Doc Ernie's Blog

Kenya Update 7 - closing observations

Ernie Franz — Fri, 24 Feb 2012 23:43:34 -0800

Traffic

Kisumu – two lane roads with no markings, poor shoulders, random speed bumps and potholes that would eat most suspensions and/or car tires and cars, mixed with piki-piki’s, tuk-tuk’s, matatu’s, bicycles and pedestrians. Piki-piki’s are a small 125cc engine motorcycle that carry from 1-4 people (I have heard up to 5). Matatu’s are everywhere and seat 14, but may carry more. They are usually a converted Toyota mini-van, of the bread loaf styling. Tuk-tuk’s are 3 wheeled and carry around 3-4 people. In general people walk everywhere, and carry a lot with them. Mix all this with cows, bulls, goats and the occasional 2 wheeled cart which generally use car tires. Any people moving vehicle may start and stop anywhere, the matatu’s the most erratic of the bunch. Vehicles are right hand drive. People walk everywhere in and amongst the traffic day and night. No traffic lights anywhere. Very little signage. No one anywhere wears bicycle helmets. Only the piki-piki drivers wear helmets, none of the passengers. People ride on the back of bicycles on a small seat, with small bars under the main seat. Some women well dressed ride side saddle and talk on cell phones as they ride.

Nairobi – very rare main roads are 4 or 6 lane. No speed limits posted, rare signage. People walking everywhere along the road side and crossing the roads day and night with very poor visibility and minimal overhead lights. Even these major roads have roundabouts, and u-turn options. Amongst all that are the matatu’s and larger buses. Again on major roads there are speed bumps not marked and the occasional big pothole. Coming back from the aiport to Hampton house at night, the road suddenly went from 6 lanes to 1.5 on each side, became rough and uneven and had big drop-offs on the shoulders, only marked by stones and rebar on the edge. No signage again about the narrowing or construction. Side roads generally very bumpy and some with major potholes and destroyed road surfaces. Very few major roads overall, mostly a network of rambling 2 lane roads all thru the city.

People

Everywhere the people are kind and smiling. They do have a sweet spirit, as my friend Gary Ames pointed out. They do not seem depressed or downtrodden. Almost all are spiritual in some manner, and most Christian. They are open to discussing prayer and Christ. Hard working, many work long hours to support themselves and family. I am told the average wage is around 200 shillings per day. Mike, our taxi driver says, that once a boy turns 15 generally they are built their own small house on the parent’s property – and move out of the parents home, “they don’t share the same entrance into the home any longer.” The kids are always smiling, seem to love Mizunguu’s and want their picture taken. They are optimistic, regardless of the setting it seems – from Kibera to the tribal village unit. They do not know any other life, nor have dreams or understanding of what it could be like…..

School is taken very seriously throughout Kenya. Education valued highly and children strive hard to be the best in class. Uniforms worn. Teachers respected. Visitors very welcome.

Cellphones

Everywhere, even in very poor regions. People obtain a phone, then buy coded cards that buy airtime. Calls apparently cheap. Texts are 1 shilling to send, free to receive. Cellphones are used to transfer money between people, generally at M-Pesa booths. No banking as such, but you have funds in your cell account, and in that way can send funds to others via cell phone. I called Frankfurt from Nairobi for 87 shillings, or about $1, for about a 3 minute call.

Food

Mostly a vegetarian diet. Ugali is a corn glob, that is stirred a long time with water over heat. When finished it is about the size of a round loaf of sourdough bread, but completely white and with the consistency of fresh Playdough. Very bland, it becomes your eating utensil to pick up food with your fingers. We had beans, green grams (lentils), and greens (like collared greens).

Fresh chicken at David Isuvi’s which they had killed was pretty tough and muscular due to its running around!! Chipati is a wheat flour flat bread cooked in a skillet with vegetable oils – saturated with fat but quite tasty! Very few utensils used, mostly hands. The tilapia meal in Kisumu was interesting for sure – see my photos (when I can get them up).

Security is big business. It is everywhere and employs a ton of people. Security for NI, hotels, hospitals, grocery stores, malls, homes, businesses. We needed security to walk thru Kibera. Three guards with AK-47’s or Kalashnikov’s escorted us throughout for 5,000 shillings. I am told that if you are caught stealing in some areas it may be punishable by death. One of the locals apparently stole a digital camera from a friend of Bob Wendel’s and he has been in prison for 3 months, still awaiting trial. Police can randomly pull you over, sometimes to extract an illegal fee for “road maintenance”. At major Nairobi roundabouts police are stationed by 5am for any incidents, and work shifts covering the particular roundabout. When things get busy, they may stop traffic to allow flow in one or two directions only. But if you are stopped, you will likely be ascended upon by large groups of individuals selling stuff from world maps to shoes to figurines to trinkets to jewelry and even Masai spears.

Placentas

Still I am baffled. We have missed something of the significance of the placenta. In US hospitals it simply disappears, or so it seems. Not so in Kenya! Some tribes have traditions with it, such as burying it on your home soil, to more or less stake claim to your family's connectedness to the earth and soil on which you live. Most have now gotten away from that tradition, but how one disposes of a placenta is still a matter of controversy. Hurlingham Women's Hospital in Nairobi incinerates them. Most hospitals we visited though seemed to use an in ground placenta pit, where it is tossed whole. Others macerate the placenta then put it into a pit. Some of the outlying clinics do incinerate them, yet the Kenyan inspectors do want to be certain your incineration temperatures are high enough; but some inspectors apparently may still require you to dig a pit. You may never know, until you are going for inspection.

Regardless, it is a big deal to Kenyans, and does hold a more honored/respected place in their culture than we may ever fully comprehend.

Thank you for reading and traveling along with me!! It will take me some time to process all this; and I know I am a changed person because of it. I hope to be able to return to Kenya/Nehemiah International someday soon to find an expanded healthcare center in operation.

Kenya Update 6 - some final visits and homeward bound

Ernie Franz — Fri, 24 Feb 2012 23:26:59 -0800

Today is my last full day in Kenya. Flight to Nairobi this eve.

Started the day with a visit to the Karunga school and almost 100 kids. No money for any sort of food program or supplements, which means most of the kids go without lunch at all. NIHS does a medical outreach here for de-worming and immunizations. Kids in bright purple uniforms, as usual smiling and giggling. They flood to anywhere a camera is shown! Met the teachers and looked at classrooms NI helped to fund and build. Momma Helen (aka Momma Jeff Krueger) was there to meet. We met Momma Mylka on the way to Karunga.

Also briefly toured the thatched roof hut village of Karunga itself.

Back to Miwani. Packed out. Met nurse John who is quite personal and rides his bicycle once per week to work at NIHS while Esther is out doing immunizations/outreach. He is married to a nurse who also works in a health center. One child, 8 mos old.

He is most interested in preventative disease, and education that goes with that. He seems very interested to work more with NIHS.

Said goodbye to Esther and staff.

Off to Kisumu to tour “Russia” hospital (named such because the Russians mostly built it before it became part of the Kenyan NHS), or actually New Nyanza Provincial Hospital. I was prepared to be disappointed, but they have greatly improved services compared to a year ago (I am told)! New building for labor and delivery – new as of less than 1 year ago. They macerate placentas and the remains go into a placenta pit. Four active delivery beds and 2 infant warmers. Post-partum moms go to another (old) hospital area; which looked crowded but not too bad. Nice staff overall, very committed to care and providing excellent services. 15-20 deliveries per day, and roughly 2-3 C-sections per day. So amazing to see people/families everywhere washing bodies and doing laundry and hanging patient laundry up on outside clotheslines; all on hospital grounds. The A&E sees roughly 30 per day, and admits usually 15. Peds usually go directly to the peds outpatient area – The Mitchell Obama Children’s outpatient unit (yes, they spelled Michelle Obama’s name that way!). There they get evaluated for admit.

501 beds. No waiting for beds from the A&E. You simply go upstairs, and if need be, you get into bed with another patient!! Or 2. Only exception – ICU admits, they are kept in the A&E until a bed opens. 2 exam rooms in the A&E, and one minor theater.

Peds wards (here called the Obama Children’s Hospital) were not too busy, maybe half full – yet several sections for various problems – malnourished section (this one nearly full), communicable diseases, age under 3, age over 3, an oral rehydration observation unit (where if they do not improve, they get admitted with an IV). Areas looked “clean”, compared to what I have seen.

Overall a much better facility than I expected. No MRI, but they do have CT.

