By F. Bruce Cohen
Chief Financial Officer, United Therapies
Co-Founder, Knock Foundation, Inc.
(Previous post: The Notion of ‘Free’ Care )
I will not bore you by going into a day by day recitation of our activities but will, instead give you a general idea of what the days entailed as well as discuss a highlight, lowlight and provide you with my general impressions.
After Monday’s screenings, the remainder of the week was scheduled for surgery. NPGH had been kind to give us access to two of their six operating rooms (of which only four actually functioned).
The doctors would begin their day back at NPGH at 7:45 am where they would make rounds and see the patient’s they had operated on the previous day as well as talk with the patients that were scheduled for surgery that day. After making rounds, we would go to the doctor’s lounge and review the charts for the day’s patients and determine the proper order and who would be working on which patients (we had three doctors and 2 ORs which meant that two of our doctors would always be working together).
The doctors were ready to begin surgery by 9 am although, as in other parts of the world, time is an ephemeral notion in Kenya even with something as significant as surgery. Consequently, although informed that they were ready to begin surgery, the doctors might venture to the OR only to find the patient on a gurney in the hallway waiting to be taken into the OR to be prepped and anesthetized for surgery.
It was one of many significant cultural differences the doctors confronted. Throughout, the doctors acted with great humility understanding that even though they were volunteers providing much needed medical services, they were visitors in this country and at this hospital and acted accordingly. The doctors would typically perform surgeries from 9 am until 6 or 6:30, breaking with their Kenyan counterparts to share a lunch of ugali (cornmeal porridge) and beans. The next day the doctors would begin anew.
Without question one of the greatest moments came when we went into recovery on Thursday morning to check on the patients treated the previous day and the four-year-old girl that had a 5 kg (about 11 lb.) tumor removed from her stomach was sitting in bed crying. For the uninitiated, this might be cause for great concern not for the two doctors that spent six hours operating on her the previous day; her crying was almost as much a sign of recovery as a beating heart.
She continued to improve when we visited and examined her the next day while in the arms of her mother.
By far the most difficult experience occurred on Wednesday when the doctors were in the OR working from 9 am to 9:30 pm. On this day, a physician performed surgery on a patient but could not get the patient fully stabilized after the procedure. The patient continued to suffer from bleeding and blockage when the doctor decided to bring him back to the OR, open him up in an attempt to get him stabilized. With the assistance of the other doctors and their Kenyan counterparts, the team worked well into the night to finally get the man stabilized.
He was sent to the ICU in stable condition with the prognosis cautiously optimistic.
The next morning when we visited the previous day’s patients, we learned that the patient died at about 5 am that day, most likely from hypothermia (the body temperature drops to a level where the body can no longer function). Had the patient been in the U.S., this could probably have been avoided through the use of blankets and a bear hugger but at NPGH where medical equipment/devices are rare it is unfortunate that seemingly avoidable deaths are far more common.
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