Trauma and poisonings and snake bites…Oh my!

I would never say that shifts in the emergency department are dull in the states. Even a “calm” shift presents unique challenges and unbelievable stories. (If I didn’t experience many of the events first hand I would probably not believe that they actually occurred.) I remember hearing my uncle talk about his shifts in the ED and thinking…that just isn’t possible. I assure you now that it is. My shifts in casualty seem to be even more remarkable than what I experienced in the states. I don’t think there is a shift that goes by in which there isn’t at least one ingestion of pesticide and a handful of trauma patients (many of which would qualify for trauma alerts or code reds in U.S. systems) in addition to almost unimaginable pathology of many kinds. Here is a brief sampling of some of the things I have seen recently.

Trauma, trauma, trauma. Ortho has an incredibly busy service because of the countless road traffic accidents that occur here. Some patients present directly to Tenwek and others are seen elsewhere, diagnosed with fractures and then are sent to us for definitive management. Long bone fractures are the norm it seems. While other injuries are less common, they too occur with some regularity. On one afternoon, a man who was struck by a passing motorbike presented to casualty. He would occasionally yell out in pain complaining of left sided chest pain. His x-ray confirmed findings from his clinical exam.

Organophosphate and other pesticide ingestions remain a sad and continued reality of working here as well. One of the more tragic cases occurred when a 20 year old presented. Initially she appeared quite stable but then began to decompensate so we then intubated her. Right after intubating, she went into cardiac arrest. After 20 minutes, we were able to get an ultrasound, which showed reasonable cardiac activity. It also showed that she was pregnant (maybe around 15 weeks). After another five minutes or so we were able to regain pulses. Sadly she arrested another two times while in casualty and ultimately, we were unable to resuscitate her.

Because open fires are used for warmth and for cooking, burns are a far too common occurrence as well. Recently we had a tragic case in which a young woman with a seizure disorder had a seizure and fell face first into a fire pit. By the time she was removed, she had second and third degree burns across her face, head, chest and left arm. She was seen at another facility where she remained for over a day. Upon arrival to Tenwek, it was obvious that the circumferential burn to her left arm had caused compartment syndrome. That, plus the burn, had caused her hand to become mummified. While she did not have stridor, the swelling of her face indicated that airway management would likely be difficult. Ultimately, when she was taken to theatre, she required an amputation of her arm and a tracheostomy because of the burns.

Tenwek is blessed to have one of the few CT scanners in Kenya. We are incredibly thankful that the replacement parts that we have been awaiting for months have all arrived and the machine is once again functional. Thus far the scans that we have obtained have been quite impressive. We have seen hemorrhagic strokes, subdural bleeds and herniation due to bleeds.

One of the questions that I was asked several times prior to leaving was whether or not there were snakes where we would live. Bomet is in the highlands of Kenya (at ~6,500 feet), which helps to keep the weather almost perfect and also reduces the number of snakes that we see. On one evening, as I was getting ready to walk out the door for the evening, I looked and saw a man who had just arrived. I noticed that his leg appeared discolored and he had a makeshift tourniquet just above his knee. Out of curiousity, I asked my nurse what he was coming in for. “A snack bite.” While he wasn’t sure what type of snack it was, one of the surgical residents, who is from this region, was pretty sure it may have been a green mamba. Although the bite had occurred within the last 30 minutes, he was having blister formation and large areas of bruising already. Thankfully we had anti-venom on hand and five vials later, the progression had stopped. His life and his leg were saved…crazy!

 

 

 

 

 

 

 

 

 

 

 

Life at Tenwek has continued to move on with full force. In the last several days we have celebrated Levi’s birthday and my birthday (and Jacob’s is coming up in less than two weeks). We have been busy showing Steph’s parents around the last few days. We were able to spend the morning of my birthday on safari and even had a picnic lunch in the Mara.  It was amazing to have the chance to see the magnificence of God’s African creation up close again.  We are so incredibly blessed to live here.  Work remains incredibly busy.  Balancing clinical work in casualty, outpatient department and on the wards with administrative duties has been challenging.  But there is no fear of becoming bored with any one job!  The past couple weeks has also marked four months since the loss of Hannah.  It doesn’t seem possible that it has been so long already.  My arms still ache for my baby girl and I often wonder what she would be saying and doing now.  I would love to see her and Levi playing tea party and wrestling.  We recently stumbled across videos of them playing together.  I almost forgot how infectious her laugh was.  We remain incredibly thankful for all of the love and support we have received!  Thank you for faithfully uplifting us in prayer and supporting us in so many ways!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Prayer requests:

-Please continue to pray for Samuel and David (their stories can be found on our Facebook group page here).  May God continue to comfort and heal their families.  Pray that He will receive the glory, even in the darkest of days.

-Dana Jacobs has returned home after her surgery to remove the tumor from next to her spinal cord.  Pray for continued healing and physical strengthening.  We are thankful for their love and commitment to God and the people of Kenya.

-Pray for our patients at Tenwek as well as for their families.  Again, we desire that each and every one would come to know Jesus in a personal way.

-Pray for the transitions occurring at Tenwek.  A lot more work is being asked of much of our staff.  Pray that the changes would not distract us from our primary mission here.

-Pray for discernment as I may soon have the opportunity to spend time working in Sudan.  We knew that when we came here that chances like this would likely arise.  We would ask that you would pray that God’s will would be made clear in these decisions.

 

“God whispers to us in our pleasures, speaks to us in our conscience, but shouts in our pains: It is His megaphone to rouse a deaf world” – C.S. Lewis