Dinner and Anne's and Dan's

 

The last time I was in Kijabe, the head nurse was Anne Mukweyi.  You can see a picture of the younger Anne in my first posting of this blog.  She is the one sitting a bit further back at the nursing station on the Paediatrics ward. Anne is a very competent Nandi nurse who ran the ward with efficiency and a good deal of wisdom when I was originally at Kijabe in 2002.

Since then we have corresponded.  She got married in 2007 to Daniel who is a Luo.  The social difference between the two tribes was imperceptible until the election troubles of 2007.  The troubles went from election controversies to property violence to murder and then to parliamentary shenanigans since then.  The recent elections earlier this year have finally ended the strife.  Daniel was a district nurse at Naivasha, a town in the GRV north and west of here, when the two first got married.  He now works in Nairobi with an AIDS program funded by the University of Maryland.  They had planned to be married when the troubles started.  Anne was in legitimate danger as she lived “outside the wall,” but on hospital grounds.  Anne’s pastor had urged Anne and Daniel to delay the ceremony because “it was no time for you two to be married.”  Anne and Daniel countered that it was, in fact, the best time to be married…and did.

They have two children:  Favor, 3, and Felix, 9 months.  We spent an enjoyable evening talking politics (Kenyan and American), gas prices, soccer matches and religion while, with infinite patience, Favor’s braids were undone and Felix’s explorations of the mysteries of cruising around a coffee table were observed.  Anne is now the “matron” (read hospital administrator) for the Bethany Kids- Kijabe Hospital, the pediatric ward of the hospital.

We had lamb stew with rice and chapatti (Indian flat bread which has been adopted by Kenya enthusiastically).  Dinner was finished with a glass of hot water.  I walked back from their cottage with the hadadas crying in the trees.

It had taken me a while to identify the owners of the cry: a cross between the croak of a crow and the quack of a large duck.  To my surprise, the calls belonged to a flock of scimitar-beaked, goose-sized, short-legged ibis, the hadada, who, despite their appearance, roost in the foliage of trees.  Their cry is supposed to be “haaadaadaah.”  Were it me, I would not call attention to my deficiencies of grace and beauty. 

I attended staff prayers on schedule and we sang a cappella “What a friend we have in Jesus,” the small group of Kenyans and Westerners mingling their voices in the music of that old good song.  We shared the deaths of patients. 

“All our sins and griefs to bear”

I prayed with Elinor, a Kenyan nurse, for the hopes of a new academic year and completion of her master’s degree.

“What a privilege to carry

 everything to God in prayer”

I suppose I can share a few words about my living arrangements.  I live in Heron House (all of the cottages have bird names with the exception of Pathology House).  It is the designated “boy’s house” and I share it with 3 other docs currently.  One is Matt who is a visiting radiologist from Birmingham.  The hospital has a CT scanner and the films done are generally excellent.  Shawn is a Christian, born in Goa, India, raised in Nairobi and currently a Pediatrics resident at Agha Kahn Hospital, the premier private hospital in the country.  He is doing a rotation in Pediatric Surgery here and for the first two weeks I thought he was a mirage, rising before the dawn and not coming back until I had turned in.  His initial take on Kijabe is the major alteration in work ethic.  He reported that he was floored when he came onto a ward to find a visiting American doc waiting patiently for a patient to arrive.  Private docs wait to be called at home in Kenya.  Prayer before rounds and surgery is a delight for him.

The last housemate is “The Great Oohmmz.”  Omar is one of ten children of a Muslim family and will be entering the government Neuro-Surgery Program next month when he returns to Nairobi.  He is tall, painfully thin, opinionated, gracious and garrulous.  He speaks with authority about most any subject and has the fine grace to make jokes at my expense as I do at his. All food found on the counter is free-range.  Food in the cupboards is safe from predation.

My own health is not as good as it could be as I got a cold and it has caused a flare in my respiratory problems.  I am better but my voice is a croak and I talk all day to its detriment.

