Go With Hope


Everything about Mwangi’s presence in my clinic room speaks of failure.

As I was racing in between giving a presentation about our research findings and a full schedule of interviewing candidates for new positions on my team, my clinical officer Jane called me and said the words I cannot resist, “Please, Daktari Rachel. Please will you come to see this patient.”

Mwangi was already in the room when I got there. He is 16-years-old and is dressed like a teenager in jeans, a t-shirt, and black jacket. His lanky arms and legs speak of a body that could grow tall, but his body is failing him. He sits next to my desk, slumped over, with his head leaning heavily on hand propped up on the desk. His face has the gaunt, hollowed out cheeks and temples of a body that has lost every possible bit of padding. Even worse, his eyes are dull, sad and distant.

The clinical officer tells me that Mwangi is an orphan. He has been looking after his own medicines for the five years since he was diagnosed with HIV. He has tried to take the medicines as prescribed, but he admits to the clinic staff that he sometimes misses them.

Looking over his laboratory results from the last year, I can tell that the medicines are not working to keep his HIV virus under control. The amount of virus in his blood is high, and the cells of his immune system are far, far too high.  He has been coughing for weeks, and Mwangi lost 30 pounds that he could not spare in the last 2 months.

I am concerned that TB is now attacking his body, allowed in by the lack of defenses. His weakness makes me concerned that his body is going to give out on him completely unless we do something very different.

I can give Mwangi a new set of medicines to try to disable the virus in his blood – and hopefully restore his immune system. I can wallop the TB with the best medicines I can find. I can get him extra calories and even put him in the hospital if he needs that kind of care.

But I am worried that I cannot give him hope.

I look into his sad eyes, and I tell him, “You can meet this challenge.” I tell him that I am worried about him and that I want to help him become strong again. I tell him that the medicines will work, that they will heal his body and give him strength and allow him to do anything that he wants to do – school, get a job, get married, have children. I tell him that this is all possible if he meet the challenge of taking these medicines. I want to believe what I am telling him.

It’s a lot of talking, but even more drawing. I like to draw pictures to show my patients how HIV tries to kill the soldiers of your body, leaving it weak and susceptible to germs, but also how HIV medicines can work to keep the virus sleeping and allow the body to recover.

I draw and I talk and try to check whether Mwangi understands me and whether this time together brings back any of the light in his eyes. I am hopeful that I see the beginning of more sparkle.

“I can meet this challenge, Daktari,” he says confidently. “I will go and become strong.”

“Go with hope,” I said.

He wants to take the drawing with him when he leaves the clinic, along with all of his new medicines and a special bottle that will help us monitor electronically when he is taking the medicines.

I hope that he carries a spark of hope with him too.

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Wordless Wednesday: My Buddies


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Running with Kenyans

Kenya takes running very seriously. In particular, this part of Kenya is home to the world-famous, marathon runners. International coaches and agents come here to scout for the globe’s best long-distance talent, and athletes from around the world come to train at high altitude with these elite athletes.


Obviously, I am neither an elite athlete nor a Kenyan runner. Every day, I am passed by real runners, who whiz effortlessly by me on their gazillionth mile as I slog slowly along.

Despite my regular running, I have never had the slightest desire to participate in a race. This seems to surprise to those who view me as an over-achiever, but the idea of devoting more hours to running seems both agonizing and impossible to fit into my schedule. Moreover, I prefer to run alone. And, unless a really good book is involved, I do not have the least desire to run further. None of this makes me want to sign up for a race.

I do not love running, but what I do love is an adventure.

This weekend, Eldoret hosted the Kass Marathon, with 5km, 12km, and 42km races from Kapsabet into the center of downtown (a center that is reached by a steep uphill incline, I might add.)  As my friends and colleagues began to discuss competing last week, I began to contemplate signing up for my very first race.

After all, if one is going to run in an actual race, why not sign up at the last minute for a race that is:

1)   Held at high altitude

2)   Taking place in hot Equatorial sun

3)   Being almost exclusively run by the world’s very best runners?

How could this not be an adventure?

I signed up for the Sunday race on Friday, along with a great group of runners from the AMPATH consortium. Here is our “before” photo before heading to the race start in our shuttle:



As it happened, we missed the official start of the race. How this happened, we are not sure. Either we were told the wrong starting time (possible), they changed the starting time (possible), or they just had a bunch of people gathered at the starting line and decided, why not go ahead and start? (possible) So, we headed out alone! After all, we had no expectations whatsoever of record-breaking times.

This ended up being great fun. Spectators lined the entire race route, with crowds and crowds cheering at the final uphill kilometer. A race is also serious business here, it seems, with relatively few people signing up “just for fun”, but we actually had a great time – as evidenced by these photos. (Note that phone camera selfies taken while running are not known for their high quality, but it was well worth running with my phone!)




Even better, I ended up running most of the race in the same manner that happens with my daily runs – surrounded by bare-footed children effortlessly keeping pace with me for kilometer after kilometer! A friend who was watching from the sidelines said I looked like the Pied Piper as I ran into town. These are my kind of Kenyan runners!


The girls ran with us all the way until the finish line, in dresses and with one of them carrying her sandals the whole way. We triumphantly reached the finish line, where our exciting prize was a much-needed bottle of water.


Truly, a great adventure day in Eldoret. I’m so glad I did it.





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My nephew sent me this adorable picture of me and “all of my kids in the Kenya.” Love him!

From Reuben_I miss you

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World Diabetes Day

Yes, it’s World Diabetes Day. It turns out that even I can actually figure out what day it is when they send a marching band and a big banner down the center of town. (In contrast to, say, my confusion on Monday through Wednesday!)


Diabetes is a chronic disease damaging the bodies of 371 million people around the world. This is not just a disease of rich and overweight countries; 4 out of 5 people with diabetes live in low- or middle-income countries. (We think that a malnourished childhood can mess up your metabolism in long-term ways.)

AMPATH has actually been incredibly innovative in testing for and managing diabetes in poor and rural places like Kenya using mobile phones and special diabetes clinics. My kudos go to my friend, colleague and long-time housemate, Sonak Pastakia, who dreamed up this effort and cares for over 2,500 patients with diabetes in Kenya (and still stores boxes and boxes of diabetes testing supplies in our kitchen!)


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