Monday, April 4, 2011
Are We Heading Back to Kenya Anytime Soon?
Masai Mara....A New Respect for My Mortality
“Really, Dickson (our safari driver) I don’t need to stare in the eyes of a lion, a safe distance will do.” What an adventure! Words cannot describe the Masai Mara, endless green savanna, frosted with zebra, gazelle, impala, warthogs and elephants. Not to mention hippos, cheetahs, lions, giraffe, water buffalo, ostrich, jackals and hyena at your fingertips...and the most brilliant, outlandish birds. Just breathtaking! And as our guide pointed out....the Masai. They always talk about seeing the Big Five (lion, cheetah, rhino, elephant and leopard) and the Masai being the Sixth. They just live out here. You’ll see a lone warrior just walking along.....in this absolutely wild land.
We stayed at the most beautiful safari camp....Amani Mara...the architecture was so unique and the owner a conservationist so the camp and the structures were built ecologically. We could lay in the pool and watch the hippos. The staff were so friendly and we planted three trees before leaving. Gus will have to go back one day and see his fig tree.
Here is a picture of where we ate breakfast one morning (lion pride in the bushes behind me). All was well until our guide said we should head back to the car....quickly....seeing a lion dart out of the bushes. OMG...I grabbed Gus and ran so fast. Then he called us back as the lion had turned and ran away. And it was just one lion after-all. Hmmm....one thing I learned traveling in the Mara is that there is never just one lion. There’s always a pride of lions. 
I think Dickson was playing a joke on us the first day, giving us a glimpse of our mortality. First our jeep got stuck next to a pride of lions, sheer panic....thank God for land rover power and giant tires. Once that frightening experience was over, within the next 10 minutes the jeep’s battery died, again next to the pride of lions. Of course this is when Gus decides to throw a tantrum. The lions had been sleep...then they woke up, one staring right at us. Me panicking again, “Here Gus eat a cookie.” Zach taking pictures. OMG...I never need to see another lion. The safari staff was teasing me later, saying “Katy you don’t like the lions but this is their home.” Me, “oh, I like lions, just from a distance.”
---Katy
Rethinking Medical Missions
One of the many reasons we came to Kijabe was to get an idea of what it would be like to live and practice medicine overseas on a longer term basis. I always thought this would be part of my practice in the future but have not been sure how it would all play out. I also always saw myself in a Spanish speaking country as I speak Spanish but didn’t want to limit myself and thought Sub-Sahara Africa sounded like a new adventure.
But one of the difficulties in making a long term commitment is not only language and culture differences, it’s educational and social reasons as well. You miss your friends and family. I’ve had the pleasure of working with Drs. Jennifer and Scott Mhyre this month. They are physicians who had been working in Uganda for 17 years, raising their four kids there (even through the ebola outbreak!). Scott and I had a great discussion during an hour long paracentesis while draining 5L of ascitic fluid out of a woman’s abdomen who most likely had cancer in her liver (very slow due to the tubing available). I was asking him how they overcame these obstacles of being a westerner in a foreign land. He said that through World Harvest, his organization that led him to Uganda, they went as a team with five families of close friends. He said the group changed over the course of the years but they always had a core group that stretched over the 17 years. He said it was ideal and really the only way he’s seen missionaries make it. You always have someone to hold your accountable, especially important in medicine as staying up with the latest information is daunting even in the states. It gave me an idea.....thinking about my fellow Swedes (residents) back home. Want to go together? Even cooler would be my closest girlfriends from med school, we all chose different specialties, we’d have a surgeon, ER doc, pediatrician, internal medicine doc, OB/Gyn and 2 family med docs. Not a bad team. Who’s up for it?
So "Stat" Means Do It Yourself
This post is a couple weeks late but I have composed many blogs in my head and am just finally now getting the time to post them on our 10 hour flight back home.
I literally walked into the Women’s Ward this morning to find an 85yo acutely ill woman with pneumonia with a heart rate in the 200’s. (Normal being 60-100). Luckily she was stable though requiring oxygen, mentally just fine. Knowing the monitors are not always accurate I checked the woman’s pulse and listening to her heart. It was definitely atrial fibrillation (a.fib), an irregularly irregular rhythm and quite disturbing as it was so fast. I tried to understand what was going on, asking her nurse how long she had been in that rhythm and that I needed a stat EKG. The nurse said she didn’t think the monitor was correct overnight and that she had been rechecking with a pulse oximeter which read high 90’s. I tried to explain that a pulse oximeter is a brief moment in time, not as accurate as a monitor but to be sure the best test is to feel the woman’s pulse. I think she understood and we examined the patient together and she agreed the patient’s pulse was abnormally fast. But alas, no EKG yet. We called to find out what was taking so long and were told all the EKG techs were at chapel and not available. I said...where is the machine located, I’ll do it myself. So I went and got the machine, ran it myself and then determined that yes we need some IV medications to slow this heart rate. Well, supposedly they didn’t have IV beta-blocker or calcium channel blockers in Kijabe Hospital, hum. I walked over to the ICU to find out how one corrects this problem here as surely this was not the first patient with atrial fibrillation. No attending docs were available. I knew my other option was to shock her back into a normal rhythm but I didn’t think that could possibly be the best option for an 85yo woman who at this point in time was stable, though I wasn’t sure how long she would stay that way with a heart rate that fast. Randomly, an ICU nurse overheard my questioning and said they have some IV heart medications in the theatre (OR). So I headed down there to find what I needed. Long story short, IV labetalol was available (only option), I gave it, corrected the situation and the patient did well. But what a round about way of doing it. It was good practice for a similar situation a few days later. That one was a little more complicated because the patient wasn’t already on a cardiac monitor and I had to wheel her bed into the more acute monitoring room myself. I guess “stat” means....do it yourself. Reflecting on these situations, Dr. Mhyre (a supervising doc) teases the nurses saying, “Dr. Katy is going to pull out all of her hair....how much does Martin (my counterpart) have to pay to get some assistance?”
