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Wednesday, March 04, 2015

Leaving Liberia

After a month in the sweltering heat of Monrovia, Liberia I’m bundled in my fleece watching jumbo jets rise into the gray sky over Brussels.  Monrovia seems a distant, ethereal memory already.

Sometimes over meals at home, we go around the table sharing “highs and lows” of the day.  That seems a reasonable way to structure a few reflections on this past month:

Highs:

- To the best of my knowledge, I did not ever touch a patient with Ebola.  While I did have the opportunity to tour the largest Ebola Treatment Unit (ETU) in Liberia - “ELWA-3” managed by Medicins Sans Frontiers —  I did not go to Liberia to work in an ETU.  I went to support the transitioning weak medical system with general obstetric care. I also ended up covering the whole hospital for general medicine and pediatrics on my call days.  We know from experience that the hidden collateral damage of every Ebola epidemic arises from the fact that hospitals just shut down in order to protect their staff.  The result is that children die from malaria and women die in childbirth.  I did quite a few C-sections - all good outcomes - to that end.
One of the OB wards


- I relished the opportunity to work at ELWA Hospital.  Jennifer visited ELWA way back in 1982, when she was in Liberia for the summer with InterVarsity’s Summer Mission Program.  As mission hospitals go, it’s been around a long time (1965).  It’s a shadow of its former glory though.  The Liberian Civil War of the early 1990s took a devastating toll on the facility.  It’s in pretty bad shape.  The good news, though, is that Franklin Graham, the head of Samaritan’s Purse International Relief came for a visit, was completely appalled at the condition of the place, and committed SP to building a new hospital.  They are 75% of the way into a $3.5M hospital construction project.  It’s going to dramatically transform ELWA into a new era.  But the real treasure of ELWA Hospital is the spiritual heart of the hospital.  The whole staff meets daily for a half hour of singing, Bible study, and prayer.  Their bedrock and strength is God’s Grace and Love.
With Dr. Jerry Brown, TIME Magazine Cover Star

- Working with some of the most courageous people on the planet…the Ebola Fighters.    ELWA Hospital was among the first hospitals to establish an isolation ward for Ebola patients (an ETU).  The hospital closed for a brief two weeks in August after three American missionaries were infected with Ebola, but Dr. Jerry Brown insisted on re-opening the hospital because pregnant women were going to the personal homes of ELWA’s midwives in order to deliver their babies.  Dr. Jerry Brown appeared on the cover of TIME magazine regaled in his Tyvex suit and goggles because he bravely treated Ebola patients when no one else would.  But there are many many others.  Nurses , midwives, lab techs, janitorial staff all came to work at significant personal risk, because they believed it was the right thing to do.  So far close to a billion dollars has flowed into Liberia from outside donors.  The ELWA staff have been promised “hazardous duty bonuses” by the government (approx $300/mo x 6 months for the midwives), but as of this writing, not one dollar has been received by any ELWA staff.  Are they on strike?  No they just keep working.  
With my team of midwives

Lows:

- The heat.  

- The poverty.  Liberia is a hard place.  The soil is sandy and there isn’t much that grows there except palm and rubber trees.  It’s billiard-table-flat so the country has no ability to generate it’s own power from hydroelectric.  When we flew in over the capital, Monrovia, I was shocked at the darkness.  A capital city immersed in darkness?  No grid electricity.  The country runs on generators.  Liberia also has the poorest physician-to-population ratio in the world. (50 Liberian doctors for 3.6 million people before Ebola).  Doctors fled in the civil war - and of those that remained, some died in the fight against Ebola.  Life was a struggle before the war, before Ebola, and now everything is broken.

- The threat of Ebola.  While I feel confident that I didn’t actually come into contact with any Ebola patients, every patient we saw was screened for the possibility (temperature taken, symptom checklist reviewed).  Everything we did was viewed through the lens of Ebola.  Almost everyone has malaria which means that many, many patients arrive with fever.  We tested many for Ebola.  We worried about Ebola.  We wore impermeable gowns and gloves for every patient encounter.  Thankfully the NIH Ebola Lab was actually on the ELWA campus so the wait for an Ebola test was never more than 24 hours.  In the last week of my work, there was only one new confirmed Ebola patient in the whole country.  That was encouraging, but the fact that in that same week, Sierra Leone had 65 and Guinea had 33, was disconcerting.  Until all three countries are Ebola-free, none of these severely affected countries can really relax.

