Our Domestic Agenda

With our President Barack Obama making big plans for the country, I 1) look forward to making plans here at home in Providence & 2) do not look forward to being within earshot of the talking heads (with the important exception of one Jon Stewart). They are difficult to avoid in the airport... but we're almost home. It bears repeating that I have learned everything I need to know about President Obama right here.

We spent our day in Nairobi seeing just a few more animals. The leopard was sorely missed in Masai Mara. It is clearly cheating to see one in an "orphanage" but was very cool nonetheless.


That the leopard is a total badass is demonstrated by the resemblance of its cage to something out of Jurassic Park.


Though some of the animals at the orphanage/zoo were overly domesticated & scratch-able for just a few shillings slipped discreetly to one of the animal's handlers, I still do not feel much for cats generally.


It is true that dogs are better... but which breed? Size? Age? Important decisions all. Anne will likely push for a house before a dog, but the searches for each will start together in earnest once we touch down in RI. High on my list is the Old English Sheepdog. Thoughts?


The Frank family has a good thing now going with Boston Terriers, so a Boston has got to be on the short list.

........

And the Franks have historically had a very good thing with Springer Spaniels. I think this picture speaks to how much Maggie loved being at home... as she just looks so sad to have been somewhere else when this picture was taken.


We look forward to catching up with YOU if you are still following along. You are encouraged to call 317-509-0071 to keep Anne company over the next day or two while she savors her last days in Providence as the one of us working fewer hours.

Kila la heri,

Joe

P.S. As one last anecdote from Eldoret, we sat next to a Kenyan on the flight out of London. Only at the end of the flight did I get my act together to strike up conversation. Turns out, he's spending a few months in the US running. Google Silas Sang & you'll find that he runs well. In this way, Eldoret followed us all the way to American soil. In many others, it will be with us indefinitely.

The Bora List

Habari zenu? What news of you all? We are back in Nairobi, which means our time here in Kenya is very near its end. This being a blog, us being bloggers, today being at the end of a period of time, we feel obligated to sum up the past two months with our very first "Best Of" List. We just couldn't rank the winners in some of these categories. Other categories, clearly, deserve only one nominee.

Be warned. This one's gotten long. And away we go...

Best New Friends

• Philip & Robina- We've described already the generous hospitality shown us by our favorite double date companions. Philip & I accomplished more in the last few weeks than either of us reasonably hoped for at the outset of our project. I have really enjoyed our work together thus far and think we share the understanding that this will be the first of many joint projects to come. Robina was endlessly tolerant of my presence in Philip's room into the late hours and more endlessly gracious in taking care of me while there. Anne & I look forward to taking Philip & Robina up on their invitation to the Masai Mara next time we're here.

• 
• Lillian & Mojo - In addition to being a favorite student on my medicine team, Lillian took care of me in the market, showed me shops around town (including the ice cream factory), and taught me how to cook Ugali, among other things.

• Dennis - My newest friend in my intern class, Dennis took us to the Busia and Port Victoria AMPATH clinics. He invited us to his house for nyama choma last weekend, and we spent some quality time with his wife, and three darling children.

• Judy - I spent time with Judy last year during her elective at Brown. She's destined for great things in medicine, but she just doesn't have the patience for success teaching Kiswahili... to me.

• Barb - A senior resident from Utah, Barb has plans to follow medicine to the upper reaches of the planet, working in Nepal and building on her past experience in high-altitude medicine. She went running with Anne & I on two occasions. Running up from the floor of the Rift Valley with a local Kenyan runner seemed a little more her style. Her husband, Peter, is a (the?) coach of US Nordic Skiing Team... which is pretty bad-ass.

• Dave - We first worked together as intern & third-year student at the VA in Providence, which is the closest we come to a resource-poor setting in Providence. It turns out we stick needles into things with even less preparation here in Eldoret. He's headed to New Haven and fatherhood in the coming months.

• Anand - An IU resident headed home to Baltimore & a hospitalist job. Anand was my resident on the medical wards and was very good at answering the question "so, what would we do in the states for ____?"

• Honorable mention, of course, to all the old friends whom we worked and came to know much better. They were, however, disqualified on a technicality.
  

Favorites in the IU House Family

• Dunia & Chelimo - Sisters, Dunia & Chelimo run the show at IU House. We were all very excited about plans to meet Dunia's family and share a hookah in a completely appropriate & legal cultural exchange... plans which were derailed by a ill-timed bout of gastroenteritis. Next time...
  
