Confessions from Paul

I awake abruptly.

The room is still dark.  My breath catches and a sense of uncertainity fills my chest.  I feel Teddy's warmth as I shift my feet in the bed.  I fumble for the phone, pushing buttons to check the time.
0534 am.  What woke me? 

My mind hovers between sleep and awake.  I am further confused when I realized that I forgot to pull the mosquito net down over my bed.

Then I remember.

I am in my bed in the midwest, USA.  I am not in Kenya.  I do not sleep under a mosquito net.  I do not filter my drinking water.  I do not fall asleep to the sound of rain.

I relax into the darkness and think about tomorrow.  Many of  my days have been spent working on my caselist, getting my house re-opened and beginning to reconnect with family and friends.  But there is also a lot of time spent alone.

Alone with just me thinking about Kenya.....being here....what to do next.

I should probably stop eating so much ice cream. 



Why can't I sleep like Teddy?!



I am awakend by a loud metallic noise.  Startled, I wonder if Teddy had done something in the kitchen.... I am confined to a small and very springy bed.  It is not my own.

I breathe and try to orient myself.

I am sleeping in the call room on a locums job in Some Hospital, Midwest.  Light from under the door way to the busy hallway outside keeps the room in an eerie glow.  It was the slamming of the stairwell door that woke me. 

My mind wanders to my patients... I think of the first case I did since returning to the US.   What did the staff see when they looked at me?  Could they tell that I was uncomfortable with the paper gown and all the paper draping?  I am so accustomed to cloth now.  And the sensation of actually scrubbing with a brush and not just a bar of soap....so foreign and decadent.  I wanted to save everything we used and wash it.....towels, bovie.....   The lights were SO bright.  I was nervous - I wasn't sure when I was allowed to start.  In Kenya - it was after the prayer.

Prayer before surgery.... it was a divine poetry to pray for wisdom and guidance...watch a patient slip so trusting into that drug induced sleep and then put cold knife to warm skin. 

It took me 30 minutes to write the post-op orders after the case - I felt like a resident again.  Looking things up, asking a hundred questions.......overwhelmed by all the options for my patient!  Incentive spirometry, labs twice daily, respiratory therapy, PT/OT - forget being overwhelmed by all the different kinds of ice cream - I am freaking out because of all the things I can give my patients after a surgery!

I awake to a dull pain in my neck.  There is small child staring at me from the seat in front of mine.  I look out the window....while I slept, the plane has taken off.  I am on my way to Oregon for a debriefing conference.  These small groups are centered around those who have recently returned to the US from the mission field; their objective to help put the past in perspective and provide hints for a smoother transition.

The child stares at me with solemn brown eyes.  She has long curly hair.  Beautiful.  I remember how my friend Elijah's daughter in Kenya loved to play with my hair when I visited them.  Her own little head was shaved bald per the protocol of the public schools in the village.

"My name is Oliver,"  my nosy neighbor informs me.  Oh.  A boy.  Okay.  "I'm four."

"Hello, Oliver."

"I wear underpants in the day time and diapers at night."

"Hmmm.  Congratualtions, Oliver."

I am so not in Kenya anymore.

Oregon 2012

Some mountain in Oregon

Life begins anew...

Paul to the Church at Corinth, in 2 Corinthians, chapter 1:

⁸ We do not want you to be uninformed, brothers and sisters, about the troubles we experienced in the province of Asia. We were under great pressure, far beyond our ability to endure.......But this happened that we might not rely on ourselves but on God, who raises the dead. ¹⁰ He has delivered us from such a deadly peril, and he will deliver us again. On him we have set our hope that he will continue to deliver us, ¹¹ as you help us by your prayers. Then many will give thanks on our behalf for the gracious favor granted us in answer to the prayers of many.

The Last Days

This post is long overdue....but sometimes even the best of stories need time....

Teddy did not help....

My last days at Tenwek were as action packed as all the ones preceeding.  I thought to wind down gracefully by stopping my clinical duties at the hospital one week before my departure from Tenwek.  Of course, my last day at the hospital was so jam packed that I missed the good-bye party that the main theatre had planned for me!

