Thursday, July 24, 2014

House of Mourning

Ecclesiastes 7:2 says, "It is better to go to a house of mourning than to go to a house of feasting, for death is the destiny of every man; the living should take this to heart."

Several days ago we admitted a very sick 19 year old who had been operated on three times over the past week at a nearby hospital and was referred to Tenwek.  Her first surgery was a cesarean section, however, she was found to have large bilateral ovarian tumors.  It wasn't clear why she had the second two surgeries.  She was then brought to Tenwek.  She was extremely ill with multi-organ failure.  

On Tuesday night I asked the surgeons to see her due to an abnormality found on her imaging, and later that night they did a fourth surgery, only to discover that indeed her abdomen was completely filled with cancer.  On Wednesday morning, after staff devotions, the surgeon, internist and respiratory therapist spoke with our team.  The plan would be to meet with the patient's family and to begin the process of removing life support.  

My medical student, Rose (pictured on the left in the picture), wants to be a critical care specialist or a nephrologist, or both.  She is remarkably talented.  After she had presented this morning in rounds, I spoke to them about how at this point how we now have multiple patients to care for.  Not only do we have our patient who is dying, but now we have all of the family members as patients, as they are suffering and grieving the loss off their daughter, sister, friend.  We also talked about how this is difficult for us as caregivers, and how we despise the face of death, where there is little else that we can do.  

Yet, when we face death; when we go through very difficult times, God uses those moments for us to reflect on our own finite physical lives here on earth.  God uses those times to change who we are, and to cause us to become more compassionate people.  If we go to a party or a celebration, very little happens to us that changes our character; however, when we mourn and grieve, even if for others, God uses that pain and grieving to stir within us change deep inside of us; indeed to make us better people and more compassionate toward others.  

The verse is worth repeating: "It is better to go to a house of mourning than to go to a house of feasting, for death is the destiny of every man; the living should take this to heart."  Please keep this patient's family and my medical team in your prayers today.  


Wednesday, July 23, 2014

...but she is still bleeding.




For the faint of heart, I will wait to share my medical story until the end of this blog, just in case you don't want to look. 

Please be fore warned that not everyone will want to see the third picture on this blog today.

One of the things I enjoy most about serving overseas is spending more time with my family.  Although Teresa is far better at making puzzles than I am, we spent a lot of time together working on this puzzle.  The shades of brown nearly drove me mad!  

Teresa, Anna and Amber spent the afternoon on Tuesday with another missionary physician's children.  Their mother needed to get some time to herself to finish off some reports.  When I walked into our apartment at the end of the day, the kids were piled up on the sofa listening to Teresa read books.  Today (Wednesday), Teresa and the girls are going to mud a hut.  I'm not sure what all is involved with that, but I told them to be sure to wear white!  Hopefully I can post some pictures soon!
On Tuesday morning I was in the morbidity and mortality (M&M) conference at the hospital, listening to my students present several patients and the ob/gyn statistics from last month.  A few minutes into the first patient presentation, my pager went off.  It was the phone number for the labor ward with a 999 after the number, which means it is an emergency.  

I called the number and my medical student, Purity, said in her usual quiet and barely audible voice, that a patient had miscarried and that she was still bleeding.  Little did I know at that moment, but that would be the theme of the day.  It seemed that all day long, everytime I was paged, the conversation would end with the words, "but she is still bleeding."  

I knew that we were in trouble as I walked into the labor ward and followed the bloodied footsteps leading to the last labor bed.  When I walked around the curtain, one of the things that I saw were the shoes of the patient on the floor next to her bed.  I can't show you the picture of what else I saw, but suffice it to say it was 100 times worse that the shoes on the floor.  After doing an emergency dilation and curettage on this woman, we then had a patient deliver a severely anomalous baby and then she had a postpartum hemorrhage.  A previous volunteer had donated a Bakri Balloon device, which is a life saving device for severe postpartum hemorrhage.  I had to pull this prized item from the doctor's locker and used it to save this woman's life, as she had bled so much that she was in the early stages of a bleeding disorder called disseminated intravascular coagulation.  I checked on her at midnight last night and she is doing well after receiving multiple units of blood.  Today I will remove the Bakri device from her uterus.  
Patient shoes on the floor of labor ward.
It is incredibly gratifying to come and to teach and to serve these patients, doctors, nurses and students here.   Thank you for your prayers and support for us to be here.  Please pray for the many patients that we are caring for that are so incredibly sick.  In the United States it is unusual for me to have a patient in the Intensive Care Unit, and here today I have four! 

