Happy New Year!

Happy New Year!  It’s New Year’s Eve here in Mutomo, with only a few minutes left of 2013.  It’s been a fantastic year.  My first few months here in Kenya have had many ups and downs.  It’s been a challenge adjusting to work in a new hospital environment where resources are limited and suffering is abundant.  It can be easy to feel down here when things aren’t going right. 

I’ve never been too fond of New Year’s resolutions, but I’ve decided to make one this year…

…to remain happy.  

It may sound a bit corny, but that's my resolution.  When things around me are looking sad, I’ve decided not to let it get me down.  There’s so much to be happy about.  How many people get a chance in life to live in Africa for a year, to meet so many new people, to help others in need, and have so many new experiences?  

To celebrate the New Year, and say goodbye to the old one, here are a few slides I've put together showing some of the friends I’ve made, the places I’ve seen, and the happy times I’ve had so far.  Enjoy…

HAPPY New Year 2014!

A Sad End to a Sad Week

It's been a rough week.  The patients on medical ward seem to be more critical lately.  There is so much suffering, and I sometimes feel so powerless to help anyone.

But this week I am also grateful that my grandmother at home, who underwent surgery and was in critical condition a few days ago, is alive, doing better, and showing a better prognosis.  Before surgery, her breathing was labored and she had to be intubated in the ICU.  While it was difficult not being there with her and the rest of my family, I am so grateful that she lives in a place where people have access to life-saving equipment such as mechanical ventilators.

Today I lost yet another patient, this time to meningitis.  Had we had access to a mechanical ventilator, we might have been able to save his life.  In the late afternoon, the patient’s relative called me to the room to look at his swollen abdomen.  But what worried me when I saw the patient wasn’t his abdomen, but the fact that he was coughing on his own saliva and was barely breathing.  I immediately set up the suction machine (which barely works) and cleared his airway.  I then checked his oxygen level, which was a staggeringly low 45%, possibly the lowest I’ve ever seen.  We are running very low again on oxygen, so I had to remove the oxygen from another patient who was less critical and give it to this man.  By this point he was only taking a breath a few times per minute.

I had already informed the other nurses, but not one of them came to help.  It wasn’t until I asked one of them to bring a replacement suction machine that anyone came, and she didn’t even set it up; just left it next to the bed and took off.  I ran to the phone and called for a clinical officer to come quickly and see the patient.  I knew it was unlikely we could help him, and yet he still had that strong pulse and a stable blood pressure, and if we could just identify the cause of the respiratory depression, just maybe we could reverse it.  Maybe it was a simple metabolic imbalance?  Or a possible reaction to the antibiotics?  The clinical officer arrived, and could offer little help or explanation.  The only possible explanation he could come up with was that the blood sugar might be low.  That seems to be the only explanation that the clinicians can ever think of, but it’s rarely ever the case.  So we checked his blood sugar and it was of course normal.  It was now clear that the patient could no longer breathe on his own, and yet he still had a strong pulse, so we began manual ventilation with the mask and bag.  The clinical officer said we should just stop.  But with the manual ventilation his oxygen was at 95% and his heart was still going strong.  I wanted to at least have an explanation for the respiratory failure before we just gave up.  I asked him to call the physician on duty to come see the patient.  He phoned and said he would come in a few minutes.  

It was more than a few minutes.  For 30 minutes I manually ventilated that man.  Whenever I stopped to check if he was breathing on his own (which he wasn’t), I saw his oxygen levels immediately begin to drop.  What a strange and terrible feeling to know that your hands are the only thing keeping someone alive.  During this half hour, still nobody came to help me.  There were two other nurses in the room, but they didn’t seem at all concerned.  In fact, at one point both of them came over to me: one to remove the BP cuff from my patient to use elsewhere, the other to take the thermometer that I was using.  Neither said anything about the patient dying in front of them.  I was so frustrated.  Doing manual ventilations is extremely exhausting, and I lost a good bit of sweat over that man; I would have really liked a little assistance. 

