Heading Home...Made It!

Kristen dressed up African style with roommates Amber and Ariella at my going away party the night before I left.

My time in Kenya is coming to a close. It is bitter-sweet. This last month has been all that I had hoped and more. God has truly blessed me. I have grown and seen and done so much. As I sit back and begin to process through everything I am struck over and over again by the richness that was this last month. Wow. I could not have asked for a better place to be. I am so thankful.

The night before we left Kapsowar it poured almost the entire night. The constant drone of rain on our tin roof makes for some wonderful sleeping, but some not so wonderful road conditions. Both of my roommates, Amber and Ariella, decided to go to Nairobi for the weekend as well - I was so thankful, it is always more fun to travel with others. These two girls have been so special this last month. I had begun praying about my Kapsowar roommates several months ago and God completely blessed those prayers. We left Kapsowar around 5am. With the mud and steepness of the road the matatu (glorified van or pick up truck used for public transportation) was not able to meet us at our house. We hiked up the road a bit (this is when I am glad I decided to wear a skirt and some flip flops because of the mud and rain) loaded up and headed down to the valley. It was completely God's blessing that we didn't get stuck in the mud. There were several times where we started sliding and I thought our journey to the city would become even more of an adventure, but we made it to Eldoret without mishap. It is always amazing to me that be it dirt road or asphalt the speed limit doesn't seem to change. The Kenyans here possess some serious off roading skills that I can only hope to obtain someday.

Once in Eldoret we caught a shuttle that would take us to Nairobi. I always enjoy taking land transportation instead of air because you get to see so much more of the country. It was fun to have A&A with me as we laughed and talked and processed through so much of what has happened this last month. Both of these girls will be in Kapsowar until mid March. I can't wait to hear about how the rest of their time goes.

...this is when the internet in Nairobi went out and didn't come back again until after I left so I wasn't able to send this blog until now....

I flew out from Nairobi to London. I had a 6 hour layover in London. I found a nice bench to become friends with and took a snooze for the first part of it. I am definitely not that entertaining of a person by myself and this 27 hours of travel has done a lot to show me how true that is. From London I flew to Chicago and then to Milwaukee. Whew....I made it! All of my luggage made it! Praise the Lord!

Tomorrow I start my next rotation at 7am. The time adjustment is going to hurt for a while. I am going to try to force myself to stay up for a little while longer...we will see how well I do.

Thank you to all of you who have read this blog, prayed for me and encouraged me along the way. Your prayers have made all the difference. I still have much to process, but the long trip back has given me time to get a good head start. God has challenged me in so many ways and as I think back through the multiple conversations and events that occured over the last month I am realizing more and more the impact this experience has had on my life. Wow, I will be forever changed. Thank you to each one who has played a part in this, I am overwhelmed.

God bless,

Kristen

64 Year Old Pregnant Woman

Well....not exactly. This 64 year old woman came into the clinic complaining of increasing abdominal distension. One look at her and you thought she was pregnant and at term. Hmmm....something isn't right. The ultrasound views quickly revealed huge masses on her ovaries and not a live baby. We scheduled her for surgery the next day.

With ultrasound as our only imaging we took her to theater to investigate. She began feeling abdominal fullness back in May, but did not come to the doctor until now. She really had no other symptoms. When we opened her up it didn't take long for the huge tumors to show their faces. This ended up being almost like a 15 lbs. c-section. Uff... The tumors were both cystic and solid, not a great sign. Careful not to rupture them, we disected them away from the other tissues and were able to take them out. It was amazing how instantly not pregnant this woman looked...I only wish we could have given her a tummy tuck to get rid of all the extra floppy skin left behind.

The truly sad thing was that as we looked around her abdominal cavity it became pretty evident that this wasn't benign. I hate cancer. It had spread to her bowel, liver and abdominal wall and it looked like the primary source was actually her stomach. That definitely leaves you with a heavy heart as you sew her back up knowing this is the begining of the end for this patient. We debated about how this would be handled back home. Would you try to take out the stomach and then send the patient for chemo or radiation? Even back home this would be a difficult case. Here the chemo option does happen for some, but they have to travel to Nairobi for treatment which is a long and costly journey. Chemo will often leave the patients so sick that they cannot come back to their homes in Kapsowar. "First do no harm" is a huge concept to grapple with. Saving a patient's life only to put them in so much debt they will never come out of it to give them a few more weeks to live isolated away from home, family and friends makes you question the good you are doing by pursuing treatment. The social and logistical aspects of medical care play a much bigger role here. Heroic measures don't necessarily make you a hero.