Sunday, July 20, 2014

Cow Dedication Sunday


After months of organizing and planning, and with the extremely generous support of so many people, we attended the first cow dedication ceremony.  Our family piled into Katie Davis' car and drove about twenty minutes this morning to the church where the cow dedication service would take place.  There was a lot of singing and dancing.  Katie Davis, the wife of infectious disease physician Michael Davis, presented a beautiful summary of the entire Bible for the church congregation, incorporating the children holding up pictures that she had brought to illustrate the stories.  
 
The pastor shared that she had broken from her line and that they had been looking for her for a few days, but that they had found her.  "A prodigal cow..." I thought to myself.  We adjourned outside where the cow was feeding.  

Typically the cows are given to widows who have children, but in this case, the Tabitha Ministries board had chosen a couple who must remain on chronic medical therapy because of a chronic immune deficiency syndrome and are struggling to make ends meet.  The decision of who gets the cows is left up to the Tabitha Ministries board members and local church officials.  This system seems to work out very well, where the process is not abused.  

This is one of the daughters of the couple who are receiving the cows.  She was a bit shy, but I managed to get her to smile.  She was also walking and holding Anna and Amber's hands.  

 This was the younger of the daughters.  She was staying very close to her mama.  They said that there were other children who were not able to attend today. 
 Here is Teresa with Janet, the pastors' wife.  They invited us over for a mid-afternoon lunch and tea time at their house, and they also showed us how they care and feed for their own cows. 
 I hesitated to take a picture of the food, but it was really good.  It was a simple mix of beans, rice, potatoes and chapati (which is like a thick tortilla made with extra lard to make it taste really delicious).  Their tiny living room was packed full of their guests.
 The senior board member of Tabitha Ministries, Pastor David, took us on a tour outside to show us how they care for the cows.  
 This is a dried high protein cow food that they make from a mixture of dried grasses and plants that are grown and harvested on the property.  
 Here is the pastor's son after a demonstration of the machine that cuts the plants and hay up into the feed mix that they make themselves.  This machine was essentially an open blade that a motor spins as you feed the plants and hay into the blade.  The pastor cautioned afterward not to put your hand in the blade, but it looked like an accident to happen to me!  I couldn't help but wonder how many fingers had been unintentionally added to cow feed. 
 Anna and Amber seems to have an affinity for cows, at least until this one slobbered up Amber's arm.  
 This is Margaret, the woman who received the cow today.  She was incredibly grateful and humble about her family receiving the cow.  
 The pastor walked us down to show us the fields where they grow the grass and plants that they use to feed their cows. 
 This cow really wanted her picture taken!  These cows were not afraid of people at all, and followed us around.  
They showed us the milking process and took some of the fresh milk to make us chai.  We adjourned back to the pastors' living room to enjoy fresh hot chai.  The chai is very sweet here, and was probably more delicious because of the fresh whole unpasteurized milk.  Yummy!

A special thank you to over 100 of our friends who have given toward the purchase of these cows.  These cows will change the lives of widows and their families.  Although the cow today was given to a family, their were unusual circumstances here.  A cow can provide food and income for these widows, and is a huge stabilization for their families.  If you would like to donate toward a cow, every $30 or $300 donation received on this blog will be considered a donation toward a cow.  One cow = $300.  You can go to the home page of this blog and then follow the directions next to the Donate Here box.  Thank you!  

Saturday, July 19, 2014

Sepsis

The sickest patient on our service is a 21 year old woman who had delivered at home.  She came to the hospital with a severe infection that initially we thought was inside her uterus and extending into her bloodstream, otherwise known as puerperal sepsis.  Later in the day her status deteriorated and we admitted her to the ICU, and before the day had ended we had to sedate her and put her on a ventilator.
We were treating her with potent antibiotics and treated her for malaria, but she was not improving.  Her fever was very high and she was developing other complications.  The medical student that we have overseeing her care is named Carolyne (pictured here on the phone in the ICU talking with radiology).

