Two Months in Kenya!

Yesterday, December 14^th, marks two months in Kenya!

Stress Free

This week in Mutomo we had the hospital staff Christmas party.  It was held just down the road at Stress Free resort, the local bar/restaurant hangout.  We enjoyed a delicious meal of goat, rice, and chapatti bread.  At every gathering I’ve attended here so far, I noticed that the Kenyans are very fond of giving speeches.  They always call on people from the crowd to “say something to us.”  I’m not really sure what they expect someone to say.  The speakers usually say a whole lot, without really saying anything.  We had quite a few speakers at the staff party, and I was asked to speak as well.  So I got up for a minute and said a whole lot, without really saying anything.  The party ended with dancing.  The Africans seem born to dance, possessing a natural body rhythm whenever the music starts.  Now even in the U.S. I’m a terrible dancer.  But if you see me dancing alongside the Kenyans, I look even worse.  Here’s some video from the party (I won’t be posting any videos of me dancing though). 

Theme was "African Dress."  Here's the competition for best dressed.

Also this week was Jamhuri Day, the Dec. 12^th celebration of Kenyan independence.  This year was especially important because it marked Kenya’s 50^th birthday.  Everywhere you walked in the hospital or in town that day, people had their televisions on, showing the festivities around the nation.  The event was marked in Mutomo, but on a small scale.  Near the local government buildings, a platform was erected and the local dignitaries gave speeches and people danced and sang.  I attended with Dr. Layla, but it was all in Kiswahili, so we didn't stay for too long.

Jamhuri Day celebration

The front page on Jamhuri Day.

I've finally got the runs... no, not that kind!  The good kind!  At home I used to go running almost every day.  When I first arrived in Mutomo two months ago, the weather was too warm to run and I didn’t yet know my way around town.  Last month it was too rainy to run.  Today, for the very first time in Kenya, I finally went running.  It’s amazing what two months of inactivity will do.  It felt so great to exercise again, but after 30 minutes my legs felt like bags of cement.  I did several loops along the main road and up and down the airstrip.  Usually whenever I walk down the street, I always attract stares, being the only mzungu.  But when I went running, I think I drew every set of eyes in town.  Some stared with curiosity, many others just laughed and waved.  People here don’t run, and I’m sure they thought I was insane… “Crazy mzungu!  Running in circles, going nowhere.”  I know I’ll be suffering the soreness in my legs for a few days.  When I got home I took a long nap (after my bucket bath).  In America, when we think of Kenya, we often think of the world class marathon runners.  But I haven’t seen a single person run since arriving in Mutomo.   

This afternoon I went for a walk and ran into a coworker along the way.  We walked and talked for quite a bit.  On the way back I was laughing at how slowly people in Mutomo walk.  Even as the sun is setting and people are heading home from work to cook, they still walk at an unbelievably slow pace.  “Your runners all run fast,” I laughed, “but everyone walks so slow.”  

The snake after maintenance had killed it.

I’ve spoken several times of my petrifying fear of snakes.  Last week I had a horrible nightmare that there were snakes outside my house which moved with incredible speed, and they were attacking me!  Thank goodness it was only a dream… almost.  That very same day, I was walking home and saw my neighbor standing outside her house, looking worried.  She reported that a snake had entered her bathroom through a hold in the window and then gone into her kitchen pantry!  The maintenance staff was called to kill it.  I later spoke with maintenance and pleaded with them to fix my windows (which don’t shut on account of rusty hinges).  They came yesterday and sealed up the windows.  No snakes in my house!!  Another concern with regard to snakes is the tall grass.  The grass here grows at an incredible rate during the rains.  The paths to the houses are usually clear, but the grass was starting to encroach.  I was starting to take alternate routes to avoid the grass.  To my great joy, the maintenance workers came a few days ago and cleared all the grass away with their pangas (kind of like machetes).

Preparing for dinner. I really miss dishwashers.

My Scandinavian neighbors left this past Friday.  I cooked one last big meal for them a few days before they left.  They’ve been wonderful company these past six weeks.  I am sad to see them go… happy to have known them.  On medical ward, it was certainly nice to have a couple extra doctors around.  Now we’re back to our usual shortage.

