Wednesday I spent the day on the peds ward with Dr. Fink (a pediatrician from Memphis), Bob (the clinical officer on the ward who functions like a PA), and one of the Kenyan residents. It was extremely interesting seeing the pathology of the patients admitted, how they are treated based on cost and what drugs are accessible, and really how long people go here before seeking treatment. Surprisingly, there is not much difference between here and home, so I surprisingly felt competent with how to treat some of the ailments. We don't have the tropical diseases fortunately though!
Here is a breakdown of some of the patients I saw:
10 yo male with a history of bloody diarrhea for a week, significant dehydration, as well as a reported weight loss of 10kg over the past month. HIV and malaria tests were negative (not that reliable I heard though) and likely had salmonella. The team came to the conclusion that the report from mom was likely exaggerated. Man though, it did not look like fun being a kid hospitalized for diarrhea as they have to lie on trash bags:(.
11 yo female with a history of shortness of breath and cough for a week. Her CBC revealed pancytopenia and they were trying to rule out aplastic anemia versus leukemia. I was able to assist with the bone marrow aspiration - uhh, not at all like it is done in the States. We gave ketamine and the some of the instruments were half missing. It was very make-shift and it was interesting to see that I was the only one who spoke to the child...definitely no child life services here!
9 mo old male from Somalia who was developing well until he started having a high fever and seizures. His mother took him to a hospital in Somalia where he was diagnosed with meningitis and treated with Streptomycin...which would not do anything for him. He continued to have seizures lasting up to one hour and 15 times per day. After about a week of this, the mom came to Kenya illegally where his antibiotics were switched to effective ones and he is now being fed through an ng tube and is neurologically devastated. Gtubes and nissens are not done here so this child will likely die from either aspiration pneumonia by the family trying to feed by mouth or replacing the tube incorrectly. The family is unable to return to Somalia so now the mom and baby will likely live in the slums of Nairobi where there is a large Somalian population (about 2 million people out of 5-6 million total live in the slums in Nairobi).
9 yo female with a history of right eye swelling and then developed fever and neck stiffness. She had meningitis and was doing very well on day 10 of 14 for antibiotic therapy.
3 yo male with a history of recurrent seizures for the past 8 months who was being treated for malaria - every child coming in with convulsions or history of seems to get treated for malaria. His aunt was his guardian as his parents had passed, and it was interesting to really figure out how to get him daily phenobarb as there is NO health insurance here unless you are wealthy.
12 yo male with a history of ascites and pleural effusions for several months. Jas had provided anesthesia when his lung was tapped showing exudate, which was pointing towards TB but he has not been responding to tx. A different pediatrician than the one I was with was thinking more of a cardiac pathology. The family denied any history of TB or chronic cough - but I have heard to take that as face value...kind of like when parents tell me they only smoke outside:). This poor guy was sick though and the outcome is not good.
9 yo female with a history of severe kyphosis and pectus excavatum. I don't think she had had this evaluated really before and now she has right sided heart failure and pulmonary hypertension. She had come to Kijabe satting 43% and was just sick. The ortho team decided she was not a candidate for surgery because of her heart and the pediatrician was having to translate this to the parents. They inquired about a second opinion from a cardiologist (there will not be a visiting peds cardiologist at Kijabe until July) and the transfer and evaluation in Nairobi would be about 10000+ Kenyan shillings (about $100) - this is huge for the majority of the families in Kenya as they live on about a $1 a day. It is was interesting to see the response of the parents in comparison to those in the US - this father was not angry, he was sad and wanted to know if this could have been treated earlier so he could share this information with others in his community to help treat another child with the same condition sooner. Also, I looked over the little girl and noticied she had a pressure ulcer to her right ear from the oxygen strap....unfortunately, no big deal to anyone else but me:(.
3 mo old female admitted for respiratory distress and had been to the ICU several times. She was doing great, ready to go home, and I think see honestly had RSV bronchiolitis - they are unable to isolate specific organisms here but they still have some of the same bugs.
3 yo female with a history of an abdominal mass which mom had discovered several months prior and was in fact a Wilm's tumor. She had a nephrectomy 2 weeks prior and was now in for chemo - they do follow a chemo regimen similar to CHOP. They have had 4 kids at Kijabe with leukemia in the past 3-4 years and only 1 is still living....all the rest came in so late and had every complication. This little girl was just adorable but did not like us! What amazed me the most is that she is given intravenous chemo through a peripheral IV! I asked if central lines or even PICCs were accessible would they use them and the pediatricians response was no bc the nurses would not be able to manage them and the risk of infections was just too great. The little girl was staying after her chemo because she was having vomiting and no stool....ended up going to the OR the next day due to a bowel obstruction and needed to have adhesions removed.