When the doctor finally showed up, he assessed the patient but said that there was little we could do.  I still wanted an answer.  What would cause a patient to lose his respiratory drive?  He said it was possible that the intracranial pressure had increased as a result of the meningitis and lead to respiratory depression.  I asked if high dose steroids would help, but he explained that it takes a long time to work.  Steroids might have helped prevent this if given earlier on, but not now… would have been nice if one of the doctors had thought of that when he was admitted.  And so we stopped.  I left the oxygen mask on him, hoping to at least ease his suffering in the last minutes of his life.  I instructed the nurse to return the oxygen to the other patient after this man died, and then I went home. 

The patient had a son, about my age, who spent a lot of time over the past few days at his father’s bedside.  He wasn’t there today.  It makes me so sad to know that he will come back to the hospital and have to learn that his father has died.  I spent a bit of time at home after work reading up on meningitis.  Maybe we can identify these problems sooner in the future.

Now that that story is through, I should end on a happier note, so I’ll describe my Christmas in Mutomo…

A couple days before Christmas, the hospital was decorated up and down the main corridor with silk flowers and poinsettias.  Near the front of the corridor just outside the pharmacy was a nativity scene, lit up and decorated with green branches gathered from outside. 

On Christmas Eve there was Mass at church, all done in Kiswahili.  In typical Kenyan fashion, the 7pm service started at 8pm, so I waited a long while.  People afterwards were laughing at me: "You didn't actually show up on time, did you?"  The church was decked with ribbons and banners, and another large nativity scene.  It really was a beautiful sight.  The music was not the familiar Christmas carols we are used to at home, but the lively and festive Kiswahili hymns, accompanied as always by drums, clapping, shouting, and dancing (see the previous blog entry for a video).   During communion the electricity went out, but flashlights were immediately brought out and the celebration continued.

Nicholas, the cook, posing with Pope Francis.

After the service I had a quick cup of tea and some chocolate bars with the sisters at the convent.  They were all exhausted from a long day and went to bed early. The priest was also hosting a gathering at his house next door, and so I joined them.  Everyone visited with each other while enjoying sodas, popcorn, and mandazi (a triangular-shaped fried bread which tastes kind of like a doughnut).  For a little while we watched the midnight Mass with the pope in Rome on TV… this was the only chance I got to hear the Christmas Mass in English.

The Sunday school children performing on Christmas morning.

 The next morning I went to church again, also in Kiswahili.  Afterwards, the children from the Sunday school program put on a performance of singing, dancing, and reciting poetry.  It was all in Kikamba, the local dialect, but still very enjoyable.  

Christmas supper with sisters Mary, Jeniffer, Esther, & Stella.

In the afternoon I had a bit of rest before another dinner with the sisters.  We had a feast of chicken, rice, sukuma wiki, and chapatti bread.  Then one of the sisters pulled out the party crackers.  We have these at home sometimes, but I’ve never enjoyed them so much as I did here.  We popped them open and were rewarded with party hats, toys, and jokes (which weren’t very funny).  The party really started when I took out my camera and started taking photos.  As with most Kenyans, the sisters put on their serious faces for the photos, until I told them they had to do it “the American way” and smile.  They found this amusing and eventually got really into it.  “Take my photo, take my photo!” they kept asking as they arranged all their props and put on their party hats for a pose.   I then set up the camera on a tripod and put it on self-timer for a group shot.  This impressed them all very much.

The next day, Anastasia (my housekeeper/cook) brought over a chicken as a Christmas gift.  She raises chickens at home and tells me she has about 50 of them!  The bird was alive when she arrived.  It was funny to walk into my kitchen and see it sitting there with its legs tied up.  I watched with fascination as she took it outside, killed it, and then brought it back inside to put in boiling water for defeathering.  As I looked at the carcass sitting there leaking juices next to my kitchen sink, all I could think of during this process was that I needed to boil water to sterilize my countertops after she left.  Despite my concerns of sanitation, the chicken was delicious (cooked in a stew) and I was very grateful for the gift.  I don’t know which I enjoyed more: eating it or watching it being prepared.  As fascinating as it was to watch, I don’t think I’d enjoy killing my own chickens; I’ll stick with the pre-killed and defeathered birds from the supermarket.

