Goodbye to Tenwek

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 1^st.   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.

The Tenwek Medical Team 2018

Tenwek OB/GYN Team 2018

At the guesthouse with some beautiful Tenwek children...

Marilyn with Whitney Potter

Shannon and her family

Zach and Sydney...entertaining "grandpa" Randy

More fun with Zach and Sydney...

Shannon, Gayle and Cyndie Williams, Whitney, Randy and Marilyn...photography by Sydney!!

Dinner in Athens with the Axts...fun times!

Petra, Peter, and Marilyn....with a guard at the tomb of the unknown soldier...Athens.

Hippos in the morning

Greetings from the Maasai Mara!  We were awakened today by the inimitable sound of hippos returning from a night of grazing…truly a memorable event not to be missed if one has the opportunity.  We started our weekend of celebration and relaxation a bit early with a surprise birthday celebration for Marilyn on Thursday (her sixth birthday here in Kenya!).  Our friends from Fredericksburg, Gayle and Cyndie Williams, were kind enough to bake a cake for her and surprise her during dinnertime at the guesthouse.  We had a great time visiting with the other volunteers, as well as a fascinating retired missionary couple (Ruth and Dilley - see photos below) who have lived in Kenya now for the past 50+ years.  They had driven in to Tenwek for appointments with the ophthalmology service, and were spending the night before driving on to their next destination… a weekend retreat with the African Inland Missions organization.  Dilley had been born in Kenya, and held us spellbound with tales of growing up in Kenya, cobbling together his first car (a Land Rover) from junk parts salvaged from a local junkyard for the equivalent of $50, working as a delivery man and repairman at Kijabe Hospital near Nairobi, traveling to the Mara shortly after the Mau Mau wars (before safaris became commonplace), having his 50$ Land Rover break down on the Mara, overhauling the engine (again with spare parts from salvage), traveling to the US with only enough money to pay for his passage to NY, and eventually making his way to California, where he was able to find work as a repairman, and eventually work his way through university, where he graduated with a degree in engineering.  Afterwards, he returned to Kenya where he met and married his wife Ruth, who had ventured there as a 28 year old newly graduated nurse from England.  She had felt the call to mission work at a young age, and has been serving the people of Kenya for over 50 years now!  What a fascinating story they had to tell!!  We had a wonderful evening of fellowship, with cake, candles, and celebration… AS WELL AS… ice cream! (thanks to Cheryl and Dean Cowles).  On Friday we left for safari with Gayle and Cyndie.  We travelled to the Maasai Mara, and stayed the weekend at the Fairmont Safari resort…what a wonderful respite time for all.  A typical day on the Mara included an early a.m. game drive, followed by a gourmet breakfast buffet, a midday trip to a local Maasai village, then the gourmet lunch buffet, an afternoon game drive, followed by an evening gourmet dinner buffet!  In between all of this eating, sight seeing, and relaxing, I (Randy) squeezed in some time for a massage, and some rest (I know what you’re thinking… “this mission work sounds rough”?).  This morning, I was treated to one last chorus from the hippos returning to the river outside our tent…what an amazing world our God has created for us to enjoy, and what amazing creatures we share this earth with!   See some of the images of our journey below.  It is now time to return to Tenwek for the last week of our volunteer time.  Gayle has been providing radiology services to the hospital, and teaching the physician staff the basics of head CT interpretation (and any other helpful tips which can be critical when radiology support is not so readily available).  Cyndie has been working with some local women, teaching them sewing techniques, so that they might be able to earn some extra income for their families.  Marilyn and I will be returning to our duties with the obstetrical and medical services.  What a joy it has been to again serve at Tenwek Hospital.  We all feel truly blessed to be able to see God doing such amazing things among the people here, and to partner with Him in the work at hand.  The needs here are massive and at times overwhelming, but the presence of Tenwek in the midst of this, is a reminder of what can be accomplished as the result of individuals faithfully following where God leads.  Our time here will soon be up, but the experiences, rewards, friendships, and memories will last a lifetime.  Thank you for your continued prayers on our behalf.  We look forward to being back among our friends and family soon!

With love,

Randy and Marilyn

Surprise birthday celebration with the Williams

Gayle and Cyndie with Dilley and Ruth

A "bloat" of Hippos in the Mara river...sweet music to my ears.

Maasai villagers...eager to share their culture with us

Maasai warriors getting ready to dance for us...

