Wednesday, December 4, 2013

The Africa you think I live in.

Before coming to Tenwek and since coming I have often heard comments about how hot I must be, or asked about how I live, or how the locals dress. For the most part Tenwek is westernized Kenya and the climate is wonderful. In a few weeks I will follow this post up with one called "the Kenya I call home" but this post is about a trip I have taken to the Africa that due to pictures from National Geographic you have embedded in your minds as the place Annette is living. This is not where I live but a place where I am currently visiting.

Back in February, I met a wonderful couple from England. They were engaged to be married and I spent a lot of time with A as we went to language school. D was around for a few weeks as he recovered from a broken toe. A and D spoke a lot about the place they were coming to Lodwar, Kenya. As they talked a picture kept coming up in my mind of “National Geographic Africa” however, I have learned not to assume anything and to not create false expectations of this place knowing that someday I would come and see it. Finally that time came. A and D got married earlier this year in England but decided to have a celebration of their wedding with the Turkana people. They have worked with one of the local villages asked the village to host a traditional turkana wedding for them. I took a week off from work and traveled north.

I decided to fly from Eldoret (instead of Nairobi) and was able to visit Dr M his wife and family, who finished residency at Tenwek a few months ago. I spent a day with them it was great to reconnect, cuddle their children and see more of Kenya. From there I flew to Lodwar. I landed on a paved airstrip walked down the stairs over to the pile of luggage they were making grabbed my bag and walked out the gate. Now I know “gate” is a term common at airports but by gate I mean the door in a chain link fence. There I met my friends and off we went. It was dark so my first glimpses were limited. I did realize one thing – it was hot, not the muggy humid oppressive heat of the coast. But the dry windy hot that this southern Alberta gal had experienced before. I arrived and met many people both local missionaries and guests for the wedding, together we had a feast to celebrate American thanksgiving. The next morning I got my first look, I was staying at the home of a missionary family who are away who graciously opened up their home to guests who had come for the wedding. I looked out my bedroom window at the pool, (yes they have a pool, that’s a conversation for another day) and saw a goat walking under the palm trees.

In the morning we all piled in the land rover and headed out to see lake turakana. This was about a hour and half a drive on bumpy roads and my first view of the areal called turkana. I saw the goats and sheep which I expected and camels which caught me by surprise. The people live in homes made from sticks with grass/leaves pulled through. People were wearing blankets tied around them and some of the ladies were topless. I decided I have arrived in the National Geographic Africa. We had a wonderful time at the lake, wading (or paddling as the brits call it) and enjoyed a picnic of leftover thanksgiving dinner. When its 38 degrees C. cold potatoes and chicken taste great. We finished up with leftover pumpkin pie. Yum.

Saturday was the wedding so off we headed to the village another long bumpy road but you get used to that out here. We were ushered inside one of the grass homes. It is a great design as the grass lets some of the light and breeze through but you are still shaded so really they were quite comfortable. We sat around the bride got dressed in her goat skins the men came in their outfits,my favourite being the ostrich feather hats. The bull and goat got butchered we danced and jumped ate some meat and went on our way. This is just a summary the day that was long but fun. At one point I even got a short nap in I woke up to a bunch of turkana men singing outside the tent and swinging the cow hide. I was thankful that the hide was not thrown into the house.


I now have a few more days in Turkana visiting with A and D It is great to experience life with them.
Dancing

Resting between dancing, all the men sit on little stools, that they carry around
Enjoying leftover pumpkin pie on the shores of lake turkana
Turkana Beads
The Bride and I, she's wearing goat skin

Camels next to an unfinished home

Tuesday, November 26, 2013

moving and BiPap

I know my last post was medical and I said my next one would be more about life so I will start by saying I moved this weekend. Since arriving at Tenwek I have been living in the home of one of the long term missionaries who was in the states for a year. She returns this week so it was time to move out. My roommate had left a few days earlier so that left me to pack up the house, most of it was mine anyway. My new home is right next door to my current one, which you think would make moving easy, just a few steps. However there are currently people living in “my” house who will be there for another month. So I have moved to a temporary home. This is the biggest place I have lived in yet and the walk from the kitchen to my bedroom feels long. I was thankfully able to move many of my things from my former place to my future place to store in the bedroom, however, I now have things in storage that I wish I had access to. It’s one ofMurphy's laws that you do not need something until it is placed in storage. So the weekend was spent moving and now that’s mostly done and I have been back to work.

I always find it interesting how things at the hospital go in trends, currently we are on a Bipap trend. Bipap is a way of helping someone breathe without putting a tube in their throat. Before I came it was done infrequently but we keep using it more and more. We have a few “home” style bipap machines that work well for some of our patients but they don’t work well for our patients who need a high percentage of oxygen. For these patients we would have to intubate and place them on the ventilator. However a few weeks ago when we had an elderly, hypoxic, COPD patient who I really did not want to intubate  I tried something different. I hooked the bipap mask up to the Servo 900C ventilator and popped it on the patient. It worked like a charm I was able to set the sensitivity so it would not autotrigger, the alarms were easy to set and that patient did well. Since then I have used the servo 900c for multiple patients as a bipap machine and it has helped save many lives. Earlier this week I had a young man who developed a PE and consolidation after he was in a motor bike accident. This man was fully awake however his oxygen levels were low despite oxygen via non rebreather mask. Rather than intubate him, onto bipap via servo 900c he went for 24 hours and then he was fine.   I am thankful for the machines I have to use and the ability to use them for various purposes.
 
BiPap via Servo 900C

In  closing I ask for prayers for a few patients I intubated a 6 month old (the first time I have intubated a baby) and she is very sick and we are not sure why. Please pray she will recover. We also had a young lady come in the other day after a motor bike accident and her leg had to be amputated, Picture is below, don’t look if you can’t handle gross medical pictures. 
to give reference the tourniquet is between her thigh and where her knee should be

Saturday, November 16, 2013

Not What I expected

Before I start I should warn all you non-medical people this is a highly medical post, I'm sorry if it is boring or confusing for you.

  When you do anything for a while it becomes your normal. There are occasional variations in the normal but you have the expected variations that you are prepared for. Working at Tenwek there is a type of patient that I have gotten to know very well – the “poisoning patient” these are individuals who have attempted suicide by ingesting chemicals, often pesticides that they have on hand.