- The deaths.  I saw a lot of people die this month.  Most heart-breaking were the preventable deaths.  A newborn developed tetanus four days after birth because his mother was not properly vaccinated and died a horrible death of spasms and respiratory paralysis.  (Did the mother fail to understand the need for vaccination—or was she afraid to come to the hospital because of Ebola?) An 8-year old died of rabies after being bitten by a stray dog.  I poured myself into the care of a 16 year girl who had severe and protracted menstrual bleeding for over two years.  After hormonal therapy failed, we began to think she might have had an inborn blood clotting disorder.  She was in-and-out of the hospital over three weeks of February during which time she received twenty units of blood.  We finally decided that it would be life-saving to remove her uterus - but the father refused.  She died the next day.  I went to my room to weep alone.  The incomprehensible senseless deaths just weigh you down.  The death of a healthy 16 year old girl.  The death of a healthy newborn for lack of a tetanus immunization.  Doctors who die from Ebola.  Our dear friend Dr. Jonah died from Ebola back in 2007 leaving five girls and his wife pregnant with their first boy.  In our human understanding, there is no way to justify these things.  While there can be beauty from ashes and fruit from the seed which dies, the fact remains that Death steals Life that it does not own.  We have six new doctors in training in Bundibugyo who were sponsored in the aftermath of Jonah’s death—but Melen is still a widow and his only son is still fatherless.  While I have been freshly struggling with the tragedy of such pointless, inexplicably wasteful deaths, I suppose that is some small way I must admit that is only in this suffering, in wading through this wilderness, that I seek and search and cry to understand the Mystery.  And as I ponder the Infinite, squinting through the tears, God is there.  And He defies Explanation.  Here is where the Psalms of Lamentation abruptly switch from wailing to worship, from agony to faith. The alternative is bitterness and despair—and I refuse to go down that path.

It’s been a long road, this path to Ebola-Land.  Jennifer has paid a high price, keeping all the balls of our Kijabe Life in the air in my absence.  Doing all the cooking, hosting house guests, taking extra hospital call, caring for the dogs, teaching our Senior Boys Sunday School, handling a bevy of crises among our Serge East Africa Teams.  She’s been burning the candle at both ends and in-between.  I’m thankful for her and miss her desperately.

Now I’m putting even more distance between me and Jennifer as I head for California to hole up and wait 21 days to make sure I don’t develop Ebola.  I never did go “skinny dipping in Ebola juice” as one of our oh-so-compassionate blog commenters suggested that I do — so I doubt it will be a problem.  I will be taking my temperature twice a day and calling it in to the California State Health Department.  I’ve not missed a dose of my malaria medicine, so I’m hoping that I don’t get any fevers at all.

Thanks so much to all who prayed and continue to pray.  And give.  We are your hands and feet.  Thanks for your partnership.


Tuesday, March 03, 2015

Two Funerals, and a Birthday

There is a song that came out right around the time of Ebola Bundibugyo, with the line, "like a swing set in a graveyard, like a bloom in the desert sands . .  love is gonna break through".  A poignant jarring juxtaposition, that highlights the paradox of redemption, where life is breaking in and overcoming death.

Today, two of our East Africa Serge colleagues attended funerals for close relatives.  Our hearts are with them, as they worship and mourn.  Faith in the hardest moments of life is real faith.  Heidi L has been caring for her mother for a long, heartwrenching, often beautiful, mostly ordinary moment-filled final year of dying from ALS.  Lesley S was shockingly and suddenly bereaved of her 24-year-old sister due to a car accident.  Both of these women missed years with their nuclear family because they have been working for transformation and hope in distant, hopeless places. For both the deaths are terrible, and too-soon.  And both are spending today in the emotionally overwhelming process of closure and goodbye with their USA community and family.  Both are places I would have liked to be today.

However, instead, I was grinding my way through call and then a busy NICU day with a sometimes-bewildered and fairly inexperienced intern team.  Scrambling to see patients in private clinic and RVA clinic too.  All with a goal of getting home to prepare for a 17th birthday party for Jack.  So this evening while my friends were waking up in the USA preparing for funerals, I was sliding pizzas onto paddles, setting out sodas, passing out party whistles and cake.  Celebrating.  Jack is a hard-working kid, smart, sociable, insightful, loyal, with a sharp wit, good humor, fast feet, and sheer speedy strength.  Tonight we had a pizza party, which is a beautiful way of honoring a person just for being who he is.  I am so thankful for him, and for the community of Senior Boys (our Sunday School) who came to celebrate with him. We ended the party praying for him, and I was thankful to know my son has friends who are asking God for closeness and wisdom and guidance on his behalf.




Two funerals and a birthday party. The context of darkness, which sets the stage for light. The real reminder that life breaks through death, that birthdays will overcome death days.

Meanwhile Scott is on an airplane high above both funerals, making his way to California for a 3-week be-sure-you-don't-have-Ebola incubation before he can return to Kenya.  And our school in Bundibugyo faces serious threats once again, possibly related to greed (for our land) and tribalism.  Anyway, please continue to pray for our friends, for those who mourn, asking for comfort.  For the Kingdom to break through, in love.

