Block Party

    Today started much more smoothly than yesterday (probably because of the shower), and we quickly found ourselves involved in all manner of interesting regional procedures in the theatre. This is mostly because there were two total knee replacements scheduled today, and it was just the opportunity we have been looking for to put in some nerve catheters and fill up some bupivacaine infusion pumps for continuous patient analgesia after what is otherwise a very painful procedure. We also got Dr. Newton excited about regional anesthesia at Kijabe, and I took a bunch of good pictures of Joe going over the different techniques with him and one of the excellent Kijabe nurse anesthetists, Alice. Here's a few samples:

Inspecting the On-Q pump

Alice placing a femoral nerve catheter

Filling the On-Q

I also did some procedures. Here I am teaching the

patient the intricacies of human popliteal anatomy.

Here's Joe pointing out that I didn't have the ultrasound machine on.

Asleep in the doctor lounge. All we need to be real

anesthetists is a half-done crossword puzzle.

     That last picture was taken by Lydia, the Theatre Charge Nurse. She's the boss here, and I think we are on her good side. That's pretty important to be able to function here since she could make things pretty hard for us if she wanted to. Interestingly, the anesthesia providers rarely take their patient back to the ORs. Instead, Lydia or Mary will move patients to their rooms as soon as the last ones are out. I can't imagine the chaos that would occur at Vandy if the holding room nurses just dropped the patients in the ORs whenever they wanted.

Lydia: Don't Tread on Me.

    We had Chai and lunch as per usual. I'm realizing that people here talk about Chai time in the same way that drug users at home talk about their habits. They always ask: "Do you take tea?", and the phrase "Do you want to get Chai?" is a bit too close to a familiar question asked of many a peer-pressured high-schooler. Here's two shots I took from the Chai room for perspective.

Just outside the Chai room: The hospital boneyard.

Chai to the right. Evil water bottle to the left.

    At the end of the day, Joe was asked by one of the surgeons if he could put a central line or an IV in for a patient the medicine team was following for a GI bleed. Joe agreed, but asked the patient to be brought to the theatre for line placement. She arrived a few hours later, Joe popped in a quick PIV in her IJ, and then took her to PACU. In PACU, we realized she was really sick. Joe called Evelyn in the ICU and told her we wanted to bring the patient to the ICU. She agreed, and the patient was in the ICU within a few minutes. On arrival, she looked bad enough to warrant elective intubation. I won't go through all the details, but the best-laid plans in this case resulted in hypoxic bradycardia and eventually pulseless electrical activity. We got her back, and there was plenty of post-event teaching to be done afterwards.

"OK, Who hasn't done CPR today?"

    Seriously, though my ACLS skills have never been sharper than after this month in Kenya. We decided that running the code should be the last thing we do in the hospital today, so we went home to meet Rob and headed up to the guard trail around RVA (it's a 1.5 mile walk around the school that is a pretty good work-out with it's steep inclines). I took a few photos on the path, and then a few on the way to the store to get supplies after the walk.

Razor wire and sweeping vistas...  Ahhh... Africa...

Useless against the honey badger

The Super Duka... Kijabe's Super Walmart

Lung Tonic and Gripe Water... For Kids!

Rob critiquing a pineapple.

It was a B+

    We came home, ate cajun chicken pasta (REALLY good), and that's all. So I'm all caught up, and have only a few more days of blogging before we head to Tsavo and the Mara. We've got AM lectures lined up for the rest of the week, and will probably find some other interesting stuff to do, so keep checking back. Kwaheri!

Mondays... AmIRight?

    Alright, I'm a day behind, but I aim to rectify that tonight. So I get to begin by talking about yesterday (Monday), which by all accounts pretty much sucked during the day. As you will remember, we didn't get our water back until mid-day Monday, so that means that I went into the hospital on Monday morning with two days of unshowered bedhead and a few fresh swipes of deodorant. It was not a good way to start the day, but start it we did...

    We began the day by walking in to an unusual message scrawled on the Theatre Board. Being the nice guys we are (and trying to not let the lack of water at home become too much of a burden), we decided to help.

"Who will save us?"

Americans... That's Who.

    Unfortunately, our defenses against Monday were soon to unravel when we heard that two ORs needed anesthesia staff since the student anesthetists were taking a test. It's pretty hard to get excited about sitting in the OR all morning when there are plenty of interesting and borderline necessary blocks we could be doing, but I made the best of it.

Seriously, this is my best effort at "happy"

After a while the boredom leads you to start photographing unusual things:

In this case, my patient's hair in Macro.

    To my relief, the student anesthetists eventually finished their test and took over the rooms. We immediately scrambled to get some blocks in. We had a handful of good-looking blocks, and then stepped out for Mandazi (the plural of Ndazi, if I haven't mentioned it before). When we returned, I went to check on a femoral block we had done before leaving. As I walked into the block area of recovery, I was disappointed (though sadly not too surprised) to see this:

Was the block successful or not?... We'll never know.

