Madaraka Day

Today is Madaraka Day in Kenya. It is a national holiday celebrated every first of June. It commemorates the day in 1963 that Kenya attained internal self rule after being a British colony since 1920. Madaraka is a Swahili word for authority/power. For the hospital it is a day off from routine activities. So emergency care and surgeries continue, but clinics are closed. I am on call for the ICU today. Rift Valley Academy does not celebrate any national holidays from any country and so for them it is school as normal

Mediterranean feasting

Eighteen months ago, pre-Covid, our family went to Egypt. It was fantastic and exciting and dusty and historical. We came home very enthusiastic about Mediterranean food. Since then, I crave pitas and creamy cucumber salads. I thought I would share some excellent recipes in case you would like to make a Mediterranean feast and in that way share a meal with us.

Shakshuka: who knew that eggs poached in tomato sauce could be so satisfying? It’s the feta cheese that makes this special.

https://cooking.nytimes.com/recipes/1014721-shakshuka-with-feta

Pitas: If you use allrecipes.com, you might already be acquainted with Chef John. These are a terrific texture.

https://www.allrecipes.com/recipe/232719/chef-johns-pita-bread/

Hummus: I modify this recipe a little (less tahini), but I like the very specific instructions.

https://cookieandkate.com/best-hummus-recipe/

Orzo salad: Giada has so many tasty pasta recipes. The addition of mint makes this one fun for Mediterranean night. I usually leave out the garbanzo beans and add a cheese, either mozzarella or feta.

https://www.foodnetwork.com/recipes/giada-de-laurentiis/orzo-salad-recipe-1944175

Cucumber: I love tzatziki, but it’s a bit of work. This salad is also popular at our house.

https://www.littlebroken.com/greek-cucumber-salad/

Here is David, looking cool and getting ready to chow down.

On being an extractor fan

One of the things that has given me the most pleasure in this last week is our new “ceiling extractor fan” as the box identified it. We have a (previously) white, all-tile bathroom at the front of the house that never dries out in the rainy season. It just stays a moist, humid, moldy place to get clean every day. Think of an unfinished basement with a bit of septic tank thrown in but right next to your front door. We have always had a plan to remodel it, but after nearly four years, no remodeling has taken place. So three weeks ago I made the drastic step to hunt down a fan in Nairobi and last week a couple of kindly Kenyans installed it.

The extractor fan is changing the atmosphere in the bathroom! There is no more funky smell. The mildew and mold are drying up. The towels are dried in between showers.

One morning I was thinking, “I want to be as healing and as effective as this fan.” Then I realized that God’s grace is like that fan. There are still disgusting, unpleasant things that we do and that are done to us. There is still the daily dousing that can propagate mold and bacteria, spiritually speaking, but God’s grace can keep us cleaned up, can heal what hurts, what causes smelliness and damage. I am a really good receiver of grace but I desire to be a better giver of grace. Only then can I absorb the sin, unkindness, lack of respect, and ignorance of those around me. Only as I extend the grace I have been given can I make the world a cleaner, brighter place. Just like our bathroom fan.

Our new ceiling extractor fan in the roof of our shower. That is our “widow maker” hot water heater on the wall in which water runs through an electrical heating element. So far no shocks although I have felt buzzing in the metal water pipe.

Liver Failure Week

I am back in a normal hospital ward for a change, and it feels so relaxed in comparison to the weeks I have spent in the ICU and in the COVID wards. It turns out this is the week of ascites and liver failure. I do not recall ever having so many patients with liver failure at the same time in Kijabe. Alcoholism, Hepatitis A, and still to be diagnosed causes for liver failure fill the wards. I have been opening my computer and looking up possibilities for liver failure and ascites to try and solidify diagnosis. In addition heart failure, intestinal bleeding, and bone infections round out the service.

I am glad to be on the wards, because we have more clinical officer interns and medical officer interns present to know and to train. Frequently I find myself pushed to improve through their questions. This week I am working with one specific intern who begins many of his questions with the phrase “with all due respect”. When I hear that at the beginning of a question, I know that I have possibly missed something and that my intern is feeling pretty secure in questioning a treatment plan. This intern has me on my toes, and it is good. He makes me look into why I am doing some treatments in the manner I am doing them. Have I gotten a little relaxed in a resource limited setting? Am I still pushing for excellence in the care of our patients? He knows what the book says, and he wants to know why what we do does not always match the guidelines. Often there are reasons that are sound because of the financial and logistical constraints of the hospital, but other times I am left with the thought that I should be pushing harder for increased levels of care. In this way it is a good push, despite the discomfort of being questioned. Even as I sit typing the post, I am wondering if all of the internal medicine consultants should get together to see if we should go over our guidelines again to see if we can become less constrained by our resources and push for less limitations in our ambitions.

