A Rhythm of Respite

Sunday, early church, then a flock of RVA/Kijabe station ladies headed to the tea farm in Tigoni for a lesson in Kenyan history and agriculture arranged by Kate D to raise money for forest preservation.  The farm's owner, Fiona, told stories of her grandfather who came to Kenya more than a hundred years ago, and made it his home.  We learned about tea bushes and plucking leaves and the 24-hour branch-to-tea-bag process which ensures freshness, about oxidation and sorting and politics and regional specialties and the advantages of high-altitude cool-weather slow-growth.  When we had toured the fields and a patch of indigenous forest, our hostess served us lunch in the lovely gardens complete with more tea and an amazing lemon mousse.  The fun thing is that we now have an actual WHM team:  Bethany, Anna, Ann and Jane, Acacia and me (Julia decided to stay home at the last minute because of her heavy load of commitments in the coming week).

This has been a weekend of respite in the midst of heavy work (strike still on !!!), political uncertainties (a grenade thrown into a Nairobi church again today!!), missing Luke and Caleb (deeply and frequently !!), and the slow resettling transition back to life in Africa after my summer retreat (embarrassingly drove on the right (as in not left) side of the road on a rutted empty patch today until two equally slowly moving vehicles headed right towards me and Bethany politely suggested I switch sides, never did that before !!).  The rhythm of Sabbath is a rhythm of faith. One that says another day of a bit more study, a bit more cleaning, a bit more exercise or cooking or seeing patients, is not going to make everything OK.  That even with loose ends and need, God says to pause.

So Friday evening Scott and I drove out to watch the football and tennis teams play at Greensteds and then have a real date, a fireside dinner for two and overnight in a tasteful luxurious banda overlooking Lake Elementatia.  Yesterday I made some really good special food and we had a group of kids over to watch a movie.  Today the tea.

Tomorrow it is back to preemies and clinic and ICU protocols and the stress of crowding too many patients into our limited space and hearts.

But for tonight I'm thankful for the respite this weekend has offered.

Wabuchire

Midnight. A full day. Off to a good start I can barely remember, happy dogs out for a quick morning jog, the clouded dawn suffusing Longonot and Mt. Margaret with light down in the valley. An hour of Swahili, most of which I now understand but find it extremely painful to extract any spontaneous sentences from my tongue. Rounds in the steamy nursery, constant ringing alarms, the lusty crying of the few term babies, the hot bubble of the incubators, the eerie blue glow of the bilirubin lights. I've brought some articles to read and share with Bob (we never manage), and I try to be patient with the new CO intern who is barely grasping a few basics, teaching as we go along.

Until noon, when an OB nurse bursts in to say we're needed in Labor and Delivery. A mother transferred in from another hospital seizing, her 9th pregnancy but first hospital visit, vague dates, and a decision to induce delivery to save her life. Only what she delivers turns out to be larger than expected, a viable-sized infant. Or just barely so. 700 grams, 26 weeks, a baby who would likely survive in a few places in the world, most surely die in most, and have about a 1 in 3 chance in our nursery. 1 in 3 is significant enough to try hard, but low enough to accept our limitations. And so ensues 9 hours of rising and falling hope. We resuscitate and gently stimulate breathing, provide fluids, warm, start medicine. Twice I go to tell the mother that the baby is dying (to which she says, and I quote, that's OK we don't need this one), and come back to find the baby breathing again. It is uncomfortable to invest in a baby that probably has no chance of life, but I'm not sure the chance is zero, so I go on, even though the mother professes not to care. Finally tonight, while another hopeless baby was trying to die (one with severe un-fix-able anomalies and overwhelming infection) and two new preterm twins were being born, she succumbed to her stiff unready lungs and exhausting struggle to live. A 9 hour life, and I was there from start to finish.

These strike days are like this. The evening is dominated by a mother of twins, also a referral, in labor, bulging belly, agonizing and panting. ONly hours go by and she still hasn't delivered her 33-week twins. When the intern decides to take her for a c-section the first pops out naturally, a boy, bottom-first, with the most alarming chest-wall retractions as he struggles to breathe. By the time we have him stabilized and on CPAP the OB team has decided baby #2 is stuck transverse and they whisk the mother off for a C/S, pulling out a slippery smaller sister who also struggles slightly but revives. (Worst case scenario a la JD: a vaginal birth followed by a C/s, so the mom is sore everywhere). Once they are tucked into their snuggly shared incubator (another strike effect, we're out of space) another referred newborn arrives with her huge spongy head and open spinal defect, her paralyzed stumpy legs and blinking eyes. I work on writing up her paperwork to help the swamped MO intern.

And then one last check in ICU, where the baby with the diaphragmatic hernia rests post-op. And where a feisty toddler whose esophagus was damaged in a failed intubation attempt in Eastern Congo after an allergic reaction to malaria meds has just had a reconstruction of that vital piece of her body. Her dad with his rounded face and trace French accent feels familiar. He's sought care from Butembo, to Mbarara, to Mulago in Kampala, to Kigali, to Goma, and finally all the way to Nairobi, a medical tour of east-central Africa. For six months he's been carting this child from hospital to hospital looking for care. Until he reached Kijabe with her. We talked about familiar towns in Eastern Congo, and then I greeted him in Lukonjo. His face just lit up. I used my half-dozen Lukonjo words and made this peripatetic parent feel happily at ease. The power of a familiar word in the right tongue never ceases to amaze me. He was lonely for his home and the language reminded him he'd go back there eventually. Wabuchire, and wasinge for reading if you got this far.

