My First Week at Work

On Monday, I began my first week of work at AMPATH/IU as a field study coordinator for a project called HADITHI. Mainly, the project focuses on promoting disclosure of HIV status to children aged 10-14 years. Believe it or not, more than half of the adolescent population with HIV do not know that they are HIV positive. Many parents fear disclosing to children for many reasons including, HIV stigma (which can include discrimination and shunning from neighbors and fellow villagers), fear of the child committing suicide, and fear of the child blaming the parents for their status. Overall, the HADITHI project has created culturally sensitive tools to explore the concept of disclosure and how knowing your status can influence your adherence to medicines as well as psycho-social interactions with peers and family members. Many of the interventions that we are providing for some of the clinics include videos of stories about HIV, individual counseling, and group counseling sessions. We hope that the interventions that we provide promote positive psycho-social responses to learning one's status and that this cohort of children can help us understand what is the most useful support that we can provide for other adolescents.

On Monday, I met with Josephine and Judy, the field coordinator and the deputy coordinator of the project. I will be working with them, side by side, in the near future. Josephine took me to all of the main AMPATH offices and introduced me to just about everyone (I must say I forget about 90% of the names, but if I were to guess it would be a "Carol" or "Judy" for a girl and a "Benjamin" or "Koech" for a guy...so I think I will be okay).

Below are some pictures of my walk around my compound...

(just outside my bedroom window)

(Beautiful flowers along the compound)

(the walk home, up the hill I go!)

Tuesday, I met with Prof Nyandiko, the PI for the project and Rachel Vreeman's co-PI on just about every project in Kenya. Prof was kind enough to let me go with him to clinic in MTRH, which was amazing. I witnessed the pediatrician in action and saw a plethora of cases. One 4 year old has CP and had the biggest smile and would point at everything followed by an "eh?". It seems that the mother took the child to a different clinic for an illness, and the Clinical officer put the child on a medication that could potentially further thwart cognitive functioning, so Prof put the child on a different medication and was satisfied with the child's health. Another patient was a girl of about 15 years. She had a CD4 count done in November 2013, which indicated low numbers of white blood cells (or soldier cells as the clinic likes to describe them to the pediatric patients). So, they ran some other tests and today was the day that prof Nyandiko disclosed to the orphaned adolescent that she indeed has HIV. The girl began to cry, having the burden of such a grave diagnosis. Prof explained to her, very carefully, that with medicines that are taken daily, that she will succeed and live a healthy life. After his positive reinforcement and encouraging words, the girl asked a few questions about how to handle the medications in front of other children. Many children and families fear other people finding out they have HIV and therefore hide their medications and keep them a secret. The girl was heading to boarding school in the next month and questioned the security and secrecy of her medications. Prof described three different options for the girl to keep the medicines a secret. He suggested that she hide them in her locker at boarding school, give the medicines to the matron who would then help dispense the medicines, or to forfeit going to boarding school and attend school near her home. The girl, who was orphaned by the death of her father, decided that she would discuss the options with her mother. She seemed very bright and her questions were intuitive of the future issues surrounding her new status. Other children that were seen in the clinic included adolescents up to 20 years who were not ready to transition into the adult clinics. At this particular clinic, which is located in the main AMPATH building, we have research assistants and counsellors there to offer our HADITHI intervention for disclosures and post-disclosure counseling. However, the space is quite tight and I imagine that some adolescents wouldn't want to discuss personal issues in a room full of other adults.

On Wednesday, Colin and I drove out to two clinics Webuye and Turbo. Webuye was about a 1.5 hour drive just west of Eldoret on Uganda-Nairobi road, toward Uganda. The road was well paved to the clinics, which is a rarity in rural Kenya. Along the roads, we saw a few people scattered between towns, walking along the roadside. Men with their cattle meandering along the grassy hillsides that lined the road. Both clinics were off set from the main roads. Both clinics were pretty sparse of any clinical materials that one would expect to be present in a health clinic. Wednesday, we had our final housemate join the group and Amy cooked Vietnamese spring rolls (pic below). They were absolutely delicious and certainly a filling vegetarian treat!

On Thursday, Colin and I visited the Burnt Forest Clinic, where apparently the prevalence of stigma is quite high. I foresee that this clinic will be visited often, as I will hopefully give advice to the counselors in helping individual psycho-social adolescents. The counselors there seem to be doing great work and pushing forward with offering individual counseling to the children. They also plan to use the video tools to help encourage parents to disclose to their children! So, it is exciting to see some of the interventions being put in the action plan at some clinics.

On Friday, the day was somewhat slow. Colin graciously took me to the travel agent so that I could pay for my flight to Eldoret and my stay in Nairobi. I was quite nervous when my new Chase credit card was declined 3 times, but after the agent turned it off and on again, the machine accepted my card (whew! that was ALOT of money!!!). Friday night, there was a happy hour at a Kelvin's, a Kenyan who works at AMPATH, apartment. Below is a picture of the sunset from his rooftop flat.