Sunday, March 01, 2015

The suffering of the poor, grace at the fray

This past week was one I would not care to repeat, and am glad to leave behind.  After a relatively good first three weeks of February in ICU where uncharacteristically everyone got better and left alive (and where I was tempted to feel competent for a moment, fatal mistake), suddenly the deaths mounted.  We lost seven patients on our three Paeds services, and all but one were either my patients/former patients, or dying on my call coverage night.  Two were excruciating decisions that we had come to the end of care for unsurvivable conditions, which is a very weighty burden especially when not everyone feels the same.  Two were similarly severely impaired by chronic medical problems and malformations and though we were giving our all in ICU, after multiple resuscitations (including the classic heart-shock-paddles for one) we had to admit defeat.  One was a newborn that I just walked in on in the final moments, but had been delivered too early, and my role was just to back up one of my partners in the last moments. Those five were exhausting but I can live with the decisions and accept our limitations.  The other two, however, really hit me hard.  One was a 9 month old with spina bifida and pneumonia, who came in severely anemic with a failing heart and shock.  Not a great prognosis, but she actually improved for several days.  Her initial blood culture showed on the third day that she was growing a gram negative rod (bad bacteria) in her blood, and since we have many resistant ones, I changed her antibiotics.  Only it turned out that my choice was the one she was resistant to, and by the time the lab reports were final, she was deteriorating fast.  She turned the corner towards death so quickly and decisively, and I spent a long night trying to control spiking fevers and falling blood pressures and low oxygen until she succumbed.  But the hardest of all was J, the 15 year old girl we prayed for a couple weeks ago.  Her apparent brain tumor had turned out to be tuberculosis, and I was practically dancing with that result because she could be treated and cured.  After a week in the ICU she moved out to another floor, and I heard she was slowly improving.  She emerged from her coma and begun to talk a little, and even walk.  In fact she was being discharged when someone noticed that her spinal fluid was leaking from her surgical site, and decided to order a head CT.  So Thursday, prior to being discharged, she was sent in an ambulance with a nursing student down to Nairobi, a stable improving patient.  It's not clear what happened but her mom gave a history that she got an injection of something that "calmed her down".  All we know is that after the CT, on the way back in the ambulance, she stopped breathing.  And in spite of the efforts of the nursing student, bumping on our horrible road in the ambulance with a dying girl, she arrived with no pulse and cold not be revived.  

And that was the hardest of all.  I ran into her mom in the hallway later, and she hugged me and cried.  I have a child who is 16, nearly the same age.  Losing a baby is terrible emptiness and robbed potential, but losing a teen, someone you have known and watched grow, must be nearly unbearable. Particularly after we all thought the danger was past, and whom we expected to recover.  I felt deflated, punched, sorrowful.  Devoid of words.  And I was only the doctor, not the mom.

And the rest of the week wasn't much better.  Scott's 15 year-old bleeding girl in Liberia died after her family refused surgery.  Two of our Africa-based team mates lost close relatives:  Heidi's mother died of ALS just like my Dad did, and Lesley's 24-year-old sister died in a car accident driving home from a final family dinner with them.  We have a family of six from South Sudan who evacuated for medical reasons, as it turns out multiple large kidney stones causing months of pain.  One of the three remaining missionaries there injured his back, resulting in phone calls and considerations of security and evacuation, though in the end it seems muscular and he's staying put.  Accusations exploded against our school in Bundibugyo this week, with politically slippery types trying to agitate against our administration.  Kids at this school, RVA, are also tired in that mid-year slump where exhaustion sets in, and not a few have had to have compassionate leaves for mental and spiritual health reasons.  All of these situations have weighed on our hearts and filled up my hours in a week with 4 call nights and 3 extra guests spending the week at our house, with little sleep and lots of meals to coordinate and serve. I had two projects due as well, which meant that every moment was a push.  And did I mention the car trouble, or the sick dog?

So this weekend I wondered, what was God doing this week?  Why was it so hard, so full of death and defeat, so discouraging? 

And that brought us to Sunday, and Psalm 22.  Jesus quoted this song on the cross, the cry of the heart when one feels forsaken.  "I am poured out like water . . my heart is melted like wax . . my strength is dried up . . ".  The psalmists describes being utterly weary and surrounded by enemies.  Which pretty much sums up this week.  

In the middle, the Psalm transitions to faith.  "But you, O Lord . .have answered me."  Right in the middle of all the painful chaos, this promise:  "For he has not despised nor abhorred the suffering of the poor; neither has he hidden his face from them; but when they cried to him he heard them . . The poor shall eat and be satisfied."  All this because "The kingdom is the Lord's and he rules over the nations."

