Rate Limiting Factor

Breakfast is always congested at IU House. The most noteable rate limiting factor was the line at the toaster. Well, no more. One of the other guests bought a four-slot toaster in town to donate to IU House! Everyone was happy this morning!

Going Away Party

Last night we had a going away dinner at a restaurant in town. I don't have pictures with me, so I'll just write about it for now. I think everyone that works in the ENT Clinic and the Operating Rooms turned out, as did the Dean of the medical school, Chief of Nursing, Surgery Department Head and the Chief of the entire hospital. It was to start at 6:30, but as is par for the course this week, most of the team didn't arrive until 7:30 or so because they were still in the OR. Of course that meant some of the staff working in the OR also came late. But eventually everyone showed up.

It was a very nice affair with complimentary speaches all around, from both sides of the world. Also gifts were exchanged. One funny thing is that the venue wasn't really set up for a group this large, and the accoustics weren't very good, so unless you were near the head table, you couldn't hear the speeches. What you could hear quite well however, was the car alarm going off repeatedly on the street below and the cappuccino machine being used nearby. Yes. Cappuccino in Eldoret. One of those crazy things in the world. A restaurant can get a cappuccino machine, but the hospital can't afford to buy equipment! I suppose we have similar issues in the US...

Medical Students

Another OR picture from yesterday. Many medical students take advantage of the opportunity to watch the surgeries.

Stryker

Drs. Moore and Sisenda using the newly donated Stryker Sinus Endoscopy equipment. I'll also note in this picture that the OR's here were designed to take advantage of natural light since it is highly reliable! In the US, room lights would be shut off or turned down to make it easier to view the monitor when using equipment like this. Thankfully the monitor that was donated is bright enough that the staff doesn't have to try to cover the windows to darken the room.

Flexible Nasopharyngeal scope

Dr. Makaya is using the newly donated flexible nasopharyngeal laryngoscope on a patient for the first time. The ENT's are happy to get this device!

Update from Monday/Tuesday morning

Monday was primarily a surgery day. It was also my (Kyle's) birthday. To celebrate, our group had dinner at the Chinese restaurant. Wednesday is Diana's birthday, and we will be celebrating at a "bush dinner" in Masai Mara on our safari. Back to yesterday... most of the scheduled surgeries were completed, but it was another late night with Susan and half of the team not getting to the restaurant until after 9:30pm. But I was glad they made it!

Today, Tuesday, is the last day of surgeries here. The list is long and there is no way to complete it, but there are a handful of cases that are more important than the others, so the team has a plan to make sure those important cases get completed. THE most important is a laryngectomy for a cancer patient. It will be an all-day surgery. The team has been operating primarily in one OR with two beds so that they can be doing two at a time all day. A couple of afternoons they've been given a third bed in another room to get even more done. I think that was the case yesterday. One thing that also needs to happen is that the surgeons need to instruct the ICU and recovery nurses on how to care for a laryngectomy patient. Some of the cases the team has completed are the "biggest" since other IU surgery teams came to do kidney transplants.

Susan has some OR pictures from yesterday, but I don't have that memory card with me at the moment. I may add an entry later if I get her card and have time.

We don't know if we will have any internet access once we leave IU House tomorrow morning. Hopefully we will make final updates once we get back home to the cold and snow!

Below is a picture from Lake Bogoria taken on Sunday with punda milia (zebras) in the foreground and heroe (flamingos) in the background.

Saturday Rounds

Before going to Lake Baringo on Saturday, the team rounded on previous surgery patients in a ward reserved for this ENT Camp. Patients include those who are recovering from surgery and those who are awaiting surgery. Unfortunately for those waiting, many will not get surgery this week because the team is essentially out of both time and money. Most of the funds we have to pay the hospital for using their operating rooms, instruments, and tests, were donated by Second Presbyterian Church in Indianapolis. We also had donations from Synthes Corporation and private individuals. Everyone in our group paid their own way so all of the donations are used for patient care. But the need is greater than both the money and time we have scheduled here. The team is prioritizing the most urgent cases every day and doing as much of those as they can, but many people will eventually be sent home without having their needed surgery being performed.

