Week in Pictures

It's been a busy but uneventful week here at Tenwek. Eric has been working many hours as the hospital is short staffed. He is on call this weekend and next, and many days in between. He doesn't complain, but we sure do miss him not being around as much. But we can't complain either, he comes home for lunch every day and has spent lots of time with the kids in and around his work, their naps and so on.



The kids continue to amaze us. They are making new friends every day...people and animals alike. They are fascinated by the birds, dogs, cats, cows, donkeys, turtles, chickens, you name it. Their favorite, and most unusual, has been the occasional chameleon. They are around and sometimes are unlucky enough to be caught by some kid who keeps them for a few weeks, feeding them flies. Chameleons are so unique and interesting to look at. Nathan wants so badly to hold one, but then gets a little squeamish when it comes time to actually touching it. So we worked out a way for him to hold it without actually coming into contact with it:
(note his favorite cap)

Julia too was impressed with this little guy. She opted for the distant touch.

And their favorite animal, by far, is Emma, the dog. Emma was a rambunctious, hard to control puppy when we left in 2004. She has grown into a mature and loveable dog. The kids love to visit her and Nathan has become very affectionate with her. He is such a good kisser!

We know that the next request will be for us to get a dog once we return home. Don't know how that will fly. But for now, they are enjoying all the dog company they can get.

Time is flying by so quickly, as we've said many times. We are already working hard to fit in all the visits to friends now so that we're not rushed at the end. It's amazing how much more social we are here. We have had more people in for meals and vice versa in this last month than in three months in the U.S. It's not that we're not hospitable in the U.S., it just seems there is less time for it. That is one thing we want to make a priority - more time with family and friends, less time doing other things that don't matter in the long run. It's more easily said than done, I'm sure, but a good goal to work towards.

Those are my deep thoughts tonight. Eric and the kids are out roaming around in the dark. The stars have been unbelievable. What an amazing world we live in.

Jodi

Brighter News
Last week the medical news was on the morbid side, but there are lots of great stories as well. This week we sent home a lot of premature babies that would not have survived long if not here. Right now we have 3 sets of premature boy/girl twins. Of course I have a special liking to them and am having fun watching them grow. Actually, the newest two are just 2 ½ pounds and not breathing very well. So please pray that they will make it through the first tough week.

Ok, so the “Brighter News” stories seem to be shorter than the morbid ones. But the vast majority of kids do well. I can remember 6 kids that died this week, but so many more that went home smiling.

Eric

Tenwek Times

Jodi's Non-medical Take on Things

This is the apartment where we are staying. There are five apartments in our building. We have two small bedrooms, one bath and a nice kitchen with a dining room/living room area. It feels small at times, especially when it is raining and the kids start to get stir crazy. Tonight, Nathan asked to go naked, so they took off their clothes and jumped from the couch to the chairs and back and forth. They had commented earlier that they were getting bored, so this was the best solution, since it was too dark outside and too early to go to bed. Talk about a workout!


The kids are doing very well overall. It's amazing how few toys we have, and how much fun they have with non-toy items. They play outside almost constantly in the mornings when the sun is shining. Nathan has his standard set of matchbox cars and trucks that he takes to bed with him. Julia has been very busy creating pictures to hang on our walls with crayons, markers, paint, glue and glitter, you name it. They have plenty to do at home, plus there are dozens of kids, a few their age, that they play with. Nice weather, lots of kids...they will really miss this when we return home in November to our house with no neighbors.



We went on a long hike this morning. Eric has had few days off, and his coming weeks look to be busier than ever. So this weekend we are taking full advantage of his time with us. We walked straight down to the river, on a ravine type path used to take the cows down for watering. It was muddy and a little treacherous. But the kids hiked all the way down and most of the way up - happy as can be. The sun was shining and the bird songs were amazing. The river runs fast, but we stopped at a bend for a snack and to throw stones/sticks into the water. Eric scouted out a path to return to the top while we watched these strange water bugs dancing on the surface. Our trip back up was even more difficult and the kids had to be pushed/pulled and encouraged. At times, they looked like rock climbers, on all fours. A hike that used to take us forty minutes took us almost two hours today with all the stops and the pauses along the way. But it was great fun and we were proud of our little hikers.


At the end of our hike, we sat on our front porch and enjoyed a bottle of Orange Fanta. The kids are not used to drinking pop and thought it was a little "spicy". But they asked for more. Now they're hooked!

Our daily lives continue to be filled with playing, naps and new adventures around the hospital compound. We visited a small book store (about the size of one of Eric's exam rooms at Walnut Creek, maybe smaller) just outside the hospital, which the kids enjoyed. We felt a little out of place, however, as we were the minority. The kids were impressed by the chicken walking around on the street and the cows that passed followed by a little boy not much older than them(Nathan always says "there's the shepherd!") Our eyes are definitely working overtime here - so many new sights and sounds for the kids to absorb. It will be interesting to see what they remember from this time. We may never know the impact this trip has on their lives, but we hope this will plant the seed in their minds for being involved in missions in some capacity.

