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Wednesday, May 30, 2012

Edge-Notes Day 3

Third day, third camp.  Each has its own subtle unique atmosphere, a combination of it's age and size perhaps, or of the NGO which "runs" it.  Today's camp is the purview of MSF, and is one of the larger ones.  More spread out, more space, a bustling market.  Humans are humans, put 150 thousand of them together and they will begin selling things to each other.  The hospital compound is thoroughly fenced and heavily guarded.  this feels more like one thinks a refugee camp would.  The buildings are plank on cement, not permanent.  Dust, tents, thorny scrub bushes.  Open rafters, naked bulbs for lights, plank benches, cluttered tables.  Perhaps because MSF normally works in war zones and disasters, this hospital has that feel.  But in spite of the external shabbiness the level of care is excellent.  The Medical Officer in charge started one month ago, and gives his opinion that this hospital has more supplies and better outcomes than any provincial government hospital in Kenya.  There are 72 malnourished children admitted in three long barn-like wards.  Only one child has died from malnutrition in the last month.  That is impressive.  The numbers are considerably down from the peak of the post-drought crisis of 2011, but this is still the most malnourished patients I've ever seen in one place.  There is a sense of order and calm, of protocol, good records, plenty of space and supplies.  These people know what they are doing.

And perhaps because of that, they are confident in their abilities, less desperate for input.  A crowd comes to my newborn resuscitation workshop, and there is good interaction and teaching, laughter and interest as they practice with the model babies.  But after the first hour, we take a break, and when I offer another topic (something eagerly requested in the other camps) the 30 or so nursses, CO's and doctors seem to drift away, busy with their own world.  They used to have lots of MSF-employed temporary doctors, so perhaps they are more used to people coming in and out.  In the last year this has changed, however, due to the insecurity of the borders and the camps.  Now, like all the other camps, there is a small army of Kenyan workers employed by the NGO's, and the expatriates stay at the base in Dadaab and make brief escorted forays into the camp proper.

Today we have to finish by noon.  There is the usual confusion of the returning convoy, the speeding along the rough road, the clouds of dust, the discussion in the vehicle about whether to wait for the police or not.  We fly by fences and thorn scrubs, rounded huts, donkey carts stacked with firewood sticks, bright-scarved women, listless goats.  The refugees themselves must stay in the camps, but there are ethnically related Kenyans who have lived in this border area for a generation or more who move back and forth.  We are deposited safely back at our base camp just in time for lunch in the small screened "mess".  

And just in time for the most surreal moment of the day.  The "mess" is a rickety wooden building with screen windows, a stove and counter, a table and plastic chairs.  And a TV, hooked up to satellite channels.  There is a loud TV blaring wherever the NGO workers gather.  This time as we're washing our hands, we become aware of the news story.   "Attack in Dadaab" reads the title banner, beneath pictures of wounded police being loaded into an ambulance.  What?  There we are standing smack in the middle of Dadaab, hearing about a 2 hour gun battle via TV.  It seems that Somali bandits crossed the border and attacked vehicles on the road 10 km outside of town, so the police responded, with numerous injuries on both sides.  

A bizarre feeling.  Life was going on as "normal" as it could, people eating lunch and chatting, while we learned of local insecurity via the media.  Thankfully we were flying out.  

And within an hour we were back at the airfield where we started, huddled under the only shade around with about 40 people all waiting for the plane.  A few Norwegians and other Europeans, us, and MANY Kenyans, all young and casual and smart, checking their phone messages, planning their arrivals in Nairobi, interacting familiarly with one another.  

And then the cool air of Nairobi, the traffic, the relief of being back in a more comfortable and recognizable place.  I'm thankful to have had the opportunity to see the AID world, the refugee world, the remote NE Kenyan world.  To have taught life-saving skills to almost a hundred health workers.  To bear witness  to the reality of this life.  To contribute in a small way to the health capacity of the 2nd or 3rd largest population center in Kenya, and an area that represents 5% of the population of Somalia.  To spend time with surgeons I respect and admire, and with my son.

But mostly I'm thankful to be home.

