Jambo! (yet another way of saying hello)

On St. Patrick’s Day, March 17, 2011, the Long Rains began. It was a day of tremendous excitement among the hospital staff because it meant that the crops just planted will survive. There were torrential downpours (which meant soggy ceilings in our third floor apartment—but that’s another story)—5” in 2 hours…dirt rivers the color of Burnt Sienna (always my favorite crayon) flowing downhill. The silence that night—the complete ABSENCE of wind—was stunning. We could hardly sleep for the silence. J I had expected that the long rains would be like living in Portland in January—rain all day every day. That isn’t the case at all—there have been days with an hour or two of rather light rain, sunny days without any rain, and days like today which are overcast most of the day with occasional showers. But, my, how green is our valley! The tan/brown parched earth has been transformed to lush green. I hope the pictures I’ve included give you some idea of the beauty.

It is hard to convey how different life is here. Take road construction, for instance. You all know what that means in the US—heavy machinery, hard hats, safety signs. Here, everything is done by hand—men push wheelbarrows up and down the hill to bring the medium sized rocks that form the base covering for the old dirt road. Then, they cover that layer with load after load of red dirt. Finally, the cars driving over the road pack it down—which means that now that the rains have come, the middle of the one lane is a muddy mire—we have some missionaries who cannot negotiate the new road even with 4-wheel drive SUVs.

Another group of workers dug deep trenches (about 3 feet deep) so that telephone wire could be laid to the houses further down the hill from the hospital—the physicians living there had to rely on cell phones to call the hospital. The reason that the lines couldn’t be strung on the existing telephone poles is that the wire had repeatedly been stolen for the copper. In the course of digging the trench, rocks and other assorted things were unearthed. One day we saw an ovoid “rock”—which on closer inspection was a human skull. We named him Yorick and were a bit concerned until the medical director informed us that we live on a former cemetery so that bones were always being discovered during the course of construction of the Quadplex. He suggested we just rebury the skull. Alas, poor Yorick disappeared before we could reinter him. Gone too soon to have known him well….

I’ve mentioned before about some of the hard ethical dilemmas that we have here—Leland asked that I give you several vignettes:

1. A 6 day old boy came to OPD yesterday from East Pokot—a very poor area in northwest Kenya. His father was older and had moderate tremor—one side worse than the other. The baby was the eleventh child and had had no medical attention since birth. I don’t think I’ve ever seen a dirtier baby in my life—the clothes were covered with dried stool and urine, he had never been bathed since birth. He had a huge myelomeningocele that was infected. He had no movement below his hips and had a very small head. As I examined him and tried cleaning his back, I realized that he had significant apneas—pauses in breathing—during which his heart rate dropped precipitously and he became ashen. After a pause, he would gasp and then start to cry. Leland examined the baby and saw that his prognosis was rather grim—if his breathing and heart rate could be stabilized, he could have an operation to close the spina bifida, then probably a shunt to treat the developing hydrocephalus. However, the chance that he had the beginning of a bad infection because of the open spinal cord was huge—which would be likely to infect his brain. Also, treating the spina bifida would require that the family do good wound care, observe him for complications (shunt malfunction, skin ulcers) as well as do catheterization to help him urinate regularly. We consulted with Pastor Mercy and she had real concerns that this family would not be able to handle all these medical issues. She recommended though that we give the family the choice of treating the baby or taking him home. That discussion (always a hard one) took place with translation from English to Swahili to the local language of the Pokot. The father seemed to vacillate—but the mother said that if the baby couldn’t be normal, she wanted to take him home without surgery—and that is what they did.

2. A 50 year old man rode via matatu for several hours and presented to Casualty (Emergency Department in British/Kenyan English) with a chronic subdural hematoma causing severe headaches and an impressive right-sided weakness. He had no money to pay for an operation. There were no beds available in the hospital. With a simple operation, he could resume a normal life—without one he would be incapacitated. The operation and hospitalization would cost 26,400 Kenyan shillings--$330 in American dollars (can you imagine how far $330 would go in the US?). One of our wonderful OPD nurses, Jane Mutinda, offered to house him and his wife with her family overnight until a bed became available. Leland paid for his operation and hospitalization—he had a remarkable recovery and is a very happy and grateful man.

