Poetry vs History (12/5/13)

A few months before we left Kijabe to travel and speak in the US and Australia, we welcomed Mike and Ann Mara and their two precious children to Kijabe. A gentle and wise mountain biking orthopedic surgeon and Irish international development guru with a passion for cups of tea and conversation–you might correctly guess they very quickly became good food friends!

As a part of her work to help the Hospital raise its international profile and begin to tell stories of the incredible Kingdom work happening here, Ann invited her friend Elizabeth Fischer, videographer and storyteller, to come for a few months. Elizabeth is working on her videos now, which will feature in the Hospital’s to-be-released new website.

There’s something powerful about using more than words or a simple narrative description to tell a story. Some scholars believe that over half of the Old Testament was written in ancient Hebrew poetic form…the writers selected poetry as a deeper and more descriptive way to express the love and interaction of God with his people than simply recording what happened and when, as a 21st century western historian might today.

This latest video from Elizabeth is like reading the Old Testament in poetic form…you can feel the love of Jesus in the actions of our Hospital chaplains, sense the powerful presence of God in the eyes of the children.

Elizabeth describes her video-making efforts this way in her blog: “I went along to film and photograph the day and the rainbow of different events that took place within a 11 hour span (drive included). There’s so much story behind this little montage of clips, so much love and care that went in to that day, went into those lives even for a moment, and hopefully went into the buckets of hope tucked deep in the cupboards of each heart who desperately wanted to be seen, loved, heard and known. Nothing can do it like the love of Jesus. I captured Him in motion, which I live for, working thru willing hearts. Loving well like He does.”.

Enjoy.

-A

Dallas Willard and nuclear submarines (9/5/13)

I was introduced to Dallas Willard in 1998 when I was freshly enrolled in the Submarine Officers Basic Course in Groton, Connecticut. I had just finished an exhausting year in Naval Nuclear Power Training School in Charleston, South Carolina–only 50% of our class would go on to be submarine officers, and I had lost my spiritual and emotional bearings in the midst of twelve hour study days and the time-independent neutron balance equations for light water reactors.

Mardi was in the middle of her intern year in Pediatrics in Charleston and would stay there while I traipsed up to Groton for three months of submarine emergency escape and tactical training. I picked up a copy of Dallas’ book The Divine Conspiracy on a friend’s recommendation on the drive up.

As I began to read, I realised within the first five pages that I could never be the same Christian again. I had lost my bearings, but in only five pages they were being re-calibrated and a hunger for the Lord was being rekindled in me. I had never read a book like this before, and I have never read one like it since.

The USS Maine (SSBN 741), on which I deployed five times between 2000 and 2003

A professional philosopher and educator, this man was not afraid to think well and deeply about difficult questions. An apprentice of Jesus, he was not content with proclamation alone and wrote about actually doing the works of Jesus. A theologian, he was dismayed by the faith-as-a-noun-instead-of-a-verb salvationist/soterian theological underpinnings of much of the American evangelical church, and had a massive influence through his writings and Renovare (the spiritual formation organisation he helped found, with whom we partner to deliver the Spiritual Formation course at Moffat Bible College in Kijabe) through his call to the church to be serious about spiritual formation.

A few of my favorite phrases of his from this book, which I have used so many times I write them here (mostly) from memory:

“Whatever you do, ask yourself, ‘what kind of [baker/teacher/soldier/doctor/business leader] would Jesus be if he were me? This is the essence of apprenticeship to Jesus.’”

“One of the major differences between an adult and a child is that an adult has learned to control their facial muscles. And one of the common traits noticed in adults of considerable spiritual stature/maturity is their childlikeness…they don’t use their face or body to hide the spiritual reality around them, and in doing so are genuinely present in their body to those around them.”

“Spiritual formation is, in practice, the way of rest for the weary and overloaded, of the easy yoke and the light burden, of cleaning the inside of the cup and the dish.”

“The primary ‘learning’ in spiritual formation is not about how to act, it is who we are in our thoughts, feelings, dispositions, and choices–in the inner life–that counts. Profound transformation there is the only thing that can definitively conquer outward evil.”

The Maine pulling into port

Dallas helped me get my bearings back during Submarine School in 1998, and then redefined and shook them up. I read The Divine Conspiracy on hikes in the Connecticut hills, underway on deployments, and at Mystic Pizza (yes, THAT Mystic Pizza). Dallas introduced me to the “already-not yet” principle of the kingdom of the heavens that Jesus spoke so often about: the kingdom is here and available to us now, but at the same time is not yet fully here until Jesus returns. And I began to develop the framework for my current understanding of what it means to actually apprentice oneself to Jesus, to learn to live my life as Jesus would if he were me.

Sunrise, on the bridge as Officer of the Deck, underway in the Atlantic

And when a few years later, my mom got me a signed copy of Dallas’ latest book, The Great Omission, I looked inside and was deeply moved to see he had written a note to this Naval Officer he’d never met, whose mother had talked to him at dinner of her son struggling to live like Jesus on a nuclear submarine. He wrote:

“Joshua 1:9, Be strong and courageous, Andy”

Sunset through the #2 periscope

He was that kind of man. Prophetic, subversive, and practical. I don’t think I would have survived, during my five subsequent deployments on the USS Maine and the year and a half that I spent underwater, without the framework of spiritual formation that he introduced me to. Dallas taught me to train in the ‘off season’ so that I would be more equipped to live like Jesus when I was ‘in the game’. He taught me the ‘principle of indirection’, where I learned that it is not through direct effort alone that one becomes less sinful and more like Jesus: rather than focussing on cleaning the outside of the dirty cup of my life (the part everyone around me sees), lasting change comes when we focus on cleaning the inside of the cup, and it happens through the power of the Spirit and not by my effort alone.

The D-5 nuclear missile, of which the USS Maine carried 24, launched underwater.

Dallas died yesterday of cancer, and I am so grateful for the life he lived, and the life of the “light yoke and easy burden” that he inspired me and so many others to lead. From submarining to a life of faith and compassionate service in Kijabe.

-A

The heartland (16/4/13)

South Australia, apparently the door to the Outback.

In March, after months of collaboration, consultation and cash, the South Australian government unveiled its breathlessly anticipated new logo – a stylised picture of South Australia as a doorway to the rest of Australia. While derided by many as a kindergarten-level piece of artwork, I kind of like it. Because Andy’s always been able to hold up his hand, point to it and say “if this is Michigan, I come from here” and point to a knuckle. So now I can tell you where we spent the last week on the Eyre Peninsula.

If you look at Australia as a house, with South Australia as the door, the Eyre Peninsula is the bottom right hand corner of the innermost door as you’d cross the threshold. Oh forget it, I guess that’s still not too clear, so I’ll show you a real map instead.

We drove for nearly 8 hours – first north, past the wine growing regions, then across the top of the St Vincent & Spencer Gulfs, around the industrial Iron Triangle, then south again to the reddening soil and early autumnal brown landscape of the agricultural heartland of Eyre.

We had been put in contact with three churches, so we travelled to connect and to share, to listen and to encourage. Our first port of call was Port Lincoln, kingfish and tuna capital of South Australia. We were welcomed by Jean and Graham, a couple whose gift of hospitality is evidenced by their guest book revealing a list of nearly 14,000 people (fourteen thousand!) who have been privileged to be hosted by them in their granny flat over the last 25 years since they had it built in their back yard. They retired from farming, passing the legacy onto their son several years ago, and Jean celebrated her 80th birthday in June – and after 4 days with them we decided to adopt them as surrogate rural Australian grandparents.

the wonderful Jean & Graham

Unity Hill, Port Lincoln

Sunday morning saw us preaching at both services at the Uniting Church, Unity Hill, on Sunday morning. Rural congregations often struggle to find regular leadership, with small communities lacking attraction for many in pastoral leadership, so Unity Hill Uniting Church is blessed to have Benji Callen as their senior pastor. After realising that his PhD in science wasn’t leading him in a fulfilling direction, he completed theological studies and ordination and relocated with his family to Port Lincoln. (Side note: as you find with most people in South Australia, we are all separated by one degree – his wife Nicole and I attended the same youth camp when we were 16 years old.) Us preaching on Sunday morning meant that Benji could preach at Poonindie, another Eyre community who relies on Benji sharing the load with their local lay preachers. It was an opportunity for us to share about our understanding of the gospel – of our heart to have a “Billy Theresa” mission, in which actions are just as important as words, whether at home in South Australia or in Kijabe. A chance to encourage people – what you do, today, wherever you are, has the potential to be important in ways you may never fully appreciate.

