Christmas Letter for Downloading

Tis the Season...

For a look back at highs and lows of 2016 in our lives...and a few color pictures too!

CLICK HERE

Remembering a Good Man with Good Words

Nine years ago today, we stood outside our home in Bundibugyo straining to hear the phone call telling us our closest Ugandan friend, Dr Jonah Kule, had died of Ebola. Scott, Scott Will, and I had remained in Bundibugyo to provide medical care in this epidemic. We had sent our team and family out of the district as the reality of the danger unfolded, but the day Jonah died was perhaps the darkest of all.

So when Lesley Stevens, one of the team leaders in Bundi, sent me an invitation this year to contribute to a new Children's Daily Devotion based on the works of George McDonald, I asked for the date of Dec 4 in Jonah's honor, and took the passage from John 12 that Scott read at Jonah's burial.

How appropriate that I got the email link this morning that the book is ready for sale. This is a collection of short daily scriptures, pictures, and thoughts appropriate for kids in the 4-10 age range. I have only seen a few but they looked good. I think 80-some authors contributed. Proceeds go to a charity for troubled kids.

Books are always my favorite Christmas gift, because words are the avenue to the heart. Like my two books (which are stories so quite different than this group project, but still valuable for world view and enjoyment) this one points kids to Truth.

Google it on worksofmacdonald.com for a better price than Amazon.

And take a moment today to remember Jonah's family in prayer. As we head into a doctor strike here in Kenya where the poorest will suffer from the injustice of the system, this season of Advent reminds us that the world still longs for light. Today we acknowledge the darkness which is the background for Glory, but cannot overcome God's flickering Presence.

Advent, a waiting

Advent
by Sr. Christine Schenk

I wait
with quickened hope
for crooked paths
to straighten,
with tough-soul’d
anguish,
while blinded
keepers of the keys
shut out
God’s own.

(If such a thing were possible.)

I wait,
and will not be
dismayed.

For tiny shoot
of Jesse tree
took root in me
to love
transform,
give sight
set free.

From Biola University's excellent daily web-based advent devotions. Access the art, music, scripture and thoughtful writings here: http://ccca.biola.edu/advent/#

We are also reading Dietrich Bonhoeffer's God is In the Manger, on Kindle. "For the greatest, most profound, tenderest things in the world, we must wait.  It happens not here in a storm but according to the divine laws of sprouting, growing, and becoming. ....God is in the Manger, wealth in poverty, light in darkness, succor in abandonment. No evil can befall us; whatever men may do to us, they cannot but serve the God who is secretly revealed as as love and rules our world and our lives. "

And Richard Rohr's Preparing for Christmas (also on Kindle) : " it was the same suffering of the centurions servant that brought the centurion out of his comfortable house and that invited Jesus into that house! Suffering and solidarity with the suffering of others has an immense capacity to "make room" inside of us. It is probably our primary spiritual teacher".

Hope you're enjoying some challenging and comforting thoughts this season.

And don't forget Christ School (see below) tomorrow!

Raise the Roof on Giving Tuesday!

While we continue to need year-end support ourselves particularly after our losses to thieves.... this school we love is also a solid place to give a gift where the impact will be multiplied. In fact we talked in the last day to two different CSB grads who are on surgery rotations, one at UVA and one at Mulago Hospital in Kampala, both learning how to save lives with a goal to serve the poorest. If you want to hear more about our history and why our hearts are at Christ School Bundibugyo, see the Serge Blog here: https://www.serge.org/featured/treasures-hearts-and-battle-lines/

For Giving Tuesday, we at Serge are promoting giving to Christ School. The team is pictured above. Check out the new web site here:

http://www.christschoolbundi.org/

Let's Raise the Roof!!!

Defeated but Punching: Thanksgiving that Good triumphs over Evil

The Scripture readings on our annual plan come largely from Revelations, Daniel, Psalms and Isaiah this week. Mysterious dreams that sap the courage out of the authors as evil rears its horned head and plagues descend upon earth. One gets the clear message that evil is defeated, but on the way down is throwing some hard punches.