Thanks for joining us here at Tenwek. We miss our families and friends, but are enjoying time with our new friends here as well. We look forward to what the coming weeks have in store for us. Time is flying by so quickly!

Jodi

Watching Babies Die
(As suggested by the title, the following entry may be a little disturbing.)

One thing that continues to amaze me here is how late people present to the doctor. I could give examples in any of the departments, but it became so clear to me the other night during OB call.

It was 5 pm and time to start call. So I strolled over to OB to see what was going on. As usual, it was chaos. Women yelling (no anesthesia here), babies crying, and a line of moaning women along the hallway waiting to get into one of the 3 delivery beds.

The nurse told me about bed 1. It was the 4th pregnancy in a row that she was going into labor too early at 27 weeks. In spite of that, she never came in for any prenatal checks. She showed up for this delivery because she was bleeding profusely. So I delivered that little baby that only breathed for a minute before passing away (abruption by the way). After showing the mother, we put the baby on the warmer right behind her head before rushing over to bed 3.

Bed 3 was a lady with twins who didn’t show up for the first time until she was in labor. Perhaps she didn’t know she was having twins. But considering it was her 6th pregnancy, she probably had an idea that this wasn’t like the others. Unlike in the U.S., we deliver most breech babies naturally in Kenya. But this one came out with one foot first (instead of a the preferred butt), so we tried to rush her to the OR for a C-section. But by the time we got her ready, the baby was coming out. So we delivered her breech without trouble. Unfortunately, we didn’t have time to get rid of the dead baby in the only warmer right behind bed 1. So we just had to put the new baby right on top of the dead one, sadly all in view of the mother who had just lost her 4th baby.

The lady in bed 2 was an HIV positive lady who was sent to us for a C-section for failure to progress. However, by the time we got all the other things dealt with, she had her baby.

Then came the most frustrating cases. We did 4 C-sections over the course of the night. Everyone had pretty much the same story that we hear all too often. They labored at home for way too long, then went to a local clinic or hospital where they labored way too long, and then finally got sent to Tenwek. By the time they got to us, they may have been pushing for 12 hours or more. Two of them had ruptured their water 4 days prior!

The heads of these babies are wedged so far down in the women’s pelvis, that it was very difficult to get them out. Only one of the 4 babies died, but they were all put at great risk. The one baby was face first, getting pushed for 12 hours. It had a face so ugly that I doubt even the mother could love it. But fortunately, being face first, it was the only baby that didn’t suck in a bunch of meconeum (baby’s BM) into its lungs. So it did better than any of the others.

That was 4 nights ago, and my forearm still hurts from wrenching all those babies out.

Yesterday at the end of my day, a lady came in having ruptured her water days prior. I was not doing OB, but was called to take care of the baby. The baby came out so infected and smelly, that it was all I could do to work on it. After a half an hour of our effort, the baby still had not taken any breaths on its own. We called it quits and wondered, again, why patients wait so long to come in.

The answer, of course, is money. They don’t have it. As a result, they are forced to watch their babies die.

Two days in a row this week I talked with parents of babies with spina bifida. The openings in the children’s backs were leaking, which means they would soon get an infection that would kill them. I discussed with the parents that their only hope would be to send them to another hospital for surgery. They both thought long and hard about it, but the $500 would be too costly. All they could do was take their child home with the knowledge that it would soon get an infection and they would have to watch their beloved baby die over several days.

Money. They don’t have it.

Week 3

We've completed our third week at Tenwek. Time is flying by so fast. The kids are doing well and seem to be more adjusted. They continue to amaze us with their observations and comments about life here in Kenya. --Jodi

(Eric) Although my favorite thing to do here is OB, we are now well staffed in OB. Pediatrics is very short staffed, so that is where I will be spending the rest of my time.

Peds is fun because kids are fun. Today I had a kid giggling so loudly by blowing bubbles that the whole ward (16 beds of kids with parents) were laughing. But peds is also tough because I am dealing with things that I am not accustomed to.

A lot of what I deal with is malnutrition and premature newborns that are having trouble gaining weight. That is not very exciting to me. On the other hand, there are always a bunch that are too exciting to me. Tonight we lost a two week battle with a newborn with tetanus. And just now I got back from the ER to help the intern admit some peds kids. The first one was a 4 year old girl that was in heart failure because of a huge amount of fluid around her heart. The next was a 3 day old girl with Turner’s Syndrome (birth defects) that hadn’t urinated yet – and never will. The next was an 8 year old with new onset seizures. The next was a 6 month old with such diarrhea that her intestine was protruding out and was partially dead. You just rarely see that much illness in a short time at home. And the night is still young.

