Happy Easter!

So finally updating after over a week. I have been really struggling in Swaziland. I have been all over the world, worked in many different cultures, and somehow connected with most, but I feel like I am struggling with Swaziland. I have made some incredible friends, dont get me wrong, but I feel that I am lacking a connection to the people as a whole and to the culture. Stef, Lauren and I were trying to pinpoint what it is and it may be the blatant degrading of women, or the violence we see working in the emergency room, but the cultural just seems more difficult to understand than other travels. I hope that I can work through these feelings over my last 2 weeks and really see the beauty of Swaziland that I know is there.

Throughout the last week, I have been working in the emergency room on evenings. I am getting experience working with very sick patients and with procedures. All 3 of us are feeling very homesick and took the afternoon off on Thursday to head down to the mall for ice cream. Nothing a little fat and sugar cant help with!

I had a hard week when it comes to difficult patients. I had multiple women come in from domestic violence. One woman was about 20 weeks pregnant and she said her boyfriend tried to kill her, he strangled her and repeatedly kicked her stomach. She was then having abdominal pains. I told her I would find her a place to stay and give her food for the night so that she could have an ultrasound in the morning (they dont do ultrasounds at night) and she said no. She begged me to call her boyfriend to ask him to come get her. She said that he promised her he wouldnt hurt her again. I told her that she was beautiful and deserved to be loved by someone. I told her that she needed to know she was worth being loved and didnt have to live a life with a man like that. I told her that he was going to hit her again guaranteed. She still begged me to call. I couldnt get a hold of him so she just left. I just hate being in a situation where I cant help someone. She has no resources, there are no non profits that help abused woman, there is no one that will take care of her baby. She has no options and I could do nothing for her.

We also had a man come in with anaphylatic shock from some allergic reaction. We immediately started to rescusitate him. After about 40 minutes of CPR, epinephrine, and multiple failed attempts at intubation, he was pronounced dead. The ER is one open room with about 10 beds all around with curtains in between, but clearly all of the patients were able to see the patient die. At least 3 patients were within 5 feet of us while we attempted rescusitation. It seems like everyone is so accustomed to death and loss that it is no big deal.

Warning- bloody details! Dont read if queasy!

Last, I saw a women be carried into the far cubicle on the end. She was yelling and rolling around on the bed. She was having a miscarriage at 2 months and I walked in to see her covered in blood. I will spare the details, but I ended up having to help her finish the miscarriage. I have never done that before, never seen that before, but it was really difficult. I dont think I will ever forget that.

In Kenya, the atmosphere of Jesus loving people was incredible. It brought love to any situation and comfort during the difficult cases. Swaziland doesnt necessarily have that other than Stefanie and Lauren around me. There isnt comfort and prayer during difficult cases. Death is so normal and so inevitable to these people that nothing seems to faze them. I would love to see God's love spread to this country and lift their spirits.



Stefanie and I in the ER during a fairly calm moment.

On some happy notes, we were able to visit a vacation area in Swaziland to shop and look around on Friday. It was awesome! The area was beautiful. We went shopping at a woven basket store (which we bought an incredible amount from) and had the most amazing lunch, literally the best food we have had in Swaziland by far.

On Saturday, we drove to Hlane Game Park near Mozambique for a safari. Four of our friends that we met in Swaziland went with us. Zakhele works in statistics at the hospital, Sandile is in charge of infection control at the hospital, Ceby is friends with Sandile, and she brought a friend from South Africa, Lindelo. While the Americans went on a safari, the Africans cooked up some amazing food on the grill. We came back and had an awesome picnic with delicious food.



Group photo before the picnic!

 

The 3 of us before the safari!



 Zahkele and Sandile sporting their Kentucky shirts that were a gift from Emily!

