Kenya 2011

This trip was with World Medical Mission and headed by Dr. David Chang. Dr. Chang is on staff at my residency alma mater, The University of Missouri, Columbia Missouri, as a facial plastic surgeon. Our main focus was to help chldren with cleft lips and palates, and we saw patients in the ENT clinic as well. We operated at another CURE hospital, similar to the CURE hospital I visited in Lusaka, Zambia in Spring 2011.

As I write this, I am thinking how exciting it is that I will be in Kenya in less than a month! So much to do, so little time. This trip is with World Medical Mission and is headed by Dr. David Chang. Dr. Chang is on staff at my residency alma mater, The University of Missouri, Columbia Missouri, as a facial plastic surgeon. Our main focus will be to help children with cleft lips and palates, though we will see patients in the ENT clinic as well. We will be operating at another CURE hospital, similar to the CURE hospital I visited in Lusaka, Zambia last Spring.

As I travel this path of medical mission trips, I find the door opens for me at unexpected times and through a variety of seemingly unrelated, inconsequential “coincidences.” For example, last Spring I connected with an old friend from medical school on Facebook. She is a facial plastic surgeon, and in the course of our “chatting” she shared with me the story of her two trips to Kenya on cleft lip teams. I told her of my, then, upcoming trip to Zambia. I thought to myself that it might be interesting to do a trip with her to Kenya some day in the future. Then, within a few weeks, I found out that my dear friends, The Cress family, were moving to Kenya and I began to think I had some connection forming to Kenya.

Finally, I read an ENT journal in late August, while cleaning off my office desk, and found an article about a mission trip to Kenya, highlighting the experience of a resident from my alma mater. In the same journal was the email address to the chair of my alma mater’s residency program. I emailed him to say hello, and wound up on a phone call with Dr. Chang, sharing mission stories. Dr. Chang mentioned his upcoming trip to Kenya (where else?!), which I thought was to be in November. Due to a scheduling conflict, he had to move it up to October, and it coincided exactly with the dates I had been plugging into Expedia the night before, planning to take a vacation to…somewhere.

Now I know where I’m going. Kenya it is! Not really a vacation, but something that speaks to my heart and calls me away from home…a medical mission trip. Perhaps I am naive or gullible or easily misled, but I believe all the pieces to my story are part of my “calling” and through prayerful consideration, and not the whim I suggest here, I feel this is what I am supposed to do, what I joyfully, wholeheartedly want to do. I hope you’ll come along with me on this adventure by following my blog, on the path to Kenya. Although your prayers, good wishes and encouragment are priceless and all I really want, some of you have requested to help offset the expense of the trip. If you are so moved, click on donate and follow the link to support me in this work. I thank you for your support!

Goodbyes at PDX | 10.15.2011
Kenya, here I come! But first, I needed some major hugs from my girls.

Travelers | 10.15.2011
Eight people coming from different geographic locations in the US met today in Schipol, Amsterdam’s airport. We found each other, which I thought was remarkable since I hadn’t met any of the other seven before, and had briefly considered how it would go if I didn’t find them…
We are a group of eight, 5 physicians , two spouses and one “energetic young adult” who’d never flown before! We finally made it through customs and arrived at the Methodist Guest House at 12:30 AM. One night here to get some sleep, and we are off to Kijabe tomorrow. I am under a mosquito net and wondering if the loud music from downstairs is going to stop anytime soon…and curious about the loud, persistent bird call–what kind? I appreciate those thoughts, prayers and well wishes!

First Day in Kenya | 10.19.2011
We arrived late Saturday night and it was so dark we really couldn’t see Nairobi, will have to wait until we leave to get a good look. The next day we drove the 90 minute drive to Kijabe and took in the scenery. Here are a couple of photos showing the view from the ENT house, where we are staying. We have a view of the Rift Valley and we are at 7,000 feet. It is spectacular! On the grounds are monkeys and lovely plants and flowers. The wind roars every night apparently related the temperature change in this large valley. I can hear it now, but it will be calm tomorrow morning when we walk to the hospital.

Getting To Work | 10.19.2011
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.

This is 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.

Working | 10.20.2011
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.

Short Break for Safari | 10.21.2011
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!

Patients | 10.23.2011
Here are two of the children that I have operated on recently, Michael had a cleft lip repair and Robert had a cleft palate repair.
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.

Mildred & Sister | 10.23.11
There are so many stories to tell about our experience here in Kenya. I’d like to write about Mildred and her family today. Mildred is a 5 year old girl with a bilateral cleft lip and palate. She came to see us, along with her mother and her baby sister. Her baby sister also was born with a bilateral cleft lip and palate. The baby is one year old, yet only weighs 5 pounds–not a typo, 5 pounds. The story is heartbreaking as the mother and daughters were chased out of their village soon after the birth of this baby. The husband/father had abandoned them and they were no longer welcome. The mother has struggled to feed them and somehow a CURE outreach person was able to bring them here to be evaluated for surgery. The baby was hospitalized and is being evaluated by pediatricians for severe malnutrition, and likely has Rickets and possibly an underlying metabolic condition as well. She is not strong enough to undergo surgery now. Mildred, however, had a very successful operation by Dr. David Chang and Dr. Jason Goodwin last week. Please keep Mildred and her mother and baby sister in your prayers, not only for their current medical conditions, but for a place to live and a secure food supply. Mildred will return in March for repair of her bilateral cleft palate.

