The last week

The last 2 weeks flew by for me. After returning from safari and then experiencing those procedures were so amazing but time just flew by. On my last weekend we went to a crocodile farm and saw the feeding a and I faced my fears of holding a crocodile. We also went to Haller Park which is a wildlife conservation and fed giraffs. Sunday brought my first ride in a Matatu. These are the local transportation vehicles that are literally everywhere in Mombasa. The drivers are extremely crazy and dangerous a lot of the time but that is just how it is. Phares and Osborne came with us to diani beach. In order to get there you have to use the ferry because Mombasa is an island so you must go from island to mainland. Recap: the hospital is located on Mombasa island but where I was staying in Nyali was mainland. There is a bridge on both sides but traffic can be so bad. We take the bridge to hospital but to the beach we needed the ferry. It was so cool because I have not been on one before and it was a zoo. Cars and trucks went on first then a huge mass of people filled in the gaps. It was crazy and its along the main port so I got to see a bunch of ships. 

Anyway the matatus are big vans that have a driver and a caller and they all try to get you to go in theirs. We had a group of 7 so it was difficult finding one with enough space. I found it as a huge adventure. This mode of transportation is the cheapest option besides walking. Because there are almost no traffic rules here matatus even in traffic will get you to where you need because they just go wherever to get through. They have amazing names and stickers on the outside. Some of the best were TAKE THE RISK?, WHY SO SERIOUS?, MONEY IS THE PROBLEM, CHANCE, WHO KNOWS? and many more. Most are even decked out with neon lights both inside and outside so at night they are really colorful. They blare music too. It's like a full time party van.....but not. 

The beach was great. I got to swim in the Indian Ocean!! Whoop whoop. Then on Monday for my last night Benson took us to a club for some dancing and celebration. We at first were the only people dancing ( we made our own dance floor) and the 11 of us just danced for like 2 hrs straight. We had a couple local girls join in later and we got some of the customers moving along but boy it was so fun. It was a great way to spend my last night out with all the interns, even the newest ones from Norway. 

Tuesday I did not go to the hospital but packed and said my goodbyes. It was such a weird, sad, happy, and slow day. The morning moved like molasses and all the staff that I had befriended were gloomy. I told myself it would have been easier to not be as nice and friendly because its easier to say goodbye to acquaintances than friends, but then I knew I would rather have to say a sad goodbye than not have sir friendship. I know in my heart I will see them again. There is no possible way that after one of the greatest experiences of my life I could not go back and see the people again who gave it to me.   

My goodbye committee 

Like a doctor!!!

So on my last week I have been eager to do some suturing or something that really gives me some hands on. Osborne has been fighting to get me to put in a cannula but every time I went to A&E no one needed one. However on Tuesday we had a BBQ and Osborne came and before he left he pulled out a catheter set. He taught me how to insert a catheter using a water bottle. Ha very funny visual right? Well on Thursday it was almost to the end of day in minor theater and no one had come for catheter change. Finally with a 30 min left a man came in and I got to do the whole procedure. I took out, cleaned, and put in a new supra pubic catheter!!!! It is simple but man I felt like I actually was doing something. It was a huge accomplishment for me. I did another of the exact same procedure right after so I got to do to in a row. Big day!!

Friday was my awesome day. A woman had come in and had a lipoma on the outside of her foot she wanted to remove. I observed and assisted slightly in the procedure. But when it came time to suture the incision guess who got to do it?! Me. Andrew one of my fellow interns did the first one and showed me how to do it and then I got to take over and do the second stitch. For my first time Andrew said I did so well and would have never guessed it was my first time. It felt so good to actually do something to help the patient and be directly involved with their care. This is how I know I am pursuing what's want to do. 

 

After stitches I went to A and E to try a cannula. Anton, the doctor we work with just took me to a patient to do it. I was doing it well but with two people holding the skin taunt I lost sight and went on the side so I put it in but missed. I did not get a chance to retry but instead I got to draw blood directly from the gentleman's vein. I did very well and it was so exciting. Makes me very happy to get my phlebotomy certificate in the spring. 

Monday on my last day I got to do my final procedure. Give an injection. I got to prepare all supplies and do everything by myself under guidance of course. But I injected into the deltoid and didn't even make him bleed. I felt so accomplished even though it was a small procedure.

