God Make a Difference

I’ve just rounded the corner of my fourth month in Mukumu Hospital. Somewhere between my return to work and reaching this milestone, I have been better able to adapt to situations here. There are so many things that I find extremely exasperating, but I have realized that if I don’t let some of these things roll off my back, I’ll never survive a whole year here. One of my biggest issues is my own lack of life experience and wisdom to decide which problems I should attempt to tackle and which I should just let lie. That being said, I have begun to learn that my college career at St. Ben’s really has planted seeds that are starting to flourish. I want to share with you a journal I wrote a few months before my graduation from college as I reflected on my journey through college.
“In college, a different kind of learning takes place than our previous schooling. We still learn some facts and concepts that are all together new for us, but more importantly, we explore those theories that we have already been exposed to on a much deeper, more proficient level. This is something that we aren’t told on our first day of college. At times, I have found myself for the past four years of college becoming so frustrated; feeling that I’m not learning very much new material and thinking ‘why did I spend $40,000 dollars every year just to relearn what I’ve already learned’. I have somehow come to a profound realization this year that college is supposed to challenge us on a much deeper level. It’s not about memorizing new facts and learning all new information. I mean, to be honest, in twenty years of life, people get exposed to a lot of ideas, theories, and concepts. However, most people in their late teens/early twenties have not had the opportunity or gumption to explore these multi-faceted theories. This is where college comes in. College teaches us to explore what we have heard and have come to know as the ‘truth’ and pick it apart piece by piece to determine whether or not it is really the right way of thinking. We go through so much during our college years because it is a time of self-examination and exploration. After all, professors, the really good ones, challenge us to define who we are and decide where we should go in life. And we fight this so much. I mean, really! Who wants to admit that their belief system is full of incongruences and contradictions? That would mean we have to CHANGE the way we think about the world…LORD have MERCY!!! Moreover, that would mean that, maybe, we don’t have all of our crap together—that we aren’t as perfect as we’d like to make everyone believe. Because of this, like a good movie or book, we leave college with not a complete resolution to life’s mysteries, but rather more questions. With these questions in mind, we can have a better grasp of what the world is and what the world can be with a little TLC. Moreover, we gain a better understanding of who we are and who we think we want to be. As new graduates, we are able to go out into the world and make a difference because we know when we don’t know something and we are honest enough with ourselves and others to admit it. College may not overtly teach us a plethora of new and profound concepts, but it plants thousands of seeds to get us to start thinking about the world in a new way because only then can we start to change the world.”
My journey through college had sparked the flame inside me to go make a difference, but I think college also influenced a bad habit of mine: I wanted to make a difference. I wanted to help people. I wanted people to remember ME and know that I had done something for this community. This desire blinded me from the job God wanted me to do here, so instead of giving it my all in pediatrics, I was trying to come up with all of these grandiose ideas to making a lasting impression here. In reality, this is not how ‘making a difference’ works. GOD makes the difference through a COMMUNITY of people. God knows where He wants us to be and He lights a flame in the hearts of all of his people. We, his people, have to kindle this flame and stop trying to receive recognition from the world. Otherwise, our desire for worldly recognition can smother the God-given embers in our hearts. Making a difference comes in when God has readied the hearts of the people in the community and they ALL come together as equals to help each other—from the poorest of poor to the richest of rich. In being here, I’ve realized that I always want to do things on my own. I’m like a stubborn child and refuse to let people help me, when I really could use the help. The Kenyans here have taught me that I need to accept that I’m imperfect, young, and still learning about life. I have seen that things go much more smoothly if everyone is working together to improve our reality: from basic necessities like cooking dinner to implementing a plan to utilize local resources rather than importing. Of course, it’s one thing to realize it, and it’s another to change your attitude enough, in which you’re willing to ask for and received this assistance. It’s definitely a work in progress for me.
