Tenwek Community Health

Two of my days last week I spent with Community Health.  It is a part of Tenwek that goes out in the communities for monthly check-ups/vaccines for women and children, mostly babies.  It was great to get outside the "walls" of Tenwek and see the countryside, and how people lived.  Many people would walk a long way to come to the clinic, and spent most of the day there.

The first day, there were 108 babies getting vaccines.  I was able to help by giving the oral polio vaccine.  The women were pretty shy around me, and laughed at my name.  Actually, everyone here reacts to my name.  Most, if not all, Kenyans have an English name, but Kimberly is foreign to them.  The first reactions are a wide-eyed look and laughter.  I have to repeat it multiple times for anyone to come close to getting it right.  Alfred, who seems to run the clinics, or at least the vaccine portion, would tell the women my name was like Emily, only it was "Kemily." :)

First day with Community Health

Richard and Claire, who's parents are working at the Hospital, helped to weigh babies

The women and children sitting outside eating lunch before walking home.

The second day our drive was much longer to a more, seemingly, remote village.  There were only 46 babies this day, and the room where they saw them was so small, they didn't really have room for us to help.  So we sat outside with the other women and watched our surroundings.  We were also watched pretty closely.

The building on the far left is where the clinic was the second day.

Women outside eating lunch and waiting to go inside for vaccines for their babies.

The walls of the shack had many things written on them with chalk in English, such as the Fruit of the Spirit, and the phrase, "Jesus Cares."

While we were there a large group of school children came by on their way home from lunch.  They were so timid to see wazungu (Swahili for "white people"), but they were fascinated.  One of the other women visiting Tenwek, Esther, started talking to them and seeing how much English they knew.  She asked if they could sing us a song.  They didn't really seem to understand, but one of the women from the community understood and got them to sing this song for us.  It was amazing.

It's pretty crazy to think about how poor most of these families really are.  They didn't have much with them, and mostly had corn and tea for lunch.  Esther asked me my impression of the poverty and I realized I hadn't even thought about it because everyone seemed so content and happy.  It's crazy to think about how discontent I can be when I probably brought more clothes with me to Kenya than many people around me own.

The average yearly salary in Bomet is 25,000 Kenyan shillings, or roughly $285, all from farming, and is above Kenya's national average income.  The most shocking thing about coming back from our safari was the immediate poverty all around us - two very extreme views of Kenya. The tourism for safari game drives is huge and so luxurious, while the people around the area comparatively, have nothing.

The children are so excited to see their picture on Esther's camera!

This is Zipporah.  She spoke English well and has a sister who lives with her family in Kentucky!  She was so excited to find out I live there too. 

Maasai Mara Safari

One of the things that Tenwek allows you to take time and do while here is to go on a safari (which is actually the Swahili word for "journey"), some time during your trip. Usually, before you fly home.  Due to scheduling conflicts with other pediatricians we went out during our time here, June 10-12. Here's our experience.

We arrived at Fairmont Mara Safari Club at 12:30pm.  When we pulled up we were greeted with hot towels to clean up from our dirt road drive and handed a glass of fresh mango juice to enjoy while checking in.  During our check-in we were told that the club was guarded and surrounded by an electric fence to keep out lions and cheetahs.  We were also told that to conserve energy they shut off the electricity from about 3:30-7:00pm and from midnight to 5:00am.  Take of that what you will. :) 

After checking in, we were then taken to our tent.

The tents

Our tent

Lunch was served buffet style from 12:30 – 2:30pm.  Game drives from 3:30 – 7:00/30 (depending on how lost, rainy, and/or muddy it is).  Dinner began at 8:00pm, and was a 4-course meal with choice of entrée.

Dinner our second night, Braised Lamb Shanks

At dinner our waitress asked what time we would like our wake-up call, and if we wanted coffee, tea, or hot chocolate brought to our tent before our 6:30am game drive.

The next morning, we expected a wake-up phone call at 6:00am.  Instead, we got a staff member outside our tent saying, loudly, “Jambo, jambo, jambo, David and Kimberly. Jambo, jambo,” until we responded.  Then he told us he has our coffee and asked to come in.  We opted to have him leave the coffee outside.

