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.

Sent from Kyle's AT&T iPhone

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...

Sent from Kyle's AT&T iPhone

"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!

Shoe repair

> Yesterday, Susan broke her shoe. Actually, where a strap was sewn into a seam, the seam let go. She loves these shoes for Kenya as they look nice, they are comfortable, and they aren't black so they don't show the dust/dirt so much.
>
> One good thing about Eldoret is that they have everything in town. The first time we came with David Matthews, one of the people he introduced us to was James, a shoe cobbler friend of his that went to the same church when the Matthews' used to live here. My Swahili teacher was able to show me on a map where to find him as he works in one of the alley shops and is difficult to find if you don't know where to look.
>
> It took him about five minutes to do the repair. He cut off the loose and frayed threads, dabbed some glue on the end of the strap that had come out, inserted it back into the seam, and used his tools to hand sew the seam again. Perfect!
>

"posting bills"

I saw a man "posting bills" this morning. He had a bucket of paste and a brush and a stack of these fliers. At every utility pole, he stopped, dipped his brush in the paste, slathered it on the back of a flier, and slapped it on the pole. The flier is advertising computer training classes - Excel, Powerpoint, etc. The entire package of 10 basic classes, including things like Excel, PowerPoint, and basic keyboarding costs 2,800/= (Kenyan shillings) or about $36.

Tuesday, day 3

Another busy day. Susan ended up staffing the clinic all day while the others were in surgery. I ended up "assisting" Susan for a while in clinic. I'm still amazed at what the physicians do and how they help people and how the need is simply endless.

Banana truck, part 2

So I'm re-posting my banana truck picture. Why? Because I fell victim to framing things within my own culture and context.

So I was visiting with my friends in the hospital's biomedical engineering workshop, asking questions about political, cultural, and agricultural topics.

One question I asked was how long before the green bananas ripen. Well, I learned there are different types of bananas and some are simply green. I showed them the picture on my iPhone. At one glance they said those were green bananas from Uganda. They are to be cooked. You can peel them and then boil or stew, or you can roast and then peel. My informal preference poll results were: two preferred boiled, two stewed, and one roasted.

Some get trucked from Uganda, across Kenya to Mombasa, the port, and are exported to Saudi Arabia and others.

Lesson learned.

Speed bumps

Dang! Our nice new road is getting speed bumps! The road is very short. I can't imagine speed is a problem. Speed bumps here are vicious! I'm not sure if it's the size/height of them or the fact that the suspension is shot in just about every vehicle. Probably both.

Banana truck

Speaking of bananas, there are two of these banana trucks parked outside the main vegetable market downtown this morning. That's a lot of bananas! They are dark green. I wonder how long before they are yellow.

I wish I could do this...

This woman is carrying a bag on her head. Her balance is perfect. No hands. And she's walking way fast. Sometimes I see women carrying huge bundles of bananas like this. Those must be heavy. I believe this woman may be carrying "charcoal" which is wood sticks and branches that have been super-heated to drive out all the moisture. It is used for cooking.

Hindu Temple

There are many Indians of the Hindu faith living in Kenya. They have been building a new temple for over a year. Attached is a current photo and a photo from November. You can see that good progress is being made. Slow but steady.

Monday. Day two

I hope I don't fall asleep before I finish this post. It's 11:00pm here. We recently returned from dinner and are winding down, answering emails and checking in with the rest of the world.

The medical team hit the ground running this morning. They removed some king-sized goiters, did a sinus case, and... I don't know what all they did. By mid afternoon they made their way to the ENT clinic to screen patients for tomorrows surgeries.

My first assignment today was to visit the hospital head of pharmacy. He is associated with Purdue and has been here for a number of years. My assignment? Pick up a few doses of ARV's, Antiretrovirals. These are medicines that one would take after being exposed to HIV. Taken soon enough after exposure, they can prevent an HIV infection. This is a precautionary measure. The surgeons and nurses want these on hand "just in case" they accidentally get "stuck" with an instrument while operating on an HIV+ patient. We get these for every surgical trip and then return them to the pharmacy before we leave. Standard procedure. The same thing would happen back home but it makes you pause and think about the HIV risk when you go pick up such meds.

I had a Swahili lesson today and hope to have a one hour lesson each day while I'm here. The "mwalimu" (teacher) is very good and keeps it fun and interesting.

I was able to set up the flexible endoscope from Olympus in the ENT clinic today and see it used on a patient. I now know what the anatomy really looks like going through the nose, nasopharynx, oropharynx, and larynx, including the vocal cords. While watching on the monitor I listened as Susan asked her to say "ahh" and watched the vocal cords come together. It was really cool to see on the video monitor we just brought.

Final note: in this photo, Susan is examining a surgery patient for tomorrow and using it as a teaching moment for some medical students.

Stryker Sinus equipment

This is the sinus tower donated by Stryker last. It is being used regularly and the team us glad to have it here.

Walking to town

Walked under this nice flowering tree.

Siam Chinese Restaurant

All 10 of us met up at our favorite Chinese restaurant! We had a very enjoyable dinner after a long day.

Day one, Sunday

So today we were up at 5:00am, which is really 9:00pm back home. No wonder we are so tired! A van took us to the airport and then returned to the hotel and picked up 19 pieces of luggage and took them to some transit terminal in Nairobi to be trucked up to Eldoret.

We flew Jetlink to Eldoret. Flight time is only 30 minutes. Our ride was waiting for us and took us to IU House.

Everyone settled in, then we walked into town, hit the ATMs, had lunch, and visited a couple stores for some essentials. Then we walked to the hospital. Susan gave a tour for the group while I sorted out our cell phones, SIM cards, and pre-paid minutes. (Everyone in the group now has a working Kenyan cell.)

