Tuesday, September 25, 2007

Happy in Your Heart?

Well, here are a few updates and stories from over the last week.
This is Ashley writing this portion of the blog. The other day I was feeling a conviction to about focusing on some of patient’s physical problems and not their spiritual ones. Sometimes when I walk into a patient’s room I can tell from the start that the patient is different- that it will be an interesting encounter. Anyhow, I met an older Kipsigi lady who was concerned about her heart. She was a delightful lady with a wonderful smile. Upon finishing her exam I told her to rest assured that physically her heart was fine. I asked her if she was happy in her heart. She said that she was. Then I asked her if she had Jesus in her smart. She smiled most assuredly and said that she did. We were all very happy about this. What a reminder that this body we are in is temporal, but our spirits are eternal.
A short time there after I saw another patient who was very involved in a cult. However, he came to us for his medical care. We did the best for him as we good and I talked with him a little after his visit. The nurse asked me why would he come here and listen to us and believe our treatment if he believes nothing else we say. I told her to be thankful that he is coming here because he must be listening to or believe what we say, which we give us eve more opportunities to share in the future.
I have also noticed patients that come in w/ we defined scars from cuts on different parts of their body. I learned that this is where in traditional medicine people would have cuts in areas that hurt to help release whatever was causing their illness. It helps me because it shows where and for how long a patient has had pain in an area.
Another things is that people have very similar names here. For example, in a meeting the other day with only a few people 2 had the same first name and 2 others had the same first and last name. Then in clinic I saw 2 patients back to back with the same name.
We also had some neat experiences this past weekend. We were invited over to breakfast at people’s homes on consecutive mornings. On Saturday we and another family had a pancake breakfast with the Robert’s family, which was very good. The next morning we had breakfast with our neighbor, Ms. Barb. She has been here for about 20 years and it has become a tradition to have breakfast with Ms. Barb. She invites us over almost weekly, but this was the first week Sarah felt well enough to go. There were several other guests over and it was a very nice time of fellowship with good food. It felt very comfortable eating in her home.
Sarah has also developed a recent love of popcorn. Ms Barb was cooking it the other day so she went next door and Ms. Barb gave Sarah some, including a bag of microwave popcorn. The next night we were going to try to make it on the stove when Ms. Barb knocked on the window and said “popcorn night!”. She had made a big tub of popcorn for us. Last night we decided to make it on our own. We quickly learned that we were to put a lid on the pan on the stove! In the end it tasted great.
Sunday however was our first real cultural experience. One of the clinical officers is leaving for school and he invited us over for his going away ceremony at his church. It was quite an experience. There was a concrete slab covered with a tarp over sticks with church pew underneath. It was to last from 3 to 5. It actually started on time, but ran a little late. Some people showed up over an hour late. There must have been 100 people under this 20x20 tent with more seats and tarps for the ground being pulled up for additional guests. Most of the time was speeches from people representing different areas of his life. I spoke as I am the “incharge” doctor for the outpatient department. At the end was the cutting of the cake. Apparently having a cake for every ceremony has become a tradition. The cake was a plain round cake made with corn meal. (Actually it was 2 cakes- one for the church and one for hospital). The cutting of the cake was as orchestrated as a wedding ceremony. However, after cutting the cake, he chose different people to feed cake to. I was surprised to be one, and then Sarah and Maggie were called forward. When we went to leave at the end, the host asked us to have chai with them, which we did before we left. It was long, but it was a fun event. We were very honored to be asked to attend. Now as Sarah is beginning to feel better we hope to be able to do more of such events in the village in the future.

