Week 1
Jambo from Kijabe! Phil and I arrived here earlier this week and we are loving it! Our flight got delayed out of Detroit on Friday, so we had to rebook the following day. Otherwise, our travels went smoothly and we arrived in Nairobi Sunday night. We spent the night at the Amani Garden Inn, which was picturesque, and drove to Kijabe the following day.
Once we arrived in Kijabe we were brought to our house, had our Wi-Fi and phones set up, and went on a tour of the hospital. There are eight ORs and an endoscopy suite. Afterwards, we went to the local Supa Duka (superstore) for groceries. I was amazed to see that they kept milk at room temperature on shelves, but it tastes great and hasn’t killed us yet!
During our first week in the ORs, we administered a few assessments of the KRNA students. They possessed a wide range of clinical knowledge and I was very impressed with the majority of them. The students take learning very seriously here and absorb information in the operating room. It is a great environment for teaching!
Most OR anesthesia teams consist of a KRNA with junior and senior KRNA students as the in-room anesthesia providers. A significant proportion of cases are performed under spinal anesthesia and the KRNA students are very proficient at performing these procedures. One noted difference is that they typically push their spinals for cesarean section up to T8, as opposed to T4. I think this may be related to the fact that pressors aren’t as abundant here as they are at Vanderbilt. However, the parturients rarely complain of pain.
Yesterday, I helped with a pediatric neurosurgery case. A 12-year-old female had a progressively expanding mass on the left side of her head that was initially thought to be related to her teacher slapping her a couple months prior. I’m surprised to hear that’s still allowed anywhere. After attempting to aspirate the hematoma and getting no blood back, our neurosurgeons began to question their initial diagnosis. It turned out to be a massive sarcoma, with extracranial and intracranial components. We spent hours taking care of our patient and were able to get her safely through surgery, despite having to transfuse pRBCs a couple times.
Now that our jet lag has subsided, our first week has been an amazing learning experience and has challenged Phil and I in numerous ways. Tomorrow, we will be challenging ourselves by hiking Mount Longonot, which is supposed to be absolutely grueling. Wish us luck!
Week 2
Week two is under way and it was definitely a different experience than our first week here. All of the KRNA junior and senior students were out of the ORs so Phil and I got to staff our own rooms. This was the first time I staffed my own room without an attending and it was a very enjoyable change as I had to rely on myself and the skills I’ve developed over the past couple years. There was no one to directly bail me out or to double check my clinical decisions. I’ve always craved independence in the OR and think that it’s a very vital part of our education as residents – to be able to completely perform cases on our own prior to completing residency and stand by the decisions we make
Phil and I were thrown into a fairly busy lecture schedule this past week. We presented lectures on every day except Friday. The students are very eager to learn and are trying to internalize as much information as possible, but they are also very quiet. The KRNA students possess a wide range of knowledge from very insightful to completely incompetent. While Phil and I were doing evaluations last week, we had to fail a couple of students who were simply unable to provide safe anesthetics. Thankfully, the KRNA program at Kijabe Hospital will tack an extra six months onto their training in an effort to ensure they can go out and practice safe, competent anesthesia. Dr. Newton told me that initially, the clinical educators received a lot of backlash because KRNA students expect to pay money for the program in exchange for a degree in a defined time period, without any setbacks. This concept of paying money for something in Kenya and getting a finished product is heavily ingrained into their culture.
We also got to go on our first safari last weekend at Nairobi National Park. What an incredible experience! We got to see gazelles, giraffes, rhinos (including a baby), ostrich, warthog, zebra, bats, lions, water buffalo, and all sorts of birds. We’ll be heading to Masai Mara this coming weekend so this served as an excellent warm up! Until next time!
Week 3
Our time in Kijabe has flown by! What an incredible month to look back and reflect on. This past week Phil and I got to function as attendings. We would typically run one dedicated room and we’d float among the other rooms. I chose to do a lot of pediatric cases and took care of kids less than three months old every single day. I became significantly more confident in being able to manage these small children and can comfortably make it through most cases in them without assistance from someone more senior than myself. The cases were primarily neurosurgical corrections of hydrocephalus and pediatric general surgery/urology.
There were multiple instances where neither attending was in house and Phil and I were the most senior anesthesia providers. It was a big leap coming from Vanderbilt where our attendings are always nearby, to not having one in house. We had a couple of emergencies that Phil and I successfully managed together. It was liberating!
The staff at this hospital have been incredible! This has been an excellent and supportive environment for transitioning into becoming an attending anesthesiologist. The surgeons are all extremely patient and willing to follow along with whatever plan you want for your patient. You do not have to ask surgeons for permission to do nerve blocks. You are the anesthesiologist and they trust and welcome your judgement. It’s very different from the surgeon-centric culture at Vanderbilt. OR nurses will typically assist with IV access in neonates and are extremely proficient.
We’ll be spending a couple days concluding our trip in the Masai Mara at the Fairmont Hotel. We just arrived earlier today, have already went on an evening safari and got to see lions, elephants, and a cheetah! We’ve been able to enjoy some good meat at the Fairmont, which is a welcome break from the rice-centered diet we’ve survived on in Kijabe. We’ll be back in Nashville in a couple days and are looking forward to applying what we’ve learned – any surgery can be done under spinal anesthesia!