First Night on Call

Tuesday was my first night to be on call in the hospital here. My first call last year was pretty spectacular in its sheer craziness, so I was braced for impossibility, but instead, I found the steady busyness, mystery, dilemma, and reassurance.

The day started with a call from Sarah, my colleague, in Nairobi, saying that our amazing medical officer, Lilian, who helps run our outpatient clinic was carrying a patient with oxygen saturation of 30% from the clinic to the casualty (our emergency department). I sprinted down the stairs and up the long hallway, running through the possibly reasons in my head as I always do. . .but unsure what to expect.

My 2 year old patient was sitting on the bed with blue lips and hands and feet - but mad, and as he screamed, his oxygen number drifted lower and lower.  We placed a mask streaming oxygen over his face and I started to play peek-a-boo with the terrified child.  As he calmed, the number drifted up, up, slowly, slowly - from 20 to 40, 40 to 70.   All the extra muscles in his chest pulled to breathe. He calmed, suspicious but intrigued, and let us listen to him. . .his fingers, belly, and chest exam belied a serious problem with his heart - that is was failing to pump blood the way it should.

I ran to get the ultrasound, and his heart looked eerily similar to a baby the week before, and his x-ray looked as if it had been pulled out of the textbook for a malformed heart - tetraology of fallot. We gave him medicine to help remove the extra fluids, and then, we started the most important part of treatment for a child with this malformation - to make him happy, because that would help his oxygen. His grandmother sat with stoic kindness at the bedside in full Maasai dress with shoulders draped in beautiful red fabric and intricate bead work adorning her ears and neck.  She helped me soothe him, and slowly slowly, this boy and I became friends. The medicine and laughter helped him and his oxygen began to improve.

As I walked out of the curtain surrounding his bed, the resident called me to the next bedside - an unresponsive 3 year old.  In the States, we would have intubated him, but here, with limited ventilators, I paused. His breathing was strangely easy, and the results of his blood work were normal.  We treated him for seizures and gave him antibiotics to help him fight the infection - we added treatment for malaria and continued his medicine for tuberculosis. I wished that our CT scanner was working and that children responded in the same way to fluids here that they do at home, and then I took a deep breath and we prayed. . .that night I walked back and forth from his bedside, judiciously putting fluids through his IV and watching as slowly, slowly, he woke up.

Next, I went to the private clinic where I examined a healthy 2 month old and learned her history with the mom - and then it was off to a delivery where the mom was struggling to bring her child into the world. She succeeded with a scream, the child cried, the mother smiled, and I was off to the next place.

The child with the strange heart was calm and more comfortable, the 3 year old continued to breathe - but around the corner was another teenager. "Can you help me?" the clinical officer asked.

Chicken pox, really impressive chicken pox. It looked different on African skin, but there was no question to the diagnosis.  I remembered the itchiness from when I was 9, but he was not phased by that - because he was struggling to breathe. Chicken pox can be deadly when it is complicated by pneumonia, and I knew immediately this would be his battle.  For now, though, his oxygen  saturation was okay and  his distress eased as we brought down his fever. The nurse searched for a place on his skin we could start an IV and gently coaxed the small tube into his arm.  I went to search  for a bed in our very full ward where he would no tbe able to infect another patient, and the intern ran for the medicine to help his body fight the disease. Around 11pm, we came up with a clear plan, I checked on the babies in the ICU, and then I ran home in the dark and wind to get dinner and some rest.

At 2 am I bolted up, wide awake, on the couch, and very worried about my patient with chicken pox.  At first, I thought it was paranoia of my first night on call. . .but the feeling settled deep in my heart and mind , so I put on my shoes and coat, not wanting to bother the residents with my worry. After 30 minutes of wandering from casualty to his first assigned bed (that was empty) to the isolation room on the ward, I found him, barely conscious  and as blue as the baby I had seen that morning.  I called the resident and rushed to find out how we could place him on oxygen and increase his fluids.  Within minutes his breathing slowed, and the finger pulse oximeter I had received as a gift right before leaving read 96%. His heart rate slowed and his glazed-over eyes cleared and met mine.

