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.

One week in Kenya

On Saturday, in Nairobi, we had a few hours to do some grocery shopping before heading to Tenwek. I did a whirlwind 1 hour tour of Nakumatt, very similar to a Walmart...but nowhere near as big and with fewer selections. We picked up some meat at a butcher and fresh fruits/vegetables that we can't get at Tenwek. We then made the familiar 3 1/2 hour trek upcountry, through the Great Rift Valley.

The roads have improved in some areas, and have deteriorated in others to the point of not being paved at all. Overall, it was a pleasant trip and the kids handled the bumps well. On our way out, we did see zebra and gazelle grazing along the side of the road, along with hundreds of cattle, sheep and goats with their Maasai shepherds.

We arrived at Tenwek just after 4 pm and got settled in our apartment. We unloaded all the bags and quickly tried to find a place for everything so we could at least get through the first night. We were warmly greeted by several old friends and felt at home again. The kids were a little hesitant at first, but started to explore our "new home". We ate a quick supper of PB & J and cereal but then were given an entire pizza to heat up, so we saved that for Sunday.

We have a nice apartment with two bedrooms, nice sized kitchen and dining/living room area. It is small, by American standards, but oh so easy to keep clean and organized. We are on the ground floor, so the kids can come and go outside as they please. There are lots of kids on the compound - a few the same age as ours. There is a rope swing just outside our door and the perfect tree for climbing.

It is cool in the evenings, but sunny and warm every morning. It usually rains for an hour or so every afternoon and cools off again. The soil is a deep red color, and is nice and moist almost all the time. It's a great place to grow just about anything - corn, lettuce, bananas, avocadoes, cabbage, carrots, cilantro, potatoes, tomatoes, pineapple and other basic garden fare are just a few items that we see regularly for sale around the compound.

We've been here in Kenya for one full week now. It's been a super busy week - more so than I imagined. The kids are adjusting well - it just takes a lot of time. We were greeted so warmly by so many people - other American missionaries and Kenyans. So many familiar faces to see and catch up with. It's amazing how much time it takes just to get from one side of the compound to the other, as you run into 2 or 3 people and have to take the time to shake hands, inquire about their family, and exchange other pleasantries. It's all good!

The kids are making lots of new friends. Our Kenyan neighbors spend a lot of time outside and there are many missionary kids here now to play with, even though most are a little older. It's fun to watch our kids interact with others - younger or older. Nathan is fascinated by the older boys. He watches them and listens to anything they say. With younger kids, he is gentle and friendly. Julia seems to be more shy at the moment, but she is coming around. The second night we were here, some good friends of ours who are studying medicine in Tanzania visited with their two children. Julia and Nathan were both shy at first and wouldn't leave our laps. But by the end of the evening, all four kids were running around the apartment and playing happily with each other. Nathan shared his beloved motorcycles and the two boys drove around every piece of furniture, all around the apartment. Julia finally opened up and shared her artwork and books. They were all jumping on the beds, at one point.

Each day has been a challenge for the kids, as they are still adjusting. Luckily, their sleep patterns have been good - that is one thing we vowed to do - keep their sleep times the same even though everything else around them has changed. They've made comments about going home, or missing our house, missing grandparents. They ask questions about our house and who's watching it, how far Ohio is and when we're going back. But the times they seem homesick are short and they are having fun overall. And of course, they always have each other. They are becoming good friends, even though they can really fight too. They are eating better than ever, which is surprising, as many foods are different here. But with fewer options, I guess they have realized that they need to eat what's available or go hungry. But they're too smart for that sometimes - they know where I keep the stash of goldfish and treats in the cupboard. I did manage to fit a few comfort foods in our suitcases, so we're not suffering too much.

Cooking has become a bit of a challenge. When we lived here last, it was much easier preparing food for two people who like just about anything. Having children here is so different - in terms of food, how time is spent and how we communicate with others. Before we came, I enjoyed collecting recipes and have quite a large selection. Plus, several around here have sent me some good recipes, using local foods. Even though I bought a bunch of staples in Nairobi, I still feel a little unsure of myself in the kitchen. I guess that is my biggest adjustment this time around. I don't mind being at home most of the day with the kids - in fact - I had looked forward to that part of our time here. They do take afternoon naps still, so I am able to catch up on emails and around the house. And I have done some work already for the Visiting Staff Coordinator at the hospital - so this is no vacation by any means.

The missionary families here have really made us feel welcome. We have eaten a few meals around the compound and are enjoying catching up with some, making new acquaintances with others.

We've received some nice letters and emails from many of you. I especially appreciated the birthday wishes today. We're having a simple bday meal, complete with a red velvet bday cake, made and decorated by Eric and the kids. It doesn't get any better than this!

Thanks for all your prayers and support. We feel comfortable after our first week and are excited about what the upcoming weeks will bring. Eric will enter a blog with medical info. - some of you may be more interested than others!

We have internet access...most of the time. It is slower than we're used to, so it takes much longer to catch up on emails and to create this blog. But we have internet and are very thankful. Our blogs may be weekly...not sure how often we'll be able to do this. But we'll try to let you know - or you can visit at any time.

