Monday, June 18, 2012

Surgical and Maternity Wards: 1 Week Left



In the maternity ward, I also saw a woman who had just had her right breast removed and a c-section in the same surgical session. She had malignant breast cancer and she was full-term pregnant (meaning that she had been carrying the woman for 38 weeks). The doctor was reviewing the stitches which sprawled across her chest and concluded that they were septic (infected). The situation was unfortunate because there was no way of knowing if all of the cancer was removed from her body but now she has an infection to deal with? I sighed. The only thing covering her newly-stitched breast-less chest was a thin blanket. And there were flies everywhere in the room. And I had just seen a mouse scurry across the floor. The normality of the situation caused no one in the ward to flinch. This was typical.




Sorry that everything is underlined
. I am not sure why it is doing this.

 I know, it is gruesome.




Cheesy picture of my in scrubs before scrubbing in for surgery. I took this as a tribute to one of the biggest medical inspirations in my life: my dad. Happy belated Father's Day!




Me after scrubbing in, just before the DNC surgery.



They preserved some abnormal fetuses. You can see that this developed into only half a fetus.



The surgical room. Rather sophisticated technology 
 relative to the rest of the hospital.










From left to right: a jar of "moles" or under-developed fetuses and worms and parasites in the last two jars. All of the worms in the last jar were recently extracted from one person.




The newborn child which I saw the natural birth for. 


Above: I decided to throw in a couple random pictures. Here is a picture of my room where I sleep. The mosquito net makes me feel like a princess.


Left: This is my program coordinator, Joshua Omolo, and I. He has been so caring and kind through this program. I want to come back next year.




Point of information: all these pictures literally took me 4 hours to upload

Saturday, June 16, 2012

Accepted

I found out last night that I was accepted into my dream medical school, George Washington University. I want to thank everyone who has believed in me and supported me through this process.
If I do accept the offer, I will attending GWU Medical School in the fall of 2014.

Never have I ever had a firmer belief in one thing: if every fiber of your being wants to fulfill a goal, everything in the universe will help you accomplish that. 

We have weekends off. I think that the house residents and I are going to watch movies tonight.

I'm inexplicably happy right now.

Friday, June 15, 2012

Births and Parties

As I had mentioned before, not too much has been happening at the hospital; however, several of the PAs have finished their rotation so I think that starting next week, we will be able to work more next week. Yesterday, I watched my first natural birth. The woman was 22 years old and up until that point, I had only seen cesarean sections in the states and in Africa.

Honestly, the female body is incredible. I had to wait and care for the woman for 2.5 hours and within 5 minutes, the child had positioned itself naturally for birth. It was interesting because in Africa, there are three steps to childbirth: contracting, vomiting, and delivery. They believe that making the mother vomit induces labor and helps to make sure that the child is properly positioned for birthing. The delivery went smoothly and the new mother, initially reluctant to push the child out, was relieved when it was over.

Sidebar: I had to leave the delivery room for a brief moment to fill discharge papers. When I returned, the nursing staff ran to me and said, "Your friends are here! Your friends are here!" When I looked around, I realized that there was another Indian family waiting to delivery a child. Kenya has an Indian population that composes about 20% of the total; but there aren't very many Indians in Migori. I exchanged some conversational pleasantries and platitudes in Hindi with the family then continued to encourage Asha (the Kenyan 22 yr old) to "sokuma! sokuma! (push! push!)".

Last night, the house bonded together to celebrate and to mourn the fact that one of our members, Kelsey, was leaving the next day. We had an enjoyable time. Here is a picture of me and my good friend Hannah.








When I typed in "good friend", I accidentally typed "hood friend". Yeah, this Caucasian Iowa-native is not from the hood...







We are going to Lake Victoria this weekend. Updates soon to come.

Wednesday, June 13, 2012

Safari: a long overdue post

It has been several days since my last post. In those days I have done the following: traveled through the Masai Mara territory, was inches away from infected malarial cell, and tapped into the soul of the universe.

