Into the Deep

Fire!

Posted on February 27, 2018     2 Comments

“There’s a FIRE!”  These words interrupted our family movie night almost three weeks ago (February 9th) as our 11-year-old neighbor burst into our house, holding a lantern high, calling out the warning. Over the next several hours, a fire destroyed one of the buildings of Tenwek Hospital as Heath worked to evacuate patients, and Angela held vigil with several missionary kids ready to evacuate the compound if needed.

After our neighbor’s warning, we quickly stepped outside onto our porch. The first thing we noticed was the sound of screaming and wailing. Living so close to the hospital, it is not unusual to hear wails of mourning when someone dies. But the wails were much louder than a typical mourning of death. Also immediately noticeable was the thick dark smoke in the sky above the hospital, which sits about 100 yards up the hill from our house. Heath left quickly to go check out the situation.

Fire in rural Kenya is a powerful and deadly force. Everyone living here knows it to be so. History has shown fire-fighting capabilities to be unreliable at best, and built-in containment and extinguishing methods are absent. No automatic sprinklers were present to come on. No fire-safe doors were present to close. No fire alarms sounded…only the screams and wails mentioned earlier, which grew louder and louder over the next few hours as villages even miles away saw the increasing flames and joined in expressing their fear and grief. The first fire truck came from the next county, about 2 hours away. When the truck arrived, the water hoses attached to rain tanks in the truck didn’t stand a chance against the inferno.

So when Heath ran up to the hospital, he had no false sense of peace that help was on the way. The building on fire was the first building inside the staff gate. It housed the kitchen, restaurant, several offices (research, statistics, visiting staff, and social work) on the top-level; and laundry, sterilization, and a patient ward (Wound Ward) on the bottom level. Heath saw that the patients from the Wound Ward were almost all evacuated. By this point, the flames were massive. Heath found one of the other surgeons, and they tried to keep people away from the fumes and fire. Attention was quickly turned toward evacuating patients closest to the fire. The orthopedic ward was in an immediately adjacent building, so Heath made his way there to find that the power was out and patients were screaming for help. Although there was no fire in this building, huge flames were easily seen from the windows, and the heat of the flames could be felt by the patients who were stuck in their beds due to their orthopedic injuries. After getting some help, these patients were moved out on stretchers or dragged on mosquitos nets to an area further away from the fire.

While the fire continued to grow, Heath joined other physicians and staff who were starting to evacuate the intensive care units. Knowing these patients well, Heath stayed with these critically ill patients who had been moved to the maternity ward and the recovery room. By the grace of God, there were no patients on ventilators. Efforts were coordinated with a visiting team of pediatric critical care nurses and physicians to get our sickest children under their watchful eye in our recovery room area. This freed Heath up to more closely monitor the intensive care patients who were moved to the maternity ward. He recruited a couple of visiting medical students to help him with these patients. Because there was no advanced monitoring, patients were closely monitored by sitting at their bedside and monitoring their pulses and respirations. Thankfully, all patients did well.

Meanwhile, other physicians and nursing staff evacuated the less critically ill patients to our new eye building. Patients were pushed up hill along a rough dirt and gravel road to reach the eye building which was temporarily converted to a patient ward. Many patients who could walk simply fled the hospital by jumping over fences and making their ways through fields and small farms to get far from the flames. One young patient who was in the hospital getting care for severe burns panicked so much at the thought of being burned again that she ran 2 miles to the nearest small town.

In the eye ward, trouble arose when oxygen began running out. Fortunately, by this time the fire had largely burned itself out, and it appeared that it would not spread to the rest of the hospital. The patients requiring oxygen were quickly transported back to the main hospital wards, which was a dicey event due to a lack of portable oxygen tanks. Again, despite a few moments of desperation, all patients were successfully transferred back. Next, the critically ill patients were transferred back to the intensive care units.

During this entire event, our visiting pediatric cardiac team was operating on one of the most challenging cases of their entire visit. Due to difficulties getting the child off the cardiac bypass machine, the surgery went into the wee hours of the morning. Despite being in a hospital on fire, they continued to operate, and ultimately the child was weaned from bypass and brought to the recovery room well after the last flames had gone out.

