Is There a Doctor on Board?

This Thursday I leave Kenya to spend nearly two months in the US.  For the first three weeks, I am going to be a volunteer attending on the internal medicine and pediatric wards where I did my residency.  Volunteering on two separate continents should get me some sort of merit badge or at least a coupon to an all-you-can-eat buffet at restaurant of my choosing.  Just saying.

Traveling back to the US can be an exciting event, but the flying part…sigh.  I have been on 8 (yes, 8!) flights where there was an in-flight medical emergency, and I’ve needed to respond.  Medical literature and the FAA cite there is ONE in-flight medical emergency for every 604 flights or 24 to 130 in-flight medical emergencies per 1 million passengers (JAMA. 2018;320(24):2580-2590).  Pause for effect…

The literature says that most emergencies are due to benign things like light-headedness or vomiting.  However, diversions or emergency landings occur in only 4.4% of in-flight medical emergencies, and these are typically due to more serious conditions like respiratory or heart problems requiring emergency landing.  Of the 8 emergencies I’ve attended to, I’ve unfortunately had to divert 1 plane in route from Istanbul to Atlanta (that’s a 12.5% diversion rate for me).  Not a great way to make friends (unless you’re the sick passenger).

Back to this summer.  Ree’L and Sylis will join me toward the end of my volunteer work, and then we will make the cross-country trek (literally coast to coast) to see as many family, friends and supporters as possible.  If you want to connect while we’re there, please send me a note, and we’ll see if we are passing through your neighborhood.

True to BS form, we will be “dividing and conquering”.  (for those of you wondering what BS is, it is the combined title of Brotherton-Street, affectionately given to us by our organization).   We will be together for a spell and then split up again to maximize the number of folks we can see.

 There are a few things we would ask for you guys to think and pray about if they come to mind.

1.  Our travel, and that each of us can enjoy the flight (i.e., no in-flight emergencies, getting our crash-course in US culture again by binge watching movies).

2.  Our meetings, speaking engagements and interactions; that we would be fully present with each person and each group.

3.  Our times of rest, that we would actually be able to do that well.

Lastly, there are a couple tangible needs that we have.  If you feel that you can join us in filling these, send me an email (

1.  Looking for an old iPhone (iOS 5 or newer) to connect to a hand-held ultrasound probe designed for low-resource settings. I’m hoping to purchase the probe soon to use in our ICU. I got to test one of these probes last week; check out the video here:

2.  Looking for good Litman stethoscopes to better equip our learners here.

Thank you all for your continued support.  Nothing that we do here would be possible without your continued love, care and support.

Not It

Teaching.  I spend a tremendous amount of time teaching at the bedside and in the classroom.  In January, I am tasked to help teach a section on Evidence Based Medicine (EBM).  In the grand scheme of things, EBM is a newer area in the medical profession where guidelines are written, and practices exacted based upon the current evidence in the literature. This evidence is drawn from (at times) well designed trials or studies that compare old versus new, current standard of care versus novel. 

Having said that, there is not always evidence to support everything we do, especially in more resource limited settings.  A prime example is this article I just wrote where I used the ONE case report in the literature to treat a pediatric patient because all the literature-recommended modalities were not locally available.  Although my write-up is now only the second case report in the literature, hopefully it will provide another data point for similar settings trying to use EBM instead of just anecdotes and/or trial and error.

Practicing EBM can sometimes be challenging in resource limited settings (as highlighted above) where we often don’t have easy access to needed information, much less relevant information for our context; we often can’t get our hands on the “best” modalities outlined in the studies; and we’re often strapped for resources, requiring great diligence with their allocation (i.e., we don’t have resources to waste when we’re not fully sure they’re going to work).  Which brings me to an exhausting word in my vocabulary…

Research.  It’s the foundation for Evidence Based Medicine.  We need it to be relevant to our context to both treat patients and to teach our learners.  The lion’s share of the studies we use for EBM are not carried out in a low-income environment, nor are the patient populations similar to ours here in Kenya.  For example, studying the effects of intervention X in Europe where the population is primarily Caucasian is likely not applicable to the African population.  We (practitioners in Africa) are left to pour over the data in order to determine whether or not it is useful for our patients, and then, of course, whether that particular medication or intervention or procedure or skillsets are available in the region.  Moreover, so many of the major studies are only published in journals that are not accessible without incredible fees, which limits access and thwarts learning.

So, what am I doing about all of this, you ask?  In simple terms, not enough. 

Research is not a core competency of mine, especially compared to many people I’ve worked with in the past – people who are far smarter, and far more qualified who can do far better research in their sleep than I can ever dream of doing awake.  As I type and believe every word of that statement, my reality sinks in, though - I’m here; I see the need for this research daily; and I have the opportunity to make some level of progress, despite all my shortcomings.  Calling “not it” suddenly doesn’t feel so great.  And, how many other places in my life am I likewise so inclined to call “not it” just because I can think of others who could or should engage in that act of love?

