Thankful for help

Judy and Kristen after operating. Our surgical gowns aren't water proof. 
Sometimes we get a little messy.

Kristen here….

 We recently had the privilege of having some visitors from home come to our hospital.  They are all members of a Rotary Club that came to support the hospital.  They brought with them so many needed medical supplies it completely blessed our socks off.  They also brought with them some general practitioners, a dentist, ophthalmologist, veterinarian and an OBGYN!  I had no idea I was going to have a partner in crime for a couple of weeks.   I am so grateful Judy was there with me, especially on the last day of their visit.

It started out like any other day.  We did rounds, checked on the laboring patients and were starting to see the line of outpatients that had come for care.  A nurse came to me from another ward and asked me to see a patient that had been admitted that morning.  She said that the patient had abdominal pain and needed an ultrasound.  They hadn’t gotten her labs yet to confirm anything, but they suspected she was pregnant.  I told the nurse to bring her down and we would take a look. 

 I looked up a little while later to see the nurse bringing the patient in by wheelchair.  “Uh oh.”  I muttered as I raised an eyebrow and followed the patient into the room with the ultrasound.  The patients here are incredible resilient.  They are almost never brought by wheelchair if they have any capacity to walk at all.  The fact that this patient wasn’t walking was my first clue that something wasn’t right and she needed immediate attention. 

I pressed on the patient’s belly and watched for her reaction.  I got nothing.  She came with complaints of abdominal pain, but never winced with any of my exam.  This stoic exterior is so typical of the patients here.  I asked the nurse why she brought the patient by wheelchair and she stated that the patient was too dizzy to walk.  Hmmm….more red flags were raised.  Judy and I did the ultrasound and it was clear that she was collecting fluid in her abdomen.  On inspection of her uterus there was no evidence of a pregnancy inside, but on my visual sweep through the pelvis I saw a walled off collection of fluid just to the side of the uterus that didn’t look right.  I couldn’t tell if there was anything inside this collection of fluid, but it didn’t look normal. My suspicions were high for an ectopic pregnancy – a pregnancy located outside of the uterus.  If this was an ectopic it is fatal for the pregnancy and can be fatal for the mother as well.  It often becomes an emergency.

I asked the nurse to get a second IV line started and collect some labs as I went to the OR to notify them we had a patient coming their way.  I didn’t have a positive pregnancy test nor was I completely sure that I had seen an ectopic pregnancy, but the amount of fluid in this patient’s abdomen told me we needed to go to the OR.  I returned to check on the patient and help move the bed to the “Theater” as we call the operating room here only to find that the staff were having trouble placing that second line and could not draw her labs.  It had been less than 10 minutes since the ultrasound and Judy and I already noticed a change in the patient’s cognition.  She was becoming more listless and responding more slowly to the nurses as they worked around her.  They tried again to stick a needle into her skin and I could see her face grimace.  Good, at least she still was responding to something.  I tried to be patient as I let the nurses do their work because hurrying the process or becoming agitated in this culture doesn’t help the process become any more efficient and can actually be detrimental, but I knew we were working against precious time.  I walked back up to the theater and told the anesthesiologist I was in trouble.  They couldn’t get a second IV line placed or draw her labs and her condition was deteriorating.  I could see the understanding in his eyes.  He knew we had to move quickly.  He told me to bring the patient to the theater and he would take care of it.  He was the only anesthesiologist working that day and had already started another case, but he got up, left the room and mobilized the OR staff to be ready for our arrival.

We brought the patient up and placed her on the operating table.  She was barely responding.  The anesthesiologist placed a large needle in the vein in her neck.  No response from the patient, no blood returned from the needle.  Not good.  We hurried through draping the patient as she drifted off to sleep.  I looked up for a moment and saw that her blood pressure had fallen to 63/18.  We had to work fast.  Her abdomen was opened in seconds and blood started spilling over the sides of the table.  The fluid we saw on the ultrasound ran red.  I reached blindly into her abdomen and grabbed the patient’s uterus and brought it up to the incision.  As soon as I took a look at what I was holding another “uh oh” came from my mouth.  That pocket of fluid I had seen sitting next to the uterus on ultrasound was most definitely the culprit of this morning emergency.  The ectopic pregnancy was found, but it was not just any ectopic, it was a cornual ectopic.  This is a pregnancy that forms where the fallopian tube meets the uterus and is one of the most dangerous types of these obstetric emergencies.  They are rare, known to bleed in incredible amounts and can be a challenge to remove.  I was so thankful Judy was across the table from me.  Like so many other times in Kenya this was something I had only read about, but never actually seen before.  It was so nice to have a more senior physician working with me to walk me through the steps of this emergency.  God’s timing is perfect.

