Tenwek Hospital

I made the three hour drive to Tenwek from Nairobi safely and on nice, new roads. The grounds are stunning, my room is spare, but clean with everything I need, including a hot shower, sometimes :)

Africa is a very different place to work. The hospital at Tenwek is a 300 bed hospital, but the size of the hospital is much smaller than one would expect. Most of the beds are together in one of several large rooms and line the walls on either side. There are male and female surgical wards with 18 beds each, although patients will often share, sleeping head to foot. The nursery consists of one large room with 3 “modern” warmers, several wooden bassinets with phototherapy lights, and multiple small wooden or metal bassinets. Most patients receive food and supplies from their family members. Milk, chai tea, and purified water are distributed on a cart twice a day that rounds through the wards.

One of the first things that you notice is that most of the hospital is actually open to the outside. There are no doors separating the wards from the hallways and hospital grounds. You can see the disinfected vent and oxygen tubing drying in the sun on the way in the door of the ICU. Nothing goes to waste here. Everything from pleuravacs to bovie pencils are 'decontaminated' in bleach between patients and re-used after drying. All of the IV fluids that patients receive are in glass bottles and there are no pumps to titrate fluid, meds, or Ensure tubefeeds.

This week, Jeremy and I did an ex-lap and attempted liver resection for a 9cm tumor but it was growing into too many adjacent structures. We did two thyroidectomies for massive, airway compressing goiters and removed a 5 pound leiomyosarcoma from a thigh. I put a silo on a preterm baby with gastroschesis who unfortunately did not survive due to respiratory failure and malnutrition. Next week, I have bilateral nasal polypectomies, a 6cm urachal cyst resection, and a thyroidectomy with radical neck dissection.

Here is the short list of crazy, never-see-it-again diseases that I have come across so far…..

--Typhoid with bowel perforation – this boy died today
--Esophageal cancer in 20 and 30 year olds
--All types of meningitis (meningococcal, TB, cryptococcal, viral)
--Lots and lots of malaria
--Small bowel obstruction from worm balls
--Rheumatic heart disease in a 14 year old girl
--Meningomyelocele in a 6 month old
--Milliary TB in a 6 month pregnant woman - both baby and mom did not make it

The list will grow each day as the pathology is overwhelming and unbelievable at times. The Kenyan people are gracious, stoic, and so grateful even though we often can not do anything except send them home with hospice. I appreciate this opportunity to help in a small way as well as gain a different appreciation for our system at home.