Marta's Part
One week down, three to go! Time flies!
One week in and we have now eaten in an authentic African restaurant, and have had authentic African food!!! On Thursday we tried authentic African mandazi (a bland (French pastry whose name sounds like benyay would be pronounced, although I know the spelling is wrong) with the flavor of cardamom), and Katy, Grace and I were invited to have chai (tea with milk and sugar) with the nurses today. (See Katy’s commentary on immunizations required to partake in chai!) Ces, a surgeon doing the Samaritan’s Purse two year post-residency fellowship was our ordering guide and we had quite a feast! Two plates of the best French fries I’ve had in a long time (maybe just hungry for them!), fried goat (it was relatively gristly and had random little chunks of bone, and one got lodged in Katy’s teeth, and is still there now!), “sukumuwiki(?spelling)”, a green substance that reminds me of a combination of spinach and seaweed (that was named because it is cheap and people can buy a huge bag for just a few shillings and therefore have enough food to make it through the week, or till the next pay day), pilau - rice lightly covered with tomato juices, and with occasional small chunks of stewed tomato. We also tried ugali – a very bland and rather tasteless maize, that is almost like a quite dehydrated mashed potato patty. It tastes minimally like corn, and has a grainy texture, but for the most part it is just blah, but we had to say we had tried it as it is a daily staple of the local diet. There was also a little bit of stewed cabbage on one of the plates, and that truly was pleasant! Knowing it was better not to test our luck, we bypassed the questionable water in the pitcher on the table and ordered bottled sodas. Katy and I both tried Black Currant Fanta.
In other food related news, we continue to make, and take many pictures of our concoctions, called African cuisine in a joking fashion only because we are in Africa, and making food, but it is nearly entirely American (although living with two Asians, there is that flavor infused as well)!! I was disappointed not to find any jarred spaghetti sauce in the main store in Eldoret where we shopped upon arrival and packed about a 75 lb box of food for the month…or as long as it lasts! So, as to make my grandma proud, I bought stewed tomatoes, tomato paste, beef mince, spices, and (again to be on the safe side) canned mushrooms, with my heart set on making something near as good as she made! (No offense to any other culinary experts, but I still maintain grandma’s is best!) I think the sauce was quite tasty, if I do say so myself! And it is always better the second day, so I can’t wait for that. This morning I made omelets with sautéed onion and mushrooms, and feta cheese. I think I have cooked more in the past week than I have in the past 2 years! We have definitely come a long ways from our first two meals of apple/orange/carrots, cheese and wheat thins when we didn’t know how to turn on the gas stove!
The discussion of food wouldn’t be complete without a small discussion on our evening treats of the past weekend. Friday night was game night at the Jones’ and they pulled out the KoolAid, Starburst, Peanut Butter M&Ms, Sour Patch Kids, Skittles, and popcorn! It was a feast…of sugar! Then, last night we went over to watch Karate Kid, the original, on their projector. Not only was there a brownie intermission, but afterwards we had smores, roasted over scented candles. In case you are wondering, there was no hint of Mango Maddness, Tropical Temptation or Vanilla flavor infused into the marshmallows!
My parents and I like to chat about the weather, so a little about that. It has been mild, never too hot or too cold. I would guess the highs are close to 80-85, and the lows are near the 50s. With the altitude here being about 7500 feet, and near the highest point in the area, there is also usually a nice breeze. The land is a lush green or red dust, and I haven’t seen much of the dry tundra I was expecting from the movies!
Our mosquito nets have been working well, but I do have two mosquito bites that I have discovered thus far. Thankfully, the mosquitos at this elevation bite, and itch, they don’t carry malaria! I have been bitten by a poisonous bug (Nairobi Eye) though. I felt this deep ache yesterday, as though I had received a very deep bruise. There was induration and erythema extending about an inch at that time, and it grew to about 8 inches over night, but is now down to about 5 inches. It still aches with every step I take, but there is no necrotic tissue or anything to incise and drain. I think I’ll live, but will definitely be on the lookout to take a picture of this nasty bugger, and then squash him deader than a doornail! (Weird expression, I know, but it came to mind!)
Oh, right, we are here for medical reasons. So…back to work! Katy and I long to be helpful, but sometimes wonder if our help makes things take longer. Thankfully, we have been reassured we are doing a great job, and we have been trusted with more, faster than almost anyone who has come through! We rounded on our patients all weekend, and I do appreciate the continuity. The baby that came in on our first day, Benjamin, weighed 1.2 kg at birth, and then lost weight, all the way down to 1.01 kg. Over the weekend, he started gaining weight! Really, can you imagine a 2.6 pound baby’s chance of survival in Africa? This still amazes me that this little dude is doing so well! On the other side of the spectrum, we were called in for resuscitation after a vaginal delivery of a patient who wasn’t more than 22 weeks into her pregnancy. The patient had had vaginal bleeding remote from term, and was hospitalized for steroids, but despite that, this little girl wouldn’t have had a chance in Africa or America. We tried positive pressure ventilation (using a bag and mask) to increase the babies respiratory rate as we got oxygen ready, but the saturations didn’t improve. The baby weighed only 730 grams (1.6 lbs). Without a ventilator, nasal CPAP, or surfactant this little one was just beyond viability, despite the steroids. We let mom know, what she had already expected. We left it to the nurses to do the culturally appropriate thing, and the mom’s choice was to lay and rest awhile. I don’t know if she ever saw or held the baby, or not.
Later that same day we were reviewing a new admission to the female ward – a woman in her 30s with headache and vague weakness. Her preliminary labs came back, and she was positive for HIV. The student who was working in the ward was hungry, so she declined the LP. I was thrilled for the opportunity and right off, got it in the right spot, and got my 15 drops of clear CSF in each vial. The results came back shortly thereafter – cryptococcal meningitis.
