Umoja wards

Nearing the end of our second week here in Eldoret, we are both just beginning to get a sense for how things work in the hospital and how we might help them to work a little better or slightly faster. For every post describing a terribly sick patient or a tragic outcome, I will attempt to take a view from a more positive point. There is indeed a concentration of very sick patients on the inpatient wards. More importantly, at least in this post, there are some very smart residents, green-but-hardworking interns, eager medical students, veteran nurses, loving families and exceedingly tough patients.

Rounds begin roughly at 9AM each morning. With 3 "cubes" per ward, 8 beds per cube & approximately 1.5 patients per bed, rounds can push 1-1:30 on a long day. I have been fortunate to work with a very talented "registrar" or resident. She functions as the Attending most days, and does so better than the actual Attending... she is pictured teaching the chest pain differential and reviewing a CXR below.


I spent some quality time of Monday teaching the 4th year students the Frank method for interpreting chest X-rays... completely made up on the fly. It went very well. The CXRs that we're learning from aren't subtle.


You can see three cubes on each side of this hallway, making up the men's "Umoja" ward. Umoja means Unity in Swahili. The other wards tend to be named for various other ideals. At 1PM precisely each day, families of patient's flood into this and every other ward. Many sit with their loved ones throughout the day, picking up where the nursing staff leaves off. The food served by the hospital is a single thick piece of bread and a mugful of a thin, brownish-grey liquid. Many families bring food to supplement this very basic diet.


Looking out the back door of the ward to an open area where the more mobile of the patients tend to congregate. Fresh air is pan-cultural.


Decisions each day, critical clinical decisions are made based on all the data that is available... and can be afforded by the patient. Before ordering any of the more moderately priced studies, a member of the team discusses the recommendation with the patient. A quite literal cost-benefit analysis. More commonly, we round the following day to find that a head CT, for instance, was not done because the patient could not afford it. Hopefully, a family member is home working on collecting the money.

A bill sits in the flimsy pink folder that is each patient's chart... right alongside H&Ps, daily notes and lab slips. Many patients spend extra days on the wards after they are discharged because they are unable to settle up with the cashier on the wards. This is good and bad. There are certainly risks to the combination of immunosuppression and a coughing neighbor(s) with pulmonary tuberculosis. For instance, one patient had what appeared to be his first psychotic break on day four or so after treatment of anemia. This would fall into the "Good" category had his discharge plan not been entirely inappropriate. Tomorrow, though, I hope to pull of a biopsy in a patient discharged days ago with a plan for this same biopsy as an outpatient... which would be good. Below, the sign at the security post at the exit to the medical wards, staffed daily by two or three soldierly men.


Finally, back to Current Events Kenya, the front page of the paper today alleges a link between corruption and famine. Seems plausible.

We will be learning profound statements in Kiswahili during our eighth lesson. Until then, nitaamka kesho asubuhi halafu nitaenda kwa hospitali na kuona wagonjwa.

Joe