Gladys, RN

 Patient and mum

  

 Patient and mum

Elizabeth, OT

Susan with patients 

Agnes & Eunice, RNs

Habari Yako,                                                                                       31/01/2013

I am sitting in the BKKH Land Rover in Machakos Town while the nurses and staff of our Mobile Clinic here today are shopping.  We had a wonderful clinic—saw one young infant with Apert’s syndrome who will need surgery to enlarge the skull—she was born with fused sutures and fused fingers.  Fortunately, Del Mount, the craniofacial surgeon will arrive on Sunday—we have about 11 cases already scheduled and will likely add a few more. We shared the open air clinic with two goats—who had left visible (and odiferous) proof of their presence on the ground under our feet.

I want to share with you some “Toto” moments.  The Swahili word for child is “mtoto” (plural watoto) but I am not referring to children here.  These are Wizard of Oz moments when one realizes, “Toto, we aren’t in Kansas anymore.”

A 7 month old girl from Mombasa was admitted in mid-December; the history was a bit sketchy since the mother of six had no idea why the father told her to take the baby to the hospital at 5 months—nor did she understand when the grandmother told her the head was getting big and she should come to Kijabe.  The morning of surgery, she refused to thumbprint (sign) the consent for surgery.  Later that evening, the mum attacked another child and tried to bite her.  Mum was carted off to Casualty and heavily medicated while calls were made to the father in Mombasa to bring someone with him to stay with the child while he took Mum home.  He came alone, so we had to discharge the baby without surgery.  He brought her in mid January for a successful operation.

A baby was admitted sometime last Monday evening; it wasn’t until Thursday of this week that we were notified that no one had seen the baby since admission.

We began enrolling patients into our new shunt study—a single blind randomized study of the regular Chhabra shunt versus an antibiotic impregnated one.  After consenting three mums, we were told that the standard pre and post op antibiotic we were to give intravenously was “out of stock.”

A 2-month-old boy was admitted with a high fever and seizures—he had recently had a shunt.  On his back was what appeared to be a pustule/boil.  I tried to express the pus to get a culture, and out popped a live larva.  I have to say it was a first for me.  I put the wriggling creature in a test tube—one of the pediatricians identified it as a tumba fly larva. The flies lay their eggs on drying clothes, then the eggs hatch and burrow into the skin until the fly is ready to “fly.”  Think of it as a subcutaneous cocoon.  By the way, the fever and seizures had nothing to do with the larva.  He also had a urinary tract infection.

A lady lacked 10 shillings (about $0.12) of her 30-shilling matatu fare; the tout (conductor) threw her out of a moving matatu into the path of a bus.  She was killed.  The mob that gathered torched the bus and carted off the salvageable parts. The police are holding the bus driver in custody.  The matatu driver and tout have not yet been identified or arrested.

I could go on, but I think you get the picture.  It is usual for very unusual things to happen here.  Not Kansas---or Madison—or Pittsburgh—or even Portland, as wonderfully unusual as that city can be.

 Children’s sermon 

  A few Sundays ago, I saw something in church that took my breath away.  Pastor Mike was beginning the children’s sermon and had invited the children to come forward.  A little 3-year-old boy very reluctantly approached, lagging behind the other children.  The sermon was about the baptism of Jesus, so Pastor Mike shepherded the children to the baptismal font.  The little boy stood back and didn’t move with the group.  Another boy, about 10 years old, came and took the hand of the three year old and stepped toward the group, but the little one planted his feet firmly and didn’t move.  I expected to see the older boy yank or pull the child but he didn’t.  Instead, he just held his hand and waited. Finally, the older boy took a small step forward and then the small one followed him to the font.  To me, this was a revelation of how God works in our lives.  He is present, always beside us, holding our hand, ready to lead us.  But He doesn’t yank—He waits until we follow.

We had a group of visitors this week—they are involved with this ministry through BKKH.  Erik Hansen, Leland, and I gave 30-minute talks at the luncheon in Kijabe last Saturday. I told them about being inspired when I was about 10 years old by Miss Emma Snyder, the missionary nurse who worked in a leprosarium in Nigeria.  I talked about having given my heart to Jesus when I was eight—and then realizing my dream of being a missionary nurse in Africa 50 years later.  As Leland often says, our lives are not lived in a straight line—so many twists and turns and detours off the main road.  But the truest joy and most amazing peace come when we follow where He is leading us.  Most times, that is not to another country—it can be to a new church, a new job, a new city, a new relationship—but we need to keep following Him along the path. 

