|
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.