We then went to the ENT clinic. Patients and staff were expecting us. The medical people screened and reviewed patients that are scheduled for surgery tomorrow. Worth noting here: unlike the US, tomorrow's surgery patients are admitted to the hospital today! I suppose here it must be done that way because most rely on public transportation and probably can't get to the hospital early in a reliable fashion. When clinic was winding down, our friend and IU driver, Javen, called...

He had picked up our luggage at the Eldoret transit terminal. We had him meet us at the hospital and we collected the bags that had medical equipment and supplies and took them to Dr. Sisenda's office for sorting and storage. Javen the took the rest to IU House for us.

The medical team then sorted through the bags enough to gather supplies they want for tomorrow's surgeries.

Now we are back at IU House in time for dinner. And hopefully a good night's sleep.

Sent from Kyle's AT&T iPhone

Sorting supplies

Susan, Mike, and Diana sort some supplies to prepare for tomorrow's surgeries.

ENT Clinic

Drs. Moberly and Weisberger with a patient.

Guard dogs

The guard dogs rest in the mid-afternoon shade... So they can bark at phantom noises during the night.

Road construction update

For those who were following our blog in November, you will recall that the road leading to IU house was being rebuilt. This is a private road inside the (security) gated neighborhood- I assume not a public project. I questioned if the work would be complete by the time we returned in February as the work was mostly manually done and it was hot and heavy work. Well, the road surface is complete and they did a beautiful job. We assumed the top coat would be a nice smooth asphalt. But instead, it is finished in brick pavers. It is so very nice. Above are the final product and a couple pictures from November.

Gotta keep movin'

Hear heavy footsteps behind you? Maybe it's a small herd of cows on the move.

Prime Chic Inn

Lunch!

Indiana House

We have arrived at Indiana House in Eldoret!

Fairview Hotel, Nairobi

Here's the photo that says we have safely arrived in Nairobi.

Schiphol Airport, Amsterdam. Halfway there!

Leaving Detroit

We scored exit row seats for our flight to Amsterdam. Legroom!

Entertainment plan

You've got to have a plan for passing the time when you'll spend the next 24 hours on planes... And especially if you don't really sleep on a plane. Our plan is to watch movies on the last long flight (Amsterdam --> Nairobi) when we're too tired to read. On the earlier flights we'll catch up on our magazine reading and shed carry-on weight in doing so before moving on to books. We will start with "This Old House" because we both read it. Then she'll read her fashion mags while I look at "Bon Appetit". I'll tear out some recipes hoping to try them. Some day...

Indy airport, Harry & Izzy's

Here's our traveling group: Susan, Donna, Ed, Mike, Aaron, & Betsy. And I'm hidden behind the camera...

Kenya February 2011

Tomorrow we depart for Kenya.  The hardest part about leaving, as always, is leaving Kido behind.  Thankfully, she will be in good hands at home with our housesitter/petsitter.  And as on our last trip, we will be able to spy on her via "kidocam" on our iPhones.

There will be 10 of us on this trip:

Susan Cordes (ENT)

Ed Weisberger (ENT)

Mike Moore (ENT)

*Aaron Moberly (ENT Resident)

Diana Sullivan (nurse)

Heather Cain (nurse)

*Leslie Helfert (Anaesthesiologist Resident, wife of Mike)

*Betsy Moberly (ER Physician, wife of Aaron)

Donna Weisberger (former teacher, wife of Ed)

Kyle Cordes (travel agent, mr. fixit, phone guy, blogger, husband of Susan)

(*) represents Kenya rookie status

The surgeons and nurses will be working with counterparts at Moi Teaching and Referral Hospital (MTRH) in Eldoret, Kenya.  The focus of this trip is to work with the Kenyan ENTs to screen and operate on thyroid patients (goiters) and to help train medical students.  The Kenyan ENT's have been pre-screening patients and scheduling them for surgery in the coming days.

Leslie is on a training rotation and arrived a couple weeks ago.  Diana left a week ago as she wanted more time to observe and teach before the big group arrives.  The rest of us depart tomorrow (Friday) and will arrive in Nairobi Saturday night.  We will spend the night in Nairobi and then fly up to Eldoret on Sunday morning.  The surgeons will go to clinic at noon to screen/review the patients scheduled for surgery on Monday.  And it will be game on!

Susan and Heather have been making requests for equipment and supplies from various medical supply companies, mostly with pretty good success.  (See previous entry on Olympus.)  They have also been saving unused supplies from home that otherwise would have been discarded.  Susan and I have packed an extra 50 pound suitcase for each traveler to take, since we each are allowed two such bags on international flights.  When we get to Nairobi, we are restricted to one bag for our flight to Eldoret, so we are having our excess luggage trucked to Eldoret.  It should arrive sometime Sunday afternoon.

Stay tuned for regular updates and more info...

Olympus donation

Olympus donated a flexible endoscope with light source, video processor, and HD monitor. The ENT clinic at MTRH (Moi Teaching and Referral Hospital) will love this! We just have to get it there... Thanks Olympus, you're awesome!

Getting ready for next trip to Kenya

Susan's office is a mess. It's time to start packing supplies and equipment to take to Kenya. Olympus is donating a flexible nasopharyngo endoscope for the ENT clinic in Eldoret. We seem to have a mismatch of components and hope we can get things straightened out with the Olympus rep before our trip! The clinic will really benefit from having this equipment. And we can't do the rest of our packing until this is figured out as this is the most important thing we are taking. We will be there in three weeks. Just the usual pre-trip stress...