Days 18 and 19

After a long weekend of safari-ing, Tuesday in the hospital was tiring! I started the day out on a run again (and of course, the people in Migori still think it’s hilarious) and then headed to the hospital, hoping for some sort of excitement in maternity. When we got there, there was one patient in labor at 4cm dilated so knowing that it can take hours before the labor progresses quickly I wandered around a bit. I went to peds first, but since they do rounds mostly in Swahili there wasn’t much for me to do so we went back to maternity, but the woman was still in labor. The way monitoring labor works here is a vaginal exam is only performed every four hours, so when they tell us a woman is at 4 centimeters she could actually be at four centimeters, or she could have been at four centimeters three hours ago but nobody has checked since. So since we couldn’t check and there was nothing to do for the patient since nurses essentially do no kind of monitoring of the moms in labor, we wandered around a bit more. You might notice it’s kind of a theme of St. Joseph’s Mission Hospital – there’s never actually enough to keep twenty volunteers busy. The thing is, the hospital is pretty wealthy relatively speaking, so they are not lacking in staff or resources quite as much as other hospitals in Africa. Although it’s so great there are hospitals here that are well equipped, it kind of sucks for us since we’re not too useful.

However, the one place always looking for help is the pharmacy, where I headed next. In the pharmacy, we help prepare baskets to take to the wards and prepare prescriptions for outpatients or patients staying in the ward. I think it’s cool to work there since I just took pharm so I recognize a good amount of the drugs, but also it’s just really nice to be able to help out! Moses, who works there, is really willing to teach and let us do what we can and it ends up being a really good environment! Plus I learned to count to ten in Swahili (kind of..) which is a good skill to have I suppose. Anyway, I worked in the pharmacy for the rest of the morning and then before heading to lunch, we checked back on the mama in labor who of course hadn’t been checked and was still, allegedly, at 4 centimeters even though her contractions were lasting 42 centimeters, indicating she was getting close to giving birth. They had performed their most recent exam at 10:00 that morning and didn’t plan to do another until 2, so we assumed if we came back by 1:30 we would make it in plenty of time.

If you’ve been keeping up with my blog, you probably noticed I’ve spent a lot of time in the maternity ward. I’m not particularly interested in OB, I’m much more of a peds girl, but we can actually get involved there and more importantly one of the other girls on the trip, Audrey, really wants to work in OB but had never seen a birth before. We’ve spent pretty much every day in maternity checking for patients and the ward is either empty or we literally just miss a birth; one day we walked in after the morning meeting just as the mom was delivering the placenta. Poor Audrey has been determined to see a birth, once staying in the hospital from 8am to 6pm, but still has missed every single one. We really thought this birth would be the one. However, once we got back from the hospital of course we walked into the delivery room and it was completely empty. You really can’t help but laugh at our bad luck, but still I felt so bad we missed yet another one! Instead for the rest of the day, I went back to pharmacy again and continued to help dispense meds.

At about 4 we came back and all headed to the market, which we decided is probably a mile away from our house. Since the water is not safe to drink here, we all have to buy large bottles of water to supply ourselves and lug them back up to the house (which is uphill, of course) multiple times a week. I go through water like a camel so I decided this time to go for the ten liter bottle so it would last me 3 or 4 days; never will I ever do that again. After the market we hung out, played mafia as per usual, and ate dinner. At the beginning of our experience here, we intended to debrief every night about our days but it never actually turned into an official thing – instead we all just kind of updated each other as the day went on. On Tuesday though, we had a really great and interesting discussion about a case presented to us in the morning meeting. A patient was admitted for the second time to the hospital – specifically the peds ward – with abnormally dark urine, a cough, an enlarged spleen, coughing up blood, and generally all of his blood cell counts were low. They did tests for all the typical suspects including malaria, TB, Hep B, Hep C, and HIV, but everything came back negative. Since the doctors rarely treat for anything besides these diseases, everyone was stumped and so were those of us in the meeting. We talked about it with our big group in the house and although we didn’t come to any official conclusions, it was a really cool experience. We have a really diverse group of volunteers here including med students, premeds, nurses/nursing students, nutritionists, physical therapists, and social workers, and it was awesome to see everyone use their knowledge from different disciplines to collaborate. Even though this trip wasn’t exactly as I expected, being able to work with so many different groups of people has definitely been rewarding.

