Change of Plans....

So, it appears that I’ll be ending my “African Adventure” a little early this time around…..The upcoming Referendum, which is basically a vote to implement a new Kenyan Constitution, is creating some concern about a possible repeat of the 2008 election which ended in civil unrest for several months. The “Yes” Camp, which includes the government and most of the media support here in Kenya are neck and neck with the “No” Camp, which includes the conservative majority. For the last couple of weeks you can spot supporters of either camp by the hat they are wearing. Red hats are “No” voters, while Green hats are voting “Yes”. It seems to be a very close race, which as everyone knows means the Losing party will be that much more upset. Fortunately, the majority of people are presuming that Tenwek will not be affected following the vote and that there is a really small chance of a recurrence of the 2008 violence. However, following that 08’ election, some people were apparently stuck in Kenya for several months before the violence calmed down enough to get home. Thus, since I would only be here another week following the vote, I (with Rachel’s FULL support) decided to move my flight up a couple of days to get out of Nairobi before the vote. So, long story short, I’ll be coming home in a week!
It is bittersweet because I miss everyone at home but also am enjoying Tenewk so much. Livingston, which is the GuestHouse Manager who was here for both of our trips in the 90’s, made Hon’s Eggless “Wacky Cake” for everyone the other night. I had a piece and it was pretty good. Unfortunately though, I still like his "salty chips" better (sorry Ray). Oh, and the guys of the guesthouse made a pack last week to not shave until we leave; so the GuestHouse is full of a bunch of scraggly looking guys….unfortunately, my “beard” leaves much to be desired. I’m sure I’ll shave it before anyone in the States gets to see it (Don’t let Daddy worry). My friend and next door roommate, Robbie, left this morning. He is 4th year med student at Emory and I was very sad to see him go. We were both on the Medicine Ward together and he always had a nice pot of coffee to share every morning before we left for rounds. I guess I’ll have to figure out the right Kenyan Coffee proportions for the remainder of my trip. Robbie, if you're reading this; don't worry, I wasn't JUST your friend because you made good coffee, you also shared your English Muffins too....just kidding. I am currently fighting a brutal cold that has my eyes and nose watering all day; everytime I pull my stethoscope out of my pocket about 10 used tissues fall out…..really gross. But, that is what I get for playing with every cute Kenyan kid that I pass in the hospital. I just can’t help but pick each one up and toss them into the air. I’m sure all of their parents think I’m crazy, but the children love it. Sometimes when I’m really busy, I have to go around the other side of the Chapel so I don’t pass the Pediatric ward and have 15 little kids running (and wheeling) out to me to play. Their smiles are so fun though and it makes me smile to see them so happy despite most of their terrible conditions.
As far as the medical stuff goes, I’m still learning a lot. I’ve now done about 5-6 lumbar punctures; enough so that I can keep a steady hand when I’m entering the spinal space. The interns here are so good at doing LP's (b/c of all of the bacterial meningitis) that they could probably do it blind. Thus, they are more than happy to let me try whenever one needs to be done. I’ve also got to practice a lot of Arterial Blood Gases (ABG’s). I started off pretty good at those, but I’ve missed my last couple and needed Doug to help me out. Everyone is really patient here and lets me try as much as I want to. Today I had to give up on one ABG after trying twice on this “hysterical” patient. Although she was sick, she was pretty funny. She was singing and kept trying to hug me and dance while I was trying to stick her radial artery. We think she has some kind of encephalopathy (Hypertensive or Uremic). I just kept saying “Asanti”, which means Thank-you and she would calm down long enough for me to try again. But finally I gave up since she was constantly dancing and I wasn’t getting anywhere. Unlike the first half of my trip, this last week has seen a bunch more lives being saved than lost. It always is nice to be able to help someone who comes in so sick just by finding the right medicine that will do it for them. They are so thankful and appreciative even though all we did was provide them with a medication that is completely free at all Wal-Marts across the U.S. Anyway, before I get sucked into talking about all the medical stuff I'll stop b/c I only got a few hours of sleep last night sicne I was on call so I think I’ll wrap this blog up and take to my bed. I can’t wait to see everyone soon, I should be getting home on a Tuesday night. See yall soon.