Off to the Green Garden Restaurant for pizza and a great virgin lemon juice-Mojito w ground mint leaves (thinking later this was the only potential source of possibly contaminated water/juice I have had – time will tell!!). Then goodbyes and flight to Nairobi. Off to be for an early morning trip to Amsterdam, then Frankfurt, then home Sunday 26 February.

Kenya Update 5 - Miwani area day 2

Ernie Franz — Fri, 24 Feb 2012 23:01:55 -0800

Our team met this morning with Grace, the Medical Officer (MO) in charge of our Miwani region, from the slope of the mountains to the railroad tracks, and from the bridge outside Kisumu then east to Miwani. Also Charles, a Community Health Worker (CHW), who may someday wish to work for NIHS. Discussion regarding our role and meeting regulations. She was encouraged by our incinerator, and services currently. She hopes we will ramp up quickly to provide these services (per the MDG’s): HIV/AIDS ARV’s, testing, follow-up and counseling; maternal care, TB, malaria, dehydration/diarrhea.

She can help set up training of CHW’s. Most are basic trained in 5 days, but in some regions they do more such as BP recording for Hypertension (HTN) screening, and fasting glucose. She does not think in our region these are problems – Diabetes and HTN. She thinks we need to train roughly 30 or more CHW’s. Additionally we will need a CO/MO position, 3-4 nurses total and a few more exam rooms. Inspections once we are ready to advance to a higher level of care. She feels we are a very important center for care to people from the bridge to the town of Miwani. Overall an encouraging meeting about our future role.

Headed then w Jeff, Anneliese, Charles and Grace to Miwani dispensary. Met George the MO. Photos taken and buildings explored. They run an HIV/AIDS clinic w counseling, ARV’s, staff workers, counseling. Roughly 36 HIV/AIDS patients they follow w CHW’s. Also a dispensary with meds, lab and such. One exam room. Very small somewhat shabby looking place – but serving the population. Roughly 8 patients/day.

Then to Chebirir Primary School where the headmaster who heard we were coming ran 6km to meet us. Students in green shorts. Some new buildings. Mostly volunteer faculty, and 75 students grades 1-7. We met several faculty. No electricity in the area at all, the nearest electricity is about 4km away. Wondered about hydro-electric power as they have water in a cistern which could be dropped to a lower cistern and generate electricity to charge cell phones, and have some lights. Or perhaps solar power. This would be a money maker for them and a huge time savings as they otherwise come to NI and pay 10 shillings to charge their cell phones every third day or so.

Termites are a problem as they eat text books, buildings and attendance/visitor logs and such. NIHS provides vaccines and healthcare to these kids. Vaccine program by coming by piki-piki once per every 2-4 weeks. We met in the headmaster’s office. Also Joyce, a teacher support person/widow took us to her home. Cow dung and mud floor. Using the bushes for bodily functions (no latrine) – roughly 60 meters away.

Back to NI where Momma Mylka had walked her to greet us and me, since she heard we had come to visit her, but she was away at a funeral.

Long nap (finally) and outside with my computer to watch a sunset while I got some work done, sipping an iced latte, and including the writing of this.

Kenya Update 4 - Miwani area

Ernie Franz — Mon, 20 Feb 2012 22:34:38 -0800

Kenya – Miwani/Nehemiah International

At the clinic this morning I spent some time with our staff and future potential staff; getting to know them and their background and experience.

Today we had a case of an elderly fellow (maybe 45-55) who has had intermittent fever, photophobia, headache, weakness. No diarrhea. Esther, our nurse, felt this was c/w either malaria or typhoid. Ken, our lab tech, was able to test for both, and it was typhoid. He received 1.0 gm iv Ceftriaxone. No iv fluids, just slow push of the drug. He is to return daily for 6 more days for additional iv doses.

Cisco is in her early 20’s. Here now briefly on school break. She is in school as a CO – or Clinical Officer. Just finished her first year. She will have 3 years of school, then 1 year of internship, which is sort of the payback time to the government. She can rank her top 3 choices, then will be placed at one of those. The school is state/Kenyan supported and costs 60,000 shillings per year (40,000 tuition + 20,000 living expenses [hostel and food]). She absolutely wants to work here when done with training. They do get basic sciences. Gross anatomy is using cadavers, but with someone dissecting for them. They can touch the cadaver if they wish, but do not have to. Otherwise sounds like PA school a bit; but not as thorough. I asked her about the brachial plexus, and she said that week the professor was not available, so it was discussed but not in that much detail.

The circumcision clinic seems, so far, to not be happening. Last week a team had arrived to circumcise 6 males, and they were to have follow-up today. For the procedure I understand they get Tylenol for pain relief!

We, Anneliese and I, headed for Kayo which is a small village near the town of Miwani. We were to visit Momma Mylka who is the grandmother to Jeff Krueger and Anna Schuler. After nearly 1.5 hours of rough road, single lane much of it, we are surrounded by trees and huts – some with thatched roofs, some with tin. Smooth hard dark dirt floors (which I later learned are cow dung and dirt), almost like concrete, mud walls supported with sticks inside. One or two windows per hut.....

The latrine is a 3 sided open structure, almost no privacy, used it appears just for stool; not likely urine. Shallow hole covered in part by sticks and mud. Located maybe 40-50 feet from the nearest hut. Water for cooking/bathing/possibly drinking from a barely moving stream, which is “boiled” we are told. A nearby well provides most of the drinking water. Small gardens, a few goats or a small cow or two, small dogs and usually no cats.

Kids happy, swarm around me to shake my hand and want their photo taken. Most very happy and yell out “Mizunguu!!” or “How are you?”, especially the latter over and over! They especially wanted to see the photos I had just taken of them. Anna Schuler, almost 4 yo, was here, she ran to greet me and held my hand for the 200 meter walk into the village. One dog was snarling, and not too friendly, we stayed away given the recent rabies in the area.

On the way back we saw a currently closed dispensary in Miwani and the Make Me Smile project of orphan girls in a re-purposed pickle ball court. They have a pond for fish and small garden patches. The house mom appears maybe 20 yo. This house rented and supported by a few young Austrians whose father apparently gave them each some funds and told them to find a 3^rd world project to make a difference in peoples lives. Around 8 girls living in this pickle ball court, ages roughly 8-20. Might have electricity, but we did no see any evidence of that. Most homes, like this one, use a charcoal interior fire for cooking. Usually a small, roughly 16 inches by 16 inches base that holds the burning coals just off the floor, with a pot on that for cooking Ugali or other items. Yes, this does put out CO, or carbon monoxide. Apparently the ventilation is good enough, as this is the standard everywhere - even in homes on the farm at NI.

Dinner back at the farm – Ugali and greens.

Kenya Update 3 - Kisumu area

Ernie Franz — Sun, 19 Feb 2012 09:36:33 -0800

16 Feb 2012 - Miwani and Kisumu

My days are filled so far with medical facility evaluations and people meeting; making connections.

First the Nehemiah International Health Services building and staff –

Many photos taken today, and staff met. Esther, our Kenyan nurse, seems content and hard working; also very comfortable doing what she does. No real sense of burn-out impending. More on her on the next update.

Esther was thrilled to get her gifts today – new stethoscope, new headlamp – both from Dr. Dan Morris. I brought along some used equipment as well, all joyfully received. They sure could use an otoscope to go with my tips I brought!

Lots of potential in our current building, just unsure how to use it all yet. Seems we need to get Dr’s. Omoto and Morris and nurse Anneliese – maybe Ken (our lab tech) too on skype and figure it out.

After a planning meeting it was off to Disciples of Mercy healthcare center. Ken and Anneliese and I spent almost 3 hours with “Saint” Natalie; we showing up unannounced. She has lived and worked here for 24 years. She outlined the plan of the transition of dispensary to healthcare center, which they have done over 5-6 years.

Deliveries, basic healthcare, STI’s, HIV testing, counseling, follow-up, family counseling, TB clinic, HIV support groups, community outreach and healthcare worker follow-up. They follow 436 active HIV/AIDS cases. Natalie estimates HIV is closer to 33%, not the reported 15% - due to all the money that has been poured in here not being used effectively, and that those funding care would withdrawal support if they knew the actual rate was 33%. This she feels is due to many not wanting testing (knowing from symptoms they have it), to factors such as if you only test well people without symptoms – you will miss many cases that would be obviously positive. Many would rather simply die of HIV/AIDS than to know they are +, others avoid testing to prevent family shame, many reasons to skip testing – even transportation.

