First days at the hospital

Kristen here....

 

My time at the hospital started a day earlier than expected.  A young girl with a placenta accreta came through the door on Thursday and I was asked to evaluate her.  Placenta accrete is when something goes wrong during a pregnancy and the placenta grows into the wall of the uterus.  When this happens the placenta never comes out causing lots of bleeding, pain and even infection.  Often a woman will continue to hemorrhage until the placenta is removed which is usually done by hysterectomy.  This patient had delivered several weeks ago somewhere and had significant bleeding since that time requiring blood transfusions.  I evaluated her in the OR and tried to remove the placenta without success.  At that point it became clear that the safest thing for her would be a hysterectomy.  This broke my heart. She was only 17 years old. I had talked to her about this possibility beforehand and had so hoped that it wouldn't come to this.  I am thankful that the surgery went well and the patient is recovering nicely.  I am thankful that she has one child, a boy.  This will make the scar of losing her ability to have children a little less painful.  When I talked to the patient the next day I was in awe of her attitude.  She wasn't angry, or upset, or sad or any of the emotions I expected her to have.  She was simply thankful.  Her inability to have any future children will significantly impact her standing in society. She knows this, but her attitude has been unwavering.

My second day at the hospital involved another hysterectomy.  This one was for an older patient who had multiple fibroids. When she came to the clinic for me to examine her I didn’t even bother to get out the ultrasound.  You could see the fibroids through her abdomen.  This was going to be a more challenging case than the surgery from the day before.  I was a little nervous as we started and there was a lot of prayer that went into the first incision.  Things went well and she is recovering wonderfully.  I am so thankful.  It is amazing the type of pain tolerance the patients have here.  We really don’t have a lot in the way of narcotics.  After surgery the patients get the equivalent of oral Tylenol and ibuprofen. With a vertical incision on my latest patient I was really worried about how she would do with this type of pain control. She seems completely un-phased by this.  She is up and walking around and not even wincing when she gets out of bed. I am amazed.  Back home patients are often hooked up to a PCA and given an IV drip of narcotic pain medication for the first 24 hours and then oral narcotics for weeks afterwards.  I wonder what the difference is…..genetic, difference in lifestyle, expectations?  I am not sure, but there is definitely a pain tolerance difference.

Well two days of work and two hysterectomies done. I wonder what this next week will hold. 

I thought I would post this picture from the hospital. This is one of the signs posted on the grounds. It gives the prices for common procedures and treatments. This is not a free hospital, but it is significantly less expensive than any other facility even remotely close to this area.  These prices are a stretch for patients to pay for, but they don’t hold a candle to the cost of health care back home.

 

 

I am not sure if you will be able to read this but translating the prices into US dollars you will pay somewhere between $50-250 dollars for major surgery (aka like the hysterectomies I did this last week). A prenatal visit for pregnant women is $2 US.  An ultrasound is $6 dollars. If you break your arm and need a cast it will cost somewhere between $1 and $20 in US dollars. When the average person makes less than $3 US dollars a day in the area it is not uncommon for people to be unable to pay their hospital bills.  The problem is that the cost of suture, sterilizing equipment and laboratory supplies still needs to be covered.  We try to get as many donated supplies as possible and none of the missionary physicians are paid by the hospital which makes the cost significantly less than other places.  Still, the seemingly staggering prices can be overwhelming. It does make me think twice sometimes before ordering "routine" labs that I would have normally ordered out of habit back home.  The bovies we use in the OR are recycled with each case and our surgical gowns are all cloth that can be washed, sterilized and reused again.  There is a fine line between providing affordable care without compromising the quality. I am sure that I will learn more about this struggle in the coming weeks.  It is amazing, however, how much can be done with so little.

Kapsowar beginnings

Kristen here….

We are settling in and the house is coming together. It is nice to have it start to feel more like home.  I am really thankful that before we left people suggested I pack pictures from home and picture frames.  It seemed like an extravagant unnecessary thing to do when we were packing, but it has really made a difference to have a few familiar keepsakes around the house. 

