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Journal Entries by Betheal Aschenaki

12/17/12

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Journal Entry #1


Our first day was in Korogocho. The clinic was set inside a school. The children were excited to see us. Once the setup was finished, we were partnered into a team of two and off to our partitioned exam room. We were excited and scared. Today, our medical team consisted of Sara (a nursing student), our translator and me.

Our first patient walked in, a 65-year old male about 5 feet tall with kyphosis and an irregularly shaped, tender-looking unilateral tumor protruding from his neck. My first thought: Thyroid carcinoma. Then, I thought, “Dear God, what are we going to do?”

We started asking the typical HPI (history of presenting illness) questions. We learned:

  • The tumor had been there for a very long time. It increased in size during the past two months. It pulls on his neck, so his neck hurts and he gets headaches.
  • He does have dyspnea, dysphagia (liquid and solid), weight loss and increased fatigue.
  • For the past four days he experienced increased nausea and vomiting.
  • His emesis is green, no blood and there hadn’t been a change in his bowel habits.
  • He had no significant medical history.
  • He doesn’t have allergies.
  • He has been taking herbal medicine, but he was not sure if it’s helping.
  • He has been smoking three sticks for 30 years.
  • His current occupation is collecting trash but in his previous occupation he worked as a spray painter in a factory. His last doctor visit was a week ago and they told him there was a vein that runs from his temple to his neck and it’s infected. They informed him that he needed his teeth removed (which they did).

Needing to confirm what I’m thinking about the patient’s diagnosis, I asked Dr. Nasiiro for a second opinion. He confirmed it was Thyroid Carcinoma. Dr. Nasiiro explained to the patient that he needs to go to another clinic and get referred to a hospital for surgery. The patient’s first question was, “Will it cost me money?” The translator told him yes and that he needed to go to a clinic as soon as possible. It was obvious he couldn’t afford surgery and we were not equipped to care for him. We gave him Ibuprofen (“Bufen” as they call it in Kenya) and some crushable multivitamins. Sara and I looked at each other with helplessness. I couldn’t help think how his management would have been different in the States.

Lesson of the day: You can’t save everyone, but you can treat to the best of your ability with what you have.


Journal Entry #2

I am very impressed with how our trip is so organized. Every morning we wake up, have a nice breakfast and we head to the clinic. So, we are done at Korogocho and today we go to the mountains. The exhaustion is catching up. It’s so cold here but beautiful and peaceful. Patients are already patiently waiting for us. Every patient is so grateful and they give us so many blessings. The patient population is elderly compared to Korogocho. Our clinic is set up in a church compound. We find our assigned exam room and our day starts. Our team today is Phil, Marvina and George our translator. It is very nice to work with the nursing students. Nursing and medicine is one system with two sides.

Most of the patients are in their 60-80’s. Most complaints are about arthritis and most of the patients are farmers. The presentation is text book. If it’s Rheumatoid Arthritis, then the condition is worse in the morning and gets better as the day goes on. We noticed there are more female than male patients. It’s bilateral and cold makes it worse. The fingers are involved. The second half of the day we conduct house visits. After lunch we are loaded in the Matatu (mini bus taxi) and off we go. At the first house Lisa and I are dropped off. We take what we think are essential supplies and walk in to a gated compound with our translators. Inside the compound there are multiple homes. The elders are sitting outside talking, the kids are playing and the chickens are running around. We say “jumbo” and they all get up and gather in one of the elders’ living room. The house is so clean and organized. We saw the same complaints, elderly with arthritis and allergies; kids with common cold. All we gave them were mutivitamins, Benadryl and Ibuprofen. After we were done they offered us some tea and we attempted to decline but we are told in the Kenyan culture it’s disrespectful. As we are sitting having some tea I am amazed at their generosity and sincerity. I could tell you we helped patients but the absolute truth is they helped us. Their patience, kindness and gratefulness reminded me how I have taken life for granted. We have everything but we complain of the one thing we don’t have. It is a very humbling experience.