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
This first week in Kenya (and the travel journey preceding it) has been all about rolling with the punches, and finding joy in the adventure (and misadventure).
Starting with last Saturday, the trip did not exactly start off on the right foot when our flight was delayed leaving Nashville, ensuring we would miss our connecting flight in Chicago for the leg of the trip to London. We managed to get on the flight leaving two hours later in the evening (phew!)….but then, guess what? That flight got delayed because of “mechanical issues”, and the miniscule layover we were going to have at Heathrow with this flight quickly disappeared (oy vey!). And here’s the thing, there’s only one British Airways flight from London to Nairobi everyday. The four of us all travelling together (myself and Sarada, as well as Cat and Dr. Sizemore from OB) started plotting the grand adventures we were going to have with our extra day in London. Once we got to London, it turns out everyone had already been automatically rebooked on flights. Everyone else had been rebooked on a Kenya Airways flight leaving later that day while I was the only one who had been booked on the British Airways flight the next morning. Not wanting to leave me alone in London, the rest of the group made sure they could get booked for the British Airways flight the next morning as well, which turned out to be a multi-hour affair (there went all of our grand plans for London).
We did eventually make it to a very nice hotel for the night, had some good Indian food and a good night’s sleep, and got on the final leg of our trip the next morning. We all made it safely to Nairobi on Monday night. Unfortunately our bags didn’t (because of course they didn’t with the way our travels were going).
Luckily the cursed travel saga is pretty much where the negative stuff ends, and even that part ended up being more hilarious than anything because we all had each other to commiserate with. We all had a pretty good attitude about it all.
We made it to Kijabe. Our bags eventually came, things are settling in well, and it’s honestly starting to feel like a little bit of a home away from home. At the hospital, I’m honestly still trying to feel out my place and my role, but am enjoying the process. The KRNAs and students have been lovely to get to know. I am already seeing so much potential for growth and learning for myself through the processing of working here these next few weeks and looking beyond to my last couple months of residency and transition to being an attending.
Chai time at the hospital is one of my favorite parts of the day. It’s mostly milk, with a little bit of tea, and it’s a welcome warm mug of comfort that breaks up the day nicely. I mostly get the unsweetened version because I’m not a huge sugar fan (and kind of a health nut), but sometimes I pour in a little of the regular kind for an extra treat.
Outside of the hospital, I’ve been trying to do as many of the “normal” things I’m used to doing to make it feel more like home (other than being on the internet, that is). It’s actually been very refreshing to disconnect a little and enjoy the small things. I do things like try to work out or do yoga when I wake up. I found a blender in our kitchen cabinets a couple days ago and was super excited to make one of my Almond milk and peanut butter banana greens smoothies I make at home with some local produce we’d got. I also love cooking healthy meals at home, and so this past Friday I made a family dinner for the house!
After a hilariously rough travel adventure and first few days of adjusting to life in Kijabe, we decided to make the most of our weekend off with some fun adventures. Saturday, we made our way out near Lake Naivasha to Crescent Island. We did a boat safari and saw a whole bunch of Hippos, and then spent some time walking around an island and getting way closer than I thought possible to zebras, giraffes, and some other cool animals. We decided to treat ourselves to a nice lodge in Naivasha for Saturday night, which was SO worth it. Delicious full board meals, a comfy bed, and drinks by the pool. Yes please! The time for relaxation was necessary, because when we woke up early Sunday morning, we set off to hike Mt Longonot. Let me tell you, it was quite a challenge but nothing beats the hard-earned view when you make it to the top!
Now it’s Sunday night and we’re safely back at Kijabe. All the dusty mess we kicked up all over ourselves during our hike is cleaned up. We are refreshed and ready for another week at the hospital. I am so excited about what I am going to learn from these Kenyan providers and how this experience may change and grow my own practice moving forward. It’s only just beginning!
Week 2
It’s the end of our second week here in Kijabe and I feel like I’m really hitting my stride. I’m feeling, for the most part, at home both in and out of the hospital. I feel like I’m learning to work with some of the frustrations of not having all the resources and comfortable things I’m used to. However, as far as low resource settings go, Kijabe is actually doing quite well. I’m also finding myself more and more enjoying some of the simple pleasures around here.
