Weekend at Lake Victoria

We are spending the weekend at Kiboko Bay Resort, a small tented resort on the shores of Lake Victoria, near the city of Kisumu, about 3 hours drive from Eldoret. Lake Victoria is the second largest freshwater lake in the world. (Lake Superior is, well, superior.) Most of the lake is in Uganda and Tanzania, with just a bit in Kenya. Lake Victoria is the source of the great Nile River, traveling north from here all the way to the Mediterranean Sea.

Quiz time: What will you find in "Kiboko Bay"? Hint: Kiboko is a Swahili word.

Flowers are so happy here

Flowers are so happy here. They can't help themselves. They bloom everywhere.

Saturday morning rounds

All the remaining ENT patients are being discharged today. The men's side is already empty. That is until surgeries start up again on Monday...

Showerhead technology

I have previously written about the hot water showerheads here. Most homes don't have a hot water heater and two-pipe (hot and cold) indoor plumbing. These showerheads have an electric line going to them and they have a little heater inside that heats the water as it's passing through. It's a great thing to have here and a great idea, but there is a trade-off between water pressure and temperature. The more you turn up the pressure, the cooler the output of the shower becomes. So do you want more water that's rather lukewarm at best? Or a nice hot trickle? Well, our shower head has been replaced with a new model sometime over the last year. Apparently they have improved the technology and efficiency. You can now have a pretty reasonably hot shower. It's a noticeable improvement this year.

Oh, but I do miss my Kohler shower head at home. It was a gift from Aunt Ellen, my aunt by marriage. She works for Kohler in Sheboygan, Wisconsin. This showerhead has a built-in bluetooth speaker. So I can listen to whatever I want from my iPhone while I'm in the shower (usually ESPN). The speaker module is removable. It is held in place by hidden magnets. I just pop it out every week or two and charge the internal battery. It's awesome!

New Cancer Center

The Hospital is building a cancer center that will include chemotherapy and radiation therapy. Today, the only radiation therapy available is in Nairobi or Uganda. For most people in this region, going to either is not feasible due to cost and distance. Having radiation locally will drastically improve access and save lives.

Not called a "funeral home"

Patient logistics and life on the ward

The ENT patients stay in "Elgon Ward." The pictures above show the building, the central nurses station as you walk in the door, and then there is a women's wing to the left and men's wing to the right.

Patients that are scheduled for surgery will meet in the ENT clinic the afternoon before their scheduled surgery. They collect their charts and then as a group are walked to the ward where they will spend the night. When it is time for their surgery, they will walk to the operating theatres. After the surgery they are taken to a recovery room where they are observed and monitored for a while and then they are taken back to the ward where they will spend at least one more night.

Why do they come the day before and spend the night? I think the main reason is that many travel a long distance and travel is not easy here, so it would not be practical to come the day of surgery. It also prevents no-show problems. Why do they stay at least one night after surgery? Again primarily because of the travel but also because they were under a general anesthetic and it gives them more time to recover. There is talk of allowing some patients to go home the same day in the future but that hasn't happened yet.

At least some of our surgeons do rounds on the ward first thing every morning and last thing in the evening before leaving for the day. They check on the patients, replace dressings where appropriate, and decide who's ready to be discharged. Incidentally, the patient cannot leave until their bill has been paid.

There's no heat or air conditioning in these buildings but it doesn't really matter because the weather is typically so pleasant. There are mosquito nets above each bed. They are pulled up during the day and dropped down at night.

The wards are crowded. There are typically two patients to a bed. If they are both adults, they will be laying down head to toe so that they don't have to be face-to-face in a little twin size bed. If one or both patients are a child they are more likely to be face-to-face. If a patient is a child, that patient will stay in whichever wing matches the gender of the parent that is with them so a boy child will be staying in the women's wing with his mother or men's wing with his father.

Any family members or loved ones that are with the patient have to sort of make room for themselves amongst everybody else. During the day it is common to see a loved one sitting on the edge of a bed adjacent to the patient they are spending time with. So that means that a bed with two patients already on it might have somebody else also trying to sit on it so they can be talking to their loved one in the adjacent bed. It gets pretty darn crowded. Nobody seems to mind the lack of privacy or personal space. That's just the way it is here.

Guard dogs

The sign on the gate to the IU house complex says "MBWA KALI". Mbwa is the Swahili word for Dog or dogs. Kali translates to severe or intense. In Swahili, the adjective follows the subject, so the literal translation is "severe dogs" or "intense dogs" as a warning. Note in English the sign says "be aware of dogs" instead of "beware of dogs". Close enough.

