While here, I’ve realized how much I throw myself into patient care.I cannot hold back, and given the length of the list and all the limitations related to language and the like, it means a lot of work.So it was no wonder that when my roommate, Heather, and I went to Lake Nakuru, post-call, for a safari, I was wiped after one long game-drive.It had been a fruitful one—after seeing and walking among a multitude of flamingos, pelicans and other water-loving birds, we got to see zebras, gazelles, waterbucks, buffalo and even rhinos.By far, my favorite animals to observe were the giraffes for their shyness and grace.
My next favorite, for sheer entertainment value:the baboons and monkeys (kima in Swahili, a.k.a. “wewe!” (pronounced wehweh) which means “you!”—so dubbed by my roommate who had lived in a tin-roofed mud hut in rural Kenya for 6 months of her first year after college and had to fight these little rascals when they made a dash for her food!).In fact, in the two minutes it took our driver to realize that he’d left one window rolled down as we parked to pay our park entrance fee, a wewe had broken in and made off with some of our biscuits (cookies)!Later, when we stopped at “Baboon Cliff” to look over the entire game park, a baboon decided to hop on top of the jeep in the hopes of figuring out how to get at whatever goodies were inside.Interestingly, our driver showed us that baboons are intimidated by men, but not women—he had me walk up close and try to scare the baboon, but the baboon tolerated a much closer distance from me than from our driver.
“If you’d been wearing a skirt,” he noted, “that baboon would never have moved.”
I have never been super-attached to animals, though over the last few years, living with and knowing dog and cat lovers has opened my heart to them :) .Yet though going on safari seemed to be the one thing I could not leave Kenya without doing, I was not overly excited about seeing the animals, till I was among them.The roads through the game park were rocky dirt paths cut through gorgeous forests and leading to the water’s edge at some points.Unfortunately, we weren’t able to spot any lions (much to our chagrin, because it seemed as though everyone else in the park had seen them and we somehow kept just missing them!).
In the evening, we went to Flamingo Hill Camp, a tented camp just outside the gate, where we stayed in order to be able to re-enter the park early in the morning without paying a second day’s entrance.It was a unique experience, sleeping under a mosquito net with a hot-water bottle at my feet to keep the mild chill of the night at bay.Though the word “tent’ might conjure up certain images, try to envision large canvas tents enclosing a room with two canopied twin beds, a bathroom (including a shower) separated from the bedroom by tent flaps.Though Heather, who’d traveled for a year paying only $5 a night to stay at certain places, balked at the price, I thought a $45 stay completely reasonable for what we got—a quiet place to relax, a gorgeous setting, good coffee and tea and dinner.
Probably the best part of the deal was the fact that we happened to choose to stay there the same night that a nearby international high school had its graduation dinner and dance there.As Heather and I waited for dinner, all of a sudden, high school students in skimpy dresses and nice suits began to congregate.Feeling somewhat underdressed, we were invited by the hotel staff to cut in line and select food for dinner from the buffet (mostly Kenyan food including nyama choma--yummy grilled meat).When the music started later, we laughed to ourselves, realizing that we both seem to have occasional adventures that no one else has—who else crashes prom while on safari?
The next day, we searched for lions in vain before heading to Crescent Island, a game park created after the filming of Out of Africa provided a location for herbivorous animals to live without their natural predators, allowing for the only walking-safari experience in Kenya.We lucked out when we got to the island (which is actually a peninsula that is difficult to reach by road)—our guide Moses was able to take us straight to the place where a newborn (that day!) baby giraffe lay sleeping.I also got the chance to see sheep in a more natural habitat than the lab I’ve been in for the last two years :P .
My last updates from Kenya, here jumbled together:
Speak up for those who cannot speak for themselves, for the rights of all who are destitute.Speak up and judge fairly; defend the rights of the poor and needy.Proverbs 31:8-9
It’s been some time since I’ve written.As you might have guessed, I’ve been somewhat subsumed by work—with a list of 50+ patients and a constantly changing team, it’s been a bit of a challenge to keep my head above water.At least half of the patients have neurosurgical issues such as spina bifida (incomplete formation of the spinal cord), encephalocoeles (outpouching of the lining of the brain with or without brain tissue) or hydrocephalus (overproduction or underabsorption of fluid in the brain)—to say the least, many issues that arise have not been ones I have seen before or would ever expect to see in the States.It is thoroughly humbling to realize afresh how little I know, as fever work-up here includes a specific algorithm for diagnosing and treating malaria—there is diagnosis by the book, and then diagnosis as a feasible matter in our well-equipped but small lab.
