Dystopian thoughts (29/4/12)

* Spoiler Alert – if you haven’t read the Hunger Games trilogy and you’re planning to and don’t want some spoilers, go and read it now – it should take you about 72 hours.  If you haven’t read it and don’t plan to, this post doesn’t really have all that much to do with it –  so go ahead and keep reading if you’ve made it through this first paragraph.

In a dystopian future, the totalitarian nation of Panem is divided between 12 districts and the Capitol. Each year two young representatives from each district are selected by lottery to participate in The Hunger Games. Part entertainment, part brutal retribution for a past rebellion, the televised games are broadcast throughout Panem. The 24 participants are forced to eliminate their competitors while the citizens of Panem are required to watch. When 16-year-old Katniss’s young sister, Prim, is selected as District 12′s female representative, Katniss volunteers to take her place. She and her male counterpart Peeta, are pitted against bigger, stronger representatives who have trained for this their whole lives.

- the Hunger Games movie summary, www.imdb.com

The first time I read the first book in the Hunger Games trilogy, I was a little confused at the end.  It was recommended to me by a sweet medical missionary mother I met at a conference in Missouri, so I was just flummoxed – Really?  You loved this book?  I’m just depressed now.

But I’ve read the trilogy twice now, and just went and saw the movie.  Some of my friends are appalled by the premise, or were disturbed by footage of fictional children killing each other.  So I’ve been trying to figure out the gradual allure of this series for me, and I think I’m getting there.  I don’t think these books and movie are great escapist entertainment.  I do think I like entering into a fable that is just a more palatable introduction than raw news footage to the world in which we actually live.

Since 1963, Syrians have been subjected to tightly controlled expression, association and assembly.  Human rights activists and anyone critical of the government has been harassed and imprisoned, often detained and tortured indefinitely.  Websites such as Facebook, Wikipedia and YouTube were blocked until January last year but internet cafes still record all comments on online chat forums.  In January 2011 the people decided they were no longer willing to endure an interminable Ba’ath Party rule and began to rise up against their oppressors .   This has resulted in at least 16,000 people killed to date, including around 1000 children who have been arrested and tortured or killed according to UNICEF.  The fictional depiction of the deaths of 22 fictional characters isn’t really so horrific to me.

The North Korea propaganda machine proclaims its utopianism to the populace, feverishly attempting to perfect airbone agents of death while the people starve.  The US State Department cites arbitrary and lengthy imprisonment, forced labor, public executions, severe restrictions on freedom of speech and religion, and of course denial of the citizens to change government.  Radio, television and news organizations, are controlled by the government and heavily censored. The fictional Capitol of Panem isn’t so far removed from reality that I don’t recognise it.

Children are wrenched from their parents daily, not annually, in a lottery of fear, with children killing children in the Lord’s Resistance Army in central Africa. It is estimated that between September 2008 and July 2011, the group, despite being down to only a few hundred fighters, has killed more than 2,300 people, abducted more than 3,000, and displaced over 400,000 across the DR Congo, South Sudan and the Central African Republic.  It may not be for the entertainment of the masses, but misplaced political idealism isn’t a particularly good reason either.

It’s impossible to know how many girls are currently enslaved as sex workers in the world.  There are probably at least half a million each year trafficked across international borders alone, and as many as 30 million girls and women involuntarily working as prostitutes around the world, 12 million just in India.  Finnick’s tale in Mockingjay is far less disturbing.

Violent fundamentalists in one of our war-torn neighboring countries blocked  relief groups from bringing food to famine victims, as a cholera epidemic and poverty spread and millions fled in desperations.  And even now, with the worst of the famine over, a group claiming to be the defender of pure religion seizes girls as spoils of war, gang-raping and abusing them, forcing families to hand over girls for arranged marriages that are essentially sexual slavery to their ranks’ morale.   Lawlessness and desperation are not so far from the movie theatre for me.

The word “dystopia” is a word I’ve only ever really seen referred to in a fictional setting – a novel or a movie.  According to the LA Times (quoting the Oxford English Dictionary), “the first recorded use of the term came in 1868 when Mill addressed the House of Commons: ‘It is, perhaps, too complimentary to call them Utopians; they ought rather to be called dys-topians, or caco-topians.’ ”   It has come to mean a society that is oppressively structured with deliberately miserable living conditions – poverty, violence and scarcity, disease and pollution.  A select minority usually benefits, to the detriment of the majority.

I wonder why this word isn’t used more in journalism.  And why in fiction it’s always about a “dystopian future”.  There are currently dystopian villages, dystopian countries – is our entire planet not just a little dystopian?

I think that’s why I like the Hunger Games.  It’s a caricature of the world I live in, and I like to be reminded to take my head out of the sand.  We live on a planet where, for all intents and purposes, children are killing children in a gladiatorial arena for the entertainment of the masses.  I’m glad to be disturbed by the stories, whether in the novels or on the big screen – I hope you are too.  I think each one of us should be trying to foment a small revolution, in whatever arena is open to us.

- M.

Taxi rides in the dark (26/4/12)

*note:  this post was written in Nairobi, and then posted upon arrival in Atlanta*

I received word this morning that my maternal grandfather passed away a few hours before.  He died as he had always wanted to:  peacefully in his sleep, surrounded by family.  He was the patriarch of my mother’s side of the family; a bulwark of faith and simple leadership.

And here I am, 9 hours later, in a taxi headed to the airport to catch a flight to Atlanta, with a driver who assumes I am a doctor because I live in Kijabe, and whose heavily-accented English produces a dissonant variation on “Andy”.

The taxi driver stops in the rain and mud of the Kijabe streets shortly after picking me up.  “You will pray for us now, Dr. Eddy?”  He tuns off his car and lights, and it is perfectly still inside the car.  Total blackness outside, rain softly falling outside.

I pray.

I am deeply moved by this simple act of praying for safe travels on this night of fog, rain, and darkness.

A half hour later.  Speeding through the night, rain pounding on the car and near total darkness outside on one of Kenya’s busiest highways.  I look ahead and realise the driver can only see about 5 meters ahead into the fog.

I am struck by the similarity of this unplanned ride in the dark to my spiritual life in general.  Hurtling towards a destination I hope to reach, often not able to see more than 5 meters ahead.  Sitting back in my seat with trembling faith, trusting that the driver will get me to the airport safely.

During my journey in the dark, I have a chance for the first time to reflect on Granddad Jack’s death.  I’ve spent most of the last nine hours with no chance for contemplation, instead preparing a presentation on solutions for the water crisis at Kijabe.  I am really disappointed I can’t attend the meeting of community leaders at which we were to give the presentation in two days.  It represents 4 weeks’ worth of hard work, negotiation, and investigations by our 7-person community-appointed Water Committee into how to provide a long term water supply to all of the 5,000 people in the Kijabe area–4 schools, 2 hospitals, 1 Bible College, a printing press, a magazine publisher, and a small town.

I don’t finish the presentation…too much time spent arranging tickets and wondering how to pay for it.  I’ll have to finish it on the plane between Nairobi and London, and email it from London when I land.

In the car, I turn my thoughts for the first time to Granddad Jack.  I am so very thankful for his life.  For the role he and Grandma Elaine played in my returning during my undergraduate days to a living, breathing, active faith.  For the Easter weekend trips I took to Coopersburg, Pennsylvania during my time at GWU:  the Passover seders and church services they took me to.   For the time I drove all night from Washington DC just to see Mardi for 4 hours.  She had flown in for 3 days to take her USA medical licensing exams in Philly, and was staying with Granddad and Grandma in Coopersburg.  After our 4 hour visit, I  drove straight back to Washington to take an exam at 8am.

I am grateful for Granddad’s life, for the opportunity to see my family again, and to reflect on the Christian hope of a physical resurrection and future restoration of all creation.   In his epic book, Surprised by Hope, NT Wright notes:

All language about the future, as any economist or politician will tell you, is simply a set of signposts pointing into a fog. We see through a glass darkly, says St. Paul as he peers toward what lies ahead. All our language about future states of the world and of ourselves consists of complex pictures that may or may not correspond very well to the ultimate reality. But that doesn’t mean it’s anybody’s guess or that every opinion is as good as every other one. And—supposing someone came forward out of the fog to meet us? That, of course, is the central though often ignored Christian belief.

As my taxi driver swerves around slow lorries, with the normally-breathtaking overlooks of the Great Rift Valley shrouded in darkness and fog, I remember that “heaven” as described in the Bible is not merely some future destiny, but sort of another dimension in our ordinary life.  God’s dimension, if you will.  God made heaven and earth, and at the last he will remake them both and bring them together forever.  This is the picture we see in Revelations 21 and 22; not disembodied ‘raptured’ souls making their way to a distant heaven, but the new Jerusalem coming down from heaven to earth, where they are both united in a perfect embrace.

Granddad died yesterday, and he is with Jesus.  In what form, or precisely how, we don’t know…in the Bible, descriptions of the future are only signposts pointing into a fog.   But one thing is absolutely clear:  one day in the future, there will be a physical resurrection, of which the Easter morning was a foretaste, and all things will be restored.

And I can’t wait to sit down and look through National Geographics with Granddad again, dreaming about travelling.

-Update:  30 hours later.  I made it to the airport, after passing roughly 20 accidents on the way in (I stopped counting).  I am now safely in Atlanta, having braved a 14 lane highway (I85, downtown) which was nearly my undoing!

This American Australian Kenyan Life (25/4/12)

It’s been one of those weeks where I’m acutely aware of how strange the juxtaposition of my worlds is.

We had dear friends from Andy’s GW days come and stay with us last week.  Ann and Patrick brought with them a mini-mall of American delights we had been anticipating with fervour – Sour Patch Kids, Lego, Cadbury Creme Eggs.   Joy of joys, they found and brought the 1980 Australian mini-series “A Town Like Alice”, balm to the soul of an Australian surrounded by non-Australians.   And they brought their wonderful selves.  It was a joy to reminisce and ponder, discuss and laugh with them as we sat in our living room – joining them on a mental trip to Annapolis MD as we talked about their life, their friends, their struggles, their joys.  We watched ridiculous movies clearly written with our sense of humour in mind, and enjoyed the excuse to absorb as many calories as possible.

We spent a day hiking Mount Longonot, a lovely crater only an hour’s drive away, while Susan looked after the kids at home.   At least that was the plan – until we got a phone call when we were half way up the ascent that Liam had fallen off a chair, hitting his head, and was inconsolable.  I figured it was worth a look at the hospital and started to slowly head home to check on him – until I got the second phone call that he was vomiting and lethargic, at which point I strarted running down the mountain.  Meanwhile Jennifer, acting as pediatrician and surrogate cuddler in the hospital, was starting to worry, and consulted the neurosurgical team to see if he should be sent to Nairobi for a CT scan.  He was asleep when I arrived in the emergency department, and I held his hand and stroked his head, my eyes glued to the monitor looking for clues that he might be worsening.  When he woke up, he sat up to ask for a drink.  He remembered everything, he wanted to go home.

Worry and uncertainty, beauty and joy.

We found out 2 days ago  that Andy’s Granddad Jack, suffering from dementia, was worsening and was close to comatose.  Ancient, surrounded by 3 generations of family and his amazing wife, he slipped away yesterday at home as he had wanted.  While not a surprise, it is still a grief – this patriarch, an example of wisdom, adventure and Christ’s enveloping love, will no longer be a part of our earthly lives.  We found out at 7am, and at 2pm we were told the funeral would be in 48 hours.  And we both realised – we wanted one of us to be there to celebrate this remarkable man with cousins and uncles and sisters and nephews from all over the US – probably in one place for the last time for a long time.  To take time out to remember that, in the midst of sometimes messy relationships, that we have been so very blessed in a richness of heritage.   Which meant leaving on a flight the same night.  Andy scrambled to re-arrange his work week, I started to arrange tickets, we packed, we said goodbye.

Grief and goodbyes, remembrance and celebration.

I am sitting on the couch right now enjoying “movie night” with the kids – popcorn and fruit salad for dinner, with even a scoop of *gasp* icecream.  We spent the morning going to the markets, doing arts and crafts and enjoying each other’s company.   Tomorrow I am at work and on call, but Susan will stay overnight with us so that if I am needed at the hospital, the kids are secure.  We have a slow cooker, laboriously carried over here by Ann and Pat, that will make a delicious dinner for us for tomorrow night while I’m at work during the day.  Jennifer is helping with another meal, many others have offered to step in while I’m single parenting if any assistance is required.  Here, in the middle of Kenya, I am surrounded by surrogate family whose love is palpable.

Andy is on a plane somewhere between London and Atlanta.  The kids already miss daddy, and are counting down the days till he returns.  They are a little on edge this evening and tears come easily.  And I have not been able to get in touch with Patrick to tell him that Andy, rather than accompanying him for a few days to Addis Abbaba, will instead be in Atlanta.

Tears and disappointments, comfort and encouragement.

It feels a little jarring – reminiscing with college friends.  Troubleshooting why yet another diabetic child has received the wrong treatment in the emergency department.  Escaping to rural Australia in the 1940s.  Making sure to remember to lock up the house properly because Andy’s not here to check.  Talking to my sister-in-law as she drives from Michigan to Georgia about my nephew’s 10th birthday and the hugs they’ll be getting soon from Andy.  Watching Dora with my daughter on my lap.

But I’m glad I didn’t have to say a permanent goodbye to any parts of this life when we moved to Kenya.  Even though they don’t quite fit together perfectly and they interrupt each other at the most inopportune moments, I’m glad for the complexity of this American Australian Kenyan life.

- M.

Brandon’s brain and how it could have been saved (14/14/12)

I first met Brandon 2 weeks ago.  Already a month old, he seemed to be doing OK at birth – except he was getting more and more yellow.  When he stopped feeding well, mum brought him to Kijabe Hospital.

I don’t know if you’ve ever seen pictures of tetanus before – a severely arched back from severe muscle spasms and a malevolent grin known as “risus sardonicus”.  This is how Brandon looked – but he didn’t have tetanus.  He had the most severe form of jaundice, called “kernicterus”.  Where excess bilirubin gets into the brain and starts to cause damage.

Kernicterus is something we learn about during pediatric training – the to be avoided at all costs diagnosis because it causes long term damage.  The only treatment for it is to, one syringe at a time, take out the baby’s entire blood volume and replace it.  Twice.

For an adult that would equate to about 10 litres of blood – for Brandon it meant 600mL.  This exchange transfusion is something I’d never done before working in Kijabe, but have needed to do on 4 different babies since I’ve been here.   So we started exchanging Brandon.  Even though the blood test told us that his bilirubin level was only 21 (378 for you Australians), we didn’t believe it – this child’s brain was under attack.

The intern did the exchange on Brandon that night – 3 painstaking hours of pulling and pushing, discarding and replacing.    After she was done, we rechecked the bilirubin level – 44 (792).  Higher.  And he was still arching his back, showing us that his brain was still suffering.

So the next day, I exchanged him again.   10mL out, 10mL in.  Repeat.  10mL out, 10mL in.  Repeat.  Sit under the nursery heaters, sweating in a sterile gown, hat, gloves, mask, so the baby doesn’t get cold.  10mL out, 10mL in.  The IV line isn’t working so well.  5mL out, 5 mL in.  Every minute, a nurse documenting how the baby is doing, making sure his equilibrium is surviving the rapidly cycling tidal pull on his circulation.

A few hours later, we rechecked his bilrubin.  41 (738), with some new signs that maybe his liver was starting to malfunction.  Arching his back, drooling.

Bradon had an exchange transfusion 4 times.  His diagnosis at this stage was still unclear to us – most babies with kernicterus have severe jaundice because their red blood cells are being destroyed for one of many reasons, but his were not.  Or because their livers haven’t formed properly and the bile can’t drain, but his was fine.  Or because they have a life-threatening infection, but he didn’t.

So we sent tests for hepatitis, and gave him medications to try and help his liver get rid of the extra bile that was building up.  And slowly, after exchange number 4, his liver has started to recover.

The problem is, his brain hasn’t.  Although he is able to breast feed, he just isn’t acting like a normal baby.  His tone is all wrong, he arches his back erratically.  His brain will never work properly again.

And my heart breaks that we couldn’t save him.

Today we got our final blood test results – he has congenital rubella.  An innocuous little infection that in adults causes a mild rash, some swollen glands – maybe some aching joints.  And when his pregnant mother had these symptoms, there is nothing she could have done – and she recovered just fine.  Brandon, however, will have a devastated brain and even if he regains any function, there is still a good chance he will have heart problems, hearing defects or blindness.

But if his mother had been immunised, Brandon would be smiling today, following her with those precious eyes, grasping her hair as he nuzzles at her breast.

Please immunise your children.  Don’t fool yourself into thinking that rubella can’t hurt you because you live in an industrialised country – while “herd immunity” used to protect everyone, cases of congenital rubella are diagnosed every year in Australia and the US.  It’s an infection that can strike any unimmunised woman, blissfully unaware of the risks her parents chose for her, from exposures both within the country and from without.

If you refuse to immunise your sons, please at least immunise your daughters.  Because Brandon could be your grandson.

- M.

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If you’ve never immunised your kids, it’s not too late.  There are great catch-up schedules available, and you won’t receive the third-degree.  We just want to see healthy babies.   

ICU Survivors (11/4/12)

This last month we have had more babies on ventilators in ICU than any other month that I, at least, have seen here.  This has really stretched Jennifer’s and my ICU skills – neither of us have a ton of training in this area, but have learned by reading, doing, discussing and sometimes just praying for wisdom.

Astoundingly, this has been a month where we have both been surprised by life.

Victoria was born almost at term, but developed tremendous difficulty breathing soon afterwards.  It turned out she had a severe pneumonia and blood infection (her white blood cell count, for my medical readers, was 88,000…) and the only way she could breathe at all was for us to put her on a ventilator in ICU.   After a few days she was able to breathe on her own, but she still needed a lot of oxygen – for days.  Then weeks.  In total, for nearly a month.

