change her ARV medication so it remains effective while we treat her for TB. I think this gave me some credibility with the attendee. After rounds and lunch we watched the 4th game of the NBA Finals in fast forward until the 4th quarter since it we dvr-ed it. I loved watching the Lakers 24 point lead shrink in fast forward. After dinner we went to a night club called Spree to watch Netherlands vs France in the Euro Cup. Our preceptor loves the Netherlands so he was excited when they won. The night club was hilarious…they play the funniest music. They love 80s music and Ace of Base. We also heard Paul Simon’s “You Can Call Me Al” and Michael Jackson’s “Black or White” which we think was played for us.

Prados aka Land Cruisers

The vehicles provided to the IU compound are Prados (Land Cruisers). All the roads in Kenya do not have street signs or laws. To keep the speed under control, they have a lot of speed bumps or ridged strips as they call them. If you sit in the very back of the Prado it is similar to riding a roller coaster. You get airborne on certain bumps. Katie, Alex and I love to ride in the back so we can experience the fun of the Prado in Kenya. We named ourselves the Backseat Junkies (BSJ).

Winter in Africa
Kenya is in the Southern Hemisphere so it is considered winter here now. Kenya gets rains in the afternoon but during the day it can get mid 70s and at night it can dip to low 50s. We saw a Kenyan guard bundled up with a ski mask and huge coat. “He looked like he was ready for the Tundra” Katie said. We laughed so hard because we are all there in short sleeves since its comfortable for us.

Imani Workshop
On Friday afternoon we went to the Imani workshops where HIV+ Kenyans make fair trade certified crafts. All purchases from this workshop support families and provide life-sustaining medications to our patients. It was amazing to see them make the bags, jewelry, journals and pottery. They make everything from scratch. Some of the beads are made from the paper in a magazine!!

Saturday
We took a trip to Kruger Farms to see giraffe. It was about 45 minutes from Eldoret. The drive was interesting in itself. We got to see outlying areas of Kenya. We saw grass huts where many people live and we saw the displacement camps. The displacement camps are large camps where people who lost their homes in the post-election violence still live. When we were told about Kruger Farms, we envisioned a field with giraffe but apparently it was quite a hike to see the giraffe. Katie, Lauren and I all wore capris and flip-flops…BAD IDEA. We ended up climbing a good sized hill (a mountain to people from Indiana)… It was difficult in flip-flops but I was able to make it to the top. The view was amazing. I liked climbing the hill more than seeing the giraffe…even though getting close to giraffe was pretty amazing. We saw 10 giraffe, one was a baby! After the hike, we went to eat at a restaurant named Kerio View, which had amazing views of the Rift Valley.

Sunday: HAPPY FATHER’S DAY

We had a lazy Sunday to recover from the hike on Saturday. We had a Swahili lesson in the gazebo then we walked into town to get lunch. We specifically asked for no Indian food and ended up at a vegetarian Indian food restaurant…just our luck. Katie and I shared this potato stuffed with peas in Indian-type gravy. Even though I was upset about the Indian food, I ordered Passion fruit juice which was amazing. Nothing else exciting happened today except I went running and listened to the following play list:

Africa-Toto (for Kenya)
Lovestoned – JT (you’re freaky and you know it)
Never Loved Before – Alan Jackson/Martina McBride (for Dad and Steph)
Sweetest Girl (Dollar Bill) – Wyclef Jean (this is always for you Melissa!)
Bennie and the Jets – Elton John (Electric boobs? For mom and claud)
I am the Walrus – Beatles ( sitting on a cornflake, Barb)
Under African Skies – Paul Simon (for Africa again)

Monday: No internet AGAIN! I am ready to cry………
I was flying solo today in the wards. My Kenyan pharmacist was not at the hospital today so I was the only pharmacist on my team. We got new med students and they were friendlier than my previous group. They all introduced themselves to me…one was funny his last name was Hillary and he said just call me Hillary Clinton in his Kenyan accent. After lunch, I went back to the wards but got frustrated with not being able to find information for my patients. I decided to take a break in the Sally Test Center which is a place for the children in the wards to hang out to stimulate faster healing. I was able to color, sing songs and read stories to the children (there was a Swahili translator). It was uplifting to get away from the filth and death of the adult wards. Also, there are abandoned babies in the center who you can hold, feed or change. They are the smallest babies you can ever imagine. They just want someone to hold them and make them feel loved. Dinner was amazing tonight….we had…get ready for it….BURRITOS!!!! Can you believe it?? Burritos in freaking Africa…they weren’t great but it was definitely better than Indian food. Then the dessert was CHOCOLATE CAKE. After dinner I tried to no avail to get online for the 3rd night…then we just hung out and listened to Tony’s tunes.

