Only in Hola..

Medical internship feels like one is pedaling a bicycle backwards. It is gruelling. For that one year, it becomes the fulcrum on which other facets of your life pivot. When I was finally done with internship, I hibernated. When my colleagues were busy campaigning for favourable posting centres, I was unmoved. There was no way any other centre would beat working at one of the busiest hospitals in the then Coast Province. So I rested in peace. Until I got my posting order — Hola.

I looked at that letter and hope left my body. How could I have been so stupid? Leaving my fate to chance and the good ol’ Government. I had been there once before with a friend who I had accompanied on a work assignment six months back. It was so far out, I didn’t think we were still within the Province.

A town so remote, it had no beginning and no end. You just stumbled upon it in the middle of nowhere. A cool 200 Kms from Malindi and 150 Kms from Garissa. See? Nowhere. I swore that there was no way I was going to report to work there. I envisioned it’s derelict state that last time I was there and felt my insides recoil.

Nonetheless I decided to go and check it out. Maybe things had changed in six months. I went about Mombasa town searching for means of transport to get there. I half expected to find a flock of camels written, ‘Destination — Hola.’ Instead I saw buses. I boarded one. A rusted old contraption that coughed and sighed when the engine came on. My resolve was made stronger.

I left Mombasa town at 7am and got there at 3pm clothed in dust, sweat and the smell of every conceivable ruminant you can think of. Every bone in my body ached from the rough ride. On alighting from the bus, I felt like I was in an open air sauna. I asked some locals for directions to the hospital. It wasn’t hard to trace. The entire town is on a 3km stretch of road. A tarmac road at one end and Tana River on the other; with the hospital smack in the middle. When I saw it, I wondered whether it doubled as an animal orphanage. First it had no fence. You just stumbled upon it. A couple of buildings idling along the road. Folk walked in and out and all sorts of livestock roamed the corridors.

Unable to fathom how I would work here, I turned away and left. But it was almost dusk. I hadn’t planned on staying the night but I had no choice. So I set out to look for accomodation. The first hotel I ended up at was 200kshs a night. I paid, got to the room and vomited in my mouth. The room had the stench of yesterday. There was half chewed miraa on the bedside table. The sheets were soiled and there was hair everywhere. It looked like a murder scene. Next.

I walked into the next hotel thinking about my life decisions. Maybe it was time to quit while ahead and follow my childhood dream of becoming a stockbroker. I knew nothing about it or even what it entailed apart from the fact that growing up, our neighbour Munge was the coolest cat on the block. He drove the latest cars, had the biggest house and was a stockbroker. I wanted to be him. So it only made sense to do what he did. Until I slaughtered a goat.

Well, I didn’t really slaughter it, my dad did — God rest his soul. Over Christmas, he would meticulously dissect the fattened animal. A doctor himself, he would be very precise in how he went about it and he would take it apart piece by piece while giving me Anatomy lessons. He would show me how each organ was connected, trace the blood flow to each of them and then name each and every part, plus its function. I was enthralled. The idea of taking something apart and putting it back together excited me more than my dream of becoming Mr Munge. That is how the choice was made. I would become a Doctor.

Arriving at the second hotel however had me thinking it was not too late to change careers. It was somewhat better than the last one though. Cleaner ensuite rooms. Unbelievable. And they served breakfast too. All for a whopping 500 kshs. I stayed the night but at the crack of dawn I was out of there. I didn’t look back.

When I got back to civilization, I went to see the Provincial Medical Officer. I begged for mercy. He asked where I was when the rest were picking centres to go to. I had no response.

“Meme, my hands are tied, “ he said, “once the posting order is out it’s irreversible. You are young and energetic. Report and stay a few months, then you can apply for postgraduate studies. I will make sure you get in earlier than the requisite two years because it’s a hardship area.”

Against all my instincts, I believed him.

I was there, two and a half years. But I am getting ahead of myself.

So I reported. After two weeks of soul searching. I was used to a certain way of life. Swimming at the beach on weekends, island excursions, and partying. What would become of me in that place? I would soon find out.

The medical superintendent was very kind when I first appeared. He gave me a tour of the hospital and introduced me to everyone. His excitement was palpable. He acted as if he had been waiting for me all his life. Still unable to accept my fate, I dissappeared for another two weeks. The kind Med sup enquired about me and even offered to send a car to transport me. I had no more wiggling room. I packed my meagre belongings and left. I wanted to carry as few things as possible because I wasn’t planning on staying right?

I had this fridge that I was forced to leave behind. I didn’t think it would survive the journey. Looking back, I should have left my clothes and carried that darn thing. Hola was so hot I very well could have lived in that fridge. I also came to find out my clothes were of no use there. I spent most of my days in a kikoi and t — shirt because a formal shirt and trousers were too extra. On arrival I was assigned a government issue house. A three bedroom bungalow all to myself. Or not. The Med sup forgot to mention that two nurses were living there while waiting for separate accommodation.

“Don’t worry Doc. Now that you are here, we will hasten the process. Let them stay a few days as we streamline things.”

They stayed six months.

My first month there was dreary. I had nothing to look forward to. On an extremely busy day the whole hospital had about 40 patients. With nothing else to do, I would see all the patients daily. That was my morning routine. Wake up, attend to all the patients then sit under a tree in the afternoon. It was too hot to sit in the house. I had no fan and there was no electricity. Yes the whole town was powered by a generator that was fired up from 7pm to 9pm everyday. That was the time to iron, have a hot shower, charge your phone and watch news. Then darkness until the next day.

You think lockdown is boring? Try Hola.

