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It is not all sunshine and roses here. OK, well it is all sunshine, but I do want to mention some of the not-so-glorious aspects of life here since someone mentioned that it sounds like I’m having a “heavenly” time. I just tend to focus on the positive. Don’t read these and think I’m all depressed, I love it here and these are very minor inconveniences.

-Dogs howling to the call to prayer. Every. Single. Day.

-A huge variety of insects are available for close inspection here. Bugs in your food, bugs in your hair, bugs in your water, bugs everywhere. Before I came here I had only mosquito bite this year. I have now broken my all-time record for bug bites.

-The water here is not clean. Hence the loads of patients seen with awful GI diseases. We filter all the water we drink, cook with, or brush our teeth with. There is a really cool project here where children admitted to the hospital with GI illnesses are provided with a water filter for home use.

People here without wells have to walk to get water, sometimes far distances because the city water may not be on that day to their nearest spigot. Some people just walk a long distance and draw from the lake. Which is nasty. There are dozens of young men who carry 5 or 6 large jerry cans on bicycles and spend all day walking their bikes back and forth and selling water. One day on the drive to work there was a ditch full of water and 3 women were scooping it out into pots and pans. Speaking of city water; it gets pumped to your house or spigot at different times of the day for varying amounts of time. So your washing machine may or may not work (which depends on if the power is on or off anyways. Sometimes it’s hard to get both the water and the power coordinated.) When the city water isn’t on we still have water, it just has no pressure and a small stream. Washing dishes takes ages, and it is almost futile to try and wash your hair. When the city water isn’t on the toilets at work don’t flush, so you have to tote water from across the hospital campus to fill up the toilet tank. The bucket that goes in the staff bathroom is pink, so that’s always fun.

-Plumbing is a problem. There is a lot of magnesium in the water here and pipes just bust constantly. My hosts know more about plumbing now then the local plumbers and have replaced at least 3 parts in the past 2 weeks. My ear is now finely tuned to know if a toilet will run within just seconds of flushing. I’ve ghetto rigged my shower piping myself already a time or two with some zip ties.

-Dratted ringtones. The most annoying thing I have encountered here is stupid ringtones of songs I disliked on the radio in America and never expected to hear in this place. They follow you everywhere and haunt your dreams. Though walking down a dirt road with destitute people and hearing “Fancy” blaring is kind of fun. Also, everyone’s text alerts aren’t just sounds, they’re songs. I can identify staff members simply by the sounds because everyone texts here constantly and never turns the sounds off, even in staff meeting. I even know some of the patients or family members’ ringtones quite well. People answer their phones while in conversation with patients, while in meetings, while pushing IV drugs.

-Length of time needed to cook. You can literally spend all day preparing dinner. For example, say you want to make hamburgers. You have to bake the buns from scratch, so you spend all morning preparing the dough and making those. It can take while to go to the market. You have to soak your tomatoes in iodine. You have to grind the beef yourself. It just takes a long time. We pasteurize our own milk and make our own yoghurt. We cut our own pineapple. If you buy pork you buy a huge chunk of it and cut it yourself. You want spaghetti sauce? Make it yourself. Etc, etc. It’s not bad, there just no fast food. You have to prepare ahead.

-People yell at each other a lot. It's completely acceptable to raise your voice at someone here. Patients yell at each other, at each others' children, at the staff. Staff yell at each other and patients. Shop owners yell at each other. Drivers yell at walkers. Walkers yell at bikers. Bikers yell at the shop owners, who probably yelled at the patients... I hate it. Can't we all just be friends?

-No AC. The only AC I have felt since arriving in Africa has been in the pharmacy store room at the hospital. I discovered this fact last Friday. I walked in to ask for dispensing bags and was so shocked I said “It’s COLD in here!” and the pharmacy tech started laughing at me. Anyways, I like being warm so it doesn’t generally bother me. There are times however, where it becomes quite toasty in the ward when there’s no wind at all because the fans don’t work. Also, I often wake up in the middle of the night burning up because the power has gone off for a while and the fans went off.

I tore the following article out of a magazine years ago and there’s no author on it so I can’t reference it properly, so I hope none of my former professors read this.

“The biggest lesson I am learning in ---- is not perfecting the bucket shower, or finding more energy to greet every person I see, or finding ways to sleep in sticky weather, or how to work with children and foster parents, or even understanding this culture. The lesson I am learning is that Jesus is everything. When relationships are broken, when I am tired and have no strength, when there seems to be no answers, when I want to give up, when I feel joy or pain, when I face uncertainty about the future, I must seek Jesus. Everything is about Jesus and His plans, His desires, and His passions. This life in --- is extremely difficult, but the crazy thing about it is from this position I know Him in ways I have never known Him before. “For the love of Christ controls us, because we have concluded this: that one died for all, therefore all have died; and He died for all, that those who live might no longer live for themselves but for Him who for their sake died and was raised” (2 Corinthians 5:14-15).

Bama Representing

Clinic day on Wednesday included 58 pts in 7 hours, including 8 ultrasound and 2 echos, and the power going out multiple times that evening. I’m telling you, the most delightful elderly people come to that clinic. I love them. They are just so grateful for everything and to still be alive and kicking. Their family members take wonderful care of them. One gentleman came in that had had a previous stroke with complete right sided paralysis. It was so packed in the courtyard that a wheelchair couldn’t fit, so two of his grandsons carried him in. They also knew what medicines he takes and help him do therapy, etc. It’s fantastic. A 72 year old lady came in who looked fantastic, and I told her so. She said she had 15 children and 40 grandchildren. And you thought I had a big family. The clinic also sees sickle cell patients. Mostly they either get blood transfusions or just folic acid prescriptions. No drug seekers here because there’s no pain medicine.

I saw a young man running along the side of the road in a familiar shirt…. Bama people, y’all are representing all over. Some 30-13 score on the back of his shirt. Apparently massive crate loads of used and new clothing are shipped from various places and sold in a huge market in the capital. I have seen a lot of out of place and very specific t shirts here. Indiana Varsity Volleyball 2004, National Guard, Smith Family Reunion 2005, Winn Dixie, etc. You also see many sweet, friendly people with quite awful language on their shirts.

