Day 6: Crocodile Farm

Sleeping in doesn't exist in Kenya. If the sun doesn't wake you up when it rises, the rooster will. This morning, the rooster woke me up at 7am. Apparently we were supposed to go on the tour of Mombasa at 9am, but only a few people were awake, so we decided to postpone until tomorrow. Dollas, the housekeeper who cleans and cooks great dinners for us every night, surprised us with some Kenyan-style pancakes, which were amazing! Then we went swimming for a while so we wouldn't get in her way while she cleaned the living room area.

After swimming and lunch, we went to the crocodile farm. We saw lots of crocodiles along with a few snakes, spiders, and exotic plants. Fortunately, we were there during the crocodile feeding time (5pm), so we were able to watch them feed the crocodiles. We had to leave around 6pm because our welcoming barbecue dinner was supposed to start soon.

Mamba Village Center (crocodile farm)

Crocodiles

Feeding the crocodiles

More crocodiles

The welcoming barbecue dinner!

The barbecue dinner consisted of burgers, fish, kebabs, and some other things. All of it was really good! After dinner we just hung out, played Uno, and went to bed.

Day 5: Osteotomy, Release/Repair, and Bar/Club

I started my day with a 30 minute run to the beach and back with Sunny and Joe. After we got back at around 7:30am, I showered and got ready for the hospital. We left at the usual 8:30am. My group - consisting of Courtney, Joe, and myself - headed up to the Major Theater again. And finally I remembered my camera!

Coast Provincial General Hospital

Part of the hospital from the Major Theater doctors' lounge.

It took a while to find face masks. While searching the theaters for them, a doctor explained that each of the four theaters has its own type of surgery that takes place. I didn't understand what he said Theater 1 is for, but Theater 2 is for gynecological surgery, Theater 3 is for orthopedic surgery, and Theater 4 is for neural surgery and more intensive surgeries (it has the most sophisticated equipment). Eventually someone brought a box to Theater 3, where we decided to stay and watch a humeral osteotomy.

Surgery #1

DX: Fractured left humerus

Operation: Proximal humeral osteotomy

A stray bullet had entered the patient's upper arm anteriorly (from the front) and exited posteriorly (from the back), causing his proximal humerus (near the shoulder) to shatter. His arm was very flimsy, almost noodle-like, because of the injury. Unlike yesterday's osteotomy, where I mostly stayed by the surgeon to watch how he went about repairing the mal-unioned femur, this time I mostly stayed by the anesthesiologist, who explained some of their techniques for monitoring the patient's condition during surgery (the monitor they use for watching heart rate, oxygen content, etc. was very similar to ours), and allowed us to see the patient's vocal cords before he inserted the breathing tubes.

The operating room in Theater 3.

The anesthesiologist's equipment in Theater 3.

The surgeon repaired the fracture by cutting the shattered humerus ends so that they were more evenly cut, drilling a scaffold through the bone to hold the top and bottom pieces together, then drilling screws laterally through the bottom piece and top piece to hold the scaffold in place. The interventional radiologists helped him place the scaffold and screws in the proper locations. Once the surgeon started putting in stitches, we left Theater 3 and went to Theater 4 to see what was happening there.

Between the surgeries we ran into some other students from our program, who filled us in on some interesting news. One of the patients from my first full day at the hospital, the one who had jumped off a bridge onto the road below (in an attempt at suicide), completely fractured his tibia, and whose leg I had held in Casualties as nurses put his leg on a stent, had woken up after his surgery in a psychotic state. He broke the window behind him, grabbed a shard of the glass, and started running down the hall with it. Security guards caught up to him and beat him with their batons. We're not sure what happened to him after that.

Surgery #2

DX: Contracture of the right middle finger

Operation: "Release/repair"

When the patient was 1 year old, a fire had burned his right hand so that his fingers were stuck to his palm. I'm not sure if they couldn't do the surgery until he was older, or if his parents just waited a long time to get the surgery done, but he is now five and a half years old. When my group entered the room, they were already making incisions in his wrist and moving skin from his forearm to his palm. His fingers, which had metal poles sticking out of them (I guess to help stabilize the fingers while separating them from the palm), were already separated from his palm.

There is only one anesthesiologist and one anesthesiologist assistant for all four theaters, and they are frequently running back and forth between cases. The anesthesiologist was not in the room, but Mwachoki, the assistant, appeared to not be busy, so I talked to him. I had noticed when I entered the room at the ventilator was off, and that the patient appeared to be taking his own quick, shallow breaths. I asked Mwachoki why the patient didn't need muscle relaxants (which was evident since his diaphragm was still breathing for him). He told me it's because he is a child, and went on to explain how they put children versus adults to sleep.

