A reminder for me to stay focused….the need is ever present.
Sometimes when I look back on the day, I am simply amazing at all the things that can happen in one day. Days back in the US don’t seem so as interesting maybe that’s because I know the culture at home better and things don’t seem as interesting.
Here’s a brief snippet of some sights and sounds of the day in chronological order.
1. Caught up with the “mama” who sells newspapers at the corner up from the IU House on the way to work. Simply buying two newspapers for the OR staff brightens her day immensely. I have never known a newspaper person who is so happy to sell papers. They cost $1 USD.
2. Cardiology morning report–the fellows are taught in American style. In other words, come prepared and come on time. Review of all cardiology consults and EKGs. An elderly patient was admitted with bad heart disease over the weekend. The ICU refused to accept the patient, because the suction was broken even though four beds were available. The patient died on the floor for a lack of suction. Yes, there is ischemic heart disease here in Kenya. Where is the person who refused to take the patient in the ICU?
3. Went to the ward to check on two of the patients we operated on last Friday. One of the patients was dead, and the second looked rocky at best. Said my final good-byes to Jumbi and Lugaria.
4. Humorous side bar–Birech the medical officer saw me in transit and called me over to say that I was becoming a real Kenyan since I was showing up to work with two newspapers. The Kenyans LOVE to read their newspapers. You can’t just have the one paper without the other here in Kenya.
5. Received text on my cell asking me to see a recent hand injury in a US ex-pat. Called the person to come down to MTRH to see me.
6. Ran to the OR to say good-bye and clean out my locker. Gave away the OR boots that Matthews wore just once in the OR. Asked several times if I was the son of Matthews. Ha, ha do all wazungus look alike? One of the medical students scrubbed into a case fainted while I was talking to the pediatric surgeon. Finally finished saying my good-byes after being asked to give out several monetary gifts on the way out of the door.
7. Office visit with Sabilia to arrange lunch. Saw the hand injury in his office with Paul my ortho resident friend and colleague
8. Went to a Kenyan restaurant with Sabila, his wife and Paul (read place where American’s wouldn’t go because they would never know where it was). There are 7 flies per person at this restaurant. Your food (chicken and ugali) is prepared from scratch so it took it two hours to get our food. I was offered the gizzard as the guest of honor per tradition–I passed on that one…fortunately Sabila liked it.
9. Ran back to the IU house to pay my bill but not before receiving two more requests for future gifts (Swahali word is zawadi)–boots and a scholarship for future training.
10. Called my favorite taxi man to help me get a quick haircut and get me back to MTRH in time for Grand Rounds. Actually was able to make it across town, get my haircut and make conference in less than 25 minutes. We might have set a land-speed record for Eldoret.
11. Grand rounds–good discussion on Acute Coronary Syndrome (heart attack), Wellen’s Syndrome and heart disease in the elderly (an increasingly recognized problem here in Eldoret).
12. Went to see a very ill-looking man on the men’s ward with John Lawrence, the retired US interventional cardiologist serving on staff here (pictured on the right). The smell of urine on the ward was overwhelming. Saw the patient laying in the bed with two other men. He was pale, diaphoretic (sweating) and on a large amount of oxygen. His echo was incomplete and not recorded permanently. The oral presentation of this patient was disorganized and missing information as well. While discussing the patient, two women rapidly carry out a third woman who is screaming and sobbing in mourning at the top of her voice. Some tribes have a tradition of expressing grief in this manner.
13. Went to dinner with John Lawrence and his wife. The restaurant was missing some staple food and drink items. Rather surprising given this restaurant caters to wazungus (Americans etc). Nice discussion about the challenges of advancing cardiology and cardiac surgery here at Eldoret. Discussed the corruption in the system and problems with tribal nepotism that hinders progress.
14. Talked with Matthews on the phone.
15. Spent time with Chrissie and Geren discussing mutual missionary friends, Tenwek etc.
16. Finally back in my room, packing, blogging and decompressing. What a day.
Friday was my last major theatre day in Kenya prior to coming home. It’s sad to be getting ready to come, but there is lots to do on the other side. I’m looking forward to seeing the kids and Ginnie. I will miss my Kenyan colleagues here (such as Jumbi and Sabila pictured on the right). But as with all things, time marches on.
This last week was fun, because two fourth year students from IU were here. Both have matched into general surgery. So after getting the stamp of approval from the IU program at home, they were able to come on rounds with us on Thursday and come to the OR as well on Friday. On Thursday alone, I think they saw 15 different surgical diseases (soft tissue infection, diabetic feet, obstructive jaundice, pancreatic cancer, upper/lower GI bleeds, toxic thyroid, abdominal eviscerations, perforated typhoid, enterocutaneous fistula, etc etc). I think by the end of rounds, they were all a little shell shocked.
Saturday, I went to Misihku (near Webuye district hospital) to attend a primary health clinic run annually by Moi in conjunction with their grant from the Belgian government. Since 2008, the Belgian government has been conducting a demographic survey of part of the western Rift Valley. Both Tenge and Otsyula from the surgery department are two investigators on the grant. Strange to think of surgeon being involved with Burkitt’s Lymphoma and primary health demographics, but it’s good to see them have external funding. Too often, I think we perceive the US as the sole country interested in research, so it’s good to see other nations funding research.
