IMF

Although I'm now at a different mission hospital (Kijabe) the frequency of treating broken jaw bones has not decreased. Our treatment methods at Kijabe vary slightly as we also have the option of open reduction using plates and screws. This patient declined this surgical procedure and opted for the more standard fixation of the maxilla to the mandible using arch bars and wires for 4-6 weeks (more affordable option at 5000 KSH).

You can see the bilateral jaw fractured at the right parasymphyseal region and also near the mandibular angle on the left; and of course the giant discrepancy in occlusion between teeth #28 and #29 below.



The IMF in place below.




Four week post-op results are seen below. Appropriate occlusion present, and good approximation of the fracture sites. We will keep him in IMF for 2 more weeks to insure healing and then remove the wires.

A 2-Liter

No this picture is not the color of Coca-Cola Light in Kenya. This is actually our morning delivery of two liters of fresh, warm, cow's milk from Daniel. I know that the era of milk men and fresh milk at the doorstep has past for most, but thankfully not here in Kenya. We are happy to receive the milk from Daniel each morning, and he is happy to earn some extra Schillings by selling fresh milk. I have really come to enjoy unpasteurized, "unhormonized", thick, creamy cow's milk especially with a chocolate chip cookie on the side.

Are you scared?

"Scarrry, Scarrry, Scarrry," Meredith whispers as she lunges in my direction.



"It's OK. It's just me," Meredith say's as she reveals herself.

Rains have come

Kijabe for the first time in over 2 years has seen significant rain. Over the past two weeks it has rained heavily for several hours every evening. Almost overnight as you can see from the pictures like a Garden of Eden everything has turned brilliant green. Flowers are blooming and crops are growing. Local Kenyans are planting again and expecting a decent harvest from their Shamba. Water tanks are full. Dry river beds now have flowing streams. We have water in our pipes and with decent pressure.

Ultrasound

It's good to have some diagnostic equipment, but not so good when the people using it don't quite understand some of the implications of their findings. Many "technicians" end-up with on the job training and sometimes certain concepts get overlooked. Today, a patient was sent for obstetrical ultrasound because the intern couldn't find a fetal heart beat at 42 weeks. After hearing the story, I decided to wander to ultrasound to see if the baby was still alive. As the tech was measuring fetal bones, I asked if she had already seen a heart rate. Her answer, "Yes." What I should've asked was, "What was the fetal heart rate?" After watching a few minutes and seeing no movement and very little amniotic fluid I asked to see the heart beat. When it was found it was 80 and the tech said, "Slow, just like before." Given that normal is greater than 120 and it seemed the heart rate may have been braycardic for a while I grabbed the patient and said, "She needs a C/S now."

Thankfully the OR had a free room and within 15 minutes (which is nearly a miracle) a 4.0kg boy was born. While he has needed special care in the nursery he is alive and seems to be fairly neurologically intact. Praise God.

More than just a filling

Although I'm not an endodontist it seems like completing root canals is becoming my own dental speciality at Kijabe. My patients who are often members of the community here at Kijabe (pastors, nursing students, doctors, landscapers, shopkeepers) come when just a filling won't quite do. Regardless, were happy to help them out with needed endodontic treatment to get them out of pain. Some of you may know toothache pain (in particular a necrotic, irreversable pulpitis, or slowly dying nerve) is a terribly annoying discomfort. No one want to come for root canal or hear they need a root canal, but I make a few friends after the fact when they are out of pain. Furthermore, as the radiographs show from two patients from yesterday, I think we provide pretty good care.

We have closed...

Thanks for the many prayers for the sale of our house in Akron. 16 months after listing, many negotiations, and the hassle of trying to get many documents sent/e-mailed from Africa, it is official, our house has sold and belongs to someone else.

Mtn. Biking in Kenya

Cows are just one of the many obstacles when riding in Kenya. Others domesticated animals grazing the trails include sheep & goats (which easily move out of your way) and donkeys (stay clear of the back of these). More traditional African animals seen around Kijabe on the trails are dik dik, baboons, monkeys, and across the highway elephant (but I have yet to see these).

In my shoe

As my foot entered my shoe I felt something cold and hard... maybe a rock I thought. But then it began to wiggle. "Ahhhh" I pulled out my foot and turned my shoe upside down. Out I shook this not so little (nearly 4 inches long and thicker than my thumb) black and orange centipede? I now know (as I have previously been told by Africans) you must shake out your shoes before you put them on. At least I did not find a snake in my shoe.

