Friday, 1 June 2012

I'm Back

So I'm back in Kenya.  And have been for over 8 weeks.  I've just been appalling bad at blogging this time.  But, in my defence, it doesn't feel like almost 2 months have passed.
So...what have I been up to?
I'm back at Tenwek Mission Hospital working in the paediatrics department as a "consultant" though I feel my role is more like a registrar really as I have nowhere near the knowledge or experience to call myself a consultant.  The first couple of weeks were strange because just after I restarted here all the long-term missionaries left for a retreat at the coast, leaving the running of the hospital in the hands of the visiting staff (and the 1 Kenyan consultant, Matilda).  This meant that even more inter-departmental referrals of patients and discussions about patients occurred around the guesthouse dining table.  It's much easier than the official routes (ie bits of paper you fill in and fax) that you have to go through in English hospitals.  In the last 4 weeks we've had a large paeds department with 4 consultants (though one was meant to be mostly in casualty....) and it's been the most culturally diverse department with English (me!) and New Zealand blood to add to the usual Kenyan and American.  (We even had a Korean with us for a couple of days this week.)  
I've been here for almost 5 months in total so far and I've been contemplating recently about what I've learnt in that time.  I sure I've learnt lots about paeds just by doing it and learning as I go through and asking for direction when I need it (a lot!).  I panic much less with ill babies (mostly babies not breathing) in front of me.  Calling for help occasionally is for "moral support" as Dr Bemm described it at one point.  I think the things I've learnt more about are in terms of leading a team.  In the absence of "The Bemmster" aka "The Bemminator" often I end up being the one to lead the rounds and general organisation of the day.  This includes delegating jobs to interns (and sometimes other consultants, sometimes them to me) when there are many things happening (eg ill patient in casualty + delivery to attend + resus in nursery + morning ward round to do).  One of the strangest things has been giving feedback about the interns.  I'm used to being the one receiving the feedback, the exception being 360 degree appraisals.  And it's different being on the other side.  Especially when they are the same kind of age as me (sometimes older).  It makes me wonder what I would have said about myself in my house officer year (which does not really compare to what these guys have to do).  I think this also pushes me on because I start to evaluate myself more and, of course, come out worse than any of the interns, but it helps to push me on to do better or improve (I hope).  I've also been learning more about integrating my faith with my medicine.  It's much easier here.  I'm expected to pray for patients and it makes talking to them about bad outcomes or potential bad outcomes slightly easier.  In England holistic approaches are spoken about a lot, but often the spiritual side is missed out.  This is not necessarily just about Christianity or even God, though here it is.  I hope to be able to put some of this into practice in England within the confines put on us in this area.  I became a doctor mostly because I believe it's what God created me to be (and there was nothing else I wanted to do) and hopefully this experience is helping me to grow in that (though He still hasn't told me anything past my ST years - guess there's still a while to go).
Recently I've found out that I'll be starting my paeds training in August in Barnsley and have had to go through the form filling in that accompanies such things.  (It's not so easy when you're in a different country - praise God for internet access and scanners!)  This has made me think about what it will be like being an ST1 (SHO) in paeds in England after being here.  Dan Landi (a visiting paeds doc) was convinced that I would be bored.  Dino Crognale (a long-term family practice doc) commented that I'll probably be relieved/enjoy it (or something along those lines).  I was thinking more in line with Dr Crognale - less responsibility generally equals less stress and sleeping more easily at night - but I think it's probably somewhere in the middle.  I was thinking about this earlier when I was contemplating the fact that I am the senior doctor looking after a 5 month old with DKA in ICU today.  There's no way I'd be dealing with that by myself in England.  In some ways that's nice - less pressure/worry.  But less learning experience and less sense of achievement when it goes ok/well.  I feel a bit like I'm "playing" doctor here, but that's not really the case.  