Thanksgiving

"Not what we say about our blessings, but how we use them, is the true measure of our thanksgiving." - WT Purkiser


I have been given a great gift by God this year - the gift of perspective.  Being in Kenya reminds me not only of the many blessings the Lord has given me but of the responsibility that I have to be a good steward of these gifts.  Among many orphanages nearby, I have had the privilege of being involved with one that is particularly in need.  This orphanage houses twenty-five children, many of whom were either abandoned or left orphaned after their parents died at a young age.  Several of the children are malnourished and suffer from HIV.  

Children and workers at the orphanage enjoying fun pics with the camera

Despite the difficult life that has been given them, these children are just like any other, wanting to belong, be loved, and have fun.  I am thankful that God has put them in my life to share His love.  A group of us went to bring them lunch, preparing a true Kenyan meal with chapati and mandazi (Kenyan donuts) for them.  It was wonderful to serve them and watch them enjoy every bite.  While it may not be the typical Thanksgiving spread we all overindulge on and often take for granted in the US, I cannot imagine a more thankful group of children as they sit on the grass and eat off of a frisbee that also functions as a plate...no grumbling, no whining.

I am extra thankful today.  I have so many material things, above and beyond what I could ever want or need.  A house with more than mud floors, heating, furniture, and a closet full of clothes.  A church that is more than one small room with electricity and cushioned seating.  A hospital with ample supplies and medicines to take care of patients.  Beyond material things, I have an incredible group of friends who support and encourage me on a daily basis.  I also have a family that has been by my side with never-ending and unconditional love.  While this past year has been very difficult for my family with my dad's diagnosis of lung cancer and my mom's struggle with early-onset dementia, I couldn't help but look at these orphaned children and rejoice for the many wonderful years I have had with my family, knowing that each day is a gift.  Above all, I am thankful for Jesus who sacrificed everything to give me an abundant life; may I use the gifts entrusted to me to make the most of Him.  Thank you Kenya for giving me a perspective on life not easily found in the comfort of the US.  

Wild Camel Day

After last weekend, I am convinced that Wild Camel Day should become an international holiday/event.  There are few places that you can participate in such activities; I'm thankful to have been around for this one.  A group of us from the IU-Kenya program took off to Rumuruti, Kenya for the weekend festivities.  We had a little glitch in the plans when one of the cars broke down four hours from our destination.  There isn't really roadside assistance or tow-trucks here so getting help can sometimes be problematic.  While waiting for someone to come get us, our white faces attracted children from the surrounding area.  Many of them were fascinated when they discovered their faces in the side view mirrors on the cars as many had never before seen their reflection.  After several hours, the car was attached to another and taken to Nakuru for repair.  After hiring a matatu to make up for the broken vehicle, the rest of the crew joined us for the camel adventures.

Stuck on the side of the road.  What seems to be the problem guys?  

A few of our admirers, one with a machete...nice.

Thankfully, we finally made it to our campsite and enjoyed a nice dinner over the campfire.  A few highlights from camping include:  two leaky tents in the rainy season led most of us to get close in one tent; a green mamba snake in the community shower kept many of us dirty for the weekend (isn't that the way camping's supposed to be anyway); and one of our nights, we had some unexpected guests, aka elephants.  Good times!

Wild Camel Day began with a half-marathon and fun 10 km run that ended at the fields where the festivities were held.  Upon arrival to the fields, you could sign up for any of the events:  Camel Polo, Camel Races, a Triathalon Relay (Run, Bike, and Camel Race), and the Greasy Kuku race (catch a greasy chicken) to name a few.  We tried to get someone into each of the events for the day.  Myself and three others joined in for the camel polo fun.  I had never played polo, let alone played while riding a camel, but what the hey, always a first for everything.  We were first to play so I didn't have the luxury of seeing how this was supposed to go, but I quickly got saddled up on my camel, named Mambo, and was given a quick lesson on riding and hitting the ball.  Needless to say, it didn't look pretty.  The game was an incredible amount of fun even with my inability to get Mambo to go where I wanted, let alone hit the ball.  We lost 2-0, but had a great time trying.

WooHoo, I actually hit the ball!

Getting a little competitive

Enjoying the beautiful day and events.

I definitely am much more comfortable riding the camel now, so bring on the games for next year.  Anyone ready to join the camel fun?