9 yo male with HIV and lymphoma:(...this little guy Emmanuel was just the coolest. I got to sit with him and his mom for a while before he received his chemo. He weighed nothing but was so stoic and even smiled when we started talking about playing outside. He obviously had complete alopecia and his head was covered with a fungal infection as the kids here really struggle with that anyway. The docs had to put their heads together as to when to give chemo and then add on his anti-retrovirals. He was doing amazingly well and this was his second to last burst of chemo. As expected he received his chemo through a peripheral and no thought of gloves were involved.
So in summary, these are the things I am learning:
Health care is not treated as a right here but a privilege. I am embarrassed to say that I have had the luxury of being picky when it has come to my own health care and I will really think twice before I complain about anything again.
Being in a remote area of a third world country gives you a different perspective about end of life issues. Here the supplies are so limited and they have to really evaluate who needs the supplies the most based on the likelihood of survival. In the states, all effort is made to keep someone alive even if the quality of life is drastically different. This experience has opened up some new conversations between Jas and I about these issues (probably more understanding on my side) that it is okay to let someone go when it is their time and not to not keep them alive for selfish reasons. You see here that the culture, stigma, quality of life, and financial state has such a huge impact and you are really not helping these families by intervening (going to all extremes) on a patient who will become or is already a total care/devastated patient.
Don't take antibiotics unless you need them! MRSA does not exist here, unfortunately it probably will as western medicine moves in. Despite the conditions in the OR, the infection rate is drastically less than the US and none of the operative patients are treated with prophylactic antibiotics....it is incredible to see that! They do have resistance to malaria drugs though as we have resistance to antibiotics.
I think that is plenty for now:). Hope as is well!
Friday, April 3, 2009
Kenyan Pain Clinic
So it seems that I have unknowningly helped start the first pain clinic in Kenya. People are coming from all over (even larger metropolitan places) to Kijabe, as we are the only physicans that offer epidural steroid injections. Our treatment scope is limited (by space, resources, imaging modalities and time), but we have also started performing blind sacroiliac joint injections (not done in the US without image guidance because not reliable placement). So now we treat mostly radiculopathies, myofascial pain syndromes, and sacroiliac arthopathies.
As part of my mission, I also had the privelage to lecture to the KRNAs and student KRNAs (see earlier blog for acronym meaning). They are technically very good and are as bright as they come. I would attach a picture of the class (but internet is slow). They main topics discussed were neuromuscular blockade and local anesthetics.
We also expanded their regional anesthesia understanding. We demonstrated successful, stimulated needle axillary blocks, interscalene blocks, and lower extremity blocks including sciatic, femoral, and ankle. This may not sound like a big deal, but with perioperative mortality around 20% nationally, less is definately more. And safer. That is why 80% of surgery here at Kijabe is done under spinal (after it sets up and the block height is stable, less vigilance is required than general anesthesia). These trained KRNAs will go to rural hospitals and educate/promote safer anesthesia and surgery.
As you have probably gotten from emily's blogs, this has been an excellent experience, both personally and professionally. We have helped influence a continent and forged friendships that will last a lifetime.
As part of my mission, I also had the privelage to lecture to the KRNAs and student KRNAs (see earlier blog for acronym meaning). They are technically very good and are as bright as they come. I would attach a picture of the class (but internet is slow). They main topics discussed were neuromuscular blockade and local anesthetics.
We also expanded their regional anesthesia understanding. We demonstrated successful, stimulated needle axillary blocks, interscalene blocks, and lower extremity blocks including sciatic, femoral, and ankle. This may not sound like a big deal, but with perioperative mortality around 20% nationally, less is definately more. And safer. That is why 80% of surgery here at Kijabe is done under spinal (after it sets up and the block height is stable, less vigilance is required than general anesthesia). These trained KRNAs will go to rural hospitals and educate/promote safer anesthesia and surgery.
As you have probably gotten from emily's blogs, this has been an excellent experience, both personally and professionally. We have helped influence a continent and forged friendships that will last a lifetime.