I think I'm doing more of what I thought doctors did than I have been doing at home (A&E being the exception).  Having the responsibility of being the senior on call definitely grows you (even if it could potentially cause my hair to go grey, curl up and die).  As does learning to run resuscitations and speaking to parents about the fact that their child is really sick/going to die/has died.  These are things that I see as the downside of the job, but they help to shape you.  (Though the sound of a mother's cry when her baby/child has died is like no other!)  The thing that does worry me about August is that I don't know much about the simple things and I'm unlikely to be diagnosing cerebral malaria, typhoid perforations and TB meningtitis (and if they occur I'm even less likely to be the primary person managing them) so I don't know if I'll be all that much ahead.  As long as I can spot a sick child hopefully I'll be vaguely ok.  (I'm using "sick" in the doctoring sense, not the lay person sense of "surely all patients are sick".  When we say "sick" we mean "really really sick" generally.)
I apologise for the lack of photos.  I have not put any on my computer yet, but I'll try to do a photo blog soon.
Tomorrow, I head for safari, meeting my dad and sister en route.  They will be boarding the plane as I'm typing this (assuming all's going well).  Looking forward to the break (including a day off on Monday - today is the bank holiday here and I'm on call).  It will be strange having them in Tenwek and probably strange for them too, being in a place they've heard me speak about on numerous occasions but never seen.
I'm just going to end with a few brief patient stories as I know that's what a few of my medical friends like to hear about.
I praise God for a few healings in patients we believed were pretty much past help.  3 involve probably TB meningitis.  One girl was in ICU when I got here and we didn't know what was going on with her at all.  She was very unresponsive and so we kind of treated for everything (bacterial meningitis, TB meningitis, typhoid, sepsis, cerebral malaria etc).  She walked out of here pretty much back to her usual self.  Another was boy I admitted during a (bad) Sunday on call.  I found out on that day that a traditional healing method for a cold is a uvulectomy (ie cutting off the uvula at the back of the throat).  He became septic post-uvulectomy and  very unwell with meningitis.  We expected that he would probably be bedbound with double incontinence and be nothing like his previous self.  I last saw him the day before discharge and he was sitting on his bed.  The next day he also walked out!  The 3rd patient is still an inpatient, but one that is slowly improving, though still has significantly neurological deficit from probable TB meningitis.  We are praying for his recovery and are pleased to see him get slightly stronger each day, though how much function he'll have left, I don't know.  There is also a baby in nursery who we'd completely given up on.  She was preterm and then kept becoming very ill with necrotising enterocolitis.  However, she's now been improving for the last couple of weeks and tolerating feeds and gradually(!) gaining weight.  She's by no means the sickest baby we have any more.  I heard her mum singing to her in the nursery today - one of those things that touches my heart the most is a mother taking delight in her child.
One patient who touched me the most was a teenager called Cheprono.  She was in and out of hospital for about a month with pneumonia and congestive heart failure secondary to rheumatic heart disease.  We would give her a full course of antibiotics and then a few days after they were stopped she would become ill again and be readmitted.  On one of my nights on call I got the dreaded page "bed 1 in room 204's condition has changed".  Despite the fact that the phone was put down before any of my questions were answered, I've been here long enough to know that's essentially a resus call.  Sure enough I headed up there to find a resus in full swing and took over leading it.  However, despite our best efforts we couldn't do anything.  Cherono, despite spending so much time in hospital towards the end and being so ill, nearly always had a smile on her face.  She was a strong Christian and in the day or two before she died she wrote about how she thanked God for watching over her and thanked the doctors for giving her medicines and looking after her.  She also drew a picture of the heart.  Her dad allowed me to take a photo of that piece of paper and it's one that in some ways will remind me more of this place than most of my photos.
I apologise for the rambling nature of this post.  It's been 8 weeks in coming....  (And my current facebook status points out that rambling is directly proportional to tiredness.)
Till next time......

