my new roommate

The good news is that my night was fairly quiet: just two baby resuscitations, timed conveniently at around 11pm and 6:15am, and both appeared to be doing pretty well when I left. The bad news is that my sleep was actually more disrupted by a certain mosquito who seems to have taken up residence in my small apartment. As it turns out, I seem to be exquisitely sensitive to the buzzing and wake up every time he passes too close to my ear. Around 4:30, I finally admitted defeat and put up my mosquito net; after that he never got close enough to arouse me from slumber. But it's not over, Mr. Mosquito. I will get you...

on call

Well, if yesterday was clockwork, today was... not. All of the disruption was for worthy causes, but nonetheless, it was a challenge.

Among other things, there was a hospital-wide meeting this morning, at which the interim CEO of Tenwek addressed the hospital community about the current situation in the country as it impacts us. One of the things that has been so sad to see in this country is that people's identities with respect to their tribal heritages have shown themselves somtimes to run deeper than their identities in Christ. I have to say, it really took a lot of bravery to challenge a roomful of people not to consider themselves as Kipsigis or Kisii or Luo or Kikuyu (or American!), but as Christian. But he was right: only then will we as a hospital community be able to be the light on a hill that we are called to be.

Rounds resumed after the meeting, and the next disruptions were from upstairs, as I was called to the nursery to evaluate two sick babies. One was a twin with meconium aspiration that had been born the previous day - thankfully, he actually looked a little bit better than he had - and the second was one who had developed abdominal distension overnight. X-rays had been taken earlier in the morning, and I was in the process of realizing that the child most likely had NEC (necrotizing enterocolitis) when the CBC also came back with a platelet count of 9,000 (that's really, really low). Sadly, in Kenya, there's not a lot to offer other than prayers when a baby has severe NEC, and in spite of some tweaks in management, the baby became rapidly more sick throughout the day. We were able to keep him alive until his father was able to reach the hospital, but once we stopped our active resuscitation, the baby died very quickly.

I was also summoned to two other baby resuscitations during the day; happily, both of these babies were beautiful, squirming, shrieking little things. It's a blessing to be able to be a part of the miracle of birth the way that it was intended to be, as well as to take care of those babies who need more help. By God's grace I made it through, and it's evening now, but in spite of the fact that the sun is setting, I'm on call and my day is only partly over. Pray that tonight will be quiet - tomorrow I'll need all the energy I can get. The Bemms are leaving for Nairobi for a court date in the adoption process of their daughter, Hannah (praying that it all goes as planned), and Thursdays are HIV clinic day in pediatrics. Chuck has very kindly spent part of the last couple of days compiling a packet for my use entitled "Pediatric HIV Care" that could just as easily be called "HIV Clinic for Dummies". I'm going to try to study up a little this evening beforehand... I think I'm already looking forward to bedtime tomorrow!

week underway

I'm starting to think that maybe I should try writing a little something everyday because so much has been happening here that after even forty-eight hours, it's slightly overwhelming to figure out what is most worth recounting...

Monday found me switching full-time to pediatrics, where, because of the circumstances, I have actually been the only consultant pediatrician during ward rounds for the past two days while Chuck Bemm has had to focus on administrative duties. Thank goodness I had Birech, an M.O. intern who is in his last weeks of internship, to re-orient me and keep me from doing anything truly foolish! God has been merciful: rounds were something of a challenge the first day - I hadn't been expecting to be in charge - but today there weren't many new admissions, I had relearned a few protocols, and, as a result, I had a greater comfort in my role. The peds wards are composed largely of two large common rooms - one for infants and young toddlers, and one for older children - with a few semi-private rooms in side halls. The older kids' ward, pictured below during rounds, is fairly typical of the wards here at Tenwek: about eighteen beds, occupied by both children and parents or relatives, make up the room. So far this week, we've had between 20 and 25 patients on the peds service, with diagnoses including protein-energy malnutrition, pneumonia, HIV, burns, abscesses, osteomyelitis, and ascariasis. (And that's hardly the half of it!)

