2 months
March 28th, 2012 Posted in Uncategorized | No Comments »
Saturday, February 4. I arrived at the KC airport before my flight to Dubai. I said goodbye’s to Jeanine (my wife) and Charlie (my son) just before going through gate security. After going through security, I went to call Jeanine, and realized that I’d left my phone on the night stand at Charlie’s. There was nothing that I could do about it at that point. The flight left for Dallas on time, and we arrived safely. After arriving at the Dallas airport, I went to the Emirates Airlines gate to check in, and I was upgraded to Business Class for the flight to Dubai. The flight was a wonderful experience. The business class seats would fold down horizontal, and you could actually lie down. I was able to get a couple of naps in during the 14.5 hour flight. After a 2.5 hour layover, I boarded the Emirates flight to Kenya. I finally arrived in Kenya at approximately 7:15 P.M.
Sunday, February 5. After 21.5 hours of flying and 3.5 of layovers, I finally arrived in Kenya. After getting my tourist visa and claiming my bags I cleared customs and was greeted by the driver from ACTS (African Christian Transportation Service). Unfortunately, there were no other passengers going to Brackenhurst Conference Center (The Community of Christ holds it’s retreats at Brackenhurst, as well.), so I was unable to share the fee with anyone. I got checked into my room at approximately 9 P.M. I was very tired, and had no trouble in falling asleep. Since I didn’t have my phone, my frequent alarm clock, I ran a program on my laptop that would wake me up in time.
On Monday, I began taking the ALSO course (Advanced Life Support in Obstetrics) from the American Academy of Family Practice. The course was good, and intense. It is normally given over 2 days, and we did it on Monday. On Tuesday, I was expecting to be taking the ACLS course, but when I went to the course site, it was full, and I was not on the list. I pulled my registration form from my laptop, and realized that I’d failed to checkmark that box (I filled out the form twice, and had a conflict in the classes the first time. I think that I’d checked ACLS the first time, but managed to skip it the second when I got rid of the conflicting class.). So I spent Tuesday reading, and finished Micro (a book Charlie had given me for Christmas). The main conference began Tuesday. During the conference, there was a worship service every morning (except the weekend), and a song service every evening. I signed up for the choir, and we sang at services on Wednesday evening (both first and last weeks) and on Sunday. On the final Wednesday service, we sang the Hallelujah Chorus. I’d never had the opportunity to sing it before, having heard it a number of times. It was more difficult that I’d envisioned, though I was finally getting it by the performance. It was a good conference. At the end we received a thumb drive with a pdf file of all of the slides at all of the talks. Some of them are great, even without the audio of the lecturer, but some of them would benefit greatly from the audio.
On Thursday, February 16, I was met at the conference center by Robert Adie, who had visited with the Shenandoah, Iowa congregation of the Community of Christ, following the 2010 Community of Christ World Conference. I traveled with him back to Nairobi to stay for a few days. We had a wonderful meal that evening of chicken, rice, greens, and a soup, similar to dal. On Friday, Robert took me to his workplace at B. Braun. At this site, they manufacture and process IV fluids of various sorts (saline, Ringer’s Lactate, hetastarch, etc.).
On Saturday, February 18, I traveled with Robert (the Nairobi Mission Center president) and Martha (the Nairobi Mission Center financial officer) to Ugenja, Kenya to visit the congregations there. Ugenja is close to the Uganda border, and this trip required several hours of travel in a mini-bus which was rated for 11 passengers, but sometimes had 1-2 additional passengers. After looking at a map and seeing how close we were to Lake Victoria, I wished that I’d gotten to see it. I am larger than the average Kenyan (I’m larger than the average American, too), and was cramped at times. On the first leg of the journey, I was on a seat that was smaller than most of the other seats, to allow for the aisle. I could not get centered on the seat, so it was hanging off of the seat for the 7 hours of that leg. I got the front seat on the following leg, which was much more comfortable. We visited two congregations near Ugenja on Saturday evening, the Ugenja congregation and the Ohando congregation. Robert and Martha were performing administrative duties for the Nairobi Mission Center. The Ohando congregation had recently had a well dug, to provide clean water to the local residents. The locals spend a significant amount of energy each day hauling water and firewood. Sometimes the water is collected from a puddle along the roadside! This will allow the locals a source of clean water that is much closer than they would have to travel otherwise. The Ugenja congregation is planning a poultry facility to raise approximately 150 laying hens and 150 broilers. Robert and Martha were there to assess whether everything had been thought out. The well remained open, with a bucket and winch to draw the water. It remained open, allowing possible contamination. They were encouraged to place a pump system and covering. The poultry facility has no water available at the site, so they were encouraged to put guttering on the church building and poultry building when it is built, to allow rainwater collection.
