What's For Dinner?

A very common question that I receive is, "What do you eat for breakfast/lunch/dinner in Kenya?"  

To appease your hungry curiosity, I complied a photo diary of some of my recent meals:

My breakfast of champions:  This month I was lucky enough to find Frosted Flakes at the grocery in Nairobi - some months its the generic Sweetie Flakes.  Add a little milk from a box - and there's breakfast!

Around 1030 each morning, life at Tenwek slows to near-halt for tea time.  Chai has become my substitute for the Starbucks fix that I entertained in the US.  It is mostly milk and sugar with a dash of strong, black tea.

Tea in Kenya is not "drank" or "drunk;"  it is taken.  And it is best taken with mndazi - a Kenyan- version of the doughnut aka... deep fried bread!

This usually gets me through lunch - which I spend working.  At the end of the day, I go home for dinner.  For me, dinner is made possible by Sara, a wonderful Kenyan woman, who comes 3 days a week to my house to cook.   

Chicken Parmesian with salad, some fresh guacamole and homemade galic bread.  And a nice cold Diet Coke.  Suddenly, the day does not seem so bad!



Another dinner....fried chicken tenders with some melted cheese, wrapped in chapti (a Kenyan tortilla of sorts), with some spciy mustard for dipping. 

Aahhhh.... a breakfast buffet in Nairobi over the weekend: yogurt, mndazi, a doughnut and the real treat - bacon!

Dessert at fellow missionary's house: cinnamon chips covered with melted Nutella and sliced strawberries.  Unbelieveably delicious!

So, as you can see, the food is good here.....in fact, I should probably take another walk or two up the hill ......

Collegiate Pride

Our guest house here at Tenwek has found a wonderful way to bring in a little US culture. 

The guest house is a three-story building with rail- walkways that overlook the surrounding valley.  Sometime in the past, long-term missionaries and guests began decorating the outside of the guest house with collegiate flags, hung from the metal railings.  When I first arrived, there were maybe 3 or 4; we are up to 9 now.

The U of L flag was the most recent addition (courtesy of my recent trip to the US!).  I love seeing these flags as I walk up the hill in the morning - it always makes me smile.  And of course, they are wonderful for instigating conversations about .....

...the good...

...the bad...

..and the ugly...  ;-)

  ** Note the views expressed in this particular blog are not well thought out and are meant only to entertain or incite riot.  Complaints can be addressed to: Teddy the Cat, c/o Kenya.

Two Sides

Though I may not be on call, sometimes I get phone "consults" from the medical officers who are covering OB for me.  (It's okay - I am happy to have the help!)  This past weekend, I had a very disheartening case:

G1 at 31 weeks with HELLP syndrome: Platelets 28,000, ALT 800+, Creatnine elevated 3x the norm.  Also, with bloody vomitus.

Pluses: My very capable medical officer could do a C section on this woman; our Peds team is able to resusitate the baby if needed.  Anesthesia is available 24/7.

Problems: We don't have platelets here - so many times that forces my hand to deliver people that I might be ball-sy and observe for steroid administration in the US.  Babies at 30 weeks or less tend not to do well here, so I try to deliver them via C section, if possible. 

So, I recommended that this patient be delivered.  She was remote from delivery; so the decision was made to do an emergency C section.  Problem:  In the 3-4 hours it took to prepare the patient, discuss with anesthesia and actually do the surgery - no one checked fetal heart tones again and my medical officer delivered a still birth by C section.  Ugh.....!

In addition, she was anuric for 16 hours before I was consulted again.  By that time it was 5 pm on Sunday.  Her creatnine had steadily increased, now with increased potassium and she had suffered 2-3 seizures.  Eclampsia - my fave.

Pluses: The are two facilities that offer dialysis.

Problems: We are not one of those two facilities; so transport is required.  Transport at night is difficult due to poor road conditions and also, the business office is closed.  And of course, money is a concern.

So, now it is Monday morning and the patient is still at Tenwek.  She has had 50 mL of urine output after both saline hydration and blood replacement.  The issue with her discharge?  Her family had to pay her bill and they could not locate the funds.  So her discharge for transport was being declined.

What?!

A young woman in Acute renal failure - Anuric - needing dialysis - to Live, being declined transport until she pays her hospital bill? Talk about motivation to pay your bills.  Here at Tenwek, we pride ourselves on providing care to the poor and suffering - oftentimes at the detriment of the hospital.  It is not unusual to see patients hanging around the wards for days, even a week, after their discharge, while their relatives locate funds to pay their bill or petition the compassionate care fund (like a scholarship for very needy patients.) 

