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Tuesday, October 18, 2016

When Words Become Walls

Today I hit the proverbial wall, and reflecting on why, I think much of it was miscommunication.  Words were meant to connect us. Word can be synonymous with Love, with the extension of self to another person.  (The Word become flesh, and dwelt among us).

But when you're working in a new place and new language, perhaps words can do more to exclude than to connect.  We don't even know many people here, but the two young women who work in the guest house are two of the few we see daily.  So when one called in the pounding rain asking me to see her sick children, I thought I was helping by hurrying back to the guest house, only she had brought them to the hospital.  Communication fail.  She was very frustrated with me.  I felt terrible.

Yesterday I made many phone calls thinking I was connecting with the myriad of people who were involved in a particularly sick patient's care.  This boy had landed in the ward after a public hospital administrator from an underserved eastern region of Kenya somehow connected with a visiting team of Texas doctors who would be working nearby . . and loaded 50-some cardiac patients on a bus across the country to see the cardiologist, hoping some kids might be chosen for free surgical trips to America.  It was a news splash in the paper, and medically kind of crazily haphazard, and not surprisingly one of the kids was so sick he didn't make it to the visiting doctors and landed instead with us.  I am not going to belabor the ins and outs of who said what, but after much effort we got him a space at Kijabe (where the visitors were headed today) and an ambulance to take him there.  Sorted.  Only I walked into the ward this morning, and there he still was with his dyspnic breaths and distended abdomen.  The uncle insisted that he was waiting there because the regional doctor who brought the kids to our town told him to do so; the regional doctor however insisted that the uncle refused to go to Kijabe.  Who knows?  It took more people and hours to sort it all out with the regional doctor insisting he would take over and take the patient back where they came from . . . only for me to get a call two hours later from Kijabe saying they landed there anyway.  So many conversations and versions of why things did or didn't happen, all to land right back where they were supposed to be, only 24 hours later.

Then there was the lab result that was days late.  Thinking I could show how it's done, I went to track it down (TB test results for a pretty sick malnourished child, so important).  IN THE VERY LAB where the tests are done, the people doing the work told me directly that though they had seen the paperwork there was no sample.  The intern was positive he had taken it there.  I went to find out where it could have disappeared to . . . and found another lab worker who said the sample was IN THE MACHINE at that moment, the machine the first two were using.  OK, maybe that sounds simple, but again multiple people, enquiries, time, resulting in confusing and contradictory stories.

Or the one moment I thought maybe I was helping teach some people, taking extra time on a 10 year old with a hemoglobin of 3 to teach physical exam points (hear the gallop?  Feel the spleen?) and list a differential.  We discussed the work up.  We ordered some tests to be done on the patient's blood before the life-saving blood transfusion.  But they weren't.  And the trainees looked at me and said, "you never explained that we had to do that".  Obviously what I thought I said wasn't what was heard.

Maybe all this sounds trivial, but when it stacks up in a day, when everywhere you turn you're in the dark . . . it's words making a wall that isolates rather than a bridge that connects.  And I wish I could say that I patiently endured, and gently sought understanding.  Oh no, I did not.  It was not a shining missionary day.  I complained.  I criticized.  I pointed out gaps.  I begged.  I badgered.  I knocked on that wall with a sledge hammer instead of looking for the keyhole.  Pretty much a failure day, for sure.

So, maybe the wall will add a layer tomorrow when I face the consequences of today.   Prayers appreciated that instead grace will seep in, somehow, that the damage won't be irrecoverable.  I am not enough for this transformation.  When words walled me out, I forgot the cross, the way of suffering, the way of love.  Ironically, the final exclusion came from the regional doctor team who arrived in their ambulance, and refused to shake my hand as I greeted them.  I had forgotten how dehumanizing it is, the infidel-foreign-female-leperousness too impure to touch in a handshake.  My awkward hand, hanging in the air, untaken, the perfect symbol of a day gone wrong.  Reaching out but ineffective, a gap not crossed.  

