Teaching and training

Today was more of the same, unfortunately (or fortunately, I haven't quite decided yet). I'm again in public health, so I spent time with Katana on his weekly disease surveillance reports, which have to be submitted up to the next level. He gets reports from the local clinics (35 or so of them, I think they said), and then puts that all together to submit up to the district public health officer, who submits them up to the province, then to Nairobi, etc. What he usually does is count them all up by hand and submit it that way, so I introduced him to Excel, which will do the summations and keeps everything in a pretty handy place for the future. I've never taught anyone how to use Excel before, so it was a little interesting to see all the things that I do without thinking (like making the columns fit the headings), from the point of view of someone who doesn't know much about the program. I did teach him the basics and how to do summations, but that was about it. I also had to teach him how to save websites into his favorites... The things we take for granted having grown up with computers, I guess.

After that, I got a call that there was a post-mortem (an autopsy) that was about to start, and since I was interested in that process, I went over to the morgue/funeral home for that. Sadly, it was an 11-year-old girl who had been hit by a bus. She was missing the back of her skull and almost all of her brain, so cause of death was pretty obvious, but they still did an internal examination to get a full list of injuries for the police report. One main difference between autopsies here and in the States is that in Malindi, they don't have trained pathologists, so they don't do histology (looking at tissues under a microscope). For cases such as this one, with obvious cause of death, looking at the tissues isn't really all that necessary anyway, but if there's a question of cause of death, or if there's something that needs to be looked at to determine if it's cancer, the tissues get sent down to Mombasa, about 3-4 hour drive down the coast. Not nearly as streamlined of a process as what I'm accustomed to.

Following that, I decided to check out how the trauma training was going. Dr. Childs was using ATLS presentations, which was good, in that they cover the standard of care for trauma treatment, but also a bit difficult, in that Malindi doesn't have a lot of the resources that are needed for standard of care. It's an interesting balance, to present what is right but at the same time teach them what to do in their situations. There's a group of German med students who are the hospital for a month who were also attending the training, so I got to chat with them for a few minutes about school and what they were hoping to accomplish on this rotation.

Tomorrow, I think I'm going with the district public health officer to inspect some of the clinics, but I haven't heard from Jeremy, so I don't know what time I'm supposed to be at the hospital to leave. This could be interesting...