Monday mornings are always a bit insane in the clinic - lots and lots of mothers lined up, sitting on benches to wait with their sick babies. Everyone holds on through the weekend with their sick little ones, eager for the clinic to open on Monday. After less than 10 minutes in the clinic, I had to put in an emergency IV and start resuscitating a little one.

Our day went beyond the usual Monday chaos with some added craziness. The nurses at the hospital were on strike. Health care workers striking is not good for patients, but it too-often seems to be the only way they can make the hospital administration meet their very reasonable demands for appropriate drugs, gloves, and medical supplies.

A peaceful protest cannot last very long here, sadly, as demonstrated by the horrific crackdown of the police on school children protesting the destruction of their playground last week. Sure enough, the Kenya police showed up today in riot gear and decided to disperse the nurses using tear gas. Insane. The tear gas came in all through the hospital buildings and clinics, making everyone wheeze and cough and gasp even in areas relatively far away from the demonstrators.

In our busy clinic, we didn't know what was happening at first. Your throat begins to burn, your lungs are closing up and wheezing, and you can't stop sneezing and crying. Tear gas is horrible.  And very, very bad for sick babies. So, that was a disaster to sort out as I tried to keep breathing well enough to make sure everyone was ok and get the sickest little ones moved to where the gas was thinner. Our babies already come in breathing too-fast with their pneumonias and fevers. Tear gas was the last thing we needed.

On top of all of this, the main washing machine at the hospital had broken down over the weekend. This doesn't sound like such a big deal, except that we had no clean linens or scrubs or gowns. This basically shut down all of our surgeries for the day, and made things more complicated for dealing with really sick patients who needed new beds in units that were closing down for lack of linens. Plus, many more patients needed gowns to replace clothing contaminated by tear gas or would have benefited from wet clothes to hold over faces.

BUT, not a single patient of mine died today, and so in my book it was not a bad day. Bad days are days when children die. This was just a crazy one.

Our entire program in Kenya is built on a partnership between Indiana University School of Medicine and Moi University School of Medicine. On the educational side of this partnership, we train up physicians in both Kenya and North America who are prepared to tackle global health challenges.

One lovely tradition in the training of Kenya's next generation of physicians is a ceremony in which all of the medical students are given their first stethoscope before they begin their clinical rotations. A long-time faculty member at Indiana University, Dr. Anginieta Biegel, provided this thoughtful gift to the students and endowed a program to sustain this gift after her death in 2008.

This ceremony is organized by the wonderful Tal and Betsy Bosin.  Tal is a retired IU professor who teaches pharmacology to the Moi medical students every year, just as he did at IU for many years. Together, he and Betsy also manage the scholarship program that enables Kenyan students from poor backgrounds to be able to become doctors. If you want to change the face of healthcare in Kenya, give poor, brilliant kids the opportunity to become doctors.  Amazing.

This Stethoscope Ceremony is a special milestone for the medical students. Each one has their name read aloud, they receive their stethoscope from a clinical faculty member, they are congratulated by Dean of the Moi University School of Medicine and the Principal of the College of Health Sciences, and then they recite together their medical vows. The students beamed with pride after being given their stethoscopes, with the hope that each "would care for those we do not know."

Seeing the bright and beautiful faces of Kenya's next generation of doctors is such a delight. My heart fills with joy to see all the hope and promise for this country's health care system in the faces of these wonderful students.

"But we refuse to believe that the bank of justice is bankrupt... Now is the time to make justice a reality for all of God's children."

Dr. Martin Luther King, Jr., March on Washington, August 28, 1963

Right now, over 3 million children in the world are infected with HIV. Ninety percent of them live in sub-Saharan Africa. In these places where kids with HIV live, in places like Kenya, our 2- and 3-year-olds have to take these medicines that you see below twice a day, every day to stay alive.

(In case you didn't count them, that's 9 pills or pieces of pills. Every day. For a toddler.)

Today, my fight for justice included the opportunity to talk in depth with the CEO of a big company that makes drugs about what we need most for little kids with HIV. He gave me the chance to give him my wishlist and my priorities for versions of these medicines that would work better for our little ones with HIV and for their families. I was more than happy to do so.

That was my part in the fight today to make justice a reality for all of God's children.

I went on a quest with my team to find Dinah's house. Dinah's oldest two children have not showed up in the HIV clinic for the last 2 months, and one of them was quite sick the last time we saw him. Our clinic outreach team had not been able to locate them and Dinah did not seem to have a working phone number, but my team had made some contacts in the neighborhood and thought we could find them.

Dinah cares for 11 children - 7 biological children and 4 orphaned nieces and nephews. We know that she is often overwhelmed with this burden, and my wonderful team and I could not help but worry about the family.

After some driving adventures over dirt non-roads and lots of asking for directions, we managed to find Dinah's house, one room in a long row building made of mud with a tin roof.  In this one-room home, there is not room for all 12 of them to sleep on the floor of the single room, so some of them sleep at the neighbor's.

The needs at Dinah's house are stark - she asks whether we could help with food, with shoes for the children so they will not be kicked out of school for having improper attire, and maybe for assistance in renting a second room.

Dinah's nephews and nieces ended up with her after their parents died two years ago. The eldest, a 16-year-old girl, told a terrible story with tears in her eyes. After her parents died, she had tried to look after her siblings, but then members of the local community had burned down the house in which they lived because "they didn't want the HIV in the house to spread." The girl speaks sadly, wistfully, about the school uniforms that they lost in the fire. They have struggled to remain in school ever since.

The good news at Dinah's house was that everyone was still alive, even the two who have HIV and have been quite sick. One of the boys continues to be quite sick, though, and I worried that he needed to start treatment for TB. All of the children are malnourished, and it is clear there is not enough food to go around. We arranged for transportation for them to come to the clinic for the x-rays and medicines that I want to make sure they have.  We can keep them alive with these medicines, though clearly this family needs much, much more.

Dinah's house reminds me of where I am, of what it means to live in one of the world's poorest places.  When you go to Dinah's house, you cannot escape from what it means that ONE BILLION people still live in extreme poverty, surviving on less than $1.25 per day. At Dinah's house, you cannot ignore what it looks like to live in a country with 1 million orphans, where it often seems like an entire generation of parents has been wiped out. You see Dinah and these 11 children fighting against all odds to keep everyone healthy and fed and in school, and it seems like they are too-often losing. It is ugly and sad and painful.

And yet.

Better to look. Better to let your heart break. Better to be aware.

When you are aware of what HIV still means for our world, you can become part of the larger, global community coming together around these families and helping them to carry on.  When your heart breaks, you draw close to the hearts of others. When you look, you know how to fight.