November 16, 2009
Today was a tough day—not really for any reason in particular, but more because it was Monday, and it’s our second week here, and I feel like I should be more useful at this point… and I’m not. I’m still struggling with how things work here. Resources are so scarce, that it’s difficult to feel like I can do anything for patients I see. So half the time I over-shoot—antibiotics for everyone! And half the time, I undershoot—“let’s just wait and see if the bleeding stops on its own.” Frustrating.
Monday is difficult too, since not many people work over the weekends. Saturday I came in and rounded on patients, and then Vy, Dustin and I actually left Kijabe for a really nice day at Lake Nayvasha. Sunday we went to church (along with everyone in the community) and then went for lunch at the Rift Valley Academy and relaxed, then cooked dinner for ourselves and a few guests. We’ve been eating well considering where we are, and often find ourselves reflecting on the fact that so many Africans are starving while we eat—kind of taints the teriyaki noodles Vy makes, and the peanut butter cookies that our guests made.
Lake Nayvasha was beautiful—we took a boat to Crescent Island, which is where “Out of Africa” was filmed in the 80’s (?) and there are hippos, zebra, giraffe, antelope, and monkeys, and a few more animals, but no predators, so you can walk around and photograph the animals safely! There were baby giraffes, one only one day old. The animals have never been hunted, so they let you walk right up to them. It kind of feels like cheating! But we deserved it after our drive there! So scary! The Kenyan people are patient, kind, and accepting, but not on the roads! There are so many traffic accidents that come through our ER, and I saw the reason—people drive so fast, all pass each other using the on-coming traffic side of the road, and there are people, bikers, goats, donkeys all on the same narrow road. I found myself closing my eyes, so I wouldn’t have a heart attack. I’ll try to find a way to post photos of the trip… not sure the slow internet connection can support it, but I’ll try!
I’m on call tomorrow… Dustin is on tonight, and when I left, he had a full ER and a line of people waiting to be seen too! I tried to help him, but he tells me that everyone in beds will be stuck there and cannot be moved because they are waiting for x-rays, labs, surgery, etc., so they can’t move people out and therefore, can’t move people in. Yikes! I hope he finds time for dinner.
That’s all for now—I’m going to bed early after a difficult day. I miss everyone back home! And I miss the football—how are the Eagles doing??? I saw a Kenyan man in a really old Eagles jacket and we saw another Kenyan man in a Chase Utley t-shirt at church on Sunday, so I at least people here have the right idea! It’s nice to see a little reminder of home every once in a while!
Monday, November 16, 2009
Friday, November 13, 2009
Settling in in Kijabe
November 13, 2009
I think I'm finally getting a sense for things here at the hospital-- things are crazy. Vy, Dustin and I have been meeting up at Vy and my place for dinners when we all get done, and we play a game of "who saw the most bizarre things today." Tonight's competition went something like this:
Dustin: "I saw a patient today who was using a bread bag for a condom catheter”
Alyson: "I told a 23yr old that the reason she hasn't had any periods yet is because she has no uterus, and maybe has testicles in her, and not ovaries, but we're not sure"
Vy: "I saw a kid with blue sclerae" (the whites of his eyes were blue)
Alyson: “ I saw a woman with endometriosis of her belly-button—it bleeds every time she has periods”
Dustin: “ I saw a patient with an umbilical hernia the size of a grapefruit on top of a stomach that was so full of fluid, it was the size of a watermelon”
It went on like this for the next 30 minutes. Back home, Dustin and I have a rule about talking about work—we try hard not to do it. It is different here, without TV, much internet, or much of a social life, we are forced to process things we saw and did during the day, and I think it’s a good thing, because we see and do a lot that is really difficult.
Kijabe Hospital takes care of a lot of Somali refugees. They stand out because they don’t speak English or Swahili, and the women are covered from head to toe. They are some of the most difficult patients to care for, partly because of the language barrier, but mostly because they have such sad stories. I operated on an 18 year old Somali woman to repair a fistula (hole) between her bladder and her vagina, that was causing her to leak urine all the time. This was the result of trauma that I don’t need to describe, but she also had a colostomy bag, and that was the result of being shot in the stomach, while she was pregnant. She woke up in a hospital in Somalia with no baby, and no uterus. Gunshot wounds are not uncommon in the Somalis, but I suspect their trauma goes much deeper than these wounds. They live in camps and tents all over Kenya, and in spite of Kijabe being a primarily Christian area, they travel very far to come here for their care.
