Going home

Each of these patients stayed on the peds ward for about one month - not how any of them intended to spend their Christmas! But, thankfully, they were all discharged home in stable condition last week. I always looked forward to greeting them each day and will miss them but am grateful for happy endings.

This little boy survived bacterial and tuberculous meningitis. Unfortunately, though, he lost his vision as a result of the severe infections. We gave the family the contact info for the Kenya Society for the Blind - hopefully they will pursue that further as that organization would be quite helpful in teaching braille and helping this boy learn how to live with blindness. The typical daily activity for a Masai boy his age, though, is to herd goats or cows, which, sadly he will be unable to do. Pray for his adjustment to a difficult life.

This is one of the few patients to learn my name. Though I like my name, I don't think my parents considered whether it would be easily pronounced in other languages or by small children. But little E greeted me "Dr. Alyssa" each day as she endured several skin grafts and other surgeries to treat her scars and contractures from burns.

I blogged about this little one with severe malnutrition earlier this month - 15 months old and 3.7kg, now quite well and discharged home at 5.2kg. She even smiled for me the day before she went home!

Intern Graduation 2011

Tenwek Hospital trains 16 interns per year who then work in district hospitals and outpatient departments around the country. Different from the U.S. system, physicians (medical officers) do not usually begin residency immediately after internship but work a couple years as a generalist at a district hospital and then hopefully find sponsorship for residency. Clinical officers (similar to physician assistants) complete a similar internship and then generally work in outpatient departments and dispensaries though some do eventually specialize as anesthetists, etc . Internship is one year and consists of 3 months each of medicine, peds, surgery, and OB/Gyn - not a lot of time to train independent, qualified doctors! But I think Tenwek does an excellent job and it's amazing to watch the growth in individual interns over the course of a year. It's especially interesting this time of year as we are transitioning from one class completing internship to another class starting. These pictures are from the recent graduation ceremony.

Lunch with one of the interns and his family

The graduating intern class of 2011

Interns pictured with consultants (attending physicians). I had the privilege to work with this class from their first call night a year ago till the end of their internship and so was proud to celebrate with them and their families on this special day.

I truly believe in educating and discipling national physicians to provide excellent medical and spiritual care for their patients wherever they go. I can care for a few patients myself who might otherwise not have received care but now there are 16 new medical and clinical officers to care for patients all over the country of Kenya and even beyond. I was so excited to find out recently that one of our graduates is planning to work exclusively in Southern Sudan. She was born there but has been raised primarily in Kenya. She voted proudly in the referendum last week as a Sudanese citizen and will be moving to Sudan soon as one of the few doctors in the southern region. And we thought we had limited resources here in Kenya! Please pray for Grace as she ministers to her people and for the country of Sudan. So far the referendum (vote to make Southern Sudan a separate country from the north) seems to have gone more peacefully than expected but the results won't be announced till next month. Please also pray for our other interns who are waiting for their postings from the government as to where they will be working next. And they didn't even get to submit a rank list! They're just told, "Report tomorrow (or yesterday) to ____." And then they get out the map to find out where ____ is!

Anyways, thanks for reading to the end of this long post! And thanks to those of you who have supported me so that I can participate in educating these young doctors!

Patient updates

First an update on the quadruplets: They are all four breathing well on their own with no signs of problems from premature lungs. Their mother is recovered from her c-section and has family helping her to feed and care for the quads. But the babies unfortunately are not tolerating their feeds very well. They all four had necrotizing enterocolitis (gastrointestinal infection that preterm infants are prone to) and are slowly recovering. We are trying to advance their feeds via NG tubes daily. Continue to pray that they will tolerate the feeds and begin to grow soon as they are all still quite small at 2 lbs each.

Now on to some other pediatric patients:

This 16 year old girl has a condition called osteogenesis imperfecta which means she is prone to fracture her bones with minimal trauma. She has been here 6 weeks in traction for a hip fracture but has maintained a good attitude throughout that time. She has been diligent in studying for school and always has a friendly smile for visitors and the medical team. Hopefully she'll be able to go home soon.

The little boy on the back of his big sister was diagnosed last week with congenital hypothyroidism. In the States, this is diagnosed with newborn screening and then patients are put on the appropriate medication as infants to prevent further problems. Unfortunately, this little one wasn't diagnosed till he was a toddler which means that even though we have started thyroid medication now, he will continue to be developmentally delayed and will likely have a low IQ.