Tonight we're both tired, tired of wandering into a maze of uncertainty where we're not understood and don't understand.  I know we should read our own cheery blog posts on how to cope.  Perhaps we cam start to survive by communicating with the one other person we get, each other.  As Scott was doing other things in Labor and Delivery he took note of a nursing student trying to assess a mother in labor, and saw that the fetal heart rate was stressfully high.  Upon further assessment he realized the baby was in danger, and the mom would need an emergency C-section, added to an already busy theatre day.  As he wheeled her into the operating theatre, he texted me while I was on rounds.  In this hospital it is not standard care for the peds team to come into the operating theatre, but Scott realized the baby was going to need more care than the nursing student assisting him could offer.  Come in 15 minutes, the text said.  So I tried to sort out the preemies I was rounding on then walked over.  Due to the fact that this isn't done, I couldn't get anyone's attention, so I had to walk in barefoot, no gloves, no mask, no gown . . . to find the limp baby with a barely detectable heart rate and no breathing, her mouth full of a bulb sucker.  Oh well.  I tried to teach the nursing student what to do as we gave the baby breaths, and watched her come to life.  Apgar 2 at the first minute as I arrived, and then 8 and then 9.  Yeah.  If words in a text, words of explanation and instruction while working on a baby, could bring life in those five minutes of the day, maybe there's hope.

Friday, October 14, 2016

Like breaths of wind

The psalmist says, what are mere mortals?  They are like a breath of wind, their days pass away like a shadow. (Psalm 144).  This comes in the midst of a plea for God to act against rampant injustice. When one works amongst the poor, lives do feel like breaths of wind sometimes, unseen, passing, leaving a little ripple of joy and sadness but elusive to hold onto.

If there is one word that describes our patient population here, it might be vulnerable.  This week alone I have a 5 year old girl so malnourished her skin is breaking down, her plummeting protein levels mean that fluid leaks out of her blood vessels and puffs up her face and feet.  A teacher (hooray for alert and kind and action-taking teachers) noticed her following older siblings to school daily and begging food.  It seems her mother left the family with an unemployed alcoholic father, and she's starving.  Or a twelve year old who was caned so severely at school (for fighting with another kid), made to strip off his shirt and lie on a table for a beating that has left him shaken, refusing or unable to walk or talk.  Or babies born on matatus, a baby whose HIV-infected mother initially didn't want to keep him (she's changed her mind!), a premature baby whom I resuscitated for a day but once I left he died, a baby with a severe heart defect.  A one-year-old who seems to have become blind when severe diarrhea on top of her malnutrition left her dehydrated and in shock.  An 8-year-old who sat for days vomiting and with half her face paralyzed, until she finally got a CT scan that confirmed a dangerously located mass, probably a tumor.  A mother who came with life-threatening pre-ecclampsia (which is like an allergic rejection of the baby) and due to one thing after another ended up with delayed care, a dead baby, then severe bleeding, and in spite of two surgeries and massive effort, died herself.

One can not walk this part of the Rift Valley under the illusion that all is well.  So many broken families, struggling single parents, unnoticed sufferers.  Women working for a dollar or two a day, trying to raise children.  Or not being paid at all.  Children who are marginally looked after, who are hungry, who are injured by adults, this is hard to take.

And this is only one tiny sub-county in a large and diverse country on a large and diverse continent.  How do we grasp those fleeting breaths of wind, or how do we avoid despair for those that slip away?

First, by remembering a billion reasons to believe.  That's my favorite coca-cola advert, for Africa.  Vulnerable patients feel like so many bursts of breeze.  But in reality there are a billion such lives and together they make a powerful force.  When the senior midwife texts to make sure we're OK after a hard day, when a new acquaintance takes time to tell their story, when we try to teach and see the spark that someone is learning, when we marvel at the ingenuity, sacrifice, dedication, perseverance, vision of our African friends, then we take a deep breath of thanks and hope.  Africa is beautiful, Africa will break your heart, but the best thing about Africa is Africans.

