New Life

New Baby, originally uploaded by momentswithmichelle.

One of my first clients in the antenatal clinic was a 16-year-old with her first pregnancy. She has faithfully made every appointment. It worked out so that I was always the provider who saw her at her appointments. As she came closer and closer to her due date I put the word out that I wanted to be in on her delivery. I told the nurses who take call “I don’t care if it’s midnight, I want to be there!” I informed Judith that I would do my best to be there to help her bring her baby in the world.

Well last night a little after midnight I got the phone call. “She is fully dilated and getting ready to push, you better come now.” William (my sweetheart of a husband) got up with me to go to the clinic. We put on our gumboots (rain boots) and tromped through the mud using our flashlights to get to the clinic.

When I walked in the room Judith broke out in a huge smile and thanked me for coming. That moment alone was worth the midnight trek through the mud. If my presence could induce a smile like that at full dilation the trip was most definitely worthwhile. Bernard, the nurse on call, declared that since I had followed her all the way through, I should be the one to deliver the baby. Thus far I’ve only assisted but haven’t actually taken the lead. Bernard coached me through step by step. I couldn’t have done it without him. And by the way, I still consider myself to have assisted in the delivery. I don’t think we medical professionals should get the credit for delivering the baby when it is the mom who does all the hard work!

Somewhere between 1:30 and 2:00 Karen Jemutai made her grand entrance. It was a difficult delivery with some minor complications. But I’m pleased to announce that both mom and baby are doing great this AM. What a joy it is to watch a new baby take her first breath and scream out her protest as she enters this world. Then those little eyes start blinking and taking it all in. Those first minutes are so precious. Mom and gogo (grandma) thought that I should name the baby. They asked me if I wanted to name her after myself. I told them that I was honored but I thought the mom should choose. Judith and Karen stayed overnight and are getting ready to walk home as I type. That is right! Just eight hours after delivery mom wraps up the baby and walks her home. Life in Africa is not life in the US!

They Came

I previously told you about Chelagat and her family. I was hoping and praying they would make it to the clinic on Tues. Well they did! Jeptoo (the mom) got the four youngest children across the river and to the clinic. William and I had decided that we want to do all we can to get these kids back on their feet again. So we informed the clinic staff to do everything that was indicated and we would eat the bill.

The three youngest are now on antibiotics for respiratory infections. All are malnourished and have been de-wormed and given multi-vitamins. William and I have been agonizing about what we can do to help this family without handicapping them. We don’t want the mom to become reliant on handouts; we want to help her find a way to take care of her family. But at the same time they are really at ground zero. They are going to need a hand up before they can move to the next step.

So yesterday afternoon William and I met with David Tarus. He is our director as well as William’s uncle. He had loads of experience with these kinds of situations and we knew that he would have wisdom to offer. It turns out our timing was perfect. ELI will be building a secondary school over the next year or so. The organization has recently purchased land for the site and there are a few houses on the property. The current residents will be moving out next week. David offered that we could bring the family to stay in one of the houses for the next three to four months. He told us that he would guide us through the rehabilitation process. The children will be closer to the clinic and will be much easier for me to access at their home.
It will be up to William and me to put out the money for food, bedding, clothing etc. We are currently under-supported but we both feel strongly convicted that this is what we need to do. David told us “You have no idea what the outcome will be. Sometimes they thrive and sometimes they crash. But you have to try or you will never know.” We will be meeting with the mom, Jeptoo, sometime before Monday.

Please pray for wisdom as we begin this huge undertaking. At this point I don’t think she would be resistant to help but you never know. I just want to see these children have a chance. Their faces are so lifeless right now.

Before leaving for Kenya I shared lyrics of the song “May the Words of My Mouth” on this site. The song really spoke to my heart. William has recently fallen in love with the song as well. The chorus says “For this is what I’m glad to do, it’s time to live a life of love that pleases you. And I will give my all to you, surrender everything I have and follow you. I will follow you.” Last night he was listening to the song over and over. He turned to me and said “Michelle this song is about those children. Helping them is part of surrendering and following what Christ wants us to do.” I promise to keep the updates coming as we continue on this journey.

Chelagat

Chelagat, originally uploaded by momentswithmichelle.

The little girl I have been sharing about (who was hospitalized for malnourishment) has really touched my heart. Her name is Chelagat which also happens to be my Kalenjin name. I checked in with our staff member, Mary, who knows the family. She agreed to help me meet them.

