These blog entries are the views and opinions of the residents during and after their international experiences, and do not necessarily reflect the opinions or positions of VIA or VUMC.
Week 1
It is both liberating and frustrating to be here providing medical care and instruction in Africa. Liberating from the everyday hustle and bustle of a busy American life with constant working internet and incessant emails and ads and posts. Frustrating in that it is hard to figure out my place here and then establish that role with a modicum of respect for those who are here all the time. I find myself just thinking out loud as a means of teaching because sometimes I don't know who's who in a room and sometimes it's hard for me to understand the accent, so I don't want to be rude and ask several times. I understand that although I have brought with me a deeper fund of knowledge and higher skill set, I am still the visitor here. The people here have operated before me and will continue to operate after I am gone. They are doing their best to provide the best care they can with the tools and knowledge they have. No good can come from forcefulness. If I do not show respect, no learning can be had.
I know they can teach me too. I have much to learn being in the attending role, as I learned today. I was proud of myself thinking I had thought of everything and had us all check that we had the necessary tools, calculated the right dosages for the induction and then lo and behold--I did not check that the student had the right size blade for laryngoscopy. Some of this comes from my assuming that their carts are as well stocked as ours back home (which they are not). We bagged the child while someone ran around the other ORs looking for the appropriate size blade and once that happened--turns out the light didn't work on the handle! So someone else had to run around looking for a new handle. Luckily, bag mask ventilation wasn't difficult, but I felt like a failure. That was ultimately my responsibility.
Being an attending is like being the parent in the room and over here it's like being the new babysitter your mom called last minute because your regular beloved babysitter was busy. I will say the students/KRNAs consider what I'm saying instead of outright ignoring me. The KRNAs are knowledgable and most are welcoming and eager to learn, especially regional blocks. I will admit I've been using the regional blocks to butter the KRNAs up. I feel like I'm sort of "on their turf" and thus need to be extra nice so that maybe they won't hate it when I speak up about something I see. I typically try to be inquiring when I see something that is concerning rather than confrontational, but even this is questioning their ways of doing things. I know that is why we're here, but again this is not my house. I wonder if I would feel like this if I were a man... I am learning something everyday and becoming more comfortable waltzing into a room and assessing a situation, but we will see what the next weeks bring.
As for Kenya in general, I love the simplicity of life here. I like walking to and from work and cooking almost all of my meals. The weather is perfect, cool in the morning and evening and warm during the day. The scenery is breathtaking and I even love the red dirt. It adds such color to the scene, although I think about parasites that might live there a lot. Evenings are peaceful albeit a little lonely without my usual crew around. I wonder what I will look forward to the most about getting back. My least favorite part about living here is the water, but at least it's running! But living in fear of severe diarrhea everyday is a little stressful to me. I bleached our veggies and fruits the other day and found myself obsessing over whether all the sides of the apples had enough time in the bleach water. I also obsessed over keeping my mouth shut in the shower and constantly blow air out to make sure none of it gets in! Also, I like cooking and Mama Chiku's is great, but I'm going to want Chipotle again at some point... and what I wouldn't give for a cold brew from Starbucks! #basic.
I think this experience will change me in a lot of ways. Not only will it further my training, but I think I will declutter my life when I get home and take more time and pride in the simple things I used to enjoy, like I do here now such as cooking and cleaning the kitchen--things I always feel I have no time for because I need to study or pay bills or answer emails or workout or rush around to do some other thing that seems more urgent. Or who knows, maybe I’ll forget I said this and revert back to my neuroses within 2 weeks of return. Hopefully, what I leave here with the Kenyans will last longer than that.
Week 2
Over the past few weeks, I have been challenged with scenarios I have never seen before or cases I have dealt with, but this time with different resources. It is satisfying and stimulating to come up with plans for these scenarios and see them through successfully. We lost a patient yesterday. Even though we had done all we could. He was 30 years old. I find myself thinking of him often throughout the day. He looked to be on death's bed when I first took him to the OR. I don't think different resources would have saved him, but my regret is that we didn't give him a little time with his family before taking him back. We were the last faces he saw before we closed his eyes for what ended up being the final time. I know it is hard to predict, but maybe when we know a case is close to futile, we should pause.
