Wrapping up October and our first month in Kenya

 We have had a pretty good week here in Kapsowar. Here are a few pics to enjoy. Above is one of Layna's favorite places to hang out. It's just outside our back door. She enjoys going up and down the steps or just sitting with her lovey and relaxing :).

 Above is a picture of Braelyn, Eunice(on the left, our house helper), and Edna on the right who is Eunice's sister and also a house helper for all the families on the station. Edna has a reputation for being the best cook around. She can make tortillas, homemade bread, pumpkin & banana bread, and probably lots more. So, she came over this past week to help teach Eunice and I how she makes tortillas here. Braelyn LOVES helping out in the kitchen. She has become quite the cook since we are doing so much baking and cooking here.

 Here are a few pics from a walk we took yesterday (saturday) to Rorock. There is a church plant there that meets at a school. We have been wanting to visit the church, so we just walked there to make sure we knew where it was and how long it took us to get there. With two whiny girls, it took about 25 minutes!! We were hoping to visit there this morning but it rained a lot last night and it is a dirt road, so maybe next week. I enjoyed getting outside the station and seeing a little more of the countryside.

 And we found a little friend on our way back :). The girls thought he was pretty cute.

So, overall, we have had a good week here in Kapsowar. I am learning that cooking two meals in one day really helps give me a break from having to think about meal planning all the time. We had pretty weather most of the week so the girls and I took a few walks outside. I shopped at the open market by myself on Friday. I will do another post sometime about food and what kind of things we eat around here. We got a lot of cards in the mail this week, which was really fun. Thanks to all of you who sent them. Aaron was able to go to the community outreach clinic on Thursday and he really enjoyed that. It was about a 45 minute drive from Kapsowar and they saw a lot of people there. He really enjoys getting out into the community. We have had power more consistently this week, which has been nice. Thank you all for supporting us and keeping up with our family. We really appreciate your prayers and support.

Please pray for me as I might have an opportunity to lead or co-lead a bible study with nursing students. Still trying to figure it out right now, but pray I would have wisdom with that.

Also, please pray for Layna. She has had a bad cough for almost two weeks now. Please pray it would go away soon. She usually wakes up 2 or 3 times each night with coughing fits. So we haven't been sleeping well in our house.

Also, please continue to pray for wisdom with ministry opportunities and a church home.

Thank you for joining with us in this ministry!

Hmmm, I don't remember learning this in residency!

Aaron here. So I've had a few people ask what kind of stuff I'm seeing here in Kenya. Honestly, I'm still not completely sure yet but I'll share some of my patient encounters with some added details for you medical minded out there.
I have been blessed to be "eased" into medicine here. I took the 1st week to get settled in our house, adjust to the time change and adjust to being at 7,000 ft elevation ( after playing some flag football yesterday I'm still not sure I'm adjusted!). Anyway, the first two days I spent following Kyle Jones around. We saw the men and women wards (maybe 6-8 patients each ward) then the peds ward (10 kids probably) Then OB (4 or 5 patients there post partum from C-sections). Also saw the nursery patients- you don't see the health babies here only the ones with problems. Then we went to the outpatient department and saw some patients waiting there to see the doctor. Also had 2 c-sections sometime during that 1st day.
The next day was similar then it happened...I was on my own! Well I still could call Kyle if needed but he's a busy guy and I didn't want to bother him on every patient.
So I started with the men's and women's wards and here is what I saw:
1. 70 year old man with an esophageal mass on EGD (the surgeons do those so that's great). He had been vomiting blood for months and unable to keep any food down during that time. He had 2 episodes of low blood sugar the night before, they use a different measurement for blood sugars that I'm still getting used to but he was low. Kyle had placed an external jugular line the day prior to get him some sugar as he for some reason had no IV line at the time of his low sugar. The day I saw him his family felt he wasn't acting correct and he seem to be somewhat delirious. but his urine output was only 300cc for the past 13-15 hours total. He was talking out of his head, vomiting blood and not getting any nutrition due to the NG tube not being able to go past the mass. His lungs sounded like there was a monster in there trying to get out with every breath!
So after standing there for a while and not sure what to do I prayed with him and his family and made some fluid adjustments, checked that he was on abx for aspiration pneumonia and went to my next patient praying he had something I could "fix" with medicine.
2. Next patient is a newly diagnosed HIV patient with cryptococcus mennigitis confirmed with india ink on lumbar puncture. He's on all the anti-retroviral therapy plus high dose fluconazole. The nurse asks if amphoterican B would be good for him... I smile and say let me check my book (oxford handbook of tropical medicine...every page I now turn to is something I have seen or treated!) so we changed him to Amp B per the oxford dosing guide.
3. Next patient is a community acquired pneumonia, seems to be improving but was also newly diagnosed with HIV.
4. Next man is an 80 year old man that has been admitted within the last few hours and is waiting on me to diagnose and treat him. complaining of hurting all over, vomiting for 2 weeks and diarrhea. Fever. I'm thinking some parasitic disease or Typhoid or both. He also has urinary retention and we can't get a cath in so he goes to the OR.
5. Final male patient has pneumonia and is improving but had a TIA yesterday but going home today
So that took about 2 hours... on to the women

