less lost

4-9-08 most interesting Maasai patient today. Not so much for her medical issue but for her dress. It was very hard for me not to stare. Dressed in brightly colored clothes with large loops in here ear lobes through which were strung a rainbow of beads. Along with terracing beaded necklace. I continued to be distracted and imagine myself as a true Dr Livingstone battling disease in a remote far-off land until I was brought back to reality by an annoying beeping in my ear. As my conscious cleared I was mortified to see this women who appeared to be out of National Geographic pull out a cell phone and procede to carry on a conversation with some far-off soul. Well civilization even reaches dreams, so much for my romanticism…
Went for a hike during my free-time in an attempt to get lost. Obviously given the fact that I am writing this, adventure did not find me. Locals very friendly. Every child I passed said “how are you?” and before I could respond they answered their own question with “fine”. Apparently this is the first english phrase they all learn. Everyone wanted their photo taken, hopefully photos are not taboo here. While I was returning, still probably 2-3 miles from the hospital I was joined by a young man. I don’t know his name as I speak no Swahili and he speaks no English. However that didn’t seem to keep him from telling me about everything we came acrossed. I must have told him 20 times that I don’t understand. Finally I gave up and just smiled and nodded at what I felt where appropriate times. He just jabbered on the whole way. By the end of our time together I came to realize that I was probably walking with a Kenyan “Forest Gump”.
As opposed to Americans who go to their physician at the hint of an idea that they have some illness, usually at the prompting from an article in the repudiated medical journals Cosmo, RedBook or Oprah, the people I have had the pleasure of treating here wait until the last minute at times to be treated. A couple examples from just today:
Miriam is a 73 years old female who was brought in by her son and daughter-in-law, weighing only 60 pounds, unable to keep food down, happily demented, and unable to walk due to hip pain. They had undergone a work-up at Kenyatta Regional Hospital but now came to our tiny little outpost for a second opinion. We were able to perform a fairly quick evaluation with labwork, x-rays and ultrasound of her kidneys. She has a fractured left hip secondary to metastasis from her probable renal cell carcinoma. I expained to the family that at this stage there is nothing that can be done and he should be thankful she seems fairly happy. I sent her on her way with morphine for pain and reglan for nausea.
Ibrahim is a 10 month old male who was brought in by his parents as he just couldn’t gain weight and seemed sickly. He has a cardiac defect that unless repaired soon will likely end his short little life. The chances of him getting this repair is slim to none. You smile at the parents and tell them they will likely lose their son.
Here in Kenya people have the option of waiting months to be seen in one of the public hospitals or paying exorbitant fees to be seen at a private hospital. AIC Kijabe Hospital attempts to fill the void. It doesn’t provide free care. All patients pay. However the cost is extremely low by most standards. For example a c-section costs about $300. Compared to approximately $6,000 in the US. This fee allows the hospital to keep it’s doors open. Stats on the hospital as follows:
Income: 212,396,409 Kenyan shillings (only 20% of which comes from donated money or services)
Expenditures: 274, 303,148 Kshs
$1 = 63Kshs
Admissions: 13,089 (93% avg bed occupancy)
Total surgeries: 5674
Total outpatient visits: 97,027