The beginning of the end

Only one more weekend-call, 24 hours of work, and I will be done with my Kijabe Paediatrics career, at least for the foreseeable future.  The jumble of emotions that comes with this is so intense that I am actually left feeling a bit numb:  sadness, the realization that I'll miss this work and these people, weariness, relief, regret for things left undone, amazement for things accomplished by God through this team, knowing I'll feel left out as life moves on.

Monday I worked in our new Developmental Clinic.  For most of my time here it has been an idea only, but Ima managed to put meat behind the idea, and Stephanie Cox the audiologist is actually making it happen.  So many children in Kenya suffer from significant disabilities, often because of inadequate care during pregnancy and delivery.  They bounce from clinic to clinic hoping for a miracle that fixes a damaged brain, and we have wanted to create a welcoming interdisciplinary environment for them to access a solid Paediatric opinion, nutritional monitoring and supplementation, physical therapy, testing and treatment for speech and hearing disorders, and the prayerful ministry of a chaplain.  Once a month we're bringing all these threads together in a one-stop clinic.  I am the least important part of this chain; Sherri with her PT skills can teach the parents and provide the equipment that makes a huge difference in the kids reaching their potential. It's a great group to work with, and very different from our usual hectic, overcrowded, low-support outpatient setting.  Pictured left, we're going through files before the clinic starts, collaborating and forming plans for each kid.

Our Paeds team is pretty large this week: visiting pre-med, pre-nursing, and med students, our usual CO and MO trainees, etc.  I have enjoyed being back in the nursery, teaching a lot of basic but good things about how to help a baby breathe, why breast-feeding is best, what is the differential of respiratory distress, how to recognize a baby who is critically ill, and what research is still needed to answer important questions.  This is Alanna soothing a baby who was very upset that we were busy with rounds and her mom was late for her feeding.

And the Kijabe-classic craziness still continues, unabated.  Admissions and consults in the last couple days include: a child with what looks like TB meningitis, a child with severe gastroenteritis and dehydration, a refugee baby with a perforated bowel, a child from a nearby country whose parents came to Nairobi convinced she had cancer and were overjoyed to find out she merely had a urethral prolapse, an orphan with perforated ear drums, and this cutie-pie pictured left.  Her mom has miliary TB and was in the intensive-care step down when she went into preterm labor at 28 weeks, and delivered this 1300 gram (a little over 2 pounds) baby, who was whisked to NICU.  I took this photo, and probably the highlight of the week was going back up to the very sick mom's bedside and showing her her daughter, and seeing her smile through her oxygen mask.

The second-to-last call night (Monday) was a doozy, with admissions and deliveries and labs and work.  In the middle of the night, this little one started falling apart.  Please pray for him.  He was just a normal baby who looked a bit jaundiced, then turned green then mottled then his kidneys failed and he was getting too tired to breathe.  I intubated him and took him to ICU on life-support, and our team has kept him alive so far this week, but it's touch and go.  We think he has a severe infection, and yesterday we did an exchange transfusion.  If he lives it would be miraculous.

I gave my last teaching conference, on Severe Acute Malnutrition, one of the topics I am most passionate about.  I love getting the interns to THINK about why malnutrition occurs, and the huge complex web of factors from soil conditions and rainfall to marriage dynamics and education.  I love showing them how we can turn someone from death to life, but also admitting how often we fail and how much we still need to learn and understand.

And we had our "Lower-Station" dessert and prayer fellowship farewell, dozens of our neighbors gathering to say goodbye to us and the Hein family as we head out.  These are the people who know how to pray for us, whose hearts are bound up with ours, with whom we have labored for 4 1/2 years now.  They graciously gave up a Friday night to love us.

I'll end with some group shots, one of the perks of a last week is that everyone is game for pictures.

Mary and Rachel, the in-charge nurses for NICU and Maternity.  Calm, competent women, a pleasure to work with.

Nursery team

Kijabe Paeds Consultants (minus Sarah who is still on maternity leave): the friendship and excellence of these women has been the highlight of living and working at Kijabe

Paeds team at morning teaching rounds!  

Our newest consultant, Caren, who has been sharing ICU and nursery with me the last two months.

Sophomore Restaurant last weekend, dressing up for a nice meal with the Massos and Justin.

Acacia and Ali  . . about two hours after he fractured his clavicle playing rugby.  Real men can still dress up and have a dinner date.

Jack and Wianne.

Lower station ladies, courageous women who are quietly changing the world.

My newest mug for tea, thanks to Jack's pottery class.  He's turning out some amazing work.

That's a lot of end, probably beyond the beginning of it.  Pray for our hearts to trust God in this major time of transition, to end well, to love and support those around us, to discern the priorities of the day.  Scott is now arriving in Bundibugyo for a week in Uganda to focus on Christ School planning and progress; I am holding on through one more weekend of work, the last Senior boys Sunday School, and a list a mile long of what must be done in the next three weeks.  Thanks.