More and more FIRSTS!

(What ELSE to call my first blog, eh? Hopefully this will appease Kevin… ☺)

Let me begin by saying “Happy Kenyan Independence Day” to all! (There doesn’t seem to be a lot going on around Kapsowar in celebration other than a few extra decorations on storefronts, but it is technically a national holiday.)

It’s taken me too long to get around to writing this, in part because there is so much to say that I’m not sure where to begin, and in part because I’m hesitant, knowing that my understanding of what is going on around me is still very limited. However, here goes!

This week, as every week here so far, has been a week of firsts.

Number 1: On Monday morning, for the first time I left the house at 7:10am when my attending physician had expressly told me rounds were starting at 7am. At home this would NOT have gone over well; however, as Kevin mentioned, I was working with Kimosop – on Kenyan time. Kimosop is a Kenyan-trained general practitioner who desires to complete a residency in Pediatrics in the future. He usually covers the pediatric ward and very tiny nursery, as well as the OutPatient Department (sort of like ER/clinic), and is the medical director of the hospital. However, for the entire time we’ve been here, Kimosop has also been covering for James, his adult medicine counterpart. Therefore, he’s been managing all of the female and male adult medical wards, any medical issues on the surgical wards, and the HIV clinic. He’s been on call EVERY NIGHT for all medical admissions and taking 1/3 C-section call. Oh, and he’s been doing teaching rounds for everyone once weekly this month. He’s clearly a busy guy, but I was glad I hadn’t arrived until 7:15am on Monday - as he rolled in about 8am! The rest of the week was a great time with him, looking after patients with HIV, Malaria, TB, and one particularly unfortunate child with probable TB meningitis whose prognosis is quite guarded at this point. (We don’t think that he will die, but he will probably have significant, permanent brain damage.)

Number 2: On Wednesday, Christina (the OB/GYN) called me in to Labour and Delivery to see my first female circumcision reversal. (She knows I’m very interested in Obstetrics and has been amazing about calling me for unique things, even if I’m on another rotation.)
It’s impossible to work in a hospital in Kenya without encountering both male and female circumcision, so let me digress for a minute here about each.

Circumcision for males here takes place between the ages of 8 and 16, whenever the boy and/or his family think he is “ready” to become a man. Usually, a traditional “circumciser” from the village is responsible for removing the foreskin as these boys lie flat in an open field in a big group. Of course no anesthetic is used and it’s considered a sign of weakness to cry or make any sound while this is happening. Then, these boys are bandaged up and heal after a few days, occasionally developing an infection or having significant bleeding that brings them to the hospital. The boy Kevin mentioned earlier with the “botched” circumcision was the most serious genital injury I’ve ever seen. I was VERY emotional about this because it’s such a medically unnecessary procedure at home, because his family seemed nonchalant about the whole thing, because there’s no one in Kenya who could fix this (particularly in a timely fashion) and, anyway, this very poor family would have had no hope of affording much in the way of surgery. We sent him to the nearest referral hospital (Eldoret) where at least he could be followed by Urology over the longer term.

Yesterday, a 14 year old female came to the hospital in early septic shock one week after a female circumcision (which is extremely common here, although it is illegal in Kenya). She’s stabilized in hospital, thankfully.

I think I’ve been EXTRA infuriated by the practice of female circumcision (which most of the medical world and human rights activists call Female Genital Multilation because this is actually a more fitting description) while reading Hirsi Ali’s book. (She’s an originally-Somali woman who is a women’s rights activist, particularly in Europe’s Muslim communities and, of course, she vehemently opposes the practice.) This is certainly mature subject matter for grade eight students (much less Jonathan’s grade sixes), but these students are actually the same age as many of the girls having this done in East Africa – so perhaps it’s a fitting discussion to have here. In any case, this procedure, of which there are endless variations, has the primary goal of making intercourse unpleasurable for women, as well as sentencing them to a life of more difficult urination and menses. Imagine, then, what a VICTORY it is for Christina (and myself) when a woman agrees to have this reversed. Our patient on Wednesday, of course, had to obtain her husband’s consent before having the procedure. Then, right before she delivered her first child (while on the “table” in labour and delivery) we incised her scar so that she will likely be able to have her next babies without episiotomy and will no longer have to pass urine and blood from a space the size of a small grape (this was the most severe circumcision I’ve seen since I got here).

Number 3: At Wednesday morning’s hospital chapel, I finally got around to singing for our friends here - impromptu-Kenyan style. During services, there is always an opportunity at the beginning for anyone to bring “presentations” forward. These can be songs, skits, praise reports, etc. I’ve been thinking about singing for a while now, but there were always some other eager volunteers, so I’ve been waiting. In a concrete building (that was nicely live, actually), I sang “Because of Who You Are,” which is an old song about admiring the character of God. That has gotten me a gig in church tomorrow, both leading a song (with KEVIN on guitar!) for the English service and then singing a solo (I think it’ll be a spiritual called “Honour, Honour”) at the Kiswahili service. Kevin and I have never played music publicly TOGETHER before….so this is a major first. ☺

Our next blog will have the details of today’s special first: our first North-American Christmas party in Kenya! We’ve been stringing popcorn and baking cookies, making decorations and putting lights on a little fir tree (actually a BRANCH of a tree) at Christina’s all day. Meanwhile, I also managed to get Mama Brian to braid my hair (an additional first!)…. so more on these things to come!

Love, and so much thankfulness for your prayers.
-Jackie

PS: The picture that I've included is of about 80 junior high kids waving to Kevin's grade 8 class back home from their bible camp...