26 January 2011

Kenya: OB.

Good evening from Kenya.  It's been a draining day - Mom has already been dropped at the hotel for a cold shower and a cold drink of water.  (Thus, no special addendum from her today.)  The heat zapped our energy, and the days' events cost us a bit emotionally as well.  I hate melodrama, but I'll keep you posted on what we're seeing.

Yesterday, I rounded again with Dr. Allibhoy.  The ICU only had one occupant, recently extubated but with active TB and sepsis.  The wards with similar cases as the last time - cryptococcal meningitis, cerebral malaria, CVA (stroke), and active TB.  One of the tell-tale signs of active TB, with treatment started even before the sputum has been cultured, is a pleural effusion.  Fluid fills outside the lungs and compresses them, making it difficult to breathe.  I observed the Resident Radiologist (really, the Attending) perform a therapeutic thoracentesis, with a sample sent to the laboratory.  The pain tolerance of the majority of people here is unbelievably high.  This patient followed everything her physician requested (needle in her back and all) and even thanked him afterwards for relieving her "breathlessness."

The rest of the morning was spent in the Emergency Department.  We saw a few rashes, abdominal pain, follow-ups with lab results, typhoid, and malaria.  All stable, thanks to God, so no true emergencies - sounds familiar. 

Then, in the afternoon, I took a matatu out for home visits with Aduda.  Remember, the guy working for the PEPFAR-funded project?!  It's actually AIDS relief funded by Catholic Relief Services.  We walked for three hours finding three separate patients.  One was a 20-something year-old male on anti-TB therapy.  Aduda's visits ensure compliance and refer those to the sub-district hospital who are having difficulty.  He documents everything well and reports back.  His social sciences training, and then work as a retail salesman, make him perfect for this work - just trust me.  We then saw a 20-something year old woman on anti-TB therapy, but in the final stages of AIDS.  In the last month, she and her baby were dropped off by the husband at her mother's house in this village - and he left.  The baby died of AIDS last week.  The mother appears weeks, if not days, from death.  Thus, Aduda encouraged her to get to the hospital the following day - hopefully his NGO will send a ride out to scoop her up, but AGAIN we see transportation is a HUGE issue.  Aduda has no car/truck/motorcycle of his own - but what if he had one? - one that costs roughly $8,000.  She may not survive either way, but his outreach could touch more people in one day, and perhaps eventually save others.

Finally, we found the last patient - a mother with twin babies.  There is a big push to educate HIV-positive pregnant mothers to deliver in the hospital to get anti-retrovirals during labor to decrease the risk of transmission to the baby.  Many still deliver in the village, the traditional method.  This mother though, delivered in the hospital, got her ARV's, her babies got their dosages of meds for 18 months, and now, at the age of 2 years BOTH twins are HIV-negative.  This is not a movie, but after seeing the spectrum of successes and failures in this one afternoon, it sure as hell felt like it.

Last night's dinner was the most Westernized we've had - it was Mom's favorite.  We sat outside by candlelight, after finding our "luxury guesthouse" restaurant down a dusty dirt road.  We were served wine, chapati bread with beans (mixed with salsa) which was awesome, boiled chicken, a salad, and tomato soup.  Our walk home in the dark afterwards (there are no streetlights) was a bit of a heart-pumping experience, with motorcycles and bicycles whizzing by, but it was only a little less than two blocks away - it would have been a shame to blow 50 cents on that short ride home. 

Today was "outreach" day at the clinic.  Mercy, one of the other young community health workers, Brenda, Mom and I headed out further in the village.  We walked door to door (they'd organized which homes we'd visit), asking if the infants or toddlers were home, if they had their clinic cards, and made sure their immunizations were up to date.  Talk about a home visit!  SURPRISE!  SHOT TIME!  Our updates today included Diphtheria, Pertussis, Tetanus, Meales, and Vitman A (supplemented every 6 months until the age of 5).  We had lollies for the kids afterwards to cheer them up, and multivitamins and  toothbrushes/toothpaste to leave behind.  Many of the grandmothers and mothers however have not seen these childproofed bottles of vitamins, and so it takes a lot to teach them to compress the cap, then turn, and then it opens.  So, you could drop off a million bottles of vitamins, but unless you open it first, pierce the top foil, then show them how to open it several times, the kid won't take a single one. 

The trek was almost three hours long, and of course this was the day Mom failed to apply sunscreen prior to heading out.  She didn't even bring her embarrassing wide-brimmed hat.  (In all fairness, we were not warned this was outreach day.)  Oh, on side note: she brought ONE t-shirt on her first trip to sub-Saharan Africa.  Brilliant!  Luckily, she's bought three more from our favority kiosk/street vendor.  OK, so the trek was long, Mom and I both got burnt, and ran out of water quickly.  We ended at the Irrigation Scheme on the river.  This was NOT working when I was her in 2007, yet 2 pumps are now working, thanks to financing from the German government, and two more are being built thanks to the Finnish.  It flows 10 kilometers downhill from the site of the pump, helping to water the rice fields and cows (I think). 

Then, we made the final visit of the day.  Brenda received a call yesterday that one of her HIV-positive pregnant women was sent home from the hospital - she'd tried to deliver there but was not in active labor so she was sent home.  This morning however, Brenda was notified that she'd delivered in the village (with a midwife) around 03:00 and was feeling weak, still bleeding, and not doing well.  We got in the truck, and drove to find this woman in the neighboring village.  She looked weak, baby looked OK, so we loaded them up and took her to the nearest community hospital.  The GP helped stopped some of the bleeding and we got her fluids running.  She'd been unable to hold down fluids since delivering and was likely very dehydrated.  Of course, this story doesn't include all the details, but they aren't necessary.  Pray for the baby and Mom tonight.  The hospital was able to get a dose of ARV meds out to the baby this morning, so there is a chance baby will not be positive.  But, transporting Mom to the hospital was another story - again, transportation was the issue.

It's embarrassing to try to put some of this in words.  There are times we are left feeling powerless, but other days I feel like only a tiny amount of time/effort/money could put into place the tiny pieces of the puzzle necessary to bring some of these projects the successes they seek.

OK - I'm headed home to check on my own mother, but overall we are doing well.  Enjoy your warm shower, your mattress, your iced drink, your immediate medical care, your loved ones and friends, and all of God's many little blessings tonight.   

Asante sana.

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