changes

Well, there are a lot of changes going on here at Tenwek.  Yesterday, Kelly and I completed our last day of our Women's Health rotation.  And although I don't see a furture for me in OB/GYN, I am going to miss all the staff on the OB floor.  And even though it was our last day, it prooved to be our most eventful.  Kelly and I each got the opportunity to be first assist in a cesarean delivery AND close.  I haven't sutured since my ER rotation, and I haven't done a subcutaneous stitch since we practiced on pigs feet in class, but thankfully I had good instruction at UK and it came back pretty quickly. 

I contemplated not sharing a particular case with you, but as this has been a learning experience for me, I thought I would share.  As you can imagine, not every day on the OB floor is a particulary happy day.  Here, the people do not have access to all of the imaging and diagnositic testing that we are priveledged to have in the states.  For example, back home, pregnant mothers have something called a Quad Screen when they are 16-18 weeks pregnant.  This test will tell the physician and family the risk a patient has for delivering a baby with Down syndrome, Edwards syndrome, or nural tube defects (NTDs).  I can only imagine that by conducting this screening, it can better prepare families and physicians for dealing with a child that may have specific needs once he or she is born.  Many of the patient's here never receive an ultrasound during their pregnancy.  Sounds crazy, right.  Families in the states look forward to finding out the gender of their baby.  Women here will only have an US if their is uncertainty about the gestational age of the fetus or if a problem arises.  The patient who's surgery I helped with yesterday had received an ultrasound that measured her babies head much larger than it should be.  Again, without access to all the diagnostic tests we have in the states, we had to assume the possibility that this baby had hydrocephaly.  A form of nural tube defect where an abnormal amount of cerebral spinal fluid builds up in the cavities of the brain.  This condition can cause all kinds of developmental problems and even death.  So there I was, scrubbed in on a C-section that may not have a happy ending.  One thing I love about Tenwek is that we pray with our patients before every surgery.  I have even had the opportunity to pray for a few of my patients. So of course we prayed for this mama, and as we all need prayer, I couldn't help but think this mother and child needed it most.  So we did the surgery and this baby did indeed have hydrocephaly.  I won't go into too much detail, as some of you reading may not do well with medical graphics, but the increased size of this infants head made the delivery much more difficult.  I had to put all of my weight on the mother's abdomen to try and maneuver the child out of the incision that had been made.  Upon further evaluation, the infant had a meningocele.  This is more commonly referred to spina bifida.  Here, an unfused portion of the spinal column allows a portion of the spinal cord to protrude.  There is usually some degree of paralysis, and infections are very common.  As of today, the baby is actually still living and breathing on his own.  NTDs are usually caused by inadequate amount of folic acid in the mother.  The nural tube has developed by the time a woman misses her first period and therefore before she even knows she's pregnant, so the recommendation is for every woman of reproductive age to take 400 mcg of folic acid daily espeically those who want to conceive within three months.  I asked my preceptor if these women have access to prenatal supplements.  He stated that there is a theory that women who live in countries with a corn based diet have greater incidences of NTDs that is possibly due to a folic acid antagonist found in the food.  Interesting.  Please keep this mother and her child in your prayers.  We serve the mighty healer.  Yesu anaweza- God is able.

On a different note.  Today is Mark's last day in the physical therapy department at Tenwek.  He will be headed back to the States on Monday :(  Several of his co-workers have asked Mark to become a full time missionary here! (don't worry family, we aren't planning on it)  They love him, and who wouldn't :)  I have gotten to watch Mark interact with the people here at Tenwek and it has been absolutely amazing to see how God has used him.  Mark has a special gift of making those around him feel special and happy.  Doing missions in Africa has always been one of my dreams, and now I think Mark would agree that it has become a passion for him as well.

As for Kelly and I, we will start our new rotations on Monday.  Kelly will be headed to pediatrics and I will be headed to general surgery.  Please keep us in your prayers as changing rotations, especially in a different country, is usually accompanied by some anxiety.  Thanks for your continued prayers and words of encouragement.  Please remember Mark as he makes the long journey back home by himself.  God Bless!!