A Day in Life @ CPGH
Our work at CPGH continues. There is a large group of students here from Drexler University CoMedicine and they easily fill up the van Elective Africa uses to ferry students back and forth from the hospital to the housing facilities. So Brian & I go into the hospital an hour earlier than them, ~ 7 – 7:30 am & work until ~ 1 – 2pm when we leave, usually later than them to return to the house.
When we arrive in the morning it is before the hospital has truly opened. Despite this Brian & I went about our day, checking on patients, reading through charts and results, etc until the clinical officer arrived. The clinical officer or intern (in their 5th & last year of post-secondary training prior to independent practice) is assigned to a ward & is responsible for patient care, orders, etc on that ward for the entire year.
The clinical officer would then round on his/her patients in the ward and generally would be followed by a cluster of ~10 medical-officers-in-training. A medical officer is a person who has received 3 years of schooling post-secondary school and is then allowed to practice medicine, including prescribing medications, etc, without supervision in the community in Kenya. They are not doctors or nurses and based on what we saw of these “senior” medical officers knowledge base & clinical expertise, I certainly worry despite the obvious need of community practitioners. We would encounter some “doctors” in the community in future events & emergencies, who were in fact medical officers with years of clinical practice. I’m sorry to say that our fears were confirmed.
Often in the midst of this pre-rounding, the consultant would arrive & Consultant Rounds would take place. Consultants are similar to Attendings in the US, a boarded medical doctor with many years of experience and seniority. Invariably the number of medical officers would instantaneously & insidiously double or triple at this point. This would make rounds look like a crowded spectacle with ~25-35 people tightly clustered around a rusty metal cot in a large rectangular room of more than 30 tightly crowded & occupied rusty cots. The crowd would be joined by the patients family members & often the neighboring patients & their family members as well. The heat would soar & the body odor would be overwhelming, especially since the habit of speaking quietly would require all of the students to tightly crowd together & jostle in order to hear. Thankfully we became more familiar with the patients & could therefore separate from this crowd, standing further back while still participating.
Consultant rounds would proceed with each patient presented to the consultant in English (this with the low speaking volume being the only privacy really afforded patients) wrapping up with the diagnosis, plan and current status of the plan. At this time these rounds would proceed either with either ascension of the plan, advisment or teaching. We most often worked with Dr. V, a cardiologist by training and a good & practical teacher. He would ask questions of the crowd regarding basic science and escalating to clinical science and finally treatment & management. Early on a system established itself as to whom & in what order these questions would be answered. First the medical officers were given the opportunity, then the clinical officer and finally he would tilt his head back & in the direction of where we would be standing signaling for us to answer. At first both Brian & I felt very self-conscious in this practice, as if we were being forced to showing up the others (be ‘gunners’) or were being objectified like “See the White Americans know all the answers”. This was particularly disturbing for us with respect to the clinical officers whom we worked most closely with and thought of as our superiors & supervisors. However, in all but one case, they quickly put us at ease. They seemed to admire our knowledge & experience, especially in areas of non-communicable disease. They eagerly sought us out during work-rounds & began many interesting discussions with us about various aspects of medicine, global health and medical culture.
The clinical officer with whom we mainly worked seemed to project a sense of pride even, that we were all working together and gravitated to her ward. She is a truly good clinician and a great person. Brian & I both enjoyed working and talking with her very much and admired her resourcefulness & the resilience of her compassion for her patients despite the many daily obstacles she faced and the generally bleak & thankless nature of the environment in which she labored.