Mothers' Union

Many of you know how important the Mothers' Union is to the welfare of the children in the 38 parishes in the Diocese of Maseno North. Nan Hardison has helped the neighbor ladies assume responsibility for the orphans in their communities. Their programs teach and feed about 500 kids per site per Saturday. The food, crunchy hot corn and beans, or githeri, has traditionally been supplied through outright grants from individual churches in the U.S. It costs about $4000/year per site. The mobile medical clinics that Dr. Hardison and the hospital staff provide cost an additional $5000/year per site to provide. Because of limited resources, only sixteen feeding programs and five medical clinics currently exist. Bishop Oketch and the Mothers' Union have suggested micro-lending as an alternative means of funding, in an effort to resolve the inequities and ultimately make the feeding programs available to all 38 parishes in the diocese.

I accompanied Nan this morning to the weekly Mothers' Union meeting, where she helped seven more parishes complete their applications for micro-loans ranging from 20,000 KSh ($250) to 50,000 KSh ($625). One program has already been funded, and Nan expects that an additional eight parishes, totaling sixteen, will be in process by the end of November. That's almost half of the parishes in Maseno North, so the caregivers were quite excited. Several business projects are planned, including farming of grains (using the labor of the women and older children, not hired help), sales of "paraffin"/kerosene for cooking within the community (short-cutting the long walk to the paraffin businesses located many kilometers away along the highway), and sewing (purchasing more fabric for parishes with machines).

Nan also announced that donors were sending money to provide rice, instead of corn, to go with the beans for the orphan program at Christmas time -- a real treat for the kids! Much hand-clapping, hymn-singing, "Bwana Asifiwe's" ("Praise God's") and "Ai-yi-yeee's" ensued. As always, Nan encouraged them, "You go, Girls!"

Diwali and Other Celebrations

Luminaria line the streets of nearby Kisumu, marking the five-day "Festival of Lights," or Hindu New Year. Kenya is a multi-ethnic country; although the Hindu population is a minority, it is well-represented in the business community here. Rich traditions reflect Kenya's 42 tribes, and a fragile peace has returned to this beautiful land.

Although controversy reigns around implementation of the Waki Report and corruption scandals are reported regularly in the local press, all headlines now focus on the upcoming U.S. presidential race. I asked a matatu driver in Nairobi last week, "Will it invite more conflict between Luos and Kikuyus if Barack Obama wins?" His answer was swift and incisive: "Obama is an American." But here in Western Province, the local populace is reading the news as avidly as the expats.

While the world awaits the outcome of the elections, my grandchildren are getting excited about Hallowe'en at home, and I am grateful to receive the Eucharist at St. Philip's. It is a lovely early-morning walk across the equator to chapel services.

Time to Feed the Chickens

That is Dr. Hardison's euphemism for "Let's break for lunch." But our days are full, and yesterday there was time to feed only the patients. Gerry diagnosed and treated everything from aplastic anemia in a pregnant mama to Potts' disease, r/t HIV, in one 25-year-old male and CIDP (chronic inflammatory demyelinating polyneuropathy) in another. Samuel has died, and Eunice is barely alive, but Rose has miraculously recovered from cryptococcal meningitis. Our Medical Officer admitted a Maseno School student with a fever and a large mass on his neck. Silus also treated a mama, who was compulsively eating dirt, for geophagia/pica and removed a cockroach from a toddler's ear. We were interrupted during afternoon rounds by a fracas outside Ward I when roaming chickens took exception to marauding monkeys. The vervets were considering lunch, themselves: baby chicks (kukus) are apparently quite a delicacy.

Borrowed by the Baptists

A funny thing happened on the way to the ACK (Anglican) services this morning... A patient's relative, the wife of the pastor of the local Maseno Bible Church, appeared at the hospital gate to recruit Doug for a church service near the Busia Road. "May we borrow you, too?" she asked, so Sue and I joined them, walking through lush green fields of corn and passing a couple of inebriated university students en route. We soon found ourselves singing "Stand up, Stand up for Jesus" and listening to a lay leader's passionate message, generously interspersed with Bible references, about hope -- our theme for the week, the month and the years to come.

Yesterday another young child was admitted, feverish, convulsing and unconscious, to the hospital. His mama had no money so she had waited almost too long to bring him in. After IV quinine and copious fluids, little Ibrahim is responding to malaria treatment, TG. Eunice and Samuel, however, with more complicated conditions, are still teetering on the brink of death, and we are running out of treatment options. But we still have hope.

