Sunday 9/27/15 - Tenwek adventures and more...

Happy Sunday friends and family,

Marilyn and I have been enjoying our first weekend off since we have been coming to Tenwek!  We have had an interesting couple of days since my last post.  On Friday, we had a visit from one of the Kenyan consulting physicians (Dr. Matilda Ongondi) who I had worked with on the medicine service 2 years ago.  At that time, she was running the medicine service and was a font of information and knowledge about how to practice medicine in a resource-poor country like Kenya.  Last year when we were here, she had just left Tenwek for her “dream job” at Kenyatta Hospital in Nairobi.  Her departure was a tremendous loss to the medicine department, but I was pleased to hear that she had been “promoted”, and would be studying hematology and oncology, and would be applying for subspecialty training.  On Friday, I was about to begin medicine service rounds, when Matilda appeared at the nurses’ station to say hello to some her medical interns, students, and consulting physicians.  She indicated that she had made a last minute decision to visit her family in Bomet for the weekend, and had stopped by just to say hello.  We visited briefly and I congratulated her on her promotion to Kenyatta.  We then parted, and I began making our rounds.  About an hour later, I had a call from Marilyn indicating that she had also had a visit from Matilda, and upon talking about her plans, had discovered that she was coming to Texas for 10 weeks to study hematology/oncology.  Upon further questioning, Marilyn discovered that she was coming to SAN ANTONIO, and would be working at the Cancer Therapy and Research Center in the UTHSCSA medical center!...furthermore, Matilda indicated that she would be arriving the same day that we are scheduled to return home…..and that she did not yet have any plans for a place to stay!!  Marilyn’s response to her was “Yes, you do….”  Clearly, a God-orchestrated encounter!  As a result, we will be hosting her for some part, or possibly all of her stay in San Antonio.  I hope that many of you will have the opportunity to meet her….she is a delightful sister-in-Christ, and an outstanding physician.  We are very excited about her coming to San Antonio…we are currently waiting to find out if we are on the same flight home or not?!  On Saturday, we decided to go on an outing to Kericho, which is a larger town about 2 hours drive from Bomet, and Tenwek Hospital.  This area has several large tea plantations and flower farms which offer tours to visitors with advance arrangements.  Our visiting staff coordinator at Tenwek arranged for a driver to take us to visit one of these plantations owned by a British company called Finlay.  We had an uneventful trip to Kericho, and after passing through an elaborate layer of security, were admitted to the Finlay tea plantation.  We enjoyed a fascinating presentation about how tea is processed, and then had a guided tour of the processing plant.  Our tour also included some tea tasting, and I can honestly say that I had the best tea I had ever tasted (with hot milk and sugar of course…all Kenyans drink their Chai this way!).  Afterwards, we were on our way to the flower farm (also part of the Finlay complex) when we suddenly heard/felt a loud, sickening, “thud” on the undercarriage of our minivan.  Our driver got out to inspect what had happened, and I did as well….to my horror, the drive shaft was detached at the universal joint, slanting downward and dragging on the dirt road.  At about that same time it started to rain….needless to say there was more than a little bit of consternation on my part!  I had visions of having to wait hours for another van to be rounded up and sent out to rescue us.  