East or West?

Every year the Christian Medical and Dental Associations provide continuing medical education for missionaries around the world to assist them in keeping their medical licensing current while living overseas. I was unable to attend the conference in Africa last year due to staffing needs at Tenwek, so my colleagues graciously allowed me to come to the conference in Thailand this year. Thus far I have loved my first glimpses of Asia - though I was a bit confused in Bangkok as to whether I had traveled East or West.

Flying into Bangkok, I noticed divided lane freeways with freshly painted lines on the roads, overhead signs, exit ramps, and cars staying in their lanes - things I don't see everyday in Africa. I traveled around the airport on moving walkways and escalators and even saw drinking fountains (couldn't remember what they were called at first - "drinking machines?"). Familiar brand name toiletries and candy was advertised at the various stores. I even found stores selling North Face and Nike gear. And the best part of all was the Starbucks coffee and Dunkin Donuts which I happily consumed in the food court overlooking the nicely groomed grounds and modern architecture of the freeway nearby. I felt a bit backwards being so amazed by such simple things and caught a glimpse of what my re-entry to the States will look like in September.



There were clues, though, that I had indeed traveled East - signs written in Thai, for instance, the many alters to Buddha, being greeted with hands together in a bow rather than a handshake, the beautiful scenery of the rain forest and the delicious Thai food.



I've been absolutely amazed to glimpse the global church through meeting missionaries from so many nations around the world and worshipping together. Some of these missionaries work in mission hospitals similar to Tenwek in Papua New Guinea, Bangladesh, and Nepal. Others work in difficult countries in the Middle East and Asia where they are not able to worship freely. I was speaking to a missionary doctor in my small group from one of these countries and she said to me, "Wow! I could never do what you're doing in Africa." I replied, "I could never work in [her country]!" But the truth is that God has equipped each of us - even those working at Mayo clinic who are at this conference to lecture and instruct us about HIV and congenital heart disease and high blood pressure - for the work He has given each of us to do. He cares about the poor and oppressed, the orphans and the sick around the world and shows His mercy and His justice by calling His children to go to those places and share His love. He gives us His grace for the experiences we have when we have them and strengthens us for the task at hand. And one day every knee will bow and every tongue confess that He is Lord! (Phil 2:10-11)

Internal Medicine service

I know I usually post pictures of children - who can help it when they're so adorable?! And I do work on the pediatric service more often but I also care for adult patients on the internal medicine service regularly - they're just not as photogenic. :) But I enjoy caring for both adults and kids and working with interns on both services. On medicine this month, we've been busy with ICU patients, consults from the OB and orthopedic services, and patients sometimes two to a bed on the male and female medical wards.

Medicine team during chai break and teaching time yesterday

Male medical ward

Top five diagnoses (in no particular order): Bacterial meningitis, esophageal cancer, HIV and associated complications, tuberculosis, pesticide ingestion (suicide attempts)

Other common diagnoses: congestive heart failure, diabetes, hypertension, pneumonia, stroke, kidney failure, anemia

Medical officer Anthony supervises the intern performing a bone marrow biopsy in a young patient with unexplained low blood counts

Being a med/peds doc, even on the medicine service I continue to follow along with peds patients as I often take overnight or weekend call for peds. Please pray for these two quadruplets (only three are remaining, unfortunately) who became ill again Friday night.

Cow's milk

As you have seen pictures and read about some of our malnourished children, you may wonder where the milk comes from to feed them. After all, there's no grocery store around the corner. I was curious, anyways, so yesterday I took a field trip to the hospital kitchen. The milk itself comes from local cows. Each morning approximately 50 people who live nearby milk their cows and walk to the hospital with 2-5 liters of milk each. They then sell the milk to the kitchen at 24 shillings per liter (approx 30 cents). The hospital buys 250L of milk per day. Two girls walking home after delivering their milk

In the kitchen, the milk is then boiled (it's unpasteurized, after all) and strained. We need high calorie formula to feed our malnourished children. Sometimes we have formula powder to add to boiled water, but when we don't, we make our own. The milk is mixed with sugar, oil, and water in prescribed amounts to make F-75 and F-100 formula (75 and 100 calories per 100mL respectively). Or we make "special ugi" - water, milk, egg, sugar, oil, and millet flour mixed to make a porridge type drink that is also high calorie.

Some kids don't like the formula as it's too sweet but this little one loved it and gained weight quickly.

Yes, L, milk really does come from cows.

Superbowl

Last year we woke up in the middle of the night to watch the Superbowl. This year, we managed to record the game and all watch it together Monday night. (We just had to be careful not to check Facebook on Monday!) Pretty close game and fun event for everyone.

Hospitality & Electricity

There are advantages and disadvantages to living with lots of other Americans - advantages are having people to watch the Superbowl with (post to follow), to celebrate American holidays together, and to generally understand my culture and frame of reference. Disadvantages are that I don't have as many opportunities to experience the local culture, and thus I appreciate it when those situations arise. I'm grateful to one of the long term missionaries for explaining some valuable nuances of Kenyan hospitality which I had noted but not understood before - specifics of welcoming guests, serving food, and closing the time together which are different from what I'm used to. I've enjoyed putting some of these tips into practice through hosting interns and colleagues this month. I recently also appreciated the opportunity to learn firsthand through eating dinner at one of my fellow doctor's home. Drinking chai with the Terrer familyLittle Debora loved helping to welcome the guests and clear the dishes. I enjoyed the Kenyan meal a lot, though I must say, I wasn't sad to see mursik missing from the table - a traditional drink of sour, charcoal milk! Some cultural experiences are ok left to the imagination!

On another note, this blog has been late in coming partly due to busyness at work but also because our electricity has been very unreliable lately. We were without power most of three days last week and it's been off a couple hours each day this week, too. Our power actually comes from a hydroelectric dam. As you can see from this picture, the river is drying up which means lack of power for us! So while those of you in the States are experiencing severe winter weather, we're also without power (but due to good weather, actually). Hopefully rain will come soon! It does serve to make us grateful for things we often take for granted - like candles and cold refrigerators!