10:25 PM

Internship snippet: Obs/Gyne

I was just thinking about how I never really managed to put out anything concerning my working experience during my medical internship during the time I was actually doing the internship (timing issues and not wanting to unceremoniously leak any confidential issues). Well, now, the internship is all but over, save for the issue of winding up and getting some signatures. I have to say that transitioning and finishing up for me has always been a bit of a difficulty. Anyway, I was talking to a friend the other day, and she asked me whether I had actually done any Caesarean sections. At the time, I told her that I had probably performed close to 100 as the primary surgeon; well, as per the official count in the OR log, it currently stands at 124 as the primary surgeon (there have been quite a number where I was the assistant, then there were also nights when I was just too tired to log in some entries).

It really has been quite the experience: Kisii Teaching & Referral Hospital, where I served my time is a really busy centre and referral cases come in aplenty. Nowhere does this sentiment ring truer than within the Obstetrics/Gynaeceology (Obs/Gyne) Department. I can remember nights when I’d hear an ambulance pull up to the hospital, say a prayer hoping that they were bringing in a case for the Surgical Department to deal with, and then rush up to the ambulance to confirm for myself. (Of course, I prayed the opposite prayer when I was doing my surgical rotation). :(

I must admit that Obs/Gyne is a hustle to deal with: due to Kenya's fascination with the Millennium Development Goals (MDGs), maternal-child health is a big deal; however, we embraced the ideals and goals, but have not exactly put in a step-by-step program to achieve them. What this did was create an untenable work environment where the onus for maternal death is put on the hospital (particularly the intern), regardless of the pregnant mothers' antenatal care history. On top of that, the work is tedious; I actually lost weight during my Obs/Gyne rotation.

Personally, I love practising surgery, and there’s no better teacher than lots of hands-on work. I still feel as excited stepping into the surgical theater as I did almost 10 years ago when I first volunteered at the Harrisburg Hospital. Performing surgery is art and science melded into one, a beautiful dance where everything enriches the experience: the anaesthetist with his/her real-time command of the patients condition, your assistants both at the operating table and those in circulation, and recovery; even the cleaners keeping the place nice and orderly are a massive help.

Obs/Gyne is not as varied a field as General Surgery, so there were very few procedures you get to perform; king of them all is the Caesarean Section. At this hospital, it's pretty much regarded as an Intern's procedure, unless there is a particularly extreme degree of difficulty inherent to a specific pregnancy. That is quite a lot of pressure to place on an intern; consider that (according to my friend in Australia) post-graduate students in other countries ONLY assist with the C-sections! The quicker you learn to be confident at performing a C/S, the better; my immediate superiors - the medical officers - were none too fond of being woken up in the middle of the night by an intern to come assist with a C-section. Knowing how to handle things at night with a skeleton crew is key.

All risks considered, a C-section is a pretty safe standard procedure; I have only had one mother succumb on the operating table (and that was because she had severe antepartum bleeding). I can't forget the near misses, though: on one occasion, a mother developed hypotension as soon as the spinal anaesthesia was injected and she just flatlined (breathing and heartbeat stopped cold)! Hence, before progressing to anything else, we basically started by resuscitating the patient; once the patients vitals were restored, we performed one of my faster C-sections. There doesn't seem to be anything written in literature sources, but it is a startling experience dealing with someone who has flatlined in the course of being anaesthetized: they pretty much seem out of their mind, overly emotional, unsettled, which in turn makes you question whether some sort of brain damage occurred. Thankfully, daunting as the experience is, the patient is in good condition when we review them the morning after.

I don't see a future for myself in Obs/Gyne, but I am at least thankful for the experience. Many a prayer were silently prayed over my patients as they lay on that table; prayers when I was starting out and the thought of being in-charge of systematically slicing someone open weighed heavily on my nerves; prayers when difficulties were imminent, and especially when complications arose. Thankfully, the Lord was faithful.

