Posts Tagged With: Tenwek hospital

Mt. Kenya: Pre-climb and Day 1

On September 14th at 7:05 AM I was scarfing rhubarb-apple-crisp-oatmeal out of a bowl I carried as I hurriedly wound my way through the dukas surrounding Tenwek Hospital until I arrived at a small green and white one.  The woman I was to meet there at 7:00AM hadn’t yet arrived.  I relaxed, taking a moment to enjoy the last bites of my oatmeal, and trying to relax my mind with its whirling To Do! list and instead relish the still quietness of the early morning as the sun lit the colorfully painted dukas around me.

Yes! The guesthouse kitchen garden had rhubarb! This Midwestern girl was DE-lighted when she saw this on her first day at Tenwek.

It was our last morning at Tenwek.  We would leave this beloved place today for another one of our “Kenyan Adventures,” but this time we wouldn’t be coming back.  The adventure in front of us was the biggest yet.  We planned to climb Mount Kenya, the second tallest mountain in Africa.  This was the reason I was outside of this small duka at seven past seven in the morning.  I had an appointment to get my hair braided with “lines” across the top and braids down the back.  I figured perhaps, with my hair braided, I wouldn’t feel quite as gross as I would otherwise after five days without a shower.

At 8:55AM, with two-thirds of all my thick hair stretched into tiny tight braids across my skull, my anxiety became too much and I told the woman braiding my hair I was very sorry, but I had to go, we did not have time to finish.  Scott had been left with empty suitcases and piles of stuff on the floor to pack and our driver was due to arrive at 9:00AM.  As I ran back through the dukas with my empty cereal bowl and my hair partly braided, I got a call from the driver saying he and his co-driver were nearly there.  And so it was that we left Tenwek that Friday morning in our usual style, a rather stressful rush.

We did our best scrambling and managed to get all of our stuff together and on the road with our driver friends, Antony and Isaac, reasonably on time.  We drove through Nairobi, dropped off the majority of our luggage, and proceeded to Mount Kenya with two bulging duffel bags crammed with sleeping bags, sleeping mats, winter coats, long johns, pants, long sleeve shirts, ponchos, hats, gloves, and lots of wool socks.

Arriving at Castle Forest Lodge on the south side of Mt. Kenya, we took a cup of chai at the lodge’s restaurant with our drivers before they left us and wished us the best of luck up the mountain.

Castle Forest Lodge. We had chai with our drivers on this veranda and dinner that night was inside this old, historic house.

As it was not yet dinnertime, Scott and I retired to our bungalow to make sure we had everything we needed to climb the mountain packed as efficiently as possible and sort out what needed to be in our light-weight day packs and what the porters could carry.  At dinnertime we feasted on an intensely green, pureed spinach soup that was so good it had me wondering if this Kenyan-trained chef hadn’t added some truffle oil to it.  The coconut curry chicken that followed was equally as impressive and you can bet that before we departed on our five-day hike the next morning I had in my possession a handwritten copy of the chef’s chicken curry recipe.  The elusive sweetness turned out to be mango chutney.  Now you know, go add it to your curries!

Anyway, back on track as there is much to cover . . .

DAY 1

After a much-needed great night’s sleep, we woke up the next morning at 6:00AM giddy, excited, and nervous.  We had breakfast at the restaurant, and met our guide, cook, and porters who would be taking us up the mountain.

Our crew, trying to fit everything into their giant backpacks the morning we left. This was done with much haggling about what I assumed to be the weight of some items compared to others.

In our party there was Scott and myself, our guide Maina (My-na), our cook Moses, a porter/cooking assistant/waiter/vocal, opinionated jokester Georgie, the head porter Bruno, and four other porters who would help carry everyone’s tents, gear, water, and food.  In total, we made a group of ten.  These Kikuyu men had grown up on the south side of the mountain and were some of the only people in the world who could show us the way to the top of Mt. Kenya using the Kamweti route.  The Kamweti route is a string of elephant trails and it is rarely used; in fact, the last time someone had used it was in February.  Due to this, we were guaranteed to see no one else outside our group until the third night at our base camp before the summit hike where we would join with the popular Noru Moru route.

We started the day’s 17 kilometer trek by walking through 8Km of forest on an old logging road before reaching a morning break stop for chai.

The only time on the Kamweti route that we would follow a visible trail.

Going up!

We knew that a year and a half ago a charging elephant had killed a woman hiking around the Castle Forest Lodge area, so our heads were constantly on a swivel.  Our eyes searched behind trees, through bushes, and up and down hills looking for the looming elephant.  God heard many prayers and appropriate scriptures claimed to help calm our nerves and put our trust in Him who puts breath and life into everything and can calm stormy seas—aka stop an animal from charging us in the name of Jesus!