 We removed the ectopic that had ruptured and was bleeding.  We repaired her broken uterus and cleared 2 liters of blood from her abdomen.  The patient was being transfused and her vitals started to improve.  It was with a sigh of relief and a prayer of thankfulness that we closed her belly and transferred the patient out of the operating room alive. 

 I was thankful for many things that day, thankful that the patient had come to us when she did.  Had it been even an hour later we could have had a drastically different outcome. Thankful that she presented during the day and not in the middle of the night when it is much harder to mobilize the necessary staff and resources needed to care for such a patient.  Thankful that I had OR staff that understood the gravity of the situation and dropped everything and moved quickly to save this patient’s life.  Thankful that the hospital had blood that day to transfuse this patient (this is not always the case here at Kapsowar).  Thankful to have the shoulder of another obstetrician to lean on when I was treading through new waters in a situation where time was not our friend.

Birthday Sacrifices

Kristen here....


I wanted to say thank you to the very many of you that made my birthday so special.  There were so many special and thoughtful moments that I am overwhelmed.

Birthday cards from an ocean away!

The day before my birthday the mail was delivered to the hospital and I received several birthday cards from people back home.  Getting mail here is a huge event in general, but to know that people back home remembered my birthday and sent a card to me halfway around the world was so incredibly special.  Thank you.

That morning I got a birthday phone call from my parents.  International phone calls from home never happen and are so expensive.  I am loved.

Homemade cards from Kapsowar kids

Throughout the day here at Kapsowar, one by one the missionary kids on the station brought me their own homemade cards.  Each one was so precious.  Each child came to me to wish me a happy birthday and I loved the constant flow of visitors bringing their art work to share with me.  One boy in particular probably wished me happy birthday half a dozen times as he kept calling out "Happy Birthday, Kristen!" every time I walked by him that day. I loved it!  My birthday was definitely not forgotten.

Nothing so wonderful as homemade!

One of the missionaries here made me a cake during the day and brought it over along with a present of a beautiful handmade bag.  The cake was decorated with Happy Birthday Kristen written in frosting.  There is no Sam's Club here.  This cake was made from scratch with hands of love and a definite sacrifice of time.  The bag was bought in Nairobi which is not close and definitely took some advanced planning.  I felt so loved.

My surprised face walking in the door

That evening I came home from work and Dan mysteriously had the kitchen door closed and told me in no uncertain terms that I was not allowed to go in.  I couldn't figure out what he had going on in there.  I waked by the door several times to try to smell what might be cooking and couldn't come up with anything.  We were just relaxing when I got a message from one of the other missionaries that she was having people over for dinner and needed to borrow some onions.  I had a few extra so I walked over to her place to give them to her. Little did I know that her need for onions was not as great as her need to get me out of the house.  Everyone had plotted a special birthday surprise without my knowing it!

I walked back to our house and opened the door to find the place transformed with candles, the table set, dinner ready and presents on the table.  I could not believe it!  Dan and Ashley had been planning this for a while.  When I was gone delivering the onions Ashley came by with the candles, presents and had made us dinner.  She made pepperoni and mushroom pizza knowing that it is my favorite food.  Not only that, she also brought ranch dressing!  This blew me away.  These are precious, precious gifts and a sacrifice here for anyone.  Pepperoni is only something we can get back home. It is saved and only used on rare occasions because of how special it is.  I have been wanting pepperoni pizza for a long time.  What a treat!  Ranch dressing is also something I have been craving and we cannot get it here in Kenya.  I love dipping my pizza in ranch dressing.  Ranch dressing mix is highly coveted.  We can only get it on a rare occasion that a visitor has enough room in their bag to bring it. I cannot believe she sacrificed those those two incredibly special food items that we all love and miss so much for me.

The surprises didn't stop there.  I started opening gifts and again realized that I had been given some very special things.  One bag was full of chocolate items - candy bars that can only be found in Nairobi and chocolate chips from home.  Such a sacrifice!  Truly treasured items.  They also had an apron custom made for me here in Kapsowar as well as some beaded jewelry. Wow, so showered with love.

