We are establishing our COVID teams in hospital. We have noticed a bit of stigma to having to working in the COVID wards. We also see undo fear regarding the disease among persons who should not have this fear. I want to remind everyone, and I do remind my interns that this is a disease that affects the old much more than the young. Those of us (I am including myself) who are younger should be willing to get out into positions that serve those who are ill. You could consider it our Christian duty. We may catch the disease despite our best intentions, but likely we will be asymptomatic or mildly sick. So I jokingly call the interns I work with the invincibles, while at the same time reminding them that they need to be careful, that they should wear their PPEs when taking care of COVID or suspected COVID patients, and that there are always some exceptions to the statistics. I personally have little fear of being mortally ill from COVID (while recognizing that I could still get sick), and I am looking forward to the chance to care for patients with corona virus. But currently I am away from the hospital on a few day break before it gets too busy.
We have prepared a 29 page document hospital document that will guide us in how we deal with “The Corona” as my kids like to call it. Despite my guarded optimism regarding this illness, being on a worst case scenario planning committee can have a bit of a psychological toll. We are going to get out of town for a few days while the getting is good! If we could go sailing we would, but as it is, renting a house with a pool and no internet will be nice!
We are still calm in Kenya. I worry more about social unrest than the virus. We have three weeks of food and the car’s has a full tank. I think our best hope is if the disease blows through Kenya quickly! I still do not think we can flatten the curve. But I am hopeful that it will not be as bad here.
I have been repeating the statistics of COVID=19 to myself, my family, and friends. I think about it a lot. I have been a part of the outbreak committee at the hospital, and I helped write the inpatient protocol for the care of COVID-19 patients. Everyday I watch medical updates on the situation, and I scan the journals looking for information.
- I am impressed that more of the world is not usually sick. If the number of illness we have now from corona virus overwhelm the healthcare system, yet this number is still such a small percentage of the human population, it means that very few of us in general are severely sick at one time. I would have thought more of us were usually ill. I guess I have a population bias since I work in healthcare. But still, it is remarkable so few of us in normal times are not more sick. Our immune systems are remarkable.
- I feel anxiety just like everyone else does. I understand statistics, infection rates, mortality rates, treatment options (or the lack of them). What I do not picture well is what our baseline ability in regards to healthcare infrastructure is, nor what it is like if everyone in the world gets sick at the same time. The healthcare system is a lean system. Every organization is set up to try and not have too many excess beds, because they cost money to maintain. You want to balance your healthcare infrastructure again the usual needs of a population and the cost of supporting that infrastructure. Hospitals like to be relatively full. They also like turnover. They want patients to come in and go out quickly. I have worked in ICUs and ERs in normal times when ICUs have been full in the hospital where I was working, and I have called other hospitals for a transfer, and their ICUs were full as well. That was during normal times. It must be much tougher now.
- The current news climate drives me crazy. It has for a long time. I loved watching the news in my mid 20s, but I stopped by the late 1990s. I did not like how it had changed into just opinion. I felt like I could never get facts. It is the same situation now. I will click on a terrible sounding headline, but the article will not be as bad. And the article will have big holes of information. I know I likely read with a more critical eye looking for specific facts to help me form a good medical opinion and medical statistics is a hard subject to understand. However I think the point of journalism is to understand and then report so we all understand. This is no new idea, but sometimes I think they are just wanting to entertain more than inform. I want understanding.
- Some good news . . . it looks like Italy is flattening a bit. That took about six weeks which is what it appears to be taking around the world. That is just my impression. We will see what happens elsewhere.
This is the truth of the situation. We cannot flatten the curve in Kenya. I think one of the things that drives me a little crazy is the social implication of this illness. The rich (including myself) will protect and isolate themselves on the backs of the poor who have to work to live. The average salary in Kenya is approximately 1000 USD per year. People cannot quarantine!
We said goodbye to Dr. Patrick earlier this week. He is moving on to bigger and better things. I do not usually go to the outpatient department meetings since I am focused on inpatient medicine., but Patrick is a friend in the hospital and I wanted to be at his farewell party. Plus I saw a picture of the cake and decided I could not miss! Since I am such an infrequent attender, the department decided that I could do the gift presentation, which I did gladly. Then I gave him the corona virus handshake. So this is a post just to show that we shake appropriately in Kijabe! Its hard to get droplets on the outside of your elbow!
It is weird is to be trapped. We cannot leave Kenya until some unspecified time in the future. We cannot leave our house after 7 PM. (I am not really sure how this helps stop virus spread so I wonder if it is for social stabilization). To be in another country without the ability to get home is an odd feeling. I have explained to my kids (and myself) that this is what I am here to do. I am her to be standing in the hospital when the crisis hits. I want to be where the need is great, and I feel fortunate to be here. I cannot really think of other good reasons to not be back in the USA. But our purpose is different, and frankly I feel so fortunate to be here. I am sad for many things that are going on around this pandemic (canceled trips for us, canceled school years for lots of kids, quarantines, and the deaths associated with it), but I am very glad to be able to be a part of the work at Kijabe Hospital. So we, like you, are trying to figure out how to make the most of travel restrictions, curfews, and quarantines. Otherwise, so far, so good in regards to coronavirus in Kijabe!
Today is a relatively normal day in the hospital. What does make it a little different are the small things that show preparation for what may be to come. My temperature was scanned as I entered the hospital and I was asked if I have COVID-19 risk factors. I had a Outbreak Committee meeting for 2 hours in the middle of the day. As head of the internal medicine department, I have been a part of developing protocols for the care of hospitalized patients as well as determining how we will staff such cases. I have asked around about what is going on in Nairobi, and I hear rumors that the hospitals are getting busier with respiratory infections. We are probably 1-2 weeks behind them.
There are things that make me optimistic. I know the statistics. I personally at am low risk as is my family. I know we will get it at some point, but it will be a flu-like illness for us if we are symptomatic at all. I live in a tropical climate with lots of sun which equals lots of vitamin D. We do not have many elderly people in Kenya, so those most affected in other parts of the world do not exist here in such high numbers. Italy has 1 in 4 people over age 65. 25 percent! Only 3.9% of our population is over age 65. The average life expectancy is around 63. We will not see the same mortality rate here. I believe at this point when all the statistics are done retrospectively that the infection and mortality rate will not be that high. The problem is that it is hitting everyone in the world at the same time!
Things that make me pessimistic. We have very limited PPE, limited doctors, limited ICU beds, very limited ventilators. Basically we have limited health care resources. The decisions about who will live and die that other doctors talk about having to make with COVID-19, we make everyday because of our decreased resources. However, we do not lack for very smart and compassionate doctors, at least at Kijabe Hospital. I get a sense that all my interns are ready to be a part of caring for their country! Our young have other conditions that may complicate their recovery. Specifically HIV, TB, and malnutrition could be disastrous for the young people who in other countries are doing so well.
I hope everyone everywhere is doing well. God is good, and I am remembering these good promises.
Philippians 4:6-7 Do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus.
Ephesians 2:10 For we are God’s handiwork, created in Christ Jesus to do good works, which God prepared in advance for us to do.