The nursery is relatively light but hot (88 F and 60% humidity) and in consequence, wearing.  A baby born 3 weeks ago weighing about 2.5 lbs. with moderately bad lung disease had an initial rocky course.  Her lung disease resolved and she was finally on her upward leg with weight gain and good feedings.  Today she suffered a setback and is on a ventilator.  Please pray for Grace’s baby girl.

“Carry everything to God in Prayer.”

Cultural Sunday at Kijabe A.I.C.

It was a week that came in like a lion and out like a lamb. 

While the weather in Kijabe is cool, never reaching 77F, the weather in the Nursery is always hot and humid.  If it ever gets down to 84F and 60% humidity, I haven’t been able to catch it.  Part of this is construction as it is a long masonry room with one small window to the outside world.  Some of it is crowding, as we get 16 to 20 babies in this space, their mothers, half a dozen nursing students, 4 nurses, three house officers, all the heat generating equipment …and me.  Most of it is an understanding that babies need it warm (true) and a lack of understanding that too much of a good thing is bad (equally true).  The average well, term newborn never goes anywhere without being wrapped in two to three large blankets, having two pairs of socks on his feet as well as woolen mittens, a wool cap, three layers of clothes and a nappy.  The single 4” x 3” square of naked skin allowed to breathe is usually shaded by blankets and solicitous mothers.  Fevers are epidemic.  Not to worry, the treatment is to exhume the baby from his clothes and to wait for him to radiate heat to the environment. It takes hours with mothers clucking at our cavalier exposure of their precious babies.  The down side to the experience is that, as it is in the USA, it is easier to give the baby antibiotics and keep them in the hospital for a week than it is to decide who actually may need the treatment.  This is my task for my remaining few weeks.

Follow-up:  The boy with “measles” had a herpes infection, and has gone home with treatment.  Lydia’s baby is on full feeds but is failing to grow.  Faith has recovered and has been sent back to Eldoret.  We have had two deaths: one a 3 lb. baby who died at 12 days from lung hemorrhage and a term infant with brain damage at birth.  God has shown his grace to our babies.  Please pray for these grieving families.

There were more than enough volunteers to fill beds in the nursery over the last weekend so the beginning of the week was even hotter and more humid than usual.  By the end of the week we were almost not-crazy.

One snapshot: Baby boy of Esther was delivered Wednesday at term (or perhaps a bit more) with no problems except that he was blue, flaccid, unbreathing and unmoving with a slow heart rate.  For those of you who know Apgars, they were: 0, 2, 2, 4, 4, 5, 5, and 7 at 1,5,10, 15,25,35,45 & 55 minutes despite care which I would be happy to see in the USA.  We brought him to the nursery and an hour later he was crying and moving around normally.  Currently he is requiring a little oxygen and we have started feedings.  He has a normal head ultrasound.  Please pray for Esther’s baby.

Today was Cultural Sunday at Kijabe A.I.C. Church.  The five tribes with representatives in the area got together to present how they sang and danced “in the times long ago.”  Each tribe (Kikuyu,

Kamba

, Ambagusii

, Turkana

, and Maasi

) gave a brief explanation of their dominant tribal beliefs, how they have been affected by the news about Mungu (The Lord God, in Kiswahili) and Yesu (a better transliteration of Yeshua than we use) and what words they have put to their own songs. Just to keep this in perspective, the background slide for the Cultural Sunday was a very nice photograph of Stonehenge on the Wiltshire Moors of pagan England. http://www.google.co.ke/imgres?imgurl=http://www.english-heritage.org.uk/content/images/iphone/stonehenge-iphone.jpg&imgrefurl=http://www.english-heritage.org.uk/daysout/properties/stonehenge/&h=201&w=251&sz=1&tbnid=bY2Y_IZzNp5EnM:&tbnh=160&tbnw=199&zoom=1&usg=__X2iHmkqVRGdv_rwEPV8eOwnVf-g=&docid=8eQ3aNfFC-kboM&itg=1&sa=X&ei=G5AHUraDHcnRtAbohIDQAg&ved=0CKgBEPwdMAs

