Go Big Blue!

We're back in the Bluegrass! Our trip was all we expected, but it is awesome to be back with friends and family (as well as drive a car, access reliable internet, and eat a hamburger!)

Thanks for reading, I hope the blog has encouraged you! We'll probably use the blog periodically-- post baby pictures on here one day or something.

--Hamm

Surgery Call

Since September 1^st, I have been rotating through General Surgery here at Tenwek. 6 am rounds have never been my idea of fun, but given the option of this or all-day rounds with Internal Medicine—I, like most future Emergency Medicine doctors, would prefer the quick, efficient rounds of the Surgeon. Plus, the Theatre has offered plenty of opportunity for procedures and I have had opportunity to evaluate acute abdomen cases.

My first two call-nights on surgery started out with a bang—literally. Mutatoos are the local public transport buses, and both casualties were the result of mutatoo road traffic accidents (RTA). Over the weekend, I experienced the mutatoo first hand—as I rode in one on our travel back from Uganda. Our bus was packed—with over fifteen Kenyans packed into a twelve person ride. On stops, there always seemed to be one or two guys hanging out the side door who had to jump in as the bus drives away. Fortunately, we arrived safely in Bomet on our bus ride. The individuals below sadly did not reach their destination.

The first mass casualty was on Thursday night last week. We got a call at 8PM that there had been an RTA in Naruk, and that they were coming to Tenwek. A bus of six people had hit a donkey and crashed. The injuries were catastrophic and the morbidity high. They arrived at 10PM. At first I focused on A., a lady who had severe wounds all over her right arm, cold extremities, no pulse she would require amputation that night. The saddest cases, however, were the children. One 5 year old boy (I.) presented having had a traumatic amputation in the field of his whole right arm. When we explored I. arm in Theatre-- glass, dirt, and blood gushed from where his arm should have been. Next a 4 year old girl (L.) lost the right side of her face, sustained a skull fracture, and right arm avulsion, all the while she was crying for daddy. Three more—a baby with open tib/fib fracture and avulsion of ankles bilaterally and two ladies—all required surgery that night. The team was up all night dealing with the tragedy. Dr. Carol Spears, a missionary General Surgeon who trained at University of Kentucky, led the team through the night. Tragedies like this are hard to put in to words; I found my heart broken for I., who will survive but must live through live without an arm.

The second mass casualty occurred two days later when twenty-three patients arrived to the hospital without warning from a nearby RTA. One patient was dead on arrival, another died shortly after our resuscitation efforts were started. Another patient I evaluated sustained a C-spine fracture, and before she had transferred to the regional neurosurgeon, she had lost all sensation and strength below her chest. Multiple dislocations and fractures were noted among the victims.

When tragedies like these occur, it may seem like God is not present. We may cry to Him as the Psalmist does in Psalm 10:1—“Why, O Lord, do you stand afar off? Why do you hide yourself in times of trouble?” or as Habakkuk pleads when Judah is oppressed—Hab. 1:2—“O Lord, how long shall I cry for help, and you will not hear me?” Sometimes there are no easy answers. We ultimately live in a sinful, fallen world, and the beauty of Christianity is the hope found in the redemptive work of Christ. God doesn’t promise all the answers now, but He does allow enough of Himself to be known that we can trust in Him through tragedy, as Habakkuk does in Hab 2:4—“…the righteous shall live by his faith.” Also God can use a tragedy to speak to us, as C.S. Lewis rightly notes, “God whispers to us in our pleasures, speaks to us in our conscience, but shouts in our pains: It is His megaphone to rouse a deaf world." Tragedy opens our eyes up to real life; we are forced to focus on things we would rather not think about in the routine day—life, death, our past, our future. If the Church is present during the tragedy, we can be Christ to the hurting. Our presence in the midst of tragedy is often more meaningful than any grand comments we can come up with.

Voiceless

Carly here.

