Adventures of an American RN in Kenya: June 2014

I've been enjoying a quiet, relaxing month here in Mutomo. We have finally entered the cool season. When I wake up most mornings the skies are cloudy. Through most of the day the air is cool with a breeze sweeping through the town. I'm enjoying it while it lasts. For the first time in months I'm able to sleep at night without a fan blowing on me.

I’ve been back on medical ward for a few weeks now. It is ten times more challenging than maternity ward, but I’m enjoying the work. It feels so good to be busy and productive rather than waiting around all day for women to go into labor. The patients are often unstable on medical ward. One problem is that most people here tend to wait to come to the hospital until they are extremely sick, by which time it is very difficult to treat them. During my second week back to medical ward, we lost five patients within only three days! Sadly, one of them was a 13-year old girl. The cause of death was cryptococcal meningitis, but it wasn’t diagnosed until just a few hours before she died (she had already spent several days on the ward). Part of the problem has to do with lack of proper equipment and diagnostic tools, part of it is due to inadequate staff skill level, but largely it is due to the late arrival of patients to the hospital. During those first two weeks we seemed to have a lot of patients admitted with meningitis. Ideally someone should come to the hospital immediately if they develop a sudden change in their level of consciousness, but so many patients wait for several days before seeking professional treatment. One reason why families wait so long to bring their relatives to the hospital is money. To be admitted requires an initial deposit of 5,000 kshs (about $60), and then a daily bed fee of 450 kshs (less than $6). This is a huge deterrent to many.

The staff of Mutomo Mission Hospital

Two weeks ago I was walking through the main corridor when I found a male patient who was nearly comatose and sliding out of his wheelchair onto the floor because his spine was so rigid (a highly suspicious sign of meningitis). When I asked the nurse in the outpatient department if he was being admitted she said they were waiting for the relatives to bring money. Of course I understand that money is important for the hospital to function, but the hospital policy states that any patient requiring emergency treatment must be admitted regardless of payment. I explained this policy to the nurse, but she told me, “He’s stable. His vital signs are fine.” True his vitals were fine, but I asked her, “Does he look stable to you? He can’t even sit in a chair. He’s lying on the floor right now.” With a little pushing, I was able to get him admitted and rushed to start testing and treatment. Unfortunately it was for nothing; he died only a few hours later. In this case there was nothing more we could have done. Even if we’d admitted him faster, I’m sure he would have died. The family just waited too long to bring him in.

Locusts have showed up around the hospital in the last two weeks!

Also a challenge is dealing with local beliefs about health. The people here are predominantly Christian, but they also incorporate traditional beliefs and practices. There is a common belief that illness is due to being cursed by someone, the remedy for which is a visit to the local mganga (witchdoctor). Recently we actually had a patient (another meningitis case) whose family felt that we couldn’t treat him in the hospital. Against medical advice, they had him discharged so they could take him for treatment by the witchdoctor.

Besides traditional beliefs, patients and their families can sometimes be misguided in their Christian practice. Last week I had a patient suffering from severely debilitating pain in her hands. She would be fine one moment, and the next be screaming in agony, unable even to speak, because she had so much pain in her hands. I’m very certain this was due to a potassium deficiency, but the family was equally certain that it was due to her being cursed. At one point they all gathered around her bed to pray that the illness/evil spirit would leave her. At the same time, I arrived with an injection to relieve the pain. Since their eyes were closed in prayer, none of the relatives saw me give the injection. Shortly after, the family was explaining that she no longer had any pain because they had prayed. “She also has no more pain because I snuck in and gave her an injection,” I murmured to my fellow nurse. The family was intent on taking her home early so they could pray over her, but with pressure from the nurses they allowed her to stay another day and we were able to treat the potassium imbalance before discharge.

"Nameless II," one of the cafes I frequently visit (there is also an "Original Nameless" and "New Nameless" in town).

Chips & Coca-Cola, a common and affordable meal for people in Mutomo.

Aside from the usual patient care, there is a lot of excitement around the hospital as we prepare for our jubilee year celebration. This year Mutomo Mission Hospital is celebrating 50 years. As part of that celebration we’ve formed a hospital choir which will be singing for a large Mass to be held in September. For the past couple months I’ve been singing along with them (I’ve been assigned to sing in the bass section). It’s a huge challenge singing in Kiswahili, and even harder to sing in Kikamba. But I’m improving. Luckily a few songs are in English and I’m actually teaching one of the English hymns to the choir. We meet every week, and it is always a welcomed and relaxing 1½ hours after a long week of work.