We thank God for providing miraculous healing for this baby. At birth he was noted to have significant difficulty breathing and a blue color to his whole body. Normal oxygen saturations are above 90% - his oxygen levels were 30%. Through a couple simple tests, we diagnosed him with PPHN - persistent pulmonary hypertension of the newborn. Basically this means that his lungs did not adapt the way they were supposed to to life outside his mother. The first 24 hours, his oxygen saturations were 30-75% despite maximum oxygen support. The second day, his saturations were 24-54%. Finally, the third day, they increased to 72-92%. He was weaned off oxygen after 2 weeks and discharged home breathing well and feeding well with no obvious problems shortly thereafter. Treatment for PPHN in the States involves things like ventilators, inhaled nitric oxide, ECMO, vasopressors - none of which we can really do here. It's quite remarkable that this baby's oxygen levels were so low for so long and yet he never had a seizure and you can see how alert and active he is (another picture below). Praise the Lord!

The next four pictures are of the same child. Little Chepkirui was admitted to the hospital at 15 months old weighing 3.7kg (8lb - less than my one month old niece Emma weighs). She is the 9th child in the family and her mother delivered child #10 shortly after Chepkirui was admitted. On arrival in the emergency department, Chepkirui was cold, gasping, and critically ill. No one thought she would survive the night. But this first picture is her a few days after admission. You can see she's in a special warmer box to help keep her temperature up.

Picture taken one of the first days she could sit up on her own.

Now able to maintain her temperature out of the box and able to feed from a small cup instead of the nasogastric tube. Pictured with the intern who cared for her that first night in Casualty.

Now weighing 4.7kg (10lb), able to eat rice and beans in addition to milk, and getting close to going home. I have yet to see a smile but Chepkirui is now quite alert and interactive and willingly lets me hold her and play pat-a-cake with her. Please pray for the family, the nutritionist, the social worker, and the community health team as they seek to find a solution to prevent her and the other children from getting into this severely malnourished state again.

A teenage girl with Down syndrome recovering from pneumonia

This plant may appear harmless but in actuality we admit several children each month due to poisoning from ingesting its fruit. Datura (Jimson Weed) poisoning causes severe agitation, dilated pupils, and confused behavior - one of the many things I've learned since coming to Kenya!

Quadruplets

The Kipsigis tribe has a very high rate of multiple births - I've seen several sets of triplets and innumerable sets of twins during the last year. In fact, we have FOUR sets of twins in the nursery right now (out of 34 babies). But today I cared for my first set of quadruplets! Thankfully the mother came in a couple days ago and so she received steroids to help with the babies' lung maturity. They delivered yesterday each weighing around 2 pounds. So far, they're all doing quite well but they have a long road ahead with all the possible complications of prematurity. Please pray for them.

Anna, one of the missionary kids, is daughter to two OB docs and loves to help hold the babies. She and I are holding the quadruplets in this picture. We'll need lots of help with these little ones in the days ahead - usually the mothers come to the nursery every three hours (night and day) to feed the babies for the duration of their stay (often months for the smallest premies) but I think this mother will have her hands full with four babies to feed every three hours!

We'd also appreciate your prayers for this littlest baby in the nursery weighing in at 564 grams (a little over 1lb). We've never had a baby survive this small at Tenwek but so far the little guy's doing his best and fighting hard.

Krismasi Njema!

We've enjoyed a wonderful Christmas here at Tenwek celebrating Jesus who came "because of the tender mercy of our God, whereby the sunrise shall visit us from on high to give light to those who sit in darkness and in the shadow of death, to guide our feet into the way of peace." (Luke 1:78-79) We've certainly seen elements of darkness this year here - sickness, death, abuse, brokenness - but we've also seen light break through in myriads of ways as God guides us in the way of peace! Enjoy these pictures from our Christmas celebrations:

Christmas caroling in the hospital and in the neighborhood:



The little missionary kids joined me in watching the Christmas movie Polar Express:



I love our women's Bible study with the interns. We've really enjoyed our Beth Moore study this year and praying and sharing together.


Christmas Eve dinner with friends:

Rachel & Maggie at the candlelight Christmas Eve service:


Christian, a one year old orphan from the baby center, has a lung condition we're still trying to figure out. Please pray for him.


My Christmas tree:


No white Christmas here, but how many of you had cows wander through your front yard on Christmas day? :)




Birthday party for Jesus:


This little girl recovered from bacterial meningitis about a month ago. We praise the Lord for healing her.


Boxing Day potluck:

Meet the McCropders

"The physical presence of other Christians is a source of incomparable joy and strength to the believer." Dietrich Bonhoeffer
"How good and pleasant it is when brothers live together in unity!" Psalm 133:1

I am so thankful to not be journeying on this road less traveled alone. During the last year, I have lived and worked together here at Tenwek with a team of three families in my same Samaritan's Purse Post Residency Program. It has been such a blessing to share this journey together in community and to discover we have a similar vision for ministry involving medical education and discipleship in an underserved part of the world. I am very excited to now officially join the McCropder team.

