Two Weeks in Mutomo

The first rain has come to Mutomo!  It poured heavy rain for about half an hour today, and an hour later the sky was clear and blue and the ground completely dry.  The ground seemed to soak up all that rain within a few minutes.  The people in Mutomo keep telling me once the rains come, that’s when all the “creepy crawlies” come out.  I’ve already noticed an increase in the flies and ants, which is apparently a sign of the coming rainy season.  The ants vary in size here, depending on the type.  Some are big, fat ones half an inch long.  I’ve been at constant war with the little ones in my kitchen since I arrived two weeks ago.  No matter how much Raid I spray around the doors and how well I pack up my food, the little critters still seem to find their way inside.

The driveway leading from the hospital building to the housing area.

Work is going well.  I learn more every day and am getting accustomed to the routine.  I was doing rounds on the medical ward the other day when I looked out and spotted a monkey the size of a dog walking across the hospital grounds, something I would never see at my hospital in California.  In fact, there are a lot of things here which I’ve never seen in a hospital before: donkeys walking the grounds, lizards and wasps crawling on the walls, birds’ nests in the hallways.  

The staff of Mutomo Hospital are very resourceful.  They do a lot with the little they have.  Still, it can sometimes be frustrating for me to work here when I’m used to such a different work environment at home.  Last week we had a patient who passed away.  He was an elderly man diagnosed with prostate cancer with metastasis to the esophagus.  Upon admission, he was already severely dehydrated and anemic and hadn’t eaten for many days.  When I first saw him in the morning, he was mildly short of breath and I thought he looked like he could use some oxygen, which we gave him.  Later in the afternoon, another nurse rushed up to me and reported the patient was gasping for breath.  We checked his oxygen level, managed to find a non-rebreather oxygen mask, sat him up in bed, and called the clinical officer on call.  He arrived and assessed the patient, only to determine that we could do nothing for him due to his poor prognosis.  I could tell by looking at him that he had only a few hours to live.  I asked if there was something more we could do to make him comfortable… there wasn’t.  In the U.S. we would normally be able to put a patient on a morphine drip to ease his respiratory discomfort, but morphine isn’t available in Mutomo... kind of frustrating!  The clinical officer said we could only put him on oxygen for comfort, which we had already done.  He died within the hour.

A huge health problem in the community here is diabetes.  At first I was surprised to hear this since Mutomo doesn’t suffer the same obesity epidemic which we deal with in the U.S.  However, I’ve noticed that the diet here is extremely high in starch, which doesn’t do much to control diabetes.  In addition to a little bit of meat or vegetables, most meals are made up of some combination of rice, maize (similar to our corn at home), potatoes, chapatti bread, or ugali (a type of starchy meal which I haven’t yet tasted).  The food is also extremely high in salt.  In addition to the dietary problems, there is the issue of foot care (a major problem with diabetic patients even in the U.S.).  In my short time here, I’ve already seen two below-the-knee amputations related to diabetes.  The fact that many people walk around with open-toe shoes doesn’t help the problem.

I’ve heard several of the staff commenting on the need for diabetes education.  Apparently some of the staff have gone through nutritional classes, but then the information never gets relayed to other staff members.  I’ve spoken with a few people and am hoping to put together some sort of simple diabetes education materials which we can provide to patients to help them manage their health at home.  I’ll just have to get someone to help adapt the information to the local culture and language.

So far I’ve been working 5½ days per week.  However, Sr. Mary (the hospital administrator) told me yesterday that it would be better if I worked for 5 days instead, so that I could have 2 full days to rest.  I could actually use the time.  Life here is quiet, but I use spare time to work on several projects.  Because of the high prevalence here of HIV and tuberculosis, I’ve started taking time to study up on the diagnosis, pathophysiology, and treatment of these diseases.  I’ve been learning a lot so far.  I’ve seen more HIV and TB patients in the last couple weeks than I did in my whole 2½ years working in the U.S.  Besides studying diseases, I’ve started reading up on Swahili.  I was visiting one of my European neighbors a few days ago and found a book on Swahili sitting on his shelf, which he kindly let me borrow.  I’ve only gotten through the first few chapters, but already I’m starting to pick up words and phrases when I listen to the doctors and patients speak on the ward.  

 

It's a complicated language!

Power outages are a common occurrence in Mutomo, though they usually last only a few minutes, sometimes an hour or two.  I know there’s a power outage if I wake up in the morning and my bedside fan isn’t running.  People tell me that Mutomo only got electricity 3 years ago.  Before that, when the sun went down (which is around 6 pm), the day was over and people slept early.  One beautiful thing about the evenings here is the stars.  Every night you can look up and clearly see the Milky Way, a rare sight in L.A.  People here are astonished when I tell them we can’t see stars at home.

Three of my European neighbors (1 from Sweden and 2 from Finland) left for home today.  I’ve enjoyed their company during my first couple weeks of transition to life in Kenya and will miss having them around.  However, I won’t be alone for too long.  Tomorrow a surgical team arrives from America and will stay for one week to do free surgeries for children with undescended testicles and hernias.  I never thought I’d be so excited to see another American!  I didn’t fully realize how much I loved my home country until I left it.  In addition to the Americans, we’re also expecting an Irish doctor who works at a hospital in Nairobi; he’ll be my housemate for a couple days.  Next week we also have another group of Swedish dentists arriving who will stay for about 6 weeks.

Me with Sr. Mary (hospital administrator) & Per (the dentist).

We had a farewell dinner last night for our current Swedish dentist.  My neighbor Anita once again cooked a wonderful feast for us all.  She also managed to find a keyboard somewhere in the hospital so that we could have a bit of music.  She arranged for me to keep it at my house from now on.  I’m thrilled that I can keep up my piano skills during my stay in Kenya.

Halloween passed a couple days ago. I didn’t go trick-or-treating (they don’t do that here), but I decided to treat myself to some candies they sell at the hospital shop.  I wasn’t really sure what they were; they looked more like dog treats than candy, but I was willing to try them… they weren’t so good.  Fortunately they were only about 2 cents apiece. 

Fun to come home & see my underwear hanging out for all to see.

I’ve given up on heavy cooking for the time being.  With the busy work schedule, I found I didn’t have much time for shopping, cooking, and cleaning.  So I caved and hired someone to help shop, cook, clean, and do laundry twice a week.  So far I’ve enjoyed goat stew, chapatti, rice, sukuma wiki (the green vegetable I mentioned previously), cabbage, and fruit salads.  Maybe eventually I’ll give cooking another try.  I was excited to learn they sell spaghetti in the town supermarket, though it’s one of the more expensive items at 100 kshs (about $1.17, more than I pay at home!).

Miss you all at home, but I’m enjoying my time here.  Pray for me and my efforts in the hospital.