Thanksgiving at Tenwek - part two

 

Thanksgiving at Tenwek

  

We usually travel to Tenwek in September. COVID altered that schedule, and we are experiencing the benefits of this trip at a different season.

This Thanksgiving is coupled with the start of Advent. Thanksgiving at Tenwek is not a recognized event. The long-term missionaries here had a Thanksgiving prayer time Thursday evening after a ‘business as usual’ busy day at the hospital. I (Marilyn) was on-call but was able to participate in the shared prayers of thankfulness before I was called away to an emergency cesarean section (he is a beautiful, healthy, baby boy). One of the thanks lifted up was for the progressive availability of technologies here to keep us in closer contact with our families at home: facetime, ZOOM, texting, etc. These were not available to us so readily when we started coming here 10 years ago. These allow us to communicate on those special family times when we are separated by many miles and time zones.

The first day of Advent is symbolized by the lighting of the candle of Hope. Tenwek Hospital is fueled by the Hope that as “We Treat…”, we know and believe, that it is “…Jesus (that) Heals”.

Thanksgiving gratitude leads to hope for the future.

This visit has allowed us to witness a new expression of community. In the long-term missionary population here, community is defined by the “common characteristics or interests, especially professional interests, living together within, or scattered through, a larger society”. So Tenwek Hospital is a multi-national (English, German, American, Kenyan) group of physicians caring for and participating in the local Kenyan population (or even international populations) who come here for care. A general surgeon/missionary and his wife from Guinea have been staying with us at the guesthouse as he underwent neurosurgery for a large pituitary tumor, and then postoperatively convalesced here.

The Tenwek Missionary community celebrated Thanksgiving on Saturday (rather than Thursday). It was a unique blend between American traditions and their own. There was a 5 K run at 7 AM, then a Turkey Trot for the four and under age group at 8 AM. Randy and I served as cheerleaders as they navigated the course. At noon, a Feast was served in an outdoor community space. Approximately fifty people attended. We were hosted at the table of a German family (he is an ophthalmologist, she is a generalist MD, and their three children). There were four baked turkeys, many styles of dressing, gravy, mashed potatoes, sweet potatoes, green beans, creamed corn, carrots, home-made rolls, various jellos, devilled eggs, cranberry dishes, etc. It looked just like home! An Australian construction contractor described it as “all weird food, but all delicious”.  At 3:30, a football game was ‘played’…. Team pink vs Team yellow.  Participants wore “pink bubble gum” or “yellow sweet potato” jerseys. The ages ranged from 18 mos- 60+years. Who cares who won or lost? ..It was a hoot!  Have you ever seen a football player carrying his 18-month-old daughter during play? God protected them all from injury! Then at 5:30 came pie-time!...pumpkin pies, apple pies, rhubarb pies, ice cream---oh my! At 8:00 PM we gathered for the UofM vs Ohio State football game---the winner of that game DID matter a little bit more! (There were a few who chose to watch International Rugby or the World Cup soccer…imagine!!). Throughout these 17 hours I saw scores of children- none of whom were ever looking at a cell phone or other digital device…what a blessing to witness!

When we visited Israel in 2011, we learned about the concept of community called “Insula”. It was a style of living that involved a collection of units (homes, tents, apartments) around an open courtyard.  In this community, one would share meals, childrearing, and various other aspects of daily life. In a broader sense, “insula” can be extended to mean families that live, work, and interact with each other on a daily basis. Young people learn from the stories and actions of the older members and all the “aunts” and “uncles” participate in the lives of all the youngsters. Life at Tenwek is very much like this… it provides a living example of “insula” and is, I believe, a picture of heaven (God’s housing complex).  

Today, on the Sabbath and the first day of Advent, my heart is filled with hope. I have so many expectations for the ‘tomorrows’ of our lives. Sometimes the road ahead is filled with loss and stress that weighs one down- we all need HOPE. I was blessed with re-connecting with a former patient, Beatrice, that I had cared for back in 2015. She is employed at Tenwek Hospital. She approached me one day and asked me if I had been at Tenwek in September of 2015 and if I was Dr Vanover.  She then proceeded to remind me that I had delivered her stillborn daughter. We discussed how the years since then had been for her. She has great peace about that time and now has two other children. I pray that she remembered me as a compassionate doctor who helped her through that trial. We both recognized that God was in the midst of it all then, and still is today. We need Jesus… the Jesus of Christmas. He is the ‘anchor of our souls’ that secures us all through the storms of life.  

