Olderkesi (Maasai Land)

We enjoyed a peaceful weekend away visiting the Steurys in Maasai Land. Jon Steury grew up at Tenwek as the son of the first missionary doctor to Tenwek (Ernie Steury). Jon and his wife Vera moved out to Maasai land over 20 years ago and have been working with community health and other projects among the Maasai people. We're thankful for the opportunity to experience their much more rural life for a few days, to see the beautiful scenery far from civilization, to learn more about the Maasai people who we care for daily at Tenwek, to share stories, and to learn from the Steurys' wisdom. Our perspectives have changed a bit in the last couple years living in Kenya and preparing to move to rural Burundi, so we noted things that might have gone unnoticed a few years ago. We will have to build our houses in Burundi, so we carefully observed things like solar energy, guesthouse layout, bore hole supplied water, water conservation in washing dishes, electrical generator, satellite internet modem, kerosene lanterns. We even took pictures of the blueprints for the Steurys' house! Don't worry, though; I'll share the more interesting pictures on the blog :)

Pet hedgehog found nearbyMaggie and me with the hedgehog, just before he poked us both with his sharp spines

Elise and Micah with the hedgehog

Jon Steury speaking the Maasai language with the father of one of John Cropsey's ophthalmology patients

The Maasai man gave beautiful beaded gifts to the Cropseys as thanks for caring for his son

Watering hole

River, evidently with more water than usual

Elise and I after hiking to the river

Washing clothes

A young shepherd

Did you know goats could climb trees?

Another young shepherd boy. Remember David? "But David said to Saul, 'Your servant has been keeping his father's sheep. When a lion or bear came and carried off a sheep from the flock, I went after it, struck it and rescued the sheep from its mouth. When it turned on me, I seized it by its hair, struck it and killed it...The Lord who delivered me from the paw of the lion and the paw of the bear will deliver me from the hand of this Philistine.'" 1 Samuel 17:34-37

We enjoyed lots of delicious meals together and even heard stories of lions in the Steurys' yard, a hyena kill just outside their house, and their son being knocked down by a baboon (but thankfully not seriously hurt) while running down to the river.

Just as we've discovered through getting to know the missionaries at Tenwek, it's so valuable for us to learn from the wisdom and experience of those who have gone before. We're grateful for them being willing to share with us their mistakes and trials in addition to their successes.

After two nights of rain, our trip back to Tenwek in the rear wheel drive 11 passenger van was adventurous, to say the least. We're thankful for God bringing us home safely and for the impressive mud driving skills of John Cropsey. After we passed the worst of the mud, Rachel requested a pit stop in order to feed Baby Ben. Eric replied, "Let's just drive 10 more minutes and stop when we see giraffes." And so we did.

Wide open spaces indeed

"For as high as the heavens are above the earth, so great is his love for those who fear him; as far as the east is from the west, so far has he removed our transgressions from us." Psalm 103:11-12

