It felt good to be back at work today. We have quite a few more children to treat before we leave.
Today, Dr. Kirchner and I did three cleft lip procedures. All happened to be left sided, but each is different. I think that is one of the most challenging aspects of this surgery, it seems that each case is a bit different and requires thoughtful planning. One of the patients today was the little Maasai child that I wrote about recently. I hope to get a nice photo to post tomorrow. He looks very good and it is quite satisfying to see the physical change in his face, but also to imagine the difference this improvement will make in his life.
I’d like to share a couple of observations about working in a mission hospital in Africa.
One, you get used to sudden blackouts in the OR. There seem to be roving power outages several times each day. There is a brief period of total darkness in the operating room before the emergency generator switches on. For certain procedures, we wear headlights and so we can continue the procedure, albeit without suction or electrocautery. However, when we aren’t using a headlight, we just sit and wait. Most often, it only takes thirty seconds, though sometimes it goes on for longer, and always it seems like an eternity. I’m sure the pioneering missionary surgeons can tell better stories, about operating without electricity at all, etc. I just thought you might find this interesting and the photo below interesting as well. And, please note, I am not complaining about this hospital–it is fantastic. Everyone here has to deal with the power outages and the emergency generator does a great job.
Operating in the dark, only a headlight illuminates the operative field. This patient has a mouth gag or retractor in place and is having a cleft palate operation. Of course the retractor is only placed after the patient is completely asleep and the lips and cheeks are carefully retracted so as not to injure the patient.
Two, the mothers stay with their children, in the same beds. Now, this can happen in the US also, but typically US moms have packed their own clothes. In mission hospitals, the moms are seen wearing hospital gowns, as their only set of clothing is hanging to dry on the clothesline outside. After seeing the Maasai village this weekend, I completely understand. For many of these families, coming to this hospital is akin to a middle class American staying in a five star hotel–with food, clean water, clean clothing, indoor plumbing and a mattress. These are dedicated mothers who love their children, have traveled long distances and are often brought to tears when they see their darling babies after surgery. It is a privilege to care for these children and work with their mothers.
Three, there are multiple languages being spoken all around. Frequently we’ll have one translator going from the mother (who speaks a tribal language) to another translator (who speaks Swahili), to me (who speaks only English). In the OR, the staff speaks English when talking to us but Swahili when speaking with each other. And so, of course, we wonder what they are saying…maybe Swahili lessons are in my future…
Our trip to Kenya has been fantastic in so many ways. Since we've had very poor internet access–until tonight!–I am posting a lot today in order to catch up. Our main focus, of course, is to care for the many children who come to our clinic with cleft deformities. We work hard and long hours on most days, but take a weekend safari in between the two work weeks. This safari was an incredible experience. The beauty of the terrain and the spectacular animals were a wonderful demonstration of God's creation and I hope that all of you have the chance to go on a safari someday. Meanwhile, I hope you enjoy some of the photos I have posted here. I included a photo of our team on safari, and one of our flat tire, which our skilled driver, Charles, had replaced in no time. It is pretty amazing that we had only one flat tire as we drove over a very rocky 63 km road (it took one hour and forty-five minutes). Not to mention the ruts and rocks we went over on the plains.
Some of the fantastic scenes we enjoyed include a couple of lionesses with six playful cubs, several indifferent and regal appearing male lions, a herd of fourteen elephants encircling our vehicle, tall and graceful giraffes nibbling the tree tops, hippos lying in a "hippo blob" (our term for the huddled mass of hippos seen below), hundreds possibly thousands of zebra, gazelles, wildebeests and warthogs. This morning our main goal was to see an elephant. Instead, we were blessed with a herd of fourteen! We were elated and sat in the vehicle watching these massive animals munch on shrubs and trees.
They have a small place for fire in the center of the floor in the home.
Dr. Vessely beside the Chief’s home
When we arrived in the village, we were greeted by dancing, singing and a very nice welcome.
For breakfast, the villagers drink cow’s blood. A small spear is used to lacerate the cows neck vein and blood is drained out and consumed. The cow lives, to produce blood and milk for another meal. They occasionally eat meat which is roasted as well as Ugali, a corn meal paste staple of East Africa. Water (which is dirty and disease-prone) comes from the nearby spring, where they also wash. They do not wear shoes and the circular area where the animals stay at night is strewn with manure from chickens, goats and cows. They live on the Maasai Mara, and if a lion kills one of their cows, the park will compensate them for the cow, instead of allowing the Maasai warriors to kill the lion. I believe this is an arrangement that is mutually acceptable now.
It was definitely interesting to see how this people live, and heartbreaking to think of the conditions that some of our patients will return to after surgery. We are encouraged to know, however, that we are making a difference in their lives. I hope to post an after photo for this child later. Due to the delay in internet access, the surgery is actually tomorrow!
Dr. Vessely with Robert in the OR.
Robert stayed with us for two nights after surgery and went home after that. We hope and pray his palate repair stays intact and he is able to eat, drink and speak more easily now.
We'll be back to see patients Sun PM, but right now I am at the David Livingston resort near the Masai Mara park watching 30+ hippos in the water, listening to their breathing and snorting. On the way, we saw giraffe, impala, wildebeest, zebra and I can hear many types of birds singing. We leave for an evening safari soon.
……On safari we saw lions, giraffes, buffalo, zebras, ostriches, gazelles, dik dik, Topi, wildebeeste , warthogs and others! Power goes off here at 10 pm.
*internet access is difficult on this trip. I'm posting this via text msg–more later!
We've finished our first week in the OR today. Actually today is a National holiday for Kenya, a celebration of independence. The OR staff graciously agreed to work today so that we could operate and will take tomorrow off. We head for a safari tomorrow afternoon and a bit of
rest and relaxation. Here is a photo of me and Dr. Kirchner with our team in the OR. We ran three ORs this week and are very pleased with how the patients are doing and how well the hospital and staff are set up to care for our patients. We greatly appreciate your prayers.
Sunday afternoon, we unpacked our personal things and headed to the hospital. We unpacked 10 chests of medical supplies (As well as the requisite bag of m&ms!), and some small toys to send home with the children when they leave the hospital.. Then, we headed to Screening Clinic. We scheduled 13 operations, hoping to get 10-12 done on Monday. It is an education in patience to understand what these families have been through to get here. Many are bringing their infants and just starting down the path of multiple procedures that might be necessary to correct the cleft deformities. Some are bringing older children who have had to bear the brunt of teasing and the burden of speech, feeding and social ostracism for years. I have to resist the urge to hurry the nurse to get the next patient back as soon as the exam room is available–it doesn't take me long to relax and learn some patience from my patients. They typically come from distant villages and often take buses to get here. A few speak English, most Swahili or other tribal languages. The OR tech told me today there are sixty tribes in Kenya and he asked how many there are in the US. (He suggested we have just one tribe, but I'm not so sure). We also see patients from Somalia and other nearby countries.
Below you'll see the view outside the clinic room window, which seems to me a metaphor of hope for these children–an open window to a better future. This cleft lip/palate clinic has been manned by US physicians for 13 years or so and every year at least three surgical teams visit for this purpose. The team members for this trip come from South Carolina, Virginia, Missouri and Oregon. After twelve hours of nonstop patients in an unfamiliar hospital, we are pretty tired. Rounds are at 6:30 tomorrow, so I'll sign off for now.