Disclaimer: This will probably end up being a pretty long post, so be prepared. I’m pre-writing it on Meredith’s laptop so I don’t have to worry about time-constraints or connection speeds, so I apologize for any meandering that may occur. I’m not sure the best way to organize this entry, so I think I’ll start chronologically and go from there.
First off, here is a link to my Week 2 Snapfish pictures: http://www.snapfish.com/thumbnailshare/AlbumID=40092925/a=6248780_6248780/t_=6248780
On to more exciting stuff:
Our safari weekend in Maasai Mara was beyond description. The pictures I’ve posted on Snapfish (http://www.snapfish.com/thumbnailshare/AlbumID=40630025/a=6248780_6248780/t_=6248780 ) do it no justice, but hopefully you’ll get an idea of the fun we had. I don’t have many digital photos because I used my manual Minolta with telephoto lens mostly so that I could get closer, more detailed shots. Those I have to wait until I get back to the States to see. Meredith and Nancy, however, have a TON of digitals, so you can go to their Snapfish albums to see more when they get a chance to upload them tomorrow.
The adventure began with the ride to the reserve, with our expert driver/guide Sam navigating some of the worst roads I have ever seen in my life. We spent half the time driving off-road in the shoulder of the highway because the potholes were so bad. It took about 5 hours to get to Maasai Mara, with two strategic “bathroom breaks” at roadside souvenir shops that exist merely to haggle with mizungos (white folk) like us for such “hand carved” items as six foot giraffe statues, endless rows of ebony buffalos, and soapstone candlesticks. They’ll also barter for such items as ballpoint pens, Advil, the shoes on your feet and the shirt off your back.
We got a preview of our weekend at one point when we looked to our right and just saw a giraffe casually eating from a tree about 50 yards from the road. Then came the zebra herd just hanging out. And just when we thought the car ride would never end, we rolled up to the gates of the Sarova Mara Resort, buried in the bush just a few miles within the park entrance. It was completely NOT what we were expecting. For $65 a night we figured we’d get your basic travelers’ hotel designed for you to go out all day on safari and be too tired when you get back to care about what the place looks like. Instead, we found ourselves in a four star resort complete with pool, a bar with a fireplace, an incredible buffet-style restaurant, and picturesque grounds that would put most American catering halls to shame. Our individual rooms were actually luxury tents that mirrored most luxury hotel rooms in terms of amenities, except for having no walls. The attached bathroom was the nicest bathroom I have seen since coming to Kenya. If you’re up for a unique honeymoon experience, this is the place you want to go.
After arriving around 2pm, Sam gave us the opportunity to freshen up, settle in, and grab lunch before heading out for an afternoon drive. It had begun to rain, but that didn’t seem to affect the animals too much. Right off the bat, we came up on a group of female lions lounging around by the side of the road. Next came a family of elephants out for an afternoon stroll. A little further down the road we found a pride of gazelles and then a group of giraffes munching on the high trees by the road. No matter how many times you’ve seen these creatures on TV, in the zoo, or at the circus, nothing compares to seeing them in their natural surroundings. It’s simply majestic. Of course, it takes a bit of willing suspension of disbelief considering that you’re standing in a minivan taking pictures from out of a retractable roof along with all the other tourists that gather at a particular spot once word spreads of an animal sighting. It’s actually amusing to watch the animals simply try to pay us no mind. You just can’t help but feel like you’re a Far Side cartoon waiting to happen.
We got back to the resort exhausted and starved. The buffet dinner didn’t disappoint. Afterwards we were treated to some traditional dancing by some Masai tribesman. The Masai are the dominant tribe in the south-central region of Kenya along the border with Tanzania. You’ve probably seen them on postcards or documentaries about Africa. They wear bright red fabric to ward off lions and are famous for their nomadic lifestyle and mastery of cattle herding and selling. In fact, one Masai told us about their belief that all cows belong to the Masai, which helps drive their way of life. It also fuels some pretty nasty disputes with other tribes, apparently. It got us to thinking…what could we claim all of and start herding for ourselves ? We came down to a few finalists: motorcycles, airplanes, computer operating systems, and donkeys.
