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Sunday, January 22, 2017

Kenyan Doctor Strike Week 7



Saturday, about 1 pm, we've been rounding and dealing with patients and crises for about 5 hours, and are about to go buy groceries then meet a taxi bringing a visitor to us from Nairobi.  Scott gets a call from casualty—they have a woman with abdominal pain and bleeding, she's dizzy and barely awake.  I find two nurses holding IV bags while an ultrasound tech confirms an ectopic pregnancy (the fetus is not in the womb, but in one of the Fallopian tubes which then ruptures) and Scott is making phone calls to get an anesthetist to the operating theatre.  Her blood pressure is 70/30, way too unstable to transfer.  It's him, or nothing.  He's done this surgery before, but not often enough to be confident.  Let alone in the circumstances of yesterday:  no power, because the workmen are installing a back-up generator only they're not done yet.  We're out of some of the necessary sutures.  The lab can't run samples.  There's no blood in the blood bank.  I run out to pick up our visitor and by the time I'm back, Scott's in the theater, wearing his headlamp in the dim light. Blood is pouring out onto the floor, the suction isn't working.  A back-up power source was running the electrocautery, but then stops (it turns out the anesthetist tripped over the plug, but we don't realize that at the time).  I stand in the theatre and watch and pray as he works.  It turns out the ultrasound tech wrote down the wrong side, so that takes a few minutes to sort out. As if there wasn't enough else wrong with this picture.  He eventually stops the bleeding, cleans out the clots, removes the ruptured tube, sews her up.  She lost about half her blood volume.  Instead of a post-op ICU, she gets a general ward with no monitoring.  But by God's grace, she lives.
This is what a doctor's strike looks like.

Weeks one and two, before we left in December, seem quite distant now.  There was the shifting rumors, the nursing walk-out, the struggle to manage patients alone, the uncertainty of every day changing, the weight of never being fully off, the couple of days spent pitching in at Kijabe.  But in December numbers at Naivasha were still low, patients stayed home thinking the strike would be resolved any day and they'd come back, there was a collective anxious holding of breath.  When we left, we never imagined that after a month in the USA we'd return to an unresolved humanitarian crisis created by political impasse.  We missed weeks 3-6 of the strike, as mission hospitals kept shouldering larger and larger burdens as the only option for many.  Private clinics continued to rake in their unaffordable-to most fees, and the poor stayed home getting sicker or dying or recovering on their own.  Doctors and the government each retreated into their own camps, willfully refusing to see the deathly consequences of their inaction.  The government offered a 40% pay raise instead of the 300% doctors expected.  No deal.  Here in Naivasha the hospital completely closed its doors for a while, as happened in public facilities all over the country.

(the miseries of life, admissions in casualty)

Then into January, 4 women died having babies  in a shady private clinic down the road.  And the senior administrative and nursing staff at this government hospital, as well as some in the county seat of Nakuru, said enough.  Our medical superintendent worked with the county leaders to partially re-open, offering maternity and emergency care in two sites, relying heavily on nurses (who resolved their strike more quickly) and some non-union clinical officers.  We are one of those two sites.  Though he's a radiologist, he stretched back to his training and put himself and two recently-graduated interns who had not yet joined the union, on OB call.  He stopped commuting home to his family a few hours north.  As he told us, he decided, this is the time I will look back on and talk about when I'm old.  We walked into this on Wednesday just as things were really starting to pick up speed again. 

