Happy Thanksgiving!

Happy (late) Thanksgiving!  This past week has been busy with starting in Peds and all of the Thanksgiving festivities.  Emily and I were a little fearful of being really homesick and missing out on this family holiday, but the missionaries here are so warm and inviting that it felt like your typical family Thanksgiving. Plus, we ate REALLY well!  I am thankful for so much this year, but it would probably take me a million pages to list them all.  I do want to say ‘Thank You!’ to everyone back home for supporting me in this journey.  I know lots of people probably thought I was crazy when I said I wanted to go to Kenya for two months, but all of my family and friends have been absolutely amazing and I know I would not be here without all of them cheering me on with their kind words and prayers.  I’m grateful for every single one of you in my life, Thank You!

Since Thanksgiving is obviously not celebrated in Kenya, we did have to work a full week.  We got a very nice meal Thursday afternoon for lunch with the White family: chicken noodle soup (perfect for the cold, rainy afternoon we were having), green beans covered in these fantastic herbs (only green beans I’ve ever been able to enjoy), bread, and apple pie.  Then for dinner the Roberts family invited us over for turkey and dressing as well as a wonderful chocolate, pecan, and butterscotch pie.  They also streamed in the Macy’s Thanksgiving Day Parade.  We played the game “How well do you know the Macy’s parade and what character is that?!” because it was a little choppy video coverage, but still enjoyable.  Yesterday, we got to have the big Thanksgiving Day feast with most of the missionary families in the atrium above the surgical theaters.  It was amazing!  We followed up lunch with pie time at 5 and the movie ‘Elf’ at 7.  There was also the option to watch some college football games at the Roberts house, but we were so exhausted we went to bed early.  All of the families here act like one giant extended family and it was a fantastic day getting to experience that and feel like part of the family.  Definitely one of my top Thanksgivings!

 The Thanksgiving feast

 Celebrating Thanksgiving with our new friend, Laura

Happy 1st Thanksgiving, Laura!

 The pie table :)

The past week in pediatrics has been somewhat busy, especially in the nursery, and it’s also been an interesting learning experience.  I try to compare it to what I would be seeing at home and it doesn’t really match up.  If I were at home, I believe I would be in a clinic seeing regular check-ups and mostly acute illnesses such as ear infections.  In Kenya, I have seen whooping cough, possible enteric fever and malaria, sickle-cell disease, and lymphoma.  We also had one child who had a dog bite who was being treated for rabies.  The little boy I spent most of my time with this week has recently been diagnosed with Guillain-Barre Syndrome and cannot movie his arms or legs and has constant sharp pains in his legs.  In the US, if he had been seen upon onset of his symptoms (weakness and pains in his legs), we could have done plasmaphoresis or given him IV Immunoglobulin to hopefully help.  Those are not options here so he basically does physical therapy to keep his limbs from stiffening up.  He has been in the hospital for over 20 days and now has pneumonia for the second time since being here.  We are hoping to get him over the pneumonia and home soon after, but he will basically be a quadriplegic the rest of his life.  Please pray for this little boy and his father who has been taking such good care of him in the hospital.

I’m also a little sad because one of my favorite patients to see is no longer at the hospital.  Mark introduced us to this boy named Washington who he was doing physical therapy with because he had to have one leg amputated.  He will be receiving a prosthetic leg hopefully very soon from a team in Atlanta, but for being such a young kid and having to go through something that traumatic he never was without a smile.  Once I started in Peds this week, I got to see him cruising up and down the hallway every day in his wheelchair or walking on his crutches and he smiled every time.  He even saw me from afar one morning walking up the hill towards the hospital and gave me a huge wave with his big grin – it melted my heart!  I’m glad he is home but I do miss his joyous presence.  I will also miss the Kenyan medical students, in particular Liz and Sylviah who I spent time with in both OB and Peds.  They were both wonderful help and fun to talk to, but I look forward to keeping in touch with them and hopefully seeing them again one day.

Liz and I in the nursery

We are down to just two weeks left in Kenya and Emily and I have both fallen a little ill since last night.  Please pray for a speedy recovery for both of us so that we might enjoy our last couple of weeks here fully.  Hopefully a day of laying around and watching movies will help us feel better by tomorrow :)


God Bless everyone!

Peds: My Homeland!

