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.
Victor, a patient of the hospital for nearly 3 months, with his gorgeous smile and dimples
One of the children's ward patients with his mom. He's still a little scared of the mzungu (white person)!
Today was a great day. It started out with the reading of Psalm 73, which reminded me not to envy what others have. No matter what my life is like at the time, as long as I am walking in the Lord’s will, that is the best place I could be.
Then, I went into the hospital to do rounds. All of my patients were doing great (including the woman who has bad rheumatic heart disease – that labor and delivery were very scary here, where there is no monitoring really). I discharged every single one of my patients! I was very nervous that an empty ward would mean a horrific day, as things never stay quiet for long. However, it was a very quiet day. This gave me time to really spend with patients. I prayed with several of them. I was able to have a long discussion with Stella, a very sweet 39 year old lady with 6 children, whom I think has ovarian cancer. We are working on improving her nutritional status, as she is currently very wasted, and then plan to do surgery next week. Please keep her and her family in your prayers. Ovarian cancer is a bad diagnosis – even in the States, where we have the best treatments available. Here, there is only one place in the country where she will be able to get chemotherapy postoperatively – the capital city of Nairobi, a 6-8 hour drive from here. I prayed with her that through this difficult time, she would know the strength and healing that only our Lord can provide.
On a lighter note, due to the lack of patients, I was able to spend some time playing cards with some of the long-term patients from the female surgical ward and from children’s ward. We played Uno, although we called it “Moja” (one in Kiswahili). They had a blast and it was fun to laugh with them. Below are some pictures from the day. The kids are a joy and always make me smile.
To top it all off, I received a packet of pictures that were drawn by some of the kids at Englewood Christian Church in Indianapolis. They were very encouraging and quite artistic. It was great to hear from home. You have no idea how much that can brighten a day! So, thanks ECC homeschoolers!
Sunday, October 4, 2009
This is a big name for a procedure that reverses the destructive effects of female circumcision (aka Female Genital Mutilation) and I did my first one ever (haven’t ever even seen one) last week. Female circumcision is an extremely destructive practice that unfortunately is still practiced in this part of Kenya, despite the fact that it is illegal. Many people are actively campaigning against it, but it is still being done in the smaller villages. It is, in fact, so common here, that I’m surprised when I see a woman who hasn’t had it done. It is done without anesthesia and under very unsterile conditions. Some girls are as young as 7 or 8 when it is done. For those nonmedical people reading this, basically all of the external genitalia are removed and the woman’s opening is closed over until only a very small opening remains. This causes all sorts of problem for the woman, including giving birth.
About 2 weeks ago, one of the maternity nurses approached me and said she had a friend who had been circumcised as a young girl and was getting married in December. She wanted to have her circumcision reversed prior to getting married, something that is unheard of in her community. She asked if I knew how to do this. “Well,” I said, “I did do a presentation on it in residency and it explained how to do it. I’ve never seen one, but I think I could do it.” So, I met her friend. I was shocked when I examined her – it was the most severe circumcision I have seen yet. She was forced to urinate and menstruate through an opening that I could barely fit my pinkie finger in. What an awful way to live, I thought. As we talked, she described to me how careful she had to be that no one at home or that knew her family found out she was having this done. She would be ostracized if they found out. (I have yet to find out exactly why this practice is still done here, but many Kenyans also find it awful.)
So, last Friday, I did my first ever circumcision reversal (after reviewing how to do it from my presentation – thank you ACOG!). There were about 10 people in the OR watching over my shoulder, as they had never seen one before, either. Don’t worry – no pictures for the blog for this one J It went well, and I’ve seen her back once. She is very happy with the results and couldn’t stop thanking me. What a joy to do such a simple procedure but have such a huge impact on someone’s life. The theatre staff were joking that maybe this will become my new niche here – we’ll see!
Last Sunday, Dave Peterson offered to take us for a Sunday drive to the valley overlook. Dave and Trudy Peterson are here from
So, we loaded into Dave’s truck and drove up the tarmac road. Once again, the views amazed me. It is breathtaking to see God’s creativity in this beautiful place. We stopped at Kipsaia at an overlook of the
It was a great afternoon and relaxing after the walk the day before. Dave says he wants to do this more, and I look forward to exploring the area with them.
When we were ready to head back, I asked if we were going back the same way we came (it had been a pretty steep downhill climb). Oh no, I was reassured. We’re taking the tarmac (paved) road back – it’s a much more gradual climb. Well, I have to admit that it was more gradual. But, it was uphill the entire way – for about 2 ½ miles. For someone as out of shape as I am, it was a feat. What normally takes about 30-40 minutes took us well over an hour. We even got caught in the rain on the way back. It felt like an accomplishment when we finally arrived back at the hospital, but oy, was I sore for the next several days. I keep telling myself that these sorts of walks are good for me – and the views are always worth it. I think next time, though, I will premedicate with ibuprofen!
After church, Abi and I headed to her home to share lunch with her. She lives about a 20 minute walk from here on a shamba (small farm) in a compound with many other relatives. Edna comes from a very large family and I don’t think even she can count how many relatives she has that live around her. She was happy to show us her farm and her cows. She welcomed us into her home for lunch and then walked about 20 minutes to get us some soda (trying to get used to calling it that). Abi and I felt bad that she had gone to so much trouble for soda, but she insisted – typical amazing Kenyan hospitality. We spent a long time talking about her and her family and her life.
After that, we went outside and played with some of her many nieces and nephews. As she showed us her cows, I mentioned that I’ve always wanted to learn how to milk a cow. She said she would be happy to teach me sometime. So, stay tuned for that!
I praise God for Edna and pray that we will be able to develop a meaningful friendship over the next couple of years.
Saturday, October 3, 2009
For now, I thought I would recount an interesting experience at the hospital about a week or so ago. I was sitting in the female surgical ward doing some paperwork when they quickly wheeled a woman in that they said was bleeding. She looked quite distressed, so I followed them into the room where we do D&C's. She looked like she was in quite a bit of pain. I spoke to her through the translator and she said she had been bleeding for a couple of days and the night before starting having what felt like labor pains. She said she didn't think she was pregnant, but couldn't be sure.
So, I lifted up her dress to examine her and she had what appeared to be a very pregnant abdomen. I asked her again if she thought she might be pregnant, but again, she wasn't sure. So, I went to examine her and felt a baby's head coming through the birth canal (at least what I thought was a baby's head!). It was at that point she told me she needed to push. So, I quickly told her I thought she was delivering a very premature infant and she should just go ahead and push. We sat there with her as she pushed and as the "baby" started to crown, I realized that it looked very odd. Gladys, one of the nurses, was standing next to me and we both looked at each other. I very quietly said "Gladys, does that look like a baby to you?" She looked at me with a look of confusion and said "No, that does not look like a baby, but what is it?" As it crowned a little more, I realized that it looked and felt like a fibroid (a benign growth of the uterus).
So, I told her to stop pushing and quickly took her to our ultrasound room. Sure enough, she had a uterus full of fibroids (including the one that had prolapsed through her cervix and was trying to deliver) and her uterus was about the size of a 20 week pregnancy. Boy did I feel silly! We took her to theatre later that day for a hysterectomy and she is doing very well.
That is definitely something I've never had happen before! There seems to be a lot of that around here.