Shoe shopping

After we arrived on Sunday, before lunch, Charles wanted to buy a pair of shoes to wear in the OR. His plan all along was to do this. He was traveling light and would buy a "disposable" pair of shoes. So he bought these shoes at a Bata shoe store. And so did Taha. Mark decided he wanted a pair, too, but they didn't have any more that were larger than an 8. We've looked at other Bata stores with no luck. Mark will go home empty-handed. And Charles likes the shoes so much that he now wants to take them home.

Who's who: Dr Makaya

Dr. Makaya and the other local ENT surgeons are employed by the hospital, which is a public hospital. To supplement their meager government income, they also have private practices off campus.

Road repairs, part 2

We came across another, albeit minor, road repair in progress. And yes, they put down some oil or tar along the edge and on the rocks and are using a wheelbarrow to dump asphalt from a nearby truck. I assume they will tamp it down mechanically. I sure haven't seen a steamroller!

After looking at this picture again, I realize it looks like the ground is dirt, but really, it is blacktop! It's just covered in the red-brown dirt that is everywhere.

Market

After leaving Robert's shop, we wandered through the fresh vegetable market. It is very crowded and chaotic. But wow, the fruits and vegetables look amazing!

Making lemonade

Since there is a delay today, while patients get lined up for surgeries this afternoon, some of us went souvenir shopping at Robert's Cultural shop. It's a great place that we visit every time here. Last year he opened his shop on a Sunday afternoon just for us. Great service.

Road repairs

This road is being repaired. In the US they would typically maintain traffic while performing repairs. Here they are simply blocking the road. The workers use pick axes to widen and clear out pot holes and weak sections of pavement. They then put down a base layer of rock. The rock has been broken down to smaller size pieces by hand using large hammers. I think they will use oil and asphalt on the rock but I haven't seen them progress that far yet.

This work is mostly manual. Labor is very cheap here with insanely high unemployment. There is no financial incentive to invest in machinery to automate or lessen the labor involved.

Change in plans for today

Susan just called me. The two "big" cases are cancelled for today. Apparently there is only one ICU (intensive care unit) bed and it is already in use. Both patients for today would need to stay in the ICU after surgery.

So they are trying to get ahold of patients scheduled for later in the week to see if they can perform some of those surgeries today.

Swahili lesson

Mwalimu wangu alinifundisha leo asubuhi.

My teacher taught me this morning.

Wycliffe offers Swahili lessons by the hour. I will start my day with a lesson all week. I won't become fluent anytime soon but it's fun and interesting.

Monday/Tuesday surgeries

I don't recall exactly what surgeries were performed on Monday, but they were geared for Charles' and Taha's expertise. There were six cases that included cleft lip repairs on babies and ear surgeries.

But because you never know what will walk into clinic and what the needs are, the schedule for today, Tuesday, is much different.

One of the struggles for the docs in clinic is that there are so many patients that they could help but they don't have the capacity to help them all while here. They have to turn many away because others have a greater need. The good thing is that most can come back and get services from the Kenyan ENTs.

Today there are only two cases scheduled. Both are "big" cases. One is a laryngectomy and the other is a parotidectomy (patient pictured).

Long day, slap-happy

It's been a long but successful day. Surgeries are over. Clinic is over. We are on our way from the hospital to Mamma Mia Restaurant. It's 8:00pm.

The hospital has provided the same driver - and the same very old but apparently reliable van - to take us home. Like last year, I asked the driver, Maiyo, to take us to the restaurant instead of home, and I invited him to have dinner with us. He is happy to do so.

Last year, Maiyo brought Susan a bagful of Passionfruits from his home after hearing Susan talk about how much she likes the juice.

Who's who: Dr. Titus Sisenda

Dr. Sisenda is the senior Kenyan ENT at MTRH. He and Susan have been instrumental in the ongoing medical exchange and partnership between the ENT departments of Indiana University and Moi University.

Who's who: Sophia

Sophia, or Sophi, is the head nurse of the ENT clinic here. She essentially manages the place. She works extremely hard and keeps the place going. While we're in clinic, she is pulled in many directions at the same time. All the docs ask her about local procedures - the things that are second nature back home but unfamiliar here - how to document this, how to order a test, is a certain medicine available here... She also acts as an interpreter for patients who don't speak English.

Coke baridi

"baridi" is Swahili for "cold". It's not so easy to find a cold Coke here. At least once a day I go to a "duka", or small shop, and buy a case of 24 sodas to take to the clinic or operating rooms to keep the team moving and motivated. 

