The next two weeks I found myself much better able to engage in the hospital system. Now I had learned the names of Benson, Mugo, Humphries all clinical officer or medical officer interns. It became my pleasure on night and weekend call to lead them through surgical triage or procedures. On subsequent calls I was able to help one of the medical officer interns through two chest tube placements. These patients had spontaneous pneumothoraces, but were not in extremis, thus I could take my time and coach the intern through the procedure. By the second placement, Mugo was able to anesthetize the patient appropriately, make the incision, and perform this life saving procedure. He remained a bit tentative, but I had seen vast improvement by this second time. These guys and gals are the front line of the Kenyan medical system, and are seeing patients in isolated places with no surgeons, or even residency trained physicians available. Teaching Mugo to place a chest tube well could benefit multiple Kenyan patients in the future.

FGHL Blog: Jason Axt - Extreme Medical Issues in the Field

Warning: This post contains graphic medical images.

Feb 28 2013

Warning: This post contains graphic medical images.

This week started with an orientation to the hospital. I learned where the theatres were, where the clinic patients were and the location of the wards. Patients were housed in common sleeping rooms with 4 – 20 patients per ward, with men and women housed separately. I was introduced to Dr. Irungu, the Kenyan consultant whose service I would join.
Spoiled. That’s the only way to describe how I feel heading back to the states. I feel that I had the opportunity to practice medicine the way my 6-year-old-self imagined it while in Guyana and I couldn’t be more thankful for the experience.
January 13

I can’t believe my time here in Haiti is over—but it is. I’m
writing this from my guesthouse in Port-au-Prince, in preparation for
my flight home tomorrow.

I would like to thank Senator Frist for forming the Frist Global
Health Leadership Program, and for allowing me to have come to Haiti
to work at HIC. I’d also like to thank the many people at Vanderbilt,
Dartmouth, and HIC who helped me make the needed connections and
organize the details of my trip. Last but not least, I’d like to give
a special shout-out to my boyfriend, for supporting and encouraging me
to leave him—and the U.S.—for three months and go work in Haiti.
Thank you.
Happy New Year!

Apart from working at the maternity this week—and getting to celebrate the arrival of 2013 with laboring women and their new babies—I’ve been busy completing the list of HIV+ women who have been lost to follow-up. From March of 2009 until November of 2012 there were 240 women who started receiving HIV care at HIC, but now no longer are doing so. I really hope that the social worker and the community health workers will make use of this list and that some of them will be found and restarted with their HIV care. I am however, not incredibly optimistic that many women will be located. The social worker and community health workers are already very busy and to try to track down 240 women—with little more than their names, dates of birth, and possible addresses—seems very ambitious. But I feel that if even one or two women are found and are restarted in care that my work on the list was worth it.
I returned to Samaria with a Clinical Officer, Waweru, in tow to staff Samaria for the week in Susan’s absence. Susan has an obligation to attend training and program review for her participation in Tunza the family planning program supported in part by USAID. If Susan is not able to find a substitute during her absence, then she must close her clinic. In this case it would have been for 4 ½ days, difficult on the patients and Susan’s income. Even so, engaging a substitute adds costs to clinic expenditures, that may or may not be recouped from leaving the clinic open. This underscores the difficulty that private clinic nurses have in taking time away from their practice if they are the sole practitioner. It is difficult to engage in continuing education, a must for any clinical practitioner, if the economics and finding a trusted substitute are onerous.
As I mentioned in my last post I’ve struggled with practicing as I’ve been taught and believe is best while also trying to respect how my Haitian counterparts were taught and what they believe is best practice.
Reporting from Les Cayes, Haiti
As the providers at HIC (i.e. the nurses) have become more comfortable with me and my abilities I’ve slowly begun to help teach the nursing students who are present during my shifts. This week I got to help a couple of the students do deliveries, which were rewarding experiences, though ones I’m not (yet) totally comfortable with. In many ways I still feel like a student myself—I graduated from nursing school in May 2012 and this is my first job practicing as a “real” (as opposed to “student”) midwife—and so it’s a bit odd for me to already be put in a teaching role. That said, I really do enjoy guiding the students and helping them grow more confident with and skilled in catching babies.
So I have moved temporarily for the week to the Mariine Maternity Nursing Home outside of Nyeri to work with Josephine Gikunja. I will go back to Samaria next week while Susan attends a training workshop. Susan has enlisted the services of a Medical Officer (Physicians’ Assistant) to work with me and help with translation.

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