Monday, October 14, 2013

The Hospital

Someone said these words to me today:  “So is this the first time you’ve seen this case, Doctor?”  “Yes.  This is my first time.”

 I had a very busy morning today!  I ironed my best button-down, cleaned my glasses, arranged my pens, and attached a fake Ivy League pin to my white coat.  I practiced abbreviating everything, scribbling my signature illegibly, checking my iPhone, ordering dilaudid, restating how many hours I worked last week….Today, I finally was going to be an internal medicine doctor!

Well, not really, but I was Camille’s guest at Naivasha District Hospital this morning.  She gave me a tour of the facility, explained how the hospital works, and I even spent some time observing the doctors on morning rounds.  I struggled some since I speak neither Kiswahili nor doctor, but it was an eye-opening experience.  I left with a newfound appreciation for what Camille does and what she is doing.  Camille is pretty awesome.

Naivasha District Hospital is an open air hospital, as most are in Kenya. Camille says the
Outpatient ward
ventilation really helps.  There are separate buildings for the men’s and women’s wards, pediatrics, the laboratory, outpatient, and a brand new maternity building that was built by a remarkable woman, Cindy Berkland, who we’ve been lucky enough to get to know.  Each ward was packed.  I guess patients often share beds, but I didn’t see that today.  Patients share large rooms, usually with about eight per room.  None of the rooms contain any of the stereotypical large medical monitors or equipment you see in modern hospitals or on TV.  Most patients had a bed, a table, and x-rays or a chart hanging above them in a plastic bag.  I saw one computer in the whole female ward. 

Pediatric ward.  Most of the patients are infants and toddlers.
New maternity ward
The hospital uses a pay-as-you-go system.  Each procedure, treatment or drug costs a certain amount.  After you're discharged, you're not allowed to physically leave the hospital until your bill is paid--families aren't even allowed to collect bodies. 

I feel awkward writing about what I observed.  What I see as neglect might be attributed to cultural differences.  Camille tried to explain.  The Kenyan doctors have been struggling with inadequate supplies, equipment, and staffing for most of their careers.  They have seen countless patients die from preventable causes.  They know what could be done for their patients, but are unable to do it.  It’s not that surprising that this can lead to frustration, burn-out, and sometimes frank indifference.  But there are other issues that may contribute as well.  There is frequently a large social gulf between the doctors, who typically come from wealthy families (medical school is expensive), and the impoverished patients at the hospital.  In this setting, Kenyans must get pretty sick of white people flying in and telling them how they are supposed to act. 

The Kenyan staff have a much higher tolerance for allowing people to feel pain and even die.  For example, a poor woman had been hit by a van, and her leg was torn open to the bone.  The nurses were changing her bandages and cleaning her wounds without pain meds, as the woman screamed.  When Camille discovered this was happening last week, she was told that there wasn’t any morphine in the hospital.  She went to the pharmacy and found ample vials of morphine, but no one caring for the patient had bothered to check.  They had been cleaning her wounds with no pain meds for days.  Today, the excuse was that they didn’t want her to become addicted, which is unlikely to occur with one dosage morphine per day.  Besides, her IV had come out.  Camille left rounds, found morphine, and told the nurses how to administer it into the muscle of the crying woman. 
Overall, it is a very different working experience for Camille than in the US, with different challenges and rewards.  I am impressed by doctors.

On rounds with Camille and the other doctors

Camille, still doctoring
Other notes:
  • Teaching update!  I had tremendous first week of teaching.  I learned that kids are kids no matter their background or where you are in the world.  These “street” boys are some of the most attentive and respectful kids I have ever taught.  They stand when I enter the room, stand when they speak, wait to leave their desks until I leave, and they always have their eyes on the teacher.  They are used to sitting and listening, while I am used to interaction, simulations and kids leading class.  We’ll get there. 
    •   So when the boys have a question, they raise their hand, but they also shout, “Teacher! Teacher!” over and over.  I now shout, “Student! Student” when I call on them.  It does liven up class.
Top animal pics of the week:

Wow.  Africa.
Wow. Africa.

Wow.  Africa.

Baboons!  The little babies are riding on their mothers
Lambs in the road.

Trespassing giraffe
  •  We took Eric to a birthday party this weekend for a sweet little four year old named Zara.  Everyone was extremely kind and welcoming.  The party, however, was like stepping into another world.  Her Dutch family lives in large estate on an animal reserve.  They had clowns, a bouncy house, endless was a child’s dream.  Eric loved it.
Loves dogs.
This little girl later pushed Eric over and stole his guitar.  Hmmmm....
That poor guy in the green hat was beat up all day
This is Eric's preschool teacher, Elizabeth.  She is fantastic

You can do it, Eric!

Yay.  Thanks for reading my blog!     


  1. Mondays are so much more interesting with the Kenyans, zebras, baboons and the Gulottas. Thanks Dan!

    1. Thanks, Viv! I'll keep the baboons coming :).

  2. The other day, I was reading and commenting on your blog with our hospital dietician who returned from a visit to Kenya a few months back (her significant other is Kenyan). One of our charge nurses walked by and noted how cool it was to have hospital staff in our small critical access hospital in western MA discussing Kenyan connections! What a challenging and enriching environment you and Camille are living and working within. And of course, Eric continues to be super cute! I continue to be super impressed with your blog and look forward to reading the Monday entries. Thank you!

    1. Thanks, Mom! Glad you are talking about Kenya in the hospital.

  3. Dan,
    Linda & I always look forward to your Monday Blogs, they are so well written and so interesting, love the pics too. As of last Sunday, Chicago renewed it's connection with Kenya, Both the Men's and Women's winner of the Chicago Marathon were from Kenya.

    1. Hi Mr. and Mrs. Rubens! Thanks so much for following the blog. I heard about the Kenyan victors in the marathon. I think some of the boys at my school will win the next one.

  4. Dan,
    This is a great entry--the three parts are informative and very interesting--the Dan and the Doc are awesome humans doing great work--Eric seems to be in heaven. Great family--I am so so proud.

    1. Thanks, Dad! I always appreciate your responses.