working against all odds

2.10.09—

After a brief vacation we are back on the wards. Each day has provided much fodder for discussion, and lessons on how things work (or don’t) in Moi Teaching and Research Hospital (MTRH).

I’ll share a couple of stories. Today was the first out of my four so far in which we didn’t encounter a deceased patient during rounds. In discussing the patient in the next bed, or in one case, the same bed, our astute intern had broken off from the group, taken the pulse, and looked in the eyes to pronounce death. The HIV rate in Eldoret is around 7%, but on woman’s ward at MTRH it is much higher.

The constraints under which Kenyan physicians work are pretty remarkable. Joe noticed a patient seizing as we were walking through the ward yesterday. Upon speaking to the pharmacist, we found that there is a nation-wide backorder on benzodiazapines (the first line treatment for status epilepticus). Not only that, but the less desirable seizure medication that was settled upon, wasn’t able to be give at a high enough, or therapeutic dose, because the hospital doesn’t have the staff to adequately monitor.

Worse, today we had a patient admitted two days prior with a very low CD4 count (monitor of white blood cells in HIV, low=bad), severe shortness of breath, and hypoxic overnight. We ordered a stat chest x-ray, only to find out that in the entire hospital (Eldoret’s tertiary care center, Eldoret being the 4th largest city in Kenya), chest x-rays weren’t being done, probably because of a shortage in blank film sheets. Further, they are out of the reagent used in the initial test for HIV.

I had to present in rounds for a Kenyan attending today, who happened to be the hospital chief of medicine. He is a tall, stoic presence with a booming voice and stern face. He was quick to reprimand, and call attention to the students’ errors. We often hear complaints that Kenyan medical students speak very softly, especially during rounds. However, today, as I was presenting my patient, he kept saying in this annoyed voice, “Am I hard of hearing? Can anyone else hear her? Speak up!” So maybe it’s not just the Kenyans…

We’ve been trying to run in the morning. We were reminded by our favorite running store owner/tri-athlete the Eldoret is the distance runner training capital of the world. The altitude has kept us to less than marathon jaunts, but it is really beautiful here in the morning, somewhere near sixty degrees, the sun just dawning. We see lots of kids, uniformed, walking to school, other runners, and are able to greet people in some of the little Kiswahili we are comfortable with. “Habari ya asubuhi?” Good morning, or how are you this morning.

For now, lala salama, or good night.
- Anne