One of the best things about our new home, however, is not the inside, but the outside. The views from our yard are amazing. We have a little back patio that overlooks the rift valley and Dan and I have been enjoying sitting out there at lunch time.  The weather has been wonderful during the day with heavy rains at night leaving everything fresh in the morning.  The sunshine is one of God’s blessings on us as we adjust to life here.

Views from our front yard

View from our backyard

One of the things that has been different here is that we lose power almost daily.  Last night we had homemade nachos for dinner by candlelight J Not normally the meal you would chose for a candlelight dinner, but it worked for us.  I am going to have to figure out how to brown meat by candle light.  It is hard to tell when it is done when the light is so dim. I even turned on the little battery operated lantern we brought, but it is just not the same.  I might have over cooked the meat a little J  Oh well, live and learn. I am thankful for a patient husband.

We have also learned that our house is the last in the row for the water pipeline here on the missionary station.  This means that everyone else’s water tanks for their homes get filled first before the water reaches us.  We ran out of water yesterday which certainly can make life interesting.  I am learning how to flush toilets with water brought up in buckets from the river, how to heat water on the stove to use for a shower and how to wash dishes without using the sink.  In all of this I just have to smile.  The water for our homes gets pumped up from the river.  We were all running low on water yesterday and had someone out looking into the problem.  It was explained to us that there is a very small pipe that pumps the water up the hill to us from the river.  If a cow steps on the pipe in the forest it can pinch off the water supply until it is fixed.  Only in Africa.  We are learning the expression TIA (this is Africa) when things like this happen.  I just chuckle.  Welp, it just forces us to get a little bit more creative.  The water situation has now been fixed and we are starting to have some coming through our pipes again.  It is nice to have water pumped directly into your home. I appreciate this convenience.

Tonight I am going to give it my first try at entertaining in our new home.  I invited one of the other missionary families over for dessert and games.  There is no such thing as restaurants, movie theaters, bowling allies or any other form of entertainment in Kapsowar.  This just means we have to make our own fun.  The way for social entertainment usually comes in the form of game nights or movie nights which entails watching a movie someone has brought over on their computer.  It is more just the act of getting together and having fun that we are all excited about than the actual activity itself.  I am trying my hand at making a cake and frosting from scratch.  Wish me luck! Back home I loved to cook and entertain and really thought nothing of the work that got put into it.  Here, everything is just a little bit more complicated, a little bit more uncertain.  I didn’t realize that vanilla is a hard item to come by here.  I wish I had brought some from home.  I am really thankful that the other missionaries never think twice about sharing.  I hope my cake turns out ok!  Our oven is a gas oven and it actually has a temperature gage on the nob you use to turn it on, but the temperature reads in Celsius.  Not really sure how to cook that way so I sort of just set it in the middle and then cooked by smell, opening the oven to check if it was done when the smells in the kitchen seemed right.  So far so good.  I will have to let you know how it turns out.

I officially start work at the hospital on Friday.  Yesterday, I was walking through the wards and got called to come see a patient that has been readmitted several times. She delivered her first baby in October and has not done well since.  I am afraid that a hysterectomy is in her future.  Such a sad outcome for this momma of one.  We are trying a few other things first, but I have a feeling this might be my first major surgical case here in Kapsowar.  I would definitely appreciate prayer for wisdom as we treat this patient.  I want to avoid surgery if at all possible.

Well, that is all of the updates for now.  Thank you so much for following along on this adventure.  It is so encouraging to hear from everyone back home and know that we are not alone on this journey.

The Eagle has Landed!

That's one small step for God, one giant leap for Kristen and me.

