Note the hippos in the river behind us!
Sunday, March 14, 2010
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!
Note the hippos in the river behind us! 
Thursday, March 4, 2010
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.
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.
Sunday, February 28, 2010
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
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 Saturday, February 13, 2010
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.
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.
Saturday, February 6, 2010
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!
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!
Thursday, January 28, 2010
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:
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:
Monday, January 18, 2010
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
http://wwwfriessfamily.blogspot.com/2010/01/10-reasons-we-will-choose-to-donate-to.html
Sunday, January 3, 2010
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.
Subscribe to:
Posts (Atom)