Wednesday, September 19, 2007

Interesting tidbits

Thought we'd take a time out to share a few interesting things.
The temperature here is about the same year round as we have said before (50's in evening/AM and 70's during the day). When we first arrived we saw several folks here building fires in their fireplace. We thought that was a little silly. Well, after a good rain the other day we looked at each other and said "let's start a fire". We got a few pieces of firewood and boy is it hard to burn. We spent over 30 minutes the other night trying and didn't get it started. One of our guests brought over some kerosene to help, but we refused and said it was cheating. Our helper even set up the wood in a way she knew would burn. Well, let's just say our new game at night is "Who can get the fire started?".
We also had a neat experience the other day. We have spent some time with one of the local drivers. He has been at Tenwek all of his life. Edna Boroff was one of the first nurse here years ago. We have been reading her book about Tenwek. Our driver said that he was one of the first people delivered by her. We thought this was neat. Driving here is a privilege. It is difficult to get a licence. You have to take a course and it is expensive. Our SP driver Raymond said if your car slips one inch backward when sitting on a hill you fail. Our driver is so good that he says everyone he has helped to teach drive had passed their test first time.
Just some interesting tidbits.

There and Back Again

What a crazy past few weeks. Last Wednesday Maggie did have her playgroup. The theme was the letter “c” and the kids listened to classical music and did have the cupcakes Sarah had made the day before. Maggie also did finger painting for her craft.
Ashley spent another day in the outpatient department yesterday AM after his long term doctors meeting (those here for 6 mos or longer). Many topics were discussed and being that we have been here for a month now, Ashley was better able to understand things being discussed and had some input of his own. On item of concern is in regards to clinical officers (COs). These are our PA equivalents who do a lot of staffing in the outpatient departments, which Ashley in unofficially now in charge of. Over the last week several have left for different reasons, putting us in a bit of bind for workers. We also have lost 2 of our OB docs recently, so pray that God will will ing the gaps where needed.
Around lunch time one of the other volunteer docs tooks Ashley on a tour of the pediatric facilities since he was on peds call for the first time last night. It was a little bit overwhelming as pediatrics is an entirely different animal here. Lots of malnutrition issues with different ways of solving it. Plus most of the kids, like the adults, are real sick. The Neonatal ICU was something else. Sure, there were wooden cribs and rigged up incubators, but the technology and the things that are able to be done there are amazing. Ashley was told that some 25-26 week born babies survive and do well.
After lunch Ashley sat through his second and final day of infection control meetings. He almost gave himself whiplash trying to keep his head up and stay away. Warm room, big lunch, no lights and quiet speakers don’t make for a good combination. The info he learned was fairly informative and will be useful in the future.
Wednesday evening Ashley was on his first peds call. It ended up being okay. He did have lots of questions when there were admissions. Sarah and our helper, Janet made spinach ravioli- from scratch- it was so good! We took some to our neighbors and hung out with them and their family. (Even though Ashley takes call from home, there is a way to forward all calls to another house, so you can go out and visit). We sat around and talked. Ashley tried passion fruit for the first time. He liked it, but Sarah did not. We were also given a lesson on how to drive and operate their car.
Last Thursday was a much needed day off for Ashley. To start the morning however, Ashley met with 2 of the 3 FP residents that are here now. It was a very informative meeting. Ashley learned he has a lot do, not the least being setting up their schedule for this year as soon as possible. After the meeting Ashley loaded Maggie up in the backpack and went for a long hike. They went down to the river and then into the surrounding village area where some of the staff and workers live. It was a busy and quiet area with colorful houses, little outhouses, and scattered cows and donkeys. We also ventured down some small side trials and even had some locals offer us direction. Maggie called the cows dogs and told a donkey “bye” when we walked on.
That afternoon was the big event, out first time driving around on our own. All of the cars are manuals and most are 4-wheel drive. The only thing is everything is set up on the opposite site of the car. Finding all the gears was little tricky. Plus, it was a diesel, which was a first for us. Most of the missions cars come from Gibralter. I thought this was odd, but they a toyota dealership that specializes in providing cars for missions and NGOs. They know how to do the paperwork and shipping. We borrowed our neighbors car to drive into Bomet, which is only about 3-4 miles away. The entrance to Tenwek is crowded, so driving here is the hardest. Driving in town is easy. He had our share of stares, especially when we would speak to folks from out the window. We had to constantly remember to stay on the left and had to deal with the large potholes. It will take some getting used driving here, but all in all was okay. Ashley drove into town and Sarah drove back. We carried our two helpers along with our neighbor’s, Peter. We only had to ask 2 taxis (mutatus) to move out of the road for us and the motorcycles drive like crazy (but we are in a very big car!) People also “hoot” their horns a lot, but you can’t at Tenwek, so we flash lights (which led to us hitting the wipers on by mistake several times).
