Jepotibin!

Last weekend this was a welcome sound to my ears.  I pulled into Lodengo for the first time in just over 2 years to many people welcoming me back with my Pokot name.  Jepotibin literally means "lover of women", but I was given this name because of the care that I helped to provide to many women who previously did not have access to medical care.
Many of you know the story of how I got involved with Lodengo, but for those of you who don't, I'll try to briefly bring you up to speed.  For many years, their was fighting between the Pokot and the Marakwet (the tribe where Kapsowar is).  Pokot borders Marakwet and the Pokot people are herders, typically nomadic.  They would often raid nearby Marakwet villages to steal their cattle.  Because of this fighting, the Pokot people used to be fearful to come to our hospital, as they would have to travel through areas they had raided to get here.  Kyle Jones, one of the other physicians here, traveled to East Pokot to follow up on a little boy he had seen in the hospital.  During this visit, many people came to be seen as they had heard a doctor was coming.  During that trip, Kyle was able to see the significant need in that area.  The people of East Pokot have very little access to basic services, such as water, health care and education.  We are their closest hospital, and the trip takes 3 1/2 hours with a good vehicle.  They have to walk about 40km to the closest transport or basic health center.  Because of this, many of the patients we see at the hospital from this area are very sick by the time they reach us.  This is how our mobile clinics started.  We began going every 6-8 weeks and would see between 100 and 150 people each time.  Each time we came, they asked us to help them with a health center, so that they could have more consistent access to health care.
Through the generosity of many donors as well as resources from the community itself (each family donated goats that were sold to buy the bricks), I am happy to say that the AIC Lodengo Health Centre is nearly complete, along with staff quarters.  (See pictures below)
I was so excited to go back to Lodengo and see the clinic building, as it was just in its planning stages when I left in 2011.  The people of Lodengo and the surrounding communities are very excited for the clinic to open!  Evans, the contractor, happily gave us the grand tour.  The building consists of outpatient rooms (including a room for prenatal care and vaccinations), a small lab, a pharmacy, a labor and delivery room (which will have 2 delivery beds), a postpartum ward and female, male and pediatric wards that will each have 5 beds.  The solar panels will be going on soon to provide power for the clinic.  The staff quarters are beautiful and consist of a duplex with 2 bedrooms, a living room, a kitchen and bath on each side.  We are currently taking applications for staff and our goal is to have staff hired by the end of October.  We are hoping for government inspections to occur at the beginning of November so that we can open by early December.
To see the joy on the people's faces as we talked about opening the clinic confirmed to me that this is a needed ministry in this area.  It was also exciting to see the local church continuing to expand.  The Sunday spent in worship with them was, as always, so encouraging.  It was wonderful to see many familiar faces but also many, many new faces.
I was so impressed with the work that has been done in the last 2 years to bring this much-prayed about clinic to reality.  Water is still an ongoing pursuit.  Currently, they have built an amazing rain-collection system that feeds into a 40,000 liter underground tank as well as several above-ground tanks.  Thanks to these tanks, the clinic and staff quarters have running water.  Water for the community, however, is still scarce.  We are waiting on a survey by an organization that builds sand dams in riverbeds as a water source.  This works well in areas like Pokot that have large rains followed by long periods of drought.  We are praying that this will finally be the answer for water for the Pokot, as all of our attempts at wells have failed (and we have been told a well is basically impossible).
Please join me in praying for the last details that need to come together for this clinic to open.  Pray for wisdom as we hire staff, that they would be able to provide not only quality medical care, but that they would also be committed to spiritually ministering to the patients as well.  Please also pray for favor from the government during our inspections.  Also, we need partners, initially, to help support the clinic.  We will need to pay for medical equipment, medications and staff salaries.  This will not be a free clinic, and so we hope that it will eventually become self-sustaining.  Until then, though, we need people to partner with us to provide much needed care in Lodengo and the surrounding communities.  Would you consider assisting with this?  If so, you can find a link on the right where you can donate funds.  Please just include my name and Pokot clinic in the memo line of your check.
Thank you to all of you who have prayed for this clinic and for the Pokot people!  The Lord is definitely answering prayers!

The front of the staff house

Access to the underground water tank

Exterior view of the clinic - children's ward is on right

 A view of where the entrance gate will be

Another exterior view of the clinic with courtyard

 The labor and delivery room (where the construction crew are currently sleeping!)

