Isabellah

For the past three weeks I have been seeing a patient named Isabellah. Isabellah came into the hospital after being treated by another hospital following a car accident. She had a broken femur and deep lacerations down her right leg. At the other hospital she had been sown up and then she transferred to Tenwek. Dr. Galat and Josh performed her surgery repairing her broken femur and also opening up her laceration to get it clean. Under the sutures they found that her tissue was barely alive. She had to go back to the operating room 2 additional times for cleaning and skin grafts before she as released for rehab. I met her on rounds and she immediately took to me. When ever I would walk past her room she would yell out "Jesska." Then I would go in, say hello, pray with her, and let her know that I was looking forward to working with her. She has been a patient that expects me to pray with her and definitely keeps me accountable to that.
Isabellah is a confessed believer. She attends an African Gospel Church- the predominant denomination here. She speaks of the Lord freely. She also comes from a family that seems to be well off. She has given me gifts often of bananas and sugar cane. She has pedicured toe nails and has been well fed.
In a previous post I mentioned that Isabellah has been the source of some of my greatest joys and frustrations on this trip. She has brought me joy in the fellowship I have with her as a sister in Christ. It is a blessing to pray with her and to be able to encourage her in her faith throughout her recovery.
Unfortunately though, Isabellah is spoiled. Her pain tolerance is incredibly low. She does not take ownership of her own body but rather expects others to do everything for her, including make her better. I feel like I have been trying to instill work ethic and determination into her for the entire time I have treated her. I have become very frustrated with her because she just will not move her leg. Trust me, she can. I have nicknamed her Drama Queen. Frequently when we first started to get her out of bed she would act like she was fainting so that we would let her sit down. Her screams can be heard in the next building when I even start to move her leg. She is afraid of pain- she is not actually hurting (because I am not actually moving it) she is just afraid of it hurting. I do believe there is a Biblical principle here. Isabellah is paralyzed because of fear. She continually tells me that "this isn't my fault." My reply is "the fact that you won't be able to walk later will be your fault." Isabellah believes that she didn't deserve what happened to her so therefore she shouldn't have to endure the pain of recovery.
So often I feel like my sinful nature isn't my fault- I can't help that I sin, I'm a victim. Therefore it should just be taken away supernaturally. The reality is that I must endure sanctification and be grateful that the Lord wants to make me better. But I must trust in the Lord that the pain of sanctification is making me better- even though it hurts.
"Our fathers disciplined us for a little while as they thought best; but God disciplines us for our good, that we may share in his holiness. No discipline seems pleasant at the time, but painful. Later on, however, it produces a harvest of righteousness and peace for those who have been trained by it. Hebrews 12: 10-11
My time with Isabellah has also tested my ability to truly love her. Loving Isabellah doesn't mean that I am always nice to her. Often I have been stern, real, and called her out on her laziness and excuses. It is amazing to see how the bond of Christ remains strong and we can always laugh and "be friends again" at the end of a session. Often she has said she misses the "old Jesska," meaning the nice one that spent 2 hours with her just to convince her to get out of bed. The great thing is that she understands that I have changed strategies to cultivate independence in her. In the course of our three weeks together she has cried, her father has cried because of her screaming, her roommate has cried because she thought I was torturing the poor girl, she has threatened to sue me, and her mother has realized how spoiled her daughter really is. Her mom greets me each day outside the ortho ward with cheek to cheek kisses (which we have head butted several times b/c of my unfamiliarity with the custom) and a smile, she understands that I am truly there to help no matter how much it may look otherwise.

Currently Isabellah is on the upswing. Her skin grafts are healing and she is slowly starting to achieve some muscle contractions. She still has one skin graft remaining to be completed then she will be discharged to go home. She is walking on her own for about 50 ft. She continues to want to lay in bed all day and complains the entire time she is sitting up, but she is making progress. She has taught me a new kind of patience and love. With her progress I have seen glimpses of a new strength in her, my prayer is that the source of that strength grows in the power of Christ.

