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

more time at Mbingo

I am writing this after a full 2 weeks in Cameroon. The main reason for my coming has been teaching and I have been enjoying my time in the classroom I have discovered the difference between an occasional lecture and actually teaching a classroom of students. It makes sense to invest in my students; what I teach them today I will build on tomorrow. I have enjoyed getting beyond the practical application and getting to the why and physiology behind what I do every day. Last week the students had a quiz, I have not seen the results yet- the real teacher is marking them, but I am afraid I have discovered that a quiz evaluates the quality and clarity of my teaching more so than it evaluates my students' ability to study. The concepts I taught were not in the book they had, they may not have had access to the internet to look something up if they did not understand the lecture notes they took and the handout I gave them was all they had.

All that being said I am really enjoying teaching. It is fun to get to know my students like most classrooms there are a mix: a few jokers, the one who asks tough questions and the quiet ones who make you wonder how much is sticking. Class is only 2 hours a day and then the students are released for the practical part of the training. Half the group is put to work in the surgical ward and can be busy with various tasks. The other 6 are sent to work in recovery room. There is a little more time here and I have been using it to help the students practice various skills or explain different things as the recovery room has easy access to the OR and I have more time than I do at Tenwek. I have also been able to see parts of a few surgeries, which has been fun.

My "Lungs" used for a demonstration, I thought it was quite ingenious. 

In my time away from hospital I am catching up with my friend A. who is a surgical resident in the USA. We met in 2011 when I was at Tenwek and she came for 2 months as a medical student. We became great friends then and have stayed in touch over the years. When I was asked to come to Cameroon, March was good timing on my schedule and when I heard A. was also planning to come to Mbingo in March the timing just could not be better. A. being a surgical resident is putting in long hours but when we are both off we have enjoyed taking hikes in the beautiful hills surrounding Mbingo. Yesterday the small sprinkling of rain turned into a downpour and we got soaked. I am not sure what the Cameroonians thought of 2 white ladies running in the rain, they were all under shelter waiting it out. But we enjoyed it anyway. This afternoon we took another hike we were not quite sure of the way but some friendly children pointed out the path to us, once we were a little way up they decided to guide us all the way up. It was a beautiful hike and thankfully we stayed dry.  

Mbingo hospital

A. and 2 of our guides on the top enjoying the view. Notice the boy sitting on the tire, he carried it all the way up with him.

Our guides getting even higher and climbing the tree

We went all the way to the top of this beautiful hill

Seeing More of Africa

 A few weeks ago if you had asked me how much of Africa I had traveled to the answer would be 2 countries (Kenya and Uganda). Since then that number has doubled as I have been able to spend some time in Tanzania and Cameroon.

Tanzania was a holiday. In my last post I talked about the visitors I had, they invited me to accompany them to Zanzibar, an Island of Tanzania for a holiday. This was a welcome vacation and I enjoyed the history of stone town, snorkeling, for the first but definitely not the last time, swimming, and getting some sun. This was also a great time to catch up with mom and dad and the other visitors without the stresses of everyday life or a pager calling me away. The trip ended with a little stress because as the plane landed in Nairobi a fellow had a seizure, I helped him out and then gathered my stuff and got off the plane. I knew good-byes would be at the airport but we did not realize they would be right on the tarmac. I had to board a bus to head to the baggage area and mom and dad went the other way to catch their flight back to Canada. We hugged and shed some tears on the tarmac and I unfortunately missed a few good-byes as some of my visitors has already headed into the terminal. I guess this prevented a long drawn out good-bye but it was tough. However I am so fortunate to have friends and family who enjoy travel and came all the way to see me.

relaxing at the coast

Cameroon is a trip for work, I am writing this now between writing a protocol for sputum induction and preparing a lecture on V/Q mismatch. I have been here for 1 week, out of a total of 3, working at a hospital called Mbingo. Mbingo is a mission hospital that is growing. They are in the process of opening an ICU and asked if I was willing to come out to help with some education. I have enjoyed the time here and getting to know the culture in this part of Africa. I have been teaching my students Swahili as I keep accidently speaking it so I have decided to teach them a word a day here's what we got so far:

Sawa – ok

Asante – thank you

Karibu – (you're) welcome

Habari za Asubuhi – good morning

Here in Cameroon they speak French or pidgin english so that is awesome. I have no clue what is being said. It is interesting to see the similarities and differences in the cultures of east and west Africa. I have had a chance to eat fou fou and jema jema (not sure about spelling) which is their version of ugali and sukuma wiki which in English is corn mush and greens. These are the staple foods in both places and are similar. There are parts of the culture that are different in Kenya, I have learned,  when visiting someone it is impolite to leave without them releasing you first; here in Cameroon it is like Canada where if you are leaving you say thank-you and go. I am looking forward to getting to know the people here better.

More Visitors

A few weeks ago life here got a little more interesting for a while, not that it has been boring. One Saturday afternoon 2 vans pulled up to Tenwek filled with 10 Canadians. Now living among Kenyans and Americans is good but I do enjoy interacting with fellow Canadians. There weren't just any Canadian but special ones. Mom and Dad, 3 couples from my church in Taber and an aunt and uncle from Ontario. This was special.

The whole group was here from Saturday to Wednesday morning. They slept at a rustic guesthouse down the hill but meals and life in general happened at my place. We were able to squeeze 11 of us around the table and had many hands to do the dishes. Games of cards were played, discussions were had by candlelight – there was no power and Tenwek was explored.

I enjoyed showing my guests a slice of my life here from a hospital tour, to walks around the area and meeting many of the wonderful people that make life here at Tenwek what it is.