While in town we went to the local Duka where Sarah and Janet picked out some fabric. Janet is a seamstress as well and is going to make some maternity clothes. Peter and I went to the security offices to pick up some boxes for the hospital. He and I also went to a farming supply store. Several folks around Tenwek have gardens and we found a plot earlier this week that is not in use. When we saw the seeds and supplies, we decided to go for it. While the men did farming stuff, the ladies went to grocery store. We had orders for 2 other people. Of note, hoes and rakes are purchased without handles. However, we found the handles we needed at the grocer! This grocery store sells ice cream as well. As some things here are really cheap, the ice cream is fairly expensive.
That evening we picked up some items from the hospital restuarant to fix with leftovers. We distributed our groceries and borrowed some DVDs from some friends for a nice relaxing evening.
Last Friday was another chance to rest up some. That afternoon Ashley began to tackle the garden. It was quite a task. No one had tended to it for several months. Janet used to work for its former owners, so she helped show us what plot was ours (and it was neither of the ones that had been some what cleared off. A lot of weeding was done initially. We have never received so many stares and comments (all good) from the locals. After some initially clearing, we were surprised to discover several things already growing, including celery, sweet potatoes, parsley, rosemary, chives, secuma wiki (like collards), and pineapple! Some was ready to harvest. Maggie helped supervise the activities.
That evening we had our second kipiganga. It was pizza them this time. It was a lot of fun as the World Gospel Mission (WGM) field meeting for Kenya was being held here at Tenwek. We saw some folks we had met previously from the states and Ashley got to speak with some folks from Kigoma, Tanzania, which is where he spent time during med school. It was an enjoyable evening. We also got to know several of the visiting MDs, including an orthopedist who left he practice to do training at missions all over the world- with his own money! Another OB was here who offered to train Ashley in doing C-sections. Sarah was also glad to meet him as he is supposed to be here in the spring around the time of our delivery.
Saturday AM Sarah was feeling pretty good, so we went with a group to a local tea factory. We packed (literally) into the car and went for the short ride. It was a nice factory and very interesting. Obviously OSHA was not involved as we were able to walk right up to the machinery and equipment. Several folks bought tea at the end, but we held off.
Lunch was with all the WGM people again. That afternoon Sarah and Maggie took a much needed nap and Ashley went with a family who is visiting on a hike to the top of Motego, the local mountain. It was beautiful walk with views of tea fields, huts, and even see Tenwek from a distance. It was about a 3 hour total hike. We met several kids who followed us on the way and wanted to have their pictures taken. Our parents even called on the cell phone and Ashley had crystal clear reception on the top of the mountain!
That evening we met with a large group at the guest house to have “Navajo Flat Bread”. It was very good and a good time.
Church was good last Sunday. After 20 years of meeting, this week the initial steps were implemented to give the church a formal name! It rained that afternoon so we took some naps. Our friends from South Carolina invited us over for a birthday party for the husband of the couple, Chris. It was a nice time of fellowship. Maggie colored him a picture as a gift which quickly went up on the bare walls of their apartment. Their are some German students here and it was interesting talk to one of them about how they have Aldi grocery stores just like we do in the states (we thought this was neat).
Last Monday was another hard day of work. Ashley spent the entire day working in the outpatient departments (Monday is usually the busiest day). He is starting to get into the routine a little more each day. That evening he worked on a lecture to do for his residents for their learning time.
Last Tuesday was another day of outpatient in the morning. The girls played on the trampoline and ventured around seeing the locals. They are building relationships with the ladies who sell produce at the front gates and were waiting their for Ashley today when he got off work.
This afternoon Ashley walked in on a sad case in casualty. A local hospital sent over a woman who had a car wreck about 2 weeks ago. She had several broken bones and was now so bad she would likely have an amputation. The ER resident said it was the work case he had seen and one of the veterans here said it was in his top 10. It makes who ask why would some one let this happen? Another reminder of how blessed we are, at home and here. After this Ashley had his first outpatient task force meeting. It was good for several reasons- a chance to meet more people. to see how a meeting was run, and t lear what is going on in the outpatient department. It sounds like several good changes are in store. As Ashley will be the day to day directory, fortunately he does not yet have to chair this committee.
