KENYA VIDEO 2013

I've made a Kenya Slideshow that covers the trip from beginning to end.  When I look at it I see the really nice accommodations that we had and feel a little guilty that we didn't suffer more, but then knowing we got the Kenyan rate because we were missionaries and it helps out the local economy I guess it's OK.  NN

KENYA - End of the Trip

We had fun on the trip as well as hard and sometimes frustrating work.  We got to visit a giraffe conservation center on the way to the airport in Nairobi and visited Carnivores Restaurant.  I highly recommend both.  We were so happy to get home to our own homes and families. 

Diana and Erin feeding the giraffe.

Molly getting a slice of ostrich.

The team leaving Naivasha Panorama Park Hotel.

We were gone 16 days.  It took 2 days to get there and 2 days traveling home.  We're all expecting some jet lag for the next few days.  It's by far the most exotic place I've ever been and for all the missions I've been on, it's the first one I felt like we had done more than just help the patients we worked on.  The new Women's Hospital in Naivasha will improve the health care of people there in so many ways.  The current hospital has wards with 32 patients in each ward, women's, men's, pediatric and maternity. The chaos and lack of privacy you'd have to see to believe.  I've not put in too many pictures because of patient privacy, so the only ones posted are with the consent of the patients or their families.  Many photos are too gruesome to post.
This was my first opportunity to work with the local ENT physician and I went away with a really good feeling that she will be able to do a T&A with much less bleeding and be able to see what  she's doing with some simple retractors and instruments.  I'll see what I can do about getting her a proper tray.  She also now is able to do a needle biopsy that she had never done before as well as nasal surgery she hasn't done.  Some of my instruments she had never seen and didn't know how to use, but she had good clinical judgement and was a quick learner.

22 year old with lumps in the neck. Probably TB.

Dr. Novotny demonstrating Fine Needle Biopsy for Dr. Maina

Dr. Maina, ENT, Margaret, clinic nurse, Dr. Novotny

I believe the others on the trip had the same feeling.  The L&D group got the maternity ward to start using the fetal monitor, oxygen and suctioning on distressed newborns.  They also got the infant CPAP working.  The babies die so easily there that they don't name them or consider them a person until they are 3 days old.  They say that babies become angels when they die so it give the families some sense of relief to know their babies are angels. There's no real count of the infant mortality because so many are born and die at home without ever being counted. The Maasai place their dead out in the bush to be eaten by animals.
Dr. Stice brought a dermatome (instrument for skin grafting) and worked extensively with the local general surgeon to help him be able to care for the many burn victims.  Her daughter, Caitlin worked on the stove project which we hope will eventually cut down on so many terrible burns.

Dr. Shulte, John Novotny, Cindy Berkland, APRN

Dr. Hawthorn, Dr. Norton, John Novotny, Laura W., Kenyan nurses, Dr. Novotny

We were so happy to get home to our own homes and families.  It was a challenging and rewarding trip that will leave a real and permanent improvement in their healthcare system, especially when the new hospital is up and running through the help of several Nebraska hospitals, medical teams and many generous donations. 

