Dr. Sharon at Kijabe

More photos from the wedding

2010-07-02T07:50:00.007+03:00

My immediate family.

My extended family - many of these guests had never left the US before coming to the wedding.

Here are Jay and Judy, long-time friends from the UK, and Ron and Angela, David's Dad and his wife.

Here are the bride and groom.

More photos.

2010-07-01T07:52:00.007+03:00

Here are some photos of the ceremony to get started with.

The processional (Liszt, Consolation No 3)

David with Jay Smith (best man) and Ron Pitches (father)

Sharon with Steve and Sandy Morad (parents)

The flower girls - my neices Keira and Brooke

Listening to the Sermon (my dad spoke on 'Marriage as a means of sanctification' - using Calvin's structure for spiritual growth - it was a very appropriate and wise)

The recessional - (Mendolsson, 'March of the Priests)

Wedding photos

2010-07-01T07:35:00.007+03:00

I've finally got back photos from the wedding. It was a wonderful day.

Here's the venue - Sweetwater's tented camp.

The main building.

The tents.

The watering hole.

Ol Pajeta House, where the ceremony took place.

And here's the garden, decorated for the wedding.

Just another day...

2010-03-25T07:41:00.008+03:00

About the only scheduling 'rule' we have here is 'prepare for it to be changed'. Here was our Tuesday morning...

First, we had a patient on the ward who had been admitted for an elective caesarean section because she had had two previous caesareans. However, she started to labour painlessly overnight, and by the time she reported to the nurses that she was feeling contractions she was nearly ready to start pushing. To the surprise of our nurses I did not rush her to theatre for surgery, but when she had pushed for more than an hour without delivery, I instead took my resident through a gentle forceps delivery (our vaccum pump wasn't working). The patient is amazed and delighted in the aftermath.

Then we had a lady come in with bleeding at 33 weeks who very rapidly delivered a little boy - he has delighted the nursery staff by how well he is doing.

Immediately after handing that baby off to nursery the nurses called us to see the new admission - a lady in advanced labour with a breech presentation. My intern was delighted when I let her conduct the delivery, restricting myself to giving instructions and occasionally readujsting her hands.

Hanging on...

2010-03-22T15:47:00.003+03:00

One of the the difficult decisions we often have to make here, is the best mode of delivery for babies that have to be delivered prematurely either because they are sick or their mother is sick. In the UK that was rarely such a difficult choice. Our good neonatal intensive care units mean that most babies more that 28 weeks gestation would survive, and that means even if you started off inducing a mother, if the fetal heart was abnormal we would generally do a caesarean section in the confidence that we had a good chance of a living baby. That, however, is not the case here. Since I have come to Africa not a single baby less than 32 weeks of age that I have delivered by caeasrean section for fetal reasons has survived. I have had some live that I have delivered for maternal reasons (e.g. bleeding placenta praevia), but not even one if it was the baby who was sick.

So when this lady came with severe pre-eclampsia at 28 weeks gestation I explained to the mother that she needed delivery and I thought we should induce labour. I also explained that in my experience, either babies were strong enough to survive labour at this age (in which case they often have done very well), or else they weren't strong enough, and in that situation I have always seen them die within a few days if I did a caesarean section. We agreed therefore, that we would not operate even if the baby seemed to be sick during labour, and we decided it would be best not even to listen to the baby's heart during labour - because it would be aweful for her and for us if we heart a bad heart rate and didn't do anything about it. Then we spent some time praying together, and started the induction.

During the next 24 hours we started labour, and when she got near the end we call the paediatrician, explaining that we weren't sure how the baby was, but could she please be there to receive it. A little boy was born, a bit flat at first, but he responded very well to resuscitation and was taken to nursery where he is slowly growing strong and healthy. His mother has learned to feed him through the tube from his nose to his stomach, and carries him 'kangaroo' style with great patience.

Baby Sharon

2010-03-22T15:39:00.003+03:00

This is the mother who had the ECV a few weeks ago - she was induced and had a very straightforward delivery. Last Friday we had two more successful ECVs. Two of my interns were with me and I had them do one each. They were rather pleased with themselves to feel the head where it belonged after their efforts.

Her story...

