Monthly Archives: January 2013

One Day

0615  The shiny black iPhone sings a tune.  Time to get up.  Switch off this amazing device which serves as walkie talkie, gps device, calendar, family photo machine, and pager.  Shuffle to the kitchen.  Bare feet, so need to squint through bleary eyes for any new house guests (spiders, Nairobi flies, unnamed creepy crawlies).  Not nice to step on them, for either of us.  Fill the kettle through a filter, the tap water might have a few amoeba or other things in it.  Boil up the water for the french press, get some nice strong coffee going.  Drinking coffee here is like eating crepes in France:  the bean was discovered and brewed for the first time by shepherds north of here, in Ethiopia.  They noticed their sheep were especially energetic after eating these particular berries, and began drying and brewing them to make what we now know as coffee.  Bosco opens one eye as I walk by, then back to sleep for him.

Coffee in hand, open the front door, check for any 6 or 8 legged friends outside the door.  The cool, moist tropical air feels so nice.  The sounds are like a scene from Jurassic park:  a multitude of sweet song birds, punctuated by the awful squawk of the black ibis couple who’s nest sits forty feet above our house.  The escarpment rises steeply to 9,000 feet directly from our back yard, and downward from our front yard to the great plateau of the the Rift Valley.  Shuffle down our comically steep rock driveway to the muddy road below.  The view is breathtaking.  Looking west from our house, the pale yellow pink sky reflects the still invisible sun creeping over the ridge behind me.  The Rift Valley is one of the oldest geologic formations on earth, and the Leakey’s finds of ancient hominids occurred along this rift.  There’s been abundant life here from the earliest times.  Small brown monkeys rest in the trees:  they’ll raid our fruit vines later.  Last week, one shot into our kitchen to snag a few bananas.

0700 Walk past the hospital gates, “Habari za asabuhi” (good morning) to the guard, and on to the adjoining Cure hospital to meet with the medical director there to discuss cooperation between the two hospitals.  Joseph is a friend, a kind, gentle, and very insightful man.  Though he’s an orthopaedic surgeon, he has visions and plans for his hospital worthy of a top business school graduate.  We have a very good, frank, and respectful discussion of how our two hospitals can work better together, while each pursues its individual agenda.  We have some tough negotiations coming up with them next week, so it’s nice to touch base in such a quiet, friendly manner.

Walk back up the hill to the house for a quick breakfast.  The kids have already walked further up the hill to Rift Valley Academy to start the new school term.  Michael carries a blood glucose testing kit, a cell phone and glucose tablets for emergencies.  Jane is thrilled, as her kindergarten class is studying bugs this term, her favorite passion.

Quick phone call to the Kijabe Hospital medical director to let him know that our c-arm is broken.  C-arm is the live video X-ray machine which is indispensable to many orthopaedic surgeries.  We have to divert any patients whose injuries would require c-arm to another hospital until we get this fixed.  Call to the biomed department director, who’s on vacation.  He’ll come in tomorrow to try and fix it, he knows what’s wrong, is pretty sure he can fix it, but he’ll talk to the guy who’s here today to see if we can get it running.


Walk back to the hospital to start the day.  Due to poor communication between our hospital and another hospital which provides us orthopaedic consultant coverage, the number of consultants plummeted from five to two on January 1.  Unfortunately, no one notified the patients, who continue to stream in.  The Kenyan roads have been particularly deadly this new year, including a crash of an overstuffed matatu, killing all twenty people on board.  Waiting in the ER is a poor man who was sleeping in the back of  a truck when it crashed, killing everyone except him.  Tragically, he’s paralyzed from the arms down due to a broken neck.  The neurosurgeon here is so swamped he asks if we can take this patient to re-align his spine, in hopes of limiting his paralysis.  Some quick consultations and orders to get things rolling, and then walk down to ER to examine the patient, and talk to him and his wife about the plan.

0830  Run into an orthopaedic colleague who notifies me that an orthopaedic surgeon we’ve been hoping to recruit is actually at the hospital today.  Quick arrangement to join him for tea.  Walk into the “theatres” (operating rooms) to help get things organized for the day.  Friendly jokes and greetings from the orthopaedic residents and interns, a great, bright, enthusiastic, intelligent team, the most rewarding part of working here.  The initial cases involve fixing an acetabulum (hip socket) fracture, taking a biopsy from a woman who’s pelvic bones are being destroyed by something, and treating a man who’s got compound fractures of both legs.  We initially occupy two of the eight theatres, but by late morning have four different cases going in four rooms.  Things are really clicking along.

Circle back to see how the c-arm repairs are coming along.  No progress.

