Posts Tagged With: Kijabe Hospital

” … an erosion of the soul caused by a deterioration of one’s values, dignity, spirit and will.”

After my annual evaluation last night, I went back over some of the things I had been discussing with Ann and our team leader Bethany.  Some of the things I was saying really didn’t sound like me:  tired, purposeless, sometimes hard to remember why I came here in the first place.  I do get fatigued here, as much from the cross-cultural differences as from the work itself.  But why was I sounding so negative?  The cross cultural stress inventory didn’t paint a pretty picture.Screen Shot 2015-05-20 at 10.53.50 PM

I got to thinking about burn out.  In the US, physicians experience real burnout at some point in their careers at close to 100% incidence.  Cross cultural living and working also has a pretty high burn out rate.  Hmm, so if I’m a physician in a cross-cultural setting, any chance at all that I might be experiencing a little burn out?

There’s a website call happymd.com which discusses the topic at length.  If any physicians reading this want to learn more about what to look for, I’d recommend you visit.  I can’t speak for other professions, but as a physician, you either have been, are, or will be burned out at some point in your career.

The website defines burnout as being depleted to the point where you don’t bounce back from normal stresses after a day or weekend away from work.  There’s a double edged sword here when in medical work that is also a ministry:  there is no end to the need, no obvious point at which you should go home, say no to another responsibility, or go on vacation.  Serge, our sending agency, is quite intentional about avoiding burnout.  I guess you have to actually listen and take the leadership’s advice for it to work.  But it kind of feels like you’re letting down yourself, the hospital, your patients, your agency, and of course, God.

A researcher named Maslach investigated physician burnout, and describes its effects in terms of physical, emotional, and spiritual depletion.  Burnout leads to fatigue, depersonalization, cynicism, and lack of efficacy.  It has effects on work, marriage, and relationships with family and friends.  She described its effects as ” … an erosion of the soul caused by a deterioration of one’s values, dignity, spirit and will.”

Maslach created an inventory, or questionnaire, to look for and determine the severity of physician burnout.  Just for a laugh, I though I would take the test.  I kind of wish I hadn’t.Screen Shot 2015-05-20 at 10.55.23 PM

On all scales, of physical, emotional, and spiritual burnout, I fell into the “severe burnout” category.  Not good.  Really, quite a wake up call.  I feel like I’m tired, not at my best, but this really tells me I may not be functioning at a very high level.

Thankfully, there is a lot of good work done on what to do with burnout.  Less time at work isn’t necessarily the answer, but looking at what parts of work are depleting, and what parts are energizing, is vital.  The key is to structure the day, week, month, and year, to find ways to engage with those parts of the work which are invigorating, knowing that other parts of the day will be “soul eroding.”

How to reconcile this workaholic, all-responsible, soul-eroding lifestyle with a life of following Christ?  You really can’t.

The message of the Gospels never promises an easy life, or lack of suffering, when following Christ.  But they do offer hope:

I came so that everyone would have life, and have it in its fullest. “(From the Gospel of John).  Or, from the Gospel of Matthew, ““Come to me, all you who are weary and burdened, and I will give you rest.  Take my yoke upon you and learn from me, for I am gentle and humble in heart, and you will find rest for your souls.  For my yoke is easy and my burden is light.”

I have to admit, right now I’m not feeling I’m having life to the fullest, or finding the yoke easy or the burden light.  I can identify pretty strongly with the weary and burdened part, however.

So my plan is to take some steps to get back to the enthusiasm and energy that brought me here in the first place.  I’m very thankful that taking care of patients has always energized me.  Being part of a team that comes alongside the sick or injured in the healing process, talking with families, working with residents and other trainees, will always remind me of why God put me here on this Earth.

I’m heading off on an outreach trip beginning Sunday, so I will be gone for a week with some Kijabe colleagues.  I’ve been to this hospital before, and find it extremely challenging and energizing.  This small hospital, outside of a small town, in the middle of a large desert, is really striving to provide excellent and compassionate care.  I will have the privilege of doing surgeries with the resident surgeon, as well as teaching a one day seminar on the treatment of orthopaedic surgical emergencies.  I’m excited and grateful to be part of such a trip, and this is definitely part of the work which invigorates and fills the soul.

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Annual Review

Ughh.

