3 blog posts in 1

So July has been a busy month with lots happening that makes for interesting reading but no time for writing, I’m finally catching up as I am starting 1 ½ weeks of vacation. I am currently in Nairobi and later tonight will be heading to the airport to see family in Holland. Anyway here is a three for one blog deal

I Lied

So I have said before that I am the only RT in Kenya – I’m sorry I lied. About a year ago I met another RT, a Kenyan lady who trained in the US and then returned home to Kenya to work. She tracked me down via this blog. We met for supper one day and chatted about everything RT related. It was great to talk “shop”. Then a few months ago while in Eldoret (read about that trip here) the neurosurgeon told me there was an RT who worked in Eldoret. I filed this knowledge away and thought – really three of us in Kenya. My next thought was how do I track this fellow down. I met some nurses who had done ICU training in Eldoret and they again confirmed – yes there is a guy who is an RT in Eldoret. Now I really wanted to track him down.

Back in 2011 I worked at Tenwek with a nurse who since moved to Eldoret, so I tracked down his number, called him, reminded him who I was and asked him for this RT’s number. He was happy to help. So now we finally connected, a brief conversation on the phone was the beginning. Now that I knew there was three of us we needed to have a meeting.

It took some organizing to get all three of us together – wait make that four of us. The fellow in Eldoret knew a fourth RT. So we met up in Nakuru for an afternoon of chatting and planning. To all meet was great. To know we were not alone. M from Eldoret has been here the longest – since early 2010. So saying I was the only RT back then was a lie. The other two ladies have arrived in the last year and are looking for jobs. We sat around the table sharing challenges of working here and where we see the profession going. We decided it would be a good idea to create an association so we are working on creating the Kenyan Association of Respiratory Therapists (KART) – makes for a fun acronym, when I created the Facebook group Facebook wanted to associate it with MarioKart. Anyway I am excited for the future of respiratory therapy in this country, and may have more updates to come.

 

4 RT's in Kenya

Drivers License

Driving is something normal for most Canadians. You turn 16 and away you go ; your license gives you freedom. Driving here is a little different and not something I have yet had the opportunity to do here in Kenya but a few weeks ago I took a step in the right direction and got my driver’s license.

                This was something I planned to do a year ago but did not think was possible. I was told before I got my license I would need a work permit. That did not come through until about October (I think). However also to get my license I thought I needed an international licence which, in Kenya, expires after 6 months. Since my work permit took 9 months the international license had expired. Therefore I thought I was out of luck unless I wanted to take the driving test and I really did not want to do that. But than a few months ago I got some good news since Kenya and Canada are both part of the commonwealth they would recognize my Canadian license to get a Kenyan license. Yay.

                So while I was in Nakuru for the above mentioned meeting I went to get my licence. It went something like this. Got dropped of outside of building and go up five flights of stairs to KRA (Kenya Revenue Agency) office. There is an elevator but I was told it often was broken, since I did not want to get stuck in elevator I took the stairs. Upon arrival in office, I saw random people lining/gathering in various places and I had no clue where I was to go. I talked to a security guard who points me to a desk so I joined the line/mob and finally get to see the lady. She looked at my papers and told me I need photocopies. Before coming I had photocopied what I thought I needed but apparently I needed more. So I went down 5 flights of stairs where I got photocopies done. I then ran across the street to buy a pen as the one in my purse disappeared and I did not think I would find one upstairs. The stationary shop was excited when I walked in to buy a pen and started showing me all these fancy pens. They were disappointed when I told them I wanted a normal one.

                Pen in hand I went back up flight of stairs and filled out the form then joined the line – security had turned it into a more organized line at this point. Got to front of line and gave my passport, ID card, Canadian driver’s license and form to lady. She dropped it in a pile and told me to sit. Sitting and making sure my pile of documents did not disappear I was called up again. Now I was told to pay 700ksh. I reached for my wallet and she said no not here, you have to pay at the bank. So given all my documents plus deposit info I went down the stairs and down the block to the bank. It was now 1230 and since the office closes at 1pm for lunch I was told not to come back until 2. Stood in line at the bank, thankfully they had a line just for people like me doing KRA deposits. Now with a hour to kill I went for lunch, which worked out well as I was hungry. Lunch done I headed back to the office, up five flights of stairs again,  and sat in a different line. Yes I said sit. Since it was always a long wait it was benches and chairs that formed the line and you would slide down a seat every time you someone got served. Much more comfortable than standing. So finally got to the front of the line and got my driver’s license, actually I got a sheet of paper. My real license should be mailed to me in the next few months.

