Day 24: Departure and Conclusion

I woke up for the last time in Mombasa at around 8am. A few students were packing to leave at around 9am, and most of the rest were getting ready to leave for the hospital. By 9:30am, I was the last one left at the compound.

I took my last cold shower and packed my belongings. Most of my colleagues returned from the hospital around 2pm, so I had time to say my goodbyes and take last-minute pictures with everyone. By 2:30pm, it was time to go, so I loaded my luggage into the van and took the ride to the airport. I flew from Mombasa to Nairobi, to Amsterdam, to Atlanta, and finally, to Jacksonville. After two days of travel, my journey in Kenya was officially finished.

Throwing stars and venus fly traps are prohibited in the Nairobi airport? Oops...

Conclusion

Over the course of the month, I have learned and experienced far more than I can possibly describe with words and pictures. My exposure to a new language, a new culture, a new work environment, and a new ecosystem was overwhelming, but fascinating to explore. Culturally, I have learned about how Kenyans live in day to day life, the kind of food they eat, what kind of hardships they face, and what activities they enjoy. Medically, I have learned the basics of how to suture, change dressings, insert cannulas, change IV fluids, inject lidocaine, take blood pressure, and administer HIV tests. In a matter of weeks, I have made a number of international friendships I intend to keep up with, and we joked that in 10 years we would all meet up again (or was it a joke?). Ultimately, my trip to Kenya was one of the best experiences in my life so far, and it’s one I will never forget.

The Elective Africa group!

Day 23: Craniotomy and Excision, Last Full Day

I woke up at 7:30am, when we were supposed to leave for the hospital. Fortunately, the van was running late, so we ended up leaving at 8:30am. When we arrived at the hospital, I first headed up to the Major Theater to make sure I could scrub into the sterile field for a surgery. They said I could scrub into the second surgery, so one of the students agreed to text me when the first surgery was over so I could attend the second. Until then, I planned on going to maternity to see some deliveries.

When I reached the maternity ward at around 10am, I managed to see two deliveries. The first was a blue baby, the second was healthy; both were girls. The doctors/nurses told me I could deliver the next baby, but after three hours, no more births took place. I got the text to return to Major Theater at around 12:45. When I got there, the surgeons decided to take a lunch break, so I ate lunch too (rice, meat, and spinach). Afterwards, we headed to Theater 4, where I would get to scrub into the sterile field for the first time.

Surgery #1
DX: Epicranial mass from metastasis of thyroid tumor
Operation: Craniotomy and excision


The Italian neurosurgeon resident showed me how to scrub in, which consisted of washing my hands and upper forearms, putting on a sterile apron, and putting on sterile surgical gloves. During the surgery, I used the manual vacuum aspirator, kept the wires for the various instruments from getting tangled, and squirted water with a syringe while the drill cut the cranium. I also got to stitch sutures under the skin and use the stapler for sutures on the outer part of the skin. It was interesting seeing a large extradural tumor being removed up close. The whole procedure took about 4 hours, so it ended up being very exhausting.

Me using the vacuum aspirator during neurosurgery!

We got a tuktuk back to the housing compound at a little after 6pm. Another barbecue dinner was prepared for us, since about six of us would be leaving the next day. With burgers, ribs, fish, and other food, it was a great way to celebrate our last night in Mombasa. Since one of the students brought a spare cannula back from the hospital, one of the UK medical school students let me try putting in my first cannula, since I didn't get a chance to at the hospital. After watching numerous cannula insertions at the hospital, I knew the general procedure, and to my surprise, I got it in! It felt good succeeding in what I considered the most difficult thing I would get to do in Mombasa. Eventually the excitement died down and I went to bed, knowing tomorrow I'll need to pack and depart on my 4:40pm flight back to the US.

Me putting a cannula in Sunny!

Day 22: Neurosurgery and Swimming

I slept in until about 9am and then went to the main building to eat breakfast. I wasn't planning on going to the hospital, so I went swimming, but then I was convinced into going with a group from 12:30 to 3:30pm. Although I wasn't there for long, I got to see the end of a cranial hematoma surgery and the beginning of a brain tumor removal. Between the surgeries, I ate some beans, rice, and cabbage the hospital provided for the doctors, nurses, and students.

