all work and some play...

today was my first day working on maternity and pediatrics, aside from being on call. we have been here in kapsowar almost 2 months now and while my first month on medicine and my second month on outpatients have been taxing at times i have considered them both a warmup for the month ahead of me. the only thing more intimidating to me than taking care of sick little babies with minimal resources is delivering sick little babies with minimal resources. last week on call i rushed from home to a neonatal resuscitation... when i arrived i ascertained immediately that the bag valve mask system they were using was not working and no air was going into the baby's lungs. i tossed it aside and grabbed another one which worked but did not have the proper attachments for the O2 tubing we were using. while i was bagging with room air the nurses taped the 2 different sized tubes together which made me feel better until i realized that the O2 concentrator was not working either. then we spliced a line off of another tank which was supplying a set of twins already and stole O2 from them. i wanted to put a line into the baby's umbilical cord but despite the fact that a visiting team recently left us a pack of 50 umbilical catheters, they were nowhere to be found. in canada they drilled into us that preparation was 90% of neonatal resus and i would dutifully check the kits in the labour rooms; never once did i find a piece of equipment missing or nonfunctional. here it is a very different story. not only are things missing but often they are just plain unavailable. instead of a choice of 3 laryngoscope blades we are lucky to have one blade with a working light bulb.

but i digress: the point of the preceding paragraph was to emphasize my trepidation at tackling peds and obs at the same time, not to complain about lack of resources. i keep reminding myself that this is precisely why i am here. after a month on these wards i will know this entire hospital fairly well and then repeat the rotation with more experience and (hopefully) confidence. i have done 4 ceasarian sections now and by the end of the month i will have had ample experience in this surgical procedure. just in the past 2 months on call alone i have done more neonatal resuscitations than i have in my canadian career. i am in the middle of a steep learning curve and it is about to get steeper. if i remembered more of my university calculus i could comment here on the integral of my learning curve (the rate of change of the rate of change) but it would be purely academic. ;-)

kylie and have had some great outdoor experiences here lately. last week we went on a hike with a diverse group of visitors and locals. i love this picture b/c you can see all the different nationalities together enjoying the view. unfortunately the 2 kenyans on the hike with us didnt make it into the frame but canada, US (korean, chinese and caucasian) britain and ghana are all represented.

i have been doing some biking around the area lately as well. i bought a bike in eldoret last month and have been putting it through its paces. it was the strongest frame i could find and i figure it corresponds to a mid level canadian tire bike. i got a helmet as well so as i have grown to trust the forks and brakes a bit more i have been working it a bit harder. the locals get quite a kick out of me flying by on the rutted out roads. by the reaction of the kids i think i am going a lot faster than they have seen bikes going before (dont worry mom, i am being extremely careful, honest... no drops and no jumps, i just need to keep my speed to get me back up the hill). one village was particularly impressed to see me do a track stand while a herd of cattle where driven across the road. however the most ubiquitous reaction at seeing me is laughter. i do look pretty amusing in my bike helmet and 200 shilling mirror sunglasses, especially when they arent used to seeing helmets at all.

biking is definitely the way to see the country though. i love seeing all the spread out farms and huts and panoramic views sliding slowly by as i grind up the hills. if there is an uphill portion through a village i will often gather a following of 5 or 10 kids and they will jog behind me as i ride. they teach me swahili, i teach them english and we all get exercise... beneficial for all concerned. having a bike also enables me to reach places i would not otherwise be able to see. i reached the village of kapsumai on the edge of the kerio valley last weekend and asked the locals where the best view was. they pointed up the hill behind them so up i went, to arrive at a hilltop family home/pasture. the family was extremely welcoming and seemed a little amused that i thought their view was so beautiful, although again it could have just been my sunglasses.

kylie and i went on a nice hike by ourselves on sunday. it was a nice mix of road, jungle and pastureland, with a few goofy kids thrown in for entertainment.

finally, i am currently fighting off my first kenyan parasite (that i know of!) can you guess what it is? i will give you a hint. the appearance is so classic this picture could be in a dermatology textbook. it is also common to 4H kids in canada.