One of the many elephant turds we crossed over. As you can see, they are very uniform with a cylindrical shape. This one looks like it’s a day or two old.

This is my “I’m slightly nervous there might be an elephant behind me” smile

Where we breaked for chai was the old village grounds of our guide, Maina. He had lived here as a child but the villagers were asked to leave by the government since they were inside the Mt. Kenya park lines and the government felt their living there might damage the natural habitat. Sad.
About the bags, they are my attempt to keep my feet dry! My porous running shoes would let water in, but my hope was the plastic bags would keep my socks dry. By Day 3 I had two layers of socks and two layers of plastic bags, worked wonderfully on that day!

After our chai break, we left the logging road and continued on through a bamboo forest using elephant paths and occasionally a machete to help hack our way through.

Bamboo forest, not sure why Scott is waving like that. UPDATE!  Scott has told me that he’s holding up five fingers because we had walked five miles at that point.

This picture illustrates well the “path” that we were on. Clearly, we would have been totally lost without our guide!

Almost to our lunch spot.

Our prayers for safety continued as we climbed higher up and over hills leaving the bamboo forest behind entering our first bit of bog where you had to be careful where you stepped lest your shoe get soaked through with water.  We rested here for lunch enjoying tomato soup and tomato and cheese sandwiches.

The afternoon portion of our hike took us through indigenous forest with beautiful trees covered in Spanish moss and others that had clusters of pink flowers on them resembling clusters of red grapes hanging all over the branches of the tall trees.

Tree draped with moss.

Pink “grape cluster” flowers on the trees above us.

We passed through more bogs that had “meadows” of Forever Flowers and purple thistle-like flowers.  It was all new to us and very beautiful, but we hardly had time to take it in or stop for pictures because Maina, our guide, moved so quickly through the forest and the bogs.

Forever Flowers

Scott and Maina standing on over-saturated ground

Afternoon break. Loudmouth (I mean that affectionately) Georgie is front and center.

I had a more difficult time making my way through the bogs in my old, porous running shoes. (They were all I had!  The hiking boots I could have borrowed were too small!)

A bog filled with Forever Flowers, tall purple thistle flowers, and grass clumps.  Beyond the bog is one of our porters and Maina heading down into the valley where we would camp that night.

After stopping to take the picture above, I hurried to catch up with Scott and the guide who had continued on.  I hopped and jumped from one clump of grass to the next and in my anxious haste I slipped off a clump of grass.  As I slipped, I reached out to catch myself and my hand got all cut up by a Devil’s Horse Whip plant.  With my hand bleeding and my shoe soaked, I felt thoroughly sorry for myself as I plodded along after Scott, who’d stopped for me, and the guide, who had continued his swift pace down the hillside and was now far in front of us on the way down to our campsite.

Me, holding my cut left hand up, walking after Maina down to the river we would camp by that night. Scott had taken the camera from me after my fall. Maybe he was trying to help or maybe he was worried I would ruin the camera, probably both.

At the bottom of the hill, we crossed over a small river and Maina actually helped me (which helped to end my brief pity party) across the river and then it was just a couple hundred meters to our campsite in the river valley.

Look what we found at our campsite! This horn belonged to an African Buffalo. Also a very dangerous animal, especially when they are alone and not in a group. Our tent is behind Scott.

The view out of the front door of our tent.

The view from our bathroom, a.k.a. the open area behind the back of our tent. Tehe. 😉  Up above you can see some of those pink flowering grape cluster trees.

Our camp. The crew’s tent is the green one in the foreground. (Still not sure how all 7 guys fit in there. I couldn’t have done it, that’s for sure.) The kitchen tent is to the right and our tent is in the back left.

That evening for dinner, Moses made the best fish and chips we have ever had, along with popcorn, a platter of fresh, tropical fruit, and chai, of course.

The dark kitchen tent in the evening.  Moses is on the right working his magic preparing our dinner over two kerosene burners.

During dinner, the porters and Maina sat around a campfire and dried this poor mzungu’s wet running shoes.  We retired to bed that night happy to have survived the first day and nervously excited about what the next day would hold.

To be continued . . .

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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!

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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

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Strength

Short Story Bios Part II:  Jocelyn*

I, Whitney, met Helen, a hospital chaplain, at 11:00AM to round and pray for patients in the surgical ward, but before we could go, we first we had to “take chai.” Taking chai is a requirement. If you like chai, it is a luxurious requirement. We took our chai with the other hospital chaplains who proved to be a very warm and welcoming bunch. Once our bellies were filled with the sweet, milky tea, Helen and I set off to the women’s surgical ward.

