A trip to Africa shows how love and compassion can be the strongest medicines
My Trip Goals
Serve others with the love of Christ
Practice pharmacy efficiently and effectively
Get experience in different clinic areas
Provide healthcare to the village
Realize how much I have
Not get sick
Come back safely
By Rebecca Carey
As a sixth-year pharmacy major at Ohio Northern University, I had the opportunity last fall to participate in SHARE Kenya, a three-week clinical program in which students, faculty and clinicians from across the country deliver health care in rural western Kenya.
All pharmacy majors at Ohio Northern are required to complete nine, one-month-long APPEs or rotations. The six required rotations include: general/internal medicine, ambulatory care, pediatrics or critical care, geriatrics or long-term care, community pharmacy and hospital pharmacy. Students then select three elective rotations in areas such as cardiology, administration, infectious disease, managed care, emergency medicine, psychiatric, trauma, nutrition or oncology. The SHARE Kenya rotation is facilitated by Dr. B.S. Bonyo, a native of Masara, Kenya, a graduate of Ohio University, and now a family doctor in Akron, Ohio. He started a clinic in Masara and helps coordinate a pharmacy and medical rotation trip.
I was offered the chance to document my experiences in Kenya and I happily accepted. I hope you enjoy the following journal entries from my trip.
Click on the images above to read the corresponding blog post
After a long restless night trying to remember everything to do and bring, I finally make the luggage weight limits, organize my visa forms, register with the embassy and finish my presentation. After tearful goodbyes with my mom, I drag my heavy and bulky luggage into the airport. The hardest goodbye was with my dad on Thanksgiving. As he choked back tears, he whispered with a tight squeezing hug, “Come back because I don’t know what I would do without you.”
A two-hour wait in the Cleveland airport allows us to shop a little and grab a bite to eat at Panini’s. We finally board the plane and are off for Chicago. I am lucky enough to be seated with Alex and Emily, two other ONU students. We keep entertained with the Sky Mall. Our favorites by far are the Darth Vader toaster and the rapid-fire marshmallow gun. We meet the rest of our group before boarding our flight for London.
Regina, Alex, and I smash into the center row. We quickly discover the video selection and map function on our TVs to entertain us on our eight-hour flight. During the well-presented and somewhat edible dinner, I ask for something diet and caffeine free to drink. The flight attendant asks if I want “Diet Sprite or Diet Death.” Apparently, she feels it was an appropriate name for Diet Coke due to the aspartame. Why all diet pop (except those made with Splenda) isn’t called Diet Death, I’m not sure. I opt for the Diet Sprite.
As we soar through the clouds, comfort overwhelms me and my anxieties from yesterday fade away. There is something comforting about knowing that we are actually on our way. In England, I am most excited for British accents, seeing the guards and the beauty of this European city … and hoping we see Harry Potter or Prince William.
After about four hours of sleep breakfast arrives — yogurt, a pastry and Diet Death. We land after about 3,000 miles and tackle customs. A bus tour of the area and a lunch of fish and chips are ahead.
After a quick trip through customs, we freshen up and load the bus for our London tour. We see St. Paul’s Cathedral, which holds 3,500 people and is the second largest cathedral and dome in the world – only second to the Vatican. The Westminster Abbey Cathedral is a smaller cathedral holding 2,500 people, but has quite beautiful architecture. It houses many famous tombs including Newton and Darwin. We also see Piccadilly Square and pass Scotland Yard.
Next stop is the Silver Cross Pub, where you can have local specials of steak-and-ale pie or fish and chips. The guide states that in London they either drink their alcohol or soak their meats in it, but either way they include alcohol in many meals. She also warns us that pickpockets are very common in London, especially in pubs. We hold all bags on our laps.
