Coming Home

As I pack my bags for my final leg home, my heart is full of mixed emotions. I'm excited to see my family and friends, but I don't know how to share with them the depth of what God has shown me here. 

A view of Tenwek and its surroundings from Motigo

Somewhere amidst the aspiring young leaders at Mamlaka Church (Jan and Tim Ryder's church in Nairobi), the bright young faces of the medical interns at Tenwek praising God for his goodness and lifting up each of their patients by name in prayer, and the compassionate eyes of adult physicians praying for each other and with each other, I was challenged to live a much more spirit-filled life than the one I am currently living. Similarly, the children emaciated and dieing from AIDS, the countless infants who suffer from permanent neurological damage from birth asphyxia, and the millions of others who die from malnutrition and preventable diseases, ignited a hunger to learn medicine in a way that had been dampened over the past few years of exhaustion in residency.

I think one of my favorite parts about this experience was seeing the way that the residents and the physicians at Tenwek take time out of every day to pray for their patients. We start our morning rounds with prayer and we will stop by the bedside of anyone who is particularly hurting to pray with them. It didn't matter how busy we were. On the admission of a new patient to the hospital, one of the mandatory topics to cover is the patient's faith. These physicians understand that more important than treating this particular illness is that, if this very sick patient dies, will he or she be spending eternity with Jesus?

I don't know where God is calling me right at this moment. But I do know that He calls me, and all of us, to bring His gospel to the nations and to live for His glory; This may be locally or may be internationally. There is a two-year fellowship with Samaritan's Purse that sends residents to one of their partner hospitals for training in medical missions. (If anyone is interested you can go to http://www.samaritanspurse.org/medical/post-residency-program/ to find out more).

This morning I was reading through the newsletter from Jan and Tim's church when I came across the testimony of a young woman about to be sent to eastern Kenya, a Muslim village, to begin community health development. The following is a quote from her that I hope to also emmulate:

"All I desire is to have a mind that perceives, eyes that see, ears that hear, a heart that loves, hands that touch, and legs that walk for God in my generation".

Masai Mara

Much has happened since my last blog entry, one of which was a two-day safari! I just arrived safely back to Nairobi and am heading home to the states Saturday evening. The Lord has shown me so many things these past three weeks and He has opened my eyes and my heart to many realities and possibilities. I would like to attempt to record some of my closing thoughts and emotions with all of you who have been supporting me during this time, but I'm too exhausted to do that right now! So instead, I will leave you tonight with a taste of the Masai Mara...... and I will send you more thoughts tomorrow. I cherish you all!

Mara means "spotted", so Masai Mara literally depicts a land that is inhabited by Masai people and appears spotted from above the Great Rift Valley because of the isolated trees and bushes scattered throughout. It is absolutely breathtaking! Although they say a picture is worth a thousand words, there is no way to portray the Mara with pictures alone.

 "And God saw all that He had made, and it was very good"

After seeing this Cheetah, we saw two that had just killed an Impalla and were ravenously feeding on it! (I'm having technical difficulties and can't seem to get all my pictures onto my computer....yes I am a girl)

There were so many elephants!! This was a younger bunch that smelled us soon and started running away. It was pretty cute. I learned that elephants need to feed for 18 hours a day in order to sustain themselves (over 240 pounds of grass!!). They cut the grass by kicking their feet and using their trunks as traction. They also eat Acacia trees.

My FAVORITE animal!! I just love Giraffes. They are so graceful and have such long eyelashes! I love the way they walk and eat off trees. The tallest giraffe ever recorded was 21 feet tall (I learned that in Whits & Wagers! haha)

Rainstorm is coming! We soon got wet =)

The spotted Masai Land (Mara). I just love those trees.

"For since the creation of the world God's invisible qualities- his eternal power and divine nature- have been clearly seen, being understood from what has been made, so that men are without excuse". Romans 1:19-20

When You Don't Understand Why

"Naked I came from my mother's womb, and naked I will depart. The Lord gave and the Lord has taken away; may the name of the Lord be praised."  Job 1:21 

I was reading this verse during my morning devotional this morning, and little did I know how much I would need to depend on it for the trials that would be faced today.  I don't think I have every felt so helpless and so overwhelmed with grief than what I experienced today.