For the story of how the team came together, click here. Also, check out the team blog here or by clicking on the Word and Deed link on the left.

Meet the McCropders:
Eric (Family Practice), Rachel (OB/Gyn), & Maggie (age 19 months) McLaughlin
John (Ophthalmology), Jessica (teacher), Elise (age 4), & Micah (age 2) Cropsey
Jason (Surgery), Heather (teacher), Anna (age 5), & Abi (age 2) Fader

The Cropseys have graciously offered to share their "P" and the Faders have also offered their "er", so either way, Pfister is now included in McCropder and no team name change is needed. :)

The team has been thoroughly researching possibilities for future ministry after our two year term at Tenwek concludes next fall and we are excited to announce that Burundi is the front runner at this point. Read more about Burundi here and here. Thank you so much for your prayers and support and encouragement through this process. I'm so thankful to bring you all along on this journey with me as well.

"Our merriment must be of that kind (and it is, in fact, the merriest kind) which exists between people who have, from the outset, taken each other seriously - no flippancy, no superiority, no presumption. And our charity must be a real and costly love, with deep feeling for the sins in spite of which we love the sinner - no mere tolerance, or indulgence which parodies love as flippancy parodies merriment. Next to the Blessed Sacrament itself, your neighbor is the holiest object presented to your senses. If he is your Christian neighbor, he is holy in almost the same way, for in him also Christ vere latitat - the glorifier and the glorified, Glory Himself, is truly hidden." C.S. Lewis

The Road Less Traveled

I've now lived overseas more than a year. It's been a year full of challenges - being far from family and friends, dealing with the tragic deaths of young patients, struggling with limited resources and health disparities, learning to teach, attempting to understand a different language and culture, seeking future direction for my life. But it's also been a year of abundant blessings - witnessing miraculous recoveries, sharing in the laughter and joy of children, discovering amazing community, being encouraged by family and friends near and far, experiencing magnificent creation, finding direction. I have seen Jesus' light shine in the darkness and have participated in His work of restoring brokenness in this life and the next. And I have enjoyed journeying on the road "less traveled by"; it has "made all the difference" (Robert Frost).

So, what's next? In seeking to answer that question, I've sought counsel and prayer from family and friends. I've considered my gifts, talents, personality, strengths and weaknesses, interests, and desires. I've studied and learned from the examples of those who have gone before. I've searched the Scriptures and prayed for direction. I've looked for the place where the world's great need and my deep gladness meet (paraphrase of Buechner quote), where I can best glorify God and enjoy Him forever (from the Westminster catechism). I've counted the cost.

And the conclusion is...

At least for this season of life, I'll be continuing in long term medical missions. I desire to continue to provide medical care for the "least of these", to educate and disciple national physicians, to live in community, to live out the gospel, to seek God's kingdom come on earth as it is in heaven. And, though I believe these goals can be heartily pursued in the U.S. and I support and stand with those working to that end in various vocations, for me it seems the path is leading towards further life and work in sub-Saharan Africa. Stay tuned for details of my travel companions and likely location...

Ethiopia pictures

The team: Miles Gresham, Jennifer Hewitt, Sarah Torsch, Mike McDonald, Jeremy Allen, Me, Candace Mothershead
Home visit

Another home visit

Me with Caleb Treadwell (age 3) and a friend

Ethiopian food - yum! Team pictured with Michael & Emily Treadwell, missionaries in Ethiopia from Red Mountain Church

3 year old girl with malnutrition likely from congenital heart disease which we diagnosed - we referred her but don't know if she'll be able to have surgery in Ethiopia. The good news, though, is she does not have HIV - the mother had been very concerned about this for some time but was afraid to have her tested so we were able to test her and give her the good news. Her mother was crying and so thankful.

More Ethiopian food!

7 year old girl from rural Ethiopia (recently moved to Addis Ababa) with severe malnutrition

This 12 year old girl came to clinic with complaints that she is becoming weaker and now can no longer walk to school or get up out of a chair when seated. On further questioning, she'd been seen by another doctor in Addis who had done a muscle biopsy. The mother actually brought the results of the biopsy but nobody had explained them to her! The child unfortunately has muscular dystrophy so she will continue to get weaker and likely will be unable to walk soon - sad news, but I was glad to be able to give them a diagnosis and an idea of what to expect ahead and also to pray with them.

We drank a lot of good coffee - macchiato - during our week in Ethiopia. This is the coffee ceremony where they first roast the beans and then brew the coffee in that small pot.

The team on the last day of clinic pictured with Michael Treadwell and Linda Swallow, long term nurse practitioner working with the project

For more info about our time in Addis, see the below blogs or send me your email address and I'll add you to my monthly email update list (which is more detailed than the blog).
Special thanks to Candace for letting me use some of her pictures - she's an amazing photographer!