Day 4 - Thank goodness for nurses

Today at the hospital I was reminded how much US hospitals can accomplish solely because of nurses. I was once again in ward 6 with Dr. Hussein. Despite the limited training and resources he has available to him, he is quite capable and clearly cares for the patients he is treating. I am used to a system where the doctor writes an order for something and the nurses carry it out.

This is not so in Kenya. Yesterday as I left the hospital, I was having a hard time understanding why the patient I was assigned in DKA was still having drastically uncontrolled glucose readings.

(As an aside glucose is measured  by different units here and so it is takes me quite some time to figure out what my patient’s blood glucose even is. Finally made myself a chart with the conversion so I am a little faster and don't think "How is my patient even alive with a glucose of 3.2?!?!" Definitely made me worry on the 1st day.)

Each day, the chart had orders written that were more than appropriate and yet his sugars remained uncontrolled. Today, I began to understand why this is the case. The nurses (and there are many of them – at least 9 for the ward of 20-30 patients) had not been giving the patient the fluids or insulin ordered. Once I learned that this is a common occurrence and something that Dr. Hussein deals with constantly, we hooked up our own IVF and infused our own insulin. This is something I genuinely don’t mind doing and have done even in the US, but back home I did it because the nurses were busy with other things. The nurses here sit behind the nurses’ station and talk. I really only see them get up to do “obs rounds” once each morning when they get vitals on the patients and hand out some pills. Literally, anything that we want done for the patient is up to us to do.

I find this particularly dismaying because the nurses I have worked with in the US are really so awesome. They are the people that the patients regard as their advocate and often the nurses know a great deal about the patient because they are the one there for the patient throughout. It is undoubtedly frustrating for the doctors here to try to get things done without many resources or the benefits of supportive help.

I saw about 25 patients today on rounds including a case of rheumatic heart disease that will require a mitral valve replacement (if… and it is a big if… the patient can afford it), TB encephalopathy, and multiple complications and consequences of end stage AIDS.

After our time in the hospital, I went out for dinner at the beach with 2 guys I met the first day that are medical students from the UK. Fortunately for me, Sidharth is actually Kenyan having lived in Mombasa before going to university in the UK so he is able to help fill us in because there are a lot of things done in Swahili that I can’t understand. The other, Gaurav, is a friend of his from the same university who is visiting Kenya for the second time himself. Fortunately, he speaks as little Swahili as I do, so I know someone is staring at the patient equally blankly when they explain their symptoms to the ward team.

(Side note...I love to listen to Sid and Gaurav speak. They call the OR "theater." Hehe! Dede, you would love it! But I think they are equally tickled to hear me when I say "ya'll.)"

Gaurav and Sidharth, respectively

The view from our table... GORGEOUS!

We just had some food and chilled by the beach at a restaurant up the coast a little bit at Bamburi beach. The view was fantastic. I had a seafood pizza complete with “lobster, tuna, and shrimp.” Or at least that is what the menu said. From the looks of it, there was also calamari and some mussel or clam. Don’t really care either because it was delicious. All of the seafood is fished locally and is easy to tell because of how fresh it is. We just sat and talked about the differences between our health care systems, the incredible amount of local prostitutes that walked arm in arm with their much, much older and white clients along the beach, how much more debt I have and how much more I'll be making as a resident, and many other things. I have plans to keep hanging out with them as Sidharth is familiar with the city and well accustomed to taking his friends from the UK around Kenya. I’m looking forward to it and that idea that I'll get to experience a good deal of Mombasa with them.

Camel on the beach that kept falling asleep.  It proved to be a great source of entertainment to watch its head bob on its long neck down to the sand. (The other camels I saw on earlier days weren't meant for riding and didn't have the seats strapped to their backs.)