"Word of our God Stands Forever"

The screams were heard at about 10:00 PM on a Friday night from outside our house. We soon found out a gas cooker had exploded in a timber built house just below Kijabe Hospital. It was a structure that housed 9 families; most of them hospital staff including one pregnant mother, a 2 week old baby, and many children. There is no fire department here, so the the hospital was immediately notified. A tractor hauling water from the hospital arrived much to late as all the homes were in flames. Thankfully everyone got out safely and there were no injuries or fatalities.

The following day the staff and I at the dental clinic walked down to survey the remains. We saw family members still sifting through the ashes and smoke for personal items (In Kenya almost all important documents including birth certificates, land titles, money, marriage papers, diplomas are stored at home). They were all lost in the flames. I talked to a father who had lived there, "The tried to come with water, but it was too late. It all happened so fast. We lost everything. But God will provide." We prayed together as a staff for these families who had lost everything they owened.

The Kijabe Hospital Chaplain has reminded us that we all need to help out these 9 families in need. It is easy to say, "He will help, or she will help, and if pass on the responsibility to others, no one will be helped." The dental staff has began filling a large action packer full of blankets, flour, soap, clothing, rice, utensils, plates, chai cups.

Thanks to many of your donations directly to our project account through Samaritan's Purse we have made a monetary donation to the fire tragedy fund to help rebuild their houses.

Lastly, I found this beautiful young Kenyan girl. She had found her Bible amongst the ashes. You can see in the picture above the pages of her Bible were crinkled, covered with ash, and burned around the edges; but the text is still readable. The fire took away her house and her belongings, but it could not take away her faith in Him.

The grass withers and the flowers fall,
but the word of our God stands forever."
Isaiah 40:8

Our prayers and support are with these families as they recover.

Addendum- Some have asked how can we help these families in need? Financial support can be directed to our Samaritan's Purse account #003548 and designate Friess/Fire Tragedy Fund and 100% of the donation will go directly to the families affected by the Fire.

Post-Resident Doctors from Africa Converge in Kenya

We enjoyed meeting our fellow post-residents from all over Africa. One couple has to purchase all the food they need for a year. Another family works as the only family on the mission compound. And while we shared our different experiences, it was clear that we also shared similar struggles. Struggles of isolation from family and friends, working in a different culture, and trying to manage the overwhelming work loads. Together we were able to talk about how we each coped with these things. We also just enjoyed the fellowship of playing together! We're grateful Samaritan's Purse provided this time for renewal and are back at Kijabe almost ready to return to work.




Pictured from left to right include (Dr. Hawk, Pediatrics Kijabe Hospital, Kenya - Drs. Gary & Leanne Finke, Pediatrics & Internal Medicine, Kijabe Hospital, Kenya - Dr. Tompkins & Family, Family Practice, Mukinge Hospital, Zambia - Dr Hoffman & Eric Hoffman, Ophthamology, Gabon - Dr. McGill & Family, Internal Medicine, Galmi Hospital, Niger - Dr. Morad (kneeling), OB/GYN, Kijabe Hospital, Kenya - Dr. Christina Francis, OB/GYN, Kapsowar Hospital, Kenya - Dr. Malin Friess (Dentistry) and Dr. Sara Cichowski (Ob/GYN) & family, Kijabe Hospital, Kenya- Scott Reichenbach- Boone, NC, Director of World Medical Mission's Post-Residency Program.

"Demolition for God's Glory"

For the past two months we have been in negotiation with a buyer for our house in Akron, Ohio. It has been on the market for 16 months. We thought we were nearing a final agreement when surprise hit. We knew our old two-story wooden garage had always been a weak point in our house. The garage door never worked, the structure was listing to the left, and had mold growing throughout the panelling.
According to the buyer's loan requirements the house simply could not be sold without the garage being demolished and cleared. As we began to receive quotes via e-mail for the cost of a demolition of a two story garage the prices were so expensive. What were we to do and how could we try to manage this situation on the other side of the planet?
We contacted our church in Akron Westminster Presbyterian Church and said,"We need help." Within just a few days a work team had been established, notice went out to request volunteers at the church, a dumpster had been rented at a discounted price, a min-excavator was available for hauling of debris and concrete.
Saturday morning several volunteers from WPC arrived early in the morning with sledgehammers and able hands to "Demolish for God's Glory." We were told the garage was demolished and cleared in less than 3 hours.
We are grateful and thankful to all the members of WPC who donated their time, muscles, and equipment to bring down our old garage. It seems to exemplify perhaps one aspect of the purpose of the church: to love and care for members of its congregation. Thank-you WPC.

