Things I've Learned in Africa

I knew when I started planning for this trip over a year ago that it would be one of great personal, spiritual, emotional, and educational growth. However, I have even surprised myself at some of the things that I have learned over the course of the last 3 weeks. Please allow me to share with you just a few of my thoughts:

1.       I can survive without being connected 24/7: We were told when we signed up to come to Kenya that our housing and the hospital would have wifi readily available. However, that actually meant that there is one room right next to the ICU with wifi and we were given a modem to use for our computer at home. It requires us to pay by the megabyte and usually has a painfully slow connection. Therefore, the tablet and iphone that I brought to use on wifi have been rendered useless. I use the internet for about 5 minutes out of every day to check my email or post a blog. The wonderful thing is that it has required me to actually use my brain when treating patients (limited access to fancy apps and no google or Up To Date to access), and it has helped to me to focus on actual relationships rather than facebook news feeds and constant email checking. Don’t get me wrong, not all of Kenya is disconnected…In fact I have seen people walking aimlessly looking down at their smartphones more than once…but at least a 1 month cleanse of limited technology has proved to me that I can survive…and become less stressed because of it.

2.       I can make decisions about patient care on my own: I realize that many of my peers are getting ready to go out into the real world of medicine at this point (3 years into residency). It’s strange to think that in just a few short months, there will no longer be an attending to ask when you are stumped about what to do. There’s no longer the mentality of “I just have to make sure this patient survives through the night, and in the morning we can sort out what else might be going on with them with the help of the attending.” Thankfully, in med-peds I still have one more year of the attending blanket, but this month has allowed me to step into roles that I would never have at home. Don’t be alarmed, there are still more senior people I can call if I’m stumped, but I am not required to run every decision by them. Some days it has been uncomfortable to think that I’m the only brain pondering about a patient issue, but it has allowed to realize that I depend on a God much bigger than I am, and he has equipped me far better than I realized to handle those situations. It makes me think that maybe one day I really can be a big girl doctor. :)

Just as an example: Today I was rounding with the NICU fellow in the nursery. After we finished rounds, our interns had all gone home (Saturdays are a commodity for those not on call!). The fellow had also left and I was trying to tidy things up for the on call team when the OB intern ran into the nursery to grab me to attend an emergency c-section.

We ran to the OR, and I prepared the resuscitation room for the new baby. Imagine a small closet with an old (but functional) infant warmer and random assortments of donated ET tubes, used suction catheters, glass bottles of unlabeled medications, and other unidentifiable equipment…noticeably missing were the ambu-bag, oxygen connectors, and laryngoscope I would need if the baby were really in bad shape.

At home we have nursing and RT’s to help set up all of our equipment while we wait for the baby. However, here we scramble to do most of it ourselves. After I’ve tried to come up with a Mcguyvor plan for what I can use of the random equipment if I need it in an emergency, the midwife thankfully comes with the proper paraphernalia.

After getting things set up, we went to the theater to wait for the baby. The c-section is solely performed by the intern and after the baby is out, we run down the hall to the resuscitation room and pray for crying.

Today, unfortunately, the baby was very floppy and not crying. We tried to suction and bag, but despite our best efforts, the baby’s heart was not beating. We had to perform CPR (something I have never had to do at home in all the deliveries I have attended). Thankfully, after a brief round of CPR the baby started to perk up and she is doing well this afternoon. However, it was humbling to realize that I had no neonatologist to run things…or to hand the baby over to when I was finished. Needless to say, I have said many prayers in the resuscitation room this last week, and thankfully the Lord has faithfully answered each one. Even when I’m making decisions without other human input I have the Lord right there with me…

3.       I’m so thankful for our ancillary staff at our hospital back home: A friend of mine spent 2 years working at a hospital in Kenya after residency. When I asked her what I should try to get out of residency in order to be prepared for third world medicine, she counseled me to pay attention to what the ancillary staff does, because you won’t have them in the developing world.

When I was on call the other night, the nurses asked me to set up the vent in prep for a patient from the OR. I thought to myself….”I have no idea how to set up a vent (much less a German one…)…the RT’s do that…” When we needed a blood gas on an infant the other day, we had to collect it ourselves. When you need a lab result, you go to the lab yourself to thumb through the giant notebook. When you order an x-ray, you read it yourself. Everything is much more hands on here. It helps me learn more skills for sure, but it also makes me thankful for those we have at home to help us with these very important parts of patient care.

4.       Infection control is a very important part of that ancillary staff: Unfortunately, over the last week we have been battling a multi-drug resistant klebsiella outbreak in our NICU. We have 7 confirmed and 2 suspected cases currently. It has been disheartening to come to the hospital each morning only to learn about a new infant with a fever. We’ve been doing what we can with isolation, gloves, and deep cleaning, but we are still praying for God to stop the spread. Fortunately, most of the babies are doing quite well despite the infection because of early identification. The hospital and administration are doing their best to identify sources and keep from giving it to any new infants, but we are just not equipped either with the space, means, or the nursing attitude of our NICUs in the states to be able to handle the infection the same way.  

It has made me think about the Ebola outbreak. While Ebola is still very far from the boarders of Kenya, I see how in this environment such a deadly disease could spread so quickly. Kijabe is a great hospital with a lot of western influence on its protocols and standards. Therefore, watching the conditions here and thinking about what it must be like in other parts of the developing world of Africa, I can now understand how such an outbreak could occur.  

5.       Life is fleeting: Luckily, death has not visited our nursery this week, but I have been following some of my internal medicine patients who were not fortunate enough to leave Kijabe in their earthly bodies. Even back home this week we received word that a couple from our church unexpectedly lost their 4 month old son to SIDS. We have been heartbroken over the news, and in constant prayer for his parents. It has forced us to face the reality of these mortal bodies we live in. Even the youngest of children cannot escape the face of death. However, we do not despair, because we know that this life is only the beginning. You could get really depressed if you think about the 100% failure rate you face if your goal is simply to keep people from dying in medicine. However, when we shift our goal to trying to help people truly live, both in this life and the next, that is where our true reward comes. Our lives on this earth are short…therefore we must set our eyes on eternity and try to show it to others along the way.  

I could continue on with far more lessons learned, but I fear I have spent far too many words already. Please join us in prayer for the family back in South Carolina grieving the loss of their sweet son. Also pray for all the infants afflicted with infection and pray that we may be able to stop the spread. I would also personally appreciate your prayers, as tomorrow I take Sunday call which includes covering the floor, the NICU and the PICU for 24 hours with no one to round on the patients. I know I have One greater than me to call upon, but I still would appreciate a quiet day…

This time next week we will be arriving back in the states, so also pray for a fruitful week as we wrap up our time in Kijabe!

