Summer 2013 update - falls, bicycling, a bothersome knee and Africa

Well much has transpired since my last entry.  Some good, some not so good, and yet I keep on bicycling and doing what I can to support our family and be involved in the life of our community.  Just a week ago the 9 year anniversary passed of my trauma.   Still hard to believe; though also what life used to be like is getting to be a distant memory too.  The new normal.

First the bad.  In December I fell on our stairs over our 105 lb. Bernese Mountain dog.  I had stepped on his tail and slid, falling backwards actually but forcibly flexing and rotating my right knee underneath me.  After lying on the landing for perhaps 5 minutes waiting for the tone and general spasms to dissipate, I got up to find my knee was none too stable.  To cut through weeks of uncertainty and a few more falls in the meantime, basically I shredded what little cartilage was remaining in my right knee.  The joint space filled with debris and floaters, which cause either knee locking (stuck in partial flexion, unable to flex or extend further) or sudden collapse (thus a fall again down the stairs just when I thought all was well with the world).  Many phone calls, exams and consultations later - we decided the best course was Physical Therapy.  Failing that, a surgical flushing out; despite the fact the plain films and the MRI looked as though a total knee was in order!  The good news - no pain at all (since I have almost no sensation below the waist), and even better yet, PT again worked wonders!  Time heals - well that and PT, and prayer and a knee brace and perhaps even Wobenzyme (a German developed combination of anti-inflammatory enzymes).

Gradually, by March, I could begin cycling indoors for up to 10 minutes!  But quickly due to my improvement the 10 minutes became 30, then an hour, then pushing personal records on a Compu-Trainer.  Soon it was outdoors, and since sometime in April I have managed to get in about 1400 miles on the road!  Lots of knee clunking and popping, but no collapses nor locking.  My weight back below 170 and a hope for further improvement.  Still a scope and a wash out are likely on the horizon, but who knows.  Time will tell.

Africa, book writing and further updates .....

 

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Kenya Summer 2012 summary

 Indeed I did make it back home safely and without any ill effects; at least none yet (since malaria may incubate for up to one year in a liver cell before it breaks forth into the blood form with its full pronouncement and all its classic symptoms - for this reason the drug Coartem is never far from my side).  Speaking of the little devil, we did end up having 4 people out of thirty from our area come down with the parasite despite "compliant" regimens of either Doxycycline (2) or Malarone (2).

So here are my final impressions of the trip.

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Kenya June/July Update #6

13 July 2012 

More interesting survey details today.  Lots of ups and downs for terrain, side hill and more rugged balance challenges.  One Muslim older woman said if you urinate into a ground fissure or dried earthen crack while on your menses, then cover the fissure with earth, your uterus too will be sealed.  Another when asked about birth control methods stated that she and her husband sleep in separate beds and in different rooms, that this works for them.  However when asked to list the side effects of this method, she stated that it led to more quarreling and discontent in the home directed toward her from her husband.   We had a woman whose husband works in Nairobi, she has very high BP, which she says is due to a witch or night runner that attacks her house all night long when her husband is away.  Throwing rocks on the roof, hitting the walls, sticking fingers over the walls, between roof and walls, and running naked thru the brush when she opens the door to get a glimpse of him.  Her husband supports this story.  This, “the reason for her hypertension”.  They had 5 children, 4 have died, the one remaining lives and works elsewhere.

Another said pills work well for family planning, but when you do have a child after pills, they will be born with 10 heads.  And again a story of pills swallowed go directly (this time) to your tubes, where they remain and must surgically be removed.  Last Depo injections can “cause your heart to come out of its cage and move” to another area of your body, in this case the woman claimed her lower abdomen.  One day while coughing and pushing there, it “moved back to its cage”.

Sad case of the day was a young early 20’s woman with epilepsy, on no meds, with 3 children.  In April she seized and fell into the fire.  Her left knee still with open wounds and scarring and oozing, and difficult to walk or put any weight on it.  Her children very thin, the 8 year old girl was 16 kg and 120cm tall.  Giving a BMI in my head of 11; so sad, I shed a few tears right there for their situation.  The WHO says anything under 16 is extreme thinness.  Did not see a husband.  Nearly empty home still under construction.

