The medical post

Patient 1- 20 yr old female from somewhere far away was able to get to the hospital barely whispering in English "Please help me".  She presents with a blood pressure of 70/40, much to low to keep the body working. Heart rate 140 bpm, meaning the heart is working very hard and hardly pumping any blood.  

Ultrasound and ECHO reveals aortic stenosis (tightening of the valve through which the heart delivers the blood to the body).  The tightness of the aortic valve is so tight, that the blood squirts through it in a weak little squirt gun manner.  The valve is the problem.  It has been bad for such a long time that the muscle of the left ventricle has grown incredibly large.  It has been striving so hard to push blood out of this bad valve that it is now constricting the ventricle further.  The blood is now partially moving up through the mitral valve back into the left atrium. 

The patient has too much fluid gathering in some places and not enough in others.  The lack of blood supply to the rest of the body is causing the liver and kidneys damage, which means she is in the end stages of heart failure.  

The cause of this terrible situation is called RHD.  Rheumatic Heart Disease is a preventable illness of poverty.  It affects far too many people who are now hospitalized for their condition, about 10% maybe.

Back in the medical ward, it is now a matter of fine tuning the treatment for the patient with heart rate control and volume of fluid as a bridge to try and get her renal and liver function back.  She needs valve replacement surgery rather soon. That could cost about 11,000 USD that a family has to come up with.  The outcomes are bleak.  Thankfully, a new RHD screening program has started early treatment and prevention education in area schools.  The simple solution of penicillin for strep throat infections and even for infected heart valves will save so many lives in the future.

Patient 2-  18 yr old male presents in emergency room with upper GI bleeding, vomiting blood.  History of sickle cell anemia (meaning his red blood cells are sickle shaped instead of round).  Faster than he can make the misshapen blood cells which are pouring into his stomach, he is throwing them up.  The source is a stomach ulcer due to bacteria called H. Pylori which is common in any low- middle income country.  Again, another disease of poverty is unfurling.

Hemoglobin was 4, bp 80/40, heart rate 120 bpm.  He was first given 3 units of blood, then sent to endoscopy and the ulcers were not actively bleeding.  He intermittently bled and stopped for several days from the deterioration of the stomach lining.  Medical team decided to give transfusions, acid suppression, and treatment for the bacterial infection.  The sickle cell disease got worse due to the lack of available blood flowing in his body, developed what is called acute chest syndrome.  

Acute chest syndrome is when the sickle shaped blood cells clog up the alveoli (part of the lungs where oxygen is attached to the blood cell).   This causes severe chest pain, hypoxia, loss of oxygen to the body overall. It is a pretty bad state to be in.  Treatment needed is called exchange transfusion, meaning all the blood in the body needs to be replaced.  Then he started bleeding profusely in the ulcers again. 

60/30bp, Hgb 2

He is sent to emergency surgery for resecting the section of his duodenum where the bleeding is coming from. The blood bank in the hospital gives 12 units of blood to him over 24 hours.  (An average person might contain 12 units in a normal healthy body)  The gift of the new and normal shaped blood cells in all of these donated pints was that they flowed properly and cleared the clogged up alveoli in his chest, opening oxygenation to the blood stream again.  It is called an exchange transfusion but was done in a very unconventional manner.

He was recovering in ICU today. Pray for Boniface when you read this, please!

The medical ward nowadays is being run by some very fine Kenyan team members.  They have a good dynamic and genuinely want to help people.  Michael is enjoying working with them and seeing their growth and development as medical professionals not only over these 3 weeks, but also over the past 11 years since he's been coming here.  They see about 60 patients a day but it is divided up quite well among the team so no one is overwhelmed.

We are also hosting 2 residents (and their dear spouses) from UT with us this time at Tenwek.  We eat lunch and dinner together in a guest house with lots of other volunteer physicians and spouses.  They show each other x-rays and pictures of things like a black lung that they helped remove earlier in the day.  The table talk can get colorful you might say.  This is a typical day in the typical life here.  

                                                    blood donation center inside the hospital

                                                        Katie's type 0+ matches our patient!

                                                        into the blood fridge it goes for Boniface

This day. 7/22/24

I remember arriving here in a cloud of unknowing and alone late last night.  The journey was long and complicated.  It started on Friday, driving the kids south to Georgia and then in driving rain, driving home to pack alone.  Then it was driving the doggie to her boarder early Saturday and nearly missing a turn due to a big selfish driver in the other lane, and bounding through a pothole in the little triangle between I-24 and I-59, splashing water all over the windshield like my adrenaline, thankful for my Jeep and those angels watching over me. There is not a minute to lose on a travel day.  

I remember my dear neighbor, Ellen, showing up to help me out the door Saturday morning and she even took out the garbage for me while I gathered my alleged wits and forgot my actual hairbrush, hand sanitizer, and phone charger.  (It’s surprising how poorly I pack for someone who has done this trip as much as I have)

I remember the macro-chaos of the micro-software malfunction Friday that caused 1,000’s of flight cancellations across the country.  My travel companions had to rebook on Saturday, for a flight Sunday, for which I would spend a day in Nairobi to await them.  I remember today, Monday, is that gift of time. (Michael has already been in Kenya for a week now, working his Daktari life at Tenwek Mission Hospital again. We will catch up with his interesting stories soon.)

I remember flying solo Saturday night across the Atlantic like Beryl Markham or Amelia Earheart, or Katie Christian, the 24 year old.  There were also 550 other souls on board the Boeing 777. But without my 2 kids and 1 husband sitting in the 4 across seats of the middle row, I was alone.  I remember trying to watch mindless entertainment and not enjoying it.  So I read a bit of poetry and the Silver Chair by CS Lewis in which I felt like Jill Pole getting blown by Aslan’s breath in silence and solitude over our world into Narnia.

I remember Sunday night landing in the foreign-familiar dark night city where stars shine on the ground and we disembark the giant “ndege” (Swahili for bird and airplane), onto the tarmac like those cavalier women pilots of the early 20th century.  But I was corralled into a bus then a building that bottlenecks the 550 souls into 3 tiny passport control portals for an hour or so.  I listened to a podcast on “Practicing the Presence of God” there. And I connected to wifi for messaging my husband, the Daktari, because we certainly know how to practice the presence of wifi don’t we?

I remember riding out to the hotel Sunday night with a British family “on holiday”.  Their teenage sons were excited to share the latest update on American election news with me.  I checked into my room alone with the confidence that The Lord is my Shepherd.  I remember acutely missing my family and how my mind gives them so much occupation.  But there is art on the wall of some lilies.  

And I remember the Mary Oliver poems I just read “How Everything Adores Being Alive” and “The Lily” and also Jesus on “consider the lilies”.  My call now is to live life fully alive with Him in the present, to see it, appreciate it, and remember it.  I will both lie down and sleep in peace for He alone makes me dwell in safety.  I realize it even if I cried a little silent tear.

And this Monday, this penultimate Monday in July, this serene day of waiting here on the terrace rooftop by a beautiful blue pool with the 4 horizons I can count-  spending this day alone with Jesus has restored my soul.  He has brought me into a spacious place today.  I looked way up and saw a graceful white and black winged crane silently, secretly flying overhead. Everyone else is looking down. They are missing all the delight of just being here, practicing His Presence.  How can I be so blessed as to be here amidst all this splendor? (Luke 17:21) It is because I am secured by the strength of God’s own deep and complete love for me.  That is why I am here today.  So are you.  Do you realize it? Look up, look around, look back. Remember.

Effie wrote to me today “There is no stronger faith builder than remembering”.

Look who came to Nairobi for dinner with me on Monday!