Let's go on Safari (Africa, not Apple)

Jumbo,

Ain't technology grand- if you know how to use it or someone who does? Tom, the IT wiz at our office just loaded another browser on my laptop remotely and it looks like I'm in business.

Less talk, more photos today

The first hour was on the two lane, paved road I traveled from Nairobi. Here's a view of market day at one of the small towns we passed through.

We turned off the main road at a small town with this central shopping area, including the Seven Star Hotel.

The next two hours (45 km) were on a dirt road that here, entering the savannah, was pretty good.

Except for the steep ravines,

a few domestic obstacles, and the washed out segments (and this is the dry season, when it only rains hard 1-2/52- the way they write 1-2 times a week)

We passed some villages along the way. This shows typical construction of mud brick wall and two of three typical roofs, tin and thatched. The third, more common in the Maasai communities were constructed with cow dung.

We finally came to the meeting place to catch our ride with the camp guide. While waiting for him, we made friends with this group. Kenyans are a friendly, soft-spoken. The children are particularly friendly love to have their pictures taken. The only thing keeping them from constantly running (getting ready for the Olympics) was this photo request. Both boys and girls shave their heads until age 18, most men continue to do so.

 Simon, our driver, picked us up about noon on Sat. and was our personal guide until noon on Mon. His English is very poor and the answer to most questions was "Yes" even when completely inappropriate. But, he has a keen eye, knows his plants and animals and was most attentive. The owner made a point of saying he intentionally hired locals to help them advance rather than the more formally educated guides from the cities.

We had a five hour tour on our way to the camp. We stopped for a picnic lunch under the shade of an acacia tree.

This was one of a herd of about 15 zebras who came within 100 feet while we ate lunch.

Let me say now there is no way I could get pictures that do justice to the experience. The plains are enormous, stretching as far the eye could see. And, while there were times we could see no animals, there were places were we could watch over 300 at time. This shows maybe 20-30 in a small part of a 360 degree panorama.

Another angle, with some telephoto of Thompson's gazelle and impala. You may note how many of the species mingle while grazing.

Mix of animals again.

Wildebeests were the most numerous of the animals. This represented those who do not migrate. When the great migration begins in a couple of weeks, there will be millions more.
Warthogs are definitive cuter in Disney animations.

Zebras were the next most numerous unless you lump all the types of antelopes and gazelles together.

It's late and it has taken over 90 minutes to load these few pictures since the internet is so slow.
I will add more animal pix along with views of the lodge tomorrow.

Blessings,
Ed

Safari: The heavens declare the glory of God

While nature everywhere demonstrates the work of His hands, there's something special about exposure to a new and different aspect of His creation. And, Africa certainly has plenty of unique sights.

Before I share some photos, let me tell you of God's kindness even in this little venture. The staff at Tenwek who arrange these weekend trips like to have as many people go at a time as possible to make transportation more affordable. So, I was originally scheduled to go my last weekend here since that was the only time anyone had asked to go. I was scheduled to go to the Fairmont (yes, THE Fairmont Masi Safari Club) for only one night, to be dropped off as the family was going to another spot. I asked to be put on a list to go an earlier weekend if someone else signed up.

Well, last Tue. I passed, Carter Harsh, a neurosurgeon from Birmingham who was finishing his last week and told me the Tenwek staff had signed me up to go with him and his son, Taylor, a soph at UAB, to a different spot this past weekend. This was a blessing on several levels. First, I got to spend the weekend with two great Brothers in Christ (attend Briarwood). Second, I roomed with them at a less expensive place so I got to stay two nights for what one would have cost being alone at the Fairmont.

And, the real blessing was this change in schedule prevented me from missing the opportunity to go at all. What, you ask? Well, I was originally scheduled to leave here 8/1. There was not going to be any GI coverage until 8/20. The day I left for safari, I learned a GI had recently committed to be here on 7/28. So, had I not been signed up for last weekend, I would have had to make a choice to come home early or stay an extra four days just to go on safari and to be at the hospital, completely underutilized, for two days with another attending here. Trust me, I would have passed on the safari and missed the opportunity of a lifetime. (Have me tell you about the time I went to Australia for 36 hrs to give a medical presentation and saw nothing but the Sydney zoo!) Anyway, got the safari and am coming home early, arriving Sun. afternoon the 29th.

Well, now a little show and tell. I'll really try to give you a few pictures every day or two. The internet is so slow here it takes a long time to transfer photos so will have to do it in small chunks.