Learning to Appreciate

Since we have come to Kapsowar we have learned to appreciate many things we have at home as well as things here that are different from home. You know how I love making lists so here goes:

Things from home I now appreciate more:
1. A dishwasher! We did not have a dishwasher when we lived in Edmonton either and when we moved to Chilliwack it was one of my criteria for our new house. I think that I really overused the dishwasher in Chilliwack putting everything that I absolutely could in it (yes this included several wooden cutting boards that I ruined) and usually ran it twice a day. This is quite a feat when you consider that there are only two of us in the house (not necessarily something to be proud of) but we did have a lot of people over.

2. Space. While we have a lot more space in our house than we were expecting and are VERY happy with it, it is very hard to entertain with a smaller house, especially when you have 25 people over. Here is everyone packed like sardines into our living room the other day for the weekly fellowship meeting.
3. Non-flat cookies. Today Juliana and Chara came over and we baked chocolate chip, cornflake, oatmeal cookies. We had a great time (I love these girls!) but our cookies turned out extremely flat. The interesting thing was though that with each progressive batch they did get a bit puffier. I sent home the first batch with the girls so they have FLAT FLAT pancake cookies. The other cookies I have made here have also turned out like this. I am blaming the altitude (which can be blamed on a lot of things here right Rob?) but maybe there is another explanation.
4. No bed bugs. I woke up yesterday with a few very itchy bites and woke up today with even more. Here is a very blurry picture of some of them. They are located in a spot I don’t usually show to the world so that is the reason for the tiny picture. I am not sure how we will get rid of them, maybe ironing our sheets. Marc has none but they website I read this morning said that some people don’t react at all. I always react very poorly to bug bites. When we were in Uganda before all my mosquito bites swelled to three times normal size and started pussing and oozing. None of the locals believed they were mosquito bites and I think were afraid they would catch some weird disease from me.
5. Hot water right out of the tap. This seems like quite a novelty to me right now. I think when we get home I will probably go to boil water for the dishes quite a bit and try and work my showers around letting the hot water heater heat up for two hours.

Things from Kapsowar I would like to take back home:
1. Greetings. It is very important in Kenyan culture to greet people that you see. This means shaking hands and saying “Habari?” (How are you?) and then having a conversation with that person. This is something I really think we are missing in the west because of constant “on the go” culture. People here take the time to talk to other people and get to know them.

2. Lack of media influence. It is so nice to walk around and not see billboards, to not be bombarded by commercials and to not walk by all the magazines by the checkout stand telling me how much weight I need to lose and what the perfect woman looks like.

3. Little things like mini marshmallows. Because people here have less than we do in the west they are more appreciative of the little things. For Chara’s birthday we gave her some mini-marshmallows that Marc’s parents had sent. In Canada if we had given this gift I think we would have been laughed at but she was so happy with them and talks about how she had “coloured marshmallows in my hot chocolate !”
4. The beautiful scenery unmarred by buildings and wires. I realize I cannot take this home with me but it is so beautiful here. Here is a picture from our walk on Saturday.
5. The people. (Yes I still love you Canadians and realize I cannot take the entire Marakwet population home with their scenery but I would love to.) Everyone here has been so welcoming and friendly to us. I especially love the lady who helps me with laundry. (And no it is not just because I hate laundry, those of you who have read this blog for a while will remember my many laundry laments last year). She is so charming and friendly and so happy you cannot help but like her. So many of the people here are just like her and we will miss them so much when we leave. No we are not leaving anytime soon but I sure find it hard to believe we have been gone from Chilliwack for almost three months! How time flies.


our new sudanese friends

we had our friends ajack and jacob over for supper last night. i have gotten to know these guys fairly well over the past month and a bit as we spend a lot of time together in the hospital. unfortunately their time at kapsowar is at a close and we are getting 2 new arrivals in 2 weeks.

ajack and jacob were both born in the sudan, educated in cuba and eventually given canadian citizenship, only to give up this winning lottery ticket in order to return to the sudan and help their countrymen. they both have amazing life stories; ajack was one of the young boys you may have heard about who walked clear across the sudan to attain the comparitive safety of an ethiopian refugee camp. last week i was lending jacob some movies to watch... knowing his history i cautioned him that "blood diamond" was fairly violent and featured scenes involving child soldiers. jacob looked at me incredulously and laughed, "man, i WAS a child soldier!" i tried to explain that this is precisely why i was concerned, but jacob shrugged me off, stating that nothing scares him anymore (and he loved the movie - thumbs up from an informed critic).