Dan then pulled out a present for me from himself.  I picked up the package and felt the weight.  This was not a light gift.  I recognized the wrapping paper and knew he had brought it from home. He must have planned this months ago before we had even left. As I unwrapped it my eyes began to fill with tears. He had given me several seasons of one of my favorite TV shows.  All of the DVDs were securely placed in a protective case.  The thoughtfulness of this comfort from home in a world where outside entertainment doesn't exist is an amazing present, but this wasn't what brought tears to my eyes.  As I held the weight of this gift in my hands I knew the sacrifice he had made to bring it here.  He had carried it over here in the one bag he was allotted for his own personal things (clothes, toiletries, shoes, etc.).  I knew when we were packing so many months ago that he was having trouble fitting everything into his suitcase due to the weight restrictions of the airlines and was forced to leave some of the things he really wanted to bring behind.  This was one of the reasons.  He sacrificed his own things so that he could bring this for me.  He willingly gave up two years worth of some creature comforts so that I would have a present on my birthday.  Wow.  That means so much when you are half a world away from all that is familiar and comfortable.

Caramel cake! The thick frosting makes the many cake layers slide, but it tasted like heaven!

The surprises didn't end there though.  Dan got up and walked into the kitchen and came back singing happy birthday.  I looked up and there was a caramel cake!  Dan had been working all day to put this together for me.  Caramel cake is a family tradition. It is a cake that generally takes two days to make, it is very complicated, very labor intensive and one that we only make for birthdays.  It is such a part of our family that my mom has made it a habit to continue to make the cake for each one of us kids and ship it to us where ever we are so that we will have it on our birthdays. This is the first year that was not possible.  Dan got the recipe from my mom and made it himself! Caramel cake even made it to Kenya. We each had a piece that night and it tasted exactly like the ones from home. So delicious!  What a perfect birthday! I am overwhelmed by the thoughtfulness.

Piles of ants in our sink

We woke up the next morning and I found myself overwhelmed for another reason.  We apparently weren't the only ones that were excited about the caramel cake.  ANTS!!!    We walked into the kitchen to find droves of ants had invaded.  These are not just any ants.  These are Safari Ants!  They bite so hard that they can draw blood.  When you stood in the kitchen quietly there were so many that you could here them walking and falling all around you.There were piles and piles of them swarming everywhere. There were crawling down the walls in such masses that they were falling down over each other.

Our poor cake demolished!

We had placed the caramel cake in the microwave thinking that it would be airtight to keep any bugs out.  We were wrong.  Not so airtight.  We both wanted to cry.  This special gift and sweet reminder from home was covered in ants.  It broke my heart to throw it away.  They were coming into the house in such masses it was completely overwhelming.  I have never seen anything like this.  The manager for the missionary station houses came to help us clear them out....a project that took all day.  We boiled water and poured it all over the counter tops, walls and floors.  We sprayed kerosene inside and outside the house to try to kill them (I didn't care if it made my home stink).  We used detergent to try to deter them with the smell.  It was incredible.  They just kept coming.  We have left other sweet things out on the counters overnight and have never had a problem.  I just could not believe the sight before my eyes.  Dan said that this might be the last caramel cake we have in Kenya. As much of a special family tradition as it is, I think I might agree with him.

One of the many lines of ants coming in through our window from the outside.

Baby Faith and Her Mom Went Home!

Myself, mom and baby Faith, Ashley who took care of the baby after birth.
(Posted with permission by the patient)

Kristen here...

Some of you have been following the story of a patient that I have been taking care of and her baby. For those that are jumping on this journey with us for the first time, let me give you a little background.  This patient came to me at about 31 weeks pregnant.  She was brought by a friend who was concerned about her and this pregnancy.  After hearing the patient's story, the reason for her concern was justified.  This patient had delivered 7 babies, but had no living children.  Her babies either died just shortly after birth or were delivered as stillbirths between 6-8 months of pregnancy. When she came to me she was 7 months pregnant and desperately seeking help.  She comes from nothing.  Her husband is an alcoholic and it was evident by her tattered clothes and slim frame she doesn't have any money of her own.  We delivered her a few days later by c-section and said a lot of prayers for this premature baby. The pregnancy was beginning to show signs of distress which pushed our hands to do an early delivery - knowing full well that premature babies can really struggle here, but also knowing she has had 5 other stillbirths at this point in pregnancy.  I am still not sure what took the lives of her other children which made this case that much more challenging because I didn't know what we were up against.

The patient and the baby did well.  It was interesting to watching this mother as she went from an attitude of indifference about her baby to one of joy and thankfulness.  Why shouldn't she be indifferent?  Hadn't she done this many times before only to go home empty handed?  The first few days of watching her child be in our NICU attached to IVs and oxygen was terrifying for her.  Was history just going to repeat itself?  Honestly, at that point I couldn't have given you an answer.

