Inevitable -Life at St. Joseph's

The file room... yeah.

     I’ve been meaning to do a post on the hospital, and it seems like I better do it now since I’m leaving so soon. There have also been a lot of things that have come to feel like they’re inevitable over here, and since most of them relate to the hospital, it’s a 2 in 1 post! It’s also long, so be warned.

     It is inevitable that someone’s phone will go off in the hospital. I don’t just mean some patient is talking to their family in the hallway. No, the doctor will be in the middle of an examination and the patient will answer their phone, or the doctor will. Granted, if a doctor gets called in the middle of rounds they generally ignore the call or tell the caller to try again in 10 minutes, but still, it happens all the time. Even in the middle of the morning meeting, the phones never stop. Surgeries aren’t exempt either. If you’re not scrubbed in and the surgeon’s phone goes off, you get to answer it. It’s crazy. Also, it’s not like the phones are on vibrate or silent. Every time someone gets a call or a message, the music is blaring. Oy vey.

Gold star to anyone who can identify this test,
A+ if you also know the result of the bottom row.

     Whether or not it’s actually inevitable, I think most of us are pretty sure we’re going to come home with at least tuberculosis (TB), if not also malaria, typhoid or HIV. We see so many patients with each of these diseases each day. Every time I see a TB patient, I think of the special rooms we have for such patients in the U.S., rooms that only allow air to enter and purify any air before it leaves. At St. Joseph’s, TB patients are just in the big rooms with all the other patients, quite possibly passing on the disease to everyone else. If I come back with anything, I’m guessing it’ll be TB. However, we did have a recent HIV scare when one of the guys got blood into his eyes during a surgery (the patient was negative for HIV and hepatitis when we retested her blood, but my friend decided to start post-exposure prophylaxis just in case) and there was a student who went home with malaria a month ago.

Patients can pay with cows if they don't have the money.

     The reality though is that most of us students will go home without a serious illness. That doesn’t mean though that we’re not going to get sick. It’s sort of become a rule that everyone will get sick while they’re in Kenya; the only question is just how bad it’s going to be. So far I’ve been lucky and have only had to deal with allergies and a sinus infection (though the dusty safari trip seems to have made it a bit worse). It’s certainly not pleasant, but it’s better than the stomach bug other people have had. A girl who was here before me had to go to the hospital every night for an IV. Having to go to the hospital for treatment is possibly our greatest fear here. St. Joseph’s is leagues ahead of the other hospitals near us, but none of us want to be patients. Thanks to a recent Harry Potter craze in the house Alex came up with our new motto for St. Joseph’s: “you could get sick, or worse, admitted.”

Filling out discharges in pediatrics

     Speaking of jokes, sickness and St. Joseph’s, it became a joke amongst us students that it didn’t really matter what the symptoms were, a pediatric patient always had “complicated malaria.” Of course that wasn’t true, but we heard Dr. Atonga say it so often that it felt like it was.

Radio and fan -two things I'm pretty sure you
don't usually see in an American OR.

     Something else I heard often, albeit before I left home, was how shocking Third World countries are. Now that I’ve been here almost a month, I’m not sure if being shocked is inevitable (though perhaps I was just so prepared to be shocked that not much has shocked me yet). However, while being shocked may not be inevitable, I feel like becoming frustrated and angry is. This is especially true in the hospital. There have been quite a few times when we’ve wanted to order a CT scan or an MRI for a patient, only to remember that the nearest CT machine is an hour away and there is no MRI machine anywhere close. Other times we’re waiting on a test to diagnose a patient, only to be told that the reagents are out of stock. Other times, you just get angry. For example, an extremely ill little girl was brought in, but despite being dehydrated and anemic, no IV was started until the second day when two medical students from Poland and some of the Medics to Africa students started it themselves. The girl’s veins were so small by that point that it was almost impossible to get the necessary blood samples for testing. Another common source of anger is the Clinical Officers (CO) who work at night. A CO is sort of like a Kenyan PA in that they function as a doctor, but they have only three years of training. Most of the “doctors” at St. Joseph’s are actually COs and most of them, like Dr. Atonga, seem to be pretty good. The two female COs who give reports in the morning though seem to know very little. Despite never having attended medical school (though she plans to next year), Alice the anesthesiologist often puts these two to shame and calls them out whenever their methods of treatment seem wrong or inadequate, which happens more than I’d like. Once Alice questioned their treatment of a patient who died. The COs may not have necessarily caused the patient’s death (heart attack), but they treated it incorrectly, using the wrong dosages of medications. The COs never answered Alice’s questions. They just started laughing. I think a language barrier played a role since Alice was speaking English and the two COs never seem comfortable speaking it, but whatever the case, the response was pretty infuriating. 

Ready to give injections in Maternity

     The language barrier is another inevitable part of life at St. Joseph’s. Every Kenyan is bilingual, if not trilingual, by adulthood. People first learn their tribal language (Dhoulo is the one in Migori) and then Swahili, the trade language. Most also speak English, which is taught in school, but most is not everyone. The staff members at the hospital mostly speak English well, but many of the patients, including the patient whose wound I dressed everyday, speak almost no English. I’ve learned some Kiswahili (the Kenyan dialect of Swahili) since coming here, and that usually helps a bit. However, I think I’ve confused a few people because I can greet them in Kiswahili and ask them how their pain is, but if they try to say other things to me, I’m totally lost.

Fibroids removed from one woman's uterus

     Being lost is nothing special at St. Joseph’s. The last inevitable thing about being a student here is that at some point (actually at many points) you will be asked to do something and have no idea how to do it. Filling out discharge papers were particularly frustrating for me at first. The good thing is, if you ask for help, the people at the hospital are usually more than willing. Even in the middle of surgery, Dr. Agullo’s a pretty good teacher, and if you show effort on rounds, he’ll push you to learn more and do more than you expected. Really in almost any department of the hospital, if you show initiative and want to learn something, someone will be willing to teach you, whether it’s tests in the lab, how to give injections, or even how to feel the position of the baby in the womb. It’s something I’ll miss about St. Joseph’s, though working here has made me more excited to work in a U.S. hospital one day.