Have I Been Your Doctor Before?

Sometimes the spheres of our lives overlap and we find ourselves totally disoriented.  A couple weeks ago my husband had a family meeting and the mother-in-law showed up.  He looked at her and she just looked so familiar to him.  "You look so familiar to me."  She smiles.  "Have you been a patient of mine before?"  "No," she says with a funny little smile, "you've never been my doctor."  "Ok," he says and goes on with the meeting.  It wasn't until a half hour later that it struck him that he was talking to our neighbor!  He comes back and ask the wife if her mothers name was ****.  She says yes.  "She's my neighbor," J says.  "I know," she laughs.  I haven't had an opportunity to talk to our neighbor about this since we normally meet at the fence and it has been so cold both of us are avoiding going outside but I can't wait to have a good laugh with her about it. 

Sometimes I don't feel like being a team player...

My husband works at a small hospital.  There are lots of doctors and nurses that staff the hospital but sort of the backbone of the hospital is my husband and the four other doctors in his group along with their two nurse practitioners.  Any patient the ER admits, they see, write orders for, and care for until they are discharged.  Any surgical patient is turned over to them after surgery.  They cover the general floor, the ICU, and my husband also does Pediatric coverage.  There is always one of them at the hospital and during the day there is also always one of their nurse practitioners.  Because the hospital is often busy they also take turns being the backup person, meaning that on days off they will usually take two half shifts to come in and help the main doctor keep things moving.  There is a lot of work to share between the five of them. 

I want to layers this over the fact that this week is spring break.  I wasn't really planning on doing anything.  I haven't been feeling amazing, and we've been moving and unpacking but J really wanted to do something to mark the days.  The problem was he was working most of spring break.  He only actually is off Thursday-Sunday of the kid's spring break.  It just didn't seem long enough to do anything.  At first we talked about taking the kids to Disneyland but J didn't want them to miss school and wanted a full seven days if we were going to make a trip like that.  Then we talked about going camping, but he wanted to go to Yellowstone.  We ultimately vetoed that idea because it is still pretty cold up there right now and could easily snow.  Finally we settled on a trip to Portland.  It is only about a 1/2 day drive from us and we figured we could at least enjoy a few nights in a suite and do some of the things they have in town there.  This trip planning though has been largely left on my shoulders since J has been exceptionally busy the last couple weeks and so I booked the hotel and planned out an itinerary alone. 

Then two days ago J calls from work to ask what our plans were.  Turns out whoever was suppose to do backup for Wednesday, Thursday, and Friday can't and they were wondering if he could pick up the half shifts.  Well first off Wednesday he's actually the one working...so basically no he can't pick up the shifts and it means he has no back up person on Wednesday and then we have our trip planned, a trip he sort of insisted we take, and the suite is already booked come Thursday-Friday.  I reminded him of that, and he was like, "Oh yeah well I can't do it then"  But someone must have been working him over because today he calls and ask if I think it would be possible for him to go in tomorrow morning and do a half shift if he starts really early because he feels bad about leaving Peter with 22 new patients.  I get that my husband is a good guy, that he is a team players, and that he is trying to do what is best for his patients and for his team.  I also know that these are the people who are there to pick up shifts if he needs them in emergencies.  I get it.  That is why I said yes.  But inside I wanted to say no because truthfully sometimes I just don't feel like being a team player. 

Post Interview Thoughts

Last night after a community tour and Dr J's interviews we went out to dinner with the department head, his wife and two other local physicians and their wives.  The restaurant was this interesting mix of Spanish and eclectic hipness.  The food was mostly steak and fish with duck thrown in for good measure.  I had steak that came out on a sizzling rock.  I'd slice off a piece and sear each side before eating.  My potatoes were heavenly and had two large prawns for garnish. The asparagus was perfect.  The tragedy of the night was I couldn't finish but because we were leaving this morning at six to fly home I had to have the restaurant throw it out.  J had duck.   For desert we shared flour less chocolate cake with beat chips and strawberries.  The company was amazing.  They were all transplants but all very happy.  They all live within ten minutes of the hospital including the department head who bought 65 acres and then moved his brother and parents out to run a tiny family farm.  Their kids have all been happy.  Dr j said one of the things that really struck him at the hospital was how happy everyone was.  Oh and they like J.  After dinner I was chatting with the department head.  Several times during dinner he'd asked about where else we were interviewing.  After dinner he made his pitch to me about how much they'd love to have us come.  Then he laid it out there with a big smile on his face, he said, "Because of the holiday things might be a little delayed but you will have an offer for sure by next week, we really hope you'll take it.". So there you go folks, I'd call that an interview success!

Sometimes When You Are Married to a Doctor - Traveling With Kids in Kenya

...you might get on your husbands phone to download vacation shots and end up with an eye full of autopsy photos.  This really happened.  I'm grateful for that human biology degree.  It helps when I'm sitting with a bunch of doctors at a table to at least have some idea of what they might be gabbing on about.  Dr. J is in his last week of working on the peds ward before we head home.  It started out pretty rough.  The mortality rates on all the wards are shockingly high but in the first week he was working on the peds ward he had eight children die.  It was more patients then he's seen die in three years of residency so far.  It is difficult as a physician to face those kinds of odds and I often think of how the Kenyan physicians see it every day of their training, how mentally strong they have to be to see that and still come back everyday.  Every month they hold a mortality conference with the peds department where they discuss the patients they've lost, go over statistics, individuals cases and try and suss out if there is anything they have the power to do to keep more patients alive.  They don't have the ability to bring in more money, more staff, more equipment, more medications but they are still trying.  Dr. J told me the statistics are staggering.  There is a 25% infant mortality rate at the mother and babies hospital.  The preemie statistics are horrendous.  When Cheetah was born I was given an over 90% chance she'd live.  In MOI referral hospital babies born at her weight have an 80% mortality rate.  Most of them die of RDS (respiratory distress syndrome).  There are no ventilators and there is no cpap so if you've ever had a child who needed that, here you probably wouldn't have that child anymore.  We wouldn't have Cheetah.  I feel fairly confident in saying that she would not have survived had she been born here.  When I first got here it drove me nuts how often people were trying to get me to put more clothes on Cheetah.  She likes being naked and getting her into coats and shoes is a battle.  I have read the studies that show that being cold does not make you ill and I want to scream it from the house tops, "People get your babies out of snowsuits, it is only 68 degrees," but when you think of the consequences of illness here, the fact that a bout of pneumonia can actual be a death sentence to a child here you start to forgive them for being uber sensitive about diseases, because they have good reason to be.

