In the middle of Kenya…
When I arrived from the hospital, there was a strange man standing next to my house. With him were scores of camels, cows and goats. And they were snacking on my fence. I was in time to see the last bit of it go into their mouths. That is how I moved from living in a compound to living in a field. In no man’s land. There was no bitter exchange between me and the strange man. No shouting match. No drama. After his animals had had some grass for dessert, he left as quietly as he had come. I guess this is what life was like in Isiolo.
I was stunned when I received my posting order to report to Isiolo. Hardship areas were traditionally meant for male doctors — or not. My imagination ran wild as I tried to picture myself living there. The Kenyan map shows that it lies at the center of the country. Yet going there didn’t feel like it. It felt more like it was teetering at the edge. Being one to charge hell with a bucket of ice cold water, I didn’t bother going to scout the place. I just packed my clothes and medical books and went.
Isiolo is 285km from Nairobi. The journey starts at a place called “Tea Room.” I got into a matatu to Meru; 4 hours away and then from Meru I boarded a 6 seater vehicle to Isiolo town. We were crammed in there, facing each other, breathing in each other’s air with our knees intertwined. Because there was no road to speak of we were bumped around; falling all over each other. I was the only light skinned person in the car but by the time we arrived, everyone’s face looked like mine. Ashen. Isiolo was full of fine white dust and it had settled on our faces like an extra layer of skin. From the town I took another hour and a half trekking through fields and forests to get to the hospital. I am pretty sure I looked like candle wax by the time I arrived.
Interesting enough, Isiolo Distict Hospital was the cleanest public hospital I had ever seen. The walls looked freshly painted and it didn’t have that distinct hospital smell I was used to. There was hope after all. When I reported to the MedSup’s office he looked visibly disappointed. Not another female doctor. Apparently female staff never stayed. I would soon learn this was a male dominated town. The workers were male, the patients were male and a good percentage of the nurses were male. Even my housemates were male. I felt as welcome as a porcupine in a nudist colony. As a result I felt I had to keep proving myself. The patients would sometimes second guess me or blatantly refuse to be managed by me. They were happy when I delivered their wives in the labour ward but for some reason would decline surgery if I was the one to perform it.
In this male dominated land most scores were settled by the knife, the sword or a good ol’ fashioned bow and arrow. They lived their lives as if they had human spare parts somewhere. There was so much testosterone around it seemed the only way to dissipate it was to fight over everything and anything. It is no shock therefore when a guy once came in with a hanging hand held by skin and some tendons after fighting over a patch of miraa (khat) with his buddy. The Meru community which was predominant in those parts specialised in cutting each other and then bringing each other to hospital. Another guy had his right knee opened up through and through during a squabble when another came in with a spear in his right abdomen. And worse still, those that needed minor surgical repairs would decline local anesthesia.
“Just get on with it Doc.” They would say with teeth clenched and enlarged veins threatening to burst through their skin.
The women there were also something else. Once a lady came in and delivered her 9th born. A preterm baby who weighed 1.6 kg. As protocol would have it, a baby is only discharged after it has gained at least 2 kg. When I told her this, she just up and left. She left us with her baby and came back after two weeks to ask if the baby was 2 kgs. She explicitly said she had delivered all her other 8 children at home and couldn’t leave them unattended to care for this one. With that, we handed over the baby to her and after 3 months when I saw him, he was just fine.
Another one, had twenty children and came in for delivery with her twenty first pregnancy.And she was only 38 years old. I calculated and realised she had never had a period in her life. She had been pregnant throughout her entire reproductive cycle and was in fact brought to the hospital by her second born daughter who was pregnant with her 5th child by then. Any conversation on family planning was met with blank stares.
During the 2009/2010 clashes between the Pokot and Boran tribes we had a myriad of trauma cases. There was this one guy who fell from a truck during the skirmishes. He sustained a pelvic fracture and was brought in by his friends in a lot of pain. We did an x-ray to assess the extent of his injury. I was no bone specialist but I had seen enough x — rays in my medical career to know what to look for in a pelvic fracture.
