Another Day of African Rounds

(from Eric)

We are back in Kenya at Tenwek for a few weeks.  Our family's goal was to get Rachel back into clinical work, with my priority being supporting our kids through this crazy careening transition known as our life.  But yesterday, Rachel was at home, and the Pediatrics team was just one visitor, so I thought I would go up and help out for rounds.  Like Rachel wrote recently, it felt like our hiatus could have been just a few months, and it was shocking how much information came suddenly flying back to the dusty synapses of my brain.  

I have no white coat, no reference books, no stethoscope.  No ID badge either, but everyone knows me, so I just kind of went around with the visitor.  We saw the two ICU kids, then a kid in the ER ("Casualty" in Kenya).  Then we met the team for a chai break, and rounded with the interns.  

At lunch, Rachel asked me what kind of things I had seen.  I gave her a little rundown:
  • More HIV than normal, several of them really malnourished.
  • One of them has a recurrent nosebleed with platelets of 6, probably chronic ITP from her HIV
  • Another was a new diagnosis at age 11, which was kind of weird, but is now really wasted with lymph nodes in his belly that are hopefully TB and not cancer.
  • There were also a lot of heart failure kids, one of whom is terribly palliative, but several were getting somewhat better.
  • Diarrhea, pneumonia, bronchiolitis, that kind of thing.
  • A few bacterial meningitis kids who are getting better, but
  • the kid in the ICU came in with presumed meningitis with an asymmetric pupil.  She's been stable, but mostly comatose for nine days, so we actually decided to recommended getting a head CT.  First head CT I've ever ordered at Tenwek.
  • There was a kid in the ER with a big swollen face, probably nephrotic syndrome, was good enough to go home, and lives nearby, so that will make their follow-up easier....
After a little pause, Rachel asked me if I enjoyed being back, because it sounds like kind of a depressing set of patients.

I thought for a moment, then told her, a tad bit sheepishly, that I really enjoyed it.


After years of preparation and spending most of our time thinking about language learning, administration, and strategic 20-year plans for a hospital, it was such a refreshing opportunity to remember that, at the end of the day, there are just sick people who need help.  And through the gift of grace that is medicine, I can fix some of them.  Others I can't, but I can at least be with them, and usually help them in one way or another.  And to have that reminder here at Tenwek, where I already know the system, and can capably teach the interns from my experience, was truly enjoyable to me.

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