The rest of the weekend saw us finding 3 of the “Big 5”: Lions, Water Buffalo, and Elephants. We didn’t get to see Rhinos or Leopards, but we DID see a beautiful Cheetah up in a tree, so we decided it was an honorary member of the Big 5. The scenery alone was absolutely incredible, with a sky so vast and endless even the elephants seemed dwarfed at times. We also got to see a Masai village firsthand, complete with a cow dung covered center where all the cattle are kept at night, huts made of dried elephant dung, and more flies than I care to ever see again. It was a bit “Colonial Williamsburg” in terms of staged presentation, but still interesting to experience as a tourist. I also got pretty good sunburn on both arms by standing up all day taking pictures from the retractable roof opening. Small price to pay…trust me. By the time we got back Sunday evening, I was burnt and ready for bed.
Monday morning I started Surgery with Dr. Kavaludi, the Medical Officer in Charge and the person responsible for us during the elective. Rounds began at 9am with the intern, Maureen, where we were seeing the usual cases of broken bones, gunshot wounds, car accident victims, mugging injuries, and diabetic feet. Then we came across a little girl named Hannah; nine years old, obviously sick, and with what appeared to be gangrene ascending both her legs. She had never been in the hospital before in her life. According to the mother, about a month ago, a classmate pushed her and Hannah fell in such a way that she hit both her feet on her desk. There was no apparent injury, no cuts, no broken bones, except for persistent pain and eventual discoloration. The feet became cold to touch, and that is when her parents began bringing her around to various hospitals and clinics. At each one, apparently, they were told the same thing: the girl is developing gangrene and needed amputation to avoid any further systemic problems. Each time, the parents sought a second opinion.
By the time she reached us, she was responsive only to pain and had a fever of nearly 102o. The gangrene in the right leg had reached the level of her knee, while on the left it had reached her ankle. On examination, both feet were ice cold and the toes on the right foot were simply stiff, black projections coming out of the foot. No pulses cold be felt in either foot, and all the way up to the knee on the right. To top it all off, she was severely anemic (4mg/dL) and had a white blood cell count of 100mg/dL, which on first glance points to a full blown horrendous infection. To this point in my medical career, I had seen anything like this. Maureen and I rushed to report this to Dr. Kavaludi, and with only about 30 seconds of history, he wanted the girl in the operation room within the next 30 minutes. The mother was at the end of her rope and could seem Hannah could no longer take what was happening to her, so she consented to the surgery.
To add a new twist to the story, when Maureen and I went to the laboratory to pick up more blood for transfusion, the lab technician brought to our attention the peripheral smear made from Hannah’s original blood sample. It seemed what was recorded as a granulocytosis by the cell cytometer was actually a proliferation of band-like cells that resembled lymphocytes, indicating that on top of a toxicemia due to the gangrene she was probably suffering from some sort of leukemia as well, which would help explain her apparent tendency to thrombus formation.
This is pretty much the medical definition of a train wreck.
I’ll spare you the details of the surgery itself, but let me just say I actually snagged Meredith from the c-section she was observing in the next room just because I wanted someone there with me. I have seen amputations in the past, both voluntary for medical reasons and involuntary due to trauma, but nothing prepared me for the sight of a nine year old girl losing one leg above the knee and another just below. And the worst part is that it was just the beginning for her. This newly diagnosed leukemia was probably going to lead her down yet another tortuous path of hospitals and clinics.
Unfortunately (or, perhaps fortunately, depending on your point of view) the next morning when I went to check on her, I was told she had passed away during the night. Apparently, she had never woken up from the anesthesia and she finally went into respiratory distress at around 1am. This was, by far, one of the worst medical situations I have ever been a part of. From the age of the patient and the seemingly benign nature of her injury to the probable preventability with early intervention, this case just made no sense and will stick with me for a very long time.
So I hope this post makes up for my lack of content this past week. Being in Nairobi, I’ll probably be able to post a little more this weekend…hopefully this post hasn’t made you all sick of me!
Miss you all. 20 more days to go….
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