Day 5

Two more surgeries today, both went well. It has been a good day the patients have done really well, both are extubated and some just on a little oxygen. It has been cool to be able to walk freely in the OR and take pictures of whatever I want. Common courtesy applies of course but other wise you may do what you want.

They moved all of the cardiac patients to one little 6 bed room and moved them out of the adult ICU. I feel so much better about that, the environment is much better and they are around others near their same age and their family stays in there with them.

I worked all night and then went home and attempted to rest before I had to come back at noon, I was slightly interrupted by my roommate Dr. Patel. He snores really loud and in fact I was even a little worried about him for a few moments. He was ok, but I wasn't getting any sleep.

The day has been really busy, just lots going on. Dr. Fingleton, Eric G, and Wynitia left for home today, so Dr. Bichell and the rest of them leave tomorrow and the next day. I can't believe that this trip is coming to a close, there are two more surgeries tomorrow.

Love to all and thanks for your thoughts and prayers.

More random pictures

I should have posted this one first since without this hydroelectric dam Tenwek would not be the hospital today without it.

These little kids ask me for a "sweet" I gave them a lifesafer mint candy. They thanked me.

Both pictures are right near the hospital compound, the one on the left are little huts they sell little odds and ends out of.

There is an interesting story about these cute litte triplets. Culture is a lot different regarding multiple births, the middle child is not wanted and might be abondend.

I won't disclose the name of someone in our group who just loved to take pictures of the mules. Every where we went she was taking a picture of a donkey and you can imagine that since there are mules all over the place this person was always taking pictures. This is downtown Bomet, a hop skip and a jump from Tenwek.

This is a mountain we were driven to, it was pretty awesome, you could see the entire Tenwek compound. We walked back, guided by Jamie Dr. Whites son, we were a little sceptical at first but soon realized what an expert he was. It was a fun walk back home.

This is a picture of the top of this thatch hut. This was a common site while we were there. I was told that if the little spire was not atop the roof then it ment that the father, or husband had been killed.

Tenwek is just off toe the right of this picture.


"Roadside Butchery"

This is another picture from the above the hydroelectric dam that provides Tenwek with all of the electricity it needs.

Here is another picture of Bomet

One our way up the mountain there as a point when even our driver ask us to get out so he could turn around. It was a little scary, I am glad I wasn't in the jeep as he turned it around.

Some more cute kids. Down the street from Tenwek.

Day 4

My day today was spent sleeping. The cardiac team completed two surgeries, one was a aortic valve repair who is already extubated and on RA. She is doing well, The other is a VSD closure, and a PAPVR repair, is also extubated and doing well on RA. Two of our cardiac patients had their chest tubes pulled and then went to the Pediatric Ward. The other still had chest tubes in so James is still in the ICU mixed with the other adult patients.
(Picture left, this was our oldest patient 17years, she too did very well) I think this was Chip 3
Below was Lucy she was cute as ever, she was so afraid of Rebekah it wasn't uncommon when you approached her bedside she would put her arm over her nose. She was just cute.

Here is the team.

My day today was spent sleeping. The cardiac team completed two surgeries, one was a aortic valve repair who is already extubated and on RA. She is doing well, The other is a VSD closure, and a PAPVR repair, is also extubated and doing well on RA. Two of our cardiac patients had their chest tubes pulled and then went to the Pediatric Ward. The other still had chest tubes in so James is still in the ICU mixed with the other adult patients.

I am sure it is a little intimidating being next to them, the patient to the right of him is a burn patient looks like isn't doing well, and the patient to the left of him is also really sick.

(The guy with the guitar is Jeff, the husband of Dr. Erin Cardiologist. He became our resident, child life specialist, tour guide, echo tech, ekg tech, doctor, equipement tech, social worker, and music therapist. We loved having him, it was a huge blessing to have him).

