"Farewell Kenya!"

My last 24 hrs at Tenwek were quite emotional—stressful because I was on call that day and had been gone for two days, and trying to pack and say goodbye to everyone. The night in the hospital wasn’t too eventful but there were a few very sick patients that had come in earlier that day. One of whom was a teen girl who came in from another hospital in a comatose state from severe DKA (diabetic ketoacidosis). She was intubated and had suffered two cardiac arrests earlier in the day. She ended up going into further arrests the next morning and passed when the team and her family decided to not continue further attempts at resuscitation. I prayed over her beautiful but lifeless body the morning just before leaving. I had never seen any mortality from DKA in the states, and couldn’t believe that she had such a tragic outcome from this potentially very manageable disease. Another boy was came in with atrial fibrillation and evidence of new heart, renal, and liver failure. His heart rate became very elevated again overnight and I was quite worried bout how to manage his heart rate with the current choice of medications he was on (digoxin) which I have never used to mange atrial fibrillation in the US. Thankfully the dose adjustments I made helped to better control his heart rate overnight. I am disappointed that for him, like many other patients currently on the service, I won’t be able to continue following after a go home. I wish I could stay and help to diagnose and treat these very sick children! I know I am leaving them in very good hands though, which is so encouraging.

Additionally, I did learn Ezra, the little boy with severe HIV and cachexia had passed the day before I arrive back from Safari. I was not very surprised, as he was barely hanging on when I left. I was sad that I hadn’t been there at the time of his passing to say my final goodbye, but at the same time was relieved that his suffering had ended and that now, I pray, he was in paradise with our Lord in a healthy, perfect body.

Despite some of the sad stories, my last day was also dotted with encouraging success stories and recoveries, representative of my entire experience at Tenwek. I was encouraged to see that another boy with HIV and malnutrition was doing much better and his heart failure was now well-controlled. One of my other patients, George, the one recovering from removal of his adrenal tumor (pheochromocytoma) was doing very well and set to go home. It was good to see him laughing and smiling again, unlike a few days earlier when he was in a lot of post-operative pain. I talked to him awhile and he even sang a song for me! (“Jesus loves the little children”) So precious.  Another girl who we’d admitted a few nights ago with febrile seizures was doing well and seizure free, only being treated for a urinary tract infection. Her mother had been so frightened that first night when she witnessed the seizure and we did a lumbar puncture, but I could see newfound relief and joy in her face now, happy that her daughter was okay and thankful for the care she had received.

My last day I was also thankful to be able to say goodbye to my friend Vickie one more time. She came and found me at the hospital and when there was some downtime in the evening we went to the hospital canteen and had Chai and Mandazi (pastry). She told me more about her childhood and the emotional journey she suffered, going back and forth between various aunts and uncles homes and the orphanage. She spoke of terrible verbal and emotional abuse she suffered on behalf of her aunt and uncles, and how she was ridiculed and discouraged throughout much of her childhood, told she would grow up to be “nothing.” Her steadfast faith in Christ is so unbelievable and inspiring. She continues to lives day by day with reliance on Him for her basic needs. I pray there is a way I can continue to keep in touch with her through email. Vickie also took me to say goodbye one more time to Valen, the kind tailor who made my skirts and tops. I also followed Vickie down to the village to say goodbye to Joy—very kind woman worked at the bookshop nearby the tailor. The walk down to her home was a true adventure, down a secret muddy path that wound among tangled fences and gardens. The neighborhood where she lived was comprised of quaint brightly painted shingled homes with tin roofs, all surrounded by lusch gardens and brightly colored clothing drying on the clothes lines. The view of the homes against the setting sun and mountainous backdrop was like a painting. She showed me her home and I learned that although no children herself, she is gracious enough to house her nieces and other women or girls in the community who need a place to stay. I was going to stay for dinner as well but ended up getting paged to go back to the hospital. I am truly amazed again by the Kenyan example of overflowing love and hospitality. A woman of little, she gives what she haves to those who still have less than she. She had embraced me, a stranger from the US, which such kindness and generosity. After having only met her at two weeks ago she was so sad to see me go. It is for reasons such as this that make it hard to stay only for a short time.

How wonderful it would be to stay for months or years and really develop relationships and invest in the people. I am broken hearted at leaving at not knowing when I’ll return. Such is always the dilemma of short-term mission work. I still can’t imagine making the sacrifice of being a long term medical missionary and don’t feel that that is God’s desire for my life, at least at this time. I can’t imagine not returning to these people and this community though, and pray that I can return soon and continue to come serve and be blessed by these people on a regular basis in my future career. 

