Patches!

Patches the paper bag puppet.

"Patches!"

That is the name I frequently hear emerge from the lips of the two young girls who I have been nannying and homeschooling the past 2 months each morning. It is a sound I am going to miss. I have really enjoyed being "Patches" the past 2 months and have absolutely loved my time with all the missionary kids.

It is hard to leave Tenwek today yet I know there are many more adventures ahead!

Beginning a new phase of adventure,

Em

The Ins and Outs of House

I thought I would give you tour of where we have been living while at Tenwek.

At first we would refer were we are staying as “Ndovu” or “the guesthouse” or “the apartment” but then we struck the perfect word and we now call it “home.”

We are so blessed to have such a wonderful place to stay. We had no idea what to expect and we were pleasantly surprised at the wonderful apartment we currently call home. After the first week it began to it feel very much like home. I just wanted to take you on a tour of our little home, with all its features and quirks.

The rooms include 3 bedrooms, 1 bathroom and a common area which is comprised of a kitchen, eating area and sitting room.

At night we sleep under colourful mosquito nets, to keep the bugs away. But regardless, I have been regularly receiving at least one mosquito bite every night even with, lots of strong bug spray and a bug net. Fortunately malaria is not prevaliant in our area.

Our electricity, although becoming more stable with the increase of rain, is prone to frequently turn off, but usually only for a short while as our electricity comes back on with the hospital generator.

Our telephone, which is used to phone around the compound, is very fidgety and frequently registers no dial tone so sometimes one person will fiddle with the cord while another talks.

Our bathroom includes a few quirks. To flush the toilet you are required to pump the lever, which we have quickly adjusted to but upon arrival we couldn’t seem to flush the toilet except for Little John, who figured it out quickly and begged everyone to let him flush the toilet. Needless to say the novelty has worn off, but Little John is still called upon as the toilet expert. Our bathroom sink includes 2 separate taps, one for hot water, and the other for cold, or simply cold and cold as our water temperature would have it.

Our lock and key are an old fashioned key hole which you can use to peek through which is fun, except when it is the bathroom keyhole, and the key can be used from both the inside and the outside...

Some of the kitchen cupboard doors can only be held shut with elastics. We had to exterminate bugs from our kitchen cupboards, which are thankfully well taken care of. Our kitchen is without many basic necessities like pot lids, but we learn make up for it.

Our water is fetched from the rain water tank, boiled for 20 minutes, cooled and put through a filter. It was amusing to hear Mom ask “can you fetch the water?” the first time, as it is not a phrase I was used to hearing, but have now become accustomed to.

Our kitchen tap requires lots of wrenching and twisting, moaning and groaning to get it to stop dripping. And even then our efforts sometimes prove unsuccessful.

The other day our microwave did the strangest thing...and still does these strange things. While sitting in the living room area, the microwave suddenly started going while no one was in the kitchen. All of us kids ran over to see what was going on. There was no time on the microwave and pressing stop was not turning it off, but we pulled open the door and it finally stopped. But the microwave started back up again when Little John shut the door. Big Bro unplugged it, but it still started again when the door was closed. Then after opening the microwave door again a bug crawled out of the control panel and the problem was solved.

It seems we heat up more bugs than food. I don’t always feel comfortable putting my food in the microwave to heat up when I see I bug crawling around. Frequently when we start the microwave there will be a loud zapping noise, signalling another bug in the control panel who just got fried.

The microwave was an unexpected blessing so we are grateful for the use we do get and the amusement it provides!

We have one couch which we frequently break as it easily falls apart, but after numerous fixing attempts it seems to be stable now.

Some wonderful visiting guests helped us put up netting in the center window to act as a screen keeping the bugs out and the air flowing. Our chameleon, when not on the banana’s catching fruit flies can usually be found on one of the screens.

We love our house and will be sad to leave it....

Em

Finalizing

Dad has been working hard at finishing his projects, and has had a busy weekend on call, here is his discription about what he has been doing lately...

Our time at Tenwek is drawing to a close. The past week I’ve been very busy finalizing details for the redesign of numerous process and operational changes.