It’s been a long time since either Joel or I posted.  Baby Moses ended up making a more permanent appearance at the Hamm residence (although it was less permanent than we would have liked).  We kept him off and on (more on than off towards the end) for about three weeks.  It was my first experience in being a mom, and I absolutely loved it.  I also fell completely in love with Moses and it was pretty heartbreaking to have to send him to the orphanage.  Praise the Lord, he was sent to an orphanage where he is one of two babies, and will receive tons of love and attention.  I heard from the friend who took him that the staff at the orphanage were so excited to be getting him that they started taking pictures of him before he was even out of the car… this comforts my heart.  Short of moving to Kenya for the better part of four years (which would be extremely difficult due to job commitments and med school schedules), there is no way for us to adopt him.  I pray and hope that God will provide a loving home for Moses with a mom and dad who are walking the Lord.  This sweet baby may have been abandoned, but he is so incredibly loved and wanted.

Joel and I are taking full advantage of our last weekend here- he went white water rafting in the Nile, and I went to an orphanage.  Very telling of our personalities, no? :).  Although we both would have liked to accompany the other on their trip, we both chose what we knew we would not regret.  Joel got to ride 8 hours (one way) on a bus to and from Uganda and I got to be spit up and peed on to my heart’s content… at least that may have been what each of us were thinking about the other’s trip.  In all seriousness, I am so glad that Joel got to have his adventure and that I got to have mine.  I have always wanted to serve in an orphanage, and I am so thankful for this opportunity.  It’s been slightly harder on me emotionally than I expected, especially now that I am personally connected to an orphan, but I’m thankful for the experience nonetheless.  The orphanage where I’m visiting is a good orphanage… but it’s still an orphanage.  It’s not a home, it’s not parents, and there’s just no way that these kids can get the one-on-one love and attention that they need and crave.  The children need moms and dads, they need forever families, they need homes, and they are absolutely powerless to do anything about it.  Have I mentioned that I'm becoming more and more passionate about adoption?

I have always wanted to adopt, from the time that I was very young, and this trip has only magnified that desire.  It’s given both me and Joel new eyes in this area, especially after caring for and emotionally connecting with an orphan.  As much as I would like to adopt rightNOWthankyouverymuch (today would be day three of the past two and a half weeks that I have gone without crying about Moses), I know that God’s timing is perfect, and we trust in that.

Joel and I can’t believe that our time in Kenya is coming to its end.  We head out Friday morning and will arrive home around midnight Friday night (with the time difference it’s roughly 24 hours of traveling).  We’ll fly from Nairobi to Amsterdam to Detroit/Atlanta (can't remember which one it is at the moment, and my email isn't opening for me to check) to Louisville, then drive home to Lexington.  We have exactly one hour for our layover in Amsterdam, so we’ll be praying that our flight arrives at the scheduled time to avoid any sprinting through the airport :).

We are so excited to see our families and friends when we get home… we’ve missed you all!  We’re also looking forward to American food again.  I’ve started relying heavily on Nutella sandwiches for meals.  This trip has been exactly the break from cooking that I needed.  Nothing incentivizes you to cook for yourself like eating the same five foods for two months.

The Lord has taught us both so much through this trip, and we can’t wait to share it with you!  We have tons of pictures (lots of which are of Moses- I now understand why people post 400 pictures of their newborns to Facebook… doesn’t everyone want to see how cute they are??) and so many memories.  God is so good, all the time.

Our Relaxing Safari Weekend

This past weekend we were relaxing on a much needed break at Masai Mara, in Southwest Kenya. Some of our pictures are below! --Joel and Carly


It's nice to take a break sometimes:



The Great Migration of the Wildebeasts, as they cross the Mara River near Tanzania:



Hamm's back in 2.5 wks!