First day in Pediatrics and I survived without kidnapping any children :)  But I definitely considered it!  I uttered the statement I would like to kidnap the entire room of children under age 6 and one of the nurses gave me a funny look.  Apparently sarcasm does not translate well from America to Kenya.....oops!

Seriously though, I am really looking forward to the next three weeks.  Today was an orientation type day to learn how things operate in the Pediatric ward and nursery: we have morning meeting at 8 am (with all of the medical staff, we have been doing this since we got here), pre-rounding at 9 (which is where I will get my own patients to see), chai tea at 10:30 (the entire hospital pretty much stops for chai at 10:30), rounding with the consultants at 11 (the same as attending physicians in the US, we have to present our patients we see to them and make sure we are doing the right thing for the patient or get advice basically), lunch at 1, then pre-rounding/rounding in the nursery after lunch to finish up the day.  I observed all of morning rounds but did get to pre-round on one baby in the nursery.  It kinda takes a while to get familiar with the different abbreviations the medical staff uses here, so I was trying to decipher the chart and then make sure I didn't write something that wouldn't make sense to them with American-style abbreviations.  Plus, these are NICU babies which is completely unfamiliar to me I feel like.  Even though I've had some in-class training, handling newborns is a little out of my comfort zone and especially in a foreign country. However, that is why I am doing this - to learn.  I do prefer to work in clinical settings over the hospital, but I want to learn as much as I can about all things peds since it is my future job (hopefully).  This is also why I still have two more peds rotations coming when I get back to the States.

One thing I have learned already in pediatrics is that he and she are kinda used interchangeably when talking about the patients and no one seems to mind (or notice, I can't tell).  It is also difficult to tell sometimes just by initial glances if they are a boy or a girl because all children who go to school shave their heads.  This is to control lice outbreaks.  Also, clothes and colors seem to be almost neutral gender when they are younger.  There was an 8 month old boy with a pink outfit on and another 3 year old boy wearing a rather feminine yellow cardigan.  I also noticed this when we were at the orphanage our first weekend here because they did not care one way or another if it was meant to be a boys' or a girls' shirt, they just loved the new clothing.  I saw a girl at church this weekend who had on a white dress, but underneath there was a brown t-shirt and sweatpants with a power rangers jacket over the top (and not the female power rangers on the jacket I might add).  Now this could be because they believe it is really cold outside when it's 60s-70s and people dress in several layers, but I still found it to be an interesting combination.  I guess I don't have to worry about offending anyone if I say the wrong pronoun but I will still do my best to double check the chart before I say one way or the other.

We did see some very interesting cases today that are going to take a lot of work trying to decipher what exactly is going on with all these kiddos.  We also had two little ones (both under the age of 3) that we had to prepare for hospice care and another one who is a little older but has a disease that will eventually end her life as well.  There was another little girl I would have LOVED to have gotten a picture of who has pertussis (aka whooping cough) and make her the poster child in America for Vaccinate Your Children (and Adults-Get your Pertussis booster so you don't pass it on to your child/grandchid/etc.!)  She was actually doing better today they said but still coughing so hard for so long she would almost get strangled and then vomit.  And yes, I am pro-vaccines :)  Moving on....

Here are just a couple pictures I took today but I am sure there will be more to come during my time in peds because these kids are just so darn cute.  Also, please pray for safety for Mark who is sitting at the Nairobi airport about to start his long trip back home and please pray for Emily as well as she started surgery today and is going to have some long hours and lots of standing....and she might miss Mark just a little bit too.

 Liz, Peds med student, with one of the adorable kids on our ward

This is how pills are packaged for patients here.

Triplet girls born last night - the third set since we've been here!

God Bless everyone!

Moving Forward

The first half of our trip has flown by!  Emily and I ended our rotation in OB/Gyn this past week and will be moving on to separate areas of medicine on Monday.  Emily will be in surgery and I will be in pediatrics for the remainder of our stay.  Mark is starting to pack up to leave on Monday as well (unless Emily hides his passport from him).  The cardiac team is leaving this weekend so it will be just Laura, Emily, and I pretty much for the next three weeks with another couple people just stopping in for a few days.  I can’t believe how fast this trip is going!