I wish I had Natalie on film; she has a deeper understanding and knowledge of HIV/AIDS that almost any physician I have ever spoken to; way beyond my awareness – and yet she has no true medical education that I know of. The system and process they have in place is amazing. Testing, verification if +, TB screening, then a week of intense counseling, then ARV’s, then ongoing family counseling, then ongoing follow-up and compliance and blood testing for CD4 counts (cannot treat unless under 300) and LFT’s.

The Kenyan government supplies ARV medications for free, but all the necessary lab testing (such as CD4 counts, liver functions), personal and family counseling, case management, and compliance checks are also to be provided free of charge by healthcare centers. So it can be a huge financial burden for those providing care to follow these patients, yet the benefits great to each individual.

Many times today I was nearly overcome by emotion; just the burden of illness and the task to make a difference creatively with little to no funding and limited resources.

Also nearly overcome with everything required to move our facility from dispensary to healthcare center – almost too many things to list. Inventory of durable goods and non-durables. Kenyan government criteria which are NOT in any one book or place, so hard to know what to do exactly until the inspector arrives. The required HIV/TB testing, separate rooms, and counseling services. Providing the necessary tests for free, despite the tests costing much. All the while obtaining funding and charging a low fee to those who can pay something. Yet I find encouragement in her spirit and heart.

She urged us to understand our mission, and to stick to that. If a donor wants something else accomplished, then they need to send their money elsewhere; but for her she wanted buildings to be able to move ahead.

Crazy traffic in Kisumu, no bother to paint lines on the roads since everyone drives where they want. Motorcycles, Piki-Piki’s (small 125cc engines – sometimes with 4 people on one bike!!), bicycles, carts pulled by hand, oxen, people, cars, buses, trucks, matatoo’s (Toyota mini-vans which are converted to hold around 14 people inside) many times people just hang outside the open doors! Three wheeled taxis as well. Also right sided steering controls and speed bumps and potholes everywhere!! I mean everywhere – even on heavy trafficked roads, where they appear randomly and without signage of any sort. That, and police just hanging out to pull you over and collect road duty fees – which is a random act. Rather a strange system!

Kenya Update #2 - Nairobi day 2

Ernie Franz — Thu, 16 Feb 2012 22:22:02 -0800

Nairobi – 15 February 2012

Wow – it’s late. The pics will tell the story when I can get them loaded.

Kibera slum today 7x10 km. 1-5 – 2.0 million people. Vendors, phone cash, food, butchers, sheep, dogs, cows, goats, kids and more kids. Sewage stench everywhere.

Walked in with Pastor John, Aaron, Jeff, our nurse and myself + 3 soldiers with AK-47’s or Kalishnakov’s. 5000 shillings for the escort – since 3 Muzunguus’ were robbed of all they had last week.

Amazing – I do not ever want to forget it, nor the kids and somehow this is all they know – the look on their faces and still joy. Several schools along the way until we hit the WorldComm site with 96 kids ages maybe 3-10 in a one room schoolhouse. All in uniform, orderly and seated quietly. They sang, recited scripture, and clapped!! There were some trinkets there to purchase, made on site – so a few items were bought.

They paid for a car ride out for me with Aaron and a security guard. Crazy bumpy single lane road – not really a road.

Wow….the red clay and dust and smells stuck with me all day – I could taste it through the dust in my mouth and nostrils – no water safe anywhere.

Then to another school. 270 kids, taught well – some orphans. High achievers. Many place in the top regionally when testing to advance. Sports – soccer, volleyball. They waited to feed everyone as they knew we were coming. Orderly serpentine line to feed, youngest to oldest. Many teachers – grades 1-8. Teachers volunteer or a small stipend. All passionate about education, Christ, scripture. Songs and poems for us as well. They also kindly served us each a cola w straw!! It was almost cool, but the taste divine coming from Kibera.

Barely to the airport in time to fly to Kisumu and then the drive to Miwani. Dinner at 8:20pm. Windy, stars, clear – yet cane fires on the distant hill. My first “at risk” mosquito bites this eve. They are small and appear out of nowhere.

Kenya Update #1 - Nairobi day 1

Ernie Franz — Thu, 16 Feb 2012 11:32:24 -0800

Lots to report - and the days so full, it is hard to take notes, swat mosquitoes, snap pics and somehow process it all; the good news = that is happening!! Yet my intentions of updating this blog are proving a bit difficult. I have some amazing photos to share, yet my connection slow enough it is difficult to upload any photos.

I will re-edit these comments when I have the time, but for now, easier to simply upload my notes and correct them later.

Kenya – Nairobi 14 Feb 2012

Exchange rate info for you - $1 USD = 83.5 shillings

Walked maybe a mile to B-fast. The Java Hut.

1. Off to Hurlingham Private Women’s Hospital in Nairobi. 61 beds; 61 nurses. Converted from a hotel to a hospital in 2001. Generally 90% occupancy.

Casualty requires first generating a hospital MR #, then pre-paying for your casualty visit, then being seen. Very kind people all along the way working in this nice private hospital, yet in tight spaces. Medical records is amazing – crazy piles of charts piled high and rubber banded together.

The IT dept is staffed by 2 people who are surrounded by junked out monitors and towers. Their goals seem to be more about computer info RE: staffing, laundry and benefits for staff, than about actual MR’s. No intent to go to an EMR, no intent to put a patient’s labs or x-rays or PMH in the computer. No intent or plan to connect all 3 of their private hospitals together with one computer system. Suggested it would be nice to pull up doctor notes, RN notes, patient history, meds, HIV status, last admit, current plan, even current admission – but NONE of this is available; nor any plans to make it available. Yet they rated their IT system an 8/10 (??? Amazing!!!)

Delivery costs 40,000 shillings and a 2 day stay; C-Section 150,000 shillings and a 3-4 day stay.

[talking to Dr. Omoto over dinner his hospital in Siaya District charges 500 shillings for NSVD and 3,000 shillings for a C-section.]

They do transfer people out who cannot pay to other public hospitals.

They had 1-3 beds for males.

1 ultrasound machine, 1 x-ray machine. No back-up.

Lab runs 24/7 with something like 7 people in a small cramped area maybe 200 sq feet. The lab machines “free”, but they pay for reagent and tubes, etc….. Blood bank, TnC, HIV, and apparently send out very few things.

Doctor’s offices in bldg. Generally clean and yet open windows, ventilation. No AC. A rare fan or two. Equipment everywhere looks like it is mostly from the late 60’s – early 70’s. Yet a lot of pride in what they do and how they do it.

Please read on for more from this same day........2. Next – Kenyatta National Hospital (KNH)........

2. Next – Kenyatta National Hospital (KNH). On a huge campus with medical school. Between Cairo and Johannesburg, this is the largest hospital. Something like 2,500 beds. 70,000 inpatient admits per year, 500,000 outpatient visits per year. Big operation with barbed wire gardens, and fenced areas – unsure why (possibly goats??)

A&E quite busy, lines of people waiting to be seen. No photos allowed at all – only outside. Proud that patients are seen regardless of ability to pay, and insurance information gathered only after the patient is triaged.

Waited forever for one elevator, which was then jammed with people – someone had to help push the doors closed, body against body – we are talking very tight!!

Got up to peds – unsupervised kids with central neck lines roaming the halls – ages roughly 3 to 12, some racing all over – others just hanging with other 4-6 y.o. patients. One maybe 4 year old put her plastic chair on top of a narrow bench over a concrete floor, then tried to sit on the chair! Zero supervision – not nearly enough staff. Saw 2 very sick kids, both ~ 1 y.o. lying head to foot in the same small bed. Many sick kids in one open room, maybe 20, with 20 + adults, and 1 or 2 staff at most. No apparent monitors – even for some kids not moving much. NO TV, no entertainment, though walls painted w cartoon characters; and a group was there handing out candy to kids.

NHIF – National Health Insurance costs 200 shillings per month for a family, including kids up to age 20 (25 if in school). Yet most cannot afford this! BUT if they have NHIF, then 100% of all medical costs are covered at the KNH and other public hospitals. A room charge is typically 100 shillings per day, but VIP and private rooms available for between 7,000 – 5,000 shillings per day [VIP most costly].

OB – lots of mom’s hanging out for observation. Again only a few nurses. Typically 8 beds to a room. Maybe one sink. Some moms waiting for DC to a safe home, they generally stay a few extra days while social work figures out what to do; to find a safe place. Crowded conditions and low staff.

After peds, our nurse and I were offered a sink to wash hands in. Soap and water (Unfamiliar soap brand) and no towels. No towel dispenser, just no towels! Most just then let their hands air dry.