---Katy
Wednesday, March 23, 2011
Hell's Gate National Park
We got to see Thomson's gazelles, warthogs, impala, giraffe, a giant water buffalo (who are notoriously dangerous) but alas no big cats yet. Gus says his favorite is a cheetah, if we don't see one on safari in the Masai Mara then we can go to a animal orphanage in Nairobi where you can supposedly pet them!
Monday, March 21, 2011
Comfort the Children International
Malaika mean "angel". At CTC Intl, there are the Malaika kids, children with various disabilities, and the Malaika Mums, the children's mothers who are working in the sewing room. This place has been a double blessing for these families, allowing the mothers to earn a living and the kids to receive therapy and an education. Prior to providing these services, it was common for mothers to "hide" children with disabilities and deformities out of shame or humiliation. Additionally in these circumstances, the father has left, so it becomes very difficult for the mothers to support their families.
I was also greatly impressed with the additional community outreach which is being facilitated here. Faith, the admin director, provided me with the grand tour and introduced me to everyone. Meanwhile Gus ran amuck, exploring the facilities and playing in the various classrooms. Some of the things happening there included: Mentoring for the students, like a big brother and big sister type of program; an Environmental Club, where they are planting Jetrophar trees which produce oils to be used as biofuels as well as direly needed shade and reforestation; and a Health Education outreach primarily for AIDS education.
We were able to donate some stuff we had brought from home, including some dresses made by local NW women (these will likely be distributed to the IDP-Internally Displaced Persons- camps, which are prevalent in this area of the Rift Valley), as well as art supplies, toys and books for the students and their visitors (local families and schoolchildren regularly visit the school to play with the students to raise awareness and acceptance of persons with disabilities). As we unloaded the goods from the car, I asked Gus if it was okay to give these toys and books to the school and he happily agreed. These were all things he has been playing with daily. Bravo Gus!
Zach
Sunday, March 20, 2011
Salome Patients - Taking Stock
One of the many questions we as resident doctors ask when signing up to go to Kijabe is what type of medical problems will I be seeing? Will I be prepared? I am cleaning out my notebook today and thought I'd take stock. I have a wide variety of patients on the Women's (Salome) Ward ages 20's to mid 80's. Most are from many miles away and have traveled days to get to Kijabe. As for the preparedness, I say yes, thank you to all my attendings and senior residents at Swedish, though it would be nice to have a cardiologist, nephrologist and gastroenterologist.....to consult with. :)
My currently admitted patients are struggling with:
Diabetic foot awaiting amputation x2
Class IV Heart Failure and End Stage Renal Disease with refractory volume overload
TB Meningitis with history of stroke
Community Acquired Pneumonia
Pneumonia with Pancytopenia
Delirium of unknown origin
Tuberculosis of the spine "Pots Disease"
Intrahepatic Cholestasis most likely due to toxin
Pneumonia with Lung Collapse history of TB/fibrothorax (see chest x-ray)
TB Meningitis
Uremia due to Acute Renal Failure (attempting transfer for hemodialysis)
Metastatic Cancer x2
Discharged:
Pneumonia x3
Consultation service:
All maternity/gynecology patients with hypertension
Postpartum hyperthyroidism
Surgical Clearance
Pneumonia in Pregnancy
Postpartum rule out pulmonary TB
Deceased:
Victim of assault with head trauma
Methotrexate Overdose
This last case was a tragedy. A young 34yo woman with a presumed diagnosis from an outside hospital of scleroderma and rheumatoid arthritis was prescribed toxic doses of methotrexate (I assume an innocent mistake) 20mg daily instead of weekly? This seems like a high dose for even weekly. She came in with severe pancytopenia, interstitial pneumonitis, stomatitis and renal failure. The antidote leucovorin would have saved her life if they had come in when her first symptoms first came on, but unfortunately she made it to us a week later, very ill but still really with it and fighting for her life. Her family were able to get leucovorin from Nairobi but it was to late to rescue her. She was transferred to the ICU the next day and attempts were made to get her to Nairobi for hemodialysis (to wash out her blood) but it was too late. She passed away within 3 days of entering our doors.
The above cases are only a glimpse of the tragic stories this women have. The patient with uremia due to acute renal failure is one week postpartum after a still birth. Her pregnancy was complicated by pre-eclampsia (high blood pressure in pregnancy to put it lightly) and then following delivery she developed endometritis but became so sick she was admitted to us with "puerperal sepsis," a creatinine of 10 (normal is less than 1) and hallucinating. She needed urgent dialysis which means transferring to a hospital one hour away. After being disconnected seven times trying to get a hold of the renal unit by phone I was told she'd have to go through the ER "casualty" anyway. After all that....time stood still....her family had to come in and accept the transfer...wow, you've got to be kidding me!
My heart breaks everyday. Thankfully some do get better and go home. Kijabe can be a beautiful place, patients surrounded by 10 family members singing and praying, each taking their turn to feed the patient or tend to the needs of the patient as nursing care can be a little too slim. Bad news is broken with prayer and hope of God's presence and strength during this time of suffering and unknown prognosis. I don't know if it this element or the fact that I am surrounded by my patients and their families all day long as I do my work that I feel more connected to my patients here than I do at home. I cannot simply check on a lab or vital sign without passing family and giving updates to each and everyone of them. At home I feel like we are always running off to our outpatient clinics, teaching sessions, our patients are scattered all over the hospital and discussions with family are over the phone. I am pondering ways to bring this home with me. Maybe more bedside rounds....
