Wednesday, 29 August 2012

Day 17: Rebbey Junior School Renovation

Wednesday, August 22

The majority of the day was spent back at Rebbey Junior School. The workers had one room almost completely plastered, so it was the girl’s turn to go sand and paint! Before we could begin, we had to go buy the supplies and thought we would patronize a local “hardware store.” This store had everything from flippers and floaties to paint and brushes, and it was all within a building the size of my bathroom. Even though we had good intentions of buying from them, the people often jack up the prices for us because they think we have a lot of money. Since this project is funded solely on donations, we had to get the best price possible, so we ended up walking nearly a mile to another store. Here we got all the supplies we needed – and then had the mile long walk back carrying gallons of paint! We finally made it back to the school and began our work. Let me tell you, sanding walls is no easy feat when you do it by hand.

The rest of the day was spent putting on primer. Since many different types of plaster were used, some parts of the wall were light gray while others were black, so primer was a must! Even though we only got the primer done today, eventually all the walls will be painted and one will have the alphabet painted on with coordinating pictures such as “A a and apple, B b and ball,” etc..

Before we left, the teacher gave us a tour of the rest of the mud hut. There was one large room, an office, and then several smaller rooms. All of the rooms were intended to be classrooms, but the founders couldn’t afford them all, so as of now, they are being rented out and that money then goes to fund the school. I also got a picture of their shower/bathroom. It merely consists of a hole in the ground, and that’s it.

I was so happy to be helping out at the school and actually making a difference in the lives of these children. Even though they have next to nothing, there is always a smile on their faces. It is truly heartwarming and an inspiration to us all!


Friday, 24 August 2012

Day 16: Back at Coast General

**Disclaimer** Graphic Pictures!

After an amazing safari and break from the hospital, we were all eager to get back to Coast General. Right away in the morning we headed up to Major Theatre, where all of the surgeries take place. There are four operating rooms – all containing the bare minimum. The surgery we observed was a 15 month old boy with hypospadias. Hypospadias is a birth defect in the male urethra in which the opening is abnormally placed. This wasnt a very servere case, but the doctor began tediously cutting and suturing. I can’t imagine how hard it was operating on such a small area! But the surgery went well with no complications – other than the cautery machine not working. And quite frankly, I was impressed the hospital even owned one to begin with.


After that procedure, we went back down to good old minor and casualty. In minor we did a lot of dressing changes, and I saw one of the worst wounds since I’ve been here. A man was at work when an iron sheet fell and cut his foot. Since he couldn’t afford to go to the hospital, he ignored the cut and kept working. After some time, the foot became severely infected and as of now, there are two spots the size of my hand where no skin remains. The pits were about a half an inch deep and covered in puss and infected flesh. The only treatment he can afford is debridement and redressing, so that’s what we did, and prescribed some antibiotics. Let’s just say this was one case where I wish I didn’t have a sense of smell!

After minor I wondered over to casualty where I found Dr. Abdul Hussein. He is another physician, originally from Russia, who has been very helpful to us students. The first patient I examined with him was a “mob justice” victim. Basically, this man had stolen from someone, and in Kenya, the punishment includes being nearly beaten to death by the people in the streets. When Dr. Hussein explained this to me, and after I saw this man’s condition, I nearly threw up. This is just one of the corrupt aspects of Africa. Anyway, police eventually break up the fight and bring the victims to the hospital – but even they show the victims no mercy. This man was severely beaten and the cops threw him around and slapped him in the face when he was unable to move. I cringed every time. The victim ended up having a cracked skull, broken wrist, and exposed bones from deep gashes. I was even able to feel this man’s malleolus (ankle bone). There were obviously internal wounds and bleeding, but since the man couldn’t afford an ultrasound, Dr. Hussein took a syringe and stuck it straight down into the man’s abdomen and aspirated the syringe to see if any blood was present. It’s quite gruesome to say the least. Upon completion of the examination, the patient was to be sent for X-rays and then to minor for suturing. Dr. Hussein asked that I do the sutures, but after nearly 2 hours later, the patient had yet to have X-rays, and was near death when my shift was over. No matter how long you nag the nurses and doctors, nothing is done in an urgent fashion – even if a life is on the line.

