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November 12, 2007

Screening patients

Hello from Kisumu. I'm going to bring you up to date on things. Last Thursday and Friday, we began
performing screenings of patients. We are at the New Nyanza Provincial Hospital, which is the main referral area
of the province. First thing you see as you park is a mssion statement of the hospital painted on the outisde wall.
The hospital was built in 1969 and funded by the Russian government, as an effort by the communists to bring Kenya into the eastern bloc.
It feels like a hospital that might be found in the former Societ Union (not that I have any idea what I'm talking about!)
The locals refer to the hospital as "Russia"

There is an interesting poster as you enter the hospital, listing the services, charges, and waiting time! In case you're wondering, we don't have
this type of poster at the University of Michigan Medical Center!

As you can see below, the hospital has covered pathways and outdoor waiting area. There is no air conditioning, but decent airflow and some fans.
When we arrived towards the Operation Smile screening area, we couldn't believe the large numbers of people waiting.
There were infants with their parents with cleft lip, there were adolescents with cleft palates, and many others with a variety of problems,
including keloids, burn injuries, and some very interesting pathology. I saw some things that I
had never seen before.

Here are some pictures of the waiting area...

Each service had their own room...one for the speech pathologists (see below)

That's Erika from Sterling Heights, Mich. and Kristin from Kansas City...both speech pathologists.

Also ones for dentistry, surgery, anesthesia, pediatrician, and a lab. To be honest, if I had to make a recommendation
for the future, I would have liked for dentistry to be with the surgeons so that we could have seen the patients together and discussed their treament.
It didn't really happen that way. The patients were first seen by the surgeons, and then they went to different areas, and the last was dentistry. (Click the link for more)

We didn't have a great idea of what the surgeons had planned before we brought the patient for an exam,
and by that time we were backed up signficantly. Okay, I won't bother you with the problems, but let's just say
Thursday was VERY busy. We performed dental exams for 200 patients! Fortunately my new friend, Dr. Ben Omondi of Nairobi and Kisumu,
arrived to help. I couldn't do it all by myself. Below is a picture of Omondi examining a very cute boy named "Washington".

Speaking of really cute kids, have you ever known anyone by the name of "Loveline"?

If you look closely, you can see Loveline is holding a stuffed Mr. Potatohead. These were donated by Hasbro, which is
based in Pawtucket, RI, right near my hometown of Providence. I made sure to point out to the Kenyans that these toys came all
the way from Rhode Island. (But actually, I looked at the label and saw that they were all made in China (oops).

I mentioned that there was a great deal of interesting non-cleft related pathology. I'm not going to show these pictures, for privacy reasons, but if you are
interested, be sure to get in touch with me and I'll be happy to share these with you.

Here was the chair I had for sitting when I examined patients.

This really reflects much of what you see in Kenya. If items are in disrepair and there are no materials to fix them, they will continue to be in
bad shape. This is a poor country...no doubt, and this is a government hospital. There is not much money for repairs or new equipment. On the other hand, there is
plenty of labor, albeit low paid. I understand the nurses are paid $3 per day on average! The housekeeping staff is paid
even less. The housekeeping staff is very active. Even though the hospital is
low on equipment and repairs, there was not a speck of dirt or stains to be found anywhere. The
floors are swept and mopped, as well as the walls on a daily basis.

At the end of Thursday, the screening area emptied out. We were all exhausted.
I mentioned that the clinics were not airconditioned. We were also pretty hot.

When Friday morning came, as we ate breakfast we had no idea what to expect for screening that day. Would there be fewer patients,
because most people had sought to be first on Thursday, believing "first-come, first-served", or would there be more, because people
may contact their neighbors to tell them that we really were there and they should come. Well, the
former was true. We had a much smaller crew on Friday, and were even able to leave a bit before 5 pm.

Tomorrow is Monday, and we will start procedures for patients. I will be helping with extractions and making some prostheses. Of note, there
is a twelve-year old girl who lost part of her nose when there was a cooking fire in her home. As I mentione dpreviously, there are many, many poor people
in Kisumu who are living in small, shanty-like dwellings and very cramped quarters. They use the cheapest means possible to cook and fires are very
common, unfortunately.

I'll end again with the beautiful side of Kenya. It is now Sunday night as I write this, and today we went hiking through the jungles of
the Kakamega Forest, which is one of the last surviving forests in Kenya, and much of Africa. We saw monkeys playing in the trees and learned some interesting
things about the "social structure" of monkey families from our very knowledgable guide. When we reached the top of the hill, we had some nice views.

In the distance are the Nandi Hills. It is from here that come the great runners of Kenya. They live
at high elevations and have developed with higher hemoglobin levels, which allow them to run long distances with less fatigue.

Good night from Kisumu.

Posted by szwetch at November 12, 2007 12:11 PM


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