After morning rounds on the pediatric wards are complete, most of the team heads upstairs to care for the other half of the peds service: the nursery. Everyone who knows how much time I've spent in neonatology in the last two years would probably not be surprised to hear that I enjoy my afternoons in the nursery a great deal. Aside from the subject matter and the adorable patients, there are the added benefits of not needing a translator (most of the time) and the presence of one of my all-time favorite NICU nurses, Linner, without whom the Tenwek nursery would be lost. Feeding time is characterized by mothers in red-and-white checked gingham overtaking the nursery and feeding their babies, sometimes by NG, sometimes by cup, and sometimes by breast. These two mothers of premies were kind enough to pose with their babies for me today... it's hard not to take too many pictures in the nursery!

So that's been my routine for the last few days, but there's so much more going on here than just the day-to-day. On Monday, after a weekend of more ethnically-inspired violence in nearby Naivasha and Nakuru, the hospital made the decision to return our Kikuyu M.O. interns to Nairobi, and some of the family practice residents left for their homes as well. This difficult decision has resulted in further staffing shortages, both for the consultants and remaining interns. There are some efforts being made to supply non-Kikuyu replacement interns from Kijabe Hospital outside of Nairobi for those posts - please pray for the success of those efforts, as it would mean more rest and a better educational experience for the interns who are already here. The situation has become more and more heartbreaking as it becomes increasingly clear that historical tribal differences are driving so much of the current violence, and that the people participating in riots and demonstrations are only destroying themselves and the land that they claim to love. The hospital has seen a slow but steady stream of victims from these areas. Hardly a day passes in which I don't hear of another patient showing up in casualty with an arrow protruding from his body, and on Sunday, a 14-year-old boy came in who had gone to "check out" a riot in Nakuru and was shot through the jaw for his trouble. It's hard to imagine now what will soften the hearts of these people and break the evil that is continuing throughout the country.

That being said, in the midst of the darkness around us, there is still light! This morning Tenwek officially opened their surgical residency program, something that has been in the works for years. It's a huge joy and praise for the folks here, and our usual morning report time was given over to several individuals who helped us to reflect on the Biblical nature of beginnings and on the vision out of which this residency program - and others sponsored by PAACS (the Pan-African Association of Christian Surgeons) - was born. So there is still joy, even during this time of heartbreaking sorrow. Praise be to God!

(pictured are the Tenwek surgical faculty, two new surgical residents, hospital administration, and PAACS representative)

sabbath rest

Happy Sabbath! It's Sunday, the second day of my weekend off, and I find myself with just enough time between church and lunch at the Ganeys' apartment to recount the doings of the past few days...

Friday was both the end of my time on the medical wards - at least for the present - and my first night of call. Since the M.O. interns arrived on campus the same day as I did, they are still very early in their year at Tenwek and largely unfamiliar with the system. As a result, the consultants (that's what I am) are much more actively involved with the on-call doings of the hospital than they normally are. The early portion of the evening was actually quiet enough that I began to worry that the phone in my apartment wasn't functioning - those medical folk among you can relate to that sentiment, I know - but I found myself up at casualty (the ER) by 9:00 helping to sort out a few patients for admission or discharge home and coaching my intern, Kevin, through his first thoracentesis. The next call, around 2:00, got my adrenaline going quickly enough that it wasn't a struggle to wake up, pull on my fleece jacket, and rush up to the hospital: "Dr. Stickney, I'm in maternity, and they are putting the vacuum on a baby whose mother has prolonged second stage labor... and I don't know how to resuscitate." The baby was fairly birth depressed, and I longed for many of the resources of my NICU back home as I prayed for her little life, but by the grace of God, she slowly improved over the course of the first hour and a half, and I watched with increasing joy and relief as her pulse ox crept over 90% for the first time while Kevin and I sat nearby, reviewing the basics of resuscitation and the evaluation of a newborn.

Yesterday morning, after catching a few precious hours of continuous sleep, I accompanied Amy, Abby, and David Bemm, along with the female portion of the Osteen clan, to Mosop School (pictured above), a nearby children's home with which the Bemms are actively involved. Begun almost ten years ago by Elijah and Rachael Bett, the school is home to dozens of orphans as well as Kenyan children whose missionary parents are posted elsewhere in the country. We spent a couple of hours under a blazing blue sky playing with the school's friendly population of orphans before a delicious lunch at the Betts' home.