The next patient I actually diagnosed on my own, and Dr. Hussein was very impressed – even gave me a high five! J The elderly woman had a mass in her right atrium which was blocking the blood flow to the rest of her heart and body. Since the heart is a muscle, and it was in overtime trying to compensate for the lack of blood supply, the woman developed cardiomegaly, or enlargement of the heart.  This was all previously diagnosed, but today the woman came in complaining of severe pain in her legs. They were severely swollen due to a lack of circulation and buildup of fluid, and her upper thigh was very tender, red and inflamed. The diagnosis was edema and cellulitis.

It was a very stressful, gut retching, and educational day. A lot of mixed emotions, that’s for sure, but its days like this that make me more appreciative of the small things. And more eager than ever to be a compassionate and empathetic physician someday.

Much love from Kenya!

Thursday, 23 August 2012

Days 11-15: Safari Time!

Thursday: We left the compound at 8 am on Thursday morning and headed for the bus station. There were some pretty sketchy looking busses, so thankfully we ended up on a bus quite similar to a Greyhound. When we originally booked the safari we were not informed of how long the bus ride would be, but when we got our itinerary, there was a 9 hour slot blocked off – all on the bus! I don’t do well on long car rides to begin with so you can just imagine how thrilled I was, especially after I found out we could have taken a plane there instead! Needless to say, Dramamine and Zzz Quill were my best friends on that bus ride.

After a very bumpy and unpleasant 9 hours, we finally arrived in Nairobi. We were met there by the Elective Africa personnel and they took us straight to our “hostel” which ended up being a place meant for backpackers. We felt a little out of place since we weren’t wearing hiking boots, but we snuggled up 8 per room – just like Jr. High church camp!

Friday: I slept fairly well, but it would have been a lot better if my pillow wasn’t filled with rocks. Anyway, we were off again for another van ride to the Masai Mara Game Reserve. What we thought was going to be a short 2 hour drive magically turned into a 6 hour drive. Lovely.  They also failed to mention that the last 2 hours of the drive would be on an unpaved, ungraded, low maintenance road. Words cannot even explain how terrible it was, but I’m quite certain I have a concussion from hitting my head on the roof so many times.

We finally got to our camp at 3:30 pm and found out we would be staying in tents! The tents were actually pretty heavy duty and were on a cement pad with a roof over the top. Even though we were pretty protected in our hut, the workers suggested we keep our windows and door completely zipped up at night…monkeys are apparently an issue. But we quickly settled in and headed out for our first trip to the reserve. Everyone was anxious since we had caught a quick glimpse of zebras and giraffes on the way in. This time of year is known as the “high season” for safaris in Masai Mara because many of the animals make the great migration from the Serengeti in Tanzania to Masai Mara in Kenya. Anyway, since we were only out for a couple hours, we mainly just saw the grazers: zebras, gazelles, wildebeests, elephants and giraffes. Zebras and wildebeests were in abundance since they migrate together. And when I say in abundance, I mean hundreds of thousands of them. I would try to describe how amazing it was seeing all these animals in their natural habitat, but words and pictures don’t do it justice.

In awe, we headed back to the camp for a great meal, which was prepared for us by the self-proclaimed “stomach doctor.” Since electricity was only available from 5:30 am – 7:00 am and 7:00 pm – 10:00 pm, we used our light wisely and headed to bed. I forgot to mention that Nairobi is FREEZING! I slept in sweatpants and a sweatshirt and covered up with two heavy blankets. So whoever came up with the phrase “It’s Africa hot out here!” has clearly never been to Nairobi!