On Thurs last week we met at Mary’s home. The mom, Jeptoo, brought Chelagat and another daughter Jepkoech. The girls did not smile once during the entire visit. Mary told me that when she went to their home there was no food at all in the house. I also learned that Chelagat was actually not discharged from the hospital. The mom was worried about the cost and took her home early. The situation stayed in my mind. After telling William about the family we decided we needed to take action.
On Saturday William and I made the journey to their house. We carried a sack of food. And it was quite a journey!!! We walked and walked and walked and walked. Then we came to the log bridge. I had heard about the log bridge but never ventured out to that area before. I hear people talk about being afraid of crossing it. So I had always begged off from trips headed that way. But these kids really tugged on my heart. I wish I would have brought my camera. You may laugh at me but the only thing I carried was my phone and my umbrella. I passed both over to William before crossing. I was afraid that if I should fall in the river my camera would be ruined. But wow, I wish I had pictures of that trip!

I made it over the log bridge and then we walked and walked some more. When we finally arrived at the house the mom was nowhere to be seen. They are living in a very small mud hut with a grass roof. There are big holes in the roof. I imagine everyone inside is soaked when it rains. Mary was correct, there is no food in the house. The children were dressed in rags (mom had dressed them up for our previous visit). Several neighbors came in to greet us and all of them had alcohol on their breath. Through those interactions we learned that the mom doesn’t drink but that she is a local brewer. Mom finally showed up and her and William had a long chat in Kalenjin.

William and I have decided that we want to intervene for these children. There are five daughters and the three youngest are pretty sickly and malnourished. Jeptoo has agreed to bring the four younger children to the clinic on Tues. I told her that William and I will be covering the bill. I want them to each get a full exam. I want them all on multi-vitamins and to be de-wormed. I’m pretty sure the two youngest will need antibiotics for respiratory infections. I didn’t have a stethoscope or do a physical exam but I know that they are sick. Please pray with me that they will come

Village Life

Termite Wings, originally uploaded by momentswithmichelle.

This week I’ve been reminded of the fact that I really do live in an African village. Saturday as William and I were taking a walk we noticed a huge crowd gathered around a tree at a neighbor’s home. We went to check it out. We discovered that someone had just caught and killed a dik dik (very small antelope) and were preparing to skin it. I have never seen them around here but obviously they live in the area. They told me that someone saw it jumping along the river and they ran to get a knife. Wow! I felt sad as I saw it hanging dead from the tree. We really do live a sheltered life in suburban America.
Then last night I heard a lot of noise outside our window. There was a swarm of termites flying around the security light and bumping the window. There were literally hundreds of them. Our cat was extremely fascinated by them. She kept running from window to window watching them. But when I opened the door she was afraid to go out. I think there were too many! I finally wound up turning the security light out because they were keeping me awake. This morning when I went outside I found many wings on the ground. William told me that it is a normal part of the life cycle of the termite. They shed their wings and crawl away. I was thanking the Lord that our house is made of brick and concrete and not wood!!

Love Them Like Jesus

*Warning: What you are about to read is somewhat graphic and may be disturbing

I HATE cases like the one I had last night. It had been a long day. After I got off work at the clinic I walked to visit a friend of mine with AIDS. She has just completed two months of intense treatment for tuberculosis. She is weak and still trying to recover. Her house is a good walk from mine so I was tired by the time I got home. I had invited my friend Adele over for dinner and we were getting ready to have beef burritos.

Just as I was about to pray for the food I got a phone call from the clinic. "Michelle I have a lady who is hemorrhaging from a spontaneous abortion. I need you to find transportation for us to get her to the hospital. And can you come to the clinic to assist?"

It was one of those times when I have to take a big sigh and remind myself that missionaries don't work 9 - 5 jobs. In fact it isn't about a job, it's about ministry. I made some calls and arranged for our ambulance to come and pick her up. Meshak our driver would have to walk about a mile from his home to the ambulance location before driving it to the clinic.

So I grabbed my torch (flashlight) and headed to the clinic. Wow, I hate these cases! But I love that I was there. Not sure if that makes any sense.... By the time I arrived they had stopped the bleeding. The patient, Elizabeth, was laying naked on the table surrounded by bloody rags. The nurse on call and the TBA (traditional birth attendant) who brought her to us were at the bedside. She had undergone an incomplete miscarriage, which meant she would be needing a surgical procedure to remove the rest of the uterine contents (whatever may have been left of baby and placenta).

