Visiting Friends

(Eric) As I’ve pointed out perhaps too often, we see a lot of kids dying here. After a while you get used to it and realize that you do what is reasonable and then pray for the best. But for whatever reason, sometimes you just latch onto a case and push with all your might. Last night starting at 11pm I had one of those cases. A one year old boy stopped breathing in the E.R. My intern called me up and we worked to get him back and on a ventilator.

This one year old was the second child of a very nice couple who had already lost their first child. The father explained to me, as if he had to, how important this child was to them. I decided I couldn’t let this one die. We did everything we could think of to do for the boy, prayed over him, and went to bed. After an hour of sleep, it hit me that I should try one more thing so I headed back up at 3:30am. But in the end, he was taken off the ventilator at the end of the day after we knew there was nothing we could do to help. I can’t imagine the sorrow.

Just minutes before, we took a 9 year old boy off the ventilator to die after getting hit by a car the night before. This week there have been at least 1-2 pediatric deaths per day (out of about 50 kids admitted in the hospital), mostly avoidable if they would have happened to have been born in America.

But lest we get too sad, today we sent home the baby that was dead for 20 minutes and now is acting like a completely normal baby (see photo with smiling mother). There are so many more good stories than bad.

The rains are tapering off, just when they are supposed to be at their fullest. We generally get about an inch a day here in April, but are instead going days in a row without rain. It seems nice for us to have great weather, but we forget that our pleasure can be hardship or death for many. Our kids are so happy when it doesn’t rain, but we explain to them that it is not our simple pleasures that are important but the lives of the farmers. But as is often the case, our own thoughts and actions as adults are not that different from self-centered kids.

Don’t we close our Mexican border so they won’t disturb our economy? Don’t we subsidize our farmers in spite of how it literally kills farmers in developing countries? Don’t we destroy countries with our bombs so that we can keep our physical and economic security intact? Yes, we too like to keep our “sunny days”, regardless of how it affects the voiceless unseen.

Jodi here – with a lighter side of things. Last Sunday we visited a good friend that we’ve known since our first term here in 2001. Peter Ronoh is a hard working, congenial man, tall with a big smile. We drove about 10 minutes and then hiked up a hill to his home. We enjoyed greeting his wife and two of his children followed by his brother, nephews, nieces and neighbors. His wife prepared delicious chai over an open fire inside their mud home. We saw his mom who looks about 102 years old (see photo), but may only be 76, according to Peter. No birth records exist. It was great to catch up with his family.

This was one day that we are very fortunate it did not rain on our trip. Julia has a true phobia of rain ever since we got caught in the torrential downpour on the side of the hill a month ago. This being rainy season makes it difficult to make plans, especially when the grey clouds begin to roll in and the thunder begins. This is a more serious problem than we ever imagined and know how to handle at times. We appreciate any advice and especially prayers for Julia who reacts with fear and tears until the rain stops. Thank goodness for the IPOD and earphones.

Overall the kids seem to enjoy life here. There are kids outside at almost all hours of the day, ready to play. Imaginations are on cruise control here with fewer toys to play with and no excuse to not be outside in the perfect weather. Homeschooling is going well, although it is a stretch for me. It takes some time each morning for the kids to settle down, but once we are in the spare “school room”, they are all business and work hard to complete all the worksheets, math problems, handwriting pages and station activities that we brought or have had emailed to us by their Kindergarten teacher. We normally work for an hour, take a recess, then work for another hour or so before finishing our school day with recess…all afternoon. Of course, we aren’t strict – often we’ll do reading in the afternoon and two days a week the kids attend an activity hour where books are read, crafts are done, games are played. So lots going on here for them to enjoy.

Another light note – congratulations to Geoffrey Mutai of our local Kenyan tribe who won the Boston Marathon in record time!

Sticking Out

On Sunday we went to a Kenyan church after being invited by friends of ours. As we got more into the bush, the drive slowed down to a crawl on what non-Africans would consider an undriveable road. But it was ok being behind schedule, since Kenyan churches (and everything else) don’t start on time. It was supposed to start at 10am, but it didn’t get going until about 20 after, which we considered great.

