Monday, April 13, 2009

Last day at Tumaini:(

We left Tumaini today and said a quick goodbye to some of our friends. Fortunately we will stop back by on Friday to pick up a suitcase and deliver some gifts. We were sad to leave but I honestly don't think our stomachs could handle it much longer:(.....we think the e coli had started to set in. We are definitely giving our thanks to God for helping us stick it out as long as we did. The pure lack of sanitation is great for the kids' digestive tracts but not good for our weak American stomachs! Bleach, paper towels, or even a little antibacterial soap do not exist in much of Kenya.

A huge thank you to all who donated baby clothes for the infants. The "mums" were thrilled and just amazed.....speechless is probably the best word. They usually inventory all of the items but when we got them out of the suitcase, they just labeled them as "50kgs of baby clothes" so too many to count! Thank you, thank you, thank you!!!! They picked out outfits for the babies that are currently there and they were all jackets. While we were sweating the babies were in full sleepers and now the winter jackets as this is the start of their "cold" season:).....I guess temperature is all relative. They are going to break ground on the Baby Rescue Center after the rains stop and will be able to adopt from there. The clothes will really go to good use and we saw first hand how precious clothes are here - they really take good care of them.

So now we are back to being tourists and are in Lake Nakuru for the night. For the first time in over a week, our tummies feel full. I can honestly say I have never appreciated chicken, fruit, vegetables, and cheese as much as I did today. Looking at a plate of food that has variety has a whole new meaning....and I say that with complete pleasure. I hope and pray to God that I will not forget what I have seen and what it means to go to bed at night with a full stomach. Guilt continues to be the theme of the trip once we go back to being tourists.

We so appreciate having the opportunity to be on this trip and spend time with our new Kenyan friends. Despite the color of our skin (though I wished I could have changed daily), everyone at Tumaini welcomed us like family. Even during the last few days, the older kids started to talk to us about where they had come from, what Tumaini meant to them, and where their parents have gone. I have no idea what they must feel in their heart and think in their minds. My mom and I are just swimming with ideas of how we can help more and really want to make this place a part of our lives.

Tomorrow we are off to the Masai Mara to see some wildlife. We did see a white rhino today which was awesome! Again, we are very safe and feeling better....many thanks to the makers of Cipro.

We love you all and pray that you are safe, happy, healthy, and going to bed with a full stomach. We look forward to seeing or hearing your voices when we return home. Much love from Kenya, Em

Thursday, April 9, 2009

Schools Out


My KRNA class

Hi from Tumaini!

Hello friends and family!

My mom and I are doing just fabulous!!!! We have been at Tumaini Orphanage in Kikuyu since Sunday and we have made lots of new friends. We have had a variety of jobs....playing with the kids, washing dishes in the kitchen, leading a bible study, jumping rope (this was Dianne), clearing a field out at the farm, and trying to teach songs in English.

The kids are amazing!!! There are 53 in total ranging from 2 months old to 19 years. They all have of a different story but nonetheless they are well fed and very well loved. The toddlers just maul us every morning when they see us. They fight over our hair and try to braid it. They are all so sweet and even take great care of one another. We are surviving off of chai tea (where we get our calories), ugali, and githeri - all authentic, cheap African food. No meat for us!! Our health is fine so far which is amazing as the same towels that are used to wipe the floor and handle raw meat are used to dry the dishes. Dianne is struggling with this:). Fortunately, I am the "dirty" one in the Ferrell family so whatever:).

We are staying at the orphanage with the kids in a small storage room with our own bathroom. No mirror though so fortunately we cannot see how rough we look. There are ants everywhere and they have gotten into our food and we are not wanting to touch our sheets, but after yesterday we are staying at the ritz!

Yesterday, we went to the second larget slum in Nairobi called Mathare.....sewage running in the streets and just starving people. We went with a PNP who graduated from Vandy and she and I saw the patients. I treated a couple of ear infections and referred for HIV testing as some had cardinal signs of AIDS. My mom weighed the kids with the social worker and gave out half of a peanut butter sandwich to each. There were kids coming off of the streets so I think we gave out a lot more. At the end the kids started fighting with each other and somehow I was left with the last bag of sandwiches. I was surrounded by about 20 starving kids that were hitting each other and sticking their hands out for the food. It was nothing like anything I have ever experienced. I had to be in my "nurse role" to keep it together but we just wanted to sob. I cannot even describe the amount of guilt we feel now for all of the worthless things we have bought over the years and for being born into the families we were born into...undeservingly. I have no desire to go back to the life I lived before and hope to be permanently changed. The phrase "there are starving children in Africa" has a whole new meaning.

