The Wards

November 12, 2009

This was my third day on the wards! It’s pretty crazy. I’m working on the Maternity Ward, Vy is on pediatrics (spelled Paediatrics here) and Dustin in on Medicine. Kijabe Hospital is not what I’d expected. It’s a fully functional teaching hospital with a few catches—need a paper towel to wipe the ultrasound gel off your patient? Not so much… there’s a shortage (and there’s a shortage of ultrasound gel too, so when you hear “there’s no fetal heart tones”, usually you have to look to see if they are not using any, and then scoop the last drop out of the tube with your finger, and try yourself). A q-tip is non-existent. We re-use a single amnio-hook for all the patients, but wash it between.

That said, I’m doing an unbelievable amount of relatively advanced surgeries that I never expected to do in a third-world country. Fertility is huge here, so I’ve done several myomectomies (removal of fibroids from the uterus) and a few tubuloplasties (fixing tubes that are scarred, usually from Chlamydia), so women can have more babies. More babies!! It’s such a huge priority for these women. But there’s a catch—infant mortality is high enough, that even when women have had 4 or 5 babies, they may only have 2 that are still alive. So the surgeons hesitate to do a c-section and a tubal-ligation in the same surgery, because if that baby you just delivered does not survive…

I’ve gotten to primary on 3 c-sections already! (Mike, can I log that in new-innovations?). I also took out a uterus the size of a basketball today (fibroids) and assisted on 3 crash c-sections, one for eclampsia (the mother was seizing and had a blood pressure of 180/115), one for a baby in distress that had sat on the ward overnight with a BPP of 4/8 and a very non-reassuring NST—that baby may die, and is still on the ventilator today (day 2) and there is only one ventilator available for babies.

I don’t do normal vaginal deliveries—the nurse midwifes do them. I’ll be called for breech deliveries (something I’ve never done, since they all get c-sections in the states) and operative deliveries. But during the day I’m in surgery and doing some outpatient women’s health as well as taking care of the women who are admitted. I just admitted someone yesterday with a complete placenta previa (her placenta is completely covering her cervix, so if she were to go into labor, she would bleed to death) that I found on ultrasound that I did for some bleeding at 28 weeks pregnant. I had to ask her family members to donate blood in case she were to bleed. I estimated the fetal weight to be about 1.3kg, and apparently the babies that are over 1kg do well at Kijabe Hospital, so that’s good news, but I suspect that this patient may need a hysterectomy after the delivery. Not the worst news, since she’s 40, and one of the family members who will donate is her 21 year old son!

The hospital is very well-staffed—there are many medical officers (like our interns) who are well-trained, and there are clinical officers, who are like our PAs. There are also many medical students, other residents, nurses and nursing students and many attending-level doctors who donate years of work at Kijabe.

I’m actually really enjoying the food—they have some staples, and they include ugali (corn-meal porridge) and sukuma wiki (which is stewed spinach) and they have yummy mandazi, which is like an un-sweetened doughnut. Chai is huge here—in fact, there is a “tea room” in the surgery theater where there is always a big pot of boiling milk for chai and lots of doctors and nurses drinking between surgical cases.

The hospital is part of what I would call a “village” of people, most of whom work at the hospital. There is also a great boarding school call the Rift Valley Academy and there are about 800 students there. We are planning on this weekend going to see them put on the musical Seven Brides for Seven Brothers. We may also go for a trip to Lake Nakuru to see the flamingos if we have time, but none of us is on call this weekend, so we’ll have to take advantage!

We are exhausted, but having fun—we’ve been asleep by 8:30pm and we’re up around 5-6 daily. I don’t know if it’s the elevation, the jet-lag, or just the stress, but we’re definitely happy its dark by 6:30, so we feel less bad about bed at 8! I miss everyone, but am so glad to have Dustin and Vy here—it’s so good to see their faces every few hours in the hospital, when I’m feeling overwhelmed or like such an outsider! Dustin is ever-positive, and good at keeping me grounded and giving me perspective when I need it. Anyway, hopefully more to come this weekend!