The crowd cheered when we walked in and we were led to the stage at the front of the church to sit. So much for our goal of lying low. So there we sat in front of the church being watched by a crowd of 400, and the service just kept going. Noon came and went. 1:00 came and went. Our snacks came and went. And at 1:30, after our patience came and went, the sermon started! By now the kids were absolutely starving and stir crazy, so Jodi took the kids outside. To my surprise, they soon came back in, our kids being overwhelmed by more than 50 kids outside the church crowding them and touching them. They meant no harm, but Nathan and Julia were probably the only white kids they have ever seen.

The sermon went on. After an hour of listening to the sermon and our stomachs growl, Julia and I tortured ourselves with a cruel (but somehow funny) game of naming all the foods we wanted to eat when we get home – broasted chicken, oatmeal pie, ice cream, creamsticks, etc. After 1 ½ hours of listening to the sermon it was 3:00 and we were done. Our kids were absolutely amazing to be able to sit quietly in there that long, but we could not make them or ourselves endure any more. So we sheepishly told our hosts that we just needed to go. Perhaps it was rude, but after nearly 5 hours of sitting in church without lunch and the rains coming, we didn’t care. And after all, it was probably better than plan B which was to tackle the pastor and then make a run for it.

I guess the good part is that we could demonstrate to our kids and ourselves that God can be worshipped in many ways and ours is not the only “right way” (although I was pretty sure at the time that there wasn’t much right about a 5 hour service), and that being hungry is a way of life for so many people. We should all go hungry now and then to be reminded of that fact.

By the way, as far as I know, the pastor is still preaching.

Things are very busy on pediatrics, but I am enjoying it very much. Indeed it is tough to see so many kids die - at least several per week – but we see so many good cases too as kids tend to recover so much better than adults. Last week we actually had one 6 week old baby die, death certificate filled out, and ready to go to the morgue. After 20 minutes, the mother fiddled with the baby and it started breathing. I am not sure the kids will ever go to college, but so far she’s doing great.

On a sadder note, we have several newly diagnosed diabetics. One is a cute 4 year old boy (see photo). The story doesn’t sound so sad at first. We get them all tuned up on insulin and diet training. However, their prognosis is terrible because they soon stop the insulin secondary to cost. They simply can’t have a whole family go without food or school fees so that one kid can have his medication. The prognosis for a diabetic is worse here than for cancer or AIDS.

School for Jodi and the kids is going well, but the kids are always anxious to head outside and play with their gang of friends. Something tells me they will be bored when they get home and have only their dull parents to play with.

Thanks again for all your prayers and support. Pray not so much for us, but for all the needs at a hospital like Tenwek, in a country like Kenya, on a continent like Africa.

Caught in a Rainstorm

On Sunday our hike started out well. But as we crossed the river in the ravine and started to climb up a steep hill with trees and jagged rocks, the storm broke. Julia and I shared an umbrella and the guys had theirs. The rain turned into hail and the wind whipped through the trees. Julia and I hunkered down behind a tree for shelter. She started crying, asking "Are we going to die?" and Nathan was worried about an avalanche. The water by that time was rushing down the hill past us. My back was soaked but we held tight. Then the rain slowed just enough and I picked her up and climbed the rest of the hill. By this time, Eric and Nathan were gone. Eric planned to rush Nathan home so he could come back to "save" us. We reached the top of the hill and saw him running down to us in the pouring rain. By then, the tears were gone and we were just cold but were laughing at Eric running towards us, soaking wet. Our plan to end the hike with an Orange Fanta changed to hot chocolate. Good memories.

Unfortunately, the storm knocked down several big trees that fell onto a power line. We were without power from 3 pm onwards and most estimated it would be up to 2 days before it came back. That isn't such a big deal except for all the meat and things in all the freezers around here...high dollar items! Amazingly enough, the Industrial Plant personnel worked tirelessly and had it back on at 8 pm! It gave us just enough time in the dark to enjoy a candlelight dinner and to spend some time outside looking at the stars in the dark sky. At our high elevation, we saw a very clear Southern Cross (only seen from this hemisphere). The kids even found a few fireflies...which I didn't know lived in Kenya.

So today we acquired two new pets. Chameleons. The kids are taking care of 2 chameleons while their 5-yr old owner is away. She gave them strict instructions that they need to eat 4 or 5 flies, twice a day. Julia, being the perfectionist, is right on target with her number of flies. In fact, her chameleon is full to the brim...Nathan, on the other hand, is a little less prompt on getting his fed. We can capture live flies and then feed them as we go but they have to be alive. And let's face it, that's tough.