perhaps some background is in order at this point. as you probably know, sudan has been torn apart by civil war between the muslim north and christian south for many years. as is the case in many african conflicts, this one took the form of mass genocide and looting of the weaker ethnic group by the more powerful one (in this case the north). this genocide created a generation of orphans who began to fend for themselves as early as age 6 - 9 (the younger kids died and the older ones were conscripted to fight) in a country with no infrastructure to speak of, much less a social safety net.

the kids (and some families) who survived were mostly contained in refugee camps in neighbouring countries, unable to return to their old home and prohibited from integrating into their new one. fidel castro personally invited 600 sudanese refugee kids to come to cuba to be educated there, with the intent of returning to their home country to put the education to good use. cuba is actually somewhat of an educationally ambassadorial country; in addition to having free public education and the highest literacy rate in the world, cuba accepts orphans and refugees from many developing countries in africa, asia and south america and provides them with a free education and institutional upbringing. the idea is that these children are to take the knowledge given to them and bring it back to help their home country.

in the sudanese' case however, the first cohort of children finished their education and were sent back to sudan, only to be conscripted into the army and killed, or avoid the army and be killed anyways. bearing this in mind, the govt of cuba decided that it would stop sending its sudanese kids back to the sudan, but this left them in a quandary. no one had passed through official channels to get to cuba, they had just been loaded on a plane and flown over. they had no immigration papers and no passports. sudan was not an option, no other african nation would accept them, and they could not leave cuba by any legal means.

an appeal was made to the UN and eventually all the remaining cuban educated sudanese were accepted into canada and given canadian passports. however their education was not recognized and they were forced to take menial jobs in canada in order to survive and to send money to their siblings in the sudan.

30 of the original group of 600 had been educated as doctors, but had not been able to practice in cuba or in canada. they were working in auto parts factories, as meat packers (many of them in brooks!) and as care aids. however they still felt strongly the ethos that had been drilled into them as they were growing up in cuba... this gift of education was meant to benefit their brothers and sisters back home. one enterprising young man got in touch with samaritan's purse in canada and explained their situation. after some thought, prayer, fundraising and planning, 16 of the 30 medical doctors were gathered together in calgary to undergo retraining under the "sudanese medical reintegration program" spearheaded by samaritan's purse.

see how being a preceptor has changed me?
just kidding! this is paul, an american doc and the father of the 2 beautiful girls in our easter post.

after 1 year of academic work at the U of C, it was time for these partially retrained docs to gain some field experience. they were sent to kenya to begin 1 year rotating internships in hospitals that practiced similar medicine to that which they would be doing in the sudan. this brings us back to ajack and jacob: they were sent out here to kapsowar for their first 6 months and at the end of april they are heading to kijabe hospital near nairobi for the final 6 months of their training. it has been a pleasure to get to know these 2 men, and a fantastic learning experience for me. in the first 2 weeks i think that they taught me more than i taught them, as i was constantly peppering them with questions about their time in sudan and in cuba, and about the political situation and medical situation in both those countries.

i have tried to step up my own teaching in the past 3 weeks as i realized that my remaining time with them is short and they have a lot to learn. we are soon getting 2 new sudanese interns who have been in kijabe for the past 6 months but they will have their work cut out for them trying to replace ajack and jacob in this hospital.

as mentioned in a previous post, we attended ajack's birthday party a few weeks ago. he was asked to give a speech, but deferred until after dinner citing time constraints. he claimed his speech would be about 45 minutes. we thought this was a pretty funny joke until he actually started his talk after dinner. he opened with a synopsis of the exploits of marco polo and segued into a brief history lesson involving christopher colombus' journeys and initial exploration of cuba before really reaching the body of his story. one part of his journey that may resonate with all you canadians was his description of stepping off the plane from cuba onto the tarmac at edmonton international airport in windy cold november and knowing that THIS was his new home. he claimed with all his life experiences, this was one of the hardest to bear!