Gladys, the guest coordinator (aka Superwoman!)

Amazing NICU nurse team

Helen, our amazing cook! Can you come home with me?!

The awesome Peds team!

One of my favorite patients, George! Going home today!

Little Annette and her sweet mom, who is much happier now that her daughter is doing well!

Valen (the tailor), her son, and Vicki!

Trying to catch a view of the hospital before sunrise

A perfect way to wrap up the trip, I was so grateful to have had my same driver, Ephraim, take me back to Nairobi. So much had happened since he drove me out to Tenwek a few weeks before. I had so much to tell him on the way, driving through the beautiful countryside and the dusty villages. I continued to learn more from him about the Kenyan way of life, every bit of information I could soak up. Fascinating was the discussion about the Kenyan circumcision practice and raising children. He also shared his dream of taking his family to the beach at Mombasa this year. He even graciously helped me find an ATM at the airport and find the right terminal that would take me to Qatar. I spent a few hours looking more at beautiful artisan crafts in the airport and finally got to try a Samosa at the airport! (the hospital canteen was always out).

I now sit at one of my favorite local coffee shop in Chapel Hill where there is still a bit of snow on the ground and the chill of winter is in the air, a contrast to the summertime weather in subequatorial Kenya. While happy to have a few conveniences and comforts back, my heart longs to b back in Kenya to have spend some more time experiencing and giving back to the beautiful country and its people. Tataonana baddaye Kenya!  (See you later!)

Last goodbye with Ephraim! 

"Maasai Mara Safari"

After a somewhat rough week in the hospital I enjoyed a much-awaited experience of a lifetime last weekend—Safari!!! I had been looking forward to this for many years ever since I decided I wanted to come to Africa for medical missions. It was truly an incredible experience in many ways and I constantly had to pinch myself to believe that the experience was real! Totally newly inspired to watch the Lion King!

We wet to the Maasai Mara reserve, one of the largest in Africa and one of the prominent Safari locals in Kenya. It is in a region occupied by the Massai tribe, a well-known warrior tribe and probably one of the tribes that still strongly identifies with its culture and has been least westernized.

I went the trip with two other short-term medical missionary couples, one of which had a 1-year-old son. Great to enjoy the experience together. I was on call the night before and slept only an hour or so but had plenty of caffeine and adrenaline to keep me alert. We took a van the 50 km or so from Tenwek to the Maasai Mara reserve. It was a long and bumpy road, very rocky and unpaved, but thankfully quite dry despite the substantial rain over the past couple weeks. The drive was so much fun. We passed through rural villages that were so quaint and picturesque. Lining the road were small farms, with tall cacti serving as fence posts around the parameter. On each farm were mud huts with thatched roofs or wooden homes with tin roofs. Throngs of goats ad cattle walking along the road were a frequent siting. Every time we passed children they smiled gleefully and waved as if we were celebrities! Many groups of children ran alongside the vehicle shouting “Jambo, Jambo!” (Hello in Swahili). They were quite enthralled by the little one-year-old White (Mzunga) baby in the van.  The landscape gradually changed and became more widespread grassland and soon we began to spot the trademark Balanitie trees aka "Desert Dates" (small lone trees seen in classic depictions of safari's, see many below). When we soon spotted a throng of baboons and then a herd of zebras from far away. I couldn’t believe we were actually seeing wild zebras!! Soon I realized they were just as numerous as cattle in that area, but the first siting was just too unreal!

As we pulled into the Fairmont Lodge after a 4 .5 hour trip to go 50 km we entered a beautiful, luxury 4 star tropical lodge and were greeted with such hospitality. The cool refreshing towels soaked in lemon juice were just perfect after the long, hot, dusty trip.  The various flavor infused water (tree-tomato/mango, cucumber-mint, ad lemon-lemongrass) were wonderfully refreshing. The lodge inside was just breathtaking, warm earthy tones, leather couches, dark wooden beams, and impressive artwork and décor honoring the local Massai tribe. A sharp contrast to the hospital and rural village of Tenwek.