 

The city that God built...

We were stunned yesterday to receive some difficult news from a couple back home who are dear friends of ours.  Their four month old son mysteriously passed away sometime in the night.  Naturally this came as a terrible shock and we hate we cannot be there with them during this difficult time.  Join us in prayer that they will receive comfort from The Comforter as they journey through this heartbreaking time.  The words of Psalm 56:8 seem incredibly close: “You keep track of all my sorrows.  You have collected all my tears in your bottle.  You have recorded each one in your book.”  How reassuring it is to have a God whose heart breaks with His people's yet also provides such blessed hope as He will one day restore all that was lost in this life.  Say a prayer for Aaron and Kayla that God's presence will be ever sweeter and all the closer in this trying time.

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Earlier in the day yesterday I had an opportunity to meet up with one of my favorite people of all time, Pastor Steve Njenga.  I thumbed a ride with our dear friend Paul and we headed to the Naivasha for one of the best reunions I could have hoped for.  I was so thrilled to see Pastor Steve and we caught up on nearly five years since we had seen each other last.  The last time our paths crossed was as he passed through North Carolina during a whirlwind trip of speaking engagements.  Nevertheless it was such a blessing to discover all the things that had taken place these last few years.  Who could have known that the greatest surprise was yet to come!

We toured a bit of Naivasha while his wife Mary was on her way to meet us from work.  Naivasha has grown immensely since I was there previously.  It seems as if multitudes have flooded the busy city as of late.  Indeed I learned that many people settled there after the period of great unrest following the election violence of 2008.  New businesses have cropped up in every corner and it seems as if the Kenyan economy is growing in wonderful ways.  Once Mary arrived we too shared some wonderful memories of old as we journeyed to Eburru.

To me Eburru is quite the special place as we traveled there at least three or four times when we were here back in 2006 – 2007.  My memories had not faded too greatly as the roads there seemed all too familiar.  I saw the same groups of baboons, impala, gazelle, rock hyrax and occasional warthogs that used to oversee our treks through the mountains.  Eburru is a unique location indeed as it is positioned near nine extinct volcanic craters.  Hot steam vents are still easy to find coming out of the mountains and the same excellent views are available of the Rift Valley, just on the opposite side of Kijabe.

As we drew near to our destination, the view gave way to a wide-spread complex that existed only in imagination when I was there last.  Smiling at my surprise Pastor Steve jumped out of the van to begin our tour.  We first started with the multi-purpose dining room and auditorium.  He told me that during the year they have conferences from groups back in Nairobi that meet there.  Directly behind the auditorium is the kitchen where they prepare daily meals for 351 students.  We stepped into the on-site bakery where a lump of dough roughly my size was being converted into countless tasty loaves.  That massive amount of dough, I was informed, would make enough bread for just three days.  After tasting a portion of one of the loaves I figured I could probably make it all disappear a bit faster!

Exiting the kitchen and bakery we passed through a few rooms, some newly built, that provide storage for the large quantities of foods and cereals they have to buy.  After that we crossed over to the newest building, a dorm for the boarding students with a capacity of over two hundred.  The top floor is in the process of being finished and it is a building that easily dwarfs the others.  The rooms inside are cozy, full of amenities and complete with study areas and lounges.  A dorm mother watches over the ones that are there presently, some hailing from as far as Mombasa. 

Leaving the dorm we passed by the large cement water tank that supplies water for the entire operation.  Water is extremely scarce in this area as the only sources are rain and condensed steam.  The water tank that Pastor Steve built can hold 500,000 liters of water and is filled by a brilliant system running throughout the school complex.  Rain water is channeled from each roof into long gutters where it then travels through an array of underground pipes to fill the massive tank.  Drilling a well here finds no water, only steam, much like what is found in Hell’s Gate.  Working that to his favor, he drilled into a number of steam vents far up the hill to condense the water and pipe it down to the school.  This provides an additional 5,000 liters of water per day.  That water is probably some of the best in the world as it is produced by nature’s own distillery.

We then passed by the classrooms for the children grades 1 through 8.  They were gathering back together after their lunch and I had a chance to share with the seventh grade class.  Some asked questions about America including our diet and a number of questions regarding snow.  It was just as difficult to explain a hamburger and hotdog as it was to describe the nine feet of snow that fell in Boston this winter.  After sharing with a few students we moved on noting how well behaved and brilliant they all are.  To go to school, especially one as nice as this, is a privilege and one the students seemed to readily understand.  They work hard and have excellent instructors.  Pastor Steve told me that they ranked above the national standard of scholastic excellence last year.

We toured the quarters where the teachers live there on site.  Due to the remote location it would be difficult to live elsewhere and make the journey to the school every day.  I also saw the garden where a portion of the school’s food is grown adjacent to a number of cows where fresh milk is gathered every day.  There is even a use for the cow’s other functions as the dung is collected in an underground tank that harnesses the released methane, powering the gas burners in the kitchen.  Everything about the facility is nothing short of brilliant and well on its way to becoming a fully self-sustaining community.  Even the children take part in chores that enable the work to be accomplished and completed in a streamlined fashion.

As I stood there talking with Pastor Steve I was nothing short of amazed.  His vision and heart for this place is tremendous.  I remember some eight years ago as he told me what he saw in Eburru’s future and so much of it has come to pass.  The stories of how God has miraculously provided are myriad and only a book of size could document them all.  Pastor Steve had a goal of not only reaching the residents of Eburru with the gospel but improving the entire community in the process.  As such thus far he has planted two churches, created a dispensary (the only medical facility within a 90 kilometer radius), a mission training center, and a nearly self-sustaining school and conference center, not to mention the great growth in moral, spiritual and economic areas for the entire village. 

I listened with intrigue as he spoke of renovating an old mansion adjacent to the school that would serve as a sort of bed and breakfast as well as housing for other conferences.  He spoke of eco-tourism, starting a high school, creating steam saunas (the only kind in Kenya for sure), bike paths and easy access to the new national park that is being created around the wilds of Eburru.  To be with him was to be with a true visionary whose only limit is the size of his God’s ability to provide.  Eventually he said the adjacent facilities will fully fund the schools while providing people an opportunity to enjoy Kenya’s culture and landscape, thus making it a ministry that is entirely self-supporting.

He told me that he announced to the most recent church he planted there in Eburru that they would preach to the world.  That has already been fulfilled as mission groups have come to visit, observed the great work God is doing and been set ablaze with the Holy Spirit to go back to their homes with greater purpose than ever before.  Pastor Steve sees opportunity with every mission group that passes through as he desires to change their perspective thus impacting the work that goes on back in their own communities.  The scope of what I saw yesterday was incredible.

