A wheelbarrow

      It always strikes me how resourceful the Kenyan culture is.  Nothing is thrown away.  Anything and everything can be used for some purpose.  

   These boys greeted us on a hike nearby Tenwek.  I'm not sure what they planned to carry in the Wheelbarrow, but they were rightfully proud of their tool.

OPG

A prominent need was filled at Tenwek Dental Clinic this past month thanks to many of your generous donations.  People had prayed for many years for an OPG x-ray machine.  God has provided.

      After being in contact with the Massachusetts  Dental Society Dr. Kuyaya found that an Orthopantomograph OP-100 was available for donation by Dr. Miller.  

      What is a panoramic x-ray?  You may have had this x-ray taken before you had your 3rd molars removed.  An OPG or panoramic x-ray (see picture) gives us exactly that; a panoramic snapshot of the the entire oral region.  It is crucial x-ray for diagnosing jaw fractures, finding oral hard tissue malignancies, and locating 3rd molars.  Our treatment at Tenwek is probably upwards of 50% oral surgical procedures.  An OPG is standard in an OMFS office.  

      Tenwek Hospital and this region of Kenya has never had such a machine.  They are costly (20,000 USD).  Dr. Miller graciously donated this machine free of charge, with one catch--shipping!

     As you can see shipping a machine about the size of a telephone booth is not an easy endeavor.  After discussions with Northwest Airlines, World Gospel Mission, Samaritan's Purse, Dr. Miller, and volunteers with the Massachusetts Dental Society we discovered that the machine could be dismantled, crated, and air-freighted for 1100 USD. 

      It was fantastic.    With the help of WGM it cleared customs at Kenyatta National Airport with no further charges as it was marked as a donated item for a Christian Mission Hospital.  The machine as the picture shows arrived by Lori in great condition and careful lifting.  It was soon mounted, installed, electrically converted to Kenyan voltage, and is now in use.  We are using this machine 20 times over per week.  We feel like we are no longer working in the dark.  We also hope it will allow Tenwek Dental to become even more of a referral center.

      Thanks so much for your donations.  Your financial and prayer support is changing the way we do things here in Kenya.  --the Dental Staff @ Tenwek

Our Meredith Hobbit

Definition of a hobbit: gentle, peace-loving, two-to-four feet tall, roundish, jovial face, shortish in the leg, small feet, like to eat two breakfasts.

      Our sister Ana noted that we were raising a hobbit.  Our Meredith eats two breakfasts (first cereal at 6:30 AM and then toast and eggs at about 7:30 AM) and also two lunches (first what we are having and then Ugali; a Kenyan staple of mashed corn.) 

     We are thankful for your prayers as Meredith has fully recovered from her two week sickness from Giardia.  She is keeping everything down she can find.    She is eating, and eating, and eating..even if this picture shows a sad face.  We happily allow her second breakfast

Very Severe Case of Rosacea

Erick Langat; my story

Let me share with you Erick's story.  I find Erick to be talented, and hard-working.  We are praying to find a way for Erick to be able to attend Dental School.

     "My name is Erick Langat. I was born in 1979 in the village of Koijat just 80 km from Tenwek Hospital in Southwestern Kenya.  I am of the                                                       Kispsigis Tribe. I was raised to speak English, Swahilli,                                                        and KiKipsigis.

            In 1997 I finished secondary school in Kakibei.  Even then I was uncertain about my future, but applied to Kenya Medical Training College in Nairobi.  Despite only three open positions for KMTC per district by God’s grace I was accepted.  

In 2003 I finished my studies at KMTC and graduated as an Oral Health Officer.  An Oral Health Officer is trained to treat the basic needs of the Kenyan People.  I am competent providing patient care with dental extractions, scaling of teeth, dental exams, and community dental education.  

After completion of my training I entered internship.  In 2006 I was offered a full time position to work at Tenwek Mission Hospital. I took on the responsibilities of Tenwek Dental Clinic as Dr. Kuyaya the full time Dentist was to leave for South Africa for two years for masters training in restorative dentistry.

I have been content working at Tenwek ever since.  I am happy here as my duties include organizing dental community outreach, tooth extractions, full mouth scaling, dental exams, taking x-rays, and keeping statistics.  

