The Physician's Oath

Today was a big day for me. It was my second day of Medical School Orientation and it was my first time to take the Physician's Oath. It was a modified version of Physician's Oath for students just entering medical school. I really hope that I can do some good in Africa with my medical education (assuming I pass!). Anyway, I thought you'll might be interested in what student doctors are supposed to aspire to:

The Geneva Version of the Hippocratic Oath
By the World Medical Association, altered by the University of Washington Medical Executive Committee in 2000 for incoming medical students

At THE time of being admitted as a member of the medical profession,

1. I SOLEMNLY pledge myself to consecrate my life to the service of humanity.

2. I WILL give my teachers the respect and gratitude which is their due;

3. I WILL practice my profession with conscience and dignity;

4. THE HEALTH of my patient will be my first consideration;

5. I WILL respect the secrets, which are confided in me;

6. I WILL maintain by all the means in my power, the honor and the noble traditions of the medical profession;

7. MY COLLEAGUES will be my sisters and brothers;

8. I WILL respect and value the lives of all persons;

9. I WILL not discriminate against any person in medical decisions;

10. I WILL maintain the utmost respect for human life; even under threat, I will not use my medical knowledge contrary to the laws of humanity.

I MAKE these promises solemnly, freely, and upon my honor.

(A woman at 3pm) "I haven't eaten since 10. I am starving!"

Since I have been back, some things in USA culture have really driven home what privileged lives we have here in the developed world. For example, you can walk into a grocery store and choose between 20 different types of toilet paper: There is the extra soft, the double layered, the triple layered, the extra-soft double-layered, the spring scented, the package of 12 rolls of extra-soft double-layered, the 24 roll package of extra-long triple-layered ultra-soft baby-scented toilet paper, etc. Have you ever thought about what your toilet paper choices represent?


There is only one kind of toilet paper in the countries I visited in East Africa (outside of Nairobi that is). It is usually colored green or pink and it is definitely not 'extra-soft.' However, it costs so much money compared to the income in rural areas of East Africa that most people can't afford it. They either use newspaper, leaves or nothing at all.

A Ugandan pit latrine (one of the best and cleanest on the trip). At night the walls, floor and ceiling are moving with cockroaches. (I actually developed a game called, 'cockroach herding' where you use the beam from you flashlight to move the cockroaches away from the hole at night). It is such a privilege to have your waste taken away/flushed practically smell-free from the comfort of your home in several gallons of drinkable water.

Last week I went to visit my family in California including my grandmother who became ill while I was in Africa. As our plane was taxing into the gate around 3pm, a woman got out her cell phone and called her husband. During the conversation she said, "I haven't eaten since 10 this morning. I am starving!" To be honest, I think that I have said things like this hundreds of times. However, after being back in the states for only a couple of weeks, I had to stop myself from laughing out loud. Americans don't know what "starving" is. If lunch being a couple hours late is "starving" then an entire day without food for an American would mean certain death.

I think that these children in the Agoro IDP camp know what the word "starving" means. I was told that children in the camps do not complain even if they go several days without food.

I just counted. I have 7 pairs of shoes. Seven pairs! (A pair of chaco sandals, a pair of running/exercise shoes, a pair of black walking shoes, another pair of sandals, a pair of fancy high-heel interview shoes, a pair of flip flops and a pair of boots). Why? Sometime in the previous years I decided that I really needed each pair of those shoes. Right now I am trying to unpack all my boxes of stuff that I packed up before I left for Africa. I have been overwhelmed by how much stuff I have. What is it that allows us to have such a privileged life and such vast economic opportunities?

An Ode to the Washing Machine

While I was in East Africa hand washing clothes for 6 months I realized how much I love my washing machine back home. I decided to write a poem to express this new-found affection for my automatic clothes washer:

Washing machine, Oh washing machine,

Such a glorious creation has never been seen!

If you've been to Africa, you know what I mean,

Put dirty clothes in, they come out clean!


.... uh....

... uh...

...hmmm. I can't figure out a way to make "I love putting in soap and pushing start so much better than beating my clothes against a rock in a germ-infested river" rhyme. Sigh. I have never been able to write poetry.