Rachael holding sleepy Victoria

Finally, this last week, she was finally able to breathe with just room air.  When we turned off the oxygen and she was able to keep breathing well, her mum Rachel just smiled.  She went home with a daily inhaler as her only medication, and today came for a weight check – she is thriving, feeding like a champion, breathing comfortably, and alive with possibility.

Faith showed up to the surgical clinic for a hydrocephalus check – and had the worst pneumonia I’d ever seen.  Sometimes in a child with hydrocephalus, you decide what battles are worth fighting, and when it is just time to let go of a child whose brain is severely injured.  The neurosurgeon told me that Faith was one worth fighting for – she is an interactive, alert, smiling little 2 month old whose brain may actually have a chance.  Barely breathing when she arrived, we put her on oxygen and checked a lung xray – her whole left lung was either collapsed or filled with infection, her oxygen level not long compatible with life.

So we decided to give her a day or two in ICU on the ventilator to see if she could fight the infection.  Two days stretched into 4 – but she’d still open her eyes and try to wiggle the tube out of her throat (several times successfully, requiring us to give her sedative drugs, a stern talking to, and a new ET tube).  4 days stretched into 6, now receiving the highest pressures her little lungs could handle without popping.  I sat down with mum to prepare her for the worst, knowing that if she deteriorated at this point, there was nothing more I could do.  6 days turned into 8 – and we noticed that we didn’t need to give her quite so much pressure with each breath.  Her left lung started to open up, her oxygen levels started to improve.  By day 10, we were able to turn her pressures right down and take her off the ventilator.

Today she is breathing and breast feeding and looking around, ready to fight another day.  I am so grateful for this little miracle girl – I lost hope for her so many times in her week in ICU, and am glad to be surprised that a little fighter like her can make it through to the other side – despite our ancient equipment (I had to flick the glass on an analogue dial many times to unstick the needle monitoring her airway pressures…), our inability to monitor blood gas levels and myriad other inadequacies.

Twins Faith and Esther

Faith and Esther are almost ready to go home, the beneficiaries of the miracles of expensive medications and generous donors, without whom they could not have survived.  Mercy, another month-early baby, has also navigated the turbulent waters of surfactant-deficient lungs and mechanical ventilation, and is now home in the arms of her mother.

I am grateful for this last month – I have never been so stretched from a medical standpoint, and have felt like I’m just keeping my head above water in a specialty I’m still trying to learn.  I am so grateful for the wisdom of those around me – for Steve, the medical director, who I could ask, “Should I be withdrawing care at this point?”, and who sagely replied, “Let’s just try a couple more days”.  For a visiting pediatric anesthetist to give me tips on ventilator management that I didn’t know and probably got Faith through her 2 worst days.  For the many donors from all around the world whose contributions to the Needy Children’s Fund allowed Jennifer and I to say to each other – yes, this twin is worth gambling a $700 medication.

Every time we admit a child to ICU, it feels like playing the odds.  Looking at our statistics over the last few months, we have had over 50% mortality of the children who have been sick enough to need ICU care (look closely at the notice in the picture of the ventilator above – I think that encapsulates our expectations for ICU patients better than anything else).  There is such a heaviness knowing that 50% of the time, the only outcome the parents will receive from this admission is a massive ICU bill.  And we have to ask – is it worth it?

This month, for the first time in a while in ICU, it has felt like maybe the benefits can outweigh the risks.

- M.

The God of the surprise (5/4/12)

I never thought these words would pass my lips, but here they are:  I suspect that simultaneous funerals and meetings aren’t complementary.

This morning was our weekly Projects Coordination Group (PCG) meeting… where the tradesman and technical folks at the Hospital get together to discuss and plan our ongoing projects.   Immediately outdoors of our meeting room is the gathering place for the hospital morgue, where mourners meet to view open caskets and grieve before a trip to the cemetery.

In Australia and the USA, grieving at funerals is private, calm, with quiet tears.  In Africa?  Public, energetic, tears accompanied by wailing and screaming.

Hence our meeting was at times punctuated, at others totally drowned out by loud screams and wails from the mourners.  When I used to facilitate workshops or seminars in Australia, I looked for spaces conducive to creativity and comfort:  natural light, space, good coffee.  Now…I look for the room that isn’t immediately adjacent the morgue.

I made a lightsaber, Daddy!

It’s been quite a ride the last few weeks…the normal controlled chaos of life at a mission hospital, family members back home making big decisions, and Mardi taking on the role of head of paediatrics.  Last week I was asked to serve on a local Kijabe Water Committee, and we were given 3 whole weeks to do investigations and prepare recommendations regarding short and long term solutions to the water crisis that Kijabe is experiencing.

But now…it’s Holy Week.  I love this week…it has special significance for the church; concluding a season of reflection and fasting with a week of events which culminate with the celebration of Christ’s resurrection and our promise of new life on Easter Sunday.  One of these events is Palm Sunday, when the church remembers Jesus entering into Jerusalem on the back of a donkey and being hailed as a conquering king by the residents.  The lectionary reading for Palm Sunday included John 12:16:

“At first his disciples did not understand all this. Only after Jesus was glorified did they realize that these things had been written about him and that they had done these things to him.”

Turns out Leland, our paediatric neurosurgeon, also has a kite!

I was deeply moved by this reading and really felt for Jesus’ disciples; perhaps partly because of our last year here in Kenya.  They must have experienced some extraordinary whiplash travelling with Jesus.

After five centuries of suffering one overlord after another–Persia, Babylon, Egypt (again), Alexander the Great, Rome–if you were a Jew living in the ancient Near East at the time of Jesus, at the top of your wish list was the coming of the expected Messiah.  Someone who would defeat the occupying Romans and restore Israel to its former glory.

Enter Jesus…who spends 3 years of public ministry doing extraordinary signs and wonders (healings, exorcisms, etc) while repeatedly counselling his followers not to focus on the them, but instead to listen to him and what he was teaching.  He even asked some of those he had healed to keep it a secret.

High hopes for a triumphant, conquering Messiah, which were starting to be met in this Jesus who performs extraordinary miracles…and then, after nearly 3 years of apprenticeship, Jesus begins to teach his closest apprentices that while he is in fact the Messiah, he will be betrayed, suffer and die.  Surprise!

And then, he enters into Jerusalem and is hailed as a conquering king?  Surprise again!  I can empathise with the disciples, who ‘did not understand all this’.

Steve, Erik, Mardi, and Kelly during recent donor visit by Golder Trust for Orphans

I heard a preacher say once that she reckoned one of key aspects of God’s character as revealed in the person of Jesus is that he is the “God of the surprise”…you were expecting the Messiah to liberate you from the Romans?  Surprise!  You get liberation from being-dead-while-you’re-alive, but you still have to pay taxes to Rome.

The last few weeks has given us a bit of whiplash also…some high highs and really low lows, with little space in between for recovery and reflection.

But in the midst of it, I’m learning to hear the calm, strong voice of Jesus calling us to trust him, follow him, to not require guarantees, or a 5 year plan before we will take action.  To relinquish our tightly held control over our lives to him and trust him.   To be willing to be surprised.

Even if, like the disciples, we don’t fully understand ‘all this’.

Riley's recent masterpiece, "Daddy and Riley", in marker on whiteboard.

Are you willing to put yourself in a place where it is okay to be surprised?  Or do you have it all figured out, with no room for mystery?  When you have it all figured out, there’s no need for faith, for trust…we pray, this Easter season, that you are able to make room for the God of the surprise to move in your life in unexpected ways.

-A

The glass is half full (31/3/12)

Princess Victoria died on Wednesday.    One of the many potential complications of prematurity attacked  - necrotising enterocolitis (NEC).  Within 48 hours she just couldn’t fight it anymore.   Despite our antibiotics trying to fight the rot in her gut, and the surgeons doing what they could, her tiny 900 gram body was just overwhelmed by the infection and we lost her.  I couldn’t help but cry after the covering pediatrician told me, as my hopes were so high.  And my heart is heavy for her mother Catherine, despite the the fact that both of us knew all along that this was always a possibility.

Baby Mercy was born suddenly at 35 weeks, and her lungs didn’t quite get the news in time, so she had a lot of trouble breathing at birth.  But this week, we had the expensive surfactant, her parents could afford it, and the ICU had room for her to stay on a ventilator for 5 days while her lungs figured out how to breathe for her.   Yesterday we took out her breathing tube, and all night long she merrily breathed on her own, keeping her oxygen level at 100%.  Today, after a week on the edge of a precipice, we were able to move her back down to the nursery, well on her way to going home.

Between the two of them, I think the glass is half full.

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Jennifer is away for 2 weeks in Uganda and South Sudan with the family, leaving me with a visiting pediatrician to cover the pediatric ward and a community pediatrician to help out for 2 days on the nursery.  On Saturday, I had to round on 3 children on ventilators in intensive care and 36 other babies and children after a post-call night of helping the family medicine doctor manage the overnight emergencies and then manage them for the whole weekend.  This morning I had to do rounds alone again.

But the visiting pediatrician was here for 2 weeks when we needed her – Stacey, a joyful, friendly, exceptionally competent kindred spirit who was willing to jump in with both feet and handled it admirably.  Mary, our community pediatrician, was able to efficiently and decisively handle the crises in the nursery, including sweet Princess Victoria’s death.   Without them, I would have been unable to cope.  And today, miraculously, only one little girl was on a ventilator in ICU and the hospital director saw her for me, and there were only 20 other babies and children to see, meaning I was done by 10am and am now free to have a weekend.

The glass is half full.

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Edmund was admitted to hospital for surgery to remove a brain tumour.  Half way through the operation, he had an inexplicable cardiac arrest.  He was resuscitated and taken to ICU, but it wasn’t until the next day that we were able to fully assess that his brain had not survived the hit it took on the operating table.   Every bed in ICU was full and Hans, the adult ICU doctor, told me there was an adult in the emergency department who had a swollen airway and could only breathe because he had a breathing tube placed – and for him to survive, he’d need one of the ICU beds.  Together, we walked around all 5 ICU beds to decide which patient needed to give up their space.  And it became apparent Edmund couldn’t breathe on his own, and was unlikely to get any better.  I had to call the neurosurgeon to ask him if he could talk to the boy’s family and tell him that there was nothing more we could do.  And then I pulled out his breathing tube.  He lasted a few hours.

Faith and Esther were born 2 weeks ago, nearly 9 weeks before their due date.  They both needed the surfactant medication for their immature lungs – 2 vials each, at 17,000KES ($200) apiece.  Our hospital pharmacy had only 1 vial.  Jennifer had decided to give them half a vial apiece and to look for more.  The pharmacist called around the country, and Dad physically went to hospitals in Nairobi to find some.  In the meantime, while both of them received pressurised oxygen via their noses, Faith developed a pneumothorax (air trapped outside the lung, making it impossible for that lung to breathe) and nearly died.  She was revived and taken up to ICU on a ventilator.  Esther, her sister, started to breathe harder and harder and need more oxygen – a sign that more of the precious drug was needed, and soon.
Dad returned from Nairobi empty handed.  The pharmacy, however, hit gold – I think it must have been actual gold, because a single vial of a different brand of surfactant, was 69,000KES ($700).  Jennifer, in a Solomonian task, had to decide what to do.  Together we decided to pay for the vial from the Needy Patient’s Fund, and give it to the child who wasn’t in ICU, as her chances of survival were better, and then we prayed.
2 weeks later, after Faith spent 3 days on the ventilator, and Esther took her place for 3 days after Faith recovered, both girls are back in the nursery.  Esther needs no oxygen.  Faith is recovering from pneumonia, a kidney infection and a separate blood infection, but is almost off of oxygen herself.  The girls are starting to take breast milk by mouth, and their mother’s smile every day I see her is just precious.

The glass is half full.

_________________________________________________

Even though I walk through the darkest valley,
I will fear no evil, for you are with me; 
your rod and your staff, they comfort me.

You prepare a table before me in the presence of my enemies. 
You anoint my head with oil; my cup overflows. 
Surely your goodness and love will follow me all the days of my life, 
and I will dwell in the house of the Lord forever.

Psalm 23: 4-6

It has been a pretty rough week.  There have been other deaths, and other babies are still hovering on the brink.  But there are babies who have lived, who have beaten the odds, are home with their families.  The cup is half full.  If I am honest, and I work through the tears, and then take a deep breath and a good look around, my cup actually overflows.

- M.

Queen Mary and Princess Victoria (23/3/12)

Some of you may have read one of my first posts after starting work at the hospital about baby Mary, born at 855 grams and abandoned.  It took us until July to untangle the bureaucratic mess of legalities surrounding her placement, but she finally went, at the age of 4 months, home to Naomi’s Village, a children’s home started by the Mendonsa family which is located just a few kilometres from here.

This is Mary last week (top left), celebrating her 1st birthday.  Vivacious, energetic, a source of love and laughter for the only family she has ever known.    Cruising around, crawling, babbling.  For me, Mary has been one of those little beacons that gives me hope when I’m not sure how much good we are doing here.

Below right is baby of Catherine, let’s call her Victoria because she is such a courageous, strong little girl.  Mum’s waters broke way to early, and Victoria’s life was in danger.  The obstetric team felt like she’d have a better chance of surviving outside of mum, so after giving mum some medications to try to mature Victoria’s lungs, she was born by c-section this last Friday.

Victoria (courtesy of www.paradoxuganda.blogspot.com)

We are always consulted before the baby is born in these cases – Jennifer had sat down with mum, and explained that Victoria’s chances were not good – her ultrasound showed that she was 26 weeks and probably around 970 grams.  Jennifer explained that we could try to help her lungs with a very expensive medication costing about $200 a dose, but that if Victoria didn’t look like she was trying to live at all, we would not spend the money and just let her die peacefully.  And Jennifer and I just waited and hoped that the other one of us would be on duty when she arrived.

So on Friday afternoon, with 3 staff members off sick or absent, a full nursery and 2 babies convulsing in the emergency department, I received the call that Victoria was coming.   We quickly transferred a twin from one incubator into her brother’s incubator to share so we’d have somewhere warm to keep Victoria.  We set up the airway equipment and the medications, including some adrenaline, and we prayed.

I have never seen such a small baby make such a ruckus when first born.  At a whopping 830 grams, where other babies would gasp like fish out of water, Victoria looked around at us, with a very stern expression, and proceeded to holler.  She actually hollered, like a term baby.  It was remarkable.

We took her to the nursery,  where we measured her oxygen level – 100% just breathing on her own. I decided that, given her prematurity and the fact that it was 3pm on a Friday with inexperienced doctors scheduled to be on over the weekend, that the best choice would be to give her the lung medication now, while she was stable, rather than at 3am after she was deteriorating.  The next hour turned into a horrible dance as, during the administration of the medication, her oxygen levels deteriorated, her breathing tube became displaced not once, not twice, but 3 times, and her heart almost stopped, requiring chest compressions and adrenaline.

After the adrenaline, she wasn’t moving.  Her pupils weren’t reacting.  I was on the verge of tears, that this vigorous little girl had so quickly been lost.

And then, incredibly, marvellously, she started to move her arms.  She started to fight.  And again, to holler at us.

Since then, she has been one of our model babies.  Deciding she needed no oxygen, thank you very much – she’d like to just breathe the same air as the rest of us.  Enjoying breast milk dropped into her stomach through a nasogastric tube.

She has a long way to go.  She’ll be with us until she’s at least 2 kg – if a blood infection, gut problem, lung complication or bleeding into her brain doesn’t set her back.  That will take at least another 2-3 months.  Her mum knows that we are not out of the woods – but the smile on her face today when I saw her in the nursery gave me such joy.

Because, if Mary can make it here without a mother, maybe Victoria, nestled in the love of her ever-present mother, can make it too.

- M.

Beautiful Mary (courtesy of www.naomisvillage.com)

Water and jobs (21/3/12)

A couple of days ago I took a walk with a couple of the residents from a small village down the road. At one point we thought we were being chased by a group of young men with pangas (machetes), but I digress.

Kijabe Town lies about 5 km northwest along the escarpment from Kijabe. It used to be a small but bustling stop on the main railway line from Mombasa on the coast to Uganda–one of the world’s epic train journeys made popular in the book “Man-eaters of Tsavo” and the film “Ghost in the Darkness”. Now, the nine railway station buildings lie dormant, windows broken and anything of value removed. The village has perhaps a few hundred residents, most of whom are subsistence farmers, unemployed, or work at the Hospital or RVA.

John is the Maintenance Manager at Kijabe Hospital, and lives in Kijabe Town. He makes the 10 km round trip walk to work every morning and evening. He and I hit it off soon after we arrived last year, and I’ve spent a bit of time helping him learn to schedule work packages and manage a growing portfolio of new construction projects.

He approached me a few weeks ago and asked if I might help him with a water project that the residents of Kijabe Town are looking to build. So a few days ago I met up with him and one of the local Kikuyu mzees (an elder in the village) in the morning on their “Main Street”: a collection of shacks and broken down dukas (shops) scattered along the dusty dirt road. They wanted to walk the route of the 2 inch PVC pipeline they’re hoping to build, and get some construction and design advice. So we set off for the spring source.

We walked, and we walked. If you haven’t been here, it’s hard to picture it: the area in which we live lies on the edge of an escarpment, about halfway down from the top of a ridge to the bottom of the valley floor, a total elevation difference of around 1000 meters (3000 feet).

John, on the side of the mountain at an overlook of Kijabe Town

The spring source they want to lay a pipeline to is about 7 km from Kijabe Town, and 1700 feet higher.  So walk up the mountain we did…past the old cave where a hyena used to den, scrambling over the largest eucalyptus tree I’ve ever seen (recently downed in a storm), through gorgeous eucalyptus, red cypress, acacia and pine forests, past a group of angry young men who ran past us waving pangas. We never did find out what they were so excited about. It was beautiful. And exhausting.

You know you're on a steep trail when you're hauling yourself up by tree trunks

As we walked, we talked. I mostly listened and asked questions in my broken Kiswahili.  Turned out that John and this mzee are members of a committee representing the “Kijabe Town Unity Group”, a group of residents who have come together to fund and construct some projects for the benefit of the community.

