Maseno Hospital

Last week I was working and shadowing the doctors and nurses at Maseno hospital, an African hospital run by the anglican church. I didn't take many pictures of the patients although I saw so many things that I wanted to take pictures of - in some cases I quickly sketched what I saw.

In particular, the event that stuck out the most was helping to hold a baby before it suddenly and unexpectedly died. We were trying to give the baby some asthma medication through a nebulizer but it kept fighting vigorously, at one point even ripping the mask off its face. All of a sudden the baby stopped moving and I thought it had gone to sleep as it had done similarly earlier in the morning after being nebulized. As I was walking out of the ward, one of nurses ran up to me and told me that the baby had died. I hurried back to the room where the mother, still holding the baby, asked me if her child would be ok. I still couldn't believe that the baby was dead and told her that I didn't know and that she should ask the professor. 

This was the first time I had seen a patient die, let alone one that I had been holding. Even when I volunteered at NY Presbyterian for a summer, I saw patients who were probably going to die, but never actually a death or even near death on the operating table. I was struck by how no one actually tried to revive the baby  after the nurses realized that something was wrong. In the US, the hospital staff would have been going crazy with defribillators, wheeling the baby out of the inpatient wards to emergency, maybe even performing a tracheotomy to secure access to the airway. Actually, it would probably never even have gotten to that point in the US because of the monitoring equipment showing the baby's vital signs at every moment

Eventually the nurses and I congregated together in a different room and the head nurse asked me to deliver the news - I have no idea why she asked me to do it (I think she just didn't want to do it herself) but I refused. The head nurse said ok and went to the room where the mother was, hugged the mother tightly, and told her the news - actually, the nurse never had to say anything because the mother fell down to her knees in tears as soon as the nurse put her arms around the mother.

Sketch of the baby made a few hours before it suddenly died

The next day, I saw a C-section. Incredibly, there was absolutely no monitoring equipment used during the entire operation. The anesthesiologist actually left the room at one point for about 15 minutes with no one watching to make sure she was properly anesthetized. The operation ended up going fine, with the birth of a healthy baby and the mother surviving, but I thought of all of the things that could have gone wrong (however unlikely) and it made me appreciate all the precautions that we're expected to take as physicians to reduce or prevent those unlikely complications and emergencies.

C-section performed in Africa. Notice that there is no monitoring equipment at all around the mother.

Nurse double-checking the medicines

Picture of Prof. Hardison, the mzungu doctor at work

The visiting nurses and the clinical officers listen intently

One of the patients, most likely has a juvenile form of hepatitis. One of the nurses put a sticker on his forehead!

this man was admitted to the hospital after his family found him lying in a coma after drinking illegal homemade alcohol which likely contained jet fuel. He ended up passing away after a few days, never waking up from his coma

This old man had jiggers all over his hands and feet. (jiggers are bugs that burrow inside your skin and lay eggs) It got to the point that he could not walk because the pain was so unbearable

We also helped deliver babies in Africa - an experience every pre-med hopes to include on their application

 

Cute little babies less than a few hours old - note that there is NO information on the babies to identify it to its mother

Volunteers busily working at the free health clinic

Just a small sample of the overwhelming number of people who showed up

While most of the patients who came were seen by a doctor or nurse, many of these women and children had to be turned away due to a lack of time and resources

Overall, I learned a lot, even though I was only at the hospital for a week. I learned how doctors are forced to think and diagnose problems, oftentimes with great uncertainty due to the absence of reliable tests that we take for granted in the US. I saw how many of the problems could have been prevented, but due to a variety of reasons - often the expense of seeing doctors regularly or a lack of education - patients mostly came to the hospital once the problem had escalated significantly (actually this is a big problem in the US also). I saw a lot of diseases, especially opportunistic infections, in its latest stages that I likely would not have seen in the US because they would have been stopped before getting to that point.

Most of all, I think I saw how little I know about medicine at all. This makes sense since I haven't even started school yet but it was a terrible feeling to know that I had the potential to help but not the knowledge. I found myself wishing that I could transport a 35+ year old version of myself, confident and finished with my training, to help the hospital. The experience actually made me excited to start school in August so that I could learn to heal others, whereas before, I had really been focusing on and dreading all the studying I would have to do for the next several years. I can't send an older version of myself back in time but what I can do is to try to fulfill whatever potential I do have so that the 35+ yr old version will be the best that it can be.

Kibuye Market

I've been to Kibuye market a couple of times while I've been in Kisumu. It's one of the largest markets in Kenya and also in Africa. You can buy pretty much anything (food, furniture, clothes, DVDs) with most of the clothing being second hand - shirts, pants, shoes, and even underwear. I thought it was funny that most of these clothes we donated and thought were given away for free are actually being sold in these kinds of markets. And so I often see people wearing clothes that they have no idea what they mean (ie: I saw one of our patients wearing a Hooters shirt, also a random person walking down the street with a "Girls gone wild film crew" T-shirt, some kid with a Chuck-E-Cheese shirt)

 

customers browsing the selection of used shoes

It's pretty crowded in the Kibuye market

They also sell spices, beans, produce, and poultry at the market

Who's that 'Chinese' guy wandering around the market?

 taking pictures in black & white: instant way to turn any photo into art

 a shot of the indoor market in Kibuye.