While i am talking about the adults and kind of a cultural thing, suicide is quite common here, the patient that is in the bed directly in front of him in the adult ICU ingested poison.

After I woke up from a good sleep, I walked down to find some of the team members who were apparently playing soccer with 450 boarding school kids, with there 14 teachers. I got lost trying to find it, and ended up down the road a few blocks, where I ran into 6 little kids carrying a bushel of sticks on their head, they ask me for a "sweet." It was a lot of fun, they also wanted me to take many pictures of them.

Well now it is me Dr. Barr, and Rebekah holding down the fort in the cardiac ICU we have 6 patients and again they are all doing well, we have frequently discussed how fast tracked a lot of patients are here, just a few hours after surgery we have them ready to go to the floor. Well that might be a little wrong but the point is they do well. I guess we are a little lucky and blessed, mainly due to the prayers that all of you offer on a daily bases for us and especially the surgeons.
Well tomorrow will be a new day. This truly had been a great experience, we have met some great people and seen some incredible things. I feel lucky to be here.

This has truly been a eye opener and a very different experience.

Thank you all for all you do thanks you for your love and concern and mostly your prayers.

Day 3

This is Phillip, he was one of the three or four nurses who were just awesome to work with. We frankly couldn't have done it with out them. They helped us translate, an really for a lot of the time were right by us tapping chest tubes, giving meds, etc. just all of the regular nursing things. Phillip helped me through my two night shifts. He was great to work with.

This family above right was a family that brought their child to the clinic.

Well it is about 15min to 9:00, on Day 3, I have a second to post because I am in the clinic today. I forgot to mention yesterday that I was assigned to the cardiac clinic. It was a great day I had a lot of fun. CArdiac clinic involves checking in patients who either have appointments or a suspected cardiac history, many also come because they have heard that we are in town and just come to hopefully be seen. We usually see everyone but it makes for a long day for our two

cardiologist doing echo's and screening patients.

I get to take vitals on these patients as I check them in and get a health history. This can be a challange due to the obvious language barrier, luckly we have many translators who help us. After I am done I get to give them things that many of you helped to purchase, stickers, baby dolls, markers, crayons, etc. They really appreciate the gifts, it is sort of fun to watch them take one marker and just get sooooo excited. The parents are also very excited. About half of them don't want to be examined, as soon as you ask them to lay back on the bed they immediatley start crying, so it becomes my job to help calm them down. I want you all to know yesterday I because a human bubble machine. We saw about 20 patients all of which also had echo's done on them (keeps the cardiologist really busy).

(Here is a great picture, one would think that this patient was sedated for this ECHO, no no, no harm was done in the screening of this patient, he just got so comfortable with the procedure and fell asleep. This was certainly an exception and much appreciated).

I suppose the most difficult part of clinic is that about 4-5 of the patients that we saw yesterday were told that nothing more can be done and one was told that she may only have a few more months of life left due to an abnormal heart condition that causes her to heart to beat in an irregular manner. If not corrected then she would die. The cost here is $200 and the cost in Nairobi would be $4,000-$5,000. This was so sad and just created a sadness in the room as our team was just very matter of fact with the family in a kind and compassionate way.
The other 3 patients that were seen just were told to maintain the current medication treatment and that nothing else could be done. This mothers face is imprinted on my mind, she was very happy and talkative in the beginning and then was clearly just sad by the news. The medical director told us that it isn't uncommon for families who find out this information to abandon their children.

For about 6 hours this morning I also spent in clinic, it was great. For some reason I was more emotional than the day before. The father of one of the patients said, "so you mean that this condition could have been prevented?" It is just sad that a simple strep test, or education and penicillin could completely stop this.

It is 0407 on Day 4, and we have 6 patients in the ICU. I am up with Rebekah and Dr. Tzanetos. We are having a busy night. We extubated two patients, and both are doing well. The unit if full and we are running out of places and equipement. We will see what will happen today. There are supposed to be 3 surgeries today.

