The Place of Winds

The word Kijabe means ‘place of winds.’   Every afternoon, the trees begin to bend gently in a breeze, as the sun moves to the other side of the Great Rift Valley.    The day passes slowly here, and sunsets can seemingly last for an hour.   Last night, we sat on our porch with our neighbors, Gary and Lee Anne Finke, watching a brilliant sunset behind a purple-gray rainstorm on the Valley.   As always, by the time the light was gone, the wind was at full-force, filling the night air with its roaring, stirring through the tall trees.

The night of our arrival, we walked through the cool night winds down to the Poenaru’s house for dinner.   Traveling from London to Kijabe via Nairobi had been exhausting.  We left the Mitre House Hotel early in the morning and walked to Paddington station where Josiah posed (asleep) next to Paddington Bear.   He and Amelia were only half awake on the train ride to Heathrow, but we made it to our plane without too many problems.

Josiah and his monkey slept for much of the flight.    We spent a night in Nairobi, and then drove to Kijabe the next day.  After all of that traveling, a nice home-cooked meal with the Poenarus was just what we needed, and we watched the sun go down behind Mount Longonot from their back porch before dinner.

The couple of weeks since then have been busy.   Our arrival coincided with that of an American pediatric urologist, Ron Sutherland, who comes to Kijabe twice each year.   Dr Poenaru had patients stacked up for him, so we really hit the ground running—operating long days and seeing fifteen or more urological consults in clinic each day.    It was sort of a rude awakening after being in the lab for the past year, but it was also very gratifying to help so many young boys with major problems that are attended by social as well as medical difficulties.   The bright smiles of the children make the long hours and busy days well worth it.

As expected, the medical and surgical diseases here are fascinating.   In my first two weeks, I saw four prune belly patients (3 newborns and one teenager), a multitude of hypospadius patients, and several children with bladder extrophy and epispadius.  These problems exist in the States, but there seems to be a higher incidence of several congenital diseases, which may be attributable to environmental factors.  For example, the overwhelming number of patients with spina bifida here is a testament to the importance of ‘simple’ interventions like adding folate to the grain supply.   As Dr Bransford pointed out, though, that is a much more difficult task in Africa than we Westerners might imagine. 

As a matter of fact, many things are more difficult in Africa than they are back home, especially when it comes to caring for patients.   One of the limitations is technology—a CT scan can only be gotten by sending a patient to Nairobi, and the radiological interpretations are sometimes suspect.   Saturday night, Amelia admitted a three year old girl with new, progressive hemiplegia (one-sided paralysis).  She came with a CT scan from Nairobi that had been read as stroke.   We were having dinner with friends when she got the call, so Josiah and I walked with her to the pediatrics ward to look at the CT scan.  It didn’t look like a stroke to us, so we decided to pursue other possibilities.  While Amelia did a lumbar puncture (spinal tap) and ordered tests, I rigged up my computer as a light box for the CT scan.  I took several pictures of the scan and sent them off the formidable Clarence Edwin Smith IV.  CE is doing a fellowship in neuro-radiology, and I knew that if anyone could give us some help it would be him.   I was right.  He fired back a thorough read of the CT scan that was much more helpful than what we had previously.   It was a lot of fun to collaborate on a patient with CE—especially when we were so far from each other.   His input helped guide the treatment plan, and we are hoping to get the girl back to Nairobi for an MRI sometime soon, at CE’s suggestion.

One of the highlights of my trip so far has been getting to work with and operate with Dr Dick Bransford.  Dr Bransford is a general surgeon in the truest sense of the word.   Over the years, he has done a little bit of everything.   In the past 10 years or more, he has invested most of his time and energy creating a surgical program for children with hydrocephalus and spina bifida.   Kijabe is now the regional center of excellence for these diseases, and the case load is astounding (I think he did 9 cases today and postponed another 3).   I have enjoyed learning how to do VP shunts and spina bifida closures, but the real privilege has been to spend time with Dr Bransford, whom Dr Tarpley calls one of his heroes.   That makes Dr Bransford a hero of a hero, whom I greatly admire and enjoy.

The operating room experience here is a little different than back home.   It’s not just the reused bovie pads and attention to conserving suture.    There’s just a feel to it that is different—perhaps it is primarily Mary’s ‘chai’.   Every day, Mary brings a large white bucket full of fresh milk (straight from the cow), which she mixes with strong Kenyan tea.   A little sugar and you have chai.   We all huddle into the ‘tea room’ and sit shoulder to shoulder on the couches drinking our tea.   This is one of the more enjoyable times of the day, when things slow down a little.   Everyone sits and talks about whatever comes to mind.  Then it’s back to work.

Each day, at the end of the day, I make my way back home to the Sitaplex, the apartment guest house where we live.   It’s the best part of the day, coming home to Amelia and Josiah and another Kenyan sunset over the Valley.