2010-03-22T13:40:00.007+03:00

Today I am grieving for an 18 year old girl who has now been with us for nearly 2 months. She agreed for me to tell her story when she was still well, and now she is in great need of your prayers…

This story began 4 years ago when a 14 year old girl from the north of Kenya was married off to an older man. He got her pregnant immediately, and at age 15 she went into labour with their first child. As you would expect, she went into obstructed labour, and after several days her husband finally agreed to take her to the local hospital. The baby was already dead, and the doctor there did a caesarean section to deliver it. After the delivery she ended up with a vesicovaginal fistula and a rectovaginal fistula (a connection between the bladder and vagina and one between the rectum and vagina – leaving her permanently leaking urine and stool).

Two years ago she attended hospital and they attempted to repair her fistulae. The RVF was repaired successfully, but the VVF repair failed after she went home. She has continued to have urinary incontinence, and though she no longer had stool coming through the vagina, she was troubled by increasingly severe watery diarrhoea which became impossible to control consistently. During those years her husband divorced her and her family kicked her out. She ended up in Nairobi living with her brother's family, but he got fed up with her because of the smell and refused to feed her.

This January she ended up with a severe bout of pneumonia and was brought again to Kijabe, and on admission it was discovered that her loving husband had left her with another gift besides incontinence - HIV. So she was admitted and treated for pneumonia with good response. Her CD4 count (repeated now 3 times) has consistently been >500 (this means her immune system is not very compromised yet) so she has not been started on anti-HIV medicines.

After getting better from the pneumonia I was asked to review her fistula. I was pretty worried about her malnutrition and anaemia, and wanted her to be fed up before we operated on her, so when her brother refused to take her back we kept her in hospital to feed her up before surgery. Well, we did take her to theatre for her fistula repair, (which went quite nicely) but post-operatively we were troubled to find that no urine was coming through the catheter, though she still had urine coming through the vagina and this terrible watery stool. I assumed that the repair must have failed – but when we tested the site by putting dye in the bladder – the fistula repair was still intact. So then came my next panic – had I somehow damaged her ureters (the tubes draining the kidneys)? – but when we did ultrasound scans there was no evidence of that.

Well I won’t bore you with all the details, but suffice it to say that she has been very perplexing, but I think we are finally seeing the light. Here is a summary of her problems:

1) Watery diarrhoea and leaking through the anus, begun after her obstructed labour. Our infectious disease team decided after careful investigation that her diarrhoea was not related to an infective process.
2) Chronic renal failure (exacerbated by dehydration), and moderate bilateral hydronephrosis with cortical thinning (i.e. the kidneys are not working well, and probably haven’t been for quite some time)
3) Recurrent episodes of sepsis (infection affecting the whole body) – but not attributable to her opportunistic infections due to the HIV as her CD4 count is still high.
4) Leaking urine through the vagina – despite a successful repair of the fistula through the bladder and vagina.

Eventually we improved her kidney function enough to do a dye test to try and identify where her ureters went, and our results showed something I had never seen before – dilated ureters filled with air, and dye in her rectum.

Last week she was doing pretty well, and so we took advantage of the presence of a visiting urologist and borrowed some portable imaging equipment from our orthopaedic colleagues. We did a cystoscopy and identified both ureters – and saw no urine at all coming from either of them. We passed small tubes into the ureters and they both came to a dead stop 8 cm away from the bladder – and when we injected dye and took pictures that provided confirmation of complete obstruction of both ureteters 8 cm from the bladder (too high up for it to have been caused by my surgery, the urologist reassured me).

Right now we think she has one ureter that is communicating with the bowel (thus causing her diarrhoea) and one that is communicating with the uterus (which might explain why we didn’t see urine coming through the cervix during the fistula operation – we had her tilted very far back and the urine was apparently flowing from the uterus through the fallopian tubes and into the abdomen – on ultrasound scan during the post-op work up we did find free fluid behind the uterus which had not been there pre-operatively). This trauma almost certainly occurred at the time of her original delivery - I wonder what they were doing at her caesarean section.

We were hoping to open her abdomen this week and repair the ureters, but several day after the cystoscopy she got another episode of severe infection – and this time she doesn’t seem able to fight it. Her pneumonia is back with a vengeance and she is barely conscious, responding only by flickering her eyes when we speak to her. This morning she began coughing up blood, and our medical colleagues are afraid that she may well have TB. Clearly a major abdominal operation is not an option for this week, and I am becoming increasingly afraid that she will not survive to discharge.