I cannot tell you how vital the chaplains are at Kapsowar. They act as both spiritual counselors and social workers. Their understanding of cultural and social issues makes all the difference. So much of medicine here cannot be separated from these things and having their help to tease out real issues or to see the problems more clearly is truly invaluable. Watching them in action has taught me a lot about the need to have someone available who truly understands the culture because often they are able to do more to help the patient than frank medicine itself. The most effective of physicians will understand both the science and the social - a very challenging thing for an outsider to accomplish both.

The Clothes Off Your Back

You don't have to go far here before your white skin becomes a magnet for little kids running up to you with hands held out yelling, "Give me sweets!" or pulling at your watch saying, "Give me watch!" This can be a really hard thing to get used to. The demanding and sometimes overwhelming way in which the children ask for things comes off as rude, impulsive and selfish to our American culture. Somewhere along the way a precedent has been set that white skin = free hand outs (candy or otherwise). I am probably as much to blame as the next person in not really doing anything to stop this cycle. I decided a long time ago that giving things away in these types of demand situations (especially things like candy) is more detrimental than helpful and therefore don't do it, however, I never stop these children and let them know how their demands come across either.

One of the challenging things about being in a third world country is the vast amount of need all around you. I could easily give away everything that I own and it not make a dent in the poverty nor would it likely really be even appreciated. God, however, calls us to walk that extra mile and to give the cloak off our back if asked. Where do you draw the line?

This was something I particularly struggled with when one of the Kenyan staff that works on station became a more and more frequent visitor to our home. This individual would walk in through our door knowing that we had baked something that day and demand some of it. Sometimes she would walk in right as we were finishing up dinner and sit down at the table and just start digging in. At home, if someone so much as knocks on your door during dinner time let alone walks in unannounced and uninvited they would immediately apologize for interrupting your meal and leave quickly. Not so here. Where is the boundary between truly being a selfless servant and giving the cloak off your back and protecting yourself and allowing yourself to really live life? Laura is such a good example of selflessness and yet if I gave into every demand and need in Kapsowar I would quickly be without even the basic means for survival.

Laura and I had an interesting conversation about this and I think she is on the right track. The Bible calls us to be willing to give up everything, but that doesn't mean we have to do so unwisely. Many will cry out with needs, but those needs should be sifted through and met in a way that can have a true impact. Laura used the example of when they first moved to Kenya they had people knocking on their door daily asking for money for food, or to pay for school fees for their children. The Rhodes felt that if they could help they should so they were continuously giving out a little bit of money here and there to help out these people. They quickly learned though that the money they were giving out wasn't necessarily going towards what it had been intended for. Giving a family 1000 schillings for school fees was not really all that helpful when it costs 20000 schillings to pay for a semester. If they really wanted to be helpful they would answer the need of one person and pay for all of their school fees instead of paying for a fraction of many people's fees and not actually really sending anyone to school. God calls us to give and not to be selfish, but also to be wise in our giving and in the way we give. It seems like the real issue is the condition of the heart - if God asks us to give up our things are we ready and prepared to do it or are they too valuable to us? I know what the right answer is, but can I really do it? He may not call us to give up everything, but the willingness to do so needs to be there. The amount of need and God's desire to make us true servants has given me a lot to consider. It is awfully hard to give up those chocolate chips when the only way to get them is to have someone bring them from the States...life's simple pleasures become a lot more complicated.

The Rhodes

Dr. Rhodes with two Kenyan nurses and James, a Kenyan trained family practice physician.



From left to right: Amber, Bethany, Ariella, Me, Laura, Vanessa, Hannah



Bill and Laura Rhodes (the surgeon and his wife) are two people who have given me a lot to think about. I am the type of person that learns by watching others. Never have I seen my own selfishness so clearly than through watching the selfless lives these two Godly people lead.

Dr. Rhodes decided to go into medicine because he wanted to serve God by filling a need and helping others. He is an Old Testament scholar and studied Hebrew in Israel before going to medical school. It is an amazing story to hear how Dr. Rhodes has shaped his life to serve the Lord so intentionally and how that goal really drives his every day. Being the only surgeon in Kapsowar this man is on call 24/7. Rarely does he ever get a full night of uninterrupted sleep. He is usually at the hospital before the rest of the staff and there long after many have gone home. Though a surgeon, he is always willing to see non-surgical patients and pitch in wherever the need arises. Never once did I hear him complain about the long hours, missing a meal or the at times frustrating lack of resources. He simply is there to serve to the best of his ability because there is a need and God has asked us to go and show His love to the nations. This man has dedicated his life to that service.