Now that that’s done I just need to work up the courage to drive. Have not had a chance yet  but maybe when I get back from vacation.

Mount Longonot, again

Last week I climbed Mount Longonot again. The first time was with some friends in language school, the second time was when my parents and friends visited and now the third time was with some staff from the hospital. Each time has had its own flavour. This time we left early in the morning with the 40+ of us piling into the bus. Out of the 40 some of us, I think only 2 had been there before one of the nurses and myself. When we arrived at the mountain we got ourselves sorted out and climbing. From what I gathered hiking is not a common hobby among my co-workers. When you walk to work most days, do lots of manual labour and have lots to keep you busy hiking for fun does not make the most sense. I heard a few people say we paid so we could walk. That all being said I think everyone had a good time. Most of us made it to the top, even two young girls who managed to go all by themselves although my friend Ann and I gave them some help for the last ½ km.

I have always been impressed about how “smart” my Kenyan colleagues look. Now “smart” is  a term here not meaning wise but looking good, clean, well put together etc. It does not matter where I am I always feel slightly under dressed. Climbing Longonot was no different I had on an old pair of runners, capris and a T-shirt. My friends were beside me hiking in dresses, suits, sandals, dress shoes and they managed to “stay smart” looking. That is a talent I don’t think I will ever have.

Up we go 

After the climb we headed to Lake Naivasha. We managed to see some birds, but no hippos. I’m a little glad that we did not see hippos as we took a boat ride and I think if in the right mood it would not take much for a hippo to tip the boat. It was a fun day and I enjoyed seeing everyone outside of the hospital environment. 

Guest Blogger - Jess's Perspective

A few weeks ago I had a lovely young lady, who is going into nursing school, spend sometime with me. It was a fairly average week in terms of workload and she wrote about it and gave me permission to share it here. So here is Jess's Perspective

     Ever since I read Ann Voskamp’s book, One Thousand Gifts, I’ve tried to practice looking at my everyday experiences through a different lens. Instead of just going through the motions and being sucked into our agenda-driven society, I want to be able to slow down and thank God for the little blessings as well as the big. With this goal in mind, I began writing 5 “gifts” that I'd noticed from the day in a journal each night. Looking back through it months later, they’ve included everything from “5. sun, beaming through fall leaves and bouncing off shiny horses’ coats" to “483. Hilarious family dinners.” Pretty random, I know, but this exercise has helped me shift my thinking and truly enjoy each day.
 
     Well, this past week at Tenwek Hospital in Kenya, I was faced with a challenge. How could I possibly find things to be thankful for in a place filled with pain and death? How am I supposed to find beauty in suffering? Is there only good in the medical success stories, or is there a gift in the sad endings too? Because I shadowed a respiratory therapist, this was a particularly challenging question that I had to face. I realized part way through the week why it seemed like almost all the patients we saw died. Any patients who begin to get better are transferred out of ICU, Casualty (their ER) and HDU (high dependency unit), and we don’t typically see or treat them again. Respiratory therapists only care for the patients who aren’t able to breathe well, so to put it frankly, I saw a lot of death.
  
        Here is a window into what my days were like… I wrote these notes in my journal one evening. "I hold the hand of an elderly man who reaches out looking into my eyes longingly, only to find out the next morning that he had died. We walk outside. Sitting in the sun is a patient who attempted suicide over 6 weeks ago and had all medical odds against him, but is going home today with his caring family. “We Treat, Jesus Heals,” I think to myself.  Next stop, HDU.  At bed 1, I cringe as I hold the swollen, crinkly head of an unconscious  5 year old child with a broken skull who has hit by a motorcycle while walking home from school. Annette re-tapes the tube going down his throat. In the nearby ward, I perform CPR on a woman with AIDS... no heartbeat, it’s been too long. Time for lunch break. We eat, then head back up the hill to see how things have progressed. A woman in ICU with severe epiglottitis  finally gets extubated, and is able to talk again. The first thing she says? "Praise the Lord!" “I've just gotta hold on to victories like this," I think to myself. We walk to Casualty. On bed 6 is a young man, my age, who has just arrived following a car accident. The staff member who is bagging (breathing for him) is paged. I offer to take over and he agrees. Several minutes later, it is decided that his brain damage is too severe. We need to let him go. Walking out of the room, I meet the gaze of his anxious, questioning brother and try my best not to let my face give away the devastating outcome. Back in ICU, the possibility of survival for the small boy with pneumonia is looking grim, the doctors and staff circle up and pray for the Lord’s healing."
 