We Treat; Jesus Heals

Some of you may remember this boy from a previous blog. On admission at the end of December, he had been critically ill with meningitis and seizures for three weeks. He initially had 280 white blood cells in his cerebrospinal fluid. We began treatment for both bacterial and tuberculous meningitis. After 10 days, he had made no significant improvement and was essentially unconscious, so we repeated the lumbar puncture. Despite 10 days of appropriately dosed ceftriaxone, TB meds, and steroids, he still had 240 WBCs in his CSF. We changed his antibiotics to ampicillin and chloramphenicol suspecting resistance to ceftriaxone. He began improving slowly and was able to walk and talk and eat prior to discharge. A month after admission, we discharged L home. But unfortunately, he was blind. Our ophthalmologist Dr. Cropsey diagnosed cortical blindness due to the meningitis and did not expect L would ever regain his sight.
He was quite happily proven wrong, however, as God miraculously brought healing and restoration of vision to L. L's parents enthusiastically greeted me in clinic last week and were so happy to demonstrate L's complete healing. He is attending school and his vision is now 20/20 in both eyes. Dr. Cropsey examined him and noted L still has pallor of the optic discs, but we praise the Lord that he is seeing just fine. The family is also so thankful to God for L's healing.
This second patient had a similar illness to L, but this one was much sicker on admission. He is 8 years old and when he came in, he was seizing continuously even after multiple doses of seizure meds. His back was arched, his neck was rigid, and his temperature was persistently greater than 104F despite frequent Tylenol. A lumbar puncture revealed over 1500 WBCs in his CSF. I truly did not expect him to survive and tried to prepare the mother towards that end. After the first night, he stopped having seizures but remained critically ill and unresponsive. The team decided to transfer him down to the floor as we needed the ICU bed for another patient and we didn't think there was anything else we could do for B. Thankfully, we were wrong. After one week, B still was unresponsive and his CSF culture grew streptococcus pneumoniae. We adjusted his antibiotics based on the culture results (incidentally one of the first cultures I've actually seen grow here). Amazingly, he began to slowly improve. Now he is almost fully recovered. He will still be here a few days to finish his meds but you can see from the below picture that he's miraculously healed. Only through God's healing power!

Weekend patients

Snapshots from my weekend call on pediatrics...

Patient A:
This little 5 year old boy first went to a national hospital in February with abdominal pain and swelling. They did an abdominal ultrasound which did not show a mass but did show left kidney "inflammatory process". They also did an echocardiogram which showed a cystic lesion in the right atrium of the heart, possible hydatid disease.

The cystic lesion is on the left in the above echo. Hydatid disease is caused by a dog tapeworm and results in multiple cysts, usually in the liver or maybe the lung. Evidently they can rarely occur in other random places like the heart. Treatment involves a special variety of aspiration as well as albendazole. Obviously it would be pretty difficult to aspirate a cyst in the heart, so A was discharged in March with 1 month of albendazole.

Unfortunately, A completed his medication but continued to have abdominal pain and swelling and then developed poor appetite and weight loss.

He presented to Tenwek with his father (left) and a translator (he and his father only speak Masai). We repeated the echo and did find the above mass in the right atrium. But it seemed more solid than cystic and it didn't explain his abdominal distension. An abdominal ultrasound revealed a large 15x13cm mass involving the left kidney. Based on our surgeon's recommendations, we then sent the child 4 hours away for a CT scan. He returned today with the results: Nephroblastoma (Wilm's tumor) involving the left kidney and extending up the IVC to the right atrium. Unfortunately too extensive for resection without cardiac bypass, so he was sent home. We may try chemotherapy to hopefully shrink the tumor from the heart and then surgery, but we're still researching the possibilities. If only it had been "simple" hydatid disease.

Patient B:

A four day old baby brought in with "spasms". Mother received no antenatal care (ie no tetanus immunization) and the child was delivered at home. The umbilical cord was cut with a non-sterile kitchen knife. Diagnosis: neonatal tetanus. This child will likely remain in the nursery for a month or more. He is being fed by an NG tube & nursed in a dark isolette in the back of the nursery as any touch or stimulation causes spasms.

Patient C:

One of three patients admitted this weekend with congestive heart failure from rheumatic heart disease. Likely the illness began several years ago with a strep throat that was untreated. The result is valvular heart disease that progresses over time. We have a pediatric cardiothoracic team that comes for a week once a year to perform valve replacements for a few of these patients. The rest we manage with medications to help keep the symptoms under control and hopefully improve the quality of life for these children.

Patient D:

5 year old boy with Burkitt lymphoma, a cancer that for some reason is much more common in Africa than in other places. It is also extremely fast growing. This child received his first chemotherapy here last week and is remaining as an inpatient in hopes of improving his nutritional status. He will have more chemo this week and hopefully we will begin to see the tumor shrinking.

