Goodbye to 2009

"Please Help Meredith" by Amelia

Because Amelia is on a year round school calendar she has been out of school since before Thanksgiving. Meredith and Amelia have done everything together including sand-box, peanut-butter spoon snacks, matching game, taking Luthien for walks, playing in the Hammock, coloring, etc. Sometimes they are happy sisters together like above.



Sometimes they can't go 1 minute without "Meredith did this, Amelia did that" conversation. If you can read the sign Amelia wrote on the ladder to her bunk-bed you can see that "little kids are not allowed." (I wonder who?)



Amelia wrote this sign on her own (we only helped her spell nicer). We reacted first maybe the way you are with a pleasant smirk, but then thought maybe we should take this a little more seriously. Amelia and Meredith together can be a combustible mix of incredibly sensitive 6 year-old and a rambunctious, loud, carefree 3-year old. The one usually in tears is the 6 year old.

So I did ask Amelia what Meredith had done to not be nice? "Daddy, like the time Meredith bit my pinkie, or wrecked my legos, or wripped my drawing, or pulled by hair, or hit my face in the bath-tub, or pushed me in the hammock, or stepped on my feet in the sand-box, or worst of all hurt my feelings."

Sisters, everyone says SOMEDAY they will be best friends!

Precious

Christmas Eve delivered a special blessing for my dear patient, Leah. She had seen me numerous times during this pregnancy and I had been doing weekly dopplers, BPPs, and exams because previously she delivered a baby that died 1 hour after birth and had a stillbirth at 38 weeks. After much worry about when I should do a repeat C/S to deliver her 3rd girl, she started complaining of decreased fetal movement. And so at 36 weeks I decided it was time. Leah sobbed seeing a live, crying little girl and of course that made me start to cry for joy as well. Her daughter had the cord wrapped around her neck twice, but did great with Apgars of 9, 10 (no baby ever gets a 10 in the States, but they do here all the time!). How we prayed for this outcome and God graciously gave Leah what she desired most this Christmas.

As you may also see in the picture, more hats from arrived from the States on Christmas Eve. Thanks Laurel for sending them and for those who made them. It was wonderful to give them out Christmas Eve as a reminder of Jesus' coming to earth in the form of a baby.

Crashing Rain, Baking @ High Elevation, & Arriving at Church 5 Minutes Early

It seemed nearly a miracle that all the Friess Family including our bible books, crayons, boots, jackets, etc arrived at AIC Kijabe Church at 8:25 AM 5 minutes before church was to begin. The pews were empty as we entered the sanctuary and for an instant we thought we had come at the wrong time. But indeed we must have been blessed because we were early. "Please come sit on the front row," the worship leader said. "

And you (pointing to Sara), you must sing well. Please pick up a microphone and sing with our worship leaders." Sara joined the worship team and led our congregation in "Shine, Jesus Shine."



The results of baking a cake at High Elevation of Kijabe (6,545 ft). Maybe some of you in Colorado can relate.



We do not underestimate the power of your prayers. As you can see the rains have come again in abundance like they never have in the past 3 years! This area of Kenya will be blessed to have crops grow again and food on the table.

Merry Christmas

After 13 months I still don't grasp Kenyan Culture. We as a family had the strangest Christmas Eve on record. It started out typical as we attended a Christmas party with snacks, kid's dressed as angels and wisemen, and the reading of the Christmas story. Then Sara was paged to the hospital (which is also quite typical).

But then it all changed. The rains came, thunder roared, the roads turned to red mud, the clouds covered Kijabe Station. Sara returned from the hospital to inform us that a pregnant patient was very sick and HIV+ but the nursing staff deemed it best to wait until the day after Christmas to inform her of her status, because no one should find out such information on Christmas Eve.

We settled into our home hoping to spend some time as a family, a cup of hot chocolate, maybe one Christmas Eve present. Knock, Knock, Knock on the door at 8:45 PM. We were surprised to see our friend Sarah K. with a very large bag in hand. The time before Sara came with a bag in it was a live chicken (for us to butcher and cook). And the time before that she came with two parakeets and two bunnies for us to watch.

