Kimbilio

Among my travels this week, I spent some time at the Kimbilio Hospice run by my friend Juli McGowan through her ministry, Living Room International. Kimbilio mean “refuge” in Kiswahili.

I have written about this refuge and about Juli before. Juli is a wonderful nurse practitioner who has built this lovely place where very sick, poor forgotten people — people seemingly beyond hope – receive care and have a resting place .  Some of her patients do die in her hospice care from terminal illnesses, but they have someone tending to their needs and keeping them comfortable. Others, like her assortment of severely malnourished children, can actually recover and have somewhat normal lives if someone goes through the immense work of feeding them and helping their bodies and spirits to recover. This is not my area of expertise, but I’ve promised to help her whenever and however I can.

Our team at Kimbilio this week. Visiting developmental pediatrician (and legend), Marilyn Bull; me, and Juli.

Our team at Kimbilio this week. Visiting developmental pediatrician (and legend), Marilyn Bull; me, and Juli.

After seeing some very sick and sad little children, I spent some time with a patient who Juli first had me see back in 2011. Juli and both remember looking at this child and looking at each other and thinking, “What on earth can we do?” I did not think this little girl was going to live, and we were really taking it one day at a time with her.

This is what I wrote about her then:

The Living Room currently has a very sick 8-year-old girl who weighs only 13 pounds (6 kilos!). Frail little C came out of a horribly sad situation, where she has not received the care she needed for a very long time. The extent of her weakness and malnutrition were among the worst I have ever seen, and it is a struggle to imagine that her body could recover from this. The general idea at the Living Room has been to hold her and to feed her (which has to be done through a very careful process when a child is this malnourished). So far, the small steps seem to be sustaining her. Even more amazing is C’s sweet personality. Despite being too weak to lift her head, she will smile when someone calls her name. And when one of the caregivers holds her and sings to her, she laughs softly. Small steps and even this damaged body may have hope again.

Little C, smiling despite all, in 2011:

Well, C lived. She is still at the Kimbilio Center, and she still smiles and laughs. They have taken excellent care of her. She doesn’t have the ability to move very much, but when you talk to her or sing to her or touch her face gently, she smiles the very biggest smile and laughs.

It is a joy that she lives. And, in her own way, she lights up a room.

C, this week:

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On Langston’s Birthday…

When peoples care for you and cry for you, they can straighten out your soul. – Langston Hughes (b. February 1, 1902)

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Three generations sit in front of me, in two plastic chairs on the other side of my wooden desk in the clinic exam room.  Toddler, mother, and grandmother.

Outside of this room, at least one hundred families wait on benches to see the clinicians at this rural HIV clinic. A rooster is crowing loudly just beneath my window. But inside this room, it is me and the quiet females spanning three generations of a family.

Mary, the grandmother, holds 3-year-old Grace in her arms. Little Grace is quiet and subdued, a too-skinny toddler looking at me with big eyes. She is holding a strip of colorful stickers I have given her, but she is not yet ready to make consistent eye contact with the scary white doctor. Next to them, Grace’s mother Florence also sits quietly, holding a brown purse on her lap that contains 6 medicine bottles – two for herself and four for Grace.

All three generations of women before me are infected with HIV. Both Mary and Florence were infected by their husbands. Mary’s husband died a year ago, and Florence’s husband left her when Florence started to get sick. She thinks he is working in Nairobi, but she doesn’t know for sure. Grace’s infection passed from her mother’s body into her own during Florence’s pregnancy, before anyone knew that Florence had HIV.

Three females with three beautiful faces. And, truly, they are the faces of HIV around the world – women and children, living in poverty in the world’s poorest places — marginalized by their gender, by their economic opportunities, by their lack of education, and by their infection.

We could have prevented all of these HIV infections.

If Mary or Florence’s husbands had worn condoms or had been taking medicines for HIV, the virus would not have passed to their partners. If Mary or Florence had taken one pill of HIV medicine a day – something we call PREP – they would have been protected against getting infected, even if their partners were not treated and even if they didn’t use condoms. If we had known that Florence was infected with HIV when she was pregnant, we could have spared Grace by giving Florence medicines to take during her pregnancy, delivery and breast-feeding. We know how to stop these infections.

We know how to stop the spread of this virus, but we have to find ways to give even the most marginalized women the knowledge and power to stop this virus. We need the political will, we need the money, we need the empowerment.

This family sits before the pediatrician because Grace has been coughing and coughing, and they are worried about how poorly she is growing. I am worried too, and I get an x-ray and start her on some medicines for pneumonia.

I can treat this pneumonia. I can give them the right HIV medicines to keep their virus sleeping and keep their immune systems healthy. I can try to get them food support and even entrance into our microenterprise opportunities. I can continue my work to make this a healthcare system that serves well the needs of 150,000 patients with HIV.

I wish, though, as I sit with these generations, that I could go back in time and put the right prevention in place. I wish for what I cannot do.

As Mary stands up, strapping her granddaughter to her back, she turns back to me and says, “Asante, daktari. (Thank you, doctor.) Thank you for your care for us today.”

