MORE PICTURES Of KENYA

 

Children of Kalunga Beach

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Kalunga Beach

 

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Pictures around Rusinga

 

We DO!!

  

Our room at Alph's

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Lake Victoria

Mombasa

 Mombasa: My favorite beach city...

 

Masai on Beach: Samwel my friend

  

Boat on Indian Ocean at low tide 

 

Boat with man on North Coast Mombasa

  

Camel on the Beach

Safari Pictures

Onge Wach (all is good)

We left Rusinga and headed to the Masai Mara for a real Kenyan safari. Having to leave Rusinga left a deep pain in my chest, but it was nice knowing we were headed to such an amazing place. We arrived late in the afternoon the first night at our "campsite". It was funny, I thought we'd actually be camping in the Mara, but these were beautiful permanent tents set up with running water and electricity from 630-930 each night to recharge our cameras. There was even HOT water (and I mean hot, it was heated from a wood burning stove and then directly shuttled to my skin).
Our game drives were a success to say the least. The highlight for me was the final drive at 6am watching the sun rise over the Kenyan Savannah...breath taking. We saw the big five and then some: Simba lions, water buffalo, a black rhino, a leopard, elephants galore, giraffes, hippos, zebras, monkeys, and a cheetah.
The leopard we spoted was up in a tree, as we sat there and watched him, he decided to climb out of the tree, walk in front of our car, stop, look at me, growl and stare. I got a wee bit nervous, but he then walked away as the driver growled back when he started the safari vehicle. Scary, but amazing. I will post pictures of this beautiful creature.
We then took the night bus to Mombasa, one of my favorite cities in Kenya second only to the islands, of course. The night bus can be quite scary, dodging oncoming traffic, playing chicken with gas carrying semis, dust filling the hot, humid air, but nothing a little Benadryl cannot take care of :) Overall, another exciting transportation journey. Mombasa is a beach city that reminds me of medical school in St. Maarten, but also quite different. The city is eclectic and alive, filled with people from all walks of life. The beach reminds me of home, but hearing the imam calling prayer off in the distance reminds me I am very far from it. It was difficult for us to communicate here as they speak only Khiswahili, a language foreign to us as we learned quite a bit of Luo in West Kenya. We relaxed on the beach, befriended some Masai warriors who gave us free Masai jewels, walked up and down the streets of old town, and just had a great time. The dhow ride along the north coast of Mombasa was a highlight for me. As I watched the sunset again on another successful trip to Kenya, I'm reminded why I returned to so many familiar places...The people I had met along the way.  I had the opportunity to meet up with an old friend in Mombasa from my last visit and he, and his friend took us around the city a few nights. It was great to catch up with old friends.
Now, as I sit in Nairobi, awaiting to catch my plane back home, all I can think about is "when can I come back?"
I cannot wait to get back out to Rusinga or Mfangano to see what changes have taken place since this visit. I cannot wait to see and treat patients again, such a humbling experience.
I cannot thank all the friends who helped us along the way.
To Alphonce (alphie, alph, alphonso, alphonses, sampson, king, director, etc :), thank you from the bottom of my heart. You were an amazing host and we would have been lost without you. Just know I am there with you in my heart and I look forward to returning.
To Dan, your smiling face again was a sight to see. Thank you for taking us to your home, showing us around Nairobi, helping us plan our journey from afar and just being a great friend.
To Deepen and Jawar, thank you for showing us around Mombasa...it was fantastic to see you again, catch up on the wonderful changes in your lives and great to be in such a beautiful city. Congrats!
And to Josephine and Mark, thank you for allowing us to infiltrate your home at 430 am (or minus 3hrs in Kenya time) and being so gracious. It was great to see you again and Mark, I look forward to your visit to Milwaukee in March.
 And to the people of Kenya, thank you once again, for being the most gracious and welcoming people I have ever encountered. You have the most beautiful country.
There are so many more that I left out (pole sana), and when I think of you, know that I am thankful and you are all welcome in America for a visit, Karibu sana and orwaki ahyinia.

