Finishing up.

2 06 2011

23 days of work.
43 C-sections.
55 babies.
4 sets of twins, 1 set of triplets.
I know of at least 7 of those babies and at least 1 mother died (there were likely a few more).
Unable to be calculated: Number of children from the peds ward who now consider a hairy white man their best friend.

Some of our favorite quotes:

“YES. This is IT!” (from Brenner’s friend James in the Peds ward, regarding a new page to color. The IT that he was so excited about? Bert and Ernie on a tandem bicycle)

“I need strong men who LOVE Jesus!” Ivasha, one of the OB nurses, en route from OB to the operating room, looking for assistance to push the heavy patient’s bed.

“Please recollect: do not put tissue paper.” A note written on a request for a stool sample on a patient who’d had diarrhea for a few months — apparently, the patient let some TP get in with her sample and lab was having none of it.

While we’ll miss most things about Tenwek terribly, there are a few we won’t:

*the nightly bug check (luckily, we’re in a studio so less room to cover)
*the hit-and-miss with hot water, and the hit-and-miss with ANY water
*the diesel garbage-carrying tractor driving outside our window at all hours

Time to get our laundry off the line and hit the road —


Kenya photo potpourri

31 05 2011

There have been a few funny and ironic sightings here at Tenwek, and we just can’t help but share a few (with commentary, of course).

Most of the supplies at the hospital are donated, which means there are a wide variety of cities and hospitals represented. Recently, I was returning a page from a phone in the hospital and happened to notice the labeling…..from a hotel in New Orleans. One of our fellow residents, Anthony (pictured above) came to work in Denver Health scrubs last week, and I ran into a wheelchair from the “VA loaner pool” (quite the generous loaner pool, I’d say). The other wheelchair I saw on OB today was chained to the wall — does it really look like something high-yield on the “steal from the hospital” list? It only turns to frustrating when you need to move a mother somewhere emergently, there are no wheeled-beds available, and the only empty wheelchair in the county is stuck to the wall by a huge lock, which nobody in Africa has a key for.

We’ve also seen some funny signs, made funny by either innocent spelling errors (no one really knows what to put in the “rappers” bucket on OB) or their attempt (I think) at sympathy towards the single female. Brenner really wanted me to take a picture of the motorcycle bumper sticker with the wife statement — the hidden meaning in the request was not totally lost on me.

When folks come into the hospital, they’re greeted with a informational sign — it took me all month to find out what HIPPO is…..the answer is: nobody knows. It’s some office where people go to take care of certain types of bills (again — what kind?). There was a thought that at one time it may have been an acronym. Either way, it’s funny.

I’ve had a few patients ask me about Obama — the country is fascinated with him, with paraphernalia EVERYWHERE. Obviously the Chai thermos would pay homage to Kenya’s favorite American.

Tomorrow is my last call, and we head out Thursday afternoon for Nairobi and our flights home. I’m around 50 babies delivered — final counts to come.

Some of the more difficult adaptations.

25 05 2011

Obviously, we knew that coming to work in Kenya (even for a short period of time) was going to require some changing of perspectives and expectations. There have been a few things, however, that have not necessarily been shocking, but still have left an impression:

*The importance of tea time — while it seems more appropriate in the outpatient setting where Brenner occasionally works, obstetrics is not a ward conducive to regular break times (the fetus can be very impatient). There have been a couple of C-sections here labeled “emergency” but I changed them to “urgent” after finishing when I realized that we didn’t start for almost thirty minutes after calling the operating theatre. Reason for the delay? Chai, of course.

*The difficult communication. As discussed previously, my Swahili is virtually non-existent (unless you need to push, or are looking for sympathy, gratitude, congratulations, or a generic greeting) but all of our staff is bilingual. Unfortunately, the large percentage of Kipsigis and Maasai patients can confuse the picture and not everyone here speaks those dialects. I’m never quite sure what language is being spoken, and my translator doesn’t always tell me if he or she is unsure if the patient understands what is being said. Last week, we had a Maasai patient who should have stayed NPO (nothing to eat or drink) for a morning in anticipation for a procedure. She kept eating and drinking with every Chai break and we would go back in, remind her to put NOTHING in her mouth, and two hours later, I’d walk in her room and see the evidence (bread crumbs all over her face and bedsheets). Her brother, a wonderful translator who actually spoke the same language as the patient, came to find me when he finally visited. His first statement to me was:
“My sister wants to know what is wrong with the hospital’s food since you won’t give her any of it.”