Yesterday, a baby born at 36 weeks who had been doing well, suddenly became very hypoxic (low oxygen saturations). We have one ventilator for the NICU at Tenwek and thankfully was available for this baby. Unfortunately, despite maximum settings on the ventilator we were unable to achieve adequate oxygenation in this baby. I watched him as his heart rates slowly drifted down overnight. I noticed how his pink color slowly began to turn purple, first around his mouth, then his extremities, and soon involving his entire body. Throughout the night I unhooked him from the ventilator to perform manual bagging, but this was really just vain effort. I decided to lay down for a few hours since I had nothing more to offer this baby. Without oxygen there is no way he would survive. We do not have the more advanced ventilators and medications that might save this baby here.

This morning when I went to check on him I was overcome. He was blue and ice cold. I picked him up and his body was completely lifeless, literally hanging in my arms like a rag doll. I've honestly never held a baby that was so dead. It was shocking to me. What makes it harder is that even as I write this, the baby is still breathing on his own and maintaining a heart rate. But he is brain dead and essentially lifeless.

He was blue and ice cold. I picked him up and his body was completely lifeless, literally hanging in my arms like a rag doll.

As I walked through the NICU, I rounded on at least six other babies that suffered from birth asphyxia, all of whom are neurologically devastated. At the same time there was a 700 gram pre-term baby who was also desaturating and whose heart rates were falling. We have no surfactant here to give this baby, so again, I have nothing to offer this baby. Suddenly I was overwhelmed with a feeling of helplessness. I was then called to the operating room for a cesarean section. The nurse who called me could not give me any information on the gestation of the baby, the indication for c-section, or the history of the mother. Before the baby was even born this nurse was telling me about another baby born earlier this morning whose heart rates were poor and who was small for his gestation. But again, she could tell me nothing more. I felt so angry and frustrated! Why could no one give me more information? Yesterday, a baby showed up at the door of the NICU literally thrusted into my hands and was barely breathing. I did not know where this baby came from or what had happened. At that moment I wanted nothing more than to run away from the hospital and get a breath of fresh air. I wanted a sense of control.

I didn't realize that this anger I was feeling was really just a defense mechanism until I ran into an OB/Gyn here who asked me how I was doing and I broke down in tears. Once I started crying I just couldn't stop. I felt so defeated at that moment. What was I doing here? Why couldn't I help more? Thankfully I had been invited over to another physician's home this afternoon. While I was there he, and several others, reminded me that ultimately Jesus is the one who heals. As it says on Tenwek's front sign, "We Treat, Jesus Heals". God has not called me here to treat these patients, he has called me here to show them Jesus.

"We Treat, Jesus Heals". God has not called me here to treat these patients, he has called me here to show them Jesus.

I continued to cry, but being surrounded by people who knew exactly how I was feeling at that moment was so healing for me. It gave me enough strength to return to the hospital and face the rest of the day. 

The mother who had given birth to the precious boy I described above is merely 21 years old, and she has already lost 3 intrauterine pregnancies.  This current pregnancy was complicated by pre-eclampsia and the baby likely aspirated meconium.  Last night when I began the process of telling Betsy (mother) how sick her baby was, she was very flat and showed no emotion.  I think she had detached herself from loving him because of the loss of her three previous pregnancies.  This afternoon, however, when I went to tell her that her baby was dead, she saw me enter the room and she immediately covered her head with a shall and started sobbing. She cried out in anguish, saying "this pain is unbearable". I held her and I cried right next to her. I prayed for her; that through this pain and suffering she would not be angry with God but that God would somehow give her peace and that He would cover her in his infinite love. I reminded her that her baby boy had been called to heaven but that even his short life had a purpose. When she stopped crying she told me that she had been planning to commit suicide that day. She could not bear the loss of another child and she could not bear the thought of telling her husband. But now God has given her strength to endure. And then she told me, "God gave me this baby boy, and now he has taken him away from me, but He is a good God." At that moment I was reminded of my readings in Job this morning. All of Job's possessions and even his family were taken away from him in one instant, but Job still praised the name of God.

 I was reminded today of God's sovereignty and my lack of control. All I can do is offer what I have, but ultimately it is He that heals. My purpose here is not to just treat the sick, but to lead the blind to Jesus Christ.