I walked out of the room and took a deep breath, thankful for a God who would wake me from deep sleep to save a life. . .it was a simple reassurance, humbling and powerful. I took a few minutes to teach the residents about viral pneumonia and its complications and then walked home to rest again.

I went in once more that night - to welcome another Kenyan to the world. As she came from her mom's tummy by c-section, she twisted her face in protest and grabbed onto the surgical drape before the doctor cut her cord. I smiled as I watched the determination in such a new little one through the OR window.

This job I have, is a holy privilege. And, this thanksgiving week away from family and familiarity, I am thankful for those of you that are walking with us and making it possible.

Happy thanksgiving from Kenya. . .

picture from last year :)

Life happens

One of the surprising things about moving to Kenya is that life still happens.

This may sound silly, but for about 6 months before we left Alabama, and especially the last few weeks in our whirlwind tour of family, friends, and churches, life seemed to  happen in tandem with us.  We are so grateful for this time and the affirmation it gave us as we boarded the plane.

Now, 2 months later and half a world away, life goes on in America without us.  Close friends are pregnant; family is traveling home for Thanksgiving; nieces and nephews grow up; summer turning into fall.  It is strange and bit sad to participate in the life we have always known in person and touch  by facebook and Skype (but we are very thankful for those fantastic avenues of communication. )

Here, we make a new "family" and friends, and life happens as well.  Connections and relationships and common purpose are forming. . .we have friends and allies, both Kenyan and American.  We receive texts about cranberry sauce on sale in Nairobi and invitations to a thanksgiving feast, and though we are in a new world, we are so grateful that we don't feel alone.  

Tragedies of life happen as well - our houseworker Ruth lost her brother-in-law yesterday when a church bus overturned. Eight men were killed, all pastors and elders in the church.  We grieve with her, as we do with our friends at home who have struggled with illness, loss, deep sorrow, and tough situations in the past months.  

But thankfully, some lives will go on because of our life here as well.  Arianna had her first night of call, bouncing back and forth from home to the hospital until midnight.  She went to sleep for a little while and then bolted awake at 2:30 am.  No phone call or page, just a strong feeling something happened to her patient, a teenager with severe chicken pox. She returned to the hospital and hunted him down, discovering that he had been moved to a different room and his blood oxygen saturation had dropped to 69 and his heart was beating dangerously fast - which meant his lungs could have completely failed or worse by morning.  She put him on oxygen and fluids, and a day later he is improving.  

Today, on Thanksgiving, our lives seem both stretched and full, definitive and uncertain. We are adjusting to the dichotomy of our lives  - trying to be present in some real way for midnight crises and continued celebrations in the States while building relationships here that will grant us the same trust and familiarity.

Life will go on, in its fantastic whirlwind. . . and for that, we are thankful.

-David

Thanksgiving at the Hansens - the day itself was normal, the kids had school and Arianna worked, but we did get together for dinner with new friends and in keeping with tradition, ate ourselves silly.

Skype with the McLain side of the family, Papa wearing the ninja turtles hat we sent all the brother in laws (yes, I'm upset I don't have one of my own!)  

Three year old Annabelle. . .she still doesn't eat Thanksgiving food except for rolls! (although she added mango and cranberry sauce this year)

Design and Discovery

So when I start to write this, I realize that it has been a very busy couple of months.  We finally caught up on designing wedding albums and finishing picture edits from before we left for Kenya, which is a relief!  Now it's on to other projects with photography, design, video, history, and book-writing!

One of the big goals of the hospital in the past year or two has been to develop a brand.  We've done this with photography, and if you have ever worked in the corporate world, you are probably very familiar with the concept.  I was talking about it with a friend, and he pointed out what a big deal it is for things at the hospital to be done with excellence and how the 700+ employees can really take pride in Kijabe hospital and what it stands for.  

A designer came up with the first logo, and since our visit last year I've been doing off-shoots of it for different hospital enterprises, the latest of which is for the Kijabe College of Health Sciences:

Another endeavor has been a newsletter/magazine called the Kijabe pulse.  Henry, a Kenyan who works for resource mobilization at the hospital, gathers stories and photographs, then it comes to me for design, then on to the powers that be for approval, then out via email to friends of Kijabe Hospital around the world.  

