Days 21, 22, and 23

On Friday, I headed back to the District hospital with my stomach in knots, just waiting to see what mess was awaiting us. Walking up to the peds ward, we saw our favorite kiddo with the punctured lung sitting outside, which was a great way to start knowing that she was doing great! We walked into the ward and saw the first bed with all of our respiratory kids completely empty. Since we saw our girl with the punctured lung, we knew she was okay, and we saw one of the babies that had been in the bed being held by her mom, but the kiddo we had worked on all day on Thursday was missing. We walked out to meet the doctor who updated us on the events of the night, and we found out that unfortunately our boy had passed away. He said when he walked in overnight to check, the boy was found without his oxygen mask on and it looked like he had thrown up; we think that he may have started throwing up during the night so mom took off the mask, but then he aspirated and had trouble breathing. Even though the kid that had passed the day before was really upsetting because none of the doctors were responsive, I was more upset about this kiddo since we had worked so hard on him. The amount of people that pass in the hospital is actually crazy so I’m not sure why I was so convinced he would be okay, which made it even harder. The doctor also told us that our favorite patient had a pericardial effusion and the night before they decided to drain the fluid out, which is why she was doing so much better. Also, since the pleural tap they had done a few days before punctured her lung, she needed a chest tube placed and it was expected that would finally happen that afternoon.

After debriefing with the docs, we switched our focus to new kids that needed our help. One was another respiratory patient, which seems to occur a lot around here in conjunction with TB, pneumonia, and often malaria, who presented originally with convulsions and when we checked on him had an oxygen saturation level in the 70s. We immediately started him on oxygen and checked his serum glucose level, but beyond that once we stabilized him there was nothing more we could do. We checked on him throughout the day and ensured mom knew to turn him every two hours, but aside from that we would have to let the meds work. 

After that, we checked out a baby in the ward who came in for malnutrition but also was forming some small pressure ulcers on her butt, so Anna and I cleaned her, dressed the wound, and tried to take the weight off of that side of her body. Thankfully the ward was much slower so that was mostly the extent of our morning.

In the afternoon we came back and the peds ward was still relatively calm. We spend most of the time in the room that is more like an ICU, but since the afternoon was quiet we decided to visit with some of the kiddos in our stable room as well. Anna brought coloring books and crayons from home, so we tore out pages to distribute amongst the kids in the hopes that they’d have something to entertain them for at least a little while. The kids didn’t really have any idea what was going on, but the moms with them were so excited about it! Once we handed them out and left I guess the kids started coloring because one of them came up to me later to show me an entirely blue colored piece of paper – to give him credit he was probably only 2. Since peds was so calm and not needing our help, we headed up to maternity and on our way stopped in on our patient getting the chest tube as she was waiting to be brought into surgery. We couldn’t go in to actually see it since there weren’t enough pairs of rainboots (which we’re required to wear in the OR), but Tyler, one of the med students working in peds with us, was going to be in there so I was happy she’d have a friendly face. She’s incredibly brave for everything she’s gone through and I admire her so much for that; even though she’s only 10 years old, every procedure she goes through she puts on a brave face, knowing that in the long run it will make her better. 

We arrived at maternity and were informed that one mom was in labor and the baby was almost out, according to the doctor (should’ve known that wasn’t quite correct given what we already know about timing in Kenya). She was pushing when we came in so Anna stood to watch while I stood at the head to cheer mama on. She was all alone and we found out later that she was only 15 years old, so hopefully she appreciated having a hand to hold! She was pushing for a while and the head started to come out (with severe molding, meaning the head sutures were overlapping), but according to the doc she was too tight and the baby couldn’t fit. They tried for a while, manipulating her cervix to get the baby out, but poor mama had no luck. They decided to do an episiotomy, where they cut the skin around the vagina, but it took them three tries, twice with dull scissors before they used a surgical blade. Keep in mind, the moms here do not have any sort of anesthesia, so they feel everything. After that was done, the baby came relatively quickly and was brought immediately to a warmer since at first he was kind of nonresponsive. I tried to stay through the end of the girl getting sutured after her episiotomy, but by that time we had to get going to the market to pick up water for the weekend.

