A Special Opportunity

As I continue to serve here in Kenya with Empowering Lives International, it has been exciting to see God work to change and heal both lives and hearts.  Every now and then I meet a special individual or community that has an urgent situation that brings me to my knees and I feel compelled to reach out and share the story. This is now of those times and I wanted to share with you about a special opportunity. I'd like you to meet Karen, an eight-year-old Kenyan girl who loves going to school and playing soccer with her friends. (Picture attached) Unfortunately Karen can no longer play soccer and has a difficult time getting to school and back.  You see, Karen has a hole in her heart.  And it’s a pretty big hole.  Without open-heart surgery she won’t make it to adulthood let-alone finish school, or ever be able to play soccer with her friends again. For the last month I've been praying for Karen and trying to seek out opportunities to get her surgery.

I recently learned that there is a special team of heart surgeons coming to a mission hospital in Kenya to do just these sort of surgeries.  I've managed to get Karen's name on the list for an evaluation which will happen just about two weeks from now.  The team will be returning to Kenya several times next year.  So they will evaluate all of the children needing heart surgery on this visit. Then they will perform surgery for the kids who are deemed to be most critical.  They will return next year to perform surgery on the remaining children.  We aren't sure yet which group Karen will fall into.  But we do know that we need to raise approximately $3,500 to cover transport, housing, and surgical, and hospitalization expenses.  This is an incredible opportunity as I had previously been quoted $50,000 for the surgery.

I would like to ask that you be praying for Karen and her family during this time. Pray that the funds will be provided in enough time to get her seen by this team of doctors.  Pray for Karen to stay strong until she can get her surgery. Pray for a total healing of her body.

If you would like to partner in helping Karen to get her surgery please click here  Once you get to the page you will click on "Ministries/Programs" and choose “Kenya Health” from the drop down menu and then write in "Karen's Medical Fund" in the comment section. All donations are tax-deductible. Your contribution will go towards helping to save Karen's life and giving her, her childhood back.

Thanks for standing with Karen during this challenging time!

A God Moment

 

This post is a little on the longer side, but I just couldn’t figure out how to cut it down. It was a powerful experience that I believe is worthy of the details.  We recently had a visiting team of nurses and nursing students from UCLA volunteering with us. The team members were anxious to help deliver a baby and were thrilled when late one afternoon a mother came in, in active labor. I wasn’t on call that night and William wasn't expected to arrive until supper. I needed to get home to relieve my babysitter

Right as William was pulling in I got a text from the clinic saying that the patient was pushing. So I headed over to join in. Something just didn’t feel right about the situation. As the patient progressed I decided to do an exam. During the exam I had a hard time knowing just what I was feeling. Was it a baby’s face? Then I felt little digits. I looked at everyone in the room and said “I think I just shook hands with the baby!” Any time it’s not the head coming first, things get a little complicated. So I called in our most experienced midwifery nurse from home to please join our delivery team. I asked if an ultrasound had been performed. The on-call nurse that night happens to be new to the clinic and hadn’t been trained on the machine yet. (As a side note, the mom was 8cm when she arrived so realistically there wouldn’t really have been time to refer her to the hospital anyway.) We pulled out the machine and could not find the head. Doing an ultrasound on a woman in active labor who is pushing is NOT easy. We were not sure if the head was already in the birth canal or up under the ribs somewhere.

So our experienced nurse, Triza, did a manual exam. She looked up and our eyes locked. “Michelle, that was not a hand you shook. It was a foot…” In that moment I believe the same memory washed over both of us. Two summers ago we worked together on what is my most horrific medical experience to date. It was a breech delivery where we lost the baby and almost lost the mom. You can read about it here.