Lincoln National Park

Midweek was a time to explore and rest, as well as to meet and connect. We spent some time hiking at Lincoln National Park and Coffin Bay, hundreds of kilometres of protected coastline, sand dunes and scrub first discovered by outsiders when Matthew Flinders was circumnavigating Australia in 1802. To walk along deserted beaches together while the children were back in Adelaide with their grandparents was a restorative blessing – peace and solitude in the midst of ministry. A chance to reflect on our journey over the last 4 months, in the context of the last 2 years, and to look forward with uncertainty mixed with faith. On Tuesday we were invited to share about our work in Kenya at a luncheon at another local family’s house. A group of around 15 took time out of their weeks to come and listen and ask questions about our ministry, welcoming us with interest and thoughtful questions about the details of life and work in East Africa. We had time to sit and chat with Benji, learning that Del Giorno’s is THE place to get coffee in Port Lincoln as well as get a glimpse of the life of a rural pastor. We were able to learn from Jean and Graham the meaning of hospitality, as well as a snapshot of the tuna fishing industry and the families who make this their life. We saw a tuna farm as Pete drew us into the world of aquaculture, explaining the months long process of procuring and fattening Southern Bluefin tuna for the export to the premium Japanese markets, who buy 97% of the tuna in order to supply 3% of their demand.

World class bluefin tuna sashimi while floating near a tuna farm? Yes please!

At the end of the week we headed to Tumby Bay, population 1351 until summer tourists swell the numbers to up to 12,000. Initially a grain storage and loading port, it supports the agricultural community with education and healthcare as well as being a centre of gravity for families and visitors alike. We met the delightful Fatchens, retired farmers who invited us to share at a prayer meeting at their home with a group of prayer warriors who faithfully keep in touch with missionaries around the world, praying for and supporting them.

Wanna go for a paddle?

On Sunday morning as we walked on the beach before church, an eager lady with a dragon boat and some extra paddles informed us that we really should come out and paddle with them – and so we found ourselves conscripted into a dragon boat training session with a bunch of friendly strangers, coasting through tranquil waters to the beat of an enthusiastic voice behind us timing our strokes (easy oar! paddles in! aaaand…. go!). An unexpected surprise to start a full day. We preached at Tumby Bay Church of Christ, complete with generator-powered projector due to a peninsula-wide power outage – thank you ETSA for making these Kenyans feel so at home! The lunch afterwards was again a spiderweb of connections, with members having attended my childhood church, or having children married to schoolday acquaintances.

Preaching, Tumby Bay Church of Christ

The afternoon found us wending our way out to Ungarra, population 241. In the agricultural heartland of the Eyre, we visited the Telfer family, 2 generations with 5 families sharing the load of farming at their massive property – wheat and barley, canola and vetch. As we chatted with Josh & Esther, 2 of the junior Telfers, we were reliably advised that if we were to be driving before sunrise the next morning, we would need to watch out for kangaroos, and shouldn’t swerve if we saw them. “Camels and wombats – they’re the only 2 animals you should swerve for. Wombats are like huge bricks – they’ll flip your car. If you eat wombat, I’ve heard they taste like sweet, sweet pork”. Excellent.

Ungarra Church of Christ

After living in rural Kenya for the last 2 years I feel a strange, new affinity for rural Australia, with its challenges and joys, hardships and rewards. It has been a joy to make these connections and a privilege to have a window into these families and communities. We pray that we’ve been able to encourage them as much as they’ve encouraged us.

- M.

___________________________

Finance update: thanks to all of you, near and far, who have contributed to our upfront costs thus far and who have committed to supporting us regularly. As of this week, we need to raise another $1800 per month in ongoing support, and $32,000 in upfront costs before we can return to Kijabe. Please continue to pray with us that all will come together in order for us to leave on May 29.

If you were a farmer, this could be your view.

Writing, not typing, with a pencil flashlight stuck between my teeth (21/5/12)

I haven’t written in a while; really since the Water Committee work started in earnest about six week ago, and Granddad Jack died and I flew to the US for a week…I just haven’t had anything to say.

Which is strange for me.  I’ve always got something to say.  Like anyone, I guess, I’ve got an opinion and I don’t mind sharing it.  But I usually delight in discourse, debate, the exchange of ideas…I even love a good argument.  And I’ve greatly enjoyed “saying something” through writing or video this past year, sharing thoughts and stories on our website.

But I lost a desire to “say something” a few weeks ago.  Somewhere in the middle of long hours working on the water crisis, my postgraduate studies, and family life the desire just disappeared.

And then the news that my grandfather died.  The wavering…should I, or shouldn’t I?  The most expensive plane ticket I’ve ever purchased.  A whirlwind trip back to the States.  Time spent reminiscing and grieving with family.  Reflecting on the influence my grandfather had on my life and the lives of so many others.  Listening to Yo Yo Ma’s performance of “Gabriel’s Oboe” from The Mission, and feeling like I had transcended the material world and could actually see Granddad going to be with Jesus.  Going into Whole Foods and, in a daze of consumer-fog and jet lag, walking laps around the coffee bins for 5 minutes before I realised what I was doing.

Cannon fodder for a writer.  I should have been writing prodigiously.

But I haven’t wanted to.  I still don’t know why, fully.  Partly, especially so close to Granddad Jack’s death, I felt I was on hallowed ground and it was too early to put what I was experiencing into words.

Partly, though, I just felt like I shouldn’t be writing yet.

I didn’t start to have insight into this reluctance until I read this passage from Eugene Peterson’s book, The Pastor:  A Memoir:

“I had always written…when something I wrote was published, it was confirmation that I was a writer.  But I was not a real writer.  Up until then writing was a way of telling others what I knew, or what I felt–I was passing on information or feelings.  Writing was a way to get published.  [But] In the badlands I became a writer.  

The badlands, this desert time for probing the interior of my pastoral vocation, continued to do its work.  I was getting into the guts of who I was as a person.  I was leaving the performance mode in which I had done pretty well up until them.  I found that there was a way of writing that I had only peripheral acquaintance with and never pursued–heuristic writing.  I began to sense that my writing was a some deeper level  a conversation with scripture.  At the same time a conversation with my congregation.  But conversation, not explaining, not directing.  I was exploring the country, this land of the living.  And I was taking my time…This, I was learning, was what real writers did.  Novelist Kurt Vonnegut described this writing as walking through a dense forest in the dead of night with a pencil flashlight between your teeth, about two feet of the darkness illuminated before you as you worked your way from word to word.

Heuristic writing–writing to explore and discover what I didn’t know.  Writing as a way of entering into language and letting language enter me, words connecting with words and creating what had previously been inarticulate or unnoticed or hidden.  Writing as a way of paying attention.  Writing as an act of prayer.  In the badlands the act of writing was assimilated into my pastoral vocation…not just saying things.  Not just writing words.

I came across something that Truman Capote wrote, with a sneer, on the work of a popular novelist:  “That’s not writing, it’s typing.”  About the same time, I read Emily Dickinson’s pronouncement, “Publication is no business of the poet.”  Capote exposed much of what I had been doing as “typing”–using words to manipulate or inform or amuse.  Dickinson rescued me from a lust to be published.

Heuristic writing…writing to learn or discover.  Not typing.

And there it was.  I realised, perhaps after the tenth time I was re-reading this brilliantly insightful section, that I was re-reading it not because it was a particularly self-aware bit of brilliance on Peterson’s part, but because the lesson he learned fifty or so years ago had grabbed my heart and was squeezing.

Writing to learn, to discover.  Not to be published, to inform, to pass on feelings.  Entering into language and thoughts as words connect into other words and reveal and create what has previously been hidden.

If I sat down and wrote tonight of what a beautiful and holy death Granddad Jack had and those with him at the end experienced, it would be typing.  I would be informing, passing on feelings.  But I want, I yearn for writing to be more than that.  To help me learn, to discover the not-yet-fully-known.

Soon I will write of this man whose love for adventure kindled in me a desire to travel and venture into the unknown.  Who was partly responsible for my semester abroad in Australia in 1997 which altered the course of my life.  But not tonight.  Because I want to do more than type.

-A

Victor with Grace (30/6/11)

I asked Grace to smile for this picture – and all she could do was laugh.  Today, after 55 days in the hospital, she is taking precious Victor home.  I have been smiling all morning.

Victor was born on May 6th, 10 weeks premature and weighing in at 1110 grams.   It took us over a month to get him to full feeds via a tube down his nose – we would think he was doing OK, then he would vomit, or his bowel would swell up ominously, and we’d have to stop his feeds and go back to IV fluids.  For one of those weeks we were putting a teaspoon of breast milk into his tube every hour, day and night – and by we, I mean his incredible mum, who every 2 hours came into the nursery to hand-express breast milk, then put 1/2 of it into a syringe to hold over his head as it dripped into his tube, with the other half given an hour later by the nurses.

Victor was one of the first babies I ever met here.  I am so grateful that by God’s grace, he has has done so well – with all of the potential complications of prematurity, he has never been on a ventilator, has avoided serious infection, and as far as we know has a normal brain.  He is growing day by day, with a combination of breast feeding and syringe top-ups, and today is 1960 grams.

I will miss Grace and Victor, but it is so wonderful to have a joyful goodbye.

- M.

Pride (25/6/11)

I started my work week out pretty well, I thought.  There was a baby – Gift – born over 3 months premature (27 weeks) who was born on my watch, and we gave him medication into his lungs to help him transition and fluid into his veins.  24 hours later he was breathing by himself, with just a small amount of minimally pressurised air into his nose to help him along and a chest xray that looked perfectly normal.

