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

Friday, October 15, 2010

The end of week 2

 Pictures of life at a mission hospital
This is the entrance to the ICU, the stuff you see hanging over the ledge (which is outside) is Vent circuits, nasal cannulas, oxygen masks, baggers etc. it is all sitting here to dry. so when you need something you look for it here

This is our elevator, these ramps connect the ER, OR, and X-ray to the rest of the hospital. to transfer a patient from 1st floor (medicine) to second floor (ICU) we run pushing the bed up the ramps (we have to run because the Oxygen tanks are either MIA, we can't find a regulator or the tanks are empty)
I find if hard to believe I have already been working at Tenwek for 2 weeks. My role here is becoming more defined, and I am getting to know my way here. There are some definite highlights to the week. I will share some of them with you now

    An evening earlier this week I was called to help out in ICU (as long as my pager is on I am on call, so far it has been OK, only 1 or 2 calls a week outside of normal working hours). When I arrived in ICU I saw a severe asthmatic on lots of Oxygen and sitting leaning forward so she could breathe better. The doctor on call was concerned we might need to put a breathing tube in. (Ventilating an asthmatic is hard anywhere and would be 10 times harder here at Tenwek). I shared his concern, the patient was following asleep while struggling to breathe she was so tired from breathing all day. We did a blood gas on the patient and it was normal - this was good. I went home to go to bed and told the Doctor to give lots of Ventolin and other drugs. I left praying for this lady and hoping I would not be called out of bed a midnight because she was getting worse. I slept well and in the morning she was doing great. In reviewing the nurses note I read this line “she is doing much better this morning thanks be to God”. Working in healthcare it is easy to look at what you have done for the patient and take the credit. This is not the case as those in healthcare know we can do everything right and the patient still dies or we do everything wrong and the patient still lives. Who is this but God.

    Being at the right place at the right time. I think my time here is best spent educating, but how do you educate so many nurses and doctors if they do not understand where you come from. This week I have been at the right place at the right time I was in ICU when they asked them to help out in a code in ER, I was in recovery room when a newborn needed more aggressive resuscitation, I was walking through paediatrics when a child went unresponsive. These were all times when I was able to help out and see how things are normally done. Either God had me in the right place at the right time or there is always something going on. I would say it is both.

A smile. In Canada we routinely have patients who come in sick we treat them and fix what we can but these patients still need oxygen due to chronic lung disease. This is not a problem we do a blood test call a home care company and they set them up with a home oxygen system, some of which is paid for by the government.  Patients dependent on oxygen is not so common here but exists and there option is to stay in the hospital. Fortunately we do not have as many as these patients as in North America. I met a lady this morning who is about 30 years old with 3 young children (Probably has pulmonary hypertension). She has been an oxygen prisoner since April. Her home does not have power for a concentrator and tanks would not last long enough. Her blood oxygen levels are low and a simple nasal cannula does not fix it. This means that she has been wearing a mask since April. Today I made her smile, and this was very encouraging I placed her on an oxymizer (a large nasal cannula). Finally her mouth is not covered by a mask and she can eat, drink and talk much easier. She is still an Oxygen prisoner but at least she has a little more freedom.

These were my highlights at the hospital from the week.

Wednesday, October 13, 2010

Pictures, most of the same ones as facebook

Finally I have been able to add pictures to the Blog, no more links to facebook. For those of you who saw the pictures on facebook most of these are the same. I have been taking some pictures at the hospital this week and will share them with you all eventually. I should be able to add them here from now on. My laptop is now working well, thank you T.

The water fall where Kenya gets its power, the building you see is the power house

Tea Field

Cows, they are everywhere, often with young children herding them.

a local boy with his tire and stick, I often see children rolling thier tires with the stick as they run behind it.

