Jet lag is such a real thing for me. We arrived at the Nairobi airport at 8pm, noon KC time. It was as I had expected with the international terminal burning down a few weeks ago. Ramp off the plane to the tarmac, bus to the makeshift tent for immigration, and of course a free for all when they finally let us into the tent with our luggage. That was fun. Grab a bag, grab a cart, lose Anne, find another bag far away, one more bag that is of course black, find it, find Anne. Perfect. Head out to the mob of people waiting with little signs that have names in all sizes written on them. I took the short cut and yelled out Samaritan's Purse, Kettler family very loud and out came our driver smiling and happy that I had made it easier. There were no mishaps on the plane as I did not hit Anne in the nose with falling luggage this year. They, whoever they are, reassigned our seats to Nairobi from Amsterdam and Anne sat next to a fairly large man who looked like a bad guy in a movie. Anne said animated movie. He drank no less than 7 bottles of wine on the trip and said less than 10 words. He was of course the aisle seat so I not only felt trapped but was. We made it, and we made it to Tenwek, no harm done. The first night we woke up very early. Anne said it seems like we just went to sleep, but it's 5:30. I said, you didn't change your watch, it's 1:30. We talked and laughed for a couple of hours. That's how jet lag starts. Then when you need to stay awake there is no way to do it. We have been here for 6 days now and it's a lot better. No more afraid to look at the clock for fear it will be 12:30.

I like the way Anne put the pictures in so I will try and take you along my journey at the hospital at times. I am in the endoscopy unit filling in for one of the long term missionaries, Dr. Steve Burgert. He is a gastroenterologist and has things really running smoothly. I go back 15 years here at Tenwek, to a time of overhead paging, like M.A.S.H., and scopes that worked not so well. I did them when I could get away from my work in the wards, and became more proficient as the demand for more complicated things arose. I have now done almost everything except ERCP's. It's challenging and the team in endoscopy is fun and good at what they do. I brought over a scope that was repaired by a Kansas City company, that we have had a relationship with through College Park for years. A small world. The service they have provided Tenwek is amazing, repairing scope after scope. Anyway, the patients receive probably the best care in East Africa, with scopes and equipment that are top quality, and a team of providers that really care about serving. Since a lot of the care centers around esophageal cancer I am happy to say the men and women who work here have not grown cold and cynical, but continue to treat people with dignity and love, praying before each case and showing concern over small details. Many patients cannot swallow and are in pain, so it makes a difference.

I was on call last night and before I went over to casualty (the ER) to evaluate the five or six admissions I had waiting for me I wrote the following in my journal.  The air here is cool with a mild breeze and I can catch a glimpse of a rolling hill several hours walk from here. A lot of people are milling around: visiting family members, staff, patients that can walk. Tenwek has 300 beds so it can be quite action packed at times. I just finished a full day of endoscopy. Lots of cases, all different. It was peaceful out here until just a few minutes ago. An older woman and two younger women tore through here screaming and wailing. Tearing at their clothes and being restrained, they came from the vicinity of the intensive care unit. I could only assume that a family member had died. Grieving here is loud and out in front of anyone and everyone. Death is so in your face here. It seems that very few escape the untimely death of someone in the extended family. Dealing with the endoscopy unit this week has brought me back to "life isn't fair." Cancer, complications, chronic illness, unmet potential, it goes on and on and comes in the door over and over. Being here allows me to be exposed. I cannot hide. I don't want to hide. I draw near to God as they do that suffer. Asking questions that cannot be answered and praying for strength and faith. I pray a lot here.

On the lighter side I made rounds this morning after a pretty good night on call. The two interns I made rounds with were Paul and Barnabas, go figure. The charts are sometimes entertaining to me.
Sick looking = ill
Elderly = anyone over 30
HOB = hotness of body = elevated temp
Loss of pulses = the best I can tell is that the patient has died.

It says pull in this direction, but there is no arrow

This is the staff toilet in endoscopy. The reading material is well, think about it.

 

I will leave you with this. You do not want to be an elderly sick looking mother with HOB just prior to loss of pulses.