All of us on the ward have become very fond of this young woman – during her months of feeding up she became friends with many of the nurses, and used to help the cleaners with their work just to help pass the time. As she has been deteriorating we are all anxious and grieving, though glad that at least she is here where there are people who treat her with kindness. And she has appreciated the love that she has been shown.

During all of her struggles here I have been praying with her almost every day, and our chaplains and nurses have been meeting with her to encourage her. And as she listened to talk on the ward and took heart from our concern and prayers for her, she decided that she too wanted to become a follower of Jesus. She has clung to Jesus during the weeks of hope leading up to the surgery, and the crushing disappointment as she realized she was still leaking, then the hope again as we told her that we may have finally figured out what is wrong, and then her realization that she is getting sicker and sicker. And now, when she can hardly respond, she has a stream of visitors who come to sit with her, tell her stories about Jesus and pray with her – and I hope and pray that while she can hear and understand, she knows that she is not alone.

ECV

2010-03-03T21:10:00.005+03:00

My final task before going home this evening was to turn a naughty baby from breech to head down. This particular technique (called 'external cephalic version' or ECV) is recommended in the UK in order to decrease the risks of a breech delivery for the baby without subjected the mother to the risks of a caesarean section. I have found it particularly satisfying to do here in Africa because it seems to work so much better (smaller babies and mothers who have had lots of kids before...). Unfortunately, it seems not to be practiced much in Kenya - and the first time Sara and I suggested an ECV our nurses were fairly horrified.

Now, however, they have seen that it does work most of the time, and this afternoon I had a group of enthusiastic student nurses come to watch Martha (our new resident - who had never seen an ECV before and was terribly eager to be involved) and me turn the baby. Our very tolerant patient agreed to the audience because she thought it would be a good thing for more people in Kenya to become familiar with the concept of ECV. She was highly satisfied at the end of the procedure when we could show her the fetal head down at the bottom where it belongs.

More often than not it's fun to be an obstetrician.

Organized chaos

2010-03-02T20:39:00.000+03:00

Today was one of those satisfying days - very busy, but controllable, and good outcomes for all of our patients. Between 8AM and 6PM we had 11 deliveries (and not a caesarean in the lot), 1 eclamptic fit and 8 operations. Irritatingly the surgery that took the longest was the diagnostic laparoscopy - because it took longer to find a scope and light lead that worked and matched each other than any other single operation.

Martha has now joined our team - she is a Kenyan registrar in obstetrics and gynaecology at Kenyatta National Hospital (the major teaching hospital in Nairobi) and she has chosen to do an elective placement with us for the next six months. She is pleasant and competent, and as she worked here as an intern she is known and liked by the staff here, which is a great bonus. We're trying to increase her operative experience - today I supervised her in a myomectomy (removing fibroids from the uterus) and a hysterectomy (removing the uterus itself) - enjoyable for both of us I think.

Then I came home in the pouring rain and have just come back from walking Luthien after it let up - and so I think maybe I'll go to bed!

Who's the guy?

2010-03-02T19:39:00.005+03:00

Recently a good friend from the UK commented, ‘Some folk have said, "Who is this guy Sharon is marrying? She has said a lot about the place they got engaged but hardly a word about the man himself in her letters or on the blog"!!!.......’ So here is an attempt to rectify that deficiency without getting embarrassingly sentimental in the process.

Let me see, I first met David in May 1999. I was in my second year of medical school and was attending a conference organized by the Christian Medical Fellowship for medics with an interest in ministering to Muslims. One of the speakers at the conference was a very intelligent senior house officer who caught my eye. One afternoon we both joined a walk through the countryside around Hemel Hamstead, and soon found ourselves deep in conversation.

David was actually a friend of a couple I had known since childhood, and through them had been brought into this ministry in London. He reminded me a lot of my father – a quick mind and great attention to detail, a willingness to take my ideas and opinions seriously (even seriously enough to disagree with), and a distinct lack of attention to time (but far greater musical talent – David’s the only person I know who has the option of being a concert organist if he ever gets fed up with medicine.)