the interesting thing about this speech (aside from its content of course) was the rapt attention it was given by all attending. not just polite attention either; when ajack speaks, people listen. perhaps it has something to do with the fact that at the same age that i was first enrolling in city soccer leagues ajack was walking across a desert, and by the time i was writing reports on the peigan natives in grade 5 he was boarding a plane to cross an ocean to an unknown country.

as mentioned earlier, jacob spent much of his early life as a child soldier. while over for dinner he was telling us how he got onto the plane to cuba. as a soldier, he was not an official resident of the refugee camp, but he was friends with many who were. for some months before, cuban teachers had been working in the camps teaching spanish. they picked out those who showed the most promise and placed them on a list to go to cuba. jacob was friends with one boy who thought he may be on the list but did not want to leave the camp. on the day the officials were handing out the plane tickets jacob happened to be around. when they called his friend's name and his friend did not come forward, jacob (on the spur of the moment) handed his AK47 to a neighbour, put up his hand and walked forward to collect the ticket. despite the fact that he could have been jailed for this deception, and even though the officer handing him the ticket knew perfectly well that jacob was not the one being called forward, he was allowed onto the plane and had only to endure being called bole until he had arrived and registered in cuba.

wow, i will really miss both of these guys. i feel privileged to have been a brief part of their education and i hope that our relationship will continue. i also look forward to meeting the new interns who are arriving soon, as we will be here for their entire rotation. working in a hospital you get to know people pretty quickly, especially when their role is to shadow you. there are many hallway strolls and tea breaks in which to discuss various issues, and the walls tend to come down when you are working together in the middle of the night. ajack and jacob, may God bless you in the last phase of your formal education, and be with you as you venture back to your homeland to finally complete the circle you initially envisioned.


A change is in the air!

There have been a few changes here in Kapsowar lately. The first change is that I actually baked a batch of bread that worked!! Kari (a nurse from the US) heard of my bread woes and said she would come and help me so this afternoon she came over and assisted in the baking of the bread. After discussing it with her I think that my first problem was that I was using water that was too hot to dissolve the yeast and secondly I was not kneading the bread for nearly enough time. Kari watched (and helped too!) me as I kneaded it for 10 minutes. Last time I attempted to make bread I kneaded it ten times in total. Whoops! I am glad to see the error of my ways though.
Punching the dough down
Kari getting in on the action (notice my sweat stain from all the kneading!)
The bread before it went in the oven, I made a dozen buns too!

The second change is that rainy season has started! On Thursday I was at the hospital teaching a piano lesson to one of the nurses and a blind chaplain (another post in itself) and all of a sudden it started POURING. I am not talking like pouring in Canada, I am talking like POURING!!!!!!!!!! (With not one but 10 exclamation marks.) I ran home in the rain (about a 5 minute run) and I was absolutely drenched when I got home. I wished that I had some shampoo and conditioner with me because I could have had a full shower.
The view from our back door when the rain was just starting, notice the already full bucket! Our friend here who has a rain gauge recorded 260mm of rain on Thursday night and then 280mm last night. Beat that Vancouver!
When I got home from my rain run. I was very cold too!

The rain is very interesting here though. It comes only at certain times. Most days it is fairly warm and sunny (25ish) and then at about 4:00 it starts to get a bit cloudier and by 5:30-6:00 it starts pouring (I will spare you the capitals here) and then it rains for about an hour or two and then stops. Chilliwack, you could take a lesson from Kenya. Raining a lot for one-two hours a day is much better than just raining all day long. I expect you to take notes and change your weather patterns by the time we get back.

Since the rain has come with a vengeance we have discovered that we have a leaky roof. Marc climbed up on the roof today to cover some of the holes with tar. Here he is framed nicely between the two banana trees in our front yard.
I got this great shot of him jumping off the roof through the kitchen window.

