It's official: I'm going on SAFARI!

I'm so excited to leave at the crack of dawn tomorrow with my fellow med students and pharmacy friends to head to the Masai Mara for Safari!

http://www.game-reserve.com/kenya_masai-mara.html

We will be going on an afternoon ride Friday evening, followed by an all-day Saturday tour, and one final Sunday morning drive. In between our rides, we'll be staying at Fig Tree Camp:

http://www.madahotels.com/figtree/index.php

I'll post my pics (and video if internet allows) ASAP upon my return :)

Transportation around Kenya

I've been wanting to post this on my blog for a while, but needed the pictures to supplement! (I will be adding them in as I can capture them with my camera!) The ways people find to get around never cease to amaze me, and in Kenya, where resources are so low, people have been especially creative (and brave!) with their transportation.

Let's start with walking. Have a load to carry, why not put it on your head and walk gracefully through crowds? I tried this down the hallway at the hostel, and it didn't go well . . .

If you're lucky to still be a kiddo, your mom might snuggle you close to her back and carry you around with her.

Now we've come to the many splendored activity of bicycling. You can ride by yourself, with a lady sitting sideways on your back cushion, 3-deep, or carrying wood, generators, hundred-pound bags of feed, whatever you fancy!

Add a motor to your two-wheeled friend and you've got an even speedier, and more dangerous, mode of transport. The scariest thing I've seen is a man driving a motorcycle with a lady holding on behind him and a toddler smushed in between them on the seat - all with no helmets! (I'm not sure how they got this motorcycle on top of the bus!)

I'm not sure what they call this next step up from a motorbike, a motor-trike? These things are mostly out in the country, and they get pretty good speed on those dirt roads.

Now we're getting to the boring but necessary for completeness simple automobiles. You can drive one of these if you are lucky enough to own one, or just decide to drive others around as a taxi. The names of cars over here are great, the Toyota "Corona" is my personal fave.

Finally we come to the Kenyan classic, matatu's. These are in-between a taxi and a greyhound. They are personally-owned small vans that seat anywhere from 1-30 passengers (11 actual seats) and have great names like, " " or " ". Some are tricked out with neon flashing lights and decals, while others keep it simple. We are not allowed to ride matatus by rule from IU because their drivers are notoriously awful, but some students have snuck onto a few here and there. The rule is, it isn't a matatu ride if (1) there isn't at least one chicken in one person's lap and (2) there aren't at least 15 people squeezed into 10 seats. Bonus if you're on the matatu so full that the extra passengers hang on with the sliding door open (see above picture closely).

Emerging Trends for Reproductive Health in Africa Student Conference

Please excuse this non-chronologically correct journal entry: in my haste to publish my giraffe pictures, I forgot to first to talk about my activities earlier in the week! The Moi University School of Medicine students hosted and planned a wonderful conference titled, "Emerging Trends for Reproductive Health in Africa" and invited students from Kenya and beyond to attend.

The event began with a grand opening ceremony on Wednesday night, which I attended and enjoyed. All of the keynote speakers gave a small, welcoming speech and the students also participated through song, poetry, and dance before the eating and dancing began! I greatly enjoy the Kenyan tradition of opening an event with a dance (see video), and found I really like East African band music, too.

I even got to hang out with my new Kenyan friend, Leon, who is close acquaintances with the chair of the ENT department at Indiana University, Dr. Miyamoto. Leon was sponsored by an American family to come to IU to see Dr. Miyamoto to receive cochlear implants a few years ago.

The conference consisted of many great discussions and presentations, all related to reproductive health issues facing the continent, especially Kenyans. I wish I wouldn't have gotten sick during the middle of it, as I found the sessions I did attend very interesting and informative. Congrats go out to all of my Kenyan medical student friends who worked so hard orchestrating the entire event - well done!

Kruger Farms

So last week was a pretty low-key week for me, since I was knocked-down from Wednesday until Saturday with a nasty-bout of gastroenteritis/flu symptoms that I was told is inevitable when coming to Kenya. Thank goodness my turn is over with!

