We need more Oxygen

The basics:

So, this post includes some medical info. If you want to skip all the reading, here are the basics. 

Tenwek needs to buy another Oxygen concentrator to support our patients. We need to move quickly to purchase and install it so we are ready for patients. I am asking for help to raise these needed funds. Through supporters and organizations, some funds have already been given/pledged, and we are moving forward to purchase the machine, THANK YOU. Funds are still needed to fulfill this commitment and for piping, installation, and renovations. 

Americans -give to WGM, Tenwek Covid Project.  OR Friends Of Tenwek. 

Canadians- Donate through Into All The World, Go to https://app.etapestry.com/onlineforms/IntoAlltheWorldInc/shortterm.html

Please send me a message via e-mail (annette.lievaart@wgm.org) or Facebook of the amount you have donated so I can direct the funds. Also, you can write Covid in the comments box. 

The Story:

Everywhere you turn these days is talk about COVID-19. Whether it be affected numbers, a salute to health care workers, the need for hospital beds, or the need for ventilators. As a Respiratory Therapist, I have never seen my profession and the work we do highlighted so much. 

Kenya is gearing up for this disease, our current count is 126 cases. The government here has put in place many measures to reduce the spread. Yet, hospitals are preparing for an influx. Tenwek is working together with the County who will care for many of these patients. At Tenwek in the last few weeks, we have been saying, “We are not scared. We are prepared.” So, we are working hard on those preparations. 

Tenwek wants to focus on the basics with OXYGEN. Not all patients who develop COVID-19 need hospital care. In fact, many will have mild symptoms. But of the ones who do need hospital care, not all need ICU care. This group of patients need oxygen to support them until they can recover, which can be provided by a mask connected to a flow meter that delivers the oxygen. 

The challenge is where does oxygen come from? This is a question I never asked when working in Canada - the answer was the wall - you plug in the flow meter and oxygen comes out. Here in Kenya, I have learned a little more about the process. Tenwek uses something called an oxygen concentrator - maybe you have seen a small one in someone’s home who is on home oxygen. The one we want to purchase is similar but on a much larger scale. This will work continually to produce oxygen for many patients. We can serve many patients with one concentrator. The hospital currently uses a few concentrators to provide for the hospital but they are at near capacity. A few weeks ago when we had many sick patients they could barely keep up. So we have decided we could really use another one as we expand. We are doing some renovations and will be increasing the number of beds in the hospital. There is a machine already in the country - we just need the funds to purchase it - will you help give funds to help us help these patients? Giving information is above. 

A few years ago we bought a new compressor to work with the Oxygen conentrator. 

Giving Oxygen can sometimes be added to by creating a simple CPAP device for babies. 

I hope socks are in this box and why is the money orange?

So I started this blog post two months ago, forgive me that it has taken so long for me to finish, life got busy.

I am enjoying life back in Kenya. I left Alberta in a bit of a snowstorm and am glad Dad's truck has snow tires - and that he is more experienced driving on snow and ice than I am. Although, I did get some practice this past year. I also left before the arctic chill moved in. I am happy to have left Alberta before it got below -25C.

My flights went well. I was able to catch up on some movies and even got some sleep. Despite landing in Nairobi many times I always am a little nervous. Will the passport line be long? - will my luggage come? Will my large bag come out at the normal carousel or at the oversize section. This time I got lucky the bags, all three, came out quite quickly. Then the next hurdle: Customs. Will they open every bag? Will they x-ray every bag? Will I have to unload my carefully balanced cart? Will they charge me fees? With a prayer and a push of the cart, I went through Customs with only one bag going through x-ray. I was thankful to be out of the plane and in the taxi after only 40 min.

Kenya is a large cash society. So a quick stop at the ATM, had me in my sleep-deprived, jet-lagged state surprised. While I was away Kenya changed their currency so instead of the normal 100oshilling notes I was used to, I got orangey/pink ones. It took a bit for me to recognize what it was and then take my money and go.