Tuesday, March 31, 2009
Food
The situation of cooking is stil interesting but getting better. I was reassured when I spoke with Sue Newton about the first meals I cooked and she agreed that it takes time to become comfortable. Mainly because there is no longer access to a grocery store...I can buy some fruits and veggies from the local market but no milk, safe meat, or items I am familiar with:).
My family will be pleased to know that the creamed tuna fish has been brought to Kenya:). It is a Ferrell family comfort meal and sure enough one can cook it in Africa. It did not taste the same as the food additives are different here, but I was pleased with it. For example, they sell Sprite but it does not taste like Sprite and the same for everything else.
I have to write a thank you letter to South Beach and Trek Bar Company as they have been our saving grace. The protein bars have supplemented or replaced many meals for the both of us.
For lunch we have peanut butter sandwiches and/or soap, which is nice. Dinner is where the fun begins!
For those who have sent me emails asking about my belly, I am doing better now than I was the first week. I probably have lost some weight, but nothing I can't gain back when I get home:). If I was to have a flare, I know I would be able to get decent tx here from one of the US doctors. Also, when we go to the orphanage they want me to call them asap if I get into any trouble and fortunately they are familiar with my ailments unlike the African docs who have no idea what Crohn's is....I heard that there is a study here in Kenya documenting four known cases among men in the 1960s. They were linking stress to flare-ups, but these men had multiple wives and the greater the number of wives the more frequent number of flares! So if I keep my stress low and stay away from multiple husbands according to the African study I should be a-okay:).
That is all of my thoughts on food for now.....hopefully, Jas will get to try some goat meat before he leaves:). Love to all!!
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!
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!
Saturday, March 28, 2009
We love safaris!!!!
Yesterday, we arrived to the Maasai Mara in the south eastern part of Kenya. It is a huge reserve with lots of animals. We are staying at the Intrepid Lodge which is like staying at the Ritz versus we have been at the Motel 6 in Kijabe for the past week. We ran out of hot water on Tuesday....so Jas and I have been extra dirty for a few days and it felt amazing to take a hot shower here last night. I can see that if you go to Africa and just stay in these lodges then you get a very warped view of life here. I am so glad we are working and really seeing the people instead of just being a tourist.
The food here is really good and last night we watched a Maasai warrior dance which Jas and I had to participate in.....I think we looked like the kids in the crowd so we were chosen.
We go on three game drives per day with our driver Raphael for about 3 hours at a time. We have seen so many different animals....zebras, elephants, giraffes (my favorite), various types of antelopes, monkeys, female and male lions, and many more. We have taken about a thousand pictures and still more to come. The most amazing part so far is that on our first trip out within about 1 hour we found 3 cheetahs under a tree resting. We stayed for a while and watched them pick out some prey (two zebras), carefully move in on the prey, patiently watch the prey, and then finally attack! Two of the cheetahs went after the child zebra and the other after the mama zebra we think to send her off. The three then tackled the zebra, one holding it's neck, one standing guarding to ward off any other predators, and one biting aggressively from the zebra's bottom. I was not sure whether to be enthusiatic as they had found something to eat or whether to just vomit. It was so intense and just incredible to watch it from start to finish. It really was agony though to watch at the end because it took so long for the zebra to die....definitely not for the weak stomachs. This morning we went back at 6:30am to see what was left over. The three cheetahs were still there and had just devoured the zebra - their bellies were so visibly full! Our guide said this was unusual because they typically do not like left overs but they are adapting to a changing environment and he thinks it is because of the hot weather and the drought. The cheetahs finally left and we saw some vultures come in. I guess it was good though that they really left little behind! Incredible though!
We head back to Kijabe for another work week tomorrow. I am going to meet Jas now since the sun is setting and the flies are attacking me. Love to you all and thank you so much for your prayers....we feel incredibly safe and secure here in Africa. xoxo em and jas
The food here is really good and last night we watched a Maasai warrior dance which Jas and I had to participate in.....I think we looked like the kids in the crowd so we were chosen.
