All in a Day's Work

October is a "special" month in our household. It's special, because every year in October, Gladys (our housekeeper) takes her annual, month-long leave. So every October, our family picks up all the routine household chores like doing laundry, washing dishes, baking bread, preparing all the meals. I know, I know - we're really suffering :)

But before you judge us TOO hard, please remember - we live in rural Kenya, where our incoming power and water are unreliable, so laundry (although we have a clothes washer) has to be done on those auspicious days when both power and water are available. Our laundry is hung on a line, and when rains come in the daytime, it has to be rescued from the line or left out to dry another day. We can buy something like Wonderbread at the local shops, but for a less highly processed loaf we make our own. Our milk comes from our neighbor's cow, so it has to be boiled, cooled, and put in the refrigerator. Again with our unreliable power, meal making may involve using the InstantPot or pulling food out of the fridge to microwave it, but we always need to have a backup (non-refrigerated, non-power operated) option in case the power is out. Of course, we do have a dishwasher. His name is Kris ;)

Our local "Wonderbread" came in a pumpkin shape this week! I assume this was a coincidence, but it made for a fun school lunch!

Gladys helps keep everything running smoothly in our household - food on the table, clean clothes in the cupboards, dishes washed and floors cleaned, milk properly processed and refrigerated, fruit, veg and eggs "sanitized" before we eat them. She makes it much easier to host visitors and meetings, because she can help us prepare food, and we can feel confident that the house will be clean and there won't be underwear hanging on the clothes line outside our front door when we welcome strangers into our home and community for the first time. When Gladys is away for the month, we miss her, and when she comes back from her leave, we are very grateful.

Before you think I'm really pitying myself, let me count our blessings. Kaylea, our intern through Serge, has been helping us with teaching Dominic since August. Having someone outside our family to help with education has really been life changing for us. Kaylea has also been helping another family with their curriculum for part of the day, so Dominic has time to sit in a classroom with other kids and has been learning a lot from the way other kids approach school.

School Lunch

In the last month, we've had multiple OB/Gyn visitors as well as multiple requests from others to come to Kapsowar. In fact, we've had so many requests that I've had to ask people to adjust their requests because we have too much help! As I said to them, after being in Kapsowar through "the Covid years," I never anticipated having so many volunteers that we wouldn't have enough work for them all! What a huge change in perspective!

OB Team

So, with all that in mind, our day on Monday looked SIGNIFICANTLY different than it would have looked in October 2020. Here's how the day went:

6:30am: Kris and Dominic left the house for basketball club

6:30am: I (Kim) woke up to a power outage, so I put coffee on the stove in the Moka pot

7:00am: Breakfast

7:30am: Washing dishes, putting clothes out on the line (washed in the machine the night before). The weather was looking pretty suspicious, so I hung everything that would fit on the back porch under our awning - it dries much slower in the shade, but doesn't risk getting a "bonus rinse" from the rain.

8:00am: Hosting Psalms and Prayers at our house. Kim led the reflection on Psalm 123, including a couple of songs on our new piano

9:00am: Kaylea takes over school with Dominic at our house. Kim - Walking into the hospital with two new visiting physicians. Quick meeting with the OB team (currently 3 OBs including myself plus our clinical officer) before running up to theatre to do a c-section. I wouldn't normally do a c-section when we have two other visiting OBs - but this is actually my third delivery of this specific patient in my nearly 5 years in Kapsowar, and so I wanted to deliver this baby (her fourth and final) myself. Kris - heading into the School of Theology to prepare for class.

11:00am: Guiding the two new physicians on a tour of the hospital and Kapsowar. It's always fun to see the hospital through a first-time visitor's perspective.

12:30pm: Run home to put on lunch (soup and homemade bread) for the "school kids" - Kaylea and Dominic, plus four other kids who Kaylea is also helping during the days. While I'm home, wash dishes and put away what laundry has dried. The power is back on, so I can boil water in the electric kettle to do the dishes, and move the fresh milk from the stove (where Kris boiled it earlier in the day and left it to cool) to the refrigerator.