Second, by remembering the larger story.  Psalm 144 describes mountain-smoking deliverance, last-minute rescue, and a future of full barns, no miscarriages or premature babies, thriving children.  All is not well in Naivasha, but all shall be well one day.  We are part of that story as we palpate and auscultate and treat and teach.  We are not passively caught in this tale, we are actively writing new endings, together with our partners and colleagues.  The arc of all these breaths of wind is upward to beauty and wholeness.

Third, by living in that paradox that though we are breaths of wind, our spirits call to God's spirit and we are united, known, seen.  God knows every sad story in our hospital today, and the back-stories.  God knows the challenges of the lady selling pineapples and the guard at the gate, and how they are created for good and for glory.  None of this suffering goes uncounted.  The universe is tilting towards justice on the fulcrum of the cross.  Every tear matters.

And lastly, by living with rhythms of rest.  God can absorb every sorrow and know every heart, but we can not stand unrelenting vulnerability.  An active engagement in the larger story gives us purpose.  But an active turning aside also restores our stamina to go on.  Last weekend we biked around Lake Naivasha.  We passed slums of crowded, cobbled, tin houses.  But we also passed open spaces, graceful giraffes, perky wart-hogs, whistling shepherds, and even (improbably) a herd of camels.  We thank God for the Job-like reminder that His power, creativity, scope is so far far beyond our comprehension, a lesson we always learn in the respite of nature.

Wednesday, October 12, 2016

Standing guard with the losers: 2016 politics near and far

When we were trying to decide whether to start work during a doctor's strike at Naivasha's big public hospital almost two weeks ago, an image came persistently to mind from a popular novel series that describes a fantasy world that roughly parallels medieval history (sidebar, you can judge me for reading this stuff because I agree that there are unsavory and explicit sections I could do without, but there is also a lot of that in real life and the bulk of the books are quite good).  In the series, while various would-be lords and kings vie for power, a smaller group of pardoned criminals and illegitimate sons live in a sort of monastic military exile on the northern border, manning a massive wall that keeps truly evil creatures out of the realms of men.  This brotherhood of exiles and outcasts refuses to take sides in the machinations of politics to their south that pit one family against another, because their mission is to keep all of humanity safe from unspeakable dangers to the north.  As we prayed and pondered what to do, I found the image of this wall and the lonely people who form the protective barrier between external evil and often-oblivious humanity somehow comforting.  I could see our purpose to tend the sick and perhaps shine a little light for those suffering and in need as an act that removed us from taking sides in the grievances between doctors who felt ill-used by delayed or undesirable salaries, and lack of opportunity for promotion, and the local government who felt unable to meet their demands.

I think the analogy holds, because we were able to slowly start, quietly, working.  Pitching in to hopefully revive a baby here or make a diagnosis there or adjust a treatment over there.  Listening and learning and suggesting and teaching.  Perhaps we don't know how our colleagues really feel, but it seems that we were given a pass as members of the exile brotherhood, guarding the wall.  As in most places, cultural control exerts itself by fear, so the young doctors around us felt they faced a lifetime of repercussion if they broke ranks with the strike, but we as missionaries could stand apart from that.

Fast forward to the next weekend, when politics in America exploded.  Monday morning, one of my interns wasn't listening on rounds, because even here in Kenya they are gawking at the news coverage of our tawdry election, reading the transcripts on their smart phones.  Now it's our own birth culture down in the muck.  I've written earlier this year with a grievous heart refuting an equilibration of Christian faith with a particular political candidate, particularly one who has consistently displayed contempt/hate/slander for immigrants, Mexicans, Muslims, the disabled, the families of enemy combatants, women, minorities, and losers in general.  So in some ways, the sudden weekend turn-around of many people of faith, seeing in real time the lack of character in the potentially most powerful leader in the world causing them to jump of the make-us-great bandwagon, has been a relief.