Pictures here include:

• A boy who had a hemangioma removed.
• Dr. Moore with a woman suffering from Graves Disease who had her thyroid removed. You can see mosquito netting in this picture. The nets are used to protect the patients from mosquitos at night.
• A woman with an extremely large goiter that is pushing against her airway. She is waiting for surgery but unfortunately may not get it for reasons mentioned above.
• Pictured with Dr. Weisberger, a woman who had a huge tumor removed. Her picture from clinic was posted previously. She was very thankful to us when making rounds.
• Dr. Matthews with two patients sharing a bed (typical here). One recovering from surgery and one hoping to have surgery.
• Susan and Dr. Weisberger looking at a patient who hopes to have a nasal tumor removed.

Friday

Friday was another long day. The team did make it to the Chinese Restaurant (that we love), Siam, for dinner. The last surgery team made it at around 10:00pm, So it was another long day, but at least everyone had a chance to unwind a bit.

3:00AM in Eldoret

Touchdown Colts!

Game Day

We spent the weekend at Island Camp on Lake Baringo and also visited Lake Bogoria. We saw lots of birds, crocodiles, ostriches, flamingos, zebras, dik diks and a few others. On our way back into town, we stopped at Sammy and Judy Sabilla's house to attend the graduation party of their son Collins who recently graduated from a university in Uganda. It was very interesting to see such a celebration in the local culture. we hope to watch the game but it starts at 2:30 in the morning (Monday).

Flowers

Flowers love the Kenya climate. The only thing missing?…

No dandelions!!!

Laryngeal Papillomas

One of the recent surgery's performed by Drs. Weisberger and Chacko was to remove laryngeal papillomas from a little girl. These benign tumors in the larynx are caused by a virus and had completed blocked her airway. The girl already had a tracheotomy performed so that she could breathe. The surgeons used the scope of the newly donated sinus tower for viewing. One of the pictures is simply a picture of the HD Monitor that was donated as part of the "sinus tower". The clarity of what they can see through a scope is simply amazing. Again, the hospital did not have this equipment until we brought it this week.

The surgeons also used a laryngoscope and microlaryngeal instruments that were loaned to Susan for this trip. Unfortunately, she needs to return them to the company that loaned them. Although benign, the papillomas will recur. In the US, a patient like this would be treated regularly to keep them from obstructing the airway. This little girl will need future treatments if she is to avoid having a tracheostomy tube for her whole life. Susan hopes to get equipment like this donated in the future, but for now, she only has a loaner set.

Thursday night

Well, it's going on 11:00pm Thursday night and no sign of Susan. She was in clinic into the evening and when finished, went to the OR to help her colleagues. No word from her. It's been a tough day for the surgeons and nurses. I know that Susan saw some difficult patients in clinic and the others had difficult surgeries to do. At least one was a major cancer surgery that was expected to take all day. I think they again used the sinus equipment that Stryker donated via Susan. I hope to blog more about that tomorrow after I hear from Susan. But it was a tough day for the medical people.

I, on the other hand, went to my friend Mark's house for dinner. Mark and two other engineers visited Indiana this summer and spent a lot of time with us. Mark and his family live in an "estate", which we would call a subdivision. He normally takes a matatu to and from work, but since there was the two of us plus another friend, Maisz, we took a cab. Have I mentioned that most of the cabs have virtually no suspension parts working any longer? We drove a couple miles on paved roads and then turned onto a wide, pot-holed dirt road. We drove a couple more miles but it was so rough that it seemed a lot longer. The subdivision was quite large with it's own area of dukas (shops) on a couple roads.

The photos uploaded in a somewhat random order. Sorry if confusing. These subdivisions are essentially walled along the road to keep intruders out. The owner of the property builds the wall along the road. You also build walls to separate your next-door neighbors. If one neighbor builds the wall (concrete block) then the other is responsible for repairs.

