Week 3/4 Daktari cases

Week 3 out of 4: a little late, but this is Africa...

The medical ward team from this month- includes 1 resident from home, 1 med student from TX, and the Kenyan staff here alongside myself...a sample of what we've seen:

Patient group 1: Sodium: little old ladies come into the hospital GBW (general body weakness) with a sodium of 106.  normal sodium 135-145, Tenwek normal 120-130.  Why?  I believe every Kenyan coming into the hospital is dehydrated by at least 2 liters. 1) Sodium and water have a nice balancing relationship in the human body and when one is missing, the other will follow. If there is no water, the sodium flows out, leaving one hyponatremic.  2) Clean drinking water has not been easy to come by historically and thus not part of normal daily meals. Chai is.  We once heard of an Kenyan man who was in his 90’s and never drank a glass of water in his whole life! 

Patient 2: Meningitis: 26 year old Massai man self-referred from Narok county hospital, headache and fever, treated for malaria without improvement.  Had bacterial meningitis with 1200 WBC in his Cerebral Spinal Fluid. Treated for streptococcus pneumoniae meningitis, improved on therapy and discharged home.  Praise God!

Patient 3: Pulmonary Embolism (blood clot in the lung): 32 year-old woman, post-partum 21 days, admitted to nearby hospital with chest pain, fever, treated for pneumonia without improvement, underwent CT scan (new to outlying hospital), found to have a large pulmonary embolism, transferred to Tenwek for higher level care.  We were able to acquire one dose of a rare clot-busting drug, streptokinase, from the pharmacy.  A newly available medicine for our services here, could revolutionize the treatment options for pulmonary emboli, ischemic stroke, and heart attacks. Thankfully for her, we did not have to give this med because she was able to keep her blood pressure up, but what a new opportunity for therapy.

-Highlights: In the  journal club with family medicine residents last week we discussed the recommendation to  get people to reduce their NaCl (salt) intake to 2 grams daily, which could save 33 million lives over 25 years!  How much sodium do you take each day?  Remember to drink your clean water with gratitude too.  Circulation article 2018.  Journal clubs here are great.  There are 100% eager learners among the residents with a challenging situation in which they practice medicine, but they really work so hard and are such pleasant people to be around.

-14 days on medical ward in a row, covering for some gaps here and there, sustained by grace and not taking myself too seriously.  One that I was helping cover for was on a mission outreach to a remote island in the middle of Lake Victoria, Western Kenya, where they were seeing 1000 patients in 4 days. I was glad to be here, not there.  We are also delighted that the hospital has hired a Kenyan consultant for medical wards since we were here last year.  Carrying one another’s burdens is much easier to shoulder when there are two or three shoulders to help.  

Sustained by grace,

Daktari Davis

Pictures from week 2/4

No hospital pictures, as you can imagine a doctor posting you on his blog may be questionable. 

Daktari has been delighted to engage in training Kenyan trainees again and challenged by the inscrutable mysteries of so many patients on the brink of survival. He coded 5 patients in one day this week. They come to the hospital largely lacking primary care and with about 20% mortality rate. Yet the access to care is increasing little by little. We’ve also been encouraged that his weekly quiz structure for medical team trainees in 2013-2015 is still going on.

We have quickly slipped back into our African alter-egos...

Here’s our happy guest house home away from home...

Hammocking about

Some things we should not take for granted-

Like spacing and punctuation!

Skimming the milk

Rip-stick Hockey is our new favorite sport!

This was a great way to spend one normal afternoon: out in villages delivering wheel chairs with the Tenwek  Disabilities Clinic 

                                         

O God, our help in ages past...

...our hope for years to come,
our shelter from the stormy blast, and our eternal home!

A thousand ages in thy sight are like an evening gone;
short as the watch that ends the night, before the rising sun.

Time like an ever rolling stream,
bears all its years away,
they fly, forgotten, as a dream dies at the opening day.  

September 2013
Two weeks after our arrival in country, a terrorist organization attacked and caused the destruction of 69 lives and the entire shopping center we had been in a few days earlier for supplying our new life. Westgate attack imprinted the reality of our new life.  Always on edge, never really "safe", but surely never lacking heart. The intensity of life in Kenya  was ratcheted up forever. Every trip to a supermarket or western restaurant comes with a security screening to remind you- be alert, the enemy is still active and out there, don’t be passive! There is no safe place, but in Jesus.

Two years later, July 15, 2015- 
We were in the pleasant places of the Sequatchee Valley, Tennessee, watching the far, far away planets of Jupiter and Saturn in the summer night sky.  At that time Jupiter and Saturn seemed closer than our Kenyan life.  Together with good friends who also moved from Kenya to Tennessee around that time, we sat by a campfire and reflected.  We were all so refreshed at living in such a safe and idyllic scene again.  Ahh, we foolishly pronounced.  "No Al-Shabab here.  Just peace and quiet." 
Until the next morning. 

 On July 16, 2015, exactly 2 weeks after we arrived back in our "home country" a lone terrorist attacked the US military installations in Chattanooga bringing our new city to a screeching halt of humble prayers.  There were 5 who fell that day, one could say gave the ultimate sacrifice for their country. Four US Marines, and 1 Navy sailor.  And we were given pause to reflect at a very deep level.  "What is safe?" The geography of safety just collapsed. Again. There is no safe place but in Jesus.

