Hats Off to Moms

In addition to being a doctor, I do have a few other responsibilties here at Tenwek. One of the things I love is the chance to be an "aunt" to the missionary kids - especially since I'm so far away from my nephew Samuel and the other kids I was close to in the States. This week, I had the opportunity to briefly experience "motherhood" as I cared for Elise (2) and Micah (1) Cropsey while their parents took a 2 day anniversary safari. Being a mom is not as easy as people make it look! How do you get ready for work when the one year old wakes up at 5:45am - and make sure he doesn't wake up his sister at the same time? How do you carry two 20lb children in the rain and hold an umbrella and bag? How do you calm down a child who wakes in the middle of the night? But there are definite blessings, too. I loved to listen to their jabbering and read them books and watch them play at their house and mine. Elise prays the cutest prayers before meals and Micah has recently learned to walk and is trying hard to keep up with his big sister. And the best part is that I was "paid" in ice cream - my favorite food and a rare treat around here! So we had an ice cream party this weekend. Besides aunt, some other "hats" I wear here include pediatrician to missionary kids, Bible quizzing coach, and hostess - for meals and football games...

Anna Fader passing out stickers on the pediatric ward

Clara, one of my patients, who just turned one year old. I received nice Bath and Body Works lotion recently for being her doctor - I've also been "paid" in KitKat bars and the aforementioned ice cream - no chickens, yet, though.

Hanging out at my house - thanks for giving me the children's books, Mom - they're a big hit!

Elise and Micah deciding where in the world to go next after these two years.

Ice cream party with Micah, Abi, Elise, and Anna

Sharing ice cream with Maggie and Rachel

Superbowl party at 2 am

Bible quizzing on 2nd Corinthians

Hosting the Hayward family for dinner

Ophthalmology

Thanks to several visiting doctors on medicine and peds, I was able to take a week to learn about ophthalmology. Some of you may remember me complaining about how difficult it is to practice without specialists - well, there are exceptions and one specialty I'm very grateful for is ophthalmology (which has the distinction of being the most difficult to spell specialty). Because we don't have a CT scanner here, we usually have to guess about what's going on in the brain - ophtho is very helpful in giving us some clues (the ophthalmologists claim the brain is just an extension of the eyes - I'm not too sure of that but I do know a good ophtho exam is very valuable). I learned a lot this week and really enjoyed getting to experience a different part of Tenwek Hospital. Note the very long earlobes!

Dr. Roberts doing retina surgery (he's one of only two retina specialists in the country of Kenya so he gets referrals from all over).

From a child with likely retinoblastoma. This surgery likely saved the child's life as the cancer would have continued to grow and spread had it remained there.

Dr. Cropsey performing cataract surgery. These operations are very rewarding as patients who are almost blind regain their sight almost immediately. "I once was blind but now I see"!

A child with congenital glaucoma - there was actually a glaucoma specialist here this week as well.

Examining a premature infant for retinopathy of prematurity.

Please pray for the eye team next month as they travel to southern Sudan. They are praying that they will be able to restore vision through surgery to at least 100 patients who have almost no access to medical care. They are also very excited about the opportunities they will have to share the gospel in a very difficult region of the world.

Kericho

This last week I traveled to Kericho (about an hour away) each day for a conference on "Integrated Management of Severe Acute Malnutrition". The conference was fascinating both from a medical standpoint and a cultural standpoint. As you can imagine, I did not learn much during residency in the States about malnutrition except as it related to anorexia or obesity. I have cared for many children here in Kenya with severe malnutrition, however, whether from lack of food supply, HIV/AIDS, or difficult social situations. Refeeding these children can be tricky as the body reacts to undernutrition by slowing down in many ways (to allow survival despite limited caloric intake) and then resists when increased calories are given. I appreciated the chance to learn more about initiating feeds, repleting vitamin deficiencies, and treating hidden infections in this unique patient population as well as preparing them for discharge and preventing the same problem from happening again.

I traveled with Mercy, the nutritionist from Tenwek, and enjoyed getting to know her as well through this shared experience. As you can see from the group photo, I was the only non-Kenyan at the conference. This provided the opportunity for many interesting cultural observations:
1) There is very little variety in the Kenyan diet. The staples are ugali (like corn meal mush), rice, potatoes, chapatis (like tortillas) - lots of carbs! - sukumawiki (greens), cabbage, and maybe some broth with small pieces of beef or chicken. We were served 3-4 of these items each day for lunch - and that seems to be what people eat every day for two meals a day without complaint (even nutritionists!). Notice there is very little protein - probably contributes to the malnutrition. But it also highlights that variety in diet is a luxury that most people in developing countries do not enjoy. I did look forward to chai twice a day, though!
2) Kenyans prefer speaking Swahili to English. The first language here is either Swahili or a tribal language and then people learn English in school - professionals speak English well (although it's more British English and thus my American accent is hard to understand.) But, although the handouts and power point slides were in English, the instructors and fellow conference attendees frequently slipped into Swahili - especially when sharing an anecdote or conversing casually. The result - I missed pretty much every joke all week! It was very good practice, though, and I noticed I understood a lot more of the Swahili by the end of the week. I even spoke in Swahili for a couple sentences Friday when it was my turn to recap the previous day's learnings. Good motivation for continuing my Swahili study!
3) Recognition/appreciation of the speaker is very important - and brief uncoordinated applause as we're used to in the States is not sufficient. So after each session we all stood up and either clapped a pattern in unison or picked imaginary flowers from the sky and "gave" them to the speaker in unison.
4) During introductions, rather than just saying "married", people said "married with one wife". One of the instructors also told an amusing story about her "co-wife" at one point (meaning her husband has more than one wife). Polygamy is pretty common here - evidently even in professional circles.
5) Audience engagement and participation were very important. Speakers frequently asked, "Si ndiyo?" (Is it not so?), "Tuko pa moja?" (are we together), "Isn't it?", or "Do you agree?" and expected responses. They also frequently left sentences what? Left sentences hanging and waited for the audience to fill in the last what? The last word.

