Sunday, December 26, 2010

The Best Christmas Present Ever Was A Day Late.

So I am going to start this blog by telling you about Christmas at Tenwek the last few days and leave you in suspense about the best Christmas present ever until the end. This is probably due to some OCD making me tell the story chronologically so here we go. I only worked one day last week - Wednesday. Monday and Tuesday I was in Nairobi Thursday I was sick, I think only my second sick day ever since becoming an RT. Thursday I was cheered up by a package sent by my friends as the Mis, thanks guys, It was exciting to receive all the Dutch Christmas treats and a card with encouragement.

Friday was a day off - I was invited to visit a local orphanage to bring them some Christmas cheer. On the way to the orphanage we stopped and bought them some flour, sugar and other staples, there were a few Kenyan youth with us who shared the Christmas story with them and then we played some games. I taught the kids to play spoons (card game) it was rather interesting as they have minimal experience with cards, and did not realize there was a difference between K,J, and Q, there was also a lot of unintentional cheating going on as they shared the cards with one another. The favourite part was the race for the spoon, so we had fun.

Friday night was Christmas Eve dinner with some friends followed by caroling at church. It is so nice to sing all the well known Christmas Carols, although I did miss Ere Zij God.

Yesterday was Christmas day. I spent it like many of you spent your Christmases I swapped gifts with friends, ate some turkey and other wonderful side dishes. In the evening one of the missionary families shot off some fireworks, this was great. The strangest things about the fireworks was that we shot them off at 730 and it was dark enough - part of living on the equator.

I am writing this on Sunday we had church this morning, Kenya does not celebrate Thanksgiving like North Americans do, so this Sunday was called a Thanksgiving service. It was great to hear how much God has worked here at Tenwek. After church I enjoyed a mango and was talking to my roommate - an OB/GYN Dr here at Tenwek when her pager went off - she was not on call this weekend but called anyway. I was glad she did, for there was a Mom in labour with Quadruplets. I talked to the pediatrician on duty asked if I could help out and than we both ran up to the Hospital. When we got there the first baby had already been delivered normally and was in the nursery doing OK, because the next baby was breech (footling) the mom was brought to the OR for a C-section (we could not find a stretcher so we wheeled her over in a wheelchair). they did the C-section in theater and the pediatrician, intern (1st year residents) and I waited in recovery room for the babies. The intern got the first one dry, positioned, suctioned and bagged and prayed that she pinks up - she did. While she was working on the first one, number two showed up, the pediatrician took care of her same procedure. Now here is the last one - mine same as the others dry, position, suction and bag. She pinked up (for those of you saying "wait only three" remember that one was born before we got there). It was so exciting to be there for this momentous occasion. These babies: one boy and three girls still have a long way to go as they were born at 29 weeks and each weigh about 1 kg, however they are breathing on their own and look OK. For all you medical people: the mom did receive dexamethasone a day or 2 ago which is good for the lung development but we don't have surfactant here. Please pray for these babies. Though there will be struggles this was a great Christmas present, and I still am so excited a few hours later.

I hope you all had a blessed Christmas. The excitement of new birth is really what Christmas is all about- without the birth of Christ we would not be celebrating today. I also learned something (I have learned a lot but I will share this one with you) for all of you saying Christmas is not really when Christ was born and the Christians took over a pagan holiday and made it Christmas. They chose December 25th for a reason, for at the time that was thought to be the winter solstice (longest night shortest day) and once that had passed it symbolized that the light was coming - and Christ is the light. Something I learned here in Kenya where there is no winter solstice.

I have also added some pictures to facebook, some of the same some different see them here

Monday, December 20, 2010


Nairobi: the big city. I am not a big city gal, and according to Wikipedia, Nairobi's population is about three million which I think is the same as all of Alberta. Anyway I traveled to the big city for a important reason my Visitor Visa expired the end of the month, I needed a renewal to stay in the country. I knew that I would be making the trip sometime in December however due to Christmas and other holidays it was thought that it would be best to get it done and over with while the offices were still open. The trip to Nairobi was different than the other times I have traveled; previously I have been in the other missionaries cars and they drive, once we hired a driver to drive the car. However, there was no one with a car heading up to Nairobi, but a friend of mine and one of his friends were heading back to Nairobi on public transport - so I joined them. I have taken the greyhound  before but this was a little different. We started out by car matatu, which I have taken before. This was for the short trip from Tenwek to Bomet (Bomet is the larger town close to Tenwek) We found a matatu and hopped in. Elizabeth in the backseat with three other adults and one or two babies, Todd in the trunk with all the luggage and another lady, I was in the driver seat not driving, that was the driver's job. However I could have reached the brake if I was unhappy with his driving. This is normally a 5-10 minute drive but about halfway we got a flat tire so we all piled out, and waited for them to change the tire, thankfully the spare was not flat (or absent). Once the tire was changed we all squeezed back in and traveled to Bomet. The first leg of our journey done. It was time to get the van matatu to take us to Nairobi.

We went to the matatu stand and bought our seats we bought four seats for the three of us so we could place our luggage somewhere. Than we waited, rather than having a scheduled van leave every few hours they just have a van wait until it is full or close to full and then go. Even though we were one of the first ones in this matatu we did all right as I think it only took 30min before we left. We were blessed with a good diver who was quite safe, and efficient. The drive continued on to Nairobi without any complications.

