Wednesday, September 16, 2009

God’s Promises

The other day, it had rained just a bit and as I walked to my first Swahili lesson (very excited about that), I looked up and saw a rainbow. I always think rainbows are pretty, but this one was especially pretty for two reasons. One, the backdrop is beautiful! Every day, I am amazed by the beauty of this place. I am trying to remember to thank God every time that thought hits me for His beautiful creation. It truly is a blessing to look out my windows and see this beautiful place.

The other reason it was so special was because it reminded me of God’s promise to never forsake His children. Kenya is in the midst of a significant drought right now and it is affecting the lives of so many. The corn, which is a major crop in this area, has mostly dried up and many have lost their crop for the season. It is also affecting availability of electricity and Kapsowar’s is turned off most days during daylight hours. It is also affecting cattle, another crucial aspect of life for so many here. But, that rainbow was a reminder that God promised to never forsake us. Also, we read a passage from Psalms that seemed particularly applicable. It comes from Psalm 65:9-11: “You care for the land and water it; you enrich it abundantly. The streams of God are filled with water to provide the people with grain, for so you have ordained it. You drench its furrows and level its ridges; you soften it with showers and bless its crops. You crown the year with your bounty, and your carts overflow with abundance.”

Please join me in praying that it will rain here and that people’s livelihoods will be saved. Please also pray that there will be a harvest of souls as well.

A reminder of God's promises
A view of the beautiful countryside

Monday, September 14, 2009

Another First

So, I was planning on writing a blog about the theatre (operating room) and then last night (Saturday), I had another first ever experience there which will make the perfect intro. We were having dinner at Salome’s (the hospital administrator) with a whole group of people from Samaritan’s Purse who are here to begin construction on the new theatre building and I got a call from maternity. The woman with twins who had been laboring since Friday was now ready to push. When I admitted her, the first baby was head first and the second was almost head first (oblique). Since she had had 5 babies previously, she was a good candidate for having a normal delivery. So, I headed into the hospital ready to do a fun twin delivery. When I arrived, I heard “Doctari, doctari” (doctor, doctor). The first baby had delivered and the water of the second had broken followed by an arm coming out and no head. I checked her and sure enough, I could not feel the head, but I could feel a pulsating cord coming out. The second baby’s heart rate was down, so I told them to move quickly to theatre for an emergency C/S. They moved very fast and the OR team was called in, but when we arrived up at theatre, we had to wait for what seemed like forever for them to get there. We prayed the whole time while the patient (E) was on her arms and knees on the gurney. When they arrived, we rushed in. Then came the dilemma. You see, if you remember, I said I came in from dinner. So, I didn’t have scrubs on – in fact I had a skirt and flip flops on. I looked quickly through the scrubs in theatre, but they, of course, are all made for skinny people. After a couple tries, I decided I just needed to go ahead in my clothes (thankfully I found some shoes). Later, I realized that I had put a pair of scrubs in maternity, but had completely forgotten this at the time. So, I did my first C-section in my regular clothes (under a gown). She bled quite a bit, but we delivered a healthy baby boy (he was transverse and I had to pull him out breech). Mom and both babies are doing wonderfully this morning. My skirt was covered in blood, but I am happy to report that it is none the worse for the wear after washing it  What, I wonder, will the next 2 years bring?

So, that is a long intro for the current theatre. It is basic, but it functions amazingly well. We are all looking forward to the new theatre building which will have 3 OR’s as well as lots of space for seeing outpatients, a casting room, a recovery room, and possibly an ICU (which we don’t currently have). Right now, the hall outside theater serves as a casting room, surgery outpatient clinic, dental clinic, dressing change area and recovery room. It gets a little crowded at times! See below for pictures.

Drying surgical sponges that have been cleaned and will be resterilized
David, one of the scrub techs/dental tech showing off the autoclave
Scrubbed in doing a tubal ligation (don't know how my mask slipped down)

Sunday, September 13, 2009

The Sounds of Heaven

Last Sunday, Abi and I decided to go to a different church. My first Sunday here, we had gone to the chapel service that is held at the hospital every Sunday. This was a great experience and it was neat to worship with the patients that we are serving. However, we wanted to experience a more typical Kenyan service. So, we headed to Roroc, a church that is about a 5 minute walk from my house.

Roroc is held in a school and when we first arrived (we were told to arrive about 30 min late, as church never starts on time), there weren’t many people there. We were ushered to the front and given prime seats. As the service started, someone quickly realized that we probably weren’t understanding much and so he jumped up and started translating. Throughout the service, different people took turns translating, something I’m sure they don’t normally do. Also, soon after we arrived, a little girl who looked to be about 4 or 5 came up to me, sat down next to me, and held my hand. She stayed there for the remainder of the service.