Saturday: The first thing we saw on Saturday morning was a hyena devouring the remains of a wildebeest. The killing must have taken place late in the night, and the lions had already had their fill. Although there was only one hyena feasting at the time, another hyena and a few vultures were waiting nearby for their turn. It was an “Animal Planet” show right in front of me. Absolutely incredible! The remainder of the day was spent covering a large portion of the reserve and we were fortunate enough to see every animal, except a leopard. I wish I could pick out my favorite animal, but it’s impossible! At mid-day we stopped under a tree and our whole group had a picnic together. From there, we headed to the river where we saw a ton of hippos and crocodiles. The baby hippos might be the cutest things I’ve ever seen! At about sunset we went back to the camp to rest up for another early morning of safari. The day was quite long, but it was one of the best days I’ve ever had!


On Saturday night we went a visited a Masai tribe. They showed us their traditional dances and had us participate, and also showed us their homes. Their diets consist of milk, cows blood, and corn - if they buy it, and their homes are even more simple than that. They were made of sticks, mud and cow manure. We got a tour and I thought I was going to suffocate in there! The women build the houses and it takes them 3 months to build. Every 9 months the tribes have to move because their homes become unstable due to termites. The village is in a circle and surrounded by a thorn fence. At night the cows are put in the middle and men stay on watch for lions that come and attack. The man who gave Laura and I a tour of his home had already killed 2 lions - with just a spear - and he was only 24 years old. Another crazy concept is that they buy their wives from other tribes, usually for 10 cows!

Sunday: We were up before the sun on Sunday morning to make sure we could see the sunrise from the reserve. It was absolutely breathtaking. After a couple snapshots, we went out farther in the reserve and actually came across a lioness that just made a kill. She was having a hearty breakfast of wildebeest! A little later we saw a hyena making his way towards the lioness to see if she was willing to share – highly doubtful. That’s about the only new thing we saw in the morning but the grazers were out and about already too.

At 9 am we packed up and headed out for another bumpy ride home to Nairobi. That evening we decided to wine and dine ourselves and went to a nice restaurant called “Carnivore.” We heard it was a little expensive, but we were all so hungry for actual meat it didn’t even matter. The meal started off with soup and bread, then a salad, and then the main course consisted of all types of meat. The waiters went around and served the normal beef, chicken, turkey, and pork, but there was also crocodile, ostrich, and ox balls! We finally surrendered and they brought us ice cream for dessert. We were expecting to pay around 2500 shillings, roughly $27.00, but no. My bill came out to be 3600 shillings. Everyone was digging deep in their pockets, but it was a great $40.00 meal! Oh Kenya, you cease to amaze me!

Monday: On Monday we ventured back to our base in Mombasa. I thought the ride was long on the way there, but the way home was much worse! It was a safari of a lifetime, but we were all happy to be back at our temporary home – and all anxious to be back in the states. One more week!

On a side note, on the way home I noticed one of the buildings had “Psalm 23” written above its doorway. It amazes me that these people still have such strong faith – but a reminder to us all that the LORD will always provide!
Psalm 23:
1 The Lord is my shepherd, I lack nothing.
2 He makes me lie down in green pastures,
he leads me beside quiet waters,
3 he refreshes my soul.
He guides me along the right paths
for his name’s sake.
4 Even though I walk
through the darkest valley,[a]
I will fear no evil,
for you are with me;
your rod and your staff,
they comfort me.
5 You prepare a table before me
in the presence of my enemies.
You anoint my head with oil;
my cup overflows.
6 Surely your goodness and love will follow me
all the days of my life,
and I will dwell in the house of the Lord

Tuesday, 21 August 2012

Day 10: Orphanage #3!

Today, I took a break from the hospital to go to yet another orphanage. When we got there, many of the children were out because they had gone to the doctor for vaccinations. I was so thrilled to hear these children were being vaccinated! The man who was in charge of the school told us that him and his wife started the orphanage & school nearly 10 years ago. The children that are in attendance are either orphans, children of single parents, or children that were born into extremely poor families. The coordinator also stated that poor families often forget the importance of/don’t care about schooling and never send their children to get an education. Sad as it may be, at least there are people like this man who care enough to help!