Terrible things happen in this broken world.  Seven bereaved mothers.  Bleeding.  Stolen breaths. Cars screeching off the road.  Hateful rumors.  Bad choices of antibiotics.  The psalm acknowledges this, and yet still holds onto two things:  God sees and hears and speaks, he enters and embraces us right in the midst of all this.  And God rules, his reign is slowly and surely setting all things right.

Wright calls this "something that doesn't cancel out the suffering, but that seems to grow out of it. . . These verses reach out, like the two arms on the cross; and they reach up, like the sign of the kingdom, pointing to the heavens.  You can't split them off from the long, dark pole of the cross.  . . they are the fruit of the suffering."  He writes of rescue and justice leading to worship.  All pivoting on the cross.

So I am praying to notice the God who comes to the poor in their suffering, the subtle ways He shows up to love and to rule.  Looking for signs that the world is being set right.  And as hard as this week was, it would have been a lot worse if God had not orchestrated a calm, competent, thoughtful, friendly visit from Dr. Becca Cook the very worst week of the year so far, and the very week when two other staff were gone.  I am thankful for ideas and companionship on the late night code runs, the early morning vent adjustments, the agonizing decisions.  

She was an RVA grad and fabulously successful academically, but more importantly has a heart for the poor just like Jesus does, and it was good to have her around.  

And once you start looking for God's mercy and rule, you see glimpses all over.  Here is our team community this week, expanded by Ann's parents and the Wallaces:
 And this morning, even though it was supposed to be an off week for Sunday School, all of my group chose to forgo extra sleep and come.  Love these guys.
 An impromptu party to watch England vs. Ireland rugby, when my pot of soup kept on giving and we all ate and cheered.
 Saturday I got to ride the bus with the team and watch basketball, and my favorite player, #11.
 And this smiling face and ginormous cookie awaited us this evening, a reminder that Jack's birthday is only 48 hours away.
 And we made it past the half-way point, the 29-day 29-day split of this separation which came yesterday.  Scott has now been gone more days than days that remain until his return.

Pray that we would keep grappling with faith, keep believing that the suffering of the poor is not forever, not in vain, not forgotten.  That God's mercy and reign keep moving in.  That the glimpses of community and refreshment this weekend will carry us through another week, even if the deaths pound on and the unraveling continues.  That there will be grace at the fray.

Saturday, February 28, 2015

20 YEARS OF CALEB


Twenty years ago, only a few hundred meters from where I am sitting right now, Caleb came into the world after an anxious pregnancy marked by preterm labor in a very dangerous place for babies.  One of the first flights out of our grass (mud then) airstrip hacked out of the jungly Ugandan bush was me with Caleb heading to Kijabe early.  His gestation was a faith-stretching time and the primary story we came back to, over and over, was Abraham putting Isaac on the altar, believing God was powerful enough to give him his son even from the dead.  It was during this time God stripped away some assumptions that being a missionary meant we would pray and everything would be alright, that we somehow deserved special treatment.  I would never have claimed those attitudes theologically, but emotionally they were there.  We faced the possibility that having a baby living where we were would end in loss and disaster, but we believed God was calling us to stay.  The Abraham story is one of the hardest in the Bible, and not one I would choose to include.  But that was our story in 1995, taking a risk without a sure outcome.  

And our story for the last 20 years with Caleb.  An early struggle with overwhelming illnesses that stopped his growth for a while.  Two emergency surgeries, one in Bundibugyo and one in Kampala. Broken arms that didn't stop him playing soccer. The terrible day he destroyed his knee and we thought his Air Force career was over.  He's one of those kids who everything seems to happen to.  One of those kids that makes your heart seize.  He's a risk-taker himself, serious, funny, brave, open to adventure and exploring new things, deeply thoughtful, extremely hard-working and perseverant.  Which he's had to be, because he consistently chooses very hard paths, for very good reasons.  Like the Air Force Academy.

And God is redeeming that story too. Because he's becoming not just a kid whom hard things happen to, but one who is looking out for others in that process.  He's developing a passion for justice, a desire to see things set right for others.  We've caught glimpses from afar of the young man who leads by serving.  Who stays up half the night with the freshmen who are stunned by the death of one of their classmates.  Who listens to friends struggling through life's difficulties.  Who takes a path less traveled and follows the directives of his soul rather than the crowd.

So today we celebrate 20 years with this boy-turning-man.  And we celebrate from something on the order of 10,000 miles and 10 time zones away, while he begins his powered flight course with a day of instruction.  We're on the edge of our seat for the story the next 20 years will tell.  

