Oct 05 2009
October 5, 2009
Global Health Leader Amelia Wood arrived a couple weeks back at Kijabe with her husband Jim and baby Josiah. She is serving as a neontologist there, bolstering health care delivery and training.
by Amelia Wood, M.D.
We have now been in Kijabe a full week. We arrived to homemade zucchini bread and an invitation to watch "So you think you can dance" from the wonderful Davis family (our neighbors just below in the Sitaplex guest house). Not having a TV at home, we were way less in the know than some of the long term missionaries here. Kijabe is like summer camp for doctors. And although there may be some sacrifices in being in Africa (like broccoli free of aphids) our overwhelming sentiment is, "man, don't we feel at home!"
We have made many good friends in the short time since we arrived, including a missionary couple who are living our dream. Mark and Sue Newton have been in Kijabe for 12 years and they are so authentic and enjoyable that they make missionary life seem easy. Mark is a pediatric anesthesiologist who spends 10 weeks working at Vanderbilt every year and the rest of their time is at Kijabe. They have a welcoming home, wonderful children, and a black lab named Moshi. Their lives are busy, but they have graciously had us over twice in the first week - of course, one of those times we arrived un-invited! But they didn't seem to mind. It has been great to listen to them and realize that some of our hopes could in fact become realities.
PRAISE THE LORD, Jim and I found an angelic nanny named Helen who I will cry to leave. She makes it possible to work in peace knowing that our sweet Josiah is cheerfully smacking around our home under her watch. I am only working until lunch time (plus taking call) which is good because everything takes longer in Africa. It is a slow walk with Josiah on my hip to the dukkas (pronounced doo-kus = produce vendors); then bleaching the vegetables is another considerable speed bump once we get home! I actually really love hanging my own laundry out on the line (although it does mean you can't leave the job unfinished until tomorrow).
So as for our "test run" here at Kijabe....I'd say we love it. Where else could a country-boy practice pediatric surgery and his wife practice academic neonatology while their children run through the country-side?
The people here are smiley and energetic. The children are beautiful, just like everywhere. I work in the "nursery" which is an absurd understatement for the degree of illnesses managed in the small, overly heated room crammed with sick infants. We pile in as one big mass of white coats to begin rounds while the nurses sing praise songs in the next room for morning devotionals. Their singing sounds like a dream or the soundtrack to a Francis Ford Coppola film. In the nursery, the mothers all gather round to listen to our discussions as we move from baby to baby. There is no HIPPA so they support each other when things aren't going well and consol one another's babies when they are crying. Mostly, it is a type of sweet interdependence and community lost in the ultra-private and sterile US. Sometimes however, it is a cacophony of cultures-a yelling match in varied languages with beeping incubator alarms and empty infusion pumps filling in any moments of silence. The Somali women are particularly prone to finger wagging and loud refusals to suggested medical plans. I sometimes struggle to teach amidst all the hot commotion.
I usually round with my friend Stephany Hawk, who was my co-resident at Vanderbilt and is now doing a two-year stint as the pediatrician at Kijabe. Together we are training African residents in pediatrics during our daily discussions of patients in the nursery. I have also been asked to lecture at Grand Rounds for the missionary physicians -- pediatricians and family docs. Because I have had the privilege to train under Susan Niermeyer, an international expert in the care of newborns at high-altitude (Kijabe is 2000 feet higher than Denver), I plan to teach about the special challenges of caring for infants transitioning from fetal to post-natal circulation at high altitude. I will also be giving lectures in basic neonatology to the nurses who do much of the bedside care and are pivotal to keeping these babies alive. I am already attached to them, and I often need their hugs on the way out the door each day-neonatology in rural Kenya is sometimes very difficult.
Our biggest limitation to sick newborn care is the lack of total parenteral nutrition. We have many pre-term babies as well as several infants with inadequate intestinal length due to operations, who would all receive TPN in the States. At Kijabe we manage them by feeding at the earliest opportunity and praying for a miracle. It is the best thing available. We can sometimes get lipids (a component of TPN) to add to their IV fluids, and there are rumors of amino-acids, but I have yet to see any-I don't really believe they exist in Kenya. So we do the best we can with what we have.
We see a lot of death and pray that we are communicating Christ's love to these moms by caring for their children who would otherwise be forgotten. This morning, I barely left the bedside of a dying child, whose mother insisted that he was already dead-as evidenced by the ventilator breathing for the baby. The baby is not dead, but he probably will be soon. With all of the challenges and obstacles, it can be difficult to persevere at times.
Still, we do see some miracles. We have two former 29-week preterm infants who are thriving and have graduated into what American neonatologists call "feeder-growers". My favorite is baby James. He is almost ready to ‘hatch' from his incubator. Another baby I love is baby Joseph-a term newborn we admitted for sepsis. I told his father (‘Babba Joseph' as the Kenyans refer to a child's father) that he should expect Joseph not just to survive but to be a normal child. I told him that Joseph will play football (soccer) with his brothers one day. Babba Jospeh smiled broadly and declared "This is a good prophecy." Indeed, I agree.
Life is simple, hard, and lovely.