Practice with the jubilee choir.

This past weekend, as another part of the jubilee year events, the hospital held a two-day retreat for the staff. Led by a visiting priest from Nairobi, we enjoyed two relaxing and uplifting days of talks, prayer, and Mass (and of course good food).

Our staff retreat.

Tea break at the canteen during our staff retreat.

On my days off of work, I continue to explore Mutomo and the surrounding area during my regular runs and walks. Yesterday, I organized a Sunday-afternoon outing with a group of hospital coworkers. We walked down the road to a mlima (mountain or hill) I recently discovered. It is my new favorite place in Mutomo, which gives a fantastic 360° view of Mutomo town and the entire surrounding region. I’m told that on clear days you can even see Mt. Kilimanjaro. Strangely, most people who live around Mutomo don’t take time for walking and exploring the area. Only one person in our group today had ever even seen the road we used. After our walk, they were asking if I could take them on another outing some time to some of the other mountains behind the hospital. Despite being a visitor here, I seem to be becoming the local tour guide.

View from the top of the hill.

Kids at Mutomo Primary school waving from below.

Dancers during the church service.

Earlier this month I was invited by Anastasia to attend her church which is just a few kilometers up the road from “downtown” Mutomo. Once again the Kenyans displayed their great hospitality. Despite being unable to communicate directly (mostly everyone there spoke only Kikamba) I was warmly welcomed through interpreters. I’ve always said how lively the African Catholic Mass is, but that pales in comparison to the activity of the protestant services. Almost half the service consisted of dancing and Gospel music, followed by a lengthy sermon (also in Kikamba). At the end of the service I was asked to address the congregation with the help of a translator… I told them I wished I could speak in tongues. Next came a tour of the compound. The congregation has outgrown its current church building, so they are forced to hold services outside beneath the trees. They are in the process of constructing a new building. The frame, which is built of handmade bricks, is completed. Now they are raising funds to buy the doors, windows, and roof. Besides the church, the grounds also include a newly-built primary school which will start boarding students this month. Before leaving, I was asked to stay to share a meal, which was a delicious feast of githeri (maize and beans), boiled pumpkin, mandazi (a donut-like bread), and tea. During our meal, three of the elder women of the church thanked me for visiting them and presented me with gifts of handmade necklaces made from the seeds of one of the local trees. The generous spirit of the Kamba people never fails to amaze me.

Inside of the old church building.

The new church building under construction.

LUNCH!

As in most places outside the U.S, football is a wildly popular sport in Africa. The Kenyans are very excited for the current World Cup. Many people here stay up late, and even wake up early at 1am to watch the matches. Whenever any African nation is playing, everyone is glued to the television. As for myself, I’ve also taken to cheering for the African teams… unless they’re playing the U.S. Last week I woke up at 1am to see the match between USA and Ghana. To the disappointment of the night duty staff (I had to watch the game at the hospital), team USA beat Ghana 2:1. This morning I again dragged myself out of bed at 1am to see USA play Portugal, this time with the Africans cheering for Portugal. It was a disappointing tie, 2:2. Looking forward to seeing what lies ahead both for the U.S. and for Africa as the games continue.

With Alex, one of the hospital security guards.

Some kids I met on one of my walks.

Among Kenyan children, it's a common practice to build toy vehicles with whatever materials can be found.

During my runs around town, I regularly have an escort of local kids. Their endurance always impressed me; I don't know if the typical American kid would keep up so well.

This group of kids kept up with me for probably half a mile!

This boy ran along with me up a huge hill... in sandals! I could tell he was tired when we reached the top, but he kept a great pace all the way there.

And here are some more photos to give you a tour around the market in Mutomo. Some are recent, some are older:

Stopping for groceries on the way back from a run.

I’ve gotten a lot better at bargaining over the past few months. Most people are fair and honest when it comes to pricing items, but a few will try to give me the “mzungu price” when they see my white skin. I’ve learned to sense when I’m being taken advantage of.