My impression of Kenya is that of a beautiful and spirited country ravished by AIDS and poverty. It is an ironic description, but the theme repeats itself as you travel and work in Eldoret. The city seems full of people so generous and kind who are appreciative of your care and your presence, but they struggle for food and money. They sell their fruits and vegetables for pennies hoping to provide for their families. But their greetings are always warm and heartfelt and every passerby says "Jambo" (hello) and responds "Nzuri" (I'm well). The people rise with the sun and go to bed with the sun. They live without our modern distractions and make you realize how different our life is from theirs, but also how we have chosen to have those "distractions" in our life, and how we can change our life to be as pleasurably simplistic as theirs.

In the hospital, the people are so thankful for our presence and touch, despite the fact many of them are dying. Their families travel great distances on foot to see the "daktari" (doctor). The wards are full of old rusting iron beds lined against the wall where patients can sleep 2-3 per bed. They never complain or demand to be moved, they are again, just appreciative of the our care. The sun provides the light and the open windows the ventilation. The sheets are old and dingy, the charts are paper folders, and the diagnostic tests are limited and often inaccurate. When you first arrive as the "consultant" (teaching staff), you can become frustrated by the fact that the students do not examine the patients daily, there are usually no vitals, the labs take days to return (or may be lost), and the therapies are limited for these who are critically ill. But the Moi hospital helps the people of Eldoret. Patients survive and go home to their families. Moi hospital provides education and jobs to many of the people. It provides a source of healing and hope for the community.

The medical students and officers give and receive education so eagerly. We, as residents, struggle with their "system" but soon realized that we are not their to "convert" them to our way of Western medicine but rather offer education in a way that supplements their own system. It does no good to talk about VQ scans, for example -- the students give you a puzzled look. Instead, you help educate them about the clinical signs of pulmonary embolus -- this they understand and can use. I spent most of my time teaching physical exam and clinically applied differential
diagnosis. The students respond well to this and use these as tools and building blocks. They in turn teach me about malaria, roundworms, and tropical sprue. The most common diseases that saw I while in Kenya were HIV and its complications (PCP, Kaposi sarcoma, lymphoma), malaria, rheumatic fever, meningitis, tuberculosis just to name a few. On Pediatrics, there was Burktitts lymphoma and Wilms tumors, pneumonia, malnutrition, malaria, and HIV. The people who have the courage or strength to come to the hospital often do not have the money to afford the therapies. So, if we are able to make a diagnosis or probable diagnosis, they lack the money for treatment or cure. Luckily the various universities that support the exchange program provide many drug samples to assist the people. Antibiotics, inhalers, anti-hypertensives, anti-inflammatories and many more medications are given to these people.

The education comes quickly and the amount of HIV is alarming. After working with Dr Mamlin, who has shared his heart and mind with these people, you realize the barriers this country faces: money, education, acceptance. The city of Eldoret is full of signs warning about HIV and educating the masses about how it is spread, but the people are scared about finding out and do not have the money or resources for HIV treatment. Some are in denial and some are ashamed. Some beat their spouses and destroy families if a wife or child is diagnosed. Many continue to spread the disease in response to their diagnosis. The fears are high. However, you cry for joy when you meet one person who has the courage to get tested and to have the family tested! Now the country needs the medications and the IU team is working with grant money and various foundations to make it happen -- not only treatment but also prevention.

As a resident, your day consists of rounding with the ward team during the morning (starts approximately 8:30-9 AM) and working up new admissions during the afternoons. Your team alternates admissions, so every other day you will have new patients arrive. On the off days, the team can give lectures or do procedures during the afternoon. Your team consists of you (as the consultant), an intern, 2 clinical officers, and 4-5 medical students. The average patient census is between 10-20 patients. The medical and pediatric wards are all in one area divided by a hallway. The outside hospital is lined with barbed wire fence so that those who cannot pay their bill cannot leave. The buildings are old and the wards are simple. One cart holds all the medicines and one small trash can. The supplies are limited: gloves, cotton balls, 2 sizes of needles, and alcohol wipes. The nurse's "station" consists of a wooden desk and chair. The hallways are cleaned first thing in the morning after dawn and after the deceased have been removed.

You live at the IU house, a five house "compound" located in Eldoret that is about 2 blocks from the hospital. The surrounding community is green and beautiful and the walk to work is picturesque. The houses are gated and guarded and create a safe environment. Each house has 4 bedrooms and 2-3 bathrooms. Each house and bedroom and named, and I lived in house 4 (the house of flowers, in the Nandi flame room -- a red blossomed tree in Kenya). The rooms and living style is like that of a dormitory but more comfortable. You certainly do not feel that you are living in an impoverished third world country. The other houses are full of other residents, staff and visitors. The IU house is supported with a cook, office manager and assistant. While I was there, the IU house was lead by Dr and Mrs. Joe Mamlin, two wonderfully compassionate people who have devoted so much of their time, talent and money to the Kenyans. The love what they do and are so respected by the people. The offer so much to them: healing, hope, and genuine love. Dr. Mamlin staffs the wards and runs an HIV clinic in the village. His drive to help and heal these ill people is amazing and his search for he monetary and medicinal resources is inspiring. Mrs. Mamlin dedicates her time to the childrens' wards and heads all the creative projects, including art projects, books, games and musical tapes. She loves the children and they love her. Certainly while you live at the IU house, the Mamlins feel like your parents. Lunch and dinner are shared with everyone sitting around a large table and talking about the day. The stories to share are endless and the large table gathering makes you feel warm.

Your weekends off gives you time to explore the city and country around you. Whether you walk into the city to explore the handmade treasures or buy fresh fruit or you travel across the country to see the national parks and lakes full of beautiful animals, this place has so much to offer! While I was there, I often ate at the local Kenyan restaurants (called "hotel") with my medical students and discovered bakeries and surprisingly, a number of internet cafes with my fellow residents. On weekends, I traveled to Masaai Mara, Lakes Baringo and Bogoria and Nakura, Mount Kenya to name a few. The city, despite its poverty and disease, is trying to expand and develop itself. The beautiful, spacious green land and hills though is such a contrast to the crowded urban areas of America.

Kenya is truly God's country!  AM