Pics from Africa...

Chris is having trouble posting on his blog and asked me to load these pictures. I emailed him and asked him to explain the pictures and/or update us. Stay tuned....

Work at Tenwek Hospital

I've been here for a little over a week now, but it feels like a month.. Work is fun, but extremely challenging. My schedule is as follows. Sometime b/w 7 and 745 morning report begans. The time varies based on the day. It lasts until 9am. After morning report, the interns round on all of the Medicine patients. We usually have about 35, and these patients are divided between 4 interns and a US medical student. From 9-11am I see consults and the ICU patients. I then meet the interns at 11 for chai. The hospital shuts down during chai time, and chai is brought to the doctors while on the wards. Because the ward smells like a combination of really bad BO and death, I have trouble drinking my chai. Because I don't want to offend the Kenyan's, I either show up conveniently late or flush mine down the drain while nobody is looking. Chai ends at 1130am and we start teaching rounds. We have 2 attendings on service, myself and a general medicine doctor from Michigan. I take 2 of the attendings and the medical student and we see the patients. They present while I listen, then examine and offer advice. Most of the medical issues are things I deal with at Duke, but there are times where I have to defer to the Kenyan interns on the correct form of therapy. We see tons of TB meningitis, HIV, malaria, and typhoid. The lab here is bad, so we really have to rely on taking a good history and doing a good exam. Because most of my patients speak swahili, my history suffers a little, but I can usually find an interpreter. We round until 1pm and then break for lunch. After lunch I do more consults. Most of my consults are from the pediatric or surgery department requesting I perform an ultrasound of their patients' hearts. This is fun, but also challenging. There is a ton of patients with heart failure from rheumatic heart disease, which is easy enough to diagnose, but I have trouble interpreting the ultrasounds of kids with congenital heart defects. After I finish consults, I check in on my team to see how things are going. At 6pm I leave the hospital exhausted. I am on call about every 3rd night, and call is pretty tough. The patients who get admitted to my service are very sick, and I usually spend most of the night helping the interns at the hospital. Most doctors here are not familiar with vent management, so I try my best to help out with any patient who is ventilated. The vents are much different then the ones in the US, so it is not easy to manage these patients. I try not to put someone on a vent unless I am sure it will save their life. There are ony 3 vents here, so you don't want to give the vent to someone who would not recover and then not be able to save the next person who probably would. After work I have dinner at the guesthouse where I stay. Sometimes it is leftovers, and sometimes a meal is prepared. There is also a pantry with things I can cook if I feel up to it (not yet). After dinner I try to do some reading, but usually fall asleep before I get very far. I hope things are going well in the states. I'll tell you about my free time in a future email.

kwa heri (swahili for good-bye),
Chris