It seemed appropriate to close the blog with a slideshow of our favorite pictures and memories from Kenya. Though this is just a small sampling of our 3,000+ photos, we think these are the best representation of our time here. (Make sure the sound is audible on your computer)
We have mixed emotions about leaving but are very excited to see family and friends. We want to thank you all for your constant support of our crazy plan; this has truly been a memorable year in so many ways. We love you all and will see you soon!
Love,
M & E
Thursday, May 19, 2011
Goodbye to the coast!
After 9 months, we have left the Kenyan coast and Diani. We are now in Nairobi hanging out with Chris, Jamie, and their kids until we leave on Sunday.
We had an amazing home for 9 months and we will never forgot our morning sunrise, the amazing people we've met or the time we shared together. It was truly God's glory on display:
We are busy ticking down "lasts" in Kenya. Last time in Msambweni, last time in Mombasa, last time on the coast. Tomorrow will be the last McKenya post as well.
We had an amazing home for 9 months and we will never forgot our morning sunrise, the amazing people we've met or the time we shared together. It was truly God's glory on display:
We are busy ticking down "lasts" in Kenya. Last time in Msambweni, last time in Mombasa, last time on the coast. Tomorrow will be the last McKenya post as well.
Monday, May 16, 2011
Wrapping Things Up
We have now left Kijabe and I have headed down to the coast to wrap things up with my UTI project. E is in Nairobi with Jamie helping with the kids since Chris gave me a ride to the coast. We will be home in the US one week from today.
One last hospital blog written last week but not posted since Blogger was down:
After over a week in Kijabe, it’s been very interesting comparing between here and the hospital on the coast.
A few days ago, I was operating with Dr. Thomas on an umbilical hernia, and someone came into the room and calmly said that the power was going to go out in about 30 minutes, and it would be off the rest of the day. Not a problem, as we were just starting to wrap up the case and just had to close the skin.
We finished up and headed into the OR where Dr. Davis was operating. He was in the middle of a laproscopic cholecystectomy (gall bladder removal with the long instruments through the little ports, all while watching on a monitor). The case was on the complicated side, and it was looking like they wouldn’t finish within the allotted time. Sure enough, about 20 minutes later, the lights and many of the machines in the room turned off. The room had windows, so at least there was some light. The laproscopic equipment had about three minutes of battery backup, but soon it turned off as well. So, now there was a gall bladder loose in the abdomen. Dr. Davis expanded one of the port sites a little bit and fished around blindly with his finger and fortunately found the gall bladder without incident. It was improvisation at its finest, as there are no textbooks for doing laproscopic surgeries without power.
In another OR (one without windows), a surgeon was performing neurosurgery by flashlight. Amazing.
Apparently, KPLC (Kenyan Power and Lighting Company) will just cut power to certain locations for a day or so from time to time, and that day unfortunately came at the same time that the hospital generator wasn’t working.
In Msambweni, we lost power from time to time, but the procedures the we did and the equipment that we used could just as well have been used under an acacia tree in the middle of the Serengeti, so Msambweni was in some ways actually better equipped to deal with the unpredictability of Kenya, as the technology better matched the infrastructure (or lack thereof). In a way, Kijabe is a victim of its own success since the doctors there are performing to Western standards with Kenyan equipment.
One last hospital blog written last week but not posted since Blogger was down:
After over a week in Kijabe, it’s been very interesting comparing between here and the hospital on the coast.
A few days ago, I was operating with Dr. Thomas on an umbilical hernia, and someone came into the room and calmly said that the power was going to go out in about 30 minutes, and it would be off the rest of the day. Not a problem, as we were just starting to wrap up the case and just had to close the skin.
We finished up and headed into the OR where Dr. Davis was operating. He was in the middle of a laproscopic cholecystectomy (gall bladder removal with the long instruments through the little ports, all while watching on a monitor). The case was on the complicated side, and it was looking like they wouldn’t finish within the allotted time. Sure enough, about 20 minutes later, the lights and many of the machines in the room turned off. The room had windows, so at least there was some light. The laproscopic equipment had about three minutes of battery backup, but soon it turned off as well. So, now there was a gall bladder loose in the abdomen. Dr. Davis expanded one of the port sites a little bit and fished around blindly with his finger and fortunately found the gall bladder without incident. It was improvisation at its finest, as there are no textbooks for doing laproscopic surgeries without power.
