Week 05: Holding Warmth in Your Hands

Renewal amid rupture

This week was a sensory overload—“stenches, sounds, and stares” really sums it up. From the pungent smell of the “isolation room” that drifted into the ward to the loud banging of glass panes being repaired mid-rounds, everything felt amplified and jarring in the soft-spoken society. Even the way people look—whether it’s the surgery team ogling Lucy and saying “mmm beautiful…mrefu,” or the constant crowding around patients—there’s no such thing as privacy here. “Everyone is in everyone’s business,” and that’s not just gossip—it’s how medicine is practiced.

The arrival of the new chief changed the tone of everything. He’s sharp, thorough, and deeply committed to teaching. He quizzed us and the interns constantly, asking about types of diabetes, diagnostic strategies, and despite our attempts to explain our education level and how we were not medical students or doctors. His philosophy is clear: “treat your patient, not their lab results.” He repeated that multiple times, and it’s already becoming his catchphrase—just like Mkumbi’s was “when in doubt, do a CT scan.”

The chief’s approach to financial realities was eye-opening. He discharged more patients in one day than Mkumbi did in a week, and not because they were all better—but because staying in the hospital was costing them more than it was helping.It’s a harsh truth: sometimes outpatient care is the only viable option, even if it’s not ideal. The dialysis pricing breakdown was especially jarring—500k for the first day and 180k per session, three times a week. Families are forced to make impossible choices.

“You know he cannot afford here and is stable so do outpatient treatment,” he said about one patient. Another time, he asked why a patient wasn’t in a private ward, and Rachel replied, “capable but not excess money.” It’s a constant balancing act between clinical need and financial feasibility.

Some cases this week were emotionally tough. Janes, the AIDS patient with suspected TB meningitis, went from alert to unresponsive in hours. Her eyes pointed upper left, and Chief said, “the eyes always point to the lesion in the brain.” I’m still not sure how true that is, but it was fascinating to hear potential diagnostic strategies in a place where resources where diagnostics were scarce.  Enock, the stroke patient admitted overnight, died shortly after his CT scan—his GCS was 6/15 when we first saw him, and by the time he reached ICU, he had no vital signs.

Sister Asunta’s case raised ethical questions. She’s clearly in palliative care, and when Lucy asked why continue meds if it’s unfixable, Rachel responded, “you want us to kill?” Dr. Ema added, “We cannot change the problem; if we see infection, we treat infection; if we see pain, we treat pain.” It’s the reality of care here—treat what you see, even if the outcome won’t change.

There were moments of levity too. At chai, I showed Rachel a picture of a raccoon and she said, “lacoon? What that!” We talked about Kufis and cultural symbols. Even the “stoner boy” hat on Sister Asunta added a surreal touch to the week.

I’m learning that medicine here is communal. Everyone hears everyone’s diagnoses, procedures are public, and privacy is a luxury. It’s overwhelming at times, but also deeply human. I’m also realizing how much I value clarity and structure—by Friday, I was burned out. The chief spoke in Kiswahili for 45 minutes about one patient, and I couldn’t follow. Still, I appreciated his commitment to teaching and his ability to synthesize complex cases. He called the medical department a “dumping ground,” where other departments send patients they can’t diagnose. It’s frustrating, but also a testament to the trust placed in internal medicine.

This week reminded me that medicine isn’t just about solving problems—it’s about navigating systems, personalities, and limitations. It’s messy, imperfect, and sometimes heartbreaking. But it’s also full of meaning. Even in the chaos of “stenches, sounds, and stares,” I’m grateful to be here, learning, witnessing, and growing.