We stop at the parliament building and see Big Ben. There the guide tells us that the bell is actually named Big Ben and that the tower itself is just called the Clock Tower. As we walk back to the bus, we also take pictures in the red phone booth. Our guide states that they are mostly located in London and have been kept red through the years due to the money that souvenirs and the purchase of them make. The most creative use she has heard of is a man who turned his into a shower stall.
Throughout the bus trip, we hear about London culture like the upcoming wedding of Prince William and the great expectation that society places on the newlyweds to quickly start having children. They also continue to put pressure until the first boy is born to continue the family lineage. The Prince of Wales actually has more political power than the King because the King and Queen are not allowed to have public opinions in any politics. The Queen’s art gallery is the largest and most expensive public art collection in the world.
After a good, but long and cold day trip, we are back at the airport to get our boarding passes. With beat music playing, I realize that we are going to Kenya! I turn on a movie and quickly doze off. I eat dinner around 11 p.m. I start a new movie and doze in and out of sleep for the rest of the night. In the past three days, I believe I’ve only had four hours of sleep each night. It seems as if all I do is eat and try to sleep.
The plans for today should be interesting. We either fly one hour from Nairobi to Kisumu or take an eight-hour bus ride. The first choice is obvious except that the airline is closed on Sundays. Dr. Bonyo is currently trying to pull strings to get a flight for us. With 37 minutes left in the flight, I am tired (although the coffee did help), sweaty and sore. Nothing will be better than arriving at the hotel and getting situated. Here’s to hoping all works out with the airport. God, thank you for your safety and comfort so far. Please continue to provide safety, comfort, peace, and a good time. Thank you for the opportunity to do your work.
We are in some culture shock. The airport is old and dilapidated. The humidity and heat in the airport along with the “scent of Kenya” is surprising. We get through the visa line and go outside, where I am warmly welcomed with a firm handshake from Dr. Bonyo.
Before the next flight, we meet up with a group from Denver for breakfast. We also meet our translators. The plane is full to the max. In order to fit our whole group on the plane (except for Dr. Bonyo), one girl from the Denver group sits in the cockpit. The only separation between the cockpit and seating area is a curtain. Crazy to think how trusting they are versus our culture.
As we land, the plane turns about as close as it can to Lake Victoria. I look around unable to find the airport building. In fact, there is not a building but rather two tents – one for baggage and one for waiting. We pile onto two buses heading for Milimani Resort.
After almost being placed in an annex, our room is in the basement or "garden level" as they call it. It is dark and not much of a view, but it stays cool and has the most water pressure. Our room looks like a kick back from the 70s, but for a developing nation, it’s nice and clean. Hors d’oeuvres and cocktails by the pool welcome us.
We then take a quick trip to the Naukumat – Walmart on steroids – to purchase water. After a nap, we prepare for dinner. Everything here is on Kenya time, which means five minutes to one hour after the time we are told to be ready. We eat poolside and are greeted by these poor skinny cats. I wish to feed them, but know that will only attract more. I turn my back and finish my meal of fried chicken, beef, fried potatoes, fruit and cake. The head chef is very sweet and concerned with what different people like. After dinner and a fun long chat in our room with Emily and Amy, we get ready for bed. We pull down our mosquito nets, tuck them in and spray a little bug spray for good measure.
The alarm goes off much too early at 7 a.m. We eat a breakfast of cereal, hard-boiled eggs, omelets, potatoes, crepes and coffee. Then we pile on the bus and head for the village of Masara where the clinic is located. As we look at the sights and sounds of the area, everyone waves and welcomes us. At least 20 little kids run after the bus to greet us all offering a handshake and a “Hello. How are you?” We chat for a few minutes with the kids and begin setting up the clinic.
The clinic itself is a U-shaped building. There is a tent set up where patients pay the equivalent of about a quarter to be in line. However, patients receive care even if they don’t have the money. Patients stop in intake where their vitals signs (temperature, blood pressure, weight, etc), chief complaints and a brief history including HIV and tuberculosis status are taken. From there, patients see the doctor for a diagnosis. They can go to wound care to have wounds addressed or teeth pulled. They also go to eye care for eyeglasses, safety glasses, and sunglasses. The last stop is pharmacy where patients give us their card with a diagnosis on it. We take the diagnosis and choose from what medications we have to treat it.
