Kenyan Medicine

There are all sorts of similarities between medicine in Kenya and the United States. For one, people bring their loved ones to the hospital in search of help, pain relief, answers. Doctors, nurses, and techs work hard, long hours to diagnose medical diseases, give medications, and sometimes even perform surgery to fix some ailment. The overall premise is the same but the route to get there is curiously different.

In rural Kenya, patients will travel for hundreds of miles to reach Tenwek. Although they pay out of pocket for the services they receive, the reputation of this mission hospital is that it is one of the best places to come for surgery, orthopaedic issues, trauma, obstetrics, and pediatrics. The nursing care is thorough and the doctors are actually available which is a stark contrast to many District, or government run, hospitals, where the physicians abandon their assigned post to work in their more lucrative private practices.

At Tenwek, the patients often arrive through Casualty, the US equivalent of the Emergency Department. It is a tiny room with seven gurneys, minimal equipment and supplies. At any given time, there are at least double that number of patients and each of them bring along 2-5 family members. It is barely controlled chaos to say the least and works essentially as our ER at home….like a triage center for admission. To give an example, today in Casualty, there was a women who died due to esophageal cancer whom I placed a tracheostomy tube in a week ago to help her breath easier, a ten year old boy who was mauled by a lion, two boda-boda (read: moped retrofitted to carry up to five people) accident patients with open fractures, and a partial finger amputation from a panga (read: bush-style machete).

The surgery service admits all general adult and pediatric surgery, trauma, ortho, urology, neurosurgery, and burns. Most go to the male or female surgical ward, two open rooms with 18 beds each, but often hold many more patients than that. You guessed it….they double up. Complete strangers, grown men and women, sharing twin hospital beds. And adding to the overwhelming humanity is all the family who bring the patients food, do their laundry, perform their physical therapy, and get them out of bed every day. Presiding over this whole enterprise is four nurses….not four for each ward….four total. They give all the meds (if we have them available), take vital signs (once a day), keep track of drain outputs (maybe), and help changes wound dressings. Their job is daunting and often impossible. It is no surprise with the advanced patient disease and lack of monitoring that, on average, one patient per day dies on the surgical ward.

Interestingly, it is not socially acceptable to talk about death and terminal illness in Kenyan culture. Death/die/dying/dead are all avoided words. How do you convey the obvious, you ask? Some of the best culturally acceptable sayings include “the patient went mute” or “they stopped taking chai”. Chai is Kenyan tea that is drunk throughout the day on the order of 10-15 cups per person—when a Kenyan does not take Chai, it is a marker for severe illness, and often, as we see too frequently here, even death.

Despite the differences, the art of medicine in Kenya and the US still strives to achieve the same goal…to heal and comfort the sick. I feel honored and privileged to be a small part of such an impressive hospital that ministers to the whole patient in both body and spirit.