Tonight was the night for our annual review.  Both Ann and I had to review our job descriptions, fill out self-assessments, and then complete a “stress survey.”  I accidentally tore the stress survey into a thousand pieces, so I’m pretty sure I didn’t need to take it anyway.

In all seriousness, these are really useful exercises.  Living outside your home country, in a place where the language, culture, and work practices are unfamiliar, is really stressful.  Researchers have found that levels of the stress hormone, cortisol, rise abruptly just by looking at a roadside sign in a foreign language.  Being immersed in a culture not your own creates a constant low level of stress, that needs to be acknowledged and dealt with.

Bethany is our amazing Serge team leader.  I think most people’s first impression of her would be that she is a kind, gentle person, probably suited to counseling or teaching.  Which is exactly what she does!  And she is amazing at it.  We are blessed to have her as our team leader, as she combines great leadership and organizational skills with the compassionate heart of a counselor.

Having a team leader, and being accountable to an organization, might seem a bit odd, but is an integral part of the work here.  Nothing we do is independent:  everything is interdependent, and all of it is dependent on God’s grace and mercy to sustain us.

Our Serge team here fills the role that an extended family might have filled in more traditional societies.  We all fall down, look silly, fail at our appointed assignments.  But we have a group of people who know us at our best and at our worst, and for some reason still love and support us.  Our team is an amazing group of individuals, couples, and families, who we can trust to be there when we just need support and someone to be with.

We meet with our team for dinner every Thursday, and get together on a Friday for a discussion every 6 to 8 weeks.  We look forward to these times, to learning how everyone’s week has gone, what joys and successes, disappointments and frustrations have punctuated the days since we last sat down together.

These dinners have a sacramental quality.  We get together at someone’s house, relax, and break bread together.  It’s fun just to catch up, get up to date on each other’s work, follow up on some concern or problem.  We share a casual dinner, prepared by the host, and then sit down for a time of prayer together.  It really feels like the early church must have felt, and how church could ideally work now.  No big ceremony, just people who love God getting together to be friends and support each other.

So we spent the evening discussing with Bethany our roles here, what has gone well, what has been frustrating, and what changes we could put in place to help things go more smoothly.  It’s encouraging to be part of such a great team.

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Difficult Discussions: Flunking Sainthood Day 24

Busy day in surgery today, as well as seeing consults between cases.  The surgeries went fine, but what was really hanging over the orthopaedic resident and I today was a discussion we needed to have with a patient and his family.  Last week, we worked hard to save the life of the man who had a terrible injury to his pelvis and leg.  You might remember a photograph of a mangled leg accompanied by warnings not to look if you would find it disturbing.

Thankfully, he has stabilized.  He has gone from the intensive care unit, to the intermediate care unit, and today was able to transfer to the regular men’s ward.  His blood pressure has stabilized, and we have been taking him to surgery every two or three days to clean out his wounds, and remove damaged tissue.

The leg is teetering on the edge of being salvageable.  The bones and muscles are so damaged that he has little hope of a well-functioning limb.  Though his hip, knee, and ankle are fine, the areas in between are mostly devoid of functioning muscle, and severely fractured.  We have had discussions with him over the last days, but wanted to have a family care conference today so everyone was on the same page.

His social situation is far more complex than I could have imagined.  He is an orphan.  Both his mother and father have died, but we did not discuss how they died.  His father had three wives, two of whom are still living, so we had the discussion with a dizzying array of uncles, in addition to his brother and older sister.  Decision making authority rests with the patient, as he is lucid and capable of making his own choices.  Kenya has a strongly family-oriented culture, however, so group discussions and consensus building are vital.

The relatives strongly recognize that they may be held accountable by other family members for medical decisions, so they made it clear that they would abide by “whatever the doctors decide.”  This puts a little too much authority in our hands, however, as the final decision needs to be up to the patient.

Thankfully, the family had outstanding English skills, and communication skills in general, and the Kenyan resident I’m working with filled in my language and cultural blind spots.  We had a long and intricate discussion, and each person voiced his perspective and concerns.  I’ve been in discussions like this a number of times, and I’m often struck by the patience, careful listening, and gentle pace of the dialogue.  It is vital for the health care providers to understand the depth and breadth of implications of decisions like this.  In the end, we met privately with the patient, who was markedly comforted by the group consensus.  We discussed his options again, prayed with him, and he expressed his decision.