We may have missed a few weeks, but we're making up for it pretty quickly in week 7.
We've been working pretty hard, long days.  It feels like Ebola, the shutdown of services, the wild few who decide to do something about it, the stretch, the constantly shifting horizon .I found 30 babies in the Newborn Unit and 23 on the Paeds ward.  It's me and two clinical officer interns assigned from the county because they are in a different program (non-union) than all those who walked out.  Neither have any pediatric experience.  Scott is the sole OB provider daytimes, and has been on call all weekend, though he will have nights off on rotation with the medical superintendent and the two young doctors and one clinical officer.  The nursing staff is back, though that was never an adequate number.  One or two per shift in each area, including maternity where the one day he counted there were 23 deliveries.  Yes, back to the 1/hour pace.  
As Scott says, it has been alternately exhilarating and terrifying.  He's tried to refer really sick or complicated patients that are beyond his usual experience, but the only place to go is the mission hospitals and while those are reasonably priced for the middle class, we can not convince many Naivasha-poverty-level patients to go.  Besides the fact that when mission hospital beds are full they actually stop admitting, so finding space is difficult.  In fact they've been sending patients in the other direction. 

So the bleeding woman stayed.  And a woman with a life-threatening syndrome called HELLP, who he took to the operating room Friday night to save her life and her baby's, whom I admitted to our NBU.  And a woman whose baby had almost stopped moving completely days after her water broke prematurely, another NBU admission.  And many more.  And while it is satisfying to see clear and dramatic saves, it is not the full picture.  I've lost three patients in 5 days.  And we know there are more out there who aren't coming in.
In closing, a few overall strike thoughts.

1.  Necessity fosters community.  It is always good to be part of a group of people trying extraordinary things, and the Kenyans around us are working that way.  I can't see 50 patients alone, and put in their IV's and draw blood and follow up labs and talk to parents and examine and write notes and calculate fluids and make decisions.  So I'm trying to teach the two CO's (one is only part time) a crash course as we work together.  And while I'd like to be the competent senior doctor who breezes in to lead from the front, I've had a rough week of preemie IV struggles.  And I've been rescued multiple times by my juniors.  The humbling lesson that I need them just as much as they need me.  We're in it together.  This leads to some moments of genuine connection, like when a nurse told Scott, "you actually act like these are YOUR patients and not just our patients that we are calling you about."  Yes.


2.  God is present in the midst of the struggle.  The NBU mothers sing praise songs and pray over their babies at the start of each day, in this non-mission hospital.  Scott prays over his surgeries.  We are in over our heads, but patients are still getting better (at least most of them are) because God is here.  This quote was in a devotion we read by Rohr:  When prayer is authentic, it will always lead to actions of mercy; when actions of mercy are attempted at any depth, they will always drive you to prayer. 

3.  The poor depend upon the Kenyan government healthcare system.  Public health care is a beautiful thing, but the system here is broken. I guess all systems are broken.  There are good people who mean well on both sides, who feel passionately justified in their positions.  There is also corruption, despair, injustice, greed, indifference, entitlement, and all manner of evil in this situation.  So while the government and doctors' union drag on in their stalemate of no-compromise, the poor keep suffering. A few times this week, I've wanted to feel really sorry for myself.  I have a nasty cold.  We're both jet-lagged. Things don't work.  But then I admit two surviving of three triplets born on a path on the way to the hospital, to a mom with AIDS.  Or a premature baby born to a 15 year old 8th grader who got no prenatal care.  Or walk out to see a mom delivering on the floor.  Then I stop grumbling and remember the privilege of walking alongside these courageous, polite, and generally cheerful women.

4.  We can't keep this pace indefinitely.  So please do pray for resolution.  In the meantime, pray for stamina, for wisdom, for miracles of healing, for kindness towards those we work with and each other, for pockets of time to focus on the rest of our Serge job and family and life.  And pray for the mission hospitals too.  They have many more staff, but are still feeling the push of unsustainable numbers of patients (another quote from a Kenyan "the Kijabe hospital Outpatient department is like a political rally:  standing room only").  Pray for our colleagues there, and in Chogoria.  (Photo is of the Kijabe Paeds team who had a day off at a nearby hotel; I was able to run over for a half hour and greet these friends, a great group of doctors).

