Got this email from my leader about what to expect on a daily basis and things such as clinic, hugs, tears, lack of sleep, HEAT, education, FOOD......GOAT, yes, I will be eating goat for the first time ever & probably a few other things! One thing I like is that at the closing of each day we get together and talk about the highs and lows and what to work on the next day!!
The email:
I thought also this week we might give everyone an idea of what a typical day on the ground in Kenya will be like. To be honest, this is nearly an impossible task because each day may be unique and different, and full of new adventures, but here are some things you might expect. To some of you this is old hat, and to others not so much.
Travel – We will be in a very rural area of Kenya. In order to reach the most needy we will need to travel by vehicle far from Nairobi. The travel will be in rented SUVs, vans or other similar trucks. Sometimes it can be over-crowded with more people in a truck than you would expect sometimes for many hours at a time. The roads (if you want to call them that) can be deplorable, bumpy, rough, washed out and unpaved. At times we may find ourselves driving off road. At times we may have to hike short distances. Begin to prepare yourselves for a few long hard days of travel up to Turkana and back.
Sleep may be hard to come by. For whatever reason, roosters crow all night, dogs bark all night, noisy trucks pass by, and you will be sleeping in a room with a roommate who might snore and need to visit the bathroom several times a night. If you think this will be difficult, earplugs are suggested! As I have stated previously, a small pillow and lightweight sleeping bag are suggested, but (especially in Turkana) the nights can be quite hot.
We will often be up early in the morning, around 6 or 7am. Breakfast will usually consist of eggs, Mandazi,, toast, tea and possibly fruit. On previous teams we have all brought snacks and put them in a team food bag/bin to share and supplement our drinks and meals. People bring nuts, trail mix, instant oatmeal, granola, ramen noodles, beef jerky, cereal bars, protein bars, candy bars, dried fruit, instant coffee packs (from Starbucks a must!), drink mixes, honey, peanut butter and the like. The selection of food there is pretty much non-existent.
After breakfast we will walk about 1 mile to Pastor Joseph’s church where we will be holding clinic. On our first day we will spend some extra time setting up clinic. After that, partially set up an area that we had used previously. In this church, it is possible for us to secure clinic items overnight. The clinic is frequently divided into several very distinct sections:
1. Intake – The area outside the clinic where people line up waiting to get in. We try to arrange for locals and local pastors to assist us with crowd control outside the clinic. Names, complaints and ages on a small piece of paper known as the “triage slip” are written and that they will bring it into the clinic with them. If any of you are joining us on the trip without any medical training, this is one of the places where you will be working. It is not uncommon to assign a nurse to this area to provide rapid triage, and to skim off people who do not need to be seen in the clinic and can be cared for in the lineup. Patients may at this point be sent to a more specific area, such as the dental clinic, or eyeglasses station.
2. Assessment – Most of the nurses will find themselves working at small assessment stations inside the clinic. If possible, a small table with a couple of chairs will be at the assessment station with some basic medical equipment (your “Where There is No Doctor” bible being one of them). The nurse and a designated translator will see patients at the station, getting a history, performing a brief, sometimes focused physical assessment and trying to determine how to best help the individual or family. Teaching will occur at this station as well as developing a plan of care.
3. Treatment area – There will also be a designated treatment area. Typically, physicians, mid level providers and nurses will rotate through this area where a more in depth assessments and treatments can be performed. Patients can be referred to this area from the assessment stations as needed. Everything from IV rehydration to pelvic exams to wound care can occur in this area.
4. Pharmacy – Staffed by a nurse and/or non-medical personnel, patients who require medications of any kind will get medication from this area. In the past we have gone from sending patients to the pharmacy to having a runner who will go from station to station and get the triage slip with the medications needed listed on it and take it to the pharmacy. They would then return it to the station. We have also had the nurse him/herself go up to the pharmacy to get the medications. There are many different ways of doing this, and as a team we can see what works the best for us.
Expect the clinic to be hot, noisy and overcrowded. Imagine 50 people, a mixture of Kenyan patients, translators and American personnel all crammed into one or two classrooms or a small church space simultaneously performing assessments and treatments. We encourage everyone to take breaks whenever it becomes overwhelming.
Part way through the day, we will be supplied with lunch. If at all possible, we may choose to take lunch in shifts so that we can keep the clinic running, but sometimes it is nice to just shut clinic down for a half an hour. This all depends on what the group feels like doing. We do make an effort not to eat in front of the patients. Lunch will consist with bread, fried local flat bread like chapattis, PB & J, fruit, our snacks, hard-boiled eggs etc. Some people bring hard salami that does not have to be refrigerated. Fair warning; the lunches are nothing to write home about…. There is a possibility, however, that we will be cooked for on a couple of occasions!
In the afternoon, we will begin to wind down clinics and gather people up outside the clinic area to perform teaching. This may happen in small increments during the day also. Teaching may consist of first aid, water purification, worms, body mechanics, nutrition, breastfeeding, fevers, cleanliness, tooth care and avoiding infection. Others will stay inside the clinic and help pack up.
After clinic we will all make our way back to the compound where we will be staying. At this point people have down time to shower, wash clothes, read, play games, nap, etc. Dinner will be prepared for us, which usually consists of some combination of chicken or goat, beans, rice, bread, soup, a variety of sauces and if we are lucky some vegetables thrown in. We will push the request to add vegetables to our diet.
After dinner we will have our team meeting to talk about what worked and what didn’t, what changes we could make, any interesting patient’s we saw, and discussions and input on treatment regimes. We will talk about our highs and lows, our fears and adventures, and anything else that suits our physical and mental needs. Then it is bedtime!
Again, each day will be different, some days we may be doing more organized education for women, men and local health care providers. We also at times send a couple people out on excursions to people’s huts or other small villages to help someone that is unable to come to the clinic or to follow up on care provided just days before.
So we hope we didn’t scare you off! This is truly an adventure in each one of our physical and emotional states, as well as being extremely educational. We see so many different diseases and illnesses that are not seen in the US and it involves close teamwork and communication. It involves laughter, crying, hugging, talking, pats on the back, and alone time to process. It involves flexibility on everyone’s part and awareness of a constantly challenging environment.
Hakuna Matada,
PS this is all subject to change at a moment’s notice, so practice your mental and physical yoga because flexibility is the key!
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