I am the 99 cent Jr. Bacon Cheeseburger

A few days ago, I got fed up with people reposting photos from the "We are the 99 percent" tumblr. While some of these stories have merit (mainly those with hopeful messages), the vast majority are sob stories meant to get attention.

Let's review

1) Almost all pictures are taken in front of a computer screen, in a living space with electricity, and with some kind of digital camera.
2) Nearly everyone claims to be destitute despite this. So much so, that they can't pay their medical bills or student loans
3)If you don't think you can pay off your student loans, don't take the gamble of going to college. You don't HAVE to have a crappy job to act as some cog in society, I can carry out my own pizza.
4)The whole movement reminds me of the "I am 99x" advertisements from 10 years ago
I am 99x
5)It reminds me more of actual destitute people who for decades have allowed themselves to be photographed for western photographers as a plea for help


I created this satire as a response you can share on your own facebook walls. Please share it with as many people as possible.

Falling from the Sky Addendum

I'm sure some of you may have had a hard time believing the largest airport in the entire country could be completely blacked out for hours-that's why I shot this movie as I drank my last Tasty tusker before the coolers warmed up. As you may know, I shot hours and hours worth of video while I was in Kenya last October-so you get the complete experience, I will be uploading some of them here for you! Keep checking back!



As a side note, while I was travelling around between Nairobi and Maseno I took Jetlink airways. While I lived, for future travellers, this may not be a good idea. Be sure to check out the video below which inexplicably is dubbed with Sarah Mclachlan techno and matrix references between plane crash footage.



Learning Swahili the Hard Way

"Ok children, if you want to talk in class I need you to raise your hand like this...(SNAP!) OH MY GOD! SOMEBODY HELP ME! DON'T FEED IT TO THE CLASS HAMSTER!!!!!"

"Haha Mwalimu wetu aliaga dunia kwa ukoma!"

Out teacher died of leprosy

Pints of Pus (A guide to become an overnight viral video superstar)

If you have read my posts about Samson and the witch doctor, you know I was dealing with some serious abscesses over in Africa. Nothing compared to the massive incision and drainage of a leg that we performed while over in Kenya. The story was a 12 year old girl was playing field hockey (like ice hockey, but without canadians and the players have more teeth) when she was kicked hard in the side of her leg. Like many of us, she shrugged it off and continued on with her life. Unfortunately, she developed a big pool of blood in the area she was kicked called a hematoma. The hematoma bleed lateral compartment of her right leg and over time, it swelled up, causing pain so severe she was unable to walk. When Dr. Hardison and I saw her she would scream and cry anytime her leg was touched. We knew we were going to have to check it out internally. We brought her to the operating room and gave her ketamine to anesthetize her and opened up the lateral portion of her leg. What followed had to be seen to believed-thankfully I had my camera in the OR and began shooting video right away. Thick blood mixed with pus began pouring out of the wound at such a fast rate it was quickly covering the table and falling to the floor. We grabbed a metal basin nearby and put her foot over it as we explored the hollowed out cavity with our probes and foreceps and pulled out long clots. I didn't think it would ever end as we quickly filled up the metal basin with I would say 3/4 of a liter of blood and pus (if not more) and packed her incision with iodine soaked gauze packing. The next day we removed the packing and cleaned out her wound a little more at the bedside-but after that she didn't have any more drainage and felt well enough to go home!

I think my most memorible incision and drainage was the one I did by myself without Dr. Hardison-and it was definitely the one I would have felt much more comfortable with someone watching over me just in case. This was a small 5-6 year old boy with AIDS and numerous complications. One of his many complications were nearly a dozen abscesses on his neck which Dr. Hardison asked me to individually incise and drain and pack. Once again, the boy was brought to the operating room and given ketamine to anesthesize him. I watched the boy's chest heave in and out-his neck moving up and down with every breath. I took the scalpal blade in my hand and knew I was going to have to make sure I was very careful of any movement and his variations in breathing. One small error and this boy would have a cricothyrotomy or worse. I elected to hold the scalpal blade with my fingertips for better control as I meticulously opened each one and drained them all without incident. Before he left to go home, I was able to finally get a smile out of him.

By now many of you are probably wondering how what I have said will make you a viral video superstar. A few months ago, I was uploading videos of my trip to youtube for later use in this blog. Well, I uploaded the incision and drainage surgery of that child's leg. Yes, I did say in the description that this was a medical procedure done under sedation uploaded for learning purposes, and yes, there are hundreds if not thousands of actual surgery videos to watch on youtube if you are so inclined. Perhaps I should have titled it something other than "EXTREME PUS DRAINAGE" but I figured no one was going to watch it anyway. Well within a few days, my video has 30,000 views! I scratch my head why and then I see on the comments section "congrats, you made the front page of www.popthatzit.com" (not to be confused with pimplepoppers.com or the boilandblackheadblog.com). If there is one thing I have learned in life, it's that there is a fetish for everything-and some people really like to see enormous zits pop. Pimples are just the gateway to bigger pus payoffs-large incision and drainages, sandfly removals, the list goes on and on. Who can say if "pus porn" is addicting, but based on the numbers I was saw on my youtube video-I would say it is. The comments on the video (you can see them here) are hillarious. Some people expressed 2 girls, 1 cup-like nausea and vommiting from the video. In the end, youtube ended my fun by pulling the videos and giving me a warning that if I post anything like that again I will be BANNED FROM YOUTUBE! Thankfully, the more progressive folks at vimeo have not pulled the video, so you can still check it out. I do warn you before watching these videos-it is a very graphic procedure so if you are easily disgusted by blood or pus-do NOT WATCH THIS VIDEO.