The internet is being ridiculously slow right now so I cant add anymore pictures, but we spent our Easter back at Malandelas, the touristy area. We originally walked to a large Easter Church service that was in all Siswati so we decided to leave since there was no English. We decided to go back to Malandelas and lie on a sheet while Stefanie played her ukulele and we sang worship songs, read some passages from the Bible and prayed, just the 3 of us having a church service on our own. It was exactly what we needed. We have been able to get around Swaziland on our own now. We are efficient at taking Kombis which are basically vans that drive around and pick people up on the side of the road and take them along a predetermined route. They stuff as many people as possible into them, usually around 20. People are sitting on laps, and several stand in the aisle way. We learn to get really close to each other. We are really starting to feel self sufficient in Swaziland.

First Week in Swaziland

So I have been incredibly unmotivated since I have arrived to update my blog, but I am attempting to finally do it! I have finished my first week and Swaziland and it has definitely been interesting. I have met some incredible friends, seen incredible medical cases, and seen some incredibly large cockroaches.

Lauren has been working in Pediatrics and loves it. She was seeing patients on her own by the 2nd day. It's great to come home at night and hear her stories. Stefanie and I have been splitting day and night shift at the ER. The mornings are slowing but pick up in the afternoons, by night time it is pure chaos. RFM Hospital is the only hospital in Manzini. Throughout my blog, I will be stealing tidbits of info from Stefanie's blog because I am lazy and she is an awesome writer. If you want to read hers also, feel free! srbrock-africa.blogspot.com

Here is a little excerpt from Stefanie's blog

Monday we were given a full tour of the Raleigh Fitkin Memorial Hospital! It is a Nazarene hospital with a history of missionaries, but was taken over by the government and has only remnants of a mission hospital. It is actually quite large and handles ¼ of the country’s childbirths! The country as a whole is on the radar for HIV/AIDS- over 65% of the patient population at the hospital has RVD (RetroViral Disease, or HIV); over 25% of the general population is infected, and over 50% of all 20-30 year olds in the country is seroreactive. There are tons of social campaigns, signs and education opportunities promoting protection from the disease, but it seems as if it is deeply ingrained in their culture (and the king is not doing much to set an example of monogamy!). The average life expectancy is 48. It seems to be a contradiction, when the literacy rate is 92%, and most of the 1 million Swazis live in urban areas and have wonderful access to healthcare!

Here is the entrance to the hospital and our home! We sleep on the second floor in a room that is connected to another room by a small kitchen. Our roommates on the other side are 2 girls from Finland that are nursing students. This hospital is actually huge going back behind this building.

Here is one of the sidewalk advertisements to help with the incredibly high HIV rate in this country. Someone out there is trying public health strategies, but it is difficult to encourage monogamy in a society where the king of Swaziland has well over 10 wives. 

The ER has been a good experience so far. I have been able to suture daily and even practice some new procedures. The types of patients we see vary incredibly. The main ones include meningtist, tuberculosis in all varieties including TB of the spine, AIDS, PCP, stabbings, assault injuries, pedestrians being hit by cars, and asthma attacks. I have has to pronouce 2 people dead, a father and a daughter who were hit by a car on the sidewalk. The police bring dead bodies to the ER so that a doctor can pronounce them dead. The HIV population is astronomical and most of the patients in the ER are positive. I have truly seen the sickest people of my life here, barely hanging on my a thread. The extent of damage at AIDS inflicts to people who are 16, 19 years old is heartbreaking. 

I have been able to practice lumbar punctures, which almost every patient with a fever gets. I feel like the doctors trust me and are willing to let me try anything as long as I watch one first. Caution to anyone who gets queasy from medical stuff like MY SISTER. I am going to put a picture of a case and I dont want to hear any complaints that I didnt warn you!

A patient came in complaining of shortness of breath. The patient has HIV positive and was on treatment for pulmonary TB. 3 months ago he had a small left pleural effusion (fluid gathering in the left lung) when he was diagnosed with TB and was put on medication. The medication caused a drug induced hepatitis and he was changed to a different medication that was only supposed to be for a short period of time and then to be switched back to the original medication. Well that never happened and the TB became worse.

