Driving on Small Rural Roads . . .

. . . you might be surprised when rounding a corner, come to a complete stop, and then grab your camera! I know this is just a normal thing for people who have grown up here, although even Kenyans generally get excited when they see the big animals up close. However for a kid from Oklahoma, these sightings are always exceptional.

What Should We Do This Weekend

Possibly some people wonder what a weekend in Kijabe is like. It is similar in to a weekend in the US, except that it is more relaxed. There are no organized sports or activities, no restaurants to eat at, and everyone we would want to see is within walking distance. If I am not on call, I will go in on Saturday morning and round on the week’s patients. Afterward, I turn my patients over to the on call physician for the weekend and I am free (sort of – it is hard to completely disengage from the hospital). The kids usually have school activities, but those have decreased significantly because of COVID precautions . . . which is a real bummer as we all agree. However most Friday and Saturday nights they have class activities up at school. If we have an occasion to go to Nairobi, we will make the hour drive to do grocery shopping or eat a nice meal. Pre-covid, we might go into the city to see a movie or go bowling. Sometimes we can go camping in one of the nearby national parks or we go to the lake that is an hour away to go sailing. If we stay in Kijabe (usually) we may build a fire in the pizza oven and have friends over for pizza as the sun sets. I go on long hikes in the forest and give the dogs a chance to run and chase monkeys. I work in the yard, Allison cooks something fun in the kitchen, I clean the storage container (a never ending process), and other odd jobs around the house are completed. Often we have friends over for coffee on the porch or we go to their place for the same. It really is a good life. So what should we do this weekend? We’ll figure out something.

Baboons

They are my favorite and my least favorite. Of the animals that come through our yard, I think they are the most interesting. However they are a menace. They drive our dog crazy, and she will bark for hours. They go in peoples houses if they have not locked their doors. They threaten kids and women. But they are so interesting . . . dog like apes. This video is from a few years ago, when two troops of baboons had a turf war in front of our neighbors house just around the corner from ours. Lots of bluff with little damage, but still scary to be in the middle of it.

Sunday Night in Kijabe

Some random thoughts this morning. Most often we attend a small group Bible study on Sunday nights. This week we hosted at our place. It is a nice time to relax and enjoy other’s company. It is a good time to pray corporately. Almost always it is part of making new friendships in the transient world of a missionary community. We miss friends back home . . . did you know we have been living outside the US for almost 9 years! It has felt short and long. Our kids were small when we left, and now we send our oldest off to college next year at Abilene Christian University. Time really does fly as they say. It is sad to see him go, especially after such a bummer year with the COVID restrictions. On the other hand I am really happy for him. ACU is a blast, or at least it was. I hope it continues to be so. In the picture below are several of our Kijabe friends. One couple runs an organization committed to environmental protection while encouraging productive farming. Another teaches at the local seminary. Another is helping to establish small clinics in the poorest communities of Kenya. Another is an anesthesiologist at the hospital. There is a lot of good work being done!

All Together Again

No picture yet, but last night I arrived in Kijabe at about midnight. Not a soul was stirring, and I was wide awake. So after dropping my bags, I got a glass of filtered ice water, sat down on our sofas and thought about the previous 72 hours and all it takes to travel across the world in a day, and how incredible it is that we can do it so easily. My flight was easy. I managed to sleep around 5 hours on the second flight which is a record for me. I do not sleep sitting up very well. Then I cleared passport control without a hitch, grabbed my bags, met our friend Philip for the drive home. Being home before midnight is incredibly efficient for that flight. It has been good to be together again. The girls got me caught up on all the happenings. Peter planted some flowers. David went to hang with friends. Life is back to normal.

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!

img_1842

Our Internal Medicine team after morning audit.

img_1846

Passing Head of Department duties happily off to Dr. Tony

img_1835

Friday Morning Internal Medicine Audit

View this post on Instagram

Teaching EKGs

A post shared by Will Caire (@willcaire) on

Another Plague – Seriously, What is Next?!

Porch Picnic

We had around a 3 week break in the rainy season, which has now come back with a vengeance. It is cold for Kijabe. That means a fire every day to warm the house, space heaters in the bedrooms, and nights huddled around the fireplace in camping chairs to stay warm. I miss the warmer nights (we were still in sweatshirts) of our mini dry spell with dinners on the porch.

Nights eating dinner on the porch are the best!