Thursday. OK, good news first. We got Happy referred to another hospital to get her leg fixed! I’m so glad. Patient advocacy, y’all. It would have healed crooked. It took some arguing and convincing and pushing around, but she’s going!

Happy's Femur

 

These are just the cutest children. In fact, most of the people here are so vibrant and so beautiful, I truly wish you all could come experience it. There was a 5 year old with malaria who was completely unresponsive on Monday, though breathing on his own. He was improving a little each day with meds, like on Tuesday opened his eyes to a deep sternal rub. Today, his NG tube was out, his O2 was off, and he was up walking around! Still weak and sick-looking, and he had an ulcer on his poor little ear from the nasal cannula, but alive! It was exciting.

Sad news: the doctor diagnosed two patients with cancer. The word cancer strikes the same fear in people here as it does everywhere else. A sweet 70 year old man had multiple cancerous nodules on his liver. The doctor had a long talk with the man and his daughter about the results and needing to get right with God. The daughter was very much in agreement and the man also agreed, but not as enthusiastically. The second patient was a 1 year old he diagnosed with Wilms’ tumor. She had a huge tumor growing on her right kidney that her parents had just felt a week ago. Luckily, there is treatment in the capitol city and children usually do quite well and survival rate is high. But the news made daddy hug her so close and both parents had tears in their eyes. The doctor prayed with them and they stayed calm and were making plans to go to the capitol. A 3 day trip, but that’s where the chemo and pediatric surgeons are. Budd-Chiari syndrome is a new thing I learned about when the doctor found a clot in a lady’s portal vein. She had massive ascites, as in 15L drained off (which is too much to do that quickly), and he was looking at her liver. There’s no treatment here. She’ll have to come to the hospital every week for the rest of her life to get the fluid drained off. She’s 32 and has multiple children, including a 5 month old.

This morning while getting ready to go to the hospital there was no power. Came home today and there’s no water running to the house. This is why laundry is difficult because you have to have both at the same time for the washing machine to work.

There were nursing assistant students at the hospital I had never seen before. No weights or vital signs had been taken. The doctor informed me that I may have to teach a new group every week because they rotate so often. So I made new friends and had a class and we weighed and vital signed every single patient in the building, which took hours. It was really full today. There were 2-4 adult females to a bed in the female ward. They were cute, as soon as they figured out what we were doing, the ones that could walk all started rotating to the scale and then moved to the bed closest to where we had the vitals machine.

I hate people touching my neck, I do. Many people, mostly my brothers, enjoy this fact. There are mosquito nets hanging over every bed on the ward. I was leaning under a net and felt something on my neck. I thought it was a fly, so I swatted at it and continued evaluating the little girl patient. I still felt it a few seconds later, so I reached up and pulled off a moderately sized spider. He wasn’t huge, but he looked like he works out several times a week. The little girl’s eyes got big, I threw the spider down, it ran away, everything was fine. I moved my stethoscope. I feel something else on my neck. I reach up and pull off moderately-sized spider’s Crossfit coach. The little girl held her breath, I threw the large spider further away, it ran away, and I quickly finished my assessment and moved away from the net. I don’t think people touching my neck will bother me anymore.

Also, one time I was swatting at flies that were around my face and one of the nursing assistant students asked “You don’t like flies?” I think I stared at her for a moment before tactfully replying “It bothers me when they’re around my eyes and face.” “Oh.”

I like being joyful, and I like being able to be joyful despite circumstances. I just forget to choose to be sometimes. “You have made known to me the path of life; in Your presence there is fullness of joy." Psalm 16:11. There is also a difference in simply being happy, and finding joy and peace in God's presence.

How could you not be joyful with a sunset like this?

 

“Faith is the art of holding on to things your reason has once accepted, in spite of your changing moods.” C. S. Lewis

I must have looked particularly rough this morning at chapel and staff meeting because I got more English “Good morning” and “How are you?” than I have had in all of my time here combined. I didn’t even know that half of the people who greeted me knew any English at all. There are at least 7 greetings that I know, and I suspect they invent a new one every day. When someone says a greeting I don’t know and I just shake my head, they keep holding onto my hand and someone nearby gives me the right answer. They make me repeat it till I get the pronunciation right. It’s difficult for me to remember how to eat breakfast at 7am, much less greet 15 people in another language and learn new words while I’m at it. But I continue on.

I love you and appreciate your encouragement!

Happy

Church at the same place as last week. This Sunday the service lasted 3 hours. There were many testimonies given, many in song. I enjoy the singing thoroughly, so I didn’t mind. Also, loads of adorable babies being passed around and toddlers playing in the aisles. The only way you knew who a baby truly belonged to is who finally took the baby out of church when it started screaming. Seriously. One man stood up to give a testimony and was holding a sleeping child… 3 minutes into his story a lady walks up and takes the child.. a few minutes later she wanted to give a testimony, so she passed the kid to the lady next to her. The lady next to her had to sing in the choir later, so she passed it on behind… I thought I was going to end up with a free baby and got excited, but it never got to me.

Allow me to try and paint a picture for you of particularly interesting woman who stood up to give a testimony. She had a vibrant traditional African orange dress on, with a fascinating pattern of horizontal stripes, green parrots, and a large triangle of gold glitter on the front. The amount of fabric required to cover her frame provided a clear view of all the details of the garment. She wore a neon pink head wrap, the top of which stood a good 8 inches above her head, and looked just like the tissue paper sticking up out a gift bag. This was also one of the women who would get up and go dancing amongst the choir members and throw money on the ground when the songs got exciting. I think I forgot to mention this little detail in my post about last church: The women in the audience make a sound like a mariachi band when they get excited or like the song a lot. I don’t know what it’s called, a trill, a yodel? There’s an elderly lady who kind of props herself up against the wall and looks like a broken hip waiting to happen. She does the sound most often. I need to take lessons from her so I can always travel with a Mexican band if I need a back-up career. Or I could be a travelling mariachi nurse. So many options.

