First Days

The past week has been a series of contrasts. I am living at a gorgeous flat in a wealthier section of town with amazing gardens (the owners of the complex are professional landscapers), a pool (which I swim in every day), and more space than I've ever had to myself. In the mornings, I get on a bicycle taxi (boda boda) for a ride into our clinic. We slowly progress from the well paved streets and quiet, gated communities of this side of town for the vibrant, people-filled, colorful streets of downtown Kisumu and the clinic.

This is an amazing place. In contrast, the US seems sterile and slightly boring. In the mornings, I pass the stalls just opening for the day's business, throngs of people walking, biking, or packed into the crowded matatus (buses) following traffic patterns that are a bit difficult to discern. (Don't worry, Tom, I showed some judgement and opted not to bike myself into work - I wouldn't last a day!)

The clinic is run by a rapidly growing number of staff (now up to 45), all of whom know a surprising number of the 4300+ patients - from receptionists to nurses to pharmacists, social workers, pastors, clinical officers (about the equivalent of our physician assistants) and two overseeing physicians. The patients start lining up before 6 am, many after walking for hours to reach the clinic because they can't afford the bus or taxi fare to come in. On average over 200 patients are seen a day - in a space about half the size of our clnic in San Francisco - which always seems packed and overcrowded! It is incredible how much they achieve and how many people are treated and given hope with so few resources and such minimally trained staff.

I can't help but compare the experience of being a patient here to what I see in San Francisco, where a diagnosis of HIV makes you eligble for all sorts of insurance and support services. The striking difference is how many patients in SF take what they have for granted - or even complain about the lack of resources, long waits, limits on tests, etc. In comparison, the patients I have met so far, think nothing of waiting for hours to be seen by a nurse only and are excited about whatever care they get. Sadly, the clinic is having to turn away many patients because the providers are already stretched too thin.