So...You want to take a night train from Paris to Italy?

There were really two fundamental flaws with this plan:
1.) Neither Harmony or I speak French OR Italian.
2.) Everything we knew about European train travel we learned from Harry Potter.

The trouble started when we arrived at our four person compartment and met the other two travelers - an elderly French couple who didn't speak a word of English. After a lot of pointing and awkward staring we did eventually get the sleeping arrangements sorted out.

So when we booked our tickets we ended up in a four person "couchette" compartment. A couchette is apparently a padded bench. We were lucky enough to have the top level couchette - suspended about six feet above the floor with nothing but two widely spaced straps to keep us from falling out of the "couchette" while we tried to sleep...on a MOVING TRAIN.

But wait, I'm getting ahead of myself. Before bed, we went in search of the dining car. And found...two Italians guys pushing a cart filled with wine and a few cans of Pringles. So, Pringles and nutella wafers for dinner it was!

After a rather restless night we woke up and ate some more nutella wafers with our coffee, pretending to be refreshed and ready for our single day sightseeing in Venice. At right around 9:30, the arrival time on our ticket, and 13 hours after leaving Paris the train slowed down and pulled into the station...at Milan. THREE HOURS from Venice.

We still have no idea what the delay was - apparently there was a "problem" overnight (assuming "problem" means the same thing in Italian as in English). As Harmony pointed out, "We should never have taken a Muggle train."

We did eventually get to Venice and figure out the vapretto system - boat public transit! - and find our (surprisingly upscale) hotel. Our bathroom alone is a 12 on my 10 point scale.

Our sightseeing today mostly consisted of finding an ATM, food, and gelato and taking pictures of buildings that might be famous - since Harmony's photography strategy is "take a picture now and then look up what it actually is later before I post it on Facebook".All that to say that I arrived safely in Europe. I'll be sure to post more photos when I get home. (since reading about sightseeing is even more boring than looking at a million pictures of the Eiffel tower) However I will keep you posted on any exciting train adventures or funny quotes by Harmony.

I'll leave you with an example:
Scene- at the Louvre
Beth: Didn't you have to take Art 101 in college?
Harmony (aghast): No! Of course not! Everything I know about art I learned from the Da Vinci Code.

Wrapping up

So, today is my last full day in Kenya. I can pretty easily say that I'm not ready to leave. While it's been challenging at times it's overall been a fantastic experience.

I haven't been that great lately about keeping my blog updated, part of that is related to the intermittent internet and part to sheer busy-ness. I've been spending the last 3 weeks rounding on the pediatric side, and found it difficult to blog about for several reasons. It's harder for me to see children with chronic diseases (rheumatic heart disease, malnutrition, etc) and know how disparate the care is between here and the US.

There were certainly kids who came in sick with acute illnesses (pneumonia, gastroenteritis, dehydration) who we were able to manage and send home after just a day or two. However, they aren't the ones who will haunt me when I go home.

One of the Kenyan pulmonary fellows commented today about the chronically ill patients (after rounding today on a 27 year old with HIV, dilated cardiomyopathy and presented with a STEMI) - "Patients like this, you know you see them in clinic over and over, and then when you don't see them anymore and you wonder, but you are afraid to ask. You know what happened, but you just don't want to ask."

However for this patient, a young mother, being able to receive ICU level care, anticoagulants and inotropes, may buy her at least a few more months than she would have otherwise. It's easy to get so overwhelmed that you lose sight of the person right in front of you that you can help, and the diffrence that it makes to them.

So this one time in Uganda...

Back By Popular Demand Following Technical Difficulties!

So, when I told everyone I'd have regular internet here, I may have been lying. THe internet has been pretty sporadic, so I have used that as an excuse to ignore the blog.
So - a quick update!
Last week I started out on the peds wards, switching from adult medicine. There is a lot I could say about that - initially was a very tough transition, mostly due to some very sick kids (by Kenyan OR US standards). However, things have settled down a little this week, fortunately.
Last Friday I also had the opportunity to travel to the AMPATH clinic in Turbo, a nearby village with Dr. Mamlin. I sat in with the clinical officer seeing patients, and it was a good experience seeing how AMPATH is transitioning from providing HIV care to providing primary care for thousands of patients here in Western Kenya. There are still a lot of challenges, but I'm optimistic that it's actually working! As anyone who has been here before knows, it's hard to spend any amount of time with Dr. Mamlin and not be inspired.