On Sunday, we attended the services at the Ugenja congregation, where there was singing with much clapping and joy, and I shared my testimony of my journey to Kenya.
Week of Feb. 20
Robert drove me to Kijabe to stay with Tim and Lori Myrick. We had pizza and lasagna that evening with Ace Barnes and his wife, . They had been in Columbia, MO in the early to mid-70’s. On Tuesday, I went with Tim and Lori to a slum area of Nairobi were they have a clinic for Somali refugees. On Wednesday through Friday, I followed Tim as he made his rounds. The patients were interesting, and complex. Diagnostic studies are limited, with Kijabe Hospital having plain films and ultrasound as their available imaging (They are getting an early generation CT scanner from Canada in the near future. They only accepted the scanner on the availability of servicing it in Kenya.). The laboratory has a fair range of available testing, though cardiac enzymes and ammonia levels are not available. They have a fair number of strokes, but diagnose few MI’s. I’m sure that the lack of cardiac enzymes contributes to missing some of the MI’s.
On Friday, Feb. 24, Robert picked me up in Kijabe, and we traveled back to his home where we shared supper. His family were all home for the weekend, so I finally got to meet his son and middle daughter. I’d met the older daughter during the time that I stayed with them earlier. though I didn’t see much of her, as she left for school early in the morning, and didn’t return until late at night. Late that night, Robert took me to the airport to travel to Zambia.
Saturday, Feb. 25
The plane left for Addis Ababa, Ethopia at approximately 3:15 A.M., and arrive as scheduled. There was an approximately 4 hour layover scheduled, but it ended up to be 5 hours. The flight to Lusaka, Zambia departed approximately an hour late. I arrived in Lusaka to go through customs. In Kenya, there had been ATMs available on the customs side of the airport, so I had assumed that Lusaka would be the same. I had had American currency in Kenya to pay for the visa, but I didn’t have any cash on me at Lusaka, and there was no ATM available on the customs side. I was told to talk to the person at the outside door to be allowed to go out the the ATM and come back inside. I was immediately met by Dr. John Spurrier, the physician from Macha Mission Hospital, who loaned me 300,000 kwacha to pay the fee (it is approximately 5000 kwacha to $1 US. I have some nice 50 kwacha notes to give out on return to the US.) When I went to go back in to the customs area, I had obviously talked to the wrong person when I left the area, because a different agent made me go back around through airport security where I had to have my carry-on bag re-xrayed and my pockets emptyed, and my shoes checked, etc (Why would I carry anything contraband back in to the area where I have to have my bags checked for any customs violations upon leaving? I’d already carried my carry-on bag out, and I’d have already gotten rid of anything, if I’d had it to begin with!) I finally got back to the passport clearance to get my entry visa, and went back to pay, and they wanted it in American currency. (What currency do other nationalities pay with?) So, I had to again leave the customs area and go find the bank in the airport that was open (2 of the 3 were already closed. They would have all been open if the flight hadn’t been delayed.) to convert the Zambian currency to US (so they could take their 2% fee for the conversion.) I made sure that I talked to the correct individual before I left the area. I finally got my entry visa and cleared customs. I went to the ATM and withdrew 1,000,000 kwacha to pay back Dr. Spurrier and to go shopping for groceries.
It was about 9 P.M., when we arrived at the Macha Mission Hospital.
Week of February 26
On Sunday morning, I went to the Brethren in Christ church near the hospital. It was about 80 degrees with 90% humidity, and after the ¼ to ½ mile walk to the church, I was wet, and my shirt showed it. And I then got to stand up and introduce myself to the people attending (as did two other first time visitors). There was a lot of singing and clapping in their service.
On Monday, I began to see patients. They saved a pilonidal cyst for my arrival. It was the worst one that I’d ever seen in that it tracked to behind(anterior) to the sacrum (which is where the rectum is). I was so glad that he didn’t have poop coming out of his wound at his dressing change the next day. He still has a lot of mucus discharge, and I don’t know where it’s coming from. I have no ability to do a CT scan, nor a fistulagram (no soluble contrast is available). I also got to see a couple of burned patients. One was a 9yo girl who apparently had been in a thatched roof hut that had caught fire and fell on her head. She had full thickness loss of skin and tissue to the skull on the top of her head. It was debrided the following day, but is not yet ready to skin graft. A second lady had burns to both thighs, one extending over the knee. Her right forearm also had a palm sized burn. Her burns were all grafted on Tuesday.
