An Update on Teddy....a little about Me, Too

June marks my sixth month working in Kenya.  The types of surgeries here and the challenge of taking care of such complicated patients is becoming more familiar and is definitely the best part of my job.

This is a patient (Janet) that I wrote about in "Ruptured Uterus."  After her C-hyst, she developed a horrible pelvic abcess that required 5 trips to the OR for wash-outs.  She was intubated and extubated multiple times.  We had her on TPN (very expensive in Kenya) and Lovenox in hopes that she would remain strong nutritionally and not develop a DVT.  Miraculously, Janet has pulled through and has recovered from an obstructed labor with ruptured uterus / pelvic abscess and anterior abdominal wall wound breakdown, to just having an area of 6x3 inches that is yet to heal.  Through it all, she has been smiling and lovely person to take care of.  Her bill is very great for her family to have to pay; please pray for them as they try to find the funding to take her home.

This is a solid ovarian tumor ~ 15 cm that was chronically torsed.  If you look in the picture - center - you can see the point of torsion.  The lady presented with a complain of an abdominal mass for 3 weeks.  Time is always a questionable thing in Kenya.

An amazing 12 fetus that I removed today from a lady who presented with an ectopic pregnancy at the fibria of the tube.  On ultrasound, I saw this little guy happily kicking away against the back drop of about 2 liters of blood that was in the abdomen.

Outside the OR, I have been pleasantly surprised at how much I enjoy being involved with the education of the interns.

As I have mentioned in previous blogs, the interns in Kenya have finished a general medical school training program and now must complete a one year internship.  The intern year is comprised of 4 rotations: medicine, peds, surgery and ob - 3 months on each service.  Then each intern is expected to be able to work indepently at a district hospital as a generalist.  So, in 3 months, I must teach the interns to do C sections, D&Cs, tubal ligations and to work up ob patients.  To me, it is a daunting system and I am AMAZED at how sharp some of these young people are!

I have become very interested in trying to improve education in Ob and also, to make some resources more available to the interns.  For example, many of them do not have proper eye protection to wear in the OR for cases.  The OB triage does not stock supplies to do nitrazine or ferning to check for rupture of membranes (only a speculum exam to check for pooling or ultrasound to check AFI).  So, I coordinated efforts with the nursing supervisor to get an OB intern "locker" on the ward.  It is stocked with various goodies: masks with face shields, nitrazine paper, microscope slides, sterile swabs, extra ultrasound gel, extra KY jelly --- and I hide my good forceps in there!  All of you who have sent me supplies - chances are - it is now in the intern locker!

I have also had a lot of fun with the interns by having "knot-tying" parties at my house.  Many are not given any formal instruction on suturing or knot-tying - they are just expected to watch and learn.  We have had a few evenings of "practice" with expired suture, tying knots on my couch cushions and suturing lacerations I cut into towels.  Then, after all the hard work - we have cake or cookies!

I think they are saying,"Yes, we DO love Dr. Huber!"

All grown up....and operating with me......*sniffle*

I recently learned that the interns are not provided with an OB textbook for their rotation.  Many have some sort of text left over from their studies in medical school, but nothing formal is recommended.  My partner, OtherDoc, made a booklet of all or Tenwek guidelines - new this year - which is a great reference material when doing admissions or needing quick facts.  I am in the process of looking at the possibility of purchasing 4-6 OB textbooks for the interns.  Something with details, but also not so dense that it will prohibit being carried easily.  The books will be the property of the rotation and will be passed from one group to the next every 3 months. 

Please remember me as I strive to be a role model (scary, I know!) and a teacher to these great young people.  There are many things I could use in my educational endeavors that are difficult to get here in Kenya so I am trying to be creative AND comprehensive.


Now, while I have been busy teaching and surgerizing at the hospital, Teddy has been busy....well....being TEDDY. 

 Here he is playing with what I like to call "the most expensive cat toy EVER," otherwise known as my iPod headphones.  While I was on vacay in Ireland, he decided to chew on them and now they don't work.  Now they belong to him.  Thanks, Ted.

 He has also been busy getting into things around the house.  He got into something that caused a big snarly knot in his fur.  I couldn't brush it out, so I cut it out.  Hence the little bald spot seen above.  Pay back for the headphones!!!

I was lucky enough to trade in my previous couch for a different one.  This one is more comfortable and it came with a loveseat, too.  Of course, Teddy has claimed both pieces of furniture as new napping spots!