Hello to anyone who might still be checking this blog- i thought i would close it out today and post a final post with just general thoughts about the whole trip. I have been back about 36 hours now and feel like i have had a chance to process some feelings and put them to paper (or in this case computer). Our travels home went fine but were very long due to excess layover times. It was much easier to sleep on the evening flight this time so i think overall our jet lag will be less. I am going back to work today so i hope it will be true.
First of all i need to thank so much many of you for all your support, encouragement and prayers. It was not an easy thing for me to do this trip- i have admitted to the control freak thing and i admit now to also not being a very good "traveler"- what i mean by that is the part about the airplanes, taxi's etc. -I love being in other cultures and i love being in new places but the part about getting there and back is the problem. If i could just be bewitched, twitch my nose and be somewhere else i would be great. I particularly don't like to fly across the ocean. I have read several self help books about this fear of flying thing and understand that is is completely illogical but that is the thing about phobias, they are illogical. Katie was very patient with me this trip and i did a good job not letting on how uncomfortable and anxious i was. One of my other "worries" was leaving the rest of my family- upon my return i can report that with the help of so many of you they are alive and actually well. I have learned that despite the fact I think i am indispensible to them, they are fine on their own. Frank actually can turn his cell phone on during the day and Andrew can actually do his own laundry and make his own breakfast. ( i spoil him terribly) Allie had several interviews for summer internships while we were away and Frank was able to counsel her and advise her. I think if i had been home he would have missed that opportunity and that is what grows relationships. I am thankful for the special time Frank had with both Allie (before she went back to Nashville) and with Andrew.
So back to the thank yous- i have to start with even before i left since i forgot a few. The evening before i left i realized that i didn't have a journal to write in - i figured i would just wing it on some loose leaf paper and cut and paste into something nicer when i returned. Also the night before i left, decided that i couldn't take mefloquine what i had thought i would take for malaria prophylaxis- there are several meds that are available and each with their own side effect profile. We have an HSA (perfect coverage for healthy family of 5 unless you need to buy expensive medications) and so we pay for meds out of pocket. The cost difference is huge in the malaria meds so we had been planning on katie taking malarone which is quite expensive as she had already had an allergic reaction to mefloquine the cheap one and that i would take mefloquine. Its main side effect is anxiety, and nightmares. who knows if it was just normal anxiety over the big trip, add alittle menopause and then the psychiatric side effects of the malaria med which i had taken for the week before the trip but i was not doing well. it was too late to go to the pharmacy again so i thought i would just sleep under mesh nets and hope for the best. Many of the permanent mission docs don't take malaria prophylaxis as Tenwek is at higher altitude for the mosquitos but most visitors take it. So Liz Niehaus to the rescue- not even knowing my dilemma she called late that evening and mentioned she had quite a bit of malarone left over from when emily went to kenya the summer before and that she would drop it off on my porch. she probably didn't know it but she left me about 250 dollars worth of meds - and in the little care package was a new journal- how did she know! Thanks Liz for your thoughtfulness - and i think the malaria prevention was extremely neccessary this trip- rainy season ended the day we arrived and there were tons of mosquitos everyday getting bitten. I am sure i would have contracted malaria otherwise.
Thanks to all who dropped off meals for Frank and Andrew- the Finches, Walshes, Smiths, Niehaus, Cannary's - they now know they like pot roast and chicken curry. They didn't go hungry while i was away. And thanks to Magradey's and Dunnigans for letting Andrew act like one of your own- i understand he spent quite a bit of time at your houses after school and on weekends.
So i learned alot about myself these last few weeks- i already knew i didn't like change but i learned that change can be good- it is God's way of shaping and molding us into who He wants us to be. It grows us as people and teachs us to be more flexible which in turn helps us to see other ways to do and look at life. Change helps us learn to adapt and takes us out of our comfort zone. And that is one thing that we can always count on in life- it will always present change to us. But in the midst of that change is several constants that can help us adapt- one is our relationships. I feel so loved and supported by my family and friends. You all are a constant that i can count on. Frank and i have never been apart for more than 7 days in our almost 22 years of married life. I realized when i came home how much i count on him for being that constant in my life. I love how much he doesn't change- even after not speaking for 3 weeks (except at the skype into church) , when i called him to tell him we had landed in the US in Atlanta and were safe and sound back in the States, he told me in a muffled voice that he was teaching a small group at the med school and could i call him back after 4 pm. I smiled at Katie and told her how lucky we were that Dad was our constant. I know he was so glad we were back so he could shut his phone off. But most importantly, I learned that God is the main constant in our lives. That without trusting and turning our lives over to Christ we are falsely thinking we are in control. We can't be in control (believe me, i have tried) and there is an incredible peace that comes when one has faith in Christ. I have been to some bible studies where people talk about "what is Christ doing in their lives". I have always felt uncomfortable about that concept- but i think for me it is not what He is doing in my life- it is just giving my life over to Him. Living my life everyday In Christ is how it works for me. Maybe it is just semantics but it is easier for me to get my mind wrapped around giving my life over that what He is doing for me. I guess another way to put it is that He "did it for me" on the cross and that is the act that changes my life. It is what He did that gives us life and if we realize that -our lives are His. That may not make any sense but it is one of those concepts that is hard for me to put in writing.