On Saturday, I was feeling MUCH better and decided to re-enter the world with a trip to Kruger farms with my good friends, the Purdue pharmacy bunch and my new medical school peers, Abe, Kaitlin, and Chris. The farm is an 8,000 acre piece of land in the Rift Valley province of Kenya, which is absolutely stunning as we found out! The farm is owned and operated by white Kenyans (which I didn't know existed) - the current owners were 3rd generation farmers of this land. Adopted giraffes have 1,000 of those 8,000 dedicated to them, and they are left free to wander and graze with occasional curious tourists like ourselves visiting for a peek at them :) We also caught some glimpses of a couple oryx's (small antelope/deer-like animals) as they sprinted away from us. Supposedly this farm has the largest single population of oryx's in the world, but I don't know how anyone figured that out since they move so fast and are so frightened by humans getting anywhere in visual range of them.

We first hiked up a very large hill to gain an awesome vantage point over the entire farm and much more! From our eagle-eyed view we could spot the giraffes in a field below grazing next to cows - that's right, regular old dairy cows! Just another realization that though this scene of agriculture could possibly come from somewhere in the Midwest, the addition of a giraffe or two reminds you you're not in Indiana anymore :)

After enjoying the fruit of our labor by cooling off and taking pictures in the breeze at the top of the hill, we began our descent down towards the giraffes. In no time, we were walking up the dirt trail towards these graceful and gentle animals, that simply stared at us as we approached. I really wish I could know what they were thinking as our group of students stood there staring at those giraffes staring right back at us! No sooner had we finished our photos with the group of giraffes we'd spotted from the hill did we spot a few extra giraffes behind us, peeking from between the trees to see who was making all of that noise (can you see the giraffe in this picture?)

After this lovely hike on such a beautiful African day, we began our journey back to the car to Eldoret. This was perfect for me, because in this short afternoon I'd moved more than I had in the last 3 days prior!

Orphans and Vulnerable Children Program

One of my most rewarding days here in Kenya presented itself through an opportunity to go into the field with Elizabeth Chester, the case manager for the Orphans and Vulnerable Children (OVC)Program last Friday (August 28th). **Note: I did not take any photos of this trip, because this was the most personal of the experiences I had in Kenya, where I was being allowed to enter the private homes of these families. Thus, I did not want to ostricize them by snapping pictures of their poverty.


The program began as a branch of AMPATH, for many children were being orphaned by parents who died from AIDS-related illnesses. The program does not, as the name seems to indicate, involve any orphanages, rather they strive to keep children with extended family in their communities. The OVC case workers at each of the 5 AMPATH outreach centers are closely in-tune with their district, and hear if children have been abandoned, orphaned, or are living in poor conditions. They investigate these claims and also regularly visit their juvenile clients and their caretakers at home to check-in.


I accompanied two case workers, Susan and Edna, along with Elizabeth to Mosoriot, an area about 30 minutes drive from Eldoret. We drove and hiked around the district all morning, on muddy roads, through fields, past grazing cattle and smoldering pits of wood being made into charcoal to the places these children live.


Most of the time, we would find two small buildings would comprise the homestead. One mud-walled, thatched roof hut was the kitchen, with a home-made clay stove in one corner. A shelf above that side of the room housed firewood, kept off the ground to remain dry and burnable. Often, Elizabeth told me, the woman (or women) of the household would sleep in this smoke-scented room because they would then be the closest to the area they worked the most in. Indeed, most of the stops we made had small blanket bundles in one corner which the female used for her bed.

The next building just normally a few feet away from the kitchen was the home, and most of these mud-walled, thatched- or metal-roofed buildings had 2 rooms. One room would either have a wood-framed bed with a mattress, if the family was better off, or simply blankets piled on the floor with or without a mosquito net. The other room would either have another bed, or would have chairs and serve as what we would call a family room. Elizabeth told me at the beginning of the trip to look for cushions on any chairs we might see at the houses - for whatever reason, she said, they indicate that the family is doing well. Other signs that the family is more financially stable include having a "store" on their property, which is a building raised off of the ground on stilts that houses grains or whatever the family harvests from crops. The bigger the "store" the more productive or large the family's crop. Also, if the family has any livestock, like chickens, goats, cattle, or sheep, this is also a sign that they at least have some capital.

