Dear family and friends,
Our time of rest and recovery is coming to an end, but we have enjoyed re-connecting with old friends prior to our return journey to the U.S.  On our way out of Kenya, we stopped by Rift Valley Academy and visited briefly with Shannon and Ryan Potter and their children, Sydney and Zach.  Shannon was one of the medical students which we had met through CMDA when she was at UTHSCSA.  Since then, she has finished her OB/GYN residency and is in her second year as a full time missionary to Africa - first in the Congo, next in Togo, and next to be determined!  She is preparing to take her board exams while her husband is teaching math at the Rift Valley Academy.  It was a sweet time of reunion and sharing of stories for Marilyn and me (hopefully for Shannon as well!).

Shannon and Ryan Potter with Sydney and Zach...and Marilyn!

From Kenya, it was on to Venice, where we had the great pleasure of reconnecting with our dear friends from the Netherlands, Petra and Peter Axt.  This was our 4th reunion with the Axts following our time served in Kenya...what a fantastic way to end our journey!!  Thanks again to Petra for serving as our tour guide extraordinaire!...you make it look so easy!  Once we were on our own, we came to fully appreciate how well you guided us through the maze of alleyways, streets, and canals that is Venice!  Till next year....

Arrivederci!!

With Love,

Randy and Marilyn

A story of God's provision

Dear family and friends,

It is with mixed emotions that Marilyn and I approach the end of our time at Tenwek.  As always, we have experienced some profound tragedies and some joyous successes (too many of the former it seems).  One patient in particular has been very moving to me personally, and serves as a reminder that God has been orchestrating our time here, and preparing our hearts and minds for this years’ challenges.  This story begins even prior to our departure from San Antonio.  Earlier this year, I helped care for a young woman who came to see me in clinic in S.A. after her wellness screening came back with some unexpected abnormalities.  She was relatively asymptomatic, but was diagnosed with a condition that is almost uniformly fatal if not recognized and treated promptly.  She was referred to a hematologist, who confirmed her diagnosis and promptly hospitalized her and performed what is called a plasma exchange transfusion (the process of totally replacing a patient’s plasma volume with donor plasma, in order to remove some harmful antibodies which cause the illness).  She received a total of 59 units of plasma, and was started on high dose steroids and her condition stabilized.  She has continued to do well since that time.  Her condition is called TTP and is quite rare.  The incidence is 3 /per 1 million population/ per year.  She was only the second confirmed patient that I have seen in 32 years of practice.  As a result, I thought it would be interesting to present her case to the students here in Kenya, and do a teaching session about this illness, other similar illnesses, and how to tell them apart.  For a few months prior to departure, I spent some time researching TTP and similar conditions, and preparing a PowerPoint presentation for the interns’ teaching conference.  After arrival at Tenwek, I was asked to present my talk on TTP at the Tuesday conference on 9/19/17.  A short time before this (9/8/17), a patient L.B., was admitted to the male medical ward with an acute febrile illness of unknown cause.  L.B. is 34 years old, and had been diagnosed with HIV at the time of his admission. The list of possible causes for his febrile illness was quite extensive.  The medical team caring for him had extensively investigated his illness with a series of spinal taps (on 3 separate occasions, all negative), x-ray evaluations of his chest and head, and laboratory evaluations of his urine and blood, and had not been able to arrive at a diagnosis.  He had investigations for meningitis, TB, cryptococcal (fungal) infection, malaria, and bacterial infections, and had been treated with broad spectrum antibiotics, anti-TB meds, antifungal meds, anti-malarial drugs, and despite all this, continued to deteriorate with fevers, decreasing mental status, and inability to eat or to communicate verbally.  The family members had begun to express a sense of hopelessness and had begun to prepare themselves mentally for his death.  After my presentation on TTP on 9/19, I was assigned to round with the intern who had been caring for him.  She asked me if I thought he might possibly have TTP and began to build a case for this diagnosis.  Much to my astonishment, the patient had all 5 of the “classic pentad” of findings associated with TTP!  A patient with TTP will only exhibit all five signs 20% of the time; it is much more common to find 2, 3, or 4 of the classic signs, but not all 5 together.  Despite this, I was not convinced that this could possibly be TTP, since it is so rare, and I had just seen a case in the U.S a few months prior….what are the odds?! Being skeptical by nature, I asked for some additional tests to try to disprove the diagnosis (or to identify some other similar, but more common conditions).  Meanwhile L.B. continued to deteriorate, and as more evidence accumulated that his condition might in fact be TTP, we were faced with the dilemma of what to do about it once it was suspected?  In a country like Kenya, with low resources for medical care, it is not possible to perform a plasma exchange transfusion (which is recommended treatment), even with a solidly confirmed diagnosis (which is not possible here, since confirmatory testing is not available).  In view of his progressive decline, despite all that had been tried for him, we decided to transfuse him with several units of whole blood (which would provide some plasma), and to start him on high dose steroids as a “last ditch” effort to save his life.  Unlike the U.S., Tenwek Hospital does not have a blood bank with donated, processed blood ready for use at any time.  Here, a transfusion means that a family member or relative must come in and donate blood for the patient’s use.  This was done, but obviously took some time to accomplish.   In the meantime, the steroids were started, and we continued to monitor him for signs of improvement.  After 2-3 days, the blood became available and was administered.  As we have monitored him this last week of our stay here, he has begun to show signs of improvement.  His fevers have ceased and the destruction of his red blood cells and platelets has begun to slow.  His mental status is improving, and he is now awake, talking, following commands, and feeding himself.  He is far from well and has many remaining obstacles to overcome, not the least of which is his HIV disease.  In spite of this, we are beginning to be hopeful!  We know that our God is the great physician, and that “We treat, Jesus Heals” (The Tenwek motto, prominently displayed throughout the hospital).  Looking back on this situation, it is clear to me and to my interns, that this was a “God orchestrated” event.  I don’t know what will happen with L.B….whether he will survive, or ultimately succumb to his disease…but I am confident that God continues to use this situation for His purposes and through it, has demonstrated His presence, His provision, His mercy, and His love….for L.B., myself, and for the interns caring for L.B.  What an amazing God we worship!  Please join us in continuing to pray for L.B.’s recovery.  Pray also that his family would be comforted and supported, and that those who witnessed this event might have their faith strengthened (and yours as well!).  Thanks to all who have been praying for our time here and who have made it possible for us to come.  Looking forward to being together again soon.

