Happy Mother's Day!

"What a heritage falls to them whose surroundings from childhood have been illumined by the Book of God, whose winds have been freighted with the prayer and concern of others for their souls." Jim Elliot

Jim Elliot in his first letter to his parents written en route to Ecuador: "I surely praised God for the valiant way you both took my going. It is true that I know very little about how you feel at seeing me leave. All I understand is that it must be very keen, deep, and closely linked with all that this life involves for you. I pray for you whenever you come to mind, asking the help that is from God for you both. You are as well a constant source of praise for all that you have given of yourselves for my sake. The will of God is always a bigger thing than we bargain for, but we must believe that whatever it involves, it is good, acceptable, and perfect."

"You probably never thought before of the fact that Amy Carmichael had a mother.” My mother

I praise God for my mother today and the sacrifices she has made for me to be here. I look forward to seeing her here in June!

Lake Nakuru

I travelled to Nakuru last week with several other health care workers from Tenwek for a conference on ARVs (medication for AIDS). The conference was quite beneficial in provided further information on the status of AIDS in Kenya and the most recent Kenyan guidelines on how to treat these patients. I especially appreciated the information on pediatric HIV/AIDS and preventing mother to child transmission as I rarely saw children with HIV during residency in the States but am caring for them daily here. I also enjoyed another opportunity for more immersion into the Kenyan culture through interacting with the other conference participants.

Beyond the educational value of the conference, though, was the benefit of the hospitality of missionaries Jim and Alice Vanderhoof. I really enjoyed getting to know them better and hearing their stories of how God has been faithful through the 26 years they have lived as missionaries in Kenya. Jim and Alice are pictured here with myself and Eric McLaughlin - another post resident working with his family at Tenwek (http://www.doctorsmclaughlin.blogspot.com/).

The highlight of the week was a tour of Lake Nakuru - a national park filled with amazing wildlife. We even saw a herd of 22 giraffes!

Lake Nakuru is most famous for the many flamingos which create a pink rim around the lake.

I am thankful to not be driving in Kenya (left side of the road, right side of the car, inexperienced drivers on the road, suboptimal road conditions, etc) even moreso now as in the past week, we had a dead battery at Lake Nakuru and a flat tire on the way home to Tenwek. Thankfully the drivers knew what to do - even without AAA! Praise the Lord for bringing us back home to Tenwek safely.

Esophageal cancer

Esophageal cancer, while uncommon in much of the world, is very prevelant in this part of Kenya. There are various theories as to why that is - diet, scalding hot temperature of tea, genetic predisposition - and research is being done here at Tenwek (primarily by Dr. Russ White) to further investigate those theories. We don't have chemotherapy to offer these patients but we do have a palliative stent that can be placed through endoscopy. This makes it possible for the patients to swallow again which makes for a much better quality of life. On average they live 8 months longer after stent placement. This patient is a 71 year old male who presented to Tenwek with a complaint of inability to swallow. You can see from the picture that he had lost a significant amount of weight as a result. The first two pictures show the esophageal (spelled "oesophageal" here) cancer and the endoscopy team performing the EGD. The third picture shows the stent in place opening up the esophagus. The last picture is the patient drinking from the "ceremonial cup" - a cup they use to give water to the patients after stenting - the patients are able to swallow immediately and are very appreciative. If any medical people want more info, here's the pubmed link to a recent article published by Dr. White on esophageal stenting:http://www.ncbi.nlm.nih.gov/pubmed/19230771.

Premie success story

On average we have 30 babies (currently 40) in the NICU at any given time, some with infections, some with congenital anomalies, many who were born prematurely. We do the best we can for these tiny infants but with homemade incubators, no ventilators, no TPN, and no surfactant (used for premature lungs), the chances are not very good for the really small ones. But there are some miracle infants who don't seem to know the odds are against them and survive anyways - thanks to the Great Physician. One of those babies is Kip__. Kip__ was born at 26 weeks gestation age (we think - dates aren't very accurate here) and his weight dropped down to 680gms at its lowest point (1.5lbs). He battled respiratory distress syndrome (immature lungs), a PDA (immature heart), infections, anemia, and very slow feeding due to his immature GI tract. But he grew steadily and was discharged in February at 1900gms (4lb). I'm posting this now because his mom brought him back for a check up this week and he is now 3kg (6.6lbs) at age 4 months and looks chubby and healthy! Also he no longer has a heart murmur. Praise the Lord! I was very encouraged to see him this week looking so well and wanted to share his story with you as so many other stories around here unfortunately end quite differently. Baby Kip__ on day of discharge - 1900gms


Kip__ with mother and nurse Gladys

Kip__ this week at 3000gm

Pasaka Njema!

