Note: This post is long but it’s incredibly important to me so I ask you read it in its entirety.
This past week I started interning full time, which means I am dropped at the Makina Clinic in the morning and picked in the afternoon. Spending the day either at the Clinic, or more common moving around Kibera participating in campaigns, or meeting with partner organizations. Nonetheless, I have spent much more time at the clinic than I have in this semester. Last week was nothing crazy in terms of the patients: cuts, burns, etc. This week was much different.
Before I dive into the real meat of this blog post I want to provide some context to the ‘clinic’. The clinic is a tiny space, with a small waiting room, a consultation room, a storage room, and a pharmacy. The floor is uneven, the walls are half-painted, and the doors hang crooked. It is in Makina, which is a part of Kibera. The power frequently goes out, and the few lights can be run off of a generator. The doctor’s office features a small table for examination and procedure, and another small table for consultations. The supplies are stored in cabinets barely hanging on the wall. The clinic operates 24 hours, with a doctor always on call. Overnight and early morning, the lab and storage rooms are locked tight but the lobby is always ‘open’ and the consultation room is always open. It is a clinic, but is not what we imagine a clinic to be.
This week started off interesting with a scenario I am still grappling with, and may or may not blog about. In essence, I witnessed a pure clash between culture and medicine, in a clinic setting, which tore me apart. While culture is important, in a ‘clinic’ medicine should come first. I fully support cultural sensitivity in medicine, but there is a time and place and there was an incident Monday where the lines were too blurred.
Tuesday (today) is what this post is about. I ask that you bear with me, and read what follows.
We arrived at the clinic our normal time, but when we walked into the waiting room I noticed the other doors locked. I also noticed that neither the doctor, nor anyone else was around. Except for about six people gathered in the room. When my colleague and I stepped in they cleared a path to a woman sitting on the bench holding a girl who I estimate to be about 9 years of age. It became clear to me that when we stepped in one of the people was performing some form of CPR. As they cleared a path and stared at us, I looked at the girl.
She was gasping for air, her eyes were rolling back in her head, she was limp, and there was a clear gurgling noise and a visible liquid in her mouth. My first thought was she was having a seizure, but I quickly realized this was not the case.
The others in the clinic (family members and a motorcycle driver who transported her) looked at me. They pointed at the sick girl. Then pointed at me. Then widened their eyes as if they were saying “do something”. It became clear to me they thought we were medical professionals, which is not the case.
I had my colleague locate our supervisor and guide Eric, who would find the doctor, as I looked for newspaper to put down on the examination table (the only paper they have to cover the table).
Even after we stated we were finding the doctor, they wanted us to do something.
I didn’t know what was happening, I only knew this young girl was unable to breathe. Liquid was coming up and we needed to make sure that she did not choke.
Hearing the gurgling sound, I knew she was not only unable to breathe but that liquid was coming up from her lungs and was already filling her throat.
Just as we were about to bring the girl to the exam room (I couldn’t find anything to put down, but it didn’t matter. This girl needed to lie on her side, not be held), the doctor walked in.
He put her in the table, and lifted her shirt.
It was clear she was malnourished, and her lungs were working harder than I have ever seen lungs work.
Her body was fighting to keep her breathing. She was unresponsive, her eyes rolling, and her lungs filled with fluid.
The mother reported the girl has a history of asthma. The doctor immediately referred this girl to Kenyatta National Hospital, the highest hospital in all of Nairobi.
His quick examination made him realize we didn’t have the equipment to do anything. He instructed the family to take her there immediately. He also provided the phone number of a doctor there who knows the Makina clinic. The family was to call the doctor as soon as they arrived, to ensure this girl could get the treatment she needed.
They left quickly.
That’s when I began talking to the doctor about possible causes. He had no idea, but it is clear that indoor air pollution and her asthma played a significant role in the severity of the situation.
This is when the heartbreaking news came from him: he said if she didn’t get help soon she would not make it. He estimated that if they could not get there within an hour, and have her lungs cleared within two hours (closer to an hour and half) she would not survive.
Her body was working on overdrive to get the little air through. He didn’t think it could keep that up much longer, especially given her young age.
We didn’t hear anything throughout the day, but we have placed a few calls and anticipate hearing either tonight or tomorrow if she made it.
I can’t help but think of the possibility she did not make it. To have that happen would be devastating. Knowing that I was one of the last individuals to see her in her last moments.
I knew this would be something I would encounter in public health and medicine; I just didn’t anticipate it coming when I was 19 years old, on a typical Tuesday morning, in a clinic in Kenya, with a 9 year-old girl, and most shocking of all the family right there and thinking I could be one to save her.
I can only pray that she makes it through.
Today was the most helpless I have ever felt.
Watching this girl struggle to breath.
Watching this girl struggle to live.
Seeing the hope in the family’s eyes when I walked in, thinking that I would be able to save her.
They were helpless, I was their hope, and I was helpless.
I did what was within my knowledge and means, but it didn’t feel like enough.
I am not giving up my dream of being a doctor, and this just proved to me that I will not let anyone or anything stand in the way of that dream.
I never want to feel as helpless as I did today.
This is one of the hardest days of my life. I can’t help but think of this girl and the look the family gave me. I am praying, and I ask you to pray as well, that this girl makes it. I will not give up working to find the result of her case. I will let you know as soon as I hear.