Dadaab Part 1 – Ifo Camp (29/9/11)

Imagine, if you will, Spokane WA, or Canberra ACT – around 450,000 people.

Imagine it without paved streets, with sand and gorse as far as the eye can see.  Imagine it without a source of water – with water tanks filled by tankers and your home supplied by filling containers.  Imagine that nothing will grow there, and that when food comes your means of obtaining it is by ration card.  Imagine that you live in a tent, or in a hut you have constructed from twigs, plastic bags and cloth.

Imagine it without a dentist, a surgeon, an obstetrician, an ophthalmologist, a pediatrician.  Imagine that your health care is provided by a doctor with one year of experience after medical school, whose job description is care of every ailment due to infection, war, trauma, pregnancy, and whose abilities have come to to include appendicectomy and c-section.

You cannot leave this town to look for a better place, or a job, because you are not a resident of the country you are in.  Imagine that, if you leave this town, without paperwork specifying where and why you are going, you will be sent back to a place that is worse.  And so you stay.  Because although this place is a little bleak, it is infinitely better than what you have fled.

Welcome to Dadaab.

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*warning – the rest of this post contains medical details and words such as “penis” which some readers may find disturbing*

From Monday to Wednesday, our pediatric surgical team held its semi-monthly clinics in the 3 main camps of Dadaab – Ifo, Hagadera and Dagahaley.  GIZ, who runs Ifo camp, transports and houses the team every 2 months.  This time the team was made up of Erik (American peds surgeon), Lebbie (senior peds surgical trainee from Sierra Leone), and me.  After our 4:30am start from Kijabe, GIZ was ready for us to start at today’s camp, Ifo, when we arrived mid-morning.

The goal of these visits is simple:  see all the children who have been referred by the camp doctors for possible surgery.  Put them in a category: “now” for surgery today at the camp, “soon” on the waiting list to come to Kijabe for surgery, “next time” if their simple surgery can be done in the camp in 2 months when we return, or “no” if their surgery is something that we cannot do or if their condition doesn’t require surgery at all.  For those that need surgery in Kijabe, GIZ will provide their transport to Kijabe and BKKH will pay for their entire hospital stay from their refugee budget.  Some of the patients have already had their operation(s) at Kijabe, and are here for followup.

We have been told there are no cases on the “now” list, so we will be purely hosting a clinic today.  So we start – we set up an empty room with 2 tables, one examination bed and a few chairs.  It’s my first time here, so Lebbie and Erik each take a translator, and I sit between them, acting as a general pediatric opinion for the non-surgical things and a scribe as I learn the system by doing.

It’s immediately apparent that many of these children will be in the “soon” category – an infant whose face and scalp are covered with disfiguring blood vessel growths called hemangiomas.  These will improve rapidly just with medication, but it will need to be given IV at Kijabe hospital with close monitoring for side effects.  The sooner GIZ flies him down to Kijabe, the better – one of these growths covers his entire left eye, and development of vision in that eye won’t happen unless we are able to let light in by getting the hemangioma much smaller.  A 4 year old boy whose penis was injured by a rope as an infant – and now urine comes out of holes that shouldn’t be there – a urologist will visit Kijabe in March, and we can make sure he is scheduled for repair.  3 siblings, all with cleft lips and palates, ranging from 2-11 years old – conditions that have made them ‘different’ for years, and between 1-3 surgeries apiece will change how others see them, how they view themselves.  A girl who, for her 16 years of life, has been living with no anus, because it never formed in utero – stool has been coming out of a connection between her bowel and vagina.  This is something the surgeons can do something about.  2 little boys with minor scrotal problems that we can put on our “next time” list for operations within the camp when the team returns in November.

Some children make it to the “no” list.  Children who, since birth, have been floppy or stiff and have never sat or talked – we gently attempt to explain that their brains were probably injured at birth , or didn’t form properly, and we are sorry but surgery will not help them.  We refer them back to Handicap International who has already been helping them.

2 minute break: let me tell you about Handicap International.  This wonderful agency has rehabilitation facilities in all 3 camps -providing physiotheraphy, orthopedic-fitting workshops and other resources to refugees.  Children with club feet who need plaster, adolescents whose polio has left them with a limp, babies who are floppy – there are caring people who can help with strength, mobility, encouragement.  What a wonderful group.

Back to clinic.  There is a 2 year old who has been having seizures twice a week, and a long time ago used to be on anticonvulsant medications.  I am able to find out what medications the pharmacy has, and prescribe for her a drug that should help.  A “no” on our list, but a condition we can do something about.

2 children with one leg longer than the other.  Much longer.  The four year old’s right leg is about 30 centimetres shorter than the other – a foot shorter.  She is too young for crutches, and so she walks on the knee of her long leg, and the foot of the other.  She is a “no” – currently, our orthopedic team does not have the budget for refugee surgery.  Every patient they see here in Kijabe is charged nothing, and their budget is stretched to the limit.  We decide that we have to tell them about her anyway – surely, there must be some way we can help this beautiful little girl.

We see around 60 children and suddenly, our time is up.  Our convoy leaves for GIZ, and it is not safe to travel without an escort – we are only 75 km from the border of a nearby country from which violence and kidnappings are not uncommon.  There are still around 10 children waiting to be seen and suddenly the room feels like the trading floor on Wall Street – papers thrust into our faces by parents with loud hurried words we don’t understand, each parent desperate for their child to be added to the list.  We scribble down some details of whoever we can as we walk out the door.

Unlimited resources.  An impossible dream.  It’s rewarding and frustrating to be here, to be able to help some, to see some who will have to wait for consideration, to know there are doubtlessly other children in this camp that are not yet, or may never be, on our radar.

- M.

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Coming next:
Dadaab Part 2 – Hagadera Camp
Dadaab Part 3 – Not quite Dagahaley Camp

Coming soon:
Dadaab – the movie! 

Blessed are those who mourn (23/9/11)

I preached today at the Moffat chapel service on Matthew 5:4, “Blessed are those who mourn, for they shall be comforted.”

I signed up to speak on this verse about two months ago as a part of the regular roster of staff preaching in chapel.  In the month following:

-My parents’ divorce was finalised
-There was a major fire in a Nairobi slum, with over 100 burned to death, including two cousins of a friend of ours, who both died in a hospital from their burns
- A staff member at RVA home in the USA on furlough died unexpectedly of a brain hemorrage, leaving behind 8 children.
-A good friend had a traumatic miscarriage.
-Mardi diagnosed a little girl in a refugee family with Type 1 diabetes, a generous friend donated the money to pay for her medical costs and future insulin supplies, and before this could be given to her family, her parents took her from the hospital under cover of darkness, we think to try more traditional ‘medicine’.  We don’t know if we’ll see them again.  It is certain the little girl will get very sick again quite soon.
-Numerous little children, each with their own story, promise, and grieving community, passed away in the hospital under Mardi’s care.

As I write this, Mardi is spending the night with Liam are in the Hospital (100 metres from our back door).  Liam’s had another asthma episode, and so he’s on a bit of oxygen to stabilise his oxygen levels and so he can be monitored.

Moment of reflection, American Cemetery, Normandy

This really turned into one of those “I had no idea how real this was going to become for me when I signed up for it” kind of sermons!

Amongst all this grief and mourning, there has also been an extraordinary amount of joy and blessing…but this is not a blog post about that.

It has been the so-real-you-can-touch-it grief which lent a new perspective my preparation and talk on “blessed are those who mourn…”

When Jesus says “…for they will be comforted”, the comfort he is referring to isn’t only a future comfort.  It’s not only the comfort we have in knowing that one day, in the age to come, God will set things right again in the restoration of creation.  It certainly does have a future component, in which we quite rightly place our hope.  But the grief I have experienced in the last few months has brought home to me the truth that if I only have a future hope, this too easily leads me to a worldview along the lines of “I’m just hanging in here by the skin of my teeth until one day, O glory…I’ll fly away…” (to heaven).  How can I be grounded in reality, in the inherent goodness of God’s creation and participate with his ongoing work of restoration around me right now, with that kind of outlook?

In the last few months, I’ve discovered through the tears and grief that a future-only hope just isn’t enough for me.  While it is ultimately where my hope is based, I find myself wanting more…how do I to connect with the reality of suffering around me in a genuine way, and how am I to reach out effectively to those around me who are suffering?

In the story immediately prior to the discourse in the book of Matthew we call the ‘Sermon on the Mount’, we see Jesus ‘travelling throughout Galilee, teaching, sharing the good news of the Kingdom of God, and healing everyone who was brought to him including casting out numerous demons.  As a result, huge crowds followed him wherever he went.’

Picture Jesus, surrounded by huge crowds of people, pressing in around him–and so he climbs up a hillside to sit down and teach.

In the crowd he was speaking to, directly in front of him were people who had just received ‘the good news of the Kingdom of God’ through him:  healings, exorcisms, a touch from God himself.  Jesus could point out in the crowd an individual who was “blessed” because The Kingdom Among Us had just reached out and touched them with Jesus’ heart and voice and hands.  I am struck by the fact that in the stories about Jesus we only find Jesus giving “Beatitudes” such as “Blessed are those who mourn…” from the midst of a crowd of people he had touched and healed.

These aren’t theoretical, philosophical, ivory-tower prognostications from a guru telling people about a nirvana-like existence they will have one day in the future…it’s real, earthy, personal, now.

A comrade in arms..."known but to God"

Jesus’ method of ‘show and tell’ ministry gives me a grid inside of which to align my longing for both a present comfort in the midst of present suffering, and future hope…he demonstrated the power of the Kingdom of God, and then he told the people he had just demonstrated it to how things work now that the Kingdom is at hand.

In the words of Dallas Willard,

Luke refers to them as “the weeping ones” (6:21).  But as they see the kingdom in Jesus, enter it, and learn to live in it, they find comfort, and their tears turn to laughter. Yes, they are even better off than they were before their particular disaster.  And you don’t have to wait until you’re dead. Jesus offers to all such people as these the present blessedness of the present kingdom—regardless of circumstances. The condition of life sought for by human beings through the ages is attained in the quietly transforming friendship of Jesus.  (from The Divine Conspiracy).

I find that Jesus’ words also give me a permission to mourn and freedom to be real:  his words presuppose events in this life which cause us to mourn:  hence, we are free to mourn, and to acknowledge these events as worth mourning, and not have to pretend that everything’s OK.  Jesus validates as genuine the mourning experienced by the people he was speaking to, even after he has ministered to them in power.  He doesn’t say, ‘You were mourning, but now that I’ve touched you I want you to never speak of it again.  Your daughter who died of leprosy?  Pretend it doesn’t still cause you grief, cause you’ll be in heaven one day.”

Validation, permission, to mourn.  Freedom to not sweep suffering under the rug, like an uncomfortable bit of conversation that comes up and you really don’t know what to do with it so you just avoid the topic.  ”Me?  Yeah, I’m good.  How’re you?”

This gives me great peace tonight, as I go to sleep with Riley in my bed (it took her two hours to fall asleep because she ‘wanted to go into the Hospital to see Liam’s xray and his bones and lungs’), my son and wife in Hospital, and friends whose Facebook status reads something along the lines of, ‘Lord, come quickly, and have mercy on us’.

I am learning that in some ways, we can’t properly understand life on earth now if we don’t have clarity as to the reality/validity of suffering and mourning, and yet that because of the in-breaking, present availability of the Kingdom of God, we can still be blessed in the middle of it.

For now, though, I’m going to do the dishes and go to bed.

-A

Freedom (20/9/11)

Emer, our new diabetic, disappeared yesterday.

