Saturday, November 27, 2010

med notes from warren...

The Casualty/Clinic continues to occupy my time. Kids continue to come in who are sick and at times confusing. A sick newborn came in recently who had been home from the hospital for 7 days. The parents took him to a nearby clinic on day 6 after noticing that the child was febrile, not feeding well, and generally acting sick. They were sent home with a bottle of amoxicillin and came to the hospital the next day after the child continued to decline. The child required a lot of work after it was determined that the accucheck was 1 (that’s around 18 in our lingo). IV access was difficult but an intraosseus line was helpful. Intubation, glucose, fluids, femoral blood stick, CSF, antibiotics and a carry up to the ICU, where I placed the baby on a little German baby vent, all went pretty smoothly. I took out the IO after about an hour when we had another peripheral line. The line had been in the right tibia just below the tubercle and the skin of the lower leg remained loose with no evidence of extravasation, but the leg from the level of the IO down to the foot became very purplish with delayed cap refill. This puzzled me. After removing the line the leg improved, with better color and warmth (what was that about?). However, sometime later in the night the poor child suffered a rather sudden decline leading to a code that ended in the baby’s demise. I was sad for the family and couldn’t help think how unfortunate it was that they had gone to that clinic instead of coming immediately back to the hospital.

On a brighter note, there are twin preemies in the neonatal unit who are 29-30 weeker’s. They came in with bilirubins in the mid twenties shortly after delivery and underwent exchange transfusions through their umbilical veins. They looked pretty terrible with little chests that looked like little birds...all retracting. That was last week and now they are still alive, on NGT feeds and they look like they will make it.

I’m into day 14 of treatment for rabies on a 10 year old boy who was bit by a crazy dog on his porch. The dog subsequently died the next day. I was told that it is possible to collect the dogs head and with the help of the pathologist (which we do have), cut the brain up in the morgue and look for those things you see in rabies; some bodies of something. It all sounded a bit farfetched so I elected to just treat as if the crazy dog did have rabies. Finding the immunoglobulin was difficult; it was found in the Nairobi National Hospital and brought out to Kijabe the next day. This kid is looking great.

Sandra is writing a grant proposal for a new building for outpatient care, which will subsequently allow for expansion of the ER. This seems like a worthwhile endeavor and would provide an opportunity for us to provide care for more people and with more efficiency.

Today we had the privilege of attending our first Kenyan wedding. Two of the young doctors I am working with married each other. We were 3 of the 5 white faces in the crowd. It was great fun.

Friday, November 26, 2010

Saturday, November 20, 2010

holidays approaching??

As we hear of reports of possible snow in Seattle, we enjoy warm sunny days with breezes turning to wind gusts late in the day, a combination that dries our laundry in about an hour on the line, and with an intensity that fades our clothes rapidly if we leave them there too long! Without sunscreen we are quickly over baked, due to the nearness of the equator.

I love this! I love the warm air, the constant supply of summer fruit, the opportunity to easily find warm and intense heat on my skin, the incredible sky that evolves and changes all day long, culminating in a spectacular sunset every single day.

But...we are all missing home now. We left home 3 months ago today. We are ready to see our girls again! (when John was little he used to say, "where are my girls, i miss my girls"...we all feel this way right now!)and we are in denial that the holidays are approaching...partly due to the fact that we don't have a single familiar changes, music, decorations in stores (actually there are a few in Nairobi), festivities filling the calendar...and partly due to the fact that we can't quite imagine them without our friends and family.

John starts a school break in a few days. We look forward to a week with Christina, Victor and Yohani in Mozambique. They are family to us so this visit will fill us up and the timing is perfect.

Monday, November 8, 2010

blog overkill??

Moses heading into Mathare

While running today I decided there was one more thing that I had to blog…overkill for two days or not!

On Sat we went to a huge slum (pop. est. 500,000). We were looking at a project for youth, run by Moses, a young man who lives in the slum, goes to seminary, and submitted a proposal to the Fluid Foundation for a kerosene business idea that he wants to use as a financial project to support the youth program. He is a busy man! And his business has started well. They have as many as 300 customers each day and it has only been a few months since they started!

As we walked through the slum the children were literally following and surrounding us saying “How are you?”, the only English they know. It is the way it was being said that made it quite memorable…I think I thought of it while running today because it would be like if you were counting 1-2-3 while running, or marching in a pre-election parade and chanting, “Yes, we can!” over and over and over…Emphasis on the first and last word.

Finally, I decided to respond with more than a smile and hello…So I said, “Nzuri. Je, na wewe?” (Good, and how are you?) To which I got a shocked look and sentences of response…no longer in English!

Oh dear…now what? I can ask if they like boiled or bbq meat better. Doubt they get either often, if ever. I could ask where they would like to visit…!? Surely a bad question to ask a child without shoes…

My language, but even more…the difference in our experience…really caused me to hesitate about where to go with conversation. Granted, those early phrases in language learning are quite funny. How often do you ask someone what foods they like to eat in the second sentence of your first conversation, or whether they like goat or turkey, or where they would like to go in the world? But these were surely the wrong questions here.

