Kips and Cheps

 

We're currently driving to Nairobi to drop Luke and Riley off at the airport. I have my Safaricom mobile modem hooked up to the computer. I had to look up directions to our hotel, Macushla House (Irish for "beloved"). Julie and I are going to skip the Mennonite Guest House for a night and have a nice relaxing and romantic night out in Nairobi. We are going to try to take the four of us to Carnivore restaurant before they catch their flight. While I was looking up the map, I thought I'd explain these pictures some. I downloaded them for Julie last night (took forever) and didn't get a chance to write anything. She was asleep last night, so didn't write about it, and she gets carsick, so she doesn't want to write now either.

Julie and Riley went to the nursery a couple days ago. There are lots of newborn babies that need close attention and stay in the nursery (the Tenwek equivalent of a Neonatal Intensive Care Unit). Julie has been before, and knew it would be a good experience for Riley. Riley has also talked about this experience on her blog.

Usually there are several babies in the nursery that are orphaned. They became orphans at or around the time of their birth due to maternal complications. All the children in the nursery need to be fed every 3 hours. Usually the mothers come in and do it, but the orphans rely on nursing or other staff, or volunteers. The day the girls went to the nursery, there weren't any orphans. However there was a new set of triplets that were just a few days old, and a very overwhelmed new mother. Riley and Julie met the mother, and teamed up with her to help take care of them for that time. They held the babies for a while, helped clean them up, and fed them.

The babies here are named in a special way. Children are usually given a "Christian" name when they get older, but their first name that they get at birth is determined not by the will of the parents, but by according to the time of day (or other circumstances) around the time of their birth. For example, since I was born early in the morning, my name in Kipsigis would be Kipkorir. Boys names start with Kip, girls names start with Chep. The second part is the time of birth. Korir means early in the morning. These babies were all born at the same time. Boy, girl, girl. Their names are Kiprotich (boy born when the cows are coming back from feeding), Cheprotich (girl born at the same time), and Cheprono, which means 'born when the goats come back from feeding' (apparently, the goats come back just after the cows). Liam was born in the evening so his Kipsigis name is Kiplangat.

I think Julie and Riley had a great time helping and bonding with this new mother.

I've been doing Pediatrics more exclusively for the past few weeks, so I've spent a lot more time in the nursery as well. One thing that I am still coming to grips with is how much neonatal death there is here. In the Unites States about 7 babies die per every 1000 born alive. With the medicines and technology available we can keep a baby alive in the states even if the pregnancy is just over halfway done (around 23 weeks). The infant mortality in Kenya is about 55 babies that die per every 1000 born alive, so around 5.5% of babies here do not live to see their first birthday.

Here, babies that would normally do very well in most cases, if they were born in a setting with more resources, just don't have a chance. There is no surfactant here (a chemical made by mature lungs but lacking in premies, that helps the lungs stay open for good air exchange). There are no baby ventilators. In fact, the closest thing we have is a make-shift CPAP machine, which involves a graduated cylinder with actual centimeters of water in it that help create a positive pressure that goes through a nasal cannula taped to the baby's face. Ingenious, to be sure, but in many cases, grossly inadequate. There is at least a baby or two, on average, that die on the Peds ward or in the Nursery every day. Extreme low birth weight, lack of surfactant and oxygenation, and infection (no GBS screening here), account for the vast majority of neonatal mortality.

The hardest experience for me so far has been when I lost four babies in a matter of 30 minutes. I've gotten more experience in neonatal resuscitation in three weeks than I ever did in three years of residency. Three of these children were actually triplets (obviously not the same set mentioned above, there is a high rate of twinning and multiple gestation here) born at 24 weeks gestation. Only one of them really even tried to breathe, and those breaths weren't effective. They were all pronounced dead minutes after birth. The other was a baby born at the same time, full-term, but with thick meconium aspiration. The baby came out with a good heartbeat, but just never breathed. We worked on that baby for half an hour, but if a baby doesn't breathe on their own, we don't have a way to make it breathe. That was a long, long walk back down the hill to my house at the end of the day.

I'm not one of those people that ask, "Why, God?" very frequently. In fact, I don't know that I've ever had an experience where I questioned the will of God. But I found myself meandering slowly home that day with tears in my eyes, wondering why. Why did this have to happen? What could I have done differently? These are the experiences that I'd rather not learn lessons from. But I know to tuck this away somewhere deep and never think about it, and never learn from it, would be to waste the precious and tragic lives of these young ones and to disrespect the grieving hearts of these young mothers.

This was just supposed to be a post about the fun Julie and Riley had in the nursery. I'm sorry for taking it somewhere so drastically different. Please pray for the mothers here and their children. Pray for me, and the other physicians, as we take care of them. And pray that I'll learn all the lessons God has for me here, no matter how hard they are.