Why Scott would love Kenya…

Hello my loyal readers…well, at least both of you who are still out there. I am writing from the town of Kikambala, on the east coast of Kenya, approximately 20km north of Mombasa. After a grueling three day work week shortened by two national holidays (Easter Monday and a surprise Day of Prayer on Friday in memory of 14 government officials killed in a plane crash on April 10th) we decided to holiday at the Royal Reserve Safari and Beach Club, thanks (big THANKS!) to Meredith’s parent’s RCI timeshare for a few days. With time suddenly flying by and our time drawing short, we figured it was time to get our feet wet in the Indian Ocean…or in one of the two pools at the resort, at least.

Before I get to that, let me breakdown my work week, which may have been short in duration but long in experience. As some of you may have judged by the title of this post, I spent the week at the Kikuyu Orthopedic Rehab center. As to why I think our own Scott Stanat, future orthopod extraordinaire, would love it…well, let’s just say they’ve got an endless supply of knee and hips replacements, freaky fractures from all sorts of crazy Kenyan car accidents and thug attacks, and pathologic bone disorders I’m still trying to find a clue as to what they are….and they are more than willing to let any muzungo hop in and lend a hand. If Scott were here, Meredith and I doubt they would let him leave.

The first thing that struck me about the center was that they are somewhat more updated than what I’ve seen up the hill at the hospital so far. Having been built sometime in the early 90’s, it actually looks like a hospital that could easily be found somewhere in the States, in contrast to the main hospital up the hill that could easily be found in another time period all together in the America. We rounded at 8am and would go to theater immediately afterwards until 5 or 6pm.

On Tuesday, the day started off with a wicked distal fracture of the tibia in a gentleman who had been in a car accident back in December. At the time, he had just received a cast and sent on his way. Why he hadn’t sought help in the past 3 months despite not being able to put any weight on it was beyond me, but here he was with an ankle fractured in three places and pieces of his tibia floating everywhere. As with every surgery at the center, the team begins with a prayer. Upon opening the leg it was pretty obvious that this was going to take a lot longer than they thought it would. First, the fibula had to be intentionally fractured to allow for the tibia to be properly aligned. Then, all the poorly formed calluses from nearly 4 months of improperly aligned healing had to be broken, shaved, and practically gnawed off just to get a decent fit between all the floating pieces. From that point on, I’ll admit my lack of orthopedic knowledge fails me, and all I can really describe was a lot of hole drilling, screw placing, foot twisting, and long metal rods being shoved into places where bone marrow once resided. Three and a half hours later, the gentleman was on his way to recovery with a halfway decent joint that may actually function once again. With what they had to work with, both in the leg and on the sterile trays, these surgeons were practically miracle workers.

Wednesday I saw my first ever total knee replacement. It was performed by a surgeon that everyone simply called The Professor. Word is he trained many of the current attendings working at the center and he continues to teach at the University of Nairobi Medical School in the mornings and operates in the afternoon. I’ve decided that one of my lifelong goals now is to be known simply as The Professor at some point in my career. No last name, no first name…just The Professor. I know what you’re thinking…I’ve read one too many comic books and it’s finally rotted my brain. Now, I can’t honestly argue to the contrary that this is probably a contributing factor, but mostly I see it as one of the highest honors a person can attain in any profession, but even moreso in medicine since so much of our profession depends on knowledge being passed down orally and by observation. One of the residents that The Professor was operating with had never done a knee replacement before, so he pretty much became a living, breathing, drilling textbook of orthopedics as they hammered and cemented into place a brand new shiny knee joint.

Thursday was clinic day. In the US, from what I’ve seen thus far, clinic days are usually a half day affair one day a week in which residents present to attendings in an orderly, pressure-free environment. At the ortho clinic, 135 patients walked through the door over the course of an entire day; and that’s only Thursday clinic. They do the same thing on Mondays, too. It was a seemingly endless parade of stiff knees, sciatica, swollen joints, cast removals, funny-walking kids, osteoarthritis, and injuries from all sorts of weird and whacky circumstances. I followed an attending around the whole time and by the end I felt like I needed some sort of orthopedic support for my feet, knees, and back. One patient that stands out was a 55 year old woman who had a swollen arm, from shoulder to fingers, and occasional fevers over the past 4 years whose X-ray showed horribly deformed bones from the humerus to the tips of her first four fingers. The only possible contributing history was a fall she sustained when she was a young girl. No one in the room had a quick answer. Why it just affected the arm and nowhere else at all was beyond us. Geoff and I talked about it afterwards and we think it was probably a TB infection isolated to the arm that just has wreaked havoc all these years as she’s grown. It is definitely a radiograph fit for textbooks.

As I mentioned earlier, Friday’s scheduled surgeries were all canceled in observance of the Day of Prayer called by President Kibaki in rememberance of the 14 people, 6 of which were Ministers of Parliament, that died in a plane crash a few weeks back. We rounded in the morning and then I headed back to the hostel to pack for Mombasa. Our train was leaving at 7pm and we would be riding overnight in a sleeper car, with dinner and breakfast provided. More on the train ride and Mombasa to follow….

10 more days!