Yesterday (Tuesday) we had 6 Kenyan interns from the peds team and our friends Myeshia, Sarah, and Jenna over for dinner. I was pretty anxious about what to make and how to fit everyone. After much deliberation I decided to make pizza, pasta, sukuma wiki, pineapple, and brownies for dessert.

Our oven is small and can only fit one pizza at a time so I half-baked the crusts so it wouldn't take as long to cook, and pizzas would all be fairly warm by dinner time. I had everything prepped, all I had to do was turn on the oven and stove at 620 to warm eveything up and start the pizzas. Andy left to bring our guests to our house and I went to start warming/cooking the food. To my horror :) there was NO GAS. I panicked for a second then began calling every missionaries house I knew...No one was home. I ran outside and found Chuck who offered to let us borrow their small propane tank from their grill. After a short intermission we were back on track.

We had such a great time talking with the intern and learning about their families and how they came to Tenwek. It was interesting to hear their thoughts about their experiences at Tenwek. Andy has worked closely with all of them in the peds ward and will miss them.

24 hours later, and still have no gas! I called industrial in the morning and they said they had no gas, so they had to go to Bomet to get it. They took our tank, but they never did come back:) maybe tomorrow! Hopefully, we will need to cook soon, our leftovers won't last that much longer!

On a side note, it is funny the new words Arathena has learned while being here: Hand sanitizer and NICU

On Friday the Sawatsky's left for the states. We already miss them dearly, especially Arathena who asks for and sings songs about Eli, Christon, and Adam frequently. Since we were borrowing their computer we will be updating and checking our email less frequently. We will be back in Pittsburgh Saturday night just in time for the Pittsburgh Marathon on Sunday morning.

Friday Arathena and I had the opportunity to go to Umoja Children's Home, an orphanage close to Tenwek. Arathena and I played with the kids, sang songs, learned songs, and played with bubbles. We got to see the chickens, sheep, and cows, and ate fresh eggs and chai. I feel very blessed for this opportunity to meet these sweet children. I am still processing it all.

On Saturday Andy had his first day off after working 12 days straight. It was nice to enjoy the day as a family. The Bemm's let us borrow their back-pack carrier and we went on a hike. We got lots of smiles and a few laughs as men do not usually carry children on their back, that is left to the women. After Arathena's nap we headed into Bomet, a nearby town to get a few items. It was interesting and a little scary to have drivers fighting for us to go with them. On our trip home we had 11 people in our little car including Arathena on my lap and Andy in the trunk:) After dinner we got to spend some time with the Bemms which is always a wonderful time of fellowship.

Today I did a feeding evaluation on a 7 year old with cerbal palsy. I felt like a real OT because when I went home I grabbed 2 of Arathena's take and toss sippy cups and modified them with a kitchen knife and gas stove to make a cup that will hopefully work better for this child.

Please continue to pray for us as we enter our last week here at Tenwek. We have had a wonderful time here and are looking forward to seeing you all when we get home!

Well, I experienced my first 48hr call weekend and I am exhausted. Over the course of 48hrs I lost 6 patients to multiple illnesses. Even with only 8 hrs of sleep over the weekend, the amount of death was the thing that was truly exhausting. The emotional roller coaster of talking and praying with families as we do everything to help their dying child and then praying with them after that same child dies is unexplainable. The thing that got me through was the two kids that should have died but are still alive by God’s mercy. The first was a 2 year boy with severe pneumonia who was placed on the ventilator “breathing machine” as a last ditch effort. Most patients here do not survive to come off the ventilator. All weekend I would just walk by to check on the child only to find some catastrophic disaster had occurred. Every time, God gave me clarity to figure out how to get the child stabilized. By Monday morning the child was breathing on his own and off of the ventilator. He is now out of the ICU and on the regular ward. Only by God’s grace will I see this child go home before I leave Kenya. The other child is a 1 month old baby with severe bronchiolitis. Bronchiolitis is an infection when fluid fills the lungs and makes them became stiff like a metal balloon. Unfortunately we do not have ventilators for infants, which could have easily supported this child until his lungs healed. But as he worsened, the last maneuver I could try was endotrachael CPAP in which a breathing tube is placed in his throat. Oxygen and pressure is delivered through the tube into the lungs to allow the baby to breathe easier and not have to work so hard to breathe air into his lungs. This baby is a true fighter and he would ripe the tube out of his throat which was keeping him alive. After multiple re-insertions of the tube he was still alive and thriving on Monday. The most sobering reminder of why we are here was when I read the nursing note in his chart that said “may we continue to observe God’s miracle at work in this child.” Thank you God for the grace we experience on a daily basis.