When I take a look at myself all too often I can see a sense of entitlement rise up within me. Entitlement to lunch or dinner, entitlement to sleep, entitlement to working only with those patients that are specific to my area, etc. There is a selfishness there that is unexcusable. How dare I let that skipped meal become more important than the patient sitting in front of me or those few less hours of sleep change my attitude at the hospital? If I truly saw every person who walks through the doors as a temple of God or a potential temple of God how much would my thoughts, desires and attitudes change? Extremely humbling.

Watching Dr. Rhodes gave me a real life example of a true servant. Loving others before yourself. He gets it. A Kenyan once told me, " You know Kristen, God gave up all of His gold in heaven to come down to earth to save my life. The least I can do is give up my bed for one night so that those He loves can sleep." What an interesting comparison of sacrifice. Those things I am called upon to give up or do without are so trivial compared to the servant example set before us by our Lord. It is amazing how one man's Godliness can show me so much of my own ugliness. It has given me a lot to think about.

Laura Rhodes is one of the most capable, dedicated, self-driven women I have ever met. She understands the inner workings of the hospital from administration, to finance, to supplies, to staff. She is the go to person if the electricity goes out or there is no more water. She is the one the community goes to and reports a problem because she cares and because she will do something about it. One of the many hats she wears is coordinating all of the visiting students, doctors and staff at the hospital. She has incredible patience as she walks each one of us through our bumbling ways of adjusting to a new culture and setting. She is so full of grace that she makes you feel welcome in an instant and invited into her life though she is fully aware the inevitable goodbyes are just around the corner. Making friends and then having to let them go in a sort of continuous cycle would be so draining and yet Laura reaches out to us all without hesitation. She continually opens up her home and gives away some of the most treasured and hard to get things in Kenya....things that have been brought from home or given to her as gifts. Never does she let on there to be a grudge about sacrificing over and over again for those that enter her life only to quickly leave. I was amazed at her graciousness. I have a lot to learn.

Dr. Rhodes and Laura have taught me so much without even saying a word. It is amazing how observing the Godliness in others can show me the ungodliness in myself. I am very much a work in progress with an emphasis put on the word work.

Theater

The front door of the OR.

I thought I would try to give you a word picture of what the OR is like in Kapsowar. All operating rooms in Kenya are called theaters stemming from the old British use of the word when an OR had stadium seating with a central stage so that medical students could observe and learn surgery. No worries, stadium seating is no more but the term has stuck nonetheless.

The theater in Kapsowar is truly amazing. Complicated ortho, neurosugery, plastics and general surgery cases go on here with very minimal equipment and supplies. From what I could tell the infection rate after surgery here is equivalent or perhaps less than those I have seen back home. This is really remarkable considering the environment in Kenya and on the wards is less sterile in general than back home and the theater itself. It makes me wonder if all of our sterile techniques back home make that much of a difference. The scrub sink is inside the OR itself. It is a huge concrete basin than sometimes does and does not have actual running water. Everyone uses the same scrub brush for weeks until it finally falls apart. The soap we use to scrub in is just bar soap from the local shop and it too is reused until it runs out.

Inside the OR. I am having my gown tied in the background. Dr. Christina is scrubbing at the sink. We are about to do two cases side by side in the same room. The first case has already been started.

Once scrubbed we walk to the side of the OR where a sterile table is set up with gowns and gloves. The gowns are made of green cloth and are reused and sterilized in the theaters one and only autoclave. Many times surgerys have been limited in a day due to running out of gowns as the little autoclave sometimes has trouble keeping up with the pace. It is amazing that something like clean gowns can limit your ability to do surgery.

Washing the instruments in the sink before putting them in the autoclave.

The autoclave that keeps the OR going.

We always gown and glove ourselves and then help in sterilizing the field by scrubbing down the exposed area of body three times with three different solutions. This is a bigger cleaning process than we use back home and perhaps this is where the true value lies in keeping the infection rates low. With the patients that we see in Kapsowar your guess is as good as mine about the last time they bathed so this extra cleaning process really is vital.

Getting ready to do an emergency c-section. Patient has been scrubbed down and is now being draped.