1000 change out of scrubs back in to street clothes, walk through the courtyard to the outdoor hospital cafeteria to chat with the prospective orthopaedic consultant.  While chatting, we run in to the guy who’s supposed to be fixing the c-arm.  He agrees to look at the machine shortly.

1030  Back to theatre.  The residents have been doing well on the cases while I was out, we’re getting a lot of work done today.  There’s some confusion about getting the man with the broken neck taken care of, quickly walk down to ER to straighten things out.  The nurse there anticipates that I’ll need some translation help in talking with the patient, and deftly steps in to help.

1130 Back to theatre to do a case with one of the residents.  This older lady had been drawing water out of a borehole, when something went wrong with the machinery.  It smashed her arm, breaking it in several places.  She went to a local health clinic, where a cast was applied.  Unfortunately, the fracture needed surgery, so when the cast was removed, her arm was crooked, stiff and painful.  The bones had not healed, but were stuck in a displaced position.  Unfortunately, the injury was three months earlier, making the surgery much more difficult.  The resident did a great job on this very difficult case, and the “shosho” (older lady) should have a functional arm.

130  Walk out of the theatre, and see that the battery pack has been removed from the c-arm, evidence that someone’s doing something about this.  Realize that the battery in my phone/portable brain is almost dead, so run up to the house to get the charger cord.  Ann and Jane happen to be at the top of the drive.  It’s still surreal to be walking through an African village and all of a sudden see my family here.  Makes me smile.  I glance into our “shamba” (garden) and see the recent rains have really made it explode.  Lettuce, spinach, pumpkins, scallions, cilantro…. It’s pretty easy to get things to grow here, it’s always warm, often rainy, no frosts, and really no seasons.

330 The final patients of the day are all in their respective “theatres”.  The man with the broken neck has been put into traction to better align the bones prior to surgery.  The man with the gangrenous foot is too anemic for surgery, we’ll have to get his family to donate blood so we can transfuse him and do his surgery another day.  As I wander down the hall, I see the biomed tech standing by the c-arm, which is running!

500 Home.  A busy but tiring day.  The kids have just restarted school for the term, and are full of stories about new classmates and topics.  Jane goes out on the porch to play, and bursts in a few minutes later with news.  “There’s monkeys on the roof!”  Michael grabs his slingshot, a handful of stones, and enters the fray.  We find the one intruder on the passion fruit vine, enjoying an evening snack.  A stone shot in his general direction dispatches him to the forest.  As we round the corner, we see his brother hanging on the bars of Jane’s window!  A near miss from the slingshot sends him shooting over to the laundry line, where he taunts us.  One more shot from Michael, and he retreats with his brother.  We continue the chase up the hill, sending a strong message that they’re not welcome round these parts.  While they’re really cute, they’re also a menace.  Besides stealing fruit, they like to throw garbage around, so we keep up this harmless battle to discourage them.

Michael retires from battlefield to read me Garfield comics from a book he’s just checked out from the school library, while Jane runs around capturing psychedelic looking butterflies in her pink net.

600 We bustle around getting ready to visit some friends for dinner.  One of the results of having few distractions here is that people spend a lot of time just being together.  You tend to get to know people pretty deeply pretty quickly here.  So we hop in the car and drive off.  We have a tradition here:  when we get in the car, I ask sternly if everyone has their seat belts on, and the kids gleefully scream “No!!!”.  As we drive down the steep driveway, my phone rings and I stop to answer it.  Jane promptly flies into the back of the seat in front of her, smacking her head, and is screaming as I’m talking to another doc on the phone.  We recover from that, make it to our friends house in one piece, and have a great dinner of lamb, potatoes, and mint sauce.

700  Ann ducks out of dinner to run the kids up to the Friday night movie at the grade school.  Every Friday night is a movie, roller skating party, pizza party, or some other school wide entertainment.  The kids run rampant, no parents allowed.  Ann returns to dinner and we have great chats, until we have to leave at 8 to pick the kids up.

A word about the car.  Almost everyone here drives a Toyota Landcruiser or a Landrover.  Here, these aren’t trendy rigs to drive to the mall.  They’re one of the few vehicles that a) won’t get stuck going up or down your driveway and b) won’t fall apart from bouncing over rocky roads.  So we have a 1999 Toyota Landcruiser, which we bought from a missionary family that was returning to the US.  Huge knobby tires, extra high ground clearance, turbo diesel engine, stick shift, and a big metal rack on the roof.  This is my dream car.

900  Back to the house, kids straight to bed.  Ann’s parents ring in on facetime, so we have a good chat, then watch some downloaded TV on Ann’s computer.

1000 Collapse into bed.  On call for the weekend, so need the rest.

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