Sunday, February 4, 2018

Friends, Food, and a Fantastic Case

This will be our last blogpost from Chogoria so we thought that a potpourri might be interestiing.......

These "hugs" from our grandchildren Stella, Dexter, Lincoln, and Edison go
with us on all of our mission travels to keep us company. We miss them!!!!

Jim Ritchie is an ER physician here - he served 25 years as a Navy doc before
transitioning to the mission field. His wife Martha is the hostess/hospitality
person for the base and has been a huge blessing for us! Their son James
is the last of their 6 children who is at home.

We enjoyed getting to know Alex Lea, a 4th year med student at the Medical University of South Carolina, Greenville
campus. He is from Nashville and looks forward to studying Family Medicine.

A mission trip would not be complete without a running picture! To the left is Dave Klee, a Family Medicine faculty from
Traverse City. Next to him is AJ Pinney, a Family Med resident. Next to me in the red shirt is Larry Smith, serving
here after practicing in Anchorage, Alaska for a number of years. By the way, Larry has done some ultra marathons -
50  to 100 mile jaunts that make my knees ache  just to think about them !!!

On the way to morning hospital duties, we look down on a courtyard filled with students decked out in their uniforms.

Susie is a kitchen magician!!! This is "BRC" - beans on rice with cheese- along with sliced carrots and mango for dessert.
Vegetables here are plentiful and we have mango or pineapple nearly every day - Yum!!

Another fantastic meal - lentils/dal to the left, Kenyan black beans (njahi), and sauteed chard with onions.
and finally, the interesting case.......

This is a CT scan view from a 43 year old man with a 3 month history of weight loss, night sweats, and abdominal swelling.
He looked chronically ill and his liver was HUGE on examination.
An ultrasound showed cysts in his liver and the CT (above) reveals 2 massive cyst/abscesses occupying much of his liver - they are the darker circular areas. The possibilities that we discussed were liver abscess due amebiasis or echinococcus and he was started on meds for both diagnoses. 

The next day, Jason Brotherton, an Internal Medicine-Pediatrics doc, inserted an indwelling drainage catheter into the liver.
He withdrew 500 cc (about a pint) of thick dark fluid which was sent to the lab for analysis. The following day, we took out another pint of fluid. There's plenty more .......................

Sunday, January 28, 2018

Wildcats and More!!!!

As proud alumni of Northwestern University, home of the Wildcats, we were delighted to see some ferocious felines on our safari drives at Samburu Park!!

The king of beasts is even more impressive in person.

We were fortunate to see a pair of leopards out for a morning stroll.

We were amazed by this cheetah - note how long and lean, built for short
bursts of speed. This one was stalking several gazelle several hundred yards
away - the gazelles (fortunately for them!) sensed the cheetah and were poised
to run if needed.  

There was a plethora of ponderous pachyderms.
This is grandson Lincoln's favorite animal!!!

Besai Oryx - so stately and magnificent. 

Gerenuk - also called a "giraffe antelope".

Reticulated giraffes.



Impala buck - note the graceful curved horns.

Some African safari parks talk about the "big five" but, at Samburu, they have the "special five" which include Grevy's Zebra, Somali ostrich, Besai oryx, gerenuk, and reticulated giraffe. We saw all five of these plus the 3 big cats. It was an excellent adventure!!!


We enjoy watching birds from our sunroom back home so were delighted to see all of the beautiful birds here!!

Our favorite bird....the lilac roller.

Somali ostriches.

The superb starling.

A guinea hen.

Weaver bird nests adorn this tree like Christmas ornaments! Male weavers build their nest to attract females.

Saturday, January 27, 2018

Unexpected surprise..........SAFARI!!!!!!

Last week, we were invited to join a physician assistant student on a weekend mini safari - how could we pass up that opportunity??? We left Chogoria after Friday morning hospital rounds and lunch, and were driven 3 1/2 hours to the Samburu Park and the Intrepid Lodge. What a blast!!! We went for 2 game drives on Saturday and another early Sunday morning before returning to Chogoria Sunday afternoon. Our lodging was in a tent that was on an elevated platform and covered by a thatch roof - in this "tent" were a plush bed and full bathroom facilities including running water! We had buffet meals for breakfast and lunch and had nice menu selections for dinner. All in all, a wonderful time....and we did see a very good selection of animals and birds!!!

Executive "camping" at the Intrepids Lodge!

At dinner with Lauren, a PA student from the Detroit area who
is going to school in the Twin Cities.

Friendly monkeys roamed around the open-air dining room, hoping for
some treats.

David with David, a Kenya tribesman who watched over the
dining room, using his slingshot to ward off the monkeys!!

Susie with Chris, a tribesman who gave talks about the local
environment and culture.

Susie and Lauren went for a walk in the dried up river bed near the lodge
and met two women from the nearby village.

