Derrick and casualty RNsAs a R3, I worked at Kijabe Hospital, Kenya for 4 weeks Oct-Nov 2007.
Kijabe Hospital is a rural 200-bed missions hospital 2 hours from Nairobi in the Rift Valley. It has 5 ORs (usually 3-4 running/day), a five-bed ICU (with 5 different vents, all in German), a robust outpatient department (100k visits/year), and a 6-bed Casualty unit. Most of the staff is Kenyan (including orthopedics, and half of ob/gyn) with ex-pat medical/surgical staff from the US, Canada, UK, Germany, and Australia. We were also fortunate to have rotating Kenyan medical students and an intern class to help take call. Hard enough for my wife to take peds home-call q2 for 4 weeks!!!
My duties were to run Casualty, and be the primary consultant for the clinical officers (mid-level provider) in outpatient. It was SO MUCH FUN running my own ER!!!
It was an amazing experience. As in any poor patient population with little healthcare access, they waited so long to seek care that the pathology was right out of a textbook. ALS by exam. Myxedema just by the clinical officer rattling off the laundry-list of complaints. Epiglottis. Prostate Ca by a rock-hard prostate. Advanced Breast Ca you could dx across the room. Filariasis. Post-partum CM. Cushing's Reflex in a 15yo with TB meningitis. Also, plenty of dirt sick HIV/AIDS, TB, trauma, sepsis, DKA/HONK, and pediatric resussitations.
The best part of the experience was interacting with ex-pats and eating up all their stories and experience. One doc who trained IM-Peds at Emory, worked at a bush hospital in Zambia for 7 years, and is now interim medical director at this hospital was fantastically encouraging. He said that his experience, EM docs were the most adaptable, teachable, and comfortable working in the bush (yay us!).
It was definitely a fun and encouraging trip. My wife and I hope to return to Africa frequently. Kijabe's an easy option for us since there'd be a place for me to work--not only could I have a reasonable standard of practice, there's definitely a need for better patient flow/triage and trauma/critical care education.
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