Sunday, December 20, 2009
So, one day I talked with Wilson, the head of nursing, about my idea to turn the office on maternity into a good gyn exam room. He was excited about this and ran with it. The old, monstrous computer table was replaced with a new slimmer model. A shelving unit was built for the wall to store textbooks and supplies. A new exam table was built to replace the one I took with stirrups from the outpatient area. I was given soak buckets for speculums. I will soon have exam lights. While it may not seem like much, it is a huge improvement and so much better now for me to care for the women here. So, thank you to those of you who have, and continue to support me. Because of your generosity, women can now be examined in at least relative comfort!
It started early Saturday morning as I boarded a matatu at 5:45am in Kapsowar for the 2 hour ride to Eldoret. I was told I had to be there early, because we were supposed to be in Kitale (about an hour and a half from Eldoret) for the wedding at 10. I was met in Eldoret by Lynn, one of the maternity nurses who was in the bridal party, and we went to Claire’s (the bride’s) brother’s house. There I was greeted by many members of the family (including the adorable flower girls and mini groomsmen seen below) who I was told had all eagerly been awaiting my arrival. It was great to see Claire as well. I settled in while they all finished (or began, rather) their wedding preparations. In true Kenyan fashion, 10 o’clock came and went and no one was even dressed yet. About noon, all the children sat down to eat lunch and about 12:30, the bride and bridal party finally emerged in all their glory. We then all piled into several vehicles that were decorated in flowers for the trip to Kitale. I rode in the front seat of Claire’s car (why the bride wasn’t in the front, I have no idea), which was a very nice Land Rover. After about 1 ½ hours (which included a bathroom/snack stop!), we arrived at the church in Kitale, where needless to say, everyone was eagerly awaiting the bride’s arrival (for about the last 2 hours).
There was no fanfare for the bride’s entrance, as we were so late, and the bridal party hurried right to the front. The service was similar in many ways to a Western wedding – a short sermon, vows exchanged, a kiss. There were, however, many additions, including a gospel choir that sang several songs, including one where the bride and groom danced, as well as several other “mini sermons” by other people in the church. Another thing I was delighted to see were some Pokot (a tribe in Kenya) people in traditional dress – including feathers on their heads, animal skin clothes, and lots of beaded accessories. Claire’s husband is Pokot and so these were his relatives. The Pokot people are a very traditional tribe in Kenya and the Pokot district borders Marakwet (where I live). They are herders and dress if very bright clothing and lots of beads. They also did some traditional Pokot dances at the reception. It was a true cultural experience!
After the ceremony, I was whisked away with the bridal party to a local agricultural center for pictures. Then it was back to the reception, where I was sat with the bridal party to eat. We enjoyed a meal of roasted chicken, pilau (a rice dish), chipate (flatbread), a cabbage salad, and soda. It was wonderful! It was a great day and I was so thankful to get to be a part of it. I’ve put some pictures below.
Thursday, December 3, 2009
Last weekend I decided to get away and go visit some friends at
So, I hitched a ride with Dave into Eldoret (2 hours). Once there, I found a matatu (a 14 passenger van and main method of public transport here in
The people I was visiting were the Cropsey family and Alyssa Pfister, fellow post-resident physicians with World Medical Mission. Our paths have crossed as we all prepared to come to
I was amazed as I saw this large hospital that not only serves as a witness to the many patients they see but also as a training ground for Kenyan physicians – training them to serve God through medicine. I also was extremely blessed by the church service there on Sunday as it was more like home with familiar songs. It was a wonderful weekend and I look forward to going back again soon (2 more post-resident families arrive there in December).
Wednesday, December 2, 2009
One of the great things about Kapsowar is that we always have people coming and going from station. We almost always have medical students rotating here, from all over the world. From Oct – Nov, Kim and Eleasa were here. We were told they were Australian medical students – so I was very surprised when I first talked to them and they didn’t have a hint of an Aussie accent. Turns out, Kim is actually from
Another sad goodbye was saying goodbye to Ben and Cathy Sawer. They were here to fill in for Bill Rhodes, the long-time surgeon here who has been in the States (and returns in less than a week). They became like surrogate parents for me here and I enjoyed many long discussions with them, as well as Cathy’s weekly Sunday night dinners (chicken, stuffing, homemade biscuits, veggies, even smoked salmon!). They are incredible people with an incredible story of hope to tell, as they recently lost their daughter to breast cancer. You can read about/hear her powerful story and testimony at www.deathisnotdying.com. They made a lasting impression on all of us here and we were so sad to say goodbye. We’re hoping they’ll be back sometime!
As we said goodbye to the outgoing students, we welcomed 4 more (well, 3 plus a husband J). More to come on them later.
