In trying
to think how I might approach the almost impossible task of summarizing the
events of my final weeks in Kijabe and now the first few weeks spent in Kibera,
I decided a retelling of a select few important moments would be preferable to an
unending slew of “…and then this happened…”s, though I apologize if you were
looking forward to a meticulous recounting. The last couple of weeks that I
spent in Kijabe were rife with fascinating surgical moments, not the least of
which included me being able to scrub in for a revision orthopedic case in
which I felt like a handyman’s lackey as we removed screws, repositioned bones,
and inserted pins. Though there are many ways to describe an experience such as
this one, the simplest way I can think to do so would be to say that it was
insanely fun. They say if you enjoy hands-on work such as fixing or building
things then you’ll love orthopedics, and I can’t say I disagree. Whereas
building and repairing picture frames as my summer job brings its own kind of
satisfaction, being a part of repairing a human frame represents an entirely
different level.
In Kenya, as in many parts of the
world, an operating room is more commonly referred to as a theater (or theatre
for you European types). In my case, this terminology felt particularly apt as
I would often find myself strolling from room to room, peering in and wondering
what show was playing that day. Oh, looks
like Neurosurgery is putting in a ventricular shunt today; that could be interesting.
Then again, Plastics will be creating new fingers for a man that lost most of
his hand in a work-related accident. Decisions, decisions…
Exaggerations aside, I mention that
redigitization procedure intentionally because it was one of the most amazing
operations I have ever witnessed in person. The plastic surgeon responsible for
this operation carried himself with such an easy air of expertise and
lighthearted humor that I felt like I was watching a maestro conduct a symphony
while cracking jokes on the side. Plastic surgeons often get a bad rap in the
States for the heavy load of cosmetic procedures many of them do, but to see
what they can do in a developing world context very nearly took my breath away.
I did not strictly remain in the
operating room during my final weeks in Kijabe, however. While on rounds with a
visiting internist, I met one patient that made a particular impression on me.
He was a 17-year-old boy from Somalia who had most likely suffered a small
bowel rupture due to typhoid, and as such, weighed about 25 kilos (around 55 pounds)
when I met him. I’m not attempting to be facetious when I say his appearance
was that of a skeleton wearing a suit of skin that was a few sizes too small;
every anatomical detail of his bones was readily visible just by looking at him.
Though he had some mobility with the use of a walker, he was most often
confined to his bed without a means to venture outside apart from someone
wheeling him out in a wheelchair. As such, I volunteered to be that someone on
the day we met. I rested a hand on his shoulder (or rather, into the sunken
space between his clavicle and scapula) and asked him if he’d like to go
outside. With a toothy grin and quiet nod, he assented. Dr. Abraham Verghese, professor
at Stanford University Medical School and author of several bestselling books,
has been asked on several occasions what he thinks the greatest innovation in
medicine will be over the next 10 years. While giving a TED Talk, Dr. Verghese
encapsulated his answer in just six words: “the power of the human hand.” As I
wheeled this 17-year-old boy through the halls of the hospital and out into the
early afternoon sunlight, completely unable to communicate except through a
translator (my small arsenal of Kiswahili was to no avail as Somalians,
shockingly, speak Somalian), I thought about this core value of medicine
implicit in Dr. Verghese’s response. There I was without the knowledge to help
this boy in a medical sense or even communicate verbally, but somehow I
understood that what I was doing mattered. As trivial as 30 minutes in the sun
might seem to you or me, it can mean a world of difference to a patient that
spends every waking hour staring at the same four walls. This interaction, more
than most others, reminded me of the simple truth that even when medical
expertise, ability, and knowledge are stripped away, you can still reach out
and put a hand on someone and, in so doing, partake of the most powerful
essence of medicine.
[Insert Kilimanjaro trip here]
Since moving back to Karen, a
suburb city just outside of Nairobi, I have spent much of my time working with
New Hope Academy in their efforts to establish a health clinic that would
provide basic care for their students, members of their high school scholarship
program, and the women of a business co-op called Project Biashara. The complex
of buildings in which we operate is located in Kibera, the largest slum in
Africa, and is only about a 15-minute drive from where we live (unless, of
course, traffic is bad, in which case it can take a couple of hours). I think
it is always exciting to be involved in the initial planning and development of
a new organizational entity, though one has to be willing to accept the
inherent challenges and speed bumps along the way as well. Even when resources
are not an issue, though they very frequently are in this case, the logistics
of coordinating people and systematizing internal operations from scratch serve
as constant reminders of the necessity for adaptability and patience above
almost anything else. For instance, construction on the clinic was supposed to
be finished by February, but even now in the middle of April, the room consists
of little more than bare wall frames, a medicine cabinet, a single cot, and a
desk.
Construction frustrations aside,
I’ve been having a blast working with the nurse who will be running the clinic,
helping her complete initial health assessments and treating the women and kids
that come in with minor health issues. I’m also proud to announce that I’ve
achieved what most people would consider impossible by becoming a doctor
without ever going to medical school. “Daktari,” (the Kiswahili word for
“doctor”) is the title by which I am addressed by children and adults alike
that come into the clinic, though I’m pretty sure this is largely due to an
unclear conception of what a premed student is in Kenyan culture. I’m thinking
about getting a certificate of my medical qualifications made so I can frame it
and put it on the wall behind me:
Daktari Robert Elrod
Band-Aid Specialist
Additional Degrees
In:
Taking Temperatures
Asking “How are you
doing?”
Referring Patients to
the Nurse
As silly as it might seem, I really enjoy my role as a small
cuts and scratches healer, probably because it’s the one thing I can do that
resembles helping patients in a tangible way. It’s also amusing to witness how
dramatic some of the students can be when I’m wiping down or removing debris
from a cut. In my mind, I’m cleaning a scratch on their knee, but based on their reactions, I’m
apparently removing their entire leg.
This guy came in screaming and crying like a crazy person after falling and hitting his head while playing with friends. Turns out he only had a small scratch on his head. Crisis averted.
On rare
occasions, we have patients come to us with more severe issues. During my first
week in the clinic, a 6-year-old girl came in with what the nurse diagnosed as
clinical malaria. I’ll never forget the way this little girl’s face looked,
barely poking over the other side of the desk, fat tears rolling down soft,
brown cheeks and fever-glazed eyes that conveyed the simple truth, “I hurt.” Her
temperature clocked in at over 105 degrees Fahrenheit, though you only had to
place a hand on her forehead to know she was burning up. We had her sit on the
clinic cot as we started an IV and plotted the best course of action. The nurse
eventually left to contact the girl’s parents and advise them to take her to a
hospital so she could be properly diagnosed and treated while I remained in a
plastic lawn chair by the girl’s side. My crippling inability to do anything of
medical relevance was once again driving me nuts, so I did the only thing I
could think to do aside from twiddling my thumbs and offered the girl some
gauze pads soaked in cool water. The eagerness with which she rubbed those bits
of soggy cotton over her forehead and face made it seem like she was trying to
wipe away her fever, as if it were a blemish that could be removed with enough
scrubbing. Though I could do nothing more than re-soak the gauze pads when they
became saturated with her body heat, it was enough for me to see her stop
crying and relax just a little bit before her father came to take her away.
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