We go on three game drives per day with our driver Raphael for about 3 hours at a time. We have seen so many different animals....zebras, elephants, giraffes (my favorite), various types of antelopes, monkeys, female and male lions, and many more. We have taken about a thousand pictures and still more to come. The most amazing part so far is that on our first trip out within about 1 hour we found 3 cheetahs under a tree resting. We stayed for a while and watched them pick out some prey (two zebras), carefully move in on the prey, patiently watch the prey, and then finally attack! Two of the cheetahs went after the child zebra and the other after the mama zebra we think to send her off. The three then tackled the zebra, one holding it's neck, one standing guarding to ward off any other predators, and one biting aggressively from the zebra's bottom. I was not sure whether to be enthusiatic as they had found something to eat or whether to just vomit. It was so intense and just incredible to watch it from start to finish. It really was agony though to watch at the end because it took so long for the zebra to die....definitely not for the weak stomachs. This morning we went back at 6:30am to see what was left over. The three cheetahs were still there and had just devoured the zebra - their bellies were so visibly full! Our guide said this was unusual because they typically do not like left overs but they are adapting to a changing environment and he thinks it is because of the hot weather and the drought. The cheetahs finally left and we saw some vultures come in. I guess it was good though that they really left little behind! Incredible though!
We head back to Kijabe for another work week tomorrow. I am going to meet Jas now since the sun is setting and the flies are attacking me. Love to you all and thank you so much for your prayers....we feel incredibly safe and secure here in Africa. xoxo em and jas
Thursday, March 26, 2009
A Day in the Life...
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).
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).
The Kijabe Nursing School
I have just returned home from a long day at the Kijabe Nursing School and I want to share what goes on there. Jas is still in the OR (he has to be exhausted) but I am hoping that I can get him to sit down and write a little about his experiences.
I started class this morning at 8:30 with the same group of students I was with on Thursday. We focused on how to perform a pediatric assessment and walked through the head-to-toe sequence. Afterwards, Anne reassured me that it was very detailed and really want she wants the students to here. I am always thinking to myself "I hope I am doing some good here and presenting the material that the principal wants me to give." The students asked a lot of questions at the end, and Anne told me that this is a very good sign that they paid attention and understood what I was teaching. They really have no textbooks individually or handouts so they must rely on memory and note taking during class....much like what it once was in the US! Afterwards, I sat down with the other tutors for chai tea (they gave me some without sugar today as they noticed that I did not drink my tea on Tuesday:). The prinicipal, Mary Muchendu came in and asked me to sit down in her office for "a chat." She spent a long time telling me about the history of the nursing school as well as the nursing infrastructure in Kenya, which does have some similarities to the US. I am currently teaching at a school that does not award a degree, but rather a diploma in nursing after 3 1/2 years of study and the students are eligible to sit for the Kenyan certifying exam to become a Registered Nurse. She was extremely proud of the new curriculum and had me look over all of the documents. She sent me home with four binders to peruse through and let me know what she thinks. She was so incredibly gracious to me and never was treated commented on how young I look! - it was a great moment.
We had a short break where I ran into two nurses from the US, one of which received her PNP from Vanderbilt in 2006! What a small world! For those reading from Vandy, she knows Terri Witherington, Renee McLeod, Margaret Anderson, etc. and many more of the instructors. Currently, she works for an organization based in Nairobi called "The Least of These" which visits orphanages in Kenya and sets of rural clinics for children. She is such a cool lady and wants me to spend a day with her next week....so I am hoping that will work out.
At 1pm I was invited to have lunch with the students and tutors, which involved standing in line, each person holding their own hodge-podge of plates, to be served out of big barrels, kind of like at a soup kitchen or a refugee camp. I kept trying to say, "oh, I already ate" but that was not working. We were served rice, tortilla, and beef stew, which was really pretty good. Everything tastes fine here it is just more of where it comes from, how it is prepared, and how it is served. I am okay so far though!
Afterwards, we went to church where there was a ceremony for the senior nursing class who is graduating tomorrow. I sat with the principal, chaplain, and medical director. I wish I knew how to video tape on my camera because all of the students were singing acapella. It was absolutely beautiful praise music in Swahili and it is indescribable to have been there in that moment. Several different people gave speeches and towards the end the prinicpal got up to speak. All of a sudden, she starts talking about this visitor who has blessed them with her time and she wants her to come up and give a speech....whooaaa! what, me! So here I am, in the middle of this remote village in Africa, being asked to give a 2-3 minute speech to the nursing school....probably about 150+ African people in the room. I am not really sure what I said....mentioned how grateful I was to be there, have the opportunity to teach, and discussed the importance of being an advocate for your patient as well as how unique our role is as nurses to care for people during their most vulnerable times in life. I think it was okay as the principal seemed pleased:)....I am glad I made it off the stage okay without falling. Some of the students came up to me afterwards wanting me to send them all of the notes and lectures I have on my computer. I love seeing this excitement and passion for nursing!