A Devastating Disease

 

There are approximately 35 millions people living currently with HIV, with a vast majority of these individuals living in Sub-Saharan Africa.  In fact, 71% of people affected by HIV/AIDS reside in Sub-Saharan Africa even though this region only makes up 12% of the world’s population.  Of these 35 million, 3.3 million are children.  In 2011, there were 17.3 million children orphaned due to both parents dieing from AIDS; 88% of these children live in Sub-Saharan Africa.  This is just a snap-shot from 1,000 feet up of this devastating infectious disease.  Of course I knew that I would be treating patients here at Tenwek with HIV but the shear enormity of the problem is astounding.  I feel as if almost every other child in the ward is HIV positive.  Many of these children have co-infections with Tuberculosis, or some other opportunistic infection such as PCP or Cryptococcus.

This week I met two young girls, ages 13 and 15, who are dieing from AIDS. They look as if they are ghosts barely living inside a skeleton of a body. Their eyes are gaunt, their cheeks and temples are sunken, and their oral cavities are covered in thick white plaques made of fungus. I can close my thumb and index finger around their legs. It is pretty much indescribable. One of these girls, Chelanget, was infected with HIV in-utero and her mother has not been compliant with giving her the anti-retrovirals that she requires. This girl is 15 years old and weighs only 18kg  (39 lbs). The other girl, Sheila, has already lost both her parents and two of her siblings from AIDS. She was just diagnosed 1 year ago and started on anti-retrovirals in November.

This morning during our morning rounds, Shelia’s aunt suddenly started screaming. Her already lifeless body was even more limp than it was before and when I went to check her pulse I found nothing. We quickly carried her into a side room down the hallway away from all the other children in the ward and began CPR. It was almost sickening to be compressing the chest of this emaciated and innocent girl, feeling her ribs crack beneath me. I thought with 100% certainty that this girl was dead. But after approximately 10 minutes of resuscitation Sheila’s heart began to beat again. It really was a miracle. We prayed over her after we had further resuscitated her with fluids and electrolytes. Her state is still quite tenuous, but she is such a sweet girl and so young. I’m praying for a miracle. Shelia’s aunt does not know Jesus so I am also praying that we can continue to minister to this family and show God’s love to them.

There are so many stories like this one, and so many children’s faces here that reflect sadness. But on the flip side, there are also many children who are being healed and bringing joy to those around them. Here are some pictures of a few children and the hospital here:

14 month old Deborah who I treated in clinic. Her family invited me over to their home for dinner!

Is she not one of the cutest things ever??!

Ken and Shelia, parents of Deborah. Treated me like a queen!!

Baby junior getting ready for discharge after being severely dehydrated and malnourished

Half of the pediatric ward

A premie with gastroschisis, The surgeons are keeping his bowel insulted in a foley bag and waiting for his stomach to grow so they can attempt to replace his bowel inside his abdominal cavity.

A newborn with obstructive hydrocephalus. His mom tenderly feeds him every 3 hours via NG tube.

Here is a picture I took today of a boy that gives me a hi-five every day. I traded him a few starburst candies for a picture =)

Hannah

 "Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day. For these light and momentary troubles are preparing for us an eternal weight of glory that far outweighs them all." 2 Corinthians 4:16-18

As I begin this blog entry I don’t quite have the words to express what I’m feeling. Honestly, I feel as if my heart has been broken. The Emergency Medicine physician at Tenwek, Dr. Kelly, shared a very personal story with us this morning during morning devotionals. He and his wife, Stephanie, along with their four children came to Tenwek fourteen months ago. They had felt called into missions for many years, but as they were preparing for Kenya, they both also felt that God was telling them that one of their children would die in Africa. They were not sure what to do about this feeling, and actually didn't even talk to each other about it. In the end they felt very strongly called to Tenwek and God gave them peace about this decision. Six weeks after arriving at Tenwek, their daughter, Hannah, became quite ill. She was vomiting a lot, eventually requiring NG tube placement and IV fluids. She continued to decline and about two weeks into her illness, she suddenly stopped breathing and had no pulse. Dr. Kelly himself described picking up her limp body and starting CPR. He and the only pediatrician at Tenwek carried her from their home to the Casualty department where Dr. Kelly was forced to intubate his one-year old baby girl. They continued to code her when she began to have seizures. It turns out that Hannah had a large medulloblastoma that had caused an obstructive hydrocephalus (the brain ventricles were blocked and could not drain so cerebrospinal fluid was building up in the brain causing increased pressure and shifts in the brain). She was taken to another hospital where there was a pediatric neurosurgeon for operative resection, but she did not recovery brain function or activity and Mr. and Mrs. Kelly were forced to withdraw care on Hannah.

