Thrown in. How else to describe it? Nate and I have been functioning as the attendings on the medicine and peds services, and what a ride it is.
To begin with, the environment is foreign. The beds are packed together in one big room (the adults are divided by gender into two rooms). The beds are so close that sometimes the mom of one peds patient sits on the bed of the neighboring patient. The charting is scanty and hard to follow. The xrays are kept between the mattress and springs, and held to the window to read. Rounding is done at bedside with nary a nod to patient confidentiality.
The diseases. This is a prosperous area by Kenyan standards, and those prospering tend to adopt a more Western diet, bringing the high blood pressure, diabetes, and high cholesterol complications (stroke, heart attack, etc) that we see every day in TC. Alongside this though is the wild array of tropical diseases—most prominently, TB, malaria, and AIDS. TB is thriving with the AIDS epidemic; there are more people infected with TB than at any other time in history. AIDS weakens the immune system and many bizarre infections show up, and the usual infections present differently than normally. Xrays and labs even are different. Malaria weakens the immune system as well, though not as profoundly as HIV, and this confuses the picture often as well. Mix in some mental health issues which look different in a different culture, and 20 years of experience no longer count for as much!
It is intense, and like many people I think, I get more serious at such times. But I am finding that humor and even goofiness go a long way. Whether it is a cross-cultural bridge (the smile, the laugh) or they are just finding me bizarre, I don’t always know, but it doesn’t seem to matter. I introduce myself to patients in a way I am comfortable being. In the end, being yourself (while hopefully being culturally sensitive) is the key.
--Roger
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