Safari tales...

So on a lighter note as I complete my time here at Tenwek, I want to tell you all about my one little excursion while here. A group of us went on safari two weekends ago, as many of those who come here to work tend to do. We went to a place called Masai Mara. It was fantastic!
Technically you stay there in tents, but man oh man the tents! It’s basically a hotel room with tent canvas walls. It’s on a concrete slab and has electricity and hot water for the shower. The bed was beautiful, and the mosquito netting around it was almost romantic-looking. I could definitely see why people would vacation there. They had a pool and patio dining for lunch. Breakfast and dinner was indoors, but the “lodge” was very handsomely designed by itself.
The day we arrived we were escorted to our tents to freshen up a bit before the first “game run” of the weekend. Now, no hunting is allowed so I guess it’s odd they still call it a game run, but old habits die hard I suppose. So we meet up and divide up into our “cars” for the weekend, as we’ll have the same driver the whole time. Someone in my group was smart enough to ask for one of the “open” landrovers so that you can just look out the side without having to stand up to get an unobstructed view. The first game run was fantastic. It started by us seeing some little gazelles called Dik-Dik (because they always come in pairs)…warning, I’m not sure if I’m spelling any of these names correctly… Then we saw some antelope-creatures called Topi. Then in the distance we spotted some elephants. It was interesting to hear the native Kenyan’s take on elephants. They actually don’t like them much. They are very dangerous as they can easily kill a man and they destroy trees which can destroy habitat. That said, they are part of the “Big five” for a reason. The big five are the five most dangerous animals to be seen on safari. They include Elephants, leopards, lions, rhino, and buffalo (here the cape buffalo). We also saw giraffes shortly after the elephant. We ranged all over and I was definitely turned around by the time it was all over, but it was great. We saw Thompson and grant gazelles (slightly different sizes and colorations). We saw wildebeasts (also know as gnus), several birds that I’m sorry I forgot the names of at the moment. It started to rain part-way into that first game run and as we were going along a cheetah was spotted under a tree. We were able to get close and take some really good pictures. We eventually headed back to the lodge for dinner and bedtime.
The second day began with a very nice gentleman greeting me from the outside of my tent with a nice “Jambo” which is kinda the touristy hello in Swahili and a wonderful cup of Kenyan coffee! (I will definitely miss that wake-up call). The day then started with a morning game run at 6:30. That morning we were, I suppose you’d say lucky, and spotted a lion in some bushes. My land rover had looped around in order to get a better view and take pictures when he decided to get up and move…he proceeded to walk right in front of our vehicles and sedately walk into the bushes on the other side…oh my, that was exciting to say the least. We later saw a lioness with four cubs, which apparently is a large litter and isn’t often seen. We saw rhinos that morning, vultures (3 kinds), and an eagle just to name a few. So at this point we’d seen four of the big five…just missing the leopard.
We then headed back to the lodge for breakfast and a break for the morning. The pool was wonderful (and doubly nice to know I wouldn’t get any surprises in the water…). Before starting our game run, we went to a local village of the native Masai people. It was interesting to see how they live and what their lives are like, but it was a very touristy experience. It was a lot like they were putting on the show and we were spectaters. I wish I could go to a village like that and really get to know them well, but at that time it was just not the setup. They're a semi-nomadic people. they build these very small houses, term is rather relative, out of mud, cow dung, and wood supports. They stay in the same area for about 7-10 years then move on to better grazing areas for their cattle and build new homes. It was neat and somewhat sad to see the conditions they live in, because as a doctor I definitely saw the lack of sanitation and couldn't help but feel for these people. They also have a small "market" where they sell trade items like carvings and beadwork and fabric. It's over priced, but you're supposed to bargain and it goes to help support the school that the children attend nearby and help those families of widows and orphans in the tribe.
After leaving there, we went for the afternoon game drive, about 3 hours out looking at God’s gift of creation, and this time we saw another male lion and got incredibly close. We also saw hyena, jackal, ostrich, baboons, more vultures, of course more gazelles/zebras/antelope/wildebeests/cape buffalo/giraffes. It was so much fun and amazing. It’s neat being out early and late in the day because the colors as the sun rises and sets are phenomenal.
We got back and played some cards before having another great meal for dinner (barbeque!) and turning in for the night.
The final morning we were there was interesting. The night before it had rained (we are in the rainey season right now) and the roads were already muddy, but now even worse. Thankfully land rovers can handle a bit of mud. We were seeing a lot of animals and ranging all over when one of the land rovers got stuck in a large area of mud. Our driver had actually just gone through that area, but we must have been lucky because the next one didn’t make it. So it was quite entertaining as we watched our fellow safari mates stuck in the mud. Thankfully with some chains and a bit of pulling by our rover, they were unstuck and able to continue on safari. We ended that morning with going to an area of the river that flows through the conservation land that the hippos love. There were so many of them! It was amazing and you could see more of them than normally in deeper areas of the river. Its neat how they go underwater and all you can see are their nostrils and then they come up and snort and flick their little ears (granted I’m sure little here is rather relative to their size).
After the last game drive we headed back, cleaned up, and checked out. Normally the driver would have been there at 1030am to pick us up to go back to Tenwek, but because of the roads they had hoped to be there by noon. I think they finally got there at 1pm or so. We were riding in this van things that are used for public transportation here called Matatus (again, not sure on the spelling). They’re pretty sturdy vehicles, but even the best isn’t up to a lot of mud. So on the way out they got stuck a few times and some of the wonderful guys in my van helped out with pushing and we made it through.
It was a great blessing of a weekend to really appreciate God’s creation and just marvel at the wonder of it all. It was also nice to have a rest before coming back to a rather busy and stressful week with many ups and downs. I of course of tons of pictures and have some of the others as well and will post some of mine as soon as I get back and can…(internet here doesn’t handle us uploading pictures very well).
I will write some more of my final days here within the next day or two, but I figured I’d make good on my promise of tales from safari.
I miss all of you back home and hope everyone is staying healthy!