In listening to Pastor Steve share I felt like I was in the class of life, learning lessons that were worth far more than gold.  He speaks with great wisdom and yet with such humility.  He shared that he has never asked for money or resources, something that is remarkably true.  In actuality it is even difficult to learn of what the needs may be even when direct in asking.  God has just connected him with people who are impassioned by the God he serves.  Not long ago he came to the United States and had 60 speaking engagements in only three weeks.  His travels took him through the south, to Washington DC and even to New York City where he sat down with some rather influential people.  As he related it all to me yesterday, he said, “I’m a nobody, what could I share with these important people?  So I just shared what I know…Jesus.”  It is clear that everything he is involved in really is just a testimony to the goodness of God. 

Needless to say I had plenty to ponder and process as we began the trek back to Naivasha.  The work of the Lord in Eburru has been incredible; it truly is the city that God built.  When we arrived back in Naivasha Paul and I departed with some delicious samosas and a heartfelt farewell.  We jumped in a matatu and headed back to Mai Mahu, Paul’s home town and the city just below Kijabe in the valley.  The skies were growing dark and I still needed to make it back home so I bid Paul adieu for now and commissioned one of the local motorcycle taxis for a ride.  Although I am quite used to being on a motorcycle, I am not so familiar with being a passenger, especially through rough terrain…this was going to be some kind of ride I was sure.

I am not positive but I think the fellow may have been under the influence of some sort of substance due to his peculiar demeanor yet we set off on the rocky road regardless.  This did not bode well when we added an additional passenger on the already dragging motorcycle.  The 125cc machine groaned under the weight of three people as it zigzagged and lurched up the impossibly steep incline.  The ruts in the road dealt with us mercilessly and I felt like sitting behind the two other fellows caused me to be the recipient of the greatest amount of jostling violence.  At long last, and still a mystery how, the motorcycle wheeled into Kijabe with its three passengers and one highly pressured carbonated drink in my backpack.  As I staggered the few remaining paces to our humble abode, the night turned the sky a beautiful dusty orange and an incredible day came to a close.  In the distance one could almost make out the shape of Eburru’s peak, stretching toward the heavens, connecting with her divine source.

 

For more information you can visit David's Hope to find additional updates on the work taking place in Eburru!

Wazungu Worship

Here is a picture of us with AIC-Kitet at worship on Sunday!

Zebras, Massive Power Tools, and Tiny Babes...

Wow, it has been a whole 5 days since I have shared any thoughts about our time here lately in Kijabe! I apologize now for any scattered thoughts as I attempt to summarize the last several days. Since my last post, we have had some Kenyan adventures on the countryside, most of which Scott has already relayed to you. However, I’ll try my best to give you a brief overview from my perspective.

On Saturday, we were fortunate to travel to Kenya’s Hell’s Gate National park (I bet no one would have ever thought that on a mission trip we would travel through the Gates of Hell…). It was very hot and dry (as anyone would expect Hell’s gate might be…) but did allow for some delightful animal sightings. We were graced with the presence of many warthogs, zebras, kudu, gazelle, monkeys, baboons and one lonely giraffe (or twiga as the locals say). After a leisurely drive over the plains area, we went for a quick hike through the gorge where we were reminded multiple times that many have died during the floods that occur with quick rains. Our Masaai friend wisely stated: “In the gorge, you must always hike looking up…” At just that moment I spotted the first dark cloud we have seen since our arrival 2 weeks ago. Fortunately, the rains held off one more day, because it would have been terrible to have been washed away in a gorge flood…

After our hike, we travelled around the park to see where our friend Richard is working with one of the local power companies. They are harnessing the geothermal energy by drilling wells for steam and piping it to power plants where it is converted to large amounts of megawatts for the entire country. While it was interesting to see how it all worked, it was also a stark contrast to see the natural wonders of the geothermal vents paired with the large drilling machinery and miles of piping throughout a national park. It wasn’t quite the undisturbed nature that I was hoping for.

Our friend Richard boldly took us right up inside the plant (that would be a huge security fiasco back home) and right to the base of one of the large drills. I loved the Kenyan attitude that all the workers we met shared. They were more than willing to stop whatever important job they were doing at the moment to explain a bit about what they were doing. While at the drill, we were told they had a goal of drilling down 3km and were only 50 meters from their goal—that they hoped to reach by nightfall. The rig was about 200 feet tall and effectively served as the largest power tool any of us had ever seen. It was comical to me as the only female to watch Scott, our driver, and Richard marvel at its massive power. I felt a bit like Jill Taylor from Home Improvement.

We concluded our time in the park by visiting a geothermal spa that harnessed the natural power of Hell’s Gate in a way that a woman could truly appreciate. There was a large pool with sky blue mineral water being drained right from a steaming natural spring. Unfortunately, we did not have the attire to enjoy its warmth, but we vowed that the next time we visit Hell’s Gate, we’ll just spend the entire day there…

On our way home, we stopped by Lake Naivasha and took a boat ride around Crescent Island, a place where several African staple animals were transported years ago for the filming of Out of Africa. The Lake was much cooler than Hell’s Gate and even presented us with a few drops of rain. We saw several hippos, scores of birds, and more zebras and gazelles. After returning to our home, we slinked into our beds and prepared for our eventful Sunday.

On Sunday morning, we travelled to Suswa to worship with our friend’s church. Scott had been there one week ago, but unfortunately, I had been on call and unable to attend. Therefore, after hearing his stories, I was more than excited about what the morning would hold. We met numerous church members, and I was soon whisked away by several ladies to be dressed as one of them. The ladies adorned me with traditional wraps and beautiful Masaai jewelry. It was such an honor to be consider Masaai for the day. They even gave me the name Nashipae which means “joy.” I answered only to that name for the remainder of the day. In fact, I don’t think I was ever even introduced as Teresa. During the service they attempted to teach me how to dance like a Masaai woman, and we all shared in the excitement of what God was doing in Kenya and in the Masaai.

Afterward, we shared a meal with Richard, his wife Evelyn, their children, and several church members. We were delighted, as one of our goals for this trip was to establish a partnership between Richard’s church and ours in South Carolina. We realize that we all belong to the global body of believers, and we wanted to make a connection that would allow us to pray for and support one another. When we return to Lyman, we are so excited to share what God is doing in Kenya, and encourage our local body to have a global mindset.

