Life on the Wards

Brief background info on my rotation:

Basically I go in at about 7:30 AM and work up as many of my patients as I can. I look at new admissions to our ward, any new labs for our current patients, and other status changes overnight. At 9:00 I round with the medical team. This includes writing orders for all new medications for the patients, adjusting doses, making therapy recomendations, and generally optimizing their medication therapy. Rounds so far have usually lasted between 3.5 to 4.5 hours depending on the team and our patient load (24 beds, up to two patients per bed - average census is about 35). Then at 1 pm I grab some lunch back at the IU house and go back to the hospital in the afternoon to present my patients to my preceptor (Sonak) and follow-up on anything else that needs to be done with my patients.

Yesterday was a lot better at MTRH (Moi Teaching and Referring Hospital). Still fairly overwhelming, but I am starting to get more organized and have begun to figure out the controlled chaos that is the Amani Ward. Thankfully, I am here for another six weeks and will be that much more effective as I gain more experience. I have already learned a lot here and the Kenyans are learning from me as well. One of the Kenyan students on his clinical rotations was not sure how to instruct patients on the use of albuterol inhalers. So, this came up when we were getting ready to discharge a patient with asthma who had never been instructed how to use her inhaler. I explained the proper technique, and Stephen translated for me in Swahili. This is meant to be an exchange; although I am learning a great deal, it is with the hopes that the Kenyans will learn at least as much or hopefully more from me.

Before our rotation, we were warned that it is not uncommon for students to faint during rounds. The combination of the sights, sounds, and especially the smells (a combination of the usual hospital/nursing home smell in addition to body odor, stool, and wet dog) can be quite abrasive. Today, all of my senses were working against me and I had to take a break a number of times to get some fresh air and keep from fainting.

Wednesday nights we go out to eat in downtown Eldoret - tonight it was Indian food (delicious!). Poverty is certainly a problem and Kenya is unlike any place I have ever been. On the way out of the restaurant some children were begging us for money and being pretty adament about it. It is sad because I could see the glue on their upper lip which means that they would have likely used the money to buy more glue for sniffing. Certainly, when I return to the states I will have some reverse culture shock because of what I have seen here. It is impressive and sad how few resources the Kenyans have.