After a few days in Nairobi getting a new cell phone sim card, buying groceries for the next few weeks and renewing my physiotherapy license. From there it was the 4 hour trip to Tenwek and settling back into my place. I moved back into the same house as before. While I was away some short term visitors stayed in my house. Some things were packed away and so the unpacking began.

Every time I move (or pack into or out of storage) I am amazed about how much space everything takes up. I had left myself a list of some of what I had in storage. I had left a note - telling myself to not bring back socks from Canada. 95% of the time I wear sandals anyway. However, while I was unpacking, I was a little worried, as I did not find my socks until the very end. A few were in the slow cooker, wrapped around kitchen stuff - boy, am I glad I looked inside before I put it on the shelf. It took only a week to get settled and after being back at work for two months, it feels like I never left. I have settled back into the routine of work being patient care and education, answering e-mails for visitors who want to come and everything else that is part of life here. Below are some pictures to give you a taste of the last two months.

When it rains here it pours, we have gotten a few days of rain every week since I got back even though it is supposed to be dry season. 

A shift change lecture to the nurses on Arterial line management

So driving home from Nairobi last month I was following this truck down the escarpment, part of this road has steep drop-offs and I am nervous in my SUV, glad I was not driving this wide load. 

Last week we did a 2 day ICU crash course for nurses who are new to ICU. Was busy but fun. 

We receive many short term visitors, these medical students and residents asked for teaching on ventilators. I never say no to the option of teaching. Especially as the residents take overnight call, and if they learn how to do it, they don't page me at 2am. 

Preparing to Go Back, WHY?

The Lord willing in three months, I will be back on Kenyan soil. I have enjoyed the last 6+ months in Canada. I have a comfortable apartment, a convenient LRT (subway) ride to work, I am enjoying being able to visit with my family often, go for coffee and supper with friends. I have a job where I am challenged but not stressed. I work with a fun group of people. I get paid well, and I don't need to raise support for it. So why would I want to leave?

There are a few answers to this question:

- I have a great place to live in Kenya too, it's comfortable, I have great neighbours, and I can walk to work, and home for lunch too.

- Family is farther away (and that is hard) but I have great community, kids who call me Aunt Annette, friends who I can call at any time. I am thankful for technology that helps me to keep in touch with the family that is far away.

- Work is the same in Kenya, in some ways, but different in others.  I am working in a Pediatric Intensive Care Unit in Alberta. On weekdays when I show up to work here there are two pediatric intensivists working, a few peds residents and one pediatric fellow (finished residency and getting more training in ICU care). Each critical patient has a nurse assigned to them with specific training in pediatric critical care. For our 16 bed ICU, we have three respiratory therapists assigned each shift.
When needed, the pediatric team of physicians can consult pediatric pulmonology, or infectious disease, or endocrine or oncology or...

-Contrast this to Tenwek: when I show up at work there are one or two pediatricians for all the pediatric patients (20-30 on the wards, ~30 in the nursery, a line up in outpatient and a few in the ICU). We have interns working who are with us for one year of training in adult medicine, pediatrics, obstetrics, and surgery. At the end of their training year, they are helpful but at the beginning they need a lot of guidance. We have one or two family residence on the pediatrics service helping out. When the service gets stuck they can talk to the pediatric surgeons, they can talk to the adult intensivist, they can talk to a smattering of other staff or they can send an e-mail home with questions.

-For respiratory therapists at Tenwek - there is one, and I am not just caring for the pediatric patients, I am helping out wherever I can.  When I go back to Kenya, the hope is to do more formal teaching so one day, hopefully soon, there will be more than just me.

So all this comes together to show need but there is more.

Eric Liddel, an Olympic Gold medal winner in running,  said: "God made me fast and when I run I feel His pleasure".

Frederich Buechner said, "The place God calls you to is the place where your deep gladness and the world's deep hunger meet."

Together both of these bring me to Kenya. At risk of sounding proud I will say I am a good respiratory therapist, when I work in respiratory caring for patients or teaching others I feel God's pleasure. When I look around I see the need in Kenya. Pulling this all together, Kenya fits for me.