That fact has not changed since being on the wards but Dr. J really has enjoyed his time with the ped patients and with their parents and with the other physicians, nurses, and clinical officers (the Kenya equivalent to physician assistants) who have devoted their lives to serving children. It actually came at a most opportune time.  When we got here we were in the midst of trying to get everything sent in for fellowship, but the fellowship Dr. J was applying for would really limit his interactions with children.  We did a lot of soul searching, prayed a lot, spoke with a lot of the different physicians here as well as ones back home.  In the end we decided to put off that fellowship.  Instead we will be looking for jobs this year.  Dr. J has decided he'll give himself two years to decide if he made the right choice, but I'm super excited because I think he'll get to do exactly what he was hoping for and do it much sooner.  Wish us luck and keep all these little babies, children, and their families in your prayers.

My Husband Is a Great Doctor, Where after 12 years of marriage I finally see him in action - Traveling With Kids In Kenya

Today I had an amazing day.  When you consider the way my day started that might seem a little shocking.  The plan for today was to play with Celeste and her kids this morning and then attend the 4th of July picnic Sarah Ellen was putting on.  The kids were super excited as was I.  Then at breakfast Cheetah was a little bit more subdued than usual.  Josie said to me, "I think Cheetah is sick?"  "Really," I said, "I think maybe she's just a little tired."  Wishful thinking.  It wasn't two minutes later that Cheetah threw up all over me, including some that got into my mouth.  Got into my mouth people, GOT INTO MY MOUTH!  Of course we were in the dinning hall so I'm trying to figure out how to clean throw up off the chair and floor, while keeping Cheetah pointed toward a garbage basket that luckily had a garbage bag liner because sometimes it doesn't and trying to ignore my own feelings about wanting to vomit myself as I spit as quickly as I could toward the trash.  Then I grabbed the vomit towels, my daughter, and myself and ran home to throw everything in the wash, including ourselves.  It was with heavy heart that I cancelled our play date with Celeste, but what else could I do.  It appeared that the day was not going to be the fun break I was hoping for.

The only silver lining was that at noon Dr. J was going to be presenting on dehydration to the moms of the pediatric patients and suddenly I didn't have any plans.  When Nancy came to clean at ten, on a whim, I asked how busy she was today.  "Oh I'm busy."  "Oh, ok, never mind."  "What did you need?"  "Well I was just going to ask if you had any time today if you'd mind watching the kids while I ran up to the hospital to listen to Dr. J's presentation."  "Oh I'm not too busy to do that."  Well great, it was set!

So today for the first time in six weeks I was without kids as I headed up to the hospital to see Dr. J's presentation.  When I got to the Sally Tess Center all of the older kids were outside on the playground and there was my husband, seated next to the interpreter, 25 woman circled around him with small babies on their laps.  He was talking to them about the causes, signs, and prevention of dehydration.  He explained how to make ORS (oral re-hydration solution).  He actually had a pitcher where he made some to show them how easy it is to make.  He pulled out his phone and showed them a picture of Peach in the hospital last year and told them about our experience having her get sick and so dehydrated she had to be admit.  Those woman loved looking at that picture and they'd loved hearing that even a pediatrician sometimes needs to take his kids to the hospital for help.  He was funny and humble and so caring and I thought "Who is this person?"  It isn't to say that my husband can't be funny, that he can't be humble, that he can't be caring but in the 11 years we've been doing this (8 for his Md/phd, 3 completed for his residency so far) I have never had the opportunity to see him as a doctor.  I see him as the guy studying.  I see him as someone frustrated with something happening at the hospital.  I see him when he is upset about not getting along with a particular patient, or parent, or pharmacist, or physician.  These are the things he tells me about at night when the lights are turned out and he is stressed and tired.  So this other guy, this great, funny, cheerful doctor, this guy I've never had the opportunity to meet and because these are not the stories I get to hear I almost had no idea this guy existed.

After his talk the woman stayed and asked questions for another thirty minutes before the kids started filing back into the center and the mom's started heading back to take sick kids to their beds.  Then Dr. J asked me if I wanted to meet some of his work colleagues and his patients.  This was actually my second time being on the ward so I knew what to expect.  There are two sides to the peds ward.  Each side has four cubes.  Imagine one long room.  It has been split by a hall and has a room on each side, but the rooms are open to the hall because they only have a half wall.  Then there is a full wall separating them from the next room that is also open to the hall.  There are two of your rooms.  Add in the two rooms on the other side and you have Dr. J's half of the ward.  Technically he is only in charge of two cubes, but the attending and Registar of the other two are rarely there and so his intern and he spend a lot of time helping the overworked intern in charge of the other two cubes.  Each cube has eight beds in it.  They are small beds, not quite as small as a stretcher but much smaller than the beds you'd find in an American hospital.  Each bed has two patients in it and each patient has a mother (mostly) or father (or sometimes grandparent) who stays with them in that bed as well and is responsible for most of their full time care.  It is the parent who is responsible for feeding the child (either by breast if they are an infant, or for getting the food from the food trolley and feeding them if they are a child).  It is the parent who bathes the child or cleans any sheets if they pee themselves, or vomit, or soil themselves.  It is the parent who changes diapers and clothes and washes them and when the child needs to go to the bathroom it is the mother who pulls them from bed and puts them over the bucket that serves as their bedpan and then takes that bucket to be cleaned after they are finished.  These mothers sit together in these tiny little beds and they hold their tiny little children and they just break your heart with the love and devotion and all the fear and hope they have.  This is not a comfortable or easy place for them to be and yet there they are working so hard for their babies, helping the other mothers and patients around them, hoping for some miracle from the doctors, picking up the slack that has been left by only having one nurse having to cover all of Dr. J's 32 patients.

