Addendum: "My Kingdom..."

Interestingly, after returning from our successful jaunt to a semi-distant town in order to get a key made, risking (I might say) great personal injury, it was noted that Alyssa's apartment key had been known to work in a number of locks on the hospital campus. So, she tried it out on our door. That's right: We had the same key.

Yep, we had been trying to make new keys for our new apartment residents, when all along they already had keys.

A Month in the States

As you may have heard, my parents flew me home for Christmas in Wisconsin. Wisconsin sometimes seems like the opposite of Kenya.

Wisconsin:
Kenya:
Wisconsin (Eating Out with Cousins):
Kenya (Eating out with blankets):

I wondered how it would feel to be "home" in the USA. At first I kept marveling at pleasures that we do not experience in Kenya. Things like quick trips to the grocery store. Things like stop signs and smooth traffic flow. Drinking fountains and fast internet and clean public bathrooms. Church nurseries. Skim milk. Predictability. Blending into a crowd. Somehow it caught me by surprise to feel at home in a different world, even in this town where I grew up.

We have been very thankful to be with my family at this time, especially when my dad underwent emergency surgery in early January. So we stayed a few weeks longer than planned in order to help with his initial recovery. Honestly, two small children and I offered minimal help, but at least the granddaughters offered some distraction. Reading children's books and watching Veggie Tale videos probably can only aid in the healing process.

Being with my family at this time reminds me not to waste any opportunities, since truly, life seems very short from this viewpoint. We are more than half way through our term in Kenya. My dad is recovering slowly from a major operation, and life even seems to speed by for my five-year-old who has her first loose tooth. It has been such a joyful gift to seize opportunities this month to spend time with family and friends.

And now it is time to return to Kenya. We are so excited to go "home" to Jason! Something tells me the girls will look forward to Christmas in the USA again next year.

My Kingdom for a Key

For over a year now, we have had but one key for our apartment, despite the fact that we have two doors with locks. One has one key, the other has no keys. It's been a recurrent minor convenience, but shocking that it hasn't been a bigger deal. However, what with our upcoming familial expansion, we are moving upstairs to a larger apartment (Thanks Alyssa and Heather!), and the new occupants will require more than one copy of a key.

Yesterday, we took our friend Jeff, a visiting family practice doc from Ann Arbor, to the town of Kericho, one hour away, to see the vast tea plantations and have lunch. As an aside, here's a current family photo from the Tea Hotel.

After lunch, Jeff and I dropped Maggie and Rachel off at the grocery store, and Jeff and I headed out to get some copies made of our lone key. We had gotten the inside scoop that the best place was "Kipsigis Traders Ltd", which we thankfully found without too much difficulty.

Inside, I told them I was looking to get copies of this key made. They looked at it, and asked if it had a number on it. It did not. They shook their heads doubtfully, and said that maybe, if I could find the number somewhere, they could special order copies from Nairobi. Apparently our keys are too old to get copies made. In Kenya. Which is quite remarkable, really.

I think the gentleman at the counter read the exasperation on my face. His eyes seemed to dart back and forth before saying "You could always get one of the fundi." I didn't know that word, though I had vague recollections that Al Pacino used it in the second Godfather. "They cut keys?" "Yes. There are several just here in Kericho. You could go out, turn right, and then right again, on the bad road. There is one near the Old Sunshine Hotel."

Having no other options, and convinced that key-cutting can't be a totally contraband activity here in our fair Kenya, Jeff and I headed out in search of the aforementioned bad road (which usually just means dirt road) and the fundi who plies his trade by the Old Sunshine Hotel. Well, it wasn't far down the road, before we found the following little kiosk (of sorts).

A close up view. We looked around, and on the opposite of the bad road was a guy sitting in a broken down wooden chair. He appeared interested in us, so I asked him if he knew how we could get 2 copies of this key made. He said yes, he could do it in just a couple of minutes while we waited. We settled on 500 shillings for the job, and he offered us the rickety chair, as I handed him the key. He took it, and promptly bolted down the road, and out of sight.