First, a little description about our camp, the Amani Mari. It's owned by a third generation Kenyan whose roots are in India (just can't get away from India, no matter where I go). His family owns a trucking business which includes many of the over 80 camps on the Mari. Over the years he developed a passion for this place so decided to start his own camp. He got 50 acres and opened the site a year ago. There are only 9 huts. He feels his niche is his attention to the ecology. I'll share some of the things he has done along with the pictures.

You're not going to believe this but I can't get the icon up to add pictures. So, I'm going to send this and figure out what I've done wrong.

Kenya: Finally some photos

I will try to repeat only enough of what I've already posted to identify the pictures.
This the Mennonite Guest host in Nairobi. Arrived late on Fri., had breakfast and headed for Tenwek.

View of the Rift Valley

Nice, two-lane road in Rift Valley with acacia tree. Next, wild life while driving along the road. Gene Scobey, eat your heart out!         

Gazelles and some other hoofed creature with Maasai herding in background

Just one baboon of a troup but we were moving pretty fast.

Zebra. Excuse the absence of cropping. It was all I could do to get photos on page. I'll try to work with it and got a little help from one of the Duke residents here- as painful as that will be!
                                                                              
Within the next couple of days will give you a view of the campus and some scenic views from a walk yesterday. Following that, I'll try to give you a tour of the hospital and nursing school.
If you want to locate Tenwek Hospital, Kenya, you can go to Google Maps.

Before I sign off, a word about church. This is the interior of Bethesda AGC, the church on the hospital grounds I've attended the last two weeks. It holds about 300 and is almost full with about 1/3 missionaries and their families and 2/3 nationals, mostly hospital staff. 
AGC is an independent, evangelical church which has it's roots dating to the 1930's with World Gospel Mission with which it jointly controls Tenwek Hospital. There are over 1400 congregations in Kenya. It's a missionary-minded church and this is missions month. One of their congregation along with her husband, who has since passed, started a mission 20 years ago to the Pokot people, nine hours north of here. The Pokots literaly ran naked and there were no churches there (an unreached people group, one of the 4000-6000 still waiting to be evangelized at the time. She gave an update on progress. There's still no electricity or plumbing but most of the people now wear cloths, 30 churches have been started in the region and she is now in the process of starting schools which will be held in the churches (little more than wooden shacks). Although education has been free in Kenya up to the 8th grade for 7-8 years, this is dependent on availability and a large percentage of the rural population still has no access.
Today's message was given by Mary Whelchel, Director of Women's Ministry at Moody Church and host of the radio ministry The Christian Working Woman. Today was Women's Day and Mary's message was on the role of women as "helper"(ezer) in Gen 2:18. She started by telling us of the frequent use of the term ezer in the Old Testament (16/21) to refer to God as a Helper to Israel, usually in a military context. She then went on to tell stories of women in the Bible who were warriors of the faith and stressed the need for women to fortify themselves with doctrine, not something that is stressed in this culture. She also stressed the significance of the relationship between a father and his daughter and her subsequent walk with the Lord, again addressing an issue which needs to be addressed in this culture.
She also mentioned a book, The Blessed Alliance, about the beauty of the ministry of women and men working together, different but equal. I'm not recommending it as I have no first hand knowledge of it but thought there might be one or more of you who are familiar and can comment.

Continue to be blessed in several levels. Constantly amazed by His grace and goodness. As expected, I am receiving so much more than I am giving on this trip, yet another example of His kindness.

I would ask you to pray that the Holy Spirit make clear to me His plan that I might align my desires with His as I read Scripture; pray; observe and talk with the Saints here.

Blessings,
Ed                                                                            

                                                                             
                                                                                 
                                                                               

