Return to Provincial Hospital
Some Good News and Some Bad News
Karen and Parham, the medical students, meet me early Wednesday morning to catch up and compare notes. These two are amazing. Not only did they come to Kenya and adapt quickly to the culture, they've worked at the hospital, visited orphanages, worked with Heaventrax to begin a health care program for widows with children and they've met with Walter to learn more about Pamba Zuko. Parham runs nearly every morning and Karen takes Kiswahili lessons! On top of all that, they're constantly looking for ways to help the local people, using funds donated by their generous friends in Canada. Their energy is constant and stupefying. The sames goes for Angela and Jackquie, the student nurses who leave today to return to Canada. I miss them already. Meeting these four young people has been a treasure. They are all so bright and caring and energetic.
I ask Parham about the patients we visited last week at the hospital. How is the girl with the broken leg and no family? He says she's doing well and is being fed. “I've bought some things for her and would like to take her some sheets and a blanket and pillow,” I tell Parham. Plus a t-shirt, underwear and socks. “Okay,” Parham says, “I'm going tomorrow would you like to come along.” Of course!
Parham tells me he was looking for the gunshot victim in the surgical ward but couldn't find him. Later, Parham was in the morgue and saw the guy. When Parham tells me this, he is laughing and says, “I couldn't find him, then I see him in the morgue.” His laughing seems strange. He delivers heartbreaking news with a chuckle. But his laughter is understandable. We must laugh or we'd go raving mad.
I ask Parham about the procedure for getting a wheelchair, that I'm thinking about getting a chair for the university student who is paralyzed from the knees down. Parham says he'll ask the physio therapist, who procures the chairs. Parham is also thinking about getting a wheelchair for another patient, a young boy.
This morning, we take boda bodas and a matatu to the Provincial hospital. Karen goes to maternity where she gets to see her first Kenyan baby being born, and Parham and I go to the surgical ward. We meet Margaret, the head nurse. When she hears I work at TICH, she says, “I'll be a student there soon. I want to work in community health in the rural areas.” How wonderful. With her experience at the hospital, combined with a degree in Community Health and Development, Margaret will be able to cure many illnesses and ailments in the rural communities. Most of the rural patients in the hospital are here because they have an easily treated illness or disease, but they don't have the money to go to the doctor, so they stay home hoping they'll heal. But many only get worse, to the point they may not recover. Working at the community level, Margaret will be able to treat these people before their wounds and illnesses progress to severe stages.
For instance, there's a new patient in the bed next to the woman with the diabetic foot. His wound looks just like her wound, but his covers the top of his foot, the entire front of his shin and runs up to just above his knee. A huge, skinless wound exposing his muscle and bone. On May 28, the skinny man was using a panga (machete) to clear his field and accidentally cut his leg mid-shin. When asked his HIV status, he says he doesn't know, but Parham and Eric, the Kenyan medical student on rounds with us, believe he is HIV positive. Which would explain why his cut became infected and spread so quickly up and down his leg in only three weeks. He'll require a skin graft for sure and may need to have his leg amputated if it doesn't heal properly.
The man with the scrotum infection is gone. Although Parham told the head surgeon the patient's stomach lining was infected, the head surgeon released the man. Eric and Parham say, in all likelihood, the man will die. His scrotum is gangrenous and should be removed. His infections will only worsen because he is probably HIV positive. I say, “So he came to the hospital to be treated and now he's being sent home where he'll die.” Parham says, “People don't come to this hospital to be treated, they come here to die.” Stark reality.