One downside to this whole experience is the sheer number of patients that we get to deal with. The intensity of the experience, at least on my part, meant that I formed deep relationships with mothers who I had to reassure and counsel on the best course of action for themselves and their unborn children. This occurred day in and day out; sadly, I can scarcely remember many of those interactions; it's as if they were wiped clean from my mind as soon as they were formed to make space for more equally intense versions of the same experience with other emergency patients. Or perhaps I'm just bad at remembering my own patients beyond a certain space of time. Thankfully, the patients never forget: Kisii is a small town, so its not unusual for me to bump into a lady on the street, for her to hail me as "daktari", and then remind me that it was I who helped her with a difficult delivery. It's things like that which make working in the medical profession a blessing, much more profound than anything money could ever offer.

I don't exactly know whats slated to come in the near future, nor where exactly I'll be headed be it another part of Kenya or Post-grad school - but I'm hopeful God will push me in the right direction (because I plain stink at transitioning).

Have a great week. God Bless.

9:37 PM

Memories: A "Buddy" Pass

Well, a picture really is worth a thousand words. The picture above is actually the conclusion to this whole fiasco after it had come full circle. So let's take a trip down memory lane.

This story starts in November 2003, during my days at Messiah College in Central PA. My elder brother, Nguza, who at that point lived at Daytona Beach, Fl., invited me over to spend the Christmas vacation at his place. He had come across a few Delta Airlines 'Buddy passes', and he sent me one of them so that I could use it to get a deal on a ticket. I'm not exactly sure about the specifics of the deal...but I do remember till today that I only ended up paying $88.00 for a Harrisburg (Pennsylvania) - Orlando (Florida) roundtrip.

Best way I could describe the Buddy Pass is to say that you were basically flying on the cheap, but you were flying 'Standby' the whole time; this meant I had to wait at the counter, get listed as a 'potential' for a specific flight, and hope that the flight either hadn't been overbooked or that everyone didn't make their flight. Oh, there was that one extra added stipulation that I had to be formally dressed...so no jeans and comfort on that trip.

The trip to Florida was for the most part uneventful. My boss, Elick Yeadon, got me to the airport safe and sound (though I remember him having to rush me back home when we pulled over to PNC Bank about 1 mile out from Messiah to get some money; serendipitously, it was then that I realized that I' d forgotten my passport). Apart from that, and maybe being passed over 2 times for a potential flight, I got to Orlando in one piece, and had a great vacation in Daytona.

When it was time to get back home, again I had to depart from the airport at Orlando. However, this time it proved to be quite the hustle to find a set of flights that would get me back to Harrisburg; it was peak season for travel, which basically meant I was stuck. Finally, someone manning the counters told me that instead of hustling to use 2 flights to get to Harrisburg, I had the infinitely easier option of taking 1 flight to New Jersey and after that taking 2 buses to get to Downtown Harrisburg.

I don't tend to hear many positive things about New Jersey, but on that day I felt New Jersey was just the Godsend that I'd been looking for. As soon as I set my sights on that NJ trajectory, everything just seemed to flow perfectly; I got the standby flight immediately, and I was headed back home. Soon as I landed in Jersey, I got the information for my buses. Turned out the first bus would get me to Allentown, PA at about 11pm, and I would have to take my bus to Harrisburg later in the morning. I surmised that I could just spend the night at the bus station.

Allentown, PA was like no other town I'd come across until then (at least nowhere in the continental US). It was only 11pm when the bus rolled into town, but everything was shut down! All businesses, even the bars: the town was dead and lifeless! Oh, as for that bus station where I'd planned to stay the night...well, it was literally just a small one-person ticketing stall set up next to a bus stop where the bus could pull over. I was basically stranded!

But then again, 'when it rains, it pours'. To add insult to injury, it had snowed earlier that night and the temperatures were frigid. So I found myself trudging through the snow with my luggage in tow, formally dressed, but not appropriately layered and stuck in a strange new town at the worst possible time. I remember walking those streets and coming across some homeless guy who looked like he was balled up in a sack and sleeping in the street. The guy was snoring so loudly, so you knew he had to be comfortable. At that point, I even considered sleeping underneath someone's porch if it was all I was gonna get.