The lodge is settled along a tributary of the Maasai River and is comprised of about 50 luxury “tents”. The tents resemble typical large canvas tents from the outside, but inside are beautiful hotel rooms with beautiful beds, tile floors, and local artisan décor. They are complete with shower, bathrobes, coffee bar, etc. and at night the room attendant puts a hot water bottle in the bed to keep it warm! There was a nice porch overlooking the river, which is inhabited by hippos. At night and early morning the grunts and splashes of the hippos can be heard from inside the tent!

My luxury tent! 

We were then greeted by a delicious 5-course meal, which was characteristic of every meal while we were there.

That afternoon we went on the first of 4 game drives. The drives took place in awesome Safari vehicles with a pop off top. Our driver, Ashford, was with us for all 4 drives and he was a true encyclopedia of knowledge about he landscape and wildlife. He actually trained for 4 years to be a Safari guide! He also saved us many times from sticky situations in the mud where I though we’d surely get stuck.

Soon after we set out we came upon a large group of giraffes. They are so majestic and graceful and so beautiful in person. They, likely most of the animals, seemed completely un-phased by our presence and would walk feet from the vehicle seemingly unaware by our presence. We saw many vibrantly colored zebra, which were one of my favorites. No matter how many of them I saw Is still have a hard time believing that their stripes were not painted on! There were many wildebeests (which I was at first afraid of due to the visions of the stampede from the Lion King! Haha). On that drive we saw many gazelles, antelope, warthogs (actually nicknamed “Pumbas” here!), ostriches and jackals (like foxes). We were lucky enough to come across a group of elephants in the bushes. They are so massive were busy tearing up the trees with their trunks.  The best siting however were the lions!! We heard a throat roar from the bushes and soon found a lioness resting in the shade. After a while she came out and walked around a bit and then the male whom she was calling to came walking over! I couldn’t believe what we were witnessing. Apparently quite rare to actually hear/see the roar. The male walked around our vehicle, just feet away from us. Also seemed to be completely unaware we were there. We saw another male lion a bit late after that as well. At this time of day when they are simply resting and trying to stay cool from the shade they seemed so gentle and docile, like big house cats that I wanted to pet! Hard to believe they are vicious hunters at night. Interestingly, the females are the primary hunters/breadwinners, although it’s the males who get first privileges at eating the kill! Also, FYI, Simba is the Swahili word for lion.

Graceful Giraffe. 

One of my favorite aspects of that drive, and all of the game drives, was experiencing landscape of the Sahara with the setting and rising of the sun. The contrast of the pinks and oranges of the sky with the blue hazy mountain peaks and the greens and golds of the savannah grasses cannot be captured by words. The acacia trees spotting the landscape and wildlife in the foreground was just spectacular and I truly felt like I was in a film or painting.

That night there was a Maasai dance before dinner, in which we watched local Massai dress in the traditional red plaid gowns and elaborate beaded jewelry and dance a very energetic routine for about 30 minutes! They sang a low-pitched chant during the song, led by higher pitched singing and chanting by the lead warrior.  Part of their dance involves jumping as high as they can in the center of a circle, and their “verticles” are quite impressive! Tall very slender men clearing 3 feet or more! Apparently jumping is a long held tradition competition at dances and ceremonies among the tribe. I’m thinking many of our NBA players have roots in the Massai tribe… At the end they invited us all to join in the lively dance with them, which was tons of fun but quite exhausting!

After a wonderful night’s sleep in the comfy bed (and much needed) we set out on the early morning game drive just as the sun was coming up. Can’t forget to mention that our wake-up call included coffee and cookies. Can I have this kind of wake up call everyday at home?

Again, one of the most memorable and breathtaking aspects of the Safari was watching the evolution of the colors and textures of the landscape with the rising sun. The fog that settled over the land from the rain the night before evoked an even more magical aura. That morning we saw many of the same animals, including a pair of lionesses that I spotted in the bushes, gracefully licking their paws like housecats. Hard for the cat-lover that I am to resist!

Storm clouds rolling in late evening

Wildebeest

Family of Pumbas! (Warthogs)

Sunset on the Sahara

After the drive we enjoyed a “Bush Breakfast” by the river. When we arrived tot he site we were greeted by the cooks who had already prepared a gourmet buffet breakfast for us! There was even an omelet station for made to order omelets! We sat at table overlooking the bank of the river while enjoying our breakfast. What a once-in-a-lifetime experience! Afterwards we gazed at the hippos submerged in the river and a couple lazy crocodiles. We mostly saw only the hears, nostrils, and eyes of the hippos but occasionally got a glimpse of their large jaws and teeth. We learned quite a lot about hippos during the Safari actually. They are in fact considered to the Africa’s most dangerous mammal, even more so than lions, do to the fact that they are quite aggressive if threatened and have crushing jaws and sharp teeth. They spend all day in the water to keep cool and can hold their breath for up to 6 minutes! At night they come out in large groups to feed traveling up to several kilometers along muddy trails to reach grazing areas. At about 6 am they head back to the rivers.