In another OR (one without windows), a surgeon was performing neurosurgery by flashlight. Amazing.
Apparently, KPLC (Kenyan Power and Lighting Company) will just cut power to certain locations for a day or so from time to time, and that day unfortunately came at the same time that the hospital generator wasn’t working.
In Msambweni, we lost power from time to time, but the procedures the we did and the equipment that we used could just as well have been used under an acacia tree in the middle of the Serengeti, so Msambweni was in some ways actually better equipped to deal with the unpredictability of Kenya, as the technology better matched the infrastructure (or lack thereof). In a way, Kijabe is a victim of its own success since the doctors there are performing to Western standards with Kenyan equipment.
Wednesday, May 11, 2011
Rift Valley View
So Kijabe is poised on the side of the Rift Valley about halfway down the escarpment which is the word used to describe the sides of the Rift Valley.
You can see from this map that we're at about 2200 meters above sea level. The green gets lighter as you get closer to sea level:
View Kijabe in a larger map
This means that it's quite a bit colder than in Nairobi although cold is a relative term when you live on the equator so it's about 65 degrees during the day and low 50s at night. Nothing is heated so the nights are quite cold since it's the rainy season but it's very possible to get sunburned from the altitude and the equatorial sun. "Kijabe" means "place of the wind" in the Maasai language and after months of palm trees, the sound of the wind rustling the evergreens was quite nice.
You can see from this map how incredibly green the Right Valley is:
View Kijabe in a larger map
We have a direct view of Mount Longonot which is a dormant volcano that towers above the Rift savannah.
Besides Kijabe Hospital, Kijabe is also home to Rift Valley Academy or RVA, the world's largest boarding school for missionary children. Kids come from all over Africa to go to school at RVA while their parents serve in the field. 10% of the spots are reserved for Kenyans and are apparently ridiculously impossible to get since the school is so popular. The teachers are all missionaries who felt called to teach the kids and live on the campus with their families.
The combination of RVA kids, RVA staff, and the Kijabe hospital staff give the town a very different feel from the coast. There are a lot of Americans here so there is more taste of "home" though as previously mentioned, the grocery shopping leaves a lot to be desired.
We've really enjoyed our time in Kijabe. It's a beautiful place and watching the rain move over the Rift Valley has definitely been a highlight of our time in Kenya.
The school also has one of the most beautiful views in the world:
You can see from this map that we're at about 2200 meters above sea level. The green gets lighter as you get closer to sea level:
View Kijabe in a larger map
This means that it's quite a bit colder than in Nairobi although cold is a relative term when you live on the equator so it's about 65 degrees during the day and low 50s at night. Nothing is heated so the nights are quite cold since it's the rainy season but it's very possible to get sunburned from the altitude and the equatorial sun. "Kijabe" means "place of the wind" in the Maasai language and after months of palm trees, the sound of the wind rustling the evergreens was quite nice.
You can see from this map how incredibly green the Right Valley is:
View Kijabe in a larger map
We have a direct view of Mount Longonot which is a dormant volcano that towers above the Rift savannah.
Besides Kijabe Hospital, Kijabe is also home to Rift Valley Academy or RVA, the world's largest boarding school for missionary children. Kids come from all over Africa to go to school at RVA while their parents serve in the field. 10% of the spots are reserved for Kenyans and are apparently ridiculously impossible to get since the school is so popular. The teachers are all missionaries who felt called to teach the kids and live on the campus with their families.
The combination of RVA kids, RVA staff, and the Kijabe hospital staff give the town a very different feel from the coast. There are a lot of Americans here so there is more taste of "home" though as previously mentioned, the grocery shopping leaves a lot to be desired.
We've really enjoyed our time in Kijabe. It's a beautiful place and watching the rain move over the Rift Valley has definitely been a highlight of our time in Kenya.