Above is a screen grab of page last issue.  If you want you can see the full issue here:

http://kijabehospital.org/wp-content/uploads/2014/04/KijabePulseIssue3web-1.pdf

Next projects, video, which is newish territory for me.  Our cameras shoot video, but it is a very different way of looking and thinking than still photography.  The fun part of the video project has been catching a vision of just how remarkable the growth at Kijabe has been in the past years and will be in the future.  In the 1980's there were a handful of doctors for the whole hospital.  Now there are Pediatricians; OB's; Orthopedic, General, Pediatric, and Neurosurgeons; ENT's - the resources and quality of care this "rural" hospital provides absolutely phenomenal.  I'm excited that Arianna can be here at a time where she can develop training protocols and impart learning that will literally spread to all of Africa.  

Here's the first video we put together:

And last, but definitely not least, the Centennial Book.  The hospital is coming up it's 100th birthday, and the question is, how do we celebrate?  There have been books written about RVA and some amazing missionaries, but very little is directly about the hospital.  So I'm working with a couple of other doctor's spouses and a growing network of people who have attachments to the hospital to compile a history and storytelling record of what God has done here.  

There are some really cool parts of this project and one of the greatest so far is the treasure trove of glass-plate slides that a local historian (Shel Arensen creator of Old Africa Magazine) let me borrow to sift through.  So I set up a lightbox and photographed them, and they are absolutely amazing both from a historical and artistic perspective.  

This is a colorized slide (originally in black and white, but color was painted in) of the original Theodora hospital that was built in 1931 on RVA's campus.  But is is also a fantastic composition with the foreground, the little boy right on the third, and the repeating lines of the building.  I assume that the missing text at the bottom said Original Location of Kijabe Hospital.  

Many of the slides will forever be anonymous, but they are beautiful.  This is another colorized slide of a Kikuyu gentleman.

Many are in negative form, like these three Kikuyu boys.

Here is another negative that I almost didn't photograph as it looks like a throwaway slide.  The original was upside down when I shot it, and it shows a view of Kiambogo, the original building at RVA (where Teddy Roosevelt laid the cornerstone) with Mt. Kenton to the right background and Mt. Longonot (the volcano) to the left.  I don't know for sure, but I'd guess from the lack of structures that this image was from around 1920.  The current hospital would be in the field to the bottom left, and all around the Kiambogo building are houses and school-buildings.  Mt. Kenton has a patchwork of terraced farms and houses, and only Mt. Longonot, which is a national park (and somewhat active volcano) remains untouched today.  Looking at something like this really is like finding treasure!  

A Tale of Two Parties, by Madeline and Annabelle

Monthly blog post from the girls about their birthday parties:

Annabelle:  Frozen Freeze Party

For my birthday, I played Pin-the-Nose on Olaf and Olaf bowling. I invited my friends, their names are Finley, Brynna, Lydia, Riley, and Liam. We also did a treasure hunt and found Olaf's ice castle and tried to get him out. We had spaghetti for lunch. We had snowball fight with cotton balls.  We made snowflake wands. We did glitter nail polish and sparkle make-up.We had cupcakes and we made a cake but we didn't eat it. It was a fun party.

Madeline: Ocean Classic Party

First, for my birthday party, when everybody arrived we made pizza shaped like fish. The thing that I found really fun was making cards. One of the games we did was play "pin the tail on the orca". Another thing we did, just like Annabelle, was a treasure hunt . We had to free sea animals stuck in ice. They were hidden in funny places and it ended with fishing for treat bags. Before we knew it, the party was almost over so we had cake and all sorts of delicious snacks. This was my party for this year. It was awesome!

 

First week in the hospital. . .

I got up with the girls, combed their hair into pigtails, and drank my coffee. Then, I walked back into my room, nervously rustling through the clothes in my closet.  I have spent the first month here arranging our home and learning Swahili as fast as I can - and that day, I would walk into the hospital for the first time with my white coat.

