First impressions

I should explain the title of the blog.  Brown University has long had a partnership with Moi University, in which internal medicine and pediatric residents as well as med students could rotate here as part of their training.  I got involved after hearing about the experience from a friend of mine who recently graduated the Internal Med program, Joanna Mecca.  Curious about the current use and potential to improve care in the developing world using diagnostic imaging and intervention fascinated me.  So here I am. 

I use the personal descriptor, "Rhode Islander" in a tongue- in- cheek manner; after training in RI for the past 3 years, I have adopted some customs and tendencies such that I now consider myself partially RhodeIslandese.

Integrating myself into the radiology department here over the past two days has already been a phenomenal experience.  The residents and staff are incredibly welcoming, receptive, and fun.  We have started each day with a stack of films, mostly CTs printed on film with selected windows and HU/ measurements as noted by the CT tech at the time of acquisition.  In the first two days here, I have seen TB meningitis, classic pulmonary TB, TB orchitis, CMV meningitis with venous infarcts, and a new presentation of advanced endometrial cancer, just to name a few.  There are many other cases we would consider "bread and butter" in the US like ischemic strokes, postoperative abscesses and cancer follow ups; in contradistinction to the US, however, scans here are infrequently negative.  For the first time, I have performed ultrasound exams entirely on my own, from start to finish, an experience generally precluded by the large volume of studies and procedures we must perform on a typical day at Brown.  Diminutive ultrasound images are printed out, rather than stored (as there is no PACS), and reports are handwritten on the back of the small order sheet, to be later transcribed. 

Aside from learning from and teaching the Kenyan residents, my goal here is to be an ambassador for radiology, increasing the clinicians' awareness of what we can do for their patients and how to access the department.  The other visiting MDs and students from Indiana University and Utah took a formal tour of the hospital this afternoon with one of the AMPATH* faculty, a pediatrician involved in pediatric AIDS and primary care.  Although it was not as critical for me to know all the areas of the hospital we toured, just being present and part of the discussion allowed me to interject regarding accessing radiology and the procedural services we could provide when the topic arose.

It's the fourth of July, so there was a cookout at the IU House.  A group of 6 of us are planning a bumpy 9 hour van ride to the Masai Mara this weekend, the most talked about game park, as far as I can tell.  We have become fast friends, meeting periodically through the day to share meals and experiences as we muddle through learning the Kenyan health system together.  What an adventure it has been thus far! 

*Academic Model for the Prevention and Treatment of HIV/AIDS