Thursday, 1 December 2011

Father God I Wonder

"Father God I wonder how I'd manage to exist without the knowledge of your parenthood and your loving care.  Now I am your child, I am adopted in your family and I can never be alone, coz Father God you're their beside me."

This is the first Christian song I ever learnt.  It was the summer when I was 4 (1990) and I was sitting on the stairs at the Pleasaunce, a Christian hotel in Norfolk we've stayed at multiple times, when my dad taught me the song.  (This is how I remember it anyway.)  I've been thinking about adoption recently.  The Bemm family have been a real life example to me of what adoption is.  They are missionaries here at Tenwek Hospital (Dr Bemm being the paediatrician I work with).  They now have 7 children.  Last time I was here they had 4!  This addition is not because of multiple or serial pregnancies, but because they have adopted/are in the process of adopting some Kenyan children from a baby centre they are involved with.  They have 3 biological children (the oldest 3 of the 7), Hannah, 4, who they adopted a few years ago and 3 toddlers they are in the process of adopting.  However, speaking to them there is no difference between any of them.  They are a family of 9 - 2 parents with SEVEN children (madness!).  Toddlers have plenty of times where they make you laugh or are just cute and adorable, but also have smelly nappies and cause sleepless nights.  However, the rough times don't make them any less a son or daughter.  They are part and parcel of being parents to young children.
So how does this relate to anything significant?  Now that we are adopted as children of God we get all the good things which come with that.  (Romans 8:14-17)  God delights over us (Zeph 3:17) as any parent does over their children.  However, once we become Christians we don't suddenly lead perfect lives.  We have days when we constantly have "dirty nappies" that our heavenly father needs to deal with.  I know I do!  Many of them!  But this does not affect our status as children of God.  He deals with us, cleanses us and gives us the spiritual nutrition we need to grow.  Furthermore, we can find our identity in being part of His family - his sons and daughters, no less. 
There is something about a father/daughter relationship.  I won't say that I always had the best relationship with my dad and we had our fair share of arguments as I grew up, but I always knew he loved me.  I always knew he cared for me.  And I rely on him in many ways even now as someone in their mid-twenties.  I rely on him to guide me and he is the one I tend to ask spiritual advice from.  He gives me great hugs and lets me know that he loves me (directly and also non-directly).  He tells me that he's proud of me and that he values me.  He's told me about the first time he held me as a baby (when my mother was still under a GA).  (I know I haven't seen my dad in almost 3 months, so may have slightly rose-tinted glasses...)  This is similar to the link we have with our heavenly father.  But how much more so with Him?  He gives us perfect guidance.  He tells me that He loves me (both directly to me and also through His Word).  He formed me in my mothers womb (Psalm 139).  
And yes, I really do wonder how I would manage to exist without knowledge of his love for me and his fatherhood.  I know that I've had times in the past, that some of you are aware of, where I could barely comprehend this, but in the end His love was probably the only thing that got me through and got me to where I am today.  I don't know that I would still exist if it hadn't been for His love guiding me through.  And I know that His love and fatherhood will continue to be my basis for existence.

Just one more note on this song.  I had a hearing problem as a child.  But also didn't know the word "adopted" as a 4 year old.  I did, however, know the word "doctor".  So my version went: "Now I am a doctor in your family...."   Interesting, eh?

Today is World AIDS Day.  Let's remember all those with HIV/AIDS both in our own communities and all over the world.  There is still so much stigma surrounding the disease which needs to be got rid of.  I have seen babies and children with HIV and seen how it affects their lives here.  I believe it could be even harder to live with in the UK as the stigma is potentially higher than here.  The theme this year is "Getting to Zero" - zero new HIV infections, zero discrimination and zero AIDS related deaths.  Is this possible?  I don't know.  But it's definitely something to aim towards.

Monday, 7 November 2011

Safari fun

As you could probably guess after my last post, I was needing a bit of a break.  And what a break! 
I went on safari last time I was here and was scared that I'd built up the memory too much and that I'd be disappointed this time.  To be honest, we didn't see any elephants and I got no photos of cute little month old lion cubs, but it was an awesome weekend all the same.
Seven of us left on Friday morning for Fairmont Mara Safari Club - Kelly and Emily (both physician assistant students), Mark (a physio and Emily's husband), Seth (an ER doctor), Barbara (a radiologist), Shelley (a CT/USS tech) and myself.  After the first few miles of paved road we had a very bumpy ride.  (Though we learnt later on in the weekend how much more bumpy it could get...)  We got there safely and enjoyed our buffet lunch and settled into our "tents".  By tents I mean structures made of canvas with four poster beds in them and a full en-suite.  This is the poshest place I've ever been in.  And it's amazing.  The service matched the aesthetics with the staff knowing each guest by name and tent number.  I don't know how they did it.  We were wondering whether they'd taken a sneaky photo as we entered the hotel and stuck them up in an office for everyone to study.  We were woken in the mornings by a choice of hot chocolate, tea or coffee with biscuits.  The yummy hot chocolate definitely made up for getting out of bed so early.  Though, to be honest, the game drives actually more than made up for that.  When we returned in the evenings the beds were turned down and a hot water bottle (which somehow stayed hot for hours) was in the bed.  
The entrance to Fairmont Mara Safari Club