I am grateful to be working as a doctor here. I have felt closer to my passion since I left. Things are in a way, simpler here. I think because I don't have a car. With a car comes a lot of other responsibilities and errands to run. Here I just walk to work and back. I can focus on just medicine and the sunset. However, when you do need a car here, it is a very unpleasant experience in my book. Kenya is very dusty and there is no AC so you ride with the windows down... my hair has never felt nastier. Cant even try to comb it, it's straight to the shower! Also, many of the roads are very jaunty. They're mostly dirty roads with huge potholes from the rain and any major roads are still only 2 lanes. The drivers are aggressive about going into oncoming traffic to pass someone. It takes two to three times as long to get anywhere than it should because of these obstacles. Additionally, there are patrols along the roads that will stop your driver randomly to question them about whether they have all the right equipment or not. There are also people standing in the middle of traffic trying to sells snacks and bottled water. The housing and shops along the road are a reflection of destitution. The nicest building we saw on our way to Lake Nakuru was our own lodge! Makes me wonder why a country so beautiful with so much natural resource is so underdeveloped. Our little trip made me grateful we are staying in Kijabe where it is beautiful and seems to be a little cleaner. We still have the best view in the house.
Week 3
We started lectures. It is so refreshing to have a crowd that is genuinely interested and has read the material. They ask good questions and are clearly thirsty for knowledge. I hope that we are delivering on that as well as they'd hoped. I have been learning a lot too, mostly about myself. Self-doubt is a bad seed that can paralyze you. I cannot let that happen. I became a doctor to help others; it will do no good to doubt and hesitate. I must live more in the moment. We have had many situations here that require a quick-thinking leader and a lot of times they look to us. I am honored, but I had some days that my fear of inadequacy threatened to overcome me. I hope this is something that also gets better with time. On the flip side, I think it's great to question yourself. It's the only way we improve and avoid unnecessary risk.
This country is so beautiful. We went to the Masai Mara this weekend and saw the Earth in all its majesty. We woke up to the hippos making their way back to the water and a bush baby who kept trying to die... at least that's what it sounded like. With all it's beauty, it is still so wild and it makes me grateful for where I come from.
Week 4
As I sit here and watch the sun set on our last night in Kijabe, I find myself sad that I'll be leaving this beautiful, peaceful place. I'll miss the sunsets, the cool mornings, the colorful flowers, the simplicity of life. Here, I just got to be a doctor and nothing else. I walked to work and back every day, cooked dinner every night, and had time to read for education and for pleasure. I felt the pressure of everything else lift when I got here and I was finally able to be what I have worked all my life to be without distraction. Navigating transitions is always tricky, but I think I handled it pretty well this time.
I think the best thing about this trip is that I got to make my own plans for patients and see them through from difficult airways to pain plans. The autonomy was nice to know that I'm not going to harm someone. I am capable.
It is amazing to me how passionate people here are about learning. Maybe it's because they know they will be practicing on their own after only 18 months of training in a rural area, so it is just that more intense, but it's refreshing and inspiring to see all the same. I think we take our education for granted in America. I have been so lucky to be able to become what I am. I confess I am not a very religious person, but the medical prayer stuck out to me the first day I was in the medical director's office in Kijabe Hospital: "It is indeed a tragedy of circumstances, my Lord, that my livelihood involves meeting people with unbearable pain. But also, it is my good fortune that you have given me this excellent opportunity to mitigate their suffering. You have cast upon my shoulders this great responsibility and have also given me dexterity to do it." Being able to serve here has brought back my appreciation for medicine and my role in it. It has chased my cynicsm away. Kijabe brought me back to life through its earnestness, purity and sincerity. We are all here in medicine to serve patients; it is our gift and our duty, no matter what the title. We all play a part, have our strengths, skills, and weaknesses. Together we can make a better world, piece by piece, through sharing our knowledge, our tools, and our spirits.