Come And Go With Me

Job descriptions are important.  It’s nice to get an idea of what you are getting into before you sign on the dotted line.  A last chance to escape, you might say.

In residency, job descriptions were very useful.  We had a whole book to outline exactly which resident would see which patient, what tests we should order depending on what symptoms were found and which attending should be called.

Life is more vague now.   Chaos and unpredictability are the two things I can rely on.

 I know that I am in Kenya to serve as an OB/Gyn physician.  I know we have our main operating day on Thursdays.  But what of all the issues?  The problems?  The loneliness?  I don’t remember any of that in the job description. 

Reflecting on this, I recently wondered if my experience could be given clarity by reading the Bible.  It’s our guidebook to life – so why not think it could help me in better outlining my job description as a medical missionary?   The twelve disciples were called from their homes and families by Jesus, so I was hoping that maybe they received some sort of outline.   I found my answer in Matthew 9:36 and Matthew 10 where Jesus sends out the apostles. 

Here’s my summary:

-Jesus says that the harvest is plenty, but laborers are few

-Jesus tells the disciples to pray and ask for more laborers

-Jesus gives the twelve Power to heal disease and cast out unclean spirits

-He commands them to preach the gospel to all

-He instructs them on how to behave

-He commands them to heal and cast out spirits

-He warns against meddling with evil and selfishness

- He warns of persecution and hatred that will be endured

Wow.  That’s quite a job commentary.  There were a few things that especially hit home with me.

First, Jesus acknowledged the upcoming struggle – Look there is a lot of work to be done, and few workers to do it.

 Now my next sentence what have been: “So get busy!”  But His was, “So pray to the Lord that He will send out more workers!”  Paraphrase mine.  There are a lot of times that I am so overwhelmed by the sheer volume of my work, that I forget this first instruction: To Pray for Aid and Guidance.

Jesus follows this command by giving His disciples the Power to heal and cast out unclean spirits.  BAM! Such an important lesson here:  to first seek God’s help through prayer, so that you will receive the power to carry out His will.

Now I am not suggesting that you will pray, then go around magically healing everyone by tapping their shoulder, but I am saying that perhaps there is a natural progression from dependence on God to the Power to see prayers answered and miracles occurring.

The remainder of the summary is vital to me because of what it DOES NOT say.  It talks about how we should behave, how people may view us and how the gospel should be our priority, but what is NOT mentioned is:

-   How WE need to change peoples’ heart or ways or actions

-   How WE are responsible for others’ actions

-   How WE are alone – in fact the opposite!  (The hairs on our heads are numbered…)

This was a great lesson for me.  At a time when I was wallowing in a pit of frustration over circumstances that I could not change, I realized that I wasn’t being ask to change those things.

Instead, my job description is this:

1.  Pray for help.

2.  Be open to receiving and viewing the power that God is working in Tenwek.

3.  Do not try to change other people’s hearts and minds; instead, refer to #1.

Even after all of this…is it still frustrating at times? Yes.  Still lonely at times?  Yes.  I think that it will just be that way…..for a while, maybe always. 

“And whatever things you ask in prayer, believing, you will receive.”  Matt 21:23

Did I Get Them All?!

For those of you who have been reading along in the blog...or for those of you who know anything about my "luck" at work at all....it will not come as a great surprise to know that my calls here have not been easy.  There have been several poor outcomes, difficult patient situations and some very long nights.

Today, I received a bit of encuragement in the form of what I hope will be a good outcome - actually four of them - when I got to deliver a mom who was spontaneously pregnant with quadruplets.

Baby A - The Impatient and Out Numbered Boy

She has been on the ward for about 3 days, after her bag of water broke prematurely at 29 weeks.  She received steroids to help with the babies' lungs.  Today, she went into labor.  Baby A actually slipped out, delivering before I could get to the hospital.  Baby B was a footling breech, so a C section was in order for the remaining babies.  We were able to get the mom to the operating room, get spinal anesthesia in place and voila! 3 sisters joined their impatient brother in the world. 