     Exhausted by the emotional roller coaster yet? I know, it doesn’t take long. Yet this is what these doctors and nurses deal with all day, every day. I admire their work. I wonder, how do they process it all?
 
      I listen to the horrifying screams of an 8 year old girl suffering from the painful spasms that tetanus brings and find myself at a loss for what such a precious, fading life could reveal about God. What is there to be thankful for in such places of sadness and pain? Surely there is more to be learned than the consequences of pain and death that occur because of the depravity of mankind.
There is a sense of raw humanity in this place. Pain and death unite the young, the old, the rich and the poor. They have the ability to bring us all to our knees, crying out for relief…and when everything is stripped away, all that remains is Christ. It is a depth of pain and sadness that I don’t claim to have experienced personally. I don’t know their grief, but I feel like I’m just beginning to envision the depth of peace and comfort that the Holy Spirit provides when a child of God is at the end of everything he knows to do.
There’s nothing I can say to take away these people’s suffering. There is nothing to do but sit and cry with them… but I know that in the midst of the pain and the loss, when we're brought to our knees, we are held by our Maker.
 
     As for my question of what the gift could be…there is no simple answer. I can’t simplify it to a line in my journal as number 987... but I know it’s there. It’s there because I’ve heard the testimonies of those who have been brought lower than they ever could have imagined. I know because of the way that God speaks to and comforts me when I’m merely watching it.
     Sometimes after a day in the hospital I like to take a little walk down the dirt road to the sewing ministry. It’s refreshing to see healthy children happily skipping down the road...to remind myself that God gives joy and health, and to hug dear sisters in Christ.
   
     The contrast of my time in Tenwek’s community and at the hospital has really echoed a quote I recently read in the book, When Helping Hurts. The author explains, "Our perspective should be less about how we are going to fix the materially poor and more about how we can walk together, asking God to fix both of us” (79). The raw humanity I saw in the hospital stripped away any remaining dividers I saw between myself and the people of Kenya. Physically AND spiritually, we’re all broken to the point of no repair. We are left with nothing but to cry “Abba, Father!” begging Him to rescue us from our state of despair. Our only response can be one of awe. Awe of our need and His redemption. This is what unites us.
 
 “Rejoice with those who rejoice. Weep with those who weep.”  Romans 12:15
"He will wipe away every tear from their eyes; and there will no longer be any death; there will no longer be any mourning, or crying, or pain; the old things have passed away. And He who sits on the throne said, "Behold, I am making all things new."" Revelation 21:4

Whose house is it anyway,

The other day I was walking home from work and saw the fellow who works for the neighbours walk into my house – I barely missed a step as I remembered I gave my extra key to the neighbours so they could use my washing machine – and he was doing their wash.

A few months ago I came home walked into my kitchen and found the 2 year old son of one of the missionaries in my kitchen; he looked at me as if to say “what are you doing here?”. The lady who watches with him was chatting with the lady who helps me out two days a week and so of course he came along.

Two weeks ago I had a friend and her two daughters stay with me and during the day we had about ten people using my home for a home base. They were part of a team of nursing students spending a few days at Tenwek.

Today while home for lunch J, the lady who helps me around the house is making stew for the group I am having for bible study tomorrow tonight. When I get home I will make a stirfry for some missionaries who are passing through, one of whom is sleeping in my bedroom.

As I am sitting here, I hear some talking outside of my door the guys from industrial have brought down a a cylinder of propane as mine ran out.

This Saturday my house is going to be invaded by 10-15 interns as we are having a pizza night. I have told them if they want pizza they must come early to help me make it – some of the guys groaned at this so I did give them the option of washing the dishes after, we will see how it goes.

So whose house is this, When I moved to Tenwek I requested not to have a roommate. I love having people around me but when you have a roommate you need to respect their space and their needs and the amount of busyness going on  this week is one thing to do to myself but something else to do to something else. Also I do need time alone and since my house is always so busy the times when it's great to be able to just spend a few moments alone.

So whose house is this – well it's God’s house. It’s a space I have been given to use, many people use their gifts and talents for many uses, but I think God has given me this wonderful space of my current home to share. To use/develop my gift of hospitality to his Glory.

My house from the front door, living room, and dining room, the bright lights are coming from the kitchen.

Do I tell you about...

So I apologize it been a long time since I have written. Things here no longer seem new or different, it is easy to write about those things. I have been here long enough that the lines are becoming blurred. So what do I write about?

Do I tell you that I am hoping to get my driver’s license? I am looking into making trips all by myself into Bomet, town a few KM down the road. That I am excited about the opportunity to drive again but at the same time scared. What side of the road do I drive on? What if the police stop me? Do I still remember to drive a stick?

