Tuesday, November 9, 2010

Mara Days

The best part of the trip to the Mara so far has been the hot air balloon ride that Kenji and I did yesterday morning. We got a wake-up call at 4:45am and were in the truck by 5:15am. We rode out to the balloon site by the time the sun was beginning to rise. The balloon was floating above the trees before sunrise was finished and the view of the Mara from the sky was breathtaking. I mean, literally. The low bushes and trees below with running animals all along the ground while just floating in the air.... It was fabulous. The balloon ride was about an hour and followed by breakfast "in the bush" which basically just meant outside in the Mara where they normally don't let tourists out of the car. There weren't very animals nearby (they stay away from people) but just being outside of the safari vehicle was a real treat. Everyone kept congratulating us on our recent marriage (the display in the restaurant was hard to miss.) "Yes, thank you, isn't a balloon ride a perfect thing to do on a honeymoon? We think so." Fit RIIIIIIGHT in. We are geniuses.

Dinner in the Boma (an outside fenced area used in Maasai housing complexes) was actually quite good last night and was a nice surprise and change from the regular restaurant routine. They had a big bonfire to keep the bugs at bay and all the food was African themed. There were lots of fresh salads (including beets-- I love beets!) and barbeque. I was hoping they would have osterich (they are a bunch of them here!) but I had to settle for crocodile instead. Tasted like very chewy chicken with a fishy aftertaste, which is what I would guess it tastes like. They have been overall incredibly good about my food allergies which is quite a relief seeing as I don't even know where the nearest hospital is. Although, when I had an allergy attack IN the hospital back in Kijabe, I did go home to treat it myself anyway since I've seen how quickly things get done in a true emergency. Still, it was nice to know they had back-up drugs just up the hill if I needed them.

The past few days have been full of rain, especially during safari time. Our safaris yesterday were actually quite enjoyable despite the rain because our companions are quite entertaining-- in a good way! Both couples are from England and are traveling together. Maggie and Chris are older and have been to the Safari Club many times-- this is their favorite place in the Mara. They bring with them Bob and Grace who are younger and have been here I believe once before. Bob is big, burly, fully of tattoos with a shaved head and large gold hoop earring in his left ear. But he is a sweetheart and says things like, "Look at that jackal, it's so lovely, idn't it? I think we should get one as a pet." Grace goes crazy over elephants and when we saw a herd of 16 of them yesterday in the open plains with several babies, she got the biggest smile on her face I've ever seen. The best part of the ride was when Maggie told the story of when they went ballooning on their first trip and during landing they knocked over three consecutive termite hills and then finally landed sideways on a huge pile of cow dung: "It would have been OK except for all the poo because then the termites got stuck all over our jumpers." Um, yeah. That's gross. Kenji and I are still laughing.

Today is our last day in Kenya-- we are flying out tonight. It's basically an entire extra day of traveling because we are being driven back to Nairobi, which takes about 5 hours due to road conditions, not distance. And that's assuming we don't hit traffic. We'll be in the airport for at least another 4 hours before getting to our gate at the airport and boarding the plane. But, at least this time I have a travel companion so it won't really matter as much as my way here. I think the total trip is about 36 hours with a 5+ hour layover in Amsterdam. I hope they have some good movie selections on the plane!

Monday, November 8, 2010

Web of Lies

We left for the Maasai Mara on Saturday morning-- time to see some animals! Kenji was particularly excited about seeing the big cats since they were all hiding at Lake Nakuru. We swung by and picked up Greg and Humphrey, the two anesthesia residents from Vanderbilt who were also going to the Mara this weekend. The Tenwek discount has been re-instated at the Fairmont Mara Safari Club so just about every foreigner that comes through Kijabe and Tenwek Hospitals now goes on safari for 1/4 the price. It's a sweet deal.

We arrived four hours later with sore tailbones, ready for lunch and safari. Turns out there were two people here from Tenwek this weekend as well which means that all six of us would be in the same safari car. They like to put all us missionaries together (wink wink.) Our first game drive started out slowly: I gotta say, I was excited about gazelles the first time I saw them, maybe a little the second, but by now they have the effect of rabbits or squirrels. Show me something big!! We did eventually see great things like two herds of elephants and lots of giraffe, some honeymooning lions with repeated mating sessions, and even a leopard with a fresh kill complete with skull-crushing sound effects! Kenji got lots of this on video-- he's gonna put together a "birds and the bees montage" when we get home. Overall, a wonderful first drive and a beautiful animal filled sunset.