Once we reached Nairobi we had to find the car we had hired to drive us around the city, this took a few cell phone calls and aimless wandering but we eventually found him. From there we proceeded to a local mall where we window shopped and we also went out for supper, something I have not done for quite a few months (unless you count eating out at a friend's place). From there the driver brought us all to our respective locations.

I stayed at the home of a WGM missionary who is a Nurse Practitioner in Nairobi, it was good to meet up with her as well as a few others who were spending sometime there until their flight left at 3 am. It was great to reconnect and say good-bye once again.

Monday meant a trip to immigration, Jo who works for WGM helped me out extremely with all of this. He is Kenyan and speaks the language as well as understands what I was supposed to do. Otherwise I think I would still be there. Even though he knew what we were doing we started at window four were sent to window five did some paper work, went to back to window four and window six to pay, then handed things in at window three waited for a while and then sent to room fifteen for fingerprinting, finally pick up the my passport again at window five (some of the numbers may be wrong). They will now issue an alien card for me which will probably get completed after it expires. At least that is done.

That was only my morning in Nairobi, the afternoon was spent at Nakumatt, Kenyan Walmart where I did enough shopping to hopefully get me through the next few weeks if not months, because I was coming home alone it meant I had lots of room in the car for groceries meaning i bought for many families at tenwek. The trip home was not nearly as exciting as my trip to Nairobi, I hired a diver to take me back home. As I was travelling alone I was advised against taking a matatu. Back home at Tenwek time to unpack, sort out the groceries, and head out to the Christmas party. I will blog again soon to share more about the holidays here at Tenwek.

Wednesday, December 15, 2010

Turi, Missionary kids and Family #3

I am writing this after a few days away. It was the annual meeting of WGM (the mission organization I am with). Therefore all the WGM staff took off for a few days in order to get things done away from the busyness of the hospital. This is also a time that the WGM family celebrates Christmas, I have found it hard to get into the spirit as the weather is warm and the grass is green but the Sunday before I left this is what I saw outside my living room window
What is that white stuff I see falling?

Yes white stuff except it is hail not snow.
A little hail to get me in the Christmas mood. Monday morning we took off for the 2-3 hour drive to St Andrews School, Turi, a British style boarding school. A great place with lots of room for everyone.
The Dorm where I stayed.

Horses and beautiful blue sky
As I am only here short term the business meetings do not pertain to me very much, however it was very important that I as well as the other short termers (short term meaning less than a year) came along. So important that we did not even have to pay (like the other missionaries) for our stay. Our job was keep an eye on the children. This was a lot of fun I was responsible for four kids ages 9-11 (I think) and we were busy. Played a game of capture the flag with the youth, played random tag like games, ziplined, ran on the jungle gym and were in the pool for 2-3 hours. I do not have any pictures of the fun, I was too busy having fun. I got a great sunburn - despite putting on sunscreen in the morning and after lunch - I am thinking it will fade to a tan and not peel. This is what happens when you are at 8000ft and almost on the equator. Living on the equator does not mean it is 30+ degrees all the time. Actually those inside for the business meeting were wearing sweaters (no AC either) the elevation makes it cool. This is great for playing outside however it does make you have to pause to catch your breath sooner - that's my excuse anyway.

At one point during the day I spent some time with 2 MK (missionary kids)  girls both four years old and it was interesting to watch them play. They decided to play house help, something I have never seen little girls play back home, but they had fun and made me some tasty pizza and mud pies, all in the sandbox.
Tenwek is a large mission compound with many missionaries this is neat as it allows the MK's to make other MK friends. They are a great group of kids. Most of the highschoolers go to RVA a Christian boarding school just a few hours drive from here. The other kids are homeschooled, however, there are a few kids in grade eight so they have class together were one mom teaches english, another art, etc. I think it is so neat, the other kids are taught at home by their Moms (or Dad) but get together  for a regular PE class. I think it is wonderful that they are able to get together with their peers. They also have a band class and they performed for us at our Christmas Party held at Turi boarding school. Smaller than other bands I have seen three trumpets, a flute, a clarinet and the drum. The drummer forgot his drumstick so some tree sticks did the job.We also had a lovely recorder concert as well as action songs, and a hilarious play done by the youth. These kids don't have regular assemblies at school like I did growing up, it was neat to watch them all perform.
The Christmas Program was enjoyable. Many of the missionaries are wonderful singers and I heard a beautiful quartet. After the program was a gift exchange for the kids. Santa Claus came out and handed out the presents that the kids bought for each other.

He was to big to sit on Santa's lap

After presents we had a turkey dinner cooked by the chef at the boarding school and then quickly packed up and headed off. The initial plan was to linger and enjoy some free time at Turi however some of you may remember that back in 2008 there was violence after the election. Wednesday was the day that they announced those whom they intend to prosecute. As there was some fear that this may cause some further violence we all wanted to be home well before dark. We all made it home safe, and in my understanding there has been no violence since the anouncement (however I have no TV or radio so news is rare). Through out the ride we did see a few more police checks than normal and when I arrived back at Tenwek I saw a soldier riding on the back of a Piki Piki (motor bike) with gun in his hands, but all is good.