Incision and drainage 2 from dan ketterer on Vimeo.

Leg Incision and drainage and exploration from dan ketterer on Vimeo.

More Swahili Translations

Try this rope swing Jimmy, it's super fun and it takes you right over acid crocodile lake! There you go, you got it....AAAGHHHHHHH!

Kamba ilikatika alipokuwa akibembea

The rope cut as he was swinging

Betsy Ross's husband's style of parenting

Alimwumiza mtoto kwa sindano kubwa

He injured the child with a big needle

Sunday Bloody Sunday

How did you ring in the 2010? Was it a champagne toast? Watching the ball drop on TV in a warm toasty home? I was on 30 hour ICU call on New Year's Eve at the Regional Medical Center here in Memphis. The Med does not have nearly as many "Code Blue" emergencies at the other hospitals, but before started my shift I got this strange feeling that there would be one that night...right around midnight.
Sure enough, the only code of the night comes as the skeleton crew (made up of 4 residents-no interns strangely) gets ready to ring in the new year. The person who coded was a very sick individual and his numerous medical problems stacked against his chances of living as we injected him with medications to restart his heart and each of us cycled the CPR roles. I felt that sickening feeling as the bent and cracked as the CPR was done. I ended being the one that got to call his wife right before midnight to say her husband was dead.

As we helped the staff clean the poor man up for his wife, who was on her way-we started the paperwork and I believe we all felt the exact same way. A strange sense of solidarity that came from the fact that we were all upper levels and experiencing a new year like few else would. The moment was not marred by the recent death, we felt connected in that moment though. I tried to get a picture of all of us with my camera phone but the other residents didn't like the idea considering what just occurred. I then thought to myself-I must have taken 1000 or more pictures in Kenya but I have almost no pictures of my fellow residents and I've been here a year and a half already! It may be the reason you take more pictures at Disneyworld than you do of your co-workers-one is exotic and the other mundane and routine-but in moments like the one I experienced at midnight I realized just the opposite was true.

It's amazing how much memory is like a sieve over time when you don't take those pictures to remind you. Of course, I didn't have my camera with me at all times with me nor did I have a 24 hour documentary crew (it wasn't in the budget-they spent the money on something called medicine instead) so I couldn't capture everything that happened. Despite my nimble fingers, there were just some things I couldn't get to that were so important to cover and I kept reminding myself I would have to come back to cover it. One of these things was the Bloody Sunday which already I feel has become a victim to my poor memory. Pieces of it have broken apart from what I thought was an impossible to forget experience. The same thing happens with my comedy-so many amazing jokes and skits lost because of poor memory or thrown away post it notes.

Tonight I am again on 30 hour call and I decided to get some sleep early in case it was going to be another long night. I had the strangest dreams/omens, not really pertaining to Kenya but haunting and none the less would soon be forgotten unless I posted it here. In my dream I am cruising through what I think is Las Vegas and noticing that many of the big hotels are modeled after famous buildings around the world (Luxor, New York, New York, etc) and I sort of laughed that instead of so many people being able to personally see the real amazing sites in person that Las Vegas was their sort of cheap alternative to world travel. As I drive through I am amazed that they have a replica of the Eiffel Tower in Vegas (I actually didn't know that there really was one before this dream-but it turns out there is here). Yes, you can see all the magnificent knock offs of famous world structures in Vegas if you are so inclined. Once I get to my destination, I am somewhat surprised to see many people that were at one time significant were waiting for me-only except I can no longer remember their name. The sky is blood red as the sun goes down and I am struck with an intense pain. My vision gets blurry but I try to keep it together but I can't remember anyone's name of the people around me to ask for help. These are not your trivial acquaintances either-but current and former girlfriends and other really meaningful people I am surrounded by but cannot remember their name. At this time I am in a building with big glass panes for walls and as I look out at the blood red sky I see 2 black clouds in the shapes of claws, one on each side of the building that I am in drawing closer. As my vision blurs and I wake up, I feel the cold black claws of death envelope me in their grasp.

After waking up, I knew before I forgot it as well I had to post about the bloody Sunday I experienced while in Kenya. I remember walking from the guest house to the hospital and rather than being greeted with the calm quiet and maybe the occasional monkey-there was chaos. Ambulances were scattered over the lawn families outside crying and moaning. This was not the quiet hospital I was so used to waking up to. I am able to piece together the pieces of the story-the major one being there was a big car accident on the main road going to the hospital. An entire family was travelling in a private car when they were struck from the side with a packed speeding matatu (van cabs). Cars in Kenya tend to lack many of the safety features that we are so used to, airbags being one of them. A husband was driving and his wife in the passenger seat and the kids in the back. The car was struck as it pulled out-the matatu smashing into the driver's side killing the dad and at least 1 of the kids in the back. The wife was relatively unscathed except for a few cuts wailed in her room in disbelief of what was happening. Her children had to be transported to the provisional government hospital. Several people in the matatu were also injured or killed as well and they were all brought to our sleepy hospital-overwhelming what little staff there was. We ended up transferring them as quickly as we could to better equipped facilities-with no ICU; there was not much we could do.

