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| 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.
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| Joseph Alexander Schulter |
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| 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
