Habari rafiki,
June 26, 2011
Leland assures me that the pleural of rafiki (friend in Swahili) is rafiki (friends). I asked if he was sure like a neurosurgeon (sometimes wrong but never in doubt) or sure like Leland. He assured me that it was the latter. I’ll confirm it with our Swahili teacher, Edward Amalu, at tomorrow’s lesson—not that I doubt Leland or anything….
We decided we both needed help in talking with the patients more effectively, so Leland arranged for private lessons 2 evenings per week. Each time, we start with Leland’s questions—how do we ask if the child is vomiting, passing stool, etc. For that reason, we don’t have the ability to have pleasant dinner conversation—but we can find out important information about the patients. We’ll work on the more socially acceptable dialogue later. In the process, Edward tells us fascinating things about the Kenyan culture and customs. It is fun to pick up a few recognizable words as the patients or staff talk around us. And the staff seem to be very appreciative of our efforts to learn Swahili—though my pitiful attempts at pronunciation still send them into peals of laughter.
An amazing thing happened at our church this past week. Four years ago, the church started a construction project on the existing church building and moved into a tent. The tent was to have been used for 6-9 months. As I explained in an earlier post, some renegade council members not only stopped construction but bribed the authorities to rescind the construction permit and had the caretaker arrested at gunpoint. On this past Thursday, the pastor was told he could finish construction—many church members worked feverishly until the early hours this morning (Sunday) to ready the church for worship today. Late last evening, a ferocious storm moved through Nairobi and shredded the tent roof, making it an even “hole-ier” place. We worshiped this morning for the first time in the new building—but Pastor Sam led us into the tent at the close of the service, and with tears in his eyes, thanked God for providing a dry place of worship, not for 9 months, but for 4 years. He spoke about Elijah and the widow of Sidon during the famine—who had flour and oil for only one cake—but God made it last “until the rain came.”
Work at the hospital has been emotionally draining this past month. Thursday a week ago, we had a week old baby boy brought to OPD with a temperature of 35.4 degrees (normal is 37), a slow heart beat, abnormal respirations, a high myelomeningocele and severe hydrocephalus. I asked the nurses to quickly get a heater and start an IV so that we could stabilize this baby who probably had a neonatal infection. After 10 minutes and no heater and no IV, I looked to see what they were doing and they were cleaning out the infamous supply drawer that has been the bane of my existence since we arrived last September. Now, I do appreciate that they recognized the need for organization—but I had to seriously question their timing and prioritization. I decided that we wouldn’t get very far in OPD so carried the baby to the nursery where he was stabilized. Later that very afternoon, another baby, 9 day old Agnes, was brought by her mother from Lodwar (“veddy far”) which is in northwestern Kenya and is quite remote. The baby’s temperature was 41, and a nauseating smell permeated the room when she arrived. She was covered with dried birth fluids and stool. I quickly cleaned her and drew fluid from her head for analysis—it was pure pus. She had the most horribly infected myelomeningocele that I’ve yet seen—leaking foul-smelling fluid. It was obvious that she could not survive. After Pastor Mercy and I told the baby’s mother, she disappeared. A little later, the OPD nurse came to me and said that the baby was gasping. I went down to find this baby girl alone in the exam room. I could not stand the thought of this child dying alone, so I held her in my arms until she died. Afterward, my lab coat was saturated with the infected spinal fluid. Mercy saw great benefit in having the baby brought to us to die—the custom of the people of this baby’s tribe is to put dead bodies out in the bush for the hyenas. By bringing the baby to us, we had the child buried in our church cemetery in Kijabe.
Several days later, a 6 year old very malnourished boy was brought to OPD with pus draining from a hole in his scalp. It had been draining for over a year. Humphrey, our pediatric neurosurgery fellow, took the boy to theatre to drain the abcess—and it grew every kind of bacteria as well as amoebas. The child will be on 4 antibiotics for at least a month—if he survives. Unlike the US, there is no Child Protection Service to call—the most that might be done is to have his mother put in jail for a few days—which would accomplish nothing. So, if we can heal this boy, he will return to his home. So, what is the right thing to do? These are the questions we face every day.