We left at 3:30pm and hung out until dinner. After dinner, we went swimming again, and I worked on my blog more. My parents and I decided it would be safest to leave Wednesday instead of the originally-planned Sunday departure, so my flight schedule was changed so that I leave Wednesday at 4:40pm. Since tomorrow is my last day, I'm going to try to squeeze as much in as I can while still having time to pack everything; this includes scrubbing into the sterile field of a neurosurgery, watching a baby be delivered, watch a C-section, and start a cannula. I'll be going to the hospital at 7:30am to try and fit as much in as I can in my last full day in Mombasa.

Days 19, 20, and 21: Masai Mara

I woke up around 3:15am, and we left on time around 4am. The airport was only about half an hour away, so we had plenty of time before our flight. On board, I was seated next to a man in a suit who said he is from Mozambique and works for Save the Children. We arrived in Nairobi at around 6:30am, just as the sun was rising.

Downtown Nairobi

Although we were supposed to be picked up at 8am, our transportation arrived early, so we left the airport at 7am. We first went to a small market in Nairobi, where we got water and food/snacks (like Toblerones). Next, when we stopped for gas, we went inside and got chicken and ice cream (the first ice cream since I got to Kenya!).

"Mint Crisp" Ice Cream!

We traveled for about 2 hours and arrived at our lunch destination, which was a small buffet in a small town between Nairobi and the Masai Mara. We ate lunch and continued for another 3 hours; the last 2 hours were on a rock/dirt road which was crazily bumpy (especially at 80 km/hr, or about 50 mph).

At a stop along the way

Wombat! (First Wildlife!)

At around 3:45pm, we arrived at our campsite just outside the Masai Mara reserve. We dropped our belongings off at our tents and went on our first safari trip. In the three or so hours we were there, we saw antelopes/gazelles/impalas, water buffalo, wildebeest, elephants, and lions. At about 7pm, we headed back since dinner was at 7:30pm. The meals were provided at a building where all members of our camp ate together. We met two Australians, two Missourians, and two Danish nursing students.

My Tent

Our tents only had electricity from 6:30pm to 10pm, and since we had to get up early anyway, we went to bed at 9pm. I was awakened at 2:30am by a very strange, hysterical laughing sound... something between a man uncontrollably laughing and a dog barking. It took me a minute to realize it was a pack of hyenas.

Saturday morning we woke at 6:30am and ate breakfast at 7:30am. Afterwards we left for safari. I've combined pictures from all three days below to show the variety of animals we saw; there are many more pictures, but due to limited internet, I've only posted a few.

Elephant

Lion

Impala/Gazelle/Antelope Thing

Water Buffalo

Giraffe

Wildebeest

Zebra

We ate lunch along a river, where we saw mongooses, vervet monkeys, hippopotamuses, and a crocodile. The mongooses and monkeys tried to steal our food until a ranger shot at them with a slingshot. After lunch, we continued to adventure around until about 5:30pm, when we left the Masai Mara and went to the village where the local Masai warrior tribe lives.

Part of the Masai Village

Their village was a small circle of a few huts made of sticks and dried cow manure. The ground was almost entirely manure from the various animals they kept (cows, goats, chickens, dogs). The Masai showed us the inside of their huts, which were very small, with beds made of dried cow skin. They taught us one of their tribal dances and explained how the man who jumped the highest paid the least number of cows for his wife/wives (normally about 20 cows per wife, and each wife needs her own hut). They also told us that the previous night, they had to fight off a group of hyenas that was attacking their animals, which explains why we heard them at 2:30am. We left the village and went back to eat dinner at around 7:30pm.