Good bye Kenya, Oriti Ahyinia and Kwaheri. I will be back so soon...until then...Asante Sana, Ero Kamano and, of course, ONGE WACH!!
Sawa sawa....
Becca Adhiambo

Reflections

It has been a few days since my last post. It has been quite difficult to get internet access. During our last few days on Rusinga island, the solar powered generator that allowed us to gain access was not working as well as it had. In order to get internet, the sun has to shine to provide power for the computers and the internet. It can get a bit hairy at the end of the day when the sun sets. The same is true for the power that generates the microscope in the lab we were using at Kageno, by the end of the day the light shuts off and we are unable to utilize the lab facilities. Anyway, here I am in Nairobi writing a blog.
We have officially left Rusinga, having said our goodbyes about 6 days ago before we took off for a week of vacation. It was difficult to say the least. We have met and made so many friends along the way. Many tears and hugs were shared. We also experienced great saddness as we were leaving, our good friend's mother passed away suddendly in western Kenya.
Our last few days of clinic were successful. We were invited to watch a book giving ceremony at a local primary school for girls and boys of the island. Alphonce and Kageno were involved, as well as the organization "One Kid One World". There was quite a bit of pomp and circumstance that went along with the ceremony and at the end, the elementary school has new books for all the students to utilize in their studies. ALphonce was an honored member of the ceremony and at the end he was given a goat. I asked him to name it Becca, but we'll see. Things are so different here, but so much the same. I think we should give chickens and goats as signs of gratitude in America.
We also visited a "special school" on Rusinga island during our last working day. There had been a "crisis" as we were told and our friends wanted us to see what was happening. We were told it was a school for the physically disabled. When we arrived we were greeted by the headmaster of the school and took the giant stair up to look at the girls dorm. There are something lik 16 students that are housed there total, and it costs close to 2000 kenyan shillings a term, or around 25-30 US dollars. Most of the kids cannot afford the costs and the goverment withdrew funding so now they are there without food. It was difficult to see. Some things I did not understand, but others were quite clear. There were stairs going into the girls dorm, but yet many of the girls are wheelchair bound. There were also HIV positive kids within the school because we were told this is a physical disability. A child with a cleft lip was placed in this school as well, and when asked why he was separated from the neighboring primary school, I could not get a straight answer. Overall, a school such as this one is needed, but I feel as though some things need to be changed. There is no reason to separate kids out of school to make them feel different, including kids living with HIV.
Overall, I feel our time was quite well spent. I cannot begin to share when I learned and how I was affected but I feel overnight it will slowly leak out. I know I am forever changed. There are many moments that will stick with me from my time spent in Kenya, I hope I shared many of those with you. I have much more to write about and many more pictures to post, but it is just too slow here to accomplish what I want. Please stay posted for a slide show of our journey and a few more stories. Thank you for following along on our amazing adventure...stay tuned for the next one :)

Mama Sarah

Last weekend we had the opportunity to visit the village and home of Barack Obama's father and family in Western Kenya. It was a pretty amazing experience to say the least. The village is Kogelo, near Kisumu in West Kenya. We were able to walk up onto the grounds where his grandmother lives, Mama Sarah, and we were then greeted by her and the President's Aunt.
The homestead is humble, with a small home, a few cows, a latrine, and a field growing what appeared to be corn. We were greeted by an unfriendly Kenyan police officer at the gate who eventually allowed us entrance into the compound after showing our passports.
We were told about the story of the family. Apparently, the president's father was married with 2 children when he left for Hawaii. There, he met the President's mother and Barack was made. The president's maternal grandfather, according to the Kenyan side of the family, would not allow a marriage to occur, and Barack senior left for Harvard requesting that the child be named after him. At Harvard he met another Mzungu (white) woman and ended up marrying her and bringing her back to Kenya. They had several children and she apparently lives in Nairobi now. Barack Senior has since passed away, but his grave site is located next to Mama Sarah's home. His home is the plot next door, where his second wife took up residence after his death for a short while.