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Karibu nyumbani na Rachel!

I thought I would write about something more fun and ordinary than tear gas and travails around sick babies… I have a house!

After more than 8 of living in a single bedroom in a group housing situation (plus a year of homelessness on both of my continents), I moved into a little Kenyan house all to myself this weekend. Hooray!

The moving process was fraught with the usual chaos of any logistical challenge here. On Friday at 4:30pm, I still didn’t know for sure where I or my team would be moving after a forced move out of our current houses on Saturday morning! However, as these things usually do, it all worked out in the (very) end, and Saturday morning brought a massive move of a dozen people into new houses over the weekend.

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Admittedly, I have had fundis (handymen of various sorts) working on the house for the last three days. But after 3 days, I now have a working toilet (well, almost there after two complete rebuilds — it can’t flush toilet paper, but it does flush now), a working sink (faucet replaced, major leak repaired, only a minor leak continuing to the floor), and a working instant hot water heater for the shower (quite variable, but I suspect that’s related to a lack of adequate power to the house.) In the scheme of housing here, it’s fabulous! Plus, the novel concept of my own space is quite exciting.

The previous occupants of the house were Hindu. The house is still permeated with the smell of incense from their worship room (which would be lovely except that I seem to be somewhat allergic to it), and I have these little decorations around the entrances to the house and rooms. It’s hard for me not to think about the Nazis with these swastikas, but I have learned that ‘swastika’ means “It is”, “Well Being” or “Good Existence” in Sanskrit and represent the god Vishnu and the sun for Hindus. I’m not sure whether I will do anything with these decorations, painted as they are on the concrete, but they have been something to puzzle over. In a way, they are a good reminder of the conscription of lovely ideas for evil purposes. I would hate, though, for them to cause anyone consternation or pain by seeing them there.

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Decorating a house offers a new world of possibilities here! Finding some basic furniture and appliances for myself was challenge number one. (I am scavenging!) Houses here do not come equipped with appliances like refrigerators and stoves, so this takes some work. Now that I am getting the basics sorted out, I am starting to dream about how to make this little concrete house a cozy spot. For now, I am adding some tiny touches of my own through locally made blankets and pillows…

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And I have roses!

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Sick Babies and Tear Gas: Health Care in Kenya

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Monday mornings are always a bit insane in the clinic — lots and lots of mothers lined up, sitting on benches to wait with their sick babies. Everyone holds on through the weekend with their sick little ones, eager for the clinic to open on Monday. After less than 10 minutes in the clinic, I had to put in an emergency IV and start resuscitating a little one.

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Our day went beyond the usual Monday chaos with some added craziness. The nurses at the hospital were on strike. Health care workers striking is not good for patients, but it too-often seems to be the only way they can make the hospital administration meet their very reasonable demands for appropriate drugs, gloves, and medical supplies.

A peaceful protest cannot last very long here, sadly, as demonstrated by the horrific crackdown of the police on school children protesting the destruction of their playground last week. Sure enough, the Kenya police showed up today in riot gear and decided to disperse the nurses using tear gas. Insane. The tear gas came in all through the hospital buildings and clinics, making everyone wheeze and cough and gasp even in areas relatively far away from the demonstrators.

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In our busy clinic, we didn’t know what was happening at first. Your throat begins to burn, your lungs are closing up and wheezing, and you can’t stop sneezing and crying. Tear gas is horrible.  And very, very bad for sick babies. So, that was a disaster to sort out as I tried to keep breathing well enough to make sure everyone was ok and get the sickest little ones moved to where the gas was thinner. Our babies already come in breathing too-fast with their pneumonias and fevers. Tear gas was the last thing we needed.

On top of all of this, the main washing machine at the hospital had broken down over the weekend. This doesn’t sound like such a big deal, except that we had no clean linens or scrubs or gowns. This basically shut down all of our surgeries for the day, and made things more complicated for dealing with really sick patients who needed new beds in units that were closing down for lack of linens. Plus, many more patients needed gowns to replace clothing contaminated by tear gas or would have benefited from wet clothes to hold over faces.

BUT, not a single patient of mine died today, and so in my book it was not a bad day. Bad days are days when children die. This was just a crazy one.

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The (Bright) Future of Healthcare in Kenya

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 up physicians in both Kenya and North America who are prepared to tackle global health challenges.

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One lovely tradition in the training of Kenya’s next generation of physicians is a ceremony in which all of the medical students are given their first stethoscope 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.

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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. If you want to change the face of healthcare in Kenya, give poor, brilliant kids the opportunity to become doctors.  Amazing.

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This Stethoscope Ceremony is a special milestone for the medical students. Each one has their name read aloud, they receive their stethoscope from a clinical faculty member, they are congratulated by Dean of the Moi University School of Medicine and the Principal of the College of Health Sciences, and then they 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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Seeing the bright and beautiful faces of Kenya’s next generation of doctors is such a delight. My heart fills with joy to see all the hope and promise for this country’s health care system in the faces of these wonderful students.

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