It was at dinner that we heard startling news: that the US Embassy had issued a terrorist warning for Mombasa, that there was an "imminent threat of a terror attack" from an al Qaeda-linked terrorist group, and that bombs or bomb components had been found in both Nairobi and Mombasa. Since we didn't have internet, we couldn't find out any more information, so we still didn't know exactly was happening. Later we would learn that Kenyan troops had been sent to Somalia in October 2011 to help oust the Islamic militant group al Shabaab, a close ally to al Qaeda. The group threatened retaliation, and various bombs had been intercepted in Nairobi and Mombasa, and some bombs had gone off in Nairobi.

Nonetheless we planned to go to the safari early the next morning, at 6am, so we went to bed around 10pm. The next morning we went on safari for about 2 hours before returning, eating breakfast, packing, and leaving for Nairobi at about 10am. We stopped at the same place for lunch, and continued until we got to a secured area (I don't know what it is called) where we waited for the Elective Africa Nairobi coordinators to talk to us about the safety situation. We also walked around a market to see what it was like (people persistently tried to sell us stuff). Finally, we went to the airport and took our 8pm-9pm flight back to Mombasa.

When we got back around 10pm, we started watching the Euros (England vs. Italy... Italy won). I was on my computer working on my blog, and I decided to check to see the status of the terrorist threats in Mombasa. I was the first person to read the news about the grenades that went off at 9:45pm earlier that night. Since then, students in the group have been indecisive about staying in Mombasa and only leaving to go to the hospital, or leaving early. We went to bed after the Euros, unsure of how bad things were or how bad they will get.

Day 18: Day Off Before Safari

I slept in until 9am, ate some breakfast, and went swimming. Sunny and I bought a pair of goggles, so I used those to swim laps. We also invented a game composed of tossing a mango and trying to rescue it before it sank all the way to the bottom of the pool (and occasionally racing to get it). After much swimming, I ate lunch, and later dinner. We played some games and hung out for a while before packing for our three day safari at the Masai Mara.

Our flight tomorrow is at 5:30am, so we need to leave at 4am, meaning I'll need to get up sometime between 3am and 3:30am. I won't have my computer with me, so I won't be able to update my blog until we get back Sunday night. Our flight back returns to Mombasa at 9pm, so I'll update it a few hours after that (I'll have a lot to write about and many pictures to post!). After packing, we went to bed early, knowing we would have to wake up and leave well before sunrise.

Days 16 and 17: Crazy Night, Morning, and Afternoon Shifts

Since yesterday and today melded together, separated by no more than 4 hours of sleep, I will write about them as a single post. Yesterday morning I slept in until about 8pm. Not much happened before my shift started; I mostly just ate, went swimming, and hung out until it was time to head out. At 8pm, we took the tuktuk to the hospital.

Dinner was spaghetti with beef sauce.

When we arrived, the hospital was the most empty I've ever seen it. Many of the areas, such as the radiology rooms and Minor Theater, were closed and locked. We headed to Casualty, which wasn't nearly as active as I was anticipating. We helped save a woman suffering from an asthma attack (apparently the nurses in Casualty just ignore asthma attacks, because they didn't do anything), and I watched one of the doctors put in cannulas. I was going to get a chance to try putting in a cannula (which was very exciting... I consider the successful insertion of a cannula as my ultimate test for this trip), but we found that the patient already had a cannula on the other side of his elbow, so there was no need for me to put one in his hand. Hopefully I'll get more chances to put a cannula in before I leave.

We also headed up to a general ward to see if anything was happening. We found a baby with cephalohematoma (collection of blood between the skull and the scalp, causing a bulge on the head). Since there wasn't anything we could do in the general ward, we went back to Casualty and followed doctors around for a while. We heard that there was a spina bifida surgery (an intense neural surgery) in the morning at 8:30am, so we decided to plan on watching it.

By 2:30am, we were tired, and there weren't any new interesting cases for us to examine, so we went for a walk around the hospital. We happened to find our van that drives us around and the driver asleep in it. There was also a really cool praying mantis on the van that we stared at for about 5 minutes and poked with a stick. Finally, we headed back to the housing complex. I went to bed at 3am, ready to get up early for the surgery we agreed to see.

Praying mantis on the van! It flew away after a few minutes.