It was a wonderful service, full of vibrant singing (lots of songs) and wonderful testimonies from various people. The sermon was encouraging as well. During one of the songs, the youth of the church had come up in front to sing, and one of them boisterously encouraged everyone to sing with all their hearts. The singing sounded to me what I imagine heaven will sound like one day. It was beautiful! At one point, they asked for any visitors to get up and say something. After several Kenyan visitors got up, they said “Are there any more visitors?” and looked right at us. We figured that meant we should go up, so we did.

After the service, we were greeted warmly by many people and invited to stay for soda and bread (yes, slices of bread). It was a special day, because all the children were headed back to school the next day. So, at about 2pm, we finally headed home. Church is definitely an event here! It was wonderful, though, and I think that on my weekends off, that is where I will be attending.

Later that afternoon, I kept my promise to the girls on the station and made them popcorn. It was quite a hit and 5 little girls downed 2 huge tubs of popcorn.

Monday, September 7, 2009


I recently received a newsletter that had the following passage in it. It was very encouraging and challenging to me and I wanted to share it with you all.

“. . .who for the joy that was set before him . . .” (Hebrews 12:2 ESV)
“On July 6, 1415, when Johannes Huss was led to his execution, he laughed as his accusers burned his life’s works in the church yard. Later as they piled the wood to his neck and prepared to light the fire, he proclaimed, “In the truth of that gospel which hitherto I have written, taught and preached; I now joyfully die.” If the martyrs throughout church history have taught us anything by their heroic and horrific deaths, it is that joy is a choice – albeit often a difficult one. It results from the spiritual work taking place within us that convinces us to look beyond our difficult circumstances and surroundings and delight in the larger picture of God’s economy.

In the unbearable stench of a Roman prison, Paul proclaimed, “Rejoice in the Lord, always!” (Philippians 4:4) Enduring the cruelty and ignominy of the cross, Jesus mustered the will to set his focus on “the joy that was set before him.” Joy is not the happiness of everything working out just right. Joy is resting on our enduring hope even when our world is burning.”

While I don't pretend that my current circumstances compare with the examples given here, I know that there will be tough times ahead. This was a challenge to me that my joy should not be based on my current circumstances, but rather on the knowledge that I serve a God who has already been there and who has given me an enduring hope. I pray that this challenges you as much as it has me.

Sometimes, though, God gives us tangibles to bring us joy. For me, this has included the people here. Many medical students rotate through Kapsowar. Currently there are 2 here from the UK, Abi and Philip. We have been having dinner together and just hanging out, which has been a huge blessing. Philip will be leaving Monday and Abi is going to move in with me for the rest of her time here (she leaves at the end of September). There is also an American plastic surgery resident here, Drew. Drew will be here for one year. I praise God that He has provided people my age to fellowship with. Also, the kids on the station continue to be a source of joy each day as I walk home from the hospital. There are some pictures below.

Abi and I holding twins that we had stayed at the
hospital all evening to deliver, then missed because we were doing a C-section

Kids with homemade hula skirts

Ruth, Joy, and Brenda (L to R) enjoying some of my chocolate chip cookies

Dinner at Mickal's (a patient attendant at the hospital). From left to right - Phil (medical student from Ireland), Nehemiah and Timothy (Mickal's sons), Drew, and James (a Kenyan physician here at the hospital)

Sunday, September 6, 2009

What a Week!!

So, I have now been working in Kapsowar for one week, and I think I've done and seen more than I would have in a few months at home. Apparently, the word has gotten out that I am here and it seems like patients are coming out of the woodwork. I am thankful for this, though. I can't tell you how many people have told me that they are so thankful to have someone here to focus on women's health. I say this not to pat my own back, but to acknowledge the providence of God that He provided the opportunity for me to come here. There are so many needs.

So, here is my tally - 7 or 8 C-sections, a breech vaginal delivery (it was awesome!), about 10 ultrasounds each day, several D&C's, 5 nights of call, and 4 Gyn surgeries - including a D&E for a fetus that had been retained for months and a myomectomy (removal of fibroids, see picture below). Apart from all of this, I have had someone come through the clinic every day this week with a fetal demise. This has been tough. It has also given me a tremendous opportunity to pray with, and I hope minister to, many women and their families. Oh, and did I mention my mom got into a bad car accident that totaled her car? She's okay, praise the Lord. I can see how the sadness will at times threaten to overwhelm. However, we serve a great God who promises to do more than we could ever imagine, including, I believe, lift our spirits in the midst of overwhelming sadness.