So instead, the kids carry these chameleons around on a stick and when they see a fly they put the stick near it and the thing will shoot its tongue out to eat it. I've watched a few times, it's very cool. Then they chew like a cow, sideways. We also took on a couple of dogs for families that are gone on their yearly retreat and vacation. The kids are loving all the pets around.

The kids seem to be enjoying their time here, even with school every morning. Here are a few shots from last week - one on the stairs of our apartment and the second at the hospital for a mandazi break (like a plain donut). Thanks to all for emails, letters, thoughts and prayers! Jodi

Eric here. As always, I have to throw in my guilt laden spin on our happenings. Today I have to wonder what our house helper thinks about purchased dog food. Certainly the dogs we are taking care of cost more to feed than their entire family. We do the same at home with our dog and don’t think twice about it. But because we are here it seems different. But in fact, it is not different. The only variable is distance. Why is it that I feel guilty when I do something here and not when I am at home? Poverty does not go away just because I do not see it.

As all the long term doctors head off to their yearly retreat, I just transferred from covering the medical ward to the pediatric ward. It is going to be a busy couple of months, especially the 1-2 weeks that the long termers are gone. It is also going to be a sad couple of months. We just went over last month’s statistics which showed that 10% of the pediatric admissions died! That doesn’t include the nursery, which I think runs in the 18% range. The top three causes of death were pneumonia (often because of AIDS), meningitis, and malnutrition. In malaria season that one is also in the running.

It is indeed sad to see so much death, especially when almost all would be preventable with good nutrition and simple medications. Today a 14 year old girl died from AIDS. She weighed only 35 pounds and could have done well with HIV meds and more food. We have a five pound 7 month old kid on the ward who probably won’t do well, and several premature babies weighing 1 ½ pounds that won’t make it. Put all 4 of those kids together and they weigh as much as one of our thin 6 year olds.

On the other hand, it is good to focus on the happy stories of which there are also many. Today a lady came in to OB for treatment. She lost all 8 of her babies due to prematurity. The obstetrician removed her circlage and wanted to send her home and await labor. She was so scared to lose another baby that they did an ultrasound just to reassure her before they sent her home. In fact, the heart beat was a very low 30-50 beats per minute. They rushed her for a C-section. The baby came out with a heart rate of 30, but with some resuscitation from the trusty new pediatricians (that would be me and my intern), the baby did great. I think it a miracle that that baby is alive.

A Glimpse of Kenya

My (Eric’s) biggest happiness this week is that seem to be recovering from a week of dysentery (which includes lots of diarrhea). And like most miserable experiences, it gave me some small insight to others’ misery. As I lay awake in bed chilling with a headache, I thought of just how unbelievably miserable it must be for the unfortunate in the hospital with meningitis or malaria that cause fever and headache so much worse than mine. But instead of two big warm blankets and a comfortable dark room, they are in a 65 degree ward with nothing more than one flimsy blanket, even flimsier nursing staff, a strange bed partner, and a room full of lights and noise. And yet they are so thankful that they are there and not dying at home like the ones that THEY call “unfortunate”.

I was on call last weekend, so I had my first days off this weekend. We went on a long hike around the area as we really haven't had the time or the bowel control to get off the compound yet. It has rained every day so far and will continue to do so, but the mornings are generally safe to hike without getting caught in the rain. I heard we are still in the snow phase at home, so I guess I certainly shouldn't complain about rain. As always, we thoroughly enjoyed our hike along with our traditional post-hike Fanta.

It is always the same when we go out in the beautiful Kenyan countryside. I can never get over how close the land must look just like it did thousands of years ago, before we started trashing the gift of our world in large scale. Instead of big smooth paved roads past strip malls, we hike down a 10 foot wide dirt path lined with acacia trees, birds, and friendly people. Through the trees you can see miles of green hills with crops and small thatched huts (although more are tin-roofed now). And the delays are good as we slow down many times to work our way through a herd of cattle being moved by their shepherd, to chat with the myriad of barefoot kids that scream hello and “what is your name”, and to cross some muddy spots (at least I hope that’s mud, but the cows were spending a lot of time there).

