pecc doings

I’m not sure if it’s a function of getting older and given periods of time feeling relatively shorter than they used to, but arriving back in Nairobi last weekend, it hardly felt that I’d been gone at all. In fairness, it’s only been two and a half months since I left Tenwek, and I’m not sure I’ve had two Kenya trips in such rapid succession before. And I’ve also remained tethered more tightly, being in contact with people on this side of the ocean a lot more frequently than I usually am.

At any rate, I’m halfway through my annual trip to KNH. Some things are the same - for instance, I can wander blithely around the hospital without any form of ID and no one seems to mind - but in contrast to years past, I’m now being evenly split by the UoN Paediatric Anaesthesia fellowship and the new PECC (Paediatric Emergency and Critical Care) fellowship. This means more fellows and a broader target audience. PECC also has a series of visiting faculty volunteers over the year, which means that it’s less urgent to cover every pertinent topic in critical care during a two-week window. (Whew!) So far I’ve met three of the fellows – the fourth will be back from leave tomorrow – and overall my time has felt a bit more structured than it has on past trips, which is actually a huge relief.

 

Lillian, the PECC fellow assigned to KNH PICU this month

One implication of supervising the PECC fellows is that I’m a bit more formally responsible for supervising patient care in the PICU than I have been before. With the anaesthesia fellows, we came along for morning rounds, and I’d help troubleshoot issues that came up during rounds, but when it was over, we walked away. Now, though, I’m supervising a fellow who is assigned to the PICU, fields calls, and is responsible for the patients: not only do we round in the morning, but we also return in the afternoon to follow up. I’m finding this has made me more aware of the challenges inherent in the KNH system and the way they impact the ability to think in an informed fashion about clinical decision making. Honestly, it can be overwhelming not to get the results of a chemistry panel for 24-36 hours when a toddler has severe acute kidney injury, or to have any idea of whether or not a baby's anion gap is elevated because the lactate is sky-high. And why does EVERYONE seemingly have refractory metabolic acidosis? A couple of patients have already made me acutely aware that my clinical exam skills aren’t always what they could be, and I have a lot of admiration for the folks who work hard to take good care of these sick babies day after day, week after week, month after month.

The bottom line is that I’m only here for two weeks, and I have it easy: I get to go back to a PICU where I’m utterly spoiled for resources, both human and medical. So I pray every morning for a heart that’s willing to jump in, to engage the trainees with whatever knowledge I can communicate and whatever critical thinking I can model. The fellows are incredibly smart without exception, and in spite of whatever anxiety I have every morning climbing the stairs to the PICU, it’s always always a joy to work with them.