I have been back to the daily grind of work for about a week now.  Monday, I was welcomed back by a trauma patient with a cervical spine fracture who coded (stopped breathing and heart stopped beating) in the ambulance just as she was about to be transferred.  The oxygen tank that I had asked for was out of oxygen, so I ended up doing mouth-to-mouth resuscitation for the first time in my life.  Thankfully, she came back after a few minutes, we stabilized her, and then we transported her uneventfully.  Unfortunately, she will probably be paralyzed from her waist down permanently, due to her spinal cord injury.    

Running out of oxygen at that crucial moment is just 1 example of the daily challenges that missionary docs face.  The fact that I cannot control everything (surprise surprise) is magnified here, where we don't have easy access to what would be considered the most basic of resources back home.  There are so many factors out of my control - like the pharmacy running out of basic antibiotics for the upmteenth time, the lab not having blood for a critically ill patient, the oxygen tank running out, orders not carried out, etc. etc. etc.  It's certainly more than enough to drive a perfectionist person like myself batty.

I think that through all the challenges and difficulties of working here, the Lord is trying to teach me how to rest, specifically to rest in Him.  "BE STILL and know that I am God." (Psalm 46:10)

I am certainly far from perfect in so many ways, but even if I (and everybody else) did everything perfectly at work -- always made the right diagnosis and formed the perfect treatment plan, always made the right decision, never made a technical error in the operating room -- patients still may or may not do well.  All I can do is give it my best, and leave the burden of responsibility for outcomes in His hands. 

For now, I believe that I am right where I am supposed to be and am very happy to report that there's nowhere else I'd rather be.  God bless.

 

WE MOVED INTO THE NEW THEATRE!!!!  

Well, this actually happened about 2 months ago :)  On August 1, Bill did the first operation for testicular torsion in our new facility.  Words and even pictures cannot fully express how drastic the improvement is, but i'll try to give you a sense with the pics belows.  (See my previous post for a glimpse of the old theatre.)  We cannot say THANK YOU enough to all the SP staff and volunteers who came out to help with this monumental project.  

Moving heavy equipment in between the old theatre on the left and the new on the right:

Digging and doing all kinds of heavy labor to install pipes and big septic tanks:

THE FINISHED PRODUCT!!!!!  Almost...more equipment to come from the U.S. 

TWO new operating rooms....and TWO scrub sinks!!

Reception and 1 of 3 outpatient exam rooms

Minor procedure room, break room, and sterilization area

Operating in the old theatre (Bill and all 3 post-residents in the room at the same time)

and operating in the new (bigger and better instruments! jk)

 

I can't believe how quickly time continues to fly.  I'm nearing the half-way mark of my 2-year commitment, and I'm beginning to think/pray about what comes next after Jan. '13.  I really welcome your prayers in this regard.  Just to give you a quick overview of the past few months:

JUNE 

Said goodbye to Christina (booooooo), our beloved ob/gyn post-resident who returned to the U.S., moved into her house, and prepared for a trip to Taiwan

Christina's last dinner with our Kapsowar crew:

JULY - Attended and spoke at a summer camp for Taiwanese and U.S. medical students (which was a total blast), visited my immediate and extended family (spent a lot of time at the hospital visiting a sick uncle who passed away shortly after I left Taiwan), and caught up on sleep and good Taiwanese food! AND got to meet up with dear friends from NY who were teaching English in Taichung

AUGUST - Welcomed a short-term medical mission team from Cali, welcomed baby Ariella to the Jones' family, then enjoyed a visit from my mentor who came to encourage me and operate with me for a couple weeks (it was so great to have her has a roomie!).  Also started taking call every night, partly because Bill and Laura went back to the U.S.

SEPTEMBER - Attended an SP retreat at a beautiful resort on the coast of Kenya for some much-needed R&R.  Ahhh how i love the ocean and miss being near a body of water.  Received encouragement from my fellow post-residents as well as spiritual renewal.

Fellow post-residents enjoying time on the beach.  Thank you SP!!!

The unfortunate thing about having such long intervals between updates is that it's difficult to know how to start.  Time seems to just keep whizzin' on by, and while life is beginning to settle into somewhat of a routine here, major life changes are going on with dear friends and family back home in the states...best friends anticipating the delivery of their first baby, or watching their first baby make their first moves, marriage, graduation, etc.  Of all the difficulties/challenges of living in a far-away place, this is probably the hardest - not being able to be present.  Love you guys and can't wait to see you all again.