This is quite different from the U.S. where a doctor must write exactly what they want. Today, we just make sure that everything is prepped and ready to go. In the pharmacy, there is a lot of organizing that needs to occur. We take apart the boxes of medicine, sort them and start pre-packing the medications into the most commonly dispensed amount.
After our job is done, we play with the kids. We hand out crayons and paper and watch them draw. They love giving us the pictures, especially the ones of buses and ourselves. Lucy, a 13-year-old girl, asks me to be her “bestest” friend. The kids have such a great time playing with the crayons, stickers and bubbles we brought. People are already arriving for health care, but will need to come back the following day. The jet lag sets in and I close my eyes on the bus ride. At dinner, we listen to a lecture about the most common diseases we will see.
5:45 a.m. comes way too quickly. Hearing “Good morning. How did you sleep?” in a nice Kenyan accent makes it hard to be too upset. After very breakfast appropriate topics of diarrhea and dysentery, we are off to the clinic. We pass rice patties, shops and hotels (tiny shacks with names on the metal roof), markets, and many people walking. As we get closer to the village, more and more people come out to the road to greet us with a smile and wave. The children are especially excited. I can barely step off the bus due to the 30-50 beautiful African children. Every one of them grabs my hand or arm and asks, “How are you?”
The Kenyan people’s stories are either quite funny or very sad. Today, I am in intake and ask a 75-year-old man if he has ever been tested for HIV or TB and he laughs, “At my age? I am too old to have any of those diseases.” My next patient is a 10-year-old child who is there with an uncle because her dad died of AIDS and her mother abandoned her. Our bus driver is in intake because he has trouble seeing far and seeing in the sun. He receives a prescription for eyeglasses and sunglasses to attach. In the afternoon, I shadow some of the doctors. There is a seven-year-old boy who just sits quietly and barely moves. Upon further questioning, I find out that he is so tired from being sick. His test comes back positive for malaria.
Heavy rain last night cause us to walk about a half mile to the clinic. The children come to meet us and walk us to the clinic. We ask one of the older children how often they eat meat. They respond by saying pretty often. After more discussion, we figure out that they only eat meat when the animal is sick. They first try to cure the illness and if they cannot, they eat the animal, which occurs about once a year.
During our lunch break, we walk through the village and see the remains of Dr. Bonyo’s home. The father builds a house in the middle and then the sons form houses around it. When a person leaves and is not coming back, they destroy the house so another one may be built in its place in the future. The community also has one hut for a kitchen and shares plots of rice for profit or for their own food supply. Dr. Bonyo’s father has one of the nicest houses in the village but it is still a very humble home.
The people also have animals that wander through the village. They know to go home and separate themselves to the proper home. We also learn more today about polygamy. The more wives a person has represent the more money they have due to dowries and supporting the families. There is a local funeral for a man who has 120 wives and more than 500 children. One of my patients has three wives and more than 10 children (he couldn’t remember how many).
Today we have two needle-stick incidents, which is especially dangerous here due to the high rates of HIV. One patient is HIV and the girl who has a needle stick will be on HIV prophylaxis for a few weeks. While in with the doctors, I examine a baby including finding the fontanel (if it is sunken then they are dehydrated). The kids see my very white skin and start crying.
We leave in a rush today to beat the rain or the roads will be impossible to navigate. It is ONU night out at the Mon Ami, a local restaurant that stocks pizza and burgers.
We walk a little way to the clinic again today. I hold hands with a cute little boy and one of the older boys translates for me so I can to talk to him. I am in the pharmacy all day. The most common medications by far treat malaria, scabies, worms, STDs and tinea capitis (fungal infection of the scalp). As I hand out medication, one of my elderly patients shakes my hand, smiles with the most beautiful smile and says, “Thank you and God bless.” Tonight a seamstress stops by with fabrics and takes measurements. I choose a brown fabric, a green fabric and a zebra print fabric to make two dresses, a shirt and a skirt.