The two others from Tenwek are Janet and Keith but they aren't together-- just friends. Janet is about 50-something and I'm not sure what exactly she does at Tenwek; she is the typical dowdy middle-aged lady who asks crazy questions and sings "Home on the Range" everytime she sees either a buffalo or two-horned animal (hint: this is practically the whole time.) Her most entertaining comment yesterday included asking the driver, "Wildebeest? I thought they were Wild-A-Beast?" I gotta give her credit though for being very inquisitive and never being afraid to ask. Keith is an ENT and has a habit of smashing my toes into the hard floor of the Range Rover everytime he jumps up to take pictures of wild-life with his massive National Geographic cameras. This is despite the fact that I have learned to keep my delicate feet nicely tucked away at the opposite edge of the seat, as far away from him as possible. It's a true talent. He is friendly, full of information and is getting GREAT shots of everything we see. For every animal fact that Keith shares with the group, Janet tells us exactly where in the Bible the animal is described. It's a lot of information to take in besides the amazing and vast beauty of the Mara.

Last night after our extensive game drive, we arrived back at the hotel and scampered off back to our tent before dinner. Our tent is right by the bend in the river which is a great hippo-congregating spot. Score! We headed to dinner just as it started at 8pm to find Janet sitting up at the front waving to us from a table set for 6. My stomach turned. Kenji, having learned from the day before, expertly piped up: "Actually, we are on our honeymoon so we'd like to sit alone if that's OK." I mouthed, "You are awesome!" as the staff member led us to the table we choose across the entire restaurant and down on the veranda.

After a peaceful dinner alone, some singing started. "They must have Maasai dancers or something," I said. Wrong. I looked up to see all the singers in hotel uniforms with the lead lady carrying a cake. Oh, a birthday. Wrong again. The snake of singers led across the restaurant, down the stairs, and was clearly headed for our table. Chorus one was followed by a second. Then they asked for a speech: Kenji's face literally looked like one of those Wild-A-Beast in headlights. Now it was my turn to step up. "Um, thank you??" It sufficed. We then simultaneously blew out two candles to more singing and clapping. This was turning into a full-on African wedding reception because next we had to cut the cake, also to the beat of singing and clapping. After they had retreated and we were officially and appropriately celebrated as a newly married couple, Kenji looked at me and said, "Wait, does this mean I don't get my tropical fruit plate for dessert?" Blue and white icing almost came out of my nose.

Ask me if I feel even slightly bad that we are involving the entire Fairmont staff in our lie to have some privacy?? Not. One. Bit.

Sunday, November 7, 2010

The View from Above

A few days ago Kenji and John Njane not only gave the widow and her orphans a completely new roof but the next day they went back and re-did several barely standing external walls and also built an internal wall instead of the bedsheets she had hanging. It was a hard few days of labor (and required quite a bit of money) but the house looks like a proper Kenyan house now. It torrentially rained the night they finished and as I lay in bed listening to the sounds, I was happy that the old lady no longer has to get wet inside her house when it rains. It was a very small deed, to help just one family, but we could see the effects. And the villagers who worked for free know that some day it will be their turn to receive help. It's all about community and we felt good about the message.

The day after construction was done and I finished at the hospital, we decided to tackle the nearest peak in the Rift Valley: Mount Longonot. We got up before dawn and were on the road by 6am. We arrived alone in the park and headed up the long dirt path just before 7am. As the only ones on the mountain except for the animals, the cool early morning was quite peaceful. It was a tough climb for me since I'd had that asthma attack about a week earlier and had been using my inhaler about 3 times a day just to keep my wheezing at bay. But, I finally made it to the top about an hour later and the view of the caldera and Rift Valley below was breathtaking. Although beforehand we had agreed that the only thing we HAD to do was get to the rim, I knew that actually summiting was in the cards. We headed up the shorter but steeper climb to the top. It's a good thing I know how to rock climb and have mastered my fear of heights as several portions were only several feet wide with steep clifs on either side and required climbing on all fours. The summit afforded a 360 degree view of the valley below and our packed lunch was delicious at only 9:45am; this is, with the exception of the fake doritos. Two thumbs down on the Poco Loco Nacho Chips. As we made our way back to the trail down from the rim, we were happy that we had started out early-- 15 foreigners and two separate groups of Kenyan school children were making their way to the top.

We were back home just after noon and leisurely starting cleaning up and packing for leaving the country. While we were hiking, John Njane had called my cell phone to ask if he could bring a friend over to meet us. He kept saying, "Kenji was telling me that you guys don't go to church very often. I have a friend who wants to meet you because of the work you did and to share her message with you." Looking back, this should have set off alarm bells but I thought it was just the language barrier. (Note to self: always be suspcious.) We agreed that they would come over between 3-4pm as we were going to be home packing all afternoon.