Meanwhile, two Swiss journalists brought their driver, in distress, to the Outpatient Department. Suffering acute abdominal pain, the patient was treated and referred for possible surgery. He was not well enough to transport the reporters to their intended destination: the home of Barack Obama's grandmother, 15 km down the highway. The poor woman was spared these two, but she must feel as besieged by the legions of international journalists camped out in Siaya as she is proud of her grandson campaigning in America.

Hope springs eternal on many fronts. Amen.

Best-Laid Plans

Reality check #9999: We tried to order the oxygenator this morning, only to discover that the local catalog price has almost doubled (to $1,500) with Kenya's rampant inflation. Since there is no reliable way for medical equipment to be securely shipped from elsewhere and retrieved at Customs, we have ordered two suction machines from the catalog, instead. It is of some comfort to know that Dr. Hardison says the need for suction equipment is even greater than the need for oxygen equipment. Again, the list and the prayers go on...

Near the top of my own wish list for Maseno Hospital is an incubator. Although the infant mortality rate in sub-Saharan Africa is extraordinarily high, the incubator we have is pitiful. A new one would cost the equivalent of $7,000. But how many more babies must die unnecessarily?

Triage Redux

It's "deja vu all over again!" Last year I wrote from Maseno about the oxygen problem here. It's not about altitude; it's about allocation of resources. We had a desperately ill child who needed oxygenation, but that meant removing the only equipment we had in the hospital from a mama who also needed it. Triage, Kenya style... Thankfully, both patients survived.

This week Eunice, with probable PCP pneumonia, TB and an 02 sat of 84% on room air, has been dependent upon oxygen for her slow road to seemingly miraculous recovery. Carol, however, with widespread consolidation in her lungs and a similar saturation level (normal is high 90's), also needs help breathing. We moved a large, unwieldy tank over from the surgical suite three days ago, but it ran out of oxygen yesterday. Dr. Hardison said it may be weeks before it will be refilled. Meanwhile, Samuel presented in acute respiratory distress. His O2 sat was a startling 67% (which we hope might also be r/t impaired circulation and finger-clubbing), so last evening we moved the equipment from Eunice's bedside to Samuel's. Then we had to wait for the electrical power to come back on in Western Province.

All three patients survived the night, TG, and today we are going to order three xray view boxes, two new suction machines and an oxygenator from Nairobi, thanks to the generosity of the Rotary Club of Martha's Vineyard and St. Barnabas Episcopal Church in Falmouth, MA. Thank you/asante sana, Everyone!

"Half a Hospital"

It is sometimes frustrating to practice medicine in a developing country because the resources are so limited. "Routine" chem screens are not routine and are, in fact, very difficult (and very expensive) to come by. Third and fourth generation antibiotics do not exist. Without a surgeon, we cannot do more than the most basic procedures in Maseno. Dr. Hardison shakes his head and mutters, "We'll never be more than half a hospital."

But half a hospital is better than none if you are Eunice or Otima or Daniel or Fillister or Margaret. To our great, albeit guarded, joy, Eunice is still alive, apparently responding to the aggressive, if limited, treatments that Dr. Hardison prescribed. Her fever is subsiding and her respirations are easing. She is still gravely ill, but we pray with her Mama that she will continue to improve. Otima's broken bone has been set, and Ibuprofen has been dispensed. She will be discharged in time to go to her granddaughter's funeral today. Daniel was seen in the Outpatient Department this morning and referred immediately to Kisumu for surgery. Had he waited any longer or gone somewhere else, a delayed diagnosis of his inguinal hernia might have created the necessity for major surgery/bowel resection.

Fillister, accompanied by her three-year-old daughter, Doracilla, was admitted with the classic symptoms of TB. Severely scarred and disfigured by burns from a stove explosion two years ago, she was then abandoned by her HIV-positive husband. Fillister may well be positive, herself. In addition to testing and treatment for probable TB, she needs to be tested for HIV, and so does her little girl. HIV infection, resulting in a depressed immune system, is of course the primary reason people contract the countless opportunistic infections we see here. (Later NB: Fillister is HIV-negative; hurrah!)