Besides checking out the living conditions of the children, and reminding the families to use their mosquito netting appropriately and encourage them to have beds off of the dirt floor, we would talk to them about the current family members in the household. How many children were there in addition to the OVC clients? Who slept where? Who did what around the house/farm? How did they make their income? How much land did they own? We would check all of these things, Elizabeth said, because the program is designed to help the families help themselves. Their goal is to start the family off with the right tools, whether that be the skills to make crafts, fertilizer and seeds to cultivate crops on unused land, etc, so that the families do not become dependent on outside help and can survive on their own. I was really impressed with the OVC's approach to assisting these families, and their system seemed to be very effective. I was able to visit homes that were just having their initial consultation and also those that were works-in-progress and successes.

Besides the above support I mentioned, OVC clients are provided with school uniforms and have their school fees paid, but are required to show their report cards to the case workers to prove they have been achieving in school, and if not, to try and determine why the child is struggling. The last resort for OVC clients is admission to an orphanage, which in some circumstances, Elizabeth admitted, is the best option for some children. She works closely with many orphanages in the area to find the best place for each child.

I found myself feeling so sad for these children, living in such primitive conditions. Most of them were pretty dirty, in clothing that was either too large or too small and very well-worn. Most of the younger ones ran around bare-bottomed, I believe because diapers are impossibly expensive and they would soil whatever bottoms they might have, and had crusty noses. But they were all so happy and so interested in seeing a white person! They would run after our car as we would pull near the home and follow us around everywhere we went, bashfully peaking around trees and corners to get a good look at us. Once they'd given us a good once over, they would proudly come up and stick out there hand to shake ours. I couldn't figure out why, after shaking my hand, all the kids would look at their palms and then back at mine. "They're trying to see if your white rubs off on them, " she told me, and then she gestured to them by rubbing her hand in front of them, " See, it doesn't come off!" We both laughed.

I had brought a bag of candy with me, and handed out a piece to each child and adult, which they devoured instantly. I hoped in a small way I'd made their day a bit better, because seeing how happy they were despite such poverty certainly made me feel less sad.

After visiting 5 homes in the morning (a small number it may seem, but all of the off-roading and hiking we had to do to get to each home really added up on the minutes!), we headed back to Eldoret. I felt like I had finally seen the real Kenya, where my indigent patients on the wards at MTRH come from and why it may take them so long to present to the hospital.

Lamu

Ah, where to start with my extended weekend in Lamu, Kenya!

We arrived by airplane on last Saturday afternoon, landing on a dirt runway at the Manda Island airport which lies right across a small body of portion of the Indian Ocean from Lamu. The airport was my favorite yet – a thatched roof over a concrete slab with plastic lounge chairs composed the terminal and check-in station and stray cats freely roamed the area. We hopped on a dhow boat, a traditional wooden sailboat, and sailed across to Lamu town of the archipelago islands.

The city was so unique and thus I will do my best to describe it through words and some pictures. The Lonely Planet guide book states that Lamu town is “the core of everything the archipelago stands for in the hearts and minds of inhabitants and visitors alike, a living throwback to the Swahili culture that once dominated the entire Indian Ocean coast.” Arab settlers created a bustling trading post on Lamu island early in the 16th century, exporting ivory, mangrove poles, tortoiseshell and thousands of African slaves. Though initially regarded as a minor player in the East African power game, after a victory over the competing traders of Pate island in the 19th century, Lamu town became a prominent force and splendidly wealthy off of ivory and slavery trading. Most of the beautiful Swahili homes around today were built during this prosperous time, which ended in 1873 when the British forced Sultan Barghash of Zanzibar to close down the slave markets. Since then, the economy of the island went into rapid decline and the town was forgotten until rediscovered by travelers in the 1970’s. “Lamu existed in a state of humble obscurity, escaping the runaway development that happened elsewhere on the coast,” says Lonely Planet. Thus the town I visited remained true to its architectural heritage and culture, a characteristic recognized in 2001 when Lamu town was named to Unesco’s list of World Heritage sites.

The town itself is very compact, with the white stone and coral buildings stacked one on top of another with narrow walkways winding throughout. Many of the buildings had ornately carved wooden doors that were spectacular! Instead of dodging cars like I was used to in Eldoret (no cars are allowed on Lamu) I found myself dodging piles of donkey poo, since these animals are the primary mode of transport. Marissa and I agreed that Lamu town reminded us of Venice, the way the streets meander in and out between the buildings, minus the canals. We wound our way through the city to our lovely hotel, Jannat House and climbed our way to our top floor, thatched roof, open air room. The only downside to the room, was the loudspeaker from the mosque next door aimed right at us – we noticed this at sundown, when the muslim chanting was broadcast loudly to call people to mosque for the evening. The day we arrived was the beginning of Ramadan, which meant finding lunch during the daytime fasting period would be a challenge!

