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Friday, March 28, 2014

And We're Off

Please consider praying for us daily for the next two weeks.

This morning we are squeezing seven people, four small tents, sleeping bags, clothes, food, a soccer and a rugby ball, homework, Bibles, ipod and speakers . . into the Landrover for a several thousand kilometer multi-country loop.  Kenya to Uganda to lead a 3-day meeting and spiritual refreshment retreat for the Bundibugyo Team (and Fort Portal), then two days to visit our old home.  Uganda to Rwanda to Burundi, to visit and encourage our two new teams in Kibuye and then Bujumbura.  Burundi back to Rwanda to visit friends of the mission who may want to open a new World Harvest field there.  Rwanda back through southern Uganda, and finally back to Kenya again.  Along the way we will be connecting with old friends, checking up on kids whom we have cared for nearly their whole lives who are now in various schools. We'll spend nights with a couple of missionaries and a couple African friends, we'll camp at least five of those nights in places where there is no where else to stay, and we'll have a handful of nights in guesthouses.  To cover this territory and be back to work in Kijabe in two weeks means we can't really linger.  It's a lot of distance.

Pray for wisdom as we meet with people who are tired, stressed, lonely, and in the throes of cross-cultural transition, or struggling with the overwhelming nature of need in remote places.  Pray for words and insight from the Holy Spirit as we teach about solitude, community, and ministry, and pray for people on the front lines of the spiritual battle.  Pray for love as we so desperately want to encourage these brave souls and lift their hearts.  Pray for creativity and communication as our kids spend time taking care of the younger missionary kids in these places, and hopefully provide a glimpse of hope for the young families that all shall be well.  Pray for grace with each other as we are cooped up in a no-frills car on no-frills roads.  Pray for safety as we dodge countless dangers.  Our first leg of the journey is on the A104 in Kenya, recently named one of the ten most dangerous roads in the world in terms of accidents and fatalities.  We'll cross borders six times, and each of those experiences can be fraught with shady rules, long lines, confusing processes, and unclear fees.

And could you pray for a little fun too?  This is Julia's last family road trip before graduation, perhaps her and Jack's and Acacia's last visit to their old home in Uganda for a long time.  Bethany Ferguson is joining Scott and me for the teaching and counseling and prayer ministry to our teams.  And the seventh person is Rich Kendall, a good friend of Jack's.  There isn't a lot of margin time for adventure, but we do have a night in a game park along the way twice.  Pray we would be refreshed by God's creation, and for humor and peace in our hearts.

Thanks for being our support team.  We have nothing to bring to these Ugandans, missionaries, teams, friends, other than what we have been given from God through you.

Tuesday, March 25, 2014

There is the sting

This has been a rough spell in the ICU.  Severe viral pneumonias with shock, overwhelming sepsis, has claimed the lives of at least five patients.  Mostly these have been normal healthy kids who get a little vomiting and diarrhea, start to cough, come in and then within a few days are fighting for their lives.  In spite of being on a ventilator, getting pressors to support blood pressure, antibiotics which aren't much use, constant monitoring, they just have been crashing and dying.  

So when the sixth one was admitted, I realized I was subconsciously detached.  I watched him following the same pattern.  I knew he was going to die.  And I just wasn't ready for one more.  I informed his mother of his lack of progress, his increasing illness, several times on Monday.  But I wasn't getting attached, wasn't getting my hopes up.  He stopped moving, stopped breathing much, letting the machine do it all, stopped responding to pain or touch.
Then she leaned over to talk to him, to see if she could get any response.  "Jack,"  she pleaded, willing him to open his eyes, "Jack."  My objective distance went right out the window.  I knew his name was Jackson, but hearing her call him by the same name I call my youngest, just went straight to my heart.  I learned that her own mother had died last week. They buried her Friday, just as Jack got sick.  Her husband disappeared from the scene, unreachable by phone.  She had come to the hospital expecting a quick check of a normal fever, and now she was losing her second close family member in a few days.

