Goodbye

I am sitting on the front porch of the guest house waiting for our ride to Nairobi to arrive.  This according to Kenyan time could be anytime in the next two hours!  The month has gone quickly in most respects although in others it seems like a year!  Like last week when I had the flu bug!Each year has been very different and this year is no exception!  Marv found the OB Dept to be in the best shape ever!  It gave him a lot of opportunities to teach residents and medical students instead of putting out obstetrical fires!  I did work in the nursery and bonded with several mothers and babies.  I also seemed to have more opportunities to visit Kenyan homes and churches than in the past.  The nursery census was lower and so I did not feel the stress of being in the nursery.  Acquaintances really want you to come and visit them in their homes.  It is often an eye opening experience.  Homes are small; some have cement floors, others are dirt. Some  have electricity; lots do not.  It is amazing how well kept they are considering the red clay that surrounds them.  

Well guess what!  Our ride was on time and I am now in the Nairobi airport awaiting our flight to Amsterdam.  The drive from Tenwek is  harrowing as there are only two lanes and a lot of traffic especially as you approach Nairobi.   However, Samaritan's Purse has reliable careful drivers and that makes it easier.  Security is tight at the airport so we were glad to arrive early and get through it all with time to spare.  

I guess what struck me most this time is how much of the labor especially in the rural areas is still  done by hand.  From washing the hospital floors, to mixing cement, to unloading a load of rock, to digging the foundation for a house, it  is all done by hand.  Field labor, most often done by women, is  also done with a  pick hoe or perhaps a donkey with plow.  In the rural areas woman do not wear pants; skirts are the fashion of the day!  It feels like one hundred years ago.  On the other hand most Kenyans carry their cell phones with them constantly!  It is a meeting of old and new.  These contrasts make our visits fascinating.

I will close by saying that I feel blessed to have been able to make this trip again after being unable to come last year.  It is definitely a spiritual experience to join voice with Christians half way around the world.  I was overwhelmed to have many many people tell me that they had been praying for me and would continue to do so.  How humbling.   We American Christians have much to learn from them.  It is always hard to say goodbye and answer the question "when will you return?"  My answer? "Lord willing, soon!"

Micki

FunzoTenwek

Nursing Instructor David Cheruiyot

I visited the Nursing School at Tenwek and heard about FunzoKenya.  This project is addressing  the need for more heath workers.  It reaches out to the community to recruit and train health workers.  That same day I received the Strategic Plan for Tenwek 2014-2018 and again read about the plans to expand training and education.

Educational development is complicated!  Here at Tenwek they have the key ingredients for that development.  The exciting part is now there are new partners!  Did I mention that the School of Nursing Chapel Hill is a partner?...SMALL world!

What should we do?

Dr. Chin Pak from Yonsei University
February 5, 2014 Tenwek Hospital

This morning, Dr. Chin Pak gave Wednesday devotions.  He is here with 6 medical students from Yonsei University Health System, Seoul, Korea.   He told of the mission history of Korea and their more recent mission in Mongolia.  It is an amazing story of faith!....a faith history with an impact in the East, West, North and South.  These experiences always move us as we see God at work building his Kingdom.

What are the biggest changes/differences?

The biggest change is how connected we are!  Cellphones and the internet allow us to stay connected.  Secondly, this place is one that attracts many people from various parts of the world.  We are part of a global church!  It is the best kind of globalization.

How can we continue to provide support?

One response is that we  change how we see the question from a "we/them" to "us".  We  should   all be encouraged to "Pray with" instead of "Pray for" God's workers in the world.  We are truly "One Body".   

My hope is to be able to support local Kenyan obstetric education.  This could mean sharing new educational materials, review of research proposals and reports, curriculum review and recruitment of others. 

What would you like to do?

Marv

   

We are one in the Spirit, we are one in the Lord

The week has gone by quickly!

