Joseph & indefatigable Mercy (28/6/12)

I promise an update about the CPAP machines is coming soon – and it’s all good news, and wouldn’t have happened without all of you!  But first, I wanted to tell you a story about one of the families you’ve helped.

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Mercy, our chaplain, is one of the most incredible behind-the-scenes members of our team.  Every day she ministers to the children and mothers on the pediatric medical and surgical services – encouraging, playing, advocating, praying.  And every day I work on the ward, she greets me with a smile, a word of encouragement, a blessing.

One of the essential things Mercy does for us is helps us figure out who is truly in need.  Some people here can afford health care, can afford the national health insurance fund that covers some, if not all, of a hospital bill if their child falls ill.  Some people have large extended families or herds of cattle in which reside their wealth, and can pay to recover from illness or injury.  But some just cannot.  And Mercy helps us sort out who is who, so that our Needy Children’s Fund assists those who need it most.  Usually it is a child who I have taken care of on the ward or in ICU, but sometimes it is an orthopedic or plastic surgery patient that I didn’t even know – and Mercy knows these kids need help just as much as any of the others.

Joseph

This is Joseph’s story, as told by Mercy.

“Joseph, 8yrs old, came to the hospital early this month. He had chronic osteomyelitis of his leg and foot.  His mother, Mary, is a lady who looked very sad. The father Samuel has no permanent job; he works here and there for his family’s needs. This is very common in our country. When I talked to him today, he was a very discouraged father. They don’t have any valuable property like a house or a garden; he rents a room for his six family members. He seemed like a responsible young man but with little income.

He was in tears when I met him and his wife in the hospital corridor looking for me. After a long talk, listening to their story, I was touched. The mother was in tears because she had waited to get out of hospital for days, trying to find money to pay the bill. When I confirmed their story, Dr. Mardi appeared, sent by God, and after shortly narrating their story, she was able to sign for their bill. Thank God for our busy doctors who listen to people’s problems even when they are very busy.

Because of God’s great love that is extended by the Needy Children’s Fund, officials and donors, this couple left the hospital encouraged thinking more of God’s greatness and His unfailing love.

Mary, Joseph’s mum

This morning when I was having a quiet moment with a number of children, Joseph accepted Jesus as his savior. I gave him a Bible that he cherishes. His mom promised to help him grow in Jesus. She is a Christian and they will read the Bible together. They asked for my phone number and I’m sure I’ll hear form them soon.

Thank you for giving to the needy children fund. What a dynamic way of  spreading God’s love – Amen.”

- M.

Can you help us save some tiny babies? (21/6/12)

Have you seen those ads on TV – “Buy now!  This offer won’t last!” ?  This is where we find ourselves right now in the Kijabe newborn nursery.

We are one of not many hospitals in Kenya that is able to provide help for tiny babies born prematurely.  Some of you have read my posts about babies like twins Faith and Esther, who have survived because we’ve been able to given them a life-saving mix of pressurised oxygen and air (CPAP) while their immature lungs attempted to catch up to living outside the womb.

Our hospital can provide CPAP for two premature babies, with 2 wall sockets in our nursery pumping out the right mix of air and oxygen.  But if the babies aren’t able to breathe for themselves the air alone is not enough, they need a ventilator – and we don’t have enough wall sockets to run those in our nursery.   We struggle then with heartrending questions:  does our 5-bed hospital ICU have an open bed for us to put this baby on a ventilator? Or are there other adults that need those bed after surgery, or for pneumonia, or after a heart attack? And even if there is an ICU bed, how long will the baby need the ventilator?  If it’s more than a few days, we know it means that others won’t be able to be saved in ICU.  And so the babies stay in nursery – and some of them don’t survive.

This week we’ve now found a way to essentially increase our number of ICU beds from 5 to 7, and it will cost us only $1900.

Recently, we’ve heard about a new machine made in the UK – a CPAP oxygen concentrator.  This remarkable device requires just electricity to work – and the electricity converts everyday air from the environment to just the right mix and pressure of oxygen.  A lifesaving machine, requiring only a powerpoint to run.  If we had one oxygen concentrator in our nursery, we would be able to use it to give CPAP to up to 2 babies.  So we could give CPAP to double the babies, or we could use our current wall oxygen sockets to set up 2 ventilators instead while CPAP is provided for 2 babies with the concentrator.  We could help babies breathe without having to rely on our 5 precious ICU beds upstairs.