Home to a last-mintue physics problem (if this ball falls and this one's thrown and the tower is 15 feet hight how many seconds before they meet . . ) and preparing to teach tomorrow. It's been a long day from intubation and writing orders and teaching and a death vigil. 4th call night in 7 days. A day redeemed by the joy of connection from a simple few words. Wasinge, I am thankful to now put it behind me (until the next call).

A new week rolls in

 Baby A is grateful for your help, though he doesn't really know it yet.  His mom agreed for his photo to be posted to thank those who contribute to Kijabe Hospital's Needy Children's Fund.  Like some of our recent visiting docs.  (If you've forgotten how email me drs.myhre@gmail.com).  Baby A was born with a cleft lip and palate, a completely fixable problem if he doesn't starve to death before he's old and big enough for surgery.  His confused and upset father took one look and abandoned him to his mother, who is dependent upon her brothers now for support.  Those uncles have been kind but are not quite able and committed to cover all his hospital costs.  He's been with us several weeks surviving a serious infection and trying to gain some weight.  We're praying he can go home soon.  He's a least-of-these speck of wrinkly skin and hunger.

The fund has also facilitated echocardiograms for some babies with severe heart problems this week, and on the weekend allowed me to help a mom get home who had spent so many days waiting to raise the last hundred dollars of her bill (the small part not covered by insurance or what her family had given) that he ran out of his seizure medicine and started to convulse again.  Kijabe hospital is the hospital-of-choice for so many Kenyans these days of strike.  We're a hundred times more functional than the rest of the public health care system, and much less expensive than the private Nairobi hospitals.  So we get referrals from both.  In many cases we give care that is just as excellent or perhaps better than our more trendy and pricey counterparts in the city.  A recent ICU patient's family told Scott (after their relative survived a situation with about a 10% chance of making it through):  we would always come here, it's not all STERILE like _______ (fill in name of "best" hospital in Kenya).  Hmm.  Not being too sterile is not always a plus, but we're glad we had these happy customers.

This weekend a similar family requested transfer from their super-duper ICU to ours, because they were out of money (cost ratio 20:1).  Super-duper ICU didn't see the diagnosis right away in this newborn's xray:  not sure I would either . . .

But if you look very very closely, there is a bubble over the left chest that should not be there.  It's bowel, which has popped up through the diaphragm.  Not a huge problem in utero where the baby doesn't need to breath or eat, but rather bothersome after birth.  In case you can't see it still, here's the gastrograffin study outlining the bowel with contrast:

(It shouldn't be up by the heart).  This baby had a good amount of lung development and with the expert care of our paediatric surgeons today we have great hopes that he will be able to survive, which is certainly not the norm in Kenya for this problem.

Because the strike has packed our casualty and outpatient areas, the new Maternal and Child Health clinic building which was due to open in October had a rushed prayer-speeches-hand-over today, so that the area could begin to be used.  A few of us from the Paeds team, the engineers who did this work, the executive director and the chaplains gathered to recognize this milestone.  Looking forward to seeing patients in this bright clean new functional area rather than scrambling for a corner in the midst of the onslaught.

We can't fix all the problems, sadly.  One of our other admits in the last few days was a baby born at home with a mid-facial cleft, a huge gaping hole in his face where his nose and lip should be.  Sadly this is associated with a malformation of his brain (holoprosencephaly), probably his heart, and his kidneys and other organs.  He will not be able to survive long, but we are working to pull him through his current meningitis and jaundice to hopefully reach a point where he can be held and fed and loved and taken home.

Thankfully Kijabe has a palliative care team who will help us provide comfort and improvement and hope and support even when we can't provide a cure.  They work with the mother, us doctors, the nursing staff, the chaplains, and as a team we try to make a plan.

Lastly, there are the babies who should survive but don't due to the frustrating realities of life in Africa at this moment.  Like the 25-week preemie who was essentially dead on arrival this weekend.  If only the clinic where her mom presented Friday with labor pains had recognized them and prescribed rest and fluids instead of letting her go back to work Saturday.  If only they had made it to a hospital with a doctor in the midst of the strike on Saturday when her labor progressed.  If only there had been an ambulance available to get her to Kijabe faster.  If only she had been kept warm and breathing on the way.  I ran to the hospital when the nurses called, but even after intubating and drugs and lots of resuscitation, her little heart never picked up.  She was gone, and her parents wanted me to take photos of her and of them, looking so peaceful, for their memory.  Until they meet her again, perfect and whole, in Heaven.

