It’s come time to once again say goodbye to Kenya and to
friends both old and new. Our time here
has been memorable as always, and it has been a privilege to work alongside the
long-term staff at Tenwek. We closed out
our time here caring for some incredibly sick patients…one in particular
captured our hearts (both Marilyn’s and my own). NR is a 28-year-old young woman who was
approximately 35 wks pregnant at the time of transfer to our facility. She had initially been cared for at another
facility for 4-5 days for a change in mental status. She had a hx of HIV, which had not been
disclosed to the patient’s family members…she had reportedly been compliant
with her HIV meds with last known outpatient follow-up in mid September. On presentation to the other facility she was
treated for bacterial meningitis, but had not had a confirmatory spinal tap
done. She was getting progressively
worse, and by the time she was transferred to us, she had begun to seize
repeatedly. She had a total of 4-5
seizures while being transported, and by the time she arrived at Tenwek, she
was unresponsive, but breathing on her own.
She underwent emergent CT scanning of the head and had a mass documented
in the right cerebellum, as well as a possible second smaller mass in a deeper
area of the brain (right thalamus). Her
right pupil was dilated and unreactive and her CD4 count came back at less than
200… suggesting that she had not in fact been compliant with her HIV meds, and was
therefore at risk for any number of opportunistic infections, as well as some
central nervous system malignancies.
Her CT scan showed increased intracranial pressure, so we were not able
to safely perform a lumbar puncture for diagnostic studies, but had to initiate
empiric broad-spectrum coverage for numerous organisms, and hope that we had
guessed correctly. All the while, we
were concerned about administering anything to the mother, which might cause
problems with the unborn child should delivery become imminent. The mother was treated for all the usual
pathogens common to immunosuppressed HIV patients including TB, Cryptococcus,
bacterial meningitis, and Toxoplasmosis.
She was also treated with anticonvulsants, and was intubated and placed
on a ventilator for respiratory support.
Her condition rapidly deteriorated over the first 24 hours and she was
treated with mannitol and steroids to decrease her brain swelling, and to
prepare the unborn child for delivery.
On her second hospital day, the baby began to show signs of distress and
the mother underwent emergency C-section with delivery of an apparently healthy
and vigorous baby boy. After delivery,
the mother began to show signs of improvement and gradual stabilization. By the time we left to return to the U.S.,
the mother was beginning to wake up, respond to stimulation and commands, and
was free of fever and additional seizure activity. She was showing hopeful signs that she might
stabilize and have some reversible cause for her mass lesions in the brain. The child was likewise stabilizing and
appeared to be doing well. The Tenwek medical
staff worked together diligently and aggressively to help this young mother and
her child…we also prayed over her on a regular basis, and remain hopeful that
God has heard our prayers for her, and blessed our efforts to help her. It’s a beautiful and rewarding experience to
see God at work in these difficult situations…unfortunately, such a case is not
by any means rare, but is all too common in this community. The Tenwek staff is to be congratulated on
the incredible work they do with limited resources and critically ill
patients. I intend to check in on NR
after my return to the states, and will continue to pray for her and her
child. I would ask that you would consider
praying for them as well. Please also
pray for the medical staff – for strength, endurance, wisdom, and discernment.
As we were preparing to leave Kenya, we again made a brief
stop at Kijabe Hospital and the Rift Valley Academy near Nairobi…. We visited
our friends Ryan and Shannon Potter and their young family. They are missionaries from the San Antonio
community, where Shannon attended medical school, and where we met her through
the local CMDA chapter. Her husband is a
biomedical engineer who has also been working on the mission field with Shannon
for the last 3-4 yrs. They are currently
in transition as they await guidance on where the Lord would have them serve. …please
pray that clear guidance would be forthcoming and that God would prepare for
them a place of His choosing where they might continue to serve together. Please also pray for their new daughter
Whitney who is awaiting cleft lip repair on November 1st. The “Smile Team” will be visiting Kijabe at that
time, and one of Shannon’s fellow missionary plastic surgery friends will be
doing the repair…what a blessing to all concerned! After visiting with the Potters, we were able
to connect with our dear friend Matilda Ongondi who is back in Nairobi, and
serving at Kenyatta National Hospital (a 3000 bed hospital!!) where she
practices Clinical Hematology. Plans are
underway for her and some of her colleagues to help develop hematology and
oncology services at Tenwek Hospital in the year ahead…very exciting news given
the high prevalence of hematologic and oncologic problems seen in this
community. Please pray for this endeavor
and all who are participating in it. It
is clear to us that God has continued to bless the Tenwek community, and has
exiting plans for the people of Kenya.
We look forward to continuing to do our small part to help where we
can. Now we are off for some rest and
relaxation with our friends from the Netherlands – Peter and Petra Axt. We are planning to spend a few days together
in Athens, and will also be joined there by some additional dear friends –
Cynthia and Rob Grimes. They are
arriving with plans to sail around the Greek islands for a few weeks. Please pray that the anticipated storms,
winds, and possible “Medicanes” (Mediterranean hurricanes) will not be as
severe as predicted, and that our time together will be safe, blessed, and
restful. Please also keep our dear friends
Cyndie and Gayle Williams in prayer as they travel home to Fredericksburg TX
today. It seems impossible that our time
at Tenwek has again come and gone so quickly…yet, we are tired (physically and
emotionally) and are looking forward to being together with you once again…our
family and friends. Till then…
With love,
Randy and Marilyn.
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| The Tenwek Medical Team 2018 |
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| Tenwek OB/GYN Team 2018 |
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| At the guesthouse with some beautiful Tenwek children... |
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| Marilyn with Whitney Potter |
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| Shannon and her family |
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| Zach and Sydney...entertaining "grandpa" Randy |
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| More fun with Zach and Sydney... |
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| Shannon, Gayle and Cyndie Williams, Whitney, Randy and Marilyn...photography by Sydney!! |
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| Dinner in Athens with the Axts...fun times! |
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| Petra, Peter, and Marilyn....with a guard at the tomb of the unknown soldier...Athens. |
