The Storm is Passing Over

Recently I've found myself humming this song at various points in my day. We sang this in choir sometime in high school (a shocking number of years ago) and it came back to me one day as I watched the clouds rolling out of our valley and the sun breaking out over our town. 

The Storm is Passing Over - Detroit Mass Choir

(If you're interested in the history of this song - or at least, the original composition and composer, you can find it here: https://hymnary.org/text/courage_my_soul_and_let_us_journey_on)

"Stormy" is a good way to describe the last month, both literally and figuratively. Kenya has received more rain that in can safely handle, and flooding has displaced many people, taken lives, and swept away planted crops. Kids were unable to return to school when originally scheduled. Meanwhile, the doctors who work at government hospitals went on strike, followed closely by the clinical officers (mid-level providers). Last week, the nurses announced that they would also join the strike from Monday May 13. For those who can afford to pay, private hospitals remained open. For those who cannot afford to pay a huge deposit to enter a private hospital, or who have an emergency, mission hospitals like ours remain an option - so we've been absorbing a lot of extra work. Last week in the course of about 36 hours, I did 11 surgeries - not an terribly unusual number for me, but the majority were gynecologic emergencies (ruptured ectopic, ovarian torsion, tubo-ovarian abscess to name a few), rather than c-sections which usually make up 80-90% of my surgical cases.

On Tuesday afternoon, the government announced that they had reached a deal with the government-employed doctors who are now returning to work. From what I can tell, the nurses have therefore called off their strike. The last few days have been dry and sunny, with only a small amount of rain at night, and though the ground is still boggy ("squelchy" is the word that always comes to mind), the kids will be returning to school next week. 

During the busiest days of the strike, though tired and worn, it was easy to remember to lean of God's grace - to get through a day (and night), to pray for a healthy outcome for a mom and baby, to remember that my continuous efforts will never be enough to pull a patient through a life-threatening illness - but that God can do all that, and more. 

The storm might be passing over. Or, as our 4-year-old neighbor keeps reminding us, this might just be the calm at the eye of the storm. We may be facing a lighter and easier week ahead - or maybe not. For now, we're basking in the sunlight, thankful for the respite, and joining in singing "Hallelujah" - praise be to God!

Inspiration

Sometimes, I need a little inspiration in my work, home life, and faith. This month, I want to share two sources of inspiration and encouragement. Enjoy!

The first is an article written by Dr. Eric McLaughlin, a graduate of the Post-Residency Program (World Medical Mission) and a physician at Kibuye Hope Hospital in Burundi - he and his wife Rachel are also our team leaders through Serge. He's also written an excellent book, Promises In the Dark: Walking with Those in Need Without Losing Heart. 

https://www.christianitytoday.com/ct/2023/november/i-stumbled-in-steps-of-good-samaritan.html?utm_medium=widgetsocial

The second is a new video from our local videographer and teammate, Regan, featuring our two plastic surgeons who have been doing facial reconstruction surgery for patients from outside of Kenya with limited access to healthcare and no access to specialized surgeons. These patients stay in Kapsowar for months at a time to have multistage surgeries performed.

(I'm not very familiar with Vimeo and can't figure out how to embed the video, so you'll just have to follow the link or search for "Becoming Whole: Facial Reconstructive Surgery at Kapsowar Mission Hospital" on the Vimeo website. https://vimeo.com/932169521 )

Fat Tuesday

This week, we celebrated our FIFTH "Fat Tuesday" in Kapsowar. We started with pancakes in 2020, quickly realized that pancakes are entirely too time consuming to make, require a lot of cleanup, and are difficult to eat outside (as necessitated by Covid in 2021), so we switched to doughnuts and haven't looked back! 

The idea of Fat Tuesday (Mardi Gras, in French) was - traditionally - to use up the last of the fat and sugar stores before starting a Lenten fast. Doughnuts definitely meet that criteria! (I'm not going to write about the WHY of a Lenten fast here, but I did find a really nice article about Christian fasting at this blog: https://gravitycommons.com/how-to-fast-for-lent/  - I'm not endorsing the whole website, I don't know anything about their organization, but I really liked their explanations of why and how to fast.)

Fat Tuesday gives us an opportunity to meet with our community, talk about our experiences with Lent and Easter (some of us grew up in very "high church" backgrounds, others grew up very evangelical and have never been exposed to the church or "liturgical" calendar, many of us fall somewhere in the middle), and discuss why or how or if it is important to prepare for Holy Week and Easter. 