The wards at Tenwek, and throughout Kenya, are big, open rectangular rooms with a row of beds lining each of the two longest walls. (For a patient to have a semi-private room they must either have tuberculosis or extra money.) We made our way into the ward and stopped at a bed one-third of the way down on the left side. The thin and delicate-looking woman in the bed had been mangled.  Both arms were wrapped in bandages from her fingers up past her elbows. The tip of her left, middle finger was missing. Because her gown was too big on her, you could see through the armhole that her torso was also wrapped in bandages. Her face was swollen, with fresh scars across her forehead that circled down and around her closed, puffy right eye. On her left cheek was a smaller slash.

Helen pulled the woman’s right eye open with her thumb. The woman’s right eye remained motionless, unseeing, and did not move with her left eye as she talked with Helen in Kipsigis. When Helen had finished talking with her about her eye and how she was doing that day, Helen rested her hand gently on the woman’s shoulder and turned to me. “This, is Jocelyn. She has been here for three weeks. She is a Christian.” She then turned to Jocelyn and told her in Kipsigis who I was and why I was there. I smiled at Jocelyn, who smiled sweetly back at me and tried out my name saying,

“Whi-ney?”

“Yes, Whitney. Chamage?”

“Mising.” She said with another smile, pleased that I knew a word or two of her language.

Helen asked Jocelyn if she could share her story with me.

“Aay,” said Jocelyn with a nod at me.

Helen fixed her eyes on me and became serious as she began to tell me Jocelyn story.

“Jocelyn and her husband had been having “difficulties” so she had gone to stay with her parents. She had occasionally done this before at times when he had beaten her badly.  Her husband was also a drunk.  She had been at her parents’ for a few days when he came to her parents’ home at a time when she was there alone. Perhaps he had been waiting and watching to see when she was alone. He came into the house and attacked her with a panga (a double-edged short, flat, sword). He attacked her so violently that he was surely meaning to kill her.”

“Oh,” I said taking it in as my eyes examined the evidence of his attack.

“Her eye?” I asked. “Will she be able to see with it again?”

“No.”

My eyes rested on the missing end of her left middle finger. Helen turned, exchanged a few words with Jocelyn, and turned back to me.
“She tells me her finger was cut off when she grabbed onto the sword tightly to stop him from cutting and stabbing her.”

A bold visual of a woman hunched in a corner with her hand protectively reaching out and grabbing the swinging sword as both the man and the woman cry out sweeps through my brain.

“Does she have nightmares of this?” I ask Helen who translates.

“Yes, she says every night.”

“Oh,” I manage with a nod and Helen continues the story.

“Some villagers had heard of the attack and came and attacked her husband, beating him. Jocelyn was taken to Tenwek. When she woke up in the ICU, she learned that her husband had been badly beaten by the villagers and that he was taken to another hospital. Then she learned that after three days in the hospital, he had died. Her husband is dead.”

“Oh,” I said again, unsure whether to be happy or sad that her husband had died.

“Maybe,” began Helen, “if he had come to Tenwek, we could have told him about the Lord,” said Helen leaning forward raising her eyebrows. “But, he was not brought here,” she said as she leaned back again, “and he is dead,” she concluded with a nod.

I nodded with her processing this information. Her husband was dead. Did God have him die as a blessing to Jocelyn? I was glad, in a way, that she was rid of such a husband. But did she somehow love him? Was she sad? Happy? Her husband being dead could also be a financial burden if he had earned money for the family. If she had kids, how would she care for them and find enough money to feed and clothe them and pay for their school fees?

I asked Helen if she had children who confirmed with Jocelyn, who didn’t look over 30, that she had five boys and no girls. In Kenyan culture, children and especially boys are a prized thing. People would say that she had done well for her husband. But now, how would she raise five boys on her own?

While I was thinking through this, and what Jocelyn future might look like, Helen had been conversing with Jocelyn and now stopped to tell me that Jocelyn children were at her parents-in-law and they had never come to see her the whole three weeks she’d been in the hospital. This was not a good sign. Why had they not come to visit? Why had they not let her children visit?

“Do her parents-in-law blame her for her husband’s death?” I asked Helen.

Jocelyn told Helen that in the years past her parents-in-law never tried to correct their son and tell him not to beat her. To them, it was best to pretend the beatings did not exist. She was not sure what they thought now, but hoped she would be able to get her children back without any problems.

