Adaptations

The following consists of nothing truly interconnected, but just various musings concerning my last two months. So enjoy the ramblings!

As I near the 2 month mark, it begins to become apparent some of the adaptations made during my stay. It has certainly been an interesting process: moving away from loved ones, changing jobs, packing all your year-long necessities in one hiking backpack and a small day pack, arriving in a brand new country (let alone a new continent), immersing oneself in a different culture....the list goes on.

By all means, it has its peaks and valleys. But honestly, that has allowed for quite the personal journey. I've experienced some of the most exciting personal moments shared right along with some of the most challenging. 

The initial move was, of course, exciting. Definitely an adventure coming to a country I have never experienced, settling into a unique community, gaining perspective on an area so very different from the US, and learning to live a much more simple lifestyle. It has been enjoyable learning these new things. 

Right from the very beginning, I will say that Kenyans are the kindest people I have ever encountered. The welcomes are so warm, smiles are eager, accommodations are readily available. It has certainly been a pleasure getting to know and slowly become part of a community so kind. I can only be extremely thankful for such a place to live. 

That friendliness has been so vital during some of the "valleys." There are certainly those days, especially after a grueling day in the ward, where I ask myself, "What exactly am I doing here?" I've found that a friendly face and a kind greeting pull you through those moments. Concerning that, the biggest thanks goes to the children. These little ones are the most sincere, the sweetest, and just down right wonderful to be around!  I credit many days being uplifted by playing soccer or tag with the kids, whether from Dala Kiye (the nearby orphanage..which will be discussed in its own entry) or the neighboring children by my house. 

Dala Kiye children. Soccer half-time photo shoot

Wild, neighborhood children. These kids are the BEST.

Obviously one of their favorite games (Yes, I caught him).

Another adjustment was towards, "African Time." It's real and it requires a real adjustment. I learned this quickly during my first days working in the OR. The nurse said, "Be here at 830 for when we open." I was there at 815 just to be prompt...and waited until 915 for the first person to show up.


Lesson learned. 


The next day, I arrived for the "830" start time at 9:00 anticipating African delay...and waited until 945. 

Moral of the story: I have to tweak the African Time formula until it's just right.

These are all just fun adaptations when moving into a different place and culture. I could write for days telling stories of different instances where I had to tailor my "American" ways to be flexible. 




However, as I said in the beginning, some instances prove to be more difficult. The primary example is the medical ward, where it is an absolute challenge to adapt my practice to a very different medical scene, limited resources, and the hardest being the extent to which we can treat the patient. Coming from the land of plenty, where our ER had all resources at the tip of our fingers, it has obviously been extremely difficult seeing very ill patients receive care limited by accessibility and/or resources. An example being a couple of recent stroke patients. The diagnostic test they need most is a CT scan of their head; however due to SCMH not having a CT scanner (understandably) and the patient's financial inability to transfer to a larger hospital in Kisii or Nairobi, the patient foregoes the scan and we manage the patient to the best of our abilities, even though the prognosis ends up being very poor.  

Another example is the huge challenge of caring for an ICU-equivalent patient with no monitors, no oxygen, and very limited medication choices (for the medical persons out there: ie no vasopressors for the severely hypotensive). Even with all the aforementioned resources back home,  this patient would still be a challenging case in the ICU. With that, it has required, if not forced, me to extremely adapt not only my nursing practice but emotional perspectives. 



It is difficult to say what this all translates to in time, but as I continue to work, live and explore here, I'm sure I will have quite the interesting journey to look back upon next year.



I will definitely keep you all posted on the journey and new challenges that await! It has been exciting and will continue to push me to new levels, making me stronger, smarter and more flexible!   

As for now, I'm going to simply enjoy these awesome sunsets!

Preface

So, it's more than apparent I have been slacking on writing entries.

With a little thought, I realized I am slow to publish because I spend a decent amount of time piecing everything together, editing, polishing, making sure things are totally correct. That's all well and good, but I am not writing for a magazine or newspaper.

Don't feel as though you will be deprived of an entry with some forethought and decent grammar; however, I feel that a more dynamic entry, like a personally written email, would do better. I would not only be more compelled (and quicker) to produce entries but I can truly continue to paint a relevant, interesting picture of my stay in Kenya.

Feel free to comment and make this more like a discussion rather than a one-sided presentation! With that, be on the lookout for some new entries!

Doin' Work!

So it may seem odd I haven't written about my actual work yet, but I felt I needed some time to settle in, scope out my role and actually gain some understanding of the hospital and ward I'm working within. Now, a month into my work, I feel a post can do some justice.

 In the beginning, I rotated through each ward gaining general insight to the work required, the patient population and how each ward functioned. Initially, my role was not completely defined so this allowed me time to see where I could best serve SCMH. Through discussions with the nurse managers of the hospital, it was noted by both parties there was a need to build a stronger nursing department.