Dan here - I told Kristen I wanted to write some of these blogs so you will have to bear with me.  We made it up to Kapsowar Saturday afternoon.  Another missionary couple met us at the airport in Eldoret which is about 2 hours away from Kapsowar.  We did some shopping at Nakumatt while we were in Eldoret.  Nakumatt is Kenya's version of Walmart.  We ended up spending 43,942 shillings on our first grocery trip.  We wont be going shopping very often as Eldoret is where our closest grocery store is located.  There are some American brands at the store but you do pay a little more.

We bought some spreadable butter at Nakumatt while we were there and tried to spread it on our toast the other day.  We put the butter in the refrigerator when we got home which is what you would do in the States.  Apparently that is not what you do here.  Our butter was anything but spreadable.  It actually was to hard for a steak knife to cut through.  So we are now leaving the butter out of the refrigerator (which is ok and what you are supposed to do with this type of butter)!

The ride to Kapsowar from Eldoret is somewhat of an adventure.  About half of the way here, the road is paved.  The other half is a dirt road which is a bit of rough ride to say the least.  Kapsowar is a beautiful place.  Our house overlooks the Rift Valley.  It is green and luscious outside.  We even have a poinsettia tree in our yard.  For the most part is warm and sunny here.  I would say it is probably in the mid 70's here each day.  Apparently this is their cold season.  I have seen local Kenyan's walking around in winter coats.  I dont think the temperature fluctuates very much between hot and cold seasons however.  

Kristen and I have been eating lunch out on our back porch each day.  I commented today how the landscape almost looks like you could be at a resort. Kapsowar does have it's drawbacks though.  We cannot drink or brush our teeth with the water from the tap.  We fill jugs of water and lay them out in the sun for the day so the UV rays can kill anything inside.  We then filter the water in a water filter before we drink it.  Another drawback is the power situation.  We tend to lose power for at least a few minutes most days.

Today, we went to the local market.  It is filled with many locals trying to sell their produce.  We purchased about a week's worth of vegetables for about 5 dollars today.  Avocados were about 30 cents apiece and red onions were about 10 cents each.

We made it to Kenya!

Kristen here...

Thank you to the many that have been praying for us. We made it to Kenya last night and all of our luggage made it too! This is no minor miracle.  Our whole trip thus far has been no minor miracle :-)

When we went to the Detroit airport to check in for our flights the Delta employees took one look at all of our bags and said there was no way they would all make it on our originally scheduled flight from Detroit to DC. The plane we were supposed to take would be too small. I had called ahead and been reassured that the number of bags we were bringing would be fine, but apparently this was not the case. After some discussion behind the Delta counter it was decided that they should rebook us on a direct flight from Detroit to Amsterdam and skip the DC layover altogether!  So wonderful. This made our long journey just a little bit shorter, gave us one less layover to get our luggage lost on, allowed us to not stress over whether or not our 40lbs of carry-ons each would fit in the overhead bins.  It was an answer to prayer that I never even prayed for. Both Dan and I were exhausted getting on the plane after emotional goodbyes to our families.  Once on board the plane though, we realized that the flight was not very full and we both got a row to ourselves which allowed us to lay down and get some much needed sleep.  Our plane was a little delayed getting out of Detroit due to the snow, but with our flight change we had a couple of extra hours to our layover in Amsterdam which was exactly what we needed to catch our next flight without issue despite our delay.  The flight from Amsterdam to Nairobi was also fairly empty so we again got another row of seats to ourselves which allowed us to get some more rest. 

When we arrived in Nairobi we collected all of our bags and went to customs.  The customs officer was going to make us open up all of our locked bags and search through them.  I told him we were going to Kapsowar Hospital and then he decided we didn't need to be searched after all and let us go.  I am so thankful.  Unlocking and going through all of our luggage would have taken hours and with the chaos of baggage claim and customs with the 5 other international flights that landed the same time as we did I wasn't super excited to show all of our things to the world.  It was a blessing to be spared the search.