New babies, new mamas, new nurses, new residents, new rules - the next piece of a new life.

The day started typically, with 25 babies under our team's care. The medical officers and residents scrambled to finish their notes and gather data. I watched, took mental notes, and smiled as Dr. Imma  Barasa deftly organized the chaos.

Babies in the left corner, born 3 months too soon, thriving on oxygen jetting through water bubbles and slowly needing less and less of our support as they declared to us that they would fight.

Babies along the right wall who had decided to come two months too soon, wiggling in their incubators and mother's diligently pouring milk into small tubes that stretched down their nose to their bellies.

Babies wearing cloth sunglasses, sleeping calmly under the blue lights that melted the bilirubin from their blood and others that are growing daily, fighting infection, awaiting surgery.

We analyzed numbers, changed fluids, changed antibiotics and flipped the blue lights off and on as the lab results returned. I started to unfile bits of knowledge from long nights in the NICU and nursery.

Then, a nurse arrived at the door, holding a lifeless tiny baby and placing her onto the only empty bed - we sprang to action as the nurses assembled the necessary equipment, the intern began chest compressions and I held the infants chin and mouth while Dr. Imma bagged the baby. A grimace, a kick, and then a cry as the babe realized she was in the world.

Moments later, another nurse arrived suddenly at the door and called us to maternity where a baby had been born in normal labor, but was not breathing or moving. I followed the residents lightning sprint around 3 corners, and we held the baby, cleaning him, tilted his neck, and blew air into his mouth - I worked deftly, with memory of things I have been taught well.  I felt at the base of the umbilical cord, and smiled. The heart rate slowly quickened and the baby took his first gasp for air and cried. Minutes later, we returned the newborn to his mom, alert and strong.

We regrouped in nursery, only to be called to the OR for an emergency c-section. Imma looked at me, "Can you go?"  "Of course," I replied, with more certainty than I felt - and the clinical officer and I walked quickly to the OR where I donned a cap and new shoes and a gown and waited for this tiny baby, 3 months to early, and prayed for her to breathe. She entered the world perfectly tiny, not quite ready to be born. And again the CO Robert and I pushed breath into her mouth and felt for her tiny heartbeat, and after 5 long minutes, she took her first breath. And then she cried, batted away the mask and opened her eyes wide. The resident laughed as I wished the tiny Kenyan Happy Birthday.

The week continued at this rapid, welcome pace. We welcomed more preemies, more babies with fever, another infant born with his intestines outside his body with 12 fingers and 12 toes. I ultrasounded that baby's heart and sent it to Dr. Romp in Alabama so we could help guide the infant's prognosis. I wrote Chris and asked her send bags and masks donated from Children's to friends in Seattle coming to Kijabe next week so we could replenish the stock of only 4 remaining in our hospital and continue to give life giving breaths. And I learned and taught and organized and laughed.

I woke up each morning a little less rested, but refreshed. I felt like myself again, so thankful for the privilege to do what I love. It is an amazing thing to be the hands that coax life into a newborn baby, to kneel with a mother and help her understand her child's battle, to work as a team and watch differences fade in common purpose.  I know that the days ahead will hold heartbreak as some babies cannot be coaxed to breathe and others enter the world too fragile to survive. But this week was a week of small victories and sacred moments - of new wonder and quiet gratitude in the midst of chaos.

First day picture (as I ran back because I forgot my stethoscope. . .)

Beautiful Skies and Broken Wheels

Tonight was absolutely spectacular.  This was the sky on the way home from the super-duka.  I rode home as fast as possible and grabbed the real camera. Arianna got the girls and put the homemade chips and guacamole we were going to eat for dinner in tupperware, and we jumped in the car to have a picnic and watch the sunset by the airstrip.  

Just before town, on the one 10 yard stretch of good road on our route, the car made a strange noise, as if we had run over something.  Invisible pothole?  A half-mile later, driving through town - thump, tilt, and flop.  Thankfully, and miraculously, we were only going 10 kph because the road is so bad.  Yesterday we had been driving 80 kph on the way back from Nairobi, and if it had happened then, we would have been in serious danger.   

