Wednesday, December 29, 2010

Christmas in Kijabe







Dear Friends and Family,

I wrote a blog posting on 12/13/10 but an electrical surge blew my surge protector strip for the American plugs on the computers. The battery on my computer died and could not be resurrected until we had purchased new strips. Then, the internet connection failed so I could not post the blog even with a fully charged computer. Perhaps that is “providential” as my Dad would have said—the blog I wrote then was a bit d
own.

As I explained in the last blog, I had reached the end of my rope so I flew to Vienna on 12/2/10 (at 12:25 am) to meet Kelly, Joe, and my granddaughter Evelyn. My temporary Kenyan visa expired on 12/1/10 which was duly noted by the customs agent in Nairobi; he said it is fairly easy to renew—I told him, No! I HAD to leave Kenya!! Upon reaching Vienna I found a winter wonderland—it snowed for two days. It was good to be back where traffic signals are strictly obeyed, no one leaps from barriers between lanes and matatus are not heading directly toward you at breakneck speeds IN YOUR LANE! Crossing the street was so...pedestrian—no suspense at all. I gained 4 pounds in 5 days (schnitzel will do that). What was really helpful (besides playing with my granddaughter) was to talk with Joe and Kelly about their experiences in Syria. Joe has spent a good deal of time working with the Syrian guards who patrol the outside of the embassy. Over his 15 months there, he has significantly improved morale among them—mostly by treating them with respect and having clear directives about performance. Although his and my roles are dissimilar, he had some ideas that I will try since morale and performance are important issues here in Kijabe.

I have to admit that I had trouble returning--not simply because I missed my connecting flight to Nairobi in Zurich, had to detour through Istanbul arriving in Nairobi at 02:10 am—and did not find the driver hired to meet my plane until 05:45 am. The sidetrip gave me the opportunity to see Istanbul from the air and to cross off another country on my mental map of the world. My attitude remained less than stellar—until one of the moms approached me for help—then my heart melted with love for these women and their babies. I realized then that it has always been the patients that have saved me, fed me, ministered to me at least as much as I have to them. It is the Erics and Megans and Chanons, and Mr. Moseleys, and Sarahs and Marks and Davids, and Danelles of Madison, Portland, Pittsburgh who have been my best teachers, my strongest supports, and sources of greatest joy in my work. So, as in the past, these Kenyans ladies and their babies drew me back to the place where God has most certainly brought me.

We’ve continued to be busy at work. In November, Leland did 72 operations (his previous all time high was 30/month in Pittsburgh; so far in December he has done 81). Our Pediatric Neurosurgery fellow, Humphrey Okechi, has been a wonderful addition to our team. Humphrey has a gift for organization as well as technical skill in the operating room, so our rounds are concise and mercifully shorter each morning. He also has learned a good deal of Swahili during his first 6 weeks (I guess if one can learn Chinese, as he did in a year, one can learn any language) so is able to have more than rudimentary conversations with the moms. Leland and I are consigned to saying “nyumbani, kesho” which means “home, tomorrow.” We do cause some giggles among the moms as we try to properly pronounce words—asking the staff to spell the word causes some consternation, as the spelling is fluid and depends on one’s native tribal language. Babies admitted as Fatih Jepkemoi become Faith Chepkemoi sometime during the hospitalization. Athan becomes Aden, Iynoam becomes Ahinoam. Also, people don’t get caught up in such things as spelling: our clinic secretary Veronicah sometimes leaves the “h” off her name—she says she doesn’t much care how it is spelled. It reminds me of Ellis Island where names of immigrants were changed because the staff processing them didn’t understand the language and assigned phonetic spelling.

Leland and I spent one afternoon reviewing the complications of the past 20 children treated for myelomeningocele. We are dismayed at the number of spinal fluid leaks, wound infections, instances of incisions falling apart (up to 20 days after surgery). We talked recently with two of the pediatric surgeons here—there are so many factors that impede healing here—intraoperative temperature (the babies get cold during surgery), nutritional status and vitamin/mineral deficiency, skin preparation (we don’t have chlorhexidine prep here—it has been shown to significantly decrease surgical site infections), even oxygen supply to the tissues. At altitude, the air is “thinner.” Most people here increase their hemoglobin levels in compensation—that happens within 120 days of acclimating. However, so many of our babies are significantly anemic—they arrive preoperatively with hemoglobins of 7-9 (normal at sea level is 11-16). We have decided on some interventions that we can fairly easily institute; Leland will change the way he prepares the skin before surgery; we will start each child on multivitamins when they are admitted and send them home with a one month supply. Intraoperatively, the temperature will be monitored and recorded every 15 minutes. I need to talk with a nutritionist in the States of ways to supplement the mom’s nutrition so that the breastmilk is of better quality. Long term, we’ll need to work with the Kenyan staff to teach moms to cook more nutritious foods, refrain from feeding cows milk before the age of one year (one 3 week old baby was being fed cow’s milk last week).

