Hi, I'm back. Its 12:45 am and the day is finally over, everyone is in bed except the ICU Doc's and nurses who are caring for the patient's post op. They have had it the worst working around the clock with rotating shifts every day and night. The team is having a hard time sleeping with the time change and working long and different hours each day. Thanks everyone for all the email responses. It's so good to hear from all of you at the end of each day. What a great way to wind down the day by talking with all my family and buddies way "over there". The internet is pretty amazing, even when it's only dial-up.
OK, a couple of responses. The weight for Kip was not a typo. He is 21 kg. Multiply that by 2.2 and you get his exact weight in pounds. He is 10 years old and severely malnourished from his congenital cardiac condition. Hard to believe, I know. Believe me; I double checked his weight more than once to make sure I was setting up the correct size bypass circuit for him. The first stop today was off to the ICU to check on Kip and the rest of the gang. He was still intubated (breathing tube in the throat, sedated and paralyzed) but his chest X-ray was improving as was the echo of his heart and lungs. After evaluating his condition, the Doc's decided it was best to reoperate on him as the 2nd case of the day (total of 3 cases today) to decrease the amount of pulmonary blood flow to his lungs from the 2 shunts that were placed on his first operative day. He returned to the ICU sedated, paralyzed and intubated again. We are leaving Tenwek tomorrow morning @ 0930 so I hope they can extubate him by then so I can say good-bye. Our ICU nursing and intensivists are staying behind for another couple of days to care for the patient's, so I can get updates from them after I leave. I'll pass them along. Thanks for all your prayers for little Kip. You know he appreciates it.
I was planning on going on a hike to the top of the highest hill in the province which is right outside the hospital with some of our group this morning, but Dr. White asked me to set up a cell saver on each of the mitral valvulotomy cases they were doing today (non-pumps, so it was a laid back day for me). On the way to the hospital today, Camera-guy was looking for his first photo-op and, as usual, it occurred within several steps out the front door of the guest house. There is a cement area under a roof a bit below the guest house where I heard kids rollerblading so I went down to see what was up. There were 4 boys rollerblading, which you'd think I would be used to having had 2 kids go through that stage in Southern CA. But these kids were rollerblading with only one roller-blade on each foot, so they could all have one roller-blade each. I don't know about any of you, but I've never seen that before. So since there were no adults around, I bribed them with some M&M's and asked them if I could take their picture. Boy, they were all over that one! When I asked them if they knew what they were, they all nodded in unison.
My day today was very hectic just trying to pack up all the supplies we had brought to the OR the first 2 days we were here and take them back to an area where they could be stored and locked away. One of the weird things here at the hospital is that everything is locked all the time. When I get to the hospital in the morning, there are chains around the cardiac OR, so you have to go find Anna to get the doors unlocked (until Dr. Bichell figured out how to break the lock and take them off himself). The hats and masks are locked up too. So people are walking around the OR without hats and masks on even in the OR with sterile instruments open. It just takes a long time to do every little thing, but the funny thing is, no one is upset about anything. They're all walking around very pleasant with a smile on their face very very hard at work. I was telling Dr. White tonight (he's had us over to his house 3 or 4 times this week) that I' m not used to working in an environment that is #1 Christian, #2 completely non-beurocratic / political - at least as far as I can see, and #3 everyone can tell that the entire medical staff is there for the kids. I've worked a lot of places that have done pediatrics with a lot of people that SAY they're there for the kids, but their actions show that they really aren't. I cannot tell you how much I have enjoyed this working environment, even though we're all exhausted. It's so refreshing and rewarding.
I don't know, I think we have so much in the States that we just want more. We're programmed for a me-me-me-me world, and some people just never get enough. And even when some people think they have enough and the guy / gal next door gets something else, they want / "need" that too. Go live in a hut for a while and cook your food in a fire on the floor. Oh yah, you'll be bringing your young sheep and goats and cattle into your one-room hut with you so the lions do get them at night. See if that doesn't give you an attitude adjustment lickety-split! These people have nothing. Literally nothing and they are all walking around with a smile on their face (unless one of us white people walk by and scare them). One thing I've noticed in the OR the last several days is that the medical staff is all very touchy feely with each other. In the States if there are 10 or 15 people in the OR watching a procedure they're all in the same room but in their own space. The Kenyans are all grouped together not just leaning on each other, but they have their arms around the person next to them. Draped around their neck or their waist. While their right arm is around their neighbors shoulders, their left hand is holding onto their neighbors left arm. It's not sexual, just comfortable. They're at ease with themselves and with each other. Just don't try to take their land, women or cattle and you'll get along with them just fine also.