Monday we were given a full tour of the Raleigh Fitkin Memorial Hospital! It is a Nazarene hospital with a history of missionaries, but was taken over by the government and has only remnants of a mission hospital. It is actually quite large and handles ¼ of the country’s childbirths! The country as a whole is on the radar for HIV/AIDS- over 65% of the patient population at the hospital has RVD (RetroViral Disease, or HIV); over 25% of the general population is infected, and over 50% of all 20-30 year olds in the country is seroreactive. There are tons of social campaigns, signs and education opportunities promoting protection from the disease, but it seems as if it is deeply ingrained in their culture (and the king is not doing much to set an example of monogamy!). The average life expectancy is 48. It seems to be a contradiction, when the literacy rate is 92%, and most of the 1 million Swazis live in urban areas and have wonderful access to healthcare!

The x ray on the left is from 3 months ago when the patient was first diagnosed with TB with a small left pleural effusion. The x ray on the right was from last week in the ER. The entire left lung is full of fluid and is pushing is heart to the right side of his chest, the trachea is fully deviated to the right side.

So, we tapped him! This was my first pleural paracentesis (where you insert a needle between the ribs in the lung cavity and drain the pleural effusion). Thick, purulent green fluid was expelled. We decided that the fluid was too thick for that small of tubing so a chest tube was needed.

The ER doctor placed a chest tube and around 3 liters of thick green fluid was drained from this man's chest. I definitely believe his complaint of shortness of breath after seeing what came out!

This is Sanna, one of our Finnish roommates. We visited a pool the first weekend and relaxed in the amazing Swazi weather!

We were feeling homesick so we decided to order pizza. It was delicious but very difficult. Laurent tried to call and order, but the woman could not understand her accent after several attempts. I finally walked down the hall in the hospital and found the IT man still there. I asked him to call and order for us. Much easier that way!

Zahkele and Stef in the background while we right in a Kombi around town. It is basically a big van that people jump in and out of as a taxi to get around. We have had 22 people in one at one time before. No such thing as personal space in Africa!

We visited a cultural village where we were able to take a tour of how traditional Swazi's live. There were monkeys everywhere! The grandmother of the village said she had to swat at them to keep them from stealing things inside the hut.

This is my favorite man in Swaziland! He is the medicine man of the village or traditional healer. He had his own hut in the middle of the village with a ton of plants around the opening that he uses to treat people. He was showing us some roots. He was absolutely hysterical. I kept telling him to smile for the pictures and he said, "I cant! I have no teeth". We told him we practiced medicine so he wanted to show us everything. He kept giving us roots of his plants so we could grow our own herbal garden.

He loovved pictures! Lauren even got his phone number!! ( I cant believe he even had a phone)

The village put on a dance. It was awesome! They kick their legs really high. Of course we were pulled to the center to dance with them. We really looked like bad white girl dancers out there!

The little boy in the front was my favorite! He was crazy on the dancefloor!

Eating fresh guavas for the first time! Ceby (a friend of Zahkele) invited us to her families home. They were so hospitable and welcoming. They made us a delicious dinner all from things around their family home including chicken, guavas, bananas, spinich, maize, corn, and pap!

Safely in Swazi

Well Stef and I officially made it to Swaziland. We left Tenwek on Thursday after a 2 hour delay and had to say our good byes to everyone. We really had so much fun there and developed such incredible relationships. I will never forget it. Little shout out to Caroline and Cindy! Truly some awesome Kenyans!

Thursday night, Christina, Stef and I stayed at a hotel in Nairobi so that we could leave for an early flight. Let's just say we made me awesome memories our last night in Kenya. We wrote our own lyrics to the Lion King's Circle of Life and choreographed a music video. It's pretty talented haha. 

We arrived in Swaziland in early afternoon on Friday. We were able to go to the airport to pick up another classmate, Lauren, who would be joining us for the next month. It was nice to see a familiar face. 

I have to say that Swaziland is waaaaaay different than Kenya or even Zambia where I have visited in the past. I know that part of the difference is that we are in a larger city, compared to a rural setting, but where we are, Swaziland is very westernized. We are about a 5 minute walk from a mall that looks like it could be right down the street in the USA. We went grocery shopping at the Pick n Pay which looked just like a Kroger Marketplace. It is definitely a way different experience than Kenya.

