- Written by Kimberly Pepmiller Kimberly Pepmiller
- Created: 17 July 2013 17 July 2013
Another beautiful morning greeted us. I think we are starting to get used to sleeping in mosquito nets and bug repellent. No one has reported a bug bite yet (myself included!!). The sun here comes up later and sets later than it does during the Colorado summer. Someone finally pointed out to me that when you are so near to the equator, the sunrise and sunset are at the same time every day (6:00 AM and 6:00 PM). A consistent cycle and routine that was continued on with the daily (albeit late) breakfast of eggs, sausage, bread, pineapple, watermelon and mini bananas.
A surprise greeted our team to begin the day. We all drove up to Botoro to the church where the medical clinic is being held. When we pulled into the complex, we discovered that the church was already completely full of people hoping to be seen. Many of them had arrived at 6:00 AM (I have no idea what time one must start walking to arrive at six!). I think word of mouth is starting to spread! We set up the clinic, had morning devotion and then got started. They tried a new method of registration today to try and make it more fair for who gets seen. There were some very upset villagers yesterday who got turned away and were not seen.
As the clinic was just starting, a small group of us ventured off for other adventures. We all took the bus down to the outskirts of Kisii. Our team leader and Catherine, the LCMS office manager, went into town to the courier to pick up the missing bag that had finally arrived from the airline (yeah for some much needed missing supplies!). Shara, the LCMS missionary traveling with us, and I went on to the private hospital in Kisii.
On Monday morning, as I was performing a rapid malaria test on a patient, I accidentally poked myself with the contaminated needle I had used for her test. A very silly mistake, and the first needle stick of my nursing career. Thankfully it was not a deep stick and a minimal exposure. Unfortunately, on the intake form, the woman who I was testing had requested to be tested for HIV. Our clinic does not have rapid HIV tests, so we do not know the status of the woman. There are not street addresses in these small villages, so the communities are still trying to locate this woman. Therefore, to be on the safe side, I needed to receive baseline lab work and prophylactic treatment. We began at Bosongo, the private hospital.
Driving up to the private hospital, there are signs for the “modern mortuary,” which is right next to the hospital (kind of unsettling). We walk in and discover a very small town, old hospital with very outdated equipment and dark hallways (most of the lights were out). The patients you could see were all in one room separated by only curtains. Immediately we were referred to the hospital administrator, as the receptionist was not sure what to do with my situation. This private hospital does not have protocols in place for its staff if they have a needle stick exposure. The administrator confirmed that they could do the HIV test but not the hepatitis C. So I was taken back into the laboratory, which could not have been bigger than a twelve foot by twelve foot room. There were two microscopes, no visible centrifuge, a collapsing table and a hand washing sink blocked off by a table. The alcohol swabs used to clean my finger were cotton balls only somewhat saturated, and the woman testing me did not wear gloves. All this being said, the rapid HIV test came back negative (wonderful!), and I am now officially registered in this gigantic, hard bound book of an HIV record in this private hospital. This private hospital referred us to a larger hospital in Kisii town for the hepatitis C screening.
This is where the unique African experience really started to begin (if the private Kenyan, small town hospital was not enough!). We walked down to the main road and had to find a taxi or some transportation into Kisii town. Your choices are a motorcycle taxi (supposedly quite unsafe), a matatu (a small van with fourteen seats that travels along a fixed route—people jam pack themselves inside) or a car taxi. We did eventually find a taxi, and it drove us right inside the gates of the Kisii Level 5 Hospital. The main area of the hospital is open air, and then there are wards, offices and services off from there. This hospital is much more similar to a hospital you would see in the U.S., with modern signs, metal doors, staff in lab coats and professional attire, and much more modern overall. The hospital was quite busy, and I even saw my first African inmates. Male inmates are in black and white stripped pant suits, and women inmates are in black and white stripped dress suits. They were not shackled and just had guards walking behind them.
After waiting for about twenty minutes, the customer care lady returned to her desk and called the laboratory. After waiting another twenty minutes or so, she walked us in the back door of the laboratory and took us to the head doctor of the lab. He showed us the protocol on the wall for contaminated needle sticks, and he immediately had me sit down to have my blood drawn, so I completely bypassed the line of people waiting. He even wore gloves to draw my blood! After waiting another twenty minutes or so, I received my lab results confirming that my HIV and hepatitis C blood work was negative (excellent news!).