1. 37 year old HIV patient with sepsis but we can't do any cultures so we don't really know what we are treating. Started on ceftriaxone but we ran out so started on sulbactamax (not a med we have in the US) but we ran out and now changing to Augmentin. Also has flagly, bactrim, fluconazole. She is in respiratory distress but on oxygen and evidently has been like this for a few days.
2. a 60 year old woman with a CT from a year ago from another hospital showing she has multiple brain tumors. She fell asleep 3 weeks ago and the family would like us to help her wake up. We all assumed she had herniated and is days from dying but now she is waking up and following simple commands.
3. New patient that needs to be seen. She is 24 and having consistent vaginal bleeding for 3 months. She decided to come in today due to heart palpitations and dizziness. hgb is 2.6 (normal is 11-14 and we transfuse anything under 7) I order 3 units to start with and recheck on her in 3 hours and she is still waiting on the blood due to lack of supply.
4. 45 y.o lady recovering from small bowel obstruction but now her hand where he had an IV is swollen and painful up to her shoulder and I can't feel a pulse so I send her to the OR where I do find a pulse with doppler but she still gets an I&D and started on cefuroxamine.
5. 18 year old with Typhoid doing better but HIV came back positive and she is in denial and doesn't want any labs (they always send a CD4 to Eldoret 2 hours away) or meds for it.
6. 40 year old with Giardia and Amobiasis recovering well on meds
7. 38 year old with cerebral malaria recovering on quinine.

Went back later for a 3rd C/S that day with Kyle, this one was thought to have a prolapsed cord but our Ultrasound machine isn't working, needs a new power cord. Baby heart rate is 175. Ends up being thick meconium. we suction at the cords and bag for 3 hours but the full term baby tires out and dies from likely meconium aspiration. we did give meds and fluids but we have no ventilators here which would have bought her some time at least.

So to make a long post longer let me share the outcomes of these patients. Sorry I'm being lazy you are going to have to scroll back and forth to see who I'm talking about. First the male ward

1.  Pt pulled out all his lines and ended up dying 2 nights later at the hospital
2. Improved then did worse then improved and was able to eat and set up then died 2 days ago at the hospital.
3. went home
4. just 2 hours after cath was placed in the OR he died probably from having massive amounts of vomiting and diarrhea
5.  went home

women
1. Was started on PCP treatment (high dose bactrim) then TB treatment due to an ESR of 60 but not able to get a sputum sample. XR showed pulmonary edema so she was also started on lasix. Then died 2 days ago
2. Is now more alert and getting feeds via ng tube but has some large pressure ulcers that need surgical attention
3. received 2 units but was waiting for her family to come give blood. started on an estrogen taper and last I saw her she was feeling better, and had been discharged but doesn't have the money to pay her bill so she just hangs out at the hospital until her family can get the funds to pay. She doesn't seem to mind though.
4. hand is healing and will probably go home soon
5. 6. 7. all went home

So again this is NOT what I learned in residency but I am thankful to be here and although it is still hard work I am glad to be a part of it...most of the time! I am also thankful that even though I didn't learn this in my training I did learn how to learn and how to use a history and physical to guide me in diagnosis. but is still have a LONG way to go. thank you for your prayers. I need them!

So I know it was long and boring for some of you but just for getting this far you get a pic of the girls!

Getting settled

 Well we have been in Kapsowar for 3 weeks tomorrow (friday) and we are learning so much! The above picture is at the entrance of the hospital. I (Aaron) am starting to almost have some small sort of idea of how to do medicine here! I'll post soon about my 1st week of work for all you interested out there. I did my first C-Section yesterday with Kyle assisting me. I was slow but everyone involved is doing well (myself included!)

 Last Saturday night we all woke up at 230am from a huge shaking of our house, we thought someone was trying to get into our house. Come to find out it was a huge branch of a tree that had fallen on the power lines. if fell about 30 ft. thankfully no one was hurt

 Here's mom leaving at 5am. She made it home but not the exact way we planned her too! She had to buy another ticket and wait for 9 hours in the Eldoret airport. We miss having her here but as Braelyn says "Nana had to go home to take care of Granddaddy". I'm sure he appreciates us letting her go back home! She is and was such a blessing to us here. Ready for our next visitors, so everyone plan a trip!

