Goodbyes...

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

Scarves

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

The Ministry of a Grandmother

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




Reading stories to her grandaughters.



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



Helping out in the nursery feeding one of three triplets.




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

Christmas Party

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

Lithotomy

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

The Mara

Alive

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

Otolaryngologist in motion

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



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



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



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



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




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




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

"Two are better than one..."

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

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

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

Charming or Cheesy?

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

Money Matters

One of the challenges as Westerners living in Africa is how we use and manage money in relation to the ever present poverty that surrounds us here in Kenya. Daily financial situations arise that make us feel uncomfortable and uncertain with how to respond. Our helper asks for a loan on her next month's salary (Is this a loan of gift)? We buy vegetables at the local market and feel sad as we are unable to buy from each person. We are asked for money to pay school fees and do not know if the request is legitimate. A co-worker needs help for medical fees for her son and asks for a pay advance? We sell a friend a simple piece of furniture 6 months ago but have yet to be paid. These are just a few situations that we struggle with.
A century previous the average westerner had an annual income 3 times that of the average African. Today, if I am average I will make 60 times that of an average African in my lifetime. What does that advantage mean and what does God expect from us in relating to our Kenyan friends in financial matters? Should I be negotiating for prices at the market (is that cultural or being overly thrifty)? Should I be holding people accountable for "loans" or should I let it go as a gift unspoken? Ultimately how do we as a family share our resources (which are not really ours but God's) with those in need but not feel like we are getting taken, scammed, or burned? How do we find a balance between Christian generosity and using our resources wisely?
Thankfully I happened upon the book, 'African Friends and Money Matters' by David Maranz. It is a book that was developed to address the frustrations many Westerners (tourists, missionaries, diplomats, NGO's, businessmen) face when living in Africa with money matters. Each culture sees and manages money differently and these differences cause misunderstandings. With anecdotes, studies, and his own experiences he lists 90 observations of just "How Finances Work in Africa." Let me share with you several of his observations.
1) Resources are to be used, not hoarded.
2) Money is to be spent before friends or relatives ask to "borrow" it.
3) If something is not being actively used, it is considered to be available.
4) Africans assist their friends in financial need as a form of investment for those future times when they themselves might have need.
5) Africans readily share space and things but are possessive of knowledge (Westerners tend to be opposite).
6) Precision is to be avoided in accounting as it shows a lack of a generous spirit.
7) Fund raising is done on a village basis to help with personal needs. The person in need can decide best how to spend this money.
8) Many products (phone cards, dental anesthetic, food) are purchased in very small amounts even though the unit cost is quite high.
9) Africans are more hospitable than charitable (Westerners tend to be the opposite).
10) Compliments are given indirectly in the form of a request for a gift. (That is a nice bike)
11) Africans are very discreet about asking for assistance, only hinting at their needs. (we are hoping to repair a roof, we are raising funds for a funeral, our daughter is going to school.)
12) Africans find security in ambiguous arrangements, plans, and speech (Westerners tend to the opposite). Examples are; a) when borrowing it is left open when, how or if funds to be repayed b) absence of fixed prices c)commitments to attend meetings c) absence of starting times or ending times for events
13) Showing solidarity at events like funerals and weddings is extremely important. Financial contributions are expected as well as extended leave with pay.
14) Corrupt money is not expected to be paid back, accountability is not enforced, restitution is not practiced.
15) A major function of government is to provide money to those members of society that are in power. Nepotism is expected.
16) A great number of economic needs in Africa are met by friends and family.
17) An unjust settlement of a dispute is better than an offended complaint.
18) A loan is eligible to be repaid when the creditor's need becomes greater than the debtor's need.
19) The collection of debt is primarily the responsibility of the creditor.
20) Loan is often a euphemism for gift.
21) Loans of goods come with rules. a) the borrower does not return the article unless asked b) articles may be reloaned to third parties c) long term borrowing of the article becomes a gift d) normal wear and tear is the responsibility of the lender not the borrower
22) Westerners find it frustrating that Africans appear unclear and indirect.
23) Having the correct amount of money in a business transaction is the responsibility of the buyer not the seller.
24) Negotiating for prices is expected. It is part of the greeting process.
How do we make sense of this? Are some of these observations just plain wrong? But what about Biblical commands to live in community and to provide for the widow and orphan? We seek to engage, befriend, and witness to the culture in Kenya but the economic differences between us and them are staggering, unavoidable, and expanding. How do we balance grace towards the culture and also emphasize accountability? Do we strive to help (with charity) or maybe better yet help those to help themselves (with matching donations to encourage savings)? Do we micromanage supplies, accounts, donations or empower others to use them as God may choose.
As still a new family in Kenya we have much to learn and are often humbled by our own lack of understanding of the culture here. This book has shed light on our stark differences and has made us wonder, how we ever get things done? Only by God's grace perhaps. Lastly a veteran here in Kijabe advised, "Malin, I have learned to err on the side of generosity. If you are not occasionally getting burned on a loan, scammed on a donation, or pay higher for a purchase..you are probably not where you need to be. We are called to give, God will be responsible for how it is used."