The language issue is a big one—Kenyans have many different dialects that are all very different from one another, depending on region and tribe. I have a Kenyan medical student who translates for me—he is very timid and sweet! Most educated Kenyans learn both Swahili and English, but most of the patients I see speak only Swahili, and even the nurses in the hospital have a difficult time understanding me. Most of the doctors speak Swahili, but all of the medical records and orders are in English (thank God!)
One of the most impressive experiences with language I’ve had thus far just occurred today. One of the patients I’ve been following since arriving here is a 19 year-old HIV-positive Kenyan woman who delivered twins at home, and then presented 2 weeks later to the hospital in shock from blood loss from a massive post-partum hemorrhage that was made worse by the fact that she had a platelet count of 10,000 when she arrived. Her hemoglobin was 1.3—the lowest I’ve ever seen. She spent about 4-5 days in the ICU comatose. She’s been on the maternity ward since then, and I see her daily. She is considered to have suffered a massive hemorrhagic stroke (we suspect she bled into her brain) and so we understand her to be confused, and probably will always remain mentally impaired after such an insult. She is Masai, and so does not speak Swahili or English, and there is only one Kenyan intern who speaks enough Masai to ask her how she is doing each day. She would ask for the lights to be turned on every morning, when the lights are on 24/7. Everyone assumed she was just confused. She developed a severe headache yesterday, so I did a neurologic exam, and her pupils did not really respond to light, and she had trouble following my finger when I’d move it in front of her, but I assumed she did not understand my commands—then it hit me. She is blind. We’d been helping her eat and feed her infants, and we all thought it was because she was simply weak, but no one could communicate well enough with her to find out she actually cannot see. We will call her family tomorrow to ask them if they can collect enough money to transport her to Nairobi and pay for a CT scan of her head to see how much bleeding she had in her brain, and if anything can be done to help her.
Everyone pays up front for any medical care they receive at Kijabe. Patient will spend a day or two in the ER waiting for their families to collect enough money so that they can afford the surgery for their broken bones or the medications they need for their pulmonary TB. It’s a difficult system, but most things are not terribly expensive (a CT scan in Nairobi costs 6,000 Kenyan schillings, which is less than $80), and it promotes communities caring for their own. But surgeries get delayed, treatments do not happen, and I know that people die, because they are poor in this country. It makes me think hard about everything I use during the day, and every test I order—patients pay for every pair of sterile gloves you use in the OR or during their delivery. When I think about how wasteful we are in the US because of the abundance of supplies and resources we have at our fingertips (like oceans of ultrasound gel, endless packs of sterile gloves, disposable speculums and mountains of bandaids and q-tips!) it makes try to imagine what one of the Kenyan nurses would think about Swedish hospital. Oh to have a translator phone! Something I’ve complained about using and taken for granted for years! In the mean time, I’m working on my Swahili… lala salaama.
I think I'm finally getting a sense for things here at the hospital-- things are crazy. Vy, Dustin and I have been meeting up at Vy and my place for dinners when we all get done, and we play a game of "who saw the most bizarre things today." Tonight's competition went something like this:
Dustin: "I saw a patient today who was using a bread bag for a condom catheter”
Alyson: "I told a 23yr old that the reason she hasn't had any periods yet is because she has no uterus, and maybe has testicles in her, and not ovaries, but we're not sure"
Vy: "I saw a kid with blue sclerae" (the whites of his eyes were blue)
Alyson: “ I saw a woman with endometriosis of her belly-button—it bleeds every time she has periods”
Dustin: “ I saw a patient with an umbilical hernia the size of a grapefruit on top of a stomach that was so full of fluid, it was the size of a watermelon”
It went on like this for the next 30 minutes. Back home, Dustin and I have a rule about talking about work—we try hard not to do it. It is different here, without TV, much internet, or much of a social life, we are forced to process things we saw and did during the day, and I think it’s a good thing, because we see and do a lot that is really difficult.
Kijabe Hospital takes care of a lot of Somali refugees. They stand out because they don’t speak English or Swahili, and the women are covered from head to toe. They are some of the most difficult patients to care for, partly because of the language barrier, but mostly because they have such sad stories. I operated on an 18 year old Somali woman to repair a fistula (hole) between her bladder and her vagina, that was causing her to leak urine all the time. This was the result of trauma that I don’t need to describe, but she also had a colostomy bag, and that was the result of being shot in the stomach, while she was pregnant. She woke up in a hospital in Somalia with no baby, and no uterus. Gunshot wounds are not uncommon in the Somalis, but I suspect their trauma goes much deeper than these wounds. They live in camps and tents all over Kenya, and in spite of Kijabe being a primarily Christian area, they travel very far to come here for their care.