Here are some photos of Fat Tuesday, and Dominic's favorite doughnut recipe, inspired by reading Farmer Boy and adapted from a recipe we found online:

African Twisted Doughnuts (adapted from www.preciouscore.com)

Makes: 24 doughnuts

12 oz evaporated milk (see recipe)

2-1/2 tsp active dry yeast

3 T sugar

3 T melted butter

1 tsp salt

1 egg

4 c all-purpose flour

Cinnamon sugar, powdered sugar, or glaze of your choice

1. Make evaporated milk: Boil 3-1/4 cups whole milk or shelf milk until it is reduced to 1-1/2 cups (12 oz) OR warm up 12 oz of evaporated milk (from a can) 

2. Let evaporated milk cool until it is just warm to touch. Stir in yeast, let rest for 5 minutes

3. Whisk in sugar, butter, salt and egg

4. Stir in flour with wooden spoon, then knead dough for 5-7 minutes, adding flour as needed

5. Cover and let rise for 1 hour or until doubled in size

6. Roll dough out into a rectangle, then cut into 24 strips (I do mine as 2x12)

7. Create twists by rolling into "snakes" with hands moving in opposite directions. Keep twisting the dough until it twists up, then pinch off the ends (this takes a little practice the first time but it gets easier!)

8. Fry in oil at approximately 350 degrees (I just get the oil hot until it forms bubbles around a small piece of dough when dropped in), turning after about 1-2 minutes

9. Roll in cinnamon sugar immediately, or sprinkle with powdered sugar after cooled, or try a glaze

Photo Dump!

 In no particular order, without explanation or excuse - photos from the last 6 weeks.

Chameleon hunting is a popular sport in our neighborhood. As far as I know, all the moms have a same-day capture and release policy. Chameleons don't thrive in captivity.

Heading to school with Dad and Nala

We love guest teachers, especially those with special skills!

Heading to Nairobi for passport renewal meant a great opportunity to check out some new restaurants! Dominic chose (no surprise) a chocolate croissant and vanilla milkshake for lunch. What was a surprise was the size of the croissant!

Some mornings can be a little chilly in Kapsowar.

First day of Grade 4! Finally learning some keyboarding!

Olie bollen for New Years Day

Obviously I'm not a food blogger - We made Indian food for Christmas lunch

No, this is not a flashback - Christmas Eve Potluck was cancelled last-minute due to a Covid outbreak at our station! We collected and redistributed food from the unaffected households, and then had an outdoor meal with what remained with a couple of our neighbors

Kapsowar's first (I think) Christmas Cookie Exchange was a great success! So many yummy treats to enjoy!

Christmas in Kapsowar

Merry Christmas from Kim, Kris, Dominic and Nala!

Two years ago, I made a promise that someday I would write about Christmas 2021. From a professional perspective, I had endured more difficult periods in Kapsowar than those 48 hours starting at about 7pm on Dec 23. But that Christmas, and the tragedies I bore witness to in the lives of my friends here, are a poignant example of why being a rural doctor - in ANY community, in ANY country - can be so heartbreaking. And why being an OB/Gyn - in ANY community, in ANY country - is a profound privilege, as we walk with families during their moments of greatest joy and deepest sorrow.

There are about 200 employees at AIC Kapsowar Hospital. If I make a conservative estimate, in the 4 years I've been here, I've probably been involved in caring for about 10% of these employees or their spouses during their pregnancies. There are 3 employees who I've cared for during 2 pregnancies each - and two of those delivered their babies on Dec 25 and Dec 26, 2021.

I met the first employee's wife when she presented with a non-OB concern VERY early in her pregnancy. I was consulted to comment on the potential risks of treatment for her non-pregnancy related condition, and found out that she had numerous reasons for a VERY high risk pregnancy- including prior stillbirth, a prior very preterm delivery due to a serious pregnancy complication, and two significant medical conditions despite appearing to be a very healthy young woman. In North America, she would have been extensively worked up by a High-Risk OB doctor before pregnancy, and been followed weekly or every other week until a likely early delivery.

However, our options for Rachel's pregnancy were limited (not her real name, of course). She was returning to her job about 8 hrs away, where she would be living for most of her pregnancy. Her medical conditions required close monitoring as they would likely worsen during pregnancy, but she wasn't able to perform the monitoring from home due to lack of proper testing supplies/equipment. Ultimately the couple decided to continue antenatal care with a specialist close to her work, but running his recommendations through me before implementing them. Things were going okay- she saw me for a growth ultrasound a checkup around 20 weeks, and there were no signs of poor health in mom or baby. But we had quite a while to go before this baby would be "viable" - have any chance to survive outside the womb. In Kapsowar,  "viability" is 28 weeks or 1kg, but babies born that early have a LONG fight ahead of them.