Last, I had fun with Carlton, an 18month old kid.  His mom said I was the first Mzungu he has ever seen in his life.  We kicked a soccer ball (old plastic bags rolled into a ball) around for a bit.  He would take a running start to kick the ball, very funny to watch.  He is a talented kid!  Well I am tired, falling asleep now while trying to type.  One half day of surveying left. 

14 July 2012

At breakfast Dr. Omoto asked me to preach for 40 minutes Sunday!  Oh boy, a bit of panic – but how can I refuse?  So prepping for that as I can.  Last ½ day of surveying went fine, hitting over 355 households in total for the 4.5 days.   Dinner had the usual amazing layout of foods.  Again, the staff washed our clothes, ironed them, folded; shoes all scrubbed and washed to an amazing level of cleanliness.  My Keens done 3 times for extreme mud; but they take their job seriously and work on anything. 

15 July 2012

Preached on Psalm 133:1 and 2 Corinthians 4.  Community.  Tied in Dietrich Bonhoeffer’s words from the Service chapter of Life Together.  Spoke to our efforts to establish community in Khwisero and Miwani areas, with the challenges of sharing the gospel and scripture and praying for those in our communities.  By surveying their health and beliefs and lives, we have had a glimpse into the life of those who are suffering and who, like us, as jars of clay – fragile vessels, may find ourselves suffering at any moment.  However this drives us to God who gives us hope, if of nothing else, of eternal life when we are released from this life.  In the meantime we can be of service to those in our community who are broken and in despair.

Omoto’s church was nice, great singing and perhaps Pentecostal?  At the end of nearly every song they all moved into spoken prayers – since I cannot understand the language it sounds like fervent prayer offered in tongues, but could be a mix of Swahili, Luo and Luhya.  Gradually these prayers would fade and another song begun. 

Again a wonderful meal at Omoto’s.  Photos taken.  Goodbyes said.

Sylvester drove us back home to Nehemiah in just under 2 hours.  Looking forward to going home which will begin tomorrow,  16 July 2012!

Kenya June/July Update #5

11 July 2012

Matt had a rough night, staying back today.  He was better by the afternoon, and even better tonight. 

Survey went well.  Lilian (one of the head nurses from Siaya District Hospital), a Community Health Worker (CHW) also named Helen, and myself tagging along.  In Khwisero, the town of Ebushybungo, with nice people and yet quite poor.  We are now at 127 households done in 2 days.  Welcomed nicely throughout.  Most with mud walls, floors and tin roofs.  None with electricity, a few with car batteries to operate radios.  Some elderly.  A few with hypertension.  Lots of missing teeth, some TNTC (too numerous to count) – or better yet to count those present – as in the case of the 86 yo man with 4 teeth present.  We did roughly 16 homes.  One woman worried if you cough hard you might dislodge your IUD and have it move to your heart. 

Lexi on a roll tonight with her language and stories.  She had one wedding proposal today, as noted, to be his first wife!  How kind, and such an honor.  At dinner she had Omoto and his staff in stitches sometimes with her mix of Luhya or Luo or Swahili.  Later a huge bug flew into dinner, after it passed over all of us, Lexi calmly swatted it from the air, and picked it up barehanded from the ground to show us the very large dung beetle.  Matt, scared of all insects, was impressed as Lexi strode out the room to toss it back outside.  Omoto quite impressed too, he could hardly believe a Mzungu would take on a dung beetle in such a manner. 

Times like these, and you think no problem, I could come back and jump into the efforts here.  Then other times like this past Monday thinking, What am I doing here! What was I thinking?!  It will be nice to be home!  So some major ups and downs – but today was very very good.  Ended with prayer and singing – after an amazing meal of rice, green grams, avocado, greens, ugali.  The avocado the best I have ever tasted, by far!!  Texture and flavor – WOW.  And the price in Kenya is typically 5 to 15 shillings at most (that is roughly 7 to 22 cents).   

