Doctor Strike

When planning this trip, Paige and I had absolutely no intention of using our medical skills.  I know that I earn my degree in three months, but I still do not feel like a full-fledged physician.  Right now, however, doctors in Kenya are on strike and small problems in Mlolongo are snowballing because people cannot access any medical care at the government hospitals.  The private hospitals are simply too expensive.  Surprise surprise... Kenya and America have something in common.  Clearly neither country has figured out how to make healthcare both accessible and affordable while compensating medical professionals appropriately.  But let's not get started with that topic.

When the word got out that there were two Mzungu medical students in the area, people flocked to the office.  We had to be very adamant that WE ARE NOT DOCTORS and still have a lot of training ahead, but we were able to handle many of the small complaints that walked through the door.  We saw many with common colds, some joint pain, GERD, and one urinary tract infection.  Unfortunately, just as in the US, we had a patient with severe liver disease.  When she walked in the door, she looked so hopeful that we could offer her a cure.  Even in the US, liver disease is complicated and difficult to treat, requiring many years of fellowship to understand.  The etiology of her liver disease was also unknown and, obviously, I could not order LFTs, a hepatitis panel, nor a right upper quadrant ultrasound.

We also had one patient who left us completely stumped- HIV+ with some unknown surgery to remove an unknown mass in the intestine who has had darkening and tightening of the skin, ongoing post-prandial vomiting, and a 30kg weight loss over the past 2 years.  With about 10 different diagnoses running through my head and confidence that I missed some of the history with the language barrier on both ends, I left feeling frustrated and confused.  If I have learned anything yesterday, it is that we, the American medical community, are too reliant on lab tests and imaging.  I tried desperately to channel the Doctors Berg, Majdan, and Mangione, leaders of my medical school's Physical Diagnosis class.

Like I discussed in my first post, expectations are high.  Even people that are getting over the flu came to see us because I think they thought we could somehow magically cure them.  To make matters even more difficult, there are barriers that seem insurmountable, the lack of lab tests or imaging notwithstanding. The language and cultural barriers make communication of medical issues borderline impossible.  I kept trying to ask people about their bowel movements and many would simply not tell me.  The way I ask questions in America just does not translate appropriately.  All of these barriers created more questions than I had answered about the patients I saw and, needless to say, it was an excellent test in my ability to tolerate ambiguity.  (To my fellow Jeffersonians, Dr. Mangione would be proud.)

If anything, this experience reinforced both the need for a free clinic and training for community health workers who may be able to screen many of these simple conditions before they spiral into a fatal ending.


SPECIAL THANK YOU TO ALL THOSE FRIENDS AND FAMILY WHO DONATED MEDICAL SUPPLIES!
We could not have gotten through yesterday without your generosity!