Mark built a "double" and rents out the other half. He and his wife live in their half. As typical in Kenya, the kids live in a sort of "lean-to" in the back of the property, separate from the main house. This structure houses a couple sets of bunk beds and a table. It has plywood walls and a corrugated metal roof. Their three kids sleep there as does his wife's sister who lives there while going to college and helping to care for the house and kids.

At the back of the house is a built-in wash basin for washing clothes. Another picture shows the clothes line.

The interior of the house is very small. You walk into a little room with a table where the boys can do homework and I think maybe they eat there when not entertaining. On one side of this room is a tiny kitchen which includes a sink, a charcoal burning open oven (with a chimney vent), and a propane range top. On the opposite side of the first room is the bathroom. It has a little sink just inside the door. At the other end is the toilet. Not "western". Just the ceramic hole in the floor. Then in the ceiling is a shower head. So the whole room serves as a shower and the toilet is the drain. This is typical here. Behind the first room is a little family room. They have some comfortable chairs packed in around a table in front of an entertainment center with a little TV in the middle. Oh, and there is a small refrigerator in this room. I did not see the bedroom. Lillian served dinner at the table in the family room. There was way too much food... beef stew, chapatis (sort of like tortillas), chicken, spaghetti, and rice. (We didn't touch the spaghetti or rice -- too much food.)

Mark's wife is Lillian. They have three boys, Kevin, Silas, and Tony. Silas is away at boarding school (nearby). Kevin and Tony were at the house. Kevin is in 8th grade and Tony is in 2nd grade. Some neighbors stopped by to meet Mark's friend from America. They were all very nice. They included Emanuel and Beatrice, the couple renting the other half of the double. He works for the local power company and she is a pre-school teacher.

Here's how one typically builds a house in Kenya. Step one: Take out an 8 year loan to buy a lot. Pay down the loan. Step two: Take out an 8 year loan and start building a house. Hopefully you can live in it soon. Step three: Take out another 8 year loan and finish your house. In Mark's case, after he had paid down the loan for the property, he started building the house himself - doing much himself plus hiring relatives from his home village to help. (Which makes sense because he is expected to help support his relatives back in the village since he has a job.) So now his house is complete after a much shorter time period than usual. His master plan, which is typical for his subdivision, is to build a bigger house on the vacant part of the property, and then he can rent out both of the double units or house his kids there and/or servants if he had servants other than his sister-in-law college student.

So another typical thing about building your own house and having these loans is that you want to start living there ASAP so you're not paying the loan and paying rent somewhere else. So once you can inhabit your partially completed house, you do. I think Mark and family lived there without electricity for two or three years. We think of electricity as a necessity, but not so! Most villages don't have any electricity. They would have an oil lamp and actually talk to each other for evening entertainment! Back to Mark's house... when you pay for an electric hookup, you then may wait for three months before an inspector comes to check your wiring. If there's a problem, you'll wait again after your repairs. It was a glorious day of celebration when he had his electricity hooked up. Family members came to celebrate. His father likes to come and watch TV. Anyway, they are very happy to have electricity, allowing them to have electric lights, TV, DVD player, and refrigerator.

update on rain and moths

Asking my friend Mark and another engineer, Faith, about rain and the moths that were everywhere. Well, it's the dry season but it still rains. Usually about once per 3 weeks and not for very long. The amount of rain and duration were unusual today. Now that it's night time after a rainy day, it is pleasantly cool.

Now for the weird stuff... Those moths were termites. Giant ones, if you ask me. They like to come up out of the ground after it rains. These are the same flying termites that create the tall, skinny mounds we see in the Rift Valley near Lake Baringo. Mark tells me that they don't create the tall mounds (I mean some are over 10' tall in the valley!) in these parts because the ground is too sandy. But in the valley, there's more clay and they build the giant mounds.

