Because I knew you, I have been changed...

It is, perhaps, fitting that the sky of Kisumu is gray and gloomy today, if only to match the pall overtaking my mood. I won’t be forced to watch the sun sparkle across Lake Victoria as we climb into the sky. The magnificent greens of the valleys and hills are but a muted pewter and not the brilliant emeralds of my memories.
Walking across the tarmac, I am thinking back on the trepidation that filled my steps the last time I was here. It seems almost laughable now. Alone, nervous, and hesistant, I gathered my strength and piled myself and my belongings into what I hoped and prayed was a legitimate taxi bound for the now infamous Sooper Guest House, all the while wondering exactly what I had embarked upon.

That first night, I stared at the ceiling through the soon-to-be familiar pores of netting, and despite two days of traveling with bare snatches of sleep stolen in economy class seats, my mind wouldn’t let my body rest. Racing from thought to thought, I saw myself struggling with patients that didn’t understand me, with responsibilities I didn’t feel confident to shoulder, with surgeons that would either expect too little or too much from me. Having spent the most recent portion of my training traveling through various subspecialties, I feared the possibility of clumsiness with general surgery. Had I only known that my bigger nemesis would be my complete lack of knowledge of orthopaedics, how much more fitful would have been my eventual sleep.

On the first full day, exploring the town, I smiled blankly when offered ugali or chapatti with my meal, squirming at the sight of the whole smoked tilapia and not even understanding the diction, choosing nothing to accompany my timid roast chicken rather than the unknown. It was not long before I was rolling the white maize polenta between my fingers with my lunch of fish and cabbage and snacking on the flat bread with my mid-morning tea.

Like the meals, patterns became established, and once my jetlag was abolished, the routine became comfortable. A bumpy ride in the little yellow tuk tuk, past the raw wooden stalls lining the roads, dodging bikes, motorcycles and matatus to arrive at the hospital compound. Swinging myself over the wooden railing and into the changing rooms, to emerge in scrubs and boots to work either with hurried abandon or at an anesthetist’s leisure. Tea and mandazi, lunch and ugali, a mad dash back into civilian clothes for an afternoon soda in between cases before summoning my little yellow tuk tuk again. Dinner, perhaps a beer, equally as relaxing with new found friends or alone with my thoughts.

There were memorable and happy deviations. Visiting a village, playing with its children, being welcomed into homes and conversations. Watching the efforts on behalf of one woman’s memory making very real changes in people’s lives and attitudes. Venturing forth, relying on the hospitality of almost perfect strangers to explore beyond my little coastal town.

My perspective on medicine shifted, in ways I couldn’t even begin to anticipate. I had developed certain frustrations with American medicine, in that it often seems our resources aren’t necessarily dedicated to maximizing good quality patient-years. There are inequalities in care, but it’s generally a difference between good and better. Not so here, the difference is between good and none, between life and death. I’ve lost patients for lack of monitoring, for lack of labs, for lack of available anaesthetist. Every medication, every operation, every thing that is done here has purpose and is needed. It may make my frustrations and irritations worse when I return home, but my hope is that it will give me the resolve to be honest about the type of surgeon I want to be.

In short, some amazing people gave me their friendship; patients gave me their trust. Chance, fate, or God gave me so many wonderful new experiences. My heart is so rich and full of the gifts I have received that it becomes easier to forget the not-so-happy memories.

With childlike fascination, I press my forehead to the window pane beside me, unblinkingly scanning the ground until the sun warms my face, the clouds are beneath my feet, and the dirt and dust of Kisumu have melted away.

Kenya has enchanted me – I will return…