Heading home

            Today is my last day in Kenya.  I fly out later tonight and arrive in Buffalo on Sunday afternoon.  I’m ending my time here as it began, by myself at Mayfield guesthouse.  Katie left last night, and the guesthouse is quite empty as everyone is leaving before the elections here on Monday. Although I’m leaving in the same position, in some ways I feel like a different person than I was a few months ago.  A vivid memory I have was saying goodbye to my parents and my sister, Catherine, in Jamestown the day before flying to Georgia for orientation in January.  As I went to hug my mom, I unexpectedly burst into tears and cried, “I’m scared!”  I was frightened of the unknown, although I knew that God had called me to come to do this.  Tears are welling up in my eyes now as I prepare to leave and am reminded of the many wonderful and challenging experiences I’ve had since that afternoon.  A song came on the radio as I was driving to Buffalo following that goodbye that I know God wanted me to hear at that moment.  It was “Whom Shall I Fear (God of Angel Armies)” by Chris Tomlin.  Here are the lyrics to the first verse and the chorus:

You hear me when I call
You are my morning song
Though darkness fills the night
It cannot hide the light

Whom shall I fear

You crush the enemy
Underneath my feet
You are my sword and shield
Though troubles linger still

Whom shall I fear

I know who goes before me
I know who stands behind 

The God of angel armies
Is always by my side

The one who reigns forever
He is a friend of mine

The God of angel armies
Is always by my side

The lyrics in bold particularly spoke to me that day and have remained in my mind when I’ve been frustrated or have felt alone here.  God brought me closer to Him through this rotation than I would have thought possible before I left.  Being away from so many of the distractions I have at home as well as the more relaxed, slower pace of life here were a welcome change from the anxieties of interviewing for residency and preparing to graduate medical school.  I know that the coming year will be one of the most challenging of my life as I start internship, and I’m so thankful I was able to have this time away to reflect on what is really important.  My relationship with God has to come first in order for anything else to even make sense.  The missionary doctors and their families made that clear to me at Kapsowar.  I’m praying that my transition will be smooth as I try to incorporate what I’ve learned in Kenya into my life in America.

            As I was writing in my journal the other night I got to thinking about some of the things I will and won’t miss about life in Kapsowar:

Will miss – fresh mangoes everyday, the beautiful environment, the slower pace of life and fewer distractions here, the weather, the missionary families, daily prayer and Bible study with other doctors before work, black currant Fanta, the nurses and staff at the hospital (particularly Lydia and Zena), my roommate, Katie

Won’t miss – Roosters crowing to wake me up daily before 5:30, speaking to patients via translator/not knowing the language, being so conspicuous on my walks, some of the strange smells, getting sick, and frequent power outages

Looking forward to – Seeing my cat!!  Coffee, self-lighting stove and oven, having a microwave, seeing my family and friends, drinking water straight from the tap, ice cream!

Not looking forward to – Coming back to winter, worrying about keeping my focus on seeking God first as I have been here

This has been one of the best times of spiritual growth I’ve had in my life.  I am so grateful for the opportunity to have come here and the privilege it was to learn from the doctors and patients at Kapsowar.  I can’t wait to share more with you all once I’m home!!

Safari Misadventure

           Wednesday was perhaps the craziest day of my life thus far.  Katie and I woke up at 5:45 am to get ready and eat breakfast before our driver, Joseph, picked us up at 7.  He arrived on time, so I felt pretty happy about that and proud of my travel arranging skills.  I asked Joseph if the resort had called him to give directions as I had been told they would.  He said no, but that he knew where he was going.  I just said OK and didn’t think twice about the fact that I had never actually given him the name of the resort.  A red flag should have gone up at that moment, but I was too excited to care too much. 

            The first few hours of the drive were so nice.  It was supposed to take about 4 hours to get to Ngerende Island Lodge, so we were planning to arrive around 11.  The road was paved and smooth without many twists and turns so I wasn’t even getting carsick as I had on a few of our previous rides in Kenya.  Katie and I were listening to music on her ipod and enjoying a relaxing ride.  We passed the town of Narok which is 120km (about 2 hours) from Ngerende.  We took a left turn in the direction of a sign pointing to the Masai Mara so I figured we were on the right path.  Soon after the turn, the paved road disappeared.  We were on rocky, rough terrain, although not as bumpy as some other roads I’ve been on during the past two months.  I should mention that our car was not an all-terrain vehicle suitable for a road like this, another detail that didn’t particularly concern me at this point.  It was 10 am, so I thought we had about an hour left to drive when we got a flat tire (the first of many).  Joseph had a spare plus a little donut tire so we thought, “Great, he’s well prepared.”  He changed the tire and we were on our way.  About 20 minutes later, the front right tire went out, too.  He changed that, and we kept driving. 