1:30-6pm: Back to the hospital for afternoon clinic, answering phone calls and emails, and meetings. I'm still working on the call schedule for November - with multiple visiting doctors for the first half of the month, as well as some learners, it is pretty complex. Kaylea and I also meet to go through her work permit application again - we're still waiting on a response from Nairobi about what type of permit she qualifies for.

6-8pm: Homework with Dominic, supper (leftovers), and bedtime.

8-10pm: Walk in to the hospital to check on a patient - the "remote access" link for the hospital is down, so I can't check her lab results or nursing notes from home. Check in with the night-time nurses before heading home. The water supply is low, so we alert our neighbors to be on water conservation efforts and don't put in a load of laundry tonight.

As we always tell people who ask about our life in Kenya - the only thing that's predictable is that things are always changing. We're entering some new territory in our daily rhythms here, but one thing is sure - we'll be glad to have Gladys back at work tomorrow!

A few of our favorite things

Meal preparation in Kapsowar is a little different than meal preparation in North America. When the power goes out, plans for using ingredients out of the refrigerator, or using kitchen tools like an InstantPot or blender are also out the window. Basic ingredients are available in Kapsowar, but most "easy" or "ready-made" groceries have to be purchased in Eldoret. Add that to the unpredictability of an OB/Gyn's schedule, and you start realizing that a lot of flexibility and contingency planning are required. On the other hand, because our housework is labor-intensive, we have Gladys working in our home 5 days a week to help us with all of that work. She does a lot of our baking, some cooking, and a lot of meal prep and shopping for us.

Over the past five years, I've been building up a small repertoire of recipes for these various occasions. Chances are if you have joined us for a meal, you've sampled Bean and Cheese Enchiladas (with homemade enchilada sauce and guacamole), Pumpkin or Potato Curry with Jeera Rice and Gladys' Chapati, or Vegan Sloppy Joes with biscuits and coleslaw.

Over the past year or so, we've also had several members of our long-term community join us or be diagnosed with gluten and dairy allergies. Now I'm adding vegan and gluten free recipes to my mental cookbook. I've realized that cooking vegan or gluten free isn't actually as difficult as it sounds, but I had to adjust my approach. Instead of thinking of my favorite thing to eat (maybe pasta with alfredo sauce) and then trying to adjust the recipe to suit a gluten- or dairy- free diet, I've started making note of recipes that I cook that happen to be gluten- or dairy- free (or close to it) already. For example - making a chocolate cake gluten free is tricky using local or pantry ingredients. But making Monster Cookies or Oatmeal Bars gluten free is super easy, requiring no adjustment at all, or just a small amount of gluten-free flour. Most curries are already gluten free, and a lot can be made dairy free just by cooking in oil instead of butter.

Another note about meal prep in Kapsowar. In North America, I used to spend a lot of time running to the grocery store for missing ingredients while trying to prepare a meal. In Kapsowar, I've learned a lot about substitutions and eliminating ingredients. It's been really freeing to just cook with what's available, instead of making sure that I have every single ingredient and spice. I'm not saying my cooking tastes good all the time, but I hope that I'm improving over time!

After all that preamble...a few of my favorite recipes for dietary restrictions (adjusted to Kapsowar ingredients, etc) 

Paneer Makhani (Gluten free, serve with rice; freezes well)

3 T butter, divided

1 large onion, chopped

2 tsp ginger (I use the prepared refrigerated minced ginger and garlic to save time and washing dishes)

3 garlic cloves

3-4 roma size tomatoes

1 tsp salt

1/4 tsp cayenne pepper (increase to 1 tsp if your family tolerates spice)

1/2 tsp tumeric

3/4 c water, divided

1/4 c whipping cream

1 tsp garam masala

1/2 tsp sugar

2 cups cubed paneer - I fry this in oil to give it a little more texture. Paneer is pretty simple to make, but I usually buy it and freeze it, then pull it out as needed. The paneer can also be replaced with rehydrated soy chunks (called meal maker in Indian grocery stores) or probably some type of meat :)