Mwalimu

Since my arrival in Kenya, the Casualty department has given me the name Mwalimu, which means teacher in Swahili.  Teaching has become one of the most enjoyable parts of my job here, primarily because the Kenyans are so eager to learn and appreciative of any efforts to provide them with more education.  To achieve the goal of developing emergency medicine in Western Kenya, where the specialty currently does not exist, it is important to begin teaching my Kenyan colleagues about some of the basic concepts in emergency medicine.  As part of this, I have started a Basic Life Support (BLS) class which everyone in the department is required to attend, including administrative staff.  The majority of people taking the class have never had any training in BLS, which includes CPR and managing choking victims.

An EM/Peds resident helping with the practical portion of the class

After teaching BLS, the Kenyans like to show their appreciation through a small speech followed by a special applause.  They have a number of special handclapping which they all do together to say thank you.  I have received a different one after each of my BLS classes.  Today was special though; after class, I received the "Obama Clap" which consisted of me standing at the head of the class waving to the Kenyans like Obama while they clapped for me.  Awkward, honoring, and hillarious all at the same time.

We have trained over a hundred people in the department and have more classes on the schedule.  With the success of the class, there has been discussion about rolling this out to the rest of the hospital to provide training to everyone on the wards.  It definitely is an honor and blessing to be available to meet some of the needs here in Kenya, hoping to improve the emergency medical care for these beautiful people.

Nap Time

Napping is one of my favorite pastimes that I wish I could enjoy more.  While people may frown upon naps in our very fast-paced American society, many famous and brilliant people were known for napping:  Albert Einstein, Leonardo DaVinci, Winston Churchill, and Eleanor Roosevelt to name just a few.  So I like to think being a napper puts me in good company.  Well, now we need to start adding Kenyans to the list.  One thing I love about this country is the freedom without judgement or guilt to just lay down wherever you are and take a nap.  It is not uncommon to find people napping in the fields, along the road, or around town.  Walking around the hospital, you will see nurses, staff, visitors, or patients taking a nap in the grass.  Here are just a few pics of people napping around Eldoret.


Is work slow, why waste time - take a nap

 

Rebecca, our maid, taking her usual nap during lunch time in the grass outside our house

Why not just sleep on this slab of concrete near a big hole in the ground?  Don't roll over! 

Looking at these pictures is making me sleepy.  Yay, Nap Time!

Welcome Back

Large signs and friendly faces welcomed me back to Eldoret.  

I arrived back in Eldoret, Kenya this morning and received a warm welcome from my housemates.  There is much to be thankful for with my dad recovering well from surgery and having an opportunity to return to work here.  This month is filled with lots of exciting projects, which will keep me incredibly busy.   I have two students coming this month (a Tulane MPH student and a US med student) who will be working on my research over the next year.  In addition to my two Kenyan medical students on the project, I will spend a good portion of the month teaching them about research and getting them to a point where they can run the project in my absence.   I am very excited to have their help, allowing me to free up some time to focus on education and clinical responsibilities.  Also, one of our IU EM/Peds residents is coming to spend her elective with me over the next 6 weeks.  It will be another milestone for our program as I develop a formal international emergency medicine elective for the residents at IU.  I look forward to this new adventure with the residents and seeing this experience through their eyes. With my clinical shifts, several lectures and BLS classes for the Kenyans, research, and resident education, this should be a crazy month at the hospital.

But, who likes to work all the time?  Not me, that's why I went into Emergency Medicine.  We have a few parties planned, a girls weekend get-away, and a weekend of camel racing this month.  Apparently there is also camel polo the weekend before the races that we might attend as well.  Who would have thought there could be so many activities surrounding camels?  I've been thinking we should look into having a pet camel here at Hilltop for such festivities.  Thoughts on a good camel name?  Spit? Humpty?

Anyhow, all this to say it should be a good month.  And Kenya is always full of surprises, adding to the adventure.  Good to be back.

God's Plans

Where have you been?  I have had several ask this question over the past week and want to apologize for not writing sooner.   It has been a long month that has taught me a number of lessons which I will share with you as a testimony to the faithfulness of God.

