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"

Emigrant

Emigrate means to leave one's country to live in another.
Immigrate is to come into another country to live permanently.

2003- I came to your country without your language, but Steven came and patiently taught me.
 I came without car, house, bed for my disoriented head, but Tim and Lorna graciously received me in as one of their own.
I was one of three people with my skin color in the town.  The other two left and I was not afraid.  I was safe from hate, safe from fear, only an object of curiosity.
There was a young lady from Sudan who wore a black covering over her head and face.  She befriended me when I was alone.

2013-  I came again to your country a second time with my everything worldly packed in some suitcases and 4 hearts full of a dream.  A husband, a wife, 2 children, and "no home little sister, we are free in the wild now".  We went on faith and they took us in.  They gave us a wild and free chance to live our dreams.  It was more than we could've asked or imagined.
 

2018- The inverse
They came to my country not speaking the language, so I offered to tutor.  No safe neighborhoods to sleep for them, no car or navigational device for deciphering this insane Leviathan of "American Health Care".  Their dad found a job at a chicken plant, a job nobody wants, but it's a job. He has five children to feed and one on the way. 
They came to my country with a few suitcases and hearts full of dreams we can't yet know about because we don't speak the same language yet. 

But something made them want to leave home for all this.

2019- Their baby was due, but we weren't confident of when. We went to the doctor's office.  I was facing the gate keeper who wanted a $100 entry fee.  No insurance.  No means to acquire insurance either.  There was the symbolic glass ceiling, but it was really a window.  Would we get discouraged and overwhelmed and quit?  I recall all the hospitality and endurance of African mothers I know so I press on.  My God breaks walls down into windows all the time. 

The first year OB resident is the very fist American physician my friend ever sees.  She is kind and courteous and treats her like every other patient she sees. Thank you!

 My friend was referred to a high risk clinic, no charge.  4 of her 5 children were born at home in Sudan, with low birth weight.  Number 6 does not need to be like that.  The mom is not worried though.  She says "They were all fine before.  This one will be fine too".

The OB in America tests, sticks, scans, screens, and labs her into culture shock.  American health care feigns at control.  But every week I took her to get that ultrasound I was amazed at the black and white image of a tiny human packed full of hope and heart beats and amazing awe that was like a first face-time encounter with a child.  They eventually determine the child's due date will be Easter and guess when she came- Easter night!  Healthy and ambitious in her outlook on leaving the tiny safe womb to come out into all this wild world. 

A few weeks later, I am at the pediatrics clinic with the siblings from Sudan.  They have been vaccinated now against polio, measles, tetanus and other things people back home die from.  The 5 year old girl asks to listen to the stethoscope.  The nurse lets her hear the child's own heartbeat, and then puts the chest piece on her own chest.  The little girl catches the heartbeat in her ears and her face lights up with wonder and awe and exclaims "Is like me!" 

 

Fall- first frost

October 2018 
    The flurry and hurry of getting 2 kids ready for school in America: out the door, to dad's truck, the pick up will drop you off and the van will pick you up.  First, brush your hair, brush your teeth, did you get all your things? Lunch is packed- please eat it all today.  Cold air rushes in the house as they rush out of it.  Remember to be kind and be honest and look out for the lonely.  Latch the door and silence.
    The cold air from outside washes over like a sugar glaze to wake me up inside.  Now it is me all alone and awake, loading up cereal bowls from the sink.  And I think, it went so fast.  Even though we woke up so early.  My little ones have now become medium sized.  They outgrew their shoes and jeans just now.  And they will have outgrown the mornings with mom before I know it.  This silence is foreboding.  So I turn on the machines that make things clean. The clothes machine, the dish machine, that do their jobs so quick and easily.  They hum and beat that old drum!  Keep moving quickly so no one gets hurt, or at least so no one feels the emptiness.  Keep moving, hustle. Hurry and worry about the appearances.  Curate, de-clutter, remove the evidences.  But life was just here a minute ago.  
   And now we are six, no seven, soon she turns eight!  And that's just the baby.  The Man-cub is both longing to stay little and growing into freedom.  I must let him grow up and out from me, however it hurts.  They never told me how labor pain continues for life in some ways.  The heart contracts to contain her baby, while forcing the strength of the child to prevail against it.  But these little daily habits of the heart, launching him on small explorations is my practice for the day he drives off to college, or to the moon, or wherever.
   In America, here we strive and pray and drive to pave the road a little ways.  And then we trust the child to blaze his trail, to grow strong, swinging his Masai sword through the woods.  He will carve a path that is his in a rhythm that is his, not to the beat of my dryer drum.  It's too cold in America to hang the laundry out to dry now.  So I shift the clothes from one machine to another and pray Dear Lord, "let mercy lead so that every footprint that he leaves there'll be a drop of grace."* And let me not mistakenly call it clutter.  So much life was here just a minute ago.

