Archive for April, 2012
Returning to Matibabu was a wonderful experience but totally different than my previous visit. The last time I was here, I came alone, worked in the community, with traditional birth attendants, in the clinics and with the government to improve education and public health. I struggled to understand the health care system and worked with the local clinical officers to figure out ways that we could more effectively triage and bring people to services.
This trip, because I came with an attending, Dr. Miller, we were the health care services. We were meant to do a month of surgery, but due to the nursing strike here in Kenya, we went to where I spent time working in the community my last visit. It was familiar, I knew the people and the places, but it was totally different because they brought us to people’s homes for evaluation. We went to the clinics to review ultrasound skills. We put our hands on people.
The Matibabu staff is truly amazing, two years have passed since my last visit but they are still tirelessly working. The Nzoia clinic has expanded to more than double its original size, a new hospital has been built and the community health workers seem more dedicated than ever. They are an inspiration.
When the nurses strike ended and we were able to go to Siaya, I was so grateful that we had the time in the rural clinics (Ukwala). We had a better understanding for how much it took to get to Siaya (The clinic visit, the triage, arranging funds for transport, the actual road in a crowded matatu and the emotional stress for these women to be away from their families as the primary care givers). We evaluated them again and counseled them regarding their condition and possible treatments, we took them to the operating room, and in most cases, did the case under regional anesthesia (the patient is awake but numb from the breast down), and they recover in the post operative wards together, sometimes two patients to a bed. Despite these conditions, our patients did exceptionally well, we were met with smiles and thanks in the mornings and Pasqaliah, the head nurse, fought with great tenacity to make sure that the patients were not over charged because Matibabu was providing a free surgical camp.
The operating room staff in Siaya also commanded a lot of respect. Our anesthetists were brilliant, and despite the conditions, gave us amazing regional blocks. Although I am very sensitive to making sure the patient is comfortable during surgery (especially if they are still awake!) I frequently leaned over the curtain to check and they would be sound asleep! The scrub nurses were exceptional, and although we did not have all our regular instruments available, they were ready and willing to take part in the process of being creative and working with what we had. And, the nurse runners/circulators, they always have a hard job, trying to pull suture and get more sponges and instruments, but with the frequent black outs, they also had to frequently reset our electrocaudery and our lights. They also had the tedious job of pouring water over our hands so that we could scrub if the water was no longer running in the hospital, and you can also imagine, it was someone’s job to fetch the water! They all stepped up and made an extraordinary team!
Dr. Miller and I would have dinner (with a Tusker) every night and de-brief, what went well, what could we do better, how would we approach the next day’s cases. The work was endless. But he said something that I hope will stick with me until the end of my career, “no other field in the world, except medicine, has these kind of responsibilities but also, these kinds of rewards.” I think back to the woman that had the ruptured appendix, another woman we operated on that had a ruptured ectopic, and I can say without hesitation, that they would not have survived if they had not gone to the operating room. I can think of countless other patients who had long-standing problems that I hope will have been remedied by the procedures we did. But I especially wish that there will never be a time when I don’t recognize the great privilege it is to be able to practice medicine, to be involved in patient’s lives when they are most vulnerable and to provide counseling to aid in patient’s feelings of empowerment over their own lives. I feel so incredibly lucky and can’t wait until my next trip!