Fistula Camp - Day Two

We all tumbled out of bed and met at 7am in the dining hall for breakfast. Loud poorly sung church music was playing on the radio. There was some kind of tour group leaving that morning sitting at one end of a long dining table – obviously unsure abou this group of loud, boisterous and obviously educated group of Kenyans with one seemingly out-of-place mzungu in their midst.
We got to Kisii hospital and there was a crowd of people at the gate – it was unclear why they were being held outside but it seems they were merely awaiting visiting hour and not urgent treatment like I initially worried.
We went straight to Ward 7 where the fistula patients were – all in one room, lying row on row some with catheters and obviously post-op and others awaiting their turn. We did the fastest ward round I think I have ever seen – 40 patients in approximately half an hour – this was facilitated by the fact that there was NO privacy when being examined in this room other than the assistance the patient’s own skirt might give her. We then went to the operating theatre where we remained for the next 12 consecutive hours. The “scrub” station in Kisii is a faucet with a bar of black soap – that was it. In our first case they tried to put a fan on beside us to keep us from overheating but unfortunately the fan succumbed to that fate, catching on fire itself which was quickly extinguished. We did only four cases that day due to the complicated nature of each case. Some of these girls believe they will stop leaking if they don’t drink anything so their urine becomes so concentrated they get bladder stones. A lot of people know about kidney stones but these are a bit different and I examined a patient that day that had a bladder stone the size of a small chicken egg which we removed but I could not contain my disbelief which splashed all over my face as I examined her making Dr. Khisa laugh and say “You have learned a lot of things in Kenya” – a very true fact indeed. When we start some of these cases I have so little faith that we will even be able to do anything but I am always amazed at what he can do for these women. That day we had a fifteen year old girl who three months ago endured a stillbirth, a Caeserean section to remove said stillbirth, a hysterectomy for a gangrenous uterus after labouring at home for days and getting so badly infected AND a fistula from the same causes. She had sepsis so bad that she nearly died and what we were seeing was the aftermath and it was unidentifiable. I would have abandoned that case so fast your head would spin needing multiple other specialties to assist me but Dr. Khisa actually restored function for this girl – a small but welcome relief for a girl who’s life is now over by rural African standards – barren at 15 with no hope of future children.
We left the operating theatre into the darkness of the night. During the day Kisii hospital is warm and inviting with manicured lawn and beautiful trees (they laughed a lot at me when I couldn’t identify an avocado tree seeing as how I have a great love for avocados but when would I have seen an avocado tree!) but at night all the harsh realities that are covered by the brightness of the midday sun become glaringly obvious. The flood lights exentuating the corridors lined with chicken-wire and the large, metal gates at every entrance – it feels like a penitentiary rather than a hospital. And there is no relief once you leave the walls of the hospital compound as there are no street lights in Kisii – the only lights pouring out from the local shops or the headlamps of the workers - it looks like a scene out of a science-fiction novel. We went to Nakumatt (supermarket) that night and I picked up two bottles of red wine for us to share for working so hard and that night they toasted “To Canadians in Kisii”. For those of you keeping track the fact that we did four cases that first day meant we had 14 left to go. We all settled into bed that night, exhausted and a little tipsy from the wine and good company, knowing there was a lot more work ahead.