The McCropders Turn 3

November 2007 marked the official decision to pursue working as a community of families, after years of pondering and joking about it. Thus, we have crossed the 3-year mark, and thought we would post some photos to commemorate it.

At the 2007 Louisville conference, with Elise missing.

June 2008: Ann Arbor on a kidless afternoon.

May 2009: Maggie arrives, and Abi is expected.

September 2009: Right before Cropseys left for Kenya

December 2009: The final McCropders arrive in Kenya

July 2010: Visiting with the Lynns

November 2010: A few nights ago after a big soup dinner with the Popps.

The Superior Intelligence of Kenyan Mice

Here in our apartments, we have regular visitors, including friendly lizards, skinks, chameleons, beetles, bees, spiders, slugs, and oodles of mosquitos. Once in a while some cockroaches. Occasionally a bird. And MICE. This week we undertook a major mice-eradication effort.

When we were in town recently, we found this metal rat trap.
When this picture was taken, the trap had been set in this set position for TWO DAYS. Empty. Just accumulating fresh mouse droppings all around it an ON it. Evidently Kenyan mice are much more intelligent than American mice.

So I set to work on a different type of trap.
It's essentially a ramp leading to a bucket in which a tin can with bait is suspended. Theoretically, the mouse leaps from the ramp onto the tin can, where he scrambles for balance as the tin can spins, causing the poor animal's descent into the bucket from which he cannot escape. The mice did not fall for it.

So I did some on-line investigation, which means that I was getting desperate. On-line investigation is a last resort here where lately it can take 10 tries and/or 10 minutes to load a web page. But at last the search yielded directions for assembling the perfect trap.
A baking dish on a tray is propped up by a bent stick. Peanut butter lures the mouse to jostle the stick, causing his certain entrapment as the baking dish falls.
And it works! Fantastic! Not surprisingly, Anna really wanted to keep the little creature. And even I had to admit that he's a cute little mouse. Cute and smart, but finally outsmarted.

Kenyan Pregnancy Taboos

(A Kenyan doctor friend Mike comes up to Rachel and says congratulations, with a gesture towards the baby bump.)

Wait a second, Mike. I had heard that Kenyans never acknowledge a pregnancy until the baby comes.

That's totally true. You can't mention it, even when she is almost ready to deliver. But you're a Westerner, and everyone knows that you guys don't mind, so we can say it to you.

Well, what if we went out to a rural village, and saw a very pregnant lady, and said, "Congratulations, mama! When is your baby due?"

Oh, that would be fine, because even in the remote areas, they know that Westerners are different on this. But, if I were with you and said the same thing, they would be very offended.

But there's an indirect way that you can ask, right? You can say, "When will you be inviting us over for tea, or lunch (implied: to see the new baby)?"

Absolutely, that is what you would say. But you can't mention it or even prepare much for it. But younger generations of Kenyans are now having baby showers and things like that. But even them, even at a baby shower, you can't verbally mention it. It's still taboo.

Wait. You're at a baby shower for a pregnant lady, but you can't acknowledge she's pregnant? Then what do you say when you give her a gift of a crib or some baby clothes?

Oh, you just say, "Here, these are for you. I thought maybe you would like them. Just put them away somewhere, and maybe you fill find them useful one day."

So, Mike, I gotta tell you that as an American, I find this pretty strange. Do Kenyans find it equally strange that Westerners would ask freely about a pregnancy?

Oh, of course, they would be like, "Eh, why are you talking about a baby that isn't even born yet?"

--The sobering part of this awesome conversation is that we were in agreement that the likely source of this cultural difference springs from the vastly differing neonatal mortality rates, and the reluctance to expect too much in a society that loses so many babies. Nevertheless, we remain grateful to friends like Dr. Mike to help us navigate the cultural waters.

Liberia Report

Since 1989, Liberia's history has been one of great tragedy.  A peace agreement signed in 2003 led to the resignation of Charles Taylor and ended a 14-year civil war in which over 250,000 Liberians were killed and untold numbers scarred in unimaginable ways.  No family was left untouched.  