I am currently sitting in the ICU in Indianapolis.  It's not where I would have imagined I would be this month, but God had other plans.  My dad was recently diagnosed with non-small cell lung cancer (NSCLC).  I was in Kenya when I heard the news from both my family and his doctor.  Hearing their tears on the phone thousands of miles away made the distance unbearable.  I quickly found a plane ticket and came home, leaving much of my work in Kenya up in the air.  Thankfully, I have a wonderful network of friends, family, and colleagues in both Kenya and Indiana who have been incredibly supportive of my trip home and time dedicated to family.

Sadly, through the difficult days of watching my family struggle with this diagnosis, I found myself questioning God and his goodness.  My dad is an amazing man, one of the best:  soft-hearted and compassionate, humble and selfless in his giving, patient and loving, hardworking, supportive, funny... I could go on forever.  The one thing that saddened me about my dad was his resistance to God.  I couldn't bear the thought of losing my dad not only in this world, but also for eternity with separation from God.  Despite the Lord's faithfulness to me in the past and the promises He has given in His Word, I began to doubt His character when it seemed as though He was ignoring my prayers regarding one of the most important people in my life.

The Sunday that I arrived back in Indianapolis, my dad showed up at church unexpectedly.  He sat quietly through the service and walked up to the front afterwards to talk to the preacher.  That morning, he accepted Christ as His Savior.  Amazing...I couldn't believe it and continued to be skeptical until we had a few more conversations which gave me more confidence in his decision.  I realized how small my faith can be and how faithful the Lord is even after many years of prayer.  Sometimes He has to lay you low so that you have no where to look but up to Him.

We went to my dad's appointments the upcoming week for staging and planning for his cancer.  Through some connections with the IU-Kenya program, they had arranged for him to see the best specialists at the University Cancer Center regarding his type of cancer.  While everyone was wonderful, people kept remarking that it was fortuitous that he had even been diagnosed this early.  He originally went in to his doctor's office for a sick visit with chills (no cough, no fever on exam).  His doctor ordered a chest x-ray and sent him home on antibiotics.  Given my dad's history of COPD/chronic bronchitis, the pulmonologist said he would have probably sent him home on antibiotics and never ordered that chest x-ray with instructions to return if worsening.  My dad would have felt better with the antibiotics, which he did, and never ended up with that chest x-ray for who knows how long...likely not until it had spread throughout his body.  However, he did get that chest x-ray and his cancer was diagnosed early (Stage 2) - curable.  It wasn't luck.  It wasn't a great doctor.  My dad responded, "The good Lord is watching out for me."  It really hit me when my dad said those words:  How wonderful our God is;  how incredible that He would even be mindful of us, even watching over us so closely in all the details in our lives.  His timing is perfect.  Not only will I get to spend eternity with my dad praising God, but now I may have even more time with him here on earth.

So, my plans are not always God's plans.  And while they may be different, it is clear that His are better (Rom 8:28, Jer 29:11).  It is embarrassing to look back at my fear and doubt in a situation where the Lord was clearly and faithfully working things out with love, grace, and mercy.   The Lord is always worthy of our praise and trust, even when we don't understand what he is doing.   Praise be to God forever and ever!

Donating Blood

There is no blood in the hospital.  This is especially concerning given the number of patients I see each day with incredibly low hemoglobin levels.  Patients wait until they're deathly ill before seeking care, making for a greater challenge with our limited resources.  This week, I admitted my record low hemoglobin of 1.8 (normal is 12-18) along with several others with levels of 2.  When I ordered fluids to help give them some intravascular volume, I received some doubting looks and questions of concern as the other staff were worried about diluting the patient's already low blood level.  No worries, I tried to explain, patients need the fluid to help their blood pressure and move those few red blood cells around the body.  Reluctantly, they gave the fluids, but the biggest battle was getting these patients some blood. 

I offered to donate my own blood for any one of these patients, but was not a match.  All I could do was encourage their family members to donate their blood to help their loved one or another sick patient in the hospital.  While on rounds, a friend of mine offered to donate blood for one of the pediatric heme-onc patients but had the same problem.  Interestingly, immediately afterwards, she had two Kenyan medical student "volunteers" being pushed by the registrars (residents) to donate their blood for the patient.  Aww, the joys of being a medical student, always forced to do whatever is needed for the team and/or patients.  Even at the IU House, there are signs advertising for a blood drive here in Eldoret.  Hopefully, we will be able to get a group to donate some blood, provide a supply for the hospital, and make a difference for the patients.