We met the Samaritan's Purse representative at the airport without problem and he took us to the guest house where we are staying.  It was so nice to arrive, take a shower and brush our teeth.  Crest never tasted so good! :-)

This morning our luggage was loaded onto a van to be taken up to Kapsowar (approx. 10 hour drive from Nairobi) and we stayed behind to take care of some things in Nairobi.  We were so excited to get to spend some time with our friends the Shirks!  The Shirks are also post residents that arrived in Kenya two months ago and are working at a different hospital. Not only was it nice to see a familiar face, but Dan and I so appreciated them walking us through the tedious process of finding some of things we needed in Nairobi.  Something like buying a cellphone takes hours.  First we went to one store that has all different types of phones and tried to decide which one is going to be what we needed. All of the phones are in a glass display case and none of them are powered on. You have to decide on the phone based on the price and the stats the vendor is rattling off to you from over the counter.  It is hard to keep it all straight. Some of them were phones that were somewhat recognizable from things we have seen back home and some were phones I had no idea existed.  After going through all the phones and purchasing the ones we needed we then had to go to another store to buy minutes for our phones.  This entailed registering our phones with our passports, buying sim cards (which is a whole new world of confusion for me) and figuring out their version of paypal.  A little jet lagged, accents that I am still getting used to, converting everything from shillings to dollars in my head and new technology for a girl that doesn't really understand anything when it comes to electronics made this a very interesting experience. Needless to say, I am so thankful Dan is here and we really appreciated guidance from the Shirks. I am still not sure how the paypal thing really works or how to add more minutes when I run out, but for now I think I will just take one day at a time and figure that out as it comes :-)

Tomorrow we will get up early and fly to Eldoret. We are meeting the McCurry's who are post residents that have been at Kapsowar for almost a year.  We are so thankful they are meeting us and are going to walk us through what is supposed to be an overwhelming first shopping trip.  Starting over from scratch in a foreign country when your grocery store is 2 hours away and Thanksgiving is right around the corner does daunt me a little.  Some prayer for that would be appreciated.  I know it seems so small and trivial, but everything takes three times the amount of effort as you do conversions and read labels to see if anything in the product is familiar or could be used as a substitute for something you don't have.  We are really looking forward to getting to Kapsowar and getting settled.  Thank you so much for following along with us, for your support, for your prayers and for the warm words of encouragement and cheering us on from halfway around the globe. It means more than you know.



Lunch with the Shirks!
 

Homeless!

We closed on our home yesterday!  This was the answer to a lot of prayers.  God has been so faithful.  It was an emotional time as this was the first home for Dan and me as a married couple.  It is also Dan’s first home and the place where he has lived for over a decade.  Lots of memories are in that house.  

It was a whirlwind to move the remaining things in our home and put the finishing touches on our packing.  I am so thankful for the help of my in-laws yesterday as we packed up the last of our things and cleaned up before leaving our home for the last time.  We could not have done this without them.  As we were weighing and reweighing our luggage to make sure that it met airline requirements I think we probably repacked everything 4 times.  How does a person choose between bringing their tennis shoes or their contact solution?

The next few days before we leave will be spent tying up loose ends and spending some very treasured time with family.  I am so thankful that my parents are flying out to spend these last few days with us.  It will be wonderful to see them.  We appreciate your continued prayers through this time of transition.  We are excited to get to Kenya and get settled into our new life after so much change.

The Calm Of My Heart

 

 

The last several months have been a journey.  They have been a journey in the priority of things and letting go of much that I held onto tightly.  They have been a journey of best-laid plans with the ups and downs of the logistics of moving and the many things that haven't gone as expected.  They have been a journey of emotions during this waiting period of transition where everything has changed. They have been a journey of hope as we have watched God provide at every turn.  I have learned a lot and changed a lot on these various journeys and I know that the journey is not yet over.

 

I am amazed as we get ready to leave and with the overwhelming amount of work yet to be done and the calm that I have and the peace that is walking with our every step.  I am sure there will be chaos in the coming days, there will be tears, there will be moments of uncertainty, but I do believe that these times will be met by a much different person than the one that started out on this journey many months ago. 