Oh well, I guess I will just have to go back to the old standby - if I can't write a poem to express my love, I guess the least I could do would be to make a card:

Yup, that's how I feel.

High Speed Internet!

Not only have I returned to the land of hot showers and flush toilets, but also the land of high speed internet. I decided to celebrate this with posting some of my favorite pictures from the trip (some of which have appeared earlier on the blog). I took 2,863 pictures while in Africa so picking out the good ones can be difficult sometimes. Thanks Dad for your help!



Two girls before a wedding, Tanzania.


Maasai boy, Tanzania.

Maasai men waiting to be baptized, Tanzania.

Girl and sibling, Tanzania.

Dedicating a church in Tanzania.

Rolling paper beads, Kitgum, Uganda.

Ants drying out, Kitgum, Uganda. Yes, I did some of them.

I would like you to take a look intense look at this picture. Doesn't something about this picture just feel wrong? The middle of the picture where the subject should be is empty. Looking at it just gives me a disturbing feeling in my gut. This is how you feel when you see the IDP camps for the first time. You just have this feeling in your gut that something is so wrong about what you are seeing.

Beware of landmine sign, Kitgum District, Uganda.

Hut in a Rainstorm, Agoro IDP camp, Uganda.

Kids playing, Kitgum, Uganda.

Two women living with HIV/AIDS in Kitgum District Uganda. They risked discrimination and stigma from the community to record their stories a on tape that was played in the IDP camps about what it is like to live with HIV.

Agoro IDP camp from hill.

The girl who never smiled. Agoro IDP camp, Uganda.

Agoro IDP camp, Uganda.

Children, Agoro IDP camp, Uganda.

Feet. Agoro, IDP camp, Uganda.

Boy holding bowl, Potika IDP camp, Uganda.

Girl holding sibling, Potika IDP camp, Uganda.

World Food Programme food distribution. Potika, IDP camp, Uganda.

Showing of HIV/AIDS education video. Potika IDP camp, Uganda.

Girl and little brother. IDP camp, Uganda.

Clinic art in Samburu District: (In Swahili) "AIDS Kills, Use a Condom"

Clinic Art on Samburu Clinic: Training Traditional Birth Attendants (TBAs)

Little Patrick, the nurse who runs the clinic in Samburu district, Kenya.

Women in Saburu district, Kenya selling their handmade crafts. This is where I bought the spear.

My fruit stand guy in Nairobi. You could buy two huge bags of fresh produce for like $4.

Fishermen on the shores of Lake Victoria. This region has the the highest rate of HIV in the Kenya.

Fishing boats off of the shores of Lack Victoria, Kenya.

A boy was having fun watching our soccer match. Kenya.

hmmmmm. Green slime in the making. This was during my cooking lesson in Kenya.

I really wanted to buy baskets from this lady in Nairobi, so I arranged a time and place to meet her after I finished my Kenya class, but she never showed. Alas, I wasn't able to bring any beautiful baskets back with me. At least I got a good picture.

A Home for the Kenyan Spear

Many of you have asked about whether or not I was able to make it home with the Samburu spear. I am happy to report that I was able to bring the spear home and I had no trouble other than a very suspicious customs agent. (The day before my flight back to the US I went all around Nairobi and finally bought a golf bag that would carry the disassembled spear. Therefore I was able to check the spear as well as all of my Tanzanian knives).The spear now sets the tone for viewing classical black and white photography in California.

Right side of the Road, Right side of the Road

Monday morning I was driving to my BLS (CPR) class for Health Care Providers and I found it strange driving on the right side of the road. Every time I made a turn, I wanted to go into the left lane. I kept saying to myself,, "Right side of the road, right side of the road." I have a feeling that readjustment might be more challenging than I anticipated.

As Jesse (who works in Tanzania) said, "I will never complain about paying my taxes in the US ever again." It is ridiculous how nice ever thing is here. Roads with no holes, freeways, safe streets, electricity, high speed internet. It is unbelievable.

My Trip Home: Emotional and Frustrating

I am back home in Washington State! I can't wait to see or talk with all of you. In the meantime, I thought I would share the details of my trip back to Washington.