Habari again—it is one week later—this week I had little time or energy to complete the posting I began above. Another eventful week—the 6 year old boy mentioned above developed very severe pneumonia despite 4 antibiotics. Of course, we had the usual problems of having the nurses change times that the antibiotics were given (one was supposed to be every 6 hours; they didn’t like that so they gave it at 6am, 10 am, 6 pm and 10 pm). The IV access was poor so he didn’t get all the doses no matter when they would have been given. His white blood count was 31,000 (normal is 4.5-11,000). When Mercy and I talked with his aunt, she called his father who said to bring the boy home immediately so he would die at home. So, we took off the oxygen and removed his IVs and sent him home on a matatu (about a 12 hour journey). It was hard for me to remove the oxygen, though after talking with our pediatrician, Dan Entwhistle, I agreed with him that the child was not likely to suffer more off the oxygen than he was with it.
I very often have trouble deciding what to share in the blog. I don’t mean to demean or denigrate the Kenyan staff—many are quite dedicated to their professions and really feel that their work is a ministry. But it is hard to see poor quality nursing care given and to not address the issues with those responsible. We have routinely had orders not carried out, medications not given or given incorrectly, dressings not done properly. To be fair, though, each nurse takes care of 8-15 patients; these are very sick children. I’m not sure how well I’d be able to do under those circumstances.
Two vignettes:
A baby with spina bifida and hydrocephalus spent a month in BKKH having various complications. Finally she was ready to go home. During the hospitalization, I remarked about how many visitors her mum had—often several friends/relatives per day—it was unusual because many of the mums have no visitors until they are ready to go home—many have no visitors at all. The day after the baby was discharged, she was still in the bed and her mother was in tears. The mum and baby had been disowned by her entire family—they did not want a disabled child in the house—and not one of her relatives wanted to take responsibility for paying her bill. Unfortunately, this is not a rare circumstance. Leland and I paid part of her bill; BKKH forgave part of it (though BKKH will pay the amount of the entire bill to Kijabe Hospital). Your donations go toward paying the bills of these babies.
You may remember the saga of the disappearing infrared thermometer. One morning last month, a security guard and one of the experienced neuro nurses appeared in front of me—the guard was holding the missing infrared thermometer. I was overjoyed and said something about rejoicing for what was lost had been found. It took me a few minutes to realize that he had found it in her purse—the guards routinely search the belongings of staff members of the hospital as they leave work because there is so much theft of hospital property. The nurse said she had used it for mobile clinics—in later versions, she said that the in-charge nurse had given it to her (clearly not true), that each nurse had one—her testimony changed even during her disciplinary hearing. The committee was unconvinced—or rather, they were convinced of her guilt so gave her the option of resigning (and retaining her benefits) or being discharged. After she had continued to work for 2 more weeks, she finally refused to resign so was dismissed. As painful as this incident was, it was very important for the nursing staff to see that there are consequences to theft, lying, etc. What was particularly upsetting, though, was learning that most if not all of the other nurses knew that she had it for the two months that it was missing. Not only did no one turn it in, or report her, but also no one thought enough of the nurse to encourage her to return it anonymously so that she could retain her job.
We are enjoying the winter here—July is like January in Wisconsin (well, relatively speaking). Even though we are just 2 degrees south of the equator, we see a real difference in weather. The afternoon sun no longer streams in the living room window; when we sit out on the balcony we almost always need sweaters. The long rains are past; we still have rain occasionally but it is often cloudy and foggy. Since there is no heat in the hospital, the staff wear parkas, hats, and scarfs. Being from Wisconsin most recently, we wear regular clothes under our labcoats, but I do have to admit that on foggy days, my hands never get warm.
Last Friday marked the beginning of our eleventh month here—time has flown. We feel much more settled here—and are feeling that we belong here in Kijabe. Making friends is still a slow process but our growing involvement with the Nairobi International Lutheran Church has helped us feel at home in Kenya. Leland has been asked to preach two sermons during the pastor’s leave. We were “greeters” this morning and both of us have been scheduled to read the scripture.
If anyone would like to see a presentation of a video about our work in Kijabe that Leland and I made at Luther Memorial Churchon May 1, please go to http://gallery.me.com/leeapowell#100069
Here is a link to a BKKH newsletter: https://app.e2ma.net/app/view:Join/signupId:1418122/accId:1408519
Thank you all for your prayers. It has been so good to hear from friends—some who were “lost to follow up” for many years. We pray that God will be glorified in all that we do—I am not just talking about our work here in Kijabe, but in the lives that all of you lead as well. I am increasingly convinced that it is not so important what work we do; what is important is that we follow our Savior so that His work is done here on earth.
Take care, God bless.
Susan