Fast forward to the week before Christmas. Aaron (not his real name), still working in Kapsowar, told me that Rachel had had an ultrasound at the specialist's office because the baby wasn't moving well. The specialist said the baby was smaller than expected. No big deal, we'll just change your due date, he told Rachel. I was speechless. We had the best possible dating for Rachel's pregnancy - a first trimester ultrasound that agreed with her last menstrual period. Rachel had at least 5 good reasons for her baby to be small or "growth-restricted," all of which were reasons for significant concern and further testing, NOT reassurance and changing her due date. I told Aaron that I was  worried, and that I recommended that Rachel either find a doctor in her area who could perform proper antenatal testing, or return to Kapsowar as soon as possible so that I could assess the baby myself.

The next day -the night before Christmas Eve - our family was at home watching a Christmas movie in the evening. I got a call from Aaron. Rachel had returned to the specialist- she had not felt the baby move for over 24 hours. The specialist was gone - traveling for Christmas holidays - but the person filling in for him had performed another ultrasound and diagnosed stillbirth, now Rachel's second. He recommended emergency c-section to remove the baby, because Rachel had had a c-section for delivery of their only living child. I asked some follow-up questions- was Rachel okay? Were her blood pressures normal? Was there any reason why she couldn't travel to Kapsowar? And then recommended that she leave her local hospital and travel here so that I could safely induce her labor and spare her a major surgery if possible. Aaron agreed.

All through Christmas Eve, Aaron and I waited for Rachel to arrive via public transport. Meanwhile at home, I tried to carry on with our Advent celebrations - but awaiting the birth of the Christ child, and anticipating the birth of my friend's demised baby, produced a sobering contrast of emotions. When Rachel finally arrived, I confirmed her diagnosis, explained the induction process to the couple, and prayed with them for a quick and uncomplicated delivery. Through that Christmas Eve night, Rachel labored, knowing that this Christmas baby wouldn't be the gift she has waited for.

On Christmas morning, Rachel was able to deliver safely and quickly, and I was even able to be there for the delivery (I don't often make it for normal deliveries since all our moms are unmedicated and can't wait for the doctor!). I went home, mourning but thankful that the worst part of the day was now over, and ready to celebrate Christmas.

A few hours later I got a call from maternity. Sharon - another employee at the hospital, pregnant with her first child after years of trying, and Aaron's next-door neighbour - had just arrived at maternity. She hadn't felt her 34-week baby move in 24 hrs. The nurse had listened, and listened, and listened for the baby's heartbeat, but couldn't locate it. Could I come in and do an ultrasound to find the heartbeat for them? Sharon was starting to get anxious.

I grabbed my things and walked in to the hospital with a sinking feeling. My nurses almost NEVER fail to find a heartbeat. But maybe these were inexperienced nurses, on call on Christmas Day. Maybe the baby was in a funny position, making it difficult to find the heartbeat. Maybe it was just fetal distress - maybe the heartbeat was low, but we could still get the baby out in time with an emergency c-section. Lots of maybes, and prayers, and pleading during that 5 minute walk to the hospital - but the ultrasound was clear. Sharon's baby had also died.

Two years later. Did it really take me that much time to recover emotionally from that Christmas, to tell their stories? Well, yes and no. This Christmas, Aaron and Rachel will celebrate Christmas with their infant twins, born last fall after a VERY closely monitored pregnancy (between me and a real High Risk Pregnancy Specialist in Eldoret). Sharon and her husband will celebrate their daughter's first Christmas - after receiving a diagnosis of diabetes and starting treatment, Sharon was able to carry her pregnancy to term and went home with her healthy baby in September. We've all talked about sadness that we experienced that Christmas, and that we remember every holiday season, and about what a blessing it is to have something (someone) to celebrate this year. And those tiny someones give me the courage to share their families' stories.

BUT. Sharing their stories is something I also do with caution. There are a lot of heartbreaking and amazing and unbelievable stories to tell in our community and in this area of the world, and I want to tell those stories with the gravity and respect they deserve, because these are real people, my real friends and neighbors, not statistics or tragic characters designed to stir up sympathy and donations. We're really excited to have a videographer on our team who is helping us to navigate that balance. Here is a recent short video that she put together about the hospital. We hope this video helps explain why we are here and why we do what we do!

If you are interested in donating to the "Needy Patient Fund," please follow this link to donate through African Mission Healthcare, an organization who supports our hospital in a variety of ways.