I woke up at 7am, ate breakfast, and got ready to return to the hospital. We left in a tuktuk at 8:30am and arrived at around 9am. As expected the surgeries were running late, mostly due to equipment failures (they couldn't get the Bovie and bipolar coagulation forceps working for a long time). They also changed the schedule, so that the spina bifida surgery came third in line. We decided to stay to watch the first one, then get lunch during the second, and come back for the last. We scrubbed into Major Theater and headed to the fourth theater room.

Surgery #1

DX: Cephalohematoma

Operation: Excision

The neural surgeries we were about to see weren't simple ones. When we walked into Theater 4, we were greeted by a neural surgeon from Spain, and neural surgery resident from Italy (doing his residency in the Czech Republic), and the resident's nurse from the Czech Republic. The team met up in Mombasa a few days ago and are here until Wednesday. It was interesting to learn that neural surgery residency takes 7 years, and the resident in this group was in his 4th year.

They arranged the three surgeries in order from simplest to most complex, with spina bifida being an obvious last. It turned out that the first surgery was the excision of the cephalohematoma of the baby we saw in the general ward last night. Apparently trauma from the birth caused a fracture in the baby's skull. The fracture healed by itself, but the bleeding caused a collection of blood to build up between the periosteum and connective tissue layers. The surgery was somewhat quick (went from 10:30am to 12:30pm) and involved cutting through the connective tissue and draining the blood.

After the first surgery, we left for lunch (at 1pm). We took a tuktuk to a restaurant called Caribou, which is near our housing complex. I got coconut-seasoned fish and a Toblerone milkshake (a great mix of much-needed calcium and more-needed ice cream). We stopped by the housing complex before heading back to the hospital at 2:30pm.

Coconut fish and Toblerone milkshake for lunch.

Surgery #2

DX: Spina Bifida

Operation: Closure

Spina bifida, Latin for "split spine," is a birth defect in which the neural tube does not close properly (instead of forming a closed tube, it is open and allows cerebrospinal fluid to leak out and form a bubble outside the spine). The condition often results in partial paralysis (especially paralysis of the legs), and while surgery does not cure the paralysis, it does close the neural tube and prevent infections that could cause more nerve damage. Spina bifida is very rare in developed countries (it is preventable by consuming adequate folic acid prior to conception), so getting to see this surgery up close is a big deal for us.

The Italian neurosurgery resident (left) and Spanish neurosurgeon (right) closing the spina bifida.

We arrived in Theater 4 just in time for the surgery we had been waiting to see. They had already finished the meningocele excision, had put this new patient (3 year old) to sleep, and were cleaning the area of operation with iodine. They cut the bubble of cerebrospinal fluid protruding from the patient's back and drained out the large amount of fluid that had accumulated. The Spanish surgeon and Italian resident worked together to suture the spinal components closed and clean up any infected tissues. They were almost done by the time we decided we should probably head back and eat dinner. We left the hospital at about 6:15pm.

By the time we got back, I was exhausted. I ate the dinner Dollas had made, which (for the first time) was fish and was arguably the best meal so far (even after having fish for lunch too). It was a long two days, filled with much hospital time and little sleep, so three of the four of us decided to take tomorrow off. We went to bed early, eager to catch up on lost sleep.

Dinner was fish, rice, and spinach.

Day 15: Day Off

I slept in until about 8am and reviewed bone and muscle anatomy for a while since it was my day off from the hospital. Eventually I got up and went to the main building to eat breakfast. Apparently some of the others decided to go to the hospital in the afternoon and night, so there were more of us at the complex than I expected. I made plans to go on tomorrow's night shift (8pm to 6am), so tomorrow I'll have the day off and the night at the hospital.

I didn't do much of anything exciting today. We picked some mangoes from the mango trees using a rake, and ate lunch and dinner. We also bought our plane tickets to the Masai Mara for the safari this weekend; originally we were going to take a bus and stay at a hotel, but we decided flying was faster, easier, and roughly the same price. Interestingly, the tickets were only $60, but the taxes were about $93... not sure how that works, but I got my ticket nonetheless. We hung out for a while before finally going to bed. After working Monday through Sunday, it felt nice having a day off.