            At this point, the resort called to check in on where we were (they had called earlier to make sure we were on our way).  Joseph told them that we were next to the sign for the Siana Springs Tent Camp.  He was speaking in Kiswahili so we didn’t really know what the conversation consisted of, but it seemed like something wasn’t quite right.  He hung up and kept driving on, just saying that it was the hotel calling to check in.  A few minutes later he stopped to ask directions from another driver and found out we had gone a bit too far along this road and needed to turn around apparently.  We turned around and asked another driver for directions.  This driver said he had never heard of Ngerende before, but thought it was on the other side of the Masai Mara (we were on the east side at this point I believe).  We had taken a wrong turn in Narok and were probably 3 hours from where we should be.  The quickest route to Ngerende was across the Masai Mara on a horrible rocky road (if you could even call it that) and we had no spare tires left.  Joseph wasn’t really even clear on what route to take, and no one seemed sure of the exact location of Ngerende.

            Now I was a bit freaked out and disappointed that we wouldn’t make it to the safari at all and that we would be stuck in the middle of nowhere in Africa.  At least we brought snacks and some water with us for the ride (I was trying to focus on counting my blessings).  We stopped at the “Puncture Repair Shop” (apparently this happens frequently out there) to get one of our tires fixed in case of another flat.  This took close to an hour.  Katie and I were sitting in the car and during this time we:

- Had 2 women approach us to take a picture of them and once we did, demanded money from us, which we refused to pay (we actually went to two repair shops and they followed us from the first to the second in search of payment)

- Were harassed by women from the village selling jewelry through the cracks we had opened in the windows to let in some air. 

- Were asked by a young guy how to help him find an American girlfriend.

Somewhere in the middle of all of this I started calling out to Joseph to come back to the car, hoping he could get some of these people to leave us alone.  I was scared, hot, and frustrated.  It was after noon with no end to the journey in sight.

            Finally, the tire was repaired and we started off on the terrible dirt road through the valley.  We were heading toward a place called Aitong.  Joseph kept stopping periodically to ask random villagers along the way if we were going in the right direction since there were many forks in the road and we were just guessing at the right one to choose.  We got a third flat tire somewhere on this leg of the journey and used the newly repaired tire to change it.  Finally, at around 2 pm we reached Aitong.  We called the resort because they had said it was close to this town.  I had been checking Googlemaps at various locations along the way, but it still felt like we were lost.  Unfortunately, we thought we had a flat AGAIN right after Aitong.  Joseph got out to check and it wasn’t flat after all.  Yay!!  I was praying we’d make it without another stop.  Five minutes later we actually did get a flat tire (#4) and had no spare left.  Joseph called the resort to pick us up since it was supposed to be nearby.  I was still a little skeptical, because it felt like we were in the middle of nowhere.  When I asked, Joseph just replied it was “not too far”.  On Googlemaps when I looked it up, it said it was 4 hours away so I started to panic just a bit.  Katie called the hotel, though, and they were 16 km away, phew!! 

            They arrived to rescue us a little after 3 pm, but the wait felt excruciating.  I was never so happy to see someone in my life, I don’t think.  I was so relieved that we were actually going to make it to the resort and not be stuck in the middle of nowhere in Kenya for the night.  Our drivers from Ngerende were Stephen and Daniel, and they were so friendly and welcoming.  They brought us fruit and water and apologized that we had gotten lost.  Apparently, Joseph had told them that we knew the way to Ngerende and were giving him directions.  Katie distinctly remembers saying at the start of the trip, “I hope you know where we’re going, because I have no clue”.  Big miscommunication.  We all laughed for a while about that. 