I would like to summarize a devotion that I read for Day 1 of Advent:

Hope for Help: To find grace in times of need.

Hope to Overcome: To overcome great obstacles and to have faith in Jesus who gives us hope. This is the victory that overcomes the world (1 John 5:4).

Hope for Power: To help us when we feel overwhelmed. Our weakness is the entry point for God’s strength.

Hope of Eternity: He gives us help, strength and power for today, but more importantly, hope for life after death: the ultimate tomorrow.

 

May this advent season be especially blessed for you all,

Marilyn

The Pepsny family

The Thanksgiving Feast

Marilyn and Chelsea Swanson

Thanksgiving meal - Tenwek style

Thanksgiving football- bring it on!

Some serious defense!

"Put me in coach (dad)"...

Pie-Time at the Roberts' home!

Dessert time!

Deborah and George Schule and family

Jonathon and Chelsea Swanson

Dean and Cheryl Cowles

 

 

Birthday Celebration - 67 years!

Reconnecting with friends from previous trips - Jonathon and Chelsea Swanson - now Samaritan's Purse postgraduate missionaries to Tenwek

Birthday cake in the guesthouse dining room...with frosting!!...an unusual luxury at Tenwek.

Celebrating with Justin Daggett - a plastic surgeon from Knoxville TN.

 

Tenwek Life - Week 1 review

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…

Why I Believe...(And why I attempt to follow Jesus...even to Africa!)

 

Warning:  Longer than usual content follows!  Hope you find it worthwhile.

Recently Marilyn and I have begun the process of planning for our final days on earth (though hopefully that will not be anytime soon!).  As part of the process, we have been following a checklist which assists with decision-making about the type of memorial service, favorite scripture passages, favorite music, etc. that one would choose to include in one’s final service (and thereby help prepare, (and spare) one’s survivors for the difficult task of having to make those decisions.)  The last item on the checklist was this: “One year after I’m gone, I’d love it if you’d celebrate my memory by doing this:”.  After some thoughtful consideration, my personal answer was to read my blog postings regarding our mission experiences over the last several years of our lives.  I believe that these experiences represent the culmination of all that has gone before…the summation of our lifetime of preparation and purpose.  It has been difficult to convey to our family and loved ones just how impactful and formative these experiences have been.  In the case of some unbelieving loved ones, it has even become a divisive issue…there is the perception that we have become “blind” to the realities of the world and the risks of our volunteering as a result of our faith. Consequently, I am reminded of the warnings of the “cost” of discipleship… what one can expect when one chooses to follow Jesus.

 Matthew 10:34-36:³⁴ “Do not suppose that I have come to bring peace to the earth. I did not come to bring peace, but a sword. ³⁵ For I have come to turn ‘a man against his father,  a daughter against her mother, a daughter-in-law against her mother-in-law—³⁶    a man’s enemies will be the members of his own household.’^[c]

In other words, one can expect strife and turmoil as a result of following Jesus…even within one’s family.  So why follow Him?  How does one come to believe so strongly that God exists, that Jesus was who He said He was, and that God does call us, equip us, and lead us into various types of Kingdom work?  My own story of faith, many of you already know…but perhaps many of those closest to me do not?  Perhaps you are reading this in real-time?  Perhaps you are reading this after my death?  In any event, let me try to explain.  I was born into a family with one believing parent (my mother), and one agnostic parent (my father).  My mother was a member or the Church of Latter-Day Saints (LDS, or Mormonism).  I was raised in this tradition and baptized at age 8.  As a child, I embraced the concept that God existed, but did not have much else in the way of a personal testimony as I was growing up.  I attended church more out of a sense of duty to my mother, and maternal grandparents, than anything else.  As I approached adulthood, and the age at which I would need to decide about going on a “mission” with the LDS church, I was confronted with the fact that I did not feel any personal conviction to do so.  I felt like I would be an “imposter” if I chose that route.  In fact, as I had progressed through school and through my pre-medical curriculum, I had begun to "worship at the altar of science".  I had begun to believe that there was no God, and that I did not see how anyone could become objectively convinced of His existence.  Perhaps you have been in this place…or still are?  I remained a non-believer through most of my early adult years.  After Marilyn and I had children, we would occasionally take them to church with the goal of providing moral instruction.  One year when my daughter was about 10 years of age, she attended a summer sports camp at T-Bar-M (a Christian sports camp in New Braunfels, TX).  She returned home from that experience “on fire for God” – she was reading her bible, praying, and questioning why we were not going to church more regularly.  I felt a piercing conviction in my heart that she was right…we DID need to expose our children to Christianity, and then let them come to their own conclusions about their faith, or lack of faith.  We made a commitment to take them to Sunday School each week, and while they were in Sunday School, Marilyn and I also enrolled in an adult class.  It was here that I was encouraged to commit to reading the entire bible over the course of one year in a course called Disciple Bible Study.  I had zero interest in doing so but was strongly encouraged by Marilyn to participate…and in the end, I decided to read this book that I professed not to believe (though had never read).  I entered the study as a strong skeptic, believing that nothing could answer my questions, my doubts, and my unbelief.  I was now about  39-40 years old and had experienced enough of the practice of medicine to realize that the god known as "Science” was anything but infallible.  As I read the Old Testament, I came upon the following Psalm of David:

Psalm 19:1-5:  

1The heavens declare the glory of God;
    the skies proclaim the work of his hands.
² Day after day they pour forth speech;
    night after night they reveal knowledge.
³ They have no speech, they use no words;
    no sound is heard from them.
⁴ Yet their voice^[b] goes out into all the earth,
    their words to the ends of the world.
In the heavens God has pitched a tent for the sun.

and later in the New Testament, I came upon the following statement from the Apostle Paul: Romans 1:18-23, 1: 25. 

¹⁸ The wrath of God is being revealed from heaven against all the godlessness and wickedness of people, who suppress the truth by their wickedness, ¹⁹ since what may be known about God is plain to them, because God has made it plain to them. ²⁰ For since the creation of the world God’s invisible qualities—his eternal power and divine nature—have been clearly seen, being understood from what has been made, so that people are without excuse.

²¹ For although they knew God, they neither glorified him as God nor gave thanks to him, but their thinking became futile and their foolish hearts were darkened. ²² Although they claimed to be wise, they became fools ²³ and exchanged the glory of the immortal God for images made to look like a mortal human being and birds and animals and reptiles....

 ²⁵ They exchanged the truth about God for a lie, and worshiped and served created things rather than the Creator—who is forever praised. Amen.

I once again felt pierced to my soul; convinced that the truth of the existence of the Creator, had always been right in front of me….as evidenced by what had been made.  As a biology major, and later a medical doctor, I was intimately familiar with what science had made known to us about the inner workings of the simplest of living structures, the cell.  I had spent many years learning about the organelles, their chemical make-up, their function, their structures, and their interdependence.  Watch the following video representation of cellular function and try to see it as a scientist sees it…the culmination of millions of years of evolutionary pressures brought to bear on non-living, inorganic materials such that through random chance each component evolves, one after the other, with  hundreds of thousands to millions of years between each component, till they all, by random chance assimilate, somehow become living organic materials,  and begin to function.  Is that not an incredible “faith” of a different sort?!

  Or is it easier to believe that there is design, structure, purpose, and intelligence beyond our wildest ability to imagine?  Which takes more “faith”?

 Or look at the night sky and the universe as we know it…is there not also design, structure, beauty, and “speech” testifying to the same Creator?

I had much the same experience while hiking in the Maroon Bells wilderness of Colorado…I recall sitting down to eat lunch, looking around me and saying to myself “No way this is all random chance….” I recalled what I had read…”His eternal power and divine nature has been clearly seen, being understood from what has been made”.

 By the end of my one year of bible study, I could no longer believe that there was NOT a God.  Once I became convinced that God indeed exists, my next dilemma was to decide if Jesus was who He claimed to be, and if so, how could I be sure?  Once again, the answer came to me through scripture, the book of Acts, chapter 9, written by Luke the physician, a travelling companion of the apostle Paul.  In it, Luke describes from first- hand descriptions, Paul’s encounter with the risen Jesus.  Prior to this encounter, Paul might have been me (or I might have been Paul!) …a non-believing skeptic of the highest order… to the point of pursuing, persecuting, and even killing Jesus followers!  The stories of what happens to Paul after this encounter convinced me that something powerful and overwhelmingly convincing had happened to him…something which caused him to completely change course and fearlessly follow and proclaim the Lordship of Jesus as the Christ.  I identify strongly with Paul…I often say that I am another of Paul’s converts, some 2000+ years later.  I believe that he was one of the greatest evangelists of all time…read him and see if you don’t agree.  In some of my previous blog entries I have written about what came next…how I came to feel the tug on my heart towards missions, and how I reluctantly came to respond to that leading.  As I have responded to that perceived call, my faith has been strengthened, and has grown exponentially.  I/we (I believe I speak for Marilyn as well) have been incredibly blessed to be able to join God where He is at work around the world…to “see” with new eyes his “eternal power, divine nature” and His incredible love for mankind.  I do not pretend to have the degree of faith that Paul exhibited.  I still have periods of doubt; spells where I do not feel God’s presence; events which make me question His control, and His purposes.  Nevertheless, I can no longer believe that He does not exist.  I now must trust that He is good; that His purposes and plans are higher than my understanding, and that I simply must strive to be transformed in my thoughts and deeds…to become as much like Christ as possible in the years that remain.  If you have not already done so, I strongly encourage you to study God’s word…the bible.  You may find that it changes your life, as it has mine.

