Weekend Madness

First of all let me say how awesome it was to have been able to live skype into the Revelations service yesterday at SVPC!!  It was amazing to have the technology to see all of you and hear your voices.  Cathy Reisch, thank you so much for making that happen. It was a special time for us to have with all of you.  Later in the day we were able to Skype with Allie (our oldest daughter who lives in Nashville) so by the end of the day we had been in touch with all of our immediate family, and so many of our church friends.  I am not sure why the connection didn't work for the later church service. Katie and i got the Skype call but we only got sound and it seemed like it was during music and announcement time.  I am sorry that we missed that part of our church family.
So besides our special skype time it was a busy weekend on call for medical wards. I am pretty tired today but for some reason can't nap well here.  I treasure a nap at home but for some reason it just doesn't work well here. I think all the adrenaline floating around my system may have something to do with it.  They call the ER here Casualty.  Because most people arrive by walking or matatu (crowded taxi like vehicles) that cannot travel on the dirt roads after dark,  most patients (which they call clients) arrive before it gets dark. At the equator that is about 7:30 every night without much fluctuation from season to season.  So there is quite a bit of overflow into the waiting area which is just this big open outdoor space outside the actual ER area. It is so strange to just call names out into the night air and someone comes hobbling in.  The ER space holds only about 10-12 people so there were 50-100 clients just hanging out all day sat. and sunday to be seen.  If a patient gets discharged from Casualty after dark they often just sleep on the ground outside (the same place as the waiting area) and walk home the next morning.  This weekend it sort of reminded me of a small refuge camp but they do have bathroom facilities available and there is a small canteen for food they can purchase so it really isn't too bad.  We had 3 deaths per day on friday, saturday, and sunday. Initially you will remember how disappointed and frustrated i was with the fact that we had so many deaths but it seems normal to me now.  They were all due to mostly irreversible problems so it didn't seem so bad.  On the upside, we had a typical "code blue" run on a young man who had taken poison that was actually successful and he is still alive although gravely ill. The ICU nurse told me he had only seen 2 successful recussitations in his 10 year career so i was glad i helped add to his third.  The Kenyans are quite impulsive people and they have a surprising number of suicide attempts/gestures, mostly due to domestic disputes. They take something called Triatrix which is an organophosphate that is  readily available to many of the farmers as it is a pesticide. It is a bonus that is also cheap.  Some dilute it to make it more palatable, some take it straight up but it is quite lethal at not very large doses. I think we have about 50 percent survival if they get to Casualty within a 3-4 hour window.  On the other hand, they don't seem to have much domestic violence - strange that when they have a disagreement with their spouse, they hurt themselves rather than to take the anger out on the other.  Someone out there in psychiatry/counseling try to help analyze that. (Nancy, want to take a shot at that?)  No other strange things now that TB and all the HIV related illnesses are old hat to me.  I did see a case of pericardial tuberculosis that the effusion was so big- for those medical people reading this it was the classic waterbottle heart and i took a photo of the chest xray to bring home with me, it was so impressive and we don't see it much in US. If we see anything like it is not nearly as severe and would be most commonly from Lupus or some metastatic cancers.
The waterfall and dam photos on the previous posting Katie took when she walked to Motego, the highest point in this area. She has found some good friends in one of the med students rotating here and a young pediatrician from Cinncinati.  The waterfall/dam is functional for several reasons to this area. They have built a hydroelectric plant which supplies all the electricity to the hospital compound. Also we realized that Sat and Sun are "laundry and bathing" days as there were apparently many people washing their clothes and their bodies on the side of the dam in the river (which is completely brown colored by the way) as the dam makes it easy to reach the water on the upside.  We always see people fishing and relaxing in this area as well so it serves for food and social as well.  It was a good picture to take and explain as the river is important for so many reasons.
Ann Canary mentioned in one of the comment sections the book Cutting for Stone-  those in Book Club will remember it- now that i am back in Africa it seems so close to home.  For those who haven't read it i do recommend it- although it takes place at a mission hospital in Ethiopia it really has the same feel of medicine in any African country.  Ann Kisinger suggested a book called The Boy who Harnessed the Wind ( William Kamkwamba author) which i just finished. I think we are reading it for Feb book club.- it is about a boy who grew up in Malawi who has a very typical African childhood who builds his family a windmill to provide electricity to his home. His ingenuity and ability to self teach was recognized by a visitor and he ends up with financial support to finish his schooling in Malawi and now is presently a student at Dartmouth University. It is inspirational and the narrative about his home life and the problems with school fees is classic.  Also his description of what he and his family had to do with famine times was excellent and common.  Malnutrition here is a terrible problem.
Thanks again for all the support, encouragement and notes. We are so happy to be sharing this with you. It is our connection to life as we know it in America- it is the first thing i check when i get up (actually i do take a shower first as we only have hot water for a short time in the am and then once hospital is up and running there is no water pressure as we live downhill and the shower just drips) and it is the last thing i do before i go to bed.  It really keeps us going knowing you are all with us in thoughts and prayers.  Tomorrow the post will may be late as i take my last night of call. Tracy and Katie