When we arrived at the resort, we were greeted by members of the Maasai tribe who led us to the main lodge, holding our hands, chanting, and skipping as Stephen and Daniel snapped photos of us with our cameras.  We received a formal introduction to the staff (including our butler, Walter) and the chef.  It was quite surreal to have gone from anxiety and mild terror to luxury within the course of  a half hour.  The safari was one of the most amazing experiences of my life, absolutely worth the trouble it took to travel there.  We just stayed for one night, but we had 2 game drives, one in the evening and another early the next morning.  Here’s a list of the animals we saw (that I can remember):

Zebras, lions (including a female lions walking with her 2 cubs and a young male lion), gazelles, buffalo, baboons, warthogs, ostriches, impalas, dik dik antelope, eland antelope, jackals, giraffes, elephants, wildebeests, Topi antelope, banded mongoose, hippos, hartebeest antelope, a CHEETAH!!, white rhinos, a black-chested snake eagle, and hyenas.  Needless to say, I was completely satisfied with the trip.  It seems like everything in Africa has been an adventure, although I’m excited to be going home soon.

Here are a few pictures.  I’ll be back in America on Sunday and will post more to Facebook then

Finishing up at Kapsowar

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            I’m just wrapping up my last full week in Kapsowar.  Next week I’ll be going on a short safari with my roommate, Katie and then to Nairobi to fly home.  In some ways it’s gone by so fast, but when I think back to my first night in Kenya it feels like ages ago.  The week before I left for Africa I went to see The Hobbit with my family.  I said after the movie ended that I felt like Bilbo Baggins, heading out on a journey for which I was anxious and not quite ready.  Of course, my sister Julia scoffed at that statement and thought it was ridiculous, but oddly enough it has turned out to be true.  I’ve been reading the book while I’ve been here and just finished the part where Bilbo rescues the dwarves from giant spiders and is gaining their respect as well as his own self-confidence.  I think that has definitely been true of me during this experience.  At times living in this different culture and environment has been frustrating and I’ve often thought longingly of home (as Bilbo wishes many times to be back in his comfy hobbit-hole), but I’ve learned a lot about myself here and have found that I’m capable of more than I originally thought. 

I’m working on the female medical ward this week and I’m learning to be a bit more gracious with myself about my mistakes.  I tend to be a little self-deprecating (as my family is keenly aware), especially when it comes to my abilities as a medical student.  My first day I felt a little overwhelmed and got almost every medical question the attending doctor asked me wrong.  I felt particularly stupid when I held up a chest x-ray backward and proceeded to try to interpret it that way.  My roommate kindly reminded me later that in America we never have to orient the films, they are usually on a computer screen in the correct fashion.  So although that was a silly error, it was a situation unique to being at this hospital.  Normally after I do a bunch of things wrong I feel really dumb for a while and think I went into the wrong field and will never be a good doctor.  This time, however, I just thought to myself, it’s ok to not know everything yet, this is just another opportunity to learn and hopefully not miss the same thing the next time.  That might be an obvious conclusion to make, but it’s one that I haven’t come to on my own until now.  

 

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Some random tidbits from the last two weeks:

-       I lit my first candle!  Everyone should be proud of me :) (the power was out for 2 days)

-       There are lots of cute baby animals in Kenya, reminding me of how much I miss my cat – can’t wait to see him soon!

-       I got sick AGAIN last week with a GI bug

-       Our apartment got infested with ants, luckily they are all gone now

-       I saw monkeys out in the wild! Unfortunately we drove by too fast for a picture, but hopefully I’ll get some exciting animal pics on safari next week

 Maurine and Leonida, nurses in the NBU (newborn unit)

 The children's ward

 One of the sweetest patients ever, she was badly burned in a house fire last fall

 The female medical ward

On a home visit after the community clinic this week

Kenyan Road Trip to the Valley

           This weekend a team of 22 doctors, nursing students, med students, social workers and other volunteers went to the village of Lodengo in the Kerio Valley to do a community clinic with the Pokot people who live there.  Although Kapsowar is quite a rural location, it is nowhere near as remote as this village.  It takes about 3-4 hours to drive there depending on how the roads are.  To say the road is bumpy would be an understatement.  We were driving over former riverbeds and through small streams at times.  The view of the valley from the mountains was amazing to see, though, so it more than made up for the difficult travel. 