Beautiful, expansive Africa!!!!

Enjoying the animals from the safety of an open top Land Rover.

At the hospital.........

Our day begins at 8 AM with a meeting of all medical staff.....attending and consultant physicians, residents, interns,  clinical officers. There are either case presentations or didactic lectures. At 9, the various teams go their separate ways.......the medical and pediatric teams meet to discuss new admissions and then go to the ward for bedside rounds. The patients have already been seen by housestaff and we, the "consultants",  review and discuss the cases with them. Our role is to teach and  help guide the house officers' as they assess each patient and initiate treatment and diagnostic testing.   Some afternoons, there are additional teaching sessions - Susie, who was a family medicine residency director for 19 years, has done several sessions with the senior physicians on "faculty development" and Dave has spoken to the family medicine residents on anemias and blood clotting problems.

The buildings are separated by beautifully trimmed hedges and
covered walkways.

Signage is excellent - each with a  Bible verse.

At the entrance of the medical ward. 

Part of the female ward. The beds are organized in groups of 6-8, all in one very large room.
Curtains and mosquito nets hang from the ceiling.
Privacy? .....not so much.

The interns on medicine: Drs. Victor, Fred, and Brian. 

Susie speaking to the teaching staff about faculty development.

Everyone gathered together for morning report. (sorry for the dark picture!)

Hospital chapel.

Welcome to Chogoria!!

Chogoria Hospital was established in 1922 by Dr. Clive Irvine, a medical missionary sent by the Church of Scotland. In 1956, management was passed to the Presbyterian Church of East Africa (PCEA). The hospital is about 4 hours' drive from Nairobi on decent roads and is at 5000 feet elevation on the eastern slopes of Mount Kenya, yielding a pleasant climate. We are only a fraction of a degree south of the Equator.
The hospital has over 200 beds. Our work has been on the female medical, male medical, and pediatric units, each of which can hold up to 40 patients. There are also separate obstetric and surgical wards. The outpatient clinic sees several hundred patients each day and there are 1000 deliveries yearly. The hospital is well staffed including American physicians trained in ER (1),  med-peds(1), family medicine(4), and pediatrics(1). Two of the family doctors are Samaritans' Purse post-residency fellows, serving here for a 2 year term. In addition, there are 2 African-trained surgeons, an Ob-Gyn, and a dentist. There are medical trainees at various levels....clinical officers, interns, and residents. This is the first place we have served that has a basic electronic medical record. Also, it is the only place we have been that has a working CT scan - the scans are sent by internet to Nairobi and a radiologist there sends a report back to us.
Due to the elevation, malaria is uncommon. We have seen quite a bit of HIV, TB, pneumonia, hypertension, diabetes, and gastroenteritis. Cancers of the stomach and esophagus are the most common malignancies.

Main entrance of the hospital compound

Looking down on the hospital, a number of buildings
separated by covered walkways with low hedges.

Ready for morning hospital duties!

We pass by a school on the way to the hospital - the children
are wonderfully friendly, often crowding around us to
shake our hands or get their picture taken.

Instead of filtering or boiling water, we use bottled water - the
10 liter jug (note size next to Nalgene bottle) costs only $1.50 and lasts 3-4 days

This is Joy's store, the local version of a 7-11. We can get our bottled
water here and some of the basics. There is a larger store not far away
plus local fruit and vegetable vendors.

Along the road near the hospital are many stalls with all the fruit
and vegetables you could ask for. Susie is in vegetarian heaven!

Sunday, November 5, 2017

Some people we've met.............

Ali is from Australia and serves as the hostess/greeter for short term volunteers. Her
husband John picked us up at the local bus station and she oriented us to the base and
our accommodations. She is an excellent resource for any questions that come up and is also
in charge of the cinnamon buns served every Wednesday at morning break!!

Dr. Drew is a family doctor from California who just left a few days ago after serving for
a month. He and Susie worked together at the under 5s clinic.

Dr. Jenn and her husband Josh are FPs from the US. They have 2 daughters so alternate
working with childcare duties. They will be here for 2 months.

Tchima is in charge ("le chef") of the Outpatient Clinic where Dave works. She does a great job
in directing the Nigerien staff and the doctors in an atmosphere that sometimes
resembles "controlled chaos"!!

                                                                                                                                                                                                                                                                                                                                                                            Balti is a 3 year old girl that Susie admitted urgently last week with cerebral malaria. She was febrile, comatose, had an incredibly low blood sugar of 21 (normal about 100) and severe anemia with a hematocrit of 8% (normal around 35%).    She was given antimalarial meds and lots of glucose.   The lab did not have any blood suitable for her so Susie donated and the blood was hung within an hour. Her hematocrit more than doubled to 19%!!  By the grace of God, Balti responded rapidly and went home today!