KENYA -Heathrow airport

We're sitting in London Heathrow airport. We have a 5 hr layover here. There's a mall (of sorts) in the airport but it's mostly things like Harrod's and Burberry's of London so a little out of our price range. I saw a little silver python clutch in Harrod's for only £625. That's about $900 I figure, so just admired it! It's so interesting to see people from all over the world wandering around. It turns out there is a shower here that I used for free. It was really nice as it had been a couple days since the last shower and a lot of dusty bumpy roads since then.  Friday was spent traveling to Nairobi. It was all highway and closer to Nairobi it was 4 lane divided highway. It was interesting to see the cows, burrows, sheep etc along the road even as we got into the city. There were vegetable gardens and burrows grazing in the median in places. Then random roadside stands just up next to the highway so you could pull over whenever you saw something you needed. We stopped to buy souvenirs in a couple places. One was a bead making place that hires single mothers and needy women. You could walk into the shop and see them making beeds, painting them, firing them in a kiln then making the necklaces, etc.  Wherever we shopped things were definitely Kenyan. None of this "made in China" stuff here. For supper Patrick made us reservations at Carnivores. When you walked in there was a big BBQ charcoal grill with all kinds of meat cooking. It reminded me a little of Hu Hots. There was a menu board with one price at the top then a long list of meats including crocodile and ostrich. So they brought a little bowl of leak and potato soup then a salad on a lazy Susan that you could take what you want family style with a choice of sauces round the top. Then waiters came one at a time with a long sword with meat on it. One had chicken, then another pork ribs, beef, ostrich, lamb, ox balls, crocodile etc etc etc. you could say 'yes' or 'no' on each one so they would put the point of the sword on your plate and cut off a piece of whatever it was or drop a meatball on your plate. We had a little flag on the table that we left up as long as we still wanted more meat then we laid the flag down when we "surrendered". I've got pictures but am using Kevin's iPad so can't load them right now. We are all willing to visit with any group and give slide shows so don't be afraid to ask. We have sooooo many stories we haven't even begun to tell and more pictures than you can count.

Being in London at least ends the bathroom adventures! The toilets flush with toilet paper right there and no squatting options to even consider. Tony came with us as far as Heathrow. The rest of the team from Omaha and Fremont are traveling through Amsterdam. We'll meet them in Mpls but Tony is going through Atlanta and already took off. He entered the team late when someone else dropped  out at the last. We are looking forward to being in our own beds tonight. 16 days is a long time to be gone and although we've toured around and seen a lot we also worked hard under difficult circumstances and unique challenges. We've come away with yet a new view of the world. The Kenyans were welcoming and the country is beautiful. NN

KENYA

Ready to leave. Minalyn came to see us off. She's the one who hires disabled, HIV etc. I gave her the few sewing kits we had left and done erasers, crayons, etc. she will distribute them to someone in need. She's the one who has helped arrange transport and surgery for Moses, the boy with the broken leg. There is a picture of her and one of Moses with his grandmother. His mother was murdered and never knew his father. He had been in traction for 3 weeks and needed surgery in a different hospital.

KENYA

We had no Internet at al last night so no communication back home. Someone got a secret password this morning so now we're all posting before we head to work for the day.

Kenya - MacGyver John's report

I thought it was time to make a post about my experience here thus far. Like most 3rd world mission trips I have been on, the usual challenges have presented themselves. In a nutshell I suppose a few themes sum it up. 1) Lack of money for needed items, services etc. 2) Lack of organization on many levels 3) Lack of desire for change by the locals and 4) Poor condition of most local equipment and available resources to fix them. This is not surprising as we are serving in a high need area, so it all goes with the territory. Normally you don' t do mission trips in low need areas, so we knew what we signed up for.

Most of my days are filled with trying to fix or patch equipment, processes or logistics to support what needs to be done. I've worked on electrical problems (which are abundant), ran errands (equally as abundant), organized supplies and materials, assisted in the operating room, etc. here, I can freely walk in and out of an operating room, and that be considered "routine". I'd never do that back home.

Yet, there is a feeling of accomplishment at the end of the day. You hope that there is a sense of teaching/learning by example more than forcing "our way" on others.

Our combined Columbus/Omaha teams have been great to work with. We all have high points and frustrations we share at some evening meetings. The food is definitely Kenyan (lots of stew, potatoes, room temperature milk, mangos, etc. Sometimes I think they are trying too hard to give us their gourmet food, and sometimes we long for just ice cold drinks (no ice routinely here), a greasy burger and fries, or something besides Coke. But the food is safe and nutritious for the most part. Only drinking bottled water though.

Other highlights of the trip have been the safari, which we got some bonus sightings you usually don't see (like the circle of life with a lion kill aftermath being cleaned up by the hyenas and vultures, monkeys, leopard, and Masai village tour (local indigenous people).