Much Needed Vaccines

Last week was a reminder of the importance of vaccinations.  Maybe it's because people think I have pertussis with a terrible relentless cough over the past two weeks...but no, I thankfully have been diligent about getting my pertussis booster.  The TB cough monitors around the hospital have been keeping a close eye on me, so apparently that's going to be next on the work-up.  Anyhow, this week brought me several patients with measles in sick child clinic.  Insistent that the mzungu see his child, one father carried his limp, ill son over to me for care.  With a fever, injected eyes, runny nose, spots in his mouth, and a rash spreading from the head down to his chest, I was reminded of the 4 C's of measles (cough, coryza, conjunctivitis, and Koplik spots - I know the last one doesn't start with a C, annoying huh?).  He was weak and having difficulty breathing as he had developed pneumonia from the illness.  Having  never seen measles in the US, I was struck by how sick these children can get.  It is estimated that measles kills about 175,000 children each year, including 18,000 each year in Kenya.  This is especially sad given the availability of an effective vaccine that prevents children from getting such deadly diseases.

Within the same day, I received an e-mail alert about managing a measles outbreak in Indiana.  Vaccinate your children Indiana!  No child deserves to suffer or die from such preventable illnesses.  And let's not even get into the myth about MMR causing autism.  There is a lot of good scientific evidence debunking this myth as well as evidence of fraud regarding the original perpetuator of this myth, Andrew Wakefield.  If depite the evidence, some are still convinced we are harming children with this vaccine, I invite you to come here and see just what suffering can result from the lack of vaccines.

Termites

The rainy season has arrived in full force this week...cold temperatures, rain every evening, and muddy paths every morning.  With the heavy rains, there has been a plague of termites, swarming around the house and through my room in the evenings.  Little did I know I should be eating these insects instead of killing them.  These flying termites are a delicacy enjoyed by some communities in the Western region of Kenya, especially the Luhya tribe.  Eli, our guard, is of the Luhya tribe and enjoyed teaching me about the art of termite eating.  Kenyans will either eat the termites "fresh", meaning live, or fried.  While I might be willing
to try these insects fried or covered in chocolate, I only had the offer of live termites.  Eli picked one up from the ground, plucked off the wings and placed the termite in his mouth.  The worst part was him showing me the termite moving around on his tongue before he finally decided to crunch the termite between his teeth, spraying termite guts everywhere.  Blech, I nearly lost my lunch!  Later that day, I went to Nakumatt for some groceries and found hoards of them flying around while several Kenyans were grabbing them from the air and having a mid-shopping snack, kind of like going to Costco.  =)  While I am usually very open to trying the local foods and traditions, I think I'll pass on this one.   

Signs of the Times

The signs you see around Africa are awesome and can't help but make you smile.  Whether it be the name of one of the hotels or shops, like the Fresh n Fleshy Butchery, or warning signs around town, they speak to the culture and state of this beautiful country. 

Mmmm...just where you want to stay, a delicious hotel.  Many of the establishments have names like this.  Other examples include the Gracious Salon or Blessed Hardware



Not sure this would be my choice for a "Grossary" store but the kids are cute



Not really sure what this means...I figure morning sex would be safer than evening sex when someone might go home with a random partner.  Any ideas?  It's not because they're worried about being late for work.

Signs are often individually done, so they all vary in appearance...love that this guy's wearing a hat

Even at the hospital, the signs are great:

Most Kenyans just squat  wherever to use the bathroom, so it can be confusing when there's actually a real toilet seat. 

And when you're done, please use the running water to wash your hands...no spitting please.

I love this sign trying to depict what illnesses for which you might need to seek care.  Nice graphics!

The collection continues to grow as Kenya continues to educate me on life and culture.  Hope these make you smile as much as I did!

What can you carry on your head?

Africans, especially the women, are notorious for carrying objects on their head.  They can keep a steady stride, turn around, start and stop with ease while balancing various objects on their head.  Studies have revealed that African women can carry loads up to 70% of their body weight.  Wow!  As hard-working caretakers of the home and family, women walk for miles carrying heavy objects on their head with their infant slung on their back.  Whether it be carrying large jugs of water on their head from a recent trip to the river or a large basket of food to take to the market, I wouldn't last a few seconds without madly waving my arms around for balance before spilling everything on the ground.  These women amaze me!