Over the years we bumped into each other a lot through CMF and Islamic events, eventually becoming good friends. He went on to train in Public Health – working first in London and then in Birmingham, and I finished medical school in Leeds and then started my OB/Gyn training. In 2007 David started working for MedAir in Eastern Congo (out of all the places in the world that MedAir works, they sent him to the same town as my sister and brother-in-law, and he got to know them quite well through the work there). Meanwhile I continued to work in Britain and prepared for my own adventure in Ethiopia. Our communication dwindled away during this time, and I assumed I had heard the last of him. But clearly God had different ideas.

In January 2009, David heard about the concerns we had regarding my father’s health and the possible diagnosis of cancer. His mother had died several years earlier of cancer, so he was able to really empathize with how worried I must be, and he began calling me every week to see how I was doing and encourage me. This continued even after dad’s illness was over, and I came to look forward to these conversations, particularly during some of the challenges I faced in Ethiopia. Then when my plans to train at the Fistula Hospital in Addis Ababa fell through, he was able to arrange for me to come to Bunia for the fistula camp with Christina de Wind. We saw each other quite frequently during those three weeks, and after years of friendship the timing was right for the relationship to change.

These years in Africa have been good for both of us – God has taken each of us through some very difficult times, increasing our faith and trust in Him. He has also shown us how our friendship and affection can support and encourage one another.

I'm rather looking forward to the adventure of being married to David - though we both will have some adjusting to do. In many ways our backgrounds are very different – I was raised in Kenya as the child of American missionaries. In my immediate family I have 1 brother and 2 sisters – now all with spouses and children of their own. My extended family numbers nearly 70, all told – though we cannot get together as often as we would wish. David is an only child, raised in Manchester with a much smaller extended family. Until moving to Congo his international experience had been confined to short trips – though he has travelled widely through Europe, Africa, Asia and the Americas. He finds the chaos of my huge family a little overwhelming – but has come to enjoy my parents and siblings, and they are very fond of him.

But suffice it to say that I am still coming to grips with the privilege of receiving the love and affection of this man, and I am looking forward to seeing how God leads and directs us as we grow in love for one another, living and working side-by-side. (There, I warned you that I was likely to slip into sentimentality – I do apologize.)

Wedding planning

2010-02-20T22:07:00.003+03:00

I have acquired the free services of a local wedding advisor. Naomi is my neighbour, and we became friends when she came over to meet Luthien. Now she visits almost every day to entertain Luthien, and we usually end up going for a walk or chatting about school, and moving around the world and cultural differences and life. She was very excited about my engagement and has helped me surf the web for possible wedding venues, critiquing them primarily for their ‘family friendly’ qualities. On Thursday she brought me some beautiful roses as an ‘engagement present’. Oh, did I mention that she is in 5th grade?

Hasn't Luthien grown?

Mental Health Day

2010-02-20T15:21:00.007+03:00

During the last two weeks the Christian Medical and Dental Association has held a medical education conference just outside of Nairobi. In addition to some very helpful lectures and workshops I enjoyed the opportunity to network with clinicians working all over Africa. And I did take the opportunity to have some fun too – one day Sara (OB/Gyn Kijabe, Kenya), Stephany (Paeds, Kijabe, Kenya), Christina (OB/Gyn Kapsowar, Kenya) and I went into Nairobi for lunch and had our nails painted.

Christina, Sara and Stephany enjoying a curry.

Pretty toes.

More pictures

2010-02-11T09:33:00.004+03:00

Here I am with David and Luthien when he came to visit in Kenya. We looked for a ring together in Nairobi. We found a tanzanite (a stone mined only in Kenya and Tanzania) - which is exactly what I had hoped for.

Here's our attempt at a sentimental engagement photo - we couldn't stop laughing at each other.

And another thing...

2010-02-08T17:30:00.000+03:00

I promised in my last post to let you know why I was in such a hurry to leave Kijabe on 29th January. Well, that's because I was on my way to Nairobi to stay with my parents before flying out to Kampala on Saturday. That afternoon I met my friend David Pitches who drove me down to Mburo Game Reserve about 200km south of the city. We stayed at Mihingo Lodge (http://www.mihingolodge.com/ for those who are interested), a hotel on a hilltop overlooking a lake on one side and a watering hole on the other. Each room had it's own terrace with a view of the watering hole. Coffee was brought in the mornings to wake up as you watched the animals come for a drink. We watched game from a nearby hide, went for walks in the moonlight overlooking the lake, and a horseback safari. Then on the final day we were together, David asked me if I would marry him - and I said yes. :-)

This is the hotel restaurant and bar on the top of the hill.