---Katy
 |
| Yes, some patients are in the hallway, it's so crowded. |
My currently admitted patients are struggling with:
Diabetic foot awaiting amputation x2
Class IV Heart Failure and End Stage Renal Disease with refractory volume overload
TB Meningitis with history of strokeCommunity Acquired Pneumonia
Pneumonia with Pancytopenia
Delirium of unknown origin
Tuberculosis of the spine "Pots Disease"
Intrahepatic Cholestasis most likely due to toxin
Pneumonia with Lung Collapse history of TB/fibrothorax (see chest x-ray)
TB Meningitis
Uremia due to Acute Renal Failure (attempting transfer for hemodialysis)
Metastatic Cancer x2
Discharged:
Pneumonia x3
Stroke x2
Heart Attack
Acute Renal Failure
Hyperosmolar Hyperglycemia State
Cryptococcal Meningitis
Pancytopenia
Prolong heavy vaginal bleeding due to cervical tumor
Bacterial Meningitis
Congestive Heart Failure
Metastatic Cancer x3
New HIV diagnosis
Excessive Salivation
Anemia
Pyelonephritis
All maternity/gynecology patients with hypertension
Postpartum hyperthyroidism
Surgical Clearance
Pneumonia in Pregnancy
Postpartum rule out pulmonary TB
Deceased:
Victim of assault with head trauma
Methotrexate Overdose
This last case was a tragedy. A young 34yo woman with a presumed diagnosis from an outside hospital of scleroderma and rheumatoid arthritis was prescribed toxic doses of methotrexate (I assume an innocent mistake) 20mg daily instead of weekly? This seems like a high dose for even weekly. She came in with severe pancytopenia, interstitial pneumonitis, stomatitis and renal failure. The antidote leucovorin would have saved her life if they had come in when her first symptoms first came on, but unfortunately she made it to us a week later, very ill but still really with it and fighting for her life. Her family were able to get leucovorin from Nairobi but it was to late to rescue her. She was transferred to the ICU the next day and attempts were made to get her to Nairobi for hemodialysis (to wash out her blood) but it was too late. She passed away within 3 days of entering our doors.
The above cases are only a glimpse of the tragic stories this women have. The patient with uremia due to acute renal failure is one week postpartum after a still birth. Her pregnancy was complicated by pre-eclampsia (high blood pressure in pregnancy to put it lightly) and then following delivery she developed endometritis but became so sick she was admitted to us with "puerperal sepsis," a creatinine of 10 (normal is less than 1) and hallucinating. She needed urgent dialysis which means transferring to a hospital one hour away. After being disconnected seven times trying to get a hold of the renal unit by phone I was told she'd have to go through the ER "casualty" anyway. After all that....time stood still....her family had to come in and accept the transfer...wow, you've got to be kidding me!
My heart breaks everyday. Thankfully some do get better and go home. Kijabe can be a beautiful place, patients surrounded by 10 family members singing and praying, each taking their turn to feed the patient or tend to the needs of the patient as nursing care can be a little too slim. Bad news is broken with prayer and hope of God's presence and strength during this time of suffering and unknown prognosis. I don't know if it this element or the fact that I am surrounded by my patients and their families all day long as I do my work that I feel more connected to my patients here than I do at home. I cannot simply check on a lab or vital sign without passing family and giving updates to each and everyone of them. At home I feel like we are always running off to our outpatient clinics, teaching sessions, our patients are scattered all over the hospital and discussions with family are over the phone. I am pondering ways to bring this home with me. Maybe more bedside rounds....
---Katy
Friday, March 18, 2011
It's raining folks and boy is it muddy!
The driver gunned the engine of the matatu (passenger van), while shaking the steering wheel back in forth to gain traction and avoid getting stuck in the mud. Never mind that the road was severely rutted and meandering, with school children and farm animals making sure to get out of our way. Thankfully, Duncan, our driver is as good as they come on these roads.
All of us were tired, a little wet and ready to go home to our families, after building a new roof for Milka, a widow that we were helping through Flow of Hope missions. John uses these guys regularly for these kind of projects. Visiting Msungo's (white people) pay for the materials; and we all work together to improve peoples lives. Rain or shine; and this day, it was mostly rain; the first big rain of the season. A blessing to the land, but possibly not the ideal conditions for roofing.
John and I purchased tools, hardware, roofing and the wood the day before, so that it would be all ready in the morning for pickup. The van was loaded, with the materials and the crew and the sun was shining. We made a last stop for lunch supplies that Milka would cook for us later and then arrived at her house. Surprise! Of course, John did not tell her that we were coming (or, necessarily that she was getting a new roof). I think he likes to show people how miracles happen out of the blue. He says it increases their capacity to hope.
Within a quick couple hours, we had the old sheeting and roof supports (I am reluctant to call them trusses, as they we just small trees and sticks nailed together) off the house and were well under way of building the new trusses, but the clouds were increasing. And it started raining, waves of heavy showers, broken by short durations of lighter rain and occasional reprieves from the onslaught. Yes, Milka's house was missing it's roof. She threw sheets of the old roofing over the beds and couch and chairs. The carpenter and a couple others put plastic bags on their heads and backs. Duncan covered up with his shawl. I gave my hat to Micheal. We stood under cover or against a building. And we worked.
These guys, Africans, were great, good spirited, never complaining and thankful for the rain. They were also wet, undoubtably cold and most volunteering. It was a long day. I was home by 7:30pm and in the bath after scarfing down some food. My hands were stained from the clay soil and I relished the feeling a full days work. Most importantly, Milka and her grandchildren were likely cleaning their muddy house, but marveling at the shiny new roof above their heads and lack of drips falling from above.
I am thankful for this time to get to know some Kenya guys, see the fruits of our labors and bless some people that live life with so little. These trips for us, to the undeveloped world as we call it, always help to re-assess our values and sense of our needs and lifestyles back home. Inevitably we will fall back into the clutches of consumerism and excess little by little. But for now I can enjoy a simpler life and explore the possibilities of a more socially and environmentally equitable world. My prayer is for less want, more love and always to trust that God provides. Always. Amen.
(There's more pictures in an album. Just click on the Picasa picture at the upper right side of the blog.)
Zach
 |
| Duncan a little worried that the van is too full |
All of us were tired, a little wet and ready to go home to our families, after building a new roof for Milka, a widow that we were helping through Flow of Hope missions. John uses these guys regularly for these kind of projects. Visiting Msungo's (white people) pay for the materials; and we all work together to improve peoples lives. Rain or shine; and this day, it was mostly rain; the first big rain of the season. A blessing to the land, but possibly not the ideal conditions for roofing.John and I purchased tools, hardware, roofing and the wood the day before, so that it would be all ready in the morning for pickup. The van was loaded, with the materials and the crew and the sun was shining. We made a last stop for lunch supplies that Milka would cook for us later and then arrived at her house. Surprise! Of course, John did not tell her that we were coming (or, necessarily that she was getting a new roof). I think he likes to show people how miracles happen out of the blue. He says it increases their capacity to hope.
