Podcasts about hdu

Hi Everyone, Welcome to Part Two of our discussion with two of the founding members of the Placenta Accreta Spectrum Team here at KEMH Dr Matt Epee-Bekima and Dr David Owen. This team was conceived in 2017 and began operating in 2018 - and has now cared for over 75 women with PAS - including 24 alone this year (2024). In this episode we continue our initial discussion with a more detailed dive into: Surgical management - team members, techniques and approach Techniques for catastophic bleeding - manual aortic compression, vascular clamping, interventional radiology Postpartum issues Controversies (ICU vs HDU, leaving placenta in -situ) Thoughts for the future Thanks Matt & David for sharing the experiences and knowledge learnt by the PAS team over the last 7 years. References https://www.kemh.health.wa.gov.au/~/media/HSPs/NMHS/Hospitals/WNHS/Documents/Clinical-guidelines/Obs-Gyn-Guidelines/Placenta-Accreta.pdf?thn=0

*This episode was recorded 'on the road' as part of the campaign travelling the country to capture the 100 Voices and their stories.Introducing another Voice to the collection - Sarah B sharing her very complex journey with EDS, POTS, MCAS and Breast Cancer. It took Sarah over 15 years to finally get her diagnosis of Ehlers Danlos Syndrome (EDS), which is known as a 'zebra disease'. The term zebra disease refers to the fact doctors in medical school are taught to 'think horses when they hear hooves, not zebras' referencing the fact that common things are common. However this culture and attitude means that for people with rarer conditions, it is taking them far too long to get a diagnosis. EDS is a rare condition which means the tissues don't produce enough collagen, and with over 13 subtypes no two EDS patient are the same. Sarah's journey of having so many rarer conditions all complicated by her underlying genetic predisposition means she's felt gaslit so many times by healthcare professionals. Sarah shares what it's like to live with chronic fatigue, chronic pain and an invisible disability, how masking becomes commonplace. When Sarah was further diagnosed with breast cancer, her treatment became complicated because of her underlying conditions and an episode of Steven Johnson Syndrome saw her in HDU. Sarah also talks about having a newer form of breast reconstruction surgery, the Goldilock mastectomy procedure and had just finished chemotherapy prior to this interview. This is another poignant interview putting the spotlight on taboos, gender inequalities in health and raising awareness of these zebra conditions that people (and medical professionals) need to remember, and how important it is to self advocate.Mortal and Strong is a campaign shining the spotlight on women facing their own mortality - those affected at a young age by a life changing illness or disease. 100 artworks produced by artists across the country along with a powerful photography series ‘Scars of Gold' inspired by kintsugi. 100 Voices sharing messages of hope and strength through our podcast. Charity led campaign supporting other charities. Founded by Dr Liz Murray.#mortalandstrong #mas #iammas #scarsofgold #kintsugi #scars #strength #hope #joy #cancer #secondarycancer #breastcancer #secondarybreastcancer #cancerpodcast #womenshealth #podcast #vulvacancer #lungcancer #bowelcancer #lupus #lupusuk #addisonsdisease #pnd #endometriosis #miscarriage #fibroids #adenomyosis #ms #autoimmunedisease #charitycampaign For more information on support available for these issues discussed in todays episode, including direction to medical information, visit our website. This episode is not intended as specific medical advice, always see your own GP/physician if you have any concerns regarding your own health. Hosted on Acast. See acast.com/privacy for more information.

Hrvatska javnost se svako malo šokira kada netko od izvođača turbo folka napuni sportske dvorane. Kako je to moguće? Hrvatski građani ne vole takvu glazbu? Nenad Kreizer od direktorice Hrvatske diskografske udruge, Maje Vidmar Klarić, saznaje što se doista sluša. Zoran Ćatić u svom redovnom izvještaju iz Sarajeva otkriva koja je tajna veza Milana Mladenovića i glavnog grada BiH. Predstavljamo niz glazbenih noviteta, među njima Milana Kosanovića koji Pleše sam i nešto sasvim novo od z++. Von Nenad Kreizer.

Content warning: We discuss themes of sexual violence in this episode. Firstly apololgies for the radio silence! We had some technical challenges. In this episode Barbara and Jamie discuss the ICU and HDU experience following their surgeries. And how being totally vulnerable can bring up past trauma and how we sometimes are seen as a "cancer patient" and not a a whole human with a complex history. At the end we lighten the mood a bit talking about our go to tv programms whilst going through treatment. Hosted on Acast. See acast.com/privacy for more information.

David: I want to talk a little bit about the hospital, but I'm also curious about your life. So first, just tell me your name and what you do at Kijabe Hospital. Linette: My name is Linette. I'm a medical officer, general doctor at Kijabe. I work in the Internal Medicine department in general wards.  When COVID was here in COVID ward – now it's respiratory center, and in ICU/HDU [Intensive Care Unit/High Dependency Unit] Unit. David: Why did you end up with adults? Linette: [Laughter]Well, I love internal medicine. Anything to do with Internal Medicine, I love it. Whether it's an adult or a baby. I just love it. I feel like it's easier and maybe it's easier because of where I went to school. . . Where I went to school there's a lot of lifestyle diseases, less infectious diseases.  David: When you say lifestyle, what do you mean? Linette: Like hypertension, diabetes, things like that, which is most of internal medicine. And so, it was not like Kenya where you have infectious disease to think about. I feel like that was my foundation when I came for internship, I found this safe place, this comfortable place in internal medicine.  So, it's like, oh, I know that. It's not new to me because I've seen it, and that just made me love it more and more because I felt like I know that and now I can build on that.  I mean, it turns out you don't know anything.  You don't know what you don't know! But it's fun to build on that one. Yeah. So [Internal Medicine] is my favorite one. And why adults? I'm very emotional when it comes to kids, and my pediatric rotation was full of a lot of tears. So, I was like, “No, I need to like, get myself together and be a doctor and look like a human. . .what?  Hard-board or something. . .like nothing is touching me, I'm just okay.” But inside I'm all mushy. So, I feel like kids really remove that from me. And then adults are like, “okay, I can cry about this later, let's deal with it now.” But then kids, cry now!  [Laughter] David: That's great.  You did your you did your internship at Kijabe? Linette: Yes. Yes. David: Tell us about medical school. How in the world did you go to school where you went to school? Linette: I went to school in Russia, the Russian Federation. And it was just it was a miracle of sorts because I had no idea that I could go to school in Russia. In fact, I didn't even want to be a doctor until my last year of high school when I feel I felt the Lord telling me to be a doctor. And I was really against it for like a month. I spent a month arguing with God in my closet. Like, really? You really want me to do that? I've never wanted to do that. I want to be a lawyer. I want to be a scientist. I want to do research. I had all these other plans. David: Anything but medicine. Linette: Yeah, anything but medicine. Everyone wants to be a doctor, but who is going to take out the trash?  Who's going to be the mechanic? Who's going to be the engineer?  I don't want to be a doctor, everyone's going to be a doctor.  It turns out not everyone became a doctor - I became the doctor! God has a sense of humor because the thing that I was fighting so hard not to do turned out to be the thing that I do the easiest.   I went to med school and God make it made it so easy for me to learn and to understand the concepts. . .to understand physiology and how the body works and what drug goes with that. So, I was like, "Hey, man, it's good to follow what you feel God is saying to you." And boy, am I glad I did that.  And then Russia. A friend of mine visited from Russia. I hadn't seen her for years. She was in second year [of medical school]. She told me Russia is good. David: She's Kenyan? Linette: She is Zambian. At that time, I was living in Botswana, that's where I grew up. So, my Zambian friend comes home for holiday and I'm like, "Hey, long time, I haven't seen you. It's been years. Where have you been?" She's like, "I've been in Russia." What are you doing? "I'm doing medicine." And I'm like, okay, that's amazing. I hadn't yet agreed with this whole plan to do medicine in my heart, but I thought, "This is a good like idea to look into Russia as a school option."  I didn't want to stay in Botswana to do my university. So, I asked her questions, and she said that teachers are good, the groups are small when you study so the teachers can follow you very closely. And she said everything except that they don't speak English. [Laughter] And I feel like God literally blinded me to that because I asked every question except, "What language do they speak?" I mean, I know there is Russian, but surely, surely, they speak English, right? They're white! No, they don't. And I found that out when I landed in the country. [Laughter] So, I out of curiosity, I study Russian. I'm so excited.  I'm going to Russia! And then, I land in Russia and it turns out I have survival skills now. I decided, "Well, I'm here, so I have to keep a positive mind about it and learn it as fast as possible so that life can get easier." And that's what I did. So, I learned it and life got really much easier. David: And so that was how long? Five years? Six years? Linette: Yes, six. David: And then. So, you're from Botswana. How did you get to Kenya? Linette: I'm from Kenya. David: Okay. Linette: I was born in Kenya. My parents are Kenyan, my dad is a civil engineer.  When I was five, my dad applied for a job with the government of Botswana, and he got it. He moved to Botswana to look for greener pastures. Then the family followed him. So that's where we all grew up, me and my sisters, except for my youngest sister, who was like a bit young when they moved back to Kenya when I was in third year in Russia. When they moved back now, home became Kenya again. So, when I finished with Russia, I came home to Kenya. So now I had to learn a new language, Swahili [laughter] because, I know how to say hi, but everything else is a blur because I was five when we left. But because I had learned Russian, I was like, "This is nothing impossible. Surely it's just a language." And now I speak it fairly well. I can speak Swahili and no one knows I'm not really Kenyan, but when I speak English, they know because my accent is not Kenyan. David: Yeah, Botswana - that's like the usually the voice actors and people like on TV in America, like that's the pure like, classic African accent.  So, like in Disney movies it's always a Botswana accent. David: And so, what were challenges? Did you have time off in between in between finishing medical school and starting internship? How did you end up at Kijabe? Linette: I had a whole year of nightmare. None of my papers were Kenyan, so I went through such a terrible time. I went to try and verify my degree and they said I had to verify my high school certificate. And then when I went to try and verify that, they said I had to verify the primary school certificate. And most of that was like, we need a physical letter from the governing body in Botswana. I have no family left there. How am I going to get like a real letter from them? But thank God for friends. I asked a couple of friends to help me, and they sacrificed time from their jobs to help me chase down that. It took a whole year from the time that I came back to the time that I started internship. And even after doing the whole verification thing, turns out you don't just do internship, you do pre-internship, which is like an internship, but then it doesn't count. And then you write board exams. So, I did that. And then just as I was about to ballot for a government place in the internship, a cousin of mine asked me, “have you tried Mission Hospitals?”  She had worked for Mission Hospitals and she feels like they're great. Linette: I was like, "I've never thought of that. What's that?"  She told me, "the last interview is next week, Monday, find a way there."  So, I found a way there [laughter], showed up, did the Kijabe interview and I fell in love with Kijabe just from talking to the doctors on the panel. Dr. Arianna was on that panel that day. I was I was so in love with Kijabe. I was like, I'm done. I'm going to Kijabe!  I didn't even interview the other two places. I'm going to Kijabe - I'm not going anywhere else. So, I went home all happy. I'm like, "I'm going to Kijabe, I'm going to Kijabe!" I don't know, that was just I was just so sure. I fell in love with this place before I came here. And since I came, I've not been able to leave since, like you think about going anywhere else and you're like, okay, so what's life going to be like there? Nope, I'll stick to this one. David: What particularly do you like about it?  Linette: I love the compassion with which people approach medicine.  I mean, there is science and there's evidence and there's all that. Anyone can get that anywhere, you know? But there's a human touch and aspect that you can't buy anywhere. You can't buy that. And then a lot of these doctors are Christians. . .and missionaries, they're here not because their homes are not comfortable, or their countries are not good.  I mean, I've been a foreigner. I know it's home that's always best. It's very uncomfortable to be a foreigner sometimes, but the [missionaries] are here because they feel like their call to humanity is higher or greater than their comfort.  I feel like because God told me to be a doctor, it's great to be around people who take medicine like a calling. There's also the evidence-based approach, you know.  It's not quack medicine, it's not abracadabra. It's, "Okay, I read this paper and it says, 'This approach is better for this disease.'" And that's what we do. We do that because the best idea wins.  The best idea is tested. It's tried. It's been through trials and studies and that idea wins. So, every protocol changes according to the idea, the evidence that has come up. The system of correction for mistakes, audit, is taken very seriously. Audit helps us change protocols, change our approach. It's one thing to say, "we will do" and then it's another thing to actually do. It's a culture that goes on from the highest doctor to the lowest staffer.  Even a patient assistant adheres to the protocol. That's a cultural thing that you can't buy. If people's mentality is "I'm here to get my money and go," then they would never do that. But the fact that we say something in a meeting, and it actually happens - that's wonderful.  David: Wow. That's awesome. I love it. So, internal medicine. . .What's good about it and what's hard about it? What do you love and what's the most challenging? Linette: Let me start with what's hard. What's hard is at least once or twice a week, there is this one patient, who, I'm like, "I have no idea what's going on here." And then, once in a while, there's this patient who everyone is like, "I have no idea what's going on."  Really? That's mind boggling. But then that's also why it's great because every time you think you know, you don't know.  You don't know what you don't know. But then, every time, you find out there's more to learn. I love that opportunity to grow.   I like places where I can be put under pressure to grow.  There's no bigger force or pressure than the feeling of "I don't know." Then there's this culture of mentorship that Kijabe has. I have awesome seniors who don't make me feel dumb for not knowing. So, when I don't know, there's always someone a phone call away who might know. And if they don't know, they're so honest. I love that they're so honest when they don't know. And they're always willing to offer advice on, "have you tried this, and have you tried that and how do you check this and that?" Then they teach you how they think so that you can be a proper mentee. I love that. That's what I love about internal medicine in Kijabe. I don't know about internal medicine in any other place, but here, it's like you're free to be dumb if you're dumb and we will help you get smart. David: I don't think that's a problem for you. You're very humble. Doctor Tony Nguyen is the head of internal medicine right now, and he was telling me that. . . Linette: He's my boss and he's awesome. David: Oh, that's great. He was talking about ventilated patients, that a lot of your patients are younger. Why do patients come to you? What are their issues? Linette: Well, our vented patients are younger, and most of that is because of our resource limited setting. Because of our resource limited setting, we can't afford to intubate everyone. So, our protocol favors a younger patient with less chronic disease going on. It's very sad that we have to make that decision, but we only have a very small amount of resources - in this case ventilators. David: So how many do you have that are working right now? Linette: We have five good vents.  David: I think your definition of good is different from mine. Linette: Like, it keeps the patient alive. That's good enough. David: So, that's the distinction. There's actual good, because you have some good [ventilators] and others from 1953 and it's a small miracle. . . Linette: It's working. It's working. (laughter) David: But that makes me very nervous. Linette: It does. It does. But then we live by faith. I mean literally surviving on small miracles. So, there's two really, really good ventilators that have this nice screen. David: The GE ones? Linette: Yeah. They have all these screens that you can read. And then there's these [old] ones which are guessing some of the stuff in the background.  David: It's totally manual, right? You have dials, you can adjust, but there's no waveform, there's no tidal volume, you're just. . . Linette: Guessing. There's nothing to see. It's just put in the settings that you want and hope and pray that that's it. Then if that doesn't work, you try something else and see if that works. And that's how we live. Imagine. David: Yeah, not that that's not good, but that's what I'm hoping we can improve on someday. Linette: If I have five solid ventilators, I think I can depend on. I mean, I think they can save five lives.  David: And so, you're saying you can have protocols for younger people.  What about - I don't know if you call it a dance or juggling - interactions between different departments work because? I mean, patients are surgical or medical somewhat, but there's a lot of overlap. Linette: Yes. It's a lot of teamwork that's required because a lot of patients in the ICU are surgical. But then if they're in the ICU, they're your patient [medical team]. They are surgical, but they're still yours. And that [relationship] needs a lot of communication between us, a lot of understanding, because sometimes we see with our eyes the medical stuff and they see with their eyes, the surgical stuff.  And we don't see what they see, and they don't see what we see. So, every time we make decisions, it's important to like double back and ask them, "Okay, we want to do this. Is this going to affect what you are doing in any way? Is this going to harm the patient instead of help the patient?" Because sometimes you might do something and maybe cause bleeding or maybe it does something that we didn't intend to do, but the surgeon would have known that, and we didn't. So, it takes a lot of teamwork to survive a patient in ICU.   Linette: Sometimes when we are admitting patients, we feel like this patient might need intubation and we might not be able to give them that resource, we try our best to refer them at the door before they even get to the point of deteriorating and needing the intubation. We just tell them, "Look, it's not looking good.” Usually, it's the family we are talking to because [the patient] is so badly off, and we tell them “It's not looking good. It's likely they're going to need intensive care. We don't have room, please go to another place.” Some of them refuse. Oh gosh, some of them refuse. They're like, “we don't have anywhere else to go.”  Those are tough because they end up staying in Casualty forever. And then we end up like creating an Intensive Care Unit in Casualty because you can't just watch someone die. That's a hard thing. And then some of them die. That's the painful part because you're like, "If we had this, they wouldn't have died," but we don't. David: Do you have a sense of what it would take? I mean, we want to get we want to get some new ventilators. We want to get ten, maybe more, high dependency unit beds. What would it take to treat everybody you think we should be treating? Linette: Oh, my gosh. A lot of money! David: Well, not in the money sense, but how many HDU beds? How many ward beds? What would it take to do everything you would love to see us doing? Linette: That would be crazy, because, if I compare it to what other hospitals are actually achieving, they can have anywhere from 20 to 30 or 40 ICU beds and we have 5. So that's a huge dream for us.  And then we have ten HDU (High Dependency Unit) beds. You can imagine if they have 20 ICU, they have like double that for HDU and we have only 10. So, it's going to take that much more muscle.  Then the other issue is staffing, because we are so few in our department and a lot of our people are missionaries. It's wonderful because they are here to help, but then they can't always be here to help because they have their homes to go back to. So, we have a lot of visiting doctors who come in. Oh my gosh, when they come, we're like, oh, we can breathe a little bit, you know.  We breathe for like a month. And then they go and then we're dying again.  We have ECCCOs who are in ICU every week. David: What does that stand for? Linette: It's Emergency and Critical Care Clinical Officer. They are clinical officers who have a higher degree in critical care and emergencies. They're awesome. Awesome. They run the ICU very well. A whole ICU really depends on an ECCCO. If the ECCCO is good, they respond to the emergency quickly. They call the doctor quickly. And they a lot of times you get to [the patient], they're already intubated.  They are so good. They respond to emergencies very, very quickly.  So, there's always one just one in a whole week who does the day and then one in a whole week who does a night and then one in a whole week who does casualty. If we were to ever expand, I think more beds would be overwhelming for one ECCCO.  And sometimes we have two because there's one and then a student. But then sometimes that could slow the [senior] one down because they're trying to do teaching, you know, like they're trying to show the other one. So that would take more doctors, more critical care nurses who by the way, are so awesome.  David: And there's training, there's a lot of training going on. This is one of the things I look at. I think, "five beds." There's the patient side. There are more patients who need help.  But then the training side, Oh my goodness. We have a critical care nursing program. We have the emergency and critical care clinical officer training program. Linette: Yes. David: And when I just look at it, I think we need to take care of more patients so they can, to use an exercise term, do more push-ups.The more patients they see, the better they will be coming out of school. Linette: It's much better for them. David: And then you're also taking the nurse anesthetists. They come through. Linette: On rotations, higher degree nurses doing their rotations and the anesthesia residents and surgical residents. David: Oh, and surgical. So that's part of their that's part of their residency? Linette: Yeah, there are a lot of learners, actually. Our teams are more than the patients by far. By far. David: That's at least 50 learners in a year.  Linette: They could be more, because per week, it's crazy.  The last time I was in the ICU, I had three ECCCO students and three KRNA's (Kenya Registered Nurse Anesthetists) and one more intern and two or critical care nurses. That's ten learners.  And then if you're on the rotation, you have to teach the ICU curriculum for that week.  David: So, you're doing that teaching? Linette: Yes. Yes. I teach. Right now, I took a break because I've been so busy with my family, but I teach physiology in the school. David: Oh, for the nursing students?  Linette: For the clinical officers. Linette: I teach human physiology. David: Awesome. That is a lot. Linette: Yeah, it is. That's why I, like, put a pause on it, because I'm like, “Let me just have a baby first and then I can think about it.” David: Yeah, that's awesome. How old is your little one? Linette: He's turning one [year old] this week.  David: So, you're entering a new phase, you're starting to sleep. And you're also starting to, realize, every second there's more trouble. Linette: He can get into. Yes, I'm battling chronic fatigue. He's such a handful. He's all over the place. And then he just discovered how to walk. So now it's like, "get everything out of the way." And just when you think you got everything out of the way, he discovers another one. David: What would it take to build a proper ICU?   That will be a phase-three of the hospital master plan.  This year there will be a new oxygen and facilities plant that they're calling an Energy Center. That will go It will be just outside of Wairegi [the men's ward]. That's part one.  Part two is the new outpatient center.  And then part three will be where outpatient currently is. They want to build a huge building that will be maternity, internal medicine, ICU. I think it'll take that [building] to get to 30 or 40 beds. But I'm hopeful that we can figure out how to do something substantially more in the near term.  If we get equipment, it can roll where it needs to go.  Knocking out walls and things like that are permanent, but equipment can follow the need. If it needs to go to Centennial [ward], it can go to Centennial. If it needs to go wherever, it can go wherever. So, I hope I hope we can do a substantial expansion this year. Because it's important and it needs to happen for you guys to be able to do what you're good at. Linette: Yeah. And now we have a renal unit, so we have, super-sick patients who we used to refer because we didn't have a renal unit. Now that we have an actual dialysis center in our hospital, we get called more and more into the unit because they code on the dialysis bench and we have to go there and resuscitate.  That's an ICU patient.  They cannot be anything less.  If you resuscitate, and then you don't have a ventilator, you'll just be bagging and bagging and bagging and you're like, "okay, I'll be the vent for now." But then, "how long am I going to do this? Are we going to get an ambulance? Are we going to go to another hospital?"   Most of them don't have the money to go to a hospital with an ICU. Kijabe is so friendly, in terms of ICU cost, on your pockets. So, you tell them about any other hospital in the family is like, "no, we can't afford that happen." David: Do you have to save ventilators? You have that dialysis situation. Do you have to reserve ventilators for surgical patients? Like if somebody knows something bad just came in, they're going to surgery. Linette: All the time. Yes. Every night I'm on call, I'm like, "how many ventilators do we have?" And the ECCCO tells me we have three vents. And then they're like, “the surgery team called ICU and they said that they're taking in a complicated case, and they want us to save a vent." So, if I get any emergencies overnight and I had four vents and I'm saving that one for the surgical patient.  If I get any anything in casualty that needs an intubation, I can't accept. So, I have to refer. And that's terrible for those who come crashing because they crash, and our reflex is to intubate. We don't even think, we just intubate. And then suddenly somebody is bagging and we're like, "we don't have a vent."  Sometimes we end up having to give away the vent we have reserved for an emergency, and that causes a whole chain reaction of problems because now the surgeon is angry at you because they saved the vent for the patient, and they've already cut. And you're like, "let's pray to God that you come out of anesthesia." Yeah, it's just a jumble, it's just a mess on those bad nights. And then sometimes we have to quickly extubate someone who we didn't plan to extubate today. Maybe we plan to extubate them tomorrow, and we're like, “maybe tomorrow they'll be able to get off the vent,” and then we're like, "Okay, you need to breathe for yourself now because we're coming off now." But you see, that's a problem because you're extubating prematurely and you're like, “fingers crossed, legs crossed, please breathe.” And then they breathe, and you say, "Thank you!"  David: So how do you manage all this emotionally?  Linette: That is just it's painful. It is very painful. Sometimes there is moral injury that comes with denying the vent to some patients because you're like, “if I had intubated, I am not 100% sure that you wouldn't have made it.” I'm just basing this decision on your co-morbidities or your other diseases and the fact that you have significant disease.   There's this other [patient] with less significant disease and that you are likely to not make it. So that's a bit hard.  David: What do you do with that? Like, how do you how do you process this?  How do you not explode? Linette: Our culture in the ICU is when you have a really tough time, we debrief, we call the chaplain to come talk to us, or the palliative team. They're very good at counseling staff members about "What are you feeling about this? What are you feeling about having to extubate this one? What are you feeling about having to do this?" And everyone opens up their heart and says, "Well, I feel like crap, like this is terrible." And, well, I have a good husband at home and he's like a doctor now because I take all my stories to him. So, I just offload on him and he's a very good listener. So, I feel better because I have that at home.  I have good support at home.  David: I love that.  Linette: Yeah. It's a tough journey, but it's also fun because we see people and its life changing. It's the difference between life and death for someone. So, our extubation days are really good. Like, "Yes, you did it, we saved one! And then 10 million more to go!” Always celebrate the small wins. David: I love that. Awesome. Thank you so much, Linette Linette: Thank you for having me. David: Appreciate, you're amazing. Linette: Thanks.