We have so many discouraging stories—Leland asked that I tell you about a different outcome. Early this week, he saw a 26 year old Somali lady who had been struck by a stray bullet—which lodged at the end of her spinal cord causing complete paralysis of her legs. She had sustained the wound December 2nd; Leland told her that he thought there was a 20% chance of improvement after surgery. The surgical procedure went well; the following day, she had movement in one leg. Two days later, she had normal movement of her right leg and antigravity movement of some muscles in her left leg. We have seen many Somali patients; Dick Bransford says that arguments will never sway them, but caring for them compassionately in Christ’s name is the best way to minister to them. One Somali mom told the translator that she wanted to hear about this Jesus because she saw Him in Leland and me. That, quite honestly, is why we are here.

Two weeks ago I gave a 15 minute talk to the nursing staff on how to do wet to dry dressings—despite our telling and showing many of the nurses, we found every morning that the dressings were done incorrectly. After the talk, we were astounded to find that the dressings were correctly done….for the next 5 days—then a lapse back to the old way. When I asked about that, the nurse said that they’d been doing the dressings their way for years and she didn’t understand why we should change. Another thing I’ve recently discovered is that the nurses have as much trouble understanding our accents as we do theirs. So, they “seem” to understand what we say but really don’t. Other nurses are really not fluent in either spoken or written English—so once again, they say they understand but don’t follow the order that has been written. Today a very sick child was not given antibiotics for 24 hours--the nurses didn't see the new order until during the night (it was written yesterday at 0645 am) and then the antibiotics were locked in a cupboard, so could not be given until the person with the keys arrived for work this morning.

We are thrilled to report that we moved into our new home—a 768 square foot apartment on the third (gasp!!) floor of the new building on the downside of the mountain from the hospital. We have the furniture that we ordered (delivered 5 days early—that’s when they were delivering to Kijabe—take it or leave it). We have drapes that I chose and were made to order on Biashara Street in Nairobi—they were done in two days!! I finally have a stove that doesn’t make bread into nuclear waste—we feel like we are in heaven. There are a few glitches—they made ventilation screens at the top of each window—so each night a roof rattling gale blows through our apartment, flapping the draperies, showering that wonderful red dust on everything. Believe it or not, the wind wakes ME up at night!! (I’m deaf!!) The showers are remarkable—we love them; but in every other tap the water comes out in a pitiful trickle. And we have solar hot water—which so far has been solar tepid water. Every time I think about complaining, though, I remember that most of the staff at the hospital—and nearly all the patients—bathe in basins with cold water or water heated over a charcoal stove. Even with the imperfections, we both feel like we are now at home.

It was a strange Christmas in Kenya. The chaplain decorated the ward 3 days before Christmas. By Christmas day, each area had a small tree. But, there was no celebration of Advent (the sermons were from the book of Esther), and other than in mid-November, no carols or advent songs were sung. Leland and I finally went to the Uhuru Highway Lutheran Cathedral in Nairobi on the Sunday before Christmas—both of us remarked that we were able to worship for the first time since leaving Madison. We had dearly missed the liturgy, the readings, the recitation of the Creed, the Lord’s Prayer—as well as the hymns. I think that we will try hard to drive to Nairobi each Sunday to worship there. Despite the identification as a “cathedral”, the church is small so should allow us to get to know the members. It has a good mix of Kenyans and wuzunga—and has both a German and a Kenyan pastor. Otherwise, Christmas was quite low key here—a few of the staff exchanged gifts—like cabbage, etc. In a way, it was good to see a lack of commercialism and greed. It is a little disorienting to see life-sized replicas of Frosty the snowman and Rudolph in the Nairobi mall—2 degrees south of the equator.

In the last blog, we asked for ideas for how to ship the operating microscope. Eric Hanson, the new pediatric surgeon who arrived, told us he has room in his crate in Boone, NC for the microscope. So, we will need to ship it to Boone, but then the problem is solved. We hear that people are passing the blog along to fellow coworkers, etc, and welcome any new followers. If anyone has thoughts about ways we can improve nutrition, please send them.

Most of all, we ask for and thank you for your prayers for us. Even when we have very hard days, we remember that so many people are lifting us up to the Lord in prayer. We are part of a very large community—not just here in Kijabe but extending all over the world—people who care deeply about the poor, the sick, the helpless. “..for I was hungry and you gave me food, I was thirsty and you gave me something to drink, I was a stranger and you welcomed me, I was naked and you gave me clothing, I was sick and you took care of me, I was in prison and you visited me. Then the righteous will answer him, “Lord, when was it that we saw you hungry and gave you food, or thirsty and gave you something to drink? And when was it that we saw you a stranger and welcomed you, or naked and gave you clothing? And when was it that we saw you sick or in prison and visited you.” And the king will answer them, ‘Truly I tell you, just as you did it to one of the least of these who are members of my family, you did it to me.’”

Take care, God bless.
We wish you a Merry Christmas and a new year full of joy, peace, and health.
Susan