On Tuesday afternoon I noticed visitors, and offered to meet with all of them in the conference room to update them on Jack's situation, which was dire.  I wanted her to hear the worst when she had a rare window of emotional and spiritual support.  The nurse did a great job helping me go through the details of his case with the stoic group of a half dozen ladies, all with head scarves and matronly clothes, kind faces that have seen too much pain, encouraging words.  I talked about the book of Job, and how Jack's mother was not guilty, how God is looking for faith in impossible circumstances, how we can't explain and make sense of all the hurts in a fallen world.  Together we decided to take him off the vent while this supportive group of aunties prayed and waited.  We put Jack in his mother's arms, and she held him as he breathed is final gasp.  

It was a good death, a good process, full of community and holiness and love.  But the sting was still there.  Hope, yes.  But the painful prick of reality, of a world broken, of the innocent dying, of unexpected loss, still jabs.  Come, Lord Jesus.

They're back!!

Thanks to Mr. Daubenmeier we have Julia photos.  She has crashed in bed asleep, but all three are full of amazing stories of elephants, dust, rapids, rock climbing, cliff dives, bungee jumping, languages, service, tree planting, markets, playing with kids, swimming with dolphins, hiking in forests, trying new languages, kayaking, spices, waves, drawing water from wells.  It was fantastic.  Perhaps photos from the other trips will appear later, but in the meantime here's Jules.

Monday, March 24, 2014

Blessings of community and rest

Last night the Medical Officer Interns treated us to dinner they cooked themselves.  In two weeks they will have completed their grueling year of internship, rotating through medicine, paediatrics, obstetrics/gynecology, and surgery for 3 months each. We have spent countless hours up at night with these cheerful learners, and days on rounds, giving lectures, demonstrating, counseling, praying, encouraging.  Now they are anticipating being launched on their own to government hospitals.  We will miss them A LOT, and we were blessed an honored by their goodbye.

 Dear friend Karen Masso celebrated her birthday on Sunday in her NEW HOME.  We are so thankful to have the Massos as neighbors once again.  The world is back in balance.  Michael made Karen this picnic table for their front porch.  He will be creating a community development curriculum for Moffat Bible College, and they will still support the South Sudan team with trips, fundraising, advice, and encouragement.

The kids are on "interims", week-long trips around East Africa where a dozen or so students and some staff disperse to learn about Kenya's varied cultures, and learn about God as they face new challenges.  Julia is pictured here with her tiny backpack and sleeping bag, heading out for a week of biking around Mt. Kenya.  Jack is with the Samburu people in the north, and Acacia learning about coastal culture in Zanzibar.  So Scott and I had our own "interim" this weekend.  That's a giraffe you see behind us on a walking safari near Lake Naivasha, and we biked at Hell's Gate national park.  We had a true sabbath of rest for 48 hours at a nearby resort on the lake, and it was Heavenly, literally.  

Now it's back to intubated kids and blood and reports and stress, but we are very thankful for our community here, and for time together that gives us staying power to press on.

Kijabe Needy Children's Fund

Meet Beatrice, a precious baby girl who was born not only prematurely but also with a blocked intestine, a place where the gut had failed to form.  She was transferred to Kijabe where she had emergency surgery, weeks of intravenous feeding, percolating in an incubator, fighting infection, on the verge of survival.  At last she was strong enough to be fully corrected surgically and begin to breast feed.  Last week she went home with a prognosis for a long and normal life.  The odds of her survival in Kenya being born 2 months early would have been 1 in 4 most places.  Add to that her surgical emergency, and it probably goes up to 1 in 100.  So it was a day of rejoicing when she was ready for discharge.  Her family was able to raise about $350, but her total bill was about $2,500.  Even with a subsidy from the Bethany Kids surgical fund, she was still left with about $1000 unpaid.  This is where the Kijabe Needy Children's Fund comes in.  
This fund was established years ago as a way to sponsor care for children whose families would otherwise be unable to afford it, a way to keep Kijabe Hospital running when the excellent care provided would be otherwise uncompensated.  We are a church hospital that has to pay the laboratory technicians, the round-the-clock expert nurses, the records clerks and kitchen cooks and maintenance personnel.  We have to buy the expensive antibiotics, and generate the oxygen and electricity.  Saving a baby like Beatrice costs money.  It costs only a small fraction of what it would cost in many countries.  About half our physician staff are missionaries, so all our supporters already subsidize this care by subtracting the need to pay us salaries.  But paying the Kenyan staff and maintaining the enormous physical plant and providing the equipment and medicine takes funds.

