Going Home

Bonjour from Charles De Gaulle airport in Paris. I'm headed back to San Francisco after a little more than 9 weeks in Kenya. This was my last of 5 trips to East Africa as part of the MGH collaborative (the first trip to Juba, South Sudan, and the subsequent four trips to the village of Sagam in western Kenya). It's been a nice ride. I've certainly learned a lot, made many good friends, and met my future wife in the process. How could I ask for anything better?

Friday was full of good-byes and well-wishing at Sagam and the nearby city of Kisumu. While Paula was rounding on the patients in the hospital, I had a chance to say good-bye to some of our clinical officers (Stella and the new eye CO, Audi), nurses (Margaret, Samuel, Mercy, and others), accounts team (Mr. Ofula and Eunice), lab personnel (Erick and Mary), pharmacy tech (Edwin), and of course Walter, our chief medical officer. There were lots of hugs and pictures with the canteen staff, that group of great women (Emily, Millicent the younger, Millicent the elder, and Janet) that has brought us great food day in and day out. And of course the hardest good-bye was to Jane and Nelson Rogo. They have been  my extended family out here and take care of us like one of there own.

We wrapped up the day with dinner at the Kisumu "Yacht Club", and I said good-bye to the medical team from Sagam. The next morning, I headed out for possibly my last run on the Kisumu loop that includes the Milimani neighborhood, goes past the Hindu and Hare Krishna temples, returns down the gauntlet that bring
s the cool lake wind at your face, and around the bend of the Impala Park animal sanctuary. Brunch with the Kisumu house crew (Anna, Griffin, Jackie and also Brianna) was at by far my favorite restaurant in Kenya, Gopala's Vegetarian Restaurant, followed by a cup of cafe and a very moist slice of chocolate fudge cake at The Laughing Buddha across the street.


As far as my role in the project goes, the question at the end of the day remains, have I done more good than harm? And my answer is still a slightly shaky, "I hope so". There are those in this line of work (NGO staff, global health volunteers, foreign aid workers and the like) that are 110% convinced that their projects are beneficial. I imagine that they sleep soundly with slight smiles on their faces as they dream of all the happy, well-fed children who's lives they are improving. I'm not in that camp. I know I have gained much from this and other projects. And I know there are some patients that are in a better place because of our presence. I also think that the doctors, nurses, and clinical officers that I've taught and learned along side with are better equipped to deal with a variety of challenges they face in the hospital on a daily basis. I do hope that the overall benefits of our presence in western Kenya (and foreign aid's presence in the developing world, in general) outweigh the harms. I don't know for sure, and I probably never will. But as I spend some time back home, catching up with my family and friends, I will have some time to think about it.

Thanks for reading along. Signing off for a little while.

Jeff

Thursday - Last Night In Sagam

Today went by quickly. Paula was rounding on the patients admitted to the hospital, so I had the chance to catch up on work emails, contact a few consultants regarding some of our patients, and do an ultrasound to take a better look at an elderly gentleman's heart, kidneys, bladder, and prostate. Being able to use ultrasound has been a true game-changer out here. Not long ago a good friend of mine was telling me how point-of-care ultrasound, or using the ultrasound machine at the bedside to aid in diagnosis and treatment, could be learned rather quickly. I didn't believe him. When I was a resident, one of the attending physicians told me I should be able to read basic echocardiography of the heart - that it wasn't all that hard. I didn't believe him either. But now just about 2 years into using ultrasound on a routine basis, I feel like a whole new dimension of medicine has opened up to me. I'm thankful that I've had the opportunity to learn about it, and I'm happy to get the chance to pass on these skills to other clinicians in training that are interested in learning.

After work I came home, took a nap and tossed the frisbee around a bit. We then made an all out Mexican feast of refried beans, Mexican rice with garbanzo beans, pineapple salsa, chips and guacamole, and tortillas. A little chocolate for desert and good dinner table conversation topped it off. It was a good last night in Sagam.

