Obstetrical Tales - Peris and Daizy

 

Early during our stay at Tenwek this trip, I met Peris. She had been hospitalized two days earlier at 27 weeks gestation. In America, if a 24-week pregnant woman delivers a baby, it has about a 75 % survival rate. In Kenya, a baby must be about 32 weeks into the pregnancy before that kind of optimism exists for the newborn. Peris had had three previous cesarian deliveries. A placenta previa is a condition where the placenta (“after” birth) is in front of the path of the delivery of the infant. In addition, a placenta does not implant normally into the lower uterus as it does higher up in the more muscular part of the womb. Therefore, if a woman has contractions and starts to labor, the placenta previa can start to detach from the uterus thereby cutting off blood flow to the baby and can cause possible catastrophic bleeding for the mother. Peris had already had several bleeding episodes signaling a progressively higher chance of her delivering prematurely. Medication was given thru the mother to try to make the baby’s lungs mature for life outside of the mother. Every day the Obstetric team would pray fervently for the baby to stay healthy IN the womb. However, on day 14 of her stay in the hospital, Peris started to bleed heavily and required an emergency cesarean section. As with ALL surgeries at Tenwek, before surgery starts, prayers were lifted to God for patient safety (in this case TWO patients), wise clinical decision making by the surgeons, and acceptance of His will for them and us. A crying baby girl, Angel Ariana, was born weighing 4 # 5oz. Peris’ intraoperative and post-operative course had a few trials for us, but nothing life threatening. Angel ultimately needed extra medications and ventilator support for her tiny, tired breathing muscles, premature lungs, and risks of infection. This morning when I visited Angel, she was about to have the breathing tube removed. Optimism prevails as prayers continue for them both.

Peris and daughter, Angel Arianna

Not all Tenwek stories end in what we can describe as miracles. However, we don’t know what God’s plans are for these situations that end, by our viewpoint, sadly. Four days after Peris and Angel’s “success”ful trial, I encountered a totally unplanned crisis with Daizy. After a failed attempted delivery at home, and then in an outside clinic, her delivery was ultimately completed at Tenwek with a stillborn baby boy, and a truly life-threatening bleeding event for the mother … controlled only be an emergency hysterectomy. Fortunately, she is alive to continue raising her five other children. Five local missionaries donated blood to help her survive. Randy “just happened” to be in the Labor and Delivery area when this all happened and was able to provide quick intravenous access to administer blood and fluids to Daizy to help her survive. We certainly can never reconcile why these unimaginably painful events occur, but continue to trust that we can bring compassion, hope and faith thru our words, and more importantly, our actions as He leads us to help the patients and each other.

So many people ask us- and probably many more wonder but don’t ask- “WHY do we do these trips”? I don’t have an answer to that question. I can only say, “HOW can I NOT”?  The Kenyan people are so appreciative of any effort we can provide. This morning a patient called me over to thank me for helping take care of her as she and her baby were being discharged. It is my honor and privilege. This year with the COVID-necessitated masks, it is amazing how much love and mutual respect we can share just with our eyes. It has helped me to really be VERY present when dealing with patients and co-workers. It has become a uniquely blessed interaction.

As we pack again to return to Texas, we are excited to re-connect with our families, friends, and San Antonio work and volunteer activities. May we continue to “be present” fully for all with whom we interact. We have felt your prayers, been aware of your concerns for our safety, and are profoundly grateful for you in our lives.

May God continue to guide and lead us thru all our future travels, decision-makings, and daily activities.

 

Marilyn and Randy

Angel Arianna, 4# 5oz.  Welcome to the world!

Daizy's surgery.

The OB/GYN team 8-2021

The Tenwek Compound kids!....one, two, three, "Avacado"!!

Joys and Sorrows - 2021

 

 