I was also able to go to the emergency department after receiving a phone call from the intern that went something like “Yes Dr Mardi?  I have a 2 week old who has not been breastfeeding well.  He is also not breathing.”  That kind of call makes you drop what you are doing and run.  When I got there, the baby – Joseph – had been given some breaths and was making some effort on his own, but his entire body was cold, and when I blanched his skin, it took over 6 seconds for his colour to come back – you worry if it’s much more than 2 seconds.  He’d also lost 20% of his body weight – probably dehydration because breastfeeding had failed.  We quickly got to work, and put a needle into his shin bone to get warm fluids in, and soon he began to be pinker, warmer, turning the corner.

It’s easy in this job, after a couple of successes, to start to feel, quite frankly, that I am pretty good.  To feel pretty good about being here, about what I’m doing.  To feel that all of my hard work has paid off, that I am here to make a difference and by golly, I am doing it!  To give myself a little pat on the back, and be a little proud.

And then comes yesterday.

27 week Baby Gift overnight had started to deteriorate – a combination of immature lungs, and probably infection from mum’s waters breaking 2 weeks before delivery and not having medical care until 2 days ago.  And during my attempts to put a tube down his trachea, I made his mouth bleed, which made everything more difficult.  And from there, on and off for the next 6 hours, it just all went downhill until his heart slowed, and slowed, and beat no more.

And during that whole day, the warm, pink, rescued Baby Joseph whose dehydration we had fixed, didn’t move a muscle.  At all.  And even though an ultrasound of his brain looks OK, we’re pretty sure that the lack of fluid in his body meant that blood flow to his brain was probably impaired for a long time, and now irreversible damage has been done.

There is nothing like sitting down at a mother’s bedside and saying to her – Mama Gift, I have some very bad news.  Even though you know you’ve had cautious conversations with her 2 days ago, and pessimistic ones with her earlier in the day.  There is no way to feel like a hero or a superstar when 4 hours earlier you have chatted with her and found out that, like you, she also has a 4 year old and a 2 year old at home but that, unlike you, she will be leaving the hospital with the pain of a healing c-section scar and a coffin.

I may be spared the second conversation with Mama Joseph.  Jennifer, who is working this weekend and the start of next week, will probably be the one to sit down and say Mama, I have some very bad news.

In a strange way, it is cases like these that make me – not a better doctor, although I hope they will – but more of the person God wants me to be.  More humble, more reliant.  Less interested in what a good job I am doing, more interested in who I am being.   More interested in the unseen accomplishments than the limelight.  Less interested in taking credit than honouring a God whose complexities still befuddle, astonish and quiten me.

Most interested in remembering why I am here – to love God, and to love my neighbour as myself.

Love is patient, love is kind.  It does not envy, it does not boast, it is not proud.
It is not rude, it is not self-seeking, it is not easily angered, it keeps no record of wrongs.
Love does not delight in evil but rejoices with the truth.
It always protects, always trusts, always hopes, always perseveres.
(1 Corinthians 13:4-7)

- M.

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Update July 15th – astoundingly, baby Joseph started to recover.   God’s grace is miraculous – he began to breastfeed, and in the nursery the mothers started to complain that he was too vigorous and noisy and was disturbing the other babies.  We gratefully discharged him soon thereafter.

The fire is burning, the jazz is on the hifi…it’s time for a little Swahili (22/6/11)

Since the second week we arrived, Mardi and I have had one-on-one kiswahili lessons 4 times a week with a local teacher, Edward.  He’s brilliant.  Sort of a combination of one of my former fraternity brothers (Sean Duncan) and an NFL linebacker.

Learning the lingua franca of East Africa is a priority for us…many of the patients at the hospital don’t speak English, and the hospital staff and students at Moffat Bible College come from all over Kenya–most speak kiswahili better than they speak English.  Which is usually their 3rd or 4th language, along with their local tribal language(s)!

I hit a low point in my lesson yesterday…all of the different balls we have juggling in the air at the moment sort of fell down in a heap at the start of my lesson.  I felt like I hadn’t learned anything in 7 weeks, and wondered if I’d ever be able to pick it up.  Trying to squeeze in language study amongst caring for patients, spending time with the kids and each other, preparing lessons, meetings, site visits, doing my MDiv studies and cajoling suppliers and contractors into providing information…it’s not something that just “happens” in your spare time.  Its all too easy for us to just add this one additional element of ‘work’ into an already busy day and before you know it, you’re spending every waking moment working, with no time for rest, relationships, and prayer.

Yesterday was a discouraging day.  You get those alongside the good days.  It is a real blessing that Mardi is a sponge for information and already sounds fluent to my untrained, possibly-mentally-impaired-at-learning-languages ear…but I can’t take her with me as my translator!

And then there’s today…I went along to a chapel service with the Moffat students, and was introduced by the Dean as the new lecturer in Spiritual Formation…and I thought, what the heck,  I’ll give it a go.  So I introduced myself in kiswhahili…”majina yangu ni Andrew Steere, ninatoka inchi ya Australia, jimbo la Australia kusini, jiji la Adelaide.  nasema kiswahili sivizouri sana, lakini nafahamu kidogo.”  And they cheered.  That made my day.

So here I sit…in front of the fire, lights down low, with a little Wynton Marsalis on our portable speakers.  It’s kiswahili learning time.  Mardi’s not here…a GP friend of ours showed up at our door at dinner with a story of an impending very premature birth, something about the baby’s leg sticking out of it’s soon-to-be-in-labor mum (at this point I tuned out and went back to my spaghetti), and could she please come and help…so here I study alone, and happy.

The kids are asleep…and the kiswahili is flowing.  It’s another day.

- A.

You got like 3 feet of air on that jump, Pedro (20/6/11)

This is my friend Rich.

Rich is a surgeon here at Kijabe.  He and his wife, Stacy and their three kids have been here 5 years.

One of the things I do in the ‘rest and health’ area of my life is ride my bike, and I brought my mountain bike (a 29er) over with us, hoping there might be one or two places I could ride.  Fellow riders and good friends Brad Adams and Tom Hills assured me I would be nuts not to bring my bike over with me.

What I found was one or two hundred.  I was unprepared for how beautiful the Kijabe area is.  People around here walk everywhere, and so the Rift Valley escarpment is criss-crossed with walking trails…which make for excellent riding!

Check out all that sweet mud

I ride with Rich, and anyone else who joins us (including Scott, a GP who recently moved here with his family after 15 years in Uganda) for a few hours on the weekend (depending on their call schedule), and it’s great.

We did recently did a 4 hour ride around Mt Kijabe and back, and despite a run in with a cactus it was a little slice of heaven on earth.  On return, I met Mardi’s medical requirement for sympathy–when I mentioned I had ridden into a cactus, she said, ‘Are you bleeding?’, and I was able to gleefully reply, ‘Yes!’.

My favorite things so far riding include:

–Rich:  ”That trail doesn’t look too steep.  Let’s go down it.”  Andy:  ”There’s no way on earth you’re getting me to go down that trail you crazy lunatic.”  Rich:  ”Look, a donkey is coming up the trail.  If a donkey can do it, so can you.” [Shamed into giving it a go, Andy follows Rich down the trail]

–Riding past villages, and having the Kikuyu children run out screaming to greet us and chase us, shouting the only English they know, “How are you?  How are you?”

–Playing chicken with the goats and cows who often block the trail

–Riding past a shepherd with his flock of sheep, goats, or cows, who has an expression on his face that clearly says, “Wuzungu (white people) on mountain bikes was literally the last thing on earth I expected to see today.  I have now seen everything.”

–Riding along the Rift Valley escarpment with views so beautiful it takes your breath away

–Seeing a dung beetle rolling a dung ball on a trail

–Conversations with Rich and Scott about life and God

–Riding past monkeys and baboons

So, to summarise:  shipping the bike over in a box along with all the little bits and bobs needed for maintenance was worth it!

- A.

Riding towards Mt Kijabe

Rich: "If a donkey with two sacks of charcoal can walk up this trail, we can ride down it."

Scott, and a short break before we descend Mt Kijabe to the floor of the Rift Valley

Best bits (19/6/11)

At the end of every day, we ask the kids “What was your best bit today?” and then say our goodnight prayers, thanking God for those things.  Here, in no particular order are some of mine for this week:

1) Sitting in the living room at night with my husband, an open fire and the sound of the much-needed rain falling on the roof

2) Seeing Brenton Wait last weekend – on a missions trip to Zambia for a week, and opportunistically connecting in Nairobi.  He changed his flights to stay for 2 nights, and we were blessed to have his company, to be able show him our lives here, to have conversations with someone who knows us already and who it doesn’t take too long to talk deeply with.

3) Cadbury Creme Eggs, ferried over from the UK from Catherine by Brenton, and Cadbury Cashew and Coconut chocolate from Kenya – one of the flavours they have gotten RIIIGGGHHHT!  Not so much their Fruit and Nut….

4) Andy watching the kids at home last Monday while I had a day to get a haircut, window shop and drink coffee.  Heaven.