            I’ll give a brief history of how Kapsowar hospital got connected with the Pokot people.  Dr. Kyle Jones is an American family doctor who started working at Kapsowar hospital 3 years ago.  During his first year here, a Pokot couple brought in their 6 month old baby who had bacterial meningitis and was so sick that Kyle didn’t think he would survive.  He treated him as best he could and prayed for healing. He said that if the child survived, he would travel to Lodengo to the couple’s home for the follow up visit.  Miraculously the baby lived (he was at the church service we went to this morning!) and Kyle went with his family to Lodengo.  When he arrived, there were about 40 other patients seeking medical care and immunizations for their children.  He wasn’t equipped at that time to fulfill all of their requests, but promised to return with medicine and immunizations.  Since that first visit, he’s been going with teams of people every 6 weeks to provide medical care.  As word spread about the Pokot people and their need, Kyle received donations from friends, churches, and others to help build a permanent clinic.  Most of the construction is complete, however there is still no source of water to make the clinic sustainable.  They’ve tried 3 separate times to drill wells (most recently 2 weeks ago) with no success.  They are exploring other options and praying that God would provide a source of water to get the permanent clinic up and running. 

            Now back to our trip this past weekend.  Lodengo appears much more like how I would have stereotypically pictured Africa to look.  It’s in the desert and is much warmer than the climate I’ve experienced in Kapsowar.  I felt like I’d stepped into a scene from The Lion King as we drove into the valley.  We stayed at the home of the local pastor who is a Kenyan missionary and has been partnering with Kyle on the clinic project since his work there began.   For the afternoon clinic, the team was split in two groups, one working the regular clinic and another group that was going to head into the village to reach some of the people who haven’t heard about the clinic before (a mission group).  I was originally assigned to the mission group to work the pharmacy and assist with medical care along with one of the other physicians on the trip.  Unfortunately, the other doctor got sick and wasn’t able to accompany us for the clinic so I was given the task to be the doctor for the mission group.  We all met first at the regular clinic site to introduce ourselves and some of the locals sang songs to welcome us before we split off into our separate groups.  I was quite nervous about being in charge of the medical care at the mission site and was secretly hoping that not many patients would come.  I prayed the whole drive to the site that God would give me wisdom and confidence to know what to do for any patients I did have.  When we arrived at the site, some of the members of the team set up our speakers and sound equipment while I looked around for a suitable place to set up a makeshift clinic.  There really was no appropriate site, so I chose a group of a few large rocks and took one of the nurses and our mini-pharmacy with me to wait for our patients.  As soon as the team announced who we were and our purpose, patients started lining up.  It was late in the afternoon, so we didn’t have much time to see them before dark, but we worked quickly to see about 10 people in the couple hours we had.  Meanwhile, the rest of the team shared the Gospel, sang praise songs, and gave testimonies for the other people gathered there.  It turned out to be a great experience and a lot of fun. 

            I think God often teaches me the most during the times when I feel the least confident in myself.  As we were driving back to the pastor’s home for the night, I felt so invigorated by the day.  I had an overwhelming sense of peace and confirmation about my calling to be a family doctor.  It may not have been life-changing for any of the few patients that I saw yesterday, but in those few hours, God reaffirmed the skills that He has given me to enter this profession.  Although it’s often difficult and frustrating (and I feel really dumb most of the time), I know I’m on the path that God has for me. 

            We stayed the night in Lodengo and went to the Africa Inland Church at Chebilion this morning before heading back to Kapsowar in the afternoon.  There’s so much more I want to share about this weekend and the reflections I’ve had on the past week, but it’s too much to write in one blog post so I will conclude with a few pictures that capture the essence of the weekend.

 View of the Pokot clinic from the front

 Women and children waiting for medical care and immunizations

 My roommate Katie and me

 Left to right:  Alfred (nurse/pharmacist), me, and David (translator) and second clinic site

 Other members of the team speaking to the community

 Pokot women praying

 