We have 1-2 of these patients a week and the treatment is usually along the lines of gastric lavage, intubation and ventilation if unconscious, atropine for low HR, watching electrolytes and if all goes well in a few days extubate them.  They get them some counseling and they go home. Depending on the poison taken some patients end up dying due to electrolyte or other abnormalities but this is still in my thought process of “this is normal for a poisoning patient”. 
 
So when I got called to help set up a ventilator for a poisoning patient I did not think much of it.  The patient came, I placed him on a ventilator – no problems. A few hours later I got a call from the physician.  The patient now had subcutaneous   emphysema and it was getting worse. My immediate thought was my ventilator did something funny – so I asked the staff to bag the patient and went up the hill to see what was up. The ventilator was working fine – well not fine, it's old, but it was not doing anything that would cause a pneumothorax. However, an x-ray was done and it showed a large left pneumothorax the surgeons came placed the chest tube and things went back to normal. Not sure how he got the pneumo as his ventilating pressures were normal – did he have a pre-existing bleb that popped? After a few more days on the ventilator,a chest tube removal, reinsertion and removal again. The patient was eventually transferred to the ward and I pray that with the help of counseling from our chaplains that he will make a full physical, spiritual, and emotional recovery.

                This patient was not my only abnormal poisoning that week. This time it was a 2am page – we have a poisoning patient and we cannot get him oxygenating well on the vent can you come help? So up the hill I went.  When I arrived I saw the patient settled on the ventilator with Spo2 -80’s. I took a listen and didn't hear any air entry on the left side. So I took a look at his x-ray and saw that his left side was completely whited out. OK,not normal. I didn't think this was in relation to the fact that this man had taken poison. So after fiddling with the vent – high PEEP, low PEEP, high rate, lower rate etc. I finally got to some vent settings that the patient managed to oxygenate with. The next day he went for bronchoscopy and he had a huge mucus plug blocking of his left mainstem bronchus – not normal. The next morning I also try to put together more of the history, he had seized in casualty – secondary to hypoxia? Had this man even taken poison? This patient had questions continually running through my brain. Sadly I never found out the answer, I left to Nairobi for a few days and when I came back I learned he coded and died. I pray that he knew The Lord. 

 Sorry to have this post end on a sad note. My next post will be much less medical and be a little more fun.

                

Monday, October 14, 2013

A weekend off, life and thanksgiving

Over the past few years I have discovered something about myself. I am a home body. I like being home where I can do my own thing, I don’t need to travel, and I can just relax. Some of you may be thinking really – is this the same girl who has taken 10 000km roadtrips, and moved across the world to Kenya. And the answer is yes. While I love to travel and visit people I highly value my own space and when I have been busy my favourite thing to do is to hide at home with a book. Living here that works some of the time but not all the time. I have a pager and it lives on my hip. As I am the only Respiratory Therapist I have told the missionaries and staff here that if something comes up on nights or weekends that is outside the ordinary and they can’t deal with it that they can call me. I am not called every weekend and it has been more than a week since I have been called out of bed but it is part of life here. The month of September was busy and I really felt the need for a break. I have learned the best way to do this is leave. So last weekend (the weekend before thanksgiving) I headed out to the big busy city of Nairobi to relax.

I stayed at a nice guesthouse that has communal meals so you can visit with other missionaries/visitors.  It is also close to many shopping centers so I can walk rather than take a cab.
Shortly after I arrived,I heard some sad news from home. A friend had died in a farm accident. This fellow, like my brothers, was a farmer and loved what he did. He was someone I grew up with as our families have always been close. I was thankful for the time away to shed tears, offer up prayers, spend time in God’s word and talk to family.
I was in Nairobi from Thursday late afternoon until Monday noon. I was able to eat lots of good food Chinese, KFC, Italian, frozen yogurt and American. Tenwek does not have much options for eating out. So if you can’t cook it you don’t eat it. It was great to eat some different food. I also did lots of shopping for everything to new CD’s to groceries and was able to visit my teachers from language school. It was great to see my teachers who I spent 3 months with at the beginning of the year we were able to catch up, and have some laughs as I demonstrated how much shang (Swahili slang) that I have learned while at Tenwek. I returned to Tenwek with food to fill the cupboard and freezer and a refreshed spirit to return to work.
KFC in Nairobi, part of my families thanksgiving tradition is to have KFC, I was glad I could too, and only a week early

The week since returning has been busy and fun. One of my friends braided my hair Kenyan style, its fun to see people’s reactions as I look quite different. I do appreciate the lack of maintenance this hairstyle gives me but I don’t think it will last long as my hair is much slipper than the Kenyans hair. A few weeks ago I had some of the interns over for pizza and I introduced them to the card game – Spoons. We had a blast and Friday was the second spoon tournament. There was about 10 of us at the home of one of the interns. We started with a supper of meat, ugali, greens, and salsa. I was shown how to make ugali and put to work stirring the mixture. After that was the spoons game it was fun and we had a lot of laughs.
Ugali in the making

2 of our Chefs for the evening - I contributed my standard of chocolate chip cookies

Nice calm game of spoons, yes that is me with the lines on my head

The spoon dive

Sunday we celebrated Thanksgiving. As Americans don’t celebrate until November I was happy to find 6 other Canadians to join in on the celebration as well as a few others to fill the table. We had a great evening filled with sharing of Thanks and wonderful food – Chicken (turkey is really expensive), mashed potatoes, broccoli, salads and of course pies. Hmm.
The last two weeks we have not had too many people on vents so my time has been spent doing other things.  We got new (to us monitors) for our ICU and HDU so I helped in the sorting of equipment and setting up and training. Some of that has included reading the configuration manual and changing the default alarm parameters – finding a balance between a machine that alarms when the patient needs attention and a machine that alarms some of the time. This is definitely not something I would ever do in Canada but here things are different. I also gave a lecture last week to the Doctors and Residents- titled  "ventilation beyond the basics." It was fun to talk about the more complicated things like PIP vs Pplat, auto PEEP in COPD, permissive hypercapnea etc.
Nice new ICU monitors


Ok so this post ended up being longer than I thought if you made it to the end pat yourself on the back.