The big vehicles to get us and all our stuff home, most of the vehicles are 4 wheel drive necessary for some of the roads

All gathered together and having some fun I reflected on Chrismas past (sounds like a line from a movie) and thought I have spent Christmas with my own family but also with my Edmonton family the P's and now here is another family to spend Christmas with. It is neat how I have so many families. For Tenwek is a family for everyone here. Other missionaries are aunt and uncles to the MKs and I feel like there is always someone to visit.
My friend Heather and me.
Tonight is the hospital Christmas party, I am wondering if we will have goat. I guess I shall see. I may have to blog again soon to let you all know. For all of you medical people reading this and others thinking these last few posts Annette has not written anything about the excitement at the hospital - is she still working? The answer is yes. The Hospital is still busy. Things here have become more routine; I am busy making an asthma education video, preparing lectures for the nurses and helping out wherever I can. 

Thursday, December 2, 2010

A busy week

I am starting this post on Thursday I do not know when I will finish it as it has been a busy week. As some of you may know, last Thursday was American Thanksgiving. Living on a mission station with many Americans this is a big deal. Thanksgiving is not a holiday here in Kenya so it was a regular work day, however many of the American physicians did take the day off. As things normally go when you  have less staff than normal things were busy. I ended up running home in the afternoon to raid my stash of nonrebreather masks. I made a stop in the mad dash to consult with the head internal medicine Dr (who was playing football on his day off) to let him know that one of our long term patients was deteriorating and that we had decided not to be aggressive in care. I was soon able to escape the hospital and join in on the football game. I  have not played much football prior to coming here but I am really starting to enjoy it although I do not understand it very well. (Maybe that is what I should ask for for Christmas – Football for Dummies).

The weekend was a trip home – not really home but the weather reminded me so much of southern Alberta (during a drought). I was invited to Olderkesi a mission in Massai land to the Massai people. This was a few hour drive from Tenwek, much more isolated and wild. We had a tour of the garden and were told that they used to go out the gate but now they go out the hole  in the fence where the lions got out. Being remote they have to make their own power and the hotwater heater is a fire under the tank. Being there did remind me of home in someways (though there are no lions at home) the hot dry weather, being able to see for miles, the wind, like a southern Alberta summer. We celebrated Thanksgiving there and had a wonderful meal of everything an American Thanksgiving should have. From Turkey to sweet potata (pronounced with a southern accent). Complete with every kind of pie that you can think of. We have a lot to be thankful for.

The evenings at Olderkesi were night game drives. We all piled in the “van” a few on the roof and drove around looking for eyes. It was neat to get closer to the eyes and figure out what animal went with it. We saw a dik dik (very small deer like animal) I learned its called a dik dik because Richard Richard takes too long to say. We also saw a Ard wolf, bushbabies, spring hares, Thompson gazelles and a few more animals like mice. One of my favourite parts of the drive was when we turned the vehicle off as well as all the lights and stood outside in the middle of the plain. It was so dark and the sky was clear and there were so many stars. I was slightly worried I would get eaten by a lion, as well as fearful we would leave one of the kids behind in the dark. I was the “responsible adult” for the first night meaning me and the teenagers and kids. We did not get eaten or left behind.

We returned back to Tenwek on Sunday night and this is were the busyness set in I packed up and moved down the hill to join a new Doctor coming to us at Tenwek from the States. Since there are now four single young ladies at Tenwek they split us up  2 in each house. It is a nice place with a beautiful view. The bathroom is tiny; you need to walk sideways in order to get in. The move went well although there are still a few things at my last house that I have forgotten. I am sure I will make frequent visits to see how things are in the old neighborhood. The main disadvantage of moving I now have a steeper longer walk to the hospital and that gets slightly annoying when I get paged at midnight (happened my first night at the new place).

Things at the hospital are going well and I am staying busy with various projects such as educating both formal (lectures) and informal (bedside) of staff, trying to find better ways of doing things and the equipment to go with it. I am currently working on preventing VAP (ventilator associated pneumonia) by finding inline suction catheters as well as a way to do oral care. Oral care is a challenge as there are no mouth swabs and our bite block are OPA’s so the nurses think the best way to do oral care is to loosen the ties holding the ETT remove the opa do some care and than do the oral care. I do not like this method as it gives the ETT freedom to move in or out and when we don’t chart ETT position this makes things challenging. Sorry if I confused all the nonmedical people reading this. One of the other projects is a video on asthma education for patients.

Since coming here I have had more than one person say I should stay longer if forever.  A local doctor and nurse (both  male) were plotting to marry me off to a Kipsigis man (local tribe) so I would stay. They figured they might be able to get 150 cows for me: 50 for being a doctor (anybody who works at the hospital is called a doctor) 50 for being white and 50 for having redhair. I think it is a compliment to be worth so many cows but one of the problems with this is my dad would get the cows and then my husband would be dirt poor. I also would have to eat ugali and moresick which if you read my last post you know how unappealing that is. On a more serious note please pray for me as I consider my options. Don’t worry my flight home in March is still booked and I have every intention of being on it however I do not really know what God has planned for me in the next years of my life. I guess if he told me now it would make life less exciting. So I started this post on  Thursday and it is now Sunday, I guess I was busy

The View, I have missed the sky at Tenwek there are to many trees

Hot water heater -  Very effective

One of the pies I helped decorate this one, I really enjoyed the canadian maple leaf the little things on the bottom are acorns

More beautiful sky   

Tuesday, November 23, 2010

A culture view – clothing and food

I thought I should share some of the observations I have made here in regards to clothing. Tenwek is in rural Kenya and therefore ladies don’t usually wear pants but instead skirts at least past the knee. I had brought some scrubs from home and although the surgeons and OBs wear scrubs most of the other female physicians are in skirts. All the female nurses are in skirts. I have therefore modified my scrubs into skirts and wear that with my lab coat every day.

