Family Visit - Part 1

Ok, so you can now stop emailing me about the blog drought.  Things have been busy, but it's no excuse.

The biggest thing that has happened since my last blog was my family's visit.  My mom (Cathie), sister (April) and nephew (Carson) flew in on Nov. 21st and stayed through Thanksgiving.  It was such a blessing to have them here for the holiday.  More than that, though, I was so excited to be able to show them this place that I have come to love.  After braving two 8 hour flights with a 7 1/2 month old, they arrived safely in Nairobi.  We stayed overnight and then they endured the 6-7 hour drive back here to Kapsowar.  They were troopers and Carson did so great!  They were taken, as I have been, with how beautiful it is here.  They agreed with me that pictures don't even begin to do it justice (hint, hint - you should visit!).  It was wonderful to have them come to the hospital with me, see what I do each day (including watching a C-section!) and have them be involved in the ministry as well.  They really enjoyed spending time with the kids on the children's ward.  This blog shows some of their time around my house and at the hospital.

Carson enjoying a bath in Nairobi

Having breakfast at Java House, one of my fave places in Nairobi

We stopped at the Rift Valley on our way back to Kapsowar

April, Carson, and Mom with the ladies that sell produce outside the hospital

Carson playing with one of the patients on C-ward

Mom with a set of "surprise" twins she saw me deliver

April with her 2 buddies - Moses and Dennis

Quality time with Carson - what a cutie!

Right after watching me do a C-section

Our family's Dr. Dolittle - April loved all the farm animals that are around!

April and Carson handing out gifts on the children's ward

Mom with Chesoot, a long-term patient here

Online giving

It is now easier than ever to support the work going on here at Kapsowar.  Samaritan's Purse now has an online giving option.

Just go to www.samaritanspurse.org/index.php/giving/wmm_doctors/ and follow the directions.

I cannot tell you how much I appreciate those of you who financially support me and the work to improve women's health care here in Kapsowar.  I hope this helps make it a little easier.

Recent Happenings and Lessons Learned

Time is flying here.  It's so hard to believe that it has been nearly 15 months since I arrived in Kapsowar.  Each day is full of sometimes routine and sometimes out of the ordinary (and challenging) patients.  However, God's grace is sufficient and thankfully His wisdom is much more than my own.  Thank you to all of you who are praying for strength, wisdom and compassion.  I can feel your prayers and covet them each and every day.
I thought I'd just show you some pictures of what has been happening over the last couple of weeks.

Halloween came and went here without all the fanfare we have at home.  I was, however, blessed with a visit from 2 very special trick-or-treaters.

Me with Hudson (God's Mighty Warrior) and Jude (a Kenyan ninja) along with Michael, a visiting medical student from Australia

I also had the privilege of delivering one of our hospital staff that same day.  We have planned for me to deliver a few others, but for various reasons it hasn't happened.  So, it was very nice to finally get to deliver one.  Sella is particularly special to me for 2 reasons.  1 - Her daughters, Brenda and Chebet, regularly come over to my house to play and do my hair. 2 - Sella previously lost some of her pregnancies, making this one high risk, so I saw her frequently throughout her pregnancy.  I was very happy to welcome baby Naomi into the world.

Me with Sella and her miracle baby

Beautiful baby Naomi

My patients never cease to amaze me.  Despite often very difficult circumstances, they are so thankful for the care they have received.  A recent patient, Salome, was diagnosed, after doing surgery, with widely metastatic ovarian cancer - at the age of 40.  We discussed the grim prognosis, especially since her family could not afford chemotherapy, and she thanked me for taking care of her.  After she was discharged, she returned about 2 weeks later, unable to eat or drink anything.  I admitted her to the hospital for palliative care.  Despite receiving all of the anti-nausea medications we have in the hospital, she continued to vomit several times a day and I watched her body waste away in front of my eyes.  Despite being miserable, though, everytime I walked onto the female ward, she would smile at me and greet me warmly.  Even an attempt to put a tube in her stomach to relieve her vomiting failed due to the rapid growth of tumor in just 3 weeks throughout her abdomen.  Finally, we knew the end was coming soon.  Salome was a Christian and so trusted in the Lord that she would soon be with him.  "I don't fear death for myself," she told me, "but what about my children?  Who will care for them?"  Her relatives quickly and quietly reassured her that they would take care of them, as is common in this culture.  I sent her home with meager pain medications to try and ease a little of the pain that was racking her body.  As she left, she thanked me again.  I had planned to go and visit her in her home later that week, but Salome went to be with the Lord 2 days after she went home.  After her family member told me this on the phone, she thanked me.

