Thursday, July 29, 2010

Nothing is ever easy in Kenya





MDK-20100709-0063, originally uploaded by monkeydoc


Thanks to Bill Tierney - I've made a major find at JKIA - it's called the Simba Restaurant - in the main terminal building outside security. After a short, small elevator ride to the 5th floor, there is a humble restaurant complete with a nice bar seating area. The real score though, is free wifi!

I didn't know exactly how much I would need the wifi until I got an e-mail from Kelvin today - "the system is not working, we cannot search" which is an ominous sign. The PACS system cannot function without the search algorithm, so this is a big problem. I immediately pulled out my laptop and attempted to log into the system using the unreliable, frequently unavailable public IP address. Luckily, the internet gods smiled on my plight and I was able to log in, find the bug, and fix it. I could just see the system being down for months immediately after I came to get things fixed, which would have been awful.

My #1 goal for the trip was to have my server and the AMPATH server exchange messages. I'm proud to report that step one for that process is complete referralPACS has successfully transferred a message to AMRS - yeah! The downer is that the message format needs some work, so we're not 100% hooked up yet. I'll take forward progress however I find it.

The other thing that I've been working on is a mobile CXR system that fits into a small SUV. Working with some folks from the NIH we're working on a proposal that will allow us to obtain digital X-rays of folks all over western Kenya - stay tuned.

Overall this has been a really great trip. I've made some amazing new friends, and got to spend quality time with several others.

Tuesday, July 27, 2010

love made visible.




MDK-20100725-0334, originally uploaded by monkeydoc


The last time that we talked, I was lamenting my laptop power situation. Well the guy in town couldn't fix my power cable, but salvation did come this weekend in the form of Paul Biondich and one bad-ass battery from hyper mac. Paul let me borrow it all weekend. It was sooooo amazing to be able to use my laptop again. I also realize now just how much I'm hooked on OsX, especially Spaces and Expose which are just all around amazing.

That was the beginning to an amazing weekend. Rose, Monica, Erin and I decided to cook dinner on our own Saturday night rather than going out. We had also hoped to convince Joe and Sarah Ellen to let us cook for them. Things were slightly complicated because the Mamlins would be entertaining a V.I.P. for the weekend - Sylvia McNair. She's a two-time Grammy winning soprano on the faculty at IU, who is visiting the IU Kenya program. Incidentally, Joe and Sarah Ellen love her and never missed one of her performances when they were living in Indiana.

Saturday morning I went by the Mamlin's house to see what the plan was and it was obvious that Joe really just wanted to go out for dinner, but Sarah Ellen had the cutest little gleam in her eye....




MDK-20100725-0331, originally uploaded by monkeydoc


She has within the last six months obtained a new range/oven which is dual fuel, and has a rotisserie!

Erin had obtained two recipes - one for pizza sauce, and the other for pizza dough from get this - her Aunt that lives in Ethiopia. So, we set out to the Nakumatt (grocery store) with Joe to harvest the supplies. We ended up making three pizzas - barbecue chicken with made-from-scratch sauce, carmelized onion, local gouda; mozarella tomato; and made-from-scratch red sauce with roasted chicken. We also made a "salad" with tomato, avocado, onion, and cucumber - utilizing the MacNeill salad dressing - olive oil, balsamic vinegar, garlic salt. Everything was a huge hit. Joe, an early detractor, seemed the most pleased of everyone in attendance. To top off the evening, Sarah Ellen made a brownie pudding, which was fantastic.





MDK-20100725-0336, originally uploaded by monkeydoc


The food at dinner was rivaled only by the conversation. Attending were Joe and Sarah Ellen Mamlin, Fran Quigley, Paul Biondich, Rose House, Monica Miller, Erin Dainty, and Sylvia McNair. The Mamlins you already know. Fran is a lawyer who has worked for the IU Kenya program in communication and development for some time. He also decided to teach law students this past year and was one of Lisa's favorite teachers! Paul Biondich is one of my geek heroes - he founded the OpenMRS project with Burke Mamlin. Rose House is a rock star who is coming here not to work in the casualty (ER) department, but to basically found the ER department in Kenya. Monica is a Purdue faculty pharmacist who is writing more books than anyone else I know. Erin is an OB global health fellow from Duke. For those medial folks out there, Erin's blog has some amazing stories from the labor and delivery ward - she really does save lives every day. The diversity around the table was truly incredible and made for great conversation. Of course, the red wine flowed freely which always makes a dinner party perfect.