Two days ago I met with the 16 charge nurses to go over some of the proposed changes. The feedback was very positive. Yesterday I met with a couple of long term missionaries to go over 6 pages of details as they will be taking over the implementation of the proposed changes. It was nice to be able to pass them on to a couple who are very capable and passionate about quality improvement.

There are still several details and revisions to finalize this week but I feel a real sense of satisfaction and accomplishment with what has been achieved so far in a relatively short period of time (it would likely have taken two years to accomplish the same amount of changes in a similar sized North American hospital due to the numerous layers of beaurocracy).

~~~~~

As a result of lots of time spent on administrative tasks, and the fact that on the medical floor my time is spent supervising and teaching the interns, I haven’t had as much direct pt contact the past few weeks. This weekend however I’ve been on call and have had some direct patient contact with a few people who died.

This morning I was present with the mom as she watched her 26 yo daughter die in respiratory distress due to severe TB, pneumonia and HIV. All I was able to do was put my arm around her to comfort her. As her daughter slipped away she started to wail. She was then taken to another room by the chaplain for further comfort and support (and to remove her loud wailing from a room of 16 other patients). There was more wailing an hour later when the rest of the family arrived during visiting hours and discovered an empty bed. It was particularly difficult to hear the higher pitched wailing from the 4 year old daughter, with no mother to comfort her. Many of the people who die here on a daily basis are children, teenagers, young wives, husbands and parents. There are many heartbreaking situations.

On the brighter side, I had a very happy mother of a 20 year old son come to the nursing station to show me how well her son was doing today – she was beaming, and so was her son. He is currently on his 8th day out of the 10 day treatment for bacterial meningitis he is currently undergoing.

~~~~~

Many of the patients come to Tenwek in a state of severe physical malnourishment due to vomiting, diarrhea or difficulty swallowing. I was struck by the contrast of how well nourished most of the people in hospital back home are – in fact “over nourishment” is a major contributor to many chronic diseases. However, many people around the world are also plagued by a more insidious and serious condition – spiritual malnutrition. It reminded me of the scripture “what does it profit a man if he gains the whole world but loses his soul”.

Daktari,

Dad

Funeral Program

While in Mombasa Mom attended the funeral of a 29 year old vetranarian who was working with Sameritan's Purse. We freuently see the death of people here in the hospital but never get to experience what happens during the funeral, and amid the family as they morn and fufill various tribal customs which vary depending on the tribe.

Ferry Ride to Mombassa

Mom brought back a program, part of which outlines the funeral she attended - an all day event.

7am - Assemble at Pandya Hospital Motuary Mombasa (viewing of the body)
8am - Departure for Mwaluvanga: Convoy Procession (a 2 hour drive away)
10am - Arrival at Mwaluvanga Home (parents land where the funeral is held.)
11am - Food Served

One of the many large pots of rice

12 noon - Church Service starts

• Prayers in the house thereater procession: Hymn: YILA SOO WA NGAI WIVUVWA
• Eulogy: Joseph Kioko
• Tributes: over 15 tributes by family, relatives, co-workers, friends, leaders, neighbours, administration...

2pm - Sermon: Pastor Godffrey Mburn

• Final viewing of the body led by Rev. David Ndungwa
• Procession to the Burial site: Christian Burial Rites by Pastor Xechariah Mwagendi (body buried on parents land.)
• Laying of the wreaths

4pm - Announcements: Mastory of Ceremony

END END (that is if the funeral dosen't go late...like this one did...)

Em

Stop Counting...

Our days left here at Tenwek are dwindling...
5, 4, 3, 2, 1, gone.

It is tempting to freak out, lament the rapid passing of time, contemplate each passing day, stare at the calendar counting down days, try to convince yourself it is not actually the day the calendar displays, but what good will that do?

Each week I open a not from a friend and a few weeks ago the card held a simple phrase on the front that was really impacting.

“Don’t count the days. Make the days count!”

It is a phrase I have heard before but it was really good to be reminded...stop counting and start making it count!

Instead of seeing another day gone, I can look from the perspective, "today I prayed with someone," "today I cared for an orphan," "today I followed God's promptings," "today God made my day count," etc.