A Plethora of Princesses

Correct me if I am wrong but we have from left to right: Snow White, Sleeping Beauty, Cinderella, Tinker Bell, and Arielle. The girls seem to never get tired of playing dress-up!

A Day's Work in Pictures (GYN pictures included, reader beware!)

Trying to capture 9 hours of work this Tuesday, I thought pictures might best demonstrate the tremendous, at times overwhelming, surgical need we encounter. Sharon and I work 3 full days operating, compared to a typical practice in the States this is perhaps 3-6x the surgical volume. Tuesday started with a repeat C/S, then a hysterectomy for pelvic mass in a 65 yo, followed by another repeat C/S with a bicornuate uterus (hence the heart shape), next a hysterectomy for fibroids, then a myomectomy that turned into a hysterectomy because both tubes were destroyed by the fibroids (also the patient couldn't remember if she was 38 or 42 and age does really matter for fertility), next an emergency C/S, and the day concluded with an ruptured ectopic pregnancy (the only thing I didn't get a picture of!).

As Thanksgiving approaches, I give thanks that Sharon is here, that we have interns and medical students to help with rounding, a great surgical staff who keeps the room going (except at chai time), and that for the most part, our patients get better and some even come to know Jesus.

Angel Alert

Amelia participated in the school Christmas program "Angel Alert." She proudly wore her white robe with red pipe cleaner tiara then sang with her classmates. The program was great and we were glad Grammie and Grampie were able to join us.Afterwards we enjoyed a Thanksgiving feast at the school cafeteria.

Meredith is working on showing 3 fingers as her birthday is December 16th! Hard to believe she was 23 months when we arrived.

Missing

As I went to use the ultrasound yesterday, I discovered the probe was missing. This equipment costs around 1000 dollars and I hoped it was just taken by biomed for some reason. However today it became apparent it was stolen. Frustrated that theft is so common here, particularly in the hospital where equipment like laryngoscopes, gloves, dopplers can easily be "put in the pocket" and sold for substantial money, I have to remind myself theft signifies a bigger need. Not just simply a need for money which can be used for food, clothing, shelter or non-essential items, but a bigger spiritual void. Stealers do not trust God to supply their needs. And yet the scripture reminds us over and over again, that God will supply our needs. The room now has a new lock and only 4 keys, but I hope that the person who took this will return it and in doing so trust God to provide.

Arrival!

Madelle & Chris (Grammie & Grampie, Mom & Dad) arrived safely in Nairobi to a pouring thunderstorm last evening. They seem to be doing fairly well with the jet lag after flights from Bend to Seattle to Amsterdam to Nairobi. We are happy that all their luggage arrived safely. The girls greeted them with lots of hugs and were unable to sleep last night upon anticipating their arrival. Dad has already helped us out with a consult patient and the tea parties have begun with Grammie and the girls. We are glad to have them in Kenya!

Amelia Update

We are proud of the young girl that Amelia is becoming. She has adapted well to Kenya and to our second move to Kijabe Hospital. She has become quite brave with new African Critters. Our friend Dr. Stephanie has a lizard in her house and has asked Amelia to capture it. Amelia currently when she grows up wants to be a pet stylist. She loves animals and believes their style matters.

Amelia has at least 5 best friends and if life was up to her she would spend every waking moment with one of her friends. By far her favorite subject at school is art. Amelia says some funny things. "Daddy did you know clouds are really air and if you stood on them you would fall right through."

Do opposites attract or attack?