The plan is to do everything we can to save his leg, regardless of cost, number of surgeries, or length of treatment.  If at any point we feel like the endeavor is hopeless, or is putting his life at risk, we will communicate this with the patient and with the family.

For this man, I think this is the best decision.  If things go well, his leg will work a little better than a prosthesis would.  Moreover, his psychological and social situation would make amputation an unusually devastating blow.  He and his extended family realize that this is a real possibility, but they would all rest easier with this decision knowing that every effort had been made.  Remarkably, one of the uncles present is on a disability awareness council, and repeated the mantra that “disability doesn’t mean no ability.”  He is encouraging his nephew that, regardless if he winds up with an amputation or not, he can continue with a productive life.

I feel privileged, if also saddened, to be part of discussions like this.  Kenya is a country with a high incidence of motor vehicle violence, and few doctors to treat the suffering.  We may or may not succeed in saving this man’s leg, but I am pleased that he knows he is cared for by his family and by the staff here at Kijabe.

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Mountain Bike Safari (Flunking Sainthood Day 9)

One of the great joys of living at Kijabe is living on the Rift Valley Escarpment, a 2,000 foot ridge which drops from the alpine forests above us to the semi-arid plains below.  There are no level surfaces here:  every road, driveway, and forest sits on a steep pitch.  Combined with the heavy foot traffic and herds of cows, sheep, and goats, the area is interlaced with world class ready-made mountain bike trails.  Over the years, different people living here have pieced together routes to nearby villages, as well as faraway towns and lakes, entirely on trails.  We decided to set out today on a mountain bike safari.

There are a handful of bikes and bikers here, and we have two skilled mountain bikers visiting, Thomas and Meghan Higgins.  They live at 6,000 feet in Salt Lake City, and love to mountain bike, so they are looking forward to the challenge.  Both Thomas and I are not on call this weekend, so we decided to put together an adventure.

We’re grateful for the loan of David Shirk’s mountain bike, as he is back in the US at the moment.  Four of us assembled at our house, got tires pumped up, found helmets that fit, and packed enough food and water to get to our destination, a small hostel called Longonot Lodge, about 20 miles away.  This lodge sits on a stunning plateau, surrounded by plains full of zebra, Thompson gazelle, hartebeest, and the occasional giraffe and buffalo, and ostrich.  The lodge was originally built by Ernest Hemingway for his wife, and is now run by a German/Kenyan couple as a guest house.  We had called the day before to book lunch at their outdoor restaurant.

We set out mid-morning, a brief climb followed by a high speed descent on a twisty, muddy road which descends through dense bush to “Old Kijabe Town”.  This is the real Kenyan village, Kijabe Hospital being a later addition about a hundred years ago.  As we reached the village, Michael suffered an early set back, a flat tire.  We spent a good bit of time getting this fixed, as we went through two spare inner tubes which had holes in them, a pump which didn’t work, and finally used the wrong-size tube for his tire.  Any port in a storm.

We continued the journey, climbing up above the village to bypass a deep ravine filled with stinging nettles.  A brief, twisting descent on cow trails brought us to a broad, rolling trail called “old railway bed.”  A non-imaginative name, as this trail represents the remnants of the colonial era Mombasa-Uganda railway, otherwise known as “the Lunatic Express.”  This railways features in movies such as “Out of Africa” and “The Ghost and the Darkness”, and is best known for the two male lions of Tsavo which ate many workers and nearly halted the railways construction.  As we ride, we are journeying over dark history, as the railway represents the worst of colonial ambitions.

We make our way down the fast paced, twisting trails.  Segments of mud, spectacular vistas over the Kenyan planes, deep ravines where we form a human chain to transit bikes and each other to the far side.  Thumping drum beats from local village churches , squealing groups of children, intimidating cacti lining the trail, dodging herds of cattle, goats, and sheep, and finally we arrive in the heat and humidity of the valley floor.

The trail is a major route for herders.

The trail is a major route for herders.

Meghan makes some friends

Meghan makes some friends

Next, we pass across the current railway, underneath a two lane highway, and set out alongside Mt Longonot, a dormant volcano that the Higgins family climbed several days ago.  With Mt Longonot on our left, we wrap around its flank on dirt roads, climb up a thin steep road through a lava flow, and then a blazing descent onto the plain nestled between the heights of Mt. Longonot to the south and the glistening expanse of hippo-laden Lake Naivasha to our north.