Well, we have to get off the computer which is the social worker's at Tumaini. We miss everyone back home and appreciate all of your prayers. We are safe and can really feel the presence of God with us and the children. Love from Kikuyu, Em & Dianne

Wednesday, April 8, 2009

EM Update







I spoke with emily this morning (evening fo her)...She and her mother went to one of the two Slums in Niarobi. She said it was the worst living environment she had ever seen (including Slum-dog Millionaire) and asked me to blog an update. They were accompanied by a bodyguard.






That's all I got. She wanted me to relay that they are safe, healthy, comfortable, and eagerly awaiting the upcoming week.






I am also including another picture, as I think they are neat.

Tuesday, April 7, 2009

State-Side


So I'm back. A could outline in excrutiating detail the trip, from Niarobi to London, then onto Chicago and Nashville...(and the hardest thing in my short married life-leaving your wife in a foreign country with no knowledge of her reunion with her mother and with a 24yo guy that you just met (although he was comforting). Babel (the movie) was going through my mind. So long story short, the sattelite air-phone was a nice option, so I exercised it. Cost: 15 dollars a minute. Hearing your wife's voice and confirming her well being with her mother: priceless.


Fun point of travel: despite alerting B of A of our overseas travel plans, they still locked my debit card. AND AT&T wont allow international calling capabilities unitl your contract is at least 6month of age...(mine was 5mo-so I made sure it was working when I return).


I called Paul (Em's dad and Dianne's husband) and gave him the update. Em and I talk every morning (got up at 04:00 this morning-trending in the right direction). She and her mom are doing great (I will say only this: 2 attractive blond women in a orphanage with 32 children-most of them having never seen someone of their genetic make-up-and the accomodations are not what they were anywhere we stayed before). I'll let her blog when she can...


Working yesterday all day till 18:30 wasn't fun. Missed the NCAA Championship Game (slept through it).


And I am posting a picture...now that we are wireless again...

Saturday, April 4, 2009

Peru Connection

Wow. My wife writes alot. She loves to tell stories. Mine are a little more succinct. While we went to Peru, we met a Kenyan Anesthesiologist named Zipporah. She lives in Nairobi. We met her at the hotel we are staying at (key summary point about Kenya: the demographic spectrum is the most extreme we have ever seen-people living in houses made of cow poop in the Masai Mara and everywhere else emily went vs. the 5 star accomodations (from US and European standards) in the hotel we spent the day at today before my departure. Feeling Guilty was the theme of the day.

Zipporah took us to dinner (funny enough the same resturant Dr. Newton suggested we dine at during our one free evening). We joined her husband and two children (4 and 6 yo) for dinner (it was Zipporah's birthday). The kids enjoyed the sifari pictures and oddly enough they were fascinated with my beard and arm hair(the youngest loved to touch it), much to the dismay of my wife.

Em's mom is on a plane bound for Kenya today, Gerald (the SP driver-all of 24yo-but thinks we as a couple are young as he has never seen such a young doctor come here) is picking us up at 20:15 ( 3 hours away). So Em and I are going to dinner and saying goodbye for the next two weeks.

So no more blog activity from us today. I'm taking the computer to aid with board prep, so I'll blog some when I return. Em has a local cell phone with local and international service, some newly acquired money, and the knife stocksick gave me as a groomsmans gift (for protection). With Gerald, Dr. Newton, Sue, and the rest of our new friends watching over her, she'll be fine. Better than working in Nashville studying for oral boards.

Em is lobbying for some blog time and telling me what to write now. She wants me to add that she may have the ability to blog when she is on her second safari with her mom the latter part of next week.

Day trip to the Spina Bifida/Hydrocephalus clinic

Thursday, I had the privilege of tagging only with a peds team to Nyahururu - a town NE of Kijabe. I did not really know who would be going and in what mode of transportation, but I was not expecting to be the only non-Kenyan person....however, I was:).