With love,

Randy.

A visit with Margret

Over the last 15-20 years Marilyn and I have been sponsoring a child through Compassion International.  Our first child was from Ethiopia, and at age 18, she "aged out" of the program.  This happened about 3 years ago, and at that time, we requested to transfer our sponsorship to a child in Kenya, since we had plans to return here on a regular basis, and had also developed a love for the Kenyan people.  This child's name is Margret Wanja, and she lives in a small village in the northern part of Kenya.  When planning to return to Kenya this year, we decided to attempt to arrange a visit with her.  This process began several months before our departure and included background checks for both Marilyn and myself, as well as multiple other logistical hurdles...not the least of which was picking a day for a visit without benefit of knowing what our call schedule would be upon arrival.  We chose Friday, Sept. 22nd (since Compassion International does not arrange sponsor visits on the weekend) hoping that we would be able to arrange coverage for ourselves at the hospital, and that we would have time to find a driver and make travel arrangements.  After beginning the process, we discovered that Kenya is a fairly large country!...Margret's village was an 8hr drive from Tenwek, meaning that we would not be able to make the drive to see her, and return the same day.  Fortunately for us, Compassion was willing to arrange to have Margret and a social worker from her school come into the town of Narok, which is only about an hour and a half drive from Tenwek.  She travelled by public bus with her social worker (yikes!!...not an experience that we aspire to!) and stayed overnight at a hotel in Narok.  Today (Friday), we had a driver from Tenwek take us to meet her and spend some time with her...what a blessing this turned out to be!  She is a shy, but delightful, curious young 11 year old girl.  She is the 3d of 4 daughters (with a 5th child on the way!...she is praying for a brother!!) and her parents are both day laborers in their village....sometimes having employment, sometimes not.  She attends a school run by the Catholic church, and her day begins at 6:00 a.m. when she begins her walk to school.  She arrives at school by 6:30 a.m. and then cleans for an hour or so, before beginning her remedial class work (she is currently in 3d form).  This is followed by 5 classes in a variety of subjects including math, science, social studies, religious education, and language (she is learning English as well as Swahili, and her tribal language).  We learned that her favorite class was religious studies, and that she would like to be a nurse after her primary education is completed.  After her classwork, she has time for "football" or PE, followed by another 45 minutes to an hour of cleaning the classroom, and then she begins her walk home at 5:00p.m.  As her family is poor, and if food is not readily available from their garden (during the drought for example), she might only eat one meal a day while at school.  Her favorite meal is chicken and chapati bread ( an African flat bread, similar to a tortilla....for those of us from Texas!)  Her favorite colors are green and pink.  As fate would have it, we had purchased a cute green dress (without knowing her color preferences) to take along as a gift... and, one of Marilyn's employees (thank you Linda!) had donated a "Love Pink" rolling suitcase to give to her as well!!  It was packed with various school items, and toys...a pink backpack, some crayons and pencils, paper and glue sticks, coloring books, and "paint with water" books.  We also had packed some snacks and gifts for her family and siblings....Trail mix, Hershey's chocolate, and chocolate milk mix, Crystal light drink mix, peanut butter crackers, and some colorful dish towels and dish clothes for her mother.  Easily the biggest hit was a soccer ball and frisbee which we "demonstrated" after lunch.   Unfortunately, I "demonstrated" that stepping on the soccer ball while running was a good way to end up bruised and chagrined....she seemed to get quite a good laugh out of this before she was able to regain her 11 year old composure...Marilyn, on the other hand, did not even ATTEMPT to hide her mirth!  In any event, I had no need for a visit to our friendly orthopedic visiting doctor from North Carolina, so all is well....just a bruised buttock... and bruised ego!  Margret seemed to really enjoy her first big journey out of the area where she has grown up, her first bus trip, her first stay in a hotel, and her first visit with her Texas "family".  She is looking forward to sharing her BIG story with her friends from her village when she gets back home. She is quite a lovely young girl (see pictures below) and we found ourselves charmed by her.  We look forward to seeing how she matures and grows over the years ahead, and look forward to the day when we can come back to see her graduate from Tenwek's nursing school (God willing)!!

