Week 1
We have just completed our first week at the AIC Hospital in Kijabe, Kenya and it has been a life-changing experience so far. My classmate Allison met me in DFW to start our journey to London then Nairobi. Our travel was uneventful and we made it safely to the guesthouse where we stayed the night in Nairobi. This was my first time seeing mosquito netting!
Upon arrival to Kijabe, we met our wonderful host, Helen, who gave us the most delicious zucchini bread!! Our home for this trip is the “Anesthesia House,” which is located on the edge of the community with a gorgeous view of the Rift Valley and Mount Longonot!
Our first week in the OR or as they call it here, the “theatre,” was action-packed. We jumped right in and started working with the KRNAs, senior students, and new students on their first day OR day. One of my favorite parts of this trip so far has been the opportunity to teach both in the theatre and in morning lectures. The students are refreshingly hungry for knowledge and ask the most thoughtful questions. It is not uncommon to be sitting with a group of three or four students, drawing out the neuromuscular junction on one of their tablets and going through all of the different drugs.
My second day started with a difficult airway. The patient was a young man with a mandibular tumor that had been growing for 9 years! I have encountered many difficult airways during residency, but this is the first time that I was in charge with no attending back up. The lack of resources (including a fiberoptic bronchoscope) made this extra challenging, but with some creative laryngoscopy and teamwork with the surgeons, we got him intubated safely for his incredible reconstruction.
The most eye-opening experience so far has been ICU call. The ICU at Kijabe hospital only has five beds and four ventilators, so there are many difficult decisions to be made. Thankfully, the attendings here have been very helpful consultants for these ethical issues. Patients here present very late in their disease process and often times we are meeting them peri-arrest, but it is encouraging to see how well the ICU team manages these critical patients.
After an eventful clinical week, we went to the market “Supa Duka” and got supplies to make a delicious omelette brunch on Saturday for the three of us and two attendings visiting from CHOP. It was nice to have a taste of home (cheese!) and spend some time in fellowship with fellow doctors from the USA.
Week 2
We have just wrapped up another exciting week in Kenya! Our week started off with an African adventure full of beautiful sights, wild animals, and great hiking. Then, we spent the rest of the week working in the “theatre,” which is becoming more familiar now.
When we returned to the theatre for the second week, we finally started to hit our stride. Now that we are familiar with many of the KRNAs, students, and staff and have learned where the supplies live, it has become much easier to get things done. Also, we have embraced mid-morning “Chai time” tea plus some “chapatti,” a tortilla-like bread from the cafeteria, which has helped us survive until lunch at 2 p.m. We have begun to cover two rooms each day, acting as attendings (or as they say, “consultants”) for cases and also performing blocks. It is very satisfying to hear from the patients and the surgeons how much more comfortable everyone is on POD1 because of our blocks!
Also, Dr. Newton has been around the hospital this week and is teaching us about the different regions of Kenya and their various healthcare needs. It is so inspiring to hear from him and the lead KRNAs about their educational efforts throughout the country.
I rounded in the ICU on Saturday, then we wrapped up the week with homemade breakfast and laundry. We have a washing machine, which is great, but no dryer so we took advantage of the first sunny day in a while to line dry our clothes. Also, I got this picture of Allison, which was too good not to share.
Week 3
We are currently sitting in the Nairobi airport at the conclusion of an amazing, eye-opening, and life-changing trip.
Our week started out with a bang! We were on ICU call Sunday, but Dr. Newton was so kind and covered the unit after rounds so that we could explore. We drove out to Mount Longonot for a day hike and did not know what we had gotten ourselves into! The hike up was a challenge, since many of the trails had been washed out from all of the rain this season. However, once we made it to the top, it was all worth it. The views from the crater were absolutely breathtaking!
It turns out that the hike up and back down around the crater (we only went half way and back due to dangerous terrain) ends up being 10 miles and 150 floors! After, our driver took us to "Java House" to replenish our glycogen stores :) This chain is owned by an American and we were so happy for a little taste of home.
This week in the theatre was quite eventful, but 3 patient stories stick out in my mind:
1) I had the opportunity to care for a young woman who had travelled all the way from Sierra Leone to have a mandibular tumor removed. Her mouth opening was essentially nothing, so we anticipated a difficult airway. Unlike my first week, Dr. Newton was there and able to access the fiberoptic bronchoscope! He walked me through his way of performing an awake intubation. This was my first time performing a trans-tracheal injection and it really helped! We were able to get the patient successfully intubated and her surgery proceeded without incident.
2) Another patient story that touched my heart was a woman who came for a scheduled cesarean section. We performed the spinal and the surgery began as per usual, then we got to talking. She asked me to tell her the sex of the child. This is abnormal in Kenya, as most mothers want to see for themselves after the baby is resuscitated and cleaned. She went on to explain to me that she had lost a baby girl a few years ago and had been praying for a girl since. When the obstetrician birthed a screaming baby girl, we both shared tears of excitement. This patient had been through so much pain in her life and it was touching to watch the pure joy and peace that she was experiencing during her delivery.
3) I also got to care for several children with hydrocephalus, while they got their VP shunts. One baby in particular stuck out to me. He was 5 months old, but only 4.5 kilograms. The poor baby was extremely malnourished. He was our last patient of the day so after surgery, I got to hold him for a while. He was initially inconsolable, but he took to my finger like a bottle. It was very sweet but sad.
At the conclusion of our trip, we packed our bags and headed to Nairobi. Since our flight doesn't leave until late tonight, we stopped by several places in town to experience ambit lord of Kenya before we leave. We got to see baby elephants at the elephant nursery and we fed the giraffes with our hands at Giraffe Manor. It was so wonderful!
Thanks for following along with our journey to Kenya. This has been an amazing experience. I hope that we were able to serve the patients in Kijabe and leave the KRNAs and students with a few helpful tricks so that they can continue to improve the practice of safe anesthesia in Eastern Africa. As they would say in Swahili, Asante sana!