July and August is a really transitional time in Kijabe – the RVA school year ends for a northern hemispheric summer break. This is a natural time for for families to end their volunteer term in Kenya, or to visit their home countries, so Kijabe has the bustle of a busy airport for a few days as people pack and tidy, farewell and tie up loose ends.
After the hecticness of transition, the remaining families often describe this time of year in Kijabe as sleepy. Long. Wet as the incessant long rains pound on the metal roof. Dull.
For us at the hospital, it has been anything but sleepy or dull.
Ten of our 25 long-term doctors either left permanently or returned to the US this July for a “home assignment” – connecting with supporters, partners, friends and family. Incredibly, we had 17 short term doctors come via World Medical Mission to fill the gaps for various lengths of time, and without them we would have foundered. Pediatricians, orthopedists, radiologists, anesthetists, emergency docs, physicians, obstetricians, pediatric surgeons…. doctors from all around the world who responded to this need way back in January to pay in advance for licenses, work permits and airline tickets because they knew that we’d be so blessed by them coming. I can not thank them enough.
Part of my job is to make sure that those volunteers, amidst confusion, sleeplessness and culture shock, know how valued they are and how grateful we are for their help which truly makes a difference. I wasn’t alone in this – there were some other long term families here throughout this time, helping to welcome, orient, troubleshoot. Visitors need oversight, encouragement. They need clarification of issues that can be perplexing in a new system at best, and crushing at worst. Inefficiencies, malfunctions and deaths are things that those of us here over the long term learn to adjust to, somewhat, and make a tentative peace with as we work towards improving the system. But for a doctor here for a couple of weeks, it can be incredibly challenging.
And as often happens here, projects that we have been planning for over 2 years all seemed to finally happen at once during these last 6 weeks. Exciting and encouraging to see the fruit of a lot of planning and a lot of generosity from partners around the world.
- Our new HIV/TB clinics, under construction for the last year, were finally completed – a purpose-built area with less chance of cross-infection. This meant moving them out of the hospital without service disruption. Renovations to the old space to maximise the efficiency and use for the physio, lab and admissions departments moving in. Trying, with variable success, to ensure that as many of those impacted were happy with the new arrangement as possible.
- Our emergency department renovations, whose commencement has been funded for 2 years but delayed for multiple reasons, started. With the two long term emergency doctors away, this meant finalising the plans they had made, ensuring the engingeering and construction teams understood the design and watching its implementation, while ensuring that the current emergency department stays functional in the wind and rain.
- Negotiating the order of $300,000 worth of radiology equipment – a big deal for us as a hospital, as this grant from Jasmine allows us to convert to a digital radiology system for the first time. We have been planning this for many months, but the companies and finance department were finally ready to liaise, and I need to ensure that all pieces of hardware and softward are compatible and that we can maintain and service them when inevitable issues arise.
- Negotiating with companies to try to rent our hospital space to their business to start CT scan services, so that our critical trauma, neurosurgical and surgical services can happen. Our ancient donated CT scanner died over a year ago, and after months of expensive troubelshooting we realised it wasn’t cost effective to continue. Relying on Nairobi CT increases both the danger in transporting our patients to Nairobi on one of the world’s top 10 dangerous highways, as well as the expense of an ambulance for people who don’t have money lying around. Moving this forward is essential for us to provide emergency and surgical services.
- Raising $32,000 by the end of August to buy urgently needed operating theatre equipment while the head of our resource mobilisation team was away in the US. The equipment company was offering to bring it over with no shipping or customs charges as it would be demonstration equipment at a trade show in Nairobi in September, so there was a tight timeline to ensure it was ours. And miraculously, through the generosity of many of you, we reached our target and put in the order – only to find out that the trade show has been cancelled due airlines cancelling flights due to Ebola and many East African delegates pulling out. We are ordering the equipment anyway – the company has offered to ship it for free – and we will use some of the money to pay for customs and duty instead of one of the pieces of equipment.
- Representing the hospital at the International Congress on Tropical Paediatrics in Nairobi. The pleasure of liaising with pediatricians from all over the country and resource-poor world to help them realise that when mission and government hospitals work together to improve care, we all win.
In the middle of exciting projects, Kenya continued to be Kenya. A national healthcare strike in protest of government interns’ salaries not being paid in over five months. Ridiculous numbers of patients coming to our hospital on top of our usual 105% occupancy rate, with admitted patients staying in the emergency department for multiple days due to full wards. Losing our most experienced radiographer and other staff to higher paying jobs in Nairobi and engaging in pay disputes with other staff. Losing all network and internet access at the hospital for 2 weeks, meaning lost emails and miscommunication – delays, confusion, paperwork nightmares.
And Ebola on the periphery – a potential threat of unlikely but dire significance, spreading this week to southern Nigeria and Senegal.
This on top of the day to day patient care, medicolegal, too-little-for-too-many-people issues that make up the day to day of my job when everyone is here. Yesterday, as the long-term doctors started to trickle back into Kijabe, I finally allowed myself to face that I felt a little overwhelmed – a little like coming through a rough night and allowing myself to acknowledge the passing darkness while watching the sun rise over the horizon.
And the sun is definitely rising. This month, in addition to the long-termers returning from overseas, three long-term doctors have just come to join us – a family doctor, an intensive care doctor, an ENT surgeon. We have just hired three more Kenyan doctors who are also starting this month – a pediatrician, a pediatric surgeon, a medical officer on the adult medical service. Another pediatrician mid-September, as well as speech pathologist.
Even though I am tired, it is a good kind of tired. I have known during this time that help is coming, that it is not up to me to keep this great ship afloat. This hospital turns 100 next May, and I truly believe it is because this is a place in which God is intimately involved.
This is a place where the poor are treated with compassion, where the sick are given the very best in physical and spiritual care.
Where God reaches in through his people and shows his faithfulness, sovereignty and love, with miraculous provision of volunteers, equipment, money for bills and patients.
It has happened for the last 100 years, it has certainly happened in the last 6 weeks, and I know it will continue long after our time here.