Ladies in skirts heading up to the hospital

The walk to visit a friend for Sunday afternoon tea

They all took off for a day to see a pineapple farm

Lunch in the hospital cafeteria

All 11 of us

Wednesday morning 8 of the visitors left for a safari in the Maasai Mara which gave me a few quieter days with Mom and Dad. I took Mom to work with me and sent Dad to the neighbours to fix a door knob. The 3 of us enjoyed the time to ourselves but it was still busy as I was working during the day and ended up hosting bible study in the evening, but Mom and Dad enjoyed bible study as well. Friday afternoon the 8 came back with stories of lions, cheetahs, and zebras after a wonderful safari. We had one last night at Tenwek before arising early the next morning to go climb Mount Longonot. I had climbed Longonot a year ago and remembered it being alright but could not remember how long it took. The day before left I was getting a nervous wondering if we would have enough time to climb it. I was happy to arrive and see the sign 3km to the summit – OK 6 hours round trip this we can do.  A few were not up for a 6km hike so they stayed back and enjoyed the sun but the rest of us enjoyed the view from the top – looking across to lake Naivasha, down into the crater and across the escarpment. From there it was back to Nairobi. After church on Sunday Aunt J. and I returned to Tenwek and the others took off on their next adventure. Aunt J and I have had a nice quiet week here at Tenwek her helping out here and there and finishing her book and me tying up some loose ends before the next adventure starts. Which is right around the corner

Aunt J. and I are joining the visitors in Zanzibar  for a few days of holiday. After this I say a final good-bye to Mom, Dad and guests and they fly home. The next da, rather than head back to Tenwek, I  will hop on a plane to Cameroon. I am going to Mbingo hospital which is a Christian hospital that Samaritans Purse also works with. They invited me to come out to do some education as they are moving toward opening an ICU. I am looking forward to the time there, but will miss the community and familiarity of Tenwek.

Mom and I at the top of Longonot

The Tenwek I call home is running out of room

So I’m starting this post while taking an extended lunch break, why – it is pouring outside. I thought the rainy season was over but I would be soaked to the bone if I tried to walk back to work right now, even if I had an umbrella as the rain is coming sideways. Yesterday, the rain and wind came together so hard that a large tree limb broke off. I was glad no one was under it and that the staff cleaned it up as soon as the rain slowed. This rain is necessary for the plants to grow and keep the Tenwek I call home green. About a month ago I blogged about the Africa you think I live in (but don’t) so this is a follow up to that post as I am writing about the Tenwek I call home.

Tenwek is in rural Kenya halfway between Nairobi and lake Victoria and is in tea country – this means we drink a lot of tea, always with lots of milk and sugar as well as grow lots of tea. Fields full of tea bushes are a beautiful site. Many of the local people are farmers growing corn, beans, potatoes etc. They also may work at the hospital, a bank or a store. People get around in their own vehicles, walk, take a taxi or bus or hire a motor bike driver to get around. They speak a mixture of kipsigis (local tribal language), Swahili and English.

The misty hills

A tea farm about 30 min from tenwek

The view from the road leading to the hospital

Tenwek however is something different in the midst of Kipsigis land. It is a large hospital that provides care for the area as well as trains Kenyan physicians, from all over Kenya. We have the ability to not only teach medicine but disciple many in their faith. Here are some of the physician groups that we train.

• ·         Clinical Officers (CO’s) – CO’s have their schooling at formal institutions but come out here for 1 year for their clinical internship they spend time in OB, Medicine, Pediatrics and surgery. We have 8 of these at a time
• ·         Medical Officers (MO’s) – MO’s have completed medical school but come to us for their intern year, like the CO’s they spend time learning/working in each of the services OB, Medicine, Pediatrics and surgery. We also have 8 of these at a time.
• ·         Family Practice Residents – After completing their MO intern year Kenyan physician’s can work for a few years before going into residency. We train 2 residents per year in Family practice which is a 3 year program, so that is another 6 people.
• ·         Surgical Residents – Tenwek trains surgical residents as part of PAACS (Pan African Academy of Christian Surgeons) We have 2 per year in general surgery, and we just started an Ortho program which is another 2 per year so we have 14 surgical residents (if the math is confusing one year we took in 4 General surgery residents) and once the ortho residency fill up we will have 20 residents.
• ·         Medical Students – as part of their MO training we have med students come out for a few months this is about 10 at a time
• ·         Others – There are also other visiting African residents that spend time at Tenwek. As Tenwek is one of a few mission hospitals to have an ICU other residents come to learn here for a few months from other training locations in Africa. We also have residents coming to learn ophthalmology. So we probably have 2 of these at a time.

Every one listed here is African and they are all at Tenwek for training if you total up the numbers that is 48 people that we are training, and as the programs get full we will be getting more. Also some of these individuals are married and many  have children. With all this going on we are running out of housing. It is the hospital's responsibility to find housing for all these people and our current housing has run out. There are plans to build a new complex to house these trainees and we would appreciate your help. Would you be willing to make a donation so we can continue to house and therefore continue to train high quality doctors for Kenya and Africa?

Some of the trainees gathering for bible study at Dr W's house. 

World Gospel Mission has an account set up specifically for this project. If you are an American you will get a tax receipt, if you are Canadian unfortunately you will not but I hope that will not prevent you from giving to this important project. To give either follow this link https://www.wgm.org/tenwek-hospital-housing or send a cheque to World Gospel Mission

note: for Tenwek Housing Account #125-35006

Donor Services

World Gospel Mission

PO Box 948

Marion, IN  46952-0948

Thank You.

The proposed building to house 44 people.