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!

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. 

 

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.

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.

Litein

 

“What place is this?  Where are we now?”

                                                                                                                                                Carl Sandburg

 

I’ve made it here to Litein, Kenya.  I’m working in a hospital with the same name.

It’s a small town.  And people couldn’t be nicer.  Everyone is pleasant and considerate.

Invariably, when I walk down the street, people are pleasant and greet me, good-naturedly trying to practice their English phrases. “How are you?” Or “Hello “muzungo” (their term for a white European person).  Being white, it’s a lot like having a blinking neon sign over my head as I walk around.

 

One thing I can say is that Africa is not what many people may think it is.  How could we know? 

We have little exposure and I’ve found the Kenyans I’ve met know more about us than we know about them.

 

Litein is 7000 feet above sea level; higher than Denver, Colorado (5280 feet).  The elevation is noticeable when I walk around.  The town center has 2 parallel roads covering ~2 miles, each lined with one-story buildings with small businesses with hand-painted signs for each.  It’s an interesting complex of rocky uneven dirt roads and asphalt streets lined with street vendors of fruits, vegetables, candies and hard-boiled eggs.  In addition to the people walking by the sides of the road, chickens, donkeys and cattle are common fellow downtown pedestrians. 

 

I was surprised to find two large supermarket/general stores. I’m surprised that I could buy everything from toothpaste to soft drinks and cookies.  The upper floors sell clothing and furniture.  There are some cars on the roads.  The local taxis are all motorcycles.

 

 

The A.I.C Litein Hospital (AIC = Africa Inland Church) dates back to 1923.  Its present building was completed in 1996.  It has 220 beds with open wards and 10 emergency room beds. The surgery clinics are busy; seeing ~90 patients each Monday and Wednesday.

Bordering the hospital grounds are living quarters for staff, separate high schools for girls and boys,

and a nursing school.  There’s also an orphanage for young boys nearby.

 

 

The Hospital is painted a beautiful shade of green. Why? I have a theory. I think it is the adjacent the tea farms.  The hospital’s green is the same as the area’s green-colored tea fields.  Tea is the dominant cash crop.  On the road north to the state capital of Kericho, the tea fields extend on either side of the road as far as the eye can see.  After seeing that, it doesn’t surprise me that Kenya is the world’s largest exporter of tea in the world: >450 tons of tea per year. 

 

This hospital and rural community where I’ve come to serve have a great deal to teach me.

“Twenty years from now, you will be more disappointed by the things you didn’t do
than by the ones you did do.”

Mark Twain; Jackson Brown Jr: Tamera O’Brien

“IN THE END… We only regret the chances we didn’t take, the relationships we were afraid to have, and the decisions we waited too long to make.”

Lewis Carroll

Everyone has a bucket list.
We all have lists of things that we would like to do,
or places that we would like to go,
before we die and leave this earth.

On my list has always been the desire to serve overseas as a full-time medical missionary.
But I’ve never really done it. I’ve done some part-time medical service trips, but I never put everything
aside to serve long-term. Something always got in the way.

I am lucky because now I am going to do it.
I’m lucky because I can physically do it.
Saint Therese of Lisieux, the Patron Saint of the Missions, could not.
She had wanted to serve in Vietnam. But she died of tuberculosis in her convent in France before she had the chance.

Then there is the story of Dr. Powe.
Dr. Powe was a physician who also wanted to serve those in great need in the missions. At the end of his career, he joined the Mission doctors Association of Los Angeles. He completed their 9-month course of formation training. Just before his mission was to begin, he was diagnosed with prostate cancer. He underwent treatment, but the treatment was not successful. He died of his cancer before he could go.
So yes, I am lucky. I have a great deal to be thankful for.
And I’m going to give it all I’ve got.