As the baby continued to thrive I saw this mother start to care for her, being at her bedside and being absolutely meticulous in every interaction with her fragile newborn.  I also saw this mother smile for the first time.  Wow, so much pain for one person to have to endure and now there was finally a glimpse of hope.  Many days later this new mother finally gave her baby a name - Faith.  Very fitting after all the prayers that went into the care of both mom and baby.  We truly were looking at a miracle.

One of the things that is different about Kenyan hospitals compared to back home is that when you come to deliver a baby you have to bring your own baby clothes and blankets.  If you don't bring your own baby blankets the newborn will have nothing to be wrapped in.  This is not supplied by the hospital. This patient didn't bring any clothes or blankets.  History had taught her that they weren't necessary.  Her babies never survived long enough.  This simple act struck me.  She really came to the hospital with no hope.  One of the missionaries caring for the baby saw this need and gave this mother the needed clothes and blankets.  A small thing in the grand picture, but a huge statement that we truly did believe her baby would live.

On the day the mom and baby Faith were discharged from the hospital the same friend that had originally brought her to us came to pick them up.  I hadn't really had a chance to talk to this friend when she originally brought the patient, but this time we had the chance to sit down and really talk.  This friend was planning on taking the patient and baby Faith back to live at her house for the next 6 months. She knows the desperate situation of the patient and her unreliable husband wants to make sure she is taken care of.  So wonderful!  One of my concerns is always how things are going to go at home after we discharge patients like this.  I was relieved to know that she was going to have at least some support. What further struck me is that as I was talking to this friend I learned that she is a retired NICU nurse that used to work at our hospital many years ago!  How incredible!  God not only saved the life of this premature infant, but also provided a nurse who specialized in caring for premature babies to go home with this first time mom and care for them both.  My eyes welled up with tears as I realized the gift that had just been given to this patient and her baby.  I could not have planned a more fitting situation if I had tried.

The patient and baby Faith walked out of the hospital and got into the waiting car.  This was the first time she had ever left with a child in her arms.  The promise of hope.  Such a sweet moment.

Her friend described to us where they will be living and we are hoping to do a home visit in another month or so to check in and make sure that all is well.  I will be sure to give you an update when we have one.  Thank you for following and for the many prayers that have been lifted up for this mom and her little one.  They were definitely felt halfway across the world!

French Fry Champions!

Kristen here...

In Kapsowar there are limited things to do for entertainment. There aren't places to go out to eat, go to the movies, etc.  We have learned to make up for this by creating our own fun.  This could be having people over for dinner, game nights or spur of the moment competitions.  The latter is what we found ourselves involved in this past Friday night.  With an abundance of potatoes suddenly available to us missionaries here what better way to use them than a french fry competition?  Each household came up with their own french fry recipe and entered the contest.  Of course my IT husband researched all types of recipes online and came up with one that he thought would be best. With all of the chopping involved to cut up each individual potato into thin fry worthy slices, I don't think I will ever under-appreciate a french fry from a restaurant again :-)  However, in the end it was worth it.  We went home the number one french fry champions....well, at least until the next competition.

Dan's visit to the OR

Dan here….

Today started out just like any other day.  We got up, went to Bible study, and then started work for the day.  Kristen mentioned on the way to Bible study that another short-termer here asked if she could see Kristen do a C-section today.  We have mentioned from time to time that I should go up to the hospital to watch a C-section but the timing just hasn’t worked out up to this point.  Today was the day!  We got some male scrubs for me to wear from another doctor here and before lunch I saw Kristen do a C-section and welcome 2 healthy twin baby boys into the world.  It was the first time I got to see Kristen work, the first C-section I have ever seen, the first baby I have ever seen born, and the first time in an operating room!  It was a great experience.  It is nice to see my talented wife at work using the gifts that God has given her. 

Getting Ready for the OR

Baby 1 of 2

Almost finished

Moments of Joy

Kristen with some of the hospital staff outside of Maternity Ward

Kristen here…

Not everything here at Kapsowar Hospital has been smooth sailing.  I have lost both moms and babies.  There have been times where we have been out of desperately needed medications.  Equipment has failed.  At times the social struggles of working with some in truly desperate situations seem insurmountable.  However, there are also moments of joy.  These moments come with hope and encouragement. They are priceless in a world where death often is the expectation and life is a gifted miracle. These are the moments that help push me forward – gifts from the Lord when endless tragedy tugs at my heart. 

