making friends with sammy...

One of our main reasons for coming to Kenya was the hope that we would be able to meet and get to know Kenyans. As obvious as this may sound, it can be challenging when you find yourself on a station with a lot of ex-pat people who are involved in the same work. Although everyone is very friendly, and we learn new names of Kenyans every day, tonight was the first time where someone came over and spent time with us in a way that felt like we might become friends.
This past Thursday Warren and I had the opportunity to ride in the hospital ambulance to a clinic across the Rift Valley where we got to spend the day together seeing patients at a small understaffed and under supported community clinic. Doctors from Kijabe Hospital visit this clinic once each month. We also had a CO intern with us (like a physician assistant in training) and a nutritionist. Most, if not all, of the people we saw there are Maasai. On the way there we saw many of them along the side of the road herding cows and goats, most of them in the traditional bright clothing and beads that we think of due to National Geographic pictures we have seen. Amazing.
One of the patients mentioned that she had a family member who works at Rift Valley Academy as a gate guard. So...last night when Warren and I were on a walk, just before dark, we met Samuel...the family member. He initiated the conversation and we made the connection. We invited him to come over today. This evening he came...with many beautiful beaded things that his wife has made, and full of stories and easy conversation. We had chai and icecream and heard about his life growing up in a Maasai village. His wife and kids are still living in a Maasai village, only a short distance from here, and he goes to be with them on his days off. He is quite eager for us to come to his village and meet his family.
Warren was asking about the animals they come across and where they are. He could not emphasize enough how dangerous elephants are! He must have said this 10 times. Apparently you can run from them if you are running downhill because the elephants ears fall over their eyes and make them blind!? But uphill...you are in trouble. They are fast and their ears are back against their head! Keep this in mind!
This seems like valuable information and none of our other friends have ever shared this with us!

Baby boy...born Sept 4, Kijabe

First night of call in Kijabe...

Overnight call for the medicine wards and ICU was quiet until a 5:30 phone call. Obonyo, the first year intern, notified me of a full term emergency C-section little boy coming to the ICU. The baby was born blue, with no pulse or respirations. After 5 minutes of CPR, intubation, epinephrine and glucose the baby regained a strong pulse. However he had little respiratory drive and we were bagging him on the way to the ICU. I had no experience with the ancient German ventilators in the ICU. So I just kept bagging the baby and called the doctor on call for Peds. He didn’t have much luck with the ventilators either but he told me that babies here cannot be ventilated for any length of time. They need to breath…or they die. By now I had been bagging the baby for about an hour and he was looking better all the time. He started out dark blue, with just a few retractions, but by now he was looking pink and was starting to breath on his own. We took him to the neonatal unit, took out his breathing tube, gave him a mask with oxygen and I went home hoping he would survive the day.
Today John, Sandra and I stopped in to see how he was doing. The nurse pointed to a vigorous crying baby who looked nothing like the baby I saw yesterday. She had to show me the chart so I could believe it was the same little person. He wasn’t even on oxygen and he looked like he was rooting for a good meal.
Sometimes stories turn out better than imagined.

weekend with wheels...sort of...

The weekend was one big adventure…both because we got out and about, and because we did it with all the inefficiency of a good solid African experience! Our route to the nearest shopping center became a detour through the heart of Nairobi…which includes huge traffic jams, what feels like millions of people, iffy roads, crazy driving…constant near misses...really harder to believe that you aren’t crashing than it would be to be having multiple crashes! We finally arrived at Village Market, well secured by guards carrying AK47’s and Billy Clubs. This did make the inside quite relaxing. If anyone tries to do anything too crazy there they will pay…at least it appears that way! We hung out, did some grocery shopping and had great food in a food court type of place…Chinese for John and Indian for Warren and I. It seemed like every nationality in the world was represented in that mall…incredible assortment of people…very cool.
Today we decided we would take a drive down into the Rift Valley and try to find some wild animals. We got ourselves all ready, got some directions and ideas from our neighbors here, got in the car ready and excited…Car won’t start. After multiple attempts, jumper cables, additional gasoline...we gave up. We went for a walk , stopped in the hospital for a peek at the baby Warren helped rescue, and I got a blanket and a book and went out under a tree. About that time Warren gave the car one more try…and it starts! At this point we have about 2 ½ hours until dark…one of the major limiters here(does not feel safe to be on the road after dark, and darkness comes at 6:30), so we jumped in the idling car and took off. The first 5 km down to the valley took us nearly 40 minutes on an unbelievable road…(Nicaragua friends: think that river bed we went up to go ziplining!). Another 40 minutes and we were on the shore of Lake Naivasha. As soon as we got to the end of the dock there was a large hippo swimming by! And on our way out we saw zebra, giraffe, an antelope type of creature…and lots and lots of monkeys as we pulled into Kijabe.
No recognition of Labor Day here of course, so we are back to our daily activities tomorrow. I now have a functioning washing machine, John made the tennis team!, and we will be doing what we can to celebrate Warren's bd! I found bd candles on Sat, and will make my first attempt at baking a cake...at 7000 feet!, with a completely capricious oven...no idea what temperature is happening in there, or how to control it! Should make for another adventure!;)Having a birthday in Africa is probably treat enough!

warren here...

