A Very Little Baby – Caroline

This is the post about the abdominal pregnancy we delivered a week ago on the Friends of Kijabe website.

Caroline was twenty-eight weeks pregnant when she suffered a fall and began experiencing horrible abdominal pain.  An ultrasound looked very unusual, and she was recommended for emergency surgery.  It turns out, she had an abdominal pregnancy, meaning that her baby was growing outside the uterus and her accident ruptured the amniotic sac, pouring fluid into her abdomen. The baby was given to the pediatrics team to give surfactant and work whatever miracle possible.The most dangerous period for a premature baby is at 72-96 hours.  Six days, past this window, baby is doing well but still in a critical stage. The family faces a three month hospital stay and will need significant assistance with bills, likely $3000 between mother and child.

Give through Kindful  – please enter Caroline in the “additional details” form at checkout.

Orthopedic Injuries



The young woman with the fractured humerus above had a tragic motor vehicle accident in which her arm was nearly torn off. I am glad she still has a shoulder!


This is a knee fusion. I am not sure what the indications were. I just happened upon the picture while I was doing x-ray reviews in the outpatient department.

A Saturday on Call

Last Saturday went like this. (As an aside I went to the hospital at 7:45 AM and did not get home until somewhere around midnight! During that time I did not eat or drink anything because I was too busy to go to the cafeteria or run home and eat something. It was sort of fun.)

7:45 AM – I go to the hospital to start rounds. I am greeted at the door by a medical officer who tells me there was a delivery just recently completed with a possible third degree vaginal laceration with resultant loss of rectal tone. I go directly to that patient to examine her. It actually looks more like a very deep and long second degree tear, but because it is so extensive we decide to take her to the operating room to repair it.

8:45 AM – I start obstetric and gynecology rounds with the medical officers and clinical officers who are working during the weekend. Most significantly we are concerned about a mother who had a post delivery vaginal hemorrhage who now has a medical balloon placed in her uterus to control the bleeding. She is stable, but has received a lot of blood overnight to maintain her blood pressure and level. Also there are several severely ill patients on the gynecology ward, one with a bad abdominal infection and the other with vaginal bleeding associated with HIV and a already low blood count related to an inability of her body to make blood.

10:00 AM – We finish rounds and head to the operating room to repair the vaginal laceration.

11:00 AM – I rush out to see a private patient who is three days post cesarean section and discharge her to her home.

11:30 AM – I am informed that we have a woman who has arrived with what appeared to be an acute abdomen, but she is also 28 weeks pregnant. She has been taken to the ultrasound room, and her pregnancy does not look right although it is not clear what is going on. The infant is under a lot of distress, the placenta does not appear to be attached well . . . something is not right. So we decide to do a cesarean section despite not being completely confident what we will find. What we do know is that patient appears very ill, and that her baby looks on the verge of dying if we do not do a cesarean section to rescue the baby. Before I start the surgery I am palpating her abdomen and feel what seems to be the baby’s arms and legs just under the muscles near her stomach. You can feel that on a rupture of the uterus, but there is no reason to really suspect that in this patient. On opening her abdomen we see something completely unexpected. The placenta is in the abdomen. Obviously it should be inside the uterus. No wonder our ultrasound report was so unusual. Since I had felt the baby from my abdominal exam already just before surgery (although I had not been completely sure that was what I was feeling at the time), I knew where to reach. I placed my hands inside the abdomen up near the stomach and liver and pulled out the little preterm infant. This patient had presented with an abdominal pregnancy which is very rare. The placenta had attached to the outside of the uterus. Unfortunately because of her bleeding, she ended up receiving a hysterectomy with the help of Dr. Chen, the gynecologist on call, to control the blood loss.

2:00 PM – Another mother who is laboring begins demonstrating signs of stress to the baby. In addition she has not dilated her cervix for the previous 4 hours. She is brought back for a cesarean section.