Tuesday, May 29, 2012

Edge Notes Day 2

The bougainvillea and acacias whisper in the evening wind as light fades and the dust and heat of the day slip away.  I am just back from a walk through D-b town with Luke.  Not sure it would have occurred to me that we could leave our UN-zone bunker but it did, of course, occur to him.  No one objected.  After being herded and jostled from base to camp to base, it was freeing to simply walk out the gate into the evening's quiet bustle of any African town.  Well, not any town.  There are more Landcruisers per square km here than probably any place on earth.  But outside of the UN compound there is a semblance of normal life.  A huddle of sheep in the middle of the road, pausing heads down, as if in prayer.  Wandering donkeys.  Pairs of men striding along the roadside.  Veiled women sitting at sewing machines.  And the signs:  you know you're in a refugee zone when the small tin shacks along the road, each selling the usual assortment of soap and sugar and plastic basins and other life necessities, have the following names (not making this up):  Tehran Fashion, Bosnia Shop, and others named Soweto, Baghdad.  Not the names that would entice customers in some parts of the world, but the life experience of the NGO-following crowd here I guess.  Luke chatted in Swahili with a few people until we located chapatis, and for bargain (50 shillings a piece) we ordered two that came with a beef stew.  Hygienically sketchy place, but atmospheric.

This morning started with the real deal convoy.  This time we were in the main exodus from D-b town to the largest set of camps to the north-east.  Though they are only 5 or 10 km away, it takes a major motorcade production to get there.  It really has to be seen to be believed.  A dozen or more nearly identical Landcruisers, each packed with aid workers, again mostly Kenyan, all mill about and vie for position at the police headquarters.  Engines idle.  Windows open and close.  People chat.  Then suddenly the police appear and zoom off, and everyone follows.  The idea seems to be to drive as fast as possible through any potential danger zone.  So we careen down the dirt highway in a cloud of dust, across open scrubland, until we reach the outskirts of the largest camp, home to 188,000 people in three sections.  The windows are closed against the dust and the back of the "ambulance" is stiflingly hot, the wash-board road and swerving around ruts forces us to cling to our seats, but the trip is mercifully short.  We see bent-stick igloo-shaped homes covered in plastic bags, thorn fences, and worn signs for various NGO's.  We turn off the main road and pass deeper into the camp to reach the hospital, the gates open, and we roll to a relieved stop.  Everyone piles out for a day of work, until the convoy will re-collect and re-careen back in the evening.  

Once again patients were waiting, patiently as patients do, squatting in the small shade of the overhang of the main hospital administration block.  There was the usual confusion and negotiation as Erik and Ken set up at table, chairs, a small exam area, met translators, decided on crowd control.  Luke and I moved on with the Matron to tour the facility.  This one was 5 years instead of 5 days old, so a bit more worn, more lived-in.  Again an impressively stocked pharmacy and lab.  18-bed wards in neat rows.  All with mattresses and nets.  Oxygen concentrators humming in two wards, the generator buzzing in the background.  Malnourished kids with stick-thin arms, listless moms.  Eerily calm, little crying or commotion, resigned people just sitting on their beds, waiting.  We asked questions and looked into rooms and checked our check-lists.  I was asked to consult on a febrile newborn, whose antibiotic choice had not been very appropriate, but the IV fluids and oxygen were well done.  Then I also got pulled in to examine some admitted and outpatients.  Most of the day, though, I spent teaching.

The morning was mostly auxillary nurses, with a few maternity staff.  The afternoon was mostly clinical officers, nurses, and the one medical officer.  Both groups were about 25 people each.  I used the flip charts and baby models to teach newborn resuscitation, because that is the crucial intervention that can save lives.  A couple of the nurses were very adept at handling the ambu bags.  Most were not.  They laughed and helped each other.  I then taught two topics (pre-prepared lectures I've done before) in the morning and two more in the afternoon.  So I was talking, listening, cajoling, trying to draw out participation, to stimulate thinking, to praise, to inspire, for about five hours today.  My hat is off to teachers.  It was very tiring, especially considering that English isn't anyone's first language but me, there are multiple cultures and levels of training represented.  But they asked questions and wanted more and I was literally zipping up my bag as the convoy vehicle was beeping for me as they finally let me go . . 