Helen then asked me to pray for Jocelyn, telling me that Jocelyn was able to understand some English.  Jocelyn, Jocelyn’s younger sister, Helen, and myself all bowed our heads and we prayed to God together as I spoke aloud.  Helen and I then moved on to another patient’s  bed and prayed for her and the baby she lost, and then we moved onto another patient, and another, but it was Jocelyn that I could not get out of my mind.

Would you please pray for Jocelyn too? Please pray for:
• Physical healing. That her wounds would not inhibit any work she might do to earn money
• Emotional healing:

  •  Pray that God can be near to her, heal any angry feelings she might have towards Him.
  •  After years of being beaten and now with a scared face, her self-esteem might be pretty low. Pray that she defines her value on God’s scale. That she know she is a Princess having been forever adopted as the King of Glory’s child. Let Jesus be the lover that she never had. Let her feel the love and strength in his steadfast, tender and healing embrace.
  •  Pray that her nightmares stop in the name of Jesus

• Provision

  •  She must now provide for her family of five boys
  •  She was discharged from the hospital last week, but her bill for her surgeries, drugs, and 3-plus week stay was Sh200,000 or $2439.00.  This cost is actually much, much lower compared to all other hospitals in Kenya (and obviously the U.S.), but Jocelyn really has little to no money.  When I last saw her, her family had managed to pay Sh9,000 ($110.00) of the bill.

• Whatever the Holy Spirit leads you to pray for

Thank you!  I know she’ll feel your prayers.

~Whitney

*Name has been changed

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A Confession

School has been out for two and a half weeks now and I (Whitney) have been doing a variety of different things, coming into contact with many different people.  I would like to share some of their stories here in a series of “short story bio” blog posts.  I plan to share the stories of Timothy, Joselyn, Tabita, Evette, Edna, and Mercy.  Some of their stories are inspiring, and others sad, even cruel, but unfinished.  I hope you enjoy meeting these people as much as I have.

Part I: Timothy

School had been out for four days and Scott and I had just returned from an amazing trip to the Masai Mara.  While we were unpacking and settling back in, our land-line telephone rang.  I answered the phone and identified myself.  The voice on the other end of the crackling line was an unfamiliar one and clearly Kenyan.  I was able to make out that the person said her name was “Helen.”

“Helen the guesthouse cook?” I asked puzzled.

“No, I am Helen Tongus, chaplain at Tenwek Hospital.”

This statement piqued my already heightened curiosity even more as I had not met any of the hospital chaplains yet, and I had no idea why one would know me or call me at home.  I asked how I could help her, hoping to figure out the reason of this mysterious call, but first she had some questions for me,

“Are you the one who has been teaching at Dr. Steury Memorial School?”

“Yes.”

“Were you teaching students who were around 11 years old?”

“Yes” I answered again, becoming slightly nervous at this interrogation.

“Why?”  I asked, happy to ask a question of my own and hoping to understand what was going on.

“There is a boy, one of your students, he told me that something you did made him very uncomfortable.”

Gulp. My sympathetic nervous system kicked into full gear and silence ensued as my brain processed this information zipping along at lighting speed alternately running through any potential scenarios in the last few weeks that could have possibly made someone uncomfortable and at the same time shouting jumbled exclamations in my head of

“No!  I’m innocent!  Ahhh!  What did I do?!  I’m doomed!  How did I get myself into this?!  Stupid!  No!  I’ve been framed I tell you!  Please no!  All I wanted was to help and now I’m RUINED!  But wait!  Wait!  I don’t even know what I did!

During my silence Helen decided to continue her interrogation.  “Did you give your students a test or homework or something?”

“Yes, homework,” I responded.

They asked for homework!  It wasn’t my idea!

“And I think you told them, like many other teachers do, not to copy from each other?” “Yes.”

What’s so wrong about that?   It’s right, other teacher’s do it too, you even said so! However, I did do something other teachers don’t do, I made frosted banana cookies and gave them to the kids who got the extra credit problem right.  Do you know about the cookies Helen???  You see, I’m not a real teacher, so I could not give them extra points, but I wanted to reward them in some way.  Is that wrong?  It probably is.  Maybe that’s what made him uncomfortable?  It is probably a terrible violation of some Kenyan cultural tradition that I didn’t know about.

“And when you marked their papers, did you ask them if they copied?”

Alright Whitney, you’re going to have to start talking sometime, just be smooth, nonchalant.  Innocent until proven guilty, right?  Act innocent!

“Ahem. Yes, I wanted to make sure that they did not cheat so I checked their papers very carefully looking for work that would indicate that they had done it themselves.  If I didn’t see enough work to support the answer of the math problem, then I called them to me in the teacher’s office, where I was correcting their work, and had them explain how they arrived at their answer.  One boy admitted that he had copied so I told him I couldn’t give him credit for that problem, but everyone else was able to explain, to a reasonable degree, how they found the answer to the problem.”