The four babies are amazingly concordant in weight - all about 1000 gms or 2 lbs each.  They are doing well for now; tucked into the warmers of our nursery with some oxygen by nasal cannula.  The babies have a long way to go - they must gain weight, learn to feed and not develop any of the dangerous lung/gut diseases that sometimes afflict premature babies.  I would like to think that I will see the day when these four are discharged home.....but for now it is enough that they were brought safely into the world. 

Thanks to the research of my partner - OtherDoc - I learned that the incidence of spontanous quads is 1: 571,787 so the existence of these babies is a rarity and miracle in itself.  Please remember these babies, and the many others in our nursery, who need your prayers.  We are very limited here in terms of what we can do for them medically, so each healthy discharge home is truly a blessing.



My grace is sufficient for you, for My power is made perfect in weakness.
2 Cor 12:9

Christmas In Kenya

I am humbled by, and grateful for, the wonderful response of support I have received from family and friends since I have been in Kenya. 

Your comments, emails and prayers have been a fortress of strength in this time of transition. I thank God for each of you - please know that your friendship and support is most treasured!

Merry Christmas and Happy New Year!

What Teddy Does.....

At least 40% of the email I get is inquiring about the health and antics of my feline companion.  I am trying to balance my blog with elements of medicine, culture, spiritual matters...and of course, Teddy. 

That being said...while I am been busy taking call and working at the hospital, here's what Teddy does......

He tries to hide.



He explores.

He spies on the neighbors.

He eats (obviously).

Mainly though - he sleeps.

Retrospect: Blood

A look at a call night in Kenya...in reverse....

Note: All times are estimates.  Names have been changed for privacy.

0130 am   The night is cool and dark as I walk home.  I don't have my flashlight, but there is just enough light to guide my way from the hospital.  As I round the last curve to my house, I pass the pasture where the cows are always grazing.  There is rustling in the grasses.  I wonder if it is a cow.  Or a wild dog.  I have scissors and an umbrella.  Not much for fighting off an adversary. 

I feel like I have been fighting all night. 

I think about the picture in my purse.....the two dead babies....and Wilma.

The words of a hymn run through my mind, "Would you do service for Jesus your King? Would you livee daily His praise to sing?"

As I pass through the gate to my house, I think that though our human timing and actions are often imperfect, God's plan is exactly perfect.  All things are happening for a reason.....as random and futile as they may seem.


Midnight:  The blood bank is clean and I am glad of that.  I lay on the cot, my arm out-stretched.   My exhaustion weighs me down. 

The tech pokes around in my arm.  I am afraid to look - I am alittle worried I might pass out after missing dinner.  How embarassing that would be.  The blood flows out of my arm and into the bag.  I begin to joke with my coworker about how in the US, I would get a cookie after giving blood. 

We talk and laugh as the two units are collected.  It feels strange to laugh.


1100pm:  I am talking to the family of the second patient, Ali.  I tell them that I am sorry about the baby.

Meanwhile, Wilma's blood pressure is continuing to drop.  It is ~ 50/30.  The drain has bright red fluid in it and she does not appear to be making urine.  She is getting IVFs and has received one unit of blood.  The second unit has finally arrived.  Her condition can only be improved by more blood, but there is no more in the blood bank.  At this point, I am worried that not even that will save her. 

"What is her blood type?" my co worker asks.
"A-positive," replies the nurse.
"I will donate to her," my co-worker offers.

I am also A-positive.


1030pm: The second baby is out in less than one minute.  The baby is taken out of the OR.  Word comes back that this baby did not survive either. 
Tears are hot in my eyes as I finish the operation.  


1000pm: OtherDoc and I place surgicel and a drain and close the incision quickly.  Wilma's BP has started to drop and I know that she needs to get out of the OR soon.  She needs massive blood transfusion..and SOON. 

Sweat runs down the sides of my face and the back of my neck. 
Meanwhile, a call has come in: there is another patient pregnant and bleeding in Labor Ward.

  
0930pm: The bleeding has not stopped: it comes from the uterus, the SQ tissues, the skin.....a thin oozing welling up constantly.  Wilma is in DIC.  I ask the anesthesia guy to call my partner, OtherDoc.


0830 pm: Not just a previa.  Previa + Abruption. The placenta - implanted over the cervix (previa), has started to rip away from the wall of the uterus (abruption), causing hemmorhage.  The blood that could not escape throught the cervix has infiltrated into the walls of the uterus.  Couvelaire uterus.  It bleeds anywhere I try to stitch.  I ask my co-worker to take a picture of the uterus with my camera.