In medicine we often feel that our decisions and action are responsible for the life and death of patients. We feel like we must do things under our own strength to save lives. But what I am reminded here is that God is in control and I can only make it through another decision or another moment by His guidance and support. I only want to work as a physician if He is the one guiding my mind and my heart as I practice.

I got a message from our friend Tara that they prayed for us at church yesterday. It is so wonderful to know we have friends back home praying for us while we are here. Yesterday we really needed prayers. Andy was on call Saturday and Sunday and I believed he got a total of 5 hours of sleep over a 48 hour period. There are many sick kids in the NICU and pediatric wards. He has a lecture he is presenting today for the residents so if you read this, I am sure he would appreciate your prayers.

On Sunday morning Arathena and I went to church at Bethesda African Gospel Church, the church on the hospital’s campus. It is similar to a western church service in that it is about 2 hours long apposed to an all day event. I really enjoyed worship, especially the Kiswahili songs. There is nothing like hearing other brothers and sisters in Christ sing in their own language. Especially Kiswahili, it is so beautiful. There wasn’t a Sunday school class for Arathena’s age so we tried to make it through as much of the service as we could without being a disturbance. We ended up leaving at the beginning of the message.
We walked up to the pediatric ward to see how far along Andy was. He had been called to the hospital around 2am and had been there since. We got to meet some of the kids on the ward and some of the babies and mothers I have been working with for feeding. It was nice to have them meet Arathena.

We are hoping to go to a local Kenyan church before we leave for the states, but not sure how we will fare with Arathena. When we went to a village church last time we were here, the service started 2 hours later than we were told and lasted 2 hours longer than we expected! My favorite memories though are of the heart felt worship and their offerings to the Lord. Even though many were not able to give monetarily to the tithe, they gave their first fruits of their labor whether it was their crops or animals. Others who had money would purchase these items and then the money raised would go to the church. It was a beautiful site to see.

Glimpses of our day

Arathena searching for chameleons with her friend Anna

NICU babies

Reena assisting a mother feed her baby who has an unrepaired cleft palate

Andy and the team rounding on patients

Top Chef

My friends back on Portland Street gather every week to watch Top Chef and apparently a new session has begun! Andy and I love to cook and we really enjoy the show. Even though we can't watch Top Chef here, I feel like we have had our own Top Chef in ways. New items we have made from scratch for Top Chef Kenya include Flat bread, tortillas, tortilla chips, English muffins, chocolate syrup, salsa, guacamole, bread crumbs, cinnamon rolls, barbecue sauce and collard greens. I am loving the cook book "New Comers guide to Cooking in Africa: Cooking American from scratch" it has all kinds of recipes including marshmellows!

Volcano in Iceland

Now I don’t know any details of the volcano that has erupted in Iceland, but I am praying that no one was hurt. I do know that it has affected us here at Tenwek in a few ways. The Sawatsky’s parents were to come to Kenya tonight, but because all the airports are closed in Europe they had to cancel their trip. This is affecting Adam and Christon’s plans as well as Christon and Eli were to travel back to the states with them. We are praying that Christon will be able to get her plane ticket changed so that she can go back with Adam. If not, she will have a 20 hour journey with Eli. Additionally, because Tenwek does rely somewhat on visiting physicians, there are some physician who are stuck in Kenya, and some who can’t get in. Please pray for the families traveling to and from Tenwek and that Christon is able to get her flight changed.

Another week of working at the hospital and many more experience. Last night was a long call night. I went up to the hospital for a twin c-section only to see a four day old infant being carried into the NICU. We unwrapped the child to find her pulseless and not breathing. Over the next two hours me and my intern coded the child. After that long intervention we were able to get her to a stable condition except for the fact she was not spontaneously breathing on her own. If I could only have a vent to get the child through that peroid of stress. The next morning I awoke to find the child had died six hours later. The last week has brought five deaths so far. On the flip side there have been countless children who would have died without the interventions were are blessed to have available. keep praying as we continue to work for three more weeks and even more for the interns and long term doctors who will be working in this environment for years to come.

