"You have been a best friend here"

I have been seeing an older gentleman in the hospital.  He had a pretty extensive orthopedic surgery after a femur fracture (femur fractures here are like the common cold at home) , but it was time for him to start moving around.  I went in the first day and he tried and tried and tried to get me to come back tomorrow.  After he realized I was more stubborn than he was, he relented and we got him up and took a few steps with a walker.  He was talking and talking the whole time in his tribal language.  The other guys in the ward were laughing and the nurse helping me just rolled his eyes.  I imagine I didn't want whatever he was saying to be translated.  After a labored short walk, he made it back to bed and I got him settled.  He grabbed my hand and said "Asante san."  That one, I have learned - thank you very much!  I smiled and said I would see him tomorrow.  

The next 2 days were pretty similar to the first, only we walked just a bit further.  However, on the next day, I was walking to his ward and found him sitting outside on a bench (the wards are separate buildings and patients often sit outside to bask in the sun and get their vitamin D, so they tell me).  He looked up and grinned.  He said he had walked all the way out here and wanted me to come and find him there.  The next day I found him walking all the way around the building.  Keep in mind, these are major orthopedic surgeries, and the most pain medication these patients are on is just a bit better than Motrin or Advil we get over the counter. 

A few days later, I went by just to check on him.  He told me he had walked all around the hospital looking for me the day before to show me how good he was doing and that he gets to go home soon.  This past week, one of the other patient’s in the ward saw me and told me that Peter wanted me to come by and see him.  I found him outside in the sunshine, and to greet me, he stood up without the walker and shook my hand.  My eyes welled with tears as I celebrated with him – less than 3 weeks after a femur fracture and surgery and here he was.  Amazing.  He thanked me and told me I had been a best friend to him here at Tenwek.  He also shared that he is going to be baptized this month when he gets home.  He has been going to a Catholic church from what I could gather, but sounds like God has moved in his time here at Tenwek.  My heart was so full!  To God be all the glory for how He has healed this man.

And they glorified God and were filled with awe

I had such a sweet encouragement today.


My second day at Tenwek I worked with 2 ladies, one with a total hip and one with a total knee, both one day after their surgeries.  They amazed me with their strength and walked with walkers that first day on minimal pain medication.  It was only a couple days later that they both went home.  Working with them had been the highlight of my day.


Today, each of them returned to clinic for their follow up appointment.  Both of them were doing fabulous and it was such a delight to see them.  One of them pulled me aside.  She said when she went back to her home, her entire village was amazed.  They were amazed that when she left she was in so much pain she couldn't walk, but when she came back just 4 days later, she could walk.  They said, "We must go to this mission hospital!"  And so today, when she came back for her follow up, she brought not only her family, but several of her neighbors who all received treatment from various clinics.  I saw at least 4 people, and I think there were at least 4-5 more at other places in the hospital.  And each of them were delighted to be there and with their treatment.


I was astounded and reminded of several times when Jesus heals people in the gospels and the person runs home and the people are amazed and glorify God.  This was such a sweet picture of this and I felt so honored to be apart of it.  I saw something in this group of people I haven't seen here a whole lot - hope.  I pray God uses that little spark for His children here that endure so much.

A Day in the Life of a PT at Tenwek

Tonight at dinner in the guest house, as we do most nights, we sit around and just hash out different stories from the day.  Often times these stories are followed by "You can't make this stuff up" or by "How in the world do you describe this to people at home?" 


In order to give some context to stories I may share, I want to give you a little picture of what my typical day looks like here:


It starts pretty early with rounds with the orthopedic docs at 7am. 
After that, often times we go grab some chai (tea) from the hospital canteen and I plan out my day and the inpatients I need to see. 

I then make my way through the wards seeing each of the patients.  Patients range from post-op orthopedics to pediatrics to acute strokes or unknown neurological conditions.  Most of the time I just get patients moving to prevent complications, because if I don't, no one else will.  The nursing staff here tends to be pretty unreliable.  I have the opportunity to pray with patients I feel led to, and end up doing a lot of patient and family education.  Beyond brief PT in the hospital, rehab in the sense of inpatient rehab, home health, or outpatient does not really exist here as part of the medical system and really isn't practical for people when just getting to the hospital once is a big ordeal.  Once a patient is discharged from the hospital, they are asked to follow up usually in 2-4 weeks in the outpatient clinics at the hospital.  So I am left to teach the patients and their family as much as I can before they leave so they can continue some sort of rehab at home.  The language barrier has been tough.  And I found that even if they don't understand you, they will nod their head yes like they do, so it's a bit tricky sometimes.  Usually a family member, another patient, another patient's family member has been able to help translate.  Once they go home though, I just pray something sticks and God uses what little I have to offer to make them well.

