One Year Out: Perhaps an overdue update

Clearly, my last post left little closure to those who have happened upon my blog. I remember having a slow internet connection requiring me to put my blog on pause for the final week. The last week of my stay in Migori was a whirlwind: trying to get into the main theater to see as many surgeries as possible, making sure I wrapped up all loose ends in town and with packing, and relishing my last days in a completely foreign culture. Joshua drove me to Nairobi the day before my flight. He showed me around, I ate pizza for the first time in a month (no one ever told me cheese was so difficult to come by in Kenya! Understandably so...), and absorbed the more-familiar city lights of the country's capital. Flying home was bittersweet for I was anxious to reunite with my family but very aware that I would not be returning to my family in Kenya for a very, very long time.

It has been an entire year later and my anklet, one that I purchased during my safari in Masai Mara, serves as a daily reminder of the incredible journey I experienced in Kenya. I saw beauty and compassion in a way I had never seen before. I gained invaluable medical experience and met unbelievable people. It is so difficult not to sound cheesy when I reflect on my time there but it was truly moving.

To those from Kenya, my dearest family in Africa, I will be back. I promise.

One of the nurses from the hospital. She had been working there since the hospital first opened!

Guess who got a braided weave?!

Single mother of 9 adopted children. One of the most inspiration women I have ever met. And! She was able to cook Indian food!

Morning of my flight. This was my newest friend, Rosepauline. She was beautiful. 

Medics to Africa
June - July 2012

Surgical and Maternity Wards: 1 Week Left

After a very relaxing and celebratory weekend, going to work today was highly anticipated. I was eager to get back into the hospital and see how the patients fared over the weekend. I had my fingers crossed that none of the patients I was wondering in the Pediatric or Surgical wards passed away over the weekend. At the morning meeting, we were informed that there were 2 deaths, both new patients who I was not overseeing. While I did have a sigh of relief that they weren't my patients, I was still saddened by their quick deaths (both patients died within hours of their admittance to the hospital).

We went to the maternity and it was the usual slew of pregnant-near-full-term-and-ready-for-labor women. It still always amazes me at how young many of the women are. There are 15 year old having their first and second children. In fact, because the high rate of reproduction among the locals, the doctors regularly perform hysterectomies; however, a colleague informed that sometimes during a c-section, the doctor will simply perform a hysterectomy on the basis that "this is her fourth child... she doesn't need any more children." it won't be until after the surgery that the woman will be informed that she can no longer reproduce. That kind of medicine would be absolutely inappropriate in USA for obvious reasons.

In the maternity ward, I also saw a woman who had just had her right breast removed and a c-section in the same surgical session. She had malignant breast cancer and she was full-term pregnant (meaning that she had been carrying the woman for 38 weeks). The doctor was reviewing the stitches which sprawled across her chest and concluded that they were septic (infected). The situation was unfortunate because there was no way of knowing if all of the cancer was removed from her body but now she has an infection to deal with? I sighed. The only thing covering her newly-stitched breast-less chest was a thin blanket. And there were flies everywhere in the room. And I had just seen a mouse scurry across the floor. The normality of the situation caused no one in the ward to flinch. This was typical.

Soon afterwards, we went to the surgical ward. There was a patient with hemorrhoids and a tibfib fracture but (please brace yourself for this picture): a 40 year old man was riding his motorcycle and he got into an accident. His entire heel was sawed in half, through both flesh and bone. He came to the hospital with the heel having been stitched together with household string and needles; naturally, the wound was severely infected and a surgical toilet was going to be performed on it immediately (a surgical toilet is a procedure in which as much of the infected flesh is removed as possible). There were flies everywhere since his would was only being covered with a little gauze (being held up by the nurse). I sighed again.

I scrubbed in to observe a DNC, in which a mass (of unknown substance, maybe blood or fluid) is removed from a females uterus. Its a quick procedure and simply helps clean out the uterus. Despite the fact that the patient was in pain and needed the surgery and the staff was completely ready, the doctor took his time getting to the theater (the surgical room). Eventually, the staff decided to just go to lunch and see if the doctor comes in the evening. I went to the ward, hoping to see if I could get the gears moving on the surgery, but the nursing staff shrugged me off saying, "the doctor isn't ready yet." I went to lunch also and found out later that the surgery was postponed until later.