Therapy

My work here at Tenwek has mainly been acute care inpatient rehab. My typical day has matured to now I see the patients in the wards of the hospital while the other therapists handle the outpatient visits and any casting needs there are in the hospital. This can be a lot of work. My days are generally longer than what I would put in at the US and they are definitely more varied. I've mentioned some aspects of care in my previous posts, but I thought an 'end of our time here' reflection is now appropriate.
Differences between therapy in the US and Kenya:
1.) Casting- Here therapists are expected to be expert casters. I have only applied one cast by myself but I have helped the other therapists apply on average 2 casts each day. I have gotten a lot of experience with the cast saw.

2.) Prescriptions- The therapists can prescribe pain medicine and anti-inflammatories. I have been handing those responsibilities over to the other therapists.
3.)Traction Pins- Therapists play a big role in inserting traction pins into the limbs of children and adults for setting up traction to heal their fractures.
4.)Spica casts- They are everywhere. These casts position the patient with their leg out to their side and externally rotated. The casts typically go up the leg around the waist and part way down the other leg. Many are modified here to only include one leg to allow the patient to walk. Sitting is very difficult for these patients.
5.) Exercise- The majority of people I work with have no concept of exercise. Which makes sense, because they perform manual labor as their exercise. But the concept of continuing to bend your leg to make it be able to bend like normal seems to be a foreign strategy. They just say "it won't bend" and then don't work on it the rest of the day, despite my instruction. Then they get pretty aggravated at me at times when I make it bend, yes it hurts, but it is always the young men who get the most mad, I think it is a control issue. A huge issue with non-compliancy with exercise is my inability to speak their language. Most of the time I can get my point across with motions, broken Swahili and their broken English. Then I ask the nurse to translate the frequency of exercises, but often I wonder if the nurse understands how they really do need to do it as many times as I am telling them. The national therapist's default for frequency here is "do it 100 times a day." I'm not sure that strategy works either.
6.) Families- The families here seek me out to work with their beloved ones. After I do my initial evaluation the caregivers keep an eye out for me all day and are sure to remind me when I walk by that their child or mother or father needs to be seen. Another difference is the gratfulness the families display. It is definitely apparent. I seem to be able to bond quickly with patients and their families here. Whether it is from the guys on ortho giving me a hard time because I don't speak their language or the children beaming when I poke my head into the room, there are definitely relationships being built. I plan on blogging about Isabellah soon- she has been one of my biggest frustrations and joys on this trip.
7.) Assistive devices- They have to pay for them before they can get them. This creates a huge dilemma for me. I will train someone on crutches (which are used a lot more here than in the US) then I have to take them away until they can pay for them. Then I see my patient either laying in bed all the time when they could be walking, or walking on the limb that they are not supposed to be letting touch the ground. This is a frustration with the system.
8.) Diseases- There have been many times when the diagnosis for a patient reads malaria vs. typhoid or cva vs seizure or just plain unknown origin. Often you have to assume the patient has the worst to protect yourself from contamination. They do not have a CT scan or MRI here which makes definitive diagnoses very difficult in many cases. It doesn't effect my treatment much, just how carefully I wash my hands afterwards.
8.) The freedom to pray- There is such a joy and comfort brought to the patients by speaking the Lord's name and praying with them as they recover. Both the freedom and how comfortable it is to pray with the patients is different from the US. It has also shown me how many opportunities to pray with my patients in the US I have let pass by.

Despite the many differences between the US and here I am amazed at how God continually shows me evidence of the fact that we are all created in his image. People seem to be the same here versus America. We are all either sinners living in sin or saved by grace. There are strong, weak, tough, whiny, joyful, sad, excuse makers, and overcomers on my case load. Personalities seem to be evenly distributed, very similar to the personalities that I see in the US. I am able to bond quickly to fellow believers and have barriers to overcome with angry or resentful patients, but they all appreciate and seem to recognize genuine care.