Afterward we were offered samples of their traditional foods (taken in the hand, while the other hand supports the wrist as no gift is so small to need only one hand to support it).  I had: Chickpeas, beans, lentils, greens, corn porridge, sorghum drink (a thick pink, sweet and slightly sour libation) and came back to Heron house well satisfied. 

This whole event was designed to raise 350,000 Kenyan shillings (~$4200) for a combined medical, beneficent and evangelical mission to East Polkot the end of this month. 

My observations have been that in the USA, Africa is viewed as a singular.  It is indeed a complication kaleidoscope of cultures that have their own history.  Tribes have fought and killed each other for generations but have found peace together in the common bonds of being the adopted of Christ, no more nor less than we are.  The past is not forgotten; the blood does not evaporate.  But as a Turkana missionary told us in Kiswahili:

Isaiah 43: “I am the Lord God, your Holy one…your King.  Forget the former things; do not dwell on the past.  See I am doing a new thing! … I provide water in the dessert…to give drink to my people.”

This week please pray for the Kijabe outreach mission to East Polkot, August 22 to 27, for those who will hear the message and for the safety of those who bring the Word.

Scenes and Snapshots

It has been a long week and I am glad for the chance to sleep in Saturday. I went to the mduka (shops) after a late breakfast.  A pineapple, large papaya, onions, field peas, avocado, jam, milk, bread and sugar rounded out my shopping list and just about filled my day-pack.  I looked out on the Rift Valley, the dark Ngong Hills, the clouds and distant rain showers making it a very dramatic scene.  It was marred by myriad power lines, however, and I walked to the far side of Kijabe town to see if I could find the “right spot.”  I came to a road and started down it, toward the distant valley. 

Having hiked alone since I was 11, one learns a certain calculus as to when to go on and when to turn around.  Losing altitude is never good but the road was fair, the surroundings placid.  I passed the local airstrip with massive concrete posts and barbed wire to prevent people from running onto the field, I surmised.  This conclusion was somewhat confounded as a mother cow and calf were placidly grazing the runway as I crested a hill. 

I had finally done the last “If I don’t see a road back to Kijabe at the next turn, I go back,” when I met a man with his wife.  I greeted him with an “Habari” and got the expected “ya Nzuri” when the man spun off a long interrogation in Kiswahili and I had to admit I did not know enough to follow more than half what he said.  His response was typical Kenyan “How is it you are a Kenyan now and you don’t speak Kiswahili?” he said with a laugh.  I had to admit I studied hard but was a poor student and he told me to study harder and I would be speaking well within the month.  We three parted smiling foolishly. It was a long climb back to the Kijabe town road, about 500 feet, and I was hot and sweaty despite the cold blustery weather when I arrived back at Heron house.

 

Kijabe is a place of comings and goings.  People are always just arriving for a tour of duty or just preparing to leave.  This has its advantages if you play your cards right.

 

Saturday, I was invited to my second “we-have-to-empty-the-refrigerator-before-we-leave-dinner.”  Dr. Adrianna Shirk and her photographer husband invited me over …and about a dozen others.  This, at least in part, is due to the metric system.  Jack had done the shopping and apparently ordered ‘mince’ (i.e. hamburger) in pounds and was served in kilograms (1kg=2.2lbs).  When he discovered he had more than twice what he needed, he called for back-up…and we were glad to come for a feed.  Since early days of my mission trips I have made it a habit to carry toy balloons with me.  Most everywhere I go, the sight of a colorful balloon dissolves any pediatric reticence. My supply of balloons rapidly vanished among the gaggle of children and the adults started a pool to see how long between the loud pops and one more sheepish child would come asking for a replacement.  I always seemed to guess too long.  The record was 30 seconds.