5) Having a work week in which none of the babies on my service died.  Not one.  Never realised that would constitute a “good” week till I got here…

6) Hearing Liam “read” 3 Thomas the Tank Engine stories to MaMa and Poppa over Skype – “Thomas is sad.  There is a storm.  Percy is sad.  Percy is happy.  What’s James doing Mummy?”

7) Playing Barbie dolls with Riley.  After a while I think I was so into dressing the dolls in their favourite fashions that I kind of forgot Riley was there….

8 ) Having coffee with new friend Megan while 3 of our 5 combined kids were at preschool.

9) Playing piano for the first time in 2 months at Rich and Stacy’s house with Rich accompanying on guitar.   I had almost forgotten what a huge part of me music & worship is.  The Davises are new friends and fellow Vineyard-ites….  more jamming with Rich on guitar to come!

It’s nice to be able to reflect and just be grateful for best bits.  Sometimes it’s nice to have Thanksgiving, at the wrong time, for no particular reason except that I realise I am so blessed.

M.

A short walk to Emi Springs (16/6/11)

Today I hiked with 5 of the Hospital engineering staff  up to Emi Springs.  Emi is one the Kijabe community’s sources of fresh water, and thieves regularly break into the pipeline carrying water to steal the iron sections of pipe and sell them for money.  Because there is a real shortage of fresh water here, loss of the Emi supply means many of us on lower station, including the hospital may lose all water pressure…for as long as it takes to fix it.

John, Jim, and Collins

It is for this reason, and to figure out what might be done to prevent the vandalism, that we hacked and sweated our way through overgrown mahindu plants, African nettles and underbrush on a 19 km roundtrip journey from Kijabe up into the mountains to Emi Springs.

As often happens, our plan changed at the last minute, and we were not able to use one of the hospital’s 4WD’s.  Their 4WD’s double as ambulances, and well, it was being used as one!  I offered the use of our 4WD, keen to test her mettle in some proper conditions.  Well, I got what I wanted!  It was a 6 km ride to the base of the mountain, partly on a dirt track (unrecognizable as such following a few rainy days), and partly on a goat and cow trail which used to be an old road to the Mombasa-Uganda Rail line.  Our creaky 1997 Prado did not disappoint, and I was grateful again we’d found it.

View from Emi Springs looking toward Kijabe

The walk started at the railway line, and was a hard slog through some unbelievably beautiful terrain.  Emi Springs is about 1000 feet above the railway line and Kijabe, and reached by a narrow trail used only by hospital maintenance and locals illegally cutting firewood for charcoal production.  For much of the first 3 km’s of the roughly 10 km’s of pipeline, due to the challenging terrain the pipe is literally hung on a cliff edge, concreted in place to prevent it from falling.  In the last 5 years at SA Water, I was involved in the design or construction of more than 80 kilometres of water pipelines…and here, I was simply astonished at the feat of construction and engineering it took to build this vital water supply line.

We learned during the walk that the 3 inch galvanized iron pipeline was built 12 years ago during a severe drought.  500 labourers over 2 months built the pipeline quickly to provide water when all other sources had dried up.

Locals come to this cave to pray and fast

It’s easy to figure out why we are having theft and vandalism issues…iron is valuable here, and much of the pipeline is exposed, on bare rock or hanging over a cliff.  We will have to concrete much of it in place in order to secure it.  This will likely involve carrying hundreds of bags of cement and sand up the trail we just walked, breaking local rocks into suitable aggregate-sized pieces with a hammer, and making concrete on a trail 1 foot wide on the side of a mountain.

It is just these kinds of engineering solutions, which seemed so unlikely to me 4 months ago in Adelaide, that are the difference between water coming out of the tap for thirsty children, and no water pressure at all.

I was reminded today by the incredible effort it took to build the Emi Spring pipeline that sometimes we undertake extraordinary endeavours…we build a pipeline on the side of a cliff, we show compassion to someone who wrongs us, we give sacrificially to someone in need…not because it is extraordinary, but because it is the thing in front of us to do.

When Oswald Chambers and his wife were asked in the early 1900s how they carried on their (phenomenally productive) work in God’s Kingdom, they replied, ‘Well, we just trust God, and do the next thing in front of us.’

What is the thing in front of me?  What is the thing in front of you?

- A.

Shed around Emi Springs

GPS Track of the route to EMI Springs

Meet the crew! (11/6/11)

Just thought I’d introduce you to some of the fantastic team at AIC Kijabe Hospital.  These guys make working here such a joy…

First, here’s Jennifer.   Jennifer and her husband Scott (a GP with more skills than you can shake a stick at) moved here in January.   Before coming here, they were in Bundibugyo, Uganda, from 1993-2011 where they were physicians and team leaders for World Harvest Mission.  One of the reasons for the move was to be closer to their 3 youngest children who attend RVA, the missionary boarding school just up the hill from us (their oldest son just started his first year of college in the US).

Jennifer has an obvious, genuine love for the babies and the mums we come across here ,  a passion for excellence and is one of those women who just does it all, and does it well.  She has crazy curly brown hair which I imagine requires a lot of taming!  I am grateful to have her as a colleague and friend, and both of us are starting to get a glimpse of what we can be as a team since we’ll be here together for at least 2 years.

This is Bob, our paediatric CO.  After 3 years of medical school and an intern year, Bob has a medical diploma (like a PA in the US) is here for his 3 years of paediatric training (equivalent almost to US residency, or Australian basic training).

Bob met his gorgeous wife Lillian here (also a paediatric trainee) and they married a year ago.  He is the glue that has held the nursery team together through the transitions of the last 6 months, training both Jennifer and myself in the what we have, what we can afford, and what is realistic here.  He will be here for the next 2 years, and hopes that we can give his somewhat nebulous training goals more definition, direction and oversight.  If all graduates of Kenyan PA schools are like him and don’t leave for greener pastures, I have high hopes for Kenyan health care down the road.

Here is Anne, our intern.  She graduated from medical school last year, and will be rotating with the other 3 interns through all the departments of the hospital, currently the nursery.  She is a delight to work with, has a ready smile and a humble confidence that just makes being around her a joy.  She and Bob see all the babies in the nursery before I start and come up with a plan for each of them for the day – there is often very little to add to their assessment and plan as they are so competent.  She also has a hunger to learn that is infectious, and challenges me as I teach her to go deeper in my understanding.

Finally, this is Immaculate, the other paediatric consultant who has done training both here and at Oxford, and is employed by the Kenyan government to be the paediatrician for Kijabe, all the outlying attached clinics and the community as a whole.  So she is paid full time to be about 3 paediatricians, and commutes 90+ minutes from Nairobi every day to do it.  Jennifer and I being here in support makes her job less impossible.  Immaculate has a ready smile, a mind like a steel trap and a passion for education – together with Jennifer and myself, we are hoping to really make a difference in nursing prowess on the paeds ward and depth of knowledge in the trainee doctors here.  Currently Immaculate is in charge of the paediatric inpatients and clinic – in August, we will switch so that Immaculate covers the nursery, and Jennifer and I cover paeds.

Just thought I’d show you my gang!

- M.

Ups and downs (9/6/11)

This Wednesday at work I was on call.  That means I worked in the nursery during the afternoon, and then from 5pm to 7am was available by phone to help the intern, and to go into the hospital if necessary.

I  discovered on rounds that baby Victor, who was born at 1100 grams over a month ago, was finally, like a champion, tolerating all of his nutrition without vomiting and was gaining weight.  Mama Victor, who has been expressing breast milk and feeding it to her son through a tube every 2 hours without fail for a month, gave me one of her lovely smiles as we understood that maybe we were approaching the home stretch.

I found out in the morning before I started work that sweet Mary, who was born with gastroschisis (protruding intestines without a covering) had died overnight.  We lacked the proper nutrition for her, and babies can’t just live on salt and sugar.  She never had a great chance, but nonetheless we had hoped that maybe, this time, we’d be able to get what we needed, and maybe she’d be the one to make it.

As I was leaving the nursery at the end of the day, a nurse ran up to me and said “You are needed now”.  Baby Ruth, snuggling skin-to-skin with mum, had stopped breathing and was blue.  We pumped air into her lungs, and as her heart rate dropped we compressed her chest.  And then an indignant cry, a returning pinkness – our tiniest baby fighting back for another chance.

At 9pm a jaundiced, dehydrated but not critically unwell sounding baby was admitted to the nursery.  At 2am I was walking over the hospital because the intern thought he had deteriorated.  At 3:15am, after over an hour of tubes and needles, fluids and drugs, I pronounced him dead.  It’s not pronouncing a baby dead that’s the hard part.  It’s telling mum and dad who 8 hours earlier had brought their baby to Kijabe with a concerns of poor feeding and high hopes for help.  It’s struggling to answer their questions out loud, while silently trying to answer the questions you are asking yourself – about what you could have done differently, what you could have done if they had come earlier, what you could have done if you just had… more.

And on the way home at 4am, I glimpsed baby Mary (right), abandoned at 29 weeks and 855 grams – who, at a hefty 2.7kg, celebrated her 3 month birthday this week boarding in our nursery.  Her uncle is navigating the bureaucratic labyrinth that is Kenyan social work in order to take her home to be near her mother who, in her grief and shame at not carrying yet another baby to term, told her friends and family that her baby had died and returned home to her husband alone.