I was able to visit Mosop in 2006 as well, but I hadn't had a chance before to spend time with the Betts, and it was so encouraging to hear Elijah tell the story of how Mosop came to be, starting with fewer than ten orphaned children and two missionary children a decade ago, and how God has been faithful to expand their slim resources over the years with the provision of land, first a larger home for the Betts and then a dormitory for the growing numbers of children, cows for milk, and many other small miracles. At the same time it was heartbreaking to hear how the recent unrest has touched them: during the demonstrations and mob violence in Bomet, the many children had to be hidden in the bush away from the school grounds so they would not be forced into joining the violence. The brokenness of this country has been pervasive in so many ways. (Below are Elijah and Rachael in their home.)

We returned to Tenwek in time to clean up and rest a little before a planned compound-wide cook-out became a cook-in in the face of a persistent downpour (always welcome in these parts in spite of any inconvenience). Dinner gave way to that comfortable sort of after-supper conversation on the Chupps' porch in which you can be discussing yogurt-making at one moment and Kenyan politics the next. It was a reminder to me of how wonderful the community at Tenwek is - that in spite of a mixture of stages and situations in life, the fellowship is always sweet. Today has dawned - and remained - gray and rainy for the most part, and I look forward to a slow-paced and relaxing afternoon, perhaps curled up with a book, before heading back to the hospital tomorrow, where there will be more to learn and remind myself of as I switch over to peds.

finally... pictures!

I thought I'd take advantage of the fact that my laptop internet connection is finally functioning and give you a real visual to connect with what I was trying to explain about our flight from Nairobi: this is a shot of the plane in which I flew shotgun, resting at the end of the Olerai runway (that's the strip of dirt in photo). Fun, huh?

I hope to have more time to post later this evening as well...

my feet hurt

I've got to say, after five weeks of (essentially) vacation, it was a little bit of a shock to the system to go back to work today. Most notably the part of the system that involves my feet. But at least the hospital I went back to work at was Tenwek, and at least I'm finally in Kenya. It was quite a saga - from which I intentionally spared most of my poor friends - as to how I finally made it back here. Suffice it to say that it involved more than one plane ticket purchase and a strong compulsion to check googlenews for the latest on Kenya five or six times a day.

At any rate, I finally got the go-ahead from both World Medical Mission and Tenwek, though, and took off on Sunday. I arrived in country on Monday evening after two incredibly-empty international flights during which I was able to claim an entire row of seats for myself and flew most of the rest of the way the next morning with another family, the Osteens, who had arrived in Nairobi on Sunday. A couple of notable things about the flight: a) I have definitely never flown in a plane that small before - it was some Cessna something-or-other that had room for six people including the pilot - so that was kind of fun, and b) it was really a gorgeous flight; we flew over the eastern edge of the Rift Valley, saw two volcanos, and viewed a lot of scenery that just seems more beautiful, somehow, from the air than a vehicle. Also I want to report that Olerai, which I had pictured as some little mini-airport in the middle of western Kenya, more closely approximates a strip of dirt with a fence at the end. Which probably explains why I couldn't find it on any maps. But I had just finished reading Acts of Faith (by Philip Caputo, a novel about the humanitarian aid community in NW Kenya/southern Sudan, definitely recommended, although be prepared to be disturbed), and so I was up for a little adventure.

Yesterday was thankfully a day to settle in and get to see a few friends I hadn't seen since last time, but this morning I was back on a full schedule. Six of the new M.O. (medical officer, like MDs in the States) interns arrived yesterday as well, and so today was a little chaotic all around. I've started on the medicine side of things, where I'll be for this week before swapping over to peds next week. Fortunately, I had two excellent third-year FP residents to help re-acclimate me to the medicine ward (where I haven't been at Tenwek since I was a med student in 2004). Probably the most dramatic thing that happened today was when one of the younger patients arrested as we were rounding on him. After three rounds of epi, we got him back - even in the States, I have mixed feelings in those situations - and then fought for him in the ICU for the next two hours until he finally died. I stumbled off to get something to eat at around 2:30 and then came back to finish rounding and to help orient the interns who had been assigned to the medical service. It was a little intimidating to be the one orienting when it was my first day, too, but the three of us made it through somehow. I feel badly - there was so much going on today that I didn't really have time to talk to patients or their families much, but it's only the first day, and hopefully we won't have patients arresting on rounds on a daily basis.

