Monthly Archives: March 2015

Catching up!

By Ann:

I can hardly believe that we are almost entering the month of April!  The short rains, which should have arrived in February, have still not made an appearance and the earth is arid and dusty.  Cows and other livestock are emaciated looking as there is no green grass to graze upon.  The farmers shrug their shoulders and lift their hands in the air, baffled by the once predictable climate patterns.  Dust storms abound, looking like tornadoes from a distance.  And still the parched ground waits for life and vitality to be restored once again.

Despite the crazy weather for this time of the year, life continues to be busy around Kijabe.  I recently transitioned out of my role as consultant with the Resource Mobilization Department.  I felt as if I had taken the department as far as I could, and there are others who have arrived in Kijabe, and who are coming, that have a lot more diversified skills to pour into the role.  And so, like the parched ground, I wait to see what God would have me do here next.  In the meantime, I am preparing a grant application to USAID/ASHA, for the third consecutive year!  It involves a colossal amount of work as USAID change the parameters and specific format each and every year. This year, as in years past, Kijabe Hospital (KH) is applying for money to build additional housing for medical trainees.  KH is one of the leading medical training centers in Africa. It has 35 full-time specialty consultants, all of whom are passionate about training the future Christian healthcare leaders of medicine in East Africa and beyond.  In 2013, KH was selected as the 25th case study in Harvard Medical School’s Global Health Delivery series. Trainees in the past have not only included Kenyans but also individuals from Cameroon, Senegal, South Sudan, Madagascar, Tanzania, Botswana, and Uganda.  The various licensed training programs offered at KH have grown exponentially in recent years and new programs are being added every year. However, KH’s ability to expand these training programs is severely hampered by the lack of available housing for medical trainees.  It is quite phenomenal what this small rural hospital has accomplished over the last few decades with extremely limited resources and little or no external funding.  The only explanation is that God’s hand is all over this ministry, creating miracles on a daily basis, enabling this place to do much with so very little.  Would you please join me in praying for the success of this grant application, which would result in US$500,000 to build a hostel type building with 30 single bedrooms, shared bathrooms, kitchens and lounge areas?

Some of the highlights in our lives over the past few months have involved animals!  Anyone who knows me, even vaguely, is probably aware of my adoration of giraffes. There is no other animal on the planet as paradoxically graceful yet gangly (have you ever seen these beasts run?), serene yet feisty (using their necks as batting weapons on very rare occasions)…and their eyes!  They have deepest brown eyes and the longest eyelashes you are likely to ever see.  Pure, unadulterated beauty and strength!  So, as a surprise for my birthday this past January (oh yeah, and Mike’s birthday too), our friends, the Zirschky’s (who come to Kijabe every year to serve at the hospital) presented us (kids and all) with a night at Giraffe Manor, in Nairobi!  The.  Best.  Gift.  Ever!  I cannot tell you how fantastic this experience was.  We arrived at the manor in time for lunch on Saturday afternoon, which is a little over an hour’s drive from our house.  From the moment you step across the threshold of the manor, everything you see if giraffe-themed, from the paintings on the walls, to the water jugs, to the candle holders, to the crockery.  I was in heaven!  After an amazing lunch of gourmet food, we took in the grounds.  By 5pm, completely on schedule, the giraffes started to amble up towards the manor house.  On every window sill (including the bedrooms), ledge and table, there are small pots of molasses-covered, dried grass pellets – the equivalent of dog treats for giraffes.  They approach you, in all their majesty, looking for treats and love and kisses.  I obliged them in all of these ways!  They come back in the morning, eager to share breakfast with the guests, and stick their long necks in through the slated windows waiting to be fed some molasses treats.  I could go on and on, but these photos can tell a thousand words of love instead… DSC_0047DSC_0057 copyDSC_0051DSC_0178DSC_0176DSC_0194DSC_0086 copyDSC_0069 Shortly thereafter, upon arrival home from being away with my parents who had come to visit us for three weeks, Jane made a startling discovery!  To our complete horror and confusion, Jane had noticed that one of her beloved bunnies had made a nest.  “Simba” had gathered together some dry grass and plucked white fur from her breast to make a snug and warm environment for her new babies.  I was convinced she was having a phantom pregnancy and explained to Jane that new baby bunnies were highly unlikely.  Simba and Carrot (who we suspected was a male) had had a 30-second chance encounter one solitary day, and from what I witnessed, Carrot was a little confused with the direction in which he was aiming.  I was quietly confident that Simba was just imagining the “pregnancy”, and the fact that she was still acting hyper and not looking large, made me prepare Jane for the inevitable disappointment.  Jane went to bed that night and prayed earnestly that God would send some baby bunnies – she wanted to raise baby bunnies so badly!  The next morning, after the sun had barely risen, Jane ran out to the cage and gently stretched her hand into the nest.  What happened next was nothing short of bedlam!  She had felt multiple warm, naked, babies!!!  9, 12 , 15, she couldn’t be sure!  God has answered her prayers!  But alas, not mine.  We now have 10 rabbits, 7 of whom are adorable, white and fluffy babies.  Jane is adamant on keeping the runt of the pack, who she would move to the front of the nest every morning so that she would get milk from her mother without being bullied by her siblings.  She’s still small, but cute, and has been aptly named, Runt.  As for the other 6?  Please, someone, take them off our hands before they approach the copulation age of 6 short months! IMG_9037IMG_9056IMG_9083 (1)IMG_9237 (1) IMG_9241 IMG_9248 IMG_9269 IMG_9279 IMG_9298 The kids are off school for the entire month of April (in between terms) and we are headed to the Kenyan coast for our Serge Regional Retreat.  Serge teams from Kenya, South Sudan, Burundi, and Uganda, will join together for a time of reflection, fellowship, encouragement, and of course, sundowners!  We cannot wait! Thanks for keeping up with our news and for your continued support, emails, cards and love!  We wouldn’t be here without you.  And, please pray for the success of the ASHA grant, which would be a huge blessing to the hospital.