Jennifer and the team had sat down with the family in the afternoon to talk with them – they had a 20,000KSh ($200) bill, of which they were going to pay 15,000 and our Needy Children’s Fund was going to cover the rest.  And then, incredibly, a friend of ours at home who has a special place in her heart for children with diabetes had offered to pay for all of Emer’s supplies.  A glucometer, the test strips, insulin, syringes…. Immediately after reading my last blog post she & her husband had sent us enough money to cover her medications for a year or two.  Incredible generosity, that we were thrilled to share with this needy family.

And two hours later, they left.  Without paying any of the bill, without taking any means of checking or treating Emer’s sugar level.  I found out this morning.  We have not been able to contact them since then at all.

There are so many emotions warring within me.  Fear, that Emer will die – and this is realistic.  Anger, that her parents, having been offered so much, took so little, at such huge risk to their daughter.  Embarrassment, that I have had to share with my generous friend that her gift has been rejected.  Resignation, that this is neither the first time nor the last that parents have rejected my advice because they have other inputs into their decision making process.   Grief, that this little girl is yet another treatable patient that we are handicapped to help, and who will suffer.  Hope – that Emer will get just sick enough to require medical attention and that her parents will see that we helped last time, and maybe they will give us another shot at helping her.

This is free will.  This is how it works.  Every day we choose – good versus not so good versus bad.  Life versus existence versus death.  Love versus apathy versus hate.

Hardly any of our choices are black and white.  They’re usually somewhere on the spectrum – and this is how God made us.  Free to choose to join him in making this world as he intended, free to choose otherwise.  I am grateful to have this freedom.  To know that my life is not cosmically predestined, that God loves me enough to say, here is life.  Do with it the very best you can, because I love you enough to let you choose.

Today I feel like a really bad choice was made.  But if God gave me the chance to choose, he gave it to Emer’s family as well.

I just wish I could have chosen for her.

- M.

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There is always hope – click here to read about sweet Margaret, who has been helped through Emer’s story

Tea (19/9/11)

It’s my birthday in a few days and so Mardi planned a surprise outing for the family to go and have lunch and a tour at a local tea farm in Limuru, Kiambethu Tea Farm.

In a word, it was gorgeous.  More than 100 years of family tradition (English, originally) in making black tea, including building the local Anglican church which has the distinction of being the burial place of the eminent archaeologist Dr Louis Leakey and his missionary parents.

We had a ball…lovely old grounds, tea, old growth forest for a bit of a walk, lunch, discussion on how tea is made, great conversation with Fiona and Marcus, proprietors of Kiambethu (and granddaughter of the founder), and more tea.

Fiona taught us how to make a proper pot of tea, and described the tea-growing, making, and selling process to us in detail.  The area around Limuru is ideal for tea growing, apparently, as it is wet, high in elevation, and relatively cool.  It has acidic soil, which the tea plants like, and once they get the tea bushes growing (their original stock was from India), the workers hand pick new shoots from the bushes every two to three weeks, year round.

It’s a crop that is harvested all year round, with a brief interlude of a few months every few years for some serious pruning.  Talk about a reliable cash crop…Fiona told us that it’s very common here for small growers to get an acre or two of tea bushes established, which can then provide reliable income for the whole family, year round.

I found her description of the process from harvest to ready-to-drink fascinating, and surprisingly moving.

Tea stalk (2 leaves + pekoe at top)

Tea bushes take about 4-12 years to bear seed, and once a new bush is grown from seed it takes 3 or so years before harvesting can commence.  The tea bushes are carefully tended, fertilised as needed, and then picked by hand–no machines here.  The workers know to pick only the newest shoots of the tea bush, which should include the newest leafy tendril (the ‘pekoe’), and the next two leaves.  They toss the whole stalk into a basket they carry on their back, and as the basket gets full they build a pile in a shady spot under a tree.  If the tea isn’t processed immediately, it will start to oxidise, releasing tannins into the tea leaf which affects the taste.  So the day’s pickings are taken on the same day to the local tea factory.

The tea factory does stringent quality assurance on the tea brought in by each farm, and randomly inspects bags to make sure that only the pekoe + 2 leaves has been picked…any further down the stalk, (e.g. the third leaf) and the leaf is hard, oxidised, and high in tannin.

The first step in the processing is to put the tea stalks in large holding containers (think the factory scene from Attack of the Clones) with large grates in the bottom.  Over about a 24 hour period, air is blown up into the containers, and this reduces the moisture content in the tea stalks by about 30%.

View from the front verandah of the farmhouse...ideal for some good Thomas playing

Once this is done, they get put on a huge conveyor belt (again, think Attack of the Clones) that goes all around the factory, and warm air is blown onto them to further dry out the leaves.  This takes about 12 hours and gradually turns the bright green stalk yellow.

Then they get a final burst of superhot air to stop the oxidation process completely.  This is when the now-yellow tea stalk turns brown, and begins to get aromatic–in short, this is when it becomes tea.  It’s not until after this burst of superhot air that it really becomes…well, tea.

The brown stalk then goes through a series of rollers and spikes to chop up the tea, and it’s bagged up and sent to the wholesalers in Mombasa for buying by the big tea companies, and shipped around the world.

I was interested to learn that tea stalks don’t taste or smell like the tea we know until nearly at the end of the processing in the factory.  All those years in growing a new bush, tending the plants, pruning, fertilising, hand-picking new stalks, rushing them to the factory, aerating them in Attack-of-the-Clones containers, heating them on conveyors…and its not until the final step, superheating, that it becomes recognisable…”Oh, that’s tea.”

In fact, unless you were an expert, at no point in the life of a tea stalk until that final release of superhot air would you even know you were holding the potential for a cup of black tea in your hand.

Fiona, proprietress of Kiambethu Farm

I find comfort in this process…in it I find parallels to my own life, particularly my spiritual life.  For me, it’s often after a long process that I begin to see things as they really are, and what God is doing around me.  It’s not until quite late in the game, after years of fertilisation, pruning, being torn off the bush sometimes, lots of heat, that I go….”Ohhh…..I think I am beginning to understand now…”

I don’t understand, I just can’t see clearly earlier in the process what’s really going on, or where it’s all headed…let’s be honest, at times I just plain lose perspective and hope and keep moving forward only with gritted teeth and faith that God can be trusted with the things that matter most.

And then, later on (sometimes years), a superhot blast of air, and…”Oh, that’s tea.”

Riley, collecting tea seeds/nuts for planting at Kijabe!

Kiambethu Tea Farm

I am grateful to have learned that the processes of my own life are mirrored in a small way in the life of a cup of tea.

-A

Resource-poor excellence (17/9/11)

Yesterday I met a sweet 4 1/2 year old girl named Emer – 4 days ago she was a healthy little girl with no problems about 100km from here.  Then she started to get thirsty, and lose weight, and then she collapsed.

A local clinic checked her blood sugar and quickly recognised she had diabetes.  They gave her an insulin injection, some IV fluids to start to treat her dehydration, and told the parents that they needed to bring her here, IV still in place in her skinny hand.

The next day she came to us.  She had a very high blood sugar and was still very dehydrated.  You know how after exercising really hard, you cannot help but breathe hard and deeply because of the lactic acid buildup in your muscles?  That is how she was breathing – we can’t accurately check acid levels here beccause we don’t have a blood gas machine, but that alone was enough to tell me that she would need to go to ICU.

It’s a tricky thing explaining diabetes through an interpreter.  Her parents didn’t speak English or Kiswahili, but a had brought a friend with them who was able to help me – Emer’s grandfather has diabetes, so the parents had some understanding.  Finding that they were literate, I was able (through the wonders of Google) to find information about diabetes in their language.  The translator’s eyes just lit up  - “This is very good!  How did you find this?  This is so good!”  Their main question, once they understood that I was telling them their daughter has a lifelong illness was – how much is the medication?  And that, in Kenya, is a really good question.

They are poor people.  I wanted to send Emer to ICU – they asked if ICU was really necessary, knowing its expense.  I explained that it absolutely was, but that I would admit her under HDU status, a lower cost than full ICU, and that as soon as she was stable I would transfer her to the regular ward.  So after a long night on call, with hourly conversations between the nurses and myself about her blood sugars, IV fluid finagling and insulin drip finessing, by this morning she was a different little girl and we were able to transfer her to the pediatric ward.

I’ve managed diabetes before in children – in the last 5 years, I’ve stabilised them in emergency.  7 years ago I managed the sickest children in ICU.  10 years ago, I looked after the children who were stable with diabetes on the pediatric ward.  I have never managed a child from emergency through to ICU through to the ward through to finalising their discharge plan and followup.  There wasn’t a lot of sleep between those hourly calls last night, as I second-guessed all my decisions and googled management on my phone to make sure I wasn’t mis-remembering things.

So you can imagine my relief to find this morning that our hospital has an outstanding diabetic nurse educator.  I peppered her with questions about everything I could think of – how much does a glucose testing machine cost here? ($30, plus about $15 a month for the testing strips – so it’s usually only children under 6 who are strongly encouraged to get one, because they may be too young to recognise or communicate the nauseating symptoms of a low blood sugar).  How much does insulin cost? ($7 for a vial that should last for 2 months).  How much do the syringes cost, knowing she will need 2 injections a day, forever? (50c each, but we tell the parents that if they are fastidious about keeping them clean and cap both ends that they can use them for 3 days).  Can we do the blood test here to look for complications of a chronically high blood sugar level?  (Yes, we can, and we check it every 3 months in the first year of diagnosis).    What do you tell parents to do if a child has a low sugar level? (This is the main thing we teach and reinforce – what the signs of low sugar are.  Give the child 4 teaspoons of sugar – if they wake up better, get them to eat something; if they are still sleepy, give them 4 more teaspoons and get them straight to a hospital).   Are there many children with diabetes here?  (Kijabe Hospital is currently following 11 – and Emer, as of today, is the youngest by 6 months).

I am constantly amazed at the level of care we can provide here.  It is sometimes frustrating, not being able to do everything we can do in Australia or the US.  But the dedication and excellence of so many of my colleagues, and the ingenuity of some our diagnostic and treatment options makes me proud to be here.

So often in western medicine, we assume more is better.  We don’t question more cost-effective ways of doing things – especially in the US, we practice fear-of-litigation medicine, where more tests always means we are covered in a court of law.  I hated practicing that way, but I did it.

Today I liked learning how to do more with less.

-M.

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Click here for Emer’s continuing story

Little scars (13/9/11)

For over 2 months, we have been watching baby Shunetra grow.

Although Shunetra wasn’t that premature, she was born very, very small for how long she’d been growing – under 1kg at birth.  She had a tenuous but determined hold on life – another one of our 2-steps-forward, 1.9-steps-back kind of babies.

We like babies to gain at least 20 grams a day when they’re in the nursery – Shunetra took about a month to just get back to her birth weight after losing weight.  Every time we would feed her, she’d tolerate some feeds, and vomit others.  She’d have days with no weight gain at all, and then maybe 10 grams here, 20 grams there.  She had a severe blood infection and meningitis.  And then both of her knees filled with pus, requiring our anxious anaesthetists and orthopedic surgeons to take her to the operating theatre to use tiny needles and the smallest scalpels to drain her infection, leaving teeny tiny scars on her knees.

Despite her setbacks, she has clung to life.  Slowly tolerating feeds via a tube down her nose.  Learning to swallow from a syringe.  Finally, wonderfully, breastfeeding.  Starting to interact with her dedicated mother whose hope in Shunetra has never flagged.

For the last 2 weeks, almost every other day I’ve been to visit the nursery, because Shunetra was finally approaching the home stretch.  Once a baby reaches 2kg, we celebrate the milestone by letting them go home.  And each day Shunetra has been 1800 grams, 1840, 1860…  and finally 2000 grams.  Graduation day!

