Adventures of an American RN in Kenya: Diabetes, Prostates, & Football

As I mentioned in a recent blog post, we’ve had a lot of diabetic patients lately. Diabetes is often poorly managed here and patients tend to come to the hospital late when their blood sugars are completely out of control. In one recent case, a patient presented with a necrotic foot ulcer. This is a common complication among diabetics, even in America, due to poor blood circulation and diminished sensation in the feet. The foot was opened and cleaned by the doctor, then managed by the nurses on the ward for a week. But the foot still didn’t improve. It put out an endless flow of pus, the patient was running persistent fevers, and even with high doses of insulin his blood sugars refused to normalize (a sign of infection). The doctor finally advised for amputation of the foot. The patient was upset and in total denial. Finally, despite the advice of the doctor, nurses, and counselor, he decided to leave Mutomo and go for treatment at another hospital in Machakos town (I’m told that hospital is even more limited than ours). This is a sad case because, given proper education on diabetes, this patient could have identified this foot problem earlier and sought treatment, possibly saving his foot. And this is only one case. We have many patients admitted to the hospital for uncontrolled blood sugars, which might be avoided (and save them a large hospital bill) if they had proper nutrition education.

Months ago, I started working on ideas for diabetic patient education, but nobody seemed interested in putting in the work and the project was abandoned. With the recent flood of diabetic patients, I’ve finally taken it upon myself to assemble education materials. I recently completed a pamphlet which we can provide to all diabetic patients to teach them very basic information about diet, exercise, foot care, management of low blood sugar, tips for proper use of medications, etc. This past week I reviewed the final draft with our department head (who recently attended a diabetes conference and is very interested in the subject), who approved the tool and will assist me in translating it into Kiswahili. Hopefully it will be able to help at least a few people.

Recently cooked an "American breakfast" for the sisters from church: hash brown potatoes, scrambled eggs, and American pancakes (which are fluffier than Kenyan pancakes).

Fruit ladies; sold me a papaya for 50kshs. They asked for a copy of their photo and I went back later in the day with some prints for them.

On a walk through Mutomo town, always filled with trash on the side of the road.

I’ve also recently helped to update some of the hospital’s forms for documenting vital signs and medication administration. The old forms were not user-friendly and I believe were also contributing to a fair number of medication errors and gaps in the vital signs trend. The new forms were approved by the clinicians, and I’m hoping these minor changes can really help in our documentation (though there are still huge documenting problems in other areas).

The new documenting tools for medication administration and vital signs.

Students with their handmade soccer ball.

On my days off work, I’ve recently found myself playing football with the local school kids next door to the hospital. I’m very clumsy and uncoordinated in the game, and the kids can easily outplay me, but I have so much fun playing. And the kids are so excited to have the mzungu play with them. Before our first game, they lined up all around me and gave me a lesson on kicking, hitting with my head, knees, etc. Then they took me to their “stadium” which is a dirt field on a slope, riddled with cracks and potholes, with a couple stones placed to mark each goal. They have a few proper soccer balls, but most of the kids resort to handmade balls which they make from plastic bags and other bits of trash, wadded up and tied together with string and netting. They are actually very innovative.

I decided to take my camera with me to one of our games. I took a few photos of their soccer ball before the match, then I put the camera away and kept it out of sight until the game was almost over. But as soon as I pulled it out, all play stopped and I found myself swarmed with kids. “Keep playing, keep playing!” I plead, wanting to take some photos of the game. But it’s no use; they all want to have their pictures taken. I try to take a full group shot. They crowd around the camera with their noses only a few inches from the lens. “Stand back! Stand back!” They stand back, but then run forward again before I can take the shot. “Everybody go stand by that tree and don’t move.” But of course as soon as they reach the tree they come rushing back towards the camera. I draw a line in the dirt: “Nobody cross this line.” They cross it anyway.

And this is the product.

Though in the end I did manage to get one group photo, but they could barely keep from rushing the camera.

People waiting for the health camp.

This past weekend, as part of our hospital’s Jubilee Year events, Mutomo Hospital partnered with The Mater Hospital (our sister hospital in Nairobi which is also run by the Sisters of Mercy) to provide a public health camp. The camp was held at the nearby Mutomo Primary School and provided basic health screening and care for the people around Mutomo, free of charge.

(left to right) Dan from Lab, Dr. Amollo, nurses Joseph and Evans, and Peter from pharmacy.

Dan from the lab doing blood sugar checks.

The team for breast cancer screening.

The Mater Hospital is one of the top hospitals in Kenya, with specialists and state-of-the-art equipment. They sent a team of doctors, nurses, support staff, and equipment to Mutomo for the camp. We were lucky to also have a cardiologist present to do echocardiograms. Other services included breast and cervical cancer screening, prostate cancer screening, BP, blood sugar, and BMI screening, reviews with the clinicians, HIV counseling and testing, family planning services, and NHIF (health insurance) enrollment. I was stationed in triage, with the task of taking vital signs and identifying patients needing further treatment, particularly children with cardiac problems. It was a long day and a lot of work (with no break for lunch!), but the event was a big success. We saw 595 patients, many of whom would probably not have seen a doctor otherwise due to the cost.

The wazee (old men) waiting for screening.

Nurse Cecelia and Catherine from records department using a typical hand-washing station.

This is Mutinda. You would have thought I was torturing him the way he screamed and cried when I took his blood pressure. But in the end he warmed up to me when I let him push the button to check his mother's BP, and he was very interested to see his photo on the camera.

Dr. Amollo working the prostate exam room (glad I wasn't stationed there). He found a lot of enlarged prostates during the day, so we may have a flood of prostatectomy patients in the near future.

The other prostate guys: Raymond (a retired lab worker who came to help for the day) and Daniel, a clinical officer.

Long queue to get into triage.

Relaxing with sodas and samosas after a long day.

In other news, this past week I received confirmation of my return flight home. I’m set to fly out of Nairobi on 13^th October. What a strange feeling to have a date set. Of course I miss my family and friends back home, but it’s going to be terribly painful to leave this place. I’ve only been here for 10 months, but already it feels like a second home. I thank God every day for giving me this experience and am trying to enjoy my final two months to their fullest.

On a recent walk to a nearby dam. People come here to fetch water. It costs 2 kshs to fill a 20-litre jerrycan. Many people carry their water back home. Others come with donkeys to carry multiple cans.