You always read about the people traveling around the Serengeti (I was surprised as to how phonetically correct the spelling of Serengeti is. Wouldn't you think its Sereghetti or something like that? I digress, as per usual) and being among the wild beasts of the African landscape. While this mostly correct, I could compare my experience on an African safari as an intensified, glorified trip to a zoo. It was incredible to be so close to hundreds of animals and drive among herds of elephants and packs of lions. But at the same time, the entire experience is from the safety/confines of a safari car. The roof-less vehicle gave me a chance to stand and take snapshots of wildebeasts and cheetahs and rhinoceroses -- but let's be serious, all I wanted to do what pet the lions. Or snuggle with the tired cheetah. Or play with the probably-pretty-aggressive elephant. Is that too much to ask? Regardless, I got some pretty neat pictures. Did you know that Simba means 'lion' in Swahili? and the Rafiki means 'friend'? I'm basically an African native now that I'm privy to all these insider facts. 

Note: Serengeti is the part of the wildlife preserve that is in Tanzania. The part of the preserve which is in Kenya is called Masai Mara.



Evolutionary and Darwinian theory really messed up with zebras. Honestly, what advantages come with having overly obvious and conspicuous stripes?






The giraffes were so awkward...




Well, who is that diva on the Tanzania and Kenya border? 



We were just driving along but we had to stop because there was a little somethin', somethin' crossing the road.
  
While we were riding around in our little cage of car, we passed by several villages filled with huts and Masai natives. They were clad in brightly colored clothes (essentially they were large clothes draped over tiny frames) and had exceedingly large gaping holes in their earlobes. The loose skin from the large earlobe holes (I don't know what else to call them) ((parenthetical commentary is apparently my best friend)) was then wrapped around their ears as a way of managing the sagging lobes. Each person, male and female, was decorated with beaded jewelry. It was really a fantastic sight to be among a completely foreign culture with virtually no similarities to me: they did not have electricity, couldn't speak a word of english, and lived in straw huts. I found myself sympathetic of their lifestyle, almost to the point of pity; however, within moments of my encounter with a native, I realized that my feelings of pity and sympathy were uncalled for.

I didn't have any type of extensive conversation with a Masai African but there was a magical moment that I experienced while I riding in the safari van. I was looking out of the window, examining and contemplating exactly as to how these straw huts were even structurally sound, and suddenly there were two children standing alongside the road. From their attire, I knew they were some of the residents of the village we were passing through. I made eye contact with a young male (or female... it's honestly quite difficult to tell the difference between the two sexes) and he smiled at me. Naturally, I smiled back and in that moment, that child and I shared a non-physical embrace. Despite the vast cultural differences, it took only a fleeting moment for me to establish a bond with this boy. He seemed happy where he was and I was happy where I was. We were happy together. We had both tapped into the soul of the universe. I read about this concept in the book The Alchemist; the soul of the universe is a rhythm that all of humanity dances to. Although humanity is immensely huge, there is a soul which runs through everyone and creates commonality -- similar to how a smile or a frown expresses the same emotion in every country. There is something unspoken that connects us all but is only realized at random moments. With this little boy, we shared a mutual understanding of humanity. Through our shared smile, we both drowned in the current that ran between us; but just as soon as the moment was realized, the moment was lost as the van drove away. I continued waving my hand until the child was out of sight.





Here are some of the girls and I working at the lab. I just examined some malaria cells under a microscope.
I'm getting quite tan.




We got 5 new Medics to Africa students and ~10 physician assistants working at the hospital. The combination of the few patients and the flux in helping hands has resulted in over-staffing. Consequently, I find myself only working for a few hours in the morning, giving me more time to do things like blogbloglbogogllbooglb.
I also want to clarify on my early statement about the healthcare system here being broken. I understand that there are limited resources and the doctors try to make do with what they have. But when a 7 year old patient is admitted the day before  with complaints of a cough and mysteriously dies over night because of lack of patient care, how is one supposed to react? The case was written off as "mysterious death" and "maybe typhoid related" and the file was simply thrown in a disgustingly disorganized closet of medical records. All of the American students had to turn their heads away from what easily could have been avoided.
I am already halfway done with my trip. I arrived on the 1st and leave on the 26th, making today the 13th the halfway mark. I think I'm going to miss Kenya. 

