The girls did a wonderful job at the mobile clinic at Mbaka Oromo. Our "waiting room" is pictured above. The clinic building is completely finished and is just awaiting furnishings. The government will post a medical officer and a nurse there once their housing is complete, which should be within a month. The village is responsible for finishing the housing and digging a placenta pit for the clinic (yes, that is exactly what it sounds like). So hopefully this is the last mobile clinic we will ever do there, from now on we can just work in the functioning clinic!
Another school sent their older girls as well, and they all received the menstration/safe sex talk and a set of reusable maxi-pads. One little girl came late and we had already given out all the pads we had. She was so upset she started crying, so we told her we would give a set to my friend, Job, before we leave, since we had more at the rotary house. I got a call from Job 2 days later asking if he could come pick up the pads that day since she had been coming to his house twice a day to see if he had them yet. Her impressive persistence gives us an idea of the impact those pads have on these school age girls. Poor Job though, he's a great teacher, but he's also a young guy, and i think its safe to say maxi-pads are not his forte:) I think he was quite relieved to pick them up so he could put an end to the daily house calls ;)
The girls also got to observe quite a few surgeries during their time in Maseno. One of the students, Maria, was also an OR tech at home, so she scrubbed in on several occasions. Not only was it a great learning experience, but it was a huge help to the hospital, since the surgeries took place at night and we were the only ones around. It was certainly a lot more hands on than the typical nursing school OR experience :). I think it was also a nice break for Aryan, our roommate and volunteer lab manager, who doubles as a scrub nurse whenever someone is needed at night to hold clamps/limbs, or recieve babies. This man is going to be very well trained when he starts medical school :)
To enter this OR, you are required to leave your shoes at the door (actually just inside the door so they are still there for your walk home), then you throw on some flip flops to keep the floors from getting covered in that lovely red Kenyan dirt. Then you head to the changing rooms to throw on some "theater scrubs" and rubber boots. We are able to do surgeries after dark now that we have a backup generator, since power outages are still fairly common. Our ventilator is still manual (you squeeze a bag to breathe for the patient), but lights and suction need electricity.
My personal favorite part of the day is rounding in the wards. The wards are set up in the old English style of large open rooms with patients only a few feet from each other.
The team then goes from bed to bed and discusses each patient, what happened since yesterday, and what the plan is today. The girls chose a patient each day to present in rounds, and explain their illness and treatment thus far. I'm sure doctors everywhere would cringe at the thought, but we are getting very good at reading a chest x-ray by window light :). I find this the most challenging and brain-stimulating part of my day. It makes me dust off some of my unused clinical knowledge, and lets be honest here-makes me look up and learn a lot of new things. Rounding with Adam while he was here reminded me of how much I don't know (in a good way :) and kinda started getting me excited to go back to school someday to fill in some of those knowledge gaps. Well, enough about my continuing education aspirations, let me tell you about an interesting patient we had.
Violet is a woman in her late 30's who was in a piki-piki (motorcycle taxi) accident. Her major injury was to her right knee, where most of the flesh was gone, but the muscle and bone was intact. Once she was stabilized, my challenge was keeping the wound from getting infected. To make this even harder, we currently have a shortage of gauze. At home, I would typically use a special type of guaze with anti-microbial agents in it, and change it 1-2 times per day. I knew we didn't have enough gauze for that, and all I had was antibiotic ointment. Some studies have shown that antibiotic ointments will actually hold excess moisture in the skin and grow bacteria if they are left on the wound too long, so I decided against that. So, as usual, Kenya forced us to get a little creative and think outside the box.
The doctor who had done the debridement of the wound had advised the family to put honey on it, but the nurses hadn't been doing that because they didn't think it was a good idea. The nurse's reasoning was logical because typically anything with sugar in it would be a breeding ground for bacteria. However, my father happens to be a beekeeping extraordinaire, and I remembered him teaching me about the anti-microbial properties of honey, and that it is one of the only natural substances that virtually no organism can grow in because the sugar content is so high.
So we decided to give it a shot. The above photo is one of my students pouring the honey on to my sterile field as I am showing them how to do a sterile dressing change and wound packing. I'm pretty sure it was a new experience for everyone involved :)
We've been dressing the wound for over a week now with the honey, and I must say, it looks great. No infection, beautiful granulation tissue forming. I don't know if it will ever be able to completely heal without a skin graft, but that is a challenge for a different day. She happens to be the neighbor of one of my dear friends, so I can find her once she leaves the hospital. I intend to follow up with her in the months to come to see how she is healing and what further treatments she might need.
As always, I will keep you posted!
Jessie
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