I hope we will be able to go to Kenya again- the work was exilarating and has refreshed me. The mission field is a place like no other where it is so easy to live an open Christian life- easily mixing work with worship. I hope to bring that back with me to my practice here in Columbia.
Thanks to all for following our blog- i know there are many of you in Wisconsin through my parents church and also friends from all over the country. We are so fortunate to have all of you in our lives. Keep in touch and know all of you are in our thoughts and prayers.
With deep thanks,
Tracy and Katie
Thursday, January 20, 2011
Thursday, January 13, 2011
Thoughts to improve american medical education and more
Yesterday marked the end of the first week of the new interns starting here at Tenwek, training in medicine surgery pediatrics and OB/Gyn. There is a daily morning conference from 8-9 am where the interns on call the night before present some of the new cases- much like how we do it in the US. Initially i thought that the Attendings (faculty physicians) were too lenient and soft on the group- i was expecting that the interns would be more prepared both to present the patient and also more prepared/equiped with medical knowledge to actually take care of the patient. It is a very different teaching style here- in the US morning report we quiz and "grill" our medical students and residents expecting them to have all the answers and when they don't there is a tendency to make them feel inadequate in their basic knowledge and frankly sometimes just outright dumb. I remember when i was a resident having times i felt completely lost and humiliated at my lack of knowledge about a particular medical problem. So yesterday i had a completely humbling and really life changing experience at morning report. It went like this-
So after a week of work, so that all the new interns have met all the faculty and have had a night of call to get their feet wet they have a unique ceremony. Whether you are a Christian or not it is an amazing change in how one would look at the role if one was a teacher/mentor. First one of the permanent mission doctors read John 13- a passage where Jesus near to his crucifixion washes the feet of his disciples- acting as the ultimate servant. He teaches them that all will be washed clean by Him and that just as he has washed their feet, they also shall wash one another's feet. Then, they had each and every new intern (there are 20 of them) take off their shoes and socks and then one by one each intern came up to the front of the room to have their feet washed by one of the Attendings. WOW! The Attendings here really believe it is their duty and their calling to "serve" these young medical doctors by training them to be the best doctors they can be. There is no way i can picture any of us in my department or any USC department getting on our hands and knees and doing that- and even if you take the actual feet washing part out, to change ones thinking and mentality that it is to be a servant to those we are training rather than the other way around- the interns/residents serving us. It was an amazing experience to be part of. I hope i will keep that in my heart when i return- that it is a privilege and my calling to train young physicians. I know it will be particularly difficult when we have a resident who is having difficulty in their training- we often just complain about how "bad" they are and sometimes we even kick them out of the program. I think there is a plan and a place for everyone, even if it turns out to not be to finish the program but to "serve" them by helping them find their way.
A second way that is somewhat unique here that i think would improve the American medical education system and can be translated into any field of work is the concept of what they call "chai time." Somewhere mid morning (usually around 10:45) all services in the hospital stop what they are doing (unless it would hurt patient care) and sit down all together- nurses, doctors, students, residents, chaplains, physical therapists (there is only one :)), and unit clerks over a cup of chai. Chai is a delicious tea that is made with milk and just the right amount of sugar. For 15-20 mins everyone relaxes and enjoys each others company, sometimes talking about medicine, sometimes life in general. It is so nice to get to know the people you are working with and the most important thing to me is there is no hierarchy. (ie; the doctors don't think they are better than the nurses or the nurses better than the unit clerk, you get the idea). It is a special time that i think actually leads to better patient care as even though we have stopped what we were doing for 15 mins, there is a sense of comaraderie about patient care. I really think it would lead to a better work environment and increased job satisfaction if we did something like that in the US. ( plus the tea is really really good)
One last story that doesn't have anything to do with bettering medical education- one for my nurse Carolyn who i hope is following this. Many of you know as you are patients of mine or work in our office that she and i are your typical Type A, somewhat OCD (obsessive compulsive disorder) type people and together we make everyone else around us who happen to be more type Type B crazy. I personally think our personality disorders improve our patient care but i leave that up for debate ( i am sure judi our other nurse could comment on that ) As you probably remember from previous postings this place is total chaos- there is no order to the charts, there is often no chart just a bunch of paper stuck together with paperclips and there is just junk/stuff all over the work space (small nurses stations) Carolyn would really need to be locked up if she was trying to work here. Yesterday while i was sitting at one of these disorganized messy desks speaking to one of the permanent surgeons about a patient, i didn't notice it but while we were talking i inadvertantly had been putting all the charts in order- first history page, then orders, then progress notes, then labs - we had quite a long conversation and then again not even paying attention to what i was doing i started to put the 6 charts (it was ICU with only 6 patients) in order- bed 1, bed 2 bed 3 etc. All of sudden the surgeon just burst out laughing and asked me if i even noticed what i was doing. He told me he remembered that he used to try and do that years ago when he came to Tenwek and that if i stayed long enough i too would stop noticing how little organization there was to their system. I didn't have the heart to tell him i hadn't even noticed i as doing it. Tell Nancy and Angela from our file room, i will be giving them a big hug when i see them next.
