Food

The situation of cooking is stil interesting but getting better. I was reassured when I spoke with Sue Newton about the first meals I cooked and she agreed that it takes time to become comfortable. Mainly because there is no longer access to a grocery store...I can buy some fruits and veggies from the local market but no milk, safe meat, or items I am familiar with:).

My family will be pleased to know that the creamed tuna fish has been brought to Kenya:). It is a Ferrell family comfort meal and sure enough one can cook it in Africa. It did not taste the same as the food additives are different here, but I was pleased with it. For example, they sell Sprite but it does not taste like Sprite and the same for everything else.

I have to write a thank you letter to South Beach and Trek Bar Company as they have been our saving grace. The protein bars have supplemented or replaced many meals for the both of us.

For lunch we have peanut butter sandwiches and/or soap, which is nice. Dinner is where the fun begins!

For those who have sent me emails asking about my belly, I am doing better now than I was the first week. I probably have lost some weight, but nothing I can't gain back when I get home:). If I was to have a flare, I know I would be able to get decent tx here from one of the US doctors. Also, when we go to the orphanage they want me to call them asap if I get into any trouble and fortunately they are familiar with my ailments unlike the African docs who have no idea what Crohn's is....I heard that there is a study here in Kenya documenting four known cases among men in the 1960s. They were linking stress to flare-ups, but these men had multiple wives and the greater the number of wives the more frequent number of flares! So if I keep my stress low and stay away from multiple husbands according to the African study I should be a-okay:).

That is all of my thoughts on food for now.....hopefully, Jas will get to try some goat meat before he leaves:). Love to all!!

Back at work in Kijabe

Hello all,



We returned from the Masai Mara on Sunday....it was about a 5 hour bumpy, dusty ride in the Newton's Land Cruiser, especially due to the drought. It was so nice that they drove us and spent the weekend with Jason, myself, and three other residents from Vanderbilt. They have five children (3 biological and two adoptive from Kenya) and it was a big splurge as they are both on missionary salaries. We had to say good-bye to our fabulous tent, hot water, and prepared food....it was funny though that Jason thought we were really going camping and staying in a "tent" in the middle of this reserve! I did not tell him that we would be sleeping in a four poster bed and be served coffee and tea every morning. I am glad I did not though as he was shocked when he saw the accomodations, but he did not bring the right clothes as he thought we were "camping." Oh, the things you come to appreciate and I hope that I don't forget this once I return to my cushion life in Nashville.



We were able to see several towns along the way as we drove through the Rift Valley. Kijabe is up the mountain from a truck stop town where prostitution and HIV is a huge problem. Also, the people everyone are just starving and are having to cut down trees for charcoal. There are absolutely no obese or even overweight people in the villages. The women work especially hard here and they are responsible for making the mud huts if they are from the Masai tribe. The men often have several wives as it is a big deal to get a woman pregnant, even if she is not your wife. I have a much better appreciation for my husband and an even greater appreciation for the family I was born into. Jason and I have joked (probably really not that funny) about how long we would have lived had we been born into a family that lives in the Rift Valley without electricity, food, clean water, or health care. We both have decided that we would have not made the cut for the survival of the fittest. Brad (my brother) and Greg (Jason's brother) might be the only ones from our family who would have made it:). It really is so interesting to see the lives of these people and how they are truely just trying to survive.



For the past two days, I have taught the nursing students about growth and development. In the US, you learn about the worst cause scenarios, but once you get into practice it is not common to see them exist. Here though, the worst case scenario is everywhere. We have spent a lot of time talking about attachment disorders mainly with those children who are living in orphanages and/or their parents have died. Also, malnutrition is everywhere and the supplemental needs of the children are different....standard to receive vitamin A. The role of the diploma nurse here (RN but does not have a bachelors degree) is much more like a nurse practitioner in the states. Because physicians are so expensive, it is much more cost effective to have a nurse run a clinic. I was a part of a lecture yesterday talking about management of fever and Ann (the peds tutor I work with) covered the malaria part. The nursing students use algorithms to determine what the management should be and for example, whether the child should be given quinine (first line tx for malaria) IM or orally or not at all because they come from a low-risk malaria region. It is tough for these students in that they are going to be exposed to so much and have to be responsible for the management of many illnesses, yet they do not have the understanding of why they are doing what they are doing as well as they don't even have textbooks! They are given paper copies of the algorithms and the textbooks are in the library....one pediatric textbook for the whole school! I looked over the neonatal resuscitation info that the nursing students are given and it basically said if you perform ventilations (bag-mask) for 20 minutes then "stop, because the baby is dead." Jason is seeing this in action in the OR as an infant was only bag-masked without any chest compressions or drugs being given until he arrived to help out. I will have to get him to write about the perspectives he is getting on the health care.