• Margaret - A warm and motherly housekeeper at IU House & hostess at church.
• Joseph Kimani et al. - One of the crew of guards on constant watch at IU House, Joseph or "Kim" was also a demanding training partner, preferring to finish runs first with a backwards run back up the hill & then a sprint to the bottom.

• Peninah & Julius - The mother & father of the IU House dining room, both in Peninah's choir, last seen singing & dancing on the back porch behind the kitchen.
  
• Naomi, Leah & Lucky - The younger generation in the family of Peninah & Julius, they were a nightly presence in the IU House dining & computer rooms, and the nighttime keymasters to the pantry.
• Benson, Simon & Kelvin - Unofficial social chairs for visiting students & residents.
  
• Gabriel* - To leave IU House, we pass through one gate & then another gate. Gabriel works six days a week at that other gate. All the hours without the IU House benefits. He always warmly received my Kiswahili greeting of the day, regardless of whether the sounds spoken made sense.
  

Favorite Foods

• Ugali - Delicious, starchy, and tricky to make, though its only ingredients are flour and water.
  
• Sukuma wiki - "Kales", translates to "push the week", suggesting that it fills those meals on days when shillings are especially tight.
  
• Chapati - If you are a fan of tortilla, naan, flatbread, pita bread... chapati is better than the all those stacked up.
• Samaki - I made substantial progress in my ability to eat the fish and not eat the bones. Philip sets the bar high. Practice, practice, practice.
  
• Orange Fanta - A ballpark estimate, I drank upwards of 30,000 mL of Fanta. I love the stuff and somehow will not drink a drop once back on US soil.

• White Cap Light (Kenyan light beer)
  
• Mango (in Peninah's nightly fruit salad)
  

Favorite Patients

• Annette - My first patient on the wards, who was carried into the Hospital and walked triumphantly out.

• Victor - An adorable child who suffered years of abuse, eventually landing in AMPATH's orphans and vulnerable children division. We started out with a handshake, but when he was discharged I received a big hug.

• Josephat - Truly a miracle, after 38 days in the ICU, smiling.

• Faith - Enduring a 6 week hospital stay with grace and a friendly greeting during rounds.
  

Most Challenging Illnesses (AKA Most Common Illnesses on MTRH Wards) - This category deserves and hopefully will receive far more reflection than it will get right here.

• Rheumatic Heart Disease
• AIDS
• Tuberculosis

Favorite Kenyan Medicine Terms

• Hotness of Body (fever)
  
• Awareness of Heartbeat (palpitations)
  
• Branula (IV)
  
• Sister (nurse)
  

Best Places in Eldoret

• Roads surrounding IU House feat. the River Path - I had some of the best runs ever, and Joe spotted famous marathoners such as Ezekiel Kemboi.

• Eldoret Cathedral

• Bench in front of the Student Hostel - Best place to socialize.
  
• Queen Chic - This restaurant has the best and biggest Ugali portions, plus fast service and chips masala.
  

Best Chorus in the "Barack Obama" Song

• The "Barack Obama" chorus
  

Obama!


Best Medical Student Hostel Dorm Room

• 1-25L - Philip & I conducted the majority of nearly thirty interviews in his dorm room. More than a full day's worth of me at the foot of the bed with my back to the wall, audiorecorder near my left knee, Fanta to my right, Philip overseeing the operation overall.
  

Best Salespeople in Eldoret

• Molo - One of the things Molo sells is metal clothes hangers. He occupies a choice location on the end of an especially industrial strip of market about a half mile from the medical wards, which are full of patients in desperate need of IV fluids but too often lacking IV stands. Molo quickly earned my business, that business being the task of turning clothes hangers into IV hangers. My interns quickly declared it the "best thing you've done".

• Monica - Enthusiastic market woman who gave free bananas and Swahili lessons

• Max - The gatekeeper to all things taxi for most of the IU House crowd... and yet another patient Kiswahili teacher.
  

Best Sightings on Safari

• Sunset, Day Two

• Two lions under a bush six feet away

• Elephant baby
• Vervet monkey baby (Close runner-up in the Vervet Monkey category is the electric blue monkey scrotum)

• Birds on giraffe neck and buffalo nose. (Of note, those ears.)
  

Favorite Intern

• Juma - At one point working without a co-intern, Resident, or attending, Juma managed a team of 40 something very sick patients during his first month of internship. I cannot imagine doing that come July.
  