The anesthesiologist, a Kenyan named Thomas, is really very excellent. I have never seen someone place a spinal faster than him. We have become good friends. Being Kenya bugs and flies are a part of life. One of the helpful tools in this Thomas' tool kit is a handy fly swater that he keeps at the head head of the patient and doesn't hesitate to use should the need arise...even during surgery. One day a fly landed on the patient while they were being preped and Thomas didn't think twice about hitting the fly and the patient. It made me laugh. Hard as I tired though, I could not get this man to pose for a picture with fly swatter in hand.

Thomas and I inside the OR.

The OR also does not have any airconditioning. Back home one of my big complaints is how cold all of the ORs seem to be. Here, however we have the opposite problem. With the African sun beating down on top of the building and us all gowned up with gloves and masks it can get really hot in a hurry. I never usually sweat during sugery, but this time I have been concious to not let the drips roll down onto the sterile field.

Suture and the availability of the right tools is hit or miss. This just forces us to all get out of our ruts and get creative. Sometimes the scissors and clamps work and sometimes not....always an adventure. We have to be careful when using suction because if we leave it on for too long it will overheat and burn out. We are constantly asking for it to be turned on and off during the cases.

Within the theater there is a little side room that dressing changes and smaller procedures can take place in. Often there are two or three patients in the room at the same time having things done.

I am continually amazed at how many people this one OR operation can serve and the complexity of the cases that can be taken care of with the limited resources. This really says a lot about the talent of the surgeon Dr. Rhodes. He is certified in general surgery and plastics, but could also be certified in ortho as well. He truly wears just about every hat and has an incredible heart to serve. What amazing talent!

Just got called to dinner...I will continue with this thought later.

Birthday Fun and Some Hard Days

Ariella, me, and Amber. My roommates put together an amazing birthday for me. Ariella made and decorated this birthday cake from scratch!

Last Thursday was such a special day. I spent my 26th birthday in Africa and what a fun celebration we had! Laura, the surgeon's wife had a girl's only bithday luncheon. Don't get me wrong, the guys here are full of fun, but it was nice to have some good girl time too. She made this amazing chicken salad which is a rarity here and some home made crossants. It was delicious. Then that night we had about 25 people over for dinner and enjoyed a mexican/kenyan style meal. It was such fun and I felt so blessed to have so many people show up and want to celebrate with me. Every meal is an adventure since everything has to be made from scratch, but it makes it fun because you never really know how things are going to turn out. I was amazed at how good the homemade tortillas and chips were! What a blessing.

My birthday lunch with all the girls! (Left to right: Amber, Bethany, Ariella, Me, Laura, Vanessa, Hannah)

The following day, Friday marked the start of the hardest 24 hours I have had here. We lost 4 babies in a row. All of the mothers came to the hospital in pre-term labor, one of them had undiagnosed twins. Term for pregnancy is 40 weeks and these mothers ranged from 24-28 weeks. The drugs here to stop pre-term labor are very limited and many of them have walked for hours before getting here and often it is too late to do anything by the time they arrive. It is heart breaking to watch these mothers labor only to know that these babies are going to be too young to survive when they are born. At home these babies would have a chance, but here if they are born before 32 weeks they almost always die. I cried many tears. The issues you face here are so different. For one of these mothers it was her first child and the child was laying sideways...a very difficult vaginal delivery. The baby was alive, but distressed during labor. After hours of laboring we decided to take the woman for a c-section. The struggle was that we knew at 26 weeks there was ALMOST a 100% chance this baby wouldn't survive. However, the baby was alive at the time and there is always that point whatever chance that he might make it. Women here get their worth out of the number of children they are able to have and c-section will limit the children you can have to 3 or 4. Back home this is a really good number, but the families here are so much bigger that you are really limiting a woman's ability to have a "normal" size family and thus the worth that society will see in her. Do you take that chance of survival and c-section this first time mom and limit her potential for a lot more children or do you let this one die and let the mother labor for a really long time in hopes of giving her a chance to have a lot more children? How can a physician make that decision? How can a mother?

I have spent a lot of time just processing these things. As hard as it is to grapple with these questions, they are real life for the people here. Wow. I am sad, but this is also part of the reason I came here, to see medicine as it really is in a third world country. I am learning so much.

These are the twins that didn't make it. Sad, but a good reminder of life in a third world country and that ultimately our Heavenly Father has all things in His hands.