Despite my happiness I feel like God has even more left for me to learn.  I want to expand my training to include fillings, biopsy, crowns, and root canals.  I have a heart for my Kipsigis’ people and felt directed to attend dental school to better serve them.  

Following God’s calling in 2007 I applied and was accepted to Moi University School of Dentistry (one of only two dental schools in Kenya).  I was unable to afford tuition.    Tuition at Moi University is about 450,000 KSH annually (5,800 USD).  My total annual salary would cover less than half that amount.  Student loans are not available for me here in Kenya.  

I sought out funding through Tenwek Hospital with the understanding that for each year of dental school I am supported I am bonded to the hospital for 2 years.  The funding was not available so I was forced to  defer my enrollment.

In 2008 I again sought help from Tenwek Hospital for tuition assistance unsuccessfully.  I was encouraged to apply to a more affordable dental school.

I have currently applied to Makerere University School of Dentistry in Kampala, Uganda.  The tuition is 200,000 KSH annually (2,500 USD).  I will be notified of my acceptance in August.

If I am able to secure funding for entrance into dental school I see myself returning to Tenwek Mission Hospital to serve the Kipsigis people.  I am a Christian and was baptized in 2005.  God has changed my life.  Before Christ I felt like just a human being, a person of the flesh.  Now I feel I am living the Christian Life.

While seeing patients I am lifted up by God’s love.  In our busy dental clinic with patients with complicated dental fractures and infections it is easy to be overwhelmed.  Jesus to me is about help.  When I am burdened I look to Paul’s words in Romans Chapter 8:31-32.

Kimwal nel anyun eng’ tuguchuto? Ngo mi Jehovah Komostanyom, Ko ng’one Kinndaech?  Inendet ne ki ma nire Weririyi ago Kigon inendet agobo achek tugul, tos magonech tuguk tugul eng’ aiybindo koboto inendet.

(What then shall we say to this?  If God is for us, who is against us?  He who did not spare his own son but gave him up for us all, will he not also give us all things with him?)

My faith has called me and inspired me to help the poor at Tenwek Hospital in Kenya.

Docotoriae, they have a patient they want you to see

"Doctorie, "  Erick our Oral Health Officer said as I was in the process of completing a root canal.  

"They have a patient they want you to see in Casualty.  He was attacked by a buffalo."  Erick completed the sentence casually just like,  Doctor Friess the patient for the filling cancelled.

     "OK, I think I'll take a break here and go see this patient."  

I walked to Casualty (ER) to find Mamusi Saii and his father dressed in their traditional red Massai blankets.  

        Mamusi is 16 years old.  His story was that a Cape Buffalo (perhaps the most dangerous animal on the Mara) charged him and picked him up in the air.  During the course of this Mamusi's spear gouged his cheek.  He suffered multiple lacerations to his face, swollen eyelids,and a fractured jaw.  Dad and I saw the patient together.  His eye was responsive to light and intact.  His mandible was fractured at the angle.  

      Erick and I spent the morning wiring his teeth together to stabilize the mandible to allow healing.  Mamusi was extremely courageous.  The entire procedure was done under local anesthetic.  

        He seems to be healing well just 3 days after the attack and plan to send him back to the Mara today.  I hope he stays far away from any further encouters with a Cape Buffalo.   

Ponga

One thing you never want to hear your child say, "Mom, Meredith has a ponga. Mom, Meredith has a ponga! Come!" The landscapers had left a ponga (machete) out and Meredith was running around with it as Amelia chased her and tried to get it out of her hands. Thankfully no one was injured. Meredith was carrying the ponga by its blade and swinging it around. We'll have to remind the landscapers to put these away and out of reach of a 2 year old (or any child for that matter)!

Barbies

When Amelia invited most of the Kenyans in our neighborhood over to play Barbies I was a little curious what they would do. So when I went to check on them and I heard Amelia say, "Alright, Pastor Ken is ready to preach," I was reassured. Indeed the girls made a congregation, church building, pews, and pastor (although I thought it would have been great if the pastor was female). Not to mention they spent hours getting the barbies all decked out for the church service. 

