Final Thoughts

Final Thoughts:
I’m 35,000 feet in the air, writing about my last week of memories in Kisumu. The past week has been full of adventures, though none quite as compelling as what happened the weekend before. But in any case, I realized I haven’t given any updates on my project that I have finally completed with the help of my co-author, Jordi.

The device, called the S.H.I.E.L.D. (Sexual Health Innovation Empowering Lives Directly), is designed to help patients in the post-operative period after undergoing voluntary medical male circumcision (VMMC). In the days following the removal of the bandage (day 3 post-op), the wound area experiences swelling, sutures catch on the pants and tug painfully, and an unsanitary environment heightens the chance of infection. Patients must be very delicate with the area until they are fully recovered (somewhere around day 14). Our innovation targets this period from days 3 to 14. Resembling a modified jockstrap or brief, the S.H.I.E.L.D. works by supporting and protecting the wound with a comfortable and absorptive material. It is also specifically designed for use in low-resource areas, as the manufacturing process is quick and requires no imported materials (at least where we designed it in Kisumu). The beauty of it? It costs a mere $2.73 to make. And that price will most likely decline if future manufacturing practices are scaled up.

We had a lot of help along the way and are excited about the process of taking this innovation further, as we believe that our innovation has a lot of potential to help those men trying to take their health in their own hands. Our next few steps will be to assess the efficacy of the device through survey and clinical trial. Beyond that? Spreading the word about the device and incorporating distribution to other VMMC programs.

It has been a wonderful six weeks. I’ve made some great friends, learned a lot about myself, and experienced cultures different from those I have grown up in. I can only hope I spend the rest of my life learning about what the world has to offer and how to help those unable to help themselves. Right now I can see myself doing it through medicine, but then again, who knows what plans life has for each of us?

In the end, I want to thank my parents for helping me out in so many ways, all of the Harvard faculty and staff for putting on a great program, Dr. Ken Elam and Dr. Thomas Burke for helping me find out about the program and providing invaluable insight about medicine, all of those who I have worked with at NRHS, Jordi for being a great co-author and friend, all of the Harvard Summer Program students for being wonderfully supportive and extremely intelligent, and, finally, all of you who have read my blog and kept up with my adventures in the past six weeks. Thank you!

Mangos and Mama Obama

Yet another day in Kenya:

Today was extraordinary. We woke up at 7:00am and all 19 of us piled into two matatus (Volkswagen bus-like vehicles), about to part for the Siaya county—the home of “Mama” Sara Obama, Barack’s grandmother. First of all, the matatus are so cramped they make the economy class of airplanes seem spacious. I had both legs asleep within the first 20 minutes of the drive. Despite the driver telling us repeatedly that the drive was only supposed to be 45 minutes, an hour came and passed and we were still bouncing down the pothole-filled road. Second, the driver took us to the wrong location. When we finally got it across to him that we wanted to see Mama Obama, he had no idea how to get there, and proceeded to pull over every five minutes to ask someone on the side of the road. We had left two hours early to allow ample time to arrive, and we were over an hour late to our meeting. That’s what we call “Kenya time”.

The visit to Mama Obama was not like anything I had expected. She lives in a small, gated compound that has been converted into a farmstead. Goats, cattle, rabbits, chickens and all kinds of other animals wandered freely within the fenced area, surrounded by mango trees bearing small but sweet yellow fruits.  This was not at all what any of us were expecting.  After a bit, Mama Obama was helped to her chair by her translator (she doesn’t speak a word of English. Instead, she speaks almost entirely Luo and a bit of Kiswahili). She allowed us to ask her questions, but refused to talk about anything related to politics. Instead, we asked about her relationship with Barack Sr and Barack Jr.  After picking some mangoes from the trees near the edge of her compound, we hit the road again.

This time the drive was rather short, and we made it to the only hospital in Sagam in a short 20 minutes. Dr. Burke had promised us a chaotic scene, but had not prepared us for the sight that awaited us as we pulled into the parking lot. There on the lawn, sprawled for dozens of yards in every direction, were over 500 children and parents. They had heard the hospital was offering free services for the day, and the announcement had drawn crowds.  The doctors of our faculty split up and got straight to work seeing patients. The students wasted no time in finding ways to make themselves useful. I shadowed Dr. Burke for the majority of the time, assisting in the gathering of medical history from patients, organizing and recording clinical notes, and helping patients into and out of the waiting rooms. I took temperatures of a few dozen children, ages anywhere from six months to 10 years. I also watched Dr. Burke’s interaction with the children and parents. He was tirelessly happy. Watching him work made me realize the incredible compassion it takes to work with patients day in and day out. Screaming children, parents who could barely speak English, and the sheer number of patients was enough to make many doctors from the United States run for the hills. But Dr. Burke kept his smile alive for all four hours we were there. In that time period we saw almost 50 patients.

