A little less than three years ago, the Mara family drove away from our house in Bend, Oregon, with a mixture of excitement, fear, sadness, and anticipation. Ann and I had lived there our entire married lives, brought our newborn babies in through the front door, and we shared a little fear that we would never feel quite as “at home” again. As I walked to work this morning, however, I realized we now have a new normal. Things which would have seemed bizarre, exotic, or even frightening three years ago now simply add to the richness of life here. Over the last three years, we have experienced close encounters of the best kind:
We have become patients ourselves:
My friends and I have had multiple bike wrecks:
We’ve gotten used to driving three hours round trip for groceries, not being able to understand most conversations around us, and sometimes feeling like a novelty or curiosity. Happily, we also feel embraced by a culture which values time spent face to face, gentle suggestions over confrontation, and family life over consumerism. I’m slowly learning that relationship is more important than achievement, love more important than efficiency, and compassion more important than titles or degrees.
Sadly, the most constant rhythm of life at Kijabe is the incessant flow of very sick and badly injured patients. Some of these patients are too injured, or come to the hospital too late, for us to be able to give them a good outcome. But the thing that amazes me the most about Kijabe Hospital, is how miracles happen on a weekly basis. I’d like to tell you about two recent patients that demonstrate this.
Ahmed broke his leg when he was struck by a passing “piki piki” (motorcycle) in a remote and lawless area of Kenya. With no access to health care, Ahmed’s family did the best they could, taking him to a local bonesetter. He was quite malnourished at the time of injury, and the forced bedrest in his hut led to huge ulcers, bedsores, which covered his back side and injured leg.
When Ahmed was finally brought to Kijabe, he was semi-conscious, with foul smelling pus and bodily fluids contaminating his wounds. He was in marked pain, with his unstable fracture allowing his damaged leg to flop around during the long car ride over bumpy roads.
I must admit, when I first saw Ahmed, I wasn’t sure he would survive, and I even wondered briefly if the most merciful thing would be if he passed away quickly. But of course, that’s not why we’re here. A team of compassionate nurses, pediatricians, pediatric surgeons, plastic surgeon, and orthopaedics took him under their wing. Intensive nursing care helped heal his wounds and improve his nutrition. Hospital chaplains came and poured love and prayers over Ahmed and his family. The paediatric surgeons performed a colostomy to avoid his wounds being soiled by bodily fluids. And our talented plastic surgeon managed finally to close the gaping wounds in his leg and buttocks.
Due to the gross contamination of Ahmed’s wounds, we could not risk operating to fix his fracture. But due to his huge wounds, treating him in traction would worsen his life-threatening bed sores. The solution was unusual, but we placed him in traction after rolling him onto his stomach. For four weeks, he had to lie on his stomach while his femur and wounds slowly improved.
And then, remarkably, he was healed. And several weeks later, he walked into clinic!
I didn’t recognize him. He wasn’t even limping. Instead of the poor, dying, semiconscious, badly infected patient, he was a happy, energetic, funny young man.
Some things can never be the “new normal.” Joyce’s story is one of those situations. Last week, in the midst of our busy orthopaedic clinic, with 90 patients waiting to be seen, one of the clinical officers came over from “casualty” (the emergency department). “Dr. Mara, could I show you an MRI scan” This is a common request, usually patients with back pain who have gotten a scan done in Nairobi and want someone to look at it. I always ask the clinical officer to describe the patients history and physical exam before we go over the scan, to emphasize that careful history taking and examination are really more important than expensive tests.
“This is a 7 year old girl. She was healthy until 10 months ago, when her legs became clumsy. Then she became paralyzed. She hasn’t been able to walk for five months. Now she can’t move her arms or legs. And since this morning, she’s having trouble breathing.” A quick glance at the MRI scan in the CO’s hand showed an extremely rare condition which is fatal if not treated. Due to a birth defect in her upper spine, her head was not properly attached to her neck.
This creates instability which had progressed to the point where her spinal cord was severely compressed at the base of her skull, at the junction between her spinal cord and her brain stem. We ran over to casualty.
Over the last months, the spinal cord damage had progressed to paralyze her legs, then her arms, and finally, that morning, was beginning to paralyze the muscles which allowed her to breathe. She was within hours of dying from respiratory arrest. We put her on oxygen, and I ran back to clinic to get Dr. Muchiri, our spine specialist.
We left 90 patients waiting in clinic, to quickly put Joyce in traction.
This is a medieval-looking but painless procedure, done under local anesthetic, which pulls the skull away from the damaged spinal cord and allows healing to begin. Within minutes, her breathing improved, and she required less oxygen. Dr. Muchiri and I were breathing a little easier too.
I came home from work that night and shared Joyce’s story with Michael and Jane. Without hesitation, they adopted her, and decided they needed me to take them to the hospital that night. Michael went and got a favorite blanket he’s had since he was an infant, and Jane collected a stuffed bunny, an embroidered pillow, a story book, and another blanket. We went to the children’s ward, prayed for Joyce and her mother, and delivered the gifts.
This past Monday, Dr. Muchiri and our neurosurgeon combined their considerable skills to decompress and stabilize Joyce’s spine. This involved removing some of the bone from the upper spine, and base of the skull, and then using metal plates and screws to fix her skull solidly to her neck.
Joyce is now able to move her arms and legs! She has a long way to go, but there is every chance she will be able to walk and use her arms normally again. Children have such amazing powers of healing, and the care she got at Kijabe Hospital has given her the best chance possible for a full life.
Our new normal involves some challenges, but also allows us to witness miracles like Ahmed and Joyce on a regular basis. As a family, we feel incredibly fortunate to be part of showing God’s love to the thousands of people who come to Kijabe.