I have always thought this policy was stellar....unfortunately, the ugly "other" side is that there are exceptions to every rule.  I am sure that exceptions have been made in that past that maybe I don't know about, maybe the threat and grandour of the policy is to separate out the truly needy from the unmotivated.  I say this because - my patient's family did find the money - and she was out the door by noon - now 48 hours anuric.  With her bill paid.

I was happy - mainly because I had envisioned needing to chain myself to the big Tenwek sign, "We treat, Jesus heals," until she was released.  I'm glad it didn't come to that.

And then there was the fall out issue....our need to be more vigilant in checking heart tones before C sections.  Such a simple idea. 

Problem: We have no working doppler right now on OB.  We have one fetoscope.  All heart tones must be checked in OB. (Can't be done in OR).  But it should have been done.  So, I meet with the interns, the nursing supervisor, the in charge of nursing students....

It is again the other side of my job - the challenge not to become so distracted by the complications, the making plans, that the simple things are forgotten.   

Yet, among all these issues...there is the one that I am most thankful for: that this is one eclamptic that will survive.  In the US, that would never have been enough.  But here, despite all my complaints and urgings to be and do better, it is enough.

 ¹¹And the Lord shall guide you continually and satisfy you in drought and in dry places and make strong your bones. And you shall be like a watered garden and like a spring of water whose waters fail not.  Isaiah 58:11

Reflections from A Vacation

1. Banana splits are the best thing in the world.  Unless its cold outside, then the best thing is Starbucks. 

2. Whoopi Goldberg does not look good on a big screen Hi Def TV.  Seriously.

3. It is so much hotter in Kentucky than Kenya in July.  So.  Much.  Hotter.

4. I have been fingerprinted so many times that I now qualify for America’s Most Wanted. (Am trying to get a medical license in the US and my fingerprints have been “rejected” twice now for various reasons – so while in Kentucky, I had TWO fingerprint cards made.  Hopefully, one will be accepted.

5.  There is a new Frosty (berry) and a new Mcflurry (Rolo).  Eh.  I'm not convinced that they've defeated the Blizzard.

6.  I still love reality TV. 



"Shut It Down!"

7.  Wine making is way more complicated than I ever knew.  I visited some beautiful wineries in Massachusetts and Rhode Island and got a crash course in wine-making.  Of course, I have forgotten most everything, but it went a little something like this: grapes, growing season, exposure to elements, hand picked versus machine picked, pressed, yeast, fermentation, bottle turning, resting, label and sell.



At the vineyard....acres of grapes in the background



These fish are an interesting community art project I found in Westport, Massachusetts.  Local artists created 40 stripers to display around the community; they will later be available for purchase on ebay.  All proceeds will go towards environmental education.

8.  It is really not necessary to have 47 different kinds of laundry detergent and 27 kinds of toothpaste.  It's overwhelming.  I was ecstatic when I returned to Nairobi and found one type of American cake mix on the shelf.  Go, Betty Crocker! 

9.  Drinking water out of the tap is Awesome.  It's cold and clean AND free! It's a gold mine in your OWN house.  Rejoice, people - REJOICE.

10.  The worst road in the US is still better than the best road in Kenya.  See previous blog: En Route. 

11.  The word "home" is so fluid.  Kentucky is my home. Cincinnati is my home.  Now Kenya is my home, too.  Home is also wherever Teddy is.  :-) 

My housemate and I at my Welcome Home Party in Nairobi.

No...not the gates of Hell...it's the meat pit at famed restaurant The Carnivore.  A favorite place for tourists, this restaurants serves up massives amounts of beef, turkey, chicken, lamb, camel, oxen, croc, ostrich and pork on giant skewers - slicing it right onto your plate.  A flag sets on every table - when you've had enough, just surrender, by lowering your flag!



Awwww, Teddy!



En Route

I have now proven that stress is a trigger for my migraines.

When I left the guest house in nairobi at 710 PM, I did not have a headache; when I arrived at the airport at 755 pm, there was an ice pick in my right eyeball

There is nothing quite like driving through Nairobi…especially at night; think survivor meets extreme sports.  The city has few traffic signs, fewer still traffic lights and there are no painted lines indicating where anyone should be driving.  In addition, the entire flow of traffic thru the city at rush hour is dependent upon the magic of several strategically placed roundabouts – where huge one way highways will suddenly merge and diverge like a giant stampede.

