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...