Stefanie & Tyler

I have been trying to sum up my experience working in the Peds unit for the last few days. It’s been a whirlwind where I have been able to take on substantial patient responsibility and learn a ton. I was quickly oriented to the EMR they use here and have been able to work at basically an intern level. I have been making my own plans, putting in orders and prescribing meds as needed. This might not sound like a lot, but it takes us a while before we are fully given this much responsibility in the US system.

What is hard to put to words is my experience. Obviously, access to care is more limited here so the entire practice of medicine is different. Each test has a very tangible cost to patients that we try to be aware of. When you order labs, the price of each one is totaled below. In fact, I think they should try this in the US and see if it makes physicians think before ordering unnecessary tests. In addition, meds and other resources are limited. The other major difference, especially when the majority of my Pediatric experience was in a rather small setting, is the cases. The disease profiles are totally different. I have not seen a single kid coming in for a cold or a flu, which generally makes up a majority of ER and hospital visits.

What I have seen is kids with devastating infections raging through their body, kids with parasitic infections unheard of in the developed world, kids who crawled into fires, tiny 28 week preemies I am amazed are still alive, and even a boy who likely has rabies. All of this was beyond my scope of knowledge in many ways, and I am learning how to approach these cases both in general and with the limitations of Tenwek in mind. But the one thing that still strikes me is how resilient kids are. The baby in the NICU who was born at 28 weeks – against all odds and without the capabilities of advanced care is still fighting, every day growing gram by gram. Kids with horrible infections or burns on their entire faces are still running around and playing outside in the sun. This very fact is what has always drawn me to Peds – kids are the toughest creatures. It is sad when we can’t help one and a little kid dies, but things that adults would never survive or would send them spiraling into depression, children fight on. While I refrain from photographing patients for obvious privacy reasons, the smiles I have seen on kids faces remind me of why I love this area of medicine.

I have definitely loved getting to do a week of Peds during my very limited time here. I know that I have solidified some knowledge (like dosing medications, the doctors here don’t use fancy EMR calculators to do it for them) and gained invaluable experience. I do hope the faces of some of these patients will stick with me through training.

Plus – all the time in the NICU here should help as I start NICU at Toledo just a week from Monday.

Saturday afternoon, myself and two other girls decided to go on a little hike around the surrounding hills. We hiked to the top of Montigo, which allows you to see pretty much 360 around the area and we could see many of the local towns dotted all around. Most of the hills are green and consist of fields after fields. It was a spectacular view.

It had started raining just before we left, but we decided to brave it anyways. Though we had to walk over steep muddy hills, we made it. We all needed a good shower after tho, and my once clean hospital shoes have now been utterly ruined. Such is life. I wasn’t expecting any hiking or I would have brought my hiking shoes. Hiking in long skirts was also a bit of am experience, but I managed not to totally ruin my pretty pink skirt.

We were walking up past some secondary schools so the kids came running out and we had a crowd of nearly 20 kids at one point following us. They mostly wanted us to give them what we had, but it was funny how we had an entourage of little kids following us.

It was a really fun afternoon and I actually felt physically tired after which is one of my favorite feelings. The orphanage, the hike, and a nice Skype date with Tyler made for a wonderful Saturday.

Saturday morning I went to one of the local orphanages. The town of Silibwet is not far from Tenwek and just past the town is Umoja, an orphanage started by one of the missionary doctors and his wife. What was once 9 kids has grown to almost 60. They have built up quite the facility and have started raising chickens for eggs, have cows for milk, and have a few hectors of land where they grow potatoes, avocados, bananas, and kale. The orphanage sells what they can’t use to help raise money for schooling. In the last 10 years, they have grown so much and many of the kids are even ready to go to university after doing well in secondary school.