Katie is out with Community Health today- i am not sure what the exact project was- someone told me they were building some kind of large sand water filter system for a village. i guess i will hear about it when she comes home tonight. Yesterday she went out with home hospice and got stuck in an amazing downpour of rain- a true deluge. I have never seen rain like that before. I think she had a good day but was frustrated with listening to swahili and kipsigis (the local tribal language) all day. She is going to look and see if they have a class in swahili at Brown- or look into mission work in one of the african countries that speak french as she has had several years of French.
I turned in my pager today and had a nice lunch (the main meal of the day here ) with the other Internist who has been my mentor. He is a brilliant man and has the patience of Job. Perfect combination to run the medical wards here.
I do not know if we will have internet access starting tomorrow but will be in touch if we do.
Lots of love and sorry about the length of this post- i just thought it might be our last.
Tracy
So after a week of work, so that all the new interns have met all the faculty and have had a night of call to get their feet wet they have a unique ceremony. Whether you are a Christian or not it is an amazing change in how one would look at the role if one was a teacher/mentor. First one of the permanent mission doctors read John 13- a passage where Jesus near to his crucifixion washes the feet of his disciples- acting as the ultimate servant. He teaches them that all will be washed clean by Him and that just as he has washed their feet, they also shall wash one another's feet. Then, they had each and every new intern (there are 20 of them) take off their shoes and socks and then one by one each intern came up to the front of the room to have their feet washed by one of the Attendings. WOW! The Attendings here really believe it is their duty and their calling to "serve" these young medical doctors by training them to be the best doctors they can be. There is no way i can picture any of us in my department or any USC department getting on our hands and knees and doing that- and even if you take the actual feet washing part out, to change ones thinking and mentality that it is to be a servant to those we are training rather than the other way around- the interns/residents serving us. It was an amazing experience to be part of. I hope i will keep that in my heart when i return- that it is a privilege and my calling to train young physicians. I know it will be particularly difficult when we have a resident who is having difficulty in their training- we often just complain about how "bad" they are and sometimes we even kick them out of the program. I think there is a plan and a place for everyone, even if it turns out to not be to finish the program but to "serve" them by helping them find their way.
A second way that is somewhat unique here that i think would improve the American medical education system and can be translated into any field of work is the concept of what they call "chai time." Somewhere mid morning (usually around 10:45) all services in the hospital stop what they are doing (unless it would hurt patient care) and sit down all together- nurses, doctors, students, residents, chaplains, physical therapists (there is only one :)), and unit clerks over a cup of chai. Chai is a delicious tea that is made with milk and just the right amount of sugar. For 15-20 mins everyone relaxes and enjoys each others company, sometimes talking about medicine, sometimes life in general. It is so nice to get to know the people you are working with and the most important thing to me is there is no hierarchy. (ie; the doctors don't think they are better than the nurses or the nurses better than the unit clerk, you get the idea). It is a special time that i think actually leads to better patient care as even though we have stopped what we were doing for 15 mins, there is a sense of comaraderie about patient care. I really think it would lead to a better work environment and increased job satisfaction if we did something like that in the US. ( plus the tea is really really good)
One last story that doesn't have anything to do with bettering medical education- one for my nurse Carolyn who i hope is following this. Many of you know as you are patients of mine or work in our office that she and i are your typical Type A, somewhat OCD (obsessive compulsive disorder) type people and together we make everyone else around us who happen to be more type Type B crazy. I personally think our personality disorders improve our patient care but i leave that up for debate ( i am sure judi our other nurse could comment on that ) As you probably remember from previous postings this place is total chaos- there is no order to the charts, there is often no chart just a bunch of paper stuck together with paperclips and there is just junk/stuff all over the work space (small nurses stations) Carolyn would really need to be locked up if she was trying to work here. Yesterday while i was sitting at one of these disorganized messy desks speaking to one of the permanent surgeons about a patient, i didn't notice it but while we were talking i inadvertantly had been putting all the charts in order- first history page, then orders, then progress notes, then labs - we had quite a long conversation and then again not even paying attention to what i was doing i started to put the 6 charts (it was ICU with only 6 patients) in order- bed 1, bed 2 bed 3 etc. All of sudden the surgeon just burst out laughing and asked me if i even noticed what i was doing. He told me he remembered that he used to try and do that years ago when he came to Tenwek and that if i stayed long enough i too would stop noticing how little organization there was to their system. I didn't have the heart to tell him i hadn't even noticed i as doing it. Tell Nancy and Angela from our file room, i will be giving them a big hug when i see them next.