There is almost an even split at the hospital between male and female nurses and I am impressed by their dress. The male nurses are in dress pants, shirt and I often see a tie always covered up by a lab coat.  The ladies are in blue skirts and white tops, I will often see the nurses put cover ups (think isolation gowns) over the clothes so they stay nice. I saw one of the ICU nurses leaving work the other day in a full out suit, he had changed into it for his 1 mile walk home. With all this clothing how they do not get too warm I do not know.

On Saturday Heather (my roommate) and I were invited to the home of one of the nurses we had a great visit but the thought of clothing came to mind once again in this picture you would think that this little girl likes to play dress up and be a princess like all little girls
My friend and her 2 girls

Heather with one of the girls in front of their home
A further look around the room shows many embroidered wall coverings. People here take a great pride in their appearance and things need to be dressed up. The dress here seen on the little girl would not be uncommon to see on a lady at church on Sunday or while walking to the market. These dresses remind me of bridesmaid's dresses and are quite popular. Sundays I often feel underdressed between the bridesmaid dresses and 80's style women's suits. Today I saw a man in very dressy pinstripe pants. Things are stylish to wear as long as they are neat and properly ironed. One of the missionaries here has said, the gaudier the clothing the better.

As I mentioned above Heather and I were invited to visit one of the ICU nurses at her home. We took a ride in the Matatu there. Originally we were invited to go on a piki piki also called a boda boda, this is a dirt bike that people hire to get around. It is not uncommon to see 3 adults and a child all on the same piki piki, none with helmets. I do not think this is the safest mode of transportation and opted to pay for the matatu instead. Anyway we had a good visit and were also fed lunch which consisted of ugali, a porridge made of corn meal and water, it also had some millet mixed in, the consistency was very strange. We also had some spaghetti noodles and beef stew as well as cooked greens. The latter foods were all ok, I did not care much for the uglali but the Kenyans seem to really like it though. The meal finished with a glass of morsik. I had heard about it and said I would just try a little bit. Morsik is milk left out to sour mixed with some charcoal to prevent bacteria from growing. Heather and I both tried a taste and I think she had the best description – it tastes like vomit.  Maybe that is why they call it morsik – more sick. To each their own.

The ride back to the hospital was a little more interesting. The nurse we were visiting has a very sick family member in the hospital and some of the family wanted to go visit him. We piled 10 adults and 2 kids (no car seats) into a station wagon like car and headed back for the bumpy ride to Tenwek. I don’t think the car had any shock or suspension left, every time we went over a bump (which was quite often) there was a bang. We stopped for gas on the way and put a total of 300 ksh in (that is about $4 CAD) and probably gave us 3-4 liters of gas. This is Kenya. Despite the interesting food and drive it was a very enjoyable visit and it was good to see friends outside of the hospital and to experience a little bit of Kenyan life. I also was able to get a bit of a suntan as we sat outside, we went inside after a bit as it was just too hot outside (sorry just had to rub it in as I hear it is -27C (-17F) at home).

Monday, November 15, 2010

A weekend away

After being here at Tenwek for 6 weeks I finally got away for the weekend. I enjoy my time at Tenwek but being able to get away from the pager and stress of the hospital for a few days was great. I was invited to go to Nakuru with a career missionary family here. We headed out Friday morning and took off on the 3-4 hour ride. I had heard some complaints about Kenya roads; this one was quite smooth but very winding and hilly. I have not been car sick since I was a child but this winding road did not make my stomach happy. After a quick stop I was able to ride the rest of the trip in the front, an easy way to get shotgun. Next trip I will bring some Gravol or a Kenyan equivalent. Back to the trip: we arrived in Nakuru in the afternoon and were able to get some lunch and shopping in. Living in Tenwek many things that are easy to get at home are not easily accessible. Therefore I filled up most of my cart with snacks. We also were able to stop at a market where they sell souvenirs and other stuff. The stuff was all very neat and I did pick up a few things for hopefully reasonable prices, I am not very good at bartering. The sellers were very aggressive and would come at you from all sides trying to get you to buy their stuff, hard to choose when a lot of it looks the same. I picked up a few things and then hid in the car with the windows shut and all the vendors standing at the window trying to sell their stuff.

In the evening we went to the African Gospel Church (AGC) Baby Center. This is an orphanage run by World Gospel Mission (WGM) missionaries and AGC (AGC is also the church that runs Tenwek). Anyway, this is for children under five and there were so many cute babies. We spent the evening feeding and playing with the crawlers and toddlers class. This is a very well run orphanage but it is still hard to see all these kids without a mom or a dad and the way they crave attention. Some of the children would cry for attention while others would smile and play. We spent time loving the children but it was hard to walk away and hear their cries.

