A day at the hospital

Scott here.  Well, what an interesting, amazing, and crazy first few days at Tenwek.  First, if interested, the typical work day for me looks like the following:

7:30-8:30: Round on patients in the Intensive Care Unit

8:30 -9:30: Morning report.  Typically someone will give a presentation on a variety of medical issues.

9:30-10:30: Interns round on the rest of the patients.  We help manage the most acutely ill.

10:30-11:00: CHAI TIME!  This is a fun tradition here.  At 10:30 am every day, the hospital essentially stops and everyone breaks for chai which provides a nice break from the busy schedule.  The internal medicine team meets in a small room with the attendings, interns and med. students.  One of the interns typically opens in prayer and then we discuss any deaths from the previous day, as well as any important issues.

11:00-1:30:  We round on all of the patients on the male and female medical wards, usually 40-45 patients. Sometimes the wards are extra crowded requiring patients to share beds or even sleep on the floor.

1:30-2:30:  Lunch

2:30-end of the day: There are a variety of things going on in the afternoon.  I help the interns with procedures or issues, intermittently check on our ICU patients to adjust meds, ventilator settings etc., see patients in clinic or in Casualty (the ER here is called casualty).

Standing in front of the Casualty (ER) entrance.

If not on call, the day typically ends around 5:30-6:30, however, call nights are different.  At Tenwek, I am considered a consultant, which is the equivalent to an attending physician in the U.S.  Basically, that means I have a team of Kenyan interns and medical students who are admitting patients, placing orders, managing issues, and presenting the patients to myself and the other consultants.  Currently, we have three other consultants including two long term staff, and a visiting physician from Canada, however, our numbers will dwindle to two including myself within a few weeks, which will greatly increase the work load.

My first day was a whirlwind, with a high number of acutely sick patients.  Although the cost of medical care here is very minimal (a hospital admission may cost only 20-30 dollars per day),  this is still a significant chunk of their income, so they often present late in their illness as they try to avoid coming to the hospital.

We see a large variety of diseases here, some are similar to the U.S., but the most common diseases here, are  rare in America.  Thus far, I have seen a large number of cases of tuberculosis, several people with meningitis, and an extremely high number of patients with AIDS/HIV (probably >50% of patients) and complications from this disease.  We also have a high rate of esophageal cancer, rheumatic heart disease, and lymphoma among other various diseases.

Mural painted just outside the entrance to the men’s and women’s medical wards.

My first night, I was on call.  It was quite busy until about midnight.  I had several interesting admissions, most of which we were able to stabilize and they are all doing well.  One patient had a large pleural effusion (fluid around the lung) which was causing significant respiratory distress.  With pleural effusions, the initial treatment consists of performing a thoracentesis which is a procedure done to drain the fluid by inserting a needle/drain into the lung cavity to remove the fluid and allow the lung to properly function.  In the U.S., we have a kit that allows for fast and relatively easy removal by aspirating 100 mL at a time.  Here, however, the largest syringe we had available was only 10 mL.  She had more than 1000 mL of fluid around her lungs, so I had to draw out 10 mL of fluid at a time, and do this 100 times in order to remove enough fluid!  It took forever, but she was a good sport and was definitely feeling better afterwards.

Most other admissions that night, we were able to stabilize and improve.  Unfortunately, one of the patients that was admitted a few days prior, passed away.  I was actually walking by the medical wards, and a nurse grabbed me to inform me a patient was not breathing.  On arrival, he was not breathing and did not have a pulse.  With his family there, we had to inform them that he had died.  He was only 41, and likely died from complications of kidney failure, as there is no dialysis available here, and it is only available in a few cities in the country.  After informing the family and offering my condolences, I was amazed at their peace about his death.  This patient had been suffering for some time according to his family.  He was an active believer in Christ, and although his mortal body failed him here, his family knows that where he is going is so much grander than here.  He is going to be with the Lord, where there will be only joy and singing.  I called the chaplain, and we prayed together in English as well as their native Kipsigis tongue as this man went to be with God.

When I made it back to the guesthouse that night, I reflected on this patient.  Although I wished we could have somehow healed him, I rejoice in the fact that he knew Christ and is now in Heaven.  That night, I read Isaiah chapter 35 which really spoke to my heart about the reassurance we have in Christ, and the  joy of the redeemed that awaits this patient, as well as all who believe.   What an amazing visual picture of what awaits us!!

Isaiah 35 (starting at v. 5)

5 Then will the eyes of the blind be opened
and the ears of the deaf unstopped.
Then will the lame leap like a deer,
and the mute tongue shout for joy.
Water will gush forth in the wilderness
and streams in the desert.
The burning sand will become a pool,
the thirsty ground bubbling springs.
In the haunts where jackals once lay,
grass and reeds and papyrus will grow.

And a highway will be there;
it will be called the Way of Holiness;
it will be for those who walk on that Way.
The unclean will not journey on it;
wicked fools will not go about on it.
No lion will be there,
nor any ravenous beast;
they will not be found there.
But only the redeemed will walk there,
10     and those the Lord has rescued will return.
They will enter Zion with singing;
everlasting joy will crown their heads.
Gladness and joy will overtake them,
and sorrow and sighing will flee away.

Well, I think that is enough for today.  Sorry about the length of this post, I will aim for a shorter entry next time!  Whitney and I are off to a pig and goat roast now put on by the surgical residents.  We were invited after Whitney proctored their end of the year exam yesterday…should be interesting.

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