The holiday season often opens our eyes to many others’ needs – whether across the street or across the world.  Let us challenge ourselves to not compare our own time, talent and treasure to others’, but instead remember we’re all uniquely positioned in this world.   In this season of giving, let’s resist the urge to call “not it” and love as we have been loved.

Thanks to all of you who so generously share your love with those we serve here in Kenya. 

The Opportunity to Say Yes

Since arriving in Kenya, I (Ree’L) have had a few opportunities to say yes to using my God-given skills and experiences to support those around me – some of those have involved working with the hospital in Chogoria, a couple with local NGOs and even a few short-term teaching opportunities inside East Africa and beyond.  However, homeschooling Sylis has clearly been the priority and has required the biggest investment of my time.

With our recent move, Sy starting school (pictured above playing Professor Backbone with his class) and the level of passion and excitement in our new home, Kijabe, (see our previous newsletter for more on this), I was hopeful to have more opportunities to say yes - yes to supporting hospital initiatives, yes to local programs and yes to other activities that support our team and community. 

Over the past couple of months, opportunities have come a-knocking…literally…on the door of our house.  Within a few days of arriving in Kijabe, a woman I met in passing a year ago came to our home.  She’s a high-energy physician, visionary, researcher, director of a community program, and the list goes on.  She said to me, “I will win the battle for your time – we will figure out a way to work together.”  I chuckled at the intensity of her comment, but was beyond excited and humbled that someone (and especially this amazing lady) would seek me out. 

Somehow, this conversation, opened the metaphorical floodgates.  Thus far, I’ve been so excited to say yes to supporting, in varying ways, Kijabe Hospital; a fundraising non-profit for Kijabe Hospital; another community-based NGO; an electronic medical records software organization; as well as continue to manage a pilot cohort for our mission agency’s leadership development program. 

And, I’ve also just said yes to partnering with another missionary here, to open a local, not-for-profit coffee shop.  We are currently in the process of establishing Kijabe Kahawa (i.e., Kijabe Coffee) with the sole purpose of supporting the community and a local sewing workshop that trains, equips and empowers vulnerable women in the area.  Prayers are very welcomed for the coffee shop and the other initiatives; more to come on these soon.

All of this is a little mind blowing – a few months ago I woke up to homeschooling 2nd grade and fitting small projects in between teaching; now I wake up excited and, yes, a little overwhelmed, at all these opportunities to say yes.  Now, it seems it’s just a matter of sleep that will begin to limit my yes’s.

Much, much thanks to all of you who have and continue to support us in the work we are honored to participate in daily.   

The Only One

The anticipation of starting at Misty Mountain Academy (pseudonym) was not without anxiety and clouded expectations from the three of us.  Sy was initially concerned about fitting in and making friends.  He also asked several times about what the school would be teaching in math and science (spoiler alert:  mom and I are heavy on the math and science; everything else was essentially non-existent in his home school curriculum). 

Ree’L and I, on the other hand, were worried about the social construct within his class and school. Would he be behind his peers due to home schooling?  And, the parent teacher conferences because, let’s face it, he’s my kid.  Many of you may remember us telling you the story when Sylis first started attending the local school in Chogoria.  He was the only ex-pat kid, so he stuck out like a sore thumb.  The uniqueness of his skin and hair were very distracting and brought him more attention than he initially enjoyed.  He understood what it felt like to be the only one who….

I rehash that story to set up this one.  Last week, we were walking home from the first day of school, and Sylis was doing his classic data-dump, detailing every last event of his day in excruciatingly vivid detail.  The most striking part was when he started to describe a young boy in his class from the Korean peninsula.  Sylis described how this young boy, like him, was new to the school but explained what made this boy’s situation different was that he only knew a small amount of English (there are 30+ passport countries represented at this school - children of workers spread out across Africa). 

Recognizing how this young boy’s lack of language might preclude his new friend from social interactions typical of elementary school kids, Sy said he went to the library and checked out a book about this boy’s home country.   He then proceeded to show the book to the boy and tell him that he wanted to learn about his country and culture. 

As he finished this story with, “Now we’re friends,” I was completely floored.  Sylis thought nothing of it because he seamlessly transitioned into describing how he fell off the rip-stick (what you get when a skateboard and roller-blade enter a long-term relationship) at recess more times than he could count.  I prodded with questions to get to the bottom of his actions, but they must have seemed ridiculous to him because he essentially kept saying, “duh dad…why wouldn’t I do that?  He’s the only one in my class who doesn’t yet feel comfortable with English.”

Our child - whom we were worried about learning, assimilating, fitting in and all those things that parents concern themselves with when their child/ren begin school - reminded us that he’s not the only kid in the school.  He reminded us that there are others, like he once was, who are “the only one in the class who….”  The level of empathy and concern that he showed for the other child was remarkable, and honestly a wake-up call for me as a parent.  There are so many times that I get wrapped up in what is going on with my life, my family and my responsibilities that I forget to look around for the only person sitting alone in their situation. 