Young Maasai children...some eager to interact with us, some not so much....

Wildlife on the Mara...incredibly tolerant of "intruders" in their midst...

Gayle doing his best immitation of a Texas Maasai....after all he does have some of the Maasai's cattle!

First world problems....Third world problems...

Greetings family and friends,

Marilyn and I are approaching the end of our first week here at Tenwek and are again reminded that we are no longer “in the world” as we know it back home.  The realization came a bit slower this time around, as I’ll explain below.  Our travel to Kenya was fairly uneventful, but grueling and uncomfortable as always.  Once here, we breezed through customs (no custom agents on duty…so no bag checks, no complicated explanations of why we were packing fetal monitors, endoscopy catheters, surgical supplies, expired (but sterilizable) instruments, etc….just a “get out of jail free” card…thanks be to God!).  Once free of the airport, we spent the night in the Nairobi Doubletree Hotel, …hardly typical Kenyan accomodations….followed by a fabulous buffet breakfast on our way out of Nairobi.  This year, I decided to try to establish a Kenyan phone number to allow easier communication between ourselves, our families,  and the long-term medical staff, so we made a trip to a local Safaricom cellphone store to purchase a SIM card and some airtime.  Unfortunately, I had not charged my old I-phone before leaving the U.S.  I had planned to use this as a “local phone”, but it was DOA at the store.  This meant that rather than getting everything set up before leaving Nairobi, I was tasked with getting my airtime transferred to my phone after it was fully charged….a very “simple” process of setting up an M-Pesa account (a funding account managed by Safaricom), putting some money into the M-Pesa account, and later, using this funding account to purchase my airtime…sounds simple right?!   Needless to say, 3 days into our stay, and 10-15 toll-free calls to Safaricom later, I still had not been able to purchase airtime for my phone!  There were any number of absurdities encountered….responses such as: “your SIM card needs to be enabled to receive M-Pesa funds” (WHAT??!!), to “ you’ve used up all your airtime, and M-Pesa requires a small amount of airtime to make the transfer”!!!!  By day 4, I was ready to flush the “local phone” down the loo, (or “choo” as they call it here)….  Fortunately, I stumbled upon a setting on my phone, which allowed me to make the transfer of funds myself…what jubilation and satisfaction I experienced! (maybe for the ONLY time this week, since I am again humbled by the medical complexity of the patients here, and the absolute lack of preparation for Kenyan medicine that American medicine provides).  So…halfway into our first week here, and I am still struggling with first world problems, right?....Wah, Wah, Wah.  The reality that is Kenya was suddenly thrust upon us yesterday, when a young Masaai warrior walked into our casualty area (Emergency room) after an intra-tribal altercation with another Masaai.  He had been shot in the nose with an arrow, had broken off the end of the shaft, but still had a good 1-2 feet of the shaft sticking out of his face.  As is typical of the people here, he was not complaining of pain, sat quietly in casualty area waiting to be cared for,  then walked himself over to radiology for his x-rays and CT scan (see below).  Amazingly, the tip of the arrow had penetrated to the back of his head, near his cervical spine, and had narrowly missed hitting the internal carotid, and vertebral arteries (puncture of either one of which would have likely been fatal).  Even more amazingly, we had a maxillofacial surgeon here who was scheduled to leave on safari, but had not yet done so.  Needless to say, his departure was postponed, and he was able to “open up the face” of this young Masaai, remove the barbs on the arrow, and extract the arrow without damage to any vital structures.  God was certainly with this young man, and His hand was apparent in every aspect of this situation.  So once again, I am shamed by my seemingly insignificant struggles and aggravations, when faced with the reality of life here.  Once again, God smacks me up the side the head and reminds me, “this isn’t about you”…. “you’re here to join MY work among these people…now put your phone down and get with the program”…message ruefully received…   I am scheduled to be on-call this weekend, and am somewhat anxiously looking forward to seeing what else God has planned for me/us here at Tenwek….hopefully just more “plain vanilla” tuberculosis, HIV, meningitis, and pneumonia…stay tuned!

Please also continue to pray for the patients under our care here, and for wisdom and discernment in our decision-making.

With love,

Randy and Marilyn.

When this image was shown to one volunteer's girlfriend back home, her response was: "I see the arrow, but what's it pointing to?"....one has to find humor in the tragedy I guess...