*The extreme shortage of blood. Please note the empty blood bank from the hospital, above.
Last week a woman came in who had been laboring at home for a day, and started bleeding — she came to Tenwek where she promptly delivered a baby that had died sometime during labor, and continued to bleed, despite all of our available interventions. On the way to the OR to take out her uterus, we got her hemoglobin results: 1.5 (for those of you who are unfamiliar with how jaw-droppingly low that number is: Most women should have a hemoglobin between 12-14. A good number of folks start feeling tired around 8-9, and the average pregnant woman in Kenya, anecdotally, averages 6-7. The lowest I’d seen in the US was 4.1) That woman survived surgery, stealing a unit of blood from a pre-op patient in the process, and a little more blood later, is rocking out with an Hgb of 6.
There are no blood drives or bloodmobiles in Kenya — no Oreos and apple juice waiting for you after you lay on a Serta mattress and are congratulated for your donation. Here, if a patient needs blood, we ask the family to donate. Folks who work at the hospital are also great about giving — especially since most of us are not allowed to give in the States with our travel histories. I donated my first weekend here
(and promptly fainted — perhaps I should have waited until I adapted to the altitude a bit more or checked my pre-donation hemoglobin — nothing a little meatloaf can’t fix!) and a good number of the long-term missionaries stay on a routine 3-4 month rotation of donating. There have been at least three patients here who have died this month — just from not being able to receive a simple blood transfusion.

*The inability to call a Code Purple. Not every hospital uses it, but at St. Anthony Code Purple means that we are getting close to divert mode, and can soon no longer accept patients. I think folks at Tenwek would never even consider a number to deem the hospital “full” — while we are extremely understaffed, patients would never be turned away, as they have nowhere else to go — the decision between no care and less-than-ideal care is an easy one for a needy patient to make. The nursery’s census is between 25-30. Earlier this week, we admitted two babies in one morning, adding to the 48 already packed in.

*Minimal specialty staff (that I generally take for granted, but will try not to from now on). Many hospitals with pediatric patients have large numbers of volunteers or staff members to provide counseling and activities for the children. Brenner serves that role here — spending a few hours most days on the pediatric ward with crayons and bubbles. He’s pictured above with a few of the long-term orthopedic kids that he “counsels” with wheelchair races and stickers.
Physical therapy is also something I greatly miss. We have a patient who was admitted to OB the week before we came to Tenwek. She came to the hospital after laboring at home for a couple of days; during that time her baby died and her uterus ruptured — she required a hysterectomy and has had terrible wound infections requiring multiple wash-out surgeries. She finally moved out of the ICU this week and is ready to start building strength in anticipation for discharge, but our therapists here are very busy and don’t have time to walk her twice a day. Noting his ability to work so well as hospital support staff, I turned to Brenner, who is now coming to OB every day to help Janet walk (see the two new friends pictured above). They have a routine; walk outside, sit in the sun and chat (a little — she speaks minimal English) about life for 30-60 minutes, and walk back in, at a painfully slow pace. Janet’s strength and outlook have both notably improved with this new relationship.

Brenner titles his new duties “Doing Less, Giving More” — seems like a nice adaptation to me.

The Midwesterner’s guide to Swahili.

22 05 2011

Soo–My Spanish skills have been (shockingly) useless in Kenya. The few inappropriate phrases Brenner remembers in German haven’t been much help either.
While Swahili is only one of the many languages spoken at Tenwek (also Kipsigis and Maasai — and a little English), it seems to be the most understood, which doesn’t bode well for us. Our staff is all fluent in English, but frequently speaks in Swanglish, which can give both patient and doctor a glimpse into what is being translated. Even though I’ve been immersed in the language at the hospital for three weeks, I’ve only picked up a few words (apologies to those of you fluent Swahili speakers for my spelling; unless I know it exactly, I’m going to be phonetic):

*Pungazie: Congratulations
*Asante: Thank you
*Skuma: Push
*Pole (pronounced Pole-ay): Sorry. So far, I probably use this one the most. If you say it twice (pole pole), it means slowly, so I try not to apologize more than once or it confuses patients.
*Sawa sawa: the equivalent of okay/cool/alright (frequently used by my interns when I give them a job to do).