Marilyn and Margret

Margret with her "Texas family"

Who knew a soccer ball and a pink suitcase could bring such joy!?

Love to all,
Randy and Marilyn.

"5th" Kenyan birthday!

Marilyn celebrated her "5th birthday in Kenya" this year.  She started off her day with a slice of special carrot? bread and a single "match candle",  accompanied by a cup of Kenyan coffee, then off to work on the OB service.  After a bit of excitement ( a prolapsed umbilical cord necessitating emergent C-section, and a surprise twin), she was able to finish out her day and spend a bit of time relaxing at our comfortable "home away from home".  She was very moved to receive cards from home (thanks Jackie!), and a special gift from Fredericksburg which she has been eyeing for some time now (see picture below).  We enjoyed a quiet dinner at the guesthouse (just the two of us), prepared by our personal Kenyan chef (Meatloaf (of some sort?), scalloped potatoes, fresh fruit, and roasted Kenyan vegetables, and cornbread...yum!)....we liked it so much, we had the same meal for lunch earlier today!!  We never have reason to complain about our meals here...we are very well fed.  Before dinner, we went for a walk around the local village and down to see the river, the waterfall, and hydroelectric plant.  While walking, we encounter some charming local school children who were anxious to be immortalized in this blog...see below.  

We were thankful for a relatively quiet evening after a night on call yesterday.  

Over our short time here, we have been fortunate to spend some time sharing meals with the local missionaries and there families.  This past Sunday, we were invited to breakfast with Barbara Pinckley ( an RN who has been at Tenwek 33 years!) and some of our fellow short term volunteers (John and Avital below)...we enjoyed Barbara's famous cinnamon roll, eggs and bacon, fruit, and more Kenya coffee!...wow!!  See pictures below...

Barbara's famous Sunday breakfast.

Marilyn, John McPherson, and Avital, at Barbara Pinckley's breakfast.

We have also had an enjoyable time meeting new missionaries and their families.  Dr. Johnny Shaw and his wife Anna have come to Tenwek this past year with their 3 children, and Johnny has joined the OB staff, so he and Marilyn have been working together.  Johnny is from Ireland and Anna is from Canada...they met on the mission field in India!!...small world!  His specialty is gynecologic urology, but he finds himself doing a fair amount of OB, while building his GYN urology referrals.  We were invited to spend an evening in their home, and enjoyed some outstanding lasagna, salad and some sweet time with their kids.  Twins Madeleine and Caleb competed for our attention with various items constructed from their magnetic building materials, while older brother Corbin generally tried to avoid being in the same room with us...at least at first!  Once the gifts came out, all 3 children warmed to us and put their new gifts to some unusual uses (see below)!

