Tuesday, June 7, 2011
Wow! Not a great way to go; only in Africa.
A 31 yo Kenyan man works in people’s shambas (gardens). He does a lot of digging and moves around the local area. Two weeks ago he is digging in a shamba on the edge of Lake Naivasha in the middle of the day. Lake Naivasha is one of the Great Rift Valley Soda Lakes that string along from Tanzania up to Ethiopia. It is a 45 minute drive from Kijabe and we like to go there every month or so. Now about hippos. They are plentiful in Lake Naivasha and one rarely sees them out of the water. They spend the day mostly submerged in the Lake, and come out at night to forage for food. They might even go 3-5 kilometers away from the lake at night looking for grass. Since they are in the lake during the day you don’t have to be afraid of them until the night when they can be up around the lake and if encountered on land can be very deadly. That is why everyone stays away from the lake edge at night, or has powerful electric fences to keep the hippos out. Back to our digging man. He is working away in the middle of the day and should have nothing to worry about. He has probably done this typical day a thousand times. The problem is babies. When hippos have babies the mom will sometimes hide the baby along the lakeshore in the bushes and go off foraging for food. Unbeknownst to our digger he is near to a hidden baby hippo. Momma is quite a long way off but looks and sees that a strange man is close to her hidden baby. This will not do and she comes running at a full gallop to “save” her baby. The poor digging man doesn’t stand a chance and is crushed in the hippo’s mouth all along his right side. His right humerus suffers an open fracture, multiple ribs are broken, there are large abrasions/bruises along the right side of the body. He goes home and doesn’t show up to our hospital for 2 days. Enough time for the wounds to fester and him to become septic. We try to save him for about a week, but in spite of OR debridement/ex fix, chest tube placement, antibiotics, intubation and local wound care, he succumbs to his injuries.
Friday, May 20, 2011
i almost forgot...
Today I realized that I had not blogged about our dinner with Jane! Such an amazing treat....
Here in Kijabe we have a vegetable market of sorts. It isn't the best. The ladies liked it better when they could go door to door and just on Tues and Sat. For some reason this has now been made against the rules and so they have to spend 6 days/week sitting all day at their tables in this little market spot. I find it stressful to go there because I feel obligated to try to buy a little something from each person...there are probably about 8 ladies?? at any given time. Their products are not all equal...so it is the situation where you are thinking, "i need to buy tomatoes, i should buy something from her...her tomatoes aren't great...and those over there...where i already bought zucchini...are much better..." And on and on...The problem is, this makes a person like me want to avoid the place if possible and this is bad for business.
Anyway, I have become quite good friends with one of the vegetable ladies. When we introduced ourselves I was sure she said "jean", so I have called her Jean all year. Not too long ago, after being told by someone else that her name was actually Jane!? I asked her to spell her name. The accent makes it hard to discern between these two names. Sure enough, "j-a-n-e"...Jane. She has never corrected me. I am going to go with the idea that she probably can't really tell which I am saying...accents can be helpful!
A few months ago she came to me with a story about her granddaughter who was in the hospital...needing money to get out etc. I suggested that I could give her money to allow this to happen but maybe she could bring me vegetables...just to make it more like a transaction between friends. (So much of our life here is about people seeking donations from us.) She liked this idea and has brought us vegies several times. But the best thing happened...The transaction strengthened our connection. As a result, she insisted that she was going to have our group up for dinner when the kids were here...that meant 8 people! I tried to get her to wait so it wouldn't be so many, but she insisted.
It was a feast! Incredible Kenyan generosity and hospitality. I know we all felt totally humbled and honored...
Here in Kijabe we have a vegetable market of sorts. It isn't the best. The ladies liked it better when they could go door to door and just on Tues and Sat. For some reason this has now been made against the rules and so they have to spend 6 days/week sitting all day at their tables in this little market spot. I find it stressful to go there because I feel obligated to try to buy a little something from each person...there are probably about 8 ladies?? at any given time. Their products are not all equal...so it is the situation where you are thinking, "i need to buy tomatoes, i should buy something from her...her tomatoes aren't great...and those over there...where i already bought zucchini...are much better..." And on and on...The problem is, this makes a person like me want to avoid the place if possible and this is bad for business.
