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!