Sylis may not yet have grasped many things about being a student in a classroom, but he does understand empathy and how to lovingly care for his fellow human, especially when they’re the only one.  I’m challenging myself and each of you to look around this week to reach out in love to the only one who…

Lost to Follow-Up

Lost to follow-up.  It’s  a physician’s nemesis.  After working tirelessly for fragile hospital patients' recovery, I, the hospitalist, must send the patients off for follow-up, not knowing whether they'll bridge the divide or fall through the cracks. Lost to follow-up is just the reality working and serving here in rural Kenya; it’s like perpetually getting the To Be Continued message, knowing that you’ll never be able to tune in for the rest of the story.

One of my “side jobs” is acting as the physician on call for a local NGO, Village Hopecore.  Their nurses provide public health services (e.g., school clinics, maternal/child health clinics, etc.) to many, many communities in our area.  Almost weekly I get phone calls from their community health workers about children, and sometimes adults, that they come across in the field. I then go see the patients either in their school or home, and many of them are in remote villages far from access to care. 

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Several months ago, I received a call from a nurse at Hopecore about a 3 year old girl who had had progressive abdominal swelling for “months.”  We will call her JW.  She was not eating and became so weak that she had to be carried everywhere.  Her family had not sought care because they were unable to make ends meet at home, let alone pay for a visit to the doctor.

Her appearance in clinic was frail, malnourished, and 90% abdomen.  Her stomach was large, protuberant, and firm from what lied beneath.  I used our Needy Patient Fund (funded by many of you, our supporters, for care for our most needy patients) to cover the cost for a CT scan (~$85).  This unveiled a massive tumor, but created another problem; where to send her now?  Our hospital does not have the capability or resources to perform this type of surgery, therefore we needed to look elsewhere.

I called one of our partner mission hospitals where our Kabarak University residents rotate, Kijabe, to see if they could help.  After a phone call and some images sent via WhatsApp a plan was made to transport her to Kijabe for an operation in the coming days.  We loaded JW and her mother in our makeshift ambulance truck and sent her off on the five-hour journey.

At this point, I assumed that was my goodbye, as she would surely be lost to follow-up. But, the pediatric surgeon at Kijabe, removed the entire tumor without any complications, discharged JW after a short hospital stay, and sent me some pictures of the removed tumor.  I was elated to hear of the success, but again assumed that she would now surely be lost to follow-up.

Yes, This tumor was inside her little belly!

Yes, This tumor was inside her little belly!

After this last communication, I often thought about her and wondered how she was doing.  Was she gaining wait?  Did she feel better, not having that massive tumor in her abdomen?  Like many times before, I had resigned myself to speculate and never know.

However, last week I received a picture from the Hopecore community health worker who had first called me about her.  She went to visit JW and her family.  Life had slowly returned to JW’s small body, and she was eating again.  Regaining strength had allowed her to start walking, and this brought tremendous joy to both she, her mom and sister. 

JW after her surgery!

JW after her surgery!

For just a moment, lost to follow-up had been conquered through the amazing communication of my colleagues.  Never knowing fully what happens, how things turn out, or even the impact made is an unfortunate part of this particular life, so I celebrated hard when I got a glimpse of this beautiful outcome.  To those of you out there who are praying for and giving sacrificially to the work being done here in Chogoria, Kijabe, Hopecore or any other mission caring for those in need, I hope you too will celebrate JW’s amazing transformation with us.

Choosing Wisely

A few years ago, the American Board of Internal Medicine launched the Choosing Wisely campaign to help physicians and patients choose care that would, over time, combat the rising healthcare costs in the US.  The initiative’s primary strategy is to provide evidence-based recommendations on when medical tests are appropriate, especially for those tests that are deemed to be overused.

Having trained at a place where resource stewardship was required, it became second nature to use these lists for clinical decision making when practicing medicine in the US.

Today, “choosing wisely” has a whole new meaning.  Before, I was selecting from a seamlessly never-ending menu of investigations and therapeutic modalities; hence the need for initiatives like Choosing Wisely.  Now, those lists of options are very limited and at times, non-existent.  Thus, “choosing wisely” here manifests like…

  • We are out of a commonly used intra-venous antibiotic.  Do I choose to have the family go try to buy it at a local pharmacy, or do I use a less desirable drug?
  • We only have one dialysis catheter left, and two patients desperately need dialysis to get them through their acute illness.  Do I choose the patient with the best prognosis, the youngest patient or the one admitted first?
  • Our hospital is completely out of oxygen.  Do I choose to use the torpedo-sized tanks procured from two other hospitals on the medical ward where the average age and oxygen saturation is in the mid-70s, or in our NICU (newborn unit) for CPAP?
  • Our blood bank is as anemic as the patients.  So, who do I choose to transfuse with those precious units of blood?

At my own doorstep, choosing wisely takes shape in other ways.  For a while, I was the only expat medical physician here so the choice of whether I could turn off my phone was made for me.  I was called.  I went.  Now, there are several more expat medical physicians here to work and serve, but many of them are still learning the ropes and need support.  Thus, turning my phone off is still hard to do.  However, I know that answering that call may result in another missed Saturday morning of pancakes or another much needed conversation ending prematurely.  That said, choosing to answer or to go in when I’m not the physician on call seems like a necessary discomfort for my family and me, in the hope that others will grow in knowledge, confidence and capability.  