On Monday, it was back to work at the hospital. Currently, I’m continuing in our NICU. It has been quite an experience in contrast to my most recent NICU rotation back home. It can be frustrating at times to have a lack of resources or the ability to care for the babies the way we would back home, but it has also been amazing to see what we can do with the little that we have. Right now our nursery is overflowing with about 28 babies (remember the size of the 90 degree plus room that I mentioned before….). Many of them have fallen sick with bacterial infections, so please pray that we are able to contain the spread of infection and that all those currently sick will be healed. It has been a bit busier than my internal medicine time here, but still a great time of learning and growth.

Yesterday, I took my first pediatric call. I was blessed that my intern apparently used to work in the peds department for 4 years. Therefore, he is certainly more experienced than I am. He skillfully handled most of the overnight calls, and we thankfully had only one admission for a 19 day old baby with a fever to the ward. (As an aside, I think the interns perform about 2-3 lumbar punctures a day here in Kijabe…and most of them are perfectly clear…they are certainly much more skilled than we are at them).

As the consultant, we handle all the ICU care ourselves, so I also admitted one young girl to the ICU who had just had an 8.5 hour surgery to remove a large brain tumor that was impinging on her brain stem. Kijabe is a premier neurosurgical center for the country, and I was so thankful for the experience that we have had in Greenville with Dr. Troup’s patients. While I still am far from knowing everything I need to know about caring for this special set of children, our experience at GHS has made me more comfortable with shunts, vent taps (which we needed to be able to do the other day), and post op management. Thankfully, the patient did well through the night with only a few calls down to the ICU for bradycardia (to clarify—we take call from home after the day’s work is done, but since it only takes me about 5 minutes to walk to the hospital, we end up walking down frequently during the night to check on things).

This afternoon I was afforded some early time off to rest. After a quick nap, Scott and I ventured once again to the school located just above us on the mountain, Rift Valley Academy. We took a delightful stroll along their trail and met another teacher in the area. She was from Mississippi and has been serving the last 8 years here. She allowed us to meet her 3 large pet leopard tortoises that she has been caring for since moving here and recounted what a delight it is to teach for the missionary children. Scott and I thought once again about how amazing it would be to live and work here long term one day, as it seems to be the perfect fit for a doctor and her teacher/pastor husband to serve.

For the next several days, I’ll continue my work in the NICU and then move on the pediatric floor. I feel as though I’m ending my stay with a bang, as that is the part of the hospital I’ve been most excited to work in. It’s hard to believe that we have been here over 2 weeks already (it feels both too short for all the we have learned and experienced, and too long for it means that we have already passed the half-way mark of our time in Kenya). We are eager to experience what else the Lord has in store and trying to soak in every moment!

"I bless the rains down in Africa..."

We awoke this morning with the confirmation that last night’s clouds were in fact carrying rain with them.  Last night some strong winds blew in heavy looking clouds that were a direct answer to prayer.  The sprinkle of rain early this morning and the continued mist has allowed the dust to settle a bit and it looks as if the long rains are about to settle as well.  As I type these words I hear Toto’s song Africa playing in my head.  The rains indeed are a blessing and an answer to no few prayers here in Kenya.  May they settle in for some time to replenish and refresh this parched land.

Saturday:

Teresa had this last weekend off, her only two days free from hospital work during this entire month.  As such we decided we would venture out for a bit of fun around Kenya.  We departed Saturday morning for one of the nearby parks, Hell’s Gate.  If you think the name sounds a bit daunting, know that within the park there are several areas equally named including the Devil’s Kitchen and even the Devil’s Toilet.  In my mind was Jesus’ words that He would build His church and the gates of hell would not conquer it.  Armed with this scripture we continued onward.  Apart from the evil monikers the park actually contains a broad sample of Kenya’s animals and picturesque landscapes. 

We saw some of the classic animals including zebras, gazelle, impalas, buffalo, kudus, baboons and even a lone giraffe.  After driving through the park for a short while we continued the journey on foot through the deep gorge carved out long ago.  As we began our hike we were visited by some friendly black-faced vervets that put on a good show for our coconut flavored crackers we were snacking on.  They charmed more than a few of them out of our lunch stash.  As we continued the walk through the gorge we came through an area where we were told by our guide that two movies were filmed: Tomb Raider and the Lion King.  I am not sure how I missed it or maybe I was just dreaming but wasn’t the Lion King an animated film?

Never the matter, we carried on through the gorge and came out near some power stations where our good friend Richard has been working.  He gave us a tour through one of Kenya’s cutting edge, green power generators.  According to what we were told these facilities of “free energy” could supply over ¼ of Kenya’s electricity needs.  The power company has a number of sites where they brilliantly drilled 3,000 meters deep to harness the power of heat and steam coming from within the earth’s crust.  This steam powers turbines that then convert the energy to electricity sent out to the far reaches of the nation.  The particular facility we were in generated 105 megawatts just by harnessing the earth’s geothermal forces.  The whole business was particularly exciting and we were honored to have a tour of one of the many green power facilities in Kenya.

Carrying on from there we came to Hells Gate’s newest feature, a hot spring spa.  Whatever you have in your mind about what this may look like, immediately erase it.  I assumed this would be a small hole off a dusty road where there was a bit of hot water.  Imagine our surprise when we saw a round circular cement pool at least fifty feet in diameter filled with sky blue comfort.  Hot water boiling forth from the earth was collected in a cooling pool which was then pumped into this gigantic circular bowl that was heaven on earth. Unfortunately we had no towels with us but we will not make that mistake again.  Apparently this is the only hot spring of this caliber in all of Africa.  It truly looked as if we had left Kenya and gone to a fancy resort in Dubai.

After the spa we made a quick ride over to Lake Naivasha for a boat ride.  While there we came uncomfortably close to some full sized hippos, tipping the scales at 3 tons our guide opportunely mentioned.  We also saw birds seemingly numbering in the thousands with every variety you could imagine.  As we headed across the lake we even saw the area where they filmed a portion of Out of Africa with transplanted wildebeests and all.  We finally rolled back in to Kijabe just as darkness was falling and, despite our best efforts, we were unable to stay awake past ten o’clock.  After all we had much to prepare for as our Sunday promised to be of even greater excitement.

Sunday:

Yesterday we had the supreme privilege to be back in the Maasai church, AIC Kitet.  After meeting up with our friend Paul, with whom we learned shared numerous mutual friends here in Kenya, we made the journey to Suswa, just under an hour away.  When we arrived the children had already gathered and were practicing their songs outside the metal-roofed, stone sanctuary.  As the morning of worship began people trickled in from rather long distances away as they journeyed to meet with a group of fellow believers not only for mutual edification but also to praise the One that gave them life for another week.