Meanwhile, we continue to press on here in our efforts to deliver quality care in a hospital limited by lack of so many resources that it's difficult to convey.  One day we couldn't operate because there were no sterile gowns (due to xyz and beyond reason).  Lately, there has not been any blood available to transfuse, or if there is blood available, there's some type of government regulations that prevents our lab from giving the blood unless a "true emergency", or even if there's blood available and the lab is allowed to test it, there's no reagent to check hemoglobin.  So today we didn't operate, and a couple patients who needed operations waited a week and ended up not getting their operation or requesting transfer due to the whole blood issue.  And on and on the reasons/excuses go as to why on any given day, we cannot work efficiently.  Forget about the fact that sometimes we're out of running water, or the most basic of sutures, oh, and did I mention that there are maybe 2? 3? portable oxygen saturation monitors for the whole 100+ bed hospital?  

 Most of my days are spent in the 3-4 rooms you will see pictured below.  If you can picture it, the first two rooms function as multi-purpose rooms.  Somehow, we manage to use these 2 rooms to see all of our pre-op/post-op patients, outpatients, trauma patients, and to perform minor procedures and dental extractions.  There's just enough space in between beds to wheel 1 gurney through.  

 

Even the operating room itself is multi-purpose - though intended to be used for 1 surgery at a time, we have often had to employ the side-by-side technique where a pregnant woman needing an emergency c-section is wheeled right in next to whoever the lucky surgical patient is in the middle of his/her procedure.  I think a few of these moms got to see way more human anatomy than they bargained for!!! And if you noticed, yes the scrub sink is right inside the theatre.   Space is a high commodity in our current theatre.  How nice it will be to move into the new theatre (sponsored and built by Samaritan's Purse -THANK YOU FRANKLIN GRAHAM!!!) which will hopefully be ready by this summer or early fall.  

Oh wait, i forgot to mention the multi-purpose chai/sterilizer room where theatre staff routinely takes morning tea, lunch, and also sterilizes instruments for surgery.  You can see the large thermoses (spelling?) for chai along the windowsill.  Kenyan chai, yum :)  The sterilizing machine is on the right.

Funny to think that some of these things which really kind of shocked me in the beginning have just become a part of life.  Well, it still bothers me whenever I see one or a few ants crawling on my "sterile field" during an operation.  I don't know how those buggers survive the hot steam in the sterilizing machine!!!

Well computer battery's almost out and the power's out, so I'll have to bid you all good night.  More to come. :)

Settling into my new home

It's hard to believe that I've been here for a little over a month now!  The big scary leap into the unknown has turned out to be surprisingly smooth and easy overall.  God has continued to show His faithfulness, and I really cannot express how much I appreciate all the support from all of you back home and abroad.  Your prayers, emails, and letters have helped make this transition a pleasant one.  I have been blessed beyond expectation, and I hope you are encouraged as you read on.

My worst nightmare come true

3 1/2 weeks ago, it was unreal to me that my mentor/new partner was up and leaving me because of a family emergency in the U.S.  At this point, I had been in Kapsowar for a little more than a week -- just enough time for me to see and be overwhelmed by how my general surgery training did not prepare me for all the orthopedics that dominates surgical practice here -- and not enough time for me to even finish getting oriented to this new hospital in a foreign country.  Talk about trial by fire.  i felt selfish for being so concerned about how Bill's leave was going to affect me, but it was incredibly daunting.  He and his wife were so supportive and empathetic for me in the midst of a very difficult time for them, and they did everything in their power to make things easier for me.  And of course, what would I have done without Christina and the Jones, my fellow post-residents who share the same vision and passion for the work here?  With Christina's help and encouragement, I did my first operation (general surgery, thankfully!) for a patient with perforated appendicitis.  It was a nasty bugger that had caused an abscess to form in the patient's abdomen, but in the end, we were triumphant and the patient recovered well.  :)  

 

My next big case was for a patient with a raging post-cesarean section infection.  At first, I was concerned that the patient had a deadly aggressive infection (necrotizing fasciitis), but she ended up having an extensive intra-abdominal infection with pus surrounding her uterus.  Christina and I cleaned up her infection and she is also recovering well.  Warning, if you get queasy easily, you may not want to look at these pictures.  The first is of the patient's umbilicus (aka belly-button) showing evidence of dead tissue underneath, the second shows a hole in the patient's fascia, and the third shows the inflammatory tissue (white-looking stuff) on top of her uterus in reaction to the infection.

