Final Post

December 20th, 2019 by Daniel Russo
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Tomorrow we leave for the airport. I am already getting a little sad about the prospect of leaving. We have already started with a few goodbyes to people we won’t see today. I also made the mistake of checking the weather at home. While it is currently 64 degrees and climbing here, at home it is 14 degrees with a high of 37. That will be an adjustment.


Yesterday I had full oversight of my team. My attending was available by phone, but for all intents and purposes I was the attending. Of course as soon as I walked upstairs to start rounds I was told one of our patients had just died a few minutes ago. Not a great start to the day. I learned that here when a patient dies the next of kin is notified that they need to come in to the hospital, but is not told over the phone that the patient has died. How this results is that later in the afternoon I was back on the floor and was told that the patient’s daughter was sitting on the now-vacant bed and had some questions. The chaplain accompanied my intern and me to the counseling room and we divulged the death to the daughter. The death had not been unexpected as he had had a massive stroke and had not had a GCS greater than 6 in the last two weeks. After a brief discussion of the medical details leading to his death and our condolences to the daughter, the conversation shifted to next steps. These questions were handled by the chaplain, and I found pretty interesting. The first step was the family had to clear the bill. After that point the next of kin could come and take the body; they would also be responsible for setting up transportation of the body. In the event that the family could not immediately clear the bill, the body would be held in the morgue until they were able to do so but at a cost. There was initially some turmoil regarding whether the daughter could take the patient’s body as his wife was still alive and not present. Ordinarily only the next of kin could recover the body but given that his wife was old, frail, and lived 6+ hours away, the issue was escalated up the nursing supervisor chain and when I ran into the daughter later in the day she confirmed that they were going to release the body to her.


The remainder of my afternoon was spent running family meetings with my intern and a member of the palliative care team. Both meetings involved the families of patients with metastatic cancer regarding goals of care and treatment options. In both cases the families were very hesitant to change code status to DNR/DNI. I did my best to explain the natural history of their family member’s illness and its terminal nature as well as the likely futility of escalating care to ICU or attempting resuscitation should they code. However neither family made any indication of being ready to change code status until my intern took over the conversation and outlined the costs of ICU care. What is usually a subconscious or unspoken conflict in the US between the desire to treat family members with every available treatment and the limitations of financial resources is here a deliberate conversation. In the States, when talking about code status I can’t imagine bringing up the costs of advanced intervention as that would seem like I’m giving unjust care to our poor patient population; luckily, discussions of medical futility and the like are usually enough for families to understand the reality of the situation. Here, where medical literacy is poor, families seem to respond less to abstract hypotheticals but much more strongly to concrete concepts such as cost.


On a brighter note, I have been visiting the patient I had performed the spinal tap on (see earlier post) in the HDU. The day after the tap he was already more awake and was able to shake my hand and seemed to attempt to speak (in Swahili). Since his transfer to the HDU they have performed serial taps and he continues to slowly improve. It seems he won’t need a shunt and transfer to another hospital after all. He is definitely one of the patients I will be wondering about when we get back home.


Last night we attended the advent night at Dr. Nguyen’s house. The theme of the night was cookie decorating so it seemed all the families with children in the complex. It was nice to see all the kids having fun together. It reminded me of stories and pictures my parents have shared with me of when we lived on air force bases when I was a child. The cookies were probably the most delicious thing I’ve had since we arrived.


Now today is our last day at Kijabe Hospital. It’s going to be difficult to leave this place. We’ve made a lot of friends and learned a lot. I think this is a viable option for recurrent short term mission trips as it is relatively easy to navigate the inpatient service with the assistance of all the interns. In addition, should we ever transition to long-term missionaries, with its perfect climate, abundant resources and the Rift Valley Academy on site this would be a hard place to beat.


Tomorrow we will leave early in the morning for Nairobi. We will make a couple quick stops for fun at the Giraffe Centre and the Elephant orphanage at the Sheldrick Wildlife Trust before grabbing a bite to eat at the mall (hopefully at Urban Burger to help with our assimilation back to American culture) and heading to the airport. 23 hours later, we will be home.


Week 3

December 17th, 2019 by Daniel Russo
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I am back on the inpatient ward. Elaina is rounding on the female ward and I am on the male ward. Overall I will say I prefer working on the inpatient side here in Kijabe. My team consists of Dr. Caire, Faith (the same MO intern I worked with two weeks ago), and Nancy (a CO intern). Interestingly there are fewer patients on the medical service in the male ward than the female ward. I’ve been told this is usually the case. It may be that males are less likely to seek care here.