 Driving through Lodengo

 Africa Inland Church - Chebilion

 Goats being herded for the "goat wash" before church this morning

          Kids singing at church

One step at a time

            This week on the pediatrics ward has been a great learning experience.  Most of what comes in to the hospital here is quite similar to America in terms of the clinical scenario, although the underlying cause is often quite different.  We mainly have admissions for respiratory and gastrointestinal complaints (pneumonia vs. bronchiolitis, diarrhea, dehydration, etc.).  One of my patients with diarrhea was positive for Entamoeba hystolitica, which, as my fellow med student friends know, is quite rare to find in the US.   There is one boy with bacterial meningitis who was admitted before I started working on peds.  He was initially not at all alert neurologically, but has slowly been recovering throughout the week.  He still has a lot of pain in his neck and back and while moving his legs.  We’re hopeful that he’ll make a full recovery, but he may have to be transferred to a larger facility.  In the outpatient department today we saw a 15-year-old girl with heart failure from rheumatic heart disease.  This is another clinical manifestation that we don’t often see in the US.  This patient is a likely candidate for heart transplant at another larger mission hospital in Kenya, so hopefully she can be set up to have that procedure soon.  It was quite dramatic to see all of the clinical signs of heart failure that I normally see in the geriatric population in an adolescent girl.   

            One other aspect of serving at Kapsowar that I’ve loved is the community health outreach I’ve participated in.  Again this week we spoke to about 350 high school girls at a boarding school in a town called Sambirir, about half an hour away from Kapsowar.  I did struggle this week with speaking slowly and loudly enough for them to understand, but I’m praying that they understood enough of my message to have a bit of an impact on their lives.  I’ve been going most weeks with one of the family doctors here and another Kenyan social worker who is a very dynamic speaker and always has the kids laughing at his stories.   I mainly share my personal story of how God has encouraged me as a single Christian woman, and some of the challenges I’ve faced in that role as well.  I’m hopeful that hearing the experiences of a female closer to their age will be influential in helping them make more positive decisions in regard to their health. 

            For the first time this week I was able to work at a community clinic that we set up near where the girls school is located.   I was amazed at how it all came together.  We set up two speakers and a sound system to be able to be able to advertise the clinic and share our message more broadly.   I saw several patients, along with another of the missionary doctors here. One of the local dentists did a few tooth extractions as well.  I haven’t had the chance to work at a mission clinic before and it was really cool to be a part of that, to help people who might not normally make it to the doctor with some of their physical ailments as well as spiritual.   

I read a devotional from Jesus, Calling this morning that was very fitting for the emotions I’ve been feeling this week.  Here’s an excerpt:

            “Follow me one step at a time.  That is all that I require of you…You see huge mountains looming, and you start wondering how you’re going to scale those heights.  Meanwhile, because you’re not looking where you’re going, you stumble on the easy path where I am now…If I do lead you up the cliffs, I will equip you thoroughly for that strenuous climb”

As I’ve been working at Kapsowar, I’ve started to dwell on the fact that soon I’m going to be starting my first year of residency, and I’ve been overwhelmed by that prospect.  Throughout my clinical years of med school I’ve been attacked by negative thoughts about by medical knowledge and clinical performance.  Now, that internship is approaching in a few months, those feelings have been flooding back to me.  I’ve also wanted to jump ahead in time and know where I’ll be living for the next 3 years.  I know match day will be really nerve-wracking because I could potentially end up on either coast.  Reading the above passage today just confirmed once again, that my worries are futile.  God has been faithful to reveal each step of my journey one step at a time (although I am always wishing that he would show me a few more steps in advance).  I’ll end the post with this verse:

           

            “For he will command his angels concerning you to guard you in all your ways; they will lift you up in their hands, so that you will not strike your foot against a stone” 

-       Psalm 91: 11-12

Prayer requests:

Patient T with bacterial meningitis for continued healing

For the girls we spoke to on Tuesday that they would remember what we said and apply it to their lives (in regard to alcohol abuse, sex education, following Christ)

That I would recover fully from my cold  

 Left to right: Ruth (social worker), Vivian (nurse), Jane (dentist), and me at the community clinic

At Chesoi, the village where we set up the clinic on Thursday

 

Brief recap of last week

Here’s a quick update on last week since I didn’t get to post over the weekend.

I worked on the maternity ward and also went to speak at some local schools for the community health program.  I shared my testimony at one of the schools and I must have spoken more clearly because there were no giggles this time!  Unfortunately I caught a bad cold/cough at the end of the last week so I was basically sleeping or in a medicated stupor for the past 4 days.  It felt a little discouraging because I was starting to get used to the routine around here and then everything kinda came to a halt.  Luckily I’ve been feeling better each day and was back at the hospital yesterday.   We also took a walk a children’s home where several orphans live.  Some of the doctors here have paid for children from the home to go to secondary school and on to college in some cases.  This week I’m going to be working in the pediatrics ward and I’m getting a new roommate today (another 4^th year medical student).  I’ll post a more thorough/thoughtful update next time! 