Many of the days that followed found me at the hospital finishing paperwork, giving last minute lectures to nursing staff, attending M&M conference and saying many, many face to face good byes.
When at home, I happily chatted with improtu visitors who stopped by to wish Teddy and I well and of course...I packed, weiged bags, re-packed, etc..

The highlight of the emotionally draining week came on Saturday.  My dear friend and co-worker organized a good-bye party for me with the interns at her home.  Interns from last year and this year all came - some travelled for hours to attend!  I was deeply honored and so excited to see everyone again.

Playing Banana-grams

There was food, games, music and of course, stories and speeches.  Each person had a moment to share a special memoy of my time at Tenwek or wish me well.   It was humbling, hilarious and so very special.

They spoke of favorite cases....like the time a patient came into casualty with a ruptured ectopic; she went into cardiac arrest and I "procurred" blood from the blood bank while a colleague did CPR.  We managed to get a heart beat and bloodpressure and I did her surgery in the theatre with only local anesthesia.  The lady lived. 

They spoke of a love for laughter, teaching and sharing snacks.....

They of course, spoke of Teddy.

But they also talked of themselves and through their own narratives, I found a happiness and reason for praise I have never known.

One previous intern shared how she is now working at a hospital where no one has ever done Phannensteil (bikini cut) incisions for C sections, instead they do the larger, more painful, vertical midline incisins.  She has decided to teach her interns the Phannensteil method.

Another intern shared how she is now working with a doctor at a district hospital to develop safety protocols concerning pediatrics treatments.

Yet another expressed concern for the lack of surgical supplies at her hospital and how using certain suture on infected wounds could increase risk of wound break-down.

It was lovely to sit and dine and hear nice memories about my time at Tenwek.  Who wouldn't enjoy such grand treatment?

But to hear my former students talking about their students, their desires to teach and change the medical establishments of their country, to improve things......there are truly no words.

I think now about how Jesus must have felt when he sent the twelve out and then when they returned and shared their experiences with Him.....that sense of hope......that eternal legacy of sharing.....how one turns to twelve turns thousands and in turn can change the world. 

I sometimes read this blog and I chuckle......it was never my story.....it was THEIRS.

The Biggest LIttle Safari of them All...

One of the last things I did before I left Kenya was to visit the David Sheldrick Wildlife Trust aka the Elephant Orphanage.  Located on the outskirts on Nairobi in Karen, at the edge of the Nairobi game park, this wildlife perserve is home to orphaned elephants, rhinos and other animals.

Right now the orphanage is home to 19 elephants between 4 months and 3 years old.  The majority have come to the orphanage because their mother's have been killed by poachers.  The organization of the orphanage is quite sophisticated.

Lunch time

Baby elephants are fed formula every three hours by a caregiver.  These caregivers are with them 24/7, making sure that they do not fall prey to nearby lions and hyenas.  This allows them to survive, yet remain partially in the wild during the day.  At night, they are put to bed in stalls by the caregivers and covered with hay and blankets to protect them from the chilly temperatures.  Normally they would seek protection by staying close to their mothers. 

Snuggling between two babies

Once the elephants reach age 3, they are moved to a rehabilitation center.  Their contact with the caregivers starts being phased out so they can begin being more fully re-introduced to the wild.  The goal of the rehabilitation center is to reintroduce the young elephants to the wild and help them "forget" their human family members.
These babies were incredibly fun to watch and learn about. For more information, visit: http://www.sheldrickwildlifetrust.org/

These larger "toddlers" can hold their own bottles.

This little guy wears a blanket to help regulate body temperature.

Life from A Pillow

Teddy and I are back on US soil!  A few highlights from the journey and my re-entry...

Thank You to the British Airways person who checked my bags in Nairobi.  Apparently, you gave me an upgrade on my bag allowance.  Your co-workers in Chicago were not amused, but you really, really made my day.  Thank you.

Culture Shock hit midflight.  I was enjoying a brief escape to the airplane bathroom when I noticed they had paper cups in there.  Free!  And why would they have free paper cups in the bathroom?  Because you can drink the tap water!  This is a luxury I hope to never take for granted again..... 
I felt so guilty in the Chicago airport....the bathrooms there had automatic flugh toilets and I was trying to change clothes to freshen up.  The stupid toilet kept flushing every time I moved - probably 5 times in so many minutes!  I kept thinking about all the people with no clean drinking water and here I was flushing a toilet 5 times in 5 minutes!

