Wednesday, December 4, 2013

Cultural Exhaustion


Habari yako,

Happy Advent!

It has been quite a while since I posted a blog.  For several months now, I’ve had mixed feelings about being here in Kenya.  Though I have felt useful, I haven’t felt enthusiastic about working and living here.  Friends of ours call it “cultural exhaustion.”  Some of the things that we found charming or amusing the first few years are now just wearing.  The road that leads out of Kijabe to Gichiengo and the high road is much worse than when we arrived.  I used to think it was an adventure to be jolted for the 15-minute ride; now it is incredibly—well, jolting.  Seeing matatus and buses heading at a high rate of speed directly toward us in our lane has ceased to be amusing.  One Sunday on the drive home from Nairobi, a man leaped the barrier and stooped beside our car so that we ran over the stick he held in our path—not sure what that was about but it was a bit unnerving. Another Sunday a lady led her 4 year old child directly into the path of our car on the main highway from Nairobi—she strolled as if taking a leisurely Sunday walk (which, I guess, is what she was doing).  We had to slam on the brakes and swerve to avoid hitting them.

Not knowing if there will be water each morning (hot or cold) used to be exciting; now it is aggravating.  The plumber came earlier this week to fix a leak in the apartment on the first floor; for several days the water pressure has been awful and today, again, we had no hot water at all.  Turns out, to fix the leak, he turned off the water to the entire building and didn’t bother to turn it back on.  Two weeks ago, while Leland was speaking at a conference in Australia, there was a deluge through his study ceiling onto the floor (through the light fixture).  On investigation, it appears there had been a leaky valve in our non-functioning solar water system—in fact, a container was placed under the valve.  Unfortunately it was a very small container and a very large leak (gallons).  So, the ceilings are again trashed and moldy (the same ceilings that were replaced last July).  We’ve given up on having them replaced or repainted—my suspicion is that this was not the last leak.  It was a good “opportunity” to give the room a good Spring cleaning.

The service has been quite busy most of the time since Humphrey Okechi stopped operating in September.  We have had three pediatric neurosurgeons visit from the US to give Leland a break (Howard Silberstein and Doug Cochrane in October) and to help out with the caseload (Cathy Mazzola in November).  With 5-7 cases per day Monday through Friday, it is too much for one neurosurgeon to handle, even with residents helping.  Humphrey was to have started a 6-month fellowship in Germany on September 1; however, there were many problems obtaining a visa, and he left Kijabe for Uganda just last week.  We hope he will be back by May when we plan a month-long break.  Leland is physically exhausted most days (as well as culturally…).

I’ve said before that we have many Toto moments (“Toto, we’re not in Kansas anymore).  This morning is a very good example of that.  At 6:20 am Leland was called about a baby who had stopped breathing in the annex on post-operative day 1 after a shunt.  We ran up to find the baby in the procedure room. The baby still had a good pulse but was not breathing.  She is 2 weeks old now, and the preoperative head ultrasound showed complete absence of the brain above the brainstem—a condition called hydranencephaly.  I saw two cases of this in the States in 12 years of neurosurgical nursing practice and have documented about 40 Kenyan cases in 3 years.  The care of children with hydranencephaly is a moral dilemma.  Western data suggest that 70% will die within 2 years; however, the heads are filled with cerebrospinal fluid and keep expanding, causing pressure sores, difficulty in caring for the child, and a huge stigma here in Kenya.  The children never develop beyond the level of a newborn despite the growth of their bodies—they suck, swallow, cry, and their eyes move, but they don’t ever see, hear, or experience pain at a cognitive level.  They never develop a social smile, speak or interact, feed themselves, walk or play.   

After that, we continued rounds on our 25 other patients.  One mum complained that she’d not been given a blanket and wanted to leave.  Her baby had surgery for a meningocele yesterday, so ideally we would have liked to observe him another day.  He had been admitted with a terrible eye infection (probably chlamydia or gonococcus) and was on oral antibiotics for his infection.  Following rounds, she tried to abscond with the baby.  That means she tried to sneak out without being discharged (or paying the bill).  Pastor Mercy saw her, went after her, and brought the baby and the mom back to the annex.  Our social worker called the Chief of her village in western Kenya and learned that the baby’s grandmother and uncle are psychotic (as probably is this young woman); that prior to her being sent to BKKH, she had seen the swelling on his back and tried to squeeze it off, then asked for a knife so she could cut it off.  There is doubt as to whether she is capable of caring for either him or his older sibling.  The Chief will arrive tomorrow to help sort out the problem.  It would be nice to refer her for psychiatric treatment but in most places in Kenya, including this lady’s home, that is non-existent.