There were only 10 rooms, each one tucked away among the trees on the hillside. The entire hotel was run on solar power and water collected from rain water. Trails were made from local rock slabs and at night they were lighted by lanterns. Birds, monkeys, rock hyrax and bush babies could be seen daily, and they had a great variety of vividly coloured butterflies living in the shrubbery.

Each room had an individual terrace overlooking the watering hole - a lovely place to watch animals as you drank coffee in the mornings or had afternoon tea.

Here are some of the impala that we could see from my terrace.

We went for a horseback safari and were able to get very close to the game - I guess the smell of 'horse' overpowers the smell of 'human' and reassures the animals. (This particular photo was taken by our guide - who clearly lacked some understanding of photo composition - in addition he was riding a rather excitable Ethiopian pony who kept prancing about during our photo session.)

This pool is just underneath the restaurant at the top of the hill (and the water comes from rainwater as well). They have built a ledge at the end overhanging the hill, so you can stand with your elbows on the edge of the pool and watch the animals when you wanted a rest from swimming. Just below the pool they have another terrace - and it was there that David proposed.

Another memorable patient

2010-02-08T16:45:00.000+03:00

On Fridays we have our gynaecology outpatient clinics. They are usually very busy, with 60-90 patients most days. And on the 29th I was just finishing up (an hour late), very eager to get off for some important weekend plans (about which more in the next blog). But on my way out the door I was stopped, 'Doktari, we have this very short woman who has come in in labour and the baby is transverse.' Well, 'short' was definately correct. I don't know exactly what was wrong, she didn't look achondroplastic, but she clearly had severe bony deformities - less than 4 feet tall, contractures of knees, hips, pelvis, elbows and wrist, severe kyphosis, scoliosis and lordosis (i.e. a very twisted and fused spine).

The anaesetists tried to site a spinal with no success and eventually did a general anaesthetic and secured an airway with a fibre-optic ET tube (all this is very fancy stuff that I'm fairly amazed we even had). Then my challenge was getting into the abdomen with her hips flexed at 90 degrees, and trying to figure out where important structures like the ureters were running (they were pushed way out of their normal position). But praise God we had a healthy mum and a healthy baby.

Mother and baby in the nursery.

Caesarean Hysterectomy

2010-02-08T15:53:00.000+03:00

Sometimes when a woman is bleeding excessively after delivery the only way to control the bleeding is to remove the whole uterus. This is pretty much a last-resort option when other techniques to stop the bleeding have proved inadequate. In England caesarean hysterectomy is pretty unusual – in six years of training I had personally only ever been involved with one – but here they are much more common. I get a lot more referrals from other units, and certain management options (e.g. interventional radiology) are not available here. Also significantly, a lot of our women are anaemic, and it’s much more difficult to get blood for transfusion.

From November to January we had 8, and those weren’t particularly unusual months.

· 5 placenta praevias with associated accreta (where the placenta is at the bottom of the uterus and cannot be separated from the uterine muscle) - (4 following previous caesarean sections)
· 1 uterus with massive fibroids
· 1 uterus that refused to contract
· 1 ruptured uterus

Many of these babies are premature at delivery, and 2 of the 8 died not long after birth. I am always very grateful for our excellent neonatal unit as without our it at least 4 others would have died as well.

This little one started off on 'bubble CPAP' to support her breathing.

A few days later she was breathing well on her own, and has since gone home with her mother.

Frankly, these are not operations that I enjoy (at least, not until they are over). They occur in dangerous situations where a woman’s life is at risk, frequently in the middle of the night with theatre staff who are not used to gynaecological procedures. They require great speed and usually you are operating in a bloodbath. Knowing when to proceed to hysterectomy is not always easy – you don’t want to rush to a procedure that will prevent a woman from ever having more children in the future, but you know that if you delay too long, she will have used up all her clotting factors and be much more likely to die.

Last Friday was one of my more interesting caesarean hysterectomies. This woman had been actually come to casualty because her husband was ill, and then she started to bleed. When I scanned her and saw the praevia I knew that with her history of 2 previous caesareans she was highly likely to have an accreta. What I didn't expect, as I was opening the abdomen was to find that the placenta had eroded all the way through the uterus and was stuck to the anterior abdominal wall and the bladder.

