H1N1

The recent news has suggested that Swine Flu (H1N1) has signs of increased activity in 30 of the 50 United States and is now being called a Pandemic. It was thought being in Kenya in an isolated area may be a place where Swine Flu would not touch.
Unfortunately just 3 days previous 30 girls from the Kijabe Girls Kenyan School were confirmed positive for Swine Flu. Thankfully the symptoms were caught quickly and H1N1 was expected. The girls were isolated and treated and as far as we know all are recovering normally. We are taking all the precautions we can here at Kijabe; although sinks, soaps, and disinfectants for hand washing are often unavailable. We have no word as of yet if, when, or how much of the vaccine will be available at Kijabe Hospital.
Our prayers are with the elderly, expecting, and the young children all over the world who are most vulnerable.

Getting Packed

Sara and Meredith are packed and ready to depart JKA tomorrow! In the picture you can see some fun Kenyan things she is bringing to be available at a First Reformed Church Bazaar for the Christmas Season.

BucketHead

As Sara begins to pack & Meredith unpack what Sara has packed for Daniel & Laura's wedding next Saturday Meredith and I have started a little conversation we repeat several times a day.
"Meredith what am I going to do when you go to Nanna and Papa's House."
"Daddy, I might miss you."
"What will I do?"
"Daddy I will call you on the phone or the Skype."
"Meredith, Amelia & I will miss you and Mommy."
Meredith then covers my mouth with her hand and says, "Daddy, don't talk about that. It's too sad."
We are excited that Sara and Meredith will be home for Daniel & Laura's wedding. We'll pray for a safe trip for them from Kijabe to Nairobi to Amsterdam to Seattle to Oak Harbor and back again!

Field Day

Awake

Living on hospital grounds means many times I still get called in to help with things even when I'm supposed to be off duty. This morning at 4 am I was called for a patient who's Hg was 3.2 (normal is 14). She had 2 D&C's earlier this week and had already received 3 units of blood at another hospital. On exam she had choriocarcinoma extending near the urethra. We made the decision to try to stabilize her by removing her uterus as that was bleeding most, knowing that this was palliative not curative. Thankfully she survived surgery and is now in the ICU. As I talked with her husband afterwards I learned he pastors a church and that they've been trying to get her help for some time. Earlier this week I was called in for a patient in shock who eventually died, her family also had been trying to get her help.

While we have patients who delay seeking help, there are many others that try to get help and just don't. Sometimes I think this is from the cultural tendency to not tell patients when things are bad and to avoid admission that the medical person doesn't know what's wrong. Sometimes this is from the cost of seeing specialists that prohibits poorer patients from being referred. Sometimes I think the infrastructure makes is difficult for health workers to know whom to refer too: there's no physician directory here. Whatever the cause, it still amazes me that many of these patients who ultimately present in shock still survive. And I have to believe that this happens only by God's grace.

Bunny #2

Daniel brought the special delivery in a small box with a piece of rope around the lid. Out hopped bunny #2 named Lucy by Amelia. Flower (the previous white bunny) we now know is not much of a flower (he is male). We don't know the gender of Lucy yet. Lucy and Flower share the same cage. We will see what happens...

Good Samaritan

Phillip is a construction worker.  By no fault of his own a brick (Kenyan bricks are the size of a mailbox) dropped from the building where he was working at struck his cheek.  He suffered a mandibular fracture.  

Phillip was struggling to raise the necessary funds to pay for his needed surgery.  He returned to his village to speak to all his friends and family but was only able to raise 2000 ksh (25 usd).  

He returned to dental as we sought a way to get his treatment accomplished.  Unfortunately many of the fees (anesthesia, hospitalization, medications) were beyond our control.  We seemed at a loss at how Phillip could get his surgery.  He needed help from someone... somewhere?

In Luke chapter 10 we read the familiar Parable of the Good Samaritan:

  Jesus said: "A man was going down from Jerusalem to Jericho, when he fell into the hands of robbers. They stripped him of his clothes, beat him and went away, leaving him half dead. ³¹A priest happened to be going down the same road, and when he saw the man, he passed by on the other side. ³²So too, a Levite, when he came to the place and saw him, passed by on the other side. ³³But a Samaritan, as he traveled, came where the man was; and when he saw him, he took pity on him. ³⁴He went to him and bandaged his wounds, pouring on oil and wine. Then he put the man on his own donkey, took him to an inn and took care of him. ³⁵The next day he took out two silver coins^{e]" style=" line-height: 0.5em; ">[e]} and gave them to the innkeeper. 'Look after him,' he said, 'and when I return, I will reimburse you for any extra expense you may have.'