Their first project was to purchase a large tent for community gatherings, weddings, and funerals. With this successfully purchased last year, they set their sights onto the next order of business: doing something about all the unemployed youth in the town.  Coming from the West, it is quite a shock to walk into a place like Kijabe Town–groups of young and older men sitting around in the middle of the day with nothing to do, looking bored or kicking a soccer ball made of plastic bags.

Kijabe Town, seen from the pipeline route about 1/2 way up the mountain

The problem and proposed solution grabbed my heart. They know they can’t just create jobs out of thin air for these young men.  But out of scarce/nonexistent resources came some creativity.

Turns out the soil around Kijabe is actually quite good for growing crops; all they lack is irrigation water. They have just enough water from a nearby spring to provide residents with drinking water to taps in front of their homes roughly two days per week. The other days they use the water they collected in jugs and tubs during those two days. But no water available for irrigation.

So they’ve decided to build a pipeline to carry water from the top of the mountain to Kijabe Town for irrigation, so they can teach these young men to farm and be gainfully employed in agriculture.

I was delighted to help them map the pipeline route with my GPS, and provide some advice on engineering and construction details to take into consideration. Now they have to apply for the water permits and decide amongst the residents of Kijabe Town if the Unity Group will undertake the financial commitment to deliver this not-insignificant infrastructure project.

It was a great walk, and good to build a deeper relationship with John and the mzee. It was also so beautiful to see an example of community-based solutions in action. They see an immediate need, and their solution is long term: provide the unemployed with jobs which both gives them income and provides sustainable economic benefit to the whole community.

At the spring source

I decided about halfway into the walk, gasping for air with my muscles screaming, that I’m going to do whatever I can to help them deliver this project.  It’s still very early on, and there are unanswered questions and permits to be resolved, but this is a great opportunity to come alongside a community-initiated project and help in a way that doesn’t just involve writing a check.

-A

Stillness (19/3/12)

Last week was a nightmare week as far as work went.   A visiting pediatrician became sick, leaving Jennifer and I to cope with one of our biggest workloads alone.

The problem with providing excellent pediatric care is that people expect excellent pediatric care.  So when we had Immaculate, Jennifer, myself and rotating visiting doctors to cover the service, we became used to taking care of 2-3 children in ICU, 20-25 premature babies, 15-20 medically sick children on the ward and a busy outpatient department.  And the standard of care starts to rise, and children survive when they may not have before.

So when it is just back to me and Jennifer, the same 44 kids are in the hospital, just as sick, but there is just one of us at a time to take care of them, because we each still have our commitments to family, school and life outside of our jobs.

Last week was really hard.  By Wednesday, Jennifer was about to drop on her feet and handed the service over to me after she’d worked 2 back to back weekends due to the scheduling vagaries of ending one month and starting another.  The busy week culminated for me on Friday with rounds on 44 patients, stabilising 2 convulsing infants, taking care of a newly-sectioned 26 week 830 prem baby whose heart stopped once before she decided to rally and seeing private patients in an afternoon clinic.  I was overjoyed to hand the service back to Jennifer once more at the end of the day.

And to breathe.

I have to say, I handed over those children to Jennifer and did not look back.  I knew she’d have to round on all the babies on Saturday morning with half of the support staff that I had had.  But Andy and I had planned that this weekend, I would have a retreat.  So on Saturday morning I went to Nairobi, all by myself, without husband or kids, and didn’t come home until Sunday night.

It is the hardest thing in the world for me to leave.  To leave Andy and the kids, knowing I have just spent 3 days at work away from them.  To leave Jennifer to round on and stabilise a crazy service before a junior family practice doctor takes over for the weekend – who will inevitably need help at 3am, and it is Jennifer who will be called.

It’s a real discipline for me to say – no, this is important, and to go.

Andy and I try to do this for each other a couple of times a year.  It should probably be more.  But we know each of us needs some space to breathe.  To rest, to read.  To pray, to ponder.  And for me, this weekend it was life.

I slept for 10 hours on Saturday night, without waking up once.

I read and rested for 2 straight days.

I drove past a supermarket, and didn’t go in.

I sat, in stillness.

On the surface, it may seem selfish.  But I know I came back last night rested, and refreshed.  Available to actually be there for my husband and kids, to listen to them, to love them, to have a little space beyond survival.  To be refilled to be able to have a heart willing to serve and love and be gracious, beyond what I was capable of last week.

While I was away, I read a devotional by Richard Foster entitled “An Inward Stillness”.  Part of it reads:

“The first avenue into worship is to still all humanly initiated activity.  The stilling of “creaturely activity,” as the patriarchs of the inner life called it, is not something to be confined to formal worship services,  but is a lifestyle.  It is to permeate the daily fabric of our lives.  We are to live in a perpetual, inward, listening silence so that God is the source of our words and actions.  If we are accustomed to carrying out the business of our lives in human strength and wisdom, we will do the same in gathered worship.  If however, we have cultivated the habit of allowing every conversation, every business transaction to be divinely prompted, that same sensitivity will flow into public worship.”

I find here in Kijabe that I become easily swept up into the floodwaters of busy-ness and self-imposed expectations, and that my stillness turns to turbulence.  And with that, I lose my way, I forget why I am here, I start to frenetically DO – to the exclusion of listening well to my husband, to being fully present and patient with my kids, to making time to actually be available to friends and family, to being fully who I am created to BE, rather than do,  in the image of God.

I am grateful this past weekend to have had a chance to re-centre.  To recalibrate myself, and to step back into the swirling torrent that is life here with an inner stillness that I pray continues to permeate each part of my day.

- M.

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p.s. As of today, we have Stacey, an American pediatrician, helping us out – then as she leaves a Kenyan will start part time, and a German full time for the next three months.  So, God willing, the worst is over!

On actually, really doing OK (14/3/12)

It’s been an interesting couple of weeks at work, and a couple of friends via our blog and at playgroup this week asked how I was coping.  And I found myself answering, honestly, that I am doing well.

It’s easy to catalogue the ways that the last week has been tough.

• Lots of deaths on the ward last week, with Jennifer having 4 more in the last 2 days – unfixable brains, inoperable hearts, unfightable infections.
• Realising that Riley’s US passport is close to expiring and I didn’t bring her original birth certificates etc over here because we were virgin missionaries who didn’t know if Kijabe was a safe place to bring important documents.
• Our visiting pediatrician being sick and our main pediatric clinical officer being away Friday, meaning I had to cover an understaffed pediatric ward, nursery, ICU and outpatient department after being on call Thursday night.  Then being in the ICU or awake most of Friday night helping a family practice doctor with a critical baby whose care was beyond his expertise despite his years of experience.
• Starting to wade through the adminstrative morass that is renewing annual non-Kenyan insurance policies, licenses et al.
• Rounding on all the children and babies again on Saturday morning while trying to make sure they were stable and that a doctor could be found to supervise them for the whole weekend as the same sick pediatrician was also supposed to be on call.
• Our water being off since Sunday (today is Wednesday) except for a brief respite during the day yesterday when I foolishly thought “ahhh, the water’s back!  I could take a shower tonight after the kids have a bath!” – a bath that filled with 1cm of water before the water ran out again.
• Finding out that the sick pediatrician won’t be back at all, and Jennifer and I have do the same thing this whole week until another pediatrician arrives for a 2 week stint from the US next week (Stacey, we can’t wait for you to come!).

Strangely, I have been feeling pressured, but unstressed.  Work at the hospital has been physically and emotionally hard, but I have found myself able to blog about things, to cry about things, to get a couple of good nights’ sleep and to feel like I am able to start the next day fresh.  I have been able, at the end of my rope, to spend a night in Nairobi at a hotel with my family, revelling in a swimming pool, a plate of sushi and time to relax and read and ponder.  I have been able to enjoy and treasure a couple of days with my kids, knowing that Jennifer is at the hospital fighting her way through the maelstrom while I regain my equilibrium ready to walk in at noon today with a steely disposition and functioning brain.  I have had space to watch a gorgeous movie with my husband (if you haven’t seen the Muppets, it is just adorable) and to plan a 5th birthday party for my daughter.

I’m going to keep blogging about the hard stuff – it helps me to work through the pain and the frustration, and I’m glad you know how things are really going with us.  Sometimes it does seem unbearably heavy.  Sometimes I feel as Paul must have when he wrote to the Corinthians:

For we do not want you to be ignorant, brothers, of the affliction we experienced in Asia. For we were so utterly burdened beyond our strength that we despaired of life itself. Indeed, we felt that we had received the sentence of death. But that was to make us rely not on ourselves but on God who raises the dead (2 Cor 1:8-9).

We are realising that we are running this race at a marathon pace (partly through people like Jennifer and Scott saying to us, “Remember, you are running a marathon now”), and we are not running it alone.  I am so grateful to be in a place where I am a co-pediatrician rather than THE pediatrician.  I am grateful for a husband who understands me, sees what I need before I see it, and encourages me to get away by myself for a weekend retreat (which is what I’m doing on Saturday).  I am grateful we are supported by people who understand me and my family, that we have a host of friends and family around the world praying for us, encouraging us, supporting us, reminding us that we are so very far from alone.  I am grateful for a God who continues to give me strength, and gently reminds me of the “why”  that makes the “how” possible.

So, to answer those of you who have asked,  I am actually, really doing OK, and thanks for asking.  In fact, I am doing well. There are ups, and there are downs.  Each day here is a stark acknowledgement of imperfection and pain, losses and grief.  But also an acknowledgement of milestones and celebration, accomplishments and joy.   I am honestly learning, day by day, to embrace them all and to look forward to tomorrow, however yesterday may have been.

But please, keep asking.

- M.

Using a lightsaber with the blast shield down (11/3/12)

[Luke is training with his lightsaber and a laser remote aboard the Millennium Falcon.]
Ben Kenobi: [gets up and takes a blast helmet] I suggest you try it again, Luke. Only this time, let go your conscious self and act on instinct. [puts the helmet on Luke, which covers his eyes]
Luke Skywalker: But with the blast shield down, I can’t even see! How am I supposed to fight?
Ben Kenobi: Your eyes can deceive you. Don’t trust them. Stretch out with your feelings! [Watches Luke succeed in blocking the lasers] You see? You can do it.

Sometimes I hear about people who have made big decisions, and all they describe is the decision.  Perhaps a little lead-up to it, and they appear to go off into the sunset at peace for rest of their days.  Quitting their job as an investment banker to become a poet.  Taking a leave of absence to travel the world.  Putting a career on hold to support a spouse or raise a child.

You don’t often hear about the ‘in-between’ moments, the panic, the fear, the second-guessing.

For the last week and today, I am having one of those in-between times.  Fear.  Panic.  Waking up in the early hours of the morning with a flood of thoughts:  How will we buy a car?  What if the car needs maintenance and we don’t have the right amount in the budget?  What if we can’t raise enough support?  What if we can’t afford to take a holiday?  What if the kids get malaria, or TB, or some crazy African disease I’ve never heard of?  What if we move back to the USA or Australia and haven’t saved for the kids’ university education?

And, ever-present…the lingering, brooding, sickening question…What are we DOING?  Are we fools?  Have we made the wrong decision?

Our lifestyle transition to Africa has been profound…a massive change.  Several years of post-university working and career progression, earning a normal salary, owning houses, being fortunate enough to basically spend what we liked…and now…rural Africa.  Some days I think I’m used to it, and then others:  the internet doesn’t work (again), all of Kenya has a shortage of Diet Coke, our old 4WD needs major maintenance again, we are in the grocery store weighing up whether or not we can afford the good muesli, I convene a meeting to which everyone shows up 30 minutes late and during which nothing is accomplished…and I want to take the fastest plane to somewhere not-Africa.  Somewhere I can draw a normal paycheck and have a predictable and safe life.

What are we doing?

We made the decision a few weeks ago that we were going to extend here another 4 years…a decision that involved prayer, fasting, seeking the counsel of other crazy risk-takers we respect.  It was kind of an easy choice, to be honest…we couldn’t really think of anything we would rather do.  We’ve never felt so alive, so like what we’re doing really matters.

But I feel like I’m trying to use a lightsaber with the blast shield down.  I know I’m supposed to, I know I want to…but I’m scared because I can’t see more than a few inches in front of me and I don’t want that little flying ball to zap me with a laser.

I can’t tell you how we are going to be able to afford to buy a car next year.  I don’t know how we’re going to be able to pay for Riley and Liam’s school fees.  I don’t know where the money is going to come from for us to take holidays, and have periods of Sabbath and relaxation.  We’re pretty a pretty typical doctor and engineer…schedules, programs, budgets…we are planning nerds.  We thrive on it.  And to not be able to answer all of the questions I have really bothers me, it makes me nervous…keeps me up nights.  I learned 14 years ago when I fell in love with someone on the other side of the globe that having a 5 year career/life plan was not in the cards for me…but now I don’t even have a 6 month plan.  I crave predictability.

What have we done?

I can’t yet tie up all these thoughts with a happy resolution…it’s still unresolved in my mind, and the only clarity I have at the moment is that I’m pretty sure it’s supposed to be.  Somehow, this fear, this second-guessing, this being forced to relinquish having the answers at hand is something to be worked through rather than to be avoided.

In my devotional readings this week, Oswald Chambers in My Utmost for His Highest says, “Being born again by the Spirit of God means that we must first be willing to let go before we can grasp something else…Along each step of this process, we will have to give up our claims to our rights to ourselves.  Are we willing to surrender our grasp on all that we possess, our desires, and everything else in our lives?  We will suffer a sharp, painful disillusionment before we fully surrender.”

Sacrifice.  Surrender.  Sigh.  Am I willing to surrender not being able to put in place a plan to save for my children’s education?  Not knowing where our support will come from in 2013?  Not knowing where funding will come from for the projects we want to deliver at the Hospital?

I don’t know.  I can say, with conviction, that it is extremely difficult, and I am not certain that I want to.

At times like this, I am grateful that the books of Lamentations and Ecclesiastes were included in the Hebrew Bible/Old Testament.  The former, with its public, heart-wrenching grieving and total lack of pseudo-Christian “Chicken Soup for the Soul”-like platitudes; the latter with its so-honest-it-makes-me-uncomfortable clarity about the reality of life.

And I am starting to read Proverbs 3:5-6 with a different sort of intensity:  “Trust in the Lord with all your heart, and lean not on your own understanding.  In all your ways acknowledge him, and he will make your paths straight.”

-A

Poo (6/3/12)

It took a supreme act of the will (and consultation with my live-in editor-in-chief) not to title this post with a different synonym of ‘manure’.

Perhaps I can blame my 10 years in the Navy on my high tolerance for colourful expletives…either way, there it is.

We have people come to our door often asking for things…money, pharmaceuticals (usually not the illegal kind), food.  It’s part and parcel of being wazungu (white) in Africa.  One of the more creative is the group of girls who comes to the door during school holidays.  With a straight face we are informed, ‘Today is our birthday.  You will bake us a cake.’

We’re careful not to give unless it’s for a harambee (literally, “let us all pull together”, e.g. a community fundraiser) for a genuine medical need, someone’s house burns down, etc.  This question of “when should I help?” is a genuine and difficult one, and we often recommend When Helping Hurts:  Alleviating Poverty Without Hurting the Poor to visiting friends or new arrivals here.

All analogies about the early (and current) missionary/NGO semi-colonialist habit of creating dependence aside, the constant call for help does get to be a bit much sometimes.  Like yesterday.

John (name changed) is a local who comes to our door regularly.  We sometimes buy firewood from him, which we have recently discovered is usually infested with termites.  Lots of termites.  He shows up on firewood delivery day in a ramshackle 1960′s-era blue pickup piled high with blue gum and wattle logs, spewing enough blue smoke to cause a localised reduction in visibility–which always brings back vivid memories for me of driving through a fog bank on a surfaced submarine early in the morning.

John came to our door yesterday, clutching his cheek.  I have a bad toothache.  You will buy manure from me for your shamba (garden) so I can buy medicine.

Now this was a first.  We have enough of a relationship with John that he understands we won’t just give him money, but we’re happy to buy goods from him at a reasonable price if we need them.

Enter the manure.  He had seen us building a chicken wire fence around the shamba (the birds and monkey will strip it bare overnight if we don’t), and deduced we had a need.

But for me, on this day…it was a bit much.  Manure?  Really?  You’ve got to be kidding.  Leave me alone, I’m busy, I have meetings and classes booked all day today.  I am ashamed to say I was short with him and sent him on his way.  When he called me back 4 hours later to remind me that he still had manure for sell, I was even shorter.

And in my shortness, I heard a little voice remind me that we don’t get to choose the people we are in community with…we’re just, well, “in community” with them.  And sometimes they come to greet you at inopportune times.  Sometimes they are smelly, and when you look at them all you can see is termite-infested firewood.

John was a bit aggressive, I’ll grant, but he had a genuine need alongside his less palatable characteristics.  Like more than half of rural Kenyans, he’s desperately poor, living day to day.  In a country with a 40% unemployment rate, where a job which earns you around $100USD per month gross is considered a good one (https://www.cia.gov/library/publications/the-world-factbook/geos/ke.html), a truckload of manure might feed his family for a few weeks.

Not that they would eat the manure, they would sell it to me and then buy food…well, you get the picture.

I am learning that this is just life here…the need to have healthy boundaries and good economic practices alongside the reality that we eat well every day, but there are people who are hungry within 1 mile of us who have no idea where the money for their medicine or their next meal is going to come from.

And I am reminded that after we bought the last (termite infested) load of wood from John in December, he flagged me down on the road a few weeks later, leaned into my car and said, “Thank you for buying kuni (wood) last month…because of you we were able to have Christmas.”

I mean, really, what do you say to that?

-A

Ishmael (4/3/12)

My heart’s a little heavy today.  Last week, Ishmael (my pseudonym) came back to us from Dadaab Refugee Camp.  I haven’t seen him since Friday since I’m not on duty this weekend, and I’m not sure if he’ll still be alive when I call the hospital tomorrow.

