The next two weeks I found myself much better able to engage in the hospital system. Now I had learned the names of Benson, Mugo, Humphries all clinical officer or medical officer interns. It became my pleasure on night and weekend call to lead them through surgical triage or procedures. On subsequent calls I was able to help one of the medical officer interns through two chest tube placements. These patients had spontaneous pneumothoraces, but were not in extremis, thus I could take my time and coach the intern through the procedure. By the second placement, Mugo was able to anesthetize the patient appropriately, make the incision, and perform this life saving procedure. He remained a bit tentative, but I had seen vast improvement by this second time. These guys and gals are the front line of the Kenyan medical system, and are seeing patients in isolated places with no surgeons, or even residency trained physicians available. Teaching Mugo to place a chest tube well could benefit multiple Kenyan patients in the future.

Spoiled. That’s the only way to describe how I feel heading back to the states. I feel that I had the opportunity to practice medicine the way my 6-year-old-self imagined it while in Guyana and I couldn’t be more thankful for the experience.

January 13

I can’t believe my time here in Haiti is over—but it is. I’m
writing this from my guesthouse in Port-au-Prince, in preparation for
my flight home tomorrow.

I would like to thank Senator Frist for forming the Frist Global
Health Leadership Program, and for allowing me to have come to Haiti
to work at HIC. I’d also like to thank the many people at Vanderbilt,
Dartmouth, and HIC who helped me make the needed connections and
organize the details of my trip. Last but not least, I’d like to give
a special shout-out to my boyfriend, for supporting and encouraging me
to leave him—and the U.S.—for three months and go work in Haiti.
Thank you.

I returned to Samaria with a Clinical Officer, Waweru, in tow to staff Samaria for the week in Susan’s absence. Susan has an obligation to attend training and program review for her participation in Tunza the family planning program supported in part by USAID. If Susan is not able to find a substitute during her absence, then she must close her clinic. In this case it would have been for 4 ½ days, difficult on the patients and Susan’s income. Even so, engaging a substitute adds costs to clinic expenditures, that may or may not be recouped from leaving the clinic open. This underscores the difficulty that private clinic nurses have in taking time away from their practice if they are the sole practitioner. It is difficult to engage in continuing education, a must for any clinical practitioner, if the economics and finding a trusted substitute are onerous.