The lab doctor told me to go to the Casualty Unit. Shara and I were both unsure of what this would entail, so we went back to find the woman at the customer care desk. In the meantime, they rolled a dead man past us on a gurney in the main waiting room! Ultimately we discovered that we had "bypassed the system" and needed to register. So we got in the registration queue, and I discovered that Kenyans cannot line up in an orderly fashion and have no sense of personal space. Eventually we made it to the front, and registration once again struggled with my name as the r's and l's have different sounds here. We paid 120 Kenyan shillings, which is less than $2, for my registration card. This led us to the Casualty Unit, which turned out to be the emergency department. The emergency department in the back looks like an episode from MASH with just a long line of curtains and patients inside. Walking through triage here we saw a man who had either been stabbed or shot.
Once again, I was taken straight to the front, and after the staff inquired about my injury, they sent us on our way to the next destination. So we were guided to the VCT clinic, which is pretty much the HIV clinic. We did pass through the mother and child center on the way, which involved walking down a long, dark hallway full of mothers and children waiting on benches. The woman in the HIV clinic wrote me a prescription and sent me to the HIV pharmacy, where I received a prescription for prophylactic antiretrovirals to help prevent the growth of any HIV in my body. The amazing part is that all of this—lab work, a prescription and a very brief visit to the emergency department—cost me less than $2! What amazes me is how affordable healthcare is here, and yet people do not access it. Apparently villagers try all of the traditional medicines first; only once those fail do they pursue hospital care. Ignorance is a piece, too, I think, because villagers may not know the cost of healthcare in a hospital setting. Amazing and quite unfortunate.
From the hospital we went out to the street to find a taxi. Along the way, we stopped at the Nakamatt store, which is comparable to a Walmart in the U.S. I was very impressed. There are clearly more goods and resources in the larger cities. From here we were able to get a taxi, but Shara had to complete some serious negotiating in order to get us back to Botoro at a reasonable price. Apparently they charge white people more money because they think we have more money, so having me along was a deterrent in obtaining a fair price for the taxi ride. Catherine made several phone calls in Sawhili to the pastors at the church in Botoro before we were finally on our way back to the clinic.
I wish I could have taken more photos of this African cultural experience today, but the hospital did not seem like the right place, and I did not want to draw more attention to us or cause problems for us. At least I have the memories!
The clinic was super busy when we returned, and it sounds like there had been some "rioting" of people quite upset about either waiting to be seen or not being able to be seen. Regardless, I jumped right back into my triage role upon arrival. There was a late afternoon break for lunch around 2:00 PM (Kenyans eat late) that consisted of pilau (spicy rice), avocado and mini bananas. Throughout the day, the clinic saw 261 patients, and we worked from 8:30 AM until 6:30 PM. At the end of the day we sent over thirty people home with numbers for being seen first thing in the morning.
During the day we did see several more interesting cases, including a woman with a very large goiter, elephantitis and more rare skin diseases. The common complaints continued of stomach ache, back pain, headache and joint pain.
There were many families and children again today. The highlight of my day were the nine-month-old twins that came at the very end of the day. The mother carries one on her back and the nine-year-old brother carries the other baby on his back. Pretty amazing! These little twins just smile, and while I was listening to one's heart, they put their hands on top of mine and were holding hands. Quite precious.
Darkness was engulfing the land as we drove back to the hotel in Kisii. It was neat to see people cooking dinner above wood fires near the side of the road. Our dinner was chicken, mashed potatoes, rice and kale. I think we are receiving some of the main food groups here!
Overall, it was another successful day. I am just amazed at how the people flock to the clinic. There is really great need for healthcare and health education in this part of Kenya. Things we take for granted, such as teeth brushing and hand washing, are not normal occurrences here. I just hope the people learn a bit from us too.
Saint John's member Kimberly Pepmiller is in Africa through July 25 with ten other doctors and nurses, lending her medical skills at clinics in Kisii, Kenya, operated by the Lutheran Church—Missouri Synod's Mercy Medical Team.