Poetry vs History (12/5/13)
A few months before we left Kijabe to travel and speak in the US and Australia, we welcomed Mike and Ann Mara and their two precious children to Kijabe. A gentle and wise mountain biking orthopedic surgeon and Irish international development guru with a passion for cups of tea and conversation–you might correctly guess they very quickly became good food friends!
As a part of her work to help the Hospital raise its international profile and begin to tell stories of the incredible Kingdom work happening here, Ann invited her friend Elizabeth Fischer, videographer and storyteller, to come for a few months. Elizabeth is working on her videos now, which will feature in the Hospital’s to-be-released new website.
There’s something powerful about using more than words or a simple narrative description to tell a story. Some scholars believe that over half of the Old Testament was written in ancient Hebrew poetic form…the writers selected poetry as a deeper and more descriptive way to express the love and interaction of God with his people than simply recording what happened and when, as a 21st century western historian might today.
This latest video from Elizabeth is like reading the Old Testament in poetic form…you can feel the love of Jesus in the actions of our Hospital chaplains, sense the powerful presence of God in the eyes of the children.
Elizabeth describes her video-making efforts this way in her blog: “I went along to film and photograph the day and the rainbow of different events that took place within a 11 hour span (drive included). There’s so much story behind this little montage of clips, so much love and care that went in to that day, went into those lives even for a moment, and hopefully went into the buckets of hope tucked deep in the cupboards of each heart who desperately wanted to be seen, loved, heard and known. Nothing can do it like the love of Jesus. I captured Him in motion, which I live for, working thru willing hearts. Loving well like He does.”.
Dallas Willard and nuclear submarines (9/5/13)
I was introduced to Dallas Willard in 1998 when I was freshly enrolled in the Submarine Officers Basic Course in Groton, Connecticut. I had just finished an exhausting year in Naval Nuclear Power Training School in Charleston, South Carolina–only 50% of our class would go on to be submarine officers, and I had lost my spiritual and emotional bearings in the midst of twelve hour study days and the time-independent neutron balance equations for light water reactors.
Mardi was in the middle of her intern year in Pediatrics in Charleston and would stay there while I traipsed up to Groton for three months of submarine emergency escape and tactical training. I picked up a copy of Dallas’ book The Divine Conspiracy on a friend’s recommendation on the drive up.
As I began to read, I realised within the first five pages that I could never be the same Christian again. I had lost my bearings, but in only five pages they were being re-calibrated and a hunger for the Lord was being rekindled in me. I had never read a book like this before, and I have never read one like it since.
A professional philosopher and educator, this man was not afraid to think well and deeply about difficult questions. An apprentice of Jesus, he was not content with proclamation alone and wrote about actually doing the works of Jesus. A theologian, he was dismayed by the faith-as-a-noun-instead-of-a-verb salvationist/soterian theological underpinnings of much of the American evangelical church, and had a massive influence through his writings and Renovare (the spiritual formation organisation he helped found, with whom we partner to deliver the Spiritual Formation course at Moffat Bible College in Kijabe) through his call to the church to be serious about spiritual formation.
A few of my favorite phrases of his from this book, which I have used so many times I write them here (mostly) from memory:
“Whatever you do, ask yourself, ‘what kind of [baker/teacher/soldier/doctor/business leader] would Jesus be if he were me? This is the essence of apprenticeship to Jesus.’”
“One of the major differences between an adult and a child is that an adult has learned to control their facial muscles. And one of the common traits noticed in adults of considerable spiritual stature/maturity is their childlikeness…they don’t use their face or body to hide the spiritual reality around them, and in doing so are genuinely present in their body to those around them.”
“Spiritual formation is, in practice, the way of rest for the weary and overloaded, of the easy yoke and the light burden, of cleaning the inside of the cup and the dish.”
“The primary ‘learning’ in spiritual formation is not about how to act, it is who we are in our thoughts, feelings, dispositions, and choices–in the inner life–that counts. Profound transformation there is the only thing that can definitively conquer outward evil.”
Dallas helped me get my bearings back during Submarine School in 1998, and then redefined and shook them up. I read The Divine Conspiracy on hikes in the Connecticut hills, underway on deployments, and at Mystic Pizza (yes, THAT Mystic Pizza). Dallas introduced me to the “already-not yet” principle of the kingdom of the heavens that Jesus spoke so often about: the kingdom is here and available to us now, but at the same time is not yet fully here until Jesus returns. And I began to develop the framework for my current understanding of what it means to actually apprentice oneself to Jesus, to learn to live my life as Jesus would if he were me.
And when a few years later, my mom got me a signed copy of Dallas’ latest book, The Great Omission, I looked inside and was deeply moved to see he had written a note to this Naval Officer he’d never met, whose mother had talked to him at dinner of her son struggling to live like Jesus on a nuclear submarine. He wrote:
“Joshua 1:9, Be strong and courageous, Andy”
He was that kind of man. Prophetic, subversive, and practical. I don’t think I would have survived, during my five subsequent deployments on the USS Maine and the year and a half that I spent underwater, without the framework of spiritual formation that he introduced me to. Dallas taught me to train in the ‘off season’ so that I would be more equipped to live like Jesus when I was ‘in the game’. He taught me the ‘principle of indirection’, where I learned that it is not through direct effort alone that one becomes less sinful and more like Jesus: rather than focussing on cleaning the outside of the dirty cup of my life (the part everyone around me sees), lasting change comes when we focus on cleaning the inside of the cup, and it happens through the power of the Spirit and not by my effort alone.
Dallas died yesterday of cancer, and I am so grateful for the life he lived, and the life of the “light yoke and easy burden” that he inspired me and so many others to lead. From submarining to a life of faith and compassionate service in Kijabe.
The home stretch… (30/4/13)
Read this post to the end for details on what needs to happen this month before we can return to Kijabe…
We’re in the home stretch. Just under four weeks until we’re scheduled to return. Home. To Kijabe.
While we are expats in Kenya, our work and the community we have become a part of has made it feel like home to us. This word ‘home’ has a bit more of a draw to me than it did 5 months ago, when we started our six month speaking tour in the USA and Australia. Travelling from the far north to the deep south of the US. Weekends in country churches in Australia. Disposing of our furniture, old children’s toys, and other memories on eBay and in garage sales.
We’re champing at the bit to return to Kenya. It is home, for now, and we feel like we’ve left a part of ourselves there.
We have been astonished and profoundly moved by the generosity of the people we have come across… as we tell stories of the work that is taking place in and through Kijabe Hospital, we have seen many of our current financial partners increase their support sacrificially, and numerous new partners come on board. We’ve been so encouraged and inspired!
Our plane tickets have us leaving on May 29, but before we are released to return by SIM, we must have 100% of our operational budget either pledged or received. This means 1) our monthly operational budget must be fully covered by pledges, and 2) all of our upfront costs must have been received.
We’ve only got a little ways to go: as of today, we need the following prior to May 29:
-$1,500/month in ongoing support (pledged, starting in May)
-$17,000 for up front expenses (plane tickets, car purchase, etc)
We’ve hopefully confident this will all come in during the next four weeks, and that we’ll be able to leave as planned.
If you have intended to partner with us in the significant work which is taking place in Kijabe but haven’t yet ‘pulled the trigger’, will you do it today? Click here for instructions, and take a moment to email us and let us know that you’ve joined our team!
A friend of mine said to me yesterday that he couldn’t understand how we could be so calm about the outstanding financial partners we still need in in the next month. We are just that…calm and at peace. You see, the Lord has repeatedly demonstrated to us that our provision on earth, our life, and our well-being come from Him. Not from our abilities or by our own hand. In 1998, freshly married and graduated from Medical School in Australia, Mardi arrived with me to our first Navy submarine duty station in Charleston, South Carolina, and applied for a position as a Pediatric Resident. Classified by the US medical system as a ‘Foreign Medical Graduate’ (or ‘FMG’ as we were amused to refer to it), her application was promptly (and repeatedly) thrown in the trash in favor of other US graduates.
All medical residency program doors were shut to Mardi, and she began to seriously consider becoming an EMT. It was possible that she might never get a residency position anywhere near either Charleston or my future submarine bases in the US. So we prayed, and we waited. And one month before that year’s Pediatric Residency program commenced, one of their interns-to-be dropped out, and they called Mardi: because she was in Charleston already.
6 years and a few more miraculous ‘there’s-no-way-that-could-happen-in-America’ stories later, Mardi finished not one but two training programs, fully qualified as a Pediatric Emergency Physician–one of the first of her medical school classmates to finish training, despite having changed countries.
‘Faith’, what is often referred to in the Bible not in its noun form but in its verb form (‘faithing’), requires regular exercise if you are to have it. In the Biblical sense, it’s something you have only if it’s something you are doing.
Faithing gave us peace in Charleston in the early days despite what looked to be dire circumstances. I recently heard one of my favorite preacher/theologians (Greg Boyd) say that just like you can’t have a dream unless you’re dreaming, you can’t have faith in God unless you’re faithing…and with four weeks left before we return to Kijabe, we couldn’t agree more.
It’s been a fortnight of traumatic incidents that have affected us and close friends. The bombings in Boston shocked and horrified the United States, and only in the last 36 hours, mudslides have wreaked havoc in Kijabe.
Due partly to deforestation, waterlogged ground from a rainy season + lots of rain, and the tricky geotechnical conditions resulting from a) a poorly constructed main road into Kijabe and b) the Lunatic Express railway line (the main rail line from Mombasa on the coast to the interior of Africa) being cut into the mountainside, mudslides roared through the area.
Thankfully there was no loss of life in Kijabe itself; however just up the mountain in Magina, a family lost three daughters. You can read the news article here.
Damage to Kijabe and its institutions has been pretty bad: 3 of the 4 roads accessing Kijabe were blocked and seriously damaged, most of the water supply pipelines leading into Kijabe were severely damaged with sections destroyed, and the damage to our sanitation infrastructure can’t be estimated until the mud is cleared.
It’s a disaster.
And yet…some tempering truth: it wasn’t as bad as it could have been. There was limited loss of life. Early pictures show the Kijabe community, expatriate and local, wading into the mud as a community to help clear the roads of obstacles and help neighbors recover. The mudslides provide a useful opportunity to raise awareness of practical impact of deforestation and poor construction techniques on roads and railway lines. Our brand new 40,000 litre tanks (4×10 kilolitre tanks) which supply water to the community appear to be undamaged (although the water pipeline supplying them is no longer there).
The pictures sent of people in the aftermath of the mudslides walking into the worst of it to help clear debris remind me of pictures taken right after the Boston bombings: moving images of policemen running toward the explosion with guns drawn. Onsite bystanders who became first responders because they chose to put pressure on a wound, or stem the bleeding of a casualty, rather than run away.
Running into danger to help.
I am deeply moved that this is what it looks like to be fully human, a person as God created us: laying down our lives for each other and running towards someone in need. When we observe pictures like those from Boston and Kijabe, something resonates deeply within us as we see a person putting their own safety aside for the sake of another–this is what we were created for, and is profoundly representative of the Father’s heart.
And now we wait for the light that will surely come from this darkness, the good which will burst forth from this evil. It always does, and on this side of the resurrection, the God-who-works-for-good-in-all-things won’t be repressed.
Support update: we have four weeks in which to reach our support target so that we can return as planned on May 29, and we are delighted to note that we have only $1,500/month in ongoing support to raise, and $17,000 in upfront costs. Have you been considering joining our financial partnership team and just haven’t pulled the trigger yet? Do it now by visiting our “support” tab…we are unable to return to Kijabe until we reach 100% of our budget.
The heartland (16/4/13)
In March, after months of collaboration, consultation and cash, the South Australian government unveiled its breathlessly anticipated new logo – a stylised picture of South Australia as a doorway to the rest of Australia. While derided by many as a kindergarten-level piece of artwork, I kind of like it. Because Andy’s always been able to hold up his hand, point to it and say “if this is Michigan, I come from here” and point to a knuckle. So now I can tell you where we spent the last week on the Eyre Peninsula.
If you look at Australia as a house, with South Australia as the door, the Eyre Peninsula is the bottom right hand corner of the innermost door as you’d cross the threshold. Oh forget it, I guess that’s still not too clear, so I’ll show you a real map instead.
We drove for nearly 8 hours – first north, past the wine growing regions, then across the top of the St Vincent & Spencer Gulfs, around the industrial Iron Triangle, then south again to the reddening soil and early autumnal brown landscape of the agricultural heartland of Eyre.
We had been put in contact with three churches, so we travelled to connect and to share, to listen and to encourage. Our first port of call was Port Lincoln, kingfish and tuna capital of South Australia. We were welcomed by Jean and Graham, a couple whose gift of hospitality is evidenced by their guest book revealing a list of nearly 14,000 people (fourteen thousand!) who have been privileged to be hosted by them in their granny flat over the last 25 years since they had it built in their back yard. They retired from farming, passing the legacy onto their son several years ago, and Jean celebrated her 80th birthday in June – and after 4 days with them we decided to adopt them as surrogate rural Australian grandparents.
Sunday morning saw us preaching at both services at the Uniting Church, Unity Hill, on Sunday morning. Rural congregations often struggle to find regular leadership, with small communities lacking attraction for many in pastoral leadership, so Unity Hill Uniting Church is blessed to have Benji Callen as their senior pastor. After realising that his PhD in science wasn’t leading him in a fulfilling direction, he completed theological studies and ordination and relocated with his family to Port Lincoln. (Side note: as you find with most people in South Australia, we are all separated by one degree – his wife Nicole and I attended the same youth camp when we were 16 years old.) Us preaching on Sunday morning meant that Benji could preach at Poonindie, another Eyre community who relies on Benji sharing the load with their local lay preachers. It was an opportunity for us to share about our understanding of the gospel – of our heart to have a “Billy Theresa” mission, in which actions are just as important as words, whether at home in South Australia or in Kijabe. A chance to encourage people – what you do, today, wherever you are, has the potential to be important in ways you may never fully appreciate.
Midweek was a time to explore and rest, as well as to meet and connect. We spent some time hiking at Lincoln National Park and Coffin Bay, hundreds of kilometres of protected coastline, sand dunes and scrub first discovered by outsiders when Matthew Flinders was circumnavigating Australia in 1802. To walk along deserted beaches together while the children were back in Adelaide with their grandparents was a restorative blessing – peace and solitude in the midst of ministry. A chance to reflect on our journey over the last 4 months, in the context of the last 2 years, and to look forward with uncertainty mixed with faith. On Tuesday we were invited to share about our work in Kenya at a luncheon at another local family’s house. A group of around 15 took time out of their weeks to come and listen and ask questions about our ministry, welcoming us with interest and thoughtful questions about the details of life and work in East Africa. We had time to sit and chat with Benji, learning that Del Giorno’s is THE place to get coffee in Port Lincoln as well as get a glimpse of the life of a rural pastor. We were able to learn from Jean and Graham the meaning of hospitality, as well as a snapshot of the tuna fishing industry and the families who make this their life. We saw a tuna farm as Pete drew us into the world of aquaculture, explaining the months long process of procuring and fattening Southern Bluefin tuna for the export to the premium Japanese markets, who buy 97% of the tuna in order to supply 3% of their demand.
