Last day of surgery

Tuesday morning, March 1. The surgeons are leaving Indiana House to walk to the hospital. The good news is that they have no clinic hours today. The bad news is they have way too many surgeries to do. It will be a long day for them plus there is to be a going away dinner this evening at 6:30. The only day they've finished that early was yesterday, when a large case canceled. This will be a stressful day. Hopefully it goes well.

Sunday night dinner

So our friend Lucy, the law student in Uganda, came to visit us Sunday. We and the Weisbergers took her to Siam for dinner. There we ran into the Sisendas and friends. They were celebrating Dr. Sisenda's 54th birthday. We joined them in the celebration and had a nice time.

Shopping at Robert's Cultural Shop

Sunday afternoon after returning from our weekend getaway, we had an appointment to go souvenir shopping at Robert's. He opened the store for us and we all bought many things to take home. At the end, he offered the last shoppers, three of us, a ride back to Indiana House, which was nice because we had a lot to carry.

A couple years ago when we were shopping there and buying something of substantial size, he offered us a ride and we accepted.

Looking back, the same thing happened both times - he first stopped at a gas station for a splash and go. Of course his passengers are obliged to offer a few shillings to help pay. Coincidence? Doubtful.

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Carpenters' shop

Construction of shelves for the OR storage room is underway. You'll see a carpenter snoozing in the background. I visited during lunch hour. He never knew I was there.

Kingfisher

I forgot to include this photo with my birds of Lake Baringo post. These are Kingfishers. They were hard at work catching and eating small fish from the lake just outside our tent Sunday morning. They would swoop down to the water and somehow come back with a fish. They'd land in this tree, eat there catch, and then watch the water again. Apparently for seconds and thirds.

For my AT&T friends

The innerduct along the road is the same as it was in November. And last February. And the February before... Hopefully work is progressing somewhere for this project.

Wildlife near Lake Bogoria

We saw zebras and warthogs as shown in one photo. We also saw elans and other kinds of antelope. Perhaps the coolest things we saw that we have never seen before were baby ostriches. Ok, Hart girls, how many babies do you see in the photo with their mom? They are a little hard to see...

Flamingos at Lake Bogoria

The Swahili word for flamingo is "heroe". There are thousands of them here as they like the briny salt water, which also makes them pink.

Lake Bogoria

On Sunday, we also visited Lake Bogoria. Both lakes, Baringo and Bogoria have bubbling hot volcanic springs, but Lake Bogoria is salt water while Lake Baringo is fresh water. These photos show Aaron and Betsy with a hot geyser behind them and Aaron testing the temperature of the water near one of the hot springs. You can touch the water here but it's way too hot to hold your fingers in it. Some people boil eggs in the water. Why? Because they can...

Fish Eagle

The Fish Eagles are great at catching fish!

Owl

See the owl? The local guides helped us find one. They know where to look.

Birds of Lake Baringo

Here are some birds of Lake Baringo...

Kokwa Island school

There is a primary school on the island. There are about 750 residents on the island and 248 of them are children in school. The girls are boarded at the school while the boys are not.

Kokwa Island, Lake Baringo

Here are some children from the island and a traditional home.

Fishing boats

The locals on The island make their own fishing boats out of lightweight Balsa wood.

Staying in a tent

Here us our "tent" at Island Camp on Kokwa Island in Lake Baringo. I'll post more on Monday but need some sleep as it's after 1100pm here.

Iten Lookout

The town of Iten sits at the edge of the plateau of the rift valley. The view from the roadside "lookout" is beautiful. We will descend to the bottom where it will be quite hot.

High Altitude Training Center

On our way to Lake Baringo, we made a quick stop at the "High Altitude Training Center" in Iten where marathon runners from Kenya and across the world come to train.

The high altitude causes the blood to produce higher levels of hemoglobin which improves physical performance.

Leaving for Baringo

We are ready to leave IU House for Lake Baringo.

Friday

An entire week has flown by. In this photo, Susan and Aaron, assisted by Kenyan nurse Mary, are doing the last surgery of the day, removing a goiter.

Tomorrow our group of ten will travel by car to Lake Baringo where we will spend the night at "Island Camp". We will be driven in two IU SUV's by Francis and Javan, the usual drivers whom we've worked with a number of times before.