Which is a good thing about this job.  I meet so many Heavenly citizens-to-be.  I look forward to eternal conversation over very good coffee from some Africa, or perhaps a whole Africa-like planetary system, with some of my current patients who are the weak and wounded and sorrowful in this life, but destined to rule and shine in the life to come.  So I'll close with a photo of the nearest-thing-on-earth cup of coffee Scott and I had on Friday.  This is one of those piled-up call weeks (tomorrow will be the 4th night in 7 days), which made that moment all the more precious as a taste of what is not-yet but promised:

Red, White, Green

Our kids' school is preparing for "Spiritual Emphasis Week" with a journal from the group "Live Dead" (live with a short i, the present tense verb), which promotes self-sacrificing team ministry to the neediest in East Africa and North Africa.  One of the entries describes the Celtic conception of martyrdom, dating back to the time of St. Patrick.

Red martyrdom, the most obvious, when blood is spilled, life lost.  Though this martyrdom is the most obvious yet most rare, many Christians around the world still face this threat for their faith, for standing against evil and getting in its way.  Dr. Jonah spilled blood because his faith led him into a path of danger.  I read that one of our current WHM missionaries is sick once again, who serves in a difficult city where forces of evil thrive on human trafficking.  Here in Kenya I talked to a local missionary whose environmental activism, which is based on his belief in God, leads him into paths of danger as he crosses the economic interests of those who destroy.  Execution, imprisonment, illness, suffering, identifying with the poor, being in the wrong place at the wrong time, these are the color red.

White martyrdom, the horizon, the desert, the withdrawal from the familiar, the sacrifice of comfort and family to serve Jesus, is a calling for more Christians.  For some it is the asceticism of fasting to pursue spiritual awakening.  For many it is the departure from an expected path, from the direction of least resistance, to move towards need.  The inconvenience of countries with flooded roads and intermittent electricity, the daily wear of misunderstanding, the grating intrusion of rodents and insects and noise and heat.  Or the more subtle sorrow of missing milestones with family, of being far away when illness or discouragement engulfs loved ones.  This is the searing white reality of missions.

But the third martyrdom caught my attention, because it is not one we often recognize.  The green martyrdom represents the loss of personal autonomy, the rough sanctifying scrape of living in community.  Evidently the transformation of Ireland rested largely on the welcoming, productive, holy, inviting, stable enclaves of monasteries where believers in Jesus kept bees and transcribed Scripture.  And as anyone who has lived in close community soon learns, it's not all honey and beer and harmonious chants at sunset.   Living in community calls for a loss of privacy, a loss of choice, a loss of cushion and protection from our true selves.  In community we are called to lay down our lives over and over.  This is green, because it bears the beautiful fruit of our own Christlikeness and the drawing in of the wandering needy.

This concept really got me thinking about our mission teams.  I think we soberly count the red and white costs.  We expect discomfort and loneliness.  But then we expect our team community to be an unending source of encouragement and support.  When community itself shapes up as a form of martyrdom, we squirm or scream.  Something must be wrong.

But perhaps the Celtic believers got it right.  We are sanctified in collaboration with our fellow saints.  Even those whom we don't think we need are God's chosen instruments for our own good and His glory.

Our new community of saints at Kijabe has been a source of strength for us, of friendship and spiritual wisdom and practical help.  It is also a much more diffuse community than that of Bundibugyo, or Mundri, or soon Kibuye.  Life is easier to live (groceries, lights, water, phones, medical services, schooling, English, so many things); and the options for relationship are MANY; and therefore we are less pressured, less thrown upon each other for survival.  Which can be a relief, but is also probably a loss in spiritual terms.

But as of this weekend, we have a little WHM-Kijabe team again.  Miss Anna is teaching 6th grade this year at RVA, which was her original direction before a 3-year detour that took her to Bundibugyo.  Miss Bethany came for just one term to fill in for a counselor on HMA.  And the Mara family just arrived Thursday night, the beginning of long-term service.  Mike is an orthopedic surgeon; Ann works with justice issues and they both raise two lovely children.  Saturday night we made tacos and talked, in between calls to the hospital.  We're looking forward to the green days ahead, even if they require some sacrifice as yet unseen.

Burdens

These are some burdens I have witnessed this week:  

--A child paralyzed by a fall from a tree, now bed-ridden, admitted with pressure sores.  Hard to imagine going from a healthy active 7 year old to complete confinement in one's body.  

--A woman who brought her large-headed newborn to our hospital, the premier neurosurgical service in Africa (and possibly elsewhere as well), hoping for a surgical cure.  He arrived extremely dehydrated and dangerously close to death, and our doctors and nurses pulled him back from that brink and got him feeding and stable.  But then we did an ultrasound of that boggy bulging head and discovered nothing but water.  There was no brain above the stem.  Enough to suck and cry and make primitive motions, but not enough to see or hear or talk or sit or live.  We sat with the chaplain and prayed for her as quiet tears fell down her cheeks, facing this shocking inevitability about her son.  

--A three-year-old hit by a motorcycle, who will probably die today.

--A baby who is sleepy and twitchy, his little brain having been starved for oxygen because his umbilical cord slipped out in the birth process before he did, and his mother had to bounce from two other hospitals until he reached ours to find working doctors and an emergency C-section.

