Week 1
Nestled in the mountains on the edge of the rift valley, the greenery, sleepy dukas and winding goat paths that surround the hospital can give a false impression of what happens behind its unpainted, arched concrete walls. At over a hundred years old, the hospital is the poster card of contrasts, modern monitoring equipment beside ventilators from prior generations that often require a little caress to work, if they work at all. All combined with a smile and can do attitude from staff, it creates a dynamic environment to work. As a centre of last resort for many, folks stream from hundreds of miles around. One may think a car accident in casualty (ED) happened an hour or so ago, however, you could often be wrong thinking such things. It can often be an accident from days ago only just arriving!
While there have been attempts at bringing in new equipment, I confess, one soon realizes how spoiled we are in the west. One often has to think fast on their feet and find alternate plans, and sometimes plans previously thought of as a last resort become rather high in consideration. But after a week of some serious review of the difficult airway algorithim and ACLS, it is noteworthy that there are several places around the hospital to relax and enjoy other aspects of life here. As a former African, a return to the bush always provides a reconnection with the wonder of our continent and the natural world, with plenty to be seen in the Lake Naivasha region.
Week 2
Teaching is what we have to do to empower folks, to allow them to run their own systems and improve their wellbeing. That being said, no one said its easy.
As a resident I always recalled attending being a little skittish around July 1st as new residents started. As a new attending now, you have a mixed set of emotions to navigate. You’re in an environment of few resources, and those that work, don’t always do so consistently. You also have self doubts from time to time that one has to work through. We have been exposed to a lot, but not necessarily every scenario we will find in independent practice. You also at times want to give your trainees the benefit of the doubt, no one liked an attending who micromanaged them after all. But it can also be hard when you give the benefit of the doubt and get burned, or a patient potentially harmed as a result.
While no one was ever harmed, this was a week of many close shaves, and many gray hairs, with personel stretched quite thin. Some was related to equipment failure, some to me trusting residents too much, and overcoming significant knowledge gaps amongst personal and cultural gaps too, differences of which can be an real challenge in medicine and anesthesia in particular that is tremendously of a fast paced nature.
In short, it was a challenging week, one where you see just how much you can do with so little. Thankfully I think we all learned and grew.
Week 3
Growing up in Africa, we all talked of being a “jack of all trades”, necessity requiring no specialization…….13 years on as a physician it comes back knocking!
As residents sure we all ‘train in ICU’…..if 4 months in 4 years is what we would like to call adequate, which often entailed forgetting everything in the 11 months between rotations!! So it would of course only be appropriate that we take a touch of ICU Call while here. Understandable, capable, warm bodies are a scarce commodity out here.
The truth be told it can be quite liberating to be free of the endless protocols we find in the western ICUs…….foley protocol, IV taping protocol, CVL protocol, PT protocols and the list goes on to form a stack of forms that no one reads anymore, and keeps auditors employed and physicians in a never ending pile of paperwork.
Better still, apparently we didn’t forget all that ICU training in the 11 month intervals, although I did wish the ED would consider intubating someone with an SpO2 of 50% before wheeling them over!
We wrapped this week up with a trip to Lake Nakuro. Always a sight to see rhino in the wild, knowing each time really could be the last.