Thursday, February 26, 2009

Expect the Unexpected

     John was my first patient.  He is 65 years old, five feet tall, and likely under 80 lbs.  He is emaciated, sickly, and dirty. The inside of his mouth was covered with a white film. He has Oral Thrush-often an indicator of HIV+ status.   I told John we needed an HIV test.  Surprisingly, he wanted to know his status, considering the stigma of HIV in Africa. 
     Lillian was my last patient.  Her mouth would not heal properly months after having several teeth removed.  We took a biopsy two weeks previous.
      The nurse returned with John's HIV status report.  What had I done?  I'm a dentist not prepared to counsel John medically, emotionally, spiritually.  The test was negative!  What a joy to give John this good news.  "I want a copy," he said, "to show everyone.  The doctors always told me I had HIV.  Praise the Lord!"
      Lillian's biopsy came back positive for multiple myeloma; a bone marrow disorder that we are unable to treat at Tenwek. Her prognosis is poor.  I shared with her our findings--feeling inadequate and discouraged.  We hope she can get to Nairobi for treatment.  We don't know.  We pray she will find treatment, and comfort in a God who can give her rest.
     Expect the Unexpected my college soccer coach would say. Two agreeable Kenyans, their life changed in a moment.   I get to be a part of God's puzzle.
     Have you figured out the picture?  This is the hand that welcomed me to Tenwek Dental Clinic: Dr. Peter Kuyaya BDS.

Tuesday, February 24, 2009

All I have needed....

"Great is the faithfulness, Oh God, my Father, morning by morning new mercies I see... all I have needed thy hand has provided, great is thy faithfulness Lord God to me." As we work and live here this hymn frequently comes to mind. This past weekend we received our visa renewals, got our groceries, were able to arrange a ride back in 15 minutes after our plans to come back with another family fell through (the family got stuck in Thailand), the girls ate ice cream and swam and we moved into a home with a piano. Some of these things were necessary, some were just fun, and I believe all God provided. It's common to give God credit for the big things, miraculous healing, safety while traveling, healthy children, but I believe God cares about our "smallest" needs as well. For me this is access to a piano, for the girls some ice cream and Malin being able to play racquetball at Tenwek.

Friday, February 20, 2009

Valentine's Day & Immigration

  The girls decorated cookies and passed out valentines.  Lots and lots of pink and red!
    We received good news at Immigration in Nairobi.  On our last day of legal residence in Kenya as a family at 3:00PM our Visa extensions were approved!  We can be in Kenya for another 90 days.  We are indeed happy to be staying here serving God at Tenwek Hospital.

An Atheist sees that Africa needs a Loving God

I wanted to share an e-mail from my sister regarding the need for God in Africa.  It is written from an Atheist perspective.  
   Matthew Parris of the NYT writes,         "I've become convinced of the enormous contribution that Christian evangelism makes in Africa; sharply distinct from the work of secular NGO's, government project and international aid-efforts.  These alone while good, will not do...In Africa Chistianity changes peoples hearts.  It brings a spiritual transformation. The rebirth is real."
     "I used to avoid this truth by applauding  - as you can - the practical work of mission churches in Africa.  It's a pity, I would say, that salvation is part of the package, but Christians working in Africa, do heal the sick, do teach people to read and write; and only the severest kind of secularist could see a mission hospital or school and say the world would be better without it.   I would allow that if faith was needed to motivate missionaries to help, then fine; but what counted was the help, not the faith."
     "But I noticed, The Christian Nationals were always different. Far from having cowed or confied its converts, their faith appeared to have liberated and relaxed them.  There was a liveliness a curiosity, an engagement with the world- a directness in their dealings with others- that seemed to be missing in traditional African life. They stood tall."