These oxygen concentrators usually cost 1500GBP ($2300) each, and we have been trying to figure out how to raise the money to buy one or two of these machines.  After paying for them, we’d have to ship them, and when they got to Kenya we’d have to wait the sometimes months that it takes things to be cleared from customs.  Once transport and customs duty is added, the cost for a single machine goes up to around 2200GBP ($3400).

I just got an email yesterday – the company that makes these machines is coming to Nairobi at the end of July for an anesthesia conference.  They are bringing over some of their anesthetic machines, and are also bringing one of the CPAP oxygen concentrators.  They’ve asked:  Would you like to buy the demonstration model when the conference is over?  It will never have been used on a patient, just used to demonstrate its function to the people at the conference.  Oh, and by the way you can have it for 1200GBP (~$1900).

What’s even more incredible is that we have a neonatologist coming to work with us from August until March – and if we get this machine now, we can bring the ICU ventilators down to the nursery and actually have an expert doctor train our nurses and junior doctors on taking this next step forward in advancing our care of babies here in Kijabe.

But I don’t have the money for the machine.  This is a “Buy now!  Supplies won’t last!” kind of offer.  I have told the company I’m interested – and that I really hope to have the money when they come in July.  And now I’m just praying it will come through.

Can you help us?  Do you or your business have $1900 that you would consider donating to save many babies’ lives?  I would gladly engrave a plaque and attach it to the machine, reminding all of us and those to come of some people in Australia or the US who cared enough to  help a baby they’d never met in far off Kenya.

If you can help, please comment below and I’ll get in touch with you – and I cannot tell you how grateful our team and mothers will be.

- M.

Mai Mahui Youth Soccer (18/6/12)

I took the spine-rattling drive down to Mai Mahui this afternoon to watch our friend John play soccer.  I had heard from him that his team had been doing well, but I was surprised by how good they were … they were really good, with some really talented players, playing as a team despite not having a coach.  They won 1-0, with John providing the assist on the game-winning goal.

Mai Mahui is the closest “big” town to Kijabe, located about 6 km’s downhill at the base of the Rift Valley.  The road to Mai Mahui is a rough switchback down the mountain, with exposed rocks and boulders … making it seem farther away than it actually is.  It’s a rough town, which in Kenya means ‘don’t stop here unless you have reason’.  It’s a convenient stopping-off point for truckers carrying shipping containers from Mombasa on the coast to the interior of Africa, and accordingly has heavy prostitution and prevalance of HIV/AIDS.  It’s not the kind of place you visit when you come to Africa on a holiday, let’s put it that way!

John does some gardening and outside work for us, we’ve written about him before.  He’s an orphan, and lives in MM with his grandparents and sisters, walking the 6 km’s to and from Kijabe each day along rough trails.  His passion is soccer, and in the last month I’ve been able to attend two of his games.  I took the kids the first time, but blonde Australian kids + curious African kids = lots of hair stroking, crowding, and hordes of fascinated children following them everywhere.  Needless to say, Riley and Liam were not overly fond of being a public spectacle, and so I went to today’s game alone.

a rare moment of solitude for Riley

John’s team plays on a dusty soccer pitch at a local elementary school, with not a blade of grass anywhere in sight.  There are some little folds in the ground carved by runoff from up the mountain, and every now and then a well-placed ground pass would inexplicably bound into the air to the chagrin of the kicker as it hit a corrugation in the ground.

John kicking a shot on goal

John’s team is the “Mai Mahui Youth” team; they play at the County level in the Kenyan soccer league system.  This is structured similar to the U.K. soccer leagues, where only the top teams play at the ‘Premier’ level, and the top teams in each of the hierarchical levels below the Premier league have a shot at advancing to a more competitive league.  The team was started only two years ago by a local youth worker trying to find a way to get the unemployed youth in town doing something constructive (more on this below) and entered at the lowest ‘District’ level, and to everyone’s surprise, they won their District last year.

So this year they are playing in the next higher league, ‘County’ … and, again to everyone’s surprise, they are top-ranked in the County this year … meaning if they continue to do well, they will advance next year to the ‘Provincial’ league.  These are boys between 16 and 22, most of whom don’t have jobs or any prospect of employment, and this soccer team gives them hope and purpose.  They practice twice a day most days, John tells me … often meeting at 5:00 am to run up the mountain from MM to Kijabe and back down again.  After which John walks back up to Kijabe … to do manual labor!  No wonder he’s in great shape.

