At Journey's end?

"Are you ok?" A few people have asked us this question. Looking back, we dealt with international travel, a terrorist attack, pediatric morbidity and death, cultural adjustment, sleep depravation, sickness, but also glorious healing, amazing fellowship, new medical knowledge, birth, life saving, Gods creation, closeness of the Holy Spirit, fruit of marriage, and vision building. There is no good answer to that question. We are damaged permanently, but in a really good way.  Our hearts are softened, our eyes are opened, and we are humbled.  Truthfully, I think this is exactly where we are supposed to be.

Returning to the US has been a challenge.  I see soccer moms in their mini vans and SUVs, paved roads, buildings with insulation, windows and roofs, and a notable absence of the trash-burning smell that seems to permeate every developing country I've been in.  I feel like the guy in the movie "Avatar," having difficulty distinguishing between realities.  Kenya feels like an alternate universe, but it was so real.

Gods Word tells me that I'm an alien and foreigner.  In fact, we all are.  I don't fit into the US. I don't fit into Kenya.  I don't fit in anywhere on this earth.  That's because I'm a citizen of heaven.  Why am I still here then? Kenya taught me that it has much more than just evangelizing.  I am an ambassador to this world - to not only testify to the saving grace of Christ's death and resurrection, but also to love people and fight back the darkness.  That's God's story for humanity, also called the gospel.  It's what Jesus did while he was here, and it's what I've been called to do also, whether in Kenya or the US.

One last thing: the Needy Children's fund is needy.  For those who may not know about it, this fund is to provide assistance to families who have a hard time affording the cost of the care at Kijabe (which is already 5-10% the cost of other hospitals).  Even a few dollars can be overwhelming to these folks. Sometimes, their medical bills are really steep.  A single dose of surfactant necessary to save a preterm infant costs 13,500 KES($150 USD- costs several thousand in the US, btw), more than a years wages for some.  This fund helps these families that are over-burdened with theses costs.  Right now, the fund is dwindling a bit.  If you feel compelled by our story, please consider giving.  A few dollars even can go a long way.  You can give through one of the missionaries' church:

INSTRUCTIONS:

1.  Write a check to "Bay Leaf Baptist Church" with "Kijabe Needy Children's Fund" on the memo line.

2.  Mail it to Bay Leaf Baptist Church/12200 Bay Leaf Church Road/Raleigh NC 27614 (USA)

3.  It helps if you email me to know to look for the transfer (drs.myhre@gmail.com)

4.  The church will send you a receipt by mail within a month.  100% of donated money goes to the Kijabe fund, so the church donates the administrative costs.

A couple of blogs to follow for more info.  These are some of the sweet and amazing pediatricians we met while there:

http://paradoxuganda.blogspot.com (Jennifer and Scott Myrhe)

http://journeybeyondtheboat.blogspot.com (Rick and Sarah Gessner)

http://steeres.com/ (Andy and Mardi Steere)

Until next time....

Bryan

Goodbye and Hello

This will be my last post about our trip. It's crazy how fast the month has gone bye in one sense, and yet in another sense it feels like we've been in Africa much longer. I'm anticipating the ,"how was your trip?" Question from many people coming soon, and I'm not quite sure what to say. How do you wrap wonderful/life changing/sad/huge learning experience/greatest challenge/blessing/awesome/grievous into one simple sentence? I don't know.