Got Milk?

2008-06-13T22:54:00.000-07:00

Friday was the first day I conjured up the nerve to drink the milk. It comes warm in a nice little box...I was surprised to enjoy it! I am now able to have cereal and bananas in the morning!! The fruit here is amazing. I cannot describe how rich the flavor is compared to American bananas and pinapple. I usually would write a longer entry but I need to get ready to go to a giraffe farm. I will blog about Friday and Saturday later today.

Love you all!
Maria

Moja, Mbili, Tatu...

2008-06-12T20:36:00.000-07:00

One, two, three...We are taking swahili lessons from Wycleff. We have learned a lot of phrases and food words. The funny thing is that I respond in Spanish if anyone talks to me in a foreign language. Lauren does the same thing and called her Kenyan money (shillings) pesos the first day we got here.

I had my presentation which went well. The doctors asked hard questions but I think I did alright. The hospital was brutal today, we had 25 people rounding on my ward so it made it difficult to hear and contribute. We admited 7 new patients which places me behind in work again. After work, Andre (a med student), Alex and I went for a run. I felt the elevation yesterday (7000ft) but it felt good to run off steam from the wards. Tony is the first to succumb to illness in Africa. He has strep and got medication from the African pharmacy in the hospital. I am surprised we all arent sick yet after spending time in that hospital. Lunch was exciting because they served pizza. It was a very interesting pizza but there was no rice which is always a plus.

The Greatest Spectacle in Eldoret

2008-06-11T12:14:00.000-07:00

I woke up this morning to great news. We emailed our professor, Ellen Schellhase (EMS), to ask her to bring us American candy (Reeses!!) since she will be coming to Eldoret on June 17 and she emailed us back saying she got our requests. Being in a primitive country allows you appreciate small stuff we take for granted in the US. I miss brushing my teeth with running water, drinking milk, walking on sidewalks, text messaging, dairy products, and tap water. Hospital rounds were as usual, I was pushed around by 15 Kenyan med students trying to hear the attendee. The smell is something I cannot even begin to explain...there are 100 extremely ill Kenyans in a room, two patients to a bed, some dead, some with TB, some with malaria, most with HIV/AIDS. There is no AC, no bathrooms, no sterile technique. I will explain the hospital fully in a later blog. The purpose of this blog is the explain the Greatest Spectacle in Eldoret: White people. We are like the animals we will see on a safari to the Kenyans. They point and stare in awe when we walk pass them. They get excited or scared if you smile and say HI or JAMBO. Some children believe we are ghosts, some patients think we are there to "save" them. Its hilarious to see the people stare as we walk by...

Well, the rest of today was spent writing my presentation that I give with Abby Sharp, a med student, tomorrow morning. Also, we ate Indian food AGAIN! That is all they eat here....

Kenya Overview (June 4-10)

2008-06-10T21:54:00.000-07:00

I know I said I was going to blog everyday but I have been busy getting acclimated to living in Kenya. I am posting a hodgepodge of stuff that has happened thus far and will continue with daily updates from here on out.