We continue to be awed by the beauty of the sky and the valley seen every day from our living room window—and also by the beauty of the Kenyan people.  It is the time of year (the start of our summer) when the wind is a fierce roar at night, the valley is visible to the western ridge, and on particularly clear days we can see a distant volcano on the horizon.  It is fantastic laundry drying weather if one can keep the clothes on the line.

We flew to the States in October to visit our children—Leland flew to Pittsburgh and LA to see Julie, Art, Todd, Lisa, and Tusk; I stayed in La Grange with Michael and Marisa while Kelly drove with Evelyn and Alex to meet us there.  Joe wasn’t able to take his vacation because of the government shut-down (he is considered a critical employee).  I cannot tell you how much we miss our families.  I used to miss a garbage disposal, going out to restaurants, taking a bike ride, walking the dog.  Now, I just miss my family and friends.  It is getting harder, not easier, to be so far from them.

The news from the Kenyan government is concerning.  The Ministers of Parliament (MPs) have passed a bill with draconian restrictions on the media—fines and imprisonment for reporting opinions, facts, with which the government takes issue.  They have also created an inquisition of the judiciary—which is the least corrupted institution in Kenya since Willy Mutunga became Chief Justice.  On a closer level, because NGO’s in Kenya have been accused of fomenting the charges against Uhuru Kenyatta (President) and William Ruto (Deputy President) for crimes against humanity, all donations coming into Kenya are now subject to 20% duty on the value of the donations.  What this means for us is that BKKH or Kijabe Hospital has to pay thousands of shillings for donated supplies.  What that means for the people of Kenya is that chemotherapy medications donated for people with cancer are sitting in Mombasa port because no one can afford the duty to free them for use.  If President Kenyatta signs these bills, then I could be arrested for saying what is in this paragraph.  If that happens, please send someone to visit me in prison…J

We honestly don’t know what God’s will is for us.  We had thought when we came that we’d spend 6 years here.  We still feel God’s call to be here—but are not sure we can physically or emotionally do 3 more years.  My hearing is deteriorating to the point where it is excruciatingly difficult for me to understand people—and that is very isolating. I often wonder what Kenya would be like for me if I could hear, understand, and interact more easily with people here.  I bought new hearing aids while in the States; unfortunately the programming for them has made hearing more difficult rather than easier.  So, I will need to make another trip to the States early next year to get them reprogrammed.  A cochlear implant (or two) is in my future—but I’ll need to wait for Medicare to get that done. 

I take great comfort in what Paul says in II Corinthians 4: 7-10,16:
But we have this treasure in jars of clay, to show that the surpassing power belongs to God and not to us. We are afflicted in every way, but not crushed; perplexed, but not driven to despair; persecuted, but not forsaken; struck down, but not destroyed; always carrying in the body the death of Jesus, so that the life of Jesus may also be manifested in our bodies….So we do not lose heart.” 

Please continue to hold us in your prayers.  Pray for the parents of the babies who are born so damaged.  Pray for Pastor Mercy—she maintains a joy despite all the sorrow she sees. Pray for the completion of the new building—about $400,000 more is needed to complete it.  Pray for Jim and Jullie Taubitz who have overseen the building, and who are our strongest encouragers here.  Pray for the government of Kenya, that it may serve the Kenyan people with wisdom and compassion.