Thursday, June 7, 2012

Pediatrics Ward and Orphan School


“You can do no great things. Only small things with great love.” Mother Teresa

I promise I’m not trying to be depressing but the healthcare system here is startling, disorganized, and blog-worthy. I’ve spent the past few days in the pediatrics ward and getting to know the hospital better. I have a few stories, both sad and uplifting, to share.

First, there was a middle-aged African male named Lucas. He came into the hospital with a machete wound. His lower leg was shattered and needed to be amputated. After having to wait a prolonged period of time to get the amputation once he was admitted, he developed complicated malaria and severe anemia septisimia while staying at the hospital. Yes, he developed a series of ailments from staying in a supposedly clean and controlled environment. Lucas died yesterday – the students and I visited the mortuary and saw his body. Lucas serves as a symbol of poor care and lost potential for us students. Note: For surgeries, there are different sets of clothes which are classified as “sterile” and “normal”. The sterile clothes are the ones which are used to clean open cuts as a surgery is being performed. I noticed, as we were leaving the mortuary, that both the sterile and normal clothes were washed and dried on the same clothing lines. How is that sanitary? How is that “sterile”? 

In the United States, the ‘normal’ hemoglobin (HB) count for blood in between 14-17. In Africa, the accepted HB is 10, meaning that the general health status of the patients is weak. Such low standards lead to higher chances of infections. Similar to Lucas, I saw a child with severe sickle cell anemia and who has developed cerebral palsy during her stay. Her mother has had to watch her daughter slowly deteriorate over the past 3 weeks. They moved the baby to acute patient care and despite the supposed “higher priority care”, the work performed on the child was mediocre. Because of the child’s sickle cell state, it needed to be under controlled hydration. Although she was technically hooked up to a saline source, the source wasn’t properly connected therefore the solution was simply falling onto the table instead of hydrating the child. The baby was dehydrating and the doctors didn’t even notice.

I observed a cesarean section yesterday. I had watched one in the states while doing research in high school. It was interesting to be able to compare and contrast the methodologies. Honestly, both times I watched the c-sections were quite similar but the primary difference was with the mother. The mother who was getting the c-section was from a tribe – a tribe that practiced female circumcision. To those unfamiliar with this practice, please take a moment to open a new tab and search this term on the internet.

Finally, we went to an orphan school today. The children were so playful and absolutely precious. When we first got there, the principal of the school greeted us mzungus (“non Africans” or more commonly, “white people”) and brought us to her office. She essentially asked us for donations and told us about how much she needed them. But, because she felt the need to be polite, she brought us all bottles of soda. How could we accept these cooled sodas when the school needed that money for the kids? We were so conflicted and we felt guilty. Other than this awkward moment, I was able to make some excellent new friends with the children. Although, I’m quite certain that they were more fascinated by my camera and my hair than by me. 

 The children at the orphan school


I’m going on a safari from Saturday until Monday. My next entry will be in a few days so be sure to look for more updates which will include magnificent tales in Masai Mara (Serengeti).  


Tuesday, June 5, 2012

Day 2: Pediatrics Ward


I went to the Pediatric ward today. It is one thing to have to watch adults suffer from burns and cuts. But it is entirely different watch a child endure the pain of malaria or typhoid or pneumonia or all three at once. One of the hardest sights of the day was seeing a child with a severe sickle cell anemia and she cannot respond to touch or pain. The doctor would push the 3 yr old around the hospital bed and it would not react. The mother was sobbing on the edge of the bed because the baby hadn’t cried in 3 days and she didn’t understand why. It was heart-wrenching to watch the doctors simply prescribe a general set of medications and walk away. I actually had to swat away a fly that was flying around the infant’s mouth because the infant remained lifeless and lacked reaction.