I work with the doctors all of today. I see a family – a mother and her three children – all with abdominal complaints and distended stomachs. It feels as though they have enlarged livers; however it is not. One of the children vomits worms. The others have general malaise. Their symptomatology is most likely due to the worms. The family drinks water from the well with the water purification tablets. Upon further investigation, we learn that they bath in the river, which is most likely, the cause of the worms.
We see a lot of malaria cases. With malaria, the patient also commonly has tachycardia. Other common ailments are arthritis, neck, back and knee pain from the hard work the farmers do, and allergies from the high amount of dust blowing around. One of the most common conditions is dehydration. Every child we hand Pedialyte to quickly drinks every drop. For the ones that look really dry, we refill and allow them to keep drinking.
That evening we walk to the market and select some goods from the vast array of colorful items to offer. We then pile into the back of trucks and drive to Lake Victoria for the sunset and dinner. In order to make it in time, we fit 16 people in the back of the truck. Our record is not nearly as good as the Kenyans who on average fit 22 people in the truck.
We are supposed to go to mass in the village, but we get stuck on the bus for three hours due to a marathon. When we arrive mass is over, but many people welcome us still. They sing and a woman grabs my arm and walks me in as she sings. She then sends Megan and me up in front of the altar.
From there we walk through the village. I walk with Josephine, 14, and her younger sister Christine, 3. We play with the kids including Lynza, Nicolas, George and Amon. Many of the kids appear to be hungry and dehydrated. Amon is very lethargic and laying in my lap. Once I give him some food, he perks right up. When I give some to Lynza, she eats only part but holds on tight to the other half possibly saving it for later. Emily holds a small girl who is also very weak and appears sick. Once she receives some food and water, she seems to do better. It is easy to become dehydrated because the temperature today is 103 degrees.
For lunch I stick with rice and banana. In the first dish, there is something that looks like an egg or eye, which makes me want to stick to the things I know. There are also bones, necks, and possibly liver in the other bowls. After we finish eating, they sit the children down and give them something to eat. I am so glad to see that they also get something to eat. Next, we head to the equator, which is much cooler because it is within the mountains. It is also a lot greener out.
Half our pharmacy team is sick. Only Ellen, Emily, Emily and I aren’t. Due to the heat and long hours, we have all become queasy, weak and dehydrated. Sarah and I restrict our diet mainly to toast, granola bars, Pringles and Sprite. The dehydration does have its benefits. I have not had to experience the bathrooms/outhouses yet.
Today there are some additional interesting cases. One of the pharmacy students met a patient with leprosy. There is also a girl with cerebral malaria but she is responding to the Artefan and Tylenol. Today we learn that many of the patients only wear their glasses when they need them because it is not as culturally expectable as it is in the U.S. As we sit on the bus waiting to leave, the children reach up to give us high fives. We make it to the Naukumat and then it starts pouring and even causes the electricity to go out. We still eat at the tent by the pool.
My diet of potatoes, pineapple, toast, granola bars, Pringles, Sprite and water continues. I play with the kids before clinic – Cecelia, Condoleezza, Nicolas, Tobias, Lucy, Ilene, Joyce, Braven and Hillary. We play tag and the children laugh when we catch and tickle them.
Our first patient has a bad tooth. After numbing the gums of the patient, Dr. Bonz pulls his molar. This large tooth comes out as well as a decent amount of blood. Although I’m not too bad with blood, I realize that I feel a little light-headed. The med student quickly sits me down so I don’t pass out. I feel much better and am ready to tackle wound care once again. I give two cortisone injections in the knee of an elderly woman and one injection into the hip for a young female with bursitis. Doctors work on a patient with a neurofibroma on her face. I spend the rest of the day dispensing medications in the pharmacy with the help of our translators – Daniel, Rose, Mercy, Mary, Molly and Brenda. After a long day, I am ready for bed.