An interesting thing happened over the past couple of days with several of the patients. As we were exposing their chests to prep and drape them for surgery Dr. White pointed out some scarring on different parts of their upper torso. Certain tribes are really into home remedies, and I'm not talking Herbalife here. They take knives and make small cuts less than an inch long, 5 or 6 of them at a time over the organs that they feel are diseased and then they rub ashes into the cuts from the fire of particular woods that they burn. One little 12 y/o boy had cuts over his heart and over his liver. The other thing that we're noticing is that all the patients, even the children have black spots on their lungs. The surgeons say that it's the same as the lungs they see of people that have been smoking for 20 years. They are breathing in the smoke from the fires in their huts when the women are cooking the meals. Of course, there are photos of these blackened lungs for all to see.
I downloaded both of my camera cards today to 4 different computers on our team (just so I wouldn't lose them if I lost Meghan's camera, or the guy that down-loaded my pictures lost his computer). I had 1700 photos, and we haven't even gone on safari yet. If any of you want a great way to see what Africa is like, rent the movie "Ghosts in the Night". I'm pretty sure that's the correct name. If not Val Kilmer and Michael Douglas were in it so you could google them. EVERYTHING in the movie is true, even the story. Dr. White had the whole team over to his house last night and he kept stopping the movie to tell us which tribe they were talking about, or what the particular culture was. The 2 lions that are in the movie are actually in the museum of Art in Chicago, so guess where we're going on the next 4 day weekend I get? I gotta see those lions. He wanted all of us to see it before we leave for safari tomorrow. ; It has some pretty graphic footage of lions killing people. One of the ortho Docs that is here this week was telling me when he was on safari, you are advised not to get out of the land rover. Supposedly you can stand up in it and shoot pictures of the wildlife over the top, but under the roof. Some guy got out of the truck at a stop to get a picture and at different times of the year the grass on the plains is pretty high (watch the movie) and when he stepped to the front of the truck to get a picture a lion came out of the grass and attacked him. Apparently lions take down 400 or 500 pound zebras all the time, so imagine what they could do to a person. According to Matt, they bite the prey in the neck and throw them down on the ground breaking their back and then they take their hind legs and rip the preys insides out. Ken, a retired OB GYN Doc that's been here all week said that he when he was on safari a leopard killed a gazelle right behind their truck and was eating it when another gazelle in front of the truck walked around into plain site of the leopard that he didn't know was there. He said they both looked at each other and the gazelle took off running with a 100 yd head start, and the leopard caught it within another 100 yards and took it down too. Then a lion went after the leopard (or the dead gazelle he had), so the leopard carried the dead gazelle up into a tree to get away from the lion. Huh?
All I know is I can get another 1000+ photos on that clean 4 gig card in my (Meghan's) camera.
There is a book y'all can read about Tenwek as well, it's called "The Miracle of Tenwek". It profiles the first Dr. that worked at Tenwek. His son was at Dr. Whites last night watching the movie with us. He's an administrator for Samaritans Purse and had some interesting stuff to tell us about the area. They live in the Maasai Mara where we're going on safari, and he says you can hear the lions roaring all the time at night.
We were telling him we wished we knew what the natives were thinking about us when we walk by every day because some of them appear quite alarmed, I made a baby cry today just by walking down the sidewalk (even as I'm portraying my Most-Pleasant-Person-on-the-Planet demeanor). He said that some of the tribes tell their kids that "white woman's lips are red (i.e. lipstick) because they eat small children". Nice! And so they don't have to tell their kids where children come from, they tell them "that they buy the children from the white people at the hospital". There is a distinct body odor (almost makes you sick) from certain people and he said the Maasai are known for not showering and smelling pretty bad. So I asked him how long they actually go without showering to smell that bad. He said the answer is usually when it last rained. And there are 2 rainy seasons in Kenya and we happen to be in one right now, but you'd never know i t when all those people are piled in the OR at the hospital. You practically don't need any anesthesia to knock out the patient the smell is so bad.
He also said that they have clinic workers that go to the far outreaches of Kenya to have clinics to immunize the children. He said there are so many illiterate mothers that they give the inoculations in each arm and each thigh and polio orally. He said even when a mother doesn't know what shots they're kids got, they know where they got the shots, and if they say the kid got a shot in the right thigh they'll know what it was.