July 6 PM

Dear All, Realize I haven't given you an overview of my routine schedule. Since I don't have any in-patient responsibilities, I don't have to be at the GI lab until 8 and it's 3 min walk up the hill from the guesthouse. That has been one of the biggest blessings of the trip so far. I get up between 5-6 to read and pray until I go in. What a difference from my usual schedule at home where I get up at 5 and usually have only 30-45 minutes before leaving for work. Sometimes I dash straight in leaving devo time until PM, always a disaster for me. From 8-9 AM, the schedule varies: Mon. Intern Grand Rounds- topic conference Tue. M&M Wed. Devotion followed by Surgical case presentation, both by residents Thu. Surgical resident Grand Rounds topic Fri. Devotion in the GI lab. There is a chaplain (they have a chaplain training program here) assigned to cover the GI lab when patients have particular needs. He came this morning to lead six of us in a time of worship beginning with singing while he played guitar, followed by covering this week's assignment in the Experiencing God workbook and concluding with prayer requests. It was sweet. Yes, Susan Leslie, I was convicted about my unfaithfulness to work on keeping our little group going at MGG. This something I have committed to prayer and we can talk about when I return. Then, 9-5 it's endoscopy interrupted by two very important events to which you would be amazed to see how well I've adapted: Chai break. Starts anytime from 10-10:45, depending on patient care, meaning we don't stop in the middle of a case but we make sure we don't start one that will take us past 10:45! The total down time is about 30'. GI lab, don't get any ideas! Lunch. Generally 1-2; once a week at the hospital canteen, four time a week at the guest house and twice a week at one of the missionary's homes where they will host 6-12 guests. This is the major meal of the day and a time to get to know not only the missionaries but the many visiting families here who are in other housing. While we have worked until 5 a couple of days, we're usually finished by 4-4:30 so sit and read waiting for possible consults. Then home on the exercise bike which I just started yesterday after getting routine down and getting used to the altitude. Supper is always at the guest house with anywhere from 6-14 people. Singles, couples and some families stay in the guest house, other families stay in condos and houses. Only singles get to eat here for the duration. Everyone else eats here for their first three days then they have to prepare their own meals- the guest house has some apts with an eat-in kitchen and a sitting room for families. But, don't feel sorry for them. Food is inexpensive and for $5/day you can hire someone to come in to shop for you, make lunch and supper and clean up. You talk about a deal. After supper, more time to read and relax before calling it a night under the mosquito net. Pretty cush job you say. Well, were it not for the emotional trauma of seeing all the suffering here (worse than India because there we don't see many of the really sick folks)and missing Sue (and, differently, y'all too), I would have to agree with you. The Lord continues to be kind and gracious, blessing me with this opportunity to serve some of the least of these in His precious name. In Christ, Ed

July 5 PM

I know most, if not all, of this uninteresting but I'm really writing this more as a diary to re,ind me of some things here. But, I do promise to work on some photos this weekend during my free time. Think about this: patients have to have families stay to help in their care in hospital. These family members frequently sleep in the bed with the patient in the open wards I told you about. Post partum mothers sleep 2-3 in a bed. Only 22% of people in this are have insurance. While everyone with an employer is in the govt insurance system, the unemployment rate is about 30% and farmers, most folks in this area, are not covered. While this hospital is much less expensive that anywhere else for the services they have available, it is still expensive by local standards. For example, a CAT scan is 10,000 KS (Kenya Shillings), about $118 USD. While a fraction of the cost in the US, we're talking about an area where a huge percentage of the population makes $2-3/day so this is equivalent to 1-2 months salary. The hospital has to charge to stay afloat. Equally importantly, they do not want to develop a entitlement society or develop dependency. Tonight about 13 of us had dinner with Mr. Geoffrey Langat, CEO of Tenwek Hospital and Mr. Jackson, principal of the nursing school and got an overview of the operation. Tenwek was founded 75 yrs. ago by missionary nurses. Dr. Steury was the first doctor to arrive in 1959. As I memtioned, the place has grown primarily ov the last 40 yrs. There are now over 300 beds and 600 employees. Other facts: - It is governed by a BOD which is 50% from the Africa Gospel Church and 50% World Global Mission. World Medical Mission, an arm of Samaritan's purse, is a supporting partner only. - 95% of the annual operating budget comes from patient fees which are kept low in part, because of the volunteered professnal service and donated medical supplies - 90% of the capital budget (new equipment and services) comes from donations. A new 501(c)3 has just been appoved in the US, Friends of Tenwek. - the nursing school is a 3 1/2 yr program and has a total of 24 students. There are 24 schools in Kenya and Tenwek has never been below #4 on boards (top 2 last year). Their graduates are highly sought and can get twice the salary elsewhere so retention is an issue. Now for the medical folks who have asked for more details. I promise to not make this graphic but just share a glimpse into the differences in the types of GI cases we see here. I think I mentioned the case of tuberculosis ileitis presenting like Crohn's. Here' what the folks had on the 10 endos I did today: 1- esophageal cancer with a stent 1- proximal esophageal cancer with near complete obstruction, couldn't dilate. Aspirated on subsequent swallow 2- gastric cancers, one presenting with esophageal obstruction 1- recurrent tight benign mid-esophageal stricture requiring a stent 2- research patients- screening for esophageal cancer which is endemic here 2- normals 1- esophageal variceal bleed requiring banding- thanks for the donation of the banding kit, literally a life saver! ALL of these patients were, and are, outpatients. NONE got sedation except the research patients (yes, they get special treatment here, too- NIH supported) Well, tomorrow will be the end of the first week. Starting to get in the swing. Some new folks arrived today, including two medical residents from Duke. This is one of nine approved international rotations for Duke which speaks to the quality of training. Went to surgical case conference today and resident did great job, fancy power point and all. It is incredible!