So I will go back, this next term will be three or four years. I am excited for what this term will look like. I am looking forward to greeting old friends and meeting new ones. I am nervous about what will be waiting for me, how will things have fared while I was away. I am hoping I am prepared.

I ask for your help. This can be done in a few ways:

1.  Prayers, Tenwek is great but hard. To give some perspective in the last six months working in the PICU and floors, I have seen 2-3 deaths of children. In Tenwek, I sometimes see that many in a week. Including adults in my count (I don't keep track as that is too depressing) 2-3 deaths a day is normal. So pray for God to encourage me. If you want some perspective of this I recommend you read a book called "Promises in the Dark" by friend and fellow missionary Eric Mclaughlin.

2. I also need financial support. The hospital does not pay me so my salary and other expenses must be raised. Donations are easy just follow the instructions in the post below this one.

There are a few more reasons to go back to Kenya. The weather is lovely all the time and it is beautiful. Below are some favourite pictures. If you ever find yourself in Kenya send me a message and maybe we can meet up.

What A Strange Bird

2 of my Favourite animals together in the wild

I took this picture just outside my door. 

Colubus monkey (4 hours away in the rainforest)

Giving 2019

Thank You for supporting this ministry. You will receive a tax receipt for donations, just follow the instructions below. 
I ask you to consider regular scheduled giving, it is easy to do and will help sustain the ministry. 

Canadians - Give via Into All the World

Ministry vs Personal - When you donate there is an option between Project and support. Both are tax-deductible. Project covers expenses beyond my salary ie travel, materials, equipment, fees etc. Support is my monthly salary. You may choose whichever you like. If needed I can transfer between funds. 

Electronic Funds Transfer, Credit card, Cheque, E-transfer
Use this IATW Form.

Web:
https://app.etapestry.com/onlineforms/IntoAlltheWorldInc/donate.html
Select my name from the drop-down list and fill in the information.


Americans - Give via World Gospel Mission


Check, credit Card
Use this WGM Form

Web:
https://www.wgm.org/lievaart.


Thank you for your prayers and support

All I want for Christmas is...

So Christmas is coming and while I am away from a lot of the commercialization that surrounds the North American Christmas season the thoughts of what I want for Christmas is on my mind. This year I am asking for something big and I am asking for your help.

This year all I want for Christmas is New Ventilators. 


These are not for me personally although I do have a collection of medical supplies in my house. Currently my desk is covered with Laryngoscope blades, I tripped over my spirometer that I store under my bed and this bag of CPAP masks is getting in the way. (Don't worry all this stuff will be used by the hospital). The new ventilators I am asking for will be utilized well. We have already ordered two and plans are to order four more.

Since I arrived in 2010 Tenwek has managed to get by with a collection of donated machines, over time some of these machines would break in a way neither I nor Bio-Med could fix and they would join the broken pile. Since I have arrived we have gotten four 'new to us' machines. Three of these were already 15+years old and one quickly became extra parts for the other two.

We still have a few machines with us that have been here for (way) too long. Two of them always alarm "check diagnostics", one no longer delivers PEEP which is needed for 90% of patients. (Yes my fellow RT's: really 100% need PEEP but head injuries and overdoses do OK with no PEEP.) Now if this was your family member would you want them on a machine made in 1981 and is also found in museums (not a lie) or would you want them on a machine that alarms and no one knows why? DO you want them on a machine that says "No PEEP must keep at 0". While we have been able to provide safe care to the patients a change is needed. So we are working with a distributor to purchase six 'new to us' machines. Two are going to the cardiac surgery area and have already been paid for but the other four will be used in our general population.

Are you willing to help me with this Christmas present? Four machines and shipping will be expensive but will help sustain the ICU and HDU in Tenwek for many more years. Some funds are already in my account but I am giving you the opportunity to help. To give you an idea of cost - I was thinking of buying a car but since I am borrowing another family's car while they are in the States for a year I figured this would be a better use of the funds. So if you want to help - it's easy click the "to donate" button on the side and follow the directions, you will even get a tax receipt. Then send me an e-mail or Facebook message letting me know that the donation is for this purpose. If by chance (that would really be a miracle) I raise more than needed the extra funds will go to preventative maintenance of these machines.

