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My OB team.  George, Janet, and Obonyo

Foundation stone outside the hospital main entrace

I said my final goodbyes today. Very bittersweet. My intern Janet came back to work today (Did I mention that she's been out with chickenpox for a week?). I took some final pictures, packed and am leaving for the airport shortly.  I don't have any profound thoughts and just pray that I have a safe return.  I'm excited to see my friends back home...even my coworkers.  Hopefully this is more of a 'until next time' departure and I can come back after residency.  How long will I stay?  Well, I'm still praying about that.

With Sylvia (one of our chaplains) and Lillian (one of the OB nurses)

Saying Goodbye

Today was my last day of work and my last day in theater. It started off with ward rounds (which I led by myself...no consultant...the norm now). I then proceeded to theater where I was operating by myself. I did a diagnostic laparoscopy and a couple of D&Cs, which I have never done by myself. My consultant then showed up to do a couple of myomectomies with me (surgeries to remove fibroids from the uterus). The day ended by taking out a huge 11 wk sized ectopic (which thankfully had not ruptured) by myself. I was concerned but it was an AMAZING day!  No complications.  Thank God!  Seriously, prayer works.

Proof that I'm actually working here...I'm in the grey gown

Our OB team...Esther and Nancy are in the middle

Our OB anesthesia team and Dr. Osoti, my consultant (far right)

The staff in theater was so nice today. They all were sad when I started taking my final pictures. My two nurses, Nancy and Esther, have been the best to work with. They're really funny women. Esther was my own personal paparazzi and took all the pictures I wanted.  Nancy...well, despite her humor, whatever Nancy says goes.  They've both been around for more than 20 years and have even taught my consultant. They have made me promise to keep in touch, which I will make a true effort to do.

I will miss the constant worship music playing while operating.  I won't miss the heat or the fact that the lighting is horrible for operating.  I will miss the tea breaks, fast room turnovers, and free Kenyan food I get for lunch.  I won't miss the fact that half the instruments work.  Even still...I'd do it all over again.

Shopping in Nairobi

Friday I didn't work. For the first time since my arrival, I played the role of tourist. We (Samantha, my new housemate, Esther, and I) went to the Village Market in Nairobi. I was able to arrange for a ride that morning through Alisha, one of the elders at church. Village Market was not quite what I was expecting. It was like a resort. It had multiple levels, a variety of stores, and a huge Nakumaat (which is like Wal-Mart but you can seriously buy anything in one stop from a stove to toilet paper).  Most importantly, the upper level contained the Masaai Market where they sell arts, crafts, jewelry, etc. We were warned that to be successful at the Masaai Market you have to price bargain which I hate doing. So if someone offers you something at 1500Ksh, you say 1/3 of that price and meet somewhere in between. Honestly I was a little timid in the beginning. The sellers were constantly yelling, “Sister! Sister! Come over her. I give you good price.” Some would even grab you by the arm to pull you towards their merchandise.  I was trying to be stern, not smiling too much, trying to not seem like the sucker American. The funny thing is I spent so much time telling Samantha tips about bargaining and she proceeded to bargain better than I ever could. We met up with Esther (the other housemate) who gave us a few more tips and then we were set. I didn’t buy much...a few pairs of earrings, a couple of bracelets, salad spoons and bowls. Nothing big. We then walked around the mall itself (mostly looking in on all the very wealthy stores like art galleries and diamond sellers). After that, we took a small break for lunch. The lower level of the mall contained the food court which is an outdoor area with huge trees, water falls, and umbrella tables. It felt like we were in a different country. There were numerous types of food to choose from like Italian, Indian, Turkish, African, and German. There was even a pastry shop which was shocking since desserts don’t seem to be a key component of Kenyan meals. We walked around a little bit more, took a few pictures, got a few more deals at the market then called it quits. It was a nice, day and a good chance to get out of Kijabe.  Now it's back to work for the last few days.