A few memorable cases stand out. I watched a six-year-old boy seize due to his epilepsy, and felt powerless when Dr. Burke told the family they would have to travel to Nairobi to get the required brain scans for the epilepsy drug prescription to be filled. I knew his family will never make it to Nairobi, and the little boy will probably die due to his condition. Another seven-year-old girl presented with an advanced staph infection that Dr. Burke guessed was drug-resistant. She will probably be a chronic carrier of the bacteria, prone to breakouts that turn into painful sores all over her legs. Yet another girl presented with moderate malnutrition, her arms no bigger around than a cardboard tube for paper towels. She was also suffering from sickle-cell anemia, a common occurrence in East Africa. Finally, a girl presented with mild fever and diarrhea, and who we later discovered had recently lost both her parents. The doctor treating her stopped writing on his pad and held her in his arms for a few minutes while she silently cried into his shoulder.

I’m guessing a lot of people might be put off by what I have just written about, but what I saw was compassion for human life at its greatest. This is what I think being a doctor is all about. And honestly, I couldn’t have solidified that statement until I was looking into the face of that girl. Practicing medicine isn’t about procedures, drugs, prescriptions or scans, it’s about making someone who is at their most vulnerable a more whole being. Sometimes those material things are necessary to accomplish this, but there are no prescriptions for hugs or someone who says he cares.

Again, for those of you reading this, do not be saddened by what I’ve described. Instead, try to understand what is happening around you and do your best to ease the life and suffering of those around you, especially those you have never met, for that is what I have learned today.

Some pictures:

So much more awesomeness

Jordi and Benard walking in the provincial hospital

James, a medical student from South Sudan

Children at the WEMA orphanage that I visited last weekend

An impromptu dance competition at the Grade 5 class of WEMA children’s orphanage

Monica’s Story

Jambo!

This past week we were lectured to by Monica, a woman who is the director for another NGO named KMET. She is a midwife by trade, and now works to promote maternal health across the Nyanza province. She told us about the night before she arrived back at school to lecture for us and I was blown away. So I have a story for you all:

Monica was riding in the back of the bumpy Matatu. As she bounced down the pothole-filled road, she watched the dark fields of sugar cane pass by out her window. Not very many people were left walking down the dusty road, except for the few stragglers who were too tired or sick to make a good pace. She glanced out the windshield. The beams of the headlights lit up a Bodaboda (motorcycle taxi) and its passenger, who was frantically waving her arms. Monica told the driver to stop. Something was wrong.

As the Matatu pulled over to the side of the road, the woman collapsed slowly to the ground. Monica hopped out of the van and hurried over to ease her down. She could see that the woman was pregnant. Very pregnant. When she asked what was wrong, the woman told her she had been trying to get to the regional hospital to deliver her baby. But Monica could tell that the woman’s time was just about up. She would not make it to the hospital.

“I knew that that baby was going to come right then, so I said, ‘Okay, we are going to do this here,'” Said Monica.

Fortunately, Monica had with her the “Mama Kit”, which is a prepackaged selection of items that can be used to help a pregnant woman deliver safely. The Mama Kits are produced by KMET.

From the Mama Kit, Monica took the paraffin plastic sheet and placed it under the woman. And there, on the side of the Kenyan road, with barely enough light to see, Monica helped deliver the beautiful baby girl. However, the birth wasn’t that easy. After the baby came out, Monica swathed her in some fresh, warm cloth and handed it to her assistant. They asked the woman to keep pushing so the placenta could follow and the process could be completed. But first twenty minutes went by. Then forty-five. Nothing was happening.

“When the placenta gets stuck in the uterus, unless there is trained, professional help, these mothers will die. There is almost no chance of survival. They become septic, they bleed, there is little hope,” Monica told us.

Fortunately, Monica had within her Mama Kit the drug Misoprostel. Misoprostel is controversial in Kenya and many parts of the world because it can be used as a means to terminate pregnancy in abortion. However, its main purpose is to cause the uterine muscles to contract, pushing out anything stuck–in this case, a placenta. Finally, after the administration of Misoprostel and another 15 minutes of suspense, the placenta was finally delivered.

Today, the baby girl and the mother are perfectly fine. However, stories like this more often end tragically. Monica is an amazing woman who is doing amazing things here at KMET. People like her are working tirelessly to change the lives of African women in the hope for a better future.