So I was pretty glad to have things wind down around 5:00 and to slip my poor throbbing soles out of my shoes. There's a rumor there's Bible study at the Whites' house tonight, which I need to confirm, but otherwise it should be a quiet evening.

Okay, I swear I finished writing this an hour and a half ago when suddenly the power went out for about two seconds. And then I couldn't get the internet to function when the computer turned on again. Thank goodness for autosave! And now it's time for Bible study - I managed to verify the rumor - so I really should just post and sign off.

back home

Five and a half days, sixteen thousand miles, and I didn't even take any pictures!

Well, I'm back (safely) in Cleveland, and though my circadian rhythm has been scratching its figurative head for the last thirty-six hours or so, I'm feeling relatively well and more at peace than when I left Nairobi Wednesday morning. I spent Wednesday night in Brooklyn with good friends processing over lasagna and cheesecake, which was good for the soul.

But the violence continues in Kenya... the rally planned for Thursday by the ODM was eventually called off when those trying to assemble in Uhuru Park were turned back by police and other security personnel. The opposition is calling for a rerun of the election within three months, which the Kibaki government appears to be rejecting. Both, however, appear to be open to international mediation at this point, and hopefully that will help calm the situation in the upcoming days. It seems, though, that there are two distinctly different things happening in Kenya right now: one is the political upheaval and uncertainty, the other is the tribal violence. And it seems unclear to me that the resolution of one will lead to de-escalation of the other. Undercurrents of tribal tensions have been so longstanding in the country that I fear many are merely using this situation as an excuse for violence. On the other hand, everything that's going on has grieved the majority of Kenyans as much as - or, likely, more than - it has grieved the rest of the world. May God calm the restlessness and violence in the hearts of the rest...

But for me it's back to the mundane of the "frozen northlands": a foot of snow, freezing temperatures, and a research project to work on.

snowballs in kenya

How quickly things change… this morning, we thought we’d be able to get to Tenwek tomorrow. We were all set to wait and see what was going to happen; we felt safe, and things were sounding quiet around town. But some of the reports from the hospital today were a little troubling, and suddenly it was going to be at least the end of the week until we could even think about traveling west safely. The rest to me seems a little bit like a blur, but we talked to several people (multiple times) both out at Tenwek and at Samaritan’s Purse in North Carolina, and the decision was made that the safest thing to do would just to be to come back to the States sooner rather than wait to see what would happen on Thursday, when the ODM and Odinga are planning a rally. My parents, God bless them, spent two hours on the phone with British Airways and bought me the plane ticket that is currently breaking my heart. So I’m flying out tomorrow morning at 10:00 and should be back on American soil just four and a half days after I left it. Anybody have an idea for what I should do for the next five and a half weeks?

The ways of God are mysterious and difficult sometimes… and still we pray for peace.

day two

Happy New Year!

This morning we packed up and moved from the SP apartments in Kileleshwa to another guesthouse (a hotel, essentially) down the road – there weren’t any safety concerns, but they were expecting more SP staff back from the field, and our rooms were needed for them. So we’ve checked in to our new accommodations, but I think we’re all feeling anything but settled. Things have been relatively quiet in Nairobi today, although we’re still hearing that the ODM is planning a peaceful rally for Thursday, which could very well end not peacefully, and there are emerging concerns about supplies (food, gas, etc.) in some of the more rural regions, like where Tenwek is located.

One of the other couples (John and Ashley) and I just got done talking to one of the long-term missionaries at the hospital to try to get a feel for how long it’s worth waiting, and whether, if we came, we’d be more trouble than help. Everything seems quite uncertain at the moment, except for the agreement that traveling in-country won’t be an option until the end of the week, at the earliest. Some of the volunteers seem to be leaning toward leaving Kenya as soon as arrangements can be made, but others of us are still uncertain. Our present safety is not a concern, and it’s very hard to tell what the next few days will bring for the country as a whole. We’re also fighting competing motivations – we really WANT to be here, but in a lot of ways, it’s a selfish desire. John pointed out that even Paul didn’t get to go everywhere he wanted to when he wanted to – the Holy Spirit prevented him on more than one occasion from entering a place where he wanted to minister. So it’s important for us to remember that just because we’ve gotten this far doesn’t mean everything is going to work out according to our plans.

It’s a tough situation.