--A mother of a tiny premature baby who has braved 50 days in intensive care.  He's grown into a cute little person who is beginning to feed and squirm and hold onto life.  But she has problems at home she won't disclose, so she's begging to leave with him, even though he's not fully ready.  Putting us in a difficult position of not wanting to ruin her life, and not wanting to risk ending his.

--A lovely couple with their floppy 1 1/2 year old looking for answers, this precious boy smiles with delight but can't sit or stand alone, or talk other than grunts.  Both husband and wife in the exam room, articulate, puzzled, hoping we'll have the magic shot or pill.

--A 9 day old whose body succumbed to overwhelming infection, the powerful bacteria multiplying and growing and consuming him from the inside out.  We lost the battle slowly over a number of days.

--Then there are the burdens of our own kids and other MK's, sometimes homesick, sometimes coughing, sometimes staying up too late and getting up to early to meet expectations, sometimes struggling to know and be in a world that is complicated.

Jesus said His yoke was easy and His burden was light.  That can only be because He is the one upholding all these precious sufferers.  I certainly can't.  This world is so broken and yet so beautiful, flowers and courage and sunlight in spite of all the sorrows above.  

Exchange of Thanks

Because I am taking care of this bundle of cuteness, I am not in Virginia.  Because I am not in Virginia, my injured mother is being cared for by others.  So as I slog through another day of doctors-on-strike-in-Kenya craziness (literally counting babies several times a day with nurses to make sure they're all accounted for because there are so many . . .) I want to shout-out a thanks to LORI, RITA, and VICTORIA, who are selflessly coming to her house to help with bandage-changes twice a day.  These are all women my age (vaguely) or younger (actually) with their own families and homes and work who are dropping everything for some time period every day to do what I can not.  I am grateful.

Strike 2, you're about to be out

Well, I felt about out today. This second major Kenyan doctor strike is hitting us hard, but one thing we are thankful for is that we're not totally abandoned.  Our Kenyan interns are in a difficult position, required to strike by their colleagues but also wanting to help us out because they're caring people.  So they worked out an arrangement to cover some extra night/weekend call hours.  Daytimes, however, it's me and the clinical officers, and today was a MONDAY in all caps.  

28 or 29 babies in the nursery when I left tonight, I kind of lost count, but am pretty sure they were all taken care of.  We had six admissions (which is a lot for a smallish intensive care unit) today.  Our competent clinical officer ended up going to the C-section delivery of the sickest one, and I did the intern-level work to admit the rest.  Well, 4 of the 5.  The 5th one I looked over and decided didn't need admission in the context of this crowding.  One good thing, I had to spit out some Swahili because everyone is too busy to help me.  Even the nurses were pushed to the limit.  I did three lumbar punctures and almost a fourth they brought me until I realized that baby was waiting for something else . . . It was just one of those Mondays where a lot of details had to be mopped up from a weekend where coverage is lighter.  Our OB service is one of the few left in the area providing safe C-sections, so the moms are pouring in.  We have several babies with serious infections from other hospitals, whom we are trying to keep isolated from our pristine majority.  Several with surgical problems who have come for our great surgeons but are too sick to be operated upon, so land in our pediatric care.  Two babies with cleft lips/palate who could not feed and became severely malnourished.  A delightful preemie who beat the odds of a 27-week delivery (he tested at 25 weeks) and now on hospital day 49 is cute as can be, but his mom is in tears about stress in her life and family and had to be begged not to abscond quite yet.  Many are improving, a few are struggling, and all require more thought and focus than I can give to so many sick ones.  We lost three kids on our services in the last few days.  Two died from severe congenital heart defects (again, transferred from other hospitals).  One was a normal 9-day-old whose frighteningly lethal bacterial infection just escalated in spite of antibiotics until his brain was full of pus.  THAT is hard, a preventable and treatable illness in many places, but too virulent for our resources.

Meanwhile in Kenya researchers have found a brand new species of mosquito that caries malaria parasites and bites earlier in the day, making it potentially a significant contributor to human illness.  Countries all around us are erupting in violence.  People we know are in risky places.  Kenya just recovered vests stuffed with explosives being prepared for suicide bombings in a neighborhood where our friends work.  The doctors and teachers are both on strike.  Elections set for next March are feared to be another stimulus for tribal violence.  I am a way-behind-in-planning mom who is still trying to book something for our mid-term weekend and something for a 3-day break between Christmas and airline tickets for Caleb . . . and so far striking out on all of that, which is frustrating.  

So in all of this, I have to rejoice that thanks to cell phones and internet I booked Luke and airline ticket to come home for Christmas (he usually does it himself but the best-price site only accepted credit cards and he only uses a debit card).  YEAHHH.  And I have to rejoice that my mom who is 76 and who loves to ride ATV's in West Virginia survived a potentially serious accident when she flipped backwards on a steep hill and came away with bruises and stitches but no broken bones or internal injuries, and her passenger was completely unharmed.  Miraculous.  And I have to rejoice in many other things I'm sure though most of them aren't coming to mind right this minute.

Because life is so often this way, a hard sprint of a day and then 11 pm catching up with the parts of our hearts that are scattered abroad.

Muslims worship who?

