Monday, March 30, 2009

The Tenwek Motto

Almost every visitor takes a photo with this sign that greets patients, physicians and families at Tenwek. But there are some hard questions that come in believing, "We Treat. Jesus Heals."

How does this motto play out? Do I really believe Jesus heals? Why are there times Jesus doesn't heal? How should we distribute limited resources for healing? Why do patients have to pay up front for most treatment? Should we ever turn anyone away? 

Learning to treat difficult and complex problems, I need to remember to ask Jesus for help and healing. It's a joy to be at a hospital where we openly pray with patients. In fact it's the first thing we do before starting any operation.  As I witness babies  revived from asystole, mothers' saved from hypovolumic shock, antiretroviral therapy strengthen HIV patients,  women recover from sepsis, I know Jesus is healing. 

Sunday, March 29, 2009


This sadly is the last full day with Grammie. We've had a wonderful time and the girls enjoyed all the reading, game playing and coloring. Malin and I often feel that the most challenging part of being here is being so far away from family and friends. 
Meredith's stomach
 has refused to contain food the past couple days. When Amelia found out the next morning that Meredith had been vomiting she commented, "Mommy, I'm very sad Meredith is sick, but I think she's awfully lucky to get to stay up with you." 

This is also the last school week as teacher Sarah returns home. This will be an adjustment as Amelia really enjoyed school and it gave her a pattern to her days. We hope to continue math and reading until she starts at Rift Valley Academy in September. 
In light of the above please join us in praying for:
1)A safe trip home for Grammie and safe travel for my parents and sister Ana as they come in 12 days.
2) Healing for Meredith.
3) Patience for Malin and I as we resume homeschooling and diligence for Amelia.

Wednesday, March 25, 2009


We have begun swahili lessons this week. Malin had already learned "open" and "close." I had learned key phrases like, "Are you bleeding? Is the baby moving?" "Are you contracting?" None, of these were very useful for everyday conversation, so we're looking forward to learning more. 

The girls had a tea party with Grammie today and we traveled to an orphanage nearby for a brief visit.  Our kids played with some of the 36 children that live there. As Amelia complained tonight that I had not put enough sugar on her cereal (yes, I let her have cereal for dinner sometimes because our "big" meal is now lunch) I reminded her that today she saw children without food, and parents to help prepare their food. I hope one lesson Amelia and Meredith gain while living here, is that they are blessed and that should result in a grateful heart. 

Saturday, March 21, 2009

Mara Visit

We traveled to the Mara this weekend to see the animals. Living just about 40km from it we couldn't wait to see some of the wildlife. The roads leading there take over 2 hours to travel, so when we arrived Malin jumped for joy. 
The girls enjoyed driving around and seeing animals as much as we did. Amelia was most impressed by the giraffes and Meredith by the elephants. I thought one of the most impressive sites was this sunset. The vastness of the Mara was truly stunning. We often sing in church an old hymn entitled "There's a Wideness in God's Mercy" this picture reminds me of that truth.
We look forward to spending one more week with Grammie. And are also excited to see my parents and sister Ana come early May. 

Massai Grammie

Tuesday, March 17, 2009

On being a Middle Child

     In Kenya being a first born son brings about rights.  The first born son inherits the land from his parents after they have passed.  Land is Kenya even for professionals is very important and carries with it high esteem.   If a man has very little land and asks for a daughters hand in marriage he may be declined.
      Today I was able to give my mother a tour of Tenwek Hospital. We were first asked by Lillian in Dental, "Is he your first born?"  
     "No," Madelle replied.  "He is my third."
      Then Gladys in Community Health spoke, "It's so nice to meet you.  Is Malin your first born son?"
     "No, he is my third of four." Madelle answered.
      Then we found Lena in Supplies, she asked, "Would he be your first born son?"  
     Madelle sincerely said, "No, Malin is not my first child."
    This same question about birth order was asked 6 times as we walked the grounds of Tenwek.  We were amused and charmed.   But this was clearly significant in their eyes.  Each response of "No Malin is not my first born," was followed by silence.
      We chuckled together as we contemplated the humorous cultural differences here in Kenya. Birth order matters, and to Darin my older brother you are highly esteemed and respected here in Kenya!