The school also has one of the most beautiful views in the world:
Monday, May 9, 2011
Word of Life Church
As we come up on the end of our time here, we’ve been thinking back to all of the people we’ve met along the way. Without a doubt, the people who most impacted our time here are those from Word of Life Church in Diani, where we went to church on Sundays and where E taught Kindergarten. If it weren’t for that fateful Day 1 when E marched down the road looking for volunteer work and found it at Word of Life, our time where would have looked very different. Mary has been a guide for E through everything here and was the first person to invite us to church. On our first day, we stood up and introduced ourselves and said we were from the US. After the service, the pastor introduced himself as Dennis and said his wife, Allison, is American. Dennis and Allison hosted us for dinner many times, gave us tips on where/how to do things in Kenya and introduced us to Chris and Jamie Suel who are our closest friends in Kenya.
Ben was my spear-fishing partner in crime, Martin and Melanie and James and Jacinta were our Kenyan "couple-friends", and there are countless others who have shaped our time here.
Below are us with Dennis and Allison:
It is difficult living in a country with such disparity and an expectation of the “rich Americans” helping everyone they see (i.e. giving people money), so it was very refreshing to find a group of people who genuinely cared about us and didn’t expect anything from us other than love and respect.
I’m doing this rotation in Kijabe now because we were introduced to some of the doctors here by people from our church!
In case you're wondering what "Kenyan church" music is like, here is a video for you:
Obviously the words are in Swahili which is true about 80% of the time for the songs though the preaching is in English. Also, did you notice the ululation that the women does about 10 seconds in? It's a common sound in a lot of Kenyan and Arabic-inspired music and women do it to express strong emotion whether happy or sad.
Word of Life is our first church as a couple, and has truly been a surprise and a God-send for us. We’re just so thankful to have been lead to a place where we have been welcomed like family so far from home.
Ben was my spear-fishing partner in crime, Martin and Melanie and James and Jacinta were our Kenyan "couple-friends", and there are countless others who have shaped our time here.
Below are us with Dennis and Allison:
It is difficult living in a country with such disparity and an expectation of the “rich Americans” helping everyone they see (i.e. giving people money), so it was very refreshing to find a group of people who genuinely cared about us and didn’t expect anything from us other than love and respect.
I’m doing this rotation in Kijabe now because we were introduced to some of the doctors here by people from our church!
In case you're wondering what "Kenyan church" music is like, here is a video for you:
Obviously the words are in Swahili which is true about 80% of the time for the songs though the preaching is in English. Also, did you notice the ululation that the women does about 10 seconds in? It's a common sound in a lot of Kenyan and Arabic-inspired music and women do it to express strong emotion whether happy or sad.
Word of Life is our first church as a couple, and has truly been a surprise and a God-send for us. We’re just so thankful to have been lead to a place where we have been welcomed like family so far from home.
Friday, May 6, 2011
The Kijabe Hospital
Since Monday was a Kenyan holiday, we started in the OR on Tuesday, and operated Tuesday and Wednesday, and had a clinic day on Thursday. I’ll write a big surgery blog soon, but I just got home from clinic and it’s fresh, so that’s what you’ll get right now.
We rounded Thursday morning on our patients that were admitted post-op at around 8 am (I know, cushy schedule), and then headed to surgical clinic at around 8:45. Dr. Davis has his clinic every week on Thursdays, where he sees patients who have been referred and might need some kind of surgery. The clinic consists of about five very small rooms separated from a main waiting area by curtains. Though there are “appointments”, pretty much everyone is there first thing in the morning, so the waiting room was packed. Most patients traveled several hours to reach the hospital, and many traveled from other countries and had waited in Kijabe weeks to see the surgeon, so a day in a waiting room is no big deal. I hope to think about this when I get frustrated that my doctor is an hour late.
There were about 100 patients to be seen today, with a team consisting of me, Dr. Davis, and an intern. I had assumed that I’d tag along with Dr. Davis and his patients for most of the day, but it quickly became clear that I’d need to cut the cord and see patients on my own.
The first patient we saw was pretty amazing. She was from a Middle Eastern country and flew down to see one of the visiting surgeons who specializes in maxillofacial reconstruction. This young women fell on her face when she was two, and broke her upper and lower jaws in several places. It’s unclear if her parents did not get her medical care, or if it was grossly inadequate, but now her upper and lower jaw on the right side is completely fused together, and she hasn’t opened her mouth in 20 years. The growth of the bones in her face has been asymmetrical, so she’s quite disfigured. The doctor thinks that he can separate the portions of jaw tomorrow morning and start her on the road to recovery. I’m excited to see the case.