Austine, the physio therapist, greets us in the hall and Parham asks about the process of getting a wheelchair. We happily learn the chairs are made by APDK, the organization in Nairobi where Heidi and Tom, fellow VSO volunteers, work. Heidi is a speech therapist training speech therapists and Tom is an engineer working in the wheelchair factory. He is helping to improve the wheelchair design as well as increase their production from 80 to 200 wheelchairs per month. APDK, through donors, provides the wheelchairs for free, but patients must pay 2,500 shillings, which covers the cost of transporting the chair from Nairobi, a membership to APDK and other incidentals. That's approximately $32.00 USD. The wheelchair costs about 30,000 shillings, or nearly $400 USD. I know my friends in Atlanta will be thrilled if their donations go to buying wheelchairs, so I tell Austine to make it happen. Parham, too, has decided to pay for one and we're told the boys can have their wheelchairs tomorrow.
We visit Vincent, the 12-year-old boy who is also paralyzed from the knees down. He has scoliosis (curvature of the spine), which may have impacted his spinal cord, though the doctors think he might have had a bone infection in the past which could be responsible for his paralysis. Vincent is not a big boy and he sits on the bed with his legs bent, propped up on his elbow. Because he is incontinent, Vincent has a blue plastic water bottle resting between his legs, holding his penis. Bed sores are beginning to form on his knees. This concerns Parham, Karen and I because we've seen how horribly extensive bed sores can become. But now, with a wheelchair, Vincent will be able to get out of bed and go home. He'll come to the hospital each day for physico therapy. He's been in the hospital for months simply because he didn't have a wheelchair. His mother carries him on her back to school each day then brings him back to the hospital. When we stop by to tell Vincent and his mother he'll have a wheelchair tomorrow, he smiles broader than usual and his mother simply shakes our hands endlessly saying, “Thank you, thank you, God bless you.” We tell them the money is not coming from us but from our friends in the US and Canada. Vincent will draw a picture of thanks. If I get a chance, I'll photograph his drawing and will post it to the blog.
We then visit the university student. Parham and the physio therapist straighten his legs as he tells us he could leave the hospital if he had a wheelchair. His mood is optimistic and he smiles a lot. On his bedside “table,” really just a plywood box nailed together, is a book called “Practicing Godliness.” We step into the hall to tell Austine we want to get this young man a chair, too, then we all step back into the room and tell him. Not only does he beam, but I look at the three older men in the room, who are all in traction, and they're smiling, too, shaking their heads up and down. The young man wants to write a thank you note to our friends in the US and Canada and I'll post it here if possible. Now he can leave the hospital, concentrate on his studies and graduate as soon as his research is complete.
We pass the guy with the tooth infection in the hall and his face looks much better, the swelling has reduced a great deal. I smile and give him a thumbs up and he returns the gesture with a smile. The guy who had been run over by the matatu, the one who lost his left ear, is not doing very well. Last week, he was walking around and seemed to have the best prognosis of all the patients. This week they are dressing his head wound, which goes down to the skull (and will require a skin graft), and the large, open wound on his right back shoulder. The bandages are bloody and there's a pool of blood at his feet. He seems depressed and when Parham and Eric speak to him, he complains of having mental problems. “You mean with your memory?,” Parham asks. “Yes, my memory,” he says quietly while looking at the blood on the floor. Parham says, “I'm going to give you three words and I want you to repeat them back to me, okay?” “Okay.”
“Car, apple, banana.” The young man replies, “car, apple, banana.” “Good," Parham says, "now remember those three words and I'll be back in five minutes to ask you again.”
We go into the next room to visit a new male patient suffering from spontaneous paralysis. Parham and Eric talk to his wife, who looks 20 or 21. Did he have a fever or night sweats before the paralysis? No. Did he experience any physical traumas? No. It's unusual for people to become paralyzed overnight. It's possible TB can seed in the spine (or any organ!) instead of seeding in the lungs, which is where it usually takes root. That's why they ask about fevers or night sweats. It would indicate TB infection. But the wife couldn't remember her husband complaining about fevers. His biggest problem now is bed sores. He stayed in one place too long, without being turned, and has developed massive bed sores. They're not really bed sores, they are now giant, open wounds. One wound covers his entire lower back and upper buttocks area. There are two openings on his right thigh, on the upper hip and closer to the knee. These wounds look as though someone did a dissection on the guy. His muscles, tendons and bone are visible. A nurse is cleaning and dressing his wounds, cutting away gray, dead tissue with a razor blade. Parham said this is not her job, that a surgeon should be “debriding” the wound (cutting away dead tissue). Two young nurses look on as the older nurse presses moistened gauze into the wound, between muscle and bone. Tragically, while the young man can't move his muscles from the waist down, he still has sensation. He is feeling everything the nurse is doing. It takes her quite awhile to dress his wounds. Meanwhile, he closes his eyes frequently and I wait for him to pass out.