We took care of him from November-January when he came to us malnourished, withdrawn, a mystery mass on his back.  Initially there was relief at the biopsy result – nothing malignant.  But no clues to what it was either.  And then, infection after infection of the area, the tissue just dying before our eyes.  A 4 year old lying in bed, refusing to eat, no interest in play, soulless eyes without hope.  Finally, an answer – an unusual mycobacterium infection, needing strong TB drugs.

Then slowly, a glimmer of hope.  Incremental weight gain.  Months of fever, disappearing.  A boy waking up to the world.  His apparently sullen father – trapped in this place where he spoke none of our languages, reliant on other women of his race to translate his most basic requests and thrust into the role of nursemaid –  starting to hope that soon, maybe his son would be well.  Maybe soon he would be able to return to his wife and children, aliens in a northern Kenyan wasteland.

And home they went – well, almost home.  To the refugee camp hospital with a backpack full of medications.  But in 3 weeks, before his eyes, his son disappeared again.  .

Ishmael came back to us with stool leaking out of his back – inflammation of his bowel creating an abhorrent connection.  His urinary system infected.  One of his kidneys completely blocked, the other one exhausted and on the brink of failure.  His heart losing the ability to pump well.  A miserable, exhausted boy at the end of the road.

Before our eyes this week, his kidneys have both shut down altogether.  Ishmael’s eyes have disappeared behind a swollen mask as his body fluids have nowhere else to go.  Dialysis is available in Nairobi for $500 per session – a temporising measure, for if the kidneys are not working, and we don’t know why, there is no hope of them recovering and transplant is impossible.

So Ruth, the pediatric surgeon, Dorothy, chaplain and translator, and I sat down with Dad on Friday to tell him, this is the end of the road.  His impassive father seemed unsurprised – he had been hoping we could have helped, but was also disappointed that he had brought his son so far from home to die, when he could have taken him to a much closer hospital for the same outcome.  Even though he is not of our faith, he wanted to join us as we prayed for his son – for the miraculous, or for a peaceful end.

We are hoping he will live long enough for his mother, who we have never met, to make her way down from Dadaab to say goodbye to her son.

I love this little boy.  I don’t know why – he hasn’t really ever been my responsibility here, he’s been a surgical patient with us trying to help with some advice.  But I just hoped for him.  And when we sent him back, I hoped to see him, maybe in a year, happy, smiling.  Playful, eating, laughing.  And I know now that he won’t.  I feel so sad for his father – who through translators I have tried to connect with, tried to cajole him into allowing Ishmael to be fed through a feeding tube.  At one time in November I had to sit down with him and via 2 translators (English-Swahili, Swahili-his language) try to explain  in a culturally sensitive way why he should stop beating his son to make him eat.  I felt like we’d established an uneasy trust, and in having to say to him, your son will die, I felt untrustworthy.

This is just how it goes sometimes, and in my head I know it.  But this week, my heart is sad – just a few too many losses.  Baby Jonathan whose liver and lungs failed while his parents kept a constant bedside vigil.  Another baby who never had a name but whose mother wept and vomited as I informed her of his death which occurred while in the ambulance on the way to us.  Tomorrow we will have to say goodbye to baby Malt, whose blood type was different enough from her mother’s that her mother’s antibodies have destroyed her before our eyes.  And now Ishmael.

My soul is weary with sorrow;
strengthen me according to your word. 
Keep me from deceitful ways; 
be gracious to me and teach me your law. 
I have chosen the way of faithfulness; 
I have set my heart on your laws. 
I hold fast to your statutes, Lord; 
do not let me be put to shame. 
I run in the path of your commands, 
 for you have broadened my understanding.

Psalm 119:25-32

What a complex God we serve.  Powerful enough to let go of control, to need us to participate with him in the restoration of creation.  Strong enough to allow us to choose, and to watch the world unravel and heal, to decay and to blossom.   Continue, Lord, to broaden my understanding – even though it sometimes cuts like a knife.

- M.

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5/3 Baby Malt died this morning.  Ishmael still lingers.  Pray for the families, and for Jennifer who has had to walk the last steps of the road with them.

9/3 Ishmael lost his battle last night.  No more suffering, no more tears.

Real life and water parks (22/2/12)

I woke up groggily for a few seconds in the wee hours of Monday morning to hear Mardi talking on the phone.  It was the tail end of her weekend on call; phone calls and trips to the Hospital in the middle of the night are part and parcel and I usually don’t wake up.  She was talking to the doc on call in our little five bed ICU again, and I just snuggled down a bit deeper and went back to bed.

You see, a few days prior, a young boy was discovered by the side of the highway at the top of the mountain above Kijabe.  He was bleeding from a head injury, unconscious and appeared to have been hit by a car.  Someone found him, put him in their car, and brought him to the Hospital.  No name, no parents, he was seen by our surgeons and then put in the ICU as he continued to deteriorate.  Six hours later, his mother was found and came to Hospital.

Mardi spent part of Sunday helping the ICU doc troubleshoot why this little boy continued to go downhill and didn’t wake up.

At 3am, she figured out that his continued deterioration was likely due to a rare genetic reaction to a medication he received.  The Hospital doesn’t stock the antidote in its pharmacy, and so there was nothing further to be done.

I woke up again at 6am…another phone call.  He was gone.  Despite all the good efforts to stabilise him, the little boy died.  He never woke up from the injuries he sustained in the hit and run accident.

Five hours later…11am.  It’s our day off, we took the kids into a little water park in Village Market in Nairobi.  Heaven on earth for Riley and Liam (and Mum and Dad)?  A water park with a few slides, wading pool and inner tubes you can float down a little concrete channel in.  Liam wasn’t too keen on what he was pretty sure were Class 5 rapids, but Riley was game.  So I put her on my lap and we floated down together.

Riley enjoying the wading pool and the only pink innertube at the park

Water park…wonderful; my 4 year old on my lap giggling and shouting as we enjoy it together…priceless.

As I floated with Riley, I thought about this little boy.

I was deeply moved by the unvarnished reality of the moment.  Here I sat with my daughter on my lap, and five hours previously, a child found bleeding on the side of the road from a hit and run died under tragic circumstances.  It was just so…real.

I am struck in Africa by the stark inability to ignore real life, to pretend it’s not happening…a child dies a tragic death, we grieve, and five hours later we are filled with joy as a family just being together.  This is reality:  it happens everywhere.  At the same time we are (rightly) enjoying something–family, a good retirement plan, a fulfilling job–people suffer, injustice happens, children are hungry and die unknown.

Liam was a bit cautious at first, but after his toy giraffe did it a few times he was game

Here, there is not much of a veil between joy and sorrow.  The sorrows don’t make the joy any less sweet, and the joys don’t make the sorrows any less sad.  Quite the opposite, I think:  accepting the reality of suffering and grieving it properly and well makes the joys even deeper for me.

It seemed easier in Australia and America to be less engaged in this reality of simultaneous joy and sorrow.  The veil is up.  Perhaps because it wasn’t happening to us, it was easier to sort of pretend it’s not happening, convince myself it is someone else’s problem, or invest considerable resources and effort to make sure the sorrows never happen.  But here…I can’t avoid it.  It is real, and it is in front of me.  The veil has been ripped down.

I am nearly able to say with conviction that I prefer the perspective I have here…nearly, but not quite.  I cry a lot more in Kijabe than I did in Adelaide or Jacksonville.  I feel like grief and sorrow are closer friends than they’ve ever been.

But I am learning that I’d rather live a few short steps from suffering, with the veil down, and have a theology that is able to embrace the full range of human experience, than to live far away from it and have the veil in place.

Reality.  Seeing the world as it really is, and engaging with people on that basis, not hiding from it or pretending its not happening.  Not being shocked into paralysis by it, or offering platitudes or trite one-liners to people going through really awful times.

I am reminded of what Dallas Willard says in The Divine Conspiracy about the “Beatitudes”:  Jesus’ collection of sayings in Matthew including “Blessed are those who mourn, for they will be comforted”.

Is it true that “Earth has no sorrow that heaven cannot heal?” It is true! That is precisely the gospel of heaven’s availability that comes to us through the Beatitudes. And you don’t have to wait until you’re dead. Jesus offers to all such people as these the present blessedness of the present kingdom—regardless of circumstances. The condition of life sought for by human beings through the ages is attained in the quietly transforming friendship of Jesus.

I am grateful for this quietly transforming friendship of Jesus which makes it possible, even enjoyable, to live in a place where the veil between joy and sorrow is torn down.

And I am so very, very grateful for water parks.

Those Class 5 rapids are a real rush

Our little miracles (18/2/12)

This little princess is Hannah.  And for us, she’s one of a kind – the very first baby to survive here with a condition called gastroschisis.  And yesterday, she went home.

Gastroschisis is one of those conditions that, when a surprise, strikes fear into the heart of a mother who has had her baby at home.  A seemingly normal pregnancy – but when the baby is born, the intestines are hanging out of a hole in the abdomen.  Not covered by anything – an eviscerated, crying baby.  And inevitably, before help can be found, the intestines twist and the baby’s gut dies, or infection sets in, and the baby just succumbs.

In the West, we diagnose this condition prenatally by ultrasound, and the mum delivers in a high-risk hospital by c-section 2 weeks before term.  The gut is kept sterile and untwisted by hanging it in a silo (which looks like a big, sterile condom), and over a few days the gut gradually settles back into the abdomen.  The surgeons close the hole, and 90% of the babies goes home, healthy.

In Kenya, prenatal care is becoming more common.  Prenatal ultrasound, however, is not common, and for those who have one the defect might not be picked up.  And so the last 2 babies I have seen with this condition arrived at Kijabe from another hospital, wrapped in almost-clean blankets – one of them with a note that said “suspect hernia”.  I think I was as surprised when I opened the babies’ blankets as their unsuspecting mothers had been.

Hannah just after her Bianchi procedure

This year, our mortality has been 100% up until now.  Babies born at home or at other clinics have come to us with probably early infection or a dwindling blood supply, in addition to the 48 hours or more that these babies have not been able to digest food.  Add that to often a day or two extra delay in us obtaining intravenous nutrition (“TPN”) after they arrive here, and the combination has been fatal.

We have been so devastated to see these babies die.  Erik and Ruth, giving outstanding surgical care, with Jennifer and I trying to help the baby fight infection and catch up on nutrition, have been unable to overcome the baby’s rough first 24-48 hours.

Hannah was born at Kijabe on January 3rd, a 4-week early surprise for her mother in more than one way.  But because she was born here, our team was able to fire all of our ammunition at her – antibiotics, high-calorie IV feeds, warmth, sterile handling of her protruding gut, a lot of prayer.  Her gut was strung up in its protective sock and over 3 days slowly fit back into her accommodating belly.  Erik and the team closed the little remaining hole with the complex sounding “Bianchi Procedure” – pulling the remnants of her umbilical cord over the hold and just taping it into place with steri-strips.

Hannah learning to breasfeed (courtesy of www.paradoxuganda.blogspot.com)

A few days later we started to gingerly feed her gut, still getting settled in its new home.  After her gut figured out how to absorb milk, she had to figure out how to breastfeed.  She took a little while to gain weight, and was slowed down by a blood infection that she fought off.  Every day we’d come into work with bated breath – was Hannah still doing OK? Every day we were praying that she would make it – that she’d be our first gastroschisis miracle.

And yesterday after 45 days in hospital, she went home.  Two weeks ago, her replacement arrived – baby Naomi, also with gastroschisis.  She was born at another hospital but was well cared for and transferred to us by 7 hours of life.  Already her little gut is safely nestled inside her belly, and yesterday she was tolerating full feeds and her IV fluids were stopped.

I love the names of these 2 little girls.  Hannah – named after a woman who, after desperately prayers after childless years, bore a son, Samuel,  whose life she dedicated to God.    Naomi – whose bitterness at the loss of her husband and sons was healed by her daughter-in-law’s dedication and love.   Both women whose lives of struggle and loss were healed.   I am so grateful to see the chance for new life for these two potential remarkable women, passing through our nursery at the start of it all.

- M.

Pioneers and Giants (14/2/12)

From February 6-16, I and many other Kijabe doctors have been trekking to Brackenhurst conference centre, about an hour away, for the annual Christian Medical and Dental Association update in Medicine, Surgery and Dentistry.  Every other year this conference is held here in Kenya, and in the off years it is held in Thailand to try and cater for missionary doctors who want to stay on the cutting edge of the medical care they are providing, as well as providing a way for them to maintain official licensure in their home countries.  We are blessed here in Kijabe to live so close to the location of the conference – many doctors have come here from all over the African continent, as well as from the Middle East and Asia.

One of the unexpected joys of this conference has been to meet some remarkable faculty.  Dr Philippa Musoke, after getting a medical degree from Makerere University, in Uganda in 1981, did further training in pediatrics in Kentucky followed by infectious diseases training at Case Western Reserve University in Ohio.   She currently works at Makerere University as the principal researcher for the affiliated Johns Hopkins University clinical research site.  She has been instrumental in conducting research into HIV transmission from mums to babies and treatment of paediatric HIV in resource limited settings.   Listening to a woman of her calibre and passion has been so inspirational, like sitting at the feet of Hippocrates.

For many years, Dr Tina Slusher spent 8 months a year as a pediatric intensivist at Rush Children’s Hospital in Chicago, and 4 months a year in Africa working as a pediatrician to relieve missionary doctors on home assignment.  She’s currently a professor at the University of Minnesota in the department of Global Pediatrics and during her spare time, she’s participated in writing one of the first practical books on pediatrics in resource-poor settings – the Textbook of Global Child Health.  This week we’ve benefited from her experience in neonatal care, pediatric ventilator management, immunisation updates and more.  Having her accumulated wisdom given to us on a memory stick at the end of the conference is a treasured resource, as is one of the many textbooks that she came to give to as many pediatricians here as she was able, including one for us at Kijabe.

Ruth Van Reken is the author of “Third Culture Kids: Growing up Among Worlds“, a book recommended by pretty much every missionary agency and NGO about raising your children in another country, and the identity they develop as not-quite from their old or new country.  Just to be able to sit and listen as she and Jennifer chatted about their experiences with their own and other families’ children was such a privilege – to hear the wisdom of their combined experiences, and to know that resources are at my fingertips as my children navigate this journey of being not-quite-Australian-American-or-Kenyan.

And of course, there is Jennifer, a 17 year veteran of rural Ugandan medical practice, whose wisdom and sensible management I am grateful for every day.  It has been a joy to be able to actually spend a little time together on the commute and at the conference, to again realise what a resource I have in a friend and colleague who is only an SMS or maybe 10 minute walk away.

There have been many others, whose lectures and breakout sessions have provided at worst, food for thought, and at best, a change to our practice for the better.  All of these doctors have come at their own expense, knowing the fertile yet dry ground of missionary doctors whose options for continuing education are limited.

Pioneers and Giants – some widely known and respected, some quietly doing the work of Jesus out of the spotlight.

- M.

Tina Slusher (left) gives Mary Adam (right) and others a refresher course on Pediatric Advanced Life Support (photo courtesy of www.paradoxuganda.blogspot.com)

February 2012 update – with some news…

Click here to read our long overdue update, as well as a look back over our first year – and we have some news!

On knowing my limits (7/2/12)

After 10 months here, I feel like we’ve finally hit our stride in our rhythm as a family here – Mummy time, hospital time, Andy’s work time, time for updating friends and family via facebook and video, date time, worship time, hanging out with friends time.

In January, I realised how little reserve there is in that schedule when I tried to add teaching preschool to the juggling act of life here.  And by the end of the month, I felt like a terrible mother, a terrible wife and just a bit overwhelmed.

On the surface, it seems a little silly – all I was doing was teaching for 2 hours on a Tuesday, and 2 hours on a Wednesday.  But that, combined with the time it took on a Monday to actually prepare the lesson, crafts and stories, was enough to tip over my house of cards.

Learning about patterns with snacks that will rot your teeth.

On Mondays, I felt like the half day of lesson prep meant that Bob and Larry from Veggie Tales were raising my kids.
On Tuesdays when I left Liam at home with Susan while I taught instead of going to playgroup together, I just felt like his toddler years were slipping away in front of me while I was teaching Riley’s class.

On Wednesday mornings, I relished being in Riley’s class and a part of her life while Liam had play time with Susan, but had to rush home at 11:30 to drop the kids off and be at work by noon, leaving me feeling exhausted at the end of Wednesday which is a busy 1/2 day teaching or attending noon conference, getting my head around the nursery patients and often covering the ward patients and outpatient clinic so Immaculate can spend the afternoon with a cardiologist furthering her training.

The delightful Angela - exactly who you'd want as your preschool co-teacher

All of the mums of preschoolers teach the class for a couple of months of the school year.  Some of them are full time mothers and supporters of husbands who teach at RVA, some of them are teachers themselves who find a sub to teach their school classes so that they can be preschool teacher for a month or two – and all of them have out of school responsibilities to students as mentors, sports coaches or dorm parents.  And I really wanted to do my part – to participate in this precious time period of my daughter’s life, and for the other mums to see me doing my share, that the “lower station” mums are not so different from them, are a part of their world.

But at the end of the month, I had to acknowledge that I don’t want another month like this.  I am supposed to be teaching again in March.  Instead, I’ve asked my friend Stacy, whose daughter Lydia has just joined the preschool class, if she will teach for me instead.  She has graciously agreed to do it, and I am still hoping to help out once every week or two to be a part of Riley’s life in school while I can – but I won’t feel the pressure of needing to prepare and to leave Liam another 2 mornings a week.

It’s interesting, the conflicting emotions that go with this – relief, that I can prioritise time with my kids during my non-work hours now.  Guilt, that Riley won’t see me as her teacher as often as she sees her friends’ mummies .  Lightness, that a burden has gone that felt really heavy.  Insecurity,  that I’m not quite “one of” the RVA mums whose community is so close knit and that it takes a while to feel a part of the circle, and that by not teaching in March I’m a little more of an outsider.  Joy, that I will be able to reconnect with the RVA mums in Liam’s playgroup, who I’ve really missed over December and January.  Gratitude, that I live in a place where there are opportunities for community in so many arenas that I even need to think about saying “no”.

