We received some saddening news upon arrival to the clinic that our child with malaria had died at 3am this morning. Malaria is a terrible illness in this part of the country; however, if it is caught early it can be treated with anti-malarial medication. Our child presented with fulminant cerebral malaria, scleral icterus, and an extremely high fever. Our clinical suspicion was that this baby had been sick for a long time and was not brought to the clinic soon enough. Unfortunately, poor familial dynamics, economic problems, and some neglect likely played a role. The mother and family were distraught but according to a nurse at the clinic, the family accepted the situation and brought the body home for proper burial. We learned that small graves behind Kenyan houses were common.
On the opposite end of the spectrum, we experienced the miracle of birth today as well. Upon arrival, a 16-year-old female was fully dilated and was having regular contractions. She, however, was extremely non-corporative–not responding to commands and rolling on the floor. The pain was unbearable and resulted in her being more comfortable delivering on a mattress on the floor. Several of us held her legs, one supported her head, and more women were encouraging her to push from above. It was organized chaos. After two hours of pushing without pain medication, it was becoming clear that the baby needed to be born. The mother was exhausted and pushing became a battle, but she was informed that if she did not push the baby would surely die.
Many of us have seen live vaginal births before, but this was far different than anything we had seen in the United States. There was no nearby operating room to transfer the patient if the pelvis was too small or the passenger was too big. The mother’s vitals were not monitored in real-time, and the fetal heart rate was listened for by a small rubber device instead of a real-time monitor. The room was absent of family members–the mother was en route but was over 3 hours away and the father was not present. The patient was also not receiving pain medication nor was it an option. It was the purest form of childbirth many of us had seen, and we realized that women of Kenya and healthcare providers deserve great respect. While women and partners in the United States tour OBGYN departments to see which places have the most comfortable private beds and greatest sunlight entering the rooms, these women just hope that their birth is without complications. We must be grateful for this luxury in the United States and applaud the healthcare providers in Kenya for working diligently with what they have. In the end, a healthy baby girl was born and will stay for the next 48 hours.
Outside of the OBGYN room, clinic these last few days has been very hectic. We saw another case of mycobacterium ulcerans, diagnosed additional cases of malaria, and determined two more women were pregnant today. The high number of Kenyans coming to our clinic is secondary to the doctor’s strike that is occurring in the country. Doctors are on strike due to monetary reasons and the upcoming election. Mama Pilista Medical Clinic is the only clinic in the area that is still taking patients, so even though resources are somewhat-limited, the patients are provided with excellent care during this tough time. It is important to note though that any referrals or hospital transfers are limited–making severe cases harder to treat.
It has already been a whirlwind of a week and it is only Wednesday! We wanted to end this post by just reviewing who our team consists of as several people have inquired.
-Two Internal Medicine Doctors–one who practices outpatient and one who practices inpatient
-Two Family Practice Doctors (including Dr Bonyo)
-One hostel building volunteer
-One donation/organizing clinic volunteer
-One fourth year KCU med student
-Two third year KCU med students
-Two second year KCU med students
-Group of 15 Lao/English translators
-Clinic coordinator and clinical officers/clinical nursing staff (10)