Then we visited Kalyie, an intern from Maryland, working in the slum as an artist. At the start of this particular class she had asked the kids to make lists of things they would like in their dream home. They were in the stage of painting these dream places when we arrived. Their painted houses looked so much like the one I know as my home in Seattle. Trees, space, flowers, windows, doors, sky, grass…

They know. They have an idea of what the good life is. In the context of a place (Moses’ Inspiration Center) where they strive to encourage and support these kids to stay in school, get out of the slum, pursue a better life…It is important to ask… What do you like, what do you want, where will you go? It gave me the tiniest bit of hope that it is possible…perhaps they can.

Sunday, November 7, 2010

Checking in on the medical front from Kijabe

Last week was heavy with RTA’s (road traffic accident’s). One of the unfortunate results of improving roads in Africa is that cars can go much faster and the resulting accidents are more severe. On the weekend a small bus collided with a lorrie it was overtaking and about 13 people came into Kijabe. Three people died and others were admitted with serious injuries. Two days later a similar event brought people into casualty, say around 14, but thankfully no one died. One young man was paralyzed from the waist down and others suffered multiple open fractures. Treating CHI’s (closed head injuries) is a challenge here. We don’t have a CT scanner so you must rely on clinical evaluation, which is a bit like crossing your fingers. I learned an interesting neurosurgery trick the other day: you can screw through the skull, insert a catheter into the ventricle, inject air and take an x-ray. Then you can tell if there is midline shift and be guided in where to drill a burr hole. I had to put a number of joints back into place with all the accidents and had the pleasure of putting my first traumatic posterior hip dislocation back into joint. I have put back innumerable prosthetic hip dislocations at Northwest and thankfully the techniques are no different for traumatic hip dislocations. I have a small pocket pulse ox/heart rate monitor and it works perfectly for cases requiring moderate sedation. I pop it on the finger, inject a little valium/fentanyl and voile, pop goes the joint…after a bit of pulling of course. I have oxygen and suction, as well as airway stuff, so we’re good on that front. I’ve had to learn to live without etomidate or propofyl here, but have come to a new appreciation for the old fashioned standbys.

just a tiny bit of an amazing week!

This week has been our most amazing so far! It is hard to even know what to say about it. Ken Kierstead from Seattle, UPC and the Fluid Foundation…and a friend of many of you, was here in Kenya. He graciously welcomed us into his adventures and plans and what resulted for us were the most incredible experiences…meeting people, seeing projects, making friends…

Last Wed we drove across the Rift Valley in order to join up with Ken, some Kenyan World Concern staff and drivers to take us in 4 wheel drive vehicles across miles and miles of horrid roads, passing giraffe, zebras, ostrich, wildebeests etc etc. until we reached an extremely remote Maasai village where 2-3000 people live! The area would be totally uninhabitable, as was the land all the way from Narok town where we met up with the group, to the village, if it weren’t for a spring which provides an endless source of clean water and makes it possible to have trees, grass, grow crops and live….not lavishly, but survival is possible. There were a few trucks, and a few matatus…otherwise it is all about walking….endless walking! ( I would love to put a pedometer on a Maasai for a day! All our “records” would be smashed immediately for sure!) We had the privilege of seeing a credit union/saving type of project whose start up the Fluid Foundation and World Concern have partnered to support. The concept of saving is so new and unusual, but here they are making headway and catching on. Perhaps the next time there is a drought, as there was for several years only ending about 9 months ago, they will be able to use the money they have put aside to help them keep from starving! It was very exciting to see this catching on. The credit union has almost 300 members as it ends the first year.

I had the pleasure of getting close contact with a young Maasai woman, a member of the board for the project. She stayed close to me and I longed to talk with her. Many of the Maasai are so beautiful. I find myself wanting to stare...which my kids say I do anyway! So this is probably really bad. Finally we were in the car together as we headed back to the village after a goat feast…this is a huge deal in Kenya…getting treated to goat…(Whether you think of it as a treat or not it would be horrible to not partake with gratitude and enthusiasm. Thankfully, Warren and I basically like it.) Anyway, we were in the car with a Maasai who speaks English so we could ask each other a few questions. She asked me, “is he your husband?” and I asked her if she was married and if she had children. She was and had two, ages 2 and 6. Then she asked me if I had children. (John was not with us) I told her about them and their ages…She clapped her hand over her mouth…shocked and realizing that I am OLD!;) It is hard to tell ages of people you don’t see often…as in other races and cultures!! We have the same problem. I was guessing at that point that she was about Alison’s age….and when I asked, exactly right. I later learned that she is someone’s second wife…

The separation of language…painfully limiting. I could have spent days and nights talking with her…hearing her story, learning about her life and culture, asking her about her hopes and dreams. Instead I went home with a wee connection that indicated that we wished for more…and a beautiful beaded necklace that she made which symbolizes that I am a queen or something amazing…and a hope for heaven…and the chance to communicate!!

Later this week I met Frances, a whole blog in himself…but he speaks 23 languages! And I believe him…He was clearly one of the brightest and most alive people I have ever met, and also Rose…who speaks 10…including fluent German, an uncommon sort of addition for a Kenyan.

Some people just get right to it.