Wednesday, October 29, 2008

A Day of Goodbyes

So, the previous blog was actually from Tuesday. Now it is Wednesday, and I have worked my last day at the hospital. It was a bittersweet day as I said goodbye to everyone.
During my morning rounds, Katherine, the head nurse of maternity told me that during chai (tea) today, a hallowed daily tradition, we would all gather so that I could say something to everyone. I figured that meant me and the maternity nurses. Oh no, when I got there, most of the hospital was there. It was such a humbling experience! Someone from each department got up and said something to me. I was given a necklace, a beaded adornment to be worn on the forehead, and an African outfit. They prayed for me. Also, Jean, one of the medical students, brought Emily, my little buddy from peds ward, who finally got to go home today after being in the hospital for 2 ½ months. I was truly humbled by what they said and praise the Lord that He was able to work through me during this short time. They all said that they knew I would be back and also were praying for a husband for me J At the end, all of the women gathered around me and danced and sang a song. I have a video of it – it was great. A true African experience.
I went from that uplifting experience to a tragic one as I scanned a young 18 year old soon-to-be mother and had to give her the heartbreaking news that her baby had a fatal anomaly – ancephaly (no brain development) as well as omphalocoele (a condition where abdominal contents are outside of the body). Her baby’s liver was even outside the body. While I was excited for myself that I actually saw all of these things, my heart broke for her as we cried together over the loss of something she was so eagerly awaiting. We prayed together for peace and for hope and pray that she will know these both in the days ahead.
Ok, so this actually will be my last post. I am all packed and am hanging out with the med students tonight. I will be off at 5:30 tomorrow morning and home around 4 pm Indianapolis time on Friday. Thank you all again for all the prayers and encouragement you have given. I love you all and have lots to share when I return.

An Amazing Couple of Days

What a great couple of days it has been. The rain has gone away and the skies have been beautiful blue with hardly a cloud. I cannot begin to describe how beautiful it is here. I know I've said that before, but it continues to strike me day after day. There's a view on the way from the hospital to my house that is just breathtaking when the weather is nice like this. I think I have about 10 pictures of it, because every time I pass it, I think "This is so beautiful, I have to take a picture."
This afternoon, I sat outside on the grass just outside the maternity ward and played with some of the kids from the peds ward, including little Emily, who I'm now calling my little African Violet, because her personality and mannerisms are so much like Violet's. It was wonderful and I also got to talk to some of the mothers.
Yesterday I had a milestone. I delivered my biggest baby yet. A lady came in to the hospital in labor with her third baby. The nurses called me and asked me to scan her, because she was so big they thought she must have twins. No, it was one baby and I knew it would be huge - I estimated 5 kgs (approx 11 lbs). I contemplated letting her try and have a vaginal delivery, because she had delivered a 3.8kg baby before, but then I saw that she had been circumcised, which greatly narrows the room for the baby to come out. When I saw that, I thought "No way!" So, we talked her into a C-section and boy am I glad we did! He came out a whopping 5.04kg and it was a struggle to get him out even with a C-section. I took a picture with him to mark the occasion :) All the nurses and students were stopping by to see him - he looks like he's about 3 months old and about 13-14 lbs.
Today was also eventful. It started out with me giving a lecture to the nurses about postpartum hemorrhage, which went well and I think was much appreciated. After that we practiced our songs for tomorrow - the maternity ward is leading the chapel service at the hospital tomorrow. During our practicing, one of the medical students called and told me that a patient had come in overnight that had delivered a dead baby at home and was bleeding. I was told that she had had a D&C when she came in and now was in a lot of pain and could I come see her when I got a chance. I asked her if she was stable and she said yes, to just come see her when I was done with rounds. So, when I moseyed over, I looked at the patient and saw that her abdomen was distended and tense - for all you docs out there, she had a surgical abdomen. When I looked through her chart, I found that she had been nearly in shock when she came in, but improved with blood and fluids. She had not had a D&C and had a previous C-section followed by now 7 normal deliveries. So, I was very worried for a uterine rupture, which can be life-threatening. I grabbed the ultrasound and did a quick scan of her abdomen - when I saw fluid (likely blood), I knew we had to head to theater (OR). Unfortunately, they were in the middle of removing a thyroid and there is only one anesthesia machine. So, we waited for an hour - what an hour that was! When our turn came, I did in fact find a uterine rupture (my first) - a very impressive one actually. She also had infection in her abdomen. We did a hysterectomy and the patient is already improved. Praise the Lord for His mercy and wisdom! Sorry for all the medical talk, it's just that this is my way of keeping track of everything that happens, and I know there are some people reading this who are actually interested in it.
As many of you know, I celebrated my 30th birthday here this past weekend. It was nice. I rounded in the morning, went to a Swahili church service (approx 2 1/2 hrs long) which was awesome and I hung out with the medical students that are here. We were invited to the hospital administrator's house for dinner, so I got to eat some Kenyan food, which was wonderful. Here's another interesting thing about Kenya - they are very interested in our elections and they are all Obama supporters! This is because his grandmother lives here and they all think that if he is elected, it will be good for Africa. Whether or not this is true, they are all very much in support of him and watching our politics like they were their own. It was the topic of conversation at dinner that night. All of them are asking if I will be home in time to vote :)
As my time here draws to a close (tomorrow will be my last day at the hospital), I feel sad that I will be leaving. I'm not sad to be at home, as I have a new little "niece" or "nephew" to deliver. But, I am going to miss it here. I could definitely see myself being here for the 2 years after I finish residency and would ask for your prayers as I pray about whether or not to come here. It is a wonderful place and they are doing a great job. There is, however, definitely a gap in women's health care. All of the nurses keep telling me that I must come back. I am excited about what the future holds.
Thank you all for all your prayer support and encouraging words. This will likely be my last blog from here. So, asanti (thank you) and Mungu akubariki (God bless)!