Which is pretty much how the week has gone. The doctor's strike looms and sadly the poorest will pay with their lives for the intransigence of the dispute between the government and the doctors over pay and work hours. The Friends of Naivasha NGO that encouraged us to plunge in at NSCH finished their planned project and in a surprise to us moved out of their hospital office on Wednesday.  We had a rotation of interns and my Paeds colleague went on leave meaning a lot of transition on the team, with some significant unhappiness expressed to me about my style. A child I was so happy we made a quick accurate diagnosis of intussecption (intestinal problem) on went to surgery and then when I looked for him, I found he'd "complicated" and been transferred (often a euphemism for death, so I was kicking myself for not doing the right thing). Our tiniest preem died. And other sick babies. Wednesday was just a rough rough day. Evil punching.

But we are to be people who can look ahead. That's why we have books like Revelations. We don't minimize what is wrong, we lament it...and then we put it in perspective. These are the punches of a defeated power. We mourn and move on. And particularly in this week, we look in between those easily seen discouraging events for the glimpses of grace at the fray.

So in spite of every evidence to the contrary, I asked my team to each say something they were thankful for today. Soon the day seemed less bleak. And we found some reasons to celebrate. A, pictured above, was discharged. The baby is 3 months old today and has been in NBU her entire life. She had Congenital TB, and her mom nearly died from her miliary TB, yet there they are smiling and improved and heading out the door after months of touch-and-go struggle. And just as I started this post I got hopeful news that baby C with the intussecption and gangrenous bowel was alive at the main referral hospital KNH in Nairobi and potentially can recover. Then I came home to find two neighbor kids playing with our puppy and felt thankful for the way Nyota has opened up some interaction with kids. 

So, happy Thanksgiving to all, even if evil has been punching you lately we hope you can look up to see the good news that it all ends well. 

Defeated but Punching: Thanksgiving that Good triumphs over Evil

The Scripture readings on our annual plan come largely from Revelations, Daniel, Psalms and Isaiah this week. Mysterious dreams that sap the courage out of the authors as evil rears its horned head and plagues descend upon earth. One gets the clear message that evil is defeated, but on the way down is throwing some hard punches.

Which is pretty much how the week has gone. The doctor's strike looms and sadly the poorest will pay with their lives for the intransigence of the dispute between the government and the doctors over pay and work hours. The Friends of Naivasha NGO that encouraged us to plunge in at NSCH finished their planned project and in a surprise to us moved out of their hospital office on Wednesday.  We had a rotation of interns and my Paeds colleague went on leave meaning a lot of transition on the team, with some significant unhappiness expressed to me about my style. A child I was so happy we made a quick accurate diagnosis of intussecption (intestinal problem) on went to surgery and then when I looked for him, I found he'd "complicated" and been transferred (often a euphemism for death, so I was kicking myself for not doing the right thing). Our tiniest preem died. And other sick babies. Wednesday was just a rough rough day. Evil punching.

But we are to be people who can look ahead. That's why we have books like Revelations. We don't minimize what is wrong, we lament it...and then we put it in perspective. These are the punches of a defeated power. We mourn and move on. And particularly in this week, we look in between those easily seen discouraging events for the glimpses of grace at the fray.

So in spite of every evidence to the contrary, I asked my team to each say something they were thankful for today. Soon the day seemed less bleak. And we found some reasons to celebrate. A, pictured above, was discharged. The baby is 3 months old today and has been in NBU her entire life. She had Congenital TB, and her mom nearly died from her miliary TB, yet there they are smiling and improved and heading out the door after months of touch-and-go struggle. And just as I started this post I got hopeful news that baby C with the intussecption and gangrenous bowel was alive at the main referral hospital KNH in Nairobi and potentially can recover. Then I came home to find two neighbor kids playing with our puppy and felt thankful for the way Nyota has opened up some interaction with kids. 