I had a couple of experiences this week in the theatre that really made me feel like “ok….. maybe I CAN do this whole ‘big kid anesthesiologist’/attending thing in a couple months.” On Thursday afternoon, as cases were mostly wrapping up and I was getting ready to head out for the day, I stepped into the room to check on the providers for a uterine myomectomy (fibroid removal) that was going on. When I walked in, the patient’s heart rate was in the 130s and the systolic blood pressure was hovering around 55-60. Yikes! It turns out that while the surgeons knew there was a large dominant fibroid, there was A LOT more than they had initially bargained for. I’ll spare you the photograph here just in case that’s not your thing, but trust me when I say the amount and size of fibroids that came out of this woman was ridiculously impressive or horrifying depending on your perspective. I quickly surmised that we had lost over 1.5L blood at that point (by the end of the case we would estimate our EBL was ~4L). Along with one of the Kenyan Nurse Anesthetists, I directed and made a plan for resuscitation with transfusion (and pressors to temporize/stabilize of course). By the time we left the room, we were stable off norepinephrine and our heart rate was 80-90. #Winning. It was honestly such a great feeling to have accomplished all of that without relying on someone supervising me to assist.
I also feel like some of the KRNAs and students are getting a lot more comfortable working with me (and vice versa) and just accepting me, which feels great. One of them taught me how to count to 10 in Swahili this week, as well as a few other words. Apparently they were impressed with my quick learning. Who knew I had a hidden talent for picking up languages? Another one of the KRNAs tried to teach me a little bit of Kikuyu, a different local dialect, and says he is going to quiz me on it this week.
Outside of the hospital, I have really been enjoying the gorgeous surroundings, the sense of community, and the slow pace of life here. Every Monday, there is dessert night that happens at one of the “long termers’” homes, and we went for the first time this week. It was a wonderful evening to enjoy some snacks, tea, good conversation and fellowship with some of the other short and long-term people working here. I continued trying to make our anesthesia house feel like home and made “Taco Tuesday” for all of us this week.
This weekend has been low key compared to our adventures at Crescent Island and Mt Longonot last weekend, but it has been so relaxing and wonderful. Yesterday, I was “on call.” I walked up to the hospital first thing in the morning and there weren’t any cases the KRNAs needed my help with, so I let them know to call me if anything came up, and proceeded to head back to the house. I decided to take advantage of the free day, beautiful weather, and gorgeous views of the Great Rift Valley from our backyard by grabbing a book, a chair, and some good music and podcasts, and parked myself outside for the entire morning to read and reflect. Wow, was that life giving for my soul!! I took a walk to the market in the afternoon to restock on some essentials and fresh produce. Hallelujah for 30 cent avocadoes!
In the evening, Matt and Ansley Kynes needed to borrow my computer for a few minutes to fix some Internet issues, and ended up inviting me to stay for dinner, tea, and a few rounds of Dutch Blitz (so fun…you should play it right now).
Today, I joined Matt and Ansley and the kids for church and lunch up at Rift Valley Academy. Now, I am just relaxing back at the house. We are starting to give lectures for the KRNA students this week, my husband comes next weekend (YAY!), and overall I am just looking forward to seeing how the second half of this experience unfolds.
Tutaonana baadaye (that’s Swahili for “see you later”).
Week 3
I can’t believe we are three quarters of the way through this experience and my time in Kijabe is so close to being done! It has been quite an adventure and opportunity for growth.
There have certainly been situations that have been frustrating, whether it’s perceived problems with efficiency, miscommunications, yearning for more resources; however, the goodness and the growth, both in my skills and my relationships built with the people here, have far outweighed those frustrations. I think I am genuinely going to miss being around the people here (and the beautiful views from our house and around the hospital) when I leave at the end of this week.
Like I said already, I feel like this month has been huge for my growth and confidence, and I think both Sarada and I realized a lot of that growth the past Friday. Dr. Kynes was away from Kijabe and Dr. Barnett had some other administrative tasks to attend to for most of the day, so it was basically just the two of us, and it seemed like everything that could go awry with cases was doing so. We were really pushed to step up as the acting attending physicians and manage it (and I think we both handled it all pretty darn well).