Shunetra’s mum opted to stay an extra day or two, just to make sure she was 2000 grams and staying there.  This remarkable woman has been hand expressing breast milk every 2 hours, sleeping in the maternity ward as a boarder, for 2 months.  Having lost her first baby at 8 months of pregnancy, Esther has determinedly been at Shunetra’s side, noticing problems before we did, buying her own thermometer to check her temperature when she felt warm, pointing out her knees to us when the signs were still subtle.  Esther and Shunetra had become a part of our nursery, a fixture that we enjoyed but couldn’t wait to reward with a one-way ticket home.

So I went in to see Shunetra for a final goodbye last Thursday – I took my camera to take this picture of this little princess with her mum.  Her bill came to AU$3000 – insurance covered $2000, and our needy patient’s fund covered some of the remainder.  Jennifer sent out an SOS to some partners in Germany to see if they could add to our Needy Children’s Fund to cover the rest of her bill.

It’s so fulfilling to get to the end of a long, long road like this.  These mothers and babies become a stable part of our sometimes schizophrenic work days.  There is something reassuring about the daily check of “How is Shunetra today?  We are getting there!  We’re on the home strait!”   There is nothing quite like seeing the tentative half-smile of a mother as we pass in the hallway become a grin because we have made it to the end together.

______________________________________________________

The next morning I got a text from Jennifer that Shunetra was dead.

She had been sleeping next to her mum, like the 5 previous nights, and had breastfed at 10pm.  When Esther woke at 1am wondering why Shunetra hadn’t cried at the 2 hour point for her next feed, she found Shunetra next to her stiff and cold.  She ran to the nursery, but it was already too late.  She had been dead for some time.

Bewilderment.  Anger.  Complete disbelief.

I cannot imagine how Friday was for Esther.  A parade of condolences, a procession of tears.  As word spread among the doctors, nurses and chaplains who had been caring for Shunetra, all of us wanted to express to her our sympathy, to let her know we shared her pain.  I wanted to say something profound.  All I could say was “I am so sorry”.  And cry with her.  And listen to her repeat monotonically her perplexed words – “I fed her at ten.  At 1 I woke up.  She was gone.  Wasn’t I a good mother?”

We see so many children here.  Most of them get better quickly, with pretty basic medical intervention – the right tests, the right drugs and discharged home.  Those successes feel so small when a loss like this happens.   The more difficult the fight, the bigger the victory feels – and with Shunetra and Naomi, we had fought so hard and the impending victory was already a celebration in my mind.  And so the defeat just feels so much larger.

I don’t really have a nice concluding paragraph this post.  No simple lesson learned.

Just a lingering sadness that other precious children will help to heal, while a little scar on my heart remains.

- M.

Best bits (10/9/11)

Highlights of my week:

- Going to the movies as a family today – we saw Mr Popper’s Penguins.  After Liam stopped crying because the closeup of “Loudy” freaked the snot out of him, we had a wonderful time as the only people in a real, live movie theatre.  Precious.*

- Finding that the Nakumatt has, in the bakery section, honest-to-goodness sausage rolls, chicken pies and pepper steak pies.  As a kid growing up, one of the highlights of my week would be (Australian meat) pies and pasties bought from the deli on the way home from church.  We have them in the fridge ready for Sunday lunch and I am a little embarrassed how excited I am about it.  And that I didn’t make them from scratch myself.  All in good time…

- Not having to worry about babies and children in the intensive care unit during my days at work, because the wonderful Dr Wayne Ellis (midwestern Med/Peds doctor here for 3 months with his lovely family, who happen to be our new neighbours) is not scared of sick babies.

- Fresh baked choc chip cookies, containing actual chocolate chips (a coveted luxury here in Kenya), made by the aforementioned delightful Ellises.

- Reading “One Day” all by myself on a gorgeous sunny afternoon while overlooking the Rift Valley – stupid fluff romantic novel which I am reliably informed is much better than the movie (which I have no intention of seeing even though Anne Hathaway is undeniably adorable).

- Rainy evenings with crackling fire.  Bliss.  And boy do we need the rain.

- Feeling at work like I almost have my head around a lot of what I am doing, for the first time.  This has not prevented me from consulting Jennifer, Immaculate, Leland and random international dermatologists about children whose conditions completely flummox me, but I have felt like I have had a handle on a lot of things rather than almost none… (seriously though, congenital epidermolysis bullosa and infantile erythroderma in one week?)

- Home made brownies, oat encrusted cilantro mustard chicken, roast lamb with mango chutney, french toast and cadbury cashew & coconut chocolate.  OK, neither the chutney or the chocolate were home-made.  But credit for the brownies.**

- Lovely emails from Jen and Fiona which have just helped me feel connected to a world wide web of friends.

This week has had moments of sadness, difficulty and bewilderment.  I don’t quite have the heart to blog about those yet.  Lakini, leo ninafurahi.

-M.

 ** nor did I slaughter the chickens or the lamb myself.  I totally cooked the meat though.

Mwalimu (9/9/11)

I started teaching my Spiritual Formation class last week at Moffatt, and it’s been great so far.

Yesterday I had my first scheduled ‘Office Hours’, for students to ask questions about their homework or reading assignments.  All 19 of the first year students are high school grads, for whom English is their 2nd, 3rd, or 4th language.  In my class (as in all of Moffatt’s classes), all of the required reading is entirely in English:  from Renovation of the Heart (Willard), Celebration of Discipline (Foster), Emotionally Healthy Spirituality (Scazzero), Christianity Beyond Belief (Hunter), and Dark Night of the Soul (St John of the Cross).  I don’t know many people who can read Dallas Willard without needing to talk with other people in order to process what they’ve read, and I figured they might also.

I walked into the classroom at 2:30 expecting at most 3 or 4 students.  I was greeted by all 19 students, backs straight, books neatly stacked, ready to go.

Once I had made it clear that Office Hours weren’t mandatory, and that they wouldn’t get extra credit for showing up, we began.  ‘So, are there any questions related to the reading assignments or homework?’

“Mwalimu (teacher), I have been wondering why the other students look at me funny when I am praying in tongues.  Can you please explain to me why some denominations of the church don’t like speaking in tongues?  How can you have the Holy Spirit if you don’t speak in tongues?”

Uh…OK.  Perhaps this is tangentially related to spiritual formation, and so I’ll answer that one.  Here’s some thoughts on the difference between matters of primary and secondary theological importance; speaking in tongues is in the latter category, yet because we like to make secondary issues primary, it becomes divisive due to our pride and poor theological and historical understanding of the context of Paul’s words about it in the New Testament.  Next question.

“Mwalimu, do you believe there is a sin, which if you commit it, is unforgivable?

Hey, that doesn’t have anything to do with spiritual formation.  Let’s try and keep our questions related to the course we are discussing.  Here’s a short answer.  No.  Now let’s try to stay on topic!

“Mwalimu, do you believe the story of Job actually happened?  How can some scholars claim the story is not historically true, yet still believe the Bible is Holy Scripture?”

OK, that’s just plain off subject.  Short answer:  scholars-historical vs. oral tradition-canon-metaphor-literal-next question please.

“Mwalimu, people in my tribe believe that polygamy is acceptable.  How do I go back to them as a pastor and tell them that polygamy is a sin, when in the majority of the Bible it is acceptable?”

“Mwalimu, it says in Matthew 6:5 that we shouldn’t pray standing on street corners like the hypocrites.  Should we always sit when we are praying?”

“Mwalimu, going back to speaking in tongues, doesn’t it say in 1 Corinthians that we must have an interpretation for it to be of any value?”

“Mwalimu, if Jesus says you will know a tree by its fruit, does this mean that we can simply judge the condition of other people’s hearts by what they do?”

“Mwalimu, what does it mean to store up treasures in heaven?  Does this mean that when I do good works here on earth that I am banking them in heaven for later?”

“Mwalimu, can God speak to us through dreams and visions?”

one of our five spiritual formation groups

It was like that for an hour and a half.  Finally, 30 minutes past finishing time, I closed our session.

At first, I was tempted to laugh…it WAS actually funny that they had literally no questions about spiritual formation, and just wanted to know what I thought about every difficult passage of scripture they could think of.  After three questions on speaking in tongues, I stopped counting.

But a few minutes into it, I realised how important it was.

These men and women aren’t perpetual students, here at seminary because they couldn’t get a job and don’t know what else to do with their lives…they aren’t in the West, with a wealth of theological study material available at their fingertips on the internet or at a university library.  None of them own a computer.  We don’t even have enough textbooks at Moffatt for them to each have a copy and so they share in groups of 3 or 4.

These questions were important to them…and they were good questions, from earnest students, learning who they are in the Lord and how to think well and deeply about important matters of faith and theology.

It was centering, humbling, and scary to think that my answers mattered.  In 4 years, they will be on the front lines of ministry…pastors, chaplains, counsellors…and perhaps never exposed to this type of educational opportunity again.

I was grateful, walking home, that I have had the opportunity to be exposed to and mentored by men such as Dallas Willard, Greg Boyd, NT Wright, Graham Twelftree, Richard Foster, Rob Bell, Mark Dever, Flint McGlaughlin, my Dad, Rob Norman and others.

It is an enormous privilege to be here serving these men and women.

I just hope my thoughts on polygamy didn’t cause any of them to stumble.

-A.

Satellites and spaceships (6/9/11)

Kijabe is at around 7500 feet elevation, about half way up the Rift Valley escarpment. We look down into the Rift Valley, and you can see for miles. Breaking up the monotony of the valley floor are the shiny roofs of Government-built camps for the people displaced by the 2007 violence, trees, the odd giraffe, Mt Longonot, and two absolutely ginormous satellite dishes.

Riley loves these satellite dishes. Every time she sees them she asks me what they are for, and I tell her they are so we can talk to satellites and spaceships waaaaaaay up in the sky; so far up you can’t see them. Do they talk to them like we are talking now, she asks? No, honey, they talk like a computer.  I then break down the principles of electromagnetic radiation for her. At which point she moves on, much to Daddy’s disappointment.

So yesterday she and I took a Daddy-daughter date, and drove down to the valley floor to have a look.

Satellite dishes 'Longonot 1' and 'Longonot 2'

We drove up to the front security gate and I asked the security guard if we could have a tour of the facility.  I’m not sure if he’d ever seen a blond 4 year old Australian before, and perhaps this helped our cause…Leonard proceeded to show us around the place!

Leonard, our security guard turned tour guide

It’s called the ‘Longonot Earth Satellite Station’, and Leonard told us that ‘Longonot 1′ was built in the 1970s, and supplies satellite telecommunications for all of East Africa.  ’Longonot 2′ was built in the 1990′s, and does some other stuff.

Riley was enthralled, I felt like a kid gazing up at these enormous structures, and it was a great date.

Yes, please!

-A

Via dolorosa (4/9/11)

I had 3 deaths in 12 hours this week on call.

11pm it was a 6 year old who suddenly died 2 hours after having his arm amputated.  By the time I got there, there was nothing to be done – make sure we were giving him oxygen, trying to jump start his heart with adrenaline – but nothing.   His dad yelling at no-one in particular when he realised we had stopped doing anything, the orthopedic doctor agreeing to talk to him and try to figure out what on earth had gone wrong – while I ran to ICU to check on another baby.

10am, after much of the night spent with another patient in ICU, it was a 3 day old baby who had been born almost dead, but had been resuscitated.  Sometimes the brain is elastic, and the resuscitation changes the story from death to life.  But sometimes the damage has been done – and for this baby it became clear over 2 days that this brain had been hurt.  Convulsions, then kidneys not working, acid building  up in the body… and then, enough.  Nothing more that can be done because the newborn ventilator is being used by another baby and this baby can’t breathe without one.

