I’ve started working at Kijabe Hospital, and it’s obvious to me that all the effort to get here has been worth it. The hospital is running even better than when I visited in 2011, thanks to the hard work of a group of engineers from Engineering Missionaries International. We’ve gotten to know two of them pretty well, Jim and Julie Taubitz. I’ve never been so appreciative of the efforts behind the scenes. Sitting here in a little village on the side of an escarpment in the middle of nowhere in Africa, it’s obvious that the line between an efficiently run hospital and complete chaos is pretty thin. Things I’ve always taken for granted are tenuous here: an adequate and clean water supply, stable electrical grid with generator backup, waste disposal, buildings that don’t fall down, sanitary conditions.
My work schedule right now includes two days per week in the hospital and three days per week in kiswahili school. Edward Amalo is an amazingly patient, kind teacher with a gift for teaching swahili to wazungu (“Europeans”). Learning a new language at age 48 is much harder than learning orthopedic surgery, and I feel like there’s smoke coming out of my ears by the end of a lesson. I get frustrated and confused, but Edward just reassures me “polepole”, or “go slowly.” I was feeling pretty down about my progress, but got a big boost this weekend. I went out for a mountain bike ride, and quickly got really lost. When you leave the village, you’re immediately in dense jungle, on the steep face of the escarpment. I tried to get back to Kijabe by line of sight, but wound up completely disoriented and in a farmers’ front yard. I was delighted to be able to be able to ask some basic questions, and even more excited when he asked me questions that I’d learned in class! It felt like progress, and I made it home in time for dinner.
The work at the hospital couldn’t be more rewarding. The orthopaedic surgery staff is amazing, tirelessly dedicated to serving the needy and vulnerable. I’m the only non-Kenyan in the ortho department, and they’ve been very gracious as I try to learn both Kiswahili and the nuances of orthopaedic surgery on the equator. Except for tuberculosis, most of the patient presentations here are not subtle. Due to the lack of available health care, patients tend to present late in the disease process, or with severe and untreated injuries.
One of the first patients I saw in clinic was a strapping, athletic appearing 19 year old man. As he walked in to the exam room, he looked perfectly normal, except that he was three feet tall. He was walking on his knees, and his legs were simply missing from just below the knee. He had tennis shoes on his stumps facing backwards, which allowed him to walk around on his knee caps. As I obtained the history from him, he relayed that both of his legs had been amputated when he was 7 months old, as the doctor thought he had cancer in both legs. While this is not possible, I also noticed that he was missing some fingers from one hand. Putting this together, it’s likely that he had meningococcemia, an often fatal infection which frequently leads to multiple amputations. I think the doctor likely made a very rapid and accurate diagnosis 19 years ago and made the difficult but life-saving decision to amputate this baby’s legs and fingers.
This young man has grown up in a culture which often looks upon disability as a curse for wrong-doing of the disabled person or his parents. There are no accessible toilets, public facilities, or any laws I’m aware of protecting the disabled. Instead of being crushed by his burden, this young man has made a great life for himself. He has trained as an airplane mechanic, and leads a good life. He came to Kijabe because he’s never been able to afford prosthetic legs. On testing the muscles to his stumps, he has tremendous strength and control, and there’s every chance he will be walking tall with prosthetic legs in the near future. I’m excited to follow him along as he is fit with his prosthetic limbs and begins the rehabilitation process to use them.
The orthopaedic clinic here has been described as “back breaking.” The waiting room has to be seen to be believed. This past week, the team saw 125 complicated patients, from all over Kenya and as far away as the Horn of Africa and Democratic Republic of the Congo. Each patient is accompanied by family members, so literally hundreds of people mill about vying for a spot in the queue. For many of these patients, this clinic visit is the one shot they have at a normal or improved life. They simply have no other access to orthopaedic care. While sitting in my exam room seeing patient after patient, it’s important to remember that for this patient, the next 20 minutes may mean the difference between a productive and pain-free life, or one of disability, shame, and poverty.
We saw one child who had a real near-miss. About a week earlier, he’d developed a severely swollen painful knee. He’d been seen at a local clinic, where a knee xray was done and correctly read as normal. He was sent away with reassurance, but became worse. When his father brought him to the ortho clinic here, he had a severely infected joint, and probably early bone infection, or osteomyelitis. If not treated emergently, this can lead to crippling joint destruction and chronic draining bone infection. The ortho team whisked him away immediately for surgery, and there’s every chance he can lead a normal life.
The compassion, care, and attention to detail shown to the patients by the Kenyan staff inspires me to try and be a better doctor. This is healthcare the way we imagine it, the way it should be, perhaps the way it once was. Though finances are always tight for the hospital and the staff, financial considerations fly out the window when a sick and poverty stricken patient needs help. Doctors and staff contribute to the “Needy patient fund” to help defray expenses, and the hospital bill is figured out after the patient is getting well, not as a determinant of care.
On the home front, we’re settling in to our house and life in Kijabe. Only three weeks here, and we’ve already seen five different friends from Bend! Heidi and Fiona Wright came over with Bosco and came out to Kijabe for a visit. Ken Wytsma had a stopover in Nairobi after a trip to Ethiopia, and we were able to join him for lunch. Chris and Madelle Friess have been in Kijabe for a couple of weeks now, and we’ve gotten to go on some great adventures with them. This past weekend, we drove about an hour to Crescent Island, the site where “Out of Africa” was filmed. Really a peninsula into Lake Naivasha, Crescent Island has one of the highest densities of game in Africa. It’s wild to just park your car, go for a walk, and be surrounded by wildebeest, zebra, giraffe, gazelles, and a few buffalo and hippos. No lions or elephants, so it’s safe to hike around, and the guides tell you how to stay away from the hippos and buffalo. We had a great hike, Chris and Madelle identified dozens of bird species, and some giraffes wandered by as we finished our lunch. Perfect day.
We also got to visit Nairobi National Park with the Friess’, and ran into some pretty scary animals there.
We seem to be settling in, and this is really starting to feel like home. The kids are thriving in their new school, and they’re both delighted that homework doesn’t start here until 4th grade! Our team leaders, Scott and Jennifer Myhre, have really helped our transition with advice, reassurance, and home cooked meals. The whole community really reaches out to newcomers, and we feel very welcomed. Please stay tuned for further updates!