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
We arrived in Kijabe Sunday afternoon. As soon as we started on the drive up from Nairobi, I was amazed at both how beautiful the country is and also how remote the area around Kijabe is. We turned off the main road, and after another 30 minutes down a dirt road filled with potholes, we arrived at the small village of Kijabe.
The first day or two we spent primary getting settled into our surroundings. We had to figure out little things, like learning how to filter water, bleach our fruits and vegetables, and how to keep baboons out of our windows (they weren't joking!)
As soon as we arrived in Kijabe, we were greeted by so many wonderful people from the hospital. Our first couple of days were full of folks dropping by our house to check on us, welcome us, and make sure we had everything we needed.
The first part of the week was a little difficult in the hospital—we spent the majority of our time getting oriented to the system and finding our role. Overall, anesthesiology in Kenya is very similar to the US—similar anesthetic plans, induction sequences, OR flow, etc. but the differences were what took some getting used to.
Being in a low resource setting where every dollar matters, supplies such as LMAs and bougies are washed and reused between patients. Temperature and neuromuscular monitoring doesn't exist. The machines are "well used" with inoperable oxygen and flow sensors, no end tidal volatile anesthetic monitoring. It's an interesting challenge to be able to cross check that you are delivering sage care without as much information. Similar to flying a plane with partial avionics panel failure.
Our decision making and skills have already been tested. So far, we've already troubleshooted ventilator failures, difficult airways, circuit leaks, hemorrhagic shock in an 8 year old, urgent cesarean deliveries... all with Brett and me acting as true anesthesiology consultants. Additionally, we routinely see advanced pathology that I've only seen in textbooks.
It's a humbling honor to be able to be here to provide whatever insight I might have. The patients are incredibly grateful for their care and are some of the nicest people I've met.
Week 2
I enjoy the challenge of limited resources. It's requires me to really think critically to create a plan with fewer monitors and fewer drugs. I also respect the vast limitations of training and knowledge, my 8 years compared to their 18 months. One of my patients’ alarm was sounding in PACU for a SpO2 of 74%. I'm used to being stat called to bedside, with a team of pannicked nurses around bagging the patients, grabbing airway bags, asking me if we should reintubate. Instead, here, the nurses are more laid back. When asked about it, they respond, "oh well she looks okay." A SpO2 of 74% is never okay.
I'm struggling to understand why a limited resource setting can't still be an efficient system that provides good care. There's a severe lack of ownership over outcome here. I don't know how to teach folks to actually care about doing a safe anesthetic. And that's what's frustrating. That's what makes me discouraged, and leaves me filling stressed after work.
This weekend we are going on safari in Massai Mara. It will be a great weekend away for some needed relaxation and time to enjoy this beautiful country.