Over the weekend two patients on the male ward died with severe anemia. Just to give you a reference range the normal hemoglobin is >14 in men. In residency the lowest hemoglobin I have seen is 4.5. The two patients that died over the weekend had hemoglobins of 2.5. My roommate Beth had a patient today that presented with a hemoglobin of 1.8. How is that compatible with life? The sad thing was the two men that died over weekend were only 16 and 18 years old.
So I discovered last Friday that there is a massive blood shortage in Kenya right now. The country gets most of its blood from school aged children and they were on vacation for the month of April. So currently in the hospial you cannot get blood unless you have a family member that can donate for you. To top it off last week the blood bank ran out of agents to cross match the blood and had to send all the blood (even the family donated blood) to Nairobi for cross matching. So even if the family donated it would take 2-3 days to get a unit of blood. This explains why my two patients died from severe anemia over the weekend.
It is hard because you just feel helpless. I went to the blood bank and provided them with the names of my patients and asked how quickly they could get blood. They told me it probably wouldn't be until Monday due to the lack of reagents. I asked if there was any way to speed it up and they said no. So that is where it ended. There was nothing else I could do.
I think there will be a lot more helpless moments to come over the course of the next six weeks. I am trying to focus on the things I can do and the ways I can help.
Monday, May 9, 2011
Sunday, May 8, 2011
More pictures!!!
Half my body is in the northern hemisphere and half my body is in the southern hemisphere...kind of crazy!!
I was about 10 ft from this guy. (I was in the car)
This is a hyena - I thought they were pretty ugly.
This giraffe walked right in front of our car, stopped, and looked at us to pose for a nice picture.
It is baby season and there were little animals all over the place. The cutest of these being the baby monkeys.
Lake Nakuru
Baboon sitting on someone's car wanting the food inside. They were pretty aggressive and really liked human food.
My roommate Beth and I overlooking Lake Nakuru.
African Buffalo - these guys are mean. They get mad when you drive by and charge the car.
White rhinos taking a nap in the shade.
The vervet monkey. He looks cute but he is a bit on the annoying side. One of these monkey jumped on top of our van and was trying to get in and get food. It was quite scary!
In Kenya they have a saying "The Big Five" - which are the five animals deemed the most dangerous in Kenya that people try to see on Safari. Well , I went on my first safari this weekend and saw four of the Big Five. So the big five include: elephants, lions, rhinos, buffalo, and leopards. We saw everything at Lake Nakuru except elephants (because there are no elephants at Lake Nakuru).
It was truly an amazing, beautiful experience. It is hard to put into words. We left Saturday morning and drove two hours to Lake Nakuru National Park. We had a safari van, where the top opens up and you can stand up to see animals and take good pictures. We spent a total of 5 hours on Saturday and 3 hours on Sunday driving around the park seeing amazing animals. The park was huge and centered around a beautiful lake. We stayed at a resort lodge within the park. Overall, it was an incredible weekend. I hope you enjoy some of these pictures.
Here is the list of animals we saw this weekend: lions, leopard, black-backed jackel, spotted hyena, vervet monkey, yellow baboons, white rhinoceros, plains zebras, african buffalos, warthogs, giraffes, common eland, impala, waterbuck, gazelles, marabou stork, great white pelican, flamingo, southern groun hornbill, common ostrich, helmeted guineafowl, and long-tailed windowbird. These are the animals we could identify in my travel book!
Thursday, May 5, 2011
Things are a little different here.
On rounds today the head doctor (consultant) showed up along with about 10 medical students. We were completing our rounds on about 40 patients and we arrived at one of the last patients in the back corner. There was a nurse/tech trying to put an IV in the patient and he had an oxygen mask on his face. No one knew anything about the patient because he had come in earlier in the morning and no one had seen him yet. The intern picked up the file and started talking about the patient. After a few seconds several of us realized that the patient was not breathing. The consultant checked his pulse and the patient had passed way. I was just shocked that no one had any idea who this patient was and why was he one of the last patients we rounded on that day.
We also had an interesting case of what we think is Gullian Barre Syndrome. This gentleman has had a 1-2 week history of ascending paralysis. He now is unable to move his legs at all. The weakness has moved into his arms and he is starting to have some difficulty with his breathing. So we called the ICU in the morning. They have 5 ventilators in our hospital and they are very selective about who can use them. Fortunately this man was transferred to the ICU because Gullian Barre is reversible and you just have to let it run it course. Very interesting case that I will have to follow-up on. I am interested to see if he actually gets intubated.