Em and orphan baby in NICU.

And I can see tomorrow as another oppertunity to serve, and make the day count.


Making each day count,
Em

Mom's Adventures

Since Mom has recovered from her fall, she has been finding herself amid many adventures. I wanted her to write a post about it but she is keeping herself occupied with many more adventures and not having time to write.

Mom near the place where she fell...quite an adventure!

She has gone on a number of Community Health trips, some to clinics in far away locations, some with car troubles and not returning home until way after dark...

Community Health Clinic

...and some working with installing bio sand filters. Each trip she comes back with stories to tell of the people she talked to, everything that happened and is eager to share excitement.

Installing water filter during Community Health Trip

Her latest adventure she just embarked on today is to Mombasa. For those unfamiliar with Kenyan geography, we are in south western Kenya closer to Uganda and Tanzania boarders, and Mombasa is on the south end of the east coast, at least a four hour drive and one hour plane ride away.

Mom left this morning along with the visiting staff coordinator here and will be gone all weekend. She is glad she is able to go to Mombasa although the situation bringing here there is rather sad. She is attending the funeral of a young Kenyan man who worked for Samaritan’s Purse in Nairobi. She really connected and supported his parents during their stay here while their son was in NICU, and is glad to be able to support them at the funeral as well.

Mom has become quite the adventurous woman and is keeping quite busy but really enjoying it. You can be praying for her throughout her trip this weekend. I know she would really appreciate it.

Mom’s girl,
Em

Working for Change

Dad has been working hard helping the long term missionaries develop changes. I will let him tell you some of the things he has been up to...

Apart from the amazing Safari that Em has already wrote about, I’ve had a very productive and enjoyable time the past couple of weeks. There is no shortage of improvements to suggest, design and implement in the hospital. The doctors, nurses and interns have all been very encouraging and grateful for my contribution. It’s fun to meet with various people from all areas of the hospital including Administrator, Finance Director, Medical Superintendant, Nursing Superintendant, IT, Supply, Registration, Medical Records, Ward Charge Nurses, Lab Director, Imaging Director, etc. Apart from my role as Medical Consultant and Intern supervisor, I have basically assumed a role as operations and quality improvement designer which I love. There are lots of challenges in dealing with different personality types, some of which are adverse to change. Before we leave, I hope to have the design, training and implementation plan in place for changes in the following areas:

• Order Processing - Chart Flags for every chart (4 options – Pink Side - Orders, Stat Order;
• Green Side - Nurse Task, Completed); I/O Monitoring protocol; Special Observations protocol;
• Glucose monitoring and insulin order sheet protocol; Diet Flag to be placed on on wall above bed
• Chart Labelling and Storage
• Lab Requisitions – revision and restocking
• Phlebotomies - work flow redesign
• Imaging – revised requisitions, US booking protocol, X-ray file stamp and improved storage system
• Nursing - Nursing Progress Notes form for bedside chart; Nursing Cardex Summary Sheet; Improved medication delivery system
• Clinician Documentation - Improved Orders/Progress Notes form;
• Hospitalization/Summary Sheet – to replace the current Discharge Summary Sheet
• Registration - Improved registration and triage processes
• Blood Donations – system to increase the number of blood donors to alleviate the chronic blood shortage (surgeries are often cancelled due to lack of blood)
• Interns – updated job descriptions and protocols
• Visiting Medical Staff – help update orientation package
• Consultants – updated job descriptions and protocols
• Documentation protocols
• Patient Education Materials
• Emergency Care Protocols – documentation and posting of relevant protocols in Casualty, Medicine Ward, Operating Room and Recovery Room

So with 7 work days left, we have a stimulating challenge ahead of us. It’s also been great having the kids and their Mom to help out with some of the above projects.

Enjoying the Journey!
Dad

Safari

“AmAZinG!”
That is the best word to describe our Safari.

Safari sunrise.

Safari felt like a dream. You read and hear about people who have gone to Africa and gone on Safari. I have looked at pictures, dreamed, “I wish I could go on a Safari someday....” While that dream came true this past weekend!

Family in the middle of the Masai Mara.