Friends,

I am writing to update you on the two patients mentioned in my last posting.  I’ll begin with J.C., the young woman with an extensive right lower extremity soft tissue infection, a large open wound, ongoing sepsis, hypotension, and underlying rheumatic valvular disease.  She was making excellent progress and was even able to go outside and “bask” in the sunshine for a few hours toward the end of last week.  Her blood pressure had been improving and we were able to take her off pressor support (medications supporting her blood pressure).  She was eating and talking, but still appeared weak and had a poor appetite with some distention of her abdomen.  She had no abdominal tenderness, but we were concerned about the possibility of her having some residual pocket of infection in her right groin which might have extended up into her right lower abdominal or pelvic area.  The surgeons were concerned enough that we had planned to evaluate this possibility with a CT scan of the abdomen.  She was in the process of being moved to radiology for this study when she suddenly became hypotensive and suffered a cardiac arrest.  She was successfully resuscitated by an ER doctor from the University of Alabama – Birmingham.  This doctor and her friend (another ER doctor) have also been serving here this past month.  During the resuscitative efforts J.C. suffered some anoxic brain injury.  When she arrived back in the ICU, she began having some seizure-like activity as well as some muscular twitching and contractions which were felt to possibly be tetany.  Many patients in this rural part of Kenya have not had adequate immunizations during childhood, and some are thus susceptible to tetanus following an infected open wound like this.  She was placed back on antibiotics to cover this possibility, as well as the possibility of some ongoing sepsis from an undrained abscess.  She again required high doses of medication to support her blood pressure and required ventilatory support for her breathing.  She made very little progress over the next several days, and her family was informed of her poor prognosis.  Attempts were made to prepare them for the likelihood of her death, and the hospital chaplain was called in to pray with them and comfort them.  During the night last night (Wednesday), she became progressively hypotensive and died early this morning (Thursday).  Unfortunately, this is an all-too-common scenario here at Tenwek.  Many young patients contract very serious illnesses and die under our care.  We do not understand why God allows so much suffering and heartache to occur, but acknowledge that He is sovereign, and good, and just.

 “As the heavens are higher than the earth, so are my ways higher than your ways and my thoughts than your thoughts. Isaiah 55:9 (NIV).

 “The Lord is good, a refuge in times of trouble. He cares for those who trust in him”  Nahum 1:7 (NIV)

We simply trust that He is good and loving and know that He can use all things for good, for those who love Him, and trust in Him.

“And we know that in all things God works for the good of those who love him, who have been called according to his purpose.”  Romans 8:28 (NIV)

 

On the same day that J.C. passed away, V.O. was successfully discharged home with no neurologic deficits!  V.O. was the young man who had come in with an acute thrombus in the venous sinuses of the brain with some associated hemorrhage.  He was seizing and unresponsive at the time of admission.  After being anti-coagulated, he improved rapidly and continued to make steady progress over the remainder of his hospital stay.  He regained speech, as well as use of all extremities; he was able to transfer himself in and out of bed and ambulate without assistance.  He was eating well, swallowing well, and complaining only of a persistent headache.  His headache has been manageable with paracetamol (a Tylenol-like drug) and should continue to steadily improve as his blood clot and the area of hemorrhage resolve.  Our team has prayed over him regularly, and rejoice that he has done so well, and that he will be able to return to his family in good health.  Again, we are mystified as to the workings and purposes of God in these situations.  We simply trust…and rejoice in the successes when they occur.

“Rejoice with those who rejoice; mourn with those who mourn.”     Romans 12:15 (NIV)

Friends, there are many such stories here at Tenwek…too many to relate.  We continue to give thanks that we are able to return here and serve our Kenyan brothers and sisters.  Please keep them (and us) in your prayers.  All praise and glory be to God the father, and to His son, Jesus Christ- our redeemer, lover of our souls, author of all life and the reason that we serve.

 

 

 

Erin Shufflebarger, Emerg. medicine from UofA-Birmingham, with Marilyn

Ashton Kilgore, Emerg. medicine from UofA-Birmingham, with Dave Fraser, Rheumatology from N. Carolina.

 

The Medical Consultant Team 8-2021
Left to Right: Dave Fraser, Esther Dindi, Jim Richards, Randy

The Medical Team 8-2021
Left to right: Carlos, Cosmos, Magara, Eunice, Esther, Charlene, Jim Richards, Randy, Dave Fraser, Ledama, Jeremiah, Shadrack

 

Tragic Tales at Tenwek - 2021

 

Dear Friends,

As has been the case on every previous visit to Tenwek hospital, there are a few particularly heartbreaking and painful cases that capture our hearts and bring out a desire to do our very best on behalf of these unfortunate individuals.  This is not to say that ALL patients do not receive our very best efforts…they do…but some elicit more time, more thought, more frequent visits, and more fervent prayer… and SEEM more tragic when things go poorly.  Often this is due to the fact that these individuals have been young, healthy, and unprepared for medical tragedy before becoming ill.  Two such patients stand out among those being cared on the medical service recently.  Their stories follow.