Anyway, I digress.  After lunch and a small amount of downtime we went on our first game drive.  We saw 2 of the "big five" (lion, rhino, buffalo, elephant, leopard) - 2 rhinos who are the only 2 left in the Masai Mara (there are only 11 in Kenya) and some buffalo.  The gamekeepers are well known to the rhinos so we  were able to get close to them under close supervision.  The skin feels quite leathery.

After consuming our 4-5 course dinner we collapsed onto our soft soft beds, looking forward to the following morning.
Yummy steak on the first night

Our driver, Jeremiah, offered to take us out on a longer drive on Saturday morning (from 6.15-10.50am) complete with packed breakfast.  We headed quite a long way out and saw 3 tiny leopard cubs playing on a rock.  Unfortunately, it was a bit of a distance from where our vehicle stopped and the zoom on my camera was not good enough to get a good picture, but you can make out a cub in the photos.  We also saw a family of lions including lion cubs of various sizes, but they were all hidden in a bush.  Of course, on all the trips we saw the usual - zebras, giraffes, antelope (dikdiks, eland, topi, thompson gazelles, impala), warthogs (I seem to remember the word "pumba" better than "warthog" - lol), wildebeest, the occasional hyena etc.  We were able to get out of the vehicle to eat our breakfast.  What an experience!  Eating breakfast in the plains of Africa with zebras in the background.  One of my favourite parts.
The seven of us after our picnic breakfast

After the morning safari we lost 2 of our group - Barbara and Shelley.  Don't worry, they were not forgotten and left in the middle of the Masai Mara, but they did have to go to Nairobi to get a plane (or 3) home to Florida/Washington.  We had a nice amount of time to relax, nap and, in the cases of Emily and myself, to get relaxing massages.  That was also one of my highlights.  No random relaxing background music was needed as there was the natural background music of the birds around the massage tent.  Definitely worth the extra money.  
The summing pool and surrounding area at the hotel

In the afternoon we went on another game drive.  Every now and then Jeremiah would suddenly start driving off relatively fast without stopping for any of the stuff he normally would do.  The first time it was to see a pride of lions.  There was 1 male (apparently there will have been another male around somewhere as 2 will protect each other), 2 females and cubs of various sizes, though unfortunately no tiny ones.  Lions are my favourite so I was really glad to see these guys.  The second time was to see a cheetah.  We had to hang around near the cheetah a bit as another car was on its way over and they'd been wanting to see a cheetah.  The drivers all talk to each other about what's where.  Apparently it's in code so that even visitors who speak Kiswahili don't even know what they're talking about.  It was amusing to see all the animals facing the same direction, watching the cheetah's every move.  As we were waiting we saw the cheetah heading closer and closer to some antelope.  Suddenly it started chasing 2 of them.  As far was we could see there was a baby antelope and a mummy antelope.  (Yes, they are the proper terms!)  It almost got the baby one, but then the mum came and fought it off.  I wouldn't have thought that an antelope would beat a cheetah!

The day was completed with another 4 course meal with an extra 5th course of birthday cake for Mark whose birthday it was.  The staff came out of the kitchen with a cake and singing.  It was great.  Kelly and I were singing that first song the rest of the evening.

The final morning had another early morning game drive (6.30-8am) where we searched high and low for elephants, to no avail.  We saw elephant dung, trees that elephants had knocked down and even an elephant skull, but no actual elephants.  Was still a great feeling to be out in the early morning seeing the Kenyan wildlife.
Sadly, we had to leave later on that morning after taking going to hippo point to see the hippos which had kept us awake overnight - they can be loud!

Anyway, I highly recommend safari in Kenya to all!  We had a great time and it struck me again what a creative God we have to come up with such beauty and splendour.  