The next day we loaded the car for our second trip to Nairobi. We were joined by a local pastor who was going to visit a local bishop who was very sick in the hospital. It was amazing this time through how much larger the little towns appeared. No animals on this trip other than the occasional gazelle. We did get pictures of baboons coming into the city. We stopped by the WGM office on the way in and then were dropped off at the Samaritan’s Purse office. There we met up with our friend Raymond who was our driver when we first came out. It was fun talking with him. We were dropped off at a shopping center where we could eat lunch and then do some shopping at the Nakumatt. Not only did we have our own list, but several folks at Tenwek had “mini-lists” they gave us of items to purchase as well. Raymond had to get to the airport, so we left around 5 and went back to the warehouse. He gave us the number to order for delivery pizza (we’ve had better) and we hung out with other folks at the guesthouse. This time we met some girls from Canada who were going to work along the coast and one on vacation from Uganda.
The next morning Raymond dropped the girls (and the girl from Uganda) back off at another Nakumatt to do more shopping and then took Ashley to the hotel where his meeting was (the main reason for our trip to Nairobi). The hotel was very nice. The meeting was for INFAMED (the institute for family medicine). I was not even very sure as to what this group was at first. It was group affiliated with mission hospitals that spearheaded to the effort to start family medicine in Kenya. Now they family medicine is a real entity, this group is now more of a support service, providing money to hospitals, educational course (such as ALSO), and scholarships. It was a small meeting, but some interesting people where there- reps from other hospital, local professors and docs, and reps from MAP international. It was very beneficial for Ashley and only ran about 1 1/2 hours late.
After this Raymond took Ashley to the mall with the girls. It was 4 stories and had several US style stores (such as an Apple computer store), but some that were uniquely African as well. Sarah went to a nice beauty shop that the other missionary ladies go to. She was able to get a neck massage, pedicure, and hot tea along with her hair cut. After this we all walked around and had a driver pick up us. It was a little frustrating because he was waiting for us for about 45 minutes at the wrong location and then had to stop twice to put water in the radiator. To top this off, we splashed thru a mud puddle that got mud on all 3 of us (we laughed about it later). We then ate outdoors at a very good italian restaurant.
When we arrived to the guesthouse, our director from Samaritan Purse, had already arrived. We were meeting there because he was bringing back a child from the SP Children’s Heart Project. This is a ministry that takes children who need heart surgery to the US for their procedure, while putting up the family and covering all expenses. This child was the son of Maasi (one of the local tribes) missionaries who serve in Tanzania. This child was actually diagnosed at Tenwek and we’d been praying for him and here he was with our boss (small world!) We got to meet him and his family, plus catch up with our boss, Scott.
Scott was going to fly out to Tenwek originally, but he took the opportunity to ride back by car with us. We made a few more last minute stops Friday morning, grabbed lunch and hit the road. We made a few more stops this time on the way back to take pics and since we weren’t as rushed. We stopped at the Rift Valley tourist traps, plus looked for Pride Rock that helped inspire “The Lion King” (we think we found it). We did see some giraffes in the distance, but nothing up close.
When we arrived we pretty much hung out with Scott all weekend. Ashley toured him around the hospital and we took hikes and walked around. He stayed over late talking with us, plus networked with the local missionaries about what SP could do here. He had fun with Maggie- they get along great. We appreciated his visit. It is always good to see a familiar face from back home and good for someone to see first hand what you are experiencing. One of the best things was that he brought a big bag of goodies and supplies from home (we still don’t know how they got so many things into one bag!)
Scott left Monday morning and it was back to the same old routine. Mondays are the busiest day of clinic. Ashley saw so many HIV patients that day- old, young, male, female. He is beginning to learn a little more daily on their care. He saw a young girl with HIV covered from head to toe with chickenpox.
The girls had a fun day, which included Maggie playing on the trampoline. She is beginning to learn to count. She does fairly well from 1 to 3. She is doing well with one nap a day and sleeping better at night.
Today was another day. Ashley to clinic and the girls doing their routine. Sarah was able to get an U/S today and we were blessed that the visiting OB doc was there and came in with us. We also received 2 packages today with food, which was fun!
Ashley is learning a little more every day about his roles here and starting understand more and more about what he can do. Sarah is also starting to learn some things that she may be able to begin doing as well.
One note of Kenyan culture, guys grab each others hands here and it is acceptable (walking as friends, in providing direction, etc.) However, you are not allowed to touch your wife in public. It finally happened- the other day one of the clinic workers grabbed Ashley’s hand to take him into a room. It was scary at first, but he survived!