Patients E, F, G, H:

A baby with a scalp wound

One of the interns evaluating another rheumatic heart disease patient in Casualty (ER)

The "greeter" on peds - this boy's been here a while and loves to greet everyone who walks by

An orphan who unfortunately was severely neglected and malnourished but is now doing much better and will hopefully go home with a caring relative soon

Patient I: No picture for this one due to the critical nature of her condition. An 8 year old girl has been sick for some time at home and received herbal treatments. She has had multiple seizures over the last 2 days and is now unresponsive, so the family brought her to the hospital. She is lying in bed sweating in an opisthotonic position (neck hyperextended and back arched) with frequent seizures that don't stop until after the third dose of seizure meds. An HIV test comes back positive. A lumbar puncture (spinal tap) reveals 1536 WBCs in her CSF!!! She also has signs and symptoms strongly suggestive for tuberculous meningitis in addition to the obvious bacterial meningitis. She amazingly makes it through the night but her prognosis is still not good.

Patient J: A 10 month old baby is transferred from a nearby district hospital with a diagnosis of intussusception (where the intestines telescope on each other and cause an obstruction). On further evaluation, it turns out the baby has had bloody stools and bloody vomiting for one day. Prior to this, he had a febrile illness and was treated with herbal medications. Our exam and studies reveal a tender, enlarged liver and florid liver failure with an INR of 7 (normal is 1 meaning the child is not able to clot his blood) and a hemoglobin of 3 (meaning significant blood loss). Our suspicion, though we're unable to prove it, is that the traditional herbal medications caused the liver failure. The baby is receiving blood and Vitamin K and hopefully will stop bleeding soon.

Patient K:

14 year old with bacterial meningitis, now well and going home

Almost all of these children are in these conditions due to poverty or due to the fact that they live here. A few of them might have had similar illnesses in other places but wouldn't have taken so long to see a healthcare provider, so the disease wouldn't be so advanced. Lack of education plays a role as does corruption in the traditional healers being quite willing to take people's last shilling without the hope of offering a cure. Many of our patients have been crossing the border to Tanzania lately to see this "miracle healer" on the border who is making money hand over fist (as are the taxi drivers who bring people to see him) and encouraging people to stop taking their HIV meds or diabetes meds or seizure meds. We've had patients die as a result.

It doesn't seem fair. And yet I know I'm not the only one who cares about the injustice of it all. Many are working to fight corruption and injustice and to address poverty around the world. And you can see the hope and joy on these children's and parents' faces just from the limited care we are able to provide. Most of all, God Himself is just and He will bring justice on the earth.

The Lord "executes justice for the oppressed and gives food to the hungry. The Lord sets prisoners free, the Lord gives sight to the blind, he lifts up those who are bowed down, the Lord loves those who live justly. The Lord watches over the immigrant and sustains the fatherless and the widow, but he frustrates the ways of the wicked. The Lord reigns forever." Psalm 146:7-10

Recent weekend fun

So, we have to be a bit more creative with weekend activities here as we live quite far from any restaurants, movie theaters, etc. - but sometimes I think that's more fun, anyways! We do watch movies together regularly and play games, too. And even when there's not much going on, I love to read and have enjoyed reading lots of good books here and then sharing them with friends. Here's some pictures of some recent weekend activities:

The Cropseys planned a murder mystery dinner complete with characters and plot. We had to get a bit creative with costumes (the fringe on my dress is crepe paper). I may or may not have been the murderer. :) We had a great time and discovered some hidden acting talents among our friends, too.

The missionary kids performed at the Fine Arts Festival last week - a great opportunity for them to participate in a school program and display their artwork from the year and fun for us to cheer them on. It's been a long time since I attended a piano recital or middle school band program - probably since back when it was me participating! I much prefer being a proud "aunt" than a performer!

Birthdays are always fun occasions for celebrating. Eric and Heather share the same birthday.

Maggie loved her Veggie Tales cakes!

We enjoyed the second Tenwek Coffeehouse not too long ago. Interns, residents, and consultants all performed and everyone enjoyed chai and cookies.

The audience participated in the singing and dancing.

And one of my favorite weekend activities - Ultimate Frisbee! We actually played twice this weekend - so much fun!