Goodbye's

As we are working hard to pack our trunks to go home, we are also making the rounds with our friends here and are saying goodbyes.

Our upstairs neighbor, Trufosa, has been pregnant the whole time we have been here and she finally delivered a couple weeks ago! However, the baby suffered seizures and stayed in the neonatal nursery for two weeks. Thankfully, the little baby girl Gracious is ok and home now. We pray she will have a full recovery and not suffer from anymore seizures. I brought her some of Liam's clothes, sleepers and socks. Trufosa was so grateful and we shared some millet porridge (uji: "oojee").



Monday was our final play group all together! The other Missionary kids and moms are here for two years, but we all arrived around the same time, in the fall and winter. These girls have been great friends for me and I will miss them. The three families make up a group of physicians who have committed to serving together in Africa. They are currently seeking the Lord and doing research on where they should plant roots. Their last names are McLaughlin, Cropsey, and Fader, so they lovingly call themselves The McCropDers.



Here outside our house is Heather Fader with Abi and Anna, Me with Liam, Rachel McLaughlin with Maggie, and Jessica Cropsey with Elise and Micah. I set out what food and toiletries I had left and they went "shopping" at the Banks Market! We are hoping to leave as much as possible here for others to use and enjoy.

Last night we had Nancy and Alfred over for dinner and chai. It just so happened that Alfred's brother, Raymond, (the short one) as well as Nancy's cousin Robert, (the tall one) were also visiting. So, we had a big group!

I served Taco Soup with rice and chapati (that I actually made myself!). Usually Nancy makes our chapati because she had been making it since she was a little girl, but I wanted to make sure I could do it before we go home, so I made her leave the kitchen and let me do it! I should have started practicing much earlier, but it is a long process, so I was always happy to have Nancy's help before. They tasted fine, but were a little "crunchier" than hers. I asked at dinner what I did wrong and she said she will tell me in private. Raymond agreed that is "women's talk." They all got a kick out of washing their hands in our sink with soap and drinking soda with the meal.

After dinner, we enjoyed chai while we looked at pictures of our Kericho trip and remembered the fun times. They kept saying "I shall remember those days." They each thanked us and asked us to come back soon and forever. We gave them a suitcase that was left behind by Riley and Luke when they visited. It was broken, but is fixable locally. They were so happy and surprised! But, the bigger surprise was inside where I had stuffed it with several of Liam's clothes, socks, blankets, toys, and some food. Most of Liam's things were gifts to us, and I know all our family and friends would be more than happy for these items to be passed on to some Kenyans who are in need of such things. Other clothes will be given to an orphanage.

Nancy and Alfred recently found out they are having a boy! They have decided to name their son Kipchumba, which means "born when whites are around." Although we will not be here when she delivers in July, we have arranged for a friend to take pictures and send them to us. They have been a wonderful bridge to the Kenyan culture in which we have been living. We told them they are like our Kenyan family and they thought that was so funny and said "oh but we are so dark!" We had a lovely evening full of laughter.

Today is our last full day and we will be busy packing and doing last minute things. (In fact, I should not be spending this much time blogging right now!) Tonight we have dinner with the Manchesters, who have been wonderful friends and mentors while we have been here. Steve is a Family Practice doctor and Teresa leads the weekly bible study I have enjoyed. Pictured with them here is Peter, one of their three sons.

Goodbyes are always sad, and of course we are not looking forward to the flight ahead of us! This could possibly be our last blog before we fly out tomorrow night. Please pray for us, and especially Liam, on this long journey we face. We look forward to seeing family and friends very soon!

Last day on Medicine

Friday was essentially my last day at the hospital. I have not been so good about taking my camera and capturing interesting cases or images, but I thought I should at least try on my last day. Here are just a few snapshots of some typical Tenwek diseases.


Ascaris. This worm emerged from a child who in fact had not even been treated for worms. The young boy is a trauma patient that had a head injury, and was on a ventilator in the ICU. I'm assuming the worm just got hungry after a few days, and crawled out of his body in search of food.


TB meningitis. This Maasai man looks great now and will be going home. What a contrast from the comatose state he was in when he arrived. It is amazing what just a few days of TB meds can do in these cases.


Kaposi's sarcoma. This patient had a CD4 count of about 30. This picture was taken after about a week of treatment, and the lesions were already starting to get smaller. He also had a lesion on the roof of his mouth, which you can see from our Picasa photo gallery.

