June 13, 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.

The flights to Kenya were easy. The legroom was sufficient, the movie selection adequate, and one of the flights even provided me with vegan meals. The latter was all thanks to my more responsible girlfriend. 

I arrived at the hotel in Nairobi late, well past sunset. Despite the dark hour, I could tell the grounds were beautiful, and the lone songbird that could not seem to fall asleep added to the ambiance. 

After a good night of rest, the dependable driver from Naomi Cabs stood outside, ready to take me to Kijabe. This is the same man who stayed at the airport three hours past when my flight was supposed to land. I felt such appreciation for him when I noticed my last name written on a piece of paper with marker, walking out from the terminal with a small Jansport backpack, and no other luggage, as it stayed back in Chicago. It would be five days until my bags found their way back to me.

The hour-long drive along both smooth and potholed roads to Kijabe was my first glimpse into a piece of Kenyan life. From Kibera, the largest slum in Kenya, to the estates hidden behind trees. From the masses walking along the highways to the competition cyclists squeezed into their tight gear. The preceding three months were part of the rainy season, so this part of the country is as green and lush as it ever gets. 

The driver effortlessly avoids nearing cars, people, cyclists, and the ever-present motorcycles that drive on the side of the road against the flow of traffic. While he keeps us safe and moving toward our destination, I am focused on the people living outside. There are people and shanty stalls along almost the entire length of road from Nairobi to Kijabe. Stalls selling fruits, meats, and wares repeat in endless fashion, with donkeys grazing on the grassy spaces between.

Kijabe, Maasai for “Place of the wind,” is a small town that is perched at 7,000 feet on the edge of the Great Rift Valley. It has a population of over 17,000 people, but if someone asked me to take a guess, I would say no more than a thousand people live here. Homes must be hidden throughout these hills and behind the trees that I cannot see. Kijabe hospital, the reason for my coming to Africa, is located in Kijabe Mission Station. This area is also home to AIC-CURE Children’s Hospital of Kenya, Rift Valley Academy, and a number of other religious schools and organizations.

I first meet with Helen who shows me to the humble accommodations that will be my home for the next three weeks. It is a new dorm called “Elimu,” which is Swahili for “education.” On its opening day, an official from the government came to witness it. This is not uncommon in Kijabe Mission Station. The hospital here is a source of pride, and the president himself has come on several occasions to see to the opening of hospital operating theatres and wards. 

A woman, who’s name I do not know, tirelessly cleans the common area, washes the dishes, does our laundry, cleans our bathroom, and even changes our sheets once per week. She comes from a town in the south of Kenya called Kajado, but moved to Kijabe eleven years ago when she got married. I am endlessly grateful for her. I would be living in a pile of muck if not for her endless drive. 

Luke, one of the most seasoned KRNAs spent the morning showing me around the operating theatre. He brought me through each of the eight operating rooms and the endoscopy suite. He took me to the pharmacy, storage rooms, PACU, showed me where the ultrasound machine should be returned to, and of critical importance, where morning chai is served. 

Chai, tea with milk, is engrained in the Kenyan culture. Some prefer it sweet, while some unsweetened. In practice, a mixture of the two seems to achieve a mild and pleasant sweetness. Chai breaks are looked forward to, as well as expected to arrive. 

The caseload and variety at Kijabe Hospital is impressive. In the five days I have worked there, I have taken part in caring for parturients undergoing cesarean deliveries, cancer patients having brain tumors removed and limbs amputated, seemingly endless children with hydrocephalus undergoing VP shunt installations, and even a ruptured iliac aneurysm that arrived in the operating theatre near midnight.

Many of the KRNAs are thirsty for knowledge, consistently bringing up cases to discuss, and seeking advice on performing regional anesthetics for both surgery and postoperative pain control. The resources at Kijabe, albeit limited, are far better than I expected, and from what I have been told, better than almost every other hospital in Kenya. In the past week, we placed a thoracic epidural in a four-year-old patient that underwent an exploratory laparotomy for complications of Hirschsprung disease, and lumbar catheter for a woman who had to have a hip disarticulation for a rare and aggressive cancer.

My timing here is fortuitous in a number of ways. I have arrived in Kenya as the rainy season is ending, leaving a green and blossoming country with clear blue skies in its wake. There are also two national anesthesia conferences this month. The first was in Addis, Ethiopia, while the second will be held in Mombasa, Kenya.  If this was not enough good fortune, it so happens that the observers of the Greek Orthodox religion in Ethiopia were fasting during my brief time there.

Unlike the fasting during Ramadan, when Muslims abstain from eating during daylight hours, the Greek Orthodox in Ethiopia only abstain from eating meat and chicken. This, therefore, results in restaurants and hotels serving an expansive variety of vegetarian and vegan dishes.  

Mark Newton, Ban Sileshi, Matt Kynes, Joash, Mary, Allen, and myself landed in Addis, Ethiopia early on a weekday morning to give us enough time to set up and run the pediatric simulation course for the 9th Annual Conference and CME of the Ethiopian Society of Anesthesiologists. I spent this time napping, as I had been in the operating theatre with an emergent case up until we disembarked for Addis. 

Over the following days, we all participated in providing lectures and workshops to assist the Ethiopian society of Anesthesiologists in educating their residents and faculty. It was intimidating, gratifying, and fulfilling. It was also delicious. Ethiopian food, particularly during fasting, is excellent.