Every day we all are faced with choices.  Each time I leave for work, I remind Sylis to “make good choices” with the hope he will be thoughtful about his decisions and their impact, not only for himself, but for those who are likewise affected.   He will soon figure out, as I have depicted above, that choosing wisely does not always fit into the binary construct of good and bad.  Sometimes we are left with choosing between bad and worse. 

The adverb wisely implies experience, knowledge and good judgement.  Reflecting on the required decisions above and others unmentioned, I am certain I have chosen poorly more often than wisely.  Therefore, I ask that you keep us in your thoughts and prayers as we consider what “choosing wisely” looks like in the hospital, our community and our home.

Life of Sy

August is a big month for our family.  During this single month we celebrate both, Sylis’ birthday and his adoption day.  He turns 8 today, August 13th, and his day of official adoption is August 22nd.  Since being grafted in to the branch of our family, he has been a never-ending grab bag of enjoyment and surprises. 

Many of you have had the pleasure in meeting him, and having him unload on you whatever it is that he has read within the last month.  But, for those of you who have not exchanged pleasantries, I’ll try to give you a brief snapshot of our son. 

He is a voracious reader and has an unquenchable curiosity.  We could probably change his last name from Brotherton to Britannica.  Although his favorite thing to read right now is Harry Potter, he has not met a book that he did not like.  He will consume anything that you put in front of him, regardless of topic.  What we find him reading most frequently are books about animals.  He loves animals. 

Which brings me to the next thing you should know about him - he is a self-declared vegetarian.  After asking some good questions and getting some answers that didn’t sit too well with him, he stated that he did not want animals to have to die for him to eat.  He has not had an ounce of meat in well over 2 years.  His commitment and conviction are impressive, especially in light of the fact that bacon was essentially his comfort food.  At present his favorite foods are black bean burgers and pesto.  Thankfully, mommy makes some of the best.

He thoroughly enjoys playing games.  Many mornings before I go to work and nights before bed are spent playing Scrabble, Trouble, UNO and Africa Trumps (thanks Jennifer).  He recently taught himself how to play chess, and after taking it upon himself to teach me, we play.  A lot.  Of course, I win but there have been several instances where I have “fallen asleep at the wheel” and he beat me soundly.  He knows that if he can get to me before the coffee kicks in, his chances of victory increase greatly.

I could write pages of attributes and stories of our young son with the old soul (literally, at times I think he’s an 80 year old man trapped in that now 8 year old body), but I will conclude with this; his ability to adjust.  We weren’t his first family, and since becoming part of ours, he has been in three different locations and as many schools. Yet, he has seamlessly taken it in stride.  He easily acclimated to life here, but as with the other transitions, it has taken him away from his previous environments.  In some instances, leaving his previous environment was for the best; in others, we are not so sure.  We do know, though, change has had an impact – for example, he has stated, he would really like to have a lifelong “best friend.”  However, all-in-all, he has a tirelessly positive outlook on life and change.

Therefore, we ask you to join us in celebrating the Life of Sy and his adoption.  Pray that we would have the wisdom to care for and shepherd his young heart and mind.  Pray that he would continue to be adaptable and find confidence in this unique quality.  Pray that when there seems to be no justice anywhere, he would develop a keen sense of justice that grows out of respect, responsibility and reconciliation.  Pray that he finds a best friend here.  Lastly, as our adopted son, pray that he fully embraces his adoption by the Most High.

Now, I must go, as part of his birthday celebration is disassembling a broken iron…

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I Had to Pee

I had to pee.  So, I walked ahead of Ree’L and Sylis back into our apartment after playing some baseball outside.  I headed into the bathroom and untied my scrub pants, only to find a burglar trying to get out through our bathroom window (which is on the 2nd floor).  There’s not enough room on this page for me to include all the details of the events that followed, but here are the highlights:

  • With my scrubs now around my ankles (anyone who has ever worn scrubs knows that you must keep a tight grip on them or gravity will soon take over), I pulled the burglar back in the window, drug him through the apartment, sat him at our dinner table and made him wait for me to pull up and retie my pants.   
  • Escorting him outside I soon realized that the typical response from the community for thieves was beating – pastors, teachers, nannies and random people materialized out of nowhere to provide their disapproving blows to this man…literally and to the face.  (We later found out if he had stolen things from the market, he would have been either set of fire or stoned; neither of which we wanted for him.)
  • Realizing the police were not going to come to us, another ex-pat and I drove the burglar to the police station.  My Western thinking assumed that I would just hand the man over to the police, tell my story, show them what he had stolen, and be on my way soon thereafter.  I was on my way relatively soon, but far from alone - I was accompanied by the burglar, four police officers (one of which smelled like he had bathed in PBR), two nurses, two school teachers, two hospital guards and numerous other random people whom were picked up Dumb and Dumber style on the way home.  We all stood in my living room replaying the afternoon’s happenings with the burglar.
  • Meanwhile, there was a plumber in our bathroom trying to fix the pipe the burglar had broken when he tried to escape.  Thus, in the midst of all this madness, our apartment had also flooded.