At the end of the week we headed to Tumby Bay, population 1351 until summer tourists swell the numbers to up to 12,000. Initially a grain storage and loading port, it supports the agricultural community with education and healthcare as well as being a centre of gravity for families and visitors alike. We met the delightful Fatchens, retired farmers who invited us to share at a prayer meeting at their home with a group of prayer warriors who faithfully keep in touch with missionaries around the world, praying for and supporting them.
On Sunday morning as we walked on the beach before church, an eager lady with a dragon boat and some extra paddles informed us that we really should come out and paddle with them – and so we found ourselves conscripted into a dragon boat training session with a bunch of friendly strangers, coasting through tranquil waters to the beat of an enthusiastic voice behind us timing our strokes (easy oar! paddles in! aaaand…. go!). An unexpected surprise to start a full day. We preached at Tumby Bay Church of Christ, complete with generator-powered projector due to a peninsula-wide power outage – thank you ETSA for making these Kenyans feel so at home! The lunch afterwards was again a spiderweb of connections, with members having attended my childhood church, or having children married to schoolday acquaintances.
The afternoon found us wending our way out to Ungarra, population 241. In the agricultural heartland of the Eyre, we visited the Telfer family, 2 generations with 5 families sharing the load of farming at their massive property – wheat and barley, canola and vetch. As we chatted with Josh & Esther, 2 of the junior Telfers, we were reliably advised that if we were to be driving before sunrise the next morning, we would need to watch out for kangaroos, and shouldn’t swerve if we saw them. “Camels and wombats – they’re the only 2 animals you should swerve for. Wombats are like huge bricks – they’ll flip your car. If you eat wombat, I’ve heard they taste like sweet, sweet pork”. Excellent.After fruit cake and coffee and a look at the biggest seeding machine in the history of… anything I’ve ever seen, we went to the Ungarra Church of Christ to share with a group of about 20 people. Another chance to share our heart for the poor and oppressed, wherever they may be. And a wonderful time of briefly being a part of a community of people we’d only just met.
After living in rural Kenya for the last 2 years I feel a strange, new affinity for rural Australia, with its challenges and joys, hardships and rewards. It has been a joy to make these connections and a privilege to have a window into these families and communities. We pray that we’ve been able to encourage them as much as they’ve encouraged us.
Finance update: thanks to all of you, near and far, who have contributed to our upfront costs thus far and who have committed to supporting us regularly. As of this week, we need to raise another $1800 per month in ongoing support, and $32,000 in upfront costs before we can return to Kijabe. Please continue to pray with us that all will come together in order for us to leave on May 29.
Malawi & Madonna (4/4/13)
Today I read an interesting BBC article about Madonna and her charity to help kids in Malawi get an education. She had planned to build an academy for girls, but in the end changed her plans and built classrooms for existing schools where the lack of sufficient classrooms meant children were forced to learn outside under trees–no matter the weather.
This part of the article, quoting the Malawi education minister, struck me:
“We’d like them to work with us so that they can be absorbed into the strategy of Malawi’s education and that goes not just for Madonna – any group that comes to Malawi to assist us in education.”
An individual should not “go to some remote part of Malawi and start doing whatever because at the end of the day we must plan for teachers”, Ms Kazembe said.
One of the reasons that I love volunteering at Kijabe Hospital is because the Hospital is an integral part of Kenyan health, endorsed by the ministry of health. The Kenyan government posts 10 medical school graduates to us as interns each year, knowing they will be taught well and experience learning to be a doctor in circumstances similar to other places around the country, but with excellent supervision. We also receive 10 clinical officer interns per year, the equivalent of US physician assistants, who train with us for 12 months, and then go on to settle into a health centre, ours or somewhere else, becoming experts over the years in a specialty – our pediatric ward and nursery would lack critical continuity and excellence without our clinical officers Lillian and Bob. Our surgical training programs are accredited across Africa, with the goal of building up surgical capability over the long term as we train future teachers. Our nurse anesthetist program, the first in East Africa, was initially accredited by the Kenyan medical board, and is now extending to our neighbouring countries who are embracing this widening of opportunity in the provision of surgical care.
I sometimes hear of churches and organisations sending short term medical missions trips overseas to needy places. Sometimes this is done well – teams of doctors and nurses going to a place that has infrastructure and long term care already in place, the team invited by those on the ground to come and accomplish a specific goal – training in advanced life support, heart surgery for which the local medics have been screening patients and preparing for for months, if not years. But every so often I hear of a team which cobbled together some doctors and nurses and bandaids and drugs, and set up tents in what appear at first glance to be remote and poor areas – but without the invitation of the local health teams, without local understanding of the underlying medical, cultural and economic problems of the people. There may be good treatment of a case of pneumonia, but lack of understanding that the underlying HIV or TB has not been considered, and a short term respite is all that has been really offered.
As we meet and talk with people about our work in Kenya, many have said something like – I’ve always wanted to go and help. Or, I’d like to take my kids to see work like that, to realise how fortunate they are. Or, what could I do do help for a couple of weeks?
My answer is always the same: There is so much we can, and should, do to help people in the resource-poor world. But the first thing I think people with compassion need to do is ask the right people – what can we do to help? If you come offering health, ask the people who are already trying to provide healthcare – what can we do to assist in what you’re already trying to do with few resources? If it’s building a school, ask – what is the national system here, and if I am building a primary school, is the curriculum going to help these kids achieve what the country would like them to achieve, rather than what I think they need, and what is the plan for teachers to be consistently available?
If it is church planting, ask the church leadership – what do you need, and how can we help disciple, encourage and pastor people over the long term? If it is sending a team of people to build a community centre, ask: would it be better for us to help the local population whose unemployment rate is 40% by hiring them to build it instead?
We all have great intentions when we seek to go somewhere and help people. But too often our good intentions are wrapped up in plans and dreams and goals of our own, or those of an NGO, instead of what is needed and how we should get there. And without the ownership, direction, vision and desire of the people who are asking for help, we are likely to provide short term help at best, or conflict, opposition, dependence and harm at worst.
The BBC article concludes: “contrary to reports, Madonna’s relationship with Malawi government is good”. I hope that when we, and you, go to help, the report of our relationship with the people, community and leadership is the same.
Two months left… (30/3/13)
We have only two months left in our visit back home before we return to Kijabe! The last four months in the States and Australia has flown and been busier than we thought possible, but been enormously encouraging at the same time as we meet with like-minded people who inspire us with their compassion and vision.
We plan to return to Kijabe on May 29, and we’re on track to do so. Before we can return, we are required by SIM to have our monthly and up-front operational expenses fully funded by committed supporters…and we’re getting there. We are delighted to report that as of March 30, we have only $2,400 per month and $37,500 to raise up-front before we are able to return.
To put this in perspective, we have already raised more than half of the additional monthly budget we needed in order to return, and half of our up-front expenses! We have been deeply blessed and inspired to see new supporters come alongside, and the continued and increased support from our current financial partnership team.
But we’re not there yet. For our up-front costs in particular, we need to raise another $37,500 in the next 6 or so weeks in order to:
-purchase return plane tickets
-buy a 4WD vehicle that will help us navigate the often-impassable-by-a-2WD-in-muddy-weather roads around Kijabe
-set up a small contingency fund of one month’s worth of operational expenses
-pay for medical costs and vaccinations before we return, and
-cover excess baggage costs for books and clothes we want to take back with us
If you haven’t joined our team already, will you help us?
There’s an interesting article in The Australian this weekend on the limited effectiveness of foreign aid. It notes a recent study which offers a scathing critique of one of the world’s largest aid programs, saying this well-known aid program has a ”limited ability to demonstrate whether its poverty reduction activities have contributed to any significant change in the lives of the people it is trying to help”.
A massive statement. And yet, living as we do in a country which receives a massive amount of this aid and working inside a Kenyan-run and Kenyan-owned (not foreign NGO) institution, we can testify to first hand experience of the far-away feel of foreign aid money, and of frustration with where it is being spent.
Do you want to participate in compassionate work in a developing country? Kijabe Hospital has a nearly 100 year track record of caring for the poor and refugees, training African doctors and nurses, and providing economic development for the local area. And it can’t keep its doors open without people like you supporting volunteer/missionary staff like Mardi and I, who receive no salary from the Hospital but whose expenses are met by friends and family back home.
Will you consider supporting us with a once-off gift or becoming a monthly supporter today? Click here to become a part of something with unquestionable long-term value, and contribute to significant change in the lives of the people we help on a daily basis.
A good night: At The Wine Underground
We had a great night last night at The Wine Underground. We were humbled and delighted to be able to share about the work of Kijabe Hospital in East Africa with about fifty old and new friends from the engineering, medical, and business sectors across South Australia.
It was a fun, deep, interesting, moving, encouraging evening. Some great questions, and conversations with several people who are considering doing similar compassionate work in the resource-poor world.
Many thanks again to our kind host/interviewer/facilitator extraordinaire, Stephen Watkins and to the kind folks at Inside Infrastructure who sponsored the evening.
You can view a short clip of the evening here:
On Tuesday, a baby was born in a rural area of South Australia known as the Riverland. He was born safely by c-section in a public hospital with less than 50 beds. On Wednesday, when he was having trouble breathing and turning blue, the state retrieval service sent, by helicopter, a paediatrician and a paediatric nurse with intensive care packs to stabilise him. Then a plane was sent with a specialised transport incubator and ventilator to pick up not just him and the medical team, but also his mother, so they could return to the safety of a neonatal intensive care unit. The public health system pays the costs, and this new family has every chance of life despite the remote location of their home.
Today I paid Riley’s school fees. As I handed over $95 for a term of public education, I had a brief moment of – wow. My goodness. $95 for 3 months of school. In a country where minimum wage is $15.96 for full time earners, I could pay for a year of education for my child by working by working for 3 days. And for this, my daughter has a teacher she adores, access to facilities beyond that of a private school in East Africa, and the bonus of a playground in which she is highly unlikely to sustain any serious injury…. unlike the playground of her local school in Kenya, in which the merry-go-round, once spinning, is only likely to be stopped by an act of God.
When I was driving through Grand Rapids one afternoon while we were in the US, I was held up by a school bus. Traffic backed up for quite a while, and I started to become annoyed – until I saw the cause for the delay. The bus was equipped with a lifter for a wheelchair, and as I watched it became clear that there was a child with special needs who needed lifting down to the ground. A child care worker was there to assist him, as his mother walked up to the bus to greet her son who had been at school all day. Not only was this child not abandoned in a field at birth, but he was receiving therapy and care, education and love, in the school system of Michigan.
In Australia and the US, we are so blessed to be born where we are born. In the lucky country. In the land of the free and the home of the brave. We are no more deserving of this chance at life, at love, at happiness, than anyone else in the world. Today I am grateful for the accidental country of my birth.
The ties that bind (16/3/13)
One of the perks of being a US navy family is that when you are moved to a new station of duty, you are MOVED. The moving men come to the house, pack up all your worldly possessions safely in boxes, put them in a van, take them to the next address, and unpack them in the room of your choosing. When we moved to Australia in 2005, the same thing happened – except this time we met our goods at the other end.
When we settled into our first Australian home, we unpacked 7 years of memories – the Rainbow Row framed picture from my internship in Charleston, the rustic coffee table from the maker-on-the-river in Jacksonville. The crockery bought piece by piece by friends and family in Michigan and New York and Washington DC from our wedding registry, the ornamental Lord of the Rings sword (oops forgot that was on the container, customs…). The coffee mugs from New Orleans, the piano that Andy bought me as a surprise birthday present – and managed to get into the house and show me at a surprise party without me knowing a thing. We unpacked again the kitchen canisters I had won on Wheel of Fortune in in Australia, transported first as newlyweds to our first apartment as memories of Adelaide for me, and now back across the ocean again. We had the luxury of not having to be brutal with decisions of what came – each piece had a memory, and we happily brought them across the sea as to build new memories on top.
Over 6 years in Australia, we made more memories. Wine glasses to celebrate our 10th wedding anniversary, our children’s first big-girl-and-boy beds. The ornamental map of Traverse Bay in northern Michigan, bought on a Christmas visit and framed in Australia as a link for Andy with childhood memories, our chunky farmstyle dining table and chairs.
All of these memories went into storage when we moved to Kenya in 2011. Although we sold our house, we stored the things of day to day life, planning to unpack 2 years later when we returned.
Except that now we’re back, we haven’t returned to live here. While we were still in Kijabe, we made the decision to come back and sell almost everything. From a pragmatic standpoint, the costs of storage would start to exceed the value of the goods, and the numbers decided for us. But from an emotional standpoint, after 2 years away, things started to lose their hold on us. As we lived in our Kenyan home, and made new memories, home again moved for us – home became the place in which our family lives. I started to forget what lay in a shed in Adelaide, and realised that if I had done without it for 2 years, I could probably do without it altogether.
At least, that’s what I thought I felt.
The last 3 weeks have been a flurry of unpacking, sorting, selling. Arranging, deciding – do we keep anything? If so, what is important enough to keep? What is just a nice memory, what is irreplaceable?
Daily taking photos of things to sell. The rustic coffee table, the ornamental sword. Seeing them sell, and feeling glad and disappointed at the sale price and relieved there is one less piece to store and aghast that we made this decision and was it the right decision and numb at the finality of it all. Relieved that noone bought the wedding dress and ashamed I had almost sold it when everyone knows that you should always keep your wedding dress and bemused that I would care about a piece of clothing I will (a) never never fit into again and (b) never have any occassion to wear again even if it DID fit.
Watching 15 people waiting like vultures outside our garage sale until the doors opened at 8am , literally racing in, jumping over one item to get to another, just out of reach. Haggling with people who didn’t realise that the meaning of a $20 pricetag was not overconfidence in its worth – it was that part of me wanted it to be too expensive because I didn’t want to sell it. Spending the next 4 hours watching Wheel-of-Fortune memories become someone’s spare kitchen supplies for the holiday house, or the cushions become a tidy profit for a dealer in their second-hand store.
Between the activity of sorting and selling, being with friends and meeting new supporters, travelling and preaching, parenting and working, I haven’t really had any time to process what is going on inside of me as 14 years’ worth of stuff walks out the door.
And so yesterday afternoon, while Andy took care of the kids, I was able to go and get a haircut and have some time to myself. I found myself walking around a shopping centre in tears. Walking past a homewares store as quickly as possible, before the lure of shiny new things mocked my losses. Adjusting to memories that were now dreams and photos rather than tangible objects.
Although we made the choice in Kenya to move our full life there, and the decision is one I don’t regret, the ties of things are still strong in my heart. And it surprises me when they sneak up on me.
There’s a hymn used by Thornton Wilder in “Our Town” that goes:
Blest be the tie that binds
Our hearts in Christian love;
The fellowship of kindred minds
Is like to that above
As I process the cutting of these physical ties, I am so grateful for the stronger ties that keep me grounded. My husband and kids, with me no matter what location I’m in or what things surround me. Our families, connected to us despite distance and time apart. Our “fellowship of kindred minds” – dear friends in Kijabe whose hearts beat as ours do, our community of partners all over the world who walk these steps with us as they support, encourage and pray for us.
Cutting these physical ties is hard. But I know that this initial pain will fade, and the memories will remain. I know that these earthly treasures lose their sheen with the passage of time, and the eternal significance of some stuff that could burn down tomorrow is negligible. I know we’ll make new memories, and inevitable new ties, as we return to Kenya. We’ll have to repeat this process again when we make our next move, whenever and wherever that will be.