One of these bright moments came on Wednesday, when a woman I had seen on Monday came back to clinic. She was pregnant for the 5th time and had no living children. She had given birth to 2 stillborn babies previously. She was very nervous, because she was approaching the point in her pregnancy when her previous babies had died. I had done an ultrasound on Monday and it appeared that her baby was smaller than it should have been. This, however, is a hard call to make here because often women are unsure of their last periods and they do not routinely have ultrasounds. So, I prayed that she would come back (she refused to stay that day) and that the Lord would give me wisdom of how to give her a healthy baby. She came back on Wednesday and the fluid around her baby had significantly decreased (a sign that the baby is not doing well). So, I prayerfully decided we should deliver her. This was a hard decision, though, because if I was wrong, I would be intentionally delivering a premature baby in a setting where there is little support. We delivered a health baby girl via C-section who was definitely small (about 3 1/2 pounds) but who is doing great now. Praise the Lord! I'm sure I'll have many more situations like this and hopefully they will have similar outcomes.

One more classic Kapsowar story. Thursday I heard that there was an emergency up in theatre (the OR). Just as I was getting ready to go up and see what was going on, I decided to check on a laboring patient. The nurse said she had started bleeding. As I listened to the baby's heart rate, I heard significant decelerations - significant enough that we needed to go to theatre for an emergency C-section. No problem, right? Well, it is when you only have one OR and there is currently a man in there with his chest cracked open after someone shot him. But, in classic Kapsowar fashion, that did not stop us. We wheeled my patient into the same room and Thomas, the anesthetist, stepped over to give her a spinal quickly (there's also only one anesthesia machine). I then proceeded to do a stat C-section on the gurney we had wheeled her in on while the general surgeons continued to work on the young man. I told my patient that she sure would have an interesting story to tell her daughter about the day she was born! Mother and baby are doing well. The young man, unfortunately, passed away later that night.

So, there's a recap of my first week in Kapsowar. It has been busy, but rewarding, and I praise God for what He is doing here. I have started trying to pray with my patients on the day of their discharge. I pray that the Lord will bless them through this and that we can see more people come into a meaningful relationship with Him because of it.

Fibroids we removed from one patient

Tuesday, September 1, 2009

What An Introduction

One of the best things about being here before was the reception I got coming back. Everyone has been so welcoming. They are some of the nicest people I have ever met and go out of their way to make things more comfortable for me. It's very humbling actually. My second night here, we were invited (me, the medical students, and Drew, a surgical resident who is here for a year) to Mikel's house. She is a patient attendant here at the hospital and such a sweet woman. We were invited for ugali (a traditional food here made of maize), scuma (greens) and a meat dish (sorry, blanking on the name). To my delight, when we arrived, she had just started making dinner, which is apparently also a cultural norm. So, we got to experience cooking Kenyan style. See the pictures below. Dinner was wonderful and the hospitality was amazing.

Another result of everyone waiting for me to come was that their were many patients who were told to come back after Aug. 27th, because the gynecologist would be here. No pressure or anything! So, Friday, when I just ran up to the hospital for a few things, I had to tell one woman she probably has cervical cancer and another that the large mass in her pelvis was a recurrence of her uterine cancer. Not the best day! However, it was good to know that at least I could talk with them about their options as well as pray with them for God's hand to be in their lives. This weekend proved to be busy as well, as I was on call Friday, Saturday, Sunday and Monday. I went in every night for a C-section and saw several patients during the day. I've already been confronted with so much pathology, it's amazing to me. It also makes me grateful for the wonderful specialists who helped train me and who have already given advice on how to manage some of the patients I've seen. I think, though, the most rewarding thing is being able to openly pray with patients. Not that I couldn't in the States, but it is definitely more accepted here. It is something I hope to do more and more of.

Yet another blessing since being here have been all the children on the station (where I live) and at the hospital. They are so fun to joke around with and I look forward to being able to talk and play with them. On Sunday, as I was headed to church at the hospital chapel, a beautiful little girl walked up to me and held my hand. She was going to church as well with her mom. When we got close to the church, she held up her arms to be held and ended up sitting on my lap for about half the service. Her name is Hilda and I would guess her to be about 2. Now, every day she sees me, she runs up to me to be held. We took the picture below the other day.

So, prayers are being answered and I am grateful to be in this place. The Lord is good and I look forward to seeing what He will do here.

Mikel's kitchen
Me with Hilda
The kids love having their picture taken and know that they can
look at the back of the camera and see it immediately
A little girl who lives by the station