I hope everyone celebrated a beautiful Easter with family and friends worshipping our risen Savior and focusing on the amazing truth of the Gospel. As with Christmas, living in this rural microcosm of the world with minimal outside influences (especially as the internet has been down the past few days), it seemed easier to focus on the celebration of the Gospel and the Passion of Christ this year. I enjoyed a three day weekend complete with a Good Friday service, watching The Passion movie, a Passover Seder (Christian Passover service), Easter sunrise service, meals with friends, relaxing, playing games, and hanging out with the missionary kids.

The cross at the sunrise service on Easter morning. As is evidently a Tenwek tradition, we all placed flowers on the cross at the end of the service.

Christian Passover service with all the Samaritan's Purse Post Residents and families

Easter egg hunt!

Easter dinner

Patients

Mother and son (both my patients) with chaplain

Baby bundled up for winter

Rounding with interns

Passing out stickers

After a couple weeks in the hospital, this child with malnutrition finally has warmed up to me! He walked up and gave me a hug right before this picture was taken. He used to scream whenever a doctor or nurse got near him.

Infant with tetanus

11 year old with likely leukemia

A smile I look forward to as I walk home each day!

Many of these pictures correlate with my recent email update (which was really too long to put on the blog). If you would like to receive the monthly emails and don't currently, just let me know.

Kips & Cheps

(N.B. I must give a shout out to Logan & Julie Banks at http://www.banksoffshore.blogspot.com/ for this blog idea.)

As is expected living in a foreign country, my patients do at times have difficult to pronounce names, but, contrary to Birmingham, Alabama where people invent endless permutations of name spelling and pronunciation, there is a finite number of possible names here. The Kipsigis tribe (most of my patients) names their children primarily based on the time of day they are born. For the most part, boys names start with “Kip” and girls names start with “Chep.” For example, I was born at 2am, so my Kipsigis name is Chepkemoi (girl born near midnight). If you know what time you were born, look at the list below and see what your Kipsigis name is:

Kipkemoi/Chepkemoi – born near midnight
Kipkoech/Chepkoech – born when almost morning
Kipkorir/Chepkorir – dawn
Kimutai/Chemutai – dawn
Kipngetich/Chepngetich – when the cows go out (morning)
Kipngeno/Chepngeno – when the goats go out (morning)
Kibet/Chebet – midday
Kiprotich/Cherotich – when the cows come back (afternoon)
Kiprono/Cherono – when the goats come back (afternoon)
Kiplangat/Chelangat – evening
Kipkirui/Chepkirui – when going to sleep

There are a few names that are not related to the time of day born:
Kiprop/Cherop – born during heavy rains
Kipchirchir/Chepchirchir – born when things are hectic (most births, right?) or during an emergency
Kiptoo/Cheptoo – born when visitors arrive
Kipruto/Cheruto – born when visiting
Kipchumba/Chepchumba – born when wazungu (white people) are present (a relatively common name around here!)

I was discussing these interesting naming methods with some of the nursing staff one day and they asked how I got my name. I explained that my parents read the name “Alyssa” in a book of baby names and liked it. They thought that naming method was actually quite strange!

These triplets, born essentially at the same time of day, are named Kiprotich, Cherotich, & Cherono (when the cows come home and when the goats come home).
These twin girls (under lights for jaundice) are named Chepkorir and Chepkoech (two different names for early morning).

Usually children are given a “Christian” name in addition to their Kipsigis name when they are older which makes distinuishing between adult patients a little less difficult.

Here's some more pictures of my vacation last week with my friends Shannon & Jed. I really enjoyed the chance to experience more of Kenya than I had previously seen. It's a beautiful country. And Shannon & Jed are great traveling friends!

The Giraffe Center in Nairobi
Overlooking the Rift Valley

Tenwek waterfall after a lot of rain

Tenwek sign

Chai at the hospital restaurant

Helping babysit some of the missionary kids

Sunrise in the Kakamega rain forest

Colobus monkeys (black and white)

The Yala River in the rain forest

Kakamega Forest

Rondo Retreat Center in the Kakamega Forest