The rest of life: 2013 year in review

In between phone calls to Colorado, life still goes on.  And 2013 feels long enough already for a year-in-review post.  Perhaps the first one in the blogosphere for this particular year . . . Here goes the 2013 year in review.






Research, education, goals, and public health:  Last week a group from Kijabe hospital joined other paediatric and obstetric doctors and nurses at the University of Nairobi and Kenyatta National Hospital to discuss our progress, or lack thereof, in reducing neonatal mortality.  60% if infant mortality occurs in the immediate post-birth period.  While overall under-five child mortality in Kenya has halved in recent decades, neontal mortality stays stubbornly high at 31 deaths/1000 live births.
We listened to presentations on the top killers:  sepsis, prematurity, and asphyxia, and discussed ways that better communication and team work, appropriate hygiene, basic warmth and feeding, could avert up to 75% of those deaths.  Inspiring stuff.

And particularly relevant at Kijabe where the new year started with the delivery of quadruplets.

Patient Care:  On Jan 1, on the way back from taking Caleb to the airport, I got a phone call from the medical director and thankfully we could mobilize four docs to receive them on short notice.  They are all girls, perhaps identical, perhaps two sets of twins.  
Here are Erika, Immaculate, and OB Martin speaking to the media.  The safe delivery and so-far survival of these 900-1100 gram girls was quite an event.  I was standing behind them looking useless and official.  The next day a random guy stopped me and said "I saw you on TV!"  That was fun.

After a couple months of ICU, Dr. Sarah and I have switched to the general paediatric floor, also covering the maternal-and-child-health clinic.  High volume, lots of malnutrition and seizures and sadness, and a sprinkling of the truly puzzling.  Last week we figured out (with tons of help) that the 11 year old girl we thought had TB because of the fluid in her lung linings actually had a quivering  floppy failing heart because her kidneys were being damaged by obstruction to their blood flow.  And that the toddler with diarrhea actually had an unusual sequelae called hemolytic-uremic-syndrome.  And the teen with a massive liver had been infected with Hepatitis B at birth and developed liver cancer.  And on and on.   Some stories I find particularly heart-breaking.  Like P, who is cradling his little cup of porridge as we try to extract his story.  Ten years old, with AIDS, abandoned by an abusive alcoholic father that ended up in jail after his mother ran away, shuttled through four orphanages already in the last year or two, stunted and infected and quiet.  We tried to find any person in his life to connect him to his family or past; he could only remember one lady who owned a salon where he used to live who was kind to him.  In the end my colleague connected him with an excellent ngo which serves HIV-infected orphans.
Or baby N, from Sudan, a refugee in the vast border Kakuma camp, born with hydrocephalus and twitching for weeks until the agencies in charge managed to transport her and her mother to Kijabe.  Where they can't communicate with anyone.  We plug through rounds day by day, hearing the stories, prodding and probing, thinking and tweaking.
Many get better, thankfully, like this bundle of cuteness.  There are satisfying moments such as popping a heavy needle through the tibia (leg bone) of a 10 month old who is probably less than an hour away from dying of diarrhea, pushing syringe after syringe of fluid, and watching him wake up, his eyes flutter open, his arms start to push us away, his face looking for his mom.

Training:  We are a teaching hospital, continuously raising up the next generation.  This past week I led daily devotions for the next class of nurses Dr. Erika is training in neonatology, to improve our NICU.  And I taught the weekly mid-day paediatric conference, this time looking at the Lancet's publication in December about the Global Burden of Disease.  But because I'd been to a teaching-training at RVA last month, I used some of my newly-learned techniques.

Here are the interns sitting in groups of four, each a committee from the WHO who must decide how to spend a hundred million dollars on health.  Targeting the most prevalent diseases?  The most lethal?  The ones which rob younger people of life?  At least no one fell asleep.  Later Luke interestingly said he'd put it all into poverty-reduction measures, because before anything was known about bacteria and viruses it was empirically evident that disease targets the poor.  Fascinating.  And true.



RVA life:  School is back in session.  We passed our two-year anniversary in Kijabe, and the kids started term 2.  I zip back and forth for Student Health clinics and Junior Class meetings, and field phone calls from the nurses about everything from sore throats to insomnia to broken bones to depression.  Here are Julia and Acacia in USAFA-shirts from Caleb, a reminder to pray for him in his trials:

Much of our best RVA moments come in watching our kids play sports, which for me is the sacrament of the present moment.   Looks like we'll get plenty of opportunities if we can juggle the hospital duties with the above schedule.  I love sitting with my community of fellow parents, cheering, soaking up some sun, not trying to multitask any other productivity into those moments, rejoicing in who these kids are.

Julia and Acacia are playing football-this is Julia getting the ball at a scrimmage.

 Jack is playing JV basketball, which is not his strongest sport but since he's 14 and passed the 6 foot mark and is generally athletic we think he has great potential.

Community and friendships:  I'll end this post with shots of friends and visits.  The Christmas season spills over into January.  Luke was with us until early yesterday morning as he flew back to school, and with Luke our home becomes more social, more adventurous, more fun.  

 He and the Congdons (Stephen from his class at RVA, Robert from a few years earlier) rode to a lake on the Kenya/TZ border which is the breeding ground for all the Lesser Flamingos in East Africa.  His pictures are beautiful of spectacular landscape and challenging terrain.  I only got the moment of departure.  Oh, and the laundry and dishes afterwards.

 We hosted families passing through, such as our friends the Wrights bringing their daughter Anna back to school, or   teachers from RVA whom we wanted to get to know . . .

Or the lovely Dr. Emily whom we met by email correspondence years ago when she decided to make her birthday party a Matiti project goat fundraiser, then visited us in Bundibugyo, then we visited her in Indianapolis and met her Kenyan friend Dr. Evans, and they both stopped by to say hello on their way from Eldoret to Nairobi. 

 We are grateful for some friends returning from HMA, like Rich K.

 And sad that others, like Luke, have to return to the US to progress in their schooling, like Rachel and Hannah, the core of the Caleb fan club and wonderful young women who are friends and role models for Julia and all of us.

And so life goes on.  We pray for Caleb, mourn his pain, and wait for each day's unfolding progress.

 We mourn Luke's leaving back to America, miss those moments of kicking a ball around, making a meal, building a fire, watching a movie.  We correspond and do homework and update databases and go to meetings and take call and do dishes, and pray for Jesus to make 2013 a year to remember for healing and deliverance and love.