Each mission trip is unique, even if repeated. We are thankful for all the folks back home that helped in some way to get us here. As with most mission trips, we probably get more back than we give. Signing off for now.

John

KENYA - Back to Naivasha

We did a morning bush drive today near our lodge and saw a herd of about 8 giraffe, one with the umbilical cord still attached, but up and running.  We then had breakfast and were on the road by 11:30 for the 4 hour drive back to Naivasha.  Part of our safari included a trip to a Maasai village where the warriors did their jumping dance and then the women sing.  The village is inside a stick fence which keeps out predators (like lions) at night.  They are herders and legend says all cattle in the world belong to them.  Inside the circle fence are about 10 huts made of sticks and dried cow dung which stands up even in the rainy season.  The village has about 60 or 70 people and the houses make a circle inside the fence.  The houses have a walled off area where the young calves and milk cows stay so they can have fresh milk every day.  They have large horns that they collect the milk in, mix it with blood, etc and drink it.  They also let it ferment to yogurt.  After the dance and singing they took us in groups of 4-6 into the huts for a tour.  The chairs were about 8" off the ground and you could only stand up straight in the middle of the room.  They sleep 8-10 per hut.  There are 2 bedrooms.  The total house including the cow room is quite small.  I'll put in a picture since I'm not good at estimating the size.  I know it's not as big as the smallest house in Columbus.

Maasai guides with our driver, Patrick

Maasai warrior jumping dance

The guides all said they were in their thirties thereabout when asked how old they were, but said they don't really count their age in years.  They count by seasons, so really if you ask when their birthday is they can only tell you it was in the rainy season when they were born and they don't know the date or year.

Megan joining the jump

Maasai home

The women all lined up and sang about mama and rain.

Maasai women singing

Inside entrance/seating area

Left side is father's bedroom.

Cooking, to Rt is women's bedroom

 The guy in red is the chief's son.  His father has several wives and they each have their own hut.  You really had to duck and squeeze to get inside.

Inside cooking, eating area

KENYA

Serious conversation between Dr. Stice and John leaving the lodge for Naivasha. About lives impacted. Many times unknown to us.

KENYA Olarro Lodge safari

We went on a bush drive near the lodge this morning and will be headed back to Naivasha at 11. We need to get back before dark. I've heard stories of bandits on the road but haven't seen anyone suspicious anywhere. We saw a herd of 8 giraffe this morning. It was really awesome to drive around near here and see that and a herd of wildebeest, zebras an all kinds of gazelle and impala which are a dime a dozen. Then add in the Maasai herders with cattle, sheep and goats, there is a lot to see. The land is kind of like western NE or Eastern CO. Dry season now so dusty grassland with bushes scattered about. Savannah. The big difference is there might be a lion or leopard under the bush! We had a leopard walk right in front of our cruiser yesterday.
I'll see if I can put on a couple pictures. Again the good pictures are on my camera so these are from my phone.
One picture is hyenas and vultures at a Cape buffalo kill.

KENYA

The safari was more than I could have expected. We had 4 Maasai warriors each driving Toyota Land Cruisers with knife, traditional costumes that they really wear from their villages along w cell phones. They go to guide school to do this and are quite good at finding big cats hiding out in the bushes. We saw about 5 lions and one leopard (hard to find) along with the usual giraffes lots of elephants. Hyenas chewing on a Cape buffalo carcass with vultures standing by just like you see in TV.
Then we went to a Maasai village. We were pounced on by the ladies selling bracelets, carvings etc. thrusting their arms into our vehicle. Putting stuff in our hands. "Only $5" "only $10" etc. turns out John and both bought about the same thing. We got to see their jumping dance and sing with the women. Then toured their stick and cow dung homes. You can stand up straight only in the center if the house. Then we went to their market where we each got a personal shopper who would hold on to anything they thought you'd like then bargain got it in the end. The price came down 90% in the end so we got some things.
We have to head back tomorrow. I'm already worried about what trouble we'll have in surgery next week but have thoughts on it all. This has been quite an experience.

