Wednesday, October 27, 2010

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

Saturday, October 23, 2010

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!

Tuesday, October 19, 2010

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

Sunday, October 17, 2010

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.