The language issue is a big one—Kenyans have many different dialects that are all very different from one another, depending on region and tribe. I have a Kenyan medical student who translates for me—he is very timid and sweet! Most educated Kenyans learn both Swahili and English, but most of the patients I see speak only Swahili, and even the nurses in the hospital have a difficult time understanding me. Most of the doctors speak Swahili, but all of the medical records and orders are in English (thank God!)
One of the most impressive experiences with language I’ve had thus far just occurred today. One of the patients I’ve been following since arriving here is a 19 year-old HIV-positive Kenyan woman who delivered twins at home, and then presented 2 weeks later to the hospital in shock from blood loss from a massive post-partum hemorrhage that was made worse by the fact that she had a platelet count of 10,000 when she arrived. Her hemoglobin was 1.3—the lowest I’ve ever seen. She spent about 4-5 days in the ICU comatose. She’s been on the maternity ward since then, and I see her daily. She is considered to have suffered a massive hemorrhagic stroke (we suspect she bled into her brain) and so we understand her to be confused, and probably will always remain mentally impaired after such an insult. She is Masai, and so does not speak Swahili or English, and there is only one Kenyan intern who speaks enough Masai to ask her how she is doing each day. She would ask for the lights to be turned on every morning, when the lights are on 24/7. Everyone assumed she was just confused. She developed a severe headache yesterday, so I did a neurologic exam, and her pupils did not really respond to light, and she had trouble following my finger when I’d move it in front of her, but I assumed she did not understand my commands—then it hit me. She is blind. We’d been helping her eat and feed her infants, and we all thought it was because she was simply weak, but no one could communicate well enough with her to find out she actually cannot see. We will call her family tomorrow to ask them if they can collect enough money to transport her to Nairobi and pay for a CT scan of her head to see how much bleeding she had in her brain, and if anything can be done to help her.
Everyone pays up front for any medical care they receive at Kijabe. Patient will spend a day or two in the ER waiting for their families to collect enough money so that they can afford the surgery for their broken bones or the medications they need for their pulmonary TB. It’s a difficult system, but most things are not terribly expensive (a CT scan in Nairobi costs 6,000 Kenyan schillings, which is less than $80), and it promotes communities caring for their own. But surgeries get delayed, treatments do not happen, and I know that people die, because they are poor in this country. It makes me think hard about everything I use during the day, and every test I order—patients pay for every pair of sterile gloves you use in the OR or during their delivery. When I think about how wasteful we are in the US because of the abundance of supplies and resources we have at our fingertips (like oceans of ultrasound gel, endless packs of sterile gloves, disposable speculums and mountains of bandaids and q-tips!) it makes try to imagine what one of the Kenyan nurses would think about Swedish hospital. Oh to have a translator phone! Something I’ve complained about using and taken for granted for years! In the mean time, I’m working on my Swahili… lala salaama.
Thursday, November 12, 2009
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!
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!
Tuesday, November 10, 2009
Arriving in Kijabe
November 9, 2009
The sunrise from the plane this morning was incredible. I guess the sunrise always looks incredible from 30,000 feet, but this was our first sunrise over Africa! We woke up this morning flying over the top of Mount Kenya (the highest point in Kenya at 15,000ft). I was worried that Vy might be sleeping through this—she is an amazing sleeper, and I think she slept through every leg our our trip so far, including 3 hours from Seattle to Minneapolis, 8 hours to Amsterdam and then another 8 hours to Nairobi. Luckily they woke us all up for food—I got served a vegetarian, dairy-free breakfast on Kenyan Air—I had tried to tell them that dairy was fine, but I guess I clicked the wrong box on the website a few months ago when I bought my ticket.
Amsterdam was beautiful. We lucked out on the weather for a little while, and had 60s and sunshine so we could enjoy walking around, but then the sun disappeared and it was suddenly very cold and windy, and we were so tired! But it was nice to walk around and see a new city. We walked through the famous "Red-light" district. So odd to see women in the windows on their cell phones, texting--I guess it gets boring!
Arriving in Nairobi was surreal, but things went amazingly well. Our driver, Davis, picked us up after we flew through the visa line and whizzed through customs (“what did you pack?” “umm, just clothes”; “ok, enjoy your stay”). Too easy. Davis took us to a supermarket in Nairobi to do all of our grocery shopping for the month. I was feeling tired and overwhelmed, and had a difficult time wondering how many kilos of rice Dustin, Vy and I would eat in the month. Somehow we made it out of there and spent about 16,000 Kenyan schillings (about $200, since it’s about 77 schillings to the US dollar). We even got a delicious cup of iced Kenyan coffee, breaking the rule of not eating ice or water in a foreign country—whoops! But so worth it! Then off to Kijabe, with a quick stop at a look-out point over the Great Rift Valley, where we were heckled to buy Kenyan trinkets and in our sleep-deprived, foreigner naiveté, we spent WAY too much on necklaces, dishes, elephant carvings, etc, just to get out of there!