A few days after deciding not to be a preschool teacher again, I was asked to take on an additional administrative role at the hospital.  Again, the war of emotions and again, the realisation that I just can’t do anything else right now and I needed to say no.

Saying no for me is really hard.  I want to please people, I want them to like me.  But I also know, that for every opportunity, I have to ask – am I the only person who can do this job?  And when I ask that about being a mother to my kids, I realise that the answer will always be – yes.  And in saying yes to that, I’m going to have to say no to some other things, and that’s OK.   My kids will both be in full time school two years from now, and I’m pretty sure I’m not going to look back and wish I’d spent less time with them when I had the chance.

- M.

Birds nest cookies - because who doesn't like getting their hands covered in coconutty goodness?

Amphibians day - can YOU hop like a frog onto the lily pad when the music stops?

Did you know that some ostriches are as tall as the ceiling? Your 4 year old does.

Plans, chambered rounds, and water permits (1/2/12)

Our work on the Kijabe Water Project has been proceeding these past few months; we finished the Development Phase in October last year and are now in the Delivery Phase, writing grant applications, finalising the design, and selecting preferred suppliers.

The ‘front end’ of projects is my favorite:  strategising sessions, ‘blue-sky’ (planning) days, development of a vision, key result areas, key performance indicators, stakeholder engagement, design.  I love the first few months of a project.  So up until October last year, I was really having fun.

He showed up with a lawnmower, and the grass was too long to cut. Out with a scythe instead.

But I also love implementation.  The delivery phase.  The execution of a strategy, when what were plans on paper turn into construction and successful commissioning of a new piece of infrastructure.  Or launching of a new project team or a strategic plan.  So in this post-October delivery phase, if history is any indication, I should be as engaged, and spring out of bed in the morning with as much energy as I did pre-October.

Not this time.

Not on this project.

No, things are different here.  I am not able to simply put up a detailed business case to a board and receive approval and funding on the basis of a suitable 30 year Net Present Value, or alignment with the corporate strategic plan.  My last few projects before moving here were fast-tracked critical-human-needs water projects, where the owner threw money and competent resources at us to get it built as soon as possible, and then hung over our shoulder asking us to build it faster and spend money quicker.

It’s somewhat different here.

Here in rural Africa, we start the grant application process, and it takes 2 months to sort out who the correct person in the organisation is to apply to.  Another two months to figure out what the application process actually is.  Another 2 months to get the application written, aligned with that organisation’s requirements, and submitted.  And then the waiting.  Ah, the waiting.  And this is the fast version–our grantwriters, June and Gretchen, are both wonderful and brilliant, and we would be lost without them.

Our ballerina demonstrating her somersault skills

We develop the statutory approvals and stakeholder engagement strategy, only to find upon implementation that the Hospital’s name isn’t even on the original water permit we are seeking to vary, and hence we must embark on an unplanned 6 month negotiation period with the owner of the water permit and the statutory authority.

We plan site visits to the new pump station site 8 km’s from the Hospital, only to have it delayed 5 times by the contractor, and then once arranged, be told that there has just been too many carjackings at a spot about 100 metres from the site, and we should really take a police escort.  We arrange for one, and have the pleasure of being accompanied by two (very professional and nice) police officers with their semi-automatic G3′s with safeties off, and rounds chambered.  I was instructed to ‘keep your window lowered, and lean back so I can shoot out your window if I need to’.  Indeed.

No, this project is different.  Like on other projects we can, and have made numerous plans, held strategising sessions, and finalised the concept design.  Since then, however, we have been thrown so many curve balls that we have had to change our plans a hundred times, and we have yet to receive funding or break ground.

On this project, I am reminded of something that former President and General Dwight Eisenhower said:

“In preparing for battle, I have always found that plans are useless but planning is indispensable.”

I’ve always liked this quote, but now I own it.  Planning is worthwhile, indispensable, intrinsically valuable.  But the plans…those have changed each time we’ve encountered a new piece of information, added a new stakeholder, or had to change the design.  And each time…more waiting.

Broken down truck on one of our local roads

I am fascinated by the parallels in my spiritual life to what we are experiencing on the Water Project.  Proverbs 16:9 immediately comes to mind:  “In his heart a man plans his course, but the Lord directs his steps.”

At Moffat, I was recently teaching on a common spiritual season of our lives that everyone will go through at some point, called by some a ‘dark night of the soul’, or ‘going through the wall’– a season in which God seems far away, and we are in crisis.  We discussed how one of the fruits of this season is learning to wait on God:

-    We gain a deeper ability to wait on God.

-    We lose a driving, fearful self-will which must produce results, must making something happen, for God (just in case he doesn’t).

-    And we learn than a failure to wait on the Lord is the root cause of most (if not all) of our greatest sins and errors of judgment.  (“birthing Ishmaels”).

This project is teaching me that sometimes we just need to wait, and learn to wait well.  We don’t stop planning, working, or exercising due diligence in working through various options, but we learn to release the outcomes and not hold onto them quite so tightly.  We plan with multiple outcomes in mind.  And we wait patiently.

If only writing made it so.

Has some life event or circumstance happened to you which required you to change your plans?  How did you handle the change?

When you make up your mind, or make a plan, and then something happens requiring a tweaking, or a wholesale change, are you able to handle this graciously or do  you lose your bearings for a while and find it hard to regroup and continue on?

Are you good at waiting?

-A

Family (31/1/12)

We’ve had a great visit with my Dad visiting us from Grand Rapids, MI the last two weeks…it was wonderful to have him be a part of normal goings-on here to get a sense of our life.  This is the third country he’s visited us in and I’m beginning to suspect he secretly prays for us to move to another country every five years or so, so that he can indulge his travel bug!

After picking Dad up from the Mennonite Guest House two week ago, the first order of business was unpacking some belated Christmas presents brought over from the USA…for me, there was Starbuck’s Christmas Blend, and that’s pretty much all it took to make my month.  I do love that coffee blend, which I consider to be a foretaste of the coming restoration of all things.

It’s pretty clear that Liam thinks Papa Bill is the greatest thing since Thomas the Tank Engine.  Photo courtesy of our budding 4 year old photog, Riley.

Papa Bill and Liam. Brothers?

I don’t know what it is about little girls and fairies, but Riley was stunned into silence for at least a minute after opening this gift!  Thank you aunty Hanna!

Riley and a belated Christmas gift

A toy motorcycle!!!

Liam and a belated Christmas gift

We took our first family camping trip while Dad was here…in hindsight, perhaps we should have told him before he came that it wasn’t just our first camping trip in Africa, it was also the kids’ first camping trip.  Not to worry.

We packed up the car with our camping gear, and headed to Hells Gate National Park, one of our favorite places to hike and do a bit of animal spotting.  After setting up the tents and unpacking the cooking gear, the kids discovered the delightfully large quantities of dust around the campsite and proceeded to stomp and play in them, making ‘steam’ as the dust rose up from their footprints.  They slept soundly all night both nights we camped, and we were grateful.

We saw lots of zebras, giraffes, buffalo, and gazelles.  No predators, but Dad did wake up to find fresh leopard footprints not far from the campsite on one of his morning walks.

Hell’s Gate, we were informed by our Masai guide, is named for the Masai families who died long ago in the last volcanic eruption from Mt Longonot.  Nothing sinister, thankfully, although one does wonder if a rebranding might not be in order.

Daddy, is this kryptonite?

There is lots of obsidian lying around the place due to volcanic action and it makes for really cool treasure hunts.

This was as far as Riley and Liam wanted to go!

We took a walk about a mile up the canyon with the kids, and they loved it…you really can’t beat throwing rocks and stomping in pools of water, and when you put the two together you get the magically awesome duo of throwing-rocks-in-water which makes time slow down if you are under 5.  I’m pretty sure it’s a physical law of the universe.

One of several hot springs in the canyon

Once the kids tired, Dad and I pressed on down the canyon another few miles while Mardi and the kids returned to the camp site.  It is simply stunning, with small hot springs bursting out the side of the canyon walls every so often, volcanic steam leaking out of the ground in random spots, and the whisper of whistling acacia and yellow acacia trees in the wind.  There aren’t words.

walking in Hell's Gate canyon

Well, actually, there were words.  On our return, right around this spot above, we heard what sounded like someone yelling midway up the cliff side on our left.  Turns out it was the sound of a preacher from a church a few miles away, echoing off the side of the cliff.  Apparently it’s not uncommon for country churches here to prop up a few spare speakers against the outside of the church so as to ‘maximise’ the reach of the preacher’s voice.

But seriously?  A few miles away?  Now THAT’S a sermon.

Once a pastor, always a pastor…while he was here, Dad spent about 3 days total ministering and teaching…two with friend Kelly Johnson a few hours SW of Nairobi, and a day here in Kijabe teaching and speaking with students at Moffat.  Look at him…doesn’t he look like he belongs here?  They loved him at Moffat, and not surprisingly.  When a 40 year veteran of ministry tells ministers-to-be that one of the greatest indicators of their future success in ministry will be their ability to release offense and unconditionally forgive those who wrong them, whether or not they ask for it, he gets their attention.  We had a great time of teaching and one-on-one ministry with these students, some of whom who were holding onto some heavy offenses.

Dad teaching at Moffat

Dad and I also took the opportunity to climb Mt Longonot while he was here.  I do love climbing this volcano.  We discovered a trail down the back of the mountain which leads all the way to Hell’s Gate; about a 20 mile hike.  That’s for next visit.

The intrepid explorers about to start the long climb up Longonot

En route to the summit, a view over the Rift Valley

When we first came here almost a year ago, I wouldn’t have guessed how important visits from family and friends are to my sense of belonging, and ‘centredness’, spiritually and physically.  There’s something about people you love observing you in situ  and being a part of your day-to-day life which connects you in a deeper way to what you’re doing, and why you’re doing it.  I now understand why a pastor we were ministering with in India 7 years ago, when asked by an Western friend “Do you think it’s a waste of money for short term missionaries to come for visits?  Shouldn’t we just send the money instead?”, replied, “You need to come.  Always you need to come.  It is good for you, it is good for us, and we encourage each other.”

Amen.

-A

Offense (25/1/12)

This week I’ve had the privilege of ministering together with my Dad for the first time.  He’s here for a two week visit from Grand Rapids, and I asked if he might teach at Moffat while he’s here.  After 40 years in ministry, from Oklahoma to Michigan, there are some areas he’s particularly passionate about in leadership and vocational ministry.  So I asked him to lead a few sessions on one of these:  the importance of forgiveness and releasing offence when people you are serving or leading offend you.

I find that forgiveness and not holding a grudge is one of those non-glamorous lessons in leadership.  Whether in the military, business, the academy, or in a church/mission setting, it doesn’t seem to headline any conferences, seminars, or bestselling NY Times books.

But after experience working in all four of those contexts, it is my observation that there are very few issues which directly affect our success in life more than this one:  learning to be a person who forgives quickly and does not stay offended long.

In each of these contexts, I’ve seen examples–CEO’s, pastors, a junior enlisted nuclear missile technician–people whose lives were negatively affected, almost controlled, by offense they had taken from something someone had done to or said about them.  Because they held onto it and did not release it, it continued to measurably impact their lives.  Being suspicious of the motives of others.  Quick to get angry over very small offenses.  Finding it hard to connect on a meaningful level with others because of filters in place which interpret normal responses as offences.  Physical, mental/emotional, and spiritual problems originating from anger and bitterness.

I have a lot of compassion for people who struggle with this, because I used to be one of them.

Sometimes we simply do not understand that in this life, on this side of Jesus’ return and the restoration of all things, people are going to say and do things which offend us regularly, usually without their intending to or being aware of it.

We know from reading the account of a follower of Jesus from two thousand years ago that Jesus understood this well, and tried to prepare his followers to respond to these offences with a forgiveness and grace which almost seemed unreasonable to them: “…it is impossible that no offences should come…” (Luke 17:1).

This topic becomes particularly important in the context of church and mission work, where we become very close to people and pour ourselves into them.  Like our family members, those close to us have the capacity to hurt us the most.

Dad taught three sessions on this topic, and it was deeply moving to watch these future pastors and chaplains respond to it.  I was unprepared for their stories, and for the decisions a few of them chose to make later in the week.

The honesty in the room during the sessions was just amazing, and some students were courageous enough to share stories of offences they had suffered which were just horrific.  I’ve been around the block a few times and seen some pretty horrific things, but some were bad enough to bring tears to my eyes and make me cringe that such a thing could happen to anyone.

The students asked for an extra session for Q&A and prayer, and so we held it the afternoon of the last day.  Their questions were deep and sometimes really painful.  We then broke them into groups to minister to and pray for each other, and it was a holy time as some of them confessed long held offences and forgave the offence and the person causing it.

One student texted me at 10p that night to tell me that he had dropped everything, and was on a matatu (minibus) headed home.  In his words, he had been angry at his father for years for something his father had done.  He decided during prayer that day that he needed to go to his father and seek his forgiveness for harbouring a grudge and judgement in his heart against him.

When he came back a few days later, I could actually see a physical change in his demeanour.  His face looked calmer, more peaceful.  He had gone to his father (who thought he had come home to ask for money for school fees) and asked for his forgiveness.  He told me, “I have never seen my father cry before.  He had tears streaming down his face, and we are now reconciled.”  The power of forgiveness and keeping short accounts in action.  I received his permission to share this story with you.

This is one story among many, and I have been reminded this week again of how powerful it is when we make a decision to not remain offended, but to forgive those who wrong us, whether or not they seek our forgiveness or even acknowledge their wrong. It can affect the whole of our lives.

I don’t spend much of my time at Moffat; most of my work is at Kijabe Hospital, but I am finding that the time I do spend with these future leaders of the church is an enormous blessing to me.

And it was just so cool to work alongside my Dad.

- A.

Koinonia (24/1/12)

Yesterday morning we received this email from our medical director:

“I received word this am that the night team rallied to help a mother in Maternity who was bleeding and needed 10 units of blood acutely overnight.  Nurses, nursing students, housekeeping and a security guard all donated blood between 1 – 4 am to get this mother through a crisis, supported at 4 am by donors from RVA.  Word is that the lab night shift was impressive, and that coverage kept things moving very smoothly.

We need to keep praying for this mother of 4 who is not out of the water yet.  But I am moved to hear of the team’s “extra mile” efforts to be the love of Christ for this family.

It is an honor to work with you all, now as much as ever.”

I love working in a place like this – where the lab has a list of the blood types of the staff and local residents, so that when the operating theatre is running on empty an SOS can be sent out.  Where the nurses and chaplains and doctors and lab techs live and work side by side, our lives (sometimes too) intertwined and interdependent, so that in the middle of the night when the new obstetrician is faced with a critical case, the not-on-call-family-practitioner who also does obstetrics goes in for most of the night to help.  Where, when it is obvious the mother will bleed to death without definitive action, another surgeon gets out of bed to do a hysterectomy.

It is a blessing and curse, living in a place where the boundaries are so blurred.  It is quite strange, your neighbours being your colleagues, your social life and your work life being often one and the same.  Your friends all have your phone number, which also means that you are by default on call 24 hours a day for your community – and they are on call for you.  It is truly astounding that, amongst these colleagues, there is no-one who rubs me the wrong  way, whose company I chafe against.   On the contrary, I have grown to enjoy and love these people, for them to have become friends and people I truly respect and admire.

I have never thought that the be-all and end-all of life was to go and live in a commune, away from the nasty evil world.  But I am appreciating living here – that amidst the loneliness of missing family and friends, with the lack of conveniences and comforts of things familiar, that we have a community that is so…  not crazy.  Supportive, normal, selfless, amusing, real.

There is a Greek word – koinonia.  It has a multitude of meanings that no single English word adequately expresses, but could be translated as “community”.  A derivative of koinos, the word for common, it signifies generous sharing through demonstrable action.  Partnership or common effort.  Shared experiences, joy and pain.  Common unity of goal and purpose.  A higher purpose or mission that benefits the greater good of the members as a whole.

I am grateful, here right now, for koinonia.

- M.

“stop doing” lists (7/1/12)

Mardi’s on call at the Hospital this weekend, and so after seeing her off this morning the kids and I went on a walk to have a bit of adventure.  Slaying dragons with paper towel cardboard rolls, collecting berries and flowers, stopping at Rich and Stacy Davis’ for coffee along the way, the usual sort of thing.

One of the trails we like to walk on goes down the mountain before meeting an old road, which we then follow along the escarpment until meeting the road down into the valley, which we follow up the mountain and back home.  Before we left I asked the kids to grab a small bag along with their ‘swords’ so they could collect treasures they find along the way…here’s what Liam showed up at the front door wearing:

Essential equipment: a backpack full of Thomas engines

Yes, that backpack is completely filled with all of his Thomas the Tank Engine trucks and engines.

I observed that an already-full backpack won’t leave much room for the super-awesome things he finds and wants to pick up along the way.  There were vigorous protests with buckets of tears.  You can still see the remnants of his accusing and suspicious “Is Daddy going to try to take my Thomases away?” look in this photo.

So walk for two hours with a backpack full of Thomas he did.  And we had a great walk, full of lots of adventure and dragon slaying.

Liam’s desire to start a treasure-hunting walk with an already full backpack reminded me a bit of what Mardi and I are doing at the moment:  an informal semi-annual habit of assessing what we spend our time on and asking, “Is there value in this?  How does what we are actually spending our time on align with our priorities?”

What we usually find is that we need to spend less time on some things, and stop others entirely.  There’s usually always something that we’ve picked up along the way in the course of several months which does not align with our priorities; perhaps we found it hard to say ‘no’ when asked to do something, and so we just picked it up and tried to make it fit along with everything else.

