Happy Thanksgiving!

Angela in her shamba.

 The Kenyans are very excited about the rain.  Many people here plant their own shambas at home (literally, shamba means field or farm, but for most here it's a garden).  For some it’s a hobby, but for others it offsets the cost of paying for food.  With the rains beginning, the people of Mutomo are looking forward to a better harvest.  Angela, one of the nurses on medical ward (who I really enjoy working with) has a large shamba on the hospital grounds.  She recently gave me a tour, showing me all the tomato, papaya, sukuma wiki, and mango plants she has.  I can tell she’s very proud of her crop.  She can be found every week on market day selling her produce in town.

Angela's greenhouse, growing tomatoes.

I’ve gotten used to the routine at the hospital now.  Some days are very good and I actually look forward to going to work.  Other days I can’t wait to get home.  A lot of it has to do with which nurses are working that day.  I’ve been struggling with a few nurses who simply seem indifferent to the wellbeing of their patients, and for me that is infuriating.  But other nurses I love working with.  For the past couple weeks we’ve had a nurse from the nursery named Beatrice working on the medical ward.  She’s fantastic.  You can tell she really cares for her patients.  She works quick, responds immediately to the patients’ needs, and is very helpful to me when I have a question.  And she’s always willing to translate into Kikamba or Kiswahili when I want to ask a patient a question.  She’s been a wonderful mentor to me the last couple weeks.  Today we have a new nurse starting on the ward.  I spent a couple hours training her, showing her the regular routine of the ward.  Hopefully I can help instill some good practices in her while she’s still fresh out of school. 

We’ve had quite a few deaths on the ward recently.  Yesterday a woman suddenly stopped breathing.  One of the Swedish doctors was on the ward at the time, and I told her to come see the patient.  She began doing chest compressions, but after a minute we decided it was pointless since there is no way to defibrillate the heart, and there really aren’t any cardioactive meds we can give to restart the heart.  They have epinephrine available, but it isn’t normally used for resuscitation, and I don’t think most people here would know what to do with it anyway.  I spoke with Dr. Amolo, the veteran doctor at the hospital, and asked if patients are ever resuscitated.  He explained that they sometimes do it with children, but it’s rare with adults; they are usually so sick that even if they could resuscitate them they would probably only live for a few minutes before going into arrest again.  I think I’d still like to have a defibrillator anyhow. 

I’ve enjoyed working with Dr. Amolo so far.  We had a talk the other night about the government hospitals in Kenya.  Corruption in these facilities runs rampant, and patients are often treated only if they pay a bribe to the doctors and nurses.  I can tell he’s very frustrated with his experiences in the health system in Kenya.  He works hard to care for his patients, often working long hours.  I’m grateful that such corruption isn’t a problem at Mutomo Hospital.

Another patient was recently admitted with a diagnosis of congestive heart failure.  For almost a week he lied in bed being treated for all sorts of conditions, some of which he didn’t have.  I took a look at his lab results and could see that his problems were clearly a result of renal failure.  For you readers with a medical background, you’ll appreciate the severity of his lab values: creatinine=12.7, potassium=7.5, and sodium=113.   We weren’t doing anything to treat this (the hospital doesn’t have dialysis capability).  In fact, some of his medications were actually toxic to the kidney, making the situation even worse.  I was able to have a talk with the doctor, and we eventually arranged to have him transferred to another hospital for further treatment.  The treatment he really needs is available in Nairobi, but the cost of both treatment and transport there pretty much make it an impossibility.  At the very least, we’ve saved him the unnecessary expense of remaining hospitalized in Mutomo.  Still, it’s sad to know that we can’t do anything for him, and he probably won’t be treated simply because of money.

Not all of our cases are so dismal.  I’ve been working with an elderly patient who recently had a laparotomy.  For days she was sitting in bed because nobody took the time to exercise her.  I finally managed to find a walker buried in a pile of old equipment, and have been walking with her regularly.  The first day we just took a few steps around the room and built up her confidence.  I tried my hand at Kiswahili, using the words for “to walk” and “help” to convey that I would help her walk.  The relative understood my poor Kiswahili and translated into Kikamba for the patient.  Each day we went a little farther, and now I see her walking around outside without even using the walker.  Nice to see at least one patient making progress.  I can’t speak with her, but her face lights up with a big smile when I come walk her, and I’ve enjoyed working with her.  She’ll be discharged home tomorrow.