Within a quick couple hours, we had the old sheeting and roof supports (I am reluctant to call them trusses, as they we just small trees and sticks nailed together) off the house and were well under way of building the new trusses, but the clouds were increasing. And it started raining, waves of heavy showers, broken by short durations of lighter rain and occasional reprieves from the onslaught. Yes, Milka's house was missing it's roof. She threw sheets of the old roofing over the beds and couch and chairs. The carpenter and a couple others put plastic bags on their heads and backs. Duncan covered up with his shawl. I gave my hat to Micheal. We stood under cover or against a building. And we worked.
These guys, Africans, were great, good spirited, never complaining and thankful for the rain. They were also wet, undoubtably cold and most volunteering. It was a long day. I was home by 7:30pm and in the bath after scarfing down some food. My hands were stained from the clay soil and I relished the feeling a full days work. Most importantly, Milka and her grandchildren were likely cleaning their muddy house, but marveling at the shiny new roof above their heads and lack of drips falling from above.
I am thankful for this time to get to know some Kenya guys, see the fruits of our labors and bless some people that live life with so little. These trips for us, to the undeveloped world as we call it, always help to re-assess our values and sense of our needs and lifestyles back home. Inevitably we will fall back into the clutches of consumerism and excess little by little. But for now I can enjoy a simpler life and explore the possibilities of a more socially and environmentally equitable world. My prayer is for less want, more love and always to trust that God provides. Always. Amen.
(There's more pictures in an album. Just click on the Picasa picture at the upper right side of the blog.)
Zach
Thursday, March 17, 2011
Everyday stuff
Zach
Baboons in the Mist
I made an uncanny realization early this morning at 3AM as I was walking home from the hospital down a lonely dirt road past a cemetery in the mist was that what I was most afraid of was not the boogie man or a man at all but a fear that I may have an encounter with a baboon. The males are enormous according to Zach who ran into a pack of them getting in the garbage cans, three times the size of Isis (our dog), and apparently not afraid of women. Great. Of course they were probably sleeping like most creatures at 3AM, but it was definitely a funny reminder of where I am.
I was on call at the hospital, my second call in Kijabe. The first was spent finishing up the out-patient clinic which ran until approximately midnight, then spent hours in the ICU trying to get an IV line on a 8mo little girl gravely ill with cerebral malaria and intubating a women with status asthmaticus who made it a few more days on a the ventilator before passing away.
I got a little more sleep this second call dealing early in the evening with a patient who was unresponsive and trying to work through the work-up etc. with the intern on the phone. It was all I could do not to go up to the hospital and do it all myself but she wouldn't learn anything if I did it for her. I did do some sneak phone calling to the nurse so I could feel good about the situation and did check on the patient after being called up to the hospital for another reason. A difficult reason too. An 11mo little boy was severely dehydrated with fever, abnormal electrolytes, lethargy...sick kid...and the mother was refusing admission. All the nurses, physician assistant and intern (all Kenyan) had spent hours trying to convince her. Apparently they don't have CPS in Kenya. We would have just involved the police in the US. I don't know why they thought I, a white girl with a funny accent, would have more luck convincing her, but luckily I did. She was of course concerned about the cost on an admission to the hospital but most of all that she would lose her job if she did not show up for work the next day. She unfortunately had been visiting her sister in Kijabe when the child fell ill and had quite a distance to travel in order to ask permission to miss work, apparently a phone call by her or by the hospital would not be sufficient. I guess a little coaxing and lot of listening was enough, we agreed she could have her sister come stay with the child in the hospital while she traveled the following day. Not bad for 3AM.
I was on call at the hospital, my second call in Kijabe. The first was spent finishing up the out-patient clinic which ran until approximately midnight, then spent hours in the ICU trying to get an IV line on a 8mo little girl gravely ill with cerebral malaria and intubating a women with status asthmaticus who made it a few more days on a the ventilator before passing away.
I got a little more sleep this second call dealing early in the evening with a patient who was unresponsive and trying to work through the work-up etc. with the intern on the phone. It was all I could do not to go up to the hospital and do it all myself but she wouldn't learn anything if I did it for her. I did do some sneak phone calling to the nurse so I could feel good about the situation and did check on the patient after being called up to the hospital for another reason. A difficult reason too. An 11mo little boy was severely dehydrated with fever, abnormal electrolytes, lethargy...sick kid...and the mother was refusing admission. All the nurses, physician assistant and intern (all Kenyan) had spent hours trying to convince her. Apparently they don't have CPS in Kenya. We would have just involved the police in the US. I don't know why they thought I, a white girl with a funny accent, would have more luck convincing her, but luckily I did. She was of course concerned about the cost on an admission to the hospital but most of all that she would lose her job if she did not show up for work the next day. She unfortunately had been visiting her sister in Kijabe when the child fell ill and had quite a distance to travel in order to ask permission to miss work, apparently a phone call by her or by the hospital would not be sufficient. I guess a little coaxing and lot of listening was enough, we agreed she could have her sister come stay with the child in the hospital while she traveled the following day. Not bad for 3AM.
Monday, March 14, 2011
cooking in kijabe
A couple people have asked how the fish turned out and I realized that I forgot to report on it. You know that cooking is a great pleasure of mine, so I've been working with the minimal kitchen and supplies available to me and trying to eat well. Our house here was not stocked with any kind of spices except salt and pepper. At our big grocery trip I only picked up curry, chicken masala, and pilau masala spice mixes.
The fish was common carp and after spending quite a bit of time filleting it (rather poorly) the night before, I coated it with the chicken masala and fried it hard on the skin side and then a bit on the seasoned flesh side. And it did in fact taste good; though way too many bones. I forget what they call the extra line of smaller bones in the fillet, but they make it a little tedious to eat carp.
