Pictures - Work & Play

Interns doing a C section together.

 

Our recovery room in the main theatre looking clean and nice for a visit from the Minister of Health.

 

Sharing stories at the Samaritan's Purse retreat in September...

 

Visiting the Geddi Ruins with a fellow post resident.

 

End of the Rotation Party at my casa...

The success of any party in Kenya is directly portional to the number of shoes

you have inside your door!

A little "friendly" competition!

Chocolate chip cookies are a hit in any country....

Pictures - Home & Garden

Column Cactus Tree, Nairobi

Cactus Palm, Nairobi

At the Flower Shop, Nairobi



My newest pet - Wilson, the wooden giraffe.

In my flower garder 

I am also a farmer!

The Gremlin In My Patient

Here's one for the medical folks: 

She was a G1P1 who presented complaining of an abdominal mass.  We are currently training new ultrasound techs at Tenwek so I was asked to scan the patient.  I saw this:

An odd looking mass, but it was located just lateral and superior to the uterus - where one might expect an ovary to be and there was no ovary to be seen, so an ovarian mass it was.  Whatever it was - it was big (10x8 cm), tender and it needed to be taken out. 

Now from time to time, we find things on pelvic ultrasound that are incorrectly blamed as being of gynecological origin.  This happens in the USA and it happens in Kenya.  In residency, nothing was more frustrating that the patient who complained of abdominal pain and had been found to have a 0.5 cm simple ovarian cyst.  Or the patient with no ultrasound findings who is generally labeled, "PID" or "Chronic pelvic pain."  However, here in Kenya, more often than not - if the problem is not gynecologic in origin - you can be sure it is at least interesting!

OtherDoc and our rotating Surgery Resident took this particular patient to theatre.  I was covering L&D but I stopped by to snoop and see what they found:

 It was NOT an ovarian mass, but it was an abdominal/pelvic mass - it seemed to be growing from the posterior abdominal wall and several small loose "cysts" were found extruding from mass and in the pelvis.

It was Echinococcosis or hydatid cyst - a parasitic disease caused by a tapeworm.  Typically the disease is passed from dogs/wild dogs or foxes to sheep/cattle and then may be passed to humans via soil or animals that are infected.  The incubation period can be months to years before symptoms are noted, depending on the location of the cyst in the body and how fast it is growing.  Generally, the cysts are found inside the liver or intestine.  Strangely though, this one was in its own little capsule that encompassed many, many eggs.  It was totally sci-fi.

It is important to not spill any cyst fluid inside the peritoneal cavity because it may cause seeding of the abdomen with hundreds of these little worm egg cysts or even anaphylaxis (from the cyst fluid).  We had to have epi and steroids close by - just in case.  I felt like I was on House!  After the mass was removed (we called the General Surgeon on-call), I got to cut it open!  Take a look:

The patient endured the surgery without any complications - including anaphylaxis - and will now require long term treatment with albendazole (anti-parasitic).

Very cool.  So gross.  I love it! 



Not Far

There are many vague descriptors for distance here in Kenya: Very Near, Near, Not Far, Far, Very Far. 

Last weekend I was invited to visit the home of my gardner, whose wife has just had a baby.  In Kenya, it is a bigger honor for you to visit someone than for them to visit you.  So, I happily accepted.  I prepared some gifts to take along: a loaf of banana bread, a baby outfit, some baby socks and baby toiletries.  I also threw in some hair bands for the new big sister.

My gardner, Langat, was supposed to come to my house at 9am so he could escort my housemate, Heather, and I to his house.  I asked him how far away his house was, to which he replied, "Not far."
He was a little late, arriving at 1030, and off we set, walking through the Kenyan countryside.

And we walked.

And walked - Up hills, down hills, over bridges, through cow poo, greeting people all along the way.

After 45 minutes, I started to wonder if I shoould have brought my passport.

After an hour, I considered just camping out and eating the bread, maybe walking back later.

After an hour and 20 minutes, I thought maybe I would just live wherever we were.

After 90 minutes, Langat signaled us that we had arrived.  His house was lovely - nestled between fiels of maize and banana trees, with lots of flowers.  His wife, mother and sister in law were there to greet us.  

Daughter Faith enjoyed her lunch!

In honor of our visit, we had a lunch of chapati (Kenyan flatbread), boiled chicken, rice and milk.  I felt very humbled because meat and chapati are typically reserved for very special occasions.  It was evident that Langat and his family had worked very hard to make this day special for us!  The nicest thing was just sitting and talking with Langat and his family and learning more about their lives. Langat has worked for me for 10 months, but I had no idea that he led the choir at his church or played many musical instruments or that his wife sang in the choir. 

Heather and the new baby

Because I buy my milk from Langat - I got to meet the cow that supplies it! 
Talk about knowing where your food comes from!

Langat, his wife (Janet) and their two daughters

After touring Langat's garden and having a cup of tea, we started our trek back to Tenwek.  On the way back, the walk did seem to go a bit faster - maybe the chai helped!  Despite the rough beginning, it was a great day.

Raging river as it goes over the dam by Tenwek