This last assessment has been no exception:  for me, a realisation that I need to cut one language lesson a week, drop a Bible study, do one less mentoring group, and answer the door less when I am working in the office at home.  Since I’ve made this decision I’ve felt lighter and freer than in a while…a freedom to focus on the things I feel called to do, spend time with the kids without trying to answer emails or phone calls at the same time, and be more “present” to my family and friends when I am with them, without being somewhere else mentally or emotionally.

Jim Collins calls this process making a “stop doing list” in his excellent leadership book Good to Great.  In his words, many good leaders have clearly articulated to do lists, but not many invest the same effort in intentionally cutting out those activities which distract them.

I’ve found this true in my own life…it’s not enough to focus on the things I want to be doing; the reality is that I ‘pick up’ other activities and tasks in the normal course of life, and it is these things which take time and energy away from my primary passions and priorities.  If I am not ruthless at cutting them out, I end up distracted, defocussed, and feeling a vague dissatisfaction that I don’t seem to have the kind of focus and clarity I would like.

Taking it a level deeper, a good question to ask might be, “Am I doing something I’m not called to?”  Am I doing something that the Lord has not asked me to do?  Wherever we are, there is always an endless parade of ‘good’ things to do around us.  Might I in fact be exhausted, burned out, or lost my focus because I have taken on things I’m not called to?  Am I bearing burdens that aren’t mine to bear?

As Mardi and I continue this discipline of “stop doing” in our new context of rural Africa, I continue to learn that at least part of the answer to greater focus and productivity is not found in “doing more” or working harder.  It’s found in doing less of the things that don’t matter.

But I think Liam should be able to bring as much Thomas as he can carry when slaying dragons…as long as he doesn’t ask me to carry it for him.

- A.

R is for Reptile (4/1/12)

School starts back up this week after a Christmas break.  This term, the 4 year old preschool class has 10 kids – Ella, Lydia, Lisa, Chloe and Riley, with Ethan, Marcus, Ian, Asher and Brennan.

Ethan’s mum Angela and I are teaching this month, and our curriculum is “animals”.  We looked at the lesson plan, which of 8 lessons devoted one to lions, one to monkeys, one to pets, one to Noah’s Ark… it seemed a little abstract to us.  We decided that our preschoolers are all pretty switched on and would benefit from learning the animal classes instead, and plus we were going to be bored spending 2 hours on giraffes.

Today Angela taught “C” for creation, creatures and classes – an overview of how all of creation fits together.  By the end of the class, all of the kids could tell us one sentence about mammals, reptiles, birds, fish, amphibians and “animals without a backbone” because invertebrates just seemed a little tricky.  To bring for snack time, Riley, Liam and I made gingerbread cookies with an animal shape from each class except amphibians.  What I would have given for a frog cookie cutter!

A giraffe that looks like a dinosaur, a "fish" (shhh it's a dophin), crocodile, chicken and butterfly. Close enough!

So after this we’re going to cover:

• Mammals (domestic and farm) including Mice and the letter “M”;
• Wild mammals including Wildebeest and the letter “W”;
• Reptiles and amphibians including Rattlesnakes and the letter “R”;
• Birds including Bluebirds and the letter “B”;
• Kangaroos, Koalas and other unique/unusual animals like monotremes and marsupials with the letter “K”- no prizes for guessing who is teaching that lesson  I’m mostly hoping one of the kids asks which category unicorns fit into…
• Dinosaurs and other extinct/endangered species and the letter “D”, talking about stewardship of our planet.

We’ll finish it off with a safari walk at a conservation park in Nairobi.  There will be a whole month later this year on insects (now THAT will be a cool month) and a whole month on sea creatures.  I hope they cover Nessie.

I’m not sure who’s going to have more fun this month at preschool – me or Riley.

- M.

Would you like to support a future pastor in his education? (3/1/12)

A number of you have asked us to let us know when you might be able to help with a specific need, or to help a specific person.

This might be one of those times for you.  We are starting Term 2 of the academic year at Moffat this week, and one of my first-year students has been sent home due to not having the required school fees.

Economic times are extremely difficult here in Kenya, with an unemployment rate around 40% (see here), and the cost of food and petrol sky high.  To put it into perspective, the inflation rate here was reported in October 2011 as around 20%.  The inflation rate in the USA is around -0.4%.  When you’re earning an average of around $2 USD per day, that’s a lot less maize, fruit, and vegetables you are able to buy when the cost of living goes up.

It’s also a lot less school fees you can afford when the option is food or fees, and I was told yesterday that roughly 20% of our students are in danger of not being able to continue their education due to lack of school fees.

This student has a calling on his life to be a pastor.  He would like to stay at Moffat for the next 3-4 years, completing his Diploma so that he can be ordained as a pastor.

He was my top student, tied for the highest overall score out of 19 students in the Spiritual Formation class I taught this last term.  I was proud of his efforts.

He is short about 54,000 Kenya Shillings, or around 650USD for this Term’s tuition.  He has 5 days to come up with the $ or he will have to put his education on hold.

If you are interested in supporting this student, please drop me an email, and I’ll provide you with further information.

-A

Was it worth it? (31/12/11)

Baby Michael, transferred to a private hospital for life-saving heart surgery, died on Christmas Day.

We don’t really know the details yet – the way we found out was Jennifer, on duty on Christmas morning, receiving multiple calls from their finance department asking us to cover the rest of the bill, double what they had told us for a 36 hour admission, before they would release the body of the baby for burial.  It was sad to hear that his surgery had failed in the most final of ways, but the means of notifying us seemed callous and cruel, especially on a day of celebration and joy.  Jennifer was incensed, the family was devastated, and when Jennifer graciously waited until the next day to tell me so as not to ruin Christmas for me, I was furious.  It has taken a week of phone calls and emails and negotiating for their accounts department to be satisfied enough to release his remains to the family.  What had been a journey of hope for us – partners from around the world raising the money to give him a chance – turned into a sudden dead end leaving a bitter taste in my mouth.  We still haven’t heard what went wrong.

Was it worth it?

2 year old Mercy, had a brain tumor that was skilfully and successfully removed by our neurosurgeons.  Wonderfully, it turned out to be benign with an excellent prognosis.  But she died on Thursday in ICU.  After her surgery, vomiting had caused a lung infection which had turned into the most serious of complications, ARDS (acute respiratory distress syndrome).  Her lungs failed, our ventilator reached its limits, and she lost her battle for life because of post-surgical, rather than surgical, problems.

Was it worth it?

________________________________________

I really struggle with these questions.

Part of me wants to gliss over their deaths – to say simply and easily, as many of our patients’ families and chaplains do, that this was God’s will.   Some may say that God will bring good out of this destruction – I know that He can and I pray that he does, that through the love the family has received from us here, that their grief will be lessened, that their picture of God will be broader.   Some may say that God takes to himself those he chooses, that he chose to take these children to heaven, that it was their time.

But I don’t believe in a God like that – who chooses to take children away, to leave the parents grieving and broken-hearted.

I believe that God, like me, grieves pain and illness and destruction and loss.

I believe that God, in giving us the right to choose, has given us a world that through free will and sin has turned out to be messed up and broken and isn’t always a nice place to be.

I believe that there is good, and there is also evil – and that sickness and poverty and violence cause innocents to suffer.

I believe that bad things happen to good people, and that good things happen to bad people.

I believe that there is a realm that we can’t see, that there are angels and demons, and that every day is a battle through which we are walking.

We see these battles on a small scale every day – in harsh words spoken in a moment of loss of control.  In children ravaged by the burden of AIDS thrust upon them.  In poverty and inequality and small injustices.  In children neglected and abused through generational cycles of despair.

We see these battles on a large scale throughout the course of human history.  Unspeakable death and destruction – in the name of purity of the human race with the Holocaust, in the name of Allah with suicide bombers, in the name of Christ during the Crusades.

To think that God allows or plans these things is just unthinkable to me – my God is complex, but he is good, and his purpose is life.   But his purpose is worked out through the imperfections of a fallen human race whose choices have consequences each day, and will not be ultimately fulfilled until Jesus returns and the earth is fully restored.

We lost a couple of battles this week.  I grieve the loss, but it doesn’t mean we stop fighting.  We fight with drugs, we fight with food for the hungry.  We fight with scalpels, we fight with friendship.  We fight with prayer, we fight with tiredness at 3am.  We fight with excellence, we fight with committment.  We fight with love, we fight with tears.

So even though we lost these two battles, we win others – and it is worth it.

- M.

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Previous post:  Masai Mara (30/12/11)

Masai Mara (30/12/11)

We’ve had Mardi’s parents here for a visit the last few weeks, and their Christmas present to themselves and us was a 5 day camping safari in the Masai Mara.

I’ve always dreamed of staying in a tented camp on safari.  Camping safaris conjure up images for me of Ernest Hemingway hunting in tall grass, mist rising in the morning, lions hunting outside your tent, wildebeest unsuccessfully dodging crocodiles in the Mara river..but before we could embark on realising this dream, we had to go through… *shudder* …’The Road’.

‘The Road’ was a 5 hour stretch of driving from Kijabe to our camp at the northwest corner of the Park.  The last 3ish hours is along a deeply rutted, rocky track which had been ruined by the recent rains–the guys at the camp later told us that the Masai elders in the area reckoned that the rains were the heaviest in 16 years.  Due to a planning oversight, we hadn’t specified ’4WD’ on our safari booking, and so we had a 2WD matatu (a Toyota minibus) as our mode of transport there and back.  Thankfully, for 2 out of 3 of our game drives we had a 4WD safari jeep.

The Masai Mara. Our camp was in the NW corner.

At times we were forced to crawl over the rocks in The Road at 5 km/hr, at others our able guide, John, threw in the towel and raced over the road at 60 km/hr, resulting in jarring and vibrations that made our teeth chatter and vertebra separate.  When we arrived at the camp, we rolled out of the minibus exhausted and it was some minutes before I could hear clearly until the dull roar from the road noise faded in my ears.  Aside:  I am delighted to note that we nearly destroyed the minibus on the trip to and from the camp…the brakes failed, exhaust system holed, and axles felt floppy and loose when we arrived back 5 days later…now THAT’S getting good value out of a vehicle!

Riley and Liam wildebeest-spotting at the Mara River

But then…the Mara.

Sunrise from our tent door

The solitude of the Mara is so compelling.  It is achingly beautiful; literally, so beautiful and peaceful that something inside me just…ached.  Deep calling to deep, perhaps.

Our safari jeep on the open grass savannah of the Mara

We left on our first game drive at 0630 the day after The Road, planning to have a picnic breakfast and tea in a suitable place.  At 0730 we came across a playful cheetah, basking and rolling in the glorious morning sun near a small herd of gazelles, who were not nearly as relaxed as Mr Cheetah.  They were standing ramrod straight at attention with all eyes on him, as if they were afraid that if they ran, he would somehow run them all down and make a gazelle buffet out of the entire herd.  We had our picnic breakfast about 100 metres from this delightful scene.  We learned later that about 30 minutes after we finished our breakfast and left he made a kill.

An all-you-can-eat gazelle buffet

We were fortunate to see so many animals…elephants, lions, cheetah, buffalo, wildebeest, hyena, crown cranes, aurora birds, ostrich, warthogs, Thompson’s gazelle, and about 10 different variants from the deer/gazelle/reindeer family.

I have a confession:  I am not an animal person.  They just don’t do it for me.  I don’t dislike them, they just hold little interest for me.  For me, it is the landscape, the trees, the cavernous sky that takes my breath away.  Achingly beautiful.  Most of the time I was fighting the urge to jump out of the jeep and just start walking in the grass.  Thankfully this urge was tempered by the constant presence of predators.

Solitude

Riley and Liam were troopers…you’re really rolling the dice with young kids on safaris, we had heard, and so we were pleasantly surprised that they bounded out of bed every morning at 0600 wanting to go on a morning safari…they were just so excited.  On our second morning, we heard soft footfalls outside our tent, and opened the tent door to have a peek…out of the mist, about 3 metres away stood a giraffe towering over us.  We quietly woke up the kids, and carried them bleary-eyed to the tent door where all four of us watched in wonder.  After about 30 seconds, the giraffe noticed us staring at him, jumped a little, and galloped away.  It was a magic moment.

life in the open cockpit

We saw some beautiful lions, including this majestic creature who was conveniently posing for us in front of a rainbow.  I mean, come on, that’s just ridiculous.

Why yes, that is a lion sitting in front of a rainbow

My favorite birds were the crowned cranes.  They mate for life, we were told by our guide, and if one of the pair dies, the other dies soon after.

a crown crane and elephant

The kids had a blast; how often do you learn about an animal from a Maisy book or Richard Scarry story, and then get to watch in wonder as it trundles past your open window?  Life is a pretty sweet fruit for a kid on safari.

*stunned silence*

After 5 days of rest, game drives and good food we were ready to return to Kijabe.  The smiles on our faces for this farewell shot mask the grimace of terror that is the anticipation of a return journey on ‘The Road’.

Family photo overlooking the Mara

- A.

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Next post:  Was it worth it?  (31/12/11)
Previous post: African Christmas 1.0 (28/12/11)

African Christmas 1.0 (28/12/11)

Christmas for the Steere family is usually some hybrid of either an extended Steere or Johns family tradition, as we usually split our holidays between the U.S. with Andy’s family or Adelaide, South Australia with Mardi’s.

But this year was different…here in Kijabe, thousands of miles from our ‘home bases’ we had the opportunity to ask ourselves, ‘what do we value?’ and put into place some traditions we want to carry forward that our children will remember.  This brought a ray of joy in the midst of our missing Christmas celebrations and tradition with extended family.  The silent stillness of a night snowfall, Christmas celebrations at the beach and a swim after lunch, catching up with family you haven’t seen for a year.

This year we observed the 4 weeks of Advent (via an Advent calendar with the kids and daily readings from The Divine Hours) leading up to Christmas, attended Christmas eve carols and prayers, gave gifts to children in the hospital (see below), and had a Christmas celebration that tried to be about giving gifts, rather than only receiving them. With a 3 and a 4 year old, this was simultaneously hilarious and impossible!

It also included observing a traditional Norwegian White Christmas meal with good friends the Myhres on the 23rd, which was a highlight of the season for us.

Mardi’s parents arrived from Australia for a two week Christmas visit via Egypt and Jordan, and we’ve had a lovely time catching up with them and having some good grandchild-Mama-Poppa time.

We love it when Mama reads to us!

We’ve had a lot of fun showing them around some of our favorite places.

Reading to Riley and Liam at the RVA elementary school ("Titchie") library

The daily rains we’ve had for several weeks dried up just as they got here, and Kijabe has put on a good show for them:   verdant greenery, unobstructed views of the Rift Valley, and wonderful temperatures.  Christmas day was a balmy 24C, while it was below zero in Grand Rapids and a decade high of 36C in Adelaide!

Spiderman and the Christmas Fairy on their Christmas bikes

Chris and Tom brought over some small toys to give to the children in the Hospital on Christmas Day, and so we went over to the pediatric ward Christmas morning and handed out little koalas and kangaroos to the kids and their parents.  It was a beautiful and holy time to give a kind word and gift to those kids and families on Christmas.

I bet that's the first time they received a Christmas gift from Spiderman

Merry Christmas!

Beautiful

Then it was time for Christmas lunch!  We had Erik and Amanda Hansen and their brood of 4 over for Christmas dinner and there was much laughter and celebration.  Erik is a paediatric surgeon who works with Mardi.

A Texan encounters his first Australian Christmas pudding and custard

This season of Advent and Christmas was a meaningful one for us here in Kijabe; a time of new family traditions in a new place, sadness to be far from family and friends, and joy to be with new friends and with Chris and Tom.

It was a time to acknowledge the ‘already’ of the presence of Jesus around us in his Kingdom while we look forward to the ‘not yet’ of his coming again.  As we celebrate the ‘advent’ of his birth 2000 years ago, we look forward to his coming again and bringing healing and restoration to the brokenness and injustice around us.

If you celebrate Christmas, Merry Christmas!  If that’s not your tradition, Happy Holidays and may your new year be filled with peace and joy.

- A.

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Next post:  Masai Mara (30/12/11)
Previous post:  Relationship (2/12/11)

Relationship (26/12/11)

I learned something from an African last week.

Part of my work here is to facilitate relationships with stakeholders, donors, and statutory authorities for the projects underway at the Hospital.

I had a meeting last week with the head of an organisation which funds HIV/AIDS-related programs in Kenya.  As a part of their work they fund WASH (water, sanitation, and hygiene) projects to allow those suffering from HIV/AIDS to take their antiretroviral medicine without getting sick from the water.  On paper, their goals directly aligned with the objectives of our projects, and this was very promising!  I spent a lot of time planning my approach beforehand on paper, with agenda items and key outcomes highlighted.

At 2:00p, I was greeted warmly, invited in, and offered something to drink.  The Chief Executive enquired about my family, their health, how I liked Kenya…we had a warm and friendly conversation for 25 minutes about our respective families and each other.  We then shifted gears, and he explained a bit about the corporate goals of his organisation.  It became clear that in his view, there was not alignment between their goals and our project needs.  I pushed on this a little bit, as on paper it appeared that there was.

Without telling me “no” (because he is Kenyan, and this would be culturally akin to slapping me in the face with a goat), he explained their goals in greater detail and suggested a few other avenues the Hospital might explore to look for funding.  It was clear there is not a fit between our two organisation’s needs, and I thanked him for his time.  At 2:30, we said our goodbyes.

Total meeting length:  30 minutes.

From a Kenyan perspective:  Time spent on important matters = 30 minutes.

From a Western perspective (including this outcomes-oriented project manager):  Time spent on pleasantries = 25 minutes, Time spent on important matters = 5 minutes.

Over the last few days, I have kept returning in my thoughts to the difference between our cultural approaches to this meeting.  The CEO took the relational approach deeply embedded in African culture:   politeness, honor, relationship, conversation, family.  I took the outcomes-oriented approach, and saw the first 25 minutes of the meeting as somethign to be ‘gotten through’ until we approached the ‘real work’.  As I adjust to life in Africa, these differences can be maddening at times…from the perspective of the Western business mind, on the surface it seems so much ‘productive’ time is wasted, discussing personal matters in meetings that could be ‘parked’ until after the important agenda items are dealt with in a meeting.