To top it off, there have been barriers with communication and the new hospital system to learn.Today, for instance, I spent much of the day trying to arrange for a contrast swallow study for a patient who had a large neck mass removed the first day I arrived.She had some nerve damage from the surgery and has had some difficulty swallowing in a coordinated fashion.There are no full-time radiologists here, only some techs who are seasoned, but still have limited understanding and ability to perform the necessary tasks.So it’s back to being an intern—taking the patient down to radiology, mom and Somali interpreter in tow and having all of us in lead aprons to coax the child through the process.Who knew the contrast would taste like candy to a child who hasn’t eaten anything by mouth since the procedure?
Pastor Renner is the German missionary who received a calling to work with the Somali patients here.Actually, he used to lead a church in northeastern Kenya, where a bunch of Somali people live due to the arbitrary delineation of borders between Kenya and Somalia.He and his wife did such an amazing job of sharing God’s love with that people that the local Muslim leaders gave them a warning, saying essentially, “we like you, but if you keep doing what you’re doing, we’re going to have to kill you.”Somehow, despite that roadblock in their ministry, the Renners are still ministering to the Somalis and have become dedicated translators at Kijabe.The Somali patients know them as “friend” or “one who walks with you,” and there are radio advertisements aired in Nairobi telling Somalis that if they have medical problems, they ought to go to Kijabe.It’s pretty crazy, because even in Mogadishu, where there are hospitals for Somali patients, the word on the street is apparently that if you need medical care, it’s best to go to Kijabe—there’s someone there who can help you through the process (Pastor Renner) and you’ll get good, inexpensive care there.
It’s funny—though the Somali patients are the ones I have the toughest time communicating with, my heart goes out to them the most.The children just bloom when you smile at them and interviews and exams are a community effort—Somali mothers (and sometimes fathers) who can speak English or Swahili are constantly being enlisted by other patients on the ward for translation—such a refreshing difference from the rules about patient privacy I usually deal with in the States.And when I can get either of the Renners to help with translation, quite a queue develops.
It is humbling how little I sometimes get done in a day, due to my lack of knowledge of the system or the need for translation.But in the end, if the patients understand what we’re trying to do for them and know we’re doing our best, I am satisfied to have provided that care.
My most recent adventure (after driving cross-country in a uhaul truck with terrible gas mileage and moving my dusty stuff out of storage into my semi-clean house) and trying to stay fit in 100-degree-plus weather came last weekend when I tried to figure out why my lawn was looking yellower and yellower. I was considering calling the lawn guy to tell him to leave the grass longer when he mowed it, but I also knew there were some missing sprinkler heads. My limited experience with sprinklers so far consists of me replacing the ones that got knocked off by the lawn mower. Imagine my surprise when I found that the electrical connections to the sprinkler control box had come loose. . . which I discovered due to the handy-ness of an older woman who lives down the street (who needs a husband when I have such a great neighbor?).
Following this, I did a "manual start" and found a few points from which water was leaking but not vigorously spouting. Much to my surprise, some digging around in the grass unearthed a buried sprinkler head (yay!) and revealed a completely missing one. I tried to dig down around this to find the pipe threads onto which I could seat a new sprinkler head, but much to my dismay, the threaded pipe (which I had to determine by feel, as it was sitting under an inch of brown water) was missing. Which means I need to dig a bigger hole and figure out what the heck I need to do to replace it. And which meant that when the sprinklers came on that night (because I'd forgotten to reset the time on my sprinkler control), I had a geyser in my front yard. It'd been a hot day and I had my windows open and the house fan running, so I'd heard my sprinklers start, and they seemed a bit louder than usual. It wasn't till I decided to peek out that I saw the geyser and a bunch of amused neighbors standing around down the street. *blush*
You get three guesses.What has long legs, a long neck and brown spots?And what has black and white stripes and is considered (in the States) to be far less common than horses? (Sorry, non-medical readers—this is a commonly used admonition in medicine to consider the most common causes for disease.)And what animal was known, in The Lion King, to clear the savannah after every meal?
You’d think I’d been on a safari, but I was simply being driven to a rural church near Lake Naivasha.That name may or may not ring a bell for environmentally-minded folks (apparently, this is one of a few U.N.-protected wetlands areas), but Crescent Island, a game park that allows the unique experience of walking safaris (all the rest are done by jeep), is where the movie, Out of Africa, was filmed.They apparently imported a bunch of animals there and then left them when the movie was over.The animals have flourished because there are few predators, and venture quite close to the road.(I’ll have to post pics when I get back—a giraffe looked up out of curiosity and I was able to capture that image :) ).
