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Monday, January 17, 2011
Friday, December 31, 2010
12/31
I the day rotating through the general and trauma surgery wards. I have not [yet] shadowed surgeons in the US, so I am unfortunately able to com First thing in the morning, I was most surprised to see several policemen (armed with machine guns) surrounding a young child with a severely swollen abdomen and several bruises on his face. I later learned that he had been abused by his mother, and would be taken to a shelter after surgery.
One surgery had to be rescheduled because the hospital was low on potassium solution. The surgeons informed me that this occurs at least twice a month. Orthopedics allowed me to see engineering meet medicine, and I was amazed by the level of creativity surgeons must possess in the "simplest" of fractures. Leg braces were stabilized by actual weights (i.e. standardized hunks of metal) hung at calculated angles. One individual has the job of conducting these calculations; to be qualified for his job, he had to complete a one-year certificate program after high school.
One patient was leaking fecal matter and fluids through an abdominal tear. Surgeons repaired the tear, created a stoma until the point of surgery heals completely, and told the patient to come back in 3 weeks.
Another was brought for a post-surgical follow-up. He had been born without an anal opening. Surgeons created the opening, but he had to return every day for a period of three months so the anus could be dilated with a standardized piece of metal. There were four additional patients throughout the day who needed this procedure. The last was unable to pay for future visits, so the surgeon gave her the instrument to take home and do at home. This woman was more comfortable in my native tongue of Hindi, so I discussed with her the importance of continuing to use the instrument even if it makes the child uncomfortable--the anal opening would clinch shut and another surgery would be necessary without daily perturbation.
At the end of the day, we booked the operating theather for three patients. One had a worsening aganglionic megacolon and would undergo a colectomy. Another had hypospadias and needed surgery due to fertility issues. The third had an ascended testicle due to a sports injury and required immediate intervention.
My time in Kenya so far has been a flurry of emotions. I have witnessed grave medical consequences of ignoring symptoms, as well as severe repercussions of being malnourished and impoverished. I'm looking forward to being back on US soil within a week or so and reflecting on my trip. Unfortunately, I will be without internet for the rest of my time here.
One surgery had to be rescheduled because the hospital was low on potassium solution. The surgeons informed me that this occurs at least twice a month. Orthopedics allowed me to see engineering meet medicine, and I was amazed by the level of creativity surgeons must possess in the "simplest" of fractures. Leg braces were stabilized by actual weights (i.e. standardized hunks of metal) hung at calculated angles. One individual has the job of conducting these calculations; to be qualified for his job, he had to complete a one-year certificate program after high school.
One patient was leaking fecal matter and fluids through an abdominal tear. Surgeons repaired the tear, created a stoma until the point of surgery heals completely, and told the patient to come back in 3 weeks.
Another was brought for a post-surgical follow-up. He had been born without an anal opening. Surgeons created the opening, but he had to return every day for a period of three months so the anus could be dilated with a standardized piece of metal. There were four additional patients throughout the day who needed this procedure. The last was unable to pay for future visits, so the surgeon gave her the instrument to take home and do at home. This woman was more comfortable in my native tongue of Hindi, so I discussed with her the importance of continuing to use the instrument even if it makes the child uncomfortable--the anal opening would clinch shut and another surgery would be necessary without daily perturbation.
At the end of the day, we booked the operating theather for three patients. One had a worsening aganglionic megacolon and would undergo a colectomy. Another had hypospadias and needed surgery due to fertility issues. The third had an ascended testicle due to a sports injury and required immediate intervention.
My time in Kenya so far has been a flurry of emotions. I have witnessed grave medical consequences of ignoring symptoms, as well as severe repercussions of being malnourished and impoverished. I'm looking forward to being back on US soil within a week or so and reflecting on my trip. Unfortunately, I will be without internet for the rest of my time here.
Thursday, December 30, 2010
12/30
I spent the day at Kenyatta Hospital. I arrived at 7 AM, and was in grand rounds with the doctors of internal medicine until 1:30 PM--there are so many beds! I was astounded by the prevalence of end-stage disease. Many do not have the means to seek treatment until their symptoms unbearably worsen, and this leads to a much more grim prognosis when attention is finally received. Many patients did not have beds and were on floor mats or hallway chairs. It was not uncommon to move "less serious" cases to the hallway or floor after a more exigent case was admitted.
One particularly disappointing case was a mother who had to be released because there was no one to take care of her child. The child went to school too far from the hospital to stay with her there, and the doctors therefore gave the mother a series of vaccines and medications for self-administration at home. There were far too many patients for doctors to take the time to explain the importance of taking the treatment, so I spoke to the mother and ensured her understanding of instructions.
The cases themselves, unsurprisingly, are similar to diseases seen in US hospitals. The cultural differences and overall logistics were remarkably different, however. For one, patients' shirts are marked with their record number because wristbands are not available. It was also acceptable for doctors to sit on patients' beds as they diagnosed them, and many doctors had their personal cell phones go off in the middle of rounds that they were able to attend to without repercussions. Patients were often not completely informed of their treatment regimen, likely due to cultural differences with regard to the position of healer in Kenyan society.
The lack of attention to mental health was astounding, although largely expected from my background research. A psychiatrist was not paged for a suicidal patient ("they are as crazy as their patients," according to the ward matron), but instead an internal medicine doctor cracked jokes with him for a few minutes to "cheer him up." No references were made to his suicide attempt, and there was not attempt to understand his background or address his mental health. He was discharged rather quickly and without any major observation period.
I ended my day at 5:30 PM because I wanted to be home before sundown. Experiencing the wards at one of the busiest hospitals in Africa was unforgettable.
One particularly disappointing case was a mother who had to be released because there was no one to take care of her child. The child went to school too far from the hospital to stay with her there, and the doctors therefore gave the mother a series of vaccines and medications for self-administration at home. There were far too many patients for doctors to take the time to explain the importance of taking the treatment, so I spoke to the mother and ensured her understanding of instructions.
The cases themselves, unsurprisingly, are similar to diseases seen in US hospitals. The cultural differences and overall logistics were remarkably different, however. For one, patients' shirts are marked with their record number because wristbands are not available. It was also acceptable for doctors to sit on patients' beds as they diagnosed them, and many doctors had their personal cell phones go off in the middle of rounds that they were able to attend to without repercussions. Patients were often not completely informed of their treatment regimen, likely due to cultural differences with regard to the position of healer in Kenyan society.
The lack of attention to mental health was astounding, although largely expected from my background research. A psychiatrist was not paged for a suicidal patient ("they are as crazy as their patients," according to the ward matron), but instead an internal medicine doctor cracked jokes with him for a few minutes to "cheer him up." No references were made to his suicide attempt, and there was not attempt to understand his background or address his mental health. He was discharged rather quickly and without any major observation period.
I ended my day at 5:30 PM because I wanted to be home before sundown. Experiencing the wards at one of the busiest hospitals in Africa was unforgettable.
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