How I Draw/Talk About HIV

“Your drawings help patients and their parents understand this disease.”

After a morning seeing patients together in the HIV clinic, this was the lesson the pediatric resident remembered from our clinic together.

I do like to use drawings while I am explaining to a family how HIV attacks the body or counseling an adolescent on why it is so very, very important that they take their medicines every single day. The resident saw me draw the same picture over and over again (with slight modifications to make the child in the picture look more like the child in front of me.)

And my patients here seem to really like the drawings. They always want to take them home. This may be largely the novelty… Too often, the other clinicians do not take the time to explain these ideas to them. Plus, in a setting where much of the learning is done by rote didactics, lecturing and demanding memorization, learning with something visual — something that I keep changing as we talk — stands out. Of course, I hope that it improves their understanding too.

Tomorrow morning, I am training pharmacy technicians on how to counsel families and children about HIV medicines, so I have been giving extra thought to my usual drawings and words. They don’t need to make a drawing like I do, but they do need to be able to use words and concepts that families understand well enough that the families can grasp why we want them to take these medicines in the way we do.

Here is my spiel and what I would draw for you on the back of a lab request form….


This is you! Otieno! And this is how I want your body to look – healthy and strong and growing. I want you to be healthy and strong so that you can do anything that you want to do. I want you to be able to run and play. I want you to be able to go to school. I want you to become an adult and have a family if you choose. I want you to have a good job.

DSC_8877germs copy

For all of us, we must be concerned about the germs that are around us. We sometimes call these germs “bacteria” or “viruses.” Germs are tiny little things that can come into our bodies and make us sick. It is germs that cause problems like diarrhea, pneumonia, malaria, and TB. We don’t like these germs that can make us sick!


Thankfully, our body has soldiers to protect us against these germs. These soldiers are very small, but there are many of them throughout the body. Our body has an army of soldiers to try to protect us against the germs that want to make us sick. This is called your immune system. These are the soldiers of your body. We will give the soldiers guns that they can use to kill the germs. We want your body to have many, many soldiers to protect it and to keep you healthy and growing. The name that we call these soldiers is CD4 cells.

DSC_8877the snake

Unfortunately, as you know, your body does have one virus living inside of it that cannot be killed by these soldiers. This is the HIV virus. I am going to draw it as a snake because I hate snakes. You do not have a real snake living inside of your body, but we will think about the HIV virus like a very bad snake that is inside the body.

This snake is so bad because it wants to kill the soldiers of the body. It tries to kill the soldiers, and then you have no army to protect you from the germs that can come in and make you sick. This is how the snake tries to defeat you. It is very, very sneaky in how it tries to kill the soldiers of the body. When it destroys the army of your body, then the germs can make your body weak and sick.

We do not have medicines to kill this snake. We do not have treatment to remove this snake from the body. I wish that we did, but there is no treatment anywhere in the world right now that can remove this snake from the body. If scientists find such a treatment, I will try to bring it to you right away.


What we do have is sleeping medicine for this snake! We have medicines that will keep this snake sleeping, so that it cannot kill the soldiers of the body and so that your body’s army can become strong again. This snake is so bad that one medicine cannot keep the snake sleeping. Even two medicines cannot keep the snake sleeping. But when we use three medicines, we can keep the snake sleeping.

If the snake is sleeping, then your body will remain healthy and strong. You will grow. You will be able to do all of the things that you want to do – go to school, become an adult, get married, have a family. We must keep the snake sleeping so that you can be strong and healthy.

These medicines that keep the snake sleeping, they only last for about 12 hours. But we want the snake to be sleeping for all of the day and for all of the night. So, we must take these medicines in the morning to keep the snake sleeping during the day.  And, we must take the medicines again in the evening to keep the snake sleeping during the night. I know that it is difficult to take these medicines every day and to take them in the morning and then again in the night. I know that this is a challenge for many. But this is how we keep the snake sleeping. And we want to keep the snake sleeping so that you can be healthy and strong.


If you miss to take the medicines in the morning or in the evening, the snake can wake up. Whenever the snake is awake, it starts to kill the soldiers of the body.  If the snake keeps waking up again and again, then sometimes it becomes stronger than the sleeping medicines. If the medicines can no longer make the snake sleep, then your body’s soldiers will be defeated again. We want to make sure that this does not happen. (We call this the virus becoming resistant to the medicines) This is why it is so important for you to take the medicines in the morning and in the night. We want the sleeping medicines to continue to work and to keep the snake sleeping.

I have high hopes for YOU. I want you to be healthy and strong, Otieno. I want you to be able to live positively. I think you will be able to meet this challenge of keeping the snake sleeping. I think you will GO FAR.