J.O. is a 21-year-old young Kenyan woman who developed rheumatic valvular disease (of her heart) as a consequence of repeated bouts of streptococcal infections and associated rheumatic fever over the course of her childhood.  This is a very common problem seen here in East Africa, and results in some very severe end-stage heart problems occurring at very young ages.  It is a very easily preventable disease when these strep infections are treated early with antibiotics, and when antibiotics are administered appropriately to prevent recurrent infections.  It is noteworthy that these problems are rarely seen in the U.S. and other developed countries but remain a problem in areas of the world where access to medical care remains limited.  J.O.’s heart lesions have been moderately severe thus far, and she has been able to bear children and function relatively normally.  A few weeks ago, she noted a blister-like lesion on her right foot, as well as some itching.  She scratched the area and thought nothing more about it.  Over the next few days, the foot became more painful and began to swell.  She waited a few more days and noted the swelling and pain to be spreading up the inner aspect of her foot, calf, and inner thigh.  She began to have fevers and weakness, followed by skin breakdown and ulceration in the areas of swelling and tenderness.  She did not recall any bites or stings, any contact with sick or diseased animals or livestock.  She ultimately came into the hospital when she became too weak to walk.  She was evaluated in our emergency department and was diagnosed as having septic shock related to an overwhelming soft tissue infection in her right lower extremity.  It was not clear if she had septic thrombophlebitis (a bacterial infection in the superficial veins of the leg), or possibly a case of cutaneous anthrax (usually seen in individuals with some exposure to diseased/or dying livestock- particularly cattle.)  She was started on antibiotics aimed at covering these possibilities.  She also required administration of large quantities of IV fluids, as well as medications to support her blood pressure.  She was critically ill and was admitted to the ICU for close observation and care.  The surgical team was consulted, and she underwent extensive debridement (removal of dead, and/or infected, non-viable tissue) extending from her foot to her right groin.  After surgery, she has been gradually stabilizing and improving, but remains very tenuous from the standpoint of her blood pressure and heart rate control.  This is complicated by the presence of her rheumatic valvular disease.  Because she has a narrowed mitral valve, she cannot tolerate very high heart rates – if the heart rate is very high, she does not have enough time for blood to cross the narrowed valve and fill the left ventricular chamber – this results in a drop in her cardiac output, and a drop in her blood pressure.  The medications used to slow her heart rate, can also drop her blood pressure; additionally the infectious process has caused a drop in her blood pressure – therefore her post-operative course has been a delicate balancing act between giving her adequate IV fluids to maintain her vascular volume without overloading her, keeping her heart rate under control to allow her heart to maximally function without dropping her blood pressure too low, and gradually weaning her off  medications which have been supporting her blood pressure.  While giving her broad-spectrum antibiotics to cover all possible causes of infection, she has now developed an antibiotic-induced colitis – another serious, and sometimes life- threatening infection.  Consequently, she is having fluid losses from diarrhea, as well as fluid losses from the large open wound of her right leg.  She has been making gradual progress on all fronts over the past 2 weeks but remains very ill.  Many of the decisions that we are making for her will also have to take into account the considerable costs that are accruing to her young family.  Most of these families have few resources, and government health insurance (if they have it) covers only very basic costs.  If she survives her infection, she is going to have a very long period of wound healing and recovery, only to have to face the need for valvular heart surgery at some point in the not-too-distant future.  Our medical team continues to watch over her carefully, and to pray for her daily.  Perhaps you could be praying for her as well – pray that we will make wise decisions on her behalf; pray that she will heal well and quickly; pray that she will be provided with adequate resources to deal with her mounting expenses; pray that she knows (or comes to know) and has placed her faith in the God that we serve.

V.O. Is a 30-year-old previously healthy Kenyan male who started complaining of headaches about 3-4 weeks ago.  He was evaluated in an outlying facility and had a CT scan of the head which was within normal limits.  He was treated with analgesics but continued to complain of headaches.  He subsequently began having seizures 2 days ago and was brought into Tenwek Hospital for evaluation.  He was obtunded at the time of presentation and was loaded with anticonvulsant medications and a repeat CT scan of the head was done.  An area of hemorrhage was noted, and the scan was sent (electronically) to the U.S. for interpretation by a consulting radiologist.  He was admitted to the hospital and observed.  The CT scan was read as showing a thrombosis of the venous sinus of the brain, with some associated hemorrhage into the adjacent brain tissue.  Additionally, he was found to have a low platelet count, and the possibility of thrombotic thrombocytopenic purpura (TTP) was entertained.  (Basically, this is a rare condition, affecting about 3 patients/million population, having a >90% mortality if not appropriately treated.  “Appropriate treatment” involves a plasma exchange transfusion, which is not available at Tenwek Hospital, or most other hospitals in Kenya).  If this diagnosis was to be confirmed, this would essentially be a death sentence for this young man with no prior health problems.  We reviewed his peripheral blood smear and determined that he did not really have a low platelet count (rather had “clumping” of his platelets) and had no other evidence for TTP.  This meant that he likely had a diagnosis of spontaneous venous sinus thrombosis – another rare condition, but with a lower mortality rate, and treatable with blood thinners (which are readily available at Tenwek).  The problem in this situation is that if the diagnosis is wrong, and you administer blood thinners to someone who has had a bleed in the brain for other reasons, you can worsen the bleeding, and even cause death.  This is only the third case of venous sinus thrombosis that I have seen in my career, but both of the other cases have done surprisingly well with anticoagulation.  With some trepidation, the orders were written to anticoagulate him last evening. On rounds this morning he has begun to open his eyes, mumble a few words, and follow some commands.  He has had no further seizure activity and is moving all his extremities.  He has no prior hx of spontaneous clotting, and no history to suggest a cause for his current venous sinus thrombosis.  He is probably going to turn out to be one of the many Kenyans that we have seen over the years that have spontaneous blood clotting, and a hypercoagulable state of unknown cause.  It is too early yet to tell if he is going to have a full recovery and return to normal functioning, but early signs are encouraging.  Please add him to your prayers as well.  