After a few weeks, I made some friends. They introduced me to a place they called ‘sitting room.’ Where all the civil servants met to eat and drink. Soon enough it became my afternoon ritual. We would while away the afternoon on meat and liquor until it became mundane. I didn’t like the frequency and amount of alcohol I was taking, so I stopped going there altogether. I bought a fan, got movies and started to stay in the house.

By then there were more generators so we had electricity all day.

One day, life took an interesting turn. First, remember the kind excited Med Sup? He wasn’t chirpy for nothing. A few weeks after I reported he miraculously got a transfer and left. I invariably became the alpha and omega. I was next in line and was appointed the Med sup. So my afternoon ritual changed again. I would spend the afternoon in the office carrying out administrative duties.

It was during one of these afternoons that I got a call to carry out a postmortem. Until then I hadn’t got a chance to cut or suture anything. A dead body wasn’t ideal but at least it was something. I instructed them to take the body to the morgue as I finished up real quick. I got to the morgue and was confused. The ambulance guys were packed outside and the body was still at the back.

“What’s wrong? Why aren’t you in the morgue?” I asked.

“There is no morgue.”

“What do you mean? Where do you store your bodies?”

“We don’t. Anyone who dies is buried within 24 hours. Those are our practices. Besides we don’t have cold stores. It would cost too much. Without them, no one would dare keep a body here in this heat.” He said as he pointed to the walls behind the ambulance.

“This was supposed to be the morgue.”

I was bewildered. There were walls for sure. No roof, no door. Just walls with huge gaping spaces where the mortuary cabinets were supposed to be. Instead of human bodies between those walls, there were goats. Several of them. Sunbathing in the morgue. They looked like runaways those goats.

“So where will I do the postmortem?”

“In the ambulance.”

No kidding. It was going to be a technical nightmare. I couldn’t fit in there with the body, let alone carry out a postmortem. So I asked them to remove the body and place it on the ground. And they did. It was a spectacle. What shocks me though, is the goats. They didn’t move. They watched us with as much enthusiasm as a blind man in a strip club.

The guy had been found in the nearby river — dead. When they lay him before me, he looked like he would explode if I as much as touched him. He was unsightly. Literally bursting at the seams. He had four huge holes on his torso. Two on his chest and two on his abdomen.

“Doc these are hippo bite marks. He was probably attacked by a hippo.”

I nodded in bewilderment; still stuck at hippo.

Cause of death: Hippo attack.

After that, the days became akin to a script from ER. Only for me it was ER in the wild.

A few days later, a lady walks into the hospital carrying another lady — whose leg was hanging precariously loose from its socket. Again, I was in the office signing something or other. I was called.

I get to casualty and the first thing I see is the leg and blood. Lots of it.

“What happened?” I asked the clinical officer as I put on my gloves.

“I was bitten by a crocodile.” The lady answered.

I wasn’t sure whether to be shocked by the fact that crocodiles and hippos were the new road traffic accidents or that the lady whose leg was half amputated was speaking as if she was addressing the nation.

“Have you given her painkillers?” I ask the clinical officer.

“Not yet. These people… They have a high pain threshold.”

That explained her demeanor.

Regardless we got down to work. Painkillers here, IV fluids there , blood tests, antibiotics and everything we knew to do. The lady who carried her there seemed more distraught. She refused to leave her side, encouraging her and praying silently with her. We needed to clean the wound and needed some privacy. So I politely asked her to excuse us.

“No. I am staying.” She said

“Who are you?” I asked

“ Her co — wife. She is the first, I am the second. We were fetching water together when the crocodile bit her leg. I poked it’s eye with a stick and it let go.”

I couldn’t hide my admiration. Such loyalty to her competition. Any other woman would have pushed her farther into the water and run away. A peculiar people — these ones. We took wife 1 to theatre but after a few days she got a bad infection and we couldn’t save her leg, so we amputated.

In my two and a half years in Hola, I encountered many more of these cases. But none came close to this guy who once came in with a gangrenous hand. He was a known diabetic patient with poorly controlled sugars. The thumb and index finger on his right hand were badly infected with intervening dead tissue. I needed to take him to theatre to clean the wound and try to salvage what I could.

Hola was such a low resource hospital, it had no anaesthetist. So for minor procedures, I would sedate the patient, and then carry out the procedure. You know those nice beeping state of the art machines you see in theatre that are attached to a patient? We didn’t have those. The nurse manually took the patients vitals every five minutes and updated me as we went along. She was a human machine. So as I am busy cleaning out the wound, she suddenly yells, “Doc his BP is unrecordable.”

I immediately jumped on his chest and started performing CPR. I was so intent. He was not going to die on my watch. After a few minutes, he came back up, then down again. I gave him CPR three times in a row. I felt like I was in a tug of war with death. It pulled and I pulled back. I won. Scrawny physique and all. I quickly sorted out his hand and we moved him to the ward.

The next morning during my rounds, I was reluctant to check on him. I would be mortified if I found his bed empty. He looked so frail after that procedure, I chose to go to his ward last. I got in and stole a glance at his bed half expecting it to be empty — but there he was. I was relieved as I walked to him to find out how he was.

“Doc, thank you so much. You saved my hand. Thank you. I was so sure it was going to be amputated.”

I didn’t say much. I was so happy to see him alive. Then he said, “But Doc, after I woke up I have been having some chest soreness. What could it be?”

I explained to him what transpired in theatre.

A few weeks later, while taking a siesta in my house, I hear a knock on the door.
It was the hand guy.

“Doc. I am indebted to you. You saved my hand and my life. I have brought you three things to say thank you.”

With him was a hen, a goat and his teenage daughter.

Only in Hola.

As Narrated to me by Dr Muriuki Meme

This month I will take you, my readers on a journey into our hospitals and the crazy experiences health workers face as they save lives. Enjoy