While many people feel like the world is headed back to normal, many kidney patients can feel left behind. COVID-19 is still top of mind for those who are immunocompromised and we're here to offer resources and support. On today's episode, our guests will answer your questions about how COVID-19 affects transplant, dialysis, and early stage CKD patients.   In this episode, we spoke with: Dan Weiner, MD Dan Weiner is a nephrologist at Tufts Medical Center and Associate Professor of Medicine at Tufts University School of Medicine. His clinical interests include home and in-center dialysis, hypertension and CKD. His research has focused on cardiovascular and cerebrovascular disease in CKD; clinical trials in CKD, dialysis and hypertension; decision-making in advanced CKD; and policy. He works closely with the American Society of Nephrology on kidney disease policy. He is DCI's Medical Director of Clinical Research, and he is the Editor-in-Chief of the NKF's journal, Kidney Medicine, and the NKF's Primer on Kidney Diseases, the 8th edition of which will be published in early 2022. Patrick Gee Patrick Gee is a Community Activist, fighting against systemic issues such as poverty, social and racial injustices, criminal justice reform, and education reform. Patrick worked for the Virginia Department of Corrections and the Virginia Department of Juvenile Justice, where during his time in service, he acquired several awards and recognitions. In April 2013, Patrick was diagnosed with Stage 3b End-Stage Kidney Disease (ESKD). He began doing Peritoneal Dialysis (PD) in December 2013. On April 21, 2017, Patrick received a kidney transplant. Patrick has been very passionate in his pursuit to speak on behalf of the underserved, undervalued, and disenfranchised communities of color. Because of this, he serves as an advocate and kidney patient expert for a number of organizations including the NKF, CMS, FDA, KHI, AKF, AAKP and HDU.     Additional resources: COVID-19 resources What you need to know about COVID-19 in 2022 COVID-19 vaccine and treatments for people with kidney disease Regional resources for COVID-19 Kidney disease and COVID-19 Episode transcript   Do you have comments, questions, or suggestions? Email us at NKFpodcast@kidney.org. Also, make sure to rate and review us wherever you listen to podcasts!

As we face a second wave of Covid-19 coupled with other winter bugs, health officials say they are our best form of protection. It comes as 8395 community cases were reported today. And almost 700 people are in hospital with the virus including 13 in either ICU or HDU. But after almost two years of mask wearing, experts fear too many New Zealanders have become complacent. Samantha Gee reports.

Stalling booster rates are worrying health chiefs, who say people shouldn't consider themselves fully vaccinated unless they've had their third dose. The number of COVID-19 infections has edged up again, with 21-thousand-616 new community cases and two deaths. 960 people are in hospital with the virus, 22 of them are in ICU or HDU. Jean Edwards reports.

Back in September 2021, Danny of Boomer Death Squad along with Josh and Jason of Heat Death of the Universe discussed the first episode of the then just premiering third season of American Crime Story: Impeachment, which focuses on the Clinton sex scandal (well the "big one" at least) that spawned an endless barrage of shitty late night show host and morning drive by radio DJ jokes and allowed a nation to be fooled once again by Slick "Epstein's Flight Logs MVP" Willy.Please enjoy this as bonus/supplement of sorts while the two hosts of Heat Death of the Universe adjust to (temporarily) being on opposite sides of the globe. A new episode should be dropping by midnight-ish, US Central Time, Monday (12/20/2021). Until then, enjoy this new configuration of BDS and HDU.Support the show (https://www.patreon.com/heatdeathpod)

Remember the call earlier this week with Janine? If you were with me, you won't have forgotten it just yet. Janine was the one who said the hospitals were being overwhelmed with unvaccinated Covid patients who were denying other people the opportunity to receive treatment.  And then we had the febrile Jan yesterday, who was terrified of latte-drinking Aucklanders, coming to the South Island because everybody in the little retirement communities that she lived in would end up dead. And I remonstrated with both women. One in strident terms. Yesterday, I was far more restrained.   I said the hospitals were not being overrun with Covid patients. They might be overrun, but it wasn't with Covid patients. And I have also said time and time and time again, that if you get Covid all the stats, the chances are, the risk analysis is that you will be fine. Some people won't, and they are unfortunate. But the vast majority of people who get Covid will be fine.  Well, that got the luvvies completely up in arms. And when Janine said I should be grateful to the Government for looking after us, that is when I lost my cool, but that was another day.  Today, we're going to look at the announcement from Health Minister Andrew Little about extra funding for hospitals and thank heavens for that.  You know it was a boost and funding across the country for all of our beleaguered hospitals. 36 hospitals to be upgraded. And a 644 million health funding boost. I'm not going to quibble. I mean, I think there could have been more money put into health given the years, and it's not this Government, it's successive governments of underfunding, but you know, yay, good for the funding.  So, the announcement was made. Within the body of the press release was this quote from the Health Minister. Andrew Little said, “Throughout the pandemic there had never been more than 11 Covid patients in ICU at any one time.” That's across the country. Never more than 11. Andrew Little said the vast majority of people who get Covid won't need to go to hospital, let alone need an ICU bed. Increasing ICU and high dependency unit capacity, said Andrew Little, is part of the wider plan to rebuild our health system.  Now I'll just repeat that for the Janine's and the Jan's. It's what I've been saying all along. The vast majority of people who get Covid won't need to go to hospital, let alone need an ICU bed. Are we all going to take a chill pill now? Janine's and Jans around the country?  Those people who are terrified of vaccinated Aucklanders traveling to their part of the world?   Of course, the vaccinations and the circuit Breakers of lockdowns were part of protecting the health system, but please can we just get a little bit of sense, common sense into the conversation.  If you heard some of these callers.  Honestly, I had an email last night from a man who felt that Jan was a set up. The one from the South Island. He said you're just making up these callers. I swear to you, I'm not. There are people who are genuinely that fearful they're not looking at the numbers. They're not looking at common sense. They're not looking at anything, other than the “stay home, save lives” which was last year message, which was very effective at putting the fear of God into all of us and making us stay home, we don't need that message now. And the Prime Minister tried to turn that around and she's tried to give different messages to say that, yes, Delta is in the country, but with vaccinations, we should be fine. She was a victim of our own success. That fear mongering and the modelling, for God sake, that had bodies stacked on the side of the road like so many double burgers. You know it didn't, it didn't happen for a number of reasons.  Andrew Little told Mike Yardley this morning that the announcement of 23 new intensive care and HDU beds was just part of the wider plan to rebuild the health system.  So, yay for our health professionals. Yay for the different treatment....

Hospitals across the country are getting more ICU beds ... but we don't have nurses to staff them. The Government has announced there'll be 23 new ICU or HDU beds, and eight temporary bed conversions to ICU. It will take about six months to implement.  Australia New Zealand Intensive Care Society's Andrew Stapleton told Heather Du Plessis Allan it's a start, but real obstacles remain. “There are still some irritations with getting even kiwi trained nurses back from abroad, they're still not on the specialist register for getting across easily, and they can't get here unless they've got a job offer written.” LISTEN ABOVESee omnystudio.com/listener for privacy information.

Hospitals across the country are getting more ICU beds ... but we don't have nurses to staff them. The Government has announced there'll be 23 new ICU or HDU beds, and eight temporary bed conversions to ICU. It will take about six months to implement.  Australia New Zealand Intensive Care Society's Andrew Stapleton told Heather Du Plessis Allan it's a start, but real obstacles remain. “There are still some irritations with getting even kiwi trained nurses back from abroad, they're still not on the specialist register for getting across easily, and they can't get here unless they've got a job offer written.” LISTEN ABOVE 

Jessica is a single mum by choice, choosing to have a baby using a sperm donor and not waiting for the right partner to come along.She had been diagnosed with endometriosis at the age of 21 and once she had further tests done at the fertility clinic it was also confirmed that her right tube was damaged from a surgery she had as a baby, and her left blocked from the endometriosis.This meant she would need IVF treatment .  Jessica found a sperm donor through an online forum  and began her treatment.Her first cycle of IVF was sadly unsuccessful and was swiftly followed by her dad passing away.On her second cycle of IVF Jess got two embryos but they both had to be frozen as we had just been plunged into Level 4 lockdown.  She would have to wait until we were back at Level two before she could do any transfers.Her gynecologist helped her petition to ACC for compensation for what happened to her as a baby, which was affecting her fertility now.  She was given 2 cycles of IVF compensation for this injury.On Jessica's fourth transfer, she became pregnant but had an early miscarriage.On her 5th transfer, she became pregnant with her little baby girl Hazel.Jessica planned a homebirth.  All went well and she got to 10cm dilated at home but then things slowed and she was transferred to hospital and ended up having a c-section.Hazel struggled with her breathing at birth and was transferred to NICU.  Jess lost a lot of blood and was transferred to HDU.  They were separated and Jess struggled with that.However, by the next day Jess was well enough to spend all day with Hazel skin to skin in NICU and by that night they were back on the ward together.Shortly after the birth of Hazel, New Zealand went into lockdown and Jessica and Hazel spent the first few weeks locked down together at home, having friends and family visit by looking at Hazel through the window.Jess has spent a lot of time processing the birth and working through her guilt at the separation they experienced in those first 24 hours. Connect with JessicaInstagram - https://www.instagram.com/houseplant_mother/Email - jesskaj@hotmail.comConnect with JaninePodcast instagram - https://www.instagram.com/waitingforyou.podcast/Photography instagram - https://www.instagram.com/janinefoxphotography/Submit to the podcast - https://www.janinefoxphotography.co.nz/podcastPhotography website - https://www.janinefoxphotography.co.nz/ 

People, we've been together for a full 200 weeks! We started in early 2018, and now we are nearing the end of 2021. And I can tell you how time flies. And with that flight, comes a handful of new music. But yeah, do you remember maybe what was the first thing we aired on the Good Music Incubator that January 8, 2018? It was 'Everything in me wakes up', a duet of Damir Kedža and Zsa Zsa, which was named Song of the Year according to the Croatian Record Association. Our first radio gathering was dedicated to performers and releases that HDU declared the most successful in 2017. Today, by choosing, we will be in today's musical moment, but just as attractive as 200 weeks ago. You can find all previous episodes on audio podcast services, and today's brings an overview of events on the Hrtop 40 list, music news and the presentation of the Album of the Week. This is Zrinka Posavec's record so beautifully called 'Songs about love and body'. We will be accompanied by songs performed by, among others, Fluentes, Ivana Kindl, Lorena and Baby Babilon. Tracklist: Vatra - Nova godina nije se dogodila, Dallas Records; Silente - Poljubi me za kraj, LAA; Fluentes - Sve je baš tako kako treba bit', Menart; Zrinka Posavec - Golub, Croatia Records; Ivana Kindl - Pusti da se dogodi, Universal Music Hrvatska; Boris Rogoznica - Sad i zauvijek, Hit Records; Lorena - Tvoja i gotovo, Tonika/Croatia Records; Massimo - Putujemo i kad stojimo, Aquarius Records; Baby Babylon - Pitanja, Aquarius Records; Zdenka Kovačiček feat. Matija Cvek - Tvoje usne, Dancing Bear; Sanremo - Muzika, Dallas Records; Vanna - Pjesma o tebi, Croatia Records; Klapa Sveti Juraj HRM - Kad jednom ostaneš sama, Scardona.