July 16, 2018,
The billboards around town are transformed for a few days to say "Never Forget" and they have the 5 uniform hats of those service men to remind us what happened.  I drive by the spot weekly on the way to my kid’s piano lessons. For heaven's sake, never forget what we are living this life for.  It may be taken in a moment of gun blast or car crash or long slow sickness.  But what is truly terrible is the ebbing of life under the deception of materialism and vain pursuits of pleasure.  To miss the moment by moment grace to be alive at all, to chase 3 fundamental idols of Power, Control, and Comfort-  as in spending our life on small conveniences, and the perversion of the "American Dream"- the pursuit of selfishness - that is the terror of losing Real Life.  I am not safe even in my own heart- only in Jesus. Pastor Kevin always tells us at New City Fellowship “The safest place for a sinner is in the arms of Jesus”.

July 16, 2019
Reflecting on the normal day, normal town, normal job, that our Fallen Five were living their normal life in, I wonder do I live for what I believe in every normal day? Or do we forget? Is my goal self oriented (yes by default) or is my heart remembering that my life has been bought at a very high price- the Life of Jesus? Will my life be eaten up by hate and fear and political ratcheting of anxiety? No. I have been four years pondering this story. I pray that you ponder it four seconds even. Where is your Safety?

week 1/4

7/11 There’s a Lifting

Foreword: We started this blog to document the medical missionary life.  It was hard to get the medical experiences in writing during the crucible days of 2013-2015.  We returned to the States July 1, 2015 and have come back to do one month rotations here in Kenya for the past 3 years.  The blog will now try to resume its original identity for a while in attempt pull out of the mommy-blogosphere. 

Back home in Chattanooga, TN, New City Fellowship was worshipping the last Sunday in June with the song “There’s A Lifting” and it has been reverberating in our heads ever since.  The song is about lifting up our eyes to realize where our help comes from.  Our help comes from the Lord, the Maker of Heaven and Earth.  As we lift our eyes, he lifts our hearts.  Here are some case reports of the lifting:

 Patient 1 is a 31-year-old man who was admitted to Tenwek for an upper gi bleed caused by an ulcer in his duodenum.  There is an increased incidence of peptic ulcer disease in the developing world because of the prevalence of a bacteria called Helicobacter pylori.  The bacteria spirals down into the lining of the stomach, and allows the stomach acid to erode down into blood vessels below the surface.  This causes the bleeding.  Yesterday he had an endoscopy procedure to cauterize the bleeding vessels.  Today, he done fell out on the way to the bathroom just because there was not enough blood volume in his body to perfuse his brain when he stood up from the squatting position. This man, thankfully fell on the floor near, not in the bathrooms  (The bathrooms are not a pleasant place for falling out as you could imagine). Thankfully for the medical team, the excitement of shouting family members called our attention to him. The team ran to him, and found he was awake and talking so we raised his legs up to drain the remaining blood volume up to his head before he was lifted up and put into a wheel chair, then promptly placed in bed with his legs elevated and a nice pint of hearty blood transfused from the family  (that’s how we get blood  here at Tenwek- family donors on the spot- no lie).  Imagine- the family members were documenting the event on their mobile phones the whole time.  Maybe we will be on their social media posts.

Patient 2  is an 81-year-old man who suffered an intertrochanteric femur fracture from a fall.*  He had also some shortness of breath and a cough, and was “sick-looking” thus an internal medicine consultation was requested for evaluation prior to orthopedic surgery. He improved after a day of antibiotics and supplemental oxygen, was breathing more comfortably and had no other cardiorespiratory conditions to prevent him undergoing an operation to fix his fracture. After reviewing the American Heart Association guidelines for perioperative clearance, we gave our clearance to proceed with surgery.  Approximately 10 minutes after we cleared him for surgery, he sat bolt upright in his bed and fell over dead.   Resuscitation was attempted with what was available on hand i.e. our hands., but unfortunately unsuccessful  (90% of patients remain dead after losing a pulse in the developing world hospitals).  We have no idea why he suddenly died and there is no way to find out for sure.  As we broke the news to his adult grandson who was there to care for him, he stood bolt upright also and yelled aloud and  fell out on the ground.  Gladly, at least the young man recovered.

Life is not a guarantee. Doing medicine here can knock me over at times too.   It’s intense, and an intense challenge to my assumptions: that I can figure out and fix the medical problems that our patients are suffering.  I lift up my eyes to the green hills of Africa- where does our help come from? 

Every Wednesday at Tenwek we have staff devotions at 8 a.m..  Today, our hospital statistician, Geoffrey Mushyoka,, gave the message to us.  He said, “You people are wonderfully trained and gifted by God to serve your patients.  But by yourself you can do nothing.  Jesus is the only healer. Our job is to serve the best that we can but without Jesus, we can do nothing.”  .  He is the Lifter of our heads and our hearts. He is the Lifter of the living and the dead.  We must realize where Our Help comes from.

Lecture 1- today I gave a lunch time lecture on antibiotic stewardship in the hospital classroom. We had 2 faculty members attending and about 20 medical students, interns, and residents.  We came here for the purpose of preparing God’s people for works of service, so that the body of Christ may be built up.  These are the long term investments we are aiming at: teaching the teachers, equipping the national providers to steward medical resources wisely.  The projector was broken and thankfully too, because power point is a smoke screen all too often.  So I “hand crafted” the lecture on a white board with markers.  The risk of drug resistant bacteria in the developing world is far more potentially hazardous because the only available antibiotics are on a very short list here.  We must carefully steward the gifts that God has given us through modern medicine. Antibiotics are a gift, but they too must be submitted to the LORD for appropriate usage.  Here’s a picture of how that wonderful design works scientifically:

Thanks for lifting us up in prayer,
Daktari "Davies"