I (Scott) sat in a meeting a few weeks ago and heard a chaplain make reference to "some of our patients who are worshipping their little gods in our courtyard."  It surprised me and, unfortunately I think, revealed a prevailing view of many Christians who believe that Muslims worship a "little god" or an "idol."  

In light of the current raging fire of protests against America sweeping across the Middle East, I've begun to re-read a book I just finished a couple of months ago: Allah, A Christian Response by Miroslav Volf.  Volf is currently a Professor of Systematic Theology at the Yale Divinity School.  Having grown up in the  former Yugoslavia, he experienced first-hand, a bitter war between Muslims and Christians.  In his dedication of the book he says this: 

To my father, a Pentecostal minister who admired Muslims 

and taught me as a boy that they worship the same God we do.

Volf says that the goal of his book "is to explore how Christian and Muslim convictions about God bear on their ability to live together in a single world" (p.12).  

In the end of his first chapter he has a section which he calls "Hot and Spicy."  Here he lays out a number of theses which he realizes are sure to rile the feathers of a lot of people who have fixed ideas about the religion of Islam and the relationship between Islam and Christianity.  The first of his theses is plain and unambiguous:

Christians and Muslims worship one and the same God, the only God.  

They understand God's character partly differently,

 but the object of their worship is the same.  

I reject the idea 

that Muslims worship a different God

 than do Jews and Christians.

This is a fascinating book.  Like Volf, I venture publicly into this inflammatory topic with great trepidation. Volf does say early on that he leaves "the question of salvation and eternal destiny aside.  To use technical terms, the book is not an exercise in soteriology (the doctrine of salvation), but political theology" (p.12).  

While some may doubt whether Volf is a Christian, he makes explicit statements about his faith:  "What matters is not whether you are Christian or Muslim or anything else: instead, what matters is whether you love God with all your heart and whether you trust and obey Jesus Christ, the Word of God and Lamb of God.  I reject making religious belonging and religious labels more significant than allegiance to the one true God" (p.14). 

And his final "hot and spicy" thesis has relevance for some of the current debate in this election season:  "To give allegiance to the one God who enjoins humans to be loving and just to all, as Muslims and Christians do, means to embrace pluralism as a political project--the right of all religious people to articulate their views in public and the impartiality of the state with respect to all religions.  I reject the idea that monotheism, properly understood, fosters violence and totalitarian rule" (p. 15). 

So, I implore those of you with any interest at all (and those of you who are Americans should be interested in light of the current Muslim protests against all things American) to grapple with Volf.   You may not end up agreeing with him, but he's studied the Quran, dialogued with Islamic theologians, and sought to find common ground for discourse and peace.   Personally, I think he should be nominated for the Nobel Peace Prize --and not because he's conjured up some fiction to appease Christians and Muslims, but because he's perceived and articulated some real truth in one of the most incendiary issues of our age.

Benediction

As the hands and feet of God,

we put our faith to work in service to the world,

trusting in the One who has helped us,

named us,

and called us

to lead us to those in need.

Let us love as God loves:

with hands ready to get dirty,

with feet ready to walk far,

with eyes ready to see hardship,

with hearts ready to receive.

Let us love as God loves:

with lives ready to serve.

(from http://www.d365.org/todaysdevotion/)

(This is the benediction for this week's devotions on this site.  A fitting prayer for our days at Kijabe, and yours wherever you are).

Benediction

As the hands and feet of God,

we put our faith to work in service to the world,

trusting in the One who has helped us,

named us,

and called us

to lead us to those in need.

Let us love as God loves:

with hands ready to get dirty,

with feet ready to walk far,

with eyes ready to see hardship,

with hearts ready to receive.

Let us love as God loves:

with lives ready to serve.

(from http://www.d365.org/todaysdevotion/)

(This is the benediction for this week's devotions on this site.  A fitting prayer for our days at Kijabe, and yours wherever you are).

a short thankful list

Fifth day back in Africa, third day of work, and starting to feel like we never left.  I'm getting used to sweatshirts and down blankets, to the rattle of wind and the cadence of Swahili.  But I'm not used to the absence of half our family.  Rinsing dishes, setting out the morning granola, hearing the motorcycles, walking into the bedrooms, the startling absence of guitar chords, all leave a gap.  More like a crater.  So tonight I'm remembering a few things to be thankful for.

 First, Scott.  This is us in our favorite airport, Schipol, on the way home.  Only the coffee gives you a hint that we had been awake for more than 24 hours straight at that point . . . This year has involved a lot of separation, and more to come, something I didn't think we'd allow in our lives but now seems to be part of the territory of compromise.  Allowing children to be different ages with different needs, allowing jobs to continue.

 These smiling faces.  Julia hard at work on a Bible paper, when she's not at tennis practice, or a meeting.  She's a jewel.


And Acacia shown here working on an art project, standing as she prefers when working.  Note the incredible drawing of her cleat.  So thankful to have her in our family for a good chunk of the year.

Jack I think refused to be photographed . . .

NMy USAFA paraphernalia.  Besides the rainbow moment, the placement of Caleb in the THUNDERBIRD squadron was a most confirming moment for me that he's in the right place.  My dad's car, and the camp where Scott and I worked the summer after college.  This was like walking into the chapel at Yale and hearing a hymn that meant something very specific to me, ways that God affirmed His presence and planning.  On a lighter note, my mom found this late 1940's pillow in an antique shop in the small town where my Dad grew up.  She had to buy it.