Oh yah, then there was the circumcision conversation. Dr. White was telling us that boys are circumcised at the age of 14, and the different tribes circumcise their kids different ways by the amount of skin they leave behind. So my curious mind was wondering how exactly you would go about cutting a 14 y/o boy down there. That's a pretty private part of a kid at that age - heck at ANY age. So the answer is, the father stands behind the boy with a spear and in the old days they would spear the kid and kill him if he screamed. Now a-days the hard-core Dad's will ostracize the kids from the family and disown them because a screaming kid is a disgrace to the family (even if they're getting their who-who cut with a knife!) Wow, just don't get that one. Then he said that the scrub tech at the table was a minister and he's the one that does the circumcisions in his church. When he stopped laughing at me for all my stupid questions, he said the boys are much more afraid of their fathers than they are of getting circumcised. Still don't get it.
We were talking about Elvis getting shot in the neck with an arrow, and he said that his Dad had a guy come into the hospital one day with 3 arrows in his chest. When he asked the guy what happened, he said he was trying to steal his neighbor’s cow. Apparently, the Maasai believe that God lowered a leather rope from the heavens down to the earth that all the cows walked down on. The Maasai believe that all cows on earth are their property and they go around stealing cows all the time from the Kipsigis in the area. Once again, I wasn't quite sure how you go about having a disagreement that ends up with one guy pulling out a bow and arrow and shooting it at someone. He said when all Maasai tribesman dress in the morning, they are carrying at least one knife or arrow and a wife-beater to protect their cows and themselves. The Maasai hold the spear out as the lion is charging at them and try to put the spear into the lions mouth with o ne hand while hitting it up-side the head with the wife-beater with the other hand. Yah, right! Apparently they'll take after you if you take their picture too, because they think you're stealing a part of your soul.
The other day one of our nurses took a picture of a little baby at an open market, and the mother immediately said, "You buy tomato now!. Mary Beth didn't have any Kenyan Shillings on her so she just said no and walked on to the hospital. This woman kept yelling at Mary Beth every time she walked by the stand (which we have to do to get to the hospital), "You buy tomato now", so she borrowed some money from me yesterday to pay the woman off for the picture.
So the surgeries in the other rooms today were a little baby that was burned with sulfuric acid on both legs. I got to watch them take a dermatome and but a thin layer off the top of each of his thighs, run it through a tenderizer type machine that makes small cuts in the skin so you can stretch it, then cover the burned legs with it. Cut, tenderize, graft over and over and over. Poor little boy. Daniel (the circumciser) is supposedly great at skin grafts because small babies frequently fall into the fire and epileptic women typically fall into the fire when they're cooking. He said it's nice that Americans cook up high so no one will land in the fire that is up that high. Somehow it happened in his father's car.
Then there was a 30 y/o women who was brought in after a 10 hour drive to Tenwek with a snake bite to her leg and they amputated her leg about 6 inches above her foot. I thought of our friend Steve who was bitten by a rattlesnake in Pasadena but had a hospital a few blocks away and the ability to obtain anti-venom from several neighboring towns. These people are so deprived.
Today there was a camera crew in the OR from Nairobi doing a story on our team being there doing open heart surgery, so they used my photos for the newspaper article. He said he'd email me a copy of the article and a DVD of the news spot on Nairobi TV, so we'll see.
Well, it's 2:30 am again and I'm heading up the hill at 0730 with Dr. White to look out over the valley, so rest assured Camera-guy will document the expedition appropriately. Then we leave at 0900 or 0915 for the safari in Maasai Mara. I promise to stay inside the truck, but that zoom lens is going to be right in the thick of any activity on the Serengeti Plains. I'm hoping to have some great pictures of all the wild animals. We're all eating at the Carnivore Restaurant tomorrow night. It's a very well known restaurant in Nairobi where they cook a variety of exotic meats (zebra, elephant, rhino's etc) and cut it off the skewer right at your table. Probably all tastes like chicken.
We're staying in tents, so I don't think I'll have computer access after tonight, so I'll check in again when I get home if I can't get on a computer in the meantime. We leave on Monday for the US and it'll take us 2 days to get home. We arrive Wed afternoon into Nashville, so I'll probably spend the first few days getting caught up on my sleep.
Wish me luck on the safari and continue praying for Kip. Our second mitral valve patient arrested tonight in the ICU, so keep him in your prayers also.
See you on the other side. It's 2:45 am and it's mosquito net time in Kenya.
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