12 July 2012

Survey day.  Matt much better!  He slept solid.  All is well mostly, the imminent feeling of impending malaria fading a bit.  Somehow during the night I spilled some urine out of the urinal onto myself, my shirt and bedding.  Argh!  Thinking I would shower off in the morning, but no power and just as I am wondering what to do, the gentle knock on the door of “warm water at your door.”   Amazing.  Finishing up my morning routine, 40 minutes went by before I would access the warm water.  No wash cloth, decided to strip and pour some over me with a 3 liter water pitcher.  Mistake.  The water was intensely hot!  Still, now 10 hours later my skin is burning, but no sign of burns.  It hurts though.  On top of that the cracked toilet seat (yes, even at Dr. Omoto's guest quarters) managed to inflict a 2-3 inch long superficial laceration to my thigh this morning; no pain as I have little to no sensation there, but still not good to get up from the seat and find a bloody surface.  Oh well, the ups and downs continue.

Surveying went smoothly, though I bonked for some of it – needing food and/or water.  Made it till 4 pm.  Some interesting cases though.   One lady 170/120 for BP.  Stopped her Nifedipine 3 months ago due to the cost of 250 KSH ($3 USD) every 2 weeks.  No money to afford it.  She has been having chest pain and palpitations recently.   The next home we visited had an 18 year old with a history of seizures.  No sooner had we entered than she went into a classic grand mal seizure.  Her mother restraining her through the tonic-clonic phase then released her to be postictal.  About 15 minutes of slowly becoming more arousable, and she was soon up.  The mom said they had tried phenobarbital and what I later discovered was Dilantin, both without success.  So they gave up.  Not even sure she ever hit therapeutic doses of each.  She is quite talented with crochet, having knit many items quite precisely – a table runner, pillow covers and decorative items.  She apparently seizes 6-10 times per day.  I wrote out a list of other possible medications to try (Tegretol, Neurontin, Lamictal, Depakote) and we encouraged them to pursue care again.  Next we had a 22 year old with what first looked like a dense cataract (in the dark of her home), but outside it was actually a corneal scar near the central visual axis that she had for 5 years.  Perhaps scaring from infection, an ulcer or trauma?  It was only about 4 mm in diameter and solid white. 

Traditions.  Learning lots of these, and myths too, or perhaps "urban myths, or legends".  Many Kenyan women, who are close to getting married, have their lower front 6 teeth broken out?!  This as a sign of a marital commitment.  No numbing, just trauma to break them out as proof “she is tough enough to be an adult woman”.  Fortunately this practice may be declining as we saw this more commonly in women over 40, but not usually in the yonger.  Birth planning, and complications of contraception were always interesting parts of the survey.  IUD’s can apparently travel to the heart, where they are a cause of persistent coughing as one tries to bring it up.  Depo is preferred by many women, as their husband cannot detect that they have had a shot and then not be upset.  Apparently many who use pills have to argue with their husbands who can see they are trying to not have children.  Another said she did not like taking pills because they will go to the uterus when swallowed and cause it to be blocked, once enough pills are taken, and you will need surgery to remove the blockage.  One other felt a part of a condom would be left inside the vagina, and this too will block later attempts to get pregnant.  One man commented he does not like the IUD because during sexual intercourse he feels it and it hurts him.    Another woman, whose husband’s testicles never descended, had been unable to get pregnant, so she had a child by another man.  But in the meantime her husband learned the cause of his impotence, and he knows the child is not his.  He was furious.  Beyond this we have two unusual practices.  Wife-inheritance and polygamy – both common.  If a husband dies, his wife is inherited by his brother next in-line, if he wants her.  If he does not, the option goes to the net male in line.  If she is not chosen, then she is considered “shamed”, and is to stay out of public view as much as possible (not going to market, or even to be seen outdoors in the garden is bad luck to other men who might cast eyes upon her). And beyond that, polygamy is common, especially if the woman cannot bear a husband a son.  We saw several cases of the man and his wives all living in the same compound, just not under the same roof.  One of them commented for birth control he “just senses when one wife is ripe for conception”, so he “runs” to the other wife’s home during those times.  I cannot believe the women put up with this!  Soon, though not soon enough, perhaps they will stand up for their rights and things will begin to change.  When both polygamy and wife inheritance are gone it will impact HIV/AIDS transmission; but even beyond that, women need to be more respected, given a voice and an ability to generate their own livelihood/income.