Another injury I saw that day was one I had never seen before, but considering the risk factors for getting this injury, I was more surprised I had never seen it before. The patient was a college student at Maseno University across the street-pretty and young, receiving blood transfusions. I asked Francis the clinical officer what had happened. Apparently, she was having sex and the man was so well endowed that he actually punctured through the posterior part of her vagina (the posterior fornix for those medicos out there). She was now had an open cavity into her peritoneum and was bleeding into it-not good. We ended up boarded her onto the ambulance with the car accident victims and transporting her to Kisumu.
I am scratching my head now for other things that happened that day to later cause me to label that day as "Sunday Bloody Sunday" but I cannot remember now. Was there another death or injury I am forgetting about? The fragile nature of memory had caused that day to now be fragmented where I once thought it was bulletproof. Thankfully, I have this journal, and thousands of pictures to help me remember Francis, Samson, Lynette, and Dr. Hardison and all those who mean so much to me, that I will not lose them in that red sky.

I will post some more swahili translations once I get home

St. Mary's Presentation

UPDATE 1/3/10 Parts 3 and 4 have finally been uploaded-now you can see the conference in it's almost entirety!

This entry is currently incomplete-part 3 hasn't been edited yet but I wanted to put up parts 1 and 2 in the meantime-youtube still may be converting them so the quality will be much better this afternoon. Many of you requested seeing the video feed from the Kenya talk I gave at St. Mary's last weekend. Double click on the videos to go to the youtube page-I left a pretty good description in the part 1 video (which you will see on the right side of the page).

Part 1


Part 2


Part 3


Part 4

Stinging in the rain

Another interesting phenomenon occurs when there is damage the cervical spinal cord at levels C3,C4, and C5. Instead of chorea like dancing this time causing spontanous diaphragmatic impulses resulting in unintelligible but patterned sounds to be bellowed out without consistant tone or pitch but with some sort of underlying repition. This medical condition was initially discovered by Japanese researches and named after the Japanese word meaning "to sing" which is "karaoke"

Here are some affected patients


While I was in Kenya-I suffered from an unfortunate Panga injury to my cervical spine-causing spasms of the nerves which innervate my diaphragm forcing me to have recurring belches that resemble something like singing. My condition seemed to be triggered by humidity because whenever it would rain-I would sing! (Gene Kelly suffered from a similar condition). So when I felt it come on, I would try to sing traditional African songs until the spasms stopped. Since few people here know these traditional African songs, I don't expect you to recognize them but have fun watching me sufffer!

Caucasian Chorea Compilation

Medicine and dance have always been intertwined like two tango partners. Since the drawn of medicine with the ancient greeks, diseases have been described by actions they may create. One such disease described by the greeks is "chorea", in which the victim uncontrollably performs dance like movements. Chorea is a sign of many organic brain diseases (as opposed to inorganic brain diseases which use pesticides and exploit farmers)such as Huntington's disease.




Once someone's brain is damaged so severely, the body becomes unable to control itself and random nerve firings trigger sometimes violent muscle jerks. When analyzed closely, these jerks can sometimes be patterned and actually resemble a dance-which is why "chorea" is the greek word for "dance". What I am trying to say is that every one of us has the capability to become a dancer-provided we suffer an inordinate amount of brain damage. This may be why alcoholics are often regarded as the finest dancers.

Therefore it should come as a surprise to no one that part of my medical mission was to honor my medical forefathers and show the Kenyans some of the hottest dance moves on the planet. While there Westerns that came to Kenya with the goal of treating a village for malaria, or help infants with HIV, but just as important as this is to teach children the pure joy that comes from learning a complex dance that reaches deep into your soul and dig through those years of oppression, hunger and death and rise to the surface the joy and harmony that can be expressed though dance. It was with this goal in mind that I chose to teach the children of Kenya the Stanky Legg.



Link to official video
http://www.youtube.com/watch?v=H0TpyCU6iv4

David and Helen, my two fellow medical missionaries I was living with, are far more skilled at dancing than I'll ever be. I remember one night David and I were both sitting at the dining table with our laptops out and listening to music. David's music selection on his computer was radically different than what I listen to-namely it was the dreaded "adult contemporary" music. David lets it slip that he still dances quite a bit and Helen asks for a sample. David puts on some Calypso music on through his tinny laptop speakers and they danced right there in the dining room. I'm not a dancing expert, but it looked pretty good and seemed to be a compilation of several white people dances: ballroom, latin, and square (only missing were the chicken dance, electric slide, and macarena).