Tuesday, October 1, 2013

Why I Do what I Do – Mary’s Story

I love what I do as a Respiratory Therapist, but the work has its difficulties. Most of my time is spent in the ICU working with the sickest of the sick. What I say here may offend some people – which is not my intent. I also need to state that I value life highly and am against euthanasia of any kind. Now that that is clearly stated I will explain why. I operate machines that breathe for people, people who without such machines would die. Now this may sound like a good thing but not everyone who goes on a breathing machine, in my opinion, should. I distinctly remember one Christmas in Canada where we had a 90 year old fellow with MS on a ventilator. We kept him alive with machines over Christmas and when the patient’s family realized he would not recover the machine was removed and he passed. Placing him on a machine did not prolong his life but his death. I, and my, co-workers all have many similar experiences and many of us have said if this happens we don’t want to be put on machines in certain situations. RT’s are often the first ones in the ER to ask the difficult question – how aggressive in this individual's care do we want to be? If this patient gets worse will they go to ICU? Why – will they get better?
This is the work that I do and given that it is easy to ask the question – why? Why - Because some patients have a high chance of getting better and without the care that I can help provide they would die. To illustrate this I will tell you Mary’s Story.
                I met Mary a week ago. She had been at Tenwek two weeks ago when she had a C-section for twins, at the time she suffered from pre-eclampsia (dangerously high blood pressure that can happen during pregnancy). After the C-section, for healthy twins, she was doing much better and was sent home. She returned with severe shortness of breath and dangerously low oxygen levels despite oxygen (Spo2 60s on NRM). Her chest x-ray showed pulmonary edema. We tried her on biPAP, a tight fitting mask to help her breathing (I used the servo 900C as my biPAP machine as my VPAP can’t give 100% O2) with no success so she required intubation and ventilation.  On the ventilator her oxygenation improved some but she required the maximum my machine would give her (I wish I had APRV). I checked on her over the weekend, with medication (lots of lasix) and time she slowly got better. After five days on the ventilator, she recovered and we weaned her off support from the ventilator, and just before we did rounds where the decision to take out the breathing tube would have been made – she made the decision for us and pulled out the tube herself. She did well breathing on her own and was discharged to the ward.
                So this is why I do what I do. This young lady would have not recovered without the care an ICU can offer.  She would have left two babies without a mother but now in a few days she will be able to go home to her babies and return to her life.

I cannot take the credit for her life although I worked hard, without God’s hand on this lady she would not have recovered. 

Monday, September 16, 2013

Working in a resource limited setting

 Tenwek is a fairly well equipedhospital and we can do a lot. We have a total of 13 ICU beds, a CT scanner, a well-equipped OR with talented surgeons, an inpatient and outpatient medical service that also boast wonderful physicians. However, we also have challenges that are unique to mission hospitals. We are one of a handful of ICU’s in the country: the next closest CT scanner is a two hour drive. We don’t have STARS air ambulance to fly patients to another critical care site. When patients come to our door they are ours and we have to treat them the best as we can. We can occasionally transfer patients out for dialysis or other care but these cases are few and far between.
                I mentioned that we have 13 ICU beds but for these beds we only have four ventilators, and five fully functioning monitors (more monitors are coming – Praise the Lord). Doing care in this setting has its challenges. We have many sick patients, and not all will recover. So we ask ourselves: can we intubate and ventilate the 70 year old with a stroke who may not recover? Probably not. What about the young man with meningitis and brain abscesses? The man with meningitis might not recover and if he is on a ventilator does that mean I can’t ventilate the young lady who tried to commit suicide because she found out she is pregnant and has no support? The suicide attempt has a high chance of recovery and finding the Lord and hopefully a support network when she recovers. These are questions I am asking every day. As well as the question: is this patient getting better – does he need a ICU bed? What about that young man he has not improved, will he recover? Should we send him to the normal floor. As I work with every service (medicine, OB, Peds, & Surgery) I am facing the pressure of the resource crunch every day. When a Doctor/Resident needs a ventilator they turn to me. Sometimes I can say yes; other times the answer is not now but I will see what I can do. I walk away thinking, what am I supposed to do, make a ventilator out of thin air (there is some irony in that statement). Every time I have received that request, by the grace of the Lord, we make something work. The patient who has been on the ventilator for about two weeks and was recently trached as he was a difficult wean breathed on his own all day. So at 3 am,  we try him again on trach cradle and he does well. Another time I was able to get a new ventilator working just before another one broke keeping the census at 4. (Our machines are old and it does not take much for one to quit working). These are just some of the challenges I face regularly. It does not cover the other problems we face such as an inconsistent supply of blood for our blood bank, lack of certain labs, lack of beds, lack of pillows etc.

Don’t get me wrong, I love working here and the challenges keep life more interesting, however, there are times when I envy my life back in Canada where I had a storage room full of machines, extra ICU beds across the city and the ability to safely transport patients to such ICU beds. Please pray for wisdom and patience as the staff and I deal with these problems on a regular basis. Also praise the lord, as I have a few new (to us) ventilators that have been donated and will hopefully arrive here within the next six months. As a side note if anyone has a BEAR 1000 ventilator sitting around that they are willing to give me some parts for let me know. 

Sunday, September 8, 2013

Saturdays

A few weeks ago I was asked by a short term Tenwek Visitor what I do on weekend off – I didn’t have a great answer for her. Why? Because I am doing life here. Living here is not a long holiday but normal things. Just like you sitting in your house right now, my Saturdays are busy.  Last weekend was a slower pace.  I was watching two boys as their parents were  gone for the weekend. They are ~11years old and therefore fairly easy. However, being responsible for them has given me an excuse to turn down some other requests for the weekend so it was rather relaxing – I took a short nap, backed up my computer, baked some cookies.
I also made 2 trips of to the hospital. We have been having a difficult problem, I only have four functioning ventilators and they are all in use. Last Saturday, I got a call as they needed to intubate a fifth person and needed a ventilator. OK. Hard decision time – we tried one of the patients on T-piece and she did okay so her ventilator went to the next patient. I also looked at the other three patients on ventilators trying to figure out if I get called again, who is next?  Is it the septic young man, the fellow who has poor muscle strength for unknown reason or the craniectomy patient who is not waking up? Hard decisions I am praying that another ventilator will not be needed until we can get the existing patients extubated. However I was able to get a plan in place with the surgeon if we need another machine. We have a few broken down machines and I am hoping they can be fixed to prevent this problem from happening again.
Anyway back to my Saturday. As you can see last weekend was rather relaxing – I am completely serious, it was. Another Saturday I was expecting a relaxing weekend but found out my Youth Group had a soccer tournament at Tenwek. Being there to show support to these boys is important so I spent the day in the sun watching soccer – it was a fun day but not the day I expected to have as I only found out about it the day before.
The weekend before that I had an adventure with my ICU and HDU nurses we travelled to a place called 14 falls on the way we stopped for chai.  Chai to Kenyans is like coffee time for Dutch people, it must happen. We also stopped to see a pineapple farm – I had never before seen pinapples grow, I thought they grew like cabbage but they are off the ground – it was neat to see. The water falls were beautiful, however, I was disappointed by the amount of pollution in the water. Usually I am the first one to get my feet wet but I refused to touch this water. Regardless the day was fun and it was great to spend time with my co-workers outside of the hospital.  
That is life at Tenwek. I often wonder where the time goes as there is always something to do, someone with a need, or a game to play. Please pray for me to have wisdom and strength for the busy times and the courage to say no.

