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


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