At 3:30pm, John and Elaine arrived at our door. We all sat down at the dining table with cold pink lemonade for everyone and shared niceties. Elaine is a missionary who has lived in Kenya for over 40 years and in fact, she grew up in a missionary family in Africa. She is very kind. However, I started to get the point of this visit when she pulled a Bible out of her bag. We then endured an hour of Bible passages and admonishment that our lifestyle is not that of "good Christians." Poor Kenji got the real brunt of the session when she realized that he has not been baptized since he is Japanese. I thought she was going to collapse on the floor in a religious convulsive fit. After the interminable discussion of why we aren't good people despite the fact that we had acted like human ATM machines for the past several days and practically rebuilt this woman's house from the ground up, we all prayed together that K and I would find the right path. I politely led them out after the pink lemonade had been exhausted and tried not to feel betrayed by John and ambushed in our own home. As they were driving away, Kenji turned to me and said, "Next time, I'm just gonna say we go to church every day. Apparently we're going to hell anyway, so what's one more lie on top of everything else?" Word.

We are now on safari in the Maasai Mara and are in between morning and afternoon game drives. More on these adventures later!

Wednesday, November 3, 2010

Not What I Was Expecting

While this altogether sums up my time here at Kijabe, it certainly applies to today. I went in this morning thinking, "this is going to be a long last day." Not because I was dreading it, necessarily, but because it was the last. Rounds did take forever this morning but I was sad to tell the two charge nurses that today was my last day. They truly do care about their patients and while things happen at a different pace here in Kenya, I've come to realize that these two amazing ladies have made it their mission to make sure things happen when it counts. This morning I was examining a baby who was clearly very dehydrated and I wanted the baby to either get formula or IV fluids sooner rather than later. I told the team we needed to tell peds right away so that they could come start orders. The charge nurse looked at me and said, "No, I'll just take the baby to them right now so it doesn't get missed." Was this happening before and I just didn't see it? Did I completely misjudge them? Or have they realized that sometimes an hour really does make a difference in a life?

I found this happening all day whenever I was telling people it was my last day. Some were sad, some wondered how it could be so soon, some kept telling me to come back right away. And I in return started thinking, "maybe I will come back someday" even though not even 24 hours ago I was rejoicing at the thought of being back home in familiar medicine and not having to deal with this anymore. Maybe all that pink-lemonade I've been drinking gave my contact lenses a rose-colored sheen? Or did I just adjust and finally learn to work within the system? Wait, was I really sad to be leaving? I think I might be...

I was pondering all this walking through the halls after lunch when my pager went off. It was the operating room, they wanted me for a c-section. I walked over and the Kenyan Ob/Gyn (whom I like very much) and I had the following discussion which brought me crashing back down to the hard, dusty Rift Valley earth:

Osoti: "So, there is a c-section going on in room 8 I'd like you to cover if you have time."
JGG: "Sure, no problem. Whom am I going to be doing it with?"
Osoti: "Oh, you want someone with you? Ok, I can give you the medical student."
JGG: <<perfectly mastered Kenyan blank stare with internal monologue going 1 million miles a minute with something like this: "Uhhhh, you mean Martin who has never even SEEN a C-section before and ME, alone, by myself, no-one else, on a real-live patient, who has a husband, and children, and a living baby inside and might die and again, by myself, no-one else, just me??? Are you crazy?? Did your mother drop you on your head when you were a child?? What are you thinking you crazy Kenyan OB/GYN who thinks I can do anything??! I know I am awesome but lets reel it in a little bit here!!">> I think I actually coughed to hide my fear.
Osoti: "So, is that OK? You'll take Martin. And I'll take Naomi (the intern) to help me with my case."
JGG: <meekly> "OK, I'll just go take a look at the patient's chart while they are doing the spinal."

Then I was flipping furiously through pages of handwritten notes and praying, yes, actually PRAYING that this is a primary c-section. Nope, two previous. And she wants her tubes tied in the same operation. This is when I lost it. Yup, over a silly tubal ligation which literally a monkey could do. Don't ask me why I thought I can take scalpel to abdomen and uterus and literally cut a living baby out of a human being but I mentally had a breakdown at the thought of tying some suture around her tubes and cutting in the middle.

Until this point in my medical career, I've lived by the motto: "Fake it till you make it." In fact, this has gotten me through my toughest spots (please refer to the seizing preterm newborn from a few nights ago or rheumatic heart disease delivery via vacuum.) But really? REALLY? This was no time to fake it. I don't care if I'm in Kenya. I don't care if I actually COULD do it all by myself. Why should I model to the interns that it's OK to do something outside your field of knowledge when there is someone two rooms away who has more experience than you and can help you LEARN how to do it so that next time, maybe you CAN do it all on your own? Upon this realization, I found myself marching with strong conviction down to Room 4 where Naomi and Osoti were prepping their patient.

JGG: "Hey, I change my mind. Would it be OK if I steal Naomi for a little bit and then when she is done with me you can have her back? It's just that this lady has two previous scars and I want someone OTHER than me who knows what they are doing in case there are a lot of adhesions." (I'm lying, I'm sweating bullets at the thought that he will say no and tell me I can handle it all by myself.)
Osoti: <knowingly smiles> "Ok, but make it quick, it's just a c-section!"