All patients receive oxygen, nitrous oxide, and halothane (an anesthetic - puts the patient to sleep). Thiopental or "sip." (not sure what it stands for) are then administered as short or long term anesthetics, respectively. In children, this is all they receive; in adults, they also receive Scoline (short-term muscle relaxant) followed by either Atracurium (intermediate-term muscle relaxant) or Pavulon (long-term muscle relaxant). To reverse the anesthetics and muscle relaxants, atropine and neostigmine are mixed in a syringe and injected through the cannula.

We left a little early to meet with the rest of our group in the Minor Theater. The patient there had been the driver of a hit-and-run, and people had caught up to him and beaten him over the head. He was, for the most part at least, unconscious as the UK medical students from my group and some Danish medical students were cleaning his head gashes and injecting local anesthetic. They taught me the basic technique of applying sutures, and I stitched two myself. The hardest part was using the tools, but I got more used to it the more I used them. Finally we finished at the hospital and headed back to the housing complex.

We ate lunch and relaxed, playing card games or talking, until dinner. Joe chased a chicken into the main house and we cornered it in one of the bathrooms. A few people went to the market, but I didn't need anything this time. After dinner, we had planned to go downtown to one of the local bars/clubs, so we played some games for a while and then headed out.

Caught the little chicken!

The place we went to used a metal detector to search for weapons, and then admitted us without checking IDs or charging cover. Otherwise it was like just about any other bar/club in the US. There was a bar, multiple tvs, tables/chairs, a dance area, and music. It turned out to be a fun place, even though the 13 or 14 of us who went were the only foreigners there.

At the bar/club!

After we got back, we went for a quick swim and went to bed.

Day 4: Osteotomy and Mastectomy

Our housing complex ran out of running water when I got out of bed at 7:30am, so half my morning was spent trying to flush the toilet by filling up a cup with water and pouring it into the back of the toilet. Eventually it had enough water to flush. The latter half of my morning consisted of eating and getting ready to leave for the hospital at 8:30am.

The rooster that wakes us up every morning, this time at 6:30am.

The dogs! Julie (left) and Pepe (right).

My group, which consisted of myself, Courtney, and Joe, were supposed to go to "General Surgery." When we got to the hospital, we looked around trying to find it (I'm not sure if there actually is a place called that at this hospital), but we ended up in the Burn Ward. Since there wasn't anything for us to do, we decided to head over to the C-section area. They didn't have enough extra surgical scrubs for us, so Joe used his spare scrubs and stayed to watch a C-section, and Courtney and I went to the radiology area, since it was the only remaining place we knew about that wasn't taken by other groups. When we got there, the group of 3 radiologists/radiology techs/nurses were on their way up to the major theater, which we had tried to find earlier but had failed to do so. We followed them to the major theater and scrubbed in.

Surgery #1

DX (diagnosis): Mal-union of the right femur

Operation: Proximal femoral osteotomy

As we entered the OR (operating room), we were directed to put on lead aprons to protect us from the radiation emitted by the fluoroscope. Inside the OR, the patient was still awake while they took more X-rays of the fracture and put the breathing tubes down her throat. The patient was put to sleep with an anesthetic injected into a cannula, and possibly also through the ventilator.

There were about 12 of us in the OR: the surgeon, the PA (physician's assistant), the scrub nurse (who hands the surgical tools to the surgeon), the anesthesiologist, the three radiologists/techs/nurses, three other nurses, and the two of us students.

After sterilizing with iodine solution and making the initial incision, the surgeon dug around with his bovie (electrocauterizing scalpel) until he reached the improperly healed fracture. Then he broke apart the bone where the fracture had been and used a drill to insert a screw to hold the bones together so they could heal properly. During the screwing procedure, he would regularly ask for fluoroscope readings to make sure the screw was going in the right place. Lastly, he put in 2 layers of sutures to hold the incision closed. The whole procedure lasted about two and a half hours.

Surgery #2

DX: CA (cancer) of the left breast

Operation: Unilateral simple mastectomy

Joe had found us towards the end of the first surgery, and after the surgery he led us down the hall to another surgery that he had noticed being set up earlier. We entered the room - this time without needing lead aprons - and watched the anesthesiologist put the patient to sleep with nitrous oxide. As far as I could tell, no other anesthetics were used, which seemed strange to me. The nurses applied iodine solution to sterilize the left breast that was to be removed.

The incision and electrocauterizing took a little over an hour. When the breast was finally removed, a surgical drain was inserted to prevent excess fluids from accumulating, and 2 layers of sutures were sewn to close the gap where the breast was. These last steps took nearly half an hour.

