August 19

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Manage Your Expectations!

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I have now been in Kisumu, Kenya for just over 5 weeks now. I have experienced so many things both uplifting and heartbreaking. I have come to realize that life is all about managing your expectations.

On the lighter side, 3 weeks ago I traveled to the Masai Mara for a weekend fun break. We made our reservations through the transportation manager at our NGO and were informed that we had been able to get a cancellation as this was high season and that we had also been given an upgrade. I have never been camping before…so please don’t laugh! I bought my first backpack for this assignment to be used as a carry on and an everyday carrier. In my mind, I had expected to be staying in a tented lodge. I packed a hairdryer and a dress for sitting sipping after dinner cocktails!! The reality was an 8 hour drive along one of the bumpiest roads I have ever encountered. When we arrived at the “camp” we were shown to our room. It consisted of a wooden platform with an army type tent that had a heavy duty zip and a padlock. There were 2 small beds with one sheet, one pillow and a course blanket that smelled like goats! There were no lights and of course no electrical outlet for my hairdryer! The shower was an open stall inside a stone structure that also held the bathrooms and was located a short distance from the tents. There were no towels provided! I was lucky enough to get a roll of toilet paper that I shared with my roommate! For 2 days I used wet wipes and deodorant! I think I still smelled better that the blanket. MANAGE YOUR EXPECTATIONS! My biggest problem was when I needed to pee (can I say that?) in the middle of the night (I should not have had that beer after dinner!). I tried to ignore the urge but then just had to give in and go. I unzipped the tent trying not to wake my roommate, and stood outside for a moment to get my bearings. It was so dark and I only had the light from my cell phone. I was so sure that I heard “something” growling!! I took off running up the path, clad in nightgown and sweatshirt, and just prayed that I would not meet anything that would want to eat me on the way!! Well as you can see I lived to tell the tale and had an amazing experience the rest of the weekend. I saw hundreds of animals, including zebras, giraffes, elephants, a leopard, and a cheetah, tons of wildebeest, hippos, crocodiles, buffalo, vultures, ostriches, and lions. I even saw a group of lionesses bring down a wildebeest. Life can appear very cruel on the Masai Mara but it is part of the circle of life.

Now back to the more serious side of my life here. Over the past few weeks, I have seen so much and experienced things that I never would have the chance to do in my everyday life. My assignment is the OB Fistula project but I have also helped with cervical cancer screening and a tubal ligation which may I add was done under local anesthesia! I have had 4 women diagnosed with stage 2 and 3 cervical cancer. They are told to go to Nairobi for radiation therapy as the treatment is not offered in Kisumu. This is not an option for many of these women who are poor. I gave one lady a hug and she clung to me like a drowning person clinging to a life raft. It really affected me and she said to me “don’t worry, I have God”. The women are beautiful, strong, caring, gentle, patient and accepting of the hand that they have been dealt in life. MANAGE YOUR EXPECTATIONS!

I visited my fistula patients on the Gyn ward. I asked one of the girls if she slept well. She said yes but then I noticed that she had shared a bed with another woman. There are often two to a bed in the Gyn ward! She had one sheet and a pillow and that was it. The nurses and doctors are few. When I accompanied my patient to theater, I passed the surgical ward. There were patients everywhere; some were even lying on mattresses on the floor. The acrid smell blood and sweat and body odor was quite overwhelming. I waited for several hours while my patient was bumped for other cases. In the interim I saw a 17 year old girl who had a removal of an ovarian mass the size of a football, and a 19 year old with a ruptured uterus and a dead baby. There are two qualified nurses running 4 theaters from 9 am until after 6pm. Most of the time the rooms are staffed by student nurses.  My turn now. I scrubbed in to assist the doctor with the Fistula surgery. No scrub brushes with betadine, only a bar of soap and cold water! I had scrubs, a plastic apron and then the theater gown. The theater (OR) gowns are cotton and not waterproof. The surgery took longer than expected. The” jambo juice” i.e. adrenaline and saline that is injected into the surgical area to curtail bleeding did not appear to be working. The doctor continually asked if the adrenaline had expired. We had suction for a short time then it was taken to another room for another case, so we had to suffice with gauze to blot the bleeding and clear the field so that the surgeon could repair the hole which was between the vagina and the bladder. MANAGE YOUR EXPECTATIONS!  The surgery took over 4 hours. I had not eaten or drank anything since 6 am and it was now close to 4pm. It was hot and I was beginning to sweat under the plastic and cotton apparel, the surgical mask and the room which did not have any flow of air. I was also standing holding instruments in one position. I thought that I was going to faint! Luckily my slow deep breathing and a minute seated on a stool saved me!! At the end of the repair, the doctor asked me to do the dye test, which meant pushing methylene blue into the foley catheter to check if it came back out through the vagina or into the foley bag. Success. No more leaking, the dye started to flow into the urine bag. Yeah! We could finish and go home!! Another successful week!

My apologies if this entry seemed long but there is just so much to share. I don’t want to forget and hope to continue to MANAGE MY EXPECTATIONS both while I continue my assignment her as well as when I return home. Until next time. Asante Sana.

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