Posts Tagged With: Africa

Brief recap of last week at Tenwek

Hello!  Hello!  As you might have guessed, we have been quite busy the last few weeks.   I started typing the post below two and a half weeks ago.  Though we are back in the US now, there are still many things we want to share with you and record for ourselves.  In the meantime, I figured I would just share this short post with you.

Our last week at Tenwek flew by.  There were so many errands and things to do to prepare for our departure that I told Scott more that once I felt like I was running around “like a chicken with my head cut off.”  One of the things I did was host a gathering on our last Monday evening in honor of our Kenyan friends.  For the get-together, I made an array of desserts:

  • Banana Fosters layer cake,
  • Chocolate cake with chocolate orange frosting (Kenyans, at least at Tenwek, are not familiar with frosting so these cakes were quite novel to them),
  • Mint chocolate chip (brought from the US) brownies,
  • Pumpkin (they have pumpkins here!) pecan (pecans brought from the US) pie (This was my friends’ first ever pie and they really enjoyed it!),
  • “fruit punch” with mango and pineapple juice mixed with a Stoney (a soda here with a strong ginger flavor).

The food table after the party. I forgot to take a picture before and during the party! Pictured here clockwise from top: empty punch bowl, mint chocolate-chip brownies, Banana Foster’s cake, savory roasted tomato bites, pumpkin pecan pie (Clearly Kenyans don’t know that pie is normally sliced into triangle wedges! They scooped this out like a casserole, which is an ok way of doing it too!), and chocolate cake with chocolate-orange frosting.

All items turned out great, despite many substitutions according to what was available.  At first, our Kenyan friends didn’t quite know what to think of it all, as everything was very different from what is normally available to them. Thus, they were a bit timid to try the foreign desserts I prepared.  After sampling one thing though, they had to try everything and told me they loved it all saying, “It is too sweet,” which is a great compliment here!

The rest of the week was filled with laundry, packing, travel planning, cooking big batches of food to last us the rest of our stay as well as provide snacks during our two weeks of travel, and many “goodbye” errands.   The goodbyes were bittersweet because we don’t know when we’ll be back, but yet they felt good because we realized just how much we’d accidently come to mean to these people and how much they appreciated us, without us ever doing anything “extraordinary.”  We are in awe and so thankful for all of the relationships the Lord blessed us with in Kenya.

Below are some pictures from our last week in Kenya.  Looking at them now makes me “homesick” for Tenwek and these people!  Praying that the Lord himself will go before them and will be with them. He will never leave them nor forsake them.  May they not be discouraged and fear far from them.  (My prayer paraphrase of Deuteronomy 31:8)

Some of the teachers that I taught with and myself. Due to the teachers’ strike, these were the only teachers present at school the day I went to say goodbye to them. These teachers were not government employees and therefore not part of the union. Even then, they did not teach for fear of retaliation from other teachers. For a few days during the strike I taught math to the 8th graders (who are having “life-determining” national exams in two months), but then I too stopped just in case my teaching might cause a ruckus. I was sad not to see everyone before I left and sad not to be able to teach!

My teacher friends who were at school my last full day at Tenwek were very glad to see me and were sorry about the national strike. We chatted for a while and they would not let me leave without taking lunch first (pictured above, rice with beans and carrots). I was happy to do so because I had come to really love these humble, but tasty meals!

Before I left, I snapped a few pictures of the 8th grade boys playing soccer (football!).  The 8th grade class was still coming to school despite the teachers’ strike so they could review material on their own together.

Celebrating

I love this action shot with the ball up at the top of the frame. I also like that this picture shows the normally neat and tidy uniforms as haphazard and ripped in this picture, giving the viewer more information.

The road in front of the hospital on my way back from visiting the school. You can see the piki pikis on the left, women roasting corn over jikos in the top center, and cars used as taxis on the right.

I passed by these mamas’ stalls . . .

This is Nancy. Nancy is always sweet and smiling whether I buy fresh produce from her that day or not. In front of her, you can just make out a bowl with fresh beans in it. She was shelling beans to sell them when I took this picture.

This is Amy. Her stall is next to Nancy’s and she managed to sell me more bananas for “banana cakes” than I can count! Amy also always greeted me with a smile and a handshake and asking how I was and then “How is Daktari?” finally instructing me to greet my husband/family for her when we parted ways.

And then Nick’s duka . . .

