Don't let perfect be the enemy of good

Another two weeks have flown by so quickly! Actually, I have been terribly sick these past two weeks, because I jinxed myself by bragging that I haven't been sick since October. But, I am recovering well and finally able to blog again (thanks to everyone who pushed me! So grateful y'all are reading!)

We have (mostly) finished our rotations through the different clinics. With the current nurses' strike, public hospitals are operating at sub-optimal levels, which has led to changes in our schedules. But, my focus now is working on my research project, a diagnostic mobile x-ray truck that operates in the most rural areas of Busia County. The truck was a response to the spread of TB in Kenya, which goes undetected and kills many people, especially in areas of close proximity. I have been traveling out to these clinics (about 3 hours away from where we are) with Joe Mamlin (undoubtedly something I will treasure forever and ever) to talk to the clinicians and ask them about the challenges they face in utilizing the truck services. Everyone has such great perspective and honest feedback. The operation of the truck really reflects many challenges rural medicine faces, including basics like lack of functioning computers to access the XR images or Internet. I approached this project quite timidly (after all, who is this kid asking questions of these amazing clinicians who do SO much to help their patients?), but I have found that everyone is so willing to talk to me, and it seems, really happy that their perspective is being solicited and valued. This is something Joe has mentioned too-he travels out to these clinics every week "for 12 different reasons", one of which is to go out and get a feel for how everything is actually running, something you cannot gauge from three hours away. He wants to make sure the clinicians out in these rural areas feel supported and I am continually amazed by his genuine, personal connections with both patients and clinicians.  

 

Roshni1

Me with Joe at Lake Victoria-already one of my favorite pictures

 

I have been reading, too! I just finished the book Mountains Beyond Mountains, a biography about Dr. Paul Farmer. Dr. Farmer is regarded as a pioneer in global health and has worked in Haiti, Peru, and Russia to provide healthcare in rural areas, to those who otherwise do not have access. I think this book really helped me continue thinking about how I fit into a global health landscape, especially why me, why now, and why here. My blog post title is inspired by a quote in the book-one that I've heard before, but that really resonated with me this time. Of course, undergraduates and fledgling medical students are not fully licensed physicians with a developed skill set, but exposing students when they are young, and giving them the opportunity to learn and grow from their mentors is how the next generation of global health leaders will be shaped. Arguably, this is good, and makes sure the work keeps getting done. So, if I'm here, and if I don't come back to work in global health, are these opportunities and resources wasted on me? I posed this question to my wonderful, thoughtful friend Ashley over Facetime and she assuaged me much more concisely and beautifully than I will put it now-that my time here, even if it doesn't manifest into me coming back to this exact organization to work, that I will still pay it forward in many way, by telling others about my experience, in my interactions with my future patients, and in ways I have yet to imagine. In a perfect world, the most qualified people would be here, doing this work. Actually, in a perfect world, every healthcare system would be fully developed and independently functioning within their own communities. But, it is important to remember thatgood,maybe not perfect, butgood, work is done by individuals who want to make a difference, bring others into their vision, and build together.

My good friend Aparna, who is also doing wonderful public health work in HIV/AIDS in NYC, wants to hear more about the HIV resistance clinic here, so I will take a second to talk about that now. Yes, HIV resistance! I did not know HIV could be resistant until I got here, either. Here, after a patient is diagnosed with HIV, they are started on first-line antiretroviral drugs, which I have been told are "fairly easy to mess up." After six months of treatment, their viral loads are measured and their adherence is assessed. If a patient fails first-line treatment, they are started on second-line ARTs, which have more side effects and are typically taken twice a day. If a patient is failing second-line treatment, here is where HIV resistance clinics come in. 90% of the time, patients are failing treatment because of adherence issues-stigma against taking the medicine, side effects from medication, or just a lack of desire to take the medicine. The other 10% of the time, the HIV strain the patient has does have resistance against the ARTs. However, it is hard to have genotype services performed here, so clinicians look for the typical presentation associated with resistance, the major giveaway being that the patient's viral loads are usually consistent around a 1000-2000 copies/mL. So, more than in any clinic I have seen, HIV resistance clinicians spend time assessing a patient's motivations in taking medicine, home life, stress levels, access to food, and more, because most patients are not resistant to the virus they have.

Travel! Two weekends ago, I went to Kakamega Rainforest with a small group of people. We stayed at a resort in the middle of the forest, which was so relaxing and wonderful. We took two hikes, one of which was a hike at 5 AM up a mountain to see a sunrise. It was beautiful-I almost wish I woke up more often to see sunrises-almost.

 Roshni2

Sunrise hike at Kakamega Rainforest

 

Posted at 00:34

Hello from Kenya!

Hello! My name is Roshni Dhoot and I am a rising 2nd (!) year student at IUSM. I am originally from Valparaiso, IN and attended IU-Bloomington for undergrad. This summer, I am spending 8 weeks with AMPATH as a Slemenda Scholar, primarily in Eldoret, but with so many opportunities to visit clinics in surrounding areas and work in the field.

Tomorrow (6/8) will mark two weeks here in Kenya and these past 14 days have been nothing short of amazing. I am spending the first three weeks rotating in AMPATH's many clinics: from medicine and pediatrics to HIV resistance, diabetes, and palliative care. After that, my focus will shift to field research on AMPATH's mobile diagnostic X-ray truck that travels to clinics without imaging capability, to see what issues are preventing the truck from functioning optimally. I actually had the opportunity to observe it in action and talk to several clinicians and engineers involved the project about their opinion and I am really excited to see what I might be able to contribute to such a necessary and innovative initiative.

In addition to being in clinic and out in the field, it has been great to talk to so many amazing people in the field of medicine and especially in global health. At IU House, where I have been staying, people from many different fields (public health researchers, chemists, surgery residents) come and go, but everyone is willing to answer questions about their motivations and career goals. In fact, dinner has become one of my favorite parts of the day because everyone usually stays for 1-2 hours afterward just to talk about their day and any other topics that might come up.

My favorite conversation to have has been about the reason I came to Kenya-to learn about sustainable healthcare systems in developing countries and how I might fit into this extremely complex, important landscape. During undergrad, I became aware of the damage that can be done to developing systems and economies by volunteers who come with the best of intentions, but for short periods of time and without the skills that the community may need. Not wanting to do more harm than good, but still very interested in global health, I wanted to spend some time reconciling my desire to serve abroad with the potential negative impacts of my presence in a community in which I would not reside long-term. Reading Walking Together, Walking Far (a great and short read about AMPATH and its history!) really convinced me that if I wanted to learn about sustainable healthcare, empowering home communities, and what global health really means, AMPATH was the organization with whom to do it. And here I am-not yet having reconciled these seemingly conflicting ideas in my head, but definitely on my way. More on this to come, I hope!

We are also highly encouraged to travel on the weekends and so this weekend, we went to Hell's Gate National Park, Lake Naivasha, and Mount Longonot. Hell's Gate included a very fun bike safari and hike through a gorge and other rock formations. Lake Naivasha was a boat safari which included several species of birds and a few animals (read: hippos!). Finally, Mount Longonot was a five hour hike up to 2780 m (9180 feet) and by far the hardest physical experience I have ever had in my life. See very unglamorous pictures below!

 Roshni1

 

Posted at 06:49

Roshni Dhoot, Slemenda Scholar 2017

Check back in late May when Roshni heads to Eldoret, Kenya! 

Posted at 08:54

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