I was picked up at 6am by a paid driver in his small personal car, Gilbert (social worker from Kijabe), and Jan (a Kenyan nurse on the peds ward). We then drove up the mountain above Kijabe and picked up Mary, another nurse from the peds ward. Thanks to my brothers, I am very used to the back middle seat with my knees pressed together:). I was told the drive would be about an hour and it really was almost 3....this is very Kenyan. Oh, I forgot to mention that I am always early here as well. Driving in Kenyan or riding is a car is pretty scary...there are no lanes really and they have these crazy road blocks with spikes and really high speed bumps without markings.

Once we arrived in Nyahururu, we ate breakfast at a cafe which is kindly paid for by the hospital fund. I had eggs, toast, and a bottled water for about a $1.25. The group spoke swahili the whole time unless the questions were directed towards me.

The clinic was held inside of a nice building run by a Catholic Ministry (if it were not for Christian organizations many of these services would never be offered!) which catered to street kids, substance abuse, HIV tx, and disabled individuals by providing housing and work opportunities. We were located in the "physical therapy gym" and laid out all of the patient paperwork and charts to start seeing patients. Many of the patients were there for a follow-up visit following spina bidida repair or shunt placement as these clinics are set up over a years time all over Kenya by Bethany Kids so families told have to travel the distance to Kijabe. However, there were new patients which was where it got interesting.

The two most interesting ones I saw were:

An emaciated 10 mo male was the first patient with his mom who was also malnourished. He was covered with tons of dirty blankets and when I uncovered to look at his back I saw a very large, unrepaired myelomeningocele that also had a fungal infection on the sac. Wow! - I have never seen this in a child this old as in the states it is repaired in utero now or shortly after birth. This patient had never had any real health care. When I did the exam, it was clear that the infant was flaccid from the waist down and had a neurogenic bladder. My goodness. The mom did not understand the condition and still had hope that her child would walk someday. Jan did a really good explaining this to her in Swahili. She told the mom that she needed to be honest with her so the mom could begin to adjust to the reality of the situation and get involved in a support group. There were definitely tears and this was a blunt conversation (so different from the way we often sugar coat things in the US and well as don't speak in absolutes in order to avoid lawsuits), but hopefully the mom can make the transition. Gilbert set her up with a transfer to Kijabe on Sunday so the child could have surgery next week.

- the sad thing about it is Jan said the dad might divorce the mom or may not even approve of her seeking medical care. There is so much stigma here with disabilities and many of these babies are abandoned. Many of the tribes believe this would be a curse and/or use some form of witch craft/alternative tx for the child, which may do more harm in the end.

The other shocking patient, was a 6 week old whose mom had noticed an increase in head size for about 3 weeks. She went to a local hospital where she was told to go to Kijabe but the family could not afford the transporation. The body of the child was teeny but when I measured the head it was 51cm! Average size for HC at 6weeks is about 35cm and my HC is 58cm as an adult (and I have a large head). This child was sick and needed to have a decrease in ICP! The nurses here are trained to perform a tap of the fontanel and it would have been extremely helpful. The child had been vomiting for a week and only able to eat about 4 times per day. The father did not approve of the mom being there so Gilbert told her to not go back home as he would not allow her to go to Kijabe. She also has six kids at home and is a farmer (many of the women are farmers -a very small operation). The Catholic organization was able to pay for the transportation and she went straight to the hospital.

I saw the infant on Friday in the OR holding area and he was waiting to have a shunt placed. However, this child will never be okay and it will likely not be good for the family.

We gave out lots of folic acid and I walked around in the waiting area giving all of the kids Vitamin A drops. It was incredible.

The hospital treated me to a late lunch which consisted of a whole fish with the head still on:) and chips (french fries) for about $2.75 which was the most expensive item on the menu.

I was unsure whether we would make it home as we had to push the car at one point and traffic was crazy! I got back at 7:20pm and said goodbye to my new Kenyan friends. It was so nice that they let me come along.....as they were probably thinking who is this young looking white girl from America when they first picked me up:).

I have a new passion in my nursing profession.....teaching moms about spina bifida in Africa and giving out folic acid. We have talked to many of the US docs here and it is interesting to see their opinions on funding that is given to Africa. Huge sums of money are given for HIV meds and they say this is good, but they would like to see more money go to prevention programs and to patients who they deem "have a chance of life and are not terminal." Hopefully, I can make this possible some day and really raise some funds to help prevent spina bifida.