So we walked into the cubes and Dr J, started introducing me to his mom's.  "This is so and so.  Here is her beautiful daughter so and so.  She came for this but we've got her on the mend and she will be going home soon."  And while we are all smiling and shaking hands he looks over at her bed mate who has an extremely distended belly (some type of cancer probably although they've been waiting for several days for a biopsy to confirm before they can start chemo and are still waiting as far as I know).  The little one is on oxygen but her breath is very rapid.  Dr. J ask a few questions from mom which have to be translated by her bed mate.  He gets the answers.  Quickly he looks at her catheter bag and says, "I'll be right back."  He goes and gets the intern Dr. Mohammed and Sister Nancy, the nurse, and they all congregate around the girls bed.  Adjustments to the mornings treatment plan are quickly discussed.  They share it with mom and then Nurse Nancy runs off to get some fluids and medications that yesterday the pharmacy didn't have, but this morning they just got a new shipment.  Mom starts to cry a little and I give her a little squeeze.  "They are going to work their hardest to help your beautiful little one," I say, knowing she probably doesn't understand me at all but I just want to wrap her up in an envelope of love.  After Dr. J sees that the new plan is being followed and puts in a few more request for a couple more patients we head off to lunch.

I think about that little girl the whole way to Sizlers, a local joint in town that serves American style hamburgers, hot dogs, and ice cream.  I think about the other extended belly kids sitting in the cube.  This is a public referral hospital so anything from the outlining community that can't be taken care of by local health care workers gets sent here.  As far as I know there are only two public hospitals in the whole country like this, one in Nairobi and this one, both are situated by the only two med schools in Kenya.  It is one of the few places in the country citizens working in the public system have access to chemotherapy or dialysis or any other number of things.  Because of this many of the kids that come to this hospital are very sick.  When you throw in the fact that few are getting very basic well child care checkups many of them are coming when their diseases have already progressed astoundingly far.  I understand the economics that contribute to this situation.  I mentally go through the system failures we are witnessing, I think about the countless Kenyan medical professionals here that continue to come to work each day even when they are faced with astronomical odds, I think of the institutions, the money, the man hours that have been donated, the people that are here working each day trying to make a difference.  I see the big picture with all it's complexities and there is a certain part of my mind that understands it, but that doesn't mean that I have to like it.  I just want to scoop all those children up into my arms and rush them to Riley.  I want to make the proclamation that no child should ever die of dehydration, that no child should ever die of pneumonia, that no child should die of diseases preventable by immunization, that all heart defects that are easily treatable as an infant should be fixed, that survival rates for cancers should be the same as in the US, that no child should die because their family can't afford the catheter for dialysis or that no doctor should ever have to walk away from their hospital pharmacy without the life saving drugs their patients need because of shortages or cost.  I want to make these proclamations but have no power, ability, resources to do so.

After lunch we stop by the store to grab some apple juice and crackers to give to our own little one trying to avoid dehydration .  We pick up a watermelon on the side of the road to take to the Forth of July picnic.  We figure one person will go with the three well kids and one will stay with the sicko.  We get some cash out of the ATM machine since we are down to our last 500 shillings.  I can't believe how fast our money goes here.  Dr. J tells me he just wants to do a quick walk through of the ward.  As we approach the ward Dr. Mohammed joins us returning from lunch.  When we get to the cubes Dr. Hussein eagerly greets them.  "I want you guys to come with me to go and see...." I take the bags from Dr. J and tell him I'll just meet him at home as the three of them walk off shoulder to shoulder.  He is late getting home tonight for the picnic but I don't really mind.  I've been given a rare glimpse into his world, one that because of HIPPA, culture norms, desires for privacy, safely, and hygiene I'd never have been able to witness at home.  I've seen him teach his interns with passion, complement his very overworked nurse while guaranteeing that she understands the severity of the request he has just given her, I've seen him talk with love and compassion to his patients and their parents.  For the first time in 11 years I've been able to witness what all of this was about, what all of this was for.  He may not be the best at replying to e-mails or sticking to academic imposed deadlines, he may not always get along with everyone, and he may still have a lot to learn, but today I got to witness that my husband is a really great doctor and that almost makes all the schooling, and hassle, and nights alone worth it.

Equator Crossing, More Conversations With Josie, Trying To Find My Place - Traveling with Kids in Kenya

You know Josie is sort of my saving grace here right.  I feel bad complaining.  I just read this book today about the guys that founded this program...wow their wives did some amazing things with them.  Joe and his wife went to Afghanistan after he finished residency.  He turned down a cardiology fellowship at Duke to join the Peace Core and try and start a medical school in Afghanistan. The Peace Core gave him $75 a month and a bicycle for his trouble.  They had zero supplies and zero teaching materials.  Apparently he'd put together lectures and then had them transcribed out into Pashto so the students had materials to study.  The hospital had no supplies at all.  People just basically came there to die.  I read in the book their house was always covered in dust and he told me that there were no stores to buy anything at.  They'd purchase food from farmers (when there were crops to be purchased) and even their furniture they had to make themselves.  He said they built a bed out of 2x4's and then had a man come and fill a big huge cotton sack with cotton as their mattress.  Bob, Dr. J's adviser, after his chief residency year where he worked something like 330 consecutive days, including the day his wife gave birth took his family of four to Haiti for a year.  She lived in a little hut with no windows, electricity, or running water.  I read that at night they would put the kids to bed and then play scrabble.  After that they'd turn off their kerosene light and hop into bed as fast as they could, trying to get under their nets before the bats would fly in the window.

My complaint..I'm bored.  Doesn't that make me seem incredibly shallow and pampered?  I had assumed most of my days would be spent trying to get food together and take care of the house.  Turns out I live in a compound where food, shelter, water, and house cleaning is provided.  It is nice in some ways, but in others it sort of feels like a cushy prison.  My children are getting stir crazy and I am along with them.  It seems like anytime they find something they enjoy I have to take it away from them.  One of their favorite things is playing in the canal/gutter that line our street.  I'll admit it makes me a little nervous when they walk the edge, especially since they get deeper as they go down the road but they love to slide into them and climb out of them and walk down them.  The problem is the other parents don't think this an appropriate way for our children to spend time so if they see my kids in the canal it really stresses them out.  I feel for them, especially since they have to live here for always and they are worried their younger children are going to fall in the gutter when they are not around and I'm just this weird interloper but I also feel for me, because my kids are going nuts.  The other thing they found particularly fun was hanging on the gate as Michael opened it and closed it for incoming cars.  It seriously probably wasn't the safest but people we are living in a prison of pampering.  Some of the residents here though got upset with Michael about it, as if it is his fault I let my kids do unsafe things so now I won't let them do that either.  It just doesn't seem right that he should get into trouble for my kids.  So instead we just walk the compound over and over and over. 