This process is exactly that – a process. I didn’t come home yesterday with a renewed sense of tie-less-ness. There will probably be a few more tears, amidst my impatience and anticipation of returning to Kijabe. For now, I have decided to keep the wedding dress, some friends have offered to store the wedding crockery (random fact: they too received the same style of dishes when they were married), baby albums will remain stored carefully elsewhere.
This is a messy, exciting, difficult, joyous, complex time. Thanks for walking through it with us.
South Australian speaking itinerary (6/3/13)
(updated March 16, 2013)
It’s here! Our draft speaking itinerary for our few months in South Australia. If we’re not able to catch up with you personally, or you’re not able to attend any of the private speaking engagements we’ll be at, we’d love to see you at any of these events in South Australia. Stay tuned for updates; we’ll keep this updated regularly.
-Mar 10: Padthaway and Bordertown Vineyard Churches, 10a.
-Mar 12: SA Water, 4p.
-Mar 17: Southland Vineyard Church, 10a.
-Mar 26: Information night, The Wine Underground (Adelaide CBD), 730p.
-Apr 2: Women’s and Children’s Hospital, Mardi giving lecture to PED nurses
-Apr 4: Information night, Southland Vineyard Church, 730p
-Apr 7: Port Lincoln Uniting, 9a and 1030a services.
-Apr 13: Tumby Bay Prayer Breakfast.
-Apr 14: Tumby Bay Church of Christ, 1000.
-Apr 14: Ungarra Church of Christ, 1700
-Apr 28: Copper Coast Baptist Church, 1000 (Kadina)
-Apr 30: ATO Lunchtime Legends Seminar, 1300
-May 19: Hallett Cove Uniting Church, 0930.
-May 29: Return to Kenya!
An evening with the Steeres at The Wine Underground (6/3/13)
Interview on 891 Adelaide ABC Radio, South Australia
On Monday we were invited to be interviewed on Adelaide’s popular AM radio station, 891 Adelaide, on Ian Henschke’s morning program.
It’s a short interview, only about 8 minutes long…click on the link below if you’d like to have a listen.
Hiding in the bathroom (19/2/13)
When we got to Adelaide, I had run out of words..
I’ve always been on the shy side, pretty introverted. Quicker to watch and listen than to join in and speak. Over the years, through learning to perform – on the piano, dancing & marching on the stage for calisthenics I have adjusted the outside me to appear confident, to initiate conversations, to teach, to be up front.
But inside, I prefer to watch, to listen. To sit by myself and read, ponder, wonder.
As a child, when asked to perform a piece on the piano at a recital, my heart would hammer in my chest and I would start to feel a little sick. But over years of playing in church, then backup singing, then finally leading a congregation, I became used to the stage, to a sea of faces who no longer made me feel afraid.
I will never forget the first day I walked into a hospital as a medical student. to examine my first patient. The nausea, clammy hands, elevated heart rate. The relief, at the end of the day, that it was done. The apprehension that tomorrow, I would have to meet new patients, reintroduce myself, and start again.
Over the years of medical school, I gained confidence, taught myself to meet new people without anxiety. And as I began to enjoy the science and art of doctoring, the anxiety faded away and I developed a comfort in my new skin of pediatrician – a belonging and ease in my chosen profession.
But the inside me hasn’t really changed. I recently read an article written by an introvert who explained that when she is at a party, every so often she goes to bathroom – not to use it, you see, but to, for a few minutes, escape conversation and noise and interaction.
I have been doing that – or washing the dishes at dinner parties – for as long as I can remember.
So these last two months of travel, daily sharing our work and stories and passions, has been a challenge for me. Staying with dear friends and family, some of whom I have known for decades, has been a joy and an encouragement. The opportunity to meet and thank supporters and partners has been precious.
But it is the most exhausted I have ever been. Moreso than the 6 years I worked 80-100 hours a week. And strangely, more than working in Kijabe, with its complexities and emotion.
I recharge alone. In the silence of an empty house. When children are asleep and my husband is out with a friend. When I can’t overhear someone else’s conversation or thoughtful enquiry. When I can sit at the piano and play and sing and know that noone else is listening.
We arrived in Adelaide on Tuesday, grateful to be on this second leg of our journey. But we decided to take the first week off – off of conversation about our ministry, off of planning, off of doing, away from people. My parents kindly looked after the long-awaited grandchildren while Andy and I went away for 2 nights. My husband is my best friend, which is why we were comfortable with hardly talking to each other for most of the weekend – a companionable silence, a retreat. Some time together, some time apart.
And I find myself, at the end of it, finally with some words. Able to blog, a little, for the first time in a while. Less tired, more available to be with people, to be in the middle of rather than at the edges.
So, Australian team, we’re back. We are so excited to see you, and can’t wait to catch up with you. There is time – a lot of time – we are going to have to be with you until the end of May – catching up and lecturing and preaching and telling stories. But you’ll understand when sometimes, there will be times when we’re not available. Recharging time before heading back to the intensity of Kijabe.
If you look hard enough, you may find me in the bathroom, or doing the dishes. But I promise, if you wait just a little while, I’ll be out soon.
engineering success (17/2/13)
The young Alexander conquered India.
On his own?
Caesar defeated the Gauls.
Did he not even have a cook with him?
-Excerpt from Bertolt Brecht’s 1935 poem “Fragen eines lesenden Arbeiters,” in which Brecht imagines a young German worker beginning to read a lot of history books and being puzzled that they are chiefly histories of great men.
(from Engineers of Victory: The Problem Solvers Who Turned the Tide in the Second World War, by Paul Kennedy)
In January 1943 Winston Churchill, Franklin Delano Roosevelt, and their chiefs of staff met at Casablanca in North Africa to decide upon the future grand strategy the Allies would follow in World War II. They decided on four strategic directives before they posed for photographs and headed home:
1. The Axis powers (Germany, Italy, Japan) would have to offer unconditional surrender before the Allies would stop their offensive;
2. They must win control of the Atlantic sea-lanes, to allow supplies from the United States to reach Europe;
3. They must attain command of the air over all of west-central Europe so that the UK could act as a launching pad for an invasion of the continent and the destruction of the Third Reich, and
4. They must invade Europe across Axis-held beaches and carry the fight to the European heartland.
Within a little more than a year, against astonishing odds and despite previous debilitating and repeated losses, all four of these strategic aims were either accomplished, or close to it (the “unconditional surrender” part would take another year).
In his excellent book, Engineers of Victory, the eminent historian Paul Kennedy notes that the story of World War II, and specifically the achievement of these four strategic aims is often told as a grand narrative, as if it were fought by supermen or decided by fate. But rarely, if ever, are the creative operational strategies, tactics, and organisational decisions which turned these four lofty Allied objectives into a successful reality discussed.
I read this excellent book while on a silent retreat with Mardi this weekend. We needed a weekend of silence and reflection after our intensive (but good) last two months in the States; it helped to clear my head and recalibrate my inner mental, emotional, and spiritual compass.
I found Kennedy’s book profoundly enjoyable not only because it is an excellent inter-service and inter-campaign historical examination of the entire War, but also because the main point of his book is something that I have been passionate about for 15 years. From my experience as a junior officer on nuclear submarines in the United States to managing water infrastructure projects in Australia, I have noticed that while leadership at the top is important in setting strategic direction, it is the mid-level managers or operators who provide a majority of the leadership and operational innovation which get the job done.
Readers of the late management expert Peter Drucker* will recognise this truism from his oft-repeated research findings: a broad majority of leadership and innovation within an organisation comes from within the middle ranks, not the top tier. Clear strategic priorities (the “what”) are crucially important to the success of an endeavour, but it is in the development of mid-level operational plans and the creation of a work culture which encourages and empowers mid-level problem solvers/project managers/managers (the “how”) that the truly hard work of successfully delivering an endeavour, project, or objective is done.
In other words, leaders don’t just order something to be done, and presto, it is accomplished, or presto, it stumbles. Nor does hiring a charismatic or brilliant executive or Commanding Officer mean success is assured. Or, as I have seen too many times, on too many continents, simply developing strategic goals and mission statements are not the guaranteed precursor to a successfully delivered project or increase in organisational effectiveness. No, to use Jim Collins’ phrase, studies show that “getting the right people on the bus” in terms of empowering the right mid-level workers/managers is actually a more important lead indicator of the success of an enterprise than where the CEO tells the bus to go. And, the dynamics and mechanics of how a strategic aim is to be successfully delivered is at least, if not more important than what you’re trying to achieve.
Recognising and being intentional about the difference between the “what” and the “how” of a plan or project is something I enjoy incorporating into planning and project management workshops I facilitate. I find that particularly in Africa, where the landscape is littered with failed projects but lots of good intention and vision (almost always amongst work by foreign NGO’s and governments, but don’t get me started), having clarity about the difference between the what and the how can be a powerful first step toward delivering a successful project or enterprise.
*if you haven’t come across Drucker yet, perhaps start with The Effective Executive: The Definitive Guide to Getting The Right Things Done
We’ve been on the road for eight weeks now. Speaking in various churches. Planned and impromptu meetings with old and new friends to share about our work. Watching the kids while Mardi gives a lecture. Trying to maintain a semblance of a business-as-usual rhythm of life with exercise, prayer, and family/relationship maintenance time. The sensation of being homeless as we travel: Nairobi-London-Boston-Chicago-Grand Rapids-Dayton-Annapolis-Virginia Beach-Greenville-Beaufort-Atlantic Beach-Los Angeles in two months.
For me, the last two months have been equal parts adventure/awesome and tiring/chaos. But I noticed today that the pace of our travel schedule combined with its shock-to-the-system change from our everyday work in Kijabe has begun to produce in my mind a bit of a fog. Something like the fog I would sometimes experience as a submarine Officer of the Deck during the very brief periods we would spend on the surface in the Atlantic. I know where I want to head in this fog; I have a map, radar, GPS, and my ears…but I get disoriented sometimes and have to rely on my instruments to help differentiate between where I think I’m headed and where I’m actually headed.
A very few brief examples:
December 27: 7p, Michigan. Q&A evening with old family friends in Grand Rapids. Home by 2300, get some sleep and hop in the car at 0800 to meet a friend in Kalamazoo. Turns out she is passionate about our work and offers to arrange a Q&A evening for a few people at her home in Albion in two weeks’ time.
January 8: 6p. Drive the two hours to Albion. Kids excited to eat at “Old McDonalds” and get a Happy Meal. Q&A evening for a few friends has turned into Q&A evening for 30 people, held at the church my Father planted twenty years ago. Present on our work, answer questions, tell stories. They lay hands on us and pray for our work and family. The Lord moves a few people deeply and they receive a fresh vision of a Jesus worth abandoning everything for. There are many tears. A beautiful, totally unplanned evening.
January 9, on the road to Atlantic Beach, Florida. Hop in minivan lent to us by a good friend for our two months in the States. First stop, Akron, Ohio, dinner with a supporter whose Sunday School class faithfully provides some funding to the Needy Children’s Fund. A few days in Annapolis, Maryland, Virginia Beach, Virginia, and Greenville, South Carolina follow over the next week with friends and supporters. Onto Beaufort for a few days to visit and care for the family of my good friend Matt while he is on deployment with his Marine Corps F-18 squadron in the Pacific. Attend their church on Sunday and spend some time chatting to one of their pastors. Are invited to present to their missions committee the following week.
January, Atlantic Beach. Back in Jacksonville, our home for 5 years in 2000-2005. Every day, 2-4 events/meetings planned: Lead worship and speak at a women’s retreat. Present our work to old friends and invite them to become regular financial partners. Lead worship at church on Sunday morning. Preach the following Sunday morning. Drive eight hours round trip to Beaufort for a 1 hour presentation to the aforementioned missions committee. Return at midnight, and nine hours later Mardi gives a lecture on “Pediatric Acute Care in the Developing World” at Grand Rounds to the emergency physicians at one of Florida’s busiest hospitals. In the midst of this, unplanned deep conversations and moments of prayer percolate to the surface of our days and flood my soul with delight and an awareness of the presence of the Lord.
February 4, Atlanta. Here to visit family. Invited by my uncle, a pastor at one of Atlanta’s megachurches, to speak to his men’s discipleship group. Show up and discover that an attendee is a prominent Christian political leader. The night is a tender evening of telling stories, answering questions, and praying together.
February 7, flight to Los Angeles: get on plane, wrung out from constant human interaction and being on the road. Look out the window and imagine that if I could just have a walk in the mountains surrounding LA that I would be refreshed and ready to do this all over again in Australia. Sort of a Louis L’Amour moment. Mention this to Mardi, agree it’s unlikely. Arrive in LA and are picked up at the airport by friends and short-term volunteer docs at Kijabe, and drive to their house in Santa Clarita. It turns out to be perched on the edge of a cliff overlooking the San Gabriel mountain range, and there are 360 degree views of rolling hills and peaks. Thank you, Lord. I go for a walk to pray this morning, and see a deer standing on a nearby ridgeline, sillouhetted in the sunlight from the rising sun. Eagles ride the rising canyon breezes, lazily making huge spirals, and a gentle wind stirs my cheek.
I have been reading Oswald Chambers’ writings since my grandmother gave me a copy of My Utmost for His Highest twenty years ago. He was a chaplain to the ANZAC troops in North Africa in WWI, and both as an Australian citizen and a former military officer I’ve always felt a special affinity for his reflections. Today’s devotional is from Isaiah 40:26:
Lift your eyes and look to the heavens: Who created all these? He who brings out the starry host one by one, and calls them each by name. Because of his great power and mighty strength, not one of them is missing.
And I felt the fog begin to clear. I’ve been overwhelmed, short with my kids, tired…and I reflected on this verse and heard the Lord saying, “be in the moment, Andy…look around you and see that I love you, I have provided these mountains, this deer, these eagles for you to enjoy and to know that I am with you. Regardless of the chaos around you and uncertainty about tomorrow, forget these things and be present to my reality of joy and peace around you. If I am caring for you right now, won’t I care for you in the future?”
There goes the fog, burned away in the sunlight of God’s presence. The fog of the constant inclination to think about who we’re meeting with tomorrow, where we have to be next week, and which invitations need to be made for the lecture in Australia next month. The fog of worrying about tomorrow, of being mentally and emotionally anywhere but where I am right now.
Chambers goes on in the devotional to say:
The people of God in Isaiah’s time had blinded their minds’ ability to see God by looking on the face of idols. But Isaiah made them look up at the heavens; that is, he made them begin to use their power to think and to visualize correctly. If we are children of God, we have a tremendous treasure in nature and will realize that it is holy and sacred. We will see God reaching out to us in every wind that blows, every sunrise and sunset, every cloud in the sky, every flower that blooms, and every leaf that fades, if we will only begin to use our blinded thinking to visualize it.
February Grand Rounds lecture: Pediatric acute care in Kenya (31/1/13)
Mardi gave this lecture at Grand Rounds to the emergency physicians at Shands Hospital in Jacksonville, Florida on 31 January, and the following day to the University of Florida pediatric residents at Wolfson’s Children’s Hospital.
It is uploaded (click on the image below) due to the requests she’s had to publish it. Enjoy!
This update brought to you by the letter ‘e’… (6/2/13)
… that’s ‘e’ as in ‘encouraging’.