Our final day was a great representation of all these emotions colliding. We had agreed to round early so that we could be present for all of rounds, facilitating a smooth transition of care to the attendings who would be taking over in both the nursery and on the ward. However, just about a minute after I walked into the hospital Thursday morning, I got a call from one of the interns "Dr. Sarah, it's Samantha. You need to rush." That only means one thing at Kijabe. I was on the ward about ten seconds later, finding one of the patients I've been looking after in cardiac arrest (not breathing, no pulse). My interns had already started chest compressions. Her IV had blown and wasn't working for us to give epinephrine, so we prepared to intubate and give it down a breathing tube. Several minutes and two doses of epinephrine went by and still we had no pulse. One of the pediatricians I was working with came and was able to place an intraosseous line (an IV that goes straight into the bone marrow which has great blood supply). We gave more epinephrine through that line, but still no heartbeat. We gave another drug, atropine, and finally got a heart beat again. It was a miracle. We were able to change the beds around in the ICU so as to get her a spot and moved her there for mechanical ventilation and blood pressure support. Then, our medical interns and the pediatrician missionaries surprised us with a going away party! It was supposed to be at 830 (they fooled us by asking for early rounds) but anyone in medicine knows that plans can change in a moment. So we all took a seat around 1030 when they gave us a traditional African goodbye party, with everyone going around and saying a way that thy had been blessed by us being there. We decompressed and celebrated simultaneously.  Bryan and I agreed that it was one of the nicest things we had ever experienced in our married years. It was really humbling. Apparently, I am strict but funny. I force people to follow up on their patients and I can talk about the same patient for more than forty minutes as i dissect their problems by body system (this is so normal to me but they thought it was crazy!) I also know way too much pediatrics (my how wrong that is!) and help people think outside the box about what could be wrong. Bryan, on the other hand, sweats a lot while working they say! He is "loud like all Americans" but he really cares about finding what's wrong with his babies. He is strict, like me, and the team he worked with laughed as they said his first words in the morning were always "Ok, let's get started," so they knew they needed to be ready. (It reflects a little bit of a culture difference because there is a much more relaxed pace in Africa... Rarely is there hurry). We assured them we had learned as much or more from them. They've taught us to stress less, look at patients Instead of labs and to value relationships even when there is a lot of potential to just stress and "get the job done" because lives are on the line. We've learned to be quicker to pray for people and to trust Gods hand because ours are more tangibly limited. I could go on and on and on. 

We met one of the moms of a mutual patient of ours (I admitted her premature baby from clinic with severe sepsis at 1 month of life and Bryan took over her are in the hospital). She asked us to come see her baby before we left and say a prayer of thanksgiving with her because of the baby's improvement (truly a miracle that the baby lived). We went with her and I took a picture of her with the baby and Bryan. "You gave me hope" she told us. "God told me to bring my baby to Kijabe." It was a huge encouragement, as our hearts were still heavy from the morning. We have seen so many kids not make it this month, but we have also seen so many miraculous recoveries. It's good to be reminded of them.

We had to hurry to turn in phones and grab our bags afterward. And ever since we've been journeying toward Greenville. 

There is no question that I already miss Africa. I never expected that. In fact, I may have told some of you in the past that I didn't feel called somewhere like that, so far away. For sure I knew that I felt no calling to a career in academic medicine. God has a way of changing things, doesn't he? Im pretty sure ive already said this. Im bad about repeating myself. Bryan and I feel like our job there has just begun, and its easy to want to be frustrated by leaving. I don't want to be that way though. I think that while God has given us a huge love and vision for Africa, he's also clearly assigned us somewhere else for now.

Back to life as we knew it, but I believe it will be different. I'm excited about all that I have yet to learn. I'm excited about becoming a better teacher. I'm excited to complete my assignment to be a resident who glorifies God in all aspects and pray for the power of the Spirit to finish well. I'm excited to see Sarge and to ride my bike. I'm excited to see all of you and give you a hug! 

Words can't say enough thank-yous for all of the prayers and support you have given over the past four weeks. They have been heard and we have been abundantly blessed as we've sought to be a blessing.

The journey has just begun! Goodbye to Africa but hello to home. We think we will keep the blog so folks who so desire can keep up with us. Stay tuned.

SB

And Last but certainly not Least...

Tonight is our last evening in Kenya. Our hearts are heavy, and we feel like the job isn't done - in fact, we feel like the job has just started. Our last week here has been particularly challenging. For me (Bryan), probably the toughest nursery week yet. This past weekend was wonderful. We took our safari and saw just about every animal possible with the exception of cheetahs and elephants, which are not endemic to the park we were at. We took some amazing pictures! Sarahbeth will have to post them on facebook. We went with a local driver, Philip, and a missionary from Passion church named Emily. I think our time on the safari was magnified 100x because during the trip we sang hymns, hillsong, and Chris Tomlin (who is huge in Kenya! Philip knew all of his songs). We shared our stories on the way back and bonded in a really neat way. I also learned a little swahili. Philip was sad to see us go. We returned Monday with Sarahbeth on call (we take call from home, so I was also on call...). I learned a very valuable lesson - I grumbled a bit as she asked me to assist her with a delivery. I was convicted of my bad attitude and swung my feet over the edge of the bed at 11:30pm and headed to the hospital. Boy, am I glad I was there. The resuscitation was a nightmare. The call was a meconium delivery with bradycardia. The baby came out totally lifeless. I intubated and suctioned 3 times. Sarahbeth was able to get some practice and intubated and suctioned once. I have never seen so much meconium in a baby's airway! Every time we suctioned we got more and more out - I kept thinking "there is no way this baby could fit more meconium in his airway. The heart rate began dropping and I was preparing to start CPR. Fortunately, the baby started crying after Sarahbeth suctioned the last time (it took a woman's touch). Two days later, the baby is doing great, on room air and will likely go home tomorrow. Later that night, another one of my meconium babies (don't ask me why we've had so many) started deteriorating, so we put him on the vent. He's required a little dopamine, but now doing a bit better. Sadly, there have been several other babies that did not do so well in the past week. Notably, I had a trisomy 13 (patau syndrome) baby born on Sunday and die the next day of a heart defect. Mom was devastated. There really isn't much prenatal care and she was expecting a normal infant. We were able to provide comfort measures. Sarahbeth lost a patient to lupus nephritis. She was a 14 year old that presented with decompansated heart failure. We suspect she also had some cardiac involvement, but not having a full time peds cardiologist, we couldn't get an echo. Our hearts are heavy at these losses. Sadly, things present so late here. In the words of Sir William Osler, when a patient presents late, the diagnosis is easy but the treatment difficult. We are packed and ready to head home tomorrow. We cannot wait to see everyone and share what we have seen and what God has done! We also can't wait to return to finish the job... - Bryan

