I thought I would give you all some background about what we are doing here in Kenya on a day to day basis. Plus, some info on the strike and the Kenyan medical system.
First of all, the medical system here is very different from the US. There are multiple types of clinics and hospitals through the country and each type provides a different level of care. Dispensaries are local clinics where patients can pick up medication or even see a nurse for follow-up care. Anything complicated is usually referred to a Health Center. Health Centers are larger and provide more services than dispensaries.
They have maternity care, mental health, chronic disease state care, and will even perform some surgeries. When patients present with something more complicated, they are referred to a referral hospital. There are only two public referral hospitals in Kenya, one of which is Moi Teaching and Referral Hospital (MTRH) where we are working and the other is in Nairobi. There are also many private hospitals throughout the country providing various levels of care, but most people cannot afford to be treated at a private hospital.
There are also different names for residents, interns, etc. This was, and still is, the most confusing thing about starting to round at the hospital because I never knew what was equivalent to US schooling. I’m going to attempt to tell you what I know so far.
Consultants = attending physicians in the hospital – many consultants also have private practices or clinics they work in to supplement their income as doctors do not make anywhere near the same as in the US.
Registrars = medical residents – I believe you have to work as a registrar for multiple years to become a consultant (sorry, still figuring this out as I go)
Medical Officer = finished medical school, but has not done a residency – if they want, they do not have to go on to be a registrar or consultant
Medical Officer Intern = training to be a medical officer
Clinical Officers = similar to physician assistants in the US – they help diagnose, write orders, etc.
Clinical Officer Intern = training to be a clinical officer
Ideally, in a world without a lecturer strike, we would have one or more of each of these people rounding with up on our teams. About the strike – the consultants that are employed by Moi University (the medical school affiliated with MTRH) are striking for better pay and better hospital conditions. They are called lecturers, so you will find more information if you search the Kenya lecturer’s strike. Last year around this time all doctors were on strike, but this is different as it only includes the lecturers. As a result of the lecturer’s strike, the registrars are not able to work because they do not have anyone to supervise them and without that supervision they will not get credit for their schooling to become a consultant. Currently, there are a very limited number of the Kenyan equivalent of physicians and residents on the wards.
About the Hospital:
MTRH is split into male and female wards. Each ward has 4 teams. The nine of us were split up into 3 different teams – 2 teams in the female ward and 1 team in the male ward. I am on the female side of the ward with Carli and Lindsay. We are the only group with a consultant employed by the hospital and not the university, so he will actually come to rounds and is super helpful. We also have a US third year medical resident and fourth year medical student that round with our team. We have been having 20-30 patients on our service during our time here, but that number is always fluctuating. A typical day starts at 7AM on the wards working up our patients before rounds at 9AM. Rounds last anywhere for 2-4 hours depending on the number and acuity of our patients. At 1PM, we walk back to IU house for lunch. Then we go back to the hospital to finish following up what we discussed during rounds. Typically we are there until 5ish.
Some of the biggest differences from the US:
Paper charts. Everyone has a file with all of their notes handwritten and tied together with a shoe lace. They are not organized and are very difficult to decipher, particularly because most of their medical abbreviations are different from what we use in the US. For example, instead of saying the patient came in complaining of fever it would say the patient complained of “hotness of body.” Another difficult thing to adjust to was the ever-changing drug availability checklist. You never know if something is going to be in stock and the formulary to begin with is very small. One day you could switch a patient to something and the next day it won’t be available, which is very frustrating. Besides that, the biggest challenge is that there is only 1 nurse per team. Yep. One nurse. These are patients who would be in an ICU if they were being treated in the US. It is absolutely horrible to see patients die that would have probably survived if they were in a US hospital. The thing is that we are doing everything possible to care for these patients, but there is not enough staff. This is compounded by the lack of attending physicians. There are times when teams of pharmacy students, medical students, and medical officers are the only people on the team rounding. It can be very tough. On my last post I talked about all the things I love about the relaxed Kenyan culture, but when one of my patients doesn’t get their dedication because someone took an extra break it can be very frustrating. If only we could marry the relaxed Kenyan nature with some sense of American urgency, it would be perfect.
Oh, also, there is no such thing as a private hospital room here. The ward is basically an open room sectioned off into what we call “cubes.” Each cube holds 8 single beds. The beds are so close to each other that basically every patient knows what’s happening with her neighbor’s care. This can be super helpful when one of the patients or a family member can speak English because they usually end up translating for us. One last big difference: patients can only leave the hospital once they have paid their hospital bill. If they can’t pay, they stay inpatient until they come up with the money. It’s not uncommon for a patient to stay in the wards for weeks after they are technically discharged.
The best thing by far has been getting to know the patients and their families. One caretaker is allowed to stay with each patient during their stay. Some even stay overnight and sleep in the same beds as their loved ones. They help administer their medications, feed them, bathe them and even empty bed pans. Each cube really becomes a little community. One of my patients had literally 15 friends and family members visiting her in the evening and her neighbors were happy to have them sit on their beds so they could be closer to her. Can you imagine something like that happening in the US? Because I definitely can’t.