Sunday, February 28, 2010

Sunday Thoughts

Yesterday I was at a Seventh Day Adventist Church for the entire day. As a clinic we have been doing quite a few health-education outreaches lately. We had been invited by this particular church to come and give a health presentation after the service. We arrived around 9AM and took part in the morning small-group Bible study. That was followed by the service. Let me tell you that church can sing! I felt like I had stepped into a concert hall with all of the beautiful melodies and harmonies.

After the church service it was time for lunch. This is where the fact that I was the only white person in the group became really apparent. We were served a very traditional lunch of maize and beans. As I was eating my lunch I spotted a bug, then another, and then another. That's when you have to make the decision to stop looking for bugs, focus on the people around you and just eat!

As we finished up the meal I was surrounded by children. Now most of these children have seen a white person before but not touched one. I told William last night that I kind of felt like I had become an animal in the petting zoo. I had so many children trying to shake my hand, touch my arm or stroke my hair. Because I live in a village where the people are used to me and other wazungu (white people) I don't get the reaction of kids clambering to touch me on an everyday basis.

After the visiting time, the church had a scheduled business meeting. By the time we were starting our presentation I think it was around 4PM. Needless to say, it was an all-day experience. But we had lots of interest and lots of questions at the end of the presentation. I'm glad we went!

Next week is going to be pretty full, so I had decided that after an all-day church experience on Saturday I was going to make Sunday a day of rest. I slept in a bit and then enjoyed breakfast with William. As we ate, he put on a slideshow of all the pictures from our visit to America in 2008. As we saw pictures of people surrounding and encouraging us we were both blessed. It was a wonderful reminder of the team we have back in the USA and around the world who are standing with us in our work here! As we saw pictures of specific donors or prayer partners we took a moment to thank the Lord for their partnership.

My heart was filled with the knowledge that sometimes we can be the hands and feet behind the heart and mind of those outside of Africa. We truly are a body doing ministry together! So to those of you who help make it possible for us to be here, please know that you are truly appreciated. Have a beautiful Sunday!

Friday, February 26, 2010

The Degree's I'm Missing

Sometimes, when I feel that I have to be a Jack-of-all-trades, I wish that I had more education to back me up. I think by now I should have earned honorary doctorates in flexibility and creativity.

Yesterday I was wishing that I had formal training in accounting. I have always HATED math and dealing with numbers. Just ask my dad who persevered through my tears in teaching me my times tables. As the clinic administrator I handle clinic finances. I've been keeping these beautiful spreadsheets updated. (I just learned how to use Excel last year!) But it's about to get a lot more complicated as I'm learning the Kenyan way of managing a checkbook and bookkeeping. They prefer paper to electronic. Say a prayer that I maintain my sanity!

Today we had another one of those complicated cases that makes me wish I had a strong background in social work. I'm telling you, being a medical provider in a village definitely has different dynamics than being one in Southern CA! Two of our community members got in a fight early on in the afternoon. We could hear the emergency village alert screams coming from across the river but didn't know what was going on until the wounded started showing up at the clinic.

The first patient had his head cut and needed suturing. The other man didn't show up for a few hours. But when he arrived we could see the situation was critical. He was intoxicated and had been stabbed in the flank. The wound was extremely deep. He needed to get to the hospital. The challenge was that he didn't have the funds to pay for the fuel to be transported. What is really frustrating about this situation is that one of my colleagues had hired him for a short-term labor job. She paid him a decent sized sum of money for the work just last night. So we knew that less than 24 hrs ago he had more than enough money to handle the situation.

We had to call the family to get them to pool resources to buy fuel for the transport trip to town. It's times like this when I really wish I could pick up a phone and activate the social services system. However it never ceases to surprise me how families and community members do come together at times like this. Hopefully the man's internal organs weren't horribly damaged. After all he does have a family to take care of (and an alcoholic habit to break!).

As I was in the process of writing this post I was reminded of a third skill I've had to acquire, grant writing. We just received word that our clinic has been chosen to receive a grant for a medical referencing program. I had applied for it last year and actually forgot that we were waiting for an answer. I recently applied for another grant which would fund us for a women's health education program. Please pray that our proposal is looked at with favor during the review process. We won't find out about that one until sometime in May.

Well I need to finish up a brochure I'm designing for the clinic and then I'm going to call it a day! Tomorrow we are doing an outreach project at one of our staff member's church. Have a blessed day!

Wednesday, February 24, 2010

Baby Warmer

At the clinic we recently had this awesome "Baby Warmer" custom made for us. Thanks to a generous donor in the USA we were able to design and have this piece of equipment built for our maternity unit. Heat loss in a newborn can be a serious situation. So it will be a huge blessing to have this unit to assist babies who are in distress or just need a little warming.

The unit can serve as a crib, a warmer or a resuscitation unit. There is a heating unit on the left side that blows warm air on the baby.

The front and right side break down so that the nurses can get in close to the baby to do emergency procedures if needed. There is even a hidden drawer on the right side where emergency equipment can be stored.