Safari in Lake Nakuru National Park

Just a couple pics I snapped this weekend! We had so much fun (and yes I am this close to the giraffe... Crazy crazy.)

Faith and patience

I read this morning in Hebrews that we should be diligent to not become sluggish in our faith but rather follow the example of those who've gone before us, "who through faith and patience I inherited the promise." Faith and patience. It's easier for me to have faith than patience personally. Once God shows me something to believe for, I have no trouble. He can do the impossible! It's the waiting,the patience, that is harder for me. I think the best example is probably Heaven. I am already a citizen of my true home, the kingdom of God. I have the faith to look forward to it and it's where my hope is. But what I experience of Heaven now is only a shadow. So often I long for Heaven on Earth. I want every one of these patients to get up out of their bed totally healed. I hate having to watch their mom's grieve when they die, and I love rejoicing with them when they improve. But the complete promises of God are inherited with faith AND patience. Not all of his promises are immediate. Not all of his healing is in this world. All of my patients will be healed, but for some I have to be patient to wait and rejoice with them in heaven. 

I'm not sure if that makes sense to you. My heart is heavy today because another one of my patients died last night. She was a really sweet 14yo female with Lupus. She came in with renal failure as well as a pleural effusion and seemed to be doing better clinically. We cant get many labs here and the turn around time is really long, so we didn't have a perfect picture of everything. She started bleeding in the night though and the physician on call couldn't resuscitate her. I'm not sure if she had such bad nephrotic syndrome from her Lupus that she was hypocoagulable or if her lung disease was so severe that she had a pulmonary hemorrhage. Families don't do post-Mortem autopsies here so I will never know. It breaks my heart. I will have to patiently wait for Heaven to see her healed.

Another example is just being here at Kijabe. It has stretched my faith to follow God's leading us to Africa (the only place I was sure I wasn't called to go about a year ago). Now that we are here, I have had my heart so enlarged for not just the patients but the medical students who are in need of teaching so much (another thing I was fairly sure I was not called to do... Academic medicine). And now that I have faith that God has purposed me for the mission of caring for the really poor and training up physicians, it's time (almost) to go home. It's time for patience. 

So for today, faith and patience in every arena of life is what God asks. I am patiently waiting to see Ruth again in heaven. And my heart is full of faith, knowing that God has fulfilled his promise to heal her because she is his child.  My heart is also being stretched for faith to believe that I am and can be  a missionary in a way i didn't think before now was for me. And I'm patiently wondering... when and how we will get to come back to Kijabe to continue the work we've started. 

That's the way the toilet flushes...