Desperation

Terminating a viable pregnancy is illegal in Kenya. Consequently women go to extreme methods to terminate "unwanted" pregnancies. We had three patients admitted this week for this reason. The first patient was in septic shock, the second patient in renal failure and the third patient in acute respiratory distress. Each woman, eventually shared why she did what she did and the intense remorse each felt. 2 of these women are still in critical condition, and the most critical care I can give is assuring them of God's love, forgiveness and desire to enter into relationship with them.

Preventative Dental Care in the Bush

     Preventative Dental Care such as teeth cleaning and check-ups are a foreign concept in Kenya.   Typically the only time a Kenyan patient comes to our clinic is when there is a major problem; swelling, pain, bad odor, bleeding gums, or a gigantic portion of their tooth missing,. 

      It was a pleasant surprise to meet Jonathan, a Massai who took interest in caring for his teeth. After I told Jonathan I was a Doctoriae Wa Meno-- (Dentist), we visited the Pepper Plant.   He broke off a branch and we stripped the bark from the limb.  "This is a Massai toothbrush.   Scrub your teeth and you will taste the pepper."

     I'll admit the Pepper Plant toothbrush had a winter-fresh flavor similar to Colgate.  Jonathan worked his toothbrush for the next 30 minutes.   

       

Family

We've had a good visit with Nana, Papa, and Auntie Ana. We've able to tour a tea factory, see some animals, visit an orphanage and take some hikes. My parents brought many donated dental supplies which Malin has been busy organizing. They also received some money which we used to buy groceries for an orphanage. Stuffed along side the dental equipment were baby hats made by Westminster Presbyterian Church, our church in Akron. Yesterday we enjoyed picking out hats with the mothers in the NICU for their babies. Its a privilege to share in these tangible expressions of God's love.

Chaff in the Wind

Isaiah 40:21
Have you not been paying attention? Have you not been listening? Haven't you heard these stories all your life? Don't you understand the foundation of all things? God sits high above the round ball of earth. The people look like mere ants. He stretches out the skies like a canvas— yes, like a tent canvas to live under. He ignores what all the princes say and do. The rulers of the earth count for nothing. Princes and rulers don't amount to much. Like seeds barely rooted, just sprouted, They shrivel when God blows on them. Like flecks of chaff, they're gone with the wind.

   

Happy Easter!

      Mom, Dad & Ana were welcomed to Kenya by a 6AM sunrise Easter service service. After a time of prayer, scripture and reflection we placed flowers on the cross. It was truly beautiful to see the sun rise over this cross and rejoice because Jesus is alive. 

We also gave thanks because the rainy season has started. Drought is affecting most of Kenya, but our area is receiving rain vital for crops, animals and people. This rain also replenishes the river and waterfall that provide our hydroelectric power. 

The girls are holding dolls Nana brought for them. Amelia diligently changes her doll based on the weather and time of day. Meredith also carries her doll around and reminds Amelia, "No, sister this is mine." 

A Tree that grows Missionary Kids?

      Amelia (hidden behind the branch) always enjoys a trip to the guest houses in Nairobi despite the 4 hour drive.  The new friends she finds are always worth the travel. 

Family arrived

Thanks for all who prayed for a safe arrival for Mom, Dad and Ana. Also, for those of you that prayed for Meredith, we give thanks she is better. In fact, she's "trying" to put back on the 5 pounds she lost quickly. This a.m. she ate 3 breakfasts starting with cereal, then trying eggs and concluding with yogurt and granola!

We're going to a village market today to get some groceries and fabric. I'm also hoping to arrange a trip to an orphanage and tea factory. But overall the best part about having family around is just being together. 

 

Exodontists...

     There is an unfortunate "profession" that has developed in the rural of areas of Kenya.  These "professionals" call themselves exodontists.  They are men who are unlicensed and without training who extract teeth with dirty pliers, in dirt floor shacks, often without any anesthesia.  

    This is Chepkorono.  Chepkorono surprisingly, had already had her tooth removed.  She visited us one week after seeing  an exodontist not to far from Tenwek.  As you can see she has not healed appropriately.  It is likely that she has developed a massive submandibular cellulitis due to the use of dirty/contaminated instruments.   Sadly all in attempt to save a couple Shillings.

