How do you say "no anus" in Maasai?

Now that vacation is over, it is back to normal life here at Tenwek.  Back to the OR, the clinic, to resident Bible study.  I realized that I haven't posted in a while about some of the interesting cases I have been taking care of.  Therefore, to quench everyone's (ok...some of your) thirst for oddities, here we go.

On call last night my first patient was a man who presented with features of a bowel obstruction and anemia (hemoglobin of 7...normal is >12)  However, the confounding factor was that he was newly diagnosed with HIV... or he knew and didn't want to tell us.  The cat was out of the bag when our testing came back positive.  We test all patients here as the positivity rate can be up to 30%.  I could tell from his body habitus that he was NOT the healthiest man in the village...in fact he was skin and bones.  When I examined him, his abdominal exam was not tender, just distended. The abdominal XRAY showed dilated bowel and a little fluid, but not much else.  His vitals were stable and he wasn't septic looking. (no fever, tachycardia, etc.)  His WBC was normal.  In Kenya, bowel obstruction equals OR...but I didn't want to rush an ill looking, wasted, anemic, end stage HIV patient to the OR.  So, we watched him for half a day and ran some more tests, and waited for blood.  Later that evening we eventually made it into the OR where we found....an entire abdomen filled with stool and gas.  Yummy.  Not what I was expecting.  Enlarged lymph nodes dominated his abdominal cavity, (along with the stool) distorted his anatomy, and filled his retroperitoneum (the space behind your belly).  This was consistent with lymphoma that had caused his entire sigmoid colon to fall apart, spilling stool all through his belly.   In a normal person, he would have been extremely tender on his exam, septic, and with a high heart rate.  In retrospect, he had so much free air on his abdominal XRAY that you couldn't even see it...because it took up his entire abdomen.   Because of his HIV (which destroys your immune system)  he couldn't generate an immune response to the infection, and therefore the magnitude of his illness was hidden.  I told the resident that I would buy her lunch if she could keep him alive over night. I owe her lunch, as he is still hanging in there.  Nice job Liz.

Just after we finished with that case, the residents took me to see two Maasai babies in the nursery that had come in that evening.  One baby was a boy who had been born that morning (a home birth of course) and the other was a 2 day old girl. These newborns had arrived to Tenwek at the same time...in fact, they rode in the same car.  I'm sure they would have been brought in on a motor bike, but the journey was too long.   The story that the resident told me went something like this.
"The mother of the baby girl born yesterday noticed that her baby hadn't pooped since she was born and that her stomach was getting distended.  When momma looked at the anus, she noticed that there wasn't one. She told her sister in law (who had just given birth that morning to a baby boy) of her findings and this prompted her to check out her son's backside.  Well, what do you know...no anus on him either."
Newborn cousins sharing the same problem at the same time...imperforate anus.  This prompted me to wonder how you say in Maasai, "Does your baby have an anus?  No?  Mine neither.  We better go to Tenwek to get our babies a place to poop out of."  
We stabilized the babies overnight and today I did diverting colostomies for both Maasai cousins.  For the pediatricians out there, the girl had an associated cloaca, and the boy had no evidence of a rectouretheral fistula (a more rare form).  We will fix the lack of anus once the babies get bigger (6 months to a year.)  Truthfully, I'll be waiting for a visiting pediatric surgeon to teach me how to fix a cloaca.
We will see what tomorrow brings.

XRAY of one of the babies showing lots of gas in the abdomen, and no gas going to the anus (where the coin is taped to his butt.

 Baby boy parts and no anus.

 Making a colostomy

 Finished product...for now.

Another interesting case of a 4 year old with a brain abscess that we drained.  She initially couldn't mover her left arm and leg, but is now slowly regaining function.  Not sure why she got the infection in the first place.  All too common story.

Everyday brings new challenges and more education.  It's good to be back to work.

Greece Part 3

Greece Part 3

The rest of the week was filled with conference sessions for Eric, Greek school (as they called it) for the boys, spouses sessions for me, checking out potential future ministry opportunities, swimming, meeting new people serving in many different places, the kids program in which they performed their songs from the week, including a Greek dance (only Cole would go up- in their defense, it was in front of 700 people), eating more good food, playing on the playground, clean water, and in general just enjoying a break from our normal life. 

Friday we headed to the airport via a “big big bus” as Tucker would call it and then proceeded to fly all night back to Nairobi (arriving at 3:30 a.m.) I will spare you the details, just know it included very little sleep, quite a bit of crying, lots of movie watching and prayers that time would pass quickly. We crashed at a guest house in Nairobi till about 9 a.m. and then headed home.

All in all, we are so thankful we were able to go and have a break from normal life, Eric to get his CEU’s and to meet new people! 