Anastasia with the bird... as with all Kenyans, neither of them is smiling.

Being defeathered in my sink!

The final product.

Merry Christmas!

Merry Christmas!

Coming to Africa was a frightening experience for me.  How terrifying to leave behind the comfort, safety, and security of home.  On Christmas day we will celebrate the birth of Jesus Christ.  How much more terrifying was it for him, the God of Heaven and Earth, to be become a weak human being, to place himself among us and be born into our violent and troubled world? 

Every year we send out Christmas cards with beautiful depictions of the Nativity scene.  While they paint a nice picture, they are certainly romanticized... would any of us really want to put our newborn infant to sleep in a dirty animal feeding trough?  I can’t help but imagine Bethlehem 2,000 years ago being somewhat similar to Mutomo.  It was certainly not the center of the modern world, but rather a small town in an obscure corner of the world.  It was probably dirty and smelled like animals.  The people were probably poor and uneducated.  And yet the son of God chose to be born here in this humble setting.  In all the trials, sorrows, sufferings, and pains that are part of being human, we can know that he also shared in them.  What a wonderful show of solidarity. 

Jesus is often called Emmanuel, which means God is with us.  And so despite the temptation I may have to feel sad at being away from home this season, despite the temptation to sometimes feel hopelessness in the dire conditions here, I am still filled with great joy this Christmas season, for God is with us.  No matter where in the world we are, God is with us all, and that gives me hope.

Okay, enough philosophizing for one night.

I’ve just recently finished reading Charles Dickens’ A Christmas Carol, a tradition I’ve kept the last several years.  And so I’ll finish by quoting Tiny Tim’s famous closing line: “God bless Us, Every One!”

Donkeys are more violent than I realized.  We had a patient last week admitted with a fracture of the right humerus and a wound to the left leg after being attacked by her donkey… did Mary and Joseph have to deal with such things on the way to Bethlehem?

Here's a video of Christmas Eve Mass... which was all in Kiswahili.

Two Months in Kenya!

Yesterday, December 14^th, marks two months in Kenya!

Stress Free

This week in Mutomo we had the hospital staff Christmas party.  It was held just down the road at Stress Free resort, the local bar/restaurant hangout.  We enjoyed a delicious meal of goat, rice, and chapatti bread.  At every gathering I’ve attended here so far, I noticed that the Kenyans are very fond of giving speeches.  They always call on people from the crowd to “say something to us.”  I’m not really sure what they expect someone to say.  The speakers usually say a whole lot, without really saying anything.  We had quite a few speakers at the staff party, and I was asked to speak as well.  So I got up for a minute and said a whole lot, without really saying anything.  The party ended with dancing.  The Africans seem born to dance, possessing a natural body rhythm whenever the music starts.  Now even in the U.S. I’m a terrible dancer.  But if you see me dancing alongside the Kenyans, I look even worse.  Here’s some video from the party (I won’t be posting any videos of me dancing though). 

Theme was "African Dress."  Here's the competition for best dressed.

Also this week was Jamhuri Day, the Dec. 12^th celebration of Kenyan independence.  This year was especially important because it marked Kenya’s 50^th birthday.  Everywhere you walked in the hospital or in town that day, people had their televisions on, showing the festivities around the nation.  The event was marked in Mutomo, but on a small scale.  Near the local government buildings, a platform was erected and the local dignitaries gave speeches and people danced and sang.  I attended with Dr. Layla, but it was all in Kiswahili, so we didn't stay for too long.

Jamhuri Day celebration

The front page on Jamhuri Day.

