A matter of perspective

Well…another week has passed and we have now officially crossed the one month mark of our time at Tenwek.  It seems like we just arrived, yet it seems like we have been here for so long.  Just tonight we were discussing how it seems like Allentown was a lifetime away…weird how time passes.  We have really began settling in to our new roles here.  Steph and the kids have their routine worked out pretty well.  Homeschooling is in full swing and we have mostly adapted to the extra work required for daily activities.  I’d like to say that I have everything figured out at work but every day I find myself searching through textbooks and programs on my phone trying to make diagnoses.  Many times I find that I am treating based on an educated guess and praying that we are doing the right thing.  It is somewhat comforting to know that the consultants that have been here for years often do the same.  I have at least started to figure out the system here and I definitely enjoy working with our COs, interns, and residents.  I’m still trying to find time to learn the language(s).  I think I need to purchase something to use on the computer (wanted to get Rosetta Stone but they only have an on-line subscription plan and the internet is just not reliable enough for that to work).  Anyone with suggestions, please let me know.  The primary language I want/need to learn is Swahili.  The local language that I may try to learn, at least a little bit, is Kipsigis.

 

As we’ve gotten into the swing of things, it has allowed us to really start to reflect on the decisions that have brought us here and on life.  (Warning…I may attempt a bit of deep reflection here…feel free to skip to the part with medical stuff and pictures.)  For those who don’t know, missions has been on our hearts for years (check out the “how we got here” section of the blog for details).  My time in the D.R., Honduras, and Jamaica has allowed me to see how so much of the world lives (and it is nothing like the news reports it to be).  It is interesting, and sad, to see how much of the world looks at us as well.  As we were preparing to leave, so many people commented on what we would be giving up…and the reality is that we have and will continue to give up many worldly things while we are here (and probably once we return as well).  But a greater reality is that, despite what we have given up, we still have so much more than many of those with whom we work and serve.  Here is one such example.

 

When we arrived, we hired a woman to be our house help.  After a trial period, it was decided that Joyce would be the woman who would work with us.  Her job description includes cooking either prep work or a full meal, cleaning, generalized house duties, and helping to watch the children.  She has been a huge blessing for us.  While my interaction has been limited, as I am generally a work, I have seen her start to open up more to Steph and the kids.  This past week we have learned a lot more about her and her living conditions.  This woman, who makes what in the U.S. would be a ludicrous salary (the fair wage that she receives is 210 Ksh/day….that is about $2.50 US…maybe we can discuss at a later time why we can’t increase that), comes to our, small, mismatched, no frills, home (these terms are all relative) and sees that we are in a mansion.  This realization came when we found out that she lives in a one room structure that houses her bedroom, kitchen, etc.  It has one light bulb, no running water, and an outdoor toilet.  In her eyes, and in the eyes of the many other Kenyans that live in similar situations, we are rich and we have much.  How could they possibly understand what we sacrificed to be here?  Only a trip to see our ivory towers, and the self-dedicated monuments that we create could convince them that our current dwelling is less than we are used to.

 

I’m not going to get on a soap box a bash those who have been blessed abundantly.  It is not my place to do any such thing for I have also been blessed beyond measure.  I don’t understand why it is in our human nature to always want more, bigger, better.  I know that I have always found that even upon achieving that pinnacle that true happiness and satisfaction were still lacking.  And yet, despite these realizations, we all continue in our attempts to build our mini-paradises.  Again, no soap box here, but one of the reminders that these trips and experiences allow is that so much of what we allow to consume our daily lives is temporal…it isn’t going to last.  My fear is that many people will approach the end of their lives and look back and regret that less of an investment was made into people and their eternity and more time was wasted on temporal goals that burn into nothing.  If anyone made it this far with my diatribe, I just pray that this would not be the case for you….that you would realize the amazing blessing that you have and use them for the glory of the One who created you…for the One that died to be with you.

