"Vac" Begins

As any school has, RVA has its own lingo.  The time between terms is not called break or vacation, but "vac" (which rhymes with break).  So, to mark the beginning of this Vac, and to get away as a family before our homestay, we went to a little cottage about an hour from Kijabe that is owned by a family with children at RVA.  It was in a beautiful setting - a mature acacia forest with abundant wildlife.  Thankfully, the directions that were given to us were pretty clear, because this is a screenshot of google maps on my iphone as we drove along the dirt road that did not, in fact, end:

View of cottage/yard from behind.

The cottage was simple but more than adequate - a bedroom and bath downstairs, open room with kitchen, eating area, and sofa, plus a loft upstairs with 3 twins for the kids.  Rick described the steps to the loft as "navy steps," and I made Emily come down backwards to hold on better!  The hot water was provided by a wood fire system that actually worked great and provided hot water as long as the embers were burning.  Ingenious, actually - we would really like one in Kijabe!

Wood is added where you see the glow of embers, and the hot water is collected in the tank on the wall.

The first morning was nothing short of magical - a symphony of bird songs that I had never heard before.  I wished I could have recorded them to remember later.  I haven't looked up the birds yet, but here are a couple of my favorite shots....

This is a colobus monkey - they make a horrifying racket at night!

We drove into Naivasha both days to explore - the view from the roof of the car was as much fun as anything.  We saw lots of cows, goats, and sheep - and even camels, but my favorite was the children waving and yelling greetings to us. :)

View from the roof rack - Emily's favorite seat!

 One day, we explored Hell's Gate National Park - an area that reminded us of the region of Colorado around Mesa Verde.  We were thankful to have a guide, John, to show us around and get us out of their safely.  John is a young Masai man who lives about a 20 minute walk from the gorge.  He told us that he has been giving 3-5 tours 7 days a week for the last 8 years - I couldn't help but notice that he was wearing well-worn dress shoes.  I was embarrassed by our comparatively nice shoes, still far from new, and the knowledge that we each had several pairs at home.

This entrance to the gorge wouldn't pass any kind of regulations in the US.  We entered the gorge through this "Emergency Exit."  John told us that the water quickly rises 30 meters during heavy rainstorms.  We were thankful for a sunny day!

Magnificent!  God's handiwork is stunning!

This dead-end made us feel really small!

Having lunch at a little Indian restaurant behind a gas station that was recommended to us. :)  Eating out is a rarity that I really appreciate now.

Anna learned how to make Peppermint Patties!  Yum, yum!

Love,
Sarah

Psalm 8

Lord of all creation
of water earth and sky
The heavens are your Tabernacle
Glory to the Lord on high

Chorus:
God of wonders beyond our galaxy
You are Holy, Holy
The universe declares your Majesty
And you are holy holy

Lord of Heaven and Earth
Lord of Heaven and Earth

(God of Wonders by Third Day)

Thanksgiving

Thanksgiving - a distinctly American holiday.  There are many "harvest festivals" in various countries that have been celebrated over the years, and Canada actually has a similar Thanksgiving celebration in October, but the origins of the first American Thanksgiving are unique.  The first Thanksgiving was a feast in 1621 with the Pilgrims and the Native Americans - a time to celebrate and thank God for the provision of food for the Pilgrims through the help of the Native Americans.  They would not have survived that first year, if the Native Americans had not stepped in and taught them how to farm and fish in their new surroundings. 

