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.