I am headed back to the hospital now to meet with the peds ward nursing director, Brenda, who is setting up a trip for me on Thursday to go to a clinic an hour away with the neurosurgeons to evaluate patients with spina bifida and hydrocephalus. Should be VERY interesting.

Love to all and hope you are doing well!

We love safaris!!!!

Yesterday, we arrived to the Maasai Mara in the south eastern part of Kenya. It is a huge reserve with lots of animals. We are staying at the Intrepid Lodge which is like staying at the Ritz versus we have been at the Motel 6 in Kijabe for the past week. We ran out of hot water on Tuesday....so Jas and I have been extra dirty for a few days and it felt amazing to take a hot shower here last night. I can see that if you go to Africa and just stay in these lodges then you get a very warped view of life here. I am so glad we are working and really seeing the people instead of just being a tourist.



The food here is really good and last night we watched a Maasai warrior dance which Jas and I had to participate in.....I think we looked like the kids in the crowd so we were chosen.



We go on three game drives per day with our driver Raphael for about 3 hours at a time. We have seen so many different animals....zebras, elephants, giraffes (my favorite), various types of antelopes, monkeys, female and male lions, and many more. We have taken about a thousand pictures and still more to come. The most amazing part so far is that on our first trip out within about 1 hour we found 3 cheetahs under a tree resting. We stayed for a while and watched them pick out some prey (two zebras), carefully move in on the prey, patiently watch the prey, and then finally attack! Two of the cheetahs went after the child zebra and the other after the mama zebra we think to send her off. The three then tackled the zebra, one holding it's neck, one standing guarding to ward off any other predators, and one biting aggressively from the zebra's bottom. I was not sure whether to be enthusiatic as they had found something to eat or whether to just vomit. It was so intense and just incredible to watch it from start to finish. It really was agony though to watch at the end because it took so long for the zebra to die....definitely not for the weak stomachs. This morning we went back at 6:30am to see what was left over. The three cheetahs were still there and had just devoured the zebra - their bellies were so visibly full! Our guide said this was unusual because they typically do not like left overs but they are adapting to a changing environment and he thinks it is because of the hot weather and the drought. The cheetahs finally left and we saw some vultures come in. I guess it was good though that they really left little behind! Incredible though!

We head back to Kijabe for another work week tomorrow. I am going to meet Jas now since the sun is setting and the flies are attacking me. Love to you all and thank you so much for your prayers....we feel incredibly safe and secure here in Africa. xoxo em and jas

A Day in the Life...

