Hospital

Work at the hospital has been better. However since the hospital is so small there is not a ton of work to be done. I typically round on 7-25 patients a day w dr Mbonike - she is from here but trained in Russian and speaks awesome English. At first she was cold to me but really warmed up and we have a good time. From what I've observed it seems to be the African way to be blunt and almost yell at your patients to get them to do things. It was very eye opening when she turned to me and said " all their hiv meds are free I have absolutely no idea why they won't take them"  (side note it is awesome the US is helping provide this free service altought their immune system has to drop some before they are provided drugs) I pondered on this for a while as it is the same in the US ...this is a world wide problem! I've helped take blood pressures and draw blood and some other things but my role is limited bc a. We have super limited resources and there's not a lot of things we can possibly do. Pain meds are ibuprofen, can only do X-rays or ultrasound, not even enough oxygen to put people on it and b. Their way of doing things are sometimes much different than what I know...teen girl with sharp chest /back pain and they calling it angina and saying she needs to go to another hospital to get cathed...I know this is Africa but having a "heart attack" seems way low on the differential. They use many different drugs than I do- the malarial meds, penicillin, etc. I am surprised there is not a lot of examining the patients ( I figured their PE skills would be killer since they don't really use imaging etc) and it's more about classifying them into more " known diseases" as their are limited tests . available. Also frustrating that things get used up fast and we don't get a new supply for awhile such as a certain test tube which prevents me from doing procedures : wanted to do a para ( tap fluid off the belly) to send out to see if it was abdominal TB (!) but we are still out of these tubes!

I see a lot of TB, HIV w related crytococcal meningitis, malaria , dysentery ( mostly amoeba) severe severe anemia, CHF and the occasional diabetes , hypertension ( and patients are horrible about following the diet but can't really blame them as most people survive off carbs like rice and they for various reasons won't take their pills-either too much money or just don't want to anymore) . It is a totally different system in that I saw a man with a hemoglobin of 2.7!! (Normal is like 14-15) and they gave him like two units blood that  his family donated and didn't even recheck til the morning ( sometimes the machine will even be broken at this point and it has to wait until the next day!) in the US we would be checking like every 4 hours and freaking out haha. That patient actually did fairly well but he ended up dying all of a sudden. He didn't look amazing but not near death. I was out in the hall and dr m came to me and said you know that pt? He's gone. I said " where'd he go?" Then she said "he passed" and I obviously got it. It was weird bc i usually have a sense of when people will die in the hospital and that took me by surprise. I had gotten used to his family, his very caring son, who always wore traditions Maasai cloths. He was pretty stoic but had a few years. For some reason I thought there would be some different customs with an African or even Maasai death. Turns out I was right..when the women got there (hadn't even seen them the whole time during his hospitalization)  , it got very intense. They ran through the courtyards wailing and throwing themselves into the dirt which created a big spectacle from the other patients/families. From what others told me, one most physically show how upset they are. And as far as funerals - people are buried not cremated and the funeral is a big community event.

In kids I see TB, dysentery, pneumonia, and some rare things ( mumps, cholera -and today a boy that had lock jaw probably from tetanus) *plug for vaccination~although due to foreign aid it's getting more ubiquitous* The worst is malnutrition in kids 😟 Especially when they are neglected. The Maasai are polygamous so the next wife and her kids sometimes fall towards the wayside. Mothers esp seem to dote on boys more ( very evident when their are twins which there seems to be a lot of for some reason). They are pale with sunken eyes and cry a lot. A lot of babies end up going to cows milk and porridge almost right away bc mom can't breastfeed (can't produce or too busy) and can't afford formula- I even saw one infant who was drinking milk from the backyard cow and caught bovine TB which I didn't even know was a thing. It's hard to fathom that there are no legal consequences...in the US obviously there would be major legal ramifications. Today I saw one who already had rickets and she had craniotabes ( have never seen this) and her skull felt like the consistency of a ping pong ball. Her genitals were also mutilated which was horrifying but a real problem here and efforts are being made to stop this. On that note today I saw a boy who was like 3 and was just circumcised at his local pharmacy (!!) and now was infected.   I never really know what I'll see next.

Random note: found out it only costs 2$ per day to be admitted in the hospital but they charge for everything : even the gloves the doctors use. Chest X-rays are like 10 bucks. The family brings the food and gets most meds for the patients (md will give them the rx) but it's not too bad - a course of Iv abx for meningitis is only like 15$ . Even still probably many African families could not afford this.

Took the donations to the kids yesterday. Will write about that later as well as trying to get Matt to write something on here