Death has become an inevitable part of work here.  And over 4 months, I have become used to the conversations with the mothers, the post-death analysis – Could we have done more?  What can we learn?  What was inevitable?  And I have made a tentative peace with mortality, with the uncertainty of this journey, with this never-predictable-length-of-a-piece-of-string that is the walk of my patients, of their parents, of all of us.

And then at 11am I was called to another resus on the peds ward.  The automaticity of my role takes over – a staccato rendition of “What is the story?  What has been done? Right – I need a laryngoscope, a 3.5 ET tube….”

And then a double take.  Someone had said this was bed 43.

Bed 43.  Naomi.

Under the mask on her face, I see baby Naomi, 3 months old.  Born in our nursery, a delicate tiny doll with some syndrome we hadn’t been able to definitively diagnose.  With us for a few weeks until she tenuously gained weight, despite the hole in her heart,but home with mum.  Readmitted 45 days ago because she couldn’t gain weight at home and then had fever after fever after fever.  Her patient, gracious and ever-smiling mum stoically tolerating our testing, our uncertainty, the improvements followed by relapses, her tiny daughter gaining weight, losing weight…

And then today, she was ready to go home.  Finally off oxygen, finally gaining weight.  Mum’s bags packed and waiting for family to collect her to go home.  Home.

In a resus, I have been around long enough for most of it to be automatic.  A – B – C.

But now, tears well in my eyes.  This is Naomi, she should be going home.

Push the tears back down.  Push the needle into the shin, dilute the adrenaline, continue the chest compressions.  Secure the airway.   Listen for a heartbeat, look at the pupils.

But she is gone.  There is no question.  We have lost.

So out I go to talk to mum.

As I walk down the hallway, tears just start to fall down my face.  And mum is there at the end of the hallway, about to walk back in.  She sees my face, and I put my arm around her, and I don’t need to say anything because she knows.  Together we cry, and my mother’s heart breaks for this woman.

Jennifer and I both had come to the conclusion that Naomi would not have had a long life.  We had hoped to get her stable enough to go home and have some time with her family, for a few months, a few years – we didn’t know.  But it felt like a kick in the stomach for her to die here, now.

Jennifer called me to after I sent her a message that we’d lost Naomi.  I so appreciate her wisdom, her experience, and her friendship – a debrief, a chance to reflect.  We all knew Naomi better than any of her family did, because she’d spent her life with us, and we, the nurses and the other mums in the pediatric ward loved her in a way her community had not had a chance to.   That Naomi’s battle was a tough one, and it had to come to an end.

I don’t think there’s any way around a shift like that.  I don’t want to not love these babies – I don’t want to grieve the loss of every child like they are my own, but I want to get to know some of them enough that death never feels easy.  I want to walk in this tension of the “already-but-not-yet” life – heaven being the other side of the veil, but being a part of bringing heaven to earth, here and now.  Feeling the certainty that I am not in control, but at the same time knowing that I can be a part of fighting this timeless battle of injustice, oppression, sin.

So I’ll keep meeting and treating these babies and children, these sons and daughters.  Some of them a fleeting visit, some of them catching a hold of my heart.  All of them precious.

- M.

All that is gold does not glitter… (30/8/11)

All that is gold does not glitter,
Not all those who wander are lost;
The old that is strong does not wither,
Deep roots are not reached by the frost. 
From the ashes a fire shall be woken,
A light from the shadows shall spring;
Renewed shall be blade that was broken,
The crownless again shall be king.

-Lord of the Rings:  The Fellowship of the Ring, by J.R.R. Tolkien

The first semester of the new academic year began today at Moffat, and Mardi and I went to the kickoff Holy Communion service tonight.

It’s been a busy last few days at Moffat…students returning, new first year students wandering about the place looking intimidated and lost, and the mechanics of registration.  I’ve found it a real challenge to prepare lectures and lesson plans in the last few days…it’s been difficult for me to shift gears between my work at the Hospital, my studies, and lecture prep.  I’m not sure what’s worse…the challenge of the mental transition, or my frustration that I am not able to transition as quickly and effectively as I’d like!

So tonight was a needed centering point for me… a time to welcome the students and share the Eucharist / Communion as we kick off the academic year.  It was a joyful time, with students raucous and filled with energy fresh from the holidays…and a holy time, as we worshipped to traditional hymns written before any of us were born, and remembered the death of Christ, enabling us to be more fully human.

I was deeply moved by the service tonight, and felt the centering work of the Holy Spirit reminding me to be fully present where I am.  And I noticed a few things…the song books/hymnals were published in 1979, the songs were ancient, and the liturgy was old school.

I was reminded tonight of this this poem/song about Aragorn in the Lord of the Rings.  All that is gold does not glitter…

Coming from a used-to-be-a-movement-and-now-it’s-a-denomination like the Vineyard as we do, it’s not hard to unconsciously fall into a sort of rhythm where you’re always looking for the latests and greatest:  worship, missional theology, movement of the Holy Spirit, etc, etc.  But I am reminded tonight, amongst students who will go to far corners of Africa as chaplains and pastors, never to have their name in lights or be considered the ‘latest and greatest’, that sometimes old school is gold.

I am glad to be here, serving these students, and being a part of something that is gold but isn’t very glittery.

I took a minute or so of video of one of the songs we sung in English…you can have a look here.

-A

Kids you’ve helped (30/8/11)

Jennifer posted these stories to her blog yesterday – these are 3 kids that we’ve been co-managing and have now gone home healthier with a chance they wouldn’t have had without the hospital.

“Kijabe Hospital Paediatrics . . children come from nearby villages or from neighboring countries, some with major surgical problems that can not be treated very many other places south of Cairo or North of Johannesburg. Some come with the same issues that kill most children in the world: hunger, socially non-coping parents, exposure to lethal infections, poor quality water and food and education. And many come without the resources to pay for their care, even though that care is offered at about 1% of the cost of similar care in the States. Since this is a not-for-profit hospital belonging to the Africa Inland Church, we seek to help all of them, while still paying our Kenyan staff and maintaining a decent facility. Which is easier said than done. So some years ago other missionary physicians started a “Needy Children’s Fund” to subsidize the care of select patients who were so poor they couldn’t even afford the minimal fees charged by Kijabe. Here are a few of the kids we’ve helped with that fund this week.

The first (top left) is a 16 month old girl with Kwashiorkor (a form of severe protein malnutrition), peeking around her mom’s shoulder as she rides on her back, similar to my patients in Bundibugyo. Malnutrition, a mom that weaned her too early and was unable to provide enough food, a father who seems to be at odds with the rest of the family. A treatable condition that is too often fatal. (After only a few days of treatment mum wanted to leave – but we convinced her to stay, reassuring her the hospital bill would be covered.  She stayed and became bright-eyed as you see her).

The second is a 10 year old boy (right) who had been progressively more and more tired, unable to play and run like he used to, until in the last two weeks his whole body began to swell up. He was in heart failure, and we subsidized his referral to a cardiologist for an echo in Nairobi which confirmed that he was born with a major structural heart defect (common AV valve). The cardiologist helped us get him on a good combination of medicines, and he left feeling MUCH better.

The third is a 3 year old who came in with a bad cough and was found to have TB, which lead to the diagnosis that she and her mom are both infected with the HIV virus. Now they are being treated for TB and AIDS, and what would have been a few months’ decline until death can be redeemed into a decade or two (or more?) of life. All three of these children would have been dead within a few weeks or months without treatment. All three will have ongoing challenges, but left improved and hopeful.”

I have some bad days – 2 babies died within 6 hours of each other one day last week – but there are also many good days.  These good days keep me going, knowing that some battles are lost, but some are always won.

- M.

If you want to contribute to the Needy Children’s Fund here at Kijabe Hospital, please click on our contact/support button to read more about how partner with us.

Transience (29/8/11)

Since we got back from Mombasa, I’ve been in a bit of a funk.  Partly due to recovering from the “don’t you wish you had malaria instead?” virus, but partly because I realise I’ve been grieving losing friends already.

We’ve spent time getting to know quite a few of the families here in Kijabe, but inevitably the ones we’ve become closest to have been our neighbours with kids whose ages are close to Riley and Liam.  One of our friends is 3 year old Lydia who, in addition to a really cool Thomas the Tank Engine train track and some great dolls, has 2 parents (Stacy and Rich) and an older brother and sister (Adam and Gabriella).  Stacy and Rich are a down to earth Californian couple with a dry wit who come from a similar church as we do. He is a general surgeon who plays the guitar and mountain bikes, she is a super-mom who, among other things, delivers meals to local widows with HIV and knows the best local walking trails, and we really just love hanging out with them.

A couple of weeks ago, the Davises had to return to the US – Rich has had a 6+ month mystery illness that finally needed more diagnostics than are available here, and Stacy’s dad became very unwell.  And I have missed them – being able to walk down the trail past the monkeys to Lydia’s house to chat with Stacy or jam with Rich.   They aren’t sure how long they’ll be back in the US, and seeing their vacant house just leaves a little bit of emptiness.

Another couple of friends are Claire (5) and Ford (3) who live with their parents Rhett and Megan, and little brother Gus (2).  I’d been stalking the Shirleys’ blog before we left Australia, and since we arrived Claire and Ford have become regular companions at playgroup, preschool and Sunday school.  Rhett and Megan are a wonderful Southern couple who take pride in engendering gentility in their children, while having wicked senses of humour and being the kind of people you want to hang out with for just a bit longer.  Rhett is an Infectious Diseases specialist whose opinion I sought while dying of the plague in Mombasa (OK, it was just a bug….) and Megan has a background in PICU nursing with most recent experience being the most well-read full time mother I have ever met with a hankering for DIY home renovation (and I will be following her blog when they go back to the US to see what fixer-upper they settle on…..)

Inevitably, they will be returning to the US to live in mid-October.

As a mum, I am starting to grieve the loss my kids will feel, even though I knew it was coming, and the other part of me as a type-A personality is starting to think “I need to find them new friends now!”  Personally, I will miss Megan, who I have just clicked with on all sorts of levels and who has been a sometime walking companion, sensei of all things Kijabe and loaner of small appliances when mine have broken.  I felt like I was just starting to get to know Stacy when they had to leave, to gain some of the wisdom of her 6 years experience here, to start psyching ourselves up to finally get on mountain bikes (mostly at the urging of our husbands).

I have been anticipating this would happen, knowing the transient nature of a place like Kijabe.  I know I will make other friends here, as will the kids.  There are other people here whose company I enjoy – the Myhres with their incredible stories, generous hearts and Lord of the Rings kindred spirits, the Hansens with their wonderful blended family and Cosby-esque children’s stand-up comedy, and others.  I am grateful for these relationships, some in their infancy, some feeling much older.

It’s just a bittersweet place to be – investing in relationship because it’s so precious and if we weren’t here, we would not have had the chance to get to know some of these amazing people.  Knowing that these friendships have a lifespan, and that’s a sacrifice worth making.

- M.

Susan (28/8/11)

This is Susan – the 5th member of our family here.  Susan comes from a village around 10 hours from here, and came to Kijabe to look for work to support her mother, father and 4 younger siblings who live in poverty.  She lives with her Aunt Agnes, who is one of the chaplains at the hospital, and was recommended to us as someone who’d be a potential fit for us working in our home.  And what a good recommendation that was.

Life in Kijabe lacks a lot of conveniences – fresh bread (or any baked goods….), screens on the windows to keep out the dust and dirt, dishwashers, grandparents, clean vegetables to name a few…  and Susan makes the difference between keeping on top of things while serving here, and drowning.

