Habari!

I have tried to give you some idea of our lives here—and have shared some humorous anecdotes. Leland reminded me that I haven’t given you much information about how hard working here can be. So, with this installment of Updates from Kijabe, I’ll try to do that.

These past two weeks, we have seen two children die, and have had 4 intraoperative cardiac arrests. The old saying, the operation was a success and the patient died unfortunately applies. The first boy, Said, was 4 years old—he had a very large tumor in his cerebellum—much larger than his scan from July indicated. Toward the end of the 3 hour operation, Leland noticed that his blood was thin and asked that he be transfused. There was no blood available; despite Leland’s emergency donation directly from his vein to Said’s, the boy’s heart stopped, and he could not be revived. The tumor resection, though difficult, was complete—and Said died of a completely preventable cause. Two days later, a 15 year old girl, Lilian, had what we thought was an unusual and very serious reaction to anesthesia (malignant hyperthermia)—this was after a successful resection of an extensive spinal cord tumor. She also arrested on the operating table—and despite being resuscitated, later died in the ICU of brain damage. This Friday, a 3 year old girl with hydrocephalus had a cardiac arrest after being given anesthesia—even before her operation had started. Just afterward, a 73 year old man with an acute bleed in his brain also arrested just after Leland had successfully evacuated the blood from his brain. Both of these patients were successfully resuscitated and appear to have had no damage from their arrests. Because of these problems the anesthesia equipment was examined; it now appears that three of the four arrests may have been related to malfunction of the anesthesia equipment.

There are cultural differences that make working here hard. In the West, organization and planning ahead for potential problems are part of everyday life in hospitals. Here, they are, in many ways, foreign concepts. Little things like organizing supplies so that they are readily available when needed---don’t happen. Everyday, I spend valuable time searching for tape, going to the Central supply office for packs of gauze (none were available on Friday), locating scissors to cut bandages, finding sterile gloves for procedures. Something as simple as a dressing change becomes an hour-long process (hard when we have 30 children on the service). In the same way, staff here don’t plan for potential problems—like children having respiratory difficulties. I disagree with some missionaries who have said the staff doesn’t care—I really believe that many staff don’t recognize when children are in trouble and are at risk of dying. This is true not only on the ward but also in the ICU—intubated patients on ventilators have died with plugged endotracheal tubes. It can be difficult to get people to respond quickly when a child is unstable.

And we have so many very sick babies and children. I have never seen so many with severe anemia, such complex and extensive congenital defects. On Friday alone, we admitted four children with myelomeningoceles—a day old baby with both a cervical and lumbar defect, a three day old baby with a lumbar defect, a day old baby with a large, leaking thoracic defect, and an 11 month old boy with a bleeding and leaking cervical defect. This is unheard of in First World countries. Another one month old baby admitted this week has hydrocephalus, bilateral cleft lip and palate, a congenital absence of her left arm, and bilateral club feet. Her name is Rahama—her mother died when Rahama was 13 days old. Her older sister also has spina bifida that has never been repaired. Because of malaria, anemia, and other congenital anomalies, the risk of surgery is greater in these children. I am continually challenged to use every bit of my past education and experience as a pediatric nurse practitioner, former pediatric ICU nurse, as well as my neurosurgical experience in ministering to these children. Leland also acts as much more than a neurosurgeon—he evaluates abdomens, listens to chests—it takes everything we have ever learned to take good care of these children—and yet, some die. That is a very hard thing.

We know that we need to pace ourselves—and have tried to do that by taking breaks. Last Wednesday was one of the two Kenyan Independence Days (the other is in June). We drove down the worst road I have ever seen (worse than the one in Monument Valley, kids) and over to Mt. Longonot, a volcano in the valley. We spent about an hour climbing up to the rim (no switchbacks here—just straight up the side!). Unlike parks in the US, there are no guardrails, fences, or even rangers at the rim—just a sheer drop into the crater with a path along the rim. Unfortunately for us, a large group had arrived before us—they were having a loud prayer meeting along the rim. People were praying in Swahili (eyes shut), arms raised to God, walking around—it was terrifying to us because we had very little room to walk without fear of falling into the crater if one of them bumped into us. Obviously, that didn’t happen—we loped down (the dust was so slippery it was easier to lope than climb) and then drove into the valley to celebrate the climb the Kenyan way—by having roast goat. Then we tested our little car by driving back up the worst road I have ever seen—which entails an extensive ab workout just by maintaining an upright position, not to mention working off those calories. These excursions help us maintain perspective as well as refresh our spirits.