Church at Bethesda Chapel

     Bethesda Chapel our place of worship in Kenya is located inside the Tenwek Hospital Compound.  Bethesda Chapel is attended by hospital staff, visitors, and our friends the Kipsigis.  
Sara was immediately added to the worship team.  She plays preludes, hymns, praise music, offeratories...and sometimes wearing Scrubs when she is on call.  I have joined the team as a Conga player.
     The services can be long, so occasionally Meredith joins Mom on the piano to "turn pages."   Amelia has learned to hold a hymnal and find the right page.   The worship music is combined English and Swahilli, but thankfully the sermon is in English.   
      The second picture was taken on December 25th.  This is our Mary holding baby Jesus.  A reminder that the Incarnation is real and relevant to every tribe and nation.

Before & After

This is Paul.  Paul walked into Tenwek Dental clinic back in November my first week in Kenya.  It became clear that dentistry would be a much different in Kenya.
Paul's lip had been growing like this for the past three years.  It was not painful but certainly affecting his self esteem.  We took x-rays (we have no panoramic machine available currently) and diagnosed this lesion as a benign nasopalatine duct cyst.  
      Paul was operated on in January along with the help of an OMFS.  He was indeed happy with his results and proud to pose for this picture two days after his surgery.

Stuck in the Mud

Wednesdays the dental team and eye team drive the Tenwek bus out to rural health dispensaries for outreach.  The dental team provides extractions of diseased teeth and the eye team screens for cataract and glaucoma.
   Last week after a successful trip (we saw over 25 grateful patients) our driver choose a different route back to Tenwek. As you can see the bus got stuck. We pushed,  Leonard (our dental technologist) pulled, we dug out tires, we placed rocks under the wheels--all without luck. 
   We prayed and down the road came a tractor with a chain.  We were back on the road.
      The next day I gave a lecture on Dental Triage--and suggested before we can do outreach to patients, it may be the dental team that needs to be reached out to in the first place. 

Wednesday, February 18, 2009

Off to Nairobi

We're leaving early tomorrow to renew our visas in Nairobi. Tomorrow is actually the last day we're allowed legally in country on our current visa. So we're praying for a smooth trip and ease at immigration. The girls are particularly excited about this trip because we are going with the Crognale family to a pool on Friday for fun. Amelia claims she is ready to learn to swim better and Meredith already dunks herself in the bathtub. Malin and I are just hoping the weather is hot and the water warm. 

Our grocery experience, is well, always an experience. Friday we head to the local version of Walmart "Nakumatt" and buy all the non-refrigerated items. Next we go to Guilliani's to order our meat and have it frozen for our trip back to Tenwek. I imagine it's like a trip to the deli in the early 1940s. Individual service, every cut imaginable. And the most ironic part is that hamburger costs the same per kilo as a steak. It's all part of the same cow. But since meat is expensive we're eating a lot of vegetarian meals, pumpkin soup, quiche, rice and beans, etc. Saturday we buy the odds and ends we need. Sunday it's time to pick-up our meat, and go the green groceries for veggies and fruits. All and all I find it exhausting to think ahead for meals for the next 6-8 weeks. But it does mean that I will be out of pager range and truly able to relax (after we arrive safely from the drive). 

Thursday, February 12, 2009


There are an abundance of avocados in "our" front yard. The girls love collecting them after the boys have climbed up the tree and knocked them down. Amelia brings them to me as gifts. Meredith tries to pry them open with rocks and plays with them. We enjoy avocados. 

Next weekend we head to Nairobi to renew our visas. That means we will have been in Kenya 3 months. We'll also get our 6-8 week supply of groceries.  Amelia and Meredith's 10 favorite things about Kenya, in their own words:
1) "The river and waterfall near our house."
2) "That the trees are easy to climb."
3) "The mangoes are so good here."
4)" Chai in my cup!"
5) "Playing with friends."
6) "Making forts in the bushes."
7) "There are rocks here that are sparkly."
8) "That you can find Chamelions on trees."
9) "Janet and Rose" (our house help)
10) "Going to school with my friends."

