The Kijabe Hospital

Since Monday was a Kenyan holiday, we started in the OR on Tuesday, and operated Tuesday and Wednesday, and had a clinic day on Thursday. I’ll write a big surgery blog soon, but I just got home from clinic and it’s fresh, so that’s what you’ll get right now.

We rounded Thursday morning on our patients that were admitted post-op at around 8 am (I know, cushy schedule), and then headed to surgical clinic at around 8:45. Dr. Davis has his clinic every week on Thursdays, where he sees patients who have been referred and might need some kind of surgery. The clinic consists of about five very small rooms separated from a main waiting area by curtains. Though there are “appointments”, pretty much everyone is there first thing in the morning, so the waiting room was packed. Most patients traveled several hours to reach the hospital, and many traveled from other countries and had waited in Kijabe weeks to see the surgeon, so a day in a waiting room is no big deal. I hope to think about this when I get frustrated that my doctor is an hour late.

There were about 100 patients to be seen today, with a team consisting of me, Dr. Davis, and an intern. I had assumed that I’d tag along with Dr. Davis and his patients for most of the day, but it quickly became clear that I’d need to cut the cord and see patients on my own.

The first patient we saw was pretty amazing. She was from a Middle Eastern country and flew down to see one of the visiting surgeons who specializes in maxillofacial reconstruction. This young women fell on her face when she was two, and broke her upper and lower jaws in several places. It’s unclear if her parents did not get her medical care, or if it was grossly inadequate, but now her upper and lower jaw on the right side is completely fused together, and she hasn’t opened her mouth in 20 years. The growth of the bones in her face has been asymmetrical, so she’s quite disfigured. The doctor thinks that he can separate the portions of jaw tomorrow morning and start her on the road to recovery. I’m excited to see the case.

The next patient, I was on my own. I walked into the room and there are four Somalis, two men and two women. There is a Somali refugee camp a few hours away that houses about 300,000 displaced Somalis, many of whom come to the hospital for long-delayed medical care. A man quickly greets me and says that he lives in the US and can speak English. Thank goodness. I ask him where he lives in the US and he responds, “Columbus, Ohio”. Turns out he lives about a mile from where I grew up. Very small world. Anyways, we get down to business and figure out that the women has diffuse bone pain, large lymph nodes in her armpit and neck, and a breast mass. I examined the nodes, and then it came time to examine her breast. Hmm, they didn’t teach us the proper protocol for breast exam on a veiled Somali Muslim. I asked if I could examine her, and the men quickly left the room. The mass has actually ulcerated through the skin, so the pathology was pretty apparent. We did a needle biopsy, and within an hour has the results which showed ductal carcinoma. At this point, I called in backup (Dr. Davis) to discuss treatment options. She was very resistant to the idea of a mastectomy (understandably), and was repeatedly asking for “dawa” (drugs) instead. She ended up leaving without a scheduled surgery. Hopefully she comes back.

I saw a few more patients with ridiculously advanced disease, and then had my first patient who didn’t speak a lick of English. So, Swahili it was. I started out slowly, but got into the swing of things and was pretty happy with our communication level. I can definitely see how working in a clinic like this would teach you the language very quickly. Next step: start consenting patients for surgery in Swahili. This process was much slower, as I wanted to make sure that I was able to adequately explain the procedure and the associated risks. I’m sure some of the phrasing was very awkward, but it got the job done. Sentences like “mpira itakaa umeni na wiki moja” (the tube will live in your penis for one week) were abundant today. The most challenging patient of the day was a Somali man who brought his brother to translate, but only into Swahili. I think there was probably a lot lost in translation.

Clinic made me very excited about the possibility of returning at some point after I’m at least closer to being finished with my training. It was amazing to connect even a little with patients in a completely different language, though I’m sad that so many of the patients spoke Arabic and Kisomali, languages that I have no idea about. One of the American doctors here speaks English, Swahili, Kisomali, Arabic, Kikuyu, and some of several other tribal languages. No big deal.

Lots of surgeries on the schedule for tomorrow. I’ll have some pictures for the next blog.