Holy Crap! Crap! Tours.

Warning: This is a vent-session.  If you would like to zoom to the interesting safari part, head to the bottom of the post!

As expected, working on the adult side is very different from the pediatric side of MTRH.  We admit every other day, as opposed to every 4th day, which results in a census consistently in the 30s.  These patients are often very complex and very sick, and are far less resilient than the children.  Result--we loose a lot of them.  The first patient we lost that hit me hard was a 19 year old with terrible endocarditis.  We thought he had turned a corner, but 2 days later I was watching his blanketed body get wheeled through the wards.  There was another day that I went to try to "admit" a new patient after rounds, but found I couldn't communicate with him or his caretaker.  This happens fairly often, so I mentioned it to my intern and we decided to see him after lunch.  By the time I was back on the wards, he had passed.  That one really bothers me...I went to see him within a couple hours of his passing.  I did nothing.  I can take a step back and realize that I wouldn't have been able to do anything about his passing, but that's all the "blablabla" and not the experience...of.....essentially ignoring a dying human.  This makes me sound pretty terrible, doesn't it?  Stuff like that happens all the time here.  I just thought I wouldn't be involved when it does.

OK, so a lot of those were sick patients who essentially came to the hospital to die.  At the end of the day, what is really getting to me is the system.  MTRH has a 6-bed ICU, so patients that would certainly qualify for ventilation, cardiac telemetry, etc etc in the US all end up on the wards.  We have to deal with everything.  Oncology.  Neurology.  Cardiology.  All on the wards, all being managed by a team which consists of 1 Kenyan resident, an intern, a PA, and a group of medical students.  On top of that, the resources are severely limited.  We run out of gloves, tape, even paper on a regular basis.  Good luck finding sterile gloves.  The lab frequently runs out of reagents, and therefore can't complete our lab requests.  Imagine Wishard not giving you creatinine values for a week.  The next week, they can't get you LFTs.  One night the hospital ran out of oxygen.  Oxygen!  One medicine team lost 6 patients that night.  Then there is also the culture of never being in a hurry...which is great outside of the hospital, but when people are dying in front of you...a little hurry goes a long way.

I knew what I was signing up for.  This is a "resource limited" setting, and MTRH is doing the best it can.  ...or is it?  I'm realizing just how damaging the corruption in the Kenyan government is.  Exhibit A: one Kenyan politician is spending 3 billion kshillings ($37 million) on helicopters for the upcoming election.  I don't know about you, but there might be a better way to spend that money.  Like on OXYGEN for your HOSPITAL.  Cue Indiana University, who walks a fine line between functioning in the system yet also providing much needed resources (currently still largely only available for HIV+ AMPATH patients).  We are here to learn and to help, and hopefully to encourage change in the system.  Leading by example, if you will.  Of course, I wonder if "the system" will keep breaking down and expect IU to pick up the slack.  That isn't the goal of this partnership, but it could easily head that direction.  And of course, this has me thinking a lot about health care systems in general.  I used to badmouth "rationed care" where patients have to wait weeks to months for their tests/surgeries/whatever.  Considering where I am now, where certain resources just aren't available and/or affordable, I may have to change my stance.  Yes, it has been a very interesting, very eye-opening, and in the day-to-day, very frustrating experience.



Maasai Mara Safari!

After 6 weeks without a day off, and beginning to feel particularly rundown, I decided it was time for a little tourism--Safari at the Maasai Mara!  It was amaaaazing!  We had SO much fun and saw some incredible WILD wildlife.  On our very first "game drive" our Maasai guide said he had heard of the location for some cheetahs.  Cheetahs are difficult to spot, so we flew by a ton of other interesting things in search of them.  Zebras, elephants, even an entire pride of lions (which was crazy because I wanted to stop for everything!  I had just gotten there!) but it quickly paid off and we found the cheetahs!  That's pretty much how the whole safari went.  If we were hunting for something in particular, we found it.  If we were just driving home after a successful day, we stumbled upon some new and amazing animal find.  We definitely had luck on our side, and it made for a very successful and exciting safari!  The elusive leopard, check.  The camouflaged cheetah, triple check.  "I'm surprised we haven't seen--oh, there they are!"  The hunt for the rhinoceros, our missing piece of "the big 5" was especially exciting.  We were slowly and quietly searching around a huge new area of the mara when we ran into another safari van who had spotted the rhino up ahead.  He gave us detailed directions on how to find him.  The closer we got, the more excited the other passing vans were to tell us the news.  Eventually we were racing to reach him before he disappeared into the bush.  The last van was our friend Max, who only slightly slowed down to yell at us in swahili to "hurry! hurry!".  It was so exhilarating!  Especially because we eventually DID find him, and spent the next hour watching a wild rhinoceros chill in his natural habitat.  Having successfully checked "The big 5" off our list, (lion, elephant, buffalo, leopard, rhino) we asked our Maasai guide what else there was to see.  He responded with, "Only the smaller animals, like mongoose and jackals."  What did we find later that day?  2 giant groups of mongoose, and I'll claim credit for spotting the 3 jackals on an adjacent path!  On our last morning drive we had no particular plan, but ended up catching a caracal cat cross our path--an animal that our Maasai guide had only seen once before in his life!  (See the wikipedia page for just how rare spotting this cat is.)  We also paid a visit to our guide's village, which was a really cool experience.  We danced with them, watched them make fire, hung out in one of their tiny houses, and bought a ton of souvenirs. 

I really want to write about all of the other hilarious things that happened because I remember laughing so hard for so long that I couldn't fully laugh anymore...but it has all blurred into the awesome safari that it was.  I DO remember referencing and/or singing "Only in Kenya!" an exorbitant amount, much to the annoyance of 2 of our safarimates, haha.  (Please reference my first blogpost for a link to the video.)  Cynthia also kept saying "Holy crap!" when we would see something awesome, which was often, which played into our obsession with that video.  (Holy crap! Lions! Tours.  Again, please see video for further understanding.)  And then there was just the fun of trying to stay standing upright while driving on the bumpy mara roads!  Bah, it was an amazing 4 days.  I would LOVE to post more pictures, but my internet is being particularly slow.  However, I have posted a few videos onto my snazzy youtube channel, if you are interested! 

Link to my youtube channel here!



Tomorrow I leave for white water rafting on the NILE!  I've definitely reverted back to my tourist-self, but it is a much needed break from the wards.  And I'm having a blast :)  Then one more week of work, a last weekend having fun somewhere in Kenya, and then I head back to the US.  It has FLOWN by!

As always, thanks for reading!  Comments/questions/life updates are encouraged!