Week 3: Female Ward

December 20th, 2019 by Elaina Truax Russo
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It is hard to believe week 3 is now complete, which means our time at Kijabe has come to an end. The time surely has flown and it is sad to be leaving. However, I have a feeling we will likely be back someday in the future.

This week, I was on the inpatient female ward. My team consisted of Consultant Dr. Tony (Internal medicine attending physician originally from Texas), a clinical officer, a clinical officer in training, and a medical student. The first few days I mainly observed on rounds in order to get the hang of things. The past 2 days, however, I had the chance to run rounds with the team and act as a consultant (attending).This was a great learning experience as it gave me a feel for what things would be like if we return in the future, after residency. It also gave me a chance to do some teaching and to make some medical decisions. When making decisions, cost of care was often considered as well as long term goals and prognosis.

Unfortunately, we had some very ill patients this week. There were several women with advanced (stage 4) cancers. This led to discussions about goals of care and code status. There is an ICU at Kijabe and they have the ability to intubate and have patients on ventilators. While these resources are limited, this is much more advanced than other hospitals we have worked at in the past in Africa.  I had the opportunity to sit in on two family meetings which were run by the palliative care team. It was interesting to see how these conversations culturally compare and contrast to conversations back home with families.

Christmas is right around the corner. On Wednesday morning in chapel, we sang Christmas carols in both English and Swahili and had a cake to celebrated the birth of Jesus. It was a special time of celebration. Last night and tonight, there are advent activities at some of the long-term missionaries houses. We have appreciate the kind hospitality of the people we have met during our time here.

If you are considering going to Kijabe, I highly recommend it. It was a great learning experience as a resident. I could see this as a place to return to periodically over the long-term. The people are kind and gracious and the landscape is absolutely beautiful and seems like what the Garden of Eden would have looked like. I have never been anywhere quite like it and I am thankful for this opportunity.

Tomorrow we plan to go to the giraffe center and elephant orphanage before our flight out. It will be nice to be home in time for Christmas.

Thank you to everyone who has supported and prayed for us during this this trip. We greatly appreciate it.


Week 2: OPD

December 14th, 2019 by Elaina Truax Russo
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This week we were seeing patients in OPD. This is the outpatient clinic for older children and adults. Like pediatrics, the visits are walk-in. The majority are acute visits , however, occasionally people would come in for a blood pressure check, medication refill, or hospital follow up visit.

It always is tough changing departments and starting fresh on the first day. The logistics of referring patients, knowing who to call if there is an emergency, which medications are available, etc. takes a few days to figure out.  By the end of the week, however, we started to get the hang of things. We were thankful for the kind ladies in OPD who helped us find English-speaking patients and helped us figure out the flow of things.

One of the interesting logistical things we became more familiar with this week is how patients pay for treatment. This was a painful lesson to learn as it occurred while we were trying to do a lumbar puncture on a patient we were concerned may have cryptococcal meningitis. Before the procedure could be done, the patient had to go to the cashier and pay for the procedure and all the supplies including gloves and a spinal needle. Once payed, the procedure could be completed. As we were new to the process, the patient unfortunately had to go to the cashier a few times as we originally did not order the lab work (CSF fluid studies) that also needed to be payed for ahead of time. The patient took this all in stride and was very understanding. In some ways it makes sense to have patients pay up front as they are not stuck with a big medical bill at the end of the day, however, from a provider standpoint, it does slow the process down and it was difficult to learn the flow.

We often asked patients how far they had traveled to come to the hospital, out of curiosity. It was not uncommon to hear >5 hours and some said upwards to 12 hours. They often traveled the day before or overnight in order to arrive at the hospital early in the morning to get in the queue. Many were elderly or families traveling with small children. Many had also seen providers closer to home but were either referred to Kijabe for further care or were not having improvement in symptoms causing them to seek care elsewhere. One patient traveled 8 hours to be treated for an ear infection. Another patient was referred for a second opinion on constipation. Overall, many illnesses are similar to what we see in the US. However, there are differences. For some reason, DVTs and PEs are pretty common here. Breast cancer is fairly common and routine screening is not performed so women often come in with breast masses or similar concerns. Cervical cancer is common however the HPV vaccine is becoming somewhat more routine so hopefully this decreases in the future. Pap smears are actually fairly expensive (1250 KSH, or $12.50) compared to a TB test which is 250 KSH ($2.50).

On Tuesday, I had the opportunity to give a lecture to the interns about “chronic cough”. It was interesting to hear about some of the differences between workup and treatment in the US vs Kenya. In the US, we often think of “asthma, allergies, acid reflux, smoking” as common causes of chronic cough. Here, when I asked the interns what is on their differential for chronic cough, TB and PCP pneumonia were at the top of their list. To test for TB, instead of a PPD test, they use a Gene Xpert test which is very fast and cheap. Also, everyone gets the BCG vaccine (TB vaccine) here, so they were surprised to learn that their PPD test would come back positive if they were ever tested in the US.

On Thursday, the clinics were closed due to Kenyan independence day. We were on call and went to the hospital once that day for an admission. Overall, it was a nice day.

This weekend, we are on call as well. The time is going fast and we only have one week left. Next week, I will be on the inpatient service.

Maasai Mara

December 8th, 2019 by Elaina Truax Russo
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The hospital kindly gave us the weekend off to do some traveling! We are currently at Maasai Mara which is a wildlife reserve and definitely one of the most amazing places I have ever been.  Kenya truly is beautiful.


