Samaritan's Purse Post Residents Visit Kijabe

Bottom Row (left to right) Dr. Cropsey (Op), Dr. Friess (DGP), Dr. Cichowski (OB/GYN), Dr. Hawk (PED)
Top Row (left to right) Mrs. Shirley (Nurse), Dr. Francis (OB/GYN), Dr. Fader (Gen-SUR), Dr. Mclaughlin (FP)

We've Been Flashed!

Driving in Kenya at night is to be avoided at all costs and now we know why. Last night we got behind schedule and drove the last 30 km up the Rift Valley to Kijabe Hospital in the dark. The picture to the right assimilates our vision of oncoming traffic.

We learned three things about driving in Kenya in the dark. First, painted lines to identify passing lanes, shoulders, medians, the center of the road are non-existent or too washed away to see. Second, checkpoints where police stop traffic to check cars for proper markings are marked with one small dim kerosene lamp. Third, there is a pattern that as you approach oncoming traffic it is expected to "Be Flashed," that is to blink on your high beams until you pass the oncoming traffic.

Thankfully we are home safe..and will now make every effort to avoid Being Flashed at night again.

Being 3

Our 3 year old daughter Meredith has hit that unique moment in life when she has the words to express a wide range of emotions, matched with the impulsivity to melt down into a pool of tears in an instant. Some of her new favorite phrases...
I don’t want to talk about it.
That is totally not fair.
Ha-ha I said stinky.
I'm having a sad day.

Some of the rules we have recently set for Meredith.
Meredith stop licking the salt shaker.
Meredith stop drinking the bath water.
Meredith stop biting Amelia.
Meredith no washing your hands in Mocha's water bowl.

Meredith can then redeem herself with moments prior to falling asleep where we have had the following conversation...
Daddy you are a good daddy.
Daddy, only you can be my daddy.
Daddy, I don’t want you to die (I think that one is a complement in a 3-year-old sort of way).

Course of Treatment

July 8, 09 35 YOM presents to dental clinic (no significant medical history, otherwise healthy, no allergies) with “swelling on right side of the face and trismus. Unable to do intra-oral examination. Referred to Kenyatta National Hospital.”



August 1, 09 Dx- Trismus, Periocoronitis secondary to impacted #32.
Plan- Take to Surgery for GA (because of trismus) and surgical removal of impacted #32.

August 3, 09 Kijabe Hospital. Consent, GA, Throat Pack placed. LA, Buccal Flap raised adjacent to #32. #32 Sectioned and removed completely without incident. 3 Chromic sutures to close. Rinse with sterile saline. Throat pack removed. Patient awake with out adversity.
Rx- Pen V-K, Paracetamol, Ibuprofen

August 10, 09 Healing WNL. No signs of bleeding, pus, or infection. Trismus still present (opening of 10 mm). Encourage physiotherapy with finger excercises.

October 12, 09 Painful swelling on right side persists. Masseteric Space infection. OPG and PA shows no residual root tip.

October 21, 09 Patient reports abscess draining intraorally (distal to #31). #32 socket not completely closed. Rx- Amoxicillan, Flagyl.



October 27, 09 Pus still draining distal to #31. Limited opening still at 10 mm. OPG taken..poor quality. Rx- Augmentin

November 11, 09 #32 Socket now healing. Trismus still present and swelling masseteric space (painful to palpation). Rx- Chlorohexidine Mouthrinse BID and finger exercises to increase opening.

December 10, 09 R side Masseteric Space swelling decrease in size, Max opening improved to 20 mm. No visible pus. Saliva normal flow and volume. Rx. Ibuprofen.

January 13, 10 Swelling reoccurs on R side Masseteric area. Pus discharge distal to #31. Opening decrease to 10 mm.
Tx- Curetted area distal to 31. No bony fragment, cyst, or tooth roots removed.
Intra-oral and extra-oral aspiration attempted but with no aspirate achieved.
Plan- refer to KNH for better imaging.



