Well, I've finally made it to Tenwek and have a moment to blog before going to bed. I'm on call tomorrow and still feel a little jet lagged!
The flights from US through Europe to Kenya were problem-free and after waiting in line to get my Kenyan visa, I finally met my driver and we arrived at the Nairobi guest house around 10pm after more than 24 hours of traveling (see pictures below). Although it is the dry season, they had some unanticipated rains so everything looked and smelled fresh and green. Although I desired a restful night's sleep, there was a huge torrential rain storm complete with thunder and lightening most of the night that needless to say, kept me awake. I anticipated rain during the rainy season, but this was heavy, monstrous, torrential rains! Gives me something to look forward to when the rainy season actually arrives in April...
The 4 hour drive from Nairobi to Tenwek was very interesting. I was able to get a picture of how people in the region live their everyday lives. We passed so many small towns built of homes made out of whatever materials people found available. But they were all functional and signs indicated barber shops, hotels, printing places, grocery stores. I was very glad to have stayed in my well constructed, clean, but no frills, guest house in Nairobi, as the ones along the road looked a little suspect for caving in at any time or hosting undesired animals like the many dogs, goats, mules, sheep, etc that roamed the streets. There were lots of people herding sheep or cattle; apparently this region is very agricultural and dependent on livestock. We did see a wild giraffe roaming free along the side of the road, just munching on trees (see picture)! So Rachel, one down and one to go- and that's even before a Safari!
My driver was fantastic and we arrived at Tenwek safe and sound. But I can't say the same for the car that ran off the side of the road in the Rift Valley that held up traffic on the mountainous road for 30+ minutes. And somehow these cars, tractors, and motorbikes manage to fit in inconceivably small spaces - the entrance to Tenwek was blocked by cars dropping people off and waiting for people and still cars were trying to create a 2 lane road with the remaining one free lane- and somehow they managed (much worse than even the front of Duke Hospital).
The people here are fantastic! They are all welcoming and fun to work with. I have met several people with Triangle connections. There are 1-2 other residents here, but mostly older attendings and 4-5 medical students. My pediatrics team consists of 2 US medical students, 4 Kenyan interns, a 2 year WMM post-family medicine residency missionary, and a career pediatric attending missionary. The Kenyan interns go to medical school like the British system, then do one year of internship rotating through all the subspecialties, then are sent out to government hospitals to work on their own. So the expectation is that they are very independent from the beginning and don't expect much supervision. I'm acting as an attending here and take call with an intern ~ every 4th night. Tomorrow is my first day of call!!! (So please pray I learn quickly where everything is, what resources they have to treat people and how to respond to issues that arise tomorrow!)
Today we rounded on probably 80-90 patients including ICU, wards, nursery, postop. The number is just an estimate because everyone is sharing beds, sharing incubators, sharing oxygen when needed, and I just lost count of how many patients there actually were. The charts are always walking away somewhere and because the patient to nurse ratio is lower than ideal, things get done at a slower rate than often is desired. This hospital has amazing resources and capabilites compared to other African hospitals, and patients get transferred from other hospitals because of the resources available. But that being said, the options are still limited compared to the states and a fair number of patients die. But somehow many of the patients still improve with the treatments that are offered. It's great to see the resilence of the peds patients in that way. And the families stay by the bedsides to help care for the patients since the nurses are not always available to reposition the oxygen mask or give a gavage feed, etc; I think it makes such a huge difference in the care of the patients.
A typical day is 8am morning report, 10:30am ward rounds, 12pm chai break (tea time) during rounds, 1pm lunch with missionary families or conference lunch, 3pm nursery rounds, and usually done by 5-5:30pm. We'll see what a call day is like... And there is an outpatient clinic that is very busy that I have not yet experienced.
I've found that skirts are a welcome attire on the equator where it is hot all the time, boxed milk can actually taste just like cow, remembering to take a daily medication is a little challenging, bednets are actually kind of fun (just like the tents we always wanted to sleep under as kids) and an N95 mask can be protective against malaria as well as TB (see pictures). Oh, and apparently I'm too short by Kenyan standards too, as the attending peds doctor greeted me by jokingly commenting 'I was expecting someone older!'
God is good, trustworthy and worthy of glory. Please pray for these patients and their families, there are several that are likely going to die from their diseases because of lack of financial or appropriate medical resources. Please pray that I will quickly work through the stages of adjusting to a new culture to arrive at an understanding and acceptance of why things are done the way they are. Please pray for my sleep and call schedule as it appears to be a very busy service right now.
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| Rift Valley road with traffic due to accident. Venders selling furs and fur hats in 80 degree weather! |
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| giraffe grazing on side of road |
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| My apartment in Tenwek, complete with bednet (N95 works great!). It was attached to the ceiling hook on the other bed, but with a little creative hanger use, I was able to move it to the ceiling hook above this bed. |
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| Robin, no water beds, but it's pleasant at night even without AC. |
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| guest house in Nairobi |
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| shower, no curtain, in guesthouse in Nairobi- but nice warm water felt great after a long 2 days of traveling |