Mama Sarah is actually the President's step grandmother. In the Luo district of Kenya, polygamy is quite common practice as we have witnessed over and over again. Barack senior's mother left when he was a child and his father's second wife, Mama Sarah, then raised him as her own. This is the President's grandmother. This is who he visits when he comes to Kenya and where he stays while he is here. Mama Sarah is a wonderful woman who greeted us so humbly. She welcomed us and called us by our Luo names. She allowed us to take pictures and answered our many many questions.
Overall, I would say that meeting Mama Sarah was a moment I will never forget. Listening to her pride for her grandsone and Kenya's pride for "their brother" is quite amazing. It is intriguing how one person can change the perspective of a nation that was undergoing such turmoil following their recent election in 2007. Yes, he is America's president, but if you ask anyone here, they say "He is Kenya's President, the World's president". I don't want to get into a political discussion or pretend to know much about politics, but all I have to say was that was a pretty amazing experience...Thank you mama Sarah.

HIV in the Islands

I spoke with a VCT counselor, Bernard, while on Mfangano Island. I had the opportunity to ask him many questions. As most people know, sub-Saharan Africa is in filled with people living with HIV and AIDS. Kenya is no different. In particular, western Kenya has been hit particularly hard by this epidemic.  After speaking with Bernard, he confirmed what I had already learned: the behaviors of the fishermen on the islands of Lake Victoria are the reason for the high rates of HIV out here. The islands are beautiful, yet isolated from the rest of the world by a huge body of water, Lake Victoria. Thus, often women are forced to get into the only industry known, fishing. In order for a woman to become a “fish monger” or get the fish from a fisherman, they must have a sexual relationship with a fisherman or be married to one. Often widows are left to fend for themselves on these unwelcoming islands, and the only way to make money to feed themselves and their children is to become a fish monger. Thus, the practice of Jaboya was born, or “fish for sex”.

Jaboya promotes the spread of HIV in this region by promoting unsafe sexual practices. The women are left hopeless on the rocky islands. There are often many relationships the women of the islands must have in order to actually get the fish sold on the mainland. First, the sexual relationship with the fisherman in order to get the Omena, Nile Perch, or Talipia. Second, the sexual relationship with the Matatu boat driver who is bringing the fish via boat to the mainland. And lastly, the relationship with the mainland matatu driver in order to get the fish sold in the markets on the mainland. Thus, the spread of sexually transmitted diseases, including HIV, exist in high numbers on these islands. We have been given many quotes, the most accurate I believe from the chief and the VCT counselor on Mfangano. He stated up to 30% of the population of Mfangano, 14% of Rusinga, up to 40% of Remba and Ringiti. It is devastating.

VCT counselors are located on Mfangano and Rusinga, but not on many other islands throughout this district. They are working to break the stigma, educating people about the virus that causes AIDS. There are so many myths surrounding the spread of HIV it is a difficult thing to combat, but the communities are working hard at decreasing the stigma. Now we find support groups, especially for women, throughout the islands. As I stated, these were not present in 2006.

Bernard informed me that all VCT counselors are trained by a group called Liverpool in Kenya. It is affiliated with the government, but most VCT counselors are affiliated with an NGO in order to receive salary. At most designated VCT centers, there is also an ARV site for patients diagnosed with HIV to receive treatment and education. The people administering the ARV’s or “anti-retroviral medications” are trained by this Liverpool organization as well. They are trained on side effects, adherence, and nutritional support. ARV’s and VCT counseling are free to the public, and any care associated with HIV is free from the government of Kenya. 

Bernard states that Senna, the A RV facility on Mfangano, is growing. He tests about 8 patients daily, with usually 1-2 testing positive for HIV. He also has run several campaigns to go door to door testing people throughout Mfangano. They also go to Remba on Tuesday every week and Ringiti on Thursday each week, which is funded through IMC or international medical corps, an NGO or non-governmental organization in Nyanza. Senna and each ARV center is supposed to have a functioning CD4 counter. 