We come to a crude gate, manned by no less than three “guards” who are a bit startled by our arrival.  In a halting mix of swahili and English, we struggle to understand each other.  Ann has passed by here an hour earlier with both ours and the Higgins children in the car, so we are eventually ushered onto the property.  This gate marks the boundary of a massive land holding, Kedong Ranch, which itself is part of the bloody history of the Lunatic Express Railway.  We descend further onto the plain, and enter paradise.

We are many miles from the nearest building, the nearest paved road, or any other signs of civilization.  As we pedal across the plain, we are surrounded by herds of hartebeest, Thompson gazelle, and zebra.  The many giraffe and buffalo in this region are nowhere to be seen today, and the ostrich are hiding somewhere as well.  A short climb brings us to the top of the hill, where Ann and the children are already enjoying the peace of Longonot Lodge.

We sit down to a lovely lunch of locally caught tilapia (fish), buttery potatoes, and slivered carrots.  Not bad for the middle of nowhere!  The lodge uses solar water heating, and has a small wind farm for electricity.  Hot coffee washes down the delicious food, and helps energize us after the long and tiring ride.  The fatigue, gentle heat, lazy breeze, and overwhelming vista lull everyone into a state of relaxed contentment.

But the inevitable time for departure arrives, we load the bikes onto the car, and head back to Kijabe.

Bikes loaded up for the trip home.

Bikes loaded up for the trip home.

The trusty rig, ready to take us home.

The trusty rig, ready to take us home.

A quick check shows that the patients for tomorrow include the man who suffered a machete attack with multiple fractures who needs his wound covered with a “flap”, two women with broken legs, one with a broken ankle, and the lady with a broken wrist who was cancelled last week due to high blood pressure.

Weekends like this really allow us to dive into the week ahead with enthusiasm and energy, hopefully giving the best to our patients and staff.  Family time, laughs with friends, and enjoying the amazing creation surrounding us fill our souls and make us all thankful for the work we’ve been called to do.

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What Protestants think about Catholics (Flunking Sainthood: Day 3)

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Please share this post as widely as possible, because it relies on audience participation.  At the end, I want you to “comment” and give me some of your thoughts.  Protestants only please:  Catholics, you’ll have your turn.  Please re-blog, post on FB, share anyway you can.  I’m really interested in the feedback.

Growing up in a devout Roman Catholic family, I think it is unlikely that I draw a breath or have a thought in my head not seasoned by my rich upbringing in the Church.  A family of eight, Irish Catholic, all six children’s names from the mother land (Maureen, Shannon, Michael, Sheila, Kathleen, Colleen), all six children attended Catholic grade school and Catholic universities.  Dad was president of the parish council and church historian, mom with a masters degree in theology and another one in adult spiritual development.

The rhythm of our life was mass, the sacraments, prayer, and study.

It’s been years since I attended mass regularly or participated in the sacraments, but the reasons for this are  pragmatic as well as theological.  As a result of our upbringing, Ann and I have both had the opportunity to feel loved and loving, accepted and accepting, in both Catholic and Protestant settings.

I am not oblivious to the fact that some on each side of this divide have strong feelings about the heathens on the far shore, but I have also had the opportunity to see loving, humble servants in each camp.  My gut feeling is that “God”, whatever we make of him, is having a good chuckle at any party that thinks they have Him completely contained in their particular box.

About six times a year, our team here at Kijabe gets together to have a discussion on a Friday night.  One member leads a discussion on a topic of personal interest.  We’ve talked about Islam, spiritual disciplines, and Biblical justice.  The evenings are social, low-key, fun, and interesting.  This Friday, I’ve volunteered to talk about my upbringing in the Catholic church.

My reasons for this are several.  I have fond memories of spiritual mentors, the comfort of liturgy, and unforgettable direct experiences of the divine.  But perhaps more than this, I’ve come to understand that most Protestants’ understanding of Catholicism comes from their Protestant pastors.  These pastors, in turn, get their understanding of Catholicism from their reformation history classes in seminary or bible school.  These classes, in turn, are taught from the perspective of 16th century Church corruption and scandal.  Missing are the counter-reformation, the Council of Trent, true Catholic theology, Vatican I, Vatican II, and the fact that billions of Catholics over the last two millennia have served Christ humbly in the best way they knew how.  Once the cobwebs of the last 500 years are cleared away, the two camps look very much like earnest, truth-seeking followers of Christ.