Sunday, 30 October 2011

Lifting my eyes to the hills

There was a cardiac surgeon called Prof Hart who died and ended up at the pearly gates.  There was a massive queue and he was used to getting everything when he wanted.  He went up to St Peter, “I’m a professor in cardiac surgery, please let me come in,” he said.  “Sorry,” said St Peter, “but you need to stand in line with everyone else.”  There was also another late doctor there – Dr Jones, an eminent oncologist who had spent a lot of time developing cancer treatments.  He also went to Peter and explained, “I’m a famous doctor and oncology researcher.  Please let me in.”  Again St Peter told him he must wait like everyone else.  A few minutes later up walks a man in a white coat with a stethoscope around his neck.  He goes up to St Peter who gives him a smile and lets him straight in.  Prof Hart and Dr Jones muttered amongst themselves for a few seconds about how unfair this was and decided to confront St Peter about this.  The reply: “That was God.  He sometimes thinks He’s a doctor.”

This is not the most well told joke ever, but it does point out how we can try to place ourselves in God’s position.  Especially as doctors, we tend to be people who need to fix things and make things better.  This isn’t always possible.  Even when we do good things and “fix people” is it really us?  The motto at Tenwek Hospital is “We treat, Jesus heals”.  God is supremely in charge.  No-one else, including doctors, lawyers or even politicians.  We also automatically by having the title “Dr” gain some recognition and status.  We need to remember that it’s still Jesus who does the good work. We are just the vessels that he uses if we let Him. 

These last 2 weeks have been the toughest so far.  I was on call at the weekend – a full 48 hours, which I’ve never had to do before.  I also covered another 2 nights (though one I slept through) and had to go into the hospital on a night where someone else was covering for me because there was too much going on for her to handle alone.  Here is a selection of things from the last 2 weeks:
·         A 12 year old with meningitis who crashed twice, the second time we were unable to get her heart going again.  If she’d come a couple of days earlier instead of going to a dispensary where she was treated for the wrong thing it might have been a different story.
·         An 8 year old with probable anaphylaxis from a penicillin injection that she’d had before with no problems.  She was intubated on ICU, but she died later that day from problems with her airway (which would not happen in the UK or US).
·         A 3 month old with HIV we are treating for PCP, meningitis, severe oral thrush and severe malnutrition.  She has a history of very little feeding for 2 months.  (That’s 2/3 of her life!)  She got acutely worse last Saturday evening, but is somehow still alive although the effort that goes into every breath is massive.  Please pray for her and her mum (who has already lost 2 children).
·         A pregnant lady was brought into casualty by her neighbours after being in labour for an unknown long amount of time.  She didn’t have a pulse.  After commencing CPR on mum the baby was delivered by section.  Unfortunately the casualty/OB team could not help mum and we were unable to save the baby.  There was a large uterine rupture and apparently the mum’s abdomen was full of blood.  Again, if she’d come in earlier both would probably be alive now.
·         An 11 year old girl came in recently diagnosed with HIV.  She weighed only 13.5kg!  5 months ago she weighed 26kg.  She was being treated for sepsis.  She was one I saw in the very early hours of Tuesday.  Unfortunately she died on Tuesday night. 
·         A lady who was 32 weeks pregnant was kicked by a donkey and came in.  The following morning she delivered her baby who was fine.  Then we found out there was another baby still in her uterus.  (Many women don’t have scans during pregnancy although antenatal care is available.)  The second twin was delivered by Caesarean section and refused to breath….we bagged for 1 hour (probably too long), a while after that the baby started gasping and then started breathing about 5 hours after birth!  Unfortunately she still died 3 days later.

There have also been a number of other deaths in the past 2 weeks both on the ward and in the nursery.  Some are patients I had nothing/little to do with, some are patients I’d been very involved in.  With the latter there are always many thoughts going around your head.  “Did I miss something important?”  “Would someone else have done it better?”  “What did I do wrong?”  Really the most important thing to know is that you’ve done your best and trust in God’s sovereignty that He has everything planned out.  There is the freedom and actually the expectation here that you will pray with patients.  For me this is as important as the other things you do for each sick child.  The chaplains are invaluable, but to pray with patients and their relatives myself is so important, trusting God that He will take care of the child.

