Thursday and Friday were my first two official days on the Nyayo wards. I am currently assigned to the all male ward. I believe later we will switch things up so I will spend time in the women’s ward, pediatric ward, and the inpatient psychiatric unit. I will be the only one on the inpatient psych ward as no one else wanted to. My interest in psych prevailed on top of the fact that three psychologists are here from Brown and I can work with them in their research which may get published.
The work here is difficult, and that’s not even factoring in the emotional component. Thursday I rounded with Sonak, my preceptor, so he could show me the ropes. With 30 patients to round on, it took 4.5 hours. My legs and back were killing me. Our main jobs as pharmacists are to order medications when the doctors prescribe them (they do not write orders themselves) as well as ordering medications when we feel they need to be. This means you must hang on to every word the doctor says which is harder than you think because Kenyans are THE most soft spoken people I have ever encountered in my life. On top of this, we must ensure the patient actually receives the medications they are prescribed as the nursing staff here has a tendency to just skip over patients or not give meds if its too time intensive. When we’re talking antibiotics and antiretrovirals, this is a HUGE issue and builds worries of resistance.
I learned a lot from talking with Sonak on Thursday and learned even more just from watching. On a side note, they do not use IV pumps here so there are no set infusion rates. Everything is hung and flows by gravity. I saw a patient in bed receiving a blood transfusion. The bag was hanging on the IV pole, but the nurse hadn’t put the patient’s IV in correctly and so the blood was simply flowing over his arm and onto his sheets so he was literally lying in a gigantic pool of blood. Sonak urges doctors here to not give blood transfusions unless they absolutely can not avoid it as donated blood is not checked for HIV/AIDS or hepatitis which puts patients at an enormous risk I’m sure they are unaware of.
Friday I was to be on my own but I paired up with Evelyn, a pharmacy student from here at Moi. I learned more from her than I thought was possible in one day. I suppose when you don’t know anything there is no where to go but up! She trained me in the therapy of toxoplasmosis, PJP pneumonia, malaria, TB, and cryptococcal meningitis. All of which are not seen often in the states and can be acutely life threatening (some within hours) if not treated properly right away. She was a wealth of information and also very sweet. Rounds on Friday only lasted 2.5 hours as I had a different medical resident (called registrars here) and the attending came so everything was much more efficient.
Friday we also had our first patient pass away. Day 2. There’s no easing your way into this. The lady was up and talking just fine with the team one minute, and ten minutes later she was found dead in her bed. They suspect a pulmonary embolism but no one really knows as x-rays, labs, and every other test takes forever to get back. They also do not do autopsies as they would probably not get much else done with the time they would need to spend on all the deaths. It is just so unfair and frustrating. Kind of feels like a punch in the gut and all the wind is knocked out of you.
It is so bizarre here. Patients are allowed to get up and move around at their leisure. You’ll pass a man in the hallway and, 20 minutes later, you’ll round on him and learn he has a hemothorax with a collapsed lung (blood filling the space between the lung and chest cavity causing the lung to collapse), advanced AIDS, and TB! A patient like this in the states would be in isolation and bed ridden for days on medical orders and here he is strutting around the hallways and outside on the grounds. You can never guess here which the patient is and which a visitor is. The Kenyans are so tough and can put up with a lot. I really respect them. As one Kenyan explained to me, “we are very simple people, but God still smiles on us.”
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Wow, that sounds quite intense and I'm not sure how you're taking all that in emotionally. It certainly sounds like the patients there deal with so much and yet take in just in stride as if it were an ordinary day, which I find astonishing as I'm sure you do. I have a feeling that in just a couple of months there you will have learned so much more than what you would have doing a 2 month unit here.
ReplyDeleteOn another note, it was really nice to talk to you today. We're so happy we got through to you on skype. Maybe we'll try to get through for short phone calls again on the weekends. Afterall, we miss our Iz time just as much as Matt. :) haha Anyway, Scott's still talking about your "jungle feva" (with Phil) and we're still in disbelief about the whole bat thing. Seroiusly, one to the face, yuck! Well, take care and we'll talk to you again soon, hopefully.