ON SALE ... Two days only

Jennifer's 2nd book ...

Only until the end of the day on Friday...

from New Growth Press for only $8.79

CLICK HERE to go to NewGrowthPress.com and order...

World Preemie Day

World Preemie Day should also be called Heroic Moms' Day. I told the 40-some mom's of babies admitted to the newborn unit that we were celebrating the survival of premature babies today and asked these four if I could take their pictures. Because behind every surviving Preemie is a mom who suffered the pain of birth and the shock of the unexpected timing. Who gets up every 3 hours around the clock for months to squeeze milk from her breast and pour it through a tube. Who prays, grieves, hopes, strives.

The top picture is our current tiniest baby W, born at 980 grams. She's a week old and fighting on, with pink shriveled stick-like limbs and as you can see an occasional outburst of protest. The second baby P we have nearly lost several times in the last 3-4 weeks, with infections and a connection in her heart that should close at birth but sometimes doesn't in preems. I know how the night has gone from this mom's face when I arrive. The third is our rock star baby V. When I started I found her having been revived over and over by the nurses. She was born at 26 weeks and weighed 900 grams. Now she's close to tripling that and has moved into the less acute room. And at the bottom is little R, the only surviving triplet born at 29 weeks. He'll be 2 weeks old Monday and we are really pulling for him. It is not easy to mourn the loss of two babies (the two girls died between the delivery room and admission but the boy, who was the smallest and sickest looking, somehow held on) while caring for a third one.

Today we salute the survivors and solemnly remember the many we have lost. Each story gives us hope that we can improve care and see more smiling moms. Jesus gave special attention to the smallest, the weakest, the most vulnerable. I think these babies will be sitting at the head of the table at the feast of the Kingdom!

A week we would rather not live again

In the last week we have:

• Prayed and wrung our hands over sickness and injury in our kids far away. 
• Had a break-in our last night in our 6-week guest house stay. Clever and well-prepared thieves cut security cables and forced open locked suitcases to steal both our computers and all Scott's camera equipment, a decade of investment. Though they rifled through everything else, they left inconspicuously with a suitcase so we are grateful that back up hard drives including thousands of photos were left behind. However you aren't hearing much from us. I am typing this with thumbs on a phone. Doing our jobs with no computer is not easy. The tenuous cellular connection makes it even harder. 
• Moved, more rapidly than anticipated into our nearly finished home, which we love. But moving is a very disorienting process.  Trunks of junk ccovered in a year's dust from storage. Realizing we don't have pillows. Or blankets. Or food. We are making progress but it has been exhausting. 
• Woken up the morning after being robbed to very unexpected election news and a national outcry. Watched coverage of post-election violence. Listened to people poised to abandon the American democratic system. Listened to gracious concessions and welcome by President Obama. Listened to the younger generation's feeling of betrayal and fear. Listened to Kenyan friends wonder what will become of immigrants they depend upon.  Listened to others feeling hopeful about abortion. Or smug about winning. Again, exhausting. More on that when I can use all ten fingers to type. 
• Been adopted by a puppy. Yes our first morning in this house, a whining little 5-6 week old puppy followed us home. It's our job and heart to notice the helpless and respond to cries. We thought we knew a family who would want her, so we cleaned her up and fed her and in all our spare time moving and working, got her immunized. Only to have the news that the family can't take her. So here we are, with a baby that cries and pees on the floor and wants to be fed and held. But she is cute, and has been a bond with our landlord's son. 
• Dealt with leaks, deliveries, mistakes, broken appliances, workmen,  and all the usual trials of making things work in a broken place. 
• Walked through daily ward rounds and work, preemies dying, and all the usual struggles of a place like our new hospital. 

So yes, let's try not to repeat this week.

On the other hand...