A plan was presented to both the nursing managers and administration through a small proposal I drafted up. It stated the overall importance of a strong nursing department and offered methods of encouraging and empowering the current nursing staff into becoming patient advocates and active participants in the management of patients' well-being. The entire idea behind this is with empowered nurses, vital collaboration with doctors can be had, the hospital works efficiently and patients are provided the best care, allowing optimum patient outcomes....the whole goal of a hospital! Well, it was accepted and decided that I should spend approximately 4 months in each ward to slowly initiate these ideas.

The first rotation began in the general medical ward, where the patients with complicated tuberculosis, extrapulmonary TB, malaria, meningitis, pneumonia, sepsis, AIDS and AIDS-related illness are admitted to. It has 40 beds and typically is at 85% capacity on most days. The severity truly ranges; some patients just need a few days for IV meds and recuperation, others are some of the sickest patients I've cared for (who honestly would be in an ICU in the states.) With a small staff—approximately 1-2 techs, 1-2 nurses, and 1 doctor/clinical officer—the workload is heavy and it's definitely a busy shift.

Medical Ward

So far, it has been challenging learning the limitations of rural medicine and beginning to understand the true needs of the department and hospital. I have definitely had to adapt my role as a nurse, not only for practice within a different clinical setting but how to evoke my best managerial skills as well. Regardless of any difficulties, the most satisfying part is seeing patients become well and go home with a smile on their face. 

My buddy, Zilpa! Went home happy and healthy.

Peter! We became good friends during his stay.
He drew a rough map, using rivers, rocks and hills as landmarks,
 to his house for me to visit.
Time to put my navigation skills to the test!

Honestly, time will only tell how my role at SCMH will make the greatest impact. My true goal is to not simply assume one role in one ward, but to create the most sustainable system of nursing; moreover, I hope the work accomplished can continue to grow and expand the nursing capacity well after I leave.

I hope this provides a decent overview. It's hard compiling the experiences of that last month into a concise, understandable post. Do ask questions and keep your eyes peeled! I will be sure to update.

Flies In Your Eyes

Orr in Catch 22 had it right. Flies in your eyes.

Except he forgot to mention your mouth...nose...ears...hair....pants. Flies are literally EVERYWHERE. I've never seen anything like it. In swarms, they appear out of nowhere and just engulf you. Your only hope is to close your eyes and swat your hands like a madman; hopefully you remain on path and escape the 4^th Egyptian Plague sequel.

Nasty, magnified visual of the culprit.

 The locals tell me the flies show up just prior to the rainy season. In it's own twisted way, these flies are a good thing.

No, my camera lens was not dirty. SWARMS!

I'll tell you one thing about these bugs, they are the dumbest insects. They fly with no direction and once they bump into something, they're dead. With that, floors become blanketed and fly-drifts appear in corners. The nurses station in the morning is covered. Everything that could contain a fly, contains multitudes of them.

If the same proverbial phrase of eating a pound of dirt before you die applies, I am far ahead of schedule. 

My fear. Just picked up and carried away into Lake Victoria.

  

The Elephant In The Room

Time to discuss the elephant in the room; the heated topic, the looming questions revolving around the presidential elections in Kenya (that are occurring today!) It's a topic I didn't really want to touch with a ten foot pole,but it warrants attention. With that, I will only write this from a neutral perspective; one of someone with no political biases, no cultural influences, and most importantly no personal interests concerning the outcome. My sole, true interest is that Kenya elects the president they deserve, the person who will lead this country into a united future and that all is done peacefully.

To provide some background, the 2007/2008 presidential elections ended with widespread violence across the nation, resulting in 1,100 people killed and over 600,000 citizens displaced. More importantly, it fractured the country even further with tribalism.

2007/2008 post election violence. Never to be repeated again.

You may ask, what is tribalism? In brief, there are 42 individual tribes residing within Kenya and between some of the larger tribes, there have been longstanding disputes over land, resources, and power. These tribal roots exist passionately within communities and is, honestly, the driving force behind voters' decisions and how the campaign has been conducted. I am not offering any opinion on whether or not these aspects should influence the political sector of Kenya; I am just stating its existence.

All things considered, the two primary candidates in the running (although there are a total of 8) are: Uhuru Kenyatta of the Kikuyu tribe and Raila Odinga of the Luo tribe. These two have extensive ties into the political scene, with family holding various positions of power over varying amount of time throughout Kenya's political history. In short (and with my minimal knowledge), these candidates are of opposing parties and more importantly, of rival tribes.

Odinga

Kenyatta

It becomes clear of how and why these pending elections are heated, a topic for much debate, and pose serious question on what is next for Kenya's immediate security and future success.

The way the campaigns began however, with a fully inclusive presidential candidate debate, was very positive and an informative venue for the citizens to learn of each politician in a fair event (albeit it was in a very American style haha). Also, I had just learned that this is the first election that district/ provincial governors will be elected, an excellent way for each district (of varying tribal backgrounds) to be equally represented in the republic.

Well, I hoped this helped shed some light onto the much anticipated and discussed Kenyan elections. Again, my only hope, regardless of who takes office, is that these elections proceed peacefully...which so far, in Karungu, they are!