Our last week in OB proved to be a very interesting one (defer reading here if you don’t like medical details).  We have seen several things here we would probably not see in the US while on rotations such as a gangrene uterus and a female circumcision (formerly practiced by several tribes here in Kenya but now becoming less and less common).  Our last day ended up being a mix of emotions between both of us excited to first assist on c-sections and close but also having to see some difficult births and outcomes.  The c-section Emily assisted on was on a full-term mother who had had an ultrasound done that showed an enlarged head leading to the decision the baby could have hydrocephalus.  In the US, mothers are put through various screenings looking for possible health risks for the baby (and mother) as the pregnancy progresses and they also receive ultrasounds at various stages throughout their pregnancy.  This is not the case over here.  There are no regular screenings for Down syndrome, neural tube defects, or other fetal abnormalities and women rarely receive ultrasounds unless they need to estimate gestational age or suspect some problem.  I do not know the circumstances surrounding this particular mother’s prenatal care, but it is a very good thing she received that ultrasound.  The c-section was difficult due to the size of the baby’s head and it took lots of hard work trying to maneuver him out of such a small incision.  The baby also had what is called a meningocele, which is commonly associated with spina bifida.  It is an area of the spinal column that did not fully fuse and so the spinal cord is left protruding through the opening in the bones.  The hope is that the baby will be transferred to another, more equipped hospital to have surgery on both the meningocele and hydrocephalus.  Please keep this family in your prayers.  Here is just a glimpse at the baby - please do not scroll down if you do not wish to see.  I adored him the minute I saw him!

 The nasal cannula did not like to stay in the right place.

 Look at that adorable nose and mouth!

The same day we also had two mothers give birth back-to-back where the babies were not breathing.  Unfortunately one of them could not be resuscitated.  The other was carried to the nursery and was doing okay when we left the hospital Thursday.  It was a difficult reminder that there are not always happy endings and even though we might not understand why it happened, God has a plan for everything and that baby is resting happily in heaven.  I am sure as I move forward into pediatrics here that I will see more heartbreaking things happen.  People who know me know that I have voiced an interest in working in Pediatric Oncology so I think God is definitely going to use this experience here as a toughness-building exercise.  If I am to work in that area of medicine, I know that I will constantly be surrounded by difficult situations and well, I'm kind of a crying fool.  So I will have to build up a resistance to crying so to speak.  That doesn't mean it won't still break my heart or that I'll become cold-hearted towards my patients, I'll just have to be a strong support for them and their families.  For some reason God blessed me with a very strong desire to work with kids, specifically children with illnesses, and I look forward to seeing how He molds me for that future.

We are once again enjoying a nice, relaxing weekend around the Tenwek grounds-the weather is beautiful! We have weekend-ly movie nights which are actually starting to occur more frequently because they remind us of home.  Tonight we are going to relax watching some comedy television from various TV shows that our OB preceptor, Dr. Carrie Huber, has on DVD.  Tomorrow Mark and Emily will be venturing out to a community church with the PT that Mark worked with here, Solomon, and then enjoying lunch at his house. I will be hanging around here attending church and then finishing up studying for the women's health exam for when we return in December because I'll have to start studying Peds come Monday. Must.Contain.Excitement!  Only 3 1/2 more weeks left in Kenya!

God Bless everyone!

Kenyan Money

Can you imagine only paying $3.00 for an x-ray?  How about $12.00 for a CT csan?  Well, that’s the US equivalent price for those imaging studies here at Tenwek.  We found that out when Emily went for an xray of her foot on Sunday.  It was still giving her a lot of trouble so we decided, for fun, to just see if she had a fracture.  The ortho docs and her PT husband, Mark, had all said it wouldn’t change the current course of treatment due to where the fracture would probably be, but we were still curious because of all the swelling and sharp pains she was having three days after the sprain.  Good news – no broken bones!  She is actually doing much better today and has been off crutches since yesterday.  Mark also turned his ankle playing raquet ball the other day, so I’ve learned to not play sports with the Gibsons.  They are intense!  It’s also different for me to not be the sickly and injured one and I plan on keeping it that way here in Kenya.