 
14 Falls

Soccer game

Thursday, August 15, 2013

Where has the time gone?

Two weeks ago, I reached the seven month mark since arriving in Kenya, my six month tourist visa had already been extended for a month, and I was still waiting for my work permit. So a few days before the expiry, I started to make some phone calls about where I was at. I had numerous conversations while continuing to help with a sick child. Conversations progressed from having to travel out of country for a few days to being told to go to Nakuru, 4 hours away, as there is a helpful immigration official who will help me out. So I ran home, grabbed a quick bite to eat, called a driver to pick me up in an hour, sorted out who would feed the dog I was watching, and put some things in a bag. Off I went to find my car – to my surprise there were two drivers. I went off with the one who I was told was coming. I had a good weekend in Nakuru relaxed in the home of the country directors of WGM Kenya, wonderful people. I also got to do some fun shopping, eat some tasty Chinese food and most importantly I was able to get a two month extension on my visa. Hopefully before Oct 2, I will get my work permit, or I will have a repeat of two weeks ago.

The second weekend of August was also busy. I headed out to Nairobi as I had a Respiratory Therapy student coming to Kenya for two weeks to work at Kijabe and Aga Khan Hospital. His coming was part of another group I am involved with called Respiratory Therapists Without Borders. Sunday afternoon the RT student and I arrived at Kijabe hospital we got settled in and planned our lecture for the next morning. Monday and Tuesday were busy. We gave two lectures a day, checked  and fixed baggers, put together about 40 new baggers, did rounds, checked out all the vents, etc. Tuesday afternoon a second RT arrived from Canada – three RTs from Canada in one place in Kenya – WOW. I spent the afternoon orientating the new RT and then I packed up and returned to Tenwek. These two RTs will complete the week at Kiajbe and hopefully have a good experience.   Maybe they will return to Kenya or help out elsewhere in the future. I was also thankful that these individuals brought many supplies that were split up by three mission hospitals in Kenya,- Kijabe, Tenwek, & Litein.
A lot of baggers - THANK YOU

The view from my front door a Kijabe - the Great Rift Valley

Three Candadian RTs in Kenya

Tuesday afternoon, I left to return to Tenwek. The driver and I left at 4pm which should have given us plenty of time to be back at Tenwek before dark, as traveling after dark here is not advised. So we left Kijabe and got to the town at the bottom of the hill. We stopped in a gas station and were told “hakuna” (there is none).  The driver said we will be fine until Narok. So we stopped in Narok, at the first station we heard "hakuna", the second station: "hakuna", the third station: "hakuna". The fourth station we saw a fuel truck ready to unload and 100 piki pikis (motor bikes) and 75 cars in line. The driver looked at the gauge and said we should be fine. Five minutes out of town the low fuel light turned on so we turned around and joined the line. The fuel delivery truck had just arrived so first we waited for him to unload and then the line started to move. We slowly inched forward until eventually our turn came. The Piki Piki’s were in line first and they just kept coming. Also other piki piki drivers would get to the front with an empty bottle pay for their 1 liter and happily take off. We waited about an hour and a half to finally get gas and then it was dark and rainy making the hour and a half drive to Tenwek not fun. I was thankful for a good driver who was familiar with the road – he knew where all the speed bumps and potholes were. I finally made it home a little after 9pm. A three hour trip that turned into five hours.

So now I am back to work.  Please say a prayer for us at the hospital as we have a lot of head injuries and other traumas lately. Also recently, we had a morning where in the space of three hours we coded and lost two babies under the age of one, both in the ER department.  Please pray for the families as well as all the staff and me as it was a tough morning.



The line for gas
This man was excited to get his 1L of gas - yes it is in a water bottle


Thursday, July 25, 2013

It's the little things

So what is it that makes living and working in Kenya so much different - it’s the little things. Many of these things are good and many of them drive me crazy. Sometimes it’s the same things that at one point I will enjoy and another time will make me crazy.

To illustrate these points I will show case a few normal everyday things that are made different by little things.

My walk to or from work.
I love that my house is just a short walk (300m) to work. Mornings are beautiful with the sun peaking up over the clouds, the birds are singing and its quiet with no hi-way noises. When I reach the road I take a quick peak to make sure there is no motor bike coming up the road. I often see a certain motor biker waiting for his passengers. He wears a Canada Post Jacket. It’s a nice touch of home. Often when walking home I get delayed with greeting people. Here a simple hi or wave is not appropriate. You must shake hands and ask how things are going. The other day I met a young man from my youth group. I saw the cows that he herds before I saw him. We chatted for a bit as his cows kept walking on, once the conversation was done he went off and tracked down the cows – he said they knew the way. There is no rushing or worrying. This is a great thing…outside the hospital.


Cows in my back yard

Making Supper
I have house help a lovely lady who comes a few days a week to help me with cooking, dishes, laundry etc. However the other day I had some visitors for supper on a day when J was not around. So supper was up to me. I asked a friend to pick up some lettuce from Nairobi. Once I got the lettuce we (my roommate and I) washed it in a weak bleach solution and then rinsed it in filtered water. We had to do the same with the tomatoes. Avocadoes are in season so we had fresh guacamole. I walked to a few different fruit stands before I found the limes needed to go in the guacamole. I took three and asked how much. I was told 30 shillings. I paid and the lady gave me 5 limes. Not quite sure how that worked, and I did not really need 5 limes but it was easier that way. I had J make the tortillas the day before so I did not need to worry about that and I had some taco spice from a visiting Dr. There. Tacos done. I picked tacos because it was an easy meal.
 