For in spite of the rigorous and tiring travel schedule we’ve had the last few weeks, we’ve been greatly encouraged as we’ve travelled around the States…seeing that many of you have caught a passion for equipping and training African doctors, nurses, engineers, and pastors. Seeing that many of you from the U.S., in a country which has one surgeon for every 2,000 people and one physician per 350, have become deeply moved to help train doctors in a country that has one surgeon for every 670,000 people and to help us send medical teams to care for refugees in camps totalling 600,000 people with no resident pediatricians or surgeons.
It’s encouraging. And humbling. And inspiring.
We’re encouraged by the family who bought a minivan, drove it to Michigan for us to use, and then will pick it up from Atlanta when we’re done. We’re encouraged by those of you around the globe offering to house us as a family of 4 for as long as we need, because you understand that we’re a part of a global family whose needs are yours. We’re humbled by those of you who, nearing retirement, are increasing your monthly support to us because you believe in participating in what we’re doing. We’re inspired by those of you who always wanted to do something in the resource-poor world, but were never able to go due to health or finances or family – and who are now working in Kenya with us by joining our team as regular supporters.
As we travel, we tell stories to encourage and inspire – and we find ourselves encouraged and inspired by you. Because we’re just a part of a team, you see. Followers of Jesus call it the ‘body of Christ’; but whatever you call it, we’re just one member of a community of people doing this work. Our work is to live and work in Kenya and report back on our progress, and it’s the work of others to be monthly or one-off financial supporters, helping us pay for things like food, diesel, and school fees for the kids.
Financial support update: only $3,400 per month and $41,000 up-front remaining
When we started our partnership development efforts in December, we needed to find partners who would commit $100, $200, or $400+ per month to cover the additional $4,800 per month budget which we need to return to Kenya for another five years.
I am delighted to report that as of today, due to new financial partners coming onboard and existing partners increasing their support, the amount we need to raise is down to $3,400 per month. Additionally, our up-front expenses remaining has decreased to $41,000. We’re getting there!
Will you join our financial support team?
Neither of us receive a salary of any kind from Kijabe Hospital – having humanitarian volunteers/missionaries on staff at no cost allows Kijabe Hospital to continue its compassionate work of providing low-cost or free health care to the poor and marginalised in East Africa. Our only income is provided by private financial supporters like you.
For our first two years in Kijabe, we were partly self-supporting as we were fortunate to have some funds in savings. Now that we have decided to commit to Kijabe for another five years (at a minimum), this self-supporting model is no longer sustainable and we need additional financial partners willing to commit to supporting us monthly or through one-off gifts.
It is our desire to return to Kijabe in May 2013, as Mardi has been asked to be the volunteer Medical Director of Kijabe Hospital. We have chosen Serving in Mission (SIM) as our sending agency for financial accountability and administrative support, and they (wisely) will not allow us to return to Kenya until we have 100% of our monthly budget covered by committed partners, and 100% of our up-front costs raised. You can view a one-page summary of these breakdowns here.
Will you help us to get back to Kijabe in May by joining our financial support team? Click here for details on how to do this.
High dependency (23/1/13)
When I first arrived at Kijabe Hospital, there were two options for care if you were a sick child – admit to the ward, where there is one nurse for 12-20 patients depending on the workload, or admit to intensive care. The intensive care unit had 5 beds for the whole hospital – so taking a bed for a child meant taking a bed away from an adult who also needed one. It has often been a Solomonian task – if I send this child to the ward, will they be watched closely enough? But if I send them to ICU, will someone else not get the care they need and die? There were many 5pm episodes of walking around ICU with an adult surgeon and an obstetrician, each of us asking – which if our patients needs this bed the most?
Several months ago, the pediatric medical and surgical teams got together and decided – we need to convert one of our 4-bed pediatric bays into a 3-bed high-dependency unit (HDU). Again, a tough decision – we lose a pediatric bed, in a ward that is always full with beds in the hallway, but we gain an area where 3 children can be monitored by a single nurse. And we all decided that it was worth it.
Bethany Kids donated the money – around $10,000 dollars to purchase monitors, buy beds, pipe in oxygen and suction where none existed. A ludicrously small amount for a renovation by western medical standards, but insurmountable in Kenya without external donations. Erik, the head of pediatric surgery and a good friend of ours, gave the project the go ahead and we waited for the overworked engineering team to have the space in their always-full project schedule to start the conversion process.
So finally, a couple of weeks ago, we were able to welcome our first patients to the new HDU. On a day when intensive care was already full of adults and children, it welcomed a child with severe malnutrition, one with liver failure and another with critically high blood pressure. Our pediatric ward nurses, lacking confidence in caring for the sickest children, are being trained by our intensive care nurses, increasing their skills and confidence. And already, our first survivor – the severe malnutrition navigating the first dangerous days of high dependency care to graduate to the ward, and finally home where our nutrition team will follow her and her family to make sure they have what they need to continue to thrive.
It might not seem like much, but 3 extra beds for us is just one more step in the right direction. The direction of being able to more closely monitor a child who may be alive in the morning because we were able to detect their falling blood pressure, rather than finding them dead in the morning at 4am in between vital sign checks. The direction of training our nurses and doctors to care for a child who’s just a little bit sicker than the others, increasing their confidence and competence for the good of so many more children.
And so we continue – the high dependency of these kids mirroring our high dependency on God and each other as we navigate this unending journey of serving poor and vulnerable kids in Kenya.
January update: we’re changing (16/1/13)
Click here to view our January update.
Infrastructure revolution! (16/1/13)
A few months ago, I wrote an article for the The Australian Institute of Project Management, as a case study on the infrastructure explosion at Kijabe Hospital and how we’ve managed to deliver projects in a resource-poor environment.
They published it this month, and you can read it here!
Information night and reception in Albion, Michigan (9/1/13)
We were delighted to share some stories and answer many questions last night in Albion, Michigan. It was organised by Anne, an old friend of the family, and Mike, Senior Pastor of New Hope Worship Center…the church my father pioneered 22 years ago. After a rather stunning array of drinks and nibbles, friend Jamelah hosted an informal Q&A interview with us for an hour and a half, and we had a blast sharing our work with old friends.
Many thanks to Papa Bill for child-wrangling during the evening, and to Ann and Pastor Mike for their efforts…also to the delightful New Hope family who are doing the work of Jesus amongst the community of Albion and setting an inspiring example for what it looks like to be the body of Christ in the 21st century in America.
What in the world are we doing? (30/12/12)
It occurs to me today that it’s already been a month since we left Kijabe. It has been so far a delightful whirlwind of seeing old friends, reconnecting with family, detaching from the intensity of work in rural Kenya.
I know some of you have been wondering, though – 6 months? What on earth will you do for that long? So I thought I’d explain why we’re taking so long to get back home.
Historically, Christian missionaries spent months on a boat to venture to distant lands. They sometimes took their coffins with them, secure in their call and their hope. As travel became more feasible, the concept of a regular missionary “furlough” became the norm – missionary families staying in their adopted country for 4 years, and returning home to their country of origin for 1 year – a time to connect with financial partners and partner churches, rest, obtain healthcare, restock on supplies for school and survival, connect grandchildren with loving grandparents and themselves with friends and family.
If you look up “missionary furlough” on Wikipedia, it redirects you to “vacation”…not even close to an accurate synonym. The term “furlough” has now been replaced for many with “home assignment”, which is closer to what these 6 months are for us.
So…our first home assignment. What does that even mean? For us, it’s a few things:
A much needed rest. The intensity of poverty, death, success-followed-by-several-steps-back, distance, living in another culture, learning language means that we need a break. So we are building in some special family time to this period – a weekend in Chicago. A few days at a cabin in northern Michigan, courtesy of a ministry to missionaries that donates vacation rentals. We’ll have some special girls and MaMa (my mum) time in Melbourne, Australia in April. And it is a joy to detach, to rest, to celebrate togetherness.
A time to connect with our incredible partnership team – family, friends, new partners we’ve only ever met online and now get to meet face-to-face. We work hard to keep people updated through our blog and Facebook, but distance still makes connection less than perfect. So we are seeing as many of you as we can – wonderful dinners and lunches and playdates and outings with families that we and our children love and emjoy. Preaching and speaking at churches whose love and support have been a foundation for our lives, both separately and together. These connections and sharing the results of the last two years are an important part of our work.
A time to tie up loose ends in Australia. When we left in 2011, it was for 2 years, so we put our lives there into suspended animation – furniture, clothing, dishes into storage, ready to hit re-start when we came back. Except that now we are committed to Kijabe for at least another 5 years, and it no longer makes sense to keep things on “pause”. So we need to unpack our belongings and sell most of our household goods – not a minor task after 14 years of marriage! So we will spend 3 months in Australia doing that (among other things) while the kids attend a term of school to give them a sense of structure and stability during this transitional time.
A time to meet and connect with new partners, to broaden the team of people “with us” in Kijabe. We’re sharing at people’s home groups, dinners, informational events, connecting with people one-on-one from Michigan to Florida in the US and in both urban and isolated rural areas in South Australia, preaching and speaking at new churches. Sharing our passion and love for the suffering and oppressed in the developing world, sharing our hope and joy at being a small part of bringing restoration to a broken world in the name of Jesus. Inviting people to be a part of this ministry with us.
When we decided to move to Kijabe in 2011, we quit one set of jobs and signed up for another. The jobs we left in Australia had provided us with income and security – our jobs in Kijabe provide the joy of a calling and a mission, without any income. We receive no benefits or salary from Kijabe Hospital, so for the last 2 years, our living and ministry/business expenses have been provided in part by wonderful partners, faithfully participating with us by providing monthly or one-off support. The rest has been covered by our savings. When we signed up for a 2 year committment, this made sense. Now that we have committed to at least another 5 years, we simply can’t continue to self-fund part of our expenses.
Building relationships with our partners during this home assignment is a joy – being with people all over the world gives us a deeper understanding of how important and necessary every part of the “body of Christ” is. But it’s also an important part of our work. Because until we have enough committed financial partners we won’t be able to return to Kijabe.
And we really want to go back. We both feel like Kijabe is exactly where we are supposed to be right now.
We are grateful for the people already committed to partnering with us on an ongoing monthly basis. As of today, we need to raise an additional $4800 per month, plus upfront costs for airline tickets and a car that won’t slide off the road in the rainy season or require frequent repairs. We’re slowly getting closer to our goal, and it’s because of partners who are people like you. Already in our first four weeks of home assignment we have been so very blessed. Encouraging emails and calls, new partners committing to support us financially every month or once-off. It is an incredibly humbling position to be in – watching God work through people around us, when we can’t really DO anything to reach our goals except share stories of how he’s been working through us already.
So that’s what these 6 months are. A not-quite-home assignment, since Kijabe is home for now – work and rest, connection and encouragement. Partnership in the flesh for a short period of time before we head back, with you, our partners, to continue what we started.
To partner with us on a one-time or ongoing basis, please click here to reach our “how to partner with us” page. You’ll be able to see our current needs as well as a breakdown of where your monthly support goes. We are so grateful for our partnership team and couldn’t do this without you!
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Honey for Christmas (21/12/12)
Yesterday, just in time for Christmas, we received a wonderful piece of good news for 150 families around Kijabe who are affected by HIV/AIDS.
About a year ago, I (Andy) had a conversation with one of our health workers in the Hospital’s HIV/AIDS department (see footnote for more background on this). He was on his way to make a routine home visit to a teenager who was HIV positive. Sally was “positive” [name changed] and had also been orphaned, along with her brothers and sisters, when both of her parents died of HIV/AIDS a few years back.
Sally had attended a summer camp the Hospital runs for “Positive Teens”, and he had heard she was considering prostitution in order to buy food and clothes for her and her siblings.
I asked him what he was going to say to her, and he sighed, “I’m going to encourage her that prostitution is a bad idea, and she should find other work instead…but I know there isn’t really other work that she can find, and so I don’t know what to tell her. I wish there was a job I could give her. I have a similar conversation like this almost every week with other HIV positive teenagers.”
This conversation, and the heartbreak of the cycle of dependency and hopelessness which results from a lack of economic opportunities for HIV/AIDS sufferers stuck with me. So when we got a call from my friend Tom in Adelaide a few months later asking if there were any community projects in Kijabe that his engineering consultancy could help fund, we thought of Sally and her problem.
Tom’s engineering consultancy runs a small NGO called Golder Trust for Orphans (GTO) which makes grants to community projects which benefit orphans in Africa. After his call, we invited GTO to come to Kijabe to for a visit, and after their visit we put together a grant application to fund a beehive project for family groups like Sally which are caring for children orphaned by HIV/AIDS.
You see, beekeeping offers lots of potential for economic development amongst African individuals and families. For about $55 USD, a beehive can be purchased which will produce more than $100 US dollar’s worth of honey in the first year alone. It is simple, practical, and can be replicated and production increased easily as communities come together and share costs for harvesting equipment (gum boots, aprons, smokers and gloves). A honey purchasing cooperative already exists throughout Kenya, and so getting the honey to market is a matter of placing a phone call.
So you can imagine our delight when we heard today that GTO has approved our grant application! For less than $12,000 USD, our HIV/AIDS department will purchase 150 beehives, give them to families which care for HIV/AIDS orphans, and provide them with a few years of ongoing training and assistance to help beekeeping ‘take’ in their community.
The principal project objective is that each of these family groups will be provided with a sustainable income-generating activity (beekeeping) and then encouraged to sink part of their annual income into more beehives, with a view to them having multiple beehives and sustaining their entire family on the income from them within a few years.
This has been some wonderful Christmas news…much needed encouragement for me as we undertake our own work of partnership development thousands of miles from Kijabe, and joy as I consider what this means for Sally and families like her–a chance to start to break free of the the cycle of hopelessness and despair.
I am delighted to work alongside people such at those within GTO that have a heart to fund projects like these, as well as alongside our HIV/AIDS department, which despite the daily grind of working alongside people who may have lost hope, continues to care for those impacted by HIV/AIDS in a practical and compassionate way.
Merry Christmas, indeed.
footnote: Kijabe Hospital runs a best-practice HIV/AIDS program which utilises a community-based treatment approach to restore hope through provision of antiretroviral drugs, health education, testing, support groups, and community health worker training. Our AIDSRELIEF program, funded by PEPFAR funds from the United States is considered ‘best-practice’ in that it collaborates with other programs in the community to focus on income-generating activities for families with HIV/AIDS sufferers and the many situations where an entire generation within a family group has died from HIV/AIDS, leaving the grandparents to raise their orphaned grandchildren. Income-generating activities provide a long-term strategy to improve the economic condition of families and HIV/AIDS sufferers, allowing children to receive sufficient nutrition, schooling, and a start at a different life no longer hindered by the negative economic impact that HIV/AIDS brings.
A not-quite homecoming (17/12/12)
We’ve arrived back in the States a couple of weeks ago and it’s been a bit of a whirlwind, but a good one, since we arrived. It’s been great to reconnect with friends, family, and partners.
Highlights so far:
-Riley and Liam spending time with the ever-resourceful Nana in Boston–who organised a scavenger hunt for them in Barnes and Noble…with the participation of store management, no less
-Riley clinging to Papa Bill whenever he’s within arm’s reach, and her full conviction that if she wants it to snow, Papa Bill can make it happen (he has connections, you see)
-Spending some good time with Grand-Nana, who is finding it harder to hear and communicate but who is still a source of encouragement and spiritual strength to me
-Meeting the kind and lovely Beth, my father’s new wife, for the first time
-Pilgrimages to heavenly Robinette’s, the apple farm that has been a West Michigan donut and apple cider icon since 1911.