Sorry that everything is underlined. I am not sure why it is doing this.

 I know, it is gruesome.

Cheesy picture of my in scrubs before scrubbing in for surgery. I took this as a tribute to one of the biggest medical inspirations in my life: my dad. Happy belated Father's Day!

Me after scrubbing in, just before the DNC surgery.

They preserved some abnormal fetuses. You can see that this developed into only half a fetus.

The surgical room. Rather sophisticated technology 
 relative to the rest of the hospital.










From left to right: a jar of "moles" or under-developed fetuses and worms and parasites in the last two jars. All of the worms in the last jar were recently extracted from one person.

The newborn child which I saw the natural birth for. 

Above: I decided to throw in a couple random pictures. Here is a picture of my room where I sleep. The mosquito net makes me feel like a princess.


Left: This is my program coordinator, Joshua Omolo, and I. He has been so caring and kind through this program. I want to come back next year.




Point of information: all these pictures literally took me 4 hours to upload

Accepted

I found out last night that I was accepted into my dream medical school, George Washington University. I want to thank everyone who has believed in me and supported me through this process.
If I do accept the offer, I will attending GWU Medical School in the fall of 2014.

Never have I ever had a firmer belief in one thing: if every fiber of your being wants to fulfill a goal, everything in the universe will help you accomplish that. 

We have weekends off. I think that the house residents and I are going to watch movies tonight.

I'm inexplicably happy right now.

Births and Parties

As I had mentioned before, not too much has been happening at the hospital; however, several of the PAs have finished their rotation so I think that starting next week, we will be able to work more next week. Yesterday, I watched my first natural birth. The woman was 22 years old and up until that point, I had only seen cesarean sections in the states and in Africa.

Honestly, the female body is incredible. I had to wait and care for the woman for 2.5 hours and within 5 minutes, the child had positioned itself naturally for birth. It was interesting because in Africa, there are three steps to childbirth: contracting, vomiting, and delivery. They believe that making the mother vomit induces labor and helps to make sure that the child is properly positioned for birthing. The delivery went smoothly and the new mother, initially reluctant to push the child out, was relieved when it was over.

Sidebar: I had to leave the delivery room for a brief moment to fill discharge papers. When I returned, the nursing staff ran to me and said, "Your friends are here! Your friends are here!" When I looked around, I realized that there was another Indian family waiting to delivery a child. Kenya has an Indian population that composes about 20% of the total; but there aren't very many Indians in Migori. I exchanged some conversational pleasantries and platitudes in Hindi with the family then continued to encourage Asha (the Kenyan 22 yr old) to "sokuma! sokuma! (push! push!)".

Last night, the house bonded together to celebrate and to mourn the fact that one of our members, Kelsey, was leaving the next day. We had an enjoyable time. Here is a picture of me and my good friend Hannah.

When I typed in "good friend", I accidentally typed "hood friend". Yeah, this Caucasian Iowa-native is not from the hood...







We are going to Lake Victoria this weekend. Updates soon to come.

Safari: a long overdue post

It has been several days since my last post. In those days I have done the following: traveled through the Masai Mara territory, was inches away from infected malarial cell, and tapped into the soul of the universe.

You always read about the people traveling around the Serengeti (I was surprised as to how phonetically correct the spelling of Serengeti is. Wouldn't you think its Sereghetti or something like that? I digress, as per usual) and being among the wild beasts of the African landscape. While this mostly correct, I could compare my experience on an African safari as an intensified, glorified trip to a zoo. It was incredible to be so close to hundreds of animals and drive among herds of elephants and packs of lions. But at the same time, the entire experience is from the safety/confines of a safari car. The roof-less vehicle gave me a chance to stand and take snapshots of wildebeasts and cheetahs and rhinoceroses -- but let's be serious, all I wanted to do what pet the lions. Or snuggle with the tired cheetah. Or play with the probably-pretty-aggressive elephant. Is that too much to ask? Regardless, I got some pretty neat pictures. Did you know that Simba means 'lion' in Swahili? and the Rafiki means 'friend'? I'm basically an African native now that I'm privy to all these insider facts. 

