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