Imagine my shock when I put up the x-ray film in the viewer and something just didn’t make sense. The man appeared to have three limbs. I called in reinforcements to figure out what we were seeing, but everyone was puzzled. Because the era of social media had not arrived, I wasnt able to take a photo of the x ray to send to my colleagues. So I decided to go and examine the patient again. And there it was. His third leg was in fact the longest penile shaft I had ever seen. It stretched all the way to his knees — a tourist attraction. I don’t know whether it was a genetic disorder or just a rare malformation. We were supposed to insert a urinary catheter for him but that was not going to fly. We brought in the longest, largest catheters from the stores and they did not suffice. I was forced to put in a suprapubic catheter. (see below).
With time I adapted to life in Isiolo. It was mostly slow but with waves of drama and excitement. In between attending to patients, I ate meat. It was everywhere. There was a lot of value placed on livestock and patients occassionally brought us goats as a sign of gratitude. Speaking of value — once a nomad came to the hospital with a gangrenous foot as huge as life and he only consented to admission after his cattle had been accomodated — within the hospital no doubt.
Out of all these cases, the one that changed the trajectory of my life was this one lady. Once I got a phone call from a colleague who worked in Garbatulla — a hospital 60km away. She told me she was referring a pregnant woman with obstructed labor because they did not have a functional operating theatre. We quickly set up a team and prepared for her knowing she was definitely going to be in a bad state when she arrived. We were ready. We waited and waited. The day passed and she was a no show. Another day passed and still she was nowhere to be seen. When I called my colleague to ask about her, they said they had released her 3 days prior. By the 4th day we gave up assuming that she may have passed away along the way.
Ten days later, I was called to the hospital. That a pregnant lady had arrived from Garbatulla. ‘It couldn’t be her,’ I thought. But it was. She had arrived tired, dehydrated, and dusty — on a camel. We got her into the ward and were shocked that her baby still had a heartbeat. But a very weak one at best. That they were both alive was a medical miracle. We quickly rushed her to the theatre and that was by far the hardest cesarean section I had ever done — to date. I had to call for help. It was so difficult to get the baby out, to repair the uterus and to control bleeding. It took us 7 hours to sort her out. It was gruelling. And post op she developed a fistula; a known complication of obstructed labour. Unfortunately her baby didn’t make it.
As she continued to get better physically, I expected her to be down in the dumps. But she wasn’t. She kept asking me whether her uterus was ok. She was so grateful that her uterus was intact. I didn’t get it. The culture there is that a woman is as useful as her uterus. And throngs of relatives who came to see her clapped for me because I saved her uterus. Her fistula was later repaired in Nairobi. When she came back, she came to see me and asked me how she could prevent having a situation like the one she had had. Clearly the trauma of her previous delivery had been debrided by time.
Because there was no way she could deliver another baby vaginally I told her, her only option — if she was to conceive — were through cesarean sections. She proceeded to conceive not one or two but six times after that and she insisted that I was going to be the only person who would operate on her. She was so serious that even after I left Isiolo a year and a half later, she would travel to Nairobi to where I was; to deliver her.
It was during her sixth cesarean section that I informed her of my intent to leave the country for further studies. Because of her belief that no one else could operate on her, she requested a tubal ligation. Something unheard of in her culture. She now has six children. As a parting gift, she made me a symbolic cultural ring which was six rings bound with one ring around it. I have kept it and wear it to date.
As narrated to me by Dr Dorcas Muchiri — now an obstetrician gynecologist.
A suprapubic catheter is a hollow flexible tube that is used to drain urine from the bladder. It is inserted into the bladder through a cut in the tummy, a few inches below the navel. This is ideally done under a local anaesthetic but we know what these guys felt about anesthesia.