But the process of so many finally calling out that the emperor has no clothes has also been sad, confusing, and hard to process.  If it's happening in America, are we still one-step-removed on that border between evil and humanity, or can we jump into the fray?  Jesus said His Kingdom was not of this world, but He also didn't mince words when it came to the powerful abusing their position.  So allow a few thoughts on why this week's revelations and the shift in evangelical opinion have been so heartbreaking.  First, because it took so long and revealed just how vulnerable we Christians are to promises of power, how willing to overlook 95% of everything the Gospel stands for as we nearly sold our very souls to win earthly power.  Second, though, because in spite of everything, I do feel the pain of the faithful remnant for whom the entire question is the lives of well over half a million babies who are aborted annually.  For those who are swallowing the double pain of not only shocking disappointment with the election choices, but also dwindling hope to protect those children, I am so sorry.

For those, I say, come to the icy wall of misfits and pardoned sinners with us to stand guard.  Serve a bigger goal of living a life that is a witness to a cosmic battle of good and evil, healing and death.  Speak out against harm to the most vulnerable fetuses, then stand in the gap for the many more millions of infants who are born into poverty.  Let's not pin our hopes on either very tarnished candidate, especially the one whose habitual self-serving mistruths make the chances of a pro-life impact vanishingly slim.  Let's not trust someone who brags about breaking most of the ten commandments to turn around and force them upon a diverse and dissonant public.  Instead let us by holy love, consistent ethics, sacrificial service, and quiet integrity take the harder but surer road of Jesus.  Who fed and healed and loved individual after individual into a newness of perspective that seeped out to change the world.  When Christians do what they do best, protecting the stranger, feeding the hungry, loving their neighbor, speaking the truth, then the world will start to be curious and become open to listening to us speak for the unborn.

We're huddling on the wall of ice, with one eye to the next incursion of evil we must resist to protect our world, and another to the vying for the temporary powers of humans that can make life a little better or a little worse.  Whichever you're called to focus on, let's take heart that in the end, all shall be well.

Thursday, October 06, 2016

And so it begins. . .

 . . this new chapter of life.

With awkwardness, hesitancy, humility, learning, mistakes, watching, plunging, trying, wondering.  Monday and Tuesday we rattled around nearly-empty wards, saw the few patients who had somehow been retained in spite of the 2+ week doctor strike, sat down with some key people (thankful for the peculiar pause which allowed this) to get their views and advice.  We had some haphazard tours, perking our ears and collecting facts and phone numbers as we went.  We heard multiple views on the strike's causes, the positions, the problems.  Though it was theoretically called off on Saturday, the first day with actual rounds, admissions, and operations was Wednesday, with today being busier.

On the huge positive side, Scott ended up doing a C-section today when no one else was available, and that's just one big hump that's good to be over.  Though he's done this over 500 times, it's a new place, new people, different sutures and instruments, and it's been a year since he was last operating.  Another huge blessing is that we truly appreciate the senior nursing staff.  There are a handful on each service who have weathered strikes and storms for decades, who are there because they are committed, who have the experience and clinical skills to make a difference.  And they have been welcoming, pulling us in for chai and working alongside us.  My sole paediatric colleague returned to work Wednesday too, and we had some good time to talk about the future.  There's an excellent University of Washington chief resident in Internal Medicine here for a year too.

However, it's still been an exhausting week (and it's not even over).  Being cross-cultural most of the time (except when we're alone in our little room) takes a toll.  We're hearing a decent percentage of the Swahili and stumbling along trying to talk.  The charting, the expectations, the rhythms, the attitude . . are all different.  Pray for us to be patient.  To go slowly.