If this were me, my luggage would fall off backwards and take out my baby...oops.

A common site around town or in the market

One with a cooler on her head, another with a large bowl of wood

There was a line of women walking miles carrying large amounts of wood on their head

I feel like such a wimp when I have to call a taxi to take me home after a trip to the market, especially when I am passed by some of these strong African women carrying three times my load. 

Easter

Christ has risen from the dead; we are one with Him again!  It has been a beautiful day to celebrate Easter here in Kenya.  After church, we hosted a group of children from the Orphan and Vulnerable Children project at the IU House for an Easter extravaganza.  The children currently live in a shelter near the IU House, awaiting placement or hopefully repatriation with their families.  In the meantime, the OVC program works to provide shelters with support for school fees, school uniforms, nutritional counseling, food assistance, medical expenses, clothing, bedding, and more.  I can't think of a better way to spend an Easter celebration than with this group of beautiful children in need of such love and hope.

Some of the activities included arts and crafts, where they made bunny ears to wear and baskets to carry their Easter eggs.  The children had interesting creations for the bunny ears; one made a hat with four bunny ears...I'm guessing they've never seen a bunny.  It was adorable.  Afterwards, we had an egg hunt followed by several relay races with eggs and water balloons. 

A successful easter egg hunt



The egg relay became increasingly difficult, now carrying them on a spoon in their mouth



Loving some water balloon toss

oops....dropped one

laughing after the balloon broke in her face

The day ended perfectly with the children pelting the wazungu (white people) with the leftover balloons.  Fun times!  It was so wonderful to spend such a great day with them - laughing, playing, and carefree.   Happy Easter!

Around the Hospital in Togo

Here are some pictures from all around the hospital to give a better look at my time in Togo. 


Despite being stuck in the hospital hooked up to oxygen for weeks, she was always smiling - a great source of fun and laughter for me every day.  Love her!



No need to get too spoiled with a bed, all the kids and/or the parents preferred the floor, just like home.

Pediatric wards at night.

The acute care/triage area where patients were admitted and/or watched closely.

My wonderful nursing staff....the best nurses in Africa

One of my clinic patients wearing the traditional dress for Togolese men

Bob Cropsey and Emily doing a c-section on twins while I wait for the babies

Yay - 2 beautiul healthy babies

This mission hospital here in Togo is a great place to work.  I would highly recommend this hospital for anyone interested in either short-term or long-term missions.  I know I hope to be able to go back.

On Call

Much of my time in Togo this week was spent at the hospital being on call.  The first part of the week wasn't so bad with a managable patient load and straightforward cases, giving me a couple of good night's rest.  This quickly changed as the hospital filled with very sick patients:  severe strokes, seizing children with end stage renal disease, sick men and children with opportunistic infections from AIDS, massive heart attacks with heart failure, cerebral malaria, etc.  Night after night, I found myself standing with families around their loved one's bed, explaining their critical status.  While delivering bad news in a place with a different language and culture can be very challenging, the fear and sadness are still easy to see on their faces.

We had a number of deaths this week which is not unusual, but never easy.  Parents tearful in disbelief, expecting to bring their son for a clinic visit and simple blood transfusion, but instead watching their son die within 24 hours of arrival from renal failure.  Despite all of my efforts to medically manage his electrolyte abnormalities, he needed dialysis, something not available here.  We prayed together.  The father, devastated and helpless, had to walk outside while I sat with the crying mom until their son took his last breath.  Whether hugging a sister, standing with a husband, or holding the hand of a daughter as we prayed for their dying loved one, these difficult moments are forever in my mind.

