So, it's been nearly a week since we touched down and I'm finally getting around to writing my final thoughts. My apologies. Apparently, as I have found to my dismay this week, traveler's diarrhea is not exclusive to the trip there. Thank God (and Bayer Pharmaceuticals) for Cipro. I'm pretty much back to my usual state of health (minus a few pounds, it seems) and figured it was as good a time as any to post a few parting thoughts...
By week six, I'll be honest, I was ready to head back. Not out of any kind of ill-will or negative experiences, but rather out of inevitability and good ol' fashioned homesickness. The trip for me was an overwhelming success and I felt as if I had laid some significant groundwork for any future trips I could make during my career. My eyes were opened, as I had hoped they would be, and my heart took to Kenya in ways I didn't think it would. It was an experience I wish more people in our profession would undertake and I personally would love to take part in helping future students and physicians reach this part of the world.
We spent our last weekend shuttling back and forth from Kikuyu to Karen and Nairobi in search of last-minute souvenirs, cultural events, and, of course, food. We spent Saturday exploring the Karen Blixen Museum and Karen Blixen Coffee Garden, then walking to Karen Center to hit the Rusty Nail one last time. That place is just incredible. We met the owner, Clive, who is the son of British expats and was born and raised in Kenya. He bought the Rusty Nail along with his sister and they've run it since the late 70's. Fascinating story. He got us caught up on all the Kenyan politics, past, prestent, and future. I really can't wait until I can go back and eat there again...it was seriously that good.
Sunday and Monday (thanks to Kenyan Labor Day!) were spent in Nairobi. We caught a play at the local arts center entitled "The Burning of the Rags" that was absolutely fascinating. I won't go into details about the plot, but I found it refreshing to see the universality of themes we take for granted in the US: big city thinking vs. the village way of life, the double standard women bare for their indiscretions, generation gaps, and women's rights. It was billed as a comedy, and it was for the most part, but it got pretty serious by the end and concluded with a lady, who I presumed to be Death, leading the spirits of two dead characters onto the stage and delivering an ominous message about regrets and unrequited love. Quality stuff. I could see this off-Broadway somewhere in Brooklyn, easily.
My final rotation at the hospital was with the medicine team, which meant rounding, rounding, and more rounding. Now, if I had written this post right after I had finished the rotation a week ago, I could probably provide more details on interesting cases. But all that sticks out in my mind at this point was that our legendary patient, Mr. Uremic Frost, at one point refused to come out from under his covers because people were telling him that the food was dirty and that he wasn't going to get better if we kept looking at him. This poor gentleman was admitted just before we had arrived with a chief complaint of "open wound on the toe". Since his admission, he had been diagnosed with uremic frost that turned out to be non-uremic, developed a mysterious bowel obstruction that, upon exploratory laporatomy by Dr. Kavaludi, yielded nothing but gas, developed open bed sores on both heels, and finaly had a psychotic break that made communication with him pretty much impossible. It's that final problem, it turns out, that will probably be the straw that breaks the team's back since phychiatry is still a pretty tough service to come by in Kenya. It is pretty much administered out of one hospital in the whole country, and unfortunately it has the reputation of Kings County's G-Building...multiplied by a factor of 50 or so. Then again, the odds of Mr. Uremic Frost getting out of the hospital any time soon is pretty slim considering the bill he's accrued. Have I mentioned the fact that bills must be paid in full before a person can leave the hospital in Kenya? It's an amazing system that seems to work surprisingly well at PCEA Kikuyu Hospital. Imagine trying to implement that in the US. They'd have to relocate Kings County and Downstate to Ryker's Island just to accomodate the extra capacity. Which system is better, though? One seems perfectly logical in that you pay for what you receive, as with everything else in life. The other is more along the lines of the altruistic medicine we all claim to love in our med school essays, but that end up costing us 1/3 of our GDP in healthcare costs. I guess the jury's still out on that one.
Slowly, but surely, I packed every evening during the last week. Tuesday night found us at Maureen's (surgical resident) apartment eating the best Kenyan of the entire trip, hands down. We ate until we couldn't eat any more. The walk home in the dark and the mud was hilarious, though, sadly, it ended up costing me a pair of shoes. I like to think that somewhere, right now, some big-footed Kenyan is plodding around in a pair of size 14 Kenneth Cole Reaction bowlers and loving them as much as I loved them.
We ended the clerkship with a lunch outing with Dr. Kavaludi in the town of Wida. We had a lively discussion about politics, medicine, vegetarianism, and how the elective could be improved for future groups heading there next year. He expressed his ultimate goal in having an exchange program for residents and attendings, in addition to students, between PCEA Kikuyu and Downstate. Logistically, it sounds like a nightmare to negotiate between visas, salaries, and accomodations. But logically, if we're ever going to make strides in spreading medical knowledge and practices globally, then immersion seems like one of the most direct and exciting ways to go about doing it. After seeing first hand, I'm a believer.
Friday morning, 4:50am my alarm went off and so began the long trek home. It was 9:50pm on Thursday night in the US. In the end, I stayed awake for 26 straight hours before finally resting my head on my pillow back home in the Bronx. That accounted for three different X-ray checkpoints in Kenyatta National Airport, waiting another hour before our flight actually left, one 8 hour flight to London that included 4 movies, a brief layover with bathroom break, another flight of approximately 7 hours that had 3 movies, the endless wait for baggage at JFK, a welcome home pizza party at my sister's house, and a drive back to the Bronx at around 10pm. I slept like a rock, to say the least.
Oddly enough, I was up bright and early at 7am sharp and ready to reacquaint myself with driving on the right side of roads that didn't have the appearance of having been imported from Baghdad. Jetlag is a funny phenomenon.
In the end, sadly, it starts to all feel like a dream. It's incredible how quickly the mind can just start to fragment, store, and reshuffle memories, especially those that are particularly unique. An hour into my ER shift at County on Monday, and it was as if I had never left. It's as if 6 weeks in an incredible land halfway across the globe is no match for four years of the stained tiled walls and gothic architecture of Kings County Hospital. Sad, really. But thankfully, I have all these entries, my own journal I kept, and the nearly 3,000 pictures we all managed to take to keep my memories fresh whenever I find myself forgetting what the hostel looked like or the names of the residents we met. I truly can't wait to find myself back there sometime in the future, in a role that actually permits me to strategize and help more effectively. I wish those students who are going next year the best of luck and I hope they can use some of these entries to their advantage when they finally start planning their journey.
I will be posting a grand presentation of pictures soon, so please check back often.
And for those of you who'd like to follow me along as I enter the next adventure in life as an intern in Ob/Gyn, feel free to pass by whenever you get a chance and throw in your two cents....
Cheers!
Jerry.
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