Rebecca became pregnant easily with her first child but struggled to get pregnant a second time andunderwent fertility treatment through a clinic.After two cycles of IUI treatment she was still not pregnant and felt that she was letting people down not being able to become pregnant, even with this fertility treatment help.On their third cycle of IUI Becca became pregnant but then miscarried.  She describes this time as the loneliest she has ever felt.  After a failed fourth IUI Becca carried a lot of guilt about the process not working.Becca was encouraged by her clinic to now apply for public funding for IVF treatment but she kept putting this off.  She had conflicting feelings about this.  She already had one child and she didn't want to take an IVF space from someone who had no children.However, on their  6th cycle of IUI she became pregnant  and at the 6 week  scan they discovered that she was pregnant with twins.  She didn't need the IVF funding after all.At 19 weeks pregnant they had a scare with limited fluid around baby Neve and she was put on full bed rest.  The twins were born healthy at 36 weeks, but Becca had a bad bleed and ended up in HDU.  Thankfully she got well, and the twins were healthy and they became a family of 5.Music written and performed by Alan Meharry and Stu FoxWaiting for you instagram page - https://www.instagram.com/waitingforyou.podcast/Janine's photography instagram page -  https://www.instagram.com/janinefoxphotography/Janine's photography website - https://www.janinefoxphotography.co.nz/Submit your story to the podcast - https://www.janinefoxphotography.co.nz/podcast

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In this episode of HPN Liam chats with Dan Mabon about the differences between the Australian + British health care systems + just how lucky Australia is in the face of a global pandemic. We hear about our nursing colleagues in the UK on the frontline who are not only extremely underpaid but undervalued in the world's most trusted profession of nursing + as a result, both men chat about their contribution to alleviate the pressure Covid has brought to our shores.We also about the moment every nurse has... of sitting with someone as they pass away + how that has shaped nurses to being extremely empathetic even after the patient has passed. They both dig into the unique quality nursing brings to life, the ability to reflect not just on the job but in all areas, using the data from that reflection as fuel to move forward.Dan also reveals the work involved in setting up a HDU + how that has strengthened his management style, defining what makes a good leader by giving his key tips + tricks for creating a great, cohesive environment that more reflects a family than a workplace.Thanks for listening!Loved the episode? Leave us a review!Want to dive deeper into this episode and search for something particular? Use our AI to search here!5 Ways we can support you in your nursing career ✅Join our Free Nurse Career Growth Hub and access our free nursing application, interview and career growth guides here!Join our Nurse Career Academy and work with us to help guarantee your next nursing role!Book a free Career Clarity Call with Liam to discuss your career situation!Join our private FB community to surround yourself with like minded nurses!Check out our Youtube Channel for more nurse career support!Looking for awesome comfy Scrubs? ❤️ We are so grateful to BizCare for sponsoring the High Performance Nursing Podcast!Click here to snag some scrubs! PS: this is NOT an affiliate link, meaning I do not make money if you use this link and the upside? You get AWESOME scrubs!

Local GP and NEDOC Medical Director, Dr Illona Duffy tells us that while case numbers have fallen slightly over the last couple of days, there are more patients in ICU and HDU with complications due to Covid. See acast.com/privacy for privacy and opt-out information.

MC393 ค้นหาชีวิตด้วยการตอบ 3 คำถาม by CREATIVE TALK

This is Amy's story.  Amy is 18 years old and was only diagnosed as having Type 1 Diabetes a few months ago, just at the start of the Coronavirus lockdown in the UK.  You can learn more about how Amy has coped with this shock diagnosis and how her positive attitude is already having an impact on her Diabetes Management.  We discuss -  Symptoms pre-diagnosis  Why Amy ended up in HDU  Using lockdown to learn more about Diabetes  The importance of accepting your condition  How crucial the online Diabetes community can be 

As of June 14th, HDU is officially 25 years old! This is why this week`s Incubator is dedicated to the best of Croatian music in the past quarter of a century. In this special, we are going back in musical history and hearing from some of our favorite musicians of today. We`re going to learn more about top charts, streaming services, and music awards, as well as taking a peek into the world of Croatian show-biz. Tune in, cause we got the best hits from ET, Parni Valjak, Tony Cetinski, Massimo, and so many more, coming right up in this special episode. List of tracks:  Dino Dvornik – Afrika (Croatia Records), ET - Da ti nisam bila dovoljna (Scardona), Magazin, Lidija Horvat Dunjko – Nostalgija (Tonika), Parni valjak - Sve još miriše na nju (Croatia Records), Bolesna braća - Lovačke priče (Menart), Tony Cetinski - Sve je s tobom napokon na mjestu (Hit Records), Detour - Kroz tebe se vidi (Aquarius Records), Pavel - Zbog tebe (Dallas Records), Igor Delač - Nikad nije kasno (Croatia Records), Zdenka Kovačiček Adut (Dancing Bear), Josipa Lisac – Daleko (Croatia Records), En Face feat. Damir Urban - S dlana Boga pala si (Dallas Records), Massimo - Mali krug velikih ljudi (Aquarius Records)

HDU is celebrating their 25th birthday on June 14th! And what better way to celebrate than to dedicate an episode of Incubator to the greatest hits of the past quarter of the century. So, stay tuned because that is what the next weeks episode is going to be all about. This week we`re bringing you the best NEW hits on the Croatian music scene. This weeks Album of the week goes to Ivana Kovač and her excellent new album “Srećo i tugo”. We`ll hear the best of the best as we go through the songs on the latest HR Top 40 list. Today we are listening to ITD Band, Pavel, Detour and Ogenj. Let`s listen! List of tracks: Massimo - Mali krug velikih ljudi (Aquarius Records), ITD Band – Zagreb (Hit Records), Daria Hodnik - Srce od stakla (Croatia Records), Ivana Kovač i Banana Band - Samo ljubav (Scardona), Neki to vole vruće - Teška vremena 2020 (Croatia Records), Pavel - Bijela jedra (Dallas Records), Detour – Šarena (Aquarius Records), Nela - Melodrama (Acoustic) (Croatia Records), Sandi Cenov - Naša mala tajna (Hit Records), Pravila igre - Usne od šećera (Gema Produkcija), Ogenj - Zanavek buš moja (Dancing Bear), Veja - Teško majki (Goran Farkaš/Sedma sekunda),Toni Starešinić - Savski epilog (Menart)