This is Nick, in the center of the photo. I met Nick on one of my first few days at Tenwek. He was the first Kenyan-on-the-street that I spoke with. I remember I was a bit nervous and slightly scared/intimidated, but I just smiled and tried to be nice. Turns out that’s all I needed to do to make a friend. He works in his brother’s duka and we often bought napkins, toilet paper, or soda from him. Nick is trying to be a cool cat in this picture and refused to smile for me. He is missing his left front tooth so I think this is likely why, that, and he’s probably seen many a rapper pose like this.

I then started joking with Nick and managed to sneak this photo of him smiling. I felt bad resorting to trickery to capture him smiling in a photo, but after I showed him this picture of himself he was quite happy with it so I think it would be OK with him to share it with you.

Crossed the road that leads to Mama Joyce’s house . . .

Mama Joyce has a beautiful shamba where she grows many, many different things. When I visited her shamba she gave me a full stem (branch? stalk?) of bananas, two pineapples, and a 6 foot tall piece of sugar cane.

. . . and reached home where I had to pack up some things to give away.  When I was just ready to leave one of my favorite students came to say goodbye.  I was so surprised and happy to see her!!  This girl, Dorcas, is awesome!  Besides being smart and participating in class she is very wise and totally loves the Lord.  As we sat and talked about life and the future, she referenced the Bible multiple times and I was amazed how well she could comprehend certain lessons of life I have only recently learned!

As a goodbye gift, she gave me some bananas and a loaf of white bread she had just bought at a duka (with permission from her mother).  Of course the gift was completely unnecessary, especially when I have plenty of things, but I thought this was so, so sweet of her.

Dorcas and myself

I said goodbye to Dorcas and made my way to my two best Kenyan girlfriends, Mercy and Betty, to give them some food, containers, and ziplock bags (these do not exist in Kenya) that I hadn’t used up and they would appreciate.

Betty is on the left. She is a seamstress and a single mother to Victor, who is 10 months. Mercy is on the right with her son Caleb who is 2 1/2 years old. She too is a single mom and I met her because I bought a lot of fresh produce from her and she had Scott and I over to her home to have chai earlier on in our stay at Tenwek. She has great faith! She introduced me to Betty when I needed someone to sew me a skirt. Both women would come to my house after church on Sundays and I would show them how to make some typical “American” meal and we, along with their sons, nieces, and Scott, would all feast together.

After saying goodby to them, I went home and started packing again.  When Scott got off of work, we went together to say goodbye to our friend James who runs and owns a duka and restaurant.  On our way we fortuitously met some of my other 6th grade students!

Me with some of my most participatory boys. I was so glad to see them again! (Please excuse my outfit.  I was testing the hiking boots, which I deemed to be too small and uncomfortable to use on Mt. Kenya, and the over-sized sweatshirt is Scott’s because all of mine were packed!)

Scott and I with James in his duka. We loved James! He has great English and is very quick-witted and fun to talk to. On this evening he was so happy to see us as he had eagerly waited to give us gifts. Scott received roughly 30 pieces of candy to help him climb Mt. Kenya for “energy boosts.” For me he pulled out a beaded bracelet he had talked about getting for me before so I could buy it from him cheaper than I (as a mzungu) would be able to get it myself and gave it to me for free. Then, after thanking him and raving about it for a little bit, he pulled out another one just like the first, but a different color. This one he also gave to me as he remembered I originally wanted the bracelet for a friend back in the States. I thought this was so nice and thoughtful of him!

On our way back home both Scott and I remarked how much we appreciated James and his friendship and how we had been so blessed with so many great friends in Kenya.  We love and miss them all and because of them, our time in Kenya was truly special.  We praise God for these promised blessings of friendship.

We packed late into the night and woke up early the next morning to leave Tenwek. Though we left it physically behind, I think we will always keep Tenwek, and the people there, close in our hearts.

~Whitney

P.S. There are more posts on their way in order to complete our Kenyan story!

Advertisements
Categories: Uncategorized | Tags: , , , , | 1 Comment

Chronicles of Casualty

Well, 0ver the past two weeks, I (Scott) have made the transition to work in Casualty, which is the name of the ER at Tenwek.  Needless to say, this has been quite the interesting, challenging, and unique experience.  In addition to working in Casualty, I continue to round in the ICU and on the medicine service in the mornings, then cover casualty in the afternoons/evenings.  This double-duty has made the past few weeks especially busy, but Steve, a fellow Duke resident, is also on the medicine service now, so it has been enjoyable working together and brainstorming solutions to a variety of dilemmas.  Below are some of my experiences I’ve had while working the last two weeks.