This afternoon I visited an orphanage where 55 children reside.  I was impressed with how well kept up it is.  Many of the children were in primary school.  The young ones ages 4-7 were in a class at the home.  Several  of the children  ages 14-15 are waiting for money to come through so they can attend the secondary school where they have been admitted.   This money comes from donations received through the long term missionaries here and the need is always great.  It costs about $400.00 to send a child to boarding school.  This includes books and uniforms but is an insurmountable amount for these kids as well as for many families.  If anyone would like to help I can give you the information and you can know that your money is being well spent. 

Sadly what a day.  The sunt operation for baby Jesse could not take place because she has a severe infection.  Of course Mom is afraid and discouraged.  So am I.  I fear that Jesse is going to be very impaired cognitively.  I think mom is beginning to realize this as well.  Kenyan Mothers are so stoic; they rarely cry or show emotion.  I wish that she could just break down and sob. It is what I feel like doing.   

On a lighter note, I fed some twins whose mother has been psychotic postpartum but is doing much better. She  came tonight to try and breast feed and it actually went quite well.  I was thankful for that as it was important that she be able to have enough milk!

I can report to Circle 2 and a Sunday School member from First Presbyterian that the house you donated for the widower with nine children is a reality.  Today, I met with the pastor of the village church and with the lady who conducts Bible study in that area .  They both were impressive intelligent people.  Two churches will work together as community and hopefully begin to build the house next week.    I will report on the details as I get them.  We may have a little extra money to buy a bed or some blankets for the family.  The pastor reports that the twins are being cared for by the grandmother and doing well.  We prayed together at the end of our meeting that God would bless this new house and bless this family and that all of the children would come to love the Lord Jesus.  We  also thanked God for the people in America that have made the house  possible.  My eyes were pretty misty at the end of the prayer.  I am blessed to be a part of the generosity from the village church and from my home church family. 

Micki
January 31, 2014

p.s  This post was delayed due to technical issues of internet access.

Lake Nakuru

Quality Research

Today, I had the wonderful opportunity to meet with Dr. Juma and review his research thesis for fulfilling his requirements to be credentialed in Family Medicine.  I had previously described how exciting it was to first hear about the projects.*   Now, I had the opportunity to see it almost completed!

In addition, there were two visitors from Cambridge, England to assist with development of other research proposals.   It was a wonderful privilege to be with this young group of residents and the faculty as they address their research concerns that can improve care here. 

These residents are making a difference!  Continue to pray for this new generation of healing agents in Kenya that their work will be productive of improved care and outcomes.  

Marv

*http://tenwek2012.blogspot.com/2012/03/obstetrics-102.html

"Teaching Materials"

At Tenwek there is no shortage of referrals, complications and diagnostic challenges!   So the educational experience for visiting staff as well as the permanent staff is amazing!  A difference is that now there are educational tools that connect this place with the world!  What is the same is the dedicated teachers who mentor, encourage and organize the clinical challenges! 

On February 3, 2014 there will be a “White Coat Ceremony*” for the entering new interns and residents.  It is a dedication that involves families and friends.   It is also a time of recommitment of the teacher clinicians.  I will send pictures of this celebration! 

What is amazing is the growth of the teacher clinicians.  This now includes more Kenyans with increasing relationships to the medical school in Eldoret that is about 2 hours from here.   The educational growth and mission of this hospital continues to provide care to this community and Kenya!  As one patient told me this morning when a complication occurred at a small facility, “I was told to just go to Tenwek!”