One example was a case that came in for Direct Laryngoscopy and biopsy for a patient presenting with hoarseness. By all observable measures, there was no concern for a difficult airway, but when it came time to induce, we found ourselves unable to intubate with multiple attempts, including with the video assistance of the glide scope. We could get an optimal view, but had difficulty passing an endotracheal tube, or even a bougie. Eventually, the surgeon had to help with a rigid bronchoscope to assist intubation, and it was at this time we discovered that the patient had much more severe pathology than expected based on her symptoms and exam. She had extensive subglottic fullness creating a severe stenosis, as well as a very small laryngeal opening for her size. The case proceeded smoothly once the airway was secured, but at the end of the case the patient woke up thrashing with some serious emergence delirium and ended up pulling out her IV. Luckily, I was able to secure a new one after a couple attempts even with her fidgeting about on the table.
In another room, I had a child wake up from a tonsillectomy and have a severe laryngospasm following extubation, requiring administration of propofol and succinylcholine. He desaturated into the 20s (aka VERY BAD), but recovered with additional bag mask ventilation. He then proceeded to have the same reaction again, though I think he may have also had a bronchospasm, or possibly a small aspiration. His lungs sounded horribly rhonchorus and wheezy (when we could even hear air movement at all, that is). I ended up having the KRNA reintubate and give Albuterol through the ETT as well as suction down the tube. We were going to remain intubated and go to the PICU, but there was no bed available. Luckily, the child’s exam improved incredibly with the suction and Albuterol, and his lungs sounded much clearer. This time, we successfully extubated without incident and he ended up doing just fine.
It was quite refreshing and empowering to handle these challenging situations (successfully, I might add) without a supervising attending to step in or guide.
As we’ve tried to do for most of the time we’ve been here, we also managed to find some good time to relax, unwind, and have a little fun this week. We met a few 4th year medical students this week, and ended up having them over to the anesthesia house for dinner and game night on Saturday. I kept up with my trend of being the mom of the house and cooking healthy meals for everyone by making up a big batch of pork chili for us all (and it was spicy and DELICIOUS). Pair that with some Tusker lager and a few rounds of Crazy Eights and Bananagrams, and you’ve got a pretty fun evening of fellowship.
We rounded out the weekend with a GORGE-ous Sunday adventure (pun 100% intended) at Hell’s Gate National Park and Gorge. We rented bikes at the entrance gate and biked 7km to the start of the gorge, passing zebras, giraffes, buffalo, and warthogs (what’s up, Pumba!!) along the way. We spent a couple of hours hiking with our Massai guide through the gorge, and it was absolutely stunning! Heading into the final week now hoping to soak up whatever I still can!!
Week 4
Wow! I genuinely cannot believe how quickly this month at Kijabe has flown by! It has been an absolute joy working with the men and women here at the hospital and feeling like I at least have a small part in helping train providers and strengthen the ability to provide safe anesthesia for more and more patients in Africa.
My husband came to join me at the beginning of this week, and it felt so natural just doing life with him in Africa (foreshadowing for a potential return trip with him for a longer stay??? Perhaps!!). He even got the chance to go down to the valley with an acquaintance of the Kynes family this week to an orphanage/school and really enjoyed it. It was wonderful and reassuring for him to quickly fall in love with Africa the way I have.
It was harder than I thought to say goodbye to everybody on my last day of work on Wednesday, but so wonderful to have positive feelings from the KRNAs and students I had worked with throughout the month. A couple remarked that Sarada and I should stay, perhaps for at least a year they said. Pictured here are Luke and Bedjouk, a couple of my favorite hardworking friends.
On Thursday, my husband and I left together to the Masai Mara for a safari, which was an awesome way to end our time in Africa together. We got a great deal through the hospital for a beautiful Full Board safari resort with beautiful tent accommodations, delicious food, and two daily game drives included! We saw all of the Big Five (Rhino, Lion, Elephant, Cape Buffalo, and Leopard) and had a wonderful time together!
It was a looooong and for part of the way, a very uncomfortable and bumpy drive back from the Mara to Nairobi today. Thankfully, we arrived in Nairobi in time to head to Africa Yoga Project (one of my favorite studios in Nashville, Small World Yoga, modeled their non-profit/community yoga off of it) so I could move my body a little bit before getting to the airport for a full night of flying to our next adventure. We will vacation in Belgium and France before heading back to Nashville. Now I am parked at the Turkish Airlines lounge thanks to my Priority Pass membership (if you travel much, get yourself a travel rewards card with this perk…it’s SO worth it!). I’m enjoying a buffet of food, free showers, and beverages. I am grateful for all I have learned and gained this past month, and excited for what is ahead.