A Week of Firsts

I just finished my first week of surgery here at Tenwek. It has already been a great experience. I've seen some amazing medical cases - things you may never see in an entire career in the States. Here's a quick run-down (get ready for some medical jargon):

I helped repair my first inguinal hernia, my first femur fx ORIF with a SIGN nail, first supracondylar fracture with pinning, several pediatric burns ranging from 8-45% TBSA, so I've gotten to do some skin grafting.  I've hung out with a urologist for a while, we've done some cystoscopy, suprapubic caths, retrograde urethrogram, my first bilateral orchiectomy, rectal biopsy (to dx Hirschprung's), repair of anorectal malformation, and a vesicovaginal fistula repair.  I also helped place my first VP shunt.

I'll mention one case in particular, that took place on the operating table you see above.  On Thursday I was called to see a lady in Casualty (the ER) who had been to another facility a week prior for a D&C after a spontaneous miscarriage.  She had been fine until a couple days ago when she had sudden onset abdominal pain and vomiting.  She had actually been to our ER at Tenwek both days previously but was sent home.  This day, she just looked sicker and the surgical resident that saw her thought we should do surgery.  I examined her belly and wasn't impressed.  She reported mild tenderness upon palpation, but looked unphased, and had no rebound or guarding.  She looked exhausted, but it didn't look like an acute abdomen.  We debated some possible causes of her pain, from ascaris to typhoid, and decided the most likely explanation was a complication from her D&C, which meant we really needed to look inside anyway.  So we decided to take her to the theater (the OR).  We prayed with her before we started, something we do before every surgery, and opened her up.  This was another first for me: exploratory laparotomy.

What we found was a week's worth of bowel in her abdomen.  Not only had the outlying facility perforated her uterus during her D&C, they perforated her small bowel as well.  We repaired the uterus and the small bowel and irrigated with 10 liters of saline.  Her bowels were swollen and inflamed and coated with fecal material.  We even identified some of the local leafy plants that are commonly eaten here.  After we closed the abdomen, we started her on the broadest spectrum of antibiotics available here.  So far, so good.

Thinking about the mess that was inside her belly, I'm amazed at how unimpressive her physical exam had been.  This serves as a reminder to me of the strength and resilience of the people we are caring for here.  I'm thankful we went ahead and decided to take a look.  I'm not sure what the outcome would have been if we had waited any longer.

Please continue to pray for us, and for the patients we are caring for.  Stories like this one take place every day.  There is no shortage of pathology here at Tenwek.  But as Jesus said in Luke, chapter 5, "It is not the healthy who need a doctor, but the sick."

At the end of that verse He says, "I have not come to call the righteous, but sinners to repentance."  Jesus, the Great Physician, can heal not only the body, but most importantly, the soul.  Please pray that I won't be the only Physician that my patients meet during their stay here at Tenwek.

MVP so far...

This backpack is the MVP of our stay in Kenya so far. This picture is actually taken on Christmas in Branson when we got it. But, this is how I carry Liam around everywhere. He loves it, I love it, and people we pass love looking at him! Sometimes they are surprised and even laugh because they just think I am carrying a backpack, and then they see this cute little head poking out! Logan even carried Liam in the rain and he stayed dry under the built-in rain sheild not pictured. I'm sure we will have pictures of us here in Kenya in action, but for now, you get the idea! Thank you Luke and Tracy!

The back door

Here is our back door which is in the kitchen. It leads out to a little alley which leads to our washing machine. This is also the door we go out when we fetch rainwater, which we boil, cool, and then put through the filter you see here. That is the water we drink, brush our teeth with, and use to bathe Liam!

No, No Liam!

Here Liam is perfectly demonstrating exactly what he does in the kitchen. This boy, I tell ya! It's either the stove nobs, the trashcan, or under the refridgerator! All not good places for my sweet ten month old. Don't worry, I watch him very closely.

Dining Room

This is where we eat our meals! This is one of the windows that the little kids smash their faces against to watch us! You can see the fireplace on the left. The fireplace separates the two rooms and you can walk around on both sides. Liam likes to do laps around the whole thing. He also loves to push these chairs so they make a loud squeeeeeek!

Liam's Room

Here is Liam's room. This dresser is borrowed from a Missionary here whose youngest just outgrew it. There is a changing table built on top, so it is perfect. Here is another bag of toys! he knows right where the stash is! His bed is like a tent and completely zips up so the mosquitoes do not get in. We tried the ole normal mosquito net, but he pulled two nets completely down into his bed! Strong little guy.

The Living Room!

This is our living room. You can see the front door and then a big window. We have previously posted the view from our place. I keep a bag of toys in this room for Liam to play with throughout the day. He is so busy! Oh, the brick you see in the corner of the shot is a fireplace. We have not used it yet, but perhaps when it gets colder.