TB can be nasty. Not just in the lungs, but the way it shows up in other organs. Another patient, a woman in her early twenties, is lying on her side, face down, writhing in pain. Austine pulls out her x-ray and Parham says, “Oh my god,” which makes me feel better about making anguished faces during rounds. TB lodged in this woman's vertebrae, about mid-way down her spine. She's had pain for four months but didn't go to the doctor. The x-ray shows a destroyed vertebrae. She leans forward to relieve pressure, causing her spine to bend inward. There is a jutting point on her back where her spine climbs up then turns in sharply. She requires traction, which will relieve the pressure and stop the progression of spinal erosion. If she continues like this, the spinal cord will be damaged, leading to paralysis. Traction will straighten her out, relieve the pressure and the pain. Traction costs 1000 shillings and the hospital will not begin it until she pays. I'm pissed off and say I can't believe this hospital, established by the government to keep it's citizenry healthy (because you can't have a healthy republic unless your people are healthy), doesn't go ahead and start traction for this woman. Why allow her to writhe in pain and eventually become paralyzed because she doesn't have 1000 shillings (about $12 USD)?!!
Once she's started traction, she'll require a lumbar corset, which costs 2000 shillings. I only have 500 shillings left after paying for the wheelchair. Later, I kick myself for not giving them the 500 to start traction. Parham and I discuss it and decide we'll probably go in together, using our friends' donated funds, to pay the 3000 total this woman needs. We have a long conversation about who should be helped. Someone who has a good chance of recovering and contributing to the world, or someone in immediate pain, though their outlook isn't good? It's very difficult to weigh these options.
I chose to spend about $10 USD on the mentally-challenged young woman with the broken leg. Parham, Eric and I put the sheets and blanket on her bed, but we make her cry because we have to move and turn her. Her cast comes up around her waist and the hospital doesn't put diapers on her, they simply allow her to defecate in the bed. At least she has a catheter to catch urine. We don't put underwear or pants on her. Jackquie left behind two sets of scrubs for me to donate, so I chose to bring one set for the young girl. But because she can't wear pants, and we learn from her roommate that she tries to pull her clothes off anyway, we simply leave her naked. However, I give the scrubs to the head nurse and tell her to dress the young woman when her cast is removed and she's able to leave the hospital. We also learn from the roommate that our favorite patient has a tendency to chew on everything, including clothes, the back of her hand and even her urine collection bag if it's left on her bed. Parham explains the oral tendency means she's still in a primitive developmental stage, though she appears to be in her late teens.
We go back to the memory patient and Parham asks him to repeat the three words. His face shows concern. I later remark to Eric that the patient is obviously experiencing distress over losing his memory and his psychological state must be addressed, in addition to exploring the cause of his short-term memory lose. I have no medical training. Obviously. And I should probably keep my mouth shut. But even as a layperson, I see how this patient's condition can deteriorate rapidly if these issues aren't addressed. He has certainly worsened since last week, when I had so much hope for his recovery, and his deterioration appears to be caused by his worsening mental and emotional states, not his physical wounds. So when Parham asks the patient to repeat the words, his face shows concern and he says, “I cannot remember them.” Ever so quietly, while flat on his back, eyes still downcast, he says “I cannot remember the words.”