We luckily were able to find food each day, and were by no means scraping by. I enjoyed some of the best tasting juice smoothies and seafood I’ve ever had, for extremely reasonable prices! Besides the food and beautiful culture of the town, my favorite parts of the trip were (1) the beach, and (2) our dhow boat day trip.

We walked to Shela (pronounced Shey-la) beach, which is a 40 minute walk from Lamu town on our first full day, and found an almost deserted, undeveloped horizon of sand and water awaiting us! The sun was strong, but a lovely constant breeze kept us surprisingly cool. The sand was white and soft, and soaked with enough moisture from the earlier high tide that it didn’t get picked up by the breeze to fly in our faces. We ventured into the ocean, which was the temperature of bathwater and clear, and swam out to sandbars close by for another awesome perspective of the island.

The next day we were again drawn to the ocean, but this time took a dhow boat ride to the eastern shore of Manda island to the site of an old Swahili town ruins. Our ship was powered by wind only via its lone sail, which made for a peaceful and relaxed trip on the water. We took a pit-stop to wet our whistles at the floating bar, and continued on our way. The town ruins were very interesting, thanks to the tour given by our dhow boat captain, and the icing on the cake was climbing to the top of the hill overlooking the Indian Ocean on the east coast of Manda island at sunset. Our ride back to Lamu found us under a blanket of stars so bright and infinite that we all were pinching ourselves to make sure we weren’t dreaming!

The rest of our time we spent meandering through the town, visiting with the locals, shopping (and for Ryan, bartering his headlight for some jewelry with the town’s silversmith). I never would have known of the existence of such a unique town had it not been for my adventurous peers who departed back to the States after this trip, leaving me to hold down the hostel until the next batch of students get here next week. I miss them, but can’t wait to catch up when I’m back in Indy in October :)

**I will be adding additional videos on my youtube channel (username: doubleevers) as soon as the internet speeds up a bit to allow me to!

Weekend #3: Get-away to Lamu

I'm very excited to be going with the other med students on their last trip (sniff, sniff) before they depart back to the US. We are headed to Lamu, Kenya, which is supposed to be a very interesting and beautiful place (http://www.go2africa.com/kenya/lamu-island)!

Can't wait to blog about it when I get back next Wednesday!

The Wards

My routine during the week consists of morning rounds at Moi Teaching and Referral Hospital (MTRH) that usually start around 9am. Tuesdays and Thursdays we have 8am morning report, where students and staff will give presentations of interesting patients or topics commonly seen on the ward. I’ve been grateful for being able to sleep in until 6am or so, when Kim & I go on a 35-45 minute run just as the sun is rising. It’s peaceful in the mornings, compared to midday when people, bicycles, and cars hurry around the hostel and hospital across the street. Plus, the morning air isn’t filled with diesel fuel fumes from all the cars and matatus (or buses), which are quite noxious.
When walking from the hostel to the hospital in the morning, I usually pass by relatives of patients on benches outside the hospital gates waiting for one o’clock in the afternoon when visitors are allowed into the wards. I next walk past workers diligently mopping the outdoor stone hallways, which sometimes look cleaner than the ward floors themselves. The hospital consists of a number of small buildings, with covered walkways connecting them and beautifully landscaped grounds in between that starkly contrast the dark, decaying building interiors.

