So got up at 06:30, off to the hopsital and into the "theater" by 07:30. All of the rooms (5) are staffed by nurse anesthetists trained by Dr. Newton (pediatric anesthesiologist, mentor and vanderbilt faculty). 80% of the primary anesthetics done are under spinal (subarachnoid block). For the medical people, we are covering dermatomes of T1-S5 (so upper abdominal surgeries). Patients are escorted to the rooms by the circulator, where the KRNA (Kenya registered nurse anesthetist), meets them and begins the monitoring and anesthetic. One thing different that the US: prayer occurs before every surgery. Days go from 07:30-17:30. Wednesday mornings prayer begins at 07:00 and ends at 08:00. The Kijabe hopsital is 150 bed hospital: covers neurosurgery (shunts and myelomeningocele closures), and general surgery (which here includes ENT, ortho, urology, etc). To give you an idea of my days since I've gotten here: I've coded 2 people (one had a non-survivable PE), anesthetized a 3 week old with VACTERL (long pneumonic-google it), treated an eclamptic (pregnant lady having seizure), and emergently fiberoptically awake intubated a patient with an anterior mediastinal mass (not many things make an anesthesiologists ears perk up-this is one of them). If he extended his head he couldn't breath, so ke kept his chin flexed next to his chest). The ICU here only has five beds, 4 ventilators, and ecompasses all specialties. So triage is important. The young man with the anterior mediastinal mass ended up having -nonHodgkin's lymphoma-so after staying intubated overnight we transfered him urgently to a goverment hospital in Niarobi for treatment (chemo/XRT). Let me say this about the drive: Thank God for Moses (our driver): He expertly navigated the dirt rodes to the main single lane highway, weaving in and out of three lanes of cars on a one lane road, and going on the round-abouts against traffic-while I was being thrown from one side of the van (or Ambulance) to the other and desperately holding on the endotracheal tube with Valerie (ICU nurse) bagged-with our RATIONED oxygen source. Monitors included my finger on the pulse and a portable O2 finger monitor. I got back approximately 13 hours later. Just had dinner- all boiled vegetables, pasta tomato sauce, and tuna from a can (yes they have that here too). We are leaving for Safari tomorrow (early in the am). I plan on lecturing next week on chronic pain (yes: they have that here too, and Kijabe is the only hospital in Kenya doing epidural steroid injections (interlaminar-no flouroscopy).
Emily had a good day also...and I'm sure she'll write about it (and probably already did). We will update the pictures as we can (internet is dial-up).
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