This last week was interesting in that I relocated two completely dislocated ankles. Two in one week seemed surprising since I relocate an ankle at Northwest about every year or so. The first young man had been in a car accident around three in the morning and friends took him to a nearby hospital. He brought an x-ray that showed a completely laterally dislocated left ankle. The hospital had also fashioned a posterior plaster ankle splint that did a fine job of keeping his leg firmly dislocated. We wouldn’t want the ankle flopping around. He shows up outside the ER around noon in a friend’s car with a referral note from the other hospital. The distal tibia is completely exposed as the skin over the medial malleolus has torn open. I track down a vial of 500mic fentanyl and after 350mics he tolerates me pulling his ankle back into place. He can even wiggle his toes afterwards, and has a good DP pulse. He then went off to the OR for a thorough washout and an ex-fix.
A day or two later another young man shows up straight from a walking injury to his right ankle. He has fallen and suffered a complete medial dislocation with the distal tib/fib exposed and a large skin tear over his lateral malleolus. I find more fentanyl and after giving him 650mics he is still talking on his cell phone but he doesn’t seem to mind when I pull the ankle back into place.
People here are very pain tolerant. They don’t do a lot of screaming/writhing around like I would if I had the same ailment.
Wednesday, October 20, 2010
Saturday, October 16, 2010
Samuel and family...
Our Maasai friend, Samuel, brought his wife and baby to meet us tonight. They had just been to a staff banquet at the school, where he is a guard, so they were dressed in Western clothing. We had so much fun. Samuel is very interested in all things new and modern...He wanted a Facebook account. So...we set him up. He comes to our house to check his email once in awhile and I am sure it will be Facebook now! He said he knows two other Maasai with Facebook so he was trying to find them.
We took a few pictures to load onto his site...Quite a fun and funny project...
His wife speaks much less English, but she was obviously amused by the whole process.
Wednesday, October 13, 2010
a day in the life...
I was feeling a little down this morning…an email that I read before starting into my day?? The return to our “routine” after a few days away?? The fact that the nursing matron wasn’t there at our “appointed” meeting time…Who knows…
After doing a few errands at the school I headed toward the “dukas” (shops in Swahili and the common name for our shopping area, such as it is!
On my way I ran into Samuel, our Maasai friend who works as a guard for the school. He always greets us with friendly eagerness and openness to chat. We ended up in a conversation about family planning, educating his daughters, preventing early marriage for his children and the cultural challenges of his generation as they seek to help their children have more opportunities for their lives. An obvious privilege to get to be in this conversation!
Then I walked to the vegetable market where my friend Jean followed me out after I made my purchases. I sat on the ground with her where she was taking maize off the cob so it could dry on tarps on the ground…She told me about the different types of foods she cooks and I asked her a million questions. I have no idea what they do with many of the things that are for sale here! I hope we can arrange for her to come and teach me. We can.
After lunch our Swahili teacher, Edward, came. At the end of our lesson we ended up having a chat about differences between here and where we live… He is smart and well informed about many things. He had great questions.
Just before dinner Rachel came over. She was bringing me Samosas. I had fresh cookies so she sat down, ate a few and we had a little chat…about her children and mine, about her husband…who isn’t great, about her very elderly mom…and the funniest…about weight differences in our cultures. She could not believe that thin is considered so beautiful in America. I found a Vanity Fair that Alison gave me for the plane ride and announced…”we will not find one fat, or even chubby person in this magazine…even though America is full of larger people….” She could not believe it…and she did not think those thin people were attractive. She said, “you know, if a woman’s husband leaves her here, they will try to get fatter so he will feel bad and think he shouldn’t have left…” I burst out laughing telling her how we have the same syndrome…just the opposite. The world is crazy…
In the end...it was a perfect day....
After doing a few errands at the school I headed toward the “dukas” (shops in Swahili and the common name for our shopping area, such as it is!
On my way I ran into Samuel, our Maasai friend who works as a guard for the school. He always greets us with friendly eagerness and openness to chat. We ended up in a conversation about family planning, educating his daughters, preventing early marriage for his children and the cultural challenges of his generation as they seek to help their children have more opportunities for their lives. An obvious privilege to get to be in this conversation!
Then I walked to the vegetable market where my friend Jean followed me out after I made my purchases. I sat on the ground with her where she was taking maize off the cob so it could dry on tarps on the ground…She told me about the different types of foods she cooks and I asked her a million questions. I have no idea what they do with many of the things that are for sale here! I hope we can arrange for her to come and teach me. We can.
