Sunday, April 29, 2007

Notes from an American doctor in Kenya

Here is a report from my friend Honora, who is a newly minted doctor spending some time in a service program in Kenya.

Hi guys,

I just wanted to send you all a quick note to check in from Kenya. I feel at a loss for words of how to relate some of the experiences that I have had in just a few days, but I will make a brief attempt...

Yesterday was my first day on the medicine wards. I am working on the women's side of the hospital, and caring for about 40 patients. They suffer from diseases of poverty; the pathology is astounding. I have the true privilege to work with Kenyan residents (registrars), interns, and medical students, as well as a few incredibly bright and capable med students from Indiana University. I am considered a visiting "consultant" or attending, and today the Kenyan consultant will also be on rounds.

Though there are barriers of language with patients, and my knowledge of infectious diseases feels so limited, I was amazed at how the familiar experience of hospital rounds quickly gave me a sense of connection and ease amidst the chaos. The afternoons are less structured, and yesterday afternoon when I returned to the hospital to give a talk on the request of a few students, I passed by another student looking at a chest x-ray. Glancing at it, I noticed an enormous tension pneumothorax (for those not in medicine, this is when the lung pops and air builds up in the chest, causing the lung to collapse and push the contents of the chest to one side -- it can be quickly life threatening). Together we quickly gathered more history and found out that our patient was ISS+ (immune suppressive syndrome -- they don't say HIV+ because of the stigma, which is a whole separate discussion...) and likely had PCP pneumonia. She was stable enough for me to consult my Kenyan intern as well as the group of others around us, and we were all clear that she needed an emergent procedure. I will spare you the details of the rest; however, it took several hours to secure clean supplies to perform a definitive treatment. I will share that in all of my residency training or work [in the US], not once was I in the position to be the most senior person to perform this kind of procedure. The severity of illness and extent of disease is mind blowing...

It is clear to me that the vision of this program is so well-aligned with solid values of respecting and learning from local culture and needs, and that by providing public health education, community organizing, HIV/primary care, and sustainable farming, there have been real positive changes in this community.

What else - at grand rounds yesterday, the presenters were congratulated on their presentations with a series of 3 claps and 3 stomps by a room full of Kenyans that was led by the very dynamic facilitator. It was the best applause I have ever participated in. The food is great, the people I am living with (all Americans) are interesting, bright, compassionate and welcoming, and there are beautiful flowers and true African skies...

5 comments:

Anonymous said...

We should be ashamed for complaining about OUR health care system here in the U.S.......

Carl Meyer said...

I have been in several Russian hospitals in the last 10 years, all in smaller cities. Like the last comment states, despite all the problems of American Medicine, we should be proud of what we do. The Russians are decades behind us in even the basic medical care. I assume that Kenya is the same.

Anonymous said...

I'm not certain that we should be ashamed for complaining, but I think it does highlight the need to "give back". Developed nations have done an excellent job of attracting healthcare professionals from many under and developing nations, compounding the shortages of professionals these countries face.

We bare some responsibility for these shortages of professionals, since developed nations have lured the best talent away.

Uri Blackman said...

A little delayed, but anyone going to Africa that wants to brush up on their Infectious Diseases knowledge, should check out GIDEON (Global Infectious Diseases and Epidemiology Network).

Cancer Free Women said...

Sounds very typical of Kenyan healthcare system, the most advanced in South of Sahara except South Africa.
November breast cancer month exposed USA doctors and nurses to what I'd call "Gore" (Look it up) of breast cancer. Visited just a few hospitals and identified 16 cases of fungating breast cancer masses, some of which were too serious that only hospice would have helped.
Next year, we're hoping to put together a team of surgeons, doctors & nurses to help offering free treatment during breast cancer month