Susan started working for us in May, helping us to clean, cook and look after the kids.  She started out shy and uncertain, but enthusiastic to learn.   Now, 3 months later, the kids call me “Miss Susan” by mistake and wonder where she is when she’s not here.  She has blossomed from a junior “extra” in our kitchen, to a friend who is quite happy to tell me to stop talking in English and talk to her in Kiswahili because she knows I want to learn.  She has a ready smile, a winning way with the children, and bakes the best zucchini bread in Kijabe.

The thought of having someone in my home 4 days a week was a bit scary and claustrophobic to me at first – I am an introvert who likes to be queen of my castle, and would prefer to have a house of controlled childhood chaos during the day, interrupted by the blissful silence of afternoon nap time, without the requirement of me interacting socially unless carefully scheduled.  Having to converse with someone without first psyching myself up for a conversation is something that used to fill me with dread.  But in the last 3 months, Susan has become a part of our family, and I can’t imagine how we would cope here without her.  It’s nice to have a helper, a nanny and a friend around, and to get to know her as we work alongside each other.  To know that the kids are happy and secure with her when I am at work, despite the loss of the time the kids used to have with their grandparents when I worked in Australia.  To have chats at coffee time about her family, her dreams, her hopes, and to be a part of that journey as she explores who she is, who she wants to be and how she will get there.

The hard part about having Susan around is – as you come to love someone, you want so much more for them.  As she learns in our home to bake and cook, and in her free time to use a computer during weekend classes here in Kijabe, I know she will outgrow us.  She has a keen intelligence that, given the right circumstances and opportunity, could see her end up anywhere.  She finished high school, but could have gone a lot further if the family could have afforded to pay for further education.

I hope Susan outgrows us, and that we can help her along that journey – I just hope she doesn’t do it too soon.

-M.

Sabbath rest? (21/8/11)

I was hoping to write a great post on the benefits of Sabbath rest after this holiday.  My newly-refreshed, invigorated and restored post-beach self was going to be able to say, rest is good.  For so many reasons.  To have time to spend with husband and children, forging life-long memories without distraction of other tasks.  To dial down, to turn the mind off of work, of ministry, of doing.  To re-discover that place of solitude, of silence.  To remind myself that making space to rest makes space to love and give to my husband and children, makes space to pray, to listen, to meditate, to rest.

After 3 days of spending most of my time in bed with chills, fever, headache and nausea, my post-beach self was honestly a littled p***ed off yesterday.  That I hadn’t been able to eat crab at the beachfront grill, that I hadn’t been able to go on the catamaran with my daughter, or even been able to get into the grown-up pool once.

Sabbath whatever.

But that’s the thing about rest.  We need it when we need it.  And I guess my body needed me to rest while on holidays, in a different way than I was expecting.

I have this tendency to push things.  If I have an unscheduled change of plans caused by some stupid virus, and my task list beckons, I will ignore the flu, cutting down my task list by 25% to allow myself a little space to recuperate, but I’m not going to take a full day of rest.  I’m far too important for that.  My kids and husband need me.  The hospital needs me.  The world needs me.  What would the universe do if I didn’t show up?

Maybe there is something I can glean from this getting-sick-on-holiday thing.   Not that it was “meant to happen this way”, but maybe I there can be some good from this – to have had time to recover from a pretty bad illness in the best way I could have, without feeling guilty about letting people down at the hospital, when my husband was rested enough to parent and play with our children without having to also prepare lectures, attend engineering meetings and drive 2 hours on a grocery run.  Maybe this illness will be briefer because I have really been able to listen to my body rather than beat it into submission, as is my wont.  And before I got sick, I still had a wonderful 3 days at the beach, snorkelling, on a glass bottomed boat watching the wonder of my children as their daddy swam below with the beautiful fish on a coral sea.

We are built for rhythm of work and rest, doing and being.   The creation story in Genesis is a beautiful poem, a rhythmic dance – God seeing and creating, brush stroke by brush stroke, part by part, and on the final day, handing over his masterpiece of creation to someone else to manage and tend – and then, Shabbat.  Rest.  Cessation.

The God of creation knew how to hand his important tasks over to someone else – even though there was a pretty good chance we’d mess it up – and rest.

I’m pretty sure God, through the author(s) of Genesis, was trying to tell us something crucial there.

So tomorrow, I am going to call in sick to work.  And the hospital will not fall apart.  And next Monday, like every Monday, our family will take our weekly day of rest, and we will re-enter this rhythm of living here, in a way that helps to keep us alive, truly, fully alive, for as long as we need to be.

I’m sitting in bed with the laptop as I write this – we just got home a couple of hours ago.  So I better sign off because I think the fever’s coming back.  Maybe I should re-read this post…

- M.

___________________________

Update 23/8 – the fever finally went away the next day, and I am now all recovered and close to hunky-dory.  Thanks for the love and prayers! 

Death and dying (17/8/11)

We’re on holiday on the coast at Shanzu Beach (30 km north of Mombasa) and so far it’s been a wonderful, restful time.  I’ve been re-learning the art of doing nothing “productive”…we’ve been spending time with the kids, exercising, catching up on our favorite TV shows, and reading.  I think I smelled smoke from Mardi’s Kindle this morning, she’s used it so much.

This Sabbath rest has also been a good time of reflection on our experiences since arriving here.  One of the areas in which I’ve been deeply moved is the “everyday-ness” of death and what death is.

A few days after we arrived in Kijabe, I noticed that crowds of people and cars gather at the rear of the Hospital (50 metres away from our back door) nearly every day, and sometimes 2 or 3 times per day.  They usually have red ribbons…tied to lapels, car aerials, hair.  They are there for a funeral.

By my count, Mardi sees 1-2 or so of her paediatric patients succumb to severe illnesses every week.

She recently told me of a conversation with one of our friends (an infectious diseases doc who sees an extraordinary amount of suffering and death) where they were discussing the matter-of-fact way people seem to deal with death here…when Mardi informs parents or relatives that their child has died, the first words she sometimes hears in response is “Where is my paperwork.”

Our child has died, no use fussing about, let’s get the paperwork, pay our bill, and go home.

This proximity to dying and death has impacted my perspective towards it.  Until recently, death just seemed farther off in the distance; something someone in their right mind would want to delay as long as humanly possible.  It was less a normal part of life, and more of a sort of singularity in time and space…life-shattering, somewhat scary, sad, to be avoided as long as one could.

From recent conversation, it seems to me that even for many of us who follow Jesus, with a clear hope for a future life in the new heavens and new earth described in Revelations 21, death sometimes seems to be a time mostly for grief; joy perhaps (a bit forced), but overwhelmingly a disruptive event.  Certainly not a part of an everyday rhythm of life.

Here, death feels like the tides…part of the ebb and flow of life.  More of a transitional activity along a continuum, and less of an event.  To be sure, it is also an event, and people do grieve–our language teacher, Edward, told me recently that in his tribe (Luhya) it is not unusual to hire professional funeral attendants to wail and grieve with you if you don’t think the funeral will be sufficiently attended.

Hence my meditation in the last few weeks on life after death.  Why has it previously felt like such a singularity in time and space? What is my imagination, my picture, of life after death?  Where is my hope?  Growing up as I did in the American pentecostal and charismatic tradition, my imagination has been shaped by stories of the ‘Rapture’, calls to consider “Do you know where you would go if you died tonight?”, and pictures painted of heaven as a place in the clouds which, wherever it was, was someplace else to which we would be evacuated in a disembodied fashion after we died, or the Second Coming, whichever came first.

One of the first followers of Jesus, Paul, wrote a letter nearly two thousand years ago to a troubled church on the outskirts of Athens.  Some of his words in this letter have helped bring clarity to my reflections these past few weeks (2 Corinthians 5:17 ):

So if anyone is in Christ, there is a new creation: everything old has passed away; see, everything has become new! 

It is perhaps strange that in being surrounded by death and suffering, the Lord should start to cement my understanding that in Christ, all things really have become new, and the old way of life really has passed away.  The death and rebirth narratives woven throughout the Old and New Testament are starting to crackle and pop a bit more for me now. Reshaping my imagination of heaven not as some place with a lot of harp-playing in the clouds and bored angels but as the new and re-made existence described in Revelations 21, where God’s original plan for mankind of co-stewardship and active participation in the management of his creation is realised.

I noticed something interesting in my Bible readings these past few weeks:  Matthew uses the phrase ‘kingdom of heaven’ (as in Matt 5:3, Blessed are the poor in spirit for theirs is the kingdom of heaven) 31 times in his book about Jesus.  John, in his, never uses it once.  John uses the phrase ‘eternal life’ 17 times in his book about Jesus (as in John 3:16, For God so loved the world that he gave his only Son, so that everyone who believes in him may not perish but may have eternal life). Matthew uses it a grand total of…twice.

Some scholars think this striking difference in Matthew and John’s description of the words of Jesus is due to their each choosing a different Greek turn of phrase to describe a similar concept:  God, through Jesus Christ, has inaugurated His rule and reign in the new heavens and new earth (‘kingdom of heaven’), and this is both a present and a future hope.  ’Eternal life’ (zoe aionious in the Greek) then is our invitation to participate in this present and future hope:  the Greek words translated ‘eternal life’ in our Bibles can refer to both a quality and a duration of life.  It is a different kind of life, one where we live as fully human, fully alive, as we were created to live, in alignment with God’s rule and reign, bringing life and not death through what we do.

But it also has an element of duration to it:  importantly, it is a life which begins now (not “where you go when you die tonight”), and in which we will live beyond the grave, after a bodily resurrection, to be active participants in a fully restored creation.

A present and a future hope.  Eternal life as a different kind of life which begins now and carries on into eternity.  These are everyday-feeling concepts which resonate in my heart and head in our new context of death and dying here in Kijabe.

- A.

Donate to famine relief

The famine in the Horn of Africa is affecting over 13 million people.  If you’d like to donate funds to get food directly to these people, we have a couple of recommendations:

Donate to the UN World Food Program here - the UN is one of the only organisations we know that can get funds and food directly into the Dadaab refugee camp and into S_m_l__ itself.

or

Donate through SIM Kenya’s Emergency relief fund here.  This money will be given to contacts we have in the AIC Church in North Eastern Kenya to assist the poor and hungry in rural villages directly affected by the drought, and we are hoping to assist the church in digging wells where they are most needed.

Widows and orphans (8/8/11)

Last week I met Ria, who brought a girl (let’s call her Precious) to Kijabe for treatment.  Ria runs a home for abandoned children, and is one of the most remarkable women I have met.

Ria was born in the US, and moved here when she was 2 years old with her parents.  They ran a home for street kids – the lost, abandoned and alone.  She grew up here and although she attended college in the US, Africa has always been home and so when she graduated, it was to Kenya she returned.

Philip had lived in the home Ria’s parents ran.  Seeing such great need, he moved on to start his own ministry to the marginalised – Morning Star Children’s Home.   It wasn’t too much later, in 2008, that Ria and Philip were married – a team uniquely gifted to serve children who had no-one else.  With the help of their staff, their home grew to be home to over 70 children – who, from a life of survival and neglect, found a family.

Until 18 months later when Philip died, leaving a pregnant Ria to run a home for 70+ children.

3 weeks later Ria delivered their first and only child, a beautiful little girl with a tracheo-esophageal fistula – a condition where the esophagus is a short sac that doesn’t join onto the stomach.  The baby can’t swallow anything, and the stomach is connected to the trachea instead – a dangerous risk of lung damage from stomach contents.  I have seen 2 babies so far born at Kijabe with this condition, and neither one has survived long after surgery.

So Ria’s daughter had surgery soon after being born.  In ICU, she was on her last legs.  Ria was praying in desperation – God, first Philip, please not my daughter.