Saturday, October 25, 2008

The Lord is Merciful

The Lord was merciful today (Friday). Let me start by explaining my state of mind when I arrived at the hospital this morning. Yesterday proved to me that the previous rains were a drop in the bucket. It POURED yesterday. All of the mud road from the hospital was like a mudslide with water rushing. One of Dr. Larson's daughters, Juliana, had come by the hospital earlier in the afternoon to bring her dad an umbrella. It started pouring when she got here, so I gave her my rain poncho to go home in, figuring that with as hard as it was raining, surely it would be stopped by the time I went home. Boy was I wrong! It actually got harder right at the time I needed to go home. So, I was sopping wet by the time I got home. I had felt a cold starting yesterday during the day, and it hit full force last night. I didn't sleep much because of the cold and awoke with a horrible sore throat. So, I was pretty tired when I headed into the hospital today.
When I arrived, I was told that a woman had just gotten there and was complaining of bleeding since last night. She told us that her and her husband had walked, uphill, all night to get to the hospital, because there is no transportation available at night. She was bleeding fairly heavily and had had 3 prior C-sections. I did an ultrasound and noted that she had a placenta previa (where the placenta is sitting over the cervix). I also noticed that the baby was dead. She and her husband were crushed and said that they had gotten here as soon as they could. I reassured them that this was not their fault. For all the OB/GYN types out there, you're probably starting to have the same thought I did - previa, 3 prior sections, pretty good chance of a placenta accreta at least (where the placenta invades the uterus). So, I quickly called the theater (OR) and told them we had an emergency and found the visiting general surgeon to let him know that I needed his help. To make things more exciting, her hemoglobin was 8 (normal is at least 12). So, long story short, we got her to the OR and I was prepared to do a cesarean hysterectomy. She did, in fact, have a placenta increta. The baby looked like it had been dead for about a week. Her blood pressure at one point was 40/20 and the OR staff was doing a great job trying to keep up with our blood loss. An amazing thing happened - the visiting surgeon I was working with noted that his blood type was the same as hers. Because warm blood is a better resuscitator than cold, he hooked himself up to a blood collection bag and gave a pint of blood that was then promptly given to the patient. Her BP responded immediately. Praise the Lord! We ended up resecting part of her uterus and closing it. She is now doing well (don't worry, we tied her tubes too, so she won't get pregnant again :)) I do fell bad for her though, as she is in a ward with mothers with their new healthy babies and she has empty arms. I pray that she will find peace in the midst of all of this.
Friday night I was on call. So far, call here has been a breeze - I haven't had to go in once. That all changed Friday night. It had rained all day again and was still raining when I got the call that we would need to do a C-section. They said they would call me back when the OR was ready. I got a call a little while later and was expecting them to say they were ready. What they actually said was that another lady had just arrived completely dilated, double footling breech with the feet hanging through her cervix. It was her first baby and a fairly big baby. So, I tried to rush into the hospital. I say tried because it was still raining, I had a small flashlight, and I was slipping and sliding the whole way into the hospital along the muddy path. It was comical, actually. So, I got there and we did both C-sections. The Kenyan medical students that are here came in and helped me and we all had a great time. Both mothers and babies are doing well, PTL!
So, this morning (Saturday), I slept in a little. I am still battling this cold and praying that it goes away before I get on the plane. We were going to walk about an hour to go to an orphanage that is nearby today. However, since it looks like it will rain yet again, the path is muddy, and I am still not feeling well, I thought it best to postpone that. I likely won't get to go before I leave, which is sad, but if I come back here (which is, I think, a very strong possibility), I definitely want to get involved there as I still have a passion for ministering to orphans. I also found out the the wife of the surgeon that is normally here is very involved there.
So, can you tell I'm having a blast? It actually is great and people keep telling me that this many days in a row of this much rain is very unusual. I can't wait to share more with you all!