Julia and Nathan are still having a great time. I often complain that kids don’t want to play outside like we used to when we were kids. Now that we are here and our kids suddenly don’t want to spend any time inside, I have figured out that we just have too many fun toys in our house at home. I guess deep down I knew this before, but kids seem to have just about the same amount of fun in the long term with about whatever they have at their disposal. So it might as well be sticks and trees, because that is going to be better for them in the long run. Our empty Fanta bottles have truly been played with for hours at a time, longer than any toy I can think of at home.

But of course we can’t just say that about our kids. Today I got in the shower and soaped up. For some reason, at home I have been convinced to need separate soap for my body, my face, and my hair. Beside the fact that I don’t have enough hair to justify shampoo, my one bar of soap here in Kenya seems to work just as well as the three soaps I buy at home.

And of course, we can’t just say that about our soap.

Worst moves for the trip so far: 1. Eating whatever it was that had Shigella in it. 2. Watching Benji on our laptop tonight which had Julia weeping at length because she misses our dog, Furbie. 3. Yet to be determined, but may have to do with the fact that I don’t know what I ate that had Shigella in it.

Best moves so far: 1. Packing lots of Imodium. 2. Showing our kids a glimpse of how the majority of the world lives, that God cares for everyone the same, and that we can each try to make a small difference for the better. 3. Apple dumplings for desert tonight.

Thank you for all your emails, regular mail, thoughts, and prayers.

The Millers

First week at Tenwek

It has been a week of work both for me (Eric) at the hospital and Jodi at home teaching the kids. We have adjusted well I think and are enjoying ourselves. The first day was hard to get much done at the hospital because an elaborate greeting is needed for everyone I knew, which was the majority of the hospital staff. There is a three stage handshake, hugging on each side of their body, then asking about family and such. It was kind of bad that I couldn't remember more names, but even worse on day 2 when I couldn't remember who all I already greeted. It is bad form to go through a big greeting 2 days in a row!

I was assigned to the Medical ward, which consists of 1 large room for men and 1 for women. There are about 20 beds in each room and, unfortunately, about 25 people in each room. So they just hop on in with another sick patient and cuddle up for warmth at night. The people with fevers are the warmest, so if you get one of them you are lucky (the ones that are vomiting aren’t as good).

The illnesses vary greatly from things we see at home like strokes, pneumonia, and skin infections, to more African illnesses like malaria, meningitis, and tuberculosis. Then there is a whole slew of folks that we simply don’t know what they have. They tend to slowly dwindle to death as we continue to be clueless of how to help them. The medical floor averages about 1 death per day, but there were three over the last 24 hours. We are really struggling to keep a 21 year old college student with rheumatic heart disease from being number four.

We estimate that 40-50% of the patients have HIV. The prevalence of HIV infection in our area as a whole is about 7%. This makes winning the battle against whatever illness they have difficult.

It looks like Tenwek has pretty good OB coverage, so I don’t know how much of that I will do. That is where all the exciting stories come from, so you might just have to read more boring stories this time around. Perhaps I will just make up a few good stories if I run out of interesting material (perhaps I have already hit that point).

The kids continue to be enjoying themselves here. Our 2 next door neighbors have 3 girls that know English fairly well. They are the kids favorite playmates, which is amazing since Nathan has been in a “No girls allowed” phase (to the point of writing it ON his bedroom door with a marker before we left, by the way).

Speaking of Nathan, he was the first to succumb to the stomach bug. But in true Nathan form he felt like he was going to vomit in the morning and was eating burritos by lunchtime. Friday night the bug hit Eric. He completed rounds in the morning and slept most of the afternoon. He, on the other hand, is staying as far away from burritos as possible.

Yes, we eat burritos here and just about anything else we want. The only difference is that you have to make everything from scratch. So for burritos, for example, you soak dried beans overnight then cook them forever the next morning. We live very close to the butchery, so we hear our hamburger bellowing in the morning, and could be eating him for supper. The tortillas are rolled out and cooked on the stove. The salsa and guacamole are also made from scratch of course. So although it is more work (partially done by hired house help), the end product is fantastic.

The fruit has been delicious and we have been eating everything mango since they are wonderful right now. Mango on cereal, mango smoothies, mango salsa with fish, mango juice, homemade mango jam, and just plain mangos. Other fruits that we have plenty of are papaya, pineapple, and bananas.

