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!

A typical week in Kenya continued...

When the weekend rolls around we are always ready for some fun, so this Saturday after rounds (yes I said Saturday rounds!) Juliette picked me up and we went back to Nairobi. We turned up at her friends house for a traditional 'bride price' negotiating ceremony. Can you imagine their surprise when a mzungu (white girl) like me walks in? This is part of the preparation for being married. Basically they cover 10 girls up completely and the groom has to pick which one is his bride. If he fails he can be fined money or told to come back and try again in a few years, but if he succeeds, the negotiations begin! The elders of each family fight it out to see how much of a dowry has to be paid. Traditionally 100 goats was offered, but now they tend to pay in kenyan shillings. It was hilarious and long, and the poor bride is locked in her room until the families agree. Luckily for Juliette's friends, the families did agree. According to Kikuyu custom, the couple are now officially married (not according to Kenyan law though). What do you think about that Daniel? Am I worth 100 goats?

On Sunday morning Juliette and I attended her church, called Mavuno. The music is incredible, if you can imagine a full band and gospel choir you will know what I mean. I feel awkwardly white, especially when they dance during worship, but I'm getting used to it slowly.

After church we visited the Nairobi Museum and took a drive through the city centre. Although Nairobi is home to more than the population of New Zealand, it has a small town feel to it. The CBD is compact and only has a few high rise buildings. The other thing immediately apparent is that the Kenyans really take pride in their national identity, especially given their recent olympic success, and thus have flags blazing wherever possible.

Just before we left Nairobi we had the pleasure of meeting up with Gael, a friend from Dunedin. We had ice cream together and caught up on the amazing time Gale is having working with African Impact, before she heads to Zimbabwe to complete an internship at a Law firm there. She is enjoying Kenya heaps, and spend her time working with kids in orphanages.

On our way back to Kijabe, we dropped Gael at her house in Limuru, an absolutely stunning town half an hour from Nairobi. The area is known for its lush landscape and rolling tea fields. She lives in a cute wee cottage there with her boss and his wife, and Doug's brother Adrian (Doug is another friend from Dunedin).

Finally we made it back on the road again. The drive to Kijabe is stunningly beautiful (have I said that already?) especially as you pass by the Great Rift Valley. I am trying to catch a sufficiently representative photo. Here is the valley at sunset tonight.

And now I am home, writing to you and wondering what the next week will bring. I will endeavor to include some photos of my work in the hospital next time. Sawa, it's time for bed.

Good night and god bless!

A typical week in Kenya

Sasa my friends, another action packed week has passed! I hope you are all keeping well. I thought I would write a little of what I get up to over a week in Kenya.

My week begins with an early start on Monday morning, trudging down the hill for a 7am continued education meeting ie. a lecture. This is the main entrance to Kijabe hospital, and those are med students in the stunning white coats!

Following the lecture we begin our morning rounds. I am on a general medical team with the lovely Dr. Peter Mwaka, a kenyan 'family physician' or in other words, a GP who can do surgery (C-sections, appendectomies etc.). We visit each of our patients, taking time to make sure they are being looked after well, and often praying with them or their family members on the way. This usually takes til about midday.

Every day at 1am we have traditional kenyan lunch (usually rice, stew and chappatis) and listen to another lecture (continuing education is big over here). After a wee catch up with the rest of the colleagues, I spend my afternoons finishing jobs and seeing patients in the Casualty department (ED).

We finish at 5pm and wander back to the house for a light dinner (I'm honestly always stuffed from lunch) and a relaxing evening. UNLESS.... you are on call. Call begins at 5pm and finishes at 7am the following morning. As a medical student, you are first on call, meaning you respond to the pager when it goes, and call the junior doctor if you need help. It is terrifying and exciting and tiring all at once. But at least I know I'll be ready to be a junior doctor when the time comes!

Photos from Kenya

Some photos for your viewing pleasure. The first is a view of a village on the way to Kijabe Hospital.

Juliette and I waiting for the wedding to begin.

And finally, my little house at Kijabe! Thats my window at the bottom nearest to the tree :)

I have arrived!

Jambo everyone, habari (how are you)? Niko salama (i'm well) I have arrived safely in Kenya! I spent a night in Nairobi with my friend Juliette (whom I lived with while at university) and then travelled to Kijabe Hospital about 45 mins north of Nairobi the next day.

Kijabe is run by missionaries from all over the world, and funded by donations. It has the largest paediatric neruosurgery service in Africa, doing lots of operations of kiddies who are born with spina bifida and hydrocephalus (water on the brain). I have started on the general medical team, and am already having an amazing learning experience. I think I've learnt more about HIV/AIDS in the last week than I have in my entire time at medical school. It truly is a huge problem here, but with access to newer medications and lots of education, hopefully one that can be minimised in time. After my time in general medicine, I'll spend three weeks in Obstetrics and Gynaecology, and then four weeks in Paediatrics, with a week long break/Safari with Jules somewhere along the way! There will surely be more stories to follow.

Over the weekend Juliette took me back into Nairobi to attend my first real african wedding! Although to be honest, this was not your typical African wedding by any standards. The bride was a gospel singer, the groom a music producer and their 10 bridesmaids and groomsmen formed a huge gospel band that stood on a huge stage erected in the middle of the church. They band sang the bride down the aisle and as she arrived she took the microphone and led the congregation in a couple of full on gospel worship songs. It was incredible!

Now I am back in my wee home in Kijabe where I live with four other medical students. I'm loving the african food, especially the mangoes and pineapple I just bought for $80 shillings ($1.50). Bring it!

All thats left to say is that I am loving Africa so far, it's wild! I hope you all get the chance to spend some time here.

Love to you all, keep me in your prayers. Kwaheri!

The Depature

Hello my friends, this is the first installment in what I hope will be an enlightening and entertaining way of following my trip to Kenya. I will aim to post a message and some photos at least weekly, but as most of you know communication is not a strong point so forgive me! I am finally all packed and ready to leave for my flight, and now all that is left are some goodbyes. Love you all, hope you have a wonderful three months in New Zealand while I am away and I will write again soon!