From that point things got pretty wild. I knew that there was a HUGE chance that we were going to need to do resuscitation on the baby when we finally got him or her out. So we put the visiting team into action setting up all of the equipment we might possibly need. Triza and I began talking through that case from two years ago. What could/should we have done differently? What can we do now? We came up with a game plan. It was a HUGE blessing having so many skilled hands in the room. The patient was a young mom who was not cooperative at all. She began kicking and thrashing quite a bit as things progressed. One of the student nurses actually wound up at the head of the bed just trying to prevent her from kicking us in the face.

I sent a few nurses to my office to search my textbooks for any instructions on a footling breech delivery. Every book they looked in advised an immediate C-section. I’ll spare you the details, but thanks to God’s grace and past experience we were able to get the baby out much faster than I was expecting. At one point things were looking a little grim and I asked the visiting team that if anyone felt that they couldn’t handle what was to come they should please leave now. Everyone stood strong!

As I was guiding the baby’s body out, I could feel a slow but strong heartbeat. I knew there was hope! The baby was born blue, motionless, no crying, and no breathing. But her heart was beating, just too slowly. We immediately began team CPR. Part of the resuscitation process involves keeping the baby warm and pumping oxygen directly into the lungs with something called an ambu bag.  Because of the third world electrical wiring we can’t run both the oxygen condenser and heater at the same time. So we had this system going. I would yell out OXYGEN and the nurse in charge of that machine would switch it on, while the nurse at the warmer switched it off, then shortly after we would switch again. I was alternating between doing the respiratory resuscitation and using a special devise to suction out the babies airway while another nurse did the chest compressions. It was a beautiful dynamic. Within a few minutes the heartbeat picked up and the baby began to breathe independently.

Once it was clear that the baby was in the clear, we continued to provide support with blow-by oxygen and heat. It is extremely rare (as in I’ve never had it happen before!) to get an action photo while a situation like this is going on. But once we knew the baby was in the clear one of the American nurses got some pictures. 

Suctioning the Baby's Lungs

Providing Blow-By Oxygen

More Suctioning and Oxygen

 Just after the above picture was taken the power went out in the room. We were all overwhelmed by the fact that the power had stayed on through the entire resuscitation process! One of the team members said it best, “It was a God moment.”

Just this last week the mom brought her daughter in for a well-baby visit. They both looked great. I hardly even recognized the mom. And the baby girl, well she is doing fantastic! She is eating well, moving well, and her reflexes are intact. Here she is!

To Hurt that We Might Heal....

One of the hardest things for me as a medical provider is inflicting pain to help bring healing.  This summer I became aware of a slum on the outskirts of a small community center just a 20 minute drive from our home.  This slum has over 600 family units living there.  One of the challenges faced in this community is that of chiggers or jiggers.  They are extremely small bugs that imbed themselves in skin and lay eggs there.  They create itching, pain, inflammation and infection that can destroy the tissues in the feet. Because they imbed so deeply in the skin they must be removed using needles and scalpels.  It is a tedious and painful process; but necessary in order to treat the patient. 

This hurting to heal makes me stop and contemplate a bit.  Just as in the medical profession it often takes pain to bring healing, so it is in our spiritual walks.  There are times when we endure emotional pain that actually leads to growth and health.  The key is in sitting still while we allow God to use the scalpel and needles to dig out the root of the problem.  It’s in remembering that He also has the soothing salve and dressings to help heal the wounds so that we might be better off in the long run.

 But let me get back to the main subject of this blog, the community with the chiggers!  Since the discovery of this need, we have been able to make a few trips to do chigger care clinics.  The first time we were joined by a few ELI interns who helped sponsor the outreach.  Click here if you would like to see some pictures from that outreach.  This most recent trip was made possible by a team of nurses and nursing students from UCLA who also helped us with the treatment of the patients.  Our next chigger outreach will take place on October 10^th with a few team members from Water of Life Church joining us.  They have also raised funds to help purchase shoes and socks for the patients being treated. 

