Going Home

Elijah, Enoch and Ezra

Happy Sunday afternoon!  We went to church this morning and let me just say that church goes on much longer here  than at First Presbyterian, Wilmington North Carolina!  Wonderful praise music in Swahili and in English as well as some of the old hymns like Blessed Assurance!  The sermon was taken from Colossians and centered on anger, controlling our tongues, malice, and lying .  Good lessons for me and for everyone in this world no matter where you live! 

This afternoon we are meeting with a young man that we have taken an interest in over the years.   He is trying to earn enough money to pay for his lodging while pursing a certificate in IT.  We have promised to help him with tuition if he can raise support for living expenses.  This is not easy to do as wages are very low.  Also culturally you are obligated to help your family or your neighbor if you have available money.   So for example, if you have a family member who needs help paying a hospital bill you must help with the bill and begin saving again.  This is a wonderful thing but it often makes it difficult to save for things like school. 

Friday turned into a fun day.  First of all the Mom of twins came back for her one week check up with Louis and Lewis!  They are doing great and  growing!  That was fun to see and also to meet her husband who came with her.  Wonderful to meet an involved father; something we do not always see as the women often come great distances to the hospital.

Louis & Lewis

The second thing that happened was that the smallest triplet received a discharge weight by 3 PM  o’clock on Friday.  Very eager to go home after a month in the hospital,  Mom quickly called Dad and he arrived to pick them up at 5:30.  We dressed Enoch, Ezra, and Elijah  in cute  clothes, their knitted caps, and swaddled them in many blankets for the hour and some ride home.  It was a parade going out the main gate of the hospital with Mom, the “other batiem”, (grandma), and me each  carrying a baby with Dad following behind with the luggage!   Dad haggled with matatu drivers for the best rate and when that was settled they climbed into a small station wagon.  In typical grandmotherly fashion I cautioned the driver to drive safely as he had precious cargo.  I began waving goodbye and could not understand why he wasn’t leaving.  It turned out that he was bargaining for more passengers.  He put a woman in the front and then opened the back gate to load two more women.  Finally he started the engine and they were off!  Oh how I wondered how that first night went!  Did she have time to boil the river water to make  clean formula when she got home, where did they all sleep, and other myriad questions!  She is a wonderful Mom and so I know that she handled it well but triplets are a lot of work especially when you also have Joy age11, Faith age 9, Rehema age 5, and Blessing age 3, eager to greet you as well!  Maybe I will call her in a few days and find out how things are going!  I will let you know! (by the way she has informed me that her family is compete!)

On Friday, I passed out the colorful  knitted caps lovingly made by the women of First Presbyterian.  The Moms are always shocked that these are gifts and not something they have to pay for!   It is truly a gift of love and appreciated!   I know that many women have probably never received a gift in their lives!  I love telling them that they are made by Christian sisters in the US.

Tomorrow is a big day as our family arrives!  Bill, our son, and his family, Penny, Mimi, and Preston as well as our daughter Betsy and a friend , TR Goins, will get here in the early afternoon.  Pray that they have safe travel and that their time here is meaningful and productive.  Also pray for Nana as I will be responsible for doing homework (including math!) with the grandchildren!:):)

Till next time, lots of love from Kenya,

Miriam

Education

View from Tenwek across the valley
"The River is Low"

My initial impression returning to Tenwek is the increasing importance of education.  We have been in the midst a Critical Care course with visiting faculty from Alabama and Tennessee.  Beside bringing education there has been visitors here to learn with our Kenyan hosts - obstetric residents and medical students from the U.S.  It is a wonderful educational environment where we all are learning together.

What is still ahead is a work in progress of the implementation of a residency program in obstetrics and gynecology now that the curriculum has been approved.   The Issues to be addressed are finance and faculty.  These are universal issues for any academic program.  These are the investments that will reap rewards for the future.  

What has been personally rewarding is seeing Kenyan educational leadership  development.  This has been particularly evident in the Surgical program.  This can and will happen in obstetrics and gynecology program!

Marvin

Reference

Herath C; Zhou Y; Gan Y; Nakandawire N; Gong Y; Lu Z. A comparative study of interprofessional education in global health care: A systematic review. [Review]

Medicine. 96(38):e7336, 2017 Sep

Love Abounds

Ezra, Elijah and Enoch

Good morning America!  We have already finished our first week of service here at Tenwek!  It has been a week of renewing friendships and making some new acquaintances.  The needs here continue to be overwhelming especially since secondary school fees are due now for the coming year.   I have been approached by many already asking for help with these fees. Knowing when to say “yes” and when to give an empathetic but firm “no” are extremely difficult.  That is especially true when you know that you can help them but that it is wrong to build up a dependency on missionary help.  As we all know it is better to give them seeds and let them produce their own crop.  Again, not easy

The twins that I was helping with have gone home.  The tradition here seems to be to name the children with the same initial so they were called Louis and Lewis!  You must know that Louis is pronounced “Lois” here!  Still a bit confusing!  Now I am helping a Mom with triplet boys named Ezra, Elijah, and Enoch!  Mom has a family of seven now having had four girls before the three boys!  She assures me that her family is complete. Thankfully her mother-in-law is here helping too so it will be a community effort raising these babies!  I am impressed with both of these mothers and grandma. They are all loving and smart.  It is not easy keeping track of how much formula versus breast milk each tiny premature baby receives every three hours around the clock.  Over the years I have been generally very  impressed with African moms; their love and devotion to their children is to be admired.