So the sun has set and Jas has still not come home. I feel guilty in that I have had another warm and cuddly day while he has been in a hot and sweaty OR which was supposed to close 2 hours ago:(. We will see what happened during his day.
Tomorrow in the afternoon we are going on a Safari for the weekend with the Newtons and three residents from Vandy. We are headed to the Masa Mara, which I know is going to be incredible. I will write more probably when we get back. Hope all is well back home and send me emails if you can to let us know how you are doing. It is so great to hear from people and be encouraged about our work here. Love to all!
I started class this morning at 8:30 with the same group of students I was with on Thursday. We focused on how to perform a pediatric assessment and walked through the head-to-toe sequence. Afterwards, Anne reassured me that it was very detailed and really want she wants the students to here. I am always thinking to myself "I hope I am doing some good here and presenting the material that the principal wants me to give." The students asked a lot of questions at the end, and Anne told me that this is a very good sign that they paid attention and understood what I was teaching. They really have no textbooks individually or handouts so they must rely on memory and note taking during class....much like what it once was in the US! Afterwards, I sat down with the other tutors for chai tea (they gave me some without sugar today as they noticed that I did not drink my tea on Tuesday:). The prinicipal, Mary Muchendu came in and asked me to sit down in her office for "a chat." She spent a long time telling me about the history of the nursing school as well as the nursing infrastructure in Kenya, which does have some similarities to the US. I am currently teaching at a school that does not award a degree, but rather a diploma in nursing after 3 1/2 years of study and the students are eligible to sit for the Kenyan certifying exam to become a Registered Nurse. She was extremely proud of the new curriculum and had me look over all of the documents. She sent me home with four binders to peruse through and let me know what she thinks. She was so incredibly gracious to me and never was treated commented on how young I look! - it was a great moment.
We had a short break where I ran into two nurses from the US, one of which received her PNP from Vanderbilt in 2006! What a small world! For those reading from Vandy, she knows Terri Witherington, Renee McLeod, Margaret Anderson, etc. and many more of the instructors. Currently, she works for an organization based in Nairobi called "The Least of These" which visits orphanages in Kenya and sets of rural clinics for children. She is such a cool lady and wants me to spend a day with her next week....so I am hoping that will work out.
At 1pm I was invited to have lunch with the students and tutors, which involved standing in line, each person holding their own hodge-podge of plates, to be served out of big barrels, kind of like at a soup kitchen or a refugee camp. I kept trying to say, "oh, I already ate" but that was not working. We were served rice, tortilla, and beef stew, which was really pretty good. Everything tastes fine here it is just more of where it comes from, how it is prepared, and how it is served. I am okay so far though!
Afterwards, we went to church where there was a ceremony for the senior nursing class who is graduating tomorrow. I sat with the principal, chaplain, and medical director. I wish I knew how to video tape on my camera because all of the students were singing acapella. It was absolutely beautiful praise music in Swahili and it is indescribable to have been there in that moment. Several different people gave speeches and towards the end the prinicpal got up to speak. All of a sudden, she starts talking about this visitor who has blessed them with her time and she wants her to come up and give a speech....whooaaa! what, me! So here I am, in the middle of this remote village in Africa, being asked to give a 2-3 minute speech to the nursing school....probably about 150+ African people in the room. I am not really sure what I said....mentioned how grateful I was to be there, have the opportunity to teach, and discussed the importance of being an advocate for your patient as well as how unique our role is as nurses to care for people during their most vulnerable times in life. I think it was okay as the principal seemed pleased:)....I am glad I made it off the stage okay without falling. Some of the students came up to me afterwards wanting me to send them all of the notes and lectures I have on my computer. I love seeing this excitement and passion for nursing!
So the sun has set and Jas has still not come home. I feel guilty in that I have had another warm and cuddly day while he has been in a hot and sweaty OR which was supposed to close 2 hours ago:(. We will see what happened during his day.
Tomorrow in the afternoon we are going on a Safari for the weekend with the Newtons and three residents from Vandy. We are headed to the Masa Mara, which I know is going to be incredible. I will write more probably when we get back. Hope all is well back home and send me emails if you can to let us know how you are doing. It is so great to hear from people and be encouraged about our work here. Love to all!
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