• Scott celebrated his birthday by hiking Mt Longonot with Bethany and me, four hours up and around the crater, breezes and sunshine and conversation. And raising money for Friends of Naivasha to hire nurses in outlying clinics, to ease the overwhelming burden of patients (about a baby an hour born here, around the clock, 365 days a year.)  A beautiful day and a worthy cause. 
• Friends rallied to join us in celebration, including a cake and sponsoring our walk. 
• Our new neighbors have been friendly and helpful. 
• My Paeds colleague said goodbye for a 2-month leave, but in the process warmly affirmed my partnership with her, which meant a lot. And an acquaintance at church told me how much his aunt, admitted to Scott's care,  appreciated his effort. Little affirmations that mean a lot. 
• Two of our kids went to Herculean efforts to intersect over the weekend. When you are far and inaccessible, it is very encouraging when kids try so hard to be family to each other. 

I suppose the take home message of the week is, life does not proceed smoothly along the paths we would choose. But a caring, supportive, connecting community makes all the hard parts survivable. 

Praying that those who feel desperately disenfranchised by the election find power and meaning in caring together. And those who feel hopeful for their agenda and priorities will look around to lend a hand and understand those who do not. And that the insanity of riots and fear will give way to clarity and love. And that we will survive this hard week and, in the words of Luke 21:19 in yesterday's reading:

¹⁹By your endurance you will gain your souls.

The Spiritual Discipline of the Present Moment

For many years, we have learned the peace of living in the present moment by watching our kids play sports.  Many things contribute:  the setting, outdoors, sun and wind, a taste of God's presence.  The kids running and giving their all, a taste of God's joy.  Sitting with fellow-parent friends, catching up, a taste of God's community.  Focus on what is happening in the now, preferable with no distractions or other places to be.  Now that the Masso kids are who we have closest to hand, we have to add plays and concerts to sports.  Enjoying watching kids do their best, and cheering them on with people we love.

So in an otherwise hard week, driving back over to RVA for the last home game of the boys' football season and for the dress rehearsal of this year's drama, served some healing purpose.  On Thursday evening, we were able to celebrate Madeline's birthday and pray over the Shirks as they head on HMA, then sit with team to watch the dress rehearsal of "The Mouse that Roared" with Gaby in a significant role.  (Really loved the play, humorous and creative and the story line kind of appropriate in a country that was colonized and a school that is so USA dominated).  Friday we came back for the football game, sat with parents whose daughter and son played on teams with ours.  What a kindness to relax into that community again.  The boys won in a closely contested and hard-played game.

Here are Scott's excellent photos, with a plug for watching kids in sports and drama and music when we need to settle into the NOW.

On Contentment, and the Gentleness that makes others Great

I think it is a measure of life's edginess when Bible verses consistently jump off the page.

Though our week at the hospital was shortened by the Litein/Kabarak trip, the three days felt like an age.  Last week we had a team of 2 consultants, 2 Medical Officers (finished their internship), 2 Interns, and 7 clinical officer (like PA) interns.  It's a challenge to interview, examine, write notes, draw labs, think about 80+ patients while teaching with a team of 13, but it's nearly impossible with a team of 3, which is what happened Thursday morning.  Some of that was beyond my control, murkily shifting hospital assignments, people sent to seminars, a funeral.  But the cluster of the youngest trainees abandoned me en masse after I seemed too impatient to start rounds at 9 am, and asked if they would be able to take vital signs on patients before the 8 am CME that happens twice a week.

Fail, again.  The social shaming of the group action, I found, is quite painful.  I didn't think I was being unreasonable, but in their view I was, so they just held back in the nursing station while I worked on alone, then left.  So the one remaining intern, one CO who broke ranks, and I were left to plow through the day's work.  We split directions and did our best, which it turns out wasn't good enough when a patient I hadn't seen due to the division of labor died in my hands 24 hours later.

