Tuesday, September 14, 2021

Kamuzu Central Hospital

"Pray as though everything depended on God. Work as though everything depended on you." 

-St. Augustine

Kamuzu Central Hospital and the Service Requirement

During the middle of my time here in Nkhoma, I was called to serve for 6 weeks at the Kamuzu Central Hospital (“KCH”) in Malawi’s capital city, Lilongwe. Working there is a requirement for Malawian licensure for all expatriate physicians.

KCH is one of Malawi’s largest free-of-charge public hospitals. It has specialists that most other district hospitals do not have. It is an important training and referral hospital. And KCH is HUGE: over 1000 beds! However, one of the side-effects of being a ‘free hospital’ is the extreme over-crowding, and the waiting and delays. People often wait for weeks in their beds for their needed operations. If one is poor and has no other means, then it’s either waiting at KCH or going back home.

When there are no more beds, people will place their own cushions on the floors in the hallways.

People here put up with a lot. They often will forge on and live with their ailments for as long as they can. They come in for treatment late and their diseases are often in advanced stages when it’s harder to help them. Why is that? Is it poverty? Is it mistrust? Is it the fear of contracting Covid in coming to the hospital? Are they scared to death of coming to the hospital? I really don’t know.

Despite the conditions, I had a great time there. I loved teaching their surgery residents-in-training. Like back home, the African residents are smart, eager to learn and excited to have us teaching them.

I enjoyed the challenges doing my best to help take care of people with big problems in a resource poor hospital. One of my patients even survived an attack by a hippopotamus!

As people, we can do the best we can with our hands and what we know. Beyond that, we’re only as good as the system and the machinery that surrounds us. If the pharmacy doesn’t have the medicines, then we can’t give them. If the Operating room and its team of anesthesiologists, nurses, scrub techs and don’t share a common mission, then people are neglected. If there’s no scanners or if the laboratory can’t do tests, then it’s harder to know what is wrong.

Any act of kindness goes a long way. When people’s needs are great, it feels like the kindness goes further. The same is true back home. When we are sick, we are all poor. And it’s Jesus who is hurting, lying in those beds. We can all be extensions of God’s love in the world by making that love real.

The early AM ride into Lilongwe: fog and smoke

Since Nkhoma and Lilongwe are about 40 miles apart, I had to hire a hospital driver to take me back and forth each day. We left each morning at 06:00. Each trip took an hour each way. Those rides were a great chance to see the local county side. I saw open land with rocky and rolling hills with dotted with scattered rural brick farm houses.

Entering the capital in the early am, the air was not clear. It was a combination of morning fog and smoke from the many small fires that people huddle around for warmth and socializing before the day begins. This was their winter. Temperatures fall down to the 40’s at night and early morning. It doesn’t sound that cold, but it is a bit chilly without central heating.

The daily bicycle parade

Every morning there is a parade of men on bicycles riding along the road to the capital. All the bicycles are weighed down with things to sell. Bicycles are used to move charcoal, potatoes, firewood, goats and whatever else that can be sold. Each bundle of charcoal will fetch ~$8.00 each. That a lot of pedaling for very little.


 

Malawi’s capital: Lilongwe’s skyline and profile

From a distance, Lilongwe is a long expanse of low-lying buildings, mostly 3 stories or less, over rolling hills. The city builds outward rather than upward. There are numerous cellphone towers spread across the entire city. Internet access is surprisingly good!

On Blending in to new places: Bits and Pieces

A medical missionary once advised me about coming to a new place.

“Don’t make any suggestions for 6 months. And don’t try to change anything for at least a year.”

I definitely agree with the spirit of waiting and listening when arriving in new places.

Measuring one’s words carefully. Picking one’s spots. Watching and learning about the local context. Making small daily discoveries: ‘bits and pieces’.

No one can tell you everything there is to know about anywhere during your first few days or weeks.

