Catching up

Thursday, June 21st, 2007

Many of you have pointed out that after an initial prolific stint as a blogger, I deserted my fan-base to stuff myself with chapatis and chai until I was oily and milky in the face. I am sorry for the radio silence and the precipitous decline in my ability to respond to emails in the last two weeks. My laptop is (unsurprisingly) on the fritz right now—my power cord shorted out about a week after I got here—and as such I am trying to snatch bits of time here and there to write down everything that’s been happening. That being said, there’s nothing like productivity to beget productivity, so since today was my first really productive day in a long time, it seemed an appropriate time to start filling in the last two weeks.

Quick overview: when last I wrote, I still had another week left in Nairobi while I was waiting for Mkaya to arrive and shepherd me down to Voi. I was considering going on a brief safari or something to fill up the time, but I ended up having to wait around in case I needed to be at any more meetings at the University of Nairobi (I didn’t) or if I would end up having a good enough time in Nairobi that I wouldn’t want to leave (I did!). I finally left Nairobi on a bus with Mkaya last Friday the 15th and arrived in Voi that afternoon, where we made a quick stop at the hospital to introduce ourselves around, and then spent the weekend visiting with different members of his family and generally taking it easy until Monday. When that important day came, we met with a few more key people, found me a place to live in Voi, and packed him off on the midnight train to Georgia/midnight bus to Nairobi. I sulked for the first day after he left, celebrated my birthday on the second day, and finally got to work on the third day, today, June 21st. Okay, now for the real, Miriam-ified verbose version…

Friday, June 8th
I don’t think I will ever forget this day because it was my first experience with a) matatus, b) Kenyatta National Hospital, and c) finally getting to check my email and post on my blog!

Matatus are every bit as smelly and deathtrap-resembling as you might think they are. As everyone always seems to say about everything in Nairobi, “You should have seen them 5 years ago!” Apparently the 14 passenger limit (everyone now HAS to have a seat equipped with a never-used seatbelt) changed everything. Just noticed that I don’t have a picture of one, or (what would be best) a video from the inside showing the absolutely BUMPING music that blares in your ear, something which I will have to remedy. These babies are so tricked out, frequent (one comes every 15 seconds or so almost anywhere you are), and CHEAP (a ride costs only 20-40 shillings depending on the time of day) that it’s not surprising how popular they are, despite problems with Mungiki, the drivers’ apparent death wishes, and the constant shifting and asses in your face as people get in and out. Anyway, in true mzungu style, I was mostly so petrified of getting my bag ripped off while alighting that I mostly avoided them except when I was with Ruth. I rode in 4 that day, and maybe one or two others over the course of the next week, and that was it for me and mats.

KNH, as the public hospital in Nairobi is called, is vaguely akin to Bellevue in size, patient population, and array of patient maladies seen every day, but having recently visited Bellevue when I was interviewing at NYU Med, I can safely say that that’s about all these two hospitals have in common. There’s no way to capture in words the sights and smells of KNH. Even two weeks later, there are so many images swimming in my head that I can’t make much sense of it. So many people warned me about the conditions there before I went that I didn’t react as strongly as I thought I might. Instead I was just in a kind of daze as the whole thing kind of washed over me. Bullet points might work best here:

- Burns ward where many of the patients had burns on >50% of their bodies, and most of those induced by spouses during arguments or when sleeping
- Orthopedics ward where patients were three to a bed or sitting/lying on the floor, and the doc I was with recognized a few of the guys as having been her patient when she rotated through that ward six months previously!
- Hydrocephalus: I’ve never seen it in the States, and in one ward on one of the 10 floors of the hospital, I saw at least 15 kids with hooorrible cases of hydrocephalus
- Hand-washing: I certainly never did it or had an opportunity to in the 2-3 hours I was there.
- Speaking of the 10th floor: I guess a lot of patients jump from there.
- 50-60% mortality rate at the hospital
- Babies: often when it’s busy there are 3 in a single incubator. Because appropriate temperatures have to be compromised, it’s not uncommon for one baby to die PER HOUR in the nursery.
- There are patients that have been in the hospital for YEARS. Mkaya told me about one guy in Neurology that had been there for 13 years. Residents would go to the ward just to see him. The doc I was shadowing told me about a baby she had helped deliver from a mom who was in a coma. That was 2 years ago. No one has ever come for Nancy (as the hospital staff named her) or her mother in that time.

I have lists of other stuff, but I think you all get the point. My head was swimming after I left and I have thought about it often since. A common theme that I have observed in lots of medical facilities here in Kenya and that the 5th year student I was shadowing at KNH mentioned to me is this: these medical professionals, every bit as well trained as doctors in the US--if not more so because of their vast and early experience--have the frustrating job of seeing these patients, recognizing their diseases for what they really are, and being unable to properly treat them. Whether because of time and workload constraints (everyone at KNH is beyond overwhelmed) or because their patients finally turn up too late to do anything or because of insufficient resources...whatever the reason, there is a disconnect between diagnosis and treatment. Both the doctors and the patients suffer as a result. While mostly we think of the patients as the sad victims of this "system", from the other side I think how disheartening that must be as a doctor! And yet they cope.

Back to the light stuff. That night we just made toasted sandwiches for dinner at the house (grilled cheese with the best tomatoes ever! What more could Miriam ask for??) and watched TV. I needed to unwind.

More soon…

Missing everyone and warily scratching at my potentially malaria-inducing mosquito bites,
M