Week 1

It's Friday night here and I am exhausted!  It makes me chuckle how insane the days are--I mean, the things that are done to 'get by' just never cease to amaze.  I don't know where to start in expressing my thoughts--there is so much to take in with just being in Africa, let alone experiencing the clinical medicine side of Kijabe.  I am on call all weekend for the ICU but have lectures to prepare for the nurse anesthesia students for Monday morning--so it'll just be a work weekend.  That's ok, next weekend I'm going to hike Mount Longonot and see Lake Nakuru (flamingos!)...

Big, juicy living room

Kijabe Hospital is a Christian mission hospital that was founded in 1915 and serves as a referral center for the whole country, really.  With that wide referral base, they see a lot of very specific diseases...for example, and as I mentioned previously, neural tube defects are repaired daily here (and many kinds in a day, at that).   As you can imagine, a 300 bed hospital (with outpatient clinics) requires a lot of support staff and so there is a community around the hospital with schools and rickety shops and the like.  In the evenings after I am out of the hospital, I have been exploring the area on runs down the mountain and through the brush.  Let me tell you, running at 8,000 feet is no joke--I've got more than a few hills that I'd like to conquer in the next two weeks.  Wildlife is everywhere on these runs and I'm not going to lie, it's a mix of wonder and fear--so many unfamiliar animals flying/running out as I go.  It's ok, no mambas or rabid baboons yet!

Trail to my place--it isn't much to look at but check the view...

My favorite part of this trip so far is to see the enmeshment of the spiritual in the medical care of these patients.  Part of our 'OR timeout' before incision is made is to pray over the patient, and I gladly do (don't worry, I open my eyes for the long-winded ones).  It is as though things are as they should be (and will be) when Jesus is praised openly for recoveries and equally trusted openly when things don't look good.  It is liberating in both circumstances: liberating from pride in the successes and liberating from depression/frustration in the failures.  My tendency is toward seeing myself at the center of success or failure, underscoring the importance of praise/genuine thankfulness to me.

Rift Valley, aka Valley of Megiddo "Armageddon," extends from Africa to Jerusalem and is right out my back door!

TIA - This is Africa

It's hard to believe I'm only 3 days into my clinical duties here at Kijabe Hospital--it's been such a surreal, action-packed experience.  Wireless is at best sketchy here--so I will summarize my week to this point, in anticipation of blogging more if/when the satellite receiver is up and running.

We flew into Nairobi Saturday night, after an uneventful trip through Amsterdam.  Though the two eight hour legs didn't feel terrible, I was jet lagged for my first 48hrs here.  There is only so much that Ambien can do when you're getting asked to stand up every hour for the window-loving 5 year old two seats over.  I guess I can't complain--being able to travel from NC to Kenya in less than 24hrs is pretty amazing.  So it was on to Kijabe on Sunday after a night in Nairobi.  We had a quick walk-through/orientation to the village on Sunday and after getting my ICU call pager and locker etc. on Monday morning, it was off to the OR. 

Now, starting in the OR here has been...ummm...interesting.  Very little is prepared for--preoperative evaluation?  Ha!  I'll give you an example.  Yesterday I finish case number 3 for the day, which was a myelomeningocele repair in a severely dysmorphic 3 month old.  I extubate this child in the OR--against my learned instincts--there are no more pediatric ventilators in the hospital (the two that are, are being used).  It's a little dicey but the little dude does alright.  I drop him off in recovery and return to the operating room where my next patient (had a tethered cord for release) awaits on an operating table that has not yet dried from the cleaning wipe down.  I know nothing of the patient--he is an infant and has Somalian parents.  We're proceeding.  The tech. fetches me an appropriately sized, washed breathing circuit...I scramble to find appropriate drugs and we proceed.  7 cases in the OR that day--6 major cord defects and a shunt.  Sweet sassy.

Go to medications for cases include: pancuronium, atropine (no glyco.), morphine/meperidine, thiopental and halothane (for mask inductions).  Thankfully there is isoflurane for maintenance now!  Basically, if it's cheap and nobody else wants to use it...those are the supplies that accumulate here.  Quincke (cutting) spinal needles--yes please!  Disposable pulse oximeters are used until they literally fall apart.

Other cases that I've been involved with this week already include:
- Continuous spinal for hemiarthroplasty in a 90 year old Somalian woman
- PEA arrest in a 2 year old for posterior fossa craniotomy for tumor excision (arrested while prone--revived after 5 minutes of PALS)
- Surfactant administration to a 35wk infant while on ICU call (I'm the attending and by far the most experienced--yikes!)
- Intubation and subsequent extubation of a 29 year old with massive retropharyngeal abscess after mandibular fracture--suctioned .5L of puss from the back of his throat before extubating him in the ICU last night because I needed his ventilator for another crumping patient
- Inverse ratio ventilating a 2 kg infant with sepsis from pneumonia

There's so much more that I could write but dinner awaits and so does shower and bed!  I will try to write more frequently and with pictures once I have an internet connection.  I have a bit of humor to share re: Dr. Anderson but that will have to wait until the next time I write.  Let's just say--I think he might be looking forward to teaching seminary up at Kitale after this week! 

After years of thought and several months of preparation, I am finally ready for a month at Kijabe Hospital in Kijabe, Kenya.  Dr. Jay Anderson and his wife Holly will join me for the 24hr journey to Nairobi on March 23rd and I will work at the hospital until April 15th.  These are exciting times for me and I plan to write about a lot of my experiences and related musings here.  With the help of UNC's department of anesthesiology (anesthesia technicians, attending anesthesiologists, medical suppliers, chairman/program director), I am amply supplied for this trip--so much so that I feel humbled and immensely blessed to be able to work for such an amazing department.  Here's what I'm taking:

Stay tuned.  More updates to come!