 

While I do miss my coffee, restaurants, clean and consistently running water, fast/reliable internet (this is a biggie for me), and other conveniences of the states, I don’t want to miss them at the exclusion of people.  People who are hurting (physically and spiritually).  People who appreciate a handshake and a smile just as much as anything else.  My hope and prayer is that day by day, as I continue to let go of more and more that is temporal, that I may draw nearer to the One who created me in such a way that I may truly begin to see the world and those around me as He sees them.  I want to see

 

 

Now for the update on the Kelley clan.  So as many of you know from fb, Jacob has a small issue with a stick trying to gouge his eye out.  I received a call from Steph in which words like, “stick thrown in eye”, “he can’t see anything”, and “I can’t see his pupil” were used.  I told Steph to bring him up to the hospital so I could take him to the eye ward where our friend was working.  As I carried him up to the ward, I was able to do a superficial exam, which had already improved from what I was imagining.  A slit lamp confirmed that he did have a corneal abrasion but thankfully nothing more serious.  So as we wean off his antibiotics for his toe (which is healing nicely) we now have proceeded with antibiotic eye drops.

 

Hannah has continued to be a bit of a mystery.  She continues to have episodes of vomiting (although we can control them somewhat with zofran).  After more discussions with the pediatrician/neighbor/friend, we decided to treat her for possible Giardia.  While her sx are not textbook, they often times are not and this type of infection is one of the most common here.  We completed her first full day of treatment today.  The morning was better but this evening she was still a bit of a mess.  We will see…..

 

Levi continues to find new locations to add bruises and scrapes on his body.  A somersault over his little bike contraption ensured a colorful face.  A semi-fall from a tree attempted to add additional contour to his previously round head (good thing he has a lot of hair).  Apparently his next move is a triple-backflip out of our second story window to the sidewalk below.  He has been caught at two windows trying to analyze his attempt.  We are in the process of having lockable window boxes made!!!

 

Now for the medical update.  Instead of a weeklong overview, I’ll take you through one of my days.  So part of my responsibility here is to take medical call (peds call may be in my future as well….yikes!!!!).  Call over the weekend means rounding on the wards…one of the reasons I chose emergency medicine in the first place.  My ADD does not do well with systematically going through one patient after another again and again and again….and again.  Call during the week basically means I have my pager and receive calls from MO and CO interns when they have issues or people to admit.  As long as they can handle it I don’t have to leave my house.  On Wednesday night they couldn’t handle it.

 

5:00 pm – 7:30 pm  A 26 year old is in casualty.  She looks bad….very bad.  She is somewhat cachectic, minimally responsive, tachycardic in the 140s and sating in the 70s-80s on a non-rebreather.  We also not that her left leg is swollen, but only from the knee through the thigh.  Clinically, she had a pulmonary embolism and even with first class treatment, her survival is questionable.  I intubate her and we begin medications that may give her a small chance of survival.  I happened to have called a visiting radiologist for another case so he could evaluate a CT and he took a look at her leg to search for a DVT…no luck.  We transferred her to HDU (high dependency unit – similar to a step down unit) because the ICU was full.

 

The other patient that I was consulting our radiologist on (Thanks again Christian!!) was on a patient that was sent in for evaluation of profound left sided weakness along with altered mental status.  She was in her 70s and was almost completely paralyzed on the left.  They had raised funds for the CT and the results explained her deficit.

 

I discussed the prognosis with the family.  She may continue to have swelling, which could cause her to herniate and die.  She may remain at her current level of functioning.  She may even regain a small amount of use of her arm.  There is no way for us to determine which will occur.  Time to go home.

 

12:30 am -3:30 am  I receive a 999 page (run to the location of the page) to HDU and am informed that our patient had coded.  Several rounds of treatment made no difference.  I pronounced her and awaited the arrival of her mother.  We still don’t have a clear answer as to what killed her.  While waiting I went to casualty to see if any pending admissions where there.  I walk through the door and hear, “Good!  You are here.  The CO isn’t answering her pager.”  I look to bed one and see a man in his 60s who is unconscious, with sonorous respirations, and who smells of urine.  The condensed story is that he is a diabetic who started seizing at ~11 am.  He was seen at a dispensary and was given 10 mg of Valium.  He continued to seize and was brought to us.  His blood sugar was found to be 1.2 (very very very low).  Despite large amounts of sugar being dumped into his body, his seizures persisted.  I had a very candid conversation with the family regarding the direction of his care, the likelihood of permanent brain damage, and the cost of ICU care.  They decided they wanted him intubated.  This was done and he was placed on medications to prevent future seizures.