Kenya June/July Update #4

9 July 2012

Siaya, and needing to vent a little bit.  All is mostly well, at least thankfully I am doing okay. 

Admittedly some fear since Matt developed malaria while taking Doxycycline.  He is sure he has been faithful about it, perhaps one dose  taken 10 hours late.  Anyway about 40 hours ago he developed teeth chattering chills, sweats and fever, with nausea and extreme weakness.  Wiped out, awful feeling.  No appetite.  Decided to start him on the Coartem that I had bought on my last trip here.   So far all is well, he is doing much better.  A fast response to the meds.

Though I am fearful of what is to perhaps come for the rest of us.  All others also on Doxycycline 100 mg once per day.  So a bit disappointed to see it may not be the 99% effective drug I thought it was.  That and now 48 hours ago I got at least 15 bites while watching Sherlock Holmes with the gang in the coach house.  Feeling like the more bites I get, the more at risk I am – which is quite true.

NOTE: I did later happen upon a meta-analysis which stated Doxy is 92-96% effective; still is that per person or per single bite?

The lectures today to the “medical students” went well, though honestly the students were actually the equivalent of graduate level nursing students.  So needed to flex a bit to talk at a slightly lower level, nonetheless all seemed to be well received.  One more day of lectures, then onto Mundeko and Khwisero to work with the survey in that area.  The 3 girls will start there tomorrow, after they spent the day observing at Siaya District Hospital.

My hotel room is pretty funky.   Not quite as pictured on the internet!  Two light bulbs, one of which is out often – that is, when we have power to notice it is out.  Power out today for a while after a thunderstorm.  No internet.  No mirror anywhere, so hard to shave or groom.  Sink does not work at all.   Unable to wash except in the shower.  The previously used sink “soaps” are actually broken chunks of the deodorizing blocks of crystals they toss into the base of urinals.  Toilet leaks onto the floor.  Shower basin does not drain at all, unless the water gets high enough (as the drain is the well established high point of the shower floor itself), even so leaving 1-2 inches of water in the basin.   My mosquito net seems effective thank goodness, though barely reaches to the edge of the mattress.  My pillow stuffed with bubble wrap for firm support!  Toilet seat badly cracked with chunks of plastic missing, it threatens to completely come apart every time I sit down.  Just a few of the challenges for me!!  Lord grant me patience, a sense humor and continued health measured with gratitude for what I have.

Tired and off to bed, hoping that no chills and fever await.  My headache through the day was helped for a brief time by a Tusker beer, but quickly returned and again in the night with Tylenol 1.0 gram just taking a tiny edge off.  I think this is a caffeine withdrawal headache – no coffee or caffeine since Sunday morning, it is now 36 hours later.  Wow, it is bad – I am really surprised and annoyed at how bad it is.  Were I home, besides getting shots of espresso, I would be in bed.   But this is Siaya, and there are lectures to give shortly.

  10 July 2012

For breakfast at the Mwisho went for freeze dried Nescafe (my Dad’s old standby!).  Two packets in a ½ cup of hot water and I began to feel some life infusing back into my veins.  Two more, and even a bit more life and the incessant headache began to fade!  This was the medicine I needed.  So again once more, 2 more packets before lecturing and I was running on nearly four cylinders.  Shortly thereafter the headache gone – and still gone, Hallelujah! 

Observed the Physiotherapy department and took several photos.  They have so little equipment, very battered and falling apart at the seams (literally, the medicine balls were splitting apart at the stitched seams).  They could use Pilate’s balls, my Body-Blade, any hand exercises, weights, almost anything.  They are hoping for a massager, a TENS unit and more.  To fix their exercise bicycle they need a new seat, clamp assembly and quick release lever for seatpost adjustment.