A young boy who wanted me to take a picture, and than told me I should give him my camera

a view halfway up motigo

View from the top

The inside of the home where we had chai (local tea made with lot's of milk and sugar)

The Outside of the same home

2 children standing in the doorway of the kitchen, a round mudded hut, this is the kitchen for the house where we had Chai

most of us who climbed u motigo

they liked to get pictures of the strange looking redhead, and asain - we both also happen to be Candain

The view from my balcony, today the lawn was mowed all by a push mower, it looks nice but that would have been a lot of work. I don't know why but for some reason I did not expect to see lawn mowers in kenya.   
this is is my nyumbani (kiswahilli for home) I am on the top in the corner by the stairs

Monday, October 11, 2010

Thanksgiving Abroad & Pictures Link

I will start this post by apologizing first for not being able to post pictures on the Blog I have added a few to facebook and anyone even if you are not on facebook can view them here Tenwek Pictures. I am hoping I will be able to get the internet working better soon, and be able to add more pictures. Second I apologize for my poor spelling and grammar in the previous posts, I can and will try to do better.
Today as most of you know is Canadian Thanksgiving. My thanksgivings growing up were probably different than most peoples. Sunday we would usually have a family from church over and a good meal of Lasagna. For Thanksgiving Day my Dad and brothers were out in the field harvesting sugar beets. So after church on monday Mom and I would stop at KFC and buy a really big bucket of chicken, drive to the field and hand out chicken to all the workers, that was my thanksgiving day. When I moved to Edmonton things were different my friends would not let me go to KFC and I was invited over for wonderful turkey dinners. Now that I am at Tenwek I faced a problem first no KFC and second no friends having big turkey dinners (I will have to wait until American thanksgiving). Due to this I made my own thanksgiving, cooked some chicken, potatos, and carrot cake and than it was time to find some people to enjoy it with. My roommate was an automatic in (despite being from Tennessee), I heard that the mom of the family below us was born in Canada (also southern Albertan with dutch parents) so with her family and 2 kids that made a few more. I also met a physician assistant student who was from Vancouver. So the 7 of us had a great time together.

Being thanksgiving I think it is apropriate that I create a list of things I am thankfull for, so in no particular order here it is:
  • Salvation through Christ
  • Friends both old and new
  • Family - who is always there for you even when you are at the other side of the world (thanks for the last minute recipe - the chicken turned out great)
  • chocolate
  • Technology that allows me to communicate with family and friends including poor internet and especially cell phones that allow me to phone home cheaper than I did before (thanks for the unlocked phone S.)
  • Good health
  • beautiful weather (I here it is nice back home as well)
Well I should go on but I am getting tired so I am also thankful for hot showers, a comfortable bed and a mosquito net.

Saturday, October 9, 2010

End of week 1 at Tenwek

When I last posted I was starting to be more utilized by the staff and still defining my role here which is still going on. However in the meantime I have gotten very busy I have seen more death in the last few days than I have seen in a long time, the hardest part was that these were all young patients. It started on Thursday morning when I was called to casualty (there word for emergency) to help them out with a CHF/COPD exacerbation. An elderly lady in severe respiratory distress - I brought here to ICU and placed her on CPAP the first Non invasive ventilation that Tenwek has seen. I worked wonderfully on her which is exciting for me as the next few weeks I will be doing presentations on CPAP/BiPAP and that it worked so well on the 1st patient will make “selling it” easier. At the same time as this lady a 16 year old boy came in very short of breath and hypoxic room air sats of ~50% (normal is 92-100) we discovered that this boy probably had active milliary TB, as he was coughing up blood. He did not improve very much with oxygen so the decision was made to treat him palliatively - he died by noon. As all this was going on  a 8 year old boy coded (heart stopped) and we attempted to get him back but were unsuccessful.  This all happened before 1 in the afternoon and is not abnormal for Tenwek. The rest of the day was better and when I left at the end of the day I gave them my pager number just in case the lady with CPAP needed to go back on. I was paged at 1 in the morning, my CPAP lady was fine but they were having trouble with another patient on the vent and would I come help. The patient has HIV, previous TB, chicken pox in the last week and an ARDS like CXR. He was in our 6 bed ICU with all the beds in one room (infection control would have had a heart attack). I was able to get him stabilized and the ventilator working somewhat.
This was how my work week ended but life at Tenwek continues way from the hospital as well. Friday night supper was pizza at a missionary couples home followed by movie night at the guesthouse. The guesthouse is for short term staff a few weeks to a few months. Today is Saturday, a day off, I think I don’t know what hours I am supposed to be working. I hike up to mutogo (spelling?) a large hill beside Tenwek. This hike was with a few visiting staff and it was great to get out and see the land. We walked by some corn, tea and sugar cane fields as  well as a small village where we stopped at the local church where they were holding a prayer service for the students who are writing a very important exam soon. At the top of the hill lives a family, and the dad is the house helper of the fellow who was leading our hike. The son invited us inside and we had some chai tea. Too sit in a small hut, visit and discuss issues about life at Tenwek as the rain started to come down was amazing. This is something that would never happen in Canada.
Living in Kenya for the next few months is an experience that will change me. I don’t think I will be the same person when I return. I wonder what God has in mind for me here and what he plans for my future. Is the plan to take all I have learned back home or to continue this work here or someone else. I do not know and someday God’s plan will be made known to me but in the meantime I believe I am where he has put me and despite the sadness of death there is good here. But I have to end this post so I can take my laundry off the line it is starting to rain. I will hopefully get some pictures either here or on facebook soon.