A tough case:

My first day in casualty was actually rather calm with no trauma cases and no pediatric patients (two types of patients that Internal Medicine physicians like me do not typically provide care for).  However, day two was especially hectic with several minor traumas and an overflowing Casualty unit.  One particular patient was especially difficult.  He was a 17 year old young man who presented with right leg swelling and difficulty breathing.  He had been completely active and healthy 5 days prior, and never had any medical problems.  When I saw him, he was clearly in distress.  His heart rate was very fast, his blood pressure low, rapid breathing, and his oxygen saturations very low at 54% on room air (normal is >90%).  With his leg swelling, I presumed that he had a blood clot in his leg that migrated to his lungs causing a pulmonary embolism (PE), which is a blood clot in the vessels that supply the lungs.  I gave him a shot of Lovenox, which is a blood thinner used to treat the clot.  Ultrasound was done which confirmed the clot in his leg, but we are unable to do a CT angiogram or VQ scan, which are the tests to confirm PE.  Nonetheless, based on his history, it was clear that this was the diagnosis.

Unfortunately, over the next few hours in Casualty, his condition deteriorated.  He became more hypoxic, restless, and developed more labored breathing.  He was still able to saturate ok with an oxygen facemask, but I anticipated we would have to intubate him if he worsened.  I grabbed an ultrasound machine, and did a bedside echocardiogram on his heart.  What I discovered was a massive clot in his pulmonary artery and that the right side of his heart was in complete failure due to the clot.  In the U.S., this would be someone that would be a candidate for thrombolytics, which are potent “clot busters”, however, we do not have that here.  A few minutes after the ultrasound, he suddenly coded, stopped breathing, and his heart stopped beating.  We immediately started CPR, and shocked his heart several times due to an abnormal rhythm.  During the code, his labs came back that he was also in renal failure with a high potassium, which may have contributed to the code.  We continued the resuscitation attempt for about 30 minutes giving him continuous CPR, shocks, multiple drugs, and intubation, but we never regained a pulse.  I was devastated…probably more than any other death I have had in a long time.  I don’t know whether it was that he was so young, or that the cumulative effects of all of the mortalities I have witnessed here, finally taking its toll, but whatever the cause, this death was especially difficult.  After talking with the family, I came home, and was fortunate to have Whitney to help process my emotions, as I was struggling.  That night was a near sleepless night.  I replayed the events of that day over and over again, trying to determine what we could have done to save this boy.  Through prayer and reflection, I eventually realized that no matter what we do for patients, whether in Kenya, or even in the resource rich United States, we cannot always save everyone, which is a hard truth, but the reality.  Although I was able to re-compose myself in order to continuing taking care of patients the next day, I will never forget this patient, and his memory will always be with me.

Happy endings:

Fortunately, despite having several patients pass away, we are able to help the vast majority of patients.  We had a number of patients come into casualty this week that made dramatic recoveries as well.  One such patient, was a 20 year old college student.  She presented with acute lower right abdominal pain that had just occurred 2 hours prior to arrival.  She was previously healthy.  On arrival, she had a very low blood pressure, and severe lower abdominal pain.  We gave her several liters of fluid while awaiting her lab work to return, but her pressures continued to be low.  She denied the possibility that she could be pregnant, but we checked a pregnancy test anyways given her age and presentation.  While waiting for the results, she was found to be very anemic with a hemoglobin of 5.7 (very low).  We ordered emergency blood products to transfuse her, as she was becoming drowsy, and more hypotensive.  We continued infusing fluids rapidly, and eventually her pregnancy test returned positive.  Immediately, based on that result, I suspected a ruptured ectopic pregnancy, which occurs if the fertilized egg implants in the tubes instead of the uterus, and then ruptures.  A quick ultrasound confirmed that there was no embryo in the uterus but a large amount of fluid (likely blood) in the pelvis.  We rushed her to the OR where the OB team operated and confirmed the ruptured ectopic.  She also had >2L of blood in her pelvis, which is why she was so hypotensive.  She is now doing great after getting transfused, and the proper operation. Praise God that she presented when she did, and that we could help!

There are numerous cases such as these of patients who present likely hours from dying, but after stabilization, a careful physical exam, and focused diagnostic workup, we are able to help many patients.  We also have continued to have patients give their lives to Christ while in the casualty bay.  Yesterday morning, casualty was slower than usual with only a few patients in the unit.  Moses, one of the young Clinical Officer’s (equivalent to a PA in the U.S.) who was with me in casualty was very excited about the hour or so with casualty not being busy.  Instead of just sitting around, he excitingly proclaimed to me, “Scott, this is a great chance for us to really talk to our patients about the love of Jesus.”  We walked around spending extra time with every patient and there family about God’s love, the gospel, answering spiritual questions, and praying for patients.  It was awesome to see Moses’ excitement to do this, as if he could not contain the love of God within himself,  but just had to share it!