5.  And lastly, in the midst of the craziness of the last five days, we're grateful for our neighbors who kindly look out for us, for an old friend Scott Ickes who worked with us in Uganda and is back to visit in his role as a professor of public health at U of Washington working on a grant for important research on the outcomes for kids post-hospital-admission, for our dear friends the Massos and Bethany who made us lunch at Kijabe when we ran over to drop Scott off today.  As it says in one of my favorite movies: No man is poor as long as he has friends.









Tuesday, January 17, 2017

Still Alive, and mostly well


Christmas Day, the above photo says it all:  6 Myhres together, at the farm in West Virginia, sunshine and joy.

Otherwise, the last month has been FULL, and though we landed back in Kenya almost 24 hours ago and now have computers (thanks supporters!!), I don't think I'm ready to process the richness or face the reality of life moving on from January 17.  Between goodbyes, travel, jet lag, a full day of unpacking and settling and touching base with friends, and a cold settling in by the hour, let me just say welcome back to the blog.

Since we last posted we flew to the USA, spoke at our main supporting church, gathered our adult children to WV, baked and cooked and ate and walked and biked and kayaked and baked and ate some more, cut down a tree, decorated and celebrated Christmas, drove to North Carolina for New Year's fun in Charlotte with my mom and my sister's family including ice skating and movies, drove to Fort Benning, Georgia where Caleb is posted so we could glimpse his life, then flew to California with Jack, Julia, and Acacia to visit Scott's parents and our niece in Half Moon Bay with more biking and walking by the ocean, then flew back to Philadelphia for annual leadership meetings with Serge while the kids went back to start their new semesters.  We flew back to Kenya over the weekend via London with a side trip to Liverpool to visit Kenyan doctor friends from Kijabe who are there for further training.  Which brings us up to today, Naivasha, back to our house and growing puppy and the doctor strike.

Bearing in mind the lack of technology through most of the above, here is a small sample of photos that shall have to suffice:












Here's to 2017, and being back in communication again!!

Thursday, December 15, 2016

Christmas Letter for Downloading

Tis the Season...

For a look back at highs and lows of 2016 in our lives...and a few color pictures too!

CLICK HERE


Saturday, December 03, 2016

Remembering a Good Man with Good Words


Nine years ago today, we stood outside our home in Bundibugyo straining to hear the phone call telling us our closest Ugandan friend, Dr Jonah Kule, had died of Ebola. Scott, Scott Will, and I had remained in Bundibugyo to provide medical care in this epidemic. We had sent our team and family out of the district as the reality of the danger unfolded, but the day Jonah died was perhaps the darkest of all.

So when Lesley Stevens, one of the team leaders in Bundi, sent me an invitation this year to contribute to a new Children's Daily Devotion based on the works of George McDonald, I asked for the date of Dec 4 in Jonah's honor, and took the passage from John 12 that Scott read at Jonah's burial.

How appropriate that I got the email link this morning that the book is ready for sale. This is a collection of short daily scriptures, pictures, and thoughts appropriate for kids in the 4-10 age range. I have only seen a few but they looked good. I think 80-some authors contributed. Proceeds go to a charity for troubled kids.

Books are always my favorite Christmas gift, because words are the avenue to the heart. Like my two books (which are stories so quite different than this group project, but still valuable for world view and enjoyment) this one points kids to Truth.

Google it on worksofmacdonald.com for a better price than Amazon.

And take a moment today to remember Jonah's family in prayer. As we head into a doctor strike here in Kenya where the poorest will suffer from the injustice of the system, this season of Advent reminds us that the world still longs for light. Today we acknowledge the darkness which is the background for Glory, but cannot overcome God's flickering Presence.

Sunday, November 27, 2016

Advent, a waiting

Advent
by Sr. Christine Schenk
I wait
with quickened hope
for crooked paths
to straighten,
with tough-soul’d
anguish,
while blinded
keepers of the keys
shut out
God’s own.

(If such a thing were possible.)