Helen continued, “Ok, so this boy is, I think, one of your students.  Last week his parents noticed that he was not acting like himself.  He was quiet . . . He was not active . . .  They were worried that he was sick, so they took him to Tenwek.  The doctor in Casualty [Tenwek’s Emergency Room] evaluated him and said that there was nothing wrong with him and told the parents he was not sick.  I thought to myself that maybe the boy had something else wrong with him, something emotionally disturbing him.  So I asked his parents if I could take the boy aside and talk with him.  He was able to confess to me that he had been picking on his neighbor kids and he had also copied his homework from his friend and then lied to his teacher when she asked if he had done it on his own.   He felt very badly about this, so much so that he felt physically sick.  He had been told that God sees and knows everything you ever do, and he knew that God had seen him cheat and lie.”

“Oh.” I said, wondering at this turn of events, this boy’s story and curious as ever what Helen’s agenda was in calling me.

“I then prayed with him and we asked for God’s forgiveness because he knew that he had sinned against God.”

“Like David.” I managed dumfounded, thinking of Psalm 51:4.

Helen:  “Yes, and then I explained to him that all was forgiven because he had confessed and asked God for forgiveness with all of his heart.  That Jesus had already paid for that sin on the cross for his sake.  So that he could become the righteousness of God, clean and perfect before Him.  I told the boy he had nothing more to be worried about, he could now feel comfortable having confessed to the Lord.  Still, he told me that he wanted to see you and confess to you, his teacher, and ask for your forgiveness too.  I tried to find you that Friday afternoon, but I was told you were in the Mara.  So, I called the boy on Saturday, after he had confessed to his parents, and I prayed with him and encouraged him then.  He still wanted to meet with you and confess to you, so I am very happy to have reached you tonight and I would like to prepare a time to meet with me and the boy, Timothy.”

“Yes, yes please.  Anytime is good for me.” I stammered.

Aye!  Wow. Oh Lord, this boy and his pure, sweet, uncontaminated spirit humble me.  I am honored to be a part of this.  May he never become jaded to sin and accept the world’s tolerance level.  May he always desire to be clean, and therefore near you, as he does now.  Thank you for the indwelling of your Holy Spirit convicting him.  Thank you that he heeded your Holy Spirit and did not find ways to justify himself, even though his peers may also cheat and lie.  May I also be this sensitive to my sin, I don’t want to deceive myself, may I be weary when I find myself reasoning and justifying.  Thank you for this boy’s example.

I met with Helen, Timothy, Timothy’s mother and younger brother three days later on Wednesday.  Helen led the conversation and Timothy told me what had happened and asked for my forgiveness, saying that if I forgive others, our heavenly father will also forgive me.   I thought this was so sweet, that his reason and plea for me to forgive him, was so that I too could be forgiven by God, a quote of Matthew 6:14.   I assured him that I forgave him, praised him for listening to the Holy Spirit’s convicting and humbling himself, leaving his pride, which enabled him to admit that what he had done was wrong.  That is hard to do!  I encouraged him that all had been forgiven by me, Helen, his parents, and God, and that now he could grow in his faith and walk closely and joyously with God.  When we have sin, it’s like a wall that separates us from God and we can’t feel close to him, but when we confess it, that wall is removed, gone forever, and we can be in communion with our loving Father again.

On a scrap of paper, I had written down some thoughts and favorite verses that I go to when I have sinned and wonder at God’s forgiveness.  I gave this to Timothy and encouraged him to read through it.  I also included Psalm 32:1-6, which reminded me exactly of him and his story.

Helen asked me to close in prayer, I prayed, Timothy and his family left, happy, and Helen and I rejoiced at Timothy, his character, and how his mistake had caused us to meet.  We planned for me to round with her on the surgical ward the following week.  This arrangement caused me to meet Josephine and Evelyn, two women with unique stories that I will share here in the following days.

For now, peace and blessings to you!

~Whitney

“Great peace have those who love your law, and nothing can make them stumble.” Psalm 119:165

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Miracle at Tenwek!

Hello all!  Scott again.  I wanted to share a story from the medical ward. 

