March 27 and COVID-19

It is weird is to be trapped. We cannot leave Kenya until some unspecified time in the future. We cannot leave our house after 7 PM. (I am not really sure how this helps stop virus spread so I wonder if it is for social stabilization). To be in another country without the ability to get home is an odd feeling. I have explained to my kids (and myself) that this is what I am here to do. I am her to be standing in the hospital when the crisis hits. I want to be where the need is great, and I feel fortunate to be here. I cannot really think of other good reasons to not be back in the USA. But our purpose is different, and frankly I feel so fortunate to be here. I am sad for many things that are going on around this pandemic (canceled trips for us, canceled school years for lots of kids, quarantines, and the deaths associated with it), but I am very glad to be able to be a part of the work at Kijabe Hospital. So we, like you, are trying to figure out how to make the most of travel restrictions, curfews, and quarantines. Otherwise, so far, so good in regards to coronavirus in Kijabe!

March 26 and COVID-19

Today is a relatively normal day in the hospital. What does make it a little different are the small things that show preparation for what may be to come. My temperature was scanned as I entered the hospital and I was asked if I have COVID-19 risk factors. I had a Outbreak Committee meeting for 2 hours in the middle of the day. As head of the internal medicine department, I have been a part of developing protocols for the care of hospitalized patients as well as determining how we will staff such cases. I have asked around about what is going on in Nairobi, and I hear rumors that the hospitals are getting busier with respiratory infections. We are probably 1-2 weeks behind them.

There are things that make me optimistic. I know the statistics. I personally at am low risk as is my family. I know we will get it at some point, but it will be a flu-like illness for us if we are symptomatic at all. I live in a tropical climate with lots of sun which equals lots of vitamin D. We do not have many elderly people in Kenya, so those most affected in other parts of the world do not exist here in such high numbers. Italy has 1 in 4 people over age 65. 25 percent! Only 3.9% of our population is over age 65. The average life expectancy is around 63. We will not see the same mortality rate here. I believe at this point when all the statistics are done retrospectively that the infection and mortality rate will not be that high. The problem is that it is hitting everyone in the world at the same time!

Things that make me pessimistic. We have very limited PPE, limited doctors, limited ICU beds, very limited ventilators. Basically we have limited health care resources. The decisions about who will live and die that other doctors talk about having to make with COVID-19, we make everyday because of our decreased resources. However, we do not lack for very smart and compassionate doctors, at least at Kijabe Hospital. I get a sense that all my interns are ready to be a part of caring for their country! Our young have other conditions that may complicate their recovery. Specifically HIV, TB, and malnutrition could be disastrous for the young people who in other countries are doing so well.

I hope everyone everywhere is doing well. God is good, and I am remembering these good promises.

Philippians 4:6-7 Do not be anxious about anything, but in everything by prayer and supplication with thanksgiving let your requests be made known to God. And the peace of God, which surpasses all understanding, will guard your hearts and your minds in Christ Jesus.

Ephesians 2:10 For we are God’s handiwork, created in Christ Jesus to do good works, which God prepared in advance for us to do.

Busy OB Call

Another night of obstetrics call is in the books. It began with mother who was admitted with a femur fracture from a traffic accident. She was 31 weeks pregnant, and the baby’s heart tones were not completely normal. I watched her overnight as she was readied for surgery the following day. I imagined that her placenta would separate from the wall of her uterus due to the trauma, and I would have to rapidly take her back for a cesarean section; I wondered if I would need to call the orthopedic team to fix her fractured femur at the same time. Next was a severely ill pre-eclampsia (high blood pressure in pregnancy) patient. Her pregnancy already was complicated by severe growth restriction in the baby and loss of fluid around the baby both of which indicate that the placenta is failing. The estimated weight of the baby was about 2 pounds which indicated she was about a month behind where she should be. As I watched the heart tones of the baby they were minimally reactive indicating a unborn baby at the end of its rope. I took her for cesarean section and pulled out such a small little girl. She is doing well as of now on a ventilator, and I hope she makes it. The call ended with a delivery of twins right at midnight. The first came out normal looking for the exit. The second backed its way out in a breech position. The interesting thing is despite being twins, because of the timing of their birth, they have different birthdays. Cool!?

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Midnight twin delivery. Born on different days.

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Exams

I spent the last Saturday morning participating in the exams of our Family Medicine residents. They were given 20 minutes with different patients to demonstrate their ability to interview, examine, and diagnose a patient. Overall they did well. I drove to Nairobi in the afternoon to see Avengers with a bunch of high school boys. Almost two hours in each direction makes for a long day, and the movie had better be worth it.

Kapsowar is Cool

I had the privilege of meeting with the McCurry family in Kapsowar. They are Christian Health Service Corps missionaries, and they have been her for years. It was a blessing to see them in their hospital, working hard to help meet the need of many. One of the best parts of my job is meeting with other missionaries. I have just started to make it happen here in Kenya. Hopefully I can get out to some of the nearby countries to visit our people in other places. It is always inspiring to see the good work that people are doing. You can check out the McCurry’s blog at https://mccurrysinmissions.wordpress.com/ Click on the pictures below to see them bigger.

Travel to Chogoria Mission Hospital

I went to visit our other Christian Health Service Corps missionaries in Chogoria, Kenya this past weekend. The PCEA Chogoria Hospital is an old mission hospital where recently missionaries have begun working again. We have two missionary families working in this hospital. The Brockington family has been in Chogoria since 2017, and they are tasked with caring for the sick who come to the hospital as well as supporting the Family Medicine Residency. You can read their blog and story at The Doctors Brockington.

I also went to visit the Ryan Miller and Haley Combs, a newly married couple who has arrived to Chogoria. They are also with the Christian Health Service Corps. It was good to see their excitement in their new posting even as they deal with some challenges.

It is good to be able to visit our workers and get to know them and hopefully support them in the good work they are doing for the sake of the gospel in Kenya. I felt privileged to be there to show them that we care and that others care. They are not forgotten even though they are a long way from home. Thank you to all of you who support us and allow us to show love not only to our patients at Kijabe Mission Hospital and the students at Rift Valley Academy, but also to the missionaries serving with CHSC.

The Brockington family
Ryan and Haley in their tiny kitchen with no oven, one burner, and lots of heat!
Jared teaching on newborn nursery rounds
I was told these are giant Bird of Paradise plants. Wow!
Sometimes you can get a little stir crazy
One of the things that is culturally difficult for me to see in Kenya. So many kids go to boarding school. Even in grade school the children are sent off to live away from home. This is a girl’s boarding school for grade school children.
Proof I was there