"Greetings, I am here. I told you I would come and I have come!" In the bag was a Twister (a wicked Kenyan blender), 6 conconuts, and Kenyan Cheetos for the girls. Sarah K. had come to make us coconut milk on Christmas Eve at 9:00 PM. "Well thank-you Sarah. I don't know what to say."

I wasn't quite sure if Coconut Milk was a tradition on Christmas Eve. "I need a hammer," Sarah K. said. Minutes later she was driving the hammer into the blunt edge of a knife and cracking open 6 coconuts brought from the coast. The banging went on and then the roar of the Twister as Sarah K. fed this machine bits of coconuts and out came a chunky milky substance.

Hospitality is valued in Kenya over privacy. Not making time for friendships is condemned. Unannounced visits are to be expected. It is Christmas..and the greatest gift of all was an unexpected birth of child in an unexpected place who came to redeem the world. And that is how God would intend it to be.



Merry Christmas from the Friess family.

COHOs

COHO is the acronym for Community Oral Health Officer and I could not do my job without them. This is Naomi (COHO employee at Tenwek for the past 2 years) and Sylvester (COHO intern for the past 4 months). COHO's go through a 3 year training at Kenya Medical Training College in all aspects of dentistry. Just as Dental Hygienists fit the need of patient's in America (we all need regular cleanings) COHO's fit the need in Kenya (many Kenyans need multiple and regular extractions of diseased teeth).

Well over half of our patients come to Kijabe Dental in pain, with oral infection, oral pathology, or advanced periodontal conditions. The COHO's (we have 4) triage these patients and take x-rays as necessary, extract diseased teeth, counsel regarding oral hygiene, and provide full mouth scaling for those with calculus. I am available as a 'consultant' which frees me up for elective care, unknown pathology, teaching restorative, difficult diagnosis, molar rct, crowns, orthodontics, etc.

Naomi is a product of Kijabe born and raised just a few Kilometers from the Hospital. She is part of the Africa Inland Church Choir and a teacher in the youth group.

Sylvester stays in Northwest Kenya. He is 1 of 13 children and has invited me to his home to eat Mangoes and meet each of his siblings. When asked about the size of his family he told me his parents did not understand or know about birth control. He is currently dating but say's, "I am leaving a lot open to change."

Luthien

Luthien is the the fairest of the elves in Lord of the Rings. Luthien as we know her is the above 8 week-old Cocker-Spaniel Puppy we have been watching for the last 2 weeks. Amelia loves cuddling sweet Luthien and takes her on morning walks. Meredith likes to pick Luphien (the 'th' is hard to say) and drag her up and down the stairs as Meredith finally has someone around she is bigger than and can boss around. Luthien has developed several endearing nicknames including La Diablo, Dorcian, and Lucifer. Luthian will stay with us one more week and then return to her owner.

For over 4 years we lived in Ohio with no pets, but in the last week we have at one time in our house 2 gold fish, 2 birds, 1 dog (Mocha), 1 puppy (Luthian), 2 tadpoles, and 2 bunny rabbits.

Theatre Christmas Party

We celebrated the OR staff today and the work that they do. Food was prepared for 80 people and thankfully there is a caterer so I only made the desserts and organized the party.

Before the party was about to start I went to check on a critical post-partum patient who I was trying to get a CT scan and referral to neurosurgery in Nairobi. My best potential diagnosis's were a ruptured aneurysm or stroke that led her to present with a GSC (coma scale) of 4. She had previously been admitted for eclampsia and aspiration pneumonia and had survived and gone home well. I can't even describe the sadness of seeing her return in such poor condition. Well, as I was checking on her, her BP began to drop quickly and I called for the crash cart and began CPR. Our resuscitation was not successful and so I had to tell her husband. The baby had died 3 weeks earlier and he collapsed in grief over his wife. Please pray for Michael; he has lost so much and yet somehow he was able to profess to me, "Thank you Daktari, we know God knows what He is doing."