Because sometimes it's hard.  Really hard.  I will be honest that there have been a few times this week when we've wondered what we got ourselves into.  In the moment I was trying to start Paeds rounds this morning, one intern told me there was a resuscitation in the NBU (Newborn unit = Nursery = lower level NICU) which needed help, and he'd stay and handle the dehydrated shocky new admission on the floor with the Medical Officer.  I went to the nursery and found no one resuscitating anyone, a dead baby covered with a blanket (2nd morning in a row to find that), and next to it a blue, tiny, gasping, not-yet-dead very small preemie.  As I got a bag and mask to get him breathing, his heart rate came up, . . .  then the power went out.  No electricity, no oxygen, no warmth.  I quickly assessed that he looked 26 or 27 weeks, and put him on the scale at 750 grams.   I looked over to the next bed and saw another baby marked by pallor and poor respirations that was about twice the size, but still tiny, 1.4 kg and 32 weeks . . . so with one hand I bagged the first dying baby and with the other called the intern to come bag the second one.  He couldn't help because he was in the middle of reviving the shocky dehydrated 1 year old.  So, two doctors for three emergencies . . .  I had to let the tiny preem go.  I made him as warm and comfortable as I could, and moved on to the baby I thought I could save.  By the time I got that one a bit stabilized (working around the power outage with an oxygen cylinder, working on the baby while on his mother's skin for warmth, setting up CPAP and getting meds into the IV), the tiny preem was dead.  He had been a twin, born out at a flower farm, brought in during the night.  At some point his twin had already died.  I don't think anyone expected him to live either.  I think moving on to the larger baby was the right choice given the realities of the limitations of that hour, but not the kind of choice I like to make.

The dead baby from the day before had been another premature baby, born under a bush by the roadside when his mother (who had no prenatal care) felt labor pains and started walking to town.  A good samaritan picked up the bloody woman whom she saw squatting in the bushes, and wrapped the cold wet baby in a cloth.  Good nurses warmed and revived him and we kept him alive 24 hours, but he had very immature lungs and couldn't last.  No surfactant here, no ventilators, no working incubators, no working monitors, etc. etc.  This hospital is the open door to the poorest of the poor, and they come bringing their floppy, cold, gasping, tiny babies delivered at home, or in cars, or literally in the bushes.  It's urban enough that there are hundreds and hundreds of pregnant women within walking distance, yet non-urban in the unreliable electricity, equipment, supplies, etc.

On the positive side, though, the intern did a great job with the 1 year old in shock, who improved as the day went on.  Then there was the kerosene ingestion (the brother left a can of it in the kitchen, the small child thought it was water) and the sickle cell patient with a hemoglobin of 2.3.  ICU-acuity in a very basic ward, but all getting reasonable care and improving.  And in spite of already 3 deaths in 2 days, as the morning went on I felt like there were opportunities to teach, to encourage, to perhaps save some lives in the short term, but to certainly impact lives of trainees for the very long term.

This morning I read this in a devotion about St. Francis and Clare, who lived in the 13th century and left lives of comfort and consumption to choose simplicity, devotion, and care for the poor:  "Francis and Clare showed us it is possible to change the system not by negative attacks (which tend to inflate the ego), but simply by quietly moving to the side and doing it better!"  Amen.  Pray that for us.  We want to quietly move to the side here, and serve in a way that motivates young doctors to work with integrity and skill.

Only four days down, and months and maybe years to go.  We're out of our element, and yet we know that this is exactly how all our missionaries feel.  We're supposed to be the leaders, and now we're leading by being right back in the thick of cross-cultural angst, trying to shed a small light, hoping to build some trust, working quietly by the sides of our Kenyan colleagues.  Keep praying for that.

Tuesday, October 04, 2016

Two Decades of a Daughter

Today, 20 years ago, a spunky little girl took her own sweet time to make an appearance, and changed our family forever for the better. (photo above, David Shirk, below mostly my phone . . . )

Her name is Julia Kathleen Myhre, and she can hold her own when three brothers push too hard, she can score from a corner or defend fiercely in football, she can plant trees and wash dishes and slip in quietly to help, she can write papers and do research and think outside the box, she can pray and hope and inspire.  She's as kind and dependable as they come, glowing with beauty, strong in spirit.
Appropriately, this is also the feast day of Saint Francis, and she reflects his generosity, dedication to simplicity, affection for nature and animals, commitment to community.
Split Rock, 2016

A high pass on the Rwenzori climb, 2008

Florence en route to a Serge conference, 2004

  Today actually started for her in India, took a pause in Dubai, and is ending in South Africa where the southern Atlantic meets the Indian ocean, an appropriate geographical tribute to someone who integrates two continents and two hemispheres in her very being.  Though we are far away, we're extremely grateful for a few gifts of connection.  First, it turns out that Emirates airline has a social media coordinator who responded to facebook messages, and so provided her with a big slice of birthday cake on her flight, to share with her friends.  Second, it turns out that SIT study abroad is a reputable and organized outfit so within a couple hours of landing she had a sim card and internet connection and we could chat.  Third and fourth are small treats still in progress so we'll keep mum on those.