Still the ER has no monitor, no EKG machine, no defibrillator.  And this, a 220 bed hospital.  In fact, no defibrillator for the entire hospital, ER, OR nor anywhere!

The beautiful African Clinical Officer (CO) who was evaluating children did not examine them, or barely so.  Hannah described her as “modeling gorgeous”, and Matt as “the most beautiful African he has seen anywhere, anytime”.  She was mostly taking a brief history and reviewing some lab tests for malaria.  Sometimes would look at the conjunctiva as she reached across the desk, but no stethoscope and generally “hands off”.  Otherwise asking the mother a few questions and even with the Electronic Medical Record (EMR), minimal documentation.  That, and she, was working for free!  Finished with school, she cannot get a job apparently that pays, so just volunteers and sees 150-200 patients per day.  My favorite new chief complaint by mothers for their children?  HOB = “Hotness of Body”.   Reserving “fever” for documented temperature elevation.

Lectures today went so much better!  Mostly because I was not too hot, and the headache was gone!!  The students seemed quite attentive, and had worked on their learning objectives as well regarding some DKA treatment.  My last lecture was on the trauma I experienced and a changed life.  For some reason I struggled through it emotionally in several spots; which really surprised me.  When finished they were really gracious and kind with comments.  I heard a few sniffles too.  The elder stateswoman nurse for them pronounced a wonderful blessing over me, and said we can see you are a Christian, that God has spared you for His purpose and work, and we pray a blessing upon you and your efforts.  The kind words washed over me and were amazing, all making it worth any effort I had put forth.  Then she asked one of the other Sisters to pray for me, they all stood and insisted I sit down and the prayer in Luo or Luhya was emphatically prayed.  Several were very sweet.

After observing the aforementioned striking CO Helen, we went to Dr. Omoto’s home where they have been without power for 24 hours.  Shortly thereafter hit with a prolonged thunderstorm, we discussed the day over Chai tea with Matt feeling worse by the minute.  Finally in darkness the girls returned.  More Chai and then a great dinner of cabbage, chicken, rice, chipati, and broth.  Matt off to bed with no dinner accompanied by shaking chills, and yet only one dose away from completing his malaria meds.  Walked back the 300 yards from Omoto’s to our room with thick red clay stuck to my Keens, so much that walking became very difficult.  Only then to find Matt soon having prolonged vomiting and diarrhea and thankfully he could use my headlamp to aim both!  So in the dark, he was wretching, bundled up with shaking chills and V&D.  Ugh!  Hopefully he will make a quick turnaround tomorrow.

So highs and lows both.  Such is life.  Glad I could share my life and information with the graduate nursing students; yet feeling bad for Matt and praying for a quick recovery.  Tonight not feeling so anxious about impending malaria, but will see what the new day brings tomorrow, hopefully power for a start!

Kenya June/July Update #3

 Sorry that this update has taken so long to post.  Excuses, excuses...... too busy, no power, or power and no internet, traveling, or recovering from travel, or (now home) too preoccupied with catching up on life.  Enough of that - here goes.

The preliminary survey in the Miwani area covered a total of 3 days, and in total we saw 157 households.  We were kindly received and all went well.  Many surprises, and some concerns for certain.  We will all know more once the numbers are analyzed.  Though I participated in day one of the survey, the other areas our teams covered were too far a distance for me to cover on foot (some were close to 10 miles roundtrip).  For the most part everyone walked, yet there were a few instances of hitching a ride in a passing truck or hiring piki-piki's (motorcycles - despite prior agreement not to do so from those I am responsible to "supervise").  Thankfully - all went well.

Saturday July 7 saw the 4 Mzungu's hike to Nandi rock and into Nandi itself.  They were gone all day and tired that eve, but not too much so to still watch Sherlock Holmes.  With my impaired sensation I managed to get 15 mosquito bites during the movie, not feeling them attacking my exposed flesh.  Still I figured I was "covered" by my Doxycycline, or so I thought....   more on that thought soon.