It takes time to learn why things are as they are. Egotistically blundering into a new situation and trying to force one’s views on everyone, while singing that tune of “this is how we do things back home where I come from” never goes well. Living in the spirit of service and love to God, our patients, and the people I’m working with is the way to go.


 

Tuesday, August 17, 2021

Nkhoma CCAP Hospital

 “I believe the Lord helps those who have set out to do great things for His sake

and He never fails those who trust in Him alone…”

St. Teresa of Avila

 

African Killer Bees

Killer Bees in the backyard!

One of the night guards put his flashlight on a giant beehive on one of the backyard trees.  How long had the hive been there?  I didn’t know.  They are quite dangerous.  Pet dogs have been killed by them.  This was a problem bigger than me. I put out the alert by calling members of our small mission community.  A chain reaction began with one person talking to another and soon the hive was gone.

 

 

Guardians

There are no such things as “visiting hours” in developing world hospitals.

A family member, or “guardian” is always required to be at the bedside in the hospital with their loved ones.  They are required to help with physical needs including food and water.  There is no food service. 

 

Guardian Sleep Area

 
Guardian on Cellphone

Medical Stuff:  Changes in my practice

How is it different?  Back home, I’m addicted to CT scans, daily CXRs, and daily lab tests.  Not in these places. There’s no CT scanner.  The patients are poor.  Plus, I’m hesitant to order extra tests that they can’t pay for.  I rely more on the basics: history and physical examination.  Treatment of cancer is often delayed because pathology results can take up to 6 weeks to get back. 

 

“What’s with that?”  I am put in my place.

When I was at Kijabe Hospital in Kenya, I had dinner at the home of Dr. Will Caire, his wife Allison and their 4 children.  The Caires are veteran missionaries with the Christian Health Service Corps.   

I complained to them.  Here I was, a US citizen working in Kenya, while there were many Kenyan physicians working back in the USA.  What’s with that?” I asked.  Dr. Caire stopped, took a breath, and reminded me: “That’s because you’re here for a different reason than they are over there.”  

 

Children's Table
 

I forgot.  Absolutely right!  We’re here for God, trying to do great things for His sake.  And thank God for all the support that is sent our way from people back home.  It couldn’t be done otherwise. 

Everyone has their own unique part to play.

 

Monday, August 2, 2021

Nkhoma

“Go courageously to God along the way He has traced out for you,
steadfastly embracing the means that He offers you.”

St. Margaret Mary Alacoque

Nkhoma
I’ve now moved south to Malawi. I’m working at the Nkhoma Mission Hospital. The hospital is quite rural. Farms are everywhere. Lots of chickens and goats running freely through the town; cows and donkeys too. They grow maize, sweet potatoes, pumpkins, onions, carrots and tomatoes.
There are monkeys in the trees but there are fewer of them, because there are fewer trees. Monkeys don’t bother me anymore. They really are just “big squirrels”.
The ground is quite rocky and there are lots of hills. When it gets dark, I really need my flashlight.
My iPhone’s light works well.


The Nkhoma Mission Hospital: The “Brick Hospital”
My nickname for Nkhoma hospital is the “Brick Hospital” because brick is all I see. Every building is made of brick. Brick is also the favorite building material in most buildings in town as well as the farm houses. It functions as a District Hospital. It has 250-beds and provides outpatient and inpatient services in surgery, obstetrics, pediatrics and adult medicine.

Nkhoma is located in central Malawi. It’s an hour’s drive east of Lilongwe, the capital. Lake Malawi is another two-hour drive east. Nkhoma is part of the rugged Dedza Mountain Range running north and south in Central Malawi. This is winter and dry season, so things are a bit brown. Besides English, Chichewa is the local language. It commonly spoken in southeastern Africa.


Puppies for sale: on the street! 
Along the roads in Lilongwe, puppies are held up for sale as pets. Cats too.
I’ve been told that it’s illegal but you know how that goes. They are hard to resist. The puppies are so cute! But I have to be realistic. 
 

