Kernicterus, meconium, and good Kenyan Food

Hey Everyone,

Bryan here.  A few medical updates:

I saw my first case of acute bilirubin encephalopathy.  Consequently, I also performed my first exchange transfusion.  We received a 5 day old on my first day of call.  Not believing that he had a bili of 35 from the outlaying facility, we repeated his bili.  No, it wasn't 35....it was 47.  For the non medical folks out there, I start getting worried around 18-20.  He was continuing to have fevers, so we repeated the septic workup and did an exchange transfusion that went into the middle of the night.  It worked, but his direct bili continues to be high.  My blood culture just came back positive for Klebsiella that is resistant to just about everything except carbapenems and zosyn (and chloramphenicol...yep they still use it over here).  Scary.  It is this exact same organism that has given rise to the infamous NDM-1, which basically can't be killed with antibiotics.  I count my blessings there is something we can treat this baby with.  Sadly, she has some neurologic findings that are consistent with the intermediate phase of biliary encephalopathy, nearly ensuring that she will end up with kernicterus.  Her bili is back up this AM.  Please pray for Baby Grace.

I also performed my first solo resuscitation on a baby with meconium aspiration.  I have never been so terrified in all my life!  I had an intern and midwife with me who had virtually no experience.  For the first time, I had no one around to back me up if somehting went wrong.  By God's grace, I was able to intubate and suction.  Got a big old plug out and the baby started breathing and crying.  It was a very emotional moment for me.  He only required a couple of days of CPAP then O2 and miraculously has had no major complications.  Baby is doing great and should be discharged tomorrow.  The irony of the situation is that I was a very sick baby with meconium aspiration that nearly died at delivery had it not been for a pediatrician..  I've now come full circle!

On a lighter note, we went to church today.  It was really good to worship with the folks here at Kijabe.  A few of the songs were in Swahili, which was fun to listen to (although felt a touch out of place...).  It's good to be able to relate to other believers through the international language of the Holy Spirit.  The people here are truly wonderful.  They have a very connected church and welcomed us very warmly when they asked us to introduce ourselves.  We are quickly falling in love with the people of Kenya!

We have also really connected wiht the long termers (=long term missionary physician) and short termers here.  We have gone out to eat, had someone over, or been over to someone elses house nearly every night.  We share some really good laughs and conversation.  I was encouraged to hear that they would really like to have a neonatologist in country.  There are no neo fellowships in Kenya, so when the occasional neo comes to visit for a few months, they feel spoiled.  They have been excellent counselors.  I am very humbled to be among them.  All these people have given up the life of an American (or european or australian - gooday mate!) physician, but none of them regret it.  One is even a pediatric surgeon, another a pediatric neurosurgeon.  By the world's standards, this idea is complete foolishness.  However, none of them consider this to be suffering but an honor.  To boot, they are also very normal people - no weird long dresses, bonnets and kumbaya (my impression of what missionaries would be like).  They all confess that it isn't for everyone, however.  God will work out when and how long, but we both know we will be coming back to Kijabe!

Our hearts continue to be full!  Thanks again for all your encouraging posts!

- Bryan