Friday, August 5, 2016


Janeth and her husband Charles were expecting their fourth child this month. Their three older children were excited about welcoming a new sibling. When Janeth went into labor, they got into their car and headed to the hospital. They had delivered their other children in a hospital, and had never had any problems. Mom was young and healthy-and her labors were getting shorter and even a little easier. She would be away for just 2 days-then they would all be together again with their newest addition. Before she left her home, she hugged each of her children-8, 5, and 3. The 8 year old boy looked a little worried, and hated to see his mama go away. “I’ll be right back,” she smiled and said to him. He tried to hold onto her. But it was time to go.
The hospital ward was busy that night, but the nurse midwife who checked her in was kind and reassuring. And labor went FAST. She felt the urge to push after only an hour of hard pains. The baby delivered and cried a loud and strong cry. She cried in relief too. Dad came by to see his newest son. A good night!

But something was wrong. The afterbirth delivered but then the bleeding did not stop. She was bleeding a lot. The midwife ran to the phone. MInutes later, a young Kenyan intern came. They gave her an IV. They were pressing on her uterus. They gave her a shot, followed by some tablets. The blood kept coming. Next, a muzungu* daktari came in. Another IV. Fluids were running. She felt cold cold cold. Where was her husband? Then she felt better. The bleeding had stopped. She was still cold. They said they were getting blood for her. Her husband was beside her. She lay underneath a blanket, and felt dizzy but so grateful the bleeding was done.

Then another gush. More blood. The muzungu daktari was back, and then—she was being moved to a stretcher. Where was she now? That doctor was calling out orders in English. She could not understand her-which was strange because she too spoke English. Why was she so cold, so dizzy, and why was everything so loud and confusing? She no longer knew where she was. She remembered her son on her arm before she left her home that afternoon. She remembered his face close to hers. His kiss on her cheek as he said goodbye. Her younger children too-her new baby. Who would care for them? She knew she was dying.

In the middle of a cesarean, my intern got paged. There was a hemorrhaging patient back on Maternity.

I told him to run and take care of the patient-and I would finish the surgery. My scrub tech offered to close the skin for me at the end of the case-so I could go and evaluate the patient too. The midwives and the interns had done everything right. She needed a second IV and a foley catheter, but she was stable. She had uterine atony, a condition whereby the uterus does not contract after delivery. I did a quick ultrasound -her uterus had no retained placenta-which often contributes to this condition. She had been given pitocin and misoprostol. We massaged her uterus and it contracted down. Her bleeding stopped. Now we needed blood. My intern ran to the lab to see what he could do. Her husband came and stood with her. We got her a blanket and worked to get her blood. She had no margin left-but her bleeding had stopped and she was stable.

30 minutes later I got a call to come quickly. There was no blood in the lab for her blood type. She had suddenly started to bleed again. Her uterus was soft and would not firm up. She was becoming unconscious. No. Time. Left.

My intern got the husband’s consent for a hysterectomy. I was running with the patient to the theatre. The theatre team was ready, and the anesthetist got a central line and gave her fluids along with anesthesia. I made the incision and-there was no bleeding. She had no blood pressure. She was close to death. I prayed and I kept going. Faster-faster-faster. Hands work faster. She is dying. She is going to die on the table. 

Blood-finally-from the lab. More and more fluid was being given along with the one unit of blood the lab could send. Then-she started to bleed from the surgical sites. She had a blood pressure-but had no ability to clot. She had lost all of her clotting factors from hemorrhage. She had DIC, and I had no way to reverse it. There was no fresh blood available.

We prayed. I packed her pelvis, and closed her skin. We had no ventilators available that night-and so we had to move our anesthesia machine into the recovery room to keep her alive. Her husband sat with me and prayed. 

We gave her more blood. We waited. 

She woke up two days and two surgeries later. She looked around. She was still in a bed, but it was quiet. She looked up-and there was Charles. He was crying.

Post op day number 3. She was sitting up in bed. She was able to breastfeed her little one. She felt well-and even was able to walk around the ward, although she was still sore and tired. The doctors said she could go home in a day or two. She held her baby and thought about her children at home. She had told them, “I’ll be right back.” And now, she would.

Janeth returned home to her family last week. She is well, without any sequelae from her near death experience. Postpartum hemorrhage is the leading cause of death for women in Africa. 

* Muzungu is a common way in some areas of Africa to refer to Caucasians. It means "someone who wanders."

Wednesday, July 6, 2016

Helping Kenyan Orphans Complete Their High School Education

In 2014, a study concluded that there were as many as 2.8 million orphans and vulnerable children living in Kenya.   The largest concentration of these children is in the Rift Valley – over 800,000.  The WGM missionaries serving at Tenwek Hospital work closely with four children’s homes seeking to provide care for these children.   Kenyans working at Tenwek Hospital Community Health and Development along with WGM Missionaries formed the Tenwek Orphan Outreach Ministry with the goal of coming along side the Children’s Homes to assist and provide a better life.

The children living at Paul Kenduiwa, Umoja, Bosto Africa Gospel Church, and Mosop Children’s Homes range in age from toddlers to high school students, and each home relies on support from the church, the community and outside sources to feed and clothe their children.   These Homes and these children struggle each day, but the children are blessed to be in Homes where their basic necessities are provided.  However, each child knows that a day will arrive when they can no longer continue living in the home.  This is a frightening reality, and the Tenwek Community, through the Orphan Ministry, is striving to provide hope to those children who age out of their Homes. 