Call nights in Africa

Sorry its been a while since my last “blog” but I’ve been trying to stay as busy as possible to keep from missing Ray and everyone else at home. But, don’t worry, I have plenty of friends here that are really nice. Dolly and her husband Vince even found the British Open on the satellite TV so I could watch Tiger after they heard I was sad I was missing it! Dolly even made a huge thing of popcorn for everyone. (The TV is a projection screen that is set up in the basement floor of the new addition on the guesthouse. It usually is used for movies only, but they bought a two month TV deal so that everyone could watch the World Cup). Hon, you will appreciate this……I wasn’t sure if I mentioned it last time, but a new couple came in last week and the husband will be the Resident with me for the next month. His name is Doug Johnson, and he is a resident in Internal Medicine at Duke. His wife, Sarah, is with him and is a physical therapist. Its interesting b/c he went to Med School at UAB and his parents live down the street from us in Bluff Park! His Dad is a Pulmonologist at UAB. He also is good friends with Tim Heacock from our yearly NC beach trip. Its crazy to go all the way across the world and be working with someone who lives less than 5 minutes from where I grew up (and now live) in Bluff Park. Anyway, since my last blog, I have taken call a few more times and had several new patients admitted to me on the ward. On Friday, my call started with a comatose 31-week pregnant patient who came in after apparent seizure activity. Since she was not HTN, didn’t have protein in her urine, and had normal platelets and Liver Function Tests, the OB team didn’t believe she had Eclampsia or HELLP syndrome and so they admitted her to us?? By the time I got there they were already admitting her to the ICU b/c her pupils were blows. According to the OB team, first priority was the mother b/c nobody knew how long she had been seizing and the baby’s prognosis was already extremely poor. Anyway, right when she arrived in the ICU she stopped breathing! The worst part was, that she stopped breathing right in front of me and none of my upper levels had arrived yet. Luckily there were two nurses there to help me, as I started chest compressions and they began to bag her. A few minutes later the Kenyan intern, Damaris, came in and we intubated the patient and got ready for the defibrillator. She initially regained her pulse and was stable for about 30 minutes until crashing again. This time the CPR code lasted for about 45 minutes (I was completely soaked with sweat by the end of the code from doing chest compressions…..and Rachel knows that I don’t sweat that much normally!) before my Attending said that we had done all we could do…..she and her baby had passed. It’s very hard not to get discouraged and frustrated having these kinds of results so often here, and I’m quickly learning how fortunate we are in the States to have the kind of care we have. In Kenya, most patients do not seek any kind of medical care until the last unbearable moment. In this patient’s case, she didn’t seek care until her family found her comatose and her baby had most probably already passed. But I guess, if we had to walk 3 hours on dirt roads to receive medical care, similar results would occur in the U.S.. Another sad tradition in Kenya is to never bury a deceased baby and mom together. Thus, the morgue had to remove the baby so the two could be buried next to each other. I’m just glad I didn’t have to be there for that part…too sad. But fortunately, even though I have experienced a lot of deaths, there are far more stories where patient’s have been saved and sent home! On Monday, I had a previously healthy 25 year old guy come in who was fine the week before but during a hospitalization at another hospital he developed seizures, tremors, confusion, multiple lower extremity joint pain, and ascending weakness. They didn’t know what to do, so they sent him to Tenwek. Even though his wife said he was walking normally last week, by the time I was examining him he was paralyzed from his toes to his hips. He also had a severe intentional tremor and was so confused all he could stutter was, “I think I should be fine soon.” With no past medical records (or any records at all) a lot of the time we have to treat empirically w/o having the exact diagnosis. In this patients case, his differential consisted of Guillan-Barre (classic for ascending weakness), Transverse Myelitis (usually seen in MS and needs MRI to dx), Lupus (need ANA or anti-smith antibody titers to dx, which we don’t have), Lyme disease, TB meningitis, cerebral malaria, polio, typhoid fever, and bacterial meningitis. Since diagnostic and treatment resources are limited, we had to really have faith that the treatment we choose is most likely to cover the disease at hand. The first thing we started him on was IV steroids to hopefully stop any autoimmune/inflammatory/infectious process causing his weakness. Then we began daily IV ceftriaxone (to cover deadly meningitis), RHZE (TB treatment), and a dose of quinine. He was so nice and scared, which made me want to help him so much more. Luckily, two days later I finally got him to move his big toe!! Then later that day he was using his Plantar Flexor muscles (like stepping on the accelerator). Yesterday, he was able to pick both legs off of his bed! With his LE strength improvements, also came improvements in his tremor and confusion. Today he stood up for the first time in 2 weeks and was speaking almost back to normal. The exact diagnosis is unknown, but I believe the most likely dx was Transverse myelitis, which can be caused by a host of viruses.
Another success story included a woman who came in the other day after being gored by a cow’s horn! It was a very serious puncture and so she was rushed to surgery. A fellow resident in the Guesthouse, Vince from NY, was the Surgeon on call who opened her up and reported that the cow’s horn had punctured her intestines in an “accordion-like” distribution, producing 5 holes in need of closure. During the procedure, Vince pulled out a tapeworm that was over 50 feet long! Talk about an incidental finding!
Other than that I’ve had a few more interesting cases, which include an extremely nice 50 year old male with osteomylitis, a 20 year old boy with (what we think is..) Osler-Weber Rendu disease (a rare Autosomal dominant disease where some of your blood vessels don’t form correctly and you have recurrent nose bleeds, AVMs, and other bleeds). This kid had a hemoglobin of 3.0 (normal is >13.5) and was walking around w/o complaining. In U.S. we freak out if Hgb is <7. I also had a case of Infective Endocarditis, which is an infection that spreads to the valves of the heart, and requires 4-6 weeks of antibiotics to cure (the patient even had the classic splinter hemorrhages of his fingernails). Another patient had a spontaneous pneumothorax that we believe was caused by TB. His CXR and physical exam were crazy. The collapsed lung had pulled his entire mediastinum (which contains the heart) over to the right side of his chest. Thus, to listen to his heart, you have to place the stethoscope over the right chest. Very cool! My last patient was a 70 year old man who presented with several weeks of “severe sickness” and anuria (no urine output). On lab check, his Creatinine was elevated to over 35 (normal is 1.0). Again, in US we freak if it is over 5. It turns out he had such a large prostate he couldn’t pass any urine and so he got bilateral hydronephrosis and damage to both kidneys. We finally got a catheter through the obstruction and drained a ton of urine. He immediately looked at us like we had just cured cancer and hopped out of bed feeling like a new man! He was so thankful, but he didn’t realize that all we did was catheterize him and drain his urine. We sent him home later with some BPH meds.
Saturday afternoon was nice because most of the young people (including myself) were off and we had a chance to hang out. We played a lot of ping pong and a new game called Walley-Ball, which is volleyball played inside a racket-ball court. It was a lot of fun. Then we watched the british open, and I crashed around 9:30 since I only got 3-4 hours of sleep the night before (call=night). I went to Church this morning and got home and had 9 missed calls from Rachel! I was so worried. I finally got through and discovered that our House Alarm had gone off around 4:15 in the AM while she was asleep. She called my house and my Dad ran over to check everything out and convinced her it was safe to leave the room. Probably a false alarm….but of course something like that happens while I’m over here in Africa. Anyway, I’m glad she’s o.k. Well, my computer is about to die so I will end this ever-long “Blog”. Hon, I hope your happy because I just realized this dad-gum blog is like 2.5 pages! Well, I miss everyone and look forward to seeing you soon. Anna, tell Janie-Bird I said hello.

