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!