As you can see by the prices I gave above, the health care system is very different from the United States.  However, we also have to take into account the different customs and lifestyle here in Kenya.  While that x-ray may be equal to only 3 US dollars, it is around 285 shillings (current exchange rate $1=95 shillings) for the people of Kenya and that amount may not be so easy to come by for everyone.  One thing I have learned is that money is handled very differently here.  Most people in America have cash, checking accounts, savings account, and credit cards through which they spend money.  The people of Kenya do not hold on to money here.  Their belief system is that money (and commodities) will be used or spent as soon as they are available.  If they personally cannot use them immediately, they know that someone else such as family or friends can.  They consider holding onto such resources to be hoarding and this is unsocial.  We also learned that if, for example, a patient cannot pay their hospital bill upfront, they will hand over something of personal value to the hospital until they come up with the money.  These valued items can be things such as a deed to their house or farmland.  Try that at an American hospital (or moreso, with the insurance company) and see what happens!

The only type of insurance we have come across here at Tenwek has been NHIF, which stands for National Hospital Insurance Fund.  From what I understand in talking to some of the medical staff, the NHIF is an optional insurance into which Kenyans can pay a yearly fee to have and it will cover any hospital stays they may have during that year.  It does not cover any clinical visits or check-ups or the outpatient labs/tests.  The hospital submits a claim on behalf of the patient once they have been discharged, but unfortunately the claim can be rejected just as in America.  This is the one similarity I have found – you must submit all of the vital information when it comes to the patient’s care!  We did encounter this type of situation with one patient we saw who refused to leave the hospital because she did not believe we were helping her.  (She was 35 weeks pregnant and not in any labor or pain, but she thought she was 43 weeks pregnant and needed to deliver.  The doctor diagnosed her with TOBP: tired of being pregnant.)  Once we mentioned that the NHIF would not cover her stay (because there was no medical reason to hold her), she decided it was okay to leave.  However, she was only one of very few patients we have seen with NHIF.  Most people pay upfront, stay around the hospital until someone can bring the amount they need, or leave something of value until they can return with the money in order to cover their bill.

As I stated earlier, the equivalent amount in US dollars seems so cheap, but to these people I am sure it is not as simple.  I am not sure of the average income, especially for the patients we see here at Tenwek who mostly come from rural areas and very far distances, but I am sure it is a far cry from what most of us are used to.  I can’t imagine what it may take sometimes to get the amount of shillings these people need to cover their health expenses.  They are a tough, hard-working group of people whom I have a tremendous amount of respect for.  Emily and I have both stated that we feel bad “haggling” with them over the cost of souvenirs sometimes, but it’s what they expect.  They name a price, such as 4000 shillings for several different items, and then we are to say what we think we should pay.  That is roughly only $42 and they are all hand-crafted, beautiful items!  We are pretty sure we have helped James, a local seller here at the hospital, put his kids through college because we have bought so much from him.  He gives us such great rates since we’ve been so many times that we don’t feel the need to haggle anymore.  He is just so happy to sell to us and the price to us is reasonable as is.

I am loving all that I am learning from this culture and I know I will continue to learn for the next four weeks.  I think we have all started to take to heart the lifestyle of these people and have a great respect for them.  Mark donated blood last week for a patient needing surgery and today, Emily was led to donate for another patient needing surgery.  Since I can’t donate blood (due to the fact I don’t weigh enough, go ahead and insert your tiny person joke here!), I am waiting to find where I will most be of service.  For some reason I believe that moment is not too far away as I am starting my Pediatric rotation on Monday – the rotation I have been waiting for since we started school!  These kids will pull at my heartstrings before I can even blink and I can’t wait to see how God uses me there as well as how He uses the kids to teach me.  Oooh, excitement!

God Bless everyone!

God's Plans vs. My Plans

“For I know the plans I have for you,” declares the Lord, “plans to prosper you and not to harm you, plans to give you hope and a future.” – Jeremiah 29:11

My two favorite parts of this experience here at Tenwek are the Sunday morning church services and all of the discussions that occur, whether they are just between Emily and myself or with the visiting staff or local Kenyans.  Today, those two things collided in only a way that could be from God. 

 I know that as far as school is concerned I came here to learn medical skills, but for me it was more about learning a different way of life, growing as a Christian, and hopefully figuring out where God is leading me in my life.  Over the past few years, I have struggled with trying to determine where my life goes after school.  You see, I am an organizational type of person.  I plan.  I plan short-term tasks and I plan long-term future events.  I used to have everything all planned out: 1 year after graduation, 5 years, 10, 25, and so on.  The funny thing is God has his own plans and His plans do not always match ours.  God spoke loud when letting me know that what I wanted did not match with His plans for me.  At first, I was scared and a bit timid to listen.  Then one day, while sitting at church in Lexington, a video played of missionaries who had helped in Haiti after the earthquake and I finally listened to what God had been trying to tell me.  (Lightbulb!) That’s what I was suppose to do!   I was to use my position as a PA to do medical missions and I was to start by going to Africa.