December 8th, 2019 by Elaina Truax Russo
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It seemed like each day in the pediatric clinic last week had a theme. Day 1, we saw a lot of congenital limb abnormalities and developmental delays (delayed walking, talking, etc). We referred many of them to physiotherapy and some were also referred to the AIC-CURE international hospital which is an orthopedic pediatric teaching hospital located right beside Kijabe Hospital. This is a fantastic resource for people in the community. At Cure, they are able to perform surgeries for club feet and other orthopedic conditions. Their website is really interesting and we hope we get a chance to go into the hospital before we leave.

Day 2 seemed to bring in a lot of children that we referred to the outpatient pediatric surgery clinic which happens on Wednesdays. A lot of hernias and other surgical things.

Day 3 brought some sick kiddos.  One child was hypoxic (low oxygen) in the clinic to the low 80s. We immediately took this little one to casualty (the emergency room) and hooked him up to oxygen. He ultimately got admitted and treated for pneumonia.

At the end of the day, a very jaundiced baby came in. Jaundice starts at the top of the head and works its way down on the body. This baby was jaundiced all the way to the feet! He was starting to look like a highlighter, which is never good. Unfortunately, we had received word earlier in the day that one of the machines in the lab was broken and only specific labs could be run that day. Therefore we were unable to get a bilirubin level on the baby to see what treatment he would need. The family was advised to drive to Nairobi for lab work and treatment.

Day 4 had some heartbreaking moments.  A baby came in with craniosynostosis (cranial sutures close too early, causing skull abnormality). The parents traveled a long way via public transportation (at least 6 hours according to a direct route on google maps, but likely much longer with public transportation). The parents were told by a pediatrician in their community that the baby needed to see a neurosurgeon and the dad said he “googled” it and found Kijabe’s website. Unfortunately, the neurosurgeon at Kijabe left a few months ago so the hospital currently does not have one. The parents were advised of another missionary hospital they could go to which is actually closer to their home. The parents took this in stride (much better than an American parent would have taken it) and simply said “sawa sawa” (OK).  It was actually very fascinating from a cultural standpoint. The Kenyan people are very soft-spoken, kind, and easy to laugh. Never once in the pediatric clinic did a parent yell or express anger over waiting to be seen or dissatisfaction with the medical recommendations. Much different than the US!

Later in the day a child came in with hearing difficulty. He was not doing well in school as a result. The patient had been treated with antibiotics for pneumonia as a baby, so the hearing loss was likely a result of a side effect of an antibiotic. We were able to send this child to ENT and he had a hearing test done. The plan will be for hearing aids when the family can afford it.

Day 5 was the day of jaundice. A lot of newborns came in for a checkup and we needed to check bilirubins. Thankfully the lab was working this day and we were able to get the labs that we needed. Two babies did have to be admitted for phototherapy. It is interesting that if the bilirubin level is very high, they have the ability to do IVIG and Exchange transfusion here. At home, we would send these babies to a pediatric hospital for care.

Overall, a very interesting week in pediatrics. Intermixed among these interesting cases were common colds and gastroenteritis. In regards to malnutrition, they do have a nutrition department here. They also supplement every child with vitamin A and a multivitamin. They give iron-folic acid to pregnant mothers. Most children are vaccinated. De-worming is done every 6 months from age 1-5 years.

A note to self and to others who may be coming to Kijabe in the future: I would definitely want to bring a tape measure next time to measure mid-upper arm circumference in children.

Monkeys at the hospital (mama and baby monkey on her belly)

Week 1

December 5th, 2019 by Elaina Truax Russo
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Week 1 at Kijabe is almost over and we have gotten over the jet lag and are feeling more settled. This week I was in the pediatric outpatient clinic. I do not have access to the computer system yet, so I worked with one of the interns this week seeing patients. We saw a good mix of pediatric cases, many similar to what I have seen at home. There were a few malnourished kiddos, but the clinic has a nutrition center and keeps close tabs on them. The intern I worked with was a rockstar in regards to seeing patients and it was really nice to learn from her about how the system works and the resources the are available. The majority of appointments are walk-in, meaning that we never know what the day will hold. The nice things is, it is not just the primary care offices that are walk-in, but referral services are as well. Therefore, most referrals are seen same day, or at least the same week, which is really nice. For example, if we needed a child to see ENT, we would put in the consult and send them to the ENT building to be seen. This is different than at home as it may take a month or so to set up this appointment.

Overall, Kijabe is a well-oiled machine. It is a teaching hospital so they have residents and consultants (attendings) just like back home. They have lab capabilities, CT scan, an electronic medical record, physiotherapy services, dental, nutrition, plastic surgery, and the list goes on. It really is amazing.

The sureounding land is beautiful! We usually see monkeys on our walk to work which is a lot of fun. We’ve been told to not forget to close our windows at night as the monkeys are known to enter homes and cause a mess. We have not forgotten these words of wisdom!

Tonight is our first night on call. We are a little nervous as we are not quite sure what to expect. It will be good to get the first one done and it is nice that Dan and I can do it together.


Here we go!

November 30th, 2019 by Elaina Truax Russo
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After  having a breakfast of leftover Thanksgiving pie, we made it through security and are now waiting to board our flight 🙂

My husband and I are both third year family practice residents and are thankful to have the opportunity to go to Kijabe together.  We plan to be there for about 3 weeks and return home right in time for Christmas.

Stay tuned for periodic updates once we get settled in Kenya.




Introducing Myself

November 30th, 2019 by INMED
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Hello! My name is Elaina Trax Russo. I am a Resident Physician at Wellspan York Hospital Family Medicine Residency. I am starting my INMED service-learning experience at Kijabe Hospital in Kenya in December 2019.