Posterior view

0700pm: There is blood on the delivery bed and on the floor.  She is uncomfortable, writhing in pain.  She is known to have a 24 week IUFD (intrauterine fetal demise).  Now she is actively bleeding.  A quick bedside ultrasound confirms my fears: an apparent previa.  I call for IV fluids, an emergency CS and 2 units of blood.

I quickly review her paperwork.  Her name is Wilma and her hemoglobin is 8.4.


Oh that You would bless me indeed,
And enlarge my territory,
And keep me from evil,
That I may not Cause pain.

1 Chronicles 4:10

The Road Home

I started work on Tuesday - just a half day - then jumped right in on Wednesday and finished out the week.
My work day starts with a physical challenge.  As I have alluded in previous posts, the combination of the altitude, the terrain and my personal distaste for exercise has caused my transition here to be a little rocky.  I thought I would share a little more about the neighborhood....just to defend all my whining....


This is the first hill that I encounter outside my house.  Here I begin to experience shortness of breath.  The sidewalk is slightly tilted to the left, so I also imagine that one leg is growing longer.

 This is the second hill.  Here I often feel like I might not make it the rest of the way.  Talking is out of the question.  This is where, on Thursday, I regreted eating chili for lunch. It will give you reflux.  And it alwas makes me feel a little bit like I have to urinate.  Strange.  There are sometimes donkies here grazing by the roadside, sometimes a cow.

This is the third and final hill.  By this time, I am hoping that I don't see anyone at the top because I am too winded to talk.  My legs usually are feeling tired - especially if it is the second or third trip of the day.  I am usually wishing I had taken the afore mentioned donkey.

Overall, I have decided to view this physical stressor by pretending I am on one of those reality TV shows - like The Biggest Loser - only I am in Kenya, and I have participate and continue my job. 

Here's some other views from my walk:

The view from "my" side of the hill

Home at last!

Home Sweet Tenwek

The community of Tenwek is built around the hospital and is rather like a college campus.  Most everyone living here works in some capacity for the hospital.  The terrain is very hilly and the elevation is a severe ~8000 feet. 

The altitude takes some getting used to - I have had headaches, fatigue, achiness and shortness of breath when walking.  It's a lot like residency.  Or heart failure.

I have to walk up a rather steep hill to get to the hospital - it only takes ~ 4 minutes, but the combination of my poor conditioning, the altitude and the terrain leaves me huffing and puffing.

My house consists of a kitchen, living/dining room, bathroom and 2 bedrooms.  There is actually a lot of closet and cupboard space.  It's a little barren yet, but I am getting settled in. 

My living room: Notice Teddy on the fireplace!  Unfortunately all my lovely curtains
were left behind in Cincy, so I am sporting the Kenyan motiff.

Another view of the living room and the door to the guest bedroom

My very small bathroom - it has both hot and cold water!  It is also
a weight loss motivator because it has only about 12 inches between the tub and
sink!   There will be no running to this toilet.....

My bedroom: The mattress is very firm, so I improvised.  I folded a blanket
and a thin mattress pad in half right in the middle, so now it is slightly less firm.

Another view of my bedroom.  The over the door shoe rack
may be the BEST thing that I brought to Kenya.  It is multipurpose.

Another bedroom view and a shot of my bedside table made of my ActionPacker
(the one that KLM didn't destroy)

The dining room "area".  Note the Charlie Brown Christmas Tree.
No ornaments because *sigh* Delta made me leave them behind. :-(

Shopping In My Sleep

After five abandoned bags, four days of travelling, three uncaring airlines, two long layovers and one missed flight, I finally made it to Nairobi.  (HA!  Best 12 days of Christmas EVER!)

Only one more task lay between me and my goal of getting to Tenwek  - my home for the next two years: the big shopping trip.  Because Tenwek is ~ 200 miles from Nairobi, a large degree of planning goes into food shopping.  Food staples – flour, sugar, rice- can be bought in nearby Bomet.  Some fresh produce is available at Tenwek, as well: potatoes, carrots, pineapple, bananas.  However, the majority of food stuffs – meats, cheese, dairy and other “necessities,” are purchased in Nairobi.  The trip is only made every 6-8 weeks, so quantities purchased are large, the bill is high and it can be quite a change for someone who is accustomed to running to the grocery twice a week.