View of Monrovia -- note the sea of shanties along the beach

A transitional government was put into place until President Ellen Johnson-Sirleaf (first and only female African head of state) was elected in 2006.  Not only did most of the educated leave the country during the war, but nearly all major infrastructure was looted and destroyed.  The country is now in a rebuilding phase and the world is watching and hopeful that the elections next year will be peaceful.  

Ministry of Health building that was never finished after the war

Monrovia City Hall -- one of the buildings that has been renovated

The Cropseys were sent to explore the medical opportunities.  In 2003, there was not a single remaining Liberian doctor in the country per the Dean of the medical school!  In 2005, the number had increased to a whopping six.  Some estimate a total of 60 docs in country now, but they are mostly in Monrovia.  So the need is great, no question, especially for educating the next generation of doctors for the country.

A.M. Dogliotti College of Medicine - they have some beautiful new buildings and labs.  JFK (the big government hospital in Monrovia) seems to be doing pretty well.  The people that we met with at both of these institutions were very eager for us to come.

On arrival, we were warmly welcomed by the Colby family, who are working with SIM (Serving in Mission) at the historic ELWA campus.  ELWA was given 137 acres by the government over 50 years ago and has been involved in radio ministry, education, and medical outreach at ELWA Hospital.  Prior to the war, ELWA was considered the "Cadillac of mission hospitals" with over 200 ex-pats on campus.  Today, there are only a few SIM missionaries (none of them doctors), handling a very large load.  Three doctors on loan from the Ministry of Health are keeping ELWA going while Dr. Rick Sacra is on home assignment in the USA.  

View from the guesthouse -- ELWA housing is right on the beach!

One of the many houses on ELWA's campus that hasn't yet been renovated.

 ELWA Hospital 

Our welcoming team (L to R) -- Jackie (dental hygienist), Kristin & Keith Chapman (dentist), Dr. Alfredma Chessor (Liberian doc trained in the U.S.), Natalie & Ben Colby

Liberia is certainly a place with huge need.  If we go to Liberia, we would primarily be stationed at ELWA Hospital with opportunities to teach at the medical school and JFK, eventually helping to start residency programs in country.  Please pray for ELWA Hospital as they are going through some tough transitions right now.  And keep the McCropders in your prayers as we try to discern God's calling for our team.  

COTW: Decision-Making

A few weeks ago, we admitted a 3-month old child, reportedly previously healthy as well as previously unimmunized. After getting the story of the illness and examining the child, the most likely diagnosis was Pertussis, or Whooping Cough. She was put on oxygen and started on antibiotics.

A couple days later, she began to get worse with her breathing, and it became evident that if she was going to survive, she would need to be put on the ventilator to assist her breathing. Having no other option, we did this, with the help of our visiting Respiratory Therapist from Canada.

The next few days were extremely touch-and-go, but she persevered. We knew that Pertussis can take a while to resolve, and so weren't surprised that she didn't seem to be able to yet come off of the ventilator.

We decided to get a chest x-ray. This was her first chest x-ray, which may surprise you, but we go to great lengths to preserve cost for our patients (and that's another conversation). Here is our xray.

The most obvious thing about this xray is that the heart (the white part in the center and to the right) is huge, at least twice the size that it should be. The most careful observer (with a higher resolution image) might also notice that the ribs and spine have multiple anomalies, likely from birth, including hemivertebrae and fused ribs. Putting this all together, what we see is that she is extremely likely to have been born with a heart malformation. Thus, she may have Pertussis, before even before that (and thus, after it as well), she would not be healthy, but rather has a condition that has likely no recourse to fix here in rural Kenya.

So, now what do we do? We could keep her ventilated, try to improve her heart with medicines, and hopefully get her off the machine, but even if she managed to get discharged home, her days are extremely limited.

In the meantime, her family is accumulating a big hospital bill, which means food and school fees for the other children at home may have to go unsupplied. This issue of cost is marked here. In the US, it's frustrating that we spend 15% of GDP on health care, but no one is missing out on life necessities because of a hospital bill. And keeping her here means that 1 of 2 ventilators is occupied, and 1 of 6 ICU beds is occupied, and terribly sick patients are showing up all the time.

Our training didn't teach us how to answer this question. And, in this scenario and culture, discussing the options with the family in order to let them make their own decision is not an adequate solution for a number of reasons.

We face these questions very often, ones that matter intensely for patients and families, and for which we aren't certain of the right answer, and no one can supply us the right answer.