-Any and every moment spent with my sister, brother-in-law and their boys Will and Quinn
-Riley and Liam having a sleepover at Will and Quinn’s house and going to Krispy Kreme donuts for breakfast the next morning
-A few days with the inspiring Fiona and David in Cape Cod, another multi-cultural couple (British and Irish…a match only possible in heaven)
-Visiting (and rejoicing with) my aunt and uncle who narrowly survived a terrible car accident three weeks ago and are starting the long road to rehabilitation and recovery
We’ve also enjoyed starting to share personal stories with our partners of what their financial partnership has done for a child, a refugee, a future chaplain or pastor, or our rural community in Kijabe.
Having lived on three continents so far, we’re not unfamiliar with culture shock…and so we were prepared for a bit of re-entry turbulence. It’s been mostly mild, but most of it has been humorous more than anything:
-Mardi wandering around Meijer in a daze before running out early because the size of the store was overwhelming
-My (Andy) not being comfortable driving at night or on the interstate, and feeling like a 70 year old man navigating Grand Rapids on backstreets to avoid four lane highways
-Staring in fascination as my cousin (the foodie wizard Mike McKay) made a frittata…and realising after a full minute that I was entranced because he was using white eggs without chicken poo and feathers stuck to them. WHITE eggs! What will they think of next?
-Checking out books at the library and having to ask the librarian for help 4 times because I couldn’t grasp the “automatic check-out system” (nerd factoid: RFID chips in every book).
In the 1960′s, my paternal grandfather transitioned to his third career…WWII test pilot to automotive engineer to church planter in Grand Rapids. The church he planted is healthy and thriving today, and we spoke at both services yesterday. It’s hard to put into words how much of a blessing it was to be with a church I have visited off and on for 37 years, and which felt like family the moment we walked through the doors.
Preaching 48 hours after the most horrific mass murder in America’s history provided additional context to the talk we gave. We spoke on the backstory to the hope, longing, and anticipation that is the season of Advent and the new Exodus that we are called to as followers of Jesus. There were lots of tears…but it is a time for grief and lament in America.
We hold eight passports between the four of us (four of which are American), and so returning to the States is always a good feeling…but after our nearly two years in Kenya, coming back ‘home’ hasn’t feel quite like the homecoming it normally does. You see, part of our hearts are in Kenya now.
It is good to be back in the States, and it will be good to be back in Australia in February…but rather than coming ‘home’, I feel a bit like we’re visitors to someone else’s home. I love that person, I am grateful for their hospitality and relationship and it is a delight to hear their stories and share some of ours…but I don’t want to overstay my welcome. I look forward to returning to our work, our leaky home with the front door that doesn’t lock properly, and roads with potholes so large you could hide kids in them.
And I must say…going for a run without having to constantly look down at the road to avoid rocks or goats or fallen trees is mighty nice!
All in all, it’s good to be back for a visit.
Being a servant (8/12/12)
Dr Leland Albright, adopted grandfather to Riley and Liam, and our pediatric neurosurgeon at Kijabe Hospital (in that order) is not only leading a team which has made our Hospital #1 or #2 in the world for treating vulnerable children with hydrocephalus and spina bifida. He is also a deep thinker who gave an outstanding devotional this week at Chapel on servanthood.
He gave me his permission to post it…enjoy.
And read this in the context of a man who left an illustrious career as one of the world’s leading pediatric neurosurgeons to come to Kijabe and work 6 days a week operating on children for no pay, in conditions far below what he was used to…because he is a servant.
Giving thanks (6/12/12)
Marrying someone from another country means you marry a lot of their customs. Some of them were big adjustments. Hominy and liverwurst (liver sausage and grains drenched in maple syrup). Birkenstocks. The Beastie Boys (music?). Some of them were delightful. Ben & Jerry’s icecream. Snow at Christmas time. Gorgeous secluded campsites in every national park.
But by far my favourite American tradition is Thanksgiving. A holiday set aside every year to sit down in gratitude and reflect on blessings. No gifts, no cards, just a meal with family or friends. I have gladly adopted this tradition, and although it doesn’t quite work in Australia in steamy November, we had Thanksgiving in July for the years we lived there, taking the opportunity to read the story of Squanto to tolerant friends who dutifully followed my emailed recipes to bring foreign dishes such as green bean casserole and pumpkin pie to celebrate with us at my parents’ home each year.
This year, Thanksgiving in Kijabe occurred 3 days before we left, perfectly placed for us to take stock of the last 12 months, to reflect in gratitude on the relationships and community we have developed in our African home. Jennifer invited the pediatric medical and surgical doctors and families to celebrate together, and when the numbers swelled to 41 Amanda Hansen graciously offered her slightly-bigger-than-Jennifer’s home to host us. Jennifer baked a massive mutant turkey, others pitched in with beef and ham, and everyone brought their favourite Thanksgiving dish & dessert and we sat down to just enjoy each other’s company.
When we arrived in April 2011, the pediatric department consisted of Jennifer and Immaculate, valiantly trying to juggle the load of the newborn nursery, pediatric ward, medical consultations from the surgeons, the outpatient department and the occasional ICU patient. As we left Kijabe last week, pediatrics was amply covered by Jennifer, Sarah Muma, Sarah and Rick Gessner, Ima & Erika with our outstanding clinical officer Lillian. Which is a good thing – in almost 2 years, our patients have swelled, with 3-4 children in ICU, multiple extremely premature babies and a full ward and outpatient department being the norm. Now, when there is a pediatric emergency in the hospital, there is a doctor who can help. Immediately.
Our hard working pediatric surgical team of Erik, Leland and Susan continues to set the standard of care in East Africa, complemented by our newest neurosurgeon Humphrey and our trainees Situma, Lebbie and Ken.
And in addition to the medical bodies in the room, Thanksgiving was a day of being surrounded by friends – not only colleagues whose company I deeply enjoy, but families and spouses whose love and support have ensured we have surrogate family. People we can call upon when children fall off of chairs and hit their heads, or wheeze in the middle of the night, or when I need someone to chat with over coffee, jog and debrief with or laugh with over dinner.
So this is a post just to express my thanks. To God, for providing the resources we need in Kijabe to do what we do. For providing friends and family when we’ve left friends and family behind. To you, reading this post, for doing what you’re doing to make this possible – for your partnership, support, encouragement and love which made you present at our Thanksgiving table in spirit, if not in person.
Thank you, and we cannot wait to see you soon.
Mystery, planning, and Mother Teresa (15/11/12)
We’re in the final countdown before we leave for our short furlough in the States and Australia: finishing and handing over projects and putting everything in “self-sustaining” mode until we return.
Administer Moffat final exam…check. Finish Greek II assignments and take final exam…nearly check. Handover project management of USAID grant…check. Make final presentation to Kijabe board of elders on water situation…check. Write journal article for Australian Institute of Project Management…check. Facilitate one last planning retreat…check. Negotiate MOU between Moffat and SIM…check. Book speaking engagements in the States and Australia and develop presentations and talks…check. Have final mentoring sessions…check. Give our camera to a Moffat student (third child of the fourth wife in a plural marriage) who wants to start a small business taking photos so he can earn money to help his family…check. Try not to let all this affect my baseline love and grace for others, especially my family…nearly check.
In the middle of this countdown, I have been finding delight (and tears) in a biography of Mother Teresa called Mother Teresa: Come and Be My Light. Much of her life I was already aware of–stories of how this amazing woman was completely abandoned to Jesus, suffered unbelievably for the sake of the poor and outcast in the slums of Calcutta, pioneered powerful works of the Lord and changed countless lives.
But I was unprepared for the letters the bio includes between her and her superior, the Catholic Archbishop of India (Perier), in the three years leading up to her receiving permission to leave her convent and establish the now-famous Missionaries of Charity in Calcutta.
In these letters, Mother Teresa recounts supernatural experiences where she heard Jesus repeatedly calling her to “come and be my light” to the outcast in the slums of Calcutta, and asking her if she was willing to give it all for Him. Called “ecstatic” experiences in the Catholic parlance of the 1940′s, she had visions, heard the Lord speaking, and felt a tangible pain and terrible grief for the poor and suffering.
For her, leaving the relative safety of her European-style convent and starting a new missionary society in the slums wasn’t the fruit simply of a pragmatic analysis that there were no missionaries to the poorest of the poor (there weren’t), and as such she ought to consider it–no, she was moved primarily by a desire to respond to Jesus’ cry on the cross, “I thirst” (John 19:28) and desired to quench the thirst of Jesus by quenching the thirst of the poor in Calcutta. It was a deeply supernatural, deeply personal call.
But here’s where it gets really interesting: Archbishop Perier recognised that that her mystical experience were likely from the Lord, but he was concerned that she might be getting a bit too caught up in them. Worried that if he set her loose too quickly her heart for the poor might sputter and die, in 1947 (after two years of her begging him to let her start a new society) he asked her to sit back, deliberately stop focussing on the visions, and do some intentional planning. Before he would give her permission to start this new Missionaries of Charity endeavour, he needed answers to some explicit question:
It is not desired to have a long description of what you fancy you will be able to do. What we want is to know in a few words: the aim, the means, the rules, the recruitment, the possibilities of success. I do not say the glamour nor do I mean the humiliations, hardships, etc. but if we start something it must be able to achieve the object for which it is started—that’s what I call the success.
He asked her for planning details, in six categories:
1. What do you want to do
2. The means by which you desire to bring it about
3. How you will form your disciples
4. What kind of disciples/nuns you intend to recruit
5. Where you intend to focus your work
6. Whether it is a better idea to reach your goals through an existing organisation
Mother Teresa’s reaction to this was in keeping with her deep humility and strength of character: while she was taken aback, and felt strongly that “if these visions are from the Lord, there is no chance of failure“, she was completely obedient and took several months to think about these questions, and write down plans and strategies.
And in the correspondence between them in the years preceding and following her move to Calcutta, the fruit is apparent: the supernatural experiences started her on the journey and sustained her in the hard times…but it was the considered plans and strategising that she had undertaken before she started the Missionaries of Charity which were a key factor in it being the successful, sustainable, worldwide endeavour it is today.
I spend a lot of my time here in Kijabe working to improve project management practices, facilitating planning sessions and meeting, and writing plans and reports. I don’t know why I enjoy it…I just do. I have for a long time felt a burden that intentional planning is a critical factor in the success of endeavours, whether ministry-based or business-based, and that passion, vision, the leading of the Spirit, or good intentions alone are not enough.
I’ve always felt it takes both: starting with the vision/passion, and then doing the hard work of planning and considering the “what” and the “how” of your vision.
My burden for this has increased dramatically since arriving in Africa almost two years ago…the African landscape is just littered with failed projects. There are so many that successful, sustainable endeavours are considered the exception. When asked the question, “Did you deliver what you said at the beginning you wanted to deliver?”, the answer is often “no”, with multiple caveats as to why this was the case.
I find the combined efforts of Mother Teresa and Archbishop Perier in the 1940s very interesting, and deeply moving. It was in the combination, the nexus of the supernatural and the natural that Mother Teresa’s work grew to be so profoundly effective.
May this be so of our work amongst the poor and suffering here. And may I be even 1/10 as obedient to the call of Jesus as Mother Teresa was.
Squalling babies and holy privilege (11/11/12)
It’s Sunday morning and I’m almost exactly half way through my last weekend on-call for pediatrics. Knowing this is the last time for a few months that I will need to be available to instantly run to the hospital for 48 straight hours, I said to a friend at the beginning of the weekend – it doesn’t matter if I don’t get any sleep, this is my last weekend! Do your worst!
Which is, of course, exactly how last night worked out.
Our newborn nursery has space for 16 babies in cots or incubators. So when I started rounds yesterday morning and found 19 babies there (including 2 sets of twins sharing incubators with their sibling), that didn’t bode well. Hearing that there were two mothers in labor with premature babies didn’t bode well either. The interns and I saw all the babies and realised none of them were ready to go home – and thus began the dance with the nurses trying to make space where none existed for the 2 babies we knew were coming.
Ultrasound is an amazing thing – I asked the obstetric team how big these babies would likely be, and they were able to tell me one was 10 weeks premature and would be around 1400 grams, and the other was 7 weeks only and closer to 1800 grams. We sent one of the bigger babies in the nursery out to sleep in the same bed as his mother (the standard for newborns in our hospital), freeing up one space – and we just jammed another incubator into a space that didn’t really exist but had a power outlet for us to plug in one of the lifesaving oxygen-producing CPAP machines.
We were ready for the 2 babies.
And so, of course, the rest of the day consisted of babies arriving from unexpected corners, while the laboring mothers of prematures percolated slowly along.
First it was the 3 day old baby with a cleft lip who had been referred to us because he couldn’t feed. We gave him a special bottle and mum some medications to increase her breast milk supply, and admitted him to one of the maternity beds to sleep together with his mum, leaving our precious nursery space available.
Next it was the “term” baby whose mother’s blood pressure was dangerously high – so after a c-section she came out clearly over a month premature and 1900 grams. We managed to scrounge an extra cot from the bowels of the hospital and cram her into a space that had previously held a cabinet – the cabinet unceremoniously dragged to the milk-preparation room to be dealt with later.
At 8pm I was paged so the intern could tell me about a child with asthma he was admitting. I thoughtfully asked and answered his questions, and together we came up with a plan of action. As I was about to hang up the phone, he casually mentioned that he needed to go to the operating theatre for a c-section of a baby with “grade III meconium”. A baby was about to be delivered who was swimming in a sea of its own thick stool. This was a perfect teaching opportunity about how to try to make sure theses babies don’t inhale their own stool when delivered, avoiding the dreaded and potentially fatal lung damage that can occur.
I rushed immediately to the hospital, into the operating theatre – the baby hadn’t been born yet, so we started to prepare. We didn’t have the special suction device needed to remove thick stool from a baby’s trachea, so we sent someone to find one as I connected a different, not-quite-as-good sucker. As I connected the suction, the midwife rushed into the room with the baby – a floppy, not-breathing girl covered in yellow- brown slime. Exactly the situation when the immediate action is to look deep into the baby’s throat, find the trachea, and put a suction tube down, before the baby takes a breath and inhales the stool past the point of no return. We looked, we found, we suctioned. It was time to help the baby breathe.
Except that in our rush to prepare the suction, we hadn’t had time to prepare the oxygen. And nowhere in the room was there the bag-valve-mask device for us to pump air into the baby’s lungs. I must confess I started barking orders at that stage. I sent the midwife to RUN to the operating theatre to find one. I dried and rubbed the baby to try and make it breathe. Nothing. No midwife. I told the intern to RUN to the nursery to grab a bag valve mask. I was left alone in the room with a blue baby with a dropping heart rate. Which left mouth-to-mouth resuscitation.
After 5 breaths, the intern and the midwife both returned carrying bag-valve-masks – and the baby started to holler. Indignant, protesting her unceremonious introduction to the world.
At midnight, I’d just fallen asleep as I got the page to the nursery. The nurse answered the phone when I called – “the doctor says come!”, no further information required. I arrived to find the first of the long-awaited premature babies had arrived – 10 weeks early as promised, but at 1240 grams a little smaller than we expected. By the time I arrived, the intern had resuscitated a determined fighter who, after a few puffs of oxygen decided she was ready to go solo with the whole breathing-thing. Once she was warm and dry we were able to put her into the expectant incubator with just a little oxygen to help her breathe. A relief to know her little lungs had been matured by the medications the obstetric team had been giving her mother in preparation for this moment.