 

Maasai Child & Village | 10.23.2011
On Thursday, we saw this child and scheduled him for surgery this coming Monday to repair his cleft lip. His mother isn’t sure, but thinks he was born in 2008 (he appears older than that to me). They are Maasai and I was quite interested in her appearance. She is a very striking woman, dressed in typical Maasai clothing and adorned with many beads. Her ear lobes have been elongated and now the loops are covered in beads. I’m not sure which village they come from, but we visited a Maasai village today and it opened my eyes to the lifestyle of the Maasai people.

The Maasai are a nomadic tribe and stay in one locale for approximately nine years. Their homes are made of wood sticks covered with a mix of cow dung and sand to make the walls and to cover the roofs to make them waterproof. John, the chief’s son, showed us his house today. He explained that the women build the homes. The “mens” are out hunting or shepherding the many cows and goats. Their homes are built to form a circle, and at night the animals are brought into the circle. The homes are tiny. I’ll post a photo of me next to the home and some photos from inside the home, which is very dark.

 

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!

Safari | 10.23.2011
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.

Operating in the Dark | 10.24.2011
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…

Update on Maasai Child | 10.25.2011

I wrote a few days ago about the little Maasai child who came in last week. I did his surgery yesterday and I’ll post his pre and post op photos below. His mom is dressed in typical Maasai dress with the beaded ear lobes and beaded neck jewelry. She is smiling and happy with her son’s improvement. He has a small bolster tie on his nose that will come off in several more days. It is sewn on with absorbable suture and will just fall off so he doesn’t have to return for removal of stitches. Although he is a bit swollen from surgery, I think you can see a significant improvement.

 

Tonight we had guests for dinner, Tom and Jolene Boeve and their four children. Tom is an ENT surgeon from the US who is working here in Kijabe as a missionary doctor–the first ENT residing and practicing here full time, ever. He shared some incredible stories about how he and Jolene and their four children ended up here and what they are doing here. I didn’t realize (until this trip) that long-term missionary doctors have to secure all of their funding via donations from individuals, churches, etc before going to their assigned mission. In addition to covering his family’s expenses here, Tom also has needed to raise money to expand the clinic to have room to see patients and to purchase specialized medical equipment. He has started a program called Ears to Hear and provides solar powered hearing aids to hearing impaired children. He was able to get funding through CLASP International, click here for more information or to fund a hearing aid for a Kenyan child. Prior to the solar powered hearing aids, many of these children were forced to live in and attend the deaf school. According to some early data, it appears that up to one third of children in the Kenyan deaf school aren’t deaf, merely in need of a hearing aid. I continue to be impressed with the doctors and other medical staff stationed here in Kijabe. What a blessing they are to the thousands of patients that come through here every year. Tom also travels to some nearby countries to do ENT and cleft surgery and is headed to Sudan in the next week or two for a cleft lip trip. Only two more days of surgery for us and then we head home. Well, I am taking a short detour to visit dear friends, Sandra and Doug, in Nairobi. I can’t wait to see them and hear all about their lives in Kenya…

Heading for Home | 10.28.2011
I am sitting in the Nairobi airport waiting to board the plane back home. I can’t wait to see my children and look forward to starting in the new office on Monday. But… Part of me is sad to leave, wondering when I will be able to return. Certainly, there are those moments of doubt or fear that make me wonder what I was thinking when I came over here, but they are fleeting, and usually related to a flat tire (two this trip!) or flood waters we must drive across from heavy rains, to the wild “overtaking” aka passing on the highways. But what will bring me back is the people, the children who are so sweet and innocent and just need an operation or two to change their lives. And, the animals and the beauty of the countries here in Africa. So, today, I bought a cell phone that will allow me to switch out sims cards for different countries. As much as I love my iphone, ATT let me down on this trip and I won’t plan to travel again without cell service and hopefully email to contact my loved ones and office.

I’ve missed blogging the past couple of days, so I want to catch up on a few patients. Remember Mildred? She is five and had her bilateral cleft lip repair last week. She looks great and is very happy. It was bittersweet for us, as her baby sister, Joyce, was hospitalized with malnutrition and we didn’t think we’d be able to repair her bilateral cleft lip. Thank God that the pediatricians were able to tune her up and clear her for surgery! She had a successful cleft lip repair on Thursday and is on her way home. What a blessing for both girls and their family as this will improve all of their lives substantially.

I had the pleasure of working with a fabulous team on this trip. I appreciate Dr. David Chang putting this team and trip together for all of us and leading with grace. We had incredible staff to work with in the clinic, the operating room and on the inpatient ward. It was wonderful to also work with Dr. Eric Dobratz, Dr. Cam Kirchner and Dr. Jason Goodwin. We wouldn’t have been nearly as organized, efficient and able to see as many patients if it weren’t for the dedicated hard work of Diane Kirchner and Bobbie Goodwin who photographed all the patients, organized their paperwork, put together post op medications and a goodie bag for each child. I haven’t seen them yet at the airport, so I hope they weren’t caught up in that crazy traffic jam in Nairobi… Oh, they just arrived! So, now we are all boarding our flight to Amsterdam and then going our separate ways.