• ashirk@gmail.com
  • Kijabe, Kenya
on expanding emergency care

on expanding emergency care

I have written on here on and off about our PECCCO program for Pediatric Emergency and Critical Care Clinical officers . . . how it was inspired by the amazing nurse practitioners I worked with in Alabama and by Bob and Lilian here, how it started at our kitchen table with Michelle and Martin, how Shruti helped me solidify the curriculum, how Nate and Wayne worked tirelessly to finesse the technical things to get it approved by the Clinical Officer Council of Kenya, how the first group trusted me to do it before we every thought it would get approved and were able to be grandfathered in. . .

And next month, the first full group will graduate after going through the 18 month curriculum. . . they are graduating in the next month and going to our county hospitals and staying with us to facilitate the program and take care of our patients.

They sat at our table last week and talked of the journey – of the impossibility of it all for and how God opened doors to make it possible, about their love of children, about how they were changed, about how they were determined to carry forward with excellence. . .they acknowledged how Bob has shepherded them and brought the program to life. . .and how many people had invested in their growth.

I tried not to cry as I looked at these amazing clinicians – some of whom had not even seen a pulse oximeter, much less a ventilator, when they started 18 months ago.

Last Monday, we had a day in PICU that should have been chaotic. One baby on a vent. One crashing baby from NICU that needed intubation. One baby in shock with dropping sugars. One baby needing sedation to secure a cancer diagnosis. Another we had just extubated that was having seizures and needed intermittent help with suctioning and breathing. Another with a sodium of 175 that needed teaching and swaddling. I had several meetings I needed to go to as well in the midst of this. .

It was a day where we all ran. But I smiled as I saw Kunga, my FPECC fellow take charge in the sedation. Tabitha kept the list and kept things moving forward. Sharon, our new PECCCO student bravely attempted the intubation. The nurses taught each other the new way we had decided to tape the breathing tube. Jack, who will join next year’s PECCCO class, sat and read a book to the 5 year old scared by the chaos around them. Brian did an echo on the child in bed 3. The team worked fluidly, ebbing and flowing from one patient to the next.

At 4:30pm, when it was time to handover, every thing on the list was checked off, every patient was settled, and every one lingered after checkout – making sure everything was in place to ensure the progress of the day continued as the sun started to set over the volcano. . .

These graduations are milestones to be savored – to see the difference a decade of slow progress can make in the lives of the 8 kids we had that day and the 1000 kids that pass through our PICU and HDU every year. . .It changes me day to day too – my day had started the day from a place of determined exhaustion and I was carried by this team into a place of hopeful anticipation.

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