You know you are in Africa when....

*you no longer bother to chase bugs out of the shower.

*the power goes out in the grocery store, your home, or even in the middle of the high school play and no one even flinches or interrupts their conversations.

*the few cars in the "doctor's parking lot" are not from this decade, this century, or even this millenium!

*there are iron bars on all windows and doors.

 



















 *it is not surprising to find patients' parents doing their laundry when you enter the room.

*you have to enclose your shamba (garden) not to protect from deer, squirrels, or birds but from the monkeys.  (ours is the right side of this photo, behind the under-construction chicken coop)

 









 


*"doing laundry" may mean hanging it to dry, taking it down to avoid the rain, then putting it back out again, bringing it back in...  (two times up and down is my personal limit!)

*spa/manicure appointments are out of the question, but "free body massage" is the norm while driving

*"Mom, can we ride on top of the car?" is not an unusual question, and the answer is frequently "Yes!" (in Kijabe, not on the highway!)

*On any given day, I - a general pediatrician - am likely to be mananging Tb, malaria, pneumonia, HIV, rickets, liver disease, congestive heart failure, asthma, meningitis, congenital heart disease, UTI, severe acute malnutrition, or a variety of syndromes

 *a friend's video makes me laugh until I cry, because I have seen wildebeests in acton (The Dumbest Animals Alive!)  https://www.facebook.com/photo.php?v=10151273861093646    

*your neighbor yells "it's big and it's hairy and IT'S IN MY HOUSE!!" and it isn't her husband, it is this: 



*morning activities may include helping to "herd" your neighbors chickens

Anna made these - Reece's, eat your heart out! ;)

Love,
Sarah

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

 

Mashujaa Day

Today we'll have a history lesson. :)

Friday was Multicultural Day at RVA - a day that has grown out of respect for Kenyan history and the people among whom we live and serve.  Kenyatta Day (which was Saturday) is a national holiday that honors the first Kenyan president (Jomo Kenyatta) after Kenya gained independence in 1963.   Last year, the new constitution changed the name to Mashujaa Day, or Heroes Day, to recognize that there were many heroes involved in helping Kenya gain its independence.  In Kenya, there is no school on Kenyatta/Mashujaa Day, so a few years ago RVA began a new tradition of celebrating Multicultural Day - fitting because there are students from 28 or 29 countries this year!  It is a day that the students can both celebrate their heritage AND learn about and appreciate so many others.  There is a flag ceremony at the end of the assembly during which 1 or 2 students carry their country's flag and say something in their language at the microphone, while the national anthem of that country plays.  Many of them were dressed in the traditional clothes of their country.  It had a very Olympic feel and was quite touching.  During Olympic opening ceremonies - and during this flag ceremony - I always like to imagine how all the peoples of the earth will one day worship God together and what that will actually be like.  Mind boggling, inspiring, exciting!  Enjoy a sampling of countries (and please forgive my lack of cropping!).

Madagascar

New Zealand

Norway

Republic of South Sudan - as you can imagine, there was a lot of cheering for him!  His life at home must be quite different than his life at RVA, but you can't distinguish any difference as he interacts with his peers from all over the world.

Uganda

Singapore

United Kingdom

United States-I was surprised by the emotions I felt when these kids started down the aisle amid raucous cheering.  It is hard to be a cultural minority and to be so far from home and everything you are used to.

Kenya - I really shouldn't have been surprised that Kenya was saved for last.  After all, we are all here in this country to serve and work among these people!  The sound in the auditorium was, in a word, deafening when they started down the aisle!

After the assembly, there was an event called the One World Run which is an international 5K race to raise money for AIDS orphans.  Rick, Ted, and Anna ran, I walked and photographed, and Emily cheered us all on!

Ted sprinting for the finish line!

A silly photo after finishing 25th at 7500 feet. :)

Rick actually smiling as he finishes!  He has not been running here, but still finished in under 30 minutes!

Here comes Anna!

Emily with Julia, one of her favorite friends from our time in Machakos. :)

That evening there was a pickup "American football" game (you have to distinguish it from football/soccer here) followed by fireworks on the field.  There was also a perfectly stunning sunset!  The mushroom cloud on the left is a rainstorm in the valley....