Saturday morning we woke up bright and early and headed out to Lake Nakuru Park. I was very excited my first safari. We all piled in a van with a pop up roof and started exploring the park. I spent most of the time standing up and looking for wildlife. It paid off as I spotted many animals. Our guide had seen a leopard in an area of the park earlier in the week so we spent some time searching, no luck with the leopard but in the process we also saw

 All so beautiful. For those people thinking "wow! Annette's got a great camera look at the zoom." The truth is I don't have a fancy camera with a strong zoom (only 5x), we were really that close to the animals. With no luck finding a leopard. I was quite happy spotting the lion - so close and a male lion with a mane wow. I should add that the lion was sick/old and could not walk more than a few steps, we did report him to the Kenya Wildlife Service so they could check him out. Anyway we continued on our drive with the plan to head to the lake to see the flamingos on the way to the lake this is what we saw
Rhino with flamingos in the background

All the zebras in a winding line

The same line of zebras. Why they did not wind around the water I do not know, it would not have been far.
This picture is from Baboon Cliffs, overlooking Lake Nakuru 
After a morning of exploring we were hungry and stopped for lunch at a resort in the park. We had a great lunch and then had a dip in the pool it was great to go swimming after so many weeks without the opportunity. (There is a river close to Tenwek but I think I would have to take antibiotics before I got in.) After lunch was more searching mainly for lions and leopards no success but we did come across a few more animals that were exciting some giraffes and one of the the highights of the trip a baby zebra probably only a day or two old.

After a busy day on safari we headed back to the Baby Centre to play with the babies and headed to bed early. What a great day!
Sunday we headed off to church where we had a sermon on being thankful. Appropriate as I am at the time between Canadian and American Thanksgiving. But also apropriate as I spent so much time in God's beautiful creation. The week before coming to Nakuru was like many weeks at Tenwek, difficult due to the amount of sickness and death - it is easy to question God. But I was reminded that everyday is a gift and I am to be thankful for it. After church was the ride back to Tenwek, more hilly winding roads that my stomach did not appreciate but beautiful nonetheless.

Saturday, November 6, 2010

Conclusions of the Week

Through out the week I tried to figure out what I could blog about next. I started this blog on Saturday afternoon, and it has been a great day. It began with breakfast of Oma Pancakes with mangos, hmm. (I was able to buy a pineapple and 2 mangoes – the price equivalent to 1 Canadian dollar). I also climbed Mount Motigo this morning with some friends. My roommate is training to climb Mount Kenya so she climbed it twice yesterday, but once was good enough for me (I also got a little sunburnt; I am hoping it will fade into a tan but we shall see). 

From the top of Motigo, the rain never did come.

In the afternoon I met my new roommate. There are now 3 of us in #10. The day ended with apple pie and frozen yogurt with some friends. A very enjoyable day.

Life at the hospital is going well and I am starting to settle into some routine. A typical day starts at 8:00 with morning report. I meet with the physicians, residents and med students. Here we either have a presentation by an intern or discuss some of the cases that came in overnight. Morning report is also the time where any visiting staff are introduced. We start the day with prayer, this prayer seems to be more real than the morning prayer at the Mis. After morning report I head off to ICU and recovery room (ICU overflow) and discover what happened overnight – who is ventilated, who self extubated and who is newly admitted. This is also the time when medicine, peds, and surgery services do their ICU rounds (the ICU is an open ICU).  I try to participate on rounds and use it as a time to educate the staff on respiratory related things.

After rounds in ICU I do my own rounds in the nursery, ER, medicine, surgery and pediatrics. As I check out what is on all the units I look for patients who look very ill, find their charts and figure out if I can do anything or offer any advice to help out the staff. A challenge here is that just because a medication is ordered and available the nurses will not give it. Bad asthmatics are routinely ordered hourly Ventolin and it will probably be given a few times a day – so I help out the patient (and physicians) by reminding the nurses to give the medication. Usually the discussion with the nurse goes something like this, “this child sounds really wheezy does he/she have Ventolin? Oh look he/she does have it ordered. I think this child could use some now they sound really wheezy”. This usually works and the nurse proceeds to give the patient Ventolin, and I come back in an hour or two and repeat the process. The rest of the day proceeds along this pattern going from unit to unit helping out where I can. A unique thing about the hospital is sound travels everywhere through the open windows. This is sometimes advantageous as I can hear the ventilator, and SpO2 monitor (the really loud Nellcor machine) alarming from the other wards in the hospital. The only problem is I do not know why it is alarming – 90% percent of the time it is because the machine has been disconnected and no one has bothered to put it back on or silence the alarm. So this is my day.

I work Monday to Friday, at the beginning of the week I am going strong and I am able to handle the amount of sickness and death that I see. By Friday things are a lot harder to handle.

I met with World Gospel Mission pastors this week and they encouraged me to continue my personal devotions to not get worn down. This message was timely as Friday morning I found two ventilated patients in the ICU, one of whom, a young lady who had poisoned herself, was critically ill. Her heart had stopped overnight and she required CPR, this lady had also been 25 weeks pregnant, the poison and cardiac arrest caused the baby to die. Please pray for this young lady as she is still critically ill. After I learned about this lady I went to check on the other ventilated patient who had been ventilated for a week for Tetanus. The monitor was not reading the heart rhythm so I grabbed a sticker to replace the one that had fallen off. I replaced it and the rhythm was still not picking up. The SpO2 was not picking up either, I checked the probe and found that it was on the patient, I than checked for the pulse, at this point I called the physician over as I could not find a pulse. The patient in the ICU had died without anyone noticing (this would not happen back home). This made my morning discouraging, but heeding the advice of the pastors I spent some time during my lunch break in prayer and study of God’s word. God is good and led me to a bible verse:
John 6:27
Do not work for food that spoils, but for food that endures to eternal life, which the Son of Man will give you. For on him God the Father has placed his seal of approval.”
This is a verse I heard before but it spoke to me now – life here will end but Eternal life in God is forever, and that is what the mission here really is. 

