First Days at Work

The first few days at the hospital have been somewhat overwhelming. It's difficult to learn a new system in a new country with patients having diseases I've only read about in books. Despite this, I'm trying to stay positive. The first few days of any rotation are hard, because everything is new, and I expect this is magnified greatly by the fact that I'm in a different country.

The medical teams are organized differently than in the US. There are the Consultants (basically the equivalent of our Attendings), the Registrars (upper level residents), Interns (Interns), Medical Officers (like Nurse Practitioners or Physicians Assistants), and Medical Officer Interns. Add to that 5-10 medical students of various nationalities and stages of traning, and you've got one big team huddled around small beds.

I've started on peds wards, where the patients (and their mothers) are always 2 to a bed, usually 3 or 4 if the hospital is busy. The wards are pretty much what you might expect in a developing nation -- crowded, hot, and not subject to the strict standards of sterility, etc that US hospitals are.

In my 2 brief days, I've seen quite a few interesting things. Lots of malaria, of course, quite a few cases of HIV (often newly diagnosed in both patient and mother), and a few kids with TB. We have one little boy who I think is very interesting -- he's 13, and has had intermittent facial and leg swelling for almost a year. In the past 6 weeks he's been hospitalized 6 times for the same thing (at an outside hospital) and has been diagnosed with heart failure every time. Well, this time his mom reported a big decrease in urine output and change to "coca cola" colored urine -- basically this little boy has kidney failure for unknown reasons. Because of it he's having a lot of problems with hypertension and all-over body swelling, as well as needing a special diet very low in salt and protein (not as easy to do as it sounds). He really needs a renal ultrasound, healthcare here is all pre-pay before you get the service, so tests usually take a few days to get, so the family has time to get the money. Sometimes the registrar or consultant can choose to waive the fee if the patient really needs someting, which I think we might do for this little guy.

The other really difficult thing about the past 2 days is that our team covers the peds heme/onc ward as well. These little guys are so sick. And most of them present so late in their illness that most care is palliative. We have some AML and ALL patients, as well as a few Hodgkin's disease patients. One little boy came in with a midline cranial tumor that has basically taken over his face. It's very sad. They all get chemo and pain control, but unlike in the US, there are a very limited number of chemo drugs available, and what is used may not neccesarily be what is the very best for treating a particular kind of cancer.

Not to make this a depressing post. I'm very happy to be here doing what I'm doing, and learning about things I will rarely see in the US.

Yesterday Priti and I moved into the hostel. This was an amusing experience. Being girls, we both have a lot of stuff, naturally. Well, this is pretty much the smallest room imaginable, and we have to cram 2 people and their stuff in it. If anyone remembers my freshman dorm room at Anderson (mom? dad?), this room is actually about half that size. But, it forces us to be social, as we're only in the room to sleep basically. Once Dayna goes back to Indiana at the end of this month, one of us can move into her room, so that will give us a little more space. The hostel itself is -- functional -- but definitely the roughest type of place I've ever lived. The 2 rooms that IU rents from the hostel are on the 1st floor, which is the male floor, so we actually have to treck up to the 3rd floor for the bathroom & shower. I say "shower" very lightly, as it's really nothing like in the US or even at IU house. It's all cold water, and most of the time there's not enough pressure to have water coming out of the shower head. Most people take bucket-type showers, which I did last night -- that was an experience. Luckily, IU students sort of leave stuff behind in the IU hostel rooms, and someone left a plug-in water warmer contraption, so at least our bucket showers will be warm!

I bought what I thought was a converter yesterday, so could charge my camera batteries. Well, I plugged in the charger and it didn't turn on, so I thought either the converter was bad or I had ruined the charger by trying to use the Kenyan outlets (which is likely). So, I decide to plug in my hair dryer to see if it was the converter. As soon as the prongs touched the converter, there was a loud bang, a ball of fire and smoke leaping from the outlet. So of course I screamed, and quickly moved the curtains and the mosquito net out of the way, so as to not set the hostel on fire on my first day there. Apparently what I bought was just an /adapter/ and not a /converter/ so much. Doesn't really matter now, as I've already ruined the only 2 electrical appliances I brought with me. It's ok though, I can just buy batteries in town and I don't need my hair dryer anyway.

We had the afternoon off today, so Priti, Larien and I braved town for the first time on our own without Dayna and Erin (who know where everything is), and we actually did quite well. I found the bank where I can change my Ameican money (which I did), though apparently you need to bring your passport with you every time. The teller let me use my student ID this time though. Then we went to the Eldo-Chem (pharmacy) where I bought the rest of my malaria prophylaxis -- it's much cheaper here than in the US. Drugs and such are much less regulated here than in the US -- you can buy pretty much anything over the counter, but of course the selection of available drugs is much less.

I really don't mean this to be a negative or complaining post. I'm pretty satisfied with how things are going thus far, though I do look forward to more familiarity in terms of the living conditions, wards, and the town. Although I am already much more used to being stared at everywhere I go.

I read this in the Lonely Planet guide to Kenya recently, and wanted to post it:
"AIDS IN KENYA. Like most of its neighbors, Kenya is in the grip of a devastating AIDS epidemic. There are 2.5 million Kenyans with full blown AIDS and nearly 700 people die from the disease every day. AIDS is predominantly a heterosexual disease in Kenya and now strikes all classes of people. At least 890,000 children have been orphaned and many others are infected while in the womb. Teachers have been badly affected - at least 18 die daily - because they are predominantly in the 20 to 29 age group that's most affected by HIV/AIDS, and Kenya is facing an education crisis as a result, leaving even fewer people to spread the AIDS-awareness message. Around 85% of prostitutes are affected, and young girls are especially vulnerable, due to the widespread belief that AIDS can be cured by sleeping with virgins. Drug treatments that are available in the West to increase the lifespan of AIDS sufferers and reduce the risk of infection passing to the fetus in HIV-infected women remain well beyond the financial reach of most Kenyans, few of whom have access to even basic health care. The problem is unlikely to improve as long as Western drug companies refuse to allow developing countries to produce much cheaper generic versions of their products. Currently the cost of treating a single AIDS vicitm for a year is US $34,000, while the annual wage of most people in Kenya is under US $500."

Those statistics make me cringe. Though I do think things are getting better -- albeit slowly. At least in Eldoret, AMPATH has gone a long way to reduce the stigma of HIV/AIDS, and more importantly educate people about transmission and prevention; as well as giving treatment access to those who need it. I read that and I'm reminded of a large reason I decided to come here.

Now it's time for dinner and a shower at IU house!