“Mice-On-A-Stick” for sale: on the street!
I couldn’t believe it when I saw it. On the country roads, children hold up their ‘mice-sticks’ for sale to passing cars. This is yet another food I am not curious about. My kitty-cat back home would love them! Fine. But I am not bringing them home!

Nkhoma Mountain
Nkhoma Mountain throws its massive shadow over Nkhoma town at sunset. The mountain dominates the northern horizon. It’s huge, stark, rocky and beautiful. My daily workout is climbing up the trails that lead to the top. I don’t think that I’ll actually ever actually go to the top. It’s a long way and the last major stretch is so steep that it requires all 4 of our extremities to get there. The last thing I need is to fall off that mountain during an afternoon climb. Still, I keep venturing further, higher and higher.
One of the missionaries put a big white cross on one of the ‘sub-mountain’ peaks, and it is plainly visible for miles around.

Tuesday, June 15, 2021

Small victories; Promises kept

For we are His handiwork, created in Christ Jesus for the good works which God prepared beforehand, that we should live in them.”
Ephesians 2:10

When I left the AIC Litein Hospital few months ago, I made a couple of promises.

The first promise was a slide projector.
Litein’s educational sessions lacked a projector for presentations. This is something definitely needed in a teaching program. Dr. John Kanye and I agreed that this was a problem. When I left, I put in a deposit into their discretionary fund. The results?
Dr. Kanye bought a large state-of-the art computer screen, into which internet and PowerPoint presentations could be done. Well done, John! Whew! That’s one promise kept!

The second promise was Operating Room equipment.
A good skin grafting handle was needed. When I left Litein, I regretfully had to bring mine with me, because I wasn’t sure that I might need it later on. I made a promise to have the next volunteer coming bring one. Litein also lacked a rigid sigmoidoscope. They really needed one to help treat lower intestinal emergencies (sigmoid volvulus). I also promised that I would find a way to get one to them.



So the bucket brigade began. It’s amazing what you can buy on the internet.
Mackenzie Welde of World Medical Mission got me in touch with Dr. Matthew Schultz, a Family Physician, who was going to Litein from Minnesota. Matthew agreed to carry anything I sent to him.

I also enlisted the help of Cheryl Mitchell RN, the Chief OR Nurse of LIGA International.
Everything made it to Litein! Thank God. Well done, Mackenzie, Matthews, and Cheryl!
 

Whew! That’s two promises kept!

Thursday, May 13, 2021

AIC Kijabe Hospital

 “If I had my life to live over again…

I would have burnt the pink candle that was sculptured like a rose before it melted in storage.”

                                                                                                            Erma Bombeck

 

“Do one thing every day that scares you.”

                                                                                                                                                                  Eleanor Roosevelt


Kijabe’s name is Maasai for "Place of the Wind".  And it is!  When the winds blow, you can hear them whistle through the tall trees, which sounds quite wonderful.  The area is surrounded on three sides by a lush forest.  It’s the rainy season now.  It rains nearly every night.  The altitude of 7200 feet keeps the weather cool, even though it’s close to the equator: sweater weather.   Nairobi is about 45 miles to the south east. 

 

The AIC (Africa Inland Church) Kijabe Hospital, the AIC-CURE International Children's Hospital of Kenya, and the Rift Valley Academy all border each other on the hill and escarpment overlooking the beautiful Great Rift Valley.  The view of the valley is quite incredible.   

 


Monkeys on the roof

Monkeys!  They show up at strange times.  They really sort of freak me out.

I am used to seeing monkeys on television and in the zoo.  It’s just that when a herd of them runs across my front lawn or starts climbing my roof; now that’s new and different!  These monkeys are as big as dogs and they move unpredictably fast.  I am slowly getting used to them.  They are harmless really.

Like big squirrels.  I think.  I have been warned to keep my windows closed when I am not at home because the monkeys will enter looking for food!   

 


Baboons in the parking lot!  Baboons coming to your door!