And I'm sure this makes me incredibly boring which is such a bummer.  Since Jill, Kristin, and Corrine left our table has been absent any extra interlopers so I eat most meals alone with just the kids.  It is sort of a bummer deal and yet I really can't blame people.  I mean first off the kids are crazy, Cheetah is always trying to run away, Peach always has her shoes off, Gigi won't eat with a fork and what do I have to contribute.  "I walked this compound twenty times today.  We pulled Guava off a tree.  I fought with the kids about how many movies they could watch.  I listened to a guard and a student from west Africa have a heated argument over the merits of polygamy.  (The guard, who is studying business, was for it.  He said it helped men deal with their biological imperative in a legal and safe way.  The West African who is a medical student in France and is just here for the summer to improve his English so that he can more easily work on a research project he is doing was against it.  He felt like it was degrading to woman and that men should be expected to behave better) "  I seriously have nothing to share.  There is a this super annoying girl here, I mean she just drives me nuts.  In fairness to her I probably am weighing too heavily  a rude comment she made the first time I met her, but even trying to ignore that, she just is a little bit of a pain and yet that girl is in much higher demand than I am when it comes to dinner/traveling companions.  It is enough to weigh a girl's heart down.  

My one shinning bit of life since the girls all left (Jill, Kristin, Corrine) is Josie and for the most part on the weekdays she keeps me pretty entertained telling me about Kenya, her family, customs, the novellas she watching, asking about the states...whatever.  So here is an interesting little side note on the dowry.  Remember when I said that dowry keeps a girl's worth, well it does for the family she is born into, but once the dowry is passed you essentially no longer belong to your family and none of that wealth or price should go to you.  Josie told me that it is even taboo to eat anything that was given as part of your dowry, to take anything that was part of your dowry, or to use anything that was bought with money from your dowry.  Once you are married you are expected to give up your family and to now belong to your husband's family forever.  I was talking to her about how someday maybe we'd have a little mother-in-law suite for my mom or mother-in-law to live in and she told me how much she wished that she could live with her mother again, but that it isn't possible.  "Isn't possible," I said, "anything is possible."  "No," she said, "not in Kenya."  I sort of had already known this.  Jill had told me earlier that a friend of hers who had married more than one wife whose 1st wife wasn't very happy about it had moved back with her parents.  Her parents let her come home but they were exceptionally liberal in doing this.  They were educated city people.  Back in the village this would almost never be allowed to happen because if you did allow your girl to come home the whole village would shun her and the rest of your family.  So this sort of leads to some impossible situations for woman once they are married.  They are given no wealth from their dowry and they can't go home so if things aren't great with the husband, if he wants to marry a second wife, if he is cheating, if he abandons the family, if he gets an STD, if he beats her, whatever the case, if you leave him or he leaves you very few woman are going to have any wealth or property and will not have anywhere to go.  I'm not saying that all marriage are unhappy or all woman need an exit strategy or anything like that, I'm just saying if your marriage is unhappy there really isn't an exit strategy.  So that is sort of a depressing side of Kenya.

People what am I going to do with my life?  Dr. J keeps asking me this question about our family, "What are we going to do with our lives?".  He is suppose to be finishing up his fellowship application if he wants to do fellowship and he just can't decide what to do.  Joe tells him he should just stick with primary  care.  His heart tells him he really wants to go closer to home.  His wife gives him a blank look and says, "What is it that you want to do?  I'm sure whatever it is you can make it work."  But the truth is his wife doesn't know what she wants to do with her life either.  There is so much need here and all over the world that I just can't be happy sitting here in the house trying to figure out how to rig it so that I can cheat and get Pandora and Netflix.  I said to Dr. J, I really think it is time for me to go back to school.  I need to get a degree in nursing, or be a radiology tech, or nutrition or something because just being this useless lump isn't helping anyone.  

A few weeks ago one of our friends here was asking me for advice one how to help his kids deal with his impending divorce.  I shared the very few bits of wisdom I had and then listened as he sort of described the situation they currently found themselves in and as I listened a cold chill settled on my spin.  I think Mo told me that in their married life they had lived in 28 countries.  They'd done all kinds of amazing things, helped all kinds of people, won all types of awards and recognition but in all that time his wife had made their children her primary focus, and here is the truth people, someone has too.  I mean really, you don't do that kind of amazing time consuming stuff and have well adjusted kids by accident, someone really had to put the time in.  That someone was his wife.   But now the kids were starting to leave home, and maybe he wasn't as attentive as he should be, but she just felt like her life was empty because none of the achievements of their family were things she could truly own.  It is a balance people and I don't have any really great answers but I do know that when you spend your time surrounded by all these amazing and interesting people spending your days walking ten times around a compound just can't do it for you, it is not enough because you just feel like you are not enough, and there are so many needs.  You just feel like you need to do something.  So what should I do with my life? 

And on that sort of negative note please enjoy my family picture at the equator.  It took us about 1 hour to get there.  I'm fairly sure that this was the first time in my life I'd ever been in the southern hemisphere, weird but true fact about me.  How much cooler are my kids than me, they aren't even in double digits yet and they've already been on both sides.  There was a cute little nick knack store right here on the crossing but they had no one manning it so all we have to mark the occasion is this picture.  Here are my observations of being on the equator.  It is not nearly as hot as I thought it would be, but what do you expect when you are living at 9000 feet.  Weirdly enough even though we are just slightly to the north of the equator we are in our "winter" right now.  It seems to be driven more by when the rains come.  They are pushed by cool air, hence why our sweaters and long sleeves have actually been getting worn.  Even though the temperature is fairly mild the sun is pretty darn strong right here.  It doesn't take a whole lot to get burned.  One of the new guys was teasing another new guy about his safari hat.  We were like, "Nope he's the smart one, try and sunscreen those ears up so you don't get burned."  

