In Memory of E

Yesterday I experienced yet another Kenyan cultural first, although this one was one I wish I could have avoided. I attended my first Kenyan funeral. It was for a patient and a friend.
E was a wonderful Christian woman who I actually met last year when I visited Kapsowar. She and her husband ran a convenience shop just outside of the entrance to the station and I enjoyed many conversations with her when I would go for little things needed at home. She always welcomed me with a smile and often a hug. I soon realized that she and her husband were both wonderful Christian people and it was a joy getting to know them.
Soon after I arrived this time, she came to see me. She had been having some bleeding and pain and had been seen by another doctor without an answer. After evaluating her, we decided she needed a hysterectomy. Although things had looked fairly normal (except for fibroids) pre-op, it was clear when we did her surgery that she had cancer. Her surgery went well and afterwards I sat down with her husband and daughter and explained what I had found at surgery. At the time, I hoped it would be an easily treatable cancer. A few weeks later, we received the pathology report back and it said metastatic cervical cancer. Worse than I thought, but still able to be treated.
We arranged for her to go to Nairobi for radiation treatments. Nairobi is the only place (and only one hospital in Nairobi) where you can get radiation therapy in the entire country of Kenya - a country of approximately 40 million people. People are often put on a waiting list and wait up to a year to begin treatment. Thankfully she was able to start fairly quickly and things seemed to be going well, with a few minor setbacks that are common to radiation/chemotherapy. However, a couple of weeks ago, she became very sick and had to be admitted to the hospital. While she showed a little improvement, on Feb. 9th, she became worse and peacefully went on to be with the Lord.
I was devastated when I heard, although thankful at the same time that she was no longer suffering. My heart ached for her husband, who had loved her for nearly 40 years. She was only 55, so young. She left behind 8 children and 5 grandchildren. My only consolation was that she is now with her Lord and Savior and reunited with so many loved ones.
Her funeral was yesterday. Her family is large and very connected in this community, so the turnout was huge. People came from all over Kenya. The ceremony took place in a field by their house and there were probably 500 people seated everywhere. A funeral is much different here - it lasts several hours (I was forewarned to go late so I wouldn't have to sit for so many hours). Probably 20-30 people got up to give speeches remembering E and her contribution to their lives. Songs were sung. Members of Parliament were even there. There was a viewing - much like at home. Then a sermon was given about how death is not final for those of us that know the Lord. Her casket was then driven up to their home and she was buried in a small plot of land by the home.
As I looked around, I couldn't help but be struck by the differences. It was more of a spectacle here. On the flipside, though, the way they do it here gives so many more people an opportunity to express to her family what she meant to them. What a testament to her life! All you had to do was look around and you could see that she was an amazing woman who touched all that she came into contact with. As I spoke with her husband, you could see the pain in his eyes and my heart broke. At the same time as his pain was evident, though, he said that he knew God was sovereign and that He would get them through this. I praise the Lord that even in the midst of such pain, He brings hope. Please remember E's family in your prayers as they struggle to recover from this loss.

Mental Health Day

As I said in my last post, one of the great things about being at this
conference has been the time to network and fellowship with other
medical missionaries from all over the continent of Africa. Last
Friday, we (me, the 2 other OB/GYN's in the post-residency program,
and Stephany, a post-resident pediatrician) decided we needed what we
termed a mental health day in Nairobi. All of us have been facing
fatigue and emotional exhaustion at times and felt that we needed a
day to refresh.

So, we piled into Sara's car and headed off to Nairobi - to a
wonderful place (my new favorite place in Nairobi!) called Village
Market. It is a beautiful outdoor mall much like one I've been to in
San Diego. I felt like the little country bumpkin as we walked
through, which I think made everyone else laugh. We first headed to a
coffee shop much like a Starbuck's to get our caffeine fix for the day
- it was very good. We then went to a nail place for mani's and
pedi's - much needed relaxation! It was wonderful. Afterwards we
went to the food court area and ate perhaps the best Indian food I
have ever had. What a treat that was! We spent the rest of the
afternoon just walking around and doing some shopping at the Nakumatt
there (a large grocery store).

While at Nakumatt, I saw a familiar face. It was one of my medical
school classmates whom I had not seen since graduation. After getting
over our shock of seeing each other in a grocery store in Nairobi,
Kenya, I found out that he is working at Kijabe Hospital - the same
place I've been staying with friends for the last week. Just when I
think the world couldn't possibly get any smaller, it does :)

It was a great day of relaxation and female bonding and made me so
thankful to have so many other post-residents here in Kenya with me.
Being with all of these wonderful people for the last week has made me
realize that wherever the Lord places me long-term, I need to be
somewhere with a team of people. The support and encouragement gained
from that, as well as the expanded wisdom base, is invaluable.
Village Market also has a movie theater, bowling alley, miniature golf
course, and water park. I think I will be going back again sometime.