Adrianna is a resident at AUB and will shortly finish her training.  She shared with me tonight that she and her husband have applied to be full-time missionaries in Kijabe.

 

A few snapshots:

Faith is a three year-old little girl who was found abandoned on the streets of Eldoret about two months ago.  She was taken into a Christian orphanage and named Faith Kutamaini (literally Hope).  She was found to have a heart defect (PDA) and was sent to Kijabe for her repair which happened this Tuesday.  It was a rocky post-op course as Faith’s condition had been neglected for so long that her lungs had been damaged.  She is still on oxygen now but doing much better.  Please pray for Faith’s continued convalescence and her life in an orphanage.

Since I arrived we have had three babies born weighing from less than two lbs to a little less than 3 lbs 3 oz.  These are small even by USA standards.  Since I was last in Kijabe, artificial surfactant has been added to the pharmacopoeia.  Our littlest one had a tube inserted into her windpipe as a part of resuscitating her at birth.  The surfactant was injected down the tube about an hour later and she was extubated and placed on nasal pressure CPAP.  She has done well for three days and fair for the last two.  We placed my first umbilical line in Kenya (a routine in NICU’s in the USA since early 1950’s) here on day two and so far have not had any complications.  Please pray for Lydia’s baby girl.

I was called to Casualty (i.e. Emergency Dept.) on Monday to see a boy sent in with “measles” from an outlying health clinic.  Other than having no signs consistent with measles, the diagnosis was spot on.  The 18 month-old boy’s tongue was obscured  by a dirty-green fetid and friable coating.  The health center had based its diagnosis on a few spots which might happen with measles but had ignored the fact that he had none of the usual signs (cough, runny nose, typical rash).  I brought a working flashlight and encouraged the staff to look before accepting the story they were handed.  He had a history more consistent with another viral infection and was admitted for two days.  His mother has AIDS but he is unaffected.  Please pray for Joshua.

Please note again that funds may be sent to the “Needy Children’s Fund” to help these sick and very precious babies.

 

Please include “Gessner/Kijabe Needy Children Fund” on the memo line

Checks should be mailed to:

Bay Leaf Baptist Church

12200 Bayleaf Church Rd.

Raleigh NC 27614

USA

Habari..Nzuri

“Hello, habari, my name is Onesimus.”
 

I was met at 9 PM by the World Medical Mission http://www.samaritanspurse.org/what-we-do/world-medical-mission-2/driver at the exit from the international terminal at Kenyatta Airport. “Habari” means “What is the news?” but suffering from fatigue and episodic politeness I responded “Nzuri”…”Good.” I am back in Kenya and again among those whose names ring like a New Testament to the faith of much of East Africa. Onesimus was indeed “Useful.” The flight from Atlanta on the 20th July was uneventful, the seat uncomfortable and the food unmemorable. I had gotten through the Forex line, the visa desk, luggage retrieval and customs in only 45 minutes and Onesimus and I exited into the cool diesel-fouled night.

 Although Nairobi is essentially on the Equator, its altitude keeps it cool year round. Onesimus caught me up on Kenyan politics (much better than 3 years ago) and the local rains (“It was a good year but we are now in the dry season”) on the trip to the Mennonite Guest house in the suburbs north of the city. Despite my fatigue I re-packed my bags, sorted out various denominations and nationalities of money, showered and changed into something less lived-in before dropping off to the sounds of a nightjar in the distance.

 

By 10 the next morning Onesimus had picked me up and we were off to Kijabe…after a trip to the local Nakumatt, sort of a grocery store cum Wal-mart crossed with several varieties of cell phone stores. On our way again after buying victuals, we started along Waiyaki Way, a major road along the north of Nairobi. Driving in Kenya is a marvel to behold …as long as you have made peace with your Maker ahead of time; near-misses, abrupt turns, lumbering trucks with a loads that seem to be attached only by bonds of habit and inanition and the occasional pedestrian of fleet-foot or suicidal ideation present themselves at regular intervals.

