A Second Home

From Thursday (we're trying to catch up now that we have internet!!):

For the first time since we have arrived in Kenya, I slept pretty soundly through the night. I only woke up once around 3 AM when it had begun to storm around. I’m hoping by next week, I’ll be able to sleep a full night even with any combination of animal sounds, monsoons, or people pumping water before dawn. It’s troublesome getting up before the sun because really – what can you do? I am also developing a personal vendetta against the rooster outside who insists on crowing every 5-6 minutes starting at 4:37 AM and the geckos that sound like a broken beeper that doesn’t turn off.

We ate our breakfasts and had our morning disease presentation in the gazebo this morning. It was a little muggy and cloudy outside, but the temperature is still quite nice. The gazebo is actually more like a giant hut, replete with giant thatched roof, concrete floors, and mismatched furniture. We all huddle together around the table and eat our PB & banana sandwiches and drink chai.  A few people have brought some mini speakers so we tend to have music playing the background at times, which also kind of brings a little bit of the US to our African experience.

Clinic today was in a village called Masango. It was “near” in Africa terms, which means over one hour away. On the drive over, Masango seems to be a more developed and populated area than some of the other places we have been. There were lots of shops and gas stations along the way. The roads were generally well-paved and we saw lots of schools (with playgrounds!). Wherever we seem to go, people – 99% of the time hordes of children – come running out to wave at us and yell, “Muzungu!” (def: foreigner) or “How are you!” (not an actual question; usually said in lieu of hello). I feel as my arms will fall off, but I cannot in good conscience, willingly not wave back to a child.

When we arrived to our destination site, we were in one little building so many of us had to set up tables and chairs outside. Shortly after arriving, this wizened old lady named Judith came inside. She said hello to all of us as she clasped our hands individually and kissed them, thanking God and us for being there today. She is a tiny little lady with a huge smile and some missing teeth, but so much energy and sweetness. She brought out a drum and rounded up some children to sing a welcome song for us. Both she and Ann, one of our favorite translators, led the song. It was a wonderful opening to the day.

Kenyans are some of the most welcoming people I have encountered in the world. In many different cities and villages all over we have met people who have tried their hardest to make Kenya a second home to us, whether it was at the hotel outside of Nairobi or here at Icodei. They have gone out of their way to make our weeks here as comfortable as possible, whether it is cooking us meat, when meat is quite a luxury, or whether it is putting a light bulb in our room so that we can see in the dark.  Bishop Ruben and Mama Betty have truly become surrogate parents to us all!

As has been the case, surprisingly enough, we encountered lots of chronic diseases today, like reflux and angina. Lots of back pain. I remember taking a course in college where we read an article issued by WHO about the changing face of disease in developing countries – and how chronic diseases that we associate with the Western world are rising in incidence and even sometimes surpass classic tropical diseases. There are a lot of people who smoke and eat a lot more unhealthy foods (yay intercontinental trade), so a lot of what we are seeing are patients with problems very similar to what we see back in Louisiana. One patient of note that I saw today was a lady presenting with left sided burning and tingling pain that apparently started one year before when she had neck surgery. It seems like the surgeons must have injured a nerve at the time, but no one has seen or treated her pain. Unfortunately, we are limited with what medicines we have and had to give her the name of an affordable medicine that she could hopefully find at the local chemist (pharmacy). This is what seems to be the most frustrating aspect of this trip: knowing all the resources we have in the world to diagnose disease and the medicines to treat them, but then operating in a resource-scare area, with only my brain and stethoscope to try to figure it all out. That’s a battle in itself. 

- Monika Kumar

Little Girl Blessed

Tuesday Clinic

The first time we met Blessed we thought she was dead. Her mother brought her into clinic and sat down on the bench next to our group and patiently waited her turn. Her seven-week-old baby, Blessed, was wrapped in numerous layers on her lap. She patiently waved over our translator, Ellah a Kenyan physician who was helping translate for us. Ellah calmly looks over to us and states, “It’s an emergency.” Side note: all Kenyans seem to speak impossibly soft and are difficult for loud Americans to hear.

After Ellah states that it’s an emergency, we come over and see this tiny infant looking blankly into the air. After a few agonizing seconds, she blinks. Feeling her forehead, she is burning up. Dr. Walter Scott, a pediatrician was called over. He states that she is having a seizure and feeling her head quickly determines it’s a febrile seizure.  While we spend time worrying about how to stop the seizure, he’s worrying about the cause of the seizure. Her mother begins to unwrap the multiple layers that surround the child, which seems to grow smaller the more clothing/blankets she takes off. Finally, we see her thin body and are able to examine her. Her pulse is racing and she is using accessory muscles to breath. Wheezing is heard over her chest. She probably has pneumonia and needs more than we are able to give her. Dr. Scott immediately orders a shot of antibiotics to give to her before we transport her to the hospital.

            The shot is brought over and her leg looks too small to give a shot. It is so thin. Blessed’s mother states that she has been feeling like this for one month and has been seen and treated at the local hospital without improvement. She couldn’t afford to go back. Three of us got into the van to bring her to the local hospital while Ellah stayed behind but called the hospital and told them to expect us.

            We arrived at the hospital and men with guns opened the gates to the parking lot. We got off the bus and followed our translator to a room full of five women who were completely confused by our presence. The nurses here are on strike.  Evidently, a different civil service group goes on strike every week according to the locals. We then go to the ER check in and jump to the front of the line. Robert was there and said he had just gotten off the phone with Ellah and was waiting for us. He briefly looked at the child, did an exam, and spoke with the mother (Lillian) and decided to admit the child for work up and treatment for possible pneumonia. We tried to pay ahead of time but we told to wait until discharge. Robert was told numerous times to take good care of Lillian and baby Blessed and that we would pay.

            We haven’t been able to get back to the hospital to check on baby Blessed and pay the hospital bill, but Mama Joyce, the medical coordinator here, has been in contact with Lillian. We hope to check up on them soon and see the progress Blessed has made. This is just one example of the times when you feel like you really made a difference. We hope to have many more in our remaining 2 weeks of clinic. 

Anna Craig

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