Bethany Kids

Jesus said, "Let the little children come to me and do not hinder them,
for to such belongs the kingdom of heaven."
Matthew 19:14

Up through the bowels of the hospital and down a long, lighted hallway is the pediatric ward at Kijabe Hospital, called Bethany Kids.  Early Wednesday mornings I cross the road outside our gate and then the lower parking lot and head there.

Most of  the little ones admitted here have a serious, life-threatening disease or have been in a horrible accident or are waiting for (or recovering from) surgery.

Passing down the rows of beds you will see lethargic babies with hydrocephalus (enlargement of the head due to water in the brain) and other deformities, others with scary diseases like malaria and meningitis, children with metal pins protruding from their heavy casts because they have been hit by cars or pikis (motorcycles), and burn victims covered with rolls of white bandages. 

Oddly, there is very little crying. Mostly there are only the sounds of mothers talking to each other and the occasional news report on the TV.

Each mama stays with her child in the same bed. She feeds him and changes him and washes his few clothes. Despite the differences in tribe or nationality or socio-economic status, there is fellowship and community. I don’t think there is a greater bond between two mamas than the pain of having hurting children. 

I enter quietly and begin going from bed to bed greeting each parent in Kiswahili. Usually I sit or kneel next to them and ask a few questions—what is your name, where is your home, is this your first born or do you have other children and finally, may I pray for you? 

Then I hold a hand (or two) and we lift up the worries and fears weighing on our hearts. Sometimes we have no language in common except the words “Jesus” and “amen.” But it is enough. And as we humbly pray together I can sense the overwhelming presence of the almighty, compassionate Lord. And in that moment the hospital ward becomes a sacred, holy place.

For some of these children the future is bright—the bones will heal or the scars from surgery will fade. But for others the outcome is unclear or even too clear. In Kenya there is little or no help or support for families with mentally or physically handicapped children. Babies and children die, parents and families grieve.

Yet today when I turn to leave there are many asantes (thank yous) and Mungu akubariki (God bless you.)

Na wewe, mama. You, as well.

- Kathy

Hospital Life

So His fame spread throughout all Syria, and they brought Him all the sick, 

those afflicted with various diseases and pains, those oppressed by demons, epileptics and paralytics, 

and He healed them. 

Matthew 4:24

In many ways, our life revolves around the hospital. I work mostly in the Outpatient Department, Kathy visits and prays with mamas in the Bethany Kids pediatric ward, and we walk through the hospital on our way to the dukas (shops) or to various friends' homes.

Our hospital has been designated by the Kenyan government as one of the top referral hospitals in the country, and much more growth is envisioned for the next few years. Each day, patients travel hundreds of miles and often from other countries to see one of our doctors.






It's a lively, bustling place, filled with patients, visitors, and staff. We see several hundred outpatients every week, and the 300+ inpatient beds are often completely full.















On nice days, patients and families like to gather in the central plaza, in the sunshine or under a tree.

We see some pretty interesting things here. This teenager from western Kenya had been coughing for 2 years, and we found the cause - an object lodged in his airway. 






Unusual injuries occur during everyday life in Kenya - here's what happens when you get hit in the leg by a jerry can filled with fresh milk.

I've grown to love the people I work with, and I often walk home grateful to be part of an amazing team in an amazing place, sharing the love of Christ through the care that we provide.

- Doug

RTA

For He will command His angels concerning you,

to guard you in all your ways.

Psalm 91:11

I’m on call at the hospital this weekend. Today I made rounds in one of the “High Dependency Units” at the hospital, for patients who need a higher level of care, but not quite ICU care. Today’s rounds left me feeling angry and sad.

The HDU has 5 beds, and 3 are currently occupied by victims of what we call road traffic accidents, or RTA’s. Two of them have severe brain injury, with a guarded prognosis. 

In Snohomish, we have a skilled nursing facility which has specialized over the years in caring for patients with severe traumatic brain injury. But no such facility exists in Kenya, so these two men will spend weeks in the hospital before going home to an uncertain future. 

Due to the level of surgical and orthopedic care we offer, and because of our proximity to the highway, Kijabe Hospital treats a large number of RTA victims.

But many don’t make it. Every year thousands of Kenyans die in road traffic accidents, a large number for a country this size. Hardly a week goes by when we don’t hear of another tragic accident somewhere in Kenya, often on the main 2-lane highway on the escarpment above Kijabe. Last week a bus careened off an embankment west of here, crushing the bus and killing over 50 people. 

Other times it’s a matatu accident, often involving high speed, reckless driving in these 14-passenger minivans. Most of the main highways have only 2 lanes, and it’s common to see vehicles passing dangerously on a curve or playing a Kenyan form of “chicken” with oncoming traffic. Buses and matatus are often not maintained properly, and safe driving laws are routinely ignored.