This weekend we’re going to Lake Nakuru for safari! I’ll have lots of pictures to post when I get back, that’s for sure. Also, our colleague at KMET is currently developing the prototype of our device so I’ll give more word on that once we have it finished.

Until next time, thanks for reading!

Provincial Hospital

Provincial Hospital

Oops…

Ideas and Innovations

Hey Everyone!

I tried to not let another week go by without posting, but each week we do so much that by the time I can sit down to write, here we are! Here’s the latest:

Our classes at GLUK have continued, and this week we have discussed our project design in terms of clinical research with greater detail. Our two new faculty are Dr. Anita McGahan (MBA & PhD Harvard University) and Dr. Chris Kabrhel (MD, Harvard Medical School). Anita has been discussing the importance of financial models and their integration with local business structures and customs.  The idea behind this is to understand a problem at a cultural and community level in order to craft a financial model that can run efficiently with the human resources present in the area. Chris has been guiding us through a thorough look at clinical research and its practical application to our current projects. His lectures have been enormously helpful in helping Jordi and I design a study around our chosen healthcare problem and subsequent innovation. But I realize I haven’t mentioned what our innovation is!

Our classroom at GLUK

In our work with the Nyanza Reproductive Health Society (NRHS) we have (after much difficulty and several setbacks) come up with a viable solution to an identified problem. Over the course of several interviews, Jordi and I have discovered that opposition to Voluntary Medical Male Circumcision (VMMC – read the previous post to see its benefits) has arisen due to socioeconomic factors. Basically, many men here live day to day in providing for their families. If they don’t work that day, they don’t eat. And neither do their families. This is a problem as VMMC often comes with an associated recovery time after the procedure. Usually the time ranges from 2-7 days before an individual can return to regular daily activity. As a result, clients who are in support of VMMC ask what NRHS is going to do to support their family in the time that they must recover.  This is a problem as this represents some majority of the 51% of Kenyans living in the Nyanza province where we are working. The more people who we can bring in for circumcision procedures, the better the chances Kenyans have of living healthy, HIV-free lives.

Our field leader Benard Otieno corralling kids into the back of a pickup truck for delivery to the circumcision clinic

And so, the innovation comes in the form of a device that will help reduce recovery time. Jordi and I came up with the idea after seeing an organization by the name K-MET (another NGO our program is working with) sustainably produce female sanitary napkins for menstruating girls in schools. The napkins are washable, sanitary, and extremely cheap to produce. After seeing this, Jordi and I began wondering if that same kind of material could be used to make a post-operation surgical wound dressing for men exiting the VMMC clinic. Currently, bandages are applied to the wound, but those must be taken off after 3 days. In the following days (3-14 or so), the penis may become infected due to excess swelling, friction of the frenulum (underside of the penis) against the inside of the pants, and the sutures may catch on the fabric of the pant lining (a VERY painful experience we are told). The device would consist of an absorbent material and an elastic waistband, to be worn under the underwear, that would support support and protect the sensitive area. The beauty of the whole device is that it would be sustainable, because it is produced locally, and cheap, not having to heavily modify current manufacturing practices. Doctors and other healthcare workers have told us that they are surprised no one has thought of this before.

Me with the kids of Mbali primary school before a sexual education talk given by NRHS

Currently, Jordi and I have met with the heads of both NRHS and K-MET, and have begun the process of designing a prototype device. If such a device can be made, then efforts to analyze cost-effectiveness, patient opinion, and end-goal effectiveness will ensue. Needless to say we are extremely excited by the potential and buzz our conceptual device has generated thus far. More on this to come as time goes on!

One of the program coordinators, Genna Purcell, reading the goodbye card we wrote to her

On the fun side of things, the group will be going on two excursions in the near future: A safari to Lake Nakuru, a vast wildlife park with nearly every imaginable African animal (except elephants, sadly), and a visit to Barak Obama’s grandmother! Apparently she lives just outside of Kisumu, and has been named “Mama Obama” by the locals. Hopefully I’ll come out of these trips with great stories and even better pictures. Also, last weekend we visited a rooftop bar called The Duke of Breeze. It has a great atmosphere, comfy seats along a stuccoed roof, and (perhaps most importantly…) good and cheap drinks.

Me unintentionally doing a prom picture with this hollow tree…

Breaking down on a Kenyan road on the way home from Kakamega rainforest

Looking across a field at one of the many slums in Kisumu

That’s all for now! Thanks for reading. I miss you all and hope that you keep leaving comments and sending me emails. I love getting news about your life from home!

To the bat cave!

Hi everyone!

So this past week has been full of adventures, and I’m excited to share them. I am also beginning to understand more about the culture and lifestyle here.

But first thing’s first.