But that's not the really weird part. Some people eat the termites. They love them. Faith loves them. They're quite sweet. You heat up a pan (very hot) and drop handfuls of the termites on the pan. (Yes, live. I asked.) No other ingredients. No oil or anything. Just bam. On the pan. They're done. And you eat them by the handful because they taste so good. So says Faith...

Rain in Eldoret

We have never seen rain in Eldoret before. This is the dry season. Rain typically doesn't come again until April. But it started raining after lunch and has been steady for a couple hours. The sky looks to be clearing though…

And now the rain has stopped. And strangely the sky is full of moths. David says that these bugs show up once a year for a week or two. He also says some people eat them. Oh my.

note from the editor…

just FYI, some postings are not in chronological order. Some I am writing during the day with my iPhone and some at night or morning on my laptop. Sometimes I don't upload from my iPhone until after I've used the laptop so things get out of sync.

For my AT&T friends…

Innerduct is being placed in Eldoret. Soon a fiber optic cable will be installed in it. Eldoret is going fiber. I asked one of my engineer friends at the hospital about it and he confirmed that they will have a fiber optic connection to the world and the hospital will be connected to it.

Also FYI for my AT&T friends, Susan and I brought a couple of older unlocked GSM tri-band phones with us and bought local SIM cards and prepaid minutes. Our entire group has cell phones with Kenya phone numbers for the trip. Being able to communicate while we get dispersed doing different things is very valuable.

Matatu

A "matatu" is a van used for public transportation. They make up the bus service in Kenya. The vast majority of people don't have cars, so they take these intra-city and inter-city matatus to get around.

Eldoret is a safe city, but we are advised to not walk after dark. So Monday night after clinic ended, we arranged for the hospital to give us a ride back to IU House using their van and driver.

Dr. Ed Weisberger was seeing his last clinic patient Tuesday night, and in conversation asked the patient if he had a job. The patient said he was a driver. Ed asked him what kind of driver. He said he drove a matatu. Ed asked him what a matatu was and heard the answer. Ed asked him if he had it with him. The answer was yes, so Ed asked him if he would give the team a ride back to IU House. And that's how they returned Tuesday night.

Sunset Wednesday. Big deal??

So what's the big deal about a sunset picture? It's not like a Corona commercial on a beach or anything exotic... What it does signify is that clinic ended before sunset yesterday! We actually went to dinner last night(!) which was a big deal and a big improvement over the previous two night. Drs. Moore and Chacko, and Heather, one of our nurses were in surgery but still joined us at the restaurant later.

The group attacked the day a little differently on Wednesday. Susan and David Mathews spent more of the day in clinic, essentially getting a head start, while the others operated and completed more cases than the day before. Dave is a general surgeon who speaks Swahili, so in clinic, he and Susan made a great team and made quick progress.

Susan and David also took breaks to visit radiologists and a pathologist to review some findings of some of their Monday and Tuesday clinic patients. Susan also gave a lecture at 3:00pm on Sinus surgery. I think it was a "grand rounds" lecture meaning that it was for everyone and not just a student group. Her talk was well received and she received a "three clap salute" that she can tell you about.

Wednesday clinic

Clinic continues to busy and interesting. One lesson learned is that too many patients have been scheduled for this "camp". (You sure learn a lot the first time you try to do something this ambitious!) The surgery schedule is essentially full through Tuesday, our last work day in Eldoret. Some of the first patients that were scheduled included large goiters that are causing discomfort in the neck. While these patients need surgery, their condition isn't life-threatening. So as more desparate cases show up, we are cancelling the goiters and replacing them with the other cases. Because there will continue to be clinics every day through Monday, many patients won't be offered surgery, but they will still be seen, evaluated, and advised by the ENT's.

keloid, post-op

Here is the keloid patient, post-op the next day. Keloids keep coming back so he'll never be rid of them due to genetic disposition, but he's so happy to have the large one gone! You see parts of surgical gloves sticking out of his suture lines. Well, those are being used as drains to drain any fluids that might otherwise collect. They will be removed with the sutures. He should be released from the hospital today (What is today? I think Thursday... time has less meaning these days...)