I've finally got the runs... no, not that kind!  The good kind!  At home I used to go running almost every day.  When I first arrived in Mutomo two months ago, the weather was too warm to run and I didn’t yet know my way around town.  Last month it was too rainy to run.  Today, for the very first time in Kenya, I finally went running.  It’s amazing what two months of inactivity will do.  It felt so great to exercise again, but after 30 minutes my legs felt like bags of cement.  I did several loops along the main road and up and down the airstrip.  Usually whenever I walk down the street, I always attract stares, being the only mzungu.  But when I went running, I think I drew every set of eyes in town.  Some stared with curiosity, many others just laughed and waved.  People here don’t run, and I’m sure they thought I was insane… “Crazy mzungu!  Running in circles, going nowhere.”  I know I’ll be suffering the soreness in my legs for a few days.  When I got home I took a long nap (after my bucket bath).  In America, when we think of Kenya, we often think of the world class marathon runners.  But I haven’t seen a single person run since arriving in Mutomo.   

This afternoon I went for a walk and ran into a coworker along the way.  We walked and talked for quite a bit.  On the way back I was laughing at how slowly people in Mutomo walk.  Even as the sun is setting and people are heading home from work to cook, they still walk at an unbelievably slow pace.  “Your runners all run fast,” I laughed, “but everyone walks so slow.”  

The snake after maintenance had killed it.

I’ve spoken several times of my petrifying fear of snakes.  Last week I had a horrible nightmare that there were snakes outside my house which moved with incredible speed, and they were attacking me!  Thank goodness it was only a dream… almost.  That very same day, I was walking home and saw my neighbor standing outside her house, looking worried.  She reported that a snake had entered her bathroom through a hold in the window and then gone into her kitchen pantry!  The maintenance staff was called to kill it.  I later spoke with maintenance and pleaded with them to fix my windows (which don’t shut on account of rusty hinges).  They came yesterday and sealed up the windows.  No snakes in my house!!  Another concern with regard to snakes is the tall grass.  The grass here grows at an incredible rate during the rains.  The paths to the houses are usually clear, but the grass was starting to encroach.  I was starting to take alternate routes to avoid the grass.  To my great joy, the maintenance workers came a few days ago and cleared all the grass away with their pangas (kind of like machetes).

Preparing for dinner. I really miss dishwashers.

My Scandinavian neighbors left this past Friday.  I cooked one last big meal for them a few days before they left.  They’ve been wonderful company these past six weeks.  I am sad to see them go… happy to have known them.  On medical ward, it was certainly nice to have a couple extra doctors around.  Now we’re back to our usual shortage.

Kenya is suffering a doctors’ union strike right now.  They say the strike not only includes the doctors, but also the nurses and clinical officers.  It’s been a big headline lately, with government hospitals completely abandoned, and people are undoubtedly dying all over the country for lack of treatment.  Luckily the strike hasn’t affected Mutomo too much.  We have one doctor who was planning to go on strike, but apparently he has a contract with the hospital and was told he is not allowed to strike… thank God!  But the strike still affects us indirectly.  There are many treatments and diagnostic tests for which Mutomo isn’t equipped.  In these cases we usually refer patients to other hospitals for testing or treatment, and then have them return.  But since nobody is working at the usual referral hospitals, we are forced to keep the patients here and watch them go untreated. 

Dr. Layla and Daniel, one of our best clinical officers.

My favorite piece of charting so far. After questioning of of the patient with no clear answer, Dr. Layla made this note in the chart.

Working with nurse Winnie and Dr. Layla.

This past week we had a patient who was reportedly vomiting blood.  At one point during the day, one of the relatives of another patient rushed to the nurses’ station and signaled for me to come quickly.  I rushed into the ward to find the man spouting blood from his mouth like a geyser all over the bed.  Never in my life have I seen anyone vomit so much blood!  While the other patients and relatives in the room were turning him onto his side to prevent aspiration, I raced out to get the suction machine to clear his airway.  He was very unstable for a while, but after a few hours of oxygen, IV fluids, and beginning blood transfusion, his mental status returned and his vital signs stabilized.  We checked his hemoglobin afterwards at it was an extremely low 2.3!  This patient desperately needs to be referred to another hospital for endoscopy, but again, the strike has drained the neighboring hospitals of healthcare staff.

Our wheelchairs have flat tires, but they still work.

Doctors Layla and Terje.

Nurses Beatrice, Evans, and Angela with Dr. Terje.