Thursday, February 5, 2009

A Memorable 31st Birthday

After being on-call the night before I woke-up to a page. Malin got-up as well and said, "Happy Birthday" and gave me a stone he purchased in Tanzania (any guesses as to the type?). After receiving cards from the girls, I round and then work on knot typing with the new interns. That brought me to lunch. We're sitting down as a family to eat tacos, one of my favorite things Janet makes, I get a phone call,"Daktari there are two emergencies; come to casualty."

Running up the hill again. There in casualty is a 20 year-old pregnant woman brought in for eclampsia coding. I ask how long she's been down, no one knows but they think around 5-10 minutes. Asking for a scalpel and gloves I perform what I hope is a peri-mortem C/S. We stop resuscitating her and begin working on the baby boy. I wish I could say we were successful....I believe the mother actually died prior to beginning our resuscitation efforts as did the baby. We found the family and talked to the husband and brother. The brother says this is the husband's 2nd wife and child to die from eclampsia. After praying we take him to see his wife and son. There are no words to explain the grief.

Remembering there was a second emergency I go to the OR. Dr Hage, a visiting MFM, explains that this woman also coded, but was resuscitated and they have nearly completed the surgery for the ruptured ectopic pregnancy. I ask if there is anything I could do, "She needs blood," replies the anesthetist. She's O-positive and I head to blood bank to see how much they have. Only one unit left, she needs more than that, so I give a unit of my O-positive blood. It's now 4pm, Malin walks me home.

After some chai, I'm feeling well, and prepare for my "surprise party." At least Malin made a tremendous effort to surprise me, but accidentally sent me the e-mail describing the surprise party. We head to the kipiganga for cakes, pies, fellowship and a singing program put on by the girl missionary kids. Amelia sang her heart out to "Doe, a deer..." from the Sound of Music and then led us all in Hookie-Pookie with her friends, Emma, Claire, Elizabeth and Bella. It was a delight.

So, what is most memorable about this birthday? The tragedy of this woman and baby's death and learning this am that the woman who received my blood also died are inescapable, but in the end God has provided Malin, Amelia, Meredith and friends at Tenwek to encourage and support me. Furthermore we have family and friends back home also praying, sending packages and letters to encourage us. So, what stands-out most to me about this birthday is God's love. God's love for me, for our family, for the patients and their families, and my prayer is that you would also know how deeply God loves you.

Happy Birthday Sara!

Sara: Wife, Mother, Doctor, Pianist, Friend, Daughter, Sister-is 31 today. Happy Birthday Sara! We love you!

Monday, February 2, 2009


Amelia, Meredith and her friends, Elizabeth and Bella enjoyed "ballet dancing" this weekend. We are so thankful for the friendships the girls have made here. Today Amelia added to her animal collection a frog. This frog joins the slugs, chameleons, grasshoppers and other creatures we've had living on our porch. I did awake to Amelia screaming one morning, "Jumper got loose!" That meant the grasshopper was hopping around our living room. (If you come visit, we did find Jumper and he's back outside.)

Most of the time I awake to other phone calls, "Daktari the patient is seizing", "Dr.Sara the patient needs a c-section", "We have a patient who is bleeding," "The placenta is stuck," "This patient doesn't look good," "Our patient's status has changed...." And as I get into my scrubs, coat and work shoes..... Amelia knows what this means and often asks, "Are you going to deliver a girl baby?" Meredith knows what this means,"Kisses mommy, kisses. " But often I don't know what I'm going to find and for the 1/4 mile walk up to the hospital I'm anxious. A lecture was given yesterday on how to present patients to the new interns hoping this would help us anticipate better what we are called to. In all honesty though, I think that there will always be times I'm not entirely certain what to do. For example this past weekend a mother came in with 2 wiggly feet presenting for delivery---c/s or vaginal delivery? I had never seen feet kicking at me from this perspective before; (I choose to deliver vaginally and thankfully all went well.) This can be true of parenting and marriage as well. Sometimes we don't know what. And so, we talk to friends, read books, research and most importantly pray.