A couple days ago, I was shocked to discover that all the bottles which the patients use for drinking water were filled with mold on the inside, green as grass!  I asked the ward assistant who was supposed to clean them, and they said they are cleaned by the kitchen staff daily.  Turns out they were only cleaning the outsides!  I spoke with another nurse about it, who took it the administrator’s assistant and arranged with the kitchen to clean all the bottles daily… on the outside and the inside.  I’ve been checking the bottles every day since, and so far so good.

Thanksgiving is here!  Last night I celebrated an early Thanksgiving dinner with my neighbors.  Anita, who was kind enough to pick up a turkey and a pumpkin in Nairobi, is leaving town this week, so I wanted to have the meal before she left. 

I poured a lot of sweat into making that meal… literally.  With the oppressive heat, cooking is no easy task, and I was dripping sweat for two intense hours while I cooked.  The menu: turkey seasoned with rosemary, mashed potatoes (I bought my from Angela in the market), stuffing made with sukuma wiki (a Mutomo staple), cranberries, and a pumpkin pie made from scratch.  Some items were very cheap.  Others were surprisingly expensive.

2 turkey breasts and a drumstick: 3113 kshs ($36)

1 pumpkin: 129 kshs ($1.50)

1 can cranberries imported from America: 3800 kshs ($44!)

2 kilograms potatoes: 80 kshs ($0.94)

1 tub of “fat spread” (margarine): 280 kshs ($3.30)

Keeping an American tradition alive in Africa: priceless

This huge mess...

I’ve never made a pumpkin pie before, and certainly not one from scratch.  Canned pumpkin wasn’t to be found in Nairobi, so I spent several hours the night before the meal washing, cutting, scraping, steaming, and pureeing a whole pumpkin!  The very next day a care package arrived from my parents at home which contained, among other things, a large can of pureed pumpkin!  So now I can say I’ve had the experience of making a pie from an actual pumpkin, but I’ll probably never try it again.  I’ll stick with the canned stuff.

...just to make this.

I had a lot of help from my neighbors.  Anita made the pie crust.  Dr. Layla was busy with me in my kitchen, peeling potatoes, making gravy, etc.  The Swedish doctors were kind to host the event at their house, since they have a large patio with a full dining set.  I was surprised how well the meal turned out.  The turkey was moist, the stuffing flavorful, the potatoes creamy buttery (thanks to spoonfuls of “fat spread”), and it was nice to enjoy a pie in a place where desserts are not too common.  Today I get to enjoy another Thanksgiving favorite: leftovers!

 This year is a very special Thanksgiving.  Being out of the country and away from all the things I take for granted is difficult, but it gives me a new perspective of all that I’ve been blessed with.   

All of us at home really won the birth lottery when we were born in the U.S.  We don’t have to worry about going hungry (in fact most of us are overfed), while malnourishment is a big problem here.  We  have excellent healthcare at home, and even those who can’t pay their bills are still provided care.  Here, people have to pay part of their bill upfront before receiving care, and they are not released from the hospital until they can pay for the rest.  As I mentioned earlier, diseases can go untreated if a patient can’t afford to pay.  In the U.S. we go to sleep every night in houses that are warm and secure.  In Mutomo, many people live in brick houses (they make their own bricks) with dirt floors and a metal roof if you can afford it; otherwise it’s grass roofing… and the houses aren’t snake-proof (we’ve had 3 snakebite patients this week!).

Enjoying turkey with the neighbors.

 I may be living among the poor and seeing their way of life, but I’m living in relative comfort here.  I’ll never know what it means to be truly poor.  And so this Thanksgiving, I am especially grateful for the privilege of being an American, to know that I have a good home waiting for me when I return.  I’m grateful for my health, my education, a full stomach, clean drinking water, and a warm bed at night.  And though you are thousands of miles away, I’m grateful that I have family and friends to share in life’s journey… and this year I am also blessed with new friends in Africa.

Sorry for all the food pictures, but I have to show off my work.

Anita holding the homemade pie!

 For all of life’s blessings, “Asante sana!” 

(Thank you very much)

Happy Thanksgiving!