Yesterday morning on rounds our patient opened her eyes when we said her name and began gesturing that she wanted to have some of her tubes removed from her mouth and nose.  Although she was restrained, she was able to reach up and grab her endotracheal tube and pull it out of her mouth.  
As the tube was removed she also vomited, and this ascaris worm came up.  This worm is about 5 inches long, and can cause all kinds of problems with patient management.

Please be praying for this very sick woman.  She has so many things wrong with her, and she still is in critical condition.  Her baby, fortunately, is doing very well in the nursery.  Please pray for her doctors, that we would have wisdom and clarity of insight as we treat the many problems that she has.  I am grateful for the devoted students that I have the opportunity to teach while I am here, and am very grateful to the dedication that Carolyn has shown to her patient.  

Healing for Hewa




In July 2012 we were given the opportunity to go with a small medical team into the jungles of Papua New Guinea to a people group that had never had access to western trained physicians before.  An extremely talented media team went with us and just this past week Samaritan's Purse released the 32 minute documentary on their website.  Please sit back and enjoy...with a box of Kleenex!  http://www.samaritanspurse.org/women/healing-for-hewa/

Back breaking surgery...

 For all of my medical friends out there following this blog, today it is my desire to show you the level of difficulty of the surgeries here.  Also, even more so, to all of those of you who contributed to the purchase of the ultrasound machine, it is being put to tremendous use to help women and their babies.

The first photograph is of me scanning a patient prior to surgery on the operating table.  She has large uterine fibroids and has never been able to conceive a baby and needs to have a myomectomy to remove the fibroids so that she can conceive.  Her uterus can be felt nearly up to her xiphoid.
 We made an incision from the top to the bottom of her abdomen and lifted her uterus up into our hands and rested it on her abdomen.  After four hours of back breaking surgery, we had removed 38 fibroids weighing 5.2 pounds.  

And here I am at the end of the surgery closing her uterus.  I am very grateful to report that at the next day she is recuperating very well.  We showed her the pictures from the surgery.  She kept thanking us over and over.  I am overwhelmed with her gratitude.

Thank you again to all of you who contributed for us to be here; for the ultrasound machine; for our expenses, and for all of the medical and surgical supplies that we brought with us.  We could not be here and do what we do if it were not for your generosity and prayers.  

Thursday, July 17, 2014

The Simple Things...

I apologize for those who are waiting for me to post something from Kenya, but the internet issues have not been easy to overcome.

Our daughters, Anna and Amber, have been working on their knitting hobby, and this morning Amber brought this newly made hat and asked me to take it to the NICU and put in on a baby.  I walked into the NICU and the first baby on the left inside the door looked like the perfect candidate.  Amber was so proud of herself when I returned home to show her the picture, and I must admit I was a pretty proud father, knowing the love and concern that Amber had put into making this tiny hat for this tiny baby.

If I had to choose one word to choose to describe the work here it would be OVERWHELMING.  Just today I was dealing with patients with cervical cancer, uterine cancer, HIV, tuberculosis, cryptococcal meningitis, herpes, rheumatic heart disease, puerpural sepsis, malaria, infertility...and the list goes on.  The staff and students here at Tenwek Hospital are amazing and helpful.  I am working with two medical students and two PA students and one equivalent of a resident physician.  Plus this week and the week after next I am working with one of the World Medical Mission post-residency ob/gyn physicians, Dr. Rebecca Ross, who is here for two years.  Next week she is taking the week off, since I am here, and I am eager to give her a break.

This place is a kid haven.  Teresa has been busy making cookies and attracting all of the missionary kids to our house.  Anna and Amber have loved making new friends.  Today Teresa and the girls went to a Kenyan primary school for the afternoon.  They had a great time playing with the kids and interacting with them.

I promise to write more later!

Allan for the rest of the Sawyer Family