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Happy St. Patrick’s Day!

As missionaries, we have to celebrate in a special way one of the most amazing missionaries of all time.  Only two hundred years after the Gospels were written, this Scottish slave converted a nation from druidic paganism to Christianity.  “St. Patrick’s Breastplate” is a fourth century Christian prayer, which pulls from the ancient Celtic spirituality of Ireland.  An incantation as much as a prayer, it is said to convey God’s protection on those who pray it:

 

I arise today
Through a mighty strength, the invocation of the Trinity,
Through belief in the Threeness,
Through confession of the Oneness
of the Creator of creation.

I arise today
Through the strength of Christ’s birth with His baptism,
Through the strength of His crucifixion with His burial,
Through the strength of His resurrection with His ascension,
Through the strength of His descent for the judgment of doom.

I arise today
Through the strength of the love of cherubim,
In the obedience of angels,
In the service of archangels,
In the hope of resurrection to meet with reward,
In the prayers of patriarchs,
In the predictions of prophets,
In the preaching of apostles,
In the faith of confessors,
In the innocence of holy virgins,
In the deeds of righteous men.

I arise today, through
The strength of heaven,
The light of the sun,
The radiance of the moon,
The splendor of fire,
The speed of lightning,
The swiftness of wind,
The depth of the sea,
The stability of the earth,
The firmness of rock.

I arise today, through
God’s strength to pilot me,
God’s might to uphold me,
God’s wisdom to guide me,
God’s eye to look before me,
God’s ear to hear me,
God’s word to speak for me,
God’s hand to guard me,
God’s shield to protect me,
God’s host to save me
From snares of devils,
From temptation of vices,
From everyone who shall wish me ill,
afar and near.

I summon today
All these powers between me and those evils,
Against every cruel and merciless power
that may oppose my body and soul,
Against incantations of false prophets,
Against black laws of pagandom,
Against false laws of heretics,
Against craft of idolatry,
Against spells of witches and smiths and wizards,
Against every knowledge that corrupts man’s body and soul;
Christ to shield me today
Against poison, against burning,
Against drowning, against wounding,
So that there may come to me an abundance of reward.

Christ with me,
Christ before me,
Christ behind me,
Christ in me,
Christ beneath me,
Christ above me,
Christ on my right,
Christ on my left,
Christ when I lie down,
Christ when I sit down,
Christ when I arise,
Christ in the heart of every man who thinks of me,
Christ in the mouth of everyone who speaks of me,
Christ in every eye that sees me,
Christ in every ear that hears me.

I arise today
Through a mighty strength, the invocation of the Trinity,
Through belief in the Threeness,
Through confession of the Oneness
of the Creator of creation.

 

May this be a blessed Patrick’s Day for you!

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Managing Surgical Emergencies

One of the greatest blessings of living and working in Kenya is getting to be a teacher of surgery.  My work at Kijabe Hospital involves working daily with trainees.  Some are senior level orthopaedic surgery trainees, honing their skills before embarking on their new career.  Some are clinical officers, like a physician’s assistant, who don’t do major surgeries but will be on the front lines of diagnosing and providing crucial early treatment to the injured.  Almost every patient we see, and every surgery we do, involves teaching young Kenyan professionals.  In a country and a continent with a heart- breaking shortage of trained medical personnel, it is incredibly exciting to watch young trainees grow into confident, and competent, professionals.

Much of the teaching we do here falls under the auspices of the College of Surgeons of Eastern, Central, and Southern Africa (COSECSA).  Through COSECSA, I have the privilege of working with and training young surgeons from Burundi, Ethiopia, Kenya, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia and Zimbabwe.  South Sudan and Somalia have also applied for membership in the college.  This is a college without walls, a huge group of surgeons from Africa, Europe, the UK, US, and Australia, who come together to teach the next generation of African surgeons.  Thought leaders in surgical education from around the globe strive to provide advanced training and assessment.  The testing and assessment process is in some ways more thorough than the board examinations I went through in the US.