But do Good Samaritans still exist? Does a stranger help another stranger in need in real life in real time? That doesn't happen any more does it?   Budgets are tight with the current economy.  People in Kenya daily struggle to get by.  People out of necessity have to look our after themselves and their families.  

A stranger approached me after over-hearing my conversation with Phillip.  This Kenyan lady (I never caught her name) said, "I want to help him."

"You don't even know him..and you want to help him."

"Will this do?  Will this be enough so he can get his surgery." The lady handed me 8000 Ksh (100 USD).  

"Yes, Yes we can do it. Thank-you, Thank-you so much. You have really inspired me.  We can do Phillip's surgery.  You have really made a difference in his life."

She left and I'm not sure if I will see her again.  Phillip you can see with his receipt in hand and in Theatre received his surgery the following day thanks to a modern day Good Samaritan.

Missing Teeth

Amelia is proudly standing next to the Missing Teeth chart in her 1st grade classroom.  As a dentist I'm am pleased to know her teacher is taking an interest in the kids stages of mixed dentitician.

Amelia seems to be holding her own at 3 with the 4th soon be any day now.  Jeffrey is clearly way out in front at this point at 10 missing teeth.  Jeffrey is a great kid from Turkana land adopted into the Titchey school.  But based on his sporting abilities, height, and amount of primary teeth exfoliated...we are wondering is he really 6?

Things are getting better

About 400 employees, friends, and supporters of Kijabe Hospital participated in a fundraiser yesterday.  Led by police escort and full marching band we walked from the top of the highway 5 km down the windy road to Kijabe Hospital.

This was all accomplished to raise funds for the upcoming addition to Kijabe Hospital.  They are seeking to increase the number of surgical theatres, and expand the palliative care and maternity wards.

Donated funds to our project account supported the dental staff to buy t-shirts and participate.  We walked as a team and waved at the onlookers. (Can you spot Malin?)

Although this march did not raise a large sum of money, I believe the morale of the hospital was lifted.  I think God was glorified as we marched to the drums and trumpets and the Kenyan song, "Things are getting better, Things are getting better, With the Lord on our side, We can be assured  Things are getting better, Things are getting better."

Ballerinas

The girls started ballet classes this week at Kijabe (thanks to a mom who has found a teacher to come once a week for all station kids interested).

Meredith couldn't completely enjoy the first class as all she could talk about was how she could not find her other ballet shoe.  But she has worn her ballet costume everyday this week.  Meredith says she learned how to "walk on my tippy toes."  Meredith does not like the name pumpkin or snickerdoodle, she says you can call her "chicken and rice?"  

Amelia is singing in church on Sunday with her classmates.  She is learning positions 1-4 in ballet. For classics day in art class, she drew a nice picture of Charlie Brown (I guess he is history now).  She also told me the other day she likes when she pulls a scab off and there is skin underneath. 

Would you like to see Malin dance?

Wednesday morning at 8:00 is hospital wide chapel.  Around half of the 600 person Kijabe manage to attend this weekly service which includes greetings, announcements, time of praise and worship, brief sermon, and prayer.

Annually each department is expected to organize chapel.  This morning it was the dental chapel.  For the past weeks we have not only been working on a song in Swahili (Sifea Bwana) but also a dance. 

Currently I am the only Masungu in Dental and also the only male.  But even more importantly, I'm also the only one who has no rhythm, can't shake his hips, and can't move his right arm and left arms independently.  As the chapel was approaching I was fearing how I could pull off this dancing and singing swahilli at the same time.  And of course where could a guy like me hide up there on stage. 

It was with great wisdom that at the last moment I volunteered to give the sermon and left the dancing and singing to Doreen, Winnie, Grace, Margaret, Caroline, Agnes, Millicent, & Naomi.  

Many were disappointed at dental last minute change of plans.  To see Malin dance is something that is never forgotten.  There is always next year...