With Samantha and Esther at Village Market

Healing

I feel so much better.

Today was an amazing day. I slept last night (I’m now 3 for 3 when it comes to sleeping away my call nights), I got to do some amazing surgeries, I ate with no problem, and it was absolutely beautiful outside. Today a lot of people were asking me what day I leave, when am I coming back, and telling me what a great job I did and it felt good. (seriously my consultant wanted to know my program director’s number to ask for two more weeks…that would be nice but Rachelle would kill me if she had to change the schedule for the 100th time). All I could do was think about how good God is. I’ve been a part of some pretty cool healing here that I couldn’t have planned for. Typically I would usually share one particular tremendous story that sticks out as an example, but I don’t have just one. It’s every single patient that we’ve treated, hasn’t experienced a complication, and gets healing whether it is medicinal or spiritual that has renewed my excitement in being able to work like this for Him. Plus, I get to spend a month in Kenya, doing what I love to do in one of the most beautiful places I’ve ever seen. My mother’s favorite Psalm is Psalm 100 and that was all I could think of today. There are five verses but the part that I kept hearing was this: It is He who made us and we are his…For the Lord is good. That says it all, better than I ever could.

Only 1 1/2 weeks left

So I don’t know what happened to the past week. Well the past few days I’ve been curled up in the fetal position in bed. Before that, it was a usual Monday with rounds and Maternal Child Health (MCH) clinic. Not too bad actually. I was done for the day after about 2pm. That night I had dinner with a couple that one of the girls here knows through her program. They are affiliated with Moffet Bible College here and are nice people. Slow to converse with in the first 15 minutes you meet them but funny after that. The wife (Janet) is actually the musician for the church here and her husband teaches at Moffet. There house is located right in the compound with the college and is a nice house. They have a 2-3 bedroom house. The living room was nice/spacious with a piano and fireplace. They also had a TV, DVD player. It was the only other TV I’ve seen here besides the one in the airport and the one we use on our antepartum unit to play Christian music videos for the patients. We had a good dinner and then after dinner, she offered to let us watch a movie. This was like a small personalized gift from God.  They lead us into the office where there are probably 150 DVDs. The collection was more random than mine. Anything from Star Trek to Pride and Prejudice (the BBC version) to Eureka and Firefly. I stood there happy like a kid at Christmas. In the end we decided to watch Sabrina (that’s what happens when three girls pick the movie).


Tuesday we had theater. We only had a TAH, a Cesrean section and Myomectomy. That doesn’t sound too bad until you realize that they myomectomy took three and a half hours. This uterus looked like the blob. She had over twenty fibroids and in the end we just couldn’t get them all. Hopefully it’ll help her fertility in the end. Fun case. I was on call that night and so was my intern. Before I left for the day I got to help my consultant do a vacuum assisted delivery. The best part about Tuesday was that night I didn’t get called once. No pages all night. The worst part about Tuesday was that I started getting a stomach ache that night but I didn’t pay too much attention to it.

Wednesday/Thursday: Rounds, theater (D&C, C-section), then I came back to the house to work on my presentation for our OB/GYN case presentation for Thursday. However, I spent the entire night curled up in my bed or in the bathroom all night. I'll spare you the details but I had the worst abdominal pain I’ve ever had. I thought I had anything and everything from pancreatitis, gallstones, perforated ulcer, toxic megacolon, worms. I even stayed home Thursday feeling the same way. I took some azithromycin, Immodium, and TUMS and stared to feel somewhat better. Janet came by the check on me Wednesday which was nice and I was also able to give her the presentation I worked on so that I didn’t feel totally bad for missing work on Thursday. I started to feel better Thursday night so that my housemates and I could still walk to Mama Chiku’s (the local restaurant) for dinner. I actually ate a bit. Then we went to the Supa Duka (market) and bought ice cream! So good! It tastes like cream. And only 60 shillings for a decent sized cup. Then we walked home and watched the Proposal. Nice dinner and a movie girls night.