So got up at 06:30, off to the hopsital and into the "theater" by 07:30. All of the rooms (5) are staffed by nurse anesthetists trained by Dr. Newton (pediatric anesthesiologist, mentor and vanderbilt faculty). 80% of the primary anesthetics done are under spinal (subarachnoid block). For the medical people, we are covering dermatomes of T1-S5 (so upper abdominal surgeries). Patients are escorted to the rooms by the circulator, where the KRNA (Kenya registered nurse anesthetist), meets them and begins the monitoring and anesthetic. One thing different that the US: prayer occurs before every surgery. Days go from 07:30-17:30. Wednesday mornings prayer begins at 07:00 and ends at 08:00. The Kijabe hopsital is 150 bed hospital: covers neurosurgery (shunts and myelomeningocele closures), and general surgery (which here includes ENT, ortho, urology, etc). To give you an idea of my days since I've gotten here: I've coded 2 people (one had a non-survivable PE), anesthetized a 3 week old with VACTERL (long pneumonic-google it), treated an eclamptic (pregnant lady having seizure), and emergently fiberoptically awake intubated a patient with an anterior mediastinal mass (not many things make an anesthesiologists ears perk up-this is one of them). If he extended his head he couldn't breath, so ke kept his chin flexed next to his chest). The ICU here only has five beds, 4 ventilators, and ecompasses all specialties. So triage is important. The young man with the anterior mediastinal mass ended up having -nonHodgkin's lymphoma-so after staying intubated overnight we transfered him urgently to a goverment hospital in Niarobi for treatment (chemo/XRT). Let me say this about the drive: Thank God for Moses (our driver): He expertly navigated the dirt rodes to the main single lane highway, weaving in and out of three lanes of cars on a one lane road, and going on the round-abouts against traffic-while I was being thrown from one side of the van (or Ambulance) to the other and desperately holding on the endotracheal tube with Valerie (ICU nurse) bagged-with our RATIONED oxygen source. Monitors included my finger on the pulse and a portable O2 finger monitor. I got back approximately 13 hours later. Just had dinner- all boiled vegetables, pasta tomato sauce, and tuna from a can (yes they have that here too). We are leaving for Safari tomorrow (early in the am). I plan on lecturing next week on chronic pain (yes: they have that here too, and Kijabe is the only hospital in Kenya doing epidural steroid injections (interlaminar-no flouroscopy).

Emily had a good day also...and I'm sure she'll write about it (and probably already did). We will update the pictures as we can (internet is dial-up).

The Kijabe Nursing School

I have just returned home from a long day at the Kijabe Nursing School and I want to share what goes on there. Jas is still in the OR (he has to be exhausted) but I am hoping that I can get him to sit down and write a little about his experiences.

I started class this morning at 8:30 with the same group of students I was with on Thursday. We focused on how to perform a pediatric assessment and walked through the head-to-toe sequence. Afterwards, Anne reassured me that it was very detailed and really want she wants the students to here. I am always thinking to myself "I hope I am doing some good here and presenting the material that the principal wants me to give." The students asked a lot of questions at the end, and Anne told me that this is a very good sign that they paid attention and understood what I was teaching. They really have no textbooks individually or handouts so they must rely on memory and note taking during class....much like what it once was in the US! Afterwards, I sat down with the other tutors for chai tea (they gave me some without sugar today as they noticed that I did not drink my tea on Tuesday:). The prinicipal, Mary Muchendu came in and asked me to sit down in her office for "a chat." She spent a long time telling me about the history of the nursing school as well as the nursing infrastructure in Kenya, which does have some similarities to the US. I am currently teaching at a school that does not award a degree, but rather a diploma in nursing after 3 1/2 years of study and the students are eligible to sit for the Kenyan certifying exam to become a Registered Nurse. She was extremely proud of the new curriculum and had me look over all of the documents. She sent me home with four binders to peruse through and let me know what she thinks. She was so incredibly gracious to me and never was treated commented on how young I look! - it was a great moment.

We had a short break where I ran into two nurses from the US, one of which received her PNP from Vanderbilt in 2006! What a small world! For those reading from Vandy, she knows Terri Witherington, Renee McLeod, Margaret Anderson, etc. and many more of the instructors. Currently, she works for an organization based in Nairobi called "The Least of These" which visits orphanages in Kenya and sets of rural clinics for children. She is such a cool lady and wants me to spend a day with her next week....so I am hoping that will work out.

At 1pm I was invited to have lunch with the students and tutors, which involved standing in line, each person holding their own hodge-podge of plates, to be served out of big barrels, kind of like at a soup kitchen or a refugee camp. I kept trying to say, "oh, I already ate" but that was not working. We were served rice, tortilla, and beef stew, which was really pretty good. Everything tastes fine here it is just more of where it comes from, how it is prepared, and how it is served. I am okay so far though!

