On Monday, we traveled to Mosoriot, a clinic that is on the same road as the Eldoret Airport. It was quite funny to arrive at Mosoriot, to meet 2 other Carols that work as RAs/Counselors. Carol or Caro Sabul is the counselor, and Carol Kerich is an RA. We joked that this clinic would be my favorite since I will be surrounded by so many with my own name (I fear a cluster of confusion in future emails, but I think we verified that we will call each other appropriately Sabul, Kerich, and Carole). On Thursday, we traveled to Kitale, a clinic that is about 1.5 hours away that has a rough road for travel. The views were beautiful, as Kitale sits atop a hill, we were climbing the hill, ever so slowly as to avoid rupturing the tires with the ginormous potholes and protruding chards of rock that drape the road. The day was very clear and you could see Mount Elgon in the distance, with hills of tea leaves and various crops glistening in the morning sunlight. Rachel, my boss, and Megan, a peds resident from IU/Riley, both joined Colin, myself, and the SAFI RAs to the clinic site. SAFI is a project that Rachel is spearheading that seeks to better understand the influence of HIV related stigma on pediatric clinical and psycho-social outcomes. Basically, we are going to conduct Focus Group Discussions with parents/caregivers and children (separately) to discuss ways that HIV stigma influence their daily decisions, including taking their medications. It is a much needed research arm for this disclosure and adherence work, since we deduced from the previous disclosure focus group discussions that were conducted last year, stigma related to HIV seems to have a grave influence on family, psychological, and social functioning and HIV care.
At the Kitale clinic, a control site (and therefore no individual or group counseling offered to participants), there was a 12 year old boy who refused to take his medications. Masila, the Research Assistant called Colin and me into the room in order to give the child a stern talking to (which is completely out of our job description, as we are white, we can only talk to patients who are willing to discuss HIV and other items with us, we cannot force any child into talking to us, let alone at a control site). Each visit, we collect MEMS bottle cap information. MEMS are a type of medicine bottle that digitally records each time it is opened. Therefore, physicians can track how many times and at what times bottles are opened, and thus relating to the frequency of medicinal intake. This particular child is orphaned, by the death of his mother to HIV/AIDS, and has a father, living in the same house, who is HIV positive. The father, himself, refuses to take ARVs or anti-retroviral medicines that basically help put the virus in a standstill and stops it from progressing and diminishing all of the body's white blood cells that fight infections. The father seems to have a stubborn attitude toward the medications, stating that the medicines aren't actually useful and that the clinic just wants money, thus telling his own HIV+ children to stop their own medications. The aunt, who takes the children to and from clinic, was completely defeated in her attempts to provide care for the children. Her body language was slumped over and she faced away from the wazungu (Colin and me), seeming annoyed and frustrated. Masila asked us to talk to the child and tell him the importance of his medications. This seems like an easy task, however, many children, although they state that they are disclosed and know their status, actually don't know and have not heard the explanations about soldier cells or white blood cells and the influence of the virus on their health. So, you can't just jump into a conversation with a child, even if he or she has told you that he/she knows why they are taking medicines! Colin tried to speak Kiswahili to the child, and he refused to answer any questions, so we thought it best to bypass the intervention that Masila was hoping for, and chose to refer the child to Dr. Vreeman, who would be able to assess what is best for the patient's care. This was quite a frustrating incident. I have always had a dream of conducting psychological counseling to diverse populations and to be culturally respectful, but was thwarted in this attempt by several factors a) being white can actually deter a productive patient-counselor rapport, b) ethics of patient care vs. the study's goals, and c) the adolescent did not care for any sort of intervention, and had adopted the belief system of his father, which will eventually lead to his demise. Without medications, the virus will take over the immune system, and opportunistic infections will eventually team up and kill this little kiddo. Cases like this make me want to become a clinician and help, and hopefully there will be a cultural shift in the influence of a mzungu providing mental health care. One can hope!
I was thankful that wine night at Laura Ruhl's (a pediatrician that lives two doors down from me in a servant's quarter) took place on Thursday night. The evening was great...tons of wine..tons of people...and tons of homemade hummus! I probably overstayed my welcome as there were three of us still lingering around teh half empty bottles at about 7:30, but the conversation was enchanting and the wine, although sub-par according to McAteer standards, made for a great evening to unwind from the challenges at Kitale clinic that day.
On Friday, we had a team building day at Kolol retreat center, about 20 minutes outside of Eldoret. The retreat center was located right along a dam and a riverbed, which was gorgeous. The weather was absolutely beautiful, with the sun beating down on us wazungu, each of us leaving the day with a bit of red on our noses and cheeks. Sabul and Caroline Watiri (yes, another Carol), were the leading RAs that put together team building games. Although there were several minutes between games of us waiting for instructions for the next game, quarrels about how to conduct the game best, and others who were not paying attention, all in all it was a great day, full of laughs. Lunch was provided, with nyama choma (we shipped a goat to the restaurant, alive, that apparently rode tied in the boot of a car, pissing the whole way...can't blame him!).
Friday night, I attended yet another happy hour, but this happy hour took place at Katie's. She works on a psycho-social project with Eve Puffer from Duke. The happy hour was short, but a great time, none the less and my Trader Joe's Spicy Thai chili cashews were a hit!
Saturday morning, I woke up at 5:30AM to head down the hill to catch a ride to Kakamega rain forest and Rondo retreat center. The rain forest, according to the brochure and description, boasts tons of flowers, monkeys, birds, frogs, and plants. The retreat center was absolutely gorgeous with clipped grass and surrounded by giant palm trees and banana leaf plants. A few Colobus monkeys sat in the tall trees above us, I am sure laughing at the tons of tired wazungu with our backpacks and hats. We had a travel guide/hike guide named Ben (who apparently hit the sauce a bit too hard the night before, thus making for a lackadaisical guide). The smells of the fresh greenery and the sounds of the various chirping birds was phenomenal. We started our hike at about 8:25AM and hiked until lunch stop along a river at about 12:45PM. We then had about another 2 hours of hiking until we reached the Rondo retreat center, again. Toward the end of the hike, as we were all pretty sweaty and breathing pretty heavily with the altitude, the tour guide stopped the troupe of 9 people along the trail. He then pointed to the ground at an ant hill under my feet, and exclaimed to the group, "you see these ants? these are safari fire ants, and they bite!" Meanwhile, Chris (a med student) and I had several ants creeping up our legs inside our pants, chomping away at our sweaty limbs. I was severely irritated with the guide. How do you stop an entire group standing directly over the ant hill? RUDE! Even though we had a ton of uncomfortable bites, we walked away laughing that we could now say that we have had "ants in our pants." Although it was quite a sweaty adventure, it was definitely a beautiful hike and one that I think I will do again! I think this location would be perfect for a weekend away and definitely a McAteer family dream location!
Below are some pictures from our hike.
(beautiful flower outside of Rondo retreat center)
(two monkeys chilling in a tree above a villa in the retreat center)
(beautiful flowers along the roadside of Rondo retreat)
(a pathway in the rainforest)
(a view atop the hill overlooking the rainforest)
(another view of the hill top)
(panorama view)
(vine along a tree)
(huge banana palm plant along our hike)
(lunch at a waterway)
(another pic of the river)
(a villa at the Rondo retreat center)
(a view from one of the villas at Rondo retreat center)
Sunday was my first day driving in town in Eldoret and surprisingly I didn't hit anyone!
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