I go to this duka because it has a power line going to it, which means it has COLD drinks.  Most don't. They typically sell sodas, loaves of bread, and various snacks. I took a picture of the inside when the shopkeeper stepped out for a moment. 

I request a mixed case, usually half Coke and a mixture of Sprite, Fanta Orange, Fanta Black Currant (like grape), Fanta Pineapple, Krest Bitter Lemon (Susan's favorite), and Stoney Tangawizi (an intense ginger beer common in parts of Africa.)

Each soda costs 30 ksh, Kenyan schillings, or about 37¢.

Sent from Kyle's AT&T iPhone

Just in case

I tend to blog about less serious things most of the time. But as most are aware, HIV/AIDS is a huge problem in Africa. Due to the higher risk of being exposed to blood products of an infected patient, my first job today was to go to the pharmacy and pick up some ARV's, or anti-retrovirals, so the team has quick access to them if needed. These are drugs that fight HIV. If someone on our team believes they have been exposed to blood of an HIV+ person, they will begin taking a scheduled course of these drugs to prevent HIV infection.

The same drugs are used in the same way back home, but here we keep them close at hand. Just in case.

Hopefully, at the end of our trip, I will return them to the pharmacy unused, just like our previous trips.

Who's who: Dr. Henry Nono

Henry is the most junior of the three Kenyan ENT's at MTRH. He visited us in Indiana this past September. He attended the national annual ENT meeting in San Francisco and spent another three weeks at the IU med center working with the IU ENT's and residents.

Who's who: Vickie Firkins, RN

This is Vickie's first trip to Eldoret. She has been a nurse for many years and often heard docs talking about their trips to Eldoret. Then a few year ago, her friend Diana went (with us) and talked about it some more. She told Diana to let her know when she was going again. Each time she had conflicts with her schedule. (She is an administrator these days so is burdened by the inherent bureaucracy.) This time Vickie was able to go and jumped at the chance. She and Diana went a few days in advance of the larger group and helped get things organized and ready on the ground. The work is off to a smooth start thanks to Vickie and Diana.

Weather in Eldoret

Monotonous, glorious weather forecast.

Our friend Lucy

Our friend Lucy and her daughter Amani visited us today.

The team screened patients in the ENT clinic after lunch. It was fully staffed by employees even though it's Sunday. Surgeries are now set for Monday. 

Internet has been down at IU house all evening and still Monday morning. A bit frustrating for those wanting to Skype home. I'm submitting this brief update over the cell network. 

The new Hindu temple

Before and after. For the past two-plus years we've been marking progress of the construction of the new Hindu temple that we walk by on the way to the hospital. Here is a photo from last year and a current one. It looks fabulous now. Pictures don't do it justice.

Lunch at Siam

We met up with Dr. Sisenda, Samson, and Eric from the ENT clinic for lunch at Siam, our favorite place!

We've been here enough times that the owners recognize us. Actually, I think they remember Susan since she's tall and blonde. I'm just another middle-aged mazungu.

Jetlink to Eldoret

This is our Jetlink regional jet taking us to Eldoret this morning. After settling in at "Indiana House", we plan to go into town and have lunch with Dr. Sisenda. (Hopefully at Siam, our favorite Chinese restaurant.)

The medical folks will then go to the ENT clinic. Diana and Vickie, the nurses who arrived a few days ago, have been pre-screening patients for surgery. In the clinic today, the group will decide what surgeries to perform tomorrow and on which patients.

I, on the other hand, will finalize our Kenyan cell phones. We borrowed phones from the Matthews', and they are working, but the pre-paid value has expired on a few of them. I'll sort all that out so we can call and text each other.

Who's who: Dr. Kim Rutherford

Kim is a graduate of the IU School of Medicine and while a student, completed a rotation at MTRH in Eldoret in 2006. Currently she is in her chief year of ENT residency at Uconn. Next year she will begin a facial plastics and reconstructive surgery fellowship at Alabama.

She and Mark were medical students together. Both became ENT residents but at different programs, so this trip is an unexpected reunion for them.

Missing Moshi

Our pet-sitter sent us this photo of Moshi. We miss the little guy.

Fairview Hotel, Nairobi, Kenya

We have safely arrived in Nairobi, survived the lines at immigration, collected all our luggage, passed thru customs with minimal questions, transferred to our hotel, checked in, and have made it to the bar before closing time (11:00pm) for our Tuskers!

One more 8 hour flight (on this 747) and we'll be in Nairobi. This plane is configured for maximum density, not comfort.  Its now 4:00am Indy time and we are dragging...