Afterwards, we went to church where there was a ceremony for the senior nursing class who is graduating tomorrow. I sat with the principal, chaplain, and medical director. I wish I knew how to video tape on my camera because all of the students were singing acapella. It was absolutely beautiful praise music in Swahili and it is indescribable to have been there in that moment. Several different people gave speeches and towards the end the prinicpal got up to speak. All of a sudden, she starts talking about this visitor who has blessed them with her time and she wants her to come up and give a speech....whooaaa! what, me! So here I am, in the middle of this remote village in Africa, being asked to give a 2-3 minute speech to the nursing school....probably about 150+ African people in the room. I am not really sure what I said....mentioned how grateful I was to be there, have the opportunity to teach, and discussed the importance of being an advocate for your patient as well as how unique our role is as nurses to care for people during their most vulnerable times in life. I think it was okay as the principal seemed pleased:)....I am glad I made it off the stage okay without falling. Some of the students came up to me afterwards wanting me to send them all of the notes and lectures I have on my computer. I love seeing this excitement and passion for nursing!

So the sun has set and Jas has still not come home. I feel guilty in that I have had another warm and cuddly day while he has been in a hot and sweaty OR which was supposed to close 2 hours ago:(. We will see what happened during his day.

Tomorrow in the afternoon we are going on a Safari for the weekend with the Newtons and three residents from Vandy. We are headed to the Masa Mara, which I know is going to be incredible. I will write more probably when we get back. Hope all is well back home and send me emails if you can to let us know how you are doing. It is so great to hear from people and be encouraged about our work here. Love to all!

Life in Kijabe

We are using a dial-up connection that is really slow (better than nothing!) so my posts are going to be hit or miss. We are really enjoying our time here and each day presents something very new. Here is some info about our life here and the lives of our new friends:





Weather: The best comparison for weather is Tahoe in July and August. It is hot during the day with a pretty intense sun...we are only about a 45 minute drive south of the equator and we are at a 7500 elevation. At night, it does cool down and it is very windy. Everything including Jas and I are covered in dust! Kenya is currently experiencing a drought but it did rain last night for about 5 minutes....I heard the Kenyans praise God today for the rain. It was muddy since all of the road are dirt, but by the time we went to work it was not too bad. I have gotten more sun than Jas and my schedule does not keep me inside all day.



Food: We were spoiled our first two nights here as we ate with the Newtons the first night and had lasagna, fruit salad, bread, etc. The second night we ate with the ICU doctor (trained to be med-peds but going with the flow here) and his wife who is a missionary and a Physical Therapist. She made a Moroccan chicken dish and the word on the street that I am a "selective eater" had reached her. She was so nice to have all of the parts of the meal separate for me without any spice. Last night was my first night to cook....argghhhh!!! I had walked to a section in the village where the women sell fruits and vegetables on the side of the road. I made a new friend, Edita, a nurse from Canada who has lived here for five years and she was kind enough to show me the ropes. We bought a little bit from each vendor so we could spread our money around....the women are so poor. So Jas and I had boiled potatoes and carrots with pasta and marinara sauce for dinner that we had bought in Nairobi. I know you are thinking, hmmm - not so bad and really it wasn't but where the food products have been is a little iffy. We both stood in the kitchen peeling the potatoes with the knife I brought to protect my mom and I at the orphanage:) and there was just this odd smell of poop coming from everything I had purchased. Jas was not too excited about boiled potatoes & carrots, but hey, we are going to boil anything that we eat!!! There is a cholera outbreak about 40 kilometers away from our village and Edita told me oh sure, you will probably get a little giardia while you are here. We are trying to take as many precautions as possible but it is still difficult. I have been boiling drinking water every night as our supplies now that we are in a remote area are limited. Hopefully, I will say my praises everytime I cook at home for having clean water to wash my food with!



The people: The people working at the hospital are very friendly and appreciative of the medical staff that come here to volunteer. The men especially seem to be more talkative than the women. The patients and families at the hospital to me seem very quiet and somber. You would not believe how much I stand out as I walk through the courtyards. There are families lying everywhere in the grass waiting to be seen or for the family members to be discharged. I have seen a lot of HIV, polio, and TB. The hospital is filled with local Kenyans as well as Somalians as there are I think only two anesthesiologists in that country. There are no anesthesiologists in Sudan. Several groups of people from these countries have traveled here for health care and there is a very large group of Muslims here as well. I was told that about 90% of the Somalian men are addicted to a drug that is very potent, comes in the form of a leaf, and the chew on it all day. It is some sort of amphetamine and causes them to be very aggressive...they were easy to spot as they were hovering at the reception desk and wanting to be seen asap.



