Marilyn's 6th Kenyan birthday!

A little cross-stitching to start the day!

Enjoying birthday cards from friends and family....

Cake and ice cream with our new visiting staff friends

Why am I here?

Greetings from Kenya to all our friends and family. 

Most years when we come to Tenwek there is that one special patient (or sometimes several patients) that seems to answer the recurring question:  “God, have you really intended for me to be here”?  I have spent much of the last week feeling like I wasn’t being particularly useful to the medical team, and again found myself wondering anew, “Why am I here”?  While on call last night, I met the “reason” for this year’s trip.  Her name is E.O. (to preserve her privacy).  She is a 28-year-old Kenyan woman who had been healthy (to her knowledge) all of her life.  She had never been under the care of a physician and had no significant past medical problems.  Her family brought her into Tenwek last night (Tuesday) with the story that she had begun having difficulty with her breathing when she would try to do anything strenuous.  This reportedly started about a year ago and gradually worsened, but she had never sought attention for these symptoms.  About 2 weeks ago, she began to have more difficulty breathing, and had been rapidly worsening since that time. They reported that she was now having difficulty breathing even when sitting and resting, and was no longer able to lie flat at night to sleep.  They also noted that her feet had begun to swell and that she was fatigued, weak, and lethargic.  The family became concerned, and brought E.O. into Tenwek for evaluation…they had to carry her into Casualty (the emergency dept.) because she was no longer able to walk.  On arrival, she was assessed by one of our visiting Emergency Medicine fellows from the U.S.  Dr. Swanson was alarmed by her appearance, and noted that her BP was quite low at 70/40; he was able to perform a bedside ultrasound evaluation of her heart and found massive enlargement, as well as evidence of rheumatic valvular disease (severe mitral stenosis and mitral regurgitation for those of you in medicine, or for those just curious!).  She also had a rapid heart rate and an irregular rhythm, which was aggravating her rheumatic valvular disease (atrial flutter with variable block to be precise).  The mitral valve narrowing was making it difficult for blood to flow into her left ventricle, and the rapid heart rate meant that the time between contractions, during which filling of the ventricle could occur, was shortened.  In all likelihood, this rhythm change may have occurred a couple of weeks prior, and “tipped her over” into fulminant heart failure with a reduced cardiac output.  This is a very tenuous and critical situation for a patient with these valve lesions, with death occurring in a significant number of these patients.  To complicate matters, there were no ICU beds, and no ventilators available in the hospital.  My intern for the night had not previously dealt with this particular set of circumstances (nor had I, at this level of severity) and was having difficulty prioritizing the various aspects of her urgent needs.  I found myself whispering a silent prayer (and not for the last time over the course of the night!) ….”Lord, now would be a good time to show up if you intend for E.O. to survive”.  We set about attending to her most urgent needs, and trying to stabilize her blood pressure.  While we were doing so, 2 of our other patients became unstable, arrested, and required our efforts at attempted resuscitation.  Sadly, these resuscitative efforts failed, and there were grieving families to console.  Meanwhile, E.O. had been teetering on the brink of cardiopulmonary arrest herself, but amazingly, had not done so while we were occupied with others.  As a result of these patient deaths, one of the much- needed ICU beds had become available, and we were able to reserve it for E.O.   A few hours after getting her into this ICU bed, she began to have more restlessness and more difficulty keeping her oxygen levels up.  She began to struggle and fight against efforts to keep her oxygen mask in place.  She began to exhibit “air hunger”… a frantic effort to keep breathing…and during this time, pulled out the IV catheter that was providing her with medications to support her blood pressure and to treat her rhythm disturbance.  