Our first day in clinic

The staff starts every work day by gathering in a circle outside the clinic. As each person arrives they go around the circle to shake hands and wish every person a good morning. We do the same. Then someone leads us in a song. One day it’s a traditional Luo song and the next day, it’s in English. Someone then leads us in prayer, then any announcements are made before we head in our separate directions. It's a wonderful way to start the day.

The clinic received 4 people with cholera over the weekend so there’s an emergency meeting where the chief nurse gives an overview of the infection. This is followed by a discussion of how best to manage a potential epidemic, how staff will be taken care of if they get sick and where to isolate the patients. After the meeting a cholera “ward” is set up in the education building. They have 5 cholera beds so any overflow patients will be placed on the floor or in the courtyard. 1992 was the last big epidemic and Hugh said they had patients lying in the yard with IV’s hanging from the trees. We all hope it won’t come to that.

I spent the rest of the day shadowing one of the nursing clinicians. She was seeing prenatal patients who typically were already in the late second or third trimester with no prenatal care. They all planned to deliver at home with a TBA- traditional birth attendant. TBA’s were embraced and supported for years by the government but for some reason, Kenya has decided to do away with them. They want everyone to deliver in hospital. Since this is impossible for a hundred different reasons, the woman all plan to do what they’ve done for generations and deliver at home.
One woman was 32 years old and 29 weeks into her 9th pregnancy. She had 5 living children. She is expecting twins and hopes to have a C-section so she can also have her tubes tied. As the nurse said “the problem with African women is that they aren’t empowered”. Women can only practice family planning surreptitiously so a tubal ligation would be perfect. If that doesn’t work she’ll opt for Depo-Provera.
As we were ending our morning a woman came into the clinic screaming for help. She was carrying a hefty and healthy looking toddler. He was lethargic and having trouble breathing. She said they took him to a neighborhood “pharmacy” (could be operated out of someone’s home) and got him a shot for malaria but his condition worsened. Within minutes of his arrival he was seizing and respirations became shallow. The nurse started an IV and gave him medication to stop the seizure while I tried to keep his airway open by “suctioning” him with a bulb syringe. There’s no emergency equipment available. In fact, we didn’t even have a stethoscope or thermometer close at hand. He may have cerebral malaria and was transferred to a hospital 1 hour away. That hospital doesn’t have any emergency capabilities and I was told not to start CPR on anyone because there’s no where to send them for advanced care.

In the afternoon we again see all the morning patients to review their lab work. They were all checked for HIV and one test came back positive. The patient was 26 and in her 6th pregnancy with 5 living children. I watched the patient’s face as the nurse explained the results to her in Luo but I couldn’t tell the moment that she was told the news. She accepted the news in a matter of fact way- I was told she didn’t expect it was at the same time, wasn’t surprised by it. No one really knows how many adults in this area are infected but it may be as high as 40%. She was started on medication to prevent transmission of HIV to her baby and will try to get her husband in for testing.