Honey and Hospital Rounds

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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Maseno and Maternity

The girls have now arrived in Maseno and they have jumped right in. The very first night Annemarie got to witness her first birth. We thought it going to be a C-section, but the surgeon refused because there wasn't any blood available in case he couldn't control the bleeding.

So we did a type and screen to determine her blood type, and ran it over to the lab and tracked down the tech to run it. As luck would have it, she was the same blood type as Aryan, so after a lengthy hunt for a blood bag, Aryan donated a pint. Then we had to send the driver out again to get the surgeon. Take into account, between each of these steps was a trip between the lab/maternity ward/men's ward/etc in the dark, with a headlamp. While we were trying to get the surgeon to pick up his phone, I heard the nurse in the delivery room say, "scuma!"' Which means push, so I tossed a pair of rubber boots and a apron to my student and she got to see the delivery. Talk about jumping right in :).

The girls are not only sharpening their nursing skills, but they are learning to do it by headlamp light when the power is out, as pictured above (all pictures including patients were only taken after asking permission). A lot of them are interested in going into something maternity related, so they that is where they have been spending their first 2 days. Most deliveries here are conducted by. Ursing students or nurses, but doctors are rarely called unless they need to assess for a C-section. Quite a bit different from the US.

 

 

 

 

 

 

Nancy and the students also put on a seminar with the Maseno School of Nursing using Mama Natalie, which is a simulator designed for developing countries to teach simulations of birth complications and post-partum hemorrhage. Both groups of students really seemed to enjoy it and learn from it.

We also spent some time sorting through the plethora of donation the girls brought, the most exciting being several hundred cloth, reusable maxi-pads. There are quite a few schools in the area wanting us to come and talk and include their girls in our pad program. And it that isn't cool enough, the pads come in pretty patterns and colors :). Sweet! If you would have told me a year ago I'd be up to my elbows in pink flannel maxi-pads when I came back to Kenya, I'd have scoffed......life is funny that way sometimes:)

Jessie

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I haven't worn this yet, why is it damp?

I know I am super behind on posting, so I will be putting these up a little retroactively, as to can catch up all my faithful followers.

Well, things are going swimmingly here in Kenya, and have now traded in my two travel companions (Adam and Lauren) for a posse of 9 wazungu(my students).

Adam did a phenomenal job at the hospital, and now I am being peppered with questions of, "When is Daktari Adams coming back?"

He was completely unphased by the lack of a daily schedule or consistency, and seemed to delight in the frequent, awkward situations arising from the language and cultural gaps......this bodes well for him if he decides to pursue a longer stay in Africa.

 

 

 

 

 

 

 

 

 

 

 

 

 

Lauren has been a delight to have here and may very well be the hardest worker I have ever seen. I have yet to see her tire. She has been helping me with all the preparations for the children's home we are hoping to establish on the hospital grounds.

This is her helping move mattresses into our stockpile of supplies for the new house. They got to experience haggling at its best when we took a little trip to the Luanda market to get all the things for the children. Right now we having a growing stash in the back room of the Rotary House while we are waiting on official hospital approval to move the kids, which I am afraid will eventually come down to the Bishop.

We kept quite busy the first week trying to secure a house for the kids. I knew of one empty house in the compound I was hoping to get, but the hospital administration offered me an even better one. Awesome. The only hiccup was that someone was still living there. Not awesome. And we had to move two families into other homes to open that house up. So Lauren and I made trip after trip down the dirt path with arms filled with boxes and pots, until everyone was where they supposed to be.

One of the many blessings on this trip has been our 4th roommate, Aryan. He's been living here for the last 5 months, and appears to have made friends with, literally, everyone in Maseno. We'd emailed and talked on the phone a good bit before his trip here to arrange some travel details, but this was the first time we had met in person. The first thing he said when he met me was, "I thought you were a 50 yr-old lady!". Despite His poor assessment of my youthful character over the phone, he has been a great help and delightful friend. He's been a wonderful resource and help navigating the choppy political waters of the hospital. It also helps that he and Adam seem to be long-lost brothers. For those of you who know Adam, you can imagine our evenings together in the Rotary House are never dull :)

I have also had the pleasure of seeing my electrican and fundi (carpenter) almost every morning, since there seem to be an endless list of things that need to be repaired on the house. Sigh......'tis the life of a guest house manager, I suppose :)