Christmas poinsettia, Kijabe

Living here in Kenya is an experience in extremes--exciting, exasperating, exhilarating, exhausting, hilarious, heart-breaking.  We see the rosy blush of dawn on the Valley, the curtains of rain on the horizon, the sparkling of the Milky Way at night, the incredible ever-changing sunsets over the far ridge of the Valley.  We see so many children cherished by their families—babies who are born with terrible anomalies yet are deeply loved.  We see so many children die—5 over the week between Christmas and New Years.  Children with brain tumors are misdiagnosed as having rickets—and we see them when they are finally having brain herniation, too late to save them.  One 7-year-old girl was admitted two weeks ago—and died during the night; her operation had been scheduled for first case that morning.  Often these children have been to many other health facilities before they reach us; one had been seen at Kenyatta National Hospital (KNH) in mid–December and had a CT showing a large brain tumor and severe hydrocephalus.  The doctors at KNH gave him a return appointment for Jan 28, 2013.  Despite his parents bringing him to BKKH 5 days after the CT, he stopped breathing right before his surgery the morning after admission.

Through a united effort among pediatric physicians, surgeons, nurses, BKKH engineers, and administration, our 3-bed HDU (high density unit) is operational.  We have monitoring for the sickest children and a patient:nurse ratio of 1-3:1 instead of the usual 8-12:1.  We still do not have the capability of monitoring those children who may have shunt malfunction or severe hydrocephalus pre-operatively—who seem stable now but could deteriorate quickly.  The nursing staff has been under a great deal of stress—the nurses in the national hospitals have been on strike for 3 months.  That means that both our census and our acuity is higher than normal.  I think the nursing care has never been better than it is right now—and many nurses are taking an active role in improving it even more.

We continue to have water problems—and I will never again take for granted turning on the hot water tap and actually having hot water come out!  Our solar water has been non-existent since the roof repair last July.  This week we have no water at all from the hot tap.  However, we do have cold water (which can be heated in a pot for an “African bath”)—which is more than I can say many mornings in the hospital.  Musyoka, our infection prevention and control technician, frequently announces with some exasperation that there is no water in the hospital today.  It is hard to give the babies their preop antiseptic baths without water.  And after examining a newborn with spina bifida and feces all over the legs, it is particularly unpleasant to learn there is no running water—hand gel just doesn’t cut it.

Please continue to pray that we find someone to help Leland and Humphrey with the heavy numbers of operations.  Leland thinks he has found a neurosurgery fellow who can start next January, but we need help from now until then.  Please also pray that we find a helper for me—there is a clinical officer who will join us for the month of April—if she likes the work with our kids (and with us), there is the hope she will join our team.  I would love to go to more of the mobile clinics where there is a need for someone to look at scans and identify children who need neurosurgery.  But traveling to mobile clinics leaves the OPD and wards without daily support for the nurses.

If you have interest in helping with this ministry, I encourage you to go to the Bethany Kids website www.bethanykids.org. While it is tempting to give to special funds, I will tell you that BKKH needs donations to the general fund in order to support all the ministries.  We have dire need of funds to finish the sewage system updates that must be in place before the new hospital building can continue. This isn’t a glamorous use of donations, but if the sewage system isn’t funded, then all construction for the new hospital ends—and the government could shut down the entire hospital.

Throughout scripture, God is very clear about His priorities.  We are to be the face, hands, feet of Jesus to the poor, the oppressed, the lonely, the sick, the hungry, naked, imprisoned.  I once sang a solo in Bellefield Presbyterian Church—from Micah 6.  It is one of my favorite scriptures.  I will leave you with that….

The word of the Lord came to Micah, and he said,

Wherewith shall I come before the Lord, and bow myself before God on high?

Shall I come before him with burnt offerings, with calves of a year old?

Shall the Lord be pleased with thousands of rams, with ten thousands of rivers of oil?

Shall I give my first-born for my transgression, the fruit of my body for the sin of my soul?

It hath been told thee, oh man, what is good.  And what doth the Lord require of thee, but to do justice, and to love mercy, and to walk humbly with thy God.

Take care, God bless.

Susan