The last couple of weeks have given me several of such moments.  I smile each time I think about the patients involved.  I can’t help it.  One of these moments presented itself when a patient that I had been following came to see me in clinic because she felt like something “just wasn’t right.” When a pregnant mother says that to me the alarms start to sound in my head.  More often than not the mom is right.  They just know and then it becomes my job to figure out what is wrong.  This patient was of particular concern because she had no living children, but 8 miscarriages haunted her past.  This was the first time she had carried a pregnancy into the third trimester.  This was the first time she had the chance at having a healthy baby.  I held my breath as I scanned her baby with the ultrasound.  Still alive, breech and low on amniotic fluid, but we hadn’t lost the child yet.  With two weeks to go until her due date I turned to the mother and told her that today we were going to have a birthday party.  At first she looked at me in disbelief and then the tears started to flow.  Tears of joy, tears of surprise, tears of fear.  The long awaited day had come, but she had already experienced so much loss. Would her dream of having a baby actually be realized today?  I prepared her for a c-section and walked with her up to the OR that afternoon.  A beautiful baby boy! Watching this new mom during her subsequent days in the hospital made my heart soar.  The pride and amazement she had over her newborn baby was evident.  What an incredible thing to be a part of, what a privilege to watch as a miracle unfolded before me.

Another patient presented a few days later.  She was young, she was anxious and well into her third trimester.  Every little twinge of pain and fetal movement bothered her.  I probed deeper into her story and realized that she had been pregnant once before.  She had gone into labor thinking she would bring home a child only to deliver a stillborn baby.  One of a mother’s worst fears.  The image of that limp, lifeless body that you have grown and nurtured for nine months doesn’t ever leave a woman’s mind.  Horrifying. No wonder she was nervous.  I kept her in the hospital for several days, she was too anxious to go home, but she wasn’t really in labor yet.  Several times she begged myself and the hospital staff to just take her for a c-section.  Lots of reassurance and monitoring was given.  It wasn’t time yet.  This baby was doing well.  Suddenly one night her body decided it was time.  Labor came with a vengeance and before the evening was over a new life was brought into this world!  Two days later I laughed as I watched this new mother literally skip out of the maternity ward once she was discharged with her new little one bundled up in her arms.  You would have thought that she had won the lottery instead of just recovering from giving birth.

Some of the nurses in the NICU

The last patient story I want to share is one of joy and ongoing prayer.  Some of you might have seen the facebook post we shared a few days ago regarding a mother with an obstetrical history more brutal than anyone should have to bear.  This patient comes from a really poor community and literally has nothing and no family to care for her.  She came to the hospital desperately seeking help and was very upfront with us that she could not pay for our services – even willing to walk away from help because the cost was too great.  I am struck by her honesty and the personal responsibility she feels for taking care of her own debts – not always a quality found here.  She came for help because her past holds a graveyard of 7 children.  She had delivered 2 that had died shortly after birth and 5 others she delivered in her third trimester only to realize they had died before they could ever take their first breath.  Devastating for any woman.  This patient was now in her third trimester again, a time that should hold much joy and preparation for an expecting mother.  This patient, however, had been taught by history that this was the time most greatly to fear.  After giving the mother some medication and monitoring the baby for several days we began to see signs that we were losing the battle for this pregnancy.  Much prayer was put into the decision to deliver this patient because the baby was small and not all premature babies do very well here.  There was deep risk involved no matter what decision was made.  We proceeded to the operating room and the cry of that first breath of life never sounded so good.  The mother was in disbelief.  The baby was taken to our NICU due to the prematurity and the mother was taken to the maternity ward after surgery to recover.  Over the next few days the mom visited the baby periodically, but it was very hard to read any expression on her face.  What was running through her head?  Finally, three days after delivery. The day that marked the longest she had ever had a child live I was sitting next to her on her bed going over her care and discussing her baby.  The mom indicated to me that she was scared.  She was worried because the baby was on oxygen by nasal cannula.  What did this mean? Was this one going to die too?  Quickly, I gave reassurance.  The baby was actually doing very well, in fact better than expected.  The baby was only on a small amount of oxygen and would soon not need even that.  This stoic mother’s eyes filled with tears.  The stress, relief, anxiety of the last 7 months was finally coming out.  She actually had a baby that wasn’t dying on her.  It was an incredible moment to be a part of.  I put my arm around this patient as my eyes welled with tears too.  I was watching a miracle.  The subsequent days for this little one have been up and down.  Fighting rapid weight loss and even a fever on one occasion have kept all of us praying for this mother and her baby.  Overall, things are still heading in a positive direction.  Now on day 5 of life I am watching this mother spend time in the NICU caring for the baby, meticulously washing her hands and drying them under a heating light before touching her baby, learning to do feedings through a nasal tube and bonding with the only child she has ever gotten to hold.  Though the story isn’t over yet, it has been one that has given me incredible joy to see.  

