Saturday, July 9, 2016

life update and why you should get your tetanus shot

So my plan has been to write a post once a month. I have failed again. Sorry. Since I last wrote I made a quick trip to Canada to attend a friend's wedding and see family. It was great to see everyone there again, if I missed connection with you I am sorry. I have joked that I am the missionary that never leaves as since arriving in Kenya in January I have made 2 trips back to Canada. The February trip, as you know was unexpected. This trip that I just took was planned already in January, and I am so thankful for that. I don't have any further trips planned so it will probably be a year before I am back in Canada. It was hard to be home without mom but also good to connect with my family. I have found since coming back I have progressed further out of the grief. The other day at work I was singing. I used to do that often but not in the last few months. It is good to feel more normal although I am sure there are times when it will seem to bog me down again. 

Work at the hospital continues and I would like to share a challenge that does not exist in Canada but is one of the hardest things about working here. Healthcare at Tenwek and many mission hospitals is often referred to as working in a resource limited setting. That limitation of resources vary vastly on the spectrum and Tenwek is a better equipped resource limited hospital. However we still have to be judicious concerning our use of this equipment. For me a weekly question is the use of our ventilators. We currently have 5 working ventilators (1 broke while away and I still can’t find a replacement part). When a patient is placed on a ventilator that means we can not use that machine for someone else so decisions need to be made about how appropriate this is. 

Let me share a story about this. A few weeks ago I got to work to discover a child with Tetanus had deteriorated over night and was placed on a ventilator. Tetanus is an ugly disease - so please get your vaccine. If it progresses to the point of needing a ventilator the chance of survival is poor, but there is still a chance and without the ventilator in this case the child would have died. So the decision was made and we continued to care for this child. Tetanus means the child may need a machine for 2-3 weeks. Therefore we are unable to use the machine to care for other patients with this machine (although I have 4 more) meaning other patients may die or may not. There are weeks when I only have 1-2 patients on a machine and some when all are in use. 
So here we were with this child on the machine. Praying, treating and hoping he will recover. 
However there is a second resource limitation here - the families resource. Staying in the ICU is an expensive treatment. About $100/day or more. That is cheap by western standards but if you only make 5$/day this is a lot. With all your funds going to pay the hospital bill still not being enough some families have to sell their land to pay the bill. Yes, Tenwek is a mission hospital and does provide care to all patients and we have a fund to help patients when needed but a large amount still falls onto the family and their community. So back to my patient after 2 weeks on the machine he died. Now not only is the family grieving a loss their savings have also been depleted. Limited resource is hard. 

Now a few weeks later I get a page, another child also with Tetanus, not doing well. Now what do we do. We have a ventilator available - do we use it? Is this a good choice? Again the family has no money? Transferring to another hospital is not an option as the government hospitals will also charge and require a large deposit up front. These decisions I hate. A colleague of mine once said “don’t make a decision based on what happened to your last patient” not sure if he was quoting someone else but we took this advice. We decided to put the child on the ventilator and 24 hours she is doing a little better and she came off the veniltator, not on purpose the tube fell out but momentarily stable. So we observe. She may need the ventilator again she may not. She may live or she may not. 

In closing - a public service announcement: this is the 3rd child with tetanus in a few weeks, 2 have died and the 3rd we still don't know. Please, wherever you live, ensure you have your tetanus shot. 

Sunday, April 24, 2016

Back to work, life and rest

Since coming back to Tenwek I have not yet shared with you what's been going on. I have felt like a bit of a yo-yo as I was in Kenya for 3 weeks than back in Canada for 4 (for Mom's funeral) then back at Tenwek for 4 weeks and then off I went again for a week of retreat. By the time you read this I will be back to work at Tenwek again.

I love the work I do at Tenwek and did not really know what to expect when I got back in January. After being gone for 11 months would I still be remembered, would the nurses I invested time in teaching still remember what I taught them? would they still be there? Would the physicians welcome me back allowing me to run my machines and care for patients?  Would my equipment still work? The answers to these questions was vastly positive. My first few days back at work were busy greeting everyone. Many of the nurses wishing me a Merry Christmas - a bit of a joke as they had not seen me for so long and I missed Christmas. I was happy to see many nurses still there and still remembering much of what I taught, however other nurses have gone to other departments, hospitals or for further training. The physicians were happy to have me back and let me know by paging me for something almost every day for the first two weeks (including nights and weekends). As for my equipment that was a different story - I came back to every single ventilator not working or "working" with multiple problems. I spent the first two weeks hurriedly trying to fix the machines. I was happy to have the help of a bio-med from Samaritans Purse who had come to help out the cardiac team. We took machines apart, swapped parts, put them back together and said lots of prayers. Some machines were just broken from normal wear and tear, others had just missed out on some routine maintenance, and one had been put back together wrong and fried a piece - when it smells burnt you know you have a problem. So fixing machines has been a priority. I can not care for patients if equipment does not work, nor can patients benefit from a life support machine that is not working. Two weeks ago I had six functioning vents and each one was in use. We were turning away patients and unable to provide the care we would have liked to for others. In Canada, this happens but a well equipped ambulance is there and able to take the patient to another hospital also well equipped. However Tenwek is the only hospital in a large area that has ventilators so so if we say no.... This is hard so I am hoping to fix another ventilator when I am back next week - I have one that is more broken so current plan is keep swapping parts until it works.

