When Kenya Tried to Kill Me

This month marks ten years since my first visit to Kenya. TEN years. Crazy.

Doctor V on the wards in Kenya in 2004. I still remember that abandoned baby.

Doctor V on the wards in Kenya in 2004. I still remember that abandoned baby.

During my first visit, Kenya tried to kill me.

There was the wretched Giardia infection that rendered me unable to keep down solid food for weeks, the feral cat bite that led to a rabies scare and quarantine, the inexplicable rashes covering my entire body, the jellyfish sting… The country threw quite a lot at me. The closest that I came to death, though, was on the mountain.

Mount Kenya

Mount Kenya

I embarked on an expedition to climb Mount Kenya at the prompting of my dear friend, fellow chief resident, and roommate for our two months on the wards in Kenya — an intrepid Swedish pediatrician named Maria. Maria thought there would be no better adventure in Kenya than scaling the 17,057-foot mountain, Africa’s second tallest peak. I did not have Maria’s level of enthusiasm, but I figured that one only gets so many chances to climb a mountain in life and so it was worth trying.

That’s how I found myself clinging to the face of the mountain in a blinding blizzard, fighting death with my brain rapidly swelling.

The problem with altitude sickness is that you don’t realize that anything is wrong until it’s too late. I did fine with the first 3 days of climbing, but we were all feeling the effects of altitude at the highest camp before the summit. We were all lying awake in our rough bunkbeds in the bare-bones camp with our hearts racing and heads pounding. We shivered with cold in our sleeping bags and could not sleep despite a long day of exertion.  I did not feel good, but I was not any worse off than anyone else.

Shipton's Camp, below the Lenana peak. (Photo from Chris Murphy)

Shipton’s Camp, below the Lenana peak. (Photo from Chris Murphy)

To summit Mount Kenya, you leave the highest camp at 3am in the hopes that you can make the steep 3-hour climb to the summit in time to watch the sun rise at 6am. At sunrise, you have the best chance of clear weather and a good view. In retrospect, I was sleepy and clumsy during those first hours of summiting, but when you are climbing in complete darkness at 3am, it seems pretty normal to be sleepy and clumsy.

Eventually, though, I reached a point where all I wanted to do was lie down in the snow and go to sleep. (This is what happens when you have cerebral edema or swelling of your brain; you start to lose consciousness.) Every time we stopped moving, I fell over unconscious into the snow.

To make matters worse, we were stopping quite often because a terrible snowstorm had started. The blizzard was bad enough that you could not see more than 10 feet in front of you, and our guide kept having to stop to pick out foot holds for us in the ice with his pick axe. None of the rest of us had any gear for ice. Every few feet, when we stopped, I passed out in the snow until the group yelled at me loud enough to bring me back to consciousness. I came to and managed to pull myself back up to keep climbing.

I was just with it enough that I would keep my arm on the side closest to the mountain outstretched so that, when I fell, I would not fall off the narrow path along the mountainside to my death, but would instead fall towards the mountain. I wasn’t so concerned about the passing out, but falling off of the mountain seemed like a bad idea.

Eventually, the guide began to realize just how sick I was, and he brought me to the front of our slow, single-file climbing crew so that he could hold on to my arm and prevent me from falling off the mountain when I passed out.

When a person has altitude sickness, the number one thing that should happen is to bring the person DOWN the mountain. In our case, descent was complicated by the blizzard conditions. Our guide thought it would be faster to continue over the summit and then down on the other side in the midst of the bad snow. And the weather was bad enough that splitting up would have meant sure death for almost any of us. So, we kept climbing.

This is what it would have looked like where we were climbing during this time -- if we had been able to see anything.

This is what it would have looked like where we were climbing during this time — if we had been able to see anything.

As it turned out, the blizzard made any strategy for getting down slow slow slow. It took us almost 9 hours to make it to the summit, instead of the usual 3. I marked our historic summiting by beginning to alternate between passing out and vomiting. My friend Maria’s husband, an Emergency Medicine doctor named JT, got a good look at me for the first time once we reached the summit. (In the midst of the snow on the treacherous, icy, narrow path, we couldn’t see each other very well.) I am told that JT took one look at me on the summit and thought I was going to die. This was particularly concerning to him since he worked very closely with my brother at the time, sharing an office space.