Radiology does have CT and MRI. Area outside the A&E for urgent care (tents in photo). Many lower urgency cases cared for here.

3. Dinner w Drs. Omoto – She, Lana, seemed quite tired. Has been to the US 4 times or more. Working w U of Maryland now on HIV/AIDS.

Jackton – kind, thoughtful. Both have a passion to help Kenyan people at low cost, and a focus on the millennium development goals – malaria, clean water, dehydration/diarrheal illness, HIV/AIDS. Some MDR TB concerns, and yet a lot of basic health like Diabetes screening, and HTN. BIG advocate on community units – his term for comm. health workers. A huge benefit to Kenyans. Thinks training is key for them – but does not have much hope in them even being able to take a BP reading. Pulse and temperature yes. Thinks they can be taught to recognize nearly 80% of common ailments. These chw’s would live in their own village, community – and periodically report into us.

Sees a NIHC developing over 5-15 years; and plans for it to be overseen by even someone else in the future. Sustainability.

Think ED physicians would be a huge help!! Mostly in teaching others at his government supported hospital in Siaya. Really interested in what training we could bring – especially when he found out it was not ALL about trauma that we do. Just anything acute.

A Doppler would be really good, not US. Yet still thinks a fetalscope is the way to go!

Enough for one day!

KENYA !!

Ernie Franz — Thu, 09 Feb 2012 20:46:20 -0800

As I write this, I am on my way to Kenya, to an area east of Kisumu to help with the advancement of a current medical dispensary to become a healthcare center with increased services and staffing. I am thrilled to be a part of this!

It should be an interesting time with its own challenges. I Skyped with our nurse Anneliese yesterday and found she had questions of how to best treat a woman whom had been "squeezed" by a python and has evidence of crush injuries and bruising. Also the CDC of Kenya reported yesterday an outbreak of rabies in the area east of Kisumu; and that with limited to nonexistent access to rabies vaccine and rabies immune globulin. I will not be petting or getting close to any dogs, that is for certain. Though monkeys, cows and even rabbits can be carriers, I find it difficult to be suspicious of them.

Here is an email I sent to my friends and family just days ago regarding the adventure.....

Dear friends and family,

I wanted to write you about an exciting adventure I am privileged to take part in!

I am leaving for Kenya tomorrow, on Weds. 2.8

For the past 2-3 months I have been meeting with leaders of Nehemiah International

http://nehemiahinternational.org/what-we-do/

They have a 130 farm just south of the equator, roughly an hour east of Kisumu, Kenya; and to date have served Kenyans in this area with an orphanage, school, church, apprentice programs, dairy farm and crop production. “The goal [of Nehemiah International] was to create a self sustaining training environment that would impart life skills to African families and to orphaned children.”

Recently a generous donor from our area has committed funds toward the establishment of an on-site healthcare center. Currently there exists a building, an office and a few exam rooms. Along with a Kenyan nurse and a lab tech working on-site, an American nurse from our area has committed 2 years toward the advancement of the dispensary, to a healthcare center which would eventually provide more comprehensive care (potentially surgeries and some inpatient beds). We hope to train community healthcare workers, and to hire additional staff as we grow to serve those in the immediate area. There are approximately 25,000 in this area with no access to healthcare currently, with infant mortality at 170/1000 by age 1, and 275/1000 by age 5 – primarily from dehydration/diarrheal illness and malaria. 15% of the population has HIV/AIDS. Mosquito netting, water filtration, malaria and HIV/AIDS medications and basic healthcare should make a huge impact on the health of these Kenyans.

The purpose of my trip is to meet the kind Kenyan physician who will serve as our medical director (who is able to work on-site one day per month, apart from his chief of staff duties at a Kisumu hospital), to establish connections with local villages, survey the need, and to see what organization/structure we can provide from the US to help advance the project and make a difference in the lives of the people. I will be returning home on February 26.

I will be traveling much of the way with my dear friend Jeff Krueger who with his family lived on the farm from 2004-7.

It is our prayer that this trip my help establish a foundation for medical teams to serve at Nehemiah over the next few years, but beyond that to establish a healthcare center that will both train and employ Kenyans to serve the people of this area.

Thank you for your prayers and thoughts! I will make an effort to keep my blog updated, though the internet connection can be a bit sketchy.

Certainly would have never thought this possible just over 7 years ago lying in Harborview post-injury.

I certainly have much to be grateful for!!

Best,

Ernie

Update on micturition dysfunction

Ernie Franz — Sun, 04 Dec 2011 13:58:49 -0800

Well it has been some time since I updated this section. I am doing so to share my experiences and to encourage others that though these changes are quite different from "normal life", they are no longer problematic and in fact are somewhat freeing - less stress and anxiety about planning the next pit stop.

Again, what follows is primarily for those with spinal cord injuries or bladder dysfunction who require intermittent catheterization......

In the summer of 2010, six years post injury I finally saw a Urologist that clarified what I needed to be doing the rest of my days on this earth, well, at least in regard to voiding. In summary, my bladder capacity is 500-550 cc (roughly 16-18 oz). When I try to empty my bladder like 99.99% of the world's population does, I am still left with generally 300 cc AND that 10 oz is under high pressure. Since the pressure in this plumbing system is seeking a place go, it also puts pressure on my kidneys. This over time can lead to hydronephrosis, or distended, bloated and generally very unhappy kidneys. Untreated the final result would almost inevitably be renal damage and the risk for renal failure and dialysis..... No, I don't want to go there! The other problem has been with my altered sensation, I never feel like my bladder is nearing capacity until the volume gets to roughly 475 cc; and then suddenly - wow, I need to find a place to go or run for the bushes.

The solution? Simply catheterize 4-5 times per day to get my bladder volume back to zero and therefore my system pressure back to zero. This is a good thing!!

Yes, fortunately I remain completely continent. The unanticipated huge benefit for me is I no longer spend much of my day figuring out where the next accessible public restroom is - especially while bicycling and when traveling by car. So I am now among the many with spinal cord injuries who self-catheterize 4-5 times per day.

Shortly after figuring this all out, I decided to sample a variety of catheters and options to determine what I should use for the duration. I sampled just about every product out there as most manufacturers would appreciate your business and loyalty for the years ahead. My Urologist preferred I use red rubber caths that could then be washed and re-used over and over, sparing the dump from unnecessary waste. I was not so sure of this. Doing required laundry every day, rinsing, washing, drying catheters. Fortunately my wife is quite understanding, so she does not seem to mind several caths draped over paper towels drying in our bathtub.

One of the hydrophilic single use catheter varieties I considered came with an extra incentive; "try our catheters and we will send you a $10 gift card to use at Amazon.com". Sign me up! Well, let me tell you what happened. This super flexible catheter was so soft, it actually kinked inside my urethra, buckling in such a way as to cause a urethral tear and bleeding. It never did make it into my bladder. So as much as you would think a soft, compliant catheter is a good thing - at least for me, it was too soft and flimsy, which caused the catheter to lose its sense of direction and purpose. With altered sensation (meaning I did not feel any of the urethral tear occurring), before I realized what was happening I had done some major damage which even now, almost 18 months later, is still occasionally a problem. The net result being I have an area just prior to the passage through the prostate that is a bit tight and seems to have a small blind alternate passage. I now must use Coude catheters which have a narrow bent tip I can direct to avoid the trouble spot. Fortunately the Bard red rubber Coude catheters work well, yet I still must say I prefer the single use disposable Lo-Fric Primo Coude catheters. These are especially handy for any travel; doing catheter laundry just does not work when you are on the road. To be honest, I would prefer to use the Astra Lo-Fric caths all the time however I just recently found out (due to a billing mistake by my Medicare supplemental plan; they were paying 100% of my catheter costs, then suddenly realized they should only cover 80%) I still need to pay out of pocket just over $200 per month for catheters. After over 8 months of no catheter charges, I received in one single day bills for 6 months times $200. Argh!! So as of this writing, I am back to doing my daily catheter laundry and reserving my Lo-Fric Primo caths for travel.

My wife suggested perhaps I could become a "sponsored" catheter user! You know, like those who endorse certain product lines - pro athletes or celebrities, who are then supplied with product. Gwen even suggested she could envision me in a pair of Astra Tech Lo-Fric Lycra cycling shorts complete with logos down the thighs! What a strange reality we now survive and attempt to thrive in.

Disability thoughts - Thanksgiving and Confusion

Ernie Franz — Mon, 28 Nov 2011 11:09:44 -0800

Conundrum - co·nun·drum - from Merriam-Webster's Dictionary; first known use in 1645.