Once I finish up with the wards and put in some brief documentation in the computer, I make my way back over to the orthopedic clinic.  Orthopedic clinic is the outpatient clinic.  It's a walk-in clinic.  Everyone lines up outside the door by about 10am (clinic starts at 9).  There are 4 exam rooms that are filled by a rotation of PAs (called COs here) and residents and then one of the orthopedic surgeons usually floats around.  Then there are 2 rooms for physical therapy (this has actually been a new addition since I got here).  Solomon is the head physiotherapist here and there are 2 others.  There is one room dedicated to casting which they do a lot of here.  The  2 other physios besides Solomon, from what I can tell, they do ortho tech type stuff - casting, cast removal, splinting, placing patients in traction in the hospital, distributing DME.  They also do whirlpool and wound care.  Solomon, however, functions more like an orthopedic PA.  As I mentioned, there's very little physio like I am accustomed to in the US.  He sees patients directly and then manages them, ordering imaging and prescribing medications.  He may do some manual and give them exercises, but follow up is usually no more than once every 2 weeks and I haven't seen one patient yet who remembers even one exercise.  Follow up is pretty inconsistent as well.
 
There is also no flow or efficiency to the clinic whatsoever.  I was really frustrated with clinic the first week because there seemed to be no rhyme or reason to it.  One of the visiting doctors who had been here a while told me to think of outpatient clinic as "A Day at Tenwek" for the patients.  They all show up about 9-10am and they wait.  The doctor calls them back, but then they may have them go back outside and wait more while they work on something.  They may be sent up the hill to get an x-ray or have lab work done and then they come back to clinic where they wait again to see the doctor.  It's insane and people in the US would be furious and wouldn't tolerate it at all, but here they don't mind and are some of the most gracious people, always thanking you profusely as they leave. 

So in clinic, I help Solomon in whatever way I can.  Sometimes that is typing the note and putting in prescriptions for him while he talks with the patient - he's slow with computers and is grateful for my help, always saying "you were born with a computer!"  I'll go through exercises with a patient and do some manual.  I do pull back some of my own patients, but once again, the language barrier is tough and in clinic it's really hard to find someone to help translate.  I'm also still learning how the system works.  I'll have a patient and know what I want to accomplish, but it's difficult figuring out the channels to go through to make those things happen here.  I'm learning though, slowly but surely.  I'm also using a lot of my differential diagnosis knowledge from PT school!

In addition to the traumatic injuries and fractures here, we see a lot of back pain.  We also see a lot of arthritis, but I think I have seen more TB arthritis than OA - I'm pretty good at identifying Pott's Disease at this point.  I've seen a few neuro patients, a couple strokes that were pretty severe.  In pediatrics, in addition to ortho patients, I've seen a few meningitis patients and other neuro cases.  They do not have a neurosurgeon here or an MRI, so specific neurological diagnoses are limited.  Patients are referred to another facility about 2 hours away. 

In general, you see things you would never see in the US because people do not seem to seek care for a really long time.  We've see tibia and femur fractures 10 days or more after their injury.  There was a little girl today who had had pus draining from her lower leg for a year, but in the past couple weeks, they noticed her leg becoming more crooked, so they decided to bring her in.  She has diffuse osteomyelitis of her tibia and had developed a pathological fracture due to it.  What?!  What seems so common sense to us just doesn't exist here.  And part of it is due to poverty.  I read a story in a missions book before I came here about a little boy who was taken to the hospital and underwent an extensive course of medical care.  Finally, after the bills kept wracking up, the mother refused any further treatment, even at the risk of her son dying.  She said that it would be less expensive to have another kid.  It seems so harsh at first glance, but at the end of the day it came down to paying for one son's medical bills or feeding the rest of her family.  She had no other options, and while I am sure she loved her son and it broke her heart to lose him, at the end of the day it was simple math and logic - care for one at the expense of all of the others.  As Spock would say, the needs of the many outweigh the needs of the few, or the one.  I can't even imagine.

Clinic usually finishes up between 5 and 6.  I then go back to the guest house and decompress before joining the rest of the visiting staff at dinner downstairs in the guesthouse.  After a little rest, it all starts over again.