The opposing team’s replacement goalie on a goal kick. He was sent in as a sub when the primary goalie was knocked out.

As I watched the game today, I was struck by a few things:  the family of goats feeding in a culvert of trash adjacent the soccer pitch.  The little clouds of dust that lept into the air whenever the ball bounced, or a foot pounded.  The 3 minute delay-of-play that occurred when a goalie deflected a well-placed shot on goal into the air, and the ball flew into a building with no roof, to which no one had the key, requiring an enterprising onlooker to scale the wall and throw the ball back into the game.

snacktime for goats, soccer field to the left through the bushes

The lack of any kind of water or juice, much less Gatorade, available to the players on the sidelines.  No cushiony grass on the field, resulting in some scrapes and blood from normal dives.  The opposing team’s goalie getting knocked unconscious during a midair collision, and revived with a bucket of water on his head before he was led off, staggering a bit.

But the highlight of today was meeting Bernard.  I guess you’d call Bernard the team manager; he started this team (and a younger team for 10-16 year olds) a few years back and is the guy who keeps it running.  He lives in Mai Mahui, and worked as a youth worker for several years before hitting on the idea of starting a local soccer team to help local youth become, in his words, “aware that there is life in Kenya beyond the black hole of Mai Mahui”.

Bernard, team manager

We talked for about 30 minutes or so on the sidelines of the game, and he shared with me his passion for helping young men in the area.  He told me he learned in years of youth work that if he promises to bring a soccer ball to a youth event, he’ll have a packed event and a captive audience.  So he started youth soccer teams in Mai Mahui as a vehicle to teach these young men about HIV/AIDS, teamwork, leadership, and give them an opportunity to experience the outside world as they travel to away games.

He got a bit more than he bargained for … Despite not having a coach, any sponsorship, and sometimes not able to afford the petrol to get to an away game, the team has come together and defeated almost every team they’ve played over two years.  And now they are facing the very real prospect and significant honor of advancing to the Provincial league (one step below the National league) without any sponsors to help them buy uniforms, travel to away games, and hire a part-time coach.

Bernard told me that he found a sponsor to buy cleats for the team a couple of weeks ago, meaning they have their own cleats for the first time … just enough so that the players on the field have them, but not enough for everyone, meaning a player coming off the field for a substitute quickly takes off his cleats so the oncoming player can wear them … regardless of the size.

A sub, waiting to go in and swap cleats with the off-going player

These boys are good.  I mean, they are really talented.  And for many of them, playing on this team and practicing twice a day is all they have to take pride and find meaning in.  Bernard told me they desperately need a sponsor if they are to continue, and especially if they advance to the Provincial league next year … they need uniforms, enough cleats for all players, and a coach.

This is the joy and the challenge of being on the ground here in Kijabe … surrounded by need and opportunity, so many good things we could be doing … but we can’t do them all, or we’ll be stretched too thin and not do anything well.  So, for now, we’ll continue to encourage John, enjoy these games, and be inspired by men like Bernard.

John kicking a curving corner kick 

Stages and Starbucks (15/6/12)

This morning, Riley, Liam and I had the privilege of attending Caleb Myhre’s graduation ceremony at RVA … Caleb is the second of four children in the Myhre family, and in the always-on-call life that is living and working in a small African mission hospital, Jennifer and Scott are more than co-workers to us … they are mentors, good friends, and family.  The Myhres raised their family and worked at a mission hospital in Uganda for seventeen years before coming to Kijabe during their kids’ high school years at RVA, and so this graduation ceremony had special meaning for them.

At Caleb’s ceremony today, I was unprepared for the emotion I experienced.  It was more than the tears in his graduating class, many of whom have spent their entire lives in Africa despite the fact that they hold South Korean, American, Australia, British, or Canadian passports, and are like family to each other at RVA’s boarding school … more than the normal emotion-inducing milestone that a graduation or marriage is for a parent … I was moved by what this all means, and by the thought that I might be experiencing this one day.

Scott, Caleb and Jennifer

The child who has grown up in Africa and doesn’t fully know life in any other culture, going away to another country to university, where the only real thing they have in common is the seal on his passport … the parent who has braved the risks of raising a family in the under-resourced world, and then says goodbye to their child to go off to university on another continent, in a culture that is not really their own.  There is a term for this amongst missionaries and expats…”third culture kids“.