Karen and Parham, the medical students, meet me early Wednesday morning to catch up and compare notes. These two are amazing. Not only did they come to Kenya and adapt quickly to the culture, they've worked at the hospital, visited orphanages, worked with Heaventrax to begin a health care program for widows with children and they've met with Walter to learn more about Pamba Zuko. Parham runs nearly every morning and Karen takes Kiswahili lessons! On top of all that, they're constantly looking for ways to help the local people, using funds donated by their generous friends in Canada. Their energy is constant and stupefying. The sames goes for Angela and Jackquie, the student nurses who leave today to return to Canada. I miss them already. Meeting these four young people has been a treasure. They are all so bright and caring and energetic.
I ask Parham about the patients we visited last week at the hospital. How is the girl with the broken leg and no family? He says she's doing well and is being fed. “I've bought some things for her and would like to take her some sheets and a blanket and pillow,” I tell Parham. Plus a t-shirt, underwear and socks. “Okay,” Parham says, “I'm going tomorrow would you like to come along.” Of course!
Parham tells me he was looking for the gunshot victim in the surgical ward but couldn't find him. Later, Parham was in the morgue and saw the guy. When Parham tells me this, he is laughing and says, “I couldn't find him, then I see him in the morgue.” His laughing seems strange. He delivers heartbreaking news with a chuckle. But his laughter is understandable. We must laugh or we'd go raving mad.
I ask Parham about the procedure for getting a wheelchair, that I'm thinking about getting a chair for the university student who is paralyzed from the knees down. Parham says he'll ask the physio therapist, who procures the chairs. Parham is also thinking about getting a wheelchair for another patient, a young boy.
This morning, we take boda bodas and a matatu to the Provincial hospital. Karen goes to maternity where she gets to see her first Kenyan baby being born, and Parham and I go to the surgical ward. We meet Margaret, the head nurse. When she hears I work at TICH, she says, “I'll be a student there soon. I want to work in community health in the rural areas.” How wonderful. With her experience at the hospital, combined with a degree in Community Health and Development, Margaret will be able to cure many illnesses and ailments in the rural communities. Most of the rural patients in the hospital are here because they have an easily treated illness or disease, but they don't have the money to go to the doctor, so they stay home hoping they'll heal. But many only get worse, to the point they may not recover. Working at the community level, Margaret will be able to treat these people before their wounds and illnesses progress to severe stages.
For instance, there's a new patient in the bed next to the woman with the diabetic foot. His wound looks just like her wound, but his covers the top of his foot, the entire front of his shin and runs up to just above his knee. A huge, skinless wound exposing his muscle and bone. On May 28, the skinny man was using a panga (machete) to clear his field and accidentally cut his leg mid-shin. When asked his HIV status, he says he doesn't know, but Parham and Eric, the Kenyan medical student on rounds with us, believe he is HIV positive. Which would explain why his cut became infected and spread so quickly up and down his leg in only three weeks. He'll require a skin graft for sure and may need to have his leg amputated if it doesn't heal properly.
The man with the scrotum infection is gone. Although Parham told the head surgeon the patient's stomach lining was infected, the head surgeon released the man. Eric and Parham say, in all likelihood, the man will die. His scrotum is gangrenous and should be removed. His infections will only worsen because he is probably HIV positive. I say, “So he came to the hospital to be treated and now he's being sent home where he'll die.” Parham says, “People don't come to this hospital to be treated, they come here to die.” Stark reality.
Austine, the physio therapist, greets us in the hall and Parham asks about the process of getting a wheelchair. We happily learn the chairs are made by APDK, the organization in Nairobi where Heidi and Tom, fellow VSO volunteers, work. Heidi is a speech therapist training speech therapists and Tom is an engineer working in the wheelchair factory. He is helping to improve the wheelchair design as well as increase their production from 80 to 200 wheelchairs per month. APDK, through donors, provides the wheelchairs for free, but patients must pay 2,500 shillings, which covers the cost of transporting the chair from Nairobi, a membership to APDK and other incidentals. That's approximately $32.00 USD. The wheelchair costs about 30,000 shillings, or nearly $400 USD. I know my friends in Atlanta will be thrilled if their donations go to buying wheelchairs, so I tell Austine to make it happen. Parham, too, has decided to pay for one and we're told the boys can have their wheelchairs tomorrow.