Serving Together

Dr. Cichowski MD (Ob/GYN) and Dr. Sharon Morad MD (Ob/Gyn) both Samaritan's Purse Post-Residents serving together in Theatre surgically treating a patient suffering from incontinence due to a vaginal fistula.

All went well!

The surgery today went well. Linda did great and we believe the results will be functional for her and she will be continent again. Her mother started crying and kissing us after surgery. Together we gave thanks to God that all went well. I also give thanks to have a colleague to discuss, share and work with. While neither of us had done a vaginal pull through procedure before, together it was less intimidating and went smoothly. 

A pastor recently pointed out to me that Paul always had someone with him and when he didn't he requested that someone come and help. Going together to the mission field is established in the Bible and the more Sharon and I work together the more I understand the importance of going together.

Linda

This week Sharon and I are operating on a 14 year old with an congenital anomaly I don't think has been reported. She has distal vaginal agenesis with absence of the posterior urethra. She is unable to menstruate and has a large volume of blood "trapped" inside with urinary leakage.   We had planned for the operation on Wednesday, but she came tonight in severe pain and will need surgery tomorrow. Speaking with her mother tonight she asked, "How many surgeries like this have you done?" I had to tell her I couldn't find any other girls with this combination of anomalies, and so we've been studying about what to do. We prayed together for wisdom and I would ask you to pray as well for this child. Pray that we can construct a functional vagina and that we will be able to repair the urethra as well.

Parched

Kijabe has been unusually dry.  It is dusty, the few creek beds are empty, and the hillsides are brown.  

The dryness came to be a reality in our house this morning. We turned on the faucet this morning to find nothing.   Not even a few drips of water. We're not sure if the tank is empty, faulty plumbing, or something else.  Futhermore, we have not been told when to expect water in our house again.   

Fortunately up the hill at the Waring house the spigot produces water.

Tight Squeeze!

Doing My Own Thing.

When Meredith dresses herself.  I can't quite place the style....

BOH

There are many unique medical abbreviations in Kenya and probably in every country, common things get shortened. However, sometimes these abbreviations can be a bit mind boggling. Some of my personal favorites ISS (immune sero status-HIV), 1PS (one previous scar), PMTCT (perinatal mother to child transmission), and BOH (bad obstetrical history). BOH took me a while to figure out and remember, and indeed many histories here are simply "bad." So today there was a C/S for a BOH. This mother had 2 babies die during prolonged 2nd stages (pushing) and I advised a C/S this time. Showing her, the vigorous baby boy was a delight. 2 weeks ago I delivered another mom who had lost 3 babies during or immediately after delivery. Above are the pictures of these little ones.  I think a new abbreviation can be added to these charts: BOH BPG BL (bad obstetrical history but praise God baby lives).

Treehouse

Nancy

She came to the clinic by herself with chart in hand to be evaluated for a jaw fracture.  The cause of such trauma is usually motor vehicle accident or assault.  Sadly her trauma was due to the latter at the hands of her husband.

"He hit me with a piece of wood.  The long stick smashed under my chin and my mouth began to bleed.  Then he raised the wood up and brought it down on the back of my shoulders. He then grabbed my neck with both hands and choked me again and again."

Nancy rested uncomfortably in the dental chair supporting her neck with the palm of her hand.  Her front lower teeth were displaced, bloody, and painful to the touch.  No jaw fracture was present.  We numbed her mouth and extracted her front 3 hopelessly mobile teeth, placed gauze in her mouth, and prescribed the appropriate antibiotics and pain medicine. I guess that is all we can do for you.  I left to attend to the next patient.

After a break I asked Hannah one of our assistants, "What will happen to Nancy? Will she go back to her husband? Will she prosecute him?  Will he face justice?"

"You see the problem in Kenya, and most of Africa is that when you are a victim first you have to hire a lawyer.  That takes a lot of money.  And if the other person has more money, their lawyer will win due to bribes, or just because they have more money." 

"Do you think Nancy will return to her husband."  

"She has family in Nairobi, but the problem is that of course in Kenya the women are responsible for the children.  She has three children.  Her husband has the land and house.  She has no way to provide for the children.  Also, getting a divorce in Kenya is very hard.  Culturally when we marry we see it as you stick together no matter what. Legally, if you are married in a church in can take over 4 years to receive the divorce papers."  