February 21, 2010 Patient returns with OPG (good quality). Shows mixed RO RL area in R condyle tracking near the IA foramen. Masseteric space infection increased in size and painful to palpation. Pus still draining intra-orally.

Dentistry's Workhorse

Although I would like to think that as a missionary dentist I'm always doing something dramatic like fixing a broken mandible, doing extractions in the Bush, or rescuing a teenager who avulsed a central incisor; the majority of my time is doing the same thing I would be doing back in the United States; good old fashioned class II amalgam fillings (dentistry's workhorse) to treat inter-proximal decay.



Amalgam fillings have a longer and seemingly more derogatory rap sheet than Mike Tyson, Dental Amalgams have been blamed for almost everything including Autism, Alzheimer's disease, Meniere's Disease, Multiple Sclerosis, Arthritis, Alopecia, Tennis Elbow, and probably even Athlete's Foot. It doesn't really matter how many studies have shown that Amalgam is safe, junk science seems to predominate. It doesn't matter how many case studies show that after removing dental amalgams neurological disorders fail to improve (there is always one vocal person who swears by this treatment). It doesn't matter how many materials experiments show that the mercury in amalgam form is inert, OSHA is making it more difficult on our profession to use this material (even though the risk of mercury is much greater from eating fresh Tuna Fish than from amalgam fillings.)




Now I'm first to admit these fillings are neither sexy, fashionable, and/or state of the art. I completely understand that many who have the time and budget are going to prefer white fillings on there back teeth. But dental Amalgam has been our profession's workhorse for the last 150 years. There benefits are many including strength (withhold chewing forces), long lasting, self sealing, easy placement (able to be placed in a wet field), relatively quick placement allowed (good for children), and lastly are relatively cheap. In the end in Africa these restorations are appropriate, cost effective, and serve the community at large very well. I have amalgam restorations in my mouth and they will remain. And, after a quick polish they don't look too bad.

The Obama Conga

Even as President Barack Obama's approval ratings decline in the United States he remains very popular in Kenya. President Obama's ratings in Kenya hover at around 94%. Obama chewing gum, Obama conga's, and Obama t-shirts can be found at about any rural Duka.



The Obamas are member of the Luo tribe; Kenya's third largest ethnic group. President Obama's father was an economist in Kenya. It seems that nearly everyone you meet is somehow Obama's "cousin." And I have been told that "President Obama is currently Kenya's honorary second president."

Butterfly Hospital

After learning about Monarchs (which mean King) and chrysalis at school Amelia took to our neighbor's backyard to find, catch, and capture butterflies.



Amelia and Meredith began to notice many of the butterflies they found had damaged wings. They decided it was time to build a Butterfly Hospital to help rehabilitate these insects. I asked Amelia how the healing was going, "Daddy we have almost healed one butterfly. We raise them up on one finger so they learn to get air under their wings again."

CMDA Brankenhurst Conference 2010

The past two weeks we joined over 250 missionary doctors, dentists, nurses, and community health workers from all over the globe at Brankenhurst Conference center for the 2010 Christian Medical & Dental Association African Conference. Joining us were over 60 lecturers from Mayo, Hopkins, Brown, Cleveland Clinic and other institutions throughout the West.



The conference serves three purposes. The first is to provide Continuing Education such that missionary doctors can retain their current licenses and remain up-to-date in the ever changing fields of medicine in their particular specialities without having to leave Africa. Throughout the two weeks Sara and I received combined nearly 90 CE hours (more than enough to retain our current State License) and we completed ACLS certification (of which Sara beat me on the test 96 to 88...I'm humbled once again by my wife). Sixty percent of the lectures are geared toward Western standard of care.

The second purpose is to provide educational topics that are relevant to doctors often working in high need and resource poor areas. Just a sample of the lectures included were sustainability in mission hospitals, dental extractions for the non-dentist, management of snakebites, effects of mobility on missionary kids, Help! my patient has a syndrome, culture shock; coming and going, traveling with infants and children, prevention of maternal to child HIV infection, and mandibular fractures workshop. Forty percent of the lectures are geared toward care in a resource poor area.