After four long hours and many, many other twists and turns, everyone departed our apartment.  The police took the burglar with them, and the plumber left us with an oversized rubber band tied around our pipe to reduce the leak.  Ree’L and I then managed to clean up the mess and have a few chuckles as we recounted the day.  And, yes, I finally got to pee. 

Thank You, Sir, May I Have Another?

With the turn of the new year, and near completion of our first year in the field, it is virtually impossible not to look back on our tenure here thus far.  Peering in the rear view, it’s easy to see many people and situations that have been responsible for shaping our experience.  Some good, some bad, some outrageous, but all of them lasting.

We are currently still in the throws of one of those experiences - the strike.  The strike is now in it’s seventh week.  I have never been a part of a strike.  My only other related strike experience is with the nuclear plant where my dad worked when I was a kid.  My brother and I thought it was cool because he was home all day until its conclusion.  This time, it’s not so enjoyable.  Myself and others like me in surrounding mission hospitals, are logging countless hours to try to ensure that every patient is seen and well cared for.  I have had only one day off since the walk out, and I believe I speak for all of us when I say we are exhausted.

Our hospital is literally bursting at the seams.  There is no more space to put a bed in our medical ward; so, if more patients are admitted, they will have to share beds with their nearest, non-infectious neighbor.  HIPPA is non-existent in this context. 

Recently, while shuffling through our metal wired beds to do rounds, I came upon one of our patients standing in the threshold of a doorway.  He appeared to be studying the ward, but not giving much attention to me standing before him.  As I tried to slide past him and continue seeing patients, he raised his right arm and in it he clinched six feet of rubber coated wire.  Before I knew it, this octogenarian was beating me like I stole something.  It was the only time in my career that I was thankful to be wearing a white coat, as it provided an extra layer of protection from his arthritic, yet effective blows. Needless to say, the five patients in the isolation room remained as such; isolated.  Our demented doorman was not allowing anyone entry.

Maybe he thought I was responsible for cooking the food he was served?  Maybe he thought I was responsible for the strike?  Maybe his smoldering dementia turned to delirium from being in the hospital, which is completely understandable.  Either way, just when I thought I couldn’t be mentally or emotionally beaten any worse from the many consecutive days of work, I got a quick and welt-producing reminder that it can always get worse. 

Reflecting on the call of our lives, we are reminded that in being called, we are not promised to be liked,  successful or fruitful in ministry.  We are not promised safety and security; not even from an eighty-plus year old dementia patient with a solid right arm.  We are, however, promised that the Father will be with us and not forsake us.  That makes the sting of life’s unfairness, or that of rubber coated wire, a little more bearable.


TB or not TB? That is the Question.

TB or not TB, that is the question.  Although this may be a clever play on words from Hamlet’s famous manifesto, it is a question that health care providers across the globe ponder all too often.  For Hamlet, these words were birthed out of his existential crisis of whether or not anything but the present is true; suggesting the past and future are illusive and unknowable. For those with tuberculosis, not only is the present a real and imminent danger, it is a reflection of their past and has tremendous ramifications on their future.

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A recent report from the World Health Organization detailed the increasing number of cases of TB worldwide.  A growing number are multi-drug resistant, and give rise to many more deaths annually (1.8 million deaths per year) than Ebola ever claimed.  Common among TB patients from high, middle and low income countries is that this is a disease of poverty.  Crowded living conditions, malnutrition and chronically uncontrolled comorbid conditions place men, women and children at risk for acquisition or reactivation of this aggressive infection.  Therefore, an individual’s past and present situation can have an exponential effect on his or her future.

During rounds in our rural, under-resourced hospital, we are faced daily with this question...Is it TB or not?  Anyone who knows anything about TB knows it’s not only a question of whether or not they’ve had productive cough and fever.  TB is the new “great masquerader” and can present similarly to a myriad of diseases and disorders.  In the short time that I have been here, we have diagnosed cases of pulmonary TB, as well as meningitis, pericarditis, endocarditis, arthritis and peritonitis due to TB.  All of these were in individuals who were HIV negative, and considered immunocompetent.  Now imagine how our patients with HIV or full blown AIDS present.  Needless to say it has been a daily exercise in humility and further education.

To combat one of the other collateral effects of this horrid disease, domestic and foreign governments have worked to offer TB medications at no cost to our patients here in Kenya.  This allows them to gain access to the medications, while not diverting their household income from other essentials items like food, transportation or school fees.  However, this is not without its own complications as the incidence of multi-drug resistance is increasing globally, at times rendering us completely helpless.

While Hamlet remained anguished and paralyzed by his current suffering, we likewise should be anguished about the suffering of our marginalized brothers and sisters around the world.  Though being anguished, let us not be paralyzed.  Let us move forward in love and deed to those across the street and across the globe who are suffering because we have One who knows our suffering and has suffered for us.  