Testing consists of a screening test first called “determine”. I believe it is our form of ELISA testing. If that is positive they move onto the “Bioline” test, which is confirmatory. I believe this is similar to the Western blot in USA. Then if there is different results from both tests, a specific 3 test is then completed, “unigold”. ARV’s are given to patients once CD4 count gets below 250 per Bernard and they are also initiated on multivitamins and Septrim (Bactrim). They stated the first line treatment is Stavudine, Lamivudine, and either Nevirapine or efavirenz. The government gives out the medications through various facilities, and there are apparently 1^st and 2^nd line treatments. I have not seen a patient with protease inhibitors, but my information is coming directly from various patient’s medications.

Senna health care facility on Mfangano was nothing more than a corrupt government facility in 2006. We were told patients we sent there  were getting ARVs but we were misinformed. Patients would return to us empty handed in 2006 saying “they ran out”. We found this strange, so we decided to check it out ourselves. We were greeted by staff who showed us around the facility but would not show us any medications. After our visit I felt they were keeping medications for people they may know and withholding it from others or charging some. Now, it is a well run facility, people are getting ARV’s for free. People who are able to get to the facility are initiated on ARVs.

Overtime, Kageno Mfangano and Rusinga hopes to have to have a trained ARV employee administering the medications at the two facilities. This would greatly benefit the communities of Rusinga and Mfangano. Currently they are walking long distances, or paying too much to take the matatu boat to get medications monthly. I hope to see these advances in the future when I return to the islands.

Mfangano Kageno Clinic

We set out for a 2 day clinic excursion on the island of Mfangano. I had spent most of my previous trip in 2006 on this beautiful island and it was a great return. The chief, Michael, of Mfangano North, welcomed us as we arrived. He was there in the full uniform of a chief of the islands. The clinic was cleaned and ready to see patients and yes, the sun was shining. What a beautiful day to help with the initiation of such a wonderful facility, Kageno Mfangano.

The clinic structure was complete, however, it resembles much of the clinic I remember on Rusinga from 2006. The cement walls are barren with a fresh coat of paint. The windows were in place and the grounds down to the beach were cleared so patients could pass freely too and from the clinic facility. The building does not yet have examining tables, electricity to run a proper lab, or permanent physicians or nurses to stay and run the facility.

The chief of the community announced the opening and there was such a great response. We saw over 150 patients the first day and over 50 patients the second day. Mfangano is an isolated island, and Nyakwiri beach community where the clinic is located is an even more isolated point of the island. It takes a lot just to get there, but it is much closer for many of the people who were forced to make the journey to Senna health facility some 16 KM away if need be. Many people could not make that journey and were left to succumb to illness because they were too poor to afford the 100 shilling (about 1 dollar and 20 cents) each way cost for the boat trip (the island is very mountainous and difficult to pass in certain parts, thus boating around is the best and easiest means of transportation). Thus, a facility in this location is a much needed addition to such a wonderful community.

Present at the clinic were myself, Anjali, Lillian a clinical officer (similar to a PA in the US), Grace our lab tech from Rusinga island, Nancy from Senna Health facility on Mfangano who was administering vaccinations to children and also running our limited pharmacy, and Bernard a trained VCT (volunteer counseling and testing HIV). Many people of the community helped translate and overall I would call the clinic a great success. However, when we left, we left behind a empty clinic for the time being.

We saw patients ranging in age from about 6 months to 99yrs old. Ailments common in the US were prostate issues, pneumonia, HIV, and eczema. We also saw many rarer infectious tropical diseases such as Malaria, Entamoeba Histolytica, Ascaris (roundworm), and a likely measles case. We think there may have even been a case of mumps, but being trained in the US I could not tell a case of mumps if it slapped me in the face, which it likely did on many occasions.

The pharmacy was helpful, however, we were only able to procure enough meds that we could carry. Kageno Rusinga has a well stocked pharmacy but it is funded only for the island of Rusinga and taking meds from Rusinga and bringing them to Mfangano only meant that the people of Rusinga would go without medications. It was a very difficult concept for me to grasp, but we did have to refer many to dispensaries around the island to fill various prescriptions. We did have enough treatment for Malaria, the mainstay being Cortem (artemether/lumefantrin) and Fansidar (names which I just learned here and dosages as well). We had Flagyl for parasites, and a few tabs of doxycycline for the rampant Chlamydia problem we found. I also ended up treating a lot of pneumonia with the cipro we were able to bring with from America (yes I know it is not the best respiratory fluroquinolone, but we really had no other resources).

