Maintenance

Since I last wrote, Emily turned 9!  :)  She had a fun time having 3 friends sleep over and she heard from some special people in the States. :)  We were going to go to Naivasha, a town about 45 minutes from here, to swim on her actual birthday, but it turned out to be quite cool and rainy.  We decided to make the best of it and go anyway, but the car wouldn't start.  Grrrr.  We have already sent the car back once for repairs.  Maintenance of anything, including vehicles, is an interesting thing here in Kenya.  It is not a straightforward thing to find someone that you can trust to buy the car from or work on the car, and then there is the whole thing about finding/ordering/receiving parts.  Evidently, you can wait weeks to months for parts.  (By the way, if anyone has a desire to look for the weather stripping for the front windshield of a 1996 Toyota Land Cruiser Prado, I would be very grateful for the help!!  The rust from the leak is staining our clothes.)

Other happenings.....we have now weathered our first true stomach bug in Africa.  Not counting the GI problems in Machakos.  Not too bad, all things considered, but I found it quite difficult to manage the laundry when the water stopped coming out of the tap.  What?!!  Why, you ask?  Well, it took me most of a day to find out, but evidently the main water holding tank "failed."  Maintenance again.  So, the tank is old and I don't know all of the issues, but the missionary engineering team here has a plan in place that they are working on to increase both the capacity and the reliability of the water supply.  Hooray!  So, in 4 or 5 months, the water supply should be pretty dependable.

In the hospital, there are some children improving while some children not. Some we are clearly in control of the diagnosis, and some we are still trying to figure out.  Some I am able to pray with, and some I find communication with nearly impossible due to the language barrier.  I am learning that smiles of joy and tears of anguish are universal languages, and in both situations words often add nothing.

 I posted this photo  earlier of a boy with this massively swollen thigh who was wasting away.  Well, Rick took the photo below just before he went home!  Evidently, he had a deep tissue fungal infection that began to improved rapidly when we treated his oral thrush with fluconazole.  I say "evidently" because we never were able to get a tissue diagnosis, culture,  or any kind of confirmation, but he is remarkably better and eating well again.  I saw him in outpatient clinic at the end of this week and he was smiling and looking quite "normal."  The family had run out of the medication, though, so we refilled the prescriptions that he will need to take for 6 months.  Maintenance again....

 Samuel is a little boy that has been here for some time for congestive heart failure, of presumed metabolic or viral cause.  There is a surprising number of small children that come in with heart failure related to the strain of malnutrition.  So avoidable and heart breaking.  Samuel needed to be on a medicine called digoxin to help his heart, but he developed this rash about 5 days after beginning digoxin. 

 So, after a lot of reading, I decided that he may have toxic pustuloderma (a fancy name for a pustular drug reaction).  Do I stop his digoxin and risk worsening heart failure, or keep him on the digoxin but risk the 5% mortality that comes with this reaction? 

 Well, his heart must be improved because he has faired okay off of the digoxin, and his rash is clearing after desquamating.  He is close to being off of oxygen (we think) and will be able to go home.  This is how he looked on rounds this morning. :) (A trial off of oxygen failed.)

We had to talk mom out of leaving with him yesterday.  Actually, I have had several parents this week who wanted to take their children home despite our advice of the need for treatment.  One family still may take their daughter home tomorrow, and I can understand their desperation.  This particular girl has a large thoracolumbar menigomyelocele (a out-pouching of her spinal canal through the skin of her back) which is infected with 2 different bacteria (one of which is Acinetobacter baumannii - yuck!).  She must finish 21 days of antibiotics and then neurosurgery will close this defect.  The estimated bill is 100,000-120,000 Kenyan shillings (around $1200-1400!), if everything goes smoothly.  I think the father is looking at that number and just thinking that it is impossible.  Lots of tears are shed on the ward for fear of not being able to pay.  There is a Needy Children's Fund that is able to help contribute to many patients' bills, but generally they need to contribute what they are able.  The family usually gets an estimate of the bill and then goes out and tries to "find the money," which means that they enlist the help of family and friends.  If you feel led to donate to the Needy Children's Fund, please contact us.  It is a huge help to so many families here that struggle to pay their bills - some of which actually contemplate leaving the hospital when the child would die without treatment.