Love is in the air here at Tenwek!  I have been surprised with how many of my young nurse friends have gotten married during the past year.  They are quite secretive about it and kind of spring it on me in a quiet moment.  Yesterday, two young women whom we have known and helped through the years also announced that they are in love; one is getting married on March 11!  Not only that, the minister preached on Love and the importance of fidelity in relationships. 

Miriam

On Call

Tenwek Rainbow

Taking “OB Call” at 76 is probably a little crazy - but here I am.  The reality is that there is and will be limited senior staff here at Tenwek Hospital - so here I am.  In a bizarre way it is an exciting place to be serving with young residents, interns and medical students.  The service contains some obstetrics and gynecologic challenges - a new diagnosis of rheumatic heart disease in pregnancy, intraperitoneal TB, malaria in early pregnancy, placenta accreta, severe thromobphelbitis, et cetera.

For the expatriates like me, these are rare opportunities to learn about and provide care for these women and their babies.   It is for many of the learners a life changing experience.  

It is also a time to be with young Kenyan interns.  It is more difficult to assess your presence with the Kenyans who have seen so many different consultants come and go.  It takes some time to “learn together”.  

More later as the opportunity to be “on call” continues.

Marvin

References:

Hage ML (2018) Healing Together

http://healingagents.blogspot.co.ke/2018/01/healing-together.html

Returning Joys

Another beautiful morning in rural Kenya!  It is eight o’clock and I have done two loads of laundry , showered, eaten, and now ready to blog with you!  Life starts very early here and what we have to remember is to go to bed earlier to compensate.  This old body needs its rest!

Yesterday, I had the joy of going to nursery and seeing my nurse friends. The nursery is as hot as ever!  The census is currently low with only 20 babies. Unfortunately those 20 seemed quite sick.  However there are triplets and twins among the 20 so I think that there is work for me!  I have not brought the knitted caps or the blankets lovingly made by friends at home up there yet. I have to spread out the excitement!  Yesterday’s Valentine Hershey kisses were enough for the day!

We had the most fun experience on Sunday night.  At 7 PM we streamed in the 11 AM church service live from First Presbyterian in Wilmington, NC!  It was as though we were there!  No problems!  It is the miracle of science and very hard for me to fathom!  When Marv was here in 1997 the only thing available was the BBC!  Now we are connected to the world except when the power goes out!  How marvelous!

Marv is back in stride and loving being a physician again!  In fact after a sabbatical from night call last year they have put him back in the schedule.   Fortunately last night was very quiet but we will see how this works at his grand old age!

Miriam/Micki

First Day

Happy  Monday morning!  We are finally here at Tenwek and getting settled into our tiny studio apartment on the third floor of the guest house.  I think they forget how old I am or else they remember and think that climbing steps will keep me in shape .  I have not attempted  to go up to the hospital yet so that will be the real test of my stamina.  It does take a few days to get used to an altitude of 7000 feet  coming from the flat land of eastern North Carolina!  

On Sunday we hired a driver and went to Kijabe Mission Hospital which is about an hour and a half outside Nairobi.  We had worked there about six years ago so we were eager to see if things had changed.  We were able to see some friends and Marv was able to talk with several people in the OB department.  He also was able to talk with the doctor who is in charge of their medical education which is a primary interest of Marv’s. The best part was that her husband was wearing a U of M t shirt!  The world is very small as he  had spent a short time in Ann Arbor.  

The four hour trip up here was uneventful thankfully.  We noticed how dry everything looks until we got very close to Tenwek.  Things are dry here too but a bit greener than along the way.  The bougainvillea is blooming as are many other flowers.  The tea leaves cover the hillside with a lush green .  We are right next to a road the leads to the back of the hospital and so we have a fair amount of traffic; especially of  small motorcycles or boda boda’s , as they are called ,coming and going.  It is fun to wake up to the sound of children’s voices as they walk to school  around 6:30 AM.  

  

As I look out my window I have a clear vision of the building that burned last Friday night.  It was a very big deal!  Stories are emerging of patients fleeing their hospital beds, Moms gathering up their babies and running.   The fire was not immediately threatening the maternity wing but the sound of the flames and breaking glass petrified patients.  African women wail when tragedy strikes.  I am told that the wailing could be heard for miles and miles as people could see the flames leaping into the air. 

I plan to visit the nursery this morning but will probably wait till tomorrow too really begin working there.  I wonder if the heat in the nursery will be a problem for me .  It is like a sauna !  Since it is Valentine’s Day tomorrow I will bring chocolate!  Many things are universal!

  

Miriam/Micki

Fire & Ice

Snow in Paris

We have  arrived safely in Kenya!  It was a frustrating trip as we were delayed by snow in Paris for eight hours.  We arrived at the Guest House at four AM but non the worse for wear!  That would amount to a 24 hour trip!  The good news was that there is very little vehicle traffic in Nairobi at 3 AM!  

We fell into bed to be awakened at 10 by the news that our driver was here. We had arranged for a driver to take us to a couple of shops while we rest up here today and tomorrow as our housing  at Tenwek is not available until Monday . Sadly we received awful news from Tenwek this morning that a major fire broke out there last night.  It sounds like it destroyed the restaurant, laundry, sterilization room, and some offices.  Fortunately they were able to move patients out of a ward in the basement and no one was injured.  They believe that the fire started in the kitchen of the restaurant. Please pray for the hospital, employees, and administrators as they work on a plan to rebuild.  It will impact surgery, sterilization, food prep for patients, laundry for patients and staff and countless other details that help a hospital function.  It will be a major undertaking.  

As I write I am sitting on a patio surrounded by beautiful plantings, the sound of children playing in the yard, and birds chirping in the bushes.  All is good!  We are always so grateful to God for safe travel.

Micki & Marv