Sunday July 8 and we will as a team be headed to Siaya and Siaya District Hospital.  Two days of teaching at the hospital, and observing their Emergency Department before we head off to survey the Khwisero area with Community Health Workers.  Overall I have been feeling very good, many days thinking I could do this long term and without difficulty - other than my usual accommodations. 

Kenya June/July Update #2

3 July 2012.  In many ways it feels as though much of the real work of the trip started today.  After a training session and trial run with a couple of farm families, we began using the survey tool today around Nehemiah.  

So the survey is a combination of suggestions of the US team and of Dr. Omoto and his staff from Siaya.  It is 6 pages in length and has roughly 45 questions of demographic data and also some "test" questions to determine the knowledge of families we are surveying in regard to basic health issues.  It includes questions on hand washing, latrines, dish rack use, mosquito nets, personal and family income, number of people living in the household and immunizations and the timing of them.  Also covered are family planning, contraception and HIV, as well as pregnancy risks.  We then measure BMI (by height, weight and age if less than 20), visual acuity, blood pressure for those over 20, and perform a dental check for missing teeth/cavities.

We met this morning at Nehemiah and split into 3 teams.  Generally one community health worker, one person from Nehemiah and a Mzungu (one of us).  We went out on foot to Karunga, Kaleng and an area close to Kibos.  We surveyed huts/homes from 9am till 5pm.  Amazingly for day one, we covered actually 59 huts/homes!  Beyond that several other children to gather BMI information as well.  We found we were welcomed into huts and offered seating.  Most seemed to answer questions without hesitation, though we all seemed to hit resistance on income and most could not identify the timing of immunizations.  

Most homes were of mud walls and flooring, with generally thatched roofs.  Many had fires burning for cooking inside the home with charcoal.  Prior to coming I was concerned about CO, or Carbon Monoxide poisoning for these people burning charcoal indoors, yet the studies I could find reflected levels of around 30 ppm of CO; whereas 200 ppm is toxic.  It appears they all have such adequate ventilation, that CO poisoning is not an issue.  It was so good to spend the day observing, in our team's case 16 huts, and the life they have.  Corn planted around the huts, some with attached latrines, or perhaps 15 feet away; but many used only the bush and no latrine even in a village area somewhat populated.  Children everywhere, happy in most cases, though my mustache and cane scared a few who began crying.  Lots of great photo opportunities which I will have to upload when home.  Most men and women adults seemed to run about 42-52 kg and roughly 160 - 165 cm tall.  I will begin to work on the calculations tomorrow.

The only real problem encountered was with the team I was with. And even then God's hand was all over that!
Shebby, Victor (our CHW), Lexi and I were approached by two older men who asked in a somewhat gruff manner what we were doing (after we had surveyed about 6 huts), and who had given us authorization. A kind explanation by Shebby did not help and they seemed intent to get rid of us. Shebby explained we had authorization from the chief, they said they had no knowledge of that and had not heard we were coming. Just then Shebby called Ken Olindo who had gotten the authorization - and at that exact moment Ken was with the chief and was interviewing him and his family for the survey! The two men with us (one an associate chief, the other a village elder of the clan) did not accept that, and one called the chief himself the next moment. The chief answered the phone, and whatever he told the assistants, they simply had a change come over their faces and both said "Sawa" and walked away......
So I guess the money was worth spending, especially since all teams will have authorization until even the larger Bainbridge group is done. We have an official signed letter from the chief as well that Ken is photocopying.

In regard to the mentioned funds.  A few days ago we found the "Miwani chief" required payment to "authorize" our survey.  This was to assure safe travels and acceptance in the area, in exchange for 3,000 KSH.  Though several felt this was again corruption at work and an abuse, I felt after all we had been through that this was not that much to pay - if it made a difference (only around $35 USD); so though it was in theory not the right thing to do (after all we are trying to help these people by learning about them and already spending a lot of money to do that), I did go ahead and pay the funds this morning myself.  It now looks like that was the right decision.