Culture shock has hit in other ways - some I have experienced before and some new.  I am always shocked by the general lack of clothing worn by ladies in the US.  Seriously- I've seen paper gowns that cover more. 

And there time and temperature differences. Surprisingly, the normal heat and humidity of the midwest is causing me to feel a bit ill after the cool temperatures at Tenwek. I compensate by hiding inside with the AC during the afternoons.

Teddy battles the heat with a bath...

The myth of the rude american: The airport is American/European culture at its worse (I would also add the DMV into this category!)  After 3 flights, 18 hours and 2 lost bags, I felt like everyone was yelling at me for no reason and that everyone was just plain mean.  I was tired and very overstimulated......to the point I was nearly in tears.  But once leaving the airport (and the DMV), I have been able to view my fellow Americans much more positively!

Re-entry: Since arriving back to the US, I have slowly been able to re-discover things I once enjoyed: Pandora, Netflix, super fast internet.  And I have continued in my Kenyan way of some things - grocery shipping is a big difficulty for me right now.  As much as I thought I missed food from the US, I find myself buying and cooking the same "menu" I ate in Kenya.  Plus ice cream, of course.  I missed American milk and dairy products!  I am enjoying my bed immensely - I never really got used to the one in Kenya. 

I am learning and re-learning some new things about living in the US.  Apparently now they have little crystals instead of fabric softner - and they just go in the wash anytime!  Amazing....

I miss seeing all my friends and colleagues back at Tenwek.  I am praying earnestly for them in hopes that they continue to perservere and fight for our patients, even in my absence.

I am learning to drive again.  I am blessed to have been given a van from a fellow missionary (the Jarrett family van aka Batiem!).  I have stayed on the right side of the road so far and am realizing I really missed driving!

Overall, re-entry is like the new pillows I bought for my "old" bed....its hard to get used to right now...but it time it will feel more comfortable.  Not better than life before.  But eventually...comfortable.

Teddy is re-learning some old favorite nap spots...

Advice for Others:  Re-entry can be a difficult time for missionaries.  I have decided to cope with it by re-integrating slowly and quietly.  I apologize to all my friends and family who I have no called or visited yet - I promise I am very excited to see you all.  Please continue to pray for me as I go through this difficult time of adjustment.

I have been working through the book: Re-Entry by Peter Jordan.  Jordan advices that there are several signs of reverse culture shock:

1. Feeling out of place - wanting to participate, but not quite being able to
2. Feeling lonely - relationships and people change during the time you spend on the field; upon returning those relationships have to be "renewed"
3. Reacting in odd ways - introduction to a new culture can be so overwhelming that little things can an extreme emotion.  For example, the grocery often overwhelms because there are so many options - in other countries - there are few if any options.
4. Negative reactions to material goods - there is a big discrepancy between what one has in their home culture and the field culture; this may cause feelings of guilt.

I list this both as information for other missionaries but also for people in my own life.  Just in case you see me acting strangely....

Jordan closes with this:

"The apostle Paul, who moved freely among a number of different cultures in the exercise of his ministry, had this to say on the sibject: 'I have learned to be content whatever the circumstances. I know what it is to be in need and I know what it is to have plenty.  I have learned the secret of being content in any and every situation, whether well fed or hungry, whether living in plenty or in want.  I can do everything through Him who gives me strength' (Phil 4:11-13)."

Encore Performance

On June 5, I worked my last day at Tenwek Hospital, planning to spend the next week packing and saying good-byes.

Then, on June 10 - the day before leaving to travel to Nairobi - I performed one last procedure.  Something I had not done yet in Kenya.  Actually two things.

I delivered the wife of one of my interns.

And the baby was white!

This particular intern and his wife have an interesting story.  After coming from the US, he decided to pursue formal education in Kenya, in hopes to better integrate into the medical system.   So, they are living at Tenwek while he completes the mandatory one year internship.

It was truly a great honor for me to deliver Baby Samuel and be able to take part in their special day. I know that God will bless them, their mission and this new addition to their family. 