A few weeks ago, a middle aged man was admitted to our medical service and was found to have a hemoglobin of 3 g/dL (normal 12-15 g/dL), white blood cell count of 4,000 mm/³ (normal 4,500- 12,000 mm/³) and platelets of 5 (normal 150,000-450,000).  Needing to act quickly, we typed the patient’s blood for transfusion (O Positive) then queried our lab to find the nearest bag of platelets.  The result was Nairobi, four hours away, and to make matters worse, our hospital was fresh out of O positive blood.  Crap. 

We moved to plan C and asked the family to donate blood, hoping for a match, but not one member was.  So, now what?  It then occurred to me that I was O positive, so I proceeded to the lab to provide the blood. 

After being on the business end of that needle that I remembered being much smaller the last time I donated blood, I had a few minutes to think about the current situation. I thought about the importance of blood, and how it is a vehicle to take oxygen to the far reaches of our bodies so our cells can carry on countless molecular processes without us giving it a moment’s thought.  Wow, what an amazing Designer we must have.  I wrestled with the reality of the finite nature of my blood, only capable of being a literal and proverbial Band-Aid for this man.  I then reflected on the One who not only gave His blood, but His entire life for all regardless of tribe, nation or tongue.  My feeble attempt at giving of myself seemed incredibly minuscule.

Interestingly enough, this patient was not from Kenya.  He was from a neighboring country that does not have a good working relationship with Kenya.  As a non-Kenyan with only a short history here, it was easy for me to view this person as an image bearer and not an enemy.  For others, though, perhaps this was more difficult – he was one of “them.”   In a day and age where “us versus them” leavens every aspect of our lives from politics to sports to bathrooms to peanut butter (crunchy definitely), it can become easy to dehumanize “them.”  It challenged me to think about my definition of “them.” Would I have been so eager to give my blood to someone who I defined as “them?”  Thankfully, there was One who gave His blood for me when I was still an enemy.   

Bag filled, needle out and back to the list I went: internal medicine, pediatrics, neighboring and trying to love because we have been loved first.

Until next time...

What Did I Just Say?

When you’re young, you have those things that you’ve heard others say that you swear you’ll never say.  These are not those.  These are things I haven't considered saying before now.  Sometimes, I laugh after hearing what has just rolled off my tongue. I'm sharing so that maybe you, too, can have a little chuckle with me.

1.       Get the glue gun and Velcro…the screens on the windows are coming loose.

2.       Turn…turn…turn…no...I don’t see any blood. 

3.       How many days have you worn those socks?  2?  Sure, you can wear them again today.

4.       Don’t throw that ziplock bag away.  I'll wash it and hang it out on the clothes line to reuse.

5.       The kitchen’s flooding….AGAIN!

6.       No thank you – I don’t need a live chicken today.

7.       Quick, blend everything we need for dinner...the power is flickering.

8.       Don’t put the eggs in the fridge; just sit them on the counter…I’ll wash the poop off as I use them.

9.       Expiration date was when?  Two weeks ago?  We’re good; it’s only a suggestion.

10.   Is that a live animal on that motor bike with 4 other people?  Yup!

11.   Uuuugggghhh – I just fried another electrical device!

12.   Open the oven door to let out some of the heat; otherwise the nobs start melting!  [Our oven doesn't have a thermostat.]

13.   As usual, you look nice today, sir. [speaking to the working farmer who is wearing slacks, a button-up and a blazer.]

14.   To the left, to the left… (repetitively singing Beyonce’s song while driving to remind myself to stay on the left side of the road.)

15.   Could someone bring me a bucket of water to fill up the toilet?

16.   Hurry, get the clothes off the line – they just set the trash on fire again!

17.   Why does it sound like there’s a [fill in any given animal] right outside of our window?  Oh, because there is. 

18.   It’s 65 degrees.  You know you should have on your toboggan, gloves and coat to go to school.

19.   Relax.  I know it's time for church to start, but we’ve got another 10 minutes before we’re actually late.

20.   Scalp ringworm, you say?  Is that better or worse than lice?

Until next time…[hopefully my head will have stopped itching by then.]

Ready or Not?

Volume and variety were the norm inside of the historic walls of the Los Angeles County Hospital, providing a robust clinical foundation to propel the avid learner out into the world of medical practice. Training at Mother County made me ready to handle a multitude of things, but it only took a single patient in Chogoria to point out all the ways I was not fully prepared for medicine in this new setting.

When the intern covering the pediatric service called in the middle of the night about a 10-day old baby girl, I was confidently ready to:

  • Address her serum sodium of 175 (normal 135-145);
  • Cover her for bacterial infections given her age;
  • Intervene when the potassium and creatinine (marker of kidney function) in her blood began to rise;
  • Manage respiratory distress with minimal equipment;
  • Treat her oliguric renal failure.

However, I was NOT ready to:

  • At best, check the baby’s labs once per day because of our hospital’s fickle machine;
  • Hear we could not obtain cultures…of any kind;
  • Learn that we do not have common medications to lower her potassium;
  • Hold a piece-meal face mask to her tiny face to supply oxygen while the intern went across the hospital property to find our lone CPAP machine;
  • Use the smallest nasogastric tube I could find because we had no urinary catheters;  
  • Fight off a bird during the process until it finally showed itself out the open window.