I loved getting to play with the kids. We had our obligatory chai and talked about how everyone was doing. Then we toured the facility and watched as the kids sang and danced for us. It was quite a treat. After, we had just enough time for some futbol, jump rope, and lots of hugs. Even a little doctoring as we noticed some pink eye, so I did a few quick exams and we bought some medicine from the chemist in town to help prevent spreading.

I took so many pictures of the kids and the grounds, but here are just a few.

Friday I worked in the eye clinic. It was so busy. We easily saw over 100 patients before lunch and it was quite chaotic. Even with the most organized system, this many people would have been a lot to handle.

I found myself seeing new patients and I had this mom come in with two adorable daughters, Angel and Mary Praise. Angle was two and had previously had eye surgery for cataracts. Her vision is likely better, but her eyes were still not aligned so she had a significant amount of cross-eye and strabismus. Mary was only 5 months old and was found to have cataracts and her eyes did this roving maneuver where they just move all around and never fixate. This is often a sign of kids with no sight at all and the eyes are searching for stimulation. Her pupils also appeared to be completely closed. With kids, a good eye exam is near impossible, so we needed to schedule both girls for an exam in the OR under anesthesia.

I spent some time talking with the mom. Her name was Ann Wanjiru Kamau. She was neatly dressed with this embellished blazer and beautiful curls in her hair. She was unable to see, but you would hardly be able to tell. She told me about her names and her tribe. She was from Naruk which was some 60km away. She asked me all about myself and what I do and where I am from. She asked if she could come visit me if she ever came to NY and made me promise to come visit her at her home if I were to ever return to Kenya. She told me of the chai we would drink and the singing and dancing of all the people.

Ann, being blind herself, and her daughters having both had eye problems indicates a genetic problem, likely congenital cataracts. We told her about what we would try and do to restore as much sight as we could for her daughters. It’s costs almost 17,000 shillings for the operation and with two children, that is a lot of money. We assured her that the hospital could help and I prayed with her and for her. Ann was so grateful and her smile beamed so radiantly. I only wished I could do more.

Ann, Mary and Angel will be coming back on Monday and hopefully go to the OR Tuesday. I will certainly try and go see them on the wards. It was so wonderful to connect with a patient so deeply and I hope you will join me in praying for this adorable family.

This question is one we pose to all patients whenever we see them, why are you here? It’s the most essential part of caring for them. Well, being in a missions hospital means some of the stories are a bit exotic. I have collected some of my favorites below. Most of these a local would never have thought twice about. This why I love getting to practice medicine in as many settings as possible.

1) 45 year old woman went down to get some water when she was attacked by a hippopotamus. Fortunately, she was able to run away but, along the way, she tripped and sustained a severe wrist fracture.

2) 12 year old boy who drank some Tink (a poisonous substance used to wash udders of cows) who passed out and was attached by a couple hyenas, presents with apnea and bite wounds.

3) 52 year old woman who was tending to the cows when she was head-butted by one and broke her hip.

Just wanted to share a few images I took of the hospital. It’s a huge campus and this is just a couple quick snapshots I took.

Main entrance/ER

One of the wards – the wound unit

The guesthouse where I am staying

Today I finally started working at the hospital. Getting to know people and figuring where I should be is not always the easiest task. Most people are friendly enough, but I’m terribly shy when it comes to introducing myself to big groups of strangers.

Today I met with Dr. Mike Chen and worked in the OR with him. It was a long day of surgery lasting from 9-1 and then 3-6. We probably did at least 15 surgeries. Eyes are so small and delicate it’s amazing the precision that goes into operating. We saw quite a few kids. I learned it is quite common for them to poke their eyes out playing with sticks. We try our best to do something, and often it takes a couple surgeries and they still loose their vision. It’s sad. The doctor was saying how much money not treating them could save, but how you sort of feel obligated to try. It was a neat experience, but humbling as many of these kids will never see again. But on the other hand, removing cataracts from other patients restores sight which is purely magical.