Phew! I finally had it figured out. What a relief!  But wait…. What about my family and friends?  Where do I live?  Do I get a job in the US and do short-term missions or is this supposed to be long-term mission work?  I always thought I would move back home because family is so important to me and it’s probably one reason I had such a difficult time listening to what God was trying to tell me.  Through discussions with people here at Tenwek, I have found that I am not the only one who struggles in this way.  (It really helps to know that Emily is a planner, too I.  I may have found my match in who is the biggest planner!)   It is strangely comforting because I do not wish for others to feel such an internal battle but it puts me at ease to know I am not alone.  During one of our talks, someone mentioned how God creates each person a certain way with particular characteristics.  We would not be planners if it wasn’t how God intended us to be so it is not a bad thing.  God knows our inner thoughts and desires always.  We just have to pray for our desires to match God’s desires and to remember to have open ears and open hearts.

Many are the plans in a person’s heart, but it is the Lord’s purpose that prevails. – Proverbs 19:21

Today at church the preacher continued his series on spiritual gifts and preached about adjusting our lives to God’s service.  God wants the best for us and what’s best for his ministry.  He will not lead us down the wrong road.  He did not lead Noah down the wrong road in building the ark, but he helped Noah to understand and adjust his life so that he could do this great thing that was needed.  What a great message!  Sidenote: We also got to sing some praise and worship songs in Swahili today.  I am beginning to love this language, even if I can’t pronounce it all right yet!

This entry is a bit of a personal, journal-type entry, but this is the journey I am on here in Kenya so I feel strongly to share it with others.  I still haven’t got it all figured out, but the wonderful thing is that somewhere along the way I began to trust in God a lot more, the way I should have always trusted, and my fears do not consume me.  My faith has become such a large part of my life that fear has no room.  I still hate the question “Where do you plan on working after graduation?” because there is no answer yet.  So I answer honestly, “I don’t know yet” and I am okay with that.  The organizational freak on the inside has finally learned that the unknown is very exciting and I look forward to learning where God’s path leads me.  I am ready for this journey!

God bless you on your journey!

Psalm 118:24

Happy 2^nd Birthday Ryder Scott!! Being an aunt to two of the most adorable boys I know is one of the greatest roles I get to play these days.  I get to play cars, building blocks, trains, Sorry!, tackle football, and Wii as well as watch endless cartoons all weekend long when they visit and I wouldn’t trade it for anything.  I miss them tons but I am so excited that they were able to skype me in for Ryder’s birthday party today.  It was great getting to see some of my family and see Ryder blow out his candles and open some presents – just like being there (almost)!  I can’t wait to get home in five weeks and see what new things both boys have learned, especially Ryder who was finally starting to talk more when I left.

This is the first weekend we haven’t had any big plans here so we are spending the time studying for the first of our two exams when we return to Kentucky in December.  Emily will also be taking the time to recuperate.  Mark, Seth, and Emily were playing basketball Thursday night when Emily sprained her ankle.  She took the day off yesterday due to being unable to bear weight on it but today she is able to put some weight on it and walk with the use of just one crutch.  Hopefully she will be back to a healthy status by Monday for our last week in OB, otherwise she will be going to get it x-rayed to see if she might have fractured it. Prayers for Emily, everyone!

It’s been a busy day full of studying, eating, playing cards, and skyping (I also got to meet my best friend’s new daughter, Claire, via video chat – I love the internet!)  Tomorrow morning Mark is getting up to make us all some eggs so we can eat more than our daily cereal or toast and then we will go to another wonderful church service here at Tenwek.  After thinking over how great our time has been here, especially being able to enjoy a day like today, I am reminded of a verse that we sing often at church (usually as kids) and that just so happened to be part of our discussion this week at bible study. Hope everyone’s weekend is as wonderful as ours!

This is the day which the LORD hath made; we will rejoice and be glad in it. - Psalm 118:24

God bless!