The mural painted in the office where I see patients.

We are legal!

Kristen here...

This last weekend Dan and I, along with the McCurry's (another missionary family here at Kapsowar) made our way down to Nairobi to get fingerprinted for our work permits/visas that will allow us to be here for the long term.  This was definitely an adventure.  We left at 4am to make the drive.  The first hour and a half was on a really rocky dirt road.  It was dark out and the dust cloud created by the car in front of us resembled those days when I would try to drive to work back home through a raging snow storm.  The only difference was that we weren't driving on ice.

We then got to the paved road and I thought things would get better.  Wow, driving sure is different here.  The two lane highway that runs through most of Kenya forces people to spend most of the trip passing big trucks and playing a game of chicken with oncoming traffic.  Every lane is a passing lane no matter what the lines painted on the tarmack tell you and as a courtesy you try not to run the motorcyclists that are coming towards you off the road as you drive in their lane.   Every little village you go through has a series of speed bumps, most of which are not marked.  We definitely flew over a few of those! Then you have to dodge people as they cross the road in front of you and try not to run over their feet as they swarm your car trying to sell you things in those moments you slow down for the speed bumps in their town.  Missing the pot holes isn't easy either especially when you are trying to watch out for the cows, sheep and zebra that are standing in the road and monitor what the guy coming towards you is doing and if he is going to get back in his lane on time for you to miss hitting him.  Whew.....driving is definitely not for the faint of heart.  8 hours of this definitely tests what you are made of.

When we made it to Nairobi there are a whole different set of traffic rules.  You make up the lanes as you go and if you don't have a lane sometimes you just drive on the sidewalk. Red lights don't mean a thing and whoever is the most aggressive driver wins.  It is by God's grace we got to our guest house without any issues.  I took a shower that night to get all of the dust and grit off of me.  I cannot tell you how wonderful that was.  I had all the hot water I wanted, with enough water pressure to shave my legs and actually get all the soap off and I didn't even get electrocuted once!  Those small things make all the difference in your bathing experience.  :-)

The next day we went to the immigration office to do our fingerprinting.  This process made the DMV look like the most organized and efficient system known to government.  At one point they told us they needed us to supply them passport photos.  Where in the world are we going to get those?  Apparently this is not an uncommonly asked question, because right on the street corner someone had set up a little side business providing just this service.

Ashley McCurry getting her passport picture taken on the streets of Nairobi.

We arrived at the immigration office at 9am and by 4pm the fingerprints were done. We are now legal alien residents of Kenya!  I am just so thankful that we were able to get everything done in one day.  During the middle of the day while we were waiting for the paperwork to be completed some friends of ours took us out to see the nearby sights of Nairobi. This adventure included a stop at the local Cold Stone Creamery.  Yes, Cold Stone has made it to Kenya!  Ice cream never tasted so good!  We also climbed to the top of the tallest building in Nairobi and got to view the city from the roof top.  It was amazing to me how big this city is and how there is so much of it that I didn't know existed.

Bird's eye view of the heart of Nairobi. No two buildings look alike.

We were able to do some shopping in Nairobi.  Small things like discovering a tube of Crest toothpaste in the grocery store or Mac N Cheese out of a box or a can of sweetened condensed milk totally made the shopping trip fun. I know it seems silly, but it almost feels like Christmas when you discover some of these familiar items.  I also discovered a store with contact solution.  Unfortunately, the going price was $30 US dollars a bottle.  Hmmmm....I am going to have to figure out some other way to get this.

Overall the trip was fun, successful in that we accomplished our paperwork goals and a good time to spend time with friends away from the hospital.  It was nice to have a little time away and to enjoy a few tastes from home like Cold Stone ice cream and Dominos pizza.  There aren't any options for eating out in Kapsowar so this was a huge treat.  I discovered that my husband is a driving ninja and has mastered driving on the left side of the road from the left side of the car (we drive on the British system here).  I am so thankful for him, because I don't think I could work up the nerve to make the drive myself.  The adventures just never stop.