A wonderful story to tell is that a boy and his mother came to our hosptial because the child was sick. This family is part of a very violent, warring tribe nearby and are mortal enemies of the people here. They came because this is the only hosptial around that could help their son. We treated him for severe malaria, anemia and dehydration and it was really amazing to see the transformation. The tribe these people come from have massacred many from the tribe in Kapsowar. It was very clear from how the mother acted when she first arrived that she knew she was in enemy territory. The doctors prayed for this family from day one knowing that it was a huge step for them to come here for treatment. We continued to show them love and rejoiced as the boy got better. They left smiling and I believe trulying feeling a love they could not explain and from a human stand point did not deserve. God definitely is at work here and I am curious to see what ripple effects this patient will have on the community here.

Every Sunday night the hospital staff get together for a Bible study. I love it and it reminds me of my Lifegroup back in Milwaukee. This last Sunday we studied Judges 19 and 20. The story isn't exactly your feel good, live happily ever after story, but it did bring home an interesting point that I have been thinking about ever since. God calls you to be faithful and not necessarily successful. I often feel that if I am doing God's will He will bless my work and I will see the fruits of that...however, I think that is a false and probably inmature assumption. In Judges the Israelites asked for God's direction and He gave them the go ahead to go to war. They followed His command, but He allowed them to lose for several days inflicting huge casualties upon the people. It is an interesting concept to take to the mission field. God calls us to be faithful and that is it. The successful part is up to Him. Just something I have been pondering for a while.

It has been rainy here on and off for the last few days, we lost power for a day or so and water as well. I am just continually remided that a good attitude and not assuming to have creature comforts will get you through. I am continuing to split my time between maternity, childrens ward, theater (OR) and the adult wards. I have gotten to do more spinal taps, help fix broken arms and place plates in the OR and see first hand what Typhoid looks like. Wow...very busy!

Open reduction, internal fixation of a forearm fracture. The yellow baseball cap is the head of Dr. Rhodes.

Thank you to everyone who has been praying for my family. Just a quick update from home...my dad came back to SD and had a second surgery to remove the stent and break up some of the stones. Things seem to have gone well though he is still recovering. A huge praise is that his doctor back home looked at his imaging and does not think there is anything wrong with his spleen or pancrease! Thank you Lord!

New Experiences

I came to Kenya to experience and learn things that I could not in the United States, and that I definitely have.

One notable experience was with a child who came into our hospital with a slight fever, anemia and was vomiting blood. We immediately tested the boy for a variety of diseases, but the tests all came back negative. Finally, a nurse mentioned that the local children often go down to the river to drink. Unfortunately, they drink up baby leeches along with the water. These leeches attach and grow. Sure enough, a leech was the culprit. We removed it and the child began to get better.

A woman who lost her ears also came into our hospital this past week. The story of her injury is found somewhere in the depths of dating the wrong guy, a jealous girlfriend, etc....needless to say, conflict managment is much different when an ex-girlfriend solves things by cutting off new girlfriend's ears. We are going to wait for them to heal a little bit more before Dr. Rhodes does some skin and bone grafting to make new ears for her.

There also was a man who came in with a machete in his head. He had arrived home late and his wife was in a tirade. She took the machete and hit him. It was so deep that during surgery we could see his brain. Unfortunately for him, we were out of general anesthisa. We had to put him back together using only local anthesia. He is doing fine, but the lack of anesthisa is becoming a serious problem here.

More later...

Random Potentially Interesting Info

A sneak peak inside the hostel. The top picture shows our toilet, sink and shower all in different little rooms at the back of the hostel. Very convenient when sharing the place with multiple girls. The bottom picture is of my room (this was taken the morning I got rid of the bed bugs..yes I did have a mattress, it was just outside at this moment). Very cozy, with all the basics.

We have running water in our homes and at the hospital, but occasionally we do run out. The water heater has to be manually turned on about an hour before you want to take a shower, but a hot shower was definitely way more than I was expecting and I am so thankful. The water out of the tap is not safe to drink. To purify it we fill up liter sized water bottles in the morning and lay them in the grass in the sunlight. They cook in the sun all day and then they are safe to drink...pretty simple, but very effective. The water still can have some grit in it so we do have an extra purifier to clean out the dirt if we want...but honestly, we don't always use it because it is really slow.

Sunning our water on the grass outside the hostel.

To wash veggies we have to use bleach. We soak our vegtables in bleach water and then rinse them in clean water. If you cook with enough spices you cannot taste the bleach so it is not a big deal, however it does make preparing meals take a little longer than they would normally.

My roommate Amber showing off her amazing cooking skills by making homemade tortillas in Kenya!