3:30 PM – We have a twin pregnancy that is classified as monochorionic / monoamniotic which means the babies are sharing the same placenta and amniotic sac. Also one twin is noted to be significantly bigger than the other which indicated that one twin is basically stealing nutrition and blood from the other. Her case is also complicated by a pregnancy related cardiomyopathy or heart failure. All of these signs are indications for delivery, and she is taken for a cesarean section. Indeed, the first twin is quite a bit larger on delivery than the second, but both cry immediately on delivery. After surgery she is noted to have some respiratory failure related to the shifts of body fluids that occur with anesthesia and delivery of her baby via cesarean section. She is given medicine to decrease the lung congestion, and she responds well. She goes to the higher level of care (HDU) unit for close observation after surgery.

5:00 PM – I go to see a couple patients in the gynecology wards who are having some difficulties. One is developing respiratory distress (trouble breathing) with fever and a high heart rate. She is already being treated for abdominal / pelvic infection. I order imaging studies, lab work, a urine test, and advance the strength of her antibiotics. Probably the best thing we do for her is give her a big dose of intravenous fluids to get ahead of possible sepsis. She responds well over the next few hours. I also see a woman who has HIV, anemia, low platelets, and chronic vaginal bleeding from a protruding uterine fibroid. She is relatively stable, but she has had some increased bleeding so we get a blood count and start looking for blood to give to her and help support her.

7:00 PM – A woman with two previous cesarean sections presents to the obstetric ward with contractions. Because having two previous uterine scars puts her at risk for uterine rupture with labor she is taken to the operating room for a repeat cesarean section. She is noted to have significant scarring and adhesions so that we are unable to bring her uterus out of her pelvis to close her uterine incision. Bringing the uterus out of the pelvis makes the operation much easier. However in her case, I repair it with a little bit of difficulty deep inside the pelvis. Overall she does well.

9:00 PM – I step out of the operating room to be told there is a mother in the pushing stage of labor who has stalled and may need a cesarean section. I go and check and it appears to me that she can continue pushing. She gets close to delivery, but in the end begins showing signs of distress to the baby. So I use a vacuum to delivery the baby who does well.

10:00 PM – I make round on all the sicker patients of the day checking on the 2 patients in the gynecology ward, the cesarean section, and the patient in the HDU. Everyone is stable.

11:00 PM – I go back by the labor ward and I am told there is a patient who is in the pushing phase of labor who has become acutely psychotic. She is hallucinating, talking to nobody, and refusing to push. I look at her and the infant’s head is almost delivered. I grab my second vacuum and help her finish the delivery. The baby does fine, and interestingly, her psychosis clears after delivery.

12:30 PM – I lay down on the living room floor to catch some sleep if possible after finishing a very late dinner and drinking about 100 tall glasses of water.

3:30 AM – I am called to be told that a patient has a 4th degree laceration after delivery. This means the tear goes through the bottom of her vaginal all the way through her anus and rectum. I tell them to get her to the theater for repair. The stabilize the patient and wait for an orthopedic emergency to finish to move her to the operating room.

6:00 AM – With the help of Dr. Chen we repair her 4th degree laceration.

8:00 AM – The 24 hours of call end.


A Weather Report

From one of the science teachers at RVA.

So far in April we’ve had 7.85 inches of rain (average for April going back roughly 30 years is 8.10 inches). As of April 24, we have had rain every “day” except for 4 days. (our weather station counts a day as from midnight to 11:59 pm). Some of those days were 0.01 or slightly more (8 days with 0.1 inches or less). But today has been our first day since 11 April without any rain!

May tends to have less rain if that’s any consolation (average is 6.1 inches). But the El Nino year of 1998 (with 60+ inches!) had close to 20 inches in May.

So far for the year we are just over 22 inches (we got 24 in total ALL of last year) with the yearly average being just under 38 inches.