Who knew a jump rope had so many uses!?

After using the jump rope as a "floss" of sorts, there was talk of a "zip line"....who says boys and girls aren't entirely different creatures??

Madeleine, however,  preferred to play with mom's phone while the other two tried to restrain each other!

What a wonderful Christian community this is!  How we would love to bring some of it home with us...and promise to try to...!

Church with one of the Copeland children...what a charmer!!

With love,

Randy and Marilyn

Dear Blog-followers, friends and family,

Welcome to ‘the story’ of our first week adjustments to Tenwek….every year it becomes easier. It reinforces our commitment to this venture that God has ordained for us.

We are back at the guest house- and in our ‘old’ room (freshly painted I might add). We miss Livingston, our previous cook, but Emmanuel is striving – and succeeding, in filling those cooking shoes. However, there was ONE meal that none of us could determine exactly what the entrée was----chicken (most votes), fish, or pounded beef patty, breaded and served on a hamburger roll. The next day we confirmed it was fish----tilapia (clearly very mild, and tasty enough that it didn’t matter WHAT it was) !

We re-acquainted with long-term missionaries within minutes of arriving.  Barbara has taught at the nursing school here for > 30 yrs. She saved lunch for us since she knew we were arriving. Her traditional sukuma wiki (spinach, kale, or collard greens?- I KNOW mom, you said I would like it someday), rice and carrots and homemade sherbet were, as always, a welcome delight to our taste buds AND heart while catching up with her.

We were able to make rounds with our new respective teams that afternoon. We both believe they are the best interns we have ever had.  Prayer starts our days together, ends our days together and is woven throughout the day with EVERY patient interaction. We both continue to struggle with situations that over-step our comfort zones, but God always joins us, especially at those moments, and leads us thru. He comforts us with the hospital mantra, “ We Treat, Jesus Heals”.

 

The hospital itself is always attempting improvements. This year there is an expanded library with individual department areas. It provides opportunities to meet, discuss patient needs, and have access to books, without interfering with other users.

We have only a few other visiting doctors at the guesthouse this year.  Mark is a pediatric cardiologist from the Univ. of Michigan, performing and teaching echocardiograms in preparation for upcoming visiting cardiac surgery teams. It is sad to acknowledge that only a small number of high priority patients will be selected from the incredible numbers who suffer from cardiac anomalies.  Oh, did I mention...Mark, his wife and 5 children ‘just so happen’ to live 2-3 blocks from my sister Jackie in Ann Arbor?!  John is a radiologist with the military and is experiencing his FIRST mission trip ever…. his 4 daughters ‘just so happen’ to live in Michigan also.  Avital is an Israeli/US citizen who is doing her neurosurgery residency at the Mayo Clinic, and is working here with a long-term missionary she knew from residency.

The Ob/Gyn group has also been in flux this month. Cheryl and Dean are in the states raising funds to continue their long –term missionary work here. Joy Draper is on maternity leave as her husband Bill, and son Walter have all been welcoming the new addition to their family….2 yr. old Frank (see pictures).  Joy will be back in the hospital in 10 days. God has granted me the opportunity to work along side her for a third year…what a blessing!  Their family was overcome with gratitude for the clothing donations my office staff sent for their new son, Frank. He donned shirt after shirt on top of each other—which is a typical Kenya style of dress despite his roots being Ugandan.  His American influence? Ketchup (“please”) on every food on his plate!

The patients continue to woo and break our hearts. The unbelievable amount of maternal health issues are overwhelming---hypercoaguable conditions + pregnancy =blood clots and pulmonary emboli. I have 6 pts. on service now with those issues. The hypertension, the consanguinities, the 1 out of 20 pregnancies with twins lead to likewise serious struggles. The stillbirths and birth defects seem overwhelming. The pastoral staff is an integral part of our team.