I am sorry the posts have been few and far between, it is hard to get a hold of a computer + working Internet on a regular basis.
This weekend we had the opportunity to go on a safari. Originally we didn't think we would be able to go on one because of Andy's schedule. We also didn't know if it would be safe for Arathena, but we are glad we talked with the Larson's who encouraged us that it would be safe for her. Last time we went our friend Christy slammed her head on the metal frame of the vehicle as our driver tried to race the storm, so we were hesitant, but glad we brought her.
We had a wonderful time and feel so blessed for the opportunity.

Some highlight of going on Safari with a toddler:

• As we were 10 feet away from 2 male lions, I hear my daughter scream...apparently Andy let her have her pacifier and she dropped it outside of the vehicle...Agh! So this isn't any pacifier, our friend Lisa gave it to Arathena one day when I couldn't find hers and it is her favorite. I looked everywhere to buy another one before we left for Kenya but could not find it. Apparently, Lisa got it when she was at a specialty store at an outlet mall because it was the only place that sold pacifiers and she needed one for her baby. I seriously considered jumping out of the vehicle to get the pacifier:) Fortunately our driver was willing to wait till the lions passed and reversed the car and reached down and saved the day
• Morning vomiting
  
• Losing hat x2 but close to safer animals than lions
  
  

Overall it was a great experience. It is sad Arathena is probably too young to remember it:(

Arathena

Arathena has been slowly adjusting to her new environment. She likes spending her days running around the missionary compound, playing with the kids and animals, and giving her mama a hard time about eating.
The Bemms have 3 turtles that she enjoys watching and she loves two dogs; Samson and Walker. She will search the whole compound till she finds Walker, her favorite. She gave us a hard time with eating for the first week, but has been eating pretty consistently since. She is quite the diva with her pink sunglasses, pink purse, and mostly pink attire; she is defiantly Andy’s kidJ
She has also had to adjust to not being the only child in the family. Since we are living with the Sawatsky’s she has a little brother by her side. This has been interesting since Eli enjoys touching her all the time, but by the time we leave she will be so sad to be apart from him.
Arathena has also gotten to go up to the hospital and see the kids in the pediatric ward. She was sad that they had boo boos, but I assured her that her daddy was taking care of them. She has learned the Kiswahili and Kipsigi greeting and says hello to everyone she meets.
Overall I think Arathena has transitioned well and is happy here. It will be exciting to take her to see the animals this weekend.

Cooking

Cooking here has been interesting, but because we were here in 2006, I was much more prepared. We make everything from scratch which is fun but time consuming. Some things we have made that I don’t make back home include hamburger buns, bread, tortillas, pizza dough, kidney beans (I buy canned ones, already cooked). It has been hard for us to get vegetables so our diet has been limited. Fortunately, we just found a place that sells some vegetables by the hospital. There are plenty of avocados for guacamole and bananas.
We can’t use the water from the tap for cooking or drinking, so we catch rain water, boil it, then put it through a filter. We have to use filtered water to clean vegetables and for all cooking, including boiling pasta, so making sure we have enough water is important.
Also, we have to light our stove and oven with a match in order to cook. I do not like matches, but I have grown to be less scared of this process.
Cooking does consume a lot of our time but for the most part it has been enjoyable. For example it took 3 people 4 hours to prep and cook a meal of hamburgers, french fries and some sides. I do feel like I have been cooking for months and it has only been a week!

Andy

I have been hard at work from the time we reached Tenwek. It is surreal that I am considered an Attending level physician here. The first week has been like a whole year of residency compacted in 7 days. So far I have cared for Cutaneous Anthrax, Tetanus, Fulminant Liver Failure, Gastroschesis, Omphaloceles, NEC, CHF, Malaria, Typhoid ferver, TB, HIV, Chronic Osteomyelitis,Wilms Tumor, neonatal seizures, Lymphoma, Meningoma, Severe Burns, Hydrocephalus, Osteogensis Imperfecta, Protein Energy Malnutrition, Multiple levels of severity of mengitis and pneumonia. Every day I am rounding on 40 patients on the regular ward, 2-4 patients in the ICU and 30-40 patients in the NICU. Luckily I have been fortunate enough to have 4 wonderful interns who are all exceptional. Four more weeks to go and I do not know how I will continue to see so many new things.
Besides the overwhelming medical experience, Kenya has been a beautiful place to live for this short time period. I have been waking up early and running. Those times of running through the country side has been an experience I can not even put into words. The rolling hills with small tea farms arranged on hillsides or running through the small roadside towns has been on overwhelming experience.
More to come about our experience soon……

Moses

It was a hard road that brought us to Tenwek in 2006, but like many difficult journeys we were left changed in the end.

