Sunday, December 20, 2009

New Gyn exam room

Having a gynecologist at Kapsowar is a relatively new thing – there hasn’t been one here for over 20 years. As such, word is spreading quickly and I’m seeing more and more gynecologic patients, which is a great thing. The not so great thing – there was no good set-up for doing a decent gyn exam (every woman’s favorite thing). I was making do with seeing patients in the ultrasound room and then if they needed a speculum exam, moving them to the OB triage room to a bed with no stirrups and using my headlight for a light. It was less than ideal.

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!



A Real Kenyan Wedding

A couple of weekends ago, I had the distinct privilege of attending my first real Kenyan wedding. It was a special one, too. Many of you might remember me writing in my blog a few months ago about reversing a woman’s circumcision. Well, this was her wedding. She asked me to come and ride in the bridal car with her, which is a huge honor. So, of course I went. Little did I know I would basically become part of the bridal party!

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.

2 of the adorable flower girls with another relative
One of the mini groomsmen
The bride making her first appearanceThe front of the bridal car
The bridal party arriving at the church
The bride and her parents entering the church
The happy couple
The entire bridal party
Me with Claire
Rose (who will be an anesthetist at Kapsowar soon), Me, and Lynn
A Pokot woman


video

Thursday, December 3, 2009

Trip to Tenwek

Last weekend I decided to get away and go visit some friends at Tenwek Hospital. If you have read much about medical missions, you have probably read about Tenwek Hospital. It was started back in the 1930’s as a dispensary and became a full-fledged hospital in 1949 when Dr. Ernie Steury (a native of Berne, IN) arrived as the only doctor for about 300,000 Kipsigis people. It is now known throughout Kenya and throughout the African continent as one of the premier mission hospitals. It is much bigger than Kapsowar and has more capabilities as they have an ICU, a large NICU, and endoscopy. I have read about, and been inspired by, many physicians who have worked at Tenwek and have always wanted the opportunity to visit.

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 Kenya) to Bomet (where Tenwek is located). I had previously been told that I would need to switch matatus in Kericho, but the driver in Eldoret assured me he would go directly to Bomet. “Ni pesa ngapi?” I asked (how much is it?). 650 shillings he told me. I had been told it shouldn’t cost more than 500 shillings (about $6). I told him this and he said it was more because I was going direct. “Is this what you charge Kenyans?” I asked. He laughed and assured me it was. So, I paid him and off we went. When we got to Kericho, about 3 hours later, he said I needed to change matatus. But wait, I said, you told me you would go to Bomet. No, he said, I needed to take another one. I made him pay the other driver what I had paid him for the remainder of the journey and followed him across several streets to get to the matatu to Bomet. But, I found a seat next to a very nice lady, so I figured it would be easy going from there on out – especially since I had been told Bomet was only about an hour’s drive from Kericho. Little did I know the driver would decide he needed to change a tire and then stop about every ¼ mile to let people off and pick more people up – at one point I counted and there were 26 people in the 14 passenger van! 2 hours and 45 minutes later, I arrived in Bomet. Thankfully, from there all I had to do was take a taxi for about 10 minutes and I was finally at Tenwek!

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 Kenya and we have stayed in close contact. It was great to see familiar faces and have guides around Tenwek, as well as a place to stay (thanks Alyssa!). The Cropsey’s children (Eliese, 2, and Micah, 10 months) were sick the whole weekend, which didn’t bother me, but did significantly impact John and Jessica’s sleep. They were still fun to be around, though, and helped me greatly, as I have been missing the Hubartt kids. We had a great time hanging out and exploring the area around Tenwek.

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).


Part of Tenwek's mission station (just one small part - it's
much larger than ours)
The backyard haven at the house where I stayed
Cutey patootey Micah Cropsey
One of the kids on station feeding her chameleon a fly. What
a great way to grow up!
Part of the hospital. The large building in the back houses
the operating rooms.
Me by the sign at the entrance to the hospital - new for its
50th anniversary this year
A nearby waterfall. The hospital gets all of its power from
here - they have their own hydroelectric plant!
Alyssa getting into a book she was reading for the Cropsey kids

Wednesday, December 2, 2009

Saying Goodbye to Friends

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 Taiwan, spent her high school and college years in Canada, and is now in medical school in Australia. Eleasa was born in Hong Kong, grew up in Canada and is also in medical school in Australia. We are quite a multicultural bunch! They were a joy to have here and always provided smiles wherever they went. They are just finishing up their first year of medical school, and so everything was new to them, which was fun. We were so glad to have them here and sad to see them go. For their last night here, we presented them with some Kenyan clothing (see below) and watched, what else, “Australia”.

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.


Eleasa (L) and Kim the night of their goodbye dinner
Me with Ben and Cathy



Tuesday, December 1, 2009

The New Theatre and Why We Need It

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.


Smoothing out the newly poured concrete
This is hard work, as you can see, and all done by hand
Dave supervising the work in his mud boots - an essential here