Mass Casualty

A few days ago was an especially interesting day in casualty.  First off, we were crazy busy.  Our casualty unit has 7 beds, however, that day we had at one time 15 patients in casualty, most sitting in chairs or where-ever they could find room to sit.  By 6:15 pm, we still had 12 patients in Casualty, most of them had been admitted, but were waiting to be taken to the various wards.  However, since we were so busy, our two casualty nurses did not have time to wheel the patients to the wards.  At 6:20, we received a phone call that there had been a serious, multi-car accident, and that 8 patients were being taken by ambulance to Tenwek, and would be arriving in 20 minutes!

Over the next twenty minutes, myself and Steve, took matters into our hands and were wheeling patients all over the hospital trying to clear out the unit for the victims of the car accident.  We quickly wheeled patients to the ICU, medical wards, surgical wards, pediatric wards, and for the ones not yet admitted, we moved them into the hallway to wait.  Before we knew it, we had completely emptied casualty.  This left a few minutes to inform the on call surgery residents, and additional clinical officers, and any other personnel that was around.  We set up eight stations with IV lines, oxygen tubing, IV fluids, and other essentials.

Next came the victims.  Initially, the first two patients walked in and aside for some scrapes and bruises, looked not too bad.  It seemed that maybe this wouldn’t be so bad after all.  However, a minute later 6 patients were brought in, all bleeding, hurting, or even unconscious.  Each consultant and resident assigned themselves to a particular patient.  Since we didn’t know their names, patient were assigned a number based on the severity of their injuries with #1 being the sickest.  The patient I was working on was patient #2.  My patient had a massive laceration of his head with a large hematoma.  He also dislocated his right hip and had a severe fracture of his left arm.  Fortunately he was conscious.  After getting him stabilized and determining the extent of the injuries, he was taken to the OR where he was fixed up.  Patient #1 ended up dying, although everyone else has now been discharged from the hospital.  It was a unique experience for me, since I have little experience working in an ER, and during those previous experiences, never had a mass casualty like this.  It was cool to see the efficiency and teamwork displayed during that chaotic, but effective two hour period.

A few images:

Once again, I could go on and on with countless stories about the interesting cases we encounter on a daily basis, but again I have become more long-winded than I intended.  I am on call this weekend, our last weekend at Tenwek.  I cannot believe our time here is coming to an end.  It has gone so fast, and been life changing!  Please pray that our last week here will be fruitful and cherished, as we say goodbye to friends, patients, staff, etc.  I hope to post once more before leaving.  Anyways, I thought I would end with a few xray and CT scan images from some of the cases I have seen that may be of interest.  Thanks for reading.

This is a young woman that had a large brain abscess (the white ring you see) with severe edema. She came in with multiple seizures, and could not move the left side of her body. We were fortunate to have a visiting neurosurgeon to drain the abscess, and she was recently discharged with continued antibiotics. Pray for her recovery!

This woman presented to Casualty a few days ago after falling off a motorcycle taxi and smashing her head. At the top of the image, there is a large, depressed skull fracture. The fracture caused intracerebral bleeding and edema. Additionally, some of her brain was visible outside the skull. She received emergency surgery, and left the ICU yesterday. She is doing amazingly well with only mild neurologic deficits.

This was the mass casualty patient that I saw (trauma patient #2 as discussed above). Here you can see his humerous (left arm) is fractured in multiple pieces.

This patient was admitted for “asthma”. However, when I met him, I heard what sounded like stridor (a high whistling breathing noise caused by airway obstruction). On examination, he had a massively enlarged thyroid gland that can be seen extending into the chest above. CXR showed his trachea was displaced and extremely narrowed with as little as 1-2 mm left for air to pass through. He was likely only hours from completely obstructing his airway which would cause him to suffocate. Fortunately, we had his thyroid removed, and he did great!

This xray is extremely abnormal. This is an unfortunate woman who came in with severe anemia. She received a unit of blood from a relative on arrival, and within hours of her transfusion, she developed severe respiratory distress, requiring intubation. Her xray revealed that she likely had TRALI (transfusion related acute lung injury) which is a rare reaction to a blood transfusion. Unfortunately, despite our best efforts, she later developed kidney failure and passed away.

This is what disseminated, or miliary TB looks like on CXR. We see this often, and patients tend to do poorly with this, especially if they also have HIV. This woman recovered well and has been discharged home.

Until next time,

Scott

Categories: Uncategorized | Tags: , , , , , | 4 Comments

Create a free website or blog at WordPress.com.