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Wordless Wednesday: Kenyan Fashion

blue skirt

Green skirt_1

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school girls_kisumu

Dorothea has been scraping together every bit of money that she can. The new school year begins this week, and she needs to buy a new uniform if her granddaughter is going to attend high school. The regulation blouse, skirt, socks, and shoes cost far more than Dorothea has left at the end of one month, or even six months.

School attendance is a sacrifice of love and community here. Dorothea and her granddaughter have been getting by on just one meal a day for the last few weeks to save a few shillings. An empty belly in exchange for an education. Dorothea has gathered small amounts of money from her two remaining adult children, from her neighbors, from her pastor and her prayer group. Money from anyone she can think to ask. Everyone is asking at this time of year. School fees, school uniforms, books.

Her granddaughter’s parents both died in the past 18 months, and Dorothea now holds Dinah’s future in her hands. Hands with knuckles swollen from arthritis and age and 60 years of cleaning houses count out one crumpled small bill after another in the school uniform store, praying that they will be enough. Enough to launch her granddaughter into a future of promise.

Dorothea’s story is echoed around the world. Mothers, fathers, grandparents, communities making sacrifices to launch their children into a better future. Everyone circles round to contribute whatever they can, to fan the small flame of hope.

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I am not good at shopping for groceries. On the relatively rare occasions when I go to a grocery store in the United States, I wander the aisles in the disoriented manner of someone who cannot quite figure out why they are in this unusual setting. I don’t know where things are. Even my thorough list-making cannot rescue me from the craziness, which is probably magnified by the fact that I lack food preparation skills. The grocery store is probably the one place where I still consistently feel culture shock; I am overwhelmed by the size of the selection, the carts, the packages, the people.

Oddly enough, I love going into a grocery store in a different country. Somehow, the added strangeness turns my grocery disorientation into an adventure. I enjoy exploring what items are and are not available. I love the novel packaging, the unusual advertising choices, the challenge of figuring out what common good is being described in a language that I don’t know. Is this hair conditioner or body lotion or something very, very different?

hair tonic

While I am fairly accustomed to grocery shopping in Kenya at this point, it still presents these small adventures. Adding to the thrill of the hunt is the fact that an item that has consistently been stocked in the store may one day disappear completely. Diet soda? There will be none for at least two weeks. That cereal you used to buy every week? Never to be seen again. This creates an urgency that one must buy something if you see it and want it or ever might use it.

Random items will appear out of nowhere, never to make another appearance. Rice noodles? The double-sized espresso press? Belgian dark chocolate? Who knows how they arrived here, but it is almost guaranteed you will never see them again. Buy them now. Every expat that I know here has a story about the item-that-got-away. I still remember the time Philadelphia cream cheese suddenly appeared, triggering an expat community-wide phone chain and 24-hours of experimentation with making our own bagels.

Highlights from this week’s shopping trip in Eldoret….

Is this Sensodyne toothpaste? It resembles it, and the store’s display would indicate that it is, but I cannot read this writing. How willing am I to gamble on a type of toothpaste? (Very.)


I routinely buy this amaranth to mix with my morning oatmeal, but the package lists a host of outlandish claims. Will amaranth really cure herpes? Much myth-busting is needed here.

amaranth package

I seem to have developed a small addiction to pistachios. I thought this 6 weeks in Kenya would break that habit as I had not previously seen pistachios in any of the stores. Suddenly, they have pistachios available – but at a ridiculously high prices. The worst possible scenario for an addict…

I buy my fruits and vegetables at the open-air market, which is by far my favorite grocery-gathering spot. There is something about the colors and smells and the busyness of choosing and selling produce that makes me smile. I am also able to buy a ridiculous quantity of amazing fresh fruits for a very low price. This week, I took home 2 boxes of fruits and vegetables for under $30. How I love my mangoes… My housemates tease me about my ability to consume all of this produce before it goes bad (Until this week — see below — I could not refrigerate any of the produce, which is a challenge), but they marvel at my ability to come through week after week. With my limited cooking skills, the roasting of vegetables is my new area of expertise.

fruit market

hanging fruit

The thievery of olives. I did experience a sad first at the grocery store last week. One of my bags of groceries seems to have been stolen by one of the workers who helped me carry the groceries to the car. Sad, but true. I particularly mourned the loss of a jar of nice olives and a jar of almonds, both of which were treasures for which I paid dearly. I can only hope that he or his family enjoys them at least a little bit. Sigh.

This small sadness was much overwhelmed by the grocery news of the week at my house — we got a new, full-sized refrigerator!


I never knew that one could experience such refrigerator excitement, but after years of sharing a miniature refrigerator among 6-7 people, this radically changes one’s ability to store food. I bought 3 containers of yogurt in celebration! I might even be able to store a few produce items in the cooled interior. Yes, I was so inspired as to draft “An Ode to the Refrigerator”! (The mustaches are our magnets.)

ode to refrigerator


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Wordless Wednesdays: Not Big Enough To Nurse


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