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!