All the while, I was beginning to take note of a slowly expanding bladder (after being pumped full of Chai tea!).  Furthermore, our driver had begun to search around the area, and had located some yellow “caution tape”, and a piece of barbed wire…he then proceeded to slip under the vehicle in the mud and rain, and I believe he had every intention of trying to raise and secure the drive shaft so that it would not drag on the ground!!  Amazingly, this did not work! (I’m not sure if he had any real expectation of accomplishing this or not?).  Shortly thereafter, an ambulance happened upon our vehicle, disabled in the middle of the road and obstructing the entrance to a small bridge.  Our driver and the ambulance driver had a brief conversation in Swahili, and to my shock and amazement, both of them, as well as another passenger from the ambulance (wearing a suit)….all proceeded to slide under the van in the rain and mud.  After they were all thoroughly “slimed”, the ambulance departed with the 2 passengers, and our driver returned to us (still safely ensconced inside the vehicle) to report that the ambulance was going on ahead and would bring back “an engineer”.  All the while, he had been attempting to contact our visiting staff coordinator by cell phone, but seemed unable to get a signal or to connect?  At this point, I had lost all hope and was beginning to look around for a suitable “green toilet” off the main road.  After perhaps another 30 minutes?, the ambulance returned with the same 2 individuals and a tool box…it was all I could do to not laugh out loud at the ridiculousness of our situation.  Again all three of them got down in the mud and rain and proceeded to “bang and clang” for another 30 minutes or so.  When they later emerged from under the vehicle to inform us that everything was fixed and ready to go, I was understandably skeptical (right?!).  Our driver was again gesturing and talking rapidly in Swahili…I interpreted THIS conversation very clearly….he did not have any money to offer our “rescuers”!  I reluctantly asked the 2 individuals from the ambulance how much they would like to be paid for their service…I was admittedly a bit nervous that they were going to exploit our helpless situation.  To my great relief (and shock!), the “engineer” asked for 3500 Kenyan Shillings (about 34 dollars), and I also gave the passenger in the suit (now beyond recognition as such) another 20 US dollars.  They were profusely grateful and jovial despite their condition…the engineer informed me that “Obama is my cousin”, and the passenger in the filthy suit also claimed that “he is my cousin also”!!  What are the odds?!....Another clearly God-orchestrated event….our president’s relatives as our rescuers…small world!  What is even more shocking is that we were able to drive the vehicle on to the flower farm (where we were turned away because we “did not have an appointment”), and back into Kericho where we stopped for a restroom break.  By this time, I was absolutely convinced that I was in acute urinary retention due to overstretch of my bladder….I didn’t even mind using the foul-smelling trench hidden behind a rusted, fenestrated, piece of sheet metal labeled “men’s urinal”.  I don’t recall ever seeing a more welcome sight.  Thereafter, we got back in the van and made it all the way back to Bomet and Tenwek Hospital without further mishap.  I told Marilyn that we had just had the most expensive cup of tea ever (about 150$ total including the repair costs!!  What a bargain!).  On Sunday (today), we decided not to tempt fate, and spent the day attending church, having lunch with one of the long-term missionaries, and generally relaxing.   Below are some pictures from our various adventures.  Enjoy!  Looking forward to seeing many of you the week after next…

