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