Lockdown Shutdown

Many of you know we have been in a governmental lockdown for the last month. We are over one year into a curfew. Schools have been closed for the past month, and mostly closed for the past year. We did not know if our kids were going to finish school online or in person. We were praying for in person. Today we got notification that everything is open again!. For us this means freedom of movement through all of Kenya. The lockdown spoilt a vacation we had planned for early April, but at least we now have flight vouchers for an obscure regional Kenyan airline. Maybe we can use those next Christmas to go to the coast? Instead we did a trip I have been wanting to do for four years to Amboseli National Park which happened to be within the region we were allowed to travel. Amboseli is a beauty. There were not so many animals as hoped, but the setting made up for it. So although it was no the trip to the beach we had hoped for, it was a nice respite nonetheless.

It took us hours, but we finally found some elephants. This was a bit disappointing because usually there are hundreds, and even thousands of elephants at Amboseli.
The magnificent Kilimanjaro!
Looking good!
A cup of java on the savannah. The good life!

At Last Will is Going Too!

Today I fly to Kenya! Getting back home did not go as smoothly as hoped, but at last it is happening. Wednesday I went for my COVID test to be cleared to fly, and it came back inconclusive. What!!! That same day I got my second dose of the Moderna vaccine. And so yesterday I was up early to try and get another COVID test, but was also noticing that I felt a bit feverish and chilled. I knew this could be a side affect of the vaccine . . . I have heard that even some people get chills to the point of shakes. However, since I had an inconclusive test the day before, I was imagining that at last I was possibly coming down with COVID the day before I was scheduled to fly to Kenya. I will add that despite the fact that I felt a bit funky, I could have pushed through it without concern if not for the inconclusive test and the possible delay of my flight making me imagine worse outcomes. So I went back to the lab to get my test, and they told me their internet was down. Uh oh! Time to scramble to find another testing sight. Luckily there is an ER that will do the test for $450!! dollars with results in a couple hours. I drove over there quickly, and got my test. Negative! So I went to bed early last night after taking some Nyquil, and I feel better this morning, if not perfect. However, no fever or chills. I am off to the airport in an hour or so for the long flight and travel to Kijabe! I am glad to be going home, and I am glad to see my family soon. It has been too long!

At last . . .

Today, after multiple attempts, Allison and the kids flew out to Dallas toward Nairobi. Allison received her tourist visa this morning, and so we got up early and had the tickets changed and put everyone but me on a plane today at 3PM. I am so glad for them. It allows them to avoid sitting in a 2 week quarantine in Kijabe before they could attend school in person. So tomorrow around noon our time in Dallas, Allison and the kids should be landing in Nairobi. Yeah!

Ready for takeoff

A Day in the Life . . . Friday in the ICU

I walked the long way into work (its not long really) because we have closed off all but two entrances into the hospital so that all can be temperature screened before entering. It is nice to enjoy the very brisk morning air, watch the monkeys, and listen to a podcast.

8:30 AM     Time for the weekly audit of mortalities and close calls on the internal medicine service. This week a lot of time was spent discussing the COVID ward and some ICU complications from the past week. At the end I got a nice despedida with a coffee mug that I had been hoping to get with the Kijabe Hospital logo.

10:00 AM     Rounds in the ICU. In the last 2 days we have added 8 new patients. Yesterday was worse when I had six new patients in the span of just a few hours. Today it is just two new patients. Severe hyponatremia, a patient with a adrenalectomy in whom we have to closely watch the potassium and blood pressure, a myasthenia gravis with mucus plugging causing one lung to not function well (she got a tracheostomy yesterday), a traffic accident with a broken hip and ribs, status epilepticus, sepsis in a patient with esophageal cancer, another who has had her right shoulder and arm removed for cancer complications, severe diabetic ketoacidosis and sepsis . . . the list goes on!

12:30     Time to do some record keeping of the patient for the last week so that we have good records of what they presented with, how they did, how long they were in the hospital. We do this to see trends in our care and illness and improve quality over time.

2:00     No lunch today. It made me wish I had eaten breakfast. The coffee from the morning was serving me well. Time to teach EKG reading to my trainees. One is an orthopedic resident. The other is a medical intern (1st year out of medical school). They have been with me all week on the ICU service.

3:30    Afternoon rounds on all the patients from the morning to see how they have progressed. Everyone seems to be ok, although many are still sick. Several are well enough to leave the ICU.

4:15     I get a call from one of my ECCCOs (ICU clinical officer) stating there is a problem in one of the HDU (like an ICU but without a ventilator). One of the surgical patients we have been rounding on who had major spinal surgery now has a heart rate of 200! This is new to us. An EKG is ordered. She is stable, and I take the moment of getting the EKG to take Dr. Steve on rounds of all the patient in the ICU service. Steve is on call tonight, and I confess I am relieved that he can take the lead on dealing with the tachycardic patient. Is it a sinus tachycardia or atrial fibrillation with rapid ventricular response. Hopefully the EKG give him some clues.

