OB, continued

I continue to enjoy my work as a full service physician - adults, kids, pregnant women, phone consults, email consults (from my sister :)), house calls, ICU, clinic, multiple specialties. I even gave antibiotic shots last week to a staff member's child with pneumonia at their home. Praise the Lord; the little one is much better now. I love the variety present each day (though I do at times get frustrated with the interruptions) and am so grateful for my thorough training in internal medicine and pediatrics. And now I'm enjoying adding new obstetric skills to my repertoire. I'm thankful visiting doctors came at the right time to help on the medicine and pediatric services so that I can learn some obstetrics and hopefully help women down the road in Burundi with this knowledge. Here are some photos from this week on the OB service:

Suturing the C section incision

A very young mother with her newborn

The three remaining quadruplets (pictured above and below) continue to grow slowly but surely. Their mother (pictured here on the left) doesn't have sufficient milk for all three so we are working out an alternative plan with formula for now (very expensive, though) and likely cow's milk later. Hopefully the babies, now three months old and at their due date, will go home soon.

This young mother had eclampsia with seizures and very high blood pressure. She unfortunately lost the baby but needed to have a C section as delivery of the infant was the only thing that would improve her medical situation and potentially save her life. After the C section, though, she developed kidney failure (Creatinine 12.2 and minimal urine output) and we referred her for dialysis (not available here at Tenwek but available 3-4 hours away). She never went for dialysis, though, due to the family's inability to pay for it. We thought it likely that she would not survive and transferred her out of the ICU so that another patient with a better chance could have that bed. Amazingly, though, slowly but surely, she began to wake up and her kidney function began to return. Her recovery did not happen overnight, but in the course of a week or so, it was clear that she was recovering. She was discharged last week after almost a month in the hospital with a creatinine of 2.4, normal mental status, and regained strength. We praise God for her miraculous healing.

One of three C sections I assisted with on Friday (I'm on the left)

A monumental event: my first cesarean section without an OB attending scrubbed in. Intern Githiomi and I delivered these healthy twins, both girls, the first one breech. Our attending was in the room to ensure the babies came out ok, but we did all the cutting and sewing and delivering!

The OB/Gyn team

Anesthetist Jackson displaying a visitor to the OB ward

"For I resolved to know nothing while I was with you except Jesus Christ and him crucified." 2 Corinthians 2:2
As we continue in this Easter season and as I learn these new skills, I pray that all my knowledge would be overshadowed by the surpassing greatness of knowing Christ Jesus my Lord (Philippians 3:8).

Med/Peds/OB??!

So, in making plans to head to Burundi long term after Tenwek (for more details about that upcoming adventure, click here), I suddenly realized that, though we have an amazing team with six doctors (compared to no full time doctors currently at Kibuye mission hospital where we're going), we each represent different specialties (surgery, OB/gyn, family practice, ophthalmology, med/peds, emergency medicine). If we're going to avoid being on call every night, we're going to need to learn a bit about the other specialties in order to help each other out. So, as there are sufficient visiting doctors to cover medicine and peds this month at Tenwek, I'm learning obstetrics! I have no illusions that I can learn what OB residents learn in 4 years in one month, but I'm hoping I can learn enough of the basics to give Rachel (our OB/Gyn) a few extra hours of sleep in Burundi. The first baby (girl) I delivered by C section (with assistance, of course!)

Now, though I haven't held a scalpel in an operating room since my third year of medical school (and even then, rarely do they let the medical student hold the scalpel!), I have seen quite a few C sections as a pediatric resident at a busy women and infants hospital. But I obviously didn't see what happened after they handed me the baby! And still, as those kind enough to teach me here will testify, my allegiance still lies with the baby. The OB interns are getting tired of hearing me ask if the mom got dexamethasone (to help premature infant lungs mature) and if the baby is feeding well. And on several occasions in the operating room (or theatre as they call it here), I have been a little too intent on suctioning and resuscitating the baby when I should have been concentrating on stopping the mother's uterus from bleeding! But I'm learning, slowly but surely.