Ups and downs.  Victories and defeats.  Gratitude and grief.

And then again tomorrow.

M.

Bedan (1/6/11)

My very first day in the SCBN (Special Care Baby Nursery), I met Bedan.  Bedan was born with a congenital problem called an encephalocele – this is where a portion of brain lining, spinal fluid and occasionally brain tissue protrudes out of a gap in the skull, covered by skin.  In Bedan’s case, it was protruding right between his eyes, causing his nose and upper lip to be split by a protruding mass.

Before you read any further, this one has a happy ending.  Thought I’d set you at ease!

Now, to continue….

Bedan had his first of 3 surgeries in his first week of life.  This removed the brain lining, some fluid and a tiny portion of protruding brain, and left him looking like you see him (top left).  A huge crevass between the halves of his nose, and a top lip that wasn’t complete.  The plastic surgeon who would be in charge of reconstructing his midface was responsible for the scotch tape – he assured us that if we just pulled the sides of Bedan’s face together, over time it would become close enough for him to sew the halves together again.

Despite the fine work of the neurosurgeons, Bedan developed meningitis.  In Kijabe, this is no small thing.  His infection was caused by an uncommon bacteria, and it took 3 weeks of our most potent antibiotic (meropenem) to clear the infection.   But it cleared, Bedan soldiered on, continued to grow, and continued to have his high-tech scotch tape therapy replaced and tightened, shortened and tautened.

So the plastic surgeons were able to sew his nose and top lip back together (see right for how he looked straight after surgery – the bandage on his head is for an IV for fluids and medication).   He now had a top lip – and after a couple of weeks, the plastic surgeon said he could start to breast feed.

As with so many babies we see here born with anomalies, Bedan came up with another complication.  A new swelling developed further up on his forehead – an ultrasound confirmed he had hydrocephalus and would need a VP shunt (essentially a hose from the brain to the abdominal cavity to drain away excess fluid).  So Bedan underwent his third neurosurgical procedure, and came out like a champion.  No complications, starting to feed by mouth after a few days.

Below is a picture of Bedan last week – day 50 of life, and ready for discharge.  He went home with his mum, feeding by mouth and thriving.  He isn’t out of the woods completely – he will have followups with neurosurgeons and plastic surgeons, and anyone who knows a child with a VP shunt knows that constant vigilance is required for the hose breaking or blocking and fluid starting to build up in the brain again.

Bedan had a hospital bill of 247,000Ksh when he left – around $3000.  Through the generosity of several organisations, Bedan’s family paid 5000KSh, and the rest will be covered.  It’s days like that that make this job so incredibly rewarding.

M.

James (31/5/11)

On our second day in Kijabe, we were driving around the station to take photos.  As I was snapping the hospital sign, a Kenyan with a huge grin on his face came up, hand outstretched, to introduce himself.
“You are new here?  Praise the Lord!  I am James.  You will be at the hospital?  Glory to God!  I will meet your family!”  He bustled me along to the car where Andy and the kids were sitting, and proceeded to enthusiastically greet them.
“You are living here how long?  (to Andy) You are working at the hospital?”  My wife will work there, she is a pediatrician.  (James, to Andy): “Ah, you are a doctor!” (the first of many times people will, upon meeting us, assume Andy is a doctor or ask me what role of my husband’s has brought us here).

James gave us his phone number, politely told us we would give him our numbers, and emphatically assured us we would be coming to his home for dinner soon, probably to his son’s graduation and quite possibly to visit his distant family and preach at his church shortly thereafter.

So on Saturday night, we ate dinner at James’ house.

James has lived in Kijabe since 1990 – prior to that he was living in poverty in North Eastern Kenya with his wife and 4 sons.  He brought a sick friend to Kijabe hospital one day, and while here he asked if there were any jobs available. There was a job in the laundry, and he has worked there ever since.  His wife and youngest 3 sons still live 5 hours away, and he and his wife take turns visiting each other when time and money permit.  His oldest son is training to be a pastor here at Moffat Bible College.

We met James at 6pm at the Supa Duka (imagine a general store from Little House on the Prairie, take away the movie lighting, picture windows and 75% of the size, and you pretty much have it), and from there we drove James to his home.  His one room home is made of what charitably would be called wattle and daub, but is more likely to be just mud/dung and sticks without the framework.  His wooden slat door has a padlock to keep out thieves.  Pieces of cardboard block obvious chinks in the wall, but do nothing for the 2 inch space between the tin roof and the top of the walls.  His house measures about 6ft x 10ft, a third of which serves as the sleeping quarters which are partitioned off with a sheet.  The main room has a small table and 4 chairs – at least on the night of our visit – and a small bench for a spirit burner stove.  The walls are decorated with grocery store calendars spanning several years.  He has electricity to a single light switch, and he and his neighbours share a single outdoor water tap supplied by a bore.

In this room, James had prepared for us a feast.  On his camping stove he had made us a traditional stew of yams, potatoes, sweet potatoes and cabbage, flavoured with green plantains, tomatoes and onion.  He explained that he had wanted to cook us meat, but there was none available – which more accurately probably translates to “it was too expensive”.  He had bought or made Mandazi, a Kenyan sweet bread, that the children devoured.  He had made a huge thermos of chai – sweet, milky tea.

We ate together, the 5 of us, by the light of one bulb with the radio serenading us with 1990s worship music.  We learned about his life.  We formed a blurry mental image of his wife Katherine, whose subsistence living has withered with drought, requiring James to send more money to buy food for the family.   We heard of his intense love for Jesus and his deep pride that his firstborn son will, in one month, be a fully trained pastor, the first in his family.  We prayed with him, for his family, and for ours.

Relationships in Africa are a complex and sometimes fraught process.  There is an unspoken expectation of reciprocity – that resources will be shared.  The experienced and the cynical will ask, what does this Kenyan want with my friendship?  I have a car – he does not – transportation will be expected.  I can afford a television and a fare home to Australia – he has to pay school fees and his distant children had only one meal yesterday.

James has made western friends before.  Indeed, his son’s Bible College fees are paid by some of them.

For now, he is a new friend who asked us to dinner, who has invited us into his life.  We will have him to dinner one night, possibly with his visiting wife.

And from there, who knows?

M.

The clasp on my watch is broken (30/5/11)

If you ask Andy and me how we are doing, overall you will get from us that we are doing well.  That we are settling in, we are making friends, and our life is starting to establish a routine and a rhythm, and we are seeing exactly why we’re here, why the doors opened for us to come and be adopted Kenyans for a time.

But the clasp on my watch is broken.  About 3 times a day, it feels loose and digs into my skin and nearly falls off.  And I wake up in the morning and it’s another game of find-the-accessory-in-the-bedlinens.

And amidst the peace and certainty, I really want to swear.

I spend a day at the hospital, assisting with the ICU management of a postoperative baby boy whose oesophagus didn’t form properly and has had an operation, and know that even though ICU isn’t my area of expertise and our resources are limited, I really am able to help, to encourage the pediatric surgeon, to offer some suggestions on management.  And even when I get a message before church on Sunday that his organs have failed and he has died, curiously I am doing OK – I know we did all we could with what we had, and if we were not here he would have had no chance at all.

And then I check my mailbox and find that a letter sent from Australia 4 weeks ago, still isn’t here.  And my mood alters.

These are the realities of culture shock.  Having a different landscape from my front window, the local market, different social norms, water that doesn’t come out of the tap for 12 hours, an underresourced hospital - these are the things you expect, these are the things you embrace.  These are the things you read about in books and stalk people’s blogs to prepare yourself for.  And then you congratulate yourself that you are coping so well, that you are open-minded and multicultural.

Stupid bl**dy watch.

Then I sit down and have some silence.  And allow myself to think, to pray, to listen.  To be honest with myself and with God, and say, I think I’m doing OK.  But today, I’m going to need some help again, to realise that if I am swearing at my watch, maybe I’m just burying the bits I’m not coping with – and instead, I need to face them, to talk about them, and to really and truly hand them over to a God who can handle them better than I can.  And as I do that, it becomes real, he does take the burden, and I can start the day again, actually feeling, deep down,  that I AM  doing well, and that we ARE truly starting to live life here well.

I think I’m just going to superglue the clasp on my watch.  I wonder what inanimate object will bear the brunt of my wrath tomorrow before I realise it’s just a …. camera.

M.

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Update 31/5 – Thanks for all of you who offered my assistance with my watch.  I have indeed superglued the clasp and am again serene.

We have maji (water)! (28/5/11)

Well, we had it before, but it was high in fecal coliforms (poo particles) and fluoride…which means regular gastro and discolored teeth.

A little background…The water network for Kijabe is a creative web of pipes and multiple water sources, and has no water treatment of any kind.  Management does an admirable job of keeping the water flowing, considering the significant elevation changes involved and limitations of the system.