Amelia Friess (1st Grade Class Picture)

Returning and update

It's always strange trying to change sleeping, eating and awake habits by 10 hours. But I'm thankful our family gets to spend next week together at a retreat with our mission organization Samaritan's Purse. Hopefully by the end of the week we'll all be sleeping through the night again.

I went briefly into the hospital today and received many warm greetings. Many also thanked God for a safe return and wonderful time with my family. I also received an e-mail from a patient when I returned. Many will remember me asking for specific prayers for Linda as she had a rare vaginal anomaly that we repaired. Below is the e-mail from her mother:

habari Daktari
linda is doing fine i just want to inform you that LINDA RESIVED HER PERIODS on saterday the flow is well no pains she is just okey and no complain it abit heavy but i think its just normal will come on 30 end month
have good time while saving other peoples life

God bless you
Beatreice and LINDA


I recognize that probably only a gynecologist could get excited reading that a young adolescent is getting periods, but it was encouraging to know that the surgery was successful. I attribute a lot of that to the wisdom God provided through the power of prayer.

Back in Kenya

Sara and Meredith arrived safely in Nairobi last night. We are thrilled to have them back in Kenya. Meredith has been telling me all about her fishing adventure in America, "Daddy, I go on Papa's boat and got the Ling Cod."

Ready to have our family back together

Sara and Meredith are currently in the air on their way back to Kenya and we can't wait to see them! We have missed them greatly and are ready to have them home.
Amelia's teacher told me the other day that she had asked Amelia what we have been having for dinner since Mom has been gone. Amelia told her teacher, "Well sometime me and Daddy have cereal for dinner, and some time we don't have dinner at all!"
I did take some exception to that remark as our standby meal has been hotdogs in the toaster oven, ketchup, carrot sticks, gatorade to drink, and boreos for desert.
Sara and Amelia are expected to arrive this evening. We pray they arrive Hakuna Shieda (no problems).

Herpetologist available?

After living in Kenya for nearly 11 months it is easy to forget you live in Africa. Amelia goes to a Western style missionary school. We have Wasungu neighbors. We often eat traditional American foods like pizza, hamburgers, and peanut butter and jelly sandwiches. And finally, most people around speak english Yesterday I remembered, "Oh yes we are still in Africa."

As I came home from lunch I heard Nancy our helper scream as she exited our front door. She was holding Mocha's sleeping blanket in the air and had a broom in the other hand. As she pulled out his blanket out crawled this snake. Before I could do anything the gardener next door smashed the snake's head with a shovel. It continued to squirm for several minutes and of course Amelia and her friends were quite amused as they continued to aggravate the dying snake by poking it with a snick until it would twist.

Oh, I thought no big deal must just be some ordinary snake. Why did the gardener destroy it so quickly? But wait, we are in Africa home to some of the most dangerous snakes alive including the puff adder (strikes incredibly fast and holds it victim), black mamba (its venom is a potent cardio and neurotoxin and can kill in as little as 30 minutes), gaboon viper (has the longest fangs and highest venom yield (1000 mm) of any snake), and the eqyptian cobra (preys on rats and chickens).

I imagine this was most likely a non-venomous snake. But if anyone out there can identify the name of this snake it would calm all our nerves, including our poor dog Mocha.

Words shared this morning at church

I had the privledge of sharing with 1st Reformed Church of Oak Harbor this morning. And thought perhaps others might like to read what I shared, so below is the meditation.

He leadeth me: O blessed thought!
O words with heavenly comfort fraught!
Whate'er I do, where'er I be,
still 'tis God's hand that leadeth me.

For some reason the words to this old hymn written during the civil war keeps coming into my mind as I work at Kijabe Hospital, Kenya as an OB/GYN. I usually only remember the first verse and find great comfort knowing God is leading me as I see each patient and treat many problems I have only read about, but as I reflected on what to say this morning I felt an urgency to read the rest of the hymn and so this is a meditation based on He Leadth Me.

Sometimes mid scenes of deepest gloom,
sometimes where Eden's bowers bloom,
by waters still, o'er troubled sea,
still 'tis his hand that leadeth me.

