Friday, August 31, 2012

Dr. Quack, banks, driving in Nairobi, and Dr. Quality

Arriving in Nairobi 6 months pregnant, I really felt the pressure to set up quality prenatal (antenatal) care for myself and our unborn child. I read many expat blogs and came across one which recommended a doctor that has a private practice very close to our home. Walking distance is very good when we don't have a car and public transportation is effective but scary. I may start taking pictures every time I see a mutatu or city bus in an accident to emphasize how often they occur...I've been here 3 weeks and seen at least 5 of them involved in crashes, 6 if you count the two that got is a crash with each other.

So, I called the provider that is so close to our home and was informed that I could come into the office any day for walk in hours, which are after 2 pm. On Friday, 8/24 Jason left work early (though everyone leaves work early on Fridays) and we walked over to the clinic. Upon arrival I filled out my personal information and then we sat in the waiting room. We arrived 10 minutes prior to the start of walk in hours, and there were only a couple women in front of me. There were no other men in the waiting room..perhaps women here don't bring their partners to antenatal appointments?

This is the view from the stairwell of the office tower, looking South across Upper Hill, Nairobi.

The waiting room was both comedic and slightly uncomfortable. It was very small and the only seats available were under a flat screen tv mounted on the wall. Across the room was a mirrored wall so we could still see the tv and hear it. What was both uncomfortable and comedic about the scenario was that the cable channel that was being watched was all American broadcasting of the sort you might find on Spike TV in the States. Commercials blaring out "the dumbest..Americans, the craziest...Americans, the WILDEST..AMERICANS!" with images of people jumping off roofs, running through fire (and catching themselves on fire), fist fights breaking out at weddings, backflips with people landing on their head, testicles getting smashed, etc. Having also been the only white people (and coincidentally the only American people) in the waiting room, many eyes were shifting from the television directly above our heads to our faces directly below the screen. Fortunately, the hilarity of dumb people seems to be a comedic phenomenon cross culturally, as we all wound up laughing together during our wait to see the doctor.

About an hour after arriving at the clinic I was seen by a nurse who took my blood pressure and sent me across the hall for a urinalysis. Across the hall was yet another waiting room, where we waited for another hour before being given a specimen cup. When I say "cup," I actually mean a vial, as the opening was about the size of a nickel in the States. I bow down the talent of the women here that are able to make it into that opening. Another feature of my "cup" was that it was clearly being reused. There was sticky residue where a previous patient label had been attached and removed so that my label could be added. I told myself that it had been sterilized somehow and went an my business. Another feature of the cup became apparent when I tried to place the lid on it and found that the lid was mismatched and would only screw on in a cross-threaded fashion that left it susceptible to leaks. Oh well. :) I turned in my sample and went back to the main clinic where we were advised to have a seat and wait. Another 2 hours passed! I was starving, approaching a cranky mood, and very uncomfortable from the heat of the room and the long period of sitting.

I approached the receptionist, who informed me that next time I can make an appointment and be seen in a more timely way. I informed her that I had requested an appointment and she told me they only do appointments in the afternoons on Wednesday's. "Okay, so can I come back next Wednesday with an appointment" I asked. I explained that I had not eaten for too many hours and that I needed to leave for food. She explained that the doctor would see me very soon, and would I like some fruit ordered? She promptly called a food delivery service which brought Jason and me two large servings of fresh fruit salad. Bananas, avocado, papaya, and pineapple were my salvation while I continued to wait.