Most of the children were malaria and typhoid patients; however, on a more uplifting note, I met Alfred. He is an 8 month old child who just recovered from malaria and it was so inspirational to be with him. Some of the children, despite their age, are so strong and beat the worst odds. Also on the positive, I now know how to properly discharge a patient and write prescriptions. I’ve worked with a couple of doctors since I’ve come: Dr. Atunga, Dr. Mbongo, and Dr. Josiah. Cool names, just thought I’d throw them out there.

 Dr. Mbongo and I. I had to play with the brightness settings in order to properly even see him. Consequently, I look a bit doe-eyed.



Some shops just outside our living quarters. 









Later on today, I will be going back to the hospital to check out some labs – looking at various diseases under the microscope. I’m exciting to see and be able to identify various illnesses on a microscopic level. As usual, updates to come.

PS, there is some superstition in Migori against left-handed people. When some nurses saw me write with my left hand, they were so fascinated. “You can write with your right hand too, right?” and they were shocked when I shook my head “no”. CULTURECULTURECULTURE. Also, our cooks are making chipatis for dinner—these are an Indian flatbread (the Indian population in Kenya is about 20% of the total population).

Monday, June 4, 2012

First Day at Work: Broken System



I woke up at 6:45 AM after a night of restless sleep. I was filled with nervous thoughts of my first day at work. What could I expect? Amputations? Intense surgeries? Was medicine even right for me?
Having taken a nice cold shower the night before, I got out of bed and slipped into my Medic to Africa tshirt and a nerdy pair of cargo pants (no offense to anyone who genuinely wears cargo pants). I had a delicious omelet (yes, we do have African cooks who make the most delicious and flavorful foods. Marya, I don’t even have to add a grain of salt! It’s all properly salted!). The mistake I made was having two cups of coffee.

We walked over to the hospital at 7:55 AM and met with 3 physician assistants (PAs) in a room before the doctor walked in. I was a little thrown off by how pretentious these Portland, OR-based Pas were but I then realized two things: 1) they were from Portland, OR and 2) this is the medical world. Obviously, the medical profession is centered on helping others for the betterment of humankind but the process of becoming a physician is rather dog-eat-dog. Anyway, these couldn’t distract me from my first day at work at the St. Joseph’s Mission Hospital.

 CHEESY FIRST-DAY-AT-WORK PICTURE
 its sideways but honestly, the upload time is preventing me from doing anything about it














 
The doctor walked in around 8:15 AM and gave us all a brief on the patients who had died over the weekend. Having worked in the medical environment previously, I was well aware of the element of detachment necessary for medicine. Compassion is a principle characteristic of a doctor but it is integral to understand that death is natural. From death comes life – which is why it was befitting for me to spend my first day in the maternity ward.

In the maternity ward, I saw about 7 patients, one of which was only 11 or 12 years old (having her first child). All of the women had c-sections and the doctor detailed as to what conditions called for a c-section cut down the center of the stomach or horizontally over the uterus. We even say a woman, who had already delivered, have a midline c-section which was infected; therefore it looked like she was still pregnant because of the excessive inflammation. The doctor squeezed her stitched and bright yellow pus came out of her stitching. 

Following rounds in the maternity ward, we went to the surgical ward and it was in this ward that something terrifying happened. We were looking at the wounds of various patients – mostly gangrene patients but also women who fell into fires (GB, yes… even more people falling into fires). One of the patients had a skin disorder in which it looked like coral was growing on his feet. What I didn’t notice was that the windows were all closed in the patient room therefore there was no draft. The combination of the lack of air flow and the dehydrating effects of the tea starting caused me to feel light-headed. The room began spinning, my body temperature spiked, and the exposure on my vision was turned up extremely high. The other Medics to Africa students noticed that I started becoming pale and they quickly caught me as I was beginning to faint. They took me to a bench nearby and gave me some water. I had never experienced anything like that before and I am so thankful to have had my coworkers nearby. 