Katie is out with Community Health today- i am not sure what the exact project was- someone told me they were building some kind of large sand water filter system for a village. i guess i will hear about it when she comes home tonight. Yesterday she went out with home hospice and got stuck in an amazing downpour of rain- a true deluge. I have never seen rain like that before. I think she had a good day but was frustrated with listening to swahili and kipsigis (the local tribal language) all day. She is going to look and see if they have a class in swahili at Brown- or look into mission work in one of the african countries that speak french as she has had several years of French.
I turned in my pager today and had a nice lunch (the main meal of the day here ) with the other Internist who has been my mentor. He is a brilliant man and has the patience of Job. Perfect combination to run the medical wards here.
I do not know if we will have internet access starting tomorrow but will be in touch if we do.
Lots of love and sorry about the length of this post- i just thought it might be our last.
Tracy
Wednesday, January 12, 2011
Jenny Walsh's magic flashlight
I took my last night of call on tuesday and worked with a new intern named Edna. I think it is sort of weird how they all have English/American names yet live such different lives. Just before i left for Kenya, my dear friend Jenny stopped by to drop off a few things and to see me off. She has been to Kijabe, a similiar hospital a bit nearer to Nairobi so she had some helpful advice. She brought me some medical books which i have used quite a bit, but the most amazing gift (i can't remember is she told me i have to give this back so it might have been an amazing loaner) was a unique small flashlight. Initially i thought it was totally unneccesary and that i would just put it in my backpack. Of course i acted like it was really cool and that i would use it alot. Little did i know it would be one of the most important things i carried with me to Kenya. First, Katie and i are living in some housing called the Guesthouse. It has small studio apartments and a few single rooms for medical students rotating here. It is at the far corner of the hospital complex. When we came to Tenwek as a family in 2006, we were given a nice home that was right in the middle of everything on a well lit path as there was a family who works here permanantly on furlough. I also didn't take nearly the night call in 2006 as i did this trip. So my first use was as a normal flashlight to find my way to the hospital at 3 am as the path to the Guesthouse to the main walkway is not well lit. Secondly, in contrast to the US where every exam room has a oto-ophthalmoscope on the wall that functions as a light, there is nothing like that here. Also, there are no drug reps to give you free penlights here and none of the Kenyan doctors seem to have invested in a light to look at the mouth or pupils or to better illuminate any body part for that matter. So, the magical flashlight stayed in my white coat pocket during the day. Thirdly, it is a really cool device that the lighted end screws off and then you can turn it upside down and reattach it to the base and use it then like a candle as it sends off more of a diffuse light signal. This was so helpful in the late evenings if Katie wanted to go to bed earlier, or i was needing to look something up in a book in the middle of the night so i didn't need to turn on any of the lights in the room as we have a single studio. Lastly and most surprising on several occasions on call while in the hospital it served as the ONLY light available during what seemed to be frequent power outages. Often the power would go out for just a few seconds but occasionally it was minutes and on one memorable occasion it was probably 10 minutes. On that fateful night, i was in ICU and one of the interns had just began to put in a central line (a larger IV line that goes into the neck or under the clavicle.) For those of you who know medicine, it is something that once you start you do not want to get interrupted as you have to use guidewires etc. So just as the blood flash comes through the needle (first step after "prep and drape in the usual fashion") the lights go out. So Jenny Walsh's flashlight to the rescue! I quickly pulled it out of my pocket and the intern continued the procedure with me holding the light just where it needed to go. The Kenyans thought i had magical powers! They didn't have much time to gawk as with a 10 min power outage several of them had to manually ventilate the 3 patients that were on the ventilators we have as they don't work without electricity. It all was surreal. And they don't get upset or frustrated as that is just how life is for them here.
So Jenny, i am so glad you had such wisdom in your gift- little did i know how much use it would get.
Katie is off on a great adventure today with home hospice team (can you believe they have that here?) They can only visit 5 to 6 homes a day as they are so far apart- also i understand that the hospice job involves some hiking as the vehicles can only make it so far. I know she will have some amazing stories to tell when she returns.
Tomorrow is our last day of work so more news soon- it is hard to imagine we have been here 2 weeks- we have friday, sat. safari and then sunday one day to explore nairobi ( Liz- if Emily has any suggestions let us know as she spent all summer working in and exploring nairobi) Monday we return but since it takes 24 hour travel we don't get home until tuesday. Thanks to all who have been taking care of Frank and Andrew- i understand they are not going hungry and Andrew has not been lonely living some at the Magradey and Dunnigans. Thanks so much, i know i could never have left my boys without all of your help.
