14th Sep

14th September

Wooowza today was superb!! So ive realised that I actually don’t hate surgery and that I wanna be a bloody surgeon and so Ive been spending some time with these American Drs at the hospital. Basically they are a team of older, loaded and well connected American physicians, who come to Kenya three times a year for about a month to do a load of operations for free. The Main surgeon usually is alone or with a single assistant when he his operating. I befriended him the day that I was diagnosed with malaria, he got my blood investigated for the parasites and in turn I promised him that I would spend a few days ‘assisting’ him. And so this afternoon we did two operations together.
Firstly, he taught me how to do a couple surgical knots, I forget their names but he made me practise for an hour whilst he had lunch lol. I love how suddenly when im working with an older white gentleman all the other staff suddenly have respect for me. Jokes man. Pff. Anyhow we began by amputating this elderly ladies diabetic foot. Fuck, the smell of dead, gangrenous flesh is worse than birth fluid, ergh. It was grim but i had had to just think this is an amazing opportunity and get on with things. I cut of her third and forth toe and the Dr did her second toe. Man the smell was really really really bad, and man the pus, yuck, but we did it, didnt take long as she had lost a lot of her foot including the little toes already, she had a special vacumm dressing applied to the wound in hope that it would suck out all the infection and leave us with a clean wound to skin graft on Friday.
The next patient had a small hernia, which was dissected out and pushed back with a mesh covering the defect in the abdominal wall, I was allowed to close the skin wound, this made me happy. To behonest, I cant actually believe that I am able now to stand for so long during operations with out fainting, I think that this was the fear that ruled out surgery as a career for me. Bit gutted though as if I had known that I wanted to follow this path, I could have undertaken a surgical elective, but I guess better late than never. Tomo and Thursday (my last official day) Il be in from 9-6 assisting the dr, just me and him, cant bloody wait.

In the morning I was in a ward round with Dr Adongo, who im not gonna lie is getting on my nerves. In Siaya hospital, patients who are on the verge of dying or just dying, are sent for unnecessary test all the time. Today we saw a patient with a CD4 count of 1. Yep that right one and a really high viral load. The man had been on anti virals, but had developed a meningitis and was now comatose. Dr Adongo wanted to do a lumber puncture to isolate the pathogen causing the menigitus. The other medical student and I argued that if he was comatose and had been for some time and frankly with a CD4 count that low and a really high viral load, why don’t we just send him to palliative care and prepare the relatives. The relatives cant afford any more treatment for him, and to behonest we didnt think he was gonna be doing anybetter and LP carries risks for the brain (which hadn’t been imaged). Look I dono everything about medicine but i do know that a lot of the patients in the male ward especially, present when they are literally knocking on the door of death, these men are wasted thin, usually delirius or in a coma, have no money, sometimes no family, are riddled with opportunistic infections from having such low white cells and most have TB. And what do the Drs do? They list everything that is wrong with the patient, and try and treat everything. Not a single thought is cast on perhaps palliative care. Usually the patients die a few days later and the family (if there is any) is laden with an avoidable bill that they cannot pay. Ive really had to bite my tongue (so hard) so as not to get into an argument with the DRs.
One DR today, tried to put in a cannular into a boy with suspected meningitis, he failed three times, then left the patient to answer his phone.

Ive been told that my experience of hospital life is frustrating me because I am at a lower level hospital. The level of hospital is decided by how many services and consultants it has. Nairobi hospitals would be better than village hospitals. Thing is Im cool with that, here the village im doing lots and lots, somthing I couldn’t do in Nairobi as the patients are less willing to be pretty much practised on by students. I maybe should have organised a week so as to compare hospital standards but its not so much the hospital I have a prob with its the behaviours of some of the staff. However, I was told by a few of the other students that they were told that the problem of apathy and patriacy is cultural trait of the tribe of the area, and that they were told that different tribes exhibit different behaviours, and that the repression of women is associated with the tribe of the village in which I live! Interesting, cos I would hate to think that all Kenyan women are treated the way that the women are here!!!

Speaking of women, something I noticed on the male wards was that all the men dying of AIDS related complications had dutiful wifes, supporting them. However, the wifes were negative for HIV. So not only are these women on the whole second rate citizens but they are looking after their cheating husbands. I guess not all the women could be negative but having many wifes, or partners is allowed in the western Kenyan culture, its not fair that the village wive is laden with the responsibility and sadness of looking after her bigamous husband. Heyho.

Oh god sad case today, a women bought in her son, who had been playing with friends at school, fell over, banged his head and has been comatose since. The incident happened two days ago. I really felt for this women, a teacher, her son 18 and nobody was telling her shit. She had no idea what was going on and her son looked helpless in bed, in his uniform, like a child mate. It was only until that ward round that he was referred for a head CT by Dr Adongo, nobody had clerked or seen him since his fall. The look of fear in a worried mother eyes is haunting.

Lastly, I started a fight with this fat ‘i am god’ Kenyan women on the bus home. I was ushered to sit at the front of the bus by the conductor and she refused to most. And so me being the stubborn girl that I am, asked her again, she said , why are you asking me to move up. I said im getting off before you so maybe I can sit closer to the door. She replied, are you shouting at me. I said im not but I will be soon. And then she began a crazy black African women monologue that lasted about half an hour. You stir a mamma and boy they don’t shut up. I moved to the back of the bus cause she threatened to give me the beating of my life. I dared her to try and see how i respond. She was too fat to beat me, otherwise i wouldn’t have said shit, cause ya never too old for a beating from a stranger in Africa. Anyhow for the last ten minutes of her rant she got out pictures of her sons in the uSA and how she couldn’t accept being spoken to like she was nothing with sons in the USA. Man alive, the girl next to me had to tell me not to respond to her , cause she could she that I was getting exasperated with her, my sons are in the USA nonsense. Anyhow, i began the argument, and boy do I like an argument, kinda relieved that she didnt beat me but i would have LOVED TO SEE HER TRY!