Wednesday, October 22, 2008

Rain, Rain, Go Away

Yesterday, I experienced the full force of rainy season in Kenya. It rained most of the day, turning my path from the hospital to my house into a mudslide. Needless to say, the rain boots that I contemplated buying before I came here would have definitely come in handy. I am told that yesterday was an odd day as usually it rains at night only. It then got pretty cold last night – all the Kenyans were bundled up in 4-5 layers. A sweatshirt worked for me :) Today it is very sunny and warm, so that's an improvement!
Things continue to go really well here. I have established good relationships with the nurses here. They are a great bunch of ladies and dedicated to their patients. Also, I have gotten to know the OR staff well and they are wonderful. They are always ready with helpful suggestions during surgery. It has also been a joy working with the Kenyan medical students. Yesterday, one of them scrubbed a tubal ligation with me and I let her do a lot of it. She was SO excited afterwards. Apparently, during their training here, they only get to observe and rarely get to do anything. So, it was great to let her experience what actually doing surgery is like. She is thinking about doing OB/GYN, so anything I can do to encourage her is worth it.
An update on a lady I told you about. Betty, the patient that became very sick after her C-section and was transferred, is doing well. We have heard from her family that she has been discharged from the ICU. Still haven’t heard what the final diagnosis was, but I praise God that He protected her and that she will be able to be there for her new baby.
A couple of days ago, the Lord blessed me through a conversation with Tekla, one of the head nurses at the Maternal Child Health Clinic here. She spoke to me openly about how she ran from her family to avoid being circumcised and about how difficult that was. She also talked to me about her heart for young girls who are still, in some parts of Kenya, being forced to undergo female genital mutilation against their will. They are doing it in younger girls now (8-9 years old) because they fight back less. Even though it is banned by the Kenyan government, it is still being practiced in some tribes, including the Marakwet tribe in this area. She is passionate about reaching out to these girls and hopes to one day have a place where they can come and be protected. She is also passionate about health education and it was great to hear her ideas for how to reach out to the many women in the villages that never make it to the hospital. I really appreciated her willingness to share. It gave me a lot of insight into what women here go through.
Please continue to pray for wisdom and guidance as I search out where I should go after graduating. I am having dinner with the Larsons tonight to talk with them about possibly being here. I appreciate the prayers of all of you who have been faithfully praying for me. God Bless you all!

Monday, October 20, 2008

The Joys of Obstetrics

So, here is why I love the practice of OB/GYN. I arrived at the hospital this morning to find out that we had no scheduled C-sections, no one in labor and I only had one postpartum patient to see (the nurses see all of the routine postpartum patients). I thought "I hope this won't be a boring day." No sooner had I told Lydia, one of the nurses, that we needed some business did she get a call saying there was an emergency. A woman was carried in on a blanket by two of her family members (they had likely walked a long way like that) obviously in labor. She was moaning and thrashing. We got her into the labor room and we asked her what pregnancy this was. Initially she said her first (at least that's what I had translated to me). I went to check her and noted that she was circumcised (unfortunately a very common practice here). She was completely dilated and screaming in pain. When I went to feel her abdomen, I noted that she had a scar. I asked what it was from and they said "Oh, she's had a C-section." So, obviously not her first baby :) With the amount of pain she was in and the shape of her abdomen, we were worried that she had a uterine rupture (also very common here), as she had been laboring for several hours at home before coming in. The baby's heart rate was in the 100's (on spot check - no continuous monitoring), so we went for an urgent C/S. She didn't have a uterine rupture, thankfully, and mother and baby are doing well. What a way to start the day!

