This was the first of many weeks on the wards. The hospital is state-of-the-art for a small city in Kenya. The hospital compound is MASSIVE and includes medicine wards, an ICU, surgery suites, a maternity/fetal hospital and even a stand-alone children's hospital. However, it is going to take time to adjust to the conditions here. Despite having all the traditional wards, it is a far cry from the sterile and fluorescently lit hospital rooms in the US. Every room is open to the outdoors (yes, even the ORs) and is crawling with cockroaches, flies, and even the occasional lizard. There are routinely two patients per bed with completely separate medical conditions. Everything is done on paper charts and it is impossible to read anything, order anything. Patients wait on the wards for days with hemoglobins of 2, hoping and praying their loved-ones can donate blood to save their lives.
I personally was on the GYN wards this past week. Unlike the traditional GYN patient in the states, most were post-op ectopic pregnancies and previable pregnancy complications. Another important difference, the age of viability here is 28 weeks (compared to sometimes 23wk in the states). So during our rounds we had anything from newly diagnosed Stage 3b vulvar carcinoma, to a woman at 25 weeks with severe preeclampsia (a hypertension disorder in pregnancy) who was refusing treatment. Below is an example of a ward "firm" that I shamelessly stole from @KevinKuo because I can't seem to take any HIPPA compliant ones.
On our one GYN surgery day, we attempted a bilateral tubal ligation with the historically finicky laparoscopic equipment. The GYN surgeons typically do ALL open cases, which adds days of recovery in the already overflowing ward. For those of you who are not medical, open abdominal cases are reserved for particularly difficult surgeries that need large access points and better visualization. Tubal ligations are actually easier done laparoscopicly. SO after 1 hour of set-up and 1 hour of attempted entry and failed CO2 insufflation, we converted to open. Another patient from an elective surgery that will most likely be in the hospital for 3 days post-op. It is hard to keep costs and energy down when you're fighting upstream.
Peep the OR conditions below, with the door open to the outside. There is a rumor floating around that once a goat ran straight into the OR during a surgery. Allegedly the surgeons stopped what they were doing (did not scrub out), shooed the goat back outside, and picked up their instruments and resumed.
Not everything is hopeless! Kenyan patients (and people) are some of the most resilient and positive people I have every met. They never complain about sharing a bed with someone. They never whine about the extra day they're spending in the hospital because the MRI queue is 3 days. They smile from ear to ear when I try and say "habari ya asubuhi" every morning, despite their prognoses. Family members help other patients to the restroom when they are too weak to stand.
I can't wait to face the challenges and see some of the innovative Kenyan solutions over the next 7 weeks here in Eldoret. Thanks for reading!
Rebecca
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