Went with the diabetes team to Webuye Hospital, about 1.5 hrs from Eldoret and about 1hr from the Ugandan border. Roads full of potholes much like Costa Rica. Driving in Kenya is like a free for all..people all over the road trying to avoid the potholes.
We had about 60 people waiting when we got there. Viv Buckwalter, a family doc from Lancaster Pa has been at this hospital about 15 years and we discussed how he treats DKA without insulin infusions. Prior to 6 mo ago the mortality rate was about 20%; since starting an IV push protocol it has been 0.
Most of the patients are subsistence farmers living on small plots of land. Many live in mud huts with straw or tin roofs. No electricity or running water. They all have cell phones!! They come dressed nicely and many of the men had sport jackets; old and worn, but very presentable.
Blood glucose control was very variable based on multiple factors. Do they have the insulin? Is it spoiled since they don't have a refrig? Do they have food for every meal? Are they out in the fields working or sitting at home....etc. Despite all these problems, their A1C levels are not terrible. When they come to the clinic they get a blood sugar and point of care A1c. Many pts check their readings twice a day on a regular basis..much better than my pts at home. I questioned the staff as to why they are so compliant; these pts were enrolled with very poor control,,A1cs>14 or were hospitalized with poor control. They know how much better they feel with better control. Also many cannot afford another hospitalization.
On the way home we stopped on the side of the road for fruit...women farmers brought them to our car and I have bananas and a very big papaya. We also stopped at an orphanage and bought gouda cheese;all proceeds go to the school.
Off this weekend to Lake Naivasha for some touring, eating and bike riding.
No comments:
Post a Comment