Challenges

I try to strike a balance both on this blog and in life between dwelling on the difficulties and tragedies of what I do and focusing on the joys and fun parts. Next week, I'll be blogging about our trip to the beach for our retreat on the Indian Ocean, so today I thought I would share with you some of the challenges of the medical ward.

1) Poisoning patients. The number 2 reason for admission to the medical ward last month was "poisoning". These patients attempt suicide by the means they have available to them - drinking pesticide. The pesticide is actually quite toxic and patients do die from it. Others are placed on mechanical ventilators and given medications to treat bradycardia (low heart rate). Some are simply admitted to the ICU for observation and discharged 1-2 days later after talking with the chaplain. This week, our hearts are especially heavy as a single mother decided to attempt suicide in this manner because of financial struggles but she also decided to poison her 3 children at the same time. The 4 year old has died; the 2 year old is in critical condition on a ventilator; and the 6 year old is improving slowly. The mother is alive and was taken to prison today. Please pray for her and her children and family.

2) HIV/AIDS. On average, the HIV rate on the medical ward is 30%. This week it has been 50%. The most common reasons for admission of these patients are meningitis, tuberculosis, fungal disease, and pneumonia. Often patients remain on the ward for two weeks or more receiving IV medications. At discharge we refer them to the HIV clinic to be started on medications for HIV - many times they don't follow up and we see them back a few months later with meningitis again, more severe wasting and malnutrition from HIV, and an even weaker immune system. But there are actually hundreds of patients (adults and kids) on HIV meds through our clinic at Tenwek; many are doing well and are never admitted to the hospital.

3) Traditional healers. There is still a significant distrust in the community of western medicine. Patients often pay a lot of money to traditional healers before finally coming to the hospital for their cancer or AIDS. The herbs and other methods these herbalists use are sometimes harmless but they also can cause significant kidney and liver damage or even burns to the skin. Plus they create false hope and delay patients from receiving the care they need sometimes until it's too late. This week we had a patient die from very advanced leukemia within 8 hours of him finally coming to the hospital. He had multiple markings all over his body from the traditional healers. If he had come earlier, we could have referred him to Nairobi for chemotherapy but there was nothing left to do at the late stage of his disease.

Even in these tragedies, maybe especially in the tragedies, I take heart and hope from the words of Romans 8:37-39:
"No, in all these things we are more than conquerors through him who loved us. For I am convinced that neither death nor life, neither angels nor demons, neither the present nor the future, nor any powers, neither height nor depth, nor anything else in all creation, will be able to separate us from the love of God that is in Christ Jesus our Lord."

Neighbor Kids

Several of the neighbor kids came over to play recently. They loved playing with the big ball, blowing bubbles, and facepainting. I didn't take pictures of the facepainting because I was busy making sure Micah didn't eat the paints! One of my favorite parts of living here is being surrounded by families and hearing kids laughing and playing daily - reminds me of fun times from my childhood playing with my sisters and the neighborhood kids. It's also so refreshing to come home to happy, healthy kids after a long, difficult day at work.

Bring Your Niece to Work Day

Anna, age 5, was so excited to come visit the nursery with me - she's been looking forward to this for weeks. The babies seemed to enjoy being held by Anna, too! I loved getting to show Anna the nursery and the tiny babies and to introduce her to my work. Her enthusiasm was contagious - it caused me to remember that it truly is a remarkable place where I get to work every day. Maybe Anna can join me in pediatrics in another 25 years!

A Patient's View

So unfortunately I experienced Tenwek from the patient's perspective this week. I tripped and fell walking on the uneven road after dark last night and landed on my right hand. Today I got an orthopedic consult, x rays, an official read on the x rays by a visiting radiologist, and a wrist splint applied by a physical therapist - all for $7 and minimal hassle - the benefits of living and working at a mission hospital in Africa! [I don't think I'll turn that receipt into my insurance company!] Thankfully there's no obvious fracture but the wrist is sprained so I have to wear the splint for a couple weeks and then get a repeat x ray to make sure a fracture doesn't show up later. It's annoying that it's my right hand! But I have been well cared for and received much sympathy from friends, work colleagues, and random Kenyans who see my splint. I would definitely recommend Tenwek Hospital to a friend!