CPR Training
As I stated in my last post, I found that the nursing students in Kenya are not trained in CPR. With further investigation, I realized that most of the clinical officers and doctors are not trained either. I’ve also inquired about whether the hospital has an AED or defibrillator on hand, and I have been informed that they do not. I was absolutely shocked by this knowledge because it’s a no-brainer in America that if you are in the medical field, you will be trained in CPR. Even many lay people these days are being taught CPR. Anyway, I proposed the idea of teaching CPR to the students to one of the public health professors, who in turn proposed the idea to the principal of the school. I received word from them that they would love for me to teach the students, and that they would like me to teach the following week. Of course, it’s Africa so no one gave me a definitive day and/or time that I would be teaching…and of course I am a slacker and I decided to put the presentation on the back-burner until someone told me when I would be teaching. Well, I didn’t hear anything from them for a week and a half and I thought that maybe they had forgotten about it. Honestly, I was fine with this because I hate public speaking and although the concept of teaching CPR sounded lovely and worthwhile, the thought of actually following through and standing in a room full of my peers (actually most of them are older than me) and give a presentation, was agitating my sympathetic nervous system. It’s the same feeling I get when someone tells me that he is going to force me to ride the Millennium Force roller coaster at Cedar Point.
Unfortunately for my nerves, the principal came to me this Tuesday, while I was at work, and informed me that she would like me to do the presentation the following day. WHAT?! Needless to say, I practically pooped my pants realizing that I had to create an entire PowerPoint on CPR in less than 24 hours. It was like a flashback to college, in which I was not the most scholarly student and tended to leave huge projects until the night before (if anyone questions this, you can talked to my buddy Alisha Thill or any of my roommates for that matter about the infamous 40 page synthesis paper). Unfortunately this time, unlike in college, I wasn’t able to coax my roommates into a car for an Emergency Ice Cream Run (I sure could have used one of those). Thanks to the Lord (and a very long night), I was able to finish a fairly decent presentation. Problem #2 arose when I got to the classroom and realized that there was no projector. This is one of those examples were you just have to “go with the flow” and work with the resources available. I utilized the chalkboard when I could, and if I had inserted a very important picture on my PowerPoint, I would pass my computer around the entire room until everyone had seen what was written. This made the process a lot slower than usual, but it was the best idea that I had. The girls actually did fairly well considering our lack of resources and they asked many critical thinking questions, which told me that they were learning and retaining what I was teaching. One of the hardest questions was one that I had expected, but dreaded to answer—how long do you continue CPR before you declare the person dead? I had to honestly answer that I didn’t know, but it’s something that you never know. I once read a story about a man who was successfully resuscitated after 90 minutes of continuous CPR. I told them it was up to the discretion of the family or the presiding doctor. One student spoke up and argued that in Kenya, they let the patient die naturally. Her statement did hold some merit, however, when I really thought about it, I realized that no one really dies naturally at the hospital. When someone is critically sick, we don’t just let nature take its course. We give them life-saving drugs, Oxygen, IV fluids, administer NG tube feedings, and apply urine bags. Unfortunately, considering the amount of time I was allotted, I wasn’t really willing to start an ethical argument about life and death, so I kept my mouth shut (also, I was really impressed that she was critically thinking, and I didn’t want to stomp out that flame).
Hindsight, this experience was actually pretty fun. Who knows, maybe, down the road, I’ll go back to school for my doctorate and teach in a nursing school.
Work in Theresa Ward
As I’ve said before, I work in the Pediatrics ward which is called Theresa Ward. Things have been getting busier and busier. I have been told that when the rainy season comes (Starting in Mid-March), the malaria rates increase exponentially and the number of patients in Pediatrics will skyrocket. Well, it’s not even the rainy season yet, but I’ve had more patients in my ward than I’ve ever seen before, and most of them have diarrhea. I even thought that there could possibly be some bacterial growth in the water from a certain area. Unfortunately, my epidemiology skills are lacking and frankly, with the amount of patients in the ward, I have absolutely no spare time for in-depth questioning of the mothers. Moreover, communication is always a huge barrier and I think it would be impossible to get all of my questions answered adequately.
As of late, there is a strike going on in the public hospitals; both doctors and nurses are striking. Therefore, we are receiving all of the public hospital patients, even the cases which we cannot handle.
We still struggle with a lack of medications, supplies, and staff, which makes matters worse. Part of the standard treatment regimen for diarrhea here includes zinc sulfate, which really seems to work. However, the hospital has been out of zinc sulfate for 3 weeks now and there is no sign that they are going to get it again. This is another thing that exasperates me. I’ve noticed that people here tend to be reactive instead of proactive. It seems like common sense that when you see that you down to the last bottle of zinc sulfate, you would order more. However, things don’t seem to work that way here. It’s seems that I must beg and even get nasty with people before they decide that something needs to be done. Even then, it’s hit or miss whether or not the people will do anything about the lack of supply. This problem is not limited to the pharmacy. A couple of weeks ago, there was no reagent in the laboratory to analyze the full hemogram—this is a blood test that analysis the concentration of the different blood cells in the body. Without this test, we aren’t able to confirm whether or not someone has an infection. Because of this issue, most of the time, diagnoses are made primarily from the report of symptoms. This can be a dangerous game to play because there are many diseases that have the same presenting symptoms.