With love,

Randy.

Our rescuers....Obama's cousins.....not visible, but note the toolbox!

Natashia Senket...in her Sunday best!

Lunch at Anna's...a longterm Tenwek missionary.  Seated: Marilyn, Valerie, and Clark Sleeth (planning on long-term commitment to Tenwek).

Marilyn and Valerie...checking out the local restaurants.

Wednesday 9/23/15 - Joys and Sorrows at Tenwek

Dear friends and family,

Our experience at Tenwek continues to be one of intermittent joys and thanksgiving, alternating with the all too frequent stories of heartbreak.  One such story begins with a young Maasai woman by the name of Silolo N.  Silolo was 34 weeks into her pregnancy when she developed a blister on her left 4^th finger, which she decided to open using a thorn.  Over the next 5 days she became ill, and developed nausea, weakness, fever, and tenderness in her left armpit and breast.  As is common with the Kenyan people, she waited until she was ill enough that she was unable to walk before she came into the hospital to seek help.  At that time she had developed associated abnormalities in her liver function, renal function, white blood cell count, and platelet counts.  She was seen by the obstetrics team and was admitted and begun on treatment for a suspected soft tissue infection originating with her finger, and spreading to her adjacent armpit and breast.  Given the appearance of the lesion, the diagnosis of cutaneous anthrax was entertained, and the history of a recent outbreak of anthrax in the Maasai tribe was also uncovered.  The medicine team was consulted, and after review, her illness and presentation was indeed felt to be compatible with cutaneous anthrax with regional spread and some systemic symptoms.  She was started on high dose antibiotics directed at this specific organism, and after several days of treatment appeared to be recovering.  She was beginning to eat and to feel strong enough that she was up and walking around the maternity ward.  It looked as if she and her baby were doing well, and everyone caring for her had begun to breathe a sigh of relief.  On Tuesday morning, Silolo suddenly ruptured her membranes and had a precipitous labor and delivered an infant who was stillborn.  Following the loss of her child, she began to bleed heavily due to the low platelet count and some coagulation abnormalities.  She was transferred to the high dependency unit (ICU) for close attention and monitoring.  She required placement of a device in the uterus to attempt to compress the site of bleeding, until clotting could take place, and the site of blood loss could be controlled.  Later in the afternoon, Siolo began to have swelling of her abdomen with pain and distress.  Her blood pressure was low and she was suspected to be bleeding into her abdominal cavity.  The OB team and Medicine team worked for hours administering blood and medications to support her blood pressure and to control her bleeding.  One of the many problems in Kenya is that there is typically no stored blood in the blood bank.  It is often necessary for a family member to donate blood in order to receive a transfusion.  She was transfused with 3 units of her family’s donated blood over the course of the afternoon, and again appeared to be stabilizing, though she remained critically ill.  After attending to her in the ICU for several hours, we felt that she was finally beginning to stabilize, and had just returned to our apartment to rest, when I was called back to the unit with the report that she had suffered a cardiac arrest.  Attempts were made to resuscitate her, but after 30 minutes we ceased efforts and pronounced her dead.  Unfortunately, this kind of story is all too common at Tenwek.  People come in incredibly ill, and the doctors and nursing staff all work diligently to help to the best of their abilities, but often the patients cannot overcome their illness.  Every time that Marilyn and I have been to Tenwek, there always seems to be a few special patients who grab our hearts and makes us try all the harder to achieve a good outcome…Silolo was one of those patients.  Though we could not communicate with her (she did not speak Swahili or English, only her Maasai tribal language) we felt a special connection to her and her sister who was always at her bedside.  She was especially beautiful with fine features, and exhibited all the usual stoicism of her people, yet she seemed frail and vulnerable and often looked frightened at all that was happening to her.  My last memory of her will be the way she looked as she clutched my hand on one side of her bed, and Dr. Joy Draper’s hand on the other side of the bed…she looked back and forth between us with pleading and fear.  We prayed over her with the pastoral staff and several of her sons and nephews, and she seemed to calm down and rest.  The next time I saw her, her spirit had departed to join that of her recently deceased newborn.  It’s difficult to describe the type of emotional toll that this takes on the doctors who work here…for those of us who are here but a short time, it is especially devastating, but I see from the reactions of the long-term staff, that it has not gotten any easier for them with time.  What makes it tolerable is the joy that is felt when someone survives such a life-threatening event.  At the same time that all of the above was taking place, our two other young Kenyan mothers (mentioned in earlier posts) continue to improve….one of them was actually discharged that same day, smiling, and thanking us as she left with her husband and 1 mo. old infant.  The second young mother (of twins, Monica C.) who had respiratory failure, is now walking on the ward, and able to be off oxygen for short periods of time.  The joy that one feels at their recovery is equally difficult to describe, and is surely made all the sweeter by stories such as Silolo’s.  Please pray for Silolo’s family, and continue to pray for Monica C., and all of the doctors, nurses, and hospital staff who live and work here every day.  Marilyn and I feel honored to be able to join them, and work along side them for a couple of weeks each year.

Blessings to all our friends and family.

Randy

Silolo's suspected cutaneus anthrax.

More pictures from Marilyn's birthday

The birthday coffee cake at Barbara Pinckley's Sunday morning breakfast.

Birthday in Kenya!

Marilyn celebrating birthday #3 in Kenya!...Even had a candle in her coffee cake for breakfast!!