The last change and yes I am stretching here is that we will have to start watching a new TV show soon. We have been hooked on “Veronica Mars” since we came and are now finished the first season and do not have the second one here. For those of you who have never seen it, it is a teenage mystery show (yes sounds cheesy) but it is very clever and has characters with depth and is very entertaining. Think funny, think drama, think romance, it has it all! I think I may have to ask my mom to bring the second season when she comes in June because I am just not up to all this change right now. ;)


Recent Excitement!

we have had a little bit of excitement here in quiet kapsowar lately, although most of it actually took place outside of town:

last week i went on my first dispensary visit. our hospital provides a doctor one day a month to seven small nurse run clinics in rural areas around kapsowar. the dates of the doctor visit are well known in the local community and the nurse often books patients to return on that day. the kiplombe dispensary is pretty well stocked and actually has a basic lab with the ability to analyze blood smears for malaria, and check hemoglobins and do urinalysis and a few other things.

the guy in the white coat is our lab tech joel

some locals (i can't talk about this girl's problem, but i can tell you that it wasnt depression)

anyways, on our way back to kapsowar we went through eldoret (the nearest major centre to kapsowar) to run some quick errands. after picking up some meds at the local chemist we were driving up the main street where micah, the nurse who came along to the dispensary, had to drop off some drycleaning. there was no parking available, so jonathan, our local nurse/optician/driver, stopped briefly on the side of the road. Micah jumped out of the passenger seat, leaving Gemma (a scottish medical student) and me in the back of the hospital land cruiser and jonathan in the driver's seat. about 10 seconds elapsed and suddenly a police officer jumped in the passenger seat and began berating jonathan. we tried to explain that our friend was coming right back but the police officer began yelling, so we started driving up the street assuming that he just wanted a ride. after a couple blocks he made us pull over and we breathed a sigh of relief... however he then demanded the keys to the vehicle. when jonathan initially refused he got physical and ripped them out of his hand. he then jumped out and walked away. jonathan apologized to gemma and i and then hurried after him. 5 minutes later they returned together and we began driving again. after a few blocks there was an explosion of swahili and gemma, micah and i were ordered out of the truck. the police officer was arresting jonathan and taking him to the station to book him!

to make a long story slightly shorter, we waited over 2 hours while it got dark for jonathan to return. we met a lady on the street who knew micah and also knew a local cop, so she phoned him and micah and the cop went to the police station to find out what had happened to jonathan. eventually he was able to post bail and return to collect us and bring us back to kapsowar, but now he has a court date in eldoret. for what, double parking? with the vehicle running? kenya is a lot different than canada! we figure the cop saw gemma and i in the back of a land cruiser and thought he could shake down our "driver" for some quick cash. too bad for him, as well as the rest of us.

kylie already mentioned our trip to eldoret on the weekend. we took a matatu there on good friday and got prime seats in the cab of the truck.
our view on the way there, a catholic march on good friday

on saturday we did some grocery shopping and then lugged our supplies to the matatu park to catch a ride back to kapsowar. unfortunately there was a conspiracy of circumstance rendering matatus extremely scarce. it was a long weekend, so many people were travelling home, and many matatus had been booked privately for weddings and other functions. also (like in canada) the police were out in force on the long weekend and many matatus were not driving b/c they did not want to risk a ticket or worse. so instead of the usual controlled chaos of the matatu park there was actual chaos. 50 people waiting and no matatus to be seen!

i was just on the phone with our medical director explaining that our return may be delayed when a truck pulled up and got mobbed. we figured this might be our only chance to get home but the whole truck filled immediately. luckily 2 local guys had taken pity on us mildly retarded muzungus (ie. slow) and jumped in the back to save us 2 seats. somewhat reluctantly we surrendered our backpacks to be tied on the roof and jammed ourselves into the back of the rusty toyota truck with our grocery bags. initially i counted 19 adults and their luggage in the back of the truck (think 19 people jammed into the back of fraser's truck with the topper on). after we passed the police checks (i guess 19 people is the legal limit) we stopped and let one lady out with her baby, only to admit 3 more!!! by this time there were also 4 or 5 people on the roof and we couldnt even see how many were in the cab. i literally could not move and kylie was jammed right in the back corner of the box. the saving grace was a window right by our faces for fresh air and a possible exit for projectile hamburger and fries (thankfully not necessary). kylie found the whole ordeal quite stressful and actually came close to a full blown panic attack, but aside from consoling her i actually quite enjoyed the whole experience... this could have been due to the fact that i had not one but two lovely kenyan ladies in my lap for most of the trip! finally we arrived home, squished and tired and dusty but still breathing, and most of our groceries were intact!
imagine all the people piled in the back of this!

for the last of our excitement, on tuesday night we had a goodbye party for gemma before she left for scotland. at one point she looked out the door and stated calmly, "oh look, that bush is on fire". i ran to her side to see a 10 foot high crackling blaze in her backyard. we started a bucket brigade and i rushed next door to alert the director, whose house was possibly in danger. luckily the fire was big but not that hot and we managed to control it before it spread along the hedges to the other houses! and no, the burning bush did not speak to us.
gemma taping her goodbye party (after the fire excitement)


Happy Easter one and all!