The pediatric ward and nursery is full of things like meningitis, TB, hepatitis, AIDS, typhoid fever, burns (from cooking fires), an arrow wound into the brain (accidental from big brother), abuse, and four newborn spinal bifida patients. There are also a few that I just don’t know what is going on with.

Changing the subject to something more palatable, a lot of people have asked about our food situation. Many assume we have it pretty rough. Actually, we are eating quite well. Everything must be made from scratch which is time consuming, but tastes great. We eat plenty of homemade bread, desserts, tortillas, and even homemade corn chips. We eat great spaghetti and pizza, but have to make the sauce from a pile of tomatoes rather than opening a can of sauce. We eat chicken, but we first Crock-Pot a whole scrawny chicken and then take the meat off. We eat fillet steak, which is cheap. But it has to “bleed” in the fridge for a few days before we eat it.

We also eat a lot of local fruit and vegetables. Bananas, avocados, pineapple, and passion fruit are some of the local favorites.

Our drinking water comes from collecting it off our roof into a tank. We then boil and filter it. We haven’t been sick yet, by the way.

Because it is so time consuming to do anything here, we do hire a house helper for a few hours, 3 times a week. It makes us feel bad to throw away any food around her. We feel wasteful when we tell her we don’t want to save the skin on the chicken. But she is happy to hear that, as that means she gets to eat chicken skin for lunch.

Ok, so much for being palatable.

Jodi continues to spend time with the kids and other missionary moms and kids around the compound. She is trying to find a way to do special projects either from home or for a few hours a day. But for now, she has been experimenting with new recipes (with what's available here) and enjoying more quality time with Nathan and Julia. Nathan and Julia continue to explore around our home and were quick to make some new friends this week. In fact, Nathan disappeared a few times the other day to visit his new friend, Angela. She's about 2 years old and lives just down the sidewalk. I would see Angela outside, but not Nathan. Apparently "playing with Angela" means playing with her toys inside her house. So we've made a few new rules about when and how far the kids can go from our home. So much for these kids to learn and absorb!

Thank you for reading our blog. We hope that we are giving you a bit of a picture our current corner of the world.As always, thanks for your prayers. We are working hard but having fun.

Eric and Jodi

First Day Off

Today is my first day off, so we went on a nice long hike in the beautiful Kenyan countryside. We were a hit among the locals, who always stop what they are doing to come and say hi to the strange beings passing through. We saw lots of great birds like crowned cranes, but around here the only big animals are cows, donkeys, and dogs. Many people are out during the day, picking tea and tending to their banana trees and other crops.

Although the kids are loving the constant outdoor play (no room in our apartment), they are still not adjusting too well to the constant hordes of people that they don’t know. Everyone wants to meet them, so they come bursting up to the kids in full force which the kids don’t like. We hope it will get better, but realize that this is a huge change for them.

In the hospital things are still busy. I have been working on the general medical ward this last week. Like before when we were here, almost half are AIDS related diseases. The good thing now, though, is that there are accessible anti-AIDS drugs. That fact changes a lot. Last visit here, I dreaded the frequent conversation with mothers that went something like this.

“Unfortunately, the reason your baby is going to die is that she has AIDS.”
“Well, how did she get AIDS?”
“From you.”
“From me? I don’t have any symptoms. How did I get it?”
“From your husband.”
“How did he get it.”
“From another woman. You will also need to have your other children checked.”

Nothing like telling an already beaten down woman that she and her whole family are about to be wiped out by a slow, miserable disease that her family and friends will shun her for. So with the free anti-AIDS drugs from the U.S. and other places, this conversation no longer has quite the sting. I am so thankful for that.

But patients still die daily from things that are easily preventable. There is a baby in the nursery with neonatal tetanus, with a still uncertain outcome. One night I was called up because a pregnant lady pushed all day at another hospital until her uterus ruptured. The baby died, but thankfully the mother survived after a difficult uterine repair. Last night a 14 year old girl came in after battling typhoid fever for 4 weeks. By the time she came in, the surgeon said there were about 2 gallons of pus in her abdomen from a perforation in the bowel. She simply came in too late and died this afternoon. The baby that had a bad home delivery that we “saved” in my last blog entry, has long since past away. Their was a 4 year old girl who ate wild mushrooms at home and didn’t show up for about 6 hours. By then we could not pump the mushrooms out of her stomach. We had her on the ventilator overnight, but we removed it unsuccessfully the following morning. Etcetera.


But there are more good stories than bad. We see so many patients that come in looking like they are going to die, but somehow rebound and walk out alive. It is a good reward. Most of those are things like pneumonias, malnutrition, meningitis, and TB.



It is not hopeless. It is worth our effort.