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| Rheumatic Heart Disease (RHD), a complex infection from a simple untreated strep-throat infection. The fall-out is disastrous - with the heart valves narrowing from scare (stenosis) or becoming leaky (regurgitation)...or both. About 12 million people in developing countries (mostly children) suffer from RHD. Understanding the burden of this disease, Tenwek has partnered with a cardiovascular team from Vanderbilt and Brown. Their long-term partnership is aimed at prevention of this pediatric pathology, and surgically treating those with end-stage RHD and other inherited forms of heart disease. It was thrilling to be a part of this effort. Dr. White and the cardiothoracic surgeons operated everyday from early in the morning until sometimes after midnight. I was able to break-away from research in order to operate with Dr. White on two cases. For one boy, we reconstructed (valvuloplasty) his mitral valve, for the other we replaced the valve. We put the kids on ‘cardiac bypass’ and arrested their hearts while fixed the problems. It is a special opportunity to give these children a new lease on the life that has been given them. Some would say this type of tertiary treatment is extravagant for developing countries. I agree. It is extravagant and wonderful! We expect it for our children, why not for other children? It is made possible because these teams have determined to give of their time, equipment, knowledge, and resources. What they have to give is technologically advanced – but it is what they have, and they freely give it. Also, this long-term relationship is made possible by a certain man’s determination, self-sacrifice, and long-obedience in the same direction – Dr. White. An extraordinary example of a life honoring our God. | | |
| I'm hesitant to write another sad post, but....well, I had a sad morning. We had a lady come into Tenwek from another hospital, and she was quite sick. She delivered her baby six days ago, had heavy bleeding and a retained placenta. Sadly, the baby died. This morning as she had an oxygen mask on and was breathing very fast, that told us that she had been in this state for six days--since delivery. I was worried about her. So were some of my senior medical staff, others weren't. I was thinking that she needed to be intubated and put on a ventilator (breathing machine), but I was feeling my low position on the totem pole and didn't push it. A short while later, while I was getting ready for a C-Section, I heard there was an emergency in OB, and my heart sank as I was sure it was this patient. I went running to OB along with the resident, and sure enough, the internal medicine team (including Courtney--my good friend from med school who is visiting) was running the code (basically advanced CPR). I jumped in and did chest compressions (this was my second time to do chest compressions this morning) and could barely hold back the tears. We did all we could and tried to resuscitate her for fifteen minutes, but to no avail. Stopping CPR on a young, otherwise healthy patient is truly a horrible feeling. I couldn't help the tears, and frankly, I didn't really care that I was crying in front of my seniors, other patients, the nurses and interns. There are few tears here--largely I think because people who make it to the hospital are so sick to begin with and death is so common. But though I'm seeing death more than I do in the States, it still breaks my heart. I could only think of her five children at home and her husband, who not only lost his child, but now also his wife. I cried as I picked up the tubes and IVs and pulled the sheet back over her young body. It made me too sad to cover her face, so I just pulled the covers up to her shoulders, wishing that she were just sleeping. It feels worse because I think we should have done things differently, including intubating her. I wish I could do it again, and do it better. But I will not have that chance for her. Courtney gave me a hug and that meant so much. The resident, Muruka whom I respect and enjoy working with, also touched my arm in sympathy. They were sad too, which made the sadness easier to bear. It's hard to stay soft here. I know that I have to get a little numb to be able to stand as the waves of suffering and death crash around and over me. And even today I felt that I am starting to be more accustomed to the losses as I was able to keep moving with my day....as I walked out from the code, the nutritionist was waiting to talk to me about two of my patients and I just had to pull it together and move on. I'm trying to learn what it means to receive Jesus' invitation to give my burdens to Him. Soon after this tragedy, I had a bright spot in my week. One of my favorite patients, Winny (who was here for over a month previously, and I got to know her well) is back in the hospital with a very, very bad case of tuberculosis. She also was pregnant. I had been lamenting that I wouldn't be here when she came to deliver her baby (she