Work day without a pager

I enjoyed working a full day Wednesday without the interruptions of a pager. It's very difficult when that pager goes off with it's annoying beeping to avoid immediate feelings of irritation, complaint, and even anger that my plan for that minute has been interrupted. Thankfully God gives strength to remember that His plan is perfect, not mine, and He also gives me a break from the pager from time to time!

On Wednesday, I traveled with one of the interns to Eldoret (almost 4 hours away) to speak to the graduating medical student class and hopefully recruit some of them for internship at Tenwek beginning in January. I enjoyed the chance to get to know Damaris better and to learn more about medical education in Kenya. It's a bit surreal that just one year out of residency myself, I have such a significant role in training interns and residents at Tenwek. I frequently remember my mentors and educators from med school and residency and am grateful for their role model. As is often the case, I learn a lot through teaching as well - and I'm quite thankful for my UpToDate subscription (medical reference site)!

While we spent a long time in the car to and from Eldoret, the scenery was beautiful and we enjoyed a good lunch with representatives from other training hospitals in Kenya. I love living in such a pretty place!

[The above picture is coffee bushes along the side of the road. The last picture below is people lining up in the tea field after picking tea all day to have their pickings weighed and their wages distributed accordingly. For an interesting article about tea and HIV very relevant to where I live and work, click here. Kericho, the town mentioned in the article, is just an hour away; we have many tea fields around Tenwek; and our HIV program is funded by PEPFAR.]

Oxygen Prisoners

Some of our most challenging patients on both the internal medicine and pediatrics services are those who are oxygen prisoners. These patients have been treated for pneumonia or tuberculosis or HIV related lung disease (PCP) but for one reason or another have been unable to wean off oxygen. They remain in the hospital for weeks or even months receiving oxygen as we have no way of sending them home with oxygen tanks. It's common to have 1-2 of these patients in each ward at any given time. We have had infants in the nursery born very prematurely who developed respiratory distress syndrome and then bronchopulmonary dysplasia and remained in the nursery for oxygen - the two most recent infants in that condition slowly improved and were able to be weaned off oxygen by 2-3 months of age and finally were sent home. A 2 month old Maasai baby recently spent 5 weeks on the pediatrics ward due to low oxygen levels from pertussis - a good reminder of the importance of immunization (this child was too young to have been immunized, but if his siblings had been immunized, they wouldn't have passed the pertussis on to him!).

This little boy is one of my favorites! I love greeting him each day - he always chatters on and on in Kipsigis and seems to have no idea that I can't understand a word he's saying! His lung disease is due to tuberculosis (we think) but unfortunately the drugs that treat tuberculosis have caused liver disease. In the 6 weeks he's been in the hospital, we've tried stopping and starting the meds and different meds but each time the liver tests become more abnormal. Until we can treat the tuberculosis effectively, we can't wean him off oxygen (though you can see he's quite used to having low oxygen levels and often removes the oxygen himself!). We'll be trying a new regimen again soon - please pray his liver enzymes remain stable this time so he can get better and go home!
Another favorite patient I look forward to seeing is "Faith". (When patients are in the hospital for so long, you get to know them better than most.) Faith unfortunately has been hospitalized since April. She was initially critically ill and the family was not given much hope that she would survive as she was persistently hypoxic despite maximum oxygen therapy. Her lung disease was thought to be due to tuberculosis but that could never be proven. Without CT scans or other diagnostic interventions, making a specific diagnosis can be challenging. Regardless, she now has chronic lung disease that has not responded to various treatments. Her oxygen levels remain low and she is unable to rest comfortably without oxygen (she removed her oxygen mask for this picture). The team continues to work to try to arrange an oxygen tank for her to go home with but until then, she's an oxygen prisoner in the hospital. Despite these challenges, Faith always greets me joyfully with this beautiful smile. I am encouraged by the faith she displays even as she is away from her children and stuck in the hospital.