Safety First

The story of the Good Samaritan is told in Luke 10:25-37. The Samaritan was not the first to come upon the wounded man that day-- the first two men "passed by on the other side." Could the the first two men just been afraid? Abandoned man on the highway, stripped, beaten, half-dead-- sounds very dangerous and ... unsafe.
Safety first! It is a mantra of modern suburban middle-class American culture. We avoid the uncomfortable, choosing instead the comfort of our safe schools, suburbs, and streets. We stay away from the inner cities; it's too dangerous! We ignore when millions are starving in Somalia; let's pray for the missionaries (when we remember to pray), especially pray for their safety and safe return to modern American comfort.
Christ didn't play it safe. It wasn't safe to challenge Pharisees, to be with publicans and sinners, to have no place to lay his head even. He wants obedience even in the absence of safety. See Luke 9. Francis Chan, in Crazy Love, proposes, "It is not scientific doubt, not atheism, not pantheism, not agnosticism, that in our day and in this land is likely to quench the light of the Gospel. It is a proud, sensuous, selfish, luxurious, church-going, hollow-hearted prosperity." Ouch!
Extreme poverty has a smell. I smell it now each day in Kenya. One of my earliest encounters with the smell of poverty was in the backseat of our 1994 Pontiac. I'll never forget riding with the hitch-hikers my dad picked up when we were kids. Not only the smell, but the tattered clothes and "help me! i'm homeless!" signs have been embedded in my head since I was a youngster. Associated with this image, are the many spiritual conversations that took place in that car.
Picking up hitch-hikers is probably considered an "unsafe" practice. Most the time we keep driving-- are we lacking in compassion or is this too unsafe for us (or both)? Certainly I think this is situational (as I would never want my wife to pick up a man for example), but I think as Christians we should be actively involved in loving our neighbor somewhere. It will look different to different people. Maybe there is someone near you that you never thought to help, but now can see the need and are not afraid. Again, from Crazy Love, "If I were a non-Christian, would my life look any different than it does now?"
The beauty of the Good Samaritan is as an individual he decided to love his neighbor. He didn't second guess the traveler's choice of road or time of day that he had traveled. He could have easily said, "You shouldn't have traveled here." or "You should have had defense." How often is this our excuse for not helping-- the "they brought this on themselves" philosophy. I do believe it is as important how you help someone as in the fact that you do help them. But, ultimately, we should act. The Good Samaritan didn't question; he acted in obedience even in a dangerous and unsafe world.

Right to Bear Arms

This week, a fifty year old man walked into Casualty (British for Emergency Department) complaining of being shot in the neck by an arrow. He claims he was gardening when a young boy shot him on purpose unprovoked. The arrow went posterior to anterior into the base of his neck. Surprisingly, he was fairly stable, alert and oriented, and talking. The only exam finding was left-sided decreased strength on the upper and lower extremity, but otherwise he was intact neurovascularly. For immediate management, he was hypotensive when he came in and was resuscitated with one liter of intravenous fluids.
We couldn’t assess how deep the arrow had gone until we got the lateral and anterior-posterior cervical spine X-ray films shown below. Obviously, the arrow went much deeper than we had hoped and our patient was sent to Theatre (British for Operating Room) for Exploration and Foreign Body Removal. Dr. Bacon, a trained Orthopedic Surgeon from North Carolina did the surgery since we do not have a trained Neurosurgeon at Tenwek Hospital. At Tenwek, staff members are often asked to work outside of their area of expertise, as in this case. He was able to completely remove the arrow, noting that it had torn through part of the Dura Mater that encases the spinal cord। He said he was unable to determine if the spinal cord had been damaged due to extensive bleeding.


Reports are that the patient is recovering well. It may take a while until we know the full extent of the damage to neurological function. As far as his social situation is concerned, we still have questions about the incident. Stealing in Kenya is a very serious offense. One report we heard was that a woman’s arm was chopped off because she was stealing tea leaves from a farm. Whether our patient’s “gardening” was actually thievery remains to be determined. People are reluctant to go to the police because they know the perpetrator often gets away with the crime via bribery.
Similar incidents are actually not uncommon here in Kenya. In fact, injuries from arrows or spears are more common than gun shot wounds at Tenwek Hospital. Violence occurs whether guns are widely available or not. Guns are outlawed unless authorized by the military. In Northern Kenya, however, arms are quite available, being shipped in illegally from Somalia.
Lethality is an argument used against guns. In the case above, had our patient been shot with a gun, we would have died. However, the purpose of a well-regulated militia, as George Mason puts it is to "prevent enslavement." This requires lethal weapons owned by the citizenry.
The Kenyan staff in Casualty was surprised that I owned two guns and that owning a gun did not require a license in many States in the United States. I taught them some American history about our 2nd Amendment and “Right to Bear Arms.” From discussions with Kenyans, I would argue that Kenya needs reforms in many areas politically as corruption is very prevalent here. A trustworthy military and police force would be a good place to start. Violence broke out in 2007 over election results, but the elections next year are not expected to cause the turmoil they did this year. It is still something we can keep in our prayers.

