Tuesday, August 21, 2012

Tuesday In Sagam

Here is a bit more info about an average day for me in Sagam village.

Woke up, had some green tea, muesli and yogurt while listening to the calls of the many birds that live in the area. I got online to catch up on the news and look up answers to some clinical questions that have come up over the last few days and weeks (e.g., does malaria infection cause the type of white blood cells called lymphocytes to increase? what is the dosing of rifabutin for HIV positive children also on the drug Kaletra? what, exactly, is the sound of one hand clapping?). Then Luke, the hardest working of our lot, went to the hospital to see patients with the clinical officers. We waited around for the plumber and electrician to come and check out various things around the house (they didn't show up), and to see if we were meeting with the dean of the university (he had to postpone). So we headed into the hospital to see what cases Luke and the rest of the team wanted us to take a closer look at with them.

The cases were interesting and varied.  We reviewed the case of a child with sickle cell anemia (a genetic disorder that developed over the centuries to make it more difficult to be infected with malaria) who came in with severe pain in his sternum from clogging of the small blood vessels in that bone.  We examined an adult with HIV and likely Kaposi sarcoma, a blood vessel cancer that is caused by a virus that affects people with weakened immune systems. The patient seems to have tumors in his skin, lungs, and lymph glands. We saw a young man who we had played soccer with last week that had been in a machete fight and had a blow to his head. There were patients with complications from diseases like diabetes and hypertension, such as gangrene of the toes from a poor blood supply and infection, or a ballooning of the part of the aorta that lies in the abdomen, probably due to long-standing high blood pressure. We also saw a woman that was about 5 months pregnant and taught the clinical officer a little bit about how to use ultrasound in pregnancy for checking the fetal heartbeat, seeing the amount of amniotic fluid that is surrounding the baby in the uterus, and how to measure the head, abdomen and leg length of the fetus to determine how far along the pregnancy was.

We then had a nice lunch of beans, greens, and tasty, greasy chapati. We walked the 15 minute long journey home (included is a pic from the walk, as well as a look at some of the trees on the grounds where our house is), and then had a chance to read, go for a run, and even play a little music (I brought my sax, and so far haven't been thrown out of the house for practicing). Luke whipped up a pasta dinner, with a side of avocado from our tree, and we watched a moving documentary on Darfur, Sudan, that was directed by our new friend Mark.

I'd say, all in all, it was a pretty nice Tuesday.


sarah said...

Sounds like a good life. We miss you, though, and are counting down the days ... Also, I'm still not clear on what the question is with respect to training family docs in Kenya (the second to last post). Is the question due to the ways they are/are not currently functioning there? Whether a second program is redundant? Because other issues like a lack of equipment is so limiting that it must take priority? We can discuss in 37 days =)

Jefe said...

Sarah, miss you guys, too. In answer to your questions: yes, yes, and yes. The government is still getting used to having family med docs in country (there are less than 20), and what their role is in a hospital is evolving. Do they just fill doctor slots (e.g., the hospital has an internist and obstetrician, but no pediatrician, so the family doc comes in and basically works as a pediatrician), or do they work at a smaller hospital where they are expected to do it all? Or do they help run the ER, and keep a mind to the community as well? Also good to know if another program training family docs is necessary? Why isn't the door of the current training program getting beaten down with a flood of applicants? And would training clinical officers or nurses make more sense? These were some of the questions. To be continued in less than 37 days!! Abrazos - jefe