The 4 flights to Africa

This was the longest trip of my life and I have never felt more greasy and dirty. We began flying from Indianapolis to Washington DC. We had a 7 hour layover in DC. We killed time by walking the entire airport and sleeping on random seats. The second flight to London wasn't bad, I watched Vantage Point and then slept the rest of the way. We got to London at 6 in the morning and had 13 hours to kill so we ventured out into the city. We had a lot of fun just walking around and not being cooped up. Tony was super excited to see Big Ben and Parliment and we went to a couple of pubs. I had a beer at 11 am because I wanted to try their local brew.... We also saw part of the changing of the guard and walked to the Tower of London. Then, the flight from London to Kenya was terrible! I was in a middle seat and there wasn't any leg room for some unknown reason and my seat did not recline.We ate our first Kenyan meal last night on the plane and it was not good! There was a strange fish in this white sauce and nasty coleslaw. I was so tired and super cranky by that time, I feel bad for Katie since she was sitting next to me. I lived through that 8 hour flight somehow and we got to Nairobi, Kenya. We had a driver holding a sign for Purdue Students x 5 when we got to Nairobi who was to take us to a different airport in Nairobi. We then had to take a smaller plane to Eldoret. At the smaller airport, there was only an area of open airfield and the "gate" was right in front of the airplanes. You have no idea how happy I am to not have to be on a plane anymore.

The Indiana University Compound Houses

We live in Eldoret, Kenya at the IU Compound which has a total of 8 houses. I am writing this email to you straight from The Sausage Tree room which I share with Lauren. They have named each room and ours is wonderfully named the Sausage Tree room.Across the hall is Alex and Tony. Poor katie is in another house across the compound and her room is called the Red Hot Poker Room. Our beds have mosquito nets we have to sleep under. There is a pool down the street that we can swim in and running trails we can go on with a partner. The weather is gorgeous but it gets a bit chilly at night (around 45-50). We also have seen the effects of the rainy season, it is similar to Florida when its sunny until mid afternoon for the cloud bursts

The Food

The food here is surprisingly good but we have determined that it is mostly Indian food. I would be happy to never eat rice again. We had a real Kenyan meal once and it was alright, but very bland. We have been to two restaurants and one was an Indian food place and the other an Italian place..in AFRICA.
The Moi University Research and Teaching Hospital

We got the rundown of our rotation and it is going to be really intense. I will officially be in charge of 30+ patients and their treatment on my own. Its a bit intimidating for the first rotation but hopefully they understand and help us out. I am really excited for this rotation because my preceptor, Sonak, (the guy in charge of us) is going to allow me to work in the oncology clinic once a week since I am interested in it and I will be able to round in the pediatric wards for the last month. I am super excited about this rotation...it sounds as if I will be able to be exposed to a lot of areas that I am interested in and I will be challenged to learn as much as possible. The first real day in the hospital was tough...the smell and heat was unbearable at times. It was so crowded and after 4 hours of rounding with patients I was ready to keel over. Terrible turn of events, Kenyans are the softest spoken people in the world and I am the most deaf American....so that means I cannot hear a word anyone is saying. I am pretty overwhemed, I have a lot to learn.

Club Sonak
Our preceptor, Sonak, has a huge plasma tv with DSTV and an Xbox and Wii console. We all hang out in his house and watch movies or play video games. We are addicted to tennis, bowling and Dance Dance Revolution now! Lauren, Katie, Alex, Tony and I did Dance Dance Revolution if you can believe that....I bet it was a sight to see. . We also have intense tennis matches with the IU doctors, I am happy I had previous Wii training before coming to Kenya. Another fun culture experience is the music. I am in love with their african club music. It has a great beat and makes you just want to dance. Pictures Katie and I have webshots websites with pictures. We have only added London pictures so far. I have included the links for you all to see below... http://community.webshots.com/user/kring85
http://community.webshots.com/user/Swimgal55

Tuesday, June 10 Update
Tuesday was just another day in the hospital again. We had to make sure we filled out all patient info for your patients. I have 25 filled out and I am sure I missed a couple of patients. We stayed at the hospital longer than everyone else, but we needed to catch up on work. There is this patient on the men's ward named Lewis who is psychotic and in love with white people, especially Tony. He calls him Alex and called our preceptor Philip even though his name is Sonak. He thinks Lauren and Katie are Sonak's wives. Whenever he sees me he shakes my hand and says THANK YOU THANK YOU. He is hilarious, until he unzipped his pants in from of tony....that kinda got scary but Tony's face was priceless. We saw a man herding cows down the street today using a tree branch as his whip. Standard. At night we hang out with the IU doctors and med students. I will introduce you to everyone who lives here in a later blog.

ta ta for now!
Maria