Education is the means to enable these children, soon to be adults, the opportunity to provide a life in which they can support themselves, their future family and their community.  The Tenwek Orphan Outreach Ministry currently provides full scholarships to over 100 high school age boys and girls.  These students attend day and boarding schools in their local villages.   The boys and girls are required to maintain a grade average of C or higher, and members of the orphan ministry work with the schools to insure that our students receive the resources they need to succeed.   Upon graduation, the children, now adults under Kenyan law, are no longer eligible to live at the Children’s Home; however, with an education each has the ability to seek meaningful employment and even attend University or Technical Schools if they have achieved outstanding grades.

Our students are currently completing their second term of the year, and their final term will begin in September.  Unfortunately, at this time, the ministry does not have the resources to pay the school fees needed to keep these students enrolled for the remainder of the year.   The cost for each student is approximately $100 for the final term.  Therefore, we need to raise $10,000 by July 15th so that these young people may finish their school year.  The Orphan Outreach Ministry is seeking the help of those who are called to assist these students and help provide a future for them.  If you would like to play a role in this ministry please consider making an online donation at or you can find information at for other means of making a donation.  All donations are tax deductible.  If you have any questions regarding this ministry, please feel free to contact Bill Irwin, Director of the Tenwek Orphanage Outreach Ministry, at .  

Thursday, June 16, 2016

Because I am called . . .

Because I am called.
For this time. In this place.

What does it mean to "be called?" As a doctor, I have spent many nights “on call.” I started taking call in the summer of 1991, as a brand new third year medical student. So I guess that means I am working on a quarter of a century of being “on call.” But when I think of “being called,” I always remember the time when I knew beyond a shadow of a doubt that God had called me to be a missionary doctor. I was a kid, and no one took it very seriously-except my mother, who encouraged me every  step of the way upon a very long road.  I know then that this is my calling: to GO, and to TEACH, and to MAKE DISCIPLES, by helping women and by teaching others to do what I do, all in the Name of my Savior Jesus. And it has not been well understood by some. And it has been criticized by others. Some folks simply have chosen to withdraw from our lives altogether. Many more have loved us no matter the distance, no matter the time, and have said goodbye through tears. And this part has been painful. But when you are called, regardless of your personal comfort, when your pager goes off in the middle of the night and someone is dying-YOU GO. Regardless of anything else. You become responsible and you cannot ignore the call. For me, this it what it has felt like-being here in Africa, working in this hospital, far away from everything I have ever known: a pager in the night, a telephone ringing in a dark room, a frantic knocking on my door: "Dakari, come now. She is going to die, the baby’s heart rate is too low, she is bleeding . . .  ." And so I GO. I am called. 

I was called up to the hospital at 2 AM. Zeddy, a 41 year old mother of six, was bleeding to death from complications of a miscarriage. I performed an emergent D&C, and we got her blood, as well as covered her with multiple antibiotics. She survived. She returned to her children.

I was called to her bedside. Caren delivered her baby at an outside facility but had hemorrhaged, and had undergone a cesarean hysterectomy. But she was not doing well-she kept on having pain and was not able to eat. She had evidence of an ongoing infection. We treated her with antibiotics and fluids and she had a waxing and waning course. Some days she was better, then she would worsen. Her wound was looking sicker and sicker. We took her to the operating theatre to explore her pelvis and abdomen. We found, in layman’s terms, a real mess. The doctors who had tried to save her life by doing the hysterectomy had tied off all of the vascular pedicles in her pelvis-so there was a lot a tissue that had been left that had died-even her ovaries. The surgery took about 3 hours. And afterwards, we did not know if she would make it. I watched her everyday thereafter, as she tried to nurse her baby through her own pain and sickness. She missed her four little ones who waited for her back in her village. Three weeks later, I watched her walk out of the hospital with her baby on her back, well, and heading home. 

I was called to tell the family that she could not be saved. Linner had abrupted her placenta at an outside facility and had undergone an emergency cesarean section there. They could not stop her bleeding and had sent her to our hospital. When she arrived she had lost most of her blood volume. She could no longer form clots-her blood was like water. Her body was no longer perfused. There was nothing we could do. Her husband stood by her bed and held her hand and prayed. She was a beloved teacher and mother. She left three children behind.

I was called up to tell a story. I stood on a hillside on a cool afternoon, and read a Bible story to 30 children who are growing up in a children’s home in the Highlands of Kenya. Some have distant relatives who have placed them there, some have no family at all. They do not have mothers to care for them. They go to sleep every night in dormitory rooms filled with old bunk beds. They eat beans and rice or ugali every day, but seldom see fruits or vegetables on a regular basis. They sang a song to us after the story. Their eyes were dark and deep and beautiful and told their own stories, as old as time: the stories of children abandoned or left behind, dreaming of a mama they never knew or perhaps remembered only dimly, sadly, wistfully. 

An African doctor recently asked me about being called-actually, she asked me why we were here. She was astounded that we would come to help women and children in a place so far away from our home. She said so. Then she asked, “Why did you come?” 

Why did we come? Why do we stay? For all of the Zeddys and Carens and Linners. For the young African doctors who come here to train and wrestle with their faith and future- and graduate able to care for women and perform skilled and competent surgery in the remote areas of this continent, and share their hope and faith in Jesus without shame, without compromise. For those parentless children on the hillside who hear the story of Jesus in English, Swahili, and Kipsigis. For those children who wait for their mother and new baby sister or brother to come home-and they do come home. For hope’s sake. For love’s sake. Out of a faith rooted in the Word of God, and in an old rugged cross and empty tomb.  Out of the belief that all women everywhere, created in the image of God, should be protected and cared for with gentleness, respect, skill, and love. In Jesus’ Name. 

Because I am called. 
For this time. In this place.