Vanovers' Travels: 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.