The mother is doing very well post-operatively, but her baby is struggling a bit, still requiring CPAP.

Twins...

2010-02-08T15:27:00.000+03:00

When we first arrived the labour ward team was very anxious about twin deliveries. They know all too well the kind of things that can go wrong - epitomised by a young woman who died in our unit recently. She had delivered in another facility - twin 1 survived but twin 2 died. Then she had a post-partum haemorrhage, a late decision to procede to hysterectomy, and she eventually sustained severe brain injury do to lack of oxygen. She never regained consciousness after surgery and was transferred to us essentially to die. We looked after her during her final week of life and our paediatric team helped the family to prepare for how they could look after the surviving twin.

But although twins are certainly a challenge, delivering them safely is one of the most rewarding parts of my work. For the last six months Sara and I have been working with our midwives and interns, encouraging them to develop their skills and experience, and we have seen them grow in competence and confidence.

This is Pauline, one of our new interns, with a set of twins that she delivered. We supervise our interns very closely to ensure that they are well supported and learn safe management from the beginning.

I also have the midwives manage these deliveries whenever possible, though again, I am always present for supervision and support. After this woman delivered her managing midwife was very pleased with how things had gone. 'I am so happy to be working in this hospital,' he announced to me. 'In most other hospitals in Kenya this would have been an automatic caesarean section. But here we know how to safely deliver twins.'

P.S. The little girl was named after me. :-)

January - the drama never ends...

2010-02-08T14:45:00.001+03:00

Since returning from my holidays we've been pretty busy in Kijabe. Here are a few medical memories from the last few weeks...

Just after getting back we had a woman with an 18 week abdominal pregnancy. This baby was growing outside the uterus with the placenta stuck to part of the bowel. She came to us complaining of pain, and she had started to bleed internally. We had to operate, and though the baby could not survive, the mother lived.

Almost all of our operations are carried out under spinal anaesthetic, so the patient is awake during the surgery. One of the more interesting features of theatre ritual here is showing the patient the specimen after we have removed something from their body. My nurses were perplexed when I explained that it was not typical practice in the UK to show patients their uterus after doing a hysterectomy. 'How do they know that you removed it if you don't show it to them?' the nurses wanted to know.

My favourite operation of all is still repairing obestetric fistulas. This young woman is one of our typical patients - Like many of our fistula patients she is from Somalia, a teenager with an early marriage, obstructed labour at home for many days, finally delivering a stillborn infant and left with the hole between the bladder and vagina. Less than an hour of surgical time and two weeks of care in hospital and this young woman went home dry for the first time in years - smiling with hope for the future.

Sometimes patients forget to read the textbooks before presenting to us with problems. 'Everyone' knows that patients are only supposed to get eclampsia after they have first had pre-eclampsia. It's only courteous of them to warn us that they intend to have a convulsion by getting high blood pressure or protein in the urine first. However, two of our patients this month decided to have their convulsions before the other signs and symptoms. Fortunately we were able to stop the fits, stabilize them and deliver them safely of healthy babies. How grateful I am to have magnesium sulphate!

Christmas Day

2010-01-17T13:57:00.001+03:00

Brooke and Chad came downstairs on Christmas morning

and were amazed to see the pile of presents under the Christmas tree.

Breakfast at Aunt Jenny's - all the grandkids are blowing out candles on our traditional 'St. Lucia's Crown' after singing 'Happy Birthday' to Jesus.

Now the Morad clan has a huge row of stockings:

Steve (aka Dad/Guka), Sandy (aka Mom/Shosho)

Sharon

Stephen, Leigh, Ethan, Liz

Suzanne, Joey, Brooke, Chad and ?

Stephanie, Aaron, Keira

Christmas Eve

2010-01-17T13:44:00.001+03:00

Chad, Liz and Brooke went to great effort to be sure that I understood what was happening as we watched 'Cars' together.

After the Christmas Eve service at church, the whole Chicago-area clan gathered for supper. The universal favourite was the chocolate fountain for dessert.

Brooke and Chad love raspberries - they can stick their fingers in the hole!

10 more minutes of playtime before Brooke needs to go to bed.