The weekend was good. I was on call all weekend, but didn't have to come in much. I was able to see the big town center, which consists of one street. We went to the market and Dr. Larson's wife saved me from paying too much for avocadoes (they tried to charge me about 12 cents apiece instead of the normal 6). I was able to spend some more time with the Larsons, including having a game night on Saturday night which was really fun. They are a remarkable family and have been a huge encouragement to me. Their commitment and trust in the Lord are amazing. Did I mention that they are a family of 7 living in a 2 bedroom house? They will be moving into a larger house soon, which they are very happy about.

Last night, we all (me, the Larsons, the Lee's (another missionary family), and the medical students) gathered at the Larsons for weekly fellowship. We sang and I gave the talk (which I found out about the night before). It was a time of great encouragement as I sat with these people who have already been through what I am going through and understand the call to missions. It was also a tough night as the Lee's (Dr. Lee is currently the medical director here) are moving on Tuesday to southern Kenya. He has been diagnosed with mountain sickness (chronic altitude sickness) and they have to move to a lower elevation for his health. They have been here 5 years, and so the goodbye's are tough.

I have also made new friends. Today, I played for a little while with Emily and Brian, 2 longer-term residents of the peds ward here. They are both adorable and I taught them how to do High 5. I have pictures of them, so I can't wait to share them. Emily is 3 and I couldn't help think of little Violet and how much she would enjoy playing with the kids here.

Ok, that's all for now. Oh, another great thing about this place - we all pray together with the patient before we start any surgery. I love that!
God Bless you all. Thank you for all your prayers.

Saturday, October 18, 2008

Items of Interest

Well, I have a little bit more time to write now, so I thought I would write about little things that I find interesting here. Before I start, the connection is way too slow to try and upload pictures right now, so I'll just have to show them to you all when I get home.

I just returned from "chai" or tea. Every day at 10:30, everything stops for tea time. It's actually a wonderful time to talk to the hospital staff and it has given me an opportunity to bond with the nurses here. As those of you who know me know, I usually hate tea. Here, however, it is very good. It is made with steamed milk and water and they add some sort of spice that gives it a wonderful flavor. Also, every day with tea we eat manazi, which is basically like a beignet without the powdered sugar. It is quickly becoming my favorite thing here.

I normally consider myself a pretty kid-friendly person in that kids usually like me. Not so much here, though, with the little ones, at least. They just kind of stare at me and I have made several cry. I'm told this is quite normal, though, as many of them have never seen a white person. Dr. Larson tells me that he regularly makes kids scream when he walks through the village.

Women here are tough! You walk through the maternity ward and don't hear a sound. Also, when they leave the hospital to go home, many walk up to an hour or more to go home, carrying their infants and their bags up steep hills along bumpy roads. I think I may now find it hard to feel sorry for many of my patients in the States :)

There are a group of kids that are often playing in the open area in the middle of the "station" (where all the mission houses are). They like to point at me when I walk by and then they say something to each other and giggle. Yesterday as I was walking by, they yelled "Muzungu!", which I knew meant foreigner from a book I had been reading. I then said "Abari" (how are you?) and they replied "Mzuri" (good) and smiled. I think it was a breakthrough!

Everyone here continues to be wonderful. They always stop to say hello and shake your hand (they shake hands like Americans hug). Last night, I had a movie night with the 2 female medical students here from Nairobi. It was a lot of fun. I was also thankful that the usual nightly rain didn't happen while I was walking back to my house.

Well, not much more to write right now. I'm on call today, but right now it's pretty quiet (knock on wood). Later today, Alysia Larson (Dr. Larson's wife) is going to go with me to the town center to experience some culture and pick up a few things.

Hope all is well at home. I'd love to hear from everyone! God Bless.