I had to leave Adam and Lauren for 2 days to hop a bus to Naitobi to fetch my students from the airport (pictured above). Traveling with my students is Erin Kane, a fellow Duke nurse and dear friend of mine. I nearly had happy feet waiting in the arrivals bay waiting for her to come though the door. There are few things in this world I love as much as sharing my Kenya with a dear friend:)

 

After traveling to Nakuru and visiting an incredibly well-run hospital and orphanage, we headed to the Kakamega rainforest for an little adventure. Adam and Lauren met us there and we stayed in little Banda huts in the middle of the forest. Even though the name should have given us ample warning, my students were slightly unnerved by being perpetually damp for 2 days. But they were troopers, and still had a great time.

The highlight was definitely the sunrise hike we took to the top of a little mountain where we could see out over the treetops. We started the hike in the dark, around 4:30 am, when the forest was completely silent. By the time we reached the top it was nearly roaring with all the sounds of birds and insects singing, and monkeys calling to each other.

 

 

Not all the students were as keen on hiking as I am, but I was very proud-they all made it to the top. Most even braved the bowels of the mountain and went into the bat cave near the top. There really weren't very many bats in there, but there is something very unnerving about any winged creature flapping about your head. It was certainly enough to make your hands sweat and your heart race a bit, and I think those are the only two iron-clad qualifiers for an act of bravery :)




 

To reward our brave girls, Tony and Isaac, our friends and drivers, brought us sugar cane to munch on. It took a little practice as sugar cane is neither a dainty or effortless treat, but they got the swing of it.

I will continue to update you with our adventures as we head to Maseno and prepare to roll up our sleeves and jump into the Kenyan healthcare system :)

Jessie

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Soccer and Sunning

I am lacking the energy for a full blog post, but thought you might like to see a little of the view from where I am. This is what we have been up to for the last few days. My students arrive soon and we will be going to the rainforest in Kakamega before Adam and Lauren leave for their safari.

Me and Lauren basking in the sunrise.

More Basking.......

The hand shaking begins.....I kinda like it, makes me feel like the president :)

Lauren did a fabulous job with the pad/puberty talk :)

It has become common to find a troup of boys waiting by our door when we get home, requesting "Adams" to play with them. They don't even seem to mind when he uses his height/weight advantage to steal the ball :)

Our front lawn has become the new designated soccer(excuse me, futbol) field. This is a pic of Lauren gaining some street cred with the neighborhood boys. They find it fascinating and hilarious that this mzungu lady not only plays soccer, but does it barefoot :) She may go down in history here as the coolest girl ever.

Jessie

 

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Sunrises and the Sex-talk

Our adventures continued as we trekked up the mountain behind our house for a little sunrise action. The mountain, which those without an imagination might call a large hill, is scattered with massive boulders. Tucked in between the rocks are little tin-roof houses with mud walls and bright blue doors.

We finally reached the top of the mountain to see an amazing sunrise. Lauren called her family to greet them from the mountaintop.

Right behind the "sunrise rock" is a school called Emmatsi, where we were greeted by a mass of students whispering, "mzungu, how are you?, how are you?"

After shaking about 50 little hands, we parted the sea of children to greet John, the principal. To make a long story shorter, we arranged to come back the next day to give the dreaded period talk with the teenage girls at the school. It is a common problem here that girls cannot get sanitary supplies during their periods. They either use rags or stay home from school. The boys in their classes are aware of their dilemma, and offer them pads in exchange for sex. Our talk included basic female anatomy, hygiene, and the dangers of unprotected sex. At the end the girls all stood and took an oath that they would respect themselves and their bodies, that they would not accept pads for sex, and that they would finish secondary school (high school).

Since Lauren is such a stellar seamstress, we also gave all the girls cloth, reusable maxi pads she had sewn. The pads have a waterproof back and removable inserts. They should last the girls 3ish years. To add a little rainbow to that sunshine, the pads are also pink and green and fun colors like that :)

Another great day in this land I love!

Jessie

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Mzungu on Matatu

We have arrived! And when I say "we", i am referring to Adam and Lauren Hill, for those of you who do not know my travel companions. Adam is one of the doctors I work with at Duke, and this is their first time to Africa. Adam and Lauren are settling right into life in Maseno and have jumped right in to the lovely chaos that is Kenya.