Trying to wrap things up quickly. Praying for my dad’s surgery on Monday.
It certainly is unclear what the future of cardiac surgery will be at Eldoret. I think it will go forward. At what speed remains unknown. The surgeons here already perform select thoracic surgeries and will be performing heart surgery for patients with mitral stenosis from rheumatic heart disease. The mitral valve sits in the left ventricle. These patients can be extremely symptomatic (short of breath, faint etc) and would benefit from dilation of their small mitral valve. I just spoke with the Duke cardiologist here at MTRH. He apparently has a long list of patients ready for the procedure and has brought the Tubb’s dilator back for Otsyula to use. In addition, the cardiac cath lab is realistically scheduled to be online in the next 2 or 2 1/2 years. Certainly, the closed heart program will take off with the cath lab and the Tubb’s dilator.
Open heart surgery would require a heart-lung machine which is not here yet. The open heart team has trained for 15 months over the past five or so years. In the picture to the left, you see Charles (cardiac anesthesiologist), Rose (cardiac perfusionist) and Zipporah (cardiac scrub tech). They are extremely dedicated people who have been waiting years for an open heart unit. After discussion with some of the key Kenyan players, this unit would most likely require a dedicated separate cardiac ICU, dedicated nurses (which is not the norm, usually the nurses rotate), and the procurement of a lot of infrastructure (heart-lung machine, more vents, more monitors, stable supply of drugs/OR materials etc).
This task of opening an open-heart unit might seem daunting if not for the fact, that progress is continually made at MTRH. For instance, the hospital OR started with one room that served as an ICU and minor procedure room. Now there are eight ORs. In addition, IU has built a mother-baby hospital for the neonates. Toby Tanser is also raising funds for a brand new pediatric hospital on the the hospital grounds. The ground breaking ceremony is to begin in two weeks or so. Here’s a blurb about him from a Facebook page.
“It all started back in , when Tanser was one of those elite-runner mazungos training in Kenya. He had arrived in country with the sole purpose of training with the world’s best. He got off the plane with bags filled with his training shoes. Deeply affected by the poverty he saw during his stay, he left with nothing, deciding to give everything away — even the shoes on his feet. After that memorable trip, Tanser founded Shoe 4 Africa, a charity that gives donated running shoes to impoverished Kenyans.
Fifteen years later, Shoe 4 Africa has grown by leaps and bounds. The charity still takes used shoes, but also accepts monetary donations. With the money, Shoe 4 Africa sponsors races for HIV/AIDS awareness and has recently broken ground for a new school.Tanser isn’t resting on his laurels, however. Shoe 4 Africa’s latest project is enormous: building the largest children’s hospital in the entire continent of Africa — a $15 million project in Eldoret.”
Now this hospital project has been in the works for several years and $1 million has been raised, so I anticipate it will be a while before it’s finished. I find the information on the Tanser website interesting especially the proposed design of the hospital seen below. I’m not sure how this hospital will fit in the existing space if you recall the photo of MTRH that I posted. We’ll have to see what happens.
The website also states: “After 15-years of experience in Kenya, this is the first water-tight project I have found. It is almost too simple to be true, and all the medical experts I have spoken too, whether they be American or Kenyan, who have delved through the plans, the studies, and the proposal, agree that this is a solid and very doable, and will be a hugely effective, project. It is going to happen, and thousands upon hundreds of thousand of lives will be bettered because of it. People talk about sustainability, but all the ‘white elephant ghost projects you see are the ones that the Western Investors did not believe and invest in the local work power. The MOI Referral has been through the fights for Independence, changing Governments, wars, and more, and continues to run in an impressive fashion for the last 90-years. It is a center of excellence for the region and well known in the Western medical world. Please help the children of Kenya get their own public hospital in this amazing set up; a place where the Kids are the priority. We have a fantastic team of Doctors, builders, Ministers, & members of parliment, to make this dream a reality.” Toby Tanser, Founder/CEO.
Certainly, Toby has garnered some publicity for MTRH. He interviewed with CNN’s Sanjay Gupta last month. I don’t know if the IU staff would appreciate this following line from the print interview about the 2008 post-election violence.
“I was there when Kenya erupted with tribal violence, 18 miles up the road from a church that was burned with around 50 women and children locked inside. I saw all the Western aid workers, well-paid and trained to help in Africa in crisis situations, leave the country, airlifted out, as the poor men and women on the street stood up and opened their hearts to the sick and wounded.”
Six men were implicated heavily in the post-election violence. Known as the Ocampo Six, they just presented to the Hague for an international trial. Per the Kenyan paper, the Daily Nation–“The events which led to the charges stem from the violence which engulfed the country after the disputed Presidential election of December 2007. A total of 1,133 people were reported to have been killed and nearly 600,000 displaced.”
Hopefully, things won’t get ugly again. The story notes, “Presiding judge Ekaterina Trendafilova said the court’s attention had been drawn to signs of a new bout of violence through articles published in Kenyan newspapers”.
Well in any event, I’ll be praying about my role in all this. Life is no easier on this side of the pond.