At my wits end, I just walked up to a payphone and figured I'd call 9-1-1. I remember thinking I'd better give the police officer (dispatcher) the correct impression about my situation; didn't want him to think I was pranking him and find myself unceremoniously locked up in jail. He understood my predicament, and gave me directions to a nearby 'Halfway' house. (maybe he was new to Allentown and didn't know of any other options...or he knew how dead the place was and gave me the best option).

I got to the halfway house after a short walk, and I rang the bell. The Supervisor showed up and let me in; unfortunately, he couldn't let me sleep in one of the rooms because I had shown up too late. The best thing he could do was to let me sleep in the lobby, and attend to me later in the morning. It was a chilly place, and not the most comfortable of places to sleep, but it was better than my other options. In the morning, I got to eat breakfast with some of the residents, and by 8.30 am I was already down at the ticketing office finalizing my bus ticket. Long story short, I got home safe.

Fast forward to the end of J-Term 2004, at which point we were done with our classes, and some mission trips had been set up by the school. My good friend, Collins Mwangi, and I ended up going on one of the trips together. I don't remember if we had a choice concerning the area we were posted to, but suffice it to say we ended up in Allentown

I don't remember majority of what transpired on that Mission trip, but I do remember helping to stock food products for the Soup kitchen store; I also remember that we were hosted by the kindly Mr. Garcia and his family, who took us out for a basketball game at LeHigh University (...still have the entrance ticket stub till today). And, last but not least, we ended up at the Halfway house...Yes! The same Halfway house where I'd holed up that one eventful night.

To capture the event for posterity, on January 31st 2004, I had Collins take a picture of me seated in the very same lobby chair where I slept that night - the very same picture at the start of this post. So there you have it: finally come full circle. Memories indeed!

God Bless!

1:05 AM

Just a snapshot

I've neglected to write anything for quite sometime, and that was mainly because of all the stress that I went through during my stint in the Obstetrics/Gynaecology Department, but I've finally moved on to a slightly less hectic department: Internal Med.

Suffice it to say, the experience did nothing to sway me away from considering a specialty in Surgery. (I've only just managed to get over the episode of PTSD induced by the whole experience.

While I have been neglecting the blog, I managed to finally open a Tumblr account - http://wmu1ah.tumblr.com - and started to do something I should have done 2 years ago: putting the 'Compendium' pictures of the 1st Affiliated Hospital online (similar to the one shown on this post). During my last year at Medical school, a group of us invested hours and hours of our time putting together this massive project that would highlight the new 3,300 bed hospital and, in turn, bring much need attention to our medical school.

Personally, that project is all at once one of my greatest accomplishments and greatest failures. At this point, it's easier to ruminate on the failure, because, honestly, these pictures are coming out 2 years too late; I can't even begin to think of all the other compiled work that is sitting on multiple computers, idle, serving no useful purpose. Whatever the long story behind the whole process, I'm glad that I still have Tumblr to show some semblance of what we hoped to achieve.

My most heartfelt thanks go to all members of Compendium who helped with all the major lifting, particularly Hafiz, our trusty photographer, whose great skill shines through in this particular Tumblr.

Now that I have this bit of work off my chest, I can find another hobby to occupy my mind.

God Bless.

3:36 PM

The Music of Pat Metheny - Everyday, I Thank You

I had usually skipped this piece whenever I came across it in my playlist. The long drag from Michael Brecker's sax usually implied to me that this would be a depressing piece (...and this one certainly is long, coming in at a full 13.5 minutes).

Thankfully, one day I just let the shuffle button do its thing in my PMG playlists, and I had a chance to listen to the piece in its entirety. It is by all means exquisite; a ballad perfectly crafted. Starting out with the song's chorus framed by an ethereal pipe synth portion, Michael Brecker paints us an eloquent picture, and in a quickening of pace, Mr. Metheny adds yet more pastels to the song. (Love that rubato!)

