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.

Togo Here I Come

Quick facts about Togo:

Population:  5.6 million people (44% of which are children less than 14 yrs old)

Capital:  Lome

Official language: French

Religion:  51% Indigenous beliefs, 29% Christian, 20% Muslim

If you're like me, you had to get out a map to figure out where Togo is.  That's exactly what I did when I heard of the opportunity there.  One of my church's global outreach partnerships is with the ministry in Togo, West Africa.  Due to my length of stay in Kenya, I am required to leave East Africa at least once in order to get a new visa.  I had been trying to figure out where to go for a short trip when our pastor announced the need for physicians in Togo during one Sunday morning service prior to my departure.  One of the other missions organizations that supports the ministry there is WMM (World Medical Mission, the medical division of Samaritan's Purse), which is the organization I went to Zambia with in 2008.  I was very excited to have the opportunity to serve again with WMM and even moreso with my church.

I will be working at Togo Hopital Baptiste Biblique (HBB), also known as Karolyn Kempton Memorial Christian Hospital (KKMCH), which is a 40-bed hospital that opened in 1985.  KKMCH is in southwest Togo, just north of Kpalimé.  It is a major medical, surgical, and acute-care facility that serves approximately half a million people. The bulk of the patients are Togolese, but some come from neighboring Ghana, Burkina Faso, and Benin.  There are currently three physicians working there full-time.  The pediatrician recently became ill and is now home in the US for the next year, leaving them short-staffed and in need.  I am looking forward to helping out over the next two weeks.  The current missionaries are hoping that I will consider coming there for the next year once I finish my stay here in Kenya.  Just in case, they are getting me a one-year visa.  While my committments with IU may prevent me from staying there over the next year, I am open to helping out as much as possible and we'll see what God has for the future.

So after teaching Basic Life Support all day on Wednesday, I will catch a plane to Nairobi.  I get to hang out in the Nairobi airport until 3 am (anyone who's been there knows how exciting that will be...or not) and then will travel to Ethiopia and finally to Togo.  Pray that I will quickly be able to adjust and be effective in my role there.  I will do my best to keep you posted on the Togo adventure.
   
"As each has received a gift, use it to serve one another, as good stewards of God's varied grace." 1 Peter 4:10

Mungu U Mwema (God Is So Good)

The last several Sundays have been very encouraging to me.  Here in Kenya, I attend Sirikwa Church which provides good doctrinal teaching and a mix of worship in both English and Swahili.  Unless I bring a visitor with me, I am usually the only white person there.  Sunday mornings, I wake up early to begin the 30 minute walk to church.  It's a good time to spend with the Lord, preparing my heart for worship.  I find myself wishing for other believers within the IU compound for fellowship, encouragement, and accountability.  Over the past couple Sundays, it has been nice to have some visitors from home to attend church with me.  Last week, a resident surgeon from Indiana, Aaron Abarbanell, came with me.  He took some video of the singing (sadly the Swahili worship clip didn't turn out well); you can view them by clicking on his name and looking at his blog.  His wife is a staff peds cardiologist and he hopes to be a pediatric cardiothoracic surgeon - crazy.  Anyhow, they are seeking the Lord's guidance for eventual placement on the mission field.  He has also been to the hospital where I am going in Togo and was a great encouragement for my upcoming trip.  It was wonderful to talk with him about the spiritual challenges of working and living here compared to other places overseas, a great encouragement to me.  Thank you Lord!

May I develop at least a few good friendships with other Christians here, especially some of the Kenyans in my church.  In the meantime, it is wonderful to be able to worship here.  Today while singing "Najua Mkombozi wangu anaishi" (I know my Savior lives), I couldn't help but be overjoyed by the image of every tribe, tongue, and nation worshiping together one day...all because of our great God and His sacrifice.  Thankful for Easter season, a time to celebrate!

The Mosquito

"If you think you are too small to make a difference, try sleeping in a closed room with a mosquito."

There have been countless nights that this African proverb has resonated with me.  Last night was one of them.  These guys are relentless.  I'm not sure how they get in my mosquito net, but somehow it happens.  The war begins.  It starts with the buzzing in the ear, the most annoying sound to me.  It quickly wakes me from my sleep as I swat around usually hitting myself in the head.  Annoyed, but in my sleepy state, I just want it to go away without any effort.  This usually leads to the next step, trying to sleep with my head under the covers.  As someone who can't sleep with my feet tucked in, I don't know why I always try this.  Not even minutes later, I am hot and suffocating.  I then create a small opening in the sheets around my nose to provide fresh air, hoping the mosquito will not find me.  It always fails.  Last night while battling the mosquito, I got to this point and fell asleep.  When I awoke, my upper lip felt huge; for a moment I thought I was having an allergic reaction to something.  Nope, I quickly realized as I began itching my lip that the mosquito got me.  That was it.  I turned on the light and went after him.  I found him on the net but before I could smash him, he disappeared.  I sat on my bed looking around for him without any success.  I thought about sleeping outside the mosquito net and taking my chances with the rest of the room.  Oh well, I'll get him in a minute, I thought, as I fell back asleep with the lights on.  I woke up later scratching my neck; he got me again.  Exasperated, I jumped out of bed and went after him, desparately wanting sleep.  This time, he didn't get away.  The blood stain on my mosquito net gives fair warning to any others that might want to try me.  Finally, peace for the remainder of the night's rest.

Answering the Call

Working Casualty

Pushing me beyond compare

Daily frustration

I wrote this in a response to a friend's haiku concerning her enjoyment of a mango today.  Yum, my favorite too.  But there was no time to break for one during a busy day in the emergency department.  She responded well to this and brought me the perfect antidote after a long day. 

Mangoes are plenty here, but chocolate...yay!  Let the weekend begin!