1: a riddle whose answer is or involves a pun

2 a : a question or problem having only a conjectural answer
b : an intricate and difficult problem

The word to describe my current thoughts seems to have existed some 200 years prior to the invention of accident or disability insurance, but nonetheless that seems the best single word to sum up the situation not only for me, but for many other disabled friends.

So yes, my title is correct; I approach this subject with great thankfulness and yet much confusion.

Though I would love to obtain a paying job, to do so threatens me with the loss of my medical insurance (Medicare) and my social security disability (SSD) monthly payments which allow us to stay in our home and meet expenses. To be more specific, if I were to earn more than $750 per month, I would then lose my medical insurance and SSD (which alone is significantly more than $750/month). That is what I can legally earn per month, yet compared to others I know with spinal cord injuries or other disabilities, I have found their threshold levels are set even lower than mine! Perhaps this is due to my pre-injury income compared to theirs and/or the number of years I had paid into Social Security, though I am not certain how the calculations are made.

Though extremely grateful for my medical insurance and SSD payments, it seems the ceiling of what I could earn per month ought to be raised, and not just for me, but for many others as well. In doing so we could tap into a huge resource of talent, those disabled who can bring many skills back into the job market.

Read onward for more thoughts on this subject; my own recent personal experience, and a solution I have in mind. Believe me, I have already begun to share some of these thoughts with my bicycling buddy from just up the street, Jay Inslee - US Congressman, who is currently running for governor of Washington state.

This past July I was offered a job! A paying, full-time position as medical director of an everyday care + urgent care facility. Though this involved mostly on-site supervision of PA's and NP's, it also included medical care provided by myself on-site, as well as remote supervision through the use of telephone-texting-email consultations. It was an honor and a huge lift to my spirits to be wanted again as a physician - to be sought out for such a position. Those were some of the details of the position, yet there were concerns too.

It would involve commuting to the Seattle Capital Hill area 4 days per week minimum, in addition to several days per month of off-site remote availability. This was to be for 49 weeks/year with a pay scale that would exceed my current disability pay by $800 per month. Still, I must confess, I was interested. Yet before I proceeded any further I thought it best to seek consultation from my attorney and two insurance agents whom could review my SSD and personal disability policy. I had already known that if I were to earn more than $750 per month I would lose my Medicare and SSD payments, but once the legal language of my personal disability policy was deciphered, the conundrum was apparent.

Yes indeed, I would lose my SSD and Medicare, yet the real risk came in the ramifications this would make to my own disability policy. Once a job was taken for 90 days or more, if it later became apparent I could not physically do the work, I would need to wait 6 months before my own policy would resume any monthly payments to me. In the meantime, I would need to reapply for SSD and Medicare. Simply stated, there is no way our family could exist without income for more than perhaps 2 months, if even that long. Beyond these risks, once a job was accepted, if even for a short time my disability policy monthly payments would be calculated no longer upon what my salary was as an Emergency Physician at Virginia Mason; but instead would be based upon the medical director salary of the potential new position (significantly less pay than as an ER physician). So that even after a 6 month wait for payments to resume, once they did, they would be at several thousand dollars less than we currently receive. Such was the intricate and difficult problem. Accept a position which would net me $800 more per month than I currently receive; but at the risk of truly losing our home and many other things we now enjoy if the job proved to be too physically demanding for one with a spinal cord injury.

I was advised to turn down the offer by all those reviewing the options. And that is what I did. Certainly I am deeply grateful for SSD, Medicare and my own disability policy; without them I am uncertain what life would look like. It would be hugely different from what it is today.

So here are my thoughts on the way SSD, Medicare and disability policies in general are set-up. They are not work-friendly. In their current form, they do not encourage one to obtain a job - the risks, as in my case, are too great. Here is my proposal. Most people who have a spinal cord injury cannot physically work a full-time job; perhaps a few, but most cannot work full-time. Even for me as much as I am able to walk and bicycle and maintain physical conditioning, it is very challenging and exhausting to be on my feet more than a few hours a day. Part-time work might be possible, yet that is not enough to obtain job benefits such as medical insurance; but it is enough to cause me to lose SSD and Medicare. And if you are disabled, you must have some medical insurance coverage, or you risk living on the street. So to limit me to $750 per month, or others I know to even $100 per month before each of us loses our SSD and Medicare, is just not right. It makes no sense.

What does make sense to me is cost sharing or means-testing. Simply put, if I make more than $750 per month, don't eliminate my SSD and Medicare entirely, just have me pay a bit more for my Medicare coverage and at the same time lower my monthly SSD payout. I would gladly do this! It is doubtful and risky that I could ever work a full-time job again as I have pointed out, yet a part-time position or intermittent consultant work seems quite possible. Not ever likely enough to qualify me for vital benefits, such as medical insurance, but enough to help our family's budget. In this scenario, as my monthly income goes up, the amount I pay for my Medicare goes up too and the amount of SSD I receive goes down. If at some point I find I can work enough to obtain benefits, then at that time take my Medicare away; and eventually too if my earnings are enough my SSD would go away. Similarly with my own disability policy, rather than an all or nothing approach to monthly payments, it seems appropriate to have a sliding scale. The more I earn per month, the less the disability payout to me. Create some incentive to work, by having the net monthly income (job income + disability income) be beyond what the disability income alone would amount to. As one is hopefully able to adjust to longer work hours and more days of work, your own disability policy begins to support you less and less.

I think that is fair, and I also think such a system would encourage many disabled people to actually find a paying job. A job that would give them a purpose, an identity, a sense of worth and value to society. Yet right now, we are all faced with the hard reality of financial ruin and loss of medical insurance if we work, and for most the upper limit of what you can earn is ridiculously low. As a consequence we have many sharp intelligent people who are paralyzed by the current systems and policies; forced to live a life of simple means. If one cares to otherwise carve out a new identity and purpose there is always volunteer work to be done. Not that there is anything wrong with that, it is just that it would be nice to earn a little money at times!

Thanks for reading.

Sometimes you just have to get... MAD!!

Ernie Franz — Wed, 16 Nov 2011 13:27:03 -0800

This past weekend a tragic accident occurred in Seattle that really upset me. The more I think upon it, the more angry I get. The accident claimed the lives of two innocent young adults, and was entirely caused by the unbelievably reckless driving of an apparently sober individual. Turns out there is even more to the initial story that is confounding...

I doubt this link will last long, but you can read about it here - with my thoughts to follow.

So the facts are that this 43 year old man, who was driving at a high rate of speed on generally a very busy in-town 4 lane road, with two young girls in his vehicle (ages 10, 11), during daylight hours plowed into a car stopped at an intersection for a red light. The collision carried both vehicles forward some 100 yards from the point of impact, whereupon the smaller car struck by the SUV burst into flames consuming the two innocent young (ages 26, 33) occupants. A witness believed the SUV to be traveling approximately 70-80 mph.

Miraculously the two young girls in the SUV survived, as did the reckless driver. They will be released from the hospital soon enough.

What really distresses me is that the driver who caused the accident was guilty of vehicular homicide in 2009. At that time he took out a woman in her 60's after he again was driving at 80 mph on Seattle city streets and rapidly changing lanes. Again he was apparently sober, but served no jail time, instead paying the victim's funeral expenses and being placed on probation for 2 years. The Seattle Times article seems to indicate he was believed to be psychotic. Even prior to the 2009 accident he apparently had one DUI.

So fast forward to this past weekend, with now 2 more fatalities notched on his (seat)belt. According to authorities, he may now face up to one year in jail. That is again, up to 1 year, unless he is released significantly early for good behavior or perhaps felt to suffer from a mental condition which would make his jail time "inappropriate". Of course he is quite likely to drive again; all it takes is a key and a car. As we know, many are out driving today with no license or a suspended license; yet that does not keep them off the road. We seem to think this is our right, not a privilege.

It seems to me we have failed as a society to take the proper corrective action. Jail time is rarely rehabilitation time, more often it is punitive time - for which we taxpayers fund. Our nature is to give others a second (or third) chance..... but really, is that the right thing here? I wish there was a mechanism for ensuring that he never ever drives again - but that is unlikely. I don't have the answer, nor do I have a solution to propose. I do believe however there should be consequences for our sins, for our actions that harm or kill others.......