If memory serves me right, it was Pat who wrote this song, but from listening to it, it's clear that the good relationship he had with his late friend allowed them to concoct pure magic. Mike Brecker is front-and-centre on this tune, but Pat is never far behind - each of them coming in to accentuate different portions of the song. Every bit of this song just works. If the title of the song is anything to go by, they really expressed their gratitude as sincerely as could possibly be done. And in turn, I thank God, everyday, for this music which conveys sentiments that cannot be described adequately through wording.

 Everyday, Father, I thank you.

1:03 AM

Rant: The Registrar of Companies

This is the second time I'm having to deal with the Registrar of Companies at Sheria House, and I cannot claim that the experience is any less painful than the last time. In my previous post, I had mentioned that I already knew the necessary steps required to initiate my business. As usual, the lynch pin was the people manning the counters at Sheria House.

This past Monday, armed with a new name for the business - "Aykornia" or "Aykornium" - I wanted to run the prerequisite name search. Would you believe the Registrar has only one desk dedicated to this process (Counter 1 - File Perusal/Name Preservation); to cap it off, at 10.30am the employee-in-charge of the counter just got up and left, leaving a growing number of us in a queue stranded! And these things aren't complete unless they come in a
trifecta: some of the employees from the other counters who glanced at my desired company name told me that my company name HAD to consist of at least 2 words.

 My complaint concerning these 3 issues remain unchanged from my last post, and I'll put them down here again. First, Counter 1 is redundant and can literally be manned by even a trained high school student who would only be required to receive your application and give you a slip allowing you to pay for the transaction. It would even be more effective to actually digitize the procedure to ease the whole process and decongest the registration hall. These two mere measures would free up the people manning the counter to 'possibly' make themselves useful somewhere else.

And I've said it once,and I'll say it again: some sort of guide needs to be published to assist fledgling entrepreneurs concerning the idiosyncratic rules governing setting up businesses. I am tired of having random clerks randomly chipping in with ad hoc rules that complicate an already complex and infuriating process. I would like to think that any worker worth their salt would strive to improve the processes associated with thir work stations, but it is becoming clear that some of these civil revel in the confusion; others just do not care enough to want to change anything.

 The last time I went to Sheria House, a guard at the gate approached me and basically offered to 'expedite' the process if I basically 'greased his fingers'. The corollary is that if his fingers are 'greased', someone else on the inside is also having their fingers 'greased'. The only other option is to have a lawyer bulldoze through this process for you, and that certainly doesn't come cheap.
So for the clerks, the modus operandi is just frustrate! frustrate! frustrate! the common mwananchi.

 I hear people talk about how easy it is to start a business in Rwanda - a maximum 3 days (even for foreigners) to have the legal documentation in their hands. I compare this to Kenya and think that there's nothing really special involved here. Just Discipline and the ability to understand that allowing business to flourish in Kenya is good for the country as a whole. However, if the current civil servants can't understand that, they need to be sent packing instead of positioning themselves as stumbling blocks in everyone else's path.

That's my 2 cents for today. God help us all (especially if we have to go to the Registrar of Companies offices)

8:13 PM

My Fascination with Kickstarter


 Since discovering it late last year, I must admit that Kickstarter has evolved to become a major part of my daily internet read. I can't lie, their webpage design endears itself to many allowing for many joyous hours of reading pleasure. Far better than that though is the varied number of stories of mastery of a myriad of crafts, and the great amount of work that goes into crafting each product.

I usually spend my time perusing 3 different categories: Design, Comics and Technology; there are a lot more sections to pick from, but I find myself drawn to these ones in particular. There is truth to the saying, "Necessity is the mother of all invention"; as long as there will be a ton of problems to solve, there will always be forward-thinking innovators who can anticipate solutions to those same problems. The big question is whether they can make any money off those solutions.

One project that was particularly elegant in design was the Muse Clock by Nate Borozinski. True, this is merely a wall mounted clock, but the new spin he took on this idea is an artistic marvel.

