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