I believe a lot of this internship was for building my confidence in myself. The first day I was so unsure of what to do or say or look for but after seeing then doing thanks to Osborne, I became confident in asking history and doing physical examinations. I think that is a huge thing; mind over matter. The thing I am really taking from this is the experience and confidence so when I am in school and learn how to do histories and procedures I have a background and can be confident in my practice of them. 

My confidence coach Osborne. 

Cecilia another mentor 

Safari

So on the 8th I got to go to the Masai Mara for a 3 days safari. I left Mombasa Thursday morning and took an 8 hr bus ride to Nairobi. My fellow interns took a flight on Friday so Benson, our assistant caretaker came with me. The ride was long hot and bumpy for sure but worth it. Nairobi is so urbanized compared to Mombasa. There are tall buildings, traffic rules, and definitely just more of a big city feel. It was almost like being home in Denver. 

On Friday I took a van from Nairobi for 6 hrs to the Masai. We stopped at the great Rift Valley, and ended up driving through it. Pretty cool if I do say so myself. 

Once we got to our camp we put our things there and went on our sunset game drive. O

Although it was raining a bit we still saw a lot but did miss the sunset :( but it was amazing to see giraffs from almost a mile away walking and then driving close to see them. The coolest part was seeing a huge pride of lions. It literally was like the scene from the lion king! We were less than 10 ft from them. 

 

The next day was our full day game drive and we saw so much from giraffs to elephants cheetahs wildebeests and buffalo. They have the Big 5 here which include elephant, rhino, cheetah, wildebeest, and buffalo. We saw 4 of the 5 because seeing the rhino is very rare. The group before us from elective Africa were the first in 12 years to see one. But still how close we got was amazing to everything. We even saw a mom and cubs eating a freshly killed wildebeest. 

  P

After the all day drive we got to visit a Masai village and learn about their culture. 

 

The next morning we sis our sunrise drive and for those who haven't seen on Facebook this view is what I have been waiting for 

 

And more cheetahs

 And of course my "Rafiki" tree as I call it.

These are just a couple of my amazing pictures and experience on safari. 

The fun stuff

So most of my posts have been about hospital stuff but a lot of my time has been exploring and becoming part of the culture. Besides going to the school and teaching class and playing sports and singing and dancing, I have seen much more. 

When going to the school we toured the area Were the kids live and come from. It is one of the many slums around. It's very humbling to see. We walk through this alley where they place all their trash and the chickens pick at it. We just walk over it for 30 yards. It's an experience that I will not forget and remember back home in being greatful. 

On Saturday the 3rd me and the two British girls went on a tour of old town Mombasa. We went to fort Jesus, the spice market, saw the famous Mombasa tusks, got henna done in a local house, walked through multiple markets, went to a famous hindu temple, local streets, and saw the Holy Ghost Cathedral. It was crazy and very fast paced and our tour guide actually lit up a joint and was high while taking us through the outside of the Fort. It was such a crazy but hilarious and fun experience. 

 Spice market 

 Hindu temple 

 Henna tattoo 

 Cathedral 

 Fort Jesus 

 Tusks 

I also saw a giant tortoise at the entrance to haller park. We became buddies 

On the weekends we teach the teachers how to swim. On Sunday I am blessed to go to mass with Simon and benson. The church is beautiful for its simplicity. The music though is absolutely AMAZING. 

We also go to the beach on weekends and go to the resort near by and chill out. It's very relaxing. 

And at residence they watch tv a lot which I am not used to so I made everyone play cards one night. 

And we hand wash our laundry!!! Oh yeah my grandma taught me well. 

Hospital days

I completely skipped a whole day to write about and it was one of the most interesting learning days. On Thursday the1st I went to the male medical ward where ward roundwasgoingom with the consultant. There was about 12 interns and us going from bed to bed and talking about the patient and their case for learning purposes. I saw so much and learned how they go about treating things. I won't go into boreing details but here is a simple list of what I saw:

1) strokes

2) epilepsy patient with complications with urinating 

              Learned that the antibiodics for UTI lowers seizure threshold which is very important with a patient with epilepsy

3) ulcerative colitis 

4) ischemic stroke

     Patient could not talk so we know the hemmorage was in frontal lobe. 