Tuesday, February 24, 2015

The broken edges

After a relatively encouraging month, February is ending in fracture.  Life on the broken edges.  Painful, possibly dangerous, definitely challenging.  Yesterday morning I walked in to find a colleague who had been resuscitating a newborn for an hour, with only intermittent heart rates.  The baby was gone, and I could see the weary pain in my friend's eyes.  And from that point on, we were all running ragged all day.  A convulsing month-old baby in the casualty, struggling for IV access.  Juggling beds.  Malnourished kids.  Three in ICU, trying to get my mind around terrible lungs and proper ventilator settings.  Blending into a call night where two babies died, and one was resurrected.

Both deaths were the end of painful journeys for kids a few months old with terrible congenital malformations.  The first had hydrocephalus, a collection of fluid in the brain, that had resulted in infection and seizures.  After a month of hospitalization he was no better.  While my partner kept his heart going a while longer I spent an excruciating half hour with the parents gently trying to help them accept the inevitability of the impending end.  His mom's tears actually soaked through my skirt, her head resting on me as she trembled and wept and basically shut down.  The second was a 9 month old with Down syndrome and a severe heart defect that had become infected, with raging fevers, a too-fast-to-keep-going heart rate, dehydration.  She had been dwindling for a day so her mom had more of a quiet, resigned cry when she died at 5 this morning.

In between, another baby a few weeks old who was post-op from a spina bifida repair, suddenly with no breathing, no movement, no heart rate.  Thankfully we were only steps away and could do a full code, rounds of drugs and CPR and oxygen, and we got him back.

Scott texted that he was taking care of a 15 year old girl with a hemorrhage, who nearly died, and he had to do a small surgical procedure he had never done before to find a vein for a transfusion.

And in between all this, a litany of other types of brokeness:  two missionaries from South Sudan with medical problems needing attention and phone consults, crisis in our school in Bundibugyo as usual as disgruntled people with ulterior motives stir up trouble, car issues with the mechanic, our ancient dog fell in a trash pit and needed rescue, running up to RVA clinic, following up on multiple kids and issues, local friends with deep sorrows, and a half-hour video-conference prayer time representing our field for a meeting in our mission's main office.

Bethany reminded us this week, that this very experience is part of the point of Lent.  The early disciples did not see the crucifixion through the lens of resurrection.  They experienced the pain and despair unmitigated.  In this season we enter into the broken edges of the world, where we get scraped and remember the desperation of a world gone awry.  Babies who do not live more than a few hours or months; slander and hate; hunger and hopelessness.  I will end with the quote she referenced:

“But in the economy of God, what seems the end is but a preparation…it is the experience of genuine grief that prepares us for joy. You see? The disciples approached the Resurrection from their bereavement. For them the death was first, and the death was all. Easter, then, was an explosion of Newness, a marvelous splitting of heaven indeed. But for us, who return backward into the past, the Resurrection comes first and through it we view a death which is, therefore, less consuming, less horrible, even less real. We miss the disciples terrible, wonderful preparation. 
Unless, as now, we attend to the suffering first, to the cross with sincerest pity and vigilant love, to the dying with faithful care-and thus prepare for joy.”

Prayer: Jesus, come again! You need never suffer again. That was done once and for all. But come and remind me of the suffering so that I recall and regain the utter joy of your rising after all.”


-Walter Wangerin, Reliving the Passion

Sunday, February 22, 2015

A week in pictures, with a praise and a prayer


Sunday night, a week in review:  Visitors, and more visitors, who knew February would be so popular in Kijabe?  Midterm weekend with two of Jack's classmates staying over.  Some really encouraging saved lives, the miraculous survival of baby Blessing after her dad's prayer.  Texts and calls with Scott, news from Liberia.  Working on a research abstract due next week, juggling patients, following labs, going to meetings, puzzling over cases.  Making dinners. Jack at Model UN all week, meaning early mornings and late evenings, driving back and forth, and one overnight in Nairobi, plus one more college interview. The social-event-of-the-year Junior-Senior Banquet (think of an elaborate dinner theatre with set and drama and food all put on by kids and their hardworking parents and sponsors).  Perhaps the highlight, 5 out of 6 Myhres on a family Google-chat one night.  Too tired to be profound, and on call expecting a baby in respiratory distress to arrive in our ICU soon, so just going to throw some pictures here in no particular order:

 On midterm, I drove the boys to Naivasha for a swim Saturday afternoon.
 And then to Nairobi on Sunday, to visit the Mixon's church (below) and eat Ethiopian food (above).

 Jack has taken over Scott's taco-making job.
Scott realized that the TIME magazine cover is Dr. Jerry Brown, the Liberian surgeon he's working with.

 Went to Rosslyn on Wednesday for a sound defeat, but our boys played with spirit and had a come-back, just not quite soon enough.
 Baby Blessing as she was off the ventilator.  Now she's back down in the nursery and holding her own, though still quite sick.