Keira's ready to sleep in her mommy's arms.

more photos

2010-01-17T13:34:00.000+03:00

Melissa and Kaitlyn Leigh making candy

Christmas is always more fun with children - and we had a lot underfoot.

Brooke, Rachael, Kaitlyn, Keira, Chad, Aunt Beth

Playing with Shosho.
Chad is following in the footsteps of his big sister.

Kaitlyn and Brooke

Exhausted adults.

Aaron, Stephen, Leigh, Kevin

Family time

2010-01-17T11:57:00.001+03:00

This is the first time in 5 years that my whole family has been together, and we certainly made the most of it.

Playing in the snow.

Guka and Brooke making a gingerbread house.

Decorating Christmas Cookies.

Brooke, Stephanie, Liz, Aaron

Ethan

Keira & Brooke

Grandma's birthday

2010-01-17T06:32:00.000+03:00

All of the Jorden kids were able to be there for Grandma's 80th birthday.

Here are my grandparents with the 'Precious 9'.

From left to right (back row) there is Beth, Kris, Sandy (my mom) Debbie, Judy, Sue

(front row) Jenny, Jim, Grandma (Janet), Grandpa (Paul) and Paul.

Grandma received a scrapbook with pages of memories and photos put together by her family and friends.

We shared a lot of laughter as people shared memories of my grandmother.

My grandfather lead us in devotions each day we were all together; and the family also took time to pray together.

Back home

2010-01-03T07:03:00.000+03:00

So I’m back in Kenya after my visit to America. Here have been the highlights of the last three weeks (pictures will have to come next week since most of them are on my sister’s camera and she’ll be sending out a CD of them with my parents):

1) Just before I left we had a ward Christmas party. The staff enjoyed a nice meal catered by a local restaurant and were especially impressed by the decorated sugar cookies.
2) On the way back to the states I stopped in London for about 24 hours to visit my friend David. It was nice to be back in the UK even for a short time.
3) The first week in America revolved around extended celebrations for my grandmother’s 80th birthday. Over 30 member of my extended family gathered, including my mother’s 6 sisters and 2 brothers. It was lovely to see so many of my relatives.
4) A visit from Melissa and Caleb (close friends from my university days at Northwestern) and their daughter Kaitlyn.
5) Shopping for the ward – I managed to obtain fetal dopplers, a cardiotocograph machine, some pulse oximeters, and most importantly – an ultrasound transducer to replace the one that was stolen.
6) Christmas celebrations – my brother, two sisters and their families gathered for nearly a week – the first time we’ve all been together in the last 5 years. It was fun to see the youngest generation of cousins getting to know one another.

I had safe travel (with no delays despite snow in Chicago and increased security in London following the antisocial behavior of a certain gentleman on a Northwest Airlines flight on Christmas Day) and am glad to be back in Kenya now. The next few weeks will undoubtedly be busy and exciting – I’ll try to keep you updated.

HIV and haemorrhage

2009-12-06T17:59:00.000+03:00

This week the government of Kenya is having a massive campaign to encourage people to have HIV testing. As part of this effort our church had a service focusing on a Christian response to HIV. They gave a good factual education of how HIV is transmitted and how it effects the body, explained the ABC (abstain, be faithful, use condoms) approach to prevention, and highlighted the AIDS Relief project in the hospital (where 5000+ people receive treatment for HIV, with one of the best anti-retroviral compliance rates in the developing world). Above all they stressed that a godly approach to people with HIV is compassion and love, not judgement. After the service tents were set up in the church grounds for VCT (voluntary counseling and testing), and all members of the congregation were encouraged to attend for testing.

I didn't attend for testing myself - but that's because my next HIV test is due in mid-January, two weeks after I finish my post-exposure prophylaxis. (I had a needle-stick injury when operating on an HIV positive patient - the truly annoying this is that I can't really blame anything except my own carelessness - it was my fourth emergency operation in less than three hours and I was rushing to finish - a moment's distraction and I had a needle in my finger, stupid really...)

