Wednesday, March 23, 2011

Can I Leave?

I am writing this post with only six more days of work left until I leave back to Canada. I am coming home - this is a fact and I am looking forward to seeing my family and friends as well as going to fast food restaurants. However, I am sad to go. I have made many good friends and have loved my time here. I am also worried about what will happen when I go.

To illustrate that fact here is what happened today:
I was awoken up by my pager at 6:30am - the patient was not doing well and the resident would like some help. I got up the hill and find a patient who was not doing well - his heart rate was 170, respiratory rate was 50 and SpO2 was 75. I did what every RT does and fiddled with the vent settings for a bit with no improvement - take a listen to his chest and I discover that the air entry is poor. Asked about a CXR - the portable machine is broken. I then took the patient off and bagged - amazingly he was easy to bag (his PIP was 40). Thinking the machine was broken, I swapped out machines - seemed to help for a little while but then same problem again. We paralyzed him and finally he settled. This man has a head injury and was breathing so fast that the ventilators (both of which I tried) could not keep up. We managed to get this all sorted out in time for 730am rounds and 8am M&M (morbidity and mortality).

After M&M, I sneaked away from the hospital to have some breakfast - finished just in time as my pager went off, they needed my help in the nursery. Up the hill I climbed to discover the resident bagging a sick baby with poor SpO2 we bagged the baby for a while but we were unable to save him. I comforted the Mom and said a prayer with her and the chaplain. As I was leaving, I was told they were having trouble with a one year old on the pediatric floor. Off I went and found a grunty 1 year old just maintaining his SpO2 on a non-rebreather at 15lpm. So we took him to ICU - after making a stop off in x-ray to take a chest film as the machine was broken. In ICU he did not look much better and we were debating about intubating him or not; we went for a compromise and put him on CPAP. How do you CPAP a one year old in Kenya? You take your home BiPAP machine and an adult nasal mask and you are good to go. The child looked really cute (only a RT would say a kid looked cute with a mask). The SpO2 maintained and at a reasonable level and the child was able to rest his breathing muscles.

That done I was able to escape for lunch and some computer work. Came back after lunch to check up on the previous patients and teach the new visiting Doctor how to use our ventilators. I had a scheduled lecture for 3:15pm but was told (at 2:45pm) that the lecturer for 4:15pm was unable to make it so could I do her presentation as well. So off I went, reviewed her lecture (on Trach care) and gave lectures all afternoon. The day ended with a quick round to see how things were going. I headed into Casualty (ER) and saw two patients receiving side stream neb treatments - set up like a pipe. I was so excited as the nurse had set them up properly. Maybe I can leave after all.

So sorry if I bored and confused all you non medical people. Really, I am worried about how the staff and more importantly the patients will do when I am gone.
On a lighter note I had a great week last week my friend J was here and I had a great time working with her as well as taking of to the coast – Indian Ocean. I celebrated my birthday there and enjoyed a surprise birthday party from my friends at Tenwek when I returned. We have also been blessed with rain in the last week which means the grass is green, crops can now grow and the hydroelectric dam can give me power. On a sadder note my computer screen has died – I have been able to borrow the guesthouse computer but has made it difficult to post pictures on the blog – sorry, when I am back I will post some.

Monday, March 7, 2011

Culture Shock in Kijabe

I am starting this post on Friday – I am currently in Nairobi relaxing at the Mennonite Guest House – a great place to stay.  I am looking forward to supper in 20 minutes. I have heard the food here is great. As I alluded to in my last post, I spent the last week in Kijabe. Kijabe is a mission station, I have heard it is one of the largest mission stations in Africa (no clue if this is true) however it is made up of:
~Kijabe Hospital which includes Bethany Kids Hospital;
~Cure Hospital
~Moffet Bible College
~Rift Valley Academy (RVA) – a Christian boarding school where many MK’s (missionary kids) attend, including a handful from Tenwek.

