It's only technically the second day I've been in Kenya, but I haven't been sleeping well. Even though I passed out from jetlag, I woke up around 11PM and then 3AM. My ears have just gotten so sensitive after having dogs who needed to go out in the middle of the night that I can hear my roommates walking to the bathroom to pee and then slamming their bedroom doors when they return. Tip: the toilet sometimes doesn't flush well until after you wait a really long time, so either you do all your business before flushing, or press down on the handle multiple times until enough water flows down to wash off most of what has been sitting at the bottom of the toilet.
After being startled by the sound of birds and activity in the living room, and laying in bed since 6am, I finally started getting up around 7-8am, reorganized the kitchen to make things more logical, and googled a recipe so that I can contribute to cooking (I mean, after hearing about how some prior residents cooked here, e.g., Josh and his wife)- I have to show them up somehow, right?? The challenge is to make something with pasta and little seasoning so that Ginger would like it, but lots of seasoning and no pasta so that Rochelle would enjoy it -.-
Morning breakfast consisted of milk and cereal again, after which I showered, sprayed permethrin on my clothes, and scrubbed up. They wore skirts and open-toed sandals while I was in scrubs... everything about PPE and personal safety that they enforce at UW, thrown out the window here!
Because Rochelle has been doing this for so long, orientation the initial day seemed like a whirlwind filled with LOTS of gaps in knowledge. Login information, which software to use, she could not remember. There wasn't a lot of explanation to things, I remember mostly finger pointing to things that I should be aware of but not how to use them properly, such as the grossing area and Dragon dictation setup. I think for future residents it would be good to write up something to help orient them... the only reason I could find to delaying the global health elective until after CP1 is that experience from FileMakerPro on the heme/coag rotation helped me navigate the software without much guidance from Rochelle (in fact, I think I even knew how to use it better than her!) FileMakerPro will be what you log into to enter your diagnoses on Surgical Pathology and Cytology (GYN Paps and non-GYN specimens) cases. The other thing to worry about is when we need to send photos over to UW or to people Rochelle knows for consultation. I was only familiar with the Eos software because I used to think about learning how to use a DSLR camera and purchased a Canon eons ago, which used that same software to download/upload images.
Since I was already there and gowned up after setting up the dictation software, I began grossing, and Ginger was my assistant! Sadly there are no safety goggles available, so I ended up using my sunglasses with the fan on and window open. It only became unbearably hot when the sun shone through the open window. Lots of culture shock grossing in specimens- poor ventilation, and some specimens are thrown into pill bottles (e.g., the prostate TURPs were collected in an empty bottle of antiretroviral meds) with formalin. The challenge was retaining the formalin, filtering the specimens, and making sure specimens are not contaminated by other specimens sitting in opaque containers. At this point I started beginning to feel how spoiled I am at UW with air conditioning, PPE, increased availability of grossing equipment... rather than Q-tips with ink, they reuse paintbrushes. They reuse all the blades- the short blade was chipped in several areas along the sharp edge, and the scalpel was rusting. Vinegar along with formalin is in short supply, so they need to be used sparingly. Several things we take for granted to be able to do our job well we never really think about, but then again there seems to be opportunities where those in a more developed country could shave down on costs. Less tissue blocks submitted, less work for technicians, less glass and stains used, and less time spent at the microscope.
In the middle of grossing, I decided to change my overly dirty gloves for a fresh pair, only to notice that my thumb had green ink all over it, likely due to my left glove being nicked at some point. So much for protecting myself from formalin... at least I still had my sunglasses to protect my eyes (I had gotten formalin in them at the VA during my 1st year when I was rotating there with Bitania, and then a 2nd time was a near-mostly miss when prepping a prostate at Montlake with goggles on).