After Helen and David danced for a while, they tried to get me involved as well. All the dances they had done pretty much were for 2 people so what could we do? Helen suggested doing some indian-esque dancing, David also having some slumdog millionaire sounding songs on his computer. Helen explained:

"To do Indian Dancing you need to lift one knee up and pretend you are going to high five it while keeping your upper body straight". Yes, that's all there is to Indian dancing. So the three got on the dining room dance floor, I handed the camera to Helen our housekeeper and we filmed this monstrosity-(remixed by DJ Vaggy!) The stupid hats were inspired by Helen-not alcohol.



Look for the follow up to Caucasian Chorea Compilation very soon where I show you what happens when you have cervical spinal cord dysfunction!


Not like he was going to raise you anyway...

Baba yangu alikufa ajalini

My dad died in the accident

Revisionist History-Little Orphan Annieshequa

Little Orphan Annieshequa was the most adored entry I have done so far. How can you resist those adorable orphans smiling, singing, and admiring the rims of the land rover? So much of the experience could not possibly be put in words, which is why you get another revisionist history.



I took so much video that my camera battery-which had a full charge-was dead by the time I left. Here I was expecting a dark, dank shack filled with orphans in potato sacks requesting more porridge (I may have been thinking of Oliver Twist or Employee appreciation day at the Nike Factory). Winding though those precarious narrow dirt roads on a bright sunny day- we reached the church to find 40 or so orphans circled around a shade tree singing in perfect 2 part harmonies. I quickly brought out my camera and filmed the traditional Africa Spiritual "Ride that choo-choo Pirate Jesus".



Two days ago I was talking with my colleague Carlos and Dr. Steinhauer-all of us having spent a month or more in Maseno about their inherent singing ability.

Dr. Steinhauer said

"In church, they would go into perfect 4 part harmonies without any instruction-it like they just knew".

The ability of the Africans far exceeded that of any Caucasian. I know this because I went to church on Moi day, which is a national holiday. All the Africans were absent, so it was just white people trying to sing. Worse still, there were percussion instruments (drums, tambourine, etc) that white people without rhythm should NOT USE! "He has made me glad" sounded as cheerful as a funeral, but you be the judge.



Compare this to our swahili service



When I went to go help out at the Orphan program with David-we saw that Kindergarten through second grade kids were being taught basic math skills on chalkboards outside. David and I could do basic math with the help of our cell phones, so we volunteered our skills to teach these kids. We were whisked away and brought into an actual public school and told we should teach them something. I brought out my digital camera and David and I just winged it for that whole class. David and I (especially me) really wanted to know what the kids would do to improve the country. I really wanted to hear someone say "rise up against government corruption", but I am not sure that idea would be tolerated in a public school. If you watch the videos, one child said exactly that. Eventually, it became a lecture about teaching kids about HIV/AIDS-it was amazing. I took the time to upload all these videos in hopes that someone will watch them-and as an added incentive, within one of the videos is a code-first one to email me the code will win a prize from
Kenya!









It's thanksgiving today, I hope everyone is with the people you care about today. I know I appreciate what I have so much more now.

Revisionist History-26+2 (the birthday post)

It's time again for some more revisionist history-this time for my birthday entry (a.k.a. 26+2)

DID YOU KNOW?!?

That many of the titles for my posts are song titles or references to songs that are relevant to the themes of the post? I did this there because I want you to explore deeper into this project, and part of the way I do this is through these cryptic messages. If there is something you don't quite understand why I put in there-google it! You will be happier to discover it yourself! This particular entry was a reference to "fourty six & two" from Tool-a complex song about changing one self, its lyrics very much relevant to this post. Look around though, you might find some more surprises I hid for you.



As with all of the videos I post on here, if you double click them-you will be taken to the youtube site where you can then click the "HD" button in the video toolbar to watch these in widescreen HD!

The first video I am putting up is one I debated with myself about putting up. In my entry, I talk about going to the Maseno Club and that Helen and David as my present each said 3 things they really liked about me. Yes, 6 total nice things about me. Here they attempt to do the impossible I didn't say in the entry what these things were, but I did film it as it happened in real time from a 1st person view perspective. This is the video below.



This next video is at my super special birthday dinner as Helen, David, and Emmah sing me happy birthday. Blowing out the candles was probably a bad idea though since we then lost electricity and that was the only thing keeping the room lit. Sing along if you know the words!



I come up with a birthday comedy routine so funny that Steve Martin parodied it 30 years ago-it's THAT good!

The case of the patient with the new leg

While I was in Africa, I encountered numerous medical problems I had never experienced in the states-some of which I will document here in the coming days. The case of the patient with the new leg is a little different though. Let's start with a picture.

This wound is about 3-4 cm across and was draining foul smelling discharge. The patient had been seen at other hospitals for this in other villages and they thought he had a skin abscess and would heal over time with some antibiotics. The abscess wasn't healing though and it had been going on for a few months so they were brought to the Maseno Mission outpatient clinic.
He was seen by Francis, one of our clinic officers and admitted to be started on antibiotics. We x-rayed his leg and found this.


That's his femur on the right-and that's not normal.

Here's a normal right femur for comparison


Notice on the normal femur it is thin and rod-like and has a demarkation between the outer bone (compact bone) and inner bone (spongy bone)? That's all missing on the xray of the patient I saw.