When this tiny patient’s condition was not improving, I was ready to transfer her to Nairobi for a higher level of care.  However, I was not ready to:

Our hospital's bay where we met the ambulance to take us to Nairobi.

Our hospital's bay where we met the ambulance to take us to Nairobi.

  • Hear that the parents would have to pay her hospital bill in full before she would be released;
  • Learn that because it was getting close to night fall we would not be able to travel until the morning because of the numerous dangers of Kenyan roads after dark;
  • Ride four hours in the back of a hulled out Land Cruiser while holding the baby in my arms because it was the safest of all our options (i.e. no car seat, isolette, papoose or gurney) as her parents sat scrunched in the front next to the driver;
  • Listen to the siren’s unrelenting plateau next to my ear as we navigated the insanity of Nairobi traffic;
  • Argue for two hours at the receiving hospital to have her seen by a nephrologist such to get her started on dialysis.

After leaving the hospital, I replayed the scenario hundreds of times in my head and wanted to fast forward to see how it would all work out.  Interestingly enough, two weeks later in the market, I felt a tap on my shoulder from the patient’s mom who asked me, “Daktari, do you remember me?”  When I saw her, I was completely ready to hear how her baby had received dialysis and was improving.  I was far from ready to hear how she was in the Nairobi hospital for three days, and never once received dialysis.  When finally taken to the operating room on the fourth day for insertion of the dialysis catheter she arrested and died on the operating table.  

At that moment I was ready for her to be angry, hurt and express her disappointment in our ability to care for her young daughter; all the things I likely would have done if our roles were reversed.  I was not ready for her to say thank you and then give me a hug.  In the midst of her pain and loss and suffering she offered me something that I so often am ready to receive, but am not ready to extend.  Grace and mercy.  

In moving my family to Kenya I was ready to use all that I had learned to listen, teach when necessary, and do when needed.  I was not ready to be taught so much by a young baby and her mother.  This lovely woman reminded me that when we are not ready, in the midst of our weakness, there is One who is ready to fill us with what we need.  By grace and mercy strength is made perfect in weakness.



Growing up in rural Appalachia, it goes without saying that we have a special way of expressing ourselves.  Syllables and vowel length have been mere suggestions.  Creating melodious, multisyllabic words in a single bound are somewhat of an inherited super power.  However, our proverbial kryptonite is learning a new language seeing that we are still trying to master our first one.

This is Millicent, one of our amazing language helpers.

This is Millicent, one of our amazing language helpers.

While at our training in Colorado, we were taught many techniques on how to learn a new language.  We were introduced to a new phonetic alphabet, how to execute glottal stops, what on earth a fricative is (my favorite new word) and that sometimes it’s ok to spit when you speak.  We were also reminded that learning a new language, and in turn a new culture, is a wonderful exercise in humility.  Our octogenarian instructor said we would spread great cheer amongst the locals while learning the language.  He would often repeat, “no one will speak your target language quite like you.”    He enthusiastically encouraged us to get out there and “butcher it to death” because in his mind, there is no other way to learn than to give it a shot and make a million mistakes along the way. 

So far he has been right.  No one in Chogoria has spoken Swahili quite the way we do; at least no one around here has a southern accent like ours.  And over the last 7 weeks, we have done everything in our power to butcher Swahili.  We have spread cheer in the market, at church, the matatu stand and to our language helper.  Rarely have we seen another grown person laugh so hard.  The great thing about it is that it is not a laughter of mockery, but one of endearment.  Our language helper has gracefully loved us while we have destroyed her native tongue with our non-stop onslaught of pronunciation snafus and grammatical mishaps.  At times subject verb agreement eludes us in English, so you can imagine how many mistakes we make when the sentence structure is completely opposite of what we are accustomed to (yes, I just ended that sentence with a preposition).  Some of our greatest hits are as follows:

1.       When asked what my favorite food is, I quickly replied “tacos”!  I was subsequently informed that taco (spelled tako) in Swahili means buttock.

2.       While attempting to put together some incredibly rudimentary sentences, I supplanted the word for “show me” with the word for “breastfeeding.” 

3.       Again to my surprise, and to our language helper’s enjoyment, the word for house and the word for fart are only one letter different.  You can guess which one I used.  Despite my intended kindness, inviting someone over to your fart, doesn’t quite extend the same courtesy in any culture.

4.       Lastly, the word “prepare” is very, very close to the word “circumcision.”  I’ll let you fill in the blanks.  

So, we will continue to lay our pride aside and continue to walk in humility towards some semblance of fluency.  Along the way we will likely be able to create our own dialect out of our innumerable mistakes.  We’ll call it Swahilbilly.  Regardless, this has been another area for us to lay down our ideas of success and self-sufficiency, and fully rely upon the Father for provision.  We may never fully learn Swahili, but we will never forget the lessons of unconditional love, mercy and kindness we have been shown by all throughout this process.


