Today after merely 3 days of working with the interns and
learning the hospital system, I stepped fully in to my role as on call
attending…for the next 48 hours. My morning began leading rounds with my team
where I was pleased to be able to impart some wisdom about meningitis management,
INR monitoring, and HIV opportunistic infection prophylaxis. After completing
rounds, my team of two left the hospital promptly at 9:30am not to return until
Monday morning (nothing in the hospital runs on Sundays except for the lucky on
call attending who rounds on the team by themselves). I can’t blame them,
however. They work up to 120 hours a week, often taking call every 2-3 days on 3
different services at once without the benefit of going home mid-day when they
are post call.
After seeing my sick step-down unit patients by myself, I
spent my afternoon helping my intern with admissions and putting out fires on
the wards (i.e. status epilepticus in an adult male with congenital
hydrocephalus s/p shunt->brain abscess->osteo of the frontal bone->
removal of the bone->large defect in the head permanently->seizures). It
has been both terrifying and invigorating to be given so much responsibility
and the ability to teach the interns, and likewise to learn from their vast
knowledge of both medicine and Kenyan culture.
I feel that in only 4
days, I have already grown so much as a physician and a person as I try to
rationalize through each differential (in an world with HIV where anything is
possible), pay keen attention to my history and physical (in a world where diagnostic
tests and limited and no prior electronic history is available), and think
through the absolute need for a test and what it will change (in a world where
the patient has to pay upfront for everything I order). It also has been
liberating to practice in a culture where records are kept for strictly a means
of communicating thoughts rather than to please insurance company reviewers and
coders (who do not exist). On the flip side of the coin it has been difficult
for the anal-retentive in me to watch interns cover nearly every patient in the
hospital without a list, any form of check out, or way of determining what
happened overnight. Overall let’s just say that this is a culture not bogged
down with administration or logistics work.
To sum up Kenya, I would say they are a beautiful group of
people who are relationship oriented contrasted against our American mind-set of
being task oriented. For example, on Friday after rounds we all went to the
cafeteria and had chai (tea) and manadazis (think cake donuts). We sat for an
hour and a half while the team relayed to us the stereotypes of each of the 42
tribes in Kenya, the political climate after the tribal unrest of 2008, their
views on marriage and dowries, and their hopes and dreams for the future. As I
soaked it all in, I felt as though in only 3 days, I was having deeper
discussions with my team than I ever had back home (and I feel like my fellow
residents and I are pretty friendly people…still). All the while I thought
about how I would traditionally have been scurrying around trying to tidy up
orders and check on patients during that time.
Before leaving for Kenya the Lord tried to gently remind me
of this relationship driven vs task driven dichotomy. I too often get caught up
in trying to accomplish my own means on Earth while neglecting to take time and
invest in eternal things like my relationships with others and sharing a word
of prayer with a patient who desperately needs some hope and encouragement. As
a result, I end up stressed and anxious and feeling like my life is lacking the
purpose it was designed for. I’m not there yet, but I’m praying Kenya will be
an instrument to help perfect this concept in my life.
Praying hard for you! I know the Lord is at work and ... "being confident of this, that he who began a good work in you will carry it on to completion until the day of Christ Jesus."
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