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First day at Kenyatta National Hospital. The smell is sour and distinct. The building is a dull gray and the lights are dim. The patients are desperate. The day was spent in the pediatrics department that consists of four separate wards. Mercy has suggested we spend most of our time here because it is the most organized of all the departments. That is, as organized as could be while maintaining nearly double the capacity of beds and operating completely on a system of paper records and steno pads.

And then there's Isaac. Isaac is one of about 25 children housed in the pediatric oncology ward where we spent some time entertaining. He is about 4 years old and hops around on his remaining leg. I spoon fed him some saucy mystery meat and rice and then he fell asleep in my lap. He stood out in the room because of an unusually kind smile but the reality is that each child shares a similar story. Heartbreaking.

Day two brought a little more comfort but no fewer challenges. I spent the morning in ward rounds in another pediatric unit including the acute cases. The overcrowding was no less than Mercy had described. The mothers are living in the hospital right along side the children. In one case, there were two adjacent beds that housed mothers-to-be, in addition to their already severely ill children. And I literally mean “housed”. These families are living here. The cart comes along in the morning with some sort of slop and a piece of bread. And it is carefully rationed. It's too bad the little girl in the hallway barfed all of hers up because she won't be getting more. And then there was the puke trail that made it's way into each of the units because nobody even noticed that the little girl lost her breakfast. I should have been disgusted but I laughed really hard. I hope that's not insensitive. Coping, I guess.

Dami and I were together for the day and in hindsight, thank goodness. We were standing in the back of a group of students while a festering IV port had to be removed. The child was screaming and writhing, making the process much worse as the needle tore through his skin. I looked at Dami and she was clearly upset but said she'd be fine. I was doing pretty well, just shivering a bit because they keep all of the windows open. I suppose the alternative is to have TB floating around in confined areas. At least now it floats around, then floats out the window. I hope I don't get caught in the crossfire. Anyway, I was cold and I looked to Dami and sweat was beading down her face. She left the room and I later found her in the staff room. A short pep talk was all she needed and we were back at it.

The afternoon was spent in the lecture hall with the medical students for “grand rounds”. That includes a presentation about work related stress (ha. Really? You're telling them now?) and a lecture on a case of tumor lysis sydrome. Thanks to a biology class and a minimal histology/pathology background, it made a surprising amount of sense.

And now I'm exhausted. Since I arrived in Nairobi and as of today, I hadn't spoken to my mother. We connected for only a few seconds before my cell phone time ran out. Shoot. Most know by now that she was diagnosed with breast cancer just weeks ago. She goes in for surgery the day after tomorrow and I think about her constantly. I would brave all the TB, malaria, and meningitis in Kenyatta to make sure she's ok. Miss you mom.