 One day this week I actually got to go on a morning run, with this panorama, and my somewhat clueless but joyful companion.
 Christine and Maria visiting Kijabe.  Christine's dad Bill was visiting us in Uganda 16 years ago when he got appendicitis, and through a surgical mishap in Kampala nearly lost his life. Scott had to physically remove him from the hospital there and fly him to Kijabe.  It's a long and dramatic story, but the short version is that God used that week to build all our faith.  Maria is a former World Harvest missionary who still manages children's homes in Kenya, so they had come for a supervisory visit.
 Nyambula Esther was our houseworker 17 years ago when we had evacuated from Uganda for war, and came to Kijabe where Jack was born.  A year ago she had her own baby, Michael, and I saw him in clinic this week and brought them home to lunch.
 The Mbega Boys.  This is the dorm that has adopted Jack, with welcoming and wonderful dorm parents Steve and Sharon Entwistle.  These boys are all dressed up for Banquet, and spent a fun hour on the football field in various poses reliving all their memories and groups, before going to pick up their dates and walk them to the venue.
 Jack and his date, Carlene, who is a lovely articulate athletic young woman from Kenya who has lived all over the world due to her dad's work.
 My Sunday School class posed with me !
The station boys of Mbega
 Jack picking Carlene up at her dorm.

Jack and John Amos, great friends and sometimes confused as twins.
Emily and Evans: we met Emily when she decided to throw a Birthday party that sponsored a goat for malnourished kids in Uganda.  She is a doctor in Indianapolis and her program is connected with one in Kenya, which is how she met her husband Evans.  They were back to visit Evans' family and passed through Kijabe.

PRAISE:
In the last week I've had 6 overnight guests and probably 20 for meals . . . I love the way visitors are a blessing in Africa, and I feel that deeply.  Right now I have a former RVA grad who is now a senior resident staying with me, and she's helpful, smart, and good company.  Friends whom we have known for probably 17 or 18 years, who work in a closed area, are staying as well for the rest of the week, and their company is always great.  I guess God thought I might get too lonely without Scott so has sent me some rescuers.  The Wallace family from South Sudan also arrived on station, though they are staying at a local guesthouse and will only be joining for a meal. 
PRAYER:
Please pray for our US kids as they plow on in the winter doldrums of hard work and snow.  Pray for our friend Heidi, formerly our Bundibugyo nurse, then South Sudan, and now on a furlough in the USA to care for her mom.  Her mom is dying of ALS, which is how my dad died, so I feel for her deeply.  They are near the end.  And lastly pray for our former foster-son Basime Godfrey, the young man who is nearly blind, who had the amazing rescue of surgery in the states because a visiting generous ophthalmologist took it upon himself to make it happen . . . Basime and his wife Eve had their first baby this weekend.  Eve's labor was long and difficult, and the medical system is still dysfunctional.  They were referred very late for a Cesarean section, and by the time it happened the baby was in bad shape.  Basime called in tears and we prayed for his son, who lived about 24 hours, but died yesterday.  I'm thankful I've been able to call and pray with both of them several times, and kind team mates have gone to visit and help.  Today he texted that "we are standing strong" . . . so please pray for their comfort, and their healing, and their faith.  So many hard situations crying out for the redemption of the New Heavens and New Earth.  


Friday, February 13, 2015

Data and Life



This week I had a lot of late nights, two on call and the rest scrambling to prepare our Nursery Audit a week early.  Every week we enter data into spreadsheet, tracking every admission, the weights, the positive cultures, the diagnoses, the need for oxygen and phototherapy.  Then once a quarter we review the data to see how we measure up, where we can improve.  At the end of the year, I try to also collate the entire year's worth of data.  And since we've been doing this for three years now, this represents the whole shebang.  My presentation ended up having 70 slides.  Everything from our goals and our team, to the proportion of males/females or the outcome of babies treated with surfactant, to tables documenting admissions and deaths by birthweight, gestational age, and place of birth for every quarter.  After the summary stats, I went through all the deaths, focusing on about 4 or 5 that I felt we could have prevented with better care.  This is how we learn, and change.  Scrutiny, data, facing real facts, being vulnerable. Naming our mistakes.  

The table above compares the survival of babies (preemies and term) at Kijabe to a brand new study of 22 Kenyan "teaching" hospitals where interns are trained.  We're the top lighter-blue line.  It was very encouraging to see that we are leading the way in what is possible.  And a challenge to bring up the stats for the smallest babies.   I love being part of a team that wants to do this.  Data and life, crunching numbers and hands-on care.  Data IS life, perhaps.