My own sins have consequences most certainly. And yes, I can seek/ask forgiveness for my actions or inactions, BUT still there are consequences - a penalty to be paid, or loss of chance, or broken relationship - somehow it is going to cost me. Not always financially, nor involving incarceration (hopefully), but still there is a cost. Separation or disruption of what could have been. Similar in so many ways to my sin that keeps me from a closer relationship to our Lord.

So where I am going with all this? I don't have all the answers. Yet I do hope somehow out of the senseless tragedy of this past weekend in Seattle, lessons and corrective actions can be put into place to prevent such future events. Though at some time in the years ahead forgiveness may be appropriate for the driver, the consequences for his actions should remain in place.

Thanks for reading.

Speaking out - now available for hire!

Ernie Franz — Mon, 24 Jan 2011 11:43:33 -0800

Greetings! As I have mentioned in a few previous entries, I enjoy speaking to a variety of audiences. IF anyone can glean lessons from this story of my life as it unfolds, it gives me great satisfaction and has me believing that what occurred to me can really turn out for the greater good of humanity.

In the past few months I have spoken to our military regarding the behavior choices they face when both on and off duty. Sharing the story of what happened to me hopefully gives us all reason to pause before we get behind the wheel of a car, especially if one has enjoyed a drink with friends. Clearly the choices we make do impact the lives of others. While there is great opportunity for good and bringing joy to others, there is also the potential to bring sadness and brokenness. This of course applies not only to driving, but I am speaking here of how we treat each other - within our own families, and throughout our communities and cities.

After I spoke to several hundred at both the Puget Sound Naval Shipyard and Bangor SubBase, I was asked to speak to about 1000 of our local Bainbridge High School students during a drug and alcohol-free week. In September of 2010, I spoke during all 3 Sunday morning services at NorthSound Church in Edmonds, WA. The last of the 3 messages was recorded and can be found thru this link here. The message is about 20 minutes long; I trust you will find it interesting. You will need to download it and follow the instructions on the website. Out of that opportunity has come yet another, to speak at a CRISTA service in of all places - Palm Springs, CA this spring.

I am available to speak and share my journey. I do not ask for much in the way of compensation, only to cover my travel expenses and to provide a small stipend. I can speak with deep personal experience to the following topics.....

Making the right choices with regard to alcohol and subsequent behaviors

Overcoming loss, injury and disability - getting back on the bike

Faith and how it is challenged by life changing events

Insurance topics such as disability, medical and auto

The injured physician; what is is like to go from being an ER physician to a major trauma patient with a spinal cord injury - all in the blink of an eye

Forgiveness and how to process that, when what you love and do for a living is taken away from you by another.

Resiliency

Physician to patient communication and bedside manner

These are a few examples of topics I have already spoken to. All these are dear to my heart, and if you think that any of these may be of interest to you, your organization or business, please contact me further. I love to travel, meet new people and effectively communicate the personal growth and lessons I have learned from this tragedy.

Thanks for reading!

Financial Update 2010 - adjustments to life

Ernie Franz — Fri, 19 Nov 2010 11:48:40 -0800

Normally this time of year I bring to you a bicycling update, though this year has been different than the last two years which were filled with a lot of great miles and season ending goals being met or exceeded. More on that soon.

A primary focus has been on family sustainability; making good decisions and allowing us to live where we do for at least the near future. Some of the "cutbacks" have been rather minor and possibly a bit humorous; like eliminating home delivery of milk and purchasing it in our local grocery. I made the executive decision to move to a wonderful milk offered in glass bottles produced by grass fed happy cows thriving in Lynden, WA. We have given up home delivery of milk by another good company - a decision my wife laments. Yet I have reminded her, we have to make some sacrifices in order to still enjoy life as we know it; in this case we now save 20 cents per half gallon purchased!

Other changes have been more difficult, but in reflection, only more troublesome because they required a deviation from what had become our "standard of living" for the past 22 years. So merely because I now drive a VW instead of an Audi (which I had really enjoyed the past 12 years), I can be quite thankful it still moves me from point A to B reliably and safely, with better gas mileage and is still a kick to drive!

What follows is then a brief update on life and finances. I will blog about job opportunities and some medical health updates very soon (promise) ....

Since I last wrote in July 2010 about the uncertain financial terrain we have made some changes beyond just the milk we now drink!

1. We did sell both our cars, an Audi and a Volvo, and purchased two smaller fuel efficient used cars that still meet our needs - a Honda and the aforementioned VW. Though the plan was to put some money back into the bank, that did not quite happen - - yet we should be good with transportation for some time to come. Much to be thankful for in the realm of moving about safely and yet with some thrills behind the wheel. I can still dream one day of possibly owning a Porsche, and yet if it is a dream unfulfilled I am okay with that too.

2. Our home has been re-financed to a 30 year fixed rate loan at a nice low interest rate. Should our finances improve one day, we can make additional payments on the principal; yet for now this has significantly lowered our monthly expenditures.

3. We did restructure our medical/dental insurance coverage which both has lowered our monthly bills, and improved our coverage. When I last blogged, my Medicare coverage did not start July 1st as it should have. Yikes! Turns out - all my paperwork and application to Medicare was lost! Fortunately I had saved enough snippets of paper to prove successfully that I had indeed applied in a timely manner and my appeal was upheld! So by October 1st all was finally in place - Medicare coverage and a Regence MedAdvantage plan that provides me infinitely better coverage (including prescriptions and basic dental care - yeah!) - all at a lower monthly cost.

4. As for family insurance - first I would strongly urge you to seek out a clever creative knowledgeable insurance agent, which we happen to have. The market is confusing and constantly changing - quite obviously. While I completely agree healthcare reform is vital for many reasons, for now the insurers and those covered are sorting our what this all means and how it impacts rates, benefits and the future. The other four members of our family have moved to another health savings plan, but with a significantly lower monthly cost and which had the option of dental coverage! That coverage will pay 1/2 the cost of each child having their wisdom teeth removed; a huge benefit!! I have again begun to feel as though we can provide responsibly for these children Gwen and I have brought into this world.

5. I have hinted already that much of this has been difficult only because we have grown accustomed to a certain level of income and the freedoms that afforded. We have now had one year of reduced income via the ending of one of my disability policies; and though we travel less, purchase less clothing and non-durable goods, and seldom go out for dinner - life is still very good and enjoyable. Challenging - YES; a growing experience - yes, but I have much to be grateful for.

Thanks for reading! More soon.....

Rough financial terrain - the current landscape

Ernie Franz — Thu, 08 Jul 2010 12:39:13 -0800

First, an apology - I am not the best of bloggers, which is perhaps obvious! I am not inclined to feel like you, all of my readers, need to know every detail of our existence. Yet during my recent bicycling rides I have been pondering just what honest truth I can share with each of you about this life as one with a spinal cord injury.

What follows then is, more or less, where we are at as a family in terms of finances following my injury. You may have noticed I have until this point avoided this topic; yet lately a bit of financial angst has set in - so that, if nothing else, this writing gives me a chance to vent some of those frustrations. This also will give me the chance to relate what I am trying to do about our ongoing financial shortfall, and (as writing can do) perhaps organize my thoughts around this topic.

Thanks for reading and for even possibly for considering my employment .... some ideas on that topic as you read the following.

When I was injured at the hands of the intoxicated teen in August 2004 he was driving an uninsured vehicle. He and his family had no resources to compensate us, and though a lawsuit was filed initially it was dropped as there was nothing to be had. Our hope had been that some 3rd party, like a store or business, could be found at fault for selling alcohol to a minor - but that was not to be. In 2005 the state of Washington ordered the driver to provide restitution payments to me for damages caused, and determined that he should pay me $8,000 for uncovered medical expenses from the initial trauma. Since that time I have been occasionally receiving typically $40 checks; of which interestingly enough - if I fail to cash, I will owe the state a $50 fine!

We did receive a payment from our own auto insurance company. Basically if you are in any accident in which a car is involved, whether that be in an auto, or as a pedestrian or as a cyclist - your own auto insurance policy may cover you with PIP - personal injury protection, or if applicable UIM, or under insured motorist coverage. In my case we received a payment (minus attorney's fees, especially since this all became complicated) as I was truly hit by an under insured "motorist". In my case, I believe it was primarily the PIP coverage for which we received compensation. Those funds went to the following areas: our 3 children's college funds, to provide a vehicle we needed to purchase that I could get in and out of, pay uncovered medical and rehabilitation expenses, and finally to provide a better viola to my full-time professional musician wife (who struggles as almost all musicians to meet expenses; yet who provides music, joy and thereby brings meaning to much of life).