While Heath was busy moving patients, Angela hosted a “safe-house” where several families and missionary kids (whose parents were up helping with the fire) hung out waiting to possibly evacuate the compound. Everyone had passports and cash in the car, ready to drive away if the fire began to spread. From our perspective down the hill, we could see only a wall of giant flames, with no knowledge of how much of the hospital was burning. Our sky was filled with thick smoke, the loud sounds of popping glass and tiles, and the African-styled wailing. Cell service was down, so communication was very limited. Rees and Mary Taylor stayed calm despite their fears, and used what they had to help calm the younger children (songs, stuffed animals, prayer, and encouraging words).

We praise God that the fire was contained to one building, and specifically, that the Boiler and Generator buildings were spared. We remain amazed at His protection over patients, staff, and volunteers…NO one was injured! We are grateful for the stone walls and cement floors that likely helped to prevent further spread. Wood fencing, edging and roofing were torn down manually during the fire to also help prevent spread. We are also grateful to all of the staff and community members who bravely fought the fire with buckets of water and small fire extinguishers.

Pastoral staff and a counseling team were on site the next morning, meeting with staff, patients, and community members for post-crisis intervention. Many staff and families have gathered to share their stories with each other and have participated in counseling provided. We have had an incredible outpouring of support from the community, county and national governments, and international partners.

Hope from the ashes…A beautiful promise over the destroyed building!

For the current time, Wound Ward has been relocated to the former Eye Ward. Kitchen services have been temporarily shifted to the Tenwek Hospital College of Health Sciences Kitchen. The lower level services of Sterilization, Laundry, and Tailoring were restored within the first week. The offices on the main floor of the building are being relocated to other areas. Therefore, the hospital is back in service!

Tenwek Hospital Administration is now evaluating the best ways to restore services long-term and fulfill the ministry of Tenwek Hospital. Even this week, an engineering and architectural partner will arrive to give input.

THANK YOU to those who stepped in so quickly to contribute financially toward the rebuilding process. Many of you give faithfully already to our ministry here, yet you have responded readily in our time of need. “Thank you” seems so insufficient!

If you still wish to give toward the recovery effort, please give through this link: Tenwek Hospital: Fire Recovery.  We hope to have ability to not only rebuild, but to also install some appropriate fire safety and prevention measures throughout the rest of our hospital.

Full healing will take time. Please pray for the patients who came to a place of safety and healing, and instead experienced a terrifying event… for our Administrative staff as they seek wisdom in rebuilding… for our community to continue to pull together in support of one another… and for God to be glorified even in this tragedy.  Please continue to pray for our family as we seek to live out the motto of Tenwek Hospital: “We treat ~ Jesus heals.”

Our worship team singing ​”Jesus is the Rock” in Swahili the day after the fire in our church which sits a mere 20 feet from the destroyed building. Thank you Jesus for being our Rock! (You might recognize a singer and ukulele player here!)

Trauma and Critical Care Training:  What was I thinking?

Posted on October 2, 2017     2 Comments

At some point in 2004, I walked out of the Univeristy of New Mexico Hospital with a smile on my face.  I had just completed my last day on the trauma service.  No longer would I be up in the middle of the night taking care of labor-intensive injured patients.  No longer would I sit for hours in the ICU taking care of the sickest of sick patients while others operated on the “interesting cases.” My career path was taking me towards the aspect of surgery that I loved the most- operating, operating, operating.  I was happy to be in the OR all day while critical care specialists helped take care of the sicker patients whose care I was involved in.
I spent the first decade of my career as a busy, private practice surgeon which meant I spent a lot of time in the operating room.  I loved it.  But as our family transitioned to Kenya it became very apparent that good outcomes in complex surgical patients at Tenwek were hard earned.  Yes, a technically perfect operation is imperative, however,  a good outcome depends on much more than just a good operation.  Technically difficult operations could be completed, however, patients who became sick after these procedures or who were admitted to the ICU after life threatening trauma often times died when they shouldn’t have.  Was it my care?  Was it the residents’ lack of knowledge of critical care medicine?  Was it our monitoring capabilities?  Was it nursing?  Was it specific problems in our rural Kenyan population?  The answer to all of these questions was yes.  And there are many more problems.  The bottom line is that it is largely a systems issue.  We as physicians like to tackle specific diseases and problems, but we often times neglect the development of a system of care that can be applied to a broad range of patients.   It became clear to me that we can  teach our residents how to be expert operators- even at advanced techniques such as laparoscopy that are rare in rural Africa. However, until we develop a better system for caring for the critically ill, outcomes in our sickest patients are not likely to change.