Shortly after our arrival some Maasai ladies whisked Teresa away outside the sanctuary and dressed her in traditional shukas and loads of beaded jewelry.  Our Maasai friends also gave her a new name, Nashipae, which means “joy”.  The morning service had no shortage of that very thing as the meeting seemed to take a page right out of the New Testament church manual.  Although the service had a general order of things the entire morning was peppered with numerous testimonies, words of praise and even a couple of folks who just wanted to sing a song that was on their heart.  As I witnessed the passionate faith of everyone in the service I noted that because each person was a participant there was no room for spectators.  The service they took part in was not built around a sermon but rather the living demonstration of God’s work throughout their previous week.

I did have a chance to share a few words but what can you share when so many have said it far better already?  I shared from the Sermon on the Mount and spoke of the hope we have of great reward in the life to come.  Despite the difficulties of this life, we know that God’s kingdom seems to stand in direct opposition to that of this world.  Those who are poor, mourn, and are persecuted, and yet in the midst of it all turn their gaze towards God, it is these who Jesus said are blessed.  That brings an entirely new light to the differences of American Christianity versus that which Jesus communicated.  We even enjoyed a special time of prayer at the end of the service for some in need, following the Biblical command of coming together and laying hands on those requesting prayer.  It was a powerful time and although I could not see it, I could almost sense their faith reaching out and taking that which they needed from God’s outstretched hands.

After a tremendous time together we journeyed to the house of Pastor Richard for a meal and some additional fellowship.  Our new friend and driver Paul came along and could not stop commenting on the kindness and warmth of Richard and his family.  We ate a wonderful meal prepared by Richard’s wife, Evelyn and shared numerous memories, some old and some new.  It was such an honor to sit in the house of a longtime friend; if we only knew what had been in store ten years ago when we met on a dusty journey to Nakuru we might not have believed it.

We made our way back to Kijabe through the winding roads and bid farewell to our friend Paul for now.  I will catch up with him later this week as we go to Naivasha and then on to Eburru to find Pastor Steve, one of the most warm, loving and brilliant men I have ever had the privilege of meeting.  We rolled back into our place of residence only minutes after another dear friend had arrived.  Connie Donlon, who I had the honor of working in the Kibera Slums with, had come for a visit.  What a blessed time of reconnecting with those who God is using mightily here in the beautiful country of Kenya!

Close quarters, an afternoon hike (with MORE monkeys), and new friends

Wednesday I said goodbye to my internal medicine team and my patients that I had been caring for, and transitioned to the world of pediatrics. Currently I’m working in the nursery which is the equivalent of a level 2 NICU back home. We have patients on cpap (although the set-up is much different but simply brilliant), tube feeds, and German monitors. The room is about 12ft by 15ft and accommodates about 17 babies, their mothers, about 5-6 nurses and our team of 5. Needless to say it gets a bit crowded. Furthermore, because we need to keep the babies warm, the room stays about 90 degrees all the time with no air flowing through. It has allowed to me to feel as though I’m truly practicing medicine in Africa.

As with any NICU, it is a completely different world. I’m fortunate that I just finished my upper level NICU rotation back home, as next week I’ll be helping a first year NICU fellow from Canada with attending duties. Yesterday I got to go to a c-section and learned that usually the medical officer interns attend deliveries by themselves and resuscitate the babies. I realized how pampered I am at home with such knowledgeable nurses and RT’s…and NICU attendings always available to assist. Just as with medicine last week, I know I will be stretched in many ways. I’m learning that Kenyans have quite different protocols and standards with their infants, but it has been encouraging to have each mother so engaged in her baby’s care.

Today I was granted my first afternoon off since arriving. Scott and I were very excited to have the chance to explore Kijabe for the first time together since my tour of the area has thus far consisted of the 150 meter walk to the hospital from our house. We walked down below the hospital on a search for hyenas, a view of the valley, and the many exotic plants that exist on the side of the mountain. We also visited Rift Valley Academy which is a world class African boarding school where missionary children attend. It is just about 150 meters up the mountain (opposite the hospital) from our house. We walked a trail around its 100 acres and discovered a few stray cows, several colobus monkeys, and some fantastic views through the valley.

While strolling about, we ran into a delightful couple from Iowa who are serving as teachers at RVA. We exchanged some polite banter and they kindly offered to have us over for dinner (after having talked to us for about 3 minutes). We spent the evening in their home with another couple serving as teachers from Pennsylvania and their many delightful children who just wanted to be held and play with my hair.

After homemade pizza and cookies, we sat down on their couch to stream a March Madness game. As the couple were avid basketball and Iowa State fans, I learned that my dear UAB beat Iowa State yesterday. Go Blazers! (They joked that had they realized I was from UAB before inviting us to dinner they would have kept their mouths shut….something to be said for inviting someone you just met to dinner).

 It was such a treat to be allowed into their home and to watch such an amazing internet connection in Africa (our own here in our house is not nearly as effective…). However, more than the food and television, we were blessed by their wonderful hospitality. In fact, since arriving in Kijabe, we have been invited to lunch or dinner at least 2-3 times a week. People here have been so willing to open their hearts and their homes to us.

It reminds me of the church in Acts where people shared all that they had and met daily together to break bread. (In fact, almost everyone here has offered to let us borrow something or stop by whenever we need anything).  I was challenged today to continue with a spirit of hospitality when we return to the states. Many of you have probably noticed that Scott and I are both introverts and tend to prefer to stay at home by ourselves...or focus on our own busy schedules. However, I know the Lord has blessed us with so much and we have been so blessed here…I was reminded I should be doing the same for others.

Tomorrow I am fortunate to have the weekend off, so Scott and I will be exploring the Kenyan countryside with an old friend of ours. We are excited to see what we will get in to. Pray for hydration and safety as we attempt to make it off the mountain for the first time since arriving! Also, look forward to some good pictures and stories to come!

Medicine is a universal language

I’m not sure whether I have made it clear in my other writings about Kijabe, but this is a training facility where Kenyans are educated both in medicine and in the Word to go out and fulfill what I have personally felt to be my life’s calling from Luke 9: “to preach the gospel and heal the sick.”  Therefore I have had the privilege of learning from our US equivalent of other fellow residents and trainees. We sit in lecture together, run to the lab together, and look after one another’s patients. I’ve been so thankful for their kindness in taking me under their wing and never complaining over the plethora of daily questions that I have.  I’ve come to consider them my friends in just the few short days I’ve had the chance to get to know them.

 Last night our attending (a hospitalist from California) had them all over for a pizza party. It was so exciting to sit around and hear the banter that we all shared. I realized that medicine is medicine everywhere. There was a common bond amongst us as we commiserated over medicine consults to perform history taking for ortho (sorry for the insult to my surgical friends…you know how it is…), nurses not charting appropriately (again, sorry for the insult to any nursing friends…some of them are very good here, but you know how the chatter goes), and all of the other things that residents laugh about when they are tired and overworked. It was thrilling to me to watch as we sat and laughed all the while a few checking their smart phones and looking at facebook pictures. Even though we live in very different places, our worlds are not so different.