After sad farewells to friends and classmates in Nairobi, I took a taxi to the airport Friday morning Kenya time or late Thursday night Washington State time. The Nairobi airport is extremely inefficient. I had to wait over an hour to get in the front door. I checked my bags with Ethiopian airlines, got my passport stamped and boarded the flight from Nairobi to Addis. When the beautiful Ethiopian airline attendant came to serve us drinks I instinctively started speaking to her in Swahili. I stopped myself remembering that Ethiopians speak Amharic and realized that my knowledge of East African customs/culture and my ability to speak (very limited) Swahili were now useless. These had been my most prized skills over the last 6 months. I was leaving Africa! I felt like superhero robbed of my special powers. I stared blankly at the stewardess for a couple seconds and then gave my order in English. After getting my ice water, I almost broken into tears on the airplane. I was going to miss Africa so much.

Ethiopian Airlines jet like the one I spent 2 days on. (Photo from Google image search)

In Adis I recovered emotionally and boarded my plane to DC. I walk down the aisle and found a middle aged Ethiopian man sitting in my window seat. I said hi, smiled at him and told him that I thought he was in my seat. He responded by showing me his ticket stub and saying forcefully, "No, seat this mine." His stub was for the seat next to mine and I showed him the diagram on the bulkhead and repeated that I thought I had the window seat. He once again responded with, "No, I sit here" while pointing to the window seat. Even though before leaving I had called my travel agent to ensure that I got a window seat for my flight to DC, I decided to let him have the window seat. As the flight unfolded, it became apparent that the man was a chauvinist in addition to being a rude window-seat stealer. If he wanted to get up to go to the bathroom he would simply turn to me and say in a strong voice, "Move." When the stewardess walked by he would say, "Woman, bring me wine."

We arrived in DC around 9am on Saturday morning. I collected my bags and in customs I was sent to the special agriculture screening area. They checked my shoes and my bags and then I departed across the airport to check into my 12:25 United Airlines flight to Seattle. Once I reached the counter, I was informed that my 12:25 direct flight to Seattle was cancelled and I was put on a 5pm flight. As you can imagine, I was completely thrilled to spend an extra 5 hours in the airport after traveling for 2 days.


At 4:30pm we boarded the flight. At 5pm, our scheduled departure time, the pilot informed us we were going to wait for some luggage from other flights. At 6:30 our plane left the gate and got in line for the runway. At this time the pilot informed us that during the pre-flight check they discovered a problem with the circuit that allows the plane to land in adverse weather. He said that the problem should be fixed in about 30 minutes. Three and half hours later we were still sitting inside the plane and the problem still wasn't fixed. Infants and small children waiting in the still plane began to cry. At 10:00pm they moved us and our luggage to another plane. Once again we sat in the plane at the gate. At 11:30pm we were still sitting at the gate and the pilot came on to inform us that the pilots and flight crew had now been working too long to make the 5 1/2 hour flight to Seattle and the flight had been delayed until tomorrow morning. We disembarked from the plane and began to wait in line for hotel and $5 meal vouchers. I got my vouchers at 1:30am. They still hadn't picked a departure time in the morning so they told us to just be at the airport at 8am and they would tell us then when the flight was leaving. They informed us that we couldn't access our checked bags, where all clothes were located. After waiting outside in the dark at the hotel shuttle pick-up location for over half an hour, I arrived at the Sheraton Hotel at 2:30am. I took a hot shower (which was wonderful) and then stood in a towel while using a bar of facial soap to wash my clothes in the sink. I then dried them with a hairdryer. After 3 and half hours of sleep I returned to the airport and checked in to the flight and discovered it wouldn't be leaving until 12:45. By the time our plane was finally taking off I found myself thinking that I will probably never voluntarily fly on United Airlines again for a very long time. Their customer service, planning, and the attitude of United staff was completely sub-standard and made the 18 +hour delay even less pleasant.

A United Airlines plane flying - something the planes I got on didn't seem to be able to do. (Photo from google image search).