A Day Off

I had today off after a week of daily rounds at the hospital. The electricity was out for most of the day, so I took the opportunity to sleep in. We are a busy house, often with 5 to 9 guests in fairly tight quarters. So it's nice to have the chance to read quietly or play guitar without worrying that you'll be bothering anyone. I'm reading a book about Americans who choose to live off the grid, which is a little ironic, since so much of Africa and the rest of world lives off the grid by default. The rest of the team living at the house came home in two groups. I had a chance to throw the frisbee with Rachel and watch the sunset with Rachel, Lana, and Brianna, which turns out to be a very nice way to spend a late afternoon. We whipped up some sautéd veggies and potatoes au gratin, and followed dinner up with fresh pineapple and dates. Sanjat and Paula got home late after a long day at the hospital. I have only two days left in the hospital before heading back to California. Time is slipping by.

Tuesday: Last Day of Rounds

Today was my last day of rounding with the clinical officers (COs) on the wards. With the trolly of lab and x-ray order forms tagging along with us, we visited the patients first on the male ward, then the female ward, and finished up with the pediatrics ward. One of our patients passed away suddenly last night. We knew she was elderly and quite sick, but I was still surprised and taken aback by the news. Her family had been doing such a good job caring for her at the bedside. I hope they are doing OK.

Thankfully, a lot of patients were doing better and several went home. The patients were here with varied afflictions - from malaria to malaise, and from acne to AIDS. As usual, some patients didn't really need to be in the hospital. Others needed to be in a  much better equipped hospital than ours. But we did the best that we could with what we had at hand.

I've enjoyed working with our cadre of full-time COs. They are hard working and have their hearts in the right place. Their clinical skills have also really advanced over these many months.  As I watch the decisions made by some of the visiting part-time COs that pass through, I'm at once disheartened by the quality of education they've received but also impressed with how far our great COs have come. It's been a pleasure working with them and hope they continue to care for their patients and teach their peers for many years to come. 

Sunday, Lovely Sunday

Ahh, what a nice Sunday. We worked steadily on rounds and were able to be out of the hospital a little after midday. The crew at the house fixed up an amazing brunch of savory and sweet crepes, banana bread (with a chocolate swirl), and mimosas. We got some work done in the afternoon and then had a blast tossing the frisbee around the yard. We played a little guitar and then had some leftovers and more good dinner conversation. Electricity...check. Hot water...check. Internet...sort of check. Good people. Good times. What a Sunday.

Sagam Saturday

Today we had a visiting doctor from a company in the US that sells mostly used medical equipment at reduced rates to the developing world. Our hospital has benefitted from their equipment, and it was interesting having her see how the equipment is being used. Not all of it fits perfectly in our setting. Though in general it has been much more appropriate than many donations I've seen over the years at other hospitals. Well-intentioned American hospitals will often donate their unwanted, outdated machines to struggling hospitals in the developing world. The donors feel good about their generosity, and the receiving hospital uses it until it breaks (if it could ever be used in the first place) and then allows it to sit, derelict, on the hospital grounds for years like a wrecked ship. In contrast, last night, the surgeon operated in our theatre that her company helped outfit. Today, we had a delivery on their donated delivery bed, did an EKG with a machine from her shipment, and used our well-loved and oft utilized ultrasound machine donated by a separate group. These were all helpful, showing that smart, carefully selected donations can make a difference.

Friday Rounds

We rounded on the patients in the hospital, starting around 830AM as per our usual routine. The kids on the pediatric ward were getting over their malaria and diarrhea and got to go home. The men in the male ward were getting over their malaria and pneumonia and also went home. The female ward was another story. We have a mix of acutely and chronically sick patients, few of which were well enough to go home. One patient, who has been on the ward for about 3 months, looks like she will finally go to the operating theatre for removal of a pin that was placed to hold her fractured leg bones together. She is calling her family members to raise money for the procedure. The whole cost, including the hospital fee plus the outside surgeon's and anesthetist's fees will be about $300. This would be a bargain in the US but would be out of reach for many in the area. She will get the surgery tonight, and we'll work out the finances later.

We have had electricity for most of the day. When the power goes out, we start a generator the size of a suitcase that can run one power strip. This allows us to give oxygen via an oxygen concentrating machine (oxygen via the tanks typically used in the US is too expensive for most of the world), to run a few labs, and to charge lanterns. But today we were doubly lucky: plenty of electricity and no patients sick enough to require oxygen. I count that as a good day, indeed.