 

Last but definitely not least, I had a patient come in the middle of the night after his brother shot him in the chest with an arrow.  When I first heard the case over the phone, I thought he would probably just need a chest tube to take care of the air I suspected was leaking out of his lungs.  He turned out to have a large amount of free air in his abdomen on x-ray, signifying injury to an intra-abdominal organ. When we explored his abdomen, we found 2 holes in his colon that were leaking stool.  We were able to repair the holes, and the patient seems to be recovering well, too.  Don't worry, no gross pictures of this case. :)

It wasn't so bad after all :)

Bill and Laura returned home safely last week, and I'm so glad to have them back.  At the same time, I can now say that it was good for me to be challenged and stretched during the time that they were away.  I would never have chosen such circumstances, but now I'm almost glad that things worked out the way that they did.  I survived!  and so did my patients!!  God's grace in action.

And on a lighter note, things I do here that I wouldn't have done in the U.S.

- Inspect my room for spiders and other creepy-crawlies before I go to bed.  Most nights, i end up killing at least one something or other, and a couple of them have had the added pleasantry of splattering bug juice...yech.

- Remember to turn on the water heater about an hour before I take a shower

- Turn my refrigerator to the coldest setting so that if the power goes out, my food will hopefully last longer

- Wash and re-use ziplock baggies

 

- Buy fresh mangoes for 5-7 schillings each (1 U.S. dollars = 77 Kenyan schillings).  Dirt cheap!

- Have house help who do my cooking, cleaning, and laundry.  Yes, you can call me spoiled!  But honestly, with all the work at the hospital and without modern conveniences like a washer/dryer, I would not have been eating or taking care of myself.  Additionally, it is a good source of income for the Kenyans, even though "good" is a relative term given that my house helpers make the equivalent of $2-3 a day.  

FINALLY i'm getting around to this, and I can't believe i've been in Kenya for 3 weeks now!  Some pics and thoughts from the beginning. (Mad props to Ne for setting this blog up for me!)

As many of you know, the last few weeks and days leading up to my departure were hectic and emotional.  This consuming goal that I had struggled to pursue for so many years was finally about to become reality, but I found myself needing to live off of others' excitement as I began to long more and more for the stability and comfort of the familiar.  Any spirit of adventure I may have had seemed to disappear.  And I just wanted the "normal" life that my close friends were living - being married, starting families, etc.

But i did make it, despite all the cold feet, last-minute business, and packing headaches.  (seriously, how did Delta expect me to pack up my life for the next 2 years into 3 fifty-pound bags?)  By the time I boarded the plane, my biggest relief was not having to worry anymore about how to downsize and mash everything into as little space and weight as possible.

My parents, bro, and dearest girlfriends saw me off with tears, hugs, and prayer.

My flight itinerary took me from Canton --> Atlanta --> Amsterdam --> Nairobi.  I left Canton at 1:16 pm on Tuesday and arrived in Nairobi around 9 pm Wednesday evening.  Total travel time was about 24 hours.  Thursday was a huge shopping trip with my new friend Christina (another post-resident stationed at Kapsowar), and Friday was the 6-7 hour drive from Nairobi to Kapsowar.  I was welcomed to Kapsowar by a power outage and lack of running water :) but i truly felt warmly welcomed by the missionary community.  Kyle is another post-resident here for 2 years.  He has a family including 3 way-too-cute boys, and I enjoyed dinner by candlelight with his family and Christina my first night in Kapsowar.  

Staying at the Mennonite guesthouse in Nairobi

On the road to Kapsowar, notice anything different?

One more shopping stop in the nearest city Eldoret (about a 2 hour drive from Kapsowar, at least 1 hour of which is over bumpy, unpaved road)

Driving through the "forest" where monkeys can be seen at dusk and dawn, and...

ARRIVING AT KAPSOWAR!!!

 

 

This is my first post! 
Missing my peeps back home.