Dr. Caire has given me near-free reign of the team. Today I rounded on the patients with the interns and made decisions regarding their care, only later discussing the patients with Dr. Caire. I am certainly getting a feel of what it is to be an attending on this service.


One of our patients on the ward has been deteriorating the last two days. Over the weekend he was talking and joking and now will only open his eyes to pain and does not retract his limbs when stimulated. He has cryptococcal meningitis but confusingly is HIV negative (tested 3x) and has no known cause to be immunocompromised. He has been on appropriate treatment but now has become less responsive and has spiked fevers overnight despite being covered with amphotericin, fluconazole, anti-TB meds, and meningitis-dose ceftriaxone. His last lumbar puncture 1 week ago had a mildly elevated pressure of 20 cm H2O, but not generally high enough that he would need serial taps. With all this in mind we obtained a CT of his head (after a delay of a couple days) which showed ventriculomegaly and was read by the radiologist as concerning for OBSTRUCTIVE hydrocephalus, meaning that something was blocking the flow of the CSF out of the 4th ventricle. This can be a complication of meningitis as cellular debris can clog off the flow of CSF and effectively create a dam. However, this is usually seen with bacterial and TB meningitis (which we were already covering for anyway) but not usually with cryptococcal meningitis. The importance of this finding is that if true, the patient would need a shunt from the CSF to allow the pressure on the brain to decrease. That would require a neurosurgeon which would mean transfer to Nairobi or Tenewek. This patient’s family has already been struggling with financial issues and this may not be a possibility. After Dr. Caire called the NS in Tenewek and ran the case by him we all decided the best next step was to repeat the lumbar puncture. If the pressure in the spine remained low, this would almost definitely mean that the patient would need transfer and a shunt placed. However, if the pressure was now very high, this could still just be due to high CSF pressure in general from cryptococcal meningitis and all the patient may need to recover is serial LP’s over the next few days. So just before lunch my interns and I placed the patient on his left side and my intern attempted the LP, two tries, unsuccessful. She then offered to let me try. Now this is not a procedure we regularly do in the States. Either the ER doc or the interventional radiologist has done the LP for the few patient’s I have seen that need one. Earlier this week (see another blog post) I had tried unsuccessfully to do one on a patient that then ended up passing out and vomiting. But sure, let’s try again. This time on my first try I felt the soft pop as I entered the dura and as I pulled the stylet out and saw the flow (pretty brisk flow) of CSF drain I definitely felt a sense of pride. Low and behold his pressure had increased to 36 cm of H2O which is quite high. Hopefully now with serial LP’s his mental status will slowly improve and he won’t need transfer or surgery.


Immediately after the LP I had to hustle down to the education room to give my lecture to all the interns on BPH and prostate disease. It was relatively well-received and we had a good discussion about PSA testing and cancer screening. Interestingly, here they seem to jump to ordering a PSA (which is a send out lab and likely not cheap) on any male with urinary obstruction, even before thinking of checking a urinalysis, doing a DRE, or starting on tamsulosin. One of the Kenyan attendings was present at the talk and indicated that this is a management style they are hoping to change.


Last night we went to the weekly dessert night hosted by the long term missionaries. This time it was at Bob and Hope’s home. Bob is a Family Physician who works part time at the hospital on the palliative care team and part time at the local Bible college teaching a course on HIV. It was interesting to hear how the pastors are educated on HIV/AIDS and how to counsel patients and their congregations on the disease. He noted that there is still an entrenched anti-condom sentiment amongst some of the students, even amongst the protestants.


They chose to have their dessert night be themed as a “Love Feast” which is a traditional meal of coffee and sweet bread shared amongst Moravians as a sort of communion. Now no one in attendance was Moravian but Bob and Hope had lived in a Moravian-founded town in North Carolina so they wanted to share this tradition with us. While most of the attendants (from Australia, Somaliland and Nebraska) had never heard of a Love Feast, by pure coincidence I am actually from an originally Moravian town called Lititz and was familiar. Of course there was a bit of a Kenyan twist with the coffee being spiced with cinnamon, nutmeg, and cardamom. We spent the evening singing Christmas carols and they even had candles for us to hold while singing Silent Night.