Only skin deep

Kenyan Bible studies require a few simple ingredients - the Word, some good chai, and a group of bundled-up Kenyans complaining about how cold the evening is (as I sit with them sweating). I just got home from our weekly Bible study a few minutes ago. It is such a remarkable time to experience the Church Universal with all of its colors and backgrounds and accents.

Some things are unmistakably unique to this group. One of the Kenyan residents hails from a village renown for its witchcraft, and his comments on the impact of spiritual warfare sound strange to my American ears. Another has such a familiarity of scripture that I feel ignorant as he rattles off reference after reference and one obscure Biblical character after another. The third speaks lazily with such a thick Kenyan accent that I never quite understand what he says.

Other things are strikingly the same. I am still amazed to find that the struggles that we encounter are only "what is common to man." Despite traveling thousands of miles to a people of different skin and language and temperature-preference, we engage the same battlefields. Much of our discussion tonight centered on pride and obedience and believing the Gospel fully. They struggle in the same ways that I struggle. We fight against wanting to make a name for ourselves instead of the Lord. We grapple with living in true repentance. We wrangle the same sins of unbelief. While our skin may look different, at heart we are all the same.

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When we begin a procedure in the OR, we start with a simple incision. The knife slices through a thin layer of pigmented epidermis. This shallow black layer is less than a millimeter thick. The tiny distance is actually quite baffling. Once we pass through this infinitesimal barrier, all of the rest of the tissues are absolutely identical to an American's or an Eskimo's or a politician's or an atheist's. We are made from the same "lump of clay" and face the common effects of a sinful flesh. Thanks be to God for the grace that makes all things new and unites worshipers from all tribes, tongues, and nations to sing His praise.

Hakuna Matata in the Mara

So, it has been a childhood dream of mine to go on safari. I have always been an animal lover. My favorite movie is Lion King. I think Land Rovers are very cool. So, when time came this past weekend to make that dream a reality, I was pretty excited to say the least.
On Friday we loaded up the "mini bus" also known as a mutatu with nine other people from the guesthouse. It was truly a blessing to be able to go with this group of people. It has been amazing to see how quickly we have been able to bond with them, and we consider them great friends. Our time at Tenwek would be a very different place if they were not here. Each one of them seem to be at a transition in life similar to us, whether it be going into residency, finishing residency, or graduating from graduate programs, we all are very excited to be here, but also have big things right around the corner when we return home.

So Josh and I and our nine new friends headed down the bumpy road, amazed by how many herds of cows that we had to wait for to get out of our way, on our way to Masai Mara. About 2.5 hrs into our 3 hr drive the other van travelling with us pulled over, not because they had hit a cow, but because their tire was no longer attatched to their vehicle. So, after the tire being secured by a rope (!?) we continued on our way 30 minutes later to the reserve.
We had been told that we would be sleeping in tents at the resort. Well, these are 5 star tents. We were very pleased with our accommodations in the little oasis in the middle of no where. Yes, it was a tent, but it also had all the amenities of a hotel room. We were woken up each morning with a man saying Jambo outside our tent with our fresh personal pot of coffee. That is, he woke us up if the hippos, which were in the river below our tent didn't wake us up first (they like to migrate in around 4 am).
In total we went on 4 safaris. They were great. We drove around for 2 or 3 hrs at a time and were on the hunt for the "big 5." We saw lots of animals but the big 5 that we were looking for (the ones most dangerous to man) were the lion, leopard, rhino, elephant, and cape buffallo. We saw all but the leopard (but we saw a cheetah instead, so that counts in my book) and got lots of great pictures (thanks mom for letting us use your mega zoom camera, it worked great!). My personal goal was to see all the animals that were in the movie The Lion King, I saw them all except Timon (the Meerkat), they only have mongeese (mongooses?) in the Mara.


After Josh getting out and pushing the mutatu a couple of times through some muddy roads on Sunday, we finally made it back safe and sound. We were very tired, but ever so grateful for this amazing experience.