Things we miss? Walnut Creek Cheese accessibility. Dutchman pastries. Of course, friends and family. This morning Julia curled up on Jodi's lap, in tears because she misses Furbee, our dog, among other things associated with home. Both kids have felt overwhelmed at times because of all the new people, different schedules, etc. But overall, they seem to love it. They have instant friends next door, Eric is home for lunch almost daily and even was here this morning some to read geography to them...fun. And what could be better than spending most of the day with Mom - in school, during recess and all afternoon? We're all enjoying this time together - away from cell phones, long-term responsibilities at home/work, etc. It's good to really get away from everything for a few months...that way we'll appreciate home and responsibilities in a new light when we do return.

And by the way, we got our toilet fixed.

So far, so good.

Arrival at Tenwek

Our trip to Kenya was great. Just like last time, the kids did beautifully on the plane because of the individual TV screens for each seat. The only way we could get Nathan to sleep, eat, or use the restroom was to turn it off momentarily. Every now and then I had to hit pause just so he wouldn’t drool from lack of remembering to swallow. I am quite certain that Nathan could have undergone a major surgical procedure without noticing.

After 24 hours of travel, we finally arrived in Nairobi. I realize that everyone THINKS they pick the slow line, but we indeed DID pick the wrong line to get our visas. After over an hour of waiting, we were the only ones left in the previously crowded room. Our kids were grumpy, but not as grumpy as their dad. The good news was that once we finally made it through, it was easy to find our luggage since they were pretty much the only ones on the luggage carousel.

We were picked up by a van driver who thankfully didn’t give up hope on us. Sometimes they scrounge up a car seat or two for the kids, but not that night. As a matter of fact we could not even find seat belts. As we raced down the road, I had to wonder why our driver insisted on driving 15 feet behind the car in front of him. Perhaps it was because he couldn’t see them since many of the cars had no tail lights! Needless to say, I wasn’t feeling very safe . . . but we’ll get used to it.

We stayed with our friend in Nairobi for a day to recoup and get some groceries before heading to Tenwek. The 3 hour van ride to Tenwek was fantastic. We have never seen the Kenyan roads nearly so smooth. Apparently the quality of the roads is improving in Kenya, although for the last 25 years there has been almost no road expansion in spite of a ballooning population.

On the way to Tenwek the kids were happy to see baboons, gazelle, and a couple giraffe alongside the road.

Once we got to Tenwek we were completely humbled by how warmly we were welcomed. The door had welcome pictures from some 5 year olds anxious to meet Nathan and Julia and our house had cards, gifts, flowers, and lots of food treats. We were greeted by many old friends as well as from many newer people that we did not know but soon will.

Our apartment is bigger than last time which is nice since Jodi will be homeschooling the kids in kindergarten. The apartment is very simple, but all we need.

We are tempted to complain about some small things, but soon catch ourselves. We were a little down that rainy season just started here. That means it will rain every day, making it harder for the kids to play outside and making it very muddy. But it also means that we will have more electricity, which has been off a lot lately because we get our power from a hydro-electric dam on the compound. (Not to mention the more important fact that farmers can grow food after a long dry season.) We were a little down that every time we flush our toilet, a half quart of water runs over the bathroom floor. But then again, how can we complain about running water (albeit “running” across our floor).

The kids are enjoying their first days of summer. There is a nice mix of American and Kenyan kids everywhere. So Julia and Nathan have been playing outside pretty much nonstop with not more than one ball and one Frisbee (but lots of trees, sticks, and critters). We took our first hike, our favorite Tenwek pastime, and got drenched 200 yards from our home. When it rains, it rains hard.

So far, so good. Work starts tomorrow.

Back to Kenya?

Here we go again! We are beginning to make plans to return to Kenya in Mar/Apr/May 2011. It doesn't seem like it will have been almost 3 years since we were last there. Since that time, the kids have started kindergarten, we've added a dog to our family, Eric turned 40 and we celebrated our 15th wedding anniversary! My how time flies when you're having fun!

We are excited about returning to Tenwek Hospital and invite you to join us as we blog our way through (hopefully with better internet this time). Our tentative dates are to leave mid-March, returning after Memorial Day weekend.