That's my typical day at Tenwek.  It's pretty wild.   I read the parable in Mark 2:1-12 yesterday about the friends who lower their paralyzed friend from the roof to the feet of Jesus, and because of their faith, he was healed.  I have felt so inadequate here, helpless in a lot of ways.  But I was reminded that sometimes all I can do is set them at the feet of Jesus and have faith even though I cannot see amidst the brokenness and pain here, the seemingly insurmountable struggles and barriers. 

Mezungo

"Mezungo" is the Kenyan word for foreigner, but it literally means "restless people."  It came from way back when Portuguese settlers came to Kenya, and the Kenyans said they must be restless because they left their home.  The name just stuck as a label for foreigners.  Although, the original meaning still applies to us Americans who find ourselves in Kenya.  We come from a much faster pace lifestyle and jobs.  Everything here is slower and hakuna matata is not just a cute Disney song.  They seem to worry about very little. 

 

In general, it's been nice to relax into a slower pace, but in the healthcare field, sometimes urgency is necessary.  Often that urgency is absent in the Kenyan healthcare workers.  It can be frustrating and tempting to think they just don't care.  Which is not true.  Their worldview is just so different from ours.  Tenwek is known as the best hospital in Kenya, but to me it seems like how I would imagine a US hospital in the 1950s.  But in their mind, this is the best in Kenya and they are doing a great job.  They can't imagine anything greater, don't know how to aspire to anything more.  Part of this is from a life of poverty for so long, a lack of hope. 

The long term missionaries here have a daunting task.  Even in the past 2 weeks, I have felt such frustration with this at the hospital.  How do you inspire people to reach for something more, to expect and hope for more?  And not for our glory, but to provide excellent healthcare for the least of these for the glory of God and the renown of His name here in Bomet, Kenya and the surrounding regions.  By God's grace, there is progress.  It's slow, but the faithfulness of the people living here and walking alongside the African residents and doctors is truly inspiring.  It's a different type of heroism than the more dramatic stories you hear of missionaries, but heroism nonetheless; the unsung heroes trudging along with only God as their strength, comfort, joy, help, and peace.

Like so many things, there is a balance.  I find while this slower pace, lack of urgency may be frustrating me in the healthcare setting that I can also learn much from their culture.  God says "Be still and know that I am God."  One translation says "Cease striving."  Whew, that's a tough one for me.  Cease striving?  And then  also "Do not worry."  Man, I struggle with those commands. 

Please be praying for these people and the missionaries here.  That God would strengthen those serving Him and give them vision for Tenwek Hospital, and that many would come to know Jesus as their only Lord and Savior.  90% of Kenya is supposedly Christian, but their culture is largely fruitless.  From what I understand, the people tend to accept all religions.  They are really open to anything "white people" want to tell them or have to say, and generally accept it, but it seems they may add Jesus to the shelf of things they believe.  Pray for true saving faith of the Kenyans.

TIA

Hard to believe tomorrow completes my first work week at Tenwek.  It's been interesting from a physical therapy standpoint figuring out the places I can best plug in and help.  It's also been interesting seeing the differences here in medicine and in the people and culture. 


As we were rounding the first day, one of the ortho docs from the States who has been here a year asked me, "How many narcotic pain medications do you think I have prescribed in the past year?"  ZERO!  We just finished going around to these patients who have had open fractures of tibias, femurs, just a couple total hip and total knee post-op patients, and he has prescribed ZERO narcotics, just NSAIDs.  I was blown away.  "They're tough!" he said.  The past 2 days I have been working with two ladies, one with a total hip and one with a total knee.  Post op day 1, they were both out of bed walking with a walker.  They said it hurt, but they just cruised right a long.  Today, the lady with the total knee was out of her immobilizer and I was asked to start range of motion.  90 degrees of flexion after about 5 minutes of working on it with no problem.  I was shocked!  The doctors asked me about patients in the US, if they had CPM machines and the continuous ice units - I said "yes, and most of them don't do nearly as well weeks after surgery as these 2 ladies have done 2 days after surgery."  Indeed, they are tough.


