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Wednesday, March 22, 2017

5 countries, 15 days, Grace at the Fray

There and back again, by budget sketchy jet, reliable MAF prop plane, canoe, 4WD truck, taxi, motorcycle, foot.  From Kenya, to Uganda, to Congo, to Uganda, to Rwanda, to Burundi, to Kenya. The Area Director portion of our life got short shrift for over three months during the 100-day doctor strike, squeezing in emails near midnight, stepping away from the ward to make phone calls.  But we left two weeks ago by faith to complete a planned visit to several of our teams and a potential new partnership in the DRC.  We left with the promising hope that the strike was ending, but the doctors actually returned just before we did.  It was agonizing to walk away, but we saw God's hand in the journey and believe it was the right decision.  We returned with a great potential for a new team in a new place, with having witnessed some supernatural reconciliations, with a solid Memorandum of Understanding with one of our main partners, with hours of conversations and prayers and connections with people we love.

A handful of Scott's amazing photos can be sampled below; he has not yet downloaded most of them.  But they will help illustrate a few summary points about Serge in East and Central Africa in 2017, what we do and why we go to those fraying edges to testify to God's grace.

The land and the people, the rain pouring green into hills and rivers.  We work in some spectacularly beautiful places, where creation has not been drastically altered by the exploitation of humans.  The humans are there though, in force, the paradox of rural density, curious children popping out to accompany us, to greet, to observe.  God made the thousand shades of green from banana stalks to cassava leaves, and the thousand shades of people with their unique reflections of the Trinity.

Binding the Fray
The unraveling of peace by the forces of evil takes many forms, so teams work holistically in diverse ways.  Drying soy beans, corn, and sorghum to make a porridge to treat malnutrition (above).  Using surgical skills to restore sight to the blind (below).  Building wards.  Translating the Bible.  Teaching school.  Piping clean water.  Sitting with the sorrowful to pray.  Celebrating weddings.  And burials.  Investing in church leaders.  Living out the good news on the sports field.  And on and on, threading grace through rough edges.

Projects and people
We love engineers.  Because we know that the same roads, water, health care, schools that we all took for granted growing up are part of the way God's blessing flows.  So sometimes we need the skills and tools and funds to put up a new 80-bed Paediatric ward, or create low-tech incubators.  But most of our time and effort has been poured into people.  When God wanted to rescue us, He sent His Son.  At Serge we primarily send people to work and live and pray and sweat alongside those who are struggling.  As we put our shoulders to the work together, as our lives intertwine, we are all transformed.

As Area directors, we work most closely with the Team Leaders.  So it is our joy and privilege to listen to them, to pray with them, to wrestle with difficult decisions and ask God for wisdom together, to share meals and family news.  Serge now has 8 teams in 3 countries in East and Central Africa (plus South Sudan on hold because of war).  

We serve at the invitation of our national partners, and part of our job is to honor and maintain those relationships.  In some places we work with a particular church, or a Christian university, or a coalition of churches for health work, or a local government.  But we are always guests.  This era of missions means we collaborate, we walk alongside, we listen to each other.  While we don't hesitate to politely strive for what we believe is best, we have to keep pace with our hosts.  You can pray for all of us in this regard.  It is so easy for cultural chasms to divide us, for our own pride to trip us up.

When families relocate, kids get caught in the nebulous universe of the "third culture".  They are not quite your average North Americans like their parents, but they are not fully embraced by the local culture either.  Enter the MK teachers, who enable families to live in remote places but keep their kids on a grade-level-appropriate pace for eventual schooling in their country of origin.  Concern for kids, their health, their sanity, their safety, their connection to extended family, their adjustment to the new language and culture, their traumas, their learning disabilities or speech delays, their friendships, their development . . . fills a big portion of our Area Director hearts.  Ours looked like these two just a blink of an eye ago.