Against all odds, her daughter made it.  After weeks of care, Ria and her daughter went home.  And now Ria is mother to a 2 year old daughter, and a surrogate mother to many more as the director of the home.  I’ve seen Ria a few times in the hospital – sometimes with her own daughter, who still needs followup for her own condition.  But this week she came in with Precious, and has hardly left her side.

Precious is 10 years old.  Her parents died from AIDS when she was very young, and she had been living with an “aunt” in whose care she received abuse, TB and HIV.  She was referred to Morning Star in 2007, and has found a family, friends, a school to attend and medical attention.  She came to us this week because the fight against HIV is a 2-steps-forward, 1-step-back process and she has a new infection.  We are still trying to diagnose what is wrong – measles, Kawasaki disease, PCP pneumonia, varicella pneumonitis?  There are other children in the home who have HIV who are walking alongside Precious, as well as children with different physical and emotional scars who are their new brothers and sisters.

The local police chief has Ria’s number, because he know she won’t turn anyone away.  So when he had 2 children in a cell for 3 days because their mother was arrested for prostituting herself and her other daughter (half price), it was Morning Star he called.  They have never turned away a child.  Despite sporadic income, a child there has never missed a meal (although Ria and the staff have had to) and all of them have a roof over their heads.  These children have moved from a life of hopelessness and despair to one of knowing in a tangible way that Jesus loves them, through these angels with skin.

Widows and orphans.  These were the people with whom God got our attention 6 years ago, and who we are now privileged to serve.

Learn to do right; seek justice. 
Defend the oppressed.
Take up the cause of the fatherless; 
plead the case of the widow.
- Isaiah 1:17 

- M.

_________________________________________________________

Update 10/8 – Precious went home today!  Her fever went away and chickenpox never reared its dangerous head.

If you want to know more about Morning Star or how you can help, please email Ria at morningstarchildren@yahoo.com.

Losekan (5/8/11)

Last Friday morning was supposed to be the last-of-the-out-of-control-busy days for me at work.  Which is probably why the morning went something like this:

8:28 – arrive on pediatric ward with optimistic spring in my step ready to start rounds.
8:30 – text from Jennifer: “Let me know if you need help this morning – know it’s busy”
8:31 – confident text from me: “Doing great! Only 12 patients on peds, nursery OK!  Enjoy your day off! xx”
8:33 – nurse to me:  ”Annex just called – can you go now please?” *run to annex*
8:34 – awesome pediatric neurosurgical NP to me on arrival: “I’ve been doing mouth-to-mouth-resuscitation on this baby because the equipment here isn’t working…”

Baby Losekan, 8 weeks old, has already had 2 neurosurgical procedures since birth – her lower spine never closed properly, and her spinal cord was malformed and protruding, and this had been repaired a week earlier.  She also had hydrocephalus, and a few days ago excess fluid was allowed to drain from her head to lower the pressure.  Today, she was due for a VP shunt – a hose to drain fluid from her brain to her abdominal cavity.  Only she had stopped breathing.

We resuscitated her, suctioning thick, goopy stuff from her nose and mouth, her colour returning, her arms flailing, a strong cry.  After a good look and a good think, our suspicion – a lung infection, maybe some inhaled milk, needing good oxygen, a chest xray, possibly antibiotics, definitely close observation and no surgery today.

9:00 – return to pediatrics to start rounds
9:03 – a call from the nursery – a c-section requiring me to be there in case the baby needs help
9:20 – a healthy, grumpy and active little girl requiring a good bath but no medical attention
9:25 – passing the labour ward to go back and check on Lokesan – “Are you paeds?  Come now!”
9:25 1/2 – nurse hands me freshly born, teeny tiny, 28 week blue but crying 1040 gram baby
9:26 – Mardi running through the hall to the nursery in heels hoping not to drop aforementioned baby
9: 45 – 28 week premmie has won “baby of the day” with refusal to deteriorate and decision to breathe all by herself with just a little bit of oxygen.  Champion.  Nursery team kindly agree to do appropriate things to ensure tiny baby continues to be fine.
9:50 – back to pediatrics to start ward rounds
9:52 – “Dr Mardi – please go back to Annex”.  At this point I threw in the towel, and SMS’d Jennifer, tail between my legs – “Pls cld u come in and round on nursery – haven’t started peds rounds yet – resus, c-s, 28 wk prem…”
9:53 – the same needing-mouth-to-mouth baby, who had gone to get a chest xray, stopped breathing in radiology again.  We don’t know how long for.  Second verse, same as the first – baby starts to breathe.

This is where things becomes difficult here.  This baby has stopped breathing twice.  In Australia or the US, we would intubate the baby, put her on a ventilator, for as long as needed, and breathe for her.  But this is Kijabe, where we have 5 ICU beds.   For the whole hospital.

So the question is this:  is THIS baby worth the resources?  How long will she be on a ventilator?  How long until she recovers?  WILL she recover?  Is she not breathing because her brain isn’t quite right?  Or just because she has a chest infection?  If this is just an infection and she lives long enough to get surgery for her hydrocephalus, will she grow up into a little girl who will go to school, will she dream dreams and see them realised?  Or will she survive surgery to find that she is capable of no movement, an indescribable life for her and a burden on her impoverished family in a country that doesn’t have affordable or accessible physical therapy, occupational therapy or services for the rural poor?  Or will she not even survive surgery, leaving her parents with a hospital bill as their only Losekan memento?  Or will she not even get out of ICU, because the only think keeping her alive is the ventilator?

All we can do in these circumstances is pray for wisdom.  ICU had a bed, and a ventilator.  Her xray looked like an infection, and she looked like a fighter.  We decided to put her in ICU – to watch her and see if she stopped breathing again.  And if she did, to put her on a ventilator and give her 48 hours to show us how much she wanted to stay around, to fight.

Turns out she wanted to fight.

She stopped breathing again, and was put on the ventilator.  But after 12 hours, she’d cleared up her lung xray, and gave us indignant looks and lots of activity every time her sedation wore off.  And even though after 48 hours she wasn’t quite ready to come off the ventilator, she kept giving us hope  - keeping her oxygen levels perfectly normal when we started to lower how much oxygen we were giving her.

On Wednesday the team knew that it was time to take her off the vent.  They sat down with mum and said, this is it.  It’s time to try.  And she might make it.  But if she doesn’t make it, we’ve done all we can do.   And we’re not going to try again.

We honestly didn’t think she’d make it – Tuesday she’d looked like once her vent settings were lowered all the way that it would just be too exhausting for her to breathe on her own for long.  Jennifer finished her shift on Wednesday, and I started mine, and I went up to ICU with my heart in my throat, to ask mum if she was ready.  I was prepared to sit with Losekan and mum as she tried to make it off the vent, pretty sure it would be a long, painful afternoon resulting in sadness.

But she breathed.  And breathed.  On her own.  Today she’s still been breathing, and we’ve been able to cut down her oxygen, little by little.  Now she’s out of ICU, back in the ward with the other babies who can breathe by themselves.

We still don’t have a lot of those answers – will she get off oxygen all the way?  Was her brain damaged by not breathing?  Will she get to surgery?  If she does, will she make it all the way through surgery?  Will she survive the surgery and still be looking at us and batting at us with her arms?  Will she grow up into a little girl and go to school, will she dream dreams and see them realised?

I really hope so.

- M.

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p.s. Jennifer is a saint.  She worked until at least 1pm to dig me out of that hole on her day off.  I am so grateful to have her and many other such amazing people in the trenches with me.

Update 28/8/11 – Losekan finally went home over 2 weeks later – a slow recovery from her chest infection, but a recovery.  I hope to see her again when she comes back in a month to the neurosurgical clinic for review.

John Stott’s death (3/8/11)

John Stott died last week, and I have been surprised at the depth of feeling his passing has stirred in me.

My first introduction to John was in reading a book of his (Basic Christianity) with a few others at InterVarsity Christian Fellowship while in university in 1997 at GWU in Washington DC.

My second introduction was standing in Graham Twelftree’s library in Adelaide, South Australia a year later.  I noticed a copy of Basic Christianity on his bookshelf, and commented that I had recently read it and thought it a rather dry and uninspiring description of what being a follower of Jesus is all about.

To which Graham replied, ‘I see.  He is a friend of mine, and godfather to one of my children.’

This was not the first time, nor the last, that I have had opportunity to learn that keeping my opinions to myself until they are sought is not unwise.

In reading some obituaries of John’s death (Christianity Today, NY Times) and speaking to Graham again last week (who is now the Distinguished Professor of New Testament at Regent University), I have been deeply moved by John’s life, his effectiveness, productivity, and passion.  John was known for extraordinary discipline, focus, and clarity.  He was also not without his flaws.  But he had a deep desire to discern what the Lord’s will for his life was, and to order his life around doing that…and I have been surprised by how deeply that has stirred something inside me.

John was ruthless about eliminating ‘good’ things in his life that were not directly related to ‘the best’ (what he felt called to do), and he was known for regularly saying ‘no’ to good opportunities that came his way if they weren’t in line with his priorities.  He rose early (about 5 am) every morning, and was unbelievably productive.

As we settle into a new rhythm of life here in Kijabe, one thing is obvious the moment we step out of our front door:  there are a huge amount of ‘good’ things for us to do.  But we can’t preach in everyone’s church, we can’t manage every project, we can’t supply food and shelter to everyone in need, we can’t work 12 hours per day in the hospital and still raise emotionally and spiritually healthy children, much less still be happily married in ten years!

We have God-given limits, and we are learning that this is a beautiful and life-giving realisation.  As I try to find a healthy rhythm of rest and activity, I am inspired by John’s life of discernment and action, and learning to be comfortable saying no to good opportunities so that I can focus on what I feel called to do.

And having moved from two cultures where individualism and self-promotion is valued, to this quiet corner of Africa, I am also deeply moved by John’s humility and labours quietly behind the scenes.  From the NY Times obituary:

For all his fame on several continents, Mr. Stott’s travels and appearances were remarkably devoid of pomp, befitting his simple message of reason and faith and his unassuming demeanor. Those in his ministries knew him simply as Uncle John. In his later years, he lived in a two-room apartment over the garage of a London rectory, and for many years he kept a small cottage on the Welsh coast, where he did much of his prodigious writing in longhand and, until 2001, without electricity.

“Pride is without doubt the greatest temptation of Christian leaders,” Mr. Stott said in 2006 during a visit to the United States. “And I’m very well aware of the dangers of being feted and don’t enjoy it and don’t think one should enjoy it.”  

Amen.

- A.

Intensity and gratitude (24/7/11)

For the last week and a half I just haven’t had the headspace to be able to blog.  Some of you know that I was able to go to the UK from July 4-9 for my darling friend Fiona’s wedding to the dashing Irish David, with the wonderful bonus of being able to see Catherine Wait, my closest friend from high school who moved to London in January.  It was a precious few days – spending time with dear friends who know me in a way not a lot of people do, just being able to be myself, and to rest.  It was a blessing, made possible by my amazing husband parenting children solo in Kenya, while Jennifer sacrificed time with her own family to fill in for me at work.

I got back on a Sunday, and had 3 wonderful days reconnecting with the kids and Andy, being able to be present and rested, able to give Andy some space after surviving a pretty horrific week with sick kids and sick daddy.  Our family works much better with 4 people than 3, and it was nice to be back.

And then, back into the work maelstrom.