Fresh cilantro to top

In an instant pot, saute the onion in 2 T butter for 3-4 min, then add the garlic and ginger. Add tomato paste, fresh tomatoes, salt, cayenne, tumeric, and 1/2 c water. Cook on high pressure for 3 min, natural pressure release for 5 min, then quick release the remainder of the pressure. Add 1/4 c water and blend with an immersion blender. (I often double the recipe, and remove half at this point to freeze for later.)

Add 1T butter, cream, garam masala, sugar, and paneer, then heat to simmering (I use the saute function for this). Serve with rice, cilantro to top.

Layered Refrigerator Salad (Can be made dairy free or gluten free by adjusting the ingredients, but I wouldn't attempt to eliminate the eggs. Mayo is dairy free, so eliminating the dairy is actually pretty easy)

Layer 1: 3c green leaf or romaine lettuce, washed and shredded (I use 2 heads of romaine or salinova(

Layer 2: 1.5 c small pasta, cooked, rinsed, and drained

Layer 3: 3 hard boiled eggs, sliced, sprinkles with salt and pepper

Layer 4: Red and/or green pepper, diced, one total (I've also used cucumber or shopped snap peas in this layer)

Layer 5: 16 oz frozen peas, thawed

Layer 6: 1c mayo plus 1/4c sour cream (I substitute an ingredient called Mala, which is basically plain yogurt) plus 1/4 c chopped green onion plus 2 tsp Dijon mustard

Layer 7: 1c cheese, shredded (I use gouda, cheddar, or something called "everyday")

Cover with plastic wrap and refrigerate several hours, up to overnight

Pineapple-Star Anise Sorbet (Gluten Free, Dairy Free)

(An ice cream maker makes this recipe much more convenient, but isn't strictly necessary. You can do a freeze/mix/freeze/mix process if you don't have an ice cream maker. The star anise in this recipe adds a nice contrast to the pineapple, which can otherwise be overly sweet.)

650g fresh pineapple

50mL water

200g sugar

1.5 - 2 pieces star anise

3T Lime Juice

Zest of 3 limes (if you're using fresh)

1 Tbsp Vodka (optional, prevents crystallizing)

Combine fresh pineapple, water, sugar and blend. Place blended "juice" and star anise in a pot and heat until the sugar dissolves, stirring occasionally. Turn off the heat, and place the lid on the pot. Leave for 40 minutes to cool and for the star anise to infuse the liquid. Remove the star anise, add the lime and zest if using. Place in the fridge until chilled (I usually do this overnight). Once chilled, churn in an ice cream maker or using your favorite method (I put mine in the KitchenAid ice cream maker attachment for 25 minutes). Freeze for at least six hours, overnight if possible.

New Things!

 August has been an extremely busy but fun month.

We went to Eldoret and stayed at an AirBNB to do some shopping, and to watch the Olympics!

I (Kim) flew to Nairobi for a day. I arrived at 8:30am, met my driver (friend of a friend) who took me around the city to visit two used piano stores, and then back to the airport by 2pm (see below). After trying out about 20 pianos, I put in an offer on one, and it was delivered to our house, installed, and tuned just 5 days later!

Picking up Kaylea, our new intern, at the airport in Nairobi

First Day of School with Miss Kaylea!

Thankful that Dr. Allan is here helping with OB/Gyn while we get Kaylea settled!

Our hospital laundry has been "benefitting" from extra rinse cycles during a particularly wet rainy season. We're grateful that the sun has come out the last three days, and we've had dry laundry AND hot showers.

Meanwhile, work at the hospital is ramping up, as it usually does this time of year. We're grateful for the short-termers who help relieve some of the work load and call responsibility. Kris is getting ready to start a new school term, and Dominic is now doing most of his school work with Miss Kaylea (just a few subjects to add back into the schedule next week). As a new school year begins in N America, we hope your Septembers are full of new, fun things too!