As I paused at the beginning of ward rounds yesterday and explained to the Kenyan residents about our American Thanksgiving (I didn't talk about football, because I didn't think it would make sense - but you and I understand!), I realized two things.  Shared backgrounds really are a bond between people because, although they listened politely, they just don't have the same frame of reference. The second thing I realized is that in this new land that we have come to, we have also needed a lot of help and instruction from the people already here (both Kenyans and missionaries) in order to adjust and thrive.  Going to a new culture and land is difficult, and you have to be ready to ask for and accept help and advice - we are thankful for all the new friendships and help as we have acclimated to Kenya and Kijabe!  We are also so very thankful for our friends and family back home who sustain us with encouragement and prayers.  :)

So, did we celebrate Thanksgiving here?  Yes!  It was a school day for the kids and I worked, but we had a huge potluck dinner with the pediatric department/peds surg/neurosurg/ortho in the evening.  Everyone brought their favorite foods, and it was delightful to have the traditional American foods, but many with a twist that we hadn't had before.   We brought an apple pie, homemade rolls, and broccoli casserole.   Our kids wanted the broccoli casserole, which was so amusing - they didn't love it in the US, but they insisted on having it here!  Do you know that the recipe specifies that you must use frozen, not fresh broccoli?  Well, I just finely chopped it and boiled it and - voila! - "frozen" broccoli.  ha!  

Broccoli casserole

Ted's partially filled plate

Our Thanksgiving celebration! :)

I heard on the radio a few years ago that the average American eats 7000 calories on Thanksgiving Day - wow!  That is a lot of food!  Here are some more animal photos, all depicting them eating...

Ostrich

Zebra

Rhino

Elephants

Thomson gazelle

Bird outside of our window - I haven't identified yet

Lion eating wildebeest

Vultures "cleaning up" a lion kill

What many of you did after eating yesterday!

We play football or walk on Thanksgiving, so we don't look like this. :)

Sunrise at the Mara

With a thankful heart,
Sarah

I Chronicles 16:34
O give thanks to the LORD, for He is good; For His lovingkindness is everlasting.

The week in review - medical segment.

I have decided to have a nonmedical and medical post this weekend, which gives you some flexibility in how much you want to read about the nitty-gritty of the hospital.  Most people seem to like the medical aspect, though,  and I will try to explain things in "regular English" too.  :)

The ward is busy right now (15-18 patients each day this week), and I think the type of patients are fairly typical of an average week.  I continue to be impressed with the high level of medical care that is provided to these kids with debilitating illnesses and conditions, but the reality is that we cannot always provide everything they need. 

Joseph is a 17 month old boy who came in with tuberculosis and congestive heart failure.  He was found to have an elevated left hemidiaphragm on his first chest xray, but the stomach bubble looked normal and it was unclear why the left hemidiaphragm was elevated.  That xray was not good quality and only PA (straight on, as opposed to from the side).  Lateral chest xrays are very difficult to get here, even if you order them.  

Joseph hanging out on his bed, doing much better than when he arrived.

A subsequent xray showed actual loops of bowel in his chest.

So, this little boy had a previously undiagnosed congenital (born with) diaphragmatic hernia!  (His stomach/intestines and spleen were in his chest cavity instead of his abdomen.)  When he was stable enough to go to the OR (called theatre here - even the spelling is British), he was repaired by our incredible pediatric surgeon, Erik Hansen.  Below is his immediate post-op xray, and he was doing beautifully!

Post-op...looking good!

Another little boy, named Philemon, also came in with a diagnosis of tuberculosis.  He had been on appropriate medications for 6 weeks but had continued to worsen.   Unfortunately, he was too sick already and there was not much we could do for him.  He acutely decompensated on the floor and was taken to the ICU, but died shortly after arrival.   He was our one death on the ward this week.

Notice the large pneumatocele on his right, not to mention the diseased lung tissue.

After the pneumatocele burst, his right lung totally collapsed.

Victory is a little boy who has one of the most patient, gentle mothers that I have met here.  She doesn't speak much English and my Kiswahili is still very rudimentary, so we can't have a conversation, but I love to watch her with him.  I thought he was going to die 3 or 4 weeks ago before we got a handle on his infection - and he needed blood but it took 3 days to find blood that matched his type!  She waited patiently with him, sharing his bed, and has never questioned what we are doing.  They have been here such a long time, but they may be ready to go home on Tuesday!  I asked mom how far away they live - 12 hours by matatu (a little Kenyan minibus packed with people)!!  Imagine being in a hospital with your very sick little boy for weeks, and then having to get into a crowded minibus and travel 12 hours home.  We have to plan to have his discharge ready early so they can catch an early matatu.  Please pray that he gets to leave and makes it home safely - I am going to miss them.