This condition is called chronic osteomyelitis in the United States and it's very very common. We see numerous elderly patients, generally with diabetes or peripheral vascular disease. It is a very hard to treat illness and antibiotics are given over several months and it's not always possible to eradicate it. Many times, amputation is the only way to control it. It's caused by a bacteria (usually staph aureus, but other bacteria can cause it too. Over time, the infection in the bone causes an influx of inflammatory cells that can kill the bone (or necrotize) as they try to kill off the infection. Sometimes even new bone is made as is in the case of the patient above-his body trying to make up for the dead bone made the strange shaped leg you see above.

The real shocker comes when you see what this patient looked like though.

This was not old person with diabetes, or decubitus ulcers, or paralysis.



This was a happy, smiling 4 year old boy!

He probably had trauma to that leg some time before and the infection was never properly handled and continued to worsen-killing off his bone and causing him bone pain. Eventually the infection even formed a sinus tract (the "abscess") to his skin. Amazingly enough, the boy walked with relatively little dysfunction. We ended up treating him with a few days of antibiotics and after his fever went down, sent him home with several months of antibiotic pills. He was one of the happiest patients I had though-where other kids his age were very shy or would cry when a white coat would come by-he would always smile for me. I really hope he gets better and doesn't have to have his leg amputated.

Hard Lessons in Swahili

Actually this was true for this patient-but why it was in a translation book for kids is anyone's guess

Ana mguu mmoja mfupi kuliko mwingine

He has one short leg than the other

Revisionist History-Red Ribbon Revival

Oh man, did I take a bunch of pictures and video on that day I went on my walk with Praxidis. Read the story of the red ribbon revival below then check out these pictures and videos. The videos are in glorious 720p HD as well!






This was the quail farmer I was so interested in





The average household of those we visited-this one contained 5 people


The matatu ride on the way back



And as always-watch out for the white dude with the panga-he's had one Tusker too many!

Hard lessons in swahili

Next time we'll try antibiotics instead of enemas and Sprite

Kiljana aliyekuwa na niumonia aliaga dunia

The boy who had pneumonia died

The Ballad of Tom

Whoever said beauty is only skin deep has never had Toxic Epidermal Necrolysis.

While I was in Kenya, I actually saw 2 patients with a rare illness called Toxic Epidermal Necrolysis or TEN for short. TEN is basically a very severe allergic reaction causing the physical equivalent of a whole body burn. Skin can just come right off in huge thick sheets. TEN even involves the mucus membranes of the individual-their mouth and eyes ulcerated and bleeding-it is truly a terrible disease. Let's say you are fortunate enough to live in an industrialized nation with access to a burn unit-even then you have a 1 in 3 chance of dying from this disease. We of course had nothing even close to an ICU let alone a burn unit. We had just discharged a patient a few days before with TEN who had managed to hold on for several days. The allergic reaction removes a good portion of what protects your body from infection and keeps your fluids and electrolytes inside you. People that die from TEN often develop overwhelming infection or severe electrolyte imbalances and require a good deal of care to give them the best chance of living.

This is Tom.




Seeing someone like Tom come in with such severe disease I knew would be a death sentence-we couldn't even keep the flies from eating his dead flesh, how would we keep him from getting infected. Tom didn't talk to us, and his family did the talking for us-apparently he had been sick and received some antibiotics (penicillin is notorious for causing TEN) and then 2 weeks later had severe burns all over his body practically overnight. While we were taking care of Tom, I learned that the patient that we had sent home with TEN died in her house within a few days and Tom looked much worse. You would pull back his blanket and his skin flakes would create a cloud of dust in the air so that you were terrified to inhale but you kept Tom covered so he would not develop hypothermia.





Every day I would show up in the morning expecting Tom to be dead-but we did wound care as best as we could and gave antibiotics. I remember one day Dr. Hardison coming in and without gloves pulling napkin sized pieces of skin from his leg-showing everyone he was growing new skin underneath. I couldn't believe it when Dr. Hardison said that Tom was well enough to go home-not going home to die like our last patient with TEN. Even with our limited resources and with a disease that kills >50% of patients when they come to a place with low resources like our hospital we still saved him. Look at the after pictures below




It usually wasn't the patients like Tom that ended up dying right away though. Even with a relatively low patient load, I saw a good share of death that month. There were a few that stand out in particular though. I saw one man in the clinic that was there with his brother who had fallen ill in the last few days. He was febrile and apparently had a seizure earlier that day. When I saw him, he had reduced mental status. I also found out that this young man (around 24 or so) was a heavy Changaa drinker (moonshine) and had stopped drinking a few days ago. I admitted him and gave him scheduled valium for what I thought were withdrawal seizures. Within 2 hours of me admitting him, he had a seizure and died. I remember walking in the ward to see if he made it up ok and the sheet was over his head, his brother that was just there with him at his bedside-I tried to think of something to say but was too overwhelmed myself and figured my words would be useless in this situation-so I said nothing. Another patient later was admitted overnight for seizure disorder which Dr. Hardison believed was pseudoseizures because of the truly bizarre way she was behaving ended up also suddenly seizing and dying on us-these were young kids-early 20s at best. I'm used to death being all around me and I accept it as just a part of life we all must face and embrace at the right time-but the people that were dying in front of me had no past medical problems-it was like the helicopter accident in the Twilight Zone movie that killed the actors, life just snuffed like the candlelight and just the smoke remains close to the cold wick until it gathers itself up toward the heavens.