Because this is a malaria endemic area, almost all of my patients are treated for malaria, even if their blood slide comes back with no trace of malaria. The problem is that up to 6 blood slides should be taken to fully rule out malaria, but because of financial constraints from both the hospital and patients, typically only one blood slide is taken. This is also a dangerous chance to take because 1) over treatment of malaria can lead to resistance and 2) quinine, the main drug used to treat malaria, has serious side effects including vision and hearing loss. I had the mother of one of my patients beg me to put her 5-month-old child on quinine because after one day in the hospital, her son was still sick. I kept telling her that she would need to give the medication more time to work and I educated her about why I didn’t want her son to get a medication that he didn’t need, but she didn’t care. She wasn’t seeing results and couldn’t understand why I didn’t want her to get quinine. I was furious when the head nurse of the hospital completely disregarded what I was saying and made the clinician prescribe the quinine. After a few days, they took lab results and found that the child had some bacterial infection of the gut, NOT malaria. So, that child received quinine for no reason other than to make the mother happy.
A few weeks ago, I came into the ward to find 6-year-old Lukas (name has been changed) seizing uncontrollably and struggling to breathe. Immediately, I transferred him to our ICU area, which is equipped with oxygen. We don’t have a stretcher to transfer patients from one bed to another, so I had to carry him. While I was carrying him, his small body contorted and stiffened, and I feared that he would die right there. The last child who was seizing this way had died. Poor Lukas was in rough shape, but I was determined that he was not going to suffer the same fate as Mia. I took his mom’s hand and told her that we were doing the best that we could for him. She looked at me and told me that she could see that I was doing as much as I could for her son. It is the best compliment I have ever received from anyone. This boy struggled for a week, and everyone had written him off as a goner, even I wasn’t so sure he would survive. There was a time that he had horrible secretions in his chest. I could hear the gurgling as he struggled to hold on. I knew that he needed suctioning, but our suction machine was being used in surgery. I was frantic and I knew that the only other thing I could do was physiotherapy on his chest. Physiotherapy is a technique that is typically used on patients with cystic fibrosis, whereby the patient is placed in certain positions, while someone performs chest and back blows to loosen the secretions. It was something that I had only read about and had never seen performed, but I figured that I had nothing to lose and if I didn’t try something, this child was going to die. I rhythmically thumped on his chest and then turned him to his side and continued on his back. By the grace of God, the blows were sufficient enough to loosen the secretions and I was able to sweep out a large amount from his mouth. After a week of intense treatment and care, Lukas woke up and after a week and a half, he was walking and playing like a normal 6-year-old child. I’m convinced that this child survived because of those of you who were praying for him back at home. Prayer works and I am a witness to it! Thank you so much for your vigilance. Lukas became my buddy in the ward, as his treatment had been expensive and he was required to stay in the ward until his parents could pay the bill. I was actually a little sad when he finally was able to leave. I’ll always remember his big brown eyes staring back at me mischievously as he tried to convince me that he hadn’t received a sticker. This situation with Lukas was a turning point in my journey here. It gave me more confidence in my abilities as a nurse and I realized how much of a difference a little TLC can make.
Check your Shoes
I have learned the hard way that checking for critters inside your shoes is a crucial step in my Kenyan morning routine. Monday, I was running late for work, so I donned my stinky work shoes and raced to work. I was very busy that morning, so even though I thought I felt some phantom movement on top of my toes, I continued to press on. During Doctor’s Ward Rounds, about 2 hours after I came to work, I noticed the wiggling again and then realized that there had to be something in my shoe. Of course, panicked and flipped my shoe off in the middle of the ward to find that the culprit was a baby salamander. Unfortunately, in my panic, I squashed the poor thing (of course, it left a nice juice stain on the top of my sock—how nice will it be to have to scrub that one when I wash my clothes). On Tuesday, I started running early before work, and of course, I’m not a morning person. As I groggily stumbled to put on my shoes, I felt a foreign object in my shoe. To my rude awakening, there was a gigantic cricket inside my stinky shoe. I learned my lesson after that: ALWAYS check your shoes before donning them. I sincerely do not understand the reason that these critters find my smelly shoes so appealing—I mean they are gross.
