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