Saturday 9/19/15 - weekend on-call

Hello friends and family,
Marilyn and I are halfway into our first weekend on-call and are happy to report that we are still standing!  The first part of this past week has been pretty brutal (at least on the medicine service), but things have begun to settle down a bit, and some patients are actually getting better!  It's always a joy to see some of our desperately ill people beginning to make progress.  The young mother of twins that I reported to you about last posting is continuing to improve and is really looking quite stable - she has a bad bilateral pneumonia (we think), but is requiring less oxygen for support and looks quite comfortable.  She speaks pretty good English ( I discovered today!) and is able to report to me that she is feeling significantly better.   The Kenyan people are so warm and sincere....I can't count the number of times each day that we are told by family or patients, "we are very grateful".... I think it is part of why we keep coming back here.  I am also taking care of another young mother who has serious rheumatic heart disease and congestive heart failure, and she is also steadily improving.  She has the most engaging bright smile, and warm, wonderful spirit.  It has been so rewarding to see her sitting up in bed in the intensive care unit feeding her newborn infant, and no longer struggling to breathe herself.  Both of these young mothers are patients that Marilyn and I have had the privilege of caring for.  This evening there were 2 admissions from casualty (what they call the emergency department) who serve to demonstrate how the successes of any given day can be offset by sadness and despair.  The first patient was an older man who presented with a huge mass of his larynx, which has grown to the point where he is now struggling to breathe, and is unable to swallow without feeling like he is smothering.  He has declined a tracheostomy (which would temporarily divert his airflow below the level of his obstruction) and therefore we have nothing to offer him but morphine or other sedatives to help with his restlessness and "air hunger".  My intern and I offered to pray for him at his bedside, and he responded to this with attentiveness and some temporary decrease in his restlessness...He was not able to talk, but his eyes said to me: "I am grateful".  My second patient this evening was a young woman in her mid 40's who has had multiple sclerosis and involvement of her spinal cord which has caused paraplegia and a chronic bedridden condition.  Consequently, she has developed deep bedsores and ulcerations from persistent pressure to the skin of her back and hips.  She had been in the hospital in another town for 6 weeks without improvement and was discharged home today to the care of her family.  They subsequently brought her into Tenwek casualty and I was asked to see her there to see if anything else might be done for her.  Once again, her situation is medically hopeless as there is no effective therapy here for her MS, and no real surgical option for flaps to cover over her chronic pressure ulcers.  As a result, we had to explain to her and her family that we had nothing to offer her. Again prayer was offered and appreciatively received.  It always amazes me that these people in such dire circumstances seem to have such a deep faith in God....perhaps because they have nowhere else to turn.  It is so sad to me that people in our country, who have so much to be thankful for,  typically live with such spiritual poverty, whereas the materially impoverished, often have such rich spiritual lives.  I hope that it does not take the destruction of all that we take for granted for our people to turn from sin and back to God...but I fear that that may be our future.  In the meantime, the experience of serving in Kenya reminds us of all that we take for granted and all that we have to be grateful for.  It also gives me great hope for the next generation of Africans and the health of the world church.  I will include a photo of some of these young African children, who represent the hope for the future of this nation.  The older of the two children has taken to following us around while we are making hospital rounds....he is unrelated to the child in the chair....he is just using his time to help out his little "brother".  Hope you enjoy it as much as I do.
With love,
Randy.