I wasn’t sure I could handle another night like these.  Despite my wishes for rest, the patients kept coming.  Two nights before leaving, a 3 year old with congenital heart disease presented to the hospital.  She looked terrible – sweaty, vomiting, and too weak to move.  Her heart rate was 255 – yikes!  No EKG machine, no pediatric blood pressure cuff, and not many options for medicines.  We gave her some fluids and tried a few maneuvers to bring her heart rate down without success.  I then broke up an adult tablet for slowing heart rates (a beta-blocker) and gave it to her to take.  After a couple doses, her heart rate was down to 190 – better, not great, but better.  An hour later, the nurse called me to come quickly as she was unresponsive.  She had cool extremities with no palpable distal pulses.  With a sustained fast heart rate, her heart was failing.  After loading her with some digoxin, I knew it was time for another much dreaded conversation.  We prayed with the family; she was in God’s hands now.  The next morning, she was still the same.  We continued the medicine, praying for some response.  Thankfully, her heart rate slowly came down to normal and she became more alert.   That last night when leaving the hospital at 4 am from a c-section, I walked past her bed.  She sat up, smiled and waved goodbye to me.  My heart melted, my eyes teared up…just what I needed as I walked out of the hospital for the last time before leaving for the airport at 6 am.  Praise God!   

Me with the congenital heart girl and her father, happy she's looking good  

God doesn’t need me to heal people, but I’m thankful that he chooses to use me.  He is bigger than our limited medical care and in control of each situation.    Even though it’s not easy or comfortable, it is during these times of weakness that His strength and grace are more evident. 

"'My grace is sufficient for you, for my strength is made perfect in weakness.' Therefore most gladly I will rather boast in my weaknesses, that the power of Christ may rest upon me.  That is why, for Christ's sake, I delight in weaknesses, in insults, in hardships, in persecutions, in difficulties.  For when I am weak, then I am strong."  2 Corinthians 12:9-10

Giving Everything

"Take up your cross and follow me" is the call for complete surrender.  The work in Togo is a tangible example of just that.  The work is seemingly never-ending, but incredibly rewarding.  I am thankful to be a part of this ministry for the next week.

I arrived to the hospital with a warm welcome and was quickly put to work.  The full-time missionaries here were leaving within a day for a conference in Gambia, leaving the hospital to a group of short-termers, some who had never practiced medicine outside of the US.  The short-termers included myself, 2 surgeons (one of which is Bob Cropsey who started the hospital here but retired a few years ago), 1 orthopedic surgeon from College Park Church in Indy, a peds resident, and 3 medical students.  I was put in charge of all the medical patients:  medicine, pediatrics, and OB/GYN.  I certainly don't mind the responsibility; it's just a little crazy being on call every day.  Thankfully, I have some wonderful medical students that help share the work load.  One of them will be one of our EM residents next year at IU so it will be fun to be his staff at home as well.

Each day usually begins with early morning rounds (~7:30 or 8).  A couple days of week begin with devotions and prayer which I have the privilege of leading this week; it is a refreshing start to the day.  Rounds tend to be a little chaotic as emergent cases frequently interrupt the process.  My first day presented with a trauma patient who had multiple rib fractures, pneumothorax and pulmonary contusions; 2 men who were electrocuted trying to tap into a power line, a child seizing from cerebral malaria, and a seizing pregnant woman with eclampsia.  We also have a child with Beckwith Wiedemann syndrome (not sure why I seem to always see this overseas?).  An awesome variety of pathology for the first morning. 


This sweet granddaughter of a patient would cling to me on rounds, always shaking her head yes to whatever I said.  Great confirmation for me.   



Our girl with Beckwith Weidemann Syndrome

After rounding and stabilizing the new patients, I spend the remainder of the morning and afternoon in clinic.  By this time, there is usually a long line of patients on the benches outside.  After finishing clinic, I usually grab dinner before going back to the hospital for evening rounds.  In the evening, I see the new patients, re-assess the old ones, review labs from the day, and field any questions.  This usually saves me some calls during the night, allowing for a little more sleep.  My day at the hospital typically ends sometime between 9 - 11 pm, leaving me pretty exhausted and praying for a quiet night on call.

Seto (my interpreter) and me in clinic 

Despite the long days, I love working at the hospital here.  The physicians, nursing, and other staff are all committed to excellent patient care, spiritually and physically.  The Togolese nurses are especially amazing in light of my experience in other African countries.  Since being here, I haven't had to start one IV, draw one lab, give one medication, etc.  They anticipate problems, follow through with orders, and work as a team.  Everyone here is giving everything and making a difference despite the limited resources.

**Sorry these are a little late as I didn't have great internet access, so will be catching up with my Togo experience over the next couple of days. I have been sharing my experiences tonight with friends here in Kenya...we are ready to start another branch of AMPATH...Sonak has named it AMPATH To-go.