Goodbye Greece!

Isn't he scrumptious? What a cutie!

Everyone’s favorite parts:

Erin- meeting new people and our whole weekend trip to Athens

Eric- talking with the older missionaries and Mars Hill

Cole- Greek school

Cooper- food and swimming

AJ- sliding on the rocks at Mars Hill and the Acropolis

Tuck- Airplane

Some thoughts:

- it is impossible to keep little boys clean. I bought a few new shirts for them for this trip since all their Tenwek clothes look ragged and dirty, and still they manage to get food all over them at every meal, dirt, mud, etc, etc. It could have to do with how they eat and the fact that they roll around on the ground. I try people, I really do. Are girls this messy??

-Everything in Greece is OLD. So old, it is crazy to me to be in a city that was around before Jesus lived on the earth. I can’t help thinking about the people who built all these structures and those who walked these same paths.

- At all the historical sights there are ropes everywhere to mark where “you should NOT go”. The boys think it means 1) Go under here-please! 2) Hang on me, come on! or 3) The real fun is behind this skinny little rope, they must not have really intended to keep you out or they would have built a wall!

- People everywhere in Greece kept saying to us, “Are these your 4 boys? Congratulations!” I should have been born in Greece, or in Bible times. I am coveted by all for this crew (even if they’re dirty!)

- This was the best field trip ever!

-The marble on the ground of the Acropolis is slippery, the boys thought it was great, the first slides!

- Greeks love ice cream! There are ice cream shops everywhere and people are always walking down the sidewalks eating it! Do they need missionaries in Greece? ;) Paul thought so.... We so enjoyed ice cream after not having it in a long time!

-Everything in Europe is small: the sidewalks, the shops, bathrooms, portions, cars, etc. It makes me realize how everything in America is huge. Everything in Africa is just, well, African.

Funnies: 

Our friend Annie (age 3)  to Tucker: Tucker, speak English!

Tucker: I want my home! Where my home??? (so confused about where we are!)

Erin: Tucker, where are you from?  Tucker: From my home.

Erin: Alex, carry this water bottle home

Alex: To America?

Erin: No

Alex: To Tenwek?

Erin: No

Alex: To our room?

Erin: Yes.

Again, so confused, we’ve traveled a lot in the past year!

They told me in childcare that Tucker is the music director of the group. He kept singing Holy, Holy, Holy :)

I had Tucker in an Oscar the Grouch shirt the other day and AJ kept calling him “Oscar the Crotch”.

Alex was so convinced that we were going to see the Eiffel Tower. He asked multiple times a day when we will see it. Wrong country, kid.

AJ: (at the Parthanon) Why’s that falling down? Who keeps wrecking it?

So there you have it...now we can stop blogging about vacation and get back to real life! (sigh, vacation is great though, isn't it?) 

Greece Part 2- Trip to Athens

Trip to Athens!

    

Saturday through Monday we went to Athens as a family. There were day trips you could take that were organized through the conference, but we had planned out what we wanted to do ahead of time and Eric spent many hours plotting, planning, reserving, researching what we were going to do. (yea Eric!) 

 

Waiting for the bus

 

     We got up early and waited for the public bus (that we were pretty sure drove by without stopping for us, only to be relieved when the real bus did stop for us!) and hopped on for a 1 ½ hour trip to Athens. The public transportation in Greece is very nice and pretty easy to navigate. We had been staying on Evia island. The distance between the mainland and the island if very minimal. I feel like we could swim it.  We arrived and hopped off the bus, and had to move quickly, we had to get on the Metro, switch from green line to red line, (with our suitcases, backpacks, stroller and 4 kids....) find our tour group meeting at 10 a.m. (it was 9:55) AND Eric had to run our bags to our hotel. Thankfully we chose a hotel about a block from the Parthanon so we were right there. It was on this quaint little street, it’s was so cute. Anyway, we made it! We joined a 3 hour walking tour of the city. The boys did really well, all things considered. We had a hard time keeping up with the group at times since we had a stroller (that one wheel randomly falls off of) and 3 midget walkers. Eric basically listened to the tour guide each time we stopped and I kept the children from either a) walking into the street b) walking off with treasures from vendors c) throwing rocks at each other or I was busy d) giving them water and candy. Then he would summarize to me what was said. It worked. 

 

Look hard, we're on the right, gazing at the theatre!

 

After the tour I was sooo beat. We came back to our cute little hotel (a one minute walk!) and ate lunch and I took a nap with the littles. Eric took the big boys around the neighborhood and then they sat up on our hotel roof. 