In Seattle, I was waiting for my bags and my longer golf bag (that I got to carry to carry my Samburu spear) required special handling and ended up in the 'odd sized baggage' pile. Dealing with this made me miss my airporter shuttle by only 5 minutes. Score - just what I wanted: To sit in the airport for another 2 hours waiting for the next airport shuttle going north towards Stanwood.

Once I was in Stanwood, I was so happy. I got to see my family again! A long trip, but it is great to see everyone again.

I Saw Lions!

The last two days of the Kenya course we went to the Mara National Park. It was pretty fun even though our car broke down in the middle of the park and we sat outside in the grass with the wild animals for an hour or two. The highlight of the trip for me was when we saw lions. In Tanzania we went on a game drive/safari in Mikumi National Park and we saw lots of animals, however, we never saw a lion. In the Mara National Park we saw several lions and I thought I would share some of the pictures with you'll:

Here was the larger male lion we saw. It was amazing to be only 8 or 9 meters away from such a spectacular animal. You can see from the background that the Mara is a much drier place than the Mikumi Park.

This is the female lion we found. She was sleeping under a bush and only sat up with the car pulled up close to her.

This was our CRAZY guide. He was so animated. He didn't stop moving and talking wildly the whole time. I nicknamed him "Rafiki" after the crazy and energetic monkey in the Lion King movie. Despite his slightly irritating personality, he knew the area well and was very good at spotting animals.

My New Secret Talent: The Ability to Cook a Really Good Pot of Green Slime

During the Kenya Course we stayed for almost 1 week in Kakichuma. A mid-sized village in Bungoma District. There we learned how rural households are responding to the HIV epidemic. Many households that have people living with HIV or AIDS, orphans, or widows are using kitchen gardens and indigenous crops as a way to improve their nutritional status. We met with countless HIV support groups and saw their creative gardening techniques. Some people are growing soy beans and peanuts to improve their protein intake. Others are growing the new Vitamin A enriched sweet potato to improve their immune system. Many gardens are re-introducing indigenous greens such as sun hemp, spider plant, and other crops that I don't remember how to spell.

Christine, the leader of a widows support group in Kakichuma. She had a REALLY nice kitchen garden. 3 acres of well weeded, healthy maize, soya, groundnuts, sweet potatoes, carrots, beans, cabbage, and a indigenous greens.

All this was fun, but the highlight of the week really came when we got a cooking lesson with all these Bukusu (the tribe in the area) grandmas. They taught us how to cook the traditional "greens." I was pretty fun. This is how you do it:

1) Pick off the leaves from the sun hemp, pumpkin, spider plant, or other weed-looking leafy vegetable.

2) Wash the leaves several times in unfiltered dirty well water.

3) Add one cup of ash water (literally water that as been soaking in a pail with ash from a camp fire and then strained).

4) Cook on an out-door coal "stove" of 10-15 minutes. Apparently the ash water reduces the cooking time.

5) Add a small amount of cream and some milk. Only about 2 cups of milk per large basket of leaves.

6) Let the mixture simmer for a few more minutes.

7) Serve hot or cold with Ugali.

Green slime goodness. They taste even better than they look. I think the ash water really helps.


To be honest, I really hesitated about posting this blog entry. Why? The reason is simple. I don't want to have to fend off all the American men who are going to want to date me just because I know how to cook green slime. Really, isn't that just so shallow?

(I have very good source of information that green slime-cooking ability is a very attractive item for men. A Bukusu grandmother who was teaching me how to cook, told me that I would get a husband "very fast" now that I knew how to cook traditional greens).

YIKES! My Fall Medical School Class Schedule!

One of the first things I did when I returned to internet access was log into the "MyUW" webpage to see if there was any important med school related information I needed to take care of before flying back to the States. A truly terrifying sight greeted my eyes: My class schedule for fall quarter. It was such traumatic experience that I wanted to share it with you all. My schedule is 31 quarter credits. The classes I will be taking are are:

1) HUBIO 510 Microscopic Anatomy: Histology (6 credits)
"Lectures and laboratories in microscopic anatomy designed to provide the principles and concepts of histology, to define the morphological characteristics of the cells, tissues, and organs of the human body, and to relate this information to functional processes studied in concurrent and subsequent courses."