• Kairu, Pita, Omar, Blano - Fact is, all the interns claim the distinction of taking care of many, many sick patients with inadequate guidance or supervision, but plenty of gusto. This is an incredibly hard-working bunch.

Favorite Phrases Inexplicably Written on Matatus
(Please allow one more day in Nairobi for full data collection)

Favorite Kenyan Politician Traveling on our Flight to Nairobi

• William Ruto - The Kenyan Agriculture Minister has been in the news frequently in the past two months. There was a "Maize Scandal" which I was never fully able to figure out. A maize shipment had been lost, stolen or otherwise mishandled, and blame landed on Ruto. There was a censure motion in Parliament, watched and listened to by most Kenyans, it seemed. He made it out with his political life but may have had to agree to reinstate some other Minister recently kicked out over corruption. That's either a gross oversimplification or a rational explanation where there is none. More recently, he was tagged as the Minister most likely to have been the Kenyan Minister banned from the US permanently for his corruption. We knew something was amiss when a helicopter landed at the Eldoret airport. I stared as much as I could to confirm his was the mug so frequently on the front page of The Nation.

Favorite Riots in Nairobi in the Past Month - When all other forums for redressing injustices have proven themselves useless,

• Mechanic's riot
• Kenyatta University student riot/protest
• Nairobi University riot/protest
  

Cutest Pictures of Anne & Joe (AKA Frontrunners for the Save The Date Card) - This category was designed with our mothers in mind.









Tunasafiri nyumbani,

Anne & Joe

Tuliona wanyama wengi kwa Masai Mara

The Masai Mara is "a large park reserve in south-western Kenya, which is effectively the northern continuation of the Serengeti National Park game reserve in Tanzania", so says Wikipedia. It is named for the Maasai people who have traditionally lived in the region & the Mara River... also in the region. It is a popular travel destination from all parts, especially from IU House in Eldoret.


I didn't make it to "The Mara" in 2007, so Anne & I had counted our shillings in anticipation of this finale weekend. It was spectacular. The views, both in the presence of the abundant wildlife and with that of the horizon alone, were uniformly breathtaking. We had a wonderful time, some of which was spent not viewing our surroundings through a 3-inch camera screen. A collection of more than 1,100 pictures from the group says otherwise.

We traveled with a group of six, all students fresh off matching at their residency of choice & myself, fresh off Anne matching at my residency of choice. Our travel agent, driver & guide Eric is on the left... with Jason, Molly, Rozi, Dave & Anne up top.


The Big Five includes lion, elephant, cape buffalo, leopard & rhinoceros... We saw so many of the first three that we were passing them by in search of newer sightings on our fourth and final game drive. A game drive consists of sitting or standing in the above pop-top mini-bus and looking out. Just looking and looking. I somehow came to believe that leopards were to be found in the trees. Even hours after leaving the park, I couldn't keep myself from eyeing the contours of individual branches of trees, searching for a dangling tail or spotted fur. The elephant in the foreground is right-tusked, as he or she has worn the right tusk down with use.




I am still completely fascinated by giraffe. They have only seven cervical vertebrae like you and me... as well as a long, black tongue.


Our two guides were a mysterious duo for most of the weekend, stopping, looking through binoculars and talking rapidly in Swahili, never really filling us in on their safari guide ways. On one occasion, someone picked up the word "simba" as we rolled in amongst some bushes. As the van passed within three feet of the male lion in the twosome, he stood up and took a few steps away. We gasped & lunged toward the far side of the van, only to creep back to the glass and stare, stare, stare. We were close enough to see the bugs crawling on the female's belly. We speculated that those same bugs were the cause of the male's disinterest in her affection.




There are several hundred more where those came from and time in the coming days to sort through them all, posting only the finest, of course. Hyena, hippos, wildebeest, hartebeest, topi, two species of gazelle, zebra, baboon, vervet monkey, warthog, mongoose, a cerval cat and various birds, the largest shown below.


The game drives either began with a sunrise or ended with a sunset. I have plenty to get done before we leave Eldoret tomorrow afternoon, and I have just now sat for at least fifteen minutes, completely incapable of making the difficult decision of which picture of the sun rising or setting over the Masai Mara to choose.




We now have one day in Eldoret, one day in Nairobi, one day in the air and another day in Providence before getting back to work at the Miriam. I expect we'll continue to reflect on the past two months in the days & weeks ahead... mixing in the more mundane tasks of buying a home in Providence and a dog to put in it. We are sad to leave but excited to get home.

Usiku njema,

Joe