*Thank you, Rich Mullins and Beaker for that song! Let Mercy Lead- Brother's Keeper 1995
 
  

Shop talk

Daktari here.  Checking in after the first couple of weeks on the wards at Tenwek.  Grateful for a rainy season Sunday afternoon off from work, and the mental space to sit for a minute to reflect.

Being a member of the medicine ward service is a great privilege.  I am continuously amazed at the passion and curiosity of the Kenyan interns, their eagerness to learn, it's a heady drug to a professorial type.  Their humility when approaching uncertainty in clinical decision-making (and there is a great deal of uncertainty) inspires and challenges me.  This time around I get to spend my afternoons with a Family Medicine resident from Congo, learning the ways of the intensive care unit, and the mathematics of pulmonology and nephrology; the light coming on as: CO = 2 x NA + 1.15 * GLU/18 + BUN/2.8 starts to make sense in light of a patient with toxic alcohol poisoning = bad home brew.

A couple of clinical stories from the ward: We have a young healthy 18-year-old who stepped on an acacia tree thorn.  He does not have his bottom two adult teeth pulled like many of the older generation Kenyans.  They used to pull those teeth to secure a way for delivering nutrition in case of illness such as this: lockjaw, tetanus.  The man who stepped on a thorn contracted bacteria from the soil called Clostridium tetani that releases the toxin tetanospasmin.   The toxin makes muscle fibers contract irreversibly, causing a terrible contortion of an arching back and every muscle of the body is contracted until the nerve endings that were killed by the toxin can regrow.  Thank God for the treatment: source control (wound debridement), immune globulin to bind circulating toxin, antibiotics to kill remaining bacteria, and sedatives and magnesium to counteract and relax the spasms. Also because his original dose of toxin was low enough, his reaction was not fatal.  Sometimes the spasms of tetanus can break one’s own bones.   He has been moved out of ICU and is now stabilized in a regular ward bed.  Working on loosening, stretching, strengthening those muscles once again.  Daktari loves vaccines, they are a gift

A 20-year-old young man with a congenital heart disease died last week.  Tetralogy of Fallot it's called. He had received a bridge procedure 10 years before as a sort of stop-gap that wouldn't fix the right-left shunt, but allow him to live for a few years.  His father was by his side throughout this time, and as he passed, said these words, "I thank God that He has given us the life of my son, and that He gives life to my son, even now, with a new heart in a resurrected body."  

I leave you with his words, and ask for you to pray today for healing specifically in a young man called Kevin, with what I believe to be kala-azar (visceral leishmaniasis): a parasite from the bite of a sand fly that causes liver, spleen, kidney, and bone marrow failure. The treatment is quite toxic and we don't know if it is going to work yet.  

Until next time, Daktari.

The Hunt: Week 2

The Hunt

At night, we hear mosquitos whining in the air.  We don’t see them in the darkness but we know they are present.  Like a prison camp search light sweeping the walls, our cell phone light seeks out whom to destroy.  The little pests are hard to see though.  Daktari and Man Cub have an electric tennis racket that they hunt with at night to zap the mosquitos in the house.  It’s a fun game while we are awake.  When we are asleep however, we are under mosquito nets, imagining it to be a force field holding them at bay.  Who is hunting whom really?