A different night when we had a lasagna making lesson
Work
I can’t outline all the little things that make work different but here’s just a simple story that has happened many times. This is a typical story and here’s how it may go.
I get paged to help out in casualty (ER) I find a young lady in the back room unconscious, not on a monitor and a Dr saying we probably need to intubate. I go assess the patient – make sure she is still breathing, check her sats and see how awake she is. As these are all fine I go set up for intubation. I set up suction – I grab the tubing and canister off the drying rack as they have just come out of the bleach we use to disinfect. I discover that one of the tunings does not quite connect to my yankeur so I go find another one. I take the bagger out of the bags we recently hung that should contain my needed supplies, I discover that the mask is the wrong size so I dig through  a container of masks mixed with random connectors and find a better one. Get the laryngoscope out of the drawer – thankful that we have a complete laryngoscope set in a good box. Now that I am all set up the Doctor and I and possibly a nurse go to put the tube in after the 2nd attempt the tube goes in the lungs – I hear air entry on both sides and the SpO2 stays good –confirmed ETT placement. Now the patient who was previously breathing isn’t breathing so much on her own. So I stand in casualty and breathe for her by squeezing a bag. While doing this I keep the gastric lavage going to clean out her stomach. I cannot leave the patient for more than a few seconds at a time as if I leave patient does not breathe. After 30-60min I hear we have a bed ready in ICU but they need me to go setup the vent. So I call a nurse to take over my job of bagging and head to ICU. The nurses set up the vent well and with a minor change we are ready -  I tell them I will be back in a few minutes with the patient. I walk back to casualty and grab an oxygen cylinder to use as we transport the patient – but after turning it on I discover it’s empty. I than switch the regulator to the next tank. It’s also empty. I walk back to ICU and ask to borrow there tank they give me permission as long as I promise to return it. I turn it on and discover there is a large leak around the regulator. I remove the regulator and see that there is no O-ring to help seal the regulator to the cylinder. I find an empty plastic IV bottle and cut it up to make an O-ring. I manage to finally to get it to seal and then I hear a commotion behind me. The casualty staff decided they were sick of waiting for an O2 cylinder so they made a mad dash from casualty to ICU. The patient is still on my SpO2 probe – the only monitor aside from the odd BP we have done since her arrival at Tenwek, anyway the mad dash brought her SpO2 down to 83 – not bad. I throw her on the vent and she recovers. The casualty staff take their bagger back to casualty and I hunt up an ICU bagger to keep by her bedside in case the power goes out and my vent shuts off. The first bagger I find has a small leak – I pull out the glue that is in my pocket and seal it. Now we are good to go. Patient looks good on the vent and is stable. Hopefully she will wake up in the next day or two and then we can take her tube out.


Rounding outside on our ICU patients. They have (all 3) recovered from their suicide attempts.


So I will end there. Please pray for me for patience to deal with and enjoy the little things.

Tuesday, July 16, 2013

Mystery Patient Part 2

So a few weeks ago I shared here on this blog about a mystery patient. I have been asked to share what we figured out with the patient. The truth is we figured out nothing. He remained in HDU(High Dependeny Unit - same as a step down ICU) for a few weeks with intermittent episodes of increased work of breathing and increased PaCo2- 105. In between the episodes he would have some signs of mildly increased work of breathing but was otherwise fine. He would walk around, eat, talk etc. We did a few blood gases during these periods and they were normal.

After doing this for many days with no diagnosis in sight and realizing that whatever the diagnosis was we probably could not treat it. With this knowledge in mind a discussion was held with him and his family and a decision was made to send him to the general ward and stop the bipap. A few days later he went home. He was off the bipap for about 5 days straight before he left and had no episodes. I don't know if God healed this young man or if he since he went home and he passed on. However, I do know that this man knows the Lord and whatever happens I will see him again whether here or in heaven.

Saturday, July 6, 2013

Mimi Fundi wa kupumua

Being a respiratory therapist I am used to the question: what is it that you do? I have blogged about it a few years ago when I came to Tenwek the first time. In attempts to explain what I do I have changed my job title to Fundi wa kupumua. Fundi is a Swahili word which in language school we defined as expert. Here at Tenwek I have been told it refers to a repairman. I think either work. Kupumua is breathing. So literally translated I am the repairman of breathing.
 I have had some debates but I like the title.
The fundi part of the title here is a lot more true here than back in Canada. My troubleshooting of ventilators goes a lot further than “it doesn’t work” – I have a closet full of exhalation valves and flow sensors which I pull out when needed. I also walk around with a wrench in my pocket and have started filling O2 cylinders (E size). I am hoping to learn how the O2 and air compressor works and how to trouble shoot them so when there are problems I can fix them. This is something that is currently done and I will in no way assume the duties from technical but rather share the load.
Today I learned that when filling tanks I can’t hear my pager – something I need to remember as I start doing this more often.
Don’t think I am filling tanks and becoming a mechanic because I am bored – that is far from the truth. I am doing it as its necessary to be done and helping out the technical service with simpler tasks frees them up to fix my ventilators that are out of my expertise.

On the kupumua (breathing) side of things I have been busy this week. We have some visitors from America who are helping us out with cardiac surgeries. We are doing one case a day. This week has been mitral valves, next week will be aortic valves. I get involved with the patient post-op as we wean off the ventilator and get the patient stabilized. As we do not have an intensivist managing the patients post-op it can be interesting as the responsible physicians are busy doing surgery. If problems arise the nurses and I figure something out as one of us relays info back and forth to the operating room.

This week I started a relationship with another mission hospital about 45min away, so not far. They are in the process of opening an ICU and I am advising them on things. I will probably making 2-4 trips a month for the next few months providing education to the nurses and physicians there. Its fun to help create something and I pray that they do well.


Here are some random pictures of life and work.
Chai time in ICU - one of our patients joined us/

An evening game of balderdash

My ICU nurses excited about the "new"monitor- if only we could get it to work  all the time

A patient needed blood - so I gave some, and I did not faint. 

My O2 tank filling station

What do I do?

