Monthly Archives: March 2014

Hope

As we’re closing in on the end of the second year since we left Bend, some things are starting to seem normal which probably shouldn’t.  While many Kenyans in and around Nairobi or other large cities lead lives similar to people in the US or Europe, far more live in rural areas with little access to health care.  As a result, we see things at Kijabe that are unimaginable in the western world.  And sometimes I forget what a shining star, what a ray of hope, Kijabe represents.  There are times when I feel overwhelmed by the need, and feel hopeless myself.  But what always brings me back to enthusiasm are meeting patients whose lives are changed by this little hospital.

Yesterday, we operated on one patient, all day.  The main road to Kijabe is called the Nairobi-Nakuru highway.  It was recently listed by a British firm as one of the 22 deadliest stretches of road in the world. 

Poor road conditions, insane passing maneuvers, huge trucks, overcrowded buses,  motorcycles, pedestrians, goats, cattle, donkeys, and the occasional baboon all combine for an experience that would be comical if it weren’t so deadly.

There’s a surprisingly sharp turn on this highway, near the city of Nakuru, about 80 miles north of here.  About two years ago, a large fuel tanker lost its breaks, slammed into oncoming traffic, killing many.  The truck then began leaking fuel.  As local villagers rushed to gather the valuable fuel, it burst into flame, incinerating many more.  Unbelievably, this just happened again.  This time the truck exploded immediately, so no crowd had gathered, so I guess that’s a horrible silver lining.  Fewer people were burned this time.  The local hospitals were quickly overwhelmed, both by the number and seriousness of the injuries, so Kijabe received some of the most severely injured.

The first patient we treated was a 46 year old woman, Jane, who’s legs were severely crushed.  She was awake and alert, but in incredible pain.  Examination of her legs showed they were both dead, and her crashing vital signs showed that the acid and potassium leaking into her body from the dead legs was quickly causing her heart and other organs to fail.  As she was on a ventilator, with a breathing tube, she couldn’t give informed consent for surgery.  I phoned her brother on his mobile, letting him know the gravity of the situation.   We rushed her to surgery for emergency amputation of both legs, but to no avail.  She succumbed to her overwhelming injuries a few hours later in our humble intensive care unit.

Another victim, Jacob, had injuries which seemed incompatible with life.  He had shattered all four of his limbs, including both femurs (thigh bones).

Both Femurs Fractured

Both Femurs Fractured

His forearm bones on the right were sticking out through the skin.  His left wrist was broken.  His right ankle was dislocated and crushed, and most of the bones in both feet were crushed.  He had second degree burns from the mid-shin down to the toes.  His rib cage had been crushed, with fractured ribs on both sides and a chest xray that showed his lungs were bruised and filling with fluid.

left femur fracture

left femur fracture

open forearm fracture

open forearm fracture

skull, wrist, and foot xrays

skull, wrist, and foot xrays

Burned and Broken Ankle

Burned and Broken Ankle

crushed and burned ankle

crushed and burned ankle

right femur fracture

right femur fracture

Keeping Jacob alive would be a challenge at the best university hospital in the US or Europe.  And this is where Kijabe is beyond belief.  Using patched together instruments, donated ventilators and surgical equipment, patients like Jacob are routinely given state of the art trauma care.  We were allowed a brief surgery to stabilize the most urgent problems, and the patient was then whisked to the ICU to support his breathing, blood pressure, receive transfusions, and pain control.  Several days later, we were given the go-ahead to complete his trauma surgery.  He entered the operating room at 8 am as a shattered person, and was wheeled out at five pm, ready to get out of bed.

Everything fixed, ready to get up out of bed!

Everything fixed, ready to get up out of bed!

The amount of teamwork this requires is beyond description.  I’ve seen shows on TV where surgical teams rehearse complicated surgeries ahead of time.  None of that happens here.  When the situation calls for it, everyone just shows up, does her or his job without fanfare, and gives the patient hope for a decent life.

Amazing Anesthesia Team

Amazing Anesthesia Team

Today in clinic, one of the clinical officers from the outpatient department came in with an xray, to ask us about a child she was seeing.  Eight year old Samuel and his mother had been sent to Kijabe to have his leg amputated.  He’d been seen at a large national hospital a few months ago with leg pain, and sent away with pain killers.  A few weeks later, the main bone between the knee and ankle protruded out of his skin.  He’d been living like this for several months, before being seen at another hospital, which referred him to Kijabe for amputation.

I reviewed the xray with a junior orthopaedic resident,

Protruding bone due to osteomyelitis

Protruding bone due to osteomyelitis

who I asked to describe the findings and make the diagnosis from the xray.  He did well, answering correctly that this was chronic osteomyelitis, a deep infection of the bone frequently seen in malnourished children.  As the infection worsens, parts of the bone die, and then migrate out of the skin until they fall out.

I was grinning from ear to ear, both because the resident was doing well, and because I knew that Samuel did not need an amputation.  We rushed over to the outpatient department to meet Samuel and his mother.  As we entered the room, we were greeted by the familiar stench of infected, dead tissue.