Te Whatarangi Dixon is a man with much "Mana' (The Maori word that means to have great authority, presence to command respect). Despite his relative youth at age just 30 he has twice already stared his own mortality in the face.  He was the victim of Guellain Barre Syndrome or GBS for short. Guillain-Barre ) syndrome is a rare disorder in which your body's immune system attacks your nerves. Weakness and tingling in your extremities are usually the first symptoms. These sensations can quickly spread, eventually paralysing your whole body. In its most severe form Guillain-Barre syndrome is a medical emergency and in this case is what severe and meant Te Whatarangi was months in hospital. The exact cause of Guillain-Barre syndrome is unknown. But two-thirds of patients report symptoms of an infection in the six weeks preceding. These include respiratory or a gastrointestinal infection or Zika virus. Te Whatarangi lost all control over his body and literally watched his body fail and start to die while his brain remained fully conscious. The fear, the uncertainty, not knowing if he would live or die or if he lived if he would ever have any quality of life again or be trapped in a body that no longer worked sent Te Whatarangi through a long night of the soul. But he eventually emerged. Stronger, more resilient, more empathetic and more driven that ever before. This is a comeback story of survival and of love. The importance of family and how they helped him through. Te Whatarangi is now a qualified neuro-physio and knows exactly what his patients and clients are going through. He knows the battles they face and he guides them back on the path to their goals. Heartwarming and raw this interview will inspire you and make you grateful for the blessings you have.    Te Whatarangi's greeting to you all in Maori   Ko Putauaki te māunga Ko Rangitaiki te awa Ko Mataatua te waka Ko Ngāti Awa tōku iwi Ko Te Pahipoto tōku hapū Ko Wayne Haeata tōku matua Ko Kay Mereana tōku whaea Ko Blair Te Whatarangi Dixon ahau   I have come from very humble beginnings. I am a product of my whānau (family) and I would not be the man I am today without them supporting me every step of the way. Everything that I am and everything that I strive to be is a reflection of not only myself but my whānau. I represent them and I hope to make them just as proud as I am of them. I was diagnosed with Guillain-Barre Syndrome (GBS) in 2014 and again in 2019 where only 1 in 100'000 people are diagnosed globally with a 1% chance of contracting it twice. Always an optimist and through my journey of self-discovery having faced the possibility of my own mortality, I am now proud to call myself a Neurophysiotherapist. My journey has been challenging yet unique and I wish to share my story with the world in the hope others feel inspired and to allow their light to shine.   We would like to thank our sponsors for this show: For more information on Lisa Tamati's programs, books and documentaries please visit www.lisatamati.com For Lisa's online run training coaching go to https://www.lisatamati.com/page/runni... Join hundreds of athletes from all over the world and all levels smashing their running goals while staying healthy in mind and body. Lisa's Epigenetics Testing Program https://www.lisatamati.com/page/epigenetics/ measurement and lifestyle stress data, that can all be captured from the comfort of your own home For Lisa's Mental Toughness online course visit: https://www.lisatamati.com/page/mindsetu-mindset-university/ Lisa's third book has just been released. It's titled "Relentless - How A Mother And Daughter Defied The Odds" Visit: https://relentlessbook.lisatamati.com/ for more Information ABOUT THE BOOK: When extreme endurance athlete, Lisa Tamati, was confronted with the hardest challenge of her life, she fought with everything she had. Her beloved mother, Isobel, had suffered a huge aneurysm and stroke and was left with massive brain damage; she was like a baby in a woman's body. The prognosis was dire. There was very little hope that she would ever have any quality of life again. But Lisa is a fighter and stubborn. She absolutely refused to accept the words of the medical fraternity and instead decided that she was going to get her mother back or die trying. This book tells of the horrors, despair, hope, love, and incredible experiences and insights of that journey. It shares the difficulties of going against a medical system that has major problems and limitations. Amongst the darkest times were moments of great laughter and joy. Relentless will not only take the reader on a journey from despair to hope and joy, but it also provides information on the treatments used, expert advice and key principles to overcoming obstacles and winning in all of life's challenges. It will inspire and guide anyone who wants to achieve their goals in life, overcome massive obstacles or limiting beliefs. It's for those who are facing terrible odds, for those who can't see light at the end of the tunnel. It's about courage, self-belief, and mental toughness. And it's also about vulnerability... it's real, raw, and genuine. This is not just a story about the love and dedication between a mother and a daughter. It is about beating the odds, never giving up hope, doing whatever it takes, and what it means to go 'all in'. Isobel's miraculous recovery is a true tale of what can be accomplished when love is the motivating factor and when being relentless is the only option. Here's What NY Times Best Selling author and Nobel Prize Winner Author says of The Book: "There is nothing more powerful than overcoming physical illness when doctors don't have answers and the odds are stacked against you. This is a fiercely inspiring journey of a mother and daughter that never give up. It's a powerful example for all of us." —Dr. Bill Andrews, Nobel Prize Winner, author of Curing Aging and Telomere Lengthening. "A hero is someone that refuses to let anything stand in her way, and Lisa Tamati is such an individual. Faced with the insurmountable challenge of bringing her ailing mother back to health, Lisa harnessed a deeper strength to overcome impossible odds. Her story is gritty, genuine and raw, but ultimately uplifting and endearing. If you want to harness the power of hope and conviction to overcome the obstacles in your life, Lisa's inspiring story will show you the path." —Dean Karnazes, New York Times best selling author and Extreme Endurance Athlete.   Transcript of the Podcast:   Speaker 1: (00:01) Welcome to pushing the limits, the show that helps you reach your full potential with your host, Lisa Tamati, brought to you by Lisatamati.com Speaker 2: (00:13) You're listening to pushing the limits with Lisa Tamati. Today I have a guest to Te Whatarangi Dixon from Rotorua who is an amazing young man. He's a neurophysio something I'm very interested in. But he is also a victim of the Guellain Barre Syndrome. Very hard to say. We'll call it GBS. Now this is a syndrome that's a rare disorder in which the body's immune system, attacks your nerves, weakness and tingling in the extremities are usually the first sort of symptoms and the spread right throughout his body and it can be fatal. And he was certainly in deep die trouble for many weeks in the hospital and he shares his story today and his comeback journey. It's a really interesting, I'm very interested in people who have overcome the odds in comeback. Journeys for obvious reasons. And I think this journey just really that fax has been on is incredible and why he's tackled it in the way he's coped with it. Speaker 2: (01:09) He was then gone on because of this to become a neurophysio. So he's used what was a terrible thing in his life to do something good. So it was a real honor to have him on the show. I just want to remind you before we go over and talk to te there, my book is now available on audio. It's available on ebook, on Amazon on my website every which way you can get it now. Relentless. It's also in the bookshops. I had the greatest pleasure the other day when I walked finally into a shop and there was my book. So that was a pretty exciting moment. After seven weeks on lockdown, it's finally out there. So if you're interested in getting that, the book is called relentless and you can grab it on my book, my website at lisatamati.com Right now over the to the show with Te Whatarangi Dixon. Speaker 1: (01:54) Them. Speaker 3: (01:57) Well, hi everyone. Welcome back to the sharp pushing the limits. It's fantastic to have you back again. I am sitting with Te Whatarangi Dixon all the way over in the Rotorua. How are you doing mate? Good, thank you. Good. Thank you. Super excited to have you on the show. It's really cool. We've connected through your father in law who is a lovely man, Steven who I spoke for. He is a great man. He is a lovely man. And he just said, you've got to talk to my son in law. He's so interesting and I thought, yes, he is very interesting and I want him on my show. So today I was going to hear a little bit about Whatarangi and we're going to call them facts from here on. And and now Whatarangi is a equally a neurophysio. You're just just qualifying right now, sort of in the midst of finishing things up and getting him into a new career and job. Speaker 3: (02:49) But the reason, one of the reasons I want, I want to talk to you about that, but I also want to talk to you about you've got an inspiring comeback story. Can you tell us a little bit about GBS we, we you've had GBS twice and we're trying to pronounce it before Guellain Barre Syndrome, something like that. So yeah, it's a very big word. So we'll call it GBS and can you explain what that is and your, your journey with us a little bit and a little bit who you are for status. Speaker 4: (03:22) Yep. Okay. So my story basically starts from a little town called tickle. So that's where I'm actually from and my family is, and I grew up pretty much in the Bay. TNT. I think probably people will always think that my story is interesting is because Guellain Barre Syndrome or GBS as we call it is as 100, a hundred thousand people, I think contracted, well that's the neurological condition. And then basically a textual, your peripheral nervous system. So it's quite similar. That's how I kind of describe it to people. I'm totally on the stand that getting into the technical kind of tends of things is similar to that. You miss you miss the textural central nervous system either and GBS a textual peripheral nervous system. Wow. Cause people get what that is so they can proceed. It's kind of similar but there are differences. Speaker 4: (04:20) So I had a strength called ampersand, which is what's a text basically or your motor neurons. Annual sensory neurons. You can have different trends with the tech, just primarily your motor neurons or your sensory or I think he got five different Sharon's, I'm not, can't remember specifically about each one, but yeah, those two. Yeah. I had em send, so I took an attack my motor neurons in my, in my sensory neurons. But the potential for it to recover as higher because you have a special cell called Schwann cells in your peripheral nervous system and they can regenerate over time. So that's why if you have, if I wouldn't wish it upon anybody, but basically if you had GBS your what your and you and you were able to stop it from progressing, quite possibly, even people have, it can't be fatal. Speaker 4: (05:11) But if you at the interventions from the hospital placed on you I think within three to four weeks until you sat on told JPA starts to kind of overtake your body, you'll be lucky to recovering this quite high but post four weeks and you haven't had an intervention with they call it immunoglobulin therapy or plasma faceless where they basically take our, your white blood cells and replace it with others. Wow. so basically you'll be your pasta, your, your ability to recover. That's a lot higher with your peripheral nervous system because your central nervous system are made out of oligodendrocytes and that's what they make up are once they damage, they don't rip you. Wow. So if you about a motorway system, once you've got an issue major, such a major highway, so one roads basically destroyed, it'll never be recovered. Speaker 4: (06:05) You'll be able to actually try and tap into other areas and go off road and then come back on, wow, I want to kind of destroy their part of the road and we'll never recover. Whereas Guellain Barren Syndrom, once that Schwann cell is basically damaged, if they're forced to before the damage, its ability to, to re regenerate as higher Scwh is in. This isn't the bird Swan. Swan. So S C W H. Okay. So that's a german. SCWH. Okay. So how does it manifest itself in your body? So you've got the, luckily not the central nervous system one, but more of the peripheral. How did that sort of manifest and what were the symptoms? Okay, so for me in 2014 mindset of half the thing is they don't actually fully understand why it HIPAA or like what actually causes causes a bacteria virus. Speaker 4: (07:09) We don't yet, but they understand what happens to once it starts. What's a, what's a begins to happen. So for me how they described the words, I, I basically called a guarantee Stein bug basically a month before GBS kind of started to could have been related. I go to my body, yes. So what they, what they perceive as what happens, it's an auto immune disease. So I had discussion or anti Stein nonfiction and I recovered from that. But however, what happened is you obviously when you get sick, you build up your immune cell or your immune system starts to kick in and you build get your killer T cells and then eventually you'll have resistant T-cells to action to buy down the killer T cells. Cause they've already destroyed the bug. Yep. What's happened is in my immune system, my resistant T cells to to actually hinder and stop the killer T cells from producing and actually start to generate around the body, they don't actually start to kick in. Speaker 4: (08:12) So your immune system had all these killer T cells floating around. And then I think obviously then I just got another random cold bug about a month later. And because you had these killer cells, so floating around in my body, I'm talking kind of later and I used to help you find fully understand it's important. Yeah. And so basically what's happened is my immune cell, my immune system has decided to, they've got this new bug, these qualities are the floating around. I have no idea what to do with this new bug and all of a sudden have started to just manipulate itself and then attach in a tech my, my peripheral nervous system. So phone cells instead of that classic auto immune shoot all the goodies and the baddies at the same time. Yeah. So it spawns my, my immune system starts to attack my own body. Speaker 4: (09:03) Yep. Essentially. Yeah. And so you don't, you don't know whether it's coming from there you know, that that gastrointestinal thing or not, but quite likely that that's caused that caused this reaction in the body. Obviously when you, when you're sick, obviously you get increased inflammation, which means that increases your immune system. And so it just, just helps you like a, like a, like as if you're standing in front of her train. And so basically how mine started was I just started getting pins and needles and my peripheral, like basically in my hands and my feet. Yeah. And it slowly kind of, I started basically just getting pins and needles and it started gradually kind of coming out of my arm of my legs. And then I started losing sets on my sensory kind of went, went away first. So SABIC losing sensation. Speaker 4: (09:54) And then basically as it came up through my, through my feet and into my ankles, we have a thing called proprioception. And they basically tell us it helps you understand its joints on the stand we are in relation to space. And that's that it's to dissipate and actually kind of disappear for me. So I started losing balance. It wasn't anything wrong with my brain, it's just that I couldn't get the right signals from my feet and from the white bearings, my weight bearing joints to my brain to understand and tell my body where I was. I had that with mum, but from a brain injury. Yeah. And so she didn't know who she was away. She stopped the way the world started. Special awareness because it's very hard to explain. Yeah. So this all just started happening. I don't know why, what's happening? Speaker 4: (10:43) You just kind of just randomly came on. So I started losing sensation and eventually started losing weakness in my hands. My jaw. I just knew something was wrong. I went to the doctors. The first time when I started getting pins and needles actually seeping into a physio, like some form of nerve issue of my lower back or, or something. Cause at the time I had, I had an injury, I'm a little bit. Yep. So say me, the basically nothing happened. A week later it started getting worse. Went back to my GP. He doesn't know, he didn't know what was happening. Obviously we could have the GP and had, you know, had I had signs of symptoms, they kind of live on possibly being meningitis as well. Yeah. He's sent me into, he see me in hospital, showed away basically after their next visit. Speaker 4: (11:31) So this was two weeks after that sort of started happening. A huge and obviously because he sent me diagnosed me possibly with a hypothesis of possible, possibly meningitis. I was treated for meningitis when I got there. By winter it wasn't, it wasn't I went and had my spinal taps. Yeah, spinal tap generally for meningitis in GBS cause they do present quite similar if they, if they think so. They're trying to cross the cross all the T's. We then, and then as they actually, when I went into hospital, I started getting huge migraines. I was getting migraines and I was skinning photophobia. So I've kind of actually optimized the life would just penetrate and just give me huge headaches. So I, when I was presenting what's, you know, and that's even another sign of possibly being in Jarvis and migraines. I, however, I didn't have a rash. That was, I need public one real, something they usually would get from in a data cell. We then had my spinal tap done, went for a CT scan. And then I was isolated basically because if I'm in a ditis spread it out at this point they still didn't know what I actually had. They were just going on. You know, the signs and symptoms on me, possibly heavy meningitis skins fascination and hits the spinal tap, then CT scan. Speaker 3: (12:55) Yep. Carry on. Mum's bringing in the middle of the webcast. She always does. Everybody who listens to the podcast knows this is a key ring from Mark to carry on mate. Speaker 4: (13:08) Yeah. And then and then I'll, then they for a week nothing basically improved. So all the all the drugs that they go to me throughout the time to help me try and beat meningitis were working. I was getting worse and I started losing what I'd done in relevance to that. I was actually getting really weak, but I couldn't actually convey that to them because I started getting, you know, I started losing my, my, I couldn't breathe and I started, I get to be on a ventilation also just so much pain. So I started getting hyper sensitivity. So basically cold felt like hot hot, felt like cold, a polo felt like a waste of time. I felt like I was driving into into the beat. So when I was just lying on the bed, I felt like I was getting pulled down by gravity. So [inaudible] rotation or anything kind of going out of whack, you everything just becomes imbalanced and it might, your brain can not understand or what, and it's trying to rebalance itself. And in that process that's kind of having, it's actually being detrimental to your, to your ability to kind of actually understanding the world just cause everything. Like basically if you'll need to bombard your nurse to actually understand, you know touch smells like every foot of sensation that you can basically think of. Speaker 3: (14:27) We had for granted so much and we know that this is, yeah, something's touching my right hand or I'm feeling my left hand or, Speaker 4: (14:35) And then basically third weekend I had an MRI and then the neurologist was actually away at the time. So the neurologist said that was actually from the house and told him the hospital for us. He was a white, you ever sees on a, on a spent sabbatical at another hospital. And so the neurologist from Palm smelt was coming up two or three times a week. Yep. So he came up and he basically once they won't say best, so he thought busters, a meningitis B bike. And I started and I had an Ida, my sister in law, she found a possible link to being something more neurological because I had this window of opportunity. We actually felt, you know, everything kind of normal, a little bit full for a time. And I asked Glen to kind of do some, do some assistance on me, who's my sister in law. Speaker 4: (15:25) She's now registered, now open a hospital. Wow. and she just chose a fifth year medical student at the time and she just done some systems on me and she felt my reflex is going through. I couldn't, my sensation was, was basically gone and she just went straight to straight to my consultant. My consultant got the neurologist to come in and they're all just basically look there, make straight away any new show way that ITVS basically Australian. I went straight into HDU. I was throwing spirometry, so I actually checked around my lung capacity was gone of the migraines. They organized for me to go for an MRI just to see what type of thing my body information was. And all of my, you know, all of my CRP scans, we were just through the roof. White blood cell counts were through the roof. So they knew that your, your menu system, but they couldn't, they didn't know what was happening on it. And obviously people, it's so rare you know, you, you come across that every, I don't know, once or twice in your lifetime. Speaker 4: (16:33) Okay. So now you're, you're in the, the finally worked out does it, is this thing. Yep. What sort of a battle did you have on your hands then? I was in the battle. Basically, they're trying to save my life. Wow. Yeah. Yeah. So my, my, basically my, my lungs started to shut down. I immediately went down to about 50% capacity. As soon as I went into HDU I was intubated with mechanical ventilation to the full Monte, so conscious, so my brain's still, they're not just getting migraines. Stuff's like, it's still kind of occupational life. Nothing's happening mentally. It's all just the, my physical body shutting down. I can't move. I started all like, basically I lost all control of my bowels and whatnot as well. So there was things we didn't see wise. It was just, it just, everything went away. Speaker 4: (17:29) So like a massive brain damage. Yeah, something's happened to the brain, but it's just a little bit, it's just my, my peripheral nervous system is shutting down. So I was 23. Wow. I was 20. It started 2014 and yeah, so that, that all happened aren't you baited? And they basically, they started me on what they call immunoglobulin therapy, which is basically other people's antibodies. So, and that's about $1,500 a bottle. And I had about, I don't know, I think it was a call center of over five days, three bottles a day. Sorry, I'm trying to overpower it with, with normal white blood cells. Yeah. So basically trying to combat my immune system so they're pumping and you know what white blood cells from other, basically it's basically a blood transfusion into my body to basically, it can't stop DBS, it can only spoke. Speaker 4: (18:41) So the progress of it. So like I said before, you know, these, they're four week kind of if their month window that month window to try and stop it to get possibly from being a fatal condition. So I was in the third week, halfway through the three weeks, so they just water them. And you know, I already got to the stage where basically I was a vegetable and basically I was just trying to save my life. So I was intubated, heading immunoglobulin, stuck to a wall hours days. And I was in the hospital for about three months in ICU for about a month and a half. And then I went up to just the general ward. So it was amazing. So once they open up here, but it's just a waiting game, you can't really, you can't do much, they can do something else. Speaker 4: (19:30) You can do. You just watch you just hoping that, you know, me being a young kind of 24 year old at the time, it was going to kind of, that was going to be in a box, which to me, thankfully it was. It was. Yeah. And that's very grateful. Someone under the age of basically 50, 40, 50 to get genius. Wow. cause you, have, you got, you know, I, I love diving into the body. Do you think you have a predisposition to immune and overreactive immune system? Have you even thought about functional genomics and doing some testing along that lines to see? Well, you know, I've always thought that I'd always thought about looking at basically my DNA cause but you know, when I look at my, look at my look at my family, but I look at my family history, I've got none of that in my family. No kind of history of a neurological emission. We've got you know, quite a, the only thing we probably have in my family is the Alzheimer's cancer in our family. We don't have you know, you know, really what do you call it? Systemic kind of conditions, you know, mommy and my family have died of heart attacks. I think one. Yeah. [inaudible] Speaker 3: (20:50) We've got type two diabetes, but that's not genetic. That's just, you know, your modifiable risk factors that you can change. Well there is genetic fathers did it as well. Yeah. But it would be interesting. I mean I'm just fascinated by functional genomics and looking at understanding of why your immune system would kick into overdrive and actually cause an S is this likely to happen again? Not GBS. Well, we'll get to that in a minute, but you know, for other immune responses now here on land. Yeah, I'll definitely be interested in looking at research that we can. When I'm working with the DNA company and I've had dr mincer on the say they've just opened their labs up again and it'll be a few months before I'm qualified. But I can definitely connect you this if you want to have a look at that just to, I mean it's, I think it's something that everybody should do once in their life anyway. Speaker 3: (21:49) Yeah, it's fantastic, Dan. The stain, it can definitely help you plan and prepare for your future. Not stupidly, but just preparation was, you know, you'll tell him to stay on what's happened. Like what could possibly happen for you and what, you know, change it while you can change in regards to modifying your lifestyle to be able to enjoy, enjoy your, you know, your quality of life to the full extent. And even like things like, and this is getting a bit off topic, but you know what medications you might interact with in a, in a bad way or you know what your detox pathways are like. So do you need to be super vigilant when it comes to outside toxins, that type of thing or your hormone pathways or everything like that is involved at, so it's pretty, pretty, pretty good information to have. It's like, I reckon it should be like passport. Speaker 3: (22:43) So you have it, you know, and then you take the interventions to stop problems. But