The lower pictures show those guard dogs. Two friendly, playful little puppies. They are cute and fun to play with.

Artist at work

We've been handing out little coloring books and crayons to the young patients...

Patient responsibilities

Patients are responsible for their "investigations" (labs, tests) and their "findings" (results). Patients coming into the clinic bring any test results with them, including CT scan films, ultrasound pictures, lab results etc. There aren't electronic medical records. The patient is expected to transport any test info themselves.

Perhaps the oddest thing to me is that the patient is responsible for taking things to the pathology department themselves. For example, I've seen a biopsy taken in the clinic. The tissue is put in a specimen bottle, the lid is screwed on, and tape is placed around the cap to make sure the cap doesn't come loose. It is then given to the patient to take to pathology.

Incidentally, the tape is the basic 1" white cloth tape you typically see in medical settings. Here they refer to it as "strapping".

Walking Together, Walking Far

Dr. Joe Mamlin is one of the founders of the IU partnership with the local medical school here. He and his wife, Sarah Ellen, have lived here for years doing their work. We find them to be very inspiring people.  Susan will quickly tell you that she would do anything for Joe.

"Walking Together, Walking Far" is a book about the creation of the partnership. It's a very interesting read. If I remember correctly, the title comes from the notion that if you walk alone, you can walk fast. But if you walk together, you can walk farther.

The description of the book is:

A remarkable partnership between the Indiana University School of Medicine and the Moi University School of Medicine in Kenya has built one of the most comprehensive and successful programs in the world to control HIV/AIDS. Calling upon the resources of the Americans, the ingenuity of the Kenyans, and their shared determination to care for patients who had been given up for dead, the program has been nominated for a Nobel Peace Prize and described as a miracle by the U.S. ambassador to Kenya. Doctors from Kenya and the United States—employing methods once considered unfeasible, such as successfully administered antiretroviral regimes—have created a model program for saving lives and empowering the sick and impoverished. Against formidable odds, these partners demonstrate how medicine and caring can overturn preconceived notions about Africa and help wipe out the world's most devastating pandemic.

Sent from Kyle's AT&T iPhone

Dr. Joe Mamlin

Dr. Joe Mamlin found Susan at breakfast this morning and consulted with her on a very interesting patient case. Joe has taken a personal interest in a patient with a disfiguring fungal infection in her face. Technically her diagnosis is "giant orbito-facial basidiobolomycisis". I get the impression this is very rare.

Joe is working to cure the fungal infection, which may take a year. In the mean time Susan will research to find any literature on how to reconstruct/repair her face from a plastic surgery perspective. She will arrange for a plastic surgeon to come and do the surgery or get prepared to do it herself.

If she can't find any literature on reconstructing after such an infection, she will write a case report to be published so that there will be info available for the next surgeon faced with such a case.

Happy birthday

Last night, after a very long day in theatre plus seeing more patients back in the ENT clinic (until 8:15pm), we were invited to Henry and Fridah's house for dinner. First we celebrated the birthday of their fourth daughter, Hope. She turned 3 yesterday. In the photo, Hope gets help cutting the cake with big sister Ashley looking on.

ENT HQ

Here's Kathi at the ENT command center located between the two operating rooms dedicated to ENT this week.

Wednesday, Operating "Theatre"

Top: Kia and Susan performing sinus surgery using equipment we brought a few years ago, donated by Stryker.

Bottom: Henry and Bruce removing a sub-mandibular mass.

Mangos

Henry, one of the local ENT's and a good friend, brought us some fresh mangos. We enjoyed a few at breakfast this morning.

Lights out

Clinic is going late this evening, and now the electricity went out and no generator kicked in. So everyone is working with headlights and cell phone lights and pushing through. There are more patients to be seen!

Patient laundry

Every day there is patient laundry hanging up to dry between the patient wards at the hospital. Family members typically do the washing in large plastic pails and dry the laundry on clothes lines or on top of bushes.

Coke names

Most days I buy a case of sodas from a nearby duka (shop) and take them to the operating theatre for refreshments.

Similar to Coke's recent marketing plan in the US where they put names on Coke cans and bottles, here they put names on bottle caps of the returnable glass bottles.

More on clinic

Here's Kia examining a boy with a thyroglossal duct cyst. His mom didn't speak English, so a med student acted as an interpreter. And he probably learned from Kia's exam at the same time.