Kathy and I travel somewhere every couple weeks, usually with a private driver whom we have hired. We know that there is a risk every time we take to the roads, and we pray each time that God will keep us safe. And we pray for the thousands of Kenyan families who lose loved ones every year.

- Doug

Photos courtesy of The Daily Nation

The Mara

And God made the beasts of the earth according to their kinds and the livestock according to their kinds, 

and everything that creeps on the ground according to its kind. And God saw that it was good.

Genesis 1:25

The Masai Mara never ceases to give us wonder and amazement. Teeming with wildlife, there are miles of open grasslands, tall acacia trees, and thickets of brush.

We went there last month with another couple, Morgan and Kim, visiting pathologists from California. Together we spent three days with our guide Joseph in a safari vehicle, driving around the Mara, wherever the animals were, pulling in close while respecting their dignity and wildness.

I'll let the photos tell the rest.

- Doug

Antelopes of many types, from the tiny dikdik ...

... to the mighty eland.

White rhino, endangered and protected.

The king of beasts!

And the lioness, resting after a night of hunting.

A few members of a huge herd of Cape buffalo.

Hyena resting in the shade.

The elusive leopard. 

Stopping for lunch.

Zebra.

Cheetah, in the shade ...

... and in the open.

The Masai Mara.

OPD

“… the people immediately recognized Him and ran about the whole region

and began to bring the sick people on their beds to wherever they heard He was.”

Mark 6:55

OPD (Outpatient Department) is a fascinating place.

Patients come from all over East Africa; many are local, from Kiambu and Nakuru Counties, but others come from western Kenya near Lake Victoria, some from eastern Kenya near Somalia or along the coast, and some with the means to travel even come from other countries in East Africa, such as Ethiopia, Somalia, Rwanda, Burundi, and Congo. 

Many travel for hours or overnight in order to see a doctor at Kijabe Hospital. They have heard about the quality of care here; it’s often better than what they can expect at a government facility or even some of the private hospitals in the cities.

Most come by matatu. Matatus are small tightly-packed 14-seat vans that are the basic public transportation in Kenya. When we say “the bus came in”, it’s literally the case here! Others arrive riding on the back of a piki (motorcycle), and a few have their own cars.

It costs 500 Kenya shillings (about $5) for a new patient in OPD, and 300KSh for a return patient. A small fee by our standards, and affordable for some East Africans, but a large amount for the majority of Kenyan farmers and laborers, so they don’t come unless they are quite ill. There is also the Private Clinic, where one can pay a bit extra to see a doctor while avoiding the crowd. I staff the Private Clinic one day per week.

OPD is all walk in, first come first served. After paying their fee and being screened by the triage nurse, patients wait on benches to be called. The very sick are sent next door to Casualty (our ER). Most patients will be seen by a resident MD or by one of our Clinical Officers (like PA’s), who do an excellent job evaluating and treating patients – I’m impressed with how competent they are. 

Along with another senior MD, I serve as a consultant for the 6 or 8 CO’s working each day, and I may also see a few patients who can speak Kiingereza (English).

OPD can be a noisy, congested place, with people going every which way. The rooms are small, often cold, and minimally equipped. Jonathan and his crew orchestrate who is going where, and somehow it all fits together. When we order a lab test, Xray, or CT, the patient sees the cashier to pay for it, then goes to get the test done – everything is prepaid in Kenya. 

When the results are back, the patient comes back to us for review. We actually have a PACS system for viewing Xrays, doing our own interpretations. CT’s are transmitted to a radiologist in Kisumu, a city on the edge of Lake Victoria, and we get a report back in about an hour. Ultrasounds are interpreted by the tech, who gives us a typed report.

When the visit is over, patients head off to the cashier to pay for their medicine, pick it up at the pharmacy, and head up the hill to the matatu stop.

Start to finish, a visit to OPD can consume the entire day. We feel some pressure to tie things up for a patient, as many of them have travelled hours and many kilometers to get here, and the matatus leave by late afternoon. We can’t just say come back tomorrow for your test results. But getting it all tied up is not always easy to do, so we sometimes compromise, doing as much as we can in a day, prescribing a trial of treatment, and advising them to return in a week or two.

We have some specialties available here, such as GYN, surgery, ENT, and ortho, and a few Kenyan specialists such as a cardiologist and an oncologist who come to Kijabe once a week. MRI’s can be scheduled at various facilities in Nairobi. A state-of-the-art MRI costs around 15,000KSh (about $150), quite cheap compared to U.S. prices, but still expensive for most Kenyans, so sometimes we must do without.