Beyond our common bond of medicine, it has been exciting to share a common thread of the Spirit. To know that we all love the Lord and seek to glorify Him with our work has been both fulfilling and challenging. One of my fellow teammates and I discussed a patient who had passed in the night the other day before rounds. As we stood on the ward, we reiterated what the Lord has been impressing on us about striving for eternity and knowing that our medicine is only a small step in showing someone God’s love rather than being able to reverse the inevitable. After our conversation ended, I looked at her and concluded, “We have just had church this morning!”

I know that many of my fellow residents in the states and I also share the same relationship with the Lord. I wanted to come to Greenville in part because I knew I would be challenged to remember to love on my patient’s with Christ’s compassion there. However, I fear that in my busy rush to get things done, I don’t share this part of my heart with my peers as much as I should. I am challenging myself to continue to share with patients and encourage my fellow workers in the field to bring honor to our Lord as we work for “things unseen.”  

Monkeys, Hyenas and Dust Clouds...Oh My...

As the days seem to pass all too quickly here in Kenya I thought I might take a moment to reflect on the past few.  After a busy weekend we slightly recovered with the start of this second week here in Kijabe.  Teresa has had no lack of opportunity or work as she has been in the hospital every day since arriving.  Tomorrow marks the shift from the medicine side of the hospital to the pediatric side which she will be involved with until our departure.  Monday evening we had a wonderful time during the weekly dessert night for the missionaries who serve at the hospital.  It truly is a blessing to have such a wonderful community of individuals passionate about the Lord as well as the work to which He has called them.

I also had an opportunity to work with Moffat Bible College both Monday and today.  Today I got to sit in on their chapel service which happens to be one of the last for this semester.  Their school calendar is a bit different than American schedules and next week will mark their exams and semester’s end.  Nevertheless, this chapel service was a bit out of the ordinary as the president of the college wanted to handle some “housekeeping” matters.  His remarks included a warning against “Pentecostalism” around the college which I later learned included students having marked outbursts during their meetings, rolling around on the ground and slapping the walls with their raised hands in some wild display.

He also shared that the fellows should have a shaved head, look smart, pay their fees on time and not wear open toed shoes.  His presentation about open toed shoes was most entertaining as he stated that God created men to keep their feet covered because no one wants to see their feet.  On other hand God permitted women to wear open toed shoes because their feet are generally more delicate and not as off-putting as a man’s.  This was met with raucous laughter by both the men and the women in attendance.  Lastly he warned the students against putting too much information on “the Facebook” as people do not want to see them kissing other people or see their posts about silly, insignificant things.  I chuckled a bit inside as the exhortations from the president seemed remarkably similar to the words shared in American schools, albeit in a different cultural presentation for sure.

Additionally we continue to make great connections with people here and recognize what a small world it truly is.  I met a fellow this morning who is teaching at the Bible College who went to Furman University and previously served as a chaplain at Greenville Memorial Hospital.  How wild to fly halfway around the world and meet people who have the same reference points as you.  Crazy enough I was talking to a fellow just last week who referenced eating at Wade’s in Spartanburg and I had to check to make sure I was still in Kenya!

I went out earlier this week for a walk and found a beautiful view of the Rift Valley on the edge of Kijabe just a bit west of here.  I found a few mischievous monkeys swinging about in the trees, curiously looking to see if I had anything they could steal.  Those here who live on the opposite side of the hospital from us told us that they have to be overly cautious as the monkeys will find a way into their houses and take whatever their little paws can get a hold of.  I also stumbled upon a few signs of a local hyena or two which I had no knowledge of being around Kijabe.  I do not think they come up quite as far as the hospital but we were warned to keep an eye out.  At this point I am not sure what to do if we do see a hyena but I have played out a few scenarios in my mind where I use various implements to either poke out his eyes or break one or two of his legs.  Otherwise the natural world here in Kenya continues to delight.

Despite the beauty of this land, do join us in praying for the people here in the Rift Valley as the delayed rains have caused increasing problems.  I heard a report today that not only are people’s gardens drying up but they cannot even find basic vegetables and food at the markets.  Water is a resource that is all too scarce.  Also due to demand the prices of things have dramatically increased bringing additional strain to families that already are struggling.  One fellow was telling me today that a Maasai was asking for water and when some was brought to him he first poured a bit into a basin for his sheep and he drank some himself only after they had a bit.  Life here is hard forcing the precious people of this land find a greater dependence upon their Creator.  May God bring them both spiritual and physical rain as He nourishes a world in need of His renewal.

Scott

 

The most interesting call weekend I have ever had…

DISCLAIMER: The following post is quite lengthy and filled with medical jargon. It was written more for my own remembrance and mental cleansing after a long weekend. However, if you want the important point, Scott tells me you can just skip to the final paragraph and get all you would ever need. (Although, I find the rest pretty interesting too...J )Thanks for reading!

As I mentioned in my last blog, this weekend I was charged with the responsibility of rounding on the internal medicine services and overseeing the admissions by the interns. Being not far from their training myself and not knowing the girls I was privileged to work with, that meant that I came in to see each of their admissions with them as we worked collaboratively through their presenting symptoms. Since in Kenya healthcare is only available to those that can afford to pay up front, many people present very late in their illness, and many only when they are on the brink of death. Needless to say, the admissions were fairly complicated. However, I was excited to tackle the weekend and see everything from falciparum malaria to classic ST elevation MI (massive heart attack).

Since I have already relayed to you most of Saturday’s events, I would like to walk you through my last 24 hours: The morning began with rounds by myself on our critically ill patients. One patient who had been admitted overnight on Friday was not faring well, as her pulse was in the 160’s, her blood pressure was in the 200’s and her breathing had become labored. She was admitted with known HIV, a diagnosis treated much like stage 4 cancer here. Therefore, a collaborative physician decision was made that she was a DNR, as the likelihood of her surviving was slim. She was being treated for liver failure of unknown origin (suspected to be from either her AIDS medications or some herbal concoction she had received from a traditional healer).

Hepatic encephalopathy is not a diagnosis we are unfamiliar with in the US, but she was not responding in the way I would have liked. Therefore, I did what any confused resident is likely to do…I went back to the drawing board and attempted to make a differential for altered mental status in an HIV patient. I did not have the benefit of any prior health history or a CD4 count. I’ll spare you the details of my varied list, but I systematically tried to rule each in or out, and decide how, or if I could treat them. Unfortunately, lab tests on the weekend are hard to come by and basic at most. Imaging is limited to ultrasound or x-rays unless a patient is stable enough and wealthy enough to make a trip for a CT or MRI to Nairobi about 2 hours drive one way (not an option in an unresponsive patient without an airway). Therefore, I started antibiotics empirically to treat any of the possible infectious causes we were not treating, and prayed for the best.