Chips & Salsa!

As Logan and I are preparing to leave Kenya, we find ourselves talking about home a little bit more. We are remembering what life was like, and frankly, the everyday things are so much easier! For instance , in the US enjoying the most simple snack, chips and salsa, involves popping open a jar of salsa and ripping into a bag of Tostitos. Oh wait, you have to drive to the store first and make the big decision of what brand of salsa you want. I forgot that step!

Here in Africa it is a little more difficult! We have to make our own tortillas in order to make our our tortilla chips! I combine flour, baking soda, salt, and water then knead it for 5 minutes. Kneading is the key to a good tortilla. Then I make about 20 little dough balls and roll them out as flat as I can. After that, they each get fried on both sides on a dry skillet. If things are moving right along, this process takes about two hours.

I then cut the fresh tortillas into triangles, brush with olive oil and lemon juice (no limes locally here). I sprinkle a little salt, cumin, and paprika on them for a slight kick and into the oven they go!

Now for salsa! I throw Liam on my back and we go down the hill to the woman who grows cilantro. Mmmm. Now we walk up the hill to the vegetable ladies who are ready to haggle for a good price. We buy tomatoes, onion, garlic, green peppers and a lemon. After convincing them that Liam does not need any mangoes at this time, we walk back down the hill to our home.

We have to wash our vegetables in a bleach-like solution and rinse with rainwater that has been filtered. After they are dry, I start chopping! I don't have a blender, so my salsa is the chunky kind! I dice tomatoes, onion, garlic, green peppers and cilantro. I add vinegar, cumin, salt, pepper and lemon juice. Of course we taste it along the way to make sure it is just right!

So now, half a day later, our chips and salsa are ready to enjoy! We have learned to savor every bite because it takes so much time and effort to make. Homemade chips and salsa taste much better than store bought because of the fresh ingredients and the effort that goes into it. Logan wants to dig in right away, but I insist on trying to arrange the chips and salsa so that I have a beautiful presentation. It's the least I can do! I will never view this "simple" snack in the same way again!

Ballet Class - Video Link!

We had our final ballet class yesterday. Our ballet class has been meeting every Thursday afternoon for one hour for the past 5 months. This last class was just a celebration of our wonderful performance last week and a time to party! The girls made Thank You cards for me, or should I say "Asante Sana" cards.

We have our class in the raquetball court with a small weight room attached. The girls love it because it is big and it echoes! I will miss these sweet girls pictured here. Back row next to me: Elizabeth, Claire, Lydia. Front Row: Bella, Anna, Anna.

 

The parents of Anna Fader (the youngest one) were able to upload a video of the performance on to YouTube. We could not believe it! Normally it is impossible to upload a video, or anything using that much bandwidth. But, here is the link of our performance at the Fine Arts Festival last week.

http://www.youtube.com/watch?v=q_85C9y3Bcc

In case you missed our blog about the Tenwek Fine Arts Festival, click here.

Enjoy!

Dinner with the Towetts

Last night we had the pleasure of having dinner with a wonderful Kenyan family, the Towetts. Perhaps we would not have met them at all had it not been for our friends and fellow Missionaries, the Dooleys.

Scott Dooley and his family are working at Kudjip Hospital in Papua New Guinea. He and Logan graduated from the same Residency in Springfield. They were on furlough last December, and we had them over right before we left to come to Tenwek. They had been to Tenwek in 2001, while Scott was still in residency, and became close friends with the Towetts during that trip.

We were thrilled to join the Towetts for dinner and sort of "represent" the Dooleys. Phillip met us on the road and escorted us back to his house in a nearby village. Anne had called me the night before to cancel because the walk is so muddy, but I insisted that we are used to the Kenyan mud now!

I am glad she did finally agree to let us take the walk because we had a wonderful dinner of beef and carrot stew, rice, cooked cabbage, chapati, and what we would call guacamole. They even served us Coke!

Phillip and Anne have come a long way since being Peds nurses when they met the Dooleys years ago. Phillip now teaches Community Health in the Nursing School and Anne is the Head Matron (Nursing Officer in charge of all nurses at the hospital). So basically we were dining with a couple of the uppity-ups here! Conversation flowed easily as he told us how his daughter Faith, who is away at Boarding School in Bomet, and the Dooley's daughter, Allison, became friends and penpals.