As you can see from the below pictures, I also enjoyed beautiful and interesting scenery en route to Kericho and back each day. Some of the tea you drink probably comes from the Kericho area (tea is one of Kenya's main exports). The tea fields are very green and beautiful - and the leaves are all picked by hand! We also saw monkeys daily as we ate lunch and even visited the Kericho District Hospital. Thanks for reading to the end of this long blog!

January pictures

Here are a few random pictures from various January events:

The Giraffe center in Nairobi last weekend:

The Maasai Market in Nairobi:

January has been unseasonably cool and rainy (January is usually hot and dry here) which has been nice - note the rapids and the increased size of the waterfall:

A recent trip to Narok (a Maasai town 1-2 hours away) to visit some friends from med school and residency working at a clinic there for a month (small world!):

Pictures from the intern graduation:

Samaritan's Purse relief to Haiti

Just thought I'd pass on a link to another Post-Resident Kenyan blog. We've received bits and pieces of the news of the Haiti earthquake and have been praying for Haiti daily during our morning report. This blog post highlights some of the work Samaritan's Purse (who I'm working for) is doing in Haiti already. I know firsthand that their relief work is top notch in efficiency and quality. If you are looking for a way to contribute to the earthquake victims, I would highly recommend SP. Donate online at www.samaritanspurse.org.

http://wwwfriessfamily.blogspot.com/2010/01/10-reasons-we-will-choose-to-donate-to.html

Pediatric patients

First, Happy New Year! We had a fun celebration here - no watching the ball drop in NYC but we improvised (see picture)! We enjoyed egg nog (homemade), snickers pie (with snickers bars bought specially from Nairobi), and games - and we counted down to 2010 about 8 hours before most of you did! I am excited to spend 2010 in Kenya!

Thanks to being a med/peds doc, I get to enjoy a lot of variety in my work. I have been working primarily on the pediatric service until this point but I will be switching to adult medicine in the next couple weeks. I have really enjoyed peds - as you can see, it's such a blessing to be greeted by these adorable children each day. Each of these children has a story - I learn a small part of that story through my interactions with them (the history of their current illness, how many siblings they have, what means their family has to provide food and pay hospital bills, etc). But with the language barrier, most of my interaction consists of smiling and giving out stickers and handshakes. It amazes me to realize that the same God who created the world and names the stars knows the complete story of each of these children. I shared my story of how I came to know God and be here in medical missions during doctors' devotions last week. I was reminded of God's faithfulness from the time I was a small child - even when I was in the hospital myself at age 10 paralyzed with Transverse Myelitis - to draw me to himself and accomplish a mighty work in my life. I pray He continues to do the same with these children through the difficulties they are facing.

Christmas at Tenwek

I enjoyed a Christmas full of activity in Kenya this year. No snow but still many familiar old traditions and new memories and traditions as well. Without all the hype of commercial Christmas, it seemed easier to reflect on Jesus' birth and the reason we celebrate. These are pictures from our visit to the orphanage (the kids sang English and Swahili Christmas carols for us), Christmas Eve with some other Post Residents, Christmas Day caroling at the hospital and having dinner with the Manchester family (including homemade peppermint ice cream!).

Great Rift Valley

Although some things are not too different for me now (nice house, electricity, warm water, good food), driving through the Rift Valley en route to Nairobi is quite a change of scenery - see above picture. We saw zebras, baboons, and gazelles just off the side of the road (plus cows, goats, sheep). I enjoyed the trip for more than just the scenery, though. I realized I haven't been more than a mile from my house in almost 6 weeks! It was good to have a few days off from the hospital and to see more of the country. I also enjoyed the shopping (those of you who know me may be surprised at that statement but when you haven't shopped in 6 weeks, your perspective changes!). I found a 2 foot Christmas tree and some other decorations and presents in addition to groceries. It was great to welcome the McLaughlins to Kenya as well - there are now 6 physicians from Samaritan's Purse's post residency program at Tenwek (see the below picture and http://www.mccropders.blogspot.com/ and http://www.dangalatkenya.blogspot.com/) which is very fun. It's such a blessing to be able to share this experience with others.

The weekend came to a bit of a sad conclusion, though, as I found out one of my favorite patients died. KB was 14 years old and suffered from a chronic rheumatologic condition (maybe Lupus). We had actually consulted several pediatric rheumatologists in the States via email on his case. He was admitted a couple weeks ago with a likely pulmonary embolism and was improving until Thursday when he took a turn for the worse. I always enjoyed greeting KB in the mornings - he spoke English and always said he felt "better" - he never complained no matter what pain he was in. It is comforting to know, though, that KB prayed with the chaplain to receive Christ during this hospitalization. Please pray for his family. (His picture's below.)