Hard Lessons in Swahili

I will trade you that black pen for a black eye-that's what girls get for trying to learn!

Alivunja kalamu yake ya wino ("ya wino" is actually part of the translation!)

He crushed her fountain pen

Lessons from Space

With the windows down it was like God was whispering the idea in my ear

Engine off, parked on the side of the street, still in my scrubs and white coat I sat in my car with the driver side window down. The sun was rapidly dying below the horizon behind my head-yet I wouldn’t have to be locked inside tonight. I had time to think as I always did, but now I had the capacity to do something I hadn’t before-anything. You only really know how free you are to do something until you are powerless to do anything. I equate my time there to being in a vacuum-away from everything you know and everything that worries you. I guess it’s like being in space or solitary confinement. When you don’t have this aching nag of reality, you have a lot of time to think about what really matters.

When I came back, I felt like an astronaut coming out the space capsule and immediately being hosed down in case he picked up a bad case of Martian herpes from the green skinned women you would see an old issue of “Amazing Stories”. I had no stronger desire than to take a really long, hot, non-bucket shower. I looked at my arms covered in a raised, spotted rash and wonder if I got that alien pox from Africa as the steaming hot water ran over me. I thought back to the last leg of my trip as I came back from Amsterdam-after what happened when I wrote “Falling from the Sky”

The flight to America from Amsterdam was uneventful and I was awake the entire flight over the pond watching “Harry potter and the half blood prince”, “Star Trek”, and “Terminator: Salvation” before touching down in Detroit for a massive layover. Going through customs I thought about the 2 foot machete in my bag as I went though customs.

“Do you have any plants, vegetables, fruits, food from where you are coming from”

I shook my head no, and said I brought some beer and before I could even tell them about my 2 foot knife they said go ahead and I rapidly progressed through customs. I sat in the Detroit airport for 4 hours awaiting my next plane-putting the finishing touches on the “Pastasafarian entry” while CNN looped it’s news stories in the background-one of which being a big health festival in Kakamega, Kenya (about 3 hours to the north) where folks were being tested for HIV, shown how to purify water, and use mosquito nets.

Seeing Bethany at my gate at Memphis was the best thing ever though-she had wanted to surprise me (she bought the ticket right when I left) but she told me about it a little earlier. She could only overnight before she had to go back but it was amazing having her back in my arms, I missed her so much.

Before I knew it, I was back on wards and had my ward team of my own. Even at the MED, which I remember thinking was “dumpy” as I started as an intern last year was looking glamorous by comparison-daily labs could be ordered on patients. it’s so easy to go back to fixing the numbers, but at the same time in the back of your head you think back to the people in Africa who do fine without the aggressive micromanagement of western medicine.

Those first few jet lagged days hit me hard-I didn’t know which side was up. I couldn’t believe how many people in my program read my blog and I am still not entirely sure how it got around to everyone. Desi, the resident who is going to be there this month found the blog helpful though.

So I find myself back in the car, engine off, windows down, sun rapidly dropping below the horizon behind my head when I grab my phone. I texted old friends and called those who I hadn’t been in touch as quickly as I could. Life is too short to lose those who are close to you-that’s what you learn in the vacuum.

Hard lessons in Swahili-The Kenyan Government-cause every 2nd grader should be a responsible voter!

Cause it's easier than counting hanging chads

Chama chake cha kisiasa kilifungwa wiki jana

His political party was banned last week




Cause the tough issues like universal health care take the backseat to being able to make Toll-house cookies

Kila mplga kura alihongwa kwa kilo ya sukari

Each voter was bribed with a kilo of sugar





Because the new constitution will tell us when we need to write new constitutions!

Tulitake katiba mpya kwa sasa

We needed a new constitution by new

Tons of Pics and New content!

I thought it would take a day or 2 to get over the jet lag-not quite. While I planned on doing a big update yesterday evening, I actually fell asleep at my desk at 6:30pm and ended up sleeping until 5am. I am still wiped. I did manage to upload some of the safari pics in the meantime and there will be SEVERAL more entries coming-and I will even load the video of Helen and David saying the 3 things they appreciate the most about me and even teaching the Kenyan kids the stanky leg.
For now, enjoy some safari pics!

Safari Pics and videos and journey home

Falling from the sky

Then there was complete blackness...

In my hand, a bottle of Amarula liquor, and I'm about to purchase it at the Duty Free Shop at the airport. I had just haggled with the register girl because she was offering me a bad exchange rate for my shillings. As I was handing over the money-blackout. The entire airport is covered in a shroud of darkness. The chatter outside the store now absolute dead silence as everyone pulls their belongings to their side and wait for the backup generator to kick on or the power to go back on.

And they wait...