    By the time we saw her Chepkorono was quite sick with fever, fatigue, and naturally lots of pain.  Eventually this type of swelling can be life threatening if it begins to impinge on the trachea.  

     Chepkorono was taken to Theatre and a small incision was made below her mandible to drain out (burst out) cc's of foul smelling straw colored fluid.  This was repeated again the next day.  She has made a full recovery..and has promised to visit Tenwek for any further dental care.

  

Stress

Meredith has still been vomiting the past 2 weeks. Although she's keeping some food/liquids down it's been stressful seeing her sick, waking up at night to care for her in between being called to the hospital and hoping that we are treating the right thing (giardia). She's laying on the couch right now, quietly sucking her thumb. Meredith is usually moving all over, even in her sleep. 

Call has also been particularly challenging. Not just the volume of on-night call, but the complexity. Last night a patient in her third trimester came in with pulse of 200, respiratory rate of 60 and sat of 70%. She was in thyroid storm and I wasn't sure that I could stabilize her with the limited medication supplies we have. Thankfully she lived through the night. 

So I'm grateful that the next 10 days I have off to spend time with my parents and sister who arrive Friday. Time to take more care of Meredith. Time to read and research more about certain obstetrical issues. And time to prepare for the Easter service this Sunday where we are reminded that Christ loves us. 

Goodbye to Grammie

Grammie left Monday and after a 4 hour drive to Nairobi, 10 hour wait until her flight, 8.5 hour flight to Amsterdam, 4 hour layover in Amsterdam, 10 hour flight to Seattle, 6 hour layover, and then a 1.5 hour flight to Bend, Oregon, she made it safely home and slept. It's not easy to get here, but we promise it's worth the trip!

Sparkly Eyes

     Amelia Kate Friess enjoyed the spotlight as child of the week at Tenwek's MK school.  She shared with the class:

1) My favorite color is pink.

2) My favorite food is fruit. (it use to be french-fries)

3) My favorite activity is climbing trees.

4) When I grow up I want to be a veterinarian, gem scientist, and "Planet Earth" movie maker. 

5) My favorite flower is the rose.

6) My favorite holiday is Christmas.

7) My favorite pet is my fish Buluga.  We left him in Ohio.

8) My birthday is July 26, 2003.

9)  She has a new nickname from the boys.  The call Amelia Sparkly Eyes.

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. 

Family

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.

Kiswahili

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. 

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

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.

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.

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.

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.

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.  

     

Expect the Unexpected

     John was my first patient.  He is 65 years old, five feet tall, and likely under 80 lbs.  He is emaciated, sickly, and dirty. The inside of his mouth was covered with a white film. He has Oral Thrush-often an indicator of HIV+ status.   I told John we needed an HIV test.  Surprisingly, he wanted to know his status, considering the stigma of HIV in Africa. 

     Lillian was my last patient.  Her mouth would not heal properly months after having several teeth removed.  We took a biopsy two weeks previous.

      The nurse returned with John's HIV status report.  What had I done?  I'm a dentist not prepared to counsel John medically, emotionally, spiritually.  The test was negative!  What a joy to give John this good news.  "I want a copy," he said, "to show everyone.  The doctors always told me I had HIV.  Praise the Lord!"

      Lillian's biopsy came back positive for multiple myeloma; a bone marrow disorder that we are unable to treat at Tenwek. Her prognosis is poor.  I shared with her our findings--feeling inadequate and discouraged.  We hope she can get to Nairobi for treatment.  We don't know.  We pray she will find treatment, and comfort in a God who can give her rest.

     Expect the Unexpected my college soccer coach would say. Two agreeable Kenyans, their life changed in a moment.   I get to be a part of God's puzzle.

     Have you figured out the picture?  This is the hand that welcomed me to Tenwek Dental Clinic: Dr. Peter Kuyaya BDS.

All I have needed....

"Great is the faithfulness, Oh God, my Father, morning by morning new mercies I see... all I have needed thy hand has provided, great is thy faithfulness Lord God to me." As we work and live here this hymn frequently comes to mind. This past weekend we received our visa renewals, got our groceries, were able to arrange a ride back in 15 minutes after our plans to come back with another family fell through (the family got stuck in Thailand), the girls ate ice cream and swam and we moved into a home with a piano. Some of these things were necessary, some were just fun, and I believe all God provided. It's common to give God credit for the big things, miraculous healing, safety while traveling, healthy children, but I believe God cares about our "smallest" needs as well. For me this is access to a piano, for the girls some ice cream and Malin being able to play racquetball at Tenwek.