As I have mentioned, Rick and I are covering the pediatric ward during the week right now, but when we take call we cover kids in the ICU and nursery too.  A couple of weeks ago, I went to the delivery of a 27 weeker - she was 970 grams....that is 2.1 pounds!   She did not even need to be intubated, but breathed on her own with the help of CPAP (continuous positive airway pressure).  What a champ! :)

Baby M right after stabilization.

Baby M a couple of weeks later - not even on oxygen! :)

On my most recent call night, I was called to the resuscitation of a 37 weeker, who actually looked more like a 34 weeker.  She was only 1.45 kg, or 3.1 pounds, so she had not had a very healthy intraunterine life.  She looked like such a serious old woman who had already had a hard 8 months or so!  She needed oxygen, but I think she will do well.

Back to the ward, this little baby was admitted for severe malnutrition and rickets, but she is otherwise a totally healthy and developmentally normal 5 month old......only she weighs 2.7kg.  That is about 6 pounds.  She is only crying here because she didn't want to be undressed - she was a cute little thing often playing with a couple of small toys her mom had.  If you look closely, you may be able to see the knobs on each rib that one gets with severe rickets - in medical slang, it is called a rachetic rosary.  I had never felt one before coming to Kenya, but now I have felt many.

Six pounds at 5 months.

Mom wanted me to take a photo with me too. :)

On Friday, I had to tell one mom that her previously healthy 10 month old will never be normal, presumably because of the recent meningitis she had.  Also that day, I had to tell two different families that their daughters had cancer.  They both have a fairly good prognosis....if they are able to be treated.  One has Non-Hodgkin Lymphoma - that dad was stoic and focused during the entire conversation.  He asked good questions, but I could not get a good feeling for whether he would take the girl (a 5 year old) for treatment.  They live fairly close to a government hospital that offers chemotherapy, but the waiting lists for treatment are long and the costs are prohibitive for some families.  The other girl is still an inpatient in Kijabe - she came in with new onset severe headaches and seizures.  We were able to get an emergent head CT for her which showed a likely low-grade astrocytoma.  I think we will have to use the Needy Children's Fund for her MRI (about $200) to better delineate the tumor to see if she is a surgical candidate.  Kijabe Hospital has a very good neurosurgical department, so she is in the right place here.

During my talks with these families, I have found them to be very open to praying together - whether just with me or with the chaplain too.  The chaplaincy department here is so important - they come visit with the patients, learning about their lives and needs in a deeper way than we can; they come to family meetings that bring bad news to bear; they follow up with patients and families and help us know who needs financial help; they really care about these families and want to model Christ's love to them.  I am so thankful to be on a team with them!

For the most part, the patients have to overcome tremendous obstacles to be treated - transportation, finances, time away from family obligations or work.  Last week on Thursday, a father came to take his daughter and wife home because the wife was in danger of losing her job due to missing too many days.  I talked to the dad about how, if they left, I would need to see her back on Saturday, to which he agreed.  Then, as I have gotten into the habit of asking, I inquired about how far away they live - 5 hours.  So, they were going to leave at 4 or 5pm, ride a matatu 5 hours home so the wife could work on Friday, and then come back and go home again on Saturday.  Life is hard here.


Love,
Sarah
Matthew 11:28   Come to me, all who are weary and heavy-laden, and I will give you rest.

The week in review - nonmedical.

