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.

Good News

Not just good news, terrific news! Kibaki and Raila have come to an agreement for shared powers in Kenya. Why is this so good? Because it means that the months of conflict should now be over. All of my Kenyan friends are declaring that life will be back to normal soon. Although I have to wonder..... With all that has occurred in the last two months how can life go back to normal overnight???

Online Donations

I've recently been asked several times if there is an easier way to donate than sending checks in to the office. William and I are now able to receive online donations through Logos. Just use the following link: https://giving.logosmanager.com/ and register through the site. Our account is currently in my name: Michelle Kiprop. Thanks for your partnership!!!

Toulouse

Toulouse, originally uploaded by momentswithmichelle.

We inherited Toulouse from another missionary family who moved away. She is great at catching rats!!!