Dr. Kelly shared this very personal story and accounted the horrors of those days. But he also recounts how God has introduced him to parents and families, both in the U.S. and here in Kenya, that are suffering from similar losses. Dr. Kelly has been able to share the gospel of Christ with these families and provide comfort to them in a way that no one who has not gone through this experience possibly could. At home in the U.S. losing a child is rare, but here it is a common occurrence. He reminded us that our ultimate purpose is to glorify God and to sacrifice our lives in order to bring God glory. Dr. Kelly admits that he would give anything to have his daughter back. He was holding back tears as he told us this story. But he also recognizes that our lives are not our own, they are God’s. The Lord has created us in His image in order to bring Him glory.

Over the past two weeks I feel that God has impressed on my heart the idea of radical abandonment; releasing my hold on the treasures in my life and sacrificing them to the Lord in order that He might be glorified and that I might experience his abundant love and blessings. This morning God challenged me to be willing to not only give up material possessions, but to be willing to give up relationships, family, jobs, and more in order to spread His word and glorify Him. I have been wrestling with the call to missions in my life for some time now. Since arriving at Tenwek I have been trying to discern whether or not God is calling me into the mission field as a long-term missionary or short-term. I can’t say that I have that figured out quite yet, but I can say that this morning God clearly spoke to me and told me that whatever I am holding on to at home, I need to surrender. I’m scared to ask God to take my life and use it completely for His purpose. I’m afraid of what that might mean giving up. But God has promised to be ever faithful and the blessings that we will reap from surrendering our life to Him will be so much greater than the blessings that we might enjoy without that abandonment.

God has also promised us His Holy Spirit to sustain us, empower us, teach us, and guide us. John 14:25-27 says, “I have said these things to you while I am still with you. But the Advocate, the Holy Spirit, whom the Father will send in my name, will teach you everything, and remind you of all that I have said to you. Peace I leave with you; my peace I give to you. I do not give to you as the world gives. Do not let your hearts be troubles, and do not let them be afraid”.

I had planned to write today’s blog about a few of the patients that I have been treating, but God really led me to write all of this down and post this today instead. I would encourage you to read more about Dr. Aaron Kelly and Stephanie’s story on their blogs:

www.aaroninkenya.com and

Karibu

Me buying too many things from Lydia's shop!

Karibu means "welcome" in Swahili, and this word probably describes the people of Kenya best. I have been overwhelmed by the generosity and kindness of the people here. As I walk through the hospital I am greeted with a handshake at every corner. A less formal greeting involves a kiss on both cheeks. If an individual walks in late to a meeting (which happens a lot here!!) it is not uncommon to see that person walk up front and greet everyone with a handshake, whereas we in the U.S would likely try to sneak ourselves into the back row without being heard. Jan Ryder described the Kenyans to me as "wanting peace with everyone". Another local Kenyan told me that "Kenyans welcome everyone and love everyone". This is certainly true! I wanted to share with you all a few stories of people I have met and their generosity.

On Friday I was finishing up a busy day on the wards and in the NICU. The pediatric clinic was still overwhelmed with patients so I went to help see the last few patients of the day. A young couple with a 14 month-old daughter, Deborah (it is very common for Kenyans to have both a Kenyan name and a biblical name), was waiting very patiently to be seen. I introduced myself as an American physician who was spending a few short weeks here at Tenwek helping out with pediatrics. Immediately the mother and father exclaimed their appreciation for my being here and repeated over and over how blessed they were to be able to see me on this day while I'm only here for 3 weeks. I thought to myself, "believe me, you are not lucky to see me! There are many physicians here much smarter than I am!!". At the end of the visit, they insisted that I come to their home for a traditional Kenyan dinner. I was on call Friday night but they will be coming by the hospital to pick me up on Monday evening and take me to their home for dinner. I can't wait!