I carefully explained to Samuel and his mother that, though he would not need an amputation, he had a long road ahead of him.  With good nutrition, several surgeries,  and months of antibiotics, this can almost always be cured or brought under excellent control.  Children who have been ostracized and unable to attend school can have a decent life, can have hope.

I then asked the resident to perform a “sequestrectomy”, or remove the dead bone.  This is usually a large surgery, done under general anesthetic.  However, with Samuel’s bone sticking out through the skin, there was no reason not to remove this part of it immediately.  As the tissue is dead, there is no sensation.  With some hesitation, the resident put on gloves, and tentatively gave the exposed bone a pull and a twist.

protruding dead bone

protruding dead bone

Dr. Nyambati's first sequestrectomy!

Dr. Nyambati’s first sequestrectomy!

Bone Removed

Bone Removed

To his, and Samuel’s amazement, the dead bone eased out of the infected leg.  It took a bit of convincing, but Samuel eventually understood that he was going to keep his leg!

Samuel after "sequestrectomy"

Samuel after “sequestrectomy”

Hope.

For Jane and her family, we failed.  But they know, and they told us, that we did everything we could for her.  In Kenya, that means a lot.  They know we really cared about her, talked to her before surgery, suffered a little with her.  They are grateful for what we did, even though we feel we failed.  I guess that gives me hope.  For Jacob and Samuel, conditions which would frequently be crippling or fatal can be treated.   They can both have hope for a good life.  And all of these people come to Kijabe because this rather small, nondescript building on the side of a muddy escarpment means hope.  Probably the hardest part of living and working here, both for Ann and myself, is swinging between despair at the overwhelming suffering, and gratefulness to be a part of something so amazing.  As always, thank you for being here with us, supporting us and praying for us.

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Camping at Hell’s Gate

Despite the name, Hell’s Gate National Park is one of the most beautiful places on earth.  It is home to scores of animals including zebra, giraffe, cape buffalo, antelope, and warthogs.  It’s about an hour’s drive from Kijabe and this past weekend, we decided we needed to “get out” and have an adventure.  Mike is an avid camper (Remember?  Chalk and Cheese!!), me…not so much, BUT, I am learning to like it because the kids think it’s the best thing to do with your free time!

So, last Friday, we picked the kids up from school at 3pm and hit the road, loaded to the hilt with pre-made meals, tent, sleeping bags, pillows (because we can!), drinking water, bikes and a gazillion other items that are needed for such a trip.  It’s good to get away from Kijabe from time to time…to gain perspective, to take a deep breath, and to remind ourselves that we live in one of the most stunning places the world has to offer.

On our drive there, besides seeing about a dozen near accidents, 4 lanes of traffic driving in the same direction on a two-lane road, some animals came out to greet us by the roadside.

giraffe

road thereHell’s Gate is the perfect place to camp.  It is full of wildlife, but there are no predators.   If you have ever watched Tomb Raider, this is where it was filmed.  After we paid in at the entrance of the park, Michael and Jane counted over 100 zebra within the first 3 minutes!  We drove to the designated campsite high on a ridge, overlooking the canyon and proceeded to set up camp where we were the only campers.  The “boys” put up the tent while I started dinner.

tent setting upThat evening, as we roasted marshmallows over the fire, we could hear the calls of the hyenas in the canyon below us.  It’s hard to describe just how beautiful the sky looks at night here.  Sitting in the pitch black with only the light from the quarter moon, the blanket of stars that stretch like a canopy across the sky are simply amazing.  You can actually make out the curvature of the earth by how the stars appear like a domed roof. Every so often, we would hear a rustle, shine our torches, and were able to make out pairs of eyes surveying us from a distance.  Most likely Mongoose.  As the sounds of the hyenas yelping came closer, we took ourselves into the “safety” of our tent!  The last time we camped there, Mike brought a Panga with him (a large sword-like knife used here for cutting grass and branches) and slept with it under the bed.  When his Kenyan colleagues heard about what safety precaution he had adopted, they fell on the floor laughing!  They said that the hyena would simply catch the blade in its jaws and proceed to attack anyway!  Not exactly what you want to hear when you’re wanting a relaxing get-away!

CampfireThe next morning, we woke up to the stillness and beauty of the park.  It feels like you’re all alone, sitting at the ends of the earth.  Mike and the kids got ready for a long bike ride, while I gratefully grabbed the book I was reading and settled in for a couple of hours of bliss!

morning view

zebraThe kids had a ball, tearing around on their bikes, seeing a ton of animals, and making bike jumps out of the dirt!  Mike and I on the other hand, quite honestly, were exhausted!!  The packing up, setting up, restless sleep, driving home, unpacking,  and the cleaning!  And then it was Monday!  On the way back to Kijabe, we stopped off at a petrol station for some Indian food and a load of fresh fruit and vegetables from a shop that supplies Del Monte….papayas, mangoes, pineapples, avocados, mushrooms, berries, spinach…two wicker baskets full to the brim, for about $20.  Enough goodness to make green smoothies for at least three weeks…in the comfort of our home…with running water…a kitchen…a bathroom…  I don’t claim to be a camper yet 😉

Bike jumps no spitting

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