All in all everyone is encouraged!  The survey will continue in the Nehemiah/Miwani region over the next 3-4 days.  Mostly on foot, with areas to come beyond my walking strength.  I felt I held up well today, though likely because so many are praying for our team and our health. 

More soon! Thanks for reading.

A Kenyan Birthday

 1 July in Miwani, Kenya.  Thinking I would have a quiet peaceful day, but so far it seems not to be that way.  Still taking it all in.

At 0530 Kenya time I got a text from a new Sikh friend whom I met here in February.  "Respected Bro, wishing you a very happy & blessed b'day. The Lord bestow his blessings on you with happiness. Good health this auspicious day and years to come always. Johnny and family"  Then two hours later a call from him as well.  He and his three daughters are cooking Indian food to bring over to feast with us this evening in further celebration of the day.  

Then after church I seemed to have a line of people waiting to greet me.  Last Sunday was an introduction to many, and making again friendships with others.  This Sunday had several asking me directly for money to pay for their medicines, or healthcare, or food for family, or funds to start a business.  More overwhelmed with the need, and how little so many people have.  One mother with her 2 year old who has had malaria several times, now again with intermittent fever and cough with scleral icterus (jaundice) and dark urine.  All I could do was tell her I would read about this and try to educate myself on what it may be (will do that shortly).  Most seemed to think having met me once or twice, I now would be more sympathetic to their plight and give money.  It is hard to say no when my wallet is basically empty, and my heart is full.

A visiting pastor asked me to please start a medical clinic near his home of Port Victoria, Kenya.  Apparently there is a lack of medical care in his area as well.

Last, another family wanted to greet me in the church afterwards.  Thinking this again might be another financial assistance request, but no.  A widower whom we met this week, teaching pre-school in Miwani who is barely surviving I am certain (whom herself was injured falling from a Piki-Piki in 2009 and walks with a bad limp), had brought me a gift.  A colorful chicken.  A birthday chicken!  The cost for her to give that up for me, likely incalculable.  I thought of the Bible story of the widows coin - giving nearly all she had back to the church.  In this case her thankfulness for our being here and helping with a survey to study the health of the local people.  

So it is barely noon, and I am already overwhelmed by the generosity of those around me.  

More to report.

So a final update on the day's events.  Our entire group had a wonderful Indian dinner with Johnny and his family, including a traditional Kenyan beer they brought for me - Tusker.  Chocolate chip cookies put together from no-standard ingredients and baked by Hannah Berkimer were outstanding.  Overall a restful day spent with friends from the southern and northern hemispheres.

Last, medically - the 2 year old likely has recurrent malaria given the mild jaundice and ongoing illness from mother's report.  I suspect they have no mosquito net, though did ask her that and got a puzzled look only.  According to the CDC malaria website, mild jaundice is common.

Tomorrow we start training for the survey trial with 2 nurses coming from Siaya.  The days following that we will survey mostly on foot around Nehemiah.  All for now.

Kenya June/July Update #1

 I am back in the Kisumu area with 4 young adults (ages 17 - 22).  We have been on the ground now for a week.  It has been very good to have some time to adjust and to get settled-in before we begin the real work ahead in Miwani and Yala/Siaya areas.  I flew to Amsterdam 2 days before the rest of the team to give my aging body a chance to adjust to the 10 hour difference between Seattle and Kenya; met with the team at Schiphol airport in AMS before we then flew together to Nairobi.

Our first week has been focused on friendships and re-establishing Kenyan contacts.  I have been in conversation with Dr. Jackton Omoto as often as the internet connection will allow, in regards to the surveys we will undertake in Miwani and Yala.  While our team in the US had established a short form, Dr. Omoto it seems has bigger plans!  The form our team had created focused on BMI (weight, height, age), visual acuity, blood pressure, mosquito net use, dental condition, water and sanitation.  Dr. Omoto's 7 page form incorporates those parameters, but also looks at income, housing conditions (floor, walls, roof), hand washing, family planning, preferred contraception, immunizations received, dish rack use, appliances owned and a few other things.  I must admit, at first I was very skeptical we would be able to obtain this information, yet Dr. Omoto hopes we can be well received by having several Kenyans on our survey team - with more Kenyans than Mzungus (perhaps 2 Kenyans for each American).