As in previous years, it always seems that we have just the right people in place to deal with the unusual problems as they occur.  This year, we had a visiting rheumatologist (who is also an ordained pastor!) from North Carolina who is nearing retirement age and has been feeling the call to missions.  This has been his first international mission experience.  He has been a wealth of experience and knowledge and has been invaluable in managing the two patients above.  In addition, there have been several other unusual rheumatologic patients that have come through the pediatric service and the outpatient clinics this week (including Marilyn’s gyn clinic) …he has been extremely helpful in these cases as well.  It has been humbling and awe-inspiring to see how God continues to orchestrate these encounters over the years.  Marilyn and I continue to be grateful to be able to serve in Jesus’ name through Samaritan’s Purse and Tenwek Hospital.  What a good and mighty God we serve!  All praise and glory be to Him!!

 

Love to all,

Randy and Marilyn

V.O.'s CT scan showing area of hemorrhage and evidence of venous sinus thrombosis.

 

The Beauty of Christian Community

 

Dear friends and family,

Marilyn and I are finally getting settled into our roles here at Tenwek Hospital in Bomet county Kenya.  It has again taken a bit of time to adjust to the time change as well as the transition from outpatient U.S. medicine to inpatient Kenya medicine – the two are quite literally “worlds apart”.  Thus far, our time here has been a bit unusual compared with prior trips – the hospital census has been down for all services, and the types of problems being seen are a bit unusual as well.  The local physicians theorize that the change might be due to the implementation of mandatory COVID 19 screening prior to being seen in casualty (the emergency department), and prior to admission to the hospital.  The cost of screening is about 3000 Kenyan shillings (Ksh) (the equivalent of about $30 USD) which is quite a lot of money for the local people of Bomet county.  Most of the local residents are farmers and are living on about 400 ksh/day (about $4 USD).  In addition to the cost of testing being somewhat prohibitive, there is a growing stigma which is attached to being diagnosed with COVID 19 (much like we have seen with the diagnosis of HIV here in the past).  Once an individual in the community is diagnosed with COVID 19, he or she is often shunned by family members and friends and becomes very isolated.  The belief is that these factors are leading patients to remain at home rather than seek care.  Consequently, there are fewer than normal numbers of patients being seen and admitted to the hospital.  Even the OB deliveries are lower than usual- presumably this means that more patients are delivering at home.  This is not to say that we have nothing to do…just that we are a bit less busy than usual.  The impact of COVID 19 on the missionary community has been very harsh as well.  Many of the staff have become infected, though fortunately all have recovered thus far.  Over the past year, the number of visiting staff has been dramatically reduced, and Tenwek is only just now beginning to see more visitors coming through (including ourselves).  When we were here in January of this year, we were pretty much alone, with the exception of one other physician from North Carolina.  It was a particularly lonely time…we had very little contact with the long-term staff during that visit.  As a result, both the long-term staff and the short- term visiting staff have been very isolated, overworked, and stressed.  The critical importance and therapeutic effect of in-person interactions, and Christian community was brought home to us again this week when we were invited to attend a going-away party for one of the local clinical officers that both Marilyn and I have worked with in the past.  His name is Brian, and he is a particularly bright and friendly young man that we have been fortunate to know and work with over the years.  After a few years of serving on the Tenwek staff as a clinical officer (the U.S. equivalent of a physician assistant), Brian has made the decision to go back and train to become a physician (which means an additional 6 years of medical school on top of his already completed clinical officer training).  While at Tenwek, Brian has had many deep personal relationships with other CO’s, MO’s (medical officers), and physicians.  He has been involved in weekly bible studies hosted by a long-term missionary couple, weekly luncheons for students and clinical staff at the hospital, regular devotionals at the hospital, and weekly worship services with the African Gospel Church here on campus.  As a result, he is KNOWN and well LOVED by those in his community.  We had the opportunity to witness this love and friendship up-close during his going-away celebration. When those attending were asked if they had any advice to impart to Brian before his departure from Tenwek. the advice was obviously heartfelt…most of his friends stressed the importance of finding fellow Christian students to hold him accountable, to provide love and support when he was experiencing hard times or periods of anxiety and stress, and to provide him with community and respite from the rigors of training and study.  All of his friends covenanted to be in prayer for him, and to be available to him should he need a sympathetic ear, or reassurance that what he was going through was normal and surmountable.  There was much laughter, some moments of quiet sincerity, a few tears, several prayers, and even some dancing!  I am including some pictures and a video clip (below) from our evening of celebration with Brian and friends, and hosts Dean and Cheryl Cowles (Cheryl is head of the OB/GYN program here at Tenwek,  and her husband Dean is a pastor and the liaison between all visiting staff and the long-term staff).