This morning we heard a wonderful sermon from Romans 14:1-23 by Pastor Muhota of the AIC church. He spoke of Paul’s exhortation that we not be critical of differences—in what we eat, in the way we worship, in whether we dance or stay rock still during songs. Yet on the walk home, another missionary criticized us quite severely for making rounds to see the children scheduled for tomorrow’s surgery instead of “honoring the Lord’s Day.” I wondered what she thinks of the nurses who work on Sunday taking care of the children. It is hard not to respond sharply (I appreciated having just read Craig Barnes’ sermon from 10/10/10 on not using our weapons (my sharp tongue) but trusting in God—thank you Craig).

Then there are the peculiarly Kenyan inconveniences that make our lives less predictable—some would say more humorous. This morning the electricity went out---about 6 times. It was interesting to have the lights and sound system go on and off during the church service—and getting a shower can be downright suspenseful since we have an electric showerhead that heats the water—or doesn’t as the case may be. Shampoos are especially tricky; I think I’ve gotten the shampoo/conditioner segment of the shower down to less than a minute. And cold water rinses are supposed to make hair shinier, right?

Whenever we feel discouraged, it seems that God sends us a gift. One morning it was the end of a rainbow over the valley; one evening a spectacular sunset over the Mau range. Last night, we were both too tired to cook; we had just checked on the progress on our new apartment being built (and to our dismay, found that it will have an electric stove—reread the above paragraph) and so we stopped by the hospital “cafeteria” for some mukimo, beef stew (Leland), and beans/maize and rice (Susan)—only to find they didn’t have most of that. However—Pastor Mercy was leading about 30 ladies to the wards—they were a women’s choir and they gave us an impromptu concert, including dancing and ululations. Those are the moments that feed our souls—and make us so grateful to God that He brought us here. It is a privilege to be here, to use what gifts God has given us to serve him. We have much joy here.

Until next time, take care, God bless. Please continue to pray that God will use us for his glory. Thank you for your prayers—we feel supported—and we need your prayers.

Susan

PS: I am having a lot of trouble importing photos--will try to solve the problem with the next post.

17 October 2010

Dear Friends,

Habari. So much has happened since the last update from Kijabe. The President, Mwai Kibaki, dedicated the new operating room suite at Kijabe Hospital on Friday, 8 October. Our hospital was given 4 days notice that he would attend, so in that time, the hospital was painted inside and out, the road from the highway was repaved, new curtains were hung in the wards, all the hedges and gardens were trimmed! We should have him visit more often. The hospital employees were so proud—at the ceremony the Maasai murans (warriors) danced, there was a brass band that curiously played The Star Spangled Banner along with God Save the Queen and the Kenyan anthem, and there were many speeches. I missed the dancing because ALL of the nursing staff left the wards to see the spectacle—leaving the patients with no staff. Ah, things are different here….

I am struck with the fluidity of things…time, dates, spelling, rules. Time is an approximation; if one starts rounds at 0630, that really means sometime between 0640 and 0715. Leland and I joke that church has a rolling start here—although the published “start” time is 0830, things are really underway in earnest by about 0850. Birthdays: in the US, one of the patient identifiers is the birthdate. In Kenya, most Muslim children have a birthdate of January 1 of the year in which they were born. Non-Muslim children may have a recorded birthdate that is somewhere in the month in which they were born—but that date may differ on successive admissions. Names also are fluid—sometimes Stacy is spelled Steicy, Josaphat morphs to Josphat and back again—last names also change spelling from day to day (Muthamni becomes Mutharimi)—making sure what patient is being discussed can be challenging. The nurses also switch patients from bed to bed—so that one day bed 71 is Maxwel, but later that day it is Hosea—Maxwel is now in Hosea’s former bed 81. If you are confused, imagine how we feel making rounds—especially when the staff insists on using only the bed number as the identifier—not the patient’s name. Rules: although there are traffic lights that turn red and green (only in Nairobi), no one pays the least bit of attention; if you see an opening you take it—or someone else will. On our death-defying drive to Nairobi yesterday we were a bit taken back when, on a divided 4 lane highway, we swerved violently to avoid a head-on collision with a matatu (almost always a Toyota van that carries people from town to town) driving in the wrong direction. On the way home, a huge traffic jam caused us to follow everyone else to the other side of the median barrier, so all four lanes were traveling in the outbound direction. It worked surprisingly well until we met the traffic headed toward Nairobi. I’m actually not entirely sure how we got out of that mess, but I do remember it involved frantic arm waving and driving over curbs.

