internet dependence

That's different from interdependence, in case you were reading a little too quickly there...

I've arrived in Nairobi, now three days ago, and am beginning to settle in to what I think will be my routine here. Due to malfunctioning wifi in our otherwise-lovely guesthouse, however, the first few days were characterized by a rather acute awareness of my dependence upon access to the internet. Finding a Kenyan SIM card for my ancient iPhone 3 on Sunday morning truly felt like re-establishing a connection to the world (including the Kenyan world!), and I'm pretty sure I became giddy when we returned last night after dinner to discover that the malfunction had been remedied. In spite of the giddiness, I want to acknowledge what a sobering realization it is... that if I can't text my sister or Google an answer to the random question that comes up, I feel absolutely cut off. My home church engages in weekly fasts during the Lenten season; I wonder what it would be like to fast from our smartphones for a week. Less distracted, that's certain.

Faye, my travel colleague, and I took a deep breath and plunged in to the hospital early Monday morning. Because Nairobi traffic is... unpleasant... we leave each morning at 6:30 to arrive at Kenyatta shortly after 7:00. Kenyatta National Hospital (pictured to the left) is, among other things, enormous. As the only public tertiary referral center in Kenya, it boasts 1800 beds, and it's apparently not infrequent for the census to run well over that number. (Bedshare, anyone?) Even with that many beds, there is a single med/surg ICU with only 20-30 beds (I'll count tomorrow, I promise!) that cares for who we hope are the 20-30 sickest patients in the hospital. The beds are always occupied - though no double-bunking here - and I was told today that the pediatric residents who are rotating through ICU routinely canvass the pediatric wards after rounds each day to see if there are patients who really ought to be in ICU. I also met a pediatric resident today who told me that she is working on a study assessing the prevalence of ARDS among pediatric patients on the wards. On the WARDS. (That's shocking because it's really an ICU diagnosis.)

Just hanging out in the hallway.

At any rate, I've spent my mornings in ICU rounding on the few pediatric patients there. Two of the anesthesia fellows have been assigned to ICU this week with me, and they'll exchange places with the third next week. Whatever pediatric patients are in ICU are covered by a team of peds residents and an attending pediatrician who is ICU trained (they are a group of three). It would be a little overwhelming to talk about all of the different things that are so different, so I'll just mention that on my first day, I got to give a round of chest compressions to one patient, helped manually ventilate a second for well over an hour because he had such severe airflow obstruction that it was impossible to keep him on the ventilator, and was asked - two hours ahead of the conference - if I would like to make a presentation at the pediatric mini round that afternoon. Yikes. Someday maybe I'll have impressive presentations that I can pull out of a hat, but I am so Not There at this point in my career. So I begged off until next Monday, and then successfully dodged a rather public attempt three hours later to have me present at Grand Rounds on Wednesday. And by "dodged", I mean I'm doing that next week, too. And this Thursday is an anesthesia symposium at which I'll be giving three half-hour talks, only one of which I have in complete form...

View from my workstation.

With all of that presenting to do, Faye and I decided to make for Village Market this evening to do some work; it's a lovely mall near our guesthouse that appears to function as a little slice of expat heaven. We purchased gelato from the Italian ice cream place upstairs and settled into the open-air food court to enjoy the free wifi and available electrical outlets. Blissful and a little bit wrong all at the same time, it was in clear contrast to the hospital, where I swear I've seen all of two other wazungu in the course of two days. The gap between the haves and have-nots in Kenya can be so wide that I truly feel like I'm occupying two entirely different worlds in the same location.

And just to end with a bit of humor before I do a few more slides and head to bed, I should mention that when I ordered post-gelato coffee at Dorman's today, I made the incredibly awkward mistake of telling the cashier that I was "black" when I saw her prepping a small cup of sugar for me... at least she got a good laugh out of it!

All right. Back to work, then another early rise-and-shine. Tomorrow I'll count the ICU beds and report back, with pictures for added interest. For you praying types, please pray that I'll have the requisite focus and energy to put the work into my presentations that they deserve.

Good night!