11/11This update is an overview of what I saw yesterday on my first Monday at KMET as well as today since I did not have time to update last night after my day due to random power outages (a common occurence in Kisumu and the slum called Nylenda where I live).
On Monday our day started with everyone from every department in the office joining together in the meeting room to discuss any results from last week’s work and any what is planned for this upcoming week. Once the meeting was over I headed to the side of the building that houses the health clinic. In this wing of the building there is an examination room with an ultrasound machine for expectant mothers, there is a room for dental work, there is a general examination room for sick patients, a small laboratory for diagnostics, and a store room containing some medications that can be prescribed by KMET.
I first met and worked with Moses, a clinic officer as he is called, who appears to have a job that lies somewhere between a doctor and a CRNP to equate it to United States health care providers. Moses see’s patients and has the ability to prescribe medication and he is also the one in charge of the ultrasounds done on expectant mothers. Moses first explained to me a program he is creating called MUMS which I believe stands for Maternal Ultrasound by Midwives. This initiative basically trains general health practitioners in using ultrasound as a diagnostic tool on expectant mothers. In Kenya, the physicians are not trained in using ultrasound in this manner unless they are going into a field such as radiology. For now, most expectant mothers that go to a general physician with questions about their pregnancy get referred to a radiologist or OB/GYN to perform the necessary exams. MUMS aims to train these general practitioners and certify them in use of maternal ultrasounds as a diagnostic tool. At the end of June I will get to spend a week traveling to various hospitals with Moses and his team to review how physicians who were previously trained are using their new skills and how patient care has improved.
After going over MUMs, two patients arrived that needed ultrasounds so Moses asked if I would like to watch (obviously I did). He explained to me that when a pregnant mother came in there were 7 things that needed to be done during the procedure. First, it needed to be confirmed how many fetuses were in the womb. This was done easily by looking for how many beating hearts or heads were seen. Next, one had to determine gestation period thus far. There were four methods used to determine the gestation period and the final number calculated for how far along the pregnancy was is calculated by averaging these values. The circumference of the head, the circumference of the abdomen, the distance from the outside of the skull at one parietal lobe to the inside of the other, and the length of the femur were all measured and used to calculate the gestation period of the fetus. Finding the femur is sometimes very hard so if it could not be accurately measured it was left out since the other values give good approximations. Then the fetal heart rate had to be determined by finding the beating heart on the screen and using a program in the ultrasound that could determine heart rate (in bpm) of the fetus. Then the amniotic fluid index (AFI) had to be taken which was done by visually dividing the stomach up into four quadrants and measuring the area of the most fluid visible on the screen in each quadrant. On an ultrasound the black seen on the screen is fluid. Finally, the position of the baby and placenta were looked at to be sure no placental previa was present and that the fetus was oriented properly in the womb. Placental previa is when the placenta falls low and covers the cervix which can cause some bleeding and other health problems for the mother and fetus. After he explained all of this to me and showed me a little bit I thought I would sit back and watch. Instead, he handed me the transducer and let me do the procedures (of course, as he watched). I even surprised myself with my ability to pick up performing and analyzing the ultrasound. A few times it was difficult to find the femur and sometimes determining the AFI was hard because when pregnancies are close to ending there is not much space for anything but the fetus. Other than that the procedures went perfectly and I had a lot of fun and learned a lot so I think I will get to continue being the ultrasound operator whenever I am in the clinic. After the ultrasounds I saw a few sick patients with Moses and it was awesome because he would always ask what I thought about a diagnosis before he would make one or say anything to the patient. Then I went to the laboratory to observe Adrien and watching him perform various tests like malaria and HIV. It was really cool to do the malaria tests because their diagnostic instrument for that is the compound light microscope like the one used in cell bio (miss those times). So the rest of the day I hung out in the lab and talked with Adrien and went over various diagnostic tests and how you read the results and what not. Hopefully I can help him perform more tests in the future!
Today we went to three schools about two hours away with another department of KMET that provides schools with a nutriflour product they make along with various medications and supplements like de-worming pills and Vitamin A (for kids 5 years old and under). It was really neat to go see all the kids at these school because they were all so excited when they saw the car pull up and they knew it had food for them. At one school Ludi, Emily, and I got to go into different classes and hand out de-worming pills to the students. They were all excited to see mzungu’s at their school and they stared a lot and giggled when we spoke because we sound weird. Many of the kids in that area do not speak much English if any at all. Before we left hundreds of the curious students crowded around us, looking really nervous and scared but one of the teachers said they wanted to say bye and shake our hands so Ludi reached out to shake a hand and once the rest of the kids saw it was ok to do so they all started running up and trying to shake all of our hands and continued smiling and laughing. It was really neat to see that at the end because once they warmed up to us it was obvious that they were very grateful for what KMET has been providing them. I attache a photo but I don’t know if it will show up…I guess this post will tell: [X] [X] [X] [X]