Anyway, I have become quite good friends with one of the vegetable ladies. When we introduced ourselves I was sure she said "jean", so I have called her Jean all year. Not too long ago, after being told by someone else that her name was actually Jane!? I asked her to spell her name. The accent makes it hard to discern between these two names. Sure enough, "j-a-n-e"...Jane. She has never corrected me. I am going to go with the idea that she probably can't really tell which I am saying...accents can be helpful!
A few months ago she came to me with a story about her granddaughter who was in the hospital...needing money to get out etc. I suggested that I could give her money to allow this to happen but maybe she could bring me vegetables...just to make it more like a transaction between friends. (So much of our life here is about people seeking donations from us.) She liked this idea and has brought us vegies several times. But the best thing happened...The transaction strengthened our connection. As a result, she insisted that she was going to have our group up for dinner when the kids were here...that meant 8 people! I tried to get her to wait so it wouldn't be so many, but she insisted.
It was a feast! Incredible Kenyan generosity and hospitality. I know we all felt totally humbled and honored...
Monday, May 16, 2011
seattle weather forecast.
Today a friend from home wrote and told me that it has not reached 70 degrees in over 190 days in Seattle??!? Wow. That is a long time...and 70 is not even a great target in my opinion. This is not good.
The closer we get to returning home the more we anticipate and the more we think about what we might miss. I know for certain that I will miss the weather. Kijabe enjoys some of the most perfect weather in the world. It has to be. We have sunshine everyday, most of our rain comes at night, I rarely need a sweater, never need a coat, and I have worn out a few pairs of flip flops because that is all I wear. I need to get out of this perfect weather place because my skin is getting too much sun! What a problem...
The Kenyans don't experience it quite the same as we do?? Not sure how this works. This is considered the "rainy" season...and the slight change in temperature is classified as "cold". Even when it was dry and a bit hotter we often saw people wearing down sorts of coats and children bundled like they were about to head out into the snow for a few hours. Warren has often removed balaclava type of hats from children's heads wondering if they have sort of grown with the hat on??, as it seems the child must have been a different size when it was first applied!
So apparently there is a lot to experience and perception, even with regard to weather. I doubt that a year in the sunshine is going to help us with having a positive perception of weather in Seattle when we return. We will have to readjust.
As we begin to anticipate all that we will find easy to adjust to upon our return(John talks about his favorite eating spots a lot!), we also think about what we will miss here. I am still obsessed with the sky...every day, and acacia trees, and the color of the air itself...I recently read a description of the African sky..."Everything stands out, as though...a fourth dimension of space has overlain the world."
Exactly.
Hopefully the impact of these experiences and perceptions will color our return and our life from here forward. One of my first goals is to find paint as similar to acacia bark as possible and fill my upstairs with that color! Since it looks different in every light.....should be an interesting challenge.
Ali and friends have reported in from Morocco. Their adventures continue.
The closer we get to returning home the more we anticipate and the more we think about what we might miss. I know for certain that I will miss the weather. Kijabe enjoys some of the most perfect weather in the world. It has to be. We have sunshine everyday, most of our rain comes at night, I rarely need a sweater, never need a coat, and I have worn out a few pairs of flip flops because that is all I wear. I need to get out of this perfect weather place because my skin is getting too much sun! What a problem...
The Kenyans don't experience it quite the same as we do?? Not sure how this works. This is considered the "rainy" season...and the slight change in temperature is classified as "cold". Even when it was dry and a bit hotter we often saw people wearing down sorts of coats and children bundled like they were about to head out into the snow for a few hours. Warren has often removed balaclava type of hats from children's heads wondering if they have sort of grown with the hat on??, as it seems the child must have been a different size when it was first applied!
