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 4th 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
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| Silolo's suspected cutaneus anthrax. |
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