The next patient, I was on my own. I walked into the room and there are four Somalis, two men and two women. There is a Somali refugee camp a few hours away that houses about 300,000 displaced Somalis, many of whom come to the hospital for long-delayed medical care. A man quickly greets me and says that he lives in the US and can speak English. Thank goodness. I ask him where he lives in the US and he responds, “Columbus, Ohio”. Turns out he lives about a mile from where I grew up. Very small world. Anyways, we get down to business and figure out that the women has diffuse bone pain, large lymph nodes in her armpit and neck, and a breast mass. I examined the nodes, and then it came time to examine her breast. Hmm, they didn’t teach us the proper protocol for breast exam on a veiled Somali Muslim. I asked if I could examine her, and the men quickly left the room. The mass has actually ulcerated through the skin, so the pathology was pretty apparent. We did a needle biopsy, and within an hour has the results which showed ductal carcinoma. At this point, I called in backup (Dr. Davis) to discuss treatment options. She was very resistant to the idea of a mastectomy (understandably), and was repeatedly asking for “dawa” (drugs) instead. She ended up leaving without a scheduled surgery. Hopefully she comes back.
I saw a few more patients with ridiculously advanced disease, and then had my first patient who didn’t speak a lick of English. So, Swahili it was. I started out slowly, but got into the swing of things and was pretty happy with our communication level. I can definitely see how working in a clinic like this would teach you the language very quickly. Next step: start consenting patients for surgery in Swahili. This process was much slower, as I wanted to make sure that I was able to adequately explain the procedure and the associated risks. I’m sure some of the phrasing was very awkward, but it got the job done. Sentences like “mpira itakaa umeni na wiki moja” (the tube will live in your penis for one week) were abundant today. The most challenging patient of the day was a Somali man who brought his brother to translate, but only into Swahili. I think there was probably a lot lost in translation.
Clinic made me very excited about the possibility of returning at some point after I’m at least closer to being finished with my training. It was amazing to connect even a little with patients in a completely different language, though I’m sad that so many of the patients spoke Arabic and Kisomali, languages that I have no idea about. One of the American doctors here speaks English, Swahili, Kisomali, Arabic, Kikuyu, and some of several other tribal languages. No big deal.
Lots of surgeries on the schedule for tomorrow. I’ll have some pictures for the next blog.
We rounded Thursday morning on our patients that were admitted post-op at around 8 am (I know, cushy schedule), and then headed to surgical clinic at around 8:45. Dr. Davis has his clinic every week on Thursdays, where he sees patients who have been referred and might need some kind of surgery. The clinic consists of about five very small rooms separated from a main waiting area by curtains. Though there are “appointments”, pretty much everyone is there first thing in the morning, so the waiting room was packed. Most patients traveled several hours to reach the hospital, and many traveled from other countries and had waited in Kijabe weeks to see the surgeon, so a day in a waiting room is no big deal. I hope to think about this when I get frustrated that my doctor is an hour late.
There were about 100 patients to be seen today, with a team consisting of me, Dr. Davis, and an intern. I had assumed that I’d tag along with Dr. Davis and his patients for most of the day, but it quickly became clear that I’d need to cut the cord and see patients on my own.
The first patient we saw was pretty amazing. She was from a Middle Eastern country and flew down to see one of the visiting surgeons who specializes in maxillofacial reconstruction. This young women fell on her face when she was two, and broke her upper and lower jaws in several places. It’s unclear if her parents did not get her medical care, or if it was grossly inadequate, but now her upper and lower jaw on the right side is completely fused together, and she hasn’t opened her mouth in 20 years. The growth of the bones in her face has been asymmetrical, so she’s quite disfigured. The doctor thinks that he can separate the portions of jaw tomorrow morning and start her on the road to recovery. I’m excited to see the case.