Hospital was good on Monday, interesting. Staff meeting included one of the loudest arguments I’ve heard yet about the drug of choice for malaria. The 20 year old guy in a coma died over the weekend. No doctor had rounded on any of the patients for the weekend, so we were busy catching up. We were like discharge fairies on the pediatric ward. You get to go home on malaria meds and Tylenol, and you get to go home on malaria meds and Tylenol, and everybody gets to go home on malaria meds and Tylenol!

A 6 year old girl with a fractured femur still had her leg in traction. A different physician had decided against referring her to a hospital that can do the surgery. The physician I round with actually did an ultrasound and could see from the bone’s shadows that the bones weren’t quite aligned, so they realigned the traction, but she’s going to have a crooked leg when it heals. There is no portable x-ray here, but the ultrasound was better than guessing. The girl is very sweet natured and giggly, for having spent the last 4 days with her leg tied to the bed. Her name is Happy. I was talking to her and she started singing “If you’re happy and you know it, clap your hands.” She doesn’t speak English, her mom doesn’t speak English… I’m not sure where she got the song from, but she’s adorable.

Happy!

 

I was checking a sweet 60 year old’s heart rate, and it was jumping from 50s to 90s, so I listened to her, the doctor listened to her, diagnosed her with atrial fibrillation. She had come in for a cough and shortness of breath, but her saturation was still 98%. I asked what we do if we suspect pulmonary embolisms or what kind of meds are available for a-fib. He said they have aspirin. Possibly digoxin, as that is usually available here. An EKG might be done later. We move on. A little while later, screaming erupts from down the hallway. She died. She could have thrown a clot, she could have gone into a lethal arrhythmia… God only knows. Abnormal heart rhythms here are bad news because of very limited treatments available.

A kiddo with asthma needed a spacer for his inhaler… they made one out of a saline bottle. Inventive.

The doctor did eight ultrasounds after rounds. One lady had twins kicking around in her tummy! She was so thrilled, it was awesome.

After we finished at the hospital, we went shopping to go get a voltage stabilizer/converter for the new oxygen concentrator a church sent. Eight stores later… we finally found one. There’s no Home Depot here. You just go from little shop to little shop and ask who might have one. After that, I went with two other American women to a different market to find fabric and vegetables. It only took us five shops to get the fabric and two stalls for the veggies. You know, there are times in life when you just have to accept that blending in is absolutely impossible. For example, when you’re white and in a market in Africa.

These types of dresses are actually worn.

Inside the vegetable part, where it's actually dark and not hot

 

The power has been going off multiple times a day recently. It’s a little rough on some of our friends on oxygen because the convertors just shut off. There’s no back-up power or generator at the hospital. The fans in the ward don’t work anyways, so power doesn’t affect the work otherwise.

The power went off last night at the house and I went for the matches and candles. My hosts, who are around my parents’ age, went for their phones. Generation gap.

At the beach I heard a mom calling for her child multiple times who was busy playing in the waves. When she finally got her attention she said "Do you know how many times I called your name? I need you to be listening for me calling your name, even when you're having fun. I may need to tell you something important to keep you safe."

I looked around for someone to draw a spiritual lesson out of that for me, but I was the only one who had heard. So here you go:

How many times does God have to call my name for me to hear Him? How closely am I listening, even when I'm having fun?

Thank you wonderful people for all your encouragement!

Dance, Monkey

Apparently Saturday is wildlife day in these parts. Zebras last Saturday, saw them again today and monkeys were all over the beach! Usually they try and steal your food, but they were polite today and posed for pictures instead.

 

Baby monkey butt

 

Baby monkey circled in purple for those who are as blind as me

 

 

It also rained as we were leaving the beach. I believe the phrase “torrential downpour” would be appropriate. The road going to the beach is a dirt road that is very bumpy and rough anyways, then with the huge rain it started flooding within 3 minutes. 4 wheel drive is a gorgeous thing. Because the dirt is so dry and packed here, the water doesn’t soak in at all, it just rushes over the roads. People were running outside and putting buckets out to catch the rain, goats were standing up against the sides of buildings to shelter, and the little dalahs were parked on the side of the road because the water was over the tires. Miniature mud avalanches everywhere, the car slipping and sliding a touch. It was exciting (and we got home perfectly safe, Grandma.)

I wrote the above on Saturday, but we’ve lost power multiple times the past few days so I just didn’t get around to posting it. Sunday I was struggling with the stress of not having a home to move back to when I’m done here. I jokingly told my parents at the beginning of the summer that “There’s a fine line between minimalist and homeless.” I’ve been meandering around on the homeless side of that line for a few months now and sometimes I get tired, both of my literal duffel bag and the metaphorical one. (Can you have a metaphorical duffel bag? Is that a thing?)

However, my conclusion after quite some time of reflection is that I have a firm trust and knowledge that God is very good and so very stable. It doesn’t matter where my physical home is, or where I sleep. You know: “For this reason I say to you, do not be worried about your life, as to what you will eat or what you will drink; nor for your body, as to what you will put on. Is not life more than food, and the body more than clothing?” Matthew 6:25

And Jesus said to him, “The foxes have holes and the birds of the air have nests, but the Son of Man has nowhere to lay His head.” Luke 9:58

I don’t need a nest or a hole. For our citizenship is in heaven, from which also we eagerly wait for a Savior, the Lord Jesus Christ. Philippians 3:20

Hot Potato

Clinic day on Wednesdays! My favorite. It’s nice being busy and also getting to spend time with patients. We saw some of the cutest children and most delightful people. One kid cried when he saw me and his mom said he had never seen a white person before. Apparently I represent poorly. I apologize. A young pregnant lady came in with her husband. She hadn’t felt the baby move in a week, and sadly the fetus wasn’t viable on the ultrasound. The doctor was able to pray with the parents which was neat. The mom said she had lost several children in pregnancy, but did have 2 living children. I think I’ve mentioned before, it is quite common here for women to have multiple unsuccessful pregnancies and to lose infants or children. A man came in with a very high blood sugar. He lives out in a village and it costs him 2 weeks wages to travel in to the clinic to get his medication prescriptions. We prescribed him double the usual amount. He had nail clippers on his keychain. One old iron key and nail clippers. Just the necessities.