Me with Salome on the day she was supposed to get her G-tube

One thing I have learned from the people that I serve here is how to suffer with grace and dignity and what it looks like to be thankful in the midst of suffering.  I have realized that I have no idea what it means to truly suffer.  Through my patients, I have seen what it means to praise and glorify God in the midst of suffering.  My prayer for myself and for anyone else who this resonates with is that we could learn how to see God's goodness in the midst of suffering.
"Not only so, but we also rejoice in our sufferings, because we know that suffering produces perseverance; perseverance, character; and character, hope.  And hope does not disappoint us, because God has poured out his love into our hearts by the Holy Spirit, whom he has given us." Romans 5:3-5

Another Birthday in Kapsowar

Yesterday, for the 3rd year in a row, I celebrated a birthday in Kapsowar.  In 2008, I came to Kapsowar for a visit, knowing that I might be coming here for 2 years with World Medical Mission's Post-Residency Program.  That year, I celebrated a milestone birthday with the Kenyan medical students that were here at the time.  I enjoyed the fact that it was very low-key.  Last year, I had been in Kapsowar for about 2 months and celebrated with Kenyan and "wazungu" friends at Mikal's house (you can see my blog post from that).  This year, I was treated to many special treats.  When I came home at lunchtime, I found a homemade sign and balloons from the Jones (see pic below).  I was then treated to a very yummy ladies luncheon at the Rhodes house - along with Laura, Vanessa also came and two of our visitors - Janie Shumacher and Kristin O'Dell.  We had chicken enchiladas, guacamole, mexican rice, salad (with real lettuce thanks to Vanessa's garden) and fruit salad complete with kiwi.  What a treat it was!!!  Laura also made a chocolate cake, which was, like all of her cakes, scrumptious.  Last night, despite several power outages, everyone came over and we enjoyed watching "National Treasure" on the big screen at my house.  It was a wonderful birthday and I feel so blessed to have the community I do here.

My birthday sign from the Jones

(L to R): Laura Rhodes, Janie Shumacher, Me, Vanessa Jones

My yummy birthday cake

A Beach Retreat

Pictured above are all of the Samaritan's Purse Post-Residents that are in Kenya currently along with families.  This was the first time we have all been together in one place and what a joy it was!  We gathered in Nairobi on Oct. 2nd to have lunch together - I think it took about 15 pizzas!  We enjoyed hanging out, sharing stories, and encouraging one another.  If anyone had gotten hurt, we probably could have taken care of them - represented here are 3 OB/GYN's, one Med/Peds, one General Surgeon, one Dentist, one Opthalmologist, one Infectious Disease specialist, and 2 Family Practitioners.  I'm so thankful to have this group of people here in Kenya and am sad that over the next year, we will see this group dwindle as we all move on to the next phase.  I am confident, however, that they will remain life-long friends.  Thank you Samaritan's Purse for sending us all here.
The next day, all of us except for 2 families (the Friess' and the Shirley's) headed for Mombasa, which is a city on the eastern coast of Kenya, on the Indian Ocean.  It was my first time going there and I was so excited.  I had heard the beach was beautiful and it did not disappoint.  We went not only for a much-needed break from our respective hospitals, but also for a spiritual retreat and time of reflection on what we've learned over the last year and to seek wisdom for where God is leading us next.  James Paternoster, an elder from a church in Ann Arbor where 3 of the families here went, graciously gave up a week to come and lead our retreat.  He was such a blessing and challenged each one of us as we used the story of Abraham being called to leave all that he knew to go to the land where God had called him to examine our own callings and responses.  It was a blessed week and I enjoyed getting to spend time with all the other post-residents.

We rented 2 houses.  This pool (above) was just outside the bigger house, where we held all of our retreat sessions.  The beach is just on the other side of the palm trees.

A traditional fishing boat

A budding romance? (Anna Fader and Hudson Jones)

These little guys were all over the beach in the evenings

A beautiful beach with the finest white sand I have ever seen

Ednah, my house helper (pictured here with Isaac Jones), went with us to help care for the children during our retreat sessions.  It was her first time to see the ocean and she loved it!  We even got her to venture into the water, which she was scared of at first but then loved it.

James took Alyssa and I out to dinner one night.  We enjoyed our dinner on the beach.

We had one day to just have fun and we decided to rent a glass-bottomed boat.  It was so much fun!  They took us out over coral reefs and then we stopped here and were able to go snorkeling.  We saw starfish, zebra fish, and Nemo fish as well as lots of different type of coral.