For any geography buffs, we will be leaving the mild climate, high elevation plateau where Eldoret is located and descend down into the Rift Valley where the climate is more desert-like and HOT. We will spend the night on the island and maybe visit Lake Bogoria on Sunday before returning to Eldoret.

Research question for the Hart girls, our next-door neighbors: What bird makes its home at Lake Bogoria???

Sunday afternoon, when we return to Eldoret, we have an appointment to visit "Robert's Cultural Shop", our favorite souvenir store in town. He is closed on Sundays but I met with him today and asked if he would open for us as everyone is too busy to leave the hospital during normal business hours. He will be happy to open for us. And he will make a lot of sales.

No Internet where we are going, so fewer blog posts for the next couple days...

Diana in charge

I don't know what all Diana does when she's here. But what I do know is that the entire team depends on her to keep things organized and on track. She's worth her weight in gold. Or at least in chocolate.

iPad

I introduced the iPad to some of the clinic employees. They had never seen anything like it. Here they are playing "Scrabble" and telling me that the computer cheats! (ever play this version of Scrabble against the computer? You'd say it cheats,too!)

Passionfruit

The ramp

The main hospital building that houses clinics, doctors' offices, and admin offices is a two story building. There are no elevators. There are stairs and this ramp.

Remember, we brought a flexible endoscope system with us. It requires a cart so that it can be moves around in clinic. I was allowed to remove one from storage in the OR to take to the ENT Clinic (2nd floor).

Earlier this week. I was moving the cart to the Clinic and dog-gonit, they were mopping and had it closed off. All I could do was wait.

They sweep and mop floors every day. But I wonder how often they clean the restrooms. Certainly not often...

AMPATH farm

Before going to Clinic yesterday, I visited the AMPATH farm which is a two acre irrigated farm on hospital property. They also have another six acre irrigated farm not too far away, and they provide various forms of help to the clients who farm throughout the region.

Their clients are HIV+ patients. The farm provides jobs and fresh vegetables for them.

They have some fruit trees but mostly they grow carrots, kale, onions, tomatoes, etc. They also have a greenhouse where they start seedlings. In some cases, they sell them to the public.

They also sell passionfruit seedlings. I learned that there are at least two varieties. One is from the coast and is resistant to root disease while the local variety has better fruit but has root disease issues. So at the farm here, they are using root stock from the coast and are grafting the local variety onto the root stock. They sell these seedlings to clients for 35/= or to outside farmers for 40/= each. They may sell a few hundred of these to a single farmer.

Thursday. Teamwork

"Teamwork" was the word of the day. The team did a lot of teaming to keep things moving. Who's doing what surgery and when? How can we best get all the work done? Susan was the first of the surgeons to go to the ENT Clinic to see patients there. Betsy and I both assisted her by helping with paperwork. We were taking any load we could from her in order to increase her throughput. While she was seeing a patient with Betsy, the next patient would come to my area. I'd get her chart ready for Susan. Then when Susan came and took care of my patient, I took notes for the chart while Betsy readied the next and so on. Since Betsy is a physician, she was much better than me, but I think I helped some.

Somehow with the teamwork, whether performing surgeries, seeing patients in clinic, or making post-op visits on the ward, everyone finished at the same time, around 7:30. Dr. Sisenda was also there and invited us all to the Eldoret Country Club for dinner.

Remember Maiyo, our "assigned driver"? Well, he really is assigned to us. The day before, Susan was making small talk and mentioned that she like passionfruit juice. I called him to take us to the Club, and he gave Susan a big bag of passionfruits. (I have given them to the IU cooks and they will juice them.) Maiyo didnt have any other responsibilities, so I invited him to join us for dinner, which he did.

We had a nice time but another late night, not getting home until after 10:00. If everyone can survive Friday, I think we will enjoy our weekend getaway at Lake Baringo.

Hardware store

Thursday, Mark, Maisz and I picked up the material list from the carpenter an walked to a big hardware store. Along the way, we made arrangements with a man who has a pick-up truck, to pick up and deliver the plywood we were buying.

This was a big hardware store but different than in the US. There were some items being displayed, but for the most part, you waited to talk to a clerk at a counter to place your order. Then they'd go in the back and get it. Except the lumber, which we ordered at a different counter...