Sad Update - Traveling With Kids in Kenya

The baby died two nights ago.  Last night another patient who I'd be hearing about for weeks also died.  He had super complex problems, even in the US it could have happened but it means that in the last two days since Dr. J started working on peds he has had five patients die.  Five patients!  Each one I shed a tear for.  I can't help it.  I don't know if it is the pill or just the fact that I'm an emotional being but I just feel like each child deserves their own moment of sadness.  Dr. J told me he allows himself to feel sad while he is standing there with the parents but then he has to put it behind him for the day because there are so many patients on the wards and so few doctors and nurses and he needs to focus on the patients he still has living.  Right now he has a great intern and that guy is a gift to work with.  He has a great nurse as well but she is currently covering 32 patients...some of whom at home would be sick enough to be in the PICU where the ratio at most would be 3 patients to 1 nurse, at most!  His registrar, his Kenyan resident counterpart is ok.  Personality wise he is fine but he's been cutting out every day at noon.  It drives J crazy.  When Dr. J told him they'd lost three patients over the night he said, "What can we do, they were sick enough they should have been in the ICU."  (I mentioned before there are only six beds in the ICU, all of which are filled).  It is as if he's washed his hands of the responsibility.  It is sort of a common problem here but it is difficult to know what drives it.  A lot of the Attendings (Dr. J's Attending is not actually not one of these...he rounds in the morning, goes to clinic, but then he actually comes back after clinic to make sure things have happened while he was gone, so that is actually really great) only do morning rounds a few times a week and spend the rest of their time in the clinic so it is definitely something modeled from up top, but I'm just looking at this system from the very outside, (not even working in it from the outside like Dr. J is) so I have no idea if it is money thing (I've heard they only make money working with their private patients), just a what you do thing (sort of grandfathered into the system), or just a frustration thing (because honestly I think it would take a special kind of person to have patients dying at these rates because of lack of beds, nurses, resources, ICU slots and stay positive and invested over the long term).  I don't know.  I keep praying every night for the patients in the ward.  I keep praying for the doctors and nurses. I keep praying for doctor J.  I even keep praying for the relationship between Dr. J and the Registar.  Yesterday Dr. J told me he's going to invite him out for lunch.  It can't hurt to make friends and maybe he can get him to stay a little longer each day to help if they are buddies.

Sort of on a weird side note, tomorrow we are on lock down in the compound.  There is a political rally scheduled by the opposition party in town so they've asked all the IU house people to stay at the compound at least for Friday then depending on how things go maybe for the weekend. A bunch of people are bummed out because it means they might have to cancel their weekend plans and for the pharmacy students who had to cancel last week because the lake they were going to had had some tribal violence at it, it is a double blow.  We'd already intended to stay close to town this week because we spent a ton of money on safari last weekend but we were hoping to do some things in town so fingers crossed the rally stays peaceful and we are off lock down Saturday.  Dr. J will probably be late tonight trying to get all his patients set for the possible long weekend.  Maybe if things are good  he can check on them sometime after Friday since I'm pretty sure he was going to be getting a new Intern this week as well.  Seriously Kristin I wish I would have given you more than that one weird awkward hug when you left.  How were you doing this everyday?  I don't know what we are going to do if we get locked in the compound for the whole weekend.  We have a bunch of dental students here with us, pretty sure I've mentioned them before.  Last night they had a wild late night drinking party, but I think if another one of those breaks out Adrian might clear the kitchen with a broom.  Our window faces the back of the compound and we heard dogs all night but Adrian's faces the dining hall and he thought the party was from a bar up the street.  Now that he knows it was here I'm sure he won't stay silent.  Our weekend saving grace, yesterday we had Indian catered in from this super yummy place Jill took us to before she left and the pharmacy students told us they've been ordering take out from them on all their weekends stuck here and that there is no delivery charge.  So there you go.  Indian for the SAVE!

Not Every Day Is Going to be Happy but Yesterday Was Pretty Bad - Traveling With Kids in Kenya

Left To Right Our Family, Zach (med student here for the summer),
Jill, Kristin, Corrine

Yesterday evening Gigi said, "I wish we could go home.  All of our friends are leaving and it is getting really lonely without them."  The thing is she is sort of right.  The beginning of our trip coincided with the second half of Kristin, another Med/Ped resident's, trip, the one month Corinne, a surgery resident, was here, and the one month that Jill, a pediatrician who works with the program was here doing cross cover.  These ladies are just so nice and amazing.  We've done quite a few trips and dinners with them and I can attest that we probably wouldn't have made it through most of our hikes if it weren't for them and all their help.  Throw Mo in the group who we will lucky have for another month and you just have a group of amazing, fun, helpful people to hang out with.  In a short time I just felt exceptionally close to these people and I was really sad to see them go.  On Sunday we dropped Kristin off in Nakuru before heading home.  On Monday Corinne left at like in five in the morning.  Jill could see I was pretty sad about the whole thing.  It didn't help that Captain E threw a huge temper tantrum in which he spent a good part of the morning berating me.  It is one thing for your kid to keep yelling he "hates you".  It is something else for him to do it in ear reach of other people, hello awkward!  That kid just does not deal with disappointment or correction well at all.  At school when we had all his evaluations done they put him on the Aspergers spectrum.  Dr. J did not agree but since then we've had several serious talks where we have discussed how this very well may be a possibility, but that is a story for another day.

The story for today is that I was just on the verge of tears all day Monday and Tuesday.  Monday Jill was still here and when she got back from lunch she came and gave me a hug, at which the tears of course spilled over.  So she went and talked to Dr. J and before you knew it he was watching our overly grouchy kids and I was walking up to the hospital with her to check out the Sally Test Center.  The Sally Test Center is totally amazing and I plan to write a post entirely just about that, but I also got to tour the pediatrics ward with Sarah Ellen, chat with the pharmacy students in the medicine ward, and go with Jill to see Mo in the CCU.  It was a nice break and it was amazing to see what has been built out here and also where there is still room for growth.  When we got home Dr. J headed back to the hospital and Jill and I had a great talk and then we headed over for dinner.