A Massai Lady at the hospital in her normal attire, it is beautiful

Sunday, October 31, 2010

Halloween, poisonings, and frustrations

The younger kids Trick-or-Treating


A huge slug I saw, the toe of my sandal is in the picture for perspective

some kids who wanted to get there picture taken, the benches in the background is there church

More Kids

Every thing that is in my pockets as I work all day. I wish I could fit a bagger in there and an full oxygen tank and a...

Last night (Friday) was the Halloween celebration for all the MK’s (missionary kids) here at Tenwek. I was not sure if they would do Halloween here as it is not a Christian holiday. Halloween was a lot of fun. They had games for both the younger and older kids as well as trick-or-treating of course. The kids had some amazing costumes, some home made and some store bought. It took me a while to figure out what was different about the costumes but it eventually came to me – they were not a few sizes to big so the snow suit could go underneath. The older kids trick or treating was made into a scavenger hunt of sorts and we had to give them a clue (with the candy of course) when they came to the door. The clue my roommate and I were to give was a scream. We did a decent job of it I think, I am sure some Kenyans in the neighborhood wondered what was going on (Halloween does not exist in Kenya). The night ended with a fire and smores as well as a scary story in the dark. I think it is so neat that there is such a large community of missionaries here that the kids can have friends with similar heritage to their own and make events like this possible.

I don’t know if Halloween weekend had anything to do with it but Friday was a very busy day at the hospital. I felt like everywhere I went there was someone else acutely ill who needed intensive care- if we had a rapid response team it would have been called a few times, as well as the code team. There are many illnesses here that I never/rarely see in Alberta but something that I see much too much of is suicide attempts. The method of choice here is poisoning, the poisons of choice are chemicals used to kill the bugs on the cows or other such chemicals, the words triatics and organophosphate are all too common here. These patients generally come in unconscious and require getting their stomachs pumped, they often require intubation to protect their airways. The other day I went to casualty (ER) to help them intubate one of these patients, the smell in the room was overpowering, but familiar, it took only a few minutes to place the smell. It was the same smell I would smell if I went into the chemical storage room on the farm. I do not know how they are able to drink so much of this stuff, the taste must be horrible. I am not sure of the exact number but we seem to get 2-3 of these poisonings a day, thankfully not all require intubation. A few of these suicide attempts are successful and it is sad to see these individuals, often quite young die. A difficult challenge with these patients is they frequently require ICU care, this is hard as we have a limited number of ICU beds and ventilators and giving these resources to someone who tried to kill him/herself can be disheartening at times. I wonder if there is a solution to this problem. I have heard the Kenyan staff say we should send these individuals to jail (attempted suicide is illegal here). I don’t know if this will deter more poisonings from occurring but I tend to think we need to look at the route of the problem, how can we help these people mentally, spiritually, emotionally and physically. This is a challenge and a difficult one; please pray for all of us here as we struggle to find a solution to this mess.
Despite the frequency, or maybe because of the frequency I am, at times, frustrated with the nursing care, or more lack of nursing care, and lack of readily available supplies (we have the supplies just in central storage) that these patients receive. Here is an example I was called Friday to casualty to help them with the intubation of a poisoning patient. Before we intubate the Dr had to figure out if we had a ventilator and a bed for the patient, once we had something figured out we went to casualty and I saw the patient, a boy of 17. He was in the side room of emergency, breathing through an OPA, no nurse in sight, not being monitored. Being a RT who always likes to know a patient's SpO2, I decided to check. Remember at this point the patient had probably been like this for at least ½ hour if not more- the Spo2 – 50%. At this point I asked the staff for an ambu bag (I have to call it an ambu bag or they do not know what I was talking about).  I also started looking, the only one we could find was pediatric, (I guess the patient was 17 but…) so I bagged the patient and the Dr ran to ICU to get a bagger. I later learned that this bagger was taken from the bedside of a patient we had just reintubated and was therefore dirty. I don’t think the first patient had TB. At this point someone else started to bag so we could get setup for intubation. The battery in the laryngoscope was burnt out so once again we ran to ICU, ICU was willing to part with the handle but did not want us to dirty their blade – I don’t know why they just clean it by wiping it down with there version of an alcohol prep. Finally we were set up for intubation, the patients SpO2 had quickly improved with bagging – I even had them up with the pediatric bagger. So we put the tube in. The ventilator was ready for us but ICU wanted the casualty nurses to put a foley in (some things are the same as at home). However before the nurses put the foley they discovered a code brown. So first they had to clean him up, this entire time I was bagging the patient but thankfully I was standing by an open window so I stuck my head out and got some fresh air. Finally we brought the patient to ICU, the oxygen tank was empty so we just ran up the ramp with the patient. When we got to ICU I put the patient on the vent and before I could even check the setting I was called to the next bed as that ventilated patient was coding. I had to look for a bagger (we had stolen his bagger for the other patient). The code proceeded from there as codes normally do CPR, drugs, more CPR, get him back for a while codes again and pronounce. Well, at least we have another ventilator to use now.
My fellow RTs are probably reading this and can see my frustration; for the non-medical people who are reading this I am sorry if most of it did not make sense. I am getting used to things not being available, or functional, I have not decided to if this is a good thing or a bad thing. On Monday I am doing a presentation to the nursing staff; pray that they put what I tell them into practice. The nurses are all well educated I just find there is often a gap between what is said and what is done.