As our first term in Kenya was coming to an end in June of 2016, we began to think about how we would spend our time in the U.S.  Angela and I had decided that we wanted the girls back in school for a complete school year.  Angela wanted to mainly focus on helping the girls transition back to the U.S., and I hoped to be able to work.  But as I thought about working, I felt like my time would be best spent by trying to learn things that I could take back to Kenya.  We discussed the possibility of me doing a fellowship in surgical critical care and ultimately decided to ask around to see if there were any available fellowships spots.  Fellowships are additional training programs that physicians can do once they have completed a residency.  To be a cardiologist, one does a fellowship after a medicine residency.  To be a heart surgeon, surgeons will do a 2 or 3 year fellowship after their general surgery residency.  Surgeons can do a year of specialized training in surgical critical care which prepares one to care for the sickest of sick surgery patients.  In practice, most surgical critical care specialists are also trauma surgeons due to the fact that traumatized patients often make up a large percentage of patients in a surgical ICU.  In the current era, the evolving specialty of acute care surgery has emerged, which encompasses surgical critical care, emergency general surgery, and trauma surgery (which makes up a huge chunk of what we do at Tenwek).  Most practitioners of this specialty in teaching facilities are board certified in surgical critical care.  And so, my hope was to find a fellowship which would allow me to do this.

After sending out multiple inquiries, we were delighted to hear that the program at the Univerisity of Tennessee in Knoxville was willing to allow me to join them for a year as one of their surgical critical care fellows.   I couldn’t be more grateful to the trauma and critical care faculty at UT who helped create a spot for me.  They allowed me the freedom to spend time learning skills would be beneficial to the work at Tenwek.  I was even able to spend a month at Parkwest Hospital (the hospital were I worked prior to going overseas) working with the cardiac anasthesiologists learning how to take care of cardiac surgery patients.  However, the year of training had its struggles.  I felt all of my 43 years of age during the busy call nights.  Recovery after these busy call nights took an extra day or two more than it used to.  Time with our family was more limited than we had hoped after being away for a couple of years.  However, it was a privilege to have the opportunity to sink my teeth into learning the nuances of trauma and critical care surgery.
Now as we transition back to Tenwek I am looking forward to putting new knowledge to work.  Like many other areas of medicine, modern critical care capabilities are lagging in the developing world.  In Kenya, there are nicely developed critical care units in some of the larger hospitals in Nairobi, however, distance, money, and transportation issues limit access to these facilities for a large percentage of the population.  Fortunately, the need for surgical ICU development in low and middle-income countries is  increasingly recognized.  A nice article by Drs. MacLeod, Kirton, and Maerz was published in 2016 highlighting the incredible need for critical care development as well as possibilities for a way forward in development.  Here is the link to this article for all of you as nerdy as me: Surgical Intensivist and global critical care: is there a role?  The authors point out staggering statistics such as the fact that 90% of deaths due to trauma world-wide occur in low and middle-income countries. Each year, 8 to 10 million children under the age of 5 die, however, 90% of these deaths occur in the 42 poorest countries.  Many of these deaths could be prevented by access to critical care services.  Although ICU’s in the west are often thought of has being high-tech, expensive, sophisticated units, the authors correctly point out that major improvements in patient outcomes can be achieved by implementing basic tenets of critical care.  It is my hope to continue to make improvements in the way we deliver surgical critical care in our relatively rural setting at Tenwek, but more importantly, to educate our residents so that when they leave our program they are capable of ministering to the sickest of sick.