Weekend Call and Adventures

December 15th, 2019 by Daniel Russo
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This weekend we have been on call. Thankfully call is very light (especially compared to our in-hospital call back home). It’s generally taken from home via cell phone and only requires you to return to the hospital if there is a patient who has acutely worsened or if the CO/MO’s presentation is not clear enough. The presentations we have received over the phone have been more than thorough (although not very concise) and for the most part the interns have a reasonable plan that only requires slight adjustments. With our remaining time this weekend we have been able to fit in some fun as well as explore a bit.


Yesterday we did a bit of shopping at the local market. It is set up in a building’s lower level right outside the hospital. While it doesn’t have much in terms of prepared foods or frozen meat (both of which can be picked up from the Duka (shop) across the street), there is an abundance of vegetables, as well as tortillas and samosas imported from the capital. Our goal however was to shop at the various souvenir and craft stands towards the back of the market. However, as soon as we enter (and are the only customers in the shop), the food vendors immediately began calling out to us. Now we already have enough vegetables from previous trips to the market to comfortably last the rest of our time here. Times are currently tough for the ladies that run the market stands, though, as many of the missionaries are on leave for the holidays and the boarding school in town is empty on Christmas break. The cash flow at the market has clearly diminished. We were immediately offered tortillas upon entering. I offered to buy 4 which was met with a scoff and the shopkeepers insisting I buy at least 20. 20 tortillas it is. We then pushed to the back of the store and did some Christmas shopping. At the stand closest to the food vendors, I was discussing pricing with the shopkeeper when one of the vegetable vendors approached Elaina and said, “please it would make me so happy if you just bought some carrots.” She indicated a bucket containing a dozen large carrots for $1. That’s pretty hard to say no to, although we have at least as many carrots waiting on our counter at home. Fast forward to later that evening. In order to get a cross breeze through the house we opened our kitchen window as well as the living room window. As I sat on the couch I heard a squeak and saw a Syke’s monkey had entered the kitchen through the barred window, grabbed two carrots and ran back outside. Like I said, we are in no shortage of carrots so we were not upset. We just wish that he had grabbed some tortillas as well.


Today we started our morning by walking to church. Today marks the first 24 hour period that we have been here that it has not rained. The roads are starting to dry (as they are predominantly dirt roads) and it was a pleasant walk through the wooded lane. AIC Kijabe Mission Church is much larger than I had anticipated (with a sanctuary as big as our home churches). They offer two services, one in English and one in Swahili. The English service was very well attended, nearly filling the pews. This may have been in part due to parents coming to see their children performing their Christmas skit and songs today. It was interesting to see the children playing shepherds holding what were probably actual shepherds’ staffs and wearing Maasai blankets around their shoulders as the shepherds in the valley do.


After church we made lunch which believe it or not contained a large amount of carrots. We then met up with Dr. Caire who had offered to give us a tour of the boarding school on site, Rift Valley Academy. The school is surprisingly huge with separate Elementary, middle, and high school buildings as well as dormitories for the boarding students and multiple sports areas including a gymnasium, outdoor basketball court, racquetball courts, and a rugby field with the best view we have seen in Kijabe. We saw the cornerstone to the original school building which had been placed by Teddy Roosevelt while on his safaris through Africa. After the tour, Dr. Caire led us on a hike along the road to Old Kijabe. Since there is excellent cell reception here we were able to go even though we were still on call. At one point we made a detour down to a collection of caves which were of historical significance. They had been used as a camp by the Kenyan freedom fighters during the Mau Mau rebellion in the 60s. Unfortunately the path was quite muddy and Elaina and I both slipped and fell multiple times. As we approached the end of the trail leading to the caves we could hear a man yelling loudly in Swahili within. Now, given that it’s Sunday and preaching can be a bit boisterous here the most likely explanation was that some sort of preaching was taking place within the caves. Given the location’s historical connection to anti-Wazungu (white people) sentiment, the agitated sound of the speaker, and our inability to ascertain what he was saying, we decided to turn back and forego the caves. A few slips later we were back on the main trail. The hike was a total of 4 miles with a total climb of the equivalent of 45 flights of stairs. At 7000+ feet above sea level, it was certainly a work out.