Wednesday, September 5, 2007

"Day by Day"

(Note: This was to be post on 9/3/07

Hello Friends,
It has been about a week since we wrote you last. You have today off for Labor Day, but for us it was an ordinary day. Today marks the 4 week mark for us at Tenwek. Names are starting to become easier to remember and faces easier to recognize. Day to day things are beginning to become a little more routine. However, doing things like smelling garlic in the kitchen reminds us at times of our favorite restaurants back home.
Ashley went for his first real “run” this week. The altitude is still a factor but the scenery is so beautiful.
Maggie has also made some new Kenyan friends who live nearby. The youngest is Angela (about the same age as Maggie). Amaurice is the oldest and she has a twin brother, Alan. They have another brother, Duncan, and sister Allie. Maggie and the kids like to play ball, read books and walk around exploring together. Maggie also began attending a weekly play group with some of the other MKs which she seems to enjoy.
Avacados are bountiful here. There are several trees growing around the compound. Sarah bought 3 huge ones for the equivalent of a few cents each. She says the same ones back home would cost several dollars. Then the next day one of the helpers on the compound brought Sarah several more that he picked out of a tree. This made for some good guacamole.
Yesterday Sarah reached the 10 week mark in her pregnancy. The ultrasonographer here offered to do an ultrasound for us last week. We took him up on the offer and the dates and measurements matched exactly. It is such a blessing to our baby’s little heart beat. Sarah is still battling sickness, but is managing to battle through. On the day she ran out of her nausea medicine one the local doctors found his huge stash of the same drug (although it is from Bangladesh) and gave it to Sarah. Praise the Lord.
Ashley is beginning to settle into the medical thing here, but some things are still difficult. He had 3 unsuccessful codes in one day. However, he did have one successful one yesterday. He also has to make difficult choices such as who gets to be one of the 2 ventilators and who does not. This past weekend Ashley was on call and on Sunday had to round by himself, which took almost 5 hours. However, on an early morning trip to the ICU on the nurses stepped away and sat with another nurse and began singing “Nothing but the blood of Jesus”. This is truly what these patients needed to hear. They said that they did this early every morning.
The locals are very sensitive to changes in the weather. It may be in the low 50s and we will be in a long sleeve shirt while some of the locals are in jackets in ski masks. One of the ICU nurses wears a parka almost every morning!
This past week we received several letters and packages of goodies from back home. This was a true blessing. We are also able to use Skype now, so if you have computer with this, look us up. The only thing is we are having trouble buying more minutes. We also have the Mac up and running wireless online, which is a huge blessing. We are still having some issues withe sending pictures, which we hope to resolve soon.
Ashley is starting to fall into his leadership roles. He actually got to meet with a few of his residents today and set up meeting times to review some educational materials with them. The OB service as struggling as several attendings are gone at once. Ashley had to impromptu help revise the schedule to make sure this service was covered. Also several of the outpatient workers left recently, leaving big gaps in coverage. Ashley will be working in the outpatient sector all month. Fortunately, an ER resident from the states started work today which will help with things in casualty.
Sarah helped one of our workers load about one hundred pounds of wood up onto here head to take home for firewood, which was amazing. We also had to let one of our workers be set to working only 2 instead of 5 days a week, which was difficult to do, but had to be done because there is just not enough work for 2 people here full time right now.
We are thankful for and love our friends and family back home. Pictures coming soon. The internet is slow tonight. Hopefully it will be up and running well before 3AM when the Clemson/FSU game will air here online. We hope you all had a great labor day weekend. God bless.