Adventures of an American RN in Kenya: January 2014

Tomorrow marks 3 months in Kenya. There hasn't been anything too exciting lately to report, so I thought it would be good for me to paint a picture of a typical day for me in Mutomo.

My alarm clock sounds every morning at 6am. I grab my flashlight, open up my mosquito net, scan the floor and my sandals for scorpions and other insects, then climb out. The first thing I do is take my 100mg tablet of doxycycline for malaria prophylaxis. I proceed to get ready for the day:

I take care of toilet duty. It takes about half an hour for the toilet tank to refill, so I’ve learned to use my flushes wisely: flush for solid waste… save my flush for liquid. I head to the washroom to make my face all pretty for the day (shaving and washing my face). It’s usually humid here, and my face will be wet with sweat again in a few minutes.

I can’t eat anything for an hour after taking my medication, so I wait for breakfast and head to morning Mass at the church next to the hospital. The service lasts about half an hour. The church is usually filled with school children. There are two priests at the parish: one with very good English, and another who is incomprehensible. So depending who the priest is that day, I may spend the half hour engaged in the Mass, or daydreaming. The kneelers aren’t padded for comfort like they are in the U.S., so for about five minutes every morning, I kneel in pain, praying that I won’t have arthritis by the end of the year.

I head back home hungry for breakfast, which usually consists of some combination of toast (if we have electricity), fruit salad (watermelon, papaya, pineapple, mango, oranges), bananas, or homemade banana bread. When I brush my teeth after eating, I don’t use the tap water for rinsing my mouth and toothbrush, so I have to pour a few drops of pre-boiled water into a glass each time. If the electricity is working, this is usually the time when I check my emails and skype with family and friends online. Whenever I have a chance, I try to charge all my electronics since the electricity is not always reliable.

Main corridor through the hospital.

I leave home and make the two-minute commute to work. Kenyans have a different perception of time than Americans… which is a nice way of saying they are always late. When I arrive at the hospital, there are usually one or two nurses who have not yet arrived, but we usually begin without them anyway. Before beginning the morning report, the nurses take a moment to pray together for God’s help through the coming day. The people in Mutomo in general are a very spiritual people.

We then begin report on all the patients, which is usually very simple. Only a few seconds are spent on each patient, and a typical report goes something like: “So-and-so had a fair night. Blood pressure was___. Temperature was___. Heart rate was___.” And that’s it! In the U.S. we might spend 40 minutes reporting on 5 patients. Here we spend five minutes reporting on 40 patients! I often slow down the report, asking questions like, “Is the patient still in pain?” “Are they still having difficulty breathing?” “Is the nausea, vomiting, diarrhea controlled yet?” I wonder what some of the nurses think of my questions… a waste time maybe? We do a quick round of the ward, checking on every patient, making sure the lights are all off (to save the cost of electricity), and making sure all the windows are open (to increase ventilation and prevent TB).

Doing ward rounds with the clinical officers.

We then go about the day’s duties, preparing for the doctors and clinical officers who arrive soon to do ward rounds. We gather information for the rounds, checking the vital signs of patients who’ve been unstable, making sure all the lab results for the previous day were recorded, etc. Ward rounds take place only on Monday, Wednesday, and Friday, and are done either by a medical officer (a doctor) or a clinical officer (something similar to a nurse practitioner in the U.S.). We review every patient on the ward and discuss the way forward for their care. On days which are not rounding days, they see only patients which the nurse requests to be reviewed (which is everyone if I have my way). Once rounds are over, new medications, tests, and lab requests are ordered in the computer system. This is the time when the nurses will start to take their morning tea break. Since I’m not accustomed to drinking so much caffeine, I don’t usually drink tea during work hours (to avoid the hassle of frequent bathroom breaks).


Waiting area in the outpatient department, empty on a Sunday.

The garden area outside the hospital's general office.

Around noon is when the patients receive their medications. This is one task which all the nurses step up to do, so this is when I usually decide to take my break and leave them to work alone. Most days I make a sandwich with egg, tomatoes, and avocado seasoned with a bit of salt, pepper, and curry powder. Two hours is actually a lot of time to kill in the middle of your day. I head home, heat up my lunch on stovetop, eat, wash dishes, check emails again… and still only 30 minutes have passed! I try to pass the remaining time reading up on different diseases and medications, working on hospital projects, listening to music, napping on my front porch, running errands in town, playing solitaire on the computer, etc.

Waiting to give the ward report to the nursing matron.

Back to work. The afternoon is the time to finish up on anything from the morning that wasn’t yet completed. I may spend time wheeling patients up and down the hospital for x-rays and surgeries, restocking certain patient medications, rounding on the patients again, managing new admissions, or simply sitting at the station updating the charts. At last 5:30pm arrives, and with it the relief nurse (it’s usually more like 5:45). We give another report, and are then free for the night.

Mass is held in the hospital once every month.

After work, I have about half an hour left of sunlight. The sunsets are usually very spectacular. The clouds in the west burn bright purple and yellow, while the mountains to the east of my house glow a vibrant orange. The first order of business once home is to shower. On top of the layer of dust and sweat that I’ve accumulated, I’m also covered in who knows what germs from the hospital. I take a plastic tub, pour in one scoop of water, then pour another half scoop over my head to wet the hair. The water isn’t warm, but that’s okay since it doesn’t get too cold in the evenings. Soaping up and scrubbing is never a problem, but I never completely get all that soap off when all I have is a wet washcloth to rinse. Nevertheless, I always feel surprisingly clean after my bath. For a while on the bathroom ceiling there were two spiders, one large, one small, which were always present in the corners, watching over me every night as I bathed (the closest thing to a pet). At first I was a little disgusted by them, but I actually grew to enjoy watching them and even named them: Yogi and Boo Boo. Occasionally the big one would catch an insect and I would watch it wrap it in webbing and eat it. But the spiders have recently disappeared, so I shower alone now.

Once I’m all cleaned up I heat up dinner. No microwave; everything is heated on stovetop (which has to be lit with a match). The local diet consists of only a few dishes. Despite eating the same thing week after week, I surprisingly haven’t gotten tired of it. I’ve come to really love the food here. My dinners usually consist of some combination of a starch (rice, ugali, potatoes, chapatti bread), a vegetable (green cowpeas, sukuma wiki, or cabbage), fruit, and sometimes chicken or goat meat cooked in a stew. Again I wash the dishes… I don’t dare leave anything unwashed in the kitchen for fear of the ants. On a few occasions I’ve come home to find the kitchen swarming with hundreds, if not thousands, of ants. The tap water is cold, so if I need to clean any dishes really well, I have to boil water again. When all this is done, it isn’t too late (maybe 7:30?), but the African sun and heat tire me out quickly, and I don’t stay up for too long. I may spend my evenings visiting with the neighbors, maybe chatting online, playing piano (keyboard), or simply reading a book.

Time for bed, usually around 10pm. I fire up the bedside fan, without which I wouldn’t be able to sleep. After a quick peek beneath the bed to make sure there’s nothing alive down there, I turn out all the lights, make sure all the doors are shut tight to keep out the bugs, crawl into my mosquito net and tuck it into the mattress tightly, and pass out within one minute. In eight hours, I repeat the whole process again.

Here are some more photos from around Mutomo...