Again would say, I don't feel I have any right to ask a Kenyan living in a rural area about how much they earn every month, or other personal questions (such as family planning) - BUT, perhaps with other Kenyans present that may occur.  Also I am reminded, the purpose of our smaller team is to prepare the way for the larger Bainbridge team coming after us - and to trial the survey to see how it actually works.  So in the spirit of adventure and for the sake of learning even more about Kenyans in Miwani and Yala, our team will gear up for the task!  If it does not go over so well in the two areas we are going to survey, then we will look at altering the methods and length of the survey.  Dr. Omoto feels we should due able to get all the questions answered within 30 minutes of time per hut, or housing unit.  The goal is to understand health conditions as well as their living environment/socio-economic status.

Beyond the survey discussions, I am working on my lectures for the medical school in Siaya.  The schedule is a more manageable 2 days of presentations.  I will incorporate a few Problem Based Learning cases from my teaching at the University of Washington school of medicine that will tie in with the topics covered.  Lecture topics will be Motorcycle Accidents in Kenya: statistics and trends; Lower Extremity Trauma, Head Injuries/Trauma (both topics as they relate to motorcycle trauma), Diabetic Emergencies, Chest Pain, and my personal story as it relates to lessons I have learned from being a patient, and how care providers can connect more closely with their patients to meet both their medical needs and their emotional needs.  I am hopeful the Problem Based Learning cases will impart some practical knowledge, and teach a method of thought to craft a differential diagnosis list, a problem list and the manner of thought needed to either rule-in or rule-out a potential diagnosis.  I look forward to seeing how Kenyan medical students work in a small group setting where they come up with learning objectives, and report back to each other the following day on those potential diagnoses.

I will do my best to keep this site updated.  Our internet coverage has been very sketchy, with frequent outages, and literally a small zone (like a 10 foot square area of coverage) of reception.  Once evening hits, the mosquitos become rather active, and since my reception is outside - I am a ripe target!  Possibly a fried electrical part will be replaced this coming week.....

Back to Kenya! June - July 2012

Yes, the title is correct!  In less than 2 weeks I am headed back to the Kisumu area for more medical work.  This trip will be for a bit more than 4 weeks in length, returning home in time for our 30th wedding anniversary!  I will be leading a team of 4 college aged adults from Bainbridge Island, who will help me along the way.

I will be involved in several medical adventures this time; whereas the first trip involved more observation and understanding of the Kenyan care delivery system, this trip will include many more hands-on endeavors from teaching at a medical school near the Siaya District Hospital for nearly a week, to studying the health of two separate populations.  One of these near Siaya, the other close to the Nehemiah International property/farm east of Kisumu.

Dr. Jackton Omoto, chief of staff at Siaya District Hospital, has asked me to speak to medical students and medical officers on various topics of Emergency Medicine.  We are still working through those details, as he initially hoped I would be able to provide 6 hours of lecture per day for 5 consecutive days!  I simply do not have the time to prepare that much material.  Instead I have suggested I would be able to teach over 2-3 days; including several problem based learning cases (an interactive teaching method I have learned as a volunteer at the University of Washington school of medicine the past 6 years).  Additionally I would like to spend a day or two observing emergency care delivery in the Siaya hospital to see if any improvements may be realized - looking at everything from supplies, response to crises, available medications and testing capabilities.

While in that area, Dr. Omoto has asked that our team survey the health of children and adults.  I have been purchasing equipment to perform a basic health assessment on people for this trip.  This will include BMI (body mass index - which gives a very good sense of nutritional status from age 2 to adult via measuring weight/height/age), hypertension screening in all over age 20, visual acuity, and dental hygiene - looking for obvious cavities.  For villages we hope to obtain population, births and deaths in the past 12 months, mosquito net use, sanitation (garbage and human waste) and water sources.

This will also be undertaken in an area around Nehemiah in an effort to begin to understand the health needs of the community and how we can begin to meet them.  More details below.....

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