2) HUBIO 511 Gross Anatomy and Embryology (13 credits)
"Structural organization of human body at the macroscopic level to provide a foundation for physical examination and functional assessment of the human organism. Integrates embryological development with study of the cadaver and examination of the normal living body. Concentrates on exploration of the body cavities and the viscera they contain."

3) HUBIO 513 P-Introduction to Clinical Medicine (3 credits)
"Instruction in communication skills and interview techniques to form the basis for the doctor-patient relationship and for the skills of communicating with patients. The patient profile is obtained. Attention to developing comfort in the physician role."

4) HUBIO 514 Biochemistry (4 credits)
"Classical molecular and cellular biochemistry, cellular physiology and molecular genetics. Metabolic interrelationships as they occur in the individual stressed and related to disturbances in disease states."

5) HUBIO 516 Systems of Human Behavior (3 credits)
"Effects of behavioral factors in major management problems faced in medical practice relating to cultural background, social role, sexual identity, and belief systems. Acquisition of skills in analyzing behavior, defining objectives, and designing precise treatment strategies."

6) MED 530 AIDS: A Multidisciplinary Approach (2 credits)
"Comprehensive overview of the public health, clinical, and laboratory aspects of human immunodeficiency virus (HIV) infection and disease. Topics include the pathogenesis, natural history, and management of (HIV) infections. The impact of HIV/AIDS on community and global health care and prospects for prevention and control."
(This is an elective)


I guess I won't have much of a life starting August 27th. I hope I can catch up with everyone and chat before then! :)

Wanted: Advice from My Blog Readers, "How to Get a 7 Foot Spear Through Airline Security"

I leave for the United States in approximately 30 hours. I am trying to pack and I have run into a couple difficulties. The most prominent packing issue so far has been a 7 foot spear I bought from a Samburu warrior. These spears are used by the men to protect their livestock from lions and other animals. They are also used in traditional dances and hunting before the rite of passage into manhood. Anyway, the spears are pretty cool. One warrior really wanted to sell me his spear in Samburu district and I bought it for 1,300 shillings (about $20 US). The spear disassembles into three pieces and I thought that the pieces would fit in my suitcase. (Over-estimating the size of my suitcase seems to be a consistent issue I have during African shopping expeditions. In Malawi I bought a goat-skin shield that also wouldn't fit in my suitcase). Anyway, my current idea is to try to carry on the spear onto the airplane. Maybe the security guards will think that it is a touristy spear that isn't even sharp. What do you think? (Even though the 6 inch blade that the tip of the spear is sharp it has to have a leather cover to prevent it from cutting other items unintentionally). Any ideas?

Warriors in Samburu dancing with their spears.

One part of the dance is a competition to see who can jump the highest.

My suitcase and the spear pieces that won't fit. hmmmmm. Oh, I forgot to mention that I also have a drum that is too big (in diameter) for my suitcase. What was I thinking?

Here is a picture of me with the tip of my very cool, but hard to transport spear. It is hard to see from this picture, but it is very sharp.

I Passed My Language Proficiency Exam!

To graduate with a Master's in Public Health in International Health and Development, all students are required to demonstrate level 2 proficiency in some language other than English. This may not seem like a very difficult task for most of my educated multi-lingual blog-readers out there, but this was the MPH requirement that had me most worried. The language proficiency required is:

"Level S-2: Limited Working Proficiency (Base Level) Able to satisfy routine social demands and limited work requirements. Can handle routine work-related interactions that are limited in scope. In more complex and sophisticated work-related tasks, language usage generally disturbs the native speaker. Can handle with confidence, but not with facility, most normal, high-frequency social conversational situations, including extensive, but casual conversations about current events, as well as work, family, and autobiographical information. The S-2 can get the gist of most everyday conversations but has some difficulty understanding native speakers in situations that require specialized or sophisticated knowledge. The S-2's utterances are minimally cohesive. Linguistic structure is usually not very elaborate and not thoroughly controlled; errors are frequent. Vocabulary use is appropriate for high-frequency utterances, but unusual or imprecise elsewhere."