On a side note: I love the natural lighting in Africa; every picture looks ultra dramatic like it's out of a magazine

video walking through kibuye market

There's hardly any other mzungus at the market so it's important to be wary of your belongings because a lot of people will be after them - either by ripping you off or more blatantly, by pickpocketting you. I didn't buy much at the market but I did get a sweet pair of masai sandals (which were custom made according to my design and size specifications) and also a belt since I didn't bring one to Africa

 workers making a pair of masai sandals from old tires. They live on a couple of dollars a day

this guy is working on the custom sandals that I ordered

the final product

glad to finally have a belt to hold my pants up!

The countdown

I can't believe that I am in Kenya for only 2 more weeks. I remember when I first came here, all the days went by so slowly and even as I told others that everything was great, I was wondering how I'd get through 8 weeks. After the first 2 weeks here, the next 4 weeks really just flew by. To anyone who's wondering (maybe no one), I also finally bought my return flight home - I'll be back in the US on July 9th, flying into JFK from Tel Aviv, Israel. Then ill be leaving Jul 15 to go to South Korea and Singapore.

Some of you who I talked to before coming to Kenya knew that I had a dilemma around when to go to Kenya. I had tickets to a Hillsong concert in Boston and considered leaving about 8/9 days later, and also considered potentially delaying another 3 days to go to Columbia Med School's revisit weekend. In my mind, I was rationalizing, "how much of a difference does 1 week even make?" Nonetheless, even after trying to come up with excuses to go to the Hillsong concert (ie: it's ok since it's a christian concert right?), I felt really strongly about leaving early and almost saw this as a test of my commitment - if I couldn't even sacrifice this concert, how serious was I in coming here?

During my first week here, I remember regretting not going to the concert, thinking that coming about 9 days later would not really have been a big deal. I actually wondered why I felt so strongly about coming early in the first place. But then the volcano in Iceland exploded, grounding a large number of flights to and around Europe (my flight, as with most that go to Nairobi from NYC, connected in London), meaning that the I would not have just been delayed 8/9 days by going to the concert, but potentially, for twice that amount of time or more. This would all have been time spent away from Kenya, missing out on learning and seeing new things, and meeting people. Everything happens for a reason.

Anyway, this week I'm working at a hospital, shadowing a doctor who is a retired medschool professor from UCSD. I'm excited to get some clinical exposure and at an academic level, to see the kind of things I wouldn't necessarily see in the states: diseases that are rare in the US, cases progressing to a level that they would not have allowed to get to, treatments and solutions using the kind of resourceful necessitated by a lack of supplies.

Yesterday I was able to join a group of nursing students from the US who are here for less than a week and hike up a short distance up the mountain in the rain (it rains here almost every day since it's the rainy season). We went up to deliver some clothes and toys to a family living there. This group of people brought multiple luggage cases full of clothes, shoes, toys, etc from the US. (Which btw they could have all purchased IN Kenya - no doubt, they imagined Kenya as this desolate place with people living in huts)

Anyway, once we arrived at the home, they took all the gifts out and began distributing them to the family and then taking pictures of members of the family holding the donations. All this happened quite frantically (maybe due to the rain) and I couldn't help but feel a little sick at the spectacle this family had become - like we were exchanging these toys/shoes/clothes, in exchange for photos to show to friends in the US. One of the girls grabbed the youngest child and took a photo - the obligatory picture holding an African baby which will no doubt end up being her facebook profile picture.

I also felt a little sick realizing I had done these exact things, in a similar kind of way (sans facebook profile pic) during my first few weeks here. Actually, I still sort of do it but hopefully in a more sensitive/respectful way - I guess it's really a balance of wanting to show people at home what you're seeing but also respecting the families that you're supposed to be helping. Obviously, I, having been here for a full 6 weeks felt so much more sensitive to this balance than these 5 day "tourists".

This experience reminded me of something my pastor was talked about a few months ago. In New York City, people who have been living in the city their entire life (born and raised) get annoyed by the "fake" NYCers who live and work here, who in turn get annoyed by those who have recently moved here to find a place for themselves, who in turn get annoyed at tourists and people from NJ crowding up the streets. We're always trying to one-up each other, comparing ourselves to another in trite measures and finding significance in insignificant differences (really, are you more of a New Yorker if you've lived in NYC for 5 yrs vs. 3 years?). And like the Remand Center where the kids will fight over every little thing - an extra colored pencil, another piece of paper, cutting in line to get their pencil sharped first - we will continue to fight for every scarce resource, no matter how trite it may be. In the end, we're all fighting to be the skinniest kid in fat camp.

And really, I wonder how trite all these things we fight for, care about, compare ourselves against with others must seem to the Truth. When you take the limit to infinity, the difference between any 2 things will seem infinitisimal. Part of the amazing thing about grace is the realization that we all never deserved it in the first place and that none of us earned it - even if you lived a 6% more moral life than your neighbor.
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From the day we arrive on the planet

I thought I would put up some pictures from my safari to Masai Mara. It was a pretty amazing trip with gorgeous views, meeting a lot of interesting new people, and of course getting to witness the "Circle of Life" firsthand. As corny as it sounds, I had the Lion King soundtrack running on my ipod which provided the perfect auditory backdrop to the beautiful visuals.

video of the tent we stayed in. I was pretty happy about the fact that we had western style toilets and a shower

picture of the African plains

we saw many elephants on our trips, including a lot of baby ones!

wasted potential - fastest but also laziest animals ever

one of my favorite pictures on the trip - we were lucky to see a rainbow after the rain

You can view more of the pictures of the Masai Mara trip by going to my Flickr Album here: http://www.flickr.com/photos/50102930@N06/sets/72157623919696649/