I did my first lumbar punture today on a patient. Lumbar puntures here are a WHOLE lot easier because the patients are so skinny and you can actually feel their spine. This guy has severe neck stiffness and was not responding very well. The Medical student tried first and was unable to do it, so I gave it a try and GOT IT....I was pretty excited. Ofcourse the fluid came out so slow I had to sit there for about 30 mins watching it drip one drop at a time. We had to label the sample with small pieces of paper taped to the bottles and carry across the hospital to the lab to make sure it got done.
So on a lighter, non-hospital note the weather here is awesome. It has rained a few times but it is mostly sunny and in the 70s. I am going on a safari this weekend to Nakuro National Park which is know for rhinos, hippos, and flamingos. So I am sure I will have some great pictures. I will try and post some more pictures soon.
We also had an interesting case of what we think is Gullian Barre Syndrome. This gentleman has had a 1-2 week history of ascending paralysis. He now is unable to move his legs at all. The weakness has moved into his arms and he is starting to have some difficulty with his breathing. So we called the ICU in the morning. They have 5 ventilators in our hospital and they are very selective about who can use them. Fortunately this man was transferred to the ICU because Gullian Barre is reversible and you just have to let it run it course. Very interesting case that I will have to follow-up on. I am interested to see if he actually gets intubated.
I did my first lumbar punture today on a patient. Lumbar puntures here are a WHOLE lot easier because the patients are so skinny and you can actually feel their spine. This guy has severe neck stiffness and was not responding very well. The Medical student tried first and was unable to do it, so I gave it a try and GOT IT....I was pretty excited. Ofcourse the fluid came out so slow I had to sit there for about 30 mins watching it drip one drop at a time. We had to label the sample with small pieces of paper taped to the bottles and carry across the hospital to the lab to make sure it got done.
So on a lighter, non-hospital note the weather here is awesome. It has rained a few times but it is mostly sunny and in the 70s. I am going on a safari this weekend to Nakuro National Park which is know for rhinos, hippos, and flamingos. So I am sure I will have some great pictures. I will try and post some more pictures soon.
Wednesday, May 4, 2011
First Day in the Hospital
An overwhelming day...I think that sums it up. But I will share a few more details with you :) So to start I went to bed last night at 8:30 pm (with the help of a Tylenol PM) and slept until 7am. I had breakfest which included cereal with warm milk out of a bag. It actually wasn't too bad. I met up with my group and headed to the hospital around 9am.
The hospital is actually nicer (no cleaner) than I expected. It is quite large with a lot of different sections and a variety of services. I am on the general medicine ward. The medicine wards are spilt into two - female and male. I am currently on the male side. There are 60 beds on each side and there are two people in each bed. There are two teams per side - so that equals 60 patients per team. For my fellow residents in the USA - WAY OVER CAP :)
So the team leader is called the Registrar (he comes a couple of times a week) and we have two interns who pretty much do all the work. There is an attending, but they do not come very often from what I hear. Then there are a variety of medical students that come every now and then. Finally, there is me and a 4th year medical student from Indiana.
We rounded from 9am until 1pm. We walked from bed to bed and talked about (we didn't talk to the patients) and occasionally examined a patient. I quickly discovered that the are many limitations to medications you can order and labs/radiology you can get. A quick example...we have a patient that has rheumatic heart disease and suspected endocarditis (infection of the heart valve). They have been treating him for 4 weeks for endocarditis. On rounds I asked what bacteria they were treating. I discovered they cannot order blood culture and they were just treating him empirically for 6 weeks of IV antibiotics.
The other big difference here is that the patient has to pay for everything. You have to record every pair of gloves you use and they will be billed for it at the end of their hospital stay. They are not allowed to be discharged until they have paid their bill. They have guards at the doors to make sure the patients don't leave until they pay. If they can't pay then they don't get the procedure. We had a guy today with suspected gastrointestinal bleeding, he was vomiting up blood. He needed and endoscopy which costs $45. He is unable to pay for it at this time so he is going to go home and try to raise the money in his home town and get the procedure done as an outpatient. You really have to think about every little thing you order or use because the patient has to find a way to pay for it. Another patient has metastatic cancer and the Oncologist wanted us to order a CT scan of the abdomen. The Registrar said no because he knew the family had trouble affording food for their family.
Sorry if this seems a little depressing. If you read this blog you might have to get use to some sad stories. Hopefully there will be some success stories I can share too.