Wednesday 9/16/15

Greetings friends and family,
I'm finding it difficult to put into words what this place is like....After being back in "the world" of San Antonio for a while, I tend to forget what life here is like.  For the long-term missionaries that live and serve here, there is an incredible tight-knit community that all live within short walks of each other, share there children's education and extra-curricular activities, share their work, share their meals, and share their worship time.  As "outsiders" and short-term volunteers, we are immediately welcomed into this large extended "family", and invited into their homes to share mid-day meals with their wives, husbands, and children.  Our temporary home is known as the "Guest House", which is a three story building containing several small efficiency type apartments.  The social center is the Guest House dining room, where all visiting staff share evening meals and fellowship time.  This year, we are sharing quarters with a visiting engineering team who are helping to plan the new labor and delivery suite, as well as an expansion of the "Theater" (or operating rooms).  We also have several U.S. physicians who are here serving along with us...one retired OB/GYN doctor from Michigan, and 2 retired Family practice physicians ( from Michigan and Indiana), a 3d year FP resident from Minnesota (who was born in Kenya), a 4th year Med/Peds resident, and his PA Hospitalist wife from Lexington, KY, and a surgical intern from Germany!  An incredible mix of people from around the world and from different walks of life, all coming together as the body of Christ, to share their unique talents and skills.  The guest house area is very lush, green, and beautiful; there are surrounding mountains providing a pleasant vista and the climate is very moderate....nothing like what I always imagined Africa to be.  At 6800 ft elevation the mornings and evenings are cool, and the mid-day temps are warm, but not overly hot.  As one volunterer describes it: "it feels like I'm on a mission in the garden of Eden".  In spite of our physical surroundings, the hospital work is anything but a "garden of Eden"....each time I return here I am stunned at the severity and complexity of disease and human suffering.  In the last 24 hours Marilyn and I have taken care of a young woman with twins, who came into the hospital with pre-eclampsia, bilateral lung infiltrates and respiratory distress, and oxygen saturations in the low 60% range.  She was taken directly from the emergency department to surgery where she had an emergent C-section and delivered a set of twins, who seemed to quickly rally and "perk-up" after birth.  The mother is now under my care for her persistent pulmonary infiltrates and respiratory distress.  In additon, we had a young man come in with an acute leukemia with a hemoglobin level of 4 (incredibly anemic), and a platelet count of 25K (dangerously low), and a WBC of 160,000 (very bad!!)...there is likely to be very little that can be done for him.  On rounds we found one of our admissions to be unresponsive, with fever, and a stiff neck (she had bacterial meningitis),  another young man (25 yrs old) with pulmonary edema secondary to valvular heart disease ...again, likely to die from his disease unless he can be stabilized long enough for the once a year CV team from the U.S. who comes in to do open heart surgeries and valve replacement surgeries.  In addition, there was the usual smattering of TB, meningitis, and HIV.  Death is a nearly daily occurence ( 2 on our service last night), and yet these people are so appreciative and patient...our hearts ache for them and all that they endure.  We feel so inadequate to the task....mostly we just do what we can with what we have and pray....please pray for them as well.

Arrived safely at Tenwek

Dear family and friends,
We are safely at Tenwek, connected up to the Internet, and recently fed....now off to bed.  It was an exhausting 48 hrs to get here (via Istanbul, Turkey rather than Brussels, Belgium), but we made it safely and are in possession of all our belongings.  We had no problems with customs, but some minor miscommunication with our driver (who didn't know when we were to arrive despite our best efforts to keep him updated).  I won't go into any details tonight, but suffice it say that we are safe and well.  First day of work tomorrow and stories to follow...good night for now!
Thanks for all the prayers for our safe travels!
With love,
Randy and Marilyn

Greetings from Istanbul!