And the Real Center of it all:  Bodies and Souls, loved by God

Saturday, March 04, 2017

Kenya Doctor Strike: 13 weeks down, and a Myhre interlude

After heart-wrenching gut-dropping soul-searching deliberation, we decided to go ahead with our planned Congo-Uganda-Burundi trip starting tomorrow.  The chronic never-ending nature of this strike has made it very difficult to plan, and resulted in us falling far behind in our Serge Area Director job.  We are physically weary, emotionally exhausted, and in desperate need of a break.  Flying a small plane into Eastern Congo for days of intense cross-cultural meeting and vision setting isn't exactly a vacation, but we are moving forward trusting God's strength in our weakness.  And trusting the sovereign timing of God's care to push a resolution to the strike.  As of yesterday, the intervention of religious leaders (along with the Kenyan Law Society and the Kenyan Human Rights Committee, and the President) offered the first real glimmer of hope for compromise we've seen in a long time.  Our visas miraculously came through on Thursday, Scott went to get them in our passports Friday, and we bought tickets last night.  Today was another non-stop day of "our brand is crisis" and tomorrow we are off.  Some photos I had on my phone from the last couple days below.  Pray for our patients to be healed by the mercy of God as we go, and for us to be filled with wisdom and love for others as we listen and serve across three countries in two weeks.  

Baby Hope, would you hope with me she would survive?  Severe dehydration caused her kidneys to fail, but she may still recover.  Pray for her.

The busy Newborn Unit, when you get 4 preems of about a thousand grams being transferred in one day . .  and dozens of births per day . . .it gets crowded.

Preem corner, our two best incubators holding four babies who total up to weigh less than many American babies.

Jua Kali--Kenyan for "in the hot sun" which refers to the creative make-do engineering this country excels in.  This, my friends, is an oxygen concentrator.  

This mom finally went home with her very very premature baby, a triumph that took almost two months.  The other moms took up a collection to get her some clothes to go home with, and bus fare.  She was an 8th grade student (father was in high school).  I love her smile, and resilience.  And I love the way God's people are here in this place of need, moms helping each other.

My team.  Grace works part-time while in school, but Zachariah is with me almost every day, and has proven himself to be thorough, compassionate, and reliable.  I wouldn't have made it through the last two months without them, as things got much busier after December.  This week they admitted an ICU-level critical baby without me one day when I had to leave briefly for a passport issue, and they did everything right.  That made me so happy.

This brother brought his sister with AIDS back for follow-up as requested today . . since he's in school I saw them on a Saturday.  She sadly also has TB, but we are hoping that treatment will extend her life.

One day I had these two admissions in rapid succession:  1120 grams on the left, 4135 on the right.  Quite the contrast.

Maternity at Naivasha traditionally requires two patients to share each bed, it is so crowded.

Hoping to post from the road, but if it's not possible, don't forget to pray for us, and for those we leave behind.

Thursday, March 02, 2017

19 Years of Jackness

Happy Birthday to our mulibah, the last-born, who as this little selection of pictures since the last birthday (and one from the actual birthday) show, is a wonderful paradox of tough rugby-playing, running, hiking, wild man and quiet reading, cooking, artist.  As Grampy used to say to get a rise out of us daughters, you truly are a gentleman and a scholar.  It is a great grace to be the parents of a young man who forges on through the world with courage and integrity.  We love you so much Jack!

Ashes to Ashes

Yesterday, on the day most of the world's church begins the season of Lent with a day of repentance called Ash Wednesday, the Masso family said their public goodbye to their Papa Jon.  We gathered in the Daystar University auditorium where he was a professor of physics and instrumental in building a science faculty, the Masso family joined by most of our Serge team from Nairobi and Kijabe, a classical choral society that Jon sang with, dozens of former street boys enfolded into the Ahadi home through the senior Massos' ministry, and a few hundred colleagues and students from the university.  There were speeches, tributes, flowers, music, and memories.  As sad as it was to see the casket containing a soon-to-be-ashes body, the day was also a tribute to a quiet man of integrity who steadily taught and encouraged and believed across continents in a way that impacted untold numbers of lives.  I found it encouraging to ponder the fact that the Massos' Kenya phase of life began when they were just a bit older than we are now.  There are still a couple of good decades ahead, I hope.  And encouraging to see the cross-cultural mourning uniting us, and the way God orchestrated this past year of celebrations and goodbyes for Jon.  There was a glimpse of the eternal that permeated the review of the last 75 years of temporal, but a death and a memorial service ground us solidly in earth.  Appropriately so, for the day.  The ashes of Ash Wednesday are to remind us that we are made of dust and to dust we shall return.  While that may sound depressing, in the context of mourning and of the struggle of this life, it is actually a humble relief.  All suffering in this world comes to an end.  The Maker knows our feeble frames.

