Day 10

Hello friends, family, and newcomers. Welcome to or welcome back to my blog where I am documenting the process leading up to and during my first humanitarian mission to Eldoret, Kenya.

Today is Tuesday, April 8th, marking the fifth day of our mission with just two days to go. I can hardly believe I'm writing this—only two days left!

This morning, we woke up at 6:45, got ready, and headed downstairs for breakfast. I typically have the same meal each morning: strawberry yogurt, hard-boiled eggs, pork sausage, and either oat porridge or some kind of bread or pastry. I particularly enjoy the oat porridge when it's available, as I like to add bananas and honey, though it's not offered daily, so I sometimes choose other options. After breakfast, we went to the lobby, got into the vans, and departed.

Today, I had a significant amount of education to provide, needed to see patients post-operatively, check wounds, and prepare to administer a large volume enema to a patient with anal stenosis. We gathered in the conference room for our morning meeting and then proceeded to our respective areas.

I began my day in the wards, checking in with the rounding team. I requested that the patient scheduled for a large volume enema be moved to a private room, as I believed it was unsuitable to perform this procedure in the wards and wanted the patient closer to a restroom. With limited supplies, I contacted a former colleague for advice on administering the enema with the materials I had, and she promptly responded. After relocating the patient to a private room, I started gathering my supplies: a urine Foley bag, a 24F catheter, dish soap, cooking oil, and tap water. I needed a large IV pole, which the nurses provided, and we set it up in the room, using a backpack under the pole to stabilize it. I filled the urine Foley bag with 1000mL of tap water, cooking oil, and dish soap. I cut the tubing from one end of the catheter and inserted it into the opposite side for fluid exit, taping the two pieces together. A 24F catheter was attached at the end of the tubing, and a clamp was placed on the line to control the flow rate of the solution into the patient. The bag was hung two feet above the patient. The catheter was inserted into the rectum, and the enema was administered over 15 to 60 minutes.

A large volume enema helps break up stool in the colon and is performed over several days to ensure effective bowel emptying. This was a significant experience for everyone involved. Education is crucial for both the patient and the local staff, as the patient will continue these procedures at home. Everyone must be well-informed to ensure the process is conducted safely and efficiently, which can determine the patient's eligibility and readiness for surgery.

After completing the enema, I was called to the clinic. I wasn't prepared for what awaited me. I encountered a three-year-old with bladder exstrophy (the bladder is outside the body) and a prolapsed colostomy. The colostomy was being covered with a diaper due to the lack of proper supplies that most people do not have access to, leading to skin breakdown and irritation around the abdomen. Families do the best they can in these situations. Figuring out how to pouch it was incredibly challenging, one of the toughest tasks I've faced. I enlisted Becci and Karim to assist me. I gathered all the necessary supplies: a pouch, powder, skin barrier wipes, a ring, and scissors. Anticipating that cleaning the area and applying a new pouch would be extremely painful, I distracted the patient with my name badge, showing her how it extended and letting her play with it while I worked. Despite everything she was enduring, her big smile warmed my heart. I managed to secure the pouch, reinforced it with tape, placed a diaper on her, and got her dressed again. Once we finished, she got off the table and began running around, giggling and happy, holding our hands with a radiant smile. You would never know she was experiencing such difficult circumstances if you hadn't seen it. Her spirit and soul are so vibrant and strong. She was admitted to the hospital to schedule her for surgery.

I then proceeded to educate a patient who had undergone a colostomy creation and was preparing for discharge. I made sure the patient understood how to properly care for the ostomy, including changing the pouch every 3-4 days. I advised that if it started leaking, he should remove the pouch, thoroughly clean the skin, and apply a new one. I discussed dietary restrictions, recommending a gradual reintroduction of foods into his diet and advising him to avoid anything that caused pain or discomfort. I also outlined activity restrictions for the upcoming weeks and explained how to care for the wound on his bottom. I answered any questions he had and connected him with social work to ensure he could continue to obtain necessary supplies after discharge.

The patient will return to a refugee camp after discharge, making the involvement of social work CRUCIAL. Without close monitoring and social work support, these patients often become disconnected from the system, miss out on necessary supplies, and fail to attend follow-ups. Social work plays a vital role in patient care here, ensuring post-operative patients receive the required support and resources after discharge. Unlike back home, where institutions and companies handle supply orders and deliveries, such services are unavailable here. The hospital itself takes responsibility for follow-up and ensures patients receive the supplies they need. Without their dedication, the fate of these patients would be uncertain.

Today, I had my usual lunch: rice, meat, lentils, cabbage and vegetables, chapati, and fruits. I was extremely hungry, so I ate a substantial amount. After a long and demanding morning, I needed to refuel for the afternoon. We also got the pleasure to meet Naomi Korir. Her story is beyond inspiring. She is a middle distance runner, but before becoming a runner she was a fistula patient. Undergoing life changing surgery at the age of 14 at Gynocare and getting her life back. She is currently training for world's and has her mind set on the 2028 LA Olympics. She is true inspiration for many and we wish her all of the best as she prepares for these amazing milestones.

In the afternoon, I visited the Beyond Fistula shop to place an order to bring home. Every item is handcrafted by the seamstresses there, and each piece is truly beautiful. I'm thrilled to have the opportunity to gift these items to loved ones, friends, and those who have supported me. They began making the ostomy covers that Tayler featured in a video, which was amazing to witness. Some of my colleagues were ordering these to take back to their hospitals.

Since our arrival, all the donated ostomy supplies have been stored in Dr. Mabeya's office. Today, I began transferring these supplies to the ostomy storeroom to start sorting and organizing them. My goal is to make them easily accessible and simple for them to find.

I observed an intriguing laparoscopic procedure involving a woman suspected to have a vaginal septum, which is a division of the vagina by a tissue band. Upon examination, it was discovered that her uterus had not developed. She had two fallopian tubes and two ovaries, but there was only a cavity where the uterus should have been. This was fascinating to witness. Unfortunately, the reality for the patient is distressing, as she will never be able to bear children. Additionally, she will require education on vaginal dilation to be able to engage in sexual intercourse, which is culturally crucial for marriage eligibility. These situations are highly sensitive, and while I may not entirely comprehend them, it is my duty as a nurse to ensure the patient receives precisely what she needs.

We concluded the evening with a total of 163 cases. After changing, we boarded the vans to return to the hotel. I may not have mentioned this before, but our hotel is located within a mall. On previous nights, we returned too late to visit the grocery store inside, but tonight it was still open. So, we went to the grocery store, and I bought more mini bananas, which are my absolute favorite. They are incredibly flavorful and very sweet.

We had a much-needed dinner of soup and ice cream tonight. These two comfort foods provided great solace. I'm starting to feel the mental strain, with the sad cases and moments weighing heavily on my mind today. I empathize with every woman and child we are treating. While there is much good happening, it's important to remember the anguish and pain they endure due to their circumstances. It's saddening to realize that the world could be so much kinder to them, given how kind they are to it and to others. When you talk with them, hear their stories, and see their smiles, you witness both beauty and pain. You see the grief and hope they experience.

Tomorrow is a new day, and I'm going to get some good sleep to clear my mind and return refreshed, ready to make a difference. Although I know I will never be able to change their lives as profoundly as they have changed mine. Until tomorrow :)

All Love,

Meg