Hotel roof-top view

      Once everyone woke up it was time for ice cream! We got some yummy gelato that gave us the energy to climb up the Acopolis! (the whole hill area that the Parthanon sits on top of) Pretty amazing. I love how old it all is. We took our time looking around and taking pictures. Then we started off to find a place for dinner. We looked in a few shops along the way, bought the boys Greek god shirts (Alexander the Great!) and ate some super yummy gyros. Then we put those kids to bed! 

Our fun Greek shirts, Hercules, Achilles, Alexander the Great and Pegasus!

A moment to remember!

Almost to the top of the Acropolis

      Sunday we went to Aegina Island for the day. Eric did such a great job planning everything out ahead of time, so we knew exactly what Metro to get on, where to transfer, where to pick up the ferry, etc. It was a 30 min. ferry ride (it was enclosed, no risk of children falling over the edge!). It was such a quaint, cute island! We first walked around all the shops and restaurants, just looking around. Then on a whim, we decided to rent one of those big huge bikes that would hold all 6 of us and peddle around. It was so funny! The best part was going down hills. The kids loved it. 

So fun!

We then ate some lunch, some ice cream and swam in the sea. 

We had planned to stay till 6 pm. but by 4 we were ready to go. We went back to our hotel which was so conveniently located, and strolled around till we found an outdoor pizza place. We had a Greek pizza (!) and some pepperoni too. It looked more like ham so the boys kept telling me I ordered wrong. Trying to explain that pepperoni is different in different parts of the world was not understood. Good thing they like ham too! 

Yummy dinner! We made the boys try Gyros and they loved them.

      Monday we set out to find Mars Hill (where the Apostle Paul preached to the Athenians) and after a few detours we finally found it (right after our stroller broke :( ) We brought our Bible to read Acts 17 and Eric and I were embracing this moment and all it meant....as the boys slid around on the slippery marble rocks. Oh well, you win some, you lose some. 

Reading from Acts

We then tried to do some shopping but didn’t have a lot of success. We weren’t really in the right part of town for the kind of shopping I was looking for. (people, I just want a Target, is that too much to ask??). We finished out our day in Athens with McDonalds for lunch for the boys and yummy gyros for Eric and I. (I’m pretty sure I gained 10 pounds in Greece). We then headed back to Evia and the conference in time for dinner. Last part of the trip and some funny moments coming in the next update! Stay tuned...

Greece Part 1

For those who care, I'll be telling about our trip to Greece in 3 parts.  We headed to Nairobi on Saturday afternoon, April 26th and went to dinner, put the kids to bed at 8 and then had to wake everyone up at 12:30 to head to the airport! Luckily (or unluckily, depending on how you look at it) there were TV screens on every seat, so our kids were in heaven. Cole never slept again. The others slept varying amounts throughout the next 6 hours. Tucker managed to spill an entire cup of water on my lap and need a diaper change in the world’s smallest changing area, an airplane bathroom.  Tucker was also a huge hit with the Turkish airline stewardesses. Once he decided he was done with his car seat and was walking around, they literally were all over him, kissing him. This one lady must have kissed him 30 times! Then she brought him chocolate. J Eastern Europeans love children, random people in the airport in Istanbul would stop and touch them, try to hold them and even kiss them!

Crazy kids killin time in the Instanbul airport!

Turkish Delight!

We were traveling with our friends the Kelleys and the Davis’s, so we had 6 adults and 9 kids to keep track of as we navigated the airports. It was quite a herd. We entered the 1^st world again in the Istanbul airport, to a huge mall area, something we hadn’t seen in 9 months. Lots of white people (unusual) and lots of things that had not been available in some time. We spent 2 ½ hours there before leaving for our destination....Greece! We arrived in Athens around 2:30, very tired but ready to be there! The first thing I saw as we flew in was an Ikea! We’re not in Africa anymore, baby!

            Monday was a free day for Eric so we spent the morning exploring the grounds. We found the playground, the beach and the pool. It wasn’t that warm (60’s) but the boys insisted on going swimming. So they got in the freezing cold water for a while. The meals are served buffet style in a big cafeteria. The food was awesome. The two littles and I took a nap in the afternoon. There was a huge rainstorm in the afternoon. We hung around dinner for a while extra and then came back and put the boys to bed.

The ocean!

The freezing cold pool, so much fun!

            Tuesday Eric started classes with an ultrasound class. I got up and ran before he left and then took the boys to breakfast. There is Nutella and croissants, which was a favorite among the kids. They begged and begged to go swimming again so I took them all to get ready and they swam in the freezing cold water for approximately 10 seconds and then ran around the pool for the next hour+. They played with their friends Josiah and Annie and then we met up with Eric for lunch. Afterward I kept all the kids in while the littles napped. It was akin to torture for the older two. That evening we had a main session where everyone came (there are 700 people here) and it was an introduction, naming all the countries people came from and we were all to wear dress from our country. Very cool. 