 I have enjoyed being back at work it has challenges but also many rewards - being able to see patients get better after a severe illness. We had a young man who was quite sick after a road traffic accident. On top of multiple fractures his lungs were affected (Fat emboli/PE/ARDS) he spent a good week on the ventilator and it was great to see him get better and leave the ward smiling.

Life at Tenwek is always a changing landscape - I have found myself missing friends from last time who were only here for a 2 year term and staying busy meeting new people. I dove back in facilitating bible studies Wednesday nights and helping with youth group when the Kenyan youth are home from boarding school. After retreat, I plan to soon restart pizza parties with the interns; a  fun way to get to know each other and relax. I practiced my rusty pizza making skills a few weeks ago as there is a couple from Edmonton now at Tenwek so I had to catch up with them. I see so few Canadians. As I am now a long term missionary at Tenwek instead of a visitor that does not leave I am now responsible for furnishing my house. I have borrowed furniture for a few more months but have done a fair amount of shopping - this weekend was expensive as I bought a fridge and washing machine. I am having a bed frame built and will also buy some furniture from a family that is leaving this summer. It is fun to set up house. 

As I mentioned earlier, I also just had a week of rest. Every year all the missionaries with the organization I am with here in Kenya (World Gospel Mission) take a few days of retreat. About 100 (including children) of us headed to the hot and humid coast. It was exactly what I needed, as you can see from above it has been a busy few weeks - this has not given me a lot of time to grieve the loss of my mom. This retreat gave me a chance to talk with my colleagues who are also so busy at Tenwek, we worshiped together -  most times of worship had me singing with tears running down my face. I hate crying in public but this was a safe and good place to do so. God also sent us a great speaker. A christian counselor and psychiatrist who has worked with missionaries all over the world. He led a session on grief that reminded me I was normal and reminded my colleagues that I will need time. The session wasn't just for me - most missionaries are grieving something whether something big like a death or a collection of smaller things - being away from family, not knowing if you are doing what's best for your children or the cumulative loss of too many patients etc. Anyway, this was a well needed break, a reminder that I have a missionary family that loves me and even more a God who loves me.
So this post has been long I will end with some pictures of the beautiful coast.
Woke up early to watch the sunrise