back, back to give a story. So you, you, you're fighting for your life now in your, you've, you've gotten through that really bad, horrific stage. How were you mentally coping with us as a 23 year old when you started to come back to life, if you like what you've been through, this traumatic, horrific experience. Have you dealt with that? You know, I've probably, I'm a very optimistic person, just like as a put my personality. I have a very optimistic look and I'm just in life in general. It was really tough. So at the challenge me a lot I wish I knew my wife, that's, it would've been easier, definitely been easier. You know, just being, you're being 23 and I'm very much a mum mama's boy. Yeah, absolutely. Nothing wrong with that. And my mum at the time Speaker 4: (23:47) You know, after raising my brother, my sister and I her entire life as a single mother. Wow. yeah, it's off to half. Yeah. I have a lot of, a lot of things in life. She was in Spain, so she decided, you know, how all of us, we're all growing up, we're living our lives. We started our new careers and, you know, looking, you know, what's going on in our own adult lives. If you took this opportunity, you know, to actually just enjoy this and go off on another Valium sabbatical for six, seven months over in Spain, lift my lift, my stepdad, he just say, I'm going to Spain. I'm going to go off and have all that. And she was basically two months in over there, and then they'll say, great. Trip as well. You know, I tried to, we rang basically nearly ever tried to ring every night through Oh, he used to be called Viber, you know, the original kind of. Yep. I guess. And you know, I basically said to every single time, as hard as it was to me, just to say on the phone was, you know, I said, I kept on saying to mum, don't come back. I'm going to beat this. And I'm not gonna pray, I'm not going to buy as much as I probably cried a lot of the time thinking that I was going to die. Speaker 4: (25:17) Yeah. To face your own mortality though, I mean ridiculously young age you know, like how do you see that now? What's your relationship with it now? I mean it's a pretty hard thing to buddy. Others that's I think I look at it more is I don't ever look at it as a, it's a fear concept. I probably look at it as a, as an opportunity to kind of, like I said, like before we even started a podcast, that's just an opportunity to actually still learn. Even though, even though I was going through this, I was like knocking it, if I get through this, what am I going to learn from this? So that's how I actually probably got me through. A lot of it was, you know, I'm not going to let this beat me, so what can I do with my life if I, you know, not if I was going to, it's like I was spicy. Speaker 4: (26:06) I was trying to tell myself that I wasn't going to, but you know, facing, facing that possible. Yeah, it was either I have my down moments. You know, you sometimes you're probably just thinking about wanting just to give up because it was just so that was quite hard and you know, seeing my family and my family and my family just probably, which has definitely been, you know, my Maori being from a Maori family, my and my mum overseas, I'd always had someone next to me. So yeah, my aunties, my uncles, my brothers, my sisters, my Dad, they all kind of took their time out of their days to kind of one at a time, go on a roster and just be there 24, seven basically, isn't it? It's so important to have that support. Yeah. And you know, like I'm a big, I'm a very holistic kind of person. Then before MALDI back home we have a thing called all, you know, like mother that can be, and so basically in anything, so a person, an object or you know, any inanimate kind of thing. But by them being there, they actually predicting them announcing me, if that makes sense. Absolutely makes sense. You know, if I didn't have them, I don't know if I'd even be here. Being beside your loved ones and having walking with them and their dark times is just so, so, so crucial. Like very family orientated person. So yeah. Speaker 4: (27:36) And you got a good one. I didn't have them beside me. I don't think I definitely would not have probably made it on my own. Because they were actually my thyroid, my motivation to actually fight and fight cause you need to fight, you need to fight when you're in deep, deep trouble and to find that fight when you're in pain and in, in terror and fear and all the rest of it. And the reason probably why I say I would show my wife at the time was because she's actually given me that strength and power to actually on the same or separate afflictions. Yes. I never actually fully understood it and she comprehended it. So I was obviously me being a 20 young, 23, all these just think of the physical aspects of life. And I never really considered, you know, how impactful the mental side of things, the emotional side of things and the spiritual side of things. Speaker 4: (28:25) But it's actually, she really helped me also is actually trying to understand who I am, what my identity is. Wow. I shocked. Cause if I had that back then as well, you know, I definitely would. Mmm. Fully understand and actually I would have been a hell of a lot better position to actually get full without ever even thinking or considering those kinds of things I would consider and think about them, but I wouldn't have, I wouldn't, you know, consume me. Yup. Yup. If they make sense. So I'm a big believer in if you have a strong, I didn't say even cultural identity, if you understand who you are, yeah. It gets you through. So, and that's, you know, being honest to yourself, being yeah, even on the others. And just taking them one step at a time, you know, it's not going to, you need to fully appreciate it. Speaker 4: (29:17) I understand that sometimes you do need that time to just kind of look at yourself and understand who you are. Cause if we don't, then you struggle. So this has brought you wisdom beyond your years really, isn't it? Yeah. So, okay, so, so you, you were in the rehab now for over a year trying to come from this thing and what was that better like? Like was it like coming back from a stroke or a brain injury? Was it like that now? Yeah, so basically it was really weird. So for me, I actually quite enjoyed it, but obviously obviously food through. I, I enjoyed the rehab, but the time that I was in the hospital, that was the tough part. So yeah, it wasn't until I probably got past it every elevation there point where I knew I wasn't going to buy. Yeah. Basically once they, once their fear of my own mortality here to pass, I was, you know, basically they basically told me, I was like, I've been in it and now all I have to do is put the work in. Yep. So be able to give myself from where I am right now, being dependent and now becoming, you know, my independent self again. Wow. I'm still alive so I'm stoked. Speaker 4: (30:39) I'm going to fight like crazy to get better. So I'd never looked at it as being, you know, I never looked at myself as being disabled ever. Maybe sometimes I maybe shouldn't because I know I probably pushed a lot of stress and, and you know I'm on my family when I was going through it there first time cause I, you know, obviously I think we forgot to mention them. I got this last year as well. Yeah, yeah, yeah. This is what we've got to get to yet. So, yeah. So that, you know, I wish I probably was able to be honest. If I say, you know, on, on basically my family going through a lifetime because I know how stressful it was for them to kind of see me in that position and all they wanted to do was just help me and all in all I would do was just kind of internalize it and just keep it to myself and say, no, I almost went homeless and do it myself. Speaker 4: (31:36) Right. But, you know, that was a very selfish thing. Like when I look back on it, it's a very selfish approach that I had on it, even though I know they called me it. But that's because I was only ever thinking about the physical side of things still because you were young and I was young and you know, for me, being a 23 year old, you know, the physical side of life, very, very important. And being a man, you know, you messed the and he gets challenged and it was very, very hard to kind of get through that without ever feeling like I was burdening my family. So, you know, and that way when I look at it now, I, that was the wrong approach. But yeah, so basically once I got past, they pointed at this past the point that I wasn't going to be, that wasn't going to die. I was in hospital until basically I was my, I wasn't head. I took out the mechanical ventilation and I started doing some form of physiotherapy in the hospital and then they had organized me to go to a festival or a Ferguson. I know I Speaker 3: (32:40) Tried to get mum in there, couldn't get her and sorry. Speaker 4: (32:43) I got, I don't know where I got my funding from yeah since I was three months in hospital. And my rehab basically consisted of a lot of it was orientated around my goals and what I wanted to reach back to. However, when I read what I really enjoyed about lower foods, and it's basically like a campus that's a rehabilitation campus and it's for people that are under the age of 60. So it's not a, it's not a retirement village. It's actually for people that are, wants a big goal, be there long term. They had some of them who have long term conditions and took some of them terminal to a certain extent, but they're all there for the purpose of what's in there. Try and get better. Speaker 3: (33:29) Love that. I love that. Yeah. I did try to get my mum in there. She was too old to get there and we couldn't get funding and so on. But it did feel like a place where you were going to actually do something because I must say you're a neurophysio now, so we'll get to that shortly. But I must say the physio care that we had in the hospital was nothing short of atrocious. Yeah. I could have done it in my sleep. I think they went, they'd eat the lunch. That's pretty harsh. But that's, that's how I felt. Speaker 4: (34:02) And it's, it's really hard when I think about that because they are quite restricted in a lot of what they can provide. You know, me being like going through placements in one note as well in the hospitals, they all want to change how they approach things on the hospitals. That's why they're trying to implement, you know, code rehabilitation, gems and whatnot there as well to get more involved. But at the same time it's really tough because systems at the system is built around, you know, you've got so many patients that you have to see on a ward and you've got what, 10, 2030, 30 minutes at the met with them. Speaker 3: (34:41) I must say I must, I must re repair what I just said. The ones that were came round to us on the ward during the acute phase were lovely. Awesome. Yeah. When we were later put into the rehab with mum I fought to get her back into the system to get, you know, cause they said at the beginning she's never going to do anything again. We're not going to bother basically. And I fought and after a year I got her back in for two times a week and there was atrocious. And I felt like a box ticking exercise. The ones on the ward were different. They were very passionate and really, really wanting to help. So in, and this is no indictment on any one person or thing, but there was a systemic problem and there is a systemic problem with the way that the, the things are run at least an hour, the, our hospital and the way that you are judged, I remember and don't want to take her out for the interview, but six weeks she had as a block of two times a week. Speaker 3: (35:43) And honestly what she would do in that six weeks I would have done in a day with her. The tests that they tried to put her through, she was intimidated. She felt like a school girl, so she was not interacting with them. Because they were very judging her all the time, whether she should continue in the program. And at the very end of the program, they had a big panel where they all came in to decide your fate, whether you'd be considered to continue in the program. And they, they talked to me not to hear who's sitting next to them and says she's below the level of the worst dementia patient we've ever seen. You know, she's never going to do anything and this is a waste of time. And I turned to my mom and I said, well how does that make you feel mum? Speaker 3: (36:28) And she said, you know, well I was feeling quite empowered until I came in here. Now I feel totally, you know, down before. And they just looked at me and then jaws drop cause I had never heard her speak because they had never spoken to her as a intelligent person. So she had responded because she was intimidated by that medical setting and I knew that she was a nurse. I knew she had a, you know, stuff going on and she was intelligent and she was coming back. I believed in her and I just said to them, you can stick your program up there somewhere. I'm going to bring my mum back. And I did. From that point on I was like, right there is no help. I will go and do this all myself. And that's, you know, that's, that's just that particular bunch of people in one particular place. And that's not an indictment on them all. But that was, that was quite sad. And then I had a wonderful neurophysio. So let's get onto your neurophysio cause you've gone down this path now after going through this. Was that the reason that you went and studied neurophysiology? Speaker 4: (37:35) Yeah, definitely swung my Martha sessions that go that way. Yeah. I wasn't actually through PSI. I had an amazing neurophysio and when I went, when I was at Laura, focus on the reason why I decided to go down this path though you know, it was just, she just knew how to push me in the right ways and I wanted to do that for other people. And even when I was at Laura Ferguson, I met so many amazing people that had never asked the, you know, to have a stroke, to have no image, to have Huntington's disease, to have pockets. And so, you know, they never, never, they never asked for that. And just to be able to have it's just you know, the, the, the thing I think about the most is people, there's dependent, you know, if you're, if you lose your independence, I feel that's the huge, like the biggest thing as a human, you don't read it like it, it's that old cliche of, you know, you don't know what you have until it's gone. Speaker 4: (38:36) And so basically it's a pout. Somebody that does the pendant become independent again. That's the most rewarding thing that I can even think of from from, from absolutely. When I, when people ask me why I wanted to become a pussy, I say there's three things. So one of those I knew I always wanted to help people work from a health perspective. And originally I actually wanted to become a doctor and do medicine. So they laid onto their leads onto my second reason. That was the reason why I toasted the physio and it's purely because I probably had hit the, you know, Gordon, she was amazing. I'm going to start her name out there because she is amazing. They she made me understand that being a physiotherapist you just were able to have. And there's just this natural and therapeutic relationship that you just can't have as a doctor is, you know, as a relationship proficient. Speaker 4: (39:34) Yeah. Your ability to be able to have those real deep connection with, with your patients was like, there was, that's the reason why I really got back to where I am today because of that. So, yeah. Yeah, yeah. I'm a very people person. So having that intense of kind of relationship with each other collectively, you know, having that shared goal of kind of getting to that, to that same, to that shared place where they want to, that they want to achieve. As you know, second to none. It's a bond for life really, isn't it? I can see how much you love and respect what she did for you and how much it means. And this is why it's on me to becoming a physiotherapist rather than a doctor. The complete opposite of like, I had a neurophysio too who came to our house afterwards and he was wonderful. Speaker 4: (40:31) He gave me the belief that we could do this. He gave me the basic tools so that I could work every day with here cause I couldn't afford obviously everything. But he gave me the information that I could then put that into practice on a day by day by day basis. It's really common sense. It's just being able to apply it in the right way and try to break movements down. Now how do you teach someone to, I specifically look at it in three ways, you know, narrow cause as I think of it as he got function, strategy and impairment, that's basically, that's, that's my, that's like my go to for anything basically. So you know what you wanna achieve as function, you have strategies to achieve that function and then by you have an impairment which affects the strategy to be able to perform the function. Speaker 4: (41:18) Yes. Yep. So obviously the goal is function by why you have to do a specifically time work on the impairment and then effectively your strategies should try and improve and then you start, that's how you progress to the next kind of thing. And then, then what happens is you'll be able to perform their function again. It's like a soap tech. I'm like, I'm trying to simplify it, but that's how I try and approach things. Yeah, no, that makes absolute sense to me. Yeah. That's like free three steps and there's a variety of ways of how you can integrate your treatment methods. So there's a variety of treatment methods that you can use, but that's the ultimate call it, that's the, that's the basis of it that I run by. Wow, I'm going to bring them up to see you one day, what's the next thing I can do with it? Speaker 4: (42:06) So they basically, when I funded, when I recovered, I decided to become a therapist. So I enrolled into A A T and started in 2016. Obviously because I got a dog, cause 2015 had already started because I had a bit of paper and I just kinda wanted to give them my stuff that either actual year where I just worked and just got back on it to actually get back to normality. And then I decide to go on on the intake in 2016. And AAT is now I'm gonna fly should be an, it should be an advertisement for them or something. Yeah. Yeah. They're amazing. So I love that. I love being a part of that. They invest like the way our lectures were, they all came from a clinical experience. They weren't, they were heavily based on the theory. Speaker 4: (43:02) So, you know, they, they basically, they, they pushed down a farts to be able to have a clinical reasoning. And maybe I want to think on a fetus practitioners as clinicians, I want us to be clinicians. They want, they don't want us to be bookworms and lab and just writing, research things out all the time. Cause at the end of the day, you know, our, we're providing a service and we want it to be based around real good quality service. Not just, you know, anyone go on Google and find out and do this, you know, you know, I can do that. We want it to be able to, so they've really and forced their kind of encourage and encourage that type of learning. So it was very practical. And I'm a very practical kind of person. And it's really weird, you know, obviously when I was going through my rehab with his 2014 and they're learning and become in basically going through my physiotherapy degree, I look back on when I was through my rehab and I could see all the little tricks that you said. They will create these signs and your physio you create like the games and really it's actually, it's an objective measure for being. So I didn't really realize that it was actually like a, she's, she's testing me but I didn't know that. Wow. We've got them on or big take tests in all photos just to help me with like picking up things and putting them in. But secretly she had been timing me. Speaker 4: (44:37) She had made it basically. She made a lot of things cause I'm very sport all of my sports. So she made a lot of things in the games like paying the, we you know, you just, you can be as creative as you like as a neurophysio just to get that function back. Yeah. and you know, you learn, you learn basically all the main three, which is cardio, musculoskeletal and neuro. You always remember the principles of all three. Highly effective when you come out of uni, you kind of the side, we really want to kind of stop that all like basically to down and down. And so I obviously obviously matches. Obviously neuro, I do have a miscarriage. I do like that as well. And most people do do musculoskeletal. That's like your normal, full possessive, your body. Everybody knows about. Speaker 4: (45:28) But yeah, my interest is always possibly always going to be neurons just purely from an empathetic point of view. Having that rewarding feeling of being able to help someone get from a to B and just being a part of their journey with them. Yeah. They've ever wanted to be a credited with any of the, you know, them getting there. It's because it's all in. It's just being able to share their journey with them. But it's amazing to be able to, to provide that framework for people to, to learn from and to grow from. And so I just wanna like wrap up in a few minutes, but I want you, you got this again. Yes. You went through this whole thing again in January this year. Speaker 4: (46:12) August last August, 2019 so I was the special 1% of the entire world to get GPS twice. Wow. That's insane. It's super, super unlucky. But this time I have my wife, yes. Father-In-Law. I can never be grateful and thankful enough for them because this time, at least they, we knew what we were dealing with and we see Australia and stuff. It was just a lot and was still very tough and I still kind of, you know, internalized a lot of things. And you know, that, that same thing that the last time when I kind of found my cell phone with regards to my, you know, challenging my masculinity and keeping things internalized, trying to get through myself instead of feeling like I'm burdening everyone else with what's going on with me. But you know, Claire and Steven definitely helped me get through that. And I should apologize to my wife because I know it's probably very, very, very tough on it. Anyone you love and when you're going through hard times, you're always going to have moments where you didn't do what you wanted to do. When you look back afterwards. I mean, I've had times like with where I've been, like Speaker 3: (47:30) Afterwards gone, shit that wasn't good behavior, you know, on my behalf and, or you think, you know, but you're just in a desperate state of exhaustion and fatigue and the grind of it all and you did things that you're not surprised of. Now, you know, in my case where you think, you know, we have yelled at her for something or you know, just gotten frustrated and gone, Oh for goodness sake, you know, and then you're like, that's Speaker 4: (48:03) Time is as much as I was plus time round. It was amazing. Effectively Steven was my head of Gordon the farm. That's, you know, we went, we went to the polls basically three times a week and we went into the hospital twice a week. And he was the one basically taking me through all of my exerciser and whatnot and you know, clearly had to obviously go to work every day. But at the end of the day, she's like my biggest inspiration, the person that I aspire to be like, cause she knows who she is. She sounds awesome. Gotta meet. He's he always makes me want to be a better person or just a better man. Yeah. She, she sees me like she, she can, she sees through me if they make sense, she feeds me. She knows me better than I did myself. Yeah, Speaker 3: (48:52) You can be, you can be real with her too. You, you are who you are and she loves you for all the, all the good, the bad and the ugly. And isn't that what it's a wonderful thing. Yeah. Speaker 4: (49:05) Well the whole my kids look, I mean to me I couldn't make it bad side loss basically up to my elbows, into my knees as time. So I still had function and my, you know, basically my, it wasn't as bad, but it was still GBS even still take like six to seven months before I can actually, he's coming out the other end of this couldn't have been on myself. Yeah. Speaker 3: (49:31) Right. We're gonna wrap up now. What's the message? You know, there's a couple of good messages that have come out of today saying like, as a, as a young Mari, you know, men, you've faced us with amazing strengths and the wisdom that you are beyond your years. I mean, what are you now, 29, 2030 29 30 turning 30 wisdom beyond your years because of what you've been through and that is going to help so many people and your career and what you, what you do. And I'm very excited as it is. I know Steven is to see where you go in life because you know the power and the money that you already have now because of what you've experienced and your openness and your thing. I just think it's fantastic. And you're going to really be empowering lots of other people going through and this is probably, you know, your life's call and you know, is to help people and to do this and to share your story. You know, I think it's important. So this is hopefully the first time you were sharing it and won't be the last, I guess Speaker 4: (50:37) My take home is search after everything that I've been through with everything and all the people that I met. And then I have my wife and Steve and everyone inclusive my family. I think the biggest thing for me will be I think I'll probably look at it at this time of the kind of leader that I want to be like. So it's really, as I said before, it's being able to understand and having their perception of others, you know, never worrying, never caring about the perception of myself. You'll never, if you, if you can understand the perception of others you want to have, you always have an empathetic point of view on my fear. You'll be able to actually stand on the feet, stand in their shoes, sorry. And then understand, tied on the stand, what they're going through and instead of a sympathetic point in life, because at a point when you can become too sympathetic in not feeling sorry for them and then that's not going to help them at all. Empathetic, sympathetic. So that's the kind of leader that I want to be like. And that's what I want to, Speaker 3: (51:41) You're well on your way to doing that and you have a lot of money. You can see it. It just comes out through the screen. So thank you very much for sharing so openly and honestly today, your journey because it is empowering to other people who are going through difficult times. And this is, you know, part of the job of the show is to educate people around, you know, health and fitness and the latest science and the latest stuff. But also to make us understand like we're all human and we all have these feelings and we can get through tough times strategies and tools to do that. And you obviously found a few along the way. So I wish you well and you know, I'm excited to see where you go mate. And any last words, any last words before? Speaker 4: (52:29) Speaker 3: (52:35) Love it. Thanks. Thanks. Bye. Speaker 1: (52:37) That's it this week for pushing the limits. Be sure to write, review and share with your friends and head over and visit Lisa and her team lisatamati.com.