 

My friend who wanted me to take a picture of him roaring like a lion. There's no HIPPA here.



Thursday was interesting. We didn’t do rounds on Wednesday because of clinic, so the wards were a bit messy. Apparently without constant reinforcement things do not get taken care of the way they should and there are no consequences for jobs poorly done. However, there was a group of nursing students and nursing assistant students there that followed me around and laughed at my Swahili, but were willing to learn. There doesn’t seem to be a great deal of direction for their clinicals, they stand around until the nurses tell them to do something. They do a lot of cleaning and a lot of unsupervised work. The doctor suggested while they were unoccupied that I do some teaching. With much stumbling through Swahili and English, we actually did spend a good while on a variety of subjects. Two of the nursing staff, two medical students, and one of the nursing students spoke good English. Topics of discussion included: turning patients to prevent pressure ulcers, how to take vital signs correctly, why taking vital signs are important, what normal and abnormal vital signs are and when to report them to a physician, how to weigh a patient, why accurate weights are important, etc. They were largely unaware of all of these topics, even those who were in their later years of school. I would understand the nursing assistant students not understanding the pathophysiology and why we do things certain ways, but nursing students? Very different from our schooling.

How does one go about trying to help in a way that will last? It’s a very difficult situation to try and figure out. I don’t work here, I’m not a manager. I’m a short term volunteer who can hardly communicate and don’t want to be overbearing with my western ideas of how a hospital should run. I want to obey God foremost, but I also get very caught up in thinking about how everything could be so much better “if they only did this.” I’m praying a great deal and would appreciate yours as well.

On the pediatric ward there were 2 patients that had 2^nd degree burns. It was strange, they were very similar. One was 4 years old, the other was 5. Both had burns on their butts and upper thighs posteriorly from boiling water. I don’t know if it was from bathing or playing near the cooking fire, I did not ask. The one kiddo was screaming, the other was fine. The poor screamer only had Tylenol equivalent ordered every 6 hours. I got some ibuprofen and we rewrote the MAR so he was getting something for pain every 3 hours. There’s nothing stronger available for kiddos. The medication administration papers are handwritten here, no fussing about scanning your meds.

The wards were not very full so after rounds the doctor did several ultrasounds and I did some more English/Swahili with some of the students. They’re very interested and want to meet next week for “English lessons.” We’ll see if that works out, but I’m perfectly willing to try and glad for the opportunity to build relationships. Should probably brush up on my English over the weekend. A sweet lady that the doctor did an echocardiogram had an absolutely massive heart, she was 32 and had peripartum cardiomyopathy after her last child was born. I checked her O2 saturation out of curiosity, it was 86%. Apparently 1/3^rd of women with peripartum cardiomyopathy get better with meds, 1/3^rd stay stable, and 1/3^rd never improve. She has 4 children. I hope she improves. The doctor adjusted her meds a little bit and sent her home.

Interesting facts: Healthcare for women is free for all prenatal care till 42 days after giving birth. Healthcare for children is free till 5 years old. Healthcare is free after 60 years old.

Started off Friday with a riotous staff meeting. The hospital is out of gloves. Someone ordered a wrong dose of medication. Everyone had an opinion about every topic. I went to my happy place. It is amazing to me how many people they can fit on these small benches. These are well-nourished, fully grown adults, squeezing 6 of them on a bench that comfortably fits 3. I suppose many of you are aware, but there is no concept of personal space here. For example, the pediatric ward was completely full today. As in we had more patients than beds. Since the moms stay with the children, a few of the beds had 4 people on them. It got a little confusing, almost like a large game of hot potato going on with the charts as well as the babies.

The 2 boys with the burns were so much better today! They were limping around with little canes and were all smiles. They both had their wraps are tied over one shoulder so it wouldn't touch their burns and they look like miniature old men, it was so precious.

We were crossing the street and someone told me to “look out, because sometimes people forget that we drive on the left side and look the wrong way for traffic.” As she said this, a goat bumps my legs, 2 children with brooms run past my right arm, a man with a basket of fruit on his head passes me on the left, and 2 bikes, a motorcycle, and a van drive in front of me not really following any type of rules. Cars on the left side are not what are worrying me.

 

 

 

It's not a monster, it's a man carrying grass on his bike



 

Now for this very reason also, applying all diligence, in your faith supply moral excellence, and in your moral excellence, knowledge, and in your knowledge, self-control, and in your self-control, perseverance, and in your perseverance, godliness, and in your godliness, brotherly kindness, and in your brotherly kindness, love.  For if these qualities are yours and are increasing, they render you neither useless nor unfruitful in the true knowledge of our Lord Jesus Christ. 2 Peter 1: 5-8

Pray that these qualities will be mine and increasing so that I will be useless nor unfruitful in the true knowledge of our Lord Jesus Christ.

Pictures

I finally got some of the photos off of my phone from the first tour of the hospital. Plus a few from my camera. It takes ages to upload pictures here as the Wifi takes naps.

One row of the pediatric ward

Family waiting outside of labor and delivery
 

Just because this is my favorite picture.

I feel so at home

This lady had been walking on this fracture for 5 days before she came to the hospital

I know you've seen these already, but they're ZEBRAS!

 

 

For those of you who have been asking how to donate to the hospital and the work here, the easiest way for the ministry to get the money directly is to go to this link:

https://netcommunity.imb.org/SSLPage.aspx?pid=300

And put "Larry and Sally Pepper Hospital Ministry." in the additional information section. If you would like to donate for a specific reason you can put that in there as well. For example: For Larry and Sally Pepper ministry, for malnourished children." Dr. Pepper says they usually use the "random" ministry funds for feeding malnourished kids, buying medications for mobile clinics in villages, or buying expensive meds that families can't afford. Generally churches are the ones who commit to buying oxygen concentrators, funding a building project, etc.

