Difficult Questions

South Africa near Stellenbosch

When you have had profound and intense experiences like what we have had this past month, it is difficult to respond succinctly to the questions, “How was your trip?” or  “When will you return to Africa?”.  

How was your trip?

The best short answer is “Wonderful” and “Difficult”.   What is probably more important is what was different!  Here are some of the new experiences:

(a) Sharing the experience with our daughter.  What a gift to be with her and see her interactions here at Tenwek.   

See her blog:  http://betsy40.blogspot.com

(b) Learning more about the complex history of Africa particularly with our trip to South Africa.

(c) The educational interactions using social networking - A work in progress

When will you return to Africa?

The truthful answer is “We don’t know”.  But despite uncertainties about the future, we need to stay connected!   Part of the connection is through WMM via Samaritan’s Purse: http://www.samaritanspurse.org/index.php and the other with Tenwek Hospital web site: http://www.tenwekhospital.org.  Most importantly we will stay connected with new friends and colleagues.

Was it difficult? “Yes”, but like previous years it was “Wonderful”.   We have been blessed to have this experience!  Thanks for reading the blog and your comments.

Marvin, Miriam and Betsy

p.s.  Did I tell you that Miriam has already decided to return next year!

Joyous Goodbye

Dear Family and Friends,

It is bedtime and we are leaving early in the morning for Nairobi but I just had to send one last blog and tell you about my most amazing day!  It began early when Marv came to the nursery and told me that Joyce, the mother of the darling little girl I have been feeding, was better!  Joyce has been psychotic for the last 3 weeks due to renal failure and has shown very little interest in her baby.   She thought that Marv was a witch doctor!   I had to see for myself and so I took her baby to the ward and it was true.   There was light in her eyes, she wanted to hold her baby and her smile was infectious!  It was the first time I cried today when she embraced me and said Asante. (thank you)   Words fail to express the joy I felt at this miracle!  She said "God is good!" Thank you  for praying for me!" It truly was a miracle!   At the noon feeding Joyce came to the nursery with her sister who has been caring for her and feed her baby via NG tube for the first time.  It was the second time I cried today!

At noon we had a party with chocolate chip cookies for the moms in the ward and cake for the staff near the nursery.  After we finished they urged me to come back to the nursery at 2 PM.  When I came  all the moms had gathered in the hallway and wished me farewell with a lively African song.  Then they wrapped a blanket around Marv and me and continued singing.   It was the third time I cried today with tears of joy.  

I wanted to especially thank the two moms of twins that I helped take care of by giving them something to remember me by so I asked them to meet me privately in the office.  Anne, the head nurse, helped interpret for me as I gave them each a Bible in Kipsigis and told them that I hoped that they would raise the twins to love Jesus.  They were both overwhelmed. I don't think that anyone had ever given them something before!  Belaney, who is tall and stoic, sobbed in my arms.   Mercy, tiny and quiet hugged me tight.   Again, God is good!  It was probably one of the most profound experiences of my life in feeling the power of God's love. 

So dear ones, it has been a wonderful month full of blessings beyond belief in a tiny, steamy, over crowded NICU in Tenwek, Kenya!  Thanks for being a part of it.  We leave early in the morning and fly to South Africa for some R and R.  We are excited to see a country we have always wanted to visit and thrilled that Betsy will be with us.

love to all,

nana and poppy

Micki and Marv

Obstetric Emergencies

from http://www.tenwekhospital.org

There has been global concerns about responses to obstetric emergencies!   This last 24 hours has been a short course in what obstetric emergencies look like “on the ground”!  The direct providers of care were an intern, an anesthetist and an obstetrical attending.  

The first case was a patient with placenta previa at 39 weeks, bleeding with a recent fetal demise.   The second case was a patient with obstructed labor at term for at least 8 hours also with a fetal demise.  Both of these cases had preventable fetal deaths and both were potential maternal deaths.   The good news is that both mothers survived!

The primary reason for maternal survival was the availability of operative facilities with staff, anesthesia and blood.   The primary prevention and missing response was having trained nurses and personnel to detect the pre-emergent presentations of these common complications of pregnancy.   In the developed world, team management is the issue.   In the developing world, the issue is having the basics!   Places like Tenwek are providing responses to obstetric emergencies that are both preventive and emergent. 


Marvin

References:

Paxton A.  Bailey P.  Lobis S.  Fry D.  Global patterns in availability of emergency obstetric care.  International Journal of Gynaecology & Obstetrics.  93(3):300-7, 2006 Jun.

Merien AE.  van de Ven J.  Mol BW.  Houterman S.  Oei SG.  Multidisciplinary team training in a simulation setting for acute obstetric emergencies: a systematic review. [Review]  Obstetrics & Gynecology.  115(5):1021-31, 2010 May.

Strong Kenyan Women

We are at the beginning of our last week at Tenwek and it is hard to believe.   Betsy brought a newspaper and it was the first one we had read in a month!  Internet is sporadic enough that I often get frustrated trying to get the news and just give up.  But honestly, I can't say that I have missed the news, the TV, etc. It is rather calming to have a slower,  though hectic,  pace of life!  I would recommend mission trips to any and all of you.  God can use all kinds of skills and people in developing countries!

One of the more exciting things I did all day on Saturday was defrost the small refrigerator in the Nursery where they keep meds and "cows milk" for babies who transition off  formula to cows milk as they are ready to be discharged. (formula is too expensive for most families to purchase).   The ice had built up to such an extent that I thought the fridge would soon break down.  The mothers were fascinated as many of them had never seen ice let alone touched it!  We had a good laugh saying, "ice" and "cold"; enjoying new experiences!