Good Quote

Increasingly, I am of the view that republican government, in the classical sense of that term, is possible only in a polis where the citizens are committed to trying to understand one another affectionately and believe in showing mercy to their ideological opponents. Short of that, it is hard to see a way out of the current mess. And that problem is of concern to far more people than just conservative journalists. – Jake Meador on Mere Orthodoxy

About Support – A Letter Shared

This is an edited copy of an email I sent to a friend asking for details about our financial support. I thought it might be helpful to anyone who wonders about what we do and how we are paid.

I want you to know that I am thankful for you and your support. But I also understand that we all have our criteria for what we decide to give to in regards to charity, so I will not take any offense if you decide you need to move your money elsewhere. I am honored that you were willing to support us just out of caring for us, not dependent on what we were doing. That is very kind, and thank you.

We have several roles in Africa. The first thing we are doing is medical work. I am working at Kijabe Mission Hospital full time. My role there is two-fold. I have a major teaching responsibility which is probably the most important thing I do. All of us that are volunteers at the hospital are very involved in training Kenyan and other African doctors toward in good medical care as well as professionalism so that they can take those skills to other parts of the country and continent. In this task we are joined by the employed Kenyan physicians who work at the hospital. We have residencies in Family Medicine, Surgery, and Orthopedic Surgery currently. We also teach Medical Officers which are the most common type of physician you will find in Kenya. They come to our hospital for one year after finishing medical school to receive more training before going out to be physicians in many rural areas. All of that is within a Christian context that includes Christian mentoring and discipleship. My second responsibility is simply providing good medical care within the teaching context. We are a mission hospital, so we have poor people coming from all over eastern Africa to receive good and cheap care in our hospital. We provide many services that they would not be able to receive elsewhere. When it comes to patient care, I split my time between obstetrics, emergency medicine, and the clinic. Serving the poor has always been a big motivator for me.

The next area of focus is at Rift Valley Academy. RVA is a boarding school for missionary kids. We have youth from many African countries in the student body, and most of those kids are coming from areas in which education on the mission field is impossible. Allison teaches full-time at the school, this year in 9th grade English, and next year she will be an Spanish AP (maybe), Spanish 4, and Spanish3 teacher. So that mission is a supportive role for the work of evangelism that is going on in the hardest places of Africa. Those families trust their kids with us so that they can keep working in the areas that they feel God has called them to serve. I think it would be impossible for me to do the same, but I am glad we can support them in this way. Allison is really enjoying working there. And we consider these students as part of our ministry as well.

The third role we have is as East Africa Team Leaders for the Christian Health Service Corps. We have missionaries in several countries in East Africa, some of those countries are open, others are closed. My role with Allison is to do our best to be a support to them. Most recently we had a organizational meeting in Greece associated with a big medical education conference which we attended. That is a role we are still growing into, and it will probably become a bigger part of what I do in the future. It is challenging as we have already had to work through several issues that have been difficult. As I said, we are learning a lot as we go along.

Your financial support basically goes to pay our salary in those jobs. If I go to any conferences that are work related, I can draw upon our donations. If I have to make a purchase that is work related I can draw on those donations as well. Otherwise I receive a monthly stipend, and I budget my living expenses to include housing, groceries, gas, movies, bills, vacation, etc. out of that salary. I support myself some by doing online consultations, but that does not come close to paying for everything. I would have to do it as a full-time job to pay my salary. But it helps me feel OK about sometimes doing a little bit extra for the family when we go on trips. For example, when we came back from the conference in Greece, we stayed three days in Dubai. I used our vacation fund for that part of the trip which includes some of my consulting income. In that way I try and keep our accounts for personal and ministry use clean and separate.

Again, the organization we are under is called the Christian Health Service Corps. It is specifically focused on medical missions. They receive a 10 percent overhead for their services toward us. They are sending doctors and other types of medical workers all over the world. They also have medical training conferences in the United States, and they are involved in mission support to include building projects in different mission hospital.

So I hope that is not too much information. Thanks for asking. I may copy and post this email with some editing to our blog in case other people have some similar questions. Let me know if there is more I can tell you to be more clear.