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.

Choir of angels

Hi everybody, I had a surprise trip to Kijabe yesterday for 24 hours. Kijabe is where we served last year and so it was fun to ride with a missionary wife who was visiting her son at the Rift Valley Academy for his 14th birthday.  

I renewed a few friendships and had a fun visit staying in a dorm with 16 8th grade girls.  Their  house mother became a good friend of mine through a Bible Study.  I have a new appreciation for her after being there a few hours!  Wow,  I had forgotten what giggle boxes 8th grade girls can be; especially when you get 16 living together!  It was poignant to go to their nightly devotions when they discussed whether or not they had ever really heard God speak to them.  Many of their comments were really insightful. God spoke to them through their friends, or when they were feeling lonesome, or through nature, or through reading the Bible or talking to the Lord through prayer.  It was a precious time especially when I think that these kids are apart from their families for a good part of the year and truly must often feel the need of God's presence in their loneliness.

I returned to the nursery as soon as I got back.  The twins are all growing and I am still helping, but I am also NG tube feeding a little girl whose mom is very sick and has not even been able to hold her yet. (she is 5 days old).  This little one is so thin and needs some love and bonding.  I am so glad I can give her that.

Another wonderful thing happened today in the nursery. We formed a Mother's Choir!! I was singing "Jesus Loves Me" to one of the twins and a Mom joined in!  Then I went to "Precious Jewels" and she knew that one too!  Before we knew it we were singing, "Count Your Blessings", "All through the night", "We are One in the Spirit", etc. We have a hard time communicating but we were singing together!  Now, they are teaching me a Swahili song and are  having fun laughing at my pronunciation.  As Jesus said, Suffer the children to come to me and forbid them not!  This was so real to me today. Mothers all over the world sing to their children and teach them that Jesus does indeed love them.

love to all and happy birthday Jack, glad you went to the circus!

nana and poppy

micki and marv 

Sunday Service in Kapkesiego

It is about 6:30 PM on Sunday afternoon and it is pouring rain!  The kids are loving it!

We have had a full day beginning about 9:30 this morning as  we traveled out into the villages around us.  Our destination was a small place  among the tea plants called Kapkesiego and a small church called Liberty Gospel Church.  Riding in a big four wheel  Range Rover with one of the missionary physician wives at the helm was rocky to say the least.  As I have said before, Kenyan tires are the toughest products around!  Through a ministry at Tenwek a family received a cow this morning during the service and so this was a celebration and praise service for this little church.  The  singing was marvelous with a men's chorus, womens chorus, a children's chorus as well as testimonies and a good sermon to boot!  Some of tunes were familiar, some not; but the joy was contagious. Truly the Lord was present!  We were asked to say a few words and brought greetings from our brothers and sisters at First Presbyterian in the U.S.  It means a great deal to them to know that they are thought of by fellow Christians.  It means a great deal to Dad and me that these Christians pray for us.

Another ministry which is growing by leaps and bounds is the Tabitha Womens Bible Study.  Branching out from Tenwek this bible study reaches over 1500 village women each week.  Imagine the impact this teaching is having on families in this area!  The ladies were interested to know that women in the U.S. are also are involved in Bible Study and that these studies cross denominational lines and bring Christians together in unity.  There was a great deal of talk in the testimonies that we are all one in Christ and how glorious it will be in heaven when skin tones and different languages will not divide us. How true!

It has been a blessed day.  I think I will tell Ernie that our services are way too short after the marathon today!

with love,
mom and dad
micki and marv

Obstetrics 102

During the last two days, I have had the wonderful opportunity to listen to research proposals by the family medicine residents.   As a part of their education, they are required to design, execute, defend and publish a research project.

Today, I listened to a proposal that addresses perinatal morbidity and mortality in this region and the utility and function of referrals.   We make a lot of assumptions about the realities of geography, roads and means of transportation.  What is encouraging is the critical thinking that I see demonstrated by these residents who will have an impact in the care of women and children.

As you know, the obstetric referral in the United States is also difficult and key in either setting is communication.  I shared with them the work of nurses Carla Edwards and Betty Woodard on the improvement in communication between referring and referral hospitals.  Although there are many differences between the challenges of obstetric care there are common problems that we both face.  

I hope to continue to be available to support these young Kenyan physicians looking to improve the processes and outcomes of obstetric care.  

Marvin


Edwards C.  Woodard EK. SBAR for maternal transports: going the extra mile.
Nursing for Women's Health.  12(6):515-20, 2008 Dec.

Mixed Emotions

View from our Apt 7 Window

Warm enough?

Saying "Goodbye"

It is hard to believe that parts of Kenya are having a drought because we have had 4 days of rain, mostly at night but today is a bit cloudy.  The hillsides are very green and really beautiful! It is fun to hear the rain pounding on the roof late at night.

I was quite honored today when one of the patients named her baby Miriam!  Of course she is an adorable, beautiful baby!  The other thing that happened recently is that the father of the twins I spoke earliers about  has come back and is wanting to take the twins home. This is good and bad.  It is good because he is taking responsibility; bad because he is very very poor and it will be difficult to feed and cloth these children in addition to the other 5 he has at home.  In order for him to have the twins  discharged  from the hospital the family must pay the entire bill.  If the bill is not paid the patient can not leave which means that the bill continues to mount.  Can you imagine this in the US?  These twins have been here for 2 months at 1000 shillings times 2 a day; plus the bill for his wife who died. The total bill is approximately 120 thousand shillings which in US currency is about 1200 dollars.  He has already sold one cow and only has one cow left to feed his family.  This is a tragic case, but it is not unusual.  I have no idea how it will be resolved. 

On a happier front the other twins I am helping to feed have terrific moms and are thriving!  We are feeding them through NG tubes and it won't be long before they can go home.  You would get a real laugh out of seeing me sit  in the steamy nursery surrounded by moms who are chatting non stop in the  Kipsigis language. I know that they are talking about the old white mazunga who is sweating non stop!! We are becoming good friends through body language, laughs, and hugs.

Hope you are all having a good day. We send out love
mom and dad
micki and marv