My recent experiences have left me wondering if the African relational approach may actually be an echo, a reflection, of how we were originally created to live and relate to each other.  Something that we in the West may have forgotten in favour of the (good) habits of productivity and hard work.  It’s not that ‘relationship’ is to be valued to the exclusion of productivity; on the contrary, both are good and I think a reflection of how we are intended to live and prosper.

They are both good.  But I notice in myself a tendency, a habit, to sacrifice relationship for outcomes and productivity when necessary.  To subject one to the other, relegating relationship to a tier below that of the ‘real work’.

Edward, our kiswahili teacher

I suspect that a specific example of this prioritisation of outcomes over relationship can be found in how we approach God in prayer.

Over the last 24 months, as we have walked through some pain and struggle in our family, and have moved to our third country in seven years, I have noticed in myself a growing lack of desire to pray.  I have prayed regularly for certain people and outcomes for years, and seen no discernible answer.  This has had the net effect of decreasing the amount of time I spend in prayer ‘asking God to do things’.

As usual, it is in what we actually do that what we believe can be found (as opposed to giving verbal assent to a list of doctrines), and as such it is clear from my prayer habits that I have developed two ‘beliefs’ in recent years:

Belief #1.  God largely stands outside his creation, and allows us to care for ourselves.  He has created us with ‘free will’, and hence we largely ‘reap what we sow’.  There certainly is a supernatural dimension to life, and God does interact with us on a additional plane from merely the natural, but by and large he does not intervene in the world.  Hence, praying for him to ‘do things’ is more often than not a waste of time.

Belief #2.  Much of prayer, at its core, is trying to get God to do something.  It is outcome-focussed.  When God doesn’t answer my prayers, I either pray more fervently (depending on how strong I feel about the outcome), or I stop praying for it.  See Belief #1.

Mind you, if you meet me on the street and ask me if I agree with these two beliefs, I will say of course not!  How could I, when I have multiple examples around me of the opposite; of a God who regularly interacts with his creation, and with whom I regularly spend time in prayer about what we are doing together.

But my actions would contrast sharply with my words.

These beliefs, especially the second one, are being challenged by the lessons I am learning in Africa.  There’s something totally absent from both of them:  relationship.

The theologian and scholar J.R. Lucas points out that in the natural world, we can usually cause the outcomes we desire to come about by following the logic of the natural world.  For example, if I want my lawn to be lush and green, I fertilise, aerate, mow, and water it.  If I wish to take good photographs, I might buy a good camera, learn how lighting affects a photo, and study how to compose a good landscape or portrait.  But Lucas points out that this ‘logic of thingly causality’ bleeds over into our relationship with God to our detriment.

“…God we may not take for granted: he is a person, not a thing…Paul’s antithesis between justification by faith and justification by works could be rendered in modern terms as the insight that salvation depended on one’s attitude and was not a matter of technique, It follows from God’s being a person….Because God is a person, we cannot hope that he can be secured by anything less than a whole-hearted approach [emphasis added].  A grudging observance of the law of nature is enough to secure domination over nature, but a grudging reception of the sacraments or a prudential obedience of some moral law will not win the love of God any more than it will the love of a human being.”

God is a person, not a thing.  Like my wife or my children, he can’t be ‘secured’ by anything less than a whole-hearted approach.

The African relational approach is teaching me that I can’t cause God to act by my own ‘logic of thingly causality’–He is a person, and wants a relationship.  He wants a whole-hearted approach, where we are talking together about the things that are important to both of us.  Hence prayer itself is a natural extension of a relationship; outcomes naturally follow from the time we spend with your friend.

This insight helps me see how bereft of relationship my two beliefs above have become…and I am deeply convicted that an outcomes-focussed approach with God widely misses the mark of what He desires, and causes us to only skim the surface of the depth of relationship that He desires to have.

And it makes me want to pray more and pray deeply.

- A.

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Next post:  African Christmas 1.0 (28/12/11)
Previous post:  A gift of hope (24/12/11)

A gift of hope (24/12/11)

A week ago I blogged about Michael, a 4 week old who needed heart surgery.  The next day, not having read our blog, a friend of ours sent us an email – his family wanted to donate $2000 to our Needy Children’s Fund.

I was astounded.  This is the first time I have really wanted to raise a large amount of money to help a single child – usually the need around us is so great that we ration out the fund in small chunks to do small things to help as many kids as possible.  But this one procedure had the potential to change a baby’s life.  So our chaplain Mercy and our team were praying that this would be a possibility for this family.

And now it is.

Mercy told his family, who were blessed beyond belief.  Through the generosity of their family and community, they were able to raise the other $500 needed for the operation, and the wheels were set into motion for his heart to be fixed.

Yesterday, we sent Michael to Mater Hospital.  And today, his procedure was done.  We don’t know the details of how it all went, but we know that it was done, that he is alive.  And this Christmas, a family has received a precious gift – a gift of hope, that their son may have a chance, through the kindness of strangers.

What a precious blessing – that on this eve of Christmas, as we celebrate the gift of love and hope that we received 2000 years ago, we have been able to be a part of our own small story of hope, through the generosity of people across the other side of the world.

And that’s what Christmas is about, isn’t it.   Participating in hope – the hope of new life, of restored creation, of God’s kingdom coming to earth – initially in the guise of a baby, now in the form of love and restoration through all of us, His partners here on earth.

What a privilege to be a part of this rich tapestry, of which so many of you are a part.
A joyous, hopeful Christmas to you all.

- M.

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Next post:  Relationship (26/12/11)
Previous post:  A tale of two hearts (16/12/11)

A Tale of Two Hearts (16/12/11)

We see a lot of babies here born with heart problems.  Usually they come to us at a few days, weeks or months of age with a puzzling lack of growth and trouble breathing.  An xray shows a heart like a balloon, and an echocardiogram shows a heart that looks like someone twisted it like a Rubik’s cube, and now none of the connections are in the right place.  We sit down with the families and tell them that these problems cannot be fixed in Kenya – and then we send the babies home to die.

But this, week, for the first time, we found heart problems that maybe, just maybe, we can do something about.

Michael (top left) is 5 weeks old.  You may remember him from my previous post about the strike - he was the 4 week old baby arriving in heart failure, with no money to pay for his care.   This week we, through people’s generous contributions to our Needy Children’s Fund, were send him to get an echocardiogram by a cardiologist in Nairobi.

His heart showed a relatively simple problem – most connections in the right place, but a severely narrowed pulmonary artery (joining the heart to the lungs).  This has meant most of his blood just goes into his heart, and takes the easy route through a sneaky little hole straight to the aorta, bypassing the lungs, and back into the body.  This is a problem – the lungs are Oxygenville, and if the train skips that station then Mr Engineer (the heart) has to work harder and harder to get at least some of the blood through the narrow artery into the lungs.  And over time, the heart just wears out.

So our cardiologist has recommended that he get a relatively simple surgery – where a balloon is inserted via a leg vein up, up, up into the heart, and then inflated and pulled through the narrow artery to widen it (pulmonary valvuloplasty).  Voila, the blood flows into the lungs and this baby has a chance at a long life.

This relatively simple surgery costs 250,000KSh – around $2500.  An astronomical sum, out of this family’s reach.  But we are starting to investigate options to try and raise the money to pay for this surgery.  In the meantime, he will stay in the hospital.  We wanted to send the family home with oxygen for him, but you can’t have oxygen in the same room as a cooking fire – and when you live in a tiny one-room home, your options are limited.

Peninah (right), is a gorgeous 9 month old who came to us 2 weeks ago.  Her devoted parents have employment, an income, a home.  But she wasn’t gaining weight well, and when she came to us we found a dangerously low oxygen level, and heart sounds that instead of going bah-DUMP bah-DUMP bah-DUMP, went SHGGGGG  SHGGGGG  SHGGGGG.  Her echocardiogram was a little more like the Rubik’s cube – instead of 2 separate ventricles pumping the blood to either the lungs or the body, she has a single chamber in which the blood all mixes and then goes its merry way.  She also has a narrow artery like Michael’s so most of the time the blood chooses to bypass the lungs and go back to the body, with just a small portion getting the oxygen it needs.

Remarkably, a surgery is available in Kenya that could help her – a Glenn shunt.  This is essentially a graft, or short hose, that will connect her heart to the lung artery, away from the narrow portion, and allow more of the blood to get oxygen.  It is a much more complex procedure, as it is actually open-heart surgery, so we were astounded to hear that Peninah’s Dad’s employer had an insurance scheme to cover it.

Or, as it turns out, some of it.  This surgery will cost 650,000-750,000 KSh ($6500-7500), and her insurance will pay for 150,000 of it.  This still leaves 500-600,000 KSh to raise – still an astronomical amount for this family who have gainful employment, but not a lot to spare.  We are also looking into options to help this family, and the family is looking into raising money through a Harambee (community fundraising celebration).  Peninah may be able to go home on oxygen next week if she is not deteriorating, and wait to see if the funds can be raised.

And that is the joy and the tragedy of medicine here.  The procedure is available – but may be financially out of reach.  If we raise the money for this operation, it will be spent at a private hospital, lining the pockets of the administration and surgeon as we try to save these two sweet hearts.

- M.

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We are grateful for Simone Anders at Help a Child in Germany, who has started to try and raise money for us to help Michael and Peninah.  You may remember Shunetra’s story, and it was through Simone that we were able to pay her hospital bill and ease some of her mother’s grief.  If you want to help Michael or Simone,  please contact Simone or let us know.

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Next post:  A gift of hope (24/12/11)
Previous post:  Celebrating Advent (13/12/11)

Celebrating Advent (13/12/11)

On Sunday night, we were invited to an Advent Celebration at the Myhres’ house.  As an extended cobbled-together family of paediatric-associated people, we got together to sing carols, meditate on this precious time of remembering Christ’s birth and the significance of his presence in our daily lives and, of course, to eat cookies.

One of the highlights was hearing Jennifer read the story of Papa Panov’s Special Day.  Originally written in 1899 in French by Reuben Saillens, translated into English by the Russian Tolstoy and then retold for children by American Mig Holder, this lovely story has travelled around the world to be retold on a chilly December night to Australians, Americans, Africans and Canadians in Kenya.

It tells the story of an old man, sad and alone, who is hoping for Jesus to visit his village on Christmas day.  As the day fades and his hopes sink, he uses his time to help needy villagers who pass by his door on a wintery day, some cold, some hungry, some lonely.  And as the evening passes and night falls, he realises that Jesus has indeed passed through his village – through his compassion and love for those who have passed by his door.

One of the scriptures that we read was a passage that has been foundational for me in this journey from Australia to Kenya – Matthew 25:37-40.

Jennifer on piano, Scott on guitar, and flanked by Leland's marvellous baritone and the dynamic worship team duo of Lillian and Bob. Who knew doctors had artistic skills?

“Then the righteous will answer him, ‘Lord, when did we see you hungry and feed you, or thirsty and give you something to drink?  When did we see you a stranger and invite you in, or needing clothes and clothe you?  When did we see you sick or in prison and go to visit you?’  The King will reply, ‘Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.’

The evening was a lovely reminder, through story, song and scripture, that as we look forward to this anniversary of God sending his son to earth, that the restoration of a broken world began 2000 years ago and continues right now.

And then, of course were cookies and treats, coffee and friends.  A celebration for so many reasons.

- M.

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Next post: A Tale of Two Hearts (16/12/11)
Previous post: Friendly Fire (9/12/11)

Friendly Fire (9/12/11)

Today is day 5 of Kenya’s doctors’ strike.  No doctor employed by the Ministry of Health in Kenya has shown up for work for this whole week, and the strain on the system is starting to show.  The private and not-for-profit hospitals are attempting to care for a country full of sick people, most of whom struggle to pay for public care, let alone slightly more expensive not-for-profit care, and the people who are suffering are the poor and the sick.

Kijabe is one of the not-for-profits.  We charge a little more than the government facilities, but a whole lot less than the private hospitals.  In order to make this sustainable, all of the doctors who are not Kenyan work for nothing.  The Kenyans who work for the hospital are paid, but a very low salary, which they do because they have a heart for serving the poor and displaced of their own country.  And the government, seeing that we provide care for people they simply do not have the resources to treat, pay for our interns to be here.

Our interns come here because they are Christian and also have a heart for the poor, the lost, the needy.  Part of their training here is practical, but it is also a wholistic training facility.  We have some excellent interns, and they are an indispensible part of our team – especially overnight and on the weekends.   Not only do we miss them – we need them.  At the best of times.  And these are not the best of times – our workload is the highest it has ever been.

One man went to ICU after 36 hours of bouncing from one non-functional hospital to another after his road traffic accident.  Many pregnant women have come here to deliver their high-risk babies after realising that their obstetric care could not be continued at Kenyatta (the state hospital in Nairobi).  The maternity service is bursting at the seems.

Peris arrived on my night on call on Wednesday.  At 3:30am I received a phone call from our clinical officer intern, a very junior PA-equivalent with no pediatric experience, with a slightly panicked phonecall that there was a “20 week baby in casualty”.  Alive?  A baby born at only 5 months?

Peris, it turned out, was born at home 16 hours earlier, suddenly, prematurely at probably closer to 30 weeks, and her twin sister didn’t survive.  Mum took her remaining daughter, this 700 gram scrap of an almost-baby, to the closest hospital in Kikuyu, which doesn’t provide care to premature babies.  And, knowing that our nursery was full, and that the neonatologists at Kenyatta are on strike, they gave her oxygen, some IV sugar, some Vitamin K and sent her to us anyway.

We had no incubators, and nowhere to send her.  This glistening pink shiny doll, however, was opening her tiny eyes and looking at me.  And breathing, all on her own.  Her face seemed to say – I have come this far, on my own.  I am a fighter.  Give me a chance.

And so we admitted her anyway.  Under a baby warming resuscitaire, with antibiotics and oxygen and IV fluids, praying that tomorrow one of the other tiny babies would be big enough to donate her incubator to give Peris a chance.  And so far, she has made it.

Today, 4 week old Michael came in.  It was immediately apparent that he was born with a heart condition, and it is getting worse.  Mum has no money, no insurance.  We don’t have a cardiologist, no way to tell what his heart problem is, and we don’t have the right drugs to stop it worsening.  The cardiologists at Kenyatta are on strike.  So he has been admitted anyway – we will try to do what we can on Tuesday, after a public holiday weekend, if he is still alive, if there are doctors working who can help him.  Or we will access our Needy Children’s Fund and pay for him to see a private cardiologist and do what we can here.

And my last patient of the day, Richard, who came in with weight loss and swollen glands, it turns out has leukemia.  Dad almost left before doing any tests because he has almost no money.  The oncologists at Kenyatta are on strike.  So we, with no oncology facilities, will admit him over the weekend, and try, on Tuesday, to talk with a private hospital in Nairobi to see if this curable cancer can be given a chance through their Benvolent Fund.

Frustration – that these innocents are caught in the middle of the tragedy of friendly fire.

- M.

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Update 11/12/11 – Sweet Peris lost her struggle in the wee hours of this morning.  Despite finding an incubator for her the next day and some strong medications, her strength just wasn’t enough to overcome a rough start in life, and her kidneys just didn’t make it.

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Next post:  Celebrating Advent (13/12/11)
Previous post:  My ridiculously heavy white coat (4/12/11)

My ridiculously heavy white coat (4/12/11)

Every day before I go to work, I don a white coat – all doctors, clinical officers and medical students wear one as our identifying uniform.  The absolute best thing about a white coat is the number of pockets – I don’t carry a bag because in my coat pockets I have hospital protocols, an otoscope/ophthalmoscope, pulse oximeter, reflex tendon hammer, patient note cards, tape measure, keep-the-TB-out face mask, thumb drive for teaching, glasses, hand gel, emergency chai money, beeper and small umbrella (because you can guarantee it will rain at some stage most days).  I could pretty much camp out for a week and survive if I got locked out of home.  Or at least set up an ad hoc clinic.

The absolute worst thing about a white coat is the number of pockets.  My white coat weighs a ton.  And as soon as I put it on in the morning, I feel weighed down.

It’s interesting, the weight I carry at work.  The weight of feeling that I’m not knowledgeable enough, that when the new ICU doctor calls me for advice on a child, I may not know the answer or I may not be skilled enough to put in a needed central IV line.  That one of my decisions may make a child worse, that my lack of understanding of Kiswahili and Somali means I may miss subtle but important cues.  That I am spending too much money doing tests on a child, that I am not doing enough.  That I am trying to do more than I am able by not referring enough children for specialist care, that I am referring too many because I should be more able to manage these conditions.

The weight of having to decide to take a brain injured 2 year old child off the ventilator right now, knowing they will probably die,  because there is a 30 year old bleeding to death in the next ward who may actually make it if this bed in ICU becomes available for her.  The weight of wondering, was the brain injured when the baby came in, or could it have been because of something we did or something we missed?

At the end of the day, it’s a real discipline to take off my white coat.  To not wear the heaviness home, to leave my coat in the laundry where it belongs.  It’s really easy for me to keep my pockets full at night, on the weekend, to forget that I can empty those out and feel the lightness of being at home, away from work, and to be fully available to my husband, kids, friends and distant family.

Tomorrow, there is a very good chance that all of our interns will be on strike as part of a national call for better wages, as well as our Kenyan doctors who are employed by the government.  This will leave us, especially overnight, overwhelmed by calls usually fielded by our junior doctors, and possibly overwhelmed by patients who come to us because we will be one of the few hospitals that still has any doctors working at all.  And over December, we are all attempting to take some leave – which means the workload for those of us remaining escalates.

The trick, our medical director has been encouraging us, will be to not make our white coats heavier.  To realise that the pockets are full already – and that we may need to be comfortable with that.  To realise that we are not capable, nor should we be, of providing 100% of what we really want to provide with the resources we have.  To realise that we need to prioritise how much of the load we are mentally shouldering, for it to be OK to say, I may need to spend less time micro-managing this child, to be prepared for some things to slip through the cracks and for it to be OK.

