Strike week 25/51 . . .

As per the UW chief resident who has been working here at Naivasha in medical education for a year, that's the tally.  I should have been keeping track, but I'm sure as we move into our 9th month it's actually more than half the time.  This week it is the nurses, who came back quickly in December after their short strike when the government formed an agreement with them . . that was never signed.  Word on the street is that the doctor's agreement wasn't signed either, so they may join on Monday.  The inability to anticipate patient load or collegial help day to day gets very tiring; I am sure the inability to even access care gets MUCH MORE TIRING for the patients who must face a choice between suffering, and potentially dying at home, or calling in every favor to raise the downpayment for a private admission.  For many there isn't really a choice.  I think the sheer duration of incessant and repetitive strikes makes it clear that this is not an efficient means of progress or change.  Punishing the poor to force the hands of the powerful doesn't seem to work very well.  And in a society where political affiliation is almost purely tribal, such actions don't impact voting much.  The government can run the health sector into the ground and still be re-elected.

Meanwhile here in Naivasha, we keep plugging on at about (maybe slightly below) half-normal numbers using "contract" (non-union) nurses.  You can run for 100 days without doctors, but not even one without nurses.  We're taking emergency admissions, and continuing to care for our long-term nowhere-else-to-go patients.  We have our clinical officer interns, and our medical officer interns who just started their year after the mess of the long doctors' strike, for now (no telling what will be true come Monday).

And in spite of how we sometimes want to throw up our hands or cry, there really are remarkable things happening.

Baby E's mom came in severely dehydrated because her mom had an abscess and wasn't able to feed her well.  By severe, I mean a sodium of 192 and a creatinine upwards of 900 (that's over 10 for mg/dl).  No ICU, just weeks of fluids, antibiotics, care for the mom and baby both, using what we learned at Kijabe.  Yesterday they went home.  A miracle.

And in the NBU we have just discharged a whole preemie class of a half-dozen who grew from 1 kg to nearly 2, and the tiny ones keep coming.  Over a dozen right now who are mostly in the 880 gm-1.2 kg range, a few getting up to 1.6 or 1.7.  It is hopeful to see the team calculating fluids, knowing what antibiotics to give, watching for jaundice, paying attention to gestational age.  They have come a long way, and I am pretty sad that the CO interns must change rotations next week and the doctors might strike again.

Yes, we had one positive cholera case on the male ward, but so far our Paeds samples have been negative (though we lost two kids in the last two weeks shortly after admission, before even being reviewed by one of us, so those might have been real cases).  Meanwhile the classic cholera cots in the hall remind me of Bundi and make me happy to see them not in use.

Having the patient census at about half, but the CO and doctor team fully present, allows for more teaching.  I prepared a lecture for this morning for all the hospital trainees, giving some evidence-base about respiratory infections and teaching them to use the Kenya protocols for treatment.  We do bedside teaching every day, and enjoy it.

After the first C-sections with interns took more than triple the normal time, Scott bought $3 worth of meat and did a surgery clinic with his new interns.  They seemed pretty happy with the stitching practice.  This kind of investment in teaching is a big reason we came to Naivasha.

And lastly, just for fun, since the American president's name is in the news even here in Kenya for good or for ill . . . I finally met my first baby T.  Yes, that's right.  We had a lot of Obamas (Kenya was particularly proud) but so far only one T.  

Please pray for the many who are left without care during yet another upheaval in this health system, and pray for justice to roll down like the rains we so desperately need.