On Wednesday, I decided to try out another hospital here in Migori, the Migori District Hospital. Saint Joseph’s is a Catholic Mission Hospital, so as a result it’s much wealthier and usually only more affluent patients can afford their services. District is a government  funded hospital meaning not only do they take a wider variety of patients, there are also a ton more people with a assortment of cases in a significantly smaller space. Since it’s so chaotic, District tries to be more structured too, so we were told they only wanted medical students to help out along with the one registered nurse, Anna, that is on our trip. Since I didn’t want to get in on rounds or do anything the medical students would be responsible for, I decided to go anyway and follow around Anna since she’s a pediatric nurse! I expected the hospital to be crazy, but seriously I had no idea what a completely different world it would be. We expected to be helping out the nurse, but for most of the morning she sits in a “triage” room handing out medications. Vitals are rarely taken since according to the nurse there’s no time and really the only nursing care done is medication administration. The pediatric ward has two rooms, one for patients who are relatively stable and the other for patients who need to be closely monitored. The docs were rounding with the more stable group, so Anna and I started in the other room at first just observing how everything is handled but eventually rounding with the intern and helping do examinations.

The rooms themselves are miniscule compared to the wards at Saint Joe’s and since there are so many patients there’s hardly any room. As a result, they have two or three kids to a bed, along with at least one of their parents there – as I’m sure you can imagine, it is crowded as all get out. It also became clear the hospital really isn’t equipped to handle some of the cases they are given just because their resources are so poor. One girl today was having major trouble breathing and when they did a pleural tap, they found a large amount of fluid in her lungs and decided they needed to insert a chest tube. Just with this patient alone, they were unable to provide her with oxygen because they only have two machines available and neither were in peds, and then they had use IV tubing and a catheter bag instead as a makeshift chest tube. I was really worried about the patient since she really was doing poorly and had been crying all morning, but despite all of the complications, according to Anna, this afternoon the patient was doing significantly better (thank goodness – she was my new favorite :) ). After doing rounds – which was exciting since I actually kind of know how to examine patients – there were a few kids who required procedures, so Anna, me, and two of the med students went in to help out. One little boy came in to the hospital yesterday after three days of convulsions along with hob (what they call hotness of body), and today he was still unresponsive even to a sternal rub. They suspected malaria, because that can cause convulsions, and also potentially meningitis, which they had to test for using a lumbar puncture performed by one of the medical students. We also had to flush his IV with a 10% dextrose solution, which is supposed to help revive patients from their comas, and insert an NG tube since he was hypoglycemic. I helped out with both procedures which was cool since I’ve been taught to do both of these in school but have never actually seen one performed in person. Still, after all of our interventions the poor kiddo was still out cold and burning up with insanely high respirations and heart rate. I wasn’t back at the hospital in the afternoon, but once Anna and the two med students came back they reported that he had unfortunately passed away since the parents had waited too long to bring him in.

We stayed in the hospital until 1:15 ish and the rest of the day flew by pretty quickly.  We had other patients  who needed IVs, blood drawn, or burns cleaned, but I wasn’t too involved with them. After lunch I had intended to go back to the hospital, but Harriet, our “house mom” told us the skirts we paid for were ready so we had to go back into town at 2 to pick them up. I forget if I mentioned it, but there’s a place in town where we can pick out fabric, have a woman take our measurements, and then she will make skirts for us! It took her about a week to make them for all of us so we were all really excited to pick them up today! Mine turned out pretty well and I’m excited to wear it around here and back in the US. Afterwards, we came back to the house and quickly got a call that there was yet another birth going on – obviously Audrey and many of the other girls jumped on it and I was more than happy to let them go, so I stayed home. They just got back and we’re all dying now because Tyler, one of the med students who was in the room, got the baby named after him! It’s just comical because there has been not a single Kenyan yet who can pronounce his name correctly…. So good luck to that kiddo. There’s still another labor going on now, so we may be able to go back tonight to see another labor! Hopefully with my next blog I’ll have exciting updates about the birth!