Note: Serengeti is the part of the wildlife preserve that is in Tanzania. The part of the preserve which is in Kenya is called Masai Mara.

Evolutionary and Darwinian theory really messed up with zebras. Honestly, what advantages come with having overly obvious and conspicuous stripes?

The giraffes were so awkward...

Well, who is that diva on the Tanzania and Kenya border? 

We were just driving along but we had to stop because there was a little somethin', somethin' crossing the road.

  
While we were riding around in our little cage of car, we passed by several villages filled with huts and Masai natives. They were clad in brightly colored clothes (essentially they were large clothes draped over tiny frames) and had exceedingly large gaping holes in their earlobes. The loose skin from the large earlobe holes (I don't know what else to call them) ((parenthetical commentary is apparently my best friend)) was then wrapped around their ears as a way of managing the sagging lobes. Each person, male and female, was decorated with beaded jewelry. It was really a fantastic sight to be among a completely foreign culture with virtually no similarities to me: they did not have electricity, couldn't speak a word of english, and lived in straw huts. I found myself sympathetic of their lifestyle, almost to the point of pity; however, within moments of my encounter with a native, I realized that my feelings of pity and sympathy were uncalled for.

I didn't have any type of extensive conversation with a Masai African but there was a magical moment that I experienced while I riding in the safari van. I was looking out of the window, examining and contemplating exactly as to how these straw huts were even structurally sound, and suddenly there were two children standing alongside the road. From their attire, I knew they were some of the residents of the village we were passing through. I made eye contact with a young male (or female... it's honestly quite difficult to tell the difference between the two sexes) and he smiled at me. Naturally, I smiled back and in that moment, that child and I shared a non-physical embrace. Despite the vast cultural differences, it took only a fleeting moment for me to establish a bond with this boy. He seemed happy where he was and I was happy where I was. We were happy together. We had both tapped into the soul of the universe. I read about this concept in the book The Alchemist; the soul of the universe is a rhythm that all of humanity dances to. Although humanity is immensely huge, there is a soul which runs through everyone and creates commonality -- similar to how a smile or a frown expresses the same emotion in every country. There is something unspoken that connects us all but is only realized at random moments. With this little boy, we shared a mutual understanding of humanity. Through our shared smile, we both drowned in the current that ran between us; but just as soon as the moment was realized, the moment was lost as the van drove away. I continued waving my hand until the child was out of sight.

Here are some of the girls and I working at the lab. I just examined some malaria cells under a microscope.
I'm getting quite tan.

We got 5 new Medics to Africa students and ~10 physician assistants working at the hospital. The combination of the few patients and the flux in helping hands has resulted in over-staffing. Consequently, I find myself only working for a few hours in the morning, giving me more time to do things like blogbloglbogogllbooglb.

I also want to clarify on my early statement about the healthcare system here being broken. I understand that there are limited resources and the doctors try to make do with what they have. But when a 7 year old patient is admitted the day before  with complaints of a cough and mysteriously dies over night because of lack of patient care, how is one supposed to react? The case was written off as "mysterious death" and "maybe typhoid related" and the file was simply thrown in a disgustingly disorganized closet of medical records. All of the American students had to turn their heads away from what easily could have been avoided.

I am already halfway done with my trip. I arrived on the 1st and leave on the 26th, making today the 13th the halfway mark. I think I'm going to miss Kenya. 

Pediatrics Ward and Orphan School

“You can do no great things. Only small things with great love.” Mother Teresa

I promise I’m not trying to be depressing but the healthcare system here is startling, disorganized, and blog-worthy. I’ve spent the past few days in the pediatrics ward and getting to know the hospital better. I have a few stories, both sad and uplifting, to share.

