Team-Building

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The highlight of the week here in Kenya was holding “a team-building” for my study team. (“Team-building” is used as a noun here.) My study coordinators organized a day-long event for our personnel from 8 different clinics across western Kenya, some of which are at least a three-hour drive away. Our study evaluating disclosure of HIV status to children has been in place for almost one year, and we are also transitioning to involve a new North American field coordinator. It was a good time for everyone to come together.

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Lots of “snaps” were taken

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Games with potatoes

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In our team “Indiana University Children’s Health Services Research” t-shirts

Looking around this group of talented, laughing individuals, I was humbled to think about what they are accomplishing. Together, they follow hundreds of families with children with HIV, assessing how the families are doing clinically, emotionally, and socially. In the past year, we have recruited all of these families at 8 different clinics; developed new materials to help with disclosure counseling; started counseling individual parents, guardians, and children; and instituted group counseling sessions for children who have learned about their status. So much good work!

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We gathered at a riverside resort a little bit outside of Eldoret. The team-building featured lots of games and a goat roast (nyama choma) for the entire crew. We actually purchased the goat in town and sent it to the site early that morning by motorbike to be prepared for our feast. Certainly, not every day in Kenya is fun and games, but this one came close.

Our lovely site.

Our lovely site.

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The North American members of my team – my pediatric research scholar for the year (Amy), my out-going field coordinator (Colin), and my newly arrived field coordinator (Carole)

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These ladies have been running my research studies for 6 years now.

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Kenya’s Future Doctors Get Their First Stethoscopes

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Our entire program in Kenya is built on a partnership between Indiana University School of Medicine and Moi University School of Medicine. On the educational side of this partnership, we train physicians in both Kenya and North America who are prepared to tackle global health challenges.

One lovely tradition in the training of Kenya’s next generation of physicians is that all of the medical students are given their first stethoscope in a ceremony before they begin their clinical rotations. A long-time faculty member at Indiana University, Dr. Anginieta Biegel, provided this thoughtful gift to the students and endowed a program to sustain this gift after her death in 2008. This ceremony is organized by the wonderful Tal and Betsy Bosin.  Tal is a retired IU professor who teaches pharmacology to the Moi medical students every year, just as he did at IU for many years. Together, he and Betsy also manage the scholarship program that enables Kenyan students from poor backgrounds to be able to become doctors.

This ceremony is a special milestone for the students as they have their names read, receive their stethoscopes, shake hands in congratulations from the medical school Dean and Principal, and then recite together their medical vows. The students beamed with pride after being given their stethoscopes, with the hope that each “would care for those we do not know.”

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Prof. Mamlin, one of the legendary founders of our program, shows the students the stethoscope he was gifted upon entrance into medical school in 1958. “I have used Stan’s gift for all of these years,” he said. “You will use Angie’s stethoscope.”

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Abigail helps me cope with my to-do list.

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Abigail is overwhelmed. When she sits in our office in the HIV clinic, her shoulders slump as though she is carrying a huge sack of rice. You can barely hear her whispers as she recounts her story.

Her husband died three years ago, leaving her alone with their three small children. Abigail never went to school beyond 5th grade, and she struggles to find even small jobs so that she can pay for food and shelter for herself and the children. She says that when her family found out that she had HIV, they rejected her. Her mother sometimes watches the three young boys, but she will not let Abigail or the children stay at her compound for more than a day or two.

“I am all alone,” says Abigail with a deep sigh.

Abigail’s one-year-old son, Noah, has his HIV medicines in a special bottle. This bottle has a chip in the cap that records electronically the exact time that the bottle is opened each day, and then my study team can download a history of when the bottle was opened onto our computer. My study team can see more evidence of just how overwhelmed Abigail is – gaps of days when Noah did not receive his medicine. Her youngest boy is at serious risk of dying if he does not get these medicines.

Much of my research in Kenya is focused on those gaps – how can we find out when families are having problems giving children their HIV medicines? And when they are having problems, what can help them?

