on being a bit academic
One of the big reasons I came to Kenya is to teach. . .I love the fact that we are training new Kenyan and East African doctors with passion and dedication and excellence. With teaching and training comes lots of other things – more academic than passionate – like learning research and quality improvement. . .
This week was one of those weeks where the role of these things in my year hear seemed more apparent.. Research and quality improvement, in all the dryness of those words, can be exciting when you are certain they will make a difference.
When I arrived in Kijabe, I realized the types of antibiotics we needed to treat the most serious infections were completely different here. Where I was used to abscesses and chronic bone infections, staph aureus pneumonias and cardiac infections, I was now seeing septic shock from really difficult to treat Klebsiella and E. Coli. The most basic drugs were no longer working, but we didn’t have concrete or specific knowledge of how serious the problem was. . .
So, I built on the ideas that came from a conversation with of one of our interns and one of our medical officers and decided to create an antibiogram. Serious sounding, right?
In a lot of ways it is. . . It is a 1 page chart summarizing how to approach and kill every bacteria that we had grown in Kijabe. I recruited three fantastic medical students that were visiting from the States. They shadowed in the morning and sat at my kitchen table every afternoon playing music and sharing stories and working diligently. We took the big blue binders from a closet in lab that held all 5,000 cultures that had been done for the year and scanned everything into an iPad app and then manually entered it into a spread sheet. We took advantage of some incredible software from the World Health Organization and entered it into a program that processed everything for us. . . it took 2 solid months. At the end of it all Taylor made this magical document. All of those numbers help us treat patients
They changed the way we treat our premature babies. They changed the way we treat infections in the urine. They guide how we change antibiotics when a patient is getting sicker. They changed how we interpret some positive results and showed us what to ignore and what to trust.
I am not an infectious disease doctor or microbiologist, but with the help and advice of a lot of smart people that have graciously lent their time and brainpower, we are making final modifications to the document and putting this data into practice. When I got up in front of all the doctors in the hospital yesterday to present this, bright and early at 7 am, I was really nervous. I knew what I had learned, but I didn’t know what the response would be – if I knew enough or how helpful people would think it was.
And they were so excited. And full of ideas to make it better.
And I sighed as I closed my computer. One of those happy sighs when you finished something you thought was impossible. Full of contentment and excitement and joy to be part of such an incredible team here in Kijabe and worldwide that had helped me refine the data. I live in a place where we do much with little – where we work everyday to make things better – where we walk forward with determination to answer the hard questions. . .
I presented this data at the Kenyan Pediatric Association meeting last week too, surrounded by 200 fantastic Kenyan pediatricians that I am so grateful to have as colleagues. And they worked along side me in figuring out how to deal with growing antibiotic resistance, how to be wise in our treatment of kids in the changed world of 100% vaccination rates here, and we talked of shared worries and struggles.
As we were walking to dinner, on of my fellow pediatrician’s classmates walked up to her and asked her if she was still in Kijabe. . .”I hear nothing but good things coming from Kijabe. . . it seems you are doing miracles there.”
Perhaps, in the midst of it all, we are.