Shiftwork

I apologize for not posting more this week. This has been our first week actually rounding with our teams on the wards, and it basically keeps me busy from about 5:45 in the morning when I wake up until about 9 or 10 pm when I stop studying. By that time I just wanna curl up in bed, watch an episode or two of Community or West Wing on Netflix (praise God for Hola) to let my brain veg out for a bit, and then pass out like nobody's business.

I figured for this post I'll just give you a general overview of what a day is like for me here. I wake up at 5:45, brush my teethes--never letting the water run, just like Barney taught me--and get dressed. The other Purdue students and I eat breakfast at IU House before departing for the roughly mile-long walk to the hospital (called Moi Teaching and Referral Hospital, or MTRH for those who didn't know). Once we get there, we put our things in a room where they'll be safe and head to the wards. The wards here are like nothing I've ever experienced or most likely ever will again in my career. They smell pretty bad, although not quite as terrible as I expected based on what we were told. We work in the adult wards only, which due to the conservative nature of Kenya and lack of private rooms of any kind is divided into men's and women's sides. I am one of the students on the men's side. Each ward is divided into six little alcoves, or "cubes" where they stuff 8 beds to a cube with just enough room for a team of doctors, med students, and clinical pharmacists to maneuver from bed to bed. There are no doors separating anyone, and beds typically have two, and--when business is unfortunately good--three patients in them. Most of you reading my blog aren't in the health care field, and I'm still pretty confident you figured out on your own that this is not the most ideal environment for treating sick people. We do what we can with what we have, though, and I continue to be impressed with how well we do given our disadvantages we're working with. Anyways, sorry for my tangent, back to the schedule (pronounced 'shed-yule' in my head as I type).

We get to the wards by about 7:15, and our first task is to locate our team's treatment sheets, or "T-sheets." As you can imagine, this hospital doesn't have enough computers to establish electronic medical records for patients, so it's done old school with good old lumber pounded down into paper thin… paper. As pharmacists, we are the ones responsible for maintaining these T-sheets (one for each patient), monitoring what medications our patients are on, making sure that doses are appropriate given their kidney function, liver function, electrolyte levels, or disease, and that the nurses administer them as scheduled. In summation, it's pretty much our job to make sure the patient is receiving the treatment they need while suffering as few adverse reactions as possible to their medications. On Mondays, Wednesdays, and Fridays we rewrite the T-sheets so that nurses don't run out of room to document administration. On Tuesdays and Thursdays, we have morning report at 8 o'clock. After rewriting T-sheets or morning report, we check up on our team's patients, make sure that they are actually getting their medications--sadly, with paper records and, to be frank, disorganization and the hectic nature of the hospital, it's not uncommon for this to slip through the cracks--and that they are doing well.

At 9 o'clock--or sometimes 9:15/9:30 if your team operates on what we at IU House call "Kenyan time"--we begin rounds with the doctors and med students. We, the pharmacy students, round with the team and carry all of our patients' T-sheets with us as we go. The med students present their patient to the registrar (the equivalent of an American third or fourth year medical resident) or consulting (in America, the attending). Sometimes, as some of us in this group as well as the previous group have found out, we don't even have a registrar or consulting and it's just us and the med students. Occasionally a question will come up--usually by one of the superior doctors--about what the patient is currently taking. We have the T-sheets and are in charge of the patients medications, so this is part of where our role comes into play. We answer said questions, and we also will often have questions of our own. For example, the most common question I have been asking so far is, "What are we treating with ceftriaxone (an antibiotic)?" It seems like every patient here gets put on ceftriaxone, regardless of the reason they are admitted. Admittedly, this is slightly understandable given how rampant infectious disease tends to be in this part of the world. However, as the pharmacists in this setting one of our jobs is to make sure our patients aren't on medications that they don't need. After all, every dose received has to be paid for, and each medication brings risk of side effects and adverse events. Sometimes we bring up ideas that the doctors don't necessarily agree with; sometimes we bring up something they do. Most of the time for sure, though, they seem very appreciative of our help and at least receptive toward our recommendations.

Time-wise, rounds varies a lot depending on how many patients your team is following, how much time your consulting or registrar spends on each patient, whether your team admitted new patients the night before, etc. Once they are over, the team disperses: consultings often have jobs in the private sector to go attend to, registrars and med students have patients to follow up on and notes to write--don't forget about that whole paper records thing--and we take the T-sheets back to the counter near the nursing station, finalize any dosing on newly added medications, and take them to the pharmacy so that patients can be charged for their medications before they are set to be administered at 2 pm. Once that's finished, we typically have some follow up of our own to do on our patients. Sometimes that's checking a patient's electrolyte levels to make sure their medications aren't pushing them into toxic ranges. Sometimes that's walking to over to the anticoagulation clinic or the AMPATH clinic (HIV clinic) to refer a patient or check up on what HIV medications a patient in the wards is taking. This varies day by day and can take anywhere from 15 minutes to a couple hours. Once we've completed following up on our patients needs, we return to the wards and write up our own reports on each patient so that we can discuss them with our preceptors (on-site teachers) throughout the week. This sounds boring and uneventful, but it can actually become a challenging, often times frustrating endeavor. You see, the worst feeling in the wards is relinquishing those T-sheets to any human being besides yourself. Once you do that, there is no telling where they will end up. Once you get used to it, you can usually narrow down the possibilities to three or four places, but there is no guarantee that you'll be able to find them. As difficult to find as the T-sheets are, finding a specific patient's medical record is comparable to finding a good parking spot at Purdue without a parking pass. Once we find our patients' files, we work up our reports until 1-1:30, occasionally answering a med student's question or following up on something new for a patient. We walk back to IU House for lunch, and then we typically get back to the hospital between 2-2:30. From there, we either have T-sheet review with our preceptors, or we continue to work up patient reports, advise med students when asked, and keep checking on our patients until anywhere from 5-6 pm. We go home, thankfully eat, and then study any topics or treatment guidelines that our preceptors asked us to that day until 9 or 10 pm.

There's some variation, but that's a typical weekday for me. Well marafiki ("friends" in Swahili) we're getting up early tomorrow with some of the IU Med students to go to Hell's Gate! I haven't looked much into what it has in store for us, but I hear there's animals, hiking, and even the rock that Pride Rock from The Lion King was inspired by! Obviously you can expect a post and pictures from this adventure Sunday or Monday depending on how tired I am. Kwaheri! (Goodbye!)

"You learn how to cut down trees by cutting them down." ~ Bateke proverb