Tenwek is amazing. Where most mission hospitals have a handful of western-trained physicians, Tenwek has a dozen. Where other hospitals have a few visiting docs, Tenwek has a houseful of docs with specialties ranging from ENT (Ear-Nose Throat) to Urology. This last week, a team of cardiac surgeons, anesthetists and cardiac by-pass technicians replaced heart valves at an amazing rate, doing several in a day. They will be here for another week. They are training the Kenyan nurses in the techniques of open heart surgery, cardiac anesthesia as well as the pump routines. In consequence the wards are filled with children who have huge dilated hearts from the effects of Rheumatic Heart Disease and the scarring of the heart valves which frequently happens. I have never seen the concentration of this disease in my career; I have a half dozen at the moment and it allows me to get a great deal of experience in caring for this important condition.
In a lot of ways, however, Tenwek is a typical “mission hospital;” the wards are crowded with the diseases of the poor: tuberculosis, AIDS, trauma, massive burns, pneumonia, congenital defects, malnutrition and malaria. There is also the typical menagerie of medical rarities, human tragedies and colorful stories. The hours are long: 8AM to 7PM. The call schedule daunting. The usual actions of medical care are compounded by an overworked staff who do not speak (my) English. It takes several phone calls to get a whirlpool treatment for a girl with Stevens-Johnson syndrome, causing blisters over most of her body; that is, however, it takes several calls to get assent in principle for the treatment, the 5 year old girl has yet to actually get it. Labs are neglected or misplaced; unfamiliar treatments are merely ignored. On the upside, quinine is given on time and accurately, nurses make a point in the gentle accent which English takes in East Africa, to bring the over-looked needs of anxious parents to the attention of a passing, harried and distracted doctor.
The general chaos is multiplied by the fact that it is “logical July.” July, as many may know, is NOT the time to be sick in a teaching hospital in the USA; new residents and interns are just figuring out how to begin their training and much time and effort is expended in caring for their needs as well as the patients. In Kenya, this start of the academic year is in January. We are doing daily training rounds for all the Clinical Officers and Medical Officers in resuscitation and intubation; the deer-in –the –headlight look is epidemic in the ranks. Medical Officers, by the way, are interns and will be here for but one year. Clinical Officers, who operate rather like Physician Assistants” are not MD’s but for my purposes in the Pediatric Ward are much the same in function.
The hospital, like so many mission hospitals, is built going up and down a rather steep slope. Top floors of one building bridge over onto bottom floors of other buildings in the long low architecture of third world hospitals.
In contrast, the new surgical theatre building is tall, with clean lines, tile roofs and marble floors. As in most busy mission hospitals, Surgery casts a large shadow over other specialties. The thinking being (and accurately I have to admit), that surgery requires no ongoing expense and compliance from a population which is cash-strapped and uneducated in the need for long term medical management. We have just gotten a girl successfully out of ICU after coming in with diabetic coma, after the family failed to buy more insulin due to its cost, about $4 for the month.
I have been given a room at the guest house; think of it as your freshman dorm room without the acne and posters. It is spare, cinderblock, chintz curtains covering large unscreened (“Keep them closed at night and take your anti-malaria treatments!”) windows with a small bathroom with drizzle (calling this a shower is inappropriate) and an efficiency kitchen. The bed is lumpy and with the mosquito net, claustrophobic, the furniture is limited and of local (approximate) manufacture; the food is plentiful but bland (working on finishing off a bottle of Kenyan Tabasco sauce in consequence); and then there is a Kenyan Canary (donkey) who has insomnia, judging by his singing all night. I am where I should be.
One sad story: a baby a few days old was treated with traditional medicine. This meant that the infants was treated by passing her repeatedly over a steam bath filled with the “herbal medicine.” She suffered 85% second degree burns. She was repeatedly treated in this fashion for two more days before coming to the hospital. She survived for a scant two days more.
The mortality rate among young infants is daunting, but even those who survive infancy are not proof from disease. A 10 year old girl who was brought in due to confusion rapidly slipped into a coma and after ten days on a ventilator without any improvement was taken off life-support at the parents’ request and my agreement. We have no idea what poisoned/ infected her. Diagnoses ranged from insecticide to rabies. I pronounced her and, as I was filling out the paperwork, her father carried the shrouded body of his eldest child home to bury.
I went walking last weekend (as I was on call-this last weekend, I had precious little time to sleep). A wazungu (Westerner) and a camera was too much of a temptation for two school-girls I met. They demanded that I take their pictures and then one of them wanted to see my (very odd) glasses. The photos speak for themselves.
What they do not show was that I had to bargain for my glasses back again, much to the hilarity of the assembled kids. Children are the most seductive of humans; how else would we choose to feed, cloth and house them for so long.
The Kipsigi children of Kenya, are bright, smiling and engaging with none of the stern reserve that is shown by their parents at first meeting. I have found that parents hearts are softened and sensitized by the plights and pleasures of their children. Bringing a smile to a young patient by making faces at them during rounds is frequently followed by giggles and embarrassed smiles from behind the hands of a seemingly dour mother . My attempts at Swahili are guaranteed to bring laughter even as the pronunciation and grammar are corrected with a “polae polae, sawa sawa” (excuse me! Perfect!).
Jesus Heals at Tenwek as in the whole of Creation. The missionary doctors’ prayer which I find I recite daily:
“Lord, my Creator, You have made us and you know us from the smallest part even before we ourselves were born. You have made and sustain us minute by minute. Lord, my Master, I do not know why this child has been sickened so terribly. His pain is beyond what I can do to help him. You have allowed me to ask for what I want and it is for his complete healing I ask. That is what I want; but I want more to be your creature and servant. I pray that your will be done on this earth. Lord, we praise you for your sending out savior Jesus, who was wounded for our healing. Bring Your peace to this family in whatever happens. It is in your Son’s name, my savior I ask this.”
Relayed by Dr Walt January 27, 2010 2:14:33 PM EST
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