We referred many to the district hospital on the mainland in Mbita town. This was difficult knowing most would not make it. We worked closely with the VCT counselor Bernard who was testing people for HIV and also counseling them. Overall he tested 24 people and he tells me 5 tested positive for HIV. The Nyakwiri beach community has a HIV prevalence rate of greater that 30% we are told and it is likely due to the practices of the fishermen.

Overall, the experience was one I will never forget. We were so graciously welcomed and honored. I learned so much and I cannot thank the community enough. We had the opportunity to walk down the fishing banda following clinic (the place where the catch of the day is brought prior to its loading for transport to the mainland) and speak with many patients we had just treated in the clinic. Many people would likely be hospitalized in Milwaukee, however, here they are going about their business and getting ready to go out for the nightly fishing expedition to catch OMENA the local delicacy (something that resembles minnows and dries on the beaches during the day).

The clinic structure is present, but sustaining it will be a difficult task. More fundraising is needed in order to have a full time nurse or clinical officer there to see patients daily. A functioning lab is a necessary requirement here, as we learned after many days of working in the islands. The rooms are well structured, but without exam tables. Also, a proper women’s exam room with equipment is a necessity in this community as pregnancy related issues are very common. Otoscopes and tongue depressors would be basic necessities we were lacking as many kids come in with upper respiratory infections and ear infections. Also, a functioning VCT center with a full time VCT employee present is a need that cannot go understated. Also, a person trained at administering and training patients on ARV therapy is a must as this community is so isolated.

Overall, I thank this community for welcoming us with open arms. We thank Michael, the chief for showing us such great hospitality. We thank Kageno for providing transportation  to and from the island safely and for allowing us this great opportunity. We have many great memories of this experience and I look forward to the chance of sharing them with all who care to know. We are forever grateful…          Ero Kamano Ahyina Mfangano and Kageno.

Home Visits: Back to the Heart of Medicine

Last Friday we visited homes of AIDS patients too sick to make it to clinic on Rusinga Island. I was not quite sure what to expect. As I entered each home I was faced with a different adversity, but a few common things: AIDS and Poverty.

Patient 1: a 34yo male who was diagnosed 1 year prior and had been in and out of the hospital.

As we walked into the mud hut, a man sat on the floor with only a mattress and mosquito net. He was surrounding by bottles of pills and a container of urine. He appeared extremely thin and had little energy. He stated that he was recently in the hospital and is “having the TB”. I swiftly pulled out masks for all those in the room and the translator looked at me with concern. She too is HIV positive and had no idea she was at risk of contracting TB. As I went through his medications he told me he was diagnosed with TB over 9 months ago, but he has continued t o cough and lose weight. He has little appetite as well. He is unable to take his medications every day so he likely has a resistant strain of TB. I also found a medication called Lasix in his bag and he was unsure why he was taking it. He states he does not urinate often, which Lasix can make you do, so he is likely too dehydrated and has some kidney failure. He did have swollen legs, so we deduced this was the reason for his Lasix. He states he has Kaposi’s Sarcoma, an AIDS related illness, on his Left lower extremity. We sat with him for 30 min discussing nutritional concerns, clean water and sanitation. We also gave him a TB mask to wear when visitors come into his home.

Patient 2: a 40yo male diagnosed 1 month ago with AIDS with a CD4 count of 1, now on ARV’s x1 month.