The surgical team once again had fewer patients than expected, so went back to base camp mid day.  I ended up on my own at the hospital for lunch and the afternoon, which was fine, it didn't waste their time waiting for me.  But I am still glad to be safely back with the guys.

One more day, one more camp.  There are many hard-working people here doing a pretty reasonable job in a difficult situation, and it's a privilege to give them a boost.  

Monday, May 28, 2012

Notes from the Edge Day One

4:30 a.m. we squeeze into a taxi, the escarpment is dark and cool and quiet at this hour, and I am wedged in the back seat between a paeds surgery fellow who was once a national rugby player for Kenya, and my own 19 year old whose 6 foot 2-and-a-half inch frame is more muscular and substantive after two years of collegiate club football.  Consolation:  if we get into trouble here, these are two of the kind of guys you want to have your back.  We squint at oncoming headlights, pass trucks, weave in and out of matatus and buses even at this predawn hour, all the way to Wilson Airport.  The UN has people flying to K-a on the Sudan border and D-b on the S0mali border, with their coolers of vaccines and blue diplomatic passports, their jeans and scarves and NGO-casual wear, their newspapers and glasses.  Perk of the international aid scene:  there is a coffee bar which opens before our plane boards, with legitimate lattes.  Hooray.  

We doze at the 19,000 foot cruising altitude and descend through thick clouds towards the srub-land of NE Kenya.  Thorn kraals and tiny white goats and cows are visible against the dusty red earth; the slight green of acacia trees and no buildings or tarmac for miles in any direction.  Then out of the desert there is a camp, strictly straight lines of roads with an impossible conglomeration of dwellings crammed into every millimeter of the grid they form.  Homes made from sticks covered by bits of plastic.  Then the airfield, and we touch down.  Into a world that is uniquely its own.  We're in Kenya, so there are Kenyan police in camo with guns.  But the airstrip is tarmac, and neatly apportioned, and everything here is clearly controlled by the UN.  A veritable fleet of white landcruisers awaits the plane.  Each says "Owned by UNHCR for use by ______", fill in the alphabet of organizations.  Each driver searches for his particular people, until they are all sorted into the proper nearly identical white 4WD for the five minute trip to UN central.

D-b used to be a sleepy crossroad with a few dukas.  Now it is the epicenter of aid.  The roads are wide and graded.  Containers and mbati have been transformed into a thriving market.  We pass through a security checkpoint into the home base area for all the organizations which support this massive community.  Behind sandbags and barbed wire, apportioned areas are given to each NGO.  There are guest houses, open areas for eating, offices, computers, dusty paths.  I am escorted to my room-a couch on a screened porch, my own bathroom and simple bed and mosquito net--to drop off my things and head out to the first camp.

Back into the ubiquitous white landcruiser, and out of the maze of the secure compound, we pick up our required police escort vehicle and follow it out of town.  Through the final checkpoint, and then out into the wasteland, roaring along in a cloud of dust.  We are in the middle of nowhere when our lead vehicle stops.  The armed policeman and the driver get out.  No, not s security risk, just a flat tire.  A totally blown out tire, and as the driver explains, "hakuna spare".  So we wonder which is riskier, sitting like a duck out on the road or continuing on unescorted.  Before long other vehicles come, the policeman switches to a new lead car, and we continue while the first car waits for a spare tire.  (On the way back, the police escort vehicle was stalled and had to be pushed and coaxed to life by the crowd getting rides in the back.  There is considerable debate about whether the presence of security makes one more or less secure).

Our first camp is a handful of kilometers southeast of D-b.  The geography is this:  the foreigners and most of the Kenyan staff (the vast majority of aid workers here are Kenyan) stay in makeshift compounds which have grown into the sprawling UN village in D-b, and make forays by armed convoy out to the camps, which are tightly clustered masses of humanity surrounding schools and hospitals.  It feels surreal and controlled.  We are delivered through another guarded gate into the small universe of the International Rescue Committee, the organization that basically runs this particular camp of 132,000 people, and also serves a newer camp of about 10,000.  Each camp is the kingdom of a different NGO.  The IRC has just poured a boatload of money into this hospital.  New facilities, cleanly painted, sport plaques saying they were dedicated four days ago.  Incongruously, the place feels fresh and clean, a hot wind blows through, patients cluster and squat in the shade, until they see the Kijabe team then they push forward to muscle their way into line.  While the surgeons examine a smaller-than-expected number of referrals and follow-up patients, Luke and I spend the morning in the maternity ward and nursery.  We talk to nurses, midwives, and doctors, thumb through records, make notes on facilities, ask questions. 