Just when we thought that things couldn't get any better, we were invited to a special meal at the Chinese restaurant in town. The owner, Mr. Yu throws these invited dinners a few times a year. This evening the dinner was in honor of his daughter who is attending Wake Forest on a complete scholarship MD/PhD program. We enjoyed so much spectacular food including the most amazing lobster any of us had ever had. Two truly special meals back to back, with great memories I won't soon forget.

Wednesday, July 21, 2010

No Good Deed Goes Unpunished.


Sad power adapter, originally uploaded by monkeydoc.

It's one of my favorite Jon Laws sayings - I guess I'll never learn.

One of the other visitors here at the IU house had their power adapter blow, and I felt bad for them so when I wasn't using it on my trip to Kitale, I let them borrow it. Only to return home to a completely dead power cable. Turns out that it was plugged into a surge protector, and still got hit with a surge.

When things get bad, you know who your real friends are - about two hours after I figured out that it was blown Lisa had two new adapters ready for someone to carry. Also, Joe and Sarah Ellen offered to call their adopted Kenyan son Dino to find one for me in Nairobi. Unfortunately, since most of the other apple users here have smaller computers, their power adapters won't work for me, and with my luck I'd hate to be responsible for blowing someone else's adapter.

When Dino wasn't available, Joe called one of the AMPATH computer guys who mentioned that there are shops in town that repair power supplies - likely a good business because the power is so crazy here.

The above photo is from the Eldoret TechSmith shop. My favorite part is the completely ingenious use of the speaker for a soldering iron holder - another example of how things are just a little different here, usually with similar results. We found a blown fuse and a blown resister while I was waiting there. Unfortunately, there was still a short so I had to leave the adapter. I get to call him tomorrow to see if he's been able to fix it.

So, I'm going to be "slumming" in the common computer lab. Luckily they have linux boxes so I can get my programming tools put together pretty easily.

Oh yeah, I'm getting a cold too and feel like crap.

Sunday, July 18, 2010

So Long and Thanks For All the Fish




MDK-20100708-0355, originally uploaded by monkeydoc

Well folks, sorry there haven't been more blog posts, I've definitely been busy here. Busy reading CT scan after CT scan after CT scan, busy making new friends, and hanging out with old friends (Dr. Abuya and Dr. Jane Carter pictured above).

I didn't quite accomplish my main goal for the past week, but we've made forward progress. Which in Kenya means a lot. We're close to having reports from our baby PACS system go into the AMPATH database, hopefully next week.





MDK-20100718-0393, originally uploaded by monkeydoc


The best part of my weekend was a fishing expedition with the American head of AMPATH - Joe Mamlin. Joe is so busy that any time spent with him is precious. Last night, when Joe was talking about leaving for fishing someone asked him if he eats what he catches. His response was classic - "I pull them out of the water, introduce myself, and let them go on their way".

We left the house at a reasonable hour and traveled to the Nandi hills region. Joe found out about the lake from a missionary who gave him the following directions - turn right on the first dirt road past Nandi Hills Town and whenever you come toward a fork - head toward the radio tower. After a short trip on the dirt road, we finally arrived at a beautiful piece of land nestled in between tea fields with two small stocked lakes.




MDK-20100718-0385, originally uploaded by monkeydoc

The grounds surrounding the lake were beautifully groomed and had all sorts of flowers and colorful plants. We saw a few birds and the tail end of a few colobus monkeys. I caught a few small fish, but more importantly I enjoyed being outdoors with good friends.




MDK-20100718-0391, originally uploaded by monkeydoc

Tea fields (above) are some of my favorite Kenyan countryside. People in the countryside are amazingly friendly. This is especially true if you're a mzungu, which apparently literally translated means "one who wanders about aimlessly", how ironic. This photo is of a local man on the road, we stopped near him for a photo and he came over to say hello.





MDK-20100718-0394, originally uploaded by monkeydoc


There are a few things that I always hope I'm able to do when I come to Kenya. One of these is visiting the Oasis with Joe and Sarah Ellen. The Oasis is a little restaurant in Eldoret that sells fried chicken, hamburgers, fries, and most importantly milkshakes. All the seating is outdoors, and you're surrounded by beautiful flowers. It's one of the best things about staying in Eldoret on the weekends, and one of the experiences that I cherish the most.

Sunday, July 11, 2010

Lazy Sunday




MDK-20100710-0069, originally uploaded by monkeydoc


At the end of the first week of my trip, looking back I'm pretty pleased with what has been accomplished. My #1 goal for this trip is to electronically connect our chest X-ray system with the AMPATH medical record system. I think that we're about 75% there. This week, the goal is to move our server into the AMPATH data center and complete the linkage between the two servers. Uniting these two servers has been a dream for quite some time, so if it comes to fruition before the end of the week, I'll be thrilled.