Me and Baby Samuel

Baby Chebet

Managing high risk pregnancies is very difficult - even at a well equipped hospital like Tenwek.

We cannot do NSTs every day due to limited resources.  Only myself or other visiting US attendants know how to do BPPs and our growth ultrasounds remain very inconsistent in accurancy.  In fact, it is difficult to even get a correct AFI!

But what we lack in precision and accuracy, we attempt to overcome with perserverance!

Betsy came to us with a BOH or bad obstetrical history.  She had had five prior pregnancies - all lost at approximately 26-28 weeks gestational age.  This was her first time coming to Tenwek - she was actually travelling for four hours - from a large teaching hospital to see us!  The history was murky and there were no records.  She said that she had no previous medical problems - no high blood pressure, no illnesses and the babies were all stillbirths.

At the time she presented, she was ~ 24 weeks.  An ultrasound showed adequate fluid but there was a severe discrepancy between the head and abdominal circumference.  The placenta looked to be grade II by my ultrasound.  Her blood pressure was normal, but her HIV test was positive.  She was counseled and started on anti-retroviral medications.  I decided to keep her on bedrest until another ultrasound could be done in 2 weeks.

Over the next two weeks, Betsy began complaining of .... well everything!  Body weakness, pain, fatigue, postprandial vomitting, nausea, dysuria....etc...  She seemed to keep a constant urinary tract infection and at times she would have an occasionally elevated blood pressure. 

I began to get a little frustrated.  It was difficult to tell if her symptoms were real, rooted in fear, the result of her new ARV medications....but after two weeks, a repeat ultrasound suggested that there was still a component of disconcordant growth, so I continued her hospitalization and tried to give her reassurance.

At 28 weeks, the baby appeared to be growing though still was not a normal size for the dates.  Again there was discordance between the head and abdominal size and now, her blood pressures were consistenly elevated.  A diagnosis of preeclampsia was made and some medicines for blood pressure control was added to her long med list. 

At 30 weeks, Betsy began asking me to deliver her.  She had never made it that far in any previous pregnancy and she was scared to continue the pregnancy.  At 30 weeks and 2 days, a routine lab check showed decreasing platelets and elevated liver enzymes, so we opted to deliver by emergent C section. 

The baby, a girl, weighed only 1417 gms and was quite vigorous!  She squirmed and tried to cry as I held her tiny body in one hand.

Betsy was overjoyed to see her baby.  And of course, I was satisfied because I had managed the case as best I could.  But as obstetricians, sometimes we forget that our part of the story is truly only the beginning....

Baby Chebet is now ~ one month old.  She is gaining weight but recently was diagnosed with pneumonia.  Please pray for this tiny girl and her mom!  Betsy continues to perservere in supporting her daughter and says that she thanks God for every moment that they have together.....

Betsy and baby Chebet

Baby Chebet

What's In A Name?

In Kenya, a Kipsigis baby's name is chosen based on events surrounding the child's birth: the time of day the babe was born, if guests were there, if a white doctor delivered the baby, if the parents were travelling, etc...

Also, the names are descriptive of if the baby is a boy or a girl:  "Chep-" for girls and "Kip-" for boys.

Since Kipsigis is the most popular tribe around Tenwek, I have become very interested in the meanings of these names and the stories they tell. 

A few weeks ago, two of the nurse on OB were chiding me for not yet having a Kipsigis name.  (Most people have both a Christian and a Kipsigis name and may go by either one.)  So, they had me tell them the story of MY birth so they could help me pick a name.....

It went a little something like this:

"What time of the day were you born?" asked one nurse.
"810 am," I replied.
"Chepkoech means born in the morning." he replied.
"Do you prefer cows or goats?" asked the second.
I wrinkled my forehead.  "I don't know.  Either I guess.  I just don't like donkies."
"Or you could be Chepgnetich - that's born when people are waking," suggested the second nurse.
"Well, I was born breech and there was no OB doctor - what about that?" I asked.
They both looked impressed.  "Oh - you should be Chepchirchir - born with emergency."

Hmmmm.....Carrie Chepkoech/Chepgnetich/Chepchirchir.......

Now, I just have to find a name for Teddy...will have to ask about "born with fur".....

My name advisors...