A beautiful sunrise - photo courtesy of Alyssa Pfister, there was no way I was getting up that early on vacation :)

It was a wonderful week and I returned to Kapsowar feeling refreshed and encouraged.  Thank you fellow PRP-ers!

A Little Blood Goes a Long Way

(WARNING - This is a long, but important, post)

I recently had an experience that left me convinced, more than ever, of the importance of donating blood. We all hear that it's life-saving, but maybe you've never heard just how life-saving it could be. So, let me share with you how just a few pints of blood can not only save a life, but save 8 children from growing up without a mother.
"B" came to me one afternoon very distressed, because she knew she was losing her pregnancy. She had 8 children at home and wasn't even sure she had wanted another baby, but now that she was losing her baby at just 14 weeks of pregnancy, she asked if there was something we could do to save her child. However, as I examined her, I saw two little legs coming out. I sadly told her that we could not save this pregnancy, which I think she already knew.
She was stable and not bleeding very much, so I took her to the ward to be admitted and gave her some medicine that would help complete the delivery. I checked on her before I went home that night and she was resting quietly in her bed, waiting for the inevitable.
I got a phone call at about 8:45 that night from the nurse on the ward asking me to come quickly. B was not doing well and was losing a lot of blood. As I headed up, I have to admit, I was thinking "I'm sure it's not that bad." Boy was I wrong! When I got there, the floor was covered with blood and as she laid on the bed, I could hear blood pouring into a basin, as if someone had turned on a faucet. B had gone to the bathroom and passed the baby there, but part of the placenta was stuck in her uterus, preventing it from contracting down to stop the bleeding. As many things were done - more IV's placed, IV fluids given, a D&C set prepared - she stared at me and asked me to help her. We gave her some IV pain medicine and I quickly did a D&C, hoping to get the remaining placenta out and stop her bleeding (at this point she had lost about a liter of blood). Even when all the placenta had been removed, she continued to bleed. I did all I knew to do - uterine massage, oxytocin, cytotec, repeat all of the above. After a few minutes, it was clear this wasn't going to work. B was becoming more and more drowsy and I knew we were in trouble.
I shook her awake and told her we needed to go to the OR quickly and remove her uterus or she was going to die. She gave a slight nod of her head, all she could manage, to give her consent. On arriving in the OR, we couldn't get a blood pressure and could barely feel her pulse. She was in shock and by the way she looked, her hemoglobin, which should be 12, was about 2. Our anesthetist looked at me with uncertainty - if she put someone so sick to sleep, would she wake up? I pointed out the blood that continued to pour from her body and told her we had to start immediately. So, we started the hysterectomy. I have never seen this before, but when I made my incision, there wasn't a drop of blood. Not a good sign! She had lost so much blood that she wasn't circulating blood to anything but her vital organs.
The lab technician had been called in and informed us that the patient was O+ and we had 2 pints of O+ blood in the hospital. We asked for these immediately, but I also knew we would need more, and fresh blood is better at resuscitating a patient. One of our visiting physicians, Gerhard Shumacher, had just the day before told me that his wife was O+. So, I had someone call her and within a few minutes, they were up at the hospital. After another few minutes, her blood was being given to B and we began to see a response in her blood pressure. While continuing her hysterectomy, I asked one of the nursing students to go to the nursing student housing and find any students who were O+ to come and give blood. After a hesitant look, she left. As I was finishing up the surgery, I asked how many had come to give. "No students came, daktari" responded the lab tech. B's blood pressure was still 60/40 and her heart rate was over 130. She needed at least one more pint of fresh blood. I happen to be O+ as well, so after I closed her skin, I took my gown off and gave a pint of blood. As it went into B's body, her blood pressure slowly responded. She received a total of 4 pints of blood. In the US, she likely would have gotten 7 or 8 pints, but we just didn't have it.
Over the next several days, B showed great improvement and on the 6th day after her surgery, she was discharged home. I had asked B what she remembered from that night and she said nothing. I told her what had happened and even joked that she now had mzungu (white person) blood in her body, which made her smile. On the day before she was discharged, I met one of her daughters. B asked me to tell her that I had given her my blood and her daughter laughed and hugged me and thanked me for saving her mom. Of course, it wasn't me that saved her. Only God could have saved her in the state she was in, and B, a Christian, praised Him for that.
After it was all said and done, I wondered why, out of 80+ nursing students, not a single one had come forward to donate. I asked around and found 2 main themes - they were either afraid to be tested for HIV, or they thought that they would become sick or weak if they donated. I was so saddened to hear these students, future healthcare professionals, give such feeble excuses for why they couldn't save someone's life. I have since talked to the nursing students about the importance of blood donation and how we, as healthy individuals, can handle donating one pint of blood.
I think 2 things can be learned from this. First, the importance of donating blood cannot be overstated. Stories like this are happening all over the world, including in the US, every day. B would not be alive today were it not for the blood she received. And 8 children would be without a mother.
Second, what a perfect parallel to the life-saving power of the blood that Christ shed on the cross for us. I pray that this story can serve to emphasize to those who don't know Him that He gave His blood to save us for eternity. What an assurance to know that we serve a God who gave of Himself to save us and that His blood was all we needed.
"In Him we have redemption through His blood, the forgiveness of sins, in accordance with the riches of God's grace, that He lavished on us with all wisdom and understanding." Eph. 1:7-8