 

I have been reading through Psalm during this time.  I am not sure exactly what prompted me to turn to this book.  It is not one that I have often felt very connected with, but this time it has been different.  This time the Psalms have spoken to me in the very moments of deep turmoil and at the heights of joy.  The Psalms and the places it has led me has been my safe haven.  The promises it holds have walked me along this journey and reinforced many life long lessons. 

 

During a period of time when Dan and I really weren't certain about what we should do with the house, when it seemed like the mountains in our way to getting to Kenya were far higher than we could ever scale and we had some impossible decisions to make these were the Psalms that plopped into my lap over those days and weeks.

 

"I will instruct you and teach you in the way you should go; I will counsel you with my eye upon you. Be not like a horse or a mule, without understanding, which must be curbed with bit and bridle, or it will not stay near you." Psalm 32:8-9

 

"Trust in the Lord, and do good; dwell in the land and befriend faithfulness. Delight yourself in the Lord and he will give you the desires of your heart. Commit your way to the Lord; trust in him, and he will act." Psalm 37:3-5

"He makes wars cease to the end of the earth; he breaks the bow and shatters the spear; he burns the chariots with fire. Be still, and know that I am God. I will be exalted among the nations, I will be exalted in the earth!" Psalm 46: 9-10

What really struck me about this last passage was how there is seeming chaos.  It speaks of wars and the destruction of things including fire and shattering of weapons.  Then there is a great victory.  In my mind this victory isn't a quiet one, it is full of shouting and excitement and triumph.  Celebration! The war is over! In the middle of this very tumultuous scene, however, God puts in a sentence that doesn't seem to fit.  There is so much going on, all kinds of emotions and this is the moment that he calls us to be still. To just be quiet and understand who he is.  To take a moment and recognize him amongst the chaos.  He doesn't lead the reader down some pristine path with a bubbling brook with a doe and her fawn drinking peacefully and then ask you to stand still and contemplate him.  Certainly this can happen, but this passage is different.  The chaos described all too often reflects the chaos of my life and yet these are the moments that he is asking me to stop and acknowledge him.

Anyway, these are some of the things I have been turning over in my mind lately.  Thank you for letting me share them with you.  I still have much to learn and I am sure I will be brought back to these same lessons many more times over the coming months and years.

Get ready, get set, go!

November is here and the weeks are flying by so quickly.  There is still much to do, but Dan and I are excited to be moving forward.  We are Kenya bound leaving the country on November 19.  

Looking around our house things sure are different. We no longer have a kitchen table, both of our dressers have been sold and we are living out of suitcases, no desks for either of us and we will be moving out our couch this week.  Crazy!  

We have prayed over this and we are excited for the future, but we know that the road in front of us may be long.  Many of our fellow post residents are already on the field.  They are scattered over many different hospitals and countries and most of them are also keeping blogs of the journey.  Dan and I have been following their stories.  It is interesting that though they may be in completely separate places their stories are all very similar.  There is chaos in preparation to go and in the days leading up to their flights, there are tears with their final goodbyes, there is exhaustion after the many days of travel, there is excitement as they arrive at their new homes, their is loneliness when reality starts to sink in and everything is new and nothing is easy, their is adjustment to a new life and new normal in this new place called home.  It seems that no one who has already moved has not struggled with feelings of homesickness and loneliness.  Yes, the road ahead may be long.  We have been warned by the pattern we have seen in others.  During this time of adjustment and learning the ropes we are asking for extra prayer from those back home.  We are going to need an extra amount of grace and wisdom as we navigate uncharted waters and we are praying that God provide just the right people at just the right times to help guide us through those areas of uncertainty.  Everything will be new and we are very aware that we are the rookie.  Thank you for walking with us and being excited for us! We are excited too and thrive on your prayers and encouragement.