Phoebe, one of our expectant mamas was checking out the new unit with our nurse, Percival.

Friday, February 19, 2010


Well I had this great plan of trying to make sure that I get at least one blog post up every week. And it's been more than two weeks since my last post. Oops! Sorry for those of you who regularly check!

It feels like the last few weeks have really just flown by. It's been good though. I spent quite a few hours pounding out a grant proposal. I've been dreaming about doing a big women's educational outreach for a long time now. So I've recently applied for a grant to run an education program for the women and girls in our community. After all those hours of work to get it submitted before the deadline, it's a bit of a let down to realize that we will have to wait almost four months to hear if we will be awarded money for our project!

We did a photo shoot with the clinic staff earlier this week. I really believe that we have been blessed with an awesome staff! It's been exciting to see the different people who I believe God has hand-picked to work together in this ministry. It's great to see the heart's of compassion that they have as we reach out to patients on a physical, emotional and spiritual level.

In these last two weeks our friend Juli brought in the first two patients for her new work, Living Room Ministries International where she will be providing hospice care. As the ministry is just launching she doesn't really have a regular working staff yet. There are a few volunteers from our community who are cooking and care-giving to these two ladies. One of the patients really needs a high level of care and has been suffering for some time. The building the patients are staying in is on the same compound as our clinic. So we can all hear her regular cries of fear and pain. I told Juli that I was willing to assist her however I could, and we made arrangements for me to come assess the patient's pressure sores and help put together a skin-care plan.

Some of our clinic staff members came to my office yesterday before I left and said that they want to help Juli and her patients. So a few of our staff joined Juli to help care for her patient yesterday afternoon. It was a heart-breaking and moving hour as we assessed her skin and provided wound care. As I would approach her wounds she would cry out and scream like a fire-siren in both fear and pain. There were moments where I wanted to put in ear-plugs or run out of the room. But there were other moments where my heart was so full of love and compassion it was overwhelming. As I would take this beautiful woman's hand in mine and look in her eyes I could see Jesus. She would make eye contact through the tears and one time did her best to smile at me.

Please pray for Juli and her team as they launch this powerful new ministry. Pray also for our clinic staff as we will often be working closely with the ministry in our work. It is such a blessing to me to see what can happen when a group of people not only listen to the call God has put on their hearts, but respond to it in action!

Friday, February 05, 2010

INSANE 24 Hours

WOW! The last 24 hours have been absolutely insane! If I hadn't put up two posts yesterday I wouldn't even know where to start. We've had a few major events since the last post. Here are the highlights and then I'll go into details below:
  1. My sister Danielle Buckland gave birth to her firstborn a little before 6PM on Feb 4th. Baby boy Lex had some complications and may have to spend some time in the Neonatal Intensive Care Unit (NICU)
  2. Right around closing time at the clinic here in Kenya, we had a twin delivery. The second baby had complications and we provided support resuscitation for over an hour before she perked up.
Now for the details! If you read my posts from yesterday you will know that it was a rough morning and our staff were already wiped out by mid-afternoon. It's been over a year since we had a patient die at our clinic. So our staff took it pretty hard. Especially because we all thought that this little girl was going to make a full recovery. We were able to get her body transported to her home where she would be buried.

Late in the afternoon we had a mother in labor arrive. She was already dilated to 7-8 cm so she was too far into labor to refer out. On assessment Kiptoo found she was carrying twins. Baby girl #1 delivered just fine. The problem was that part of baby girl #2's umbilical cord came out with baby #1. The danger of a prolapsed cord is that it will be compressed as the baby delivers. Basically the cord gets squeezed during the delivery process. That squeezing cuts off circulation to the baby thus depriving her of oxygen.

As soon as we saw the cord, the power went out and the room went completely dark. Thank God we had some awesome donations of head-flashlights by some teams last year. We now keep one in each department. So I fumbled around finding the maternity headlamp as someone else ran to get a second one. In less than a minute I was gowned and gloved and reaching in with my fingers to decompress the cord. I could go into a lot of graphic details here but I've probably already gone a bit to far....

So finally the baby was delivered in the dark and was pretty much non-responsive. No breathing, but she had a strong heartbeat. So we initiated support breathing with a resuscitation bag. After a few minutes the heartbeat dropped below 100 so we began support compressions. We were now doing CPR for the second time in one day. A pretty big deal for our little clinic!

We continued with supportive resuscitation and suctioning for well over an hour. I kept doing spot checks and kept finding a decent heartbeat. Our team decided that as long as we had a heartbeat we would keep going. And we were thrilled with the fact that the baby never turned blue. About thirty minutes in she started trying to gasp every few minutes. As her gasps got closer and closer together our faith grew. Her sister start crying and we told baby #2 "Can you hear your sis cheering for you? Come on breathe little one!". Then as I would suction her she would make an effort to suck on the tube I was placing in her mouth. Soon enough she started breathing steadily on her own. Within a few hours she had a hearty cry and was breast-feeding. Mom and both babies were doing great when they discharged this morning.