One of the other fun experiences last week was celebrating International Women's Day in the Nursery!   I handed out Hershey almond kisses to celebrate women!  When I went to help Benaly,  the twins mom,  I noticed that she had not eaten the almond.  I asked why and found out that she was afraid to eat it as she had never had one before.  When we reassured her that it was OK she popped it into her  mouth and decided that it was good.   In fact she thought that it tasted like honey!   What a joy to see  her eyes pop out in delight.   I think I have said it before, but I continue to be so impressed with African women!   From my vantage point  in the nursery I see strong women who are  wonderful moms  to these tiny babies!  Benaly wants me (Nanya) to go home with her to Trans Mara so that I can care for the twins while she goes out into the fields to plant!  They are awfully cute; but I think I would miss my own grands way too much!:)

love to all,
micki and marv
nana and poppy

p.s.  Don't forget to check out "Asante" at betsy40.blogspot.com

Family-centered care

Hi Everybody!

We are so excited to say that Betsy, now known as Elizabeth here because they can not pronounce the "ts" sound, is here at Tenwek.  It almost seemed surreal to see her walking up the path to the guest house!  Within 3 hours of being here she had been to the nursery, helped feed a baby, seen the delivery of a baby, watched her Dad do surgery, toured the hospital,  found out where Ortho rounds are at 7 AM this morning, and checked out the Physio Dept.! WOW!  At least it kept her awake from jet lag until she retired at 9 PM!  We hope that she her short visit will be a great experience for her.

Having Betsy here just reminded us of the love we have for family and friends!  I am reminded of this everyday in the nursery when I watch moms interact with their newborns.  It is a bond like no other! We also see it in the hospital as there are always family members who have accompanied family members on their journey. We do not have Ronald MacDonald Houses here and so family often sleeps in the bed with the patient, under the patients' bed, or on the ground surrounding the hospital. The important thing to know is that the  love and support of family and friends is universal!  What a blessing in all of our lives to know that we can count on others when life becomes difficult!  I believe that the Lord works through our loved ones to show His love for us.  What comfort to know that we are never ever alone. 

with love from us to all of our friends and family,
micki and marv
nana and poppy

p.s.  For a first hand report, check out Betsy's blog, "Asante" at betsy40.blogspot.com

Children of the World

It is Thursday evening already between the 6 PM and 9 PM baby feedings!  Our windows are open and the beautifiul voices of a Praise team singing African hymns is resounding through the station.  These Christians do know how to praise God!  We love to hear them.

We are privileged to meet other visiting physicians, dentists, water resource people, students, etc. while here.  Recently there was an MD here from Mayo who had a wonderful story to tell.  I think that it could be an inspiration for those of you who support children throughout  the world  through World Vision or any other non profit.  This fellow and his wife "adopted " a young Rwandan boy who was the only survivor in his family during the genocide of the 90's.  They continued to support him through secondary school and university.  He is now married, the father of 3 children, and the headmaster of a secondary school.  The best part of the story is that he waited to have his children baptized until his adoptive American family could come to Rwanda and be a part of the service and celebration.  Our friend got tears in his eyes as he told us how powerful that day was for him and his family.  Keep on supporting those kids wherever they are; it does change lives!

Its back to the nursery now!  My life really revolves around these little ones.  I have had to give up some other opportunities to keep this schedule but I think this is my mission this time at Tenwek.  I have been able to bond with Kenyan mothers as well as the nursing staff.  It has been such a blessing to me.  Please pray for  the mom who was transferred to a hospital hours away for hemodialysis and for her very tiny baby who stayed behind in the nursery.  She is the one I am focused on now.

love you all,
mom and dad,
micki and marv

Obstetrics 4000

Tenwek School of Nursing

Jesus instructed him, "Don't talk about this all over town. Just quietly present your healed self to the priest, along with the offering ordered by Moses. Your cleansed and obedient life, not your words, will bear witness to what I have done." But the man couldn't keep it to himself, and the word got out. Soon a large crowd of people had gathered to listen and be healed of their ailments. As often as possible Jesus withdrew to out-of-the-way places for prayer.  Luke 5:14-16 (The Message)

This hospital provides care for some 4000 deliveries per year and it is likely to exceed that number given our current census.  Besides being a referral center it is also a provider of care when the national health system is “on strike/slow down” given either the demands of physicians or nurses.  

This is a opportunity to consider the larger context of care and care systems.   No matter where we live, it seems that demand always overwhelms the resources.  Mission hospitals are no different.   The system of care in Kenya is based on the “British” system that utilizes nurses as the primary providers and the physicians as consultants.  Any system has its limits and at this time the impact of the lack of nursing resources in other hospitals puts a  heavy pressure on hospitals like Tenwek.

From a U.S. perspective, we see similar stresses when we have natural disasters that disrupt normal delivery of care...remember Katrina and Joplin.  In either case, delivery of care is interrupted and people suffer.  Emergencies are redefined and triage is used to limit the impact.  

Like Jesus, we are forced to think and pray about new “delivery” methods.   Can we redirect human and material resources to prepare us for the new demands.  It is important to see the demands as a new opportunity to more effectively provide the care when the systems seem inadequate!

Iserson KV.  Moskop JC.  Triage in medicine, part I: Concept, history, and types. Annals of Emergency Medicine.  49(3):275-81, 2007 Mar.

Moskop JC.  Iserson KV. Triage in medicine, part II: Underlying values and principles. [Review] [23 refs]  Annals of Emergency Medicine.  49(3):282-7, 2007 Mar.