5) stroke and chronic kidney failure

         Learned what must be checked before putting a patient on dialysis 

6) ischemic stroke

7) ascites- had to determine if it was due to liver, stomach, or kidneys. Patient history is 70% diagnosis 

8) jaundice 

9) anemia

10) malaria

11) this case was interesting. It was a 12 year old boy who since February had been vomiting and diarrhea and after tests decided he had anemia and was put on meds but after 2 weeks he got worse. They tested again and found tonsillitis. They tested for TB but it was negative. He was taken off meds for 3 days and got worse. He went to another clinic and chest X-ray showed TB. After meds he still was vomiting and became very weak like jelly. Under physical exam it was found a lump in stomach and enlarged liver. He was put on injections to stop vomiting. They were planning an endoscopy to be done. However what I came to learn later on was that the consultant knew exactly what the boy had but did not reveal it to the patient and his mother while all the interns were there. He kindly waited till after the round and the interns left to go discuss with the mother that the little boy had HIV. It is a terribly and sad diagnosis and I am so happy the consultant waited to tell mother until it was appropriate and not with 14 student doctors just hovering around her son like a spectacle. They planned to take tests from his family members to see where he got it from. This worries me because of how HIV is spread if a male in his family is positive for it it could mean that the boy had been sexually abused. It is very sad and such a terrible circumstance. 

After a tolling morning it was nice to relax and spend time with the girls.vus girls went down to the cafe and had milkshakes and then did a little shopping. It has been so fun learning about each other and the things we do where we are from. It's so funny to think how different things are in the same world. I thought coming here I would learn so much of the Kenyan culture but lo and behold I have learned so much about English and Australian culture as well. 

So now that I am kind of jumping days I will just do the hospital experience then do the weekend and non hospital stuff. On Tuesday last week before safari I went to minor theater because it was hard to find somewhere to watch things. When we got there we had a 55 year old man come in for an abscess drain. This man was so thin and frail it was unbelievable. He was in A wheel chair and transferring him to the gurney was a hard process. We watched as the consultant cleaned and numbed the area, which was the lo gets I had seen a doctor wait for the local to work. Most doctors don't wait for the local anesthetic to work and cut into patient before number, The consultant however waited longer than any I had seen but still not quite long enough. The abscess was drained and blood and pus came out. There was a great deal of material in the abscess and draining it took a while and after some time the patient started saying it was very painful inside. The thing was they weren't stopping and the patient started screaming for them to stop and he started kicking the assistant and punching at the doctor. They had to hold him down to finish the dressing. He was instructions to change dressing every 3 days and come back in 6 months. 

The day before I left for safari I went to main theater. Me and Anna were suppose to go see orthopedic surgery but they were not ready so we went into another surgery. This was a 3 month old boy with a grossly  distended abdomen and was suspected to have hirschsprungs. They prepared him and made an  incision and started taking the intestines out. They were very inflamed and full of gas. As they examined them they came to realize the whole colon was dialated which in hirschsprungs the colon should narrow but this boys was dialated all the way to the rectum. The surgeon made a call and then changed his plan. He started taking biopsies along the intestines to find the pathology. He concluded that the distension was idiopathic. So he took 5 biopsies along the intestines and the anus. The results will not come back for about 3 weeks. Until then the boys intestine was cut to make a colostomy. So the intestines were released of the gas and build of feces and then stitched to his side so he would have a colostomy bag for 6 months. If it is hirschsprungs then that area that the nerves have not developed to innervate in will be removed and shortened and he will be ok. However if it is more severe and not this then the boy may have something that will not be able to be fixed and will have a colostomy bag his whole life. Warning graphic pictures ahead. 

  

 

Week Update

Sorry it's been a while since my last post of what I have been doing. It has gotten a bit crazy this past week. After the hospital it has been very busy with the school and spending time with fellow interns who were leaving. Nathan left on Saturday and Laura and Athen left Monday. They are all from the UK. Even though I only knew them 2 weeks I felt like I had known them for years. We had the best times fighting over accents and how words were pronounced. The best part was I started picking up a British accent and didn't even know it. Now that they left I am back to my "American talk". Anna my fellow American left this past Saturday but I left for safari Thursday so I had to say goodbye then. It was very weird coming back and being the only girl. But two girls from Norway came Tuesday morning. So that's a short recap of that now to hospital.

Let's see the last post was about watching a Caesarian section. The day after that I started off with Andrew in pediatrics. The ward round was going on but the area was too small for us to be apart of it so Andrew decided to teach me and Anna the process of examining a child. While teaching us we got to practice the procedures as well. I learned how to listen to pneumonia with a stethoscope and access the general condition of the child. 