After these refreshing and unexpected sightings, we headed off the beaten track onto an unpaved road full of potholes with dust rising everywhere.Though it is technically rainy season, and though we were only an hour’s drive from Kijabe, we were in a far different clime.When we finally reached the church, we found a hut constructed from mud patched over metal wire framing with a tin roof.Inside, benches were lined with 5-6 adults or 7-8 kids. . . and God help the poor soul with claustrophobia or poor heat tolerance—there were only three small windows, each with a single wooden door-like shutter, plus the open doorway, to provide ventilation.
I was, as would be expected, a complete novelty.The children were curious and bold or shy and furtive, but whatever happened, they wanted to shake my hand or be somewhere in my viewfinder :) .I missed the sermon to help with Sunday school.After a story told by the wife of the peds surgeon, translated by Nkesha, an African surgical resident, I taught them a song with accompanying hand motions.I had learned it long ago, as an “imposter” in the Christian a cappella group through which I became a believer.
“He’s my Rock, my sword, my shield. . . “ I sang, making up whatever motions I couldn’t remember.It was great to see the kids mirroring me, and food for my soul to interact with and photograph them :).Afterward, we had a feast that had been cooked over an open fire and chai, their traditional tea with heated milk and plenty of sugar :) .Then we visited the pastor’s mud hut with his chicken coop and makeshift ladder, where a huge gaggle of kids gathered to stare at the mzungus through the barbed wire fence.Apparently, he knew them, invited them in, and they did the same cute, staring-through-the-fence routine as we blazed off in our SUV.Okay—we really didn’t blaze off—the dirt paths had chunks eaten out of them by the rains that somehow made those holes without keeping down the dust.
Other things I saw on the way to and from church:large camps full of IDPs (internally displaced people) living in white tents that are gradually giving way to more-permanent mud huts.Huge greenhouses for the roses that Kenya apparently exports to Holland (apparently you can get 16 for approximately $1 here!).I saw turn-offs to go to a few national parks—Mount Longenot, which has an old crater that apparently houses a forest and Hell’s Gate (where Tomb Raider 2 was apparently filmed) where I’ll see hot springs and may even run into some buffalo (don’t worry—I’ll be careful if I’m there!).
Anyway, it’s funny—Sunday’s events left me feeling a confirmation of certain thoughts that had been running through my head:I like it here.I could do this.I think I could even see myself being here for a longer period of time than a month.And so, I’ve undertaken a thought experiment:to think as though I were a pediatric surgeon stationed here at Kijabe.Monday was therefore a disaster—I woke up later than intended, found myself dealing with a ton of surprises—patients somehow admitted to our service without our knowledge, including a boy who showed up with a ginormous (yes, truly gigantic and enormous) neck mass that he’d had for the last three years.He’d been undergoing work up at another hospital when all the violence erupted around the Kenyan elections and that process had been interrupted to his detriment—the mass that was much smaller at that time has turned out to be a diffuse large cell lymphoma.Unfortunately, the pediatrician who does chemotherapy here will be leaving within the next few months and there isn’t anyone else coming who does chemo.
Beyond this, there was a young girl admitted after a bad motor vehicle accident that killed both her parents and left her with a nasty facial laceration.To my horror, we discovered her on morning rounds, complaining of some lower abdominal pain, with only one blood test drawn—a hematocrit.She didn’t get to the OR until later that day, where we found that her stable blood counts and increasing pain were the result of a small bowel perforation.It was so strange to have to turn on my “trauma brain” out here in idyllic Kijabe, where the nearest CT scanner is over 50 kilometers away and where we think twice (or in my case 10 times) before ordering some tests or work-up, as each costs at least a day’s worth of labor for these patients, if they have money at all.As I wrote orders for her post-operative care, I thought two or three times about which electrolytes I wanted to check, and whether it was really necessary to order the few (in comparison to what I’d get in the States) that I did.
I have found myself frustrated at points by not knowing how the system works here, by language barriers, differences in work habits and perspectives on disease processes.Heuric, the pediatric surgery fellow here, has been a great help, though.He’s so jovial and clearly loves his work, loves his patients and loves teaching.He and I have been operating together on a lot of small cases (mostly the realm of pediatric neurosurgery and urology—spina bifida and VP shunts and urethral malformations), and as I’ve asked him questions on the management of some patients (especially for wound care), he’s reminded me several times of the wealth of experience our attendings have had, especially with this population that has a tendency to malnutrition, anemia and lack of certain micronutrients (like folic acid!) that predispose them to the particular malformations that are making this so unique an experience to me.