Missing Rachel

Well, I finally figured out how to access the blog without Rachel's help. As most of you know by now, Rachel made it safely back home to Bluff Park leaving me all alone here in Kenya. After dropping her off at the airport, I thought I was doing pretty good until I got back to our cozy little room and saw her empty little backpack sitting on her side of the bed. I can't believe its already been two weeks. It seems like it was just yesterday that Mr. and Mrs. Vinson were knocking on our back door in Bluff Park to drive us to the airport. I am SO glad we got Rachel home safely, and without even getting sick once (that is much more of an accomplishment than you realize). Anyway, to get my mind off Ray's departure I decided to take her advice and be extra social around the Guesthouse. So the day after she left me and 5 other young med students made the 4 hour round-trip hike to the top of the mountain surrounding Tenwek. The views from the top were beautiful. Although most of the others probably didn't think so, the most fun part was that about half of the way up the clouds rolled in and completely drenched us! We had absolutely no where to take cover and so we finally gave up and continued up in our soaked clothes. That night the two long term missionaries that stay at the Guesthouse threw a World Cup Final party and cooked cupckakes and brownies for everyone (and popcorn for me). It was a good game but was hard to stay up for since it didn't end until midnight over here. The next day was a busy day in the Hospital because I was on call. My cryptococcal meningitis patient finally received his last dose of Amphotericin B. This was an accomplishment b/c half way through his treatment the entire region ran out of AMpho B and it took an entire week for the replacement to get shipped in. Lunch was awesome at the Stanfields house; we had Chicken Pot Pie, Homemade biscuits, and green beans (don't worry Hon and Ray, it didn't have eggs)! After lunch things got pretty busy. Our Tetanus patient (who has severe case of "Lock Jaw) started seizing and gasping for breaths. The resident and I were the first ones there, so I got to "schock" him, while Doug administered CPR. Unfortunately, the patient needed immediate intubation because his Tetanus had caused him to have Larnyngeal spasms, but this was impossible because his Jaw muscle was "locked" up. Its impossible to get his mouth open far enough to even get a straw through. We were about to perform an emergency tracheostomy when his pulse finally disappeared and after 10 minutes of coding him, he passed away. It was really sad, he was only 26 years old. Apparently mortality from Tetanus is fairly common around here and we were told that the Massai's will intentionally knock out their front teeth so that they can be fed through a straw in case they develop "lock jaw" like our patient. Its so funny how the Kenyans tell these stories so "matter of factly" like its no big deal to knock out your front teeth to have insurance against future "lock jaw". By the time we were pronouning this patient, we were frantically rushed up one floor to a patient with TB and alcoholic DTs who was also seizing and not breathing. We ran up there and I bagged him while others did Chest compressions. We finally got him intubated (no "lock jaw" thankfully) and I continued pumping air into his lungs while we administered other drugs to try and get his Oxygen saturation up. But of course this is Africa so something has to go wrong. Whenever we tried to swap the patient to the ventilator his O2 sats dropped into the deadly low zone. Long story short the 3 ventilators in the whole ICU were malfunctioning at the same time, so we had to move the entire ICU down to two floors to the surgery recovery room to keep our patient (and three others) alive. As were were leaving the ICU, I hung a piece of paper on the door saying, "ICU moved down to Surgery Recovery Room". Very official of course. The rest of the night went slightly better, and I am currently trying to figure out a case of ascending paralysis (thats not Guillan-Barre). Unfortunately, diagnosing diseases in Kenya is so much harder b/c we don't have 10% of the available tests we have in the U.S. Well, I just wanted to see if I could post a blog and didn't realize how long it was getting. Sorry for anyone who reads this and gets bored by the medical stuff (Alex and Susan probablty quit reading after the first 3 sentences). Thanks to everyone for your prayers and hopefully I'll have some pictures to add soon (I'll have to ask Rachel how to do that). How do you end these things anyway??