This baby was born on Tuesday.  She weighed 760 grams with all her equipment, and was an unexpected precipitous surprise at 26 weeks, feet first, head caught, an all-around disastrous start to life.  But she's pink and fighting, and her parents raised 13,000 KSH ($160, no small sum in this place) to buy her surfactant, a slippery soapy liquid derived from the lungs of pigs and cows that should be present to smooth and expand all lungs, but is not developed at 26 weeks.  So day two of work saw me struggling to pass an endotracheal tube into the minuscule airway of this tiny girl after more competent but less senior people failed.  It took two tries and a bold out-loud prayer but we got it in, and today she was improved, huffing along with the extra airway pressure blowing into her nose, but no added oxygen.  And though her chances of survival are still slim, between her spunk and her parents' love and my doubt we had to try.  Partly because of babies like the one pictured here:

Her mother walked and hitched rides on a motorcycle at night when she was born tiny and premature, arriving at Kijabe holding baby Leah against her skin for warmth.  Now she's about as cute as they come.  This is the goal, a growing active alert little person who eats and cries and is almost ready to go home.  

Home is on my list, with the profusion of blooms where once there was mud alone.  The top picture our gardener Ernest created around a bare stump that has now been engulfed in flowers.  Though this house looked cluttered and dirty and small after America, five days in it feels quite homey.  I'm thankful for this place.

Chardonnay and Star.  Nothing beats a dog.  Chardonnay is perky and pesky, Star tolerates her. (Luke take note that C is outside, and S moved inside . . )  I've taken them on some walks/jogs since returning.  Today a mentally ill frequenter of these paths saw me go by with Star, and said in the friendliest way, something along the lines of "you're running!  We clap our hands for you!"  Made me feel nearly olympian.

NOT PICTURED but the most important:  friends.  Anna L and Bethany F are now working at RVA, Anna for at least a year and Bethany for one term.  Wonderful to have team mates, people who have known us for a decade and counting, people who worked with us in Bundi.  And they're both just wonderful women.  Karen M was here when we arrived, orchestrated by God to give us a welcome.  Last night we had a prayer time with a couple of neighbors.  It's been wonderful to see my good friend and partner Mardi, and to welcome new paediatricians (3 since I left!).  More on all those people when I remember to snap their photos.  Then there are RVA friends, our fellow-sponsors of Julia's class, our fellow nurses and parents and teachers.  There's nothing like connection to ease the sorrow of goodbyes.  We've been here for less than two years, but the relationships are deepening and precious.

So we're back, immersed, in work and meetings, patients and phone calls.  We're reading books and making meals and mourning the terrible news from Libya and Egypt tonight, the news that reminds us we are strangers in a strange land in many ways, and Africa is vast and other and capable of anger.  But Africa is also home, and friends, and solid useful work, and history and love.

Re-entry, again

I never lived at Kijabe with Luke.  So when we said goodbye to him in college and moved here, departure was a sorrow, but arrival did not bowl me over in poignant memories.  I suppose that's why this morning broadsided me, going to worship at RVA where Caleb played guitar a few times and sat with us every Sunday, where the people are familiar and connected to him.  Sometimes life seems like a series of surprises of grief-waves, that one has to bob to the surface of and hold onto the raft, gulping air until the next crash.  Good to be home, yes, but this particular home points out absence as well as presence.  

And this particular home is a mess.  I'm not a good housekeeper, I admit it.  Half my family is pretty messy as well.  A veritable herd of people have slept/eaten/hung out here over the last couple of months.  It's raining and muddy.  We have a puppy who has to be kept largely indoors. There are bugs and sticks and spattered sauces and dusty corners. Junk accumulates.  We brought back four suitcases FULL of it.  None of this bodes well for visual peace or healthy cleanliness.  And it's all ten times more noticeable when coming from my mom's.  

So in the midst of missing Caleb and Luke, and of despairing over dirt and disorder, it was God's good plan to plop a buoyant cushion of wonderful WHM friends here to soften the fall.  Karen spent the weekend.  Bethany has moved here for the term, and Anna for at least a year.   Plus I saw my friend and colleague Mardi.  Instead of merely unpacking, I had multiple good friends to share with, to hear, to debrief.  

Transitions are just tough.  Tomorrow will be a doozy of a day.  Will be glad when this week is in the past.  But given everything else in life, I'm super thankful for Karen, Bethany, Anna, and Mardi, and many others I greeted at church, even if their kind words made me cry.