One of the risks, which we are assisting in addressing while we are here is the risk of loss of supply pressure.  On Monday, I will be going on a site visit to one of the hospital’s main supplies, a spring named ‘Monkey Corner’ about 8 kms away.  We’re taking along a pump manufacturer to provide us with some idea as to how to upgrade the (undersized) 30 year old pump which has been valiantly doing its duty, and is in need of replacement.   Hopefully when this project is complete, loss of supply pressure will be a thing of the past.

It’s just not a good look when a hospital runs out of water…and in the 4 weeks since we’ve been here, there’s been 24 hours where the hospital had no water. Anywhere.

Tamara Cook

Imagine the RAH running out of water…for 24 hours.  Or the Children’s Hospital of Philadelphia running out of water…for 24 hours.

That’s one reason I get all fired up and rant about doing infrastructure projects with excellence…do your job well, and no one knows you were even there.  AIC Kijabe Hospital and we want to see the water, power, and sanitation infrastructure here upgraded with excellence so that expansion and upgrade plans for the hospital aren’t limited by basic things like being able to run life support machines with reliable electricity, or water that doesn’t cause you to dehydrate from gastro.

Another risk for which we are looking to provide options for mitigation is water quality.  There’s been no formal water quality testing for about ten years, by my review of the data, so that’s job #1.  Once we’ve got some data, we can investigate options.  One thing we do know is that the water is high in fecal coliforms–common bacteria which cause gastro, and can be removed by simple water treatment processes.  We also suspect the water is very high in fluoride (as it is, apparently, for much of East Africa, I have been told), and this can cause permanent discoloration and cracking in children’s teeth (fluorosis).

S0 everyone here uses expensive water filters to remove the bacteria, and additional fluoride removal processes (such as distillation or an activated aluminum filter) if they have children.  Or they buy bottled water from the store (as we have been).

Being a bit of a greenie, I wasn’t wild about the huge amount of electricity it takes to run a distiller, and I’m not a fan of buying bottled water for two years due to the plastic waste generated…so we bought a dual filter to take out the poo particles and reduce the levels of fluoride.

*beam*

We bought it online from the US, as our good friend Tamara was coming to Nairobi from Seattle, Washington on a business trip and kindly offered to sherpa some things over here for us…never one to turn down an offer, we also added to the list three books, 8 tubes of child’s paint, and some computer bits!  Tamara is a microfinance expert with the Bill and Melinda Gates Foundation…by day.  To us, she is a good friend and loyal sherpa.  Here she is during her visit to Kijabe last weekend, posing with the stuff she brought over.

Unfortunately, our water filter didn’t arrive to Tamara’s house in Seattle until two hours after she left.  That was not a happy day in the life of our household.  Thankfully, she had a work colleague who was flying over a day after she left, and he was kind enough to bring it over for two people he’d never met.  What a guy.

So we picked up the filter from his hotel in Nairobi today, and set it up…you know, I didn’t know how much it was weighing on me that we didn’t have a reliable and safe source of water until I plugged it into the tap and voila…safe water!  It was like a weight lifted off of my shoulders.

We have water!  Time to make some coffee.

Our new car (24/5/11)

Executive summary for the women:  We bought a car.  The car seats fit (it even has baby bolts), and it is silvery-white).

Full text for the men:

Well, not “new”, exactly!

We’ve been looking and praying for the right car that fit the following criteria:

-put a beefy chunk of metal between us and a potentially unsafe Kenyan driver
-4WD (essential for navigating some Kenyan roads, and even some of Kijabe’s!)
-7 seater (to carry our family + guests/visitors/friends)
-A Goldilocks engine:  not too big or too small, just the right size
-Preferably a Toyota and not a Land Rover (better maintenance and reliability)
-Stereo with an aux out jack to plug our iphone into (a serious consideration)
-not too flashy or pimped out (carjackings and theft are not unusual here)

We were fortunate to be introduced to Kamal, a man who runs the mechanic and tourism shop at NEGST in Nairobi, and who acts as a buyer’s or seller’s agents for folks who want cars…we gave him our requirements, and he found us this car in two weeks!

It’s a 1997 Toyota Prado TX diesel 3.0L.  Imported from Japan in 2004 (most cars are), and in good shape.  4WD’s cost roughly here what they do in Australia (which is to say they are very expensive, compared with the USA), and we were pleased to get an older car in very good shape for a reasonable price.

We took it off road in Hells Gate National Park yesterday, and it did brilliantly.

We have wheels!

Family time (23/5/11)

The last month has felt a bit like a whirlwind – settling into a new house, orienting and starting work at the hospital, Andy starting to meet with people at the Bible college and hospital about various roles, daytrips into Nairobi with 90+ minutes commute each way to buy groceries, home basics, furniture.  Even in the moments that we haven’t physically been super busy, I think I have always felt like my attention is split 5 different ways.  So even though I’ve had days home with the kids, I don’t think I’ve felt like I’ve really been totally there with them – while painting with them, I’m thinking about my work schedule and how it’s going to fit, while cooking with them I’m mentally writing a grocery list so we don’t forget to get water, while playing dolls with Riley I’m reminding myself that I need to email about my work permit…

One of the things we’ve decided as a family is that our weekend is going to be Sunday/Monday.  I will need to work probably every other Saturday, and Saturday is often also a day of catching up on chores, and will become a day of work for Andy with preparations for teaching at Moffat Bible College.

So today was family day.  It’s the first Monday we didn’t have to go to Nairobi, so we decided to drive 45 minutes to Hell’s Gate National Park.

Despite its name, Hell’s Gate is wonderful.  It’s a small park, with a 16km loop trail, where zebras, giraffes, gazelles and other big, safe animals live.  Apparently, there’s also the occasional lion, leopard and cheetah.  But it’s a park that you drive to, then get out of your car and mountain bike or walk around, and there are campsites.

Today there was no-one there, except for 2 other mountain bikers we saw.  We got to drive around and spot animals with the kids, and then get out of the car and see how close we could get to a zebra before it got scared.  Liam found the giraffes before we did, and together we trundled over the grass to get a closer look.  We talked about gazelles and watched them run.   We ate lunch together at a cafe near a lake, and played together on the playground.  And the whole time, I was there.  And I didn’t have to be anywhere else.

Parenting can be such a tightrope walk.  Between consistency and love, discipline and grace.  We’ve had lots of those moments in the last few weeks.  It’s not surprising to me that today, when we could spend time with our kids, just with them, that they blossomed.  That the consistency and discipline weren’t something we needed to stress.  That love and grace are easier when your kids feel loved and important and don’t need to try in any way they know how to get your attention.

I love my family.

Dreaming big… (17/5/11)

It’s exciting to get in at the ground level on a project, and last week that’s what I was able to do.

The paediatric facilities here at Kijabe are currently somewhat… how does one say this kindly? Hodge-podge. Like any facility with uncertain funding, it started out humbly and has been expanded as need and money have coincided.

The outpatient facilities are basic, without enough rooms to see the patients efficiently. The adult casualty (emergency) department, with its 8 beds, will quickly take care of a critically ill child, if there is room, but finding the correct sized pediatric equipment amidst the adult-focussed space takes a miracle.

The inpatient paediatric unit (top left) has beds for 40+ paediatric surgical patients and medical patients, with 2-8 patients per bay. The inpatient facilities are crowded, with patients often in hallways. A resuscitation for a suddenly deteriorating patient takes place on the patient’s bed in a shared ward with 7 other anxious patients and their families watching – if the nurses can find the crash cart, and if it’s adequately stocked.
To reach the other inpatient children, you then walk outside past the toilets and the washing line….

… past the tent that currently houses rehab facilities (it really is a tent, with a tin roof), to the “Amazing Baby Centre” annex (below) where 20+ neurosurgical children stay. Over 1000 neurosurgical procedures are done every year here, including over 500 VP shunt insertions.

There is no office space at all – if any of us want to study or do paperwork, we find a spare chair in a corner of the ward, beg for use of the ward clerk’s computer or go down to the hospital basement conference room to try and teach.

So when one of the paediatric surgeons asked Jennifer, Immaculate and me to look at the plans for the new paediatric wing, it was like Christmas morning for me.

Bethany Kids is a US charity which runs the surgical side of paediatrics here at Kijabe, and is in the process of finalising plans for our new wing. This wing will increase our bed count from 67 to 80 with 2 treatment/resuscitation rooms and a high dependency unit (HDU), as well as a much needed expanded outpatient clinic area / emergency department. It will be like a mini-Children’s Hospital within AIC Kijabe Hospital.

It is such a joy to be able to be a part of the discussion – how should a resus room look? Have we thought about pandemics and can we make sure the bays can be cordoned off from others? How will traffic flow work between HDU and the operating theatre? These questions make me so excited.

These plans are at least 2 years away from fruition – and in Africa, that usually means more like 5-10. So I don’t know if I’ll ever see it – but it is so much fun to dream, to want excellence, to care about the future of a place I’ve only just met.

M.