So apparently there is a lot to experience and perception, even with regard to weather. I doubt that a year in the sunshine is going to help us with having a positive perception of weather in Seattle when we return. We will have to readjust.
As we begin to anticipate all that we will find easy to adjust to upon our return(John talks about his favorite eating spots a lot!), we also think about what we will miss here. I am still obsessed with the sky...every day, and acacia trees, and the color of the air itself...I recently read a description of the African sky..."Everything stands out, as though...a fourth dimension of space has overlain the world."
Exactly.
Hopefully the impact of these experiences and perceptions will color our return and our life from here forward. One of my first goals is to find paint as similar to acacia bark as possible and fill my upstairs with that color! Since it looks different in every light.....should be an interesting challenge.
Ali and friends have reported in from Morocco. Their adventures continue.
Monday, May 2, 2011
another update from africa...
Alison and Myles have been with us for more than 5 weeks now! Katie has been with us about 4. It has been fantastic. It is hard for us to imagine that we will be back to our smaller group after Saturday, when they head off for more adventure in Europe and Morocco! We have shared a mtn climb, a beach trip, hikes, walks, runs, FOOD, animal spotting, piki riding, sports, games...and this weekend the kids went as a group to the Maasai Mara where they camped and drove to see elephants, lions, rhino, hippos...all with babies...and cheetahs and warthogs...etc etc. With some help from our friends and new Kenya connections they were able to do this for very little money. A huge treat!
Katie and Ali are going to leave here with hair twists, scheduled for tomorrow. This will make hair maintenance easy for the rest of the trip!
They have been great sports, tried everything, reveled in being here...and seem to think that Kijabe is the best place of all.
Times in Africa aren't without incident. And here in Kijabe we have recently had a terrible murder of a child and a break in at the hospital, not without some violence as well. The recent bombing in Morocco gave them a little pause...as they contemplate being there shortly.
But adventure includes just that...and they are ready for more! So off they go on Sat. And we will miss them!!
As for us...we have about 11 weeks left here!? John has started his last term of school and Warren has a teaching/training trip planned to another place in Africa. Erika will be with us until mid June. There are a few more guests coming and going and various things to finish before we leave.
We are starting to feel excited about coming home, with bits of realization that there will be hard things about saying goodbye as well. The time is going to fly by!
Warren has been doing a bit of mtn biking. Yesterday he arrived back at the house absolutely covered in mud! And his words were, "i have to learn, i am not 25 anymore...but i really do still think i am!" Apparently, and obviously!, he had taken some amazing falls...including one where he landed head first on a rock...top of head to rock. It was a good test for the helmet. After quite a long soak in the tub and a lot of work on clean up he seemed pretty ok. Learning that he isn't 25 will take some more time.
Katie and Ali are going to leave here with hair twists, scheduled for tomorrow. This will make hair maintenance easy for the rest of the trip!
They have been great sports, tried everything, reveled in being here...and seem to think that Kijabe is the best place of all.
Times in Africa aren't without incident. And here in Kijabe we have recently had a terrible murder of a child and a break in at the hospital, not without some violence as well. The recent bombing in Morocco gave them a little pause...as they contemplate being there shortly.
But adventure includes just that...and they are ready for more! So off they go on Sat. And we will miss them!!
As for us...we have about 11 weeks left here!? John has started his last term of school and Warren has a teaching/training trip planned to another place in Africa. Erika will be with us until mid June. There are a few more guests coming and going and various things to finish before we leave.
We are starting to feel excited about coming home, with bits of realization that there will be hard things about saying goodbye as well. The time is going to fly by!
Warren has been doing a bit of mtn biking. Yesterday he arrived back at the house absolutely covered in mud! And his words were, "i have to learn, i am not 25 anymore...but i really do still think i am!" Apparently, and obviously!, he had taken some amazing falls...including one where he landed head first on a rock...top of head to rock. It was a good test for the helmet. After quite a long soak in the tub and a lot of work on clean up he seemed pretty ok. Learning that he isn't 25 will take some more time.
