(Or, you can scroll to the bottom for some Easter pictures of Eric.)
|The male ward|
We have one oxygen concentrator and one nebulizer per ward, an x-ray machine, and two ultrasounds. We have most of the medications on the WHO essential medicines list. We have ventilators for surgery only. We have two ambulances, which are primarily for transferring patients to and from other facilities.
Each ward has about 30 beds, and is staffed by 2-4 nurses. When the census is high, as it frequently is, patients are two or three to a bed. Medications are theoretically handed out three times a day, but with so many patients to care for, it often ends up happening twice, or maybe even once. Interns do their own blood draws that must be brought to the lab by noon. Results are generally not reported until the next morning. We can get a CBC, some electrolytes, blood cultures, basic urine tests, HIV tests, tests for Cryptococcus, and blood cultures. Last month we got a GeneXpert machine from the government, which lets us test for TB more accurately.
We treat many of the same diseases here that are common in the US, and some that are not: Heart failure, hypertension, diabetes, pneumonia, cancer, major trauma, strokes, sepsis, GI bleeds, psychosis, gallstones, gastroenteritis, appendicitis, pancreatitis, alcoholism, TB of every variety, typhoid, malaria, rickets, malnutrition, hippo attacks.
The residents who come here from the US are usually prepared for a lack of resources. They expect limited laboratory capacity, a basic formulary, and no high-tech imaging. They are prepared to use limited means to diagnose and treat very sick patients. But they are frequently unprepared for overworked, underpaid, and deeply demoralized hospital staff; nurses, interns, doctors who seem like they don’t care. Why did a septic patient not get fluids for three days? Why hasn’t a blood pressure been checked in a week? Why were no meds given over the weekend?
During ward rounds one day, the consultant (or in-charge) physician turned to the team of medical and clinical officer interns he rounds with once a week. “What is the most deadly disease in the world?” he asked. Everyone was silent. “HIV?” someone answered. “Cancer?” “Poverty!” he said, and turned to the next patient.
Although the diseases and patients are different, Kenya does not differ all that much from the US in this defeatism. Health care in the US is also rationed on ability to pay. In the private hospitals in Nairobi, just as in private hospitals in the US, no one goes without oxygen. There are enough nurses for every patient, there are MRI scans, chemotherapy, dialysis, stat labs, and even, occasionally, organ transplants.
That was heavy. Your Eric fix for the week: Easter!
|We went to play with our neighbor's baby bunnies.|
|Bunny is soft.|
|Easter egg hunting with Geoffrey and Matilda|
|Should I put them in my mouth one at a time or simultaneously?|