Lots of love
Tracy
So Jenny, i am so glad you had such wisdom in your gift- little did i know how much use it would get.
Katie is off on a great adventure today with home hospice team (can you believe they have that here?) They can only visit 5 to 6 homes a day as they are so far apart- also i understand that the hospice job involves some hiking as the vehicles can only make it so far. I know she will have some amazing stories to tell when she returns.
Tomorrow is our last day of work so more news soon- it is hard to imagine we have been here 2 weeks- we have friday, sat. safari and then sunday one day to explore nairobi ( Liz- if Emily has any suggestions let us know as she spent all summer working in and exploring nairobi) Monday we return but since it takes 24 hour travel we don't get home until tuesday. Thanks to all who have been taking care of Frank and Andrew- i understand they are not going hungry and Andrew has not been lonely living some at the Magradey and Dunnigans. Thanks so much, i know i could never have left my boys without all of your help.
Lots of love
Tracy
Tuesday, January 11, 2011
week and hello from katie
Hi friends and family!
The plan for this blog is I am going to catch you up from where I left off last week Thursday, and then tell you about the plans for the rest of the week.
Friday, I went to surgery which was really great one of my top favorites so far. I watched two femur fractures, some pins put in a kids broken bones around his elbow, and a pin taken out of a femur that was getting infected (so the removal of what was put in a femur fracture from years ago). It was really nice because there were two doctors' rooms that I got to pop in and out of and the cool thing was they were both using different "techniques" I guess you could call it. One doctor was using a C-arm (x-ray-ish machine used to find the exact places of brokenness and smaller/less incisions are needed for this way) and then the other doctor was doing the typical way of opening it all up like usual to see it all. I am sure my dad can fill in all the rest of the details but thats the very basic explanation.
Saturday was lazy, slept in, did some laundry, read some of a book, went on a short walk. Yep just a detox day for me. Sunday we had church in the morning and then I walked to the top of Motigo, a small mountain/hill near Tenwek (which I think mom already said), and did our skyping! But yeah my weekend was very relaxed compared to mom's. I am just going to say because I don't think she did, she worked her butt off this weekend. No one is supposed to be on call 3 days in a row, and just on accident mom didn't know that. But she was truly wonder-woman of the hospital this weekend and everyone should know that.
Yesterday I went to PEDS which was alright but not my favorite, perhaps because I don't like it that there are really sick children, and also because a lot of the time they were talking in lingo, I totally could not figure out haha. Then today I went to opthomalogy which I liked a lot. It was cool to see them take blind peoples' cataracts out and put in new lenses so that in just a few days they will be able to see again. That too would be a miracle for the patients when they can see again (which I didn't get to see today, I only saw surgeries). The doctor said I have to eventually see a patient who has had their cataracts removed and can see again for the first time, and then I will definitely become an opthomalogist.
But that is it for now. We have two more days at Tenwek, which makes us sad now that we have finally gotten used to all the kenyan eccentricities we are leaving. We are going to go on a safari for two days with two of our guesthouse friends. Then we are going to go back to Nairobi from the safari and spend the day monday there before we fly back late at night. So if anyone knows anything fun to do in Nairobi let us know! But just as a heads up there might only be two more days of blogs because I do not know if we will have internet access at either of the two places we are staying after this. But just know we love you lots and can't wait to see and hear from you back in the states!
The plan for this blog is I am going to catch you up from where I left off last week Thursday, and then tell you about the plans for the rest of the week.
Friday, I went to surgery which was really great one of my top favorites so far. I watched two femur fractures, some pins put in a kids broken bones around his elbow, and a pin taken out of a femur that was getting infected (so the removal of what was put in a femur fracture from years ago). It was really nice because there were two doctors' rooms that I got to pop in and out of and the cool thing was they were both using different "techniques" I guess you could call it. One doctor was using a C-arm (x-ray-ish machine used to find the exact places of brokenness and smaller/less incisions are needed for this way) and then the other doctor was doing the typical way of opening it all up like usual to see it all. I am sure my dad can fill in all the rest of the details but thats the very basic explanation.
Saturday was lazy, slept in, did some laundry, read some of a book, went on a short walk. Yep just a detox day for me. Sunday we had church in the morning and then I walked to the top of Motigo, a small mountain/hill near Tenwek (which I think mom already said), and did our skyping! But yeah my weekend was very relaxed compared to mom's. I am just going to say because I don't think she did, she worked her butt off this weekend. No one is supposed to be on call 3 days in a row, and just on accident mom didn't know that. But she was truly wonder-woman of the hospital this weekend and everyone should know that.