I’ve wanted to share with you more about the children and moms here. You cannot imagine how dearly these children are loved by their moms. Despite having very damaged babies with devastating neurological problems, these moms play with, sing to, kiss, caress, and really delight in their babies. We have an annex with two large rooms containing 19 cots—the moms and babies sleep together (no Kenyan mom would think of using a crib). Although most of the children have had surgery, there is surprisingly little crying—if the baby fusses, he/she is nursed immediately. When a mom needs to use the toilet, another mom watches her baby—in fact, the older children in the ward, if not too sick, play with the younger ones. All the moms talk together and provide support to each other—it is quite different from the US where we are so concerned about privacy and confidentiality. I’m not sure but I think this system works better—at least in providing mutual support. I wish you could hear the moms sing; the chaplain, Mercy Nganga, led the moms in singing the other day—they broke into harmony; the beauty of it brought tears to my eyes.

We do find that we need to get away from Kijabe weekly for a few hours—last week we drove to Naivasha, seeing Maasai herding their cows and goats along the highway. Once there, we had lunch outside and then walked to the edge of the lake—where we saw a bird standing on a rock—which ascended until ears and eye were visible. Then a little farther out along the shore, we saw a group baptism with the hippo submerged about 50 yards away. Gives the term “trusting in Jesus” a new slant.

Kenya is also a study in contrasts—the almost indescribable beauty from the ridge at 8000 ft overlooking the Great Rift Valley with the volcano crater, Mt Longonot in the distance in a blue haze, the rich terra cotta color of the earth, the jacaranda trees covered in periwinkle blue blossoms…the abject poverty of the rural people living amid trash and scraps of plastic bags fluttering in the wind, the donkeys grazing by the highway (giving literal meaning to the term “being at the end of one’s rope”), the tin roofed shacks advertising Blessings Butchery, Susan’s Saloon, God’s Promise Tailoring and Beauty Shop, Gichiengo Omuja Hotel and Butchery, the men pulling carts heavily laden with 10 gallon water containers, women carrying huge bundles of wood on their backs, men handshaping the building stones for the new construction here at the hospital complex.

Some short stories:

Each patient, before surgery, is led in prayer by a surgical team member—sometimes Leland, sometimes Mary, the nurse anesthetist. On Friday, a 14 year old Muslim girl was ready to be put asleep for surgery and she agreed to a prayer. After Mary had prayed, the girl asked, “Why do you pray to your father?”

I traveled to Embu for a mobile clinic, a 3 hour drive (4.5 hour return—turns out Kenyan nurses like to shop too—though this was no mall; who knew people could get such joy out of vegetable shopping?). There I saw a 3 month old girl with a temperature of 42.9 C(it equals 109 F). She was limp, rolling her eyes. She had an unrepaired myelomeningocele and most likely end-stage meningitis. I felt quite helpless—her mother hadn’t money to take her earlier for care, and she would not survive a trip to Kijabe. I doubt she lived through the night.

We saw one boy in clinic—a 12 year old with a complex spinal deformity. Leland needed an MRI to safely plan surgery, and his mom agreed to get one. Fortunately she told a nurse that before she could pay for the MRI, she would have to sell her only goat. We were able to arrange for BKKH to pay for the scan out of the fund we established for just that reason.

We continue to be humbled, challenged, stretched, molded by our days here. We ask for your prayers that God will be glorified through the work of our minds and hands, that He will guide us each moment and give us wisdom, patience, cheerfulness, graciousness in our relationships with staff and patients.

Take care, God bless.

Susan and Leland