Walking through the slum with supplies

Tools of the Trade

Setting up the Work Stations

The feet needed to soak before beginning treatment

This little Girl kept screaming at the nurse that she was going to call the police and report the nurse

Making the incision to remove the chigger

And there is the chigger with larva

Bandaged feet and waiting for socks and shoes

We were also able to distribute de-worming medication to the community

At the end of the day I climbed up on the rock behind the church to get a shot of the team with some of the patients and the local pastor

Inspiration

The lady on the left is my mother-in-law, Elizabeth.  Also known as "Mama William".  Every day she comes to spend time with Ryan and teach him a little Kalenjin, her mother-tongue language .  This morning she brought a new friend with her.  She excitedly introduced me to Rose (holding Ryan in the photo).  She shared with me that this last week Rose entered ELI's alcohol recovery program.  Rose was glowing.  She explained that she is a trained teacher but has been unable to work because alcoholism has totally disabled her.  She is thankful for the second chance she is getting in the program here.

What you may not know, is that a little over four years ago Mama William was sitting in her shoes. For William's entire life up to that point his mother had constantly battled with alcohol.  In fact it was so bad that she was incapable of properly caring for him when he was a child.  He wound up being raised in an amazing adoptive family.  But over the decades he continued to reach out to his mother. 

Shortly after we were married in 2007 she agreed to enter the ELI Anti-Alcohol program.  At that time she completely surrendered her life to God and turned her back on alcohol.  She has been sober since then.  What is an inspiration to me is that she now reaches out to others facing the same struggles she has endured.  When she looked at Rose she knew she could be an inspiration to her.  So she is walking the journey with her and providing encouragement and hope.

Recently some people were talking about how bad things used to be for Mama William.  She asked them to stop.  She reminded them that the past is in the past and that she has a new and redeemed life now.  I'm so blessed by the way she is dedicated to inspiring others!

An Opportunity

Last week I talked about a women's clinic that I volunteer at.  It's exciting for me to know that I can make a difference in the lives of women.  What is sad for me, is that it isn't happening here in my village yet.  I'm getting in a vehicle and driving 20 to 40 minutes away to provide this vitally needed service in clinics that have equipment but are lacking personnel.  But the women in my own neighborhood aren't getting that same level of care yet. 

It is my hope and prayer to begin to launch these services here in the Chebaiywa and Kipkaren areas this summer.  We are just lacking a few more vital pieces of equipment before I can actually begin.  In the course of the last four months I've been amazed at the donations that have come in to help enable me to launch the program.  I now have about 80% of what I need to start doing cervical cancer screening.  But I don't want to actually start screening until I also have the equipment to also provide treatment for pre-cancerous lesions.

Here is an opportunity for you to get involved. Would you consider making a tax-deductible donation to go towards this worthy life-saving cause ?

• $15 Pays for a complete cancer screening procedure for a woman
• $25 Covers the cost of treatment to completely wipe-out a pre-cancerous lesion with cryotherapy (freezing the bad tissue of a small lesion)
• $50 Purchases a bottle of medicine used to stop bleeding post-biopsy or treatment and has enough medicine that it can be used on dozens of women
• $75 Purchases a pair of biopsy forceps used for biopsying suspicious lesions
• $150 Purchases a surgical packet for performing minor surgeries to remove larger pre-cancerous lesions in-office during an out-patient procedure 
• $250 Pays for a special rubber-coated speculum needed when performing electro-surgical, out-patient procedures
• $450 Pays for a gynecology exam table
• $500 Gets us a tank of the gas used for performing cryotherapy (used in freezing off bad tissue)
• $700 Purchases an autoclave for sterilizing equipment between patients
• $3,000 Pays for the cryotherapy equipment

As you can see even a small donation can help make a big difference.  To learn more about the organization partnering with me to fundraise click here.  To actually donate to this worthy cause head over to this page and select "Kenya -Women's Clinic" from the dropdown menu while making the donation.

Asante Sana!  (Thank you very much!)

