November 2017 – Nomadobgyn

Life in Kenya - Living Your Best Life

Asante Rafiki

November 26, 2017

by Nomadobgyn 4 Comments

The first time I spent Thanksgiving away from home was my senior year of college. I wanted the opportunity to soak up a few more precious moments with my college friends and to experience the Bayou Classic weekend in New Orleans. Fortunately, a couple of my friends had an off campus apartment and they were willing to host us. We all chipped in and cooked a potluck style dinner, most of us contributing to a Thanksgiving meal for the first time. I remember listening to Maxwell’s new album Now in the days when we still had a CD player. We attended the battle of the bands in the Superdome and probably went to a party or two… nothing fancy, just food, friends and fellowship.

Since that year, I have spent more Thanksgivings away from my family, sometimes because I had to work on the days around Thanksgiving or sometimes actually being on call in the hospital. On those occasions, I would celebrate with the closest friend I had to the area. Most of the time preparing a dish but sometimes showing up empty handed, when time didn’t permit me to cook. They welcomed me graciously either way.

Over the past few years, one of my friends has officially hosted Friendsgiving. Usually the Friday after Thanksgiving, to give those of us away from home the opportunity to enjoy the holiday and for those close to home the benefit of not having to choose to spend the holiday with friends or family. The best of both worlds.

This year, I spent this week in Kenya, and I am missing the turkey, cornbread dressing, collard greens, macaroni and cheese, potato salad and, since I’m dreaming, chess pie! But I wanted to take this moment to say thank you to all my friends, around the globe, that have supported and encouraged me on my journey. I look forward to making many more memories with you!

5 Reasons why I love my friends:

1.      They understand my punctuality. I have a strong desire to do everything or conversely the dreaded condition of FOMO (fear of missing out). This condition sometimes causes me to arrive early to the function, so I can leave early or sometimes I’m a little late to the party. But if I say I’m going to be there, I’ll be there. So thank you for not getting annoyed with my fluid interpretation of time.
2.     They understand my love of travel. I have friends with whom I have literally traveled around the world. We’ve planned trips together and I’ve also inserted myself into a few already planned trips 🙂 I also appreciate those friends who host me when I show up on the their doorstep, suitcase in tow. To the question, “where are you staying?” My answer, “here…?” is always met with a gracious welcome. And in the same vain, thank you to those who host my belongings in my absence!
3.      They understand my need to stay connected. This fact is especially true in Kenya. I was a little nervous about being so far away from family and friends for an extended time. Without skipping a beat, they have been supportive and responsive to my random text messages, facebook messages, whatsapp messages, emails… even when I lose sight of the time difference…
4.      They understand my need to be entertained. I love activities and I enjoy new experiences.   From house parties to canoeing to kickball games to whitewater rafting to attending the Kentucky Derby to skydiving to tattoos to dinner 1150 feet in the air, to staying up until sunrise (more times than I can count) we’ve done them together!
5.      They understand me. They allow me to be unapologetically myself in all my forms. They provide encouragement when support is needed, reassurance when I doubt myself and honest reflection when I need a little, let’s say reality check. They keep me accountable and are instrumental in helping me be my best self.

Thank you friends! I love you!

**Asante Rafiki = Thank you Friend

Life in Kenya

Nane wiki in Kenya (Eight Weeks in Kenya)

November 21, 2017

by Nomadobgyn 0 Comments

After being in Kenya for 8 weeks, I thought I’d take the opportunity to share with you 8 of my favorite photos from my time here.

Having fun with my Dad at the Nairobi National Museum.

A giraffe at the Nairobi National Park. Because who doesn’t love giraffes!

My first day of work picture, because this is what happens when your dad drops you off in Kenya.

My new favorite breakfast. Mandazi and Chai.