Final Days at Tenwek

I guess I haven't written since Monday. Monday seems like ages ago, and yet, I feel like this week has flown by. I have one more full day here at Tenwek and I think that I feel a bit numb. I don't want to think about leaving this place, the people, and especially Wiley. The past few days I have sort of been in a routine here at Tenwek. Each morning I wake up and make coffee and then everyone in the guesthouse eats breakfast together, which usually consists of cereal or toasted banana bread. My midmorning has consisted of different activities. On Tuesday, I had chai at Mrs. Manchester's house. She is one of the long term missionaries and she has tea every week for the wives/family of doctors that have come to Tenwek. I knew most of the women that were living in the guesthouse, but it was a great way to meet some of the long term missionary wives that are not in the medical field. We talked about the hospital and how long she has been in Africa. We talked a little bit about the new constitution that is about to be voted on. That seems to be a hot topic here right now. I think the vote for the consitution will be on August 4th. Hopefully it will be peaceful. I think the main sources of conflict are over the topics of abortion, land rights and recognizing the muslim courts. I am not educated enough on the subject to even summarize the issue, but there are several good articles that come up if you google the subject. Anyway, another morning I went on a walk around Tenwek with Carolyn. We did several loops around the hospital grounds. It was the perfect weather for a walk. I got a little winded walking up some of the hills. I kept telling myself that it was the altitude, but that might have been wishful thinking. Another morning I had chai with the house help. I found out that it is rude to decline an offer to have chai (of course, I discovered this after I had already declined it once before), so I have had a lot of chai while i have been here. Around 11am each day Taylor and I would go to the nursery. We were able to be of more help this week since there were 30 babies born over the weekend. I was able to hold several babies that were crying in an attempt to calm them down. While the babies were so cute and I enjoyed this task, I learned early on that wearing old clothes is a must. None of the babies had diapers on, so the first time I held a baby it used the bathroom on me! I guess i shouldn't complain though. Taylor's baby did more than use the bathroom on her, so I felt like I got out of there pretty lucky! All kidding aside, the nursery was definitely one of the highlights of my week. I really enjoyed meeting all of the nurses up there. I felt like I wasn't much help, but they were so welcoming and appreciative of what we did.
Each day at 1pm Wiley and I would eat lunch together along with the other people staying in the guesthouse. One day we ate in the canteen at the hospital, another time we ate at the guesthouse and then two days we were able to eat lunch at some of the full time missionary and staff houses. I really enjoyed those lunches because we were able to get a better perspective of what it is like to be in missions full time and to learn more about the hospital. One of the families that we ate with have been here for 8 months and will be at Tenwek for 2 years. They are planning to open up a teaching hospital with two other families at Tenwek somewhere else in Africa after their two years here.
In the afternoons on Tues, Wed, and Thursday I was able to go to a nearby orphanage with several other girls at Tenwek. The orphanage was called Umojo Children's Home and houses about 40 children of all ages. The time that I was able to spend at the orphanage was definitely the highlight of the trip. As soon as we pulled up to the orphanage the kids bombarded the car. They were so excited to have visitors that were there to spend time with them. The first day that we were there, we brought jump ropes and hoola hoops which they loved. We didn't bring enough for everyone, so we had to get creative with some games we could play. I had to pull games we played in elementary school from the recesses of my memory. Ring around the Rosy was a huge success. We played that at least 20 times. I tried
duck duck goose, but I couldn't really communicate the rules of the game very well. They would all just chase me whenever I said "goose ".
I have included some pictures of the children at the orphanage. I tried to import a video but I don't think it worked. The second and third day it rained, so we were forced to go inside and we made bracelets and colored. It turned out to be such a blessing, because we were able to really get to talk to some of the older children who sometimes get overlooked when playing games outside because the younger children get more of the attention. I talked with Joy, Mercy and Susan. They each spoke very good English and were 14 years old. Mercy was so inquisitive. She wanted to know everything about the US and the states that we came from. She said that she wants to be a pilot when she grows up. They all shared their favorite bible verses with us which they each had memorized and we were able to share ours with them. At the end of our time with them each day they would sing songs for us and would then ask us to sing a song as well. We weren't really prepared for that the first day, but we quickly learned that it would be routine for us to at least sing one song. I definitely enjoyed the time that I spent with these children, but I also greatly enjoyed getting to meet Joseph, the founder of the orphanage. He is such an amazing person. I was so encouraged by him because he was evidence of God at work in this world. He is just an ordinary person that saw a need and met it. There were so many obstacles in his way and so many reasons why he shouldn't take care of those children, but he was obedient to God's call and has seen God take care of him and these children over the past 7 years. It is amazing that 40 children now have hope for the future because Joseph was obedient. I was also encouraged ny how much Joseph depended on and trusted in God to provide for the orphanage. I was reminded about how often I deceive myself in thinking that I am in control and struggle with self sufficiency. I was sad to leave the orphanage, but I hope and trust that Thursday was not the last time that I would see Joseph and the children.
On Friday morning I really had no plans for the day. I thought I would pack and update the blog, but Patsy came to my room and asked if I would like to see a surgery. I had never seen one before, so I said yes. Her husband is an orthopedic surgeon, so we were able to watch one of his surgeries. I was not sure how I was going to react. I have never really seen someone cut open before and I was nervous that I might faint. I have never fainted either so I didn't know what I would feel like if that was about to happen. Thankfully I was okay though. The operation was to put a metal plate into someone's broken arm. We stayed in surgery for about 20 minutes and then headed back to the guesthouse. I was telling Taylor a out my experience and while we were talking her dad walked up and told us he would be performing a c section at 2pm if we wanted to watch. Since i was pretty confident i wouldn't faint I said yes. It end up being more like 5pm before the c section occurred because he had to perform a surgery to tie someone's tubes. We were able to watch that surgery as well which was interesting. I was more focused on the patient than the actual surgery. They only gave her local anesthesia for that surgery which stressed me out. She looked so scared and i could certainly sympathize, since i have a lot of experience in being afraid. I tried to hold her hand throughout the surgery, but I'm not surer if she really liked me doing that. Thankfully it was over quickly. The c section was awesome as well. The mother had been pregnant 5 times before and none of the babies had survived, so it made this delivery extra special. I felt like clapping or crying when we heard the babies first cry. I will say that they are pretty rough with the baby when they are pulling it out! I am about to post this bc i am about to board the plane. I will try to update more later.