Margaret was admitted after being run over by a piki-piki (motorized boda-boda). We tended her injuries, did a chest xray because she complained of a one-year history of coughing, and discovered that she, too, has TB. Margaret was then tested for HIV and was found to be positive. She will recover from her injuries and will be referred, with her husband, for VCT (Voluntary Counseling and Testing).

Both of these women should be able to live long and productive lives, thanks to anti-TB treatment and free anti-retroviral medications. But Margaret's marriage, also, may well dissolve through no fault of her own. The rate of HIV infection in females in Africa is much greater than that for males. Polygamy is legal in Kenya. For men. If a male is infected... well, we can all figure the odds for infection, as well as for abandonment.

As afternoon rounds are about to begin at our "half-hospital," though, I remember that even in America, the other half of getting well is always hope.

PS

Thank you all for your responses and your prayers. The mud hut tragedy is just the tip of the iceberg/mountainside, of course, but it is no worse here than in Haiti or Sudan or anywhere else in the world. Perhaps the real tragedy is that things like this happen every day, multiplied ad infinitum, and that we get complacent enough to forget them or else distressed enough to "shut down." One of my assigned tasks in Maseno is to help bring order-out-of-chaos to the medical supplies. We need ready access to oxygen tubing and nebulizers to keep people alive. One of my unspoken responsibilities, though, is to help tell the stories. We need ready reminders of one another's needs to keep human hope alive. Please don't forget that every one of us really can do "something" -- from prayer to participation. And every one of you is participating -- by reading and by caring. Asante sana and God bless us, every one.

Karibu Maseno!

It was wonderful to be "welcomed back" by the people of Maseno. Emmah had prepared a lovely room for me, replete with bookshelves for a year's supply of bug dope, vitamins and Kindle books -- TY, All! I am at home at Rotary House and happy to have the company of Sue, a premed student from Massachusetts, and Doug, a young doctor from San Diego. Drs. Nan and Gerry Hardison are fine and send their best to everyone, as do I. We celebrated their "birthday month" with visitors from Rome over a delicious dinner at St. Philip's on Sunday evening.

Yesterday's three-hour humdinger of a storm will guarantee that we'll have no electrical power in Maseno for awhile, so I'm working off the laptop's battery and typing (vs. dancing) as fast as I can, hoping to save and post this entry whenever we have "air time" again. We cannot complain; a drought and water rationing in Nairobi put our own mere power outages in perspective. We even had a 13" TV in the living room until it fried last night. It was quite a luxury -- although the local (Kiswahili) channel seemed to provide the only reliable reception. We could sometimes find Al Jazeera, however, and could occasionally even get BBC. Perhaps needless to say, every station in Maseno reports regularly on US politics. It will be interesting to be here on election day!

Meanwhile, we are celebrating the fresh morning air and sunshine, enjoying Emma's oatmeal, and readying for morning rounds at Maseno Hospital. The census was down when I arrived Sunday morning, but we had five new admissions before the day was out. Monday was Kenyatta Day, a national holiday; however, as always, there is no respite from illness and poverty in rural Kenya. In the Outpatient Department, a young mama presented with bilateral lactorrhea. She stopped nursing her youngest child two years ago, but lactation spontaneously recurred shortly thereafter. Two weeks ago, it stopped; her breasts are swollen and painful but not abscessed. She is being evaluated for a possible tumor of the pituitary gland and will return Friday.

On Ward I, we saw Washington, who came in too late for treatment for testicular torsion; he will be referred for an orchiectomy since we have no anesthetist here at present. John presented with severe headaches and has been referred to the CCC for VCT (voluntary counseling and testing for HIV) after Dr. Hardison ruled out cryptococcal meningitis. Another patient came in with gastric distress after attempting suicide; he had swallowed a liter of Formalin following an argument with his employer.

On Ward II, three-week old Abigail was admitted with possible malaria and has now spiked a temperature. Eunice, who had a stillborn baby two weeks ago, was transferred from Ward III/Maternity with recently-diagnosed HIV, probable TB and and a possible pulmonary embolism. She is 28 years old, in acute respiratory distress, and will probably not survive the day. Evelyne is recovering well after treatment for a Bartholins cyst. Two young HIV+ women are suffering acute pain with herpes zoster (shingles) -- one, involving the classic T-9/T-10 dermatomes, presented with one-sided pain and coalescing pustules around her right side; the other, with T-3 and C-8 involvement, has granulating tissue in a wide swath across her chest and back. She was misdiagnosed three weeks ago at another hospital as suffering from "spider bites." It is probably too late for antivirals to help either patient; we are limited to treating their symptoms -- codeine for pain, since there are no morphine drips and no Fentanyl patches here -- and encouraging both women to continue their ARV's. The majority of our patients are HIV-positive, with the accompanying immune suppression that invites a variety of complications.

