June 2, 2019

These blog entries are the views and opinions of the residents during and after their international experiences, and do not necessarily reflect the opinions or positions of VIA or VUMC.

Week 1
Hello from Kijabe! Week 1 is in the books and we are settling in to our new role here in Kijabe. The night before we started in the hospital, Melissa, Sandy, and I poured through our textbooks, refreshing our brains on the doses and mechanisms of thiopental, pancuronium, halothane, and other drugs we don’t use at home. 

When we arrived to the operating theaters on our first day, we were greeted warmly by Mary, an excellent KRNA who gave us a tour and introduced us to the other KRNAs and students. She evaluated the OR board, which is a large dry erase board in the main hallway of the OR suite, and assigned us to one of the eight ORs for the day.  She assigned me to OR 8, an orthopedics room staffed by a newly graduated KRNA and two very junior students. It was the junior students’ first day in the Kijabe ORs as well! The anesthesia crew in OR 8 was incredibly welcoming, and the two junior students were very excited to learn. I glanced at the drugs nicely laid out on the ventilator. Much to my relief, propofol, rocuronium, and other very familiar drugs filled in the syringes, and they also had an isoflurane vaporizer, whew! I then looked at the monitor and ventilator screen. The KRNA noticed my confusion when my eyes settled on the ventilator screen filled with question marks and alarms. 

He laughed and said that the tidal volume measurements and alarms had been non-functional for a while now, and they confirm appropriate tidal volume administrationand O2 flow by watching the bellows. It took a few cases for me to get used to the lack of calibrated or accurate ventilator settings and we had a discussion with the new students about handling dangerous issues without alarms to notify you of the leak or lack of free gas flow.

The eager new students had a whole packet of learning objectives and discussion points to cover. There were plenty of orthopedic topics to cover and, although it was their first day in the operating theater, they had great questions to follow up with during our discussion. The students hailed from all over Kenya.  One grew up an hour drive east of Nairobi, so three hours from Kijabe. The other student in my room was originally from a smaller town outside of Nakuru, about a six hour drive from Kijabe. Both would live here and then go back to their small towns after they completed their 18 month training. They spoke about how they were excited to bring back their knowledge to their small hospitals and help the people they grew up with. It was awesome to teach these new students on their first OR day knowing that they would soon be scattered across Kenya.

Week 2
Hello again! We are thoroughly enjoying our time in Kijabe in and out of the OR. Last weekend, we had a group of visitors to the Kijabe theaters over brunch. Two pediatric attendings from CHOP, Grace and Jonathan, arrived the same day we did (the were actually on the same flight!), and one of the Vanderbilt general surgery residents, Gretchen, overlapped with our time in Kijabe as well. We went to the Supa Duka on Friday and were excited to find fresh eggs for omelets. We then went across the road to the market to pick up some fresh vegetables to mix in.   On Saturday, Melissa made some delicious omelets and the six of us visited, talked about the past week, and played a card game. It was awesome to get to know these amazing people more and hear about their previous experiences visiting different hospitals throughout the world.   We also had fun watching the baboons play in a patch of grass near our house and jump on our porch and roof before they were chased away by some neighbors. Apparently the baboons will try to get into open windows and will ransack your kitchen!

On Sunday, we made a trip to Crescent Island and Hell’s Gate and it was absolutely amazing.   Crescent Island is a small crescent-shaped island in Lake Naivasha populated by non-predator animals and is ideal for hiking. Our very enthusiastic driver, Philip, picked up Gretchen and the three of us bright and early and whisked us off towards Lake Naivasha. Throughout our drive down into the Rift Valley, the fog lifted and our first stop was a boat launch that took us on a little trip around Lake Naivasha to see some hippos and birds and then to Crescent Island. The hike through the island was incredible. We were able to walk feet from giraffes, zebras, impalas, and wildebeest. It was great to explore unencumbered by paths, fences, or barriers whatsoever between the animals and us. 

After confirming that the nearly constant rains from the week before hadn’t washed out any roads near Hell’s Gate, we set off in that direction. We rented bikes near the park entrance and biked on the road to get to the official park gate and then to the gorge. Our Masai tour guide for the gorge, Joseph, told us about his life and Masai history as we climbed down into the gorge, kindly telling us exactly where to put each foot as we went so we didn’t tumble. The gorge frequently flash floods and also has quicksand so hikes must be lead by a Masai tour guide to avoid any issues. The bike back from the gorge hike was beautiful as well, and Philip delivered us safely home to Kijabe.

In the operating theaters this week, we encountered some challenging cases and very sick patients in the ICU while on call. It was stressful but fun being a true consultant without an attending anesthesiologist to add their impression or approve our plan. The students this week were six months into their training and were great to teach in the OR. We gave lectures on subspecialty anesthesia topics and they had much more advanced questions than the newer students. It was impressive to see how much the group had learned during their first six months and great to hear their stories of previous Vanderbilt anesthesia residents teaching them how to intubate or put in IVs. It was another great week of eager learners and I hope we helped advance their knowledge and skills.

Week 3
Hello again! We have wrapped up our time in Kijabe and are now on the plane back to the US. I can’t even begin to describe what an amazing experience this has been. The KRNA students were such eager learners in the OR, but we also learned an incredible amount from them, the KRNAs, and the OR teams. 

This photo is from a pediatric case where I was working with and teaching a junior KRNA, Teddy, about pediatric anesthesia. The circulator, Andrew, is also in the photo and he was absolutely amazing at pediatric IVs on the smallest babies and was always ready to help us start the case. It was wonderful to work with junior KRNAs like Teddy for more challenging cases to help prepare them for anything that came their way.

Sandy, Melissa, and I also took a photo with Mary on our last day. She is one of the head KRNAs at Kijabe and basically runs the show. Mary was the person who welcomed us to the ORs on our first day, and we were sad to say goodbye. She is an amazing person, anesthesia provider and teacher who could not have been more welcoming to us residents.

Prior to going to the airport, we had a few fun stops along the way! We went to an elephant sanctuary, the Giraffe Center, and a market to spend the last of our Kenyan shillings. We had a great time watching the baby elephants eat and feeding the giraffes pellets of food. The giraffes were definitely the highlight of they day, they were incredibly friendly if you had a pellet in hand!