Amazingly, much of the funding and intellectual firepower behind COSECSA has come from the Royal College of Surgeons in Ireland (RCSI).  Visiting faculty from both Ireland and the UK come regularly to conduct courses and administer examinations.  In accordance with ideal development practices, the European influence lessens each year while the African surgeons take authority over this African college.

Beginning last year,  I’ve been privileged to participate in a course called “Managing Surgical Emergencies” (MSE).   This is a week long course, aimed at teaching a core set of surgeries that can save life and limb using low technology and limited resources.  The course is intricate, and extremely fast paced.  The orthopaedic surgery module was designed by my great friend Dr. Yogesh Nathdwaralawa, an orthopaedic surgeon from Wales.  The longest lecture is 12 minutes, followed immediately by hands on application of the surgeries taught.  A very large pig is euthanized so junior surgeons can learn how to drain blood from a bleeding brain, save the life of a baby and a mother with a rapid C-section, stop bleeding in an abdomen traumatized by a car wreck, recognize life threatening infections and fractures, and other vital procedures.

The course is set in a remarkable surgical skills laboratory located on the University of Nairobi campus.  Professors from England, Wales, Scotland, the US, and Kenya teach the different modules.  To date, most of the funding and teachers have been from the UK, but with the class we held last week, this ends, and the African staff take over completely.  This is an historic and exciting moment in African surgical training.

One of the most remarkable things about this course is its practicality.  The students return to their hospitals and immediately start performing these life and limb saving procedures on a daily basis.  I feel if only one surgical course could be taught to medical students and interns in Africa, it should be this one.

In the few days since we finished the last course, I have had two patients who demonstrate the vital nature of the MSE course.  The first is tragic, the second encouraging.

Victor is 10 years old, the same age as my son Michael.  He has been an orphan since a very young age.  About four years ago, he developed swelling and then pus coming from his ankles.  One of the things we teach in the MSE course is how to recognize and treat osteomyelitis, a common, dangerous, and crippling bone infection.  Osteomyelitis strikes the most vulnerable:  the very young and old, the malnourished, those with AIDS.  Likely because of malnutrition and sickle cell disease, Victor had osteomyelitis in both feet and ankles.  The bones of his foot were destroyed by infection, to the point where his tibia, or leg bone, was protruding through the skin.  He is a social outcast, unable to go to school, due to the smelly pus and disturbing appearance of his ankles.  Xrays showed complete destruction of the bones of the foot.  Despite multiple consultations looking for a better answer, the only way for him to survive, go to school, and one day work and have a family, is to amputate both legs below the knee.  With prosthetic legs, paid for by our vulnerable patient fund, he will be able to walk, run, go to school, and rejoin society.  We met with him, prayed with him, and performed the surgeries this past Monday.  Within several weeks, we’ll begin the process of getting him new prosthetic legs.  The silver lining of this awful tale, is that he has discovered his faith while in Kijabe Hospital.  He is reading a Bible, and wants to commit his life to following God’s will for his life.  This has given him a purpose and hope as he faces life with prosthetic legs.  Amazing how God can work through even the most miserable of circumstances.

This could have all been prevented with some simple training in recognition and treatment of osteomyelitis in children.

Our second patient yesterday could be diagnosed from the hallway.  A 45 year old man had been hit by a motorcycle on Sunday, suffering a moderately severe wrist fracture.  A local hospital had put on a full tight cast, something we teach never to do in the MSE course.  Overnight, the swelling had progressed to the point of cutting off the circulation to the arm, a condition called compartment syndrome.  The excruciating pain and numbness brought him to our casualty department (ER).  The astute clinical officers rapidly removed the offending cast, but the cascade of events had progressed too far.  As the arm lost circulation, the pain became intractable, and we could hear the poor man screaming from the hallways by the operating room.

Thankfully, the well trained clinical officers recognized the urgency of the situation, contacted the orthopaedic team, and we rushed to casualty.  Cases were cancelled, we pushed the trolley rapidly through the halls to Operating Theatre 1.  One of our recent junior trainees from the MSE course was by my side, and I asked him to do the surgery he had just learned.  He completed the job beautifully with little guidance, saving the man’s arm.  Though he will have some scarring, he can plan on having normal function once he heals.  I was so proud of our junior clinical officers and doctors, rapidly recognizing and treating this surgical emergency.

These types of disasters and near disasters are a daily occurrence in most of Africa.  So much more work needs to be done, but we can already start to see the benefit of basic surgical training.  If we could take the MSE course to every corner of this continent, many many thousands of lives would be saved, and even more people saved from a life of crippling pain or disability.   It is a great privilege to be part of this process, and we thank God every day for bringing us here.

 

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