On Saturday, Zakhele (our new best friend who works in statistics at the hospital) showed us around. He took us out to an area called Swazi Candles that had a bunch of shopping a literally amazing candles. It was way different than I expected and hard to explain, but super awesome. We took a Kombi which is like a big van taxi that you just wave down and jump in with a bunch of people to get you places. Public transportation is the way to get around Swaziland.

Today was literally incredible. Zakhele took us to a church within walking distance. The church was super beautiful and so nice. Every was dressed to their best. Literally it was like a fashion show. I felt very underdressed in my long missionary skirt and my hair in a braid. The service was like a gospel concert. The singers were incredible and everyone was dancing like it was prom night. We had an awesome time worshipping God and seeing a totally different class of Africa.

After the church service, we grabbed another Kombi and Zakhele took us to a hotel where the manager let us lay out and swim even though we werent staying there. It was so nice to relax and get some sun. Overall it was an incredible day.

So Swaziland is going to be a completely different experience so keep checking in. The hospital we are staying at (literally sleeping on the second floor of the hospital) was originally a Nazarene mission hospital, but has essentially but given back to the governement to run. There are no missionaries here and we are basically the only white people other than 2 Finnish nursing students who are awesome! They share a kitchen with us and it's awesome getting to know them and their culture. We will be basically working with only Swazi's so it will be awesome to really get to know the culture. Swaziland also has one of the highest rates of HIV in all of Africa. In the hospital, over half of the patients are HIV positive so I will get a lot of experience working with my favorite population!

Stay tuned for more!

Catching up!!!!

I am so bad at keeping up with this blog! It is definitely busy here! Christina and I finally feel like we are getting the hang of how OB runs. We actually feel like we are helpful and relieve a lot of the workload from others. It is nice to be useful actually. We are running through 4 discharge summaries in 20 minutes!

I have finally given in and taken a couple of babies from the incubatora to hold and cuddle. It is ao hard to be running around busy all the time and never get to hold the babies! So basically I am in love with every baby I see lying around ( which is a lot).

Snuggling with a baby I snatched up from the incubator!

Christina and I with Dr. Hage, a visiting OB/GYN from the States who taught us an incredible amount of information.

This week has been incredibly busy and we lost internet access for a while so I will try to fill everything in. Christina and I are really loving the interns and physicians and nurses we are working with. It has really become a team. We have been able to assist in a lot of procedures but our real goal was to deliver a baby. In Kenya, nurses deliver all normal vaginal deliveries and the nursing students were being graded this week on their abilities so we decided that Friday night we would stay late and see what we could do after everyone went home. Christina and I both ended up delivering our first babies. It was such an awesome experience. I am hoping to get a couple of more deliveries in before I leave. The nursing staff has been so helpful and have taken a lot of time to teach us. 

The 3 "coaches" that are where the vaginal deliveries occur. I caught them when they were empty. There is almost always a line of women waiting for a coach to open up.

Here is the baby that I delivered!! Kiplangat is his name! I was a little excited at the time!

This is me handing the baby I delivered to his mom. She was so happy and grateful. She has had 3 failed pregnancies and this is her first healthy child.

On  Thursday, we decided to leave work a little early and go to an orphanage to spend some time playing. It was so nice to actually relax and act like a kid. We spent a lot of time playing jump rope, soccer, and tossing balls around. I also found a group of kids that loved taking pictures and making silly faces. At the end of the night, they sang a bunch of songs for us. It really refreshed me after a week of long hours.

There was 7 of us who visited the orphanage and we all squeezed into a compact car to get there. You cant see behind Stefanie's head, but there are 3 full grown men in the trunk.

Christina and I having a good time with a couple of the children. 