I teach an abbreviated version of Helping Babies Breathe.  I've traveled with the resucitatable model babies, twin "NeoNatalies".  We discuss the golden minute, the crucial assistance a trained birth attendant can give to make the baby's transition from fetal to extra-uterine life successful, the heavy burden of neonatal mortality.   The small class of six medical personnel practices suctioning and then bagging the babies, awkwardly learning to handle the ambu bag, to see the chest rise, to feel the cord pulsate.  They are bright and interested and game.  I thoroughly enjoy them and feel like we could spend the whole day, but before too long the surgeons are done and we are called away.

Then we embark upon a tour of the entire facility, noting the presence or absence of microscopes and oxygen, antibiotic choices, malnutrition programs.  A goal of this trip is to assess opportunities for Kijabe Hospital to assist and improve Paediatric care in these camps.  We find excellently equipped facilities but some gaps in knowledge and practice, and an eager openness to further training.  We make a list of topics that the staff would like to be taught, dreaming of the next trips.  Luke ruminates and I agree, the facilities and staff we see here are far superior to most rural African hospitals.  The refugees suffer loss of land and identity and livelihood and dignity and a thousand other things tangible and intangible.  But their access to health care is probably better than most.  Another paradox.

Now it is evening, the hot wind has cooled, a cold shower has removed the dust, and darkness falls early and fast in this eastern province.  Thankful to be here.

Sunday, May 27, 2012

Living on the edge

"If you aren't living on the edge, you're taking up too much room."  This has been a only-half-joking family motto of ours.  This week Luke and I are thankful for the opportunity to head out to an edge together.  We're accompanying a team from Kijabe (two surgical doctors and us) to a refugee camp on a border of this country.  Back to the edge.  Where the largest collection of refugees in the world (about half a million people) live.  People who fled war and drought to eke out an existence.  People who have now been there for about twenty years, an entire generation who knows only this way of life.  Through a series of providences doctors from Kijabe have been invited to provide teaching and medical care.  Ever since I read of the massive influx of population into these camps in the last year I have wanted to go, a humanitarian disaster on our doorstep so to speak.  The camps closed to NGO's for about six months because of the danger of kidnapping and attack in 2011-2012.  But now the UN is allowing workers to return.  Even up to the last few hours today we wondered if we would be canceled, however.  This is a culture where violence is an accepted expression of will, where displeasure is expressed through a grenade.  Thankfully the situation is considered stable at the moment in spite of recent isolated events affecting Kenyans mostly, who became targets when the country's military invaded their neighbor.

Jesus moved towards hostile people, and healed and loved and cared in spite of risk. 

This is a rare opportunity for us to follow in those footsteps.  Please pray for the Kingdom to make subtle but real inroads into a desperate place, and for us to be used in that process.  Please pray for meaningful service, stamina, and a safe return Wednesday evening.  And pray for precious time together for Luke and me, and for God to continue to make his future calling clear.
LUKE IS HOME!!!  For a few days our family is whole.  These days become more rare with each year, our family is in a life-phase of dispersion.  So we revel in the right-ness of his being with us until his Swahili program starts in Mombasa.  Half way through Yale.  He's energetic, full of ideas, fun, pulling out his trash-picked treasures from a two-week janitorial job moving furniture and cleaning up dorms after the students left, full of stories, and so happy to be back in Africa.  Almost as happy as we are to have him. 

Here he arrived Friday morning, and we stopped at Art Cafe on our way back to Kijabe.  