Catherine, friend of 25 years

For the last 3 months, Jennifer and I have been supported incredibly in our pediatric work – Dan Entwistle, a pediatrician from North Carolina, had come over to help us (and so that his family could be close to RVA for the last 3 months of his son Jesse’s senior year, attending rubgy games and all things senior), and we also had Immaculate working on the pediatric ward.  It all worked out beautifully – Immaculate and Dan taking care of inpatients, supervising outpatient clinics and doing consultations for pediatric surgery and neurosurgery, managing critical children in the ICU.  Jennifer and I were able to take care of the newborns in special care nursery, attend caesarian sections, resuscitate premature babies, educate our team and update protocols that were outdated or lacking, run a clinic at the boarding school on Thursday, and run a private pediatric clinic on Wednesday afternoons to try and cater for those children who are missionary kids or whose families can afford it, bringing some extra money into our just-squeaking-by-non-profit-hospital.

Until a week and a half ago, when Dan left and Immaculate remained away on annual leave.

For the last 10 days, Jennifer and I have been keeping our heads above water.  Just.

We decided that rather than both of us working full-time to fill in the gaps, sacrificing our families and children, that we’d keep to our half-a-week-each schedule and just work twice as hard when we were at the hospital, until Immaculate returns on August 1st.

It has been a lot to handle.  First thing in the morning, I’ve been rounding on 15-20 inpatient children and seeing the surgical/neurosurgical consults with CO Lillian, a FP resident and intern, while CO Bob and 2 interns manage the nursery.  Then, dashing off to nursery to see the 15-20 babies, some of them as small as 1100 grams.  Rushing back to the paediatric ward to see if Lillian and team need assistance with discharges, procedures and paying children’s bills from the Needy Children’s Fund because they can’t afford it – trying to free up the peds team to get to the outpatient clinic because at least 30 children a day need to be seen there and many have been waiting since 8am.  All the while, hoping that the beeper doesn’t go off for an emergency c-section, or admission from Casualty or clinic, or deteriorating baby, or new consultation.  At 2pm, looking at my watch realising that I should attempt to run home for lunch (quicker, actually, than going to the cafeteria…) because if I don’t go now, my beeper WILL go off and the day will be gone.  Rushing back to tie up loose ends, check results, followup tests and make sure I haven’t missed anything critical, see the admissions I have missed during my 20 minute lunch break.

That was Friday, and then I was on call on the weekend, involving the same thing without the clinic on Saturday, capped off by 3 admissions at 1am on Saturday night.  Sunday we don’t really round if we’re on call – but with 35 babies/children on the service many need checking so I was in from 9-12:30 just putting out small fires… followed by new consultations in the evening and deteriorating babies at 3am.  Breathing space with the family on Monday and Tuesday.  Then again Wednesday, Thursday (which included running to private clinic to see a last minute booking, even though I’d cancelled the clinic, because a colleague’s wife is at breaking point with their 3 year old twin boys whose behaviour, it turns out, is probably so difficult because of their not-quite-officially-diagnosed autism which has not been well explained or supported).  Another night on call Thursday, then Friday, Saturday morning rounds (kindly supported by Jennifer who realised I was losing the plot…) – then, a deep breath.

I was supposed to go  away again next week from Monday to Wednesday – I was going to join the pediatric surgical team who go monthly to Dadaab.  Dadaaab is a refugee camp in northeastern Kenya that was intended for 90,000 people and currently houses over 400,000 with thousands streaming in from nearby S-m-l–, stricken by drought and now being denied aid by its own spiritual leaders.  I have wanted to be a part of the team there since arriving – humanitarian organisations there refer difficult pediatric cases to us, and pay for us to evacuate them back to Kijabe, treat them and send them back up to Dadaab when they are well.  I am disappointed to not be going, but the timing was atrocious  and there will be other opportunities – I think I and the whole family would have spontaneously combusted if the balance had been so upset again so soon.  And I think my kids would have begun to wonder, where is Mummy again, and why isn’t she with us?

It has been an intense 10 days.  I am so grateful for so much – that I have had no critical babies in intensive care.  That I am sharing this job with Jennifer, whose advice when I am clueless is invaluable and without whom this would have been 13 straight days of lunacy  with only 1 day off to breathe.  That I have such a capable and hard-working team of Kenyan COs and interns.  That Immaculate is coming back in August and that we are not handling this load all the time.  That I have an amazing, supportive husband who knows when I need rest and space, who knows when to ask me if I am doing too much, who supports me and the kids so practically and graciously.

I am grateful that I am exactly where I am.  Despite – or because of- the intensity of this job, it is deeply fulfilling to be here, where the need is so great, and to be walking this tightrope of family and career, of being and doing.  To know that when I think I’m at the end of my rope, that the edge of my comfort zone is the place where I need to be.  To see my weaknesses, to see my priorities, to be able to assess, what am I supposed to do today?  How do I be a Mum, a wife, a pediatrician, a friend, a daughter of the King?  I think those are good questions to keep asking.

- M.

My textbooks arrived! (23/7/11)

My textbooks arrived today!

Renovare USA in Colorado sent this box of textbooks and reference materials about a month ago, and as time passed I was starting pray a bit more earnestly that they would arrive in time for classes to start at the end of August!

It’s been an up and down week, as weeks here seem to tend to be…the lowlight being Mardi having to diagnose a friend and co-worker’s twin boys with autism two days ago, and then help them think through what support and education networks there are in Africa for autism (not much).

So getting this box of books was a wonderful and needed encouragement at the right time.  And to top it all off, we didn’t have to pay customs duties on the 15 kg box, which was an unexpected blessing.

Look at all these sweet books, Dad!

Included in the box are:

1.  30 copies of Connecting with God:  A Spiritual Formation Guide (the textbook my students will use in their spiritual formation groups/interactive tutorials)

2.  30 copies of The Path to Life (an order of meeting for spiritual formation groups and daily prayer tool)

3.  30 copies of Rhythms of Life (an essay on the Christian life being a rhythm of peaks and troughs, ebbs and flows)

4.  Several books I will use to help prepare lectures and as reference/further reading resources for students:

a.  Celebration of Discipline, by Richard Foster

b.  Renovation of the Heart, by Dallas Willard

c.  Dark Night of the Soul, by John of the Cross

d.  Streams of Living Water, by Richard Foster

e.  A Spiritual Formation Workbook, by James Bryan Smith and Linda Graybeal

They also tossed in a copy of their Life with God Bible, which I use in my devotions and will make available to the students.

What a wonderful gift from Renovare, and our thanks to Lyle SmithGrayBeal and the Renovare team for their support of Moffat’s students.

Planning (22/7/11)

The new semester at Moffat starts in 4 weeks, and with it the class I’ll be teaching to first year students on Spiritual Formation…now that the water project seems to be moving forward I took this week to begin preparing lectures and lesson plans.  Getting any serious study and writing done in our house is delightfully impossible with 2 boisterous youngsters, so I headed over to Moffat to see if they had any quiet space I could hunker down in.   Thankfully a lot of the lecturers are on home assignment/furlough at the moment, and so I was given a little office to work in, which was a peaceful haven of productive study and writing this week.

Besides the opportunity for quiet study and writing, a highlight of my week at Moffat was “chai time”…every day without fail at

The empty office at Moffat where I've been squatting

1100 and 1500.  Like England and Australia, it seems all of Kenya stops for tea time, but with the strong Indian influence here, tea = chai!  Chai here is a bit different from chai in India–made with hot milk, tea, and enough sugar to cause you levitate spontaneously, but less spicy.

Rev. Dr. Paul Kamunge is the Principal here at Moffat, and we spent some time talking this week…it was Paul who came up to me right after we had arrived at Kijabe and said, ‘You are Andy Steere.  I have heard of you.  You have a passion for spiritual formation.  You will teach our Spiritual Formation class to first year students in August.’  I was delighted (and slightly intimidated) by his forthright approach and agreed to think about it…and here we are.

Renovare is providing the course materials and textbooks for the class, and shipped them over a few weeks ago…they are stuck in customs at the moment, so your prayers that this box full of classic books on spiritual formation would be released would be most welcome.

Paul, Principal at Moffat

I was sitting in a spare office at Moffat today studying and writing, with the birds singing outside and voices drifting up softly from people passing by under the window chatting in Kikuyu or Kiswahili…and I was just struck by God’s timing.  I am blessed in this season of my life to be doing three things that I love:  spiritual formation, project delivery and leadership and management coaching.

Any one of these three things would get me out of bed in the morning with a bounce in my step…but to do all three at once is a rare gift.  I haven’t felt this fully alive in a long time.  Partly because I’m coming to the end of a rough few years, but I also feel like I’m firing on all cylinders for the first time in a while.

One of the best thing about teaching for me is the study and preparation in advance…immersing myself in a subject I love, exploring the boundaries, and shaping it into something which can be taught.  For me, “spiritual formation”–the process and means by which our whole person and our whole life is transformed into Christlikeness so that we might learn to live ‘fully alive’ and experience an eternal, ‘with-God’ life now–can’t be treated clinically, with theory divorced from practice.  As I get into the Bible and other writings, I find my vision starts to sharpen, and the little bits of fog that sometimes obscure my perception start to clear away.  I find this subject to be deeply personal, and more than once this week I’ve had tears in my eyes as I’ve meditated on something and been reminded of God’s desire for us to experience the kind of life now that he has created us for.

In Matthew 11 Jesus says:

Walk with me and work with me—watch how I do it. Learn the unforced rhythms of grace. I won’t lay anything heavy or ill-fitting on you. Keep company with me and you’ll learn to live freely and lightly.  (The Message)

This is the kind of life we’re created to live…one with unforced rhythms of grace…and I want my students–future chaplains, pastors, evangelists, ditch-diggers–to begin to learn to train themselves to be available and present to this sort of unbelievably exciting, unpredictable, sometimes-scary, God-centred life.

A few weeks ago, our sending church (Southland Vineyard Church) held a quiz night to raise support for us.  From part of the proceeds of that I was able to purchase this data projector which I will use while lecturing, and then donate to Moffat when we leave…thank you, Southland for supporting these students!

Our new data projector

The last few days have also been encouraging as I’ve started to see some fruit from my coaching/mentoring efforts…there’s something indescribably wonderful about seeing the lights go on in someone else’s eyes when they realise something they’ve never before understood, or see a way forward where previously they were stuck.  This week, one of the guys I’ve been coaching started to try out some new management techniques we discussed during a strategic planning and coaching day I facilitated last week.  He came to me yesterday, filled with excitement, and shared that he’d been discouraged for a long time that he hadn’t been very successful at getting other senior managers “onside” with some of his proposals.  After our coaching day, he tried some of the new techniques and voila…different results.  He got these key players onside with a major new proposal, and in the process learned something about managing senior leaders (leading upwards), and managing laterally (leading his peers).   Wonderful.

Mary’s new home (19/7/11)

Some of you read my post about Mary, abandoned as a 855 gram premature baby in March.  Well, last week, she went home.  We never found her parents – but we ran the lengthy legal gauntlet and gained permission for her to go somewhere far better for a 4 month old than a hospital nursery.   I had to work on the day she left, but Jennifer went with her and tells her story so well – read it here.

- M.

Kijabe Water Project Concept Design Approved! (15/7/11)

Yesterday was a big day for the Kijabe Water Project…we presented the concept design to the Senior Management Team for their approval, and they approved it and the proposed way forward after 2 hours of discussion!

This is a major step forward towards successful delivery of the Project…we now transition from the Concept Design Phase to the Delivery Phase, and our first activities include:

-Apply for grants to fund the project.  The Construction Cost is budgeted at 64m Ksh (Kenyan Shillings) or around $750,000 USD, and we need to raise a total of 52m Ksh or $600,000 USD.
-Apply for statutory approvals (underway)
-Develop the concept design to a completed detailed design including For-Construction drawings
-Develop a procurement plan and shortlist likely suppliers and contractors

…all with a view to starting construction in early 2012.