Elizabeth was shivering and crying when I arrived. She had lost about a liter of blood while she was at the clinic and was bleeding before she arrived. Makan, the nurse, told me that it was an especially sad case. The woman's marriage was on the rocks and she had felt like this baby was going to be the key to saving it. Plus she had had a miscarriage once in the past and had to undergo a D&C at that time. She has terrible memories of that experience and begged us to promise her it wouldn't happen again. I couldn't make that promise. In fact by the time I arrived there was very little that I could do for her medically. I covered her with blankets and began to stroke her forehead and hair. I prayed with her. I prayed for healing of her body and her heart. I prayed that angels would surround her as she traveled to the hospital. I prayed that the Holy Spirit would comfort her. Then I encouraged her to not dwell on what was to come but to just take it one step at a time.

It's really going to take me a while to get used to the fact that I'm working with very little resources. When the TBA pulled out Elizabeth's underwear and skirt I was shocked to see them dressing her in the bloody clothes. But otherwise she would be transported naked. We don't have hospital gowns or extra clothes laying around. What a night!

Sometimes I wonder if I should share stories like this. I'm sure that at times they may be offensive to some. Sometimes they are just downright discouraging. But the fact is that life is not just full of victories and triumphs. There are times for tears as well. And there are times when you can do little more than to sit and cry with a patient. I turned on a Casting Crowns album as I began to write this post. The song "Love Them Like Jesus" came on. It was a huge reminder of why I am here. I'm here to love them like Jesus.

Weekend Mornings

Kenya 016, originally uploaded by momentswithmichelle.

Before we were married I had imagined that Saturday mornings we would sleep in and then we would make a nice breakfast and enjoy some time together. I had no idea that this would be our prime visitor time. This last Saturday we had five guests (one had not arrived yet when I took this photo). I've learned to make a BIG flask of chai for the breakfast drop ins. (William is the handsome man in the middle.) I've gotten more used to this routine. I'm ok as long as they wait till I get out of bed and dressed before making an appearance!!

Mama Karen

Mama Karen, originally uploaded by momentswithmichelle.

I met Mama Karen before our wedding in December. She is quite a lady!! She has had chronic leg wounds (venous stasis ulcers) for several years now. She believes that the wounds are due to a dog bite to that leg 20 years ago. She has asked me several times now "Are you sure I don't need rabies shots?"

My friend Adele took pictures the first day her treatment began. Thanks to a generous medical supply donation from a friend in the USA we have had some high end products to use in her wound care. She is seriously the most compliant patient I have ever encountered. She does exactly what I tell her to regarding her wound care. And she has had amazing results because of it!!

On Thurs she came to see me for one of her dressing changes. She comes every two weeks and does the dressing changes herself in between visits. I was so excited to see her progress!

Just as we were celebrating the victory she mentioned that she had been having severe headaches and was not feeling well. When checking her eyes we realized that she was incredibly pale. Well it turns out that her hemoglobin was 4.8!!! That is incredibly low!!! She had to be sent to Eldoret for a referral. I'm not sure why she is so severely anemic. I thought she would be transfused. But when I checked up on her this AM she told me that she refused hospital admission because she didn't think she could afford it. I told her just how dangerous her situation is and she promised to go back to the doctor. I'll give her a call tonight to see how she is doing.

She's Home
The sick girl who I have been telling you about (Chelegat) was released from the hospital last night. I understand she is doing much much better. I'm going to try to go visit her on Thurs afternoon if possible. I want to see how the other kids in the family look. If she was so badly malnourished I'm wondering about the rest......

Msafara
On Friday William and I attended a program called "Msafara - Wheels of Hope". You can learn more about this awesome movement on their website http://msafara.wordpress.com It is a group of Christians who are traveling around the country to promote forgiveness and healing in Kenya. They are doing some amazing things. They began in Mombasa and we were their fourth city to visit. They are going to the areas that were most affected by the post-election violence. On Thurs they had a pastors conference where they had pastors of different tribes wash each others feet and pray for and with each other. It sounded like it was pretty powerful. The rally we attended was a time of prayer and worship. During worship someone was dancing through the crowd with a Kenya flag. It was an amazing statement "we are all Kenyans and we are all Christians!" There were several times I caught myself with tears in my eyes and a lump in my throat. In some ways I don't think I have even allowed myself to realize just how difficult these last few months have been. We ended by holding hands and singing the national anthem together before a closing prayer. It was pretty powerful.

Update on the Sick Child

One of our staff nurses was able to check on the little girl who I referred to the hospital yesterday. She was admitted and a full workup had been started at the time he checked in on her. The admitting diagnosis was a cardiac problem versus severe malnourishment. It seemed they were really suspecting the problem to be severe malnourishment. It makes me wonder what the other four children in the home look like…. But I am truly thankful that this one was able to get the help that was needed.