“Humbly, I ask you to consider the experience of these attendings—to watch and understand,” he said to me on Tuesday after I confessed some of my frustration from the previous day.“I’ve seen a lot of short-termers come through and they want to apply what they know to what they see.But there are things they cannot yet know, because they do not yet have the experience.”
Such a good reminder to me, a necessary check on my pride.I am really enjoying myself here and enjoy a certain level of celebrity among the patients and even staff.They see me as the “Chinese” lady who wears a white coat, scrubs and a pink scrub hat who likes to smile and take pictures of patients.They know I’m trying to learn a bit of their languages and have fun with our inability to communicate, though it is a strain at times.And on the other hand, I am honestly struggling with understanding the system here and feeling quite out of my element with managing ventricular shunts and drains and caring for the 50+ patients on our list with a team that is sometimes out at the Somali refugee camp (unfortunately I don’t get to go :/ ) or at other clinics in the area.There is very little overlap with what I ever saw on my surgical rotations and I’m a little rusty with even the minimal paperwork we have to do here.So this week has been a chance to look myself in the mirror and remind myself that I’m not all that :) .While I know that of course, it is easy to sometimes pity myself (especially when I’m hungry, tired or frustrated).I have to remind myself at those times, that my being here is not all about me.And thank God for that!
And with that, I leave you with two verses that are good reminders of these lessons:
“Though the Lord is on high, he looks upon the lowly, but the proud he knows from afar” Psalm 138: 6.
Do nothing out of selfish ambition or vain conceit, but in humility consider others as better than yourselves.Each of you should look not only to your own interests, but also to the interests of others.Your attitude should be the same as that of Christ Jesus:
Who, being in very nature God, did not consider equality with God something to be grasped, but made himself nothing, taking the very nature of a servant, being made in human likeness.Colossians 2:3-4
So, to give you a taste of what it’s like here, I thought I’d give you a tour of Kijabe through my eyes.I wake up around 5:40 and take a shower with the window open to vent the bathroom.After eating my wheat flakes with honey (kept in a small jar sealed in a Ziploc bag to keep out the ants), I unlock and relock the door and padlocked storm-door-like gate (complete with an old-fashioned key and lock) before walking about a minute across a red-dirt road to the hospital.Usually, the sun is already coming up by the time I’m heading over and I can see, in the distance, from my porch, the vast spread and small mountains—Mount Kijabe and Mount Longenot to name a few.If I touch the bush next to the door as I pass, I’ll have the scent of rosemary on my fingers, and otherwise, I feel the cool, mosquito-less breeze of morning and see the last vestiges of the rain from the night before.
When I enter the hospital, I enter the reception area and go through a door marked “Kitchen.”This is the expansion of the pediatric ward, a large room with pink-sheeted beds and parents sleeping next to their kids.After seeing these little ones, I head over to the main peds ward, heralded by a cute sign marked “Bethany Kids at Kijabe Hospital.”There, amidst more pink-sheeted beds flowing out into the corridors, I see the remainder of our post-surgical patients.There’s another annex out the back door and down a short path, that serves as the neurosurgical ward—mostly infants with shunts or drains for hydrocephalus (too much water in the spaces in the brain) taped to their rather large skulls.Through another door, I’m suddenly in the labor and delivery ward and I find my way to the nursery, where one baby glows under a blue light (for elevated liver enzymes) and some impossibly small (I thought for Africa!) babies are holding on for dear life.Here, CPAP (a less-invasive way of giving more respiratory support than using a breathing machine) consists of humidified oxygen delivered through tubing to a nasal cannula sealed to the baby’s face as best possible with an outlet tubing plunged into some bottle filled with water and marked with the centimeters of water pressure we’re providing.
The ICU, which is next, has some ventilators from the 60’s, small boxes with all sorts of knobs.I had to put in a femoral (the main vein coming from the leg) line in a 3-year old, using “spirits” (alcohol-soaked cotton balls in an airtight container, appropriately-marked “flammable”) to clean the skin.Across the hall is the only call room I’ve seen in the hospital, replete with a pink-sheeted bed and two ancient computers that are nevertheless probably provide a faster connection than I’m using at this moment :) .No matter—I’m writing from the comfort of my living room, where some weird flying bug has decided my computer is the best thing next to light ;) .Trying not to be unnerved. . .