The third purpose is to provide professional and spiritual encouragement by gathering together and sharing our common challenges we face as medical missionaries.

The dental missionary community is small group and not well connected. I met a Bush dentist in the Horn of Africa who works with portable equipment in 130 degree heat. I met a dentist in Senegal who in 3 years has developed a full dental curriculum and fully trained nurses to operate a dental clinic. Sara and I ate lunch with an Oral Surgeon and his wife who served as a missionary in the first Dental School in India and is now coordinates heavily with CMDA and Project Med Send. I was able to pepper Oral Surgeons from the UK and Ohio State who serve on Mercy Ships in East Africa with questions regarding treatment of mandibular tumors and fractures. Our lectures (who donate their time, and travel costs) included OMFS, endodontist, and prosthodontist.

Sara gathered with other OB/GYN post-residents Sharon and Christina to find a cardiologist to help with treatment of cardiac disease in the pregnant patient. They had a long lunch with an MFM doctor to talk about treating high-risk perinatal patients in the maternity ward. They were able to talk about the ethics and management of treating infertility with a REI doctor.

We were encouraged and challenged by our lecturers and missionary colleagues around the world. Thanks CMDA for an excellent conference.

A mile wide; an inch deep

A description be it fair or not of the African Evangelical Christian Church is that the Church is like a lake that is a mile wide but an inch deep. The lake is a mile wide because a large majority of Africans would claim Christianity as their religion. 80% of Kenya claims to be Christian (remarkable considering at the turn of the previous century that percentage was less than 2%). There are Christian churches of most all types (gospel churches, pentecostal, reformed, bible churches, liturgical, etc.). Even the smallest villages usually have a Christian church and a lay pastor.

The accusation that the African church is an inch deep points I think to a perceived shallowness of theology, lack of discipleship, and marginal commitment of faith. But is this a fair assessment of the African Church? And who is to blame? If missionaries largely planted the churches in Kenya...is it the fault of their church planting strategies, their portrayed message (Western Theme), their discipleship, their taught theology? Yet missionaries in the early 1900’s literally risked their life to come to Africa..some were told to bring their coffins along (statistics showed that 1 in 3 did not return). It is through their courage via God’s grace that any form of Christianity caught on and the African church grew.

Some might say that the Gospel message in an African context somehow simply got lost. Some would criticize the church of legalism and moralism as issues of drinking, adultery, church attendance, and tithing are over consuming. Others might criticize the church of reductionist theology..your in, your out... saved, unsaved...with little interest in discipleship, caring for the poor, or evidence of fruits of belief.

The African Church just like the Church in the West I believe needs to acknowledge that the Lake is very very deep. We often linger near the shore wading in the shallow end without daring to go beyond where we can no longer touch. Look at Paul’s writings to Thessalonica with a strong emphasis of being ‘chosen’ by God:

For we know, brothers loved by God, that he has chosen you (1 thess. 1:4)
But we ought always to thank God for you, brothers loved by the Lord, because from the beginning God chose you to be saved through the sanctifying work of the Spirit and through belief in the truth. (2 Thess. 2:13)

as compared to the Gospel of John’s emphasis on ‘belief’.


Yet to all who received him, to those who believed in his name, he gave the right to become children of God. (John 1:12)
For my Father's will is that everyone who looks to the Son and believes in him shall have eternal life, and I will raise him up at the last day. (John 6:40).

This relationship of election and belief along with the Trinity, the Incarnation, Original Sin, the Cross are all incredibly challenging concepts to grasp and assimilate. But we must seek to do this through study, fellowship, education, podcasts, communication, prayer, etc. Indeed, today in a perhaps post-modern culture there is more urgency for all of God’s church to become a mile wide AND a MILE deep.