Porridge and Bananas

Today, Wiley went to the hospital around 8am to work in internal medicine ward. He is working on the male ward which consists of 20 beds in a long rectangular room with 1 to 2 patients per bed. So far Wiley has seen some very interesting cases – cryptococcal meningitis, an extra pulmonary TB involving the spine (POTTS disease), and metastastic esophageal carcinoma with a huge cervical lymphnode. I know this is a bunch of medical jargon, but I figured some people might find it interesting. Wiley’s day begins with a morning medical conference at 8am with all of the American and Kenyan doctors where a different doctor will get up and discuss an interesting case or topic of choice. Wiley will then pre-round for an hour, have chai (they have tea everyday at 10am here) and then round with the doctors. At 1pm, he either comes to the guesthouse for lunch or eats with a missionary family. After lunch, he goes to clinic and will admit and treat patients all afternoon. I think that that will pretty much be his schedule during the week while he is here - at least on this rotation. Today, Monday, I went with the Community Health Services out into the community to set up a prenatal and infant vaccination clinic. Carolyn, a public health major from Johns Hopkins, went with me. We only traveled about 20 kilometers, but the roads were so rough that it took us a while to get to the church that we would be setting up the clinic in. After everything was set up, there were about 30 or 40 mothers that came into the clinic with their infants. We prayed with them and then we were asked to introduce ourselves. They wanted to know what our names were, where we came from, how long we would be in Kenya, and if we were married or single. I thought it was funny that one of the few things they wanted to know about us was our relationship status. My first job was to help weigh the babies. This basically consisted of hanging them from a scale that was attached to a tree limb. I should have taken pictures so that you would know what I was talking about. While I was helping weigh the babies, one of the mothers pointed over at the fence and said, “they have come to see you”. I looked over at the fence and there were probably 40 school children staring at me. I am guessing that most of them haven’t seen too many Americans in their lives. I went over to them and said one of the few Swahili words that I know, “habari” which means “how are you?”. “Nziri”, they all chimbed back – “Fine”. That was basically the extent of our conversation. I asked if any of them knew English and one child said “how are you?”. We had already covered that topic so I realized we weren’t really going to get to know each other. Feeling a little desperate, I decided I would go with the handshake next. I didn’t realize that all 40 kids were going to want a handshake though! They were absolutely precious and I wish I could have played with them all day. After all of the babies had been weighed, I went back into the church and was given the job of administering the polio vaccine to the infants present. It basically just consisted of putting two drops into the babies’ mouths. That job didn’t take very long, so I went back outside and ended up talking to a woman named Jaqueline that knew English. She asked me how long I had been married and if I had any children. I told her 3 years and that I did not have any children, but I definitely wanted to have children one day. I think that she thought it was strange that I had been married for so long and had not had a baby, so she started to comfort me and tell me that God will provide and that I need to trust in His timing. I was confused at first, because I wasn’t sure if she had misunderstood what I had said, but quickly realized what she meant. Jaqueline had to leave for a little while and I began talking to another lady close by named Caroline. She had a 3 month old son with her named Kevin. As I was talking to Caroline, she asked me if I wanted some porridge. I said that I was fine, but she asked me again a few minutes later. I finally conceded and she brought me some along with a banana. I was very nervous about trying the porridge, but I could not say no to her offer for lunch. She brought it to me in a cup and it reminded me a little bit of watered down grits. I drank a few sips of it and it honestly didn’t taste bad, it was just a little bland. Caroline then told me something about how it was fermented and then I was thinking….there is no way that I can finish this. I knew I couldn’t pour it out, so I just took very small sips every once in a while. She asked me about having children and again was comforting me that God would provide. Jaqueline came back and Caroline said, "I have to go home now, Jacqueline is back so you have someone to talk to". I realized then that she had stayed around and probably eaten lunch with me rather than at her house so that I would not be alone and would have someone to talk to. I am always humbled on these trips, when I think I am the one going to serve and it turns out that the people I am there to serve end up serving and being a blessing to me. It was such a wonderful day to be able to meet some of the women of the Bomet community and to minister to and be ministered to by these women. We were basically at the clinic all afternoon and left around 4pm. We got back to Tenwek in time to eat dinner with everyone else at the guesthouse. My computer is about to die....so that is it for now. I will update more tomorrow!

