Thrown to the Zebras

I have survived my first 2 days of work. Yesterday started off well with a lecture about HIV and a tour of the hospital (about 265 beds including Men’s & Womens wards, pediatric ward, ICU, maternity ward, and an outpatient clinic that sees 100,000 patients/year). However, then the medical director left me with my new attending who told me I probably wouldn’t have the chance to be in the theatre (operating room) all month since the Kenyan interns and residents are new and need to learn. I likely won’t be doing many deliveries either since the midwives do them here. January here is like July in the States, when all the interns are new (and traditionally the worst time to be a patient!) I was really bummed at the prospect of not being able to do any procedures all month. Hopefully, I’ll be able to find a way to get to use my skills. I heard Alyson “vacuum in her pocket” Feigenbaum was very useful in November!

I then was asked to help the Kenyan intern with her rounds. She is nearly as clueless as I am since she’s about 4 days into her internship. We spent about 8 hrs in the maternal child health clinic (MCH), which is quite chaotic. It is run mostly by nursing students as there is a nursing school in Kijabe. My mom would be happy because it is a 3.5 yr program – no condensed programs here! My intern is named Pauline, and she is great (and was surprised that we don’t have much malaria in the States). I thought it was very cute that instead of asking pregnant women “have you felt your baby move?” she asked “is your child playing?” Prenatal care here is completely perplexing. The women get 4 visits (maybe) and I’m still trying to figure out what labs (“investigations”) they order. Everyone gets “fansidar” (malaria prophylaxis), and no one tests for Group B Strep.

Today I was in the MCH for a few hours and admitted a woman with preeclampsia. Thankfully, her ultrasound suggested she was 28 weeks pregnant instead of her calculated 22 weeks. I was in the gynecology clinic for the rest of the day. I think my hands might peel off from the obscene amount of hand gel I’m using. Sinks with actual soap are hard to find.

I got to see the delivery room today, which has 2 beds. In one bed was a mother who just delivered a 4300 g baby, which is big in the States and HUGE by Kenyan standards. In the bed next to her was a 25 week gestation woman who was miscarrying. My attending ruptured her amniotic membranes and the baby was born within minutes. Babies need to be about 30-32 weeks to survive here, and this one only weighed 700g. They attempted resuscitation, but it clearly was not going well. He was quite a contrast to his neighbor. It was very sad to watch that baby struggle, although he probably would not have lived in the States either due to meconium and chorioamnionitis.

On a lighter note, Aurelie (the other resident I am with in Kenya) and I are going on an excursion this weekend to Lake Nakuru, where there is a game preserve. They have rhinos and are famous for bird watching – apparently there are lots of flamingos. We have only worked 2 days, but it will be nice to have some time to explore before our first call shifts next week.

So all in all, despite a rocky first day, things are looking up.