 

We pass Kibera, one of the biggest slums on the continent; a brown-grey sea of tin shacks undulates over hills and valleys into the smoggy distance. It is home to over a million people. We pass onto the Eldoret-Malaba Road and pass Kikuyu. We continue through Limuru. A sign across the road say “If you feel that you want to stop lying…” ends in mid-sentence due to some traffic mishap.

 

The fields open out, the soil the color of ground coffee. Cabbages grow luxuriously along the peculiar “green-stick-stuck-in-the-ground-and-sprouted” look of cassava. The road splits around the Escarpment. To the left the road slants down to the Great Rift Valley before heading off to Narok and the Lake. We take the right-hand road and pass shops built along the road and half-over a cliff. I can look back along the Rift and see the Ngong Hills in the distance.

 

Kimendi comes and goes before the highway is reduced to two lanes. We pass disinterested sheep and cattle grazing at the verge of the road, oblivious to the streams of earnest automotive traffic. At intervals, my concern seems well-placed as there are road-side kiosks demonstrating for sale suspiciously familiar sheep and cow-hides. Onesimus dodges bicycles, triple-burdened motorcycles, and trucks belching black smoke as we continue to climb away from Nairobi. At an intersection festooned with signs we turn off; one of the older and smaller ones says ”Kijabe Hospital.”

 

The trip down into Kijabe is an adventure of its own. We make hair-pin turns, the roads relocated because of wash-outs from the previous “long-wet” season of rains. We pass through a one-way underpass to avoid the Nairobi-Uganda railroad which represents the reason for Nairobi’s creation little more than a century ago and finally reach the hospital gate.

 

Kijabe has muchly changed. It is larger. The old hospital was one ramp-corridor up the valley wall with buildings sprouting from the sides. The new Kijabe has whole areas which are new and connected by slanting concrete foot-paths. A whole new section is becoming the Bethany Kids Hospital and all pediatric care will be translated there within the next few years. We are now at about 7200 ft. and the air-pressure and thus the oxygen is on 80% of what we enjoy at sea-level. I find myself being winded just walking down to “Paediatrics” and back up to Heron House which I share with a Pediatric Neurosurgery Resident from the big national hospital in Nairobi, Jomo Kenyatta Hospital.

 

Like the hospital, the medical staff has grown; I was shown around my first day by Jennifer Myhre http://www.whm.org/give/missionary?ID=50134, a career Pediatrician-Missionary from World Harvest. She is one of three pediatricians on staff. In touring the nursery, we see the conjoined –twins who were born earlier in the day. They share a single heart. This is not going to end well. The nursery is kept unusually warm, in the 85-88 degree range as they have few incubators and radiant warmers. Inconsequence they have many infants with fever, a rare occurrence in the states. One of my private goals is to try to make temperature control a priority. For that reason I have brought along a few combination outdoor thermometer and humidiometers as well as more thermometers and space-blankets.

 

An interesting note: I was taking some pictures and came upon a gaggle of mwazungu (westerners, i.e. visiting relatives of one of the missionaries) who were examining a gorgeous green snake which had been dispatched by the side of the road. I was admiring him, even in his languor mortis until I got a good look at him and realized he was a green mamba. Perhaps a bit more concerning was that I realized that the scene of his repose was the road in from of Heron House. I spoke with a local mzee (old like me) who said that there used to be a lot of snakes around Kijabe although this mamba was a “bad snake although he doesn’t eat people just rats. Apparently the cattle take exception to sharing the pasture with snakes and have eliminated most, but not apparently all, of them.