You are all lovely people and I appreciate your encouragement and prayers!

Kind Of Sterile

Here’s the part I wrote on Monday that I didn’t post then:

Today (Monday) wasn’t that busy, except nothing the doctor had requested on Friday had been done. I spent the morning weighing patients and getting vital signs. None of the patients had been weighed and the most recent vital signs were from 6pm Sunday evening. The language barrier makes it difficult to explain to the nursing assistants WHY vital signs are important. One sweet girl all the way at the end of the ward was super, super sick. Heart rate 180s, elevated temp, respirations in the 60s. Severe malaria. We saw her on Friday and she was sick, but still responsive. Today she wasn’t hardly moving, but her little glazed eyes were tracking me as I worked around her. I told the doctor how bad she looked, he came and changed how often she got her paracetamol (Tylenol equivalent here) and ordered a bolus of fluids. I checked on her a little while later and she was much more responsive and her vitals were much better. Taught mom how to cool her down with water and fanning.

Another interesting case today was a 20 year old male that suddenly became comatose. MRDT (test for malaria) was negative. There’s no way to intubate or ventilate here, so he’s just chilling here, kind of breathing on his own. He would have been intubated the second he rolled in any ER’s doors in America. They can do a spinal tap here, but they’re out of needles, so they may do one tomorrow.

We went to the market on the way home to get metal rods to build little hand-washing trolleys for on the wards. Which is awesome because I like to wash my hands as often as you’re actually supposed to and there’s still no soap in the hospital. Except the bar I brought up there and put in the staff bathroom by the offices which you have to unlock 2 doors to get to. I spend a lot of time locking and unlocking doors these days. They told me not to leave it out or it will get stolen. Anyways, the rods are 6 meters long and the car is not. The dude who climbed up on top of the car wasn’t too dedicated to the tying-on job, so the ride home was pretty exciting. It was basically a jousting tournament.

When we got home, my lovely encouraging hosts decided to have story time about all the different animal sightings and encounters in the lake, which I had been assured many times before was “perfectly safe.” Now they come out with 2 hippo sightings, 3 crocodiles, 2 poisonous snakes, an eel biting, and a toothed-fish biting. I’m never going swimming again. I went kayaking and had to keep checking weird sounds to make sure there wasn’t a stray hippo alongside me. I’m not sure what kind of sounds hippos make, so I checked all of them. I’ll probably have a sore neck tomorrow.

Tuesday:

An eventful day, even without the 2 children dying I mentioned in my previous post. It started with a 1.5 hour staff meeting, which included the doctor meeting with all the head nurses to talk about expectations. He’s not positive it will make any difference. I remain hopeful.

We did an EKG on a gentleman with the only EKG machine in the hospital. Let me explain old school to you young thangs. Electrode gel. Metal cups with a suction bulb. Metal clamps for the limb leads. It looks like a torture device. And apparently this isn’t even “that old” of a machine.

After saying that I feel that I might get in trouble and hear a lot about computers the size of rooms or how they used to draw EKGs with charcoal back in the good ol’ days.

We saw 2 boys with osteomyelitis, which was cool. Not for them, but I had never seen it before. One of them had it in his left forearm, it was draining from the skin and his arm was huge. I almost cried over the other boy. His mom was sick and his dad was out of town and so he came up to the hospital by himself and was limping around with a plastic bag with his chart in it. It was so pitiful. He looked like he was 7. He didn’t understand where to go and kept walking around all lost. When he had finally gotten his x-ray and got back to us, he sat down and pulled up his pants leg and his left knee was massive and draining pus. His x-ray was nasty, his bone was destroyed. They were both admitted for antibiotics and referred for surgery.

We did the spinal tap on the comatose 20 year old. Who still has an O2 sat of 85%, despite not really breathing. You know how they make a sterile field here? They use the sterile gloves wrapping and tear a hole in it. The collection vials were “kind of sterile” according to the lab tech. "What do you mean, kind of sterile? Are these sterile?" "They're the most sterile ones we have." Allrighty, kind of sterile it is. When we finished, you want to know how the family transported the vials to the lab on the other side of town? In a glove. Each vial went in a finger of a glove, we tied the glove shut, and put a piece of tape with the patient’s name on it on the outside. Told the family member not to drop it, handed him the orders, and off it went. True story. In our hospital in the states we are required to walk LP specimens to the lab, so I guess it’s kind of the same… except he had to walk an hour and we walk 3 minutes, in air conditioning.

I’m learning a lot about being still and letting God be God. There is simply not that much that I am able to do. There are limited resources to work with and the staff is highly unmotivated and unreceptive to teaching/change. The doctor has been struggling with that for years now and we have had many discussions about how to create and maintain change. My BSN didn’t cover how to do that in a third world hospital. I don’t think the “You can be a change agent!” method will be effective here. However, as A. W. Tozer said: “How completely satisfying it is to turn from our limitations to a God who has none.”

Be still and know that I am God. I will be exalted among the nations, I will be exalted in the earth. Psalm 46:10

The Lord has established His throne in the heavens, and His sovereignty rules over all. Psalm 103:19

I am not good at sitting still. Or standing still. I want to DO something all the time. So I am learning. Slowly, and painfully, to stand still when the entire conversation around me is in Swahili. To sit on a kayak and look at the mountains and not rush. To leave the dishes to go read my Bible. To sit and pray when I have nothing to occupy my hands. To be still. To abide. To remain.

Remain in Me, and I will remain in you. No branch can bear fruit by itself; it must remain in the vine. Neither can you bear fruit unless you remain in Me. I am the vine; you are the branches. If a man remains in me and I in him, he will bear much fruit; apart from me you can do nothing. John 15:4-5

Malnutrition Is Ugly

Today was difficult. I had very few expectations in coming here, I was just obeying God and had no idea what I was getting into. However, I did expect to be useful and able to help. Two children died this morning. I sincerely hope none of you ever have to watch a child literally starve to death.

