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