And there was another baby in the nursery awaiting admission. A term baby, born again by c-section because the mother’s blood pressure was sky-high. A big boy who was just a little surprised to have been born so suddenly, and whose lungs needed a little time to catch up. He was pink, he was comfortable on a whiff of oxygen. He’d be OK till morning.
At 3:30am I had fallen asleep on the couch to be woken again by a “999″ page to maternity. En route to the hospital I called to see what I was walking into. A baby was being delivered feet-first, and after almost 30 minutes of the body protruding but the head being stuck, the obstetric intern had been called to assist, and she called me immediately knowing that I’d want to be there to help this baby whose oxygen supply had been cut off for some time.
I arrive with my heart in my throat, pessimistic – brain damage is almost inevitable after being stuck for so long. I have time to see that, again, there is no bag-valve-mask at the bedside, and while a student runs to fetch one I put on my gloves – and the baby is out (“Thankyou Jesus!” exhale the midwives). The bag-valve-mask is found and connected, and the intern and I jump to action – me pushing air into the baby’s lungs, the intern feeling the heartbeat and realising it is slow, close to absent – starting chest compressions 1, 2, 3, breathe, 1, 2, 3 breathe…. A blue, floppy, breathless baby. We need some scissors and a feeding tube, some gauze, and adrenaline. Get the intern to take over the breathing, the midwife to do chest compressions, cut the umbilical cord to try and thread a catheter in so we can try to speed up the heart with adrenaline, but failing miserably, blood and slime on my jacket as I wonder what on earth we are doing, this baby has no chance. I call for a tracheal tube in desperation to see if we can put adrenaline directly in the baby’s lungs instead.
The baby is taking gasping, shuddering breaths, but not regularly breathing and is already 5 minutes old. I put the tracheal tube in and as I get ready to put adrenaline in, we count the baby’s heart rate – it is over 100, we don’t need to continue compressions, we don’t need adrenaline. Still pessimistic, we jog down the hall carrying the baby to the nursery, puffs of air through the tracheal tube the whole way. I suggest that we reassess the baby in the nursery and see if we should stop doing what we are doing – are the pupils large and unresponsive, a sign of brain damage? Will the baby start to have convulsions? Have we resuscitated this baby’s heart – but resuscitated a shell of a person, whose brain will never function, an indescribable burden on a family that is already clinging to the edge of financial survival?
We put the little girl on the warmer in the nursery, and to my surprise, she’s breathing. Regularly. I am a little glad, but mostly worried. Babies with brain damage can often breathe. We get an IV, and I give her an anticonvulsant because I think she’s going to need it, and a caffeine-like stimulant because I don’t know if she’ll keep breathing on her own. I have already decided that if she can’t breathe, we won’t put her in ICU on a ventilator – because if the brain is broken, a ventilator won’t fix it.
But breathe she does. I pull out the tracheal tube, and she continues to breathe – in, out, in out. Then we see her move her legs – one at a time, not in a spasmodic worrisome fashion, but intentionally. And then the intern says – she’s opening her eyes. And she does. Deliberately, slowly, she opens her eyes, looks at the team, and then shuts them again, exhausted.
Tears fill my eyes. Ye of little faith.
I arrive home at 4:30, awed. What a holy privilege I have in this place. I am so grateful to have been born in a country where medical school was one of many possibilities. That despite my complete lack of passion for doctoring in high school, I was ushered into medical training because I couldn’t think of a better idea. That the children’s hospital smelled better than geriatrics and the people were nicer, so I ended up in pediatrics. That in pediatrics I was mentored and taught by people of passion. And that after finding a career that I became passionate about, God broke my heart and clearly showed me – I’ve been guiding you on this path and have blessed you – and now, to whom much is given, much is required. That He broke not only my heart, but the heart of my husband, so that the only thing we could do was come here to serve those He cares about far more than I can even imagine.
It is a holy privilege to be able to work here – to be able to not just help babies and children, but, I pray, to be a part of something bigger. To be people of passion, mentoring and training the interns and nurses and clinical officers and administrators. To be deeply dissatisfied with the status quo, to be unable to accept poverty and oppression. To live and work together with God and our partners near and far to bring restoration and life.
Update: I just came in to see the last baby, who has been named Peter. He is looking around, breastfeeding, and moving around. Except for his left arm, whose nerves have likely been bruised by stretching during his rough extraction, and should slowly recover function. I told his mother that I had lost hope, and I didn’t think he’d make it, but everyone in the room was praying – and he is a miracle. She started to cry. I love that Jesus cares about this little boy even more than she does, and his mum is so grateful to be able to share his story with you.
A quiet voice in the tumult (29/10/12)
We have just started the final week in my Spiritual Formation class at Moffat where we bring it all together…after discussing the classical spiritual exercises (fasting, solitude, daily office, etc) and the Biblical vision behind spiritual formation, we go back in time 1,500 years to study Benedict of Nursia, and the “Rule” of life he and his monks implemented as a conscious plan to keep God at the center of all that they did. A plan which helped keep a balance for these hard-working monks between contemplation (being with God) and activity (working with God).
This is hands-down my favorite part of the class…seriously, this Rule has had one of the most lasting and widespread spiritual influences on all denominations of the church for the last 1,500 years. After discussing the Benedictine Rule, these future leaders in the African church then consider what their own personal Rule might look like. Will they try to observe a weekly Sabbath, including no preaching or ministry for a 24 hour period? Will they build into their daily schedules time for solitude and prayer?
We divide the Rule into four categories–Prayer, Rest, Work/Activity, and Relationships–and spend a half day in prayer and retreat considering what activities and exercises they want to put in each. Exercises such as fasting, prayer, silence, solitude, care for their physical body, emotional health, family and community relationships.
Yes, it’s my favorite part…but I felt (again) like I was teaching myself this time around. And slightly fraudulent. We’ve been so busy in the last few months that there’s really not been much balance between contemplation and activity…it’s been almost entirely activity. Even teaching at Moffat has just been one more task to complete successfully, and I confess I haven’t felt fully ‘present’ to my students this term.
The last four weeks in particular have seen a lot of activity and change. Mardi was asked this last week to assume responsibilities as the Medical Director of the Hospital in late 2013; a senior management position that will see her transition from her current work (mostly 95% clinical and teaching time with patients and nurses and 5% management/leadership) to a different role after we return (95% management/leadership with 5% clinical/teaching). After a lot of prayer, thought, and seeking the wise counsel of some of our mentors, she said yes. She’ll have responsibility for all medical services including managing and supporting general surgery, specialty surgery, pediatrics, internal medicine, outpatients and emergency, dental and obstetrics.
I’ve been working to finalise a dental strategic plan with Edward, our head dentist, which will hopefully see East Africa’s first orthodontics residency program started here in Kijabe, so that we can start to provide full service care to children suffering from cleft lip and palate abnormalities. You see, there are a lot of programs like Smile Train and our own CURE Hospital which do corrective cleft/lip surgery at no cost, but the unpublicised and long-term need that these children have after the surgery is orthodontic and dental care to fix teeth and jaw issues that continue to lie underneath what appears to the casual observer to be a “fixed” smile. Edward has a heart for these children, and we’re hoping to care for these kids with compassionate orthodontic care.
Additionally, I’ve been working on applying for a USAID grant to fund some new housing for our medical trainees, and helping to develop some relationships between the Hospital and a few organisations in the United States that would need to partner with the Hospital on this grant. Then there’s my ongoing work on the Water Committee, with a key presentation scheduled for tomorrow that will hopefully take some more positive steps forward towards good stewardship and management of water here in Kijabe. And the Sanitation Project, Pediatrics Wing, and Palliative Care Building are just going gangbusters…you can’t walk more than 100 metres anywhere around the Hospital without hitting new construction.
You see…I have a lot on my mind.
So, Thursday night, 830p, class. We were discussing how to be intentional about planning time for relationships in a personal Rule (including things like a regular date night with your wife, ‘dating’ your kids, seeking reconciliation in a damaged relationship, etc). I had a lot of reasons to not read anything significant into John’s question:
“Mwalimu, how do you pursue restoration of a broken relationship with someone who isn’t interested in reconciliation?”
You see, I have a lot on my mind.
He wasn’t satisfied with my answer of “well, there are lots of ways, but the important thing is that you’ve recognised a desire to reconcile.” So he asked again.
“Yes, mwalimu, but how?”
I thought to myself, there’s no way I have time to give this question the attention it deserves. And I gave the same reply and moved on.
You see, I have a lot on my mind.
And then he asked a third time, later in the class.
And I sensed the Spirit gently nudging me, opening my eyes a bit wider: Andy, there is something deep going on in John’s life, and I’m a part of it…pay attention to him. And so I did. I gave him some undivided attention, recommended a book for him to read, and we discussed the first steps of seeking restoration of relationship.
I am grateful that in the midst of the everyday tumult of life, God is still leading, and isn’t terribly impressed or moved by human-initiated busyness. Pay attention. Sometimes the din around us is too loud to hear his quiet, unhurried voice…and we need to ruthlessly seek to maintain that balance of contemplation and activity in order to not lose our bearings. Sometimes the din is self-created, and we need to say ‘no’ to some things because our life is out of balance…
Because we encounter people like John regularly. And I am learning that whether or not we pay attention to them, and to what the Lord might be doing in their lives has eternal significance in a way I don’t really grasp in this life. I am also learning (and teaching my students!) that we cannot simply choose to pay attention to the Lord’s leading unless we have first done the hard work making sure that there is margin, space in our daily lives to discern his leading.
It IS hard work. It’s really, really difficult. But this hard work isn’t something that’s unique to the West or to Africa, to Benedict’s fifth-century monks or to us in 2012…it’s common. What is uncommon is when we recognise it, and submit our schedule, our activity, to the scrutiny of God’s leading and guidance.
**for more on developing your own personal Rule, see the excellent tools put out by Emotionally Healthy Spirituality.
Coming up for air (16/10/12)
*gasps and takes a deep breath*
It’s been a crazy few weeks. Somehow everything has just coalesced into needing to be done all at once, and Andy and I have just been overtaken by a tidal wave of…. everything.
I’ve had to study for my once-every-ten-years pediatric recertification exam in the US. I was actually planning on letting that certification lapse, as I thought I’d be a pediatric emergency physician for the rest of my days – until I came here and realised my general pediatric knowledge was crucial. The last few weeks have been a steeply climbing curve of revising what I thought I knew and learning things I never knew, until it all culminated in a 3+ hour exam in Nairobi a week ago.
We’ve been finalising the transition from short-term, partly self-supported volunteers to long-term, fully-reliant-on-our-partners missionaries, calculating budget forecasts, trying to figure out how to estimate what we’ll need to live here sustainably over the next few years. A line-by-line look, again, at costs of living, eating, dressing, certifying, driving, insuring, and everything else for which we will be relying on, not our professions, but God through our partners all around the world.
We’ve been planning our furlough in the US and Australia – arranging travel, meetings with precious people and mentors, friends and family, accommodation and transport, ensuring valid visas when we return. Buying plane tickets, communicating with generous friends who have offered to take care of everything from fuel to clothing for our children.
We’ve been redesigning our brochure to try and communicate to people our passion and heart for this life-on-the-edge when we meet, reacquaint, hang out with and speak to people when we are in the US and Australia – a process taking far longer than I ever imagine when I actually sit down at the computer and start writing.
We’ve been strategising the next 6 weeks – how do we tie up loose ends, without leaving unfinished business at the hospital, on committees, at Moffat? How do we make sure that we don’t leave our friends and colleagues with an additional workload of things we started but never completed? How do we finish this lap of the race well, while still keeping our engines ready to start the next round when we get back here?
We’ve been looking ahead, planning our return here – what will our roles be, who does the hospital need us to be, what will we stop doing, what new things will we start? How will those changes affect our family, can we commit to serving in similar but broader ways? Will Liam be accepted into kindergarten a month early for Kijabe, allowing him to be in the same class as his playmates and parallel to the Australian school year rather than 6 months behind? How will having 2 children in school change what life for us looks like when we get back?
And underneath it all, life here has continued. Our hospital & Moffat work of scheduling, teaching, updating, rounding, meeting, mentoring, planning. Our joyful but tiring work at home - parenting, relating, cooking, celebrating, listening, learning, being.
I have been tired – and at times, close to overwhelmed.
But in the middle of it, we’ve been sustained. The last fortnight has been a time of new friends (curiously both named Ann) – one bringing a meal over at the height of my studying when I felt I was just drowning, and the other keeping me company on my walk-runs with amusing and deepening conversations followed by cups of tea – new friendship at an unexpected but perfect time. A fortnight of not needing to manage the ever-more-complex pediatric department while Jennifer kindly took the helm and my colleagues did extra to cover a week of absence for study, and then a week of rest.
Which has been this last week. I have gone almost radio-silent on the internet, as we have enjoyed the refreshing company of Fiona, my dear friend from Florida and David, her (it turns out) delightful husband of one year, whose wedding I was privileged to attend in the UK last June while Andy stayed here with the kids. We talked, we walked, we chatted, we laughed. We hiked Mount Longonot (and unlike last time I tried to climb the mountain, Liam stayed safely off of high furniture and did not injure himself in my absence, allowing me to complete the climb). We attempted to cross the Aberdare Range on dirt roads in the rain, getting bogged on the side of a ravine, cheering hysterically when Andy managed to unbog us – and increasing our travel time from 3.5 to 6.5 hours through realising we had to retrace our steps and transit via tarmacked roads instead. We cooked stove-top pizza in a cozy cottage in the drizzling rain, shot rhinos with our cameras at a game reserve overlooking Mount Kenya, and delighted in gourmet meals courtesy of our friends’ generosity.
A week of being with the kids, Andy and friends. At the end of a chaotic June-August at work, and the escalation of the last few weeks, it has just been balm to my soul to have this week of…. being.
This week, we are back to doing. But it is less intense, and it feels like there is some more time for being as well. I feel like I’ve had good lungful of air to give us what we need to run this lap of the race well to the end, ready for what is to come next.
The many-headed Hydra (1/10/12)
In Greek mythology, the Hydra had the body of a serpent and many heads, one of which could never be harmed by any weapon. If any of the other heads were severed another would grow in its place, and the stench from the Hydra’s breath was enough to kill man or beast. When it emerged from the swamp it would attack herds of cattle and local villagers, devouring them with its numerous heads.
– Encylopedia Mythica
14 years after finishing medical school, you’d think I should know something about most things to do with sick children. But the human body is a complex beast, and its enemies just keep attacking in sometimes-bizarre ways. So this post is devoted to tuberculosis (TB) – my own personal many-headed hydra. Subtle, innocuous and deadly.
Victor came to us last week with a history of his eyes gradually bulging, veins starting to stand out of his head. He came to the neurosurgical clinic because any time a child has a big head, for whatever reason, most people assume it’s hydrocephalus and all of Kenya knows that this is the place for treatment.
Susan, our neurosurgeon’s wife who also happens to be the most outstanding nurse practitioner I’ve had the pleasure of working with, took one look at him and knew that not only did he have a big head with protruding eyes – he was sick. Pale and weak, she had already sent his blood for testing before we, as non-surgeons, arrived to help figure out what was going on. He was dangerously anaemic, but apart from that we couldn’t easily figure out what his problem was.
