Can I Leave?

I am writing this post with only six more days of work left until I leave back to Canada. I am coming home - this is a fact and I am looking forward to seeing my family and friends as well as going to fast food restaurants. However, I am sad to go. I have made many good friends and have loved my time here. I am also worried about what will happen when I go.

To illustrate that fact here is what happened today:
I was awoken up by my pager at 6:30am - the patient was not doing well and the resident would like some help. I got up the hill and find a patient who was not doing well - his heart rate was 170, respiratory rate was 50 and SpO2 was 75. I did what every RT does and fiddled with the vent settings for a bit with no improvement - take a listen to his chest and I discover that the air entry is poor. Asked about a CXR - the portable machine is broken. I then took the patient off and bagged - amazingly he was easy to bag (his PIP was 40). Thinking the machine was broken, I swapped out machines - seemed to help for a little while but then same problem again. We paralyzed him and finally he settled. This man has a head injury and was breathing so fast that the ventilators (both of which I tried) could not keep up. We managed to get this all sorted out in time for 730am rounds and 8am M&M (morbidity and mortality).

After M&M, I sneaked away from the hospital to have some breakfast - finished just in time as my pager went off, they needed my help in the nursery. Up the hill I climbed to discover the resident bagging a sick baby with poor SpO2 we bagged the baby for a while but we were unable to save him. I comforted the Mom and said a prayer with her and the chaplain. As I was leaving, I was told they were having trouble with a one year old on the pediatric floor. Off I went and found a grunty 1 year old just maintaining his SpO2 on a non-rebreather at 15lpm. So we took him to ICU - after making a stop off in x-ray to take a chest film as the machine was broken. In ICU he did not look much better and we were debating about intubating him or not; we went for a compromise and put him on CPAP. How do you CPAP a one year old in Kenya? You take your home BiPAP machine and an adult nasal mask and you are good to go. The child looked really cute (only a RT would say a kid looked cute with a mask). The SpO2 maintained and at a reasonable level and the child was able to rest his breathing muscles.

That done I was able to escape for lunch and some computer work. Came back after lunch to check up on the previous patients and teach the new visiting Doctor how to use our ventilators. I had a scheduled lecture for 3:15pm but was told (at 2:45pm) that the lecturer for 4:15pm was unable to make it so could I do her presentation as well. So off I went, reviewed her lecture (on Trach care) and gave lectures all afternoon. The day ended with a quick round to see how things were going. I headed into Casualty (ER) and saw two patients receiving side stream neb treatments - set up like a pipe. I was so excited as the nurse had set them up properly. Maybe I can leave after all.

So sorry if I bored and confused all you non medical people. Really, I am worried about how the staff and more importantly the patients will do when I am gone.
On a lighter note I had a great week last week my friend J was here and I had a great time working with her as well as taking of to the coast – Indian Ocean. I celebrated my birthday there and enjoyed a surprise birthday party from my friends at Tenwek when I returned. We have also been blessed with rain in the last week which means the grass is green, crops can now grow and the hydroelectric dam can give me power. On a sadder note my computer screen has died – I have been able to borrow the guesthouse computer but has made it difficult to post pictures on the blog – sorry, when I am back I will post some.

Culture Shock in Kijabe

I am starting this post on Friday – I am currently in Nairobi relaxing at the Mennonite Guest House – a great place to stay.  I am looking forward to supper in 20 minutes. I have heard the food here is great. As I alluded to in my last post, I spent the last week in Kijabe. Kijabe is a mission station, I have heard it is one of the largest mission stations in Africa (no clue if this is true) however it is made up of:

~Kijabe Hospital which includes Bethany Kids Hospital;

~Cure Hospital

~Moffet Bible College

~Rift Valley Academy (RVA) – a Christian boarding school where many MK’s (missionary kids) attend, including a handful from Tenwek.

Having a mission station this large means a lot of wazungu (white people) as well as white culture.  Kijabe is even higher elevation than Tenwek and is built on a hill with the beautiful Rift Valley opening up, I spent evening watching the sunset and I felt like I was on the top of the world. It is also colder in Kijabe (I had been told this but it is the dry warm season now so I have not suffered) as well as windy. A beautiful location.