We had a quick weekend away to Eldoret this weekend for grocery shopping. We stayed at a great hotel with a swimming pool and after a CRAZY matatu ride back (Marc will write more about this later) we were very happy to be back in Kapsowar for Easter Sunday.

We had a wonderful Easter Sunday today. We went to church in the morning and then went to the Larson’s (fellow doctor and family) for Easter diner with the Zierch’s (a family from Australia working on Marakwet literacy here).

We had lamb and mint sauce, oh so good, with rosemary and thyme (sorry parsely and sage you were missed!) and wonderful homemade bread and vegetables. I brought trifle for dessert that I made up. (I’m sure it’s been done before but I made a white cake, vanilla pudding, dream whip and layered it with chunks of pineapple and toasted coconut.)

After dinner we had an egg hunt with the kids outside. Here are some pictures:
After dinner play session

Marc getting the egg he hid for Chara in the middle of a very large cactus

Marc and Julianna with the egg she hid for him in the middle of the cactus.
(Wonder where she got that idea?)

Gideon with his prize!

After Easter dinner, Marc did some gardening under this beautiful rainbow.

Happy Easter from Kapsowar!


things i have learned in the past month

1. poinsettias grow on trees! this is the path i walk from one of my wards to the other. i just cant capture the scope of beauty of this walk with an insignificant digital camera. on my right is the hospital compound and on my left is an incredible vista of fields, pastures, trees, huts and rolling mountains. i would need a 200lb IMAX camera to communicate it, so its probably easier for you to just come and see it for yourselves.

2. goitrogens - our friend marrisiana, one of the kenyan docs at the hospital, was telling us that there are so many goiters here because of the high exposure to goitrogens. as soon as she said this word i burst out laughing. she got a bit defensive and said, "it's in Harrison's!" (the bible of internal medicine). the next day i went and read up on it and low and behold she is right. foods such as cabbage and cassava root contain high amounts of goitrogens. apparently these goitrogens bind iodine out of circulation, decreasing the production of T3 and T4 which then stimulates the pituitary to make lots of TSH, which stimulates hypertrophy of thyroid tissue (sorry for the physiology lesson, but i know my medical friends will appreciate this).

3. goiter belt - in the same conversation marissiana informed us that she grew up in a goiter belt (causing a repeat burst of laughter). i told her that we grew up in a bible belt and she thought THAT was funny.

4. being poor and living in a one room house does not mean you are sad all the time (at least if you're kenyan). even my parent's slideshow presentations about nigeria could not outweigh the constant exposure to african kids with big bellies and flies crowding their nostrils in the worldvision specials on saturday mornings growing up. thus even though i knew better, i still had a picture of africa as a destitute depressing place where for the price of a cup of coffee a day you could free a child from his or her prison of poverty.

i am not denying that there is awful poverty in africa, and kenya is much better off than many of the war torn countries, but even though there is shocking poverty here there are very few frowns. the marakwet are a joyful friendly people as a walk down any local footpath will demonstrate. the kids have a good time playing with whatever they can get their hands on and their parents enjoy sitting and drinking chai with their relatives and friends. the staff in the hospital enjoy their careers and work 12 hour days 6 days a week thankful that they have a steady job (granted the pace of their work is much slower than their counterparts in a canadian hospital). overall people here seem contented with their lot in life... if you get into a conversation with them they may mention that would like to move to canada to go to school or to work, but i dont think they actually do. they picture canada as a promised land where everyone has enough to eat and a nice car and a big house with a picket fence. the few kenyans i have talked to who have actually been to the west have related how much they missed africa, the people, the personal interactions and the slower pace of life. i am having trouble articulating what i mean here; suffice it to say that despite rampant poverty and 3rd world living conditions ;-) , the people here are content and (dare i say) happier than most of the people i see in the west.