This is ascites due to liver failure. It is a picture of a patient in Peru that I used to care for periodically when he came to the hospital.

By Annie Caire – A Repost from When We Lived in Peru –

Choquequirao

“This is going to be great,” Sarah exclaimed.

This was not going to be great. Dad was making us go on a four day hike that none of us wanted to go on, except of course, my little sister Sarah, who was very optimistic.

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Getting ready to head out. We have just unloaded from the vans.

We climbed out of the van with the rest of the group and started carefully going down a very steep hill that lasted for, what felt like forever, when in reality was just the rest of the day. While we were sliding down the hill, the group separated because some people went slower and some people went quicker. My parents had walkie talkies to keep in touch with my brothers who were ahead of us. When we dragged into the campsite we were exhausted. My mom was in charge of cooking dinner that night. She prepared the best spaghetti I had ever eaten. After dinner we looked up at the brilliant stars. Mom and I climbed into our cozy tent and fell asleep right away.

During the night mom got sick with diarrhea. “I’ll be okay,” she said. “Don’t worry about it.”

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Beautiful! Can you see us standing on the trail?

But as we went down the hill mom had to make many stops behind a bush. Mom saw the walk ahead and felt dizzy. We were considering going home, but mom kept going. David and I went ahead with a young couple, David and Ari. I had known Ari since the day I got to Peru. She worked in the hospital with my Dad. She was very funny and had a unique personality. Then she married my peruvian teacher, David. Peter and Sarah were a group, and Dad and Mom were a group. Mom and Dad were way behind. Dad was being patient and waiting for Mom while Mom was doing her business. The hike was super steep and we hiked non-stop. There were no flat parts at all. It was a very eventful day. When mom and dad finally got to the campsite, we had already eaten.The campsite was super cool. It had lots of wind, it was extremely high up, and it had an awesome view. It was a lot better than the other campsite.

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Dinner on the second night in a small restaurant. There are no roads to Choquequirao, and so all the provisions are brought up by mules for the people who live here.

We ate at a typical Peruvian house. We paid them some money and they brought us some food. It was cool because we got to see what it was like to live in a Peruvian house. There were guinea pigs running across the floor, and dirt walls. After that I took an extremely cold shower but it felt good. We went to bed exhausted. But I didn’t sleep very well because in the next tent they were playing games and being very loud, but I woke the next day refreshed and ready to go.

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The family looking over the ruins! For some reason Dad thought they were “awesome!”

We hiked the rest of the way to the Incan ruins. They were pretty cool but definitely not worth the hike. At least that’s what I thought. We ate our lunch there, a few granola bars and some fruit, and then started walking to the camp we stayed at the first day. It was miserable on the way down. I thought I broke my toe because it hurt so badly and I cried at one point. I rode a horse for about fifteen minutes and we were at the camp. Ari and David, that young couple me and David walked with the day before, were in charge of dinner. Basically we had raw rice and raw vegetables. They were not good cooks. I imagine they’ll get better at it. I mean they had only been married a couple months. When I went to use the restroom it was very disgusting. The toilets weren’t flushing so they were overflowing with brown and yellow. Mom went to go talk with the manager about the toilets. It took a while for them to fix it. We went to bed exasperated. That was definitely the hardest day yet.

For breakfast the next day we had granola bars, again. We were hiking up the hill that we went down the first day. Mom and Sarah were so worn out that they got on a horse together and were at the entrance in no time. David and Peter went ahead and so it was just Dad and me. I talked and talked all the way until we got to the entrance. Dad would be like “ I need to take a break Annie,” and I would say “Okay,” and we would stop. I wasn’t tired at all! I told dad about “The Ted Wars.” That was when I stole a stuffed animal named Ted from my brother David. He stole it back and then I stole it again and so on. I told him about my favorite part of the hike, about my friends, and practically everything I could think of! Right when we were walking up the final hill we saw two amazing condors soaring above us.

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Walking up the hill on our last day!

They were so close I felt as if I could touch them. It was an amazing experience. When we got to the entrance mom gave me some money to buy a snack. The car that was picking us up was very late. Something about peruvians you probably didn’t know is that peruvians are always very late. I ate my snack and talked to my teacher, David. When the car finally came I climbed in ready to get home. We all marveled at how we just did that long hike. I was glad to get home. But if someone invited me to go again, I would say yes.