Marilyn and I have been fortunate to be part of a similar Christian community in San Antonio called the Christian Medical and Dental Association (CMDA).  This group offers numerous weekly small group opportunities and prayer groups, weekly bible studies, weekly luncheons with Christian doctors or dentists as speakers, and periodic medical and dental service projects – many of which we have blessed to be a part of. Here again, we have witnessed the importance of life in a community of fellow believers.  We have also witnessed how difficult it has been to maintain this community when not able to meet in person over the past year.  It was a joy for Marilyn and me to again witness that which has been missing for us here at Tenwek since the COVID era began – that beautiful, living, breathing “thing” that is Christian community.  I suspect this is but a glimpse of the Kingdom life to come! Our prayer is that each of you might also be blessed with such friends and community.  Enjoy!

Hebrews 10:24-25 “And let us consider how we may spur one another on toward love and good deeds, not giving up meeting together, as some are in the habit of doing, but encouraging one another—and all the more as you see the Day approaching.”  NIV.

 

The 2021 OB Team (left to right): Brian C.O., Annette MD, FP resident, Abola MD, MO, Cheryl Cowles MD, OB/GYN,   Angela MD, OB/GYN, Marilyn MD, OB/GYN,  and Dorcas CO (front).

What would a celebration be without a Kenyan meal!?

Brian C.O.....at his surprise going-away party.

Making the rounds for hugs and congratulations!...

Cuddling with Cora....

Sharing wisdom with the new medical student.

Preparing for "The OB Dance"...

 The "Kenyan OB Dance" - celebrating childbirth, Kenyan style!

 

Our room in the Guest House.

Some random Kenyans in Bomet...coming to greet the Muzungus (white people).  Everyone likes to have their picture taken!

The town of Bomet... a traffic jam of sorts!

Some local children...posing for pics

Local school girls in Bomet...more pics please!

Downtown Bomet

Microfinancing for women's small businesses- Bomet

Checking out their pictures...very cute kids!

Why Go Now? - 2021

Dear friends,

The following is a post from our blog dated 9/2/2018 entitled “Why Go?”  Some of you may have read it at that time…but for most this will probably be your first reading.  I am re-posting it now because it seems especially relevant in our current COVID-19 reality:

As we make preparations for yet another journey half way around the world, I find myself again reflecting on the question that many of you probably have as well...why go at all?  Why not take the money that we will spend, and just donate it to Tenwek Hospital (where Marilyn and I will be serving)?  Then we would not have to worry about transatlantic, cross-continent air travel, terrorism, vaccinations, malaria prophylaxis, HIV/AIDS, TB, contaminated water or food sources, a number of tropical diseases, etc, etc, etc....!  We could properly enjoy a Labor Day weekend BBQ instead of trying to make 300 pounds of supplies, clothing, etc. fit into 4 suitcases, each of which can weigh no more than 50 pounds.  (No need to do the math.... it can't be done!).   The short answer is, that as followers of Jesus, we felt that we should probably pay attention to what He did, and said…He modeled a healing ministry, AND He told us to “Go”, and make disciples of all nations (Matthew 28:19).  The longer answer, at least for myself, requires some explanation.  Having returned to faith at a later stage in my life, I had never before considered that maybe I should be using my gifts and resources as God intended them to be used…they had always been viewed as things that I had achieved for myself by hard work and perseverance.  As I returned to my faith, I began to view my circumstances in a different light…I began to understand that I had been given much, and that much was expected of me.  I came to this realization gradually, but wasn’t quite sure WHAT was expected of me…I’m sure many of you reading this can relate.  Around this time, I read 2 books in succession, which changed the course of the remainder of my life.  The first book was entitled: “Radical.  Taking back your faith from the American dream”, by David Platt, and the second book was “The Hole in Our Gospel.  What Does God Expect of Us?”, by Richard Stearns.  I recommend reading them… if you dare!…. beware though, taken to heart, you may end up (as we have) in some corner of the world where you least expect to be!  One particularly convicting quote from David Platt’s book:  

“….We take Jesus’ command in Matthew 28 to make disciples of all nations, and we say, “That means other people.” But we look at Jesus’ command in Matthew 11: 28, “Come to me, all you who are weary and burdened, and I will give you rest,” and we say, “Now, that means me.”  