Troubling Day

Okay, Today has been a very interesting day.
A 10 month old boy who came in in severe respiratory distress. Although we don’t typically diagnose asthma at 10 months of age, that’s what his exam and chest x-ray really pointed to. We admitted him to the ICU and tried aggressive management, similarly to what I’d do in the US. He kept getting worse, to the point that we had to intubate him and place him a ventilator. I know before I told some of you we didn’t have vents, and that’s true for the little babies, but we do have ones for older infants and pediatric patients. The thing is vents aren’t my forte and they make me fairly nervous. But we got him stabilized that night. The problem is the medicines I have available here for an asthmatic on a vent are somewhat limited. I threw everything I could at him and did a lot of praying. As I told one friend, this is a very humbling and terrifying experience. Because last night I knew that he was completely in God’s hands. There was absolutely nothing else I could do for him. This morning he seemed to be doing better and I told the family that he was at least staying with us, but would have a lot of improving to do before we could get him off the vent. Late this afternoon I was emergently called to the ICU because his oxygen levels went way down. The entire ICU team was fantastic and we tried and tried, but it was like trying to push air through a straw into a vat of wet cement. Despite all of this his oxygen levels wouldn’t come back up and after what seemed like forever we had to stop because his exam was indicative of brain death. I think this has been the hardest death for me here, having to say everyone they had to stop because he was already with God was really difficult. The family didn’t blame me or seem angry, but grief doesn’t need an interpreter. I’ve talked with others who helped in his care and they all agree there isn’t anything else I could have done, but it still hurts. There is comfort knowing that God knows all of our days before we even live one and that all is according to his plan. Right now I just pray for His peace with accepting this death.
I know I keep promising tales of safari, but not tonight, I’m sorry. A group of us went last weekend and it was fantastic, but at this moment it almost feels like it was ages ago.
I am praying that I can continue to make a difference here and really make the most of the few days I have left. I’m on-call all this weekend, so please pray for a good rest tonight and wisdom during rounds and in the wee hours of the morning.
Missing you all…
Anne

Working hard...