The patient I want to share about is a patient whom I will call Harrison.  Harrison is a delightful young man in his early 30s who came to us with considerable shortness of breath and hypoxia (low blood oxygen saturations).  After taking a history, performing a physical exam, reviewing his chest xray, and having his sputum evaluated in the lab, we diagnosed him with tuberculosis and started treating him for this.  Incidentally, his labwork revealed severe kidney failure.  The kidney has many jobs, including getting rid of potassium and maintaining an optimal pH (acid-base status) in the body.  Since his kidneys were failing, he had a profound elevation in his potassium, and was severely acidotic.  The cause of his kidney failure was quite unclear, and our investigation did not reveal a cause.  Unfortunately, despite our initial treatment approach, his kidney function had worsened the next day, and his potassium level and pH had reached dangerous levels.  At this point, seemingly the only available option was dialysis.  However, in Kenya, dialysis is only offered in two cities, and is extremely expensive, with few able to afford it.  I explained to him that without dialysis, I was worried his heart would develop an arrhythmia and he would likely not survive (this is what commonly occurs when potassium reaches his level), and his ECG was already showing abnormalities from his potassium. 

We next had a family meeting with his wife, brothers, sisters, and parents.  He and his family are primarily farmers, and were already in hard times financially as much of their maize (corn) crop had been wiped out by a fungus.  They determined that if they sold a few of their cows, they would be able to raise enough money for at least three dialysis sessions with hope for eventual improvement in his kidney function.  I hated to put his family in financial hardship, but he was so young, and I was really hopeful that dialysis would possibly be merely temporary if his kidney function improved.  I called the referral hospital in Eldoret, a city a few hours away to arrange the transfer, but they said it would be several hours before they would be able to accept him.

Next, I updated the family on the situation and told them it would be a few hours before he would be able to be transferred.  By this time, I had developed a nice rapport with the patient and his family and we discussed various other life issues, which was made easier by their excellent proficiency in English.  He and his family were people of tremendous faith in the Lord, and they were trusting God for a miraculous healing, and trusted that his will would be done.  Before I left, they asked me if I would be willing to pray for him.  Here at Tenwek, we commonly pray with our patients, but it struck me that despite knowing he was very ill, I had not taken the time to pray for this patient.  I proceeded to pray, and I must say, while praying something came over me.  It was as if words were coming out with such ease, and with more confidence than I had ever prayed.  I knew from a medical standpoint, based on everything I have ever learned and experienced, that urgent dialysis was needed.  Yet, for some reason, I thought God was revealing his glory through this patient.  After praying, I left and prayed again by myself for God to intervene for this patient.  I sensed he was moving, so I grabbed a needle, and lab tube, and went back into the patients room to re-draw blood to recheck his kidney function (even though we had just checked four hours earlier).  I brought the tube to the lab, and just waited in the lab for the results to return.  In my head I knew it was silly to expect his kidney function to suddenly improve without any intervention, but yet I held onto that glimmer of faith, that maybe, somehow, God was actually really going to intervene.

Anyways, 30 minutes later, the technician had finished running the sample.  He handed me the printout of his labs.  My eyes went right to his creatinine, which the lab we used to measure kidney function…the higher the creatinine, the worse the kidney function.   His creatinine had dropped by more than half, meaning his kidney function had more than doubled!  Additionally, his potassium levels had considerably dropped,and his acidosis was much better!!   I honestly could not believe what I was seeing with my eyes!  This sort of thing does not just happen.  With essentially little to no treatment, over those past four hours, his kidney function suddenly and rapidly improved.  There was no medical explanation for what I was witnessing, and only God could be behind what was happening.  I was so excited to tell the patient the results, however, on the way back to his room, I honestly was overcome with emotion.  I will admit that I found a bathroom, locked the door, and just broke down after experience the glory of God revealed in this way!  Finally, I gained my composure, and delivered some of the best news I have ever been able to share with a patient.  There was so much joy in that room, and we all gave thanks to God for what he had done. We cancelled the transfer to Eldoret as he no longer required dialysis.   I eventually left the room, did several fist pumps and was able to proceed with the rest of the day.  I will never ever forget those moments, and my faith continues to expand in new ways.  The Tenwek motto indeed was true…We treat, but Jesus heals!  I am happy to say that over the next 48 hours, his kidney function completely normalized, his potassium levels are normal, as is his pH.  Also, he was weaned off oxygen and is completing his TB treatment.  He returned yesterday for his 10 day followup from discharge, and continues to do amazingly well with absolutely no symptoms.  Praise God!!

As I left the hospital that day, a motorcycle taxi (called a boda boda) crossed the road right in front of me.  Many of the boda bodas will have a message of some sort on the rear of the bike.  This particular bike had on its bumper, “Jeremiah 33:3.”  When I got home, I read this verse which reads, “Call to me and I will answer you and show you great and unsearchable things you do not know.”  This was such a fitting verse to end the day, and I am sure it was God’s way of reminding me to continue to call out to Him, and he will continue to reveal himself to me in new ways!