Last year God provided $40,000 and we spent every penny helping over a hundred Needy kids.  In 2014 already, the fund has received and disbursed over $4,000.  It is exciting to see a family right here in Kenya hand me an envelope of cash that exactly covered the bill for a young twin with malnutrition and a severe injury, or a church from Tennessee write and send just the amount Beatrice needed.  Our chaplains and finance office work with us to identify the patients who are truly in need.  The money flows in and out in pretty divinely matched proportions.  This is a picture of Mary, who has spent 33 days in the ICU.  She has Guillan-Barre syndrome, a temporary paralysis that would result in death in most places in Kenya.  But if we can support her breathing for a month or two, she should fully recover.  She got a tracheostomy two weeks into her course, and just yesterday she came off the ventilator to breathe on her own for the first time in a month.  She's starting to wiggle her shoulders a bit more.  She still has weeks to go before she can leave, and months before she can walk and run and play.  All that care will bring a hefty bill that her mother will need help to pay.

Thanks to brilliant Ann Mara, the fund is now much easier to donate to.  There is a paypal account associated with the hospital, and the money (after a very small admin fee of 3% or less is subtracted) comes directly to the account.  Then we paediatricians with the chaplains and finance office decide which patients need it the most, and it is transferred directly to cover their bills.  If you or your group want to raise money for kids in need of medical care, here is the link for sending it:
It is the second project on the list, code NCF-1. (Meanwhile take a look around our Kijabe Hopsital website which Ann also worked hard to create!)

God promises to bless those who care for the widow and the orphan.  This is something close to His heart.  And I thank those that support us personally and the other doctors here, which is equally important in providing this low-cost and effective care.  We depend upon you, and are grateful.

Lent and the Precious Exhauster

A couple of weeks ago, we noticed a foul smell around our house.  Suffice it to say that many years of occupancy had backed up the plumbing and our septic system was overwhelmed.  Enter the Precious Exhauster.  A team of men and this truck pulled into the yard and basically sucked all the years of muck out of the buried tanks.  They inserted a huge hose, turned on pumps, and within half an hour all those years of waste were emptied.  Then some hospital workers opened up the system and washed things through.  It was a pretty disgusting reveal of just what is under those concrete covers, but a huge relief.

This is the season of Lent, one that I did not grow up with but have come to appreciate as an intentional rhythm of the year of worship.  We are half-way through a period that precedes Easter with 40 days of seeking God, modeled after several Biblical examples of fasting and prayer.  Elijah and Jesus fled to the desert, and threw themselves upon God's provision alone.  Lent is a time to fast from that which we normally depend upon, to clear space, to focus intention. To prepare for new ways that God is moving and working, to align our hearts to that purpose.  