I wait,
and will not be
dismayed.

For tiny shoot
of Jesse tree
took root in me
to love
transform,
give sight
set free.
From Biola University's excellent daily web-based advent devotions. Access the art, music, scripture and thoughtful writings here: http://ccca.biola.edu/advent/#

We are also reading Dietrich Bonhoeffer's God is In the Manger, on Kindle. "For the greatest, most profound, tenderest things in the world, we must wait.  It happens not here in a storm but according to the divine laws of sprouting, growing, and becoming. ....God is in the Manger, wealth in poverty, light in darkness, succor in abandonment. No evil can befall us; whatever men may do to us, they cannot but serve the God who is secretly revealed as as love and rules our world and our lives. "

And Richard Rohr's Preparing for Christmas (also on Kindle) : " it was the same suffering of the centurions servant that brought the centurion out of his comfortable house and that invited Jesus into that house! Suffering and solidarity with the suffering of others has an immense capacity to "make room" inside of us. It is probably our primary spiritual teacher".

Hope you're enjoying some challenging and comforting thoughts this season.

And don't forget Christ School (see below) tomorrow!

Friday, November 25, 2016

Raise the Roof on Giving Tuesday!






While we continue to need year-end support ourselves particularly after our losses to thieves.... this school we love is also a solid place to give a gift where the impact will be multiplied. In fact we talked in the last day to two different CSB grads who are on surgery rotations, one at UVA and one at Mulago Hospital in Kampala, both learning how to save lives with a goal to serve the poorest. If you want to hear more about our history and why our hearts are at Christ School Bundibugyo, see the Serge Blog here: https://www.serge.org/featured/treasures-hearts-and-battle-lines/


For Giving Tuesday, we at Serge are promoting giving to Christ School. The team is pictured above. Check out the new web site here:

Let's Raise the Roof!!!



Thursday, November 24, 2016

Defeated but Punching: Thanksgiving that Good triumphs over Evil


The Scripture readings on our annual plan come largely from Revelations, Daniel, Psalms and Isaiah this week. Mysterious dreams that sap the courage out of the authors as evil rears its horned head and plagues descend upon earth. One gets the clear message that evil is defeated, but on the way down is throwing some hard punches.

Which is pretty much how the week has gone. The doctor's strike looms and sadly the poorest will pay with their lives for the intransigence of the dispute between the government and the doctors over pay and work hours. The Friends of Naivasha NGO that encouraged us to plunge in at NSCH finished their planned project and in a surprise to us moved out of their hospital office on Wednesday.  We had a rotation of interns and my Paeds colleague went on leave meaning a lot of transition on the team, with some significant unhappiness expressed to me about my style. A child I was so happy we made a quick accurate diagnosis of intussecption (intestinal problem) on went to surgery and then when I looked for him, I found he'd "complicated" and been transferred (often a euphemism for death, so I was kicking myself for not doing the right thing). Our tiniest preem died. And other sick babies. Wednesday was just a rough rough day. Evil punching.

But we are to be people who can look ahead. That's why we have books like Revelations. We don't minimize what is wrong, we lament it...and then we put it in perspective. These are the punches of a defeated power. We mourn and move on. And particularly in this week, we look in between those easily seen discouraging events for the glimpses of grace at the fray.

So in spite of every evidence to the contrary, I asked my team to each say something they were thankful for today. Soon the day seemed less bleak. And we found some reasons to celebrate. A, pictured above, was discharged. The baby is 3 months old today and has been in NBU her entire life. She had Congenital TB, and her mom nearly died from her miliary TB, yet there they are smiling and improved and heading out the door after months of touch-and-go struggle. And just as I started this post I got hopeful news that baby C with the intussecption and gangrenous bowel was alive at the main referral hospital KNH in Nairobi and potentially can recover. Then I came home to find two neighbor kids playing with our puppy and felt thankful for the way Nyota has opened up some interaction with kids. 


