Kijabe Day 2
To say this day was overwhelming would be a colossal understatement. It started with another sleepless night. Lesson number 1 of the day: I’m not a good sleeper. Julie and I attended the 7 am conference on HIV with all the new Kenyan interns. It was a pretty basic lecture on the lifecycle of HIV. When it came to audience participation by naming all the different types of HIV meds that are available here in Kenya and how exactly they work, of course I didn’t have much to offer up as an answer. Lesson number 2 of the day: seems like my nearly 7 years of medical training are about 95% irrelevant here. Makes me feel a little less pleased (as if I am pleased at all) about my hefty monthly loan payments. Of course the Kenyan interns, despite being in week 1 of their internship are all extremely well versed in HIV medications given how prevalent the virus is here. Julie and I both tried to rack our brains as to how many HIV positive patients we have seen in our own outpatient clinics in Seattle in the past 3 years. Our collective number is 3.
After the lecture we headed to meet with the medical director for a little orientation to the hospital. The planned meeting time was 8 am. He finally came to find us around 9 am. Lesson 3 of the day: Nothing is on time in Kenya and there is truly no reason to rush. There is a popular saying around here that we’ve learned. It goes a little something like this: “White people have watches. Kenyans have time.”
After orientation we were dropped off at our respective wards (OB/gyn for Julie, Peds for me) to round with the teams. Everyone in the hospital right now is extremely frazzled for two reasons. Apparently because of the public transit strike over the past few days, many people were unable to get to clinic. Now that it’s over (with no real gain in rights, from what I hear), the clinics have been flooded. I guess I should say it was a deluge, because by our standards, their normal day of seeing 300 patients in the outpatient clinics is kind of like a flood. To exacerbate the whole feeling of chaos, the interns, as I mentioned, are completely new and really need a lot of help and guidance from the attendings. The attendings are used to having self sufficient interns so this is a big hindrance to the day. This might explain why when we were dropped off at our wards, our respective attendings gave us a sort of blank fearful stare that said “Really? Another new person to deal with?” Or perhaps that was just my interpretation?
On top of the fact that we have no idea how to function in this new system (hospital, culture, language), the patients here are insanely ill. A snapshot of the peds ward right now:
10 month old male with sepsis and rickets
16 yr old male with paraplegia secondary to a car accident at age 3 with massive decubitus ulcers (ulcers on the pressure points of the backside from not moving enough) and skin infection
10 yr old male with high grade lymphoma with CNS involvement, also with AIDS, here for palliative chemotherapy
12 month old male with recurrent pneumonias, here with respiratory distress, concern for sepsis, TB
It also just so happens that the ICU is totally inhabited by peds patients as well. Here’s the roster for the ICU team::
2 month old male with microcephaly (small head), diarrhea, fever, seizure, found to have meningitis and a sodium of 167, then 192 (that’s HIGH!!)
5 yr old male with paraplegia from a large meningomyelocele (defect in spinal cord fusion) with surgery today for spinal fusion (they removed 4 vertebrae) with respiratory failure post op
2 week old female with encephalocele (born with the back of her skull open and 50% of her brain on the outside of her skull) repaired today with poor feeding
It’s overwhelming just to process these problems let alone try to treat them and make them better. My team right now is an FP attending from Kansas City who has been here for awhile on the adult med service, a Kenyan intern, and a Kenyan clinical officer which is our equivalent of a NP or PA. The clinical officer is the only one on the team who has been there for more than a few days. It’s a bit of a mad house.
After rounds I went with the Kenyan intern to the outpatient clinic. This setting is the true definition of a melee. It is first come first served. People line up and wait for hours upon hours. We are expected basically to grab a chart and start seeing patients in the cue. A few minor complications: There are rarely enough rooms available at a time to be efficient (meaning if my Kenyan intern and I wanted to each see a patient we couldn’t anyway), many of the patients don’t speak English, there aren’t dedicated interpreters so you are supposed to just “grab” someone to help you (which isn’t all that appreciated right now during this transitional period of new interns and nursing students). And let’s not even begin with the issue of limited resources. We saw a 4 yr old with a large submandibular abcess. It would have been very easy to just I and D (cut it open) right there and move her along. The clinic is not set up to do procedures at all, though, and instead we had to go hunting around in the “theatre” (otherwise known as an operating room) to find a surgeon to do it in between cases. And believe you me, the surgeons’ case load is extensive to say the least.
We are certainly hoping that with a little more sleep, a little less altitude sickness, and a little more time, we will come to feel useful and productive. It seems a daunting task at this point. But we will get up again tomorrow morning and face the Kenyan music (which is really just a lot of gospel singing here in the missionary hospital!).
Speaking of waking up, another minor snafu of my morning: I was planning to set my iphone as an alarm but the time on my phone is frozen on the last time zone where I had reception (which happens to be Houston). Lesson number 4 of the day: ATT has bad worldwide coverage. Compared to my other lessons today, this seems miniscule. Except for the fact that I had to set my alarm to wake me up at the equivalent time in Houston to 6 am in Kenya (not just simple math when you’re sleep deprived and at 7500 ft). That time happened to be 9 pm. This made for much confusion when I repeatedly checked the time during the night and was baffled to find it was already 4 (but really just 4 in Houston, not here) and I felt as though I hadn’t slept at all.
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