One skill that I’ve learned that excites me greatly is obstetrical ultrasound. I have been seeing outpatients in the maternity ward who come for sonos to confirm presentation, or other PSU like complaints that need to be evaluated by more than the mid-level gate keeper. I have been able to do sonos to not only confirm presentation and placental location, but now I’ve also done several sonos for growth and can get within 2 days of my preceptor! It is such an important skill to be able to assess fetal weight, confirm dates, and know the location of the placenta. I even did a BPP on a patient! I also confirmed an intrauterine pregnancy, and was able to rule out an ectopic on a patient that is 7 weeks along. I knew it wouldn’t be too challenging; I’m just thankful for the time, opportunity, teaching, and willingness of patients in order to practice and learn! Katy's Part
One week has gone by, and I think I’m getting used to the hang of things and the pace of the place. Most of it has to do with expectations, and many of my previous notions and ideas have certainly been challenged and reshaped this past week.
While Kapsowar is not the World Renowned Mayo Clinic, it has impressed me with the degree of organization, staffing, and resources. We’ve witnessed a nursery caring for 28 week old premature babies; a lab that has capacity for various infectious disease testing and CSF studies; a system with mid-level providers, so the doctors are not burnt out; a support staff that include full-time anesthesia personnel, nutritional consultant (someone who had completed a nutrition course), and physical therapy; and a pretty good protocol and system of prenatal and perinatal care. I feel like the hospital and its staff have been able to provide good care and make a difference in the community. This is certainly a good thing, but it is not quite the “missionary medicine” I read about Dr. Livingstone or even in On Call, so it left me wondering whether I truly understand what medical mission is like in the 21st century, if I’m stuck in an unrealistic past, if I’m simply not seeing the contemporary frontiers, and if I’m simply disillusioned about the whole thing?
The past week I rounded on the pediatric ward, and I’m happy to report that I’ve thoroughly enjoyed my last two days, as I got to know the nurses and patients more. (All the moms out there, skip this next part, so you don’t hate me). Technically, I attempted to start IV on three little babies, failing miserably; on a different day, I attempted a lumbar puncture on a little guy we suspected to have meningitis besides the malaria he’s being treated. So I guess I’m glad I’m not a surgeon. Oh, wait, I did get to do a Cesarean section yesterday on a lady with two previous sections, so there was much scarring and adhesions, but my preceptor let me do almost all of it. For the very first time, I felt like I could get the baby’s head out without anyone else helping me! (Okay, potential Via Christi applicants, ignore this last part. Just kidding.)
One of the challenges to round at the hospital here is the fact that between nurses and patients, there can be several tribal languages, so just because I didn’t understand it doesn’t mean they're speaking Swahili, nor does it mean the student nurse who’s interpreting for me is fully communicating with the patients. Just like in the States, different nurses have varying levels of experience and helpfulness, so I felt like there was a lot to juggle among trying to round, trying to establish rapport with patients and nurses, trying to teach the nursing students, and trying to figure out the system here. As some students got more comfortable with me, we shared many laughs and ah-ha moments while caring for the pediatric patients. On Saturday, as I was going around seeing each little guy or gal, I took time to pray for each of them, and when I missed one, the student asked, “We don’t pray for Abel?” J. There was a four-year-old with pneumonia, a 9-month-old with malaria and anemia requiring transfusion, a 1-month-old with pneumonia on oxygen, a happy 5-month-old with pneumonia sharing the oxygen concentrator with his little neighbor, a 4-month-old with abdominal pain on three antibiotics, a 9-month-old with malaria and meningitis (yup, my LP victim), a 20-month-old with aspiration pneumonitis after mineral oil ingestion to treat worms, a 6-day-old baby girl with sepsis, a 2-month-old with fever, and a 8-year-old girl with Typhoid Fever and anemia requiring transfusion.
An achievement at the end of the first week was being invited to chai. Every morning at 10:30am is Kenyan Tea Time, but for the most of the week we’ve been too busy rounding to have any, and I was slightly disappointed no one invited us to join them when they take their tea. On Friday, since I knew the patients better and finished rounding earlier, one of the nurses asked me if I’ve ever had chai, but it was rather funny. He at first said, “You can try a little bit.” After a short pause, he asked me, “Did you have vaccine for Typhoid?” When I said I’ve been vaccinated against many things, he replied, “Oh, well, then you can have chai.” Wow, what a thoughtful new friend, haha! Sadly, I was whisked away to rounding duties again, so I didn’t have it. That afternoon, however, another nurse asked me if I’ve ever had mandazi (a type of lightly flavored pastry) and offered to buy some for me. After he came back, he offered me tea, and we ate mandazi with chai.
After rounding on Sunday we went to the Swahili worship service again—this time indoor and shorter, but still had four different choir presentations and one random song with children dancing to the music. Not being able to understand most of the service, I was wondering whether it’s really worth coming to the service at all; however, the pastor sermon at the end was really timely for me and made me glad I went. He used Deuteronomy 2:1-8 to talk about how sometimes God tells us we’ve been at one place long enough, and it’s time to move on. It made me think about the years spent in Ames, then Iowa City, and now Wichita. Each period was a different stage, and each stage ended with a change in direction. I don’t know where my next step will be, but in many ways I feel like I’m ready to grow up to the next stage; I’ve had enough complacency.
Again, we will try to update more frequently, so not every posting will be this long. If you’ve gotten to this far, many kudos and mandazis to you J
Love, Katy
Wow exciting Katy and Marta please continue to share don't forget to post pictures- I really enjoyed the read ~Cheech
ReplyDeleteThanks for updating. I love reading it all. I think as long as the chai is hot, you should be good. :) Love you girls!
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