When nature calls (and when Ginger needed a break from grossing), one finally finds it necessary to use the bathroom at the hospital. Multiple issues arose, though: 1) it's a squatty potty?! (where you place your feet between the toilet opening and squat down to do your business) 2) the men's bathroom was out of order 3) there was no toilet paper inside the women's bathroom, so you have to grab however much you think you need before entering. Act 1. Montezuma's revenge. Delhi belly. The Nile runs. Call it what you will, but oh it hurt soooooo much (the title of this post alludes to Oregon Trail, if you haven't played it before or just don't follow the pop culture ephemera :P). The first time I aimed too far away from orifice- had to wipe down everything to get it flushed :'(. The second time I squatted too close to the orifice, and kept water splashing down from tank/pipe and onto my bum -.-! The shocking thing Rochelle told me was that all the time she's been here, she's NEVER had traveler's diarrhea. It's probably because I was greedy and ate everything at the buffet bar and grocery store. Maybe next time I should just wash and peel my own produce rather than purchasing the pre-cut ones...
Another putative culprit are the milk tea and hot chocolate they bring to the lab around 11AM daily. Their version of milk tea I believe is mostly milk and sugar- it curdles on the surface if you leave your cup sitting for too long at the desk. The other option is hot chocolate, which is also mostly milk and no sugar. One of the days this week I forgot to bring my water bottle and relied solely on both for hydration... BIG mistake. In multiple Acts =(!
Since the lab was so backlogged on so many specimens due to whoever rotated before us (Rochelle mentioned that they did all the easy cases and left us with piles of the harder/challending cases), I spent most of my initial day grossing rather than at the microscope diagnosing off slides. Some other things to note about grossing- you realize how IMPORTANT it is to describe your specimen accurately and submit the appropriate tissues in blocks before ever receiving your glass slides. A lot of the trays contained an inappropriate number of slides. For example, 5 slides for appendix or gallbladder when they really should have only put in 1 block of tissue. Excision or resection specimens (bigs) containing margins that don't make sense (e.g., radial margin for colon rather than rectum), or not even submitting/inking margins at all. Please Please Please remember your inking schemes and relevant surgical margins!!! Seeing how others practice pathology makes me really grateful of all that we have been taught at UW, including the importance of being able to gross your own specimen. Another thing about the trays: since they only have the metal trays that we use for slides from frozen specimens, that is how you will organize your workload. Additionally, they won't bother to space out the cases for you, i.e., the slides sit back to back and cases will run into each other, so you need to make sure the slide you are grabbing belongs to the appropriate case and not make diagnoses off the wrong slide(s).
Ultimately, we stopped before 4PM, which is nice because they want to get started on cooking to have dinner by 6PM and be in bed by 8PM. They like sleeping early! What do I do with my time then aside from drafting blog posts?! I GUESS boards studying, but the internet is so clunky here, even with the new router. Thank goodness I purchased an unlimited data plan from Holafly ($75 for 30 days)- there's enough decent signal to where I could work off my phone if needed. (I actually spent most of it uploading instagram posts and sending TikToks to Bitania :P)
Before dinner though, we stopped at the local market once more for carrots, english muffins, and pineapple. One of the ladies there makes English muffins that they really love, so we asked for a bag the day before, and came around today to pick it up.
For the above GI problems, I began taking azithromycin (starting with the old prescription from OSU when I had originally planned to go to Vietnam for global health before the Covid pandemic hit), 500mg. The results have been moderately successful with alternating solid to liquid quality. We'll see how it goes by the 3rd day...
Once we were back from the market, I finished blogging in my room while Rochelle slept, snacking on watermelon and wondering which food source led to my bowel's demise (sliced fruit from the store, luncheon meat, milk, hot chocolate or tea from the lab, etc.)
Dinner menu: shredded beef soft tacos with sides of bell pepper, lettuce, cilantro, yogurt (rather than sour cream), tomatoes, cheese, salsa. I must have eaten 3 of them- for now, I've been holding back on how much I can eat partially to not be rude or greedy, but also because I'm trying not to eat all the food in case they wanted to save some for leftovers.
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