Pictures

Guesthouse at Tenwek (we are on the bottom floor on the left)

Our room - through the doors are the shower and bathroom

Our room - the bed (notice the misquito net!)

Our "tent" at Maasai Mara

Rhino in the background

Maasai Mara

We woke up at 6am Friday morning to get ready to leave for Maasai Mara at 7am from Tenwek. I was happy to see that Matthew was going to be driving us again. I forgot to mention in my first post that on our initial ride in with Matthew from Nairobi to Tenwek, he and Wiley sang a song together. It was hilarious. Matthew is 24, so only a few years younger than us. Wiley was confirming that Jambo meant hello and then started singing a song he learned at Tenwek when he was 12, “Jambo, Jambo buana, habari gana, nzuri sana, ….” and then Matthew joined in and they were both singing the song together. I wish I could have gotten it on tape. Matthew loved that Wiley knew that song and started laughing. He said that he used to sing it when he was younger. Anyway, I thought that was funny. Back to Maasai Mara….It takes 2 1/2 hrs to get to the game reserve and I must say it is a very bumpy ride. Wiley and I piled in the van along with 4 other people from Tenwek. Dr. Dittrich, a plastic surgeon from NC and his son Will, Patsy and her granddaughter Faulkner from Nashville, Tennessee. Fualkner and Will are both about to enter their Senior year of high school. I have enjoyed getting to know each of them. It was a beautiful drive into Maasai Mara. We passed so many Maasai villages that comprised of little round huts with straw roofs and mud walls, cows, sheep, goats and huge fields of corn. We eventually pulled up to the Fairmont Mara Resort. It was beautiful. Wiley said that it has been renovanted since the last time that he came here with this family. We were greeted by the hotel staff and given a warm wet towel and mango juice as we entered. They have a main lodge with a room with couches, a fireplace and tv and then a dining room, outdoor porch area and a pool. The resort is located right next to the Masa river and there are hippos floating in the water right beside the resort. We were told that we would be staying in tents along the river. I hesitate to call them tents because tents make me think of camping- sleeping bags, bath houses, bugs, etc… But these were absolutely amazing. There was a four poster bed in the tent along with a bathroom with tile and marble counter tops. Definitely not what I expected! Wiley about had a heart attack when he saw it. It was so peaceful. We decide to lie down for a little while once we got there because lunch wasn’t for a couple of hours. It was so relaxing to lay on the bed and to hear the leaves rustling in the wind, the water rushing by and the sound of birds chirping. We woke up, went to lunch and then headed out on our first game ride at 3:30pm. When we arrived at the front of the hotel, we were told that our group was going to be split up, so Wiley and I were put in a group with 4 other people. Robin and Gavin were from Ontario and came to Africa to visit their son, who is working for Free the Children – building schools, providing health care, etc… for a Maasai community near the resort. The other two people with us were Ryan, from Ireland, and Alex, from Norway. They were in Kenya for vacation and were going to climb Mt. Kiliminjaro after they left Maasai Mara. They are friends and met when they were in undergrad at Yale. They were extremely witty and had a dry sense of humor. They would always provide excellent commentary for what they thought each animal was thinking. I’m sure that I boosted their egos because I laughed at basically everything that they said. Our guide for the whole weekend was Henry. I loved Henry. He would always say, “Rachel, are you okay back there?” whenever I would get quiet. He could always sense when I was nervous that we were too close to the animals. In my opinion, we had the best guide at the resort. Anyway, on the first ride we saw so many animals - an elephant, a lion, zebra, water buffalo, antelope, karibu, ostrich, etc… The whole experience felt very surreal. The landscape was incredible. I wish I had words that could adequately describe it or pictures that would truly depict what we saw. I felt like I was watching the discovery channel….and with Ryan commentating in his Irish accent, it really felt that way. We got back and took showers and then headed for dinner. Before we ate, we heard a lecture from one of the hotel staff about the various animals. At one point he was telling us what to do if we were to be attacked/chased by any of the animals. I wanted to raise my hand and ask, “how real of a possibility is it that we will be in this situation, should I be worried you are telling us this?”. For Rhino, he said to run in a straight line and then make a u-turn because Rhino can only run straight. I was thinking, “Okay, I could do that”. Water Buffalo, you play dead and then when they start to lick you (which is strange), you cut off their tongue. Also doable if I had a knife. For Elephants, you are basically out of luck. In his exact words, “they can outrun you, if you hide in the trees they will knock the trees down to find you, if you hide in a hole they will bury you in the hole and stomp on you.” Basically there is nothing you can do. Elephants were no longer my favorite animal to see out on safari. After hearing the speaker, we ate dinner and then went back to the tent to go to sleep. I slept okay, but I definitely heard monkeys playing outside our tent all night. We woke up around 6am to go on our morning safari. The wake up call consisted of a friendly “Jambo, hello, here is your coffee”. Someone actually came to our tent to wake us up and deliver coffee! It was freezing in the morning. Wiley didn’t bring a jacket, so he had on pajama pants under his jeans and then pu ton basically every shirt that he had packed for the weekend. I thankfully brought my fleece jacket and Henry had some blankets for us on the truck. The truck that we rode in each day was very open. It had no walls or a roof on it. If a lion decided that he felt like tasting human one day, he definitely had direct access to them. I got a little nervous at times because we got so incredibly close to the animals. The lions seemed to be unphased by us pulling up right next to them. There was one moment when we were looking at some elephants and as we were approaching them, I could just sense that one of them was not okay with it. It turned towards us and its whole demeanor changed. Henry sensed it and started to back the truck up. He said, “Those are bad elephants”. He said that a few years ago he was chased by an elephant for 1 kilometer, so he doesn’t mess around. I loved him for being so cautious. The last afternoon safari that we went on, we were able to get out of our truck and walk up to some Rhinos (sorry mom, I can only imagine your panic upon reading this!). There was a mother and a baby eating some leaves and we were basically about 5 feet away from them. One of the park rangers lead us up to them carrying only a stick. I was not comforted by this at all and just kept telling myself…"run, and then make a u-turn". Wiley of course loved every minute of it. He took a ton of pictures and kept inching closer and closer to them. Saturday night some Maasai warriors came in to the resort and performed a tribal dance. As a part of the dance, they have a jumping contest to see who could jump the highest. After a few dances around the room, they decided to choose a few people from the crowd to join them. I was trying not to make eye contact so I wouldn’t get chosen, but my strategy failed. I got chosen and danced around the room with them for a little while. I think I got the dance down pretty quickly, but thankfully they didn’t ask me to do the jumping part. I can only imagine what a sight that would have been! We woke up early the next morning and went on our last game ride. We headed back around 10am to Tenwek and made it back in time for the 4th of July cook out with the full time and short term missionaries. Wiley helped grill the hot dogs and hamburgers with a few of the other guys and I enjoyed getting to know some of the missionaries and new people that arrived over the weekend while we were gone. The day was ended with a fireworks show that was put on by several of the missionary kids. After a quick card game with other people in the guest house, we headed off to bed.