Yesterday, I had the day off and decided to explore the grounds more. Tenwek is located in the highlands amongst beautiful rolling hills. There is a river nearby with a large waterfall that actually is used as the source of hydroelectric power for the hospital! I don't think this hospital would be able to function at its current capacity without the hydroelectric power from this waterfall. ( If you are interested in reading more about the history of how this power source was discovered and utilized you can read about it in "Jesus M.D." or "Miracle at Tenwek").  I was crossing a bridge over the river when I ran into a girl named Clara. Clara told me that she was 14 years old and lived nearby. She was orphaned and was at a boarding school. She described to me how when she was young and her parents were both dead she lived with her brother and her grandmother. There was a quarrel in their family regarding land. Clara's cousin was so angry over the land that she actually severed the leg of her grandmother and later cut open her stomach! (I have learned unfortunately that this is a very common practice here. Many patients come to Tenwek with missing body parts that were cut off during an argument). Clara found herself at Tenwek and during her time here was introduced to Jesus. She is now "born again" and is so thankful for God and His saving grace! Her grandmother is not yet saved but Clara is telling her grandmother about Christ's love every day. Clara offered to help me with my Swahili while I am here!

Clara

Lastly, Amy and I were doing some shopping yesterday at the local market. We met a woman named Lydia who started selling her crafts years ago to put her four children through school. She had beautiful pieces of art (of which I bought too much!!). Her husband also did carvings. She introduced us to her son, Asante, which means "thank-you" in Swahili. She said that she named him Asante to thank God for the blessing of a son. She then introduced us to her husband, who when he learned that Amy was trying to learn to play guitar and that I enjoy singing, offered to give her a guitar lesson on Tuesday evening and asked that I come to sing along!

Tenwek's waterfall

These are just a few examples of the welcoming I have received here at Tenwek. It challenges me to examine my own life and ask how I am impacting the lives of people around me by welcoming them into my home, or my activities, and showing them Christ's love. I wish that everyone back home could come to Kenya and experience this time of love and welcoming! It truly is unforgettable and I think it gives us a glimpse of what we as a church should be exemplifying.

"We Treat, Jesus Heals"

This is the motto that hangs on the sign outside of the main entrance to Tenwek Hospital, and it definitely describes the attitude of the staff that I've met here. I arrived at Tenwek Wednesday afternoon, and within several hours had already received my pager, my call schedule, and had a full tour of the hospital! I will be serving as a "consultant" (aka. attending physician) in the pediatric department while here and my first call night is Friday night! I'm actually really nervous about being on call tomorrow- things are obviously done differently here than in the States. I'm not familiar with some of the medications used here and many of the medications I'm used to using are not available here. Not to mention the fact that I've already encountered several cases today that I've never encountered in the United States. I would definitely appreciate your prayers for wisdom and that God would divinely give me the knowledge and capability that I will need to treat these children!

I've met many wonderful people here at Tenwek. Everyone has been very welcoming. I attended a woman's bible study last night that was led by one of the female Internal Medicine Attendings. There were several Kenyan interns there as well as a few female spouses to physicians at the hospital. After introducing ourselves we went into the hospital and prayed with the patients and their families. It was such a unique and incredible experience! How many hospitals are there where you can freely approach your patients and pray with them?

I won't go into the gruesome details of the day for all of you non-medical folk who might be eating lunch as your read this =) But a few examples of things that I saw today:
-- A new diagnosis of HIV in a 5 y/o with a CD4 count of 124 who likely has PCP pneumonia with a very poor prognosis.
-- A child who presented with vomiting and was found to have diffuse colitis with multiple enlarged abdominal lymph nodes, a partial small bowel obstruction, several pulmonary nodules, and also has facial features of Down Syndrome. This child very likely has disseminated tuberculosis and is unlikely to benefit from treatment.
-- An 8 y/o female presented in liver failure from an unknown etiology was vomiting up worms this morning during rounds.
-- There is a 6 y/o with TB meningitis that has obstructive hydrocephalus and received a VP shunt yesterday, but the liklihood of shunt failure is quite high due to the high CSF protein content.
-- There is a baby in the NICU with gastroschesis (the bowel is currently being kept alive in a foley bag that is tied to the top of the babies incubator with a long piece of gauze).
-- There is another baby in the NICU with tetrology of fallot and cleft lip/palate who will likely be discharged tomorrow because the family cannot afford proper treatment and we do not currently have a pediatric cardiothoracic or facial surgeon.

I miss you all and am thinking of you! I hope all is well back home. Keep me posted with updates! I love fun emails =)

The view from my guesthouse! Isn't it beautiful? More pictures to come later!