The next patient, I was on my own. I walked into the room and there are four Somalis, two men and two women. There is a Somali refugee camp a few hours away that houses about 300,000 displaced Somalis, many of whom come to the hospital for long-delayed medical care. A man quickly greets me and says that he lives in the US and can speak English. Thank goodness. I ask him where he lives in the US and he responds, “Columbus, Ohio”. Turns out he lives about a mile from where I grew up. Very small world. Anyways, we get down to business and figure out that the women has diffuse bone pain, large lymph nodes in her armpit and neck, and a breast mass. I examined the nodes, and then it came time to examine her breast. Hmm, they didn’t teach us the proper protocol for breast exam on a veiled Somali Muslim. I asked if I could examine her, and the men quickly left the room. The mass has actually ulcerated through the skin, so the pathology was pretty apparent. We did a needle biopsy, and within an hour has the results which showed ductal carcinoma. At this point, I called in backup (Dr. Davis) to discuss treatment options. She was very resistant to the idea of a mastectomy (understandably), and was repeatedly asking for “dawa” (drugs) instead. She ended up leaving without a scheduled surgery. Hopefully she comes back.
I saw a few more patients with ridiculously advanced disease, and then had my first patient who didn’t speak a lick of English. So, Swahili it was. I started out slowly, but got into the swing of things and was pretty happy with our communication level. I can definitely see how working in a clinic like this would teach you the language very quickly. Next step: start consenting patients for surgery in Swahili. This process was much slower, as I wanted to make sure that I was able to adequately explain the procedure and the associated risks. I’m sure some of the phrasing was very awkward, but it got the job done. Sentences like “mpira itakaa umeni na wiki moja” (the tube will live in your penis for one week) were abundant today. The most challenging patient of the day was a Somali man who brought his brother to translate, but only into Swahili. I think there was probably a lot lost in translation.
Clinic made me very excited about the possibility of returning at some point after I’m at least closer to being finished with my training. It was amazing to connect even a little with patients in a completely different language, though I’m sad that so many of the patients spoke Arabic and Kisomali, languages that I have no idea about. One of the American doctors here speaks English, Swahili, Kisomali, Arabic, Kikuyu, and some of several other tribal languages. No big deal.
Lots of surgeries on the schedule for tomorrow. I’ll have some pictures for the next blog.
Tuesday, May 3, 2011
Kijabe Living
So while M is spending his time in the OR, I needed to find something to occupy my time. Per usual, it was impossible to set something up prior to arriving in Kijabe so I set about doing what I always do in Kenya: make it up as I go along.
The first order of business on Monday was keeping the doctor fed and watered. This is the first time in Kenya that we've lived in a town without a large food store. Although there are some small shops and a vegetable market, food shopping leaves much to be desired. The small shops carry about as much stuff as a mid-sized gas station so I've been having fun thinking up meals. The veggies are amazing though because of the constant growing season up here so we're definitely taking advantage of all of it. In addition to the food, we still need to purchase or boil/strain all of our water so I walked home with a 5 liter jug of water on my head. I still have to steady it with my hand but I've been practicing and my neck is getting stronger. Honestly, it's not that much easier than carrying things in your hands but the looks I get are priceless.
Tuesday dawned and M headed to the hospital (100 yards away). I had heard a tip that sometimes they needed volunteers to help prep the surgical kits so I headed down to the OR to see what I could find. I think they thought I was really weird but they gave me a gown, shoe covers, gloves, and a fancy hairnet and led me into the room where they prep the kits.
So as we've previously mentioned, very little in a Kenyan hospital is disposable and nothing is bought in a pre-packaged kit. So, if you've ever seen anyone tear open a packet of neatly folded and sterilized gauze, those have to be assembled by hand in Kenya. First, you take a giant 5-ft roll of gauze and cut a 6-inch square, then you fold it in thirds, and then in halves to make a neat little gauze towel. Now repeat for 2 hours. Then we prepared cotton balls and no, they don't buy the pre-packaged ones from CVS. They have a giant ball of cotton batting so you tear it off, ball it up in your hand, and make a cotton ball. Once we had prepped enough gauze and cotton balls, we began preparing kits.
Gauze piles:
When a surgeon enters the OR for a case, there are usually one or more specialized kits available with all the necessary tools for the procedure. So for example, the kit contains different instruments for a c-section vs. an ACL repair.