Tenwek

Well, we are finally in Kenya! Sorry that I am just now gettting around to posting an update. The internet has been very sporadic. Thanks to everyone for thier emails and comments. We arrived in Nairobi around 3pm on Wednesday afternoon. The original plan was for us to stay at a Mennonite guesthouse for one night in Nairobi and drive to Tenwek on Thursday morning. The reason is because it takes 3 hrs to get to Tenwek from Nairobi and they don't like to drive at night here. However, the plans changed and we were told that we could make it to Tenwek before dark and that someone would pick us up from the airport and take us straight there. When we arrived, we applied for our visa, got our baggage, exchanged some money and then met the man who was going to drive us to Tenwek. His name was Michael Collins and he was tall and skinny and had a huge smile on his face. He is 24 years old, married and has one child and lives in Bomet. It took us forever to get through Nairobi. We got there just as rush hour started, so it took us almost an hour to get through the city. Once we were out of the city, we were driving through the mountains and the landscape was beautiful. Wiley sat up front with Michael and I was in the middle seat of the van. The weather was beautiful, so we drove with the windows down for most of the trip. I was really trying hard not to micro-manage from the back of the van. I kept wanting to ask....are we getting close? Are we going to make it before dark? do you have enough gas in the car? maybe we should stop and get some? I even tried to mention these concerns to Wiley discreetly, but he didn't catch on. About halfway through the trip Michael slammed on the brakes. I shot up out of my seat and was looking around...did we blow a tire? what is going on? All he said was, "giraffe...look!". To our right there were about 5 giraffe. They were pretty far away and I was stunned that he actually spotted them, but it was awesome! Wiley took some pictures. We started back up again and 5 minutes later I was flying forward in my seat again - more giraffe. This time they were closer though. Michael jumped out of the car and told us to follow him. We went to the other side of the road, and up a hill so that we could take pictures. I never expected to see animals on the drive in, so it was pretty exciting. We got back in the van and 10 minutes down the road he slammed on the brakes again....zebra. There were at least 10 of them just sitting there on the side of the road. They were extremely close to us and seemed to not care that we were taking pictures of them. Anyway, we finally hinted to Michael that he didn't have to stop for every animal that we saw! He was so nice that he probably would have done that so that we could get a good picture. I was also very aware that the sun was setting and that we still had 1.5 hrs to go to get to Tenwek...I finally accepted the fact that we were going to be driving in the dark! As the sun set I started to get pretty tired. I fell asleep for a little while and when I woke back up it was dark outside and we had stopped at a check point. There were police outside with machine guns and they were shining flashlights in the van. My heart stopped. Michael talked to the police for what seemed like forever in Swahili. I wasn't sure what was going to happen, but they finally let us pass. Michael said that he told them we were missionaries and they let us go through. We finally got to Tenwek at around 8:15pm. Gladys, the guesthouse manager was there to greet us and showed us to the guesthouse and our room. We are in room 1 which is right next to the common room where everyone eats and hangs out. We have our own shower and bathroom and a bed with a huge misquito net hanging above it. Wiley said this is the same room that he stayed in the first time that he came to Tenwek. Hopefully I will be able to post some of the pictures so that you can see what it looks like. We met some of the other people that are here. Laura, who is an Ole Miss pharmacy student, Craig and Hannah - they just got married 3 weeks ago and went on their honeymoon and then came straight to Africa. Craig is doing research and just finished his first year of residency at Brown. Hannah is not in the medical field and has been helping Craig with his research. Carolyn is a public health major at Johns Hopkins, Emmanuel is a med student from Germany, Vince who is a resident at Brown and Robbie who is about to start his 4th year of med school like Wiley. They are all so nice and we sat around and talked to everyone for a while before finally deciding to go to bed. We lathered up with bugspray and put the misquito net over our bed and went to sleep.