Yesterday I went to PEDS which was alright but not my favorite, perhaps because I don't like it that there are really sick children, and also because a lot of the time they were talking in lingo, I totally could not figure out haha. Then today I went to opthomalogy which I liked a lot. It was cool to see them take blind peoples' cataracts out and put in new lenses so that in just a few days they will be able to see again. That too would be a miracle for the patients when they can see again (which I didn't get to see today, I only saw surgeries). The doctor said I have to eventually see a patient who has had their cataracts removed and can see again for the first time, and then I will definitely become an opthomalogist.
But that is it for now. We have two more days at Tenwek, which makes us sad now that we have finally gotten used to all the kenyan eccentricities we are leaving. We are going to go on a safari for two days with two of our guesthouse friends. Then we are going to go back to Nairobi from the safari and spend the day monday there before we fly back late at night. So if anyone knows anything fun to do in Nairobi let us know! But just as a heads up there might only be two more days of blogs because I do not know if we will have internet access at either of the two places we are staying after this. But just know we love you lots and can't wait to see and hear from you back in the states!
Monday, January 10, 2011
Weekend Madness
First of all let me say how awesome it was to have been able to live skype into the Revelations service yesterday at SVPC!! It was amazing to have the technology to see all of you and hear your voices. Cathy Reisch, thank you so much for making that happen. It was a special time for us to have with all of you. Later in the day we were able to Skype with Allie (our oldest daughter who lives in Nashville) so by the end of the day we had been in touch with all of our immediate family, and so many of our church friends. I am not sure why the connection didn't work for the later church service. Katie and i got the Skype call but we only got sound and it seemed like it was during music and announcement time. I am sorry that we missed that part of our church family.
So besides our special skype time it was a busy weekend on call for medical wards. I am pretty tired today but for some reason can't nap well here. I treasure a nap at home but for some reason it just doesn't work well here. I think all the adrenaline floating around my system may have something to do with it. They call the ER here Casualty. Because most people arrive by walking or matatu (crowded taxi like vehicles) that cannot travel on the dirt roads after dark, most patients (which they call clients) arrive before it gets dark. At the equator that is about 7:30 every night without much fluctuation from season to season. So there is quite a bit of overflow into the waiting area which is just this big open outdoor space outside the actual ER area. It is so strange to just call names out into the night air and someone comes hobbling in. The ER space holds only about 10-12 people so there were 50-100 clients just hanging out all day sat. and sunday to be seen. If a patient gets discharged from Casualty after dark they often just sleep on the ground outside (the same place as the waiting area) and walk home the next morning. This weekend it sort of reminded me of a small refuge camp but they do have bathroom facilities available and there is a small canteen for food they can purchase so it really isn't too bad. We had 3 deaths per day on friday, saturday, and sunday. Initially you will remember how disappointed and frustrated i was with the fact that we had so many deaths but it seems normal to me now. They were all due to mostly irreversible problems so it didn't seem so bad. On the upside, we had a typical "code blue" run on a young man who had taken poison that was actually successful and he is still alive although gravely ill. The ICU nurse told me he had only seen 2 successful recussitations in his 10 year career so i was glad i helped add to his third. The Kenyans are quite impulsive people and they have a surprising number of suicide attempts/gestures, mostly due to domestic disputes. They take something called Triatrix which is an organophosphate that is readily available to many of the farmers as it is a pesticide. It is a bonus that is also cheap. Some dilute it to make it more palatable, some take it straight up but it is quite lethal at not very large doses. I think we have about 50 percent survival if they get to Casualty within a 3-4 hour window. On the other hand, they don't seem to have much domestic violence - strange that when they have a disagreement with their spouse, they hurt themselves rather than to take the anger out on the other. Someone out there in psychiatry/counseling try to help analyze that. (Nancy, want to take a shot at that?) No other strange things now that TB and all the HIV related illnesses are old hat to me. I did see a case of pericardial tuberculosis that the effusion was so big- for those medical people reading this it was the classic waterbottle heart and i took a photo of the chest xray to bring home with me, it was so impressive and we don't see it much in US. If we see anything like it is not nearly as severe and would be most commonly from Lupus or some metastatic cancers.
The waterfall and dam photos on the previous posting Katie took when she walked to Motego, the highest point in this area. She has found some good friends in one of the med students rotating here and a young pediatrician from Cinncinati. The waterfall/dam is functional for several reasons to this area. They have built a hydroelectric plant which supplies all the electricity to the hospital compound. Also we realized that Sat and Sun are "laundry and bathing" days as there were apparently many people washing their clothes and their bodies on the side of the dam in the river (which is completely brown colored by the way) as the dam makes it easy to reach the water on the upside. We always see people fishing and relaxing in this area as well so it serves for food and social as well. It was a good picture to take and explain as the river is important for so many reasons.
