During the time that has passed since my last report I have been focusing my attention on the Tennessee Radon project. As I mentioned before I really have become interested in this particular project. Through my contacts I have been able to acquire short term radon tests to distribute throughout the community. Thus far I have received scores on 15 of the 20 test kits I have sent out. A safe radon rating for your home under is 4 pCi/L, so far ever test I have gotten back has scored under “1” pCi/L which is great! It has been rewarding to be able to go into the community and pass out the short term radon test not only because I can get data to record, but also because I can talk with the participants and help them to understand the major affects radon can have on their health. I feel like I am truly making a difference in some of these peoples’ lives and helping them understand what could be happening in their home is an eye opening experience for most.
Corozal
This first week has been a lot of preparation. For the orgnization - preparing for the upcoming medical student brigade and the confrence, for me - learning Spanish and helping out where I can. I try to spend an hour in the morning in language school, which is me in front of the fan looking at my Spanish materials. I´m already more comfortable saying Spanish phrases and I can understand what people are saying to me every once in a while. So I guess I´m on the road to success.
Numerous projects and learning experiences have arisen during my time at Roan Mountain Medical Center. I've learned you always have to be flexible. Originally I planned on working more with the patients and the administrative side of health care here at the Medical Center, but after a few weeks I learned there are more areas that I can reach out into.
Kijabe Hospital
It is hard to believe that my four weeks in Kijabe will be over tomorrow. It has been a wonderful trip- from the joys of getting to know a new culture and working alongside talented colleagues, to having the privilege to take care of the patients here in Kenya.
I took my first weekend of call this past weekend. As I was checking on a patient Sunday evening, I was informed by my junior resident that there was a “mass casualty” bus accident in a nearby town, and the police had called to say they were bringing a number of victims to Kijabe Hospital. No one knew any additional details, and as I arrived in the Casualty unit (Emergency Department), a tour-bus size vehicle pulled through the front gate. Within minutes, injured patients began being rapidly unloaded. As the most senior resident present, I was in charge of triaging, organizing resuscitations and directing patient care until an attending arrived. We very quickly identified several patients needing immediate attention, and moved quickly to stabilize them.
One of the great benefits of spending time in a place like Kijabe is the opportunity to “cross train”. I am a general surgery resident. But this week, I have learned a bit about being a urologist, an otolaryngologist, and an obstetrician.
Being diagnosed with a malignancy in Kenya is a very different thing than being diagnosed with a malignancy in the United States. CT scans and PET scans as means to evaluate for metastases are not locally available. A patient must travel to Nairobi, and frequently, these imaging studies are too expensive for most patients to afford. Furthermore, many malignancies are very advanced when they first come to the attention of a physician. Patients may delay being evaluated because of the cost, because of the distance required to get to a clinic, or because they must choose between obtaining health care and their family eating. Finally, chemotherapy and radiation therapy have limited availability. At the private hospitals, the costs are prohibitive for many patients which means that the queue to access the limited government sponsored facilities is exceedingly long making access to treatment all the more difficult. As a result, all of the procedures I have done in my first week in Kenya on patients with malignancies have been palliative in nature. This is emotionally challenging for clinicians who are accustomed to being able to offer surgery for cure. Still, it is a way by which to provide improved quality of life for whatever time a patient may have left, and that is certainly valuable to both the individual and their family.
H. would probably be at the top of her class no matter where she went to medical school. Like most of the Ecuadorian medical students I have had the privilege of working with she is curious, dedicated, and focused. She attends a prestigious medical school and has had the opportunity to complete clinical rotations at some of the largest hospitals in Cuenca and Quito. Her dream is to study internal medicine.
Valantina is the granddaughter of my host family in Riobamaba. The family is middle class and well educated, both parents having attended university. As is common in Ecuador, Valantina’s parents started having children very young and continue living with their parents. Before the recent death of my host mother’s mother, four generations had lived in the house.

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