We visit Vincent, the 12-year-old boy who is also paralyzed from the knees down. He has scoliosis (curvature of the spine), which may have impacted his spinal cord, though the doctors think he might have had a bone infection in the past which could be responsible for his paralysis. Vincent is not a big boy and he sits on the bed with his legs bent, propped up on his elbow. Because he is incontinent, Vincent has a blue plastic water bottle resting between his legs, holding his penis. Bed sores are beginning to form on his knees. This concerns Parham, Karen and I because we've seen how horribly extensive bed sores can become. But now, with a wheelchair, Vincent will be able to get out of bed and go home. He'll come to the hospital each day for physico therapy. He's been in the hospital for months simply because he didn't have a wheelchair. His mother carries him on her back to school each day then brings him back to the hospital. When we stop by to tell Vincent and his mother he'll have a wheelchair tomorrow, he smiles broader than usual and his mother simply shakes our hands endlessly saying, “Thank you, thank you, God bless you.” We tell them the money is not coming from us but from our friends in the US and Canada. Vincent will draw a picture of thanks. If I get a chance, I'll photograph his drawing and will post it to the blog.
We then visit the university student. Parham and the physio therapist straighten his legs as he tells us he could leave the hospital if he had a wheelchair. His mood is optimistic and he smiles a lot. On his bedside “table,” really just a plywood box nailed together, is a book called “Practicing Godliness.” We step into the hall to tell Austine we want to get this young man a chair, too, then we all step back into the room and tell him. Not only does he beam, but I look at the three older men in the room, who are all in traction, and they're smiling, too, shaking their heads up and down. The young man wants to write a thank you note to our friends in the US and Canada and I'll post it here if possible. Now he can leave the hospital, concentrate on his studies and graduate as soon as his research is complete.
We pass the guy with the tooth infection in the hall and his face looks much better, the swelling has reduced a great deal. I smile and give him a thumbs up and he returns the gesture with a smile. The guy who had been run over by the matatu, the one who lost his left ear, is not doing very well. Last week, he was walking around and seemed to have the best prognosis of all the patients. This week they are dressing his head wound, which goes down to the skull (and will require a skin graft), and the large, open wound on his right back shoulder. The bandages are bloody and there's a pool of blood at his feet. He seems depressed and when Parham and Eric speak to him, he complains of having mental problems. “You mean with your memory?,” Parham asks. “Yes, my memory,” he says quietly while looking at the blood on the floor. Parham says, “I'm going to give you three words and I want you to repeat them back to me, okay?” “Okay.”
“Car, apple, banana.” The young man replies, “car, apple, banana.” “Good," Parham says, "now remember those three words and I'll be back in five minutes to ask you again.”
We go into the next room to visit a new male patient suffering from spontaneous paralysis. Parham and Eric talk to his wife, who looks 20 or 21. Did he have a fever or night sweats before the paralysis? No. Did he experience any physical traumas? No. It's unusual for people to become paralyzed overnight. It's possible TB can seed in the spine (or any organ!) instead of seeding in the lungs, which is where it usually takes root. That's why they ask about fevers or night sweats. It would indicate TB infection. But the wife couldn't remember her husband complaining about fevers. His biggest problem now is bed sores. He stayed in one place too long, without being turned, and has developed massive bed sores. They're not really bed sores, they are now giant, open wounds. One wound covers his entire lower back and upper buttocks area. There are two openings on his right thigh, on the upper hip and closer to the knee. These wounds look as though someone did a dissection on the guy. His muscles, tendons and bone are visible. A nurse is cleaning and dressing his wounds, cutting away gray, dead tissue with a razor blade. Parham said this is not her job, that a surgeon should be “debriding” the wound (cutting away dead tissue). Two young nurses look on as the older nurse presses moistened gauze into the wound, between muscle and bone. Tragically, while the young man can't move his muscles from the waist down, he still has sensation. He is feeling everything the nurse is doing. It takes her quite awhile to dress his wounds. Meanwhile, he closes his eyes frequently and I wait for him to pass out.