We had attempted to connect with Ryan and Shannon Potter in Kijabe/Rift Valley Academy this weekend. Shannon was one of my first medical students that I met through CMDA bible studies ~ 10 yrs. ago. . Ryan became her husband during her third year of medical school while he finished his masters in Engineering.  Following her residency, they embarked on a missionary outreach to the Congo where she felt God had been leading her to open a fistula correction hospital.  Political pressures led to an abandonment of that dream after 18 months.  This was followed by a short stay at a Togo mission hospital, and more recently a teaching post for Ryan at Rift Valley Academy –where ~ 60 different nationalities of missionary children attend school. It is world- renowned.  Shannon is currently a stay–at-home mom to their 2 children while preparing for her OB/GYN Board exams. She is available to help at Kijabe, another African Church/Samaritan Purse mission hospital on the same hilltop as Rift Valley Academy.  Despite our best efforts to visit them on our weekend off-call, transportation became an insurmountable problem, and THEN the on-call doctor for the weekend had a family emergency and asked Randy to cover him----Ahhh, so God appeared to have other plans for us!…. Others over self….

We miss our American friends and family, but are building our old relationships while promoting new ones – all the while following God’s hand across the Tenwek Hospital grounds…

LaLa Salama! (good night), Marilyn and Randy

Lovin' my new clothes!...how may shirts can I get on at once?!

New high tops too!

Greetings from Nairobi

Greetings to all our friends and family!  We just wanted to send out a quick note to let everyone know that we have arrived safely and have again survived the travel experience.  Every year that we have made this trek, there seems to be a new challenge and some new source of anxiety (at least for me).  Over the years there has been the Westgate mall attack on Christians, Ebola (though thankfully never reaching Kenya), HIV, TB, malaria and numerous other infectious diseases, as well as intermittent cross-border attacks by Al-Shabaab of Somalia.  This year, we have been concerned about the national presidential election in August, and whether or not possible post-election violence might spill over into September.  10 years ago, following the election of president Kenyatta, there was post-election violence that resulted in about 1300 deaths.  Additionally,  300,000 people fled the cities for the countryside to escape the violence.  In August of this year, president Kenyatta was re-elected, but thankfully, the violence was fairly minimal (20+ deaths in Nairobi)…we thought we had dodged yet another bullet.  However, a short time before this year’s election, the head of Kenya’s national elections organization was found dead, having been tortured and murdered.  After the election, the loser of this year’s contest alleged that whoever murdered the election official, had possibly done so to extract his computer system password, and may have tampered with the electronic tabulation of results.  Consequently, he took his challenge of the election to Kenya’s supreme court.  About a week before our departure, it was announced that the supreme court had found evidence to support significant election tampering, and the election results were declared null and void…a repeat election was ordered to be held within 60 days.  The new election is scheduled to take place on October 17^th, so when we arrived back in Nairobi last night, we found ourselves in the middle of an ongoing heated presidential contest.  To add insult to injury, shortly before our departure, Kenya passed a law making it illegal to use, or to bring into the country, plastic bags (such as those used for bagging groceries)….punishable by a $5000.00 fine or imprisonment!  Now if any of you have ever travelled with my wife, you will immediately understand what kind of angst this provoked.  My wife is truly the queen of Ziploc bag packing.  Everything gets subdivided by use and assigned to it’s own Ziploc bag (snack size, sandwich size, quart size, gallon size, and occasionally even jumbo sized bags!)…in addition, many other items, such as gifts, books, clothing, etc., might be placed in a plastic grocery bag for ease of distribution. To make matters worse, one of the suggested gifts for long-term missionaries was Ziploc bags, so we had also purchased several boxes of various sizes and scattered them throughout our luggage to be distributed as gifts.   Now imagine being told the night before travel that the new law was somewhat vague, and no one was really certain if Ziploc bags were included in the ban or not!! Needless to say, we spent a fair amount of Friday evening going through our 400 pounds of luggage (8 suitcases) extracting as much plastic as we could…the good news is that this process significantly reduced our risk of any one bag being over the 50 pound weight limit!  As a result of all this turmoil leading up to our departure, my state of mind with regard to this trip, has been less than ideal…I have really been struggling to get my heart and mind right, but mostly failing.  After making it to the airport, and checking our multitude of bags, I found myself once again questioning why we continue to put ourselves through this whole process year after year.  At 35,000 ft. , while over the Atlantic Ocean on our way to Frankfurt, and listening to the following song by David Crowder, I was once again reminded of the blessings that have ALWAYS followed obedience to God’s call to go and serve.  Once again, our hearts are committed, the turmoil is receding, the peace is beginning to return, and the certainty of the RIGHTNESS of being in this place has begun.  Listen with me and enjoy!

Randy