They were all back the next day but not speaking to me when I tried to understand what had happened.  So after the first room of patients, I asked my consultant colleague to mediate and help me.  We all stood in the hall, and she calmly got them to talk until it came out.  They felt pushed.  When pushed, the culturally acceptable response is passive-aggressive.  They left.  My colleague wisely led a discussion then of how we could get our work done, and suggestions were offered all around (though coming to work before 8 is clearly not one of them).  I apologised and asked them to forgive me.

After 23 years in Africa, you would think I would get it.  But the characteristics of a good doctor:  tenacity, demanding excellence, willing to go the extra mile, task more than time oriented, modeling and expecting 100% effort, advocacy for patients . . . are pretty much in direct opposition to some of the qualities of a good missionary:  flexibility, seeking relational peace more than particular outcomes, accepting completely different ways of doing things, uncritical.  Jesus would know how to hold both true at once. I'm struggling.  It's a system that teeters on the edge of dysfunction at all moments, and holds together by the slenderest margins that have evolved over decades.  And I keep sending waves of disequilibrium.  Deep down, I know that Thursday morning was not a moment of shining light.  I was feeling the burden of abandonment, operating from pride, making assumptions, not listening.

I don't love the passive-aggressive collective-withdrawal nature of African politics, but I get it.  And I do love the readiness to negotiate, to listen, and to forgive.  By Friday afternoon, the two ring-leaders who instigated punishing me were instead smiling and helping me.  Deep breath.  I still feel tentative, and a bit foolish.  Unworthy of being an Area Director when my language and culture skills are so poor.  And all this came on top of finding out we couldn't move into our house this weekend as we had been hoping.  Still not ready.  Another week in the "dorm".  It wears one down.

Which brings us to the morning's Bible reading from Philippians 4:

For I have learned in whatever state I am, to be content:  

I know how to be abased, and I know how to abound.

Wow.  I thought we were living quite simply with grace, but when we got past a month with no sure end in sight, it wasn't easy.  When I was actively abased, it wasn't easy.  The passage goes on:

I can do all things through Christ who strengthens me . . 

And my God shall supply all your need according to His riches in glory by Christ Jesus.

The cooperation and functionality of trainees isn't our strength.  Having friends, being liked, having a home, being settled, aren't our strengths.  Those are good things to work towards and ask for, but in the meantime faith means believing that all our real needs have been supplied.  I don't have to badger people or struggle, because Jesus has us in hand, connects us to the riches of God's glory.

Would you pray for us to believe that and live in the strength of contentment this week?  Another verse from Psalm 18 this morning says "Your right hand has held me up, your gentleness has made me great".  I want to be a person of gentleness that makes others great.  Lord have mercy, that's a tall order, but worth asking for.  Thanks.

Litein Hospital and the Kabarak Family Medicine Residency Program

Litein Hospital began as a western Kenyan AIM mission outpost amongst the Kipsigis people in 1924, with a slowly growing medical and community health ministry since 1932.  We were invited to visit with potential new missionaries, and I have to say the visit was extremely encouraging.  Pictured above, the old hospital which is now a training school for nurses and lab technicians.  

Here are a dozen reasons that we would like to see a new Serge team in Litein:

1.  A long faithful track record by senior Kenyan staff.  Dr. Munala, the medical director, came in 1990.  26 years later, he's presenting the new Vision and Mission statements to us, with a strategic plan for growth.  The Hospital Director has been working persistently since 1979.  But these men aren't done.  They are dreaming big.

2.  In the 15 years since missionaries were last involved, the Kenyans built a brand new 150-bed modernized hospital.  To serve their own people better.  They aren't waiting for others to do things for them.  This is a place where true partnership is possible.

3.  This year, they hired a newly-trained PAACS surgeon (the Christian surgery training program that Kijabe and Tenwek participate in).  Dr. Blasto inspired us with his passion for teaching and excellence.  He wants to pour into the younger trainees in the same way he was mentored by missionaries.  He's a leader we would love to work with.

4.  A strong foundation of compassion and commitment.  The spirit here was palpably different than we've seen in many places.  These people take Jesus' words seriously.  One of their core values is to NOT TURN ANY PATIENT AWAY, based on John 6:37 (All that the Father gives me will come to me, and whoever comes to me I will never cast out).  