Today we tour the District Hospital, which is a public hospital. We learn that people think we are either psych patients or prisoners due to our scrubs. (We actually see two patients that are prisoners in stripped scrubs and handcuffs). If there are more than 25 males in the male ward or 25 females in the female ward then patients share a twin size cot. I see one patient take care of another and hand off his own blanket. Here a patient’s average stay is two to four days and those in for malaria are usually in for one day. Malaria and typhoid are the most common diseases. There is an isolation room for cholera. Tuberculosis patients are not in isolation and if you hear anyone coughing, they probably have tuberculosis. Right after that, the man right behind me coughs.
The OB/GYN ward is an open room with a small nursery and a delivery area. They do minor operations in the surgery ward behind a curtain but major operations are performed in the theater. The most common surgeries are for cellulitis, peritonitis, hernia and circumcision. We meet some medical students who are learning and practicing. Outside the surgery theater we chat with a nurse who is helping with a C-section. They use some anesthesia including halothane and some intubation anesthesia. I quickly notice that he doesn’t have on gloves or garb and walks outside during the procedure. Next we visit the pharmacy where they only dispense medications. The charge nurses make the IVs. They keep charges on an individual charge sheet. They do some compounding of creams but it is limited to that.
Afterward we go to the village for a party to celebrate the clinic being open for 15 years. We enjoy a live band that apparently is very popular. We dance and spend time in the shade with Nicolas and George. It is funny to watch the Kenyans and Americans dance together. As I hold Nicolas and rub his back, he asks me, “You be my mommy?” My heart breaks, but I know that he has a mother who cares deeply for him. I tell him he already has a mom. Part of me knows that, but the other part of me wants terribly to bring him back with me.
Our bus is stuck in the mud because we are full beyond capacity. They fit us all on one bus by filling all the seats with an extra 20 people in the aisle. We walk through the mud and even hold on to tree branches to walk through. It is quite a busy day with 408 patients plus those who returned for an exam by the opthamologists. During intake, I see some interesting patients including one with a giant goiter. I then dispense first doses in a treatment room. I watch one of the doctors. We see a patient with a yeast infection (and even did a vaginal exam), malaria, Burkitt's lymphoma, amoebic dysentery and tuberculosis of the spine.
Some of my favorite memories of the day include an old lady who I smiled at and she came over to give me a big hug. There also is a woman in her 70s who told the doctor that she would sell her a basket next year when she is still alive. We get off late, but Nicolas is still here to walk me to the bus. My seven-year-old buddy is always reliable. He asks if I will be back with the crow of the cock (they have a rooster in the village).
I work in intake with Ellen and Tabitha. Today, I see a patient with a tropical skin ulcer for greater than a year, two adorable girls with matching outfits, a patient whose co-wife has HIV, and a school principal who asked about weight loss for her daughter. From there I give first doses in the treatment rooms for malaria, asthma, typhoid, PID and an injured food. My favorite part of the day is walking back to the bus. I carry a larger Rubbermaid tub and Nicolas is walking next to me. He hands his wheel and stick to his friend George and grabs the box and carries it without me even asking. He can barely see over the box but insists. I finally talk him into letting me hold one handle so he won’t slip in the mud. He again asks if I will be back. It is much harder because I know that tomorrow will be my last day. I realize that Kenyans name their kids some interesting names. I met Condoleezza Rice, Barack Obama, two Fidel Castros and a male Hillary.