The Great Rift Valley - a small part of it anyway

I arrived at Kijabe on Friday night and settled in with the wonderful family that was letting me stay with them (Thanks Ls). I also got a tour of the hospital – which I will talk about later. Saturday morning, I woke up on time to do rounds in the hospital with the intensivist before he left for a month and then it was off to RVA.  It was an exciting weekend as the boys’ basketball teams and the girls’ soccer teams were having a tournament. It was like being in high school again cheering for the boys b-ball (it reminded me of the ICHS games vs PBHS) and eating all sorts of good food. Being at RVA was strange – so many white people, a good Saturday anyway, and the boys’ basketball team got first, I think the girls’ soccer team got second.

Soccer on the top of the world

Sunday was church I felt like I was back in Canada – with such a large mission compound they create their own church community and fill it – I did not count but there seemed to be 400 people and 95% white/Asian. Talk about culture shock. This trip prepared me for the reverse culture shock I will experience when I get back to Canada in April. The rest of the week was spent at the hospital.

Kijabe is a mission hospital with a slightly smaller patient load than Tenwek (this fact may be wrong but I was told Kijabe had about 200 patients and I think Tenwek is 300). Kijabe is closer to Nairobi and the city influence plays into the culture. The culture at Tenwek is African and this is reflected in the work as nothing is rushed and orders are not always completed. Kijabe was different as the staff are more influenced by Nairobi culture which has more western influence. This improved the nursing care delivered to the patients. Aside from this Kijabe is much like Tenwek – they are limited by the tests they can perform due to cost or availability, there are things that we can still not do. |We were still in Kenya -  no cath lab for the lady having an MI.

I had wanted to go to Kijabe to see how it is different from Tenwek and this was accomplished. I also went with the request to do some teaching to the ICU nurses. The plan was to do five lectures (one a day) but this being Kenya I ended up doing three – which was fine as well. I also was able to complete some tasks similar to what I do at Tenwek.  I glued baggers back together, taught the visiting Drs how to use the ventilator (all servo 900C), explored their storage room and found myself asking: why would you donate this to a mission hospital and then spend the money to ship it here – example being disposable toilet seat cover, for those of you who have traveled you may have seen the beautiful pit toilets that are common – there is no seat to put a cover on. Anyway the ICU nurse and I had a good laugh, she is also enjoying the one pair of insoles that someone put in a box, now her feet don’t hurt. Anyway I have regressed, I spent time similar to the way I spend it at Tenwek but without a pager – although I did hand out my cell phone number. The week at the Kijabe was good but I was a little homesick for my friends and community at Tenwek – being so large I felt that Kijabe did not have the tight knit community that I experience here at Tenwek. It was great to come back and get hugs from my friends, it felt like coming home.

Kijabe ICU

It’s now Monday and I am back at Tenwek and back to work – the post-op esophagectomy lady with SpO2 in the mid-high 80s and us putting off intubating her hoping she will pull through on 100% 0xygen (actually more like 80% because that is what comes out of the wall). We also have a high number of burn patients lately.  Our ICU has a young boy and a young lady both with severe facial burns, both with trachs. Please pray for them as they recover that we can keep infection away as well as the psychological challenges they will face.

I will end here.  I will hopefully blog again soon but my friend J is coming to Tenwek on Wednesday which I am super excited about but may pull me away from my computer.

I will finish this with one last prayer and thanksgiving request – my computer is dying. A friend was thankfully able to fix it after my screen died, so I pray that it will last until I make it back to Alberta.

Time

This is only my second post for February. Where has the time gone? I have been thinking more about time recently. How much more time do I have with my new friends before they return to the States? How much time do I have until I go to Kijabe (actually as I am revising this it is Sunday and I am already at Kijabe)? How much time until my friend comes to visit? And the worst question how much time do I have left before I have to say good bye to Tenwek and return to Canada? Time flies. I am looking forward to some of these things, hoping they come soon and others I wish I could put off for a few months. It reminds me of when I was younger and Oma (grandma) would come and visit in September – my brother and I could not wait for her to come and time would not go fast enough but on the other hand the same time Oma came was when school started and we wished summer would go on forever. Time – it is a good thing it is out of our control – and in God’s hands.

I am not looking forward to these goodbyes and am looking at the busyness that I will have in the next month (I return to Canada March 31). There are many projects that I have procrastinated that I need to complete. I need to leave more knowledge with the staff so they are able to get by without me. I have been trying to do my job in a way that is more educational than me just doing things – I think I may be in trouble in a few months when I actually have to do the work rather than just explain how to do it .