The exhauster truck reminds me that my heart needs to be cleared out.  Petty thoughts, jealousies, disappointments, failures, poor choices, conflicts, selfishness, festering wounds, these all percolate, sometimes hidden, flushed, covered.  Until there is no more hiding the seeping sewage.  Jesus doesn't just spray some deodorizer; He offers a complete cleaning.  When we fast from something that distracts or numbs, we come face to face with the reality of our need for radical solutions.  And holding onto our sewage would be as absurd as protesting this crew and accusing them of stealing our property.  The good news is that Jesus offers continual cleaning, creating space for something that is better, sweet, pure.  Our family is reading Wright's meditations for Lent based on Matthew, which starts with the challenge towards humble willingness to be open to new ways God might work, new paths He might call us to, bringing new Kingdom values into a world that is full of muck.  I fear emptiness, the empty nest which looms, the emptiness of transition, of loss, of grief, of aging, of inadequacy.  But this Lent I'm challenged to faith that emptying is creating space for something as startling as redemption, for something as precious as God himself.

Friday, March 14, 2014

Kijabe Paediatrics

I had to submit a short report to the hospital board today, and Mardi told me to cut and paste it into the blog.  I hope you find it encouraging.  On the orders of the Medical Director, here it is:
1.  PERSONNEL:  Bob Okeyo graduated with a Clinical Officer Degree, Lilian Okeyo and Veronica Njaramba were sponsored to attend a Society of Tropical Paediatrics meeting in Germany where they presented cases from Kijabe, Rick Gessner survived a ruptured appendix and surgery at Kijabe, Ima Barasa survived months of bed rest and  preterm labor to deliver a healthy baby boy Jonathan on Christmas Day, and we all survived another doctor's strike.  We welcomed Elizabeth Kimani, an RCO, to our team in December after completion of her internship, and she now staffs MCH clinic daily.  In 2014 we will welcome Ima back from maternity leave in May, say goodbye to the Gessners in July, then in September/October have Sarah Muma rejoining us from South Africa, and a new paediatrician from the US Dr. Ariana Shirk.  

2.  OVERVIEW OF INPATIENT PAEDS:  703 patients over 1 month of age were admitted to the Paediatric service in 2013, including 71 to the ICU.  17% of our patients spend some time in the HDU during their stay; this monitoring has allowed us to care for progressively more and more critically ill children.  10% of our patients are severely malnourished.  A third of our patients are OVC (Orphans and Vulnerable Children).  We raised and spent 3.3 million KSH ($40,000) in 2013 through the Needy Children's fund, assisting 106 patients.  Our average mortality rate is 6.7% (compared to 5.8% last year); non-palliative mortality is 2.6% meaning that most of the patient who die at Kijabe are at an end-of-life palliative stage.  Our ICU mortality is 35%.  

Admissions this quarter (first quarter 2014) are running 9% above average for last year.  Beds are constantly full and we really look forward to moving into the new BKKH wing.  Personnel will have to increase to keep up with the clinical load.  Sheer numbers and also the acuity are increasing.

3. OVERVIEW OF NURSERY:  Annual admissions of infants less than 1 month of age have increased by 33% in two years, up to 800 in 2013.  Mortality in Nursery is comparable to Paeds at 5.7% overall.  For extremely low birth weight (<1000 13="" 3.6="" 47="" 6.3="" and="" birth="" falling="" for="" gm="" grams="" is="" low="" mortality="" normal="" to="" very="" weight="">2500 gms) babies.  These numbers are all well below Kenya benchmarks as presented at the 2013 Kenya Paediatric Association meetings.  37 babies were admitted to ICU with 17 deaths (46%).  We have now had 4 survivors of gastroschisis, an abdominal wall congenital defect that is uniformly fatal elsewhere in Kenya.  We continue to work closely with Paeds surgery and Neurosurgery to care for children referred from all over Kenya, Somalia, and beyond for severe congenital defects.

Nursery has been running well over capacity in the first quarter of 2014 with 25-30 babies or more routinely, on a service planned for 18 beds.  Nursing coverage is a challenge as we want a ratio of at least 1 nurse for every 7 babies, but generally only have 3 and sometimes 2 nurses to staff the unit.