So, I know I haven’t written much over the past week. Things have just been that busy. On Easter Sunday, I went to a sunrise service then worked in the hospital so that I could get oriented before I was on-call. Oh yeah, I may not have mentioned it, but here I’m acting as the attending. I have a group of interns who see the patients on call and page me with admissions or questions. So I learned something about the patients that Sunday and then tried to prepare myself for my call night the next night.
The things I’ve seen here are so interesting. Oddly enough a lot of meningitis. I’m not sure why outside poorer hygiene conditions or patients wait so long to seek medical help simple infections get out of control. A lot of the Kipsigis (local people of this area) believe in “herbal medicine”. I was curious about this because some of this medicine seems to cause acute liver damage and really messes with all blood cell lines. So in the past the herbal remedies were passed down in the families and were actually often helpful, or at least not harmful. Over the years as Kenya has moved toward “modernization”, the recipes have been lost and people now get their herbal medicine from, I can’t describe them, I guess the closest would be a bush pharmacist, but that’s not right either. The problem is the newer remedies aren’t tried and true and who knows what’s in them! Either way, the remedies delay other medical treatment and often worsen the course due to these nasty side effects.
On my first call day/night, things went fairly well. The night before my fellow pediatric resident, Susan, admitted a baby who had been born at home, umbilical cord cut with a kitchen knife (hello tetanus…) and had progressive difficulty breathing, so they had come here. As best we can tell, the child had cyanotic heart disease, most likely due to a congenital heart lesion, as we couldn’t get the pulse oximetry (yes we have that here) about 83% on any amount of oxygen. We ordered a chest x-ray, but that didn’t happen, and it wouldn’t have really changed our course of treatment. We would have done an echo, but the one and only machine is broken. The baby continued to grunt (sign of difficulty breathing) and be hypoxic (low oxygen) all day long. That night I was called to the nursery because she had stopped breathing. We attempted to resuscitate the baby, but there was no hope, she never began breathing again. Overall it was sad, but not overwhelmingly so because I know even if I had saved her then, if she had a serious heart defect we couldn’t fix it surgically here and the family wouldn’t be able to afford such a surgery in Nairobi. In a way I could say it was for the best and now she’s in a better place, but at the same time in the US this child would never have died. We would have had a diagnosis and medicines or surgeons who could have saved her.
Since then I haven’t lost any other children, not that none have died, but not while I’ve been on call or called to. I’ve seen all sorts of things, lots of typhoid, malaria, and rheumatic heart disease. The heart disease is interesting because in the US, we’d never see it due to ready use of antibiotics. There are young teenagers or sometimes even younger children with congestive heart disease/failure due to rheumatic heart disease—so I’m managing something in the US only cardiologists would handle.
I had another interesting and sad patient. He presented with classic symptoms of meningitis before I came and was being treated appropriately with antibiotics. When he didn’t respond, we switched him to some antibiotics we don’t readily use in the US, but have decent coverage. When he continued to not respond Susan and I started reading of other causes of meningoencephalitis as his condition had deteriorated. She ended up reading about some of the viral causes and for whatever reason I read on TB meningitis. Now TB is present here in a higher incidence than in the states, but it’s still not hugely prevalent. And this child had no known exposure and although the symptoms and progression fit, it seemed unlikely. Then the day after I read this and while we were rounding, the nurse came up to me and says that two family members are being treated for TB! We had asked previously and the dad had said no. Unfortunately despite started the right TB drugs, he has not improved and I’m not sure if he will. From what I can tell the prognosis is poor based on his symptoms at the time of treatment.
It’s not all doom and gloom though, we send patients home often and in better shape than when they came in. Although sometimes you discharge a patient and they’re here for a while afterward because they can’t leave until they pay their bill. It’s an odd system, but it’s the only way Tenwek can continue to do the work it does. There are funds available to help, but they still need to pay part of it themselves. There are other hospitals who require payment on admission for the presumed diagnosis otherwise you can’t receive treatment. There is some insurance here in Kenya, but it is very rare for our patients to have it. I’m not sure if more Kenyan’s have it in Nairobi or note.
Well, I should head to rounds now, but I promise I will try to be better about writing. Next edition…Safari!

Wow continued...

Okay, so sorry my tale is taking so long to tell, but I left off at my arrival in Nairobi.
So after staying the night there, my driver Gerrold and I stopped at a local grocery to pick up a few supplies I wouldn't be able to get at Tenwek. Then the next four hours were a bit of an adventure. Near Nairobi the roads were actually fairly good, a little crowded because it was a four day holiday weekend for Good Friday and Easter, but well-paved. Then as we approached the Great Rift Valley the area became much drier and barren looking but still full of life. There's a really neat tree called a cactus tree that grows there. In this area they're working on the road in many places and you actually have to drive on the "shoulder" for a ways until the road isn't so riddled with large potholes. Further along they've recently paved, so it was smooth sailing from there. As we continued we entered greener and greener lands until we finally arrived at Tenwek.
That night I got settled into the guesthouse where I'm staying while here and met the many other volunteers here...peds, PT, ortho, medicine, FP with a slant towards OB/Gyn...and topped off the evening with a Good Friday service. Of course after that I crashed and slept for about 12 hours.
I actually didn't work the next day, so I tagged along with a group working with the Community Health Program here. Through their work they help to prevent a lot of what I may seen in the hospital. They work with groups to provide dairy goats that they can maintain for milk. Dairy cows are more expensive and the families tend to sell the milk rather than keep it in the home because it's a money-maker whereas goat milk isn't. In order to have the goats the families have to arrange a set-up for zero grazing, meaning the food is brought to the goat. This helps cut out parasitic diseases and improves sanitation problems with animals running about. Another program they do is in placing bio-sand filters in homes. (I have a picture I'll upload later) The filter provides clean water for the family without the need to boil then filter water. In order to have one the family has to meet certain criteria for good sanitation, otherwise it doesn't matter if the water is clean. They have to have a designated latrine, a specific place for refuse, a place to clean dishes outside, a clothes line to clean linen, and separate place for animals. All of this is wonderful for health prevention. There's a ton more they do, but those were the big things we saw that day.
I also have to say I've never felt so welcomed before. I was introduced to chai and chibati bread in the family's home we visited. Chai is a staple here, it's basically tea steeped in milk to which a lot of sugar is normally added (thank God for my insulin pump). They have it regularly here in the hospital. God has definitely been working in the group I met that day. They are part of a church here and are trying to establish what's basically a granary to help store maize. Right now what tends to happen is that it gets sold cheaply during harvest season to groups based in nairobi and then sold back at much higher prices during the dry season. It's a vicious cycle that these people have the foresight to try and break. They are doing so much with little that it's truly a blessing to have met them and been able to understand how hard they work and how thankful they are for what they have.
I have to get back to work right now, but next installment: first morning in the hospital!