Once I got home, Jas and I rushed over to Anne and Robert Mulwa's house for dinner - Anne is the pediatric tutor I have been working with and Robert is a nurse in the peds orthopedic department. The authentic African food was great (Anne knew I did not eat beef) and it was so fun to talk about life in Kenya from a young couples perspective. At the end, we decided that in the US or in Kenya, married couples have the same ups and downs. We hope that they will visit us in the US someday or we will see them when we return to Kijabe.

Friday is our last day in Kijabe and we will head to Nairobi for Jason to fly home:(. I don't think he is ready to go or to leave me! It has been an amazing trip and we have really grown together as a couple. Thank you for following our blog - I am hoping to post some more but I don't think there is wi-fi at the orphanage as there is not hot water.

Much love, Em

Friday, April 3, 2009

The Peds Ward

Wednesday I spent the day on the peds ward with Dr. Fink (a pediatrician from Memphis), Bob (the clinical officer on the ward who functions like a PA), and one of the Kenyan residents. It was extremely interesting seeing the pathology of the patients admitted, how they are treated based on cost and what drugs are accessible, and really how long people go here before seeking treatment. Surprisingly, there is not much difference between here and home, so I surprisingly felt competent with how to treat some of the ailments. We don't have the tropical diseases fortunately though!



Here is a breakdown of some of the patients I saw:



10 yo male with a history of bloody diarrhea for a week, significant dehydration, as well as a reported weight loss of 10kg over the past month. HIV and malaria tests were negative (not that reliable I heard though) and likely had salmonella. The team came to the conclusion that the report from mom was likely exaggerated. Man though, it did not look like fun being a kid hospitalized for diarrhea as they have to lie on trash bags:(.



11 yo female with a history of shortness of breath and cough for a week. Her CBC revealed pancytopenia and they were trying to rule out aplastic anemia versus leukemia. I was able to assist with the bone marrow aspiration - uhh, not at all like it is done in the States. We gave ketamine and the some of the instruments were half missing. It was very make-shift and it was interesting to see that I was the only one who spoke to the child...definitely no child life services here!


9 mo old male from Somalia who was developing well until he started having a high fever and seizures. His mother took him to a hospital in Somalia where he was diagnosed with meningitis and treated with Streptomycin...which would not do anything for him. He continued to have seizures lasting up to one hour and 15 times per day. After about a week of this, the mom came to Kenya illegally where his antibiotics were switched to effective ones and he is now being fed through an ng tube and is neurologically devastated. Gtubes and nissens are not done here so this child will likely die from either aspiration pneumonia by the family trying to feed by mouth or replacing the tube incorrectly. The family is unable to return to Somalia so now the mom and baby will likely live in the slums of Nairobi where there is a large Somalian population (about 2 million people out of 5-6 million total live in the slums in Nairobi).


9 yo female with a history of right eye swelling and then developed fever and neck stiffness. She had meningitis and was doing very well on day 10 of 14 for antibiotic therapy.



3 yo male with a history of recurrent seizures for the past 8 months who was being treated for malaria - every child coming in with convulsions or history of seems to get treated for malaria. His aunt was his guardian as his parents had passed, and it was interesting to really figure out how to get him daily phenobarb as there is NO health insurance here unless you are wealthy.



12 yo male with a history of ascites and pleural effusions for several months. Jas had provided anesthesia when his lung was tapped showing exudate, which was pointing towards TB but he has not been responding to tx. A different pediatrician than the one I was with was thinking more of a cardiac pathology. The family denied any history of TB or chronic cough - but I have heard to take that as face value...kind of like when parents tell me they only smoke outside:). This poor guy was sick though and the outcome is not good.

9 yo female with a history of severe kyphosis and pectus excavatum. I don't think she had had this evaluated really before and now she has right sided heart failure and pulmonary hypertension. She had come to Kijabe satting 43% and was just sick. The ortho team decided she was not a candidate for surgery because of her heart and the pediatrician was having to translate this to the parents. They inquired about a second opinion from a cardiologist (there will not be a visiting peds cardiologist at Kijabe until July) and the transfer and evaluation in Nairobi would be about 10000+ Kenyan shillings (about $100) - this is huge for the majority of the families in Kenya as they live on about a $1 a day. It is was interesting to see the response of the parents in comparison to those in the US - this father was not angry, he was sad and wanted to know if this could have been treated earlier so he could share this information with others in his community to help treat another child with the same condition sooner. Also, I looked over the little girl and noticied she had a pressure ulcer to her right ear from the oxygen strap....unfortunately, no big deal to anyone else but me:(.