Today also marks a week of A Bird, A Girl, and A Rescue's being published, and a snap-chat from Jack this morning showed me he got his copy.  I'm hoping that some others have been received too . . . and that someone is actually reading it, and willing to start posting reviews on Amazon.  Because this is the second book in the Rwendigo Tales series, and it is dedicated to none other than the birthday girl.  You'll recognize a lot of Julia in the heroine.  And the kids we are trying to boost via the sales of this book are her actual friends and childhood neighbours.

So join us in wishing the Jewel of our family a Happy Birthday.

Monday, October 03, 2016

Working faith

"This is a sane, wholesome, practical working faith: that it is a man's business to do the will of God; second, that God himself takes on the care of that man; third, that therefore that man ought never to be afraid of anything."  George Macdonald.

Sounds so simple, yet in the day to day one so easily doubts.  Is this actually God's will, and does God's definition of care meet my hopes?  We set off this morning with a bit of the "first day of a new school" feeling.  But also with a confident gratefulness in answered prayers for clarity.  Over the weekend we'd had strong voices expressing opposed opinions about this strike and our response:  DON'T go into the hospital, because then the striking doctors will resent you forever and you'll ruin your working relationships.  DO go into the hospital, because the Medical Superintendent told you to and you must respect him, and the other doctors won't judge you since you are missionaries.  We asked the local church here to pray as well as our sending churches, for true wisdom in a murky situation.  And within hours, we had the "don't" voices changing to "do", several phone calls from locals affirming we were OK to go, and most importantly the blessing of my future Paeds partner.

And so we began what we hope will be a year or two of partnership with this big, messy government hospital and all it's challenges.  Because of the doctor's strike, the wards are nearly empty, a peculiar sight in a place where there are often more than one patient in each bed.  Outpatient services continue, and the nurses are still working and doing a superb job on longer-term patients who didn't leave.  For instance on Paeds ward I saw four kids with severe burns, all getting their dressing changes and PT.  And in the NICU there are two preemies still in (mostly non-functioning) incubators--one was a 900 gram 26-27 weeker who had been completely managed by nurses only, and after CPAP and antibiotics and naso-gastric tube feeds is still alive at 10 days of age, though she does look a bit marginal.  Scott did ultrasounds, backed up the midwives on a delivery, and examined the women admitted with pregnancy problems.

Prayers much appreciated for our clinical skills to revive from their dormant states.  For our Swahili to serve us well, and expand.  For solid working relationships with these nurses who are understandably caught in the chaos of politics they can not control.  For resolution to the controversies between the doctors and the local government, which seem to be mired in the transition from centrally-paid positions to county-paid positions.  For a boldness that comes from being in God's hands, and a humility that comes from knowing how little we know.  For opportunities to simply shine a little light for a few people, from preemies to mothers to colleagues. 

Saturday, October 01, 2016

Goodbye Kijabe, Hello Naivasha

October first. A new month, a new life.

When we returned to Kenya in early July, our plan was to rent an empty missionary-home in Kijabe, in order to get through Level One and Level Two of the Growing Participator Approach Swahili program organized by Karen M,  while continuing to do our Area Director jobs.  We wanted that three-month space to focus on language after nearly a year's absence, without the pressure of resuming medical work. And on several scouting trips to our new assignment, Naivasha, we searched for housing, agreed on a rental house that was still under construction, met our new colleagues and toured the district hospital, preparing for an October shift.