It did remind me, however, just how risky my specialty is in Africa. Massive blood loss is pretty common in obstetrics, and adequate protection (e.g. long-arm gloves) is usually lacking. As I fish out retained placentas or second twins I frequently end up with blood inside my glove (even if I'm not poking myself with a needle...). Even abdominal surgery is often pretty bloody for obstetricians. Yesterday, for example, I ended up doing a caesarean hysterectomy for a placenta praevia and accreta (yet another reason why Kenya's spiralling caesarean section rate is a reason for concern). I was pretty pleased to have limited her blood loss to about 1500 mL - but you can imagine how it soaked through my non-waterproof gown before I got the uterine arteries clamped...

This came out first - a lovely baby girl.

And this came out last - a uterus with the placenta over the cervix and morbidly adherent to the uterus.

Friday night

2009-12-04T21:54:00.000+03:00

I've just said goodbye to our three family practice residents who have been working in Kijabe for a month. Alyson has been doing obstetrics with us - truly a joy to work with and a real help, especially in the maternal-child health clinic. I had them over for mung bean curry and a weird take on bread pudding (I used banana bread and threw chocolate and bananas into the custard - not too bad surprisingly). Luthien showed off abominably, and is more convinced than ever that she is in fact the centre of the world.

There have been several tough situations this week - two women on our theatre list who turned out to have unresectable cancers, comforting a woman facing her fourth consecutive miscarriage, and another whose baby turned blue several hours after delivery and and was diagnosed with severe heart problems (almost certain to be fatal).

But there have been many moments of pure joy. One 16 year old girl with a very rare cancer who tried to bleed to death on Saturday night. I managed to stop the bleeding with a hysterectomy and then telephoned everyone on the hospital blood donation list until we had enough donors. After 8 units of blood she had a haemaglobin of 7 - and now whenever I see her giggle with a patient in the next bed or smile to greet me I am tempted to break out into songs of praise to our great God who has saved her.

And one night when I was just 'passing through' the ward to collect something I was somewhat irritated that a patient noticed me and called me to see her. But there was no complaint, she thought I would want to know that the woman in the next bed had delivered, 'since you prayed for her child this morning I thought you would want to give thanks to God.' She then proceded to update me on the entire bay - clearly she had listened to my prayers with each patient in the morning and wanted me to know 'those two delivered safely, that one had her baby come back from nursery, the one next to me had no further bleeding, and my blood pressure is much improved.' She then instructed me to pray again with each patient that God would keep and preserve them through the night - and after our time of prayer I walked home in the starlight, humbled, knowing that I had been standing on holy ground.

Getting started...

2009-12-03T22:28:00.000+03:00

Earlier this week I sat staring in dismay at the list of 60 e-mails that really do require answers – almost all of them including a subtle chastisement for my poor communication of recent months. And though I know this is not a real substitute, I figured I might as well give blogging a try. The concept unnerves me slightly I confess, it feels slightly too exposed for my taste – but for those who are interested, I’ll see if I’m any better at posting news for all to see than answering individual messages.

So here are a few items to kick off with.

First, may I introduce you to Luthien Tinuviel?

She is a border collie puppy now six weeks old and she moved in with me one week ago. We are learning the process of living together. I’ve discovered that if I don’t have her breakfast ready on time I’m in big trouble and that a 15 minute walk is exhausting for her short legs; she’s learned that if she cocks her head just right or wags her tail she can get away with murder.

Luthien is extremely popular with my neighbors’ children who are glad to come and play with her when I am working.

Second, here is my favourite clinical story from November.

J. is a 22 year old woman in her fourth pregnancy. In August her family thought she looks a bit bigger than the previous three times, so she went to a clinic for an ultrasound scan, and was told that she was expecting twins. This is not a big deal in her community, and certainly not a reason to avoid delivering at home. So one night J. went into labour. After some time she delivered a healthy baby boy, and then prepared for the next child to come out. As they waited, J.'s mother pondered the size of the abdomen and concluded that perhaps there were two babies left inside - and two more babies could mean trouble. After some discussion they agreed to bring J. to the hospital, arriving 8 hours after the first baby had delivered. I then proceded to perform a breech extraction of one baby, delivering a baby boy. A minute later I had my hand around the ankle of the remaining child - and soon we have three screaming boys in the cot - all weighing >2kg. J. herself suffered some bladder trauma and developed a uterine infection (due to the long labour and delay between babies) - both of which resolved nicely during two weeks in hospital.

Yesterday her husband came to collect her and the infants. They will be returning to the older three children - all of whom are also boys.

So, how's that for a first attempt? (At blogging I mean...)