So we sent him for a CT scan in Nairobi – which didn’t show anything specific at all except for swelling of the lining of the brain. Leland (probably the hardest working and busiest pediatric neurosurgeon the continent, volunteering to train local doctors in neurosurgery here during his retirement) took him to the operating theatre and took samples – his skull bone was replaced with something that looked like tumour, and the lining of his brain looked similar. His suspicion: cancer that had spread from another site. The final pathologist report: tuberculosis. The strangest presentation any of us has ever seen.
Moses came to us from the northern part of the country with a strange story – 6 months ago, after falling out of a tree, his right thigh slowly, gradually started to swell. His family had tried traditional healing by burning the skin, but there had been no improvment so they had come to us. He was a puzzle – his right thigh was 5 times the size of his wasted left thigh, with strange lumpy areas that felt like a tumour. A superficial biopsy showed nothing specific, and an MRI scan, done in Nairobi at horrendous expense, shows… a mass. Nothing specific – not part of the muscle, not part of the bone. Just a lumpy… thing. Looking at the rest of him, he is wasted, skeletal. We know he is HIV negative, which narrows things down – but in this country, when you are wasting away and nothing else shows up, it’s TB until proven otherwise. The surgeons are going to do deeper biopsies to see if we can catch TB bugs under the microscope, but in the meantime we’ve started a 6-month treatment course.
And last, gorgeous little John. Pudgy and sweet, he came to us at 2 months of age with fevers, having already received a week’s worth of antibiotics for presumed meningitis – the other hospital had not tested his spinal fluid. When he arrived, we looked at his spinal fluid and found cells suspicious for an infection that hadn’t quite cleared, so we treated him for another 14 days. At which point we found – more cells in his spinal fluid. Although clinically he was doing brilliantly – chubby, gaining weight, no fever, happy – the microscope was telling us that we were on the wrong track. We stopped his antibiotics and retested the fluid 3 days later – MORE cells. This is TB meningitis until proven otherwise. He too has just started 6 months of daily medication.
We have no idea who infected these kids – their families don’t know of any friends or family who have TB. Which means each of them was infected by a probably undiagnosed adult who is spreading the disease to others around them. Kenya ranks 13th out of the UN World Health Organization’s 22 “high TB burden countries” and has the fifth-highest in Africa. There are an estimated 12,000 TB-infected children younger than 14, representing 11 percent of all infections.
Bulging eyes. Ever-increasing thigh lumps with the rest of the body wasting away. An silent, progressive brain infection that isn’t found until you search for it. TB, my many-headed nemesis – we will continue to fight you, and to win.
Update Oct 4 – Victor had a repeat lymph node biopsy that showed us he, in fact, does have metastatic cancer (neuroblastoma). Prayers appreciated for him and his family as they contemplate expensive chemotherapy at another hospital, with little chance of success, or letting the disease take its course.
Update and Partnership Launch (27/9/12)
Click here to read our latest newsletter, including updates pictures and news about how you can partner with us here in Kijabe.
Hippocrisy (26/9/12)“ I swear to fulfill, to the best of my ability and judgment, this covenant:
…I will apply, for the benefit of the sick, all measures [that] are required, avoiding those twin traps of overtreatment and therapeutic nihilism.
I will remember that there is art to medicine as well as science, and that warmth, sympathy, and understanding may outweigh the surgeon’s knife or the chemist’s drug.
I will not be ashamed to say “I know not,” nor will I fail to call in my colleagues when the skills of another are needed for a patient’s recovery.
…Most especially must I tread with care in matters of life and death. If it is given me to save a life, all thanks. But it may also be within my power to take a life; this awesome responsibility must be faced with great humbleness and awareness of my own frailty. Above all, I must not play at God…
I will remember that I remain a member of society, with special obligations to all my fellow human beings, those sound of mind and body as well as the infirm.” - the Hippocratic Oath (Modern Version), as taken by Kenyan physicians (abridged)
Today is day 14 of a nationwide doctors’ strike. In solidarity, over 90% of medical officer interns, residents and consultants who are paid by the government to provide health care to the country, have stayed away from work. And it is not the government who is suffering as a result.
Many sick people in Kenya cannot afford any health care at all. Some can scrape enough resources together to pay for the cheapest, subsidised medical care – the government hospitals. An elite few can afford to go to the private hospitals – medical care at the price of US or Australian hospitals, and almost at the same standard.
In between sit the mission hospitals. All set up with the goal of providing affordable health care driven by a desire to serve the poor, the vulnerable, the disenfranchised. Services for those who can afford it usually cost a little more than the government hospitals, but there is also funding to serve those who can’t afford care – and care is usually an order of magnitude better, as they are staffed by committed, highly trained physicians and nurses, working long hours for little or no pay. Staff who don’t leave in the middle of the day to supplement their incomes with private practice, as occurs at the government hospitals, but who work long into the night because they are there, quite simply, to help. These hospitals are within the grasp of a rural Kenyan, whereas the private hospitals simply are not.
So with the complete shutdown of the government hospitals for the last 2 weeks, it is the average Kenyan who has borne the brunt of the strike, with the mission hospitals furiously trying to keep up with the workload that comes from transfers from closing government wards, transfers from private hospitals when desperate people have run out of money after seeking care they couldn’t really afford, people who come straight to us because they know we are open for business, as well as our usual patients (plus the 2 bus accidents we’ve seen in the last 2 weeks with 30-50 casualties each time).
The worst part, however, is the patients that get here too late. The mother in labour whose baby’s umbilical cord has been hanging out, suffocating the baby while his mother goes to 3 hospitals before finding us. The father that after travelling through Uganda, Rwanda and most of rural Kenya finally found us to help fix his daughter’s esophagus injury after botched medical care elsewhere. The baby with pneumonia who sits here waiting to be seen for 6 hours because we are so overwhelmed that we don’t notice her in the back of the waiting room, almost succumbing to overwhelming lack of oxygen. The 26 week premature baby who was born somewhere else and may have survived if an ambulance could have been found to bring her here sooner.
This doctors’ strike is about a lot of things. Talk to each side, and you’ll get a convincing argument about who is right, who has been wronged, who deserves more, who should be patient. The reason the strike started is that registrars (doctors who have entered a training program to become a pediatrician, or surgeon, or radiologist) want to be paid to be in training, and are demanding that the government pays them – after they signed contracts saying they would sponsor themselves, knowing that the government could not afford to pay them. With approximately eight thousand doctors for the population of over 40 million, Kenya needs over thirty two thousand more doctors to meet the WHO recommended doctor: population ratio of 1:1000. The government is disastrously underresourced – and a strike isn’t going to change that. You can’t get blood from a stone. and even if you could, it sure wouldn’t be overnight. Now the strike is also about unmet promises from last year’s negotiations.
I’m at the point that I don’t care what it’s about anymore. What I care about is these kids, these mothers, these fathers – whose health, living in Kenya, was on a knife edge already.
When I was in Australia, the emergency doctors threatened to strike because we were underpaid compared to our colleagues of similar responsibility. I participated in the dicscussions, we liaised with our union, we negotiated with the government. We resolved things before the threatened strike date. And to be honest, I’m not sure, if push came to shove, that I could have gone through with it. Because I have a responsibility, not just as a human being and as a Christian – as a newly graduated doctor, I recited a version of that Hippocratic Oath, and I believed in it.
We went through this last year. 10 days of patients dying, doctors sitting, governments promising, optimistic returns to work. And here we are again 12 months later. I sympathise when the doctors are underpaid compared with other African countries, when promises are not kept by a government that finds itself out of money, out of ideas, out of poker chips to cash in.
But at a Cabinet meeting on Sept 20, it was noted that “provision of medical services was a right enshrined under the constitution and that the Government will introduce a bill to ring-fence the provision of essential services against future strikes that compromise the right to life”. With that I just have to fundamentally agree.
I think doctors should be bigger than going on strike. I think there are other ways to get what you want without literally killing people. And I think the union should be leading the way on this rather than recommending that the doctors just throw a tantrum, throw down their bat and ball and go home. Maybe they could work, but just send the patients go home without paying their bills – that would make a statement to government funded facilities. They could endorse, as a union, a candidate in the upcoming election, showing the current leaders that their promises have not been enough. They could strike overnight or during the daytime only, as some committed doctors I’ve heard of are doing – killing a few less patients. I’m sure there are literally a hundred ways to make a point which doesn’t end up with funerals around a country that, at its best, has far too many people dying every day anyway.
Update: 26/9/12 – The government has just fired all the doctors on strike, and is going to advertise to replace them from who-knows-where.
Rift Valley Odyssey (17/9/12)
I don’t often write glowingly about events which involve severe exhaustion or crashing 3 times in 10 hours. But this is an exception. This weekend, I was fortunate enough to participate in the 2012 Rift Valley Odyssey with good friend Rich (a surgeon here at the Hospital).
The RVO is a three day endurance mountain biking event, covering 240 kilometres (150 miles), with a total ascent of 4900 metres (16,000 feet).
Mountain biking here in Kenya has been life and health to me, often literally. We maintain a reasonably intense work and life schedule, which combined with living in a low-resource, developing-world setting means additional stress. I don’t mind long workdays and the challenges of working in a multicultural, multilingual environment, so long as I can balance it out with Sabbath rest and exercise.
And mountain biking has helped provide that necessary balance for me. It’s been a huge blessing.
Five weeks ago while running I rolled my ankle and tore a ligament. Thankfully not completely, nor was there a break, but it was enough to keep me on crutches. The day after I rolled my ankle, I came across a flyer for “East Africa’s premier 3 day endurance mountain bike race”…and suddenly, I had a goal and timeline for rehabilitation of my ankle! Rich and I registered that night for this ridiculously long, stupidly high elevation 3 day event, giddy with delight at being able to ride through some stunning parts of Kenya’s Great Rift Valley.
Thankfully, by race day I had enough movement back in my ankle to contemplate riding. I hadn’t ridden my bike in 6 weeks, but no matter…endurance riding is very tactical, and involves lots more than fitness to complete successfully…on-the-bike nutrition and hydration, pacing yourself, and keeping your bike in good repair are crucial to finishing the race. And finishing the race is the goal.
Friday morning at 0645 we were off, catching a ride in a matatu (minivan) driven by a friend of Rich’s to the starting line in the middle of a tea plantation near Limuru. The racers were a motley bunch; normal people without expensive bikes like us, professionals flying in from South Africa, a three time Olympian from Namibia, members of Kenya’s professional mountain bike team.
Eric, the race organiser, had been knocked off his bike a few weeks prior in a bad accident by some Masai teenagers while scouting the route deep in Masai country. Rather than riding with us, he briefed us instead, among other things advising us to “trust your GPS…it is right 100% of the time..don’t argue with it!”.
At 0800, we were off. Day 1 was 91 km (57 miles) with a total 1700 metre (5600 feet) ascent. The first half was through tea plantations, forests home to elephants (which were to be “scared away” by race officials on motorbikes), and dirt tracks. The second half descended to the floor of the Great Rift Valley, around Mt Longonot, and through the grassy savannah around Hell’s Gate National Park to Lake Naivasha.
It took us 10 hours 30 minutes to complete Day 1.
It took ten and a half hours partly because I was not in shape (not having ridden in 6 weeks), but also because I didn’t eat enough on the bike in the first three hours…and I “bonked”: I hit a wall, reached a point of exhaustion where I couldn’t go any further, at the 30 km point. Thanks to Rich, who stuck by me faithfully even though at times I had to walk the bike, and A.J., a New Zealander who recognised the signs of bonking due to lack of sufficient nutrition and gave me two energy gels, I pushed through the wall over a period of 10 excruciating km’s (which I have almost no memory of), and returned to “normal” at the 40 km point and was able to ride the final 52 km’s without incident.
The above paragraph sounds worse than it was; well, it was pretty bad, but still…it was an absolute blast that I would do again in a heartbeat! Some highlights of Day 1:
–The beauty of the Limuru tea fields in the foggy early morning
–The wizened mzee (old man) shepherd waving his arms frantically yelling “pole pole” (go slow!) just before I hit a patch of slick mud and wiped out, causing a six-rider pile-up behind me
–The “is this what dying feels like?” feeling of exhaustion, muscle cramping, and nausea in the middle of my bonk
–The little Kikuyu boys who came up alongside me as I struggled to pedal up a mild incline while bonking and pushed me up the hill
–Reaching the top of the escarpment along the Rift Valley, and gazing down into the Valley at the first descent of the day at the 60 km point.
–The silence and beautiful emptiness riding through the grassy savannah at dusk with herds of gazelles and hartebeests.
–Gazing appreciatively at a herd of gazelles at the 80 km point, and failing to see the large hole directly in front of me into which my front wheel obligingly plunged, throwing me over the handlebars in my third crash of the day.
I was so stoked to finish Day 1…I could hardly move after 10.5 hours on the bike, but it felt so good to finish the race, to push through the wall and not quit when I felt like falling over and laying on the ground. I didn’t ride on Days 2 and 3 as I didn’t want to push my luck with my ankle anymore, but Rich did and finished both days strong.
And the best part of all? Both of our families came down to cheer us on, and we all stayed at Fisherman’s Camp along Lake Naivasha. The cheers of my children as we arrived in the dark, dead last (nearly) at the finish line on Day 1 were just gorgeous…”Daddy, you won! Good job!”
I am so very grateful to our kind and gracious Creator that my ankle healed in time to ride in this event. It was a great ride.
Happiness is… (9/9/12)
- having a roaring fire with the rain pouring outside on a Sunday afternoon.
- waking up at 7am Friday morning after falling asleep at 10pm, to realise that my pager had not. gone. off. all. night.
- real Cadbury chocolate from Australia.
- going for a walk on a sunny afternoon all by myself, with the baboons totally leaving me unmolested.
- Jennifer arriving back in Kijabe and feeling like the pediatric team doesn’t need to rely solely on me anymore.
- receiving cards & stickers addressed not only to Riley and Liam from MaMa and Poppa, but also one for Snuggle Bear (Riley’s most favouritest pet) from cousin Alli, the person who gave Riley “Snugs” 5 years ago in the hospital when she was born.
- sticking a needle into a blue baby’s chest and watching him turn pink as the air from his pneumothorax escapes and he starts to breathe properly again. That kind of thing totally makes my day.
- having a gourmet dinner with our lovely friends Leland and Susan, who are both wise and deep while being absolutely hilarious with the anecdotes and the joke-telling.
- sitting with my nurses watching a baby breathe on a ventilator downstairs in the newborn nursery – impossible 3 months ago when the ventilator space was needed for CPAP, which is now provided by freestanding machines that friends, family and supporters bought for us.
- watching my kids play with the neighbour children in our back yard, despite the fact that half of the kids aren’t old enough to speak English well yet.
- finding oxygen and resuscitation bag/masks in the resuscitation room on two consecutive occasions. Unheard of a year ago.
- starting to read “Little House in the Big Woods” together as a family on the couch before bedtime.
- finding the kitchen spotless on Saturday morning when I got home from rounds, followed that night with movie time with my husband – reminding me how grateful I am that I picked absolutely the right guy for me 15 years ago, and that he fortunately also picked me.