Our travels here were relatively uneventful compared to my usual travel shenanigans that usually involve airplane barf bags :). The highlights: Adam almost lost a kneecap to an overzealous beverage cart on seceral occasions, and I discovered Lauren also shares my love for tiny, useless things-like miniature wooden Dutch shoes in the Amsterdam airport. After 14ish hours on an airplane, we arrived in Nairobi. Our driver quickly introduced my travel companions to Kenyan driving when we got stuck in a line to get out of the parking area. Noticing their was no line at the entrance to the lot, he promptly turned us around, expertly jumped the curb, and straddling the sidewalk-he got us out through the "in" lane. The next morning we got up at the crack of dawn to catch our easy coach bus to Maseno, during which I introdcued them to drinking yogurt (exactly what it sounds like), and a short 8 hours later we arrived safe and sound.

The hospital is quite delighted to have Adam here (or Adams, as they have decided to call him). On our first day during ward rounds, he diagnosed a kid with a significant VSD about 12 seconds after assessing him. Nice Work. Since then we've seen some interesting cases of cryptococcal meningitis, TB, malaria, postpartum hemorrhage, and GC arthritis (for all the other dorky medical people out there who were wondering what we're seeing over here).

On our first full day in Maseno we took a little journey to Luanda, the nearby village, to visit the Phoebe House. Their first experience riding a matatu (bus), was entertaining. Lauren got the awful aisle seat, which literally means they precariously balance a small board across the aisle for you to sit on. When a matatu is as full as you think it can get, they usually take one more person who has to lean half their body over the lap of the person sitting in the seat closest to the door to allow the door to shut, which holds them in this awkward position of personal space invasion. And the lucky duck sitting in that seat was Adam (aka "Adams").

For those of you who are unaware of the P.H., its a home for women and children who have either been orphaned or abandoned due to HIV. And that is where my precious children live, and Adam and Lauren also found them delightful. To welcome us they sang us songs and gave us "flowers" which are best described as garlands of tinsel. Although they can get a little itchy and hot in the equatorial sun, they are really quite an honor as they are only used for special occasions, like weddings.

 

Stay tuned for more thrilling updates to come!

Jessie

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Triatix and Tilapia

So sorry for my lack of posting. My delightful students have been running me ragged :)

Let me catch you all up a bit on what we have been up to. Here we are at an orphan program doing a little a little deworming. For those of you who are not ascariasis savvy, this is not a very technical manueuver- it basically involves giving them a pill:).

 

Now this albendazole was in a container that made the gutsy claim that they were chewable. What I am now pondering, is what qualifies it as chewable? Apparently the only qualification is that it's not hard as a rock. In small print it said "mint aroma". Note: nothing was mentioned about flavor. So, being the great pediatric nurse that I am, I thought we should try it before we give it to kids.

And it was absolutely wretched. I have never chewed on a piece of chalk......but I think it was pretty comparable. To counteract this foulness we got candy to administer immediately after the chalk tabs. No one gagged, so I have counted it a success.

We also treated their feet for jiggers, which are nasty little buggers that like to dig into feet and rip them up. Treatment involves soaking their feet in Triatix, an insecticide, to get rid of the parasites. It's not pretty, bit it works. The tricky thing was all the kids were barefoot, which makes it rather difficult to assess the bottoms of their feet when we can't see them through the mud. Hence the foot washing station was started. This is Sam, washing children's feet.

 

 

For an interesting cultural experience we went down to the hotels (sidenote: restaurants are called hotels here, and hotels are called guest houses) on lake Victoria for some fresh tilapia. As I anticipated, it was slightly alarming to some of the students when they were given the whole fish to eat, especially considering that they were not given any utensils. But true to form, they jumped in and gave it a try. And if we're all really honest, who isnt dying to try eating with their hands anyway?

Xoxo

Jessie

And no, Sam does not know I posted this picture of him :). Let's just keep it our little secret.

Rainforests, Home Health and Hemispheres

News, news. We spent the weekend in Kakamega rainforest hiking up mountains and sneaking photos of unsuspecting monkeys. We started our sunrise trek at 5 am to make it to the top of a mountain (just a small one) before the sun (see picture above). Very pretty and breathtaking of course. Some of us even braved the bat cave and managed not to scream like little girls when we woke them up and they started swirling all around us.