Somehow, actually, I haven’t seen many mosquitoes, though I got my first bite tonight while at dinner with my host family, the pediatric surgeon I came to work with.He likes to joke about the suffering he goes through—working reasonable hours, not operating at night, living below what would be poverty level in the U.S., but living like a king here in Kenya.They have a gorgeous stone house here on the “lower station” at Kijabe, with a back patio that overlooks the Rift Valley.From there, I saw an amazing sunset—a glimpse of pink and orange ripped in the middle of an azure wash of rain clouds.
I cannot emphasize how beautiful it is to be here.It’s a bit like being in a bubble—I keep having to tell myself I’m in Africa. Not that the people I meet don’t help me realize that :) .My housemate, a family practice resident from a program in Seattle, and I went on a run around the hospital and up to the Rift Valley Academy.It was our second run of the week, and it was deeply satisfying to find that I could run up hills a bit better the second time around (we’re at approximately 7,000 feet—I now understand firsthand why Kenyans are such amazing runners).At RVA, there are approximately 500 students from all over the place.At dinner tonight, I met one of the German teachers—a young woman who just graduated from high school in Germany and I understand that approximately 40% of her students are Korean.In fact, over dinner, the boys were talking about how the other night, the school was serving Korean food. . .
It is an extremely unique situation here at Kijabe—one that I think allows a relatively easy transition for new missionaries.Not that such a transition is ever easy, as many of them have assured me.“The hardest thing about missions is not the people you come to serve,” said Dr. Letchford, an internist who runs the ICU here.“It’s the other missionaries.”He and his wife, a physical therapist, have had their kids in Africa for the last twelve or so years.And I dared to ask—was it not too sheltered an existence to live in this sort of environment.They then described how their kids grew up in rural Zambia, 11 hours from the nearest town—how Sherri had to learn how to cook from scratch rather than the easy mixes and packets we have readily available, how the kids identified themselves as Zambian when they first returned to the States, how they somehow caught on video their youngest boy was teaching one of his little African friends how to read—when he’d just learned to read, themselves!And apparently, a former executive from Oracle heard God’s calling for him to give up his executive pay and become a driver’s ed teacher (because he really didn’t know all that much about teaching computers, to which he’d first been assigned!) and college guidance counselor at RVA.They told me about how he helped their daughter, Jessica, now at Yale, through her college admissions process—not with an awful lot of wheeling and dealing, but with a lot of prayer and fasting.Somehow, they pay less than $1000 a year and Yale provides her one plane ticket back and forth to Kenya per year!
You may think these stories are crazy, and perhaps I’m a bit too bright-eyed as I tell these stories.But these stories seem to be all over the place here, and it seems so evident that in all things, God works for the good of those who love Him and earnestly seek Him (Romans 8:28).Walking around RVA, I can see the facilities are quite nice—there’s a large gym, playing fields, and apparently a music building and even a piano building!The classrooms and dorms are built of stone and are simply designed but not in any way decrepit.They have a lovely path along the perimeter of their fence that my roommate and I have alternately walked and jogged along.And the best thing about running to the point that I wonder that I’m so out of shape (though I do think it’s the altitude), is being up on the side of the mountain.The views are indescribable—so unlike those in Colorado, which is equally, if differently, beautiful.I think it must be the vast expanse of yellow grasslands and trees with blueish mountains that appear less densely spaced than the Rockies.Somehow the sky is always a dreamlike mixture of cloud and blueness.
I have so much more to describe—about the people I’ve met and the conversations I have.But I’ll have to leave you with this:it is, in certain ways, troubling to be in such a secluded little paradise like this.I see the patients who come from all over to be here and am thankful we are here.I feel fortunate to be here at a gorgeous time of year (even though it gets super windy and rainy at night!) and so glad to be living in such comfortable accommodations.I know there’s so much more to Kenya than what I’ve seen so far and that if my experience here is to be more than a simple adventure and honeymoon, I will have to see what it’s like outside Kijabe.I’m excited for tomorrow, when I go to a rural church in the mountains.Apparently, I haven’t even seen what poverty is, and though I know the patients I see are often poor, I know that relatively speaking, what we have and the care they get at Kijabe is so much better than anything they could ever hope for.As Agneta, a Kenyan surgical resident told me tonight—“the care we provide them is not something they consider to be a right.They consider it a privilege.And their thankfulness makes me thankful.”
Again, my apologies for the scrambled thoughts--I feel like I’m taking that clichéd drink from a fire hose.I love trying to capture these thoughts for you all before they vanish into thin air.Would that you all get to experience something similar and not have to take my word for all of it.