Thanks again for reading and sharing with me in celebrating another Miracle at Tenwek!  I have another incredible story from just today of a really amazing recovery in one of our patients, but I will save it for another time. God Bless!

 

Scott

Image

Myself and Dennis, a Kenyan intern, rounding on the medical ward.

 

 

 

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“You are married? But you have no children? Why?”

Hi there!  Whitney here.  This post is a few thoughts about one of my cultural observances here so far.

I have been asked the questions listed in the title of this post by almost every Kenyan I’ve met here.  The first time I realized it was confusing and odd for Kenyans to learn I was married, but without kids, was when I was speaking with Amy, who works at a duka near the hospital selling fresh produce.  She introduced me to her three year-old, Victor, and asked me if I had any kids, to which I responded “No.”  Later that day I was walking with Scott and introduced him to Amy as my husband.  The next day when Amy saw me she asked, “When did you and Daktari (Kiswahili for doctor)  go to marry?”  “You mean, when did we get married?” I responded to Amy assuming she accidentally used the wrong verb tense in her sentence.  She shook her head and asked again.  Perplexed, I answered her that we had already been married for four years and that we were married in June of 2008.  Amy’s eyes grew wide with comprehension and disbelief upon hearing this.  “You are saying you married for four years?” she asked.  “Yes,”  I responded, happy that she understood.  Amy explained, “I didn’t understand the other day.  I thought you not married since you have no children.”  At this point, I think I looked away and shrugged bashfully.  After a pause, she asked the question that was preying on her mind, “Why you not have any children?”  Her tone and body language indicated that she could have been either sad or worried for me and was ready to comfort me.  I then explained to her, as clearly as I could so she would understand, a reason or two for why we decided to wait to have kids.

This encounter happened the first week here, since then I’ve had multiple similar conversations.  When traveling to a community health clinic with a woman named Jane, she recounted a story to me of how she didn’t become pregnant until nine months after she was married and her mother grew very worried about her forcing her to drink some bitter, herbal drink thinking it would help her get pregnant.

Then, this weekend I hiked with some missionaries and interns to the top of Mount Motigo (the one Scott did earlier and posted about) and at the top there was a group of school kids.  I spoke with them and they asked me where my mother was. (Kenyans think I’m quite a bit younger than I am–a good self-esteem boost!)  I responded that she was in the USA and I came with my husband.  The next question was “Where are your children?”

The school children at the top of Mount Motigo

Me explaining that I don’t have kids. 😉

I mentioned this story yesterday to some teachers in the staff room at school. (I’ve been helping and teaching at a primary school here–I love it!)  Surprised, Janeth (a science and Kiswahili teacher who is my age) asked why I did not have children.  Samuel (a math teacher) cut in and said “What!?  I thought you had two or three!”  “Really?” I said.  Samuel replied, “Yes, it is a given.  That is why I never asked you if you had kids because I ‘knew’ you did.”  Wanting to better understand the reason for this belief, I asked why people here think you have kids as soon as you get married.  Janeth’s response was a quick, but solemn, “It is a must.”  “But why?” I pushed only to have her say with more emphasis “It is a must.”  Perplexed, I looked around the room for further explanation.  I learned that it is an big honor to have children and culturally it is a woman’s duty to bear children for her husband.  In some tribes, like the Maasai, the number of children you have signifies your wealth and family status, even though having so many children can overstretch the families budget.  Also, a few generations back it was widely accepted for a wife to pick out a second, younger wife for her husband so the younger wife could bear him even more children.  The younger wife’s relationship to the elder wife would be that of a servant to a master, with the husband ruling over them both.  This is because in Kenyan culture the groom’s family must pay a high price (up to ten cows) to the bride’s family for their daughter.  Thus, it has been expected that the bride will work hard for the groom and serve the groom.  When the elder wife would pick a younger wife, it was elder wife who paid a price to the younger bride’s family, in a sense, “buying” the younger wife.  Elder wives picked younger wives because if they did not pick one, then the husband might grow restless and pick a mistress for himself.  Thus, however humiliating or painful it would be, it was better for the elder wife to have her choice of girl/woman and to have the formal arrangement of second wife and rule over her.  These traditions of multiple wives are no longer practiced immediately around Tenwek, but do still exist in a few parts of Kenya.  Due to these traditions, it is still very important in the culture today to get pregnant and have children as soon as possible after getting married.

So that is what I have learned about this so far.  What do you think?  Questions?

I hope you enjoyed this “Cultural Observance: Part I” installment of Tenwek Files. Until next time!

