The Adventure of Living in the Kingdom of God

Wednesday, February 27, 2013

VF: Kenya - part 3

My normal day! Each morning we met around 7:00am to run the list and review the xrays of the patients that came in the night before. Tenwek is blessed to have a digital xray system that works most of the time. The census (number of orthopedic patients in the hospital) varied from 25-50 patients spread out among the various wards of the hospital - orthopedics, male surgical, female surgical, pediatrics, wound ward, etc.  Open fractures were very common, many presenting to the hospital days after sustaining their injuries. The vast majority of the fractures we saw were the result of Road Traffic Crashes (RTCs). The taxi system includes the Bota-botas (motorcyles driven by teenagers who feel that 4+ people on one motorcycle is a good idea) and Matatus (mini-vans that pack in 12-20 people). Bad roads, high speed, alcohol, and crowded streets insure job security for orthopedists for many years to come.

We met here each morning for xray review! 

This is a 'small' list of patients! 

This is the male surgical ward. Most of the wards are this style with one large room and multiple beds per room. Each bed has its own mosquito net. Sometimes two patients share a bed. It gets pretty snug to round on people that close together. The patients are incredibly respectful of each other's privacy even in that close quarters.

 A young man (9 yrs) with a left femoral shaft fracture in traction and bilateral forearm fractures.

After rounds we would meet at the surgical board to divide up the cases and go over the cases for the day.  The board below is a typical board. Of the five total ORs, two are devoted to orthopedics. It was typical to get 3-4 cases done in a day. Above, the general surgeons are also meeting to discuss their cases.

Below, we are getting ready for my first case in theater (OR) - a young man with distal femoral shaft fracture from a RTC.

The day typically ended around 5:00pm and whatever cases were not done were simply moved to the following day. 

Two major differences between Kenya and the USA: First, in the USA, everything is disposable. In Kenya, everything is reusable - gowns, drapes, towels, traction pins, bovies, scrub brushes, etc. Second, in the USA a premium is placed on efficiency, turnover time, and productivity. The Kenyan culture is a far more laid back culture without the idolatrous desire to squeeze every ounce of productivity out of a day. A very refreshing perspective. 

More to come...

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