These kinds of cases break my heart. I truly believe that the mom did not have money. But some of my Kenyan colleagues are concerned that if people think I’m really soft they will come in trying to get free services when they really can afford to pay. It is a difficult dilemma. The clinic is partially funded by the government and the staff salaries are raised by ELI. But the majority of medicines and treatment supplies are not. When we get donations it is great; but often we have to purchase our supplies. So we rely on the client’s payments for services to be able to replenish our stock and pay the electric bill. I always imagined that when I practiced overseas there would be no fee for services. Boy was I clueless!

Please pray for wisdom for our entire staff as we encounter situations like this. I truly hate them! But I understand and can appreciate the reasons for requiring payment. We also find that people are more responsible on following through with the medical plan/prescriptions when they invest something in the care themselves. Ah the joys of rural African healthcare!!! In fact right now I had planned to be at work in the Training Center office. But I’m still at the clinic. I have a patient I’ve been following since Nov. She is a specialty case and I want to see her myself. She was supposed to be here a few hours ago. But I just got another phone call “Michelle I promise I am on my way!! Please don’t go!” Since she comes quite a distance I’ll sit here and wait. But she has been a great patient and an encouragement to me. I’ll try to get some pictures of her today so I can share her story with you in the future.

Poverty

Poverty. That word is an intense one. I honestly can't say that I really understand poverty at all. But I do know that while I was living in the States I really had no concept of what true deep poverty really is. I still don't understand it but I'm learning a lot in a hurry. I can tell you this much, it is closely associated with hopelessness. I had a heartbreaking case in the clinic this AM.

A mother brought her four year old child in to the clinic to be treated. As she carried her daughter into the room I noticed the child's arm was just hanging down beside her. The arm twisted as the mom sat on the chair and the child did not respond at all. I immediately thought "Oh, crap! This kid is in bad shape." I know, not very professional, but it turns out I was right. After a while of working in the medical field you start develop a bit of a sixth sense that tells you when things are really not right. Last time I got that feeling the baby died a few hours later. I was getting that vibe again.

Very quickly we could see that the child was malnourished. Plus she had severe pitting edema (swelling from fluid in the tissue). It was very scary because the edema went all the way to her face. She was listless and minimally responsive. She also had something going on with her skin. It actually reminded me of patients in renal failure who have not had the dialysis they need. My colleagues and I were in agreement that she needed to go to a hospital immediately.

The single mom informed us that she did not have any money at all. Could we please treat the child so she could take her home? We had to very clearly explain that her daughter was in grave condition and needed to be admitted to the hospital immediately. The mother began to weep. She told us that she had no money at all. She had no way to get to the hospital or to pay a hospital bill. She also said that she couldn't leave because her other four children would be left alone with her drunkard brother and sister. (Yes they say drunkard, not alcoholic here!)

I started working the phone trying to see what kind of help I could get for her. And I kept hitting dead ends. We finally had her sign a form agreeing that she would repay the cost of fuel later to take the ambulance to the hospital. We sent her to a government facility that we heard used to have a policy of providing free emergency treatment for children under the age of 5. We don't know for sure if that policy is even still in existence.....

It turns out that one of our staff members at the children's home is a neighbor of the woman. So she agreed to bring the children home with her for tonight. I really don't have any way of following through to find out what happened. I prayed with the crying mama right before we took her and the daughter out to the ambulance. Then I placed her in God's hands.

This situation left me shaken. I later talked with my friend Juli about the situation. She told me that often her and Allison use their personal funds in situations like this. Otherwise the child dies. It just blows my mind that this sort of thing happens. I do know that from now on I'll be carrying my wallet with me when I go to work.

Newlyweds

William and I are newlyweds!!! Ok, I know that is a funny comment to make. But you know I think this week is the first week that we have been able to just enjoy being newly married. In less than two weeks after our wedding Kenya started to come apart at the seams. We were under so much stress that I believe we were more in survival mode than anything else. There were discussions of emergency evacuation plans etc. as we watched our community and country fall into utter chaos.

Then just as an agreement was reached and a sense of calm descended upon the country we had several family emergencies come up. So this last week was our first week of peace and calm in the Kiprop family. Not to say that we haven't enjoyed being married or that we have been fighting or anything like that. We have just had too much on our plate to relax and take time to really enjoy being together and having fun. This weekend we slept in on Sat and Sun. We stayed around the house and played with our animals. It was so nice to have a sense of normalcy and some time to just let our hair down. We are now looking forward to what the rest of this year will hold for us.