We have managed to stay afloat as a family due to two disability policies I had, and with the help of Social Security disability. Unfortunately one of those policies ended five years post-injury, or last fall 2009. Since that time we have faced then a very significant loss in monthly income compared to what we have been accustomed to since 1988. Don't get me wrong – we have so very much to be thankful for !!! An amazing recovery, relationships, community, and the deep satisfaction that comes from volunteer work. Yet something needs to change beyond just our ability to pare down to basics. I find myself torn between wanting to be the provider for our family, and yet face the reality of the lack of physical ability that will keep me from accomplishing that goal.

As for work, if I were to earn more than $750 per month, I would lose all social security disability income and the ability to have Medicare and supplemental insurance coverage. Basically I need to earn either less than $750 per month, or earn a lot (over $135k) for it to make any sense to go back to some type of full time work. I am hopeful that perhaps I may find a job that could pay me less than $750 per month, yet provide some other compensation such as health/dental insurance and/or deferred compensation of some variety. I am in the process of investigating possible opportunities with some local non-profit organizations focused on global medical care; in addition to seeking out ways to work as a medical examiner for insurance companies and pursuing speaking opportunities that may pay me an income.

Here is a summary of our family's current financial challenges:
1. All three teens need their wisdom teeth extracted at roughly $2250/teen with no insurance to cover this expense.
2. In an attempt to save money I have discontinued two of my medications (at $4-5/pill) which were otherwise deemed important; and have stopped receiving injections in my left arm and hand which allow me some additional movement/flexibility in that hand. These treatments each cost $1300 and have been given 4 times per year; yet my last treatment was in October 2009. I have decreased physical therapy and massage to once per month in an attempt to save money as well, yet honestly these have both been very helpful to me in the past.
3. I have some upcoming consultations which are likely to be expensive, yet important to complete. I have not have a urologic evaluation since January 2005 and am scheduled to see a specialist in the next few weeks to help determine if I need to catheterize myself more frequently, or perhaps not at all (that would be great!!).
4. I have been keeping up with my continuous re-certification requirements for Emergency Medicine and have passed all necessary exams to date to qualify for the board exam offered this September. Once passed, my board certification will be effective until 2020. Yet the exam fee is $1750, and having not been able to practice in the ER since 2004, it is even more vital that I take a review course to prepare for the exam. That alone is $1000, and does not include air travel and lodging.
5. Our family's ongoing medical/dental expenditures typically average $2000 to $2500 per month. That includes money spent on medical insurance with the remainder being uncovered medical and/or dental expenditures. Close to 90% of those dollars are attributable to me.
6. This fall we will now have 2 kids in college, both with monthly living expenses not covered by their 529 college funds. It was a sad day when I realized over a year ago those college funds were only for tuition, books and school supplies – not for room/board/living expenses. Given the economy it has been so far impossible for both boys to find part-time work.
7. On July 1, 2010 my Medicare insurance coverage was to begin, but did not….yikes! Investigation in process.

So while I have come to appreciate what many people face day in and day out, in terms of financial uncertainty, it is hard still for the first time in 22 years to not be able to afford some basic medical and dental care, and to have no reserve for emergencies, or to experience much of the life we once knew. In order to raise some funds we are looking into selling both our vehicles to obtain cheaper/older autos; we are also in the midst of a home re-fi with increasing consideration of accepting a 30 year mortgage just to keep monthly expenditures lower.
Overall I do not want to sound ungrateful. We have been provided for and cared for and loved by our community in amazing ways. Our church body of friends and many here on Bainbridge Island have done so very much to encourage us and have played a vital role in my recovery. I am deeply indebted to so many for their prayers, encouragement and talents in aiding my rehabilitation.

You could help by praying for me. I do want to work, and though I love the volunteer work I have been able to throw myself into, the time has come for me to find something to supplement our family income. Whatever that will be, I desire it to be work that is exciting and that will thrill me to get out of bed each morning! Though I had hoped to remain a long term faculty volunteer at the University of Washington school of medicine, serve as a spinal cord mentor to others so injured, and maintain active involvement in church ministry to others who have experienced loss, illness and hardship – it may be time that some of that energy needs to be re-directed and those volunteer activities curtailed. Time and events will tell….

I will do my best to keep you posted. IF you know of any opportunities in the medical field; speaking, teaching or potentially as an insurance examiner – I would appreciate the referral.
Thanks again for reading!
Be well,
Ernie

Cycling 2009 ends with an epic adventure

Ernie Franz — Tue, 05 Jan 2010 14:10:12 -0800

Well, now that we are officially into the 2010 cycling season (sort of anyway - waiting for the roads to dry, a bit of sun and temps above 45F), thought it was finally time to give a brief recap on the adventures of 2009. Overall it was a great season with roughly 2500 miles logged on the road.

As for what has now become my standard season ending ride, the goal was once again to complete 100 miles at the Dam2Dam Mike Utley Foundation bike ride the last weekend in September. A fund raiser for spinal cord research and for other such beneficial projects to help those with SCI find life and hope once again.

My amazing wife Gwen, and faithful physical therapist Keith Heinzelman, were in attendance. Our plans changed however the night before the ride when Gwen, carrying all my bags of gear with her vision blocked, sprained her foot on the curb at the Wenatchee Holiday Inn. This shortened her ride for the next day due to swelling and pain with weight bearing....she was to miss out then on the adventure Keith and I were to have!

In 2008, and recorded in this blog as well, I was able to complete 100 miles. This year the course was altered by a tragic accident which closed the Beebe bridge, a normal part of the 100 mile route. The bridge was structurally damaged by an apple semi-truck about a month before the bicycle ride. Sadly two people lost their lives as the cab tore through the railing and plunged into the river below.

With the bridge sagging and in need of vital repairs, the route had to be changed. This resulted in our facing a significant climb which began just 30 miles into the route. Though only 5.3 miles in length, the average gradient was over 8% with several sections over 12% - gaining 2200 feet in those few miles.

For the entire climb my HR was between 170-185 for 1hr 20min. If I was not an incomplete quad, it would have been a challenge - but this was in a real sense hors categorie for me. With prayers for strength and thinking of all the people supporting us, Keith and I did eventually make it over the climb to get to the flatter 60 mile long section - - we briefly thought much of the day's work was done......

But found at the top of the climb we had now winds reported steady at 30-35 mph with gusts to 40! An all too brief 5 mile tailwind section was completely enjoyed (no pedaling required to coast along at 30+ mph), followed by somewhat manageable crosswinds (that meant leaning hard into the wind to somehow just stay on the road) for 15 miles, but then turning a corner we faced 40+ miles of full-on increasing headwinds!!

Keith and I rode into this unrelenting wind with our best effort at 4-5 mph for perhaps 90 minutes, HR around 160 for the effort, and it was all we could do to stay upright! There was simply no way to even take a hand off the bars to grab a sip of water, as it would have resulted in a fall. We were using every available muscle group just to respond to the winds and not be blown off the bike. In a sympathetic act of kindness one of the support vehicles began motor-pacing us and attempted to block some of the wind for over 5 miles, which helped Keith and I to get another 1 mph of speed. The wind was so strong that on downhill sections we could hit almost 6-7 mph! When we finally realized it was 3:30pm (stopping to look at a watch) and that we had 38 more miles to ride, most of it still into the wind (at that pace possibly 7+ more hours on the bike as Keith reminded me) - we came to our senses and abandoned Plan A.

A purely "guy thing" had happened up to that point. As it turned out in our eventual debriefing of the ride, Keith was so ready to get off the bike and into the support vehicle - but he did not want to suggest that because after all, he was by far the stronger of the two of us, and how could he admit that to a quad who seemingly was determined to finish the ride? As for me, I had badly wanted to get a ride in the support vehicle, but assumed there was no way Keith would let me give up after we had made is this far! A communication gap, finally closed by the reality of the pace and number of miles left to ride into the gale.

So the last two riders on the course got a support vehicle ride to where Keith and I could meet up with Gwen. Now off the windswept plains of eastern Washington, along the Columbia river, the 3 of us rode back the last 10 miles to the finish in much calmer conditions - as we chased Gwen who paced us home.

At the end of the day Keith and I had cycled 70 miles altogether. Gwen cycling and excelling at being a patient, prayerful and understanding wife. Some final statistics for this 51 year old incomplete quad from the day: Riding time 6hrs 7 min, 70 miles, average speed 11.4mph, maximum speed 39.7 mph; average heart rate for the ride 151 beats/minute, maximum HR 186. So my HR was over 160 bpm for 39% of the ride, or for 2hrs 21 min. That's a few calories burned and certainly an epic adventure!