After lunch our Swahili teacher, Edward, came. At the end of our lesson we ended up having a chat about differences between here and where we live… He is smart and well informed about many things. He had great questions.
Just before dinner Rachel came over. She was bringing me Samosas. I had fresh cookies so she sat down, ate a few and we had a little chat…about her children and mine, about her husband…who isn’t great, about her very elderly mom…and the funniest…about weight differences in our cultures. She could not believe that thin is considered so beautiful in America. I found a Vanity Fair that Alison gave me for the plane ride and announced…”we will not find one fat, or even chubby person in this magazine…even though America is full of larger people….” She could not believe it…and she did not think those thin people were attractive. She said, “you know, if a woman’s husband leaves her here, they will try to get fatter so he will feel bad and think he shouldn’t have left…” I burst out laughing telling her how we have the same syndrome…just the opposite. The world is crazy…
In the end...it was a perfect day....
Monday, October 11, 2010
Thursday, October 7, 2010
ER thoughts...
The ER is a unique place in any institution and it is no different here at Kijabe Hospital.
There are truisms in ER Medicine that span continents, race, and money:
1. No one who doesn’t have the ER in their blood wants to be in the ER, and lots of people in medicine don’t have it in their blood.
2. There’s no place like the ER to strip away people’s facades and expose who is going to be there when you need them.
3. I’m convinced that the ER is unique in the way the environment encourages connection, dependence, equality of function amongst all the players in the drama, and a sense of “family”.
4. Like any good family, there are many devious subplots in the ER.
For good or bad I am realizing that my goofy personality is starting to come out in the ER here. It has been a month and a half and things have been so new and serious, but just today I noticed that the jokes were starting and people were laughing and situations in the ER were starting to look funny instead of sad and so serious…….I think I’m infecting this place the same way poor Northwest was infected with me. Beware Northwest……the infection will return, and it might be multi-drug resistant and terminal. I’ll Be Back!
There are truisms in ER Medicine that span continents, race, and money:
1. No one who doesn’t have the ER in their blood wants to be in the ER, and lots of people in medicine don’t have it in their blood.
2. There’s no place like the ER to strip away people’s facades and expose who is going to be there when you need them.
3. I’m convinced that the ER is unique in the way the environment encourages connection, dependence, equality of function amongst all the players in the drama, and a sense of “family”.
4. Like any good family, there are many devious subplots in the ER.
For good or bad I am realizing that my goofy personality is starting to come out in the ER here. It has been a month and a half and things have been so new and serious, but just today I noticed that the jokes were starting and people were laughing and situations in the ER were starting to look funny instead of sad and so serious…….I think I’m infecting this place the same way poor Northwest was infected with me. Beware Northwest……the infection will return, and it might be multi-drug resistant and terminal. I’ll Be Back!
we concluded that the petrol was empty!
look closely at labeling on side of truck, and this is with at least 100 people within 50 yards!
Wednesday, October 6, 2010
"Kenyans like everything..."
Today I spent the day in a large van/bus sort of thing with 26 nursing students. We made our way through tea plantations, coffee plantings, banana trees...until we found a very rural health clinic with 3 male community health workers keeping the doors open on a volunteer basis. Their commitment and resolve was amazing, while the attention I drew from the community children was quite humorous. Jane, one of the nursing instructors said to me, "you are like a white elephant that we brought to their town!"...I am just going to focus on the white part...;)
As we were driving along the old hymn "How Great Thou Art" came on the radio in Swahili. The entire bus load sang along.....very cool.
This was quickly followed by Michael Jackson's Beat It, immediately followed by Kenny Roger's and The Gambler...All loudly accompanied by the students...By this time I was incredulous! What kind of a station is this...and how does this work that these students know all of it? Jane,apparently seeing my expression,says, "We are Kenyans. Kenyans like everything..."
As we were driving along the old hymn "How Great Thou Art" came on the radio in Swahili. The entire bus load sang along.....very cool.
This was quickly followed by Michael Jackson's Beat It, immediately followed by Kenny Roger's and The Gambler...All loudly accompanied by the students...By this time I was incredulous! What kind of a station is this...and how does this work that these students know all of it? Jane,apparently seeing my expression,says, "We are Kenyans. Kenyans like everything..."
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