From 6:30 – 8:00/9:00am we went on our 2nd game drive and returned to have breakfast.  After breakfast, from 10:00am until 3:30pm we had free time (with lunch in the middle).  We spent it getting cleaned up (in our solar heated shower), relaxing in our tent (aka napping), and watching hippos.  Which are very loud and entertaining creatures.

Hippos in the Mara River

Showing off her teeth

Then we did a repeat – afternoon game drive, dinner, sleep, wake-up call, morning game drive, breakfast.  By 12:30pm we were already back to Tenwek.

We were only gone for 48-hours, but it seemed much longer because of all we did and saw.  Everything about the trip was amazing.  Here are some of my favorites from the 4 game drives. 

I think the leopard might have been my favorite, though all of the big cats were entertaining.

The rest of my photos can be seen here!

I promise I'll post soon about some of what I've been up to here at Tenwek, but this was fresh on my mind, so I thought I'd go ahead and blog about it. :)

Guest Post: Paediatrics at Tenwek

An aside before David's post: I had to ask many questions to understand everything written below.  So it's definitely easier to understand if you're medically inclined.

Apparently the best way to become a neonatologist, pediatric endocrinologist, cardiologist, pulmonologist, and infectious disease physician in one day is to come to Kenya.

It’s been a whirlwind of a week, but I’ll start off by describing a typical day. Morning report begins at 8 am and includes all of the hospital specialties. This is pretty typical of an educational conference in the states. This is followed by rounds on the pediatric floor starting at 9:30 or 10 am. We generally see around 20 kids with conditions ranging from diabetic ketoacidosis, to organophosphate poisoning to bronchiolitis or pneumonia to TB pericarditis, TB septic arthritis, TB osteomyelitis, post-streptococcal glomerulonephritis, meningitis, rheumatic fever/rheumatic heart disease, spontaneous bacterial peritonitis, malaria, and unfortunately several unknown infections. (Too bad I didn’t get a BCG as a child, I think I see several months of INH in my future.)

This usually takes until about 1 pm with a break for chai (hot black tea, not spiced, with milk and sugar) and ndazi (think beignets sans powdered sugar) somewhere in the middle. Lunch is then from 1-2 pm and then NICU rounds start.

The NICU has had between 15-25 babies while I’ve been here, but can hold up to 45 (in about 700 square feet). Most of the babies are here for the same reasons as in the states: prematurity, rule out sepsis, respiratory distress syndrome, neonatal jaundice, etc. There is one vent available, but it isn’t used often as we don’t have surfactant to give so there isn’t much point in putting babies with RDS on a vent.

My first day here, the supervising doctor was busy in the afternoon so I was the attending for part of NICU rounds. It was beyond stressful trying to remember feeding protocols, bilirubin charts, antibiotic dosing, ROP screening, etc., but somehow we made it through. Now I’m leading rounds nearly every day with the help of another visiting outpatient pediatrician (or paediatrician as they spell it here) from the states and a handy NICU guide that the missionary pediatrician has for us to use.

There have also been some sad cases. We lost a 24 week pre-term infant yesterday after about 48 hours of life. We also lost a 2 yr old to overwhelming sepsis on the same day. It’s humbling to pray with the family of a dying child. How do you balance having the medical knowledge that a child will most likely not survive, but still pray with faith that God will heal? I want to pray for comfort for the family, but don’t want to pray as if there was no hope for their child. I certainly have a lot to learn about prayer.

There is also a 28 weeker in the NICU now who’s mom didn’t receive steroids prior to birth. Pray that her lungs will be mature enough for her to pull through.

It has been a very challenging but also rewarding week. Some nights I don’t want to go back the next day, but at the same time am excited to see what the next day will bring.

On a side note: Happy 5^th Anniversary to my wonderful wife! I love you!

Taken June 7, 2013.  5th anniversary dinner of chicken curry, pineapple, and yellow cake  :)

Where We Sleep/What We Eat

The Guesthouse. 

Our apartment is located at the guesthouse.  Flags from a lot of different universities hang outside.  An Auburn flag greets us at the door and a Kentucky flag hangs from our window.  It couldn't be more appropriate. :)

You walk into an open area with a table/chairs, and dormitory type chair and couch.  The kitchen it right beside it and outfitted with a stove, coffeepot, toaster, and microwave.  The bedroom has built-in closets and a mosquito net over the bed. The bathroom connects.

