The weekend and some pictures 

So it's been three days in the hospital since my last post but before I get to the hospital let me e plain my weekend. Saturday morning we had three teachers from the school come and teach them how to swim. They knew the basics so we took the first hour teaching then spent the next 2 playing with beach balls and races. It was quite an eventful morning. We then laid around the afternoon and then went downtown to Cafe Mocha and had milkshakes. It's weird cuz their chocolate is salty. They put salt in everything here so it was good but one of the interns got a brownie and some bites were fine but others salty. 

Sunday was a great experience for me. I got to go to mass. Me and a fellow intern Simon are both catholic and one of our operation assistants Benson is too and he took us with him to mass on Sunday. We went at 8 it was a beautiful little church. The singing was absolutely amazing. They have drums and the women echo the men. It was in English but certain prayers were in Swahili. I felt such at home being in mass. I was so happy and I get to go again. It was just funny that me and Simon were the only white or even light skinned in the whole church. 

When we got back me and the boys walked down to the beach where the girls were. The beach is white sand and not many people were there but later In the evening it got busy. I got to ride a camel along the beach with the other American Anna. It was so fun and so high. Jamal was the name of the camel and he was huge. We got like a 5 min ride up and down the beach. It was so cool. 

The kids at the school. We were the winning team!

Me teaching a class of 12 kids math. 

Playing futbol with the kids

Our residence 

Labor ward

Tuesday and part of Wednesday I went to the Labor ward. In the morning there is a consultant there and they do ward rounds. This is where the consultant has the medical students go around to each patient and read their charts and come up with what the plan should be. Most women were in active labor so most of the plans where do a VE (vaginal examination) and monitor labor progress. Some women who have had no progress in labor for hours, such as they have stayed at the same dilation for over 3 hours they Are put on a list for an emergency C section. There are many c/s done here. The consultant says it is better to take them to c section than risk the baby and have that risk on you. I could not go yet to see the procedure until my letter from the chief came in. 

On Tuesday after ward rounds all morning an hour before I left a woman came in from another clinic and was severely bleeding and they had lost the fetal heart rate. I believe when this occurs in the States or the UK, as the two midwives here told me, they would take her straight to Surgery and do a C/S. however the doctor had to take blood samples and after 20 minutes of her being there in the ward the doctor decided to do a speculum. As he was positioning her and removed the gauze and placed her feet in stirrups, she had an  ante partum hemorrhage. The blood and amniotic fluid went all over the floor and the woman was screaming. As the doctor did the speculum and used gauze to pull out the clots and blood out of the vagina to see cervix he determined it was an abruption. This was because the placenta had detached from the uterine wall. I had to leave after the speculum but asked the following day and she had a delivery but the baby was a still born. 

I have yet to see an actually birth yet, all the women were in active labor but not close enough to actually deliver. I hope to come back and see and vaginal birth and a c/s. I am going to minor theater for surgery later this week and the male medical ward. 

Antenatal 

For the past two days I have been following Osbourne through the antenatal ward. This is where pregnant women who have any problems come here. The thing about Kenya is healthcare is free. You can come and check In for free and a lot of treatments are free. Some scans and other tests do cost money but very cheap. So pregnant women come in all the time. They come with dizziness to malaria to premature membrane rupture. 

On Thursday while I was waiting for Osbourne I went to the New born unit (NBU) and told them I was waiting for the doctor. I dress in a lab coat and everything so I look like a doctor so the sister was like ok while you are waiting go and see patients. I was like I am sorry I can't I am a premed student. The sister didn't quite u dear stand and so I waited and then left to call and found out I was in the wrong area. It was just funny that I got asked to go see patients while in the States that would never happen. 

The ward is a big hallway almost with 6-7 rooms on each side. Each room just has a bed and little dresser side table. The beds though have no sheets it is just a plastic mattress cover which are never clean and have spots. The women come in all with their own sarongs to lay on but the sanitary conditions are very bad. The tops of the rooms are all open and there are just a 8 ft wall between each room and no curtain or doors. I have come to learn that privacy is not really a practice here. There will be a physical exam going on and 5 people will just walk in and out of the room. It's very different with their mentality and I guess they have to be used to things like that. 

Thursday was very interesting in learning how they examin pregnant woman and access her and the babies' health. They do everything manually. I learned how to determine the gestation stage by pressing and finding the fundal height with your fingers. They "rule" they use is I finger is equally to 2 cm which is equal to 2 weeks. So they naval or umbilical region is considered 20 weeks plus or minus 2 and then how many fingers above is how many you add. I got to determine and check with the clinical officer ( which is our equivalent to a a physician assistant) and determined a woman was 22 weeks. 