Week 2 (12/12/19)

December 14th, 2019 by Daniel Russo
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Late entry. Written 12/12/19


Happy Jamhuri (Kenyan Independence) Day! Today Elaina and I are on call for the wards but it has been a quiet day so far. We were called in for a couple admissions but have otherwise spent the holiday walking around the compound, purchasing souvenirs from local shops, and reading. Since I finally have some time to blog here is a recap of the week so far:


Since our return to work after the safari, Elaina and I have both been working in the outpatient setting. Initially she was working in the OPD (what they call their outpatient clinic for patients age 7 and up), and I was working in outpatient pediatrics. However, while the OPD is very busy, the outpatient pediatric unit is somewhat slow and I was working as the consultant for 3 providers (a CO, CO intern, and MO intern). This basically means I was waiting in the hallway to precept patients if they had any questions—and they don’t have many as they are all fairly experienced. There have been a few interesting cases I was called in “to review,” including a 6 month old with a large hemangioma involving the lower lip and jaw, and a 3 month old boy with an imperforate anus who had had a colostomy placed shortly after birth at an outside hospital close to home. The parents then brought him from over 900 km away for colostomy reversal, as they had heard the reputation of the pediatric surgery team here.


Since the outpatient pediatric providers seldom had questions, I gave them my phone number to call with issues and joined Elaina at the OPD. The OPD is run as a walk-in clinic. Patients arrive early in the morning, are entered into the computer system in the order of arrival and then are seen in that order (unless they are in extremis). The OPD staffing is tight so luckily there are enough English-speaking patients to be seen that we do not need to pull anyone to be a translator. Elaina and I work together in a room alternating interviewing and examining the patient and recording on the electronic medical record they have (which can be a little slow and crashes the computer occasionally). Again, patients seem to come from all over the country as well as from Somalia and Ethiopia to receive care here. Some of the outpatient complaints we have taken care of over the last few days include COPD exacerbation, goiter, back pain, plantar fasciitis, as well as patients returning for routine follow up visits and med refills for chronic diseases such as hypertension and lipid disorders.


One particularly memorable patient from this week was a middle-aged man with known HIV+ status (they use alternative acronyms like RVP or PITP due to stigma) who had previously been treated for cryptococcal meningitis (which seems to be a diagnosis we run into daily here) earlier in the year. He had symptoms concerning for a possible recurrence so we decided that he needed a lumbar puncture to measure the pressure of his CSF as well as test the fluid for various infections including a CRAG to test for Cryptococcus. This case taught us a lot about the “business side” of medicine here in Kenya. First there was a discussion of whether we should transfer the patient from the general outpatient ward to the “casualty unit” (what they call the ED). This would mean he would incur a bill from both OPD and casualty so we opted to do the tap first in OPD and then if needed directly admit to the ward and bypass casualty. Then we had to place an order for the supplies needed to do the LP: an LP kit, spinal needle, gauze, dressing kit, and sterile gloves. Then the patient had to leave the OPD area to go to the cashier and pay for all of the supplies (including the gloves and gauze). His receipt was then given to the supply office who dispensed the needed supplies. Unfortunately, the labs to be performed on the CSF had not been ordered at that point so after they were ordered the patient again had to stand in line at the cashier to pay for the tests before we could perform the LP. We finally had everything ready and performed the LP with the help of one of the long term medical missionaries but had poor luck and a bloody tap which clogged off the sole spinal needle we had. The patient then passed out, and we aborted the procedure entirely. Because there was no CSF collected, the patient then stood in line a final time at the cashier to receive a refund for the lab testing. It’s hard to compare this experience with doing a procedure in our clinic or emergency room back home. General supplies are considered under the global charge and nothing has to be prepaid prior to it being done. I’m not saying one way is superior (as our method of running up a huge ED bill that a patient may later struggle to pay is also not ideal), but it is a bit of a cultural difference.


Another cultural difference we have experienced this week is in regards to end-of-life care. This has been an area of interest of mine since medical school, and I have rotated with palliative care and hospice in the States so it is interesting to see the differences here. Whereas back in the United States there has been an increase in the number of patients who prefer to die at home and families that want their loved ones home with hospice care, the cultural norm here seems to be that families expect that patients will die at the hospital. There is a lot of guilt surrounding the idea of dying at home meaning that the family may not have “tried everything” to help their loved one. Another cultural norm seems to be that (and I’m quoting a Kenyan physician here) “All Kenyans should die with a full stomach.” As patients are approaching the end of their life, they naturally have a lower appetite and may stop eating altogether. This is considered unacceptable and families will tend to push oral feeding and if need be in the hospital request nasogastric tube feeds. It is not an uncommon site on the wards to see our comfort care patients in their last days with NG tube feeds in place. In America, we typically counsel that NGT feeds in end-of-life care are not helpful, actually increasing aspiration risk and possibly causing more harm than benefit, while definitely decreasing comfort. Here, they seem to remain the cultural norm. Overall we’ve had a very interesting week working in OPD.