I took a lot of pictures. Dad took a lot of video. Yet somehow it can’t do it justice. The photo’s don’t portray the experience of being 15 feet away from a pack of lions, watching them interact in the wild and hearing the sound of their teeth knawing on their recently caught carcass. Words don’t really work at describing it either.

Lions in the morning.

It was wonderful to be able to visit a corner of God’s magnificent creation we don’t normally see. Surrounded by such beauty and creation there were moments we could do nothing but praise God. It was beautiful. Out in the wild it was totally different than the zoo, but it was an exhibit of God’s zoo.

Matthew beside a baby rhino (in the wild!).

We were able to go on a brief "walking safari" to see some rhinos. Although we were able to get up close - as the rhino's are accustomed to human presence which is frequently around them for their protection - don't let the above picture fool you into thinking the rhinos are tame...

Cheeta grooming itself.

Watching the animals interact with each other in their natural environment was spectacular. An animal in a pen just dosen't have the same effect...

Zebra's running.

We were able to experience many awe inspiring moments of beauty that simply take your breath away. God painted many beautiful pictures for us this past weekend!

Giraffe in the sunset horizon.

Enjoying God's Creation,
Em

P.S. More pictures will be added at my internets earliest convinience!

P.P.S I think that is about all the pictures my internet will allow. It was amazingly cooperative at allowing picture uploading today. Enjoy!

How Beautiful are thy Feet

“[Jesus] poured water into a basin and began to wash his disciples’ feet, drying them with the towel that was wrapped around him.” John 13:6

Out of an act of service and love, Jesus washed his disciples` feet. On Saturday we had the opportunity to wash feet as well. The feet belonged to beautiful orphans living at a local orphanage, a 2 hour drive away near the edge of the jungle, and we had the privilege of equipping their feet with brand new shoes provided by Samaritan`s Feet (http://www.samaritansfeet.org/).
The shoes were brought over by one of the visitors who left a few weeks ago. There were 150 pairs of brand new shoes, which are being distributed throughout a number of different local orphanages. It is so amazing the difference a new pair of shoes can make on someone’s life.

"How beautiful are the feet that bring good news.” Romans 10:15

While washing their feet I would look up in to their beautiful face and smile and they would beam a huge grin back, and we would connect through a smile. A smile can hold a thousand words. Fortunately pictures contain more than can be put into words, so I will let them tell the story...

We had the new shoes laid out on the lawn and after the children had their feet washed they were fitted with their first brand new pair of shoes.

The children (and adults working at the orphanage) were absolutely thrilled to have their shoes.

On the 2 hour journey there we had a little delay with a flat tire (which eludes to the condition of the road...). And the way back it was a little squishy and nauseating...but that is not the important part....

Equipped with the good news and a new pair of shoes, God can take their beautiful feet many places. It was a pleasure to bless all the wonderful children.

Finding joy in serving,

Em

P.S. I intended to have more pictures and have been trying to upload them all week but with the rain (which we are blessed to have) the internet dosen't cooperate...Maybe they will upload later...or maybe not...

Dad's Blog

The following is Dad's summary of some of the things he has been involved with during the past 2 weeks. He is keeping busy and really enjoying his work. We all enjoy hearing about it...

My last week in Casualty was spent working on operational improvements in the mornings when Casualty was slow and seeing patients and supervising the Clinical Officers in the afternoon. We started a new process for registering and triaging patients that proved to be very successful.

Covered hospital pathways.

I ended up being on call for Medicine for Fri, Sat and Sun. I offered to do the Fri for the other Medicine Consultant so he could raft the Nile in Uganda with a few other visitors. When I agreed to this, however, I didn’t realize that the Fri was a stat holiday here (Labor Day). So it was a busy 3 days rounding on 40 pts a day – the first 2 days took 7 hours a day. Unfortunately I had 2 ICU patients die on the Sun morning – both were post natal moms in their 20’s who presented in late septic shock – very sad.

Female Medical Ward.

The first week on the Medicine ward wasn’t as bad as I had imagined it would be – perhaps it was because I started with having rounded on all the patients for the previous 3 days. Now I am just rounding on half the pts and had 2 interns to do most of the work. After the interns round on the pts by themselves, I go around with them to review their pts – this is a combination of supervising and teaching rounds and is a lot of fun. The interns are very bright and keen. It is a mutual learning experience.