Yep, that’s the extent of my Swahili, but seems to be generally sufficient on OB. This morning during the hospital’s church service (as a side note, the sermon this morning reminded me of a Minnesotan good-bye; the pastor said “In closing…..” and finished ten minutes later), a few of the songs were in Swahili and we learned a new word:

*Rafiki: Friend

Brenner remembered it and used it a bit today, as we spent the afternoon visiting an area orphanage. We tagged along with one of the long-term Tenwek doctors who is familiar with this particular site and the Kenyan couple who run the home. We only had to drive 20km from Tenwek, but the area seemed much farther away given the obvious poverty — our guide explained to us that this is one of the poorest parts of the district. Most of the children have lost their parents to HIV, with traumatic causes (car or motorbike accidents) second on the list.
We brought a huge burlap sack filled with all types of bats and balls, jump ropes, hula hoops and played outside until everyone seemed pretty wiped (we were spared the usual afternoon downpour, for which we were grateful). At one point, Brenner brought out the bubbles we’d brought along and the kids went wild — even the adults got pretty excited about that rare source of entertainment.
After exhausting ourselves, we had a quick tour of the site — there are two buildings to house the children (gender-separate dorms), and it appeared by visual math that they must sleep 2 per bed. There’s a larger room with benches that serves as a catch-all for studying, and some good old liberal arts schooling — crafts and music. They use one of the bio-sand filters that Brenner has been working with to have clean drinking water, but no running water in their outhouse. Most of the kids are very healthy, attributable to the close relationship the home has with doctors from Tenwek.
Prior to leaving, the children sang to us some of their fun songs and we (of course!) had chai together. While our communication was definitely not 100% (the older kids knew some English, but with the younger ones we played a lot of fun charades), Brenner was able to use his new Swahili word and the home’s host translated for us as we left:
“The children say that having you come visit is like bringing back a little of their mothers and fathers to be with them.” (You can imagine how my emotional Volstad side reacted to that comment.) Overall, a wonderful afternoon — and like many days here, reminds us of what is really important in our lives and how much we have to be grateful for.

All good things begin and end with Chai.

21 05 2011

Brenner here — I know people have been wondering what I have been up to while Berit has been at the hospital, so here is a summary of one of my days out with the Community Health Team at Tenwek.
I was working with the group distributing bio-sand filters (BSFs) to assist in providing clean drinking water to area citizens. The source of most of the drinking water here is a muddy river with a large amount of pollutants (namely, human and animal waste). Without too much operational detail about how the filters work, they basically provide a treatment to provide cleaner drinking water for families. With Tenwek’s educational programs, locals are better understanding the root cause of water-borne diseases and are trying to address problems at the source (vs treating the illness later).

We joke about the difference in urgency between my work and Berit’s — I show up at Community Health at 9:15am as directed, at which time we assemble teams and plan until 10am. Chai comes at 10am, which is the most important part of the day. This break lasts 30 minutes, and then we load the (diesel) trucks and actually leave around 11:00.

Our drive is approximately 30K on paved roads, and we stop at each market along the way so our local driver can stop and talk to his friends who work there. I’m wedged in the middle front seat, between the driver and another volunteer. The driver tells me about his sadness regarding the recent death of a promising Kenyan runner.

We turn off of the pavement down a poorly (really, not at all) maintained gravel road for another 3 kilometers to pick up the BSFs. From what I understand, the BSF project was started by a group out of Canada about ten years ago and has been largely run by Tenwek’s Community Health Program since. There have been just shy of 1000 BSFs commissioned here. Filters are made here by locals of mostly concrete, and each one weighs approximately 175 kgs. My job during loading is to shovel in various sizes of gravel to be used later in the filter.

While we load the truck (using an old tire as a hoist), area women whose homes are receiving the filters come and inspect the process closely. They are all carrying at least one baby on their back, and are very excited about their new purchase, making sure their new filter is spotless — scoffing at each crack or blemish. They run after us in the truck as we drive to each home for delivery (it’s easy to keep up with us on the road full of huge ruts and rocks). Their perfectionism is understandable, as each has invested quite a bit into their BSF — families are required to take classes on maintenance, proper use, and other sanitation practices, and they have to pay 30% of the cost (there’s a group through the hospital that pays for the other 70% of each BSF).

