Thursday, July 25, 2013

It's the little things

So what is it that makes living and working in Kenya so much different - it’s the little things. Many of these things are good and many of them drive me crazy. Sometimes it’s the same things that at one point I will enjoy and another time will make me crazy.

To illustrate these points I will show case a few normal everyday things that are made different by little things.

My walk to or from work.
I love that my house is just a short walk (300m) to work. Mornings are beautiful with the sun peaking up over the clouds, the birds are singing and its quiet with no hi-way noises. When I reach the road I take a quick peak to make sure there is no motor bike coming up the road. I often see a certain motor biker waiting for his passengers. He wears a Canada Post Jacket. It’s a nice touch of home. Often when walking home I get delayed with greeting people. Here a simple hi or wave is not appropriate. You must shake hands and ask how things are going. The other day I met a young man from my youth group. I saw the cows that he herds before I saw him. We chatted for a bit as his cows kept walking on, once the conversation was done he went off and tracked down the cows – he said they knew the way. There is no rushing or worrying. This is a great thing…outside the hospital.

Cows in my back yard

Making Supper
I have house help a lovely lady who comes a few days a week to help me with cooking, dishes, laundry etc. However the other day I had some visitors for supper on a day when J was not around. So supper was up to me. I asked a friend to pick up some lettuce from Nairobi. Once I got the lettuce we (my roommate and I) washed it in a weak bleach solution and then rinsed it in filtered water. We had to do the same with the tomatoes. Avocadoes are in season so we had fresh guacamole. I walked to a few different fruit stands before I found the limes needed to go in the guacamole. I took three and asked how much. I was told 30 shillings. I paid and the lady gave me 5 limes. Not quite sure how that worked, and I did not really need 5 limes but it was easier that way. I had J make the tortillas the day before so I did not need to worry about that and I had some taco spice from a visiting Dr. There. Tacos done. I picked tacos because it was an easy meal.
A different night when we had a lasagna making lesson
I can’t outline all the little things that make work different but here’s just a simple story that has happened many times. This is a typical story and here’s how it may go.
I get paged to help out in casualty (ER) I find a young lady in the back room unconscious, not on a monitor and a Dr saying we probably need to intubate. I go assess the patient – make sure she is still breathing, check her sats and see how awake she is. As these are all fine I go set up for intubation. I set up suction – I grab the tubing and canister off the drying rack as they have just come out of the bleach we use to disinfect. I discover that one of the tunings does not quite connect to my yankeur so I go find another one. I take the bagger out of the bags we recently hung that should contain my needed supplies, I discover that the mask is the wrong size so I dig through  a container of masks mixed with random connectors and find a better one. Get the laryngoscope out of the drawer – thankful that we have a complete laryngoscope set in a good box. Now that I am all set up the Doctor and I and possibly a nurse go to put the tube in after the 2nd attempt the tube goes in the lungs – I hear air entry on both sides and the SpO2 stays good –confirmed ETT placement. Now the patient who was previously breathing isn’t breathing so much on her own. So I stand in casualty and breathe for her by squeezing a bag. While doing this I keep the gastric lavage going to clean out her stomach. I cannot leave the patient for more than a few seconds at a time as if I leave patient does not breathe. After 30-60min I hear we have a bed ready in ICU but they need me to go setup the vent. So I call a nurse to take over my job of bagging and head to ICU. The nurses set up the vent well and with a minor change we are ready -  I tell them I will be back in a few minutes with the patient. I walk back to casualty and grab an oxygen cylinder to use as we transport the patient – but after turning it on I discover it’s empty. I than switch the regulator to the next tank. It’s also empty. I walk back to ICU and ask to borrow there tank they give me permission as long as I promise to return it. I turn it on and discover there is a large leak around the regulator. I remove the regulator and see that there is no O-ring to help seal the regulator to the cylinder. I find an empty plastic IV bottle and cut it up to make an O-ring. I manage to finally to get it to seal and then I hear a commotion behind me. The casualty staff decided they were sick of waiting for an O2 cylinder so they made a mad dash from casualty to ICU. The patient is still on my SpO2 probe – the only monitor aside from the odd BP we have done since her arrival at Tenwek, anyway the mad dash brought her SpO2 down to 83 – not bad. I throw her on the vent and she recovers. The casualty staff take their bagger back to casualty and I hunt up an ICU bagger to keep by her bedside in case the power goes out and my vent shuts off. The first bagger I find has a small leak – I pull out the glue that is in my pocket and seal it. Now we are good to go. Patient looks good on the vent and is stable. Hopefully she will wake up in the next day or two and then we can take her tube out.

Rounding outside on our ICU patients. They have (all 3) recovered from their suicide attempts.

So I will end there. Please pray for me for patience to deal with and enjoy the little things.

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