Favorite Hymn

What is a dentist's favorite hymn? Crown Him With Many Crowns.
It's certainly corny dental humor..but it has been nice at Kijabe to be able to provide this level care for our patients. Maybe you have a few crowns in your mouth and nobody I know enjoys the process of getting a crown including the injection of long lasting anesthetic, prepping the teeth, packing cord in your gums, multiple impressions, making of temporary, and returning in a couple weeks to cement on the final crown, and then of course opening up your pocketbook for the final bill.
Much of the technique for fixed prosthodontics is the same as we would do back in America, except at least the final bill is only about 20% of that in America.




Light and Medium Body PVS impression of Bridge Prep.




Working Models that are trimmed, pindexed, dye lube, and articulated. Our fixed lab work is completed in Nairobi. Years back the impressions were sent back to America for crown fabrication. As you can imagine it took a long time.



Final FPD (bridge) in place two weeks later.

Advent

This will be our second Christmas in Kenya. This year we happened upon a Christmas Tree. It took some tinkering, some duck-tape, and my two helpers (Amelia & Meredith) to get our tree up. Amelia made the star with some paper and tinfoil, Meredith hung a few ornaments on the tree, and we found some baby wrapping paper to wrap a few presents.




And although in particular we feel the distance from family and friends during Advent we in Africa celebrate with you the anticipation of the birth of our Messiah, Jesus Christ. Merry Christmas.

For to us a child is born,
to us a son is given,
and the government will be on his shoulders.
And he will be called
Wonderful Counselor, Mighty God,
Everlasting Father, Prince of Peace.

Isaiah 9:6

Signs

Funny Kenyan signs always catch my attention. We have seen signs that say "Moron Driving School" which is a motor vehicle education school in Narok. I have seen signs that say "No Way" when a road has been marked for detour. As a dentist this sign below caught my attention.



You may ask where was this sign located? No, it was not in our dental clinic (even though my life would be rosier if my patients were to do a pre-exam Listerine rinse). This sign was found above the sink in the eating area of the hospital cafeteria. Why the sign was strategically placed at that location...that is left up to our imagination. But the sign seems to be working...after I washed my hands in the sink and as I ate lunch not even one person rinsed their mouth in that sink.

Iron Women

Kenyan women have to be the strongest, fiercest, most durable, formidable, courageous women I have ever met (except for my wife). These women don't do Pilates, run triathlons, or hold Yoga positions; but these women are Africa's version of Iron Women.

I don't think I could get this load of fire sticks on my back let alone carry them up from the forest to the top of the Rift Valley escarpment which is easily 1500 vertical feet. Then after completing this chore it's time to fetch water which is likely at the bottom of a boar hole 2 km away. After that get the cooking fire going (but you can only use a few sticks to preserve firewood) to heat up milk and water for chai. If you are lucky you may have some charcoal to cook with.

Then its time to wash the clothes by hand and hang them on the line. You may have another job on the side like sewing, cleaning, or being a casual for someone else to earn an extra 50 KSH. Did I forget managing the kids (Kenya's birth rate average 5 kids per family), feeding them, cleaning them (no tubs, diapers, bibs, napkins available). Then you can't forget the Shamba (garden) that needs tending to grow potatoes, carrots, cabbage..that is if their is a decent rainy season this year. As dinner time comes (most Kenyans only eat one big meal at dinner) it becomes time to cook the Ugali, make the chipates, and boil chai over the jicho. Then cleaning up and washing all the dishes by hand with a bucket.

You won't hear a word of complaint from these Kenyan women. But I wonder... Is this lifestyle a product of corruption, marginalization, and chauvinism? Or is it just the way of life in Kenya?

Happy Birthday Meredith!

She's 3. Loves to talk, shout her ABCs, climb onto anything, play with her sister, and gives the best hugs and kisses. We celebrated a little early last week with 4 other families and while Grammie and Grampie were still here. Meredith blew out her candles with gusto and in general does everything emphatically. We love having her in our family. Sometimes I still can't believe she started life 6 weeks in the NICU surviving RDS, RSV, necrotizing enterocolitis, and a patent PDA. Truly, how great is our God.

Thanks Auntie Jennifer for making her the "3" shirt!