Jeff and I looked at each other, and immediately proceeded to try and reassure each other. "He has no motive to steal my key, right?" "Right. He has no reason to take your key." "OK, because, you know, that's the only key we have." "Yeah, don't worry," he says with just a little less reassurance than I would like. "I mean, his little stand is right here." "Yeah, but it's probably like a satellite operation for somewhere else in town." "Yeah, right..." And on it went.

So we took turns sitting in the rickety chair, and greeting the passerbys. Every few minutes, we would return to the topic. "I mean, he did say fundi with kind of a weird intonation, didn't he?" "Hmm, weird that he would try to order keys if there was a legit key-maker just behind his shop..." But about 10 minutes later, the same guy came running down the dirt road. He went straight to his blue kiosk, and pulled out a rusty can, and subsequently dumped out a pile of rusty keys. I was a bit more worried, until he pulled out my new keys from his pocket, then searched through the rusty pile for a little keyring to put the keys on. The package complete, the money changed hands, and we thanked the fundi for his service. In triumph, we returned to the grocery store, and even better, upon arrival back at Tenwek, we found that the keys did indeed work.

COTW: Higher Mathematics

Please forgive the technical and somewhat nerdy nature of this post. If you'd like to pass on it in favor of a story of more casual amusement, click here.

A couple of weeks ago, Tenwek's IVPU went down. The IV Production Unit is a brilliant little onsite operation where we produce our own IV fluids. This apparently lowers costs for patients, enables us to have a steady supply, and also allows us to produce some types of fluids not available on the local markets. It went down, got fixed, and is down again. This is a good example of something you don't value adequately until you don't have it. IV fluids are a simple, but absolutely essential, part of much of the work we do.

So we have been buying fluids from other places and trying in general to not be wasteful of that which we have. However, the NICU (or sick newborn nursery) is one of the places where the IV fluids that we need are only available to us because we make them. In other words, tiny babies require special fluids that are not available for purchase, largely because very few other places do the level of newborn care that we do.

So, the in-charge nurse from the NICU finds me last week:

"Daktari, we are out of D51/4NS."

"Really? Well, we're going to have a hard time taking care of little babies without that."

"Yes."

"What do we have?"

"We have NS, D5W and D10W."

"Hmm..."

I sat down and scrawled out the following:

Now, in the US, you just name your fluid, and you get it. So I have exactly zero practice figuring out this kind of thing. But it seemed intuitive enough, and thankfully I had a very flexible nurse who was willing to try it, despite the fact that mixing all these fluids together makes for a lot of work for them.

And now, we've run out of D10W as well, so I'm not quite sure where we're headed now.

A similar thing happened when my DKA ("very sick diabetes") patient in the ICU needed to be switched from D5NS to D10NS. The nurse asks: "OK, how do you make that?" Umm...

I was hoping to find the answer on Wikipedia, because that sounded cool, but instead I got the basic info I needed from ehow.com, and worked out the rest of the math for myself.

Just another example of the role of creativity in dealing with things we've never encountered before. Even after a year.

Good thing Jess is a math teacher.

Graduation Day, 2011

Here in Kenya, the academic year goes from January-January, so last week we had our annual Intern Graduation here at Tenwek. While we were all here for last year's graduation, most of us had just started working and so didn't really know the graduating class. This year, however, we had all been able to work with and get to know each of the 16 graduating interns, making last Saturday a special day for us. Most days in the hospital our primary role is not necessarily patient care, but instead educating and supervising the interns on how to provide better patient care. It was not what we expected before arriving at Tenwek, but has been an awesome experience for us. Now, even though the McCropders will depart Tenwek in the next 6-8 months, there are 16 young Kenyans who will be able to provide better care for their fellow countrymen, in part because we helped to train them. It's a great multiplication principle.

The Kenyan medical system has 2 different "arms." 10 of our interns had graduated from medical school before doing their 1 yr internship at Tenwek, and will now be posted to various government hospital around Kenya. 6 of our interns had graduated from a training program like PA school before coming here, and all of them will be staying at Tenwek to help in the outpatient department. It's been fun watching them improve in their clinical and procedural skills since arriving.

