Day 7 - Escaping elephants and other emergencies

Jumbo from Lewa! 

Our second full day at Lewa was a busy one.  Dr. Sidiqa went with Lydia to the hospital to observe the cataract surgeries and help with ensuring proper follow-up instructions were being given to the patients.

And the other 3 docs gave presentations covering asthma, hypertension, fungal infections and scabies. 

Some of the patients who are waiting to be seen

Some of the patients who are waiting to be seen

I was approached by John K., the manager who oversees the health clinic, that we need to aim to be finished by 5pm this evening.  Yesterday the patients who finished by 7:30 all still needed to walk across the conservancy in the dark.  This is actually not allowed and is not safe given the risk of encountering such things as lions and buffalo.  I thought a perfectly reasonable request!  He told me that while we had been conducting our morning lectures the clinic had already registered 100 patients to be seen today and the cutoff will be 120.  I warned him that # of patients did not mean # of patient visits as most of the patients will want to see multiple doctors.  This could result in over 200 patient visits easy. 

Our strategy would be to move as quickly along as possible and carefully select the cases that we believe to be rich learning experiences.  Those we would take longer with.  And we should take longer with, because our goal is not to see record numbers of patients.  That is not sustainable and only helps the patients we saw on that trip.  Our goal is to educate and train the clinicians so that they can operate at a higher level when we aren’t there.  That way the patients helped over the course of a year becomes exponential and is long sustaining.

A young patient

A young patient

However, we still needed to contend with the fact that 120 patients needed to be seen today before 5pm.  So we began seeing patients straight away after the lectures and the obligatory tea at 11am. 

After a VERY quick lunch we arrived back at the clinic to literally a mob of people.  There is tension in the air with people yelling at others for skipping the line.  They are tired, frustrated and hungry.  You can’t blame them.  We in the west get upset if we need to wait 30 minutes to see the doctor.  Some of these people have been here since 8am and it was then 2pm.  Although they may have seen one doctor they are now in another line to see another one.  It’s a mass of people that never gets smaller and we only have until 5pm to get through it!  Can you imagine being turned away after waiting all day!? 

A patient escaped 5 elephants but fell and hit his eye on a rock in the process. 

A patient escaped 5 elephants but fell and hit his eye on a rock in the process. 

An emergency case was a man who arrived with a laceration to his eye going into his tear duct.  He’s an employee of Lewa working in logistics.  He encountered 5 elephants and was forced to run from them.  Good news is, he got out of the way of the elephants but unfortunately he fell and his eye hit a rock. 

Dr. Sidiqa, our optometrist was at the hospital observing the cataract surgeries.  I contacted her, sent her photos of his eye for her opinion.  She was relieved to see that his eye looked fine, but he will likely have dry eyes and tearing issues if the laceration is not sutured properly.   We organized for transport to take him to the hospital and she was able to navigate him through the process to ensure he had immediate care.  They successfully sutured him and he will likely have no long term issues.

Another emergency case involved a 10-year-old boy who had come in contact with a euphorbia candelabra tree which secretes a milky sap that is highly irritating to the eye causing a conjunctivitis and swelling of the eyelids. The condition is quite painful but fortunately he will make a complete recovery.  It is in fact a common issue the clinic deals with all the time.

The brave little boy had actually walked himself to the clinic!   Luckily a neighbor of his happened to be at the clinic as well and was able to escort him safely home. 

One uplifting story is that a young girl arrived who we’ve been following for a year when she arrived with a heart issue.  We referred her to have an ECG which revealed that she had PDA, a whole in the heart.  The family was fortunate to have a donor from Lewa sponsor the required surgery and she is 100% cured!

Our day finally came to a forced end by 5:30 which allowed for the staff and community members to traverse the conservancy safely to their homes.  We turned away about 20 people but promised to see them first tomorrow.  Today we followed a first come first serve strategy.  Tomorrow it will be based on degree of need.  We saw many complicated cases that required more time and will be added to our complex case bi-weekly call we do from our office in Toronto back to Kenya.  However many others were minor or even “well patient” visits where the patients simply wanted to see a doctor from the West.  Although totally understandable, the worst case scenario is that the patients truly in need won’t be seen and given the counsel of our docs for proper disease management.  A triaging system will be implemented whereby Vanessa and one of the clinical officers will assess the seriousness of the condition and will queue them accordingly.  Let’s just say she is a brave soul!!

Our day tomorrow will include the second round of cataract surgeries as well as the removal of the patches of the first set of patients.  Back at the clinic we’ll again begin with lectures which we will likely shorten given the large numbers of patients who need to be seen.  The rest of the day will be examining patients.  Hopefully the numbers will be manageable and we will end on a positive note, and by 5pm!

We ended the evening with a lovely dinner full of stories of the day as well as lots of sharing about family.  We have all been without our loved ones for quite sometime and we are all very much missing them.  It makes us feel a little better (even if just a little bit) to at least talk about them.  But for sure most of the meeting is spent laughing.  This is one of the funniest groups I’ve had the pleasure of bringing over and I will miss them very much when the trip comes to an end.  

Until then…..lala salama!

And thanks for reading….as always!