 

5:30 am  I receive a page that our diabetic is seizing again.  Additional medication orders are given and the seizures stop.  (Sadly when I saw him later in the week, he remained comatose without meds.  He will likely be taken off life support soon.)

 

Sadly I forgot my coffee on the front table as I walked out the door.  I found a more effective means of an adrenaline rush upon walking into casualty however.  I followed a trail of blood to a man in his 20s who had been stabbed in the chest and back numerous times.  Immediately I see 2 or 3 sucking chest wounds on his left chest.  A definite pneumothorax is auscultated on the right.  Immediate stabilization occurred and he was prepped for bilateral chest tubes.  (This is when I received the call about Jacob.  Time to run down the hill and bring him up to make sure his globe isn’t ruptured.)

 

Upon walking back into casualty, I am told about a one year old that was seen overnight and released home.  He now returns in worsening condition, dehydrated, tachycardic in the 200s.  Labs later showed that his WBC went from 9 to >30 (a very large and sudden increase).  His chest x-ray was somewhat questionable and his mental status was not normal.  We began him on empiric antibiotic treatment with plans for an LP the next day.

 

Drunks occur in every country.  Now I haven’t had to deal with the belligerent, vomiting type yet but I have seen the traumatic drunks.  This one indulged to the point where walking became too complicated.  This resulted in blunt trauma resulting in injuries requiring admission to the surgical team.

 

 

I also had the pleasure of meeting a man in his 50s with a very complicated surgical issue.  A few years ago, he had a CT scan showing a thoracic aneurysm and a thoracic/abdominal dissection.  Seeing the degree of disease was highly impressive.  Seeing it grow further on this scan was just down right scary.  Our surgical team has consulted with experts in the U.S. and it looks like he may be going to the OR on Monday or Tuesday.  One of the significant complications is that half of his organs are supplied by the true lumen of the aorta while the other half are supplied by the false lumen.

 

 

 

I also was able to see yet another motorbike trauma patient.  He had wrecked a day or two prior and had his facial lacerations repaired.  His concern was that he thought his jaw was broken.  He was almost right.  He had fractured a segment of his mandible that allowed his front three lower teeth to be free-floating.  I walked him to the dentist who recommended significant mouth care before bringing him back in a couple days for a splint to bridge the fractures.

 

My day was filled with several other interesting and complicated cases but those are the ones that immediately come to memory.  Needless to say, by the end of the day I was ready for a nap…a big one.  Some things are certain at Tenwek, miracles are happening and God is at work, despite what we may be doing.

 

Praises/prayer requests

 

-We continue to be thankful for the wonderful friends/family that we have here.  Continuing the tradition or the Tenwek missionary community, our children have many new aunts and uncles who all care for and love our children.  Even the short-term visitors have been such a blessing and encouragement!

 

-We are also thankful for the ongoing support we receive from friends/family in the states.  Your prayers, gifts, and words of encouragement really do help to keep us going.

 

-The Kenya elections have been completed and have thus far been relatively peaceful.  Please pray that this continues as parties reconcile and people prepare to move on with the progress the country has already seen.

 

-Please pray for those who knew and loved Baby Ruth.  She was a one-year old orphan who had an infectious smile and a loving personality.  She lost her battle with a severe abdominal infection and has returned home.  There are so many little ones that don’t have permanent families and those who care for them face daily challenges that are unfathomable.  Pray that they will receive peace, comfort, and strength that only He can provide.

 

-Ann is a patient that had been in the ICU on the vent for just short of two months.  She is on just a trach now and has been able to get out of bed.  She is one example of a patient in which we did everything possible and came short…that’s where God stepped in and healed her.  Her live now stands as a testimony of the healing power of Christ.