From the African Skies

At 583 miles per hour, a thousand miles from home, far above the eastern reaches of the Sahara desert into northern Sudan, we speed southwards towards the equator.  In two hours the epic which has been a two-and-a-half month sabbatical for me, and a two-week family visit for Scott, will end.  So before that happens, a few more thoughts on the value of sabbath.We are coming up on 19 years in Africa, 21 years with World Harvest Mission.  And while we've failed to keep the sabbath at many turns, to our own harm, I think the rhythm of our life has not been completely off of the patterns established for good.  A weekly day of rest?  Mostly, at least a day of worship and family time, though in medicine one does get pulled into the mercy exceptions.  Yearly weeks of festival?  The Israelites traveled, gathered, camped three weeks a year, and we've done similarly, with team retreats and adventures, though the return travel in Africa generally seems to negate the rest of that time away.  Years of sabbath every seven?  Hmm.  We did that after the first seven years, but then as leaders we felt less option to leave for extended periods.  One year after 6 1/2, 5 months after the next 9, perhaps another year after 5 and that will even out a bit.  The once-in-a-lifetime Jubilee, the 50th year after seven cycles of seven, debts forgiven?  Not exactly, but this summer was my approximation of that, a true forty-day period of solitude, prayer, reflection, rest.  Perhaps not all these rhythms are eternally applicable to a non-agrarian society, but perhaps they do reflect the way we are created, and the concept of sabbath is part of the ten commandments.

The old missionary pattern was four years on the "field" and on year back at "home" in every five-year cycle.  This pattern was set when travel took weeks not hours.  When kids had little schooling option or flexibility.  When expectations were low for maintaining American culture and relationship in the interim, when letters crawled back and forth over the globe, when those in "foreign" lands had little contact with their family and friends left behind. And when those kids were expected to fully immerse in American school on that fifth year, because they were more American than global citizens.  It's a different world now, where we can fly to America for important events like weddings and Parents' Day weekends, where we can check on facebook and find out immediate news, where we don't want to miss anything.  What used to be the year-long furlough can be parceled out into smaller chunks that allow us to remain connected in more immediate ways with people we love.  Where our kids have consistently attended Ugandan and missionary boarding school because we haven't pulled them out for a full year.  This is largely good.  I believe it was the RIGHT thing to be physically and emotionally and spiritually more available to at least some of our kids this summer by taking a trip.  And as my mom said, it's the most time I've spent with her since I was married 25 years ago (or more likely since I left for college 32 years ago . . . ).  Perhaps one surprise of this phase of life is that graduating from high school is not graduating from the family, that it may take more from us to get ourselves to regularly input and support in young-adult lives than it seemed to when we all lived together.

"Furloughs" or "HMA's" involve visits with family, because through the years away one can't just show up for the weekend, or gather for Thanksgiving dinner.  They involve doctors' appointments, dentists, getting glasses. They involve paperwork and shopping and errands compressed into a few days that someone in America might spread over a couple of years.  They involve thanks to supporters who are the essential bedrock of everything, but too often silently taken for granted, as we show up at church, at lunches or dinners or prayer meetings.  They involve (often) meetings with supervisors, plans for the future, or debriefing the past.  They involve recruitment of new help.  They involve updating of skills and qualifications, perhaps study of some sort, a course, an apprenticeship, access to resources after years of isolation.  All of this takes time that a normal person might spread out over weekends here and there, afternoons, phone calls, vacations or study leaves.  Instead we do it in concentrated doses.  All of that with international travel can probably fit into an annual 6 weeks, or a biannual 3 months.  All of that except the most important part, the actual sabbath.  The rest.

That's why this summer was so different for me.  I did a lot of that visiting time and appointment time and errand time, and it was good.  But in the middle I had the inviolable 40-day block thanks to Caleb's basic training and the kindness of our friends who leant me a cabin-like home on a ranch.  I don't know all that happened on a soul level just by doing that, but I sense that some good things did.

It would be easy for the shorter more frequent time periods to always fill with the fixed amount of family/church/errand/appointment time, because those events are a constant whether done every year or every five years.    There is freedom, I think, for us to take the sabbath principle and use it for our good.  The sabbath was made for humankind, not humans for the sabbath.  As always truth lies in two paradoxical poles:  hard work, solid rest.  We can easily drift into over-busy over-working over-self-importance.  We can also drift into fixation on our right-to-rest, fear of the challenge can drive us to be away from ministry more than is right  It's hard enough to strike the right balance for ourselves, let alone for others.  If sabbath is always equated with leaving the "field", that can lead to disruption of bonding and language and sense of home.  I think that's why I rarely use the missionary-ese "HMA, Home Ministry Assignment".  Home is a complicated concept.  So is ministry.   The phrase implies geography, leaving Africa and going to America, which is not necessarily better for purposes of rest and reflection.  And not necessarily home for 2/3 of the family who spent their entire lives in Africa.  As I said, complicated.

More Christians who are not in professional ministry probably need to think through issues of sabbath and sabbatical, of rhythm and rest.  We're blessed to be in a profession, and a mission, where such time is valued and even required.  In the end for us it boils down to the same issues of faith that determine the rest of life.  Following God's patterns involves cost, to me, to my kids and coworkers and extended family.  Following God's pattern requires faith that the time of not-being-productive is good time, that Gods' grace will bubble up to infuse the spaces created, to supply our needs.  I need that faith as we land this evening, that the cost others have borne will not truly hurt them.  That I'll be able to walk back into relationships and work and life after such a long absence.