That afternoon was spent enjoying the sun and relaxing at the lodge, a delicious buffet lunch, and then another fun safari drive in the evening. This time we were taken to see the rhinos, a high endangered and now very highly guarded species. On the reserve there are only two White Rhinos, which are guarded 24/7 by game rangers. Actually named for their "Wide"

Bush Breakfast! 

White Rhino

mouths used for grazing ("White" easier to say?)There are only handful of them remaining in the world today due to decades of poaching. They were huge, very pre-historic looking animals. Sad to think they were killed just for the price of their ivory horns. I imagine that the game rangers who guard them are extremely protective and feel a strong bond (and respect for) the animals.

The next morning we had one last game drive before heading back. Despite much searching we were still unable to find the elusive leopards or cheetahs. I was longing to see a cheetah and her cubs, but that just means I’ll have to return for another Safari in the future! Otherwise it was a good game drive by the Safari standards as we saw 4 of the “Big Five,” the five animals that were the most heavily prized during the hunting days: lions, elephants, rhinos, water buffalos, and leopards.

 

On the way back to Tenwek we again passed through the same villages and were greeted and chased after by many children going and coming to school. So thrilling to think that seeing us made them so elated and overjoyed! Their bright eyes and huge grins never cease to make my day.  I also found myself so surprised at how fast they could run and how much energy they had, despite knowing the chronic malnutrition that afflicts them.

"Kenyan Kindness"

Despite some of the trials over the past few days, there have also been some wonderful moments spend with the local Kenyan people both in and out of the hospital, and some great times getting to know some other short term missionaries. 

Over the past couple of days I have had the pleasure of getting to know the Hoover family, who is part of the wonderful organization called Friends of Tenwek that provides support for its many outreach efforts. Dr. Hoover, the son of the founder of Friends of Tenwek, is actually a pediatric surgeon at Wake Med in Raleigh, just down the road from me in Chapel Hill! The short term volunteers and I have spent a few nights playing cards including a fast paced and very aggressive game called "Nertz," which I am quite bad at but love anyway! We also played Family Feud one night and I learned that one of the volunteers here was actually on the show with her family recently!

I've also spent some wonderful time with my friend Vicki who lives in the village. We took a walk together at dusk along the beautiful Rift Valley country side. Afterwards she invited me to her home, which is in the rural village surrounding the hospital.  I was blown away but how little she has but how generous and selfless she is. She lives in a tiny room half the size of a normal bedroom without electricity and with a flashlight and lantern for light. She cooks with a fire outside her home and due to the rain, has not cooked on a fire for about 6 months! Adorning her walls are newspaper clippings and other hand-made decorations. The place still felt so cozy and was filled with so much love. She wanted to show me something she made for me--a list of words and phrases translated from English to Swahili and Kipsigis (local tribal). Many of the phrases were ones that were particularly useful in the hospital. We went through all of them aloud, practicing the beautiful phrases.I couldn't believe she had taken the time to hand write a personal dictionary for me! One of the sweetest gestures I've ever received! I asked her a few of her favorite praise songs and we sat on her bed singing worship songs that both of us knew. Such a cool, humble moment! She talked about some of her past and the death of her parents at a young age. Although she has very little, she still sends clothing to her family members that have even less than she does. 

One of my favorite patients from last week, sweet teenage girl excited to go home! 

Vicky and me shopping in Bomet

Rustic, colorful beauty of the countryside

Yesterday I was met by her and the tailor in the hospital--they had my hand-made skirts and shirts outside of the NICU waiting for me when I was done with rounds! Wonderful to see her smiling face while at work. I met up with her later that evening and took a taxi to the nearby town Bomet to get a few things at the grocery store and use the ATM. The town was quite busy after a funeral for a famous singer from the town who had just been tragically killed.  I absolutely love the outfits that the tailor made and wore the skirt today at work! 