And it is very good to look at the big picture while slogging through the daily details of life in the trenches. Our 5-bed ICU has had 4 beds occupied by Paeds this week, meaning they are my responsibility.  It is rare to come through a week in the ICU without walking down the agonizing road of death with a family.  I am very grateful for your prayers, because there have been some remarkable glimmers of hope that have no other explanation.  This baby I mentioned before, baby of J who is now named "Blessing".  She had to be taken by CS two months early because her mother has severe heart disease.  She's the one whose dad asked us to please try and help her survive.  I spent a lot of the early week gingerly dialing her ventilator up and up as she got worse and worse from immature lungs.  On Wednesday she became very still, not moving or breathing on her own at all.  That evening, I told her dad that I thought we had reached the end.  I offered to pray and he held her hand as we lifted her up to God.  At that moment I thought of the dad in Mark:  Lord I believe, help my unbelief.  And I thought as I prayed, maybe this dad has faith for his daughter that I don't.  I had lost hope. So when I came in Thursday morning and she was opening her eyes and moving her arms and legs and breathing over the ventilator, I was in holy awe.  Then I did a blood gas on her and got the first decent numbers of the week.  I literally did a little dance right there in ICU.  She still has a long way to go and her lungs are beat up.  But she's still fighting, so we'll fight for her.

Most of my patients have been tiny, but on Monday evening I was called to casualty for a 15 year old girl.  She is bigger than I am I think.  She was living her normal life until Friday when she developed neck pain along with a severe headache.  By Saturday she ended up at another hospital with vomiting, and they started treatment for meningitis.  Over the weekend she became less responsive until she wasn't talking, sitting, walking, anything.  She arrived in a coma and with some worrisome neurologic signs.  After admitting her to ICU, intubating and putting on a ventilator, we asked for a head CT(only available in Nairobi over an hour away).  This is the case that got me embroiled in controversy and politics and phone calls, stepping on some toes in commandeering an ambulance meant for a private stable patient and arranging for a nurse-anesthetist to accompany her which is never popular.  However her head CT gave us invaluable information: NOT meningitis, but a mass in her brain.  Neurosurgery agreed to take her into theatre, and we all expected cancer.  Instead they found TB, a tuberculoma of the posterior fossa for the medically curious.  You may not think TB in your brain is good news, but it is much better news than cancer in your brain.  She is on treatment and already waking up and moving a bit. When the pathologist texted me the results on Thursday, it was my second rejoicing dance of the morning.

And taking another premature baby off the ventilator was my third. Whenever I talk to baby T's mom, she listens to me tell all the problems then says: "But she's going to be OK, right?"  "Yes, I think so, but she still has a long way to go."  Jack and I were reading a devotion on Naaman.  I can relate to the King of Israel, when he is sent the patient referral letter saying basically "here is my servant, heal him."  And the King says, who am I to heal anyone?  Yes!  Amen.  That's my life, referrals from hospitals that have hit their limits, parents who are desperate for hope, saying take this kid and make them well.  And lots of weeks that seems impossible, but this week we've seen some great progress.


Last fun story, on Wednesday afternoon in the midst of baby Blessing looking like dying and the usual press, I had a phone call from an unknown number.  It was an Ethiopian man who had come to Kijabe a few months ago because his wife was pregnant with quadruplets (IVF) and he wanted an affordable an safe place for her to deliver.  He talked to Scott, who showed him around and helped him with cost estimates.  And perhaps gave him my phone number. . . because somehow he was calling me to say that his wife was now 27 weeks and two of the four babies had died in utero, and could they come to deliver the other two?  I quickly made sure we could open up an incubator, and said YES.  Within two hours she had arrived from Nairobi.  The OB team admitted her to prepare, and Dr. Ari and Bob received these two beautiful babies, a boy and a girl.  At 27 weeks and less than 1000 grams we know they have about a 40% chance of survival here.  So please pray for them. Their mom has clearly been through a lot to get them here.

Meanwhile in Liberia, Scott did an emergency surgery on a lady with an ectopic pregnancy, and another CS on a 15 year old girl who was seizing by the time they got her on the operating table from a condition called ecclampsia, which put her life and the baby's at risk.  Not pretty, but both survived.  It is good for him to sense the purpose in being there.  Hopefully he'll give us more of the story by email.  (contact me at jmyhre@serge.org if you're not getting those and want to, and contact Serge at info@serge.org with your mailing address if you want our new photo prayer card in the post and you don't normally get our Christmas letters).

This weekend I am off, and Jack has two friends staying with us, so I'm trading in my stethoscope for baking cookies and making dinners.  And hopefully, some sleep.