Day 2

Hello all again from Tenwek, Bomet, Kenya. We had a great night, both patients made it out of the OR one was about 1530 and the other was midnight. Both came out very sick but the first case is was extubated early this morning, and the other is still on the vent doing better than last night. Is on pretty high vent settings. Both surgery's involved repairing the heart valves. The second case was three valves.

Anyway, things are going well, the ICU recover area is very basic and recovery is very basic with basic supplies and equipment. We are truly lucky to have what we do, it has really helped me realize how blessed we are to have what we do even with our very difficult and hard to work with system.

THe staff here at TEnwek hospital are awesome they are all eager to learn, and are excited we are here. We have been working with other ICU nurses here at the hospital and they are just great, we obviously couldn't work without them.

I think the things that stands out to me the most is how basic the iv pumps are, the availability of medications, and the equipment we have to use.

They just took the first case for day two back to the OR and are busy putting IV lines and making other preparations for surgery.

There are six beds in this ICU they use it a lot for overflow, they brought a patient in here yesterday that had aspirated and had to be intubated, after things were kind of settled her ECHO showed she only had a EF of 10% and she fairly old (80yo). We have heard from the locals that since her outcome wasn't very good that it comes down to either keep her on lifesupport or be able to provide food for their families. This is pretty opposite for us in the US.

The other overflow patients have been infants and small children who have presented with respiratory compromise related too much narcotics (we see this too in the states). The have a infant warmer in this ICU and we saw three newborns rush by us, one was pretty blue which I would guess had a very low apgar score, wasn't breathing, and was pretty blue. It was pretty neat to see that she was finally resuscitated and was doing well.

That is all for now, I know this is sort of disorganized and may not make much sense, I am sorry for that I hope that you will understand.

More to come later.

It's great to be here, thanks

This is a picture of the Adult ICU, our doctors were consulted about a patient who needed a chest tube. The ICU looked to be about maybe 8 beds. We saw a burn, ingestion, and many other injuries.

Patient visit from last year.

I don't remember this little girls name but she had surgery last year, Rebekah of course remembered her and naturally was excited to see she was doing well. She had a VSD repair. She was less the excited about see all of us and even her friend from last year wasn't even welcome. I can't imagine why she wouldn't want to see us???
We had to give her several intramuscular injections of medicine to sedate her so she could have an ECHO done. As a side note her ECHO looked fine her function looked good.

What a great story.

Here is more unpacking and preparations being made.

In the Unit today

Both of these pictures are the apt where we stayed.

This is a little girl who when we first got there was just so friendly and wanted to hold everyones hand. As you can see just a sweet girl. I think we later found out that she was still at Tenwek until she could finish paying her hospital bill.

These are pictures of two of the native nurses who were providing us with Chai, otherwise known as "Chai time" This was a favored time for many of our staff.

The picture on the left is in the OR and is a picture of the bypass machine.

The picture on the right is us retrieving our first cardiac patient. It was only a matter of a few feet to the OR.

As we were setting up, and organized our recovery area, they had brought a patient for our team to help with. She was 80 year old.

I am actually sitting in the unit where we will be recovering the heart patients, they are still in surgery. Things just take a little longer sometimes, but all things considering everything is going well. I am working today and going to assist in recovering our first heart patient (valve repair), the surgery is just really starting. I think they were just in the chest and I don't think they have starting exploring to see what is going on.

Our accommodations are wonderful, here in the Tenwek compound. Everyone has been so nice we have met a lot of children and kids. We are really blessed to have what we do in the US, even to have access to the things we need. We have seen zebra's, ostriages (not sure how to spell), and monkeys. It has been sooooo cool.
surgically we plan to do two surgeries everyday until Sat. Without surgery these people would otherwise die. Dr. White the md that runs the hospital said there are hundreds kids that have rheumatic heart disease, that die due the lack of resources.
Thank you for your thoughts and prayers.