(a view of the sun setting beyond some construction)

(my housemate Amy and I on the rooftop)

After two or three drinks, we (me, Amy, a few "long-termers" or so they call us, who are here for more than two months, and some medical students or "short-termers") headed to an Indian restaurant for some food. The dynamic between "long-termers" and "short-termers" is quite interesting. Pharmacy students from Purdue, who are here for 6 weeks-8weeks, tend to ONLY talk amongst themselves and don't care to meet many people outside of their niche. Long-termers, or those who live up at Hilltop, where I live, also apparently do not like to mix with the "short-termers" or the medical students and residents who come on a 2 month trip. Amy, who is considered a long-termer has done a very good job of bridging the gap and socializing with whomever. I like her style and don't think I would want to segregate myself from other interesting people because of the length of stay. Apparently it is hard for some long-termers to befriend short-termers and have them leave and meet a whole new bunch time and time again, but I don't think that is a bad thing. I think we are all here for, generally, the same purpose, so we should all try to get along and mingle with as many people as we can! I hope to follow in Amy's footsteps and meet more people...guide me Obi-Wan-Amy!


On Saturday, Amy and I headed to the Nakumatt, or the grocery store, and I again, managed to spend about 80 USD, but I just keep telling myself that I am building my pantry, so I don't mind the large bills in the first few months. I need to decide how I want to cook/what I would like to cook and get used to those items being a staple in my pantry. I think I will mostly be making vegetarian options, as meat is quite expensive in the stores. Also, I don't know how my housemates would feel if I brought a chicken home for a kill (pic of the entrails from my chicken butchery skills in Athi River, 2011).

(post-kill with the de-feathered lil guy)

(results of a dull knife butchery job)

Saturday evening, there was a pitch in at the OBGYN's house, which is just up the Elgon Road. There were tons of AMPATH people, and dishes included nyama choma (roasted goat), tandoori style chicken, couscous (which I made), salads and other Indian options. It was delicious and was a wonderful afternoon meeting new people and being greeted by Joe and Sarah Ellen Mamlin. Dr. Hanke had sent Joe Mamlin an email saying to check in with me, and so Joe took the initiative to shake my hand and greet me with a warm smile, saying "we are your Kenyan parents, if you need ANYTHING please feel free to come to us." I certainly felt the love and was very excited to get to meet the people who started AMPATH with such a warm greeting. 

Today, Amy, Peter Kussin (a Pulmonary ICU physician from Duke), and I traveled to Iten, Kenya (map below). Iten sits right along the edge of the Great Rift Valley, and is the high altitude training center for world athletes and runners. Most Kenyan Olympians stay in Iten and train year round in the training camp. We met an Australian named Simon, who had traveled to Iten to train years ago, but abandoned running and adopted cycling, and he now runs a cycling team for professional cyclers. Apparently, you can rent a bicycle and ride all the way down the edge of the rift valley, which is absolutely gorgeous. 

There is a location called Kerio Valley or Kerio Overlook that sits right on the edge of the rift valley. There is a main lodge that has a restaurant with amazing views and then there are various lodges that people, mostly European wazungu stay, which is kind of like a resort setting! The scenery was absolutely breathe taking. We took a few pictures and ate lunch in a lodge that had huge windows facing the valley. Of course we sat closest to the edge! It was awesome, as we ate and chatted, the music of Paul Simon's Graceland cd were lingering in the background, creating the perfect backdrop to our lunch scene. 

(map, showing Iten sitting just North East of Eldoret)

Below are a few pictures of the scenery looking into the Great Rift Valley. The pictures certainly do not serve any justice for the scene in person! 

(view of Rift Valley from Kerio Lodge)

(looking up at Kerio Lodge, the great big windows where we ate lunch)

(Robert's Rock, which looks over the great rift valley)

(view from Robert's Rock)

(Holy Croc!!!)

After lunch, we decided to search for the old Stadium or running center. During the British colonization, the British ran a training center for long distance Kenyan runners and high altitude training, which is walking distance from these views, so we decided to bushwack and head toward the stadium (the description of the stadium in the menu/brochure described it as "delapidated" which was mostly correct). We meandered through various farmland and asked locals where the stadium was located in our broken Kiswahili "wapi stadium??". We decided to ask these two children on the side of the street and they gave us blank, scared stares...then I motioned "running" aka did the running man in front of them and kept saying "wapi stadium?" which they then proceeded to mock by repeating the same motions and cracking up...whatevs, man, whatevs! We followed the directions of an older gentleman, which led us to what seemed to be a dried up creek bed and was certainly the road less traveled.  An adolescent carrying water noticed we seemed to be out of place and asked where we were headed, so I told him and he decided to be our tour guide. He took us to the right spot! Once we got up to the stadium, I asked him, jokingly..."wanna race?" and we both smiled and took off for about a quarter of a lap. It was quite funny and we both were laughing (he obviously was a WAY better runner than I, but glad he had a sense of humor about it). As we walked back to the Kerio View where our car was located, Oliver, our 15 year old tour guide, and I struck up a nice conversation, both exchanging questions about our lives. He was very excited to hear that we had similar foods in the US. He hopes to be a professional runner and then take over his parent's farm. I told him he should get into the business of being a tour guide, since he was so personable...he smiled and accepted that as a compliment. I then gave him 200 KES for his hospitality and told him we would be back and call for Oliver. He was delighted to hear that and asked if I could watch him run...I sure hope that this lil guy makes it far with running (lol, puns!)...he was very nice! 

(the delapidated stadium and the track where I ran the shortest race of my life)

Rachel comes into town tomorrow, so we are all kind of getting things up to speed for work. Hopefully this week goes well, I wonder how it will be with the boss here!?! Tomorrow we head to the clinic called Mosoriot, hope the travel isn't much as I will be tired from watching the Bronco's game at 4:45AM at the Mamlin's house tomorrow morning. Go PEYTON!!!!!