This approval is an exciting and encouraging step forward, and for a non-profit Hospital that regularly operates above capacity with doctors and nurses who work long hours (many of whom are volunteers), the possibility of not having to worry about getting sick from the water coming out of the tap is just a breath of fresh air.

One of my activities in the last week has been to try to quantify exactly why we need a water supply upgrade…this is important for grant applications.  Living in Kijabe, it’s fairly obvious that an improved supply of water is a critical priority…we lose water pressure regularly and can’t drink the water without significant filtering or boiling.  But the hospital has specific needs which go beyond the broader truth that we are among the more than 1 billion people around the globe who don’t have access to safe drinking water.

In addition to water shortages, we regularly experience bacterial (faecal) contamination (including e coli) of the water supply, requiring boiling of the water to prevent illness.  An improved water supply with chlorine disinfection is required:

-For nurses to make formula for infants;
-To bathe children before surgical procedures;
-To provide an uncontaminated source of water for immunodeficient (HIV/AIDS) patients.  When healthy people drink water contaminated with bacteria, there is a risk it will make them sick, but when immunodeficient patients use it, it can be life threatening;
-For staff to clean hands and equipment; and
-For hydration and taking medicine.

Here’s the physical scope of the project that has been approved:

-Replacement of the existing 5 m3/hr pump at Monkey Corner Spring with a new 19 m3/hr pump.
-Extension of electrical power to the pump station site to power the new pump
-Construction of a new water transmission pipeline from the new pump station to New Water Supply Tanks (8 kilometres long)
-New Water Supply Tanks located near the existing Kijabe Main Tank with a nominal storage capacity of 3 days’ Average Daily Use (ADU)
-A chlorination system located near the New Water Supply Tanks to disinfect the water supplied to the Kijabe Hospital Water System
-Suitable physical security considerations around the new pump station.  The risk of damage due to vandalism is high.
-Interconnections between the new supply system and existing supply system to allow for backup/emergency supply as required.

Here’s a map showing Monkey Corner Springs (a 300 metre hike up a mountain from the road), the location of the new pump station (road level), the 8 kilometre new transmission pipeline, and Kijabe (location of the new storage tanks, chlorination system and hospital):

Satellite view of the Kijabe Water Project

We will be starting to apply for grants/raise funds in coming weeks, and if you hear of any potential donors/funding sources to whom we might apply please don’t hesitate to let us know!

-A

Needy children’s fund (12/7/11)

Some of you read my posts on Bedan and Mary and have asked how you can help babies and children like them who can’t afford to pay for their hospital stay.  We have now established a link through AIM (Africa Inland Mission) whereby your money will go directly to our Needy Children’s Fund here in Kijabe.  As we use this money to help families in poverty, know that we’ll be updating our site with their stories to keep you connected.

To donate to this fund, just click here or via our Support Us page- please make sure to put “Please transfer directly into Kijabe Needy Children’s Fund A/C 70351” in the Gift Comment box to ensure your money goes to where it is most needed!

Abiding (10/7/11)

Ahhhh….the end of the week.  I’m here in front of our fireplace writing this and can feel the tension of the week start to ease out of my shoulders.  Mardi has been in the UK since Monday at our good friend Fiona’s wedding.  She returns tomorrow morning after 7 days away.

[aside:  staff housing at Kijabe is usually made of rock or concrete block, and our house is very well insulated...it's winter here, which really means 'a little wetter and 10 degrees colder than summer', and our house is always toasty warm at night.  The nightly winds that roar through here, pushing the ubiquitous red dust which is Africa into crevices and under windows and doors, are just noise...and the house stays warm.]

I’ve watched the kids on my own before; I had them for two weeks last year while Mardi was in the States on a training course.  But this week…was like nothing I have ever experienced.  Sure, we’re in a new culture, and everything is different and requires extra thought…but I didn’t expect this week.

We started toilet training Liam last week, and he picked the day Mardi left to decide the toilet wasn’t for him.  He’d much rather do it on the floor.  For three days, just to get him to sit on the toilet took a 15 minute mini-skirmish.  All three of us picked up something cold/cough/fevery which lasted five days, and which combined with Mummy’s absence meant Riley-and-Liam-no-likey-do-what-Daddy-say-very-much.  They were testing boundaries and running right past them all week…just to get them to go to bed and fall asleep turned into a 1.5 hour ordeal every night when it usually takes 30 minutes or less.

I know many of you parents right now are reading this and sympathising, and I can feel your solidarity and sympathy from here.  Thank you.  The perspective I get from knowing that my experience is not unusual is life-giving.

Oh, and my parents got divorced yesterday.

That one’s been in the works for a few years now, but it got finalised yesterday, of all days.

I spent the whole week with anger and frustration frequently boiling over a thin veneer of normalcy…4 or 5 times a day the kids would do or say something which needed some corrective parenting, and I would correct with yells and harsh words.  I don’t think I’ve ever seen my kids cry as much as they did this week…and I don’t think I’ve ever felt like such a failure as a parent or a human being like this week.

I’ve been reading Emotionally Healthy Spirituality (by Peter Scazzero) the last few months, and one of the key things the Lord has impressed on me from this brilliant and insightful book is a need to understand and not ignore the extent to which my emotions affect me.  Perhaps because of this book, at the height of my frustration a few days ago I realised that simmering underneath all of this week has been my awareness that my parents’ marriage of nearly 40 years was about to end in an ugly and acrimonious split.

This immediately brought me some perspective and recognition that my emotional responses to the kids were just the tip of the iceberg…underneath was the normal emotional response of an adult child working through his parents’ divorce.  Just knowing this helped bring perspective, and I was able to recognise:

-the blessing of Mardi’s co-paediatrician, Jennifer, coming over here on Monday and having a look at the kids to make sure it wasn’t leprosy or something weird (hey, I’m not medical, OK?).  And then coming again on Tuesday to say hi.

-the blessing of Susan, our house helper, giving me a few hours of respite every day so I could get away from the kids and do some work.

-the blessing of some excellent parenting solidarity with Megan, Rich and Stacy, and their friends the Saunders at dinner tonight, where I realised that my kids are just like everyone else’s, and that I was perhaps not in imminent danger of turning to the Dark Side, being encased in a black suit with a raspy voice and about to chart choking people from a distance with the Force.

-the blessing of the encouragement and enthusiasm of our friends Gretchen and June in the States, who are writing grants for the Kijabe Water Project.

-that, in a way it is hard to describe in words, I could actually feel people praying for us.  Just knowing this helped me understand that I wasn’t alone, and that I needed to be kinder to myself.

-that I am married to the most amazing person on the face of the earth.

It’s been a rough week, but His grace is sufficient.  Really.  During weeks like this that truth becomes less the flowery embroidered Bible verse on the wall in my grandmother’s bathroom, and more a real and earthy awareness of the infilling of peace and rest I feel when I sit down to pray or be silent at times throughout the day.

Thank you for your prayers…they have been heard, and they have been effective.

-A

Partners and friends (6/7/11)

What a busy last few weeks it has been…finalising the curriculum for the class I’ll be teaching starting in August, finishing the concept design for the Kijabe Water Project, consulting with stakeholders on the Water Project, applying for our first statutory approval with the Kenyan Water Authority, hiking up hill and over dale to various springs and walking pipeline routes…it’s easy to lose your bearings slightly in the midst of a lot of ‘doing’, and forget to stop and contemplate for a while, ponder, and reflect.

Since we arrived a little more than two months ago, a great source of encouragement to me has been some partnerships which have developed with a few organisations and individuals for specific projects over many emails, phone calls, and Skype chats.

Renovare USA, the spiritual formation organisation founded by Richard Foster and Dallas Willard, has provided curriculum development support for the Spiritual Formation class I will be teaching at Moffat Bible College.  Moffat has budget for only 40 photocopied pages per student per class, and so Renovare also offered to purchase textbooks and curriculum materials for the class.  They shipped more than 50 books to Kijabe last week, which I still can’t quite believe.

Our home church, Southland Vineyard held a quiz night a few weeks ago to raise support for us.  Part of the proceeds from that quiz night were originally earmarked to buy textbooks for my students, but due to Renovare’s generosity we are able to redirect these proceeds to purchase a data projector, which I will use while teaching and for Hospital presentations.

Inside Infrastructure, an engineering consultancy in Adelaide, South Australia, is providing pro bono engineering advisory services on the Kijabe Water Project I am helping the Hospital deliver.  They are providing invaluable (and what would otherwise be very costly) engineering support and advice on the pipeline, pump station, and water system design.  My friends Chris Hewitson and Craig Headon (founding Directors of Inside Infrastructure) started this company with a desire for it to have a grounding in Corporate Responsibility, and they are off to a flying start.

Grundfos pumps, through our friend (and Mardi’s folks’ former next door neighbor!) Ole Sorensen in Denmark is providing pump selection services, including potentially reduced pricing on the pump we will end up purchasing on the Kijabe Water Project.  With a new pipeline of nearly 8 kilometres, and with a large elevation change between the spring and Kiajbe, we require a very specialised pump which must also be reliable, and Grundfos is known around the world for excellent quality control and reliable pumps.

Friends Gretchen Pattison and June Maier are writing grants and drafting letters of enquiry as we speak.  The Kijabe Water Project is a major water supply project (even by Western standards), and we will need to apply for substantial grants in order to fund the project.  Gretchen and June have experience in NGO management and grantwriting, and will be writing grants and seeking funding for the project.  Grantwriting and application is a specialised area, and we are very grateful for their expertise and passion in this area.

Two other Australian engineering firms, Tonkin Consulting and Guidera O’Connor have offered to provide advisory services on the Water Project, and we anticipate their being a great help in the future.  A few other potential partnerships are brewing in the background as well.

My humble thanks to these people and companies that share our passion for compassionate care of the sick and the poor.  You are a great encouragement to me and I am grateful for your friendship.

-A

Concrete (1/7/11)

We lost power again today, and I couldn’t boil the jug to make coffee for an hour…I’m a little ashamed to admit how much this affected the quality of my afternoon.

When the power goes off at the hospital (as it does frequently), one of the first places they notice is the intensive care unit.  Mardi was up there caring for a child yesterday, and they lost power for a few minutes.  The nurses sprang into action, pulled the patients off their now-lifeless ventilators and began manually bagging them to keep them alive.

She told me about this today, and I just couldn’t believe it.  They began manually bagging all the patients on ventilators to keep them alive.

Our new friends Jim and Jullie Taubitz are engineers here, seconded by Engineering Ministries International to construction manage the new pediatrics wing.  They are also helping with the power supply upgrade, which when finished in September should mean that nurses running to pull children off of ventilators to manually breathe for them should begin to be a distant memory.

We’re expecting our new transformer to arrive tomorrow from Nairobi, and the construction workers have been running late in pouring the concrete slab (shown in photo) for the transformer pad.  They finished pouring today, and were expecting to place the transformer on the slab when it arrived…with only 24 hours curing time.  The transformer weighs 5 tons, which would have made a nice transformer-sized hole in the concrete when it sunk through the not-fully-cured concrete.

Transformer slab with new generator/switchgear building in background

So I dug out my uni textbook on concrete (yes, I took a class on concrete) and researched curing times and compressive strength.  I’ve been glad I brought my uni textbooks several times since being here…turns out that civil engineering hasn’t changed much in the 13 years since I received my degree!

I sat down with Jim and Kimani, the hospital maintenance head and we figured out a way to keep the concrete slab watered for 7-14 days to allow it to reach 60-80% of its design strength before we put the transformer on it.  In the meantime, when the transformer arrives tomorrow we’ll place it on wooden blocks and use a crane truck that should be onsite in 2 weeks delivering the new generator to swing it over to the cured slab.

Concrete crisis averted.

-A