all work and some play...

today was my first day working on maternity and pediatrics, aside from being on call. we have been here in kapsowar almost 2 months now and while my first month on medicine and my second month on outpatients have been taxing at times i have considered them both a warmup for the month ahead of me. the only thing more intimidating to me than taking care of sick little babies with minimal resources is delivering sick little babies with minimal resources. last week on call i rushed from home to a neonatal resuscitation... when i arrived i ascertained immediately that the bag valve mask system they were using was not working and no air was going into the baby's lungs. i tossed it aside and grabbed another one which worked but did not have the proper attachments for the O2 tubing we were using. while i was bagging with room air the nurses taped the 2 different sized tubes together which made me feel better until i realized that the O2 concentrator was not working either. then we spliced a line off of another tank which was supplying a set of twins already and stole O2 from them. i wanted to put a line into the baby's umbilical cord but despite the fact that a visiting team recently left us a pack of 50 umbilical catheters, they were nowhere to be found. in canada they drilled into us that preparation was 90% of neonatal resus and i would dutifully check the kits in the labour rooms; never once did i find a piece of equipment missing or nonfunctional. here it is a very different story. not only are things missing but often they are just plain unavailable. instead of a choice of 3 laryngoscope blades we are lucky to have one blade with a working light bulb.

but i digress: the point of the preceding paragraph was to emphasize my trepidation at tackling peds and obs at the same time, not to complain about lack of resources. i keep reminding myself that this is precisely why i am here. after a month on these wards i will know this entire hospital fairly well and then repeat the rotation with more experience and (hopefully) confidence. i have done 4 ceasarian sections now and by the end of the month i will have had ample experience in this surgical procedure. just in the past 2 months on call alone i have done more neonatal resuscitations than i have in my canadian career. i am in the middle of a steep learning curve and it is about to get steeper. if i remembered more of my university calculus i could comment here on the integral of my learning curve (the rate of change of the rate of change) but it would be purely academic. ;-)

kylie and have had some great outdoor experiences here lately. last week we went on a hike with a diverse group of visitors and locals. i love this picture b/c you can see all the different nationalities together enjoying the view. unfortunately the 2 kenyans on the hike with us didnt make it into the frame but canada, US (korean, chinese and caucasian) britain and ghana are all represented.

i have been doing some biking around the area lately as well. i bought a bike in eldoret last month and have been putting it through its paces. it was the strongest frame i could find and i figure it corresponds to a mid level canadian tire bike. i got a helmet as well so as i have grown to trust the forks and brakes a bit more i have been working it a bit harder. the locals get quite a kick out of me flying by on the rutted out roads. by the reaction of the kids i think i am going a lot faster than they have seen bikes going before (dont worry mom, i am being extremely careful, honest... no drops and no jumps, i just need to keep my speed to get me back up the hill). one village was particularly impressed to see me do a track stand while a herd of cattle where driven across the road. however the most ubiquitous reaction at seeing me is laughter. i do look pretty amusing in my bike helmet and 200 shilling mirror sunglasses, especially when they arent used to seeing helmets at all.

biking is definitely the way to see the country though. i love seeing all the spread out farms and huts and panoramic views sliding slowly by as i grind up the hills. if there is an uphill portion through a village i will often gather a following of 5 or 10 kids and they will jog behind me as i ride. they teach me swahili, i teach them english and we all get exercise... beneficial for all concerned. having a bike also enables me to reach places i would not otherwise be able to see. i reached the village of kapsumai on the edge of the kerio valley last weekend and asked the locals where the best view was. they pointed up the hill behind them so up i went, to arrive at a hilltop family home/pasture. the family was extremely welcoming and seemed a little amused that i thought their view was so beautiful, although again it could have just been my sunglasses.


kylie and i went on a nice hike by ourselves on sunday. it was a nice mix of road, jungle and pastureland, with a few goofy kids thrown in for entertainment.


finally, i am currently fighting off my first kenyan parasite (that i know of!) can you guess what it is? i will give you a hint. the appearance is so classic this picture could be in a dermatology textbook. it is also common to 4H kids in canada.