I went for a run the other evening on some of the dirt paths around town. Being on a hill makes just about everything either straight up or straight down, but nonetheless very good exercise. It is really pretty and green here with lots of trees which makes these runs even more enjoyable. What makes these runs interesting though is that they are shared by many other people. I was rounding a sharp corner the other day and almost ran completely into a cow that was sharing/hogging the road in front of me. Funny about the things you have to look out for. The children are fascinated with us Westerners and they like to run with me. Sadly, while running up hill and carrying jugs of water they can still go faster than me.

Can you believe this is Africa!?!

I learned that the natives here think our white skin is very strange. They say it resembles the look of a plucked chicken. The discription made me laugh because in some respects I think that is probably a really accurate description.

Anyway, I just thought I would add a few more random thoughts that some would find interesting....hope you enjoyed!

Updates from Home and Abroad

Thank you so much for all who have been praying for me. It means so much. Given some of the challenges I faced even prior to coming to Kenya I suspected that my time here would be met with unusual difficulties. I got a call from my mom on Sunday night. My parents were in Phoenix at a conference this last weekend when my dad had to be admitted to the hospital for severe kidney stones. The stones are too large to pass on their own and are affecting both kidneys. He had surgery that day and they were able to put a stent in one side, but were unable to remove the stones. The imaging he had done revealed an inflamed pancreas as well. The doctors felt that he was stable enough to return home the next day so that he could continue treatment in SD. Please be praying for him and for his doctors to have wisdom in his treatments. It is always so hard to have family members sick and hurting and to be so far away. Having a medical background makes me want to be there to help, look over test results and talk with the doctors even more. However, I know God wants me here and there is much work to be done. I pray that Satan is not using this as a distraction and an attack because of the work that I am doing. Bedbugs and personal injury I can handle, but attacks on my family are much more challenging.

With that being said it is becoming more clear to me why God placed me here and now. There is a big CMDA medical conference going on in Nairobi this week. Doctors from all over Africa are attending. It is a really good time of renewal, learning and connecting for the physicians. Christina, the OBGYN doc that I told you about earlier is one of the people attending this conference. With her gone the load of the maternity ward has to be taken up by those still here. I am now in charge of rounding on the maternity patients in the morning, coming up with their daily treatment plans and discharging them when they are ready to go home. It is really great to feel like I can take some of the load off the other doctors and contribute in this way. I wanted to come here to learn, but also to serve and God has found a way to use this mere medical student to serve the other doctors here. This also helps to throw me into the world of the patients even more which gives me greater exposure to their needs and understanding of how to help. In between seeing OB patients I am also spending more time on the pediatric ward. This is really giving me the opportunity to see more and understand some very critical pediatric medicine in a third world setting. Pneumonia is really common here and it can become difficult to decide which patients need oxygen when only one tank is available or what antibiotics to give when the hospital has just run out of your first, second and third choice.

Late last week I was able to do my first breech c-section delivery and my first tubal. A friend of mine took pictures. I will have to upload them on the blog when I get back home. I cannot believe how much I am learning in such a short amount of time. Breech deliveries are something I am really hoping to get a lot of exposure to. We don't see them as often in the US and they are more difficult and have greater risk which makes them super important to learn and to learn well.

Getting ready to do a c-section with Dr. Christina (the OBGYN) before she left for Nairobi. Notice there is another case going on in the background. With only on operating room, if an emergency comes up we often just bring the second patient into the room and do the cases side by side.

Success!

I was on call last Friday night when there was a 2am c-section that needed to be done. The mother had ruptured her uterus, but thankfully we were able to get the baby out in time and both mom and baby are doing well. This mother has had 2 other c-sections which increases the risk of uterine rupture significantly. As of this point she has decided she still desires more children which makes me just take a big breath because she will likely rupture again and next time she and her baby may not be so lucky. There is so much of the culture here that I don't understand. This mother already has 5 children. I think I feel more confused than anything at times. I am learning to just accept whatever decision they make and support them through it knowing that I can't possibly understand all of the dynamics that go into their choice.

On Saturday I had the morning and afternoon off so my roommates, me and one of the surgical residents got up at 6am to climb Kipkanor. Kipkanor is a local mountain and landmark of the area. The view from the back of the house I am staying at frames it perfectly. It is a 14 mile hike round trip and you gain 2,500 feet in elevation. I was definitely sore the next day, but it was an incredible experience to walk through the forest and see the view from the top. My typical thoughts of Africa are usually dry, tall grass and hot savanahs. Our view of Africa on Saturday resembled more of a tropical forest with bamboo patches lining the trail.