The Baby Whisperer

The second weekend of September we headed back to Pokot for our 2nd official outreach clinic. We were excited to go as the first trip had been such a blessing. Remember how I said last time I would need a valium for the trip? Well, that wasn't an option this time as I put my car to the test and drove to Pokot! More details to come when I get some of the pictures, but let's just say that my entire body hurt at the end of the trip from being so tense! I did receive many compliments on my driving, so I must not have scared anyone too much.
Upon our arrival, we were greeted warmly as we were the time before. This time was better, though, because our return reassured these people that we really do care about them and want to continue to minister to them. As we talked about the last time we had been there and our plan for the day, Pastor Stephen (the missionary pastor to Lodengo) said something very interesting. He said that many pregnant women were going to come that day because they had heard that the white doctor could make their babies talk! Last time we came, I brought a doppler with me to listen to fetal heart rates, and the women were amazed when they heard them and so grateful to know that their babies were okay. So, apparently word had spread and many more women did come this time to hear their babies "talk". It was also great to see some women return for the 2nd prenatal visit - especially since most never have prenatal care.

Making a baby talk - apparently I have become the Baby Whisperer :)

How it all started. Above is Kyle Jones pictured with Baby Musa (a boy, despite the pink shirt and skirt) and his mother and father. Musa was hospitalized at Kapsowar for severe meningitis and Kyle treated him. The Lord brought him back from the brink of death, and in the process, Kyle got to know his father, an elder in the church in Lodengo. He also met Pastor Stephen, and a relationship was formed. We were all very happy to see that Musa is doing well and is starting to meet his developmental milestones.
Once again, we had a very busy clinic, seeing over 100 patients in about 5 hours. This time, though, we had another doctor with us to help out. Thanks to Dr. Gerhard Shumacher and his wife, Janie, who joined us during their 3 month stay here in Kapsowar. I saw mostly OB patients and was able to identify a few at-risk mothers and recommend some interventions that will hopefully result in a healthy baby this time. One mother (sorry, I don't have a picture), had lost 2 babies previously and is now about 15 weeks pregnant. We brought her back with us and I was able to do a simple procedure (a cerclage for you medical folks) that should help her achieve a term pregnancy this time. We also arranged for 3 children to be brought to Kapsowar to have reconstructive surgery by Bill Rhodes, our surgeon. Their surgeries will be paid for by a special fund. One of the children, Chesoot, is a beautiful little girl who had a severe burn contracture of her right arm which did not allow her to extend her lower arm at all. She has now had surgery to release it and is doing well and has become a very outgoing little girl as she shows off her new arm. What a blessing to see what the Lord can do!

Above - This is pretty typical to see - a young girl taking care of a baby for her mother or another woman in the village. This baby was one of 2 twins that we saw that were very malnourished. Babies are usually born at home and they tend to feed them cow's milk early on, which is inadequate for nutrition.
The weekend ended again on Sunday with us participating in the Sunday school and church service, encouraging the local believers. This time was special because we brought 2 members of AIC Rorok church (my local church here) as we continue to try to build a partnership between the church in Rorok and the church in Lodengo. They had collected clothes and food to donate to the people of Lodengo. They also invited the women to attend a women's conference in Kapsowar early next year and are planning on raising funds to bring them here. The Pokot women were very excited about this and I was so excited to see Kenyans reaching out to fellow Kenyans and being missionaries in their own country.

Here I am with some of the kids from the Sunday school

Amanda, this one's for you - thumbs up!

It was another wonderful weekend that even included a time for Kyle to talk with the village leaders - both the chief and assistant chief came - about the health needs of the community. We hope to move forward with the possibility of starting a health center here, as the needs are great. Just yesterday, I delivered a patient who had pushed all night and all day before reaching us, and it was too late to save her baby. Please pray with us as we seek God's wisdom for how to best help the people of Lodengo and the surrounding communities.

