Back at work in Kijabe

Hello all,



We returned from the Masai Mara on Sunday....it was about a 5 hour bumpy, dusty ride in the Newton's Land Cruiser, especially due to the drought. It was so nice that they drove us and spent the weekend with Jason, myself, and three other residents from Vanderbilt. They have five children (3 biological and two adoptive from Kenya) and it was a big splurge as they are both on missionary salaries. We had to say good-bye to our fabulous tent, hot water, and prepared food....it was funny though that Jason thought we were really going camping and staying in a "tent" in the middle of this reserve! I did not tell him that we would be sleeping in a four poster bed and be served coffee and tea every morning. I am glad I did not though as he was shocked when he saw the accomodations, but he did not bring the right clothes as he thought we were "camping." Oh, the things you come to appreciate and I hope that I don't forget this once I return to my cushion life in Nashville.



We were able to see several towns along the way as we drove through the Rift Valley. Kijabe is up the mountain from a truck stop town where prostitution and HIV is a huge problem. Also, the people everyone are just starving and are having to cut down trees for charcoal. There are absolutely no obese or even overweight people in the villages. The women work especially hard here and they are responsible for making the mud huts if they are from the Masai tribe. The men often have several wives as it is a big deal to get a woman pregnant, even if she is not your wife. I have a much better appreciation for my husband and an even greater appreciation for the family I was born into. Jason and I have joked (probably really not that funny) about how long we would have lived had we been born into a family that lives in the Rift Valley without electricity, food, clean water, or health care. We both have decided that we would have not made the cut for the survival of the fittest. Brad (my brother) and Greg (Jason's brother) might be the only ones from our family who would have made it:). It really is so interesting to see the lives of these people and how they are truely just trying to survive.



For the past two days, I have taught the nursing students about growth and development. In the US, you learn about the worst cause scenarios, but once you get into practice it is not common to see them exist. Here though, the worst case scenario is everywhere. We have spent a lot of time talking about attachment disorders mainly with those children who are living in orphanages and/or their parents have died. Also, malnutrition is everywhere and the supplemental needs of the children are different....standard to receive vitamin A. The role of the diploma nurse here (RN but does not have a bachelors degree) is much more like a nurse practitioner in the states. Because physicians are so expensive, it is much more cost effective to have a nurse run a clinic. I was a part of a lecture yesterday talking about management of fever and Ann (the peds tutor I work with) covered the malaria part. The nursing students use algorithms to determine what the management should be and for example, whether the child should be given quinine (first line tx for malaria) IM or orally or not at all because they come from a low-risk malaria region. It is tough for these students in that they are going to be exposed to so much and have to be responsible for the management of many illnesses, yet they do not have the understanding of why they are doing what they are doing as well as they don't even have textbooks! They are given paper copies of the algorithms and the textbooks are in the library....one pediatric textbook for the whole school! I looked over the neonatal resuscitation info that the nursing students are given and it basically said if you perform ventilations (bag-mask) for 20 minutes then "stop, because the baby is dead." Jason is seeing this in action in the OR as an infant was only bag-masked without any chest compressions or drugs being given until he arrived to help out. I will have to get him to write about the perspectives he is getting on the health care.

I am headed back to the hospital now to meet with the peds ward nursing director, Brenda, who is setting up a trip for me on Thursday to go to a clinic an hour away with the neurosurgeons to evaluate patients with spina bifida and hydrocephalus. Should be VERY interesting.

Love to all and hope you are doing well!