Here’s where you come in:

I’m looking for open, honest, uncensored, thoughts, questions, opinions, conclusions, and vitriolic diatribes regarding Protestants’ views of Catholics or Catholicism.  Here’s your chance!  If it’s too nasty or profane, I won’t “approve” it to be read on the blog, but my intent is to find out what people are thinking.

To get you started:

Catholics worship Mary, pray to dead people, the Pope is perfect, and you can party all you want on Friday as long as you go to have your sins forgiven by a priest on Saturday.  The whore of Babylon, the Pope as antichrist….

Many, but not all of these ideas have kernels of truth which give them credence, and are great starting points for discussion of commonalities and differences.

Please respond, engage, participate.  And remember Catholics, you’ll have your turn!

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Flunking Sainthood: Day 1….make that Day 2

I just finished reading “Flunking Sainthood”, by Jana Riess.  It’s a pretty light read, documenting this spiritual tourist’s attempt to reproduce one ancient “spiritual discipline” per month, for a year.  Things don’t go as planned, as she tries to emulate a strict Jewish sabbath, practice Benedictine hospitality, tithe, and sit in contemplative prayer. flunkingsainthood But the sum is greater than its parts, as she finishes the year with some wisdom, and humility at how difficult even simple disciplines can be.  I give it two thumbs up, but I’m into this sort of thing.

Her book got me thinking about a practice I used to embrace.  In grade school, we were taught a simple prayer, traced back to the fourth century mystic “desert fathers” of Egypt.  This prayer is still practiced in Eastern Orthodox Christianity, and has recently regained a toe hold in contemplative Christian practice in the west.  How and why a Redemptorist Catholic priest in Midland, Michigan was teaching this powerful practice to 11 year olds in 1975, I can’t imagine.  But it’s stuck with me:  Breathing in: “Lord Jesus Christ;” Breathing Out: “Son of God;” in again: “Have Mercy On;”, final exhalation: “Me a sinner.”  Lather, Rinse, Repeat.  The desert fathers prayed this ceaselessly throughout the day, and some even prayed it in their sleep.  It was felt that this powerful mantra invoked the name of Jesus in his relationship as King and Son, and then placed the servant humbly in his place in the universe, in need of grace, mercy, and forgiveness.  I dare you to try it:  it’s remarkably powerful, and also a great sleep aid.

The has me considering spiritual disciplines, setting a challenge that will center me on what’s important and making time for something just because it is worth doing.

Here’s my plan: my spiritual discipline will be to write a brief blog, every day, for four weeks. At the end of four weeks, I’m going to be traveling to a country with little internet access, and zero tolerance for Christian bloggers, so that will be that.  And I wrote a blog yesterday, so this counts as day 2.  My spiritual discipline, my rules.

The concept seems a little self-indulgent, like posting on Facebook a picture of what you’ve eaten for lunch that day.  But Jana Riess wrote a whole book about her pursuit of spiritual disciplines, so I feel enabled to write a blog.  I love writing blogs, and kind of feel like it’s a chance to give a glimpse into our life for all of the people who support us emotionally, in prayer, and financially.  But too often, I’m exhausted at the end of the day, and a bowl of popcorn and episode of “Prison Break” take the place of sharing my day.  I can’t promise any profound insights, but I’ll try to just give a fair representation of the day to day here at Kijabe.

So, here we go…

Today is Sunday, and we’re deep into the rainy season.  Our cement-block house has a sheet metal roof, and the only heat is from a log-burning fireplace in the living room.  African rain can feel primordial:  it comes down so hard, so suddenly, so loudly, that it saturates the senses.  We cocoon in front of the fire, secure that our little house has stood for half a century against such tropical torrents.

Duty calls, and I’m up at 8 am to get coffee, french toast, and sausages ready for the troops.  Kenya produces dark, rich coffee beans, the sausages come from Nairobi, and the eggs are laid here in Kijabe. The kids have been on school break for a month, but go back to school tomorrow.  Ann and the kids get ready to go to the chapel up at Rift Valley Academy, but I am on call and have to go in to the hospital.