Numbers 6:24-26

²⁴ “‘“The Lord bless you
    and keep you;
²⁵ the Lord make his face shine on you
    and be gracious to you;
²⁶ the Lord turn his face toward you
    and give you peace.”’

Obstetrical Tales - Peris and Daizy

 

Early during our stay at Tenwek this trip, I met Peris. She had been hospitalized two days earlier at 27 weeks gestation. In America, if a 24-week pregnant woman delivers a baby, it has about a 75 % survival rate. In Kenya, a baby must be about 32 weeks into the pregnancy before that kind of optimism exists for the newborn. Peris had had three previous cesarian deliveries. A placenta previa is a condition where the placenta (“after” birth) is in front of the path of the delivery of the infant. In addition, a placenta does not implant normally into the lower uterus as it does higher up in the more muscular part of the womb. Therefore, if a woman has contractions and starts to labor, the placenta previa can start to detach from the uterus thereby cutting off blood flow to the baby and can cause possible catastrophic bleeding for the mother. Peris had already had several bleeding episodes signaling a progressively higher chance of her delivering prematurely. Medication was given thru the mother to try to make the baby’s lungs mature for life outside of the mother. Every day the Obstetric team would pray fervently for the baby to stay healthy IN the womb. However, on day 14 of her stay in the hospital, Peris started to bleed heavily and required an emergency cesarean section. As with ALL surgeries at Tenwek, before surgery starts, prayers were lifted to God for patient safety (in this case TWO patients), wise clinical decision making by the surgeons, and acceptance of His will for them and us. A crying baby girl, Angel Ariana, was born weighing 4 # 5oz. Peris’ intraoperative and post-operative course had a few trials for us, but nothing life threatening. Angel ultimately needed extra medications and ventilator support for her tiny, tired breathing muscles, premature lungs, and risks of infection. This morning when I visited Angel, she was about to have the breathing tube removed. Optimism prevails as prayers continue for them both.

Peris and daughter, Angel Arianna

Not all Tenwek stories end in what we can describe as miracles. However, we don’t know what God’s plans are for these situations that end, by our viewpoint, sadly. Four days after Peris and Angel’s “success”ful trial, I encountered a totally unplanned crisis with Daizy. After a failed attempted delivery at home, and then in an outside clinic, her delivery was ultimately completed at Tenwek with a stillborn baby boy, and a truly life-threatening bleeding event for the mother … controlled only be an emergency hysterectomy. Fortunately, she is alive to continue raising her five other children. Five local missionaries donated blood to help her survive. Randy “just happened” to be in the Labor and Delivery area when this all happened and was able to provide quick intravenous access to administer blood and fluids to Daizy to help her survive. We certainly can never reconcile why these unimaginably painful events occur, but continue to trust that we can bring compassion, hope and faith thru our words, and more importantly, our actions as He leads us to help the patients and each other.

So many people ask us- and probably many more wonder but don’t ask- “WHY do we do these trips”? I don’t have an answer to that question. I can only say, “HOW can I NOT”?  The Kenyan people are so appreciative of any effort we can provide. This morning a patient called me over to thank me for helping take care of her as she and her baby were being discharged. It is my honor and privilege. This year with the COVID-necessitated masks, it is amazing how much love and mutual respect we can share just with our eyes. It has helped me to really be VERY present when dealing with patients and co-workers. It has become a uniquely blessed interaction.

As we pack again to return to Texas, we are excited to re-connect with our families, friends, and San Antonio work and volunteer activities. May we continue to “be present” fully for all with whom we interact. We have felt your prayers, been aware of your concerns for our safety, and are profoundly grateful for you in our lives.

May God continue to guide and lead us thru all our future travels, decision-makings, and daily activities.

 

Marilyn and Randy

Angel Arianna, 4# 5oz.  Welcome to the world!

Daizy's surgery.

The OB/GYN team 8-2021

The Tenwek Compound kids!....one, two, three, "Avacado"!!

