Dr. Andy Baldwin, Kenya
My patient Samuel, beaming six days ago.
It was quite a day today. Here's what happened.
The morning started off pretty inspiring with the usual morning run, a brisk ten miles over a hilly course with my running buddy Isaac. The sunrise over the mountains was gorgeous and I though to myself, wow, this is Africa. Spectacular beauty!
Smiling and drenched to the core with sweat, I took some Weetabix and chai for breakfast, showered up, and got prepared for a special day of seeing patients at a palliative care/hospice center called the Living Room and then time at the HIV/AIDS clinic in the nearby town of Turbo. It would be a much different day than my usual day spent here at the Chebaiywa Clinic. Juli came by to pick me up at 9am.
Juli McGowen first arrived in the Kipkarn area back in 2004. She was an experienced nurse wanting to help the alcoholism-plagued area of in the Rift Valley here in Kenya. It was at that time that the HIV/AIDS epidemic was rampant with almost 40% of people having the virus.
As she went to work every day she passed by a tall man, whom she observed to be about 6 feet 4 inches tall and weighing about 90lbs. Each day he got thinner and thinner, sicker and sicker. He was dying of tuberculosis, which had ravaged his lungs due to the lack of an adequate immune system due to AIDS. Juli felt an overwhelming draw one day to speak with this man, knowing he was close to death, and wanting to pray with him and help him. She took him in desperation to the nearby town of Turbo to see a white doctor who she heard might be able to help. Joe, the 70-year-old “muzungu” did just that.
In fact one of the first things he showed Juli was a large cache of medications that he had. PEPFAR, AIDS treatment, had just recently been instituted and through USAID anti-retrovirals were now available free of charge throughout Africa. The issue was distribution, controlling the spread of disease, and performing screening to see who was infected with HIV. So in exchange for Juli asking Joe for help that day, Joe asked Juli for help. A lot of help. Together they would pave the way for the region’s first HIV/AIDS clinic, and lead large scale screening and continuity treatment for thousands of patients infected with HIV. Through their efforts the HIV rates in the region are down to close to 1% from upwards of 40%.
Juli's next project, which she still leads today was to establish a hospice center where Kenyans could receive palliative care free of charge. She pursued the project relentlessly, refusing to allow human beings to live in pain and suffering, especially during their final days on this Earth. Juli’s dream was realized in the opening of the large facility called “The Living Room” early this year. It is a 25-bed facility with a whole staff of nurses, social workers, and staff to attend to a wide range of patients — children brought for extreme malnutrition, poor hospital care resulting in deadly bed sores, HIV, cancer, cerebral palsy, tuberculosis.
We walked into The Living Room this morning and immediately I began to go around to some of the patients who I had met the week earlier at the International Hospice Day commemoration. “Where is Samuel?” I asked, referring to an older man with HIV who had spoken so eloquently and with vigor at the ceremony the week prior.“Oh Daktari, I am so sorry,” one of the nurses said. “He passed away two days ago.” What? This man had been so lucid and filled with heart. How could he have gone so quickly? “He died in peace, and with no pain,” the nurse replied. He had gone gracefully and in a place where he had said he felt at home and very proud of his life. Still, I had a lump in my throat having interacted with this man just days before. And now he was gone. Death is such a difficult thing for me to handle.
I found out this morning that there was another man named Samuel who also was gravely ill with HIV related complications. They called Juli and I to evaluate this Samuel and we found him outside in his gurney, having jerky movements and moaning in pain. I asked assistants to get some Valium and morphine for this man and examined him. I have never seen a man so thin before, where you can see his insides from the outside. The outlines of the bones cut through his face as if it were a skull already. I found it incredibly difficult to witness this, and urged the nurse to get the medication quickly. The drugs helped Samuel and he was more comfortable, but we knew he had but a number of hours to days remaining. We sent for his family to ask their wishes. I took a deep breath and felt someone squeezing my hand.
I looked down and I saw the most adorable little boy named Osoro. Visibly Osoro has some disfigurements caused by his condition of Burkitt's lymphoma. He basically has a gaping hole in the middle of his face around the nose cavity. He had such a large tumor there several weeks ago, that people feared for his life.
A good Samaritan in a community far away had heard about the Living Room and suggested they bring Osoro to it. When he arrived the thoughts on his diagnosis were grave. The pathology reports initially said it was a rhabdomyosarcoma (for sure malignant), but further studies showed it was Burkitt’s lymphoma which sometimes can respond to chemotherapy. Through some advocating it has been possible to get Osoro through several rounds of chemotherapy and the tumor has shrunken tremendously.Osoro was able to look up and give me a frown, and hold out his hand to say "jambo" (hello). I felt so bad for this little boy, but also full of hope that he was responding to treatment. I wanted to leave something with him, so I reached in my bag and took out a St. Christopher medallion on a silver chain and placed it around his neck. “He will keep you safe,” I said. Although hard to do with his tumor, I saw Osoro smile today. It made me smile too.
Here on the porch of the Living Room I was experiencing one patient dying, and another gaining his life back. And all around birds were chirping, the sun was shining, and cows were mooing. I took another deep breath.
“Are you ready to go to the HIV clinic in Turbo?" Juli asked. Turbo is the nearby town where Juli had set up the HIV clinic years back with Joe, and now they had a robust staff and carry the name AMPATH which receives funding primarily from USAID.
“You bet!” I replied.