CHK Day 7

I'm back again before the rest of the staff. The patients are already lining up outside waiting for the floors to be cleaned. They take a bucket of water, and poor it all over the terrazzo floors and then squeegee it out the front door. I noticed today that one wall of the waiting room is made up of a grate which has no way of closing. That is to say that all year round and 24 hours a day the waiting room has one wall that is open to the outside. That speaks volumes about the constant temperate temperature.

I worked with Jean Paul & Terreza again from 7:30 - 8:30 this morning talking about the concepts of how to perform a scan in a systematic fashion and reviewing images to understand the sonographic terminology. These are two very intelligent people and they are quick to grasp even though their primary language is French.

At 8:30 the regular crush of patients but really not too bad we (Dr. C, Dr. Landos & I) scanned 35 patients between 8:30 and 12:00. Today I saw two patients who had malignant looking lesions on both mammography and ultrasound with axillary lymph nodes, a liver that was full of tumor mass that had infiltrated into the portal vein, a new born who had bilaterally enlarged kidneys that were brightly echogenic with thickened cortex and dilated collecting systems, four or five with massive ascites.

After the morning patients I went to eat at the school which is just a five block walk. I meet up with Patrick, Benard & John for lunch in the KIST Canteen. I ask where I can buy some cheap groceries, as the two places that Dr. Konn Showed me are primarily for Muzungas who have plenty of money. Benard offers to meet me at 4:00 and go with me on the city bus to Kimioronko where there is a market. I need to get my cash expenditures down and at the current costs of groceries I'm going to have a hard time.

Back to CHK and I spend about an hour visiting with Venant (Department Head). We talk about future training opportunities and some of their challenges.

One challenge is that he feels all of the Radiographers should have TLD Radiation monitors. He tells me (to my disbelief) that there is only one hospital in the country where the radiographers have TLD badges. He shows me a set of ten pocket dosimeters that they were given years ago to keep track of their daily doses. But they have not been used and the discharge unit isn't even in the department any more but is stored in maintenance. I haven't worked in Radiology monitoring employee doses in quite a few years but I've never worked any place that felt a pocket dosimeter was considered appropriate for ongoing doses for radiographers. So he's been doing radiography for 6 years including portables and fluoro and has never had a badge to measure his occupational dose!

They are not at all upset with me concerning the processor and are happy to at least have it developing at all. Slow they are willing to put up with as long as they can process. They are quite happy that the films are dry. I got an e-mail from Doris Tontsch @ Pro-tech following up and encouraging me to help them get the parts ordered. I spoke with the maintenance guy Leonard and encouraged him to order the parts and to see if they can have the devil possessed motor serviced/lubed/worked on so if the current motor quits before a replacement arrives they might be able to limp along.

A couple of scans with Dr. L & Dr. M and then nothing left to do so I walk back to the four story KHI to meet up with Benard. What a thoroughly pleasant chap. He and Patrick are from Kenya. We walk to the city center about 1.5 miles away to change some US$ into $FRw and catch a city bus to the market. Along the way we walk past a sign saying "Sale on Cell Phones - While they last $16,900 FRw (about $32 US). I'm in, , we check it out the add is true and they are still in stock. . So I've got a phone now. Kool beans in Africa the only person charged is the caller. The receiving phone gets no charge. So I'm country code 250 then local #05153309.

On to the taxi where we sit four to a row. Out across town Beeping and careening pell mell, past the guest house like a demon, beeping, jostling, bouncing, a lady 3 rows up is reading a bible as loud as she can the entire trip, beeping a bit more. We start dropping folks off and getting a bit more room each time. We get to our destination and I recognize it as being very near the church. The market is great. About a football field in size, under a tin canopy, tables so close that two people can not stand side by side comfortably but you must dance with everyone you meet or pass. I ask about pickpockets and thieves and Benard says not to worry, it's totally safe.

I want to get some fresh chicken for a broiled chicken tonight, and to kind of scope it out, maybe get a few other supplies. I wasn't quite prepared for how fresh the chicken was going to be. They were in pens and you picked and bartered for the one you wanted , , , come back in 15 minutes and it's in a bag, plucked and gutted but all of the "Good Extras" like gizzard, neck, heart and the undeveloped eggs are included. While we're waiting for my chicken we get some other items, a shopping bag (which busts a zipper in the first ten minutes but is happily replaced at the stall where we bought it), potatoes, cauliflower, flour, some strange fruit and some Tillapia fish fillets. We also find that we can get fresh chicken in a bag without having to see it first walking around in it's feathers for $1,ooo FRw less than we had agreed to pay. Back to collect our bagged, warm hen and find the bus for me to go to the guest house and Benard to go back to KHI. He's meeting Dr. Konn and a bunch of students who are going en-masse to greet the arriving American students at the airport.

Back at the guest house Duvali is making his supper and I start the chicken. It takes a while to figure out the oven. I've got 90 minutes to put away my other groceries, clean the potatoes (which I thought were white skinned but turned out to be red skinned once they were washed). Snacked on fresh pineapple and the strange fruit, played my autoharp out in the gazebo, transferred pictures from the camera to the computer and waited for the bird to cook. The oven gets up to 350 but very slowly. Finally, the clucker is done and the cauliflower is cleaned and cooked so it's time to eat. I don't think I've ever eaten a bird as tough as this one. It was chicken jerky. After gnawing on it a while, I give up and got another one of the strange fruits. I de-boned the rest and plan to make chicken and dumplings tomorrow. Perhaps another round of cooking can do something to tenderize it.

We've got these cute little lizards that run all over the walls and ceilings of the house in the evenings. They are a bit shy but they've gotta eats bugs so I just enjoy their scampering. I'm told that periodically monkeys show up at the guest house. Benard tells me they recognize and like the muzungas because we feed them but that they'll keep away from the Africans who try to chase them off. Benard tells me that the monkeys will come right into the house and are very good at finding and opening the doors that are hiding bananas.

I remember it's Thursday & I haven't taken my weekly malarial meds yet. The cold is almost out of my head and is deep in my chest but improving quickly. I've gotten some e-mails and comments from folks who are reading the blog. Those help and keep me encouraged to keep writing. A thank you shout out to Dawn Irwin for helping to get my CVTC password reset. We tried to Skype but it wasn't very successful. I was able to see some items that she wanted to know why I'd left them on her desk and what she was supposed to do with them (I knew there was some note I had forgotten to write).