As I approach 4 months in Kenya, so much about living here is just normal now. Bartering at the market for my fruit and veg is routine, as is fending of the matatu touts at the stand, and navigating the melee of busses, cars, potholes, people and boda bodas as I walk to the shops.
It’s normal to hop on a matatu to get somewhere and pass the time listening to the radio. In all honesty, it’s difficult not to listen to the radio, as anyone who has been on a matatu will testify. The radio is unlike anything you might hear at home. A playlist might look something like this:
Tarrus Riley – Sorry Is a Sorry Word
George Nooks – What a Friend we have in Jesus (Reggae Version)
Celine Dion – My heart will go on
Chris Martin – Let Her Go (Reggae Cover)
Dolly Parton – Stand by Your Man
Adele – Hello (Reggae Cover)
One of the great joys about here is working regular hours, no nights and no weekends. Not working nights is now normal! This is something I could happily live with for the rest of my lift. I suspect I’m not going to readjust well to working nights again at home…
Kenya is a phenomenal country, and I get to travel and visit the most amazing places regularly. During recent trips I’ve been to Chogoria, Eldoret, Kakamega, Lodwar and Lake Turkana. Still on the list of places to visit are Iten, Lake Nakuru, Lewa, Masai Mara and a few other places. I have been charged with climbing at least two mountains whilst I’m here. I’m only half way there so far.
It’s now normal for me to consider the monetary cost of every intervention I make. I often think in terms of how many days food a test will cost a family. for example, the ‘routine’ requesting of an EEG and CT brain for a child with epilepsy could easily cost a months wages, and it’s unlikely to affect how I treat the patient anyway. Simple blood tests require careful consideration too. Will the result change the management of my patient? Can I trust the result I will get? I’ve really had to hone my clinical judgement.
When I pause for a moment or two, it’s also a little unsettling just how routine it is for me to resuscitate a child, and how infrequently those resuscitation attempts are successful. Performing full CPR is relatively rare at home, even when working in the largest children’s hospital in Scotland. Here though, it isn’t unusual to have a day when we perform CPR on 3 or 4 children. The reasons for this are legion. Sepsis is common and so very difficult to manage without ventilation, inotropes and other intensive care interventions. Similarly with pneumonia. We have CPAP, but access to ventilation is severely limited. Families present late with sick children, often because the cost of a hospital stay can be devastating for a family. Seeing neonates return with sepsis, not feeding, having lost 40% of their body weight happens almost every week. All this can add up to feeling like we’re firefighting much of the time. I am full of respect for the doctors who work here full time.
We have occasional wins however, and it’s important to celebrate them. That can be the child who has arrested, but because effective CPR was commenced promptly, the child is fully responsive just an hour or two later. Or it can be the child with meningitis who arrives in status epilepticus due to meningitis, but after 2 weeks of treatment, can leave the hospital and carry on with his life.
I’m aware that before I know it, I’ll be coming home. And according to everyone that’s been this way before, going home is more difficult than coming to work overseas. I’m beginning to anticipate that. It’s even got a label: reverse culture shock. According to Eldryd Parry, readjustment time can be estimated by taking the square root in years of the time you’ve spent overseas. Unsettlingly, the square root of 7 months is… 9 months. I’ll not think about that for now. I’ll keep plodding on, and enjoying as much of my time here as I can, while I can!