I also wonder if there will be a time when I come back. I often find myself saying if/when I come back I will do ____. I am sure I will know all in God’s time but please pray that his plan for my future – wherever that may be will be revealed to me, and that I will have peace with it.
Those of you who are on Facebook may have seen that I have been spending my time in various ways – some friends and I took off for a weekend and did something I never thought I would do - we rafted the Nile – wow what an experience if you are ever in Uganda I suggest you do it – it is amazing.

I have also been busy at the hospital – figuring out how the ventilator works – after 4½ months I have finally figured out that one of our ventilators is backwards SIMV means AC and AC means SIMV – I think (I miss the Evita). I have also, finally, started to work on basic instruction manuals for the vents, something I should have done long ago but procrastinated. We have had a real ICU this past week with 6 very sick patients please pray for them for me, we currently have a young man in the unit who is 30 years old, he has severe heart failure and has been on Dopamine for over a week. This morning he was sitting up brushing his teeth, while on 15mcg/kg/min of Dopamnine – his blood pressure 60/35, we don’t know what to do with him, if he were in Canada we send him to a Cardiac surgery unit and he would be in line for a crazy surgery or transplant or something. Here we will have to eventually turn the Dopamine off and then he will die – how do you do this to a completely conscious young man. We did manage to turn the dopamine off, his BP is still very low but his kidneys are functioning and he says he is fine. Last week we also lost another young man to Guillain-Barre, I found this difficult as back home we would trach him and ventilate him for a few months and then get him into rehab and his chance of survival would be reasonable. Here the decision was made not to intubate as the likely hood of him surviving our ICU care for a prolonged period of time (high likelihood of VAP, bed sores, other nosocomial infections etc) the fact that he also was immune-suppressed made this highly likely. We were also wary of giving him a ventilator for months – we only have 3 and if one patient ties one up for such a length of time then we are in trouble.

I have also been asked to update on the quadruplets born after Christmas – I am sorry to say they are now the quad-triplets, we lost one of the girls a few weeks ago, the other 2 girls were also battling some infections but appear to be getting stronger. The little boy is doing fine (strange, as girl neonates tend to do better than boys). Please continue to pray for these babies as well as all the other patients in the hospital.

I was hoping to add some pictures to this post but I am having some difficulties with internet so next time.

Perspective and pictures

Looking back at this week it has been a different sort of week. It has been good to reflect. It was a quieter week at the hospital, usually when things are quieter I go home and work on various projects. That was a little more difficult this week as we have been having power issues at Tenwek. The hospital has had power but the homes do not have the same reliable backup system and so when we had problems with the hydroelectric dam this week we were in the dark. The worst part about no power is no computer or internet; this can make things frustrating. However being without power is OK, I kept reminding myself that many Kenyans do not have regular power. We bought some more candles and things were just fine – although I did escape to the guesthouse where there was power. I am not one who is good at keeping up with current events (having no TV or Radio makes this worse) however I have heard that parts of North America have been hit with horrible snow storms. I am sure there are people there who are without power as well. Here when the power goes out the water still works, we stay warm (no heat to go out) the stove still works (gas) so it is OK. I have memories of being on the farm with no power – cooking and boiling water on the camp stove outside in -20 Celcius. Despite it being OK here to be with out power I am still happy to have it fixed and back on.

Friday I was invited to go mudding – I am sure you are thinking driving a big 4X4 vehicle through the mud in Kenya – not what I envision a missionary in Africa doing – well we did drive a big 4X4 but not through the mud. We drove to a nearby church and mudded a house. I have seen many mud homes in my travels but this is the first time I got to help make one. The local church and Tabitha bible study (started by one of the missionaries here) are helping a family build a home. Myself as well as a few other ladies here were invited to go help – mudding is a ladies only job. We were doing the third layer of mud the first two had been done previously and allowed to dry. I am not sure how exactly the first 2 layers go or what exactly they are made of. But the third layer was clay, dug from about 5-6 feet down and than mixed with water. This mud was than brought to us in five gallon pails and we smeared it on the walls. I learned there is a technique to this and I don’t know if I was very good but they did not fire me. The trick was to use the palm of the hand to smear the mud and get it in the cracks while sliding your hand up to make it smooth. I don’t know how smooth my part was but thankfully they have one final layer to go (made with white dirt from the river) and they can make it look pretty. This was a lot of fun, we had many Kenyan children observing us, I don’t think they have ever seen wazungus (white people) “playing” in the mud before. It was also great to be a part of the community and help out. 