Arianna, our friend Carola who had come along, and the girls walked home to eat dinner on her balcony. I ran to fetch the mechanic just down the road to the amusement of at least 30 onlookers, and soon all was well.  I had met the mechanic a few weeks ago, and one of the first bystanders who stopped to offer help worked at the mechanic shop.  So, we went to get jacks as the sun finally set. They lifted the car, removed the wheel, and discovered the problem was that the bolts that hold the ball-joint on the car had stripped out, fallen-off, and the last one remaining had broken in half.  

I wondered how they would tow it, but instead, they borrowed a few bolts from the other side of the car, and popped everything back together, put the wheel on, and drove it back to the shop.  We'll see what all needs to be fixed tomorrow, but it should hopefully not be much more than replacing things that are at the end of their life already.  

Arianna and I regrouped at another friend's house an hour later, strangely unfazed.  In the chaos of the night, we saw God's provision in big and small things once again. We saw the grace given to our family as our girls laughed, going to bed - safe despite a detached wheel in a new country. We were thankful for enough familiarity with town to have friends at the mechanic after only a month here. We were grateful for the wisdom that kept us from needing a tow truck. And strangely, after solving the crisis, stopping in at Mama Chiku's for a late dinner, and then returning to our house with no more pictures of tonight's beautiful skies, we felt more at home. There will be more sunsets, more crises, more provision, and more races down the road to see the beauty that surrounds us. 

The rubber and metal meets the road

The culprit

Repair at twilight (from my iPhone)

Habari za maisha? (How is life)

Maisha ni nzuri - life is good.

The past couple of weeks have been a whirlwind of mundane activity and building foundations for the coming months and years.

Our focus has been on Swahili -  lessons are an hour a day and we spend much more time studying. Though Swahili is a relatively straightforward language to learn, it has not been simple.  Many words sound like Spanish or Mandarin, and verbs in particular start to sound so similar.  Kupika means to cook and kupiga means to hit.  Kusema: to say, kusoma: to read.  Kuelewa: to know, kuolewa: to be married, kulewa: to be drunk. Then we have crazy long verbs like kusheherekea: to celebrate, and kutengeneza: to build.  And, nouns like maziwa: milk, and maisha: life.  How is your life and how is your milk are two very different questions!  

I have started my first two hospital projects - related to my background but a bit of new territory. First, I am making a short promo film for the newest  building project.  Kijabe Hospital is in a transition from being a busy mission hospital to expanding its role as a training center.  The medical officer and clinical officer training programs, surgical residencies and nursing/nurse anesthetist programs are the first of many more to come.  Arianna and her boss/mentor/friend Mardi have dreams for an pediatric acute care residency program, as do many other parts of the hospital.

I am talking to doctors who are excited about this part of their job, and others who have been through the training programs and are now instrumental in the life of the hospital and medicine in Kenya. Teaching will be the truest legacy of our time in Kijabe, and it is fun to see glimpses of how it is being done and  realize the efforts of doctors here will bring hope and healing throughout east Africa.  Pray that learning to edit video would not be too difficult!!

The second project is compiling and organizing a historical scrapbook as we approach the 100th anniversary of the hospital next spring.  This may turn out to be a colossal undertaking, but I hope it will be immensely rewarding to hear and retell the stories of the doctors and nurses who have gone before us.  

In between the big goals are the myriad of activities that make up daily life - trips up and down the hill to RVA, hardware store runs as we finish a table and benches.  Groceries at the duka, bike rides and runs, conversations with friends and strangers along the road, hosting dinner for the Pediatric department, a trip to the swimming pool with new friends, learning to start a fire with a truckload of green wood, and making Halloween (or Carnival as we call it here) costumes without the aid of Michael's or any other store.

Life is busy, but becoming normal.  And, for me, Kijabe is beginning to feel like home instead of a dream.

-David

 Madeline is a killer whale and Annabelle is wonder-woman.

 Madeline and her homemade bow-and-arrow

 Roadside sunset jumping picture