So why all the creepy-crawlies, you ask. Apparently, during the dry season, insects swarm the houses over here. I have an overabundance of ants which have made themselves at home in my cupboards, on my table, on top of my fridge, on the countertop—pretty much anywhere you look, there are ants. My house has become a retreat center for pests: the salamanders, crickets, ants, cockroaches, spiders, and yes, still the super-rats. I only sleep soundly because I know that I’m sleeping underneath a bed net, which closes out the rest of the world. 
Extra! Extra! Read all about it…Mzungu in the Mboga Stand
There is a stand righ outside of the hospital that sells mboga (vegetables), so I usually buy my vegetables here. My favorite vegetable is kunde, which is a leafy green that you fry with tomatos and onions and then add milk. TAMU SANA (very delicious)! Unfortunately, the main vegetables I see at the stand are Sukumu Wiki (shredded kale) and cabbage. The other day, I went to the stand to buy sukumu wiki and I watched in amazement as the Janet, the women who owns the stand, cut the vegetable so quickly, yet so finely. I have found cutting cabbage and kale a huge challenge for me. I neither can chop it finely nor quickly (without taking pieces of my fingers along with the mboga). Because of this, I have a personal vendetta to conquer the sukuma wiki and cabbage. I inquired how she cut it so finely, and she laughed at this ridiculous mzungu, who doesn’t know how to cut a vegetable (crazy), but she had mercy on me and motioned for me to come inside the stand to learn. Before I knew it, she had handed me a knife and a handful of sucuma wiki and I was cutting the mboga like a pro (at least I like to think so). Of course, there were a lot of gawkers, who were flabbergasted by this crazy mzungu attempting to cut mboga in a vegetable stand. Around that time, a lot of people started to buy sucuma, and though it was probably because most hospital workers were on their way home from work, I like to think that my presence in the mboga stand boosted sales significantly. Unfortunately, my excitement got the best of me, and I slashed a juicy wound into my index finger, thus concluding my fame and fortune at the mboga stand. However, the next day, I came to the stand for sucumu and Janet told me that she could bring me some kunde the following day. Wahoo!!! Best day ever! Plus, she asked me how many shillings worth of kunde I wanted to buy and I told her 40 because the previous week, I had bought a small amount of kunde for 40 shillings. Today, I went to the stand to realize that I had bought enough kunde to feed an army. Luckily, I can store my beloved kunde in my fridge, so I can save it. This batch of kunde makes up for all the times that I have been over-charged because of the color of my skin. 

There’s more to come, I’m sure. I discover and learn so many things every day here, but it’s too time consuming to write it all down. Believe me, when I return to the US, you all are going to want to sew my tongue to the roof of my mouth because I will constantly be saying: “When I was in Kenya [insert monologue here].”

Lately, I’ve really been missing home and there are days when I think it would be so wonderful to hop on a plane and come home to a nice juicy cheeseburger, a frothy Tim Horton’s Iced Cappuccino, and a Large Pepperoni, green olive, and Mushroom Deep Dish Pizza. However, I know that God plan is for me to be right where I am. No matter how small of an impact I’m making, I know that I’m meant to be here. In order to cope with my selfish desire to return home, I am starting to write a list of things that I miss and I’m hoping to post it sometime soon. Mom and Dad, I’m placing my order now, so you have time to prepare—not that you haven’t already planned this or anything. When I get off that plane in November, I would like you to have in hand a Large Pepperoni, mushroom, and green olive Deep Dish Pizza from Jets, a small frothy Tim Horton’s iced cappuccino, and a Big N’ Tasty with cheese. I don’t care if I can’t eat it all; I just want to smash my face into it all and inhale the greasy aroma. (I realize that this may sound absolutely ridiculous and a little obsessive, but I HAVE NEEDS PEOPLE!) Grandpa, you best be sporting your ‘fat’ pants, ready for a down-home breakfast at the Lake: eggs, toast, sausage, and hashbrowns. I LOVE YOU ALL!