Patients

Mother and son (both my patients) with chaplain

Baby bundled up for winter

Rounding with interns

Passing out stickers

After a couple weeks in the hospital, this child with malnutrition finally has warmed up to me! He walked up and gave me a hug right before this picture was taken. He used to scream whenever a doctor or nurse got near him.

Infant with tetanus

11 year old with likely leukemia

A smile I look forward to as I walk home each day!

Many of these pictures correlate with my recent email update (which was really too long to put on the blog). If you would like to receive the monthly emails and don't currently, just let me know.

Kips & Cheps

(N.B. I must give a shout out to Logan & Julie Banks at http://www.banksoffshore.blogspot.com/ for this blog idea.)

As is expected living in a foreign country, my patients do at times have difficult to pronounce names, but, contrary to Birmingham, Alabama where people invent endless permutations of name spelling and pronunciation, there is a finite number of possible names here. The Kipsigis tribe (most of my patients) names their children primarily based on the time of day they are born. For the most part, boys names start with “Kip” and girls names start with “Chep.” For example, I was born at 2am, so my Kipsigis name is Chepkemoi (girl born near midnight). If you know what time you were born, look at the list below and see what your Kipsigis name is:

Kipkemoi/Chepkemoi – born near midnight
Kipkoech/Chepkoech – born when almost morning
Kipkorir/Chepkorir – dawn
Kimutai/Chemutai – dawn
Kipngetich/Chepngetich – when the cows go out (morning)
Kipngeno/Chepngeno – when the goats go out (morning)
Kibet/Chebet – midday
Kiprotich/Cherotich – when the cows come back (afternoon)
Kiprono/Cherono – when the goats come back (afternoon)
Kiplangat/Chelangat – evening
Kipkirui/Chepkirui – when going to sleep

There are a few names that are not related to the time of day born:
Kiprop/Cherop – born during heavy rains
Kipchirchir/Chepchirchir – born when things are hectic (most births, right?) or during an emergency
Kiptoo/Cheptoo – born when visitors arrive
Kipruto/Cheruto – born when visiting
Kipchumba/Chepchumba – born when wazungu (white people) are present (a relatively common name around here!)

I was discussing these interesting naming methods with some of the nursing staff one day and they asked how I got my name. I explained that my parents read the name “Alyssa” in a book of baby names and liked it. They thought that naming method was actually quite strange!

These triplets, born essentially at the same time of day, are named Kiprotich, Cherotich, & Cherono (when the cows come home and when the goats come home).
These twin girls (under lights for jaundice) are named Chepkorir and Chepkoech (two different names for early morning).

Usually children are given a “Christian” name in addition to their Kipsigis name when they are older which makes distinuishing between adult patients a little less difficult.

Here's some more pictures of my vacation last week with my friends Shannon & Jed. I really enjoyed the chance to experience more of Kenya than I had previously seen. It's a beautiful country. And Shannon & Jed are great traveling friends!

The Giraffe Center in Nairobi
Overlooking the Rift Valley

Tenwek waterfall after a lot of rain

Tenwek sign

Chai at the hospital restaurant

Helping babysit some of the missionary kids

Sunrise in the Kakamega rain forest

Colobus monkeys (black and white)

The Yala River in the rain forest

Kakamega Forest

Rondo Retreat Center in the Kakamega Forest

Safari

Last week my friends Shannon & Jed visited from Boston (slightly different climate than here in March!) and I enjoyed a refreshing, relaxing vacation. I live less than 60 miles from Masai Mara - one of the best places for a safari in East Africa - so what is a once in a lifetime vacation for most is amazingly in my backyard, more or less. We enjoyed viewing all the "Big 5" animals (lion, buffalo, elephant, rhino, leopard) and many other less well known creatures. I especially liked watching the baby elephants and the giraffes. And we saw a cheetah walk through the grass while all the other animals (gazelles, zebras, giraffes, wildebeests) turned and observed his every move (from a safe distance) - quite the power! I loved sharing this experience with my friends and also introducing them to my current life and work at Tenwek. Pictures from the rest of our Kenyan vacation together will follow in another blog.

Note the hippos in the river behind us!

Medicine patients

I know my blog posts have been upbeat lately, but I want to be sure to paint an honest picture of the challenges as well. I have enjoyed a break from pediatrics the past 2 months - primarily because the pediatric deaths (which occur much more frequently than I'm used to in the States) are difficult to take. But we have had some challenging cases on the adult medical ward and ICU as well.

We have a 20 year old female on our service now who attempted suicide because of infertility. In fact her husband decided to divorce her because she hasn't gotten pregnant after 6 months of marriage. Another young female on our service aborted her child (illegal in Kenya) - probably by inserting sticks or something else and managed to perforate her rectum. She now has a colostomy bag and has been quite sick in the ICU - part of the time on a ventilator - for 2 weeks. We have another patient in the ICU (5 weeks postpartum - the baby is healthy) who is a diagnostic dilemma and despite various consulting teams evaluating and treating her, she continues to get sicker and we continue to be unable to discover the underlying cause of her illness. This week we diagnosed a 66 year old female with AIDS, possibly contracted from her work as a traditional birth attendant. We have actually diagnosed multiple patients with HIV/AIDS this month and have sent many others home with hospice for incurable cancer (usually esophageal - very common in this region). Some of these conditions are due to living in a developing country in Africa with limited access to healthcare; others are due to cultural and social issues; a few could present the same way and have a similar outcome in the U.S.

So how does one deal with these challenging patients day in and day out? I'm up for suggestions! :) It has been a comfort to me to share these experiences with others here - both expatriat and Kenyan. One of the interns was very upset recently over the death of an 18 year old boy with meningitis. And one of the surgical residents cried over the death of a 4 year old patient we cared for in the ICU. Expressing these emotions validates that these things are difficult to take - even for physicians who witness these tragedies daily.

My primary source of comfort though has been to remember that this world is not our home. Hebrews 11 speaks of the fact that the heroes of the faith did not receive the things promised but only welcomed them from a distance. "Instead, they were longing for a better country -- a heavenly one. Therefore God is not ashamed to be called their God, for he has prepared a city for them." (Heb 11:16) And Paul reminds us that these earthly trials are temporary: "Therefore we do not lose heart. Though outwardly we are wasting away, yet inwardly we are being renewed day by day. For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all. So we fix our eyes not on what is seen but on what is unseen. For what is seen is temporary, but what is unseen is eternal." (2 Cor 4:16-18) In focusing on eternity, I am reminded that though it's not always clear in this life, Jesus has overcome the world and has prepared an eternal home for us. This encourages me and also reminds me of the priveledge I have to share this hope with others.