So last post was about Match Day and the craziness that that was. Let me just say that since then, everyday has been a different level of struggling/excitement/apprehension/astonishment that's hard to describe. Firstly, I can't believe I've actually been given this chance to do a residency at an amazing hospital system like NYP. I couldn't be more excited about the change. But then comes all the baggage behind it. So much to leave in the place I've called home for the past 6 years. Midtown has been a place for me to grow up close to home, make the best friends I've ever had, make some mistakes along the way, and ultimately grow to who I am now. Wouldn't change a second of it, but hard to swallow the thought I'll be leaving it all for a while. Fortunately I've been pulling in plenty of airline miles, so I'll be back regularly.
A second note about residency and I won't get into the nitty gritty details, but after first thinking I wouldn't be eligible for licensure in NY state and being told this by someone from the Board, I finally learned from many sources that I AM in fact eligible. Can you say emotional roller coaster? Yep. So with the major help of Brian, Megan, and Jordana, things were overnighted, stamped, signed, sealed, and sent to the NY State Board of Pharmacy. It's in their hands now. Let's hope all the ducks are in a row.
Okay, so we'll do a day by day. You'll notice some days' recaps are shorter than the others. That's likely inversely proportional to how LONG they felt to me. Those boring days suck. And we've had a few. I've mentioned before the frustration we've had with the evident lack of great things to do during the week coupled with the inability to get around easily and inexpensively. It's taking it's toll, but thanks to friends back home, we're planning some day trips and planning out our weekends, the few we now have left.
Thursday: We spent most of the day in a comprehensive care center at Kenyatta Hospital, which exclusively serves HIV/AIDS patients. I was pretty excited to see this clinic and see how HIV treatment was different here versus America. So the biggest difference is the funding. As you look along the stock shelves, you notice all the boxes are labeled in various languages, mostly French and English. This is because all of the antiretrovirals in Kenya come from the CDC and WHO. And they are dispensed to patients completely free of charge. Even if patients had to pay for therapy here, it's literally at least one tenth of what it is in the States. It's pretty remarkable. So this one clinic treats about 8,000 patients for the infection. All free of charge. And this is only one of MANY clinics in the Nairobi area and all over Kenya. It's pretty interesting to see the dollars of the international community caring for these patients, but also makes me think about the patients I've personally seen rejected from assistance back home in Atlanta. I worked at Grady's infectious disease clinic, which exclusively treated indigent HIV-infected patients. There is an AIDS Drugs Assistance Program, ADAP, that helps pay for funds, and Georgia has one of the longest waiting lists in the entire nation for assistance. It's frustrating to think about, but encouraging to see that regardless, care is being given to those in need.
Friday to Sunday: This was our last day in Kenyatta for a little while. We spent it with the pediatrics unit, which was quite interesting. Probably one of our more beneficial days at Kenyatta. Patients are kept in large rooms of 6-8 patients. Care is given by 1-2 nurses for 30-60 patients. Yeah, that means that the usual ratio is 1 nurse to 30 patients. Can easily be much more. This gives the nurse about enough time to deliver all the meds, then start over again with the next round. Patient care isn't at all what it is in America. Families often stay with the children, aiding in their care. Contact precautions are, again, not a common thing. A room of pneumonia patients are right next door to the cancer patients. We talked extensively with a surgeon who recounted many interesting cases from his time. The most common surgical cases for pediatrics are actually anorectal deformities, traumas, and bowel obstructions. I won't get into the details here, but he has many interesting stories, many culturally relevant, from patients past and present.