Dr. J wasn't able to meet us.  Switching to peds is a little bit more time consuming and also this week has been a little bit of a heart breaker.  When Dr. J finally showed up very late to dinner Jill told him she was glad he was replacing her so that hopefully this little girl they'd been trying to get over to hospice would actually make it.  (Jill needs to get home to her practice and her hubby but I think she was having a hard time leaving patients on the ward that she hasn't been able to resolve a place or a  plan for yet).

Yesterday after a nice lunch Jill or Silly Jillie as Peach likes to call her out of love, headed off for the airport.  We were definitely sad to see her go although after Dr. J got home from the wards late again last night and told me what had happened I was so glad she left Tuesday and not Wednesday because Tuesday on the peds ward was not a good day to be there and I don't know how Jill would have pulled herself away after the day Dr. J had yesterday.

Tuesday on the Peds wards was a day of sadness.  Dr. J said before he even got to work a baby had died on the ward.  Then while he was there they had another baby die.  He said the nurse came and got him to check on two very sick babies.  He ran over and one had already stopped breathing and the heart had stopped.  He had no idea how long the baby had been down.  He started CPR but even as he was doing the compressions in his mind he kept thinking, "We only have 6 beds with vents, they are all full, I don't even know if we have a vent to fit this little tiny babe, I don't even know how long the baby had been down."  In the end the baby could not be resuscitated and all he could do was tell the family he was sorry and stay with them while they mourned for a bit before the morgue attendants came to take the baby.  There is no privacy in the ward.  This family had to morn surrounded by others.  Dr. J said some tried to help comfort them but in general people just tried to give them the little privacy they could in a room where there are eight beds, two patients per bed along with the two moms who are the primary care giver and food source of the child while in the hospital, and a variety of other family members and friends standing around.  Then Dr. J had to head over to the other baby.  This one had come in that day with a bladder infection that had turned into sepsis.  They are pushing fluids and antibiotics and we prayed for that baby multiple times last night but Dr. J said when he left the hospital he just didn't know if the baby was going to make it through the night.  What a sad beginning to the week.  I really hope that we can have an uphill climb from here.  I pray that when Dr. J gets to work this morning that baby will still be with us, that the antibiotics can work, that the baby can have full recovery and will be able to go home soon.  I pray for the two families who lost their babies yesterday that they can have peace and comfort and that they can be reunited with their lost babies someday.  I pray for the doctors at the hospital, that they can work hard, that they can have their best wits about them, that they can do the best for each of their patients, and that they can continue to have heart even when they face some pretty hard odds.  Finally I pray for the beautiful little patients and their families at the hospital that they can get the best care possible here and receive both comfort of their bodies as well as comfort of their souls.

Umbrella Falls - Traveling With Kids in Kenya

Distance/Time from Eldoret to the Umbrella Falls - 35 minutes, it isn't so much a distance thing as it is a mostly on rough dirt roads thing.  Cost-5000 shillings for a seven passenger jeep and Taxi Max the guy who gave us the tour of the power plant and showed us where to hike.  We split this cost with the other adults in the car.  Cost to us, 2000 shillings.  

A few weekends ago Kristin asked us if we wanted to go to Umbrella Falls with her and group of other people.  She said something to the effect of, "We're going to a power plant on a waterfall but it is suppose to be really cool.  Do you want to come?"  The answer to this after five days of our mind numbing schedule is "OF COURSE".  Seriously guys I don't know what I'm going to do with myself when Kristin leaves next week.  She is sort of like the trip planner of the group.  We are going one one last weekend hurrah with her and she true to form has done a great job of making sure everything was getting planned.  Without her I fear we will just shrivel up into boredom.  We will surly miss her trip planning skills and her company although we forgive her for heading home since she's been here without her husband almost two months at this point.  

Kristin had Max meet us at IU house at around ten o'clock.  Of course at ten most of the doctors were still at the hospital rounding so we waited around another hour before everyone was there and dressed is hiking appropriate clothing.  It wasn't such a bad wait though.  Taxi Max is highly entertaining.  He is the cab company owner we call most often when we need to get around town and while blessed with a shrewd business mind he is playful and full of stories.  When everyone had arrived we all piled into the jeep.  It was not the first time I marveled at how this is the perfect time to be here with the kids (at least as far as fitting into taxis is concerned.  In a few more years we probably wouldn't be able to fit on one bench but right now the kids are small enough that we fit just fine.

The road out to the falls was pretty wild.  In town you get lots of paved roads but out in the country you are dealing with primarily dirt roads.  Max says they grate them down occasionally but there is lots of rain here and they get a lot of traffic from cars, jeeps, motorcycles, bikes, and foot as well as a whole host of animals that use them as through-ways.  Max says the joke is that Kenyan politicians don't ever have to worry about the roads because they just keep getting bigger and bigger cars.  Anyway we eventually made it.

Immediately my kids were drawn to the animals who call the area home and the water.  The adults didn't really want them near the water the animals really didn't want them anywhere near them.  At one point Cheetah was chasing a cow that wanted nothing to do with her and there was also a point we were a little worried a ewe was going to go after her when she got a little too close to her very new look baby for comfort.  Never fear mama sheep, we weren't going to let her get too close.   

This is just an outhouse which I guess I felt the need to document because it had nice purple doors.  

You can just barely see the falls here.

There was a beautiful little valley and on the other side there were some amazing looking more traditional houses.  Seriously those people have a great view from their front door!

Let's go down the hill to the power plant.

These doors hold the generators that for years powered all of Eldoret.  Now Eldoret has it's own power plants but one of these generators is still working to provide power for the people living in the area.  

We had to wait outside for a bit while Max ran back up the hill to get one of the workers to open the power plant up for us.  

The girls entertained themselves looking at flowers...

I just love streams.

In the plant.  There are two huge generators, one of which is still functioning.  These were brought in her using just man and animal power.  In the last few years one broke and they had to get the motor out.  Max said that even with modern machinery it was nearly impossible the thing weighed so much.  It took a crane and then even then they had to roll it up the hill.  

The girls got bored so I took them outside.