Hiking the trail up to the top of Kipkanor...so beautiful!

Made it! Sitting at the top with my roommates Ariella and Amber.

On Sunday one of the nurses invited us to attend church with her. It was a little bit of a hike to get there, but I so much enjoy worshiping with Kenyans. Worship becomes a full body experience as every song is sung at the top of your lungs and is accompanied by dancing and hand motions. The children did a special song for us and my heart just warmed. The Lord loves these people so much and I can't imagine how much joy it must bring Him to have a whole group of poverty stricken children dressed in their "Sunday best" singing praises to Him. Sunday night the staff of the hospital got together for Bible study. What a special time. We sang worship songs together and then one of the doctors led the study. There are very few things I enjoy more than sitting around with a bunch of believers with one guitar and just singing the night away. Our God is so good.

Rhoda and I at the hospital. The hospital chapel is the building just behind us. Rhoda is the nurse that invited us to go to church with her.

Yesterday we had two intra-uterine fetal demises (IUFDs). The patients came to the hospitals and their babies were no longer alive. This is so common here, but still so difficult. The women still have to go through labor and deliver though they know that they will not be going home with a child. It makes my heart ache. One of these women had a transverse baby meaning that the baby was laying sideways which made the delivery even more difficult and painful. The OR ran out of anesthesia yesterday so c-section was really not an option. There was one patient we were going to induce yesterday because she is is much past her due date, but we ended up sending her home because if things did not go well and she needed a section we would not be able to help her unless we did her surgery under local anesthesia...painful for everyone. Helping the poor comes with challenges when the patients cannot pay their bills and thus the hospital cannot afford anesthetic. We are praying that more will arrive soon as it is supposed to be on its way, but must pass through a lot of red tape including taxes and government stops. I am praying that no emergency c-sections need to be done until then.

The community here at the hospital is amazing. Word got out that my birthday is on Thursday and they are already planning to have a party. I am so blessed. I was expecting for my birthday to completely pass me by and had in fact forgotten about it. Food and even ingredients for a cake are hard to come by, but the people are so generous. I cannot believe what they are planning. It will definitely be a day to remember and I cannot think of a better place to spend it.

Thank you all for your prayers. My family and I definitely need to be covered in them. Please continue to pray that God would use me, teach me and grow me.

Kapsowar Updates

I made it to Kapsowar safe and sound and with all of my luggage on Monday! Thank you so much for all of your prayers. I definitely had to repack my luggage at the airport, but it really helped having another traveler with me to take some of my luggage. I did not end up having to pay any extra fees!


Our transportation from Eldoret to Kapsowar was the Kapsowar ambulance. After doing all of our grocery shoping we did a pretty good job of packing the place out. My Kapsowar travel buddy is Dave Boweman, the gentleman you see sitting next to me.

Internet in Kapsowar is a little bit harder to come by and more expensive. They charge you by the megabite you use and not the time so the more pages I have to upload the more expensive it is. In order to help with this I think I am going to give updates in groups.


View from our backyard in Kapsowar - beautiful! The little moutian in the top right is Kipkanor...I will talk about that later.

Monday - I flew to Eldoret from Nairobi. It is amazing how flying is different here. There is no taking off of shoes at security, water and liquids are no problem and they never once asked us to turn off our cell phones. I got into Eldoret and met Laura Rhodes, the wife of the missionary surgeon at the hospital. We spend the afternoon doing some shopping and running errands. Eldoret is a "big" city compared to Kapsowar so whenever people come into town they use it to stock up on supplies. We went to the grocery store and I struggled to think of all the things I would need for the next month. That is a really hard task when you know that you will be cooking differently and you are not entirely sure what you can get locally at Kapsowar. Thankfully I have some very awesome roommates and they are gracious in sharing. I have always loved having roommates, it just makes things so much more fun. Amber is the physical therapist I am living with and Ariella is a pre-med student. Ariella really reminds me of a good friend from Davis - Laeya who came with me on my first trip to Kenya. I am so thankful for her enthusiastic and positive outlook on everything. The 50 mile drive from Eldoret to Kapsowar was driven in the local ambulance with us sitting in the back among all of our supplies. The first 20 miles were paved and the last 30 was a very rocky dirt road. Kapsowar is absolutely beautiful. It is located in the mountians at 7,500 feet and has breath taking views. I cannot believe I get to live here for a month. The first night was just spent getting my sense of direction. Amber and I walked into town and bought bananas and mangos from the local market. She gave me a quick tour of the hospital. It is an open air hospital meaning that all of the different wards are seperate from each other so we get to walk outside during the day when going from place to place. It is so wonderful, because back home I often feel that I spend all of my time inside and don't ever get to see the sun.