I had enough time to walk out of the store, find my video camera and record the complete blackness. Then the lights kicked on again, but just the emergency lights. All the stores closing hours abruptly came and the doors shut. Then after 10 minutes, the emergency lights blacked out. Apparently the backup .generator ran out of gas. The only light coming from the rapidly falling sun as it was settling on the horizon and again silence. Now-nearly an hour after the lights first went out-only the emergency lights are on. Jomo Kenyatta Airport-despite being the largest and highest traffic airport in Kenya is about 1/3 the size of the airport in Memphis, TN (which is a small airport by US standards). The airport in Kisumu on the other hand was a single runway, had 1 gate, and you had to walk to your plane-the entire airport terminal was smaller than our house in Cumming, GA and this is in a major city (Kisumu being the 3^rd largest city in Kenya).

The emergency lights then went out again...

Now that the sun is down, the only light is from traveller's laptops and the runway lights. It's truly eerie. I have shot video of this darkness, it's strange-most of the people here are white and non-English speaking. In the dark I hear French, Dutch, and a mash-up of dialects but no clear English can be heard. No power means no air conditioning (just like all of Africa), the sweat of the day odor lingers on those around me-the air is stagnant with it. At least the overpriced Tusker at the airport is still cold, it may be my last one for awhile-one of a short list of things I will miss here. Around me I hear whisperings, apparently all of Nairobi is in blackness and they sure as hell don't have emergency generators in many places.

I guess it was only fitting on my last day here that this should happen. Good thing I leaved my shaker flashlight in my checked bag. The emergency lights now being off for a 10 minutes with no sign of coming on. Overhead, a pleasant little chime and a female announces (in swahili then english) that a certain plane have arrived at the gate. Too bad no one can see where their gate is anymore, but since there is only 14 gates (that's lucky 13 more than all the other airports in Kenya) you might have a chance feeling blindly for the chest of the ticket agent at a gate-at least that's what I did.

That wasn't the only surprise to happen at a gate.

As I was sitting outside the security scan at the entrance to the airport, trying to redistribute the weight of my carry on luggage and my checked bag so I wouldn't go over limit, I thought back to the 2 foot machete in my checked bag and looked at a large sign above the metal detector. A circle slash was over a pocketknife, but also over knives, forks, and yes even spoons. Apparently, Al Queda's newest strategy is to pull your eyes out with melon ballers from williams-sonoma before vigorously brushing your teeth to death. There's no way in hell my pangaa is going to make it through. I watch as the bag goes through security and the color xray shows the huge blade. The security screener looks at me and says "you have a pangaa in your bag?"

"Yeah, but that's ok right?"

"Yes, the main problem is you have a container of aerosol (my bug spray), you have to remove that from your carry on please."

Unbelievable. After I leave the security screen I walk away, and actually rearrange the stuff in my check bag-meaning I could have grabbed the pangaa at that moment and put it on my carry on-that's scary. It looks like though at each gate they have an additional security screen like at Schipol in Amsterdam to prevent this from happening.

The last thing I want to do is create an incident that keeps me here, which reminds me of something that happened 4 hours ago.

My cervical spine bounces back and forth like a metronome as we tear ass down the dirt roads leaving from the masai mara. The dirt road is marred with beach ball sized pit holes and sudden dips that rocket my head into the ceiling despite wearing my seat belt. The entire ride feels like you are riding a jackhammer. The safari in the park was also in this vehicle and the roads were just as perilous, but we were driving at most 15 miles an hour so while it was jarring it wasn't this bad. The non-existent shocks become glaringly apparent at about 25 mph. I look at my watch, it's a 6 hour drive back to Nairobi and only about 15% of the way is paved. Our tour guide said we would make it back by 4pm, but that was before I was familiar with the concept of "African time"-meaning when someone gives you a time to meet, you should probably be happy if it happens within 1-3 hours of when it was originally scheduled. More than anything, this is the #1 complaint I get from all the folks I talk to from industrialized nations. Several hours into the jarring ride, we stop for lunch and wait on "African time" for another tour van to show up so we can swap passengers. Tired of waiting, I scope out my environment and spot a bunch of kids playing with loose strands of barbed wire. I go up to the group of kids and ask what they are doing but none of them understand English. I snap a few pictures of them, which draws a crowd of kids. These kids were beggers, which I quickly found out as their english speaking leader asked me for money. Looking at my watch and thinking about that I will be leaving Africa in a matter of hours, one thing was still left unaccomplished-teach the children of Africa the "Stanky Leg". Perhaps because they thought I would give them money, they actually did do the Stanky Leg and I was able to record it, too bad they were wrong about me giving them money. Eventually, another van shows up and we pick up 2 sweedish girls. I thought I was a real trouper being here in Kenya for a month-turns out of all the people I met on Safari I had been here the least amount of time. No one was really on vacation, and apparently Europeans actually pay to volunteer when they go to third world countries. How much do they pay? Upwards of 1-2 thousand US dollars to pour porridge for orphans! Before you think "well, it helps the orphans" think again-the money goes into the agency that arranges the volunteering. These two Swedes were also coming from Safari in the Masai Mara and were spending time volunteering in Ngong in an orphanage. While they were on Safari, they reached the Mara river and at this point the tour groups are actually allowed to leave their van and check out the hippos and crocodiles. However, since hippos kill more Africans per year than any other animal, you are only allowed to get near the river with a KWS (Kenyan Wildlife Service) employee, who just so happens to carry an assault rifle with bayonet. Well, our Swedes were given a private tour by a KWS when in the forest he turns to them and says "I will take one of you, only one of you will return to Sweden". The girls of course thought he was joking so he asks "does my gun make you afraid?" It was then they realize he isn't kidding and they head to the safety of their tour van pronto. I managed to get a video of them telling this whole account. Turns out that our added speed on that bumpy trail got us back into Nairobi by 4:30, much better than my Africa time expectations.