It has been easy to concentrate on the negative things about being here.  But, we also have much for which to be grateful.  We have loving and caring family and friends; we live in a safe place.  We lack for nothing.  When I was a child, I memorized scripture.  In my attempt to “rewire” my thinking, I’ve started to memorize psalms of praise.  My first attempt is Psalm 103:

Bless the Lord, O my soul, and all that is within me, bless His holy name.
Bless the Lord, O my soul, and forget not all his benefits.
Who forgives all your iniquity, who heals all your diseases,
Who redeems your life from the pit, who crowns you with steadfast love and mercy,
Who satisfies you with good so that your youth is renewed like the eagle’s.
The Lord works righteousness and justice for all the oppressed.
He made known his ways to Moses, his acts to the people of Israel.
The Lord is merciful and gracious, slow to anger, and abounding in steadfast love.
He will not always chide, nor will he keep his anger forever.
He does not deal with us according to our sins, nor repay us according to our iniquities.
For as high as the heavens are above the earth, so great is his steadfast love toward those who fear him;
As far as the east is from the west, so far does he remove our transgressions from us.  As a father shows compassion to his children, so the Lord shows compassion to those who fear him.
For he knows our frame; he remembers that we are dust. 
As for man, his days are like grass; he flourishes like a flower of the field; for the wind passes over it, and it is gone, and its place knows it no more.
But the steadfast love of the Lord is from everlasting to everlasting on those who fear him, and his righteousness to children’s children, to those who keep his covenant and remember to do his commandments.
The Lord has established his throne in the heavens, and his kingdom rules over all.
Bless the Lord, O you his angels, you mighty ones who do his word, obeying the voice of his word.
Bless the Lord, all his hosts, his ministers, who do his will!
Bless the Lord, all his works, in all places of his dominion.
Bless the Lord, O my soul.

Take care, God bless.
Susan


Tuesday, August 6, 2013


Bonjour, mes amis et famille,

Do you have any clue as to where we are right now?  Not in Kijabe—definitely not in Kenya.

Allow me to explain.

Humphrey informed us (that is the way it is said in Kenya—everyone becomes informed…) that he would take a 6-month fellowship in Tübingen Germany starting on September 1 to March 1, 2014.  His vacation begins on August 15.  So, we decided in late May that we needed a rest before Humphrey’s leave.  As of September 1, we will have been in Kenya 3 years.  For us, the first two years flew by—the third year has been the hardest and longest yet of our stay in Kenya.  We wanted a place to vacation where it was warm and the time zone was near Kenya’s (the jet lag problem in going to the States really makes resting and relaxing hard).  So, Provence became our destination.  We are 6 days into our 10-day stay.  Having just completed The Rise and Fall of The Third Reich, I decided to take a break and write the blog.  Many people have hinted that a posting is long overdue.

Lavender

Sunflowers

Lac D'Allos in Haute-Provence
  
Three years in Kenya is long enough to have made some observations—not so long that one fails to be amazed.

God’s Power.  Only By Prayer.  For We Go By Faith, Not By Sight.  These are nice sentiments—but a cause for some alarm when found on the back bumpers of matatus plying the roads between Kijabe and Nairobi.  The number of matatu accidents and resulting fatalities have been a concern in the newspapers—one investigative reporter obtained 6 driving licenses without having any proof of ability to drive—mostly by paying bribes.  His licenses allowed him not only to drive a car, but also operate commercial vehicles such as trucks, buses, and matatus. Many matatu drivers are illiterate—though to be honest that is less of a problem in a country where road signage is at a minimum.

We see a lot of death in Kijabe—I have mentioned before that the number of children and adults that I’ve seen die here in 3 years far exceeds the number I saw in 35 years of nursing in the US.  I thought I’d explain what happens after a patient dies.  First, the body is taken to the mortuary of the hospital.  Only after the bill is cleared can the body be released for burial.  In Nairobi, some bodies have stayed in the mortuary for years because the family has been unable to pay the hospital bill.  We are fortunate that BKKH sometimes covers the bill so that the families are able to take the body home for burial.  There are funeral homes here—with interesting names: Destiny Funeral HomeExodus Funeral Service….or my personal favorite: Hidden Treasures Funeral Home.  Most times, the extended family and the entire community will converge in private cars and matatus hired just for the purpose of meeting at the mortuary, sometimes conducting an outside service there.  It is not uncommon to see 10 to 20 vehicles and over a hundred people who have come to accompany the body home.  Some families are so poor that they cannot take the body home (one cannot transport a dead body in a public matatu—so the matatu has to be rented for that purpose).  Those children are sometimes buried in the Kijabe Hospital cemetery.  There are times when the child’s death is imminent and the parents beg us to discharge the child so he or she can die at home—most times those requests are made because of financial constraints rather than simply wanting the child to be surrounded by family at the time of death.


