***This post is more laden with health care references and might be a bit uninteresting to my non-medical peeps. But I hope you give it a go anyway :] Also, permission was granted by each client before using their photo.
In my four short years of inpatient care at large facilities I have come to find that American hospitals are more so large businesses with ill clientele rather than places of healing and refuge for the sick. Perhaps this is part of the reason why it has been an interesting transition from working in a large facility of Western medicine with patient surveys and resources galore and to a rural village clinic. I know this is sort of like comparing apples to oranges but the hypochondriac patients are nowhere to be found, there appears to be no sense of entitlement, and I can tell many are just grateful to have access to affordable care near their home.
And I really just have to tell myself to turn my ICU brain off and have come to find that the motto here is “give the best care you can with what you have.” On my first day I remember finding it a bit unnerving to place an intravenous line (aka an IV) without gloves and using needles that don’t have safety mechanisms on them to protect the clinician…but when resources are limited, again I go back to the motto. Of course, this does not imply that they give insufficient care here. In fact, not being able to magically get a 12 lead EKG or get a detailed health history forces the staff here to be more in tune with relying on their clinical skills of observation. Also, the clinic recently had a visit from the Kenyan Ministry of Health and were given a pretty stellar review.! Michelle has even worked to implement an electronic form of charting, known to many in America as an Electronic Medical Record (EMR). This is probably the only rural village clinic in the country that has converted to an electronic system, so it’s been pretty exciting for the staff and Michelle to grow this ministry in a way that will help provide more efficient and organized care.
While Hope Matters International offers more than medical support to the community, their Village of Hope Medical Centre focuses mainly on providing the community with walk-in urgent care treatment, maternal child health/prenatal care, diabetic counseling, and will soon be offering dental services! The clinic also has an onsite diagnostic laboratory that provides testing for the most common ailments in this patient population. The day to day patient demographic is most often composed of people with malaria, typhoid, gastric ulcers/infections, and those needing chronic wound management. I explained to one of the clinicians that I had never treated malaria before and hoped to learn more about the course of treatment and the disease process. She stared at me for a second in disbelief and said, “Never? You’ve never seen a malaria case?” I wasn’t sure if I should feel blessed or ashamed…and not to get all Miss-Frizzle-Magic-School-Bus on you, but let me give you the quick and dirty low down.
Basically malaria starts with a parasite carried by mosquitos causing persistent fevers, gastrointestinal disturbance like vomiting/diarrhea (which then causes dehydration), and terrible body aches and pains. Most everyone in Kenya gets it at least once (and often several times) in their lifetime. Due to it’s prevalence, it is highly recommended to take anti-malaria pills for visitors and for the general public to utilize mosquito sleeping nets. Call me a princess but I actually have grown to love my net and I pretend it’s the canopy bed my parents never purchased for me. Unfortunately if the disease progresses to a severe stage, patients suffer from convulsions/seizures from the persistent fevers, have respiratory distress, low blood pressure, anemia, severe dehydration from the inability to eat/drink, and loss of consciousness (among other things). I haven’t been here long but every day there seems to be children presenting with rampant, gnarly fevers as high as 103-104 degrees and are crazy dehydrated. So by the time they get to us we often need to give intravenous fluids and antibiotics. The cure is in fact antibiotics but I’ll spare you and not nerd out over the pharmacologic treatment here. PS I know I didn’t properly cite each piece but click here for the published guidelines from the Kenyan Ministry of Health!
However, I will say that in general, giving medicines via intramuscular injections (for my non-medical folk think any vaccination/shot you’ve been given) seems to be the gold standard for non-emergent cases as time, space, and resources do not always allow us to admit every patient for a course of IV drugs and antibiotics. And I know back home we generally go for shots in the arm but because the glutes are a larger muscle group and much of the community is malnourished, we just go straight for the buttocks (I have never given more booty injections in my life until I volunteered in Africa). In fact, before I even attempt to sloppily mime/use broken Swahili to explain the treatment plan, most patients are already pulling down their trousers to expose the top of one cheek, knowing that gluteal injections are just the norm when receiving treatment. After an initial intramuscular injection of a drug that is needed more quickly than it would take to swallow and absorb, it is then we would send them home with oral medicine.
Twice a week we have scheduled dressing changes for specific chronic wound patients. This past Friday I had the pleasure of tending to three of our wound clients and was astounded to hear the length of time they have been afflicted with caring for their injury…from three months to over two years! Can you imagine having an infected cut for two and a half years?! Because the cleanliness of an environment and nutrition play a large role in wound healing, these acute injuries often turn chronic. When you have a large open area of skin and go home to a mud hut with dirt floors, probably can’t afford to take time off from work to let it heal, and then do not have a protein and nutrient rich diet always available to aid your body in the healing process, well it all just makes for a complicated situation. It pained me to tend to a chronic leg wound of a child as I couldn’t help but think that back home as an inpatient we probably would have pre-medicated the child with IV pain meds and numbed the site with a numbing agent to try and combat the imminent pain before taking down the dressing. But again, here we do what we can with what we have so I tenderly redressed his wound, repeating pole, which is Swahili for “sorry,” over and over as the child grit their teeth and released a few silent tears. This made me think about my initial desire to enter the realm of pediatric medicine but after struggling to get an IV in dehydrated screaming three year old…well, maybe I’ll stick with my adult homies for now.
I can’t believe I’ve just hit the halfway point of my trip. This past weekend I crashed a Kenyan wedding with my host family but I’ll get into the details of that later this week. Oh and I befriended this little guy, too.
Cheers and keep on wishin’!