  One more item: Many of my patients’ parents do not have the funds to get what we consider basic medical services. X-rays, ultrasound exams, and (surprisingly) surfactant. This is one of only two medications which have been developed specifically for babies. It provides a replacement for lung fluids which are absent in premature infants and is the root cause of Respiratory Distress Syndrome. The cost is prohibitive. A common laborer makes about $22/month in Kenya. Surfactant costs over $150 a dose (as opposed to $1000 in the USA). Kijabe Hospital has created a fund which is managed by those of us who actually treat these babies. I ask you to please consider funding this effort to bring treatment to the smallest of my patients. Please see below.

Giving to the Kijabe Hospital Needy Children Fund

Kijabe Hospital is a 240-bed hospital in the rural, central highlands of Kenya. The hospital is operated as a Christian ministry by Africa Inland Church. Many of the children who receive care at Kijabe are desperately poor, and their families are not able to pay for the care that their children receive. The hospital operates a fund that helps to meet expenses for services such as CT scans, echocardiograms, ambulance transport, surfactant treatment for premature babies with immature lungs, and general inpatient care. Donations to the fund in US dollars may be given as outlined below. Donations are tax-deductible. Donations by check should be made out to: Bay Leaf Baptist Church Please include “Gessner/Kijabe Needy Children Fund” on the memo line Checks should be mailed to: Bay Leaf Baptist Church 12200 Bayleaf Church Rd. Raleigh NC 27614 USA All funds donated go directly to cover patient expenses, and no administrative charges are assessed by Bay Leaf Baptist Church http://www.bayleaf.org/or Kijabe Hospital. Members of Bay Leaf Baptist will receive a record of their donation on their quarterly statement from the church. Non-members will receive a receipt via US mail within three to four weeks of the time of their donation.

Starting the Countdown to Kijabe

I started mefloquine again today. The risk of malaria is probably small but one has to start the prophylaxis two weeks before you arrive. This reminded me that I am actually going to be leaving on the 20th for another mission trip abroad. This is a return of sorts to Kijabe Hospital, located about two hours drive from Nairobi and situated on the very wall of the Great Rift Valley.

It is a dramatic and pleasant location, except at nights. I was here in 2002 for a month and quickly learned the meaning of the name, Kijabe, 'Place of the Winds.' The GRV extends about 3700 miles from Syria to Mozambique, composed of valleys, lakes, faults and rills. Here it is a several hundred foot incline from the Kikuyu Highlands around Nairobi to the expanse of the valley which extends to Lake Victoria. It is about 7000ft elevation and cool at night. The winds are due to a cleft in the wall of the valley which funnel cold air into the expanse as soon as the sun sets. Sleep is difficult. I resorted to earplugs the last time. Kijabe is one of the largest mission hospitals in the continent.

It serves as something of a magnet institution for much of the area as well. This translates into less of the 'bread and butter' of tropical medicine (malaria, starvation, parasites, burns, diarrheal disease and injuries) and more exotica. In consequence, teaching is more important and house-staff help spread the load. I will be returning in September. It is after all a long way to go for a weekend and I hope to be able to help effect some improvements and not just be a medical tourist.

Since I was here last, much has happened. There have been an election since I was last in Kenya in 2010 at Tenwek Hospital (see link). The last election was a political and national disaster with deaths and displacements which continue to today. The election earlier this year was at least peaceful. Kenya friends such as Anne Mukwenyi (in back in 2002)

have survived and I thank our Creator for his mercies for our brothers and sisters in Kenya. Anne was head nurse on Paediatrics and is now a nursing instructor, married and has two young children. her husband is also a nurse. In 2010 I had the pleasure of staying with them at Kijabe on my way home from Tenwek. Things are much more stable now and I do not anticipate any significant drama while I am there. Not all my trips for missions (this will be # 14 since 1999) have gone easily for me health-wise and I humbly ask for your prayers for my health and safety. Cheryl will be keeping the home fires burning and I also ask you to keep her in your prayers while we are separated.