Until we blog again - take care!

Jodi

Week One at the Hospital (Eric)

As it turns out, a lot of the volunteer docs recently left to go back to the U.S. It was obvious that this is a very good time for me to have come because help is very short and the docs that are here are tired. I was happy to have been here before, because there was no one to train me if I did need it.

The first day I was put on the OB service. After starting rounds with my two Kenyan interns, I couldn’t help but think that these were some seriously complicated patients. I then remembered that every normal patient was delivered by the midwives. We only saw the patients that I usually refer to someone else. I also realized that there is no one to ask for advice. I am, for the time being, the most experienced OB here. Ouch.

I was a little nervous about doing my first C-section since coming back. I have only done about 3 in the last 4 years. So I was hoping for a nice easy one to start with as I started my night of call.

Not so. 5:07 pm I got the call for an emergency C-section for a cord prolapse. Oh, so not the way to start out. When that was finished we went straight to a lady that had delivered the first twin 9 hours prior, but had a leg of baby 2 sticking out since then. The fluid around the baby was infected by then. After a quick supper break, I went back up for another C-section.

As I was writing a note on the chart for her, I heard panic yelling for me in the OR next door. Some man had a 6 inch gash on his neck cutting several arteries and completely severing his jugular vein. I naturally assumed as I ran in the room that the OR staff was screaming for me to stop the blood that was flowing and shooting all over the room. But, alas, that wasn’t his biggest problem. The bleeding also was under his skin to the point that it blocked off his airway and he could no longer breathe. So went my first emergency tracheostomy. This means cutting into the neck until I found his trachea, cutting a hole in it, and putting a tube in it. Thankfully there were surgeons soon at hand to take care of the bleeding neck vessels.

Did another C-section immediately after that before going to bed exhausted. I had another C-section before the night was through and they kept coming on day 2.

If you are wondering, all of the above mentioned patients are thankfully doing great.

After day 2, I am tired but having a ball.

The next couple of days I worked in the ER, with lots of interesting cases. People only end up in the ER here if they deserve it.

Day 4 at the hospital is call night again. I assured Jodi that med/peds call will be a piece of cake compared to OB. It turned out to be the night of death.

Half-way through supper I got called up to resuscitate a 25 year old man with TB, who then died. At 11:30 I went up to the ER to help the intern resuscitate a 35 year old lady with an asthma attack, who then died. At 3 am I got called to the nursery to resuscitate a one month old baby with heart disease, who then died. As I was writing the death note for that baby, a 2 day old premi twin tanked. I coded him for a half and hour before looking across the room only to see an intern bagging yet another baby. All I could do was yell, “You have got to be kidding me.” The twin then died, but the last baby survived for now. My good record from call night number one was really starting to look tarnished.

The next day I talked to the chaplain that had to keep waking up every time one of my patients died. He said that 9 patients died in the last 15 hours. That is pretty impressive for a 300 bed hospital. People here are sick.

Aug 21 - 22

We had a nice visit with my parents in VA. The kids were spoiled and had a wonderful time with grandparents, cousin and aunt/uncle. On Thursday we packed up the truck (over 500 pounds of luggage) and headed to the Dulles airport. We arrived, unpacked, said good-bye to Grandpa and checked in. The kids were excited to be at the airport but a little overwhelmed at all the people and especially at the security checkpoint. Nathan didn't like having to take his shoes off! Funny, as now he lives barefoot around Tenwek!

Our flights were all on time and all went smoothly. We had a 7 hour flight to London, a 3 hour layover, then an 8 hour flight to Nairobi. From leaving the house to arriving, it was a full 24 hours. The kids enjoyed the flights, granted we allowed them to watch videos for almost half the time. With individual tv's, you can watch anything, so all of us were happy. Nathan just couldn't believe that we allowed him to keep watching show after show. The food was iffy, but we had lots of good snacks. I had packed a bunch of little toys/gifts to bring out, if the kids got bored or claustrophobic, but didn't have to bring them out. I'll save them for the flights back or give them here on a rainy day. In London, the kids ran around and stretched while we enjoyed a Starbuck's coffee. A new experience for them was the escalator...what a trip!

Upon arrival in Nairobi, we had our first delay. Just before reaching the gate, we hit something. Yes, literally hit something - we don't know if it was a pothole, an animal, a piece of equipment or another plane. That kept us in our plane for almost 1/2 hour, as they had to get someone to push the plane back and then go forward again. No small feat at 9 pm at night in Kenya. The longest delay on top of that then was waiting in line for a Visa. It was almost 10:30 by the time we got to our luggage. All but one of our ten suitcases arrived - and the one that didn't belonged to one of the missionary families. So we were thankful to have all the others.

Patrick, the Samaritan's Purse driver met us outside the luggage claim and took us to a huge van. We belted the kids in and headed to the Mennonite Guesthouse. The kids fell asleep almost immediately and missed the scenic night drive through downtown Nairobi. What great memories it brought back! At the Mennonite, we unpacked all the stuff, then whisked the kids off to bed. What a great place - an oasis in the big city! The kids woke up again and wanted to stay up, but were exhausted. We all finally fell asleep - our first night in Kenya!