A few patients I saw last week:

A 36 year old woman came with her husband from Kakamega, several hours away near the Ugandan border. She found a breast lump recently, and had a biopsy report in hand, including hormone receptor status. She was seeking a second opinion. After reviewing everything, I walked over to talk with Peter Bird, one of our surgeons, and he agreed to see her right away. She will probably need a lumpectomy and chemotherapy.

A 50 year old Muslim man from Nairobi suffered a fractured tibia when he was hit by a piki about 5 months ago. He was initially treated in Nairobi with a plaster cast, which was replaced 2 months later. Now the plaster was soft and disintegrating, and his leg was still very painful; he couldn’t bear weight on it. An Xray confirmed a malunion. I had him see orthopedics, and he will return for surgery at a later date. Surgery will be expensive, but he will send texts to family and friends, and they will transmit funds to him via cellphone so he can pay for it.

A 60 year old man came with his wife from Nakuru, about 2 hours north of here. He had been seeing a cardiologist for hypertension, marked edema, and shortness of breath, but was not improving. His chest Xray showed a large heart with a pleural effusion, but most striking was his creatinine of 9.8, almost 10 times normal. He has renal failure, likely due to hypertensive kidney disease, and needs dialysis. I asked around and found that there are many more sites offering dialysis than there were in 2010, including his district hospital in Nakuru. His wife will take him there.

A 78 year old Nandi man came with a group of about 8 family members. The Nandi people are farmers and herdsmen from dry regions of northern Kenya. He was in failing health, with worsening rib pain for several months. His blood tests were pretty good, but his chest Xray was suspicious. They had funds to pay for a chest CT, which confirmed my suspicion of multiple myeloma. He will stay with his family in Nairobi and return to see the visiting oncologist later in the week.

As a contrast, a 17 year old girl from a more affluent family in Nairobi came in with her mother because of bunions in both feet. Most rural Kenyans wear old flipflops or go barefoot (and have very few foot problems), but this girl had been wearing tight, fashionable shoes for too long, and her feet were showing it at a very early age. Western afflictions are becoming more common in Kenya!

- Doug

Bags of Food

And the King will answer them,"Truly I say to you, 

as you did it to one of the least of these my brothers, you did it to me."

Matthew 25.40

Friday was my day off. John picked us up along with Samantha (a family physician from Pennsylvania) and we drove a few miles north to Old Kijabe Town. It hasn’t changed much since we were last there in 2010. There are a number of mud and stick huts surrounded by fields of maize with occasional cows, sheep, and vegetable gardens.

John provides help to a number of widows and orphans in Kijabe Town. In the back of the Land Cruiser were bags of food for these women, each bag containing maize meal, rice, beans, a kilo of butter, and an assortment of cabbage, carrots, and potatoes. These monthly bags of food are life-giving to these women and the children they care for.

First we visited a grandmother named Mary. Mary is blind and frail, and cares for her 2 granddaughters with the help of a few neighbors. Her struggles are substantial. Her granddaughters Susan and Mary are in grades 5 and 8 at the local primary school. The term started last week, but the girls were sent home for nonpayment of school fees. Each of them needs 3,500 Kenya shillings (about $35) to stay in school this year, but the family has no money.

At the end of grade 8, Mary will take the national exam for placement in secondary school. John thinks she is pretty smart and will do well on the exam, but secondary school fees may range from $250 to $500 per term. Through the generosity of those who support John’s ministry, we’re hoping to help get these girls back to school and keep them there.

Mary has other challenges. With her blindness, it’s a long walk to the family outhouse, so John has started building a new one close to the house so Mary can get there easily.

Then we visited another Mary. Also elderly and frail, she too cares for her grandchildren. In many Kenyan families, the middle generation has died of AIDS or simply disappeared to the streets.

Mary had an operation earlier this year to help correct a spinal condition, and it’s quite a bit better, but she still walks bent over and uses a walking stick.

A group of 8 women greeted us at the next home. They are more able-bodied, able to carry a heavy bag of food with the strap across the forehead. One is nursing an infant, while the others are older.

Each woman shared with us some of her burdens – illness, family struggles, and so on. One woman’s husband had a knee operation but cannot pay the remaining hospital bill of 10,000KSh (about $100). A few others have no teeth, and are saving to afford dentures so they can chew again.







We took turns praying for each woman, and each one took her bag of food home.

Finally, we drove on down to the Rift Valley floor, crossed the highway, and made our way on bumpy dirt roads to a tiny house in the middle of dry fields of maize. Virginia was there, and we left bags of food for her and her neighbor Victoria. Both are widows who have come under John’s care.

The bags of food are life-giving for these women and their families, and sharing them is life-giving for us as we help John with his work.

- Doug