Moving on

 

My mom bought me a new pair of clogs when I entered residency in 2019. These shoes have seen a LOT - of birth and bodily fluids, running for emergencies and standing for hours, the happiest and saddest days of women's lives. 

After resoling them twice, holding them together with tape, and generally causing embarrassment to all my coworkers based on the poor condition of my footwear, it's time to move on. I have a replacement pair - in good condition, but not yet molded perfectly to my feet. They feel strange and new - not bad, just not comfortable yet.

It's a fitting (pun intended) metaphor for some changes we're getting ready to embrace. Recently, another member of our community volunteered to take over housing and transportation coordinating, a job that I had reluctantly done for a couple of years. Next month, we will be welcoming our first intern from Serge, who will be helping us with some of our education on station. And in December, the number of long-term OB/Gyns at our hospital will double, as we welcome Abby, coming to work with us through to Post-Residency Program (the same program that brought us to Kapsowar)! 

These changes are SO exciting! Just like my old worn out clogs, we're ready to say goodbye to the responsibilities of coordinating visitors arrivals, departures and housing; of being the primary educators for Dominic; of being the only OB/Gyn at the hospital. But at the same time, we're saying goodbye to something known and entering another time of change and adjustment. Some things are a little uncomfortable or don't feel quite right yet. But we know the old way just wasn't working best, and we're praying that we'll learn, grow, and adapt until the new "shoes" become even better than the old.

(Financial) Year End

We just reached the end of Serge's financial year. Now that all of our receipts are submitted (I hope!) it feels like a good time to let you know about some special projects that we have been able to support due to your generosity (through our accounts at Serge, World Medical Mission, and Great Commission Fund). The hospital and school of Theology have MANY other projects going on, these are just a few small areas that we've gotten involved in thanks to a surplus from you all!

School of Theology: Student assistance fund. Many of Kris' students have a difficult time raising money for their own school fees while also paying for their children's education. We don't want tuition to be a barrier to keep adults from furthering their own education, or providing for their families. Thanks to those of you who have donated specifically toward this student assistance fund.

Kapsowar Hospital: Infrastructure is vital to safe patient care. Our hospital's generator was receiving somewhat routine maintenance, but was struggling to keep up with the growing demands of the hospital. A generator is absolutely critical given the unreliable nature of our "grid" power. As Kris often says, the grid power goes out about once a day here on average. Usually, it's out for a couple of minutes. Sometimes, though, it's out for hours - and we have no way of predicting when that will be. Even a minute-long power outage can be really dangerous for a patient who happens to be undergoing surgery during that time! So the hospital generator needs to run smoothly and reliably for our patients' safety. 

We're grateful for a donor who responded to this specific (and perhaps not very glamorous) need and provided funds for a professional evaluation and overhaul of the generator. 

The hospital relies on a lot of donated equipment to reduce costs. We have anywhere from 4-6 ultrasounds in the hospital, all in various states of disrepair. In our radiology "suite" (two rooms, one for xray and one for ultrasound) we were using three ultrasound machines - only one was able to export files to the computer system which is needed for health insurance "prior authorization" but the pictures were not great quality, (another) one was capable of measuring color flow (needed to diagnose blood clots in the legs, characterize various tumors, and evaluate hearts), and a third gave pretty good images, but the lid was cracking off and every time we opened the machine, we were afraid it might be the last time before the lid falls completely off! During a trip to Nairobi, our hospital's medical director found a used ultrasound for sale that would take on the work of all three of the partially-working machines! The price was exactly what we had agreed to contribute as a surplus from our Serge fund toward upgrading hospital equipment, and we were able to get the machine to Kapsowar within about 2 weeks!

As we've mentioned before, your contributions help us with a lot of big and small expenses of life on the mission field. We're so grateful every day for the ways that you give, to help us serve the people in our community. Thank you!