“If you died on the summit, I didn’t think I would ever be able to go back to work and face your brother,” he said. But even an ER doc couldn’t do much at that point. We didn’t have steroids, we didn’t have oxygen, I was already on Diamox, and we were pretty much just stuck in the midst of this crazy weather on this crazy peak.

Maria did probably save my life by recognizing that I was very cold even though I has no awareness of that problem. I do remember her taking layers out of my pack and putting them on me like a child. I had only the vaguest sense that something might be wrong.

In the scheme of things, cerebral edema is not a bad way to go. I was not worried in the least. All I wanted was to lie down in the snow and take a nap. I even thought that someone had the fortitude to whistle happy songs while we were picking our way up the snow and ice, which seemed rather cheering to me. (It turns out those were hallucinations because my brain was not working right.)

It wasn’t until we finally started to descend from the summit that I became worried. As my brain started working a bit better, I realized how very sick I was. My lungs were in trouble too – filling with fluid and making me wheeze.

Everyone in my group noted that they knew the extent of my illness because I was not photographing anything. Since I love to take photos, this is a sure marker that something is very wrong.

Our time on the summit did yield one classic photograph though. Maria, with her huge, beautiful smile, is triumphantly flashing the victory sign. Immediately behind her is me, in my yellow Goretex coat, horizontal against the rocks, unconscious on the top of the mountain. When Maria and I shared an office as chief residents over the next year, we had a big enlargement of this (annotated) photo prominently displayed for its comedic value.

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When we finally got down from the summit, we still had another 25 kilometers to hike to the camp where we could sleep that night. Because of our long time on the summit in the blizzard and with the half-dying one, we were really behind schedule. Normally on this path, you would cross through a forested area for the hour or so in the afternoon before you reach your camp. Since were running late, it was already getting dark as we headed into the forest.

As he considered the looming darkness, our guide began to warn us about the real risk of encountering animals in the forest. Bush elephants, big cape water buffalo, rhinos – all sorts of animals that you really don’t want to run into on foot, especially in the time of day when they are most active. He began to instruct us what to do if you encountered a particular sort of animal. For some, you were supposed to run right away. For others, you waited until they charged you and then you would jump out of the way at the last moment. It all depended on complicated factors like whether they had better vision or sense or smell or whatever.

At this point, I was more exhausted than I have ever been in my life. After the long hours of serious illness and the seemingly endless hike, I was at the end of my reserves. There was no sprinting left in my body. It was quite clear to me that I would be the member of the group most likely to meet my end should we encounter a bush beast.

Kenya had not quite finished with me yet. Sure enough, we rounded a corner in the path through the woods and ran smack into a group of huge buffalo with horns like terrible, curving helmet pigtails. This was potentially the worst-case scenario as these buffalo are among the most aggressive animals, and the small group in front of us were separated from the larger herd.

I took this photo, but not at the time I was weeping and contemplating my death.

I took this photo, but not at the time I was weeping and contemplating my death.

The buffaloes stared at us and our guide attempted to create a distraction. I began to weep silently. I knew this was the end. I couldn’t run. I couldn’t follow his instructions to sprint. I had survived the mountain only to be gored to death by a water buffalo. Tears ran down my face.

Kenya had pity on me, though, in that moment of the longest day of my life. Our guide managed to divert the buffalo away from me, the silent and stationary weeper. Finally, we all made our way off of the mountain and through the forest. I managed to keep putting one foot in front of the other. We eventually made it to the camp where I collapsed in the most death-like sleep of my life.

A few days later, we were discussing how to describe the Mount Kenya experience to some friends of ours who were also considering a climb. Fully recognizing that not everyone gets altitude sickness, I said that I would still describe it as one of the most stressful endeavors I had ever completed. Everyone in our group agreed, including a seasoned marathoner. Maria, though, was reluctant to make that statement.

“What have you done that was more stressful or strenuous?” we asked her.