At that moment I returned to see Nancy.  Of course there is more we can do for her.  God expects more of us. Thankfully she had not left the chair.  "Why are you still here?"

"I feel weak and I don't know if anyone will come to pick me up?"  

"Can I pray with you?"

"Yes."

"We prayed that God would heal her mouth and back, that the pain would be relieved.  We prayed that her children would be safe.  We prayed that justice would be done and that her husband would face consequences of his actions.   We prayed that God would rescue her from this violent social situation."

"Will you go back? Will you forgive him?  Are your kids safe?" I asked in succesion.

"My firstborn daughter is in University.  My other children are with my mother.  My husband, he is a wealthy man. He has his own business and land.  He is crazy in the head.  I have already forgiven him.  But, I will not go back.''

My youngest patient ever.

At just under 1 month old this baby was by far the youngest patient I had ever seen.  Although the American Academy of Pediatric Dentistry recommends that the first dental exam be either when the first primary tooth erupts or by one year of age, even in the United States I rarely saw children under the age of 4.  I'll be honest I can treat fractures, infections, root canals, but this baby really intimidates me!    

From the expression on the babies face you can tell he was not happy but not because he was in pain thankfully.  He was not happy to have me prying around inside his mouth!   You can see in the above picture (if you look closely) bilateral solitary white lesions attached to the gingiva on his lower ridge.  Mom said he was breast feeding normally and growing as expected. 

 

The diagnosis made was gingival cyst of the newborn or Bohn's nodules.  These cysts are a result of degeneration of the epithelial rests of the dental lamina.   

The cyst is lined by odontogenic epithelium which is covered by a thick layer of keratin. Keratin gives the cyst its yellow color. Generally they rupture on their own with in the first two months of birth.  

I have seen him since the picture was taken and they had not burst as of yet. I'll continue to follow him week to week. 

  

Kenyan Census

Last tuesday at 8 AM I received a knock on my door from these two visitors.  They were official Kenyan census takers who along with perhaps thousand of other workers have 1 week to knock on doors of every house, apartment, shamba, and hut in Kenya.

       I invited them in to our duplex and proceeded to be part of a Kenyan census.  The questions were quite interesting ranging from level of education, religion, number of children, possession of phone, radio, tv, vehicle, and pets, and my most favorite question; how many wives do you have?  

I think our wazungu family skewed the census in many different ways, but it got me thinking about what does the typical Kenyan household consist of?

These statistics were pulled from the care international website (http://www.careinternational.org.uk/3235/kenya/kenya-statistics.html).  

Kenya is striving to meet the needs of its population of over 30 million, but as you can see it has a long way to go in regards to availability of clean water, maternal mortality rate (1/100 mothers die during child birth) and HIV care.   No surprises to see that nearly one quarter of Kenyans live on less than one dollar per day.

Kenya Statistics

Population	31.9 million
Urban population	35%
Major ethnic and linguistic groups	Kikuyu 22%, Luo 13%, Luhya 14%, Kamba 11%, Kalenjin 12% and others.
Languages	Swahili, English (both official), Kikuyu, Luhya, Luo, Meru and others.
Religion	Protestantism 45%, Roman Catholicism 33%, Islam 10% and Traditional Beliefs 12%.
Life expectancy (at birth)	45.5 years
Infant mortality (under one)	78 per 1000 live births
Under five mortality	123 per 1000 live births
Maternal mortality rate	1000 per 100,000 live births
Adult HIV prevalence rate (ages 15-49)	6.7%
Percentage population with access to safe drinking water	62%
Adult literacy rate	84%
Proportion of population living on below $1 a day	23%

Gum Boots

All of Kijabe has been praying for rain to grow the maize, fill the Ken-tanks, and turn the fields green.   It has been two years since this area has received significant rainfall.  This drought naturally adversely affects crop production and the ability to dig wells and find water aquafers.

    Just yesterday it drizzled all night long and into the afternoon.  Not nearly enough as can be seen in the parched, yellow grass in our yard.  But it was enough to settle the dust and give the girls a chance to wear there gum boots and rain jackets to school.