TB can be nasty. Not just in the lungs, but the way it shows up in other organs. Another patient, a woman in her early twenties, is lying on her side, face down, writhing in pain. Austine pulls out her x-ray and Parham says, “Oh my god,” which makes me feel better about making anguished faces during rounds. TB lodged in this woman's vertebrae, about mid-way down her spine. She's had pain for four months but didn't go to the doctor. The x-ray shows a destroyed vertebrae. She leans forward to relieve pressure, causing her spine to bend inward. There is a jutting point on her back where her spine climbs up then turns in sharply. She requires traction, which will relieve the pressure and stop the progression of spinal erosion. If she continues like this, the spinal cord will be damaged, leading to paralysis. Traction will straighten her out, relieve the pressure and the pain. Traction costs 1000 shillings and the hospital will not begin it until she pays. I'm pissed off and say I can't believe this hospital, established by the government to keep it's citizenry healthy (because you can't have a healthy republic unless your people are healthy), doesn't go ahead and start traction for this woman. Why allow her to writhe in pain and eventually become paralyzed because she doesn't have 1000 shillings (about $12 USD)?!!
Once she's started traction, she'll require a lumbar corset, which costs 2000 shillings. I only have 500 shillings left after paying for the wheelchair. Later, I kick myself for not giving them the 500 to start traction. Parham and I discuss it and decide we'll probably go in together, using our friends' donated funds, to pay the 3000 total this woman needs. We have a long conversation about who should be helped. Someone who has a good chance of recovering and contributing to the world, or someone in immediate pain, though their outlook isn't good? It's very difficult to weigh these options.
I chose to spend about $10 USD on the mentally-challenged young woman with the broken leg. Parham, Eric and I put the sheets and blanket on her bed, but we make her cry because we have to move and turn her. Her cast comes up around her waist and the hospital doesn't put diapers on her, they simply allow her to defecate in the bed. At least she has a catheter to catch urine. We don't put underwear or pants on her. Jackquie left behind two sets of scrubs for me to donate, so I chose to bring one set for the young girl. But because she can't wear pants, and we learn from her roommate that she tries to pull her clothes off anyway, we simply leave her naked. However, I give the scrubs to the head nurse and tell her to dress the young woman when her cast is removed and she's able to leave the hospital. We also learn from the roommate that our favorite patient has a tendency to chew on everything, including clothes, the back of her hand and even her urine collection bag if it's left on her bed. Parham explains the oral tendency means she's still in a primitive developmental stage, though she appears to be in her late teens.
We go back to the memory patient and Parham asks him to repeat the three words. His face shows concern. I later remark to Eric that the patient is obviously experiencing distress over losing his memory and his psychological state must be addressed, in addition to exploring the cause of his short-term memory lose. I have no medical training. Obviously. And I should probably keep my mouth shut. But even as a layperson, I see how this patient's condition can deteriorate rapidly if these issues aren't addressed. He has certainly worsened since last week, when I had so much hope for his recovery, and his deterioration appears to be caused by his worsening mental and emotional states, not his physical wounds. So when Parham asks the patient to repeat the words, his face shows concern and he says, “I cannot remember them.” Ever so quietly, while flat on his back, eyes still downcast, he says “I cannot remember the words.”
posted by Cindi at 10:13 AM
0 Comments:
Post a Comment
<< Home