Day 26

I spent my last day in Migori busy at the District Hospital peds ward yet again. The morning started off in rounds, monitoring kiddos from the day before and learning about any new admits. It started off pretty slow and about an hour after getting to the hospital, the pediatrician and all of the interns had apparently scheduled a meeting/presentation. I’m guessing it related to their schooling, because each of the interns had prepared some information about sickle cell anemia. It was actually really interesting and informing and seemed like it would be useful for doctors here to know. Again I’m always impressed with the extent of knowledge they have here about more complex procedures and diseases, but wish there was a little more focus on the simple things. In the peds ward, we’ve seen so many patients who are unresponsive due to not only their condition but also hypoglycemia, which could be such an easy fix. Anna and a few others here in the group are working on a few initiatives to make the hospital care more effective, and one of them is checking blood glucose on kiddos who are seeming hypoglycemic and keeping up treatment for that – hopefully it’ll work!

After our meeting we brought another girl down for a chest x-ray, checked on a few patients, and acted as communication between the different departments. There is really no communication between anyone here, whether it be the doctors, nurses, or families in the same department or other departments. The nursing role here is really minimal – the nurses mostly give out meds while doctors and families do the rest of nursing care – so Anna and I have realized our main role here has been acting as patient advocates. The parents trust the doctors so fully but so much is left out, so we’ve been trying to fill in the gaps getting patients the tests and medications they need as well as educating the parents on the child’s condition and what they can do to help.

We took another good chunk for lunch, since it was relatively relaxed, and then returned to the ward to find it a little crazier than expected (and by a little I mean a lot). We walked in to a crowd of people surrounding our bed with respiratory kiddos and were updated that when one of the med students walked in, one of the guys we’ve been working with had been close to flat-lining. They immediately pushed a lot of normal saline then started feeding him… then of course he started throwing up since his body was not prepared to take in so much food. We immediately came in and sort of took over, putting him on oxygen, pushing dextrose, and starting small amounts of feeding. We’ve seen a handful of cases where kids come in and are malnourished, as well as hypoglycemic and in hypovolemic shock (meaning they are low on fluid). It’s hard for any of us to treat because in America, we don’t have these kind of cases so much. It’s hard for the people who work at the hospital as well, because it’s really a vicious cycle and no one has a solution. Usually we start by doing an IV push of about 50mL of 10% dextrose, which is a good start, but if you don’t follow up the push with continuous sugar, the patient will crash. So then you can try to follow with a continuous IV drip of D5, but in a patient with hypovolemic shock they will start to retain fluid and their limbs with become extremely edematous and eventually, if the drip continues long enough, the patient’s heart will give out. Instead of giving an IV drip, we decided it might be useful to try giving patients F75, the solution given for malnourished patients, but a lot of the time the kiddos will throw up, risking aspiration. Basically it’s a vicious cycle that we’re having a lot of trouble solving. We tried to give our kiddo smaller amounts of F75, which he held down, but at the end of the day we have to leave the hospital without knowing what goes on overnight. Once the med students got back from surgery later in the night, we found out that our kiddo hadn’t lasted much longer. It sucks when we work on a kid all day, doing what we hope would be best, but still nothing can help. I know we’d all love to implement some sort of permanent system to start saving kids lives, but it’s so hard with the lack of resources and lack of devoted doctors.

Even though my last day ended on a bad note, I’m still reminded of what an incredible trip I’ve had and that even if we haven’t made huge changes amongst the hospital, what we’ve done has made a difference to some families. Although it’s easy to focus on the cases that go wrong, we have had a handful that go right and that’s what I’m trying to take away. I only wish it hadn’t taken so long to find my place at the District Hospital and that I could have had more time there to make even more of an impact.

It’s incredible to think that a month ago this time, I was nervous as could be, hoping panic attacks wouldn’t hit me and crying at the gate in the JFK airport. Everybody says these kinds of trips change them so drastically and although I don’t feel like I’ve changed too much, I can still tell how this trip will affect my future as a nurse and as a person. I’ve learned so much not only about medicine, but about truly being a nurse, advocating for your patients, asking questions, and taking chances. I’ve also made some amazing amazing friends, and I’m so glad to say I’ve found a family in Kenya. I can’t imagine how my trip would have differed if I hadn’t happened to come into Kenya with such an incredible group of people; luck was truly on my side. It was such an easy adjustment to make and I didn’t doubt my decision to come here for a second, it was so easy to feel comfortable with them early on. Special shout out to Anna (if she ever reads this) for being the best mentor I could have had on this trip. I’ve learned so incredibly much from her about technical procedures as well as just how to be a great peds nurse. Here’s to hoping she’ll actually come to Philly to work and help me survive nursing school :)
 

Finally, even though I know I’ve said it a million times, thank you thank you thank you to both of my parents. I know sending your kid off to Kenya by herself can’t be an easy decision to make (and funding it certainly isn’t that much easier!). Thank you both for believing in me, supporting me, and making this trip smooth and easy. I’ll probably have to spend the rest of my life showing you both how incredibly grateful I am for having this experience… and I’m already looking forward to my next one (shocking, right?).

Also thanks to anyone that’s been keeping up regularly with this blog!! Hope you’ve all enjoyed the craziness that has been Kenya. So for now, asante sana, Kenya and nakupenda… hopefully one day I will make it back to you!