Reflections

As most of you know, I will be leaving Kenya on June 24th to return to the States for 1 1/2 to 2 years.  This is in order to finish the application process with a long-term sending agency, raise full-time support to return here, and collect my cases for and take (and hopefully pass!) my oral boards that would then make me fully board-certified.  I am looking forward to returning home for a time and seeing everyone there.
As I now have less than 2 months until departure, I have been reflecting on how different my life will be over the next 2 years.  I have grown used to many things here that are much different than how things will be in the States.  I have come to appreciate many things that seemed strange to me when I first came.  I have developed significant relationships here that I will miss when I'm gone.

Some of the things I will miss:
1. Walking to work every morning and living close enough to the hospital that I can walk in
2. Getting to sit outside of theatre (the OR) and seeing this view while waiting for a case to start

3. People greeting me by name on the way into work, walking to the market, etc
4. The simpleness of the pace of life here
5. All of my dear fellow missionaries here

I have also realized that I have gotten used to asking my patients certain questions that probably wouldn't go over quite so well at home.  Here are some examples:
"Are you your husband's only wife?"
"How many shillings do you pay to get here?" - Easiest way to determine how far away from the hospital they live
"Will your family allow you to have a C-section?" - the mother-in-law is very influential and often the biggest obstacle to a patient having a much needed C-section
"You should not be climbing trees while you are pregnant" - said to a patient who had fallen out of a tree when she was 14 weeks pregnant and broke her hip
"Do you have another family member who can chop firewood and fetch water for you?" - part of my talk about bedrest with my pregnant patients who have high blood pressure
I'm sure there are many more, but that's all I can think of for now.

Another thing that will most definitely be different will be the presentations of the patients.  To highlight this, I'd like to share 2 stories with you from this past week.  While they both have elements of tragedy, I think they speak to the tenacity of the people here and to the need for quality and compassionate medical care.

The first patient, T, came up from the valley after having pushed at home for a few hours with her 4th baby.  Her baby was breech and she had been able to push the baby out but it had become stuck.  By the time she walked to find a vehicle and then made the 2-3 hour journey to Kapsowar, she was writhing in pain and exhausted.  Another doctor was on call and when she arrived, he did an ultrasound which showed massive hydrocephalus (fluid in the brain) which had enlarged the baby's head so much that it could not pass through the birth canal.  Unfortunately, her baby had already died by the time she reached us.  The doctor on call called me and asked me if I had ever done a destructive delivery.  I said no (and I hope I never have to) but told him that I thought I knew something else we could do.  I had never done it before, but had had it explained to me.  When I got to the hospital, I found her writhing in pain in the labor bed and begging us to help her.  I confirmed the other doctor's findings on U/S and decided to proceed with a ventriculocentesis - a procedure to drain the fluid from the baby's head so that she could deliver normally.  It was actually quite an easy procedure technically and her relief was nearly immediate.  After a large amount of fluid was drained, she was able to deliver the baby.  As I comforted her over the loss of her child, she grabbed my hands and praised God for saving her.
The second patient, J, came from Kaloa, a town in Pokot near where we do our mobile clinics.  She had begun bleeding heavily at 8 am.  Her family had to find a motorbike for her transport and then get her to Tot, the closest health facility.  When she arrived there, she was bleeding even heavier and had become very weak.  They transported her to us in an ambulance.  By the time she arrived here, she had lost nearly her entire blood volume.  Her blood pressure was barely obtainable at 60/20 and her heart rate was 140.  She was  barely responsive.  I arrived and sent her husband to donate blood as we only had 2 pints of blood in the entire hospital (which was a bonus - I though we had none).  We started pumping fluids into her as fast as we could through 2 IV's.  Her hemoglobin came back from the lab - it was 3!  (It should be 12 or above)  I did a quick ultrasound to try and determine the cause of the bleeding - the baby had died and there was a large placental abruption (the placenta had completely detached from the uterus).  Her bleeding was still brisk and after getting some blood started, we took her to theatre.  On the table, her heart rate continued to race.  Thankfully the surgery went well and we were able to get her bleeding under control.  After several liters of IV fluids and 3 pints of blood, she began to stabilize.  The next day, her hemoglobin was 4.9 (after 3 pints of blood!) and there was no more blood in the hospital and no more relatives to donate.  Thankfully she is stable, so we will just have to let her body recover.  She, too, thanked me the next day and I told her that we both needed to thank the Lord that He had gotten her here in time.  30 more minutes and she would have died.

These are not situations that I will likely encounter in the States, but they are not uncommon here.  In a way, I am very glad that I will not have these type of situations for a time - they are physically, mentally and emotionally exhausting.  But on the other hand, what an opportunity to see God's provision and protection!  I know that J is alive today because the Lord protected her.  I have seen Him work miraculously in her life.  I think, in a place where there is so much technology and medical know-how, I will have to search harder to see this (or perhaps just work harder to set aside my own preconceived notions and see what God is doing around me).  I encourage all of you to look for God's work that is all around us every day.