The trip out to Ngito (pronounced en-GEE-toe) took about an hour, half of the time on paved roads and half on rocky terrain. We actually drove a Tenwek ambulance to get out there, which the guy actually let me drive!
These dispensaries run much like an outpatient clinic. I saw some "typical" diseases here, like helminthiasis, scabies, STDs, typhoid, pneumonia (which you have to diagnose clinically here, no x-rays or CBC's in the bush). One kid comes in monthly for his penicillin injection because of his rheumatic heart disease.
Besides the tropical diseases, there is the standard chronic disease management, like hypertension and diabetes. This lady actually had both conditions, and I was helping adjust her medications.
I also saw some prenatal patients. This lady is around 24 weeks, and doing well.
There are some differences between prenatal care here and in the US. At 24 weeks we usually do a glucola test, and give rhogam if she is rh negative. Here, instead of doing either of those things, we just give empiric malaria treatment. Welcome to the tropics!
Oh yeah, and I got some practice using the fetoscope!
I saw about 15-20 patients at Ngito, which I think was a quiet day. I actually didn't get out there until around 1:00, so this would actually be a pretty busy afternoon in the States. One thing that makes visits simpler here is the charting system (I wrote about a half paragraph per patient on a 4x6 card)I was also able to use my Osteopathic manipulative skills to help this patient with some upper back pain she had been having for a couple weeks following an upper respiratory infection.
The Kaboson clinic ran much the same way as Ngito. We saw 20-25 patients in an afternoon. The nurses and staff live on the grounds of the clinic, and someone is on call 24 hours a day out there. They do around 15 deliveries a month, and have a small inpatient ward for postpartum patients.
Even the occasional emergency will present while you're in clinic (just like in the States, I suppose). This child had cut his foot a week ago, and had been to the clinic at Kaboson for treatment at that time. Perhaps it was the nurse on-call that night who saw him. They had sewn it up, and put him on antibiotics, but his foot still got infected. By the time I saw him, part of his foot was turning black. He had no feeling in his toes, and he couldn't move his foot. I sent him directly to Tenwek, and I heard later he went straight to the theatre for debridement. Please pray everything turns out well for him, and he gets to keep his foot.
It felt good to be in the outpatient clinic again, something I haven't done in several months. I had a great time practicing rural tropical medicine, exploring the Kenyan countryside, and caring for the people in these villages.
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