Do I tell you about the patient I lost last week? The pregnant mom who was on a ventilator with bad lungs  (ARDS), when she pulled out her own breathing tube we could not get her intubated and  back on full support (PEEP =20) before her heart stopped. We did CPR on this mom for 10-15min before deciding that the chance of getting her back was minimal so we decided to save the baby instead. The doctors quickly cut out the baby. We stopped trying to save mom and worked on baby instead. I was not the only one crying as this all took place. When I heard that new born baby cry at last some hope. I have gone to visit this little girl daily and Praise the Lord for her life but mourn the life of her momma, and struggle with what ifs and if onlys.

Do I tell you about the good-byes I’m saying as missionaries are leaving on to the USA for a few months to a year so they can raise support? As my trip back to Canada will be in March, I may not see some of these missionaries again until I return in 2016.

Do I tell you about the frustration I feel when after being a year I have not been able to get some things completed, and I start to wonder is there ever a chance of changing things from how they have always been?

Do I tell you about the fact that I’m tired and wish there was more hours in a day to get everything done, but other times I wonder if I spent my time better I would be able to get things done?

Do I tell you about the joy I feel when a patient who recovered from sepsis and ARDS is sitting in a chair and asking for a drink of water?

Well this blog post got long, with all sorts of things. I guess I do have something to say.

Hard days, ambulance rides and a smile

So it’s been a tough few days we have had a few unexpected deaths of children and young people. When things are hard I cling to 2 things

1.       Despite it all God is Sovereign and I will continue to praise him.

2.        I remember the ones who get better. So walking home today I met someone who brought a smile on my face.

I met this father a few months ago he had come into casualty looking bad. Without going into the medical details we thought he may have had a bleed in his brain. He had stopped breathing once in ER and as we did not know the cause we were worried it could happen again. He needed a CT scan and the machine at Tenwek was broken. As transport was going to be a few hours someone needed to go who could place a breathing tube, if necessary. So that person was me, I ran home to get some food (wish I hadn't) and cell phone credit. I knew that our ambulance would not have all the supplies I needed if he stopped breathing so I filled a basket with everything I needed to keep him breathing.

We (the nurse and I) loaded up the patient in the ambulance. His wife accompanied us and off we went. We had one monitor - the SpO2 monitor that lives in my pocket, and no IV pumps. Off we went to our 6 hour trip. A few miles down the road we stopped to swap oxygen tanks, one was empty and they had just picked up a few from the next town. O2 tanks picked up, we were set until our next stop. Our patient was awake and in a lot of pain. His wife (who was with us) called some family who lived down the road. We stopped and they gave us some pillows. From there is was smooth sailing as smooth as it can be riding backwards in an Ambulance on curvy roads, and roads under construction. My stomach was unhappy, thankfully the windows would open so I could stick my head out.

Throughout the trip (all 6 hours) I was happy that our patient was doing well, we safely arrived at our destination met a wonderful neurosurgeon and got a CT scan. We were pleased to see the scan was clear. Still with a question of what had happened that morning we traveled back to Tenwek for further tests. We could not find IV fluids in the ambulance so I went to the hospital pharmacy where we were getting the tests done and bought a few bags of IV fluids, and some pain killers. Not a question asked. Not routine for a transport in America, but it was really no different than stopping at the grocery store and buying some flour and sugar.

The trip back was uneventful, we thanked God for safe travel in the dark. The patient never had another episode and went home. I have seen him walking around the Tenwek and today when I saw him it brought a smile to my face. I don’t know what happened, maybe God healed him, maybe it was a strange migraine. But seeing his smile today was exactly what I needed.

One day

So since coming back from Cameroon I have been busy.  I was only back for a week and a half before I left to the coast for the missions annual retreat. A time of spiritual encouragement and meetings. Even though I had just been back for a short time, the time away was much needed as the hospital was very busy for that week and a half. Now retreat is done and I am back at Tenwek. Since December my life has been busy with one event after another, Trip to Lodwar, friends' visit, family visit, Cameroon and then retreat. It was a very enjoyable albeit busy few months. Now things are back to normal, and it is different not to finish one thing and immediately start preparing for the next.

I have been busy at the hospital. Here is just how one day last week went.

7am – meet in ICU to start surgical rounds, however miss rounds as asked to see patient who is hypoxic. Go see said patient and start him on biPAP.

7:30 – Join medical rounds.

8:00 – decide to check on bipap patient before heading to devotions, get distracted by very loud flow meter and go into medical ward. See that they are coding patient and help out.

