Polepole...slowly in Swahili. (say the e's, like long a) That is a good summary of how things go. Our roof is back in place and the bathroom is usable, although still in progress. At least the tree crashing through led to a new paint job, which is a nice thing. The seemingly old oil based paint that was used for the job might have taken a few years off our lives, or at minimum stolen a few brain cells!, but it does look cleaner and brighter. The paint smelled horrible!! We are pretty sure that they aren't planning to cut down the entire eucalyptus forest behind our apartment, but I am still sort of wondering. The Kenyan habit of telling you what you would like to hear, as opposed to the actual facts, makes me unsure about the "assurance" I have been given regarding this tree cutting business. The chainsawing has been steady for 3 weeks now!!
All that aside...we had a great Piki ride to our friend's place at Mayer's Ranch last night, where we ate an amazing meal and spent the night so that we wouldn't be riding home in the dark. At 7:30 this morning we rode back so that Warren could take over call in the ICU for the weekend. By the time we got to our place at 8a we had seen many birds, a dik-dik darting across the road and a whole family of baboons. They had heard the neighborhood leapard the night before so we were hoping for a sighting, but the word is that you only see a leapard when it is already on you! They have actually seen it there, but not easily or often. It did run off with the smaller of their two dogs once, puncturing him in the throat just exactly in the place that stole his voice!, but their massive Great Dane, Zeus, chased them down and Elvis has been as good as new, although silent! ever since.
I was met with an enthusiastic response from the matron of the nursing school when I offered my services to them for the year. I am meeting with the faculty on Mon at 9a. John has a mid-term break coming up next weekend. He is brewing plans for Piki rides, camping and a climb up Mt Longonot. So he seems to be settling into life here. And I am sure another weekend of call will bring a few more vignettes from Warren.
Saturday, October 2, 2010
Friday, September 24, 2010
trees through roof!
John's face said it all as he walked down the hill for lunch..."Hmmm....Wow." And then, "Mom! the bathroom no longer has any privacy!"
Yes, that is our bathroom and bedroom under that hole. Too bad the cutters didn't quite get the fall line right?! Another day in our African adventure...
Yes, that is our bathroom and bedroom under that hole. Too bad the cutters didn't quite get the fall line right?! Another day in our African adventure...
A few more vignettes....
1-a 35 year old woman comes in complaining of nausea vomiting and abdominal pain for the past few weeks. X-rays show high grade small bowel obstruction. Surgery finds multiple small abscesses; congealed material and small bowel adhered together, requiring side to side re-anastomosis. After seeing her in the ED I reconnect with her in the ICU where she is a few days post-op and I am on call for the weekend. Her breathing worsens over the weekend requiring intubation and her CXR shows evidence of ARDS; not good. I am unable to save her in spite of pressors and respiratory support. I won’t know what she had but I bet it was likely reactivation TB in her abdomen. My Kenyan colleagues tell me that they are seeing more TB in places other than the lung with no history of a prior known TB infection in the lung. Lots of TB around here, without all the isolation paranoia that we have; I won’t be surprised if I turn PPD positive by the time I’m done around here.
2-a 33 year old known diabetic with a history of pneumonia one month ago comes in complaining of increasing shortness of breath. The resident calls and tells me that the patient has pneumonia on the CXR and should do well on oxygen and antibiotics; but maybe a good idea to keep an eye on him in the ICU. I come in to check on him in the Unit and he is breathing 50 times per minute with a believable pulse ox of 66% on mask oxygen. Clearly he’s not talking much and his sugar is high-say around 600. His BP is around 220 systolic which I am glad about since it’s always nice to have more blood pressure than less; that goes for sugar too. But the CXR looks more like CHF than pneumonia and besides the patient is a little puffy. Another intubation and this time out comes pink tinged frothy sputum like a small soda fountain; just like the textbooks said ( I think that’s what they said, at least the lecturer must have said something like that). A little suction, a little lasix, and the sat’s perk right up to 88% which I consider a cure. 4 days later he’s out on the general ward. If you had seen the general wards here at Kijabe that would mean something to you. You’d better basically be ready to go home if you want to survive out on the general ward. Think of the hospital scenes from the English Patient and you have a good mental image; except throw in a little more grime and smell.
A few medical thoughts:
-Try managing ventilated sick patients with no ability to order ABG’s; it’s possible to do.
-Remember my sick newborn that I ventilated and bagged for an hour and never could figure out the old German ventilator? Well a pediatrician came this week for a month and we have two preemies on ventilators, so I got a bit of an in-service on them and now feel confident that I can set up a tiny little baby on a ventilator should I need to.
-Can patients survive without the ability to order vicodin? Yes they can, and they don’t die. I guess they just feel miserable.
-Little sticky electrodes that we use for hooking people up on telemetry monitors are really good things and when you don’t have them it is a problem. I guess they are a donated item; must be expensive.
2-a 33 year old known diabetic with a history of pneumonia one month ago comes in complaining of increasing shortness of breath. The resident calls and tells me that the patient has pneumonia on the CXR and should do well on oxygen and antibiotics; but maybe a good idea to keep an eye on him in the ICU. I come in to check on him in the Unit and he is breathing 50 times per minute with a believable pulse ox of 66% on mask oxygen. Clearly he’s not talking much and his sugar is high-say around 600. His BP is around 220 systolic which I am glad about since it’s always nice to have more blood pressure than less; that goes for sugar too. But the CXR looks more like CHF than pneumonia and besides the patient is a little puffy. Another intubation and this time out comes pink tinged frothy sputum like a small soda fountain; just like the textbooks said ( I think that’s what they said, at least the lecturer must have said something like that). A little suction, a little lasix, and the sat’s perk right up to 88% which I consider a cure. 4 days later he’s out on the general ward. If you had seen the general wards here at Kijabe that would mean something to you. You’d better basically be ready to go home if you want to survive out on the general ward. Think of the hospital scenes from the English Patient and you have a good mental image; except throw in a little more grime and smell.