 Marv

*http://en.wikipedia.org/wiki/White_coat_ceremony

A Sunday Visit

The Home of Dr. Elijah Terrer

Going to Church

Praising God

Mzungu Nyanya

Karen and Nyanya on the Phone with Benaly

Sunday was a really special day for me!  Unfortunately Marv had to work and so he could not be a part of my trip.  The Kenyan obstetrician, Dr Elijah Terrer, invited several of us to his home and to his church.  The Tenwek pediatrician was asked to give the message in church.  The trip took about forty five  minutes and I would never be able to find it again!  It was really in a rural area.  I am amazed that Dr. Terrer makes this trip  each day along with his wife who also works at Tenwek.  They love living in their "homeland" near friends and family; much like we all do.  They have recently built this home and even though they work with modern conveniences(like bathrooms) they choose to have an African privy and a Kenyan kitchen.  A Kenyan kitchen is a separate outside room where you cook over an open fire.  Their "stove", unlike most, is recessed and the smoke goes up a chimney.  Emily Terrer prepared a beautiful breakfast for us of mdaza,(like doughnuts), boiled eggs, pineapple, and bananas along with the best chai I have tasted.  Chai is the Kenyan drink of tea, sugar, and  milk but she seasoned hers with rosemary and it was delicious!  After breakfast we went to the  secondary boarding school for boys(high school) that is next to the church.   It is common that you are expected to say a few words when you are introduced as guests.  I said something but have no recollection what!  Then we walked over to the church and were seated in the front row of the packed little place.  They are in the process of building a new sanctuary so that the boys from the school can worship with them.  They have stopped building now to raise money to continue.  Fund raising takes place everywhere!  The praise choir was in good voice, we were all introduced again and said something, the pediatrician mzungu preacher spoke, and two hours later we emerged  We had lunch at Elijah's neighbors' house and then headed back home about 3 PM.  Kenyan hospitality is so genuine!

When I got back home Marv and I walked up to the nursery to check on things and to say "Hi" to our good friend Karen, a neonatal nurse.  I asked Karen if she would be willing to make a phone call for me and speak in Kipsigis.  I wanted to call the TransMara and talk to Benaly, a mom of twins that I helped in 2012 during our last visit here.  Karen dialed the number and we held the phone so I could hear.  I heard Benaly scream when Karen said this is Karen and Nyanya (Nana) Miriam calling!  It brought tears to my eyes!  She reports that the twins, Matthew and Naomi are walking and doing well!  What fun to hear her voice! Unbelievably, she told Karen that she looks at my picture everyday which I find hard to believe unless she has a picture on her telephone.  She was out in the corn field weeding when she got our call!  That call made my day and perhaps was the most poignant event of the experience so far!

All and all it was a very special day!

Micki

For a picture Benaly see: http://tenwek2012.blogspot.com/2012/03/strong-kenyan-women.html

Another Beautiful Day in Kenya

Joy

Returning to Kenya, and specifically Tenwek, has been much more emotional for me than I had imagined.  Physically it has been challenging because of the altitude.  We are at 6000 feet and so I have realized that I do not have all my pre-cancer strength back yet.  The good news is that I am here and I am climbing these hills!  It has been incredible to me that so many of my friends, both African and American greet me with Miriam, "We are so glad you are here!   We have been praying for you."  It brings me to tears very time.  To imagine that people across the world were praying for me!  I am overwhelmed by the love.  I felt the prayers.  

As I mentioned before I have not worked in the neonatal nursery as much this year because the census is low and because I honestly have not had as much energy as it takes to survive working in that warm room.  But today I went back and it seemed like home!  I was welcomed with open arms and asked where have you been Nanya? (Swahili for grandmother) What a wonderful feeling!

I noticed many changes.    The babies are wearing diapers, if their Mothers can afford them, whereas, before they were naked.  The electronic medical record is up and working which is significant as it makes labs and orders immediately available.  Many things are the same.  The small room is warm and  filled with antiquated incubators and little wooden boxes for beds.  Sleep deprived Moms dressed in ugly green striped hospital gowns still come every two hours to feed their infants and sit on the little stools in front of the beds.  Babies are still fragile and hooked to monitors and tubes. The most important thing that remains the same is the love and camaraderie that fills the room.  The Lord is ever present through the love of moms and dedicated Christian nurses and physicians.  Thanks be to God!

Micki

Reunions

Everybody has a Story

Everybody has a story.  As a guest in a foreign culture it is fascinating to hear African stories.  It is also fascinating to hear the stories of young westerners who are currently in Africa.  Let me tell you about how I spent my morning, the people I met and their stories.

Mavis is an African American young woman from Cleveland Ohio who volunteers with the Peace Corps  in a small village near here. She comes to the Tenwek guesthouse often to get on the internet and connect with friends and family in the US.  She is a vibrant intelligent woman who is educating her village on  health issues and waste management.  This week's lesson is on hand washing!   