Valentine's Day & Immigration

  The girls decorated cookies and passed out valentines.  Lots and lots of pink and red!

    We received good news at Immigration in Nairobi.  On our last day of legal residence in Kenya as a family at 3:00PM our Visa extensions were approved!  We can be in Kenya for another 90 days.  We are indeed happy to be staying here serving God at Tenwek Hospital.

     

An Atheist sees that Africa needs a Loving God

I wanted to share an e-mail from my sister regarding the need for God in Africa.  It is written from an Atheist perspective.  

   Matthew Parris of the NYT writes,         "I've become convinced of the enormous contribution that Christian evangelism makes in Africa; sharply distinct from the work of secular NGO's, government project and international aid-efforts.  These alone while good, will not do...In Africa Chistianity changes peoples hearts.  It brings a spiritual transformation. The rebirth is real."

     "I used to avoid this truth by applauding  - as you can - the practical work of mission churches in Africa.  It's a pity, I would say, that salvation is part of the package, but Christians working in Africa, do heal the sick, do teach people to read and write; and only the severest kind of secularist could see a mission hospital or school and say the world would be better without it.   I would allow that if faith was needed to motivate missionaries to help, then fine; but what counted was the help, not the faith."

     "But I noticed, The Christian Nationals were always different. Far from having cowed or confied its converts, their faith appeared to have liberated and relaxed them.  There was a liveliness a curiosity, an engagement with the world- a directness in their dealings with others- that seemed to be missing in traditional African life. They stood tall."

Church at Bethesda Chapel

     Bethesda Chapel our place of worship in Kenya is located inside the Tenwek Hospital Compound.  Bethesda Chapel is attended by hospital staff, visitors, and our friends the Kipsigis.  

Sara was immediately added to the worship team.  She plays preludes, hymns, praise music, offeratories...and sometimes wearing Scrubs when she is on call.  I have joined the team as a Conga player.

     The services can be long, so occasionally Meredith joins Mom on the piano to "turn pages."   Amelia has learned to hold a hymnal and find the right page.   The worship music is combined English and Swahilli, but thankfully the sermon is in English.   

      The second picture was taken on December 25th.  This is our Mary holding baby Jesus.  A reminder that the Incarnation is real and relevant to every tribe and nation.

Before & After

This is Paul.  Paul walked into Tenwek Dental clinic back in November my first week in Kenya.  It became clear that dentistry would be a much different in Kenya.

Paul's lip had been growing like this for the past three years.  It was not painful but certainly affecting his self esteem.  We took x-rays (we have no panoramic machine available currently) and diagnosed this lesion as a benign nasopalatine duct cyst.  

      Paul was operated on in January along with the help of an OMFS.  He was indeed happy with his results and proud to pose for this picture two days after his surgery.

Stuck in the Mud

Wednesdays the dental team and eye team drive the Tenwek bus out to rural health dispensaries for outreach.  The dental team provides extractions of diseased teeth and the eye team screens for cataract and glaucoma.

   Last week after a successful trip (we saw over 25 grateful patients) our driver choose a different route back to Tenwek. As you can see the bus got stuck. We pushed,  Leonard (our dental technologist) pulled, we dug out tires, we placed rocks under the wheels--all without luck. 

   We prayed and down the road came a tractor with a chain.  We were back on the road.

      The next day I gave a lecture on Dental Triage--and suggested before we can do outreach to patients, it may be the dental team that needs to be reached out to in the first place. 

Off to Nairobi

We're leaving early tomorrow to renew our visas in Nairobi. Tomorrow is actually the last day we're allowed legally in country on our current visa. So we're praying for a smooth trip and ease at immigration. The girls are particularly excited about this trip because we are going with the Crognale family to a pool on Friday for fun. Amelia claims she is ready to learn to swim better and Meredith already dunks herself in the bathtub. Malin and I are just hoping the weather is hot and the water warm. 