And then to take our white coats off at the end of the day.

- M.

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Next post: Friendly fire (9/12/11)
Previous post:  Seasons (1/11/11)

Seasons (1/12/11)

One of my joys in Kijabe is the time I spend running a few times per week…like with mountain biking, most of the trails people use to walk from town to town are also decent running trails.

Running is a Kenyan national pastime, and Kenya regularly produces the world’s best runners.  So people ‘get’ runners here (and will cheer you on as run by them)…although the high altitude and not-very-gentlemanly elevation changes in Kijabe mean runners are scarce.  When I pass a Kenyan mama on the trail with a load of sticks on her back, or carrying large formerly-enormous-vats-of-cooking-oil-and-now-contain-water jugs, I do feel slightly ridiculous.  I can hear them thinking to themselves as they shake their heads, ‘crazy mzungu, can’t just walk to work and climb 1,000 feet for his exercise like the rest of us, he has to put on those ridiculously small shorts and funny shoes.  What a strange people.’

My favorite running trail is reasonably level and follows the curve of the escarpment from Kijabe out past a nearby town called Machane towards Monkey Corner Springs, the site of Kijabe’s principal source of water.  I used to run on the dirt road, but we’ve had a spate of successful carjackings lately in that area so I stick to the trails just uphill.  The view looks out over the Rift Valley, and it is just breathtaking.  I am recharged looking out over the vista as I run, and I have been known to break into song.  Usually something by the Red Hot Chilli Peppers or U2 punctuated by staccato, ragged breathing, as I struggle to pull in oxygen at more than a mile and a half above sea level, but still a song…

As I ran this evening, I was brought short by something I hadn’t really taken notice of lately:  a complete transformation of the Valley floor.  This part of Kenya, like much of northern Kenya has been in drought for a while, and so when we arrived in April the Valley was a dry, dusty floor of various shades of brown, surrounded on either side by brown mountains.  This is what it looked like when we arrived–I took this picture while climbing Mt Longonot with Brenton Wait when he was over for a visit:

Rift Valley in June 2011

The drought broke a few weeks ago, and it’s rained almost every day for nearly a month.  This is what I saw this evening:

Rift Valley in December 2011

I was just stunned by the difference between the two Valleys.  One a lifeless, dusty, barren place.  Then, a new season with a lot of rain, and the Valley is totally transformed into an unbroken panorama of verdant garden with kaleidoscopic shades of green.

What a difference a new season makes.

I’ve been experiencing a dry season in my own life, my own “dark night of the soul” as John of the Cross referred to it, for a few years now due to a number of life events.  But I have noticed in recent months that glimmers of green are starting to appear, and it may be that I am entering a new season.  I’m not sure, but I am hopeful.

As I ran today and noticed this astonishing change in the Rift Valley, I was filled with hope that seasons aren’t permanent, their impermanence is good and natural.  Each season has a purpose, and is useful and life-giving in its own way.  Today, I am struck by how the ebb and flow of God’s good creation mirrors my own spiritual and physical journey.

- A.

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Next post: My ridiculously heavy white coat (4/12/11)
Previous post: Thanksgiving (26/11/11)

Thanksgiving (26/11/11)

Being an Australian in Kenya with a whole bunch of Americans means that we get the best of all the holidays.  And so this week, we celebrated Thanksgiving.

Actually, this whole month has been a month of Thankgiving for me.  When I sent out an email at the start of the month tentatively asking some friends if they’d like to join us for a Thanksgiving meal, there was an overwhelming “Yes!” response, and so for the last 3 weeks I have been looking forward to this meal, this excuse to take time out with dear people and say, thank you God –  I have a lot to be grateful for.

Turns out 20 people were going to be coming over for dinner and, since we’re in Kenya, it was a normal workday for me.  So we divided up the meal – every family brought 1 or 2 dishes in quantities sufficient for an army.  From Jennifer, a way-t00-delicious-to-be-healthy pumpkin, pecan and brown sugar concoction, as well as chocolate-pecan and pumpkin-pecan pies; from Amanda and Erik a salad with a never-to-be-revealed-secret-ingredients delicious dressing as well as stuffing and a heavenly apple pie;  from Wayne and Anna a vat of laboriously hand-mashed creamy mashed potatoes (as well as their dining table and chairs!); from Ruth a cheesy-gooey-home-style green bean casserole and flaky rolls.  Andy took the day to prepare a rosemary-basil-garlic infused succulent 30-pound turkey and sweet corn, and of course to arrange the furniture to my liking (I am so grateful to have married a man who doesn’t mind following a hand-drawn to-scale map of the dining room, including instructions as to how to alternate placemats….).

My contribution, with Liam’s able assistance, was a pecan pie made a couple of days in advance.  He’s crushing pecans in the photo – you can’t see the mallet because he’s hammering at the speed of light.  It came out of the oven looking delicious.  It tasted, however, kind of like goo made of sugar and nuts because, well, that’s exactly what it is.

It is such a blessing to sit down with friends, to look around at these people, none of whom we’d met a year ago, and realise how much they have come to mean to us already.  For the sense of family that we have, when we miss our Australian and American families so much.  For colleagues who are also friends who share our heart and our passion for showing God’s love to people who desperately need so much.  For their families, whose young children are friends to our kids and whose teen children give us hope that is IS possible to to turn tantruming two year olds into great human beings.

So, today I am happy to be reminded that I have so much to be thankful for each day.  For family and friends, near and far, in all their varied forms.

- M.

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Next post: Seasons (1/12/11)
Previous post:  Miracle Babies (25/11/11)

Miracle babies (25/11/11)

There are some things as a pediatrician you learn in a textbook, but see maybe once in your career.  I vividly remember as a resident in Florida hearing of 2 twin babies coming into our pediatric ICU, severely dehydrated, with sodium levels over 170.  Normal sodium levels are 135-145 – over 170 is getting pretty dangerous.  And the 2 twin babies, severely dehydrated because the new parents just didn’t realise that mum didn’t have any milk, didn’t survive.  It was once of those seminal training moments in which I somberly realised that sometimes, children can be so sick that they have passed the point of no return.

Since arriving in Kijabe, I have seen 4 babies with sodium levels of 200 or higher, and countless babies with sodium levels over 170.  In the last month alone, we have admitted 3 babies with sodium levels between 160-213.  And as the visiting anesthetist said to me with befuddlement on the Friday night we admitted one to ICU together – “that can’t be right… those numbers aren’t compatible with life!?”

Last weekend, Simon (pictured top left) went home with mum.  The sickest of all of the newborns, he spent a week in intensive care,  gradually turning from a shrivelled, dried chip of a baby to a healthy blooming, breastfeeding boy, looking around for his mother to take him home.   When I met him in the emergency department, as soon as I saw his numbers (doctor friends:  Na 213, Cr 11.9, K 8.5), I gently told mum we would do everything we could, but I was very worried he wouldn’t make it.  We prayed with mum, and we admitted him to ICU.  Under Wayne’s vigilance in ICU, he slowly recovered.  As did Charity, another week old baby whose shrivelled little face slowly returned to cherubic – she went home the day before yesterday.

These are conditions in which the textbooks give vague directions about how to help, or instructions that end up being actually dangerous – no-one has a ton of experience with this.  Jennifer, Immaculate and I have had a trial by fire over the last 7 months in managing these babies – and some babies, like sweet Vivian last week, have not made it.  But many of them have.

Our friend Mary Adam is managing a community newborn health project which is, among many other good things, helping educate community workers on how to teach new mothers what the danger signs are, so that these babies come in before they are critically unwell.  We really hope that as people in the community are trained in basic newborn care and recognition of danger signs, that we’ll stop seeing these little ones at all.  It would be really nice to be obsolete here – for the malnutrition and calcium deficiency and dehydration to be things of the past.  But until they are, we are here and happy to do everything we can to help these little ones when they do arrive.

- M.

The food that perishes (23/11/11)

In the last few months, our work on the Kijabe Water Project has continued its steady progress, with major areas of activity including finalising the design, putting in place procurement strategies, and applying for grants.

We are in the process of applying for around $600,000 USD in outside funding.

So when at 5pm Friday last week I received an email from an official at USAID asking if Kijabe Hospital was interesting in submitting a Concept Paper for the water project for potential funding opportunities, it got my attention.

The Project Team here in Kijabe, and our grantwriting team in the USA swung into action over the weekend.  After emailing nearly every hour and exchanging draft papers over the next two days, at 10pm on Sunday we walked the finished proposal to the Hospital Executive Director for signing.

I sent it by email at around 1230am Monday morning to USAID, and at 0830 I received a call.  Would I be able to come into the US Embassy in Nairobi for a meeting at 1030.  Why, I believe I could make that time, I said.

At this point, despite my experience in infrastructure projects and in the at-times-downright-maddening-fool-me-twice-shame-on-me vagaries of government funding, my hopes are well and truly up.  My adrenaline is pumping, and I am stoked; riding on a cloud.  This is it!  The answer to prayer that we have been looking for for six months!  Out of nowhere, someone sees the desperate need of Kijabe Hospital and wants to help.

I turn up for the meeting, and things go from good to better.  The official is just lovely, and an enthusiastic supporter of Kijabe Hospital.  Why haven’t you submitted an application for funding before, she asks.  Everyone in East Africa knows the Hospital does an astonishing amount of good with vanishingly small resources.  We’d love to help, and may be able to quite quickly.  Here’s what you need to do, I’ll pass this up the chain of command and have an answer for you by tonight.

As I leave the meeting, my hopes have gone from cumulus to stratospheric.  This is it, I think.  It’s done.  We’re not even going to have to apply for more grants.  USAID will fund the Water Project, and perhaps the Hospital’s entire 5 year Capital Plan too!  Hallelujah!

For the next 24 hours, my prayer life was better than it has been for weeks.  Prayers of thanksgiving, joy, and hope as I waited to hear back.  Planning for the future, meetings at the Hospital as we giddily programme cash flows and project expenditure, and joy just bubbling up everywhere and drowning out the stress and sadness of the last few months.

And then today (Wednesday).

I hear back from the official around noon.  Actually, we’re not in a position to help you immediately, you’ll have to wait until later in 2012 and apply in a competitive process with other applicants.

I am crushed.

Despite having done this before, despite having ridden the birth-life-death cycle of infrastructure projects many times, I feel like I’ve been kicked in the gut and the wind has been taken out of my sails.  I had such high hopes, we’ve had such excited conversations at the Hospital in the last 4 days…and now we’re back where we started?

Suddenly, my prayer life isn’t quite as filled with cherubim and elders bowing before thrones.  Lord, help me work through why this is affecting me as much as it is.  I am so disappointed.

I sit down for my noon Daily Office, and read this passage of Scripture under the midday office in The Divine Hours:

“So when the crowd saw that neither Jesus nor his disciples were there, they themselves got into the boats and went to Capernaum looking for Jesus.  When they found him on the other side of the sea, they said to him, “Rabbi, when did you come here?” Jesus answered them, “Very truly, I tell you, you are looking for me, not because you saw signs, but because you ate your fill of the loaves. Do not work for the food that perishes, but for the food that endures for eternal life, which the Son of Man will give you. For it is on him that God the Father has set his seal.”  (John 6:24-27)

Immediately I sense the Lord saying to me, Andy, don’t work only for the bread loaves, for outcomes, deliverables…be in this for me.  Work with me.  I am eternal, work with me and care as much about things that have eternal value as the here and now.  I am in the here and now, the earth is mine and everything in it, but I want you to put your hope in me, not solely in metrics, grants, schedules.

I still felt like I’d been kicked in the gut, but now I felt the Lord breathing life back into me.  Ahhhhh….yes, that’s it.  That’s the lesson he’s been teaching me repeatedly for ten or more years.  Work with me, watch how I do it, take my yoke and learn from me, for it’s easy and my burden is light.  (Matthew 11:29)

This weekend was a weekend of anticipation, hope, and delight.  Today has turned into…something else.  But as I sit here tonight and reflect on what has actually taken place, and the words of the Lord to me through them, I hear a gentle voice calling me to trust Him.  To not take on burdens that aren’t mine to carry, to release outcomes that aren’t mine to own, and to find rest in the One who clothes the flowers of the field and gives the birds food to eat.

And I’m not giving up on USAID.

- A.

Mission-focussed? (17/11/11)

Whew!  What a month it’s been.  Moving house, Moffat’s semester ending and final exams to administer and grade, my graduate school semester ending and papers on Augustine and grace to be written, the usual cycle of sorrow and joy at the Hospital, children who are growing and just being all-around simultaneously delightful and maddening, and normal life all mixed in with the signs of spring that are unfolding around us:  birds singing, flowers everywhere, and more rain than you can shake a stick at.

When the push is on in seasons like the one in which we’ve been, I get into a sort of “mission-focus” mode, where I unconsciously sacrifice everything else for the “mission”, whatever the that happens to be at the time.   To put it another way that sounds less grand or without military jargon, “head down, bum up”.

When I was on a submarine, it was operating a warship.  On an infrastructure project, time/cost/quality/stakeholders.  In vocational ministry/humanitarian work, the “mission” might be patients, students, mentees, or parishioners.

There are a number of pitfalls in my mission-focus mode, not least among them how one defines the “mission”.  Leaving that aside for the moment, a key flaw of this mode is the “everything else” that gets sacrificed:  rest, prayer, health, exercise, relationships, family, capacity-building.  It is a fascinating reflection exercise to consider how quickly and easily I justify sacrificing these things in the name of “productivity” or “mission”.

Mardi and I started a habit several years ago of setting aside time to evaluate our lives at quarterly or six-monthly intervals, cutting out things that are no longer priorities and highlighting important areas of focus we don’t want to sacrifice.  We find we have to do this regularly, as it is so easy to forget that when we say ‘yes’ to something, we are saying ‘no’ to something else.

Site visit to Monkey Corner Springs through a flooded road

Time is a zero-sum commodity, we have learned the hard way, and if we keep piling things into our schedule, we force ourselves to cheat in other areas.  With both of us working and myself in graduate school, if we say yes to every opportunity to serve–RVA, Moffat ministries, church, SIM, the endless parade of Hospital needs–we must say no to something else currently in our schedule.  Otherwise, we start to ‘cheat’ on the things we’re doing, and it’s usually family, health, and our spiritual lives that we start to cheat in first.

So as we wind up this season and look forward to Advent and then Christmas, a few highlights stand out as high points of joy, hilarity, and moments when the clock seemed to stand still for a while:

–Riley (4) piping up at dinner a few weeks ago and saying, ‘I’ll thank God for the food, Daddy!’

–A resident at the hospital coming to pick up the large baby crib left for him at our house by the previous family, and putting the whole thing on the back of a piki (small motorcycle), strapping it down, and driving away with it.  The size ratio was roughly that of putting a Volkswagen on the back of a mountain bike, and the whole thing was like a Mr. Bean episode.   I confess I made strong intimations that there was no way on earth he was going to pull out of our driveway with THAT on the back of his piki.  Pull out, he did, and I walked back into the house to Mardi who said, ‘You didn’t take a picture????’

–going on a site visit to the Monkey Corner Springs pump station two weeks ago, and, reflecting on the probability of being car-jacked on the notorious stretch of road it lies down, leaving my wallet and phone at home.  Up to that point in my life, I don’t think I’ve ever prepared for a site visit by removing valuables from my person, and given the recent spate of car-jackings we’ve experienced around here it probably won’t be the last.

–telling my Spiritual Formation class at Moffat that I would be their lecturer next year for their Biblical Leadership topic, and them breaking out in cheers and clapping.

–numerous mentoring sessions with the students in my Practical Ministry/Mentoring group at Moffat.  Getting to know them, their passions, and their hearts.  Some of their background stories are just horrific; almost all have lost at least one parent and many are orphans.

The Papa Bill Star Wars show!

–the Skype chat with Papa Bill in Grand Rapids a few weeks ago where he did a puppet show with “Princess Riley and Captain Liam”, using Lego Star Wars figures that Quinn and Will Brennan (Riley and Liam’s first cousins) gave him to “tell the Star Wars story to Riley and Liam”

–asking Riley to sweep under the table after dinner, and giving her the dustbuster to do it with…the look of wonder in her eyes as this magical tool made all the crumbs disappear was priceless.  She then proceeded to drain the entire battery by “sweeping” the entire house with it for the next 15 minutes.

–returning from Nairobi last week after dark, in the driving rain and fog.  Each of these three conditions we try not to drive in if we can help it, all together, it was the unholy triumvirate of craziness.  By God’s grace I got home safely.  In the final 300 metres, on the steepest part of the trip down the mountain on the dirt road I slid while in four wheel drive into the drainage ditch on the side of the road.  Luckily there was a sort of small flash flood in it from the rain, and the water pushed me down the last part of the hill onto the level road home.  I’m not sure I am supposed to have enjoyed that as much as I did!

–helping our outdoor worker, John, save some of his wages each month so that he can attend driving school in January, and get his driver’s license.  This will be a huge boost for his career prospects, as driver’s licenses are expensive in Kenya, and qualified drivers are sought after.  Every time he talks about going to driver’s ed he gets a huge smile on his face, which I compare to my attitude before driver’s ed in Albion, Michigan, which was something along the lines of, “Man, this driver’s school is taking away valuable skateboarding time!”

John, our outside worker and soon-to-be-driver-qualified gardener

–sharing life with Elizabeth, the lady who lives just up the mountain from us and comes to our door weekly selling delicious homemade cinnamon rolls.  She lost her husband to cancer a few years ago, her son to injuries sustained during a violent home invasion the following year, and has stayed away from church and God ever since.  ”How could a loving God allow this to happen to me?”, she asked me this morning.  She is a wonderful cook, and a precious lady, and we are praying that she would be able to move through this season of darkness and grief and emerge on the other side.

A few highlights amongst a “head down, bum up” season.

- A.