Our classes at the Great Lakes University of Kisumu (the locals call it GLUK) began on Monday, with lectures from Dr. Richard Muga, a Kenyan Professor and former manager of the provincial hospital, and Harvard’s own Dr. Thomas Burke.  The lectures focused on the overarching theme of the program: the integration of modern technology at a community level that is sustainable. Sustainable, in this sense, means that it can be reproduced from local resources and not rely on donors for materials or finances, a big problem for current NGOs.  One example is the medical device called a uterine balloon. One of the primary causes of death for African mothers is hemorrhaging of the uterus after a difficult delivery.  The uterine balloon  is already used to great effect in the United States, but is expensive and can only be used once. Dr. Burke, along with a team of Harvard faculty created a sustainable version using a cheap modified catheter and condoms tied together in such a way that when the condom is inserted into the uterus and filled with water, the pressure of the inflated condom can stop the internal bleeding. This device is still in early stages currently but it has been shown to save mothers’ lives when used by a trained medical technician.  The importance of the condom is that is strong, resistant to tearing and cheap. The catheter can be reused after sterilization and the condom discarded. Technologies such as this have the potential to cause revolutionary changes in the practice of medicine in developing nations such as Kenya.

On the campus of Great Lakes University of Kisumu (GLUK)

Group picture at GLUK

Me and program leader Genna Purcell!

On Tuesdays and Thursdays, my project partner Jordi and I have been assigned to work with the NGO called Nyanza Reproductive Health Society (NRHS). NRHS has been operational since around 2006 and focuses on treatment and prevention of the spread of HIV among the Kisumu community.  The Nyanza province, where Kisumu is located, is on the Western side of Kenya, and has the highest HIV prevalence in the country at 15%, doubling the national average of 7%. NRHS works through community outreach to educate Kenyan men and women ages 10-25+ on the dangers of HIV and how to prevent the spread of the virus. The focus of NRHS is a process called VMMC or Voluntary Medical Male Circumcision. Research has shown that VMMC reduces a heterosexual male’s likelihood of getting HIV by up to 60%, which is huge in an area where HIV is so common and takes so many lives. Jordi and I actually witnessed one of these adult circumcision procedures, when the director of medical health of the NRHS clinic let us into an operating theater. The two doctors there were efficient and extremely skilled at the operation, and the whole ordeal took about 15 minutes. More on this will come later as Jordi and I get to know the organization better and hopefully devise a way we can use our resources as students to help them solve some of their outreach problems. We will be working closely with Dr. Burke, Sean Flannery, and a few other Harvard faculty to hopefully make a difference in this organization’s mission to stop the spread of HIV.

Here is the original study: http://www.ncbi.nlm.nih.gov/pubmed/16231970

Jordi and the clinic staff of the male circumcision program at the provincial hospital.

On Friday we toured the provincial hospital, which was incredible to compare to hospitals in the United States. The hospital is one of the largest in the country and has some of the best technology in Kenya, but it is still years behind every hospital in the US. X-rays are still developed by hand, machines break and are unable to be fixed for months due to lack of technicians, and many health providers still lack basic supplies such as gloves and masks. However, it is extremely inspiring to witness the healthcare providers work so hard with limited resources. I witnessed the passion and care these providers give to their patients in the face of sometimes disabling poverty. We toured the maternity and children wards, which were full of malnourished mothers and premature babies. The babies were so thin and many were born under 1kg (<2.2 lbs). Some had neurological conditions such as convulsing or fluid filled lungs caused by the degree of their prematurity. One small baby girl who was born 8 weeks early continuously vomited white mucous from her nose and, we were told, would probably not survive more than a few days. The mothers were malnourished as well and many were unable to produce breast milk to feed their infants. A major part of this hospital’s job is to help get patients enough to eat so that their bodies can fight off infection. They do so with food and nutritional supplements from countries like the US. The problem, our tour leader told us, was that if the donations were to stop the hospital would not be able to run effectively and many patients would die. However, the hospital does so many great things for the community that the visit was truly inspirational and made me even more excited to pursue medicine as a career.

Natalie and a very tiny baby at the provincial hospital in Kisumu

On the just-for-fun side of things, the group climbed up a mountain in the Kakamega rainforest, the highest peak in 100km of the area. Along the way we saw black and white colobus monkeys, tons of butterflies and quite a few colorful birds. Close to the top was an old abandoned gold mine that has since become a bat sanctuary. The bats were about the size of mice and would fly right by my ears! Luckily, they only eat insects. I also saw a spider that was the size of a tennis ball. The internet is slow and I have to leave the cafe that I’m at, but I’ll try to post more pictures later.

