Time flies. I have less than two weeks left before finishing up my time here in Sagam. This is my last scheduled trip here. I'll have several months left of the fellowship, but those will all be spent in the US. I haven't been blogging much, and I'm not sure why not. Sure, we've been busy at the hospital, and internet or electricity are often out. And there is no lack of interesting material to write about. But I just haven't been putting my thoughts down, and I'll probably regret that eventually. Overall, things are going well here. We have a full house of volunteers currently: Sanjat, hilarious med-peds resident in New York, Shannon, an ob-gyn resident in Boston, Svjetlana our ob-gyn fellow, Paula, our internal medicine fellow, Brianna, our nurse fellow, Rachel, our logistician extraordinaire and Rashmi, visiting doc from Nepal. It's a good group. Tonight there is good energy at the house as we cook up an eggplant pasta with focaccia bread and look at all the goodies that Svjetlana brought us from Olympia (flax seed, chocolate, coffee and the like). After a week on the Sagam Hospital wards (where I took this shot of the praising praying mantis), I had a little time to breathe and stretch, which was good for the soul. A chance to strum the guitar and sing badly, to go for a run, and eat some great South Indian food at Gopala's Veg Restaurant. I start my last week on the wards tomorrow. I'll see the patients with the clinical officer, and we'll do our best to make the right diagnoses and get the patients on the right treatments. No matter how long I work in Kenya and countries like it, I think I will always struggle with the challenge of seeing patients with conditions that we could treat in the US but cannot here. Sure, come in with malaria, pneumonia, or diarrhea, we can probably help you out. We're even slowly getting better at treating chronic diseases like diabetes, hypertension, and mild heart failure (though we don't do that great of a job in the US, some would argue). But come in with an advanced neurological condition, a surgical need that requires anything but a general surgeon, an advanced heart condition, or an eye problem other than a cataract, to name a few conditions, and you're probably out of luck. If you have wheels and cash, you can get to Nairobi and to the sparkling, towering Aga Khan University hospital. And even if you have medical insurance, this really only takes you so far, as it covers a daily inpatient bed fee, but doesn't cover surgeries, outpatient visits, costly medications or labs, etc. Granted, access to care here is a lot better than in most other countries in sub-Saharan Africa I've worked. And the medical infrastructure seems to slowly be moving in the right direction. I'm thankful for what we have. It's still just tough. Two weeks left. I'll try to keep the updates coming as things wind up.