Vanovers' Travels: A day in our life at Tenwek

Greetings friends. Some have asked what a typical day here is like, so I thought I would take you with me on my Thursday journey! Unfortunately, my day begins about 1:30- 2:00 a.m…this is the time I typically awaken for the first week or so after arrival…a nasty “jetlag” effect that seems to affect me more so than Marilyn. I manage to fall back to sleep a while later, and am then re-awakened about 5:30 by roosters crowing, and the sound of boda bodas (Kenyan motorcycle taxis) and trucks coming to life outside our guest house on the rocky dirt road adjacent to our property. After disentangling myself from the mosquito netting which hangs over our bed here (and seems to do a fine job of trapping 1-2 pesky mosquitos INSIDE the netting), I carefully descend the steep and shallow staircase to the living area below. The coffee maker has been prepped the night before, and after the switch is flipped, I begin to hear the water boiling and the smell of coffee begins to fill the our snug and comfortable, but somewhat chilly apartment. The nights here are cool…usually in the 50’s- 60’s. The days are mostly sunny and warm, sometimes getting up into the mid 80’s. Afternoon showers are common and usually brief. This year we are very fortunate to be staying in the “Galat Guest House”, a two story, two bedroom furnished apartment named after the long-term missionary family that originally obtained funding for the construction of this group of houses. The Galat complex consists of a large home which now houses a family of 8, (soon to be 9), with adjacent guest housing for 2 additional visiting families. In addition, there is a large meeting room over one of the apartments, which is locally known as “the upper room”. Here the long-term missionaries and their visiting guests gather on Sunday evenings for an hour of prayer and sharing of concerns/joys. The Galat family no longer occupies the house that bears their name…that honor goes to the Copeland family who are currently awaiting the arrival of their seventh child! Will Copeland is a neurosurgeon who has been working at Tenwek now for the last several years. After a breakfast of corn flakes, yogurt, and locally made bagels, Marilyn and I sit down for our morning devotional time. The scripture for today is Romans 15:13 - “May the God of hope fill you with all joy and peace in believing, so that by the power of the Holy Spirit you may abound in hope”. The day in the hospital begins at 7:30. The critically ill patients in the HDU (high dependency unit) and ICU (intensive care unit) are seen first. Today we are caring for a woman who has been admitted the night before with new onset diabetes, and a potentially life threatening condition called “diabetic ketoacidosis” – she is responding slowly to treatment, but appears to be gradually getting better. We are fortunate today, and only have one patient to be seen in the HDU/ICU. Following this, we head up to morning report, which begins at 8 am. This is a time when all the medical and surgical staff gathers for a case presentation, followed by a discussion of a medical topic related to that particular patient. Today, one of the surgical residents presents a summary of brachial plexus injuries with discussion limited to adult patients with trauma-related injuries. This apparently is a relatively common injury around here with all of the boda boda accidents! Today, I am called out of report to assist with care of a post-partum mother who has a blood pressure of 220/140 and has not been responding to IV blood pressure medications. After morning report, the medical team gathers to discuss patients on the service before making rounds. The time begins with a prayer for wisdom and discernment in caring for the patients that we will encounter that day. This is followed by a brief period of scripture review and life application led by one of the Family Practice interns. Next we review deaths from the last 24 hr. period and discuss what we believe to have happened with each case, and what we might have done differently to improve care. Today we discuss 3 cases from the night before. During our discussion, a patient on the female ward has arrested and we are called to attempt resuscitation. This patient has been admitted with an unexplained anemia, a hemoglobin of 3.6, and high output congestive heart failure. She is in the hospital to be transfused, and to have a bone marrow evaluation performed. Her resuscitation is unsuccessful, and her family is gathered to have the news broken to them as gently as possible – this responsibility falls to my intern and myself – I have seen the patient only once, the day before, and the family has not been expecting her death – this is always a difficult discussion…in any language or place. A chaplain assists in comforting the family, and offering prayers for them and their loved one. We finish our medical team meeting with mendazis (deep fried lumps of dough) and chai (sweetened milk tea)…I know what you are thinking!!...and yes, I am ashamed!!...then head out to the wards to round on our patients. Today’s rounds are relatively brief and the patients are relatively stable (by Kenyan standards)…we only have about 20 patients to see, and I am responsible for seeing 4 of the 20 (with my intern). After rounding, I leave the interns to finish their work and their charting, and head over to one of the long-term missionary homes. Several of us visiting staff members, have been invited to have lunch with Dr. Russ White (cardiovascular surgery) and his wife Beth. As I am preparing to sit down to lunch, I am paged by one of my interns… a patient has arrived in casualty (the equivalent or our emergency room) in complete heart block and needs placement of a temporary pacemaker for stabilization… she has never done this procedure before and is requesting assistance. After the temporary pacemaker is in place and functioning, I head back to the White’s home where I catch the end of the lunchtime conversation, and am treated to a delicious meal of pasta, topped with chicken and vegetables, and green beans. Ginger cookies complete the meal, and it’s time to head back to the hospital to check on the patient in casualty. While there, I am asked to see another patient who has come in with altered mental status, a recent witnessed generalized seizure, nausea, vomiting, and hyponatremia (low sodium level) of 113. He has a hx of alcohol abuse and is suspected to be experiencing DT’s (Delirium Tremens). While evaluating him, the patient in the next bed suddenly stops breathing and resuscitative efforts are begun (this time successfully)…one bed over is our patient in complete heart block with her temporary pacemaker…she is now sustaining a HR of 80 and a BP of 90/70. Now she is in need of a permanent pacemaker, but we are told that none will be available for 2-3 weeks…such is the activity of an average day in casualty…it will only get crazier as the evening approaches. As I return home to our apartment to get ready for dinner, I find a group of young children on my porch swing. They are sweet, energetic, and charming. Norah (a 4 year old Copeland daughter) engages me in a game of “I spy with my little eye”….others soon join in. I pass an enjoyable ½ hr. to an hour before I realize it is time to go to dinner. This evening, we have a dinner meeting with the “Friends of Tenwek” to honor all the short term volunteers and there families, and to connect them with representatives of Tenwek once they return home…we are treated to the personal story of the Copeland family mentioned above, and how Will felt his calling to mission work during the final years of his training in neurosurgery at Mayo Clinic. The family is now entering their third year of full time service at Tenwek, and have no definite plans to return to practice in the U.S….Will’s loans from his medical school training are being paid by his sponsoring mission agency, freeing him to continue his volunteer service. After dinner, it is time to head over to the hospital grounds for an evening of African Worship in the local chapel of the African Gospel Church. Leading worship is a Kenyan cardiovascular surgeon…also participating is a Kenyan general surgeon, several nursing staff members, various other hospital personnel, and my medical intern, who has earlier today placed her first temporary pacemaker! Today is the first day I have managed to make it through the entire day without falling asleep in the afternoon! Perhaps my jetlag is coming to an end (with assistance from Norah and friends)? Tonight, as I reflect on the day, I am reminded of the scripture passage from our devotional time this morning…in retrospect, it HAS been a day filled with hope, joy and peace… a peace which passes ALL understanding given the events of the day. It’s now approaching the end of another day…it’s again getting cool, the mosquito netting is coming down, the coffee is being prepared for the morning, and I am looking forward, with hope, for my first full night of uninterrupted sleep (perhaps)! Tomorrow promises to be another interesting day here in rural Kenya.

With love,

Randy and Marilyn.