Back to life outside the hospital the weather here has cleared up I think the rainy season is over. It is great to have a clear sunny sky, maybe a suntan/burn will cover up my mosquito bites. At least I think they are mosquito bites, I have them on my arms and ankles. I sleep with a mosquito net but still frequently get bitten. Pray for me that these bites do not carry any diseases (I am on anti-malarials). I think I will end this post (that ended up being longer that I thought) with something to make you laugh. I was walking the other day and I passed by three young men who prior to my passing were talking and laughing. As I walked by they stopped talking and stared, not discreet look and turn back to your buddy checking out stare. This was a full blown staring contest stare.  I said hello and continued to walk on, when I was a little ways off I looked back and yes they were still staring. I thought of saying “take a picture it will last longer” but wait that’s already been done. A teacher took a “discreet” picture of me with her cell phone as I walked by, she should have turned the sound off, I heard the shutter sound. The crazy thing is these people live at Tenwek where white people are a common site; I know I am pale and redheaded but still.

So I thought I finished writing this post this morning before church. However as I was at church this morning I realized something. I will not elaborate as this post will become really long instead of just long but this week at the hospital was a tough week, many patients died. I found it hard at times to keep going and to keep focusing on Christ. At church this morning we sang the song "How Great Is Our God". While we were singing I was reminded of the fact that God is Good this is something we are quick to day when something good happens but in looking at the week I struggled with this. I realized this morning that although the man who was extubated (as he was severely brain damaged from his heart stopping during surgery) will probably die in the next few days but God is Good. This man became a christian prior to his surgery and said he was going to see Jesus. Though one of the newborn premature twins died, the other one is still alive. How great is our God, pray that I will remember this in the coming weeks and even though we do not know why something bad happens God does and he is Good.

Wednesday, October 27, 2010

Pictures from an evening walk

Today, after a busy day at work, I went for a walk. The Weather was beautiful and the sun was setting. I thought I should share some pictures with you.

This Picture is actually from an earlier walk, I thought it was neat to see the cows crossing the bridge over the dam.

These kids met me on my walk, they all ran to meet me and wanted me to take a picture - It was difficult to take as they were crowding in.

God's Artwork

A visit to Bomet and more life

After being at Tenwek for 3 weeks I finally ventured out of town. I left Saturday morning with another missionary couple. We headed to the hospital to get a Matatu (local taxi). We intended to hire a driver who would take just us and not pack the car full with strangers (as is the custom). Matatus were in short supply and we had to wait for a few minutes, a driver agreed to take us to Bomet and wait while we did our shopping but he had two people to drop off on the way. So off we went, two people ended up being three people so there were four of us in the back seat: one in the passenger seat and two people in the driver seat. All in a Toyota station wagon. Why there were two people in the driver seat and only one in the passenger seat, I do not know.

Bomet is an interesting town by our standards, the roads were not paved or graveled just hard packed dirt – it reminded of driving in the field. It has a mix of small shops and roadside stands. I was able to buy a few more phone cards for my cell phone as well as go to the grocery store. When I first arrived in Kenya we did a lot of groceries at Nakumart (similar to Walmart), I was told to stock up as many things are not found locally. Being prepared for the worst I was happy with what was in the store – there were candies (some of which tasted horrible), knorr soup mixes, peanut butter and other things. It was good to know what is available close by. The matutu ride back to Tenwek was uneventful as there was lots of room.

I have been remiss in not talking more about the people of Tenwek. There are two obvious groups here: the locals and the foreigners. Most of the foreigners are American physicians and their families. Some of them are career missionaries, here permanently unless they are on furlough raising support. There are the Samaritan Purse Post Residency people, they are here for two years. There are also the visiting staff who are here for a few weeks to two months helping us out. A small group is made up of people something in between the visiting staff and those with two year commitments, that is where I fit in. The nursing and support staff is made up of Kenyans largely from the Kalenjin tribe. They are a great group and I am starting to get to know them and hope to pick up some of their language. They all are fluent in (British) English, though sometimes their accents make it hard to understand what they are saying. The other day I was in ICU and a man kept yelling "soja", I asked the nurse what he was saying and she explained how he was hallucinating and seeing "sojas". I asked what a "soja" was and she said you know like a police man. At that point I realize we had been talking English the entire time and he was talking about soldiers.  

Many of the patients are from the Kalenjin tribe, this is good as they all speak similar languages (there are sub tribes of the Kalenjin with different dialects). However some of the patients are Massai, easy to recognize wrapped in their traditional red blankets and stretched beaded earlobes. There are also patients from other tribes that are not so visible. I met a girl last week as she was at the hospital caring for her mom, and she shared with me her disappointment that most of the staff are Kalenjin and that Tenwek does not routinely hire members of other tribes. The management of the hospital is Kalenjin as well. Hospital politics exist wherever you go.