Since I want to work in East Africa in the future, I decided that Swahili would be a useful language to know. I hoped that the 2 months of Swahili language school in Tanzania would be sufficient for the language exam. However, after the course was over I felt that I didn't have enough practice with the language to take the proficiency exam. In Northern Uganda very few people spoke Swahili as it was an Acholi/Luo area and therefore I forgot a large part of my Swahili. Therefore when I arrived in Kenya my first priority was to review and practice Swahili as much as possible. I would review my books for 2-3 hours a day and then practice speaking with the Kenyan cook or try to go shopping and speak in Swahili by myself. I was making good progress, but still nowhere near proficient. On the first day of the Kenya course I approached the instructor, who speaks excellent Swahili and can give the proficiency exam in Swahili to Tulane students, and asked her if I could make an appointment to take the proficiency exam the day after the course ended. Secretly, I was worried that my Swahili skills were going to deteriorate during the class because I would be surrounded by English speaking students.

The course ended up being really helpful for my Swahili skills because I acted as the informal translator for the other students. They would go to market or try to bargain for something and use me to tell them the general price range they should be shooting for and to translate into Swahili. I also practiced with the cook and other Swahili-speaking support staff during our course.

In Kakichuma village the whole class had a cooking lesson (translated into English) with a group of Bukusu grandmothers where we all learned how to cook one type of green slime. The next day another group of grandmothers unexpectedly came to give us another cooking lesson. Our professor said that the women were invited by accident and they had already brought all the materials needed for the lesson and she asked for a volunteer to learn how to cook other traditional dishes. The afternoon was supposed to be for working on our assignment, but I had already completed mine so I volunteered to learn how to cook from the women. There was no translator and the women only spoke Bukusu and Swahili, so we obviously spent the afternoon speaking Swahili since I don't know any Bukusu. The conversation was mostly, "now put this in", "now stir", "now cover the pot", "we use milk from a cow because oil is too expensive," "wow, there is a lot of smoke" (coming from the wood fire under the ugali pot), but it also we talked about how many children they had, whether or not they were the only wife, if their husbands were still living, how they grew the veggies, what they thought about the second president who was corrupt, etc. Our Tulane professor dropped by a couple of times to see how things were going and seemed to be pleased.

After the cooking lesson, I was sitting with the grandmothers eating the result of our cooking lesson: 3 different types of green slime with white ugali. I was covered in sweat, ash, smelled like smoke, and was still trying to maintain the animated Swahili conversation with the energetic grandmothers. My professor came by and asked me how it went. I told her that it went really well and jokingly told her this interesting cultural experience should count for my language proficiency exam. To my surprise she said, "I agree, I have been watching you and your level of language ability is more than we demand for the language proficiency certification. Congratulations! You pass!" I was, of course, very pleased and went off to sing and dance with my new Bukusu grandmother friends. This means I can graduate with my MPH in August!



Me with one of my Swahili proficiency examiners and cooking instructors.

List of things needed for my MPH Degree:

1) 45 graduate level public health semester credits. check (the Kenya course brought me up to 46).


2) A 'capstone' experience. check (The HIV/AIDS prevention working the IDP camps counts as my capstone. The resulting paper is being currently being finalized).


3) Proficiency in a language other than English. check (Thanks to language school in Tanzania and practice in Kenya, I was able to attain language proficiency in Swahili).





Other benefits/highlights of the trip:


1) I got to spend more time in Africa! Now I have spent 2 months in Malawi, 2 months in Tanzania, 2 months in Uganda and 2 months in Kenya.

2) I got to do something very different and exciting before the rigors of medical school. Med students kept telling me that I should do something really fun before starting med school medical. I got to spend 6 months in Africa!

3) I gained hands-on work experience in public health and medicine in Africa. Specifically learning how to educate people about HIV/AIDS prevention and treatment.

4) I made connections for work/volunteer in East Africa in the future. It turns out that a medical doctor who has a MPH in International Health and Development, who knows some Swahili and has 8 months of experience in Africa is quite employable in East Africa. Almost every place I stayed at was like, "After you become a doctor come back and work/volunteer with us!"

5) I got darn good at using a pit latrine. A skill set that most Americans are sorely lacking in.

6) Don't forget, I learned how to cook green slime!