There have been multiple times in the last couple of weeks where I just felt so inadequate. (Note: this is different from incompetent.)  In the times of emotional stress and physical tiredness from lost sleep I saw how God started to show some of His strength through my weakness.  When we feel like we can do everything, we place ourselves where God should be and we think that we don’t need Him because we can do it ourselves.  That’s the temptation anyway and a very real trap we can fall into.  For example, on Tuesday night Leya was doing the full call by herself (normally I do the call, but call her if I’m unsure of anything, but have never rung her at an awful hour) as I’d not been 100% well for a couple of days.  At about 2.30am I was paged and directed it to Leya with the thought, “Thank goodness I’m not on call, I just can’t do it.”  By that I meant physically, emotionally, everything.  However, by the time she called me, only a short time later to go in to help her, somehow I had the energy to get up, go into the hospital and help a very sick child.  This can only have been through God’s strength and his power.  When we are weak I think we have 3 choices – give up, struggle along as best we can, or look to God.  I am thankful to say that I did the last of the three. 

At my lowest the other day, God reminded me of Psalm 121:
“I lift up my eyes to the hills.  From where does my help come?  My help comes from the Lord, who made heaven and earth.  He will not let your foot be moved; he who keeps you will not slumber.  Behold, he who keeps Israel will neither slumber nor sleep.  The Lord is your keeper;  the Lord is your shade on your right hand.  The sun shall not strike you by day, nor the moon by night.  The Lord will keep you from all evil; he will keep your life.  The Lord will keep you from all evil; he will keep your life.  The Lord will keep your going out and your coming in from this time forth and for evermore.”

However, I’m going to end the work stuff with a good story.  This boy in the picture below came in with bad tetanus the week before last.  He was admitted to ICU originally, but was moved down to the ward a couple of days later.   With the help of large doses of diazepam he has gradually been able to move more and more and is now eating and walking.  Every time we saw him he would open his mouth to show us how much more he could open it.  Although he still has a way to go, he got to go home on Friday. 
I have also been struck by how happy some of the children on the ward appear, even those who are stuck in traction for weeks will sometimes always have a big smile on their faces.  I find this really humbling.

On other subjects, it was my birthday about 3 weeks ago.  I had a really good evening!  It was also Jonathan Bacon’s birthday.  (He’s an orthopod here for 6 months.)  We were invited round to Leya and KE Mathew’s apartment for dinner.  (Leya is possibly the best cook I’ve ever met and makes the most gorgeous authentic Indian food.)  Then we had cake and ice-cream with all the guesthouse people and then watched a film, The Gods Must Be Crazy, which is set in Africa in about 1980.  It is really funny, but does make you think a bit as well.  I definitely recommend it.  Thank you to those who sent, or attempted to send, cards and parcels.  I felt very loved that day both by people here and those at home.

·     That there has been a larger paeds team than normal the last 2 weeks which has helped with the workload
·         The God reigns supreme and is always there for us
·       For the prayers from everyone at home and those I’ve met here who I know are praying for me even after they’ve left.  (Seriously, I can tell.)
·         For those children who have got better and all the babies we’ve discharged from nursery/NICU
·         For the new friends I’ve made here over the last few weeks

·         Please pray for the interns here.  There are currently 15 (which is 1 short causing them to have to do extra calls).  They work so hard and get no annual leave.  They get 7 days off a month, but they have to round in the morning on 2 of them, so 5 full days and 2 half days.  They work so hard serving God.  This should be the last rotation for most of them, but some are having to do an extra 3 months as the next lot of medical interns don’t start till April.
·         For good rest in the times when I’m not working.  Especially on safari next weekend.
·         That I will continue to rely upon God and find my identity in Him more and more
·         There are a lot of sick paeds patients at the moment – please pray for them.
·         That the things I learn here will not be left here, but will have an impact on me after I return home
·        For continued protection over me.  I wasn’t completely well on Monday or Tuesday, but am now back to full health. 

Monday, 3 October 2011

The days of room 3

Today was the day that I was promoted from room 3 downstairs in the guesthouse to apartment 1 upstairs, hence the title of this entry.