Smashed wasps and other dying things...

Kenya has a lot of death. A lot. When we want to brush our teeth, for instance, we boil water to kill the parasites. They all die. When Jess sees an unwelcome six-legged critter flying around our apartment, she animatedly tracks it down with wide eyes and flailing hands to kill it. When a patient's injured toes have begun to share a pungent odor of gangrene, we know that the appendage has died. When our Tenwek pediatrician has a rough day, it marks that the nasty GI plague has just claimed another baby. The count was up to eight dead babies the other week.

Death is a paradoxical thing for the Christian. Looking at it from one angle, death is the most unnatural state imaginable. After all, Adam began in the Garden as an immortal being, where death was not known. After all, we are children of the One whose very breath creates life, the Life Giver himself, who knows not decay. After all, our eternal destination is to shed these temporary bodies and live in Real Life for all time.

From the other angle, however, death is entirely natural for the Christian. In fact, it is paramount and essential. Jesus modeled it that way. To follow the path of Jesus is to follow him to the cross. He invites us - no, commands us - to join him in the shame and pain of Calvary. It seems that an inescapable feature of love is death. It dies to its own desires, it is long suffering, it does not demand its rights, it humbles itself even to death. I John 3:16 tells us how to know love - "By this we know love, that he laid down his life for us, and we ought to lay down our lives for the brothers." The mark of pure love involves death.

I don't know how to do that very well. The Lord has been bombarding Jessica and I with examples and teaching from people here who die well. We heard this message recently in our Bible study and in the Sunday morning sermon. Yet when I swing out of bed in the morning, my first thought is not to crucify myself with Jesus. That would just hurt too much.

Graciously, the Lord continues to hone us. He desires that we die to ourselves and is much less concerned about our worldly comfort than we think he should be. But that is good, because comforts can distract and numb us when God would call for our full attention and complete sensation to the needs around us. It's a paradox - that we have to die in order that we might live and feel and truly be.

Easter in Africa

  What a blessing this holiday has been. The remembrance and celebration of our Lord's death and resurrection has truly been a rich time here at Tenwek. Amidst the busyness of working at the hospital, spending more time with tasks than anticipated, it has been such a glorious reminder of what we are living for. 

     On Friday we attended a Good Friday service where we were struck by the forgotten intensity and magnitude of Christ's sacrifice. The service was wonderful, placing us in a time of reflection and sorrow for the beautiful sacrifice that was committed for our sakes. Following the service we watched the Passion of Christ. This film struck  me in a new way. I literally felt nauseated and cried during much of the film, as the reality of scripture came to life. The amount of power that Jesus was withholding while he was being tortured from the time of his arrest to his death is astonishing. That is the same power that he gives to us to truly live. Josh and I returned to our apartment sorrowful but so grateful that we were being struck by the realness of the the crucifixion. I am saddened by how often I say with my actions or complaints that Christ's sacrifice is "not enough." I am so often   not joyful, not content, and striving to accomplish my own salvation. I praise God for the abundant grace that he shows despite my ungratefulness.  

   

      Saturday morning we awakened extra, extra early to hike up to the top of a mountain here called Motigo to see the sunrise. It was gorgeous. We were blessed by the beauty of creation and the promise of new mercies each morning. After taking many pictures of the incredible landscape and scenery we returned. Josh headed up to the hospital to see patients and perform procedures while I did laundry and cleaned. Around 11 am we headed to the high school field to play ultimate frisbee. We were sort of short on players for the big field, so we counted Josh as 2.5 people and continued to play (Josh's team won each time despite being always down at least one man- is ultimate frisbee a spiritual gift? If so, my husband is definitely blessed with it. ) After frisbee came lunch and a short nap, followed by Josh going to the hospital again and me performing additional homemaking tasks. Me and an friend made snickerdoodle cookies to share with the guest house then walked to an unclaimed garden to pick lettuce and zucchini to make a salad to go along with our pizza night. All the fresh vegetables (which are very difficult to find) have to be washed in either bleach or chlorine before eating, so far there have been no reports of illness from the salad last night :)  ). We enjoyed a night of fellowship with about 15 other guesthouse members and pizza, salad, and Boggle. 

