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.

I had arrived to Kenya a week ahead of time to visit the Masai Mara with my husband, Ian, and while that had helped me adjust to the time change and to get my bearings of the geography, there was still so much to learn. While in the Masai Mara, I found myself really looking forward to getting back to work in the hospital - in a place with a new language and new customs, getting into an operating room suddenly felt like a comfort blanket. At this point in my training, performing anesthesia feels like an inherent part of me, and something that helps me feel grounded in purpose.

While everything feels so different in Kijabe, I still find comfort in knowing my skill set and being able to take care of patients, even if the majority of them don’t speak English and I depend on our students, nurses and Kenyan nurse anesthetists (KRNAs) to translate. It took a couple days to recognize the familiar patterns - bring the patient to the operating room, attach the monitors, connect IV fluids and tubing - not because they are so wildly different but because I have become so accustomed in three and a half years of residency to how things are at Vanderbilt that any deviation from the exact supplies I have held in my hands multiple times a day for years feels monumental.

Once I began to see the familiar patterns, what was truly unfamiliar became more clear to me. In my practice, I never expect to be lacking anything I need; in fact, if at Vanderbilt I turn around and can’t find a medication or supply that I need, I scold myself for being so unprepared. In this environment in Kijabe, the opposite is true - sometimes we feel lucky for having the right size blood pressure cuff and a pulse ox monitor that works the first time you connect it. I find myself trusting my gut more than I ever have before, because the monitors are never quite as reliable as you want them to be. If I have done everything to the best of my ability and I know in my gut that my patient is safe, I sometimes have to trust my gut over a faulty monitor. It’s almost a leap of faith to believe in myself to that extent, but as rewarding as it is sometimes unnerving.

My biggest education in just a few days has been learning to take nothing for granted. A patient with low blood oxygen saturation triggers in my mind a long list of possible diagnoses, but equipment failure is naturally pretty low on my list. That turned out to be a mistake, because after several days and several tense clinical scenarios, we all realized that the hospital’s oxygen processing plant had been malfunctioning and instead of delivering our patients 100% medical oxygen, it was only about 31% oxygen. This isn’t always a big deal, as normal room air is 21% oxygen, but it matters substantially in children who don’t recover from hypoxemia as quickly or as easily as adults do. The solution to this problem isn’t simple, either: turns out it will be several weeks before the replacement part will be available, and we are forced to work off of oxygen tanks and conserve as much as we possibly can without putting our patients at risk. At Vanderbilt, I imagine this problem would cause surgeries to be cancelled to avoid any risk at all to patients, but in Kijabe, not performing some surgeries for patients who have saved up and traveled very far to receive care may present even more risk than working with a limited oxygen supply.

My second biggest learning task has been to supervise people of vastly different skill sets who trained in a system far different than what I know. This week, I have been pushed harder than ever to be able to walk into a room and quickly assess what’s going on and how I can help. I suddenly have an even greater appreciation for all of my attending physicians who guided me through my early days of providing anesthesia - how often did they walk into my OR and be surprised by what they saw, only to redirect my work in the correct direction? This is made even more challenging by cultural differences, the occasional language barrier challenge, and most of all by my complete unfamiliarity to my surroundings. I don’t often have the option of fixing a problem myself, because I have no idea where the supplies we need are. I’m forced to communicate what we need to others and place trust in them to help out. For someone like myself who takes pride in being self-sufficient, it is a lesson in knowledge, trust, flexibility, and confidence all at the same time.

I have no idea what awaits us in Week 2, but my own goal is to continue to push myself to take on more responsibility and communicate better with our learners. If I find myself in a place of comfort at the end of 4 weeks, I will be incredibly proud of what an achievement that is. Onward!