Ascaris (intestinal worm)



We sometimes have to be detectives to diagnose our patients.  One boy with shunted hydrocephalus arrived with a massively distended abdomen.  Although that usually means a low-grade chronic infection in the abdomen which prevents absorption of the shunted cerebrospinal fluid, in this case, no evidence of infection was found.  He did later vomit some worms—and had mildly elevated venous pressure associated with his liver.  We all learned a lot about ascaris infestation through caring for him.




Kimberly and Joseph

I want to highlight one of our patients, Joseph, a boy of 10 years who developed brain abcesses.  They were drained and treated in February of this year but recurred.  He returned in May with pus draining from his head.  Because he had undergone weeks of antibiotic coverage in February-March, we began using our strongest antibiotic, meropenam.  He required 6 weeks of treatment with meropenam at a cost of about $50/day.  During his stay, his cucu (pronounced Shosho which is Kikuyu for grandmother) developed severe diabetes and was hospitalized on the women’s ward twice—thereby incurring her own bill. Joseph required 3 operations during his stay—his bill reached nearly 400,000 shillings (about $4,800).   To put that into perspective, my hospital bill for one procedure and 5 days of hospitalization last October was $72,000. However, his family will never have any hope of paying his bill.  Joseph and his family are desperately poor—so his bill was covered by BKKH; his grandmother’s bill was paid by an anonymous donor.

   
We see children with medulloblastomas—cancer in the cerebellum.  Most of the time, the tumor can be fully resected; however, to achieve a cure the children need to undergo radiation and chemotherapy. Leland and I decided to pay for the adjuvant therapy for one of our 11 year old patients.  She was also desperately poor; her father, who accompanied her and took excellent care of her, was from a very remote region of Kenya.  Until his stay with her in Kijabe, he had never been more than several miles from his home. Chemo and radiation therapy is available only in Nairobi; since both take place over weeks, it was necessary to find a place for them to stay while in Nairobi.  Leland made a request during a Sunday NILC church service; by the next week, the ladies of the church had furnished a room on the church grounds and had arranged meals and transportation to and from the hospital. During Sheila’s treatment, they even provided clothes for Sheila and her father. We were amazed and so impressed with their servanthood.  THIS is what community is. 

Unfortunately, that does not seem to be the end of the story—after her therapy was “completed,” we learned from the oncologist that Sheila had not received the appropriate chemotherapy.  Although we ended up paying nearly double ($2300) the original quote, the costs to complete her therapy will be another $1600 plus the amount needed for her father to make the trip to and from Transnzoia.  We are in the process of praying for God’s guidance.  Even if the money for therapy is provided, we are not certain that her father will be able to arrange transportation to Nairobi every 3 weeks for eight visits.  This is always so difficult for us; the cost of the entire therapy is about what I paid for 2 CT scans during my hospitalization.

I mentioned earlier that this past year has been the hardest.  We struggle against developing a mindset that we see in some people here—one that says, “this is Africa, we can’t have excellent medical care here.”  Leland and I have not accepted that and will not.  We do realize every day that we are in Africa and understand the challenges of limited resources, lack of consistent electricity (the lights went out 3 times during Leland’s last brain tumor resection), broken equipment (the drill bits for the saw used to open the skull broke) and lack of organization that makes even writing a requisition for bloodwork an exercise (both in patience and in a physical sense—having had to run to two different wards to find the paper).  But we believe that throwing up one’s hands in resignation is insulting to the Kenyans with whom we work—most of whom are intelligent, caring, hardworking people who want to be practitioners of excellence.  And we believe that God doesn’t delight in mediocrity.  We want to “give of our best to the Master,” and we try to encourage our colleagues to do the same.