One of the great things about being here is I work Monday to Friday I start at 8am, head home for lunch at 1pm, back to the hospital from 2-4pm or 5pm depending on how busy things are and what work I have to do at home. Homework includes all sorts of things: figuring out an oral care protocol for the ICU, preparing in-services for the nurses, interns and residents, trying to figure out how to work the ventilators here and writing up a step-by-step guide. (I am very glad I learned the Servo 900C in school or I would be so confused). I am on call for the rest of the time unless I am away from the hospital but the staff are good at only calling me for emergencies. Anyway, I have enjoyed not working nights and having my weekend off.

Sunday is church. There are two churches at Tenwek, one at the hospital in English and one a few minutes away (I think it is in Kiswahilli but translated to English). I have only been to the service at the church I will venture out to the other one at some point. The services are good we sing a mixture of praise and worship songs and hymns. Our current pastor is away for the month so we have been having others preach. The message is good however at times I find it hard to listen due to the accent and not always understanding the various illustrations given in the sermon. It takes some concentration, something I need to work on. The last two Sundays we have had testimonies by different missionary couples explaining how they came to know God and how he led them to Tenwek. It is so good to hear about others walk with God.  I think I have written enough for now, sorry no pictures with this post. One of my friends back home asked about sending packages to me (no pressure) I understand  thing take 2-3 weeks and letters or flat bubble wrapped packages will give you the least trouble at customs (compared to boxes) my address is:
Annette Lievaart
Tenwek Hospital
PO Box 39
Bomet, Kenya 20400
East Africa

Also a thanks to Shawna who is editing my blog for me, English has never been my strong point.

Wednesday, October 20, 2010

Life and a Miracle

This is what I see on my sunday afternoon walk

I love this tree I walk past it everyday on the way to work

I took this picture early in the morning when I was called in, the OR is behind the picture, ER is to the right and ICU is on the top left, bottom left is medicine and peds, see the ramps

I have not shared to much what life is like here living in Africa. Many things are the same here as they were back at home but than I think of everything that is different.

We have power here and it works most of the time, I have only really noticed two blackouts since my arrival and I don’t think they lasted to long. Power here is interesting and complicated. I am not sure why it was made so complicated but it is. ½ of the outlets in the house are 120V and the other ½ are 240V none of the plug-ins are North american style but instead we have three styles of outlet, which I think are the Great Britian style/Africa (are they the same?) and than small round ones (south Africa??) and than big round ones. Confused - I am. I think the Great Britain style ones are 120V but I am not positive. To plug in all my stuff - computer etc, we just use power bars, but I need to be careful with my equipment as some of it is only 120V and I do not want to blow it by plugging it in to a 240V. So that is an interesting part about living here.

Another difference here is the Water.  I do have central plumbing which is wonderful I find the bathroom sink interesting as there is one tap and spout for cold water and another tap and spout with hot water. I guess I wash one hand in cold water and one in warm water - good thing the water does not heat up to fast or I would get burnt. The water is treated here at Tenwek and I have been told by one of  the Doctors here that it is safe to drink however it can turn a lovely brown colour at times so I don’t think I want to. This water is treated with Alum? And therefore makes getting hair clean difficult. That is where the rainwater comes in. Rain water is collected of the roof into a large black tank, and our house helper filters this water and puts it in bottles. So to rinse my hair I boil some of this water dilute it with some cold rain water, yesterday I did not dilute it enough and nearly burnt my scalp, ouch. The rain water is also used for drinking, brushing teeth, and cooking. 

What else can I say about life here, the food. The locals, I am told, have a very bland diet of  rice, ugali (corn meal mixed with water) and other different foods, therefore there is not a safeway on every corner. We can grow and purchase some produce locally as well as a few staples I have not yet been to the grocery store in Bomet (the nearby town pronounced bow (as in bow and arrow) met). I was quite happy to find out that Coke is available right here at Tenwek, as well as Fanta and other grat drinks. I am currently trying my first bitter lemon (drink) and it is quite tasty. Many things we have to buy in Nairobi about a 3½ hour drive away this is where you can buy tomato sauce, soup mixes, cheeses,  etc. This makes cooking slightly more complicated as you have to make due with what you thought you would need when you did groceries 3 weeks (or 3 months) ago. However I am eating well and my plan of losing weight in Africa probably won’t happen .

The title of this Blog also includes the word miracle. I am sure there are those who are reading this who do not believe in miracles but the amount of sickness here it can not all be explained by medical care. I don’t think I have seen so many sick kids as I have seen in the last few weeks. Part of this may be attributed to the fact that I did not work at the children’s hospital and any sick kids would mean a call to the transport team and they would be taken off to the Stollery. Here we are it, the sickest kids either come to us or are sent to us by the nearby district hospital. Anyway on to the patient, a 14 month old child severely malnourished I am not exactly sure of the weight but this child is tiny. Came in and required a non rebreather mask to maintain an adequate oxygen level. This child was breathing at about 80-90/min and with such low muscle mass I am not even sure how that was possible. She had no energy to cry, nurse, or open her eyes. I was so worried that her body would just give up and she would stop breathing and die. This was her on Thursday and Friday as she was in the ICU. Through the grace of God she was able to pull through. Today she was transferred out to the pediatric ward. Now only on ½ LPM of oxygen. Still small and weak but she is whimpering, nursing and looking around. She still has a long way to go and I ask that you all pray for her, but I think a miracle has happened.
Well that is all for now