Much of that worked amazingly well, in retrospect better than plans tend to unfold.  We had a spacious, secure, quiet home, on the far edge of the community, where we could study (see goodbye photos above from this morning).  We had a dynamic Swahili teacher who became a friend (pictured left with his new music DVD).  We had Jack and Julia with us for the first half of that time, which spurred us on.  We made trips to Bundibugyo, Fort Portal, Chogoria, and Nairobi, with regular Kijabe contact, enabling us to directly engage with well over half of our area.  We kept our hospital boundary intact so that language wasn't smothered out by crisis.

Great plan.

Except for our hearts.

As we packed up today and pulled out of Kijabe, I think we both felt the weight of an era ending.  This was the community where we served for nearly five years, where we spent significant portions of 3 of 4 kids' high school careers, where we labored over patients and poured into colleagues and cheered on teams.  The three months back gave us the illusion that we were still in that phase of life, still immersed in that rich environment.  The Massos and Bethany have been two of the best and most consistent friends we have had in Africa; the Shirks and the Barnettes two of the best recent additions.  Going on long walks, taking turns sharing and praying, celebrating birthdays and meals, we entered back into this team with great love and appreciation, and it was only the hopeful illusion that we're not moving far that made us able to drive away again.

And it's been a while since we drove off into as much uncertainty.  The house we've "booked" by advancing many months of rent to help the landlord finish construction, still isn't ready, not even close, though we've seen the pace accelerate this week.  So a few days ago we (thanks to Jonah Watts and his buddies) moved our dozen trunk and bags, chairs and boxes, accumulated dishes and books and camping stuff and whatever we've not borne parting with in the move from Bundi to Kijabe and Kijabe to Naivahsa, into the Shirk's garage.  This morning we loaded the remaining suitcases, our coffee maker, a fan, computers, a water filter, some food, our bikes, all into and onto our Landrover and drove off.  For the next weeks, or month(s?) we are living out of a single guest-house room.  It's spacious and solid and has its own bathroom . . . but it's still just a room, and cross-cultural, and will take some time to figure out how to dance around the older gentleman who owns it, the two young women who manage it, for cooking and living.

And if the tilting-off-balance of our living situation wasn't enough to test our faith, there's also the small detail that the hospital where we're supposed to start working Monday is on strike.  Kenya devolved much of the health sector funding to the county level, under pressure from the Western World who holds the purse strings I suspect, as we foreigners assume that local=less corruption.  More accountable to the people.  Only in many places we've seen, local=more pressure.  A county official has a lot of relatives.  Whatever the reason, the new system has left interns and junior doctors with months-long gaps of no salary, and now they are striking, and the senior doctors have joined in solidarity.  We've had one Kenyan knowledgable acquaintance tell us vehemently over the phone not to work while there is a strike, or risk alienating our colleagues for the next couple of years.  We've had the Medical Superintendent of the hospital tell us to come on Monday, and we consider him our primary authority.  And we've had trusted friends tell us that as missionaries we are not considered under the same standards, so working to stave off emergencies in a strike is OK.  Whatever we do, some people will be angry and others relieved.  Meanwhile the hospital is being run by clinical officers only (PA's) and women with difficult labors are going to private clinics if they have the means, or suffering, and possibly dying, at home.
(Scott with landlord today, in what will be a kitchen . .)

So here we are, on our first night in Naivasha, in our little room, wondering what the next week and next month and next years will bring.  And sensing very acute empathy for all the new missionaries we supervise.  Transition throws everything off balance.  We have to navigate everything thoughtfully, from getting water to drink, to speaking a new language,  to entering a new work place.  A year ago, we weighed all our options and felt Naivasha combined high-volume high-need work, a potential to teach and mentor a dozen young doctors, a cohort of colleagues serious about improving outcomes, and a secular environment where gospel living could shine light.  As we move into the messy reality, we have to cling to that sense of God's leading.  And believe that in these times of being off-balance, uncomfortable, unsure, needy and weak . . God chooses to do His most important work.

(sunset tonight, from the balcony of our guesthouse)