Medical ward saw many patients pass away this week.  Four died, three of them as a result of sepsis (an infection in the bloodstream).  It’s been very frustrating for me to see so many patients die of infections which are so quickly diagnosed and treated at home.  In Mutomo, patients often delay for a while before coming to the hospital for treatment.  This delay, compounded with the staff’s slow diagnosis and treatment of sepsis, don’t make for a very good prognosis.  By the time we notice something is wrong, it’s often too late.  I'm hoping to help the staff improve our recognition of symptoms of sepsis.

We’ve also suffered a shortage of necessary supplies.  Last week we ran out of oxygen.  In the U.S. we conveniently flip a switch on the wall and out comes as much oxygen as desired.  Here we have large metal cylinders which are filled with oxygen from a supplier in another city.  Unfortunately, oxygen shortage is a nationwide problem, and the cylinders can’t be refilled right now.  We have a limited supply of oxygen concentrator machines that can deliver oxygen to the patients, but the oxygen concentration they deliver isn’t so great (I’m told around 50-60%), and at least one of our machines has broken.  So if we have more than two or three patients at once who need oxygen, we’re in trouble.

Besides oxygen, the hospital has depleted it’s blood supply.  We have only a couple bags left of O+ blood which are being saved for extreme emergencies.  That patient who was vomiting blood was to receive four units of blood for transfusion; he only received two.  Because of the long weekend for the Jamhuri holiday, we weren’t able to get a new supply of blood all last week.  Hopefully in the next couple days we’ll be receiving a new supply.

Sharing a soda with James, our nurse anesthetist.

My Kiswahili notes for the hospital.

 I’m desperately trying to improve my Kiswahili.  Terje, the surgeon from Norway, left me with another book and an audio CD course on Kiswahili.  I spent several hours yesterday working on the language.  I’ve put together a quick reference sheet with terminology for the hospital.  I can’t make very many complete sentences yet, and I’m still learning to conjugate my verbs, but with a few words and a bit of charades, I can usually convey simple ideas to patients.  I'm starting to recognize more and more words when I hear the locals around me speaking.

Found these two love bugs "cuddling" on my front porch.

Look who I found!

Please pray for the patients both at Mutomo, and in hospitals throughout Kenya.

Tis the Season

Thanksgiving is over… now onward to Christmas.  There is no Black Friday in Mutomo.  There isn't the huge stress of preparing for the holidays that so many people suffer at home.  In fact, people do very little here for Christmas.  I’m told that if you live in Nairobi, there is more celebrating for Christmas.  But here, people go to church and have a meal together.  No exchanging of gifts.  No Christmas trees. 

My stocking ready for Santa. Unfortunately I'll probably just find bugs in it.

I’ve begun my own small traditions of celebrating.  I've been listening to Christmas every day.  This year, songs like I’m Dreaming of a White Christmas and I’ll be home for Christmas take on a different meaning.  I’m very grateful that Anita was able to find an electric keyboard for me.  Now I can continue playing Christmas carols (when the electricity is working).  Despite the absence of Christmas trees and other decorations, I’ve managed to add a little Christmas cheer to the house.  It’s amazing what you can do with a bit of blank paper, and box of low-quality crayons, a pair of scissors, and a roll of tape (I had to search a few different stores to find a place that sold tape).  I now have makeshift versions of a Christmas tree, Santa Clause, and a Nativity scene on my wall.  I passed the afternoon on my day off today cutting out snowflakes.  I didn’t think such simple things like music and homemade decorations could make me so happy, but they really make me feel more at home for the holidays.

Mutomo Catholic Church, all dressed up in purple for Advent.

Excited for mail!

I’ve recently received two packages from my parents.  The last package cost me $66 in customs fees!  Despite the cost, it’s nice having items from home.  I get so excited as I open my mail, relishing the experience of discovering each new item… I feel like Tom Hanks in Castaway carefully opening his FedEx packages (only without the volleyball).  Included in this latest package were a variety of food items, a Christmas stocking, a strand of Christmas lights (for when I have electricity), and two CDs of Christmas music.