3 mo old female admitted for respiratory distress and had been to the ICU several times. She was doing great, ready to go home, and I think see honestly had RSV bronchiolitis - they are unable to isolate specific organisms here but they still have some of the same bugs.

3 yo female with a history of an abdominal mass which mom had discovered several months prior and was in fact a Wilm's tumor. She had a nephrectomy 2 weeks prior and was now in for chemo - they do follow a chemo regimen similar to CHOP. They have had 4 kids at Kijabe with leukemia in the past 3-4 years and only 1 is still living....all the rest came in so late and had every complication. This little girl was just adorable but did not like us! What amazed me the most is that she is given intravenous chemo through a peripheral IV! I asked if central lines or even PICCs were accessible would they use them and the pediatricians response was no bc the nurses would not be able to manage them and the risk of infections was just too great. The little girl was staying after her chemo because she was having vomiting and no stool....ended up going to the OR the next day due to a bowel obstruction and needed to have adhesions removed.

9 yo male with HIV and lymphoma:(...this little guy Emmanuel was just the coolest. I got to sit with him and his mom for a while before he received his chemo. He weighed nothing but was so stoic and even smiled when we started talking about playing outside. He obviously had complete alopecia and his head was covered with a fungal infection as the kids here really struggle with that anyway. The docs had to put their heads together as to when to give chemo and then add on his anti-retrovirals. He was doing amazingly well and this was his second to last burst of chemo. As expected he received his chemo through a peripheral and no thought of gloves were involved.

So in summary, these are the things I am learning:

Health care is not treated as a right here but a privilege. I am embarrassed to say that I have had the luxury of being picky when it has come to my own health care and I will really think twice before I complain about anything again.

Being in a remote area of a third world country gives you a different perspective about end of life issues. Here the supplies are so limited and they have to really evaluate who needs the supplies the most based on the likelihood of survival. In the states, all effort is made to keep someone alive even if the quality of life is drastically different. This experience has opened up some new conversations between Jas and I about these issues (probably more understanding on my side) that it is okay to let someone go when it is their time and not to not keep them alive for selfish reasons. You see here that the culture, stigma, quality of life, and financial state has such a huge impact and you are really not helping these families by intervening (going to all extremes) on a patient who will become or is already a total care/devastated patient.

Don't take antibiotics unless you need them! MRSA does not exist here, unfortunately it probably will as western medicine moves in. Despite the conditions in the OR, the infection rate is drastically less than the US and none of the operative patients are treated with prophylactic antibiotics....it is incredible to see that! They do have resistance to malaria drugs though as we have resistance to antibiotics.

I think that is plenty for now:). Hope as is well!

Kenyan Pain Clinic

So it seems that I have unknowningly helped start the first pain clinic in Kenya. People are coming from all over (even larger metropolitan places) to Kijabe, as we are the only physicans that offer epidural steroid injections. Our treatment scope is limited (by space, resources, imaging modalities and time), but we have also started performing blind sacroiliac joint injections (not done in the US without image guidance because not reliable placement). So now we treat mostly radiculopathies, myofascial pain syndromes, and sacroiliac arthopathies.



As part of my mission, I also had the privelage to lecture to the KRNAs and student KRNAs (see earlier blog for acronym meaning). They are technically very good and are as bright as they come. I would attach a picture of the class (but internet is slow). They main topics discussed were neuromuscular blockade and local anesthetics.



We also expanded their regional anesthesia understanding. We demonstrated successful, stimulated needle axillary blocks, interscalene blocks, and lower extremity blocks including sciatic, femoral, and ankle. This may not sound like a big deal, but with perioperative mortality around 20% nationally, less is definately more. And safer. That is why 80% of surgery here at Kijabe is done under spinal (after it sets up and the block height is stable, less vigilance is required than general anesthesia). These trained KRNAs will go to rural hospitals and educate/promote safer anesthesia and surgery.



As you have probably gotten from emily's blogs, this has been an excellent experience, both personally and professionally. We have helped influence a continent and forged friendships that will last a lifetime.