All this madness is punctuated by the glaring and large electronic billboards that display ads for pampers, cooking oil, cell phones and lotion.  Total sensory overload.  Then you have the street vendors who cruise their wares between the waiting 3 or 4 lanes? of cars at intersections (controlled by suicidal police not lights).  You can buy anything while waiting in traffic: produce, snacks, kittens, puppies, chickens – live or dead, harmonicas, wall maps, clothing, harmonics…..   Other people sit along the curb or median with a tin cup – looking for a spare shilling.  

Children wander the streets too – as both beggars and vendors; I would think they should be home, hopefully even in school.  No adults with them, cars and trucks whizzing all around.

Thankfully, we arrived to the airport without mishap and my flight to Paris went well.  It was a nice moment, stepping through Parisian security and catching that first whiff of fresh coffee and expensive perfume from the airport shops – the smell of commercialism.  To be caught between two worlds, constantly reminds me of how lucky I am: to have safe drinking water, indoor plumbing, parents that kept me safe.  Things I am learning more and more should be a right, but for many is a privilege.

Lessons in High Risk Obstetrics

My life has started to look a lot like Residency Part II recently: Work, Eat, Sleep, Rinse and Repeat.

This is an ultrasound I did for a patient who presented with bleeding at 26 weeks.  I have been spending a lot of time on trying to improve my ability to diagnose IUGR (IntraUterine Growth Restriction), because women here often present with pregnancy complications and unsure dating.  While I was scanning this feisty baby, he decided to start sucking his thumb - so I snapped this pic with my camera!  This Mom delivered (Chronic Abruption and Preterm Labor) at ~ 27 weeks and baby is in the Nursery.

This baby's mom presented with severe IUGR and ITP (Idiopathic Thrombocytopenic Purpura - a disease where the immune system destroys platelets, necessary for blood clotting).  One challenge here at Tenwek is that I don't have access to packed platelets - only whole blood.  The patient's Hb was quite good, though her platelets were 32,000.  I tried steroid administration and blood transfusion on the day of CS, but at the time of surgery her platelet count was 28,000!  Thankfully, everything went well.  I was only able to give her one unit of blood because post-op her Hb was 18!  Again, the steroids did not help in the absence of platelets and on discharge, her platelets wer ~34,000.  The baby is doing well in the nursery, just gaining weight.  The patient has had 3 other fetal deaths, so this is her first liveborn baby!  She still cannot believe that she has a live, healthy baby.  Postop, when she was waking up from the general anesthesia (necessary due to her low platelets) - she kept asking: "Where is my baby?  Is it alive?  Are you sure she is okay?"

Another patient came in with a "BOH," or Bad Obstetrical History.  Her last baby was a postdates induction of labor, complicated by meconium stained fluid.  Now, remember that we do not have continuous fetal monitoring here at Tenwek - only Dopplers and fetoscopes.  So, meconium presents a problem for us in regards to vaginal deliveries.  I have definitely seen the truth of a "normal" fetal heart tone does not ensure a good baby.  I am sure many of our babies have horrible variabilty with decelerations - I just can't see it.  So, typically, if I have a patient with meconium who is remote from delivery, I usually just do a CS.  Sounds extreme, I know, but otherwise the risk can be too high.

Back to my patient - her baby delivered with meconium and seemed to be doing well, but then died within a few hours of birth.  When she came to see me she was 40 weeks and 3 days with the second baby and was very nervous about the idea of being induced again.  We discussed her options, all the associated risks, and she decided she wanted an elective primary CS.  Oh - and did I mention she is the relative of a staff member?  No pressure.  On the morning of her CS - everyone was excited. 

Unfortunately, one of the aforementioned risks occurred - she got a high spinal.  She became profoundly hypotensive, developed respiratory distress and needed to be intubated.  Needless to say, it was a much faster CS than anyone had planned.  The baby did well and weighed 8lbs 9 oz!   

Many of our patients here are Kipsigis - the local tribe.  Their children are given traditional names based on their sex and the circumstances surrounding their birth; ie... what time of day it was, if vistitors were around, etc...  So, this baby was named: Kipchirchir.....Kip (for boy) and chirchir (for entering the world very FAST!)  I felt very complimented! 

Now, one might think that I am all work and no play these days.....but I am very, very happy to announce that I will be getting a vacation!  I am going to be visiting my family in Kentucky for a short time!  Please pray for my travel and my adjustment in the US as I leave later this month. 

And no, Teddy will not be traveling...he has opted to stay at Tenwek with his friends here.....!

King Teddy, Part II

For those of you who think I only blog about "the cat," please stop any eye-rolling at the sight of this blog and see the many previous blogs NOT about Teddy.

If you are part of the cult-following that likes my cat better than me - enjoy!  :-)

 I want to be a cat when I grow up.....

Some of us are now too good to drink from a water bowl....