Since I wasn't traveling this weekend, and there were fewer pages on call than expected, I actually had time to enjoy socializing with the other visiting residents. Unfortunately, the current group of visitors is leaving soon. But new people are always coming in. Friday night we watched the African Queen and Saturday night we watched the Lion King, although it was not as exciting as I remembered. Sunday evening we had a fire and a birthday party for one of the visitors.
The food this weekend has also been very good. After being here a month, there are some foods that I've started to miss from home. I miss spicy Mexican food and frosted mini-wheats cereal with skim milk. I plan on having both when I get back to the States. :) The long term missionaries celebrated St. Patrick's Day on Friday with a potluck dinner that included fantastic American food and desserts. Saturday, I was invited to lunch with one of the doctors and he introduced us to 5-minute Artisan bread, which I will have to attempt to make when I get back to Durham. Saturday night dinner consisted of home made pizza! It was definitely much better than the 'pizza' the guest house cook makes, which includes beans and chili as the pizza sauce. This pizza was made with fresh pineapple, bell peppers, bacon, onions, mozarella cheese and tomato paste. The dessert pizza was even better; we compiled all the sweet things we could find around the guest house to put on the pizza. This included nutella, peanut butter, cinnamon, chocolate chips, and pineapple. Although it may sound like a strange combination, it was really yummy. Sunday night we had cake and ice cream during the birthday party. And Monday night we had poppyseed chicken and cinnamon rolls. Definitely a good weekend for eating 'real food,' although there were a few meals with chipati, rice, and beef stew, too.
According to the locals, winter weather has arrived. Everyone is wearing jackets. Rainy season has also started and the rains are very unpredictable, as far as I can tell. They say the rain typically comes in the afternoon between 1-3pm, but it has rained in the evening, in the early mornings, at lunch, and all day long. I've tried to be prepared by taking my umbrella to the hospital, but inevitably I either have my umbrella when I don't need it or leave my umbrella at home when there is torrential rain. I have had to run home in the rain due to not having my umbrella. The rainy season makes running a little more challenging because it is hard to predict when there will be an hour free of rain in which to run. And the rain creates paths of mud with large mud puddles that make for a very slippery terrain and create very heavily caked, muddy shoes. But I managed to run up Motigo this morning in the mud without too many problems.
A few more strange sightings around the hospital:
-a girl with heavy shoes that weigh more than she does and go 'clomp, clomp' when she walks down the hall
-a mother leaning over the bed to breastfeed her crying infant while we are attempting to place a foley catheter to obtain urine
-ROP exams being performed in the NICU by a retinal specialist
-starting chemotherapy in Africa on a Wilms tumor patient
Now for some medical cases and graphic medical pictures!
NICU surgical cases from this weekend:
1. 2 week old male presenting with abdominal distension and left scrotal swelling that started 8 hours prior to presentation. He was a full term infant born via SVD with normal stooling and urination. His parents are farmers and mom's serologies are negative. He was being fed herbal medications daily. He has no history of omphalitis. On admission, he was crying in distress and had a very tense abdomen and mild tachypnea without retractions. An xray of the abdomen showed no dilated loops of bowel, no obstruction, no free air, and no obvious fluid collections. An abdominal ultrasound showed normal anatomy without ascites. His admission labs included blood gas 7.514/16.5/58/13.3/-10. WBC 3.9, repeated 27.4 (N 100). Hgbl 14.1/hct 36. Plts 26, repeated 98. His urinalysis showed dark urine, ph 5.0, WBC 1-2, RBC 10-20, bacteria 4+. He was taken to the OR the next day for ex-lap. The surgeons found thick pus throughout the abdomen with fibrous caking. There was no perforation of bowel but there were dilated loops of small bowel secondary to ileus. He was diagnosed with primary peritonitis of unknown etiology and started on antibiotics. He is currently doing well.
2. 3 week old preterm infant being fed herbs and breastmilk at home who developed 3 days of abdominal swelling and yellow vomiting. He was passing stools. His admission exam was significant for tense abdomen, tachypnea, and no stool in the rectal vault. His xray showed distended loops of bowel. An ex-lap showed distension of the cecum due to a collection of herbs and cecal necrosis. He underwent cecal resection and anastomosis of the remaining bowel. He is currently doing well breastfeeding. Apparently part of Kenyan culture includes bathing infants in herb water and then giving them the same herb water to drink!
3. Preschool child presented with abdominal distension and small bowel obstruction. He was taken for ex-lap and found to have worms obstructing the bowels! See below for graphic pictures. Most of the children on the wards are dewormed during admission, especially those that pass worms in their stool, vomit worms, or have severe malnutrition. I'm told that children are also routinely dewormed a few times a year as an outpatient. Better to deworm frequently than to have bowel obstruction! I may even consider taking medicine to deworm myself before leaving, just in case.
4. We have had two patients with Wilms tumor in the past 5 days. The first patient presented to casualty with huge abdominal distension, but was stable enough to be referred for an outpatient ultrasound and surgical followup. The ultrasound confirmed a large right kidney mass and he was taken to the OR for resection yesterday. The turmor was the size of a small soccer ball and his IVC was removed from the renal veins to the liver due to the location of the tumor. We are actually going to start chemotherapy on him tomorrow! The other child presented with massive abdominal distension but was not stable enough to have surgery and he passed away.
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| Enlarged ileum filled with worms. |
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| Squeezing the worms out! |
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| A bowl full of Ascaris worms. |
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| A Tenwek ambulance. Ambulances are not used often because of the huge expense incurred by the patient for transportation via ambulance. We attempt to stabilize patients prior to referral then send them via private car (or less desirable, public matatu transportation) to Nairobi or Eldoret for consultation. |
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| The schedule board listing all the surgical cases scheduled for Monday 3/21. The surgeons are always very busy. |
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| The hot, sauna like NICU becomes even more crowded with the nursing students rotating through. |
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| The nursing students rotating through the pediatric wards learning how to measure middle upper arm circumference to evaluate malnutrition. We had several shining examples of malnutrition to show them! |
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| Examining a patient during rounds with Cindy. |
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| A 2 year old that presented to casualty with a huge abdominal mass, thought to be malignancy. |
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| After ultrasound confirmed Wilms tumor, surgery removed a soccer ball sized tumor involving his right kidney. We are going to start chemotherapy tomorrow! |
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| An aerial view of Tenwek. |