This was the first little point where Max took us out to get a view of the valley below.  I was seriously so freaked out by this ledge I refused to go out onto it.  Meanwhile everyone else had to stand out there with my kids and tell them to stop standing so close to ledge.  All the pictures of the valley that follow were taken by Captain E because mom hates heights and is a huge baby about it.  

Then Max had us hike down about halfway so we could get a better view of the water fall.  I was totally freaked out about the whole thing.  I thought I was going to puke and more than one time Kristin told me I didn't have to go through with it, but I was a little embarrassed about refusing to go out on the ledge so I kept following.  Something about when my foot is inclined, my mind just stops working. I for the life of me can't figure out how I'm going to get back up, and then when I do I'm like, "Ok duh, it isn't like you are just going to fall down this huge rock, you can use your hands or press your body kind of forward," but I'm such a baby and when I'm going down I just can never see how I'm going to return.  

This water fall was pretty darn amazing.  There was quite a bit of water coming down it and you could see why it would be a great place to generate energy.  I think in these pictures it is really hard to get a good idea of how tall the falls are but later when Dr. J goes behind them with 3/4 of our kids you can see they are over ten of him tall.

At this point Max took our group behind the falls.  This was too much for scaredy cat me so I volunteered to stay behind with Peach and Cheetah and take pictures of everyone behind the falls.  Of course at this point Cheetah became a total wreck and I was worried about how I was going to keep her safe on the edge of this cliff.  Dr. J to the rescue.  He tied Cheetah on his back and off they went.  At this point I was a little anxious about them hiking where it was wet and step but Dr. J is a mountain goat and figured the kids were probably safer with him then they were with me.   

Somehow Max got them all safely behind the falls and then back to me again.  Gigi and Captain E had a great time back there and were super excited to tell me about how cool the water fall was.  Cheetah got a little angry when they stop moving to take pictures but settled down pretty good after they got back and she was allowed out of the carrier.  Dr. J said it was neat but that it was a little slippery in places.  Our friend Mo told us later that people have actually slipped at these falls before and been seriously injured or died.  This is information I'm glad I didn't have at the time although I remember thinking while I was watching them take pictures that if one of them slipped and went down that they would really struggle to get out from under that pounding water.  Scary!  Peach and I had fun playing tic-tac-toe in the dirt.  This girl is just so easy going and friendly.  I really enjoy being her mother.  That being said, a little Peach story for you, today she was in a grouchy mood and at one point said to me, "I'm not going to be your sweet little baby anymore, I'm going to be a grouchy big girl."  Well alright then.  

Open Vegetable Market - Traveling With Kids in Kenya

Today we went to the open vegetable market.  It also happens to be the market that sells all the used stuff we discard.  No seriously, they box it up, the stuff that won't sell at places like Goodwill and ship it overseas where it is bought by someone middleman.  Then he distributes the stuff out.  One guy sells kids shoes, one guy does adults, one guy just had a bunch of polo fleece Columbia jackets.  I'm not really sure on the environmental impacts of this.  On the one hand there is the whole shipping of items and the fact that it seems to keep production of stuff here down...on the other hand it is reusing stuff and it does lead to a huge market.  I guess I need an economist to tell me if it is good or bad.  But today we walked down to this market.  It meant we walked almost the entire length of the downtown commercial area.  Dr. J told the kids he was looking for the kid who wanted to win the non complainer award.  They did amazing.  No one asked to be carried (although we carried Cheetah almost the whole time because she was just everywhere), no one cried, no one asked for a taxi, or said they were to tired.  Mom on the other hand was exhausted.  By the time we got to the market we'd be sucking in pretty serious exhaust fumes for probably twenty minutes.  There is one main road that goes through Eldoret and that road is the road that leads from Niarobi and Mombasa to the interior of the continent.  So anything dropped off at Mombasa is probably coming through our town on huge black smoke spewing trucks, driving on this two lane main road.  I seriously thought I was going to pass out.  But then we were in the market and sort of away from the road and it was better.  The vegetable market reminded me of other markets I've seen before.  Two things of note, it smells a lot nicer than the one in Amman, Jordan but it looks a lot worse.  The road isn't paved at all and we are in Monsoon season here so it was muck, muck city.  I saw some rain boots at one of the used shoes booths and seriously considered taking a look but the crowd was oppressive.  Almost as soon as we walked into the market people started pressing us on all sides and the call went out repeatedly, "Mzungu, Mzungu" which basically just means white people.  Can I tell you how weird it is for me to be called white person.  Seriously I wish I could take the town to Phoenix to give them a glimpse of how white people there think I am...oh well.  "Mother come and look at my wares", "Mother, are those all your children", "Mother, give me one of your babies."  This was the part we did not like the most.  There was this constant barrage of arms trying to take Cheetah out of our hands.  Most of it was done playful and with a smile but not all of it felt friendly and it was just so much touching that Cheetah froze up and pushed her head into our shoulder trying to keep her face away from prying arms and hands. Peach also got picked up a few times but she was able to laugh it off although when one guy held her a little too long she started to kick her legs until he put her down.  For her trouble he gave her handful of fish.  They looked sort of like sardines that had be left out to dry and were now sort of in a jerky state.  Peach had zero interest in eating one but she did really want to carrying one around as a pet and she did for pretty much the rest of the day until at lunch she put it down and Dr. J "accidentally" swept it up with the trash.  We did score some nice deals though.  For our trouble we got five large mango and probably ten oranges for 200 shillings, about two and half dollars.  Not bad when you consider we pay about 50 cents an orange in the regular store.  So it was sort of a toss up for us.  We loved the deals of the market and we liked being in the city with everyone, but we were a little uncomfortable with the scene our children caused.  I think if we return we will probably do so without the kids or return on a weekday when it is less crowded.  

Sorry there are no pictures of the market.  I'm sort of in a moral dilemma with pictures right now.  I love documenting our trip and loving getting shots of the kids but I also don't want people to feel like I think their lives are like some show for my entertainment so I'm never quite sure when is a good time and when isn't a good time to take a photo.  It is probably for the best though that I didn't have my camera out because seriously with the crush of people it took both me and Dr. J's four hands to keep all the kids together.   