We also visited the hospital next door called Cure which is predominantly orthopedic and does a lot of procedures to help disabled children. There’s a large play room and very friendly staff. While we were they we sampled their cafeteria. This is the lunch special of the day (lentils, rice, and chapati) which cost about $2 each.

End of week 1

December 14th, 2019 by Daniel Russo
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Late entry. Written 12/7/14.


While I sit in the main lodge of the Fairmont Maasai Mara, it is hard to recall the events of the last few days prior to arriving (as the events of this weekend have been so exciting it seems to have pushed out the other memories). Here’s what I can recall.


On Thursday we had a change in attendings as Dr. Wandia was at a conference. Our new attending, Dr. Letchford runs a charity called Bandia which sets up electronic medical records in remote small clinics as well as helping them get certified with the National Health Insurance. He brought to rounds a very different point of view. He challenged us to narrow differentials, switching from empirically treating a patient for PCP pneumonia, cryptococcus, and pulmonary TB at the same time, to a more focused approach aimed at treating the most likely cause and limiting medications to keep the patient’s bill low. We also have had a few palliative admissions the last few days for metastatic cancer (esophageal, lung, liver), and because of his main job he seems to have limitless connections with village clinics, thereby facilitating transfer to hospice-capable facilities closer to the patients’ homes.


On Friday we had a grand rounds presentation by the anesthesia department. The speaker is originally from Vanderbilt and continues to bring teams from that institution annually. They have begun training nurse anesthetists at Kijabe who have already spread out not only around the country but also to countries like Tanzania, Uganda, and South Sudan.  There is a severe shortage of anesthesiologists in Africa (only 4 in Kenya outside of Neairobi) so this is an important gap to be filled. After grand rounds we had a 30 minute or so break before M&M so I stopped by the cafeteria and ordered a coffee. I now know the importance of ordering BLACK coffee. What was presented to me was a mug full of boiling-hot milk with a packet of instant coffee on the side. I did not want to waste it (and needed the caffeine) so I thanked the man and drank it. Looking back it makes sense as the way they generally prepare chai (the more popular hot beverage) is by steeping tea leaves in boiled milk.


Morbidity and mortality conference was a different experience from how we run it in our residency. Each mortality from the adult wards and ICU was discussed as a full verbal presentation by the intern or clinical officer and then discussed and assigned a numerical value which was logged that corresponded with the circumstances of the loss (such as 1 being passed away on hospice/comfort care, 3 being a system-based issue contributing, 6 being a completely unexpected loss of an otherwise healthy person). I think incorporating this type of system into our residency’s M&M’s would be a helpful addition.


On Friday I said a half-goodbye to the inpatient Salome (female ward) rounding team. I will be switching to outpatient next week and will miss working with Grace, Faith, Korir, and Winnie. I hope that I have been able to teach them something during rounds this week; they have certainly taught me a lot and it would have been impossible to round without them.


Early Saturday morning we set out from Kijabe to Maasai Mara National Park. The road leading out of Kijabe to the north is a bit treacherous, unpaved, filled with potholes and with a very steep decline. It did however offer us a great view of the Great Rift Valley. We then drove through the valley with familiar sights of savanna, and fields of sheep, goats, and cattle grazing, interspersed with small villages and a few congested cities. The last hour of the drive was what our driver Jonathan referred to as a “compulsory kenyan massage.” By this he meant that it was the bumpiest drive we have ever been on. Due to the rains (we’re nearing the end of tthe short-rains, hopefully) much of the dirt road was badly damaged and even washed out in a couple of locations necessitating us to drive through a small amount of running water. He did a great job and we got here in one piece. We first had a cultural experience by visiting a Maasai village which is still inhabited. The villagers give tours of the homes, cattle corral, demonstrate some singing and dancing as well as how they start fires without matches and of course offer a small market of homemade goods.


Now we are at the Fairmont Maasai Mara and are thoroughly enjoying our break. We are very grateful to Kijabe to give us the weekend off and so far have been able to see lions, cheetahs, elephants, giraffes, gazelles, and more, all in their natural environment. Words certainly do not do it justice so here are a few pictures.