Liam talked and talked the whole time. He was constantly on the go running in and out of the kitchen. Phillip and the kids were great with him. He complimented us on the "training of our child," but I was a little uneasy because Liam has just started this squealing/screaming thing when he gets excited. At times he will literally scream as loud as he can! Kenyans kids are so quiet, but Ezra and Mercy quickly warmed up to this loud little boy and played right along!

After dinner we were, of course, served chai. The Kenyans drink it boiling hot literally, but Phillip is used to Americans needing it cooler. Instead of poking fun like some others do, he very kindly poured our chai into a metal bowl, swished it around and carefully poured it back into our mug. This made it the perfect temperature! I found that very thoughtful and hospitable.

It was a great dinner with a great couple. They have been very loyal to Tenwek for many years. We pray many blessings to come for Phillip, Anne, Faith, Mercy and Ezra.

Sunday School

We only have one more Sunday left here in Kenya! It has been such an experience being a part of the local church here. It is surprisingly Western feeling during the service, but we do sing a couple Swahili songs a week. Please click here for a story you don't want to miss about one of the men's meetings after church recently. Things like this remind us that we are in fact in an African church.

I have had the opportunity to teach the children a couple times, and this Sunday was my last. We started outside with all the kids ages 6-12. Dr. Bemm had an object lesson to illustrate sin. Using an interpretor, he divided the kids into two groups facing each other. He had two boys stand at the front of the groups facing each other with a full cup of water. They pretended like they were angry with each other and threw the water on the other one. Of course, many kids got wet! This showed that when we sin against another person, it hurts not only that person, but will also hurt many people. I think the kids got it, and of course had fun being outside!

I then took the 6-8 year olds up to the hospital cafeteria and told them the story of Adam and Eve and the very first sin. It was nothing new to these kids, but I tried to make it exciting by acting out the whole thing playing the roles of Eve, Satan, Adam, and the voice of God. The kids got some laughs, but I know they were into it because when Eve finally gave in and took a bite of the fruit, all the kids gasped and some said "Noooo!"

We memorized Romans 6:23 as well. For the wages of sin is death, but the gift of God is eternal life in Christ Jesus our Lord. Here is a small video clip of them learning the verse. You can also tell how they do speak English, but with a heavy accent that you have to tune your ear to hear.

Time was up before I knew it and we all headed back outside where Dr. Bemm was letting the kids have a shot at him with the water! This of course made their day!

Thanks again to Logan for keeping Liam while I help out with the kids. It's kind of a struggle since there is no nursery or anything for the babies, but we just take turns being responsible for him. In the end it is worth the sacrifice and I pray these children hide the Word in their hearts all the days of their lives.

So Long, Farewell, Kwaheri and Goodbye!

Saturday was the much anticipated Tenwek Fine Arts Festival. This is an event where the Missionary Kids who homeschool really get to shine. They are bright kids and the moms here to an amazing job of giving them an excellent education.

These 5 months I have been here, I have been giving a ballet class every Thursday afternoon. I have 6 students ages 4-9. The girls have absolutely loved it, and so have I! I taught them the basic positions of the arms and feet, and a few other beginning ballet skills. The girls like the ballet, but what they really look forward to is the last 15 minutes of class when we have fun dancing to songs like the Duck Dance, Hokey Pokey, etc.

I choreographed a dance to Over the Rainbow for them to perform at Fine Arts. They all pooled together what pink tu-tus and things they had, and they ended up looking like a real little dance group! They loved putting their hair up in a bun, and some of them even wore a little make-up! What more fun could a little girl possibly have? They did a great job and opened up the Fine Arts Festival beautifully.

I volunteered to be in charge of this year's Fine Arts Festival, even though I had never been to this event before! I heard the buzz word "fine art" and I was in! The families here have been doing this for years, but only recently has it been held in the newest wing of the hospital where there is a beautiful glass atrium shaped like Kenya and an auditorium meeting the US standards.

There are about 13 kids ages 5-13 homeschooled here at Tenwek. The older brothers and sisters go to Rift Valley Academy, a boarding school about 3 hours away. For that reason I really have not gotten to know the high schoolers very well. But, the younger ones I have grown to love! They all had the opportunity to present something in the program. It was a variety of music and recitation. Wil hammed it up with a poem called A Tragic Story.

A few students recited scripture from just one verse for the kindergartener, to the whole first chapter of James for the middle schooler. A couple students played the piano for us as well.