Christina and I woke up this morning and assisted on rounds to help out the interns. We finished about lunchtime and went for a walk down to the river. We spend most of the day outside.I am trying to catch up on some sleep this weekend so that we can finish this week out strong. Stefanie, Christina, and I leave for Nairobi on Thursday where we are going to stay the night. Stefanie and I head off to Swaziland early Friday morning and will be there by the afternoon. We are very sad to leave Tenwek, but know that there is another adventure waiting for us in Swaziland.

I almost forgot! Christina and I went  to the eye ward this morning to say good bye to Peter. He is finally heading back to Waamba. On Thursday, Stef, Christina, and I made him a batch of brownies and brought him a Swahili Bible. He literally about jumped out of his bed when he saw us. I have been on more mission trips than I can count on 2 hands, but I dont feel like I have ever connected with someone the way I have with Peter. I feel that if the reason for going to Tenwek was so that I could make some kind of difference to Peter, then it was worth it. He immediately opened the Bible and started reading to us in Swahili. I pray that he grows to be a strong Christian man. I hope to return to Kenya in a couple of years with Barny and see how Peter is doing. Michael (who was our main connection between the Samburu people when we did the surgeries and he set everything up for us) came to pick up Peter this morning. We hadnt arrived yet to say good bye and he asked Michael, "Where are the muzungus?!" Which means where are the white people? Of course, we showed up and gave him our hugs. We will keep in contact with Michael to find out how Peter is doing. Stef and Christina took some great pictures for the brownie night with him so hopefully I can steal some of them to show you the joy on his face. He had never had a brownie before, but obviously liked them after he demolished 3 of them.

Here is a picture of us with Peter earlier in the week.

Safari Fun

Christina and I are finally home from the fun filled safari weekend! We arrived around lunch time on Friday to the most beautiful Fairmont Mara Safari Club. We were greeted with warm towels and fresh mango juice as we exited our car. It was definitely one of the nicest places I have ever stayed. We were taken to our "tent" where we would be staying the next 2 nights. It was beautiful! Our deck looked over the Mara River where about 5 hippos snorted, grunted, and splashed the whole time we were there. We had a rain fall shower head that was the best shower I have ever had in my entire life. That is definitely going on my bucket list to own one day. 

The hippos outside our tent! This is for you Grandma Hawk!

This is our beautiful tent. Christina and I were too scared of crazy animals coming into our room, we slept together in the bed farthest from the door!

Kind of a dark picture, but this is the lobby. 

We were able to have a nice lunch outside before we headed out on our first safari. Overall, we went on two 2 hour long safaris and two 3 hour long safaris. Our driver was Moses and he was so patient answering all of my ridiculous questions about the animals. If you really know me, then you know I can be quite inquisitive. He made such an effort to get us to see a ton of animals. We were able to see lions, cheetahs, wildebeests, cape buffalo, hyenas, elephants, zebras, giraffes, baboons, and we even were able to see a cheetah attach some antelope without any success. 

Christina and I in the land cruiser on the first day!

The elephants with the most adorable baby! The mom kept ushering the baby behind her to protect her from us. There were elephants everywhere so it was really awesome to get so close to them.

One of the many lions we saw.

A couple of cheetahs.

Sunset on the first day. It was so amazing to be so far out in the wilderness and be so far away from civilization. This area is only allowed to be inhabited by the Maasai tribe. They serve as protectors of the animals. They never kill any animals unless it is a lion that is attacking their herds. Many of the animals (like zebras) go to sleep outside of the Maasai villages because the lions are afraid of the Maasai and stay away from those areas.

The "daddy" lion that looked pretty beat up mostly likely from a fight with another male lion. He got within 10 feet of our car.

A couple of giraffes "necking". It made me laugh because they looked like they were moving in such slow motion that it couldnt possibly be doing any harm.

Christina and I joked that we were on a romantic getaway because we stayed in our robes and read our books together.

Standing on top of the seats so we could look out the roof. 