Malaria is very common down here and of course it causes problems in pregnancy. So in order to treat it they insert a cannula and put Quinonine on a drip for 4 hours then another one for 4 more hours. It's a very long process. I watched the inserti g of a cannula twice and then got to tape the cannula and insert the IV. The woman had to leave for a urine sample so I got to take it out and put it back but it blocked and the drip would not work. So in order to check I got a syringe and water to flush. I did this to also check that the cannula was still in the vein and not in the tissues. I then inserted the IV again and set the drip speed. 

After the ward rounds Osbourne taught me how to do history taking and accessing the patient from his medical book. I got to see how they access each patient and how they check routinely for jaundice, pallor, edema, cyanosis, capillary refill, dehydration, and lymph nodes. In the next coming weeks he will teach me how to listen and check the respiratory system with stethoscope and cardiovascular and other systems it is very exciting. I also will learn how to do a VE or vaginal exam to check dilation of the cervix and use the Bishops score.  

I got a small cold Friday morning so after hospital took a nice nap before the farewell BBQ for one of the English interns Kris. It was cool because a lot of the doctors came to our compound and we got to talk and teach about our culture. Saturday was a really calm day. We actually taught two of the teachers from the school to swim this morning and one of our interns. They made so much progress. It was so amazing. Even on our day off we get to do fun things and teach and be with the people and learn more about Kenya and the way of life here. It's both a medical and cultural experience. 

Gynecology 

Today I went into Ward 9 which is gynecology. I was a bit nervous it being my first rotation but excited. The hospital is so big that finding the way around is confusing, took me 20 minutes to get to the right place. I was placed with Dr. Osbourne. He is a medical intern and this was his first day as well in gynecology. Just a warning: I talk about the procedure below so may be too detailed and graphic for some so read on at your own wish. 

When I got there he was in the middle of a procedure. A woman that had an IUFD ( intrauterine fetal death) earlier and now because her cervix was closing the blood was clotting in uterus. These clots needed to be removed. We did an NVA. Used a cannula and placed inside cervix and the vacuum created in the tube would then allow for the clots to be suctioned out.  We spent over 40 minutes doing this because we had to continue until there were no clots and just fresh blood present. The conditions are, as you can imagine, less than ideal and proper placement of materials as well as the disposal of blood was not practiced. Makes me very grateful for the doctors, materials, and resources we have in the US. 

Dr. Osbourne said they really should have pain meds before procedure but because of resources they are only given after. This woman had a lot of discomfort but like all Kenyans was tough as nails. 

After the procedure Osbourne explained to me the cleaning process and I helped clean the tools. The metal was going to be autoclaved later but the plastic was dipped in chlorine then rinsed then soapy water then rinsed again and put Into another sterilizing solution.  It is very hard to watch this when accustomed to disposing of everything after one time use but they are very frugal here and must sterilize (to their standars) and reuse. They do try to be sterile as much as possible but it is from from the aseptic technique that should be practiced. 

After the procedure all the doctors and nurses went Into this conference room and we listened to a presentation on Cardiac Disease in pregnancy. It was very in depth but very interesting to learn. Some of the information I knew other parts not at all. It was interesting to experience the classroom setting with professionals. 

After the lesson we went and check on a woman who had had a septic abortion a couple days to a week ago. She was on antibiotics but was getting worse with a fever and she had a hard time breathing. Every breath she took you could hear all the mucus in her lungs. Osbourne said gravity and walking around would help it work it's way day out of her lungs but with her fever she has not been walking around so it's sitting In her lungs. They were going to put her on a nebulizer to loosen up the mucus to expel it. We put a  cannula in the vein on her hand and was taught how to see if it was in correctly and flush it to see if the tissue around swells it means it is not in. We had to do this because the woman was anemic so once the cannula was in no blood came out. It didn't swell so we knew it was in correctly. We tested her blood glucose level too before I had to leave. They also wanted to give her oxygen but the main doctor said no. I wanted to stay and help and see the treatment further but my time was up there.

Some of the school children came today to our pool and we taught them to swim. It is so amazing how involved we get to be with the children and this school. I can not believe I get to help Kenya children know how to swim and hold their breath. We got to play with a beach ball with them and race and a bunch of little games. They are so sweet and want to play with white people and all us interns all the time. It was so  fun. 