It turns out that, during a stint in the Swedish military (the fact that Maria volunteered for service in the Swedish military actually explains a lot about her), she had to participate in an insane training activity. She and her fellow soldiers were dropped in a cold Scandinavian forest in the middle of the night and told that they had five minutes before the pack of attack dogs would be released after them. They had to run, through the night, through the forest, towards a distant location, and avoid being attacked by the dogs.

“That was more stressful,” she said, “Because you were running and running, all night, through the rivers and in the complete darkness, and always there was the barking of the dogs just behind you.”

We agreed. Being chased through the night by a pack of dogs as you run through a dark, cold, Swedish forest was potentially more stressful. But we noted that she had to specify to normal human beings that THIS was her benchmark for a strenuous activity.

As for me, there will not be any more mountains in my future. While I seem to be fine up to 14,000-15,000 feet, I don’t particularly want to take the increased risk of having my brain swell up and kill me. Not until I am well and truly ready to go, that is. In that case, I might choose cerebral edema on the mountain peak, and they can add my name to the plaque at the summit of Mount Kenya that commemorates all the people who have died attempting to scale its peaks.

And despite its valiant attempts to shake my spirits, Kenya did not dissuade me. Over these past 10 years, I have continued to live in Kenya for 5-6 months of the year, pursuing my work to provide the best possible HIV care for children living in the world’s poorest places.

Maria now works in the office next door to mine in the Children’s Health Services Research group at Indiana University. And she still sends me off on every trip with instructions not to die. I promise to keep trying.

Doctor V with another little one in Kenya, October 2014.

Doctor V with another little one in Kenya, October 2014.

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Bright and Shining

Here is a thing of beauty:

Ethan is 18, and he has been living with HIV since he was born. For the first years of his life, he was sickly and small. Every day, in the silence of her heart, his mother wept for him. She was sure that her son would not live.

She wanted the world for him. Silently, she begged God to save him, to spare him, to let him grow up and know love and happiness and find his way. After years of watching her son get sick over and over again, there came a day when she was given a new test result. The doctors had tested Ethan for HIV and they found that he was positive. This meant that Ethan’s mother was positive too. She carried in her blood this virus that threatened to kill them both.

This was the worst day — and the best day. Because finally getting that diagnosis meant that the doctors knew what to do for Ethan at last. He was started on the HIV medicines that could restore his body’s protective immune cells and prevent him from getting sick again and again. Ethan began to grow. He became his mother’s strong and laughing boy. Slowly, she began to have hope again.

Ethan has done extremely well on his HIV medicines. He graduated from high school this year, and he was the star of his school’s soccer team. He loves soccer, but even more, he loves the youth of his community. His passion is to help other kids who are growing up with HIV to know that HIV is only part of the story of who they are — that they can still growth and thrive and dream.

“I will always do all I can to support those in need of care and support,” he says.

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Ethan has organized a youth soccer tournament for kids ages 10-14 who are also growing up with HIV. He has 10 teams organized for the tournament, and the big competition is planned for December 1 — World AIDS Day.  On this World AIDS Day, these children will be laughing and shouting and playing their absolute best on the soccer field. These children will be a bright and shining example of what it can look like to live with HIV when you have access to the medicines you need. They are the lucky ones; 2/3 of the world’s HIV-infected children do NOT have access to HIV medicines. Most of those children will not be playing soccer. They will be too busy dying.

Today, these kids here in Kenya became lucky ones in another way too. Thanks to a gift from Adidas organized by our partners at The Pocket Square Project, we were given a bunch of wonderful soccer balls. Every single team will have a BRAND NEW soccer ball to play with. I cannot tell you how excited they will be — and how delighted Ethan was at the prospect of having this kind of support for his tournament. Remember, my kids play soccer barefoot in the dirt. They make balls out of plastic bags knotted together. A real ball — let alone a beautiful new Adidas ball — is a marvel they will cherish.

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Their doctor was really excited too. It is a joy to see my remarkable youth leaders supported and encouraged in this kind of tangible way. HIV medicines give these children life and hope, but this kind of gift brings them the encouragement that friends around the world are cheering for them too. Thank you.

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When you are nine…

She brought her baby sister to the clinic all by herself.