It was now obvious that she was going to require sedation, placement of an endotracheal tube, and support from a ventilator if she was to survive…but there were still no available ventilators in the hospital.  As we were furiously calling around to different units in the hospital, we discovered that the operating theater was holding 2 ventilators for planned cardiovascular surgery patients who were scheduled for surgery the following day!  We decided to push ahead and to intubate E.O, and to delay worrying about how we were going to support her till directly faced with the problem…at worst, we could “bag her” (use a compressible bag to force oxygen into her lungs through the endotracheal tube) until a ventilator became available.  This generated yet another urgent prayer on E.O.’s behalf…. “Lord, I am only going to get one chance to get this tube into her airway, or she is going to arrest…please guide my hands, and spare her life…and, please make a ventilator available for her”….needless to say it has been years (thankfully!) since I have been in a similar situation, and I was feeling the stress acutely.  My own heart was threatening to escape my chest, and yet, I felt with some certainty, that God was there with E.O. (and me), and did not intend for her to perish.  During the intubation, I was not able to see her airway well, but the tube went into proper position with a single effort.  Thanks be to God!!  We now had control of her airway, and she was very relaxed after the IV sedation.  Now what!?  We had an intubated patient, but no ventilator!!  The night nursing staff in the ICU began to rotate turns  “bagging” E.O. This effort went on for about an hour, while we started making some calls and begging for release of one the reserved ventilators.  In order to obtain release, I had to directly appeal to one of the on-call Kenyan cardiovascular surgeons.  He was very gracious and listened to my patient’s story with great interest.  He made a personal visit to the ICU (now about 4 a.m. local time) and not only approved release of the ventilator for her stabilization, but also promised to review her case with his cardiovascular team the next day.  For E.O. to survive for any extended period of time, she was going to need surgical replacement of her diseased mitral valve.  In the meantime, it was our job to “tune her up” to the best of our ability with medications and other forms of support.  After securing a ventilator for her, and getting a central venous catheter placed (another long story which I won’t go into now!), we were able to administer her critically needed medications, and safely administer her much needed supplemental oxygen.  She has been steadily improving into the early morning hours, and now looks as if she may continue to stabilize.  The cardiovascular team has seen her, and will be putting her on their waiting list for a much needed valve replacement sometime in the future…I’m confident that it will happen if God wills it….I’m betting that He does.  I don’t know what God has planned for E.O.’s life, and certainly she has a long way to go before she can be thought of as stable.  I only know that I am thankful to have been led here… to have an opportunity to join God in the work that He is doing in E.O.’s young life.  On Wednesdays (today) at Tenwek, all the medical and surgical staff gathers for morning devotionals.  Here, a member of the hospital’s staff is asked to speak.  Today’s topic turned out to be “Why does God allow suffering”?   We were taken through the story of Jacob’s son Joseph, and how he was sold into slavery, imprisoned, and seemingly hopeless, only to emerge years later as a trusted advisor to Pharaoh, and ultimately a savior to the nation of Israel during a period of drought and hunger throughout the land.  The speaker’s message was: “that which man intends for evil, God can use for own His good purposes.”   The message that I heard was:  “ we don’t always understand why God allows suffering to occur, but He often uses suffering for His own good purposes”.   I trust and hope that E.O.’s suffering (as well as that of many other patients here at Tenwek) will only bring some future “divine good” into their often difficult lives.  May that be true for us as well.