It has been a big week here!  President Mwai Kibaki was supposed to come to dedicate the new wing of the hospital that is scheduled to be built in the next couple of years, the CT scanner that is being installed (donated from the States), and the new Maternal/Child heath clinic.  I heard that the last time he visited a few years ago, they patched the road down from the highway the day or two before he visited.  The afternoon before the festivities this week, people were whitewashing the parking curbs and putting up tents, but the road was still in terrible condition, so I doubted he would come.  

The Deputy Prime Minister arrived to represent President Kibaki.  The top four in command of the Kenyan government are the president, the vice president, the prime minister, and the deputy prime minister, so number four is nothing to sneeze at.  There were speeches and band performances for most of the day.  I was not able to attend, but I am told that the during the speeches the hospital administration asked the DPM for road repair (needed terribly for the road from the highway to Kijabe), a new ambulance, a police vehicle for the local police (not many police stations have cars here, so you have to go pick them up - tricky in an emergency!), as well as government support of the hospital and national doctors.  Government support of a more reliable water supply may have been part of that, also.  I think I mentioned a couple of weeks ago that the water spigots were slow or dry at our house for 1-2 days.  At the hospital yesterday, the water stopped at the sink I was using, and I had to go to 3 sinks to find one that had water to finish washing my hands.  I don't understand how that happened, but water is definitely not to be taken for granted here, as it is in the States.

The Kenyan Police and Military on the morning of the dedication.

Happenings on the school front:  This week Anna had a band concert and Emily had a reader's theater presentation with her class.  Ted has exams next week as the term draws to a close on Thursday.  (Yes, we have school and work on Thanksgiving Day, which is not celebrated here.)  Most of the kids grade 4 and up have been working on Pinewood Derby cars for the last few weeks, and this morning was the 39th Annual Pinewood Derby.  It was a big event with electronic timing and photo finishes!  Each grade competed among themselves.  Anna's car did very well, and she ended up in 5th place overall.  It was also Senior Store, which is a monthly event for the seniors to raise money for their senior trip.  For us, this translates into powdered sugar donut dots and chocolate covered donuts.  Yum! 

A heat getting ready to run - Anna's car is in Lane D.

Picture of the video screen showing the photo finish - Anna's car is in Lane F this heat!

Anna's band concert

Emily with the neighbor's cat, LP.

Ted brought a couple of buddies from school to dinner last night - one from Nairobi and one from Rwanda.  I wonder if they heard about the feast we put on for Caring Community last weekend!  (Caring Community is a program where the classes are broken up into groups of 6-8 kids and hosted by a family - events about once a month.)  For Caring Community, we grilled chicken and filet (the "t" IS pronounced here and it is less expensive than chicken!), had baked potatoes, fruit salad,, broccoli salad, homemade bread, and several kinds of dessert.  Rick sent them on a photo scavenger hunt in two teams, and they were quite creative!  One of the challenges was to find and photo a monkey, which none of them could, - if they could only have been around the last couple of days, they would have seen many in our yard and on the porch!  They have been climbing on the roof and using the chicken wire "roof" of the shamba (garden) like a trampoline!

Hanging out after dinner at Caring Community

Monkey on the porch railing

Emily found a new friend in the yard. :)

The sunsets were spectacular this week - they always make me think of my parents.  My dad especially loves to watch the sunset over the pond where I grew up. :)  Here are two of my favorite photos from this week - enjoy! :)

As we approach the celebration of Thanksgiving, know how thankful I am for each of you!

Love,
Sarah
Philippians 1:3-6    I thank my God in all my remembrance of you, always offering prayer with joy in my every prayer for you all, in view of your participation in the gospel from the first day until now. For I am confident of this very thing, that He who began a good work in you will perfect it until the day of Christ Jesus.

Philemon 1:4-7    I thank my God always, making mention of you in my prayers, because I hear of your love and of the faith which you have toward the Lord Jesus and toward all the saints; and I pray that the fellowship of your faith may become effective through the knowledge of every good thing which is in you for Christ’s sake. For I have come to have much joy and comfort in your love, because the hearts of the saints have been refreshed through you.