I saw an both an elderly man and a small child with possible small bowel obstructions. I thought that the man’s was not obstructed, but was an ileus from a UTI, while the child had stool extending to her cecum, and thought that she was obstipated. I was correct with the elderly gentleman, who started passing flatus after a couple of days, but I was wrong about the child. We took her to the OR on Saturday, Mar. 3 and resected a strictured segment of small bowel where an adhesive band was obstructing her. I don’t think that there is as much room for error, here, as in the US she would have at least had some peripheral hyperal during the wait. She is now more malnourished and having to have surgery. I think that it is probably better to operate early and be wrong, rather than waiting to be absolutely sure. On Friday afternoon, we operated on a 24 yo man who presented 4 days following perforating an ulcer. His surgery was difficult because of the degree of inflammation, and after initially patching the hole, he leaked more when attempting to close, so it took another hour to repatch the hole. It was a struggle to return his edematous bowel into his abdomen, so I’m sure he probably had abdominal compartment syndrome. He died later that night.
Week of February 4
There were quite a few less people at church on Sunday. They have a board that lists the attendance and offering. There were 780 people listed on the board as having attended last Sunday. I’d bet there were half as many this week. There is girls’ school that attends, and they were somewhere else. The small child with the bowel obstruction is doing well. She’s eating and pooping normally. She did develop a wound infection that required the wound to be opened, but she’s doing well. A 20 year old young lady with epilepsy was severely burned on her torso and left arm and hand when she had a seizure and fell into the fire. She was alone at the time, so the burns are deep. She’ll loose her hand, if she survives. I’m told that sepsis is the most common complication in patients with a similar extent of wounds. They don’t do early excision and grafting, because they don’t have the blood available to do it. If you wait for the burn to demarcate and begin to separate, it’s not as bloody a procedure. The young girl with the burns on her scalp was taken home because we weren’t doing enough for her (it’s a slow process to get burns to granulate so that you can graft the wound). We saw about a 5 year old girl die from malnutrition while an iv was being started. I also had a middle aged man die when I had him turn on his side to put in a chest tube. He had not yet received any medication. The girl who’s legs were skin grafted has had about a 70% take of the grafts.
Week of February 11
Rah! Mizzou! I was told at church on Sunday that Mizzou had won the Big-12 tournament. I hadn’t been able to check up on them. I had briefly had internet access, but I used up all of my subscription within a couple of days. (I had a 30 day/1Gb subscription and used the 1Gb up over 2 days by uploading full size photos, and downloading the upgrades for the computer). I had no idea that I was consuming all of my allowed amount. If I post any more pictures, I’m only going to post thumbnails until I get back, because I’m not going to spend $15/day for access. In order to purchase a certificate for access, you have to go the the internet service provider, who is located about a mile from the hospital. They also had a branch bank, but the government said a bank couldn’t be located in a cargo container. They had it furnished and air conditioned, but the regulators didn’t like it. The ISP is also in a shipping container, and they have an internet cafe with 8 computers. The problem is that they close at 5PM, and I haven’t been free before 5PM, let alone walk out there before 5. Last Thursday was a holiday (Womens’ Day), and the clinic only had a morning session, but the internet provider closed at noon as well. I found that out after I’d walked out there. Today (Monday March 12) was a holiday, too (Childrens’ Day) and it was a half day also, but they were closed at noon today, too. I was out there at a wedding reception, but I didn’t stay for the feast. I didn’t want to walk back in the dark (actually I didn’t want to walk back when the mosquitos were out). There isn’t as much malaria here as there used to be, though, but I’ll still not take any chances. There was an article that Dr. Spurrier gave me to read that was in the Brethren newsletter (It may be available online at http://inpart.org spring 2011.) The malaria research institute was founded in 2005. In 2001, they had 1800 pediatric admissions for malaria with 64 deaths. In 2011, they had 42 admissions and 2 deaths. Malaria doesn’t have another host, only humans. So, whenever someone comes in with malaria, they go to the community and test everyone, because someone had to be the host carrying the parasite, and mosquitoes don’t fly very far.
The power is off every day or two, with some outages being for only 2-3 minutes, and others for several hours. One outage was for about a day and a half. The guest house that I’m staying in is a duplex. I had neighbors for the first week, Dave and Emily. They were residents from the University of Utah. Dave is originally from Omaha. Apparently, there was a problem with the toilet in the other half, and now that nobody is staying in that half, they’re working on it. But, they’ve cut off the water for the past few days. The water heater is in the attic, so I have had hot water, so I’ve been able to bathe, but I wasn’t sure how large the tank was, so I used it sparingly. Even when there has been cold water, the pressure hasn’t been great. There is a lot of mineral in the water, and everything that has had water in it for any length of time has a scale buildup.