Tonight, I made chicken coconut curry with potatoes, onions and collards (wishing I had a tomato to throw in) and masoor dal (lentils) with the pilau seasoning and rice, again worried about the lack of spices and ingredients at my disposal. Low and behold, another decent meal.
Tomorrow will be mac and cheese casserole and the neighbor family of four is coming over. I'll have to borrow some flour for this from the neighbors first.
Later in the week I'll soak some beans, buy some chapatis (tortillas) and hope to find some chili powder and attempt "mexican"
Tomorrow will also be shopping day at the market, for fruits and veggies and fresh samosas (every tues and sat). I'll have to take some pictures of bananas and pineapples in their native environment and add them later.
Now you are probably getting hungry for dinner. bon appetit.
zach
The fish was common carp and after spending quite a bit of time filleting it (rather poorly) the night before, I coated it with the chicken masala and fried it hard on the skin side and then a bit on the seasoned flesh side. And it did in fact taste good; though way too many bones. I forget what they call the extra line of smaller bones in the fillet, but they make it a little tedious to eat carp.
Tonight, I made chicken coconut curry with potatoes, onions and collards (wishing I had a tomato to throw in) and masoor dal (lentils) with the pilau seasoning and rice, again worried about the lack of spices and ingredients at my disposal. Low and behold, another decent meal.
Tomorrow will be mac and cheese casserole and the neighbor family of four is coming over. I'll have to borrow some flour for this from the neighbors first.
Later in the week I'll soak some beans, buy some chapatis (tortillas) and hope to find some chili powder and attempt "mexican"
Tomorrow will also be shopping day at the market, for fruits and veggies and fresh samosas (every tues and sat). I'll have to take some pictures of bananas and pineapples in their native environment and add them later.
Now you are probably getting hungry for dinner. bon appetit.
zach
Sunday, March 13, 2011
Mount Longonot
Kijabe looks right out over the Rift Valley and directly at Mt. Longonot. Today we took the morning to climb up to the view point. Breathtaking. We didn't traverse the rim with our little G, but don't have any regrets as it was a hot and dusty hike. Feeling satisfied with a little exercise and a pretty view.
---Katy
Saturday, March 12, 2011
Just What the Doctor Ordered
I am really starting to like my work on the Women's Ward. Most likely because I'm getting to know the patients that have been there all week with me as well as the nursing staff. It's very different than working at the hospital at home, in Kijabe all the patients are located in the same 4 rooms on the same floor instead of spread throughout a 12 story building in a high-rise in Seattle. The same nurses come in everyday and you start to get to know them more each day and well as the idiosyncrasies of working here and within the Kenyan culture. And all 16 patients are mine, I take care of them from 7am to 6pm (and sometimes late at the night or the weekends when I'm technically off but know no one is watching after them or knows their stories as well as I do). I do have a wonderful teammate Martin, a clinical officer which is like a physician's assistent, who is brand new out of training so has a lot to learn but is motivated and a great help with "scut work" and translation. Dr. Scott Myhre is also on our team, a US trained physician who is also new to Kijabe, but has been working in Uganda for several years and who's awareness and depth of knowledge about treating tuberculosis and HIV related complications is invaluable. It's a lot of work and we have some very sick patients but I feel very dedicated and honored to do it, just wish I had my fellow Swedes (residents) here to whip this hospital into shape!
After Saturday morning rounds Zach, Gus and I headed out of town for the afternoon to Lake Naivasha. We went to a beautifully landscaped country club with a pool and also took a boat out to see the wildlife. Gus finally got to see hippos! As well as many birds, giraffes, monkeys, etc. It was a very relaxing day, just what the doctor ordered.
---Katy
After Saturday morning rounds Zach, Gus and I headed out of town for the afternoon to Lake Naivasha. We went to a beautifully landscaped country club with a pool and also took a boat out to see the wildlife. Gus finally got to see hippos! As well as many birds, giraffes, monkeys, etc. It was a very relaxing day, just what the doctor ordered.
---Katy
Friday, March 11, 2011
Flow of Hope
I've been hanging out with John Njane quite a bit and getting to know the area outside of Kijabe, which is quite isolated from the typical Kenyan lifestyle because of the missionary influence. For instance the Rift Valley Academy (RVA), which is a large school for missionaries children, is as nice as any school back home, with amazing ball fields, gyms, playgrounds, etc. And then the troops of baboons that hang around the perimeter are just a bonus. John is very motivated to help improve his community and has been a blessing to many people. He received some generous support from an individual when he was younger which allowed him to complete school and learn his trade in mechanical engineering. He was profoundly affected by this gift and opportunity to better his life and I suspect he will spend the rest of his life passing that blessing on to others.
Flow of Hope is his mission and is based on direct involvement from its benefactors, with the ideal that seeing and participating directly with community improvement here is the most practical for all. His mission is to instill a sense of hope in people so that they can strive to better their lives and to continue to hope for better and better things, thus the continued "flow" of Gods love and desire for us to care for each other. So, I will try to provide a brief overview of Flow of Hope here, which I have found to be very well thought out and organized.
Flow of Hope is the umbrella structure for multiple outreaches. Widows of Hope, I believe, was the first to develop and provides assistance to older ladies that are often supporting multiple grandchildren and kids in the community with little to no resources. These women have received house improvements, livestock, seeds, and assistance with school fees. As their houses are improved, it enables then to continue to care for their children and alleviate the risk of losing them to the streets (if there is not enough room at home, kids will leave to fend for themselves).
Then there are multiple trade programs targeting different groups. Thread of Hope is providing sewing machines and training for young women that often resort to prostitution as a means to support themselves. There are the street boys, which for now, John tracks down in the community to act as a role model and instill in them some pride in their appearance and demeanor, so that they may have a better chance of getting work. Currently he has organized soccer tournaments to get these kids involved. He hope to develop Wood of Hope (wood shop), Metal of Hope (metal shop) and Wire of Hope (computer training).
With the sewing machines he plans to provide machines to individuals through a kind of micro-loan program, where they will be able to earn money and pay off the cost of the machine. The basis for all of this work is to enable people to be able to provide for themselves. The people here are very laid back, so if they are given too much, they will not be motivated to care for themselves. Another example of John's contributions are with school fees. The widow we visited yesterday owes a balance in school fees. John provided her with half of the money, a little more than $1 worth and expected her to work for the rest. When we arrived at her house, she provided a receipt showing the payment to the school that she made which was for more than he had given her. So, it is working.
