Tuesday June 8, 2010

This is the 21^st day of our trip and the first time I am finally sitting down to give an update. I’ll try my best to give a short but informative synopsis of the first three weeks but I know that I my attempt will fall short. This experience has been incredible and there is no way I will be able to convey the richness of the past days by trying to describe them from memory. I will start with today and work backwards with the intention of beginning with what is most fresh and in the process jump-start my memory in reverse.

We’re currently in Migori doing rotations at St. Joseph’s Mission Hospital and staying at the guesthouse down the road. For breakfast this morning we had the same thing we do every morning: a hard-boiled egg, sausage, three slices of tomato, toast and tea. Today was the first day Michelle wouldn’t take one of the extra sausages. If you’d been with us for previous breakfasts' you’d understand the magnitude of this event. Needless to say, some variety would be nice.

After breakfast we went to the hospital and met Dr. Agullo in his office. We heard the hospital statistics for the previous day and reviewed the cases of the three patients who died, two of whom were children. It is not uncommon for children to be brought to the hospital after they have been very sick for a number of days. Part of this is due to the financial situation of many of the families and part of it has to do with subsistence farmers not appreciating the severity of their children’s sickness until it is too late. Both of the children died within 24 hours of being admitted. Severe anemia as a complication of severe malaria was implicated in both. Although it was agreed that nothing could have been done to save the children, Dr. Agullo was concerned that the staff did not respond fast enough when the condition of one child worsened during the early morning. “Let us not lose children because we are not responding fast enough,” he said.

After the meeting we went to x-ray room to watch a hysterosalpinogram in which fluorescent dye was is to visualize the uterus and fallopian tubes. The patient was a woman who could not conceive. Once on the examination table, Dr. Agullo asked her how long she had been married (5 years), how many children she had (none), and whether or not her husband had a “co-wife” (he did not). After that we all headed to our prospective wards.

Michelle and I accompanied Dr. Agullo to maternity while Jamie and Jessica went to outpatient. Joshua and Nikki rounded on the medical ward and Jeanette was in pediatrics. We first checked on a woman who had been in the hospital for three days with a pregnancy that was two weeks overdue and a delivery that was not progressing. When Dr. Agullo found that she was no more dilated than she was the night before, he ordered an emergency c-section. Despite mild concerns, the baby’s heartbeat was loud and regular.

We also checked on an Indian woman who had given birth during the night. It was really neat to see a large Indian family in the maternity ward of a Kenyan hospital excitedly chatting with Dr. Agullo in fluent Swahili. With two American medical students in the room, it was certainly a cool international moment.

While they prepared the surgical theater for the cesarean, we continued on our rounds and found a young woman who was admitted late the previous afternoon due to an infection she acquired after the home abortion of her 5-month old fetus. We later found out from one of the nurses that abortions are illegal in Kenya. The woman was in severe pain and was resistant to even the lightest touch. Dr. Agullo called for an investigatory laparotomy. We finished rounding and Michelle and I wrote the discharge notes while Dr. Agullo went back to his office.

The notes done, we rushed over to the theater and changed into our scrubs. Michelle scrubbed in while I got my camera ready for the first c-section either one of us had seen. Dr. Agullo finally arrived and the procedure began without incident. As soon as the uterus was opened and the baby was visible, it was clear that this was not going to be the happy occasion we had all hoped for. It was immediately clear that the baby was slightly blue and as he was pulled out we could see that the umbilical cord was wrapped around his neck. Feces were covering the lower half of its body, an indication of traumatic labor, and the were no signs of movement or breathing. The anesthetists tried to resuscitate the baby while Michelle and Dr. Agullo closed the incision. Their attempts were unsuccessful. The baby was placed on the scale and then wrapped in a blanket and removed from the room. It weighed 4.2 kg. I didn’t end up taking many pictures; it didn’t feel like the right time.

When the procedure was over the three of us returned to Dr. Agullo’s office to see outpatients during the 30 minutes it would take the surgical staff to prepare the room for the laparotomy. During that time we saw the woman whom we imaged earlier in the morning and the husband of the woman we had just operated on. The first woman turned out to have an abnormally shaped uterus with two uterine cavities instead of one. On film, it looked like a compressed cartoon heart. Only the left lobe had an associated fallopian tube and ovary. Agullo suggested uterine reconstructive surgery and the woman left the office like most of the patients we’ve see in Kenyan, without affect. The would-be father was more engaged in the interaction with Agullo, perhaps because he spoke better English, but was nevertheless stoic in his response. He thanked Dr. Agullo for all of his work and left.

At 1:00 pm we returned to the operating theater (without lunch) for the exploratory laparoscopy and I scrubbed in. When we got into the room, we found that Nikki and Joshua were already there and that Joshua had already scrubbed-in and gloved-up. Joshua addressed the situation in characteristic fashion by replying to my inquiry about who should assist by saying, “as far as I am concerned, the more the merrier.” The operation went well but on gross examination nothing abnormal was found that could be causing the woman’s pain. At the end of the operation, Dr. Agullo returned to his office and left Joshua to place the last few sutures. It was pretty cool and somewhat nerve-racking to be at the table without a physician. In the end, Joshua did a great job and we both left the room happy.

The four of us returned to the guesthouse and ate rice, greens, and eggs for lunch. I did some laundry and Jamie, Jessica, Michelle, and I returned to the hospital at four to attend a weekly mass for the staff and any sick patients wishing to attend. When attendance was found to be wanting, the priest decided to postpone the service until next week. We stopped at the canteen for a ginger soda and headed back to the house for some rest and relaxation. I read a few chapters in “The Lost Art of Healing,” a book that Tina gave me as a graduation present and listened to some music that Justin put on my iPod. We ate dinner, watched Anchorman, and now I am finishing up this first post. I am not sure I like how it is turning out, heavy on the narrative and lacking in my impressions and feelings about what has been going on. Hopefully if I keep this up I can strike a balance between the two. As far as the synopsis goes, I guess it will have to wait. You will have to be patient not knowing who any of the people are that I referenced. I will try to describe them too when I have the change. For now you should know that everyone on this trip is great. I could not have asked for a better arrangement or a better group of people and students to be travelling with. Anyway, it’s getting late and we have to be at the hospital by 8 am tomorrow morning.