Kijabe is at just over 7000 ft elevation, and tucked away in the hills after passing slums, farms, sheep, goats, donkeys (no elephants yet, but we did see a herd of giraffe already, just as we left the airport in Nairobi!). We have met many very kind people so far, and everyone is eager to teach you about Kenyan culture and a few words in Swahili. Jambo, salama and habari, are all words to say hello, how are you, nice to meet you, etc. It is customary here to greet everyone and shake hands with everyone. Vy and I are staying at a beautiful complex, with a huge window overlooking the valley. We have 5 beds and a large kitchen and living space, but Dustin has to stay in a house about 200 yards away, since it would not be culturally appropriate to have Dustin staying with the two women. He has a housemate who is an engineer from Mississippi who is helping to build a surgical “theater” in Kijabe. Apparently, Kijabe Hospital has a great reputation for its surgery. We just had dinner with Doug and Kathy Trotter (from the pacific NW) and Doug tells us that of the 27 doctors on staff at the hospital, about 20 are surgeons.
Grand rounds tomorrow AM at 0700—our first time in the hospital and I think off to a running start! I’m sure I’ll have much more to write about then… I suspect I’ll sleep well tonight, in spite of the anxiety about my day tomorrow!
The sunrise from the plane this morning was incredible. I guess the sunrise always looks incredible from 30,000 feet, but this was our first sunrise over Africa! We woke up this morning flying over the top of Mount Kenya (the highest point in Kenya at 15,000ft). I was worried that Vy might be sleeping through this—she is an amazing sleeper, and I think she slept through every leg our our trip so far, including 3 hours from Seattle to Minneapolis, 8 hours to Amsterdam and then another 8 hours to Nairobi. Luckily they woke us all up for food—I got served a vegetarian, dairy-free breakfast on Kenyan Air—I had tried to tell them that dairy was fine, but I guess I clicked the wrong box on the website a few months ago when I bought my ticket.
Amsterdam was beautiful. We lucked out on the weather for a little while, and had 60s and sunshine so we could enjoy walking around, but then the sun disappeared and it was suddenly very cold and windy, and we were so tired! But it was nice to walk around and see a new city. We walked through the famous "Red-light" district. So odd to see women in the windows on their cell phones, texting--I guess it gets boring!
Arriving in Nairobi was surreal, but things went amazingly well. Our driver, Davis, picked us up after we flew through the visa line and whizzed through customs (“what did you pack?” “umm, just clothes”; “ok, enjoy your stay”). Too easy. Davis took us to a supermarket in Nairobi to do all of our grocery shopping for the month. I was feeling tired and overwhelmed, and had a difficult time wondering how many kilos of rice Dustin, Vy and I would eat in the month. Somehow we made it out of there and spent about 16,000 Kenyan schillings (about $200, since it’s about 77 schillings to the US dollar). We even got a delicious cup of iced Kenyan coffee, breaking the rule of not eating ice or water in a foreign country—whoops! But so worth it! Then off to Kijabe, with a quick stop at a look-out point over the Great Rift Valley, where we were heckled to buy Kenyan trinkets and in our sleep-deprived, foreigner naiveté, we spent WAY too much on necklaces, dishes, elephant carvings, etc, just to get out of there!
Kijabe is at just over 7000 ft elevation, and tucked away in the hills after passing slums, farms, sheep, goats, donkeys (no elephants yet, but we did see a herd of giraffe already, just as we left the airport in Nairobi!). We have met many very kind people so far, and everyone is eager to teach you about Kenyan culture and a few words in Swahili. Jambo, salama and habari, are all words to say hello, how are you, nice to meet you, etc. It is customary here to greet everyone and shake hands with everyone. Vy and I are staying at a beautiful complex, with a huge window overlooking the valley. We have 5 beds and a large kitchen and living space, but Dustin has to stay in a house about 200 yards away, since it would not be culturally appropriate to have Dustin staying with the two women. He has a housemate who is an engineer from Mississippi who is helping to build a surgical “theater” in Kijabe. Apparently, Kijabe Hospital has a great reputation for its surgery. We just had dinner with Doug and Kathy Trotter (from the pacific NW) and Doug tells us that of the 27 doctors on staff at the hospital, about 20 are surgeons.
Grand rounds tomorrow AM at 0700—our first time in the hospital and I think off to a running start! I’m sure I’ll have much more to write about then… I suspect I’ll sleep well tonight, in spite of the anxiety about my day tomorrow!
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