Hello family and friends!
Yes, I know that we are supposed to be in Brussels today, but God had other plans for us.  We left San Antonio on Saturday around noon as planned and had an uneventful flight to Dulles.  We were supposed to pick up a Brussels Airline flight to Brussels, and be leaving D.C. around 5:50 pm, but on arrival at our gate for the Brussels flight, we were informed that our flight had been cancelled and our plane was "unsuitable for flying"!  Apparently the incoming flight to Dulles had been struck by lightning, and they were concerned about the functionality of the plane....YIKES!  How's that for a divine intervention....you WILL be taking another route to Nairobi.  So instead of a relaxing 3 hr wait for our connecting flight, we (and about 300 other passengers) were faced with collecting our luggage (many kudos to Marilyn for persevering and finally rescuing our "luggage in limbo"...another story of collosal incompetence on the part of airline bureaucracy...for another day), leaving the secured area, and standing in line to talk with one of 3 Brussels gate agents faced with re-routing the whole planeful of passengers....how would you like to have been one of those gate agents (or one of the passengers for that matter!).  In any event, we fortunately had an after hours emergency contact number for the travel agent who makes the arrangements for Samaritan's Purse volunteers.  While standing in line for hours on end, I was able to reach her, and she quickly reserved 2 seats on Turkish Airways (a Star Alliance partner) connecting in Istanbul, and then on to Nairobi late Sunday night.  Unfortunately, she was only able to reserve the seats, but authorization still had to come from the Brussels airline agent who was barely visible (with my telephoto lens!) at the front of my seemingly endless line.  After about 5 hrs of thanking God for keeping us off an airplane that we were clearly not supposed to board!?...right?.... We were finally ticketed on Turkish Airways, had an uneventful, though malodorous flight  (perhaps Google will one day allow us to attach an "odor file" to these documents?...now THAT would be something special!), and are now in Istanbul, awaiting our second overnight flight later today.  Consequently, we will once again miss our planned overnight stay in Nairobi, and will be arriving at the Nairobi airport about 8:00a.m. Monday, to be picked up and transported directly to Tewek Hospital on Monday afternoon.  We will probably not have internet access again till late Monday night (which means Monday am or early afternoon San Antonio time (7 hrs later in Nairobi)).  I will try to update everyone again when we get settled into Tenwek.  In the meantime, I'm on the lookout for God's purpose in this change of affairs....hopefully He wasn't trying to tell us to stay in D.C.!  Please continue to pray for safe travels, safe passage through customs, safe travels to Tenwek.  Marilyn and I both feel a great love for Tenwek, the people who serve there, and the people who are cared for there...we have a strong certainty that this is God's call for us at this time.  Looking forward to seeing what the coming weeks will bring!
With Love,
Randy

Preparing for Kenya

Dear friends and family,
I've decided to make a valiant effort to keep an online journal of events during our upcoming trip to Kenya and Tenwek Hospital.  Many of you have suggested that I create a blog for this purpose, and have expressed interest in being able to follow along with our experiences while there.  So far, that has seemed like it might entail "work" rather than pleasure, so I have been resistive.  However, during past trips, our families and friends have worried when out of touch with us for long stretches of time, so this seems like it might be a good way to keep everyone "in touch" with us, as well as to journal our encounters and thoughts.  As most of you know, this will be our third trip to Kenya, and to Tenwek Hospital, so it is beginning to feel like a return to familiar ground and to some amazing friendships which we have made over the years.  While there, Marilyn will be working with the OB/GYN service, and I will be working with inpatient medicine service.  Each time that we have been there in the past, we have felt like we were stepping into an alternate universe...where patients are "sicker" than any I have encountered anywhere else in the world, and where diseases are totally unfamiliar, and more advanced than we are used to seeing in the U.S.  Marilyn has had to struggle to deal with delivering infants who would easily survive in the western world, but who have no resources to survive in the African world.  Similarly, many of the medical patients have treatable disease, but little or no access to more advanced procedures, and thus perish in their harsh environment.  This is probably the most difficult thing that we have had to learn to accept.  Despite these hardships, the Kipsigi and Maasai people that we care for are truly amazing...they are some of the most patient, stoic, and appreciative people groups that Marilyn and I have encountered.  In addition, the Kenyan nationals that we have served alongside are truly remarkable as well.  All are deeply committed Christians who worship together before beginning their work each morning, who pray for their patients and each other, and are warm and welcoming to their U.S. brothers and sisters. One of our fondest memories from past trips, has been the early morning sound of worship songs in Swahili, softly wafting out of the nurses station and the ICUs.  It is an indescribable experience of feeling so instantly connected to people from another world and culture....best described, I think, as "the Christ in others welcoming the Christ in me".  So once again, we are looking forward to serving at Tenwek Hospital, where "We treat, Jesus heals" is prominently displayed around the hospital grounds, and is so evident in the attitudes and actions of those with whom we serve.  Please pray for us....that our travels would go smoothly, that our encounters with customs would be uneventful, and that our hearts and minds would be prepared for those that we encounter over these next 3 weeks.  I don't know how often I will be able to post, but will do my best to keep all informed...hopefully at least every couple of days!
With love,
Randy and Marilyn.