Thursday, September 25, 2014

2014 Kenya Recap

Coming to the end of another 4 week rotation in Kenya, as I reflect on what has been accomplished I'm quite pleased.



Our x-ray truck is finally operational and has visited several rural sites taking x-rays for many patients without major issues. The images are being uploaded to the PACS and are now ready for interpretation by radiologists. I've been waiting for years to write that sentence. 

 

I had a ton of food adventures during the four weeks including:
  • Making yogurt with Patrick and Wendy
  • Granola with Jess (fruit after baking, doh!)
  • Making Jon Laws' pickled green beans with Jess
  • A Lebanese feast prepared by Jess
  • Cucumber pickles with Patrick
  • Three amazing meals with Jane who makes everything look easy
  • One 'oven surprise'
  • Ugali that actually tastes like something edible at a Moi's Brigde choma zone (pictured above)
  • Brie and Peppered salami imported from Nairobi
  • Chili paneer from Siek Union
  • Dinner at Sanjeel complete with cheese nan and tandoori paneer 
  • A fabulous send-off dinner complete with a pumpkin cheesecake by Jess and Katy
Overall, I'm incredibly grateful for the opportunity to travel to Kenya, bring new services to patients, and have an amazing group of friends. 

Friday, September 19, 2014

Kenya Mobile X-ray Unknown Case


Our mobile X-ray truck continues to work well, which is incredibly exciting.  Today, our first patient had a really good, interesting X-ray.  

37 yo with history of Tb that was treated.  She successfully finished her course of treatment, but has persistent chest pain, which is worse with coughing.

The clinical officers here had never seen a finding like this and would have missed the diagnosis, which changed treatment.  

Leave a comment with your diagnosis :-)

Saturday, September 13, 2014

Roller Coaster Ride


It's been an exciting week on the x-ray truck. Last Friday we felt that we had sorted out all of the engineering issues and the truck was ready for general use. 

On Monday we moved the truck to AMPATH center in Eldoret and began taking x-rays of patients in earnest. We took x-rays of 9 patients and were feeling pretty great. 

Tuesday we returned to AMPATH center and only had one patient just before lunch. After exposing the patient, the CR reader malfunctioned and refused to work. I was heartbroken.

You may recall that we have two sets of equipment for the truck. The reader that we are currently using is our backup.  Last year the primary reader feel down in the truck and was damaged. It initially worked, but failed shortly after I left last year, so we've been using the backup.


Interestingly, both the primary (humpty dumpty) and the backup failed in the exact same way. Suggesting that maybe the trauma that the first reader suffered was a red herring. 

Wednesday I picked myself up by my bootstraps and Patrick and I investigated the primary reader. We are lucky to have a very good service manual and a sweet diagnostics program on the laptop.

We identified that the rollers that move the x-ray plate (kind of like film) were not moving.  After investigating many options - blown motor, seized or dirty rollers, and many other parts of the device we found the voltage parameters for the roller motor in the service manual. When we measured the voltage we realized that the motor was not getting any power. We traced the motor connection back to a set of fuses, one of which was blown. 

Let me explain something about Kenya: shops here are much different than in the US. They tend to be locally owned and randomly supplied by unreliable distributors.  There is no Home Depot or Lowes, no amazon.com. The hardware stores tend to be very specialized (one is best for bolts, another for metal, another for wood).  There is a local walmart equivalent, but there is certainly no guarantee that even a simple fuse would be easy to find.  So, finding even a simple fuse could take weeks for the uninitiated.

Luckily, I have a secret weapon: Patrick. Patrick has lived and worked in Eldoret and has solved so many of these challenges that he knew exactly which store could help us. We dropped by just before lunch; 10 minutes and 60 shillings later ($0.90) we had two new fuses plus several backups.

We took the fuses back to the workshop and installed them. Both readers sprang back to life and worked flawlessly.  It was hard to contain our excitement. 



Friday, the truck made a successful visit to a rural clinic (Turbo). Joe was also working at the clinic and it was great to be able to read X-rays for him.  We were able to x-ray another 8 patients. The truck made it to and from the clinic without troubles.  

Stay Tuned: next week we are looking forward to traveling to a more remote site with rougher roads to see how things fare. 

Sunday, September 7, 2014

The Little Generator That Could



I spent most of the first week working on the X-ray Truck.  I'm happy to announce that Patrick has the biggest engineering challenges related to generator.

The power issues and X-ray machine errors boiled down to a generator that couldn't respond fast enough to the short and hard power requirements of the X-ray machine.  Patrick tells me that the technical term for this is power factor correction.  Most people solve this with a much larger generator (heavier, more fuel, etc) than is required based on initial calculations.  We were stuck with the existing generator vs making major truck changes, so we made this generator work.  

The two most important fixes were: proper setting of the generator governor, and installation of a 1500W immersion heater that allows us to load the generator prior to firing the X-ray machine.  Patrick did a really beautiful job rigging up the heater so that the heater is engaged by the radiographer immediately prior to firing the x-ray machine just by pushing a small button near the doorway.

We're going to test patients at AMPATH centre tomorrow, and then roll out into the field.  We still face many logistical challenges regarding uploading and storing images, but we're making important strides.

Tuesday, September 2, 2014

Some Things Change, Others Not So Much

Change

Nairobi has a Porsche dealership close to Ole Sereni
The new international terminal at JKIA is built and it looks beautiful - lots of glass, open architecture.

Not So Much

Passport/VISA line is still super disorganized even in the new beautiful building.
The early flight from Nairobi to Eldoret is very early.
The Kenyan Registrars are amazingly engaged learners.
I still have amazing friends in Kenya, it's a wonderful place to be.