 The children's home

 At one of the schools where we spoke

First Week

            I’ve been in Kenya for a little over a week now and in Kapsowar for 5 days.  There have been so many transitions and new things I’ve seen or done, it’s hard to know where to start! 

I was in Nairobi for the first 3 days staying at a guesthouse before traveling to Kapsowar with one of the doctor’s families.  I think that was the most difficult part of the trip, anticipating all that was to come and feeling a bit like “what was I doing, coming here by myself?”  One thing that’s been clear is that God has been guiding my trip each step of the way.  Although I haven’t known what to expect from one day to the next, God has provided people to encourage me and to help me not feel alone here.  I met so many interesting people at the guesthouse from all over the world who were stopping there in preparation to head out for missions in various parts of Africa or who were heading home after many years on the field.  I also met another medical student from Australia who was about to do an elective at a different mission hospital in Kenya for the same time as me.  We had the same fears and anxieties about what we were doing so it was fun to hang out with her for a day.  We went to the Maasai market, and we were forewarned that we should be a bit skilled at haggling if we didn’t want to overpay for our items.  Needless to say for anyone who knows me well…I probably paid about 5 times what my souvenirs were worth at the first stop.  When the shopkeeper was leading me to an ATM to get enough money to pay, I knew I had gone wrong somewhere.  I’ll never do that again, but it was still a fun experience. 

            I left Nairobi early Monday morning to fly to the city of Eldoret, which is about a 2-3 hour drive from Kapsowar.  It was a relief for me to get to my final destination and meet everyone that I’ll be working and living with for the next few months.  Kapsowar is breathtakingly beautiful.  I will post a few pictures later because I know that I can’t describe it well enough in words.  I’m living in an apartment that’s right next to the hospital with a third year family medicine resident who’s here until the end of January.  Another 4^th year med student is coming to take her place after that.  The apartment is much nicer than I had expected and doesn’t feel too different from my apartment at home.  One thing is that we have a gas stove that needs to be lit with a match each time.  As my family can attest to, I am not very skilled with matches and have never successfully lit a candle before this trip (pathetic, I know).  The motivation to be able to cook my food won out over my fear of fire though and I have successfully lit the stove several times now!

            It’s been an interesting first week at the hospital, too.  There are two family doctors and two surgeons from the U.S. who are here with their families long term.  The remainder of the staff at the hospital is Kenyan, and I’ve worked with a couple of the Kenyan doctors as well.  The first few days here I’ve mainly been getting acclimated to the hospital and the people, rotating among all the different departments.  My first day we did a community outreach at two of the local schools, talking about nutrition, hygiene, alcohol abuse, and sex education among other things.  I spoke for a few minutes and all the children were giggling…apparently they understood none of my English since I was speaking too fast.  I’ll have to work on that for next time.  I delivered a baby on Wednesday night and have had more opportunities for hands on experience in OB, which I’m really excited about.  The nurses here are very patient teachers and have been so friendly and welcoming.  On the pediatrics ward there have been some difficult and sad cases including a child with HIV and pulmonary tuberculosis.  Medicine is definitely much different here – with limited resources making a definitive diagnosis can be a challenge.  That being said, the people here are very resilient and are so full of joy.  The resident I’ve been working with was saying how in American medicine we can trick ourselves into thinking we are in control.  Here, God is teaching me that we are not in control of anything.   I was reading a book the other night about medical missions and the author said this about serving about serving in a short-term capacity:

            “Love and respect the patients you treat.  Take this opportunity to see the Great Physician at work without the trappings of modern medicine to interfere.  Learn His art; copy His love.  In all things extend grace”. *

That’s my prayer for the rest of my time here that I would be able to live that out and encourage the patients I see as well as the long-term missionaries and staff who are here. 

 

* Medical Missions:  Get Ready! Get Set! Go!  By Bruce Steffes, MD

 Mayfield Guesthouse

 The hostel where I'm staying in Kapsowar

 My room

 View from my yard

 Backyard at Mayfield guesthouse