So, happy Thanksgiving to all, even if evil has been punching you lately we hope you can look up to see the good news that it all ends well. 

Defeated but Punching: Thanksgiving that Good triumphs over Evil


The Scripture readings on our annual plan come largely from Revelations, Daniel, Psalms and Isaiah this week. Mysterious dreams that sap the courage out of the authors as evil rears its horned head and plagues descend upon earth. One gets the clear message that evil is defeated, but on the way down is throwing some hard punches.

Which is pretty much how the week has gone. The doctor's strike looms and sadly the poorest will pay with their lives for the intransigence of the dispute between the government and the doctors over pay and work hours. The Friends of Naivasha NGO that encouraged us to plunge in at NSCH finished their planned project and in a surprise to us moved out of their hospital office on Wednesday.  We had a rotation of interns and my Paeds colleague went on leave meaning a lot of transition on the team, with some significant unhappiness expressed to me about my style. A child I was so happy we made a quick accurate diagnosis of intussecption (intestinal problem) on went to surgery and then when I looked for him, I found he'd "complicated" and been transferred (often a euphemism for death, so I was kicking myself for not doing the right thing). Our tiniest preem died. And other sick babies. Wednesday was just a rough rough day. Evil punching.

But we are to be people who can look ahead. That's why we have books like Revelations. We don't minimize what is wrong, we lament it...and then we put it in perspective. These are the punches of a defeated power. We mourn and move on. And particularly in this week, we look in between those easily seen discouraging events for the glimpses of grace at the fray.

So in spite of every evidence to the contrary, I asked my team to each say something they were thankful for today. Soon the day seemed less bleak. And we found some reasons to celebrate. A, pictured above, was discharged. The baby is 3 months old today and has been in NBU her entire life. She had Congenital TB, and her mom nearly died from her miliary TB, yet there they are smiling and improved and heading out the door after months of touch-and-go struggle. And just as I started this post I got hopeful news that baby C with the intussecption and gangrenous bowel was alive at the main referral hospital KNH in Nairobi and potentially can recover. Then I came home to find two neighbor kids playing with our puppy and felt thankful for the way Nyota has opened up some interaction with kids. 

Thursday, November 17, 2016

ON SALE ... Two days only

Jennifer's 2nd book ...
Only until the end of the day on Friday...
from New Growth Press for only $8.79

World Preemie Day










World Preemie Day should also be called Heroic Moms' Day. I told the 40-some mom's of babies admitted to the newborn unit that we were celebrating the survival of premature babies today and asked these four if I could take their pictures. Because behind every surviving Preemie is a mom who suffered the pain of birth and the shock of the unexpected timing. Who gets up every 3 hours around the clock for months to squeeze milk from her breast and pour it through a tube. Who prays, grieves, hopes, strives.

The top picture is our current tiniest baby W, born at 980 grams. She's a week old and fighting on, with pink shriveled stick-like limbs and as you can see an occasional outburst of protest. The second baby P we have nearly lost several times in the last 3-4 weeks, with infections and a connection in her heart that should close at birth but sometimes doesn't in preems. I know how the night has gone from this mom's face when I arrive. The third is our rock star baby V. When I started I found her having been revived over and over by the nurses. She was born at 26 weeks and weighed 900 grams. Now she's close to tripling that and has moved into the less acute room. And at the bottom is little R, the only surviving triplet born at 29 weeks. He'll be 2 weeks old Monday and we are really pulling for him. It is not easy to mourn the loss of two babies (the two girls died between the delivery room and admission but the boy, who was the smallest and sickest looking, somehow held on) while caring for a third one.

Today we salute the survivors and solemnly remember the many we have lost. Each story gives us hope that we can improve care and see more smiling moms. Jesus gave special attention to the smallest, the weakest, the most vulnerable. I think these babies will be sitting at the head of the table at the feast of the Kingdom!