I was on rounds the other day and I was distracted by a group of 3 baboons running around the hospital parking lot.  They didn’t break anything.  It was just… different.  The Great Baboon warning: Lock your front door. They are smart enough to know how to open it!  Well… if the baboons ever show up in my living room, I’m leaving!

 

Everyone who lives here seems pretty blasé about the whole monkey thing.  Generally, the monkeys do keep away from us.  The hospital and the school are surrounded on three sides by a thick tropical forest. There is plenty of habitat space for our animal friends, so who can blame them when they show up on the hospital grounds and everywhere else?

 


Hospital Cats

I am being teased.  I love cats.  There is a little black cat who lives on the hospital campus who looks just like my little black cat back home.  Naturally, I leave bits of sweet bread out for her and all her other cat friends to eat.  So far, I’ve counted about 4 different cats.  They are all quite feral and will not let me get close, but that’s ok.  I love them all anyway.  

 

 

The morning squawk

Every morning at 6 am without fail the Kenyan Pied Crows squawk in great disharmony to greet the morning light.  No alarm clock needed!  One thing about living near the equator is that the sun goes up and goes down at about the same time every day with little variation: 6 am and 6 pm.

 

 

Rift Valley Academy (RVA)

In 1906, missionary to Kenya Charles Hurlburt was faced with a decision many missionaries had to make with their children at that time: either send his children back to England for schooling or give up being a missionary.  His solution to this dilemma was to start a school of his own.  That idea has now grown to be a fully accredited first-world elementary and secondary school for missionary children: ‘Rift Valley Academy’, (K- 12).  It is rich in history.  President Theodore Roosevelt laid the cornerstone of the school’s first building.  It serves over 500 missionary children representing 30 nationalities and 80 mission organizations and churches.  They also accommodate a small number of Kenyan national students and expatriate, non-mission students.   


 

AIC Kijabe Hospital and the CURE Orthopedic Hospital : Two excellent hospitals

The effect of this juxtaposition on Kijabe Hospital has been dramatic.  It has contributed greatly to the

numbers and types of medical missionary specialists who come to work here, including

Pediatric Surgery and Surgical Oncology.  In addition, next to Kijabe is the CURE Orthopedic Hospital.  They have specialists in General and Pediatric Orthopedics, Spine Services and Physiotherapy.  Things are on the move upward.  Kijabe is expanding the Operating Rooms from 9 rooms to 15.  There is a nursing school here too.

The people in Nairobi certainly know how good Kijabe is.  Kijabe has an excellent reputation.  Many will drive the one hour it takes to come here for care and second opinions.  So even though the area around the hospital looks somewhat rural, the types of problems we see here are complex and challenging.  In the surgery clinic we see a great many cancers of the GI tract and breast, often at late stages.  Kijabe has training programs in General Surgery, Internal Medicine and soon, Anesthesia through PAACS (Pan African Academy of Christian Surgeons).  I know I’ve been challenged a few times in the Operating “Theater” here.

 

Nursing

There is a Nursing School at Kijabe.  The ward nursing ratio is one nurse to 8 patients.  In the ICU, the nursing staff has to mix their own IV infusions of pressor agents when they are necessary.

 

A great community

Like many other mission hospitals, the homes of the medical staff are within walking distance.

With the two hospitals and the Rift Valley Academy so close together, there are more housing structures and a bigger community, including school teachers and their students.  One of the charming ways that people socialize here is an invitation to dinner.  It’s been really fun to meet some extremely outstanding people.  And I listen and learn from them.  All their children attend Rift Valley Academy.   I had dinner with one British missionary family with their 3 children who left their mission in Madagascar to specifically come here so that their children could attend a good first-world school.

 

Food

When I get tired of the rice and beans in the hospital restaurant, I’ve been going to a ‘super duka’.

It’s really just a very cramped one-room store with two 15-foot aisles separated in between by a two-sided shelf, stuffed with all sorts of food products: no wasted space!   I also go down the hill and buy fresh vegetables and mangos from a group of older ladies at their food stalls.  At home, I’ve conducted some cooking experiments in the kitchen with a low-level of success. 

