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).

My Great Commission

I've never blogged before.  I'm assuming all I have to do is share what's going on so here I go.

During my third year of medical school, I wasn't sure if I was called to be an oversees missionary.  I'd battled that path since college really but I was presented with more opportunities in medical school that began to appeal to me more.  Sure I was going to be a doctor...that was the easy part.  Figuring out where I am supposed to be a doctor still remains the hardest part.  So as a fourth year medical student, I traveled to Kenya for two months and fell in love with it.  It was satisfying. It was rewarding.  It was proof that I was going to spend my life doing medical missions .

So here I go again.  I'm just beginning my third year of residency and I have the chance to spend an entire month in Kenya doing medical missions.  However this opportunity will be different in that I am traveling and working with World Medical Missions.  It's like Doctors Without Borders but it's a Christian organization.  Such a relief!  I'll be working in an area of Kenya called Kijabe which is Masai for "Place of the Wind" (hence the title of my blog...trust me, I'm not that creative).  The hospital itself is in a more rural area but is a very equipped hospital that provides care in many different areas such as dentistry, pediatrics, general medicine and of course obstetrics/gynecology.  I'll be mainly working with two OB/GYNs and I've been told repeatedly that I'll be busy.  Great!  This time around I will actually get to practice medicine while I'm in Kenya.  Seriously, as a medical student you're pretty limited when it comes to actually providing hands on care.  Now I will actually be the one with instruments in hand, performing surgeries, and not strictly observing. Even though I'm beyond excited for my trip, I wouldn't be completely honest with myself if I didn't say that I have a couple of personal reservations about my upcoming travels.  I know it's only for a month but still. I leave behind a mother who is recovering from two strokes (last time I traveled to Kenya she had two strokes two weeks after my arrival).  Praise God that she's doing as well as she is now   I come back having to make decisions about the next steps in life in terms of my career.  Fortunately I don't have to figure that out anytime soon though.

But I'll be back soon to my beloved couch, DVR, work in Ann Arbor and friends (if you're still my friend after many years of feeble attempts to keep in touch, I appreciate it...hopefully this blog will help).  I hope to provide some humor along the way and a few glimpses of how God is present and working in ways that I often forget about.   I'm confident this is what I'm supposed to do. God said "go" and I'm doing my best to be obedient.