Wednesday, April 20, 2011
time out in mombasa....
Turquoise water, white sand, warm air, fresh fruit, monkeys, coconut dropping out of trees, rain, sun, bugs...fresh fish...constant requests for money, hawkers selling things we don't want or need, "mzungu, mzungu"(white person, white person), family together...plus friends, relaxation, exercise, snorkeling, reading, sleeping, sweating...walking, running, eating, drinking...talking, laughing...games...Ali leading yoga sessions...
Our week of vacation in Mombasa...
Today we went into the old town of Mombasa where we saw the sights of movies and books...Swahili culture, slave caves, old forts and harbors, feral cats, dead rats, flies on fresh meat, spices of all colors including bright pink, burkas, an old Caprice Classic in the road...How did this get here?
We are staying in a true African beach chalet...on the beach, but not without ants, lizards, a cockroach or two, hermit crabs, monkey thieves, cats and fleas!? Today Warren asked that our mattress be changed out....hoping to get fewer flea bites tonight! Somehow he is getting eaten alive despite the mosquito net?? They have no interest in me...no surprise.
Today I told Erika that I felt tired. She asked if I thought I might take a nap. I said,'no, i mean of this continent'. I was feeling wiped out by the day of travel and sightseeing, as in sight seeing...many sights, not all great. And an hour plus long wait for a ferry ride in incredibly hot conditions...with the ferry(s) in constant site...taking an assorted group of vehicles and people, but never quite getting to our line?!!?
Eventually we made it. It was a classic TIA episode.
But so was the fresh red snapper and garlic prawns that waited for us, cooked by our cook for the week, Hassani, who has whipped up an assortment of seafood and curry to die for all week long. So taking the bad with the good...we will enjoy another day of white sand and sunshine tomorrow, with plans to end the day at a restaurant inside a coral cave!
Our week of vacation in Mombasa...
Today we went into the old town of Mombasa where we saw the sights of movies and books...Swahili culture, slave caves, old forts and harbors, feral cats, dead rats, flies on fresh meat, spices of all colors including bright pink, burkas, an old Caprice Classic in the road...How did this get here?
We are staying in a true African beach chalet...on the beach, but not without ants, lizards, a cockroach or two, hermit crabs, monkey thieves, cats and fleas!? Today Warren asked that our mattress be changed out....hoping to get fewer flea bites tonight! Somehow he is getting eaten alive despite the mosquito net?? They have no interest in me...no surprise.
Today I told Erika that I felt tired. She asked if I thought I might take a nap. I said,'no, i mean of this continent'. I was feeling wiped out by the day of travel and sightseeing, as in sight seeing...many sights, not all great. And an hour plus long wait for a ferry ride in incredibly hot conditions...with the ferry(s) in constant site...taking an assorted group of vehicles and people, but never quite getting to our line?!!?
Eventually we made it. It was a classic TIA episode.
But so was the fresh red snapper and garlic prawns that waited for us, cooked by our cook for the week, Hassani, who has whipped up an assortment of seafood and curry to die for all week long. So taking the bad with the good...we will enjoy another day of white sand and sunshine tomorrow, with plans to end the day at a restaurant inside a coral cave!
Thursday, April 14, 2011
kili images...
I tried. For some reason I can't get any more images to upload!? Oh well. Here are the Fisher kids...together...so nice!