6 losses

How does a mom cope with losing 5 babies? Yesterday I delivered a baby with fetal hydrops secondary to Rh isoimmunization (dad's a positive blood type, mom is a negative blood type).In the States, we give Rhogam to prevent this from happening.  After the charge nurse spent her morning calling for a blood donor for the baby and getting the blood ready for immediate exchange transfusion and resuscitation, arranging for the pediatrician to be at delivery and he making sure all resuscitation equipment was available, I started the c/s. The little girl came out with a weak cry, completely pale. She lived 90 minutes. Mercy has now lost 6 babies from the same preventable problem. Please pray for her. The sadness pours from her face and the grief unbelievable and unfair. But even in this, her faith is sincere and strong, that God loves her.

Friday, March 13, 2009

Grammie Arrived Safely

Grammie (Mom/Madelle) arrived safely in Kenya yesterday evening. The major road to the airport was closed to resurfacing project so our driver had to go against traffic on a major freeway to make it to the airport just minutes before her moving through customs. All her luggage arrived--with only a few questions regarding why she had dental supplies.
Grammie seemed to travel very well, just "very thirsty." Thanks for your prayers. Amelia and Meredith are thrilled to have Grammie in Kenya. We will leave for Tenwek tomorrow morning.

Thursday, March 12, 2009

72 hours

Tenwek is a referral hospital. The patients referred often come by their own transport without a letter explaining the problem and without a qualified person to transport them. Last night I was called for a referral from a nearby hospital for CPD. Basically the referring hospital thought the pelvis was too small for the size of the baby. What lead them to this conclusion? The patient had been at their hospital 72 hours laboring without progress completely dilated. The patient arrived and the baby still had a heartbeat. We rushed to emergency C/S. When I tried to get my hand in to get the baby out and I realized there was no space for my hand and the head I was worried. The next 10 minutes were some of the most exhausting of my career. Thankfully a surgical resident came in to also help retract the head as I pushed from below and the baby boy delivered. After chest compressions, intubation, epinephrine the boy began to weakly breath and the heart rate improved.  

I didn't sleep well the rest of the night. How could a "hospital" allow a patient to labor this long before intervening? How will we convince mothers 
to come to the hospital for delivery if this is the care they receive? (60% deliver at home.) What else could I do when a baby is stuck? Does this mother understand this is not her fault? Who should be blamed?

I went to see him this morning, his face looked bruised, but he was breathing without assistance and pink. Thankfully he had not seized and seems to be neurologically intact. I believe it is only by God's grace this baby is alive.

Tuesday, March 10, 2009

Grass Skirts

     Many worried (myself included) how our  princesses would adapt to life in Africa.  We are pleased with their flexibility! As you can see Amelia designed flowing green grass skirts for herself and her sister.
      Meredith and Amelia (better known as Sister) keep busy playing, cleaning, and designing the various rooms of their fort with mud-pies, sticks, and whatever they can find.
     Meredith rarely stops talking.  She says phrases like allowed, dinner ready, and her favorite I do it, I do it.  Meredith would proudly show you how she goes all the way under the water in the tub.  She likes to sing a Swahilli Praise song, "Mambo Sawa Sawa"  which translates into In God things are getting better.  
    Amelia is learning addition at school, African Geography, and her site words (and, the, is, etc.)   She is proud to know how to count by twos, fives, tens, and threes.   

A Pain in the....

Where was this arrow located? Culture shock hits everyone eventually and those things that at first seemed endearing, unique, "challenging," about the culture turn into true aggravations and frustrations that in colloquial terms are a "pain in the ....." (and that truly was where this arrow landed over a cow dispute). 

For example, I needed a  STAT lab yesterday. The lab was drawn at 830am and when we went to look for the results at 1030am we found the entire lab taking chai with our lab sitting undone. Now, at first I might have respected the chai break that occurs everyday, but yesterday I just couldn't. In my mind they had already had over 2 hours to run the 3 minute lab test and until that was done there should be no chai. So I asked who was running the INR tests and then asked that person to run the test now. He initially just looked at me and kept sipping his chai, but after standing there, staring at him a good minute he got up and ran the test. 

