February 4, 2020

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.

First Day
After a long day of flights and layovers, we arrived in Nairobi after nightfall. Since the hour drive to Kijabe is via a highway that is heavily trafficked and currently under construction, a guest house in Nairobi had been arranged for the night. In the daylight, the quaint gardens of our guest house could be better appreciated - a small oasis in the middle of a large and bustling city. Our driver from the previous evening, Elius, picked us up promptly at nine and greeted us with a friendly “Jambo!”. After a “brief” stop at a local super market, we made our way to Kijabe. The road included frequent diversions off the main highway onto unpaved roads because of construction, with brief glimpses into the lives of those living in sprawling urban neighborhoods.

As we neared Kijabe, we got our first good look down into the expansive Great Rift Valley. Turning from the main highway, Elius navigated down a narrow, winding road into the heart of Kijabe. The relatively small, rural Kenyan town is home to approximately 7,000 people and sits on a ridge overlooking Mt. Longenot and the Rift Valley. November is the beginning of the rainy season and the hillside was covered with lush vegetation, trees and flowers. When we arrived at our new home for the next month, we were greeted by Hellen. She gave us an overview of the house, which included basics like turning on the stove, the switch for the hot water heater and how to refill the water filter for drinking water. Hellen had another guest to welcome and left us to unpack with the promise of returning soon. Thirty minutes later we heard a knock at the door; however, when we looked through the glass there were five large male baboons sitting on the front porch. Our confused questioning of whether baboons could possibly have knocked on the door was interrupted by another knock at the side door. It turned out that Hellen had returned to the house to find the baboons on the porch, so she went to the side door. Hellen explained that while the male baboons could be mischievous and at times aggressive, particularly toward women, she had not heard of them knocking on doors!

The rest of the day consisted of a tour of the AIC Kijabe Hospital, Super Duka (aka small grocery store), market and famous Mama Chiku’s restaurant. The hospital cafeteria generously provided us with a welcome meal of traditional Kenyan food - white rice, cooked cabbage, stew and what would soon become our new favorite food - chapati!

Last Day
Today was our last day in theater, aka the operating room. Since my fellowship interview last spring, I have spent the last year and a half looking forward to the opportunity to come to Kenya and it is hard to believe that the four weeks have come and gone.     Despite attending simulation, lectures and speaking with previous participants - nothing fully prepares you for what it is like to experience Kijabe first hand. There are stark differences between practicing anesthesia in the United States and Kenya, the most obvious of which are the availability of equipment and medications. 1) All ventilators in the ORs are refurbished models that have long since been retired from the majority of hospitals back home. 2) There is no gas analysis for inhalational agents and therefore no way of knowing or estimating MAC during a case. 3) Over half of the vents only reliably provide volume support - so to accommodate the small lung volumes of young children, the children must either breath spontaneously or be hand ventilated. 4) All “single use” blood pressure cuffs and pulse oximeters are used countless times on many patients - only being retired after they no longer stay on with the help of extra tape. 5) Bougies and stylettes are also hot commodities, so each KRNA keeps one of each and carefully sterilizes them after each use. In terms of medications, the KRNAs are taught to use what is currently available. During the past month we not only had to become comfortable using medications we had only previously read about in text books, but we also had to learn to do without medications that we are accustomed to having. The most surprising difference in patient populations is the stoicism of the Kenyan patients. Where typical American patients appear visibly anxious and request/require sedation, the Kenyan patients are calm and reserved. For example, I saw repeated patients sit straight up in the bed for a spinal with a broken leg and never flinch or complain of pain.

While these differences exist, many similarities can also be found. There is the familiar hierarchal educational team structure with students, residents and consultants across a variety of specialties. In theaters 6 and 8, orthopedic surgeons can be heard making jokes amongst themselves about their physical strength and ability to use power tools. Across the other theaters, you will see many of the same types of cases being done back home: split thickness skin grafts, endoscopies, tonsillectomies, free flaps, mastectomies, thoracotomies, even pheochromocytoma excisions. Additionally, you will also find the friendly and ongoing banter between surgery and anesthesia about who is to blame for slowing down the momentum of cases.  

In such a short time, a rural hospital, thousands of miles from home has started to feel more similar than different. We have made many friends both inside and outside the hospital, and even have been given our very own Kikuyu names - Njeri, Wambui (Kat), and Wanjiru (Katie). While the three of us gave daily lectures, I think we are leaving Kenya having learned as much, if not more than we were able to teach. Kijabe has reminded us to be more efficient with our resources and shown us how to provide a safe anesthetic with the limited resources that are available. The experience has been invaluable and I highly recommend it to any future residents or fellows!