After this period of reflection and tears, it was high time for a little lighter fare, and so the kids and I took our weekly trek up to the primary school library, where we unloaded our laundry basket full of Berenstain Bears, Richard Scarry, and train books, and refilled the basket with…new Berenstain Bears, Richard Scarry, and train books.

And then back home to unpack the latest shipment of books from Renovare.  They’ve partnered with us to deliver the spiritual formation class at Moffat Bible College, and this was their second shipment of course materials … including nine copies of Celebration of Discipline by Richard Foster, and a new compilation of classic Christian writings, 25 Books Every Christian Should Read:  A Guide to the Essential Spiritual Classics, with selections from each book.  And last, but not least … two bags of Starbucks coffee.  Now these are people who understand spiritual formation!

Spiritual classics from Renovare

Coffee!

This afternoon it was off to Moffat, to attend the farewell party for Rich and Kathy Harrell.  Rich and Kathy are heading back to California to retire after 35 years as missionaries in Africa.  They are the kind of people you wish you could put in Calvin and Hobbes’s “Duplicator” and just make more of … encouraging, joyful, wise, passionate about excellence.

Rich and Kathy

Rich was Academic Dean at Moffat when I arrived last year, and I sought him out for advice before I taught my first class.  Among his wise pearls imparted that day was:  ”In each class you’ll have students from a minimum of 5 tribes, most of whom have lost one or both parents, all of whom come from poverty, and all of whom speak English as a third language … I suspect you are going to be a great blessing to them, and they will be a great blessing to you.”

He was right … I’m not sure who has learned more from my classes … me or them.  It’s a close call.

A few hours later, early evening, I receive a phone call notifying me that the board of elders in the Kijabe area has approved all of the 7 proposals that I presented them yesterday on behalf of the Water Committee.  First off the bat is new water tanks for the community, which will immediately alleviate the water shortage being experienced by the community.  Next off the bat is a new water pricing structure to encourage conservation and fund capital improvements.  After that, a change to how water is managed in the Kijabe area … we’re introducing “Water Supply Zones” based on elevation, each with their own Main Supply Tank and multiple sources of water.  We’ll have five of these … you can see four in the attached graphic.

Kijabe Water Supply Zones

Today was a day of being reminded of something I learned from managing infrastructure projects … at any given time, a project is in one of three stages:  birth (development), life (delivery) or death (commissioning and closeout).  And each stage has a different “feeling” to it … a different level of excitement, energy or work culture.  Some people like the birth and life stages more, and join a project at the beginning, and quit before the end so they can move on to a new one … and some enjoy the “death”, the closeout of all the details, disposing of assets, and final paperwork.   And, often, in a program of multiple projects, you are experiencing all three at the same time on different projects.

Today I was privileged to experience all three at the same time:  the “life” of a graduating senior, the “death” of a retirement ceremony, the “birth” of a growing relationship with Renovare, and the “birth” of a new season of adequate clean water in a community.

-A

Being unbusy (12/6/12)

The Hospital made the decision this week to commence construction immediately on the Sanitation Project.  We don’t have the money for it yet, but our leaky, oozy, and in-places-nonexistent septic system has become an unacceptable health and environmental hazard … so we decided we couldn’t wait any longer.

For the detail-interested:  the project involves a complete replacement of the existing sanitation system including decommissioning of the old and undersized septic tanks, and constructing a basic wastewater treatment plant (new transfer pipe, grit chamber, flow stabilisation chamber, and primary and secondary treatment ponds) in their place.  This is one of the “Big Three” projects (water, electricity, sanitation) which will define the future of Kijabe Hospital for the next 20+ years in terms of core infrastructure and sustainability of operations.

Part of my work here in the last year has been to work with the Engineering team to develop a concept design, budget, and delivery plan for this major project, and so I was stoked when it received the go-ahead.  I immediately went into overdrive to generate construction and procurement plans.

But something just hasn’t felt quite right … instead of being excited, I have sensed in the last week a hesitation, a lack of passion … how are we going to successfully deliver this project on top of everything else going on?  How am I going to fit in the additional work of this project alongside teaching at Moffat, taking MDiv classes, coaching and mentoring at the Hospital, delivering the water projects, being a father and a husband, and supporting my wife to fulfil her calling as a paediatrician and medical administrator?

Where are we going to find the money to complete this project, so that it doesn’t end up like so many other African infrastructure projects … half completed, with bits of rusty iron and concrete left out in the open because the money ran out or the aid organisation left?