So my only disappointment with this trip is watching the toilets flush. For years, I've been told that toilets in the southern hemisphere flush in the opposite direction. Well, I was all ready to video record a toilet flushing when I got here. Unfortunately, the toilets don't flush in any direction. They flush straight down. Oh well. I traveled around the world to answer this one pressing question and now the madness will continue. I was also able to start a fire in our furnace...consistently. This was a monumental occasion as the anatomy of the furnaces here require kerosene or charcoal, neither of which I have. However, I have learned that obscenely large amounts of dry grass acts as kerosene. Who knew? Our living room looks like a stable, but at least it's warm. On a more serious note, we had a couple of small premies admitted to nursery last night. One of them was a 28 weeker weighing in at a whopping 850 grams. We had the necessary surfactant to save the baby's lungs. I think the baby has a really good chance. Fortunately, we have already broken out the TPN (IV nutrition, very $$$) for our TEF baby, so we can spare 10cc/day and start this baby on trophic (trickle) feeds to reduce the chance of NEC (really bad gut death thing). Sarahbeth tells me my posts are too medical, so I'm trying to make it easier to read. I continue to be amazed at the need for a neonatologist here. I think each person's calling is unique. Is the need here more desperate than anywhere else? Certainly not. However, I have always felt that teaching was part of my calling, and it is an awesome opportunity to equip others to reach children in the far reaches of Kenya and Africa. Every one of the people I talk to here has a different reason for coming. I don't think there is a unifying idea or theology that one must subscribe to in order to minister in a particular setting. It's simply a individual and unique calling that each person has. Sarahbeth and I have become more and more settled and comfortable with this idea during our time here. It's easy to compare and contrast, to scale, and to stratify calling to calling. The truth is that the master said the exact same thing to the man who invested 5 talents as he did to the man who had invested 10. Somehow, you can't quantify the kingdom of God. One physician's calling is no more or less than the next. What He wants from us more than anything is a willing, obedient and faithful heart. This is the beauty of the body of Christ. Well, we are going on Safari this weekend! We plan to drive through a place called crescent island where we will be able to do a real walk about with the giraffes and zebras. Then, it's off to Nakuru Saturday night to stay at a guest house. We will go into the park at sunrise and hopefully see some great animals. The last couple that went saw 20+ lions! We'll take some great pictures for you!! - Bryan

Wish I had some Propofol...

I'm getting better at my lumbar punctures. However, in Africa there is no such thing as routine sedation for children that go through these procedures. So, I've been faced with the challenge of a rapidly moving and screaming target. Today, I've been trying to sedate a girl who is 8 because the intern was unable to successfully do the procedure earlier. I'm trying, giving her dose after dose of IV versed with her not seeming much sleepier. Where is a child life specialist when you need one?! Or a dose of Propofol... That would be nice.

In other news, baby Cecilia is doing much better. She is the little girl who came in with the wound infections the first day I was attending on the ward. She had her chest tubes taken out today and her sounds were closed! After just a few more days of antibiotics she will get to go home. Bryan mentioned several of my kids who have passed away. There was a baby with a type 4s neuroblastoma which is a rapidly growing tumor in the abdomen. Typically, in the states the baby would be intubated to avoid respiratory compromise caused by the tumor making it hard for it it breathe. Then, after a few weeks the tumor would begin involuting  on its own (isn't that crazy?). Sometimes, a small dose of chemotherapy would be given to help the tumor shrink faster, but this puts the infant a risk of tumor lysis syndrome, where the dying tumor cells release certain things that are very harmful to the body. For this baby, she stopped breathing because the tumor had compressed her lugs so much. I and my team were able to resuscitate her, but she started having seizures and repeated episodes of respiratory arrest. It was impractical for us to intubate her and wait several weeks because there are only two ICU beds in the hospital for children. It would have take the bed away from many children who would need it during that time. We also were unable to and her to another hospital that does chemotherapy because her parents didn't have the government insurance. Her parents decided that given their financial situation it would be best for us to provide their baby with comfort care until she passed away. She died the next day. The other child who passed away this morning had severe malnutrition and a skull abnormality that is very rare. At 7mos of life, he weighed less than his birth weight. He went to surgery yesterday to start repair of his skull abnormality. This is really important for normal brain development. We were treating him appropriately for his malnutrition as the medicine team, and after he went for his first surgery yesterday to repair part of his skull he did very well. However, as the night progressed he seemed to be dehydrated as he wasn't making urine. You have to be very careful giving fluid to a malnourished child because you can overload their heart. But he got some small amounts of fluid and initially did ok until his heart rate just precipitously dropped. He initially was resuscitated but had another event about one hour later. We aren't entirely sure what happened, but we speculate that his malnutrition made his body so weak that it couldn't handle the stress of surgery. His mother was so stricken with grief. 

There is definitely more death here than what we are accustomed to, and often times you don't have the comfort of knowing "why." It's hard, but we are doing the very best we can to take good care of the patients and their families seem to know And be thankful for that.

Tonight we are going to a missionary family's house for dinner and I am getting ready for a presentation on congenital and acquired syphilis for tomorrow based on a recent case I've had. I'm doing it morning-report style for those of you who know what I mean! I think and hope it will be interesting :) 

Love you guys! Thanks for staying tuned.

Sb