With love,

Randy.

E.O.'s Chest x-ray...yes that large white blob filling her chest cavity is her heart!!

E.O.'s ECG...for those interested!

African Worship Night

A short video from African Worship night at Tenwek.  Enjoy!!

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.

Our Galat Guest House Accomodations

View off our front porch

Entrance to our apartment

Our local produce vendor

Norah Copeland

Norah's friends ....and my porch companions

Friends of Tenwek dinner...Dr. Hong and family

Preparation amidst chaos!

Greetings friends!

As Marilyn and I prepare once again for our annual trip to Kenya, we have been consumed this year not only by our preparation for our trip, but also by a whirlwind of activity surrounding the sale of our family home, and looking for another place to live upon our return!  This may be the first time we actually look FORWARD to getting on a plane to begin our grueling 20+ hour journey!  As many of you already know, we placed our home up for sale in Mid- March, and after many months of tepid interest, we were resigned to leaving for Kenya without having sold our home as anticipated.  The plan was to leave our home on the market until we returned in October, then to take it off the market for the end of the year holidays, and re-list it again in the spring of 2020.   Once again, the old adage: “be careful what you pray for” has proven to be true!  On 8/13, a couple driving around our neighborhood saw an “open house” sign that had inadvertently been left in the boulevard leading into our development.  Our open house had actually taken place on 8/11, but the sign remained in place.  After driving into our development, the couple saw our “for sale” sign and stopped to check out the “open house”.  At the time, Marilyn was at home preparing the house for a viewing by yet another couple that same evening.  She was just about to leave the house for the showing, when the errant couple came knocking at our door and inquired about our “open house”, and whether they might “have a look around”.  Being the gracious person that she is, Marilyn explained the mistaken situation, but invited them in anyway.  After a quick tour, they left with profuse apologies, only to call and request a second visit with their agent the following morning.  They came back again for a third viewing that same evening.  By this time, we were getting anxiously excited about the prospect of a potential buyer, but very nervous about our upcoming Kenya departure date of 9/5.  After about 10 days of anxious waiting, we were notified on 8/22 that the couple had decided on another property.  We heaved a sigh of relief, mixed with some disappointment, and set about preparing for our journey to Kenya.  On 8/24, their agent called back and asked if we would still consider a potential bid on our home.  On 8/25 we received, and signed, a contract on our home, with the stipulation that we needed to be out by 10/7.  After some furious calculations, we decided that this was “do-able”, but only barely…. after all, we were scheduled to return from Kenya on 10/1…. And closing was set for 10/3… how much more time did we need!?  On 8/26 and 8/27 we viewed some properties for sale, as well as some for rent…on 8/28 we submitted a bid for purchase on a house, and on 8/29/19, the contract was signed.  Closing on our new home is set for 10/4.  Our move is planned for 10/5…In the MEANTIME, we have been furiously packing up our house, packing for Kenya, arranging for requested repairs on our old home, having inspections done on our new home, arranging for moving services, talking to tree trimmers, pool service people, electricians, title companies, insurance companies, etc., etc., etc.…  WHEW!!!!  We are exhausted, and we haven’t even left yet!!  Following this week of frenzied chaos, we attended church this past Sunday.  The pastor spoke about living in God’s will, and how to discern His will for our lives.  We were reminded that our work is to “remain in His word”, our identity is to be “rooted in Christ”, and that we are to be “ambassadors of Christ” in the world; or “living love letters to the world” on behalf of God.  On Tuesday night, we attended our weekly bible study with medical and dental students (as well as other healthcare professionals) associated with CMDA (The Christian Medical and Dental Association).  The topic of discussion was “How to discern a calling from God”.  Our CMDA director, Scott Phillips, used the metaphor of a ship being guided through a treacherous channel by the use of 3 lights, which when perfectly aligned, appeared as one, but when out of alignment appeared as 3 separate lights.  We were reminded that the first light represents scripture – all callings from God should be consistent with scripture.  The second light represents circumstances in our lives, and counsel from trusted brothers and sisters in Christ – all callings should be compatible with our circumstances and with Godly counsel.  The third light represents inner witness – confirmation from the Holy Spirit…. God within us… that our leading or calling is actually from our Creator, rather than our own selfish desires.  Do you think perhaps there is a message there in the midst of our chaos?!  It was as if God was reminding us…He had indeed called us to Kenya, we are to be his “living love letters” to others, his ambassadors to the sick and less fortunate, and that by the confirmation of His spirit, all 3 “lights” are in alignment…we are indeed where he wants us to be…and Oh, by the way, “leave the rest to Me”.  So once again, this time in the midst of great chaos, we are off again to partner with our brothers and sisters in Kenya…we hope that you will join us…at least through this blog, and hopefully by your prayers…and be blessed, as we are blessed by our experiences along the way. 

With love, Randy and Marilyn.