Greetings from Eldoret

Where to begin…I arrived last Tuesday evening along with my classmates Whitney, Adam, and Jess. We joined up with two fourth-year  Brown students, Mayuree and Caitlin, who will be here through February, and Becky, another IU student. (You'll notice there aren't many males around.)

My first impression of IU House is that it is summer camp for physicians. This is most certainly an oversimplified view of a much more complex program, but the camaraderie and spirit at the house elicits a certain charm that I find incredibly compelling. We happened to arrive at IU House at a time when many of the "big wigs" from IU, including the Dean of the medical school and chairs of Medicine and General Surgery, were visiting AMPATH. One day at lunch, I happened to be chatting with a fellow student, chomping away on one of the many delicious meals provided by the talented cooks here, when a man who introduced himself as "Pat" sat down and began casually conversing with us. I only realized later that indeed this was Dr. Patrick Loehrer, director of the IU Simon Cancer Center and quite the accomplished physician. First names and easy conversation are simply part of the culture at IU House. Later that night, Dr. Loehrer walked into the dining room to find a group of us---med students, residents and attendings---all reading or checking email on our computers, and declared, "Well I found Nerd Hall!" I chose not to point out the irony to him.

I am dividing my two months in Eldoret into one month of adult Internal Medicine and one of Pediatrics. I started on Internal Medicine wards on Thursday morning as part of Firm 3. In theory, each firm is assigned to one "cube" of eight beds on either the men's or the women's ward. In most hospitals in the US, this would imply eight patients. However, at MTRH, this is not the case. There is no shortage of patients being admitted to MTRH, and often patients share a bed, lying head to toe (my friends at home seem to have no concept of this outside of the grandparents in the original Willy Wonka film).

two to a bed

Adding to the overcrowded nature of the wards is the billing system of Kenyan hospitals. Instead of going home and being sent a bill post-discharge, Kenyan patients are required to pay before leaving the hospital, so much so that the guards at the hospital gates are more concerned with who is coming out than in (like the man who checks your Costco receipt … only it's your health and not a 12lb bag of gummy bears). This then creates the phenomenon of "discharge-ins"---patients who have technically been discharged but cannot leave the hospital until their families have raised enough money to pay their bill. Certainly, despite all of the warning, "overwhelming" does not even begin to characterize my first impression of the sight (and smells) of the wards. What I found to be most shocking was not necessarily the overall appearance of the hospital but the details instead. For example, date of birth for many of my firm's patients is simply a year. No month, no date. Think about how weird it would be to never know the exact day you were born (and to not be able to look it up on Facebook!). I personally have yet to spend one of my 28 birthdays not celebrating, with at least a piece of dessert, the simple fact that I am alive. A group of friends and I recently put together a 2016 calendar with photos from a New Year's trip and in addition to things like National Peanut Butter Day, the one thing we were sure to include was each person's birthday. It seems so trivial and unimportant when you have the luxury of forcing your friends and family to meet you at a bar and buy you drinks once a year, but we actually make a big deal out of it. For many of the MTRH patients, this just isn't a part of life.

But I was also surprised and impressed by a number of positive things as well. My firm, to begin with, is phenomenal. Seth, our third year Kenyan registrar (roughly equivalent to a fourth year resident in the US), appears to have memorized every medical text ever published. The sixth year Kenyan medical students (roughly those at my level of MS4 in the US) make me look like an idiot 75% of the time. All the students, interns and residents are more than capable of taking vital signs, starting IVs and changing lines, things we unfortunately rarely do in the US. This past week I saw and read for the first time in my life a CT scan that was printed on something that I only know as "old timey X-Ray paper." I've heard more real heart murmurs in eight hours on the wards than I did my entire third year of medical school.

After leaving the wards on Friday, the seven of us students as well as Kirsten, an OB-Gyn resident from the University of Toronto, took off for a safari in Lake Nakuru National Park for the weekend with our trusty guide Peter. After 12 hours of game drives, approximately 45 gallons of sunscreen and a combined 6,758 mosquito bites among us, we were able to see lions, hyenas, lots of zebra and water buffalo (who thought you could ever get bored of seeing zebra walk right next to your car?), warthogs, giraffes (my favorite!), lots of different birds, rhinos, impala and water bucks. It was quite lovely. We spent our evenings drinking Tusker (the official unofficial Kenyan beer), watching acrobatics shows, and trying to get the songs from The Lion King unstuck from our heads. We also learned that one can approximate a zoom lens camera by holding up the camera of an iPhone to the viewing end of a pair of binoculars, in case anyone was wondering.

That's about it for week one. Keep on keepin' on, friends.

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