Wednesday, July 29, 2009

Out of the Woods

Today has been a super intense day. It's pushing midnight but I know if I don't write right now it won't happen. This morning a friend and family member of William and I attempted suicide. One of the challenges of being a medical provider in a small community that has two medical providers is that you frequently have to care for friends and family.

The patient arrived at the clinic just a few minutes ahead of me this morning. As I walked towards the clinic I saw a vehicle and a crowd. Never a good sign... I heard there had been a suicide attempt and the other nurse was with the patient. When I heard the patient's name my initial response was "no way!" But when I walked in the room I found it to be true.

Our friend had diluted a large volume of a poisonous pesticide in water and chugged it. I honestly don't have much experience with poisonings. His pupils were pinpoint, he was vomiting and dripping sweat. My colleague, Kiptoo had given him a shot of Atropine and induced vomiting. I went to work tracking down the poison and it's treatment.

Kiptoo was running mobile clinic today so less than an hour after I arrived he left me back at the main clinic with the lab tech and pharmacy tech. Everything I read up on the poison said that the first 24 to 48 hours are critical and that respiratory failure can pretty much happen at any point during that window of time.

Throughout the morning we continued to induce vomiting and get him to drink milk to help neutralize things. I was running an IV of normal saline. He continued to be very out-of-it with slurred speech, impaired motor function and pinpoint pupils. His breathing however was holding stable. By lunchtime I was getting pretty frustrated that there had been no improvement and kept thinking about the possibility of respiratory failure. I had given him another dose of Atropine but that was the last dose the clinic had.

I kept wishing that I just had someone with a lot of poisoning experience who I could talk to and get advice. Then it hit me, I have a friend who is an ICU physician at Kijabe Mission Hospital (about five hours from here). So I called her up. And boy did she know poisoning! It seems that in Kenya when someone wants to do him/herself in they typically take poison. She talked me through everything I needed to do and I went back into the patient room with a renewed confidence.

She had encouraged me to keep giving frequent high doses of the drug atropine through his IV. I called our driver (who happened to be picking up a body from the morgue) and asked him to bring Atropine back with him.

During the afternoon I also saw several malaria cases, infected wounds, did a sports physical and removed a bean from a four-year-olds nose! Oh, and we had another critical patient who had to be transferred to the hospital.

At 6:30 this evening my patient's eyes dilated then became reactive to light. I could have jumped up and down for joy. I wanted to shout "He's out of the woods!" but quickly realized that no one would know what that meant. So many people were praying for him today!

The other nurse and myself are taking turns checking on him throughout the night. At my last check I found that he was stable enough for me to remove his foley catheter. We will likely discharge him in the morning.

I spent a few minutes talking with him and sharing with him how important he is to William and I. I told him that when I moved to Africa I didn't know I would find a family here. But that he has become my brother and he means a great deal to me. I had been praying with him throughout the course of the day as I wasn't sure if he would live to see tomorrow.

Please join me in praying for this friend. Pray for healing of his body, mind, and spirit. And pray for wisdom for myself and Kiptoo as we continue to encounter difficult situations like this one. Thanks for reading and thanks for caring!

Tuesday, July 21, 2009

Social Issues

*Please note that this blog posting contains adult content not suitable for children.

As I write today my heart and mind are both very full. It's been an extremely full day today. It seems that I've now been in Kenya long enough that I've really been accepted by the community. It is amazing to me the issues that I'm being made aware of by Kenyan friends. Issues that I didn't even know existed when I moved here! What is really exciting is that since I first started learning about these issues late last year I've had Kenyan ladies approaching me asking me to help them start tackling some of the challenges. Some of these things have been in my heart for a while. I've been waiting for the right timing and it seems that the time is now.

About five months ago a gogo (grandmother) brought her 15-year-old granddaughter into the Mama-Baby clinic we hold every Tues and Thurs. The girl was shy, embarrassed and quiet. The grandmother wanted her to get a pregnancy test. Sure enough it was positive. I've been having monthly check-ups with the young mom ever since.

Today during Mama-Baby clinic she showed up in labor. The exam showed that she was going to have a tough delivery. I won't go into all the details but sure enough, it was a really tough one. This was one that I'm guessing probably would have become a C-section in the states. We wound up doing an episiotomy and pushing/pulling the baby boy out.

The baby needed some resuscitation before he started breathing. The mom looked like she didn't want to have anything to do with the baby. It was a difficult situation. Thankfully there were some very supportive relatives who showed up after the delivery to help take care of both mom and baby.

During the delivery I was running back and forth between the clinic room and the delivery room. I finally had to ask the many moms who were waiting to be seen to wait until the new baby came. They waited patiently. I apologized for the long wait and one woman said "What can you do? A baby comes when he wants to come!"

These teenage pregnancies are always tough cases. When I first moved here I would hear people talking about how "our girls need to be educated" and I always wondered to myself "What about the boys?!". I've since learned that most of our teenage pregnancy comes not from teenage boys but from married men in their 20's and 30's. (Although I still think educating the boys is critical!)

It just so happened (maybe a God-incident?) that one of my friends who is a local school teacher stopped by the clinic to talk to me this afternoon. She wanted to talk about the issue of teenage pregnancy. I told her that one of her students had delivered earlier today. We talked about how many girls are offered clothing items, food or maybe a little less than a dollar in exchange for sex. Most of the men making these offers are older and typically married.

We also talked about how abortion is becoming more and more common in our village. I've seen several post-abortive women with severe physical complications. Abortion is illegal in Kenya but many women seek out medical professionals who are willing to do one off-the-record. Others try to drink soap or herbal concoctions to induce labor. I've heard some pretty terrible stories in the past few months.

My teacher friend pleaded with me to come and meet with the girls at her school. We have set up a date for me to go on September 15th for a health education class. We decided that I should try to start coming on a regular basis to work on building relationships and trust with these young ladies.

I've also got another project in the works related to women's health. Since I first started working with the Mama's and babies I've wanted to increase education in the community. At the beginning of this year I was approached by another Kenyan friend who happens to be a pastor. She asked me if we could partner together to start women's health classes. She will do a devotion and then translate my lesson for me. In the last few months as I would treat women and their children I would ask them if they would be interested in health education classes. The response has been overwhelmingly positive. In fact, last week two ladies asked me when the first class will be held. Helen and I will have our first class with the subject of family planning sometime in August.

I have to confess that there were times last year when I wondered if I was really doing anything worthwhile. I felt that I didn't quite know exactly where I fit in, in both the ministry and the community. But it is absolutely amazing just how much I feel a part of the community now. I have really found my niche and feel like God is using me to touch the people in our community. And to think the adventure has just begun! I look forward to seeing where God will take these new ventures during the rest of this year.

Monday, July 20, 2009

Long Time No Post

Sorry it has been so long since you last heard from me! I promise that I will do my best to very newsy post up very soon. It's been a very full month thus far. But day-after-day I'm reminded that God's grace is sufficient for each new day.

Yesterday someone from a visiting team (awesome team by the way!) snapped this shot of William and I after a church function. The picture was taken in our front yard. I know it's been a while since I've put up a photo of the two of us so I thought I would get this one loaded with a promise of a more thorough update to come soon.