mtrh

from allison...
the pediatric ward-firm i’m on - upendo (means love) - has about 12 beds for general peds and 8ish for oncology patients. with the ability to double patients up in beds, that leads to the potential for >40 patients! there are 2 pediatric wards with 2 firms/teams per ward. that being said, the day before my team was admitting, the general peds ward had 7 patients one day, that same day i also rounded with oncology and i think there were about 13.

i’m glad we had been somewhat oriented by people who had been before about what to expect about what the hospital was like, what resources there were, etc. so i guess i didn’t feel as shocked or frustrated as i could have. an asthmatic ordered for breathing treatments every 4 hours had received 2 in the past 24h. there are only certain medicines available, there are only certain tests that are possible, and each is somewhat carefully considered before being ordered. then there is the likely hood that the medicines will be given, tests will be done, and if the patient’s family can afford it, all to be considered. i’m still trying to figure out where i fall in the team’s care of these patients. on one hand i’m about to be done with my residency, on the other i’ve never taken care of patients with some of the diagnoses these kids have and don’t really know the system here at all.

rounds are in english generally and the med school is taught in english, but most of the patients don’t speak english. they mostly speak swahili, or sometimes some other tribal language. i haven’t come across it, but others have had patients who no one can communicate with very well due to a language barrier.

medical education in kenya is lengthy. medical students start straight out of high school and it is 6 years. more than a dozen 4th and 6th years come to round with our team (equivalent to 3rd and 4th years in US). there is a 4th year student from IU on my team too. after med school an internship is required which consists of continuing training in essentially all different aspects of medicine for 1 year. there is an intern on our team. after this they are a medical officer (physican) and are assigned to a post by the government for several years. after this if more specialized training is desired they become ‘registrars’ which is similar to residents in the US. there is a 1st year pediatric registrar on my team who i work most closely with. then there are “consultants” who usually (50/50) come to round with the team – they are the staff or attending physicians. but not in the same way as in the US at all. they can be different people every day of the week. they help teach mainly and offer suggestions about diagnoses and treatments. but it is really the interns and registrars who do the work and make the decisions. there are others on the team as well – nurse, nursing student, clinical officer intern (PA or NP like), nutritionist, etc – which makes for quite a herd.

i hope i will be able to help the interns and registrars more in ‘working patients up,’ and i anticipate i will be able to work more in teaching the medical students (kenyan) too. we’ll see. i have been the most senior person a few days so far and didn’t have to make any big decisions, but I was looked to for recommendations/ guidance. we did end up starting an asthmatic on an inhaled steroid, something i’m much more comfortable with…