Theatre to Market

By virtue of being the only one dressed in scrubs yesterday, I got to have my debut in the theatre to be the primary for 2 c-sections. The procedures went well and the babies were healthy. One of the moms had several prior fetal demises, so she was very happy and named the baby Gift. We either misunderstood her or she changed the name, because today the baby was named Precious. I also go to do 2 dilation and curettages – one woman with a retained IUD and another with post menopausal bleeding. The OBs do the big cases, and one was particularly sad – a 26 yr old woman with ovarian cancer who got a hysterectomy.

I was on call last night but had a little down time in the evening since we do home call here. I went to the vegetable market up the street to buy some ingredients in hopes of making yellow curry. There are about 8 women with little tables selling the exact same thing, and I’ve heard they get upset if you don’t buy something from everyone. They are very persistent. If you don’t want a pineapple, how about plums? Take home these mangos! You can’t buy 2 peppers – 3 is a better number! I ended up with WAY too much stuff, and at the last minute another vendor sat down at her table – 2 more oranges in the bag. I spent about $5 for nice potatoes, passion fruit, peppers, potatoes, oranges, cilantro, tomatoes mangos, and green beans. Two women selling tortillas and English muffins out of a bag stopped me on the way home, but I was out of schillings. Shortly after I started to prepare the veggies, I got called by my intern Pauline about a woman with slow progress of labor.

The hospital is a quick 5 minute walk from my apartment. I reviewed the non-stress test (NST) with Pauline and it looked fine, so we let the lady labor a little longer. However, she got stuck at 8 cm and went to c-section last night. Pauline got to do it, and I went home to bed. It was a quiet call for me, but Aurelie was up most of the night with kids in respiratory distress.

I really enjoy working with the interns, and Pauline in particular. We chatted last night about our families, medical school, and life as a Kenyan intern. Today Pauline showed me the staff break room and we had some “drinking chocolate” (hot chocolate). (Aurelie and I tried to buy drinking chocolate because we liked the name, but actually bought “strawberry drinking chocolate” by mistake). The hospital staff take a break around 11 or so for chai tea and some kind of snack like mondazis (doughnuts) or chapati.

I get a kick out of the Kenyan idiosyncrasies. Many of the patients complain of “hotness of body” (fever). Additionally, the hospital has suggestion boxes all over it – in the waiting room, in front of the IT department, outside the pharmacy, by the lab…I wonder if anyone makes suggestions. There are several signs in front of the hospital that say “polite notice...” Kenyans also really like to shake hands.

Fetal monitoring during labor is also quite different here. My attending asked me to teach the Kenyan resident today about fetal heart tracing. It’s hard to read an NST when the contractions patterns aren’t recorded and the printers work inconsistently. We planned to review the NST for a mom with possible preeclampsia and premature rupture of membranes, who was somewhere between 37 and 44 weeks gestation. While waiting for the tracing to print, we heard a few decelerations down to 60 beats per minute (not maternal.) We finally go the NST going…deep decelerations in the absence of labor. The Kenyan resident did her c-section with me as his assistant. Thankfully, the baby boy was vigorous and 2.8 kg.

The evenings are quiet in Kijabe. Sunset is at 6:30 and we usually cook, use the computer, read, knit and go to bed. Tomorrow we are having dinner with our neighbors, Phil and Carrie, from Minnesota. There are also anesthesia residents here from Vanderbilt and several eager beaver med students from Wake Forest and a military med school. The place is overrun with visiting Wazungus!