Here is a very happy mom whose baby has a complicated congenital heart lesion (single ventricle physiology with coarctation of the aorta and patent ductus arteriosus) and who today finished her last day of antibiotics for E. coli meningitis!!   She will be going on Monday for repair of the heart lesion.  Mom was praising God today for her improvement and the chance to have the surgery.  It is wonderful to be able to praise God with the patients who are improving!

Below is a patient in the ICU who is on CPAP.  I won't go into the specifics of his case, but notice the water bottle on the table with the top cut off and the tubing going into it.....that is his CPAP contraption!  If he needs more PEEP (for the medical people), you just push the tube farther under water.  1 cm = 1 unit of PEEP.   I also found out this week that it is common practice to use plastic water or soda bottles as spacers for asthma inhalers.  Pretty ingenious, actually.  If anyone wants to know how to set it up instead of paying $30-50 a piece for spacers in the States (insurance often doesn't cover it), just shoot me an email!

Here is our wonderful Dr. Mardi  in the resuscitation room giving a talk to the nurses about the basics of resuscitating a baby/child.  ABC - airway, breathing, circulation.  I was called to see a baby in the resuscitation room on Friday morning.  Long story short....he had a massive bleed into his head.  The oxygen tank was empty (maintenance....), so they had to go get the one from the peds ward.  So, Mardi has clued me in on the importance of checking for yourself that there is oxygen in the tanks of the 2 resus rooms and supplies in the crash carts - pediatric masks, ambu bags, suction, ETT, laryngoscopes (with batteries!!!), I/O needles, etc. 

Hospital laundry

Beautiful flowers at the "new" house - we move on Tuesday.

A woman cutting hay with a machete on the roadside-presumably gathering for her animals.  It makes my back hurt just looking at this!

We followed this truck for a while on the big highway back from Nairobi - we were a little hesitant to pass on the left!!

Another common site on this highway - to cross the street, they run across 2 lanes of traffic, jump the barrier, and run across the other 2 lanes of traffic!

It appears that some people have knocked down areas of the wall to make it easier to cross.  There are many of these "holes." Reverse maintenance.

A great view of the crater of Mt. Longonot.

I asked the kids at dinner if our medical conversations are different here than in the States (the curse of a two doctor family).  Anna said "yes, you used to talk about injuries and ear infections, and now you talk about whether a child will die or not."  Fairly accurate.  I have been praying for specific kids with the girls when I put them to sleep recently.  I did that some in the US, but not often enough.  Hence, they are fairly aware of how sick the children in the hospital are.  Emily has learned to make these cute little finger puppets lately, and recently asked me to give one to a child in the hospital.  I gave the first one to this little girl with nephrotic syndrome (note the puffy eyelids) - she loved it!  Emily made several more today for me to give out - I can't wait! :)

This bird has caught a nice breakfast!  He flattened it several times with his beak and then swallowed it whole.

 I know I have mentioned a number of things that belie some degree of frustration on my part.  I'll be honest, some things here are incredibly frustrating.  On one particularly frustrating day this past week, Emily was complaining to me about how her memory work was hard - to which I replied that sometimes hard is good because it makes us better.  And then I heard what I was saying....to myself.  Ouch.  James said something similar:

     Blessed is a man who perseveres under trial; for once he has been approved, he will receive     
     the crown of life which the Lord has promised to those who love Him.

In fact, he went a step further by saying that I should by HAPPY about it.

     Consider it all joy, my brethren, when you encounter various trials, knowing that the testing of      
     your faith produces endurance. And let endurance have its perfect result, so that you may be    
     perfect and complete, lacking in nothing.

And Paul said in Romans that I should even be EXCITED about it!
 
     And not only this, but we also exult in our tribulations, knowing that tribulation brings about 
     perseverance; and perseverance, proven character; and proven character, hope; and hope does not
     disappoint, because the love of God has been poured out within our hearts through the Holy Spirit 
     who was given to us.

So, joyful endurance and perseverance = crown of life, perfect and lacking in nothing, HOPE.
And, hope does not disappoint.  

Please pray that I keep the hope ever before me and do not get bogged down in the frustrations.

Love,
Sarah
James 1: 2-4, 12
Romans 5:3-5