July 5 PM

I know most, if not all, of this uninteresting but I'm really writing this more as a diary to re,ind me of some things here. But, I do promise to work on some photos this weekend during my free time. Think about this: patients have to have families stay to help in their care in hospital. These family members frequently sleep in the bed with the patient in the open wards I told you about. Post partum mothers sleep 2-3 in a bed. Only 22% of people in this are have insurance. While everyone with an employer is in the govt insurance system, the unemployment rate is about 30% and farmers, most folks in this area, are not covered. While this hospital is much less expensive that anywhere else for the services they have available, it is still expensive by local standards. For example, a CAT scan is 10,000 KS (Kenya Shillings), about $118 USD. While a fraction of the cost in the US, we're talking about an area where a huge percentage of the population makes $2-3/day so this is equivalent to 1-2 months salary. The hospital has to charge to stay afloat. Equally importantly, they do not want to develop a entitlement society or develop dependency. Tonight about 13 of us had dinner with Mr. Geoffrey Langat, CEO of Tenwek Hospital and Mr. Jackson, principal of the nursing school and got an overview of the operation. Tenwek was founded 75 yrs. ago by missionary nurses. Dr. Steury was the first doctor to arrive in 1959. As I memtioned, the place has grown primarily ov the last 40 yrs. There are now over 300 beds and 600 employees. Other facts: - It is governed by a BOD which is 50% from the Africa Gospel Church and 50% World Global Mission. World Medical Mission, an arm of Samaritan's purse, is a supporting partner only. - 95% of the annual operating budget comes from patient fees which are kept low in part, because of the volunteered professnal service and donated medical supplies - 90% of the capital budget (new equipment and services) comes from donations. A new 501(c)3 has just been appoved in the US, Friends of Tenwek. - the nursing school is a 3 1/2 yr program and has a total of 24 students. There are 24 schools in Kenya and Tenwek has never been below #4 on boards (top 2 last year). Their graduates are highly sought and can get twice the salary elsewhere so retention is an issue. Now for the medical folks who have asked for more details. I promise to not make this graphic but just share a glimpse into the differences in the types of GI cases we see here. I think I mentioned the case of tuberculosis ileitis presenting like Crohn's. Here' what the folks had on the 10 endos I did today: 1- esophageal cancer with a stent 1- proximal esophageal cancer with near complete obstruction, couldn't dilate. Aspirated on subsequent swallow 2- gastric cancers, one presenting with esophageal obstruction 1- recurrent tight benign mid-esophageal stricture requiring a stent 2- research patients- screening for esophageal cancer which is endemic here 2- normals 1- esophageal variceal bleed requiring banding- thanks for the donation of the banding kit, literally a life saver! ALL of these patients were, and are, outpatients. NONE got sedation except the research patients (yes, they get special treatment here, too- NIH supported) Well, tomorrow will be the end of the first week. Starting to get in the swing. Some new folks arrived today, including two medical residents from Duke. This is one of nine approved international rotations for Duke which speaks to the quality of training. Went to surgical case conference today and resident did great job, fancy power point and all. It is incredible!