Pray that we would have wisdom.

Appropriate Technology?

When I first arrived at Tenwek, I remember being amazed at how well equipped they were for a missions hospital in the developing world. They have ventilators! They have a defibrillator (machine that gives the heart a shock, used in life support stuff)! They have scopes of all sorts--for endoscopy (looking into the stomach), colonoscopy, cystoscopy (bladder), and laparascopy (abdomen/pelvis). This is the biggest shocker--we have cardiac teams come out a couple times a year and somewhere in the recesses or the OR basement is a BYPASS MACHINE. Seriously? This is a machine that is used in open heart surgery and basically acts as a heart and lungs for the patient undergoing surgery. Unexpected.

Also, because of the various teams of surgeons that come through Tenwek, people are always brining new equipment with them to donate to the hospital. We recently got something called a Ligasure donated to the hospital. It is a clamp used in surgery that also employs electrocautery to seal any blood vessels in your clamp. Most hospitals in the US have them, but I'll bet most hospitals in the developing world don't. I've used it. It's great!

But sometimes I have to stop and wonder about how appropriate all this stuff is. When I can use cutting edge technology to do a hysterectomy (which is nice, but the surgery can also be done with far more basic equipment), but I can't find a simple metal speculum to examine my OB patient, or a clean sheet to put on the bed for her, is there something wrong? Should we be focused more on stocking the basics needed to provide better patient care before we move on to high tech? Or should we say, hey, the Ligasure was a free donation! Use what ya got!

One of my former OB attendings, Bryan Popp, is now working with me at Tenwek. He was known as somewhat of a laparoscopic guru, and I was looking forward to doing some L/S cases with him to keep up my skills. Above is a photo of us doing our first laparoscopic case together. It looks like we are engaged in great medical discussion about how to care for the patient, but instead, we are shooting the breeze while waiting for the L/S stuff to get set up. About 45 minutes after the patient was put to sleep, we still hadn't started, because of some problem with the carbon dioxide gas valve. In fact, we ended up just making a small incision and doing an open case. Other L/S cases have been cancelled for similar reasons. We have the technology, but sometimes don't have the ability to maintain it or work with it. So, I could keep trying, or I could decide that what works in the US and is "best" for the patient, might not work or be the best option for my patient at Tenwek. And there are also issues about WHO gets to take advantage of the technology. When you have ventilators, but only two, which patients should get them? The sickest patients? The youngest? The ones most likely to get better? We're still trying to figure out some of this stuff...it's an ongoing process. Hopefully we'll have some more blogs in the future addressing some of these issues as well.

Off to Liberia

John & I are sitting in the Nairobi airport right now waiting to depart for Monrovia, Liberia.  We are excited about embarking on the third McCropder exploration trip.  Please keep us in your prayers over the next week.  Here are some specific requests:

1)  Safety in travel (both in the air and on the ground)
2)  Beneficial meetings with medical workers and government officials
3)  Health and peace for Elise & Micah who are staying at Tenwek with trusted friends
4)  Clear direction from the Lord as to whether this is a good fit for the McCropders

We'll post an update when we return.

COTW: Operating Together

John and I have had a few occasions to operate together, which is a unique opportunity for a General Surgeon and an Ophthalmologist. On one such case, an older gentleman came in having been stabbed through the eye and into the brain. He didn't come into the hospital for a few weeks until he had persistent pus coming from around his eye. He also had headaches and fevers. So we sent him 3 hours away to get a CT scan of his head, and he came back with a scan which showed an abscess in his brain, as well as around his eye.


So John and I did a tag team operation. I started by drilling a 3/4" hole in his head around where the abscess was. Then Rachel's department lent us a gynecologic ultrasound probe (thus involving three McCropder doctors in this operation) to look through the hole and locate the abscess. Probing a needle into the abscess under ultrasound guidance, I drained a few cc's of pus. After I closed up his head, John did some fancy eye exposure to get the pus out from around his eye. This is how he looked after we finished:

He did well after the operation and some IV antibiotics. We look forward to our next combination case.