A few quotes below make clear the purpose of the 2nd amendment:

"I ask, Sir, what is the militia? It is the whole people. To disarm the people is the best and most effectual way to enslave them." --George Mason, Co-author of the Second Amendment during Virginia's Convention to Ratify the Constitution, 1788

"Firearms stand next in importance to the constitution itself. They are the American people's liberty teeth and keystone under independence … from the hour the Pilgrims landed to the present day, events, occurrences and tendencies prove that to ensure peace security and happiness, the rifle and pistol are equally indispensable … the very atmosphere of firearms anywhere restrains evil interference — they deserve a place of honor with all that's good." --George Washington, First President of the United States

"To preserve liberty, it is essential that the whole body of the people always possess arms and be taught alike, especially when young, how to use them."
Richard Henry Lee, American Statesman, 1788

"Those who hammer their guns into plowshares will plow for those who do not."
Thomas Jefferson, Third President of the United States

-- Quotes from taken from: http://cap-n-ball.com/fathers.htm.

Baby Moses

Carly here.

Joel and I have an unexpected but very welcome houseguest tonight. Moses, age 17 days, has joined the household until tomorrow morning.

Three children were abandoned at the hospital last weekend. One sibling pair, a boy (2 weeks) and girl (20 months) were left along with Moses. I was told that the abandonment wasn’t extremely uncommon- several of the missionary families have adopted children from Kenya, so women will sometimes leave their children in hopes of giving them (what they perceive to be) a better life- but there aren’t normally that many left at the same time. One missionary family took the brother and sister, and another took Moses. They are caring for them until arrangements can be made to take them to the baby center. (The baby center is the orphanage for children under 3 years that’s located in Nakuru, about an hour from Tenwek.) The family that took Moses had to go to Nairobi tonight and the other family has their hands full with the sibling duo in addition to their 7 children, so they asked me to take him!

For those of you who know me well, watching a newborn for 24 hours is pretty much the equivalent of Joel’s opportunity to watch Kentucky play in the Final Four. Heaven. Pure bliss. To say that I’m enjoying myself is quite the understatement :). Moses snuggles a ton, eats, sleeps, poops, and occasionally projectile vomits. He hardly ever cries, even when he’s hungry, and he makes all of those adorable little newborn noises. Basically, I’m loving life right now :).

While his story is sad, I’m thankful for the opportunity to love on him, even if it is only for a day. He was left in a place where his mother knew he would be well taken care of by people who love Jesus. He was not left to starve or killed before he was born. He will go to live in an orphanage, but the missionaries tell me that babies are well-loved and well-taken care of there. I wonder what his life will look like and I am so thankful to have the opportunity to pray that he will grow up to be a man of God.

And for those of you who are wondering… You have to be a resident of Kenya to adopt from here.

The Atkins Diet

Carly here.

Joel and I are both going to have to lose some weight when we get back. While I wouldn’t trade not having to cook, I’m realized that being the main cook in the house does give you a certain control with the menu. I love vegetables. Lots of broccoli, green beans, red peppers, sweet potatoes, and even salad sometimes. I’m not a huge fan of meat, but Joel is, so I do typically incorporate it into the menu. So far, our experience with food in Kenya has broadened our horizons in this area. Carbs are our new staple.