Not only was this a true rainforest, but it is also mid-rainy season right now.....needless to say our rain jackets got to see some action. We arrived in Maseno last night happily exhausted and ready to crawl into our bunk beds (or double-deckers, as they are called here).

We've now spent one day in Maseno and the students have jumped in with both feet. One gave immunizations in the MCH (mother child health) clinic, some went out on home visits with HIV adherence counselors, and others rounded on the wards. We started off our first day with some great experiences. We had planned on sitting in on a surgery to repair a tib-fib fracture (broken leg) but the patient couldn't come up with the money so the surgeon didn't come. He's already been waiting in the wards for 2 weeks, so I'm sure the surgeon thought, what's one more day anyway? We at least replaced the scraptacular cardboard and gauze splint with a somewhat more legitimate one, so he seems a bit more comfortable. We're hoping he'll get in to the OR tomorrow.

We also snuck a little walk in before darkness took us prisoner in the house until tomorrow morning. We walked down to the marker on the equator and did the little north-south hemisphere dance, and all other hemisphere-related activities. It isn't often after all, that one can lean over and have their nose in a different hemisphere as their toes.

We took the long way back to go through the Maseno University campus. I am really enjoying getting to introduce my students to Maseno and show them around, despite the fact that a group of 10 wazungu (white people) looks nothing short of a parade around here, and typically attracts about an equal amount of attention. Tomorrow we will me going on more home health visits, helping with a mobile satellite clinic, rounding on the wards, and meeting with an HIV support group. Should be quite an interesting day.

Jessie

 

Orphanages and Operating Rooms

My students arrived safe and sound and I must say, they are quite fantastic. They are a group of 8 nursing students, some of whom have never really left the country before, and they have embraced everything Kenya whole heartedly. We arrived a few days ago at Mercy Mission Hospital in Nakuru where we will be spending a week. The guest house, where the 10 of us would be sleeping, had 6 available beds. I love Kenya planning:). But they jumped right in and said that's okay, we'll share. These are single beds mind you. Three of the girls pushed the beds together and rigged up a double mosquito net over them. So resourceful. I was so proud. We also do not have anyone to cook for us, so Vivian (the other instructor) and I will be cooking for 10 :). They have a hot water heating system, but it heats the sink water and the shower is frigid.......wiring problem or just ridiculously bad planning?

Last night our drivers, Shadrack and Tony, joined us for dinner and we were regaled with the most fascinating stories of growing up on the Maasai Mara and of the manhood ceremony that involves circumcision and killing a lion. Crazy. Each of us was sitting on the edge of our seat in suspense for about 2 hours. What a lost art story telling is, and how delightful to spend an evening with someone who excels at it. Just fascinating. They gave us gory details of how each animals like to kill their prey. And you all know how nursing students love gory details.

Our first day, to ease them in, we visited an orphanage and mission hospital run by the hatholic church that blew me away (see pic below). It was so pretty and well-kept and well managed. For those of you who know Kenya-this is nothing short of an act of God. It was quite encouraging to me, and gave me hope for the future of the Phoebe House. At least I now believe it can be done.

 

Yesterday we started rotations in the HIV testing and clinic, the wards, maternity and outpatient surgery. Yesterday on our tour, about 10 minutes in, we walked in on a woman who had come in for a incomplete abortion (spontaneous miscarriage) and had retained products of conception and was bleeding heavily. The medical officer introduced himself and asked them to jump in and assist. Yikes. A little intimidating, but true to form they embraced it and learned a lot. It's been great so far. As much as I miss Maseno right now and my own work I am doing there, I love being an instructor. I love teaching, and most of all I love seeing the students falling in love with this country, and these people. I feel very blessed to have this opportunity.

Today we started the day a little early with an emergency C-section and 2 of my students got to scrub in and receive the baby. Very interesting to be in the OR here, quite a different experience than what we are used to. Yes-we are wearing skirts, gowns, and rubber boots with no socks (except Aaron). We were all impressed with the skill and precision of the medical officer who performed the surgery. The rest were spread out between the delivery room, the outpatient clinic and the wards. I'm waiting to hear all their stories tonight. One got to assist in her first birth!

That's all I have for now. More fascinating updates to come!

Jessie