Tulikula chakula wakenya

Umeshindaje leo? Translates, I believe, to "How have you won your day today?" The reply to this question, just as it is the response to that of "How are you feeling today?" put to a clearly badly-feeling Kenyan patient... is "Nzuri" or good.

This past week, my final week was the first in the Internal Medicine rotation for a new group of students, still very early into their first clinical year. I found myself excited for the opportunity, the hope, the off-chance of playing a role in laying down the fundamentals... Med Student 101. To say just a few words, set a few examples on those first days on the wards before other examples are available.

At the end of the week, mixed results. I really enjoyed the time spent with this group of students, nonetheless. Ah, the SOAP note. Perhaps an American convention... but a really useful one. (For those of us unfamiliar to wards medicine, SOAP is a format for writing notes in a patient's medical chart... One that should help in thinking (hopefully in a critical and organized way), but thinking at all is the key). Anne apparently had a much higher success rate in getting SOAP notes from her students than I did, but I did have one or two successes.

Our friend Barb, a resident from Utah, pulled off an elaborate contest amongst her medical students on her final day. It involved scoring for content and presentation and required a level of organization of rounds that I can still not fathom. My successes were more modest.

A fourth year student named Lawrence presented a 40-year-old woman, status post two failed courses of treatment of pulmonary TB with a recent tissue diagnosis of an intrathoracic chest wall sarcoma. Bizarro... But we had a really nice discussion of the issues at hand. He was given all of 30 seconds to present before the team summed things up for him and moved on. A sixth year student named Cynthia was given even less time to describe her plan for a uncontrolled diabetic with a foot wound. Ambrose, another fourth year, however, did get credit for diagnosing and fixing a patient's kidney failure... and was all over the patient's medication regimen, thanks to our work together.

Prerounding, which is the fine art of the medical student evaluating a patient on his or her own each morning day after day, is a new and fragile experiment in one corner of the wards, started last month by an Attending physician named Deb Litzelman from IU. It has met with resistance in some ways from the students. It has, so far, bent but not broken. I doubt that this short week will make the difference in whether the "pilot" project lives or dies. I do think that Ambrose now knows the joy of a creatinine, once deranged, again within normal limits.

More recently, Anne, Philip & I orchestrated a feast at the IU House last night. Kenyan students who will shortly be traveling to IU, Brown & Utah joined a few American students & residents for dinner... and did every bit of the work in preparing a huge traditional Kenyan meal. For the price of (delicious) sushi in our beloved Cranston, RI, we fed 25 hungry people. Philip was responsible for talking down the women in the market from the "wazungu" price... to something slightly more reasonable. At one point, we agreed that he would be more likely to get a decent price on peas if we weren't nearby. We separated. The peas were still expensive. Either the demand for peas is way up, or word travels fast when wazungu are in the market. Pictures to come shortly...

Joe