An overwhelming day, but I really liked it. I am going to hit the text books before bed to try and learn about all the crazy diseases my patients have.
The hospital is actually nicer (no cleaner) than I expected. It is quite large with a lot of different sections and a variety of services. I am on the general medicine ward. The medicine wards are spilt into two - female and male. I am currently on the male side. There are 60 beds on each side and there are two people in each bed. There are two teams per side - so that equals 60 patients per team. For my fellow residents in the USA - WAY OVER CAP :)
So the team leader is called the Registrar (he comes a couple of times a week) and we have two interns who pretty much do all the work. There is an attending, but they do not come very often from what I hear. Then there are a variety of medical students that come every now and then. Finally, there is me and a 4th year medical student from Indiana.
We rounded from 9am until 1pm. We walked from bed to bed and talked about (we didn't talk to the patients) and occasionally examined a patient. I quickly discovered that the are many limitations to medications you can order and labs/radiology you can get. A quick example...we have a patient that has rheumatic heart disease and suspected endocarditis (infection of the heart valve). They have been treating him for 4 weeks for endocarditis. On rounds I asked what bacteria they were treating. I discovered they cannot order blood culture and they were just treating him empirically for 6 weeks of IV antibiotics.
The other big difference here is that the patient has to pay for everything. You have to record every pair of gloves you use and they will be billed for it at the end of their hospital stay. They are not allowed to be discharged until they have paid their bill. They have guards at the doors to make sure the patients don't leave until they pay. If they can't pay then they don't get the procedure. We had a guy today with suspected gastrointestinal bleeding, he was vomiting up blood. He needed and endoscopy which costs $45. He is unable to pay for it at this time so he is going to go home and try to raise the money in his home town and get the procedure done as an outpatient. You really have to think about every little thing you order or use because the patient has to find a way to pay for it. Another patient has metastatic cancer and the Oncologist wanted us to order a CT scan of the abdomen. The Registrar said no because he knew the family had trouble affording food for their family.
Sorry if this seems a little depressing. If you read this blog you might have to get use to some sad stories. Hopefully there will be some success stories I can share too.
An overwhelming day, but I really liked it. I am going to hit the text books before bed to try and learn about all the crazy diseases my patients have.
Tuesday, May 3, 2011
Far Far Away!
I am really far away from home. I can tell this because I have been travelling for the past two days. I don't think I could get on another airplane even if I had to right now. But the good news is several hours ago I safely arrived in Eldoret, Kenya. Things are kindof a blur right now because I am so worn out. The combination of jet lag and just plain lack of sleep is catching up with me. Overall, my trip went as well as it could have. No big hiccups and I made it to my final destination.
The IU house is very nice. I just finished unpacking all of my stuff and I think a nap is in my near future. I think I will be getting a tour of the hospital later today.
Sorry this is so short, I just wanted to let you all know that I am here. The pictures above show the Eldoret airport and the plane that I took from Nairobi to Eldoret. Hope all is well back home. I miss everyone! Will write more soon.
Sunday, May 1, 2011
Landed in Amsterdam
I have landed in Amsterdam and I am waiting for my plane to Nairobi. I still have about four hours of waiting. I discovered you can get 30 minutes of free wireless internet so I thought I would throw a quick note up on my blog. So far the trip is going well. I am bit on the tired side, and not really looking forward to getting back on another plane for 9 hours. I can't complain because every thing has gone smoothly thus far.
I was excited to see a Starbucks at the Amsterdam airport. So I ordered my classic Vanilla Soy Chai (which does not have any coffee in it), I guess a Vanilla Soy Chai in Europe is different because mine sure tastes like coffee. Oh well...I can probably use a little extra caffeine.
I think the best part about airports is people watching. It is amazing the diversity you see and all the languages you hear if you just stop and listen.
Well I miss you all already! Thanks for following me on my blog. I will write again soon from Kenya!
Ivan: I watched the movie Black Swan on the airplane, it was really dark and strange. Just thought I would let you know :)
I was excited to see a Starbucks at the Amsterdam airport. So I ordered my classic Vanilla Soy Chai (which does not have any coffee in it), I guess a Vanilla Soy Chai in Europe is different because mine sure tastes like coffee. Oh well...I can probably use a little extra caffeine.
I think the best part about airports is people watching. It is amazing the diversity you see and all the languages you hear if you just stop and listen.
Well I miss you all already! Thanks for following me on my blog. I will write again soon from Kenya!
Ivan: I watched the movie Black Swan on the airplane, it was really dark and strange. Just thought I would let you know :)
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