It is entirely possible I'm a bad parent and some people watching - Traveling with Kids In Kenya

The man who started this program Joe is still living out here.  His house is right across the street from the little block I live on and he has offered my kids and anyone living out here free reign of his yard.  I see him almost everyday at lunch or dinner and he always has a kind word for me.  Today he told Claire, "This lady, this lady here, she is just super, a real supermom."  "Claire, I think what he means to say is I'm super good at being super bad at this parenting thing," I told her later.  "I'm seriously concerned that for years after we leave people are going to be telling stories about that crazy couple with the crazy four kids and that baby who was already running away with no shoes on."  "Yes," she said laughing, "that may happen."  Today I caused quite a stir because it while I originally had Cheetah in pants and a long sleeve shirt (we are in the Monsoon season here and while climate change has kept the rains at bay we are maybe averaging 70-75 degrees daily) she insisted on changing into a sun dress after lunch and was walking around shoe less.  The Kenyans did not approve.  This is a culture where the more clothes on a baby the better.  Josie my nanny friend from next door even said to me, "You need to get some socks on that girl and a sweatshirt or she is going to get a cold."  There is a part of me that laughs at their over bundling and sort of dismisses it as a more traditional belief but there is no part of me that can deny that whatever Kenyans are doing they are making some amazing children.

Talk about some serious feelings of parental inadequacy going on right now.  The last two Sunday's I have been blown away by the Kenyan children in primary with us.  In the states my kids are already not the behaved but here oh my goodness, you could take the best kid in almost any Sunday School class and they would not compare to the group as a whole here.  I taught primary for almost 5 years and let me tell you, every Sunday was a little game.  I came prepared with games, fun, props, treats.  Shoot I still bring treats to my 12-13 year old Sunday School kids.  Here though the lessons are presented in a very straight forward manner, think English boarding school 1950.  The teacher stands at the board with the chalk in hand, reads points from the manual and writes them on the board, and all the kids hurry to write down the point that she's written in seriously some of the most beautiful handwriting I've ever seen.  Then she will ask a question to reiterate the point.  Every hand in the room goes up, a student is called on, answers, the teacher thanks them for their contribution, ask if anyone else has any questions or anything to add, and then moves on to the next point, repeat the whole cycle again.  I was talking to Jill about it, how they do this.  She says they aren't into corporal punishment here but even at a small age parents will set up expectations for kids and give them a look and stern voice if they do not meet them.  I saw exactly what she meant when a few of the kids didn't have their pen for talking notes.  "Children," the primary president said, "Notebooks without pens, this is very ridiculous.  Next week you will all have your notebooks and pens, right?" "Right" all the students responded, and I have no doubt very few of them will forget.  Meanwhile I was recently thinking about adding notebooks to my 12-13 year old class but thought, "Ah, then I'll have to haul them back and forth every week because I just can't expect them to remember them."  Well maybe I can and maybe I should.

Last weekend we joined a cardiologist and his family at the one 5 star hotel in town for brunch and swimming.  He'd heard we had four kids, he has four kids, so he came over a few days ago to check us out, then called around the next day to get Dr. J's phone number, and invited us to hang out.  They are a seriously great couple and are doing what Dr. J and I hope to do someday with our lives, working half the year in the states and then half the year out of the country.  The guys seemed to really enjoying talking medicine, the kids had fun playing in the pool and jumping in the bounce house, and Celeste and I had a great talk while watching the kids at the pool.  We had a good laugh about the different parenting styles on display.  The Kenyan parents were very close at hand, gently redirecting their kids away from anything they thought might be dangerous, messy, or disruptive.  We the American parents were also sitting pool side, but we were a further distance from our kids and tried to only intervene when absolutely necessary, like Cheetah's million attempts to leave the baby pool for the super deep, super slippery adult pool.  Then their were the European parents.  They were sitting very far away under an umbrella table and even when their son who had to be somewhere around Cheetah's age came to play in the baby pool they didn't really ever seem to look over our way until they were ready to go.  It was just interesting to see how different each culture dealt with the same situation. I wish that I could take all the best part of each culture and somehow meld them into the best parenting experience for my kids.  WHY CAN'T I BE AMAZING LIKE THAT!  WHY CAN'T I!!!!

Anyway just in case anyone cares I did eventually get Cheetah out of that sundress and into a pair of long sleeved pajamas.  She has been falling asleep every night mid dinner and Dr. J and I finally decided it would just make our lives easier to take her over in pj's so we could just slip her into bed when we get home.  Our dinners have got a lot more busy.  When we first got here there were probably only ten other visiting physicians or so at the compound rounding out the more permanent staff.  Today ten dental students showed up with a couple of dental professors.  So far we've had a pretty tight knit group here and it was hard for me not to want to automatically see them as intruders but while trying to stay positive I did notice a few first day differences that we will have to see if the next few weeks change my mind about.

First off dental students are so young, I mean really, really young.  Most of the residents here are in their last year of residency, so they have at least three or four, or more years on the oldest dental student.  Shoot even most of the medical students here are older.  It seems like there is a certain type of person attracted to this type of work, and it is the type that maybe teaches for a few years, spends some time out of the country, moves through a couple of jobs and then finds their true passion in medicine. These dental babies almost seem to be on some great two week adventure, while everyone else seems to be in the mist of a life mission.  These are obviously generalizations based on very few interactions and I do have to say that the dental group leader is quite an interesting person.  She came up to me earlier in the day and told me about raising four kids in Tanzania, so there is definite passion there about serving in undeserved areas but from the students I haven't quite felt it yet, and being around the people here can be really intense.  Did I tell you about the high school senior who was here after writing a grant and fundraising to get money to work with street kids.  Like I said, life missions.  Finally I just found they way they sat at meals to be really interesting.  On the dental side you had all the students at one table and all the faculty and their spouses at another.  It is the opposite on the med side.  When the doctors come into dinner they all bunch together, often finding a spot closest to the most senior physician and mixing specialties. It doesn't take long for them to start bringing up patients.  "Today on the ward I saw this?  Have you ever seen this?  What do you think of this treatment?  I used this as an alternative?  What do you think of that?"  It is one of the great things I've observed here, even in their spare time they are always collaborating, always bouncing ideas off each other, always trying to see if there is something they missed, something they can do better, something else they should try.  I love being able to witness the melding of hearts and minds.  I just wish I could contribute in some way.