The next day was the school carnival, which is not unlike our Fall Festival back home.  The girls each dressed up with their "Big Sisters," while Ted dressed up as Pajama Heroes with our friend Julia. :)

Macaroni and Cheese

Hawaiian Hula Dancers

Pajama Heroes or Pajama Mashujaa!

This is our first full week in the hospital and we begin taking night call.  We are still trying to wrap our mind around the sorrows and the joys here at Kijabe Hospital....but will save that for another post.

Love,
Sarah
Ecclesiastes 3:1-13

Things I thought I would never see....

The title is not a judgement...just a true statement.  There are things that I might have consciously thought that I would never see, and then there are things that I happen upon and think "Wow - I never thought I'd see that!"  There are a lot of the latter here in Kenya! 

Flip flops made from old tires - very impressive and practical recycling! They are appropriately called Treads.

Ok, really - how do I describe this?!  This guy is actually rollerblading down the HIGHWAY leaving Nairobi.  To say this is not a safe road for rollerblading is the understatement of a lifetime.

The next 2 photos are of a Somali boy's thigh and his MRI (for the medical types; he had the MRI at another hospital).  While it is obvious that he has a very swollen thigh (mass vs. infection), it is not so clear how the skin findings are related.  And why are the lesions in a distribution that is sharply demarcated at either end of his thigh?  It turns out that the family tried to use traditional medicine to heal his thigh by burning him with hot metal rods - 2 months prior!  The family obviously did it out of love, and - before we snort and judge -  it is not that different in philosophy than the early American practice of "bleeding" a patient.  At any rate, the uncle volunteered that they would not use traditional medicine again....an interesting comment, since the boy is still so very sick after almost 2 weeks here.  The double language barrier (English to Swahili to Somali) with this Somali family is difficult - I cannot just sit down and talk with the family.  There are many patients together in his room, and some of the other patients just jump in and start translating.  There is not the same concept of privacy here.  Sometimes it is helpful and sometimes it is downright confusing, with everyone talking at once!   Please pray for this boy, Ahmed, as he is so sick and not responding to treatment.

Right thigh

MRI

Part of the surgical pathology lab

Other part of the surgical path lab - notice the barred door.  Bars are ubiquitous in Kenya!

This is a silly one, but many of you commented on the photo with all the different beans, so you may be interested.  All this came out of one 0.5kg bag of beans - half of it is little stones!

Coolest bug in Kenya (so far)!  I learned last week of another bug, called a Nairobi Eye, that causes a chemical burn if you smash it on you.  I wonder if that is why so many people don't brush flies away (if the bug in question is a Nairobi Eye instead of a fly, they will end up with a nasty burn!).

I was called to the post-op area to see this 2 year old girl with some respiratory distress after surgery.  Her oxygen saturations were upper 70's-80 (out of 100%) when I arrived, but came up easily with oxygen.  At one point, I stepped away to answer a call and, when I came back, the nurse had given her a piece of hard candy (!) to distract her from the nasal cannula.

This is the official hospital memo regarding chai time for employees.  Patients are served chai also!

The next picture is a head CT that belongs to a 14 year old boy named James.   He came in with severe headaches and degenerated to hallucinations, weakness, and focal neurologic symptoms.  There is a fund here called The Needy Children's Fund, which basically helps fund procedures and some costs that families can't afford.  It is a huge blessing to families, but it only has so much money in it (from donations), so it has to be tapped judiciously.  I am still trying to navigate our involvement in the financial aspect of things since we are asked daily to help one patient or another, but this was the first patient that I okayed paying for something from the Fund.  His family is scraping together money from extended family to pay for the hospitalization/medications, but they couldn't afford the CT and ambulance ride to Nairobi to have it done.  You don't really need a medical degree to see that there are round lesions in his brain that aren't supposed to be there.  Tuberculosis, toxoplasmosis, neurocysticercosis?  He seems to be better over the last 24+ hours on TB meds, and his mom is praising God for his improvement.  This is why we are here.

It is spiritual emphasis week at RVA, which is a time for the students/faculty/parents to reflect on their walks with Christ.  At last night's worship time, I took this photo from behind students in grades 7-12.  I was so touched by the sincere worship of these teens...what a testimony to me!

Love,
Sarah
“For I know the plans that I have for you,’ declares the LORD, ‘plans for welfare and not for calamity to give you a future and a hope.” Jeremiah 29:11