Guilty as charged!!  After coming to the realization that, as a Christian, I had obligations as well as privileges, I began to feel a tug on my heart toward the medical mission field.  I wish that I could say that once convicted, I rushed enthusiastically forward in obedience to the perceived call on my life, but that would be quite a stretch…. in truth, I DID NOT WANT to leave my comfortable little niche in the world.  I tried any number of ways to convince myself that this was not what God wanted or required of me.  I remember clearly “negotiating” with God as He drew me toward my first international medical mission trip to Guatemala (at the urging… “pestering” might be a better word…from my friend Rob Grimes).  I remember being on call on the weekend; it was Sunday and I had the usual 15-20 patients to make rounds on, AND I was on call for the ER.  I had promised Rob, that I would try to make the noon meeting of the team heading to Guatemala later that summer.  In my mind, I knew that there was no way I could finish rounds (and avoid new admissions) and be across town by noon…so I challenged God:  “Okay, God, if you want me on this team, you need to make it possible…let’s see if you can get me there”.  Needless to say, I was finished with rounds by 11:30 a.m. (a “miracle”!) and across town by noon (another miracle in and of itself!).  I was still not convinced, so I upped the ante:  “Okay, God, if this is where you want me, I need another unequivocal, clear sign”.  I remember walking into the meeting, being introduced to the team leader, Mike McCord (who did not know me or my wife), who greeted me by saying:  “You’re an internist…GREAT!  We need primary care docs…. and we need OB/GYN’s too…know any?”…. Thus began Marilyn’s call (and mine!) to international missions.  Suffice it to say, WE survived that first timid “stepping out”…no personal illness, no encounters with the drug cartels, and no gun battles with our army escort.  What I DID encounter, that was unexpected, was a profound sense of “rightness”, peace, and tranquility…a love and respect for the long-suffering people of Guatemala…a sense of awe at the apparent joy and happiness in the midst of such poverty and disease…an acute awareness of where God was at work in our midst…and a deepening of my personal faith life which, I am convinced, could not have happened had I not “stepped out in faith”.  Marilyn and I have made several more trips to Guatemala…also to El Salvador, Nicaragua, and Dominican Republic…sometimes together, sometimes one without the other.  Each time, has been easier and more rewarding than the last.  As we began to search for opportunities to share our volunteer work together, we began to hear about this mission hospital in Bomet, Kenya:  Tenwek Hospital, whose motto is “We Treat, Jesus Heals”.  We first heard about this place through a CMDA Fall Banquet speaker by the name of Carolyn Spears.  She is a general surgeon who has been a long-term missionary at Tenwek, and has a powerful personal testimony about her experiences there.  We looked at the hospital online out of curiosity, and noted that they were a 300 bed Christian mission hospital which provided medical, surgical, pediatric, orthopedic, and OB/GYN services…they were advertising a need for short term volunteers in all of these areas of service.  We did not give it much serious thought at the time, but then went to an international medical missions conference in Louisville, KY the following year.  While there, we explored some of the opportunities that we had scouted out ahead of time, only to find, that these programs would have no need for one, or both of us.  Doors were slamming right and left…. but then we happened upon the Tenwek representative, who excitedly told us:  “Yes, we could use the both of you…come some time and check us out!”  The last “nudge” came from the president of CMDA at the time, David Stevens, who just so happened to have served at Tenwek for 10 years in the early part of his medical career…he too had a personal testimony which spoke to our hearts, and convinced us to take yet another “giant step of faith” into yet another unknown part of the world.  We took our first journey to Africa (Kenya) in 2012, and again found the needs to be massive, overwhelming, and often heart-breaking.  At the same time, we found a warm, welcoming, gentle people…often of deep faith.  The peace that comes, and the sense of being in the place that God has ordained for us is unmistakable.  In addition, the act of going, serving in the name of Jesus, and being His hands and feet to our brothers and sisters in Kenya, is something that a “donation” of money can never buy.  So, my long answer to the question of “Why go?” is this:  God calls us to serve; He leads us if we ask, and are willing to follow; He equips each of us with unique gifts, talents, and resources; He enters into our areas of weakness and ineptitude, and by His strength enables us to accomplish what we could not accomplish on our own; and in so doing, glorifies His name, and deepens our faith and our relationship with Him. 