Questions without easy answers (14/5/11)

“Dear Kijabe Hospital,
I ….  was admitted on ……..  I was diagnosed with hypertension and I was 27 weeks pregnant.
I was told that the child I was carrying could not grow and so she was removed.  On removal she was found to be only 855 g and she was taken to the nursery.
Due to the huge bill I incurred in the hospital which upon the time I was discharged I could not clear, I could not afford to pay the money which could help my baby grow.  I have so decided to give the child to the hospital.
Yours faithfully….”

What do you do when you read such a note?  The hospital here charges for its services, as does every government-run and mission hospital in the country.  A hospital bed is charged at 200KSh (about $2) per day, drugs are obtained at deep discounts and charged at close to cost.  The hospital staff are paid Kenyan nurses and some doctors, with most of the doctors volunteers.   Yet after 2 months, this little princess, alive and thriving, has accumulated a bill that is prohibitive for her mother.  A mother whose decision is difficult to question when none of us has walked in her shoes.

That baby is nearly 2kg now, beautiful and ready for discharge.  We haven’t been able to contact mum for weeks.  Social work is working on finding her extended family, and in this culture where family is everything, where any wealth obtained is always shared, I know this child will find her way home.

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Last week,  we received a surprise admission.  A surprise because after asking to be transferred to the children’s hospital, this little girl had left us.  Born with a cleft lip and palate, heart condition, and probably several other problems we haven’t found yet, with us she could not receive heart surgery.  She was on an arsenal of old-man drugs – digoxin, lasix, sildenafil, and as stable as we could make her.  And so her parents got together the money for her admission in Nairobi under a cardiologist for an opinion, and a charitable organisation paid for her ambulance transfer.

And then she was back the next day.  It turns out the hospital required a deposit for high dependency care of 20,000KSh ($200) – an astronomical amount in this rural area where unemployment is around 40%, and if a menial job can be found it might pay around 8,000KSh per month.  They were then advised to try the nearby government hospital, where after 5 hours of waiting to talk to somebody they gave up and came back to Kijabe.

The question is – what was lost and what was gained?  This baby has multiple problems, and may have an undiagnosed genetic disorder.  Is the heart condition what we should focus on?  Should we spend the money finding what else is wrong?  Would any or all of it be fixable?  Does this baby have a condition which would cause her to succumb before its first birthday no matter what we do?

She’s been deteriorating over the last few days.  She’s on a lot of oxygen, because the blood pressure in her lungs won’t let the blood get in properly, despite everything we’re doing.  I’m not sure how much longer she’s got.

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There are many wonderful stories I’ll tell you in another post, about lives saved, about babies snatched from death’s door who are now snuggled up to their mum’s breast back at home.  This was just the stuff that grabbed me today as I was in the nursery, filled to capacity with 20 babies and 2 nurses.

I wouldn’t be anywhere else right now.

M.

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Update 17/5 – The second baby above died today.  Her heart just couldn’t do it any more.  Sometimes, in the middle of our angst, our questions answer themselves.

On being generous (13/5/11)

By noon, we sometimes have had more than 4 people coming to our door asking for things.  Some are selling goods (our favorite is the tortilla lady), some are asking for money for medicines or school fees or for food.  We’ve come across a few people we suspect are just out to get a free lunch, but others are trying to build a relationship, and the money/food request is simply a part of the African relational dynamic:  friendship implies a material reciprocity to give when someone else is in need.

I find it challenging at times to deal with these frequent requests for assistance or to purchase flowers, tortillas, English muffins (who knew?) or samosas.

Knowing that I have limits, I am not God, and can’t meet everyone’s need helps.

But I am finding my generosity, or lack of it, being brought front and centre.

The pastor at the church we are attending, Africa Inland Church—Kijabe Mission, shared this story on Sunday:

There was a missionary long ago in Kenya who came and taught the people.  Among other things, he taught them the principle of tithing, and that you should try to give 10% to God.

One day, a boy came to him with a fish and offered it to him.  Aware that he had been teaching this boy the principle of tithing, he was also aware that they boy needed to eat, and was concerned for his health.

“Where are the other fish, my boy?”  he asked.

The boy replied, “They are in the river, and I am going to go and catch them now!”

I love this story.  This boy understood the principle behind giving.  It’s not about 10%, it’s not about how you give or when you give, it’s not about whether or not people see you giving, it’s not about how much you give compared to others.

It’s about being a generous person—being the kind of person, on the inside, who has a generous heart and wants to give to others and God.

In my experience, giving is not primarily about precedents in the Bible, or even God’s promises that we reap what we sow…it is fundamentally a reflection of my view of God and how he operates.

Is he a generous God?  Is he good, awesome, and loving?  Is the relationship between God, Jesus, and the Holy Spirit one of unselfish love and generosity?

My giving, then, is a reflection of the nature of God’s relationship with me and with his creation—unselfish generosity.

A useful litmus test for the ‘health’ of my picture of God and of my life with Him is my giving and how I feel about it.  Am I holding tightly onto my money and possessions?  Am I thinking constantly about how I am going to provide for the family, what my bank balance is?  Or am I at peace, and delighted to look for opportunities to give to and serve others?

What would a litmus test of your life show?  Is your picture of God, or of the universe that of a generous, safe place?

Settling in (9/5/11)

It will be 2 weeks tomorrow that we moved into our new home in Kijabe.  Acclimatising to this new life has in some ways happened very quickly, and in some ways I know it’s the start of a very long process.

Things that are easy:
- moving into a furnished home – in many ways it feels like we’ve been here for much longer than 2 weeks.  Having a fridge, a stove, an oven; being able to cook familiar recipes and have our home smell like ours.  Having the kids bedding arrive and their rooms feel instantly familiar.  Having 3 bedrooms – more space than we imagined we’d have – and a serene view from our front yard.
- making new friends -  when we arrived here, there was a welcome card from Megan, zucchini bread from Stacy.  Fresh baked chocolate chip cookies and a visit from Amanda and Erik, a scoping-out-Andy’s-mountain-bike welcome from Rich.  A huge smile and guide to the practicalities from Elisha and a guide to homemaking in Kijabe by Helen.  A novice’s guide to the markets and pasta dinner from Sue and Mark, a welcoming family dinner at the end of Jennifer and Scott’s stupendously busy work day.  A royal wedding high tea from our resident Brits Jacqui and Charlie, a 2nd birthday celebration with Rhett and Megan.  We have been so grateful to be embraced by this community, and it has made this transition easier than it had any right to be.
- having a job that is looking to be a perfect fit – Although I’ll not be a pediatric emergency doctor here (I will  be looking after paediatric hospital inpatients and newborn babies, both premature and term), I love the patient population, and I love the mix of staff.  There are Kenyan nurses, medical students from Kenya and around the world, junior doctors and consultants from Australia, Kenya, India, the US, Britain – all with a deep love for these people and a desire to train and equip, to mentor and serve.  The Kenyans are paid to work here, the expats are all volunteers.  It is a diverse group, with a passion for excellence and God’s heart to bring healing to individuals and an often struggling community.  It looks like Jennifer and I are going to be able to divide the duties to be able to spend precious time raising our kids while being the doctors we know we’re both called to be.  It is a real blessing to feel the dissatisfaction I felt in Adelaide slipping away – as much as I love my workplace and colleagues there, it was time to be here.
- seeing opportunities for Andy start to open up – Andy’s role has always been a little more nebulous than mine.  So in the last week as he’s started to have conversations with people about the possibilities, it has been exciting to watch.  Between Jim and Jullie, the eMi engineers here (who happens to be an ex-submariner on Boomers, just like Andy was – who knew?) and the animated discussion on the water supply here, and Paul and Dan at Moffat Bible College discussing their needs for people with a heart for Spiritual Formation (more on that in a future post….), it appears that Andy will also find a niche that was made for him here.

Things that take some getting used to:
- moving into a furnished home, with couches that are deeply uncomfortable, every window barred to discourage petty crime, windows that are either fully closed, or fully open to invite the bugs in.  A panic siren and light in case of trouble, knowing that the local policemen only have bicycles….  remembering to never turn on the tap for drinking water or teeth brushing, and to make sure there’s filtered water always on hand.
- internet access that isn’t lightning speed – or even available much of the time.  As a mother of preschoolers in Australia, I have been so dependent on the internet for communication with the outside world – and now, without the physical communication with friends and family, it has felt pretty isolated.  So grateful that we seem finally to have a modem that is working…
-baking disasters when I fail to account for the altitude (grateful for the 2 Kijabe cookbooks I now have, with altitude-adjusted recipes!)
- not yet having a routine – I will start work officially next week, and have just been shadowing and orienting up until now.  But waking up in the morning and not being quite sure of what we would be doing – it has been a bit unsettling for the kids, and for Andy and myself too!  As things are progressing though, and preschool and playgroups get underway for the kids, we can see things starting to come together for our family to have a daily rhythm that will help us to feel like this is everyday life now.  I am blessed to have Jennifer as a colleague, whose move to Kijabe from Uganda was at least partially out of the desire to have her nuclear family living under one roof, with the opportunity to be involved in their teenage children’s lives – together, we have come up with a regular schedule that allows us to have fixed days in the hospital, with some times fixed for family while the other of us works.   I am so grateful God has put Jennifer and I together with similar hearts and priorities.

