Mtoto!

The last few days in Kijabe have been action packed. My patient Sarah did end up having an ectopic or possibly heterotopic pregnancy (pregnancies in the tube and uterus--the twinning rate here is 1/20!). I got to do her d & c and ex-lap on Tuesday. She ended up having 2 tubes, so may have had a salpingostomy with her first ectopic. Her recovery went well, and she left today in good spirits, although she was disappointed I didn’t get to meet her mother. Yesterday I got to deliver a cute healthy baby named David. I admitted his mother from clinic also on Tuesday for induction. The nurses told her to stop yelling and start pushing. There are no epidurals here so laboring women are often screaming, although some are very stoic. I was walking recently through the labor ward and a woman yelled out “Mtoto!” (Baby!) I grabbed some gloves to help delivery her cute baby girl, Elizabeth, right in her bed.

Today I got to spend a lot of time in the theater. The nurses grabbed me to help with a retained placenta for a woman who had PPROM’ed at 26 weeks. That placenta was not coming out without a fight. My attending ended up pulling out tatters of shredded placenta. I got to do her d & c. I think the baby came out looking like a 30 weeker, so maybe he will be ok. Then, I removed a mass from another woman’s c-section scar, which sounded like an endometrioma but didn’t look like much. I also go to help with an urgent c-section on a 38 yr old woman who had no amniotic fluid. It was a bit of a scene – the patient was having a weird reaction to the anesthesia, the blood pressure cuff stopped working, and then the scrub tech knocked over all of the sterile instruments. My attending got the baby out very quickly. The patient was a first time "mum," and she was thrilled. Baby Samuel is doing well. Later, I attempted a LEEP today for CIN II, but somehow broke 2 loops in the process. I don’t like to blame the tools, but procedures here seem to take longer and have more unexpected complications than they do at home. It is rare that I get to spend this much time in the theater, so I had a really good day.

The pathology here is pretty shocking. Probably 30% of the people I see in clinic get admitted to the hospital. Yesterday, I admitted a 25 yr old woman named Immaculate who was 26 days post partum from a normal delivery at another hospital. She had been sick with abdominal swelling and pain and fever since post partum day #2. After a 10 day admission elsewhere, she came to Kijabe since she was not improving. (Kijabe Hospital has the reputation for being affordable and trustworthy). The patient was febrile, tachycardic, anemic, and had a boggy tender uterus and a distended abdomen. Her ultrasound showed a large cystic septated mass coming off of her uterus and free fluid in the pelvis. There is nothing good going on in that abdomen. She will likely go to theater soon and hopefully will not end up with a hysterectomy.

I also saw a woman in clinic who was 23 weeks pregnant and had bleeding for a week. Her ultrasound revealed a molar pregnancy. I had to tell her that she had no baby in her uterus and needed urgent surgery. Despite having a really good nurse help us communicate in Swahili, the patient left against medical advice. I couldn't tell if she didn't believe me, but she kept laughing even though I stressed the gravity of the situation. Get some O negative ready...

Another woman came in last night because she had been told she had a 20 week fetal demise. She came to Kijabe for confirmation. I did an ultrasound tonight and told her it was true. I am out of kleenexes from telling people bad news.

Last night I went to one of the interns’ house for dinner. The interns eat together nearly every night. We had mashed potatoes, cabbage, and some delicious mixture called “green grams.” They are so supportive of each other. We are hoping to have them over next week for taco night. I tried to explain tacos to my team, and Tembu (the family medicine resident from Nairobi) said, “I am pretty sure it is a jumbo sandwich.”

Matt and Ben arrive tomorrow, so Aurelie and I are excited. My favorite driver (recommended by Vy and Alyson) is picking them up in Nairobi. We hear they made it to London!