Digging a ditch

Drainage improvement project on the road to the hospital. A new drainage ditch is being hand dug by men using pick axes and shovels. First thing in the morning an outline is created with chalk for the day's digging. Then it's all manual labor. No backhoe here! They dig about 100' per day, nearly two feet wide an two to three feet deep. The sheep in one photo are just a bonus for our blog viewers.

Market scenes

A walk through the market on Monday before going to the hospital.

Lecture Monday

Dr. Michael Moore giving a lecture to 5th year medical students on Monday.

Sample of clinic from Tuesday

Here are some photos that Susan took of patients she saw in her clinic Tuesday evening...

keloid picture

Here is a man with the king of all keloids. It was so big, he had to carry it wherever he went. I don't want to be more gross than needed, but this thing carried infections, oozed puss, and let's just say that you're all lucky that you can't transmit smell over the internet.

I'll spare you the surgery photos. This was removed yesterday. After the man awoke from the anaesthetic, he kept saying "thank you, thank you, thank you!".

Tuesday

Another long day. As I write this at 8:30pm, Susan and the other ENT's are still seeing patients in clinic. we started our day hauling out equipment and supplies to the hospital. Actually, the hospital sent a van which had room for our gear, bit not us, so we walked.

Much of the morning was spent with diplomatic duties, tours, and the like. But also we sorted through our supplies which will pay dividends the rest of the trip.

I spent the majority of my day helping the "engineers" put together the "sinus tower". We were successful as the equipment worked and was used for one of the later cases today. This is equipment that Susan asked for from an equipment company who happily donated some used equipment. The hospital had no such equipment before.

I think the surgeons completed about 5 cases, but they had signed up many more! something will have to give. If my math is correct, you can't sign up ten surgeries each day but only complete five the next. We will see how this is resolved. My guess is they will have to turn patients away sooner than anticipated.

The "surgery of the day" had to be the removal of an enormous keloid. If you don't know what a keloid is, look it up. I hope to post pictures tomorrow. Let's just say this patient was very happy and relieved after the surgery was over. The giant keloid weighed in at 18 lbs.

Stay tuned…

Monday: what a long day.

Susan and gang gave lectures to medical students and then saw potential surgery patients… until 9:00pm! Everyone is exhausted. had a late supper of cheese sandwiches and beer back at IU House. There are ten patients signed up for surgery tomorrow, plus clinic to screen more patients, plus some diplomatic meet-and-greet duties before the day really gets going. Oh, and we need to cart our extra bags of medical equipment and supplies to the hospital in the morning. Can't do sinus surgery without the equipment!

Weather is great - hot and sunny.

Good to see friends from here again, either in the hospital or out on the streets.

Hope we get some real sleep tonight.

Welcome to Eldoret

We have arrived in Eldoret!

Nairobi

We made it to Nairobi safe and sound. We are staying at the Serena hotel which is very nice. We leave early in the morning for Eldoret. We did have a little trouble at the airport here. One of our "medical" bags is missing. we suspect that someone picked it up by accident, leaving behind a similar bag. We had a slight delay getting through customs. Susan had official letters for us all from both IU and the local hospital requesting that we be allowed to bring medical supplies. The letter from the hospital in Eldoret seemed to do the trick but the officer wanted to keep one of the letters for the office. we will be glad when we get all this stuff to Eldoret tomorrow (hopefully).

Of course, here's a Tusker beer…

Detroit: boarding for Amsterdam

Boarding in Detroit for Amsterdam waiting for takeoff. Lots of confusion at the desk in the terminal. Apparently the Delta aquisition of Northwest becomes complete this weekend and they are having many issues integrating their computer systems. Who knew that this transition would be more difficult than Y2K???

Indy airport

Every trip starts at McDonald's…

7 of our group of 1¹have checked in. Our 50 pound bags are checked through to Nairobi. That's a relief! Next stop: Detroit.