June 21, 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.

Day 11 of 27 days in Kenya. It feels a lot longer, having left my wife and 10-month-old daughter for the first time. But I am one of the visiting consultants who will spend the least amount of time in Kijabe. In the past 11 days, I have met physicians from all walks of life who have left the luxuries of the U.S. behind to live and practice in Kijabe full-time. My initial thoughts focused on what they must have sacrificed to be here, but it didn’t take long to realize how much they are actually gaining from this experience. After speaking with many of the native Kenyans, it is evident how much respect and admiration they have for the consultants who devote their time and energy to bettering healthcare in Kenya.
Reflecting on our first day in “theatre” brings about a whirlwind of emotions. After spending the beginning of the day being in orientation, touring the nine operating rooms and being introduced to the KRNAs and students, David (Roberts) and I immediately started spending time in patient rooms helping with inductions, wake-ups, etc. That time was more devoted to educating us on the machines, drugs, equipment, and lack thereof than it was to us educating other anesthesia providers. Their resourcefulness and economical practices allow them to care for more patients before running out of supplies.

 As we were walking through the hall discussing our experiences, David and I were directed to OR 6 by a surgery resident who said people just went rushing in. As we entered the room, chest compressions had already begun, and one round of epinephrine was already administered. The young lady was undergoing an operation to repair a femur fracture she sustained in an automobile accident about one week ago. ROSC was achieved, but she required an epinephrine infusion to maintain an adequate blood pressure. The surgeon quickly closed the wound, and we started to prepare for ICU transport. That was when we were informed that all four adult ICU ventilators were in use, and the ICU did not foresee the ventilators becoming available anytime soon. This situation was certainly new to me. The patient needed more intense management and monitoring than we could provide. We continued to do what we could by providing hemodynamic support to the best of our ability. She remained in the OR all day.

Around 3pm, we were called into her room to assist in obtaining further IV access. One of her lines infiltrated which meant we had to depend on an external jugular line. We were attempting to find further IV access when we saw rhythm abnormalities on her ECG monitor. Based on what happened so far, we anticipated another code event and quickly called for help and administered CPR when necessary. After nearly 30 minutes of attempting to obtain ROSC, she was pronounced dead. I have been fortunate throughout my training to not have many patients with cardiac arrests, but this situation made me realize how well I was trained to manage these situations. While I certainly wish the outcome was different, I am thankful for the learning opportunity so I can better care for my future patients.