Friday, August 10, 2012

Sagam: First Impressions

It’s Friday night, and somehow it’s been a number of days since I last blogged. I’ll try to keep up a little bit better. 

Since I last wrote, we’ve flown from Nairobi out West, to Kisumu, Kenya’s third largest city. Kisumu is located on the eastern banks of Lake Victoria, and it’s the home of the Luo, one of Kenya’s major tribes. Barak Obama’s father was Luo, and actually I passed the road to his grandmother’s house a few days ago. Every day many people come to visit Mama Obama, as she’s known, and I hear that she has security posted at her house in case anyone wishes her, or the US, ill will.

We spent a night in Kisumu at a house filled with about 7 other Americans. Most of the crew was emergency medicine residents from Oakland and San Francisco, here to give a course in basic ultrasound to African health professionals. Ultrasound is a very learnable skill, is portable, doesn’t involve dangerous radiation, and is a game changer here in Africa. I’ve been learning more about using ultrasound at the bedside, and it’s been fascinating.

A few others at the house were from Boston, and they were involved in holding trainings for the uterine balloon tamponade device.  Many mothers in Africa still die during childbirth, and the major cause of maternal death is hemorrhage.  And the major cause of maternal hemorrhage is an atonic uterus (a floppy, flaccid uterus that does not contract appropriately after the throes of labor and delivery). After the baby and placenta exit the uterus, this expanded bag of muscle must contract down so that the its blood vessels stop bleeding. To encourage this, healthcare providers vigorously massage the uterus through the abdomen. If this fails to cause it to contract, additional measures are attempted, including emptying the bladder in case it’s in the way and giving various types of medicines to cause the uterus to contract. In the US, another method available is inserting a medically manufactured, very expensive balloon in the uterus so that the pressure from the balloon stops the blood flow and encourages contraction.  In collaboration with MIT, MGH has developed a similar balloon that is made from a simple urine Foley catheter, a condom, and a few pieces of string. The condom is attached to the end of the catheter, a few pieces of string attach it to the catheter, the apparatus is inserted into the uterus via the vagina, and clean water is used to fill up the condom in order to put pressure against the inside walls of the uterus and stop its bleeding. This kit costs about 5 dollars. The woman can then be given a dose of antibiotics, stabilized with intravenous fluids or a blood transfusion (if that's available, which it usually is not), and transferred to a facility with higher capacity to take care of ill mothers. It’s fascinating, and it seems to already be saving lives here in Africa.

We then made our way from Kisumu about an hour north to Sagam, a small town on the main highway. We were taken directly to Sagam Community Hospital, a small, clean, private hospital run by Nelson Rogo, a “retired” businessman and veterinarian. It’s here that we’re setting up our home base, and it’s where we hope to help establish various programs that strengthen medical education in the area. The plan is to meet next week with Maseno University, where they have recently started a medical school, in order to help them set up a family medicine residency.

Sagam is lovely. The weather is moderate during the day and comfortable at night. Unlike Juba, where due to a lack of city power the sound and smell of diesel generators are impossible to escape, I’m awakened by roosters and the music of song birds. The landscape is lush and verdant, and the horizon is undulating. The hospital has no doctor but three capable clinical officers that are eager to teach, learn, and show their impressive clinical skills. I’ve been impressed with what I’ve seen.

I'm being well taken care of.  We’re staying in a four-bedroom guesthouse on the Rogo family compound, where we usually have electricity and so far always have had running water. When not at the hospital, we’ve gone on runs, played soccer with the local students (and where we're introducing Ultimate Frisbee!), and played some music (I brought my sax to Africa for the first time; Michele plays violin and Luke plays the guitar). Tonight we were invited to Nelson and his wife Jane’s house for dinner and Olympics. We had a fantastic meal of chapatti, bitter greens, cabbage, potatoes, lentils, and ugali, a maize based food that’s what the child of cornbread and polenta would be. We saw Kenya pull ahead at the end of the 5,000 meter race to grab the silver, as well as the amazing American women’s 4x100 relay that won the gold and set the new world record. The local news was all about the Kenyan from the Masaai tribe that won the gold for the 800 meter race (his father had won a silver for the same race in the past). Apparently all the Kenyan runners train at altitude in the next province over, not too far from the town of Eldoret that we’ll be visiting to learn more about their family medicine residency (the first one in Kenya, at Moi University).

Tomorrow we’re off for a few days in the “big city” of Kisumu, where we hope to finalize opening our bank account, buying some things for the house, and watching the men’s 4x100 relay final. Hope you’re well, and thanks a lot for reading.



sarah said...

Sounds like good food and fun times! Z and I missed you on our 7 minute walk to pick blackberries this afternoon. I like the story about the cheap version of the balloon to stop postpartum bleeding ... It's interesting -- I think F used those same items to create something very different in highschool ... But why water as opposed to air?

Jefe said...

hmmm, i'll have to ask you more details about that high school business. Hi Z! i miss the 7 min blackberry walks. my blisters have almost healed. that's a good question about air vs water. we need to ask a physics teacher i guess...

Nadeah Vali said...

Jeff- glad to have checked facebook today to get the link to your blog and learn what you're up to. Glad the first few weeks are challenging but rewarding.

On the water vs air Q: I imagine a heavier water balloon pushes against the uterus wall with more pressure-more effectively clamping down arteries pouring out pressure blood.
Cheers from Thailand!

Nadeah Vali said...

Logged in as my wife :)
Yousef "dr yoyo" Turshani