It has now been 9 years since our first journey to Tenwek Hospital, and the question “Why Go”? continues to be relevant in 2021…especially in view of the COVID -19 pandemic.  The answers remain the same…only the obstacles appear to have become larger in recent years.  In truth, our past trips have not been without significant risks and fears of various types as well…COVID-19 is just the latest to add to the list.  Admittedly, it IS one of the more frightening ones… both to ourselves and our families.  This having been said, a choice has to be made:  Do we continue to trust God ?...knowing that we have no guarantee of the outcome, or do we surrender to fear?...knowing that we have no guarantee of the outcome? We continue to feel the call to serve at Tenwek, AND, we now have relationships and friendships as well…long-term missionaries and their families, returning short term volunteers that we have served along side in past years, Kenyan physicians and their families, and even some returning patients that we have cared for in the past!  We have chosen to trust God, to continue to live our lives as we feel called, to take as many precautions as possible to remain safe and healthy, and to leave the outcome in His loving hands.  My prayer remains that each of you can also learn to discern God’s call on your life…to trust that He will equip you, and lead you, and walk with you…all the while growing your faith, and deepening your relationship with Him.  Expect obstacles and fears along the way…a sure sign that the Enemy is taking notice!  

Our love to all our family and friends…May God bless you, and keep you, and make His face to shine upon you, be gracious to you, and give you peace.

Randy and Marilyn.

Last 24 hours in Kenya 2021

Dinner at the Doubletree Hotel, Nairobi while awaiting COVID test results.  Marilyn and Dr. Jim Owens, FP from N. Carolina

Celebrating our neg. COVID testing with some Cold Stone Creamery ice cream!

Dear Friends,

Our time in Kenya is coming to an end for another year.  We are currently in Nairobi, resting up for our upcoming trip home.  During our time at Tenwek, KLM airlines (which we were scheduled to fly) decided that a COVID- 19 PCR test taken within 72 hours of arrival in Amsterdam was not adequate.  They have now required that all passengers arriving in Amsterdam (including passengers transiting the country) must now have a rapid antigen test taken within 4 hrs of departure time!  This means that we would have had to have a rapid antigen test done in Nairobi, no earlier than 8PM, for a midnight departure time!!  Additionally, there is no onsite testing available at the Kenyatta International airport, so this would have had to be done somewhere in the community prior to our being able to check-in and board....  Needless to say, we were not going to be able to meet KLM and Amsterdam's requirements to fly, so we had to re-book a flight through another European country with less stringent requirements.  Consequently, we are now flying home on Lufthansa airlines, connecting in Frankfurt, Germany.  Their only requirement is that we have a COVID- 19 PCR test within 72 hours of arrival (which we were already prepared for). Amazingly, we had our testing done yesterday (Friday) at 1PM, and had our results e-mailed to us by 10 PM.  This may be the only thing which has been done efficiently during our month long stay here in Kenya...with the possible exception of our Samaritan's Purse drivers and logistics co-ordinator (thank you Heather Blizek for all your help in getting us re-booked and out of the country!).  We are looking forward to getting back to the U.S., and are not even dreading the 10d quarantine...this should give us time to "decompress" and catch up our mail and communications (and laundry!).  Thanks to each of you for all your prayers and well wishes on our behalf.  We look forward to being with you again soon.

With love,

Randy and Marilyn

Our Medical and OB Teams 2021

"DFK" (Dr. Fitness Kenya, aka Esther Dindi MD), and Trizah.

The 2021 Medical Team: Dr. Nathan M.D., Lilah C.O. intern, Dr. Esther M.O. intern, Dr. Winne M.O. intern, Joan Cheptoo C.O. intern.

OB/GYN chief Cheryl Cowles, and Brian, CO staff

Lillian Lipesa, FP resident; Ruth Wanjala, MO intern; Cheryl Cowles; Marilyn; Dennis, CO intern; Lydia, med. student; Fridah Wambui, CO staff; and Alex, CO intern.

Extremely hard-working team members...caring for incredibly sick and complex patients...I'm very proud of these interns!

More Scenes from Tenwek 2021

Scenes from Tenwek 2021

A COVID 19 greeting!

Dinner with the Terer family...our newest Kenyan family members!

Our excellent chef, Evans...keeping us fat and happy!

Nora and Emory...keeping us entertained and smiling!

Harper and Marilyn...learning to do cross-stitch!

Another tasty casserole from Evans and the ubiquitous fruit salad...

Only in Kenya...YIKES, hope the orthopedists are ready for this one...

 

The construction site for the new Cardiothoracic Center...

Local school children...out for recess...

View from the new residence tower at the Cardiothoracic Center...

The residence tower living area...

The residence tower kitchen...very nice!

The residence tower bath...WOW, when can we move in!!

Exterior view of the new residence tower at the Cardiothoracic Center

Dining area, residence tower...