July 4th in Kenya

Let me begin this note wishing you a Happy 4th. It was, of course, a regular work day here but prayers were offered for the US by the Kenyan doctor who led morning devotionals. But, the real celebration was last night hosted by the missionaries here. It was a good old American picnic with burgers, beans, slaw and a bunch of other goodies. Desserts included a cake decorated as a US flag. There was fellowship with an opportunity to meet more of the staff and visitors. The evening ended with singing of the national anthem and some firecrackers. Among those visiting was Mary Whelchel, head of the women's ministry at Moody (I don't know if we get her radio program in Memphis) who is leading a week-long seminar being attended by several hundred women. There is great hunger here for the Word of God and for an understanding of how it is to be incorporated into our daily lives. Another day of being humbled by God. Again, avoiding the medical details, I will tell you I was doing a procedure called ERCP, with the intent of placing a stent in the bile duct to relieve an obstruction caused by a cancer. This is something I've been doing for 30 years and is a area of particular expertise. Well, the stricture was so tight I could not remove the deploying devise through the stent no matter how hard I pulled. This has NEVER happened to me before. If the devise could not be pulled out in the usual manner, it would require surgery to remove. We always pray before each procedure but in this case, after 30 minutes of struggling, we stopped and fervently prayed for God's mercy on this poor lady to whom we were trying to offer some palliative relief. Five minutes later after some more effort, the devise pulled through! I knew I was here to be humbled, but I didn't expect it in this way. But, I should not have been surprised that He would have used a situation in which I normally feel confident to remind me of my constant dependence on Him. Praise God for His goodness and mercy! I have received some particularly helpful and encouraging notes from a couple of you who I know do not want to be recognized but I want to give you thanks and let you know what a blessing you have been. In Christ, Ed

July 3- second work day

Dear All, I've finished day 2 and there is so much to tell, I don't know where to begin. But, I better start or I'll never get started. Reluctant because I know you want pix and, while I have taken some, haven't downloaded yet. Trip from Nairobi to Tenwek is 100 miles, 3 1/2 hrs on a good, two lane highway. Not nearly as crowded as India, b it the poverty is every bit as great once you get out of the city. Went from high elevation down to the Rift Vally which extends from Jordan to south of Kenya. It was about 35 miles wide where we crossed. Grassy plains with occasional herd of cows, sheep and goats led by Maasi, a semi-nomadic people. Got photos, honest, of zebra, baboons, and gazelle. Then, up a plateau to Tenwek, located in Bomet which is at 6500 ft., 100 mi south of equator. This is the coolest month with highs in the upper 70's and lows in low to mid 50's. In Jan., the hottest month, the highs are mid 80's And lows in upper 50's. So, as you can imagine, it's a green, beautiful place. The hospital has over 300 beds and is run by 15 full time medical missionaries (when they are all here), ~ 30 trainees, and a varying number of visiting staff like myself. There are at least 8 of us here now, most with families with young children. The facility has been here 75 yrs. starting with one small building and one doctor. There has been incredible growth over the last 30 yrs. Some highlights are a dam to generate power in 1967 to give reliable electric. Prior to last year the best water they had was from rain cisterns which had to be boiled. Now there's a single UV water purification system where you can get good drinking water- which conveniently happens to me in my building, the Guest Quarters. Photos, I hope, of all this later. And, the highlight, was the addition of a CAT scan machine last year. But, by US standards, the resources are limited. Patients are in open wards, including ICU, of 12-20 people with open curtains and lots of family members, no privacy. Most places have windows which are always open and no screens. Upper endoscopy with no sedation. As limited as the resources are, I'm told this is the best mission hospital between Cairo and South Africa. Beside the local population of > 300,000, people come from hundreds of miles, even bypassing Nairobi because of the reputation and relatively low cost. I don't want to bore you with a lot of medical details but do want to share with you the reality of medical care in this world of limited resources. Yesterday afternoon there was an auto accident involving a family of 5 which involved the car rolling (eerily like the Chism accident.) All 5 sustained massive trauma. Four needed to be put on respirators. But, in the 12 person ICU there are only 4 working respirators and two were being used. So, the staff had to triage as we're trained in combat casualty and make a decision on who would most likely make it. The other two, the father and a child, we're prayed over and let go to meet their Maker. Sad, but an all too regular part of life here. Just scoped a bleeder which I couldn't stop endoscopically. Called the surgeon at 22:30, a career missionary, who is on salary. He came immediately with a smile on his face and went to work. This is medicine delivered in Jesus' name as it should be! Much to learn, much to share but all for now. Please know the people of Kenya are praying for the US this 4th, that God would continue to bless us and that there would be revival. Blessings, Ed