Two weeks later, with Gwen's encouragement, I made up for some of my "missed miles" by riding 44 miles roundtrip to a scheduled doctor's appointment. He and his office staff seemed to get a kick out of that. So for now I am once again indoors with group fitness spinning classes, until the drier slightly warmer weather appears. This changed life is not easy, but it still is very rewarding, challenging and exciting. I'll try to write more soon.....Thanks for reading.

Blog Orientation Essentials

Ernie Franz — Thu, 30 Jul 2009 15:20:23 -0800

This entry serves to give a quick orientation to recommended reading and audio/video links to those who might be visiting here for the first time. I have listed things below in a chronological order so that you may understand where I have come from, up until this point in time. You can get to those sections/links by clicking on the highlighted words. The first two entries are articles I have written from within the blog itself. Following that are a series of video and audio links.

As for reading within this site I would recommend starting with The Trauma section, which will give you the details of my injury August 23, 2004 - including x-rays, the car, and initial recovery.

You may then read more about my recovery and rehabilitation via two articles in this section entitled Recovery, which also includes the statement I made to the fellow that hit me, prior to his sentencing.

At the one year anniversary of getting swatted I was fortunate to be able to finish the ride home by cycling past the spot of injury and making it safely back to homebase. That story is nicely told in a 2 part video Bicycle Blues in the Key of E (be sure to watch it in HQ): Part I & Part II.

Last fall I was asked to be the lead-off speaker at the Spine Symposium Conference - Improving Outcomes in Spinal Injury, held at the University of Washington/Harborview. My 8 minute talk follows brief introductory comments by Dr. Jens Chapman, host of the symposium. I think you will find the segment interesting. Follow this link, then you will need to click on your choice of media player and speed connection to view the lecture. My talk starts at about 2min 35sec into the program.

Late Spring 2009 I particpated in a local Ride of Silence, an event now held across the US, which is ridden in memory of those cyclists killed or injured by automobiles. Our local newpaper presented this nicely done video segment of the ride.

In July 2009, Dave Beck of local NPR station, KUOW at 94.9 FM, contacted me for an interview about recovery from trauma, and to discuss life changes that occur after illness or trauma. Though I certainly wish that what occured to me, now almost 5 years ago, never had happened - I can say for certain that my life has changed, and in many ways for the better since the injury. Certainly not in a financial sense, but in my relationships, my faith, in the way I now approach life, the opportunities I have teaching medical students, and in working with those who have experienced trauma and loss. You may listen to that 20 minute interview here, which is also available as a podcast.

Thank you for following along on this journey! I pray you will find some material of encouragment to yourself or others. Be well....

Spine Symposium talk on UW-TV

Ernie Franz — Wed, 06 May 2009 23:05:01 -0800

In October of 2008 I was honored to serve as the lead-off speaker at the Improving Outcomes in Spinal Injury conference, which was organized by Jens Chapman, MD of Harborview Medical Center. Dr. Chapman is both a friend and my physician. He is following me for spinal stenosis in my lumbar spine, a condition inherited, yet also accelerated in its advancement due to my injuries in 2004.

After Jens gives a brief overview of the day, I provide a brief 8 minute presentation of my injuries and my perspective on how outcomes can be improved in spinal injury care. That talk may be found on UWTV via this link. You will then need to select your media player of choice and connection speed. At that point a video stream of the presentation should open up for you.

Thanks for watching!

Ernie

Inspiration from various sources

Ernie Franz — Sat, 17 Jan 2009 18:45:27 -0800

What follows are a variety of quotations and comments from various sources which have inspired me and helped me in the recovery process. My intent is to keep adding verses and quotes to this section as I come across new material that in turn my inspire you in your own personal journey.

"Faith does not operate in the realm of the possible. There is no glory for God in that which is humanly possible. Faith begins where man's power ends." - George Muller

"Faith is not an instinct. It certainly is not a feeling - feelings don't help much when you're in the lion's den or hanging on a wooden cross. Faith is not inferred from the happy way things work. It is an act of will, a choice, based on the unbreakable Word of God who cannot lie, and who showed us what love and obedience and sacrifice mean, in the person of Jesus Christ." - Elisabeth Elliot

I command you, be strong and courageous! Do not be afraid or discouraged. For the Lord your God is with you wherever you go. Joshua 1:9

"God's people have no assurances that the dark experiences of life will be held at bay, much less that God will provide some sort of running commentary on the meaning of each day's allotment of confusion, boredom, pain, or achievement. It is no great matter where we are, provided we see that the Lord has placed us there, and that He is with us." - John Newton

I love the Lord, for he heard my voice; he heard my cry for mercy. Because he turned his ear to me, I will call on him as long as I live. The cords of death entangled me, the anguish of the grave came upon me; I was overcome by trouble and sorrow. Then I called on the name of the Lord: "O Lord, save me!" The Lord is gracious and righteous; our God is full of compassion. The Lord protects the simplehearted; when I was in great need, he saved me. Be at rest once more, O my soul, for the Lord has been good to you. For you, O Lord, have delivered my soul from death, my eyes from tears, my feet from stumbling, that I may walk before the Lord in the land of the living. from Psalm 116

"Faith is to believe what we do not see, and the reward of this faith is to see what we believe." - St. Augustine

YouTube Video Links

Ernie Franz — Sat, 17 Jan 2009 17:12:19 -0800

Three videos have recently been uploaded to YouTube which tell various parts of this ongoing story. The first two are due to the wonderful work of Kevin Lynch, who in 2005 put together a movie for our local Bainbridge Film Festival featuring my recovery and my "finishing the ride home" on the one year anniversary of being struck. Bicycling past the spot of injury, this time with a police escort, 20 or so close friends, 3 other ER docs, and a US Congressman - among others. The movie is entitled Bicycle Blues in the key of E. Part I via this link, and Part II here. Be sure to enable the "watch in high quality" or HD setting below the screen to your right. Kevin Lynch is a master spin class instructor on Bainbridge Island when he is not flying about the globe competing in and/or filming professional triathlons.

The other video was done for the Kitsap Sun newspaper group with support from MADD; it chronicles the effects of alcohol and driving and the lives of those impacted in our community. There are three parts to this video, with my interview taking place here in Part II.

I believe these videos will give you a deeper sense of what I have gone through, and also will help you understand a bit more of my character and the key supportive roles so many have played in my recovery process. Enjoy, and thanks for watching....

100 Miles! Cycling update fall 2008

Ernie Franz — Sat, 22 Nov 2008 15:28:37 -0800

First, an apology…..
I am sorry that it has been so long since my last update. I am obviously not a blogger who is into bringing you each tidbit of news or accomplishment achieved in my life.
Yet there are a few very important physical goals that have been able to achieve since my last update in June.

During the dry season here I was able to average 100 to 120 miles per week bicycling on the road. Total miles on my Moots titanium hybrid are now 2500 in the past 15 months. Now that the rainy season is upon us, I am back indoors in group spinning classes 3 to 4 days per week. Dry roads and temps above 43 degrees F keep me outdoors and on the road.

Now to the reporting of two fantastic goals accomplished this cycling season....

I can now ride the entire Chilly Hilly bicycle route, 33 miles and 2500 feet of elevation gain – and do not have to get off to walk any sections. Long hills are okay, yet the steeper the gradient the more difficult it becomes. Riding the ~ 18 percent gradient up to Battle Point Park is the most difficult, fortunately it is only a short section of steep road before leveling off. My heart rate is typically 185 on that climb, not too bad for a 50 year old pump.

On September 27th 2008 I was able to complete my major training goal for the season.
I bicycled 100 miles in the Wenatchee, WA area on the Dam2Dam ride for the Mike Utley Foundation to raise funds for spinal cord injury research. The actual stats were 102 miles in 7 hours 10 minutes on the bike, average speed 14.1 mph, total elevation gain ~ 3250 feet, average heart rate 144 bpm.
I was supported by my wife Gwen, who rode 60 miles (only her third time on the bike all summer), Keith Heinzelman (my amazing physical therapist) and good friend Tom Crane who both rode the whole route with me.
Honestly, it is still hard to comprehend and believe that a C5 incomplete quad can complete a 100 mile bicycle ride in one day, riding on a two-wheeled bike. The more people I meet with spinal cord injuries, the more fortunate and blessed I realize I truly am.

Here are a few photos from the ride. First with my wife, then with Keith and Tom at the finish, and finally with Mike Utley.
Thanks for reading!