Pastor Don and Brad talk with Lee Bramlett about the challenges of learning the Hdi language and culture as well as what it meant to find the breakthrough word 'hdu' which means unconditional love.  This was a key finding that changed everything for the Hdi people and their perception of God's character. 

David - What is your name and what do you do at KijabeLilian - I’m Lilian and I’m an Ob-Gyn in Kijabe, for the last four years, but been here a lot longer.David - When did you start?Lilian - 2007, internship for two months, elective term, 2009 internship for one year. I left for 8 months and came back in October 2010. Then residency, and I came back fully in 2015.David - Who is your husband and when did you meet?Lilian - He’s George (Otieno) – we met in undergraduate in our third year of medicine and surgery. When we came to Kijabe from the first time we were already dating.David - Lilian is head of Ob-Gyn at Kijabe, here you say obs/gyn, is that right? George was head of internal medicine, but now he’s promoted right? He’s inpatient subdivision head. Both do so much for the hospital, they’re amazing.What we’ve been talking about lately, and working on, are some of your needs for the OB department. Some we’ve gotten sorted and some are in process. Two years ago, we were having a big problem with the delivery room. And now that’s done.Lilian – Thank God. Now we can walk in and smile and not be embarrassed. That used to be my nightmare. For example, patients come, they don’t know where the delivery room is, and they walk into this ugly room. That used to be a very big problem for me, it was nothing for a woman delivering her first child. I’m happy.David – And now it’s really nice.Lilian – Thank you for spearheading that process for renovation.David – It’s night and day different. I think there is a process we are going through, not just in Kijabe, but in Kenya, where the bare minimum is not acceptable anymore.Lilian – No it’s not. We have to give the best to our women. . .and to any patient who walks into any hospital. I think we have gotten used to the poverty mentality to the point that we are not willing to go the extra mile to make things better, as opposed to just living today.David – We were just talking with a doctor who wanted to come visit a clinic doing more open surgeries than laparoscopy. Which is reality for a lot of places. But here in Kijabe, I feel like we have the option to do things with excellence. That’s why you’re here!Lilian – That’s why we are here. To make a difference, and to live our purpose too, which is to do everything with excellence.David – What we’ve been talking about is how as Friends of Kijabe, we can help with the Obs/gyn department – what is feasible to do, and in some ways, what is the Christian thing to do.Why don’t you tell me about the patients or populations/demographics that have been the most stressful, and that we agree these might be able to most easily address their needs?Lilian – Among the patient populations we’ve been concerned or have special interest about have been cancer patients who come and need urgent care, yet they’re not able to pay for the services offered. These are patients who are coming and don’t have National Insurance Cover. National cover requires three months to mature, even if someone was to apply as soon as the diagnosis is made, but that is too long to wait.David – Because with cancer, usually they’ve waited too long anyway right?Lilian – Yeah, so by the time they are coming, we need to make radical decisions at that point. As much as it may be a small population, we feel like the care they deserve should be accorded to them, regardless of their financial status. That’s why we feel they need support.David – So for gynecology-oncology patients, do they require surgery and chemotherapy or sometimes just surgery?Lilian – It depends on the type of cancer and the stage or the spread. Early cervical cancer patients might require only surgery and that is it, unless they have evidence of spread, like in the lymph nodes in which case they need chemo-radiation. In case of radiation-therapy they have to be referred out of Kijabe.David – Chemo, you can usually do here now?Lilian – Ovarian cancer, most of those cases will go through surgery, then eventually will require chemotherapy after, which can be given to them in Kijabe.Some cases are strict referrals, for example, advanced cases, which are not operable. We will refer for the combined chemotherapy/radiation therapy. The few we are able to handle here require chemotherapy and surgery.David – This is becoming a big issue in Kenya, it’s all over the news.Lilian – It’s all over the news. I think, partly because of improved diagnostics. There is more advocacy for screening and early detection. There are over 3,000 deaths from cervical cancer every year.Our joy has been able to sort patients at an affordable cost compared to what they would have to pay in Nairobi.In 2016, we had 11 cancer surgeries for gyne. In 2017, we rose to 31, in 2018, we had 41. We hope this year we can have an even higher number that are detected early to get surgical management. There is more awareness and people are coming through referrals and we are doing aggressive screening for cervical cancer.David – I don’t know if it would directly relate to your patient population in Kijabe, but life expectancy in Kenya has grown 1 year every year for the last 15 years. Fifteen years ago, life expectancy was 48 and now its 63.Lilian – Yes, it’s 63 now.  It’s an improvement. As much as we know many are still dying, I really think there is something positive happening as far as improving primary health care and advocacy for many things, with health being a big agenda for the president. We are seeing a lot happening even in the country places. We appreciate that they are doing something.David – That’s gynecology/oncology, what’s your other patient demographic that you personally stress over? This isn’t something out there, it’s something very close to your heart.Lilian – For gyne-onc, I’ve also lost family through cancer and I think there is so much we can do in terms of primary prevention and early detection, which is not really emphasized so much. I think for Kijabe that’s one area we could do well in.A second type of population we see are young pregnant women who need emergency care and they can’t access to the point of saying “don’t admit me.” We know that whatever happens on the other side, the care they will get is substandard.For example, a patient who comes with preeclampsia in the 7th month of pregnancy, the baby requires newborn ICU admission and the mom require HDU or ICU care, clearly you can’t refer those patients because of finances.There are teenage girls with unplanned pregnancies coming with no insurance cover, who require emergency, comprehensive obstetric care. That population is at very high risk for mortality and morbidity for both mothers and babies. They may be few, but those few deserve to live.David – you’re concerned specifically about abortion or if the baby does come, what happens to the baby afterwards.Lilian – We’ve had different encounters with primary school, high school girls coming and wanting a termination, and we’ve said no. But even if we say no, we are supposed to be giving them solutions, alternatives. Who is going to help with the clinics? They are already high-risk by virtue of age, by virtue of them wanting to terminate. Who takes care of the clinic bills, who takes care of the delivery, who takes care of the child afterward in postpartum clinic reviews? If baby requires specialized care, what happens? These are young girls who are prone to depression, psychosis, suicide, and I feel like they deserve better because that’s a point of ministering to them. I think those few hours we spend with them are enough to actually change their lives, not just because of their condition, but even in terms of eternity.These high-risk patients that come to us and they don’t have better options, I think they deserve more. Especially those who come with unplanned or what you call crisis pregnancy.David – There is precious-few resources for things like that.Lilian – One, young people are condemned by society for making wrong choices. Two, there are no options given to them. If they are given, they are poor options, like terminations, which means going to the backstreets to terminate. It is cheaper of course and it won’t be known. That has resulted in high mortality for girls.Among the top 5 [maternal] killers in our country, we still have abortion. Beyond hemorrhage and hypertension, have abortion topping because of girls going to the back streets for termination of pregnancies.As we take care of them and do abstinence and user protection, when all those steps have been bypassed, we need solutions for these girls.David – I’ve seen Kijabe babies be placed in homes.Lilian – There are many options, it’s just I think we don’t take that time that has to be spent walking with such, there is the financial aspect that must be considered from way before, during pregnancy, delivery and thereafter. We have a few rescue homes that do a job for these girls, but not all go to the rescue homes. So, can we be a sort of rescue home in terms of the medical care that we’re giving.David – And we can make sure that they are not making bad decision for lack of finance. A delivery in Kijabe is $250 or $300.Lilian – That could be all it takes for them to actually see there is hope.David – Who is the one you were telling me about that came with the grandmother.Lilian – At least a happy one. This was a sixteen year-old, who got pregnant while in form 2.  For you guys, that would be 10th grade. Every time she would come for a clinic, she would be accompanied by the grandmom who would pay the bills for the clinic. And the grandmother would make sure she was okay.This was a grandmother who lost her daughter, and her daughter left her with a grandchild who became pregnant. She was taking care of the great grand-child after the delivery.I think what really made my heart feel warm was the love, and the fact that she was there to support her and tell her, I’m here, I will pay your bills, and I’ll take care of my great grandchild, and you’ll go back to school after the first few months.That love shown to this young girl who may have opted for termination if there was no other option.The grandmother was able to afford some coins to walk through the journey. No fancy clothes for the babies, but maybe, some coins to buy a packet of chips, to say, “I’m here for you.”David – One other one that was very special for several of us and for me personally, the first time I walked through this process, was a teenager who came in with a pregnancy, I think it was twins and they lost the first twin. I think it was 30 or 32 weeks. I heard about it from Dr. Mary Adam, “Hey, there’s this little baby and the mom has gone, she has abandoned.” All the nurses and the doctors at the hospital, said, “this is our baby.” That was the first person we ever crowdfunded for individually. The way it happened was amazing. I walked through the NICU one day with a camera. She raised her hands up to me. "You want this picture don’t you? You want people to take care of you!" In that picture she was wearing a diaper that came up to her neck, and now when you see her, she is two years old, she is round and chubby.For what it takes to do the right thing, in my mind, it’s such a tiny amount of money, to take care of the mother and the baby.We do have some general funding coming in toward this. We hope that can increase over time, as some of our obgyn’s become involved. Also, any of you guys who might be listening to this, anyone who gives to the Friends Fund, a portion of that goes to vulnerable patients. Basically we want to say yes when someone needs something. That’s the goal.Anything you would like to add?Lilian – Just requesting humbly for support wherever it comes from. Of course we are very grateful for those who have had Kijabe in their minds, and for whichever way they support, whether by been human resource, whether it’s financial, whether it’s prayers, whether it’s encouragement.David - AbsolutelyThe Estimated Incidence of Induced Abortion in Kenya: A cross-sectional study. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4546129/