We walked for over 40minutes to reach this remote village where we found an extremely thin, ill man preparing to eat his lunch of Rech and Ugali (fish and millet mash). He was just recently diagnosed despite his 2^nd wife having been diagnosed with HIV several years prior. She had been taking ARVS for 1year and appeared healthy. We discussed the importance of medication adherence with this gentleman and he told me he understood. However, he states he is unable to swallow because of pain in his throat. Thus, he cannot take his medications or eat. He was a tall man, but likely only weighted about 130lbs. He told me he thought he had heart burn and wanted medication f or this. After examining him, it seemed likely he had a fungal infection in his mouth and esophagus as a result of having AIDS. However, we were unable to carry the proper medications with us to each visit as we were not sure what we would find in the different villages. I wrote out the medication he would likely require and instructed his wife to go to his HIV center and speak with his doctor. It is difficult to see this and feel so helpless. He would likely improve if only he had the proper medications to improve his swallowing. After returning to Kageno, I spoke with the nurse. She told me she was going to get him the medication. She knew his first wife and sent her to me in the clinic. I gave her the medication and she will hopefully bring it to him.  

Patient 3: A 30 something female, recently widowed with 4 children and diagnosed with HIV with a CD4 count in the 30's. She lives in a dirt hug, filthy inside, with dogs and cats living around her. As I approached her home we were greeted by the several animals. Entering her home I was filled with sadness. It was horrible to see someone in this state. She pulled out a plain xray film she had taken of her lungs a few days prior. She apparently was hospitalized for TB or some other opportunistic infection she was unable to convey through the broken english of the translator. As I again placed my TB mask on my face, I could not help but feel nauseated. I looked at the Xray (it actually looked pretty good), and thumbed through her various medications: stavudine and  lamivudine for HIV, septra to prevent opportunistic infections, INH/Rif/PZA (TB meds).I asked her how she was taking them and she told me appropriately. I then asked if she was eating. She told me she is unable to eat because she cannot afford food. The meds are free, but food is not, and thus she gets enough to feed her children on occasion, however, she is unable to feed herself. Looking at her she does not appear to be a woman who has taken antiretroviral medications for 1 year. She looked thin and malnourished. I talked with her about the importance of her nutritional status in order for her to combat her various illnesses: Malaria, TB and AIDS. She told me she understands, but there is only so much she can do. We spoke of her gaining enough strength in order to care for her children and possibly get a job. If she passes, she will leave 4 more orphans on this island. Unable to do much for her, we again educated her on the importance of medication adherence, nutrition, clean water, etc, however, it is difficult to do knowing she is unable to afford food and WaterGuard (the chlorination product used here to ensure clean water). As I left her home I felt helpless...a feeling all too common here. The women of the Kamasengre AIDS support group stated they would try to provide for her, however, it is difficult to care for her entire family. If only there were more I could do here...

Community Health Worker

A new Kageno employee, Pamela, is running a community health service for Rusinga. It is a fantastic addition to this community. After visiting many homes with Pamela last week, I understand her services are required. However, many more are needed in order to effectively work. She can in no way provide the services required of the community alone. Thus, Kageno is figuring a way to provide more community health workers. They would be able to do home visits, work with the various community AIDS/HIV groups, provide education to the community on various issues: nutrition, sanitation, HIV/AIDS, ETC. I feel that adding many more of these community health workers will provide the education and health care the community here requires. It can be difficult for many too ill to come to clinic. It can also be difficult to educated many together. Going to the community homes, discussing issues close to their hearts will help bring this community closer. Over my weeks here, my time spent in homes was the most worth my while. Speaking with patients, addressing their questions and concerns, and providing comfort and empathy for their ailments is something that is needed here. With more community health workers, concerns of the community will hopefully be address and treated, and lives will be saved through education and treatment.