Ann Canary mentioned in one of the comment sections the book Cutting for Stone- those in Book Club will remember it- now that i am back in Africa it seems so close to home. For those who haven't read it i do recommend it- although it takes place at a mission hospital in Ethiopia it really has the same feel of medicine in any African country. Ann Kisinger suggested a book called The Boy who Harnessed the Wind ( William Kamkwamba author) which i just finished. I think we are reading it for Feb book club.- it is about a boy who grew up in Malawi who has a very typical African childhood who builds his family a windmill to provide electricity to his home. His ingenuity and ability to self teach was recognized by a visitor and he ends up with financial support to finish his schooling in Malawi and now is presently a student at Dartmouth University. It is inspirational and the narrative about his home life and the problems with school fees is classic. Also his description of what he and his family had to do with famine times was excellent and common. Malnutrition here is a terrible problem.
Thanks again for all the support, encouragement and notes. We are so happy to be sharing this with you. It is our connection to life as we know it in America- it is the first thing i check when i get up (actually i do take a shower first as we only have hot water for a short time in the am and then once hospital is up and running there is no water pressure as we live downhill and the shower just drips) and it is the last thing i do before i go to bed. It really keeps us going knowing you are all with us in thoughts and prayers. Tomorrow the post will may be late as i take my last night of call. Tracy and Katie
So besides our special skype time it was a busy weekend on call for medical wards. I am pretty tired today but for some reason can't nap well here. I treasure a nap at home but for some reason it just doesn't work well here. I think all the adrenaline floating around my system may have something to do with it. They call the ER here Casualty. Because most people arrive by walking or matatu (crowded taxi like vehicles) that cannot travel on the dirt roads after dark, most patients (which they call clients) arrive before it gets dark. At the equator that is about 7:30 every night without much fluctuation from season to season. So there is quite a bit of overflow into the waiting area which is just this big open outdoor space outside the actual ER area. It is so strange to just call names out into the night air and someone comes hobbling in. The ER space holds only about 10-12 people so there were 50-100 clients just hanging out all day sat. and sunday to be seen. If a patient gets discharged from Casualty after dark they often just sleep on the ground outside (the same place as the waiting area) and walk home the next morning. This weekend it sort of reminded me of a small refuge camp but they do have bathroom facilities available and there is a small canteen for food they can purchase so it really isn't too bad. We had 3 deaths per day on friday, saturday, and sunday. Initially you will remember how disappointed and frustrated i was with the fact that we had so many deaths but it seems normal to me now. They were all due to mostly irreversible problems so it didn't seem so bad. On the upside, we had a typical "code blue" run on a young man who had taken poison that was actually successful and he is still alive although gravely ill. The ICU nurse told me he had only seen 2 successful recussitations in his 10 year career so i was glad i helped add to his third. The Kenyans are quite impulsive people and they have a surprising number of suicide attempts/gestures, mostly due to domestic disputes. They take something called Triatrix which is an organophosphate that is readily available to many of the farmers as it is a pesticide. It is a bonus that is also cheap. Some dilute it to make it more palatable, some take it straight up but it is quite lethal at not very large doses. I think we have about 50 percent survival if they get to Casualty within a 3-4 hour window. On the other hand, they don't seem to have much domestic violence - strange that when they have a disagreement with their spouse, they hurt themselves rather than to take the anger out on the other. Someone out there in psychiatry/counseling try to help analyze that. (Nancy, want to take a shot at that?) No other strange things now that TB and all the HIV related illnesses are old hat to me. I did see a case of pericardial tuberculosis that the effusion was so big- for those medical people reading this it was the classic waterbottle heart and i took a photo of the chest xray to bring home with me, it was so impressive and we don't see it much in US. If we see anything like it is not nearly as severe and would be most commonly from Lupus or some metastatic cancers.
The waterfall and dam photos on the previous posting Katie took when she walked to Motego, the highest point in this area. She has found some good friends in one of the med students rotating here and a young pediatrician from Cinncinati. The waterfall/dam is functional for several reasons to this area. They have built a hydroelectric plant which supplies all the electricity to the hospital compound. Also we realized that Sat and Sun are "laundry and bathing" days as there were apparently many people washing their clothes and their bodies on the side of the dam in the river (which is completely brown colored by the way) as the dam makes it easy to reach the water on the upside. We always see people fishing and relaxing in this area as well so it serves for food and social as well. It was a good picture to take and explain as the river is important for so many reasons.
Ann Canary mentioned in one of the comment sections the book Cutting for Stone- those in Book Club will remember it- now that i am back in Africa it seems so close to home. For those who haven't read it i do recommend it- although it takes place at a mission hospital in Ethiopia it really has the same feel of medicine in any African country. Ann Kisinger suggested a book called The Boy who Harnessed the Wind ( William Kamkwamba author) which i just finished. I think we are reading it for Feb book club.- it is about a boy who grew up in Malawi who has a very typical African childhood who builds his family a windmill to provide electricity to his home. His ingenuity and ability to self teach was recognized by a visitor and he ends up with financial support to finish his schooling in Malawi and now is presently a student at Dartmouth University. It is inspirational and the narrative about his home life and the problems with school fees is classic. Also his description of what he and his family had to do with famine times was excellent and common. Malnutrition here is a terrible problem.
