Saturday

It's Saturday.

Teddy played in the mosquito net, while I slept in. 

After a breakfast of juice, pineapple and crepes with powdered sugar, I decided to visit some of the neighbors. 

For some, it was a day for chores....

For my co-worker's pet turtles, it was a day to...... well, whatever.

Meanwhile, those who had the weekend off gathered for a rousing game of ulimate frisbee.

 Followed by some Kenyan soccer practice.

Meanwhile, at the hospital, my quads are still hanging in there.  They are now day of life # 27.

All have had problems with gaining weight, temperature instability and scares with necrotizing enterocolitis (an infection that can be deadly for premature babies).   Their mom had to be taken back to the operating room because of a wound infection from her C section incision.

However, as of now, all babies are still surviving and mom's incision is now healing beautifully.

Please continue to remember them, and all of us here at Tenwek, in your prayers!

Hope your weekend is wonderful and relaxing!

Ahhh....Interesting.....

This is for all the students...who are now the teachers.....

An exciting thing to happen recently at Tenwek is that we have had a new class of interns start their internships.  In Kenya, interns are just out of medical school, but are not in specialized training.  Instead, they spend one year learning all the different core specialties - 3 months in each - before starting a two-year committment to an assigned hospital where they may have to do medicine, surgery, peds or OB.  After those two years, they may decide to pursue a residency training program.

Teaching interns in Kenya, is very similiar in some ways to teaching interns in the US.  Today, I decide to make a list of all the things I said to my current interns to see just how similiar.  See what you think.....

Pregnancy is painful.

What is that?!"

Take your fingers out of there.

Preeclampsia is your enemy.

That's fine.

Do you want to take chai or do you want to do a tubal?

How will a CBC help us?

Don't touch the needle with your finger!

Use your pick-ups!

The person who saw the patient should be the one who calls me.

Is the patient still bleeding? 

Perhaps I will do this one since the patient's BP is dropping quite low.

Excellent.

We will practice more tomorrow.


Learning Quote of the Day:

Never say, "oops."  Always say, "Ah, interesting."  ~Author Unknown

Regarding Pelvic Masses.....

It seems like none of my gyn cases here in Tenwek are as they seem.  

What I expect, is rarely what I find.  This is likely because I am still getting accustomed to the new pathology that I am finding common to East Africa. 

For example, my case on Thursday:  I saw a 39 yo old multiparous patient in our gyn clinic who presented complaining of abdominal and pelvis mass since March 2010.  Her menses were regular.  She had an ultrasound from another facility showing bilateral ovarian masses measuring both roughly 8x5cm.  The masses were septated and appeared to be within the ovaries.  The uterus appeared normal. 

When I saw the patient, just two weeks ago, I was able to palpate bilateral adnexal masses.  There was no ascites; uterus felt normal.  A repeat ultrasound revealed again bilateral ovarian masses; the right larger than the left, measuring about 10x6cm.  Again the mass was septated.  So, on Thursday, OtherDoc and I took the pt for a TAH/BSO.   I didn’t really expect to find cancer; maybe some type of benign process.  But I did not expect this:

The entire uterus/bilateral adnexal complex was encased in an what appeared to be a filmy inflammatory tissue.  Forgive my lack of a better description.  It took a few minutes to dissect and find the plan between the uterus and the right adnexal mass to even decipher what was what.  The right adnexa had been replaced by this ugly loculated mass which was adherent to both the sidewall and posterior bowel.  Ditto for the left adnexa.   Once we dissected away the encapsulating adhesions, we were able to lift the right adnex out of the pelvis and amputate it. 

Here you can also witness some of our varying OR- head gear!

The Right Adnexa

Then we were able to proceed with a fairly routine TAH/RSO.

Uterus and Left Adnexa

Afterwards, we examined the specimens.  The adexal masses were filled with a straw colored fluid and appeared to be separate from the ovaries. 

Final postoperative diagnosis?  Bilateral Hydrosalpinx. 

Pathology pending.

Of Waterfalls and NeckTies...

This past weekend, I finally mustered up enough energy to walk around Tenwek just for the sake of taking a walk and visited the Tenwek hydroelectric dam and waterfall.

Tenwek Hospital is powered by a hydroelectric dam that was constructed between 1984-86.  It replaced the previously less reliable and more expensive diesal generator in 1987.  The dam was constructed just up river from the waterfall - a very peaceful and beautiful part of Tenwek to visit.

OverView of Dam and WaterFall

Waterfall

 

A lady doing her wash at the base of the dam



Laundry finished!

For all the big game hunters out there- this is the most exciting game I've seen around Tenwek!

I also wanted to say another thanks to everyone who has been sending cards, packages, emails and comments on the blog.

I cannot tell you how awesome and uplifting it has been!

Recently, I received a package that had goodies for me and even a little something for Teddy......So, this picture is his way of saying thanks too!

Say What?!

In my first month at Tenwek, I have seen, heard and done many interesting things.  Among the most interesting, is learning the cultural aspects of conversation.  Learning to speak "Kenyan" English has been both frustrating and amusing. 

Here's a few examples:

Phrase 1: "Perhaps...."
This is often used as a way of responding negatively, but in a very vague but polite way.  Consider the following conversation:
Me:  Nurse, have you seen the intern this morning?
Nurse:  Perhaps, he is in room 100.
I go look in room 100, but no intern.
Me:  Nurse, I cannot find the intern.  Have you seen him?
Nurse:  Perhaps he is in Labor Ward.

I know now that this means that the intern is not here, no one has seen him and perhaps he is home in bed.

Phrase 2: "Yes..."
This may mean "yes," "no," "I don't know," or "?"

Me: Did you see the patient?
Intern: Yes
Me: What is her problem?
Intern: Yes, I am just coming now to see her.
Me: So you have not seen her?
Intern: I am just seeing her now.

Or......

Phrase 3: "It is unclear...."
This is my favorite.  Another expression of doubt, without saying "I don't know."

Me: Hi, this is Dr. Huber.  I am returning a page.
Muffled voices.
Nurse:  It is unclear to me who paged you.  Perhaps you can call at another time.

Phrase 4:  "He/she has not yet come."
The ultimate phrase of maintaining public respect.  It gives the illusion that although the person is not here NOW, he/she IS planning to come.
This is always used during a public event...about half through the event or later.

Pastor:  I think John has an announcement.  Is John available?  Oh....John has not yet come.

These phrases, along with all the new vocabulary and medical phrases I am learning, make each day both exciting and very amusing.  I can only imagine what the local Kenyans must think about some of the "strange" phrases and words I use.

Taking a little break in the recovery room.....

Here's a little vocabulary lesson from my journey so far:
bathroom = choo
cellphone = mobile (mow-bile)
tape = strapping
flashlight = torch
operating room = theater
miscarried/delivered (referring to a dead baby) = expelled
tea = chai

Random Picture that I just like.

Flowers Outside My House

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