    Now before you freak out and start accusing me of being a monster, you should know that he was just asleep (though that didn't stop me from very slowly lifting the blanket up from his face when I went over to talk to him). Creepy... A few of them have done this, and it really freaks you out when you see it. Anyways, we quickly went back to the business of regional anesthesia. Our next patient was a guy who was having a distal femoral debridement, and I talked with him about having a femoral nerve block before the procedure. He said he has had his leg worked on multiple times before, and preferred general anesthesia. I told him that that wouldn't be a problem, and that we would do a quick IV, a quick femoral block for post-op pain relief, and then a general anesthetic for the case. Well, the quick IV turned into a semireliable left arm line under ultrasound after 6 tries by Joe and myself, and the femoral nerve block was complicated by an initial intraneural injection. When we finally got him back to the OR, we induced with 200 of propofol, 25 of fentanyl, and 25 of ketamine. A normal man would have gone down with that. A normal water buffalo would have gone down with that. OUR guy just complained of terrible arm pain. Awesome. The arm, on closer inspection, was unmistakably huge and tight. Super Awesome. We did a quick inhalational induction and put new IVs in after he was asleep. I finished up in the OR by squeezing propofol from his arm.

From now on, everyone gets a central line.

    I felt a bit rough by then, so we headed out for the day. Joe was on-call for the ICU, so he went for sign-out while I waited at the pharmacy for a prescription of zofran (an anti-nausea drug we are planning to use on the bumpy flights around Kenya on safari next week). It was kind of surreal sitting amongst a huge group of Kenyans waiting to be called to the window to pay and pick up the drug. Whenever someone would cough I would hold my breath and wonder what kind of terrible malady I may be exposing myself too. The other interesting thing about the pharmacy is the newly-installed opaque screens in the window. Apparently armed gunman came into the hospital a few weeks before we arrived and demanded cash from (who else?) the cashier. The screens are a protective countermeasure against such actions in the future, because nothing stops automatic rifles like tinted plexiglass.

Check and Mate, evildoers.

    I came home, took a (glorious) shower with our renewed water supply, and waited for Joe to seek enough cover from his ICU black cloud before heading over to Dr. Newton's house for Dessert Night. This was our second (but final) Dessert Night, but it was a really good time. We played with a stargazing app and looked at the moons of Jupiter through some binoculars. It's really amazing how much of the night sky you can see in a place like Kijabe. It's actually an advantage of spotty electrical coverage.

    So that was it, a bit of a rough day in the OR, but it finished well enough. As a bonus, I'm including a series of photos I took during the day that highlight the various colors of the OR and ICU. I think they are pretty neat, and most people don't get to see blue mosquito netting in their local ICU.

Even Lazier Sunday

    So as I was brushing my teeth Saturday night after Longonot (and after the last update), I looked into the mirror and saw something quite unusual about both my eyes. As it turns out, squinting into the dust and sun on Longonot all day without glasses creates a pretty awesome pattern on your corneas.

If you do THIS all day...

...THIS happens.

    Not to worry, it was gone within 24hrs and I'm back to normal (well, CLOSER to normal I guess). We woke up late on Sunday, but still had time to get to the service at RVA. Unfortunately, we weren't able to shower prior to the service as our water was out. This happens periodically here (as well as electricity outages), but this particular water dearth lasted until mid-day Monday, so it was a little more distressing (since no one can shower, wash dishes, and (most importantly) flush the toilet). Such is life. The service at RVA is impressive. Lots of people, and many of them very into the program (lots of singing and raised arms with some dancing). I took my camera, but forgot the battery, so I don't have any pictures. The general structure of the services here include some time (20-30 minutes) of singing, followed by a sermon of some kind. There was no guest speaker that morning, so They pulled down a big screen and we watched a video of a sermon given in Atlanta, GA for 45+ minutes. Afterwards, we went to the RVA cafeteria for lunch. It is a large impressive meal, and very delicious. I wanted to get some shots of all the African national flags in the caf, but it will have to wait. Highlights include Angola's flag with it's machete, and Mozambique's with it's AK-47. True patriots, the lot of 'em.
    We finished eating and came back to rest at the house. Jonathon and Rob returned from their safari in the Masai Mara in the afternoon, and we looked at some fantastic pictures before they flew out of the house to get a bit of exercise before dinner.

Yeah right.

    For dinner, we went back to Susan's for pizza (which we all pitched in to make). I started taking some shots of the scenery (as I do).

I don't know why she doesn't have 1000s of these photos.

Seriously, it's beautiful

Let's focus on some color.

     As I was shooting, I heard some kids behind me yelling "One picture! One picture!" Kid's around here are pretty aggressive, but I agreed.

Now run along...

    Sadly, this only opened the door for them. They requested individual photos, which I agreed to. They then requested I take the photos out of the camera for them to have, which I did NOT agree to. They then started asking who else was inside, could they come in to meet everyone, could they have some food, would I sponsor them for school, etc. Long story short, it ended up in a tense staredown with me giving them threatening stares and they plotting how they would steal the chips sitting on the patio table. They eventually left, and I was able to return to photographing the sunset, which I did with great personal joy.