After the surgeries, it was time to leave (2pm), so we headed back to the hospital entrance where our van/driver were waiting for us. We arrived at the housing complex, ate lunch, and went swimming. After swimming, I received my first mosquito bite so far this trip. I'm the last person in the group to get bitten.

The pool at the housing complex!

After dinner, we played Uno and went to bed.

Dinner was rice, beef stew, spinach, and passion fruit juice I bought. It was great!

Day 3: First Full Hospital Day

I didn't hear the rooster at all this morning, so I slept in until about 6:45am. Due to only one van transporting all 16 of us to the hospital, we split into a group that left at 7:30am and another that left at 8:30am. I left at 8:30am. I forgot my camera, so hospital pictures will have to wait another day.

My bed, where I wake up in the morning.

When I arrived at the Coast Provincial General Hospital, a couple of us went to Casualties (what we call the ER - Emergency Room). First, we saw a guy who was in a tuk-tuk accident. The nurses showed us how to clean (with iodine) and bandage the cuts.

The next guy fell off a bridge onto a road and was bleeding in various spots from head to foot. His tibia was completely broken near the foot (with an open wound), and a piece of bone fell out. I helped hold his leg as the nurses wrapped the stint around it. I then tried to take him to get his X-ray, but the power went out so I had to take him later. The electricity has gone out three times so far: once at the Mombasa airport, once at the complex, and once at the hospital. In addition to the power going out, the Casualties room ran out of running water, so we had to sterilize with a bucket of purified water and a cup to pour it on our hands.

Another patient had an ectotopic pregnancy, but we only saw the history-taking and diagnosis. The nurse/doctor showed us how to calculate gestation time by the date of last period (subtract 3 months, add 7 days, and adjust the year).

The last patient we saw had been mistaken for a thief and had burning propane poured onto him (not sure how that happened). He had first and second degree burns. One of our group injected pain killers, and then we headed back to the housing complex.

We ate lunch and saw several monkeys roaming around the yard. They're pretty common here.

Monkey in the yard!

Monkey in the tree!

Monkeys everywhere!

After hanging out, reviewing things we saw at the hospital, eating dinner, and playing Uno, we went to bed ready for another 8:30am departure.

Dinner: Mukimo with beef stew (and watermelon/mango).

Day 2: Hospital Orientation and Indian Ocean

After the complex's rooster woke me at 5:15am, I ate beef jerky, trail mix, and cereal and got ready to go to the hospital. We left at 9am for the hospital orientation. The hospital was spread out across different buildings with many wards containing many patients in the same room, with little to no privacy. I didn't bring my camera because I wasn't sure if the hospital would be alright with us taking pictures, so I don't have any pictures of the hospital at the moment. We toured the hospital until about 12:30pm, then came back to the complex and ate lunch (including green oranges).

Green oranges (which are green when ripe) have a lot of seeds.

Later, we went to the beach of the Indian Ocean. On the way, we saw some monkeys climbing around the trees on the side of the road. Apparently they're pretty common in the area. At the beach, the water was clear but full of seaweed, so we didn't swim for very long. Again, I didn't have my camera, this time because I wasn't sure if it would be safe. Next time we go and we have someone to hold our stuff, I'll definitely take some pictures. After the beach, we washed off in the pool and ate dinner.

Dinner included chicken stuff, rice, and a tortilla-like thing.

After dinner we played Uno, tried to decide which wards to go to in the morning (which I still haven't entirely decided on), and went to bed.

Day 1: Arrival and Orphanage

After finishing my series of flights from Jacksonville to Atlanta to Amsterdam to Nairobi to Mombasa, I arrived at my walled-in and gated housing complex. There are about 5 or 6 buildings in the complex, with one main building have the most bedrooms, the kitchen, and the living room. The other buildings are mostly just bedrooms and bathrooms. My building is small and has 2 of us in one room and 4 in the other.

The housing complex is walled-in with a gate for security.

 The main building's front door, which leads to other buildings, the pool, and clothes-hanging areas.

The living room leading to the kitchen (left) and a bedroom (right). The water bottle 

supplies us with safe drinking water since the tap water is unsafe for consumption.

The living room in the main building where we will likely spend much of our downtime.

After getting settled and meeting the other 15 or so pre-health students, we were driven to an orphanage down the road. There, we sang to the kids (Twinkle Twinkle Little Star, I'm a Little Tea Pot) and they sang to us. Then we told the kids about ourselves one at a time, and then we took pictures with them and kicked a soccer ball around with them.

Very rough living conditions on our way to and from the orphanage.

Lots of kids at the orphanage. 

More kids. 

Face.

Happy!

Finally we headed back to housing complex and ate dinner. Tomorrow morning starts early for hospital orientation!

 

My first homemade Mombasa dinner: spaghetti and meat sauce with vegetables!