The Real Deal

Today, I truly felt like I was in Kenya. I was offered a respite from the daily grind of c-sections to go to a rural community clinic in a Masai Village in Sayipei. It's a clinic staffed by nurses every week but the doctor is only "in town" one time a month when they get someone to volunteer to come from Kijabe down to the village. On good weeks there is more than one doc who offers to take the trip-- including this one! This week, it was me and Warren Fisher, the ED doc from Northwest Hospital who is here in Kijabe for a year.

The trip started out in the usual Kenyan fashion, 25 minutes past our absolute departure time and continued in the typical manner of stopping at several stores, picking up other passengers, and making random errands along the way. By the time we were past the bumpy rode out of Kijabe, there were 11 people in the Range Rover and only the driver had a seat-belt. At least no one was hanging off the roof. The morning drive through the Rift Valley was beautiful although slightly desolate at that hour (both people and animals seemed to already be at their daily tasks.) We were almost to Sayipei when our ride inevitably broke down on the side of the highway (because when does a 2 hour drive in the Rift Valley NOT include running out of gas and being stranded on the side of the road amongst gazelles and a rain-water pond??)

We got to the clinic late but not late enough to skip tea before seeing patients (if you've ever been here, you wouldn't be surprised.) After I gulped down my chai, I started seeing the many patients that were already waiting in the holding area. I saw more disease today than I saw healthy although I don't know why I am surprised by this anymore. Diagnosed my first case of brucellosis, which I likely will never see again after I leave here. The clinic workers were shocked I had 1) never seen a case before and 2) didn't immediately know which drugs to treat it (one of which included chloramphenacol...) I did later end up giving my first dose of chlor, but this time for a raging case of PID/salphinitis with the husband refusing to also be treated despite my pleas that she's just going to get it again if he doesn't. I resisted the urge to give him directions to the infertility clinic when she can't get pregnant in a few months. I then saw some pretty standard stuff from my world: venous stasis ulcers that needed debriding (they looked at me like, you're gonna do WHAT with that scalpel??,) uncontrolled diabetes, GERD, rotator cuff injury and of course, diffuse abdominal pain from.... constipation. Back to the common for Kenya was the 2 year old girl with congenital hydrocephalus who wasn't meeting her developmental milestones (duh) and the 3 year old boy with horrendous clubbed feet such that he has been crawling his whole life. The crazy ones were actually the easiest to take care of because they just needed to be referred to Kijabe Hospital to get specialist care and surgery. It was the brucella case and the uncontrolled diabetic with high blood pressure, blurry vision, and polyuria with no ability to get a blood sugar, electrolytes or kidney function on that I was worried the most about. The patients went on and on and continued even after we left due to the fact that we wanted to drive back up to Kijabe in the daylight hours (I don't like to tempt fate either.) The drive back was actually quite beautiful with the blue sky, dusk lighting over Mount Longonot and even some giraffes by the roadside. And this time, enough gas to last us the whole way :)

I think the oddest part about my day was when a young Masai woman randomly reached out and started petting my head and inspecting my curls. A close second was writing my first prescription here on a blank piece of paper with no name, date of birth, and no official paper or ink required. Just the prescription and my signature. Sweet, less paperwork!

The clinic today was an amazing way to spend the day and I wish that I could go back rather than be stuck in the OR all day again tomorrow. I think working at that clinic is more similar to what I thought working in Kijabe would be like, with very little resources and having to really use your head at every turn, from what supplies you REALLY need to use and how to make do with what you have. Kijabe hospital is a resource poor hospital compared to the US, no question, but for the most part, you can get what you need when you need it. Unless of course, you want any sense of urgency or efficiency and then you are just out of luck. Best to just adjust and chillax about the time schedule unless it's life or death (which, it actually IS much of the time.)

I'm on call tomorrow for three days straight for medicine and peds and I have no idea what to expect. I'm not on either of those services so hopefully I won't royally screw anything up. At least I discovered how to get directly from my house to Causalty (the ER) today-- this will make my headlamp-lighted journey at 3am much easier since the nearest entrance is closed after 5pm. Now, all I have to do is figure out how to keep the trash monkeys from attacking me...