Joys and Sorrows - 2021

 

 

Friends,

I am writing to update you on the two patients mentioned in my last posting.  I’ll begin with J.C., the young woman with an extensive right lower extremity soft tissue infection, a large open wound, ongoing sepsis, hypotension, and underlying rheumatic valvular disease.  She was making excellent progress and was even able to go outside and “bask” in the sunshine for a few hours toward the end of last week.  Her blood pressure had been improving and we were able to take her off pressor support (medications supporting her blood pressure).  She was eating and talking, but still appeared weak and had a poor appetite with some distention of her abdomen.  She had no abdominal tenderness, but we were concerned about the possibility of her having some residual pocket of infection in her right groin which might have extended up into her right lower abdominal or pelvic area.  The surgeons were concerned enough that we had planned to evaluate this possibility with a CT scan of the abdomen.  She was in the process of being moved to radiology for this study when she suddenly became hypotensive and suffered a cardiac arrest.  She was successfully resuscitated by an ER doctor from the University of Alabama – Birmingham.  This doctor and her friend (another ER doctor) have also been serving here this past month.  During the resuscitative efforts J.C. suffered some anoxic brain injury.  When she arrived back in the ICU, she began having some seizure-like activity as well as some muscular twitching and contractions which were felt to possibly be tetany.  Many patients in this rural part of Kenya have not had adequate immunizations during childhood, and some are thus susceptible to tetanus following an infected open wound like this.  She was placed back on antibiotics to cover this possibility, as well as the possibility of some ongoing sepsis from an undrained abscess.  She again required high doses of medication to support her blood pressure and required ventilatory support for her breathing.  She made very little progress over the next several days, and her family was informed of her poor prognosis.  Attempts were made to prepare them for the likelihood of her death, and the hospital chaplain was called in to pray with them and comfort them.  During the night last night (Wednesday), she became progressively hypotensive and died early this morning (Thursday).  Unfortunately, this is an all-too-common scenario here at Tenwek.  Many young patients contract very serious illnesses and die under our care.  We do not understand why God allows so much suffering and heartache to occur, but acknowledge that He is sovereign, and good, and just.

 “As the heavens are higher than the earth, so are my ways higher than your ways and my thoughts than your thoughts. Isaiah 55:9 (NIV).

 “The Lord is good, a refuge in times of trouble. He cares for those who trust in him”  Nahum 1:7 (NIV)

We simply trust that He is good and loving and know that He can use all things for good, for those who love Him, and trust in Him.

“And we know that in all things God works for the good of those who love him, who have been called according to his purpose.”  Romans 8:28 (NIV)

 

On the same day that J.C. passed away, V.O. was successfully discharged home with no neurologic deficits!  V.O. was the young man who had come in with an acute thrombus in the venous sinuses of the brain with some associated hemorrhage.  He was seizing and unresponsive at the time of admission.  After being anti-coagulated, he improved rapidly and continued to make steady progress over the remainder of his hospital stay.  He regained speech, as well as use of all extremities; he was able to transfer himself in and out of bed and ambulate without assistance.  He was eating well, swallowing well, and complaining only of a persistent headache.  His headache has been manageable with paracetamol (a Tylenol-like drug) and should continue to steadily improve as his blood clot and the area of hemorrhage resolve.  Our team has prayed over him regularly, and rejoice that he has done so well, and that he will be able to return to his family in good health.  Again, we are mystified as to the workings and purposes of God in these situations.  We simply trust…and rejoice in the successes when they occur.

“Rejoice with those who rejoice; mourn with those who mourn.”     Romans 12:15 (NIV)

Friends, there are many such stories here at Tenwek…too many to relate.  We continue to give thanks that we are able to return here and serve our Kenyan brothers and sisters.  Please keep them (and us) in your prayers.  All praise and glory be to God the father, and to His son, Jesus Christ- our redeemer, lover of our souls, author of all life and the reason that we serve.

 

 

 

Erin Shufflebarger, Emerg. medicine from UofA-Birmingham, with Marilyn

Ashton Kilgore, Emerg. medicine from UofA-Birmingham, with Dave Fraser, Rheumatology from N. Carolina.

 

The Medical Consultant Team 8-2021
Left to Right: Dave Fraser, Esther Dindi, Jim Richards, Randy

The Medical Team 8-2021
Left to right: Carlos, Cosmos, Magara, Eunice, Esther, Charlene, Jim Richards, Randy, Dave Fraser, Ledama, Jeremiah, Shadrack