Heartbreak at Tenwek

Greetings friends,

Our time here is again coming to a close, and it is always bittersweet to review the joys and sorrows of our time at Tenwek.  One particularly heartbreaking case this year involved a young mother who was on the medical service most of the month.  Her name was Jacqueline R., and she was 23 years old.  She had given birth to a son at the end of 2020, and was about 2 months post-partum.  After delivery, she had developed a post-partum cardiomyopathy and congestive heart failure (a weak heart muscle and inability to generate a normal cardiac output, which usually resolves over time).  She also had developed a deep vein thrombosis in her leg (blood clot), and was on our service receiving treatment for these two problems.  When I would make rounds to check on her, she always had her infant son with her and was often breast feeding when we would arrive.  Additionally, her husband or mother was often present to help her with her needs while she cared for her son.  Her young son would always be wrapped in his shuka (a traditional Maasai blanket with its bright red/yellow/blue plaid pattern unique to each tribe) and always looked so peaceful and content.  His mother always expressed her gratitude to us for caring for her and on several occasions asked us to pray for her and her son (which we did – sometimes in Swahili, sometimes in English).  She was making steady progress and I was expecting that she would be ready for discharge in 1-2 days (after adjustments to her anticoagulation regimen).  On the last day of her expected hospital stay, we went in to visit her and noted that she had developed a peculiar affect and seemed to be having some confusion and anxiety.  Her vital signs, examination, and oxygen levels were all unchanged, and we thought that she might be developing a post-partum depression with anxiety, or perhaps some post-partum psychosis?  Her discharge was delayed while we attempted to address these issues.   In her confusion, she was again oriented enough to ask for prayer – which I provided for her.  I recall asking that God would comfort her, give her peace, and heal her body.  I also asked for wisdom and discernment in making medical decisions for her care.  We started her on some anti-depressants and returned to see her the next day.  At that time, she was more clearly psychotic, but still stable- appearing.  We changed her medications to include some low dose anti-psychotics, and my intern briefly prayed over her again in Swahili.  During this time of her mental decline, her mother had started to come in daily to provide childcare, since the Kenyan culture does not permit husbands to physically care for their children (feeding, diaper changes, etc.).  On Thursday morning of this past week, her mother had come into the room and found her daughter unresponsive and not breathing.  The nurses were notified, a code was called, and CPR efforts were begun.  I just happened to be walking up to the ward to begin rounds, when I saw the activity outside her room and went in to find her in the middle of resuscitative efforts.  Jacqueline was lifeless, not breathing and CPR was in progress.  She received 12 vials of epinephrine, 10 vials of bicarbonate, and was being bagged with 100% oxygen.  She had a cardiac rhythm on the monitor, but only had a pulse with chest compressions.  While these resuscitative efforts were in progress, my eyes were continually drawn to the small bundle, wrapped in his shuka, and sleeping peacefully in the bed adjacent to his mother’s bed.  While her life was ebbing away, he was warm, snug, and blissfully unaware.  The resuscitative efforts were continued for about an hour, and as we were getting ready to stop efforts, we noted that she was making some gasping respiratory efforts, and had visible chest movements corresponding to her heart rhythm.  Despite this, she had no palpable pulse or discernible blood pressure.  At this point, we were in a quandary…we had already called for the chaplain to help notify the family of the patient’s demise, and yet she had not technically “died”.  While discussing whether or not to make additional, seemingly futile efforts on her behalf, my eyes were again drawn to her infant son.  “Let’s make every possible effort…for her sake, and for his…” was the final decision.  We bolused her with IV fluids, and her pulse became faintly palpable.  She was intubated and arrangements were made to transfer her to the ICU where she was placed on an epinephrine drip and a bicarbonate drip.  Despite escalating doses of fluids and epinephrine, she was never able to generate a measurable blood pressure and continued to remain very hypoxemic (low oxygen levels in her blood).  It appeared that she had probably had a massive pulmonary embolus (blood clot in the lung), despite being adequately anticoagulated.  She survived for another 4-5 hours during which time we were able to counsel the mother about her prognosis and the likelihood that she would die sometime later that day.  We were told that the patient’s husband had fled the hospital when it appeared that his wife was dying, and the mother was not sure if he would return.  She informed us that she was a poor woman, but would find family to care for her daughter’s son if need be.  Her only request to us was that we again pray for her daughter, her grandson, and her family…which we did with great sorrow and heartbreak.  Too often, such is the case here at Tenwek…great poverty, great hardship, and great sorrow…. but also great faith and trust in a loving God.  I have continued to silently grieve these past few days for Jacqueline and her infant son and family.  Please join me in praying for protection, comfort, and provision in their time of need.

Psalm 34:18   “The Lord is near to the brokenhearted and saves the crushed in spirit.”

2 Corinthians 1: 3-5   “Blessed be the God and Father of our Lord Jesus Christ, the Father of mercies and God of all comfort, who comforts us in all our affliction, so that we may be able to comfort those who are in any affliction, with the comfort with which we ourselves are comforted by God.”