      This morning Josh and I attended our first ever sunrise service. We gathered in the yard of one of the missionaries while it was still dark and welcomed the new day as we read scripture and sang praises to our God, remembering the hope found with the resurrection. It was a beautiful service which concluded with each person placing a flower on the cross as the sun rose over the mountain in front of us. Wonderful. Josh then went to the hospital to round and then we attended the regular service at nine. During the service I was very excited to look down the aisle and see a wheelchair. It was Gideon. He was sitting there among the Muzungus with a huge smile on his face. I am even more convinced that the Lord is working in his life. I doubt that he could understand much of the service, as it was in English, but he seemed very grateful to be there. His father was not with him, which makes me realize that I need to be in prayer for him during this time, especially with his illness looming. 

    The Galat's have graciously invited us into their home for Easter lunch. We are very excited about this opportunity to fellowship with them and have a unique lunch. We were instructed to come at 1:00 because the goat would not be done until then... I think we are having lamb also. Yes, it will be different, but I'm sure we are going to enjoy ourselves. Josh is currently trying to get tasks done at the hospital before lunch so that he will have a free afternoon. We are having company for dinner, a couple in the same position as us- 4th yr med student going into Ortho, we are looking forward to that fellowship as well. The Lord has blessed us this weekend and we hope that each of you have had or are having a wonderful Easter, savoring the magnificence of our Lord's resurrection. Happy Easter!!! 

 

Lessons learned

So we have been here in Bomet, Kenya for one month. Time has passed very quickly and we suspect that the following month will pass by even more rapidly.

There are so many little tid bits here and there that have been discovered. Here are a few of the lessons learned after one month in Kenya:
1.) Beans take a long time to cook.
2.) "Sakuma wiki" (kale... we think) can be quite tasty and is our main source of vitamins.
3.) You have to have really strong teeth to eat sugar cane.... not I.
4.) Sunrises on hilltops in Kenya are beautiful.

5.) Even though English is spoken it can still be very hard to communicate.

6.) "Communication is key" even here.
7.) Air dried laundry can be stiff.
8.) Toyota Corollas can be sold as off road vehicles.
9.) Mosquitoes like showers and sinks, when they can't get to people.
10.) Mosquito nets are not that bad.
11.) There are different grades of tea, BP1 is the best, it is grown in Kenya but exported to more wealthy nations.
12.) Many Kenyans think that the US has population control- only 2 children per family.
13.) Saying you have "no children" means that you are barren (so I have lots of children, but just not born yet....)
14.) Our refrigerator here works better than the one in Lexington (thanks to the Lindemann's for taking care of our broken fridge mess last week!)

15.) Chai does not mean spiced tea, it means tea boiled with milk and lots of sugar.
16.) Do not get injured at 10:30 AM, as all of the hospital workers will be observing Chai time.
17.) People everywhere appreciate care.
18.) People can threaten lawsuits even in Kenya.. (I had an unhappy wealthy teenager as a patient).
19.) Prayer is powerful.
20.) Everyone wants you to come to their home, no matter if it is 4 hrs away.
21.) The US really is odd with not using metric units.
22.) Medicine is such an easy field to love on people.
23.) You can definitely serve with a bad attitude.
24.) It is much more fun to serve for the sake of others instead of for your own purposes.
25.) We are dependent on our computers.

26.) Pictures fascinate children.

27.) Wealth is often determined by the number of cows you own.
28.) Areas are characterized by what they grow, Kentucky's tobacco is not that impressive of a crop to the Kenyans, and they don't understand the concept of "growing horses."
29.) We live on a lot more than we "need."
30.) You really can appreciate each day being beautiful.
31.) Chameleons make great pets.
32.) Faith is displayed in various fashions, but it is awesome to see the signature of God on it all.
33.) Education goes a long way.