In Jack & Carole Mayhall's book "Opposites" the authors investigate the differences in the way people think, relate, talk, act and look at life and how couples can turn their differences into opportunities. Although people don't fit into neat and tidy boxes and this book is by no means entirely new information, I think their observations are worth looking at. As a couple browses through the categories I think we are able to quite easily place ourselves.

The Way We Think.

1) Factual (linear learners, may neglect to ask others how they are feeling, need help understanding emotions) vs. Intuitive (feelers, take criticism, teasing harsly, can't say no, may overcommit themselves)
2) Logical vs. Relational
3) Objective (likes a political debate) vs. Subjective (doesn't like personal attack)
4) Conceptual vs. Detailed

The way We Relate

5) Introvert (energized by internal stimuli/reflect then act, wakes up slowly) vs. Extrovert (energized by external stimuli act/reflect, hits the ground running)
6) Organized (you say stop, decisive, closure, plan, structure, control, get decisions out of the way) vs. Free Spirit (go, openness, flexable, wait and see, curious, doesn’t like to commit or be tied down)
7) Affectionate vs. Reserved

The Way We Talk

8) Revealer (asks lots of questions, good listeners) vs. Concealer (too many questions seem like prying, silence precludes arguments )
9) Speaking Facts. vs. Feelings
10) Confronters (how we fight, find out what is wrong right now and here, anytime, anywhere, anyhow--will bring up the past and secondary issues, want to win argument ) vs. Withdrawers (how we fight--walks away, silence at times is golden, crying, surrendering, interrupting, want to win through silence)

The Way We Act

11) Perfectionist (Do it right, correct, precise, orderly, tend to be critical) vs. Non-perfectionist (Right now, never mind, it’s okay, don’t worry)
12) Aggressive (Step forward, take charge, outspoken, control-oriented, may not ask for help) vs. Timid (indecisive, peacemaker, humble, wishywashy, fainthearted, step back)
13) Serious & resolute (thoughtful, sober, solemn, sedate, sincere, resolved, determined, purposeful) vs. Casual & Relaxed (easygoing, spontaneous, informal, relaxed, lackadaisical, haphazard, random)
14) Dependent (influenced, controlled, attached, subordinate) vs. Independent (self reliant, unconstrained, free from control)

The Way We Look At Life

15) pessimistic vs. optimistic

So what can be made of these 15 categorical differences? By my best estimate Sara and I are are on different sides of 13 out of 15 of these catergories (I won't say which categories and to where we belong)! We are very different people. I would be curious to know where other couples stand??

Mayhall makes the argument that incompatibility is grounds for a great and full marriage. He would argue that is a good thing we are not alike.
1) If we are both logical we would be unaware of other's feelings
2) If we are both introverts we may never entertain
3) If we are both independent we may be adamant that we are always right
4) If we are both dependent we fall apart in crisis
5) If we are both pessimists we worry all the time
6) If we are both confronters heads will roll during arguments
7) if we are both withdrawers no intimacy will develop

The trick is learning how to complement each other rather than compete with one another. A biblical marriage is described as two becoming one; a new entity that together is far stronger that either alone. May we all praise God for our differences and for what we are becoming as a couple.

Wear Your Seatbelt!

Our patient was involved in a MVA (Matatu Vehicle Accident) 3 months previous. Having an image like this (3-D CT scan reconstruction) is a rarity. He was diagnosed with multiple avulsed teeth, bilateral symphaseal jaw fractures, and fracture of the left maxilla with displacement.



We will see how the treatment goes as the fractures are 3 months old and have begun to fuse and unite in the wrong positions. The lesson learned could be if you have a seatbelt, buckle up!

Thief in the Night

We were behind schedule this morning so we hopped in the car with Meredith & Amelia to get to school. I placed the key in the ignition and twisted..nothing. Again I turned the key and nothing. "We have to walk girls, the battery must be dead." But how could the battery be dead I thought? The battery was not dead, as you can see from the picture. The battery was gone.
It seems that the thief came at night with a Panga (knife). They cut a hole in our "cactus fence" and entered our backyard. Somehow they got under the hood of the car and made off with the battery. I assume they will sell it for a profit. This was the second theft from our property as our wheelbarrow was stolen 2 weeks previous while we were at retreat. Unfortunately about anything can be stolen here in Kenya, especially items from a car. Kijabe has seen the theft of hubcaps, license plates, the lug-nuts on the wheels (you find out by driving away and having a wheel fall off), and even two cars in the last week out of the hospital parking lot.
Being robbed is always a drag. Of course the items can be replaced, we are safe, and feel not physically threatened, but I don't enjoy the cat and mouse game that plays in my mind from here on out. How can I chain this more, lock this tighter, better light this, so I will not be a victim again. I would rather believe and trust in the people here, than feel threatened by a few criminals.
Apparently Mocha our "wathdog" was fast asleep.