Before leaving we stopped back at peds to pick up our stuff and check on our chest tube patient, who had finally finished. When we got there, the two med students that were in on the surgery told us that the anesthesia for her, which should have been local, was having no affect so she was aware of almost everything until they put her completely under. She loves Thomas, another med student who is huge (he’s 6’8”), and in the time she was awake during her surgery, she was calling out for him. So sad that she felt it all, but we all thought it was adorable that she wished he was there so much. He has no interest in doing peds but that’s why I love it, you can build such easy bonds and really have an effect on your patients. When I went in to visit her, she was still under a little sedation but was excited to see us there although she was STILL asking for Thomas. He was unfortunately home sick with strep that day and couldn’t visit, but we promised he’d be in the next day to visit with the rest of us. Afterwards, we headed out – in the rain – to make the long walk to the market and back to the house to have a chill night playing cards and eating guac (which everyone has been craving). 

On Saturday we finally slept in, although granted it was only until like 8:30. I had a ton of laundry to do and since it needs to be done by hand it takes forever, so I started on that after breakfast and until 10:00. At 10:30 we left for the hospital; even though we don’t have to be there on weekends, we had a list of kiddos we wanted to check in on. We started with the boy with respiratory problems that we worked on for part of Friday and he was pretty much the same - we kept him on oxygen and couldn’t do much else. One of the patients in particular we wanted to see was a two year old boy who had spilled hot tea all over his legs and was suffering from second degree burns. Anna had brought these burn pads containing some sort of silver compound in them that would accelerate healing and could stay on the patient for a week, so we wanted to try them out. First we had to warm up salt water to rinse his burns (which took forever because the warmer moved at a glacial pace) and then we brought him into their procedure room/doctors office. We should’ve known it would be an awful experience because when he came in, he was already bleeding from his burns probably because they had been left uncovered to heal and he was moving around. 

We started by using gauze and cloth and wiping him down and he really started freaking out. As a two year old, we couldn’t tell him to sit still or anything, so he was thrashing around kicking and screaming and could not be consoled. We tried to move fast, cleaning him then placing the silver pads on and wrapping them in gauze and the poor kid was not having it. It was such a different experience from the last burn patient I worked with, who had really severe third degree burns all over her arms and chest, where she was very calm and showed few signs of pain even though her dressing change had to be so much more painful. Even though I felt like we were torturing this kid, in the long run it’ll be better to help heal his wounds that much faster and he won’t need another cleaning or dressing change for a week! Hopefully that will give him a chance to recover and be a little less afraid of us as well! We thought we were finished for the day but then our chest tube girl needed an IV put in, so we stayed to comfort her as Anna tried to do that, but her veins kept blowing. The poor girl got stuck 4 or 5 times before finally having a successful IV in place but she stayed cheery, singing us songs and talking to Thomas (of course).

After coming back, with bruised knuckles I finished my laundry which took a total of like 3 hours. The rest of the day we just hung out for the most part, playing games and reading. It was the last night for three of the girls, so we were planning to go to one of the bars around our house to get samosas, which we’ve been waiting to have since we got here, but we ended up staying in and chatting and playing red light green light in the dark – each person here is truly a child at heart, it’s great.

On Sunday morning, we all woke up way early to make the 7:00 mass at the same Catholic church we had gone to before, except this time the service was actually in English. It was way more school kids than before and didn’t seem quite as festive – there was no dancing with the Bible and not as many dances to go with the songs. I still had no idea what was going on during the mass and thought for half of it they were speaking Swahili – it’s way hard to understand their accents sometimes – but I was just excited I got to wear my new skirt and see more of the culture here! After we came back the three girls had to pack up and leave and we all started to realize it’s crazy how fast it’s going. Now people really start packing up just one after the other; I leave on Thursday, Audrey (my roommate) leaves on Saturday, then two more will leave on Monday. We’re all in denial, but it doesn’t get any easier with each goodbye. 

The rest of the day has been very quiet. Since the people here are so religious, there’s not much to do on the day of rest so we’ve just been hanging out! After weeks of discussing it, we finally bought the Lion King and watched it, getting really excited with each animal we saw on our safari. Even though we don’t think the movie actually took place in Kenya, we’re pretending Pride Rock was at the Great Rift Valley and the rest of the movie takes place in Maasai Mara – wishful thinking. In the afternoon we hung outside, planning to read and sunbathe, but ended up just talking the whole time. It’s the first time I’ve actually spent a good amount of time outside, so even though I’m in Kenya and on the equator, I’m coming home way pale still. I can’t believe it’s actually my last few days here so I’m trying to soak up all of the Kenya I can. Even though I’m definitely sad to leave, it’ll be nice to be home to see my family again – plus I’m just a little excited to get a milkshake, my latest craving :)