Khartoum has passed beneath us as I type, and we are nearly to the Ethiopian border, nearly to the curtain of night time.  My body has changed time zones a lot lately--this is the seventh switch in a month, from 1 or 2 to 7 or 10 hours difference.  Ironic that rest should make one weary, but anything that is worthwile usually does.

Parenting 101

Perhaps by now we're actually in Parenting 212, or 365, or even a grad school course.  We've been at it for 19 1/2 years, which is longer than it takes most people to get a PhD.  But the subject keeps changing faster than we keep learning.  We made enough mistakes in the first year (horrendous sleep habits, for instance) that we probably did deserve to fail and repeat. Which we did.  But parenting, like living in Africa, is one of those endeavors that never morphs into something simple.  I know when we had our first full night of sleep (at the end of year one) we probably thought we had arrived.  Instead the whole thing just keeps getting more complicated, but also more interesting, and more fun.

Now we're in a whole new phase.  Two kids in America, two in Africa.  Two in college, two in High School.  Plus the bonus child, Acacia, who comes to us 9 months a year as a gift.  Plus a dozen ambiguous, good, "foster-child" sort of relationships with teens and young 20's back in Uganda.  It's a phase that involves a lot of email, and airline flights, and prayer.  And a whole new round of sleep deprivation.

The cell phone question nearly did us in.  In Africa it is fairly straightforward.  You buy a phone, for as little as $20 or as much as $100 depending on the model.  You buy a SIM card for $2.  You buy as much airtime as you want, load it on, and you're good to go.  It takes a few minutes, only requires a few decisions, and if you don't like the SIM you chose there are a handful of other companies and you're only out $2.  Ten dollars of airtime can last days, weeks, or months, depending on what you do.  An SMS costs next to nothing.  Calling America is about 5 cents/ minute.  Data is more complicated, but possible.  It's not perfect by any means, but it is no preparation for life in America.  We just watched Hurt Locker, with that fantastic cereal-aisle scene.  We felt equally bewildered by the simple necessity of buying our son a cell phone.  Prepaid versions it turns out don't work at the academy due to some fluke in which the companies don't rent that tower for that service or something.  That means a 2-year contract . . . as we were trying to sort all this out we could tell that we didn't know what we were doing, and this was small comfort to the child involved.  We also messed up communication about Thanksgiving break and airline tickets, another unexpected steep learning curve where information is not very forthcoming from the academy and we aren't on top of it all.  Being around too many other parents always makes me feel like we are behind the curve.  Then there is the whole unexplored territory of relating to your kids as adults, of their character and emotional state and potential relationships, their friends.  Of all the things we don't hear or know anymore, because we aren't around.  It can feel like a lot to learn.

Thankfully a very nice Sprint guy explained the whole cell phone contract in ways we could understand, like an unexpected angel.  Luke worked out Caleb's travel.  Others keep offering help.  We've had three great days with Caleb at the Grahams, with their comfortable, private basement apartment allowing him to just relax, sleep late, do homework, skype friends, and not be under the constant pressure of the USAFA. We heard about some of the myriad of opportunities and the things that draw his heart and imagination, and came away with even greater peace that he listened to God's call and is in the place that is right for him.  We had a great time with Luke before that, meeting his friends, and giving him what he called the "perfect start to Junior year".  He is also in the right place.  Little moments of grace, of food, of hugs, of asking questions, listening. 

And mostly of seeing with a degree of awe what people these sleepless/ sleepy babies turn into.  I think at this moment that's the thesis for the degree:  discerning what unique gifts have been instilled in each child, and cheering for them along the way loudly enough that they have the courage to step out, to become their own person, to choose hard directions, to march to their own beat.  Hoping that they stand confidently upon the love, that all our mistakes do not obscure the fundamental truth that they are particularly and absolutely loved.

This phase has some amazing views.  And more than a few tears.  As we bustled Caleb back in his full dress uniform for the 7:10 pm deadline to sign into the dorm, the sun was dropping behind the Rampart Range of the Rockies, the eastern clouds suffused in grey and pink and then a stark half-arc of rainbow stretching right up from Caleb's dorm.  Scott pointed out that it looked very much like a promise from God not to destroy something, like Caleb, and instead to bring hope.  We were about to say goodbye when the loudspeaker system came on at 7:05, all over the cadet area. Playing, I kid you not, "I'll be home for Christmas", in a tinny sappy Bing Crosby voice that immediately made me cry.  Thankfully we are planning that Caleb and Luke will be home for Christmas.  But not until then.  And I thought it was a bit cruel for every mom getting and giving goodbye hugs to be hit with that song.

So this chapter, this unit, ends tonight.  Tomorrow (Tuesday) we fly to Virginia, drive to West Virginia for one day (Wednesday), then depart for Kenya on Thursday, arriving Friday.  To another good chapter, the one where we study how to support high schoolers again, where we cheer for Jack playing varsity football (soccer), Acacia playing JV basketball, and Julia playing on the tennis team.  Where we go to sponsor meetings and health clinics and work and feed the dog and cook and pull in friends and proof-read papers and quiz on vocab and find missing uniform pieces and art projects.  And the one where we try to SMS and email and stay in touch with the two college sons too.  

This is one course from which I have no desire to graduate, only progress.