Kenya is suffering a doctors’ union strike right now.  They say the strike not only includes the doctors, but also the nurses and clinical officers.  It’s been a big headline lately, with government hospitals completely abandoned, and people are undoubtedly dying all over the country for lack of treatment.  Luckily the strike hasn’t affected Mutomo too much.  We have one doctor who was planning to go on strike, but apparently he has a contract with the hospital and was told he is not allowed to strike… thank God!  But the strike still affects us indirectly.  There are many treatments and diagnostic tests for which Mutomo isn’t equipped.  In these cases we usually refer patients to other hospitals for testing or treatment, and then have them return.  But since nobody is working at the usual referral hospitals, we are forced to keep the patients here and watch them go untreated. 

Dr. Layla and Daniel, one of our best clinical officers.

My favorite piece of charting so far. After questioning of of the patient with no clear answer, Dr. Layla made this note in the chart.

Working with nurse Winnie and Dr. Layla.

This past week we had a patient who was reportedly vomiting blood.  At one point during the day, one of the relatives of another patient rushed to the nurses’ station and signaled for me to come quickly.  I rushed into the ward to find the man spouting blood from his mouth like a geyser all over the bed.  Never in my life have I seen anyone vomit so much blood!  While the other patients and relatives in the room were turning him onto his side to prevent aspiration, I raced out to get the suction machine to clear his airway.  He was very unstable for a while, but after a few hours of oxygen, IV fluids, and beginning blood transfusion, his mental status returned and his vital signs stabilized.  We checked his hemoglobin afterwards at it was an extremely low 2.3!  This patient desperately needs to be referred to another hospital for endoscopy, but again, the strike has drained the neighboring hospitals of healthcare staff.

Our wheelchairs have flat tires, but they still work.

Doctors Layla and Terje.

Nurses Beatrice, Evans, and Angela with Dr. Terje.

Medical ward saw many patients pass away this week.  Four died, three of them as a result of sepsis (an infection in the bloodstream).  It’s been very frustrating for me to see so many patients die of infections which are so quickly diagnosed and treated at home.  In Mutomo, patients often delay for a while before coming to the hospital for treatment.  This delay, compounded with the staff’s slow diagnosis and treatment of sepsis, don’t make for a very good prognosis.  By the time we notice something is wrong, it’s often too late.  I'm hoping to help the staff improve our recognition of symptoms of sepsis.

We’ve also suffered a shortage of necessary supplies.  Last week we ran out of oxygen.  In the U.S. we conveniently flip a switch on the wall and out comes as much oxygen as desired.  Here we have large metal cylinders which are filled with oxygen from a supplier in another city.  Unfortunately, oxygen shortage is a nationwide problem, and the cylinders can’t be refilled right now.  We have a limited supply of oxygen concentrator machines that can deliver oxygen to the patients, but the oxygen concentration they deliver isn’t so great (I’m told around 50-60%), and at least one of our machines has broken.  So if we have more than two or three patients at once who need oxygen, we’re in trouble.

Besides oxygen, the hospital has depleted it’s blood supply.  We have only a couple bags left of O+ blood which are being saved for extreme emergencies.  That patient who was vomiting blood was to receive four units of blood for transfusion; he only received two.  Because of the long weekend for the Jamhuri holiday, we weren’t able to get a new supply of blood all last week.  Hopefully in the next couple days we’ll be receiving a new supply.

Sharing a soda with James, our nurse anesthetist.

My Kiswahili notes for the hospital.

 I’m desperately trying to improve my Kiswahili.  Terje, the surgeon from Norway, left me with another book and an audio CD course on Kiswahili.  I spent several hours yesterday working on the language.  I’ve put together a quick reference sheet with terminology for the hospital.  I can’t make very many complete sentences yet, and I’m still learning to conjugate my verbs, but with a few words and a bit of charades, I can usually convey simple ideas to patients.  I'm starting to recognize more and more words when I hear the locals around me speaking.

Found these two love bugs "cuddling" on my front porch.

Look who I found!

Please pray for the patients both at Mutomo, and in hospitals throughout Kenya.