First Day on the Wards

Thursday was a very busy day - I wrote this then and just have had the chance to post it now!

I met the resident and staff physician from Providence Portland Health System that are on my medicine team at 7:30 for breakfast, and we've been going non-stop until now. We rounded all morning with our Kenyan counterparts on the team through one-half of the men's ward. Our patients are very sick - probably the most sickly people I have ever seen. Most are malnourished and have hollowed-out faces with glazed over eyes. Their diseases range from pericarditis, meningitis, sepsis, and tuberculosis, and 2/3 are HIV-positive.

Interestingly, we don't use the term "HIV-positive", because of the stigma associated with the label. Instead, we say "ISS positive" which stands for Immune Suppression Status positive, and we call the HIV test the "DTC test" or Direct Testing Counseling test. Following this sentiment, patients often refuse wearing masks if they are HIV-positive or TB-positive, because of the assumption people make when they see them wearing the mask. This, along with poor sanitation and the fact that up to 3 patients share a twin-sized bed increases the patient-to-patient spread of disease. For example, TB pneumonia is considered a hospital-acquired pneumonia at the hospital, which is absurd to fathom for those of us used to working in the US.

The nursing care is poor, and it is not uncommon for patients not to have received their medicines because the nurses didn't feel like giving them. Often, family members are at the bedside of their sick loved one, and perform a majority of the care including feeding, bathing, and rotating the patient in the bed. Coupled to the poor nursing care is unreliable laboratory testing, which takes on average 1-day to 1-week longer for most testing to be completed. For example, a simple CBC takes about 24 hours to be completed here, whereas in the US tests return in a couple hours usually.

Physicians here also have to be conscious of the cost of caring for the patients, because almost all of them are uninsured and pay cash for services. The hospital is notorious for riding the families for payment, so most people refuse tests or medicines if they cannot find the money. This is especially troublesome for some of our patients with altered mental status that are HIV-positive and need a head CT. This costs 5,000 kenyan shillings (ksh) which equates to about $71, which seems reasonable at first glance, but when you consider that the average family income is $7,000 per year ($100), you can see what a huge expense this is for these people. And at discharge, if the patient cannot pay his balance, he is not allowed to leave the hospital and remains in his hospital bed until he does. This leads to many becomming ill from acquiring infections from other patients, and the patient is often readmitted without ever leaving his bed.

Despite these frustrating circumstances, people are treated and helped by the services through the hospital. The AMPATH program is a shining star of the hospital/university, as they are successfully treating 86,000 Kenyans with HIV currently and have been keeping excellent medical records modeled after Wishard Hospital in Indianapolis. I hope the next few weeks will provide more positive outcomes I can share with you!

This evening, on the way home from the hospital we bought grilled corn from a woman on the street. Our attending physician had talked to her earlier in the day and found our her husband has recently died, leaving her to care for their 5 children (one little one pictured beside her above). Despite looking delicious, the corn was not the expected sweet corn, but actually maize (or feed corn) and was very tough and bland in flavor. No worries, though, because we had dinner at IU house shortly with a post-meal fireside chat with Dr. Mamlin who founded the IU-Kenya partnership.

Dr. Mamlin discussed living life as a global health professional, which was very interesting. He encouraged us to find our own way to contribute to the care of the underserved, be it in the US or abroad. "Don't pick a project because you know it'll work out. That's no fun," he said. He challenged us to find our opportunities where we can, sharing his theory that medical schools provide a great environment to establish programs to educate and promote development of health care systems for the underserved.

I'm certain tomorrow morning will be eventful as well at the hospital, seeing as I make it through my morning jog with my wonderful resident Chloe and her peer from Portland, Megan. My next post will be Sunday or Monday with plenty of pictures from Hell's Gate!