Wednesday, October 6, 2010

What is A Respiratory Therapist

This is a question that I have frequently heard before coming to Tenwek. My typical response is I work with individuals who have breathing problems whether be it COPD, CHF, Asthma, or Croup. I also explain how I work with ventilators and in the ICU. Normally I am explaining this to nonmedical personnel. Here at Tenwek things are different I am explaining my role to everyone as I am the first RT they have had for more than a few weeks. The role of an RT is unknown to all  aside from the American medical mission staff. The explanation I give is the same as what I gave in Canada but I am also elaborating on the teaching role. It also brings up the question of what is my role at Tenwek? This is a challenge as over the next few months I wish to be helpful and busy  however when I am not being replaced by another RT when I leave in march so I need to make sure that I do not take over any tasks wich would cause the nurses and physicians to lose there skills/knowledge.
Despite all of this I am being received well and each day is busier than the last. I have been told by the ICU charge nurse that the ICU is to be my home. He is quite excited that I am here, it has been a slow week in ICU with no vented patients and he was telling me today that he is hoping we get one soon so I can share some knowledge with the staff (he did say that he does not wish any one to get sick enough to need a vent though). I have also ventured out to pediatrics and medicine where I am seeing various patients. Pediatrics is challenging as that is where I have the least experience as well as different pathologies - I have a patient who probably has pertussiss (whooping cough) a toddler presenting with croup like symptoms (including steeple sign on CXR) but has not improved in the last week despite inhaled epi and dex. A definite challenge - if this child was at the misc we would be calling for PICU transport. Challenges here that will definitely increase my skills and knowledge- I have read more textbooks and articles in the last few days than I have in the last year. Another challenge here is altitude - Tenwek is some where between 6000 - 8000 feet above sea level.  This has a slight effect on  ventilation (related to Boyles law  for all you keeners).  Normal oxygenation levels are slightly lower here for example my SpO2 is normally 97-100 today I checked and it was 94 a new normal.
My Life at Tenwek has been more than work (though this is large part) and I am sorry for all non-medical people who got confused and bored in the last paragraph. I am also getting used to living where I can’t call for take-out and the TV usually has something on to watch. It is a slower pace and I am enjoying, howver I am looking forward to meeting my roommate (she is on retreat this weekend) as it will be nice if it wasn’t so quite in the evenings. Part of my living arrangement includes a house helper. A local lady who comes 3 days a week she cooks, cleans, does laundry and even does some local shopping for produce. The idea behind this is that it frees up more of my time for mission work whether at the hospital or elsewhere. It also allows me some consistent contact with the local culture. I am not quite used to the idea yet but it is nice to come home for lunch break and have a hot meal on the table.
I hope to be able to post some pictures soon of my apartment and Tenwek but the sun has not shined long enough for me to take some nice pictures.