Friday: The braids are back!!! I got my hair braided today. It only took 9 hrs compared to 14 hrs like last time. Plus it was only $15! That’s unheard of back home! I’m still getting use to the color…what do you think?

Only thing missing is my couch

Even though I woke up late, I made it to church again today. The first service at 8:30am is the English service and the second service in Swahili is at 10:00am. The walk to church is about 10 minutes, uphill the entire way but beautiful. We’re studying the book of Ruth now and today was focusing on Chapter 2. It’s a pretty similar style of church compared to church back home with songs (mostly American worship songs…just when I thought I could escape Chris Tomlin…nope), announcements, offering, and a message. It was a good message today but last week’s message seems to still be on my mind. Last week we focused on the transition that Naomi and Ruth make out of Moab.  Subsequently we were all challenged to remember what it means when God messes up our plans. Oh how I plan so many things. Basically what I was reminded is that God’s trying to get my attention, He has a better plan, and is ultimately calling me to trust Him. So true. And yes I needed to hear it again.

Sundays tend to be mostly lazy days with not much to do so I thought I’d take a few picture of the local sights.  I unfortunately can't upload them directly to my blog because of the internet connection.  I'm also trying to upload some pictures to a Facebook album but I haven't been able to do that either. I'll keep working on it.

Not my usual Showplace 16 Theater

On Tuesdays and Thursday we have theater days (Operating room days). Tuesday consisted of four C-sections, a tubal ligation, and an abdominal hysterectomy. Here are a few things I learned from just one day in the OR here:

1) I can literally sweat from every pore on my body. I’ll just leave that one alone.
2) Room turnover time can literally be 3 minutes…all you really need is a mop and new sheets.
3) Who needs a bovie? All bleeding stops eventually. “Just get the baby out.”
4) The concept of a waiting room means that family members sit on a bench directly outside the O.R. and you run into them with the stretcher as you exit.
5) Overhead lights are not always essential.

Most surprising of all is how little the consultants actually do in the operating room. I spent the entire day operating while my consultant played DJ (meaning he sat at the corner desk and played songs from his laptop all day...mostly American worship songs but that's beside the point). It’s so shocking how much autonomy the interns have here. Basically the interns here are doctors that have completed medical school and spend their one intern year rotating through the various areas of medicine (surgery, pediatrics, OB/GYN, medicine).  After that time, they’re expected to be able to function as an actual physician wherever they choose to practice whether it's in an actual town hospital or in a remote rural area where they are the only doctor. Even after only one year! They are INCREDIBLY busy! I seriously won’t complain ever again about work and call (well…I’ll try not to ever complain about those things again). They (2 interns) manage the inpatients which includes all OB and GYN patients. They are also responsible for seeing the outpatients in clinic during the day (which can be anywhere from 20 to 100). They also help the midwives with any high risk laboring patients. The consultant is really only called upon to finalize plans. The craziest part of it all…they operate without a consultant even in the middle of night on high risk patients. I would have to sign away my first seven children because of all my lawsuits if what happens here actually happened in the U.S.

So my intern (the one I've worked with the most and who is awesome by the way) operates like she’s an actual surgeon even though this is here third and final month of OB this year. That is what's expected of them. That’s the pressure and workload that they deal with. My job is basically to assist them like a consultant but I try and help out in any way I can. I staff and also see patients in clinic, tell them when a laboring patient needs a C-section, help with surgeries…I’m trying to help in any way I can but I still feel like the interns do so much more.

I could easily weigh 500lbs.

I LOVE food…seriously if you don’t know that about me by now, are we really friends? Just kidding. But I do love food. So I was THRILLED to eat Kenyan food again. I don’t even know what some of it was but it was SO good. We get free lunches at educational conferences (which I don’t even get at home) so I’m pretty much a happy woman. One word: chapatti. And there was some sort of Kenyan beef and greens with rice. Mmmm...and Kenyan tea. I can’t remember what was actually taught at conference but…I remember the food (I think we talked about low blood pressure at one point…oh well).

