Hey Everyone,

I have finished my second day in the clinic. I am still feeling really great about my time here. The staff at the clinic have been slow to warm up but, after today, I feel as if I made some progress in explaining to them what my role as a nurse is in Canada and how I can be helpful in the clinic.

Nurses in the health clinics here in Kenya act as a family doctor would in Canada. They are incredible. They assess all the patients and prescribe appropriate treatments until the doctor arrives, which today was not until noon. They were surprised that I don't prescribe medication as a nurse at home, and even more surprised that I don't have a broader skill set/knowledge base in my own profession.

I told them how - after graduating from nursing school - nurses pick an area of exp health care delivery is not as segregated as ours. They don't have a different hospitals to specialize in different treatments and only major cities have hospitals. Communities the size of most Canadian suburbs do not have a hospital, strictly smaller clinics like mine here. Furthermore nurses in Kenya only specialize if they are in such hospitals and even then only if they work in the ICU or Emergency care. Other than that, mostly all other nurses work with the complete gamete of patients in clinics.

Today I learned from the doctor at the clinic, Dr. Ashiembi, that he is not a true doctor in a sense. His title is technically medical officer. This is a three year certificate degree with a one year internship. This program was created in Kenya to increase the amount of physicians in health clinics across Kenyan communities. Medical officers cannot specialize in any other form of medicine and health care. They do not even provide treatment for HIV/AIDS patients. This would be somewhat comparable to a family doctor in Canada, or even perhaps a Nurse Practitioner.

Dr. Ashiembi also explained that, legally, it is assumed that the diagnostic accuracy rate in health clinics is less than 80 percent. However, actual doctors in hospitals are held to an accuracy of greater than 90 percent because of their access to labs and diagnostic equipment.

I noticed this in their prescribing practices because the doctors and nurses here prescribe antibiotics for anything and everything, from a runny nose, mothers' accounts of fevers, and right through to mild abdominal pain. They don't even have a thermometer in the clinic. I asked Dr. Ashiembi why this was and he explained that it is done for prophylactic reasons. The practitioners do not want more severe infections invading the patients while their immune systems are compromised. Due to the hugely poor sanitation levels and the extremely poor quality of life, this would most definitely be the case. It is really sad.

Today, they trained me to operate the dispensary and the treatment room for injections. Dr. Ashiembi will not be in the clinic tomorrow, I am not too sure why, so it will be myself and one other nurse for the day. Should be very interesting.

I am going to take it easy tonight. Most of my house mates are leaving to go on a Safari tomorrow for four days so I will have to find some touristy things to do over the weekend.

Please post comments, love to hear from everyone...

Sending my love,

Jake