More training

This time, the training isn't for me. Yay!

I started the day in the public health office, where we did active surveillance for polio and measles. This involves going to the outpatient physiotherapy and occupational therapy logs, and checking the diagnoses to make sure nothing sounds like "acute flaccid paralysis" (which is polio), and then going to the pediatrics ward and making sure nothing looks like "fever and a rash" (which could be measles). It would also be possible for acute flaccid paralysis to be the inpatient peds ward, but we didn't see that (or fever and a rash). This is good, because with the two cases of neonatal tetanus from before, Malindi District Hospital already has enough to report to the WHO.

That didn't take too long, so I was off to do more preventive medicine-type things, which was seeing how their vaccination clinic worked and what exactly happened in the family planning clinic. The vaccination clinic was interesting, just because there's so much logistics that we don't usually think about. Cold chain is very important, especially for the measles vaccine; if the vial gets to warm, it's useless (and no, I don't know what that magic number is). So they have the stocks of the vaccines in a freezer, which is only opened twice a day, once in the morning to remove what would be needed for the day, and once the evening, to return anything that wasn't used. The vials that are going to outlying clinics were placed in a cooler and packed with freezer packs (the fake ice stuff usually used in coolers). Those that were going to the vaccination clinic at MDH were placed in a fridge in the clinic, except what they needed at the moment, which was kept in a cooler with the freezer packs. Whenever that cooler was emptied, they opened the freezer to get more. It was somewhat complicated, but it works, which is the most important part.

"Family planning" is the PC term for birth control. I haven't seen the actually study that says this, so I don't know if it's true, but according to COL Coldren, women in Kenya seek family planning after they already have a kid. Men want it before they have a kid, but once they have one, they want more, so they don't want family planning anymore. Sometimes this means there's a little bit of sneakiness on the part of a wife, who will go in for Depo-Provera shots (birth control shots) when she has to go to the clinic for her baby's shots. From what I saw, Depo is the birth control of choice here, because it's cheap (70 KSH a shot, which is about $0.80) and you only have to think about it once every three months. Family planning is offered to anyone who wants it, but from what I saw, it's usually women who already have at least one kid and are trying to space kids out, which is good.

And now back to the title of the post. Today a trauma surgeon and Navy reservist arrived to provide training in care for trauma patients (this is his annual two weeks of active duty time... talk about having a hard life). His original plan was to do Advanced Trauma Life Support (ATLS) training, which is a 2.5 day training back in the States (I did it during C4, during intern year). Well, ATLS requires all sorts of skills demonstrations that they just don't have here, so his plan is to use a lot of the ATLS lectures and just teach whatever skills he can manage to teach, given the resources of the hospital. This training was requested by Dr. Buni, the medical superintendent, because they're opening up a Casualty ward (essentially an ER), and he wants to make sure he has medical officers and clinical officers who know what they're doing in it. It's going to be a busy two weeks for Dr. Childs, given that he has to make up some aspects of the course and given that there are about 50 people who want/need training. I'll drop in on some of the lessons, to see how the training goes and offer my assistance if he needs it.

After work, I lounged around for a bit before heading over to the gym and putting in some treadmill time (ugh). It's not exactly fun (in fact, compared to doing some real running, it's pretty much torture), but it has to be done. In a little less than two weeks, I'll be back home and will get to do all the running I can handle (hopefully without ending up in a fracture boot this time...)