Dreams

I find that lately I have been dreaming a lot. Now that I've been at the clinic for a few months I'm feeling a little more settled into my role there. It is amazing the difference that this little community clinic is making. We are well on our way to becoming a medical center. The number of patients continues to increase each year. We are also in the process of expanding our services. By the end of the year we should have a dental office and optometry in addition to our "usual" medical services. We are also hoping to move our home based care team (Tumaini na Afya) over to work out of the same location.

What is amazing to me is that up until this week we have been functioning with two Kenyan RN's, myself, a dental tech (who comes once a week) and a pharmacy student doing an internship. Often the flow of patients is so massive that it is hard to think about preventative health care. But lately I've been dreaming of ways we can improve the quality of health care we provide.

As of today we have two new staff members joining us. One is a Clinical Officer (very much like a PA) and the other is a lab technician. In the last few weeks the other nurses and myself have been talking about what a difference it will make to have a few extra pairs of hands.

So what am I dreaming of? A whole lot! Here it is:

1. Typhoid Immunization. It is crazy to me that if an American plans to travel to Kenya he or she must first be vaccinated against typhoid; but the Kenyans who live here don't even know that there is a vaccine against typhoid! The cost of vaccination is just under $5 per person. But treatment of typhoid runs around $320 if you have a bad case. My hope is to at some point this year hold a month long Anti-Typhoid campaign. I would love to have one day where we go to a public location and offer the vaccine to everyone in the community. Right now I'm doing the research to see what it is going to take to make this dream a reality.
2. Well Children's Clinic. We currently hold an immunization clinic on Tues and Thurs every week. The mama's bring their babies to get poked and weighed. And then that is the end of it. Honestly up to this point I don't see how any more could have been done. There just hasn't been the manpower around to pull it off. But I would love to actually do physical and developmental assessments on all of the children. If diseases and disorders are picked up early and life there is so much more that can be done about them. Often even to the point of saving lives.
3. Women's Clinic. We currently provide prenatal care and that is the extent of our women's health program. Did you know that cervical cancer is one of the easiest cancers to treat with a very high curative rate? But if women are never tested for it how can they be treated? When one considers that many women in this area have HIV and that cervical cancer is a lot more common than HIV one can see that the need for screening and treatment is huge. For this one to happen I would need to get some further training and equipment. But nonetheless this remains a big dream of mine that I hope to one day see become a reality! When I spoke with our new clinical officer briefly last week she expressed that she also has interest in women's health care.
4. Hypertension Screening and Treatment. Hypertension (HTN) or high blood pressure is a big problem here. Unfortunately because patients with HTN don't feel sick it often doesn't get picked up. There isn't much understanding of the damage that HTN can do to the entire body. When clients are treated they often get a one or two week prescription and then that is the end of the story. I'd love to start screening for and treating this disease.
5. First Aid Many of our patients travel quite a distance to get to us. Often if some basic first aid could be performed before arriving at the clinic it would make a drastic difference in the patient's overall outcome. Simple things like applying pressure to a bleeding wound need to be taught. I'd love to develop a one day course in basic first aid. We could start be offering it to the Empowering Lives Staff and then offer it to a broader audience.

So there you have it! Some of my dreams for medical work in this community. I'm learning so much in my daily practice in the clinic. This truly is FAMILY practice. We do everything from delivering babies, to treating illness and injury, to managing chronic illness in the elderly! You never know what will walk through the door next. I'm loving the fact that I am living my dream of providing medical care in rural Africa!

Msichana!!!

Today I helped deliver a baby girl (msichana). As soon as we brought the mama in the delivery room we noticed her huge abdominal scar. She had had a c-section for her one and only previous pregnancy. Not a good thing! This says a few things to the practitioner.

1. Something went wrong last time (which means her chances of something going wrong this time just went way up!)
2. She is at risk for a uterine rupture during contractions

Her contractions were only 2 minutes apart and she was fully dilated when she arrived. But the baby was not engaged at all. So let me translate that into English. (No I didn't mean the baby should already have a fiance!) The contractions were close enough together to tell us she was most definitely in advanced active labor. The inside opening for the baby was completely open. BUT the baby was not in position to come out. Realizing that this could mean even more strain on that poor uterus we called for the ambulance to come and be on standby.

My colleague John Makan said "Don't worry Michelle, God is going to deliver this baby". Right before the ambulance arrived that little msichana scooted into position. In less than an hour a baby girl was born! Both mom and baby are doing great. In fact they will probably go home this evening. Today was one of those days where I really love my job.