This weekend was laid back with a long walk to the huge grocery store - Nakumatt. It's probably 1/2 the size of a Wal-Mart and has just nearly as many varied products. Kenya is changing, like it or not. In fact, today in Nakumatt I found the glass-lock containers that Lisa and I like for lunch. They were impossible to find anywhere in Indianapolis - we had to order them from Amazon. After the big walk to the grocery store, I made brownies, which were a big hit. Then, dinner with Joe and Sarah Ellen, which was excellent as always.

Today brought a lot of time to hang out with one of my good friends - Jane Carter. She's a pulmonologist from Brown and a Tb researcher. She has been involved with the Kenya program for 11 years, and I look up to her as a mentor. She has established extensive infrastructure both for Tb clinical care, and research despite the fact that Tb isn't sexy. At times, no one seems to care about the little tiny acid-fast bacilli that can ruin people's lives. Especially those with HIV.

Today I discovered that Jane is a foodie - she shared with me several DVDs of Julia Child's show from WGBH Boston - French Chef. It's quite fun to watch these old black and white shows and see how well her techniques hold up today. Jane also shared with me 9 GB of Gourmet Diary of a Foodie video podcasts with intriguing titles like - Oaxaca - The Seven Moles, and Contraband Cuisine I'll definitely be set with entertainment for the ride home. Who could ask for a better Sunday?

Thursday, July 8, 2010

IU House revisited




MDK-20100707-0056, originally uploaded by monkeydoc

IU House is now a bit of a misnomer, it should really be called IU compound, neighborhood, or base. There are roughly 10 separate buildings all within one neighborhood in Eldoret where IU and other AMPATH folks stay. This also doesn't include the houses that long-term folks own.





MDK-20100707-0054, originally uploaded by monkeydoc

One of the best things about the IU house is the landscaping. The Mamlin's house in particular is beautiful (above). There are several gardeners that work everyday all over the compound making sure the bushes and grass are trimmed. There are flowers everywhere you look.




MDK-20100707-0052, originally uploaded by monkeydoc

This time, I'm living in a "servant's quarters" room. That means that I have a toilet and shower just outside my room. The shower has an "instant" heater which is instant, but isn't much of a heater. I also learned today that the bathroom that I thought was mine alone is shared with a medical student from Toronto. Oh well, maybe I'll bother her more than she'll bother me.




MDK-20100707-0053, originally uploaded by monkeydoc

This is a shot of my bedroom - which is small, but private which is a huge plus.

The IU house is a 10 minute walk to the hospital. The weather has been very, very nice, mostly in the 70s. In the evenings it's looked threatening for rain, but we haven't had much yet. Thunderstorms are when the electricity gets really bad surges and outages, so let's keep our fingers crossed.

LACE that's not so pretty

AMPATH has started a legal aid clinic (LACE) for AMPATH patients and others in the community who have been sexually assaulted.

There are two law students currently staying at IU house. One of them is in Lisa's class but in the other section and the other is a graduate student. It's a really great program because so many of the AMPATH patients who have been cut off from their community because of the stigma of HIV that is still rampant throughout Kenya, leaving them with children to care for and no means. LACE assists with property issues as well.

The two law students went to court this week and brought back a heart-wrenching, awful, shocking story. Please proceed reading at your own risk. The names are fictional and there is no happy ending.

Sometime in March, Mrs. Jones decided to go shopping at a popular local store in a small town outside of Eldoret. It was approximately 8:30 PM. Shortly after entering the store, the two wealthy store owners locked the door behind her and proceeded to beat and rape her. They then tore their own clothes, and called the police (whom we're sure they bribed) to take the woman away claiming that she attempted to rape two grown men, who each weighed more than doubled her size.

As she was unconscious, the police took to her to the hospital where she was examined. The doctor's report from when she presented to the hospital documented that she was both raped and beaten. She was still unconscious at the time that she arrived at the hospital.

Near midnight that night she was arrested and thrown into jail with bail set at 10,000 Ksh ($120). The charge - false allegation of rape. Unable to post bail, she stayed in jail for a month. Her family did not know that she was in jail for two weeks, and may have assumed that she was killed or kidnapped.