The peds ward: Oh, the peds ward! It is overflowing with patients. They have about 65 patients and only 4-5 nurses at a time....the director did not believe that the nurse to patient ratio where I work is 1:4. They rely so much on the mothers to care for the children. Edita (nurse from Canada) does infection control, quality control, and performs chart audits twice a year. Tomorrow morning I am giving an inservice on history & assessment to the staff at the request of the peds director, but Edita really wants me to talk about just the importance of orienting the patient to the ward and documenting 2-3 sentences on the status of the patient which needs to be done on the day of admission. We reviewed some charts and she showed me that the minimum standards are not being performed. The nurses are in such a tough spot as they have too many patients, they are stretched so thin, and do not feel the need to chart according to Edita. It will be interesting to see their reaction to me tomorrow as I cannot relate very well to the environment that they are called to work in. One can see that the patient advocacy has been lost and I was told that 6am is when most of the deaths occur among the children as they have not been monitored through the night. The physicians seem to be the only ones that assess the patients and I it takes them awhile to even get to each patient. They need more funding for staff!



There are moments that I have to stop and think "wow, we are in Africa right now. " I had one of these moments on Tuesday as I walked by myself down the dirt road to the market in the village. It is so quiet here and to just look at the Kenyan people pass me by on the road, thinking how different I look from them but how cool it is to be a part of this culture for only a short time. It is truly a blessing to be here and I hope that it is only the beginning of many trips to Africa.

First day on the job....

First day on the job....
It is currently 7:45pm on Wednesday, March 25th and we just got connected to the internet here in Kijabe!!! Kevin (Kenyan IT guy at the hospital) and I have spent several hours and phone calls on this, but we are up and running (slowly) now. Wow!....we are so spoiled with wi-fi:). I am going to write an update about our first day on the job and then post another for today.

Tuesday, March 24th

Em's 1st day on the job: Dr. Newton walked me to the Nursing School which is located at the back of the hospital property at 8:30 this morning and is pretty nice....really old building with no AC. I met with Anne Mulwa, the paediatric (British) tutor who was very excited to see me which was nice. She took me straight to my first class where I introduced myself to 35 Kenyan nursing students. They are about 18 years old and this is their second month of college...brand, spankin' new. We had some technical difficulties with my lectures but fortunately I brought my laptop and worked from there. I talked for 5 hours with a 15 minute break about Communication and How to take a Paediatric Assessment. They told me I talk too fast and needed to slow down, which stretched things out a lot more.
The students are so young, innocent, respectful, and attentive. I love my students back home and some of you might be reading this:)....but in regards to lecturing to a large group of students this was VERY enjoyable! No one was falling asleep or looking at me like they might harm me for taking time out of their day to listen to a paediatric lecture. I had so much fun talking to them and answering their questions....which were different then what I am used to. In Kenya, the people are typically very conservative and traditional. When we got to the sexual health comment, this was where the majority of the questions were. I have learned that it is very uncommon for Kenyans to get married before the age of 25ish. They typically have children soon after (I am thinking that birth control is uncommon here) so I have received many questions on why I do not have children since I have been married for almost 3 years:)....I am focusing on my career I say! In contrast, they know very little about sexual health and yet they unfortunately know a lot about HIV/AIDS. The rest of the questions focused on how to communicate with mothers who feel guilty about passing HIV onto their babies and are very angry towards the staff. I think my responses were appropriate and useful, as Anne agreed with me. During my break, I was invited to sit down with the other nursing staff...a midwife, the librarian, etc. and have some kind of tea concoction:) - come to find out it was Chai tea. I so wanted to cross my arms as to refuse drinking from the cup at the Catholic church since I thought they were giving me coffee (all I could think about was my poor belly), but fortunately it was so hot I could only take two sips and then it was time to go back to class.
I left the day feeling invigorated and excited about nursing! Anne was so appreciative and pleased with the lectures I had prepared and asked if she could use them in the nursing schools curriculum. I return home after 5 hours of talking to enjoy the hot day in Kijabe and prepare more lectures.

