All Creatures (and Problems) Great and Small

We are too busy with people to pay much attention to birds, although Kenya reportedly has 1070 different species. This morning, however, I can verify that a stately Hadada Ibis was wandering about the yard in the company of our patriarchal rooster and his kukus.

Nadia stitched up a gaping head wound in the operating theatre today. (Note the shoes outside the theatre door, so we don't track in dirt -- just "athlete's foot"!) The patient's brother had attacked him with a panga, believing Joseph to be the thief who was stealing his maize. We noticed that, in spite of the heat, our patient was wearing three pairs of pants. We were told it is commonplace to wear several layers, everything a person owns, to the hospital: if clothing were left at home, it would be stolen.

Not unexpectedly, Shadrack died last night. His daughter came into the office in tears this morning to thank Dr. Hardison for being "so kind and so honest" in his assessment with the family yesterday. Jessica's ascites was tapped again (1.5 liters of fluid), but her temperature is rising, her CD4 count is falling (23), and she is clearly failing.

There was no chest tube "available" for Esther, and the medical officer on duty declined to use an NG tube, a routine substitute here, in its place. As a result, Dr. Hardison removed 330 ml more pus from her chest with a needle to at least relieve her discomfort. She was discharged on Augmentin today and invited to return for a repeat chest xray and follow-up on Monday.

Andrew's biopsy results (supposedly negative) came back; he is still in obvious distress, and Dr. Hardison still suspects a lymphoma. A visiting surgeon will do exploratory surgery this afternoon. Our cardiac mystery man continues to improve, in spite of all logic -- and in spite of a BP of 115/15. There's no way to tell the source of his problems without diagnostic equipment unavailable anywhere in Kenya.

Meanwhile, even our one pulse oximeter is not behaving; the problem appears to be with the probe.

More happily, we witnessed a mama's prolonged labor and ultimately successful vaginal delivery last night. Hearing six student nurses shouting "Sukuma! Sukuma!" ("Push! Push!") -- all the while pressing frenetically, not even in turns, on the fundus -- in a stark six-bed delivery suite in Africa is quite unlike hearing Pachelbel's Canon and having only a mother's partner present in a private, pastel hospital room in America.The newborn was suckling with surprising vigor this morning, however, and mama -- who had climbed off the delivery table and walked back to her bed in the ward -- was resting peacefully.

Tomorrow we hope to go to Kisumu to visit the cultural museum -- and an ATM, so I can keep on blogging, patient readers.