So I’m a little tired right now, hoping to catch up on my sleep…eventually. I probably work at the hospital about 50hrs/week and then come home where there is more work: catching up on e-mails, helping out with visiting staff, working on equipment etc.  My days are very diverse. I don’t know what to expect each morning when I wake up but rarely am I bored.
To give you an idea about how I spend my time here’s what I have done in the past week:
·         Assisting with the ventilation of multiple patients from a 14 month old with ???, to a young OB patient with serious bleeding problems, to  the youth with ARD’s– and a few others.
  •    Held babies – they are in ICU and crying, the nurses are busy so I make sure the child does not fall out of bed.
  •  Gave blood – the patient was in severe need of blood with clotting ability, which here is only in fresh blood, so at midnight I gave her some.
  •   Attended lectures on cardiac tamponade, pulse oximetery, hirshprungs disease.
  •   Gave representatives from Coviden (medical company) a tour of the hospital
  •  Practiced Swahili with the nurses over chai breaks – learned today that my pronunciation for understand(elewa) is to close to the word drunk (lewa) or married (olewa).
  •    Fixed/trouble shooted ventilators
  • Sorted supplies in the storage room
  • Gave many informal lecture from CXR to Evac tubes
  • Talked with a Dr from another hospital about their new ICU – I will probably visit there when they are running to provide education
  •  Did CPR – I usually do this at least once a week if not more
  •  Helped with Intubations
  •  Weaned O2 on various patients
  •  Helped out the physicians by finding lab results, taking verbal orders when the Dr is busy doing surgery, providing vent support
  • Bagged patients – We don’t have a ventilator in ER so when we intubate some one needs to stand there and bag – usually end up being me.



I am sure I missed something but that gives you a general idea. I am on call 24/7 so while many of these things happen Monday-Friday between 7am and 5pm some happened at 5am or during supper on Sunday. And that is just fine.

Sunday, June 23, 2013

Mystery Case

So I thought of titling this case of the week but I don’t think I will be doing this regularly – this is case that has mystified the internal medicine service so if you think you have an answer please let me know. For all my non-medical friends sorry if this is boring/confusing I will get an update more about life soon, I do ask that you hold up this young man in prayer.  Also as I would like some feedback soon I have posted this post before my editor reviewed it I apologize for any grammar/spelling errors.

I got called to meet Kibet (not his real name) last week, a 20 something year old man. He had come into casualty (Emergency Room) talking and complaining of difficulty swallowing and shortness of breath. Over his time in casualty he deteriorated and became obtunded. When I was called to see him he was unconscious GCS – 3 and his RR was 10. We started bagging and intubated him. The intubation took some time as we were teaching the interns by the time we got the tube in his GCS had improved to maybe a 6. By the time we got him to ICU we had to give him Versed to keep him calm to keep the tube in. I set him up on the vent (Servo 900C). He was happier on the vent and no longer required versed. I turned him to pressure support but he had no Respiratory drive, so we left him on A/C. After some time on the vent An ABG was done with a pH of 7.56, PaCO2 30, HCO3- of 32 (I’m pulling it from memory so it’s not exact) We left him on the vent overnight and the next morning he was triggering the vent some so I placed him on SIMV hoping to wean him some. An upper GI Scope was done which was normal as was a Lumbar puncture which showed increased WBC – so possible Meningitis. We started treatment for bacterial meningitis.
The next morning he was triggering the vent better and we extubated him by mid-morning. A blood gas done a few hours later was pH 7.46, PaCO2 40 and HCO3 of 28 (again from memory). Also throughout his whole time he has not been hypoxic/requiring O2.
The patient was quite awake and co-operative both on and off the vent. Once he was off the vent  we were able to get a better history, he has had trouble swallowing for about 3 months – which is not a normal time frame for bacterial meningitis so we are thinking maybe TB meningitis??? He has not been working the past few months as he has been weaker than normal however he had reasonable leg/arm strength.
The next few days myself and the medical team expected him to get confused and hypercarbic again. As we think something neuromuscular is going on. The patient did well. I would find him in a chair, having coherent conversations and no signs of Resp. distress. We did not do serial ABG’s as they are about a day or 2 wage here.
However this morning I got called out of bed – he has done it again and is obtunded again. We grab another ABG pH 7.15, PaCO2 – 104, HCO3 – 34. Rather than intubate him again we place him on bipap. Within 45 min he is awake and doing well. This time as he was in ICU we were able to better watch his deterioration – apparently his Blood pressure is very positional, he is comfortable sitting straight up with his head arched back and with his legs bent underneath him.
So now he is on and off BiPap I talked to him this afternoon and the bipap his helping – however what is the problem. Is it treatable? I can’t send him home on Bipap as I don’t have enough machines. Anybody have any ideas – feel free to comment on this blog or e-mail/facebook me. Please also hold up this man in prayer.
Thanks

Annette 

Thursday, May 30, 2013

Work in the basement

So it is high time I get a blog post up. I have been debating about what to write those of you wanting stories from the hospital it’s the same as last time. My ventilators don’t always work, patients are very sick, and I am enjoying being part of the team here.
Today I have been having a new adventure. Tenwek being a mission hospital gets many things donated. These things all end up on the shelves in Central Supply, much of the donated equipment is used and put to good use however among every container of donated supplies is the junk. Things are donated because they are no longer needed by the place that donated them. Maybe it was a mistaken purchase so its fine for us to use or it is something completely random that would never be used – ever. When I was here two years ago I spent some time in Central Supply familiarizing myself with the items on the “respiratory shelves” which is a lot of equipment from little connectors to 40 feet of oxygen tubing.  Amoung these shelves I also find the obscure like hoods – no clue what these hoods are for – I think maybe the OR. Although now that I am writing this I should double check and see if they’re oxyhoods. Anyway I was asked today to assist the staff in going through these shelves. It is tedious dusty work but I am enjoying it. We emptied one whole shelf today. I found some treasures: in-line suction catheters and incentive spirometers, and sent some things to the trash: water traps are useless when your humidification is HME. I also have matched up some supplies to other areas of the hospital such as double lumen endo tubes to the thoracic surgeon, he did not know we had them – we have 38.
I will probably end up spending a week down there taking breaks to see my patients and respond to pages. Today breaks involved doing CPR, chest physiotherapy and some ventilator checks, as well as a few e-mails to Europe as someone there has some equipment he wants to donate and wants to be sure its appropriate, I am so thankful he asks.
I will end with a few pics of my work. 
I head to work around 7am and caught this beautiful sunrise out my front door.

We have been having trouble with the power to our CT scan, so we now have all these batteries to  hopefully fix it.

This is currently behind the hospital, not sure why?