KENYA - safari

In case anyone was wondering about this man cave. John and I have our own room. Mosquito nets and all. Nila

KENYA Friday 2/15/13

I finally have reliable Internet and a little uninterrupted time to write. We've had quite the trip and quite the day. There are so many new things every time I turn around. This is not for the faint of heart. 

The week of surgery was full of ups and downs. It was a little frustrating because most of what I found to do was tonsils which is a slick and easy thing to do for the most part.......  Unless the electricity and equipment doesn't work and then it's a nightmare!  Dr. Stice had it right when she brought what she calls her entire OR with her including her scrub nurse and a supersonic electrical transformer. I think I wore out Kristy, Wendy, Megan and Kevin, who took turns scrubbing for me. They were all enthusiastic and quick learners (thank goodness) and helped each other out as they switched back and forth but I'm sure they all have a new respect for an experienced scrub nurse just as we've all come to respect the areas we've gotten to participate in that are outside our usual comfort zone!

The weird ear tumor I found the first day in clinic popped out like a marble. He's got terrible ear disease deep inside his head still though he said the pain was much better and now he can sleep. Patients like this tend to bury their heads in the sand about the ear as long as it doesn't bother them but it will come back to haunt him some day so I told him he will need to go into Nairobi to see someone who has the ear equipment that Naivasha doesn't have. I got a lead on an ear microscope from an ear group in Michigan that they might donate. We (mainly Dr. Stice) are sending a large container of medical equipment when we get the $10,000 cost to ship it so we might get the microscope to send along. A new microscope will cost $20,000 so it's a bargain if it gets donated. The new hospital isn't open yet for lack of the proper electricity. Surprised?  We saw a huge electric station on our drive today. They get electricity from thermal power from nearby volcanoes. 

The drive to the Maasai region today was littered with goat and cattle herds grazing along the roadside. You couldn't drive a half mile without seeing them. There are scattered donkeys in the mix. In Naivasha there are donkeys pulling cards with water barrels. They buy water at the Catholic Church, which has a well. Then they drive along the road selling it to households and businesses. 

John has been befriended by everyone around the hospital with something to fix and that's about everybody. The maintenance guy is eyeing his tools so John will give an in service on how everything works next week and leave the tools with them. 

I wish I could post some more pictures but I'm using Johns iPad and most of the pictures are on my good camera so I can't easily transfer them. Please read The links to Kevin, Wendy and Megan's blogs. I think you have to join to read Megan's but the others you can just click on. Also Molly and Erin are posting lots on their FB pages and I'm putting others on FB Columbus Medical Mission Team - Africa. You can look at it even if you are not on FB since its a public page I think. 

Well, I'd better head to bed. We have a wake up call at 5:30 am. We leave for the safari into the Maasai Mara game preserve at 6 which they say is prime rhino time. We get tea and coffee before leaving and eat breakfast and lunch in the "bush". NN

KENYA Safari

Somehow Cindy managed to get us Kenyan rates on both he hotel in Naivasha and the safari. I've had the most fun I've had for a long time! Laughed so hard I thought I'd die! We traveled 4 hrs. 3 on good highway and 1 on a very bumpy dusty road to get to the Olerro hotel in the Maasai region. They had us walk through the bush for a bush supper. We saw zebras etc along the way. Then a 5 course meal and topped off with Maasai worrier tour guides for tomorrow's safari! They drove us back to the hotel in the land rovers we'll use tomorrow. John and I are in a suite "the man cave" with Ray, Kevin and Tony. It's awesome. Look it up in the Internet if you're interested. Molly knew what to expect. I'll post a picture of the room. Gotta go to bed. We're getting a wake up call at 5:30 for the Maasai Mara.