FULL EPISODE EPISODE SUMMARY Conversation with Dr. Mardi Steere about Mission, Leadership, Emergency Medicine and Ebenezer Moments from her 8+ years at Kijabe Hospital. EPISODE NOTES David - So today, I'm talking with Mardi Steere. This is a conversation that I don't want to have. It's about leaving about memories, and about Kijabe.And I don't want to have it because I don't want you guys ever to leave. That is the hardest part of life in Kijabe. But amazing people come and amazing people go and you're gonna do amazing things and stay in touch. First, why don't you give the introduction you gave at the medical team the other day. Mardi - So this is bittersweet for me as well. We came to Kijabe in 2011 and planned to stay for two years and here we are eight and a half years later, taking our leave. And in some ways, it's inevitable. You can't stay in a place forever. It's been a real opportunity for me to reflect. David - Let me pause you real quick there. So when you first came, who is we? And then what did you come to do? Mardi - In 2011, I was a young pediatric emergency physician with an engineering husband looking for a place where we felt like God had said "To whom much is given, much is required," and we knew our next step was to go in somewhere with the gifts and the passions and the exposure and education that we've been given. And so I came as a Pediatrician, and the hospital hadn't had a long-term pediatrician in quite a while. Jennifer Myhre had just joined the team in 2010 and my husband Andy is a civil engineer and project manager, and now, theological educator as well.We moved here with our then two-year-old and four-year-old to do whatever seemed to be next. David - That's amazing. So give the theological introduction to the Ebenezer. Mardi - It comes from first Samuel Chapter 7 verse 7-12, where there's a battle between the Philistines and the Israelites and Samuel lays a stone to God for being faithful and to remember what God has done. When Andy and I got married in 1998, actually, it was a scripture that was read at our wedding. And we were encouraged when these Ebenezer moments come, take stock of them, step back, and acknowledge what God has done . Those moments will be key moments in your marriage. As I was talking to the medical division the other day, I felt like it was just another reminder that, as we have our professional lives and we work in a place like Kijabe and we serve, it's really easy to get caught up day-to-day in the daily struggles that we all have - with life and death and bureaucracy and not enough money and not enough equipment and team dynamics and conflict. But there are these moments when we take a step back and we see what God has done. This hospital has been around for 100 years, and I've only been here for a little over eight of them, but there are so many moments where I look back on where we've come from - and the journey that we've been on - and I see these landmark moments of God intervening. David - How do you see the balance here between medical excellence and spiritual - I don't know if excellence is the right word - between medical excellence and spiritual excellence. I think the origins of medicine were very intertwined with the spiritual, but at least in Western medicine, it's very divorced and I feel like in some ways, what I see happening here is not taught in classrooms anywhere else. Mardi - This is one of those things that I am going to be taking with me for the rest of my life. I don't know who's listening to this, but Americans have a cultural Christianity where it's acceptable in medicine, I think, to ask medical questions and maybe you ask a spiritual question and saying God bless you and bless her heart, and praying for people is somewhat accepted but still it's a parallel track to medicine. In Australia, it's completely divorced. There's almost a cultural fear of discussing the spiritual in Australia, a very agnostic country. So to be a Christian in Australia, you have to make a choice. But then when you go to medical school, it's taught to you almost don't bring that in. This is a science, and one of the things that I love about Kijabe is that they are inextricably intertwined. There isn't a meeting that we start here without prayer. When I'm covering pediatrics, as a clinician, we start with team prayer and depending how busy things are, if you're trying to see 30 patients on rounds, you might pray for the room, as you start. We ask the parents how they're doing, and then we pray for the mom with her permission, and for the baby or the dad or whichever caregiver is there. We ask God to intervene, we ask God to give us wisdom, we ask him to be a part of the science. We ask him to be a part of the conversations. When it comes to the even bigger picture, when it comes to strategically planning the hospital, and our core values again - they're inextricably intertwined, and it's a gift. One thing that I'm gonna take with me as a leader and as a clinician, is that it is not difficult to ask anyone, "What is your world view and what is your spiritual worldview? Because all of us have one in Australia. That world view might be... "I don't believe there's a spiritual realm." That's so important to know. But what if the answer to that question is," I believe in God, but I don't see him doing anything." What an opportunity we miss. What if we have immigrants in our population in our community, and we don't ask them "What is your spiritual and cultural world view? What do you think is happening beneath the surface?" and we don't give someone an opportunity to say without derision, "I think I've been cursed" or "There is a generational problem in my family," and we don't open up the opportunity to intervene in a way that's holistic, much we miss by not intertwining the spiritual and the physical? The fact is every one of our communities has a spiritual world view, and shame on us if we don't explore it with them. David - Amen. It's fascinating here because before coming here, I thought of missions as giving. The longer I'm here, the more I think of it as receiving. When you stop and pray for a family, the encouragement received from those family members is huge. The trust and the love, and you do see people who come in the halls and you ask, "Why are you here?" "Because my doctor will pray for me." Mardi - So what's interesting to me is there are some conversations going on in medicine around the world right now about this "innovative new concept of Compassionomics." And really it's exactly what you're saying, it's not new and it's not innovative. I think that Compassionomics is our fearful way of re-exploring the spiritual. It's taking the time on rounds to say, "How are you doing as a family, how are we doing as a team," and to take the opportunity to draw comfort from each other. It comes from a spiritual foundation, that I think that we've lost, and I think a lot of it comes from burnout and from the way that medicine has become a business and a commodity. We're starting to re-explore through Compassionomics, and I pray through exploring the spiritual, the deeper side of medicine that around the world I think people really miss. David - Right on. Mardi - And if that's not reverse innovation, I don't know what is. David - It's fascinating, this space that Kijabe fills and how we think about it and how we talk about it. I use a phrase - World class healthcare in the developing world - but when I use that, I don't mean that I want Kijabe to be the big hospital in the big city in the West, because there are certain aspects that we don't want to lose. Yes, absolutely, it would be super-cool to be doing robotic surgery, and some of these wild technological things, but really I feel like what Kijabe excels at is not fancy and not glamorous. It fundamentals of medicine. I remember Evelyn Mbugua telling me this one time. I asked her, "What do you think about medicine in general?" "When I have a challenge or when I'm stuck on a patient, I go back to their history." It's fascinating that that's fascinating! Some of the basic fundamentals of medicine are practiced here, just looking at your patient and laying your hands on them and touching them and talking to them. A conversation is both a diagnostic tool and it's actually medicine. If the numbers are true, I know it's different from orthopedic surgery than for outpatient, but, if half of medicine is actually placebo, this stuff is really important to healing. And it's not anti-science. It actually is science to care about people. Mardi - It's interesting when you mentioned the placebo effect. I think that the placebo effect is considered as nothing, but it's not the placebo effect, is actually a real effect. It's that time and conversation and compassion, truly do bring healing and the point of a control trial is to see in a drug-do better than that. But the thing we're doing, already makes sense. It's interesting to me that medicine around the world is getting faster and faster and more and more advanced. Time is money. I think that around the world, we wanna save money in medicine, we wanna do more with what we have, but we're willing to sacrifice time, to make that happen. And why is that the first thing that goes? Burned-out physicians in high income countries, the thing that they love, is when they have to see more and more patients in less and less time because they know what they have to offer is beyond a drug, and beyond a diagnosis and beyond a referral and beyond a surgery. The one of my favorite phrases in medicine that I truly don't understand but want to spend the rest of my life working on it, is a "value-based care." I think to define value you have to define what we're offering. If value is time, then one of the things I think that Kijabe and mission hospitals can continue to pioneer the way in is, "how do we cut costs in other areas but refuse to sacrifice the cost of time and make sure that our impact is helpful for our patients but that also helps our team members and our clinicians receive the value that comes from being a part of a meaningful conversation. I think that's what patients want too. They don't want the robotics, they come to us because they're helpless vulnerable and afraid, and those are the things that we're treating. They trust what we tell them and if we don't have the time to build up that trust, we've lost a lot of the value that we offer. David - What have you seen change about team? You guys have been part of this big culture change process, but I think it's something that's started long before long before either of us. What do you see is the arc of Kijabe and the archive teamwork and the arc of culture? Mardi - So, Kenya is an incredibly multicultural and diverse country and Nairobi is high-powered and it's fast and it's a lot of white-collar and highly educated people and Kijabe is not so far from that. I think we operate more in a Nairobi mindset than a rural, small town mindset, but that's actually been a huge transition, I think, is going from presenting ourselves as a rural distant place to a part of a busy growing rapidly advancing system, and so that comes with leadership styles that become more open and more I guess, more modern in style. And so that's been the first big thing that I've just seen a huge jar over the part of the decade that I have been here is that leadership is no longer just top-down, enforced. It's participational leadership and I'm a massive fan of that. Leaders do have to make hard decisions and make things happen, but the input of the team has become a much, much higher priority in the last decade. And that's huge because our young highly-educated, highly-aspirational team members have got some great ideas and shame on us as leaders, if we don't take the time to listen to their approach to things. So that inclusive style of leadership has has been a huge arc. And then I think the other thing is just our changing generations, millennials are not confined to high-income countries. We have a young generation of people here who aren't gonna stay in the same job for 40 years like their parents or their grandparents did, and that's the same globally. And so we've had to question, over the last decade, how do you approach team members who are only gonna be here for a little while? Do you see that is, they're just gonna go, or do you get the maximum investment into them and benefit out of them in the time that they're gonna be here and then release them with your blessing? And so that's been something that's been huge for me is when we've got these new graduate nurses or lab staff radiographers, to not be on the fact that three years after they come to us, they go it's to say, "You know what, we've got these guys for three years, let's sow into them, let's get the most we can out of their recent education... Let's do what we can to up skill them with the people that we've got here and then let's release them all over Kenya to be great resources for health care across the country and across the region. David - I would say, for healthcare and for the gospel. I've been wrestling a lot with what does it mean for Kijabe is to be a mission hospital. I think the classic definition - I don't know if we define it as such, I don't often hear people say it out loud, but I think it's an unwritten thing - that what makes a Mission hospital a Mission Hospital, is that it cares for the poor. Hopefully on some level, or on a lot of levels, that will always be true at Kijabe. But I'm really excited about the possibility of what you just described, that if these guys are here for three or four years and we are to training them with the attitude that they are going out as Christian leaders and as missionaries to these parts of Kenya that honestly, you and I will never touch. And a lot of the places I've never even heard of. But if we're equipping them to be the light that's the huge opportunity that Kijabe has to be missional. Mardi - This is a much, much longer podcast, but defining mission is really really important, isn't it? I think that there's a couple of things that stick out to me as you're talking and one is that, I think mission has a history that can be associated with colonialism. And one thing I love about my time in Kenya is seeing that we are a globe of missionaries. The church that we attended in Nairobi, Mamlaka Hill Chapel, these guys would send mission teams to New Zealand, which is fabulous. It's not that lower middle income countries are receiving missionaries anymore. All of us need the gospel, all of us need the full word of Jesus and when you're spreading the gospel, what are you spreading? I think that this is a much longer conversation, but I believe that we are called to go and make disciples we are called to serve the sick, we are called to serve the poor, we are called to serve those in prison. I focus on the parable of the sheep and the goats, it is one of my life scriptures, "when you are poor and sick and needy whatever you did for the least of these, you did for me." And what I hope for Kijabe does is that for whoever passes through our doors, whether it be patient, whether it be staff member, this is who we are, we love Jesus and we want you to know this incredible King who gave so much for us and who has an eternal life for us that starts now. And eternal life starting now means making an impact and restoring that which is broken, and it means restoring it now, wherever you are. As our team members go out to work in other hospitals, I would hope that one of the indicators of success for us would be a lack of brain drain, because it would show that we've shown people, "You know what there are people here that need you in healthcare. And this is why I'm here." If I had wanted to be an evangelist rather than a health care missionary, I should have stayed in Australia, for less people in Australia know Jesus that in Kenya. But I felt like my call in mission was to serve the sick in a place where I could help other people do the same. That's been my passion here, but I'm called to go back to Australia now. Does that mean my mission life is over? Absolutely not. It means that I'm going back to Australia to love Jesus and serve sick there and to do it in a different way. And I think that understanding that all of us, whoever is listening to this podcast right now, wherever you you have a call to mission, it's that sphere of influence that God's put you in. It's to take care of the poor or the sick, or to love the wealthy, who are lost around you that are never gonna step foot in a church but need a love of Jesus every bit as much as one of our nursing students here in the college. David - Amen again, that's fantastic. So back to Ebenezers, back to the the stones. What are things come to mind as you look back over on your time at Kijabe that were hallmarks or turning points? Mardi - There's a few of them. One evening sticks out to me because it's so indicative of the bigger picture and what we've been working towards. I'd been here for about nine months or so. . . One of the things that Jennifer Myhre and I noticed is we started out on pediatrics was that our nursing staff were incredibly passionate about their kids, but no one had really had the time to teach them about sick kids and how to resuscitate them, just basic life support, because they were so overwhelmed. You know, there was one nurse who was taking care of 12-15 patients at a time. That ratio is now one to eight, so it's much easier. But they just hadn't had the opportunity to learn some of the basic life-saving assessment in resuscitation skills, and so we started doing just weekly mock resuscitations with the nurses and as we got to know each other and they got to trust me and to know that I wasn't there to, to judge them, but to try and help them, we would do mock recesses every week, and people would stop being scared of coming and would come with by interested and actually came to test their knowledge. When I started in 2011, about once a week I would get called in, in the middle of the night to find a baby blue and not breathing, who was dead, and there was nothing that I could do. But what we worked together on was setting up a resuscitation room, and setting up the right equipment. And so after about nine months of this, I was called in for yet another resuscitation in the middle of the night, and by the time I got there, the baby was just screaming and pink, and I asked the nurse is what had happened and it was the same story as always, this baby choked on milk, they had turned on the oxygen given the baby oxygen done some CPR and they resuscitated that baby before I got there, they didn't need me at all. And the Ebenezer for me was the was the pride on their faces. "We are experts at this and we know what we're doing." That has just escalated leaps and bounds. Now we've got outstanding nursing leadership and they're being equipped and taught and up-skilled every day. But that was an Ebenezer moment for me that the time taken to build relationship and team and invest doesn't just bring a resuscitated baby and life is important, but it builds team and it builds ownership and pride in "this is what I've been called to do, and I'm good at it." It's interesting because it's what you would do is individual doctors with your teams and doing the mock code. But it's also very much a systems process for Kijabe hospital, right? A big part of solving that challenge was getting the right nursing ratios, but also setting up high dependency units to where children you're concerned about could be escalated. Did that happened during your time here? Mardi - So when we started here in 2011, children weren't really admitted to the ICU at all unless they were surgical patients who just had an operation, and then the surgeons would take care of them and transfer them down to the ward. So the pediatrics team wasn't really involved in any ICU care, extremely rarely. We didn't have a high dependency unit. And our definition of high dependency unit, here, is a baby that can be monitored on a machine 24-7. This is something that shows you how reliant we are on partnerships, David. So for example, the nursing and the medical team together decided, "Look, we think we need a three-bed unit, where at least the babies who were the more sick ones can be monitored on machines." And so, Bethany kids were the ones who equipped... We turned one of our words into a three-bed HDU in the old Bethany kids wing, and that was the first time we could put some higher risk babies on monitoring so that if they deteriorated we knew about it sooner. And we saw deaths start to drop, just with that simple thing. The other thing was that pediatricians who worked here in the past weren't necessarily equipped in how to do... ICU care. And so Jennifer and I said, "Well I'm a Peds-emergency physician, and she is an expert in resource-poor medicine, between the two of us, we can probably figure this out." We started putting some babies in ICU who we knew had a condition that would be reversible if we could just hook them up for 24 hours to ventilator. So we started ventilating babies with just pneumonia or bronchiolitis. Or sepsis, that was the other big one, something that if you can help their heart beats more strongly for a day or two, you can turn the tide. And so we just started working with the ICU team to say, "Look, can we choose some babies to start bringing up here? And four years later we were overtaking the ICU at the time and that's why we had to build a new Pediatric ICU, which opened in 2016. All of these things are incremental, and we stand on the shoulders of giants. The Paeds ward existed because a surgeon said "I don't want babies with hydrocephalus and spina bifida to not get care." And then we came along and said "We think that's great, but we think that babies with hydrocephalus spina bifida, who also have kidney problems and malnutrition, should probably have a pediatrician care for them." And over time, that degree of care, that we've been able to offer has just grown and grown. And we had Dr. Sara Muma as a pediatrician join us in 2012 then Dr. Ima Barasa - she was sponsored into pediatric residency long before I got here. That was the foresight of the medical director back then, to say "We are gonna need some better pediatric care". And then I stepped into the medical director role and people like Ima and Ariana came along and they've just pushed it further and further and further. None of us are satisfied with what we walk into, and we keep saying we can do better because these kids deserve more. David - That's fantastic, I think that's another way when you think about the influence and the impact of Kijabe, it's that refusing to settle. It's to say, "Yeah this is possible. Let's figure it out." And for all the team members to say that and commit to it, and for the leadership to support that I think that's what makes Kijabe special. I read something that the other day, it was just an interesting take, someone said [to a visiting doctor] "Why are you going to that place? It has so much." But Kijabe only has “so much” because the immense sacrifice of so many people over so much time. None of this showed up without the hours and the donations and years and years and years of work. I remember you saying that about Patrick with his ophthalmology laser? How did you phrase that? Mardi - Patrick, he's such a wonderful example of the kind of person that doesn't look for reward, but sees a need and just walks to the finish line. He started out, I believe, on the housekeeping team in the hospital. He's been here for 20 years at least, I think, and then went through clinical office or training, which is a physician assistant level training, and then received higher training in cataract surgery. He started our ophthalmology service in 2012. Since then he had nurses trained around him. He's been doing cataract surgery, and then he said, "We've got these diabetic patients and the care we offer isn't good enough, we need a laser." He went to Tanzania, and got laser training, and now he's going to start doing laser surgery on patients with diabetic retinopathy. He refuses to be satisfied with the status quo. And that's the heritage that we have here. You know, talking about even a moment I feel them enormously privileged to have been here in 2015 as we as a hospital celebrated our centennial. It took us a year to prepare for that, and I know you were a part of that process, David. David's job was find all of the stories and all of the photos and interview all of the people and make sure to document everything that might be lost if we lose these stories now. Being a part of that process... I was in tears so many times when we would hear one more story about somebody's commitment and sacrifice. We've been able to write down that story from 2015, with the Theodora Hospital as we were known then. The stories of not just these missionaries but these extraordinary early nurses, like Wairegi and Salome who worked here for decades, who were initially trained informally, because we didn't even have accreditation for the nursing program. David - We didn't even exist as a country. Mardi - That's a really good point! To hear those stories and to see our very first lab technician was just amazing. And then when these 80 and 90-year-olds came over and saw the scope of the hospital as it exists now, it just gave me a glimpse into whatever we do today, we have no concept of 100 years from now, the fruit that that will bear. And I think a missional life, is like that, isn't it? It's being okay with not seeing fruit. There's foundations positive and negative, that all of us lay in the interactions and the work that we do and I think all of us, our prayer is that those seeds that we plant would bear fruit. We have to be okay with not seeing the fruit with saying this has been my contribution. I've stood on the shoulders of giants and now I hand over the baton to you, who will come after me. Make of it what you will. It's not my dream and it's not my goal, I've done my part, and let's see where God takes it through you. David - And so, very shortly, you're about to become a giant. [laughter] I really appreciate you, I appreciate you bringing that up. That was one of the most important things that could have ever happened. It was in the 2015. It was before we started Friends of Kijabe. The realization for me I always come back to how long life is. It's both amazingly short and amazingly long. Watching Dr. Barnett and realizing that he worked here for 30 years, and then went back to the states, so now he's... I think he just hit 102 years old. It really does bring in a clear view what is legacy, what does it mean and what are we building? But also that this is very much outside of us. We get to pour everything we have into it for a time, but then others will take up that work. And it's both humbling, and amazing and... Mardi - And I think it's helpful to as many of us have a sense of calling on our lives, I think that this is what God has for me now. But we have to hold that with open hands because our view and our understanding of what God is doing is so small and what he is doing is so large. I think sometimes in this kind of setting, you come in with a dream and a passion and a goal, but you see that path shift and change during the time that you're here and that is good and that is okay. I think a danger is when we come in and think that we have the answers or we know exactly where God is going, and then things don't work out, and we burn out or are bitter or disappointed. To come into a sense of mission and calling... Saying "not my will but yours be done," and to just obey in the day-to-day and to see where it goes and to be okay with the direction being different at the end than it was at the beginning - I think that's how we lead a life led by the Spirit. We hold these things with open hands and say, "God take it where you will" and if it's a different place, let me just play my part in that. David - Okay, I gotta dig into that cause. How do you balance that? I would frame it as vision. I feel like a good example to look at, I don't know if it's the right one, so, you can choose a different one if you want to, but the balance between vision and practicality and reality. Because you say that, and you are walking in the day-to-day, but I just think of the Organogram that has been on your wall, which was on Rich's, wall, which is now your's again, which is about to be Evelyn's wall. And you had this vision back in, "this is how I think the organization should work to function well." But there's a four-year process in making that come to pass. How do the day-to-day and the long-term balance? Mardi - I think we're talking about spiritual and practical things combined aren't we? I think that anyone who's in organizational leadership knows that you, your organization as a whole needs a trajectory and a long-term plan. We make these five-year strategic plans which are based on the assumptions of today and every strategic plan. You need to go back every couple of years and say, Were those assumptions right? And just to be a super business nerd for a minute, you base things on SWOT analyses and you base things on the current politics and economics. David - What does SWOT stand for? Mardi - Strengths, Weaknesses, Opportunities and Threats. Then you do a PESTLE analysis, you look at the politics, you look at the economy, you look at the social environment of the day, etcetera etcetera. In technology everything is changing quicker than we can keep up with. And so I think that when you're looking at a place like a happy, which is large and complex, you set yourself some goals, and you work with them, but, you know, so something's going to change. Politics are gonna change, the economy's gonna tank, maybe there's gonna be a war on the other side of the world and we’re the only source of this, that, or the other?Maybe India falls into the sea and we start doing all of the surgeries that India was doing? I just don't even know. One thing for me, I've been enormously privileged to have been the medical director for two different terms that were separated by two years. And so I think I have a slightly unique perspective because from 2013 to 2016, I set the way I thought that our division would work and I came back into the role, two years later and already it had changed, but Rich had made it a better. It's funny, I when I came into the role, my predecessor. Steve Letchford said, "Look, you're gonna need a deputy, you can't do this by yourself." And I looked at my team and said "Um, No, I need four deputies, four sub-divisional heads because this is too much for one or two people and I can't keep my ear to the ground without it. I came back after two years away and there were five deputies and my initial gut reaction was, "You changed my structure!" And then I realized that Rich and Ken had made a really wise call. It did have to be five deputies for lots of really good reasons and that team of five has been my absolute rock this year. David - Who is the team of five? So the team of five, I've got a head of inpatient medicine and pediatrics, and specialties and this George Otieno. There's a head of Outpatient Department, and Community Health and Satellite clinics, and that's Miriam Miima. I've got ahead of Surgery and Anesthesia, and that's Jack Barasa. There's a head of Pharmacy, and that's Elizabeth Irungu. Then there's a head of what we call Allied and Diagnostic that incorporates the Lab and Pathology, Radiology, Physiotherapy, Nutrition and Audiology, and the head of that, it is Jeffrey Mashiya who is a radiographer. What's amazing to me about that is when I instituted this framework in 2014, there were four people and they were all missionaries. And I've come back in 2018 and there are five people and they're all our Kenyan senior staff and they're extraordinarily talented and any one of them can stand in for the medical director, when the medical director is away. What a gift that has been. David - I can't imagine how important this is for continuity. Because you think right now, you're handing off your responsibilities to Evelyn, but she has five people that...those are the executors and they actually get to groom her in leadership. That's amazing and for the strength of Kijabe and the stability, it's indispensable. I don't think there's another way to build a strong, stable system other than to build that. Mardi - Yeah, that's actually one of the things that brings me so much joy as I leave is the team isn't going to notice too much the change in senior leadership because that level of day-to-day practical strategic and operational leadership is just so strong. I think it made Ken as my CEO, I think it made his job easier to say, "Look, who should fill the position that Mardi is vacating?" He was able to say, "Who's got institutional memory and who's got leadership expertise and wisdom, and who knows how the senior leadership team works?" Whoever that person is, they're gonna have a team around them that will mean that no voices get lost in the transition. When I took the job in 2013, hearing the voices of specifically missionaries and surgeons can be really noisy and you hear their voices, but who's listening to the head of palliative care and who's listening to the head of laboratory who's listening to the head of nutrition, which is a tiny team of four people, those voices are well represented by wise people who all listen to each other and make the system work around them. It's a tremendous gift and there's no way to do this job without a team of people like that around you. And you know what, that's one of my other Ebenezers, David. Thursday, we installed Evelyn as the incoming medical director. Seeing those five sub-divisional heads praying for Evelyn and as that took off, I will never forget that. David - Absolutely. I wasn't here the first time, but I remember I should print out a series of those [pictures] because I remember you handing the hat to Rich and I remember it going back to you and then watching you give Evelyn the hat and stethoscope. There's this legacy of people that care. It's interesting to think about... 'cause you are, I mean you’re building this remarkable team and your system and things that operate independently of you. But at the same time, you're unbelievably special, and have given a ton over the past years and you. As Rich phrased it, you walked in shoes that not many other people will get to walk in. It's special. I imagine is what it's like when the former presidents get together for their picture. There's things that only only you guys will know and only you guys will have experienced. Mardi - You know, one thing that is really special is I think a lot of leadership transitions come through pain, brutality and war. And one thing that I noticed on Thursday, is that in the room as I handed over leadership to evil and were Steve Letchford and Peter Bird, who have both been here for decades and who've previously been the medical directors. I think there's a beauty about the transition of leadership here in the clinical division that it hasn't come through attrition, war and burnout. I'm leaving with a lot of sadness, and I'm not cutting ties with this place to see. . . there has been a cost. Rich. I know, I would still love to be here in this position as the person who is my predecessor…but to see such strength of leadership that is here and sowing into the next generation rather than leaving when they died. They've stepped down and gone into leading other areas to ensure that the team that follows them is strong, I think that's a tremendous gift and something unique about Kijabe. People love this place and they love this team and they wanna be a part of its ongoing success in its broader mission. David - And they love and they love that above their own glory and their own desires. I think it's what makes an organization great, it’s what makes a country great. I think it's probably gonna be easier in a place of faith, honestly, that this is God's ministry, not our own, not any one persons's. FPECC What is FPECC? I think it's important for people to know a little bit about how hard is it to create a training program or anything new in Kenya? Mardi - So FPECC is the fellowship program in pediatric emergency and critical care. Ariana [Shirk] and I are pediatric emergency physicians, we trained in pediatrics, and then we did specially training in how to take care of emergencies and resuscitation. And were the only two formally trained pediatric emergency doctors in Kenya. Critical Care is taking care of kids in ICUs and currently in the country, there are four pediatric ICU doctors for 55 million people. I don't have the stats that my finger tips, but it's extraordinarily low. I think of the city where you live and how many ICU beds there are, and how many children's hospitals you have just in your own city if you're based in a high income country. For 55 million people, there's kids just can’t access that care. David - Recently, I'm sure it's gone up, but two years ago, it was 100 beds for the country. Mardi - For adults and kids. . . In the country, there are a 12 pediatric ICU beds. Actually no, that's not true, there are 16 and eight of them came into existence, when we opened up our Peds ICU here three years ago. David - And keep in mind, this is East Africa, of the 56 million people. . .33 million of those are under age 18. So 16 beds. Mardi - That's right. Think of anything that can cause a critical illness. Trauma, illness, cancer, you name it, that's not enough beds. So when I came to Kenyo, I had no dream of starting a training program that wasn't even remotely on my radar. But sometimes things just come together at the right time. It was actually University of Nairobi, where they have the only other Peds ICU, they had been working with University of Washington in Seattle to say, “Look, can you help us start some training?” This is really important, because in East Africa there is nowhere that a pediatrician can learn how to run an ICU. Think of the US, where every state has got multiple training programs, where pediatricians will spend three years to learn to be an ICU doctor. There is nowhere for 360 million people in this region to learn how to do ICU care for children. Just think about that for a second. 360 million people... No training program. There's one in Cairo, and there's one in Cape Town, but that's for 600 million people. So I'm just taking a few of them where there's nowhere to go. University of Nairobi was talking to Seattle. They've got two Peds ICU doctors in Nairobi and they were thinking of starting a program. Then just through several contacts, actually through the Christian mission network, one of University of Washington's ICU doctors grew up in Nigeria but she's involved with the Christian Medical and Dental Association, and so she knew about Kijabe. The University of Washington team came out to Kenya for a visit, and they said, "Hey we heard you doing some ICU care caring Kijabe. Can we come out and see what's happening?" That was in 2013. They came out and said "Hey what are you guys doing here?" And we showed them around, and their minds were blown, they didn't know there was any peds ICU happening outside of Nairobi at all. And so, we rapidly started some conversations and said "Look, why don't we start a training program in Pediatric Emergency Care and Critical Care and our trainees can train at both Kijabe hospital and Kenyatta hospital in Nairobi and they can get an exposure to two different types of ICUs. They can also take advantage of the fact that Ariana and I are here as Peds Emergency faculty, and we can split the training load. Training programs in the US have dozens of faculty for something like this, to rely on just two doctors in Nairobi was an incredible risk even though University of Washington is supporting with visiting faculty. So we said, "Look, we've got all these people in the country at the same time, let's just try and do it." So we started that process in 2013. We took our first fellows at the beginning of this year. It's taken us six years. That's how things work here. You've got to form relationships. University of Nairobi didn't know us real well when it came to our pediatric care. We had to get to know each other, we had to develop a curriculum. We had to let the Ministry of Health know. We had to get the Kenya pediatrics Association on side. The Kenya Medical Practitioners and Dentists Board, had to approve the program. The University Senate had to approve the program. We had to try and get some funding in place. None of that happens quickly. It's all relationship that's all a lot of chai. That's all a lot of back and forth and making sure that you don't try and skip anything to get through the hoops, any quicker than you need to, because if you try to go to quick it falls apart. And if University of Nairobi and Kenya doesn't own this program, it's not gonna last. And I think that's probably the first thing to take away for me is this program exists because University of Nairobi and Kenya wanted it I didn't come in here and say, "We need this.” University of Nairobi wanted it, and we said, "How can we support it?" And so Arianna showing up here for a short-term visit - which we rapidly recruited you guys as long-term - it was God's timing because Ariana and I couldn't have done this independently from each other. It's taken both of us to build those relationships over the last six years. Arianna and I are so proud of this program. Our first two graduates will finish this training at end of December 2020, and we hope and pray that we can recruit them to stay at Kijabe and University of Nairobi as our first home-grown faculty. What's been lovely about that, too, is that we've connected with people all over the world who want to support this kind of thing, they just didn't know how. David - Not did they not know how, there wasn’t a way. It literally did not exist until February 2019. Mardi - So now, we're actually talking to colleagues in Uganda and Tanzania, and colleagues in Sudan and other places about... “Hey, is this a good model for you?” I've got some contacts in Nigeria, they've got how many million people, 30 million people or something ridiculous? And there's no way to get this training there either. And people all over the world want to be able to support what a country wants to start in its own strategy. So that's something that I'm just thrilled to be leaving. Even as we leave next month, I'm hoping and planning to come back at least once a year to teach in the program for the forseeable future and to support Arianna from a distance in continuing to connect people all over the world to say, "Here's a way that your global health desires can interface with a local country's needs." David - You two are the only Peds Emergency Medicine doctors in the country and there's a realization. . .What actually is Emergency Medicine here and what is the difference between what it looks like here versus America? Mardi - Yeah, it's a really great question. First of all, Ariana and I trained in a country where there are multiple children's hospitals per city. So, Pediatric Emergency Medicine is the Emergency Department attached to a children's hospital. There are less than 10 children's hospitals on this entire continent, I think. So there are no Pediatric Emergency departments. What is really great is that Emergency Medicine combined adult and pediatric is a growing specialty here. There's been so much great work that's going on in so many countries around the region. Rwanda last year, just graduated their first class of emergency residents. Uganda just on the cusp, the great advocate there, Annette Allenyo is leading the charge for emergency medicine. Ben Wachira is an Emergency Medicine trained doctor here at Agha University, and they're on the cusp of starting an emergency medicine residency training program. You know Emergency Medicine's a funny thing. Emergency medicine in a high-income country, is a part of a functioning system. Emergency medicine in the US means that you've got ambulances that get your people to you and you've got an ICU at the other end that you send sick people to. Emergency medicine here is. . . people showing up on our door step, we don't know how to get them here and then where do we send them? I think that Emergency Medicine training here is so much more broad. We're training people not only how to provide Emergency Medicine, but how to be advocates in a broader system. And I think if you live in a high income country, you can't understand how much medical training is not about medical training. It's about advocacy and building access to care for people, no matter where they're at. What I see emerging here is…from the start, it's collaborative. Emergency Medicine training here isn't just training a doctor in a specialty to give you a certificate and leave you there. It's connecting you with people who are trying to get paramedic systems going and people trying to build ICU care. That's one of the reasons we realized that our Pediatric Emergency and Critical Care program had to be both. There's not enough places to work where you've got the luxury of staying in the ICU. Our graduates are gonna go out and work in hospitals where they will be expert trainers for the pediatricians running the ICU and the family medicine doctors running the emergency department and the surgeons who are doing pediatric surgery with just general training. Our graduates are gonna be those advocates drawing teams together asking "How can we improve the system from arrival at our doorstep till the day we send them home." It's a different focus in our training. Yes, the skills are necessary. You need to know how to run a ventilator and keep a heart pumping when it's not. But it's about building a team and being a part of solving systems issues and hopefully in a way that is affordable and sustainable. David - I love that word, systems. For me, this is the year of systems. Thinking broadly about each of these individual parts because it’s another way that healthcare here is very different from healthcare in the US. The US is just sub-specialization, that's what it's all about. And here, there's not a fine line between. . .for an Emergency Medicine doctor, you're not sitting out in casualty waiting for a kid to come in, right? If you want to find the emergency, you just walk around and lay eyes on every kid and there's gonna be one out of 70 children in that building, who is in trouble. So it really is a bigger and broader way of thinking about things. Mardi - I think another thing that's interesting to me just as we come back to the missional aspect of who we are... I think 00 years ago, a missionary was someone who would go into deepest, darkest wherever and be whoever they wanted to be. I think as we consider what is global mission, our question needs to be, “What is that country looking for, what systems are they trying to develop and how do we help them in it?" And that comes down to health…if you're a missionary, what does the local church want to do? What is their mission and how can we assist them? I think we need to ask better, what system is someone trying to build and how can we be a part of it. Because that's the key, isn't it? We're here to serve God who is restoring creation and he's doing it in lots of different ways already. We don't need to necessarily think we've got the answer, but to say "God, where are you working and how can I be a part of it, and what does it look like?" I think Mary Adam in her community health project, is a really lovely example of that. Community Health growth is a priority of Kenya. So she's gotten grant funding and she is just sowing in it, she knows every county Governor in the country, I'm suspecting. She knows how to get into the system, but how to be salt and light, and how to be the love of Jesus in making things functional and making all things new. I think that's one thing that I think Kijabe is doing well. We are looking at health strategy and saying How can we be a part of it and love that our FPECC program is in partnership with University of Nairobi. I love that our clinical offices have a program that we got accredited for called the Emergency Critical Care Clinical Officer program, that actually wasn't a part of hell strategy, but we did see a gap, and as soon as we trained people in that we went to the Clinical Officer of Council and said, "Hey you want to accredit this? This is a really good program. And they did, and now the Kenya Medical training training college has taken that program and they're doing their own program. I think those are lovely examples of saying “We're here to bring restoration but we don't want to be separate from the system. Where are you going and how can we help” David - What does that mean for friends of Kijabe? How do you see that working with Friends of Kijabe as an organization? Mardi - What's been really lovely, about Friends of Kijabe in the last year, and I know you're excited about this, David, is in what the core the Friends of Kijabe vision and mission. I think a core part of Friends of Kijabe that we've got the CEO, the CFO and the Director of Clinical Services on the Friends of Kijabe board. One question that I've heard you ask so many times in the last year is "Where are you going and how can we help, what are your priorities? Friends of Kijabe exists to help the hospital further its strategy, but also exists as a bit of a connector between people in high-income countries who really want to contribute and who have passions. Where does that intersect with the hospital strategy? So Friends of Kijabe is not going to take the whole hospital strategy and try and piecemeal help every part of it. They're gonna say, "Hey you're a part of your strategy that are happy resonates with and that's become very clear. A lot of Friends of Kijabe funding currently goes towards whatever the hospital thinks is important. The hospital has prioritized the theater expansion project this year and that's great. But, at its core, Friends of Kijabe also says, "We support the needy. We support education. We support sustainability. How can we get there?" And so [FoK] has prioritized putting money towards each of those areas which happened to align with the core values of Kijabe Hospital. So a large proportion of what Friends of Kijabe hospital is doing this year is helping us with an infrastructure project. But every year we're going re-ask "What are your priorities, and how can we help that?" But we're also going to say, "Here is where our heart beats. Can we help with this too?" I think one of the things about Friends of Kijabe is the trust that's developed since its inception. As Friends of Kijabe, we trust that the hospital leadership is following a strategy that is meaningful, that is sustainable, and that is in line with where Kenya is going and where the African Inland Church is going because that's who we're owned and operated by. As long as our missions intersect, I think Friends of Kijabe can trust that at the hospital is taking us in a good direction. David - Awesome, anything else I should ask you? Anything you'd like to add? Mardi - No. It's been an extraordinary eight years and it's been such a privilege to be here, and it's lovely to leave with joy, even as there's associated sadness. I really can't wait to see what the next few decades bring, and I'm gonna be watching both from a distance and also up close, when I come back to visit. David - Thank you Mardi.