Tuesday, December 1, 2009
As many of you know, construction is currently going on to build a new theatre (operating room) building at Kapsowar. This is much needed as we currently only have one theatre (see previous blog about this). Just to re-emphasize our need for more than one theatre, I recently again did a C-section in theatre at the same time as a general surgery case (actually more a plastics case) was going on. This one had a bit of a twist though. At the end of my trying week, a young girl came to the hospital in labor with her first child. She was very young (probably around 14) and along with that somewhat immature and not able to handle labor well. We got to the point of pushing, but she was a very uncooperative pusher, to say the least. I tried a vacuum, but when that failed, it was clear she needed a C-section. So, we headed up to theatre (meanwhile, she’s thrashing on the bed and trying to pull out her IV). When we get there, Drew was doing a repair of some crushed tendons under local, but his patient was on the main operating bed. No problem, we’ve done this before. Only problem – the patient is too uncooperative to do a spinal, so we need to put her under general anesthesia and Drew’s patient is on the bed we need for that. So, we have Drew’s patient get up (while holding his arm above his bed) and Drew stays sterile. We have my patient move from the gurney to the operating table and then have Drew’s patient get on the gurney to finish his surgery. I can’t imagine what that poor patient must have been thinking as my patient continued to be completely irrational. Drew got his headlight so he could have decent light for his surgery, and we proceeded with our C-section. It was comical, now that I look back on it, but once again emphasized our need for more than one theatre.
Below are some pictures of the progress on the new building. It is quite an undertaking, as you can imagine. One of the biggest hurdles is that no materials are available locally, so everything has to be trucked in from at least 2 hours away. One blessing, though, is that it is providing much-needed jobs for people. They work very hard, as you can see in the pictures, for 200 shillings/day – that’s about $2.60. Every morning they have devotions together before starting work, which is providing much needed spiritual nourishment for them as well. I look forward to continuing to share pictures of the progress with you. Please keep the project as well as Dave Peterson, the contractor, in your prayers.
Saturday, November 21, 2009
This is the beautiful rainbow that I saw just before I sat down to write my last blog. Once again, I’m amazed at the beautiful reminder the Lord gives us of His hope. Thank you all for the prayers and the comments after my last blog. The prayers have definitely been felt! Last weekend was restful and a time of refreshing. During Bible study last Sunday, a comment was made that went something like “Belief is stepping out of the door into the dark”. This really left an impression on me, especially in light of that tough week. God calls us to step into the dark sometimes – to go places we are totally unsure of, not confident of, so that His power can shine. It was an encouragement to me to trust Him even when I’m called into a situation or to do something that I’m not comfortable with or feel inadequate to do. I pray that this thought will encourage you as much as it did me. As a side note, the Lord blessed me with a fairly quiet week this week. I am currently at Tenwek hospital (a large mission hospital in
Sunday, November 15, 2009
So, this was a very full week. Every day seemed to bring many surprises and emergencies. There were emergency C-sections, retained 2nd twins after a traditional birth attendant allowed a woman to labor at home knowing she had twins, too many D&C's to count including a couple that were in shock. On top of all of that, Ben and Cathy Sawer, who I have written about before, left to return to Canada. They left a hole here on station and we were all very sad to see them go.
The most consuming patient of the week was a 19 year old girl - we'll call her V - who was transferred from a health centre where she had delivered her baby prematurely and then developed postpartum hemorrhage. When she arrived at Kapsowar, she was hypotensive and had a hemoglobin of 6 (should be at least 12). She was given blood and seemed to improve a bit. Then, her blood pressure became high (probably what it was before delivery) and she complained of a severe headache - she had severe pre-eclampsia (toxemia). Who knows how long she had had it. So, I started her on appropriate therapy and she seemed to improve. Then, on Thursday, I noticed that her abdomen was becoming distended. Her exam was consistent with ascites, which can come from the liver being affected by pre-eclampsia. On Friday, it was markedly distended and an ultrasound confirmed that she had massive ascites. We decided to drain some of the ascites to make her more comfortable. As I was coming to do that procedure, I noticed that she all of a sudden was not very responsive, responding only to pain but not able to communicate. This was a definite change from how she had looked just an hour before. We quickly did what we could, but decided she needed to be transferred to Eldoret - a 2 hour drive and the closest ICU. One problem - our only functional ambulance was currently in Eldoret. So, we had to wait for it to get back in order to transfer her. We prayed over her and reassured her scared husband that we were transferring her where she could get better care. As we saw her off, I had a bad feeling. Why had she suddenly worsened? Was there something else I could have done? Should we have transferred her sooner? Only God knows the answers. All night that night, I couldn't sleep. I just felt like something wasn't right. I said so many prayers for V - that she would recover, that her newborn child (her first) would do well, that her family would have strength through this difficult time, that they would come to know the Lord.