A few medical thoughts:
-Try managing ventilated sick patients with no ability to order ABG’s; it’s possible to do.
-Remember my sick newborn that I ventilated and bagged for an hour and never could figure out the old German ventilator? Well a pediatrician came this week for a month and we have two preemies on ventilators, so I got a bit of an in-service on them and now feel confident that I can set up a tiny little baby on a ventilator should I need to.
-Can patients survive without the ability to order vicodin? Yes they can, and they don’t die. I guess they just feel miserable.
-Little sticky electrodes that we use for hooking people up on telemetry monitors are really good things and when you don’t have them it is a problem. I guess they are a donated item; must be expensive.
Thursday, September 23, 2010
Wednesday, September 22, 2010
first visitors!
Our beloved friends, Mickey and Carol Berberian, just left. They spent the past 4 days with us and it was wonderful! They were on their way home from accompanying their daughter Christina and Victor as they brought baby Yohani home to Mozambique for the first time! So this was a bonus treat for us...and we are so grateful it could happen!
We heard stories from Mozambique, showed them our new place, drove on crazy roads, walked among the giraffe, zebra, wildebeest, antelope on Crescent Island...and shopped in the Maasai Market. We saw the locales for Out of Africa and Born Free and obsessed about Lord Delamere. They got a good feel for some of the experiences Warren is having at the hospital, as he was working in and around our adventures. They heard of some of the pitfalls of this kind of medicine...and some of the bad outcomes that can come as a result of minimal resources...like death, quite a lot of it actually! But they also got to meet some of the wonderful people he is working alongside.
It will be quiet without them here now...unfortunately I doubt they will get by without taking our horrid colds with them, so we will be forefront in their memory for a few more days!
Tonight I will put up pictures from our Crescent Island visit, one of the most surreal, magical...out of this world places I have ever been.
We heard stories from Mozambique, showed them our new place, drove on crazy roads, walked among the giraffe, zebra, wildebeest, antelope on Crescent Island...and shopped in the Maasai Market. We saw the locales for Out of Africa and Born Free and obsessed about Lord Delamere. They got a good feel for some of the experiences Warren is having at the hospital, as he was working in and around our adventures. They heard of some of the pitfalls of this kind of medicine...and some of the bad outcomes that can come as a result of minimal resources...like death, quite a lot of it actually! But they also got to meet some of the wonderful people he is working alongside.
It will be quiet without them here now...unfortunately I doubt they will get by without taking our horrid colds with them, so we will be forefront in their memory for a few more days!
Tonight I will put up pictures from our Crescent Island visit, one of the most surreal, magical...out of this world places I have ever been.
Sunday, September 12, 2010
another kind of outcome...
A Kenyan man comes into the ER agitated, saying, "I have a sick boy outside..." I grab an old wheelchair and walk out with him to find a white truck with two people inside. We don't have any spare stretchers at the time, so three of us help wheel him into "Casualty"(ER) and kick someone healthier off a stretcher. Once on the stretcher the boy is found to be pulseless and apneic and we proceed with a trauma resuscitation...Kenya style. Someone initiates lightweight CPR. I intubate the boy. We establish two IV's quickly with fluids running in, adrenaline is found and given, there is an ancient Zoll defibrillator that actually charges with a whine and delivers a solid shock! I am encouraged by the fact that the machine works. However, it is clear that the teenage boy doesn't. It is a sad moment to realize that he is beyond our help. We can only stop and ask what happened??
Apparently the truck was going down a nearby stretch of road, that is much like driving down a dry river bed, when the boy ran out in front of the truck while collecting firewood. The two men in the truck collected the boy and drove him to the hospital. Here in Kenya it is important that we keep the truck and the driver from leaving the hospital while the driver must walk to the nearest police station and bring the police back to the ER for an investigation. The truck was locked in behind gates in the hospital parking lot. Eventually some police officers did show up, as did some family members. Things seemed surprisingly calm, quiet and low key really. I couldn't understand much of what was going on so I asked one of the residents to tell me what was happening. Apparently the truck driver had to bribe the police at the station before they would come to write a report. The resident said the report stated that the boy was in the truck when it accidentally rolled over.
Clearly police reports aren't about investigating the facts. So much revolves around bribes and manipulating situations so that you can get on with your day. Never mind the loss of life or the long term impact on the family.
Apparently the truck was going down a nearby stretch of road, that is much like driving down a dry river bed, when the boy ran out in front of the truck while collecting firewood. The two men in the truck collected the boy and drove him to the hospital. Here in Kenya it is important that we keep the truck and the driver from leaving the hospital while the driver must walk to the nearest police station and bring the police back to the ER for an investigation. The truck was locked in behind gates in the hospital parking lot. Eventually some police officers did show up, as did some family members. Things seemed surprisingly calm, quiet and low key really. I couldn't understand much of what was going on so I asked one of the residents to tell me what was happening. Apparently the truck driver had to bribe the police at the station before they would come to write a report. The resident said the report stated that the boy was in the truck when it accidentally rolled over.
Clearly police reports aren't about investigating the facts. So much revolves around bribes and manipulating situations so that you can get on with your day. Never mind the loss of life or the long term impact on the family.
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