getting it all covered, dark is done light still needs to be done.

muddy hands in front of the house, all the layers on the outside of the house are done

I was really tempted to start a mud fight

Hard at work with a young Kenyan watching us

More of the audience

The ladies in the pit hard at work making the mud

I recently read the book When Helping Hurts by Steve Corbett and Brian Fikkert, this book talks about how to help in a way that is helpful to all involved and to not just take over and do something for the people but focus instead on communities helping their own. This description does not do it justice, I recommend anyone going on a mission short or long to read it. I was thinking about this as I helped and was shown by the ladies the proper way to mud. I was one of them not the Canadian coming in and asking why we just don’t hang drywall.

Friday evening was a different evening. Six of us hiked up to Motigo, local high point, to camp. The group consisted of a real live mountain guide, a real live eagle scout, a real live (token) Kenyan, a real live dreamer, a real live southern gal and a real live Canadian (me). We are a fun group and after rounding up some sleeping bags, tents and firewood we were off. The timing worked well and we were able to watch the sunset from a beautiful clearing.

The children wanting to see the picture I took

Sunset

The path

 The hike up went well and was interesting, we saw six people all riding on the same Piki (motorbike) the previously seen record was five. This was an entire family so some of them were little but amazing anyway. We did not see a cow in the back of a Toyota Corrola like last time though. After we reached the top we set up camp and made a fire. The s'mores had to wait though. All the children who had followed us up helped with the fire and remained. We had some fun with the kids - a young boy who said his name was Petunia (I hope he was kidding) after we had all gathered around the fire said - this country I come from is very cold. Needless we had a good laugh. The stars were beautiful as it was a clear moonless night. The children did eventually leave allowing us to enjoy some s'mores and good conversation, until the wind picked up and we put the fire out as we did not want to start a grass fire - the problem with camping at the peak: no shelter from the wind.

I think our buddy Petunia is the one beside the white guy

The ladies enjoying the early morning sunrise

All of us at the top before we headed back down

Caveman

We hiked down Sunday morning in time to shower and head off to church. It was a lot of fun. I have decided that the sky is one of God's most glorious pieces of art. It is amazing that such a beautiful picture is painted for us twice each day.

I would like to end this blog with a request. Toshiba has generously donated a CT scanner to Tenwek. This is a wonderful donation as currently the nearest CT scanner is about 3 hours away. As we have no air ambulance or even paramedics and this transport is much to dangerous for many of our patients so we end up doing "cut" scans or just wait and see. Anyway the need for the scan is high we have the machine but Tenwek still needs to cover the price of the building to house it as well as the technology to support it. We hope to have the scan operational by early summer but we are still in need of $300 000 USD in funds. Here is where you come in please give - click on this link where you can give online at the WGM website. Please e-mail me annette.lie.87@gmail.com (this is my spam e-mail address so if you have other addresses for me use the others one but I will respond to this one as well, it just may take more time) if you have any questions.
Thanks,
Annette

Back to Work

The last few blogs have been filled with a lot of excitement. For a few weeks in a row I don’t think I had put in any five day weeks - with Mom and Dad coming, Christmas, Nairobi Visa trip and Kenyan Holidays. All that is over now and it is time to get back to work.

When we returned from safari I had thought of taking the rest of the day off as it was the last evening with my parents however, it was so busy that I could not just sit by. Mom and I took off to the hospital and Dad was content with his book in hand. Mom had a great experience as we intubated a fellow in casualty (ER) we almost coded a patient in ICU – I made Mom bag. There was also the desaturation of another ICU patient to the 60-70s, mom got to see me in action as I lectured the student nurse (he had written down the low vitals for the last hour and did not do anything about it) and as I turned down the new packaged non-rebreather mask for the one that had been bleached multiple times – this was all in less than two hours. I managed to escape the hospital for a few hours and chat with them a bit until the pager went off and I went up to set up a previously unused ventilator on a patient. The page came just as I had invited a friend to join the three of us for supper. The three of them did enjoy supper, I joined in late. All in a afternoon at Tenwek.