The Bemms came to be Missionaries to Tenwek hospital in 2004. I had met Chuck and Amy Bemm when I was a pre-med student in undergrad and had shadowed Chuck, a pediatrician, at the Christian clinic he worked at in Pittsburgh. I also worked at the clinic during a summer while I was in college. Before the Bemms left for Kenya they encouraged us to come visit and for Andy to do a rotation at the hospital while he was in medical school. We were excited to go, but in the midst of planning our trip we found out that I was pregnant and decided it would not be a good idea to go since I would be to far along in the pregnancy.
About a month later, Chuck came back to the states to take his boards and we met with him and talked about their experience in Kenya. We were sad we couldn’t go and visit them in Kenya. I told Andy that if anything happened with our pregnancy, that we should do everything that we could to try to go to Kenya.
A few weeks later we had a miscarriage. It was a very difficult time for each of us and trying on our faith and marriage. We named our baby Miriam and said that she was in Heaven watching over us and our future children just like Miriam in the Bible watched over her brother Moses.
We went forward with our plans to come to Tenwek. The day we arrived we had dinner at the Bemm’s house. Chuck was late for dinner and when he arrived he was so upset about a little baby in the NICU that he had been working with named Moses. He had been found in the river and was having complications. He was not expected to live through the night. As Chuck and Amy talked we gathered the Bemm kids and prayed for baby Moses.
He made it through the night but everyday fluctuated. I felt a special bond with Moses and prayed for him constantly. I sewed him a positioner and provided some occasional range of motion. He was so fragile and my first NICU patient. The only thing of meaning I could do was pray.
After 2 months of being in the NICU, Moses was healthy enough to go to the Baby Center (an orphanage run by World Gospel Mission) The Bemms, along with Andy and I drove the 4+ hour drive to bring Moses to his new home.
I wanted to adopt Moses, but as I looked into the process and laws in Kenya, and spoke with others, I realized it would not be possible unless we were willing to move to Kenya for a year or more. With Andy’s training the only way we could do it is if we were apart for a year.
I have prayed and longed for Moses for the past 3.5 years. When the Bemms were in the states for furlough, I learned that he had still not been adopted. Part of me was still hoping that Moses would be able to come home with us one day. I can’t tell you how excited I was to hear that he was adopted and lived in the next town.
I got a call from Amy that Moses and his family were at the hospital to do some paper work! I could not believe it! I just wanted to cry, God is so faithful to let me have this opportunity to see this boy who I have prayed for all these years. I will post pictures of Moses when he was a baby and now, he is so BIG!
I am so grateful that God gave me the opportunity to see Moses. Meeting Moses in 2006 helped me heal from our miscarriage. Because of our miscarriage, it opened the door for us to come to Kenya, and I knew my baby Miriam was watching over baby Moses.

Well it has been a whirlwind week for us but we are finally settling in a bit. I am sad I can't upload pictures, but I will make sure I do as soon as we get back. Here are some highlights from the week.

• Moved into a different house on the campus. We are now sharing a two bedroom house with the Sawatskys. This makes cooking and taking care of the kids much easier, but it is a challenge with having two toddlers in the house with sleeping. Christon and I spent Wednesday morning packing up all of our belongings and food for the month and moving it across campus. Thankfully we had help since we had the two little ones with us.
• Our computer bit the dust
• Prepped our food for the month: cut and bagged chicken, shredded cheese etc.
• Hail and rain non stop followed by our power being out for 24 hours. We had to move all of our food back to the apartment so it didn't get spoiled.
• Bible study at the Whites house for visiting staff and Kenyan residents. It was a great time of worship and fellowship.
• I (Reena) got to work with some babies in the NICU with feeding and assessing range of motion. I am loving working in the NICU here.
• Andy has been working hard in the pediatric unit, he covers inpatient floors, NICU, and outpatient clinic. He has seen some very interesting cases.
• ***** We got to see MOSES!!!! I will write more about him later, but he is a little boy that we met last time we came to Kenya. He was not expected to survive (he was found in the river) but he made it and he was recently adopted by a family in Bomet. They came to the hospital to do some paper work and Amy Bemm called me so I could see him. He is so big now. God is so good. I have thought about him so much these past 4 years and I am so happy that he his with a family that loves him.

