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.