 I realize as I’m typing this you probably thought that after reading 2 paragraphs about one patient, I would have revealed to you her mystery diagnosis, but alas even today she remains a mystery on the brink of heaven. I write this only to demonstrate the mental anguish of watching a patient deteriorate in front of you without the benefit of knowing what is ravishing her body, and the frustration of limited resources (AND lack of knowledge on my part…I was thankful that our senior attending returned today to add her own clinical expertise!).

While attempting to seek other physician opinions about the lady above yesterday, I came upon a pediatric code in the ICU. It was so much calmer than any I have seen in the states (no code stat junior called overhead, and no pharmacy, chaplain, or scores of scared residents to crowd the room). Since there was only the nurse and one pediatrician present (one bagging and one doing compressions), I quickly offered my services. They requested that I run to the blood bank to seek the blood they had ordered to transfuse him. It occurred to me as I ran through the hospital that this is a situation I have only seen in movies. When I arrived and urgently requested the blood, the lab tech sluggishly checked the progress and told me that it would be 30 more minutes. To this I replied, “It’s an emergency…the baby is dying right now!” He finally agreed to let me have what was available for an emergency protocol but only if I could go back to the ICU and get the blood carrier. I felt much like a ping pong ball, but the baby survived the code. Unfortunately this morning I curiously passed his room to find it empty. I don’t know the details since I’m not currently on the pediatric service, but I know he is frolicking in heaven unbound by tubes and lines today.

After my adrenaline calmed down from running through the hospital, I made my way toward the gate to go home for lunch. However, I stopped by the ER to see if any interesting admissions were coming our way. The clinical officer (PA) was so happy to see me and showed me an EKG of a patient who had presented with chest pain. He had classic tombstoning ST elevation in the anterior leads (massive heart attack for my non-medical friends). These patients are usually whisked away to heart cath in the US before we ever have a chance to see them. Unfortunately, a cath is not available in our hospital where a cardiologist is only here once a week for clinic. We initiated typical therapy for a heart attack and I was excited to be able to teach the clinical officer. I learned later than thombolytics are sometimes available to treat these patients, but unfortunately, our hospital was out yesterday. He was admitted to the ICU team and I moved on to the next patient.

A 50 year old lady with known HIV had presented with altered mental status, vomiting, and left sided weakness. On her exam, she was quite stiff and unable to move her left side at all. With her right arm she was persistently performing repetitive motions which made me concerned for partial seizures. We were highly suspicious of a space-occupying lesion, stroke, or infection. Her family was unable to afford a head CT, so we decided to treat for meningitis empirically, knowing that a lumbar puncture would be very risky in her. They planned to consult with family members and attempt the head CT the following day.

After getting her settled, we were called about a patient with a likely bowel obstruction and a sodium level of 103. Next, was a patient with chest pain after previous history of a heart attack. Following him, our team was asked to see a 16 year old girl with known focal segmental glomerulonephritis and pyelonephritis (kidney infection) on immunosuppressants. Then, we admitted a lady with seizures and hypertensive emergency.

After finally getting each of the above settled it was about 1:30am and the clinical officer quietly asked for my opinion about 2 other patients in the unit “since I was there.” He briefly told me their stories concluding that they likely both had pulmonary TB (number 1, 2 and 3 on the differential here for any patient). I asked to see their x-rays and I examined both.

The first gentleman had the largest, most nodular liver I had ever felt. He had an ultrasound that showed 2 focal masses and a x-ray that looked like diffuse metastatic lung cancer (although to the credit of the intern, it also looked like military TB, ARDS, or PCP …all very likely causes of his symptoms). He was hypotensive and had signs of infection on his labs. We concluded that he likely had metastatic lung cancer and potentially ARDS as the result of an infection he may have acquired while in and out of the hospital. I attempted to stabilize his shock and moved to the second patient.

The second gentleman was very thin and frail, with a blood pressure of 86/50 and saturating 75% on 15L of oxygen. On his admission vitals, it was recorded he had a sat of 32% on room air. He had clubbing (signs that he always had low oxygen levels) and was in mild distress. The intern described his x-ray as “unusual” but he wasn’t sure what was going on. Taking it to the light box, it became quickly apparent that he had a moderate pneumothorax with a white out of the right lung and diffuse patchy infiltrates in the left (one must learn to become a radiologist here, because that is another subspecialty we are lacking).

Because of the hypotension, I was concerned that he was developing a tension pneumothorax and potentially had a lung full of blood since that’s what he had been coughing up for the last week. I called the surgical resident to place a chest tube and then the intern and I prepared to do a needle decompression (something I’ve only read about but never actually done). It was slightly anti-climactic, but it did buy us time until the other physicians arrived. The ICU covering attending came and performed a bedside ultrasound to look for signs of cardiac compromise from the collapsed lung (thankfully there were none). After that, the ICU team took over. Unfortunately when I went to find the patient this morning to follow up, he was nowhere to be found. Another soul with the Lord after a long night.

After about an hour of long awaited rest, I went back to round on my patients for the day. I walked into our unit to find the nurses coding the lady I had admitted with HIV, seizures, and left sided weakness. Again, it was actually a bit calmer and more organized than those in the US. I took over the lead from the intern who was bagging and we tried to think through what might be going on. Unfortunately after about 20 minutes, she too left this world to be with the Savior.

I sat down with her family when they came to visit this morning, and it was odd how at peace they were with her passing. They knew she had been suffering with AIDS for nearly 10 years and calmly acknowledged every word without so much as a question about what happened. Given that her acute diagnosis was still unknown, I was amazed at their acceptance that God is in control.

I keep seeing over and over again this contrast between American and Kenyan culture: Kenyans believe in a spiritual universe. Whether people know Jesus or not, they still realize that there are powers greater than us at play. They understand that as physicians we are entrusted with knowledge and expected to use that as the gift that it is, but they do not blame us or question when bad things happen. They know that we do our best, but sometimes it is time for the suffering in this world to be done.