5. kenyan christians are joyful in what they have been given, even though they have been given much less than us spoiled consumer christians. their faith is often less educated, their pastors are a bit more repetitive and not quite as academic (at least for this CRC boy!) but it is also much deeper in a sense. despite the daily challenges of survival (vs. our daily challenges of staying up to date in the fashion department and trying to lose weight) they have a joy in their relationship with God that i do not. perhaps this is a consequence of HAVING to trust him more, or perhaps it is an aspect of the previously mentioned joie de vivre.

6. i have learned a lot about anemia, b/c i am giving a lecture on it sometime in the near future, but i will spare you the details. i have enjoyed the teaching aspect of my job here a lot. it is fun to be a part of someone else's education while at the same time supplementing my own. it is also fun to realize that i know a lot more than i thought about a lot of things that i didnt think i knew a lot about.

7. ultrasound! - we have an old U/S machine here from the '60s, and samaritan's purse just sent us a brand spanking new one (so new that it is still locked up) and it is one of our primary diagnostic tools... plus there are no grumpy radiologists to navigate in order to use it, i just have to wheel the patient down the walk and into maternity. i have really enjoyed developing this skill, especially b/c it is coming more into play in the ER departments i work in back home. 2 days ago i got to show a mom her baby sucking its thumb in the womb. her spontaneous smile and squeal of joy made my day!

8. warning! downer alert! please skip this learning point if you prefer your blog posts upbeat.
life is hard here. death is common and people accept it much more stoically than in canada. this past fri/sat/sun was my first weekend on call. i was pretty busy all day every day, but i was able to sleep mostly through the nights with only a few phone calls. i can't complain about the workload but it was some of the most draining medicine i have ever done. on friday i admitted a 10 day old baby that was septic (bacteria rampant in its bloodstream). in canada this baby would most likely be fine (especially since it would have been sent to the hospital by the public health nurse that visits on its 3rd day of life) but it died today. on saturday i resuscitated a newborn that was born in hospital after a prolonged labour at home. we did everything we could for it here, but it died late last night. a perfectly formed baby with functioning organs and so much potential, if only its brain had not been denied oxygen at a critical point... finally, late last night as i was preparing to leave the hospital i was called to assess a lady that had come to the maternity ward at full term in active labour. she had felt fetal movements all day and had her first contraction in the evening. when she arrived the nurses were unable to hear a fetal heart beat. i ushered her into the ultrasound room confident in my new obstetrical scanning abilities; however my confidence waned quickly as i was unable to locate a beating heart. i scanned back and forth in vain, unwilling to admit that the 4 chambered dead still object i was visualizing was the fetal heart. i continued the scan for what felt like forever, hoping against hope that my novice ultrasound skills were failing me and that a happily beating heart only awaited a clever turn of my wrist. finally i had to admit to myself and the patient what i had really known from the first minute of the scan. this baby that was perfectly healthy 4 hours ago was now dead, and the mom still had an entire labour and delivery to look forward to, with no prize at the end. i explained this to the mom, and then again to the attendant relatives with the nurse translating and me holding the mom's hand the whole time. finally the nurse asked me to pray, and i was faced with the responsibility of talking to God about all this senseless death at midnight in a small room full of women all looking to me for the answers. after all the heartache of the weekend i was amazed that i was able to keep it together, but i had to keep most of my anger and sorrow to myself. after all God is love right? God will never leave us nor forsake us right? right?? i guess i still have a lot to learn.

anyways, at no time during any of my heavy talks with any of the aforementioned mothers did any of them bat an eye, shed a tear or even let out a whimper. this is life for them, and a learning experience for me.

9. on a happier note, you can grow tasty sprouts in a tray in your living room! when my mother was helping us pack she found us a kitchen sprout garden to take along, stating fresh vegetables were one the items she sorely missed when she lived in africa. she brought it home complete with bags of various seeds. i was a bit dubious of the whole thing, but decided to give it a try last week. the package did not lie; no soil, no chemicals and in 4 days you have a thick carpet of tasty fresh sprouts. thanks mom!
day 1

day 2

day 4