About 5 hours after arriving I saw the doctor finally. He informed me right away that because of my gestational diabetes, no doctor would allow me to go to full term and therefore, he anticipates inducing my labor several weeks ahead of my due date. I politely informed him that we plan on having as natural a birth as safely possible. He attempted to convince us that because our baby was conceived with IVF, it is a higher risk pregnancy and more precious and therefore we should not take risks with natural birth. All the empirical, evidenced-based research I have read indicated that conceiving via IVF does not indicate a higher risk pregnancy than a naturally conceived pregnancy. So, Jason asked why he felt that I would need to be induced, and he did not answer this question. He then went on to say that my blood pressure reading was very high and that he would like me to take blood pressure medication. My blood pressure is normally very good, but during this appointment was around 150/90. Perhaps it has something to do with moving from sea level to nearly 6000 ft elevation, traveling half way around the world, the stressful clinic environment, the treat of inducing my labor, or the fact that I walked to the clinic? He further stated that we should have an ultrasound to check on the baby as well as blood work.

We again went across the hall, this time for an ultrasound and blood work. Blood was drawn (with a new needle I made sure) and the we went on to the ultrasound. The ultrasound was great! Baby was facing head down and is measuring right on track. We observed our baby sucking it's thumb and having an enormous yawn. SO cute!

After the ultrasound we were told to wait again. After another hour the doctor saw us again. He reported that the ultrasound looks good, but that he still wants me to take blood pressure medication and...ASPIRIN! Seriously...he wrote a prescription for aspirin. Contraindicated for pregnancy as a Class D drug during pregnancy due to evidence of fetal harm, and yet..there he wrote it on my prescription. At that point we left.

I was not feeling very confident in the medical care here when we left. Home birth was starting to look more attractive, even in a place with reduced infrastructure. I know my body is able to give birth and I know my baby is healthy. I refuse to let Dr. Quack-O derail me from my holistic approach to a gentle birth.

One outcome of the very bad medical visit is that Jason and I decided that if we were not going to rely on the medical care within walking distance, we are in need of a reliable mode of transportation to care that we deem quality. So, we decided to buy a car. We found a very great 1999 Suzuki Jimny (aka Samarai in the States) with 4WD and great economy. 4wd is a necessity here. There are incredible pot holes, and the roads are often unfinished or in disrepair. Additionally, flash flooding can occur and cars without 4WD may not be so safe. Also, we wanted a car that could get us out to see the great rift valley and Masai Mara among other things. So we found the perfect little jeep-like vehicle. It's in great mechanical condition, and in typical Nairobi condition for the body..meaning plenty of cosmetic dings and repairs.

In order to buy the car we needed to withdraw 300,000 KES, or about 3,500 USD. This required us to go to several banks, western union, etc to try to sort out how to get this money from our account back home. Eventually we founda. Bank that would do a credit card money order, up to 50,000 KES per card per day. So for several days we went to the bank slowly accruing the money for the car. We then contacted the sellers of the car and they agreed to meet us at a mall. The mall is about 4 miles away, and due to rush hour the taxi took over 2 hours to get there. Worst traffic I have ever seen...ever...and it's par for the course during rush hour here. I sure hope my labor stays far away from rush hour or we may have a backseat baby.

We bought the car, obtained insurance, and are working on getting the title transferred. This requires us to get a Kenya PIN (personal identification number). All in due time!

With our new car and insurance in place, we drove to Aga Khan University Hospital Antenatal Clinic for another attempt at antenatal care. We met with a very good OBGYN. Our confidence in the available medical care is much renewed with the visit we had yesterday. My blood pressure was very good at 130/80 (still higher than prepregnancy, but good nonetheless) and the doctor was very pleased with my diabetes management. The doctor is part of a obstetric team, and for our next appointment we will be paired up with a primary care doctor as well as an obstetrician for a team approach to the pregnancy through the hospital. It was a huge relief to have quality healthcare. Seeing the OBGYN, and providing a UA cost about $13. Fabulous!

The baby is moving around a lot, especially when Jason plays music for it. It seemed to really like Pacabel's Cannon...perhaps that's genetic? These days the movement is significant enough that we can see my entire stomach heave in different directions or just pop out in places when the baby shifts positions. Another piece of good news is that the baby has remained in a head down position for the past week, per our ultrasound last week and the doctor yesterday. :)

Hard to believe there's only 9 weeks left. Now that we have a car, Jason and I will be going to look at bassinets this weekend.

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