Our grocery experience, is well, always an experience. Friday we head to the local version of Walmart "Nakumatt" and buy all the non-refrigerated items. Next we go to Guilliani's to order our meat and have it frozen for our trip back to Tenwek. I imagine it's like a trip to the deli in the early 1940s. Individual service, every cut imaginable. And the most ironic part is that hamburger costs the same per kilo as a steak. It's all part of the same cow. But since meat is expensive we're eating a lot of vegetarian meals, pumpkin soup, quiche, rice and beans, etc. Saturday we buy the odds and ends we need. Sunday it's time to pick-up our meat, and go the green groceries for veggies and fruits. All and all I find it exhausting to think ahead for meals for the next 6-8 weeks. But it does mean that I will be out of pager range and truly able to relax (after we arrive safely from the drive). 

Avocados

There are an abundance of avocados in "our" front yard. The girls love collecting them after the boys have climbed up the tree and knocked them down. Amelia brings them to me as gifts. Meredith tries to pry them open with rocks and plays with them. We enjoy avocados. 

Next weekend we head to Nairobi to renew our visas. That means we will have been in Kenya 3 months. We'll also get our 6-8 week supply of groceries.  Amelia and Meredith's 10 favorite things about Kenya, in their own words:

1) "The river and waterfall near our house."

2) "That the trees are easy to climb."

3) "The mangoes are so good here."

4)" Chai in my cup!"

5) "Playing with friends."

6) "Making forts in the bushes."

7) "There are rocks here that are sparkly."

8) "That you can find Chamelions on trees."

9) "Janet and Rose" (our house help)

10) "Going to school with my friends."

A Memorable 31st Birthday

After being on-call the night before I woke-up to a page. Malin got-up as well and said, "Happy Birthday" and gave me a stone he purchased in Tanzania (any guesses as to the type?). After receiving cards from the girls, I round and then work on knot typing with the new interns. That brought me to lunch. We're sitting down as a family to eat tacos, one of my favorite things Janet makes, I get a phone call,"Daktari there are two emergencies; come to casualty."

Running up the hill again. There in casualty is a 20 year-old pregnant woman brought in for eclampsia coding. I ask how long she's been down, no one knows but they think around 5-10 minutes. Asking for a scalpel and gloves I perform what I hope is a peri-mortem C/S. We stop resuscitating her and begin working on the baby boy. I wish I could say we were successful....I believe the mother actually died prior to beginning our resuscitation efforts as did the baby. We found the family and talked to the husband and brother. The brother says this is the husband's 2nd wife and child to die from eclampsia. After praying we take him to see his wife and son. There are no words to explain the grief.

Remembering there was a second emergency I go to the OR. Dr Hage, a visiting MFM, explains that this woman also coded, but was resuscitated and they have nearly completed the surgery for the ruptured ectopic pregnancy. I ask if there is anything I could do, "She needs blood," replies the anesthetist. She's O-positive and I head to blood bank to see how much they have. Only one unit left, she needs more than that, so I give a unit of my O-positive blood. It's now 4pm, Malin walks me home.

After some chai, I'm feeling well, and prepare for my "surprise party." At least Malin made a tremendous effort to surprise me, but accidentally sent me the e-mail describing the surprise party. We head to the kipiganga for cakes, pies, fellowship and a singing program put on by the girl missionary kids. Amelia sang her heart out to "Doe, a deer..." from the Sound of Music and then led us all in Hookie-Pookie with her friends, Emma, Claire, Elizabeth and Bella. It was a delight.

So, what is most memorable about this birthday? The tragedy of this woman and baby's death and learning this am that the woman who received my blood also died are inescapable, but in the end God has provided Malin, Amelia, Meredith and friends at Tenwek to encourage and support me. Furthermore we have family and friends back home also praying, sending packages and letters to encourage us. So, what stands-out most to me about this birthday is God's love. God's love for me, for our family, for the patients and their families, and my prayer is that you would also know how deeply God loves you.

Happy Birthday Sara!

Sara: Wife, Mother, Doctor, Pianist, Friend, Daughter, Sister-is 31 today. Happy Birthday Sara! We love you!