The day's Scripture included the phrase "rend your hearts and not your garments" (Joel 2).  Serge's tagline is "grace at the fray", using the sewing metaphor that a serge stitch is one that re-ravels or binds up the disintegrating edge, and that's what we're up to in the world's places of sorrow.  That calls to mind the image of a rent, or frayed garment. So serging is the opposite of rending; yet an internal rending may need to precede the serging of our souls.  We rend our hearts by an honest look at our motives, our propensity to promote our selves and use other people for our own ends, our lukewarm love, our critical spirits.  But that rending is good news, because then the frayed edges of our souls can be bound with a beautiful stitch, united to a tapestry of God's making all things new.

Rending garments was also a sign of grief, one that our culture should re-consider.  For the Masso kids, there is no outward sign for their friends and classmates to know the grief going on deep in their hearts this week.  Grief inwardly rips our tidy world into little shreds.  But more good news:  that's OK, a precursor to a new design.  Grace at work again, in grief as well as in repentance, acknowledging all that is not right in the process of making it all right again.

Tuesday, February 28, 2017

Lent 2017

Our Lent started early and is stretching indefinitely on as a season of longing, and some minor deprivations, but the church's season of reflection and preparation begins tomorrow.  Forty days using physical reminders (fasting, or prayer, or readings) to shape a spiritual longing for the resurrection.

"The sacrificial season of Lent is a time for us to purposefully go deeper with Christ through reflection, action and renewal. Its structure offers practical ways to increase our devotion and love for Christ. If the church is indeed a hospital for the sick and wounded, then it follows that Lent is its yearly physical and annual tune-up. Lent has been observed by the vast majority of Christians since the earliest days of the Church. It’s a time to cleanse our wills, realign our spirits and strengthen our dependence upon God. It’s a period of genuine repentance, of concentrated reconciliation with others, of fasting from all that distracts us, and recommitting our lives to Christ in love and service."

Here is the Lent (and Advent) site from Biola we have come to love, combining Scripture, art, music, poetry, and insightful meditations.  We're also reading John for Everyone by NT Wright, part of his New Testament for Everyone series.  Our normal Bible reading come from the Church of England's Common Worship Lectionary App so we're reading the commentary on the John passage of the day.

This year the parallel to Caleb's push through Ranger school, and Luke's intensive month preparing for Step Two medical boards, and our long season of strike-related work, plus Jack and Julia's normal challenges of University . . . make 2017 Lent even more meaningful for our family.  We're designed to integrate our bodily experiences with our spiritual growth.  Lent and Advent celebrate the incarnational truth of our embodied souls.  

Join us and most of those who have followed Jesus over two millennia as we prepare to celebrate the resurrection.

Kenya Doctor Strike Quote of the day: Not Normal

This was from a text from a striking Kenyan doctor, a very young one, who believes in the cause but it getting tired of the stalemate:

"Yes it is hard on everyone.  But what's even worse is the fact that it's slowly turning into normal.  That we act like everything is fine, which isn't the case."

AMEN to that.  The chronic crisis becomes the new normal.

The possibility of a solution this week is looking dim.  But I haven't given up on a dramatic 11th hour rescue.   So keep praying.

Once again the sheer volume of work can make one feel like drowning.  Just when I thought I was getting back my intern IV skills, I was 1 for 3 today, and the two babies I kept blowing up veins on had already been poked over by the day nurse who was feeling sorry for me and tried to help.  I had two pretty sick admissions on the Paeds ward so I left for a while, and at the end of the day remembered I had to go back to do those IV's.  So I trudged in and started gathering supplies, then I looked over at one of the incubators just as the evening nurse seemed puzzled on why I had come back.  She had put in both IV's.  I actually hugged her, right there.  That's how tired we feel.  It probably scared her but she smiled.

Not long after we got home, Scott got called back because even though he's not technically on call tonight the person covering was not comfortable doing a C-section in a lady who'd already had three prior ones (too much scar tissue makes it really hard), and there was no possibility of referral.  So he went back and did it as the most experienced on the team now.  He's done about 65 since mid-January.  Which makes sense with a 10-15% rate and 500 deliveries a month and him doing the vast majority of the coverage.  No maternal deaths (except a couple of dead-on-arrival but not much we can do about that) we thank God, and only one surgical site infection which is also pretty remarkable.  My outcomes are not nearly so nice, so it helps to celebrate his.