Peace to you and in you,

Whitney

P.S. We are going with a group this weekend to Kakamega Rainforest this weekend and are quite excited! Hopefully we’ll have some good pictures!

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First Weekend on Call

Greetings!  Scott here.

Well, I just finished my first call weekend, and although it was a bit crazy and hectic, I survived, as did almost all of the patients.  The call weekends here a tough, however, since you are on call for 48 consecutive hours, and the only medicine doctor available.  Therefore, I had to cover the entire medical service, all the medicine consults, the ICUs, and all new admissions.  In total, that included rounding on ~60 patients a day, which was exhausting, exciting, and of course interesting.  I am slowly adapting to the lack of resources, and am learning on the go.  I thought I would share a few brief stories below:

-On Saturday, we had a women present with a severe nose bleed.  She had severe thrombocytopenia (low platelets) which prevented the bleeding from stopping.  In the U.S., we could give a transfusion of platelets, but we do not have platelets here.  Instead, in order to give platelets, a relative has to donate blood to be given.  No relative was available with matching blood type.  We proceeded to pack her nose with gauze, and held pressure, but she continued to bleed into her mouth, suggesting the bleed was coming from the posterior (back part) of the nose.  In the States, we would use a “Rhino Rocket” (device that goes into the nose) or have the vessels cauterized by an ENT specialist.  Unfortunately, she was losing blood fast and was developing hypovolemic shock (very low blood pressure) from the blood loss.  On a whim, I grabbed a new Foley catheter (the type that goes into the bladder and is used to drain urine).  I placed the catheter through her nose and into the back of her throat.  Following that I was able to blow up the balloon of the Foley in the back of her throat, pull the Foley back out her nose, and the balloon caught against the back of the nose, compressing the bleeding spot.  The bleeding stopped with this contraption long enough for us to be able to tranfuse her!

There have been several other situations in which I have been stretched medically, and have done things I have not previously done such as bone marrow biopsies, administering chemotherapy (typically done by oncologists…we don’t have them here), and I even did a pericardiocentesis.  This procedure is typically done by trained cardiologist under imaging guidance, but again, no cardiologists here.  We had a woman with a large buildup of fluid in the sac around the heart (likely from TB) causing pericardial tamponade, which means the fluid is making it difficult for the heart  to beat.  We attempted to treat the TB with hopes she would improve, but she worsened, and actually coded.  I had read how to do the procedure just that day, and actually performed the procedure following the code.  I inserted a syringe under the ribs, pointed toward the heart, advanced (praying I would not hit the lungs, blood vessels, or heart itself.  Eventually, I reached the pericardial sac, and we were able to drain a few hundred milliliters of fluid and she initially improved, but unfortunately died two days later.

She was only 35, and she joined several other very young patients that have passed away.  Amazingly, a few patients have gone against this trend, as we have had a 100 year old, 115 year old, and believe it or not, a 120 year old patient on service.  It is crazy to think that the 120 year old patient was born in 1892, which likely makes her one of the oldest, if not the oldest living person in the world right now!  She is still going too, after being discharged this weekend!

The daily death here can be difficult, but it offers a chance for amazing spiritual conversations and prayers with the patients and their family.  The majority of patients are Christians, but many patients are not believers.  In fact, just today, we had a 24 yo patient, with advanced cancer, give his life to Christ.  He did not grow up Christian, but has been coming to Tenwek for the last few months for his care.  He said that he noticed something different about the nurses, doctors, students, janitors, administration here, and he wanted to know what it was.  He told us today, that he has discovered that what this “difference” was, was the love and peace of Jesus Christ.  Today during our conversation, he told us that he wanted to give his life fully to Christ.  We prayed with him, and he accepted Jesus as his savior!  Praise God!  It is amazing how as Christians, whether a doctor, nurse, teacher, custodian, administrator, business person, or anything else, our attitudes, conversations, and love can reflect Christ to the world.

There is so much more I want to share, but I once again have become quite long winded.  Next post, I will share about a truly miraculous story of healing that I witnessed over the weekend, but I will save that for another time!

Anyways, thanks for reading if you made it this far.  Below, I just wanted to share a few pics from a hike that Whitney and I did last week with a few other visiting missionaries.

Blessings,

Scott

Whitney and I after reaching the river near Tenwek.

 

Here I am at a different part of the river with William, a visiting medical student from Ghana.

On our way back from the hike, we somehow ended up in a cow pasture, we needed to reach the gate in the background of the picture, however, there were several cows, and most notably one very large bull blocking the way. We opted to turn around and find a different way back, rather than mess with that bull!

We ran in to theses three adorable kids on our way back.

Waterfall just below the Tenwek hydroelectric dam.

 

 

 

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