We came back to the house around lunchtime and I found myself just drained from the day. Between patients, I learned that there were many flaws in the African healthcare system. For example, I noticed that many women had to endure spinal taps as their form of anesthesia for their c-sections. Using general anesthesia would have required an oxygen tank that the hospital could not afford. Furthermore, patients come to St. Joseph’s from other hospitals. Sometimes, the doctors from other hospitals misinform St. Joseph’s on the patient’s condition so the patients can be admitted (to “take the burden” off themselves). Consequently, because of the misinformation, the doctors at St. Joseph’s are not even aware on how to properly diagnose the patient. The system is broken.

My apologies for the obscenely long post but my first day was rather eventful. I’m excited and anxious to see what else is in store for me.

Sunday, June 3, 2012

IM IN KENYA

 first, i want to thank everyone who is following my blog/leaving comments. it is so heartwarming to see feedback from people who mean a lot to me.

okay, let me breakdown the past few days for you:

9 hr flight, chicago to amsterdam --> 14 hrs in amsterdam --> 9 hr flight, amsterdam to nairobi --> 10 hr drive, nairobi to migori

I WAS SO EXHAUSTED WITH I ARRIVED IN MIGORI.

 arrival at the kenyan airport. after my hours of traveling, this looked like the gates of heaven.




 this is Joshua Omolo, the program coordinator. we had to drive for 10 hours together.. he wasn't asleep. i was low battery and my timing was bad. haaaa





right now, im only adding one picture because our internet connection is disturbingly slow so the upload time is equally as disturbing.

i got into migori last night and met the 7 other girls ill be living with. we are all from the states and its exciting to see everyone come together and share experiences. they are all extremely friendly and we are all about the same age. my room (ill upload pictures later) is a single with a mosquito net over the bed. the living quarters are much nicer than i expected, considering we are in a third world shower. my cold shower was actually quite refreshing.

this morning, we went into town to get water. each girl has their own 5 liter water bottle and needs to refill once finished. the walk there was incredibly hot and carrying that water bottle back from town was gruesome. many of the people cannot speak english and the little english that they do know is "HI!", to which i respond, "hello!" and they respond with "IM FINE!". this dialogue occurs principally with younger children. oh yeah, we don't work on weekends. in fact, next weekend we are going on a safari! i promise that these pictures will slowly be added to blog.. my patience runs quite low with all this. right now, there are about 15 african children waiting outside the house, hoping that we come play. i think i'll go say hi but in sum: day 1 in africa (i guess day 2, if you want to count the ride from the airport to migori) has been fantastic and eye-opening in the sense that i am watching life spawn from minimal means, yet these people look much happier than those in america.

tomorrow is my first day at work, updates soon to come.

Friday, June 1, 2012

Venice of the North

I didn't know that Amsterdam is known as "The Venice of the North". After the 4 hr tour I just took, I completely understand. The city is incredible because of not only its architecture but also the canal system. There are even homes right on the canals. One day I want to travel here for a longer period of time. Since I wasn't with anyone for the tour, I found myself taking pictures of myself in front of windmills and bridges; needless to say, I felt ridiculous. Also, I'm sure you already know but the Europeans make so much fun of America, its pretty funny. Also also, I past by a coffee shop with a marijuana plant in the window. The drinking age is 18. That is all I have to say on that.

I'll be including pictures later, simply because I don't want to be fumbling around with cords and such in the middle of the airport. Oh yeah, I'm in the Amsterdam Schiphol Airport. It's also unsurprisingly beautiful. Honestly, Europe is consistently putting America to shame thus far. But I love my country. and my tribal scarf.

When I was going through customs before and after my tour around Amsterdam, I liked listening to sentimental music on my ipod. Then I would look around at everyone saying good bye to their loved ones--  I was putting a soundtrack to their special moment. It made me feel giddy. It made me smile.