was supposed to come this weekend, and I'll be gone). But, because of worsening cough and symptoms from her TB, she came early and we decided that we had to get her baby out since he wasn't getting much oxygen. So today I got to help deliver her baby by C-Section (he was breech). He is very small and didn't cry when he was first born, so I was worried about him as we were closing up her uterus. But he was resuscitated and is doing well. One of my happiest moments here thus far was giving Winny her beautiful little boy, Kibet and helping her start to breastfeed him. It felt like a dream, like a miracle. We all felt a sense of relief in that moment as we knew that we had cleared a major hurdle...her baby is alive, she is alive, and next week we'll plan to do a surgery for her lung and hope it can re-expand. Winny, in her broken English, kept thanking me. She said, "this baby is for you, Kibet is yours." I almost cried again. I told her that he is so cute that I do want to take him home, but that he needs his mama, and that I am so happy. I'm glad for some happy endings. God knows we need them. | | |
| Sigh.... I often have the weighty responsibility of telling women here that they have cancer. I agonized all weekend about going to tell a lady that she has cervical cancer. This is the third patient in a week for whom I have made this grim diagnosis. She's planning to get married in December, and of course wants children. So today I sat on her bed, held her hand, and with tears in my eyes told her the bad news. Not only that she has cancer, but also that she will need surgery rendering her infertile, and that even with surgery, she has a fifty-fifty chance of living another five years. She handled the news with such grace and strength. The word, "cancer" had the same shattering effect it does for anyone who hears this terrible word spoken over their bed. But somehow, she was able to hold this devastating news with an open heart. She told me that she will be okay, and that only God knows our future, and that she will trust Him in that. Oh, that I could have such faith.... I told her that I will pray for her, and that I will ask my friends to pray for her. So, I am asking you. Pray for her, that she will receive healing, strength and peace. And for me as I strive to be like her, and like the One I follow who held out healing hands to the suffering... | | |
| Okay, time for an update. Here's a snapshot of a few facets of our lives this week. Our friend Courtney has come to work at Tenwek for a month, and her arrival this week was a definite highlight! We were in the same class in medical school, and she's now a family medicine resident. It's sweet having her stop by for a cup of coffee on her way to the hospital or come by after work and we can go on a walk and debrief our day. She also brought a couple suitcases worth of goodies from the US! (Thanks Mom!) American diapers, hot chocolate, granola bars, brownie mix, American coffee, and some of Clara's bigger clothes.....all kinds of wonderful treats! Here's a picture of Courtney holding Clara in front of one suitcase of fun. 
A few times over the past few weeks, Jeremy and I have scrubbed on cases together, a dream come true! So far Jeremy has been helping me/us with difficult cases and is giving his general surgery expert advice. We in the OB/GYN department appreciate it! It's so fun operating with my hubby. :) 
Here is a picture of our house. It's called "The Garage House." It's a bit more appealing than it sounds, and has an interesting history. It was one of the first homes here at Tenwek--it was a garage (hence the name), but then was converted to temporary living quarters while the first real house was being built. Then someone else needed to live there temporarily....and on it went for about fifty years, and so now the Garage House is more a house than a garage. It hasn't been updated in quite a while though, so one of our goals for this year is to spruce it up and make it look really nice. We've been working on the garden on the side (we have veggies and flowers!) and have been working on the landscaping around the house. Tough to see in this picture, but it's already much improved. It's been like pulling teeth, but we have finally got the garden enclosed with a fence--now it just needs some paint! The big bush in the front is a poinsettia---see what would happen if you saved that Christmas plant?! 
And of course, the Clara update. She has started speed-crawling (watch out for the light sockets, fireplace, and trash cans!), clapping, and saying "mama" (which delights me to no end). There aren't too many white baby girls around here, so she gets lots of attention! Fortunately, she doesn't mind and in fact is turning out to be a bit of a ham. :) We think she's also getting ready to have another tooth or two erupt through her poor little gums soon--hope it's over quickly! This is a picture of Clara snuggling with her Papi when he was taking a nap post-call. Too fun! 
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