Marylin came to help me today.  Although our quarters are small it is wonderful to have help with the everyday chores of housekeeping.  She baked bread(calories!), helped with the wash, and  made  soup for dinner.  She is the mother of two children but has also taken in her brother's two children as his wife died.   Her day is very full!  I feel foolish having her help me but she is so pleased to have the work and be earning a salary.  She is also delightful and I enjoy her company.

Katy (North Carolina), Amy (Michigan) and Matt(Pennsylvania)are young American medical students who are volunteering their time at Tenwek to serve and to broaden their educations. We love it that they are willing to "hang out" with old people!  We learn so much from each other.

Rachel and Adam are Calvin College students whose parents live in Kenya and so they are spending interim here. We had lunch with them today and heard their stories. Both are MK's(missionary kids) who plan medical careers following in their parents footsteps.  Rachel's parents have lived in a remote Moslem village for thirty years; she and her three siblings were born and raised there.  Adam's dad is a surgeon at Tenwek and he has lived here since he was five.   

Hannah is a dynamic  Wheaton college grad who is here for a year to build up an organization called Friends of Tenwek.  As the hospital has grown so have it's needs.  The Friends will be an organization that provides prayer support as well as monetary help  to the hospital.   

Michelle and her three friends are from Canada and are going home today after spending seven months interning with Samaritan's  Purse Canada on water projects.   They have lived in very primitive conditions often with African families.  They have made a difference in a short time.

So when people ask me what do you do, Micki, when you are at Tenwek this is one of my roles!  I make friends with young people and hear their stories!  I am blessed! And I am enriched!

Micki

Teaching - Translation and Transformation

Teaching is one of my tasks for the month I am here at Tenwek.  I have prepared and also received “lectures” in obstetrics to share with the learners here.   The reality is that most of the teaching is problem-based and at the bedside.  Lectures are given but the “hands-on” education is the basis of the care using the history and physical findings to guide the use of other diagnostic tools or procedures.

The first task is making sure that we start where they are and respond to the needs they see every day.    This usually happens during morning rounds and at “Chi” time.  I need to translate the “Western” perspective to the reality of their world and education.    The second task is not so much about their knowledge as the task of building confidence in their abilities.  I need to affirm their passions and dreams and support their courage as they struggle with the realities that are often overwhelming.    This is the transformative task.   It is the more difficult of the teaching tasks.

So it is one thing to deliver appropriate and practical material to the learners and another to be part of their lives as they learn to make a difference here in Kenya.  For me it is the most enjoyable and rewarding part of being here!

Marv

Part of the Obstetric Team

Saturday Morning

It is Saturday and like many places in the world the pace around the hospital is slower.  Marv is not on call today and so we decided to take a walk to get some exercise.  We have been intrigued to see the generator project which is underway down at the river. Let's just say that Marv, still having a bit of little boy in him, has been more intrigued than I have, but I agreed to walk down there this  morning and check it out.  Both the walk and the project are unbelievable!  Both are difficult undertakings.  The road down there is third world, full of boulders, uneven,and steep. Betsy you would have been having a fit watching me navigate the path. But I did it!  Once we reached the river the third world meets modernity.  What an amazing sight to see this gigantic piece of machinery generating electric power for the area and now it is going to be doubled in capacity.  What vision people had 75 years ago to harness the dam so that medical care could be provided for this vast area.  Now this addition will make it possible to provide more reliable power to the area as well as supply needed power for modern technology to improve medical care like CAT scans  and MRIs.  As we were standing there at the river edge we looked up to see a woman walking across the narrow bridge over the dam with a heavy water can on top of her head.  Modernity is not part of her world yet!  That is Tenwek, a place where one world meets another. We are blessed to be a part of it; if  only for a short time. 

A New Generator

The Source of the Power

 The preparation for the New Generator

The Current Generator

A New Generation of Missions

After one week at Tenwek, here are some initial impressions/observations:

1. There has been a large influx of young recently graduated physicians and their families.
2. The hospital and clinics have been transformed by the addition of an electronic medical record.
3. There are more disciplines represented, but still a wonderful sense of community.
4. There are visions for the future of this place that are very exciting!