Chai breaks everyday at around 1030 for a half hour. The socialization and warm drink are enjoyable, but problematic in a hospital. What happens when there is a 1030am emergency c/s and no one wants to leave their tea to set-up the case? What happens when you are in the middle of an operation and the circulating nurse leaves for chai? How do you handle x-ray, lab, ultrasound and out-patient essentially shutting down every morning for tea?

I am trying to figure these things out, along with the many other missionaries before me. So, I try to speak calmly and firmly, and interrupt chai time only when I believe it is truly urgent and can't wait 1/2 hour. And pray that God gives me wisdom to learn from the things I don't understand.

Saturday, March 7, 2009

A Bag of Beans

Living in Africa with small children presents daily tangible opportunities to help Amelia & Meredith learn the joys and sometimes challenges of being generous.  
     In January of 2008 Kenya had a presidential election.  The results of the election were disputed by the country.  Consequently political chaos occurred, tribes fought other tribes, people were displaced, and crops were damaged.  Now one year later we are seeing the sad consequences of the election in combination with a drought..people are hungry.  
      When churches collect offering in this area of Kenya the plate fills with not just coins and paper money but also potatoes, maize, or a liter of milk.   These goods go to the needy people in the area.  What first seemed confusing to Amelia--now is straightforward.  People at church give food to those in need.  
      Last Sunday as many parents do at church, I gave Amelia and Meredith Kenyan coins to place in the offering.  Meredith dropped her two coins in the plate.  Amelia with cupped hand struggled to drop all three coins in the plate, (to put it diplomatically).   Amelia is not alone.  
        Is says in Deuteronomy, "If there is a poor man among your brothers in any of the lands... do not be hardhearted or tightfisted toward your poor brother.  Rather be openhanded and freely lend him whatever he needs."
       For myself generosity is unnatural, difficult, and sometimes regretful.  Isn't it money we have earned?  Should not he or she get a job.  Now is not the time for generosity with the state of the economy. 
     The very next week, Amelia came running to us with a smile or her face, "Mom, Dad there is a boy next door.  He can't speak or hear and he is hungry and has nothing to eat.  Can I give him the bag of beans we have for the hungry?"   Yes indeed Amelia.  Please give!  


The Wards

      Tenwek hospital divides the inpatients into several wards including orthopedics, male surgical, female surgical, maternity, male medical, female medical, pediatrics, nursery, and a small ICU.  Each ward is one open room with about 20 beds. It has open windows thankfully for fresh air.  Afternoons for the ambulatory patients usually involves walking outside to 'bask' in the sun or attending a chapel service.
     Having that many sick patients all together becomes logistically difficult with privacy, finding charts, and preventing spread of contagious disease.  Active TB and pneumonia are common with so much immunsurpression.  Yet it also brings a community feel to being sick, hurting, and hopefully we pray healing together and going back home. Occasionally when I have an inpatient the patient in bed 9 always know where to find patient in bed 10 and will help me translate if he or she speaks english.  
     Their are just a few ventilators in the ICU.  The nursery has no ventilators or isolettes.  These life sustaining measures that are common elsewhere are ethically difficult in a third world setting.  No one wants to make a decision regarding with limited resources which patient can or can not receive these measures or furthermore who should remain or be removed.
     Patients bring family to help with laundry and eating.  Beans, rice, and chai are served for each meal and patients bring their own plates and utensils.  Cost as an inpatient is a daily rate of 500KSH per day--about 7 USD.   In-Patients are not allowed to leave until their bill is paid.  Many often sit far longer than needed in the wards waiting for the funds to pay their hospital bills.  Collecting funds can take time as it involves rallying your local tribe for help or waiting for your husband to sell a cow.   
     Occasionally all beds are taken and patients pair up with two to a bed.  I'm told this is better than 20 years previous.  At that time the only space available was under the bed.