Perspective

Today I completed one of my goals while in Kenya: I ran with a Kenyan! Actually, I ran with about 30. I got out of clinic a bit early today, and needed to go for a run. So, naturally, I ran to the highest point around. It was beautiful. After taking in the scenery, I started to run down. However, the path went by a primary school. Not being used to seeing a mzungu in shorts running by, they started shouting with excitement. The next thing I knew, I was running with 30 barefoot Kenyans running behind me. Despite not being able to speak the same language other than greetings, I started to yell with excitement. They would repeat me. Then I stuck out my arms, acted like an airplane. They repeated. We carried on like that for 3 miles. I'm sure they will be talking about the crazy mzungu for days.




Clinic, like always, was crazy today. You never know what is going to walk in. My first patient had a mandibular mass half the size of her head. (Never mind the skeleton in the background, I was examining this patient in a storage closet)






Next I saw a patient with elephantiasis. It was classic. She was a Massai woman, decked out in her classic African wardrobe. This is an infectious disease, where microscopic worms named, wuchereria bancrofti, (awesome name, right?) live in the lymphatic system. They are spread by mosquitos, which I recently learned are the most deadly animals in the world. Many diseases are spread by them.



Working in a foreign country can be frustrating for many reasons. The cultural differences in concepts of time, appropriate clothing, and food are a few. Usually I feel pretty comfortable traveling, and don't have any issues adapting. The issues above haven't been an issue. However, the language barrier is starting to get to me. After the time-consuming process of bugging a nurse to interpret for nearly every patient, and all the cultural misunderstandings of translated words, I was getting a little unnerved by the end of the day. So naturally, when a 23 y "confused" male walked in, I wasn't happy. He was talking nonsense, even before his words were translated. At first I thought it was a psych patient and my frustration with the situation increased. Then I looked at the vitals (yep, having to rely on them a lot when you can't communicate) and noticed his pulse rate was 40. (Cushing's reflex- a response to increased intracranial pressure) I started to take him more serious. It turns out, he had a history of head trauma three days ago, had projectile vomiting, but no focal neurological deficits. Of course in the US, you would get a head CT immediately and consult neurosurgery. Here you rely on the physical exam skills. Being unable to assess for papilledema, (I would have killed for a PanOptic) I had to assume there was increased intracranial pressure. I ordered a head xray. He had a compound depressed skull fracture. Whelp... teachable moment. Thanks God.


Perspective:

The past year or two, I have been almost bitter at times towards medicine. Why do physicians work so hard? Why am I expected to work 6 days a week, round on patients 7 days a week, have my call shifts be LIMITED to 30 hours in the hospital and an 80 hour work week is normal? It's especially hard when most of my college friends are working a 9-5, making money, and moving on with their lives. One of my med school friends surveyed our class with the following question, "Would you do medical school again?" The overwhelming majority said no. Not exactly the best attitude to have as residency draws ever nearer.

I feel the need to tell you about one of my surgery chief residents, Dr. A. While serving here, I have had the opportunity to work with incredible physicians and residents. They work as hard, or harder (no 80 hour limit here) than in the US. My senior resident Dr. A is from Ethiopia, and a PAACS (Pan-African Academy of Christian Surgeons) resident. He went to medical school and completed his internship in Ethiopia before the hospital was closed. He then spent two years in Cambodia training until that program ceased to exist. His last year was spent here, and with one year to go, he's looking forward to returning to Ethiopia. His future? To take over for the only surgeon at the hospital serving a catchment of 800,000 people. The current surgeon is leaving the day Dr. A gets there. He will be on call 24/7. No weekends, no vacations.

Speaking of vacations, I live for them. That's what allows me to work hard; knowing that I have something awesome to look forward to. Last year, this Dr. A got one month vacation from residency. He went home to Ethiopia to see his parents. Before he even arrived home, the only surgeon at the hospital near his parents house heard he was coming, left for the month. My resident spent 27 straight days and nights operating, rounding, and staffing the hospital by himself, until he had to return to Kenya. For him, residency is a vacation. Next year, he will be it. No backup. When he decides to sleep, or rather, nature forces him to sleep, people will die. The weight of responsibility that awaits him is unfathomable to me.

So, a little reality check, with my residency match rank list due in a month. Sure, I'm going to work hard. But suddenly, and perhaps just when I need it, God provides a bit of perspective.