Today is the hardest day of all. I never knew that I could fall in love with a little boy who I could barely communicate with. Our main communication is about school or through facial expressions and gestures. I know I will miss him terribly. It is especially hard because I know that I could give him a wonderful life. I did the best I could by buying a bag of supplies for the family including soap, toothpaste, toothbrush, paper, crayons, pens, candy and orange pop (Nicolas is asking for soda). I ask Nicolas to take me to his mom and I meet her in the kitchen. Benta is a young 19-year-old woman and is in 11th grade. She has three children Nicolas (7), Tobias (5), and Sarah (3). She lives at the compound with her sister (a nurse) because her husband is not around. We share a tearful hug and I tell her that I love her kids and have a special bond with Nicolas. She states that he loves me, too. I tell them that I will be back in a few years when my job allows it. The whole day is a good day but one with a somber mood for me. We work and then clean up. We hand out tons of candy to the kids and play with them. Nicolas and Tobias walk me to the bus as usual. Tears stream down my face the whole walk and Nicolas looks up somehow understanding. We sit and wait for the bus to come and he leans into my lap as usual. It is a moment I will long treasure. When we finally say goodbye, I give him a huge hug. My eyes fill again with tears and if I’m not mistaken, his are a little red, too. As he smiles and waves, I know I have to come back someday to see him.
We are up early enough to be out on Lake Victoria before sunrise and go on a Hippo watch. The guide hits the side of the boat and makes a call to get the hippos to rise out of the water and come slightly closer. It’s a town with no farmland so they fish with nets for catfish, Nile perch and tilapia. I learn that hippos are the second most deadly animals in Kenya (except for mosquitoes). Hippos are in harems with one male and 20 females. Females hide the male calves until they are prepared to fight the father. We also see Lily hoppers (birds), papaya tree/bushes (used to weave baskets), fig, rubber and mangrove trees, and an African fish eagle.
At 7:30 a.m. we leave for our six-hour drive. It is a rough road and our driver calls it our African massage. We arrive at our lodge and receive cold towels and mango juice. The rooms are gorgeous and the food is great. This is a true resort experience! We then take our first safari trek with our driver/tour guide, Hassan. My safari goals are to see zebras, giraffes, rhinos, characters from the “Lion King,” hear a lion roar, have a Lion King sing-a-long, and use Hakuna Matatain a real sentence. Masai Mara is Kenya's greatest wildlife reserve within the Great Serengeti ecosystem. The five main animals we will see on the safari are buffalo, rhino, elephant, lion and leopard/cheetah. A cape buffalo is more dangerous than a lion and will never spare you. The lion is Kenya’s national symbol and its roar can be heard up to five miles away. African elephants eat 200 kg of vegetation, 260 L water and weigh 6 tons.
On the second day of our safari we see Elam antelope, wildebeests and an African white-backed vulture waiting for lions to finish eating. The giraffe can be 18 feet tall, weigh 1.4 tons, eat for 18 hours, consume 32 kg of vegetation and sleep 30 minutes in 24 hours. We learn about the Masai tribe, which is one of 42 tribes in Kenya and was started in the 15th century. They are a nomadic tribe who posts a warrior at each gate with knives, arrows and dogs to protect the village. After 3-4 years, they move due to dry lands. They need good feeding areas for their cows.
We enjoy a hot air balloon ride and champagne breakfast. On the drive back we see the Great Rift Valley, which can be seen 160 km away from Earth in space shuttle (only thing that can be seen). We also see Nairobi and the Kenya national soccer field.
After coming back from Kenya, I look around my house and part of me feels guilty. The people there are so happy to have clean water to drink, protection from the sun, place on the ground to sleep and a small bit of food to sustain them. Although I am a very thankful person, I realize that I still take all I have for granted. There are days that I complain of having nothing to wear with a closet full of clothing that fits and nothing good to eat with a cupboard full of canned goods. Although I am not perfect, I try to think of those in Kenya before I complain. I also am reminded of quite an important lesson about love. Love can cross all barriers including language barriers. A simple smile, hug, look of compassion, or pat on the shoulder is enough to show I cared. Love and compassion are truly the strongest medicines we carry in the pharmacy.