Ballet

Amelia, Meredith and her friends, Elizabeth and Bella enjoyed "ballet dancing" this weekend. We are so thankful for the friendships the girls have made here. Today Amelia added to her animal collection a frog. This frog joins the slugs, chameleons, grasshoppers and other creatures we've had living on our porch. I did awake to Amelia screaming one morning, "Jumper got loose!" That meant the grasshopper was hopping around our living room. (If you come visit, we did find Jumper and he's back outside.)

Most of the time I awake to other phone calls, "Daktari the patient is seizing", "Dr.Sara the patient needs a c-section", "We have a patient who is bleeding," "The placenta is stuck," "This patient doesn't look good," "Our patient's status has changed...." And as I get into my scrubs, coat and work shoes..... Amelia knows what this means and often asks, "Are you going to deliver a girl baby?" Meredith knows what this means,"Kisses mommy, kisses. " But often I don't know what I'm going to find and for the 1/4 mile walk up to the hospital I'm anxious. A lecture was given yesterday on how to present patients to the new interns hoping this would help us anticipate better what we are called to. In all honesty though, I think that there will always be times I'm not entirely certain what to do. For example this past weekend a mother came in with 2 wiggly feet presenting for delivery---c/s or vaginal delivery? I had never seen feet kicking at me from this perspective before; (I choose to deliver vaginally and thankfully all went well.) This can be true of parenting and marriage as well. Sometimes we don't know what. And so, we talk to friends, read books, research and most importantly pray.

Delivering a Miracle

Do you believe miracles still occur today? Webster defines a miracle as:
1: an extraordinary event manifesting divine intervention in human affairs
2: an extremely outstanding or unusual event, thing, or accomplishment
3: a divinely natural phenomenon experienced humanly as the fulfillment of spiritual law

I was on-call Monday night and the phone call I received went something like this, "Daktari, that patient with ISS (code word for AIDS), I'm calling because she coded." My response, "Keep her alive until I can get there for the C/S." Running up the hill to the hospital I'm praying. This woman has been admitted for the past 2 weeks because of nausea, vomiting, active TB, severe fetal growth restriction, HIV encephalopathy, and wasting. Her pregnancy is only 30 weeks. I find her with agonal breathing explain quickly to her mother I am going to deliver the baby to save the baby but it will likely lead to her death. She's intubated without any muscle relaxation and minimal sedation. The baby boy weighs only 1200 grams but is alive. We all agree she has to be extubated because the situation is hopeless. The tube comes out, she breathes shallowly. Off to the ICU to spend the night. I hang a big sign over the bed DNR: Do Not Resuscitate. I check on her several times that night, her vital signs seem to improve, but she is unresponsive. The next day, she needs less oxygen. We consider putting a tube into her stomach to give her medication, but by the afternoon she is conversing. Not only conversing, but making sense. I had never met her coherent; she was always confused and accusing me of being Massai and afraid I would go tell people she was HIV positive. The following day she is walking, eating, taking medication, and thanking us. Her mother, who is by her side ever minute providing care, takes my hand and says many things I don't understand with tears in her eyes, but I hear one word clearly ,"Mungu" and I agree, the credit goes to God.

Amelia's First Day of Kindergarden

It was unrealistic to think we could homeschool Amelia and work full-time. So, we rejoice at the arrival of Teacher Sarah. She's just what Amelia adores. You can't beat the ratio: 2 teachers for 4-5 students. Amelia's grade meets 2-4 hours/day. Malin is also teaching the PE segment and helping the older kids get the Presidential fitness award. This afternoon is African geology; art, science, math, reading, and language were covered early this week. When I asked Amelia what she learned at school today she replied, "It was really important, but Mommy, some things are too important to remember." 

Encouragement

We all need encouragement. Amelia needs encouragement right now for reading. Meredith for using the potty. Malin for still feeling tired after having malaria. And I needed encouragement today after spending 3 hours removing genital warts. I know that sounds unpleasant. It was unpleasant. But as I was feeling sorry for myself for missing lunch again, wondering if my surgery was making any difference in this patient with AIDS, Dr. Wesche quietly came in behind me. He had asked me to perform the surgery in the first place for this lady and has worked at Tenwek over 30 years. "Wow," he said, "Look at how much you have relieved her suffering. Some people wouldn't have bothered because of her status, but she couldn't even sit. You have helped her so much." These were the words I needed to hear and not forget. We are here to help however and whomever God places in our care.  My thoughts needed redirection away from myself and back to her. Dr. Wesche has set this example for countless years. His humility, compassion and servant's heart are spoken of frequently. What a legacy to leave and to encourage in a young physician!