When you are nine, you shouldn’t have to take care of yourself, let alone your baby sister. But when your mother has died and your father is sick and living somewhere else, you have to grow up far too fast. You are the one who makes sure that you both have food. You are the one responsible.

Caroline knew that her mother brought the baby to the AMPATH clinic. She did not know that her mother had HIV and that she was taking medicines to try to prevent this virus from infecting her baby. She did not know that the baby needed to be tested for HIV or when the baby was supposed to come see the doctor. But she knew that they should come.

Caroline’s mother spared her baby from HIV. By taking the medicines to prevent the virus from passing to her baby during pregnancy or during breast-feeding, she kept the baby free of infection. Caroline is not infected either.

Even though the medicines spared her baby, Caroline’s mother did not manage to spare herself. From what Caroline describes, she was very thin, coughing too much, and one day, a few weeks ago, she did not wake up. (My doctor’s guess would be that she had TB.) The day that she did not wake up will shape every day of life for her two girls.

We have a program for Orphans and Vulnerable Children that can help orphans like Caroline and her sister, and I was grateful to be able to refer them for assistance and follow-up. I was grateful to enlist help. I was grateful for a social worker to try to figure out if there was an adult who cared about them who could lift some of the responsibility from the shoulders of this nine-year-old.

I was grateful, but I keep thinking about them. A nine-year-old and her baby sister and the mother we could not keep alive.

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Wordless Wednesday

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The Heroes

I spent much of the day with some of my heroes.

Thanks to support from @ThePocketSquareProject and the sale of some lovely Kenyan handicrafts, we held an adolescent support day at our largest HIV clinic. Our oldest pediatric patients — young adults who were born with HIV as many as 20 years ago — gathered in our tent meeting space to talk and share and be family for each other.

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These kids. Wow. They are bright and articulate. They are brave and beautiful.

They talked about walking through fears, how they struggle daily to ignore the many voices around them that tell them that they are worthless and dirty and doomed. Instead, they cling to their dreams, their faith, their laughter, and their hope for the future. And their courage — in the midst of sickness, poverty, and rejection — is incredible.

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Matthew is the social butterfly of the group; he is an excellent soccer player who jokes freely and teases everyone, but also quotes Bible passages. He is quite good-looking, and I see the girls stealing glances at him. He led the discussion time for the support group, and when he talks about “living positively”, he grabs everyone’s attention with his organized points.

Be open with the ones who are close to you. Be as active as you can and find support from those who share your outlook. Be willing to love and to be loved. Matthew gets the group to discuss their emotions and fears and what it looks like to overcome them on a daily basis.

To encourage his peers to move beyond their fears, he uses a Swahili proverb: “A cowardly hyena lives longer, but it suffers the most.” These kids want desperately to live longer, but they do not want their potentially limited number of days to be marked by fear.

When I listen to these kids, I gather hope and energy for our quest to provide medicines, to fight the constant illnesses, to keep trying to fix the broken healthcare  system. They give me hope for their futures and for our work in Kenya.

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“These kids are going to change Kenya,” says Lucy, one of the world’s best nurses. For years, Lucy has taken it upon herself to look after our HIV-infected adolescents at the referral clinic. They call her “mother.”

My hope and admiration for their bright and shining beauty is dimmed just a bit by how it brings the depth of our losses into such clear focus. Over 50 of the adolescents at this clinic died in the last 18 months. We have lost far too many bright and shining stars. The kids talk about their “lost brothers and sisters”, and we feel those holes in the midst of this assembled family.

And yet, the youth carry their mourning, their illnesses, the frailty of some of their bodies, their experiences of pain and discrimination. They walk on towards the future. They tell each other to choose hope every day.

“We choose to shine,” they say. “We choose to live positively.”

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The youth are planning a special day in November (thanks again to our supporters!) where they will gather just outside of town at an outdoor conference facility. They are bursting with ideas about exactly what they want to do for this special day: play soccer, perform their own skits and poems and dance routines in a talent show, eat, and spend time sharing their stories. Their eyes dance in anticipation. They cannot wait.

These young adults shine with all they have. They choose hope. It’s an honor to walk beside these heroes.

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