3. In December, an 18 year old young man had resection of a medulloblastoma—a brain cancer. His family was able to pay for his surgery and hospitalization. Afterward, he needed an MRI of his spine to make sure he had no sign of cancer there. He could afford only the cervical MRI—we made arrangements to pay for the rest of the spine MRI through funds from BKKH. The MRI was clear of any signs of cancer. But, he needed radiation therapy to make sure the cancer cells were killed. Arrangements were begun to send him to the University of Wisconsin—but then we became aware of a facility in Nairobi which could do the radiation therapy (the usual place, Kenyatta National Hospital has a waiting list of 400 patients—people usually die before they can start therapy). The cost for 6 weeks of daily radiation treatments for this bright young man was KSh 200,000 or $2500. Leland and I felt so strongly that he should have the therapy (which is potentially curative) that we split the cost from our personal funds. The young man just completed the 6 week course and has started back to school.

These are just a few of the many dilemmas we encounter here—whether to treat babies with severe brain damage with expensive medicines and long hospitalizations, whether we should try treating children with massive hydrocephalus, malnutrition, and scalp bedsores, whether children with brain tumors should undergo the risk of surgery (with no ability to do scans here at Kijabe) or face death from the tumor without surgery.

Added to these often heart-wrenching concerns, we daily have incidents where ordered meds (including antibiotics for severe spinal fluid infections) are not given—or are charted as given but have not been, lab tests are not done or the results have been lost, equipment goes “missing” (the donated infrared thermometer that I brought from UW “walked off” last Friday). From time to time we have no running water anywhere in the hospital--washing hands between procedures on patients can be an adventure. It can sometimes be difficult to maintain a cheerful demeanor during the course of the day.

Last month we were informed that the “nurses” were very upset with us; we were given a list of our infractions. Both Leland and I were a bit surprised—we had seen some real improvements in our relationships with the nurses on morning rounds. Many of the formerly reticent nurses had started to actively participate in sharing information about the mums and babies—some had started to ask good questions and were showing interest in learning new techniques. So, we did some reality checking—talked to several Kenyans, other missionaries, and each other—also spent a good amount of time in prayer. We each decided that, despite what had been shared with us, we felt like we were heading in the right direction with our relationships with nurses and other staff in the hospital. We realize that building relationships takes time, and we are committed to doing that over the next 4-5 years. We also realize that cultural differences interfere with understanding—my doing the ventricular taps to be more efficient was seen as being critical of the nurses’ abilities. Our writing daily progress notes was seen as critical of the nurses’ charting. There is real reluctance among some (but not all) Kenyans to directly share information and concerns—we tend to be direct which is seen as quite rude. I feel very confident that we will sort these difficulties out—already the discussions that we’ve initiated with the unhappy nurses have soothed some of the hurt feelings. But, I also became aware of a very important truth. We did not come here to please people. We came because we both felt called by God—we not only want to be obedient to that call, but out of the gratitude we have for God’s love and mercy toward us, we want others to see Christ through us. We are here to bring glory to God, so that through us, people see, come to know and love God.

So, I want you all to know that we are very happy here; we feel an incredible sense of peace. We don’t downplay the difficulties but also don’t dwell on them. We are not discouraged. We look forward to continuing to get to know the Kenyan staff; we love working with the patients and families. Most of all, it is supreme joy to be serving God in this place every day.

We ask that you continue to pray for us—for wisdom, patience, cheerfulness, discernment. Thank you for your prayers and encouragement.

We have confirmation from Paul Buford, the bookkeeper for Bethany Kids, that the Neurosurgery Patient Subsidy Fund has been established. To access the website, go to www.bethanykids.org. If anyone feels led to contribute specifically toward care of indigent patients, you can designate gifts to that fund under “Other.”

Take care, God bless.

Susan