The graduation itself was a nice meal and some speeches (less exciting than last year where some of the open flames provided to keep the food warm "exploded" and set someone's dress on fire...no worries, no one was hurt), followed by the interns receiving white coats and diplomas. Here's Jason putting a white coat on Damaris, who will actually be joining the PAACS surgical residency program here next month.

This is Milka, receiving her diploma.

And finally a group shot of the interns and consultants/attendings (Rachel is absent because she got called away to deliver a baby):

Congrats to all the interns! We look forward to being a part of many similar ceremonies in the years to come.

Life on the Highways

This week at a conference, someone asked us to draw a picture of what our lives look like these days. I drew our family driving in the car.

In the last month, our family has driven over 5000 miles. Other McCropder families are traveling similar paths. We welcome your prayers for safety and sanity in the car as we traverse the country to attend conferences and courses, to speak at various events, and to see friends and family.

We are figuring out some of the tricks of handling life on the road:

We utilize free wi-fi and free refills at many a McDonalds.

We try to coordinate pit stops with friends when we travel to the same locations. This may not happen again for several months, but Maggie and Abi did enjoy playing together at this playground in Ohio a few weeks ago.

At a McDonalds in Connecticut, we learned to suggest simultaneous straw drinking so that we can get back in the car faster and keep driving.

We encourage children to entertain themselves quietly in the car, even if that means letting them practice photography skills with the digital camera. This is Anna's best photograph from New Hampshire.

You may notice that Abi is holding a bag in the picture. Perhaps you recall a disaster or two with her carsick stomach in Kenya. We are extremely thankful to report that she has only been that carsick once in the USA so far. I'll always remember central New York for last week's clean-up effort.

2000 miles later, our family is now in Colorado for a course at Mission Training International. Here we are enjoying the beauty of the Rocky Mountains, and we feel very thankful for all the wonderful people we have been blessed to see all across this beautiful country.

Celebrities

We knew that coming to Kenya as "wazungu" (white people) meant that we would get some additional stares.  However, Tenwek has been around for over 50 years and we thought that our presence might go a little more unnoticed.  That has not been the case.  There have been times when I am simply following my children as they walk along the sidewalk looking at bugs, flowers, etc. and people who are walking down a road parallel to our sidewalk will stop, stare for quite some time, and finally leave giggling.  I often wonder what they find so amusing.  Is it the glare of my white skin as it reflects the sun?  Quite possible.  Is it my clothes?  Highly likely.

Two days ago, I had quite the entourage of children in tow....Hannah Bemm (Kenyan child adopted by a missionary family), Leo Popp (Vietnamese child adopted by a missionary family), and my own two blue-eyed, blonde-haired munchkins.  It had recently stopped raining.  The older kids were standing under a rain gutter, getting completely soaked.  Micah was entertaining himself by playing in a puddle.  A common activity for young kids, right?  I watched as a crowd of about 15 Kenyan kids (all in school uniform) surrounded Micah, bending over to get a closer look at this strange creature.  A few were even bold enough to touch his hair or arm, which he didn't seem to mind too much.  Then they walked further down the sidewalk towards me.  I greeted them (handshake a necessity here) and asked if I could help them.  "No, we just want to watch the children.  What are their names?"  I responded and they stood and watched until we decided to head home.  Of course, we had quite the crowd following us to the gate.  I wasn't able to capture this special moment on camera, but I have a picture that illustrates this phenomenon.  Who would have thought that we needed to go to Africa to become celebrities?

Afghanistan

My parents have been working in Afghanistan for a number of years, establishing a Family Practice residency program for Afghan doctors. I have wanted to visit them since they got there, but it was always a long way and a tough place to go with my family just to visit. But then, with Heather going to the US with the girls, I saw my opportunity to make this happen. So two weeks ago I traveled to Dubai, obtained an Afghanistan visa, and then traveled to Kabul. Allow me a few observations about my trip:

I had the opportunity to lecture to and round with the Family Practice residents and physicians on two occasions. They are a very bright group of people and were really interested in learning about surgery (indeed, when they are done with their 3 years of training, some of them will choose to work in hospitals in rural areas where they will need to be able to do surgery).