Frozen Sections

I'm so grateful for our pathology department here. Although we only have basic staining the experience brought here through the visiting pathologists is better than any fancy stain. Still, I can't help but wish for frozen sections. Frozen sections are done during the surgery and give preliminary results. For me this would help most when I'm looking at a mass and trying to decide if it's cancer and if I need to do a bigger surgery. Last week a 24 yo presented with what appeared to be ovarian cancer or pelvic tuberculosis. Hoping it was TB we just took biopsies and closed knowing if it was cancer it would mean more surgery. Well early this am the pathology came back cancer. The previous 3 patients we had done this on did turn out to have pelvic TB. But before I re-operate I'll have to make sure she'll actually be able to get chemotherapy. I don't think I'll ever get used to having to treat patients differently based on what they can afford. Although I try to maintain the highest standard of care, the care is still usually influenced by the finances of the patient.

Goodbyes...

We dropped Grammie and Grampie of at Nairobi airport yesterday with tears, hugs and kisses we said, "Goodbye." Without a doubt the hardest part of knowing we are called to be at Kijabe is being away from family. It has been so good to know for the past 4 weeks that while I went to work the girls were happy playing with Grammie. Malin also enjoyed operating with his Dad. Not to mention all the fun we had seeing some of the sites of Kenya together and celebrating (a little early) Meredith's 3rd birthday. We look forward to the next family visiting which will hopefully be my parents in Feb/March.

Scarves

Amelia and Meredith would like to say thanks for making the scarves Barbara Pindergraft.

The Ministry of a Grandmother

The ministry of a grandmother is important, diverse, and should not be overlooked. An although it is often not in a clinic, ward, or operating room we are thankful for what Grammie does and her ministry to our family and the community of Kijabe for the past 4 weeks. Grammie has been our photographer, gingerbread house maker, duka shopper, birthday-cake maker, story-teller, girls tea party arranger, tailor, and much more.




Reading stories to her grandaughters.



Outreach ministry to old Kijabe town. This Christian outreach with Kenyan leadership provides monthly food delivery to widows. The widows are then responsible for street kids. The hope is that if the street kids have a home where they can find love and regular meals and that they will leave the streets.



Helping out in the nursery feeding one of three triplets.




Trying to stay warm under a Massai blanket with Meredith on Safari.

Christmas Party

Yesterday Sharon, Stephany (Pediatrician) and myself threw a Christmas Party for the maternity and nursery/NICU staff. Food was provided for 55 people and each received an angel tree ornament. The staff were visible and verbally appreciative of the party. As people were asked to give thanks one nurse said, "This is the result of woman power." (Previously both departments had been run by men.) Several others just simply said, thanks, no one has ever thrown us a party before. But I think all of us appreciated most the midwife who said, "You are the coolest doctors we've worked with!." I'm working on arranging a party for the surgical staff (theatre staff) as well and am reminded how far a little appreciation and thanks goes to improve morale and work attitude. Not to mention, I like being "cool."

Lithotomy

Sharon and I have been working in this position a fair amount recently. Lithotomy position is commonly used for D&Cs and vaginal hysterectomies, but we've been doing some other surgeries. Surgeries like repairs of rectal-vaginal fistulas, vesicle-vaginal fistulas, revision of female genital mutilation and vaginal reconstruction following un-repaired birth trauma. Admittedly, these surgeries are fulfilling. And the general success with these procedures, helps me deal with the many things we can't fix or improve surgically. That is also the time I'm reminded to pray, because while I know the limits to what I can do, God's power is unlimited.

The Mara

Alive

Following the delivery of the twins I was called for a woman with "arrested labor." After assessing the patient and deciding the uterus had ruptured from an attempted home birth after previous C/S and three hours of pushing, we rushed the patient for emergency C/S. While preparing the patient we got the Hb results 3.3..... I briefly wondered if this surgery would kill the patient and we'd be unable to revive her. Upon opening the abdomen I found the baby wedged in between the bladder and an open uterus. Miraculously the baby was still alive, I quickly embarked on a hysterectomy as the woman received 2 units of uncross- matched blood. As I closed we began to see her vital signs stabilizing and as you can see, she is now doing well with her son.

