The most difficult thing about working on the surgical team is the number of people that we are unable to help. We usually have at least one person die everyday on the service. The entire pediatric and adult surgical service has between 50-60 patients, so a death everyday is an alarmingly high percentage. I have seen more children and young adults die here in the past four weeks than during my entire four years as a surgical resident in the U.S. Many of these patients die of endemic disease like TB and malaria, but there are also plenty of children who die from simple things like dehydration and burns or adults who die from delayed care and traumas. By the time the patients arrive to the hospital, many of them are too ill to recover.
In clinic today I saw Nancy, a 32 year old woman who delivered her second child three weeks ago. Unfortunately, she was diagnosed with esophageal cancer while in her second trimester of pregnancy after she developed problems swallowing. The tumor had already spread to other parts of her body so she has no chance of undergoing a surgery to cure her disease. She had a stent placed in her narrowed esophagus to allow her to eat, but the stent is now collapsing as the tumor continues to grow. She came in to talk about options for her to receive nutrition so she can continue to breastfeed for the few weeks she has left. I talked to her about the possibility of placing a feeding tube in her intestine so she can give herself pureed food beyond where the esophagus is obstructed.
The unique thing about healthcare in Kenya and at Tenwek is that patients must pre-pay for their admissions, surgeries, x-ray studies, and medications. Although it is a fraction of the cost we see in the US, it is a substantial amount for people living on a few dollars per day. After reviewing all these details with her, she decided to return to her village to attempt to ‘raise the funds’ as they call it, before possible surgery next week to place the feeding tube. She is a strong, stoic lady who is mature beyond her years, yet is willing to have surgery at the end of her life to help her baby have the best chance of success even after she is gone.
Thankfully, not all of the stories are sad. We have had two 20 year old young adults come in over the last two days with bowel perforations. One was due to a stomach ulcer and one was due to a volvulus (twisting of the bowel). Both had been transferred from District, ie. government, hospitals because their families felt they were getting sicker. Both patients arrived in Casualty (fancy colonial term for ER, but unfortunately it is the same dreadful place it is in the US), had the problems diagnosed quickly, were taken to the operation room for repair, and are recovering well. Just a few more hours or days and they both would have likely died from their very manageable surgical problems. These are the people and stories that keep me going.
Please remember to pray for these patients and for their families. It is a blessing for us to care for such kind and grateful patients.
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