Friday night though, is a vacation in a vacation. We get off work early to head to MOMBASA! After a long week of never quite knowing what we're doing and a lot of waiting around, we finally know exactly what we're doing. And it's relaxing on the Indian Ocean! We grab a cab to the airport and do the unusual practice of Kenyan security. Here's the process: tell the guard your flight, put your bag on the belt (you can take out the laptop, but they probably wouldn't care), and walk through the metal detector. I had shampoo, gels, pastes, foods, and even a liter of water. No problem. Makes you wonder about American standards. A little unsettling though in a country currently tormented with terrorist attacks. Regardless, we get to the gate about 2 hours too early. Given the free time, I pick up my usual snack of Cadbury chocolate and a coke (yeah, I should watch that...), and we wait. I'm reading up on some NAPLEX review material while Erin checks out game drives for future trips. Finally, we board. Stepping up on the brand new Boeing jet is a step into a different world. TV screens in every seats, power ports, new leather, it's miles away from the tarmac. And all this for a 45 minute flight. About 5 minutes into settling in, we hear a COUGH AHHH COUGHHHHH. The guy directly across from us is clearly suffering from TB. (Hopefully not, but we joke that since TB is so common here, everyone with a tickle in the throat as TB.) But this coughing does NOT stop. EVER. The longest it stopped was 38 seconds. Yes, we timed it. Touching down, we step outside to find out arranged driver. Jackson is a small older man with a few missing teeth and wearing a very oversized tee shirt. He speaks English, but to about the same extent as we speak Kiswahili. Asante. We knew it'd be a long ride to the hotel, but not a 2 hour ride across two rivers involving one ferry. Driving through town was interesting due to the construction, but we made it through. The hotel we're at merits a nice description. I can't call it a hotel really, should refer to it as a lodge. And lodge is generous. It's a tree house. And yeah, we picked it because it is a tree house. We walk up to the reception area (with a pretty well stocked bar) and meet Tim. He kindly shows us our room, which is a tree house lifted about 10 feet off the ground. We have two beds with nets and two chairs on the front porch. Perfect accommodations! Tim even explains some of the wildlife we'll see here, most of which are in the monkey category. We couldn't be more excited. So we change really quickly then head off to Forty Thieves, the local bar/club. We are escorted by a Maasai man with a large machete. Badass right? We walk down a small road with our escort and into Forty Thieves, which doesn't appear to be too busy at the time. Has my research failed me? I ask the waitress, and she gives me a cute smile and reassures me that it is both open 24 hours and will be busy. We have a couple of beers before walking down to the ocean for a second, which at low tide is at LOW tide, like a couple hundred feet out. We sit back at the bar and watch the night unfold. Pretty mellow first night for us, as we head back to the tree house shortly after midnight. We wake up pretty early to a small rainstorm, then later to monkeys jumping on the roof. I guess it's time to get up. We grab a little breakfast, then put our swimming gear on and head to the Indian Ocean! It's absolutely beautiful as we approach it from the same road we took the night before. We walk up and down the beach, just taking it in, but not easily because the beach boys, as they are called, accost us with offers of glass bottom boat rides, snorkeling, and open air markets. We finally manage to get some peace and quiet when we sneak up to a hotel's private cabana area to soak in the sun. After a few hours, we head back towards Forty Thieves for some food before heading back to the tree houses around sun set. We end up meeting some of the other guests there as we feed the local bush babies with some freshly cut bananas! We all sit and have a few drinks together, recounting travel stories, experiences in Kenya and other distant lands. We have some Germans, Britons, Americans, and Israelis with us. All having a great time just getting to know each other. We agree to head out to the club shortly after a few sips of our favorite spirits. I won't belabor our night, but let's just say that dancing the night away at an open air beach bar is an awesome experience. After a night of sleep, we eat some breakfast then head BACK to Forty Thieves to just relax. Hanging out with our new friends, dozing in and out of naps, sipping and snacking on food, we just soak in the sea breeze before we have to make the journey back to Nairobi. After heading back and realizing how sun burned we actually are, we settle back into Flora and hit the beds before a new day at our industry site.
Monday to Friday: Our driver pick us up at 8:45 after some confusion. Typical Kenya fashion. We make the 45 minute drive to Kikuyu, which is about 20 km outside of Nairobi. Greeted by a German native and a Kenyan, we get a brief overview of Universal Corporation Limited. This is a generic manufacturing company, one of the largest in Kenya and East Africa. Throughout our 5 days here, we see everything from drug development to manufacturing, sales and marketing, and even engineering. It's a pretty impressive production, if I can say so with very little experience of American industry standards. One of the most interesting facts about Universal is that it is one of very few WHO Prequalified sites for their new fixed dose combination of zidovudine and lamivudine. This status basically means that they live up to WHO's high standards for production and local distribution of HIV, TB, and malaria drugs. This speaks volumes to the efforts being made to give underserved areas access to QUALITY and AFFORDABLE medicines. ARVs are ever more accessible to East African solely because of this corporation.
We struggle through some of the sessions, are engaged by others, but overall it was a fascinating week to see the actual drug manufacturing process from B to Z. I'll say B because they don't do drug development of novel drugs, just generics.
Tuesday night we meet up with Carol, who we met in Mombasa, and her friend Natalie at Brew for dinner and 2-4-1 drinks, which is becoming our Tuesday tradition. Conversation is great and we plan on hanging out with these kids again. Love meeting fellow travelers.