A weaver bird - so beautiful

Thursday, March 3, 2016

upside down

I had started a few blog posts in the last few weeks but have never finished one. I had one started about coming home to Kenya, and one about two weeks back at work but again not finished. You see, I wanted to spend some time getting it right, to share a post about how excited I was about being back in Kenya. Settling back into life and work with the people I love. However, before I could finish these posts my life turned upside down. My mom has battled a disease called scleroderma for eight years and about a week after I arrived in Kenya I heard from her and the rest of my siblings that she was not doing well. Scleroderma is an ugly disease and she has done not well before but how could I sit down and write a blogpost about how excited I was to be back when 13 570km away my mom was quite ill? How could I write when I was worried about her and time was spent talking on the phone as well as the busyness of being back at work? So I did not finish a post.
Then, I heard news that further turned my life upside down. On Feb 18, I learned my mom was transported to Calgary and was in the ICU. I was happy when my family gave the phone to the ICU doctor so I could hear what was going on in language I could understand. I thought I heard him wrong when he said cardiac arrest (I didn't). Then I began to hear more - liver failure, dialysis/prisma, unable to ventilate - only when we bag, inotropes, this doctor was painting a picture that I knew too well. I have been in that ICU as caregiver many times. The doctor said we will not do CPR again and I agreed completely. My family put the phone to my mom's ear and I said some words that barring a miracle would be my last to her.
Less than 30 minutes later I got another call. She was gone. So I was 13 570km away in my living room crying. Now what?- I called a missionary lady who lived next door and she came over. She notified the rest of the community and we did the next thing - looked at flight. It was 10 at night and driving to Nairobi was not an option until the nest morning so the earliest flight would be 24 hours away.
I was thankful to be surrounded by my Tenwek family with their hugs, tears, stories and bunnies (yes one of the missionaries brought over a baby bunny for me to cuddle). I sent people away with food from my fridge as I was told to go back to Canada for one month. Some of the ladies tidied my house and I gave them stacks of things that needed to be taken care of before I left. The next began the trip home, 24 hours after I got The News I was on a flight back to Canada, 48 hours after The News I was hugging my dad at the Calgary Airport.  However, there was some joy among all of this. The day after we lost my Mom, my brother and sister-in-law had a baby girl. A new niece.
Those of you who have lost a family member before knows what was next, tears, hugs, stories and doing the things needed to plan a funeral. My dad has been surrounded by wonderful friends, family and neighbours. The fridge and freezer were filled with soup, buns and casseroles that quickly disappeared when my mom's family from Ontario arrived.
So here I am a week later after the funeral, the house is currently quiet although visitors and food keep coming, Dad and I put a big dent in the paperwork and life continues. Part of me feels guilty about continuing life I know.  I must continue to take the next step and by God's grace I can.
In two weeks, I will return to Tenwek, Tenwek is home now and I love the life that I have there and I know that is where God wants me to be. I am glad my parents were able to visit me at Tenwek, twice, and have seen that part of my life and my Mom and Dad could see that Tenwek is my home.
I ask for your continued prayers. The acute grief of losing my mom is passing however the chronic grief of living life without my mom has just begun.  A few days before she died my mom shared some scripture with me and I will share it here with you.

But this I call to mind, and therefore I have hope: The steadfast love of the Lord never ceases, his mercies never come to an end; they are new every morning; great is your faithfulness. “The Lord is my portion,” says my soul, “therefore I will hope in him.” The Lord is good to those who wait for him, to the soul that seeks him. It is good that one should wait quietly for the salvation of the Lord. Lamentations 3:21-26

For those of you interested my Mom's obituary is here and the funeral can be viewed here, just look for memorial service for Marie.

My mom and me this past summer

Monday, January 4, 2016

Baridi Sana, Sio mbaya

So for all you non Kenyans reading this post the title has probably thrown you off. Why? Because this post is a little different. Often I write in Kenya for my North American friends about what life is like in Kenya as a missionary. This post is for my Kenyan friends about life in Canada, particularly Canada in the winter. So you North Americans are welcome to keep reading, don't worry most of it will be english. The title translated is: very cold, but not bad. 
The last few years at Tenwek when I walked to work at 7am in my sandals, scrubs and lab coat, I would run into others walking or riding to work or school dressed in thick coats, scarves and hats - in Canada we call them toques. When I would greet people I would often hear baridi sang (very cold), my reply was often hakuna baridi hapa (there is no cold here) and further explain that I am from Canada and it can be very cold there. So now I am in Canada and the last few weeks have been very cold so I will share a little about that here.
A few days before Christmas I decided to go downhill skiing with my brothers. Yes, I intentionally got up early and headed into the cold. We dressed warm: 3 layers of trousers, a thick sweater, a thick jacket, scarf and a toque. To ski you need to put these big plastic boots on your feet so I had big thick socks as well. We headed to the mountains and sat on a movable chair that carried us all the way up the mountain and then with our skis on the feet went down. The trick is to turn so you don't go straight down and lose control and fall. At the top of the mountain, where the most snow falls, there was so much powdery snow that when you fell it was just a poof and felt like you fell into a pile of feathers. It was so deep that I would put my poles down to get up again and they would sink in about a meter. While we skied it was snowing so my scarf was  white (instead of black) and very icy. It was a beautiful day a little cold at ~ -12C but lovely.

A few days later was the day of my brothers wedding it was a very cold day -25C. My parents house was full with family and we were very thankful for the furnace that burns all day and night and sends warm air into the house. The morning of the wedding I had to go to the store to get some foods for the meal that night. So despite the cold I took the car to the store and picked up various things. We all met at the church in the afternoon. Everyone was there, and on time. People mentioned the cold mostly along the lines of what a beautiful day - as it was a lovely day with fresh snow and it really was lovely. The wedding party took pictures outside, they were a little cold, the ladies in their dresses and the men in their suits but I am sure the pictures will be lovely. I went skiing another day, a different type: cross-country instead of downhill, still cold but beautiful.

When you live here life goes on in the cold and rather than suffer through it we enjoy it. So in a few weeks when am I back in Kenya and you tell me "dada, leo ni baridi sana" (sister today is very cold) you will have to let me argue.