Hi Everyone, This week I had the privilege to sit down and chat with Dr Casey Parker (or is that Paraka? - apologies a little inside joke ). Casey works up in Broome as a GP anaesthetist, in emergency medicine, the HDU, is an enthusiast for point of care ultrasound and is involved in FOAMed and a huge number of other educational initiatives. Casey has had his own very successful website / podcast / blog (www.broomedocs.com) for over 7 years and he was one of the original people who encouraged me a few years ago. This week I sat down and quizzed him about his own journey in the FOAMed world, what he has learnt along the way, what his favourite podcasts are and if he has any advice for people out there who are also interested in getting involved. Thanks for sitting down and sharing your wisdom Casey! FOAMed Blogs / podcasts mentioned in our discussion https://emcrit.org/ http://accrac.com/ www.topmedtalk.com Home Other Links https://www.nosuchthingasafish.com/ www.hamishandandy.com

Luke Pucket returns to go over the changes with 1.3.0.90 software for the RS1 and SC1 steering controllers. If you are updating an RS1 or an SC1, don't forget to also update your HDU or MDU if you have one of those installed! Raven Software URL:https://portal.ravenprecision.com/ProductDocumentation/HomePage Music Credit:“Special Spotlight” Kevin MacLeod (incompetech.com)Licensed under Creative Commons: By Attribution 3.0 Licensehttp://creativecommons.org/licenses/by/3.0/

You are called down to your HDU to review a 81 year old woman who is day one following a major laparotomy for ovarian cancer surgery. The nursing staff are worried because "she is not quite right". She hasn't made much urine over the last 3 hours, her blood pressure is a little low and she has also developed low peripheral oxygen saturations on room air and is now needing 3l/min via nasal prongs. She had a unit of blood earlier this morning and has had 4-5 litres of intravenous fluid now both during and after her operation. What to do? Should you give her a 500ml bolus of fluid to help her urine output and maybe boost her BP a little? But why are her saturations low - what if you push her into florid pulmonary oedema? Why are her sats low? Does she have pleural effusions? atelectasis? early pulmonary oedema? Should you give her a vasopressor? some frusemide? some physio? some more fluids? Aaarrgggh! You get out your stethoscope - her lungs are quiet at the bases and she is slightly breathless but you are still not sure what's going on. You move your stethoscope to teh middle of her chest and you can't hear any murmurs - but this doesn't really tell you that there is nothing wrong with her heart or valves for that matter!. Oh well at least you had a couple of quiet minutes without talking to the patient or nurse to think about what you might do next ! Only 10m away in the corner of the unit you spot the portable USS machine, which has a curvilinear and phased array probe. You remember the talk from your colleague last week on point of care USS. They described how in around 5min you could probably confidently answer most of these questions & you make a mental note that you are definitely going to sign up for that course in 2 months time... Hi Everyone, Welcome to this weeks podcast episode where Dr Parvesh Verma and I discuss the pros and cons of lung ultrasound and the vastly under utilised potential of this relatively easy to perform bedside technique. Lung ultrasound is relatively easy to learn, is vastly more accurate than lung auscultation, quite a bit better than CXR and as good as invasive radiation heavy investigations like chest CT. In just about every clinical setting we all have access to an ultrasound machine now. If you ever listen to someone's chest or look after patients with dyspnoea (in hospital or a clinic ) then hopefully this episode will inspire you to go away and learn this incredibly useful skill! Merry Xmas & Happy New Year!  This will probably be the last episode this month - I am keen to get suggestions on topics for future episodes so please send me all your suggestions and great ideas! References / Links There are a huge number of free resources out there to introduce you to this topic - please search for them yourself. The links below are not necessarily the best but you might find them useful: Practical Guide to Lung Ultrasound BJA Education - free article  Lung ultrasound compared with chest X‐ray in diagnosing postoperative pulmonary complications following cardiothoracic surgery: a prospective observational study† BMJ - Lung ultrasound: a useful tool in the assessment of the dyspnoeic patient in the emergency department. Fact or fiction? Youtube Tutorial A short video tutorial is one of the best ways to introduce yourself to the basics of lung ultrasound. Therea re a large number of video tutorials on this topic - choose your own favourite! Here are a couple which I thought were good: https://youtu.be/jh7EP7jiW98 https://youtu.be/e_wloEfvs1M

(Real Case: De-identified) You receive a call from a frantic ward nurse who tells you they have a 32 yr old woman who had laparoscopic surgery for treatment of endometriosis earlier in the day and she is in severe pain despite having had 3 doses of sublingual buprenorphine and 4 doses of tramadol since theatre 4 hours earlier. You head up to the ward and read her notes - she has had chronic pelvic pain since a teenager, she has been on analgesic drugs chronically for many years and been managed by her GP and a chronic pain service. She has a history of anxiety and depression and sexual abuse as an adolescent. Her current preoperative regimen involved tapentadol SR, amitriptyline, celebrex, pregabalin and prn oxycodone. In theatre she had a volatiel anaesthetic and a number of multi-modal analgesic medications including a small dose of methadone, ketamine, lignocaine. She needed a lot of fentanyl in recovery and since arrival on the ward has been very hard to control. You go and see her, she is definitely not narcosed from all these drugs! She is wide awake, slightly tachycardic (HR 105), restless and complaining of diffuse abdominal pain. She says "Doc it's 11/10" and is asking for you to give her something else to help please! You talk her about your options then decide together to admit her to your HDU for overnight intravenous lidocaine infusion. She has the 100mg loading dose over 10min then is started on a 1mg/kg/hr infusion. Within 2 hours she is asleep and when you see her in the morning she says her pain is only 3/10 and she thanks you profusely.... Hi this week on the podcast we are joined by my colleague Dr Kevin Chan and we discuss the pros / cons of intravenous lidocaine infusions and it's increasing use in perioperative pain management! Previous Podcasts The Opioid Epidemic a discussion with Dr Sonia Ting References Intravenous lidocaine for acute pain: an evidence-based clinical update. BJA Education, Volume 16, Issue 9, 1 September 2016, Pages 292–298. Free Article Podcast with author from the above article: Their experience at Ottawa Hospital Lidocaine Infusions: The golden ticket in postoperative recovery? Australasian Anaesthesia 2017 p 185-196 (e.g. Blue Book article). Perioperative Use of Intravenous Lidocaine. Lauren K. Dunn, M.D., Ph.D.; Marcel E. Durieux, M.D., Ph.D. Anesthesiology 4 2017, Vol.126, 729-737.

In an exclusive interview with TheRightDoctors on Emcure AICOG tv, Dr. Alpesh Gandhi, vice president of FOGSI in 2013 spoke on the topic of obstetric HDU & ICU. This is what he said : ' Obstetric ICU is dedicated to only for obstetric patients having medical complications or obstetrical complication or surgical complications .Obstetrician, medical and paramedical staff are trained and experienced in obstetric pathophysiology for better care. HDU is the concept. It is high dependency care unit. In ICU nurse and patient ratio is usually 1:1,where as in HDU it is 1:2 In both the places HDU, ICU there is continuous care antenatal care, postnatal care, intranatal care is taken by the same team in same place. It is the need of hour, across the world ICU and HDU are there, but in India this concept is not there ,now with many government schemes like Jan Suraksha Abhiyan many things are possible. Previously, 50% deliveries were happening at home and 50% at hospitals. With the FOGSI's efforts now 85% to 86% women are delivered at hospitals and now maternal mortality rate is somewhere between 150, 160 If we want to cut it down more. Our priority should be changed' TheRightDoctors, a Google Launchpad Digital Health StartUp, is one of the leaders in production and dissemination of Medical Information. We bring Insights from the World's Best Medical Minds to digital audiences worldwide across leading digital and social media platforms. Subscribe for more videos: https: https://goo.gl/BDq1gL Our Social Media Links : Facebook - https://goo.gl/YO1oel Google + - https://goo.gl/ImMXq5 Twitter - https://goo.gl/J1gtvw LinkedIn - https://goo.gl/FClkyl

Recently, I spent a few days being completely cared for. I was allowed to do nothing for myself. Forced to lay in an uncomfortable bed, unable to get out being tied in via neck and arms to machines and tubes, with more tubes coming out of my body. And all the time I was intensely aware of every single passing second. Every beep and gurgle, ever waft of air and alarms, oh the alarms. My senses were hyper alert in an environment that had simply too many parts clamouring for attention. Yes, I was in a hospital. At least this time, it had been a choice. Now, I don't tell you this to garner your sympathies. All that should matter to anyone is that I am now out and recovering very well thank you. No, it's because I relearned some incredibly basic ideas about leading ourselves and leading others. Why we hate to be trapped in a bed or any environment and how our stress is made extreme by the more basic and fundamental (perceived) threats to our life. My experience this past week in the hospital will be little different to anyone in intensive care or high dependency. You have just emerged from a traumatic experience. Shock is the most useful term here. Shock to have come through, shock that things worked well, didn't work so well and shock at the discovery of each new tether to the bed. With each tube, you have lost a little more personal control. The alarms, the incessant alarms clamouring for attention. Like the front cover of the Hitchhikers Guide to the Galaxy, these bid you not to panic but to keep calm. And then there are the monitors. Those glorious machines who flash and hum and beep and shriek. And of course, your readings are above and behind you. Out eye line. Noise emerges and you have no clue what it means. It just sounds alarming. You try to look around and make no sense of anything except red or yellow flashing lights. All you can see are the machines of others in the room. Of course, if you are in a private room you may have the benefit of less clamour, but then you won't have much company either. Seeing others are like you makes it just a little more tolerable. The gentleman opposite spent the night going through a traumatic and frightening instability at exactly the same time as I did. I can hear my alarms, feel my heart thumping, fluttering and pounding whilst watching his very very frightening numbers and his wretched face peering back at mine in the terror of the moment. The nursing staff, whilst not completely blase, really behave as if this were perfectly normal. Which for them, it is. They see this day after day after day. I am seeing it for the first time. There's me looking at a guy who's heart might explode in front of me, and honestly, I had no clue that your heart could clock that sort of rate and pressure and not explode. I'm not just not asleep, I am so awake that every fibre of my being is screaming at me. The nurses tell me that it is better to allow myself to become less sensitive, less worried. That my own stress is making it far worse. Of course, I know that this is true. That I am also in the middle of a panic attack, let alone atrial fibrillation, but I cannot turn off any of my alertness. Oh the blessed relief of sleep, but it never comes. I finally dropped back into sinus rhythm at 8.30 the next morning. The choice of drugs had, at last, done their job and I knew that recovery was somewhat more certain and a glimmer of hope began to emerge. I might actually make it out of here. Those of you who have been where I was, know exactly what I'm talking about. As I learned from my fellow inmates, whilst some are more sanguine having been through it before, the feelings and responses are essentially the same. You can tell on the faces of those who have just one single tube removed. Prior to this, they were as miserable and sickly as everyone else, and suddenly their whole countenance lifts. Immediately they look better. And, so long as it was a good decision to remove that tube, they remain a tiny bit more hopeful. Each tube is a victory of self-control.One tiny element where your mind begins to believe that there will come a day soon when you will once again be able to control when and how you go to the toilet. Yes, the pooh in the title was pooh and not the Winnie version. When it comes down to the feeling of being in control, there is little more dignity lost than when you cannot pass motion yourself. In private. Comfortably, in private. Cleaning yourself up and emerging refreshed, renewed and ready for another day. the parts of the body are bored one day and get into a discussion about who is the most important. the limbs each make their argument, then the major organs, the brain, heart, lungs, liver, etc...all make good arguments (although no one pays attention to the appendix or the spleen)...as they discuss this, the anus claims to be the most important...they all laugh, so it says 'OK. I will stop working, and see how you do'...after a few days, all the other body parts agree that the anus is, in fact, the most important part of the body...by far. (Thanks to Clive for that reminder :-)) Peeing, or passing urine as they insist on calling it is less undignifying (at least for guys). And compared to using a catheter is an enormous leap forward in being in control. On day 5 I was finally allowed to sit up out of bed on a chair. Like being back in school and having to ask permission for everything. It's just one way of being controlled and losing your own power A lot of commotion and moving containers and tubing but the bliss of being able to sit and not lie. Briefly standing between. And I took this new found freedom to realise a much-needed release. I swallowed the last tiny little shred of my dignity and finally admitted that I was not in control of anything in my life now. That I was totally in the hands of professional staff and asked for a commode. After several attempts and with some suitable medical enticements, eventually the task accomplished and I chalked up another victory on my walk back to self-efficacy. And it caused me to reflect on organisational life. How often my clients complain that they are constrained and held back. Their bosses scared to lose any control, micro-managing every decision. Some get broken by the system, surrender to the inevitable and lead miserable, unfulfilled lives from paycheque to paycheque. Others, break free one tether at a time and their faces are filled with hope and possibility. Sure it gets frustrating because there's always one last tether still in place, but that feeling of having some control over your own life and destiny is a powerful motivational force. It is hardly surprising that prisons use the strategies to take away self-efficacy in order to break the will and ensure compliance. But why do organisations and their leaders feel that they should adopt similar practices? If you want a group of compliant workers doing just what they're told, no more and no less, then, by all means, tie them to their metaphysical beds, rig them up to monitoring devices and remove as much of their human dignity as possible. Keep it up for long enough, and they will forget how to be independent and accept whatever you tell them to be true, is of course, true. Within an hour another two tubes were removed and the promise of G Ward held out for the morrow. Which was of course "hospital time" for a "couple of days". On my last day in HDU, I was freed from another tube and monitor and even managed to eat something of the porridge that someone insisted on ordering for me. I don't recall, at any time, actually requesting rice porridge and can't ever imagine that I would. Others who would willingly have consumed this were forced to down stuff that I was beginning to hanker for. A slice of bread. Not that my appetite was all that great, it was coming back in line with the more I felt that I was in control. That I now held the possibility of making a decision and choosing to follow it through for myself. Not to have to await someone else, however professional they may be, I just wanted to do something for myself. I needed to take back control of my life. Once free of tethers I was allowed to shower. I had, so far. avoided contact with mirrors but now I stared at my reflection and decided that I looked way too beaten up and sickly and that a shave was in order. Not easy with a central line still plugged into my neck but at least I could begin to look a little better. Feel a little fresher and clean the remnants of what smelled like a dead rat from my mouth. Slowly but surely, with each recovered aspect of self-efficacy, I began to feel happier, more hopeful and better. Joy and hope are sparked by the simplest of tasks accomplished alone The next step in progress is to re-learn how to walk and start re-building strength. Bearing in mind that from the second day, we've been re-learning how to breathe and cough. With assurances that practice and dedication will bring the fastest return, the physiotherapists help me get to a point where I can walk unaided around the ward. This is now the most dangerous and risky time. The operating theatre and ICU/HDU are controlled environments. Or at least more so than the General ward. Now is the time to be most watchful of complications. A tiny microbe can set you back weeks or months. So regaining your strength and cleanliness is essential and pray for protection. Choosing to take charge of your recovery from a setback is critical to that recovery. There were a few in the ward who, whilst capable of walking and rebuilding their strength, were either too scared to do so, or simply unmotivated. Sitting on their beds waiting for someone else to cajole them into exercise. Some remain for months and essentially give up their independence and allow others to take care of them from now until whenever. They made it beyond forced compliance and yet hankered for it. Those who do get up and walk, rebuild strength, recover faster and leave sooner. And just as in the organisational ranks, there are those who have "get up and go" and those who leave it to everyone else to make decisions and move things along. It's a choice we make, and I know which side I would rather be on. There are those few, those precious few, who desperately want to take charge but with one complication after another, are forced to stay behind for longer. And the longer they stay, it seems the more likely another complication will arise. After all, you are surrounded by some very sick people. A simple cold could set you back weeks. Their power to recover has been stolen from them, for a time, by a microbe or a virus. Those who continue to have hope and that drive for self-efficacy will beat it and emerge victoriously. Others succumb and are weakened physically and their drive and hope take a knock and they need someone to reignite that hope and work that drive until they have enough strength of their own again. Be watchful of your friends and colleagues who get weakened by the system. Don't always assume that it's only about choice, there are things going on in everyone's life where they have little or no control and it robs them of their strength, their hope and their drive. Be a friend and lend them your help, your hope and your drive to allow them to choose again to take control back. It is my hope that you have found this a useful podcast. If you know anyone at your work who looks like they've had their feeling of being in control stolen, perhaps it is time for you to reach out and offer your non-judgmental love and attention. If you know someone who is about to, or considering a CABG (heart bypass) or any other heart surgery and they would like to talk, please do put them in direct touch with me. Thank you for your love and prayers.