Why yes, that is a goat crossing a stream of raw sewage

I can’t see how it’s going to work.  And I just don’t see how I can fit it in.

I was reading today in Eugene Peterson’s excellent autobiography, The Pastor,  about Roger Bannister, the four-minute miler.  Roger described in his own autobiography what his life was like following his high-profile athletic success.  He was no longer breaking running records, and so he compensated by working harder and harder.  He described himself as a carpenter who “made up for his lack of skill by using a lot of nails.”

I am transitioning from a decade of my life where I have been occupied with achievements and outcomes:  submarine officer, completing a Master’s degree, big projects, speaking engagements … and now, leaving that all behind and moving to a different culture and a different role.

I am trying to slow down, trying to relax … but I am afraid of failing.  I can’t help myself.  When the Sanitation Project gets the green light, I jump out of my chair and rush to help.  I don’t have any margin in my calendar; I am a resource which is 100% utilised, to use the project management term, but I jump anyway.  I am under the influence of busy-ness.

But this isn’t who I want to be.  I don’t want to “use a lot of nails”.  I want to be someone who prays.  Someone who trusts, genuinely trusts God.  To be reflective and responsive in the presence of God so that I can be reflective and responsive to those around me.

I want to be someone who reads and studies.  Peterson notes in his book that the culture in which we live (even here, in a “ministry” context in rural Africa) can squeeze all the God sense out of us.  It requires detachment and perspective to be aware of the temptations around us.  Including the temptation to do more, feed an over-reaching ambition, try to run the world, control what happens.

I want to be someone who has time to be present to people in unhurried conversations so that I can be part of their growth and we can share life together.

I want to have time read stories to my kids.

David wrote in Psalm 131 more than 2500 years ago something that resonates in me, now:

O Lord, my heart is not lifted up,
my eyes are not raised too high;
I do not occupy myself with things too great
and too marvellous for me.
But I have calmed and quieted my soul,
like a weaned child with its mother…

Do you feel like you’ve lost the forest for the trees?  Is it difficult to see “how it’s all going to work”, or how you’re going to “fit it all in”?

You might like to join me in praying this Psalm, asking the Lord to help you keep your eyes “not raised too high”, but to have a calm and quiet soul, asking the Lord, “what do you want me to spend my time on?”

And then go and do those things, always on the look out for the temptation to embrace unthinking busyness.  Be unapologetically ruthless about saying “no” to those things which others can do, and to which you aren’t called to do at the moment.

-A

Avalanche (5/6/12)

8 months old is the most delicious age. Chubby little arms and legs, the desperate start of an uncoordinated crawl. The first “mamas” and “dadas”, little fingers finally victorious at picking up tiny objects.

Ava came to us at 8 months of age. But instead of roly poly deliciousness, she was skeletal – 3.5kg, gaunt cheekbones in a garish caricature of how a baby face should be. Ribs clearly visible, arms no thicker than your own big toe – a shell of a baby, her appearance reminiscent of a Holocaust victim. Vacant eyes, devoid of hope.

We tested Ava, pretty sure of the result before it even came back – both Ava and her parents were HIV positive. Her immune system destroyed by a vicious virus, she came to us malnourished, with thrush, aggressive pneumonia, TB, and probably a blood infection with possibly more. Her desperate body trying to fight too many battles at once, and losing.

The night after Ava arrived, she started to gasp, and she was taken to intensive care and put on a ventilator until she spat out her breathing tube. The next morning I saw her and had to have one of the hardest conversations I’ve ever had with a mother.

I told her that Ava was going to die, and that she was going to probably die that day. And that spending her time in intensive care was not going to help her – that she should be made comfortable back on the pediatric ward, but that if she stopped breathing there was nothing we could do.

I made sure that Mum understood her and her husband’s HIV status, and she did. They wanted to wait a couple of weeks and pray for healing before starting HIV treatment.

I made sure that Mum understood that if she was treated, and had more children, that the virus may not be passed on to them, that future children wouldn’t have to suffer like Ava had done.

She turned to me with a weariness in her eyes that I haven’t seen before. She asked me – is there a way I can not have any more babies, and my husband not find out?

It took me a minute or two to find words.

I gently explained that a permanent solution requires surgery, and that she would need to come to the hospital for that.

She looked away, defeated, no further conversation desired.