Fast forward to Tuesday, when she was put on trial. Mrs. Jones had to appear in court, sit in the defendant's box and listen to her attackers detail a completely factious story of how she attempted to rape them. Their explanation why she would want to rape two grown men - because she owed them money. They also explained that they closed the door to the shop to protect Mrs. Jones from the angry crowd outside. A crowd that was angry because she is "known for raping men".

We won't know the outcome of the case for some time as the magistrate does not decide the case until September.

The only good part of the story is that the law students think she will be acquitted, and because she was part of the LACE program she will not have further fees to pay. This charade has accomplished it's purpose; Mrs. Jones has understandably become disillusioned with the system and will not be pursuing rape charges against the men.

There is no recourse against the prosecutor for bringing such an obviously phony charge.

Please take this opportunity to reflect on the great country that we live in, for no other luck than where we were born.

Oh yeah and if you're moved - read more about LACE and make a donation - http://www.iukenya.org/lace.html

Monday, July 5, 2010

Day #1




MDK-20100706-0046, originally uploaded by monkeydoc


Found this little guy when I was walking home from the hospital, I hear that there are several living around the IU house. Perhaps one of them is George - past star on our blog.

Today was a day to see many friends. I'll introduce them, so that you have a little background on the cast of characters for the next month.

Joe Mamlin - Patriarch of the program, all around amazing human being
Dr. Abuya - the prior Head of Department of Radiology.
Kelvin Ogot - One of the Kenyans who helps me with IT, especially when I'm not in Eldoret.
Jane Carter - Wonderful pulmonologist from Brown, who does a ton of Tb research.
Dr. Kimutai - Current Head of Department of Radiology.
Pamela - One of the people works with Kelvin entering data into the system
Helen - Secretary for the radiology HoD

Other people who I haven't run into yet:
Dr. Wanene - another one of the hospital's radiologists. Definitely the most tech savvy of all of them.
Sarah Ellen Mamlin - Another extraordinary human - she runs the pediatric center that Lisa volunteered at in the past.




New CT Scanner at MTRH, originally uploaded by monkeydoc


The hospital has installed a new CT scanner. It's a Philips dual channel scanner. Looks like it produces pretty good images. They now have a working power-injector which is a step in the right direction. They are still printing everything on film, which is especially tragic for CT because so much information is lost in the slices that aren't printed. They are burning studies to CD periodically, but we all know those aren't archival.

Interesting bit about the new CT scanner - they couldn't put it in the CT suite in the main hospital. The CT scanner currently in the main hospital suite is a major POS. It was not the model that was described, they were bait and switched awfully, and it was a lemon, never functioning properly for more than a few months. Turns out that the lemon vendor's contract stipulated that the hospital could not replace the lemon with a scanner from another vendor. Guess we add contractual nightmares to the list of "little differences"

Dinner at the IU house is one of the best things about coming to Kenya. Tonight's dinner was memorable, to say the least. There weren't many familiar faces at dinner so it's about meeting new people. Turns out two of the new folks at dinner aren't really with our program at atll - they're missionaries. One of them got really sick and is here for medical treatment, so I guess that they're part of the crew while he recovers. Before I learned all of this, I posed a question I soon came to regret: "What are you doing here?" We were all treated to stories of their immersive experience with a primitive tribe called the Pokots, who are similar to Masaii. They wear blankets and carry spears, mainly subsisting by stealing cattle and animals from neighboring tribes. The tribe is still fairly untouched by western society and speaks entirely Pokot. This also means that the english-speaking missionaries have no way of communicating with them. They just "hang around" and "learn about their culture". Apparently the program has been going for the last 15 years, and for some reason they weren't smart enough to bring a translator on the 15th time around. Unfortunately, I wasn't able to get up after the introduction of the story and proceeded to hear about a ritualistic killing of a goat that was cooked, hide and all, over an open fire. Sick missionary #1 was smart enough to avoid drinking the goat blood that he was offered, but he thought "what the hell" and ate some of the meat. Perhaps we've identified the source of his aforementioned illness? The entire experience was described summed up eloquently as "intense". Hope I pick a better dinner table tomorrow night.

Well, I'm almost falling asleep, so I'm going to go read some comics on my giant ipod touch - thanks Monkey!

Sunday, July 4, 2010

Karibou Kenya

There were a few hiccups along the way: losing travel wallet with half my $$; running back to security to find said travel wallet minutes before flight for Amsterdam; forgot to print out boarding passes for in-country travel to Eldoret; forgot to pack a sigg; the list goes on.  At least I didn't fall down the stairs.

Bottom line - I made it, and so did my bags.  Customs didn't give me too much hastle and I have a clean hotel room with the internet.  Life is good.