It’s a very weird sensation when you jump into the deep end and you don't drown. Monday I staffed the outpatient OB clinic and was in charged of leading rounds for all the OB/GYN inpatients. It was actually FUN! I doubted myself in the beginning but asked lots of questions, called on my actual attending when necessary and survived. I took out an IUD, transferred a lady to the ICU after she quickly tanked due to a PE and admitted the patients scheduled for their C-sections in the morning. It felt like home with some limitations (medications here are completely different, STAT means oh 30 minutes to 1 hr later it gets done, and my favorite…if you need sterile gloves and there aren’t any on the ward, go over to the next bed and take it out of the other patient’s admit bag despite the fact that she already paid for it).

Speaking of a PE, in an attempt to stay active and keep my own conditioning up, I had a quest that I would run while I was here so that I could still manage to run my half marathon in the Detroit Marathon next month. Nope, not going to happen. I’ve never been in high altitudes before but being 7200ft above sea level kinda tires you out. I have a small hill I have to walk to get to my house and it’s embarrassing how winded I get. Bleh! I am still able to get somewhat of a work out here since there’s a gym at the local academy that we can use, but I may be running another 10K when I get back. To be determined. Hmmm…I should probably sign up for that. I’ll get on that soon.

I'll post some real pictures of Kenya soon I promise...and not just food.

Karibu Kijabe (Welcome to Kijabe)

It’s been a nice adjustment for me over the past couple of days (I even heard “Airplanes” by B.O.B. on the radio during my drive from Nairobi). Beautiful weather, free home cooked meals, friendly people, and I don't even have jet lag. I didn’t really feel like I was away from home until today…I met my supervisor and began working.


Today I found out that I’m basically going to be working like one of the consultants (an attending physician). Seriously! Me. Teaching residents, letting them assist me in surgery, being called in the middle of the night for emergencies/severe complications. I’m not joking. So in order to get a glimpse of what is ahead of me this month, I started by rounding with the OB team today. Our team consists of about 2-3 interns (which are like our interns, fresh out of medical school but who are not concentrating on one area of medicine), the consultant, and occasionally a clinical officer (similar to a physician’s assistant). There are approximately 60-70 beds throughout the entire maternity ward meant for antepartum, laboring, or postpartum patients. Most of our patients today were recovering after C-sections for multiple reasons…emergent c-sections for single footling breech (one foot out, the other somewhere still inside…basically…bad!), c-sections for obstructed labor/fetal distress, and your occasional routine elective repeat c-section. I almost felt like I was at home until we were called over to see a woman who was in labor at 39 weeks. She was 8cm dilated but no one could find a heartbeat. She reported feeling her baby move the night prior. Regrettably, bedside ultrasound showed no heartbeat and confirmed everyone's suspicions. This is typical for Kenya but still surprising and hard for me to understand. My consultant said that it was uncontrolled hypertension even though she had received antenatal care. Ultimately it’s a question of compliance with medication for her high blood pressure. Nevertheless she was devastated and we left her in the hands of the midwives to deliver her baby but unable to take a child home. We kept moving because there were many other patients to see. After rounds, my consultant expressed to me his own frustration with the various complications seen on rounds, but remains optimistic that it will change someday. He’s happy that I’m here and despite his smiles I’m not entirely sure of myself right now. It’s the initial amazement of working in a new situation I guess (although I was hoping to avoid feeling this way for another two years…you know, once I finished my residency). But I’m not anxious. I will wait for God to do some amazing things while I’m here. I came here so that He could…and I know He will...because that’s what He does. Oh, and bear with me on a more practical level as I try and write for those of you who don’t speak my crazy medical lingo. I’ll try and explain things as I go (and let me know if I’m not doing such a good job and you’re completely lost).