We stop at a junction where the road is truly impassable, and leave three BSFs there; the families receiving are responsible to get the filters the rest of the way to their home (I didn’t ask how that is supposed to happen). Two of the others were left at nearby markets, and we travelled to another home to help them with the “commissioning” process, which consists of washing the three levels of filtration media (sand and gravel of various sizes) four times. After the cleaning process, large amounts of water is run through the BSF daily for two weeks before it is ready for use. It was a warm afternoon; being a Swede from the north, the heat made me quickly lose interest in the manual labor. I had more fun playing with the 6 children in the home (pictured above). The home we worked in was very nice by Kenyan standards, inhabited in by a large family with multiple generations living together, and the head of the household was a police officer.
Prior to leaving, our team leader said “We drink Chai, then we go.” The family made us Chai as a thank you gesture, and we drank together. After politely just accepting just a 1/2-filled first mug (I still had some concern since their filter wasn’t operational for another two weeks), I fell prey to the deliciousness and drank a full second cup before hitting the road back to Tenwek.

Safari weekend.

16 05 2011

Our break from the hustle and bustle of Tenwek was very refreshing — the camp that housed us in the Mara provided wonderful guides and hosts, delicious food, and warm water (every time we showered, which was quite heavenly for Brenner, who has been reduced to only showering a few days a week here — dependent on our feisty plumbing). We ate all of our meals in the main lodge, where we could watch elephants, zebras, hippos, and kudu (pictured above: Brenner having his 6th cup of Chai this morning with a variety of animals in the background).

Our guide, James (also pictured above with Brenner), was really great. He was raised in the Mara (as a member of the local tribe, Maasai) and became a guide quite a few years ago — his education was sponsored by an American couple from Santa Fe who met him in Kenya about 25 years ago. He visited the U.S. a few years ago on a marketing tour and provided some interesting perspective on America: he likened folks running around our airports to termites (I had to assume it was while termites scuttled around big piles of elephant dung,) and called sunbathers “the crocodile people” — not out of mockery, but because those were the most appropriate comparisons in his mind, given his extensive animal history (and an abundance of American material during his month-long tour of the States). He remembers seeing his first obviously botoxed woman in California and how his travelling companion had to ask him not to stare, and said that his significant weight gain during his tour alarmed his wife upon return back to Kenya.

The landscape, people, and wide variety of animals living together in harmony in Masai Mara provided us with an extraordinary experience and some new perspectives on life.

This one is mostly medical.

14 05 2011

Finally got a picture of me and baby Berit — please note her jazz hands. She’s probably just thrilled to be my Kenyan namesake.

The week has been very busy for me, with some things I’ve never seen before and quite a few (really) sad moments.

We had an eclamptic woman come in on Tuesday (in short, a pregnancy complication that results in seizures) who didn’t regain consciousness after her seizure. We took her straight to c/s — but her family had no idea she was pregnant. Her baby was approximately 30 weeks and was taken to nursery. We had to intubate/ventilate mom in the ICU — she was declared brain dead and her family elected to withdraw care on Thursday morning. The baby died Thursday night.

Thursday was another call, and quite busy — 7 C-sections in total. One was done for a breech baby with anencephaly (abscence of the skull base and most of the brain). We were really hoping to not have to do surgery on this mom, but she had a complication (placental abruption) that caused her to bleed a lot so she unfortunately had a C-section for her first pregnancy, and no live baby.

The rest of the babies and moms did very well, and Brenner even came with me Thursday night to watch his first delivery in the OR! He did well, stayed for the whole thing, and even took some pictures –the one above is to prove that even in Kenya, we don’t get to leave until our paperwork is done (but to be fair, it’s quite a bit less).

Also included is a picture of the twins we delivered Monday — they were going home yesterday, although I think the mom would have stayed all weekend if she could. Being in the hospital after delivering here is a like a big sleepover — you’re in a room with somewhere between 5-15 other women, hanging out with your new baby, and away from the responsibilities of home (for the twin mom, that includes 3 older children).

Brenner’s week has mostly been spent on the Pediatric Ward with the toys we brought along, namely bubbles (which they LOVE here) and coloring books. He has begun to join morning rounds to learn more about the kids and their conditions and has found some new long-termers to spend time with (some post-surgical kids stay awhile to ensure no infection). I generally swing by there on my way home to look for him, and the kids usually seem excited to see me — but then their excitement turns to disappointment and I realize they’re actually looking for him.

We’re leaving town this weekend to visit the nearby Masai Mara — looking forward to relaxing and seeing some animals.