Jambo! That’s Swahili for hi!
It’s hard to believe that I’ve only been gone a week—I feel like I’ve been gone for months. There’ve been some moments of stress—like discovering that my Rank List for the Neuro match had not been delivered to where it was supposed to go and that I only had a few hours to somehow get a copy of it before the deadline. I’m kinda worried about what’s going to go wrong on Match Day, since everything else has. Luckily, with the time differences, there’s some wiggle room so I can figure things out, but ugh. The resident that I’m working with is from Indiana and she’s applying for fellowship in Pulm/Critical care and is having a disaster as well—apparently they’ve all sent invitations to interview through the mail, and she has her mail forwarded to come here, so that by the time she’ll get the letters, the interview dates will be filled. She also said that she had a lot of problems with the match for residency, where they mixed up her rank list order (and wouldn’t let her change it), and she ended up at Indiana, when she really wanted to go to North Carolina. *shudders* I can’t imagine going through something like that, but she seems pretty happy in Indiana, so I guess it worked out well. She’s going to be a chief there next year, so if I do end up going there, I’ll know somebody.
So more about Kenya, which is probably what you all want to hear, anyway! I don’t know if it’s been different than my expectations or not—I really wasn’t sure what it would be like. I don’t think I was expecting to feel so unuseful. I guess that I had had grand hopes that because I was an American medical student, I would be indispensable, and that’s not the case. The medical teams here don’t really need us. They don’t. They do things differently, and don’t really seem to care that they don’t know vitals on patients, or lab values or whatever. They’ve made the diagnosis and they treat that diagnosis until the patient gets better and leaves or dies. I’ve tried to be as helpful as possible, and for the past few days have been teaching the medical students (which has been a joy) how to do physical exams or interview or read a chest x-ray, because they’ve never done that before. (Their school year runs from Jan to Jan, so these are fresh, just starting fourth years and they don’t have ANY clinical exposure the first four years). And I helped the intern write discharge summaries the last time we were on call (which, since the notes are sooo short and brief, was rather easy, except they don’t seem to care if notes are in order), which I think shocked him a little bit. I think, once I become an attending (especially one who knows neurology), I’ll be in more demand. It has made me excited to do international medicine in the future.
It’s bothered some of the residents as well. There’s one guy from Indiana who was supposed to be here for 2 months, and he’s leaving next week after three weeks here. He’s just been frustrated by not being able to help out as he’s used to in the states. I think I’m taking everything by stride, and getting used to not having any expectations/responsibilities, but I understand where he’s coming from. And it’s very difficult establishing a rapport with the patients as well, when they don’t speak English and really don’t make eye contact. I’ve yet to get even a half smile from a patient—which
since I pride myself on being able to charm people is quite disturbing. Passing people on the streets is much the same. The native people who work here are very friendly, but once you step into the city, nobody says anything or acknowledges your presence.
I haven’t gotten to an LP yet. We’ve actually not had any patients with meningitis yet! I’m actually not too upset about it, because they’re a difference between doing one back home and here, where there’s no anesthesia at all. None. No lidocaine. No topical. And it’s horrible watching/hearing the patients writhing and twisting in pain—not to mention the fear at that time that you’re going to inject the bore needle into a nerve. We’ve had lots and lots of CCF (congestive cardiac failure) due to rheumatic heart disease, tons of active tuberculosis (I’m so coming back with a positive PPD. Am not
looking forward to months of Isonazid, but I don’t think it’s avoidable. I have not seen even a hint of a mask) and ISS (immunosuppressed, which here is synonymous with HIV/AIDS).
We’ve already had a patient die on us. She came in with severe anemia and needed four units of blood, but because of how the lab works here, the units had to be cross-matched after every transfusion, so she died waiting for the next unit. They had a portable screen that was moved around her bed and by midmorning, she had been move out, so someone else could take her bed. It’s things like this that really bother me—the senseless deaths. Or not having lidocaine (but they just added a new dialysis center to the hospital. Something that nobody here is going to be able to afford). We have patients who have been discharged several days before, but they can’t leave until they pay their bills, so they just sit, acquiring more bills for being there. We have one patient who had been here for a few days, fell down in the shower and now is in a waking coma. We have no idea what’s exactly wrong with her, because her family can’t afford a CT scan. So every day, the rounds consist of the registrar or consultant, saying that she’s not improved and that we’ll get a CT scan to see what’s wrong. Every day. It’s frustrating.
On the other hand, I’m really loving teaching (I’m so staying at a teaching institution), and when it is a smaller group, the teaching aspects are extremely fascinating. I absolutely love TB—everyday we seem to get another patient with a different manifestation of TB. And for getting to do hands-on neuro, where you really are localizing a lesion based on your exam, it can’t be beat. I’m hoping that next week, I’ll get the medical students and tackle some of our neuro patients and teach them the neuro exam. The resident that I work with is really great, though. Her name’s Kristen (she was the one I was talking about earlier) and I’ve really earned a lot from her. Because the groups can be so large (we had 25 today. Yesterday I was excited because we were down to 16 and it almost felt manageable) and it’s very easy to get claustrophobic (I never realized that I had a problem with that!), we stand at the back, and she usually finds some aspect to do a teaching moment on.
It’s about a half mile walk from here to the hospital, so I’m really getting my exercise. I walk there in the mornings and then back here for lunch. Then in the afternoon, it’s either back to the hospital or walking down to town, which is probably another mile from there. And I live on the second floor, so I’m constantly moving, which was what I hoped it would be. Rachel gets up and goes running every morning and then does yoga every night—I’m not quite that ambitious. Not yet, anyway. I’ve been down to town three times and ventured into the market once, but haven’t felt confident in my bargaining skills yet to tackle getting some souvenirs/necessities (I really rather need a watch). Those of us here and doing the food supplementation programs really are the only white people around. I’ve had a couple of kids beg for money (and a patient!), and someone trying to sell me a cellphone, which I’m tempted—it would be so much easier to contact the people who are picking me up in South Africa–but other that that, we’re pretty much ignored. I’m hoping to do some shopping with some of the people who work here and get a little more authentic trip, but that we will save for next week.
I’m learning Swahili! There’s a teacher here in the IU House, who gives private lessons, so Rachel and I are taking them together. So far, I’ve learned how to say hi, how are you, what’s your name and where are you from. I think it’ll be amusing if I come back more fluent in Swahili than I was in Spanish!
I’m still tired and haven’t completely adjusted to the time differences. The bed is quite uncomfortable and the dogs bark and bark outside my window all morning long. I guess it’s nice to have an alarm clock, just not at 4 am! I haven’t really been homesick, although it’s starting to creep on me today—just realizing how far away I am from everybody and that’s it’s going to be a long time before I see anybody. The people that I’m with have been very nice (although some have been cliquish. I’ve only warmed to one of the medical students, the others from IU have been very distant) and working with Rachel has been great—we were roommates for the first couple of days, and I’ve really missed sharing my room with someone. The gates are closed at night, we can’t go out and it gets kinda lonely. I’ve already finished the two novels that I brought with me (it’s been such a long time since I read for pleasure!), so who knows how I’m going to occupy my time.
We’re going to Lake Nakuru this weekend, tomorrow morning, actually, and going on a safari. One of the residents did morning report this week, and showed all of these gorgeous pictures he had taken there, so I’m very excited. I might get to see cheetahs. Cheetahs. And he saw black rhinos which are nearly extinct, so that’s awesome. It’s starting to look like it’s going to rain, and the lake’s not far from here, so I hope that it won’t spoil the trip!