Requisition cabinet

Box for charts with new orders






















It takes many people to support this work.  This year we have welcomed several neurosurgeons from the developed world who have come for periods of time to help. Sandi Lam and John Collins made their second trip to Kijabe while we made a quick trip to a conference in New Orleans.  Mark van Poppel, Kimberly Foster, Nunthasiri Wittayanakorn, and Alireza Mansouri are neurosurgery residents from the US, Thailand, and Canada who donated their time and had a surgical experience here that cannot be replicated in their home programs (Kimberly listed 98 cases in 3 weeks—including not only shunts and myelomeningocele repairs but also treatment of traumatic brain injuries, infections, and brain and spinal cord tumor resections).  We were pleased that Lianna Ben-Adani, an Israeli neurosurgeon, could spend two days with us.  Del Mount, a pediatric craniofacial surgeon came for 2 weeks with her colleague Lisa David to operate on some of the more complex encephaloceles that we see often here in Kijabe.  Leland continues to search for candidates for the neurosurgical fellowship next year.  We look forward to the next 6 months when many visiting neurosurgeons will work with us, helping us with the caseload, teaching the residents other techniques and practices, elevating the care of children with neurosurgical problems.

Back in April, while we were in the States for the conference, there were terrible landslides in Kijabe which temporarily blocked access to or from the hospital.  Three children were killed in the mudslides. The railroad tunnel was blocked; a bridge over which all the construction equipment and supplies were brought in was washed away.  The destruction was impressive—just as impressive was the local community’s response.  Within several hours, the tunnel was cleared.  The government is responsible for the bridge which has just this week been replaced.  The road from the valley had been the only access for the large construction vehicles; this caused delay of the construction of the new BKKH hospital wing and an increase in costs.

Lower road in Kijabe after landslides

I always am struck, when I reenter the Western world, of how much people take for granted.  It isn’t simply excellent roads with clear signage, or phenomenal food and great bread, or dependable electricity, or running water and clean public bathrooms.  When we go to Nairobi, we see walled compounds with barbed wire topping the wall.  There are armed security guards in every shopping area.  People in our Nairobi church have been ambushed and shot just outside their homes.  Carjackings are frequent—being mugged after use of an ATM is common.  In Kijabe we are somewhat protected, yet even there home break-ins have occurred recently.  I believe that income inequality is largely a factor in the insecurity—in Africa and even in places in the US.  The more people acquire, the more they feel compelled to defend their possessions—especially when those around them are desperately poor.  I continue to struggle with Jesus’ words in Luke 6: 29-31: “If anyone strikes you on the cheek, offer the other also; and from anyone who takes away your coat do not withhold even your shirt.  Give to everyone who begs from you; and if anyone takes away your goods, do not ask for them again.  Do to others as you would have them do to you.”  To be honest, I no longer feel guilty when I say “no” to those asking for money.  I believe that I am giving not only my money, but also my time, and myself.  Over the past 3 years, we feel “poured out” to a great degree for the children at BKKH.  We have had several patients to whose bills we have contributed or for whom we have paid the fee for adjuvant therapy after tumor resection for brain cancers.  Yet, there is always so much more we want to do.

A good friend just wrote this: “Am feeling like there is more I could be doing with my life.”  I believe that all of us, if we are truly honest with ourselves, could say the same.  As I grow older (which is another thing that has become much more apparent over the last 3 years…) I become more firmly convinced that everyone has a ministry wherever he/she is RIGHT NOW.  There is no need to sell everything and be an itinerant preacher, or to move to Ecuador and start a school.  Everyone has been given a pulpit—everyone has the opportunity to be the hands, feet, mouth, arms, eyes, ears, heart of Jesus.  In fact, I would say it is much more challenging to be Jesus in an insurance company, as a financial advisor, in a grocery store, government agency, or a public school.  But where is Jesus needed most?  In those very places.  Yes, I encourage you to give of your money and possessions—those are needed everywhere.  But more than that I encourage you to give of yourself, wherever you are—because Jesus’ presence is needed far more than your money.

Thank you all for your prayers of support for us; they become more precious and needed as time goes on.  Please pray for the parents of the children at BKKH—so many of their decisions are influenced by their ability (or lack of it) to pay the bill.  We ask your prayers for Kijabe Hospital administration, for the BKKH nursing staff which has been decimated because we cannot pay salaries commensurate with those paid by government hospitals.  Because of that we have lost experienced and valuable staff nurses.  We ask you for your continued support in prayer and money for BKKH.  Many children’s bills are paid through your contributions.