 Braelyn Layna and Isaac (the other Jones' youngest boy) watching the Ipad. It was a gift to us from a doctor in the states and has provided hours of entertainment!

 Jason and Anna Lattin and their family were here for a month and we were able to be with them for a couple of weeks. They have 4 children and their niece came with them. They finished the post residency program in 2010 where they served in Bangladesh. She is a family medicine doctor and he is a surgeon. They were so gracious to bring us diapers from the US and it was great letting the kids play together and hearing their wisdom and ideas about our 2 years here. We miss them so much!

 Braelyn and Esther Lattin. They played so well together! Braelyn is now naming her dolls after their family!

 Layna has become well reacquainted with her pacy (she cries for it and calls it her "Bassy, Bassy") It was a step back in my opinion but boy did we need it on the plane and the first weeks here. As Sonya has said "she could really go far in the fussiest kid contest" without it!

The girls are BIG fans of mud puddles. It is tough to keep them out of the mud! And the mud is plentiful when it rains here

Thank you so much for the prayers. We are living off of them right now. Things are good but any adjustment is hard for a while. We are trying to find our role and place in the community and in ministry. So much unfamiliarity but we are blessed to be here right now.
Thanks for reading! We miss you!

More pics of Kapsowar

This was our first Sunday morning here. We are all on our way to church. This is the path from the station area to the hospital. The building you see is the Nursing School.

AIC Kapsowar Church. I can't tell you much about the service because I was outside with the girls most of the time. I think there was a translator though for the sermon. 

This is our backyard. One day we came home to Kenyan kids hitting this tree with sticks to get the fruit off. Braelyn decided to help them! Later we learned that they are not suppose to be doing that :)

This is the foundation of a small guest house they are building in our backyard. The next building is a small house for nursing students, and the roof you see beyond the trees is the Rhodes house. They already have the wall ups on the house now. We will have to post more pics soon.

Coming out of our gate of our front yard this is the "field" and basketball court. It is hard to see, but the court is toward the back. It is a nice play for the kids to run and play.

This is heading left out of our gate. The house beyond the trees is the other Jones'.And that tree line is the driveway that goes left to the hospital.

This is looking toward the hospital, the driveway we walk on to get to church, hospital or town.

During the week there are always ladies sitting here at the end of our road selling produce and things.

Ok, I hope to put up more pics soon. It takes a long time to download them here. It has been a little rainy today and yesterday. Not constant, just overcast. Aaron's first few days at the hospital went really well. Thank you for praying. Please continue to pray for us as we adjust to many new things and pray we can build relationships here quickly. Also pray for me as I get used to being a stay at home mom again and try to work out some type of routine for our family. It has been a challenging few days for me. Thanks for your prayers so much.
   Sorry there aren't more pics of girls. They are missing some of the families that left last week. One of there favorite things lately has been splashing in mud puddles after the rains.
   Hope everyone has a good weekend!
  

Pictures of Travels to Kapsowar

 In the airport in Amsterdam....tired Layna. The girls did so good. Thankful we brought the stroller.

 Enjoying some fruit squeeze snacks. Layna liked having her own seat. About to leave for Nairobi.

 This was a proud moment in the Nairobi airport. Here we are with 15 pieces of luggage!!. It really wasn't that hard getting it all together. Nana kept the girls off to the side and I kept bringing the rolly carts while aaron filled them up. In the pic below I was trying to find a "welcome to kenya" sign. I couldn't find it, so this was the next best thing. It says "Welcome to the place I call home, Kenya" :)

 Here are a couple of pics from the guest house we stayed in in Nairobi. The girls LOVED this tree swing. I would love to figure out how to get them a swing here. I think it could be easily made, just need to find the right tree and make sure it would be ok to have. There would probably be lots of kenyan children to share it with. There is a great space for a playground here on the station. Maybe I will check in to that and make it a project of ours. They do have two small swings at the hospital, but that's all I have seen so far.

Hopefully will post pics of our home and the hospital in the next week or so. It takes a while for pictures to download here.
Thanks for praying for us and loving us! Aaron plans to start work at the hospital on Tuesday. Please pray for him in learning and getting back into the swing of medicine. Also, his mom, Kathy , will be going back to the states on Monday. Pray for her safe travels and for us as we will miss her dearly. So thankful she could come with us and help us get settled.

More to come soon!