Kwaheri Kenya   Leave a comment

(Kwaheri = goodbye)

The previous week has been one of transition for me as my time in Kenya came to a close.  My list of loose ends needing to be tied was fairly long and took up most of my time, but Kenya found a few ways to give me pause and say goodbye in it’s own way.

Slamendas – In the last few days, I was asked to help make preparations for the arrival of a group of five first year medical students coming to Eldoret on scholarship as part of the Slamenda program.  Space needed to be found in the dorm for the two women coming and security for my room (which would go to the men) needed to be upgraded a bit.  My main goal was to help orient the students to the dorm, wards, and city.  I wasn’t able to be shown around the dorm before my arrival and this made for a difficult adjustment period.  Dr. Helphinstine and I took the students on the wards the first day they arrived.  Despite a lengthy talk about what they would experience on the wards, two of the students became weak in the knees within minutes and needed to excuse themselves.  Some had never seen a hospital ward even in the US.  This reaction was expected and I have no doubt they will be fine in the weeks to come.

Infusion Grand Rounds – Two months is not enough time to generate any significant change to a health care system.  Members of IU partnership live for years in Kenya to help improve the system and often meet with limited success.  Something I saw on the pediatric wards obliged me to take action, no matter how trivial the result.  While rounding on our patients, the nurses go from bed to bed administering medications.  On our crowded ward rounds, it is often difficult to hear the patient presentation and considerable effort needs to be taken to block out the background noise.  Something I could not tune out were the cries of agony I repeatedly heard from children during the medication delivery.  I snuck away from rounds to find the source.  What I found was fairly shocking.  When the nurses give drugs by IV to the children, they would grip the syringe tightly and use tremendous force to push the plunger as fast as possible.  This practice saves time, but is dangerous in adults let alone small children.  I fought off the instinct to stop the offending nurse and chose rather to think of a more sustainable solution.  As I returned to the ward rounds, we began to discuss a patient who had recently had his arm amputated.  The cause; his IV had leaked medication into his arm which became gangrenous and threatened to kill him.  The next day, we saw an infant who had an IV related chemical burn on the top of his foot near the ankle.  This will likely scar and complicate his ability to walk normally.  We have placed a major stumbling block in front of his first steps. 

I had a discussion with two dedicated 6th year Kenyan students about the problem and we decided to ask for time to make a presentation to the nurses about the issue.  Our faculty advisor suggested that this issue goes beyond a peds nursing issue as several adults have recently undergone amputations for the same reason.  Our small team has been asked to give a hospital wide grand rounds on the topic in early July.  Unfortunately, I will not be able to attend the presentation, but we will be generating the materials over the next month together.  A drop in the bucket, but if it helps one person, it will be worth it.

Sally Test Says Goodbye – As much time as I could spare was spent in the Sally Test Center for Children working on small projects or simply playing with the kids.  My last day, the children surprised me with a goodbye talent show.  The IU carpenters had built a puppet stage and the kids used home made puppets to act out a series of nursery rhymes.  Apparently, they had been preparing for over two weeks!  They sat in a circle in their story area and sang songs they had been practicing and danced for us in their story circle.  One of the children I had become closest to brought me a small basket that had a sheet of cloth in it.  All the kids had made paint hand prints on the cloth and written their name on it.  The title, “For We Are Kenyan Children”.  It was a very touching sendoff from a group of children I had grown quite close to over the last two months.

Karaoke – Tuesdays are Karaoke night at the Spree night club downtown.  I sang there the first week I was in Eldoret and the invitations to return came about every week thereafter.  My last night in Kenya happened to be on a Tuesday and I had heard that the hostess insisted on my being there.  The bar quickly filled up with Kenyan medical students, friends from the IU house and even some people I had met in town.  By the time the night was over, I had been pushed to the mic at least half a dozen times.  It was a great way to unwind before my travels began the next day.

Emily – If you have been following my blog, you are familiar with the patient I have called Emily.  I wish I could say that everything was in order for her when I left.  It was not.  As with all stories, hers was more complicated that it initially seemed.  It would be inappropriate to go into many details, but I will share where I left things and what I hope for the future.  I was able to mobilize a significant team of social workers and a concerned physician to address her case.  They are aware of Emily, but with over 10,000 patients, they have not been able to dedicate a significant amount of time to her.  By the time I left, we had had several meetings about getting her moved to a public boarding school near home.  There were several good options and time will tell which will accept her.  The next session starts in August.  Max and I took one final visit to the IDP camp on a rain soaked afternoon so I could say goodbye.  Emily was alone in her tent so we sat on a bench beside the door.  I told her I had no immediate answers but assured her that many people were working to improve her situation.  I emphasized her role in this process and that she needed to continue to work hard and keep a positive attitude.  I hope we left her with a sense of her potential for success in this world.  She has many impediments to that goal, but I truly believe that with a little luck she may be one of Kenya’s success stories.  She has a stack of self addressed stamped envelopes to reach me.  I will be eagerly awaiting my first letter.

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Posted June 2, 2009 by chrislux in Travel

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