Sharon and I getting our manicures Sara (in the front) and Stephany getting their pedicures The end results

Brackenhurst CMDA Conference

So, I've decided that I am in heaven in Kenya. I am currently at Brackenhurst conference center in Limuru, Kenya (www.brackenhurst.com) for a continuing medical education conference put on by CMDA (the Christian Medical and Dental Association). The purpose of this conference is to provide continued education that is up-to-date and pertinent to physicians on the continent of Africa (and beyond) so that we can be good physicians and provide the best possible care for our patients. It is so interesting and topics like "Treating Malaria in Pregnancy" and "Snakebites in Africa" can be found here. What CME conference in the States would provide these?
Another perk to being here is the coffee shop. It's located in a building that is all windows on one side that overlooks the beautiful grounds. And, they have very American food! Yesterday I had nachos for lunch and today I had chicken burritos with chips and salsa! I hate to take so much joy in food, but when you go without certain foods for 6 months, it suddenly becomes very tasty :) They also have ice cream, which is very hard to come by where I'm at. So, I'm planning on partaking of that tomorrow.
Yet another blessing of being here is I've been able to see many friends - mostly other post-residents. It's been joked about that so many of us are in Kenya right now (2 at Kapsowar Hospital, 5 at Tenwek Hospital and 5 at Kijabe Hospital), but I have to say that it is wonderful knowing that I have all of these people here with me. We have become pretty close and it's wonderful having a surgeon, an opthalmologist, a pediatrician, 2 family practice docs, one ID doc, one med/peds doc, one orthopedist, and 3 other OB/GYN's that I can call with questions. It's like our own little multi-specialty group :) During the conference, I am staying with one of the other post-residents and having dinner with the Shirley's, another post-resident family. So, it has been a wonderful time of rest, education, networking, and spending time with friends - both old and new.
There is such a wealth of wisdom and experience here. I'm getting to learn about all kinds of things from both people from the US and greats in the world of medical missions. We (me and the other 2 OB/GYNs here with SP) cornered the OB/GYN that lectured the other day to drill him with more specific questions. He was so gracious and sat and talked with us over coffee for about 2 hours. He also gave me some vacuums (to pull babies out) which is awesome since the ones I have at Kapsowar are metal and we achieve a vacuum with a bike tire pump.
I went to a session yesterday morning about spirituality and medicine. It was very insightful and convicting, as we talked about not forgetting the most important part of being here - sharing the love of Jesus Christ with those we serve. It's so easy to get caught up in the busyness of seeing patients and figuring out what is going on with them without all of the normal resources and forget the most important thing - evaluating and addressing their spiritual state. And this doesn't just apply overseas - it should be just as important to people in the Western world as well. One of the speakers spoke about the verse in the Bible that says (paraphrased) "In all that you do, whether eating or drinking, do it to the glory of God." His point was that if all that we do has the potential to glorify God, then all that we do has the potential to not glorify God as well. So, is it possible to do "sinful ministry" - i.e. ministry that is really not glorifying to God. I'm doing meaningless ministry if I save a woman's life physically but don't ultimately save it by making sure she knows Christ as her savior. It was very convicting to me and something I pray I will remember each and every day - especially during the busy ones.
I have almost another week left of the conference and look forward to all that I will learn during that time.

Updates

I can't believe it's been so long since I've blogged. I apologize to the faithful readers out there :) The rest of January finished just as busy as it has started. We did about 120 deliveries in January which is a lot for us.
January also brought the Jones family to Kapsowar. I have been eagerly awaiting their arrival. Kyle is a family practice doc through Samaritan's Purse's post-residency program like me. He brought with him his wife, Vanessa, who has already been a blessing to me, and their 3 sons - Hudson (4), Jude (2), and Isaac (8 months). They are a joy and love coming to my house to say hi. Hudson is so cute and a definite social butterfly (can you say that for a boy?). Their first day there, he went right up to the Kenyan kids on station and introduced himself fearlessly. He is having fun getting to know them and is learning Kiswahili at a very quick rate. We even found a very cool "secret hiding place" out in front of my house with trees to climb and places to hide.
I have really enjoyed having little ones around again and having more people to fellowship with, especially the Jones, is a true blessing. I wanted to take pictures to post, but unfortunately my camera battery died and I'm waiting on some more to come with friends.
So, we've had fun with getting to know new people and having movie nights and game nights - my 2 new faves are Dutch Blitz and Settlers of Qatan. I am so thankful for this community of support I have around me, especially during the hard times.

