I knew when I started planning for this trip over a year ago
that it would be one of great personal, spiritual, emotional, and educational
growth. However, I have even surprised myself at some of the things that I have
learned over the course of the last 3 weeks. Please allow me to share with you
just a few of my thoughts:
1.
I can survive without being connected 24/7: We
were told when we signed up to come to Kenya that our housing and the hospital
would have wifi readily available. However, that actually meant that there is
one room right next to the ICU with wifi and we were given a modem to use for
our computer at home. It requires us to pay by the megabyte and usually has a
painfully slow connection. Therefore, the tablet and iphone that I brought to
use on wifi have been rendered useless. I use the internet for about 5 minutes
out of every day to check my email or post a blog. The wonderful thing is that
it has required me to actually use my brain when treating patients (limited
access to fancy apps and no google or Up To Date to access), and it has helped
to me to focus on actual relationships rather than facebook news feeds and
constant email checking. Don’t get me wrong, not all of Kenya is disconnected…In
fact I have seen people walking aimlessly looking down at their smartphones
more than once…but at least a 1 month cleanse of limited technology has proved
to me that I can survive…and become less stressed because of it.
2.
I can make decisions about patient care on my
own: I realize that many of my peers are getting ready to go out into the real
world of medicine at this point (3 years into residency). It’s strange to think
that in just a few short months, there will no longer be an attending to ask
when you are stumped about what to do. There’s no longer the mentality of “I
just have to make sure this patient survives through the night, and in the
morning we can sort out what else might be going on with them with the help of
the attending.” Thankfully, in med-peds I still have one more year of the
attending blanket, but this month has allowed me to step into roles that I
would never have at home. Don’t be alarmed, there are still more senior people
I can call if I’m stumped, but I am not required to run every decision by them.
Some days it has been uncomfortable to think that I’m the only brain pondering
about a patient issue, but it has allowed to realize that I depend on a God
much bigger than I am, and he has equipped me far better than I realized to
handle those situations. It makes me think that maybe one day I really can be a
big girl doctor. :)
Just as an example: Today I was
rounding with the NICU fellow in the nursery. After we finished rounds, our
interns had all gone home (Saturdays are a commodity for those not on call!).
The fellow had also left and I was trying to tidy things up for the on call
team when the OB intern ran into the nursery to grab me to attend an emergency
c-section.
We ran to the OR, and I prepared
the resuscitation room for the new baby. Imagine a small closet with an old (but
functional) infant warmer and random assortments of donated ET tubes, used
suction catheters, glass bottles of unlabeled medications, and other
unidentifiable equipment…noticeably missing were the ambu-bag, oxygen
connectors, and laryngoscope I would need if the baby were really in bad shape.
At home we have nursing and RT’s to
help set up all of our equipment while we wait for the baby. However, here we
scramble to do most of it ourselves. After I’ve tried to come up with a
Mcguyvor plan for what I can use of the random equipment if I need it in an emergency,
the midwife thankfully comes with the proper paraphernalia.
After getting things set up, we
went to the theater to wait for the baby. The c-section is solely performed by
the intern and after the baby is out, we run down the hall to the resuscitation
room and pray for crying.
Today, unfortunately, the baby was
very floppy and not crying. We tried to suction and bag, but despite our best
efforts, the baby’s heart was not beating. We had to perform CPR (something I
have never had to do at home in all the deliveries I have attended).
Thankfully, after a brief round of CPR the baby started to perk up and she is doing
well this afternoon. However, it was humbling to realize that I had no neonatologist
to run things…or to hand the baby over to when I was finished. Needless to say,
I have said many prayers in the resuscitation room this last week, and
thankfully the Lord has faithfully answered each one. Even when I’m making
decisions without other human input I have the Lord right there with me…
3.
I’m so thankful for our ancillary staff at our
hospital back home: A friend of mine spent 2 years working at a hospital in
Kenya after residency. When I asked her what I should try to get out of
residency in order to be prepared for third world medicine, she counseled me to
pay attention to what the ancillary staff does, because you won’t have them in
the developing world.
When I was on call the other night, the
nurses asked me to set up the vent in prep for a patient from the OR. I thought
to myself….”I have no idea how to set up a vent (much less a German one…)…the
RT’s do that…” When we needed a blood gas on an infant the other day, we had to
collect it ourselves. When you need a lab result, you go to the lab yourself to
thumb through the giant notebook. When you order an x-ray, you read it
yourself. Everything is much more hands on here. It helps me learn more skills
for sure, but it also makes me thankful for those we have at home to help us
with these very important parts of patient care.
4.
Infection control is a very important part of
that ancillary staff: Unfortunately, over the last week we have been battling a
multi-drug resistant klebsiella outbreak in our NICU. We have 7 confirmed and 2
suspected cases currently. It has been disheartening to come to the hospital
each morning only to learn about a new infant with a fever. We’ve been doing
what we can with isolation, gloves, and deep cleaning, but we are still praying
for God to stop the spread. Fortunately, most of the babies are doing quite
well despite the infection because of early identification. The hospital and
administration are doing their best to identify sources and keep from giving it
to any new infants, but we are just not equipped either with the space, means,
or the nursing attitude of our NICUs in the states to be able to handle the
infection the same way.
It has made me think about the Ebola
outbreak. While Ebola is still very far from the boarders of Kenya, I see how
in this environment such a deadly disease could spread so quickly. Kijabe is a
great hospital with a lot of western influence on its protocols and standards.
Therefore, watching the conditions here and thinking about what it must be like
in other parts of the developing world of Africa, I can now understand how such
an outbreak could occur.
5.
Life is fleeting: Luckily, death has not visited
our nursery this week, but I have been following some of my internal medicine
patients who were not fortunate enough to leave Kijabe in their earthly bodies.
Even back home this week we received word that a couple from our church
unexpectedly lost their 4 month old son to SIDS. We have been heartbroken over
the news, and in constant prayer for his parents. It has forced us to face the
reality of these mortal bodies we live in. Even the youngest of children cannot
escape the face of death. However, we do not despair, because we know that this
life is only the beginning. You could get really depressed if you think about
the 100% failure rate you face if your goal is simply to keep people from dying
in medicine. However, when we shift our goal to trying to help people truly live,
both in this life and the next, that is where our true reward comes. Our lives
on this earth are short…therefore we must set our eyes on eternity and try to
show it to others along the way.
I could continue on with far more lessons learned, but I
fear I have spent far too many words already. Please join us in prayer for the
family back in South Carolina grieving the loss of their sweet son. Also pray
for all the infants afflicted with infection and pray that we may be able to
stop the spread. I would also personally appreciate your prayers, as tomorrow I
take Sunday call which includes covering the floor, the NICU and the PICU for
24 hours with no one to round on the patients. I know I have One greater than
me to call upon, but I still would appreciate a quiet day…
This time next week we will be arriving back in the states,
so also pray for a fruitful week as we wrap up our time in Kijabe!
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