First, there was a middle-aged African male named Lucas. He came into the hospital with a machete wound. His lower leg was shattered and needed to be amputated. After having to wait a prolonged period of time to get the amputation once he was admitted, he developed complicated malaria and severe anemia septisimia while staying at the hospital. Yes, he developed a series of ailments from staying in a supposedly clean and controlled environment. Lucas died yesterday – the students and I visited the mortuary and saw his body. Lucas serves as a symbol of poor care and lost potential for us students. Note: For surgeries, there are different sets of clothes which are classified as “sterile” and “normal”. The sterile clothes are the ones which are used to clean open cuts as a surgery is being performed. I noticed, as we were leaving the mortuary, that both the sterile and normal clothes were washed and dried on the same clothing lines. How is that sanitary? How is that “sterile”? 

In the United States, the ‘normal’ hemoglobin (HB) count for blood in between 14-17. In Africa, the accepted HB is 10, meaning that the general health status of the patients is weak. Such low standards lead to higher chances of infections. Similar to Lucas, I saw a child with severe sickle cell anemia and who has developed cerebral palsy during her stay. Her mother has had to watch her daughter slowly deteriorate over the past 3 weeks. They moved the baby to acute patient care and despite the supposed “higher priority care”, the work performed on the child was mediocre. Because of the child’s sickle cell state, it needed to be under controlled hydration. Although she was technically hooked up to a saline source, the source wasn’t properly connected therefore the solution was simply falling onto the table instead of hydrating the child. The baby was dehydrating and the doctors didn’t even notice.

I observed a cesarean section yesterday. I had watched one in the states while doing research in high school. It was interesting to be able to compare and contrast the methodologies. Honestly, both times I watched the c-sections were quite similar but the primary difference was with the mother. The mother who was getting the c-section was from a tribe – a tribe that practiced female circumcision. To those unfamiliar with this practice, please take a moment to open a new tab and search this term on the internet.

Finally, we went to an orphan school today. The children were so playful and absolutely precious. When we first got there, the principal of the school greeted us mzungus (“non Africans” or more commonly, “white people”) and brought us to her office. She essentially asked us for donations and told us about how much she needed them. But, because she felt the need to be polite, she brought us all bottles of soda. How could we accept these cooled sodas when the school needed that money for the kids? We were so conflicted and we felt guilty. Other than this awkward moment, I was able to make some excellent new friends with the children. Although, I’m quite certain that they were more fascinated by my camera and my hair than by me. 

 The children at the orphan school

I’m going on a safari from Saturday until Monday. My next entry will be in a few days so be sure to look for more updates which will include magnificent tales in Masai Mara (Serengeti).  

Day 2: Pediatrics Ward

I went to the Pediatric ward today. It is one thing to have to watch adults suffer from burns and cuts. But it is entirely different watch a child endure the pain of malaria or typhoid or pneumonia or all three at once. One of the hardest sights of the day was seeing a child with a severe sickle cell anemia and she cannot respond to touch or pain. The doctor would push the 3 yr old around the hospital bed and it would not react. The mother was sobbing on the edge of the bed because the baby hadn’t cried in 3 days and she didn’t understand why. It was heart-wrenching to watch the doctors simply prescribe a general set of medications and walk away. I actually had to swat away a fly that was flying around the infant’s mouth because the infant remained lifeless and lacked reaction.

Most of the children were malaria and typhoid patients; however, on a more uplifting note, I met Alfred. He is an 8 month old child who just recovered from malaria and it was so inspirational to be with him. Some of the children, despite their age, are so strong and beat the worst odds. Also on the positive, I now know how to properly discharge a patient and write prescriptions. I’ve worked with a couple of doctors since I’ve come: Dr. Atunga, Dr. Mbongo, and Dr. Josiah. Cool names, just thought I’d throw them out there.

 Dr. Mbongo and I. I had to play with the brightness settings in order to properly even see him. Consequently, I look a bit doe-eyed.

Some shops just outside our living quarters. 

Later on today, I will be going back to the hospital to check out some labs – looking at various diseases under the microscope. I’m exciting to see and be able to identify various illnesses on a microscopic level. As usual, updates to come.

PS, there is some superstition in Migori against left-handed people. When some nurses saw me write with my left hand, they were so fascinated. “You can write with your right hand too, right?” and they were shocked when I shook my head “no”. CULTURECULTURECULTURE. Also, our cooks are making chipatis for dinner—these are an Indian flatbread (the Indian population in Kenya is about 20% of the total population).