Keep praying for these people and please pray that God will give me the wisdom to help them as much as I can.

Wow

Well, as you can now guess I made it across the big wide ocean safe and sound. I mainly slept on the first flight, but on the second flight I was awake the entire way. It astounds me how much american television non-americans watch, both on the plane and after when a swedish man was asking me about levels of training and he said his knowledge was based on american TV. Looking out the window on the flight was fantastic! I believe the mountains I saw were the Swiss Alps, but I don't know for sure, but man are they a testament to God's creation! And I didn't know from the sky you could see mirages, but I think you can...as we flew over what I think was Egypt I saw vast deserts. On the edge of your vision it would look like an ocean, but as you moved forward you'd find it was just more magnificent desert.
My arrival in Nairobi went fairly smoothly, although the visa line was long and slow I got my visa without a hitch. Finding my ride was the interesting part. Apparently a famous Jamaican band came in on my flight and there was a large group out front that had been waiting for them and it turned into this jam session...right where I was supposed to find my ride. So here I am, this lone little mazunga (white person), wandering around desperately looking for someone holding a sign with my name on it...thankfully he found me in the crowd. Another medical mission doc, Dan (ortho), was there picking up his inlaws for their visit so I could start asking some questions about Tenwek and what to expect. That night we stayed at the Mennonite guest house which is a beautiful place. It used to be a british barracks, but long ago was converted into what it is now. It has a gorgeous garden and pretty dining room with all these windows to let in the morning light.
Well, I'll try to write more later (internet can be a little fickle as we're in the rainy season right now)...

D-day at last!!!

Yes, it's that fatefull day...Departure Day!
I'm finishing up my last couple hours of my nightfloat, up-all-night, crazy-lady shift before I go grab my bags and fall asleep in one of many airports to come.
I was excited to recently find out that there's another pediatric resident at Tenwek right now named Susan. And small world, she's also going to be a peds heme-onc (blood and cancer disorders) fellow starting this summer!
So at this moment I think I'm actually too tired to be either excited or nervous, but once I sleep I'm sure both of those emotions will come back full-force!
I really appreciate all of the well-wishing and notes of prayer for me and this trip. I really feel God is going to do some great things with this trip.
So the next time I post something it'll be from Kenya (or possible Amsterdam as that's where I'm connecting through). Here's hoping TSA and luggage security abroad doesn't wonder too much about my odd medical donations I'm taking...

Countdown!

Well, I'm just barely over two weeks from my departure date!
I'd like to send out a big thank you to everyone for the prayers, support, and encouragement -- It's been really touching to know that all of you have really helped me along with this crazy venture of mine.
So I started this blog pretty much for the sole purpose of keeping in touch while I'm there. Thankfully I will have internet access, but they would like us to keep whatever we do online fairly simple as their access can be a little finicky. So unfortunately this means no pictures while I'm there, but I'll definitely load them as soon as I can when I get back.
Right now, I'd really appreciate prayers for good health (getting over my second cold in the last 3-4 weeks), safe travels, and an ability to pack wisely! (I'm trying to take some much-needed supplies when I go).
I'm definitely excited at this point to see what God has in store for me there, but I'm definitely nervous because I know I'll be challenged -- in ways I can predict (medical knowledge with diseases I just don't see in the US) and ones I won't even see coming...
I'm not terrific at blogging, but I'll try to be good while I'm there so I can keep you all in touch.
Again, thanks a ton for your support and encouragement and please keep the prayers comin'!