5:00    Steve is in charge. I leave notes on all the patients for the weekend coverage doctor, and head home to start packing for my flight on Saturday. A pretty full day for my final ICU day for awhile.

Being at Kijabe has to be one of the best jobs in the world!

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Our Internal Medicine team after morning audit.

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Passing Head of Department duties happily off to Dr. Tony

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Friday Morning Internal Medicine Audit

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Teaching EKGs

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Par Three at RVA

Last week there was a golf tournament at RVA. One of the staff at the kid’s school put together a small par three course around the upper field. So now this spring instead of rugby cheers on the paddock, you hear cries of “Fore!” Small groups moved around the course, with a closest to the pin contest and free cokes for each hole in one. The low scorer won two free pizzas from the local Pizza Inn. Its a tiny course, but it is a lot of fun for a quick nine holes. Tennis courts are water hazards. Soccer goals are tall trees in the fairway. The wind blows across the pitch toward Mt. Longonot in the valley. You are considered in the hole when your ball is within a club length of the flag. There are no greens and the fairways are deep as rough. David and Peter have picked up clubs for almost the first time, and progress is being made by all of us in our nine iron game.

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RVA Par 3

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Hash-up Mash-up

During quarantine, I’ve noticed that everyone’s new favorite hobbies are cooking and baking. I say amen to that. What’s better than a hobby you can EAT? I’ve been thinking I should revive my occasional recipe sharing on the blog.

To that end, here’s a super simple yet satisfying meal for those celebrated “breakfast for dinner” nights. I suppose you could make it before noon, but that’s your call.

Hash-up Mash-up

Ingredients:

enough potatoes to grate about 4-5 cups; 5 or 6 big potatoes, 12 or so medium red potatoes

10 eggs

cooking oil

salt and pepper

  • optional: bacon, Freddy’s Fry Seasoning

Directions:

  1. Boil the whole potatoes in water to cover for 15 minutes or until fork-tender. Set potatoes aside to cool a bit. (If you are in a place where you can get a bag of frozen hash browns, you can skip the potato part of the recipe. This is a missionary blog, so this is how we make it.)
  2. If you are using bacon, start by frying bacon in your biggest, most non-stick sauté pan.
  3. Grate the cooled potatoes on the biggest holes of your box grater.
  4. Leave the bacon grease in the pan or if you didn’t start with bacon, put 2-3 tablespoons cooking oil in the pan.
  5. Put the grated potato in the oil or grease and spread it out to the edges for a layer of potatoes.
  6. Here’s the part that requires patience– let it sit at least 5 minutes or more without moving it (more time if you started with frozen hash browns) When you lift up one edge and it looks good and golden brown underneath, flip pieces of hash browns with your spatula. Now let the other side brown. You may need to drizzle more oil on so that you get a good fry. While the potatoes are frying, generously sprinkle with salt and pepper. *On a whim, I bought a jar of Freddy’s Fry seasoning and brought it to Africa. If you live on the I-35 corridor and can get some, we recommend. If not, you can make it. Good stuff to add at this stage.
  7. With patience, you’ll get a pan of beautiful golden brown hash browns. While you are waiting, crack 10 eggs into a bowl.
  8. Now you will add the protein. If you have a thick layer of hash browns, you can make little divots in the hash browns to receive eggs. Pour the eggs over the hash browns, evenly distribute the yolks if needed, and cover with a tight lid. The steam from the potatoes will make sort-of basted eggs and the bottom will get nice and crispy.
  9. Serve a wedge of Hash-up Mash-up with ketchup, sriracha sauce, hot sauce, and/or Ranch dressing, plus bacon, fruit salad, waffles, etc. ¡Bon appétit! 

 

Sarah’s Pet

She won’t touch a grasshopper, but she loves a slug!

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Sarah’s new pet

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April 13 and COVID 19

I am back into the hospital today after the weekend off for Easter. So far no cases in Kijabe Hospital which makes us wonder what may be going on in Kenya and in Africa in general. We keep saying we are a week or two away, and then nothing. I am glad, and I confess each day makes me more optimistic that we will miss the worst of it. There are multiple reasons that could play a role in what appears to be a less significant outbreak. We live in a tropical zone with lots of direct sunlight. Most of the population has received a BCG anti-tuberculosis inoculation which could impart some partial immunity. A higher percent of our population is on anti-retroviral medication (the treatment for HIV). Maybe there is a genetic predisposition against the virus. Also we have quite a few corona-type viruses that circulate through our community that could be imparting a partial immunity. Possibly an early move to partial quarantine slowed the infection rate. In the end it is confusing, because none of the listed reasons above seem to explain what appears to be less cases here. So maybe we are just behind, and it will come on strong in the next month. In the end I am thankful that it is not bad, and I pray that God will have mercy on the people of Africa, especially the poor.

Happy Day after Easter from our family!

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