It was late by the time I got home. After assisting with a delivery I always want a hot shower. Our shower uses electricity to heat the water and since the power was out I heated water on the stove to get washed up. We had scrambled eggs for dinner. Sometimes I wish we had take-out or could call for a pizza!

About 20 minutes after I went to bed I got a call from my sister Danielle that her water and broken and she was in labor. She delivered a baby boy a little before 6PM CA time. Baby Lex had a double nuchal cord which means that the cord was wrapped around his neck twice. He was born almost three weeks early and was 6lbs 5oz I believe. My sister had gestational diabetes and when Lex was born his blood sugars were extremely low. There was talk about sending him to the NICU but they are trying to bring his blood sugars up while he is with Danielle and Brett.

They are closely monitoring the situation and will take him to the NICU if it becomes necessary. Danielle went totally natural for the childbirth and has already advised me that when it is my turn I should come to the USA and get hooked up with an epidural! I've asked them to text me if he gets admitted to the NICU. Otherwise I'll just call them in the morning (my evening) to check on things.

As you can probably imagine, I'm hoping for a calm, slow day today!

Thursday, February 04, 2010

From Hope to Tragedy

Well I don't often blog twice on the same day but I feel obligated to follow through on what happened to the girl in my previous post.

As I mentioned in the last post, she came in with malaria this morning and was treated. She quickly improved and was looking close to being ready to discharge home.

I was getting ready to wrap up some paperwork when I got a call from William that there was a group of wazungu (white people) headed my way. He said he met them on the road and they wanted a tour of the clinic. They arrived just a few minutes later.

I was starting the tour with them when our receptionist came and told me that Kiptoo (our most experienced nurse) needed me NOW. I knew that there was no way Kiptoo would have interrupted a clinic tour for something minor. I rushed to the observation room and found him with emergency resuscitation equipment and our little girl. In medical terms she had crashed.

I gave myself about two seconds to get over the shock and then started in with CPR. We worked on her for a good half hour doing CPR and giving resuscitation drugs before acknowledging that she was gone and there was nothing more we could do.

Her mother told us that right before she got really sick and became unresponsive she told her mom that she had fallen out of a tree that morning but hadn't told anyone at the time. She said that her chest had been hurting since but she didn't say anything because she thought she would be in trouble.

Our staff all came to the conclusion that she must have had internal injuries from the fall. Because her malaria was turning around and we thought things were looking great before she suddenly crashed.

Talk about a rough day! We then had to go out in the hallway and break the news to mom. We took her in my office. It took a while for the fact that her daughter had just died to really settle in. The moment it really hit her she doubled over and began wailing. My eyes filled with tears as I wrapped my arms around her. Days like this are so hard. Yesterday we victoriously helped save a young life, today we lost one....

This is How We Do It

Every now and then I'm reminded of the vast differences of practicing medicine in the USA and in rural Africa. This morning I had another one of those little reminders.

Before moving here I had worked in an emergency room for a few years. Whenever we had a patient come in by ambulance we would get a phone call ahead of time. Before the patient arrived we would know the age, sex, chief complaint and some vital statistics on the patient. The patient usually had an IV in place by the time they arrived. Once the patient arrived a team would practically pounce on him/her drawing blood, giving medications, prepping for x-ray/CT scan etc.

This morning one of our nurses, Percival, came and got me from my office. "We have an emergency on the way. It's a child maybe about ten-years-old." I was surprised that she had this info in advance. So I asked her if someone had called to let us know that the child was coming. "Oh no, I just looked out the window and saw the mom carrying the child here." By the time we got to the front of the clinic the mother and child were almost here.

Sure enough it was an 11-year-old girl with severe malaria. Fever of 103.6, vomiting, weakness, headache, body aches etc. When I first moved here I probably would have motioned to send such a case to the hospital immediately. But with time I've learned that our clinic can manage a much higher acuity than I would have expected. Time and time again I've seen these cases turn around with just a few hours of treatment in our observation room.

Don't get me wrong, we do refer patients to the hospital, just not as quickly as my American mindset originally thought that we should. Yesterday we sent a 12-year-old girl to the hospital. After an hour of treatment it was clear that she was not improving and was possibly even getting worse. We all started working the phones looking for a vehicle to take her. It wound up being our ELI Kipkaren director, Peter who drove her to the hospital in a vehicle from the Training Center. As our staff carried the girl to the car and tried to make her comfortable the thought crossed my mind "This is how we do it." No fancy Western-ambulance transfers, no medical transport team, no frills, bells or whistles. But we always do the best we can with what we have to work with. And our awesome little team saves lives every week.

Peter later reported to me that the doctors who first saw her told him that there was nothing to do for her at the moment because our clinic had already done so much. The last update was that they would admit her for observation and do lab tests continuing the treatment we initiated in a few hours.

Our little girl today got some IV fluid, quinine, antibiotics and medications to stop the nausea and bring down her fever. After an hour her fever had broken and she was resting much easier. We will keep her for a few more hours to make sure she is really on the mend before letting her go home. She'll have to return for another injection tonight and again tomorrow morning.