Second C section - healthy baby boy (mother below)

Though it's a bit intimidating to be back at the beginning again not knowing what I'm doing (though I certainly still feel that way at times on medicine or peds), I've realized that my med/peds knowledge still is beneficial on the OB service as we discuss medical complications with the mothers or answer their questions about their babies. And it's so fun to see all these healthy babies! What a blessing!

Twins I helped deliver - a boy and a girl

I'm enjoying a bit of a break from the peds and medicine services as well. Peds has been particularly rough lately as Kenya is in the midst of a drought now. My first week back from Thailand, peds had a child die from severe malnutrition every day. We're hoping the rain is coming soon. OB is not without its complications, though. We have a mother with eclampsia (seizures and high blood pressure during pregnancy) who lost her baby and then developed kidney failure. Her kidney function was slightly better yesterday (creatinine down to 9.5 from 12.2), so we're hoping her kidneys will recover on their own as we don't have dialysis and the family can't afford to take her to a place that does have dialysis. Another mother with rheumatic heart disease (relatively common here) is now paralyzed on one side due to a stroke caused by her irregular heart rhythm. A 16 year old girl delivered a healthy baby at home but tore all the way and required surgical repair to regain continence of stool. Another 16 year old was raped. Please pray for these patients and also pray for me that I would learn what I need to in order to help obstetric patients in the future.

I did get the privilege of being the pediatrician for a very special birth on March 7 at 2:36am. My friends Eric and Rachel McLaughlin (previously mentioned OB) requested I be present at the birth of their son Benjamin Kenneth Kipruto as the pediatrician. I was so honored to be part of that special event - and so thankful that my skills were not needed! Praise the Lord Benjamin is perfectly healthy and was able to be held immediately by mom and dad. We welcome him joyfully as the youngest missionary kid on the McCropder team and in the Tenwek community.

Jessica, Rachel, and I with Baby Benjamin at his surprise baby shower

Thailand fun

Our days at the conference began at 6:30am and continued until 9pm each night with many fascinating lectures on relevant medical topics (translating into 45 hours of CME credit for me!), spiritual renewal sessions with Os Guinness (Christian author), field reports from missionaries in vastly different settings - from a special needs orphanage to a government clinic to a mission hospital, worship time together with the ~500 conference attendees (including families), and sharing struggles and triumphs with each other over meals and in small groups. I thoroughly enjoyed each aspect of the conference, but, as you can imagine, the schedule was exhausting - especially by the end of the second week! So I'm thankful for the fun interludes with friends on the two weekends:

Zip lining through the rain forest

Exploring the city of Chiang Mai

Buddhist temple

Traditional dancers

Feeding elephants

Starbucks at the Chiang Mai wall

I wouldn't believe the elephant painted this landscape if I hadn't seen it with my own eyes!

Or that elephants could play soccer!

We ate lunch at a tiger exhibit

And viewed an orchid farm

I loved so many aspects of this cross cultural experience in Thailand. But it was so much bigger than just Thailand. This year's conference attendees serve in 35 different countries, mostly in Asia, many in very difficult living conditions. Quite a few have served for several decades. I sought out every opportunity to learn from their wisdom and experience as I head down this road in medical missions. I heard excellent advice on transitioning back to the U.S., navigating cross cultural communication, managing conflict, helping third culture kids thrive, caring for those Stateside as well as those in the developing world, cultivating a ministry of listening, dealing with family challenges, etc. I also was so encouraged to share together with friends of mine in the same situation I am as newer medical missionaries looking ahead to an uncertain future. I look forward to crossing paths with these friends and colleagues for years to come.

Though I enjoy traveling, it's also really nice to come back to welcoming friends and routine in my own familiar surroundings. I'm happy to be back at Tenwek!

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!