There is a phrase I had heard in a movie, but apparently it's also pretty widely used by ex-patriots here in Africa.  Sometimes you just have to shrug your shoulders and say, "TIA" which stands for "This is Africa."  That's all you can say in some of these situations.  For example, there is a tribe near here that is known as the warrior tribe.  Primarily, they shepherd cattle.  They believe that their god made *all* the cattle for them, so therefore, cattle that is owned by people in nearby areas was stolen from them and they fight to get them back.  So when people from that tribe come in, it's bound to be interesting.  One man had an arrow wound to his neck...with a piece of the arrow still intact.  Don't see that walking around the hospital everyday!


There was another man I met the first day who had an amputated hand and an injury to the other hand.  Apparently, this man, Peter, was owed the equivalent of $3.50 from another man.  He went to collect his money and the other man took a machete and cut off his hand.  Insanity!  I've heard stories like this, but it never really crossed that border from storyland to reality until I was standing there looking at this man who had lost his right hand.  *TIA*


Sometimes it's funny though too.  Like when a group of us walked down to the waterfall and were stopped by a Kenyan couple who took pictures with us for 10 minutes because we were white.  Apparently they weren't from near Tenwek.  It was like we were Hollywood superstars.  *TIA*


I'll end tonight with a prayer request.  There is a dear old lady in the hospital.  She has a really bad infection in one of her legs.  The best course of treatment for her at this point is to amputate.  She has refused to have this done.  She's over 80 years old, still keeps her home and garden and is really independent until she began having leg pain and was brought to the hospital.  She will not accept that this is what is best for her and does not want to give up her leg and independence despite her family's pleading.  She told them point blank, she would rather die.  It's just a really tough situation, so please pray for wisdom, discernment for all of those involved.


Also for me.  The language barrier has been tough with patients.  And it's taken a few days to start to figure out where I fit in among the more long term folks working here and how I can best help them. It's going so well though.  Tenwek is such an amazing place and I know God is working powerfully here.

Overwhelmed

So I made it to Kenya.  It was a long journey and I have never been more thankful for a bed than after over 30 hours of travelling!  I woke up at one point on my flight and looked out the window and saw a large river in the middle of a blinding desert of sand.  Could that be?... No!  Surely that's not the Nile.  But it was.  I know I sound like such a nerd, but that was the coolest thing to see this river that I have heard about my entire life and only imagined, that has been such a huge part of history and geography - to see it!  It was cool.


And that was just a foreshadowing of what it would be like to step foot on the grounds of Tenwek Hospital - a place I have heard incredible stories about from people as well as in the book Miracle and Tenwek - to be here and be apart of that.  Sheesh.  Just blows my mind.


Anyways, so I met up with Dr. Keith Forwith and his daughter Allegra Monday morning at the guest house in Nairobi.  Dr. Forwith was on a mission trip to Nicaragua with me in 2012 and it was through him that I found out about Tenwek in the first place.  I had contacted him the week before my trip to let him know I was going and he replied that he was leaving for Tenwek the same day I was!  So awesome to know someone who has been here before. 


We then made our way to Tenwek.  We got here in the afternoon, had lunch with one of the career missionaries, Barbara - she's been here 33 years and teaches in the nursing school.  I met some of the other visiting staff and got settled in.  We had a brief tour of the hospital and then a group of us hiked down to a waterfall that is on the river below Tenwek.  It is also next to the hydroelectric power plant that supplies electricity to the hospital and was instrumental in the growth of the hospital.  While at the waterfall we had one of many "TIA" moments (where you shrug your shoulders and think "This is Africa").  A Kenyan couple was taking pictures by the waterfall as well.  They saw us coming and for 10 minutes I knew what it was like to be a Hollywood superstar - they wanted pictures with all of us and were so excited to see white people.  It was funny.


It's so beautiful here!  It's chilly at night - around 50 but usually warms up during the day and there have been occasional brief showers.  The Kenyans are all freezing - they wear puffy down jackets and beanies!  haha.


Today was my first day of clinic.  And wow, that was overwhelming.  I started with rounds with the ortho docs and some inpatient PT.  The ortho here is primarily traumatic fractures.  A lot of open fractures of the femur and tibia, which is kind of crazy!  The rest of the day was in outpatient.  It's kind of chaotic and I'm still learning how the system really works.  In the inpatient ward today, I had a chance to help a man walk who had been in a bed for 6 weeks on traction due to an acetabular fracture.  He was so excited to walk and go home soon.  He got a little dizzy but did great!


I'm learning so much, not only PT wise but about the people here - and it's only day 1.  It's interesting.  I hope to post some more reflective stuff, but for now, it's bed time!