Living/Dining Room

Kitchen and bedroom closets

Bedroom

All the food we've had, so far, has been pretty normal - and better than all the airplane food we had on the way. (Except for maybe an ice cream bar they handed out.)  

Breakfast at the Mennonite Guest House consisted of granola, yogurt, eggs, toast, and fruit served with coffee or tea.  At the Narok Coffee House we had grilled chicken, fries, and creamed spinach.  

The past 3 days our meals have been provided by the guesthouse staff and have included: rigatoni with ground beef and peas; rice with creamy chicken, carrots, and peas; scalloped potatoes and chickpeas; and spaghetti and meat sauce with a side of peas.  Also, most meals have had some kind of homemade bread such as dinner rolls and cinnamon rolls.  Yesterday, the cook made chocolate cake. Today we start cooking on our own, though we do plan to hire a cook, which is encouraged in order to give a local employment. 

Before getting here, we thought coffee would be a pretty popular drink, since we often buy Kenyan coffee in the States.  But tea is actually much more popular.  Tea time occurs multiple times a day. They make their tea and add milk and sugar, just the way I like it.  Turns out chai is the Swahili word for tea, not to be confused with Indian spiced tea we know in the States.  Another of the families here, who was actually on our flight from Brussels, and I had some chai and ndazi yesterday for a snack.  Ndazi is basically a beignet without the powdered sugar on top.  So... it's delicious.  Total cost for tea and ndazi, about $0.40.

Chai and Ndazi

Arriving

May 30 - We left for Tenwek Hospital.
May 31 - Arrived in Brussels for our flight to Nairobi.
After 21 hours on an airplane we landed in Nairobi.  Joan Cusack and her family were on the plane in a row right beside us.

We made it to Africa! (and that's Joan Cusack, though, getting her in the picture was not intentional)

Everything went incredibly smoothly.  Flights, all of our luggage made it, got a visa, exchanged some money, and met up with our driver.
June 1 - 12:30 am - Arrived at our hotel for the night.
1:30 am - Finally got to sleep
7:30 am - Wake-up breakfast bell goes off throughout the hotel.  And we head down for the breakfast buffet.

Mennonite Guest House

We had a great time talking with everyone we met.  Most people lived nearby and worked with a Mennonite group.  They were in town for the hotel’s monthly Hymn-sing.
9:00 am - We head out to the grocery store to buy our groceries for the month before setting out to Tenwek.
12:30 pm - Stopped for a quick break at the Narok Coffee House and got lunch.
2:00 pm - Arrive at Tenwek Hospital and head to the guesthouse to our apartment, “Twiga” (Swahili for giraffe).

View from our apartment window

The thing that has struck me most about Kenya so far is how pretty it is.  The plants, flowers, and countryside are beautiful.  When we landed in Nairobi and our first night here, David and I both had this moment of fear, thinking, “Oh gosh, we’re in Africa.  What are we doing here?”  Thankfully, by the next morning, our fear was gone and we were ready for the day.  Definitely an answer to prayer.

We’ve had a pretty relaxed last 2 days, which has been a nice recovery from all of the travel.  Since it’s the weekend, David won’t get to work until tomorrow morning.  He’s been spending his free time reading about different tropical diseases/treatment. 

We were able to go to church this morning in the hospital complex.  There were probably 150 people there, half Kenyan natives, some patients at the hospital.  The service was in English and very similar to American churches, but led by a Kenyan pastor.  David and I both enjoyed singing the hymns/songs this morning, some we haven’t sung in years.  The lines from Lord Most High, “Exalted in every nation, Sovereign of all creation” held more meaning today. There’s also another church close by that hold their service in Swahili.

We took a walk this afternoon down to a river and dam where there is a manmade waterfall that is part of a hydroelectric power plant.  On our way back we were passed and gawked at by about a hundred or more primary school students.  They would say “Hi, how are you?” and if we responded they thought it was hilarious, as they are just learning English.

There's a lot more I could type, but I'll save it for later.