Friday, August 29, 2008

In the hospital, the busy hospital...


Hi again, I hope you are all keeping well and that winter is slowly retreating. I am pleased to say that the weather here is also becoming more friendly, with sunny days most of this week. I always thought of Kenya as an extremely hot country, given its position right on the equator, however I was surprised to learn the climate is very temperate. It tends to sit between 20-30 degrees. Kijabe (meaning ‘place of the winds’ in Maasai) is even cooler, with a breeze picking up every evening. Aah, just like home :)

As I promised last episode, I thought I’d give you a look at the medical side of my life in Kenya. This week is my last in general medicine and was particularly challenging. Disclaimer: the following stories may be too graphic for those without strong ‘tumbos’.

On Tuesday night, I was on call and was paged to see a patient in Casualty (ED). I went down and found a 41 year old man, who complained of lesions on his hand and in his groin. I was struck first by the awful smell coming from his general area, and then as he showed me his right hand this is what I saw…

He had several hundred purple-black lesions covering his right hand and extending up his forearm. The smell intensified (as did my nausea) as he revealed that his groin was also covered with similar lesions, which appeared to be infected. Having never seen anything like it, I assumed these were warts. I ordered a few tests, gave him some antibiotics for the infection and organised his admission. In a half an hour or so I received his blood results which revealed he was HIV positive. In the light of this I took another look at his hand, realized that these were not common warts, but Kaposi’s sarcoma, a type of cancer that occurs commonly in HIV.

A couple of days later, on morning ward round, we were given a new patient who had been admitted with heart failure over night. She had been treated in the past, but over the last four years had not had the money for her medicines and had resorted to traditional witch doctor treatment. As we were assessing her, we realized we had not yet seen her Chest X-ray. This is what we saw…


I’m not sure if you are used to looking at X-rays, but basically the globular opacity in the centre is her heart. Normally the heart takes up about a third of the thoracic cage, as you can see, hers is on the large side. On listening to her heart sounds, it was difficult to make anything from what you heard. It was basically just once big murmur. In a third world community such as this, we assume that she has suffered from severe Rheumatic heart disease. We prescribed her some treatment, but unfortunately there is not much you can do for a heart like this (other than transplant). While we were visiting our next patient, we were called to a cardiac arrest (my recently gained resus certificate came in handy). Unfortunately, we were unable to resuscitate the patient. Only seconds after, shaking from the adrenaline of the last arrest, we were called back to this lady who had also gone into arrest. I am unhappy to say that we were similarly unsuccessful in our resus. I could not believe it. Two in ten minutes!

SO… that was my week. Today I am pleased to say, none of my patients have died. I am learning to treat many conditions that are much more severe than you would see at home. Although interesting and exciting, this experience can be emotionally draining. On that note, I’m happy to say that Juliette, Emily (another med student) and I are heading to Lake Nakuru national park for a weekend Safari (meaning journey) and some relaxation. Hopefully I will have some happier photos for you next time!

3 comments:

Nick said...

Oh wow!
Even I can see that heart is massive! Man it looks like you're having the most incredible experience there, medically and personally. Very jealous :)
Have a great time on safari!

Anonymous said...

Oh wow Chlo, that's pretty extreme! What a week! Hope you have a good relaxing time this weekend, and just think of all the people that you have been able to help in your time there. Lots of love

Unknown said...

I cant see the heart...

but faaa intense stuff for you!!

shot for going eh...

xx