I am now settled at Tenwek having been here almost 3 weeks.  I find it strange to think that for some people that would be the end of their time here.  There has already been one couple who've come and gone within the time I've been here so far.  The turnover at the guesthouse is pretty quick, though some people can stay here for a few months at a time.

I'm learning a lot whilst I'm here.  I'm learning how to act in a more senior role, reviewing patients who've already been seen as well as seeing patients myself.  I'm learning general paediatrics (albeit slightly African stylee) with some neonatology thrown in.  I'm learning more how to praise God for everything and trust in Him more in my everyday working life.  I'm learning how it feels to be really rich.  And I'm sure I'm learning more than this.

The feeling rich thing is interesting.  I'm not badly off by any standards in the UK, but here where there are some people who have so little it becomes really obvious.  Practising medicine here is very different from the UK.  You have to consider every test that you order and every medication you prescribe.  The patient has to pay for each thing.  There is a national insurance scheme that some patients have, but not all.  I think this makes a better doctor in some ways.  It can be so easy ticking a load of boxes, but then to think about whether you really need everything that you've ordered.  There's the new CT scanner (which we're waiting for approval to use at the moment) which is going to cost about £40 for patients to have a scan which could really help their treatment.  Even at a price that cheap, so many people will not be able to afford the scan.  We take CT scans and MRI scans and even nuclear medicine scans so much for granted in the West (even if sometimes you end up arguing with a scary radiologist to get them).  Although it has so many problems, the NHS really is a good thing at its heart - everybody being able to access free healthcare at the point of access.  It doesn't matter whether you are thousands of pounds in debt or a millionaire, you can still get the treatment that you need without having to worry about a massive bill.  I've been getting so used to a nice amount of pay entering my bank account for the last 2 years and taking it for granted, but being here reminds me how fortunate I am to have that.  But also that money is not anything to have security in.  The recession has shown that!

I'm also learning a lot being part of a Christian ministry at work.  There are doctors' devotions once a week on a Wednesday morning.  Last week one of the interns led it and what she said was just so inspired.  She basically was talking about how everything we do should be for Jesus.  We ended by singing a song together.  I just felt that it was a really powerful moment with nearly all the medical staff there praising God and dedicating their work to God together before starting work.  I find being able to pray for patients openly on the wards quite freeing.  I don't think that I'm doing it quite enough at present, but as the motto of Tenwek says, "We Treat, Jesus Heals".  This actually is the attitude of the staff here.  All we can do is love the patients and try to make them physically better with medications, surgeries etc, but it is God who really does the healing.  We can just try to be His representatives on Earth, but remember to give Him the praise for the things that He blesses us and our patients with.

A couple of Saturdays ago I went to a place called Kisumu which is Kenya's 3rd largest city.  It is on the banks of Lake Victoria.  We had a very relaxing few hours when we got there (following 3 hours of Kenyan driving, though I trust Donald's driving completely), sitting by the lake and eating yummy food.  We also went to a large supermarket called Nakumatt ("You need it, We got it") where I bought Nutella amongst other things.  It was great to see more of Kenya especially during the journeys.  I would have liked to have stayed there overnight really.

Prayer time
Thanks for:
- keeping me safe and well
- the internet and electricity working better
- that I've been able to switch rooms
- that I'm settled here and starting to make friends
- all the children who've come in and been able to go home again
Please pray for:
- protection over my mind and body
- me to hear clearly from God about His plans for me for this year and the future
- the children on the paeds ward and the babies in the nursery/NICU.  Especially for an 18 month old girl who came in really dehydrated and is still not very responsive.  There's also a baby in nursery with congenital heart disease who's requiring quite a lot of oxygen and we don't know if we're going to be able to do anything for it (although there is a cardiac surgery team coming in November).
- the interns at Tenwek as they start their last rotation
- for God to use me as a tool to show people His love

Sunday, 18 September 2011

The Beginning of the Adventure

Hi and welcome to my new blog.  I've never done this before so we'll see how it turns out.