After the conversation with the family, my call shift was finally over and it was time to begin the day with traditional rounds. As is customary on our team, we prayed to begin the day. I shared with them this verse that the Lord has been impressing upon me this weekend: “That is why we never give up. Though our bodies are dying, our spirits are being renewed every day. For our present troubles are quite small and won’t last very long. Yet they produce for us an immeasurably great glory that will last forever. So we don’t look at the troubles we can see right now; rather we look forward to what we have not yet seen. For the troubles we see will soon be over, but the joys to come will last forever.” – 2 Corinthians 4:16-18. I realize that medicine and physical things are only temporary. I’m not going to lie, I was pretty beat down this morning after feeling futile for so many patients. However, the Lord reminded me that we work for eternal things. We touch patient’s hearts and souls, and the love that we show them will last far longer than any medicine I could ever give. With that I am encouraged, and the journey continues!

Sunday in Suswa...

This morning was filled with great excitement as I got to meet up with one of the fellows I missed the most since being gone from Kenya: our Maasai friend Richard.  It has been eight long years since we last saw each other and the reunion was certainly a blessed one.  As we chatted over some chai he shared the ministries and jobs he has been involved in, how his family has grown and how God has provided in miraculous ways.  Just after 10:00 we left to make our way to Suswa, a Maasai town at the base of the extinct volcano Mt. Suswa, down in the Rift Valley.  We wound around a serpentine road that looks as if it once was a suitable path for transport but has now been mostly reclaimed by nature.   No words can quite describe exactly how treacherous the road is but with the skill of Richard’s driving and the grace of the Lord we made it to the valley floor.

The equator passes just north of us here in Kenya and there are not really seasons as we think of them.  Instead the year is punctuated by the short rains and the long rains.  The short rains come in the fall and the long rains usually begin in March and are scheduled to arrive any day now.  Once in the valley it became clear how little rain has fallen since last fall.  The plants there are all thin leafed to maximize the scant amount of moisture they can gather when water is available.  What’s more they are all covered with thorns that make the American briars look like a joke.  The lack of rain has caused everything to turn to dust, which is then gathered aloft in immeasurable amounts by the wind.

About forty five minutes into our journey a stone building with a shiny tin roof appeared, seemingly out of nowhere on the left side of the road.  It was so dry and we were all so parched I thought it was probably a mirage but it just so happened to be our stopping point.  We drove right up to the side of the building and could hear the shrill sounds of Maasai worship coming from within.  As we walked in I am afraid my white skin caused a minor distraction but not enough to take away from the heartfelt praise that was already taking place.  I am convinced that the Maasai will be holding classes in heaven to teach worship to those who were a bit too stiff back on earth. 

Everyone was an active participant in their worship and instead of staying in the plastic chairs that were lined up in the back of the meeting place, they all gathered at the front of their sanctuary dancing and jumping in unison.  As they sang their jumps, stomps and whirls churned up the dust from the dirt floor where they meet.  This continued for some time with a speaker system producing a rhythm pumped in from a keyboard on the side.  Brian, the boy playing the keyboard, and quite adeptly at that, could not have been more than twelve years old.  The scene was nothing short of glorious as it was clear what everyone had come for.

As the service continued occasional wind would whip up the dry dust through the open windows coating everything in a light tan color.  My black bag that I carried with me quickly became khaki colored and somehow dust particles filtered into every page of my Bible.  While sitting there the passage from Psalm 143:6 came to mind, “I thirst for you as parched lands thirst for rain.”  The longing for the nourishment of the land was strong but not as strong as their passionate seeking after their God.  A time of testimony came and a number of people shared, praising God for the simplest yet most profound things.  Following that came the time of offering where no ushers or plates were mobilized but rather the entire church ran to the front to deposit their shillings in a bag.  They came not out of guilt or ritual but rather joy for the opportunity to give back to the God that grants them life.

Having an opportunity to share I read from John 10, telling them of how our Savior is a herdsman just like they.  However, it is He who is the best herdsman and laid down His life for His sheep.  We had a tremendous time of reflecting on the goodness of our shepherd and His provision for us all.  With a few more announcements the service reached its end and it was only 2:00pm.  It honestly did not even seem that long but we disbanded quickly as the wind had been turned up a few more notches.  The dust clouds seemed like what I had seen in pictures from the great dust bowl years ago in the Midwest.  As everyone scattered we jumped in the car Richard borrowed to drop his kids off at their house in an attempt to save them from the wind.  We stopped at the local Suswa hotel, grabbed some meat and chapati and were back on our way. 

Heading back to Kijabe we passed two significant accidents on the road and rejoiced that we were not involved as they both happened right before us.  Winding our way back through the bush we made it to our connecting road and headed back up the mountain to Kijabe.  At one point the other passenger and I had to get out of the car and push due to the combined difficulty of the incline, the scant power of the car and the added weight of us two passengers.  Nevertheless we reached Kijabe safely and said our farewells. 

As I sit here and reflect on the day it reminds me of the overwhelming abundance and ease of life in America and at times the lacking commitment to Christian life.  Here in this harsh environment some walk for over an hour through the dust, biting wind and beating sun to meet together and praise the God they serve.  One Kenyan said it well, “Here in Kenya we have much poverty but great spiritual wealth.  You in America have much wealth but great spiritual poverty.”  I think he just may have a point.

 

Scott

Things I have seen in my first half-week

1.       TB meningitis

2.       CNS lymphoma/toxoplasmosis

3.       HIV

4.       Necrotic diabetic foot infections

5.       Pelvic abscesses

6.       DVT/PE

7.       Probable metastatic  breast cancer (with classic peau d’orange appearance)

8.       Multiple cases of likely lung cancer

9.       Pneumonia

10.   PCP

11.   Pulmonary TB

12.   Acute coronary syndrome

13.   Congestive Heart Failure

14.   Diabetes

15.   Hypertension

16.   Viral meningitis

17.   Severe septic shock

18.   Benign euthyroid goiter approximately 7-8 inches in diameter causing airway deviation

19.   Status epilepticus in an adult male with congenital hydrocephalus s/p shunt->brain abscess->osteo of the frontal bone-> removal of the bone->large defect in the head permanently->seizures

20.   Insterstial lung disease

21.   Septic shock secondary to abdominal abscess in a woman 16 weeks pregnant

22.   Stroke

23.   Diabetic leg ulcers

24.   Severe electrical burns

25.   Dental abscess with facial swelling

26.   Liver failure

27.   Hepatic encephalopathy

28.   Renal failure

29.   Pulmonary hypertension

30.   Septic joint infections

As you can see, it is a myriad of common internal medicine, infectious disease paradise, and very late presentations of disease unseen in the US. I’m sure the list will continue to grow…but I just wanted you all to be reassured that I am learning lots! Thanks for your support and prayers as I try to stretch my brain and depend on the Lord to teach me what I need to know about this intricate human body he created!

P.S. Find attached this picture of the sunset over the Rift Valley that Scott took while I was attending in the ER! J