For Abigail and Noah, my study team did a lot of work with the clinic staff, with the social workers, and with a local psychiatrist to get this little family help with things like food support and treatment for Abigail’s depression. Within our HIV clinic system in Kenya, my team follows hundreds of families very closely, asking them all kinds of questions every month about how they are doing with the HIV medicines,  using these special tracking bottles to record exactly when they are taking their medicines, and wrestling through complicated challenges like how to tell the children that they have HIV and how to deal with the stigma that goes hand-in-hand with an HIV diagnosis.

As I launch into another month in Kenya, we have an insanely busy exciting few weeks ahead for my research projects. My to-do list  — with all of its little checkboxes — is way too long, and jet-lagged Rachel cannot help but feel a bit overwhelmed. But I am still excited.

We get expand our efforts this month. We get to know new families and dig into the stories of more mothers like Abigail and more children like Noah. And maybe, just maybe, we get to figure out how to help them better.

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Gordon Brown and a Little Ranting About Injustice

In 2004, when he was the Chancellor of the Exchequer in the UK, Gordon Brown gave a speech describing how the world was failing poor families – and poor babies in particular. One doesn’t often hear the person in charge of a powerful nation’s economy talk about such things. I am not sure who else carries these words inside of their head, but I think of them when I think about the terrible fact that thirty thousand infants still die every day in the poorest parts of the world.

Gordon Brown* made the case that these thousands of babies die because of our moral apathy and lack of political will: “And let us be clear: it is not that the knowledge to avoid these infant deaths does not exist; it is not that the drugs to avoid infant deaths do not exist; it is not that the expertise does not exist; it is not that the means to achieve our goals do not exist.  It is that the political will does not exist.  In the nineteenth century you could say that it was inadequate science, technology, and knowledge that prevented us saving lives.  Now, with the science, technology, and knowledge available, we must face the truth that the real barrier is indifference.”

Babies live here. And die here.

Babies live here. And die here.

This sentiment has shaped much of my journey in medicine and why I do the kind of work I do: We know how to prevent and treat most of the things that kill the children of the world. But we have not put the systems in place to ensure that children everywhere get what they need to have a chance at life.

This injustice is the inescapable lesson of a Kenyan hospital ward, as you stand over a peeling metal bed and watch a baby die. This is the lesson of a shanty clinic where a small team in a slum overflowing with garbage and one million people crammed together struggle to test people for HIV — and yet don’t have enough medicines available for those who test positive. You can’t avoid thinking about suffering in Kenya, and you certainly can’t avoid thinking about HIV. And you can’t avoid the realization that things do not need to be this way. Lack of political will. Indifference.

How can we let babies die because they live in a poor place?

What do you tell the mother who knows that there is medication somewhere else in the world that can save her child — but she can’t get to that medicine because she is poor and lives in a poor country?

I have to ask these questions because these children are my children. I cannot forget them. I have diagnosed them with HIV. I have given them medicines and food. I have watched them cry. I have carried them in my arms, with their legs and arms wrapped around me. I have wrapped their bodies in blankets after they died from diseases we could have treated, sicknesses we could have prevented.

Because I can’t forget, I keep coming back to work in a place where I have to squat in dirty latrines, where I can’t get a latte, where forgotten children lie sleeping in the gutters along the street. Even if you have not had the opportunity to do these things with your own hands, even if you don’t have to see the suffering, you can see it. You can open your eyes. You can see and read and hear. It is there for you to witness, all around the world and also right next door. And we each get to make our own decisions about how we will live in the face of this injustice.

(*A random side note about Gordon Brown, which also gives me a degree of fondness for the man: I actually met Gordon Brown a few years ago when he was still the prime minister of Britain. After one of our medical myths books was published in the UK, I got to go to London for a bunch of book promotional stuff. Anyway, I ended up on this popular British morning TV show, and the other guest of the day was the prime minister, Gordon Brown. As they were changing the microphone from him to me, I was struggling for something to say to him. So, I told him how I have appreciated his comments on global poverty and how I sometimes use this quote of his when I teach students and talk about my work with HIV in Kenya.  His response was that this was evidence that I was “as intelligent as I was beautiful.”  He is a politician, I know, but it’s not every day that the sitting prime minister tells you that you are intelligent and beautiful!)

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Wordless Wednesday: 3

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