As I enter the main building housing the men’s, women’s, and pediatric medicine wards, I take a deep breath and prepare myself for my next few breaths of the hospital air. I’ve talked to other students about how to describe the smell of the wards, and the most consistent response is that it is a mixture of bleach, urine, human body odor, and musty old shoes. The first few days I had to suppress my gag response upon entering the unit, and was advised by our medical director to keep a low-threshold for stepping out should I feel faint. The hospital scent is now expected and I’ve adapted, now only occasionally being caught off guard by especially foul odors, like when an elderly patient with a purulent pleural effusion pulled out his chest tube, filling the wards with a smell of decay.
The patient’s records are all kept on paper, and often my morning is spent rummaging around the nurses’ station or wards to find the charts. The patients keep their X-ray films and CT scan films at their bedside – there are no computers at the hospital at all to read radiology scans or enter in orders or prescriptions. Treatment sheets are present for every cube of beds, and it isn’t uncommon for a patient’s medication schedule to be missing, thus leaving us to guess what medicine’s he has been receiving! Our pharmacy students do a wonderful job of working with the available stock of drugs, advising the team on what medicines are on hand from day to day to treat patients with, as supplies commonly run low. We have to ration a lot of our resources, like the oxygen tanks for example. The men’s ward, which houses anywhere from 50-150 patients, has only 2 oxygen tanks that are available for patient use! ICU-level patients in the US often sit on room air on the medicine wards here, and we’ve had patients die during our rounds in the morning. One patient, with an intracranial mass of unknown origin with subsequent hydrocephalus, herniated and died two days ago, because the neurosurgeons procrastinated coming to see him for 1 week. My intern told me this isn’t common for many surgery-related consultations, because the surgeon’s don’t get paid as much for treating these patients and also know they will be more ill, and more work, than patients in the private world. To me, this goes against the Hippocratic Oath let alone respect for human life, and has been one of the most bothersome realities of this experience for me.

My frank comments about these hospital conditions are made to illustrate the difference between our standards in all hospitals in the US. Though Wishard County Hospital in Indianapolis might not have the flat-screened televisions or posh interior design of Clarian West Hospital, it at least meets basic sanitary requirements and standards to keep patients and staff safe. If there is one good thing about living in such a litigious society, it is that physicians adhere to their Hippocratic Oath and are monitored for malpractice to ensure that patients are not harmed or killed because of physician negligence. A dichotomy most definitely exists here between the public and private wings of Moi Hospital. The private hospital wing across the street allows neither students nor residents rotate there, and is where Kenyans who can afford care turn for medical attention. I asked a sixth-year medical student on my team, Philip, what he thought about health care in his country, and he told me he is a supporter of basic coverage for his people. Within the last few years, some legislators have proposed different plans for health care coverage, but the plans were shot down quickly. The government officials get paid an extremely large salary by Kenyan standards: the Prime Minister gets paid $450,000 a year compared to the average income of $100 per year for an average subsistence farmer in Kenya. Philip said the officials are very far removed from the common people, and have no concerns about health care, since they are able to pay for their health care services without issue. Though the US has its own health care issues, I cannot help but be thankful for our standards of care and the faith I have in my physicians.

Nile River Explorers Rafting Adventure

I'm safely home in the hostel now, after a wonderful weekend of white water rafting on the Nile River with my new Purdue pharmacy friends.

Our journey took us to Jinja, Uganda, which is the source of the Nile River. On the drive from Eldoret to Jinja, we noticed that Uganda was much more green and tropical than our area of Kenya, and was more of the African environment we had envisioned prior to arriving in Eldoret.

The drive took about 6 hours because of poor roads and your occasional baboon crossing the street, but we finally arrived at our campsite to rest up for our big day Saturday.

We awoke to find that our campsite overlooked the Nile, which we could hear but not see in the dark of the night before. It was absolutely stunning! Below the area pictured here were showers that were open on one side facing the Nile River, so you could shower while looking out at the beautiful landscape.

We hopped on a truck with open-seating and began our trip down to the river. There we met our rafting guide, Paolo Bala, who is actually training for the world-championship of kayaking to be held in Switzerland later this month! He was an awesome guide, and we made it down all 12 rapids without flipping the boat (even though I secretly wanted to)!

Our tour of the Nile included 12 rapids, several of which were class 5 rapids. (For rafting pictures, check out the company's website (www.raftafrica.com/gallery.htm) We went through 8 in the morning, and 4 in the afternoon, with a lazy river break in the middle where we got to jump into the river and let the current take us downstream. We had lunch on the boat, which consisted of fresh pineapple and glucose biscuits (yes, that is the name of the shortbread-like cookies) and was a well-earned treat.

The Nile was surprisingly clean and very warm - it felt like bath water! Our day had started out sunny but become overcast with scattered sprinkles, so jumping into the river was actually warmer than being on the raft. In between rapids, we saw groups of people bathing in the river, women washing laundry, and others fishing. Luckily, we didn't see any crocodiles or hippos, which our guide says are rarely present in the calmer waters.