This mum has 5 other children, the youngest 8 years old. None of whom are HIV positive. It is likely that she or her husband acquired the infection some time in the last 8 years, and had infected the other. And neither one has been admitted to hospital for a contaminated blood transfusion.

A marriage in which one of the partners has acquired HIV/AIDS.
A marriage in which no discussion can be had about options for childbearing.
A marriage in which irreparable destruction has been wreaked on each other and their youngest child.
An avalanche of multigenerational grief.

Ava died that night. Her mother sat at her side, knowing what was to come and powerless to intervene.

This mother comes from a tribal group in Kenya in which only 48 percent of girls enroll in school, and only 5 percent of those who enroll reach the secondary school level. Many girls are circumcised at a young age and married before the age of 15 to men chosen by their fathers. Nicholas Kristof, a respected journalist who has won many awards for his thoughtful commentary on the invisible and marginalised, noted in his book “Half the Sky” that there’s no silver bullet for justice and aid work in the under-resourced world, but educating and empowering a woman is about as close as you can come to one. Many others agree with him when he says:

“.. girls’ education may be the single most cost-effective kind of aid work. It’s cheap, it opens minds, it gives girls new career opportunities and ways to generate cash, it leads them to have fewer children and invest more in those children, and it tends to bring women from the shadows into the formal economy and society.”

The practice of medicine is important – health is important, and I’m glad to do what I do. But it’s only one thread in what should be a rich tapestry of a fulfilling and meaningful life, in which education, nutrition and freedom to choose play a part.

Let us keep striving, each in our own way, to participate in bringing God’s kingdom to earth. To render this tapestry a beautiful work, in which each thread is long and none is cut meaninglessly short.

- M.

The Engineering Team’s first update! (26/5/12)

The Engineering and Facilities Team at Kijabe Hospital just published its first update newsletter!  I am so proud of our guys for developing, writing, and publishing this update.  Well done to John, Shammah, and Collins.

Click on the link below to read our very first update:

EF Quarterly Update Newsletter Final Edition

With so much changing at Kijabe Hospital, and so many new projects going on around the place, the Engineering team felt it was a good idea to put out a regular update for doctors, nurses, employees, and supporters of Kijabe Hospital.

The keen-eyed South Aussie may note some similarities in the newsletter between SA Water’s Water Restrictions and our new Water Conservation Measures…

Our Medical Director describes working at Kijabe like trying to build an airplane while it’s flying.  This is such an appropriate description, on multiple levels.  Most of the time we are just trying to keep up, providing essential medical services while we attempt to fix the fact that we don’t have any water.  Or electricity goes off in the middle of a surgery, forcing our neurosurgeon to turn on his hiking head lamp and hold pressure on an open brain with his hands to prevent the patient from bleeding to death (true story).

If you don’t remember this “Building Airplane While It’s Flying” Superbowl commercial a few years ago, have a look at it here…and you get a very good snapshot of what it’s like to work in a low-resource mission hospital!  In my experience this analogy also holds true for building churches and new businesses.

-A

Wrestling with imperfection (25/5/12)

*This post talks about, among other things, postmortems on children.  There isn’t a lot of grisly detail, but it’s not a pleasant topic for everyone.  So proceed only if you’re up to it.

______________________

When I was a medical student, our very first week we were taken to the basement.  In a room full of preserved bodies, we were introduced to the shells of men and women who had chosen for their last gift to the world to be the gift of education about what the inside of a human looks like for doctors-to-be.  We were given scalpels.  We learned.

I have asked for and attended a couple of postmortems since we’ve been here in Kijabe – sudden, unexplained deaths of children, whose deaths left us shocked, speechless.  The delicate and difficult task of asking a mother if we could do just one more thing to her child – just to help us know and maybe prevent another needless death, to attempt to bring some closure for a grieving family.

So on Wednesday I found myself watching the surgeon prepare for the pseudo-surgical procedure that is an autopsy.  We had admitted Thomas, a Maasai boy, last week after he’d been partially treated for meningitis at another hospital.  We started what we thought were appropriate medications, based on our vague lab results, and he seemed to be improving.  When I saw him on Friday, he had a bad headache, some chills, but was talking and eating breakfast.

By Monday morning he was dead.  We had tested him for malaria, for TB, for bacteria, treated him with the strongest antibiotics the hospital has – and despite our unrevealing tests and powerful drugs, something continued to attack relentlessly, and his brain became damaged beyond recovery.   Jennifer had to have the painful conversation about withdrawing his ventilator as it was the only thing keeping him alive, and she sat and watched as his lungs sat still and his heart gave up.