 


Southern Hemisphere Stars

On clear nights I’m seeing a whole new group of stars near the southern horizon.  The Southern Cross and the False Cross must be out there somewhere.  One of these nights I’ll be able to positively identify them.

 

Blending In

My goal has been to quietly serve where I see the need.  I am not here to ‘take over’.  That’s not my place and I’m a temporary worker.  I’m here to support those in charge.  I make good natured suggestions during ward and ICU rounds.   I’m always trying to understand first why things are done the way that they are.    Laparoscopic skills are lacking, so I’ve been able to offer something there.  I’ve taken the residents through a few central line placements.  And when I’m ‘on-call’ at night, I help the residents do the emergency cases.  Humble service and support. 

 


Thursday, May 6, 2021

Tenwek

 “Tenwek Hospital’s 300-bed facility is widely recognized as one of the Premier Mission hospitals
in the world.”

Franklin Graham

 

Franklin Graham is correct. Tenwek hospital is truly one of the best and most famous mission hospitals in East Africa.  There is a sense of community here.  As at Litein the living quarters of all the physicians and hospital staff are within close walking distance of the hospital.  I often saw parents and children playing together around their front lawns.  


Visitors
Visiting medical personnel are very common at Tenwek.  Their door is wide open for what specialists and physicians have to offer the patients and the training programs.  The hospital staff is very friendly, and used to visitors.  Numbers are down this year due to Covid.  

Guest House
There is a beautiful guest house for visiting physicians, nurses and medical students.  There is a common area where all visiting physicians, nurses, students and their families can have meals together. It’s a great chance to meet and make good new friends, from all over the country, at different stages of life.  Mr. Emanuel is an excellent full-time cook who makes sure all visitors are well fed.  In fact, his cooking is so good that many visitors gain weight during their visits.  This is playfully referred to as ‘the Tenwek Ten’, as in pounds!

Liberty University Medical Students
I was very inspired to meet a large contingent of graduating 4th year medical students with two of their experienced attending medical staff during their month-long rotation at Tenwek.     Their excitement and energy was palpable.  This is a great place for a medical student rotation.

The waterfall and power plant
The Nyangores River flows along the southern border of the hospital, and creates a large waterfall.
In 1987 this was harnessed to provide the hospital with its own electrical power source.  Amazing.



Tenwek Hospital was first built on a hillside in the 1930’s through Christian missionaries.  It is nearly 7000 feet above sea level.  When you enter the hospital through the staff entrance in back, it’s an uphill walk.  I could feel it!   Even though it is near the equator, the weather is cool “sweater weather”.  
Tenwek is a compact place and makes the most of the space.  The operating rooms are spacious and the resident lounge/work area has a reference bookcase that rises nearly to the ceiling.  Surgical procedures that cannot be done in smaller hospitals can be done at Tenwek: esophageal cancers and heart problems can be treated there.  



And I met some very outstanding people during my short two-week stay there. well-developed training programs in Internal Medicine, General Surgery and Orthopedics are among the best in the country.  This hospital is creating the future leaders in Medicine in sub-Saharan Africa.  For example, the four surgeons that I worked with at AIC Litein Hospital were all trained at Tenwek.  The Pan-African Academy of Christian Surgeons guide and mentor these training programs.



Wednesday, April 14, 2021

The AIC Litein Hospital

“Trust in the Lord with all your heart, and lean not on your own understanding;
in all your ways acknowledge Him, and He will direct your paths.”

                                                                              Proverbs 3: 5-6


The hospital restaurant
Most evenings, I go to have dinner in the hospital "restaurant".
Out of what's on the menu, I generally get the "red beans and rice".
I figure beans have protein, so I should be ok.  Dinner goes for about 150 shillings, or $1.50.
Since tea is so important here, I patriotically have an evening cup of Chai, which they always serve so boiling hot that I have to water it down with cold water so I can actually drink it.
They have a TV in the eating area, which alternates in the evening with 'soap operas' (all are over-acted and funny to watch; all in Swahili); or their local news shows, which resemble our own small network news programs, complete with roving TV reporters and cameras.
 