The next day we woke up at 7am, took showers, and ate a quick breakfast. Gladys met us at 8am to give us a tour of the hospital and the compound. Wiley was having fun identifying buildings that he remembered from his previous trips and inquiring about new buildings that he had not seen before. We walked around the various wards - surgery, casualty (ER), OB, Endoscopy suite, medicine, pediatrics. In the list of things that they told me I could do while I was here, they mentioned that I could hold the babies in the nursery. I was definitely excited to hear that and went ahead and lined up a time that I could help. Wiley met with Dr. Manchester and Dr. McClaughlin that he will be working with on his medicine rotation. After we got the full tour, we went to get lunch in the hospital Canteen. We sat with Hannah, Craig, Carolyn, Laura and Will. We had fries, rice, beans and Samosas (meat filled pastry). All of it was very good. Wiley was a little disappointed that they did not have ketchup, but he made do. I don't know what Wiley is going to do for 6 weeks without adequate condiments. We should have packed some soy sauce and A1 for him to take with him. Last night he found some soy sauce in the guesthouse and put it on his rice. I looked at the expiration date and it said April 2009! He still ate it anyway....that is how serious his condiment addiction is! Anyway, the rest of the day was spent meeting with Doctors and meeting other people that are serving here at Tenwek. I went to the nursery for a little while to get a short orientation. Wiley met with the Dr. Mike Mwacharo that he is going to be doing research with and was able to help with an endoscopy. Wiley said they were going to let him do the entire thing and asked him how many he had performed before. He said that he didn't feel comfortable doing it and that he had never performed one but he wanted to watch. The patient had esophogeal carcinoma and had a palliative stent in her esophogas. After talking to Dr. Manchester, Wiley found out that they are going to let us go on the Safari this weekend since I am leaving next Friday. I wasn't expecting to be able to go on a Safari this trip and wasn't even going to bring it up, but everyone kept insisting that we should go while I am here. I think it might work out best anyway because Wiley is just now getting oriented and will not have many patients that he will have to worry about while he is gone. So we leave Friday at 9:30am for Masa Mara. That basically sums up Wed. We ate dinner with everyone in the common room and heard about everyone's day and the patients that they saw. We went to bead early because we are still exhausted from the time change.
Thursday - We woke up at 7am and Wiley got ready for his first day at the hospital. While we were getting ready a little boy named Hugh started to talk to us. He is one of the children of the Cameron family that has been here for a couple of weeks. They have two girls and one boy - Hugh. Hugh is Wiley reincarnate. He has not met a stranger, has incredible energy, and asks a million questions. He is about 5 or 6 and has blond hair. It all started when we came out in the morning to eat breakfast and make coffee. He kept asking me for a cup of coffee with a little bit of sugar in it. Of course I was not about to give it to him. He then started asking a million questions. Why can't I have any? What is your name? Where are you staying? Can I come in your room? Will you play with me? Want to ride scooters? Want to play raquetball? Can I play with your computer? Can I have some gum? Why is your computer so small? Why do you have so many crayons? He ended up hanging out in our room all morning. Wiley told him he had to get off of our bed or else he would have to make him up in it...to which Hugh responded, "Oh that would be cozy!". Wiley almost fell to his knees laughing when Hugh said that. Like I said, Wiley reincarnate. He is super cute and I played a few games with him after Wiley left to go to the hospital. My plan was to go to the nursery at 10am and help out and then possibly go to the pediatric ward and play with the kids. Unfortunately I was not able to help out much because they babies had just been fed and were content and sleeping. So I talked to some of the nurses and helped make cotton balls. I left the nursery after about an hour so that I could watch Hugh and the rest of the Cameron family could go up to the nursery to hold the babies. After an hour or so I decided to go to the community health center to see if I could help out. They asked me to count malaria pills and to separate them out into bags. I did that for about an hour and then it was time for lunch. Wiley came back to the guesthouse and we ate with everyone. We heard about everyone's day so far. Wiley said that he is enjoying it so far but I didn't really get a lot of details. I will try to get more from him later. After lunch Hannah and I decided to go back to the nursery, but they told us it would be best to come back at 5pm. We can't ever seem to get the timing right! It is hard because I don't want to be in the way, but I want to help out if they need me. We decided to go back to the community health center and count pills, but we quickly ran out of bags and had to stop. I started to get a little discouraged that I would not be helping out much here at Tenwek and was wishing that I had some sort of medical background so that I could be of some use at this place. But I had to remind myself of a devotional that I read not too long ago. That I might not be serving in the way that I was expecting to serve, but that doesn't mean that God can't use me where I am. I know that I just need to be willing and obedient to serve wherever there is a need and wherever He is calling me...even if it is outside of my comfort zone or not what I expected. I am looking forward to tomorrow and next week. I am about to head back to the nursery, so I better get off the computer. Sorry for the incredibly long post, but I just wanted to give you an update. I will try to give an update again tomorrow.