Enjoy a few pictures from the last 48 hours, arrival, pizza with some kids and neighbors, church, a hike (not to mention being on call and doing rounds together . . )

The whole family this morning after church, and then we spent the afternoon climbing Longonot.  A long-time wish of Acacia's and a goodbye trip for Caleb and Hannah . . .

 Caleb was asked to lead worship this morning, very meaningful for us as he only has one more Sunday at RVA.


Thursday, May 24, 2012

Out of Eden . . .

. . and back to reality.  

This week felt a little Job-ish.  Perhaps it is my African world-view.  Africans don't mention the good news of a new baby, or praise their happiness, for fear of attracting jealousy from evil spirits.  But there is Biblical precedent, when Satan challenges God to allow some loss and testing to seep into his life of abundance.  And so we landed back in Kenya from paradise.  And promptly paid the price for our week of joy.  Infections in multiple body systems, the kind of wipe-out fever, two of the last four nights on call (one blessedly benign for much-needed recovery, the other typically sleepless with a deteriorating patient needing intubation and ICU admission), meetings and responsibilities and rain and mold and just the challenges of survival.  We're back to real life, but thankful for the divine hedge which protected those days away.

I like to win.  I like to fight a disease and see a rescue, a recovery.  And while that often happens, and makes much of the above worth the effort, sometimes I utterly fail.  Turanta died yesterday morning on my watch, after a week and a half of trying to get the upper hand against an infection in his brain.  My second 15-year-old previously-healthy boy to succumb to meningitis in the last month or so.  The first, James, was a 35-day battle that we eventually did win, though initially I didn't have a lot of hope, he overcame sinusitis that spread to meningitis and brain abscesses to walk out of the hospital normal.  Not so with Turanta.  This tall lean Maasai boy fell ill a few weeks ago, and bounced from a couple of other hospitals with inadequate care as his infection progressed.  By the time he came to Kijabe he was in bad shape.  Still he improved initially, then entered a slow steady slide towards death, progressing from alert to confused to restless to responding-only-to-pain to completely unresponsive to brain dead.  Yesterday morning after consultation with others and confirmation of his absent reflexes, I sat down with his older brother to explain that he was essentially gone, that his heart was only still beating because of the ventilator her was on.  Turanta's elderly parents were unable to come, so this adult brother was functioning as the caretaker and responsible family.  In the conference room with the chaplain and nurse I prayed and explained and held it together pretty well until the brother thanked us, and started to cry himself.  People have told me they have never seen a Maasai man cry.  As a mother of a 15 year old myself, I found this death very very painful.  The graciousness of this brother overwhelmed me, he accepted God's hand in the entire situation, thanked us for our effort, and agreed to discontinue life support.  He even agreed to a post-mortem (unusual) in case we can learn something that helps others in the future.  I pushed for this, because I want to know what we were treating, what we were missing, what we could have done.

I never saw Turanta when he was well, but I can imagine him running across the valley, or sitting around a fire under the stars, or kicking a football, or jostling with friends in school uniforms between classes.  And in fact I went almost straight from his death to watch my 14 year old son play rugby, his own long legs running, his strong arms tackling as we cheered his team to a narrow and hard-fought victory against the JV team of Nairobi School, currently the top Rugby school in the league.  Then we caught the final games of the girls' volleyball match where I have a 14 and a 15 year old on the team, again a close contest and hard-won victory against a nearby Kenyan school.  Then we were invited to dinner with another station family, between us and visitors there were about 8 or 9 teens around that huge table laughing and telling stories and eating heartily, seeming invincible.  But they aren't.  I love these teen years and yet patients like Turanta remind me of the fragility of these lives. There but for the grace of God any of these kids could be.  

So we continue to walk this path, reveling in the moments of Eden made bittersweet by the immediate juxtaposition of loss.  I begin to glimpse the paradoxical reality of Psalm 23:  thou preparest a table before me in the presence of my enemies.  The feast is spread in the valley of the shadow of death.  Post-mortem to rugby game, ICU to family meal.  

Both are reality.

Sunday, May 13, 2012

Pix from Paradise

here are a few snaps from our sanctuary of celebration in the Seychelles...