Naomi and I did the c-section and tubal together but I did every single part of it from start to finish. We even laughed at the end because while my incision was sewn together perfectly, more than 2/3 of it was on the right half of midline. We joked that I was trying to take out her appendix while I was in there. You see, in surgery, you can't fake it. There is no other option but to make it. And while the thrill of doing something as cowgirl as a repeat C-section by myself with no-one else in the room was oddly tempting, no baby or woman's life is worth that adrenaline rush. I hope that this is what the interns here have learned from me: You do what you know. And then you look for help wherever you can find it. Sometimes "making it" is actually realizing that you DO need help and that faking it when someone's life is on the line just won't cut it. It doesn't make you weak, it actally makes you a better doctor. And for many of the patients I helped care for this month, it actually would have saved peoples' lives if someone had just made that call.

Tuesday, November 2, 2010

The Days of K

I'm too lazy to go back and see where I left off in my last post (plus, I'm running out of precious internet time.) So, I will just start where I feel like it. Deal.

Having Kenji here is amazing, I'm not gonna lie. I'd like to say that I'm one of those people that can go anywhere and do anything without familiarity around me and be just fine. But, I don't think so. I was trying to remember back to my year and a half in Japan when I was just starting the English school and living with a Japanese family in a tiny house with very little hot water and abusive in-laws all while barely speaking Japanese and having no-one familiar near. I don't remember being totally miserable. I must have blocked it out, right?

For those of you wondering my current mental state, here it is broken down in timeline fashion:
1) Week one sucks. No way around it. It will get better, no matter how much you think it won't. Expectations make a huge difference here--> whatever you expect, it will be the opposite.
2) Week two is much better simply because you are familiar with the unfamiliar and you start to figure out the gaps of care where you can insert yourself-- having a purpose always improves your mood.
3) Week three is the real adjustment period-- you know what you can do and what you can't, how you can help and somehow, you think you get it. Then you get kicked in the butt on-call but you get back up on your feet more quickly each time it happens. This is where you can start to feel good about what you are doing-- finally!! Hopefully this continues until the end, no matter how far away that may seem :)
4) And finally, the most important revelation: worry about what is in front of you RIGHT NOW and what you can do to fix it. Don't fixate on what COULD have been done had someone called you earlier. It is HARD to directly tell a medical student/clinical officer/intern who doesn't necessarily listen to you anyway that you think they permanently hurt/killed a patient. But, you gotta do it. It will probably keep happening whether you say it or not but if you vocalize it, there is a better chance they will finally get it. (P.S. for those of you coming after me, it helps if there is a Kenyan attending backing up your words of wisdom!)

all of that being said, the night before I picked up Kenji from Nairobi was rough but not intolerable; I think I got a few hours of sleep. But, once he was here, it all seemed to melt away. It also helped that two days after he got here, I finally got almost a full weekend off and we went to Lake Nakuru. Amazing! We stayed at the Sarova Lion Hill Lodge for almost half the price (we got hooked up with the non-kenyan resident rate instead of the tourist rate) and saw lots of animals and birds in the park. Then yesterday after delivering a breech 25 week fetal demise with a head entrapment, I left work right after Rounds and spent the day with John Njane, the Kenyan man who is starting a non-profit for orphaned boys and whom many of us have worked with before. It was Kenji's first day working with him so it was really nice doing things together. We saw John's house, met his family, and then went to the widow's house where Kenji and John are going to build a new roof for her and the orphans she is raising. We spent almost the entire day measuring, buying supplies, and then transporting the supplies up to the house. The cars here are less than ideal and so we spent a lot of time securing the muffler back onto the truck, pushing several trucks without starters that were loaded down with supplies, trying to fix a broken wheel that got stuck in a deep rut and even riding on the back bumper of a truck when there was no other room. Question of the day: Is it better to be locked in the car without a seatbelt and possibly get stuck inside with some horrible injury when you crash or to be thrown clear of the whole mess but possibly smack your head on the road or tree? Hmmmm.... tough one. We re-confirmed the location of the phone number for our medi-vac travelers' insurance about mid-way through the bumpy trips back and forth. You can never be too careful ;)

One thing for sure is that if you just spend your whole time in the hospital, you will not get the true Kenyan experience. The hours and days that I have learned and witnessed the most were when I was out in community clinics and/or just in villages helping regular people. There is a lot of good to be done in the hospital trying to teach the clinical officers and interns to give patients the best care possible with the resources they have. And I knew that the patients that I was treating were the poorest people I had probably ever come across. But, I didn't REALLY understand until I saw with my own eyes where and how they live. Yet, they are happy and it makes me feel slightly better about all that I have in my life when I can help them in some small way.