KENYA - GOING ON SAFARI

We didn't have internet last night so didn't get a chance to blog.  I had a record day.........  When I took my gown and gloves off after my last case my entire scrub suit was drenched in sweat from my neck to my knees.  I have to admit sweat dripped into the edge of the field a couple times, but not in the wound.    A lady walked in during the morning with a large neck mass.  I thought Dr. Wachira and I were doing it together, but in the end he went to eat a bite, then when he came back he thought it was going so well I didn't need any more help so left without me knowing.  He lives in a different city.  At any rate, in spite of no AC and John spending about an hour on the floor trying to connect and reconnect the suction and cautery along with the fan we did well and she looked like a million bucks today.  She was in her 20's and had the mass growing for a couple years.  I'll try to post a couple pictures. The drain situation is interesting.  The little tube I thought would be a suction drain, but then realized we can't do suction drains so I put in a penrose drain (the larger one).  I rebandaged it and she'll stay in the hospital over the weekend while we're on safari.  

Gotta go.  Safari leaving.


 Then I helped Dr. Stice with a huge ulcerated scalp.  You can't imagine it.  We removed about 2/3 of his scalp.  Thing of the worst cystic acne x 10 and add large open ulcers grapefruit and pineapple size with skin 3" thick in places.  He lost a lot of blood like you could imagine if you've ever had a cut on your scalp.  I won't post pictures of that.

KENYA UPDATE

I'm up sitting on the balcony with Tony and Kevin. We decided to post an update on the various jobs here.  I'll start with Tony Waweru.  He's been giving anesthesia in the OR.  He's working Dr. Betty O. and Wycliff O, CRNA.  We have 2 ORs with 2 tables in one room and one in the other.  Only 2 anesthesia machines are currently working so the 3rd table has locals and sedation.  We have an anesthesiologist also, Jeff Hawthorn who is working mostly with Wycliff.  Tony (originally from Kijabe, Kenya) says his biggest challenge is finding where stuff is.  A scrub tech, Micheal, seems to be in charge and is THE GUY who knows where things are.  Tony says he's using it for job security. The picture is Mary, who does instruments, Wycliff and Micheal.  He is the best interpreter around.

Kevin worked in clinic today.  He helped Laura do wound care on the wards also.  There are some horrendous wounds.  I will not post those pictures.  His biggest challenge the language.  He's used to speaking Spanish so this is hard.  Some patients seem to know some English, but not much.  The illnesses he's seeing, especially the burns on children are heartbreaking.  Laura scrubs and debrides them while they are screaming.

Our OB/GYN team is really busy.  Dr. Norton and Dr. Schulte brought in an emergency C section with the Medical Resident from Washington holding his hand inside with the mother on her elbows and knees, pushing the baby off the prolapsed cord, counting the heart rate.  They got everything ready, rolled her over onto her back, put to sleep, C section as fast as you could blink.  Turns out she had TWINS!!!  Mom knew because she had 2 blankets and 2 hats.  Everyone else was surprised.  She was prolapsed when she walked in.  Molly, Erin and Wendy are in their element in L&D, but we stole Wendy and Megan today to scrub for me (Dr. N).  Kristy scrubbed for me yesterday, but when we realized there was no one in Recovery and that's what she does back home, we rearranged.

Wendy and Megan traded off scrubbing for me today.  Wendy just walked up here.  She says the hardest part is paying for Kevin's pop and water (LOL).  The hard part is knowing what she needs before you need it.  The suture makes her crazy.  We've got tons of spread all over in cupboards and totes in the new and old hospital.  I think she's locked in for tomorrow at least.  We wore out Megan in the morning.  It was pretty hot and the cautery smoke did her in.  She ended up going shopping later with some of our other women to the place that hires HIV, disabled, orphaned and criminal folks to give them work.  They make beautiful stuff and the rest of us will get there sometime.  Wendy finished up my last case and then helped out Dr. Stice, Diana and Joan doing some major burn scars on a 16 year old who was playing with gasoline near a fire months ago.  Bad idea.

Wendy, Dr. N, Med Student in OR.