First day in hospital

Today was my first day going to the hospital. I actually slept through the whole night. I am really hoping that jetlag does not catch up to me. Woke up around 7 and got ready to go. The other interns left at 8 and me and the new intern left at 8:30. We went to the hospital in a tuk tuk. It's a three wheeled big mopead with a seat in the back 3 can fit and then driver in front. It was so fun driving through the streets In an open vehicle and seeing people. People walk everywhere and walk along the road. Being white and a female people stop and stare when we drove by. It's not a bad stare people here are very very nice and always shake your hand and say hi. It's very different just always getting looked at and being different. 

We got to hospital,and got our placements first. I will be doing for one week each internal medicine, surgery, gynecology and obstetrics, and then pediatrics. After placements we met Anthony and he took us around and gave the tour. The hospital is big. So much bigger than what you would think. The building with wards was built in '81. It's amazing what they have built in the area. 

They have so many different areas. We saw the maternity ward, post and prenatal, the delivery area, we went and saw pediatric ward, dialysis, accident and emergency, medical wards, and ENT. They have both wards and then outpatient clinics. The outpatient clinics are only open certain days and there are many many people lined up. 

I am so excited to do rotation in the maternity ward and be in delivery room. Two interns her from England are studying to be midwives and I am so interested in their stories. There is one other American here from Texas but 4 from England and 3 from Australia. Us two Americans are the only premed everyone else are med students. So it is nice to be with them and they said if I don't understand things to definitely ask them. It is exactly what I was hoping for with med students taking me under there wing. 

We went after hospital today to a school. We got to go in the classrooms and help teach and play with the kids. We got to go to then to the space next to their school and play relay games and then football ( soccer) my team won two of the relays. It was so much fun. The kids are as tough as nails. They get hit and just go with it even if they are in pain. 

 We go to the school Monday and Tuesdays and then one class comes to our compound for swimming lessons. So it will be so amazing to help with that. Had chipatis tonight first time they were delicious. And my new Australian friends bought baked beans to do beans on toast. Can't wait to try that. It's full of adventures! 

First step in Africa 

After the a 13 hour flight from DC I am finally in Africa. Addis Ababa Ethiopia. It is kinda of surreal for me because I can not believe I am actually here! It was so eye opening the first thing I saw from the plane was flying over neighborhoods. It's what you see in photos from here but seeing it first hand really makes it real. The houses are squished together in a block. They are practically on top of each other. The roofs look like flimsy tin and aluminum. It was a humbling experience seeing that in contrast to this huge high tech plane I was on. Let the humbleness begin. I already feel so privileged in what I have and everything I have in the states. 

Well, language barrier. Let me tell you. That is a true barrier. I thought I would be ok but a guy came up to me and was asking me something And I could not tell if he was speaking English or not. People here are really soft spoken. I felt so confused and just shook my head said sorry and walked to find where I was going. US airports are very clear on their signs and directions. Not here. I searched terminal 2 for 15 minutes until I figured how to get to terminal 1. It is quite scary being alone and not having someone else to confide in and make decisions. First step I am growing up in is being brave. Brave in asking questions even if I look silly and being ok with being a bit confused. Through this bravery I got to where I need to be and am waiting for boarding time. More than half way there!, 

Well I made it. Got picture at airport with my sign and everything. Driving to the resident was so cool. The traffic here is crazy. No rules at all you want to go to an intersection you just go in and honk. No American could drive here for sure. 

Got to residence and met Dolles the house keeper. So sweet. And then Benson and the three Australian students played soccer In our court yard. It was so much fun. Barefoot soccer in Kenya with 3 Australians and 2 Kenyans! How many people can say that! And preformed first medical procedure......on myself. Scrapped and took off a big chunk of toenail. So first aid kit came in use today! It has been such an experience already. Can't wait for first day in hospital tomorrow. 

2 weeks till takeoff

I am exactly 2 weeks out from jetting off to an adventure that will definitely change my life. The excitement right now is also mixed with an increased sense of nervousness. I am starting to pack and prepare things to go and it is becoming more and more real with each item. I am sitting in the mountains right now and I can't help but think of the amazingly different scenery and environment I will be in. I am very excited to meet the people there. The children and doctors and my fellow interns. I have realized more things I want out of this trip. I am so excited to first get the clinical experience and see many diseases and illnesses and how they are treated In a remote area. Secondly, I am so excited to immerse myself in a completely different and new culture. I desire to come back more humble and with a greater appreciation of the opportunity and blessings I have here back in the states. No matter the challenges there I know I will never regret this experience. I hope my next post will be when I am on my way, 9,093 miles from home.