Below is a picture and hopefully we will be back next week to do the work. Please pray that this will be a fruitful gift, beyond anything we can imagine in the short term. It looks like the cost for the roof will be around $500 and any contributions made to Katy's doctors account with World Medical Missions/Samaritans Purse will be used for this project. (note, Flow of Hope is actively working on NGO status in Kenya and nonprofit status in the US, so that financial support can be direct, but for now, this is what we have come up with for interested donors. Please don't hesitate to contact Katy or myself directly with questions or interests in getting involved). Your continued prayers and thoughts are being received and very much felt in our hearts. It takes a special kind of grace and patience to be here and it is not something that we are accomplishing alone.
Peace,
Zach
Flow of Hope is his mission and is based on direct involvement from its benefactors, with the ideal that seeing and participating directly with community improvement here is the most practical for all. His mission is to instill a sense of hope in people so that they can strive to better their lives and to continue to hope for better and better things, thus the continued "flow" of Gods love and desire for us to care for each other. So, I will try to provide a brief overview of Flow of Hope here, which I have found to be very well thought out and organized.
Flow of Hope is the umbrella structure for multiple outreaches. Widows of Hope, I believe, was the first to develop and provides assistance to older ladies that are often supporting multiple grandchildren and kids in the community with little to no resources. These women have received house improvements, livestock, seeds, and assistance with school fees. As their houses are improved, it enables then to continue to care for their children and alleviate the risk of losing them to the streets (if there is not enough room at home, kids will leave to fend for themselves).
Then there are multiple trade programs targeting different groups. Thread of Hope is providing sewing machines and training for young women that often resort to prostitution as a means to support themselves. There are the street boys, which for now, John tracks down in the community to act as a role model and instill in them some pride in their appearance and demeanor, so that they may have a better chance of getting work. Currently he has organized soccer tournaments to get these kids involved. He hope to develop Wood of Hope (wood shop), Metal of Hope (metal shop) and Wire of Hope (computer training).
With the sewing machines he plans to provide machines to individuals through a kind of micro-loan program, where they will be able to earn money and pay off the cost of the machine. The basis for all of this work is to enable people to be able to provide for themselves. The people here are very laid back, so if they are given too much, they will not be motivated to care for themselves. Another example of John's contributions are with school fees. The widow we visited yesterday owes a balance in school fees. John provided her with half of the money, a little more than $1 worth and expected her to work for the rest. When we arrived at her house, she provided a receipt showing the payment to the school that she made which was for more than he had given her. So, it is working.
Below is a picture and hopefully we will be back next week to do the work. Please pray that this will be a fruitful gift, beyond anything we can imagine in the short term. It looks like the cost for the roof will be around $500 and any contributions made to Katy's doctors account with World Medical Missions/Samaritans Purse will be used for this project. (note, Flow of Hope is actively working on NGO status in Kenya and nonprofit status in the US, so that financial support can be direct, but for now, this is what we have come up with for interested donors. Please don't hesitate to contact Katy or myself directly with questions or interests in getting involved). Your continued prayers and thoughts are being received and very much felt in our hearts. It takes a special kind of grace and patience to be here and it is not something that we are accomplishing alone.
Peace,
Zach
Thank you with a goat!
I have been very concerned about a young Masai woman on my service who presented with copious uncontrollable bleeding from her mouth and nose. She had a very low platelet count of 4,000 where normal is anywhere from 150,000 to 450,000. These are the blood cells that allow your blood to clot, so obviously we understood why she was bleeding so much. Unfortunately her red blood cells and white blood cells were extremely low as well. This is what we call "pancytopenia" and is very scary and can sometimes be due to cancer, a serious infection, or an autoimmune problem. To make matters worse the only way to replenish someone's platelets here in Kenya is to transfuse fresh warm blood straight from a donor before the platelets die. They don't have frozen platelets stored like we do in the states. So through a train of translation English-->Swahili-->Masai, we were able to get her blood, control the bleeding and work toward the diagnosis. Today I got to perform my first bone marrow biopsy ever, this is where the body makes blood cells. We all celebrated with the patient and her family when we got the results that she did not have cancer and in fact her bone marrow looked like it was in overdrive and on the way to recovery! According to the pathologist it looks like she must have ingested a toxin (herbal remedy) or had a virus causing an "aplastic anemia." We are curious about the herbal remedy theory as the patient's family described similar symptoms of other women in their tribe and other doc's here in Kijabe have as well. Everyone was so overjoyed. I was standing among a family of very tall lean Masai just ecstatic thanking me, praising God and telling me they were going to bring me a goat!
---Katy
---Katy
Thursday, March 10, 2011
Gus says, "we're going to Africa!"
Yesterday Gus and I, and our new friend John Njane, took a trip to Lake Naivasha, and visited Crescent Island (see this webpage for some of the stats on the wildlife population), a wildlife sanctuary where you can walk around with the animals in their natural habitat. It is where "Out of Africa" was filmed, among many other films and animals had been brought in for the movie and then settled there. Of course there are no wild cats. There are buffalos and hippos though, which you must keep your distance from. It was so exciting! We hired a driver to take us there and as we were loading up into the van, Gus kept saying, "we are going to Afirca." I guess Africa is where the wild animals are.
Most amazing I thought were the giraffes. They are such strange creatures and amazingly adapted to eat the acacia leaves that are surrounded by 3 inch plus thorns and grow to be quite large trees. We started at the top of the hill with a guide and intended to loop around to see the giraffes, so we headed down to the shore line and traversed herds of wildebeest, zebra, and gazelle. There were also waterbuck, which seemed not to congregate in large herds but were interspersed with all of the other animals. I was impressed with their majestic striped black and white antlers.
Before we made it too far, the giraffes had headed our way and were apparently coming to see us. They had three babies with them, one only 20 days old; still quite a bit taller than me and Gus combined though.