Looking at the Indian Ocean, Diani Beach, Coast of Kenya

Life in Kenya

Counting to Moja

November 6, 2017

by Nomadobgyn 2 Comments

Typically, my clinical responsibility ends at birth. When all things go well, after guiding the mother through prenatal care, labor and delivery, I happily hand off the new bundle to the awaiting nursing or pediatric staff. I congratulate the parents and wish the baby “happy birthday”, before exiting the room to complete my notes. Here in Mutomo, my responsibility is not over. Normal newborns with no issues are assessed at birth and then discharged with their mothers to follow up as outpatients. However, we admit those neonates with complications and they become part of the maternity service, i.e. my service. As you can imagine, I had to tune up on my newborn medical knowledge.

My second week on service, as I finished rounds, I was called to evaluate an infant who had been doing poorly for the last few days. He had been diagnosed with meconium aspiration and neonatal sepsis. The treatment regimen included antibiotics and supplemental oxygen. Over the previous few days, he had increasing difficulty breathing and maintaining his oxygen levels. One of the nurses was actively trying to resuscitate the infant when I arrived; I assisted but felt at a loss in offering any additional support. As we watched the oxygen saturation levels drop into the 30’s, the infant was barely responsive to stimuli and losing muscle tone. I asked for one of the other doctors to come to assess the situation, he then relieved me so that I could report to the major theatre (OR) for a case. I learned soon thereafter, he pronounced the infant and consoled the family. A few weeks later, I was walking past the maternity unit on my way to dinner and I heard, “Dr. Mary, can you stop in?” One of our admitted infants, born to a mother the day prior after a difficult vacuum assisted delivery, no longer had a heartbeat, no longer showed any evidence of respiratory effort, no longer… She called me to write the note to certify death. As an Ob/Gyn, we handle difficult situations more often than we would like. I have diagnosed miscarriages and stillbirths however this was the first time I pronounced death after delivery. The discussion of a death of child with a mother, whether at 8 weeks, 36 weeks or 2 days after birth isn’t comfortable. It doesn’t get easier with time. There are no consoling words.

During residency and then as a public health student, I developed an interest in how I could work to reduce infant mortality, both locally and globally. One of the health predictors of a country is linked to how well the newest members of its population fare after birth, more specifically, infant mortality is the number of infant deaths before his or her first birthday. As advanced as health care is in the United States, we still do a subpar job in protecting one of our most vulnerable populations. In 2010, the infant mortality rate in the United States was 6.1 deaths per 1,000 live births. To compare, the rate in Finland was 2.3, France 3.6 and England 4.1. The discrepancy between populations in the United States is even more disheartening. We see a large gap in the rates of infant mortality between white and black women; the most recent data reveals a rate of 11.3 (which translates to a ratio of 2 to 1).

One way to combat this problem for me clinically is by providing comprehensive, appropriate care for women, especially reproductive age women. The best prenatal care starts at pre-conception and continues into the pregnancy. However, we know that adequate medical care is not sufficient and even when controlling for education and income, black women in the US still have increased rates of infant mortality. Studies have confirmed that stress plays a factor in these outcomes, especially the stress due to the consequences of racism in the United States. See the link to the PBS special entitled Unnatural Causes.

In Kenya, the infant mortality rate is 38.3 per 1,000. According to the WHO, “the main causes of newborn deaths are prematurity and low-birth-weight, infections, asphyxia (lack of oxygen at birth) and birth trauma. These causes account for nearly 80% of deaths in this age group.” CMMB through its CHAMPS (Children and Mothers Partnerships) program has collaborated with Mutomo Mission hospital to combat this situation in sub-county of Kutui South. Interventions include promoting antenatal care, training community health volunteers, supporting community health centers, providing equipment and supplies, in addition to enlisting the aid of volunteer doctors and nurses. I can see the results of this program when taking the history of our patients in labor and delivery. Women who have traditionally delivered at home are now seeking care in a skilled facility and pursue referral earlier if complications arise.

The public health community has made great strides to reduce infant mortality and the rates have decreased. But there is still much work to be done at home and abroad. Though I don’t have any biological children, I experienced pregnancy and childbirth alongside two of my closest friends. I am now blessed with two godchildren who are healthy and happy. I hope my work, in some way, allows more women to experience the same blessings.