Thanks again for all the support, encouragement and notes. We are so happy to be sharing this with you. It is our connection to life as we know it in America- it is the first thing i check when i get up (actually i do take a shower first as we only have hot water for a short time in the am and then once hospital is up and running there is no water pressure as we live downhill and the shower just drips) and it is the last thing i do before i go to bed. It really keeps us going knowing you are all with us in thoughts and prayers. Tomorrow the post will may be late as i take my last night of call. Tracy and Katie
Sunday, January 9, 2011
Friday, January 7, 2011
Highlights of the week
This week has been a nice transition for me from US medicine to the Kenyan way. Today new Interns in medicine started their training so there are many new faces of young Kenyan doctors. They have the look of "deer in the headlights." Tomorrow the graduating interns will have a ceremony and a celebration with their families. Since i am the only visiting Internist presently i will take the weekend call so the permanent doctors can go to the all day event. It will be like the blind leading the blind i am afraid.
Last week we saw at least 7 new cases of pulmonary TB and 2 of disseminated miliary TB. It is amazing how long patients stay at home without complaining. They do not have any means of isolating them so it worries me when they are put next to a patient with HIV that doesn't yet have TB. It also amazes me how fast they get better with antibiotics or anti TB meds. I think sometimes just coming in for a rest and better nutrition is the main help to them. We did see one patient with a DVT from birth control pills and one with an asthma exacerbation both of which we see alot of in the US. My most surprising patient last week was a woman who came in with fatigue and a little shortness of breath who had a hemoglobin of 1.7 , the lowest i have seen in the US is 6 with normal being 12-15. She didn't even look that bad- of course pale (in africans you look at their conjunctiva) and she moved very slowly. The anemia was probably caused by a combination of iron deficiency and B12 deficiency and got there very slowly. There was no blood to transfuse that day in the hospital so 3 of her relatives gave in the lab and they processed it for her and gave it just a few hours later. It was probably still warm- that would never happen at home. We don't allow family directed blood donation as there is a higher incidence of transfusion reaction. You are really better off to get someone elses blood that is matched than a relatives. Weird. My other wild story is of a young man who was in the bed across from one of our patients in the ICU- he was on the surgical service from multiple trauma- not sure how it happened but he had severe facial bone fractures- really didn't look bad but while we were rounding he fell face forward out of a wheelchair and when we picked him up off the ground he had CSF (cerebrospinal fluid) just pouring from his nose. That is not a connection one wants to have. So the surgeons were called and he apparently is doing well now after a surgical repair.
So no other big news- we are doing fine enjoying the work, the beautiful countryside, the food that people are preparing for us and each others company. Katie amazes me- she is so willing to do anything and is so open minded about all she is seeing. In addition she is just pleasant and fun to be around. I am so glad to have these 2 and a half weeks together. There aren't many 18year olds who are willing to be with their mom that long. I am so fortunate.
Last week we saw at least 7 new cases of pulmonary TB and 2 of disseminated miliary TB. It is amazing how long patients stay at home without complaining. They do not have any means of isolating them so it worries me when they are put next to a patient with HIV that doesn't yet have TB. It also amazes me how fast they get better with antibiotics or anti TB meds. I think sometimes just coming in for a rest and better nutrition is the main help to them. We did see one patient with a DVT from birth control pills and one with an asthma exacerbation both of which we see alot of in the US. My most surprising patient last week was a woman who came in with fatigue and a little shortness of breath who had a hemoglobin of 1.7 , the lowest i have seen in the US is 6 with normal being 12-15. She didn't even look that bad- of course pale (in africans you look at their conjunctiva) and she moved very slowly. The anemia was probably caused by a combination of iron deficiency and B12 deficiency and got there very slowly. There was no blood to transfuse that day in the hospital so 3 of her relatives gave in the lab and they processed it for her and gave it just a few hours later. It was probably still warm- that would never happen at home. We don't allow family directed blood donation as there is a higher incidence of transfusion reaction. You are really better off to get someone elses blood that is matched than a relatives. Weird. My other wild story is of a young man who was in the bed across from one of our patients in the ICU- he was on the surgical service from multiple trauma- not sure how it happened but he had severe facial bone fractures- really didn't look bad but while we were rounding he fell face forward out of a wheelchair and when we picked him up off the ground he had CSF (cerebrospinal fluid) just pouring from his nose. That is not a connection one wants to have. So the surgeons were called and he apparently is doing well now after a surgical repair.
So no other big news- we are doing fine enjoying the work, the beautiful countryside, the food that people are preparing for us and each others company. Katie amazes me- she is so willing to do anything and is so open minded about all she is seeing. In addition she is just pleasant and fun to be around. I am so glad to have these 2 and a half weeks together. There aren't many 18year olds who are willing to be with their mom that long. I am so fortunate.
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