Pray the country would not become complacent in accepting this broken system as inevitable.  Pray we would continue to build trust and relationship because we are needy and dependent.  It is no fun to need help, but it is a way to connect.  Pray for the confidence to go to Congo, Uganda, and Burundi.  And pray for those Burundi visas.  Thanks.

Monday, February 27, 2017

Kenya Doctor Strike, losing track of the weeks, but finding holy moments

And so the days go by in a blur of exhilarating craziness and dreary defeats.  The futility of pouring one's soul into one admit after another that dies.  The humbling realization that trying to hold up this service by pushing on through day after day does not guarantee better care than the mediocre chaos that preceded the strike.  Glimpses of victories.  Squeezing in the rest of life mostly between a late dinner and midnight, calls, emails, work.  Trying not to think more than a day ahead, even though that means we are no doubt very frustrating to the people we are supposed to be visiting for supervision, encouragement, and exploring opening a new team/field in March.  As in next week.  And mostly, in case you don't have time to read this ramble, realizing that the relational depth we are plumbing with God and humans is the real story, as lives come and go.
(going home tomorrow, day 51 of life, a 27-week preemie survivor)

It's hard to think back more than a few days, too much water under the bridge.  Saturday started out with my usual peek into Newborn Unit before heading to ward rounds.  Nurses seem to be doing CPR.  I walk all the way in and find a very mottled, dead baby with zero response.  As soon as I help they leave me to do the chest compressions and ventilation alone while they get the medications I ask for, and some information from the file.  Mom had just come in to feed and found the baby dead. A full term infant who aspirated meconium at delivery, but as per the file had been breast feeding and stable.  It is my first time to see this baby, and it's too late.  There is no reviving her, dead too long.  Thursday I had almost the same experience, I was examining one baby and looked over at the one sharing his bed . . who was grey and lifeless.  That one I got back with CPR and meds but not for long.  After an hour or so the responses become less and less, until there was no heartbeat at all.  Two in three days, both good sized term babies admitted the evening before, dead in the morning.  Either their critical condition and hypoxia were not recognized (since we have only 1 monitor to spot check 20-30 babies, that's understandable) or they crumbled from a rising overwhelming infection, or choked on a feeding?  It's a depressing way to start the day, comforting a grieving mother.  But there are probably 40-50 patients a day to be seen, examined, touch base with the parent, write for adjustments in treatment, draw labs or review results, discharge a half dozen and admit another half dozen.  So we go on.

But the frequent futility puts that puzzling book of Ecclesiastes into perspective.  So much seems to be in vain.  Still delving into Keller's Every Good Endeavor, trying to embrace this season and what it has to teach us.  Not just a temporary insanity to be muscled past, but an invitation to shape our work as God works.  For wholeness and newness and beauty, requiring sacrifice . . . but not necessarily demanding tangible results.

Because I want those tangible results, which in my work's case are actually lives.

Could it be that God is offering glimpses of something bigger?

A few hours later, I'm looking at a baby who has been with us all 37 days of her tiny preemie life.  Many of those days have been tenuous but on Saturday she's plunging downhill fast.  Her heart is beating at an unsustainable 225 beats a minute, and when I first check on her her lips look blue, confirmed by oxygen saturations of 77% (should be high 90's).  Her blood shows signs of another mounting infection, even though she's barely been off antibiotics more than a few days in her life.  An x-ray seems to localize the source to her gut, necrotizing enterocolitis, a dire complication.  My kind Kijabe friend what's app group responds to my enquiries with advice and rising alarm.  She may need surgery, which at this strike moment would not be available anywhere else but Kijabe.  But her mom has no money or insurance, her dad is unsteady with alcohol, and I'm afraid to put her in an ambulance looking so unstable.  Fluids and antibiotics and by mid afternoon she's marginally better, so with the gracious invitation of Kijabe's generosity we risk the ambulance ride kangaroo-style (on her mother's skin for heat).  Before she leaves, all the moms are in the unit feeding, and this baby is such a precious little long termer that I decide to ask them all to pray with me for her, explaining in my halting Swahili the problems.  We pray, I am feeling pretty emotional, then open my eyes to find her mom with tears streaming.  That, I realize, is a holy moment.  What it's all about.  The community of mothers, praying.  The teamwork of the public and mission hospitals. The mother of the sickest baby sensing God's provision, presence, support.  Running to the end of our resources, and desperately asking for survival.  And all that for something so small and fragile as a 3-pound baby.  We load her into the ambulance with our last tank of oxygen, and I hear later she's made it just in time.  The infection is indeed serious, but we have hope she will make it.