These are a couple of shots of the hospital. Each building is a different ward. The picture on the top shows female medical and female surgical ward. The picture on the bottom shows male medical and male surgical wards.

Tuesday - I rounded with the OBGYN here, Christina. She graduated from residency in Indiana this last June and it is awesome to work with her because she is still very used to teaching and has been here just long enough to really have gotten the hang of things. I am learning so much. Medicine here and even how documentation, charting, lab work and pharmacy are conducted are so different. I am really glad that I am able to see it and begin to understand how a hospital is run on a budget and with very limited resources. It is amazing how so few medications can get you so far if you really need them to. None of our patients who have had c-sections go home on narcotics because we simply don't have them and they have yet to complain about our regimen of Ibuprofen and Tylenol. Wow...tough ladies and it goes to show what you can really put up with if you have to. Female circumcision is very common here and is something I have only seen once at home. I am still trying to understand why this cultural practice is still popular. It definitely changes medicine and labor and delivery practices here. I was on call this night and got called in for a woman in prolonged labor. This was her first child and she was at a government run clinic during the day and had been pushing for 12 hours before she got to us. Not good. Baby started to show signs of distress so we had a crash section in the middle of the night. We put the patient on a gurney and ran with her outside in the open air up the hill to the OR. The OR has exactly what is needed and nothing more. It gets the job done with no frills. It is really amazing that they are able to do some relatively big plastic surgery cases in a setting such as this and have reasonable outcomes and infection rates. Every supply needs to be trucked in from Eldoret and every scrap is saved and recycled if possible. The main surgeon here wears a baseball cap instead of a surgical cap while operating...it is recycleable and it gets the job done. Both baby and mom did well. I prayed out loud as Christina made the first incision...things definitely could have been a lot worse. We did lose a baby overnight. It was a twin that had been born early and was in the most significant respiratory distress I have ever seen. We have no ventilators here and certianly nothing for someone so small. It was heart breaking to watch this little one struggle to breath and knowing there was nothing we could do but watch him tire out until he could do it no more. We grieved with the mother the next day as the reality of the loss began to set in...so hard.








Maternity ward - my home sweet home for the next month. This is an inside look at one of the wards within the maternity ward. It took me all month to find a day when the ward was this empty to take a picture. The only privacy the patients get is by pulling the curtians between the beds. Though privacy is an issue the lack of privacy really helps foster friendships and relationships between the patients.




Wed - I discovered that I had bed bugs. I came to Kenya expecting that and was actually surprised when that wasn't a problem in Nairobi. After getting eaten in my sleep I woke up early and put my mattress outside and washed all my my bedding. The direct sunlight should kill all the little critters. We will find out tonight.


View of the front door of the hostel Amber, Ariella and I called home.







A picture of my mattress sunning in our back yard with laundry hanging on our line. Hard to believe this is February!

This morning's rounds were met with a patient in acute post-partum psychosis. Not something that is seen back home very often. The limited supply of anti-psychotic drugs also makes this challenging to handle. She gave birth to twins, but now is so unsafe that she is not allowed to hold them for fear that she might do something really sad. We dont' have a psych ward here which is where a pt such as this would normally be managed. The wards here are open air hallways with bed after bed lined up. For us that would be a major invasion of privacy, but it has been a protective thing especially for pt's like this because there are so many eyes of the other women in the ward watching out for her. I hope that we are able to help her. I am praying that the Lord will step in and help her to make sense of things again.

Another interesting thing I have seen here is a baby that was born with her knees backwards. Her legs bend forward instead of behind her. Her mother is taking this very well and we have been in contact with Kijabe and there is a peds ortho surgeon there who says this condition is very correctable and is willing to do the surgery. Thank you Lord...otherwise this little one would not have a chance in a place like Africa.


Baby with her knees that bend the wrong way. This is her flexing them herself. She was casted and I saw her just before I left and it was amazing how her legs were almost back to normal after just one month!

I got to do my first spinal tap today! I have made it known that I am here to learn and do as much as possible and the staff are taking me seriously. These are skill that I might not learn in residency because they are not directly pertinent to OBGYN, but on the mission field they are really important things to know.

It has only been two days and I have already learned so much. It is incredible. Thank you for all of your prayers. Please continue to pray that I will learn all that God wants to teach me. I hope to write again in a few days.