Nearing the end of our first full week.  It has definitely been full.  As of thursday PM we've signed out 175 surgicals (so far), grossed 180, done probably 20 blood smears and several FNAs.  Had cases of CML, CLL, AML, melanoma, carcinomas, sarcomas, pituitary adenoma, molar pregnancy, TB, Burkitt's lymphoma, etc.  Culminating case yesterday was a colon half dead and full of stool.  Not a pretty site.  I won't go into too many details, but dealing with that with no garbage disposal, small sink, no ventilation and bare arms.... not a pretty site!  It came in a black plastic bag stuffed into a plastic container with the lid mostly cut off.  Don't know what we were supposed to do with it when we got it out of the container.  We had to combine two other specimens - we don't have any empty containers!  - and appropriately enough dumped the poop down the toilet.  This was at the end of the day after grossing 50 other specimens.  Some of which were STUFFED into containers with lids too small to pull them back out.  Cutting up a breast lumpectomy (with cancer) in order to remove it from the container doesn't seem the best practice.  I ended up dictating into the reports "PLEASE GIVE US CONTAINERS WITH LIDS BIG ENOUGH FOR THE SPECIMENS!!"".  I don't know that anyone will read it.

All of that is put into context however with one trip to the wards.  We received a blood smear from a baby which is full of nucleated RBC's (not normal) with no clinical history.  We found the wards to find her chart.  Clinician immediately cornered us wanting to know about the smear.  Baby is a Sudanese refuge with hydrocephelus ("water on the brain"), came here for surgery but is too sick, likely septic, likely dieing.  The decisions the clinicians have to make here are heart breaking.  Who needs the ventilator the most and is also likely to survive.  What of our limited chemotherapies can we give?  And if we do, can we support that (i.e. is there any blood to tranfuse, will a family member come in to donate blood).   Radiation is extremely limited.  Forget testing breast cancers for Her2... there is no Herceptin, forget testing for Philidelphia chromosome (anywhere in Kenya) and there is little ability to even test for ER.  AND the breast cancers here are real cancer, not the minimal things that we sometimes call cancer in the US.  It certainly puts a lot of things into perspective.  We (in the states) have no idea how fortunate we are and how much we waste resources.  If only there was a little more equity and a little more thought.....sorry, enough of that.

Luckily our walk home was quick, weather and sunset beautiful, food good, and bed at 8 PM felt wonderful.

Back of "pathology house" which actually is the side towards the hospital.  In front of pathology house is view towards rift valley.

Walk to work, the red flowered tree is a Poinsette tree!

















Emily taking photos to send back home.  We've (OK, Emily's taken) lots of photos this week!

Lab staff, door to gross room.  There is ONE microtome to cut all the blocks (>7000 per year).  Staining, labelling, coverslipping, all is done by hand.  Needless to say slides do not come out early.

We put Mom to work!!!

 

 

 

 

 

   

View out living room window

Sunset from Porch.. Time for bed!