An armed guard at a check point on our way to Kakamega rainforest

The foreboding sign to the bat cave…

Sorry this one was so long, but if you made it this far, thanks for reading! I have plenty of other pictures to put up but the internet here is so slow it takes forever. Keep checking back for more posts!

First Impressions

Jambo!

Today marks my third day here in Kenya. Africa is incredible, even though I have yet to see our University campus (that will happen tomorrow). But let’s start from the beginning…

I said goodbye to my parents at the SeaTac airport and boarded a plane from Seattle to Paris. From there, after a short layover, I hopped back on the plane to reach my first destination, Nairobi.  Walking off the plane and through customs, I could see our program coordinator Kerry with her hand-written sign amongst the sea of Africans waiting to offer a taxi or tuk tuk ride (more on tuk tuksin a bit) to any passerby. We hopped into a very British car (complete with steering wheel on the wrong side) and drove rather haphazardly to our hotel just outside of Nairobi.  I met two of the faculty, Sean Flannery and Dr. Thomas Burke, and after a short meeting with the entire group, made our way back to the Nairobi airport. From there a short 45-minute flight landed us in Kisumu.

The view from our hotel room

The group, about twenty students plus two program coordinators, split up into a caravan of the African tuk tuk vehicles (see pictures). Tuk tuks (pronounced “touk touk” with the “o” sound as in “soup”) are a strange hybrid of covered wagon and three-wheeled motorcycle.  They fit one driver in the front and three passengers “comfortably” in the back. The canopy is made out of a kind of canvas, and many must be started by a pull-start engine similar to the old lawnmowers back in the US. We arrived at the Great Lakes University’s guesthouse and it is absolutely gorgeous.  Setting our stuff down, we once again boarded into a line of tuk tuksand set off for the local mall. After purchasing phones, wireless internet minutes and a few groceries, we had  dinner at a local Indian restaurant.

Our line of tuk tuks

Inside a tuk tuk!

At the restaurant, Kerry recognized the representative to the Kenyan parliament from the Kisumu district and he addressed us, welcoming our group to Kenya. He explained how happy he was that we had come to learn and to help, and gave us a bit of history on Kisumu’s recent political connections (including a visit by the then-senator Obama and his wife Michelle).

Finally, we trekked back to the guesthouse, climbed into our mosquito-proof bed nets and fell asleep to the sound of wild birds and African dogs.

Our plane from Nairobi to Kisumu

A couple of things about Africa that I have learned so far:

  •  There are no rules to driving on the Kenyan road that I can discern except that you generally drive on the English side of the road. People also drive extremely close to one another and cut each other off like they were paid to do it.
  •  White people are called Mzungus, and Kenyan kids on the side of the road will shout “Mzungu! Mzungu!” and wave as our group passes by.
  • Kenyan weddings (we saw one at the hotel in Nairobi) are quite colorful and involve a lot of call-and-response singing.
  • Kenyans (especially those in Kisumu) are quite friendly, and love to shake hands and high-five.
  • Giraffes are huge (I saw my first one somewhat close up yesterday)

Well, that’s all for now! Pictures to come once I find a more reliable internet source. Check back again soon for more updates!

Innovations, Technologies, and Health Transformation in Africa

Hello All!

I’m writing to you from Seattle, WA, where I am currently sitting amongst a pile of clothing, sunscreen, bug spray, and suitcases.  For those of you who I have not mentioned this to, I will be in Kisumu, Kenya for the next six weeks, attending a summer program through Harvard University.  The official course is titled, “Innovations, Technologies, and Health Transformation in Africa”, and the link to the program’s website can be found here.

Essentially, the goal of this program is to explore what it means to take an identified healthcare problem and develop a sustainable and scalable solution. We will be identifying problem areas in local healthcare and will use case-based approaches to problem characterization, solution generation and refinement, and ultimately test delivery models for healthcare improvement.  Our time will be broken up between class lectures and field days, which will be spent working with a chosen NGO in a particular area of healthcare interest.

The most difficult part about this trip right now is deciding what to bring. I have never been to Kenya before–or anywhere in Africa, for that matter–and understanding what I will need on a daily basis is a challenge. So far I have all the essentials: books, bugspray, and a wide variety of medication to combat travel-related illness.  I have gotten my immunizations, done preliminary research on Kisumu and Kenyan culture, and, of course, purchased my plane tickets.

Now, however, there is not much left for me to do except enjoy the last few days I have in the United States. And, of course, eat as much American food as I can, for there certainly won’t be much of that for the next six weeks.  If you’d like to get in contact with me, you can email me at my Whitman address, roehriat@whitman.edu, or use Facebook. Check back often for new posts!