View of some of the Tenwek Hospital buildings.

On Wed morning I did the devotional for the interns and consultants which went very well. At lunch the same day I did an educational presentation to the interns on Acute and Chronic Liver Disease. On Thurs we had all the medicine interns (4) and the consultant over for lunch followed by some ping pong J. On Medicine, there aren’t too many responsibilities in the afternoon so I’m able to continue working on some operations improvements. This weekend was a nice break after working 2 weeks straight. More about our weekend activities will be provided by other family members. This Tues I’ll be presenting of few ideas and suggestions to the long term doctors at their bimonthly meeting for their feedback and suggestions re implementation. I’ll also be meeting with the head of lab, radiology and nursing. I hope to have an implementation mandate and plan in place by the end of the week. I have Fri off this week as it’s our turn to go on a Safari – we are very excited about this! Enjoying the adventure, Dad

Mother's Day

Although Mother's Day isn't officially on the calendar in Kenya, we still celebrated Mother's Day. We didn't have the fancy cards or elaborate gifts (no gifts actually), but we do have wonderful memories and wonderful Mothers to celebrate.

We were treated with a lovely breakfast in the morning at one of the missionaries house. All the women received flowers at church from some of the surrounding gardens. It was quite amusing and cute to watch as the group of boys made their way along handing out flowers to all the ladies.

Without Mom's lialacs we had to look for a new location for our family Mother's day photo. After trying a few we opted for the beautiful bush of one of Mom's favorite flowers here. (note: Big Bro, although rapidly growing, has passed Mom, but not yet passed me (Em) as it appears in the picture)

After Mom had a rest we hiked up Mt. Montego, fortunately this time with no injuries! Although the boys got caught in massive rains on the way back the girls beat the rains as we speed walked home.

We had a delightful dinner of Grandpa's pizza sandwiches, and enjoyed some family time. It was a beautiful day. Without the commercialism and presents, the focus was more on remembering and appreciating mothers and all the amazing things they do.

We had a delightful Mother's day and wish all our Mothers, Grandmothers, and Mother-like figures in our lives a Happy Mother's Day!...we miss you and love you!

Prayer

Prayer is such an important part of this trip, and of everyday life. It is the essential ingredient and our greatest support. I want to thank all of you who are lifting us up in prayer. If you let us know you are praying, we will thank you personally. It is such a blessing to know there are people praying for you and supporting you.

I am not extremely educated about prayer; I am just a 17 year old who closes her eyes to pray when she sees a mother in agony over her dying child, because it is all she knows to do. But I am a 17 year old who prays because she know it works, has seen it work, and knows God listens. The best thing about prayer is that you don’t have to be “educated” to pray. You can just fall on your knees before God at any time or place and pour out your heart.

There are so many things to pray for here it sometimes feels overwhelming...how can I possibly pray for it all? But you see a child on crutches who looks up at you as you walk by and you pray for her. You comfort a crying baby in the NICU and you pray for him. Neighbours are suffering watching their dying son and you pray for them. The rains come and you know you are one of the few places blessed to have rain in this country so you pray for those in drought. As you bump along the rural roads of Kenya, fly out of your seat and hit your head, you pray for safety. As God brings things to mind, and situations present themselves you just stop and pray.

Part of the procedure here at Tenwek is to stop and pray. In surgery, before the surgeons operate, everyone stops to pray, when I was observing surgery, it was really neat to see everyone simply freeze mid motion and bring the patient and upcoming surgery before God. There are many chaplains around the hospital whose job is to comfort and pray for patients. Taking time to stop and pray is a part of nearly every task.

Stopping to pray before surgery.

There are so many things to pray for...health, healing, comfort, safety, wisdom, discernment... You can’t cover them all, but God commands us to pray, and so we do - one at request at a time. And God works, answers, helps, heals, comforts, and sometimes unveils his own plan, contrary to our own wishes, but perfectly in line with his will.

Thank you for joining with us in prayer.

Petitioning in prayer,

Em