Crowded clinic

On Tuesday, the surgeons, residents, and nurses were busy in the "theatre" (operating room). I will go there tomorrow so I can post some photos. In the meantime, as surgeries were wrapping up in the mid-afternoon, Susan, Kia, and Diana went back to the ENT clinic to see more patients. This photo shows that the main clinic room is packed. In addition to the patients, family members, doctors and nurses; there are also eight medical students observing today.

More on cell phones

Here are examples of the messages received after making a call or sending a text, telling you how much you were charged.

KES = Ksh = Kenyan shillings.
Current exchange rate, $1.00 = 93 Ksh.

Let's talk... about cell phones

In the US, we pay monthly for cell service, even if it's a discount "prepaid" service.  Typically calls and text messages are included plus a certain amount of data services if it's for a smart phone.  

In Kenya, it is uncommon to pay for service by the month although it is an option. Most Kenyans elect to pay for airtime.  You pay for airtime by buying scratch cards. Like a scratch-off lottery ticket, you scratch off the gray coating to reveal a long PIN number.  Then you dial a series of numbers including the pin code and "send" to add the value to your account. 

See photos below of front and back of a 100 shilling scratch card. It's worth a little more than a dollar. It can be used to apply that value for calls/texts or for data services. After each call you make or text you send, you automatically receive a message telling you how much value that call or text cost. The cost is based on the length of the call and perhaps time of day and if the call was made to another customer of the same carrier or a different carrier.

Incidentally, because the pricing is different here in Kenya than in the US, it drives different behavior.  For example, calls here tend to be very brief and to the point. Kenyans don't get chatty on a phone call when paying by the second. At the end of the conversation they simply hang up. There may not even be a "goodbye".

When we first started coming here, the cell companies would handout Sim cards on the street hoping people would take them and then buy airtime from that company. Then a couple of years ago a federal law was implemented requiring all SIM cards to be registered.  Now each SIM card and phone number needs to be registered with an official ID such as a passport or drivers license.  The purpose of this is to prevent criminals from using "burner" or throw away cell phones in the process of committing crimes.

So the last couple of years it has been more difficult to get SIM cards. You had to go to a cell company's retail store to buy and register SIM cards. Also, if you don't use your cell service for three months, it automatically expires. Because of this I have to go through the process of buying SIM cards and registering them every year when we come here.

Now this year at least one of the carriers has gotten more aggressive with its marketing, and it is stationing people in various high-traffic areas with SIM cards to more easily facilitate the process. The upper picture shows a little table roadside with SIM card packages on it and a company representative who will do the registration process online via the phone. 

All in all the cost of owning and using a cell phone in Kenya is far less then in the US. I use an older iPhone while here and I probably won't spend more than $5 for voice, texting, and data.  Most people here have a simple "bar" style cell phone that makes calls and does simple text messaging.  They typically cost about $30 new or half that used. But I am seeing more and more smart phones here every year.

The data services here fail in comparison to the AT&T data services that I'm used to at home.  In most of the country there are 2G data services available and some 3G in the cities.  Even the 3G data is very, very slow. I'm a spoiled with 4G LTE high-speed data we have in the US.

Another difference here is that the cell phone companies also offer some banking services.  Many Kenyans don't have access to a regular bank. So the cell companies offer financial services similar to PayPal in a way. You can add money to your account and send money from your account to other people's accounts using the cell company network. This can be useful for paying for goods or services, or for sending funds back to relatives in a village that may need your financial support.

That's enough about cell phones, at least for now…

Sent from Kyle's AT&T iPhone

Wal-mart

Nakumatt, the Wal-Mart of Kenya. They have everything. Now open 24 hours.

Morning commute obstacles

Well, the cows aren't really obstacles, but do watch your step.

Swahili lessons

I have restarted my Swahili lessons with the local teacher, or mwalimu in Swahili, as I do each year. Because I don't keep it up, I always restart at lesson 1, but I made it through the first 4 lessons in my hour this morning. Maybe by the end of this trip I will actually advance further this year. We'll see...

For my AT&T friennds

In February of 2010 I posted the lower picture, noting that "innerduct" had recently been trenched in and I was excited that soon a fiber optic cable would be installed in it. I hoped that the area would then perhaps have better internet access speeds.

Well, five years later, I'm still waiting. Still no cable; just an empty innerduct.

No Ebola here

Ebola is on the other side of the continent, nowhere near Kenya, but there are educational posters in the hospital.