Hello. As I am sitting down to write this, I am just finishing a plate of leftover goat rib curry stew. Yes, goat ribs. We had our first experience at a Kenyan butcher shop this past weekend. In Kenya, almost all meat is purchased at local butcher shops. The butchers typically slaughter a cow or goat, hang it in the window of their little shops (unrefrigerated) and will then cut pieces for customers as they visit. The cow/goat typically will hang in the window for 1-3 days until all of the meat is gone. Whitney had been apprehensive about buying meat that wasn’t refrigerated, and I think was also grossed out a bit seeing an animal just hanging in a window. Nonetheless, our friend and driver, Antony, who is a Kenyan native, took us to his favorite two butchers who he assured us were very reliable, and their meat is always fresh. We proceeded to buy a kg of steak from the cow butcher (we ate this a few days ago in delicious steak enchiladas with homemade enchilada sauce) and a kg of goat ribs from the goat butcher. Here are a few pics from the butcher:
On the wards
Things have been especially busy at the hospital the last few weeks, which is likely in part why I have had such a long delay since my last post. When I arrived to Tenwek, I recall being amazed at how sick and acute patients seemed to be when presenting, often coming to the hospital with advanced disease and near death. Well, over the past two weeks, the overall sickness of patients is actually even worse than it was in July. In one 7 day span last week, on the medical service alone we had 17 patients pass away from a variety of illnesses. That week was emotionally, physically, and spiritually challenging. As a physician, death is something that certainly we experience and learn to cope with, but it is never easy.
Last night, I was on call, and it was a very busy, and emotionally taxing call night. In the morning we had a fairly young patient (40s) pass away. She had advanced HIV, tuberculosis, and had developed bone marrow failure, presumably related to her TB or HIV. This was her third admission of the summer, and she had been slowly declining. On this admission, she was very anemic, with a hemoglobin of 4 (normal is ~12-15). We had been trying to transfuse her for the last few days, but there was no blood left in the blood bank (this is a very common problem as Kenyan law forbids hospitals to conduct blood drives) and she had no family around to donate. Eventually, she just stopped breathing. Later on in the evening, I had just arrived home from dinner when I received the dreaded “999” page, which signifies a code blue on one of my patients. I sprinted back up the hill to the hospital, where one of our interns was doing chest compressions in attempts to resuscitate the patient. Eventually, after intubation, several rounds of CPR, and some medications we use in codes, we were able to get a pulse back. He was not breathing on his own, so he needed to be placed on a ventilator. Of course, our four ventilators in the hospital were all taken, and there were no ICU beds available. I ran up to the ICU while our intern was bagging the patient (bagging is a way to manually ventilate someone prior to placing them on a breathing machine). In the ICU, I attempted a T-piece trial on one of our patients, which is a quick way to see if they are able to come off of the vent. My hope was that we would be able to remove that patient from the vent, and use that vent for the patient who had just coded on the medical ward. He unfortunately failed the test, so again we were stuck in a situation with the patient who had just coded whose only way to survive was with a breathing machine, but no available machines. One solution would be to have the family bag the patient throughout the night until a vent came available, but that is a terrible situation, and not at all ideal. When I returned to the patient, he had lost his pulse again, but again with CPR we were able to get a pulse back. His labs arrived, and he was profoundly anemic (from a GI bleed) and desperately needed blood. We found blood that matched in the blood bank, but he is a Jehovah’s Witness and he had previously refused blood products, until finally agreeing just a few hours prior to coding. In the process of all of this, he coded a few more times, and eventually passed away while we were still trying to figure out a reasonable plan. He was only 33. It was very sad to see someone so young and previously healthy pass away.
In total yesterday, we had five patients die, which is the most I have ever had in one day. We had two men in their 90s pass away from pneumonia. These deaths had been expected as they were both very sick. They were both Christians and now can leave their suffering behind. Our final patient that died last night was a 40 year old who had been healthy, but apparently drank some local brewed alcohol and was found later in the day unconscious. When he arrived he was cold, and not breathing with no pulse. We attempted resuscitation but were unsuccessful, as he likely had died hours before being brought in. I learned today that these cheap, off market local brews are becoming a big problem. Apparently, they use formalin, and sometimes even add antiretrovirals (meds use to treat HIV) to the brew. The drinks are very strong and toxic, and likely why this patient passed away, although we will never know for sure.
As always, we had several other interesting admissions yesterday. One patient had a tumor the size of a grapefruit in her right lung. She was very hypoxic and in respiratory distress when she came in. She still is having trouble breathing, and I had a long discussion regarding the current status, likely diagnosis, and prognosis with the patients family today…which was approximately 40-50 family members. We otherwise admitted a woman with cryptococcal meningitis, another with diabetic ketoacidosis, a woman with a stomach ulcer causing her to throw up blood, a man with acute liver failure, a woman with heart failure, a young pregnant woman with pulmonary tuberculosis, and finally a man with severe abdominal pain (still don’t know why). All of these patients seem to have made some improvement today, so hopefully they will get better!
Fortunately, despite our limitations, we still can do a lot here at Tenwek, many of our patients do get better and are able to hear about Jesus. We continue to treat many patients that appear hours from dying, but through aggressive treatment and monitoring, we are able to get them stabilized, and eventually well enough to walk out of the hospital! Also, we have had two female patients give their life to Christ this week. I feel incredibly blessed to have the opportunity to treat sick, vulnerable, and dying patients and to serve as an ambassador for Christ. Certainly, especially at Tenwek, the challenges are ever present with extremely sick patients, and often limited diagnostic or therapeutic resources, however, the rewards of treating and ministering to these patients are indescribable. The Lord reminds me daily why He has called me to medicine. This time at Tenwek has been one of the most rewarding in my life, and my faith continues to grow as God reveals his glory sometimes through miraculous healings, sometimes through taking in the breathtaking creation He has made, sometimes through quiet times with Him, and even through the peace and comfort He provides to patients and their families when they leave this world to enter eternity with God. As my faith grows, and I see the word of God becomes more alive, my desire to share this treasure with others grows. These past few days, I have been reading the book of Jeremiah. In chapter 20, Jeremiah is growing weary due to being ridiculed, mocked, and insulted for preaching the word of God (which are things that have always hindered me from sharing my faith with others). Yet, despite this despair, Jeremiah says this in verse 9:
“But if I say,
“I will not mention him or speak any more in his name,”
his word is in my heart like a fire, a fire shut up in my bones.
I am weary of holding it in; indeed I cannot.
I pray that as the Lord continues to engrave his word on my heart, that I too will be unable to hold it in! Thanks reading some of my random thoughts from the past few days. I hope to blog again soon, so hopefully will not have such a long time period between my next entry. I am on call this weekend, so please pray for wisdom and compassion as I treat our patients. Thanks!