Following are a few select journal entries I wrote during the medical relief trip to Kenya this summer.

First- a few thanks are in order-

 Thanks to the other medical students I traveled and worked with over the

summer- you amaze me.

Thank you to the physicians and nurses who traveled with us, for all of the

teaching. As Dr. Berg said to me- the process of becoming a physician is an

apprenticeship. In that regard, I have been apprenticed to some of the best. 

To family, friends, and fellow students who made the trip possible with

their support, financially and otherwise- literally, it couldn't have

happened without you.

Enjoy.

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I am at 14,000 feet on the slopes of Mt. Kenya. I was supposed to be at the

lodge twenty minutes ago. It's raining, a freezing sleet, I have altitude

sickness and hypothermia, my arms won't work properly anymore. I reach the

lodge, pound water and electrolytes and acetazolamide ( a carbonic anhydrase

inhibitor used by climbers to combat the effects of altitude ..) That night

I sleep higher than I have ever slept on a mountain before- the next morning

the sunset explodes in front of Dima as we reach the top ridge at 16,200

feet- we hold hands and summit together, Dima in the lead, myself at the

caboose.

_______________________________________________________________

I am interviewing a 12 year old boy. He has come to the clinic complaining

of fever, diarrhea, and a pain in his abdomen. Looks like malaria.. Malaria

is a disease spread by mosquitoes- given  chronic exposure, it can eat at

your liver, enlarge your spleen and leave you with horrific fevers and

malaise. On physical exam my patient has jaundiced eyes, and anemia, and a

monstrous spleen that reaches halfway across the left side of his abdomen.

It should be tucked safely under his ribs. He says, through the interpreter,

that he has fevers all of the time.

I say I believe him.

He says he has a pain in his stomach when he walks, and that it gets worse

when he runs.

I tell him I know.

I ask about his parents.

"They are dead," says my interpreter. I ask how.

"His mother- he does not know," says my interpreter.

"And the father?"

" The boy says his father...." My patient is gesturing towards his own

spleen now, tears in his eyes- " The boy says his father died of this same

thing."

_______________________________________________________________

Andrew has been triaging outside of the clinic. Triage was developed in

wartime to expedite the application of limited resources to the neediest

patients rapidly. He has pulled a boy and his grandmother out of the line

and brought them directly into the clinic. I am between patients and across

the room when I first lay eyes on the child. I can see the contours of his

skull. From across the room. I am taking vital signs on him seconds later.

He stinks of piss and shit. He is tachycardic, tachypneic, febrile to touch.

I think he is about two years old, but it is hard to tell with the protein

wasting. His bloated stomach holds him in an upright position while I

examine him. I am rifling through his clothing, nearly assaulting him with

my stethoscope to get these vitals down- he should be fighting me and

screaming his head off. Any healthy, normal kid would be. But I don't think

this kid even knows I am there. His eyes are glassy. He is silent. He

doesn't even struggle against my hands. Dr. Kerkering appears to save me-

thank God, a doctor- wait, I am a doctor, no I'm not- at best I am ¼ of a

doctor and I am not even that I'm a medic for chrissake and besides what the

hell does a medic who grew up in a white suburb in the United States know

about treating malnourishment anyways?

"Alright Jeremy" says Dr. Kerkering, scooping up my patient and hustling us

to a back room " what do you want to do?"

Whimper.

Me? Hell, I wanna run!

A Paramedic I knew and respected once told me that if you ever reach a point

where you don't know what to do, start an IV. You will always need one

anyways, and it gives you time to think. Right. Start an IV.

" I wanna start and IV...." I say.

"No."

oh. darn.

" Does this child look dehydrated to you Jeremy?"

Actually, no. he doesn't. Skin turgor good. Mucous membranes wet. Snot

dripping, and fontanelles, for what they were, appeared normal.

" No- he doesn't. And we don't have the meds or capacity for long term care

anyways," I answer.

"Right..." Dr. Kerkering is calm, cool- he is in his element. He has seen

this a thousand times. He exudes confidence. I listen to what this man has

to say on things. " What does he NEED?"

" He needs vitamins... and calories. And albendazole for the worms. A

malaria test."

" Right. Good. Get started."

Five minutes later I am feeding a melon flavored vitamin/sugar solution to

this kid through a 10 cc syringe. His eyes have brightened a little already,

they are tracking me now. He is sucking down these vitamins and sugar like

it is life itself- which, in his case, it is.