 

I feel like there are trends at Tenwek just like there are back home. I have noticed a few different trends recently, I had bagging afternoon where after a quiet morning I spent the afternoon bagging various patients: one with decreased SpO2 and three others who had coded. Sadly none of the codes survived, especially difficult as two of the codes where pediatric patients.

Bagging afternoon led to fixing bagger day. Tenwek reuses almost all their respiratory equipment. This includes baggers (ambu baggers as we like to call them here regardless of brand) that are designed for single patient use. As they are single patient use they are not made to last as long but stand up remarkably well, however there are a few styles that have a port on the patient side designed for a pressure manometer or delivering medications – this makes sense as long as you have the cap however after the tenth time something is cleaned the cap disappears giving us a leak when we bag. I realized this problem soon after I came to Tenwek and would remedy it with putting my finger there or plugging it with the cap off a sharp. However, I was the only one doing this meaning patients were only bagged effectively if I was around – as there is only one of me and I am not always around a permanent solution was in order. I asked the electrician who functions as biomed for something to fill the hole with that would with stand up to multiple jikings (jik is our word for bleach). I was given a 2 part epoxy and off I went finding every bagger I could and filling the holes. I am pleased to say that it has worked well, we no longer have a leak. I am still walking around with epoxy in my lab coat pocket so that I can catch the ones I have missed – one more thing to carry, lab coats do come in handy.

I have been busy with multiple lectures, as well new interns have started at Tenwek and after three years of medical school with minimal practicum they are quite green. This is in addition to the other teaching I am doing. Last week was busy with a lecture to the nurses about high flow cold nebs and venturis on Monday, Tuesday was a lecture to the interns on low flow oxygen, followed by a Wednesday lecture to the nurse anesthetists on ventilation by pathophysiology.  A busy week. The lecture to the nurses was the hardest as venturi and entrainment are difficult concepts and there is a lot of room for error but overall I think it went well.

Besides new interns at the hospital January has brought a lot of visiting staff to the hospital as well. This makes me busier in two ways, the first is visiting staff are not familiar with our (ancient) ventilators and need education as well they are used to having a RT around. I also am more willing to help out the short term visiting staff as they leave before I do meaning they will not be left in a lurch when I am gone, in comparison to the long term staff who need to get by without me in a few month. All in all I end up helping out a little more – but that is fine. The other part of having visiting staff here is a lot more (young single) people to hang out with. I have spent evenings hanging out, learning how to play racquetball, playing settlers and going for walks. Weekends have been games of ultimate Frisbee and hikes up Motigo. This had been wonderful I am enjoying getting to know everyone and the games are a lot of fun – I think I need to keep at it as I am out of shape. Racquetball was right before bagging day and my forearm was sore.

            Being busy both socially and at work has taught me to prioritize things. This has changed up my routine and it has been great. I now have to schedule time to take for God – this has been wonderful and I should have made myself do it years ago instead of leaving what time I have left at the end of the day, making time for God and setting it aside for him had brought so much more meaning and insight into my walk with God. Please pray for me as I take this time to get to know God better and inquire his plan for my life

Ultimate Frisbee - Waiting for the next play

I am gonna say I caught this one and then we scored (really I have no clue)

everyone laughing after the Frisbee hit "A" in the head

Still laughing - see even the Kenyan kids are laughing

Can you see it

I have been back from the Mara for more than a week and it is high time I tell you about the trip rather than just the journey getting there. If you saw on the map on my previous post Fairmont Mara Safari club is right outside of the park. This did not limit our experience one bit. We stayed in large tents situated along the Mara river in which a lot of hippos live. I would sit at our table having lunch and I would watch the hippos in the river. At one point a large bird landed on the back of the hippo, probably thinking it was a rock. The hippo did not like being treated as a rock and "jumped" up it was quite exciting, all while I was enjoying my soup.
The days on the safari are a little structured with two game drives a day: one from 6:30am-8:30am and the other from 3:30-6:30. Getting up early may not sound like a holiday but being able to see the sunrise and watch the active game in the cool morning hours is beautiful and well worth it. The time between game drives is spent at the resort where my parents and I would go for walks to see more hippos, read a book, take a nap and enjoy the wonderful meals prepared for us - yum.
The game drives were of course the highlight of the trip. We had an excellent driver who could spot the wildlife from a kilometer away. At one point we were driving through the bush and he pointed out a lion deep in the bush quite far away. How he saw it while navigating the mud amazed me, practice I guess. We saw all the Big Five (name given to the five animals hardest to shoot when hunting, now refers to the top five animals to see - lion, elephant, cape buffalo, leopard and rhinoceros) except the leopard - although we did see 2 cheetahs which look similar to leopards. Rather than post all my pictueres - you can look at them here on facebook (you should have access even if you are not on facebook). However, here are five of my favourites.