I’ll spare you the details, but the boy had Marasmus, which is the form of malnutrition where they shrivel up instead of the bloated belly, which is Kwashiorkor. He had been unresponsive the last few days we had rounded on him. We couldn’t feed him because there are no NG tubes in the city right now. We even called all the pharmacies and they’re all out. Even if we did have an NG tube, there’s no real tube feeding available.

The second patient was a beautiful little girl who died of severe malaria and probably cerebral edema. I have a half written blog post from yesterday about how sick she was that I will probably post later. Today I went and saw her first, (her bed was at the far end of the ward) and her heart rate had dropped, Cheynes Stokes respirations, and fever of 39 C (102.2 F). I pulled the doctor over, we gave some ibuprofen and some more fluids, which was all we could do. We rounded on a few more patients, keeping an eye on her, and a few minutes later the mom started screaming and the girl had died. Again, none of the staff seemed to care except me and the doctor. Other moms in the ward went to comfort her. The language barrier made me mad, all I could say was “sorry” in Swahili. It was rough because I had actually been building somewhat of a relationship with the mom since we had seen her several times.

The lack of resources made me sad, but as my boyfriend reminded me: “God is who is ultimately in control, whether you have the resources of Johns Hopkins or a third world hospital.”

My loving sister sent me a link from David Platt: What the Gospel Demands.

http://www.radical.net/media/series/view/165/what-the-gospel-demands?filter=series

He talks about children dying, but isn’t vague about it.

The whole day wasn’t bad, there were good bits as well as a stunning sunset over the lake and it was clear enough you could see the mountains on the other coast, 35 miles away.

Pray for the moms: The Lord is close to the broken hearted, and saves those who are crushed in spirit. Psalm 34:18

 

This is my prayer in the desert
When all that's within me feels dry
This is my prayer in my hunger and need
My God is the God who provide

And this is my prayer in the fire
In weakness or trial or pain
There is a faith proved
Of more worth than gold
So refine me Lord through the flames

All of my life
In every season
You are still God
I have a reason to sing
I have a reason to worship

-Hillsong

 

The Pips, Sailing, and Laughter

        Today has been a glorious day. I went with the doctor and his wife to a local church this morning. This particular church is Baptist, and is on the side of town that is 90% Muslim, and surrounded by many mosques. We passed at least 13 on the way. We parked at the top of a hill where the road stopped and walked down the dusty path, accompanied by a crowd of cheerful, polite, adorable kids. These are the kids you see in everybody’s picture… beautiful smiles, giggling, shy, and eager to touch you. The polite greeting is accompanied by a handshake here, meaning 2 year olds were running up to shake my hand then run away. A great many of the little girls were dressed in what we would consider Easter or Christmas church dresses in the states, which was absolutely adorable. I really, really wish I had the opportunity to take pictures. The church itself is four brick walls and a roof. The floor was dirt, but not packed dirt, it was very loose and dusty. Wood is very expensive here, so the seating consists of benches. Benches meaning 2 thin slats of wood, braced by 3 thin upright pieces. They wobble. Small children fall off, cry, and climb back on. Since we were guests they made us sit in the front row in plastic chairs. Normally I would hate to have the attention, but since the likelihood of me falling off the bench was high, given my history, I was grateful.

Now. Let me try to explain to you the amazing worship service and why I had the giggles the entire time.

First, the singing here is so marvelous. If you have ever heard an African children’s choir, it sounded so much better. There is no inhibition: they sing their hearts out and dance and move and shout and it’s amazing. The volume coming out of these people was impressive. So that was just the congregation singing. Then the choir stands up and then it really gets going. Well. Eventually. The choir has a CD background. Whoever the guy in charge of it starts flipping through songs so we hear the beginning of several, then he picks one, lets it play for a minute, then starts it over. The choir begins to shuffle their feet, then move their arms, then they start singing. The sound was so pure and joyful, I loved it. Now, remember the floor is loose dirt. So after about 2 minutes of the vigorous shuffling, the sneezing begins. A poor girl in front of me was sneezing about every 4^th word, which gave me the giggles. I look away to compose myself, and focus on the back row of the choir, which is the men. What I had failed to notice originally were the 3 small boys on the end. Y’all. They looked like The Pips in miniature. I have never wanted to video anything more. If you don’t know who The Pips are, you are missing out on some rockin dance moves that need to be added to your collection. They were dressed in little button downs and slacks, completely covered in dirt, and trying so hard to keep up with the men.

 

https://www.youtube.com/watch?v=tSXLOQPozOc

 

When they finished singing I finally composed myself and we had a lovely message from Ezekiel 33 and Luke 15 saying that if we say we are of God, but continue to live in sin, then we are not truly of God. However, if we repent, God is gracious and merciful and will forgive us and clean us from our sin. That’s what I got from my translator, anyways.

After an hour of singing and an hour of announcements and preaching, the service ends and we make our way back to the car, again accompanied by a crowd of youths… this time, however, they start piling in the car with us. Apparently the entire community around the church is Muslim and all the church members live quite a bit away. We only fit 19 in the 5 seater today, they said their record is 21. A few adults, some teenagers, mostly little kiddos, and a few itty bitty babies. Tell you what, you don’t get jostled on the roads when you’re packed in like that. Perhaps a bit more warm and the dirt and sweat on the kids leaves mud on you, but I was going to do laundry today anyways.

This afternoon was just as glorious and just as laughter-filled. I’m sitting here, studying Swahili, and a car pulls down the driveway… the doctor’s wife goes out for a few minutes, then sticks her head back in, “Want to go sailing?” Why yes, yes I do. Turns out, a middle-aged British gentleman owns the catamaran that is parked on the beach and had brought a friend to go sailing. They were absolutely hilarious. They did not stop their banter the entire time and were so delightfully British. “I say ol’ chap, would you toss me that line there?” “What, you brought me along just to work, did you? I thought I was supposed to be all posh and enjoying myself!” “What, and leave this young girl and me ol bones to do all the heavy lifting? You’re mad, my dear fellow.”

