Saturday, September 4, 2010

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).