December 14th, 2019 by Daniel Russo

Late entry. Written 12/7/14.

While I sit in the main lodge of the Fairmont Maasai Mara, it is hard to recall the events of the last few days prior to arriving (as the events of this weekend have been so exciting it seems to have pushed out the other memories). Here’s what I can recall.

On Thursday we had a change in attendings as Dr. Wandia was at a conference. Our new attending, Dr. Letchford runs a charity called Bandia which sets up electronic medical records in remote small clinics as well as helping them get certified with the National Health Insurance. He brought to rounds a very different point of view. He challenged us to narrow differentials, switching from empirically treating a patient for PCP pneumonia, cryptococcus, and pulmonary TB at the same time, to a more focused approach aimed at treating the most likely cause and limiting medications to keep the patient’s bill low. We also have had a few palliative admissions the last few days for metastatic cancer (esophageal, lung, liver), and because of his main job he seems to have limitless connections with village clinics, thereby facilitating transfer to hospice-capable facilities closer to the patients’ homes.

On Friday we had a grand rounds presentation by the anesthesia department. The speaker is originally from Vanderbilt and continues to bring teams from that institution annually. They have begun training nurse anesthetists at Kijabe who have already spread out not only around the country but also to countries like Tanzania, Uganda, and South Sudan.  There is a severe shortage of anesthesiologists in Africa (only 4 in Kenya outside of Neairobi) so this is an important gap to be filled. After grand rounds we had a 30 minute or so break before M&M so I stopped by the cafeteria and ordered a coffee. I now know the importance of ordering BLACK coffee. What was presented to me was a mug full of boiling-hot milk with a packet of instant coffee on the side. I did not want to waste it (and needed the caffeine) so I thanked the man and drank it. Looking back it makes sense as the way they generally prepare chai (the more popular hot beverage) is by steeping tea leaves in boiled milk.

Morbidity and mortality conference was a different experience from how we run it in our residency. Each mortality from the adult wards and ICU was discussed as a full verbal presentation by the intern or clinical officer and then discussed and assigned a numerical value which was logged that corresponded with the circumstances of the loss (such as 1 being passed away on hospice/comfort care, 3 being a system-based issue contributing, 6 being a completely unexpected loss of an otherwise healthy person). I think incorporating this type of system into our residency’s M&M’s would be a helpful addition.

On Friday I said a half-goodbye to the inpatient Salome (female ward) rounding team. I will be switching to outpatient next week and will miss working with Grace, Faith, Korir, and Winnie. I hope that I have been able to teach them something during rounds this week; they have certainly taught me a lot and it would have been impossible to round without them.

Early Saturday morning we set out from Kijabe to Maasai Mara National Park. The road leading out of Kijabe to the north is a bit treacherous, unpaved, filled with potholes and with a very steep decline. It did however offer us a great view of the Great Rift Valley. We then drove through the valley with familiar sights of savanna, and fields of sheep, goats, and cattle grazing, interspersed with small villages and a few congested cities. The last hour of the drive was what our driver Jonathan referred to as a “compulsory kenyan massage.” By this he meant that it was the bumpiest drive we have ever been on. Due to the rains (we’re nearing the end of tthe short-rains, hopefully) much of the dirt road was badly damaged and even washed out in a couple of locations necessitating us to drive through a small amount of running water. He did a great job and we got here in one piece. We first had a cultural experience by visiting a Maasai village which is still inhabited. The villagers give tours of the homes, cattle corral, demonstrate some singing and dancing as well as how they start fires without matches and of course offer a small market of homemade goods.

Now we are at the Fairmont Maasai Mara and are thoroughly enjoying our break. We are very grateful to Kijabe to give us the weekend off and so far have been able to see lions, cheetahs, elephants, giraffes, gazelles, and more, all in their natural environment. Words certainly do not do it justice so here are a few pictures.