Saturday, May 12, 2012

But You brought us out

We went through fire and through water;
But You brought us out to rich fulfillment.
Ps 66:12

This is the verse I read yesterday that jumped out as a summary of where we are now.  On May 9th, Scott and I reached the milestone of 25 years of marriage.  And in the midst of a post-call stupor we worked and taught and cheered and cooked and packed, and then got up at 4:30 the next morning to travel to the Seychelles.  For a week.  Of RICH FULFILLMENT.

The taxi crawled cautiously through dangerous pre-dawn fog along the escarpment, but we made it.  Sabbath is a holy principle, and the world resists it.  Like the children of Israel trying to go to the dessert to worship, it was a veritable exodus to get released from work, tasks, worries, responsibilities, good things that can consume, and break away.  But Scott wisely made these plans months ago, and our generous parents gifted us with some extra money, and our helpful team mate Karen came to look after the kids, and our Kijabe colleagues pitched in to work extra hard, and somehow we found ourselves temporarily in Paradise.

Sun, a warm ocean of clear turquoise, birds, sand, pools.  Plates of gourmet food, stars, music.  Lush jungle, a clean room.  Space and quiet and privacy and companionship.  Remembering that we were made for relationship, for Eden, and it is good and right to celebrate 25 years with a once-in-a-lifetime trip to an equatorial island.  We are healing, resting, and leaving behind the rest of life for a week.

Prayers for renewal are appreciated, as well as for Karen who is serving our family by staying with the kids.  Thanking God today for 25 years of fire and water that make this rich fulfillment all the more glorious.  There is no one else I'd rather be here with, for life.

Through fire and water

 To appreciate the next post I am about to write, just scroll through the random download of the last week's snaps from the phone.  A week of life involves a fair amount of passing through fire and water:  the fire of being handed not-breathing babies or complicated dwindling toddlers, the water of (I'm not counting but someone did) 42-plus straight days of rain, mud, damp laundry, mold and drear.

To start, the billboard on the left I just love.  A billion people live in Africa now, and that's a billion reasons for hope.

 Good thing last week:  Caleb led worship for the senior class, plus a handful of parents and staff.  A number of kids gave testimonies, including Caleb who is a true introvert but appreciated his classmates for their unique stories and exhorted them to go out into the world and tell them.  Closure is upon us. Every event like this is bittersweet.

Baby Cristobal, who arrived at 3.7 kg, 4 months old, skinny and lethargic, from an orphanage in South Sudan.  After a few weeks of nutritional rehab, he's gained almost 1.5 kg, is perky and smiling.  Love these tiny resurrections.

This 14 year old Maasai girl came in coughing blood, with a deathly looking chest xray.  TB.  The teens of course get to my heart most these days . . . after almost two weeks of anti-TB drugs she is no longer in pain, no longer coughing, no longer infectious and ready for discharge.  You have to love curable diseases and solvable problems.  

James has been in the hospital 33 days.  Something about intubating a person leads to bonding  . . I was uncomfortably on call in the ICU when he presented with meningitis and brain abscesses from a sinus infection gone awry.  He is a normal 15 year old kid.  Like mine.  Was in school.  And almost died.  His mom has stuck by his side every hour of those 33 days.  And after untold doses of antibiotics, several CT scans, days in the ICU, and a neurosurgical procedure to drain a little pus and assist diagnosis . . he is getting well enough to be bored.  I think he may emerge from this alive and well.

Last weekend we went to a wedding:  Stephen our nutritionist (who is excellent, he consults on about 80% of our admissions and always knows what is going on) married Ndinda our MO intern who had just completed her intern year.  Here are all the people from Kijabe who attended the wedding . . we're somewhere in the back row.

 Above, two of the seven interns from last year.  ALL have been posted all over Kenya, which is part of the point of what we do.  Scattering blessings.  Isaac and Fred are competent, dedicated young men.  It was a pleasure to see all of them return for the wedding.  And Scott and I enjoyed the sermon a few days before our 25th anniversary:  marriage is not a minor league, it is the CHAMPION'S LEAGUE.  You have to be fully committed for the long haul.