Margaret, 43, however, is HIV-negative; she has nine children and will, sadly, be transferred to a hospital in Busia, her home town, for potential amputation. Her gaping "septic foot wound" -- which we had almost hoped was "just" gangrenous -- turned out to be malignant melanoma, and her lymph nodes are enlarged. Helen, 17, is suffering from unilateral swelling; she has been diagnosed with microphilia (elephantiasis) and will be treated with steroids. Kezia, a blind and deaf 81-year-old woman, came in with a fractured femur and will be transferred for surgery; she is fortunate to have a family that can afford it. And Otisa was admitted last night: after yesterday's heavy rains, the corrugated iron roof of her mud house had collapsed on her, broken her ankle and killed her one-year-old grandchild.

The list goes on... as do the prayers. Asante sana, dear friends.

The Lord God Made Us All

It's spent an inspiring few days in Nairobi. I've met with amazing Jane Muriuki of the Tabitha Project (please do find her story online), kissed giraffes (yes, there's a picture), admired women at work at Kazuri Beads, viewed cheetahs and zebras and warthogs (but no lions or tigers or bears) in the Nairobi Game Park, practiced my pitiful Kiswhahili and shared a meal with Rose and Ndungu Ikenye, our remarkable TEC volunteers in Thika... It's also been a frustrating few days, way too many hours during which I've done battle with my laptop and lost. In the process, however, I've met countless kind and helpful folks, from driver Jonhes Mulusya to the staffs at the ACK Guest House and the Safaricom Customer Care Center. Thank you all for your own wonderful messages and prayers. I'll be on the early-morning flight to Maseno tomorrow, hoping to be of some use at the hospital by Monday -- which is actually Jomo Kenyatta Day, a very special holiday here in Kenya. Lala salama (Sleep safe), everyone.

Safe (Almost-) Home

After a lovely Logan send-off (TY, Lori, Dianne, Helen and Barbara!), I enjoyed perfect connections and flights (TY, British Airways), great accommodations in Nairobi (TY, ACK Guest House), and no swollen legs this time (TY, Beth)... God is good; yes, all the time!

It was a gift to meet John and Ann from "Other Sheep" this morning, and I look forward to seeing the Ikenyes, TEC missioners in Thika, and Jane Muriuki, from the Tabitha Orphans Project, later today. I also look forward to meeting baby elephants, giraffes and a few more of the "big five" tomorrow (TY, Ann!). I'll fly to Kisumu early Sunday, then go to Maseno, at last!

Last Sunday in church in the US, we read the 23rd psalm together. Today under my mosquito net in Nairobi, I re-member "Thy rod and thy staff, they comfort me." And I know that "Your prayers and your love, they sustain me." Asante sana/thank you all!

The First Day of the Rest of Our Lives

Yes, every day is the first day. This, the first day of October, 2008, also marks the first week in 50 years that I have been officially unemployed. (In the "olden days," twelve-year old babysitters were paid 25 cents an hour for taking care of five kids, BTW.)

In the midst of packing and preparation for work in Kenya, I am also praying the words below. Often attributed to "Monsenor" (as the Archbishop preferred to be called) Oscar Romero, they were actually written by The Rev. Ken Untener:

"It helps, now and then, to step back and take a long view. The kingdom is not only beyond our efforts, it is even beyond our vision. We accomplish in our lifetime only a tiny fraction of the magnificent enterprise that is God's work. Nothing we do is complete, which is a way of saying that the kingdom always lies beyond us...

This is what we are about. We plant the seeds that one day will grow. We water seeds already planted, knowing that they hold future promise. We lay foundations that will need further development. We provide yeast that produces far beyond our capabilities.

We cannot do everything, and there is a sense of liberation in realizing that. This enables us to do something, and to do it very well. It may be incomplete, but it is a beginning, a step along the way, an opportunity for the Lord's grace to enter and do the rest. We may never see the end results, but that is the difference between the master builder and the worker.

We are workers, not master builders; ministers, not messiahs. We are prophets of a future not our own. Amen."