Last Two Working Days at Kijabe Hospital

My last call night ended Monday morning and I was off to round at the hospital again.  Overall, there were no terrible occurrences that day, for which I was thankful.  On pediatric rounds we learned that our girl with the huge encephalocele was going to get surgery the next morning.  Hallelujah!  Despite the concerns of the surgery resident over the weekend, the surgical team ended up agreeing that she was healthy enough to undergo the anesthesia and surgery risks.  I thanked God that she was finally get the intervention she needed and I looked forward to the final result.

We were consulted by surgery on a wheezing baby who turned out to have too high a dose of ceftriaxone going. We reduced the dose to the weight-appropriate levels and the patient's wheezing improved by the next day.  Wheezing is a little known and rarely occuring side effect of ceftriaxone and that appeared to be what was going on with this child.

I was consulted on a child in the clinic who was having some issues with possible syncope (fainting).  A chest x-ray was done and was unremarkable.  An EKG was done to evaluate this as well.  In the U.S., I have the luxury of having all the EKGs I order being read by a pediatric cardiologist.  No such luxury at Kijabe.  I then had to read the EKG from scratch, which I haven't done since my last pediatric cardiology rotation in residency.  It was a nice refresher on EKGs.

Tuesday would be my last pediatric conference with the interns and residents, so I spent most of the rest of the afternoon and evening preparing my talk.  I decided to hit a variety of topics that I felt would be important for family medicine interns and residents to know about pediatrics.  Among the topics was IV fluids, which is one of my least favorite topics, but I felt it was something I should review with them.  The overriding theme was that you have to make most of your medication and fluid decisions for kids based on their weight, not just their age.

Tuesday also brought no major disasters, but still kept me busy.  I was thankful to see that a pediatric resident had arrived the night before and would be taking over the supervision of the nursery.  One of the family medicine residents who was there for a month would be taking over the pediatric wards once I left, so both the nursery and pediatrics would be covered.  I recognized in the pediatric resident the same sense of both excitement and inadequacy that I had experienced at my arrival.  Knowing that she had done her Neonatal ICU rotations much more recently than I had, I was confident that she would do fine.

The boy we had intubated over the weekend remained stable on the ventilator and, as I had resolved, I did not extubate him prior to my departure.  The girl with the encephalocele was recovering from surgery and spent the night in the ICU, though not on a ventilator.  The blood sugars on the diabetic girl finally stabilized and she was transferred from the ICU.  God had answered my prayer that no one else would die before I left, and I was thankful for that.

Although there were only a few deaths in my short time there, it quadrupled the number of deaths I have had in my practice in 6 years in the U.S.  If that rate continues over the next 6 years (the amount of time I have been practicing and out of residency), that would equate to over 300 pediatric deaths in the same time span that produced 1 death here in the U.S.  By no means is that a scientific statistic, but it does illustrate the difference in pediatric health here and there.  What a great need there is for quality health care in the developing world!

One of the things Amy has pointed out when we show our pictures from out trip is the sign at the entrance to Kijabe Hospital that includes an arrow guiding the way to the morgue.  Death, tragedy, and poverty are a part of life to the Kenyan people, yet they maintain such a joyful attitude.  We could learn some lessons from the Kenyans.  I am reminded of the verse in Proverbs that states:

Proverbs 30:8b     give me neither poverty nor riches; feed me with the food that is needful for me,

⁹ lest I be full and deny you and say, “Who is the Lord?” or lest I be poor and steal and profane the name of my God. The Holy Bible : English Standard Version. Wheaton : Standard Bible Society, 2001, S. Pr 30:8-9  

We have reached the point in the U.S. where we congratulate ourselves on our wealth and accomplishments and deny God as the source of our prosperity.  We use "the American dream" and "retirement planning" as justification for the hoarding of our wealth.  When compared to the rest of the world, there are few (some, though) in the U.S. who are not wealthy.  May we recognize God as the source of this prosperity and understand that God gives us this prosperity to use for His glory, not to guarantee that we will not have to earn a living past the standard retirement age.  In fact, I think we should expect to labor throughout our living days.

Gen 3:17  And to Adam he said,

     “     Because you have listened to the voice of your wife

                    and have eaten of the tree

     ^l     of which I commanded you,

               ‘     You shall not eat of it,’

     ^m     cursed is the ground because of you;

               ^n     in pain you shall eat of it all the days of your life;

¹⁸           thorns and thistles it shall bring forth for you;

                    and you shall eat the plants of the field.

¹⁹           By the sweat of your face

                    you shall eat bread,

          till you return to the ground,

                    for out of it you were taken;

     ^o     for you are dust,

                    and ^pto dust you shall return.”

The Holy Bible : English Standard Version. Wheaton : Standard Bible Society, 2001, S. Ge 3:17-19

Don't misunderstand the above.  I don't particularly hope to continue working through my 70s and 80s; in fact, I am rather lazy by nature.  I prefer not to work even now in my 30s, at least not as hard as I must.  I like the idea of retiring and would love to do so someday.  I am just not sure that saving for retirement should prevent us from using our resources for God's glory now.  How many BILLIONS of dollars are tied up in the 401K accounts of Christians (including me)?