4.  EDUCATION:  Paediatrics continues to teach CO and MO interns in a weekly conference and daily at the bedside.  We have a NICU doctor and potentially nurses coming again this year to update skills for Nursery staff.  Dr. Steere is in the planning process for a Paeds Critical Care fellowship in Kenya through the University of Nairobi that will include rotations at Kijabe. Our staff attended the Kenya Paediatric Association meetings and a national conference on improving maternal and child survival.  We are preparing several abstracts for this year's International Congress of Tropical Paediatrics meeting in August in Nairobi.

5.  OUTPATIENT/COMMUNITY:  We cover MCH clinic daily, see private clinic consults, and manage critical children in the casualty department.  Dr. Mary Adam continues her excellent and nationally recognized work with the Newborn Community Health Project, training groups all over the country.

Concluding challenges: 
  1. The reputation and reach of KH grows yearly, bringing us more patients and more complex ones.  
  2. The staffing lags behind the load, so that our nurses, CO's and doctors are constantly pushed to work beyond their limits.  Our excellent survival statistics may start to drop if we do not pay attention to this.
  3. Nursing staffing in NICU must increase.
  4. Lab staff and equipment, and radiology, must grow to keep pace with the higher level of acuity.
  5. Costs are a challenge for the poor and vulnerable patients Jesus asks us to prioritize.  The Needy Children's Fund (70351) is a real asset and we hope Dr. Steere will be supported in her efforts to broaden support for other needy patients.

We are thankful for close and positive working relationships with BKKH surgical team, and pray for continuing integration between KH and BKKH.  It is a privilege to work with you for the care of children in Kenya, and a joy to see the many miraculous recoveries.  Submitted by Dr. Jennifer Myhre, Clinical Head of Paediatrics, AIC Kijabe Hospital

Thursday, March 13, 2014

Of waves and calm

Today's reading was from Matthew 8, the storm on the sea, the panic, the calling out to Jesus for help.  Then the order from chaos.  Wright compares this to creation, when the darkness and formlessness covered the earth, and the Spirit of God hovered to separate light from dark and wet from dry.  Jesus is bringing a new creation to bear upon the chaos of a sin-broken world, so he re-enacts the creation story by calming the waves.  And even though Jesus was present and able, he did not react until his friends cried out to him for help.  The people of God through the centuries fear God is asleep, the world threatens to drown us, and we pray in desperation to actually see the miracle of evil defeated.

This week, make that this month or this year, I've been wave-slapped.  It is rare for me to get to be so overwhelmed I can't even write.  But this is one of those seasons.  It all blurs together, phone calls every fifteen minutes through the night, treks to the hospital to sometimes blow life back into a dying baby, and too often fail, holding sobbing shoulders of distraught moms.  Rounds that drag on and on and on as the patients line the halls and crowd the corners.  Juggling that with three teens, new team mates, end-of-sports-season finals, a birthday.  On the day that we had fifteen kids for pizza making for Jack's birthday, one of my long-term patients died and the parents asked me to attend the burial.  Our life is so often like that paradox:  baby M in his coffin, defeated at only a few months of age by an overwhelming infection in spite of surviving weeks of intensive care early on for congenital anomalies that were surgically corrected, the shuffling crowd of mourners, the grave in the hillside . . .

. . . . then a celebration with huge healthy teasing young men, strong, hopeful, funny, full of life.  Then back into the fray.  After baby M, three more much healthier 4 to 10 month olds all died within the week with a similar pattern of unexplained viral symptoms, wheezing and struggling breaths, draining fluids, dwindling pulses.  I was alarmed enough by the cluster to call the national research lab (equivalent of the CDC here) who sent a team to collect samples. No clear results yet, but we have something dangerous to small children circulating.

So into the middle of the storm about ten days ago a visitor arrived.  Dr. Lina is an ER paediatrician working in Chicago who trained with Mardi years ago in Florida, then worked with my colleagues from residency in my old hospital in Chicago.  She strode into the choppy waters with energy, cheer, and calm.  It has been nice to have a friend to work with--when there are only two of us running nursery (bursting at double capacity), the inpatient floor, the ICU, the outpatient clinic, deliveries, consults, call, teaching . . well, it gets hard, and we barely see each other.  So having one more person to share the load has been HUGE.  Dr. Lina has the heart and skills of a Bible teacher as well, and blessed our monthly team meeting with a devotion that was deep and meaningful.