On Friday night, a group of Maasai men came to put on a show for all the guests at the resort. They did some dancing and chanting and then had a competition to see who could jump the highest which I guess means a lot to them. They then went around and grabbed women from the crowd to dance with them so of course Christina and I were chosen. We danced all over the lobby with them and they placed their beaded necklaces around us. Chrstina's man kept whipping his long hair in her face. We joked that we thought we were married to them after that ceremony. I got the highest jumper so I am going assume that makes me the queen. We had a lot of fun with it. 

We returned on Sunday to try to work on schoolwork. Back to the grind. I think I developed an upper respiratory infection so pray that I get over that soon. It seemed like Cindy the intern on call over the weekend worked really hard to discharge a lot of patients so we finally feel like we are getting more control of the floor. Pray that I get my strength back and start feeling better. This week Christina and I hope to get a lot of experience in obstetrics so I want to be feeling my best. Also, pray for all 3 of us as we are really missing our family and friends. Stefanie and I are trying to keep our heads up knowing we have a whole other country and adventure ahead of us. 

PS- Kenya Airways finally called me back after I have obsessively harassed them since my arrival for my missing luggage. They found it at the airport in Nairobi and hopefully it will be in Bomet by tomorrow. Thank God!

OB fun!

Well life at Tenwek in the OB department has been hectic. There is a nursing strike for the whole country so many ofnthe Kenyan government hospitals are not working right now so women from all over are coming to Tenwek to have their babies. We are so overloaded that we have 2 to 3 women in a bed.

There are women everywhere in the halls, on benchs, in corners huddled up trying to make it through another contraction. It takes our OB service 4 hours every morning to round on all of the patients because we have about 60-75 inpatients everyday. These women have major complications like post partum hemorrhage, renail failure, full blown eclampsia, and many c sections. It is a madhouse in the OB ward right now but somehow we make it. The administration has stopped us from doing any elective surgies due to the high capacity, only emergencies right now.

Christina and I are really loving the people we work with, both the Americans and the Kenyans. We all learn a lot from each other. I was able to scrub in with a Kenyan physician on a c section and it is the most I have ever felt respected by a physician. He treated me like I was another physician routinely scrubbing in with him. He had me jump right in and get my hands in there. He said, "pay attentiom, you are doing most of this next time". As a PA student, it is not often that we get that kind of trust and respect with procedures. It felt great afterwards feeling like I was really doing something.

I finished the day with suturing a patient back together after her c section incision became infected and opened back up. I think Dr. AJ, my surgical preceptor in Lexington would be proud. I feel that at the end of the rotation, I will be utterly exhausted but really familiar with a lot of OB complications.

I feel like it makes such a difference working in an environment where God is such a focus. Before surgery everyone gathers to pray over the patient, and when we all sit around the table at night, we discuss the way God has either affected us or affected one of our patients. It is so amazing to be able to share your faith so freely with coworkers and patients and it's even better to work with people who have the same beliefs and purpose.

I pray that God will continue to be with Christina, Stefanie, and I as we are halfway through with our time in Kenya. I pray that He will move within our hearts and lead us to be blessings to those we interact with during our time here.

Also, update! Peter (our adopted Samburu boy that us girls have fallen in love with) has had both of his surgeries and he is doing well. He will be going home next week and hopefully the eye team at Tenwek has kept him from growing blind. Stefanie, Christina and I gave him a Bible today that we all wrote messages inside for him.

Well I hope everyone has an awesome weekend. Christina and I are off in the morning to head to Maasai Mara game park to stay until Sunday. We will be going on several safaris and we are moooore than excited!

PS- I love you Barny and miss you like crazy!

Standing on the edge of the Great Rift Valley!

Safely under my mosquito net in the spider free room!

A couple of Samburu boys that we gave water to during our drive through the bush to Waamba!

One of our patients waiting to be screened. This is the typical Samburu clothing.

Me working on screening!

Scrubbing in for surgery in the church!

I was attacked by mosquitoes because I left my arm against the net during the night. Bad move!

My first broken bone! A chair fell on my foot!

A bunch of children waving at us at the school next door. They kept yelling Ciao! at us because they thought were were Italian since they had Italian doctors visit last time.