Getting together

Sharon (OB with me at Kijabe), myself, Stephany (pediatrician at Kijabe) and Christina (OB at Kapsowar) have enjoyed spending time together during the CMDA CME conference. We've shared some meals, walks, movies, lattes, and even a day shopping together. We've also talked about some of the unique challenges we have a female physicians and at the hospitals we work at. But more often we've talked about Sharon's upcoming wedding plans, Christina's friends coming to visit soon, Stephany's future plans... It's been encouraging and fun.

The Birds and the Bees

Well, we haven't had "the talk" with our girls yet, so here I am teaching sex education to the women attending Moffat Bible College. The first session encompassed female and male anatomy and sexual response. The next section focuses on contraception and the last session on sexually transmitted disease. In total I hope to provide 4-5 hours of education and answer questions.

While preparing these topics I came across several interesting quotes. Perhaps my favorite comes from Wheaton Alumni Billy Graham, "Sex is the most wonderful thing on this earth, as long as God is in it. When the Devil gets in it, it's the most terrible thing on this earth." The devil has certainly gotten into sex in Kenya. The average age of intercourse (per my Kenyan Medical Officers) is around 11. Mothers teach their daughters "how to handle it when he's unfaithful" rather than that a husband should be faithful. Sexually transmitted diseases are rampant. Teen pregnancy rates are high. Commercial sex workers are available only a few kilometers from the hospital. And before we get righteous, the numbers for the United States aren't much better (and in some areas worse).

Why teach sex education to the future pastors of Kenya? Well, they asked, but I also believe the church needs to talk about sex. Because God did make sex a very good thing, but intended for a specific context. And what better place, than the church, to call people to holiness and the avoidance of sexual immorality. Also, there are too many children, women and men who have suffered sexual abuse and the pastors need to understand how that can effect other relationships and show compassion towards those suffering.

Happy Valentine's Day from Africa!

I always wanted our blog to carry with it a good light-hearted sense of humor that most anyone could appreciate.

Amelia with her quick trigger finger, acute eyesight, and steady hand captured this photo on the Mara of (in her words) these "lions wrestling on top of each other. They sure are silly" (as Meredith and Amelia giggled). No birds and the bees talk as of yet, but you never know what type of education you may get on Safari. Happy Valentine's Day from Kenya!

Time For Cake

Malin turning a mighty 34 years old back on January 25. Hey, I figure I'm still closer to 20 than 50!



Sara blowing out the candles tonight (a belated birthday party) turning 29 of course!

Birthdays

Thank you to all who sent birthday cards to Malin and I. It's been fun to have mail nearly every day for a couple of weeks. We celebrated Malin's birthday with a lunch (just the 2 of us) in Nairobi in January. My birthday was right after the last D&C so we didn't celebrate then. But tonight we'll enjoy a cake made by Meredith and Amelia (with the help of Sharon) and then a movie with some friends after the girls have gone to bed.

Knelt

I’ve been uncertain about publicly airing my sorrow, our sorrow. But as the sorrow expands, it seems dishonest not to incorporate it into this journal of our time in Kenya. Also trying to hide this heartache as I try to cope with the demands of mothering, mission work, and treating numerous complex patients is exhausting. I also hesitate because I’ll be publicly admitting we want another child. And that may mean people wondering, asking and talking with us about why this hasn’t happened.

The truth is there is no good explanation for why I’ve lost 3 pregnancies in the past year. No satisfying reason that I can’t seem to get a pregnancy past 8 weeks. No comforting explanation for having D&Cs three times in the hospital here and certainly no understanding as to why this has happened. More over, I’m not sure knowing all the ins and outs about pregnancy, conception and fertility helps. And it definitely doesn’t help to be surrounded by pregnant women, some that don’t want to be pregnant, some that shouldn’t be pregnant, some that have tried to terminate their pregnancies and some that are also having a similar trouble.

The last loss was Feb 3rd, and in an effort to try to find some peace began reading a book entitled, “Praying our Goodbyes.” In it there was a poem by Robert Frost:

The rain said to the wind
‘you push and I ‘ll pelt.’
They so smelt the garden bed
the flowers actually knelt,
And lay lodged--though not dead.
I know how the flowers felt.

