A couple of months before I arrived in Kenya, my home institution switched their electronic medical record from Starpanel to Epic. To give a little background, I knew Starpanel. I was efficient at Starpanel. Starpanel was my friend, and Epic was an outsider. I found myself very clever in deeming the transition an "Epic" fail to anyone who would listen weeks before its rollout. Subsequently, on transition day, I felt unsurprised at the almost apocalyptic scene and hospital-wide confusion that ensued. It felt as if I didn't know how to do anything on this new system, but I found some satisfaction in blaming the yellow-vest wearing support team, or "yellow jackets" as we colloquially called them, as well as Epic itself for hindering the efficiency of patient care. It certainly wasn't my fault. I was already halfway through residency and I was efficient. I was confident!

Turns out I was just comfortable.

Coming to Kijabe two months later, I am even more out of my comfort zone. My first week here, I found myself clumsily navigating through paper charts. Trying to make my morning rounds, it was seemingly up to chance whether I would find vital signs, flows, or medication sheets in the chart. Most, but not all, of the previous notes would be legible. It was hard to tell if labs that were ordered had actually been sent, and it was a truly lucky day if the results were actually delivered to the ward and in the chart by the time you were looking for them. Feeling uninformed and deeply uncomfortable not knowing every detail about every patient, I longed for the consistency and organization of an EMR, any EMR...including Epic.

Although I have since learned where the lab is and how to more efficiently navigate my way through charts, I have come to realize that there are many luxuries that I previously took for granted: hot water, drinking water, sharing a common language with my patients, bedside suction, ventilators, the ability to quickly order and administer uncrossmatched blood for an unstable trauma patient, manual blood pressure cuffs, central lines, and sharp scissors. I came into this experience prepared for the limited availability of diagnostic imaging and labs. I did not come fully prepared to watch a septic patient with cholecystitis (and symptoms for one week) walk out of the hospital because he couldn't afford surgery.

However, I am learning to adapt to limited resources, and more importantly, to relax. In my first three years of residency I have learned to walk fast and eat fast, and eat fast while walking fast. In Kijabe I have learned that patients still do ok if I sit down to eat, if I take my chai in between cases, and if I take a few minutes to have small-talk before patient-talk with my colleagues. I am surrounded by attendings eager to teach, the kindest residents, and the most grateful patients. As a lover of the outdoors, I have had plenty of opportunity to appreciate the beauty of the landscape and wildlife surrounding me. In two weeks I have already made great strides in taking moments to appreciate all that is around me, including the internal and external resources with which I render patient care.

Realistically, it took less than a week to learn the ins and outs of Epic and everybody, patients and providers included, did fine. Although it is taking a little longer to feel efficient in a new country with vastly different resources, it is through this discomfort that I am learning valuable lessons and gaining true confidence.