She asked the family if we could do a postmortem, to see what had happened, what had eluded us, what we may have missed.  And so after she signed out to me, I found myself in the operating theatre watching the surgeon explore the remnants of this teen.

I am usually pretty skilled at closing the heart compartment and opening the head compartment, turning off feeling and turning on thinking.  I have walked through enough deaths that I can semi-automatically drive the car of directing medical care, one hand on the steering wheel, the other shifting gears, one eye looking in the rear-view mirror as the other looks straight ahead.  It’s only after I reach the destination that I allow myself to process the journey.

But this postmortem got to me.  Looking at Thomas, as the surgeon manipulated his instruments, all I could see was him talking to his brother, shaking in his bed with chills, breathing, living.   And it was surreal – to try to connect the soulful, hopeful boy of Friday with the lifelessness before me.

We don’t have the final results yet.  But it looks like it may have been TB.  And we hadn’t treated him for that.

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Being a doctor is a curious profession.  It’s a job in which mistakes are not allowed.  Not knowing is not allowed.  Being tired is not an excuse.  Imperfection is weakness.

I grapple with this all the time.  I know I am loved by a gracious God who forgives me unconditionally – that when I mess up, there are consequences but I have a fresh start each day.  As a doctor, I know that a small mistake may have small consequences, but a big mistake has a far-reaching impact on my patient, their family, my team and myself.

How do I reconcile these?

We are taught in medicine to educate ourselves continually – that medical school is the tip of the iceberg.  In a field that spits out thousands of research studies a day, keeping up with the best treatment is a full time job, let alone the actual practice of medicine.  And if I treat a patient based on a 5 year old textbook, and recent studies have shown that there is a much better regimen, I have not done the best I could do, and the result could be death or disability rather than life and possibility.

Surgery is even worse.  In an emergency situation, the surgeon does the best they can to save a dwindling life – and if they fail, there is some consolation in knowing that without their assistance the patient would never have made it anyway.   Then there are sick patients who may get better with a procedure – a central IV line, or a clearing out of pus from around the lungs – and the procedure goes wrong and the patient suddenly loses a lot of blood and dies.  The surgeon may find some consolation from knowing they had soberly discussed the risks and benefits with the family before the surgery happened, and that this was a known possibility. Then there are those cases in which a healthy patient has a voluntary elective procedure – and through one or more mistakes, something goes dreadfully wrong and the patient dies.

I have seen all of these scenarios played out in the lives of surgical colleagues and friends.   How does a surgeon not become crushed, how does one honestly reconcile their imperfection with the expectations of self and the world of medicine in the light of a gracious, forgiving God?

Andy’s last post was about writing heuristically, writing to discover.  I’m writing this to try to get a glimpse of who I really am, who I want to be.

And I think that as much as I have expectations of the kind of doctor I should be – maybe they’re not too high.  Maybe my expectations of who I should be as a whole person are just too low.  As a doctor, I may make mistakes, but I need to honestly assess them, see what I could have done better.  I need to be humble about my skills, seek forgiveness from a patient or family I may have hurt (trust me, doctors are not taught this well – but has been proven in studies to be a much better way of dealing with a patient’s family than institutional bluster and defense), then forgive myself and strive to do better next time.

As a person, should I be any different?  I may make mistakes in my relationships, but I need to be honest about my part, and ask myself how I could have acted better.  I need to be humble about my perspective and “holiness”, seek forgiveness from a friend or family member I may have hurt, then forgive myself and strive to do better next time.

But we have this treasure in jars of clay to show that this all-surpassing power is
from God and not from us.  We are hard pressed on every side, but not crushed; perplexed, but not in despair; persecuted, but not abandoned; struck down, but not destroyed. We always carry around in our body the death of Jesus, so that the life of Jesus may also be revealed in our body.  For we who are alive are always being given over to death for Jesus’ sake, so that his life may also be revealed in our mortal body.  So then, death is at work in us, but life is at work in you.

Therefore we do not lose heart. Though outwardly we are wasting away, yet
inwardly we are being renewed day by day.  For our light and momentary troubles are achieving for us an eternal glory that far outweighs them all.  So we fix our eyes not on what is seen, but on what is unseen, since what is seen is temporary, but what is unseen is eternal.

- 2 Cor 4:7-12; 16-18

- M.

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 7,000 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.

_____________________________________________

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