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.