8:30 – code is done, it did not go well, head up to devotions.

8:40 – get called to another code in the same ward, code said patient. Again unsuccessful.

9:30-11:00 – Check on ICU/HDU patients, enjoy some chai.

11:00 – while seeing an asthmatic in casualty a patient comes in with a swollen neck and difficulty  breathing. Observe him and help rally the troops so we can get him in the OR to put a tube in. 

1:00 – patient has tube in so I go for lunch.

2:00 – patient is out of theater and we are suspecting anthrax. Settle him in HDU and explain to the nurses how his tube needs to stay in.

3:00 – look for patient I was supposed to do spriometry on, can’t figure out what patient it is as the computer charting system is down.

3:30 sit down with nursing students who attended code this morning.

3:45 get paged out of debriefing session as a peds patient has arrived from other hospital, intubated as he has some sort of airway burns.

4:15 get called in casualty that anthrax patient woke up and pulled out his tube, yes the tube that was hard to put in and really needed to stay. Grab some staff from casualty and go to HDU – thankfully, anesthesia manages to get tube in again.

5:15 return to casualty and discover that the 2 year old managed to take out his tube, he is having trouble breathing, we struggle to re-intubate as he is awake and the drugs we are giving him to sleep are not working.

7:00 after anesthesia, with some propofol, comes and gets the tube in we get the patient settled in ICU. He is on my new vent the Servo 300 and I explain to the staff how the machine works

7:35 run home, change and grab stuff for bible study.

7:45-10:00 attend a great bible study with the interns here, we talk about our attitude and being humble.

10:00 come home, realize I forgot to turn on the hot water heater so kill time for 30 min so I can take a hot shower.

10:45 – Go to bed.

11:00 – pager goes off, the nurses are having trouble with one of the vents. Go back to the hospital get the vent working get the patient settled and happy.

12:00 – Go to bed, again. This time I was able to stay in bed until 7am when it was time to go for another day.

So that is just a taste of what life is like. Some days are crazy like the one I just shared others are a lot more calm.  Please say a prayer for us at Tenwek the next two weeks as many of the long term doctors are going to a conference and the hospital will be covered by a few of us here, some recently graduated doctors and visting doctors from the USA. I fear my next few weeks will keep  getting busier.

God's Timing

I have been back from Cameroon for a few weeks now. A week and a half after I got back I took off to the coast with most of the other Tenwek missionaries for a retreat, a time of rest and spiritual renewal. I will write about life back at Tenwek soon but first I want to share with you some more about my time in Cameroon.

I was thankful for the three weeks I spent at Mbingo. It was good to get to know the staff there and help out where I could as they do not yet have an ICU and ventilators operating. I was able to bring them a bipap machine. A bipap machine gives pressure via a mask to help patients oxygenate better and make their breathing easier. During my time at Mbingo, there were two ladies who probably would not have survived if they had not been able to use that machine.

I heard about the first patient over supper from the OB doctor.  He talked about a lady who was about to deliver. This mom has a heart defect that is so bad she developed something called Eisenminger Syndrome. Delivering a baby with this condition has a 50% chance of mortality for the mother. When I heard about this lady my first question was – does she know The Lord? That evening before her c-section she accepted Christ as her saviour. The next day the OB team delivered the baby who was thankfully healthy. Mom did OK for the first few days but after about a week she developed massive pulmonary edema.  We were able to help her breathing with the bipap giving medications time to work. She was on the bipap for a few days and was than able to go home to her family. She still has heart and lung problems but hopefully she will be able to be a mother for her children for a few more years. I am thankful that this lady was given life both in Christ and here on earth.

The second lady went on the bipap machine two hours after the first lady came off. I had not yet packed it away as I was not sure if the first patient would still need it. However, the second patient was also in severe pulmonary edema. Her kidneys had shut down and she had not made urine for a few days. Her blood pressure was extremely high and the extra fluid was flooding her lungs. I placed her on the bipap and shewas immediately  breathing  easier. The machine kept her alive long enough so we could get some fluid off, her blood pressure improved  and her lungs stopped flooding. By morning she was smiling and feeling better. I pray her kidneys start to work on their own.

I find God’s timing amazing, had these ladies come in a few weeks earlier they would probably have not survived. I was bringing in a machine that they had not used before, I had the opportunity to show it to the nursing students I was teaching and then I had the opportunity  to show how well the machine can work. As uncomfortable as the mask and machine sound and feel to a healthy individual we all saw first hand how a sick patient welcomes the assistance that the machine gave.

Practicing putting the bipap on, I made a good patient. 

The Bipap at work