But the best part of this timing was that Lina's arrival gave me the gift of a weekend off, and that was a key weekend in Julia's life, and one that I would have hated to miss.  First, the girls' football finals were on Saturday.  We played well and controlled the game, but mid-second-half there was still no score.  So when Julia had a solid shot from outside the box that dipped into the back of the net over the keeper . . well, it was a beautiful score and again a game-decider in the finals and a great end to her soccer career at RVA.  She was elated, and so was her team.  

Jack's team won their championship finals too.  It was a great day.

That night we had our "caring community",  a group of seniors who come to eat and relax and be prayed for and just let down in a safe place.

The next day, Julia's senior singing group led worship for all of us at church, and sang a special song for the offeratory.

Then we had the end-of-season football party here, which is another 25 kids and flour everywhere and circles of laughter.

So this is a tribute to crying out to Jesus in the storm and finding some calm in beautiful goals, smiling girls, music, time spent with kids.  In talking to Luke and Caleb on the phone as they were TOGETHER (Luke is visiting Caleb in Colorado for a day on an epic cross-country road trip) and hearing the wholeness in their voices, the completeness that reveals the ragged edge of always being apart.  In having a colleague to cover enough of the duties that I didn't miss milestones.  In enjoying a daughter who will leave us all too soon.  

Monday, March 03, 2014

Sweet 16

Yes, our youngest is now 16.  And he is actually pretty sweet for a 6'2" massive guy.

 Sixteen years ago I hobbled into Kijabe Hospital from the house where we were staying as war-displaced refugees and working temporarily on station.  Scott was my doctor, and I listened for his voice and pushed my heart out.  Today we were both standing in the same room by the same delivery bed as he evaluated another laboring lady, and decided to take her back for a C section.  I think being on this side of sixteen more years of medical practice makes me marvel even more at the healthy baby God gave us in the midst of pretty desperate circumstances:  attack, flight, gunfire, loss, sickness, high fever, delirium.  I was probably as skinny as I have every been as an adult during Jack's first weeks of gestation, and just about as sick with dysentery, and homeless, and on the run.  So the fact that he seems to have a pretty decent brain and body is nothing short of grace.

Jack at 16 is in many ways the same kid he was at six.  Curious, thinking in his own patterns, a problem solver, persistent.  Sharp.  A nose for inconsistency.  No qualms about delving in and diving in, getting dirty, working hard. But a great lover of his favorite couch or hammock, a consumer of books.  Intense.  A person who likes to win.  A thinker.  A kid who has known a bit too much loss, though now he's come through to the other side stronger, he still feels the missing brothers on other continents, the tenuous nature of family.  A protector of his sisters.  A teaser.  Comfortable with older kids.  An arguer.  A lego-master.

Jack at 16 contains all that six-year-old energy, yet tempered now into something new.  He likes to provoke, and laugh, but he is more comfortable in himself and confident in who he is.  He used to pray the most amazing things out loud, and now that faith has moved down into his heart more deeply, more owned and real.  He has channeled some of that sharp talent for debating me into winning a best-speaker award in the Model UN.  He has pulled on all those years of playing with kids older and stronger to be on two Varsity teams as a 15-year-old.  He has survived pretty disparate cultures and school systems to become a person who is not as worried about what others think or approve.  He has taken that drive to win and turned it into consistent performance on the field and in class.  He has strengthened friendships with boys from America, Scotland, Nigeria, Kenya, Rwanda, South Sudan, and many other places as well as Uganda.

We are thankful and privileged to be parents of this young man, and looking forward to his story as it unfolds.  It will be worth watching.