Jason’s first day on the job: Unfortunately, Jason’s day was not so warm and cuddling as mine was…often so typical even at home. His day in the OR went from 8am until about 5pm. He is working in a teaching capacity with the two anesthesia residents who are here for a month from Vanderbilt and with the Kenyan CRNAs. The third patient of the day had been involved in a motor vehicle accident about a week prior and sat in a hospital bed in Nairobi without being operated on. He came to Kijabe to have his fracture repaired and arrested on the table shortly after the surgery began. Jason said he was pretty frustrated as the monitors were not working and he could not get a rhythm on the patient. They shocked him and give him several doses of epi when they did discover that he was in PEA (pulseless electrical activity and a non-shockable rhythm). After 30 minutes of Jas performing ACLS he called the time of death. So when he got home that night and I asked him how his first day was, he stated “well, I had a guy die on me.” It by no means was anyone’s fault as the patient had a PE (pulmonary embolism) due to complications from his fracture, but still never easy. He had another difficult patient his first day….he went to extend the neck for intubation and met resistance. His first thought was “this guy has an anterior mediastinal mass,” which was in fact correct. He was able to still intubate using fluoroscopy but later in the day the tube came back out while the patient was being moved. Jason had to go in later that night to check on him. Needless to say, Jas had a very tiring first day and he could use some sleep!

I am going to post this one now and right some more later about life here in Kijabe. Thanks for reading!

We made it!

Hello all!

Jason and I have made it to Kijabe, Kenya! After a 30 hour trip, we made it to Nairobi last night and were picked up at the airport by Jerald (a super nice driver who works for Samaritan's Purse). We have been labeled as the "very young couple:)." I think it is all my doing though! We stayed in a guest house for missionaries owned by a group of Menonites. The sleep was restless and shockingly I was the Pope who was up at 7:30 and eat breakfast with other missionaries. Another driver from Sam Purse named Daniel took us took the local supermarket to buy 2 weeks worth of food. He directed me to the "meat" section and I found myself staring at a bag of giblets asking him "what is this?" After a stop at the lookout point looking over the Rift Valley which extends from Jordan to South Africa - absolutely beautiful, Jas was attacked by local craftsman and spent most of our cash! We were told though it will feed them for a month...so it is all good in the end. We then made it to Kijabe and settled into our apartment, which our driver was amazed at...so we are very fortunate to have such large quarters. The Newtons came over and took us on a tour of the village and then the hospital. It is incredible and will be a very interesting experience. I start teaching tomorrow on taking a pediatric history and pediatric assessment starting at 8am and Jas will be in the OR. Currently we are at the Newton's house and just finished having dinner with their family. We are off to bed now for hopefully 8 hours of sleep. Our internet will be set up tomorrow so I will send more info after our first work day.

Thank you so much for all of the emails and support!! We are so excited about this experience and appreciate all of the prayers, thoughts, and encouragement. Hope everyone is well!

Much love from Kijabe, Kenya, Jas & Em

All packed and ready to go!

Hi family and friends,

Jason and I are actually packed and ready to head to Africa! Currently, poor Jas is on call at the VA tonight and I have not heard from him so one can assume that the night is not treating him well:(. Fortunately he has 30 hours to catch up on sleep.
We have a variety of things packed....clothes to teach in, scrubs for the hospital, safari clothes, work clothes for the orphanage, rain boots, LOTS of protein bars, peanut butter, textbooks on anesthesia, central lines, laryngoscopes, batteries, and a lot of other supplies that people have sent us to take to the hospital. We will also be meeting up with our friend Zipporah, an Anesthesiologist from Nairobi, Kenya who we worked with in Chiclayo, Peru and Jas is bringing her some pediatric medical supplies.
We will be arriving to Nairobi Sunday night and staying at a local guest house. Monday we will make a stop at a grocery store then head to Kijabe where we will meet up with the Newtons (Dr. Mark Newton is an Anesthesiologist at the Hospital and his wife Sue is a missionary). From there we will orient to the hospital and I will be meeting with Anne, the tutor at the Kijabe Nursing School to go over the schedule for the students.
I hope to keep this blog updated as much as possible and post some pictures. We so appreciate all of the support everyone has shown us in preparation for this trip and it is just overwhelming to think about how much encouragement we have received. Thank you, thank you, thank you! We are excited about this trip and look forward to sharing some stories of our experiences in Africa!

Much love, Jason & Em