Caren

Outcomes. In the States, this is how we measure success. Here in Africa, it seems a little more complicated. Patients present late in the course of their disease. Often survival is not an option. And sometimes, when everything looks bleak - life triumphs.

Recently, we took care of Caren, who had severe preeclampsia. She was brought to the hospital at 28 weeks gestation; she was seizing at home off and on for 8 hours. She was still having seizures on presentation. Her blood pressures were markedly elevated and she was unaware of her surroundings. Initial lab tests of her liver and kidney functions and platelet count were very abnormal. Sadly, she was also diagnosed with an intrauterine fetal demise (stillborn). She was given IV medications to stop her seizures and lower her blood pressure. Upon placing a foley catheter into her bladder, frank blood was noted.

Since she was not in labor and needed to be delivered, she underwent a C-section and was then transferred to the ICU. Fortunately, she had minimal bleeding during her C-section. All of her organ systems slowly began to recover, except for her kidneys. She developed renal failure. Her creatinine was 10X the normal value. A family conference was held with her husband and her brother to recommend transfer to Moi University Hospital (3 hours away) where she could get dialysis. The family agreed and went back to their home village to try and gather funds for dialysis. Each dialysis treatment would cost $100 and Caren would need 3-4 treatments per week. This was a large amount for her family to raise.

Caren became more stable and was transferred out of the ICU while we waited for the family to return. One of the many frustrations and difficulties of practicing medicine here is that there are sometimes available treatments, but they are unaffordable. During our wait, Caren became more alert each day. We were pleasantly surprised when her kidney function started to normalize even without dialysis. As we rounded on her this week, we helped her out of bed and she was able to stand (the first time we saw her upright since admission). She was recently discharged home after spending 3 weeks in the hospital. It is very likely she will have an element of chronic renal failure, but she has three children that are blessed to have their mother home.


Caren prior to discharge

Sweet Sixteen!!

There are many ways to follow your alma mater basketball team during the NCAA tournament:
1. Go to the game and watch
2. Watch the game on television as it occurs
3. Wake up the next morning in Africa, and get the results on-line

So it goes, this year I was in the last group. Looking up the results on the internet, we discovered Butler had upset #1 ranked Pittsburgh (71-70) last night to advance to the Sweet Sixteen. It is awesome to know that the Bulldogs are having another great year in the NCAA tournament. Maybe last year was just a warm up, and this year will be when the Dawgs go all the way. I will be standing by my computer and following with all my other Butler fans.

Milk and Cookies

Today was a relaxing Sunday for the Popps. We went to church then played outside for awhile. After lunch, the boys took a nap, so Anna and I decided to bake some chocolate chip cookies to surprise the boys.

As we were measuring and mixing the ingredients, I found it amusing where all the ingredients came from. The eggs come from Joseph, a local man who spends most of his earnings running a nearby orphanage. He sells us a dozen eggs every Tuesday for 120 shillings ($1.50). The flour and sugar we buy at the local dukas here at Tenwek. We buy the butter in Nairobi, which we go into Nairobi about every eight weeks. The most treasured ingredient in the cookie batter is the chocolate chips. Here in Kenya, it is even more treasured because the semisweet chocolate chips only come from the United States. We can't buy any chocolate chips here. Those delicious Nestle Tollhouse chocolate chips have to be hand carried or shipped here by loving family or friends.

So needless to say, chocolate chip cookies are quite the treat! Bryan and Leo woke up from their naps to the sweet smell of freshly baked cookies. We had a nice cold glass of whole milk to go with the warm cookies. Did I mention that the milk comes straight from the cow? We buy our milk twice a week from Charles. It comes unpasteurized and unfortified. Once we get the milk, we boil it for 10 minutes then refrigerate it. Although the milk tastes "fattier", it sure goes well with chocolate chip cookies!

An Honor

This line of work we have chosen is largely unpredictable. It would be more convenient for all parties if babies could be delivered on a schedule of our making. Some would argue - "Where's the fun in that?" We might argue - "We could get a lot more sleep!"
But in the end, it is all about timing and location.

Delivering a baby in Africa comes with many uncertainties, but God was shining on the McLaughlin gang as they added another member to their family. There are many ways things could have gone wrong. The power outages, the lack of continuous fetal monitoring, the uphill walk to the hospital, the lack of privacy at the hospital, the limited resources for neonatal resuscitation . . . shall we go on?

But this was to be a blessed delivery - a successful labor at home (and indeed there was a power outage), a safe walk in the dark to the hospital, a private OR to deliver in, perfect fetal heart tones and an inspiring mother and supportive father. It was truly a special moment, that may well be, the highlight of our time in Africa.

Thank you Rachel, Eric and baby Benjamin Kenneth Kipruto McLaughlin. It was an honor to be part of your special day.