We Chose This Too

We were stuck out on the lake for an extended period because a hippo came and hung out where we bring our boats ashore. He eventually moved on, but too late to avoid some pretty painful sunburns.

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.

Information for Hospital Volunteers

This is from the Samaratin’s Purse website.

Mission Organization: Africa Inland Mission (AIM)/Africa Inland Church (AIC)

Profile: Kijabe Mission Station was first established by missionaries from AIM as an outpost in 1903. The first hospital at Kijabe, Theodora Hospital, was established in 1915. This served the medical needs of the area until the present complex was begun. The first building of the present complex was opened in 1961.

Today, Kijabe Hospital is a non-profit, 363-bed hospital owned and operated by AIC of Kenya as part of a network of four hospitals and 45 dispensaries. It employs over 900 staff and strives to balance Kenyan and missionary consultants. The hospital offers a broad range of inpatient and outpatient curative services to people from the surrounding farming communities. The hospital includes five inpatient wards (general surgery, medicine for adults and children, obstetrics and gynecology, neonatal care, and rehabilitation), nine operating rooms, an outpatient clinic and 24-hour casualty department, an eye clinic, and a full-service dental facility. Support services include a clinical laboratory, a fully equipped pathology department, X-ray, ultrasound, electrocardiogram, pharmacy, physiotherapy, and central medical supply. Kijabe’s laboratory offers immunohematology, hematology, biochemistry, parasitology, urinalysis, bacteriology, and blood banking services.

The pathology department provides tissue diagnostic services to 37 mission hospitals in East Africa. The OPD provides services for general acute illness as well as specialty clinics in diabetes, orthopedics, rehabilitation, ophthalmology, TB, gynecology, high risk pediatrics, and AIDS. Malaria, pneumonia, TB, tropical diseases, and AIDS are common diagnoses. A Maternal-Child Health Centre (MCH) within the hospital provides antenatal care, family planning, and childhood immunizations. Kijabe also sends mobile health teams to 12 villages each month to provide these same services.

Kijabe is a general hospital and performs more than 200 operations each month. In past years, the most commonly performed operations have included: C-section, tubal ligation, exploratory laparotomy (non-trauma), skin graft, supra-pubic protatectomy, D&C, hysterectomy, ORIF femur fracture, salpingectomy (ectopic PG), sequestrectomy (osteomyelitis), and removal of various cancerous tumors. A dental department was begun in 1978 as a satellite clinic of the main AIM dental clinic in Nairobi. The hospital also trains nurses and medical students and has Community Health Evangelism (CHE) and chaplaincy programs. Because people know they can receive quality care at Kijabe, many are willing to wait weeks or months for their procedures. Bed occupancy averages 80 percent.

Travel: Fly by commercial airline to Nairobi; drive approximately one hour to Kijabe (6 km down a steep, winding, narrow but paved road off the main Nairobi/Nakuru highway). Time Difference +7 hours Daylight Savings Time (EST), U.S.A.; +8 hours Eastern Standard Time, U.S.A.

Location: Kijabe Hospital is located about 60 km north of Nairobi. The altitude is 7,200 feet up on the edge of an escarpment overlooking the Great Rift Valley which extends from the Sea of Galilee to Zimbabwe. People The largest group of people served by Kijabe Hospital are the Kikuyus, although the number of Masai patients has recently increased.

Language: Swahili and English are the official languages of Kenya although local tribal dialects are also spoken. All medical staff speak English fluently, and nurses provide translation to Swahili or Kikuyu. Medical records are written in English.

Religion: The population is primarily Christian (Protestant and Catholic), although some of the more remote tribes practice animism and spirit worship. Muslims and Hindus comprise a smaller portion of the religious community.

Climate: Kijabe is a Masai word meaning “Place of the Winds.” Although strong winds are common, there are periods of calm on most days. The high altitude makes for generally pleasant days (about 80°F) and cool, windy nights (about 55°F). There are two rainy seasons in March–June and October–December. June–August can be quite cool and December–March is typically dry and hot. There can be a lot of mud in the rainy seasons. June––August can be quite cool. December–March is the driest and hottest season.

Housing: Housing is in modern, comfortable homes, duplexes, or apartments which have kitchen equipment, hot water, and electricity. The housing is simply furnished, secure, and near the hospital. Daily housing costs cover electricity, water, security, appliances, and furniture. The Pathology Department has its own apartment for visiting and/or resident pathologists.

Food: Meals are not provided at the hospital so be prepared to buy your own food and prepare your own meals. Most basic items (including fresh foods) that are available in U.S. grocery stores can be found in Nairobi. For More Information Contact Mackenzie Welde by email or by phone at: (828) 278-1371.