Internet...

The Internet service at IU House was "down" yesterday. Will hopefully blog more today.

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Storage room

The supplies we brought for the OR were put in the storage room. What a mess. Susan asked me to talk to Mark about getting shelves installed. Oh my, what a simple but important idea. So I spoke with Mark, not being sure how such a proposal is made and approved and funded. We offered to pay for it. Well, the next day we had a list of materials required and a price of about $175. We will pay for the materials and the in-house carpenters will do the construction. I am to go with Mark this morning to purchase the supplies. Construction may begin tomorrow, Friday.

Lectures

Part of the "medical exchange" aspect of this trip includes lectures by the visitors. In this photo, Mike is giving a lecture to the ENT Department on salivary gland tumors.

Diana has been giving lectures to nursing staff. Leslie has given talks to the anesthesia department. This morning Ed is giving a hospital-wide "grand rounds" lecture on thyroid surgery. And tomorrow I'm to talk to the engineering department. Unlike the others, mine wasn't planned in advance so I don't have anything prepared. I'll wing it.

Wednesday, day 4

Surgeries and clinic again today. Every day the medical team bites off more than they can chew and ends up working late. The need is so great that it would be difficult to do otherwise. And ENT clinic employees end up staying late as well. And they do so without complaint.

I was with the surgeons today when the work was done and it was time to leave. It was about 8pm. Dinner hours at IU House were long over. IU has rules for safety that include NOT walking back to IU House after dark. So we were standing outside the hospital at the road. We decided we would call a cab or cabs and pick up the others of our group and go to dinner. Then Sophie, the main nurse of the ENT clinic shows up with a driver in a rickety old hospital van. They had just given someone else a late ride home and she had the van stop to see if we wanted a ride.

So Sophie talked the driver into stopping at IU House for the others and then taking us to dinner. I invited them both to have dinner with us but Sophie wanted to get home and the driver couldn't be away that long. But he did offer to come back for us. I told him to come back in an hour and a half. He said he would do so and call me on my cell when he was back.

Well, dinner was slow to start and ran long. Shortly after our food arrived my phone rang. It was the driver. Time flies. I told him we had just gotten our food and we had too much and would he come in and join us. So he did. He ended up with all kinds of good food on his plate. We enjoyed having him. Hard telling what he thought of us. These things just happen here.

I gave him a generous tip when he dropped us at the restaurant. When he picked us up to take us back to IU House, he told me that he was assigned to us by the hospital and if we need a ride tomorrow night to just call him. I tipped him again. I have no idea if he's really assigned to us or what. But I have his name and number...

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"Friends and Family"

Remember the old MCI "Friends and Family" campaign? It seems we have that going on here. When the engineers visited Indiana in 2009, we learned that Mark's aunt had a large goiter. She was hesitant to have it removed before, but maybe now she would consider it. In Feb 2010, Susan saw her in clinic. She had a huge goiter. It's been growing for 27 years! Tests indicated that she needed to be treated medically before she would be a candidate for surgery. She started treatment and when we came back in Nov, Susan saw her again and had the blood tests re-run and told her she could have it removed on this (Feb) trip. Her goiter was removed on Monday. She's very happy to have it gone! The photos are before and post-op of her.

I was approached yesterday by Maisz, another engineer friend. He has a sister-in-law with a large mass on the side of her face. She started with a tooth problem in 1982 and had two surgeries in the '80s. Over the past three years it has grown quickly. She has been hesitant to have surgery again. But Maisz thought he might be able to talk her into a visit since it has grown so large. Susan then talked with him and encouraged him to get her to come in based on his description.

She came this morning and her condition is quite impressive. Susan wrote for a CT scan and asked her to come to clinic later for a biopsy.

She came to clinic and was seen by Mike. He thinks and hopes she has a benign jaw tumor, an ameloblastoma. He took a biopsy for analysis. Regardless of whether it turns out to be malignant or benign, the required surgery is the same. Mike plans to remove the left side of her lower jaw and then use muscle tissue taken from her chest to fill in the defect. It will be a big surgery but not unusual for the kind of work Mike does back home. She is tentatively scheduled for Monday.

Also today, one of the OR employees approached Susan about his relative who has a large goiter. She's coming to clinic tomorrow. Come one, come all!