One of the medical officer interns (Victor) and I

Today I also was able to get off early enough to make a trek up to the overlook of the Rift Valley called Montigo Mountain. I encountered numerous group of curious young children along the way, many of whom followed me for a short distance. Unsurprisingly, I took a wrong turn and when I finally realized it, it was going to be too late for me to still make it back before dark. To my rescue was a kind local man who owned a taxi motor bike and also a pastor. He drove me to the base of the mountain and along the way we picked up a local woman named Sophie who is actually an x-ray tech at the hospital. She was so sweet and invited me into her home! Her home is located near a school, and Ba throng of school children in uniforms greeted and followed me like a celebrity! Her home is a small 1 room house on a patch of farmland where she has several cows, chicken, and grows various fruits trees and vegetables. With bright blue paint, it was a lovely site against the lusch green valley below. I can't believe she has time to work a full job then come home and milk cows, work in the garden, entertain guests! Inside her home I sat on the couch with not only her 4 children, but about 8 other local village children! The pastor/motor bike driver also joined us for a bit. I asked the children their favorite bible verses, songs, and other questions. We all enjoyed a nice cup of hot chai tea which definitely hit the spot after riding in the cool rainy air. After a while I then walked the short path to the top of the mountain, led by the throng of children, many of whom walked up the muddy trail without shoes. The view from the top was just breathtaking. I could see a 360 degree view of the valley below, with patches of farm land painting the hills. The settling fog and setting sun gave an erethreal quality to the landscape. On the way back I nearly made it before dark, and then another Good Samaritan offered to drive me the last 1/2 mile or so. He talked about how he had met many volunteers at Tenwek and was very thankful for their help.

Talk about God truly being creative and being a provider. If I hadn't gotten lost, I would never have met these wonderful people and had such amazing encounters! Just more examples of the spirit of true hospitality and thoughtfulness of this culture of people. 

Tonight's evening ended with a big dinner (homemade guacamole and chocolate chip cookies!) dedicated to celebrating the Friends of Tenwek organization and discussing some of the upcoming strategic plans. I am definitely inspired to support this amazing organization and hope to somehow give back to them on a regular basis.

One of my favorite kiddos on the wards. We like to play hide and seek.  His mother has such a beautiful smile.

The village tailor (Valen) with my gorgeous Kenyan skirt and top! On her back she carries her little boy around everywhere!

Another outfit made by the local tailor. Love it!

Local village children I met on the way to the mountain top. Love the big smiles!

Tenwek Falls after the rainstorm. 

Sophie and I riding a motor bike up to Montigo Mountain

At Sophie's home with her children and many neighborhood kids.

Say cheese!

Finally made it to Montigo Mountain! breathtaking views!

"Life is Precious"

Wow, I can't believe it's already Wednesday evening. The past few days in the hospital have definitely had a different tone that the first couple of weeks. Whereas I had seen some very ill patients during my initial days here, I hadn't experienced much mortality. In a 48 hr period from Sunday to Tuesday morning there were multiple encounters with death, dying, and end of life discussions with family members. Much of it, unfortunately, was very unexpected.

Sunday evening a couple of our adolescent patients had grown more acutely ill. One of our newer patients, Caroline, a 17 yo girl with HIV who had presented with diarrhea had continued to worsen with increasing abdominal distention, worsening sepsis, and delirium. Her mother had become increasingly worried that night and clung to my presence when I was at her bedside. I knew she was very ill but didn't realized she was facing the end of her life that night. About 1 am I awoke to a page from my intern that she had coded after a witnessed seizure. By the time I arrived she had regained a pulse but had no respiratory effort and minimal brain activity and was intubated. She ended up losing a pulse twice more. The third time we performed CPR for about 30 minutes and despite several doses of epinephrine, fluid, and other medications we could not revive her. We brought her mother in who made the painful decision that we should stop our efforts to  resuscitate her. I had witnessed these types of scenarios various times from the outside as an observer but never myself had been the one to lead that discussion. After removing all of her lines and tubes, I actually was able to take part in wrapping her body for the mortuary, something I hadn't done in the US. In doing so I found myself reflecting on what a beautiful girl she was and how such a devastating disease had claimed this girl's life, not only the infection itself but the stigma of the disease which had led her to stop taking her medication and progress to AIDS. I prayed for her and her family as we gently wrapped her and I fixed the delicate white rosary that she wore around her neck. There was a special bond I felt among my intern and the nurses there who had all participated in her attempts resuscitation. I am so thankful to have had them there and not go through it alone. Thankfully, I suppose, I am one who can move on and continue work after difficult situations, and remain fairly disconnected from the emotion of death and dying. Being so intimately involved in the last seconds of her life was tough and I was physically exhausted after the code and emotionally stunned at what had happened. Most unsettling was not knowing the underlying cause for her sudden decline. Was it an infection/swelling of the brain, a heart arrhythmia, blood clot?  Not knowing what the reason was and what we could have prevented or done differently is perhaps the hardest part.