“I’ve only been out here twice this year, so I’m not sure which bits go where, you know? I think we’ll muddle through, though. What could go wrong?” “I thought you had some kind of certification.” “I do, I have Master’s. But I also have a touch of Alzheimer’s, so I don’t really remember any of it. Don’t you have a certification?” “No, never reached such dizzying heights as a Master’s.”

“Well, you lot take the life vests, and if you lose me, you chaps just go on without me. I’ve lived a good life.” “If we lose you we won’t be able to get back! You’ve got these ropes so muddled so as no one else could ever get them sorted!”

We set it all up, drag it in the water, we go through how we’re going to get in and who’s on what side and whatnot, we get in and somehow I end up with the ropes in my hand as well as the tiller. “Oh, there we are, I got in the wrong side, didn’t I? Mm. Well, you’ve got to learn somehow, m’dear, carry on.” “You might want to tell her how to steer it, mate.” “Oh, righto, must be posh about it. Erm, so push it that way, you go that way, push it this way, you go the other way. That’s about all there is to boating.”

The view was majestic and the sailing was so much fun. I laughed so hard the entire time and think we all need some more Brits in our lives.

Tomorrow is back to the hospital for another week. My goal tomorrow is to get every pediatric patient weighed. Provided the scale isn’t lost. Please pray that I will be useful, use what Swahili I have and learn more, and for me to be listening to God closely. I’m very grateful for this refreshing weekend and grateful for all of you!

-K

Zebras Eat Trash

Thursday we went to chapel before rounds, which is 30 minutes of prayer, singing, and a short message. We show compassion by being kind to our coworkers and providing good care to our patients was the topic and seemed to be well received by the 7 or so staff members who attended. The singing was in Swahili and of course there were no instruments, and they sounded marvelous. Harmonizing, adding parts, etc.

We did rounds of the pediatric, women’s, and men’s wards for the rest of the day.

Friday morning after chapel we attended staff meeting. Let me first explain what was explained to me: Relationships are of the utmost importance here. You must be careful to say or do nothing to damage a relationship. Therefore, incompetent people are not fired and there is no discipline or accountability because no one wants to hurt anybody’s feelings. So we’re going along in staff meeting, and someone brings up the fact that none of the patients are weighed, including the children. All of a sudden the entire room erupts into a shouting match. That one lasted probably a full 10 minutes. That finally calms down and another issue is brought up and off they go again. In the middle of that one they run out of places on the 4 benches in the room so someone brings in another bench and plops it down in the middle of the room for more people to come in and join the chaos. People are running in and out constantly, on the phone, yelling, etc. So after an hour of that, staff meeting is closed and everybody leaves… but no one is angry. Everyone is greeting and shaking hands and happy and making sure no relationships are damaged. I kind of just stared at everyone.

Rounds on Friday were much better than the other few times I’ve rounded with the doctor, but still frustrating. The files were missing again, the charts were just pieces of paper taped together. No vitals had been taken since the evening before although the machine was plugged in at the end of the room. Half of the patients had not received their meds. The doctor says this is completely normal.

Don’t read the following paragraph if you’re tenderhearted.

We round on the pediatric ward first. We’re standing at the first patient’s bed, and I look over at the second bed and say “Hmm, that child is laying awfully still.” He’s also on one of our 2 oxygen concentrators, so I went over to check. The child is not breathing, I check for a pulse and he has none. His body is burning up but he’s completely cyanotic and his extremities are cold. I call the doctor over and ask if they code kids or if they have epinephrine or something. They don’t. He said we could give him fluids is the extent of the treatment available. His pupils were fixed and dilated. The doctor pronounced him, then told the mom, who was lying next to the child while we did all this. Mom started screaming and crying, didn’t want to be touched. Everyone just stood there and stared, then shrugged and turned away. The doctor told the staff to go get screens, they put them around the bed and continued their day. I think I was the only one slightly bothered. Apparently the culture here is very fatalistic, and most parents lose at least 1 child if not 4. We had rounded on the kid the previous day, he was diagnosed with severe malaria and had been treated appropriately. There wasn’t anything more they could have done with the resources available. His last vital signs had been a temperature a 6 am and it was quite elevated. The thermometer is one you just point at the temple, you don’t have to wake up the patient to do it, so the doctor said the kid could have been laying there dead for hours.

I was upset, but not overwhelmingly so, which bothered me. I don’t know if it’s a self-preservation thing to not be emotional or just not super tender hearted anymore after seeing so much death as a nurse. I haven’t figured out a happy medium there yet.

 

While we were in the middle of the ward, one of the surgeons came running up with a huge wad of something bloody in his (gloved) hand. It was someone’s ruptured appendix he had just removed and was super excited about. All the kids were climbing up on their beds to see it. True story.

I made friends with one of the nursing assistant students who said she wants to learn English, so that could be good.

There was a woman who had had a left forehead laceration repair the day before that we saw. Her bandage had not been changed and it was that super sticky athletic tape. It took the nursing assistant 20 minutes to get it off, ripped half of her skin off and it was all infected and nasty. She was 77 years old and somehow was in a motorbike accident. Maybe it hit her, but it’s very possible that she had been riding on the back of one without a helmet.

Walking, bicycles, motorbikes, “dalahs” (I don’t know about spelling), and cars are the modes of transport here, with cars being the least common. Though I have seen a gentleman with no legs peddling a cart around with his hands, so you could probably get one of those if you needed to. The roads are lovely here. Meaning if you have back problems don’t come here, you’ll die. The cars are equipped with 4-wheel drive, which is used. If anyone wants to start a business that sells monster truck suspension stuff you would probably do very well here.