Kristy with my first tonsil in PACU

John baled us out on the cautery and sharpened the adenoid currette at the blacksmith and got the tool to sharpen the other ones. HERO
Dr. Dumitru lectured on CHF and Caitlin worked on the stove project.  She's extremely enthusiastic so it will be interesting to see how it goes.  Good day today.  NN

KENYA 2-13-13

Dr. Schulte doing an ectopic pregnancy that came in through the ER right as we were preparing to start surgery. Then there's a picture of one of the many signs posted in the hospital with the costs on them. These signs are also in Swahili. This is quite different from other missions I've been on. Working side by side with the local ENT doctor and having lots of students along slows things down immensely. Then add in equipment failures, using Kenyan equipment and electrical problems it can be quite frustrating. My ENT colleague had never seen the tonsil mouth gag I use or how to do a tonsil with cautery. She said they only pack the adenoid and if its still bleeding some surgeons hold the babies upside down so they don't choke on blood. A novel approach. She also
Was very curious about the nasal septum I did as she apparently doesn't do them at all or does them very differently. The L&D nurses are trying to convince the nurses that fetal monitoring, fundal checks and Oxygen on newborns who don't move much are useful things to do. Today they are going to work on post parting things I won't go into here. They are extremely enthusiastic. We're going early today to make rounds. Two of the horrible tumors are going to Nairobi. It looks like both are lymphoma and need chemotherapy rather than surgery. The parotid mass almost fits under my hand if its fully stretched out. She can't hardly move her head and also is HIV positive. She can't go start chemo till she has $200 to be seen in Nairobi and so will probably die soon.
It turns out there is stew at every meal so guess. What we're eating?! NN

KENYA

The hotel rooms.

KENYA

This is our hotel. You can see 4 rooms. Kevin, Ray and Tony are upper left. John and I at right below them with the open door. The other two rooms have some of the women.

KENYA - Tuesday 2-12-13

Just before we left for the hospital yesterday Nila with Megan, Erin, Molly and Caitlin in the restaurant at our hotel.  You can see what the view is like.

These are some pictures of the hospital.  It's surprisingly clean all in all.  I haven't seen a dog, horse or vulture yet.  Rumor has it that dogs make it in there.  Megan took particular interest in the ambulance.

Below are birds nesting on Lake Naivasha on our hippo tour, then is our boat driver, Paul and the long awaited hippo.  We saw maybe 15-20 total, but this was the only one who would fully get out of the water to accommodate my camera.

KENYA - Day 1 at the hospital

I will keep it short as there isn't good internet tonight for some reason.  There's lots to tell.
It looks like it won't let me load any pictures.

Today was the first day working in the hospital.  We had 3 clinics; Plastics, GYN and ENT.  We sent 'troops' all over the hospital, but mostly to OB and Pediatrics to see what they want us to do.  The nurses were frustrated by their lack of resuscitation of newborns and the new hospital isn't up and running yet, so we'll work out of the old one.  We had a warm welcome from the CEO at the hospital and were surprised to find an physician from Washington University in Seattle who is living here for a year.  The have a program to help improve medical education here and she's involved.  I won't go into the details, but it's a very ambitious program which includes students and residents from the US and Nairobi who do rotations here so we'll be working with all of them.  As far as my clinic, the patients were preselected by the ENT who comes here from Nairobi 2 days a week.  It was tonsil, tonsil, tonsil, tonsil, horrible tumor, then tonsil, tonsil, tonsil, horrible tumor, tonsil, tonsil, tonsil, inoperable horrible tumor that looked like a large melanoma in the roof of the mouth.  Only one nasal septum, but almost every patient needed surgery.  Very interesting clinic.

There is a lady in the women's ward with a huge parotid tumor covered with a bandage who just came in today.  Maybe big as a grapefruit if you partially flattened it on the side of the head.  We'll do a bandage change tomorrow and get a better look at it.  The pediatric ward is 4 rooms side by side with large glass windows for walls with 8 metal, white paint peeling beds in each room.  Most of the kids have what appears to be a mother with them, but some are orphans.