Our friendly guide also took us to a nearby Hyena den, which apparently are created by the Ardvarks, who dig for their food and then abandon the caverns that they create, providing housing for Hyenas, Pythons and probably a number of other creatures. At the den, there were remains of the "hyena picnic", as our guide referred to it. Weak, dying or dead herd animals are taken by the hyenas at night, as they are scavengers and the herd animals often do not have enough food from the drying grasslands. The rains will return here soon though and revive the land for the farmers and animals alike.
Other highlights included meeting some fisherman on the shore in a type of canoe, filled with common carp. They sold me five large fish and gave one to our guide. I later sold one fish to our driver, kept one to cook tonight and sent the rest home with John to feed his large family of foster boys. I'll have to report later on how dinner turns out. Also, we saw two water buffalo from a distance, apparently the outcast or loser males of the herd. We then walked by a large flock of pelicans and found a very nice pelican feather for a souvenir. Unfortunately, we did not sight any hippos and were only able to witness a python track through the dirt from its den.
I'm not sure what Gus enjoyed the most; possibly the van ride, seeing animals along the road (donkeys, sheep and goats), and his snacks. He did pretty good considering we walked around for a few hours, which included a short nap on my back, running around and riding on our shoulders ("airplane ride", as John called it). He was often "too hot" while walking, "too cold" from the wind while riding and interested in getting back to the "white van" to go home.
I think that he will enjoy another safari once we get a chance to all go together. Katy was on call, working very hard while we played. We are so fortunate to have the opportunity to see these animals. It seems as if the Kenyan government has done well to create protected areas. Additionally the cost is very high for tourists to visit. There are affordable entrance rates for residents and, in fact, the caretaker at Crescent Island did not even charge for John. I do struggle with spending as much as we do, as tourists, compared to what that money could be used for to help people living with so little here. For us, we hope to balance to two. This afternoon I will be meeting with John again to visit a widow that he has been helping through his Flow of Hope mission to evaluate putting a new roof on her house. I hope to pay for the materials and help install the new roof possibly next week. After our visit today I will explain more about Flow of Hope and the amazing heart that John has for his community.
Zach
Most amazing I thought were the giraffes. They are such strange creatures and amazingly adapted to eat the acacia leaves that are surrounded by 3 inch plus thorns and grow to be quite large trees. We started at the top of the hill with a guide and intended to loop around to see the giraffes, so we headed down to the shore line and traversed herds of wildebeest, zebra, and gazelle. There were also waterbuck, which seemed not to congregate in large herds but were interspersed with all of the other animals. I was impressed with their majestic striped black and white antlers.
Before we made it too far, the giraffes had headed our way and were apparently coming to see us. They had three babies with them, one only 20 days old; still quite a bit taller than me and Gus combined though.
Our friendly guide also took us to a nearby Hyena den, which apparently are created by the Ardvarks, who dig for their food and then abandon the caverns that they create, providing housing for Hyenas, Pythons and probably a number of other creatures. At the den, there were remains of the "hyena picnic", as our guide referred to it. Weak, dying or dead herd animals are taken by the hyenas at night, as they are scavengers and the herd animals often do not have enough food from the drying grasslands. The rains will return here soon though and revive the land for the farmers and animals alike.
python track and den-guide says the snake extends from the den a little further than picture shows, about 12 feet.
Other highlights included meeting some fisherman on the shore in a type of canoe, filled with common carp. They sold me five large fish and gave one to our guide. I later sold one fish to our driver, kept one to cook tonight and sent the rest home with John to feed his large family of foster boys. I'll have to report later on how dinner turns out. Also, we saw two water buffalo from a distance, apparently the outcast or loser males of the herd. We then walked by a large flock of pelicans and found a very nice pelican feather for a souvenir. Unfortunately, we did not sight any hippos and were only able to witness a python track through the dirt from its den.
I'm not sure what Gus enjoyed the most; possibly the van ride, seeing animals along the road (donkeys, sheep and goats), and his snacks. He did pretty good considering we walked around for a few hours, which included a short nap on my back, running around and riding on our shoulders ("airplane ride", as John called it). He was often "too hot" while walking, "too cold" from the wind while riding and interested in getting back to the "white van" to go home.
I think that he will enjoy another safari once we get a chance to all go together. Katy was on call, working very hard while we played. We are so fortunate to have the opportunity to see these animals. It seems as if the Kenyan government has done well to create protected areas. Additionally the cost is very high for tourists to visit. There are affordable entrance rates for residents and, in fact, the caretaker at Crescent Island did not even charge for John. I do struggle with spending as much as we do, as tourists, compared to what that money could be used for to help people living with so little here. For us, we hope to balance to two. This afternoon I will be meeting with John again to visit a widow that he has been helping through his Flow of Hope mission to evaluate putting a new roof on her house. I hope to pay for the materials and help install the new roof possibly next week. After our visit today I will explain more about Flow of Hope and the amazing heart that John has for his community.
Zach
Tuesday, March 8, 2011
Women's Ward "Salome"
"Salome" in Hebrew means peace. That's the name of the Women's Ward here in Kijabe where I have volunteered to work (and which makes me feel anything but peaceful). I say volunteer because they did give me a choice. I was told by some wise residents who were just here in Kijabe that the Men's Ward might be a little more peaceful and less costly of your time and stress. But somehow I heard a voice come out of my mouth that first day saying "I'll work wherever you need me the most." It's a pretty busy service with some really sick patients which makes the days long and little painful. But I figure I did come here to serve, so I'm digging in and pushing onward. The cases are really interesting so it isn't the medicine that is painful, it's the work-up. Finding the labs you ordered is like a needle in a haystack and then after you've flipped through the unorganized chart three time and ask the nursing staff what happened (because sometimes what you've ordered just doesn't get done), you find out that the patient or their family refused because it was too expensive. So it's going to be a challenge to say the least and the 12 hour days I was warned about by other residents is yes, a reality.
