Learning to Improvise

Our first day in clinic was Tuesday outside of Bungoma, Kenya. Our bus ride was only about 30 minutes to this particular clinic where we ended up seeing 138 patients!! Our medical team right now consists of 19 medical students, 1 cRNA, and 2 attending physicians. We work in teams of 2 medical students + a translator. Once we see a patient and develop a plan, we will present it to our attending…just as we do in the States. 

Although we see tropical diseases that we would rarely, if ever, see in the U.S., we still see back pain, constipation, ear infections, pneumonia, etc that we see back home. The consensus is that we’ve learned a tremendous amount about medicine, each other, and ourselves in just one week.

As you can imagine, treating patients in a Developing country requires a fair amount of improvisation. We have all had some frustrating moments with patients when we want to do so much more…in the U.S. we would send them for a much needed surgery. But we’ll blog more about those cases later!

On Tuesday, I happened to be seated closest to the door, which made my lap the perfect target for a mother to place her seizing child. I was working with Ashley that day and we were already seeing another patient, so it took me by surprise when I suddenly had a small child in my lap who was convulsing. I took the 4-yr-old Kenyan girl to the front of our clinic where we have the medications and where I could have a few more experienced hands/eyes on deck.  I kept her in my lap, but tried to keep her on her side while we administered medical care. She stopped seizing within about 30 seconds. Her temperature was 104.0 and we began to hunt for the source of the infection. She had coarse breath sounds and was moving very little air. Although we would have loved to admit her to the hospital and give her a full work-up, our resources were limited. We administered IV antibiotics, gave her acetaminophen, watched her for a while, sent her home with antibiotics and begged her mother to take her to the Bungoma District Hospital.  In these situations we always wish we could do more, wish we had more equipment with us to provide better medical care. Each year we think of ways to improve what we’re doing in Kenya. Ways we can set up a Global Health program with our friends at Icodei that will change medicine in Kenya. We’ve got a long way to go, but we certainly are trying!

It’s not just clinic tables/equipment that require improvisation. After my patient with the febrile seizures was treated, I required a new pair of pants. (At the end of her seizure, she released her bowels on my scrub bottoms).  No one thought to bring an extra pair of pants, but fortunately Matt H. allowed me to use his jacket as a skirt. Fun times. Pictures to come!

Mary Katherine