Mzungu = white person

Here is the first of (hopefully) many posts that I will write about my time in Eldoret, Kenya, where I am spending 2 months working in a teaching hospital.  FYI, I'm going to be including some medical speak in here - sorry to those of you who aren't familiar with it.  Thanks for reading!

Driving into Eldoret, it is clear that I am in a 3rd world country.  Tin-roofed shacks line the side of the road.  There are plastic bags littering the ground.  There is a woman wearing a business skirt-suit trying to get her cow through a gate.  And the driving is insane.  The road is just wide enough for 2 cars to pass, with a several inch drop off of the pavement on either side.  Along with private cars there are pikipikis (little motorcycles) packed with 2-3 people and matatus (large vans designed to seat probably 9-12 people, but which always carry more than that - notoriously dangerous).  When the traffic is slow, the matatus drive off the road and drive along the path where people are walking.  In the 20 minute ride from the airport, I see a matatu side-swipe a bicyclist - not a horrible accident, but not a good one either.

 The hospital I'm working at is called Moi Teaching and Referral Hospital.  The hospital itself is comprised of several separate buildings, connected by a central outdoor walkway covered by a tin roof.  I am working in the inpatient medicine wards, which shares a building with pediatrics. I am working in the women's ward - a hallway with six "cubes"attached to it (3 per side).  A cube is an open area about the size of 2.5 standard private US hospital rooms.  Each cube has 8 beds, and each bed has 2 people who lie head to toe.  There are a few curtains that are knotted out of the way and no privacy to speak of.  I've seen a patient squat in the 2 foot space between beds to urinate into a bucket.  The ward has an overlying smell of body odor and illness, with occasional wafts of feces or vomit.  It can get pretty stifling with the smell and the heat, especially during visiting hours when more than 30 people can be packed into each cube.

The hospital is a mess of disorganization and inefficiency.  The paper charts are held together with string and are strewn about the nurses station in no particular order.  Labs often don't come back for 3 days. Xrays can take days to be completed.  Currently, the CT scanner is down, so our patient with a suspected subarachnoid hemorrhage will just have to tough it out.  We don't have spinal needles, so we do LPs (lumbar punctures) with IV catheter needles, after 'sanitizing' the site with hand sanatizer, and without using lidocaine first.  There is no vancomycin or cipro available in the hospital.  Gloves run out on a daily basis. When we order 3 liters of normal saline for a patient, they will often get 1 liter or less of dextrose instead.  There is a single nurse for the 16 patients in the cube (normal in the US is 4-6 patients per nurse), so it's understandable that things get forgotten, but it is difficult not to get frustrated.  There are also no landlines, so if you want to see if a lab is ready you have to take the 5 minute walk to find out.  On top of this, all of our patients speak swahili, so my utility feels very limited.  I'm taking lessons and will hopefully be of more help later, but for now I'm pretty dependent.  On top of all this the interns are on strike, as well as some of the residents and pharmacy staff because the government hasn't paid them in 5 months.  This morning our visiting resident was gone, so our rounding team consisted of myself, 2 senior Kenyan med students, and a pharmacist.  So, no actual doctor... Oof.

Despite all of this, my experience in the wards has been enjoyable.  The medicine is fascinating.  In just 3 days I've seen patients with cerebral toxoplasmosis, cryptococcal meningitis, likely TB, sepsis, encephalopathy, subarachnoid hemorrhage, acute kidney failure.  We have a patient with AIDS complicated by moluscum contagiosum which has covered her face in tens of large crusted nodules.  Even though I can't have a conversation with our patients, it is gratifying just to offer a 'jambo' and 'Jina langu ni Terra.  Habari yako?' (My name is Terra.  How are you?)  The Kenyan medical students are very kind and helpful, as are the nursing staff.  I am working to remember that while I won't be able to change the system or make things more efficient, I can make a difference to a few individual people.  So that is my goal.

Until next time, kwa heri!