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...

Mohammed and the Mountain

Somebody else's perfect picture of Mt. Kenya

Mount Kenya is the highest mountain in Kenya and the second highest in Africa (Kilimanjaro).  Its highest peak is ~ 17,000 feet.  It was thought to be formed first as a volcano 3 million years ago during the opening of the East African rift.  Then it became covered over by an ice cap - and today it still has 11 glaciers (slowly thought to be melting) that account for its ragged shape.  Mount Kenya is located in central Kenya - right on the equator.

But this is not really about Mt. Kenya.  It's about my journey to see it.

I was invited to spend a weekend at Mt. Kenya by Esther, one of my interns from last year.  She is from the area and was happy to show me around the area. 

Our weekend began at cool and dark 4am - the plan was to leave at that time because Mt. Kenya is so far from Tenwek and we were traveling the whole way by matatu. (see Blog on Matatus) But apparently, the driver really meant 4 am Kenyan Standard Time, and so our ride picked us up a little after 5am. 

We travelled from Tenwek to Nairobi on one matatu, grabbed some food and then caught another matatu to Nyanuki.  Total time was about 8 hours and cost was $9.29.  We began walking around the town trying to find a decent looking hotel.  It became quickly evident that I was very likely the only mzungu there and I was attracting a lot of stares and comments.  "Look at the white lady!" one man called to his child.

We finally found a secure looking hotel, The Comfort Inn - which proudly boasted self-contained rooms (includes a toilet and shower).  It was pretty nice - hot water, clean, comfy bed and cable TV (so I could catch up on my Latin soap operas!).  It also had an attached restaurant where we where able to enjoy breakfast and dinner.  The hotel hostess was able to help us find a guide to explore Mt. Kenya on Saurday.  His name was Mohammed and he has been hosting tours and climbs in the area for 16 years!  He offered to drop us off at the Mt Kenya park entrance and we could walk the 10 miles to the base camp (at 10,000 feet) - I voted a loud "hapana" on that one.  Or we could pay him and his partner to take us on motorbikes. 

Now if there is any more dreaded form of transportation in Kenya that the matatu.....its the piki piki or motorbike.  People are always coming in to the emergency department after motor bike accidents.  But I came to explore Mt. Kenya...so we struck an agreement.

May is rainy season in the central province of Kenya where Mt. Kenya is located.  The storm clouds gather predictably every day at about 11 am and the rain continues the rest of the day.  We met Mohammed at 730 am to ensure that we would reach base camp in time to get a good picture of the mountain.

It was awesome zipping along the highway on the motor bikes to the Park.  The sky was perfectly clear and the air was crisp.  In the distance, the ragged peaks of Mt. Kenya were clearly visible against the blue sky, the bright white snow caps shining.  After 30-40 minutes, we turned off the tarmack onto a gravel/dirt road that would lead us into the park. 

Zebra crossing the road near the Park entrance

Because of the rainy season, the road was soft and muddy in spots......and at times the motorbikes were having a hard time carrying two passengers each up the hills towards Mt. Kenya.  So, at times we would have to get off and walk a bit.  Slowly though we were working our way towards the base camp.

Clouds moving towards the peaks of Mt. Kenya

Tall trees and lovely green along the way...

Passing through the Park entrance, we continued working our upwards.  We passed over the point of the Equator - separating the Northern and Southern Hemispheres.  I chatted with Mohammed and enjoyed the scenery despite the tough time the bikes were having with the roads.

Eventually, we started going so steeply up hill that the bikes were having more and more of a hard time carrying us.  The loud rumble of a truck behind us forced us off the road....appartently the drivers were friends of Mohammed's and they invited us to ride along to base camp with them.  So, into the truck we went!

You may be thinking that this all seems very random or poorly planned.  It was.  But sometimes spontaneous trips are the best.  And living on the mission field is often like this - even if you do plan it well!  Oftentimes....things are not what you expected - but it doesn't mean you can't enjoy the journey!

Bouncing along in our convoy, I looked out at the road ahead.  The truck appeared to be smoking!

Sure enough - it was over heating.  So out of the truck we climbed and back on our motor bikes.

Finally, after some walking and sliding around.... we made it to 10,000 feet!  I could definitely tell the difference in altitude (versus Tenwek).  Even a small amount of walking made me huff and puff.  And the temperature seemed to be dropping by the minute!

Esther and I at base camp!

Where IS the mountain?!

Pretend you see a mountain behind me....

Basking in the joy of finally having made it to the base camp - I looked around.  Where did the mountain go?  During our arduous journey, the rain clouds had moved in and completely covered it.  I could only laugh!  I can still that  perfect picture of the mountain that I had been staring out for that entire ride along the tarmack road in the morning......never thinking that would be my only perfect picture moment!  That I would ascend to my destination and find the mountain hidden!  I couldn't be too upset though....the day had been too fun....bopping on and off the bikes...into a huge truck....crossing the equator....laughter and good conversation - I even found some awesome bargains at a little duka near the Park entrance!

The flora of Mt. Kenya

Our guide Mohammed on the right.