Motorcycle taxis
Throughout Kenya, motorcycles serve as local taxis.  Young men on motorcycles are parked in front of the hospital, ready to take you anywhere.

 
The Shoe Store
Litein’s Operating Room policies are quite strict about foot-ware in the Operating Theater. 
No street shoes allowed.  Lots of farm animals are around, if you know what I mean.  I went into town and bought some clogs from a local street shoe store.  I sat on the curb and tried them on.  $2.00.
 
Rainstorms
This is the rainy season.  The storms are quite entertaining if you are not walking outside.
Clouds just automatically seem to appear around 1-2 pm.
Lots of thunder!  And it rains so hard on the steel roofs that it sounds like a freight train!
Really loud! 
 
The Daily Routine
Ward rounds begin each morning M-F at 7:15.
It’s quite a crowd.  Surgical staff, their residents, nursing students, medical assistants.
One of the electrical generators squeaks in the background so it can be difficult to hear the presentations.  Clinic is each Monday and Wednesday.  Operating Room days are Tuesdays, Thursdays and sometimes Fridays.


 
The Litein Hospital community
Many people live around the hospital.
First. there is housing for most of the staff physicians, the young residents-in-training and their children.
Everyone lives within walking distance of the hospital and each other.
Second, there are two Litein boarding high schools: one for girls and one for boys.
The high school girls sing together at 6 am each morning, like clock-work.
It’s quite nice actually.
Third, there’s a combined nursing school and medical assistant school.
We see them all over the hospital.  The nursing students wear light blue dresses with dark blue sweaters.  Fourth, there’s an orphanage for young boys behind the row of stores in front of the hospital.
And of course, there is a church. All of this is on a hill above the town of Litein.
 
The people of Litein Hospital
Dedicated.  Caring.  Clearly doing their best.  Clearly motivated.
That goes from the Nursing Director, the Medical Director, right on down to the nurses in the clinics and the wards. Their effort and good intentions are very plain.   I am inspired to work with them.
I’m always trying to come up with new ideas that might help.
 
Christian Overseas Organizations: all working together
Many different Christian service organizations have come together at Litein, serving God’s people.
Some are Mission Doctors, World Medical Mission, Pioneers, Serge, and the Pan African Academy of Christian Surgeons (PAACS).  PAACS deserves special recognition.  They trained all 4 Kenyan surgeons who work at Litein.  Training good, intelligent young Kenyan talent for the long-term.  Incredible.
 
Resource poor
Litein makes the most of everything.  All equipment is recycled as much as possible.
Electrocautery devices, tubing, everything.  All operating room gowns and drapes are made of cloth and washed and resterilized.   Just about everything is recleaned and reused until it falls apart.
Litein is a Christian Hospital without government support or insurance, so people have to come in with cash to get treated.  But they know they get good care, so they come.
 
Surgery clinic
The scope of problems is wide.  No subspecialists work here.  It all comes to us.  All the urology, ENT, lthyroids, plastics, breast, esophageal cancers and metastatic cancers all come to us.
General surgeons in small towns in the USA know what I’m talking about. 
 
Unusual problems
There have been quite a few.  The hospital doesn’t have a CT scanner, so it can make things tougher to diagnose and treat.  A small for age 3 year-old child came in with an obstructed intestine from Ascaris worms.  My goodness!
 
Skin grafts
Before I left to go to Africa, I brought a hand-held skin grafting handle and blades.  It turned out to be a pretty good idea.  That turned out to be something that was lacking.  The residents and I put skin grafts  
on a few people and they all did well.  Thank God.


Kamuzu Central Hospital

"Pray as though everything depended on God. Work as though everything depended on you."  -St. Augustine Kamuzu Central Hospital an...