Suffering is part of life, most of us have at times felt so burdened or mulled by what’s occurred in our lives that we literally feel physically, emotionally or/and spiritually crushed. What has crushed you? I couldn’t even begin to list all the reasons for discouragement in life. How do you picture being crushed by the storms of life? Tears, laying in bed, unable to do everyday tasks, loneliness, depression, exhaustion? In the poem the flowers “knelt”.

Being knelt reminds me of prayer and while Robert Frost doesn’t describe how to overcome the torrents, I think the flowers have assumed the correct position. As one songwriter says, “I get on my knees, before the Lord that changes me. I don’t know how but there is power when we’re on our knees.” We trust with the psalmist in Psalm 145:14, “The Lord lifts the fallen and those bent beneath their loads.”

The weekend before the last I attended a conference themed “Woven together in prayer.” Our speaker Jill Davis, a long-time AIM missionary reminded us that weaving involves cutting threads, adding new colors and that one side often looks tattered and unplanned. But on the other side, is a beautiful work. God alone has the perspective to know when colors need changing, threads need cutting and a new pattern must be started. So in dealing with pain, kneeling also acknowledges the humility we must have before a sovereign God.

Proverbs 3 v 5-6. “Lean on, trust in and be confident in the Lord with all your heart and mind and not rely on your own insight or understanding. In all your ways acknowledge Him, and He will direct and make straight and plain your paths.” My insight and understanding into why this has happened and why this has happened here ad-mist so much other suffering, will always be limited. And I will not find peace continuing to ask, “Why? Why me?” Instead, I will try to ask and pray, “What is next Lord? Be near me. Lord, will you enable me to keep working here? Lord, please strengthen me for my children and husband. Comfort me.”

Baboons

Do you see our little Saturday morning visitor at our back door?



All that is left up our potato crop in our garden after we were gone for a couple hours. It seem a troop of Baboons dug up every single potato plant. The Baboons are very smart as they have been pawing at the soil in our garden but patiently waiting for the potatoes to become mature.


All that is left of our harvest. We were waiting just one more week to dig up our potatoes. Well maybe there is enough left for a couple french-fries.

Your mail is of great importance to us...

December, January, & February is a time of Christmas of course and also a time where our family celebrates 3 members birthdays. Our mailbox at Kijabe has been overflowing with birthday cards, christmas presents, christmas cards, birthday presents and notes of encouragement. Thank-you (even though we can't name everyone) your support is needed and appreciated.


Although the packages don't always arrive in the best condition to Kijabe. They do make it. This package just arrived and was post-dated December 11th in Littleton, Colorado.



The package came with a note from the Kenyan Post-Office. Surprisingly, all the contents of the package arrived!


The end product. The girls love their new dresses. (Thanks Auntie Ana!)

Mzee

We really have no word quite like Mzee (prounounced Muh-zay) in English..but my patient is a Mzee. The word has many meanings including old man, elder male, respected leader, dignified, chief, grand-father, and ancestor; but I think the picture describes a Mzee better than words can. This Mzee had lived with a dental infection that progressed into a localized abscess and then a draining fistula our of his beard since August. I'll never know whether money, travel, misunderstanding, or denial prohibited him from visiting us for so long. The smell pretty much matched the sight and I can't imagine living this way for so many months.


Sara and I both fight pus quite frequently in our professions here at Kijabe. Sometimes it seems like pus is ubiquitous and that we do not always win the battle. Of course many treatment options exist. You can prescribe antibiotics and hope the pus is eliminated. You can directly incise the abscess and drain the pus. You can aspirate the pus using a needle and syringe. You can washout the pus with the liquid of your choice. Lastly, and probably the best treatment if possible is to remove the source of infection (usually for myself a tooth, for Sara a uterus, ovary, ectopic pregnancy, etc.) the necrotic tissue.

Sometimes, in the case of the Mzee we try everything including antibiotics, aspiration, incision and drainage, irrigation with Chlorohexidine and removing the diseased teeth and hope and pray it resolves.