From Nairobi I boarded a bus to the airport. A taxicab ride to the airport would be about 1700-2000 KSH but the bus was only 50 KSH, a real bargain and since I had time, I took the bus here. Turns out the buses, like the matatu van transports, won't budge until EVERY seat is filled, so I sat in the back row of the bus, the window to my right and a mother and her pooping child nuzzled up to me on my left. There was no breathing room to reach into my pocket to get my camera, and I doubt I could have gotten good shots through the dirty window, but what I saw was amazing. Like the rest of Kenya, trash was strewn in the streets, but the bus ride marked the first time I saw a particular animal: the pig. As we were crossing a bridge, several pigs were under the bridge sorting through the garbage piled up near the stream below. Not once this month, was pork ever on a menu nor could it be found in the grocery stores. Turns out that Kenyans are not high on the hog-preferring goat, lamb, beef or chicken and it doesn't seem to be due to religious reasons because only a small amount of Kenyans are of the Islamic faith. (Future edit-I discovered a few hours later on the plane sitting next to a couple that spends 4 months a year running a theological college in Eldoret that pork is available in certain geographic regions of Kenya).

Have you been in deep in an urban city and seen those vans that are covered with ads and graphics for rap stars and their upcoming albums? Kenya's matatus (crowded van taxis) are generally decked out with one of two different designs: pictures of Jesus and bible quotes or pictures of gangster rappers and popular mass murders. Other matatus will have clothing brands painted all over it (Sean John etc) despite clearly they are not being paid for the advertisement. Most of the matatus I saw in Nairobi even had names on stickers on the driver's window adding a lot of personality to each vehicle. Nairobi in general had a lot of personality and about 2 square blocks of actual money (which is where the Hilton is located)-the rest is abject poverty and a heavy population density just like the rest of Kenya. Many of the smaller storefronts are painted in safaricom or Orange ads just like in the smaller towns (turns out the small businesses get their place painted free if they agree to have it painted like an ad-which is why so many of the buildings here are neon pink (Zain telecom), Orange and white (Orange telecom) or Bright green (safaricom).

So now I look at the dark skies in the gate for my plane, a fat englishman in safari gear is talking about the "Scheduled power rationing" and that all of Nairobi should be dark right now. Getting to the airport early turned out to be a punishment considering how incredibly hot it is. There's no moonlight, no starlight here, but thankfully the backup generators are powering the runway. Hopefully the air traffic control will see the planes on the runway (unlike when I came here) and we will leave on time.

Future edit #2-of course we didn't leave on time, but the delay was only about 45 minutes. I'm now sitting at my gate at Schipol in Amsterdam as people file in to go to Detroit. Immediately after leaving the plane I felt a rush of cold air and wonder what cold weather will feel like again. Amsterdam's airport is a lot like Ikea-everything is shapely, clean, and technology is being sold at every store. Unlike Ikea, their prices are through the roof, especially since it's about 1.6 dollars to a Euro. Kenya was the same way when it came to buying tech-the latest tech was either unavailable or ridiculously expensive compared to US prices. Kenyans find workarounds though, particularly when it comes to cell phones. There are no cell phone plans as far as I could tell, it was all pay as you go. The cheapest phones like the one I used could be had for $10 US. Remember those cellphones you used 5 years ago? The ones right after the starcom and right before your Razr? The one you lost, either you thought you left it at the gym or it fell out of your pocket at the movie theater, well it ended up in Kenya. The majority of people are using 5 year old unlocked phones while Nokia phones cater to the mid and high range. I remember coming here on the 5^th of Oct and thinking that Amsterdam has the best sunrises I've ever seen, well Kenya has the best sunsets in both the literal and metaphorical way. See you all soon!

Painful Lessons in Swahilil-Triple Threat

I didn't forget that the last entry didn't have any Swahili and that I've had radio silence the last few days-here's your reward

Thankfully his kidneys had good health insurance so that they could remove the cancerous person growing around them.

Alifanyiwa upasuaju kutolewa figo

"He was operated to be removed his kidney"

Melanoma's a bitch, but so is being thrown in an incinerator during your country's latest genocide

Ngozi yake ya rangi ya hudhurungi iligeuka na kuwa nyeusi

"Her brown skin became black"

If you keep running and take performance enhancing drugs, sometimes you'll grow an extra toe or two.

Alijikwaa kidole cha mguu akikimbia

"He trippled his toe while running"