My first day

I am currently sitting in the dining room at the IU House in Eldoret, Kenya on my first day on the wards on my medicine rotation. While the diseases that are common here are much different than in the US, there is even more that is different in terms of clinical care, training expectations, etc. Take one of my patients from today, a 20 year old patient with severe mitral and aortic regurgitation from endocarditis superimposed on rheumatic heart disease, and he urgently needs a double valve replacement. There is no one in Kenya who does valve replacements. And apparently, no one else nearby except for a visiting expat surgeon currently at Tenwek Hospital in southeastern Kenya who leaves next week.