2 Corinthians 12:9
But he said to me, “My grace is sufficient for you, for my power is made perfect in weakness.” Therefore I will boast all the more gladly of my weaknesses, so that the power of Christ may rest upon me.
I awaken and check the time on my phone…It’s again 2 a.m. and I am wide awake. It has now been one week since our arrival in Nairobi and the jet lag remains very much a part of my daily routine. Outside it remains quiet…. only an occasional bird is singing, and the sound of rain on our metal roof is again noted. It has been raining daily since our arrival, though usually in the early afternoon, and usually lasting only 30-60 minutes. The noise of boda bodas struggling up the dirt road outside our bedroom window has not yet begun. I struggle to get back to sleep, but my mind is racing, and I can’t help but think about all the challenges that lay ahead for the day. Around 5 a.m. I again awaken to hear an occasional cow beginning to awaken. Outside, a few adults are walking by with yellow plastic containers which look like they should contain some sort of toxic chemical, but which have been repurposed for carrying milk for their families. Groups of nursing students, and other young Kenyans are heard laughing as they climb the hill outside our window, headed to school or work. Next comes the distant crowing of the rooster(s), then finally the boda bodas (motorcycles). I finally give up trying to sleep and get up before my alarm which is set for 5:45. As daylight approaches, the distinct raucous call of the hadeda ibis begins (see below). The workday has begun. I perform my morning ritual…shaving, brushing teeth, showering, preparing breakfast. Here the choice is always one of the following: 1. eggs (which are never refrigerated, since the protective coating which the hen provides is not washed away as in the U.S.) 2. Corn flakes 3. White oats. 4. Muesli with yogurt. 5. Toast with “medium fat” (margarine). 6. Coffee or tea. Kenya is particularly famous for their excellent black teas (they are the largest supplier to the U.K. and Europe), but their coffee is excellent as well. On my first day here, I head up to the hospital at 7 a.m. to meet up with my medical team. I approach the nurse’s station for the medicine ward and see a young Kenyan male in a long white coat with scrubs and no other identification (not unusual…here one cannot tell who is who by appearance or dress). I approach and say “Good morning. I am just arriving today; can you help me find my team?”. He answers, “I am Naas”. I reply “good morning Naas, do you know where I might find them (I have never heard this name here before, but see that my team includes Drs. Ndaro, Waruguru, Obala, Ochala, Chebii, Gakuya, Wanyonyi, and Rawambi Simei, so Dr Naas does not seem too surprising). He peers at me a moment too long with a flicker of frustration crossing his face and replies “No I am not Naas, I am Naas….N-U-R-S-E”. Embarrassed and humbled, I apologize profusely and find that his real name is Jacob…thus begins the always vertiginous, disorienting, chaotic experience of serving at Tenwek. For much of the first week I struggle to hear what is being said on rounds. With their naturally soft voices, muffled and obscured by facemasks, and their beautiful Kenyan accents, I catch only about one half to two thirds of what is being said. When I DO hear what is said, much of it is non-sensical to my western ears. Many lab results here are reported in units of millimoles per liter, rather than milligrams per deciliter as in the U.S. Therefore, blood glucoses, serum creatinines, bilirubin levels, calcium and magnesium levels, and lactate levels all must be converted to understandable U.S. units while I am struggling to understand the rest of the patient’s history. Often, I end up not really knowing why the patient came in, nor what was found to be normal and abnormal on their workup. The effect is total disorientation, and a sense of furiously treading water to avoid drowning…a sense of barely keeping my face above water. I have experienced this many times now, so I know to expect it, and I know that after a few weeks’ time, I will finally be able to comprehend most of what is being reported to me, and MAY finally be able to be an asset to the team…but definitely not in the beginning. In the beginning, I am slowing everyone down, and constantly asking them to repeat themselves, and to raise the volume of their voices. Despite this, my Kenyan colleagues are uniformly gracious, and patient, and kind. I begin to feel every one of my 67 years on this earth – the fading hearing, the fading visual acuity, the slowed mental processing, as well as the aches and pains associated with this damp and cool climate. In addition, I am breathless as I climb numerous stairs (since there are no elevators here) at 6900 feet elevation. It’s about this point that I again find myself asking “Why God…Why am I here? Have you indeed called me to be here, or have I come of my own doing, without your blessing?” At the low point of this first week, amidst the struggle, the chaos, and the feeling of inadequacy, I am called to lead the morning rounds as the most “senior” (in years only) member of the team (as the actual leader will be out all day in meetings)…it’s at this point that I recall the scripture above (2 Corinthians 12:9), where the apostle Paul states “I will boast all the more gladly of my weakness, so that the power of Christ may rest upon me.” While making rounds, I am presented with a young woman who has been treated at an outside facility for the past 5-6 days for complaints of abdominal pain, increased abdominal swelling, bloody diarrhea, and weakness and dizziness. She is 29 yrs old and has been previously healthy. She has been on Depo-Provera for birth control. She has had no history of alcohol abuse or known liver disease. She is profoundly anemic with a hemoglobin level of 5 and a hematocrit of 15. Her heart rate is 130, and she is in distress. My intern has also reported that her coagulation parameters are abnormal and that her INR is 6. (not clotting normally). She has normal liver enzymes, and no other evidence of abnormal bleeding. No diarrhea or rectal bleeding has been witnessed. Her other coagulation tests are normal and there is no evidence of DIC (abnormal consumption of coagulation factors). She (the intern) has performed an ultrasound of her abdomen and sees a large amount of intra-abdominal fluid. A paracentesis is performed, and bloody fluid is obtained. A CT scan of the abdomen has been done, but the official reading from the U.S. radiology group will not be available till the next day. We review the CT together and decide that something does not look normal in the pelvis…there appears to be an abnormality in the right side of the pelvis, but no evidence of a bowel perforation, or other free air in the abdomen. I ask about her pregnancy test, and am told that it was ordered, but not yet done, because the patient had not been given a cup to provide a urine specimen. I am reminded that she should not be pregnant, because she has been using birth control as mentioned earlier. The one thing that 41 yrs of medical practice has taught me is that one should never place complete trust in any one piece of information or data…thus, the accuracy of the history of “bloody diarrhea” (rather than blood from an adjacent area) was questioned, the accuracy of the prolonged INR with other normal coagulation tests was questioned (repeat was normal), and the infallibility of birth control was questioned (urine pregnancy test came back positive). The patient was seen urgently by the OB service (Marilyn) and was determined to have a ruptured ectopic pregnancy which had gone undetected, with resultant bleeding into her abdomen, profound anemia, and impending hemorrhagic shock. She was taken to the operating room and her bleeding was controlled, and her ectopic pregnancy removed. She was given blood and stabilized. I am confident that the medical team would have ultimately arrived at the correct diagnosis, though it may have taken another 24 hrs to get back the CT report, and to follow through on the pregnancy test which had been requested. It seems like my part (and Marilyn’s part) in this drama was small, but perhaps very significant to the survival of this young lady. I believe that her diagnosis was made at least 12 hrs earlier than it might have been, had I accepted as accurate the information provided (Occasionally my naturally skeptical nature is of some value...though Marilyn might disagree!) Once again, I am humbled. I feel that my questioning and my prayers have been answered. God has shown me that He is faithful; that He has a purpose for my (our) service here, and that His power is made perfect in my weakness. This weekend I will rest. Today is my birthday and Marilyn has planned cake and fellowship time with our fellow volunteers. Tomorrow (Saturday) she has made plans to take me out to dinner in the town of Bomet. The struggle of the first week here is behind me (us). Let’s see what the new week has in store…
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