Lessons of the Last Month

I've been putting off writing this post to my blog because the thought of putting down the emotions of the last month or so into words was a little overwhelming. But, I know that this needs to be shared. And, for those of you who are faithfully praying for me, you need to know what you prayers are accomplishing and what you can continue to pray for.
It all started the day after Christmas. I went into the hospital in the morning and as I entered maternity, I saw a group of nurses with shocked looks on their faces and James, one of our Kenyan docs, had his head down and was shaking it. "What happened?" I asked. "We just couldn't save her" James said. When I asked who, he said it was the young girl he had done a C-section on the day before (he was on call on Christmas day). She had been doing well and then suddenly became drowsy and stopped breathing. Despite resuscitation, they were unable to save her. She was only 18 and left behind a beautiful healthy baby. An autopsy was done and she had suffered from a very large pulmonary embolus (blood clot to the lung) that was almost instantly fatal. While I felt better that there was nothing we could have possibly done to save her, I still grieved over the loss of this young woman with her whole life ahead of her and for her baby that would never know its mother. The other thing that grieved me was that when I told her husband and family, there was no outrage - no demanding to know what happened or demanding why - there was just acceptance. How sad that death is so common here that the death of an 18 year old is just taken with resignation.
I remember thinking "How can something so horrible happen the day after such a wonderful day?" The following day, at our Bible Study, without me telling him that this is what I was thinking, Bill talked about what happened after the birth of Jesus. Herod had all the boys under the age of 2 killed. "Can you imagine the heartache and the weeping?" He asked. I had never thought about it that way. In the same town where the Savior of the world had been born, not long after, massive unnecessary loss occurred. We are never told the reason for that. Was it part of God's ultimate plan? Likely in some way. Was it because this world is sinful and because of that, bad things will happen? Also very likely. Regardless, we know that God knows the reason why and sometimes that just has to be enough.
Following this sad time, I had some amazing answers to prayer. 2 women I had been following very closely delivered healthy babies. The first had had 4 miscarriages followed by a term stillbirth. So, although this was her 6th pregnancy, she had no living children. I was following her twice a week with ultrasounds and praying that God would protect her baby. She came in one day and the baby had an irregular heartbeat. We decided to go ahead and deliver her and her baby girl, Glory, came out perfectly healthy. What a joy to see her with her miracle baby! We praised God together for her and I can't think of a better name for her. The 2nd woman had lost her first baby during a difficult labor. She had come to me requesting a C-section for this baby and when I did her ultrasound, she had twins! We followed her closely and when she came in at 35 1/2 weeks with elevated blood pressure, we decided it was time to get them out. She delivered a healthy boy and healthy girl and I just saw them in follow-up this week. They are all doing well and mom couldn't be happier! I am so thankful to God for these answers to prayer and to know that He is doing amazing things in the lives of women here.
It is such a roller-coaster, with the joys and the lows. Last weekend, my Saturday started early with a C-section at 4 am. A mom had come in with undiagnosed twins and the 2nd one wasn't coming out. So, we went to theatre and when the baby came out, he wasn't breathing. The team worked hard on him, but was unable to save him. It was heartbreaking. I went home, and about 15 minutes after I laid down, I had a knock on the window from the watchman who said "Daktari, there's a patient who's unconscious on maternity." I quickly dressed and headed back in to find a C-section patient from the night before barely conscious (responding only to pain) and not moving her right side. After evaluating her, I decided she most likely had had a stroke. As I stood there trying to decide what to do next, I hear someone yell "Cord prolapse!" from the labor ward. This means the umbilical cord has slipped past the baby's head and is an emergency requiring an emergent C-section. So, as I ran to do that C-section, I called James to come in and attend to the barely conscious patient. We got to theatre (the OR) quickly and I was told by the nurse that he no longer felt a pulse in the umbilical cord. We proceeded quickly with the surgery, but despite that, this baby also came out not breathing and with a scant pulse. Again, despite over 30 min of resuscitation, this precious baby passed. I cried as I closed the patient. How could I have lost 2 babies that should have survived within the span of a few hours? In the midst of all of this, nurses were coming in asking Thomas, our anesthetist, for equipment to intubate the patient on maternity as she was now not breathing on her own. Following the C-section, Thomas and I went down to maternity and found her intubated, but stable. We decided to transfer her to Eldoret, as she needed ICU care. Unfortunately, I found out that Faith, 19 years old, passed away 2 days after that.
In the midst of all of this, I think it could be easy to question God's goodness. Thankfully, He peppers all of this with glimpses of who He is and with reasons to praise Him. I don't want you to think that all of my time here is filled with sadness, because there are so many reasons for joy! It just seems that this past month, God has been teaching me to rest in the knowledge of Him and that He is our refuge and never changes. I think it is best summed up by something a pastor said in a sermon I heard recently. He was talking about being joyful despite the current circumstances of your life and he said something I found to be profound - "Instead of judging God by what we see in the world, we should view the world in light of what we KNOW to be true of God." This has been a great comfort to me and I hope that it will be to you as well.
Thank you for all of your prayers and encouragement - they are definitely felt. I praise God for the opportunity to be here, despite the challenges, because He is showing me every day how sufficient His grace is.