Otolaryngologist in motion

It has been a pleasure to have my (Malin's) parents here visiting and serving at Kijabe for the past 3 weeks. Many of you may know that my father Chris is an Otolaryngologist (ENT) doctor and has served many times as a medical missionary in Central & Latin America, but this is his first visit to Africa. Although I have been the son of an ENT doctor for 33 years I don't think I knew much of what they did besides stop nose bleeds and pull wax out of people's ears. Because the ENT clinic shares the same building as the dental clinic I have taken the opportunity to see what it is that Dad does. I find ENT diverse, fascinating, and most of all it glorifies God as so many patients quality of life is improved. Take a look at the pictures below.



The results of a T & A (tonsillectomy and adenoidectomy) surgery on a 12 year old patient. I'm not sure which is the tonsils and which is the adenoids, but I think they come in pairs and one is missing (but not forgotten in surgery I'm sure.)



CT scan of a 6 month old patient who was born chronically blocked non-patent nasal canal. He will go for surgery next week because he is an obligate mouth breeder he has trouble feeding.



Patient being examined by Dr. Isaac Wahome. Isaac is a clinical officer (similar to a physician's assistant) specializing in ENT. He is doing a month elective at Kijabe with Dr. Friess (ENT). They have had a mutual beneficial relationship as Isaac learns Tonsilectomies and Dr. Friess has a ready translator. They are examining a patient in which she had a tracheostomy placed. ENT's are THE doctors to go to when the airway is at risk either from foreign body or laryngeal cancer.



This nice gentleman came into clinic with sialadenitis (infection of salivary tissue). He came in with swelling under the tongue, puss draining into the floor of his mouth, and a stone (cashew sized at least) in the sublingual salivary duct for the past 3 years. As you can see from the picture it was removed and the patient quite relieved.




A tympanoplasty is a procedure to repair a perforated ear drum. A surgical incision is made behind the ear to access the ear drum. This is the making of a new tympanic membrane using tissue from behind the ear.




Ear surgery in Theatre under the microscope. Many eager doctors and nurses watching as the microscope was hooked up to a TV nearby (not shown).

"Two are better than one..."

I recognize that I am taking this quotation from Ecclesiastes, "Two are better than one.." completely out of context, but in the setting of vaginal deliveries one baby is better than two. Don't get me wrong twin deliveries are amazing, when they go well, but I still approach them with a healthy fear of what can go wrong... prolapsed cord, post-partum hemorrhage, malpresentation, head entrapment, etc. That brings me to why I'm blogging at midnight; I can't immediately go back to sleep after an exhilarating delivery.

Having been called for a "breech" presentation, I arrived to find a rather small scrotum presenting and a fetal heart being monitored near the mother's umbilicus. Asking if the mother knew she was having twins, the intern and midwife replied, "You think that there's two babies?" Well, generally you don't get a heart rate that high when a baby's that low, especially a premature baby. Thankfully the 1st baby delivered safely breech weighing 1000 grams. That left us with the 2nd. At this time the things going through my head are, "Position is footling breech, baby is small, but bigger than the first, head might get entrapped, C/S will take at least 30 minutes to prepare, baby's survival at this weight is only 50%, Mom doesn't want C/S, what should I do?" In the end, we started some pitocin and I grabbed the feet for a second breech delivery. While this twin was more difficult to deliver than the 1st both boys did begin crying after birth! The mom, upon hearing she had two boys, began to cry out asking God why He had not given her a girl. Apparently she already had 2 boys and as my intern explained now she needed to buy more land for her boys to inherit. Boys are expensive in the Kikuyu culture.

I kindly disagreed with her; a vaginal breech/breech delivery at 28-30 weeks with 2 babies that come out crying in Kenya means God should be praised!

Charming or Cheesy?

On a weekend trip to Lake Naivasha we found a quaint pottery shop. Obadiah the potter turned on his spinning potting wheel and with his hands artfully shaped a concentric bowl. To our surprise he then invited Meredith and Amelia to participate. It was enjoyable to see them shape a formless lump of clay into a lopsided bowl with a hole in the middle. Regardless, they were proud. Yet, I can't determine if this picture is charming (little sisters bonding while shaping clay) or cheesy (like the the second worst movie every made 'Ghost'). The worst movie ever made has to be Beaches.