Our first Sunday came in Kenya and we were able to attend church at Rift Valley Academy. Our plan was to go to RVA on the first Sunday and the African Inland Church on our last Sunday in Kenya. There was a lot of racial diversity at RVA church because there are so many internationals (and nationals) who send their kids to RVA. The service was extremely similar in structure to a service you might find any given Sunday in the U.S. What did strike me was the level of enthusiasm of the congregation during the music/worship service, adults and kids alike. As we left church that day, the rain came so we piled into the Shirley's van and were taken home. On the way out of RVA we did see a few baboons (a herd? a pack? a gaggle? According to the always reliable wikipedia :), a group of baboons is a troop.) making their way up the hill. We were told to stay away from baboons because they are unpredictable in their behavior and can be aggressive. For example, who would have predicted that this baboon we saw on the safari would be a coffeeholic?
We decide to hike around Kijabe Station that day because we were told you could find monkeys on the lower part of the station. The search for monkeys was fruitless, but we had a nice walk. I got to go play some basketball that afternoon at RVA with some of the other physicians, RVA staff, and other missionaries. Still not accustomed to the elevation, I was tired just by the hike up the hill to RVA, so playing several full-court games wore me out.
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| Cactus trees |
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| Fever tree |
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| Can't remember the name of this tree |
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| On the hike |
On the way back down to the sitaplex, I passed the trash cans where you are supposed to dump your food scraps, and found a monkey sitting on the can having a snack. I hurried down to get the kids since our previous monkey search was unsuccessful. They were very excited to see the monkey, but as we approached the cans, the little guy got nervous and worked his way up into the trees. This picture is a little blurry, but here is the monkey jumping from one branch to another:
We wrapped up the day with a Skype attempt, but it did not work too well over dial-up. Once the kids were settled, I spent some time studying and trying not to be anxious about the return to work the next day.
Monday the 22nd
Monday morning came around and it was back to the hospital. On pediatric rounds, we were consulted by surgery on a child with a shunt infection, which had been treated at another hospital for 7 days before being transferred to Kijabe. Pediatric surgery removed the VP shunt (ventriculoperitoneal shunt, for hydrocephalus) and continued antibiotics for the infection. A culture of CSF had come back that(cerebrospinal fluid) showed his infection to be resistant to the antibiotic that had been used to treat him. As we arrived to see him, we found a child with infrequent, gasping respirations. The resident, John, astutely recognized impending respiratory failure and called for a bag and mask to begin resuscitating him. We called the ICU to see if there was a bed for him and then had to talk to the surgeon to find out if the child should be intubated and ventilated. Because of the limited resources for ICU care and ventilation, not everyone who needs a ventilator can have one. The ICU did have space and the surgeon did feel that the patient should be given a chance to be intubated and ventilated.
We took the child to ICU (carried him quickly upstairs) and made preparations to intubate. The patient was then intubated and placed on the ventilator. He did not fight the intubation much, which is a worrisome sign regarding his neurologic status. He occasionally had decerebrate and decorticate posturing (usually indicative of neurologic damage), but did withdraw from pain. Once intubated, he did well on the ventilator until the next day, when he extubated himself. Fortunately, he was able to breathe independently and maintain his oxygen saturations without significant distress. He was transferred out of ICU later that day because the bed was needed for someone else. Our hope was that he would recover now that he was on an antibiotic to which his bug was not resistant.
Who gets an ICU bed is determined by a combination of who is sickest, who needs it first, and who is likely to only need it for a short time. If the patient is expected to need ventilation for more than a few days, they often don't get a ventilator. This sounds harsh to those of us in the west who are used to the availability of virtually unlimited access to ventilator and ICU care, but giving a ventilator to the patient in that situation could rob several other patients of the needed life-saving intervention. The exceptions tend to be for those who have a good prognosis once their prolonged illness is over, such as Guillan-Barre syndrome or maybe tetanus.
Much of my day was spent getting this child settled in the ICU, and another challenging day came to a close. God continued to make my path straight, though, by allowing my first few times that a child needed intubation and ventilation to occur when I had some of the more experienced attending physicians around. I would have had no idea that I needed to talk to the surgeon before deciding to intubate this child and I still needed some help getting the ventilator set up.
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