I found out the next morning when I went in for rounds that V had died at 3 am. My first maternal death. She was only 19. The unfairness of it all was overwhelming. Why couldn't I have done anything else? Why couldn't I do the labs I needed to do to determine why she had become nearly comatose? Why would a 19 year old be taken away from her newborn child? As I sat and cried, I was comforted by one of the labor nurses and one of the cleaning ladies. They reassured me that this happens here in Kenya and it would be okay. But it's not okay I told them. It's so unfair.
While I will continue to mourn V, I think that the Lord had a lesson to teach me through all of this. First, He is in control and He does have a plan. Second, I am not in control and no matter how much I think I know, ultimately, my patients' lives are in His hands. Third, I have to just trust God that what I am doing for the patients is the right thing and leave the rest to Him.
So, despite the fact that it was an exhausting, overwhelming, and challenging week, I think it will be one that I will look back on as a turning point, perhaps. I now know, more than ever, that He is in control. And I praise Him that after we have come through the flood, He provides a rainbow of hope to remind us that He is there - yesterday, today, and forever.
Friday, November 6, 2009
Last weekend, we took a walk to a nearby orphanage. It is a place I have wanted to go to and this is the first chance I’ve had to go. The walk there was, like most hikes here, breathtaking and challenging. But definitely worth it (see picture below).
This is a children’s home run by AIC (
At the children’s home, the children learn vital life skills. They are all involved in cooking, cleaning, managing a small farm as well as tending after sheep and cows. All of these things are skills that will serve them well in life here in
While the home is full of love, it is significantly lacking in physical comforts. The children sleep two to a bed in beds that most of us would complain about sleeping in by ourselves. The mattresses are thin and worn and sag in the middle. The blankets they have are thin and have holes. Up in the hills in
Several people here have been impressed by this place. Just being there, their joy surrounds you and is infectious. There are plans to build bunkbeds and buy new mattresses, as well as build new cabinets for clothes.
I was so touched by these children, as I am by most orphans. There’s just something special about them. I hope to take many more trips there.
The beautiful walk there
The next day, I traveled to Eldoret with the Sawer’s to pick up 2 new medical students from Australia (actually from Canada, but going to school in Australia). Ben and Cathy treated me to lunch at a Chinese restaurant to extend the birthday festivities. It was a wonderful birthday!
So, please pray for ES and her family. In the last year, her family has spent the majority of their savings to pay for hospital bills for her daughter, who is HIV+ and was very sick but is now doing well. She is unsure where she will get the money for radiation, but I assured her that the Lord will provide. So, please pray for peace as she deals with this news. Please also pray for healing and strength and that we would be able to help however possible so that she can get the treatment she needs. If any of you are interested in donating money for her specifically, you can mail a check to the address listed on the sidebar of the blog. Then please send me a message letting me know how much you sent and that you would like it to go to ES.
Thank you for your prayers! I will give updates as available.
Tuesday, October 20, 2009
The next day, I got up and met Angela, one of the Kenyan medical students that was in Kapsowar last year when I was here. She had arranged a hair appointment for me (I was in dire need). So, we went to a very nice mall and I got my hair cut. We spent the rest of the morning just hanging out and window shopping. It was a blessing and fun to catch up with her.
I then met up with Scott Reichenbach, the director of the Post-Residency Program, along with many other post-residents from all over Africa, including others from here in Kenya (including 2 OB/GYN’s), Zambia, Niger, and Gabon. It was wonderful spending the rest of the day with them – encouraging one another, sharing insights and frustrations, and just relaxing together. It was a huge encouragement to me and I even received 2 bags of chocolate chips (thanks Robin Jenkins!). We stayed at the hotel with them that night and began our long journey in reverse the next morning.
The trip home was much less eventful. Drew did count our max occupancy on the matatu on the way home, though, and we topped out at 26! I think the next time I go, I will stay for a little longer, but I am thankful I had this weekend there.
The morning was very slow and after going home for lunch, I ran into Thomas, our anesthetist. He asked me why I was going back to the hospital. “It’s a holiday” he said, “stay home – you only need to go in if they call you.” I seriously contemplated this. I had a lot I could do at home, and with the overcast skies, a nap was sounding pretty good. However, there were things I could do at the hospital and I just had a feeling that I should go in.
Englewood Christian Church, my church in Indianapolis, has decided to make Kapsowar their Christmas project this year. One of the ideas I had was to raise money to pay patient bills. This is a major issue here. Many of the people we serve are extremely poor and even though our prices are what you and I would consider very cheap, they are often a life savings for our patients. The hospital is in a major financial crunch, which has led to them having to lessen the number of patients’ bills that are forgiven. So, the patients are held here until their bills can be paid (they are often completely lost to follow-up once they leave). This means that some are here for up to 3 months after they’ve been officially discharged. As you can imagine, this is a huge strain for them, as many have left children at home and are not earning money for their families while they are in the hospital. So, I thought that this would be a great project.