On the ride home, we drove through fields with small mud huts lining our path. Children ran down to the truck to yell "Mzungu!" and "Jambo!" and tried to get us to wave. They thought it especially exciting if we gave them the thumbs up sign, while some stood wide-eyed and pointed at us, for seeing white people was scary to them. Being from America, seeing so many different races from an early age, it is hard to comprehend that these children found our appearance so foreign and frightening!

Once we returned to the campsite, a spread of food and beer was laid out for us, and we ate, danced and celebrated our victory over the Nile. Later on in the evening, we were able to screen the video highlights of our rafting adventure (which I later bought a copy of because it was so well done)! I'll try to post it when I get back in the states with faster internet :)

We slept in the next morning, did some shopping at the small stands around the camp, and left beautiful Uganda and The Nile River with fond memories!

Weekend #2: White Water Rafting on the Nile River in Uganda

Ok, this is a short post, but I promise I'll have much more time Sunday/Monday to fill you in on this week's and weekend's adventure.

I'm getting ready to hop in a van with 6 Pharmacy students from Purdue to head across the Western border of Kenya into Uganda to go white water rafting on the Nile River! I'm a excited (and a little scared) but my med student and resident friends all highly recommend it :) The company we are using for the adventure is called "Nile River Explorers". Not sure if they have a website or not to check out . . .

Wish me luck and a safe return!

Weekend #1: Hell's Gate National Park

The weekends in Kenya are like those in the US: they go by way too fast!

John, Ryan, Kim, Marissa, and I had a wonderful time at Hell's Gate in Naivasha, Kenya which was about a 4 hour drive from Eldoret. Naivasha itself was a fascinating area with hundreds of football-field length greenhouses lining the main highway. Our driver told us that the town is known for growing beautiful flowers, which are flown out daily to European markets. He said about 80% of the town is employed by the various flower companies.

We stayed at Fisherman's Camp, a campground with a few cabins right on Lake Naivasha. Our first night was spent in a "Banda" which traditionally would've been a mud hut but instead was a regular one-room wood cabin. We dropped our bags and headed to the lodge, which was a large open-air restaurant and bar that looked over the lake and campground. It was a beautiful night, and I got to enjoy the yummy food and my first Tusker beer. It's the Budweiser of Kenyan beers, I've been told, but I thought it tasted much better than a Bud. According to the label on the back of the bottle, Tusker was the name of the elephant that killed one of the company's founders.

We were getting bored and John volunteered to go to the cabin to grab a deck of cards when we saw that a hippopotamus had come out of the lake to graze on the grass of the campground a few hundred yards from our table! We didn't realize this was common here at night, until we saw the campground owners had hung lights to some of the trees to help guests visualize the late-night feeding of the hippos. I couldn't get any great photos b/c despite the lights it was still dark, but I did get a video where you can somewhat see a hippo (will upload once internet allows!)

We woke up early the next morning, rented our rickety mountain bikes, and rode them down to Hell's Gate. The day was overcast and cool, which was great for us working hard pedaling. Our bottoms were very sore later in the day from riding 13 miles on the bumpy gravel, but seeing wildlife without fences or car doors between us was worth the pain :) On our ride down the trail, we saw zebras, water buffalo, warthogs (pumbas), baboons, and antelope. We got to the ranger station next, hired a guide, and hiked down to Devil's canyon. I assume it is called this because of the hot springs located there, and the guide advertised if we had brought our eggs with us we could've boiled them. My pictures/video don't do the landscape justice, and our tour was breathtaking (both visually and physically) as we climbed up and down rock formations like Angelina Jolie when she shot the movie Lara Croft: Tomb Raider here.

We finished our hike and biked back home through town, and were greeted by "How are you!" yelled by the children along the way. Supposedly, instead of "Hello" as a greeting, they are taught to say "How are you?" We mzungus (white people) stand out on the street!

Back at the camp, we were upgraded to the cottage which had a comfortable front porch and more spacious rooms. We noticed monkeys running around the camp and through the trees, which was a sight to be seen. But John told us Kenyans think it's crazy that we were impressed by monkeys, because that would be like them coming to Indiana and being impressed by squirrels!

We slept well that night and into the next morning, then wished Fisherman's Camp and Naivasha goodbye. My first weekend trip in Kenya has set a high standard for future get-aways!