- hearing via the grapevine that one of the head nurses, who I thought may be ambivalent about some changes we’re making in the clinic, is enthusiastic and vociferous about the progress we’re making together to improve the care of our kids.
- seeing my daughter blossom at school, sharing her snack every day with her friends, while realising that while she’s gone Liam is a total chatterbox who is a delight to keep company. My kids just melt my heart.
- Cadbury chocolate. Yes, it’s important enough to mention twice.
At least, this week, that’s what happiness has been for me.
10 crazy hours (31/8/12)
Tuesday night I went to bed looking forward to dropping Riley at school, having a morning playing cars with Liam and starting work at noon.
Instead at 6:30 Wednesday I woke up to a call from Sarah, who was to be covering pediatrics for the morning. Poor Sarah had been up all night with her son Getu, while Dad was away doing pediatric surgical care on refugees in Kenya’s northwest – Getu had fevers and chills and was getting worse all night. So the day started off with sweet Getu arriving at our home for a pediatric visit, with Andy wordlessly arranging to have Susan come and look after Liam and rearranging his schedule to make sure Riley got to and from school, so I could go into work early to cover Sarah so she could be mum and both could catch up on sleep.
My phone kept ringing while I was seeing Getu, but I ignored it, because what could be more important than seeing a sick one-year-old at 7am?
Turns out it was the pediatric neurosurgeons calling to ask me to see a deteriorating baby. So when I got the followup 999 “run now” page for-pediatricians-who-don’t-answer-their-phones as Sarah walked out with Getu, I ran to the hospital to see what was going on. Anastacia, who I had met last week, had been born with a third leg and foot protruding from her back – a real surprise when we unwrapped her in the nursery after being told “she has some abnormalities”. The neurosurgeons had removed her extra limb and sewn up her spinal cord sac 2 days ago, but this morning she was arching her back and convulsing. I arrived with my unbrushed hair in a ponytail and my clothes over my PJs, gave her some medications, drew some blood and ordered some tests, transferred her to intensive care and snuck quickly home before anyone else could see me before I’d actually dressed appropriately for the day.
Quick shower, Carnation instant breakfast, grab the USB stick for today’s lecture, put cookies on a plate for the noon meeting I am supposed to be chairing, grab the agenda to photocopy, and get back to find out what on earth I am walking into for the rest of the day.
I send a text message to Sarah to see if there’s anyone I should be worried about on the pediatric ward or in the nursery, and she tells me that there is a baby admitted with severe jaundice. Even though Mary, our community pediatrician, is kindly covering the nursery today, I decide to stop by to make sure she knows about the baby and doesn’t need anything from me. What I find is Mary and the team already attempting to resuscitate the baby who, while I was en route, started convulsing, and has now stopped breathing and is in the middle of receiving CPR and adrenaline. Mary looks at me, and in a few words we both conclude that although this baby could be sent to ICU, his chances of survival are abysmal. Together we decide that despite the excellent job the team has done, this baby has no chance of surviving. The team stops what they are doing, and Mary gives me the nod of “there’s nothing more you can help me with here” and I leave to start ward rounds on the pediatric patients. It’s 9am.
As I walk to the ward, I see a guy with a beard who is clearly waiting for me. I dimly remember seeing a text message on my phone 30 minutes ago saying something about someone waiting to see me, and I suddenly realise that it’s Pastor Bob who yesterday said he’d be coming by. His organisation sent us a little girl last week whose face and eyelids are covered by bizarre growths, and she has not been outside of her house in months, maybe years. They arranged for her admission to the hospital for evaluation, and now I have to tell him that she has a genetic skin condition that has probably caused multiple skin cancers, and she will need multiple surgeries with skin grafts, and probably chemotherapy. Oh, and she is blind. I try to do this in a way that is unrushed and compassionate, but I don’t know how successful I’ve been.
As I farewell Pastor Bob and go to start ward rounds, the pediatric surgical resident says, when you’re done here, there’s a baby we’d like you to see in ICU. I put that on my mental list of things to do, and I start ward rounds with the team. An ambulance is waiting to take one of our kids to Nairobi for an echocardiogram, but Dad hasn’t brought enough money so before we start rounds I need to access the Needy Children’s Fund to help pay the fee. Except that the cashier’s office had an attempted-but-failed breakin last night, and the whole area is roped off with severe-sounding DO NOT WALK HERE OR YOU WILL BE A SUSPECT! type signs. We manage to get it sorted, and start seeing the patients.
Rounds are smooth, mostly because my team is so good. I re-meet Moses’ mother, who I had told 10 days ago when I admitted him that I hoped we’d keep him for 1-2 days and his asthma should improve by then. Except here we are 10 days later and he’s getting worse, and I have no idea why. Absolutely no clue. I have a laundry list of “maybe that’s the problem!” in my mind, but the tests are either impossible or out of reach financially, and I resort to the oldest trick in the book – call in the surgeons for a consult. Maybe they can look down his lungs with a camera and pull the answer out of a hat – voila!
After rounds I go up to ICU to see the surgical consult. Abdi is a 20 day old born in another country, his mother brought him to a refugee camp, and he developed an infection in his umbilical cord. By the time he saw the doctors in the camp almost 2 weeks later, the infection had turned into his entire abdominal skin turning black and close to falling off – necrotising fasciitis. So they flew him to our hospital where he was admitted to our ICU, at which time his skin DID fall off and… well, if there’s nothing to hold the insides in, they don’t stay in.
So the surgeons asked me to recommend antibiotic and nutritional therapy as they prepared to take him to the operating theatre to clean away the dead tissue and hope to save him. They have ordered a blood transfusion, as he desperately needed both red blood cells and platelets – but as I sit there the nurse tells me the hospital had no fresh blood. They are going to try to find a translator then find his refugee parents and ask them to ask friends and relatives to donate. A process taking hours. While this child is held together with gauze and tape.
I call the lab to see what the child’s blood type is. I don’t think I’m surprised when they tell me – he is A+. My blood type. I haven’t donated blood in years, and now seems like a pretty good time. Plus they give me a free coke, and I really need the caffeine this morning. Lying down on the couch also buys me 30 minutes to answer some phone calls from the student health nurses from the school clinic and catch up on emails on my phone.
At 12 I pick up the photocopies of the agenda for our inaugural new-pediatricians-of-Kijabe meeting, I meet our friend John at the front door so he can hand me the cookies I’d prepared this morning and the coffee thermos that Susan has made for us and run downstairs to finally sit down with the team and Rick, Sarah and Erika, our new pediatricians who have *just* arrived in Kenya. Except that I’ve forgotten to book the room and others are in it and I need to search for another location for our meeting. Finally, we have a chance to sit down and meet each other, to have a few minutes of this is the start of something wonderful! and plan the next couple of months and how we can all help each other and the community we’ve come to serve.
For the 1pm teaching session I’d been hoping to have a visiting pediatric gastroenterologist give us a lecture on something I knew nothing about, but he hasn’t been able to come. Instead I manage to find a lecture I’ve given before about gastrointestinal bleeding in children, which seems somehow fitting in the context of the mess of the morning.
From 2-4 I manage to drop by the operating theatre to see how the surgeons are doing with their painstaking procedure on the ICU baby, follow up on baby Jane in nursery whose blood infection is clearing, help the interns in the clinic sort out what do with sick children, follow up another child in ICU. At 4pm I’m in the nursery and in the heat and humidity of a baby-friendly-environment, I realise I’m feeling a little lightheaded. I walk past Mary in corridor and, since she’s on call tonight, I ask her if she minds if I leave a little early. She sweetly gives her blessing and I walk home.
Where I get to fly a kite with my daughter, play with Liam with the milk-carton-train that Susan has made, and read Amelia Bedelia to 2 rapt children snuggling next to me on the couch. I throw together a quick pasta for dinner, Andy gets home after his own busy 10 hours, and we all talk about what our best bits of today were.
What a crazy day. But strangely, crazy wonderful. A chance to help Sarah, when I have been similarly blessed by Jennifer taking care of me and Liam more than once in the past. A chance to try to help some sick children – some who survive, some who do not, but a secure knowledge that we have done the very best we can. A chance to welcome precious new colleagues who will see things and improve things that Jennifer, Sarah and I have just not had the wherewithal to do yet. A chance to fly a kite and play with a milk carton train, and to feel two little people snuggle in close, afterwards resting in front of the fire with my husband at the end of a long day.
Thursday was Wednesday-the-sequel: just as nuts from 7:30-6pm, followed by a night on call. But I know that for as many days when it feels like it’s mostly giving – there at least as many when I am receiving and blessed beyond belief. There is an ebb and flow of being part of a community like this, and I wouldn’t have it any other way.
One of the best parts of any day I have in Kijabe happens on those days where I meet with one of my students at Moffat Bible College. They are hungry to learn, dedicated, and in most cases, have made a decision to pursue a vocation of service to others which is not popular within their families.
Being a pastor, chaplain, counselor, or community worker is not a high-paying job, if you get paid at all. So rather than reacting with pride to their son or daughter’s announcement that they’re answering a call to serve God and others, families often disown, shun, or strongly “encourage” them not to embark on this crazy path.
Martin is such a young man. He is currently our top student in the class is just now starting their second year. Martin is a brilliant young Kenyan who picks up new languages like most people pick up slang in their own language. He has a gift for it. After graduating high school, he moved to France to work and study French (in additional to his current languages of Kiswahili, Kikuyu, and English), where he quickly became fluent. While in France, he sensed God was calling him back to Kenya to study full time to enter vocational ministry. So he quit his job and moved back, and enrolled at Moffat.
After I had Martin in my spiritual formation class last year (2011), we started meeting regularly for mentoring. He is deep, thoughtful, and not satisfied with quick explanations to hard questions. He is also extremely hard-working. In order to pay his bills at Moffat and continue to send money home to his grandmother, he teaches French at a school in Mai Mahui, a rough town about 20 minutes down the mountain from Kijabe. All the while, maintaining a full time load at Moffat, including weekend practical ministry requirements.
Martin is one of those guys that I feel privileged to be able to come alongside at this point in his vocational and spiritual development. Not just because he is talented, soaks up new languages and concepts like a sponge, or is hard-working…no, I feel privileged because he is all of these, and he is passionate about serving an under-served population in Kenya that desperately needs vocational Christian workers like Martin to minister to them.
I can’t write about this people group, because it is a security risk. But I can tell you that Martin is one of a very, very small group of Christians in Kenya and around the world who feels called to minister to this people group. They are marginalised, “unreached” (to use a missions term I dislike), and desperately in need of competent, switched-on, loving followers of Jesus to work among them.
Martin’s desire is to go as far as he can in his ministry education, pursuing a Master’s or PhD if he is able. Africa needs more well trained theologians and pastors, and I think his desire is commendable.
Why am I telling you about Martin? Because in two days, on Friday, Martin will leave Moffat and go home because he can’t afford his school fees. And this is very disappointing to me because of Martin’s potential impact on Kenya and East Africa.
This is not because Moffat is expensive (it is ludicrously cheap), but because Martin can’t make enough money teaching French to support his grandmother and go to school. Martin’s bill for the current academic year is around $1,500 USD. That’s a full year of education and board. His immediate need is for this amount, or he will be sent home. His long-term need is for a sponsor(s) to come alongside him and help him continue in his education.
Would you like to support Martin? Please email us and I will advise how you can do it.
Groundhog Day (27/8/12)
Several years ago, Mardi and I travelled to Pittsburgh to attend the wedding of some good friends. Reading the Lonely Planet travel guide on the plane en route, Mardi discovered that the home of Punxsutawney Phil (the groundhog who emerges in the spring to check his shadow) lived only a short drive away. Score!
So we got up early the morning after the wedding, bleary eyed after a night of celebration and dancing, and drove to this fabled city of Punxsutawney. Besides the home of prognosticating groundhogs, its classic-small-town-America streets were also the setting for the most excellent Groundhog Day, where Bill Murray finds himself in a endless repeating cycle of the same day happening over and over again. Until he decides to make some life changes.
The last few weeks has felt a bit like Groundhog Day here in Kijabe…the same events over and over. Constant demands on your time. Another person at the door asking for food or money, another heart-breaking paediatric case, another request to serve in a particular ministry, another crisis to manage. Never enough time or resources. And always, always…the busyness.
We’ve written some observations regarding the trap of “busyness” for the worker/ missionary/ volunteer in the developing world before. It’s a tendency that is shared with anyone working in the West, from our experience.
I was reminded of the trap of busyness last week. A. is a consultant physician at the Hospital. In one of our coaching sessions, she was discussing how difficult it is for her in a low-resource setting like Kijabe Hospital to prioritise and focus on her key objectives. She felt there was always a crisis which required her “immediate attention”, diverting her from her strategic priorities toward immediate/crisis priorities. Always another patient waiting to be seen, someone needing help “right away”, a meeting scheduled at the last minute.
This is something that seems to be not uncommon here…prioritising and being strategic seems to be much more difficult in a resource-poor setting. Limited resources + being surrounded by constant need = enormous challenge for physicians, nurses, maintenance staff, and managers to take time out to focus on delivering important, but not urgent, work.
It is difficult for an engineering manager to commit a chunk of his workweek to increasing his management capacity by studying recent journal articles when there is an open channel of untreated sewage contaminating one of our water pipes, a generator that won’t start properly when the power goes out, staff who don’t earn enough to pay the government-mandated fees to send their kids to school, and laundry machines so old they catch fire when used more than 4 hours a day.
But if we aren’t intentional, deliberate, strategic…our ministry, our compassionate service to the helpless and needy, the whole reason why we have quit our jobs, sold the house, and moved to Africa risks becoming indiscriminate, unfocussed, un-intentional.
And we get more busy.
And in the busyness, it’s easy to move from complaining about being driven by your schedule to justifying why you’re busy. The image of the harried and tired medical missionary can become glamorous, a badge of honour. Truly, there is a person sacrificing all for the Kingdom. No time for Sabbath rest, she’s giving it all for Jesus.
I’m reading Eugene Peterson’s classic, The Contemplative Pastor at the moment. I was really interested to read his suggestion that a tendency to idolise busyness is heavily prevalent amongst American pastors.
He notes that St Hilary of Tours (315-367 CE) called this tendency to busyness irreligious solicitude pro Deo; a blasphemous anxiety to do God’s work for him.
Peterson suggests that we become too busy for two reasons:
1. Because we are vain. We want to appear important, significant. “If I go into a doctor’s office and find there’s no one waiting, and I see through a half-open door the doctor reading a book, I wonder if he’s any good. A good doctor will have people lined up waiting to see him; a good doctor will not have time to read a book. Although I grumble about waiting my turn in a busy doctor’s office, I am also impressed with his importance.”
2. Because we are lazy. We lazily let others decide what we will do instead of resolutely deciding ourselves. We let people who do not understand our work write the agenda for our day because we are too lazy to write it ourselves. “We abdicate the essential work of deciding and directing, establishing values and goals to other people. And then we find ourselves frantically, at the last minute, trying to satisfy half a dozen demands on our time, none of which are essential to our vocation, to stave off the disaster of disappointing someone.”
I don’t want to be busy because I am vain or lazy. I don’t want to be driven by other people’s expectations or well-intentioned priorities for my life…I want to be busy doing the things that I feel called to do. I am passionate about this (honestly, a bit of a broken record) because I recognise in myself the tendency to glamourise and idolise busyness.
But I am starting to kick this habit. Thank God.