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Eldoret Day 1 Revisited and Day 2 updates

March 10, 2011

Hello friends–

It appears that the melatonin really helped prevent jet lag. Either that or the busy day marching all over town and the hospital our first day here. It’s been great to have two consecutive nights of solid sleep here in Kenya. It’s also nice to wake up at 6 AM in the morning feeling refreshed and have an hour or two to upload pics and work on the blog for all of our supporters following the blog. Although their are many pretty drastic inefficiencies at MTRH or Referral as it sometimes called, progress is still being made every year. Below you can see nice new storehouse built with the financial support of IU. It cost 30 million KSH (Kenyan Schillings) or roughly $375,000 USD. I can see this place getting filled up with tons of supplies for a cardiac unit.

Brand new IU sponsored storehouse

The adult medical ward

The wards are kept very clean considering that all the paths and roads around the hospital are primarily red dirt and clay. They are so rough that I even had to go out to buy a new pair of dress shoes yesterday, because I was about to wear a hole in the sole of the shoes I brought from home! As strange as it might seem, the dress is very formal with all levels of personnel wearing ties and professional attire. The dirt is pretty rough on the clothes but the Kenyans still manage to keep up the dress code everyday. Pretty amazing.

There are still 2-3 patients to a bed on the wards. They are continuing to expand the bed capacity but I am sure that the beds will always remain that full because more patients will be admitted. I know there are more out there that need beds that simply aren’t available. When I walk through casualty every day (the British equivalent of our ER), there are literally hundreds of people waiting hours to be seen. I’m certain that a good percentage need more than outpatient care.

Now onto Day 2. Today we rounded with the surgery service. There are two surgery services “Firm 1” and “Firm 2”. I have been assigned to Firm 1. We have “Major Ward Rounds” Thursday where our two consultants (or attendings in the US lingo) round with the medical officers and the medical students. On our Major Ward Day, the students present their patients and the consultants conduct teaching rounds. Here we are the bedside of a patient with an upper GI bleed discussing the management of the problem. Dr. Lugaria is on the left and the intern is on the right writing the note while the clinical officer (equivalent to a nurse practitioner in the US is writing orders).

It seems likes a well ordered system on the surface, but as with many hospitals in developing countries, there are supply shortages that slow patient care and even prevent them from going to the OR. There is a often a sense of frustration that patients can’t move forward. But what I found very encouraging was the consultant’s proactive attitude. He would acknowledge the problem at the bedside but refused to allow the medical staff to settle for nothing less than the appropriate standard of care for the patient. That’s a man of integrity to me.

My surgery consultants at the bedside

In this picture to the right you see my other surgery consultant Dr. Jumbi (Jum-bee) second from the right standing next to Dr. Lugaria (Lu-gar-e-ah) with some of the medical students from Moi discussing a patient. I confess it’s a little strange to be at my level and integrating into the service. This is primarily because, the team has really only consistsof a medical officer and the students. A medical officer (MO) is an intern in our US system, but unlike our system the intern will often go off to a post in the “district” or outlying village to be the only doctor in the area. They will have to tackle everything from emergencies, ob, medicine, psychiatry to surgery. So the medical officers have a broad range of exposure but not depth yet. In our system, a surgery intern is on a more defined path. The MO after their district service can apply to be a surgery resident or what they call a Masters of Medicine in Surgery (M Med). However, the government has been cutting back on the subsidy for the M Med programs, so the MOs have to pay for their education. Imagine that system in the US! You can imagine that many talented individuals probably do not pursue M Med in Surgery since they need to earn a living and support their families. The hospital has just started their M Med in Surgery program, so if we came back to Referral, I would likely be involved with the residency training program. I hope I can be an encouragement to some of the students and MOs since I would be considered a senior M Med in their program.

One of the biggest drivers to the program’s improvement is this surgeon on the left Professor Tenge (or Prof Tenge as they call him). He is a very talented pediatric surgery who is the Surgery Department Chairman. Here he is at his desk looking at a Pediatric Surgery Atlas that Dr. Matthews brought from him as a present. Prof Tenge was very encouraging about the potential for a cardiac surgery program at MTRH. It would be easy for senior surgeons to be dismissive of such ideas which would be a very large undertaking in a hospital where elective cases are often delayed because patients can’t afford the supplies for the surgery or where there aren’t enough sterile drapes etc. He could even have been dismissive of me as a resident. But he was a true gentleman and even laid out the political challenges of the department at our first meeting. I knew of many of these issues already, but I was encouraged by his direct nature, honesty and vision. He truly cares about the quality of medical student educations and recognizes that he only has 10 weeks to influence these future district doctors and potentially surgeons (if funded can be found for the best and brightest). It’s worth noting that the medical students are here because they scored extremely well on their entrance exams for medical school. But the problem is the clinical education provided waxes and wanes. That was a problem that Dr. Matthews tackled directly when he lived on station.

Today is the start of Day 3 at Eldoret, and I’m very excited because one the SICU nurses at IU Charity is coming today. She is here to visit one of our ED physicians for a few days. One of the challenges of started a CV surgery program is post-op ICU care. The ICU here is not ready for CV yet. But the pieces are falling into place. One of the Kenyan anesthesiologists just returned from the UK after completing some further critical care training. She is stellar. I happened to met her husband Abraham as well when I was completing my Masters degree during my lab time. I hope to catch up with him soon. As always there is a tension here for the doctors who can’t make enough to support their families solely at MTRH and work at private hospitals where patients can pay for the services provided. But in addition to doctors, we need well-trained RNS.  Charity and other RNs like her at IU could be a major encouragement to the nurses here who try to take care of the patients with the resources provided. A mutual partnership between American and Kenyan nurses would be a great step.

Ginnie talking with the Pediatric Residents

Ginnie has been busy too. Yesterday she gave a presentation on congenital heart disease to the pediatric residents. Then she helped diagnose a hypoplastic left heart syndrome (HLHS a child born a single ventricle) after the lecture. Talk about timing! HLHS is extremely rare. Unfortunately, this diagnosis is a death sentence for this newborn baby in this setting. To close–a quick update on the homefront from Melissa..she emailed us and wrote:

Playing Uno with Grandma Nancy

Tonight at dinner Esther notices a scar on Caleb’s hand and says, “My Daddy’s a surgeon, he can fix you.” Caleb: “what kind of surgeon?” Esther (proudly): “A heart surgeon! He can fix you.”

They also sent a picture of the three older kids playing UNO with Grandma Nancy (Melissa’s mom).

We do have a few praises/prayer requests:

Praises

1. Thanks for all the people praying for us. (I could mention many. But one in particular is Rob and his church. Rob is an my Navy days in 1997. I haven’t seen him but one time since then, but he emailed me and told me he heard of our trip and asked his church to pray for us.)

2. For our continued health

3. For Nancy, Melissa and Caleb as they watch all four children. They are all doing so well.

Prayer requests:

1. For the family of they baby with HLHS who will unfortunately loss their baby.

2. For an old friend from Michigan Micah. He is about my age with three kids and fourth due soon. Unfortunately, he is incredibly sick from pneumonia and is in the ICU on a ventilator. The doctors initially he would die because he was so sick. He was on aggressive ventilator support, major antibiotics and I’m sure at one point pressors.

There’s more to come but two hours on a blog is enough….off to work.

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One Comment leave one →
  1. Alyssa permalink
    March 11, 2011 6:29 am

    Thanks for the specifics and especially for the prayer requests. With you!

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