Today I emptied the shelf on the left tomorrow the right, then the next one. 

Friday, May 17, 2013

Home at Tenwek


So I should be preparing my lecture for next week, or figuring out how the new (to me) spirometer works or reviewing my Swahili. But I think you all deserve an update on what I am up to so I will write this instead, and work on the rest later.  I work the best under pressure.

I finished language school with my final oral exam on May 9 and the next day headed to Tenwek. I got here just in time for new missionary orientation. This was a time spent with missionaries who have been in Kenya from anywhere from 8 months to a few days. This was a good start to my life at Tenwek, although it did delay the unpacking a bit. I gave myself Monday off to get settled in and meet my house help, a wonderful lady who will be coming 2 days a week to help me out with cooking, cleaning, shopping and laundry. Her help is an excellent bridge into the culture around me as well as frees me up to spend more time in ministry – whether working at the hospital or the surrounding community.

I am staying in the home of a long term missionary who is currently on furlough. She has generously let me use her furniture and kitchen stuff. It is great to move into a furnished home all I had to do was unpack the bags and hang pictures on the wall.

I made it to Tenwek just in time for a graduation ceremony of one of the Family Practice residents I worked a lot with in my last term at Tenwek. Dr M. is a wonderful doctor and I am sad to see him go. We had a fun graduation evening. I skipped out of some of the speeches to play with his 2 young boys who thought this Muzungu (white person) who attempted to talk Swahili was interesting.
Sugar high=Smiles
Good-bye Dr M, we will miss you. 

I headed to work Tuesday morning. Introduced and reintroduced myself to many of the staff here many names and forgot many of them – a challenge of working everywhere in the hospital is I work with almost everyone and it makes for a lot of names to remember or more often forget.
All set for my first day at work

My days have been busy the first day I attended 3 different codes, assisted with 2 intubations and functioned as a ventilator as we waited to get a bed in ICU. I am quickly refamiliarizing myself with our equipment and the challenges we face here;  I have already had to bag patients because of malfunctioning oxygen system, my pockets are overflowing with all sorts of necessities from Peep valves to hand sanitizer, and  I have been called out of bed at midnight to help out with our ventilator that has its idiosyncrasies. I have been busy working from 7:00 or 7:30am until  5:30 or 6:00pm, long days however I am loving it. It is great to help out the career missionaries and shoulder some of the load of working here. I also love sharing knowledge with the staff as we learn from each other.

I have appreciated my time spent learning Swahili. I have been having chai with the nurses and being able to be a part of, or at least understand, some of the conversation going on around me has been great. The staff has also been very encouraging speaking to me in Swahili and saying it again when I ask and telling me what word is what. I have been able to do basic respiratory assessments in Swahili  it’s not always right but I am learning and when the patient laughs at my Swahili mistakes it’s a good form of chest physiotherapy.

Well I should end there, and get some lectures written. I ask for your prayers in the continued months as the novelty of working here will wear off and become routine I will need strength both physical as the days are long and emotional as I see a lot of death each week. I need to continually remind myself that healing the physical body is a good goal but the spiritual body is even more important. 

Tuesday, May 7, 2013

Last few days of School


I have completed my last few days of language school. May 10thI will be moving again, for the last time for a while, to Tenwek. My classmate finished last week  so that left just me in my class for the last week and a half. I  stopped working through the textbook and instead I had the teachers teach me medical things. Medicine in Kenya is done in English(the staff all communicate in English regarding medical matters) but the patients may only speak Swahili and their tribal language, or just their tribal language– in which case my learning will not be helpful but this is still time well spent.

To illustrate the importance of the time I have spent learning Swahili over the last three months here is a true story from last week. It was a holiday in Kenya and I took the opportunity to head into Limuru to pickup a few things. I went by matatu (after walking a mile to the main road). I got in a matatu where not much communication is needed, after you are seated you get a tap on the shoulder and/or a look that is your cue to pass up your fare and say where you are going. No need to speak Swahili there. After I had paid there was some confusion between the tout (guy who collects the fare, not the driver) and a passenger over the fare. This fellow ended getting off thematatu early saying in English “how would I know I don’t speak Swahili”. Now this fellow blended into the population much better than I did, and when he got off there were a few murmurs of “he should speak the national language”. At this point I turned to my seat mate and said “Nasema Kiswahili” (I speak Swahili).This spread some smiles around the matatu, and it reminded me that communication is only one of the goals of language it is also to be a part of the culture, to show respect and to be able to be one of the crowd.

So since last weeks holiday, I returned to school and continued to make my lovely mistakes. The other day I mistakenly said “when my brothers and I were cows” Instead of when my brothers and I had cows – introduced much laughter to our lunch break. I am sure that was not my last mistake and I will daily make more.

I ask that you pray for me in these final days of formal language study – that I will continue to learn and that I will know how to best focus my class time. These past 2 weeks have been fun. During the mornings I create my lesson plan – we joke that I have a clinic, and it’s not far from the truth. I am explaining, in Swahili, how to manage asthma and we are doing “spirometries”. One of my teachers desires to be an actor and he is loving putting his skills to use when I tell him – Ok you are coming to the clinic because you are short of breath. I have  learned the words to use during chest physiotherapy – interesting as the best word we have is "beat the patient", hopefully I don’t scare them away.

My next post will be from Tenwek my home for the next 2 years - the time has finally come.

Sunday, April 21, 2013

Various Adventures and the Push to the Finish.


In my last post I mentioned how I would be off on retreat, I returned from the coast the middle of last week. It was a great long weekend spent at the coast enjoying the sun, friends (new & old), and a challenging speaker. Mornings and evenings were spent either in meetings learning more about mission operations or listening to our speaker. The speaker, Dr Patrick was Canadian which was a nice bonus. Dr Patrick is an extremely smart man who has experience working in the developing world and currently teaches at Augusting College in Ottawa – a year of study there would be very interesting.
Afternoons during the retreat were free time. Given the choice of reading a book or playing with the children in the pool – the pool won out everytime. I pulled out some of my old swimming lesson techniques and had a lot of fun with these missionary kids who will be a big part of my life the next few years.

Getting back to school after retreat was a little tough as I have less than three weeks left. It is easy at this point to stop caring but I really need to make the most of these final weeks. Please pray with me for continued motivation.