34.) Napkins work as coffee filters.
35.) You can make tea in the coffee maker.
36.) Coffee and tea mixed together does not taste very good.
37.) Saying, "Praise God," after accomplishments goes a long way with sharing God's love with people.
38.) Easter is much more of a holiday here, most workers get Friday and Monday off.
39.) Pangas (machetes) are used for much more destructive things than clearing the bush.
40.) You can't tell people to "put ice on it." Refrigeration is not common.
41.) Many of the hospital workers do not have electricity in their homes.
42.) There are several people named Barack Obama. Baraka means "blessing."
43.) Most of the residents here have never been outside of their region.
44.) Running in a skirt is doable.

45.) The connection of Christ despite nationality is so apparent and amazing.
46.) No matter how "spiritual" the setting, the disciplines of prayer and being in the Word have to be made priority and intentional. Even without as many distractions these things can easily be put on the back burner.
47.) No matter how "spiritual" the setting, my selfishness can rule, causing me to serve myself rather than having the desire to serve others.
48.) Having the title of being a "missionary" can be dangerous, we still have to show people that we need a Savior, not that we are one.
49.) I am even more aware of how blessed I am to have Josh as my husband.
50.) I need Thee every hour.

The Lord has continued to grow Josh and I in so many ways. We are getting more and more excited about the story that the Lord is writing for us. Our time here continues to expand our worlds, which also makes our God bigger, greater, more loving, and gracious. Praise God.

Days of surgery

"Make the incision and find your starting point," instructed Dr. Galat before handing me the scalpel. I hesitated for a second, as I had never before slid a blade through a patient's skin. Then with a quick prayer I glided the scalpel across the imaginary line he had drawn and watched the skin part beneath its stroke. My first incision....  

I have grown tremendously in my Orthopedic experience since being here at Tenwek Hospital. The medical experience for me has been beyond what I could ever have imagined. Some of the procedures that Dr. Galat leads me through would not be taught until several years into residency. More than that, I am growing in my understanding of the principles of orthopedics.

Some very interesting cases come to Tenwek. I will offer you just a taste. About a week ago, a man arrived unconscious after being attacked by Maasai warriors. He had a splintered arrow lodged in his neck (see the xray), a panga (machete) wound that severed his extensor tendons on his left hand, an open elbow, and another deep head wound that showing that the blade had cleaved an inch deep into his brain. By the Lord's abundant grace, and several trips to the "theatre", that man is now doing quite well. Another case - a woman came into clinic with a large, oozing, smelly, black mass on the side of her heel. Feeling a baseball sized lymph node in her groin made malignant melanoma the most likely diagnosis. Her prognosis is very poor. Another case - a man arrived after falling and hurting his elbow. The X-rays we obtained showed an old fracture / dislocation of his right elbow with a new fracture of his ulna. Inquiring about his past history, we found that he had injured his elbow badly 3 years ago and never sought treatment. It is remarkable how long people will go without seeking medical care. He was only able to bend his elbow about 10 degrees for the past three years. Tomorrow we are forced to fuse his elbow at 90 degrees, the most functional position.

But the greatest privilege of working at Tenwek has been seeing the spiritual concerns of each patient as the highest priority. Before every incision, for example, the whole OR staff stops and prays over the patient, acknowledging our helplessness and dependence on the Lord for any real healing to occur. When patients face terminal diagnoses (like the woman with melanoma), the conversation always turns toward their eternal destination. Prayer for patients is a frequent treatment that halts rounds even on the busiest of mornings. We rejoice over patient's progress as the Lord's work, and we mourn with their families when the effects of this sinful world overwhelm our medical care. Without question, the motto posted outside Tenwek Hospital is being lived out every day - "We treat, Jesus heals." I am learning a ton and loving every minute of it.