I even involved the students who were not in the program by having them run the sound, and move the piano on and off stage. Of course I even rehearsed the piano going on and off stage as much as I rehearsed any other act! No detail is too small!

For our finale, I got the kids who were interested together and prepared the song So Long, Farewell from The Sound of Music. The kids had a great time learning the actions and even having a small solo each. We did it very similar to the movie, except we changed a couple of lyrics including substituting Auf wiedersehn for Kwaheri, which is "goodbye" in Swahili.

The hills of Tenwek have been "alive with the sound of music" these past couple of weeks leading up to the festival. The kids would all get together to watch the movie and you would hear that song being hummed many times. What fun!

For the ones whose skills are not in performing, they were able to show off by setting up a booth in the Atrium. The kids presented art projects, writing assignments, and anything else that they accomplished during the school year. We all milled around and asked the kids questions, and they were more than happy to tell us all about how hard they worked on their projects.

Of course this was right up my alley, and a blast for me to be involved with. Unfortunately my learning curve was too large to completely relieve the other moms, but I did organize what happened on stage including rehearsals, sound, and making sure the kids dressed up! If only I were going to be here next year... I already have ideas!

It was a great evening for all the Missionaries to get together, celebrate the end of the school year, and just love on the kids. We all brought a snack to share and James even made his special lattes!

Liam was mostly interested in just getting dirty on the ground and exploring a new place. Logan and I kind of switched places this weekend because I was at the hospital setting up and rehearsing most of Friday and Saturday, while he was feeding, changing, and playing with Liam. I think Liam didn't mind having a couple Daddy Days though! Things are always more fun with DaDa!

Medical Education

Tenwek Hospital, located in rural Kenya, is a teaching hospital, training interns as well as Family Medicine and Surgical residents. It is associated with Moi Medical School; however, the school is several hours away. There are actually several similarities between Tenwek and where I did my Family Medicine Residency in Springfield, Missouri. Cox hospital, located in rural Southwest Missouri, is home to a Family Medicine program. There is no medical school in Springfield, although we have ties to the University of Missouri in Columbia, several hours away.

A lot of similarities can be found between my medical education and that of the Kenyans training at Tenwek, but there are many differences as well. A Kenyan goes to primary, secondary, and then High School. These are not government sponsored, and all have fees associated with them. Before pursuing higher education, a Kenyan is required to take a year or two off, presumably to work and gain some broader experience. Then based on grades and test scores, they may qualify to enter medical school. This is a 5- or 6-year program, depending on the school. Then they get posted by the government to a hospital to do an internship. Kenyan physicians are called Medical Officers. There is also another form of healthcare professional training called Clinical Officers (think Physician Assistants). Tenwek currently takes 16 interns a year (a mix of M.O. and C.O. interns). These recent Med School graduates rotate in four specialties (Surgery, Peds, OB, and Medicine) for three months at a time. Here are some of the interns at a recent didactic lecture.



After internship, an M.O. will then usually work as a generalist in a district hospital. After two years of service, an M.O. is then eligible to apply to a residency, if they so desire. Tenwek has two residency programs, Family Medicine and General Surgery. Tenwek has graduated two Family Physician consultants (read "attendings"), and there are two FM residents currently in their first year of residency here. It is a three-year program, sponsored through Moi University, and includes full-scope training, including surgery. One of the recent graduates is now the Medical Superintendent at a local district hospital, essentially straight out of residency.

This adds a whole new dimension to what can be done with medical missions. It is one thing for an American doctor to travel abroad and see patients. But when one gets involved in education, the work of one physician can be multiplied through the interns and residents to have an even larger impact on the health of that country. For more on how this is being done in Kenya, check out the Infa-Med website.

There are multiple opportunities for education at Tenwek. The many physicians and surgeons that have visited Tenwek over the years have led to the development of a rather impressive medical library, so interns can read up on virtually any topic. Of course, there are always teachable moments while rounding on the wards. And there are several didactic sessions scheduled throughout the week, including a daily morning report and various lectures over the lunch hour.



This week I presented a lunch-time lecture on Hemostasis and Thrombosis. I tried to balance the lecture between teaching them the labs, tests, and treatments that are ideal and based on the best evidence, and the diagnostic and treatment difficulties they face in this resource-limited setting. Diagnosing DVT or PE, for example, with no D-dimer, no color-flow doppler, no CT scan (or even V/Q), is quite challenging.