I have also added some pictures to show the new machine and old machines.

The New Machine - We already have one,  it will be great to have more. Isn't it beautiful?

Old machine from 1981, we actually have two of these, this one with some trouble but the other actually works well. You may notice this is the same brand as the new ones we are buying hopefully they will also hold up for 30+ years

another older machine, notice the 0.00 in the top middle. That is supposed to read the amount of air the patient is breathing. A helpful value, however it does not work (despite replacing the sensor). 

Unique Talents one learns on the mission field

So living in Kenya has taught me a few things that I probably would not have learned back in Canada.  I thought I would share a few of them here.

• Ability to look at the gas burning in the bottom of my oven and know if the temp is set to 350F or 450F necessary as the temperature regulation looks identical to the ones on the stove, no numbers.
• Able to drive (a standard) while dodging motor bikes, potholes, people, cows, donkeys and other cars.
• Can now distinguish the difference between Thompson Gazelles, Impala, and Grants Gazelles. 
• Can give a speech with a few minutes notice, although my 4-H days taught me this.
• Can hear a ventilator alarm from a different part of the hospital or through the phone line and know what the problem is.
• Able to go shopping only every 6 weeks, with the exception of a few staples and veggies and not starve.
• Complete a recipe with multiple substitutions, see why above, and it still tastes good. 
• Speak to patients in various languages. My Swahili is coming along well, but some patients only speak a local tribal language - Kipsigis, interestingly my 15-20 kipsigis words include cough, don't bite, breathe, breathe by yourself and lie down (relax). I guess you learn what you need to. 
• How long it takes for me to get cabin fever - 6 -7 weeks. With elections happening we were told to sit tight. So here I am, after not leaving Tenwek for 7 weeks and I am going a little crazy. I guess I know my limit.
• Able to quickly get to know and work with a new phsyician, dancing the line between advising them what do do and telling them what to do. We have about 150 medical visitors a year so a lot of hello's and good-byes
• I'm sure the list is longer but that's all that comes to mind right now. 

Ghana, Non-Medical missions

So I am a little behind but I thought I should write a bit about my time in Ghana. I am serving with an organisation called Reach Beyond.  Missions are full of confusion so they second me to the organisation known as World Gospel Mission (WGM) that I work with at Tenwek. Anyway, Reach Beyond divides up the world into regions and I am part of the Sub Saharan Africa region. A few times a month I have been meeting via Skype with the other missionaries in the region. It was time to meet in person and with visitors from the American HQ coming out to Ghana it was a good time to go. So beginning of January I took off for a few days.

I enjoyed my time in Ghana. I got to meet the rest of the team and their families, the children who had previously been annoying shrieks over voice Skype were now fun to play with. I also enjoy visiting other parts of Africa. Africa is a huge continent with diverse cultures. When travelling across the continent it is interesting to see what is similar and different. Nairobi has much more western malls and fast food than Accra, Ghana but in Accra you can safely walk after dark.

While meeting the rest of the team in person was the best part of the trip, I really enjoyed seeing the non-medical side of missions. The rest of the Reach Beyond group on the team are not medical but do radio. It was really great to see the work going on. Christian broadcasts going out in local language, spreading the good news of the Gospel, another group who has recorded audio bibles in 300+ languages, visits to a community where the water source was a puddle and with some help from reach beyond and a visiting team, a well was put in. Changing the health of a community. The medical side of missions is great, however I enjoyed the exposure to another side, which is also great.
Rather than say more I will share a few photos

I did do some medical work, assisted a nurse in putting a dressing on the finger of one of the boys in the village.

Just like Kenya the kids love photos and strange looking people with white skin and red hair.

Recording live for the radio, we all were in the room trying to be quiet. 

It's a jungle

The DJ at work.

Cocoa beans -yum.

Village's old water source.

New water source, tastes good I drank it fresh from the tap.