The measure of intelligence is the
ability to change.
-Albert Einstein
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| Mount Kilamanjaro, Kenya 2007 |
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| Mount Longonot, Kenya 2016 A lot has changed in 9 years! |
On our way back
from hiking on Mount Longonot we started to hear a loud noise every time we hit
a pothole or speed bump. A Kenyan drove by honking at us telling us our shock
was out. After viewing the piece of metal sticking down almost touching the
ground, we started to look for supplies to at least get it off the ground so we
could drive the 2.5 hours home. After failing to find any equipment, Tammy
offered her hair tie. At first I chuckled, but little did I know that this
hair tie must have been made of steel. That little stretchy hair tie was able
to hold up the shock until just before we made it back to Tenwek. Just as
temporarily fixing a car was not the hair tie’s intended purpose, so I too feel
a little out of place at times, and I feel like God is using me in ways I did
not expect.
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| The local Home Depot |
The necessity
for me to be flexible started 2 weeks before our trip when I learned that the
Kenyan medical board had denied my license as they stopped licensing Doctors of
Osteopathic medicine or DOs. In different parts of the world “osteopath” means
different things. In America, it is the
equivalent of an MD. We take similar tests and attend similar residencies (I am
actually in an MD residency program). In Europe; however, an osteopath is the
equivalent of a chiropractor. This misunderstanding has major implications for
Tenwek, as well as several other mission hospitals, who have short-term and
long-term missionary doctors that are DOs.
Working at
Tenwek without a medical license has required a change in mindset in what I am
supposed to learn and how I am to serve the missionaries and people of Kenya. I
expected my role to be focused on patient care in the Emergency Department (Casualty
as it is called here). My role instead has shifted to more of a teaching role
and doing several practical things around the hospital. Not having a
medical license has also allowed me to do things I would not be able to do
otherwise.
Teaching
The people with whom I've had the most contact at Tenwek is the staff. In particular, I have
been working with the interns and clinical officers (equivalent of a PA or CRNP
in America). Kenyan medical school is much like America’s for the first 4
years. After medical school however, most doctors will undergo a one-year
internship and then go out to practice. Most will go on to live in one of the
larger cities (such as Nairobi) or attempt to travel to a more modernized
country where they will be able to make substantially more money. This phenomenon
is called “brain drain” - where some of the brightest and most educated leave
the poor rural areas to have a better lifestyle. The interns at Tenwek however
are a special group of people. By studying at Tenwek they are committing to practice
in a rural area in Africa. These very intelligent interns feel a special
calling to sacrifice the opportunities they might have elsewhere to help those
who desperately need medical care in rural Kenya.
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| Tenwek's front gate leading to casualty |
Along with
teaching several lectures to interns and helping them work through cases on
rounds I have been teaching A LOT of BLS (Basic Life Support). This is a huge
need as most of the staff need to be trained. I was able to borrow the
official BLS course from my hospital and have been running through this course.
I have taught 24 staff so far and have about 30 more to go! A doctor here has
already told me that he noticed a big difference in quality of CPR provided by
one of my students during a cardiac arrest.
Community Health
Because of my
lack of licensure, I have been able to branch out a little more than expected. One
of the highlights of my week was going to a rural dispensary (clinic) with the
community health team. Part of the ministry of Tenwek is providing preventative
medical services. The motto of the community health team is “Bir mat ko loo”
(Prevention is better than cure). There are three teams: a medical team, water
team and a building team. The medical team goes out about 4x/week to administer
routine vaccinations to infants, perform physical exams for pregnant females,
and provide general health tips to prevent infections. The water team assists
in access to clean water. The building team helps community leaders assess
infrastructure needs in their communities. All of these teams are able to share
the love of Christ through their ministries.
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| Our leader Samuel giving some basic health instructions |
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| Lots of mommies and babies waiting for their shots |
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| Mzungu |
I had the chance
to go with the medical team to a very rural area where I think I was the first mzungu (white man) some of the children had seen. The tiny two room dispensary
was overwhelmed by over 130 moms with their babies along with women seeking pregnancy
check-ups. A nurse and I drew up and immunized all the babies while a clinical
officer and another nurse performed the pregnancy screenings. While many of the
moms were a bit squeamish with me sticking needles in their babies, they seemed
grateful for the care that we provided.
Interesting Case
While I may not
be as actively involved in the medical care of patients, I am still able to do
rounds in casualty and the wards and assist in the decision making process. Therefore,
I’ll try to post some interesting medical cases.
The first case is
a 28-year-old male that presented to casualty with fever and chills. He was
admitted to the hospital one-week prior after being diagnosed with miliary
tuberculosis and HIV, both new diagnosis. He improved after treatment with
antibiotics, antituberculosis medicine and antiretrovirals (for HIV). After
being discharged he was home for a day then returned with similar symptoms. On
presentation he was febrile, tachycardic, and appeared septic. The presumptive
diagnoses was something I had never heard of, IRIS (Immune Reconstitution
Inflammatory Syndrome).
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| Patient's chest Xray showing the classical appearance of miliary TB, something I have also never seen in America |
HIV is so deadly
because it attacks your immune system. Particularly, it invades and attacks your
T-cells, making a person very prone to infections. Starting a patient on
anti-HIV medicine is needed, but one possible complication is
that your immune system can start functioning too well. This can lead to IRIS which
is an immune response that is exaggerated and is actually harmful and can mimic
an infectious process. This condition is particularly prevalent with
tuberculosis and cryptococcal meningitis. Our patient met all the criteria. There
is no way to confirm this diagnosis and the treatment is supportive so the
patient was treated with fluids and more antibiotics and eventually improved
and was able to be discharged.
Conclusion
This first week has involved a lot of change, flexibility and humility as we try to figure out God's reason for having Tammy, the kids and I here at Tenwek. It is definitely a different role than I expected when we started planning this trip. I may not see exactly why God has me here despite not having a medical license, but I hope that I will have the same flexibility as that hair tie to perform whatever it is to the best of my ability.