Monday, October 4, 2010

I made it to Tenwek

I tried to post some pictures from london on the Blog but the internet was very slow to upload them so they are on facebook anyone can check them out at Annettes Pictures - London

I have not posted for a few days and a lot has happened, so I guess this will be a longer one. I arrived in Nairobi Friday night and was picked up by a missionary couple from Tenwek. We stayed in Nairobi overnight and I was awoken in the morning by a rooster crowing out my window, welcome to Kenya. Saturday was groceries, Tenwek is 3½ hours drive from Nairobi meaning that I had to but than what I thought I would use for the next few months. This not easy as I was not to sure what was readily available at Bomet as well as what is already in the house. I guess my diet over the next few months will reflect my success or lack there of. I was thankful that I was not jet legged as I did this shopping (most people are) as that would have made it more difficult. In all I spent  about twenty thousand Kenyan shillings - not too bad.

Saturday afternoon was the drive to Tenwek - Beautiful. Once you leave Nairobi you look down at the Rift Valley (which you have to cross). The view was wonderful, I did not take pictures as the day was cloudy and they would not do justice but I am sure I will get some eventually. We than drove through the Rift Valley where we saw a giraffe, zebras, baboons, and a Thompson gazelle?. The drive also took us into Masaai Land. The Masaai are a local tribe who have held onto their customs, you are able to see them on the side of the road herding their cows, and goats. They look very regal in their red blankets and sticks and spears. The drive was Africa.

I am sharing an apartment here at Tenwek with another girl, who is currently on a retreat I am excited to meet her. I have been exploring and settling in on my own. It is a 4 bedroom apartment it has a nice living room and a well stocked kitchen. The houses and apartment buildings are scattered about the hospital, there does not seem to be any organization - this is fine as we walk most places as well the whole place is on the side of the hill so it probably works better that way however I am so confused and I wonder if there is a map so I don’t get lost (It took me 30 min to walk home from the hospital to my apartment today - it should take 5min)

I have had a tour of the hospital and have gotten disorientated there as well. It is built into the side of the hill so parts of it are like a walk out basement so what you think is the 1st floor is actually the basement - I will figure it out eventually. The hospital has about 300 beds a large portion of those are Maternity/L&D there are large wards of male and female medicine, surgery and ortho. Very few private/semi private rooms. The ICU is 6 beds 3 on one side of the room 3 on the other, mixed adult and pediatrics. There is also a nursery with a large number of babies. This morning I did some work at the hospital I started the day with a lecture from one of the local staff on a recent case - TB and haemoptysis. This was a good intro to tropical medicine as it involves respiratory. After the lecture I got my pager and started exploring I ended up in ICU and did some assessments, chest physio therapy, and figured out the ventilator. Before I left I was told I would be an oddity in Kenya with my pale skin and red hair. This is true, everywhere I go people young and old stare. One little girl probably 2-3 years old walked up to me shook my hand and just stared, she was adorable. I guess I will have to get used to this as the patient population is always new.

When I was studying respiratory they talked a lot about how RT’s started out and slowly showed that they had the ability to do things and quite possibly better then it has always been done. I feel like I am doing that now, however slightly different as I am hoping to do lots of education as to no leave a void when I am gone, but knowledge. A large part of that is building relationships I am meeting many new people and am struggling to remember their name and role here at Tenwek. I did have some chai tea today wich is a daily ritual where everyone stops working and has a tea break. I am not a tea drinker but quite enjoyed the sweat milky chai tea. This was also a chance to visit and build trust.

Some things here are quite different and other problems are still the same. At the lecture this morning we discussed a patient and difficulties encountered with the anesthetic gas machine not having PEEP - any RT’s out there know if and how a PEEP valved can be added to these circuits?

Something that has not come up in this Blog yet is Faith. I had a discussion with one of the doctors here about if we save there body and not the soul have we done any good. This is the way of looking at things here. Yes we still do our best for all the patients but credit needs to be given to God. The motto of the Hospital Is we Treat Jesus Heals I am excited to see this over the next few months.

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