Shock to the Heart

Defibrillators.  In the U.S., they are found in nearly every public location.  Walmart, shopping malls, airports and even sports arenas all have these devices for the treatment of cardiac arrest.  Until a few weeks ago, our 300+ bed hospital here did not have a single defibrillator.  Pause for effect…

Additionally, only a few of the interns had heard of Basic Life Support (BLS) or Advance Cardiac Life Support (ACLS), and none of them had ever received formal training in either of these.   (To the non-medical community, BLS and ACLS are effective means of providing CPR to an individual who has stopped breathing or whose heart has stopped beating.)  Thus, last week, we taught 16 hungry learners how to perform chest compressions, administer correct medications, manage airways and recognize abnormal cardiac rhythms.  It was amazing to see how eager they were to learn these new skills. 

In the middle of the second group’s BLS/ACLS workshop, the Resident on internal medicine burst into the classroom, and yelled “Where’s the defibrillator!?”  Someone pointed to its location beside the CPR manikin, and the Resident grabbed it and ran.  A young woman on the ward had collapsed at the bedside.  When the Resident returned to the collapsed woman equipped with the defibrillator, he found the Intern doing chest compressions just as he had learned only days before.  The Resident placed the defibrillator pads and quickly recognized ventricular fibrillation.  Shock advised!!!  The surge of electricity converted the disorganized fibrillations back into a regular, life-sustaining rhythm and the woman's pulse returned.  Success!  Immediate return on investment, and immediate improvement in the standard of care.  Praise God!

If this situation would have occurred just a few days earlier, the outcome would have most likely been different.   Already the Lord is using a donated defibrillator, passionate teachers and hungry learners to improve the overall quality of healthcare here.  That is not only exciting, but also life giving to everyone involved.

Until next time…

Jason teaching a group of interns BLS/ACLS.

Jason teaching a group of interns BLS/ACLS.



Karibu Kenya

We’ve been in Kenya for a little more than a week now, and the jet lag has nearly waned.   Our flights were thankfully uneventful, and praise the Lord, despite the TSA rummage sale, all of our luggage made it too!  We were graciously greeted in Nairobi by a family that has been in Kenya with another organization for nearly two years.  They helped us get our luggage and secured a place for us to stay for a couple days.   

While in the capital we were able to purchase some things that are not available in our rural area (believe it or not Ree’L found a few bottles of Mountain Dew in Nairobi), and we were able to take Sylis on a little excursion to an elephant orphanage.  For $5 we got to see the feeding and play-time of 24 elephants, aged baby to adolescent.  Because there was only a thin piece of rope separating you from these rambunctious creatures, an occasional body check or a tap from their trunks came free.

Once we regained some of the sleep lost from the flights and stocked up on items, we made the 4.5 hour drive out of the city up to the eastern base of Mount Kenya.  A good, but windy road led us on a connect-the-dot tour between towns and markets, from Nairobi up to Chogoria.  We had to take two cars from Nairobi to our new home - I wish I could have been in the car with Ree’L and Sylis to hear their impressions of what they saw as this is their first time in Africa. 

Much like at the airport, we were greeted here in Chogoria with open arms.  In our flat (i.e., our apartment), there was a fresh bouquet of flowers picked earlier that day, two dozen eggs and a fresh jug of milk still steaming from the cow’s utter.  Another family from our organization arrived here last month, and they have been a tremendous blessing during our initial transition. 

Since in Chogoria, we have met many wonderful Kenyans who have gone out of their way to make us feel welcomed.  Over the last several days we have been busy meeting our language helper and neighbors, visiting the hospital, solidifying Sylis’ schooling during our language training, getting mattresses to sleep on and unpacking. 

Sylis quickly found his Legos and got to work.  He also found the tree swing, and another tree he easily scaled.  We discovered him about 12 feet up with a puzzled, but “I’ll figure it out later” look on his face as to how to get down.  We should have brought his bike helmet.

Spending some time in the market, we procured milk from the “milk guy,” got new keys cut and filed by hand, and tried to identify the best produce prices.  We have also seen several feats that defy all laws of physics.  The greatest of these was a pikipiki (imagine small dirt bike) hauling a full sized couch.  If that is of no consequence to you, then imagine someone sitting on the couch!  I can’t even make that up. 

On Monday, we will put what we learned at our training in Colorado to use and begin our three months of intense language training. For two people who do not feel as if they have a tremendous grasp on the English language, this is going to be a great exercise in perseverance and patience.  Thankfully mangos are in season and there is plenty of push-pot coffee to go around.  With his own language helper, I’m sure Sylis will make laps around us and pick up the language in no time. 

Here are our top 5 lessons from the last week:

1.       You cannot return anything after it is purchased, even if it doesn’t work (ouch!).

2.       Unpredictable electricity requires far greater planning than expected.

3.       You can put anything, and I mean anything, on a pikipiki (i.e., dirt bike).

4.       Milk straight from the cow is utterly delicious.

5.       It’s impossible to get in and out of the cell phone store (Safaricom) in less than 2 hours, regardless of your cellular need.