 Me at PEDS ward 

After doing a couple rounds in pediatrics Andrew left and me and Anna could not get in with a doctor so we decided to try minor theater but no procedures were happening. We wandered around trying to find a doctor or our fellow interns to follow but could not so we ended up in labor ward again. As we walked in looking for a doctor we walked past a room where the afterbirth was just taking place. I got to experience that after the baby is born the woman gets a shot of oxytocin in her leg to initiate the after birth. During the after birth they must check to make sure all remaining parts of the placenta are removed from the uterus as it will cause bleeding. It was interesting to watch the examination of the placenta and making sure no pieces were left behind. After we watched the after birth we went and stayed with the baby that had just been born. He was in the resuscitaire with an oxygen mask on. The thing about here is that they only had the adult size oxygen mask and not an infant one. The midwife did not even strap it on so when the little boy moved the mask fell off. The midwife did not stay with the child but left so me and Anna stayed with the baby and positioned the mask to fit as much as possible. The baby first opened its eyes while I was rewrapping him in his blanket. I laughed when I saw his huge dark eyes because all I could think about was what he would say " mom the first time I opened my eyes I saw white people!" I could not help it because most young ones are scared of white people or muzungus and they cry if they come near and the fact I was the first person this little boy saw and I was white was kind of funny. But this little baby boy not even 20 minutes old was so cute and well behaved with huge dark eyes and cute little fat rolls. I kept warming him up by rubbing him and he smiled. 

 The first little boy who looked at me 

We left the baby because we heard another birth happening. We walked in and the woman was pushing. I could not wait to see an actual birth. I have never seen one before. The baby was cephalic presentation. I can't even describe the birth. It was fast from when the baby started crowning till the cord was cut. The baby boy was brought to resuscitator and we followed. The boy was shivering  and was cold and the second resuscitator was not working properly so we put the two boys together in the one resuscitator. After warming the boy we went back to the mother and told her about her boy and that he was doing fine. After 15 minutes we were able to being the boy to his mother. The other boy however was not brought to mother as she was still bleeding. She however stopped bleeding 20 minutes later and was fine. 

  The two baby boys  The second baby born 

Now to the crazy part of this day. After staying with those babies Osborne came to labor ward and was talking with me and Anna when all of a sudden this woman screams. Anna and I rush to the room and Osborne follows and right as we walk in Osborne goes into doctor mode and asks for sterile gloves and spirit so we get them for him. The baby was breached and despite telling her not to push the mom pushed and the butt and feet came out first. If I didn't know better I would think this was a Caucasian baby it was so white. The arms were stuck above its head. The consultant came in and helped with procedure because Osborne was just an intern. The horrible thing about this whole procedure was that the umbilical cord was clamped with a clip while the head was still stuck in the cervix. When this happened you could see the baby girl trying to breathe while still in cervix. Being a premed and pushed to the back me and Anna could not say anything or get close but even one of the nurses was like that baby is trying to breathe. It was so frustrating that something so simple was not observed and done. It's the only was the baby was getting oxygen by the cord and by clamping it was trying to breath normally inside. After about 3 minutes the head finally came out but baby was completely white and still. They even showed the baby to the mother before taking it to be resuscitated. The midwife then took baby and we followed and they used suction to clear airways and would touch to stimulate the baby. I stood behind watching this none moving baby get breaths in and then suction and stimulation and repeat for over 5 minutes. I was so concerned and was literally praying for this little girl to make it. We came to learn the mother was having twins and this was the first so we went back in and the consultant was rupturing the membrane for the second baby. This is not what should be done but once again, this is Africa. We went back to little girl and she was starting to respond and trying to breathe but it was paradoxical breathing and had limited movement. We had to leave then but Osborne contact me later and said the second baby was face presentation and was a boy. Both were doing fine. I really wanted to go the next day to the NewBorn unit and check on them but we couldn't. 

After this we went to the school and I taught science and English. It was so fun but I share a classroom with another class so it is very very loud and the children always want my attention or to choose them so they shout "Madame" and snap In my face, which gets very annoying but after telling them to sit down and write they do. We did dancing instead of sports this day because the field was too muddy. These kids are so good at singing and dancing and they love to show you how to do it. I had a boy always grab me to be his partner and would fight other kids who wanted to dance with me.