Thursday night we stop in at the Intercontinental hotel in downtown Nairobi to meet up with my parents after their whirlwind trip through Kenya. We have a few glasses on vino and eat an awesome dinner, recounting each of our adventures. They've arranged to take us to one of their tour's stops in Aberdare at a hotel called the Ark. We head home after some serious haggling with the cabbies for a good night's sleep, as we'll be up at 6am to start off this adventure.
Saturday morning we struggle to wake up, but quickly remember that the countryside awaits, not the dust and smoke of Nairobi. We cab it down to my parents, grab some breakfast, then load up with our driver Eddie, who Mom and Dad met on their adventures. Even though it's early, it's amazing to see the transition from extreme urban scenery to the country, not of course without extreme traffic jams of abrupt breaking and gunning it to keep our place in line. Finally out in the country, we pass by local farms of coffee beans, pineapple (for miles, literally - thanks Del Monte), and local crops. We pull into the Aberdare Country Club, greeted by a man presenting warmed eucalyptus towels for us to freshen up with, followed by mixed berry juice. Erin and I quickly realize this is no ordinary side trip. We eat an amazing lunch on the porch overlooking the large valley, surrounded by perfectly manicured landscapes. We take a quick walk around the grounds, spotting several baboons and wart hogs. Then Nahashon and George, our two game drive guides, pick us up in a Land Cruiser with a pop up top to begin our drive. We're all quite eager about this 3 hour journey through Aberdare Park to hopefully spot four of the Big Five. Only lions are not present here. About 30 minutes into the drive, we see a spot of rain on the windshield. Then another. Then another. Not too many now. Then it starts. The rains have come! We've been avoiding this, but as we knew the rains came in March and April, it was inevitable. We quickly lower the top and continue on our drive, but we are warned that rains are usually a negative event for drives. Still hopeful, we scour the hills looking for wildlife. While there are few animals, we still are lucky to see great exhibits of hogs, buffalo, and even large packs of elephants clearly protecting their young. Females present signs of agitation and even aggression at our arrival, but we observe from a safe distance. Driving through the hills in the rain presents its own challenges, such as sliding all of the roads in our 4x4. Turns out the dust turns to slippery mud with a little rain. The hail storms aren't helping either. But on the plus side, it's MUCH cooler now. To the point we have to wear our layers we were warned to bring. We arrive at the Ark, which is in fact an ark shaped lodge in the heart of the park. We find our rooms, none of which have locks, and we are shown down to the observation decks. We descend down to the lowest level, which is complete with a cement bunker on the ground level looking over a lake where the animals come for water. We are greeted by several elephants and a buffalo enjoying the fresh mud. We quickly begin to fill up our memory cards of our cameras with the shows of the wildlife. Even with the previous rains, we are hopeful we will see many animals. We grab some dinner, then sit up on a deck overlooking the lake sipping some warm tea bundled in our blankets and jackets. After a few hienas, hogs, and buffalos (and even a personal greeting by a bush baby), we head to bed, planning on another early morning.
The alarm goes off at 5:30am. I am NOT excited about leaving my comfy, hot water bottle warmed bed. I pull back the curtain of the window, whisper a unpostable exclamation, and jump out of bed. I didn't realize the curtains were black out curtains, and they sky is glowing with the fire of the sunrise. I throw on some clothes and grab my tripod to capture this beauty. Standing on the deck of the Ark, looking out over the lake watching the sun rise over Mount Kenya in the distance is a breathtaking scene if I've ever seen one, and I have seen many beautiful scenes in my life. We sip coffee and snap pictures, soaking in the amazing scene of the snow capped mountain.
After breakfast, we enjoy an awesome show of nine elephants, including one young elephant that they are clearly protecting. We get a show of trumpets and fighting before we're told our time is up and we need to head back to town. The ride is bittersweet as we see a few last animals on our trip back. We meet Eddie again for our trip back to Nairobi, again admiring the countryside. The difference this time is all four of us find ourselves able to sleep through the pounding roads. After arriving back in Nairobi and eating a quick lunch, Erin and I head back to regroup and get a few things done at Flora. Then we head BACK down to my parents for one last dinner and goodbyes. The weekend, without a single doubt, has been phenomenal. Seems like a whirlwind looking back as I sit in Flora now, but an amazing trip nonetheless.
So now we get some much needed rest before starting off at Nairobi Hospital, a large private hospital down the street. It'll be fun to compare and contrast the public and private systems here, so I'll be sure to include my comments.
And like I always promise, pictures are to follow! Just need to sort through them.
Thanks for reading, and sorry for the typos!
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