Take care, God bless.
Susan

Thursday, April 25, 2013


Leland and Kenyan celery




Habari rafiki,

15, 17, 63, 14, 13, 16, 61, 65, 66….that is not a series of random numbers.  That is the “order” in which I found the medication sheets in the binder for Team A (beds 13-18 to the right of the nurses station, beds 61-66 to the left).  Among those patients, there was a baby who had been moved to isolation for a multi-drug-resistant Klebsiella pneumonia ventriculitis (cerebrospinal fluid infection in the head). Two doses of the only two antibiotics to which his organism was sensitive had not been charted as given—whether or not they were given will never be known.  I become quite discouraged when I see this lack of order in the nursing care—after I discuss the problem with the supervisors, the care improves for about two weeks and then reverts to the same inconsistent level.  I refuse to accept the common belief among some here—that here in Kijabe we are incapable of delivering excellent care.  I know that my fellow nurses here are highly intelligent people and ARE capable of excellence.

I think nearly every day of things to tell you; yet I find it hard to describe our lives here.  We work hard—but so do many people all over the world.  We have days of drudgery and days of excitement, days of sadness and feelings of failure over a child’s death, and days of joy and satisfaction over a child’s operation and recovery.  Believe it or not, I wrote 2 blogs over the past month—never finished either one.  I looked at the first and thought it was a lot of whining.  As my children will tell you, I never tolerated whining from them, so I think it patently unfair for you to receive it from me.  The second just wasn’t very interesting.  So, I’ll try again.

I traveled to the US in February to greet my newest grandchild—Joseph Alexander Schulter (called Alex), born on February 5.  I had the joy of spending his first three weeks with him, his Big Sister Evelyn, Kelly, and Joe.  During the time there, I also saw my son Michael, and daughter-in-law Marisa, my sister Ginni, Joe’s Dad and step-mother, and my very good friends Bud and Linda.  I savored the great food, hot showers, smooth roads, great signage, restaurants.  I didn’t see one person leaping over the median barrier, one donkey being beaten, one chicken crossing the road (why DO they do that, anyway)?  Life there was orderly and predictable—every single time I turned on the hot water tap, hot water came out—never cold, never steam, never mud, and certainly never nothing.  On either side of the median barrier, traffic flowed IN THE SAME DIRECTION—never once was a minivan or bus traveling on the sidewalk.  I found it truly amazing.

Joseph Alexander Schulter
Marisa, Michael, Alex and Evelyn


 


The 3 week break did me a world of good—Leland subsequently had a harried and exhausting short trip to India where he gave 2 of 3 prepared lectures, used pedicabs through traffic even worse than Nairobi’s, dodging roaming people, bicycles, cars, and cows.  The red tape he encountered getting the Indian visa was even worse than that which we met renewing our alien registrations—and his reentry into Kenya was made difficult when the Kenyan customs agents failed to recognize the temporary visa he had obtained in February so he had to get US dollars to pay the $50 single entry visa fee.  I had just entered 1 week before using the exact same temporary visa and had had no trouble. 

My adventure with health care insurers finally came to an end.  My “health insurance company” twice denied payment of my hospital bill from my admission for pancreatitis last October—they claimed it was a preexisting condition about which I had not informed them on my application.  I learned a number of important things from this experience; that if an insurance company wants to deny, they will find any number of reasons to do so—and that Danish insurance companies have no appeal process.  I also learned not to call my credit card company to have the credit limit increased because in doing so, one’s card is cancelled—permanently.  I also learned how to ask for discounts in the hospital bill and receive them (ask and you shall receive worked quite well in this instance).  So, the end of the story came with my cashing in an annuity and paying the hospital “only” $44,000 instead of the $72,000 on the initial bill.  The good news is that we will have a very nice tax deduction on our 2013 taxes. 

Life here brings us daily reminders that we live in a different culture.  For instance, when we go out to eat, Leland is served first.  Men go through doorways first.  Occasionally one of the Kenyan residents will hold the door open for me—I laugh and tell them to go ahead of me—“We are in Kenya, you know.”  If a group of people is coming down the hallway toward me, they don’t move aside to allow me a path through—generally I flatten against the wall—or if I’m feeling out of sorts, I’ll push my way through them—it is not considered rude here.  People who precede you through doors will pull the door closed without looking to see if someone is behind them.  People will often just stride out in front of oncoming traffic without looking to see that the way is clear.  If people don’t hear what you say, they answer with a sharp high pitched “HUH?”  None of those things are considered rude here.  And our directness in speaking is considered quite rude.  Fortunately for me, my Kenyan friends kindly overlook my directness—in fact, a few have come to me with direct questions (without the preliminary handshake and greeting) and I’ve teased them that they are becoming American.  One of the biggest compliments to me is when someone tells me I am becoming a white Kenyan.