Scenes of deepest gloom… generally finds me daily. I entered the field of OB/GYN because generally it’s a happy field, babies, young moms, patients that live; this is not true though in Kenya. The week before we delivered 3 dead babies in 24 hours. I’ve had to perform C/S on dying mothers. I’ve diagnosed more cancers than I saw my previous 4 years in residency. At least 12% of my patients are HIV positive. Still

Lord, I would place my hand in thine,
nor ever murmur nor repine;
content, whatever lot I see,
since 'tis my God that leadeth me.

Because the fact is that this God that leads our family loves us all dearly. God has called us and brought us to Kenya. Sometimes that means living without running water or electricity. Other days it means staying awake many hours to care for patients. It means being away from family and friends that we love. But also it means that God is leading Muslim, Somalian patients to Kijabe hospital. Imagine, we get to work in one of the most developed mission hospitals, there’s a school on premises for our children, and God is bringing 25% of our patients from a completely un-reached people group from a place I would never want to live.

And when my task on earth is done,
when by thy grace the victory's won,
e'en death's cold wave I will not flee,
since God through Jordan leadeth me.

Can you exclaim with the hymnist what a blessed thought…God leads us. Or sing with David in Psalm 23: He leads me beside quiet waters, even though I walk through the valley of the shadow of death, I fear no evil for You are with me?

It’s profound: God leads us. So the question really is, “Are you willing to be led?” I don’t know if God is leading you to or away from, into, through, beyond, around or near. As a family we are also not sure where God is leading us in 1 year… maybe into career missions, maybe back to the States, maybe to another country or further education, but we are confident God will lead and that IS a comforting thought.

"Worstest Day Ever"

A moment in the eyes of a 6 year-old girl.

"Daddy I went to check on my bunnies and Flower is moving but Lucy is just laying there but I'm not sure if she is alive because her eyes are open." I followed Amelia to the bunny cage and indeed Lucy was dead and stiff and lying on her back. Of course the tears began to flow from Amelia when I told her.

"Daddy I don't know how this happened. I fed him every day. Maybe he needed to see a veterinarian. Daddy, this is the worstest day ever!" We buried Lucy in the garden so Amelia will see the grave every day on the way to school. She lined the grave with rocks and made the letter "L" in the middle.

I said whatever words I could for the bunny rabbit. "Lucy you were a good bunny. You lived about 6 weeks here with us at Kijabe. You always ate the carrots we fed you. You never scratched. We will miss you."


But just minutes after we buried the bunny. Amelia's tears all stopped. She was ready to play at a friend's house and has quickly moved on. Amelia wants to get another bunny, maybe a bigger stronger one this time. I think we can manage as Lucy cost 100 Ksh (about 120 cents).

Jane

Jane was fearful and in denial about her condition several months ago when she came to Kijabe. The swelling was present for 3 years and was hard to touch (intrabony swelling of the mandible). After clinically examining the size and extent of her swelling in her lower jaw and radiographic examination she seemed to have a dentigerous cyst. Dentigerous cysts are odontogenic cysts associated with the crown of an impacted tooth. From the radiograph you can see how the radiopacity it closely associate with the right third molar displaced to the inferior border of the mandible. Treatment requires surgery to enucliate the cyst wall, drainage of the cyst cavity, and eventual decompression of the mandible. Prognosis for this surgery is very good with full recovery of function and aesthetics.

We didn't see Jane for several months and it was unknown whether she was understandably fearful of the surgery or had not yet raised sufficient funds. She finally reemerged and we treated her in theatre with a general surgeon. After reflecting the gingival tissue and opening up the mandible into the lesion we were quite surprised. The lesion was full of blood and fibrous tissue instead of straw color cyst fluid as we had expected. The wall of lesion did not dissect smoothly off the margins of the mandible like a cyst lining but came apart in pieces. Furthermore the inside of her jaw continued to bleed forcing us to pack the inside of her mandible with 5 4x4 gauzes and leave the wound exposed.

Jane recovered quickly. Unfortunately her biopsy came back positive for Ameloblastoma (a more aggressive pathology). In retrospect examining the x-ray more carefully shows resorption of the 1st and 2nd molar root tips (perhaps indicating a more aggressive pathology) which might have led us to approach this differently. Her surgery although perhaps arresting lesion is non-definitive and she has high probability or reoccurence. Jane will require further more aggressive resection of her mandible. We have seen her once since, and hope she will agree to further treatment.

(Radiograph is inverted)