I have really enjoyed the opportunity to be involved in education while I have been here, which is something I am passionate about. While it will be hard for me to leave in just a couple weeks now, I look forward to bringing this experience back to Springfield with me when I join the faculty at the Cox Family Medicine Residency.

Day at the Salon

Nancy has been a big help for me since we have been at Tenwek. She is expecting and is due in a little over a month. I remembered my last month of being pregnant with Liam. I was tired, huge, clumsy, and aching all over! I think Nancy is experiencing the same things (along with every third trimester woman!) So, I gave her the opportunity to only work part-time if she wanted. She was so thankful when I brought it up that she jumped at the opportunity.

Now she can rest as she needs to, and can just help with the laundry a couple times a week or babysits Liam at the house if I need to go out. It is more work for me, but it has really worked out well overall.

Today is one of Nancy's days off and she told me she was going to the salon to get her hair braided. Liam and I decided to take a walk up to the Dukas and hang out at the Salon!

Not all women get their hair braided, or plated. Some just wear it natural, shaved, or under a kerchief most of the time. Nancy braids her hair about once a month as time and money allows. There are several salons in our small village, but this was the first one I actually went into.

There are so many types and styles of plating! Most women know exactly what they want. The salons have pictures on the wall of the styles the stylist is capable of doing. It was fun watching the stylist work so quickly. She divides the hair into tiny sections, braids a little, then adds some hair extensions into the braid. Nancy would add oil to her scalp to ease the pain.

They think it is so weird that I can just let the wind dry my hair. Also, it is different that I wash my hair multiple times in a week! I explained that many women wash their hair everyday. To that, Nancy just shook her head and said, "Imagine."

Liam wasn't too sure of a day with the girls at the Salon. Maybe it was a little too giggly and gossipy for him!

He kept busy with his friend, Dorcas. She is 2 years old and is one of our neighbors. She kept saying "Liam! Liam! Liam!" while they banged on big jugs outside.

Overall, we had a great day at the salon! By the end, Liam was even "helping" braid some hair.

Strong-Willed Warrior

William Justice Banks was given that name for a couple reasons. Logan and I both have Williams in our family, so we liked the idea of keeping it in the family. We love the name Liam, keeping with Logan's Irish roots, and it is a unique nickname of William. But, the main reason we named him what we did is the meaning of his name. Liam (and William) means Strong Warrior, or Strong-Willed Warrior. So when you throw the Justice in there, we just thought it was a recipe for a strong, and really cool, name.

Liam is now starting to learn, and live up to, his name. I forgot to mention something that he did when we visited Umoja Orphanage. I was explaining the song Jesus Is My Superhero to the kids by telling them that Jesus is Strong, Mighty, and All-Powerful. I asked them if they were strong and said, "Show me your muscles and say STRONG!" They did, then I heard a little "STAOO" behind me and turned around and Liam was showing off his muscles! All the kids laughed.

This morning Logan and I were laughing about that, and wondered if Liam remembered. Sure enough! Here are two videos of my little strong one showing off his muscles.

Our 'Hood

Just a few pictures of our neighborhood kids. They are loud and silly, just like American kids.

None but the oldest children understand much English besides "What is your name?" and "How are you?" But their favorite English word is "Liam! "Liam!"

They all want to hold him, but Liam wants to run and jump and play!


Many times they are out "basking" in the grass when I take Liam out to play. They quickly mob him and Liam says "Jump! Jump!" and they all start jumping together. Liam is the smallest, but he tries to do everything these kids do.

Most Kenyan 14 month olds would still be treated very much like a baby and be tied to their mother or sister's back all day, or just sit on the ground or bed in the house. These children are mostly left to play by themselves all day with no supervision. I have noticed that American moms keep a much tighter reign on her kids than a Kenyan mom. Many of these kids may also have to cook their own meals if the parents are out working.

I used to worry that Liam would get sick or catch something from the kids. They obviously do not take meds when they get the sniffles, and do not wash their hands with soap. But I praise God that Liam has remained healthy the whole time we have been here. Of course kids don't think about germs or anything, they just play!

Our porch is a favorite play spot for them. They smash their faces against the window to catch a glimpse of what is going on inside our home. They love to watch us eat. Liam is so nice to them! He just turns around in his highchair and says "Hi!" Some things that Liam eats everyday like cheese and berry yogurt, these children could quite possibly go their whole childhood without eating.

I know when we leave, they will miss Liam dearly! And he will miss them too!