 Two more favourites arrive in the form of light bulbs (Plumen 002 and Dome Lamp);

Dome Lamp

Plumen 002

However, my ultimate favourite has to be Palm Republik by Peisy. Malaysia, the country she hails from, produces a lot of the world's Oil Palm, which thus results in a lot of biomass waste. Malaysia, in the same vein, is also researching into various ways of utilizing this waste - and their most promising product is Palm Paper. Peisy took this one step further, building a company around novelty designs made from Palm Paper.

 Just like Palm Republik, I too have the idea of moulding the concepts I laid out in "The Hyacinth Economy" into a business (tentatively titled "The Hyacinth Lab"). Those aspirations will have to be postponed because my current medical internship does not leave me with any spare time to pursue the needed research...but at least the dream is still alive and kicking.

The Comics section is a visual joy because the authors usually leave snippets of their works in progress in form of comic pages, illustrations and synopsis accounts. I've had the beginnings of a graphic novel swirling around in my mind for 2 years now, so with a little inspiration I think I could put pen to paper and come up with quite a delightful read. With a finished story, I could start looking for an illustrator of repute.

But as the aspirations wait, at least I'm being inspired a little more everyday. It's been almost 9 years since I wrote my paper on Hyacinth & Phytoremediation; about 1.5 years ago, I finished my paper of "The Hyacinth Economy", and now I can picture it as a potential full-fledged business. Who knows! Sooner, rather than later, I just might throw my hand in along with the rest of the entrepreneurs; but till that day comes, at least I've got Kickstarter.

 God Bless.

6:18 AM

Ode to Rain

Living in Kisii, you have to come to terms with the sheer amount of rain that they experience around here. You can't go more than 4 days without having a serious downpour, and lately it rains everyday: intense rain, the kind that keeps you locked indoors, usually lasting more that an hour; oh, and it rains twice!

 I was simply astounded how we never ended up with any floods around here. Sometimes the place is practically bone-dry in the morning; and worst of all, at my old place we always had water shortages (mind-boggling)!

Rain is a Catch-22 kind of thing: you really suffer if it doesn't rain enough, but, then when your prayers are answered and it finally rains, then you have to scamper away and keep from getting drenched; in addition, if your paths are poorly paved, then you have to deal with lots of mud everywhere; and, if drainage in your area is poor, then you have flooding and stagnating pools of water all around. It's the kind of thing to keep people cursing both in-season and out-of-season.

 There's no getting away from the fact that rain is life; and it's not like human comfort is the gold standard for all things beneficial, but I would love for these two seemingly disparate entities (beneficial water & human enjoyment) to come together for once. I remember as a child that there was no stopping me from running in the rain and playing in puddles. Pretty sure the farmers rejoice too, because it means their crops get to flourish. I feel that most people, however, don't fall into these two classes, but there's still a way to reach out to everyone.

 I am no artist, in any sense of the word,...but I do have artistic sentiments aplenty. My current fixation revolves around giving a practical impression of beauty to each rain storm. Rain is already inherently beautiful, if you have the comfort of watching it from a dry sheltered spot. What I'm aiming for is a monument that can be appreciated at anytime, but which would be specially animated by a rainstorm. It could be something as simple as a statue that becomes a functional fountain in times of rain; or maybe something resembling a turbine, whose blades could be spun by the action of moving water, lending movement to another very visible piece.

 One item I found while leafing though "Street Furniture" by Chris van Uffelen was particularly inspiring: it consisted of two installations by an artist - Stacy Levy - who used a portion of sidewalk art/map to highlight the watershed of the locale. Once it rained, the flowing water accentuated the lakes & rivers, turning the map into a great focal point. These two installations are known as "Water Map" & "Ridge and Valley".

So for now, I have an inkling of a vision in my mind. Maybe someday I can pair up with someone who can bring it to fruition (...technically anyone who reads this). In the meantime, just thanking God for the rain, and hoping for a sprinkling of some of that childhood innocence; the kind that kept me enthralled by the beauty of the rain.

God Bless

Addendum: while going through Stacy Levy's site, I found yet another piece - Arroyo - built around this same rain motif. It's one I would really love to explore with local artists.