Week One

Wow! It’s only been a few days, but quite a bit has happened since my last post. Let me fill you in.

Andy, me and Nadine walking from the IU House over to the hospital.

Rounds

I admitted my first patient on Tuesday afternoon. He was a young guy from an outlying area who ingested this substance here called “dip,” which is basically the pesticide of choice in Kenya. Unfortunately, its mechanism of action against insects (it’s an organophosphate with similar properties to the more concentrated and lethal Sarin or VX gas, most famously used on the Japanese subways a few years ago, and also featured prominently in The Rock with Nicholas Cage) also works against humans. It also happens to be a preferred method of committing suicide here, and this gentleman was the second person on our service suffering from “dip” poisoning. Unfortunately, there really isn’t much of a treatment aside from supportive care with atropine (part of the cocktail that Nicholas Cage injects into his heart at the end of The Rock). On the upside, we don’t generally inject into people’s hearts; peripheral IVs work just as well.

Trying to see the consultant (attending) during rounds. Always a challenge.

One of the major differences between hospital-based healthcare here and in the US the limitation of resources in Kenya. This not only means that many drugs aren’t available (although their formulary is pretty extensive, actually), but also the lack of ICU capacity. There are only five ICU beds here with ventilators, and they’re mostly reserved for post-operative patients who are expected to make a full recovery. For your typical patient on the wards who “codes,” or goes into cardiopulmonary arrest, there is simply nothing that you can do. There is no code team. There is no intubation. The resources simply don’t exist. Even if you could intubate and get the patient through the initial phase, the rehab facilities necessary to bring them back to quasi-normal functioning also are scarce, and the cost associated with such treatment would totally devastate any family here.

With respect to cost, it’s also interesting here that some families pull their loved ones from the hospital prematurely due to cost constraints. We had another patient on the wards for the last two days with a brain infection caused by toxoplasmosis, which is an opportunistic organism that targets patients with weak immune systems, such as those with AIDS. This patient was not doing very well. He had a very severe infection in his brain with swelling and inflammation that had resulted in complete quadriplegia. In cases like this where the outcome is looking dim and the prognosis is poor, many families do as his did: they paid their bill, removed him from the hospital, and took him home to care for him. Most of these patients are never seen again.

Even given these limitations, the physicians and nurses here are doing great work. When I think about the fact that this hospital did not even exist 20 years ago, I’m amazed at how much progress has been made. The AMPATH program, with its cost-effective mechanisms for distribution and monitoring of anti-HIV and anti-Tb drugs, is making a tremendous difference. We see patients every day here who would have died long ago without these institutions in place. It’s definitely an honor to participate and learn from the doctors here, who have so much experience to share.

Outside the hospital

Outside the hospital, life has been good. Just like moving to any new place, it's involved a series of adjustments. Brushing teeth with bottled water. Walking 15 minutes on a dirt road to the hospital. Not being able to call home whenever I want. Having to walk another 20 minutes from the hospital down to town for any purchases I might want to make. Etc, etc.

But overall, the transition has been pretty smooth. I miss you all quite a bit, but luckily, we've got a great group here. The residents and faculty are all very welcoming, as are the Kenyan medical students. In fact, we had a chance to head over to meet some of the med students with Sarah Ellen Mamlin. The occasion? Hep B vaccines!

Andy giving a Kenyan med student a vaccine. (Not the best way to make new friends.)

The IU House also gets together on Wednesday nights for dinner out on the town. Last night we went to a Sikh restaurant on the far side of town. There were in excess of twenty of us for the feast.

Nadine, Andy, Keith and me during IU House dinner on the town

Tomorrow morning at 5 AM we leave for a long weekend trip (tomorrow is Moi Day, a national holiday named after the second Kenyan president, just like Moi University where we're working). Our destination for the three-day weekend? Maasai Mara! This trip is what you think of as a typical African, non-hunting safari. We'll be traveling through a portion of Kenya's national park, which is essentially a contiguous with the serengeti. Supposedly, we'll be seeing lions, hippos, giraffes, etc. Pics to be posted next week!

That's it for now...time to pack for the weekend.

Cheers!

PS: If you're interested, here is Keith's blog, with plenty of extra photos:

http://keithmd.blogspot.com

I'll add Andy's next week. I don't know the address offhand.