Some random thoughts from my first two weeks in Kenya

I’ve never blogged before, so bear with me. Hopefully I can make the page look sort of decent (like a kitchen someone once wanted), and maybe embed pics and stuff in a way that isn’t horrible. I’ll start with my trip to Kenya, this being a coming of age of sorts. Although I’m not sure what sort. In any case, I’ll blog from here when I get a chance. Right now I’m not blogging at all since I don’t have an internet connection. I’m at the domestic terminal of the Kenya International Airport. Pretty much as one might expect, the airport is small, cramped, the arrivals “hall” has like 6 foot ceilings and 2 immigration agents. This is the entirety of the waiting area of the domestic terminal. The business class lounge looks like a prison with half-silvered windows. Of course the price of the visa has gone down since I paid, from $50 to $25, so there go three more hours of my work.
Then I have all day to hang out here, which is why I’m blogging. Or typing offline. Whatever. I have no idea what I’d do with eight hours in Nairobi, and I’m pretty much too tired to think about it, so I’m just sitting at the airport. I already finished 2 of the three books I brought with me, so hopefully I really like that last one, ‘cause I’m stuck with it.
I spent my last two nights on airplanes, which pretty much sums up how I feel. Not like I’ve been hit by a truck. Like I’ve spent the last two nights on airplanes. For me, jet lag is a feeling like I’m made of sludge and I’m oozing out of my own pores. Is that weird? Anyway, I spent the last two nights taking sleeping pills, so that’s enough of that. Also, I think I’ll stop drinking coffee for the month. Maybe till I get back to SF. I’m not really that interested in shitty coffee, and hopefully I’ll sleep here, unperturbed by spouses, doing dishes, or cats’ noses two millimetres from my face at 5:00 am, purring loudly. As if I’d done anything to deserve that purr.
So let’s see. Amsterdam was OK, but I wasn’t up to smoking up, and I didn’t know anyone, so I wandered aimlessly and found a lot of really expensive watches. I forgot my watch at home, and it’s only taken me a couple of hours to reprogram the time in my Palm. I pretty much need a watch. But not for 135 Euros, even if that’s 50% off. 50% off their 300% inflated price.

One of the books I finished was “The Girl With the Dragon Tattoo”, which , other than having some very disturbing scenes, was pretty good. Definitely a page-turner, with enough insight and class to be a definite step up on other page-turners I’ve read (there haven’t been many) like “The Da Vinci Code”. But I don’t know about that ending. A bit too contrived, a bit too anti-Hollywood just for the sake of being that way. I’m not saying I know how it should end, but it seemed that he set it up too much to be the way he wanted, to get the emotions out one last time. Anyway. The other book I just read in its entirety here in the airport was “The Year of Magical Thinking”. I don’t think I’ve read Didion before, and I expect this is different than her other stuff, but it was good. The first half was actually very moving; I didn’t particularly want to cry in the airport, but some tears had to be held back. Toward the end it maybe wore a bit thin. But then, I guess she didn’t write it for me, she wrote it for herself, and maybe for some people to benefit from it. I can definitely see how Western thinking has pathologized grief, and that even though we allow it to some extent, we label it as pathologic when it has those characteristics we don’t like, like going on for over six months or rendering the person suffering from it unable to function. I think it’s Western culture that can’t adapt to grief, perhaps analogously to the way it can’t adapt to schizophrenia. If we didn’t make such constant demands on people, demands that have deadlines like bills to pay and appointments to keep, but could support them through such processes as birth, death, severe mental illness, maybe we’d be better off. But no, we’d rather give 6 weeks maternity leave, or drug schizophrenics until they behave the way we want, or be strong enough to deal with the death of a loved one. This is a bit extreme perhaps, it’s not like I think psychosis is all that, but we have no patience, no ability to support without doing something. We have to do things all the time.
I guess seeing kids with AIDS here in Kenya will teach me about doing things. Enough out of me. Only 3 more hours till my plane.

16/04/2009

I’m learning to write dates like a Canadian again, here in Kenya. Soon I’ll be a Canadian again. That will be nice. I had my first taste of medical care here in Kenya. These people know a lot about HIV and TB and malaria. And really not much else. It seems that they know a handful of drugs and their side-effects, and are able to follow indices of HIV progression. Malaria is easy, it’s everyone with a fever and no cough. TB is easy too – everyone with fever and a cough. OK, not quite that simple, but not too far off. So a 7 month old baby was admitted to the hospital here in Sindo with pneumonia. She was given some oxygen (there’s no ability to monitor oxygen in the blood here, either with a pulse oximeter or with a blood gas) and placed on penicillin and gentamicin. Seems appropriate enough. So I went to see her. One glance tells me she has Down Syndrome. One listen tells me she has a whopping murmur. And one look at her X-ray shows me that she does not, in fact, have pneumonia. She has congenital heart disease, and all the antibiotics in the world will not help her. It’s hard for me to know exactly whether her heart lesion is survivable, but she doesn’t look so great with what I can see. Cardiac surgery, of course, is out of the question.
It’s interesting to note that the cardiac surgeon at Montreal Children’s, where I’ll be starting in July, has started an international cardiac surgery initiative. I don’t know how successful or widespread it is, but maybe he wants to go to rural Kenya.
In any case, I’m getting used to the HIV regimens, the TB regimens, the malaria regimens. But the general medical knowledge is so poor, it makes it hard for me. For example, yesterday there was a lecture on classification of anemia. It was at about the level of a 1st year medical school lecture, given by a poor lecturer who didn’t quite understand anemia. I had to restrain myself from correcting him on several points. And I don’t know much about anemia, let me tell you.
And for those less queasy, there was this patient who was complaining of black stool, a classic story for an upper GI bleed (upper meaning above the large intestine, so in the stomach or small intestine). The clinician I was working with didn’t notice. So I ordered a hemoglobin (one of the handful of tests I have available here) on my own, and it came back low. So the clinician wanted to change his HIV regimen to exclude AZT, a drug which has anemia as one of its side effects. But of course, the AZT isn’t the culprit, it’s the guy’s bleeding ulcer or something. Again, we can’t really figure it out, since we can’t do endoscopy or anything like that, but I had to convince him to at least place the patient on an iron supplement.
So it turns out I know more than just pediatrics, and it’s difficult for me to see patients being mismanaged, to the point that a resident in pediatrics has to reevaluate adult patients. Anyway. I guess I’ll see a lot of that in my life, and not just in Kenya.