I am back in a normal hospital ward for a change, and it feels so relaxed in comparison to the weeks I have spent in the ICU and in the COVID wards. It turns out this is the week of ascites and liver failure. I do not recall ever having so many patients with liver failure at the same time in Kijabe. Alcoholism, Hepatitis A, and still to be diagnosed causes for liver failure fill the wards. I have been opening my computer and looking up possibilities for liver failure and ascites to try and solidify diagnosis. In addition heart failure, intestinal bleeding, and bone infections round out the service.

I am glad to be on the wards, because we have more clinical officer interns and medical officer interns present to know and to train. Frequently I find myself pushed to improve through their questions. This week I am working with one specific intern who begins many of his questions with the phrase “with all due respect”. When I hear that at the beginning of a question, I know that I have possibly missed something and that my intern is feeling pretty secure in questioning a treatment plan. This intern has me on my toes, and it is good. He makes me look into why I am doing some treatments in the manner I am doing them. Have I gotten a little relaxed in a resource limited setting? Am I still pushing for excellence in the care of our patients? He knows what the book says, and he wants to know why what we do does not always match the guidelines. Often there are reasons that are sound because of the financial and logistical constraints of the hospital, but other times I am left with the thought that I should be pushing harder for increased levels of care. In this way it is a good push, despite the discomfort of being questioned. Even as I sit typing the post, I am wondering if all of the internal medicine consultants should get together to see if we should go over our guidelines again to see if we can become less constrained by our resources and push for less limitations in our ambitions.

This is from the Samaratin’s Purse website.

Mission Organization: Africa Inland Mission (AIM)/Africa Inland Church (AIC)

Profile: Kijabe Mission Station was first established by missionaries from AIM as an outpost in 1903. The first hospital at Kijabe, Theodora Hospital, was established in 1915. This served the medical needs of the area until the present complex was begun. The first building of the present complex was opened in 1961.

Today, Kijabe Hospital is a non-profit, 363-bed hospital owned and operated by AIC of Kenya as part of a network of four hospitals and 45 dispensaries. It employs over 900 staff and strives to balance Kenyan and missionary consultants. The hospital offers a broad range of inpatient and outpatient curative services to people from the surrounding farming communities. The hospital includes five inpatient wards (general surgery, medicine for adults and children, obstetrics and gynecology, neonatal care, and rehabilitation), nine operating rooms, an outpatient clinic and 24-hour casualty department, an eye clinic, and a full-service dental facility. Support services include a clinical laboratory, a fully equipped pathology department, X-ray, ultrasound, electrocardiogram, pharmacy, physiotherapy, and central medical supply. Kijabe’s laboratory offers immunohematology, hematology, biochemistry, parasitology, urinalysis, bacteriology, and blood banking services.

The pathology department provides tissue diagnostic services to 37 mission hospitals in East Africa. The OPD provides services for general acute illness as well as specialty clinics in diabetes, orthopedics, rehabilitation, ophthalmology, TB, gynecology, high risk pediatrics, and AIDS. Malaria, pneumonia, TB, tropical diseases, and AIDS are common diagnoses. A Maternal-Child Health Centre (MCH) within the hospital provides antenatal care, family planning, and childhood immunizations. Kijabe also sends mobile health teams to 12 villages each month to provide these same services.

Kijabe is a general hospital and performs more than 200 operations each month. In past years, the most commonly performed operations have included: C-section, tubal ligation, exploratory laparotomy (non-trauma), skin graft, supra-pubic protatectomy, D&C, hysterectomy, ORIF femur fracture, salpingectomy (ectopic PG), sequestrectomy (osteomyelitis), and removal of various cancerous tumors. A dental department was begun in 1978 as a satellite clinic of the main AIM dental clinic in Nairobi. The hospital also trains nurses and medical students and has Community Health Evangelism (CHE) and chaplaincy programs. Because people know they can receive quality care at Kijabe, many are willing to wait weeks or months for their procedures. Bed occupancy averages 80 percent.

Travel: Fly by commercial airline to Nairobi; drive approximately one hour to Kijabe (6 km down a steep, winding, narrow but paved road off the main Nairobi/Nakuru highway). Time Difference +7 hours Daylight Savings Time (EST), U.S.A.; +8 hours Eastern Standard Time, U.S.A.

Location: Kijabe Hospital is located about 60 km north of Nairobi. The altitude is 7,200 feet up on the edge of an escarpment overlooking the Great Rift Valley which extends from the Sea of Galilee to Zimbabwe. People The largest group of people served by Kijabe Hospital are the Kikuyus, although the number of Masai patients has recently increased.

Language: Swahili and English are the official languages of Kenya although local tribal dialects are also spoken. All medical staff speak English fluently, and nurses provide translation to Swahili or Kikuyu. Medical records are written in English.

Religion: The population is primarily Christian (Protestant and Catholic), although some of the more remote tribes practice animism and spirit worship. Muslims and Hindus comprise a smaller portion of the religious community.

Climate: Kijabe is a Masai word meaning “Place of the Winds.” Although strong winds are common, there are periods of calm on most days. The high altitude makes for generally pleasant days (about 80°F) and cool, windy nights (about 55°F). There are two rainy seasons in March–June and October–December. June–August can be quite cool and December–March is typically dry and hot. There can be a lot of mud in the rainy seasons. June––August can be quite cool. December–March is the driest and hottest season.

Housing: Housing is in modern, comfortable homes, duplexes, or apartments which have kitchen equipment, hot water, and electricity. The housing is simply furnished, secure, and near the hospital. Daily housing costs cover electricity, water, security, appliances, and furniture. The Pathology Department has its own apartment for visiting and/or resident pathologists.

Food: Meals are not provided at the hospital so be prepared to buy your own food and prepare your own meals. Most basic items (including fresh foods) that are available in U.S. grocery stores can be found in Nairobi. For More Information Contact Mackenzie Welde by email or by phone at: (828) 278-1371.

We appear to be finishing our third wave of COVID infections in Kenya. I am rounding on the COVID ward this week, and while we started the week with every bed full, as the week has progressed we have decreased our census. The way the COVID ward works is that any patient who comes to the hospital with low oxygen levels, cough, shortness of breath . . . basically any sign of respiratory disease . . . will be sent to the COVID ward clinic, or if they are sick enough they go to the COVID emergency room. When I am working in the COVID ward I cover the COVID ER, the COVID wards, and the COVID ICU. I take care of patients who have COVID pneumonia (not that many currently), but I also have the task to figure out who actually has another disease such as heart failure or some other issue that can look like a COVID but is not. We assess them, and if we determine they do not likely have a coronavirus infection we send them to other parts of the hospital to receive more appropriate care. This week has been a good week. In the past everyone looked like COVID. Now most look like something else and I have been able to move them out of the COVID ward. It is a real relief.

Unfortunately, our fourth wave is predicted for July. We are all praying that despite not having many vaccines in Kenya, that maybe we will avoid the fourth wave.