---Katy
---Katy
Monday, March 7, 2011
Sunset over the Rift Valley
The neighborhood we live in is on a gently sloping hill, literally the western edge of the central highlands, which drops off into the vast Rift Valley far below. In the haze of the daytime sun, it seems as if I am looking out over an ocean far below, until I register the farm plotted land and distant road crossing the great plain. There is a magical feel to this place, particularly once the winds start every evening and continue through the night. It's not any kind of wind storm I've experienced before, but instead it's like a wind tunnel, with the winds blowing in all directions without any break in their intensity. And this is sustained all night long, until the sun comes up the next day and effectively turns off the switch and peace is returned.
Zach
Sunday, March 6, 2011
First Pictures of Kenya
We are still dealing with jet lag here, but feel that we are close to getting back to having some resemblance of a schedule. Hopefully we will not all wake up tomorrow at 2:30am, as we have the last two nights. I know this would be a huge relief to Katy, since she starts work tomorrow. Regardless of the challenges of an unruly toddler, jet lag, and other cultural and physical adjustments, I can't say enough how wonderful it is here. I love the tropics! And being in the central highlands of Kenya means we are at some altitude and the warm days cool off quite a bit at night. I was in a state of disbelief last night at dinner time when I realized that I was getting cold. So glad I brought a sweatshirt.
Okay, onto some pictures...ok...that took awhile to upload. You'll find the majority of our pictures by clicking on the "Picasa Photostream" on the right side of the blog, as I have time to make some albums there, which I can also add to throughout our trip.
Below is our little G on the move. We fear that there will be many spills and scrapes along the way. He is often intent on learning the hard way. Ready or not hear I go!
Okay, onto some pictures...ok...that took awhile to upload. You'll find the majority of our pictures by clicking on the "Picasa Photostream" on the right side of the blog, as I have time to make some albums there, which I can also add to throughout our trip.
Below is our little G on the move. We fear that there will be many spills and scrapes along the way. He is often intent on learning the hard way. Ready or not hear I go!
Beautiful Kenyan sunlight
Beautiful Kenyan foliage. The pinks and purples really pop. Also, note the ominous clouds above, building for the daily afternoon showers. very refreshing and wonderful.
Our humble abode, the right side of a duplex, which is just down the hill from the hospital. Inside we have basic furnishings and kitchenware, two bedrooms down the hall with a bathroom on one side. The housing manager kindly found us a coffee maker and so far we are making due with what was already here.
For now I am going to enjoy the last few minutes of Gus' nap in our quiet living room before heading out for more adventuring; maybe to meet some new friends next door.
Zach
Saturday, March 5, 2011
Kijabe - I think I'm going to love it here!
Kijabe - "Place of the Wind" yes indeed. Just lovely...the billowing white clouds hover in a clear blue sky and you feel as if you could just reach up and touch them, the brilliant yellow weaver birds sing and steadily work making nests for their potential mates, the flowers are the most beautiful fushias and purples and we are on the mountainside overlooking the Rift Valley staring straight a Mount Longonot. I can't believe there are zebras and giraffes down there. This is just amazing.
We are settling in to our 2 bedroom spacious home. Gus met another Gus today age 1-1/2yrs old and his brother 2-1/2yrs old and a couple of their friends, they live a few houses down, so there will be plenty of fun to be had. Unfortunately his adaptation to the new time zone is lacking, so no play date today. Hopefully the agony of sleep deprivation won't continue on much longer and we will run into them at church tomorrow and make even more friends still.
Already did a little vegetable shopping in the market and tried our first world famous homemade samosas and english muffins. Gus thought it was just great that all the vegetables are displayed at his height, creating an ever so fun game of grabbing them and then getting chased by mommy before he put them in his mouth. Utter delight....and utter terror for mommy.
---Katy
We are settling in to our 2 bedroom spacious home. Gus met another Gus today age 1-1/2yrs old and his brother 2-1/2yrs old and a couple of their friends, they live a few houses down, so there will be plenty of fun to be had. Unfortunately his adaptation to the new time zone is lacking, so no play date today. Hopefully the agony of sleep deprivation won't continue on much longer and we will run into them at church tomorrow and make even more friends still.
Already did a little vegetable shopping in the market and tried our first world famous homemade samosas and english muffins. Gus thought it was just great that all the vegetables are displayed at his height, creating an ever so fun game of grabbing them and then getting chased by mommy before he put them in his mouth. Utter delight....and utter terror for mommy.
---Katy
Friday, March 4, 2011
Mayfield Guesthouse - Nairobi
How many Mayers and goldfish cracker crumbs can you fit in a single bed at 3AM? Kenya, we've arrived! Off to do our grocery shopping for the month.
--Katy
--Katy
We made it to Africa-what time is it?
Wow, what a long trip it's been. We are glad that we took a one day rest in Paris on the way here. Gus did amazing on the flights; no problems to speak on on the first flight to Paris and only a couple minor tantrums on the flight yesterday to Nairobi. The biggest challenge to speak of so far is the sleep disruption and time differences. Yesterday I think we woke up around 4am and had to "play" with Gus until the hotel breakfast began at 6am. We were their first customers. Today, well, if you check the time of this blog post as we are 11 hours ahead of Pacific Daylight Time and I've been up for a couple hours. So, yes, Gus woke up around 2:30 am, after sleeping for over four hours. This followed probably a four hour nap on the plane. So, we are trying to keep a two year old from waking everyone up in the Mayfield Guest House, here in Nairobi. I am down the hall in the computer room and I just heard a "daddy". Better go check on my lovely family. I wonder how early we can run a bath here without it being too loud? So, as I am pulled away from trying to type a simple message, I am thinking that this is the pace of my life now: keeping up with a two year old. I can hear him again talking about his "Diego" videos. got to go.
zach
zach
Friday, February 25, 2011
Count Down to Kenya
It's the weekend before we leave and we are checking our lists and packing our bags. It's a little stressful to say the least, anticipating the airports and airplanes and connections in between with 4 bags, a car seat and a two-year-old!!!!! We are so excited though and almost ready to go.
Please bare with me, as I learn how to use the blog and include more information, pictures, etc. More to come soon.
Please bare with me, as I learn how to use the blog and include more information, pictures, etc. More to come soon.
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