Going to Greek School!

    Wednesday the kids went to class for the first time. Overall they did really well. The bigger boys really loved it. They did some sort of a Greek VBS theme. Eric went to different medical sessions and I went to the spouse’s group. We have a speaker that speaks every morning for awhile and then different women share about their fields and their joys/struggles. Then we break off into a small group for prayer/discussion. We then go and get lunch and there are other spouse’s activities in the afternoons, lessons, painting, crocheting J, haircuts and manicures (done on each other!) but I take the littles back for naps. The big boys go back to class. That ends around 4:30 when we all somehow end up back at the freezing cold pool J Dinner and then we usually have to skip the evening session to get the boys to bed to start all over again! Next time I’ll tell about our weekend trip to Athens!

Running Tales

So it’s no secret that I am not the world’s greatest runner. I am an exercise runner, not a pleasure runner. There are those rare days when I actually do enjoy my run, but for the most part I am panting and praying (mostly that my lungs don’t give out and I die during this run).

However, running in Kenya is much more exciting than running on my treadmill in Kentwood. The most exciting thing that happened on my treadmill runs was the occasional child-destroying-the-house while I tried to run or me tripping and falling off (I swear that only happened a few times).

Here, however, there are all kinds of exciting things. Let me tell you about some:

*I get up at 5:45 to run. It is usually very dark (especially if there is no moon) but I am not alone out there! There are many, many school children walking to school at this time (yes, you read that correctly)

*You may know that I like to run alone. However, I rarely run alone these days. Those same school children run with me. In front of me, behind me, beside me. Yes, I am a human ham sandwich. Yes, it is claustrophobic. But they are so excited to run with me.

This happens at different intervals. Some will be with me in the beginning and then turn off at their school, others I will pick up at a different point in my path. All are wearing school shoes, backpacks, coats and hats. (and they still could beat me hands-down in a sprint). Once I tried to avoid them by switching sides of the road when I saw them coming. They simply chased me to the other side.

*Some children I pass  are walking the opposite way I am running. These children yell things at me (mostly Hello! How are you?! occasional snide comments) and expect me to high five every one of them.

*I have to be on the look-out for donkeys. It is dark remember, so I am sometimes surprised by them. I just need to watch out that I don’t run by the back of them and startle them. No one wants a morning donkey kick. Ain’t nobody got time for that.

I also get stopped by groups of cows or donkeys passing, taking up the whole road with their “shepherd” (is that what you’d call them??) smacking them with a twig.

*The real runners are out now, training. Their legs are about as long as my whole body and when they pass me, I think “was that lightening?”Oh no, just a real Kenyan runner passing me as if I were standing still. They are beautiful to watch though.

[ Side note: Kenyan runners don’t care at all about their time in race, it’s all about the place that they finish in. They will be known to quit a race if they can tell they aren’t going to finish at the front]

*There is a man that often runs by me in dress shoes carrying 4 containers of milk. I don’t know why he’s in such a hurry.

*By far my favorite experience is when I pass the man who walks up the road playing Celine Dion on his phone. I just love some good Celine first thing in the morning. 

Remembering our Mounds of Stone

Today is my two year anniversary- two years ago I was given life back- a true gift. Time is so funny, it seems like a lifetime ago and yet the memories are still very fresh in my mind.

  There are questions: Was I really in the hospital that long? How was I so blessed with such a sacrificial mother? How did Eric endure the stress of not knowing if I’d recover? How did my kids really do through this time?

  There are many memories. Hours of lying in a hospital bed. Reading. Praying. Pain. Sleeping. Checking emails. Opening cards. Visits from friends. Watching TV. Eating hospital food. Retaining water. IV’s. Walks down the hall. Abscesses. Drains. CT’s. Trips to the ER. Re-admissions. Prayers of the Saints. Friendships deepened. Phone calls. Exhaustion. Pain. Naps. Doctors. Hope. Gifts. More gifts. Visits from the kids. Bible reading. Games. Mitchell Grand Plan. Open wound. Dressing changes. Nurses. New nurses. Bad nurses. Great nurses. Meals to my family. Help with the kids. Dad traveling every weekend. Eric sleeping on the chair. Much love. Pain. Struggling. Healing.

   Through it all the Lord was so faithful. He healed me. Would He have still been good if He let me die? Absolutely. Not all get to be healed. Some die. I lived. Why? I don’t know. All I know is that I must be faithful with the gift of life I was given. I better not squander my extra time.

  The Lord gives and the Lord takes away. Blessed be the name of the Lord.