Blessed are the Flexible....

for they shall not be broken.  I first heard that phrase back in 1998 while preparing to lead my first team to Africa.  And how true it is! Today was an exercise in flexibility.  I was scheduled to see patients who screened positive in their preliminary cervical cancer screenings at one of the clinics about 20 minutes drive from our home. The clinic was supposed to run from 9AM until noon or one-ish.

Considering this is Africa and I had to catch a ride, I felt that I was doing pretty good arriving by 9:10AM.  As I walked up to the GYN room I passed six ladies sitting on the bench outside waiting for clinic to open.  I found the door locked.  The first nurse I found told me to go to another building and look for A.  Luckily A was the first nurse I ran into in the other building.  She told me that the electricity was out so we were going to have to move our clinic to the building that was hooked up to the generator. 

Okay, I can be flexible!  So I helped her start hauling loads of equipment from one building to the other.  I noticed that the number of women had grown to 8.  As we began to set up the new room I noted that one of the leg-rests on the exam table was missing.  We searched the room and found only a piece of the apparatus.  So I went back to the main room and stole a leg-rest from that table.  Those of you who know me in real life will be proud that I actually figured out how to attach the leg-rest to the table!  By then we were all sweating.  I had shed my lab coat and went to wash my hands in the sink.  Well it turns out that not only was the sink positioned so that it would poke me in the back as I examine patients, but it also doesn't have running water.  As I took a closer look at the setup I realized that all of my supplies would be to my left side (I'm right handed).  Not exactly an ideal ergonomic setup. That's okay, I can be flexible.  Plus I brought my own hand sanitizer with me.

Now we are ready to start!  But of course not.  The nurse informs me that the colposcope (giant microscope that I use for doing exams and guiding biopsies) has not arrived yet.  I asked her if she had any idea when it was due to arrive.  She told me that she just talked to the research assistant and that he told her he thought the vehicle would arrive to pick him and the equipment up shortly.  This is where my composure began to crack.  You see he was coming from an hour's drive away!

Thankfully I know about life in Africa (FLEXIBILITY) and I had brought a text-book I'm slowly working my way through.  I made some good progress on it today!  Finally by 11AM we were ready to begin.  Nurse A told me that I had 9 patients booked. 

About 7 patients in I asked "how many more".  The answer was 9.  I'm still trying to figure how that math adds up.  About 11 patient later we were finally done.  At one point someone called for a soda delivery.  So I had a lunch of orange fanta between patients while I filled out their charts. 

And of course the last four patients had to be the most complicated ones.  Thankfully with God's help I was able to handle all of today's cases with the exception of one.  I just could not get a satisfactory exam and had to refer her to see a physician in Eldoret.  I wound up treating several infections and a case of malaria in addition to what I was actually there for.

By the time I got home I was utterly exhausted.  When William asked me how my day went I told him that I was exhausted.  He asked why?  Well because I saw a gazillion patients (duh!).  "That's wonderful!" was his reply.  "You really got to help a lot of ladies today."  Thanks honey for reminding me that all of that flexibility ultimately does make a difference in this world!

A Non-Issue

One of my highlights of our recent trip to the USA was being able to attend the National Women's Health Consensus Conference which was held in Los Angeles.  In the past three years I have acquired a vision for women's health in rural Kenya.  The biggest and most immediate issue that has jumped out at me has been that of cervical cancer.  It is mind boggling that this is one of the leading causes of cancer-related deaths in Kenya when it is so preventable.

My friends who recently launched a hospice program in our area have already shared several sad stories of terminal patients they have or are currently caring for with advanced cervical cancer.

In the last two years I've been able to expand my training and skill set in the area of cervical cancer prevention and early intervention.  I've finished my training period and am ready to begin implementing what I have learned. 

So as I prepared to launch out it in this new area of providing women's healthcare at the village level, it seemed like a perfect time to attend a major conference addressing the latest in issues of women's health.  What surprised me when I received my conference agenda, was that cervical cancer would only comprise of one 30 minute session of this three day conference.