It was nice to finally get involved with some hands-on stuff, even if just a little today. Each day I meet more people and find more cool things to be a part of. Today I met one of the amazing pediatricians, so starting Monday I will spend next week taking on my own patients on the wards and I am super excited. Wish I had remembered my white coat toys.

Well, I have finally made it to Kenya. The trip was pretty smooth, all-in-all. My layover was perfect, planes were on time and I had extra seats around me so I could lie down. I tried to stay awake most of my second flight in order to be sleepy enough to adjust to the time difference, but it’s still a bit challenging. Getting my Visa was a breeze and my bag made it – not much more you can ask for on a long flight.

Today we made the 4 hour drive from Nairobi to Bomet, where Tenwek hospital is. The drive was across is huge valley and after a while it felt like driving through central California on the 5. Nothing but farms, cows, brown land and no people. Every time we passed through little villages it was so cool to see some many people and so much fresh food. I can’t wait to get my hands on some fruit from the local vendors here in Tenwek.

I saw the hospital facilities yesterday. They are massive, to me at least. It still amazes me they have this much here. I have not met the team of doctors I am supposed to work with yet, but I will get my pager tomorrow. I did meet a guy whose wife is coming tomorrow or the next day and she is a pediatrician and he insisted I meet her. I am hoping to at least sneak a few peaks of the peds wards in my free time.

There are not a lot of medical people staying in the guesthouse area right now, most of them seem to be in the homes and apartments for more long term visitors. But I am sure I will meet a lot of people tomorrow.

Here are just a few pictures from my drive. I didn’t get to take my camera out much yet, but more to come I am sure.

The Rift Valley

As I sit here, I am wearing a mishmash of my summer maxi dresses and my winter sweaters as I try to pack for Kenya. It is rather cool (lows in the 40’s, highs in low 70’s) right now in Kenya and since I need to keep my legs and arms covered and cannot wear pants, I am finding choosing clothes to be a bit outside my normal go-to style. But so it goes around here.

So, if the post title didn’t give it away – I am going to Kenya. I leave Saturday. Yes, that is 2 days away! In typical Paulson fashion, I booked tickets less than a week ago and have barely even managed to fully process what I am about to embark on.

I have a 3 week break from my normal hospital schedule that was an unfortunate part of having to schedule a rotation in Ohio during October (more on that later). After going back-and-forth over what to do with that time, Tyler and I decided I should see if I could go to Africa. A few emails later, I had a doctor inviting me to come work with him at Tenwek Hospital in Kenya, about 4 hours outside of Nairobi. Getting plans together pushed my faith and patience some (as most missions trips do), but I am so excited to be going and getting to work in the hospital. It is going to be purely amazing! I can only imagine the experience I will have.

Sadly, it is just me traveling. Tyler’s job is not as flexible as it once was, so I am flying solo. However, in a way that only God makes possible, I am actually flying from London to Nairobi with our friend Sabet, which will help make my first night there so much easier. I will be sure to share as much as I can about my experience and hopefully lots of awesome pictures. I am really looking forward to going to see the Elephants and Giraffes in Nairobi and those little cuties I imagine are quite photogenic.

Tyler is actually in Texas right now at a conference. He gets back Saturday just a few hours before I leave. And since our life is whirlwind right now, I land back in NYC on the 6th of October and we are leaving on the 8th to start our roadtrip to Ohio to get me settled in my home-away-from-home for the month. For those keeping track at home, that is a lot of time apart.

So, for now I will continue packing and making lists and I will ask for prayers. Prayers that I will love my time in Kenya, prayers for safety and good favor, prayers for our time apart. Prayers that this fall, despite the fact that Tyler and I will be flying all over the world and country, that we will stay connected. Prayers that this trip will be amazing, I will learn a lot, and I will make invaluable connections. Prayers that Tyler won’t starve to death while I’m gone.

Stay tuned for more posts and updates. I hope to have relatively reliable internet. Email will be the best way to reach me the next two weeks (to avoid international text fees) or you can always call Tyler. Time for an adventure.