Below, the bride and groom after they are pronounced man and wife.  It was a meaningful ceremony full of Anglican tradition, purple dresses, bows and flowers and worship music.  The only non-traditional parts were the disco-ish easy-listening-romance music to which the bridesmaids did a swaying dance step for the processional, and the energetic praise music to which the bride and groom pretty much danced while standing up front.  It was lovely.

Anne is another of our well-loved and missed interns.  And Ndinda is entering escorted by both parents, who had a prominent role in praying for and exhorting their children during the ceremony.

The next day Acacia and Julia helped me address 130 thank-yous to the supporters and teachers who have prayed another child through to graduation.  We know it is no small thing to raise a child in Africa who not only survives but thrives. 

Wednesday, the Varsity girls' volleyball team celebrated a hard-fought victory over West Nairobi School.  Acacia had the largest cheering section!  Her aunt and cousin who live nearby, her grandmother in from Athi River, and her mom in from South Sudan!
 Every day there are challenges that stretch us.  Above a baby with an occipital encephalocele.  She was born at a small hospital far from Kijabe, and it took six days for the parents to decide to come, meanwhile she was nearly dead with meningitis from the leaking fluid.  Very little brain remained in her small head.  After consultation with the surgeons and chaplains and parents, we opted to support and comfort but not attempt surgery.  Tough, tough decisions.

On the other hand, here is smiling HS, the little girl from a neighboring country who arrived in the final stages of near-death from a chronic bowel obstruction.  One Saturday morning I spent an hour begging, cajoling, insisting that the upset father NOT take her home in despair.  The next day she had surgery, and we week later she was a normal little girl sitting here in her bed, smiling and eating and growing once again.  Thankful.

 Another South Sudan orphan, who was brought for care.
 One of the triumphs of the week was getting this little girl transferred to Kenyatta National Hospital for removal of her adenoids and tonsils.  The obstruction to her airway had slowly sent her heart into worse and worse failure, until she could not get off oxygen and her survival was uncertain.  We had admitted her at Kijabe numerous times, but she always seemed to be a low priority for KNH for surgery.  Finally we transferred her directly to the ENT service, and hope that something happens!

Below a mom whose face and manner I found so beautiful.  She also has a baby with a non-survivable hydrocephalus, her ballooning head stretching her skin to the point where she can't close her eyes, and her skin is breaking down.  This is her face the day we got a translator she could understand.  Thank God for translators.  I hate practicing medicine by hand gestures.
Meet Aaron and Moses.  Twins born to a (surprise) pastor who both came in for RSV bronchiolitis.  Moses went to the ICU and could have died, but they both recovered and were on their way home when I snapped this.
 Our visiting pediatrician Dr. Christine on her birthday in the NICU with our med student, MO intern, CO intern, and nurse.  A good team, and a busy one.  We've had 20-some patients on each service most of the month, which would  be nearly impossible without help from short term volunteers like Dr. Christine.  Mid-June to early August is also short staffed . . . anyone with vacation time and interested in hard work and great experience, contact us!!

 Julia is really improving in Volleyball.  We've been to every game so far.  She's a jewel.  Acacia is the youngest and newest player and is also learning and playing quite well!
Lastly a look at wet laundry.  Seems trivial, but it isn't.  With six people getting muddy in the downpours and steep paths (the day Jack slipped and fell and lost his art project was a low) and with mold growing over our walls and ceilings, well it gets a bit depressing.

My last night of call I was up nearly the whole night.  What do you do when you are paged to a code, arrive to find a baby 8 minutes old who is likely already suffering brain damage from lack of oxygen?  I intubated and gave resusitation meds and got the baby back, but not her brain I'm afraid.  After admitting her to the ICU on a ventilator I had been back home asleep for about half an hour when the same call came again.  Same action taken.  But the second baby will likely be fine. It was a long night. 

I finished the week absolutely spent.  Tough cases, demanding calls, a teaching conference I had to pull together and lecture, pouring into our own kids by cheering and attending and going to meetings, welcoming visitors, cooking and cleaning and draping wet clothes everywhere, and with a brewing URI.  Scott ended the week recovering from a pneumonia and a sprained ankle.  We were a pretty beat pair. 

Which is the context for the next chapter . . .