About 5 pm, thinking my semi-off Saturday couldn't get much worse, my hand is literally on the exit door with Scott when a midwife runs out to ask us to come see a mom 28 weeks pregnant with triplets.  Sometimes it's so crazy you have to laugh or scream.  Really?  She's in active labor.  We recruit one more nurse to double the Newborn Unit night staff, start assembling three oxygen delivery systems (tricky since we are out of tanks completely, so it's beg and borrow enough concentrators) as the babies start coming.  Scott ferries them from the delivery room to the Newborn Unit.  The first two are identical girls, sharing a placenta, 820 and 960 grams. They are followed by a big brother.  I line them up and keep passing the bag with oxygen to inflate lungs up and down the row until the nurses can get the CPAP's bubbling.  It's after 6 when an angel of a CO pops in, this young woman has miraculous IV skills, and as I'm preparing a little surgical procedure for 3 umbilical lines she just slips in hand IVs.  Hooray.  Teamwork.  Another holy moment, three tiny lives holding on because of two nurses, a clinical officer, and me, helping each other.

Sunday . . . Scott's in at 4 am and 6 am for emergencies; I'm early to church to practice for helping with the worship team.  As soon as the service is over we head as quickly as we can to Nairobi.  The day before, our dear friends' father had been admitted to the ICU at one of the best private hospitals. Michael and Karen are there with Michael's mom waiting, while his dad goes into surgery for a triple coronary bypass after a devastating heart attack.  The senior Massos had recently retired from a 15+ year term of service teaching at a Christian University in Nairobi and founding a home for street boys on the side, but were back to sell their house and transition to more of a frequent shorter term pattern of ministry.  We sit outside the operating theatre as the risky surgery goes on, sharing some stories and memories and Psalms and prayers with the family and a handful of Kenyan adults who were once in their program.  As the hours go by, and the report is only "we're trying to get him off the heart-lung bypass machine", we all become more and more sober.  Finally about 5 pm the surgeon comes to the door of the theatre hall, and beckons Michael and his mom.  He looks tired. The setting is surreal, through a cracked door, he tells us that Mr. Masso is dead.  Sobbing tears, disbelief.  Holding onto each other.  More scripture, and prayer, and a raw sorrow balanced by the truth that this dad lived life fully and well and died in the midst of doing exactly what God called him to do.  It is dark as we finally head home with Karen, still communicating with family over the globe.  The day is unbelievably draining, but holy as well, cutting to the core of family, of love, of friendship, of faith that stands in the room with a dead body hating death and separation, yet says goodbye knowing we will be reunited.

Monday, back to the hospital, an emaciated child, another with the listless swelling of chronic malnutrition.  Two of the triplets have died but the tiniest one fights on.  Tubes of blood drawn, listening to lungs, palpating, thinking, empathizing.  Scott pushing to get emergency c-sections done, made doubly difficult sometimes by the foot-dragging of others.  Hour after hour, again the day slips away, and I walk back onto the ward one last time to deliver a lab result I've just checked, when I hear a nurse talking about intubation and see a clinical officer intern trying to do CPR.  It's a 2 year old with severe burns, and there goes another couple hours of maintaining his airway and breathing while we sort out a way to send him to the ICU at Kijabe.  Once his heart nearly stops.  He'd been treated overnight at a small private local clinic, not a good idea, since he's nearly un-save-able by the time he arrives.  And while I'm bagging his lungs with oxygen, I hear from Scott that there's a mother in labor with a premature baby with a prenatally diagnosed intestinal obstruction.  You actually couldn't make up this much crisis if you tried.

So what is bigger than a few saved lives?  Perhaps it is building trust with coworkers I used to command/ criticize, learning to value cooperation and acknowledge how much we need each other, which has the potential to save many more lives.  Perhaps it is living a small glow of light that says God is present, even on dark days of a father's death, a child's burn, a baby found without breath.  Perhaps it is faith to believe this is not all in vain, even when it looks that way.

Please do pray.  It would take a miracle to end the strike this week.  We are supposed to leave for Congo, Uganda, and Burundi on Sunday.  We feel very conflicted about walking away.  Our hearts mostly want to keep at this work. But we also have committed to other work.  Pray for wisdom.