At the end of one week of African medicine it has already been an experience. Figuring out how I fit in continues to occupy a significant part of my day. I am happy to be interacting with many African MD’s, nurses and CO’s(physician asst’s). Kijabe Hospital is a training center for nurses, medical interns, family practice residents, CO’s…and also has MO’s(medical officers) who continue to work after their internship year as they pursue coveted spots in Kenyan residency programs, which they will have to pay for, rather than get paid like we do in the US. Patients arrive in cars, buses, taxis, carried by family…There aren’t any ambulances to bring people. They arrive in every level of acuity and sickness. In the last few days I have treated infected open fractures, heart failure leading to cardiac arrest and death, a young man with recent pneumonia who shows up with an empyema that we could drain with a chest tube, a young woman treated for malaria with abdominal pain who actually has appendicitis…The Western doctors in the hospital come and go regularly and it is never certain what kind of physicians you will actually have available. Normally there is no radiologist, however, for the next year we will have a great doctor from Toronto who can even do some invasive radiology. For the next 2 months we have an experienced Australian surgeon who can make use of the laporoscope equipment that the hospital already has but can rarely make use of.
For my medical friends, here is a little vignette: 49 year old complains of shortness of breath, weakness and high heart rate for one month. Vital signs: HR 160, O2 sats 80’s and low blood pressure. I asked him, thinking that he couldn’t live like this for more than one day, how long he has actually felt this bad. And he says, “One month”. I don’t believe him. However, he comes with an EKG and a CXR from 3 weeks ago, done at a clinic in Nairobi by a doctor who looks like he is a Hem/Onc specialist. The CXR shows significant CHF and a very large heart. The EKG shows HR 120 and not in sinus rhythm. So what do they do for him? I am not sure, but he also comes with a detailed report from 5 days later of an upper endoscopy. His stomach looked fine. You wouldn’t want to start any cardiac meds of course. So after that I actually believed that he was feeling like this for the past month. He started to decompensate. And, as a good ER doctor, I thought…let’s treat him. Nitroglycerine seems like a good idea, but we don’t have any. I would like IV morphine but, after a call to pharmacy, they are out of that drug. How about an IV beta blocker? We don’t have IV beta blockers, but we have Propranolol PO, so why not? We did have Lasix, and oxygen is a drug. However, in the end, a month of untreated heart failure was too much for him. This is an example of inadequate medication and support and also a lack of appropriate decision making. In contrast, I am working with a 3rd year resident level Kenyan doctor who has a fund of knowledge and ability to come up with complex differential diagnoses that is much more than my ability. It can be astounding to see Kenyan trained physicians who have the ability to function at a high level in a Western hospital but are left working with so few resources and little opportunity. Not to paint Kijabe Hospital as a backword undeveloped facility because in fact it is a true light throughout Eastern Africa; I have treated patients who have traveled from as far as Somalia, Sudan and the far edges of Kenya. Injured people on the streets of Mogadishu know to come to Kijabe.

a few photos...

running at elevation...

This morning Warren and I went for our second run since arriving here at Kijabe. 7000 feet in the air makes our efforts quite a bit more challenging...and the course, around the school campus, is full of ups and downs, a few especially steep ups. Our hearts were pounding and we were thinking about how strong we will be if we ever get to the point where we can run the course without stopping and without feeling like our hearts are about to beat out of our throats! Maybe this is a good metaphor for this experience. Life here is a bit more challenging in most areas, but we hope to be stronger for it...?? The people here are certainly stronger than we are in a million ways. Warren has been telling amazing stories about patients already...including the distances they have traveled to be here, the sickness they live with on a chronic basis, and the way he needs to think about cost so as not to burden them with unnecessary bills.
Yesterday our stove was exchanged for one that has a working oven and we happily ate chocolate chip cookies throughout the evening! Warren has been eyeing the rhubarb growing in our "garden" and is hoping for a pie...He kept turning on the broken one and hoping it would turn on if he just waited long enough!
I spent the day in Nairobi learning about food shopping and internet modems. And I saw the American embassy, surrounded by high walls, guards and barbed wire. It looks like a penitentiary. But the previous one was bombed so I guess this is understandable. As we came around the corner to pick up our friend who had gone into the embassy to pick up a letter related to the adoption they are trying to accomplish, a matatu zipped by...and the door flew off! (matatu is the word for the common taxi. they are small mini vans which seat as many as possible and they are everywhere!) The matatu stopped and a few guys ran back to pick up the door! I didn't see if they were able to re-attach it. That seems like a stretch, but who knows?! Maybe this was routine for that particular ride?
My goal is to post a few pictures before the end of today. I think I have enough internet capability for that now...to be determined later!