Our meals typically include 2-3 of the following:

• spaghetti
• spaghetti casserole
• noodles with some-kind-of-sauce-that-looks-sort-of-looks-like-cheese-but-we’re-pretty-sure-it’s-not-cheese
• noodles in a casserole with peas and onions
• noodles in soup
• rice
• mashed potatoes
• cheesy potatoes (although we’re not 100% sure it is cheese)

Dessert is either banana bread or this bread dish that looks like cornbread but tastes like cake (which is an improvement, in my opinion… I’ll take cake over cornbread any day.). There is chicken or beef a few times a week, we’ll have tomatoes or green beans occasionally, and there’s almost always fresh pineapple; however, meat and fruit/veggies are the definitely the exception, not the rule.

The food that we’re eating (or the food that we’re not eating) is often the topic of conversation at mealtimes, and I realize how fortunate we are to have that kind of control over our diets. As a middle-class American citizen, I have the opportunity to choose a balanced diet, the money to buy fruits and veggies, and the education to know that I should. Carbs are cheap and fill bellies even if they aren’t the best source of nutrition. I am so thankful (and spoiled) to have the opportunity to walk through a grocery store where I have the ability to say yes and no to the foods that I do and do not want. “Picky eaters” do not exist here. People are simply thankful for the food they have.

It is only by God’s grace that I was born in a country where I have these opportunities. We have the luxury to control what we eat, and most people in the world do not. I am so thankful. Of course, I’m also looking forward to a very balanced diet once we’re stateside again :). Bring on the salad. In the meantime, I’ll enjoy being stretched both physically and spiritually by Kenyan cuisine.

Elephant boy and the Thief on the Cross

Two case presentations for a Sunday afternoon:

Elephant Boy

Last week, a 16 year old Masaii boy was assaulted by an elephant. One full day after the event, he was found in the Kenya savannas and was alive (a miracle in itself) His injuries include a gaping chest wound via elephant tusk, through which the his lung was visible (I have pictures if anyone is interested!), tusk laceration to his thigh (barely missing his femoral artery) and laceration to his neck (also barely missing a vital structure-- the carotid sheath). Over night he did well, until the morning when his heart stopped beating and he had to be resuscitated. The kid is one of the most resilient patients I have ever seen, as he is still fighting the ICU. In fact, we predict he will recover fully at this point.

The case presentation from Morning Report: 16 yo M assaulted by elephant...

The Masaii people often are brought to Tenwek Hospital because it is the closest hospital to the savannas where they live. They are one of the larger tribes in Kenya, but unlike most of the other tribes, many of them have chosen to continue in their traditional way of living, culture and dress. Many have also continued in their traditional occupation-- as cattle herders. One would think the most feared creature they face would be one of the big cats-- the lion, leopard, or cheetah. In reality the elephants are the most dangerous, as the young warrior above found out.

One of the nurses I work with in Casualty, Robert, grew up around elephants near Mt Elgon in Western Kenya. His family has learned several secrets to escape.

Ways to escape an elephant:

1. They are scared of fire, so get a torch! They have long memories and remember when they were hunted for tusks.

2. Run downhill. The elephant's huge ears will flap in front of his eyes so they can't see

3. Most importantly, RUN! Elephants only run as fast as humans walk so we can outrun them (though I need to ask Robert if his standard for running is based on the average human speed or a Kenyan runner?). Also, change directions when you run, b/c elephant have difficulty with this.

The Thief on the Cross

The second case presented to Casualty a few weeks ago. There was 50 year old man H. with visible epigastric mass. Work-up revealed a hepatocellular carcinoma with metasasis to the adrenal glands. In the US this is a poor prognosis, here it is a death sentence. H. was talking about how he would seek help from the local witch doctors. My friend Moses and I shared how only God could comfort him through this trial and we challenged him to consider where he would be when he died, which in all likelihood would not be a long time.

We encouraged H. with some passages (Ps 23, Is 43:1, Phil 4 among them) and shared our Faith. H. came to faith in Christ that day, maybe days to weeks before his time would come. Consider Luke 23:39-43, as it is never too late:

³⁹ One of the criminals who hung there hurled insults at him: “Aren’t you the Messiah? Save yourself and us!”

⁴⁰ But the other criminal rebuked him. “Don’t you fear God,” he said, “since you are under the same sentence?

⁴¹ We are punished justly, for we are getting what our deeds deserve. But this man has done nothing wrong.”

