The first thing I'd like to clear up is that, for the record, it is NOT supposed to be rainy season here. We're emerging from the chill of July and August - months during which Kenyans in Bomet wear thick parkas and wrap themselves in scarves, though the temperature doesn't really get much below fifty-five degrees - and the short rains don't start until October. But with the exception of Tuesday, it's apparently been raining pretty consistently here for the past week. Which is not to say that they don't need it - they do - but if I wind up posting a bunch of pictures of mud and stormy skies, I want to make sure I've calibrated everyone to the fact that it's not normal.
It does, however, give me a good excuse to wear fleece, flannel pajamas, and wool socks. All at the same time. Which I love.
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| view out my window of the road to the hospital |
I'm staying at the guesthouse this trip for the first time in several years, and in spite of that, I've gotten so used to cooking for myself here that I've opted to do the same again. My apartment has an incredible number of windows, I have my own coffee pot, and the showers have been as hot as I could ever want. My only complaint is that my desk is high enough (or my chair is low enough?) that I feel really short sitting at it. Sidenote: can't imagine how short actually short people must feel sitting there. I keep getting invited to the Ganeys' house for dinner, but one of these nights, I'm actually going to give the stove a whirl.
The peds service at the hospital is not too hectic right now, which is nice for reacclimation. I think we may have discharged half of the ward patients home today, although we did also lose a child in the HDU who has essentially been in coma on a ventilator for the last several days without ever having a clear diagnosis. These cases, which I refer to as "encephalopathy NOS", can be particularly challenging, since our ability to arrive at a clear diagnosis, let alone a treatable one, is often rather limited, and it's hard to watch a previously healthy child deteriorate neurologically to the point that you can be certain they won't be able to recover. In this child's case, I arrived at the end of the story, and so I think I felt the emotional weight of his loss less than the rest of the team, but it's always both sad and frustrating. Please pray for Allan's family as they grieve his death.
Another of my least favorite Tenwek diagnoses is rheumatic heart disease, something we essentially never see in the West because of our aggressive treatment of Strep infections. We had one known RHD patient on our service yesterday (who is actually reasonably stable, albeit chronically quite sick), and today we diagnosed a second, a 15-year-old girl whom we had been treating presumptively for tuberculosis. Except now maybe it turns out it was just her heart (severe mitral stenosis), and not TB at all. As bad as TB sounds, at least it's a diagnosis with a cure. RHD is not. Her heart already has evidence of longstanding disease (her right ventricular pressures are at least systemic), but because her heart function is still preserved, she may be still at a point at which an intervention (likely surgery) might greatly improve her long-term prognosis. We'll need a lot of wisdom as we navigate the next steps in caring for her, so please pray for that as well!
... and one of my interns just called to tell me that she is admitting a third decompensated RHD patient who showed up to casualty (the emergency room) this afternoon. Sigh. May I double my request for prayers? Thanks.
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