 Pharmacy

 Laboratory

 Kyle talking to all of the people waiting to be seen before we started the clinic

 Clinic finished - time for fun!

Kyle with the local advisory committee for the clinic

Karibu tena!!!

Karibu tena!!  Welcome back!  This is a greeting that I have heard many, many times in the last few days.  After arriving safely in Nairobi on September 5th and then spending a few days getting some things done there (and picking up a visiting OB/GYN resident from St. Vincent's, Gretchen Stiefel), I arrived back home in Kapsowar one week ago today.

I was so blessed to have Kyle and Vanessa Jones, 2 of my dear friends, pick us up at the airport in Eldoret.  Then it was on to the challenge of shopping for the next month or so - while trying to anticipate what I might need to stock at my house, what meals I might need to make, how many visitors I would need to host, etc.  Not as easy I remembered it being :)  A couple of hours later, though, we were on our way to Kapsowar.  We stopped along the way at a beautiful restaurant, Kerio View, that overlooks the Kerio Valley.  As you can see from the pictures below, it was a great way to show Gretchen the beauty of this area, and it was a relaxing place to take a break from all the travel.

After eating a delicious lunch at Kerio View, we made our way back to where I really wanted to be.  Pulling back into Kapsowar was a bit surreal but also so exciting.  I was welcomed back to my house by a sign on my door that the Jones’ kids had made - so sweet!  I was greeted by many dear friends who told me over and over again how happy they were to see me.  So humbling to receive such a loving reception!

I was very lucky that Gretchen came at this time, as she was able to be oriented to the hospital on Tuesday and start working immediately.  This gave me a day to get unpacked and settled back in at my house.  Wednesday marked my first full day back at work at the hospital and it has been hopping ever since!  Word has definitely gotten out that I am back and many patients that my colleagues here were saving for when I got back have come to see me.  In the 5 days I’ve been back working at the hospital, I’ve done 3 C-sections, a vaginal hysterectomy, an abdominal hysterectomy, 4 tubal ligations and a D&C - and we have 2 C-sections, 2 tubal ligations, a D&C and a vaginal hysterectomy still scheduled for this week!  Needless to say, it has already been a great (I hope) learning experience for Gretchen and I have certainly gotten back into the swing of things here.  It hasn’t been without its hiccups, though, as I’ve had to get used to how things work here again and remember many things that I’ve forgotten.

One of the things that I’ve had to get used to is the more frequent loss of life.  The other day, a woman presented in what appeared to be preterm labor at 26 1/2 weeks.  After Gretchen evaluated her, it looked like she probably had a condition known as cervical insufficiency, where the cervix is not strong enough to hold the pregnancy in past a certain point.  Her water broke, she was laboring, and the baby was breech.  We then noted decelerations in the fetal heart rate.  In the US, this would be a no-brainer - take her to the OR, do an emergency C-section, and send the baby to the NICU where she could have the best care.  Here, however, the decision is much more complicated.  The likelihood that this child would not survive was pretty high - we have no respiratory support besides oxygen through the nose.  Most babies of this size will need significantly more than this.  However, the best chance for this baby to survive would be to perform an emergency C-section.  But, do I want to put this woman through a surgery that she may not be able to afford, when it might not mean that her child will survive?  Not an easy decision!  Ultimately, we decided to go to C-section.  Unfortunately, after attempts at resuscitation, it became evident that this precious little girl just didn’t have the lungs she needed to breathe on her own.  We heard a few cries from her and she did try to breathe - for about an hour.  When it became clear that we were going to lose her, I asked the mother if she would like to hold her.  She did for about a minute, but then it just became too painful for her.  We took the baby away and as I did, I put my finger under her hand and she grabbed my finger!  What a little fighter!  I couldn’t handle the thought of her passing lying in a warmer and so I sat there and held her until she took her last breath.  I think that I had forgotten a little of this side of things here.  This baby probably would have survived in the West.  However, I count it a blessing that I was able to be a part of her short life here on earth.  I was also able to pray with and encourage the mother as she walked through a very difficult time in her life.  I pray that the she was able to feel God’s love for her through me.

So that has been my reintroduction to life here in Kenya.  I am so thankful to be in this place at this time and I pray that I will be a willing vessel for the Lord to use.  I am excited to see what He will do.  Thank you to all of you who helped me get back here.  Please keep praying as I transition back to life here and strive to continue to improve the care that the Marakwet people receive!

Gretchen and I in the beautiful new theatre building

My office even got a bit of a facelift!