⁴² Then he said, “Jesus, remember me when you come into your kingdom.”

⁴³ Jesus answered him, “Truly I tell you, today you will be with me in paradise.”

We Treat, Jesus Heals

Tenwek Hospital

We Treat, Jesus Heals

Jambo! Today Tenwek Hospital is a shining light on a hill to people of Southwest Kenya. Tenwek is literally located on a hill overlooking the Rift Valley, with magnificent views in all directions. The hospital provides primary health care for 600,000 Kenyans and is the major referral center for most of Western Kenya. Providing for physical needs is augmented by their deep desire to make Christ known and to provide for the spiritual needs as well. It’s been a beautiful thing to watch over my first few weeks here.

On this hill, many lives are saved—physically and spiritually—everyday. This wasn’t always the case. Before missionaries purchased the land in the 1930’s, it had been used as a traditional female circumcision site. Two young girls had bled to death here and the local Kipsigi tribe considered the ground cursed ever since. The Kipsigi’s practically gave the land to the missionaries at 5 shillings/year for rent. The dangerous practice of female circumcision has subsequently been reduced dramatically as many, many Kipsigi’s have become followers of Christ through the years.

It’s estimated that over 80% of the Bomet district of Kenya are Christian. The spiritual climate is very much alive, as the church services into late afternoon every Sunday bear witness. Tenwek itself is also becoming a hotbed for sending missionaries. Franklin Graham, president of World Medical Mission, works closely with Tenwek by providing visiting medical doctors. He wrote in Miracle at Tenwek, that Tenwek “has one of the most effective evangelical outreaches of any hospital I have ever visited.” From my first two weeks here, I can see how he could make this statement. Since we’ve been here, there have been groups returning or going to the following places for medical and/or evangelical outreach—The Mercy Ship stationed in Sierra Leon, South Sudan for Ophthalmology, South Sudan to start a clinic, Eritrea for evangelism, Lake Victoria Islands for evangelism, and many trips to Kenya orphanages. Most of the trips above have been initiated by Kenyans and it is Kenyans who are going. Maybe they will be coming to the United States to do missions before long.

It is essential to direct the glory to God. We treat, Jesus heals is a mission statement that is lived out daily by those walking through the hospital halls. We pray for patients before surgery and we tell them the Good News when led in Casualty. Tenwek started out as a small clinic run by one faithful nurse. God often uses the small, seemingly insignificant to expand the Kingdom, the mustard seeds (see Matt. 13:31-32). This begs the question, do you have a mustard seed to be used in the Kingdom of God. Even if you are climbing the Pilgram’s “hill of difficulty,” remember what once was cursed, now is blessed and God can use the faith of a mustard seed for His glory.

Confessions of a First Time Blogger

I'll be honest... doing a blog is not something that comes naturally to me. I'm hesitant to do one for a few reasons.

1. I don't want our trip to Kenya to be all about me. Some of the reasons we are here in Kenya--

--To serve just as Christ came to serve (Mk 10:43-44)

--To learn medicine in a place of few resources

--To care for the poor, and practice how a Christian should respond to poverty in the world, the average Kipsigi earns 200 Kenya Shillings/day (roughly $2/day), Matt 9:35-38

--To evangelize here in Kenya

--To learn under Christian doctors, how to care compassionately for the sick and when and how to address the spiritual state of my patients

2. I don't want anyone to get the impression it is medical/Christian tourism. We will get a few weekends away and I will make sure to post pictures, but our main tasks here are outlined above.

3. Lastly, it is a lot of work

That being said, there are a few good reasons to do a blog, and thus, we are deciding to start one.

1. To encourage you to get out of your comfort zone! Follow the dream God has put in your heart and see it through. Look beyond your needs or even your family's needs. Phil 2:4

2. To promote the Great Commission, to see the Church fulfill the the task Matt 28:16-20

3. To record some thoughts in a public domain, to start dialogue about what God is showing Carly and me, and to be accountable to others in the lessons we are shown.

4. To dialogue with non-Christians about the Faith, your life and how we all need God