Mom and baby, baby was almost as big as mom

I think giraffes are one of my favorite animals

Those of you who were in Junior high art with me know how much I love sunrises

 The trip back was much less exciting than the trip there, only two hours. Then it was back to work at the hospital which had gotten really busy in my absence, five ventilated patients at one point - usually we max out at three. On Friday I said good-bye to Mom and Dad who are now seeing some more of Kenya before they head home next week sometime. It was great that they could come and see what I do here and meet many of my friends and co-workers here.

Rescued by the Masai Warrior and Canada Post

As you probably read in my last post Mom and Dad are here and you can not come to Kenya without going on Safari. So Monday morning we took off for a few days. Tenwek has a deal set up with the Fairmont Mara Safari club which gives Tenwek visitors a deal so off we went.

We were picked up at the hospital by a driver arranged by someone at Tenwek. I had not met this driver but assumed all was good so off we went. A little while down the road I asked the driver if he had been there before and he said yes - we went on a field trip when I was in school. This had me a little concerned but in his broken English (my 8 year old neighbour spoke better English than him) said he knew the way. Drivers are common here as many of us don't drive and every time I have one I simply say go here and they go, no need for me to give directions as they just know where to go, this is good as I have yet to learn my way around here.

Anyway we continued on myself giving the driver the benefit of the doubt, however I was getting a little worried as my Dad said, "we are going to Fairmont, right?" because the sign we just passed said Fairmont. We asked the driver and he responded with no this way is fine - and you have to trust the driver right. So off we went we eventually turned off the highway (at Narok for those who know the area) and headed south it was a paved road with lots of potholes - the same one I think we had taken to Olderkesi. Anyway, we eventually turned off to a bumpy gravel road being unsure I texted a friend of mine at Tenwek asking if going down a bumpy road was normal she responded with yes but we should be there in 10 minutes. Ten minutes later there was no end in sight. We then asked the driver what was going on and he responded with, "I turned late so now we have to detour a little bit." A little bit was an understatement the gravel road ended at a Masai village, an hour or more later. Here I was quite concerned as the Masai  men told us we had a long way to go - and the road had reached a deadend. A decision made was to put a Masai warrior in the car to guide us to our destination. The man climbed into the car and off we went backroading in our little Toyota (car, 2 wheel drive) we went through a river, through the mud and all sorts of other places that would have been a lot of fun in a quad but not the most enjoyable in the back of a little car at 3pm which you have been stuck in since 9:30 am (read no lunch or bathroom breaks). The amount of crazy places we went through it was amazing we made it through. There were many times that we would go through something and I would just pray that God would get us through as I envisioned being stranded and lost in the middle of the mara for a few days. Here are a few pictures of our experience

The Masai man who led us through 100km of bush, without him we might still be there

The Road - this is a better section, we may have driven through the puddle on the left if not this one others like it.

The route I think we took is in yellow, destination in red, all approximate as I had no clue where we were. I know we came from Narok and went through Talek, which there was no road to and I don't think we ever entered the actual park.

This was an adventure we were rescued by the Masai warrior and eventually met by one of the vehicles from Fairmont where the staff member was wearing a Canada post shirt, so he gets some credit in the rescue. We were met at the lodge with a late lunch (it was now 5pm) and showed to our tents. For those of you thinking drive for 7 hours and sleep in a tent - no way, The drive is only supposed to take 2 1/2 hours and as for the tent this is what the inside looked like.

Beautiful - and behind the curtains is the en suite

So the first day of the trip done, we had missed our afternoon game drive although on our round-a-bout trip to the lodge we did see some wildebeest and ostriches. I will blog again soon about the rest of the trip it was exciting as well but a much better form of excitement.