The children that remained at the orphanage performed a program for us, and one of the boys even rapped a song about AIDS. He was awesome! The other songs performed were mainly about discrimination, poverty, childhood slavery, and other topics that were relatable to their current situations. After they performed for us, they asked us to teach them some songs because they loved learning and loved singing. They’re favorite songs were the YMCA and the hokey pokey J We all plan on returning next week to help with a renovation and water project one of the Elective Africa participants is currently funding. The building, as of now, has no running water, walls made of mud and sticks, and no windows for light – clearly not a safe or conducive learning environment. The renovation includes putting in a fresh water line for drinking, adding windows, and also plastering the walls for a more support.

The evening was spent packing and getting ready for our weekend safari in Nairobi!

Below is the link for donations to rebuilding this school. All donations are greatly appreciated by us and the children of Rebby Junior School.

Monday, 20 August 2012

Day 9: Swimming Lessons!

Today was the first day our whole group was split up into different places – some went to the orphanage, some went to the hospital in the morning, and some went to the hospital in the afternoon. I of course was lucky enough to fall into the early hospital group! Since minor theatre was shut down yesterday, I knew it was going to be another busy day.

Today was actually a really great hands-on day for me! I changed a catheter, redressed a lot of wounds, and most importantly I drained my first abscess! The doctor showed me how to inject Lidacaine, and then also gave me instructions on how to cut and drain it. The affected area on the man’s back was probably a 2” by 4” area. It was rock hard. As grotesque as this may sound, I was really excited to drain the puss! I know, something is clearly wrong with me. J After the abscess was drained, cleaned, and bandaged, we prescribed him an antibiotic and told him to come back in 3 days for a dressing change.

Later that morning, two other patients also came in with abscesses – another on the back and one on the breast. One of the residents lanced the abscess on the breast, and I can’t even imagine how painful it was! Apparently abscesses are very common here…not really sure why! I’ll have to do some research on that.

The last patients we saw came in for a dressing change and stitches removal. The dressing change was on a woman who just had a baby and a Tubal. She had the baby with her and I elected to hold the baby rather than doing the dressing change – when you see the baby, you’ll understand why! I told the mother I was going to take him home with me and she gave me a leery smile…I don’t think she understood my joke! The stitches that needed to be removed were on the tip of a man’s index and middle finger. Apparently he nearly severed both tips off in an accident at work. The wounds were slightly infected so the doctor prescribed an antibiotic, but the man was still able to feel his fingers and move them which is obviously a great sign!

After the hospital, we came back to the compound and had ten, 10-12 year old boys and girls waiting for us. The children were from the orphanage/school we visited on the first day, and they were at the compound for some swimming lessons! I was expecting a younger group of kids so it was a surprise when they already knew the swimming basics. There were several of us that were previously lifeguards, but I was the only certified one that was interested in teaching them. We went through the basic strokes, floating, bobbing, and a couple of the more adventurous tried diving! It was a GREAT afternoon and the kids were all so eager to learn which was awesome.

I was pretty exhausted after swimming for a couple hours, but I got talked into playing basketball anyway. There are two outdoor courts about 15 minutes from our compound. Our assistant program coordinator, Isaac, often plays here with his friends. It is basically an African city league and various teams get together to play every Saturday. Isaac told us it’s the Rucker Park of Africa! We played three games and if I wasn’t tired enough after swimming, I definitely was after playing basketball! I may be a tad out of shape, but my team managed to go 3-0. Whoop, whoop!

The very busy day ended with a trip to the movie theater at Nyali center. We went to see “The Dark Knight Rises” and it was just like I was back at home. They serve candy and popcorn before you go into the theater and the theater itself was nicer than any I’ve been to in the states. The movie is great by the way, a must see!

Tomorrow: Another day at the orphanage!

Day 8: Lions, Tigers, & Centipedes – Oh My!