Since there was nothing happening on Maternity, I decided to go talk to the patients we’ve chosen and find out their stories. My last stop was to the children’s ward. I had a name of a child who had been discharged for 3 weeks and was still here. The bill was only 10,000 shillings (about $140), which is much less than some other children on C-ward. I wondered, is this the right person? Maybe we should pick someone who owes more – surely they can come up with 10K shillings. But, I thought I should at least talk to them. When I saw the mother, I recognized her as someone who I talk and joke with every day. In fact, her 2 year old, Festus, is the little boy on another blog who is still somewhat scared of me. I told her my church would like to pray for her and so I would like to know more about her. Her one month old daughter had been admitted shortly after being born at home for sepsis (infection of the blood). She is now doing well. She told me that she has 7 children, ranging in age from 1 month to 16 years. She is married, but her husband has married another woman (unfortunately a common practice among the Marakwet tribe). He is often drunk and doesn’t take care of the family. In fact, he told her that since the baby is a girl, she should just sell her to the hospital so that she can come home and take care of the other children. They have a small shamba (garden/small farm) and only 2 goats – which makes them very poor by Kenyan standards. To support her family, she tries to find jobs working in other people’s shambas, but often is forced to make illegal liquor to sell for money to support her children. I asked her if she attended church, and she said she did when she could. I asked her if she had ever asked Christ into her heart or if she knew that he could be her Savior. She said she had never done this, because she had no peace. I told her the salvation story and why Jesus had died on the cross. I told her that He can provide a peace that passes understanding. We talked about sin and how each one of us has a need for a savior. I asked her if this was something she wanted and she said yes. So, there in a side room of the children’s ward, Perisi asked Christ into her heart. She was beaming. She then asked me if she could change churches, as no one in her current church had ever told her any of this. I told her we would help her find a good church near her home. I welcomed her into the family in God and was rewarded with a huge smile when I told her that we were now sisters in Christ. I told her that even though she will face many challenges when she returns home, she now can go to her Savior and cast her concerns on him. The chaplains will be visiting her tomorrow and before I left for home, I was able to give her a Kalenjin Bible (the local dialect). I praise the Lord for His providence and for prompting me to go into the hospital when I wanted to take a nap!
Tuesday, October 13, 2009
So, Dr. Ben and I opened her up. As expected, there was a lot of ascites (fluid). So, we suctioned all of that and I felt in her pelvis, expecting to find a large mass. Her uterus and both ovaries were completely normal! Interesting, we thought. So, we headed to the next most obvious source - her liver (although it had looked normal on ultrasound). It, in fact, was completely normal. As were her stomach, pancreas, and kidneys. Okay, we thought, let's run the bowel. There sat the culprit - we found a tumor of the small bowel, which is exceedingly rare (Dr. Ben has only seen 3 other cases in his 30+ years as a general surgeon). So, I yelled out to Drew "Drew, this is your case now". He scrubbed in and he and Dr. Ben resected about 20cm of her small bowel and put the healthy bowel back together.
So, she had complete surgical resection and we pray that she will do well. At any rate, she should have a much better prognosis than she would have had with ovarian cancer, and won't need any further treatment right now.
So, bwana asifui (praise the Lord!)! Thank you all for your prayers. Please continue to pray for her as she recovers.
Friday, October 9, 2009
So, one of my goals while I’m here is to see as much of
The walk down to the river (a different part than we had gone to before) was nice and leisurely. It was along a gravel road and wasn’t bad at all. Once we got down to the river, we met a large group of children (see picture below) and had fun joking with them. I even took off my shoes and socks, hiked up my pants, and went walking in the water (it was very shallow).
Then came the walk back. Mama Brian said that since we had to be back to station by 4 (for another commitment), we should take the shortcut. Great, I thought, a shortcut. Little did I know that the shortcut meant that instead of walking up a slight gradient, we would instead just hike right up the side of the hill (really a mountain if you ask me). So, with the help of my walking stick (courtesy of Mama Brian), we hiked up what we figured to be about 1000 feet at a 50-55 degree slope. I had to stop every few minutes. I used the excuse that I’m still acclimating to the altitude (about 7500 feet above sea level), but really it’s just that I’m out of shape. Everyone was great about it, though, and it did feel like an accomplishment when we were done. So, anyone who plans on coming – be prepared for some hikes as I think Mama Brian has become my new personal trainer J
Me with the walking stick Mama Brian gave me. The Cherangani Hills can be seen in the background.