With all of this, I feel simultaneously settled and peaceful, foreign and frustrated.  Welcomed and embraced, distant and alone.  When I focus on myself, on the differences, things and people that I miss, things that I lack, I start to sink into a little pool of self-pity.   But I find that when I focus on my children, my husband, new friends, community and the unmistakable reminder that we are here because we have a certainty that this is where God wants us, I am doing well.

M.

The railroad tracks of apparent contradiction (3/5/11)

It was just under a week ago that we first took the steep, twisty, narrow road to Kijabe.  The stunning views across the Great Rift Valley were the first thing we noticed…breathtaking.  The people, and the ‘African massage’ you get as your car rattles over potholes the size of a golden retriever were the second.

We’ve been here nearly a week, and are settling in well…the kids have unpacked their toys in their room and created their own little nests.   We have unpacked our boxes and started to figure things out like how to bake at 7,000 feet elevation (you cut down on baking powder…who knew?), learning not to leave the windows open if you’re not home (the monkeys invade and go on a poo-tastic adventure),

Check out all the sweet dirt!

telling the kids that the three kangaroo-sized baboons in the front yard are not ‘doggies’,  and discovering that the water filter appears ineffectual…judging by the rumblings in our bellies.  We have had people bring us cookies and muffins to welcome us here since we arrived, and it has just been lovely.

Mardi has started work at the hospital, meeting patients and getting to know how they do things in Kenya.  We’ve started to connect with some of the local Kenyans here, as well as some of the doctors that Mardi will be working with, and their families…there are some amazing people here and it is humbling to be a part of their community.

Unloading new supplies

We are struck by what a place of contrasts and apparent contradictions Kijabe is.  It’s the stunning vistas over the Great Rift Valley…and the IDP^ camps in the valley filled with some of the 600,000 people who were driven from their homes during the post-election violence of 2007.

It’s the warm and welcoming generosity of the rural Kenyans who have welcomed us to Kijabe…and the lady who came to our door after dark last night with tears streaming down her face, with a story of domestic violence and could she please have money for a bus ticket to take her kids to her brother in Uganda.

View of Rift Valley from Kijabe

It’s the friendly building superintendent who encouraged us when we were feeling a bit low (and who shares my love for good coffee)…whose family was forced to move 4 hours away because of the 2007 violence and he hasn’t seen them for 6 months.

It’s the fragrant smell of hibiscus and bouganvillea in the air…and being woken up three nights ago at 4am because the hospital (100 metres away) was experiencing a violent robbery.

It’s the railroad tracks of apparent contradiction.

I recently heard someone* describe life this way–that rather than viewing life as a series of hills and valleys, good experiences and bad, they reckon it is more like following a railway, where you are simultaneously experiencing joys and sorrows.  There’s always something to rejoice about, but there’s usually also something to grieve at the same time.

Loo with a view?

I found this a helpful mental image of life pre-resurrection…experiencing the ‘already’ and the ‘not yet’ of the Kingdom of God, sometimes in sharp relief, wherever we are…Adelaide, Grand Rapids, Washington DC, Pasadena, or Kijabe.

Joy…and sorrow.  Happiness…and grief.  Love…and heartbreak.

We are feeling rather inspired to follow a master who says he came to “bring good news to the poor, proclaim release for the captives, recovery of sight for the blind, to let the oppressed go free, and proclaim the year of the Lord’s favor.”  (Luke 4:18).

And yes, we are settling in.

^UNHCR defines an IDP as:  ”Internally Displaced Persons–someone who is forced to flee their home but who remains within their country’s borders. They are often referred to as refugees, although they do not fall within the current legal definition of a refugee. The region with the largest IDP population is Africa with some 11.8 million in 21 countries.”

*That someone was Omar Djoeandy, Direction of SIM Australia, quoting, I believe, Rick Warren

A.

Eat this book

D Plus 1 (20/4/2011)

It’s not every day you have a flight layover in Dubai and feel like a celebrity being chased by paparazzi.

In this case the paparazzi were a Chinese tour group of about 40 and the celebrity was our four year old daughter and her blonde hair.  The friendly Chinese tourists provided a delightful interlude during our layover, and was an early reminder of what we’re likely to experience in Africa… ‘One of these things is not like the other…”!

Yesterday was D-Day for the Steere family as we invaded Kenya after roughly 30 hours of transit from Adelaide.  We had an uneventful trip; the kids slept nearly 8 hours on the long haul Melbourne-Dubai, and that helped immensely.  The kid-friendly flight attendants on Emirates are legen… (wait for it) …dary, and many hours of Thomas the Tank Engine and Bambi were watched.

We were met at the airport by Daniel, the SIM representative from the office here in Kenya, and he escorted us to our home for the next week in Nairobi, the Mayfield Guest House.  We’re here doing a bit of orientation and acclimation until we head to Kijabe.

This morning is D plus 1 and I write this short update with a full stomach after breakfast (papaya, oatmeal, and toast) and coffee.  The children, by the grace of God, slept from 7p to nearly 5a this morning…which meant we all got a good night’s sleep.  Hallelujah.

The sound of the distant adhan (Muslim call to prayer) from a nearby mosque which woke us up this morning, and the faint smell of burning garbage lingering in the air exist alongside the beautiful flowers lining the gardens here at the guest house, and the warm hospitality of the Kenyans we have met so far.  It’s a wonderful cacophony of sounds, smells, emotions, and sights.

We’re here, we’re safe, we’ve eaten and slept, and the kids are enjoying the little playground outside with Mardi as I write.  It’s time to start the day.

Thank you all for your thoughts, prayers, and Facebook encouragement…we’ve had as good a start to our time here in Kenya as we thought possible, and we are immensely grateful.

A

March 2011 Update

Click here for the pre-departure update recently sent to our financial partners and advocacy group.

Small things (9/4/11)

A few months ago, my diagnostic medical kit consisted of a stethoscope and a tendon hammer.

Also a few months ago, unbeknownst to me, one of the nurses at work started a campaign – in the lunch room in the Emergency Department, where people often share baked goods, fruit from their gardens, she decided to raise money to help us.   So on the table, she put a sign requiring people to make a donation in order to share of the bounty of others.  And she, and many others, brought in biscuits, cakes, home-grown produce, and started collecting small amounts to collect for Kijabe.

Today I have just packed my diagnostic medical kit for Kijabe.  But now it also contains a blood sugar monitor, a pulse oximeter for checking children’s oxygen levels, an otoscope and ophthalmoscope, 3 more stethoscopes and a large supply of batteries, as well as some money that I am able to put into a needy patients’ fund that the hospital has for children who need medical care over and above our capabilities who cannot afford it.

The nurses in their tea breaks raised over $700 to put towards needy kids in Kenya.

I am so grateful for these people, and for the incredible men and women who have supported us with single donations or who have committed to supporting us on a regular basis.  People giving what they can – and every little bit helps.  We still haven’t raised all the money we need for ongoing monthly support, but we keep getting incrementally closer, and we feel so blessed.

M.

A surprising orientation (4/4/11)

Some of you know that one of the reasons we have been waiting until April to go to Kenya is that part of SIM’s process for new candidates is a compulsory candidate orientation week, or SIMCO.  It’s usually held once a year, and by the time we’d found out about Kijabe last year, we’d just missed SIMCO for 2010.  So in planning our timetable to move, SIMCO was an immovable object that I honestly found a little frustrating.

So it turned out to be far more than an immovable object.  We spent the week of March 20-27 in Bellambi, NSW, having one of the most incredible weeks I can remember.

I have to say, I was a little nervous about going to a conference centre, on public transport, to a small beach town with no easy means of escape, to spend a week with people I’d never met who were quite possibly zealots without a discernible connection to the world that I’m familiar with.  Instead, we met and connected with 19 people whose lives are now interwoven with ours in a way I can’t quite put into words.

We had sessions on SIM’s vision and heart, which is essentially to empassion and enable local churches to do the stuff Jesus said, both locally and globally.  To help equip churches around the world to disciple each other – for mission fields to be receivers and senders of people, to empower each other to minister in a holistic way to a world that is hurting – physically, emotionally, spiritually.  This, I want to be a part of.

SIMCO 2011, Bellambi Beach, NSW

We had practical sessions on cultural differences, CIA tests on language acquisition, curiously entertaining sessions on the SIM manual (how is that even possible?), and have you thought about your taxes in the next couple of years?

We had powerful times of listening to other SIM missionaries and to each other’s journeys thus far, and getting to know these remarkable people and families – most of them our age, with kids our age, with families who will miss them as much as ours will, some of whom understand why, and some of whom do not.

We had precious times of encouraging each other, listening to each other, praying for each other.

At the end of a week, we discovered that we now had a new family – new people that it was going to be hard to say goodbye to, that we wanted to keep walking alongside somehow, despite the inevitable physical distances between us.  People that are walking a somewhat parallel yet unique path  to ours, and whose journey we cannot wait to hear more about.

If you want to know more about some of these wonderful people, all around the world, sign up for SIM’s magazine here.

M.