By Juli McGowan Boit | Published: March 7, 2016
March 3rd & 4th, 2016
Jambo, and Karibu (welcome), the operant word and attitude toward us and others here at Kimbilio Hospice and the entire community of Kipkaren, Kenya.
Thursday started with another beautiful sunrise about 6:45am (all sunrises and sunsets here are at about this time all year) followed by breakfast, prayer, debriefing and devotions. Ali, Robin and Nancy went on 3 home visits, extended by an hour or more when the bridge they intended to cross had been modified for safety reasons and was too narrow for their vehicle, necessitating quite a circuitous and bumpy detour. Mildly bruised elbows did not dampen their special experience with the patients and families, especially with Magdalene who was accompanied by 42 extended family members, all of whom introduced themselves.
At Kimbilio Hospice, the rest of us made rounds and Lisa and Evans, one of the new nurses here, got a great start on organizing and documenting inventory of some recently received pharmaceuticals and medical supplies. Following a day with 4 new admissions, there were none on Thursday, so we had time to sit with the clinical staff discussing some approaches to care. Several of the patients currently at Kimbilio came with large, deep, infected life-threatening wounds, most secondary to pressure ulcers and aggravated by malnutrition and other illnesses and lack of mobility. The staff have had remarkable success caring for patients with these wounds and many which would only have been considered for palliative management have gone on to heal completely – a testament to their consistent, competent, loving, excellent care. Hope is nourished here daily.
Later in the afternoon, David Tarus gave our team a tour of the Kipkaren Children’s Home, an orphanage and ministry of Empowering Lives International (www.empoweringlives.org) with over 120 boys and girls in grades 1-12. The set-up is family oriented, with multiple dormitories housing about 12 children each, and a set of “parents” per a pair of dormitories, 24 children, functioning as a family throughout the year. The concept of family is a core value of the ministry. Following the tour, we joined about 100 of the children in a hall for devotions. We introduced ourselves, then two of the older children gave their personal testimonies, and Marilyn led a lively devotion which had all the children, and our team as well, smiling, laughing and praising Jesus. Robin introduced a craft of making a mirror on a stick with the words around the mirror, “God Made Me Unique.” Once again, we felt very welcomed and included in this vital community of Kipkaren! We returned to the Guest House for dinner, our own debriefing, and grateful for all of this.
Friday, 4 of us went with Juli for rounds at Moi Teaching & Referral Hospital (MTRH), the second largest public hospital in Kenya, and from where a significant number of referrals come to Kimbilio. The hospital is woefully understaffed with nurses and other support staff and beds. Almost all of the ward beds were occupied with 2 patients per bed, and most caring was being done by family when present, or not at all. We rounded with the hospital’s palliative care team which started about 5 years ago as part of the oncology department. Even though it is disturbingly underused, at least it is present. We saw many patients who were in dire need of more palliative care, whether close to end of life or not – for pain management, nutrition, other symptoms, and basic care. This experience was in stark contrast to the care at Kimbilio Hospice in so many ways. We wanted to put several of the patients in our van and take them to Kimbilio. It would be easy, unfortunately, to fill Kimbilio to 2-3 per bed from the hospital without making a dent in the needs of the patients there. I’m sure the staff at MTRH are doing the best they can with their resources, but it is a woeful situation, especially for a major teaching hospital. There is obviously an urgent need for more services like Kimbilio. But for now, it is clear that the weekly rounds that Juli makes on Fridays and Daniel, Kimbilio’s social worker, makes on Tuesdays, are making inroads at the hospital, not only for patients being transferred to Kimbilio, but perhaps for thinking a little differently about patient care by at least some of the hospital staff.
The big event of Friday was a celebration for 4 graduating seniors who had been sponsored by, or otherwise connected with, the Kimbilio community in different ways. All 12th graders in Kenya take a national exam in November, the results of which will determine their eligibility for further educational opportunities. They receive the results 3 months later, which was yesterday (Friday). These 4 had scored well enough to go on to university at different levels, and the Kimbilio community gathered to celebrate their success. Juli baked a cake and our team was invited to join with the gathering community at the hospice with the graduates. Prayers of thanksgiving and testimony from friends and family were offered, and the students each gave their thanks and testimony. Their stories are very special. One of the graduates had been a patient at Kimbilio, terminally ill with severe malnutrition and immunosuppression. But she was nursed back to healing and life and a future, and on this day, she was able to speak to the next step in her future. Another young man had lost his father, later his mother was murdered, his oldest brother committed suicide under the burden of caring for his siblings, and finally his sister with whom he was living left him without notice. He arrived at the Tarus’ doorstep after that, and was taken in with hardly a word spoken, remaining part of their family today. So we shared in these and other stories and the cake and the tears and laughter of joyous celebration, and as a team we feel so grateful to be included intentionally as a part of this special loving community.
Juli says these celebrations are part of the Kenyan culture, but that even so it is easy to miss an opportunity. Because a lot of loss is an inherent part of Kimbilio’s work, she feels it is even more important to recognize these successes and events, as we experienced on our arrival. And on this day we were to lose a young adult, Silas, who had been admitted a few days earlier with terminal head and neck cancer and severe pain. By Friday his pain was well controlled, he was surrounded by family and staff including Linda from our team, and by Friday afternoon was actively dying. He remained comfortable and comforted throughout the night and passed peacefully early Sat morning. He and his family had been known by the Kimbilio staff as he had actually gone through the caregiving training here some time ago.
This day, like probably so many, was a mixture of celebrating life and experiencing/accompanying loss.
Another day we are incredibly grateful we are here. Jim
Another beautiful morning walk to Kimbilio Hospice
A precious guest at Kimbilio
Kipkaren Children's Home
Kipkaren Children's Home - five siblings of Maggie (former guest at Kimbilio Hospice)
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