Add in the fact that I had had no sleep, had only stepped off the plane a few hours earlier and wasn’t completely sure what was in the bags I repacked at the airport - and you have a mumbling, drooling recipe for disaster.  Thank goodness I had two Tenwek veterans there to help with the shopping or I may have come home with 56 packages of Ramen noodles (which I was happy to see they have here; they are about $.50 each!)

In the end, I had 3 shopping carts loaded down with $750 worth of goods!  I purchased household items: laundry basket, trash can, soap, cleaners, Kleenex, etc.. and food: canned veggies and fruit, cereal, oatmeal, bread, cat food, sugar, peanut butter, milk, soup, etc.  Then it was off to another household goods store for towels and rugs.  Cha-ching!  On the following day, cold foods: yogurt , cheese ,more produce: apples, oranges, lettuce,  and meat: chicken and beef, were purchased. 

My well-stocked kitchen cabinet!

I have never owned so much food in my life.  And it is very daunting, not knowing when you will go food shopping again. 

The milk here is one of two ways: you can either buy it locally straight from the cow – unpasteurized with the cream still on top OR you can buy it in boxes in the store.  The boxes do not need to be refrigerated until opened.  The box milk is okay with cereal, but it tastes funny to just drink.  Cereal here is expensive and it is difficult to get US brands.  I will likely be eating either yogurt or oatmeal for breakfast.

Some pictures of my new kitchen:

Will follow with more pictures of my new home! 

Oh, Teddy!

Despite our very rough start, Teddy and I made it to Kenya safely!

Of course, our journey continued to be laden with surprises.  As you may remember, I was supposed to catch up to Teddy in Amsterdam, where we would fly together to Nairobi.  Unfortunately, in addition to making me leave half my luggage behind, KLM also put my cat on the wrong flight to Nairobi.  Teddy arrived ~10 hours before I did and had to spend the night in customs.  More like kitty jail.

When I arrived in Nairobi, Igathered what baggage that wasn’t lost by KLM (3 of the 5 pieces), and then I went to find Teddy.  He was LOCKED in an iron cell, in his kitty Cadillac, which was also locked.  No food or water.  He looked so forlorn.  It was straight out of one of those dog shelter commercials – you know the one with the sad Sarah McLachlan song?  He was very dehydrated, but perked up pretty quickly.  Within 12 hours, he seemed to be back to his old self.

On Friday evening, we travelled to our new home in Tenwek, Kenya.  Teddy was very excited to explore his new home.  A little too excited.  I was busy unpacking, etc.. when I noticed that I had not seen Teddy in a little bit.  I began to look through the house.  No Teddy.  All the windows and doors were closed.  I was tired, jet lagged and completely baffled.  How do you lose a 20 lb cat in a secured house?

Suddenly, I heard a commotion in the living room.  And there was Teddy in the fireplace – covered in soot!  He had managed to sneak past the wire grate and climb up into the chimney.  Good grief.  His whiskers had dirt stuck to them and his white paws were black.  I grabbed him with a towel, but not before he made little black paw prints across the tile floor.

One dirty paw - After the cleaning!

If this wasn’t exciting enough….yesterday I lost him again.  I of course checked the chimney first thing.  No Teddy.  Doors and windows closed.  Frustrated, I continued unpacking.  After a few hours, I heard my roommate exclaim,” I found Teddy!”  He was asleep in a kitchen drawer.  He had crawled into an open cabinet and into the drawer.  When she tried to open the door, she heard a hiss and saw black fur.  So, I just emptied out the drawer and left the cabinet open.  Maybe it will keep him away from the fireplace.



Teddy in his drawer - Top View




Teddy in his drawer - Cabinet view




Nap on the Couch



Meanwhile, I am getting unpacked, getting organized and trying to recover from the jetlag.  I will send pictures of the house and surroundings soon…assuming Teddy behaves.

 My new address:   Carrie Huber

c/o Tenwek Hospital

PO Box 39

Bomet, Kenya, East Africa