 

 

Got home from the hospital and went kayaking!! It was a little wavy to begin with, then got higher and higher. Is there a word for kayak wheelies? Cause I did some. Also, I found the bat cave. I don’t like bats but since they didn’t try to strike up a conversation with me it was fine. Also, the lake is 5000 feet deep as it is the 2^nd deepest freshwater lake in the world. Glad I didn’t know that before I went out there.

Today, (Saturday), I went to a beach on the lake with another American family from here. It was absolutely lovely and I saw lots of cool fish while snorkeling. It was calm at first then got super wavy and rough, which apparently it does every afternoon. Also, it’s cold, crystal clear, and gets very, very deep.

 

Then after I got back, I SAW ZEBRAS!!!!!

 

 

 

 

 

 

Now, it is not the norm for “zoo” animals to be roaming the streets, they usually stay in parks which are 6 hours away by dirt road, but this particular pack of zebras belongs to the government and they just live here! They eat trash as well as grass, apparently. 5 big ones and a baby one. I was close enough to pet them, but thought “Young Volunteer Nurse Mauled by Zebras” didn’t sound like a good headline.

Please pray for me to learn Swahili quickly, to be useful, and to be listening to God closely.

Love you!

-K

Clinic and Lizards

Busy few days here. Staff meeting yesterday included the physicians as well as the pharmacist (who is the pharmacist for the entire region), and covered administrative issues as well as special cases of patients. An issue brought up was that there is no 2^nd line HIV treatment available in the area. Luckily, the HIV rate is only 6% here. A 7 year old with severe malaria and a hemoglobin of 4 after transfusing multiple times was the main topic.

Then we went on an official tour of the hospital and got to see the lab, the photo of which is on my phone and unobtainable. A counter, a sink, a vial rack, and a bottle of dye.

They can do malaria, urine dipstick, hemoglobin, Hep A, Hep B, and type and cross. They don’t have a blood bank. They usually type and cross family members after testing for Hep A and Hep B and just transfuse. Apparently it happens quite often.

That afternoon the doctor and I did his HTN/DM/Sickle cell clinic in a room about the size of an American bathroom. We stood at a tray table and there was a chair for the patient. It was so much fun. Sweetest patients ever. Compliant except for when the pharmacy ran out of their meds, grateful for help, open to teaching… fantastic. There was the most delightful lady that came in that could barely walk and was so grateful to have made it to 74 years old and so happy that someone could finally prescribe her medicine for her high blood pressure.

One lady came in with a history of COPD, was pretty drastically short of breath after transferring from the wheelchair. I popped my handy dandy oxygen saturation probe on her and she was at 76%. (We like people to be at 90-10%). I just looked at the doctor, he looked at me and said “We have 2 oxygen concentrators for the entire hospital and home O2 does not exist here.” I said OK and patted her hand.

A gentleman came in with history of high blood pressure and high cholesterol, complaining of sharp chest pain. He comes back in 2 weeks to get an EKG.

A sickle cell patient came in that was 37 years old and the best looking sickler I’ve ever seen in my life. Compliant with meds, said he just hurt a little bit sometimes and he didn’t need anything for pain, just coming in for a scheduled appointment. 1: That’s amazing, 2: The test that said he had sickle cell disease was done somewhere else and is unobtainable, so I suspect he might just have had sickle cell trait, but he just knew “sickle cell positive!”

We haven’t had a “normal” day so far because of visitors, but I’ll let you know what those look like when it happens. So far it’s been 7am to 3pm at the hospital, come home and run around doing errands and being busy, and then talking and then bed. No lunch and huge starchy dinners are not particularly good for you, but it’s cool guys, I picked up an oxygen concentrator today which was pretty heavy, jumped in and out of the back of the jeep multiple times, carried a mattress, and thought about doing pushups.

People here hate it when you take pictures. Some visitors were with us on the tour of the hospital and tried to take “cute African baby photos.” A few of the parents hated it and when asked would said “No picta, no picta!” Some were OK with it, but there will probably be a resounding lack of photographic evidence on my part. Sorry to all the people whose only request of me was pictures. I have some scenery photos!

 

But truly the people are beautiful and so traditionally African in dress and demeanor, walking around with stuff on their heads and everything. Oh, they totally cheat by the way, they have a stiff ring of fabric they put on their head that keeps whatever they’re carrying more steady. I feel like that would be a big advantage for people who have uniquely-shaped heads.

So I raved about the bananas, I did. Then I had pineapple. Someone could write poetry about the fruit here. Not me, but someone who can come up with something more creative than “bursting with flavor” and “best fruit ever.” The mangos taste like mango. The passion fruit tastes like passion fruit. The snozzberries taste like snozzberries. You do have to wash all fresh fruits and vegetables in iodine here to remove the evil germs. Which is my favorite thing to do, 1. Because then I can eat it. 2, Because iodone turns the water a lovely shade of lavender!

If you have a phobia of lizards, do not come here. They not only have thousands of regular lizards, they have huge geckos, and freaking monitor lizards longer than my arm. I’m not saying we both had a heart attack, I’m just saying this particular monitor lizard that I encountered and I probably both need to see a cardiologist.

Today I spent nearly the whole day on the wards. It was insane and overwhelming and super frustrating and once I’ve been able to process I’ll write about it. Malnourished kiddos, minimal universal precautions (as in there is no soap in the hospital except to mop the floors and sharps are left everywhere), and general lack of knowledge. Not very many cares are given here. Huge shout out to my dialysis and drug seeker patients from home, thanks for making me skilled at IVs in people with no veins. Came in handy today.                                                                                                                                                                                                          

Trust in the Lord and do good;
Dwell in the land and cultivate faithfulness.
Delight yourself in the Lord
And He will give you the desires of your heart.
Commit your way to the Lord.
Trust also in Him, and He will do it.

Psalm 37:3-7

Still trusting that I’m obeying God and still unsure of how much I can even help here. Prayers would be appreciated that I would be useful medically, build relationships with the staff and patients, and to learn Swahili quickly.

Love you all!

-K