And then it hit me.  In the USA cervical cancer is a non-issue.  You rarely hear of someone dying of this disease.  We have such sophisticated yet simple screening methods that we pick it up before it becomes an issue.  We have the capabilities to do provide early intervention in the form of procedures and minor surgeries in simple office visits.  In-and-out.  Same-day!

There is not a lot of research and ground-breaking news in that area because quite simply, the West has it under control.  It is my hope and my prayer that the day will come in Kenya where we will be able to say "Cervical cancer, that one is a non-issue here!"

The Hand of God

This morning I saw the hand of God at work.  It was approaching 5AM and I had just gone back to sleep after feeding Ryan when I heard a knock on my window.  It was the nurse on-call at the clinic.  She quickly told me that she had a serious emergency at the clinic.  A mom who was 28 weeks pregnant was having a lot of bleeding, but baby had a strong heartbeat.

As I was getting dressed I was mentally reviewing possibilities.  None of them looked very positive.  I knew that I wanted to get an ultrasound quickly so that I could see if there was a problem with the placenta.  As I walked into the delivery room the nurse called out "the baby is here!".  It was one of those moments of sensory overload where my ER background kicked in.  You are thinking dozens of thoughts in a moment and trying to prioritize them all.  I saw a pile of blankets in our baby warmer which I assumed held the baby.  I saw a LOT of blood pretty much everywhere around the delivery table.  As I was pulling on a pair of gloves I heard a movement from the warmer.  Could it be?  Could a baby born at just 28 weeks without a highly specialized team to receive her actually be capable of making a noise?

A quick glance and I saw a little arm reaching up.  At that point I was pulling out all the stops.  The nurse was with the mom and a quick glance showed that she could do without me for a minute or two.  I immediately got on the phone to start working on emergency transportation even as I sorted out power cords to get our oxygen condenser up and running. 

With only one power socket on hand I had to choose between oxygen and warmth.  I opted for oxygen and got the machine up and running.  I put the baby's daddy to work holding the oxygen in front of the baby to provide what we call "blow-by" oxygen.  I then called William and asked him to bring the keys to my office so I could get a power strip out of my office to activate both oxygen and the warmer.  About the time the power strip arrived our stepdown machine (converts the power so that we can use the American oxygen condenser without blowing it up) started smoking and blew up.  William went to find me another stepdown while I got the warmer moving.  Unfortunately the second stepdown only accepted two-prongs and the machine had a three-prong cord.  So back up to the main building once more to raid the dental clinic for our last stepdown.  Finally we had both warm air and oxygen being supplied to the baby.

About that same time I got confirmation that miracle of miracles we were able to get transportation to take this mama and baby to the hospital.  The majority of the time it is next-to-impossible to get transportation for a case like this.  Many times we have put life-and-death cases in the backseat of our personal vehicle and taken them to the hospital at 3AM.  But praise God, transport was on the way.  AND the baby was not only pink, but was moving her arms and legs.  She looked to me to be more like 32 weeks along.  Still very early, but not as early as we had been told by the mom.

The nurse told me that shortly before the baby was born she had done a quick ultrasound and seen blood pooling behind the placenta.  This is what we call a placenta abruption where the placenta separates from the wall of the uterus before the baby is born.  This is an extremely life threatening emergency for both the mom and the baby.  It is nothing short of a miracle that both the mom and the baby walked away from this alive.  Mom lost about 1,500 mL of blood (that's 3/4 of a 2L soda bottle!).  She should be receiving a transfusions right now and baby should be in an incubator getting the neonatal intensive care she needs.

What a way to start my Tues morning!  And what an amazing reminder of God's power to intervene in situations that would seem hopeless.  When I first realized what was happening I felt fairly certain we would have two fatalities in our clinic today.  Thank you God for working a miracle!