We’ve entered the rainy season and that means wadudu (pleural for insect).  We have mayflies (a variety of termite) that pour out of holes in the ground at dusk—they mass around light so our porch is covered with wings in the morning.  Some Africans catch and fry the bodies—I am told they are quite tasty (I have no personal experience of this fact).  As I was sitting on the couch last night, a small object dropped beside me from the ceiling—it was a Nairobi ant.  They are quite small, writhe like shrimp when they are sprayed with Morten’s Doom, and need to be “flicked” not swatted if they land on you—their bodies release a toxin when they are crushed that causes an impressive and, I’m told, painful welt.  On rounds one morning, I saw “living wall art”—a cockroach running up the wall beside one of the babies’ beds.  I motioned to Leland who took my writing pad and mashed it.  That left cockroach juice all over my writing pad—having no towels, paper or otherwise, I wiped it on Leland’s lab coat to the immense glee of every single mum in the annex.  We hadn’t realized how closely we are watched!

Three weeks ago, Leland and I were home all day on a Sunday—he was on call so we spent 3 hours making rounds and were not able to get to Nairobi for church.  Most of the day I heard a terrible racket in the attic—as though someone were banging on the roof with a hammer.  Leland went outside to see if workers were on the roof—no one was seen.  He finally went up into the attic and came face to face with an African Hornbill who had gotten into the attic but then could not find his way out.  Leland made a quick retreat and called Elisha who brought 3 men.  Using a board as a shield, they cornered the bird and one grabbed his beak; another his feet.  He was taken outside and released.



One of our best known patients died this past weekend.  Abigael just turned 2 years old and had a myelomeningocele repair and shunt soon after birth.  She had many complications related to her shunt—over the course of her life she had three different kinds of shunts (ventriculoperitoneal, ventriculcholecystal, ventriculatrial) but all had complications—either malfunction or infection.  Her 7th admission resulted in an infection that was resistant to all antibiotics we have available.  We talked with her mom and she decided to take Abigael home—but before she could clear her bill, Abigael suddenly died.  I wrote a letter for her mom today listing her hospitalizations and calculated that out of 753 days that she was alive, Abigael spent 127 in the hospital—17% of her life.  We will all miss Abigael—she cried whenever she would see me so I tried to make games of hiding from her and playing peek-a-boo.  I never did get her to laugh, though.

A young Somali mum brought her very delayed, lethargic baby to OPD with a CT scan she had obtained at Kenyatta National Hospital.  We see many children who have had scans there and have had nothing else done for them.  This child had a scan showing severe brain atrophy from meningitis soon after birth.  When I told her through the interpreter that her child’s brain was terribly damaged from infection and that there was no medicine or surgery that could “fix” his problem, she collapsed onto the exam table, wailing in despair.  I put my arm around her, but really had very little else to offer but my sorrow that we couldn’t make her child whole.  The interpreter then explained that this mother’s first baby had died soon after birth.  What is very hard is that not only is this mother grieving for her two babies, but she also has to worry about being discarded as a wife because she hasn’t produced healthy children.  There are many levels to the grief we see here—some that we never encounter in our practices in the US.

One of the frustrations here is that we don’t have antibiotics that treat our multidrug resistant organisms—or that the antibiotics that are available are financially out of reach of the patients’ ability to pay.  We also really need a pediatric infectious disease specialist to come either short-term or long-term to help us make decisions regarding which antibiotic to choose, duration of treatment, and to help the lab improve the identification of organisms.  We need all kinds of pediatric preparations of common oral drugs—like phenobarb, diazepam, cephalosporins for urinary tract infections.  There are times when we have to hospitalize infants because the only antibiotics we have available are intravenous preparations.