I'm not sure how accurate the title is to this post.  It is the beginning of my time out in Kenya, but really there has been much happening before this.
Just to fill in anyone who doesn't know, I am a junior doctor having completed my 2 foundation years working in West Yorkshire. I have decided to take a year out so that I could come back to Kenya.  I came to Tenwek Hospital for the first time 3 years ago for my 2 month elective as a student.  I learnt a lot and really valued my time here.  As I left I felt in my heart that God would bring me back here at some point.  I decided to have a gap year for a multitude of reasons, not all good to be honest, but one of the main ones was to come back here.  I originally wanted to spend the first 6 months in Australia or New Zealand and then come to Kenya for 4 months at the end of the year.  (Medical years go August-July, rather than Jan-Dec.)  The Oz/NZ thing didn't work out and so I've ended up relying on my backup plan - to come to Kenya twice.  However, I do believe that this is what God intended (and I have a couple of close friends who will help back my up on this when I'm wavering).  I did get a paediatric training post in the UK to begin August 2011, but really felt God told me to turn it down, even though I was very tempted to take the easy option and just continue in the UK with no (well, less) scariness.  God placed Africa on my heart over a decade ago and I have believed since then that I would have opportunity to work in this continent.  This is not just a sudden decision to go and do some travelling, but has been a work in progress for a while.

Anyhow, I got here safely on Tuesday after a smooth journey (despite lots of traffic near Heathrow).  I am staying in the guesthouse which is a 2 minute walk from the hospital and I'm not missing the commute in the slightest.  Still wouldn't choose to live in at home though.  There are various other visiting doctors/medical students staying here too.  I am working in Paediatrics at the moment.  I'm enjoying it so far, but as I've had minimal post-graduate experience of paeds it's all new.  To be honest it's very different from the UK anyway with a significantly different spectrum of diseases.  Many of the children on the ward are HIV positive and meningitis can easily be due to TB or cryptococcus in these children rather than just the more common bacteria.  I am enjoying working in the nursery with the neonates again.  We admitted some tiny twins born at home at 30 weeks this morning.  They are surprisingly well.  I find it very strange when interns refer to me as a "consultant".  I'm not going to truly win this title for at least another 9 years.  I'm learning a lot and studying more than I have done for the last 2 years (though that's easy to beat)!  At some point I am likely to do some obstetrics.  I'm really hoping not to do medicine because I think I would have no clue.

Most of the people who aren't Kenyan are American.  I'm currently the only British person here (and that's likely to stay that way).  Occasionally I have to rephrase things so that I don't use too English a term eg "vital signs" instead of "obs".  In some ways I like this.  For instance, I have an accent here - I don't at home.  But sometimes I can really tell that I'm from a completely different place.

The weather is tending to be warm and sunny in late morning/lunchtime, but then often gets cold, cloudy and rainy in the afternoon/evening at the moment.  Though cold as in English autumn cold rather than English winter cold.  I remembered to bring more jumpers this time.  I got bored of wearing the same one jumper last time.

Anyway, on the whole it's going well.  I'm making friends and catching up with a couple of old friends.

For those of you who are praying people I would love it if you could remember the following:
- thank God that I got here safely and that I'm settling in and getting used to life here again.
- pray for the electricity around the complex by the hospital.  Some people down the hill aren't getting any and the generator up by the hospital keeps kind of restarting itself.
- pray that the CT scanner will work.  There's been a problem with it, but apparently it's just up and running again.  Please pray that there will be no more problems with it.
- pray that I would continue getting to know people and that I will become fully integrated into the community here.  I am here for 3 months now and another 3 months from April so this is a really important point.  I felt like this was my home by the time I left last time.  I pray that it would feel even more like that this time so that I can really look forward to returning in April.
- pray that God would guide me at work so that I can give the best I can for my patients and that at times when I have little backup that it wouldn't be too busy.  Also that I learn a lot and am able to apply what I learn to my practice.
- pray that God would show me more of His plans for me in terms of African medical mission in the future. I believe that when I decided I wanted to be a doctor when I was 13 or 14, that God put Africa on my heart then.  I think that I will come back to Africa at some point after this year, but I don't know whether that will be long- or short-term trips or whether it will be Kenya or somewhere else.  One of the long-term doctors here has already worked out that I'll finish training in 2020 and can come back then.  Lol.
- pray that I continue to remain physically well.

I will be on facebook regularly so please talk to me on chat and hopefully I'll be able to access the internet on my laptop soon so I can use skype as well.