Amelia rescues Liezel

    Amelia and I found a baby Bird who had fallen from a tree branch on the path to the hospital.  We looked for a nest above with no luck.

     Amelia took the bird home and we searched the web for urgent bird rescue techniques.  First Amelia named the bird 'Liesel' (she is into Sound of Music).   She then made a nest in a basket with towels and tissues for a blanket.   Amelia gave Liesel sugar water through a medicine dropper every 30 minutes.   He has a bright yellow tongue.  Liesel began to chirp and flap his wings.  The next day Amelia made a mix of cat food and water and as you can see in the picture Liesel takes food from tweezers .  We will see what happens as Liesel is getting stronger everyday.  This bird adds to Amelia's collection of geckos named Climber, Tom, and Hisser-Tisser.

19,340 ft.

I had the pleasure of standing on the rooftop of Africa by climbing Mt. Kilimanjaro in Tanzania with 5 new friends from Michigan.  All 6 of us were successful in climbing up to the crater and to  Gillman's Point and then on to the final summit at Uhuru Peak (Kilimanjaro has a 75% success rate).  We reached the summit at 5 AM--very dark and so cold that our water bottles had frozen despite being wrapped in socks.   We took a few pictures and watched the sunrise as we came down.

       

Climb every mountain....

Climb every mountain,
Search high and low,
Follow every highway,
Every path you know.

Climb every mountain,
Ford every stream,
Follow every rainbow,
'Till you find your dream.

A dream that will need
All the love you can give,
Every day of your life
For as long as you live.

That song from The Sound of Music is going through my head for 2 reasons: first, it is now Amelia's favorite movie and she watched it yesterday, second, Malin climbed Mt Kilimanjaro and should be arriving back at Tenwek today. Even though I did not physically climb a mountain, this week seemed like a long, hard journey. 

This week included several difficult deliveries, including a breech baby at 28 weeks, surgeries for ovarian and cervical cancer, 2 procedures I had never attempted before, and pregnant patients with pancytopenia, cardiac disease, hemoglobin of 3 (normal blood count is 14), and other various complex problems. Tenwek's local Ob/Gyn has been gone most of the week and leaves next week for 6 weeks so, I have been reading, studying and praying my way through most of these problems. 

Since, this is the first time this week I've had time to come home for lunch, it's been long days for the girls. I am grateful for the help and care other mothers provided this week for my children. I look forward to Malin returning...it is easier to climb mountains with friends, another Ob/Gyn coming....it is easier to climb mountains with colleagues, being off call next weekend....it is easier to climb mountains when rested, and to spend more time in prayer for this is the only way the climb will be successful.

Girls Only

Since this is the first post of 2009--Happy New Year. I brought the year in with 6 C-sections in 12 hours. Please pray for safety as I walk to and from the hospital in the middle of the night.  New Year's Day included a family nap. Malin left the following day with another physician here, Dan Hayward, to climb My Kilimanjaro. They'll be gone 8 days and 8 nights. Amelia, Meredith and I decided it would be the perfect time to have a girl sleep over. Amelia's friend Claire came over and we painted toe nails, ate popcorn, and watched The Sound of Music. We're moving in the Dan's wife and 4 boys for the rest of the week. Suzanne has graciously offered to help with the girls as I work (she also looks forward to some girls in the house).

In clinic this week, there was a man on my schedule. I said to the nurse, "I don't see men." She replied, "But you're a gynecologist." So I repeated, "Yes, that's why I don't see men." She said, "But you should be able to help him, you're a gynecologist." I smiled and said, "Yes, my training was in gynecology I have not seen a male patient in over four years." She laughed and said,"Really?" She eventually understood and ended-up calling someone else to see him. But for those of you that our wondering,  his problem was related to a unfortunate accident which he was thinking Viagra would cure. There are many things not available in Kenya, but the "little blue pill" is.