While at Turbo I was able to sit in on an initial visit, which was an interesting experience. A young man and his wife came to the clinic after he tested positive for HIV the previous day while being treated for malaria. Once he tested positive, his wife was also tested and her test was negative. You could feel their anxiety in the room. The husband's only question after the history and physical was "So, I am now positive for the virus, pbut my wife is negative. What do we do now to keep her and our children safe?" The young man was enrolled in the AMPATH program and had an initial laboratory evalutation, and we gave him medicine for oral thrush. Sagita, the clinical officier, counselled this man and his wife on safe sex practices and discussed what it means to be a discordant couple. He will come back in a couple of weeks for follow up to see what his CD4 count is and to determine if he needs antiretroviral medications. However, by the end of the visit, though obviously still reeling from this diagnosis, they seemed to leave with a sense of hope.

Sagita, the C.O and Lillian, a mental health practioner

Rose, the cook in her kitchen

One of the clinic workers demonstrating how to eat ugali

At Turbo I was also graded on my ugali-eating skills. Ugali is the local staple - made of boiled corn flour. I've described it before as having the texture of polenta but the consistency of playdoh. Regardless, I think it's delicious! This ugali, cooked by a woman named Rose was some of the best I'd ever had! I was given a ridiculously large hunk of ugali, along with some kale and meat, and managed to eat all of it, and so scored an "A." I was pretty proud of myself for that.

After Turbo we spent the weekend in beautiful Lake Bogoria, in a tent that could only be described as "princess camping" The tent itself had an attached bathroom (score of 10/10) and beds, as well as a balcony from which you could watch the sunset. It was a nice weekend of relaxing, birdwatching and hippo spotting.

Princess camping tent, complete with bed and freestanding wardrobe!

Sorry for the long delay - hopefully the next post will be sooner!

Kenyan Bathroom Rating Scale

As you will quickly learn in Africa, there is a broad spectrum of bathroom experiences, and no blog is complete without a picture of a typical "choo." To simplify things, I am working on a numerical scoring system for rating bathrooms.



Toilet (as opposed to hole in the ground) = 2 points
Toilet seat = 2 points
Toilet paper = 2 points
Running water = 2 points
Soap = 2 points

The choo pictured above received a score of 4 points. (Toilet paper + running water)

I had an interesting morning today - we went to an outreach for street children. Many of you know that Eldoret has a large population of street children. There are several organizations that work with these kids, notably one called Tumaini Center, which is a drop in center for the kids. There are a lot of reasons why kids end up on the street - some are orphans, others live with relatives and enjoy the freedom of the streets day to day, others are homeless and have no one.
The outreach today was a soccer game for the older boys, and several of us played ultimate frisbee with the younger kids - probably 7-13 yearolds for the most part. The kids were all very friendly and seemed to enjoy the game, once they figured out the rules. One thing that really bothered me was the amount of substance abuse among these kids - glue sniffing is rampant. Almost all of the kids had bottles of glue, and many of them were playing ultimate with while holding the bottles in their mouths. Many of the kids were bright and engaging; the glue sniffing just seems like such a waste!
It was nice though to meet the kids on their own terms and to see them having a chance to play and be kids After the games we passed out bread and milk. Afterward we saw a few of the kids on the street in town; they seemed happy to see us. I hope I get to go back again, just to hang out with the kids. No pictures of this event - both out of fear my camera would be stolen and not wanting to come off as that mzungu who just wants pictures of the kids for my own purposes- maybe another time.

Overdue pictures of animals! And Mountains!

Well, I had meant to post this over a week ago, but our internet has been very spotty this last week. Also, I like posting pictures and it always feels a little awkward to take pictures of patients on the wards. Last weekend we took a trip to Hell's Gate, Lake Naivasha, and Mount Longonot National Park. I have to say, it was probably the most fun trip I've been on in my three trips to Kenya.

It was about a 4 hour drive to the parks, and we started on Saturday with Hell's Gate. There aren't any carnivores in the park, so you can hike and even rent mountain bikes to bike around the park. The bikes were all probably 15+ years old with varying braking and shifting capacities - mine was nice and had TWO working gears. :) As you bike along the dirt road you can see ostrich, zebra, warthogs, giraffe, and assorted gazelle-like animals, and eventually reached the gorge.


With our driver and tour guide-extraordinare, Javann, we hiked down into the gorge.
The gorge is probably at least a mile in length, with high walls carved by the river at the bottom (just a stream while we were there) After hiking through the gorge and then back to the top, we were ready for the bike back to the gate. However, due to poor planning on the part of the Kenya Wildlife Service, the bike back to the gate was entirely uphill. :)

The next morning we woke up early to go to Lake Naivasha, where parts of the film Out of Africa were shot. We took a boat tour to see hippos and birds and were able to take a walking tour of Crescent Island, where giraffe and wildebeast and zebra and assorted gazelle roam freely.

After our boat tour we headed over to Mount Longonot national park, an extinct volcano, standing about 9,000 feet high. You climb up the mountain to the rim of the crater, and then hike around the rim. It was a long hike, but definitely worth the sunburn (and subsequent two days of residual soreness) once we got to the top!