On my walk with Sr. Jennifer

On the days I have off from work, I really enjoy getting out of the hospital and going for walks if I can find someone to go with.  Last week I had an outing with Sr. Jennifer (a school teacher who lives in the convent next to the hospital) to a nearby dam which was recently built by World Vision.  Like many Kenyans, her lifestyle is so relaxed and unhurried.  She invited me to meet her at the convent for our walk, but not before we had sat and had tea for half an hour.  We then proceeded to the dam at a pace no faster than a stroll.  Once we arrived, I snapped a few photos and thought we were to leave soon.  We ended up sitting and chatting for a couple hours, enjoying the biscuits and bottles of soda that she brought along.  Whenever I asked if we still had time, she would reply, “The day is ours.”  I’m learning to appreciate the simplicity of life here.  People are rarely rushed.  They are content to sit outside or go for walks, enjoying one another's company.  It was a great day, aside from the terrible sunburn I got.

Sr. Jennifer, stopping for a rest and a snack on our outing.

My house viewed from above Mutomo

Today I had another great walk with two neighbors.  Mutomo is bordered to the northeast by large, rocky hills.  We went up to the top of one of the hills for a spectacular view of the town.  I could see everything from the top, including the hospital, and my tiny house.  The experience of walking uphill made me realize that I’ve become slightly out of shape these past two months.  At home I went running almost every day.  Most days in Mutomo, the farthest I walk is two minutes to get from my house to work; otherwise I sit around the house in the evenings, eating starchy, salty foods with little fiber.  I’ve identified a few good places to run.  If I ever manage to have a day off when it’s not raining, hopefully I can start to exercise.

Trying for a photo with the goat, but he wouldn't look at the camera.

Spaghetti dinner!

Thanksgiving was the first big meal I’ve cooked since arriving in Mutomo.  The experience was a bit of a confidence booster, and I decided to cook for my neighbors again this past week.  But what to cook?  The options in the market are limited and unvaried.  So I did what all Americans do when they don’t know what else to cook… I made spaghetti.  It actually came out very good, along with a homemade tomato sauce, eggplant parmesan, and chicken with rosemary (from Nairobi).  It’s nice to be able to cook my meals every now and then, though it’s a challenge in such a small kitchen, especially when the power goes off, and the cleanup is very tedious.

My two neighbors; they were comparing themselves to the Muppets...

...see the resemblance?

Proof that I actually work.

 So far it probably sounds like I only go for walks and eat a lot.  But I do actually work.  Yesterday we had one of the busiest days yet.  In the morning we had two admissions.  One of them was a woman who reportedly had some sort of domestic dispute with her husband and then poisoned herself.  After we had her stabilized and started her treatment, I went for lunch break.  When I returned, Winnie (a new nurse at the hospital) said, “Thank God you’re back!  We have three new admissions!”  We quickly set about assessing and treating them all.  In the midst of all this chaos, we had still another admission: the husband of the woman who had poisoned herself!  Turns out that "domestic dispute" was a case of domestic violence… the woman had stabbed her husband in the abdomen with a sword!  He came directly from the operating theater after a laparotomy.  Layla, the surgical resident, reported that he had lost one liter of blood.  He’s doing well today.  His hemoglobin and vital signs are stable, and his pain is well-controlled.

Posing with Tabitha the day before she was discharged.

With Beatrice on her last day on medical ward.

Sadly Beatrice, my favorite nurse to work with, is leaving medical ward.  She normally works in the nursery and was filling in on medical temporarily for another nurse on leave.  It was really a breath of fresh air to work with someone with such a passion for patient care.  I’ll be working with her again when I rotate to nursery in a few months.  Hopefully the quality of care can continue even when she leaves.  Winnie shows a lot of promise as a new nurse.  She asks lots of questions, genuinely cares for the patients, shows the ability to critically think, and is hard working, always willing to step up when something needs to be done.  The unit has been short staffed recently, and we’ve had to pull nurses from other units to assist.  On several occasions lately I’ve been the veteran nurse on duty.  Oftentimes the nurses will ask me questions, and I get to explain a procedure, a lab result, a treatment, etc.  I enjoy the opportunity to teach, and I am still learning from the staff here.  It’s nice to be able to collaborate.