The people there are amazing artisans. As the country is rebuilding, many people are reviving their culture of craftsmanship and we saw some very innate woodcarving throughout the city. We also saw many instances of the older generation teaching teenagers these crafts.














The land is beautiful. Kabul is nestled among 10,000 ft mountains, which are snowcapped during some of the year. There are fruit trees scattered everywhere (not in bloom, since it is winter). In addition to being artisans, Afghans do some beautiful landscaping.














Finally, it was wonderful to be with my parents and see how they have been living these past years. We did a lot of catching up and laughing with each other and that was very refreshing.

Practicing Retina in the Developing World

An interview with Dr. Ben Roberts (career ophthalmologist at Tenwek, currently on home assignment in the U.S.) & John....

http://bmctoday.net/retinatoday/pdfs/1110RT_business_fellows.pdf

My Debut as a Kenyan Wedding Singer

On Christmas Eve Day, I had been asked to attend the wedding of one of the nursery nurses, and to sing for the ceremony. She had heard me singing at church, and wanted me to be a part of the ceremony. I was incredibly honored, and quite a little bit nervous about how this might conflict with other holiday plans, especially leading music for our own Christmas Eve carol service. Kenyan weddings are notoriously flexible regarding time, and some friends of ours went to a wedding that started in the morning, and had to leave at 4pm, when the bride hadn't yet arrived.

In the end, I decided to go, and Rachel and Maggie stayed behind, once we learned it was 3 hours away, and down some pretty bumpy roads, but eight other Kenyan staff came along in the Jolly Green Giant, and we headed out at 7am for a 10:30 ceremony.

Once we took off, I was informed that we had been asked to stop in a town we were passing through to pick up the wedding cake, which was actually five cakes, and it took a while to find boxes for all the cakes. Our total stop there lasted about an hour, and I killed time by finding an awesome sign to add to my collection at the adjacent pharmacy:

Then we were off. I knew they wouldn't start without us, what with me playing the processional and our van providing the wedding cake, but I kept thinking that this would be the first Kenyan wedding ever delayed by the white guy showing up late. Thankfully, the last leg was shorter than we thought, and we arrived just a bit after 10:30. We walked into the church and found this:

(n.b. the two guys in the photo came with me)

An hour later, there were only about two other people there. This was the low point for me, as I pictured the Tenwek congregation showing up for a Christmas Even service while I plodded home on dark, Kenyan streets. Then, suddenly, at about noon, a caravan of people showed up, providing us with a pastor, a wedding party, a bride and groom, and I swear, about half of the congregation. In the back of the red truck below, you can see a dozen or so well-dressed wedding-goers.

And just like that, by 12:15, I was playing the processional on the church's keyboard.

And in they came. I'm told that this wedding was a mixture of traditional and modern wedding practices. You can see the bride walking in, escorted by her family. But behind her, in the doorway, you can see about 50 of her family members, who processed in after the bride and filled the first 4 pews.

A great view of the wedding and the congregation. A little too great, you might say. As in, how did you get this great photo without being crazy conspicuous as the only white guy in the building?

Well, I didn't. One of the other nurses asked to borrow my camera, and I thought that was a good idea, seeing as I couldn't take a picture of myself being a Kenyan wedding singer. I had noticed that the two guys I assume were the official photographer and videographer were super aggressive with getting good shots about two feet from the bride and groom. What I didn't expect was that holding my camera would give our friend the same license, and so he wandered around the wedding party while everyone was seated, taking photos with impunity. I have some great shots.

The exchange of rings, very sensibly way up in the air, so that everyone can see it.

Singing the song she requested for the lighting of the unity candle. Thanks to Ivasha for being my mic stand. Highest congrats to Beatrice and Philemon. Thank you for letting me be a part of this day, and may God bless you greatly as you start your life together.

(I got home with about 40 minutes to spare.)