Diseases of the Community

After hosting several clinics at Kageno Rusinga, I am beginning to understand the various complaints. Most people come in complaining of "Wia Bare" or Headache and " very much diarrhea-ring". I am seeing things for the first time as well. After seeing the 200+ kids of the Kageno Nursery school, we are now hosting adult clinics (thank god because that is what I am training in :). I also recently understand we just missed a mumps outbreak on the island. I saw a man come in with a huge abcess looking thing on his neck and I thought it was mumps because of what I was told of the outbreak. But then I remembered I am resident physician and I used deduction skills and noted it was a large abcess on his neck. It is funny how much medical common sense is lost here because everything is so different. I feel like everyone is "feeling Malarial" even if they don't have malaria. Some of the diseases we have seen thus far are:
1. Malaria (a lot)
2. Anemia (kids are eating soil, a sign of anemia, however, we are unable to run a basic blood test, a CBC to check for anemia)
3. Typhoid Fever
4. Entamoeba Histolytica (parasitic diarrhea disease)
5. AIDS and AIDS related illnesses= TB, PCP, Kaposi's Sarcoma, cryptosporidium, CAP
6. Pneumonia!! Yay, i felt comfortable diagnosing this one because we see it in the USA
7. Pyelonephritis (kidney infection)
8. Cysts of various parasites in stool
9. STDs:
10. Sickle Cell disease
11. Neck abcess
12. TB
13. Otitis Media (ear infection
14. Strep throat
15. Tinea Capitis (Ring Worm of the head: on just about every school child in the region)
16. MALNUTRITION and Associated illnesses.
Each child comes in with various other complaints, mostly skin complaints, but we are unable to do much for these. We are not trained in skin diseases, not to mention, malnutrition is something I am unfamiliar with. I have read and researched much about it and the skin problems that are associated with malnutrition (mostly vit B deficiency and protein deficiency) are what we are seeing. The kids have many sores that won't heal on their limbs.
It is amazing what these kids can go through on a daily basis. If i scratched my knee when I was their age, I would have a band-aid placed on my limb and a sucker in my mouth. These kids come in with a 104 degree fever, malaria, sores all over their limbs, they are thirsty and dehydrated, hungry and then told to go back to school.
I believe we will be leaving to host a 2 day clinic on Mfangano, the Jurassic Park Island, in a day. The chief of the island has announced it, and apparently several people are already requesting our services. I am hoping we are able to provide something, even if it is just comfort. The resources there are lacking: lab, meds, lab tech help, etc, however, just seeing people and comforting them is often somewhat of a soother. I do hope eventually we will be able to start up a clinic like Rusinga's on Mfangano. The structure is there, now we need the equipment. I can only hope to return in 1yrs time to see a clinic running effectively on Mfangano. I must now go, it is tea time at Midday, something that they should provide at hospitals in America!

Kamasengre East and West

Over the past 2 days we have visited various HIV women's support groups on the island. HIV affects all people living in this region, however women are particularly affected secondary to limited resources. In 2006, we searched for a support group in this region but failed to find one. Since that time, I found 2. They have organized a support system. The meet weekly, and discuss various issues they have encountered. The women also provide for one another if one is too sick to make food. They will pick up the medications for each other if one is too sick. We were given the opportunity to meet with these women and discuss various concerns they had. It took 1 hr to walk to one meeting and around 45 min to the other. I believe the women must walk farther. There are around 17 people in each group, and there must be at least 1 man in each group in order to register as a group in Kenya. We were given the opportunity to speak with them about various topics. We picked a few important topics:
1. Nutrition while on ARV's and with HIV
2. Sanitation
3. Clean water
4. Adherence to ARV medications
The women asked various questions.Many were asking about various side effects of the medications and we discussed this in detail. They are not given much education on the side effects of ARVs I am told.
One asked about disconcordant couples (the women having HIV and the man not) and how it happens. They were told it is a miracle and that those men are "special". Many men in these situations to not want to wear condoms, and the way it was translated to us was that many men feel as though they are "above the virus" and are untouchable.. They asked appropriate questions and it was amazing to see such a support system in such a remote region. The stigma attached to HIV is still present but I can see its diminishing effects because of such groups.

We had the opportunity to travel around with a community health worker, Pamela, hired by Kageno, to go out to the community. She gives various talks on HIV. She has 1.5yrs of training on community health and HIV and she now spends her days walking to various villages and fishing communities. She also visits those that are too sick to make it to clinic. We will visit many of those patient's on Friday.

In the future, Kageno plans to have a treatment center. This will cut travel time for many patients in this region. Most now travel over an hour to get meds each month. This is too far for many who are too ill to make it. Once the RN, Magdeline, gets government training, they will start the treatment program here at Kageno.