Some medicines are not available here in Kenya; some are available in Kenya but not in Kijabe Hospital.  We have recently had 3 patients with diabetes insipidus after brain surgery—DDAVP, the medicine to control the huge urine output is not available at Kijabe Hospital pharmacy.  The MD in the ICU had a family member who had used that same drug several years ago for another problem—he found the medicine under his sink and we used it for two of the patients—fortunately, though it had expired, it was still effective.  When the third patient needed the medicine, we borrowed a tablet from the ICU and sent the mother to Nairobi to a pharmacy that stocked the medicine—she came back later that day with a month’s supply.  Other times, when we need hormone assays, we have to have the family pay the fee for an outside lab; the blood is then drawn and sent to the lab.  If the family cannot pay, the blood is not drawn or sent.  We are fortunate to be part of BKKH—we can often have BKKH pay the lab and get the assays done.  If the patient is an adult, though, they have to pay out of pocket.  The same is true for using our new CT scanner—the fee for the scan ($71) has to be paid before the scan is done.  You can see that there is a great advantage to being a patient in BKKH—but all of these new procedures are costly—and if the family is unable to pay the bill, BKKH picks up the tab. 

Frequently seen problems among babies and younger children are severe malnutrition and rickets.  My grandson gained 2.66 pounds in the first month—some of the children we see are 2-7 months old and are still at or near their birth weights.  Many of the malnourished children require supplemental formula which is incredibly expensive (about $10 for 3-4 days).  One 5 month baby was given a prescription for infant formula—his mother brought him back for admission, and I discovered that he had been given chocolate Ensure instead of infant formula!!  Treatment of rickets requires about 6 months of Calcium and Vitamin D supplementation.  The packets cost 24 Ksh/day—about $0.28, or about $51 for the 6-month course.  But most of our families cannot afford that—so the babies often get incomplete or no treatment.

Other times, children are diagnosed with rickets and malnutrition when they have regression of developmental milestones because of brain tumors.  One such 23-month-old girl was readmitted this week; her medulloblastoma had been emergently resected in January, she had been discharged in February in an almost vegetative state.  Her parents took amazing care of her and saw her regain some speech, the ability to feed herself finger foods and sit on a chair.  However, over the past 2 weeks, she regressed and was somnolent on admission.  After talking with her parents, we all decided to not intervene with further testing, scans, etc.  She died two nights after admission, with her mum at her side.  We all grieved and yet shared a peace that she was surrounded with love at her death—and that she was now in the arms of God.

Please pray that we have the physical, mental, and emotional strength to continue our work here.  We are tired and know that we need to take more breaks.  That means that we need more short-term neurosurgeons to help with coverage.  Right now, Sandi Lam and John Collins are visiting Kijabe to give us coverage while we go for a week to a conference in the States, and Humphrey takes a quick trip home to visit family in Uganda.  Humphrey has been accepted to a 6 month fellowship in Germany beginning in September so we will need A LOT of help this Fall (to you in the Northern hemisphere), Spring to us in the Southern hemisphere.  Thank you to those who continue to support us in prayer and contributions to BKKH.  We are very grateful for your faithfulness.

Erik Hansen and his family are on leave in the US for the next 5 months—so Leland is serving as temporary BKKH medical director until Erik returns.  I ask for your prayers for the Hansen family as they spend time with family and in raising funds to support their ongoing work here in Kijabe.  They, like us, consider Kijabe home.  And while we all love seeing our families and living in an orderly world, our home and our hearts are here in Kenya.  I ask for your prayers for the Hansens, and for Leland as he represents BKKH in meetings with the medical staff at Kijabe Hospital. 

I strongly recommend Kingdom, Grace, Judgment by Robert Farrar Capon.  It is a trilogy on the parables of Jesus.  What I find striking is that all through the gospels, the disciples just didn’t get it.  Christ continually told them about God’s grace, the Kingdom of God, and what God’s judgment means.  He told them of his death—over and over again, and yet, they just didn’t get it.  I’ve come to realize that I am no different from them—that my understanding of grace, the kingdom of God and judgment is probably just as flawed and incomplete as theirs. 

For now we see in a mirror dimly, but then face to face.  Now I know in part; then I shall know fully, even as I have been fully known.
I Corinthians 13: 12

Take care, God bless,
Susan