A wonderful example is a young Kenyan family physician who plans to pursue a residency in obstetrics and gynecology with the ultimate goal of establishing an obstetric/gynecology residency program here at Tenwek.  

These impressions/observations speak to very courageous leadership and personal commitment both here and around the world.   The issue is how do we encourage and partner with this next generation of change?  

Marv

Beauty in this Place

Traveling Mercies

Dear Family and friends, As Marv has written we are safely here at Tenwek, located near Bomet, Kenya. It is a gorgeous time of the year and everything is lush and green. As we were driving here the vistas over the Rift Valley were spectacular. Here at Tenwek our average daily temperature is 75 daytime and about 50 at night. Perfect for cuddling up in a heavy wool blanket. The calla lilies are blooming along with hedges of daisies and lantana and any other flower you can imagine. No vortex here! Before I get ahead of myself I have to tell you about our trip from the airport to the guesthouse We paid our 50.00 dollar per head visa entry fee in crisp US dollars, struggled mightily with our seven, fifty pound pieces of luggage and proceeded to customs. We were carrying three bags of medical equipment which we were hoping to get through duty free. The austere customs agent looked at our paperwork from Tenwek, thought for a few minutes, and then said that there would be no charge. "Tenwek is a good place, my sister had surgery there a few years ago." Once outside the airport it is always comforting to see the man from Samaritan's Purse holding up a sign with HAGE written on it! We loaded the van and met a spine surgeon and his daughters from Soldatna, Alaska who rode with us to the guesthouse and are coming to Tenwek later this week. Now that is a trip coming from the Kenai Penninsula of Alaska to Kenya! We were engaging in a fun conversation when a fast moving huge dump truck encroached on our lane and side swiped us on Marv's side. Thankfully our excellent driver had a place to pull over or it could have been disastrous. Then the interesting part began with our driver and the truck driver negotiating the damage. This went on for an hour and a half! Fortunately our driver called for another van to pick us up as it was nearing midnight. Driving in Kenya is not for sissies! Maybe they are still negotiating! We slept well at the Mennonite Guest.It is always a fascinating experience to spend time there because you never know who you are going to encounter from the continent of Africa or from around the world. Our breakfast partner was the Minister of Education for the country of Rwanda! He apologized for his English although it was definitely better than our Rwandan! Our driver picked us up and off we went to grocery shop. In years past we have shopped at Westgate Mall which as you know was the scene of the terrorism several months ago. It is closed. We found another similar center and were able to get most everything we will need. I will have to admit that my mind wondered as I went up and down the aisles as to what terror those shoppers must have felt on that ordinary day. Finally we were off on our four hour drive to our destination. We were joined by the Edgar's from Seattle Washington. Ken Edgar is an engineer who will be supervising the construction of a generator that will double the power capacity at Tenwek. It is quite an undertaking! He and his wife, Irene, have lived all over the world building Christian hospitals and related projects. God can use any vocation in His service! The trip to Tenwek was uneventful aside from the spectacular scenery of the Rift Valley, baboons scrounging for garbage along the road, African women toiling in the fields, colorful shops lining the road, Maasi goat and cattle herders in their red attire, and darling children in their distinctive school uniforms. We arrived mid afternoon, unloaded our belongs, greeted old friends and were in bed by 7:30!

Safely in Nairobi

Arrived on time and with all bags and medical supplies.   Now for some shopping and the final travel to Tenwek.
Marv & Micki

Ready for a long day

Have You Seen A Difference?

It was a polite question from a good Christian friend and neighbor in response to hearing we would be returning to Kenya.  It is a question that can be answered easily with a “Yes”, but that is only part of the answer. 

One of the goals of this blog is to provide better and more detailed answers to the question of “making a difference” with the hope that we will all be “different” by the experiences we report and share. This trip is not about our charity, it is about the discovery of how and where that “difference” has occurred and will occur in the future.  We expect that we will see again the wonderful work of God in this place called Tenwek.

Marv and Micki