It's the CIRCLE OF LIFE!....

...AND IT MOVES US ALL!!!!

    With the pizza done, we started to eat. It was delicious, and there was plenty for everyone, but you know how things can get when people get hungry...

Jonathon about to charge in defense of a single carmelized onion.

Rob inspecting an injury sustained in the Great Pizza-Distributing Debacle.

29/1/2012 - Never Forget.

People towing the line after Susan dealt her lethal blow to Rob's finger.

    We finished dinner and came in to watch a movie, but our projector was broken, so we huddled around a laptop and watched funny YouTube videos of Germans. Also, I made a friend...

Susan's cat, Zoey, showing "Blue Steel"

    We came back, sent some threatening text messages to our landlord for not having the water working, and went to bed.

Joe versus the Volcano... also Brett

    Oooooookay, strap in for some impressive scenery. Now for those who don't know, Mt. Longonot is a dormant volcano thought to have last erupted in the mid-19th century. The name comes from a Maasai word that means "mountain of many spurs" due to it's many steep ridges. You can find plenty of pictures of Longonot in previous blog posts, but today we got a new perspective on the mountain. Our hike took 6 hours with frequent rest stops. The trail is a steep 4km climb to the crater rim, then 11km around the whole crater edge. All told, it's about 12 miles, and it is a hot, dusty, steep trail. As was the case last weekend, Phillip arrived at 7am to pick us up. Also as was the case then, you need someone as fantastic as Phillip to get around Kenya. Getting too high of a quote from our first driver could be the best thing that has happened to us here in Kijabe. Right then, on to the photos. I'll provide some narration after each one to explain. Also, sorry for slow load times. I posted 46 of the 130 some pics I took today.

On the road down from Kijabe. That's Longonot in the distance

Tree-bare steeps to our right on the main road to Naivasha.

A yellow-bark acacia tree in the Longonot parking area.

There are sometimes buffalo on the hike up the volcano, but we only saw this one on our trip

Before the hike (mountain in background). We seemed so young and foolish then...

A pit stop on the way up (this is still only the first steep ascent towards the rim).

On the first plateau. The plains behind us and....

...the ascent to the rim ahead

I only had the strength to take one quick photo backwards during the second steep climb.

That's our starting point on the other side of the plateau (to the left).

Finally at the crater rim. 

A look into the crater. I got some good panorama shots that I need to assemble at home.

The highest peak is our next destination.

Another glance inward. It looks perfect for an undiscovered dinosaur species in there...

The other half of the rim stretching out.

A look down the shear rock walls of the rim into the crater. 

This would be a long, bad fall.

On the trail to the summit we found this sign. It seems like a joke (given how steep it really is).

Joe next to the "trail" to the crater basin floor. I only saw footprints going in.

One of the many peaks on the way to the summit.

We politely let this guy pass as we neared the top. This is very steep climb (if it wasn't obvious)

A look back at Lake Naivasha, a fertile area from a previous lava flow,

and the trail behind us as we reached...

...the summit!

Another look back. our starting point on the rim was to the right of that

small white streak running into the crater on the far right of the photo.

Into the crater from the summit

West to Hell's Gate (from previous posts)

Clouds over Kenya

Coming down the other side of the summit, a look towards Kijabe. 

Kate, this position is how I ended up burning the back of my arms.

Joe looking intrepid

It's a shame this cloud missed us. It got incredibly hot coming down,

and the bright dust and rock would reflect the heat right in my face. 

Where's my hang-glider?

Just past the halfway point, a look back to the side of the crater we need to get to.

And a look back up to the summit we have just descended.

We spotted this dust devil on the rim. Interestingly, the town just above it's visible peak is Kijabe.

On the low-end of the rim, I took this picture just before we somehow got off the main path and ended up on what I suspect was a game trail that wound down the outside of the volcano.

Fortunately, it let us to the main trail as it was running up to the summit from the parking area.

The parking area is in sight!

Our yellow-brick road, almost done.

A look back at the mountain.

Our after picture. 

Like I said, it was dusty. My shoes were a different color to begin with.

Joe with his sock. I threw mine away. They were not salvageable.

Driving to lunch after hiking, a look back at the mountain.

We had lamb pre-ordered by Phillip from our favorite hotel. 

Also, Phillip met us after our hike with Ndazi. I only hope to be as awesome someday.

After lunch we went to a resort near Naivasha. These are some flowers at the resort. 

Phillip haggled for our entrance to the pool.

We swam for an hour or so. This is a really nice resort.

Random flowers growing in the grass

After swimming, we went to Naivasha Town for some supplies.

Here's the sun sinking outside the Naivas grocery store (from a previous post).

Another Kenyan Hospital. Pretty incredible in comparison to Vanderbilt.

The sun setting on the road to Kijabe. The theme song to The Simpson's

(more like theme music, I guess) was playing on the radio when this was taken. Strange.

    I probably would have more to say about the day, but I'm much to tired. If I think of anything I'll include it in future posts. Goodnight.