Sunday, February 08, 2015

Watching out for each other

Twenty-two years ago today, in a Baltimore hospital blanketed by snow, Luke Aylestock Myhre was born.  After losing three babies by miscarriage, then spending six weeks on strict bedrest waking up every 3 hours to swallow medicine, making trips to the emergency room to get IV fluids and slow down preterm labor, simply having a live baby (even a month premature) seemed like a huge accomplishment.  Within a minute of being born he was swept of to the NICU, where he perked up and his stay was mercifully short.  Nothing was simple.  I suppose the next 22 years were harder than those months of anxious bedrest and those hours of pain, but it really doesn't seem that way.  Because the big difference in the last 22 years is that we had an actual person to love and relate to, not just a wish.  A boy who exerted his will from the get-go, hated sleep, explored anywhere and read everything, saw through any pretense, caught any faulty logic and found any loophole, somehow managed to both tease/torture and loyally love his siblings, the animator and energizer of any group, with a solid heart for good and a strong leading path. (The photo is Luke holding Jack at Kijabe in 1998).  He missed the memo on how first-borns are supposed to support the status quo and follow the rules.  The world became a much more interesting place 22 years ago today.  And as his journey unfolds, we are thankful to be watching.


But watching from a distance, sadly.  I think the last time we spent a birthday together was when Caleb and I flew out to Kijabe for his 16th.  It was his first year of boarding school, and I made cinnamon rolls for the whole dorm for breakfast, and we climbed Longonot.

That premature baby had to become a premature adult in many ways. The fracturing of the family fosters independence, which is great.  And sad.

And, in tiny ways, redemptive.  We look for slivers of redemption in our deepest pain, believing that the ache signals a place where we feel the cross, and therefore where the cross is creating the all-things-new of the Kingdom.

This year, because we are continents apart, Luke had one of his best nights in med school yet.  His friends threw a surprise party for him and another classmate with a birthday.  I am grateful for those who extended kindness to make my son loved and welcome.  And because we are continents apart, when Jack told me two of his class mates had birthdays this weekend and their plan to visit one of their families fell through, we pulled a handful of Senior boys together for a gourmet grill-out and movie night.  I am thankful to care for other people's children, in gratefulness for the way other people care for mine.




Because that is community, after all, watching out for each other.  The boys above were born in four countries on three continents, but now they are fast friends.  And though I am only a small and peripheral part of their lives and those of other senior boys, I am thankful to bake, and teach them Sunday School, and cheer at their games, and make them breakfast every Sunday morning, and open our home for dinners and games and movies.  We all long for the connection that was lost in the Garden, and these moments give us tastes of the true belonging.

And that sense of pulling for other-people's-kids extends deeply into my work.  I was on call Saturday here at Kijabe, watching over three critically-ill intubated ICU babies, 22 others in the NICU, and another couple dozen on the Paeds floor, two admissions in the emergency room, and a handful of consults in the outpatient department.  I grabbed a few minutes to chat with L, the girl who was wasting away, and she smiled, which I took to be a pretty amazing sign.  Still a long way to go on the path from death to life.  Most of my day was spent agonizing over baby J, whose mother was nearly dying herself, who was born too early and whose lungs just were not working.  
Her bewildered dad simply said, please, can you do everything you can?  Yes, of course.  Over the course of the day there were slight turnings in the right direction, but it will be a miracle if she survives.  It is a weighty responsibility, the holding of other people's children, being the person to interpret every piece of data, the numbers and labs, the pallor of the skin, the squeaky resistance of the lungs, the limits that can be pushed and those that can't.  This weekend I was thankful to be consulting back and forth with our newest paediatrician, Dr. Ariana Shirk, who traded off with me this morning.  
This is Ariana with a visiting resident/physical therapist couple.  One of the joys of Kijabe is that it is a point of intersection, where people with a heart for Africa come to serve and learn, and where Africans are equipped.   
Best. Feeling. Ever.  The Sunday morning return to my house, turning off the pager for the day (note that the dog was hoping I would take her running, but I had to make chocolate-chip-raspberry-pecan pancakes for Sunday School . . . ).  This life as hostess, doc-on-call, solo responsible adult in the house, Serge rep for East Africa, and communication coordinator for a family of six in four time zones . . has been more tiring, more draining, than I anticipated.

And this month our caring for other people's kids extends across the continent.  Scott is on call today in Liberia.  Last night, a baby less than a week old died of tetanus.  This is an indirect ebola casualty.  When ebola spirals out of control, maternity services disintegrate, immunization programs are suspended.  And then babies die of horrible, painful, spasmodic, tortuous diseases like tetanus which are 100% preventable.  He has done one surgery to save a mother's life who had a ruptured uterus.  And he's been straining to listen and understand, donning protective gear to admit patients with fevers that could still be ebola (they haven't been, yet), agonizing over whether to put the in the ETU (ebola treatment unit) which could unnecessarily expose them to ebola, or in an isolation room on the regular ward which could unnecessarily expose others.  This graphic from The Economist explains why he is there:
Yes, there are more than a HUNDRED TIMES as many doctors per population in the US than Liberia.  




Watching out for these sweet little ones who can't ask anyone to help them, and thankful for those who watch out for my kids.  And those who watch out for me.