You can see pediatric instruments to the left in this photo as well as the bowls for gauze/cotton balls:
So with a really loud noise, several men entered and dumped all of the instruments used in the previous day's surgeries on the table. These instruments had already been washed at least once and now were ready to be re-packed. Everything was in a giant jumble: forceps, rods, basins, bowls, speculums, scalpels, etc.
They taught me to put together some of the basic kits and we began to assemble the instruments and the appropriate amount of gauze and cotton balls. When complete, these were wrapped in surgical material (the same material the surgical scrubs are made of) and taped closed. This entire packet goes into the auto-clave to be sterilized and then can be used in surgery. It had never occurred to me that they have to sterilize the gauze and cotton balls used in Kenya because they can't buy them sterile. It was amazing.
Another interesting thing was this sewing machine. They sew and repair all the sheets, surgical clothes, and scrubs onsite. Nothing is thrown away. I saw them piece together scraps in a sort of madras style surgical towel (I guarantee that sentence has never been written before now) so as not to waste anything.
Anyway, tomorrow I'm going to do something new since one can only fold gauze for a few hours before dying of boredom (well, if you're a spoiled American). It was really interesting though to see the functional pieces of the OR kits that the doctors use everyday so I'm glad I did it.
The first order of business on Monday was keeping the doctor fed and watered. This is the first time in Kenya that we've lived in a town without a large food store. Although there are some small shops and a vegetable market, food shopping leaves much to be desired. The small shops carry about as much stuff as a mid-sized gas station so I've been having fun thinking up meals. The veggies are amazing though because of the constant growing season up here so we're definitely taking advantage of all of it. In addition to the food, we still need to purchase or boil/strain all of our water so I walked home with a 5 liter jug of water on my head. I still have to steady it with my hand but I've been practicing and my neck is getting stronger. Honestly, it's not that much easier than carrying things in your hands but the looks I get are priceless.
Tuesday dawned and M headed to the hospital (100 yards away). I had heard a tip that sometimes they needed volunteers to help prep the surgical kits so I headed down to the OR to see what I could find. I think they thought I was really weird but they gave me a gown, shoe covers, gloves, and a fancy hairnet and led me into the room where they prep the kits.
So as we've previously mentioned, very little in a Kenyan hospital is disposable and nothing is bought in a pre-packaged kit. So, if you've ever seen anyone tear open a packet of neatly folded and sterilized gauze, those have to be assembled by hand in Kenya. First, you take a giant 5-ft roll of gauze and cut a 6-inch square, then you fold it in thirds, and then in halves to make a neat little gauze towel. Now repeat for 2 hours. Then we prepared cotton balls and no, they don't buy the pre-packaged ones from CVS. They have a giant ball of cotton batting so you tear it off, ball it up in your hand, and make a cotton ball. Once we had prepped enough gauze and cotton balls, we began preparing kits.
Gauze piles:
When a surgeon enters the OR for a case, there are usually one or more specialized kits available with all the necessary tools for the procedure. So for example, the kit contains different instruments for a c-section vs. an ACL repair.
You can see pediatric instruments to the left in this photo as well as the bowls for gauze/cotton balls:
So with a really loud noise, several men entered and dumped all of the instruments used in the previous day's surgeries on the table. These instruments had already been washed at least once and now were ready to be re-packed. Everything was in a giant jumble: forceps, rods, basins, bowls, speculums, scalpels, etc.
They taught me to put together some of the basic kits and we began to assemble the instruments and the appropriate amount of gauze and cotton balls. When complete, these were wrapped in surgical material (the same material the surgical scrubs are made of) and taped closed. This entire packet goes into the auto-clave to be sterilized and then can be used in surgery. It had never occurred to me that they have to sterilize the gauze and cotton balls used in Kenya because they can't buy them sterile. It was amazing.
Another interesting thing was this sewing machine. They sew and repair all the sheets, surgical clothes, and scrubs onsite. Nothing is thrown away. I saw them piece together scraps in a sort of madras style surgical towel (I guarantee that sentence has never been written before now) so as not to waste anything.
Anyway, tomorrow I'm going to do something new since one can only fold gauze for a few hours before dying of boredom (well, if you're a spoiled American). It was really interesting though to see the functional pieces of the OR kits that the doctors use everyday so I'm glad I did it.
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