Nairobi Grocery and off to Tenwek

(Our computer is broken so we have limited oppurtunity to blog, also connection is not that great so we can't upload pictures, but I will when we get back to the states)

Arathena was a wreck during the night. She hadn’t eaten very much on the plane. Luckily we bought some water at the airport. During the night she was so hungry and we didn’t have any milk or food, but we had water and cheezits so that helped till morning.
We had breakfast at the Guest House and then we were off to do our shopping before we headed to Tenwek. I prayed that we would have a car seat today since the road to Tenwek is so bad and when the driver pulled up we did!

Our friends the Larsons who were missionaries to Kenya had prepared us mentally for this day. Alysia insured me that I would be able to get everything I need at Nakumatt and I was prepared for an intense shopping day.

As we pulled up to the store I quickly realized that this wasn’t NakumattJ I asked the driver if we were going to Nakumatt and he said no, I should be able to get everything I needed in this strip mall. He pointed to the grocery store, the butcher shop, and a produce market…AGH!!! I decided to check out the grocery store, I took one step in and walked right back to the driver to see if I could change his mind. He explained that Nakumatt was out of the way and we would hit traffic so I agreed and Christon and began our shopping spree as the boys watched the children.

A few hours later…J we bought as much as we thought we needed, had a quick bite to eat at the Java House, and we were off to Tenwek.

The roads have improved immensely since the last time we came in 2006. We took Dramamine for the drive, but I don’t think we actually needed it. Our driver made great time and in about 3 hours we were at Tenwek Hospital.

We dragged up all of our bags to our 3rd floor apartment. In some ways our one room studio apartment was better than I expected. There was a microwave and some basic cooking utensils. On the other hand, it is had to only have one room with kitchen, bed, and table when you have a child because there is no place to put them for nap or bedtime unless you are going to sleep at the same time they do.
We unloaded some of our groceries and then had a tour of the hospital. After dinner we just went right to bed. Arathena again had a hard time sleeping at night so we were up a lot. She loves milk when we are at home but will not touch the milk here. I am scared she will lose a lot of weight during this trip since she is a picky eater.

Nairobi or Bust

We are on our way! Five checked bags, 3 carry-on bags, 3 personal bags, and a baby stroller all at regulation weight and size. It definately took some doing but we are all packed and as ready as we are going to be. We were able to fit all of our clothes in the carry-on bags, that way we had room for the medical supplies, books, and items the missionaries at Tenwek needed.

Arathena did as well as a 2 year-old can do on a 17 hour plane ride with one short lay-over. She didn't cry which we are thankful for, but she was restless at times.

When we had our layover in Paris, Arathena didn't like the milk, we later learned why. At the last hour of our journey she threw-up all over the place. Most importantly she threw up all over her favorite pink blanket and her toy dog Reggie that she got from Dan and Tara :(


Once we got to Nairobi we spent 1.5 hours in line to get our Visas. At this point we are going a little crazy with the long journey (17 hours on plane, 2.5 hours in Paris with 3 bus rides to get from plane to gate and back onto plane), but fortunatley we got all of our checked bags and literally walked right through customs without anyone stopping us to ask questions. I think it is because we looked so pathetic with all of our luggage and child in tote.


There was a sea of people as we exited the airport, but Andy spotted our Samaratin's Purse driver who had a name sign for us. We were told that we would have a car seat in Nairobi, but our driver had never heard of a car seat:) I decided I would just hold onto Arathena for dear life as we traveled to the Mennonite Guest House. No car seat, let alone lap seat belts, don't go well with my profession, but that is what we had, so we made do. We arrived at the guest house around 11 pm and met our friends the Sawatsky's there. The Sawatskys are friend we made in Pittsburgh while Andy was in medical school. They have a 1 1/2 year old son named Eli. Adam is a 3rd year Internal Medicine resident at Mayo Clinic in Rochester, MN and he will be working in the medicine ward at Tenwek. Christon and I will be helping each other with cooking and childcare.

As Andy and Arathena sleep, I am frantically making my shopping list and planning meals for the next month. I had already thought about meals but tomorrow is my big day! Food for the month…agh! There are supplies at Tenwek, but not much locally.