Week 1

December 5th, 2019 by Daniel Russo
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After completing half a week at Kijabe, we are finally getting into the swing of things. I have been on the inpatient service on the female ward. Our team consists of an attending (which they call consultant), a clinical officer (PA equivalent), a medical intern, a 5th year medical student (they do 6 years of combined undergrad and med), a nutritionist intern, and me. The first day I was unsure of where my role would be as they have a set method of rounding. First the CO, intern and med student round on their patients, then present the patients on walking rounds to the consultant. Dr. Wandia, my consultant for the first half of the week, encouraged me to observe and add anything of educational value to the students during rounds. Over the course of the week I am now acting in the role of the consultant (with the actual consultant at the wings should we need help). This has been a great opportunity to teach the students and interns as well as to learn from them the local medical nuances and logistics.


Standing behind our house in the lush forest.


Kijabe hospital is very different from the previous hospital and clinic we have worked at in Africa. Resource-wise there is everything from a CT-scanner to blood cultures to Zosyn. In terms of specialties there are general surgery, orthopedics, ENT, palliative care, OBGYN, FM, IM, Peds, dental and platics. There is an ICU with 5 beds as well as 2 HDU’s (step-down units), one in each gender’s ward. The wards themselves are 60 or so beds in 4-5 rooms with retractable curtain dividers. There are also a couple private wards with semi-private or private rooms for an extra fee.


In terms of pathology, over the last 4 days I have seen and helped treat patients with PJP (PCP) Pneumonia, Cryptococcal meningitis, urinary obstruction secondary to advanced cervical cancer, esophageal cancer, typhoid bacteremia, and a patient with a Hb of 3.3 (and relatively asymptomatic).


Everyone has been very welcoming. On Monday we went to Dr. Nguyen’s house for a dessert night designed to help short term visitors like us meet some of the long term missionaries.


True to the season’s name, it has rained every day, with occasional downpours. This has kept the foliage very green. Mist hangs on the top of the nearby mountains. There are Kolb’s monkeys that inhabit the trees (and rooftops) surrounding the hospital. They seem to enjoy jumping from the trees to our guesthouse rooftop, making a loud crashing sound.


Kolb’s monkey, Cercopithecus mitis kolbi


The food  has so far been delicious, especially the hospital cafeteria’s chapatti and samosas. In addition, there’s always a free lunch at the noon lecture, generally consisting of a stew of vegetables +/- meat along with a starch (either rice, ugali (a kind of starchy corn product) or potato). In addition we have been cooking dinner ourselves with lots of fresh veggies from the local market.


Tonight we are sharing call (hopefully not too many admissions) and then on Saturday we are headed to Maasai Mara national park to go on a safari!


Cape Robin Chat, Cossypha caffra

We’re excited!

November 30th, 2019 by Daniel Russo
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I am a third year family medicine resident originally from Lititz, PA. I am currently working at Wellspan York Hospital. My wife, Elaina Truax Russo, and I are excited to serve at Kijabe AIC Hospital in Kijabe, Kenya as an away elective for 3 weeks in December 2019. We are travelling through INMED and have just recently completed our INMED coursework.


Prior to this trip we have rotated at the Baptist Medical Center in Nalerigu, Ghana for a month in 4th year of medical school. Last year we helped staff a clinic in Sendafa, Ethiopia through a group from Living Word Community Church in York, PA. We are very grateful to our program’s Global Health Track and scholarship for partially funding our travel. We have had great experiences in the past and are hopeful that this month will be as well.


We are currently sitting at the Dulles Airport and soon will be boarding for Nairobi via Dubai. It will be a long day of travel but rest assured we have downloaded enough movies and books to stay busy.


This will be Elaina’s first time in Kenya, but I have actually been to Kenya before. As a high school senior I participated in a mission trip through Lititz UMC to Musese. I remember meeting a physician (maybe a resident?) from America at the guest house in Nairobi who was on his way to work at a hospital in the country. I remember thinking how cool it would be to be able to come back to Kenya some day and work as a physician. 11 years later (almost to the day) and we are fulfilling that dream.


We are thankful that we were able to spend the last 2 days seeing family and friends and eating Thanksgiving dinner… twice. Having fueled ourselves with leftover pie this morning we are ready to embark.

Introducing Myself

November 30th, 2019 by INMED
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Hello! My name is Daniel Russo. I am a Resident Physician at Wellspan York Hospital Family Medicine Residency. I am starting my INMED service-learning experience at Kijabe Hospital in Kenya in December 2019.