Sunday, April 10, 2011
Hospital Stories
Hello to All,
In the past few weeks we have had some good outcome cases that came through the ED/ICU:
A 50yo diabetic/htn man came in with significant chf that brought him to the ICU. One of my colleagues was covering the ICU and at 4am I got a call that could I come and help with the case. On my arrival to the ICU the man was being bagged with difficulty, sat’s were low, and he had a bull neck that had difficult to intubate written all over him. After some fentanyl and valium and three unsuccessful attempts at passing the ET tube into the trachea I was fortunate to succeed on the fourth try. The cords never were visualized. The glide scope or an eschman would have come in handy. I put the patient on the ventilator at a rate of 20 breaths per minute and within 5 minutes his heart rate went to 30 with a widening QRS. I took him off the ventilator and bagged like crazy (difficult with high pressures) gave epi, bicarb, atropine and his rate came up and the QRS narrowed down to normal. Remember that we don’t have ABG’s to help guide acid-base decisions but I was pretty sure that he was Mr. acidotic. I put him back on the ventilator, this time with a rate of 30 per minute, and he maintained good vital signs. 2 days later he decided to pull out his tube and flew off the ventilator just fine. His repeat EKG showed an MI, but except for a hoarse voice he went home feeling fine in another 3 to 4 days.
Another man came in to the ED with decreased mental status and minimal respiratory drive. He was around 30 and we postulated he probably took an overdose of some pesticide; a relatively common scenario. He was admitted to the ICU and over the next three weeks developed pneumonia (likely aspiration/hospital acquired), was ventilator dependent to the point of needing a trach, developed an expanding pleural effusion that I relieved with a chest tube, but in spite of it all he finally decided to get better and was eventually sent home walking and talking like normal. I’m glad I didn’t take him off the ventilator around day 4 when he was showing no sign off neurologic recovery and I thought he would be one of those cases with big-time anoxic encephalopathy. I figured since he was so young I would give him a little more time.
I am looking forward to returning to my Northwest ED Family in a few months. I have missed you all and appreciate the support I have felt from home. Just a few days ago I showed my kids the video I was given from all you guys over the Christmas season; they were very impressed with such a huge effort and show of affection.
Thanks Again!
Warren
In the past few weeks we have had some good outcome cases that came through the ED/ICU:
A 50yo diabetic/htn man came in with significant chf that brought him to the ICU. One of my colleagues was covering the ICU and at 4am I got a call that could I come and help with the case. On my arrival to the ICU the man was being bagged with difficulty, sat’s were low, and he had a bull neck that had difficult to intubate written all over him. After some fentanyl and valium and three unsuccessful attempts at passing the ET tube into the trachea I was fortunate to succeed on the fourth try. The cords never were visualized. The glide scope or an eschman would have come in handy. I put the patient on the ventilator at a rate of 20 breaths per minute and within 5 minutes his heart rate went to 30 with a widening QRS. I took him off the ventilator and bagged like crazy (difficult with high pressures) gave epi, bicarb, atropine and his rate came up and the QRS narrowed down to normal. Remember that we don’t have ABG’s to help guide acid-base decisions but I was pretty sure that he was Mr. acidotic. I put him back on the ventilator, this time with a rate of 30 per minute, and he maintained good vital signs. 2 days later he decided to pull out his tube and flew off the ventilator just fine. His repeat EKG showed an MI, but except for a hoarse voice he went home feeling fine in another 3 to 4 days.
Another man came in to the ED with decreased mental status and minimal respiratory drive. He was around 30 and we postulated he probably took an overdose of some pesticide; a relatively common scenario. He was admitted to the ICU and over the next three weeks developed pneumonia (likely aspiration/hospital acquired), was ventilator dependent to the point of needing a trach, developed an expanding pleural effusion that I relieved with a chest tube, but in spite of it all he finally decided to get better and was eventually sent home walking and talking like normal. I’m glad I didn’t take him off the ventilator around day 4 when he was showing no sign off neurologic recovery and I thought he would be one of those cases with big-time anoxic encephalopathy. I figured since he was so young I would give him a little more time.
I am looking forward to returning to my Northwest ED Family in a few months. I have missed you all and appreciate the support I have felt from home. Just a few days ago I showed my kids the video I was given from all you guys over the Christmas season; they were very impressed with such a huge effort and show of affection.
Thanks Again!
Warren
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