My school took a field trip this week which included some motivation to continue in my Swahili studies. We went to Toi (pronounced like toy) Market. A large “outdoor” market in Nairobi, outdoor in quotations as there is plastic sheeting covering it. Anyway you can buy almost anything there. Many of the products are thrift store cast-offs from around the world. I saw more than one Value Village price tag. I knew when I came to Kenya that I would need to buy a few things to set up house. When I priced them out at the local “Walmart”equivalent I was shocked by the prices – twice as much or more than what I would pay at home. So Toi market was a gold mine. I managed to buy bedding, towels,crocs, and material for a reasonable price. I did have to barter and my Swahili, halting as it is, did help as it told the shopkeeper that I was not a tourist. I felt like I got fair prices, although I am sure I will hear of someone who got what I got in better quality for half the price but that is the nature of shopping.
All the teachers came with us to the market and it was typical: the ladies loved every minute of it and the guys waited around aimlessly until we were done. We did go out for pizza afterwards which I hope made it worth it for them.
I will end here with some pics of the coast and our outing.

I woke up early to see the sunrise

The adult (quite/boring) pool with the ocean in the backgorund

One of the MK's who is graduating this year, we had an evening to celebrate and encourage them


Pizza after the Market, 


My fellow students showing of their purchases

Wednesday, April 10, 2013

Easter at Tenwek

So 2 weeks ago I finally made it out to Tenwek. Since myarrival in Kenya on Jan 4 I have been living in and around Nairobi. Between mypracticum, language school and recommended travel restrictions during electionsI have not been able to make the 4 hours (1 way) trip to Tenwek, my futurehome. Finally with Easter the opportunity came.
I enjoyed the drive out, the rains have caused Maasai landto turn green and beautiful. I arrived at Tenwek, dug my lab coat, stethoscope,and pulse-ox out of my bag and out of the door and up the hill I went,  heading to the hospital. It was great to greetold friends and to get back to work. It had been months since I have dealt withpatients, touched a ventilator and used my critical thinking skills as I triedto make things work. In some ways it feels like I never left as so many thingswere the same. However there were new faces and other things that made me feela little like a visitor again.
The weekend at Tenwek was also a great time to reconnectwith my Tenwek family. There are new faces to the family who I had yet to meet.I met some of these families as the kids ran around,  and met the adults as I ran around the hospitaland attended various Easter services.
Since then I have returned to school I have just over 3 weeksof class left. This week was busy studying as I wrote a test and prepared for adevotional on Thursday morning. By the time you will be reading this post Iwill be skipping school again as Tenwek’s annual retreat is this weekend. It isa time of rest and relaxation. Spiritual and community growth as well as anopportunity for me to get to know all these new faces better without the stressof hospital life.
One other thing I am hoping to retreat from is the bugs. Ihave been writing this cowering under my mosquito net with the light off as therains have driven all sorts of bugs into the house. The light attracts them andthis evening I had about a dozen flying termites in my room. I think my flip flopweapon killed them all but I am enjoying the (false) security of my mosquitonet.


should have kept this guy, as he would have eaten some of the bugs

As well as bugs in the house the birds are quick to fly in though a  open window or door. The other day I turned around to see these 2 standing in my room. 

The great GREEN Rift Valley

Tenwek Easter Cross

Tuesday, March 26, 2013

Training



 So back in summer of 2011 when the decision to return to Kenya was made, a list was created of all the things I would have to do.  World Gospel Mission (WGM) had recommended trainings for all those going through their Missionary Discipleship program to complete. Through various reasons (mainly being Canadian) I was not sent by WGM but Samaritan's Purse. Samaritan's Purse does not send medical people long term so they did not have recommended training. Thinking some training would still be a good thing I wrote down a list of the training WGM would have required of me and set out to do them. I’m thankful Samaritan’s purse was very supportive of these training courses and allowed me to use some of my raised funds to cover the cost of these courses.

                The first course I took was called Perspectives. This was a compact course that explained everything it could in a week of seven hour classes. We learned about missions, why we do them – To glorify God, history of missions, lessons we can learn from previous mistakes and how God can use anybody. This was a great course; I still have the textbook – somewhere, and will probably find it again someday.
                The second course I took was called PLANT’s, this is a Canadian version of a course offered in the States called PILAT. It was out in Ontario and fit better in my schedule as well as allowed me to spend some great time with my Ontario relatives. This course was all about language – learning styles, methods in and out of the classroom, how long it will take etc. It was a helpful course and I use some of the methods in my current studies.
                The last course that I took on North American soil was called SPLICE  - all about living cross culturally, sacrifices and joys and meeting a wonderful community of people.
                That leaves me with the 4th and final training language learning. After being taught French from grades 4-12 and being able to speak very little I was not looking forward to this time. I prayed that I would catch on quick, and be able to endure it. Six weeks in and at the halfway point I am very thankful for what God has done. Not only am I learning the language I am enjoying it.  The grammar is fun (I hate English grammar, and Shawna who edits each and every blog post can attest to the fact that I am horrible at it). Being able to have a conversation in another language is exciting, and a week after you learn a word to hear it and recognize it outside of school reminds me that this learning is a good thing. I am so thankful that God has given me ear to hear and mouth to speak this language and he is going beyond what I asked for and has allowed me to enjoy it. I still make many mistakes and you can hear my teacher's and my laughter carrying out of the classroom. This week I confused the word think and horse saying “I horse”.  I also made coffee into a verb and when I was told “no” I put in the people class making it human – I argued, to no avail, that coffee is necessary for life and therefore should have human like adjectives. Mistakes I have learned from, although I may make again.
                So by the middle of May my training that had been spread out over a year, almost to the day, will be complete and I will get to work. This year of training has stretched my brain, and had me in many places and one of the best parts has been to meet so many missionaries headed out all over the world. I plan on putting up a map surrounded by prayer cards of all my friends around the globe.
             
 Aside from language I have been exploring the beautiful country of Kenya I visited the Tigoni fall’s last weekend and this weekend I hiked mount Longonot, a dormant volcano. I have some pictures of both for you to enjoy. For Easter I will be heading to Tenwek. As Tenwek is  about four hours from Nairobi I have not been there since I arrived in Kenya almost three months ago. I am looking forward to seeing friends both old and new.
Tigoni Falls

The view from Mt. Longonot - the lake is Lake Naivasha

3 of us hikers on the rim we are scouting out the cape buffalo

Levi, one of my teacher and our friend and "guide" for the day.  the crater of Longonot is in the background