Earlier that same day, one of our patients with presumed meningitis had started to go down hill after an initial very significant recovery. He slowly developed more confusion and headache after several days of looking great and being nearly ready to go home.  On Sunday he suddenly had respiratory arrest likely due to aspirating on food. He was emergently intubated (thank God we have anesthesia here to assist with intubations!) and taken to the ICU. Unfortunately he was shortly found to be brain dead, with fixed dilated pupils and no corneal reflex. The following day I discussed with his family the prognosis after they talked with Chaplain and they made the painful decision of removing the breathing tube. He passed about an hour later. It was difficult to communicate indirectly with his family, especially his own mother, through the translator, not knowing exactly what his mother was thinking and feeling or how she interpreted my words. She was a single mother and had no funds to pay for his burial or funeral.  I told her I didn't have the words to understand her pain nor could I ever understand what it would be like to make a decision to accept the death of a child and withdraw life support. I did feel that the Chaplain who was translating understood and communicated my deep sympathy and prayers for her. We all embraced in a circle and I prayed for her and her family, I believe she felt my prayers. I know God did. I praise God that she knows Him and that she can rely on Him alone for peace and comfort.

Just after that we ended up doing something similar for patient in the NICU who had gradually deteriorated over the last day. It was a baby with sepsis and renal failure who we had intubated for what we thought was only a temporary time while his kidneys recovered. I mentioned that he had been sustained on the only ventilator available in the hospital for babies. The machine had continued to alarm again requiring another re-intubation effort on Sunday. The next day he was very edematous (swollen) and he had lost all of his IVs. No one could place one and the surgery team felt it would be too invasive and only prolong suffering to place one in his larger neck veins. We discussed the prognosis with his family and after much though among all of his family and our medical team his family made the decision to remove the ventilator. His mother is single and this is her only child. I was very thankful that she had many supportive extended family members there. He passed a couple hours later. Although she had prepared herself, his mother was still painfully emotional. I felt privileged to be able to wrap up her baby and hand him to her while she cradled him in her arms for the last time, which she had not been able to do while he'd been critically ill in his bassinet. His family was so thankful to our medical team and were also so obviously filled with the knowledge of God and his peace and good will.

"You give and take away, you give and take away, my heart will choose to say, Lord blessed be your name"

The next day also started off on a sad note, getting paged that a baby admitted early that morning to the NICU, who I hadn't heard about yet, had stopped breathing. We had to initially CPR when we arrived to the NICU, but stopped after a couple of cycles and giving epinephrine. There was little hope of reviving the infant, who we noted to have had massive hepatomegaly (large liver) and profuse bleeding. It was suspected that he baby had liver failure due to receiving herbal medications, which I am learning is very common here and can have some devastating and unpredictable effects. It was still somewhat of a shock to me that the other physicians wanted to stop resuscitation so soon, but I agreed with their decision. They also knew that as part of the culture here, most individuals choose to avoid prolonged suffering and artificial life sustaining measures for their loved ones, even children. The mother's reaction, however, was so difficult to bear. I had never seen such strong, guttural, reaction. She was hysterical at hearing the news of her child and collapsed to the floor. I had no words to say to comfort her or try to understand her pain, but through the Chaplain I tried to convey my prayer that God sustain her and give her supernatural peace during this time. Dr. Terer, the  wise supervising physician, was so sympathetic and caring and helped us to contact family members to support her during this time.

Despite the onslaught of trials over the past few days, I am nevertheless thankful for the opportunity to have such meaningful interactions with patients and their family members. There has been so much reliance on God over the past few days and I have been amazed at His ability to bring peace during the pain. I have seen the incredible faith and peace of the Kenyan people and have been privilege to be trusted by parents with the care of their children. I am also thankful for the supportive community here at Tenwek and the readiness of Chaplains and others to offer support for families.  the ability to bring Christ into such difficult circumstances, and pray openly with the fellow staff members, has been so refreshing and a real privilege that I will surely miss when I return to the US.