Friday, October 17, 2008

The Hospital

Hello to all. I hope you are all doing well.
I have had an interesting last couple of days. Since my last post, the VBAC that was laboring developed fetal distress and we took her back for a C-section. Even though I knew it was what she needed, I hesitated because it was my first time making the decision myself. Then, the path to get a patient to the theater (OR) from the maternity ward is very interesting. The patient is placed on a "trolley" and wheeled along a bumpy path up two hills to get to the theater! I want to video it so that all of you can appreciate what I'm talking about. Everything went well and mom and baby are doing fine. I then got to do my first vaginal delivery, which also went well. I have to say - the women here are tough! I went into the labor room with 3 women laboring, all completely dilated and they were completely silent. Their pain tolerance is amazing. Wednesday evening I was invited for pizza at the Larson's. It was wonderful. We were also joined by 2 medical students from Nairobi who are rotating here. Then, after dessert (brownies and homemade ice cream), their kids put on a little show for us. It was great! Their house is always full of action - their kids are 7, 5, 2, and 5 month old twins!
Yesterday was a tough day. It started off well. We had 2 scheduled repeat cesarean sections. They both went wonderfully. When we were almost finished with the 2nd one (Betty), the scrub wanted to close skin, so I scrubbed out. After completing the paperwork (yes, there is paperwork here, too), I stuck my head in the OR, and they said everything was fine. So, I headed home to get some lunch. Apparently the nurses didn't have the right number to get ahold of me and were trying to call me. I ran into one of the nurse anesthetists on my way back to the hospital and he told me that they were looking for me because Betty was not doing well. Apparently, after I left, he noticed that she was having difficulty breathing and complaining of chest pain and coughing up blood. Her oxygen saturations were in the 60's (should be 95-100). Despite being on 4 liters of oxygen, her sats were still very low and her heart rate was 140-160. So, I rushed back to the hospital and found her on the maternity ward. Dr. Larson was there as well. She was definitely in respiratory distress, but her lungs sounded fine. We were both worried that she might have a pulmonary embolus, but there is no way to diagnose that here. We switched her to facemask and bumped her oxygen up to 10 liters. Her O2 sat came up to 88%, but she was still working to breath and her heart rate was still fast. After some quick decision making, we agreed to transfer her to Eldoret, where they have an ICU. Remember, Eldoret is a 2 hour, very bumpy drive. Also, we had no guarantees that when she got there, they would have a place for her. So, we all gathered around her and prayed for her. Then, relatively quickly, the ambulance was here and we prepared to send her. A nurse and one of the anesthetists went with her. She sounded very bad when they were pulling off. I talked with the anesthetist this morning, and he told me that she is now stable. Her BP when she arrived there was 220/120, though and her HR was close to 200. Praise the Lord, though, they had one ICU bed open and she got it! Please continue to pray that Betty will make a full recovery. So far, we do not have a diagnosis.
Another patient that has touched me already is Dorcas. She is a very sweet 37 year old lady who came to the clinic complaining of abdominal pain and distention for about the last year. On exam, she was noted to have large pelvic masses and was sent to us for ultrasound. On ultrasound, you can see at least one 12cm mass and on abdominal exam, you can feel mass all throughout her pelvis. She also had a lot of ascites (fluid in the abdomen) on the ultrasound. All of this is very concerning for ovarian cancer. She said that she was unable to eat because everything just came right back up. She was admitted to the hospital and initially the doctor taking care of her drained only a small amount of the fluid to send for diagnosis (will take 2 weeks for the results). However, she continued to have significant pain. So, I suggested that they drain as much fluid off as possible for comfort. Yesterday, they drained 4 liters of fluid out of her belly. She feels much better today and is able to eat. This is only temporary, though. A surgeon is coming today and we are going to discuss the case with him. In the US, it would be a no-brainer - do surgery, then chemo. Here, however, it is a much more difficult decision to make. There is chemotherapy available in Kenya, however she would have to be able to pay for it. Also, it will be a very big surgery and she would have a fair chance of not making it through the surgery or the recovery. So, please pray for her and for us as we discuss this with her.
I am really enjoying my time here. I cannot describe in words how beautiful the area is and the people are just as beautiful in spirit. Everyone keeps asking why I'm only staying 2 weeks. It does feel like a short time. However, I am continuing to pray about coming back here for the 2 years. I could definitely see myself here. We'll see what the Lord has in store.
Until the next post, I hope you all are safe and well. God Bless!