We have arrived safely at Schiphol airport in Amsterdam. We will meet up with Kim when her flight arrives from Boston.  It's midnight at home and 6:00am here. 

In the photo, Mark and Chuck enjoy some quality time in a Dutch t-cup at an airport cafe.

Who's who: Amy Julian-Resner RN, BSN

Amy is Taha's clinic nurse back in Indy and will be a surgical nurse on this trip.

She recently completed the "Insanity" workout program with her husband who is a former iron man competitor. We'll see if the Kenyan marathon runners can keep up with her!

Who's who: Dr. Taha Shipchandler

Taha is a facial plastic surgeon who will perform cleft lip and palate repairs in Eldoret. As an IU medical student, he completed a two month rotation at MTRH in Eldoret. After a dozen years, he's on his way back.

He completed his ENT residency at Cleveland Clinic and his plastics fellowship at Johns Hopkins.

Who's who: Dr. Charles Yates

Call him Charles, call him Chuck. He's a former vending machine repairman who is now an Neurotologist. (That's a fancy name for an ear specialist.) He did his ENT residency at IU and his Otology fellowship at Ohio State.

His young daughters "helped" us pack some of our supplies one Saturday at Wishard.

For his post-medical career, maybe 30 years from now, he wants to become a master brewmaster. In the meantime, there's research to be done. Starting with Tusker.

Who's who: Dr. Mark Royer

Mark is a "chief" ENT resident at IU. This is his first trip to Kenya. He has previously performed medical missionary work in Thailand.

Mark is a fun, high energy guy and has a man-crush on Anthony Bourdain of the Travel Channel. (Mark recognized him at the Indy airport and had his photo taken with him. Most of the rest of us had no idea who he was and still aren't convinced he's a real celebrity. He's on our flight to Detroit, but Mark can't pester him in first class.)

After residency, Mark will be practicing in Washington state.

Pre-game meal

We are checked-in at the Indy airport and having our traditional pre-flight lunch at Harry & Izzy's. It's the last sit-down, relaxing meal in the US for a while.

Clockwise around the table starting at the lower left: Mark, Charles, Amy, Taha, Susan, and Kyle.

Diana and Vickie are already in Eldoret getting things ready for the group. Kim is coming from Connecticut and we're meeting up with her in Amsterdam.

Moshi is helping?

Moshi is actually NOT helpful with the packing when he keeps stealing surgery caps, thinking they are dog toys.

Final packing

Final evening of re-packaging and packing for our trip. As usual, Susan received a bunch of last-minute donated supplies.

And thanks go out to Susan's assistant, Angela, who delivered them to our house. Angela is one of those behind the scenes unsung heroes who help make these trips possible and productive.

Introducing: Moshi

Moshi. Pronounced MO-She.

We thought we might adopt a puppy from the humane society or similar after our Kenya trip. The timing would be good that way. We wouldn't need a sitter for this trip. We wouldn't have to work on potty training in February weather. And we'd simply have more time to get past some of the hurt of losing Kido.

But sometimes the plans of mere mortals don't work out. Less than two weeks before leaving for Kenya, one of Kyle's co-workers (Mike, who is also a doggy softy) tells him of a rescued puppy that his sister-in-law is caring for and is looking for a permanent home. The puppy was found at a truck stop, was covered in fleas, and had worms. (Mike's S-I-L took care of the medical issues.) Mike showed Kyle a picture. Kyle showed Susan a picture. "Would you like to meet him?". Yes. And we were hooked.

Mike and his family were even kind enough to offer to keep him until we returned from our trip. Ultimately we found a trainer for him to stay with who would help potty train him and start working on basic manners. This will surely save Mike's house from some puppy pee.

Our vet thinks he's a mix of Jack Russell Terrier and Brittany Spaniel. He kind of looks like a JRT. He has scruffy fur and hazel Brittany eyes. He's expected grow to nearly 20 lbs. Currently he is 8. He's very affectionate and loves to play. He doesn't like to be left alone.

We've already grown attached to the little guy an are sure going to miss him while we're away.

Packing for trip to Kenya

Today, at Susan's office at Wishard Hospital, we began packing supplies to take to Kenya on our upcoming trip. In total, we expect to pack about 400 lbs of donated or surplus medical supplies and equipment. The ENT focus of the last two trips was "head and neck" surgeries. This ENT trip will focus on ears and cleft palate repair. More to follow on who's going and their expertise. Stay tuned.

Kido

Sadly, we said our final "goodbye" to our dear, sweet little dog Kido this week. We miss her terribly, but we had 14-1/2 wonderful years of fun, adventure, and love with her.