______________________________________________________________

 

A small boy comes into the clinic with a deep laceration to his left

temporal lobe. Dr. Berg is observing Samir stitching him up, I am holding

the child's head in place. Dr Berg is a brilliant teacher, he is correcting

us, guiding, giving just the right amount of leeway without giving us too

much. We have pumped enough lidocaine into this child's wound to numb up a

small horse. But he is still screaming, bellowing, repeating a phrase, I

think it is a prayer. I understand, I would scream too, were I injured,

young, separated from my parents with two of the weirdest looking guys I

have ever seen stitching up my face, go figure... he howls. We irrigate, dab

the wound, Samir closes the stitches. Antibiotic and bandage, we have no

tetanus shot to give. I leave the room, and enter the main room of the

clinic- as I do so, fifty pairs of eyes meet mine. They have heard

everything, the bellowing and screaming of one of their children. They look

at me questioningly. Blood drips from my gloved fingers. Behind me the child

emerges, bandaged, quiet, dried tears on dirty cheeks. Samir beams like a

new father. Parents nod at us. I am afforded a shy smile from a young girl.

Samir's hand is grasped.

_______________________________________________________________ 

What did I see? What did I hear? Many things.

 

I saw a ringed octopus hiding in its coral home. It pulled a rock over its

hole to hide from me.

 

I saw snow gathered in cacti leaves on the slopes of Mt Kenya.

 

I placed my right hand in the prints made by a hippopotamus on the shore of

Lake Victoria. The prints were three times the size of my hand.

 

I heard a chorus of girls sing to me in their native tongue, singing thanks

and praise for the medicine we brought.

 

I saw a house with four graves in front of it. The graves were full, the

house was empty. AIDS.

 

Samir and I bought a thyroidectomy for a woman who required it and could not

afford it. It cost us about 800 shillings, or ten dollars, each.

 

I spent three and a half hours helping a surgeon repair a hand that had been

nearly completely severed by a sword. I found the radial nerve. After the

operation, the patient waved at the surgeon and I as we left the operating

theatre. Full function.

_______________________________________________________________ 

I am assisting in an umbilical hernia repair in a clinic in Mara Lai. It

goes smoothly until the surgeon accidentally cuts the hernia sack. Then the

power blows. The surgeon barely even blinks about it, this is common. We

continue. While closing, we get on the topic of tissue glue ( closing sans

stitches....) Says the surgeon-

"Yeah, I have heard of that stuff. Kenya won't get it for fifty years, if

ever. Only thing we do with glue around here is sniff it."

Stitch.

" Oh yeah?" I reply, "Is that before or after surgery?"

Stitch.

" During. He he."

We are completing the last few stitches when the power comes back on.

" Better late than never..." mumbles the surgeon. Stitch.

_______________________________________________________________  

I am flying my kite for the village of Rusinga. 300 men, women and children

follow my every movement. Traffic has stopped on the causeway connecting

Rusinga to the mainland. One child walks nearly into the crowd without

noticing that something is afoot- his eyes were down. He looks up to see

something like a bird, attached to two strings, and a Mesunga ( white person

) swinging back and forth, a rod in his hands, controlling it. He starts

laughing hysterically- my kite and I are the funniest thing he has ever

seen. Fits of laughter, I laugh with them. My kite is a two meter parafoil

stunt kite designed to spin and dodge and feign- I caress it along

hillsides, and chase kids across the causeway with it, nipping at the backs

of their heads. I have been doing this, in one fashion or another, all of my

life- in the right wind, this kite can pull with 100 pounds of pressure or

more. This is the right wind, and I am leaned back at 30 degrees, the kite

holding me upright. My movements predicate its movements. We are dancing, my

partner 90 feet above and I. The kids are spellbound. They watch the kite,

they watch me. Half of them have AIDS. I have given them everything I have

to give, the best medical care I know how to provide- thousands of dollars

of my family's money to get me here, hundreds of hours of work to pull this

relief trip off. I have nothing else to give. So, I fly my kite for them.

They paw at Katie's blond hair and stare into her strange blue eyes. My own

eyes are hidden behind a pair of shades- usually I cover them because they

are unusually sensitive to light and wind. Always have been. Sometimes

though, sometimes I cover them because meeting someone else's eyes would be

too much.

Half of these kids have AIDS. My eyes stay covered.