Wednesday, October 15, 2008


Karibu! This is a word I have heard many, many times since arriving in Kenya 2 days ago. It means welcome and the people here are more welcoming than most other places I have been. After LONG plane rides, I arrived in Nairobi Monday night. I arrived at the guest house I was staying at around 9:30pm and promptly took a shower and crashed. Then, it was up at 5:30 Tuesday morning to get ready. I then flew from Nairobi to Eldoret (a 30 min flight), which is the closest big city to Kapsowar. I was met by a worker from the hospital who took me shopping for food and necessities in Eldoret and then we began a bumpy 2 hour drive to Kapsowar. The first half was on paved roads and the last half was on clay dirt roads. I was very thankful that the mud from the rains the night before had mostly dried out!
The drive may have been bumpy, but it was so beautiful! This area is amazing. Very green, up in the mountains. We drove through a forest at one point which seemed like something out of a movie it was so perfect.
So, I finally arrived at Kapsowar around noon on Tuesday. I was shown to my house (yes, I have a whole house to myself) and met the house helper Mary, who is amazing and always has a smile on her face. I then was invited to one of the missionary’s house for lunch. Paul Larson is an FP here who has been doing all of the obstetrics. His wife and children lovingly welcomed me, including placing a handmade welcome sign on my door.
It was then off to tour the hospital and find out what my duties would be. It is a small hike to the hospital, but again beautiful. I am impressed with the work they are doing here with an extremely limited supply of resources. I am now in charge of the maternity unit and from what I hear it has been busy (in fact, right now we have 2 laboring patients and one laboring VBAC). I’m also in charge of doing ultrasounds. I am on call every other night during the week and all weekend both weekends I’m here. I am fine with this, though, as it gives Dr. Larson a much needed break.
This morning I went to a chapel service for all of the hospital staff. It was amazing to hear them lift their voices in song – I just wish I could have understood the words :)
So, things are going well here. I’ll write more soon. Still trying to figure out the internet connection, but hopefully I’ll be able to post pictures soon.
Keep praying!

Tuesday, October 7, 2008

On My Way Soon

Wow - it has been a long time since I've posted. Well, I now leave for Kenya in 6 days. I'm so excited and thankful for this opportunity. As I said in my previous blog, I will be working at Kapsowar hospital as an OB/GYN (and whatever else is needed) for three weeks. This trip has 2 purposes. The first is to be a servant and minister to the Marakwet people as well as hopefully somewhat relieve the long-term physicians that are there. The second is to check out the hospital to see if this is where God would have me be for 2 years starting next summer. I have officially been accepted to World Medical Mission's post-residency program and Kapsowar is a possible place for me to go. Please pray for wisdom as I prayerfully consider this.
I will first be headed to Boone, NC on 10/9 for a medical missions conference at The Cove (Billy Graham's conference center). I'm very excited for this as I know it will be a time of encouragement and refreshing. It will also be a time to reconnect with Dr. Dee Kotschwar, a physician from home who the Lord has used at many times throughout my life as a mentor and encourager in this journey. I'm also excited because the general surgeon who is usually at Kapsowar is one of the keynote speakers, so I will get to meet him.
Then, on Sunday 10/12, I'll leave from Asheville, NC, head to Detroit, then to Amsterdam, then to Nairobi. I'll stay overnight in Nairobi and then take a propeller plane (yikes) to Eldoret. From there it will be a 2 hr drive and at long last I will be in Kapsowar. My duties while there, as I understand them, will be to help run the maternity ward as well as the outpatient prenatal clinics. I'm sure it will be a time of learning and stretching me outside of my comfort zone.
I thank all of you who have been praying for me. I'm really excited to see what God's plan is for me through all of this.
I will be keeping this updated, so please check in and send me comments. It's always good to hear from home! I will be home on Oct. 31st.

Some prayer requests:
- That I would have a humble spirit that is teachable
- Wisdom for how to care for patients in a culturally-appropriate way
- That I would listen to the Lord's leading for the future
- Safety in travel as well as health while there
- My best friend, Amanda, will be 35wks pregnant when I leave and 38 weeks when I return. We are planning on me doing the delivery and I would be devastated if I miss it. Please pray that the Lord would keep her and the baby safe.