Fun Times

Being so far away from my family and friends back home, it's nice that those here on the mission station have become like a second family to me. Here are some pics of some of the fun things we do.

Jude helping me make chocolate chip cookies

Proudly displaying his batter

Isaac crawling over for a visit

Hudson helping me pick lemons from my lemon tree - not sure what Jude is doing

Getting ready for a movie under a homemade tent in my living room

A little Faith and a big miracle

B is a very sweet 21 year old lady who presented to Kapsowar Hospital when she was 33 weeks pregnant. She was complaining of abdominal and joint pains, headache, and fevers. While this might not sound like anything familiar to those in the West, here those are the classic symptoms of malaria. B is from Kapsowar and malaria is not actually common here because we sit at 7500 feet altitude. I asked her if she had traveled recently, and she said that she had gone to Kisumu, which sits on Lake Victoria and is a hotbed for malaria. We tested her blood and saw that she was very positive for malaria, so we started her on the appropriate IV medication.
The next day, B was feeling a little better, although still having occasional fevers. Her baby seemed to be doing well too. That night, one of my colleagues was on call, and he was called to maternity because B had become agitated and confused and now had no control over her bladder. By the next morning, she was essentially comatose, responding only to pain. She had developed cerebral malaria - a condition caused by blockage of the blood vessels in the brain by the malaria parasites. Something I have definitely never seen or taken care of before. So, after quickly reading up on it, we added another medication, placed a tube into her stomach (to prevent her from vomiting and aspirating) and waited.
In the midst of all of this, I did an ultrasound to evaluate how her baby was doing. After watching for over 30 minutes, there was no movement. She had received some medication that might have caused this, so I decided to wait a few hours and repeat the ultrasound. The next one showed the same thing. There are no textbooks to tell me exactly what to do with this - how do I best save the baby and the mom? B was certainly not in good condition to have surgery. I prayed and prayed. One of my Kenyan colleagues told me that he had seen a mom like this before who improved dramatically after delivery, because a lot of malaria parasites can hide out in the placenta, making them difficult to get rid of. On the other hand, her baby was premature and here that can be difficult to care for.
In the end, we decided to do a C-section. I spoke with her family and they agreed. When we got her to theatre, we all gathered around her as she laid there completely unaware of what was going on, and laid hands on her and prayed. The C-section went well and her beautiful baby girl came out screaming. As we brought her husband in to see his new baby, he had a huge smile on his face and thanked us for saving her.
Over the next few days, we didn't see dramatic improvements, but each day she was a little better. By the 4th day after delivery, she was able to respond to commands. The next day she was fully awake and answering questions. Yesterday, I discharged her from the hospital, doing very well. She still has a bit of a flat affect (residual effects of the malaria), but is so happy to be with her new baby.

Thank you to all of you who were praying for B and her baby, Faith! I was able to tell her that she was brought back from near death by the prayers of people all over the world. I praise God for answers to prayer and His ability to still work miracles! I also praise Him for the opportunity to work in a place where I can openly pray for patients and tell them about God's power in their lives.

Me with B and baby Faith on the day they went home

Freedom!

So, after much thought and consideration, I decided that my days of depending on matatus (the public transport here that is usually packed with 30+ people) and my subsequent nausea during travel are over.
A couple of weeks ago, while I was in Nairobi, I met with my friends' car guy (apparently everyone has one here) and he showed me a couple of cars. By the end of the day, I was a car owner and he delivered it to me the next day.



I am now the proud owner of a Mitsubishi Pajero iO. I never in a million years thought I would drive an SUV. Then again, I've never lived someplace where 4WD is required and the roads are often 3-4 inches of mud. So far it's been great and I even survived the 6 hour drive from Nairobi! Thank you to all of my supporters that made this vehicle possible.

Another Amazing Safari

At the end of their time here, Jen, Corney and I went to Masai Mara so they could experience an African safari. We had such a great time and commented over and over again how amazing God's creation is!

This is one of the coolest things we saw - a lioness had just made a kill and she called her cubs over to share in the feast

We saw a family of 11 elephants. Here were a few of them, with 2 babies.

Our tents were right on the Mara River - a favorite hangout for hippos!

This day we counted about 34 of them!

A baby elephant nursing

At one point, our driver said "Now it's time for a walking safari." We rounded the corner and came upon some rhinos! You can see one just behind me.

Corney and Jen with the plains of Masai Mara behind them

This is a secretary bird. I just thought it was funny looking.

Thank you Jen and Corney for giving of your time to visit me! I had such a great time and you were both an incredible encouragement. For all of you considering visiting - doesn't this look like a great vacation? :)