Monkey on the Line

There are many things that can destroy a nice garden including gophers, deer, rabbits, aphids, and/or an early summer frost (my Mother's annual nemesis). Here at Kijabe our pests are the monkeys. They come down from the trees in the mornings and drop into our back yard. They usually come in a group of about 8 looking for any food. So far the monkeys have not found their way into our garden which is protected by metal mesh.

Amelia is "hissing" at the monkeys to make them go away but they seem rather unthreatened by her, likely because she is too small.

Fancy & Plain in Africa

It seems that as a family we resemble the now popular young girl's book, "Fancy Nancy." You see Fancy Nancy is a fictional girl's character with a little sister that likes everything fancy. She likes fancy things like accessories, papillons, chauffeurs, and frilly toothpicks in sandwiches. She uses fancy words like spectacular, ecstatic, and posh. Fancy Nancy's parents are plain as they wear plain clothing, eat vanilla ice cream, and seem to sit around reading the newspaper. Many wondered (including me) how our Fancy Nancy (Amelia) would do in Africa?

Here we are on the way to Carnival; a fall dress up festival at school with games. Meredith the Fairy has been wearing this Tinker Bell dress, plastic high-heels, and holding a magic wand for the past week. Amelia was a generic princess with a purse and a posh puppy. Mom & Dad dressed as plain old Mom & Dad. I guess we need some "Fancy" lessons from Amelia.

Finding things

This morning greeted me with many patients and not a lot of help for rounding. As I worked my way through a stack of charts I came to one patient that needed a drain removed. While this should generally be a quick task, it wasn't because no one could find a razor blade for me to cut the stitch holding the drain in place. Frustrated I said, "Why can't we keep things like blades, gloves, gauze, strapping always available?" A very sincere nurse answered me, "We used to have blades, but they won't let us have them because we just used them to cut our nails. See look how long my nails are now." Well, now I know why.

World Map by Fertility

http://upload.wikimedia.org/wikipedia/commons/7/78/Fertility_rate_world_map_2.png

Found

Three months ago on a bike ride to Amelia's school Meredith dropped her blankee. Once we found out it had been dropped we retraced are steps, but without luck. This was Meredith's "special pink blankee." It had been with her since she was a 4 lb premie in the NICU at Akron Children's hospital. I don't think she had spent a night or nap without blankee. We were convinced that someone had picked it up and we would never see it again. We asked around, sent out e-mails, and eventually gave up.
Today our hero Stacy found Meredith's blankee. It had somehow shown up in the lost-and-found box 3 months later. As you can tell Meredith was excited and comforted to find blankee.

Malaria Vaccine

Just last week after we returned from Samaritan's Purse Leadership Retreat our daughter Meredith came down with a fever, headache (as much as you can tell with a two year old) and lethargy. We were uncertain of the cause but due to the fact that we were in Malindi and Nairobi (both areas where you can contract Malaria) the pediatrician suggested that we place Meredith on pediatric anti-malaria medicine for the next three days. Meredith's fever continued for three days along with a lot of crying and concern and uncertainty on our part. She has since recovered (Praise God).

It is estimated that Malaria takes the life of 1 million children in Africa every year. 2.37 billion are at risk from the worlds deadliest disease. Meredith is fortunate because we have ready access to needed medicine where many children in the developing world do not have the medicine needed.

A new Malarial vaccine, called RTS,S/AS2A, or Mosquirix is beginning trials here in Kenya. The first-generation vaccine is unlikley to provide more than 50% protection, but researchers believe that even that level of efficacy could make major inroads against the disease and lay the foundation for the development of more effective vaccines in the future. The goal is to have by 2025 a vaccine that is 80% effective and that lasts for at least four years. (You can find a link to the article here: http://latimesblogs.latimes.com/booster_shots/2009/11/massive-malaria-vaccine-trial-has-begun-in-africa.html)






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.