The northern parts of Kenya, bordering South Sudan, Ethiopia, and Somalia, are very remote and largely outside the rule of law.  Sadly, a wedding party was ambushed by bandits in Marsabit yesterday, on their way to the ceremony.  Multiple members of the wedding party, in traditional garments and face paint, were gunned down.  The survivors were swept up by a missionary pilot in a bush plane, and deposited at our gravel airstrip.  The victims have been undergoing surgery, one after the other, since yesterday afternoon.  Only one of the patients had a fracture, so that waits until this morning.

The surgery goes well, the bone is shattered, but the nerves and blood vessels are okay.

Gunshot wound to the humerus.

Gunshot wound to the humerus.

I just clean out the wounds, apply a splint, and we’ll come back later in the week to put a SIGN nail down the humerus to let it heal.  He should be fine.

Next up, a disaster.  Kenya has one of the deadliest road systems in the world.  14-passenger vans, often dilapidated wrecks, serve as share taxis:  Uber taxis on drugs.  The drivers are often lawless, pulling out into oncoming traffic to pass, forcing drivers to the shoulder of the road or be hit head on.  Eventually, the Pauli exclusion principle prevails, and people are horribly injured.

Kamau was a passenger in such a vehicle, and survived with a relatively simple tibia (leg) fracture, which had protruded through the skin.  He was taken to a rural hospital, where antibiotics were started, and surgery performed to clean out his wounds.  Perfect care, up until this point.  Unfortunately, at the end of the surgery, they tightly sutured his wounds, trapping any residual infection inside.  Over the next week, huge amounts of pus built up, eventually stretching the surrounding skin to the point where it died.

Kamau came to us with fevers, a horrible smell, and whitish green pus dripping through his bandages.  After his spinal anesthetic was placed, we peeled back his splint and dressings.  Seasoned operating room tech’s fought the urge to gag from the stench.  The skin of the leg was dead from knee to ankle.  Pus dripped from his leg, onto the operating room table, and pooled on the floor. We spent the next two hours excising dead skin and muscle, finding yet another pocket of pus, cleaning the infected bones, and applying an external fixator to stabilize the fractures and allow access for wound care.  At the end of the surgery, the wounds looked much cleaner, but he will need several more surgeries to eradicate the infection.

Leg cleaned out, external fixation applied.

Leg cleaned out, external fixation applied.

Once the infection is under control, we can swing muscle flaps to cover the exposed bone, and then skin graft over the muscle flaps.  He’ll probably be in the hospital for a month or so.

As I finished the surgery, the heavens open again.  I walk home grateful for the cool, cleansing shower, the scent of wet grass and mud replacing the terrible stench of infection.  Surgical scrubs go into a bucket filled with bleach and water, and I climb straight into the shower, fearful that I could bring these aggressive drug resistant bacteria into the house. Ann has been hanging out with our new friends the Higgins family, who are here for three months from Utah.  The kids are off playing somewhere, and we start organizing for dinner.  The night gets chilly, we light the fire, and get ready for another week at Kijabe.

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The New Normal

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:

Murit, Jane's adopted baby elephant.

Murit, Jane’s adopted baby elephant.

Michael and Jane with two new friends

Michael and Jane with two new friends

Simba and her litter

Simba and her litter

We have become patients ourselves:

Prayers for Jane with her surgeon and anesthesiologist

Prayers for Jane with her surgeon/dad  and anesthesiologist Dr. Newton

Ann, very stoic as she gets an IV in casualty.

Ann, very stoic as she gets an IV in casualty.

Mike going in for the first of his two surgeries at Kijabe.

Mike going in for the first of his two surgeries at Kijabe.

My friends and I have had multiple bike wrecks:

My friend Andy:

My friend Andy: “I feel cold. Tell my wife I love her” (He had sprained his shoulder)

Adam attracts a crowd after his bike disintegrated beneath him.

Adam attracts a crowd after his bike disintegrated beneath him.

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!

Ahmed, gravely ill, and now walking under his own power!

Ahmed, gravely ill, and now walking under his own power!

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.

Joyce's MRI, showing severe compression of the spinal cord

Joyce’s MRI, showing severe compression of the spinal cord

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.

Joyce lying comfortably with the life-saving traction applied to her head.

Joyce lying comfortably with the life-saving traction applied to her head.

Michael and Jane on their way to visit Joyce.

Michael and Jane on their way to visit Joyce.

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.

Joyce, a little scared, but comfortable, and awaiting her life-changing surgery.

Joyce, a little scared, but comfortable, and awaiting her life-changing surgery.

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.


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