My Grown up Christmas List

Posted on November 30, 2016     1 Comment

(2nd annual)

Tis the season!  No better day than “Giving Tuesday” to roll out my 2nd annual Grown up Christmas List!  Even though this year we will have the joy of celebrating Christmas in America, our hearts and minds are still with our Kenyan friends and neighbors.  Throughout the past few years, our vision has grown bigger, our passion deeper, and our excitement greater about what God is doing in East Africa through Tenwek Hospital, our PAACS graduates, and our local Kenyan church.  Although it has been humbling and challenging to live and work in an area of the world with such great need, it has also been rewarding beyond measure.  I know that our blog has been silent since our return to the US this past summer.  We have found it difficult to express in words the ups and downs of living between two “homes.”  Returning to the US with fresh eyes has been interesting!  Maybe we will share more in a future post about the good, the bad, and the ugly of this fresh perspective.  But one surprising outcome of our experience so far in serving as “missionaries” is the amazing way that God has allowed us to connect so many people within our circle (and even beyond) to His work in the world.  Ironically, even though we have “less” by the world’s standards now, we have been able to GIVE even MORE…by being conduits of your blessings which have been given so generously.  We have been continually amazed at how God has used YOU (our community in America) to bless our community in Kenya!  So in this season of giving, we wanted to again highlight some needs near to our hearts.  If you are hoping to make a real difference with your dollars this Christmas season, instead of more online shopping for more “stuff”…consider one of our wish-list items below!

1. EDUCATION for an orphan..

Schooling in Kenya is not free…One year of tuition and required school fees (books, uniforms, food, etc.) costs about $500 per child.  Orphans are especially at risk for not progressing through school due to lack of financial support among other factors.  Access to education for orphans and vulnerable children has been directly linked to improved health, wellbeing, and long-term outcomes.  Our local children’s homes care for about 350 orphans who rely on donations to provide this critical opportunity for education.  Could you give a child the gift of knowledge and opportunity this year?  If you can’t give $500, any amount does help!  If this need speaks deeply to you and you have interest in a commitment each year to sponsor a child’s schooling, please contact me for more information.

Donate directly at Tenwek Orphan Scholarship Fund

Mary Taylor playing with a friend at a local orphan home

2. An ULTRASOUND machine for surgical use…

Ultrasound is a vital tool for patient care at Tenwek Hospital. Our radiology department does about 50 patient scans per day, leaving little availability for ultrasound use in surgery, in evaluating trauma and critical care patients, or in teaching residents these important skills.  We are in dire need of an additional ultrasound machine devoted to these purposes.  We are raising funds to purchase a Sonosite M-turbo portable machine.  Sonosite has offered a generous discount, and Friends of Tenwek organization is contributing 50% of the needed funds!  Could you help us in raising the additional 50% needed to acquire this important tool for improving patient care and training?

Donate directly to this need at Surgery Dept. US Project

Family medicine resident, Elijah, evaluating a pediatric patient for pleural effusion

3. A TEACHER!

OK, so this isn’t something that money can buy at all, but it is my biggest wish!  Our Tenwek community is in need of two teachers committed to helping with educating our missionary kids.  This important job impacts our ministry in such a big way!  If you or someone you know is a teacher licensed for elementary or middle school with a heart for missions and a willingness to consider serving with us in Kenya, please contact us!  Help spread the word!

Tenwek MKs playing on a beautiful Kenyan afternoon

Thank you for considering supporting our Kenyan community and our work at Tenwek Hospital.  We look forward to returning to Kenya in 2017.  Thanks to our amazing partners, we have 95% of our needed monthly funds for our return already committed!  Are you interested in joining our support team?  If so, contact us to learn more, or donate directly toward our ministry .  We are in currently Knoxville, where Heath is doing additional training in critical care at UT Hospital, and Angela is working to juggle our family’s transition.  If you would like to connect, please contact us!

Our family’s last hike up our local “mountain” before our return to the US this summer

All of this is for your benefit. And as God’s grace reaches more and more people, there will be great thanksgiving, and God will receive more and more glory.”   ~2 Corinthians 4:15 NLT