Thursday, April 5, 2012

The Weekend

Apparently time flies in Kijabe, Kenya--it hardly seems possible that 2 weeks ago I was packing it up in Chapel Hill for the trip here.  In medical school I took a medical missions trip to Nicaragua with good friends Chris and Elizabeth.  It was good introduction to Latin American culture but our efforts to be medically helpful were largely thwarted, it seemed, by our lacking specific skill sets at that point in our training.  We could rub delousing serum into school kids' hair and hand out albendazole but that was about it. This trip has thankfully been drastically different on that front and I think is the big reason that I am enjoying it so much.  I was talking with one of the Vanderbilt surgery residents the other night about this and she resonated very similar sentiments and has been here in Kijabe since September!

So this week I have typically been supervising a Kenyan anesthetist student in one operating room and then performing peripheral nerve blocks or helping the regular nurse anesthetists in other rooms.  The sum of it = very busy days.  Working with the students can be harrowing.  Shoot, working with the senior anesthetists can be harrowing.  I had one ask me if she could mix her Ketamine and Propofol into the maintenance IV fluids for the case for which she was giving sedation.  She was dead serious.  After I suggested why that might be a bad idea, it was as though it had never occurred to her why that might be a bad idea!  She and several at her level give anesthetics every day without any sort of oversight.  We're friends and have good laughs but yikes!  I do not say that out of condescension--in reality the quality and safety of anesthetics delivered at Kijabe is probably some of the highest in the country, and I think that the nurses do receive good training here.  This trip has been eye-opening with regard to the quality of the medical care that we have in the U.S.  Today we did a rigid laryngoscopy on an infant that I have been caring for in the ICU for the past 10 days--she has recovered from pneumonia and had recurrence.  The reason?  Aspiration of nasogastric tube fed breast milk.  The solution?  Surgery?  Nope.  Palliation.  Yup!  Really?  In the States that child gets a gastric fundoplication, a G-tube, some Ranitidine and 73 more years of life.  Earlier this week I was told that a newborn with tracheoesophageal fistula was coming to my room for thoracotomy and closure.  It was the end of the day already, so the powers that be decided to move it to the morning.  The baby died that night...never made it to surgery.  Again, in the States that child would have gotten her surgery and probably many more years of life.  It is sobering.

Well, tomorrow I head out early in the morning to hike Mount Longonot with some friends from internal medicine and then on Saturday I leave very early for a safari in the Masai Mara.  Apparently there is no better safari experience in all of Africa, so I am stoked!
Placing a caudal block in a hypospadias kiddo--working with student anesthetist.

Teaching femoral nerve block to one of the nurse anesthetist and a student.

I was late for lunch--no rice but more veggies!





1 comment:

Sue said...

Is that the scrub cap I made??? Love seeing you in "action"!