Nairobi 10K Run for Sight

It is inspiring to live in Kenya among many of the world’s fastest marathoners. We had hoped that Kenyan residency would naturally boost our running speed. Alas, we will never be able to run like Kenyan runners, but hey, we’ll join in the run anyway. Last weekend, about two dozen people from Tenwek enjoyed a 10-kilometer run in Nairobi. This annual Run for Sight Event (which includes a Marathon, 10K, and Family Fun Run) donates all proceeds to support pediatric eye surgery at various eye hospitals in Kenya, including Tenwek Eye Unit. An impressive number of Eye Unit staff participated in the event. So we loaded up the Eye Unit bus and also the McCropder-mobile and headed to the races.
The morning of the race, our energy and enthusiasm could not be dampened, even when we found ourselves completely lost on uncharted roads of downtown Nairobi.
Just in time, we arrived, parked, and paused for a pre-race picture. L to R: Alyssa, Todd, Jason, Heather, Jessica, John, Toanh, and Bryan.
En route to the starting line, John found a new friend. A Michigan cap is ample grounds for friendship in any country, right?
We found our places at the starting line…
among a very large crowd. More than 14,000 other people also wanted to participate in the Run for Sight. This is Kenya, after all.
A few notes of interest about Nairobi 10K race attire: Running shoes are optional. Running in boots is ok. Running in jeans is also acceptable (see runner to left of center below… and note that he is ahead of us). And evidently, racing in the official race t-shirt is not a faux pas here.
Along the route, a super-size billboard of Michelle Obama cheered us on towards the finish line.
While the women in our group ran together at an enjoyable pace, chatting our way through 10 kilometers, the men ran at faster race paces. Note John and Bryan running with speed that made the picture blurry.
We were all glad to find each other again at the finish line, tired, happy and injury-free.
This week, back at Tenwek, unofficial training has begun for future participants in the Run for Sight.

ONLINE GIVING!

After more than a year working with Samaritan's Purse, we are pleased to announce the long anticipated arrival of online giving! We are generously supported both by SP, in the form of a salary/benefits, and by many of you. This is a way that will hopefully make it easier for you to support us financially, if you so desire. Note that if you are already monthly supporters, you don't have to change anything. And you can always continue to download the pdf file on the left sidebar link, print it out, and mail it in. If you'd like to save yourself some postage, however, go to:

www.samaritanspurse.org/wmmgiving

Unfortunately, if you are looking for a "McCropder" link there is none. But you can type in an individual name (there's no Rachel...she's just with Eric) and type in the amount you would like to donate. It's supposedly quite easy (if you have faster internet than us, of course, which should be all of you). Thanks in advance! We couldn't do what we do without you guys.

Fall Festivities

There are no colored leaves, football games, orange pumpkins (only green), or cider mills to remind us of the season back home.  On Friday, we had some festivities to celebrate fall so that our children aren't totally clueless when we come back to the States.  In the afternoon the small kids came dressed in costume.  We decorated some pumpkin-shaped sugar cookies to pass out and then had some games.

The three-legged pumpkin race for the older kids...

The pumpkin roll for the younger kids.  I don't remember who came in first.  I just remember being amazed at how far behind Elise was!

Bobbing for apples...

Pin the nose on the jack-o-lantern...

After the games, the younger kids went on a trick or treat scavenger hunt where they had to solve clues to figure out which house to visit next.  Of course, Maggie, Abi, & Micah weren't much help, but they reaped some of the benefits!

Here's Abi sharing some of her loot with Little Bo Peep....SIKE.  She plopped it in her own mouth immediately after the picture was taken!

















In the evening, the older kids gathered in their costumes to embark on a treasure hunt.  For each house that they visited, they listened to a sound (toilet flush or creaking door for example) and filled it in on their list.  They also received a clue to tell them which house to go to next.  At the end, they unscrambled the letters from their sounds to figure out where the final party would take place.

John & Jason added some spice to things by scaring the bejeebers out of the kids while they were visiting the different houses.  After the treasure hunt, we gathered on the Roberts' porch for some s'mores by the fire (Cadbury instead of Hershey and digestive biscuits instead of graham crackers).  We concluded with a creepy story in the dark that involved spaghetti noodles for intestines and olives for eyeballs.  It was a fun day and the kids had a blast.    

Happy Fall to everyone!  Indulge in an extra donut and some cider for the McCropders.  :)