Having a mission station this large means a lot of wazungu (white people) as well as white culture.  Kijabe is even higher elevation than Tenwek and is built on a hill with the beautiful Rift Valley opening up, I spent evening watching the sunset and I felt like I was on the top of the world. It is also colder in Kijabe (I had been told this but it is the dry warm season now so I have not suffered) as well as windy. A beautiful location.
The Great Rift Valley - a small part of it anyway

I arrived at Kijabe on Friday night and settled in with the wonderful family that was letting me stay with them (Thanks Ls). I also got a tour of the hospital – which I will talk about later. Saturday morning, I woke up on time to do rounds in the hospital with the intensivist before he left for a month and then it was off to RVA.  It was an exciting weekend as the boys’ basketball teams and the girls’ soccer teams were having a tournament. It was like being in high school again cheering for the boys b-ball (it reminded me of the ICHS games vs PBHS) and eating all sorts of good food. Being at RVA was strange – so many white people, a good Saturday anyway, and the boys’ basketball team got first, I think the girls’ soccer team got second.
Soccer on the top of the world

Sunday was church I felt like I was back in Canada – with such a large mission compound they create their own church community and fill it – I did not count but there seemed to be 400 people and 95% white/Asian. Talk about culture shock. This trip prepared me for the reverse culture shock I will experience when I get back to Canada in April. The rest of the week was spent at the hospital.

Kijabe is a mission hospital with a slightly smaller patient load than Tenwek (this fact may be wrong but I was told Kijabe had about 200 patients and I think Tenwek is 300). Kijabe is closer to Nairobi and the city influence plays into the culture. The culture at Tenwek is African and this is reflected in the work as nothing is rushed and orders are not always completed. Kijabe was different as the staff are more influenced by Nairobi culture which has more western influence. This improved the nursing care delivered to the patients. Aside from this Kijabe is much like Tenwek – they are limited by the tests they can perform due to cost or availability, there are things that we can still not do. |We were still in Kenya -  no cath lab for the lady having an MI.
I had wanted to go to Kijabe to see how it is different from Tenwek and this was accomplished. I also went with the request to do some teaching to the ICU nurses. The plan was to do five lectures (one a day) but this being Kenya I ended up doing three – which was fine as well. I also was able to complete some tasks similar to what I do at Tenwek.  I glued baggers back together, taught the visiting Drs how to use the ventilator (all servo 900C), explored their storage room and found myself asking: why would you donate this to a mission hospital and then spend the money to ship it here – example being disposable toilet seat cover, for those of you who have traveled you may have seen the beautiful pit toilets that are common – there is no seat to put a cover on. Anyway the ICU nurse and I had a good laugh, she is also enjoying the one pair of insoles that someone put in a box, now her feet don’t hurt. Anyway I have regressed, I spent time similar to the way I spend it at Tenwek but without a pager – although I did hand out my cell phone number. The week at the Kijabe was good but I was a little homesick for my friends and community at Tenwek – being so large I felt that Kijabe did not have the tight knit community that I experience here at Tenwek. It was great to come back and get hugs from my friends, it felt like coming home.
Kijabe ICU

It’s now Monday and I am back at Tenwek and back to work – the post-op esophagectomy lady with SpO2 in the mid-high 80s and us putting off intubating her hoping she will pull through on 100% 0xygen (actually more like 80% because that is what comes out of the wall). We also have a high number of burn patients lately.  Our ICU has a young boy and a young lady both with severe facial burns, both with trachs. Please pray for them as they recover that we can keep infection away as well as the psychological challenges they will face.

I will end here.  I will hopefully blog again soon but my friend J is coming to Tenwek on Wednesday which I am super excited about but may pull me away from my computer.

I will finish this with one last prayer and thanksgiving request – my computer is dying. A friend was thankfully able to fix it after my screen died, so I pray that it will last until I make it back to Alberta.