My wakeup call: 7:00 am my alarm went off.  7:01 am I lifted up my mosquito net. 7:02 I screamed bloody murder due to the CENTIPEDE under my foot. 7:03 a security guard came to “escort” it out of our room. I knew it was bound to be a great day after that start…

Surprisingly, today actually did turn out to be a great day at the hospital! I followed around a resident here named Omar, and he taught me a lot! The morning started off a little rocky because the minor theatre ran out of sterile gauze. NO gauze in the entire department. That caused minor to shut down for the day because that is where all the suturing, catheter changes and dressing changes are done – all of which require sterile gauze. There was a line of patients waiting to be seen, so we began asking other departments if they had extra for the time being. They told us “no” of course, and said we needed to “just accept” the fact no gauze would be available until the following day. The lack of supplies (which they can’t help) and the lack of empathy towards patients make some days almost unbearable. Many patients will wait at the hospital all night just to ensure they will be seen the next day – but many times we end up turning them away anyway.

That was a bummer for me, as well as the patients, but from there I went over to the casualty department which was swarming with people as usual. That’s where the “fun” began, but I use that word lightly! I was in seventh heaven getting histories on the patients and diagnosing them with Omar, but I’m sure that would be the farthest thing from fun for some others!

The first patient we saw was screaming nonsense words and phrases, growling, and moving uncontrollably – typical behaviors of a psychosis patient. One could quickly assume she was mentally unstable and send her to the psych ward, but further blood testing revealed she had Cerebral Malaria. This infection is known to cause psychotic behaviors as one of its symptoms. Luckily we were able to start treatments in time, and she will make a full recovery.

As usual there were numerous patients that were involved in traffic accidents due to the chaotic streets. The victims all had fairly minor wounds – a few stitches and a few X-rays – but the worst was an open oblique fracture of the tibia. The X-rays were unbelievable – even I could tell that leg was definitely broken! The other major complaint was women coming in with severe abdominal pains. Most were caused by a PID and the others were caused by something they termed “incomplete abortions.” From my understanding, it is when the mother has a miscarriage but fails to shed the placenta. The treatment is equivalent to that of a D&C in the states.

The most interesting case by far was a woman who came in with blisters covering her entire body, mouth, and eyes. Her skin was beginning to slough off in places, her mouth was bloody and swollen with sores, and her eyes were swollen shut to the point she couldn’t even see. The diagnosis was Stevens-Johnson Syndrome. It is usually caused by a reaction to a drug or may also be caused by other infections, such as: Influenza, HIV, Typhoid, Diphtheria, or Hepatitis – many of which are prevalent in the Mombasa area. Without treatment, this syndrome may cause blindness or even death. Luckily, once again, this woman came in just in time for proper treatment and she is also expected to make a full, yet long and painful recovery.

Those are just a few of the cases we dealt with, but overall it was an exciting and educational day. I’m so thankful for the opportunity I have at this hospital and it really makes me anxious to start my career in medicine. Hopefully someday I’ll be able to come back here – with more knowledge – and assist those who aren’t getting the help they need and deserve.

Sunday, 12 August 2012

Just Another Sunday...

It feels as though I’ve been gone for 6 months already and I think I’m becoming desensitized to the fact that I’m actually in Africa. I no longer miss my phone, chasing down tuktuks and sleeping under mosquito nets have both become second nature, and I don’t even remember what makeup is! The way of life here is so simple – which is peaceful yet nerve-racking at the same time.

Not much to blog about today…went to the beach all afternoon and the African sun got the best of me! Even though the temperature was perfect, the breeze stirred up the very fine sand and made the day almost miserable. I could hardly breathe, let alone keep my eyes open long enough to read a book. Who would have thought it was possible to have a miserable day at the beach?!  On a better note, we wised up to the locals and weren’t conned into paying for any tours today!

In the evening we went to our favorite cafĂ© which coincidentally has free wi-fi. It’s become our nightly ritual – coffee and internet. Internet and phone time get to be really expensive, and the packages we buy get used up really quickly, making it hard to stay in contact. The free wi-fi allows me to chat, keep up with my daily blog, and get some awesome grub. It’s a triple whammy!

But hitting the hay early tonight to gear up for another week at the hospital! Hopefully the week goes by fast because the weekend brings our 3 day long safari. It should be a good time! Missing everyone back home – 14 days until you get to see my face J
Much love!