In the morning, choir practice of song birds begins quite early.  I love their gentle early morning blessing that sings to us “Get up, get up, the sun is about to rise and it will be a hot and very busy day.  Get up while it is lovely and peaceful with us!”  We can’t see the birds too easily from our ground level apartment with one window.  But I do know they are there.  There is a 10 lb. book of The Birds of East Africa that I’ve been toting around for years now.  It shows me what they look like on paper.  Yet experience shows a real bird in in the tree is worth 25 in the book!  The illustrations of a Lilac Breasted Roller pale in comparison to the real life one.  A Variable Sunbird far surpasses its species name and drawing in the astonishing beauty of reality.  I renamed it the “Birthday Bird” because of its birthday party like colors and date of apparition.

We stay on the lookout, ready for the beautiful surprise that is the True Life version: iridescent flash of fruit loop blue as the wings take to flight.  The birds are there but my eyes can’t quite find them in the dim light of dawn…

Last weekend we got to go camping at Lake Naivasha with our Tenwek friends to recreate and relax together and celebrate the birthdays of a few of our Man-Cubs together.  There were not one but TWO Lilac Breasted Rollers perched in some dead trees at the shore!  I had one in my binoculars and lost the other.  Where did he go?  Then, the flash of wings was right beside me where he had landed and taken off again.  Blue and purple and white flash, opening my eyes to what was right there beside me as I looked out in the distant dead tree.  So close

There is an old Rabbinical joke George once told us about a day that God wanted to play a game of hide and seek and He wondered where to hide and the Holy Spirit told God to hide in the human heart because “no one will ever look for you there”!

Who is hunting whom?

First night in country:
We arrive in Nairobi at the "Midnight Guest House" in what felt like midnight.
Wake up in the morning to the happiest kid anywhere. "Ahhhh, when I look out the window and see that (green tropical garden and trees full of birds),  it just makes me so happy!" says the Man-Cub.

First drive through the valley:
We have a 4th year med student and a senior resident on a global health elective rotation with us.  It's a great job that we get to be doing this and call it work. Kenya is changing.  There is a new section of railway being built.  And Kenya is much the same; now in a new segment of an old story.

First Call:
Daktari on call on the first weekend here.
The hospital has open one ward for males and another open ward for females.  20 beds in a room and lots of very sick people sharing space with family members and each other.  There is a 35 yr old man who had a bleeding ulcer.  He was stable but he suddenly coded and died in the night.  35. Ulcer.
Directly across from him our friend was coding a 1 yr old child.  She also died last night. 1 year old. Next morning before church, found out a second man in his 30's also died unexpectedly before the code team could even be notified.  How it happens like an angel of death sweeping over the place, I don't know.

First weekend:
We were invited to lunch at our friend's house in the village over the river.  It was lovely to be out there again.  Real people doing real life:  growing banana trees, sugar cane, grass to feed the milk cow.  Eating real Kenyan food: chapati, greens, rice, beans, beef, and steaming hot sweet chai. Thankful for these nourishing relationships that keep pulling us back to this place.

First meals:
We were also invited to dinner with a missionary family who recounted the traumatic events of last weekend, just a week before we arrived.  Tenwek had a terrible fire at night.  Around 8 pm the kitchen caught fire and burned up an entire building of offices and the kitchen.  They community was really dramatically impacted. It was like a story of Gideon in the Old Testament and how he took his tiny army and some flash lights to defeat the enormous Midianite army.  Here in Kenya there is no EMS.  The closest thing to a fire engine was a water tank truck in town and the wheels were off for repair.  One missionary drove for an hour to the next town to look for a fire engine.  Meanwhile the missionaries and staff and local folks were tossing buckets of tap water onto the huge flames.  One man we know who is a master builder, climbed on the roof of the building to knock off all the wood trim that would spread the fire to other buildings.  The boiler room and back up generator with tons of diesel fuel were directly next door to the burning building.  The patient wards were all around being evacuated.  The Lord directly protected and contained the fire to that one building and we are all full of thanks and praise!  Not a single person was even hurt.  It was miraculous.

First impressions:
The daktari kids noticed that some of the ground rules in the community have changed for how they are allowed/expected to play.  However, they still ask if we can stay here for years and years.  It is their glory days all over again.  At least, that's their first impressions.