Nov 04 2011
by Allison Greening
Vanderbilt International Anesthesia
I arrived in Kijabe, Kenya with two other senior anesthesia residents from Vanderbilt midday Sat Oct 29th, after departing Nashville Thursday Oct 27th, flying overnight to London, and then all day to Nairobi. We spent the night in the Mennonite Guest House in Nairobi, where we met several missionaries coming and going to and from various parts of east Africa, and then were driven up to Kijabe the next morning.
We had been scheduled to travel Monday Oct 24th, but were delayed with security concerns due to the Kenyan army invading Somalia in response to recent kidnappings in northern Kenya, and threats of Al-Shabaab retaliation in Nairobi for a few days. Effectively this means we’ve missed a week, but three weeks are better than none! One of the first things we noticed about the place is its utopian feel. Justin, one of the other residents, referred to it as a “summer camp” feel. It seems funny to think of any sort of terror attack happening here, in an idyllic small town mostly made up of missionaries who either work at the hospital or international school, but evidently someone has thought of it, as it’s surprisingly secure.
We spent the weekend getting settled in, and then started in the operating rooms on Monday. I have an interest in pediatric anesthesia, so have been running the pediatric room, though my compadres have been doing lots of regional anesthesia with the new ultrasound donated to the hospital recently from Vanderbilt and Dr. Randy Malchow. (1st photo) We’ve also been involved in a couple of airway cases, using the brand new glidescope, all of which has drawn quite an audience! (2nd photo below) I’ve done some amazing pediatric cases; the two that stand out the most were an open thoracotomy to repair a patent ductus arteriosus (PDA) in a 15 kg, 7 year old boy who was an achondroplastic dwarf, and a debridement of a severe, 48 hour old burn to the face of a 3year old boy.
The first case was a pretty big deal, basically minor heart surgery in a third world country, and I was the experienced one in the room, with both a Kenyan nurse anesthetist and a Kenyan nurse anesthetist student helping. A few aspects of the case amazed me, especially how well we did with so much less than we do in the states, and even more so, how well the boy did after having such a major, and painful, surgery. Kenyans are tough!
The burn case was very memorable as well, and also good teaching for the nurse anesthetist and student. The boy also happened to have muscular dystrophy, which presented its own anesthetic challenges, on top of those unique to burns, such as not being able to use certain drugs, and potentially having trouble breathing for the patient after putting him to sleep. The burn patient, like the PDA patient, looked great the next day. There’s even quite a lot to be learned from a fairly basic case like we did today, when just a few minor speed bumps along the way became important teaching points! I should be clear though, that I am not the only one doing the teaching!! I have learned quite a bit, and already in the first week had experiences that will rival any that I’ll get during my pediatric anesthesia fellowship next year!