5.  Bright, ventilated, well-maintained spaces.  The new building has been used for about 7 years now, and we liked the design of the wards, the cleanliness and openness.  Also if you look closely, there are VITAL SIGN charts on the beds, with actual vital signs recorded.  The theatres are spiff, and thanks to one of the Kijabe-trained Nurse Anesthetists who went out and asked and advocated, they have some good equipment.

6.  Boldness to push the limits.  This HDU (high dependency unit)  has two monitored beds, oxygen, even a simple ventilator.  The man under the pink blanket had been saved by an emergency thoracotomy (open the chest) surgery the night before, when he came in with an arrow sticking out of his chest.  The tip went right into his left ventricle.  Most places he would have died.  But he was recovering well, thanks to quick surgical care.

7.  Opportunities to teach.  This is a class of nursing students.  There are 7 Medical Officer Interns (just finished med school, so young doctors) and 10 Clinical Officer interns (equivalent of PA).  The vision is to place two Family Medicine Residents here as well.  As the interns introduced themselves, over and over they asked for teachers to come and work with them.  They want to become good doctors.

8.  Medical needs.  The hospital was bustling.  We saw full wards, patients waiting to be seen, education going on, immunizations being given, specialty services like dental and ophthalmology.  Nearby government facilities refer to Litein.  There is a long history of community involvement and outreach, so the patients know and trust the place. 

9.  Wisdom and innovation.  These two run the OVC (orphans and vulnerable children) program.  Instead of collecting more kids into the nearby orphanage, they monitor them within their extended family, providing nutrition, school fees, psychosocial support.  This is great, evidence-based, truly helpful care.  Next door on this hallway there is a nurse doing a study on the impact that ARV's are having on quality of life for people living with AIDS.

10.  Climate and community.  Though the housing hasn't had an upgrade since the 1940's . . . there is space and will to do so.  The elevation means pleasant days and cool nights, surrounded by rolling green hills and tea fields.  It's a moderate town in a rural area, but accessible to Nakuru (where there is a Java house and shopping).

11.  Broader East/Central Africa impact.  Here Scott talks to Gad from Burundi and Musa from Eastern Congo, two of the poorest and least healthy places on earth.  The residents who will train at Litein are not just from Kenya, but from even needier places.

12.  Being part of the future of medicine in Africa.  Less than a quarter of medical school graduates have the opportunity for training beyond internship.  Yet only a year of internship, much of that in places poorly equipped for supervision, does not adequately prepare doctors for the breadth and depth of skill they need.  The Kabarak Family Medicine Residency is a pioneer effort to give young doctors four more years of intensive education and supervision, so they will be equipped to handle the majority of medical care (broad hospitalists), have a solid foundation in discipleship as servant-leaders, and gain a holistic view of working with people and communities.  Right now our teams in Kijabe and Chogoria are part of this program, but we need more clinical sites.  Litein seems ideal.

Though there are many logical reasons this makes sense, we ask you to pray for God's leading.  Particularly for the young couple who visited with us, for clarity.  And for team mates if they are to come.  We do see some of those fingerprints of God as we look forward.  As we drove in, it dawned on me that I had prayed for Litein because former OPC missionaries Lois Ooms and Dr. Griet Rietkerk worked there for a period of time.  Dr. Rietkerk was the woman whose talk to my church's Pioneer Girls group when I was 8, about medical missions in Eritrea and Kenya, God used to grab my own heart.  So in realising that this was a place she had worked, and meeting some of those she had worked with, more than 4 decades later . . . well, we sensed God's smile.  

We could use primary school teachers, family medicine doctors, nursing professors, pastor/chaplains, OB/GYN's, hospital administration or resource-mobilization types.  Give us a message if this post stirs your interest.

Kenya on a Saturday

A perk of being an Area Director:  we sometimes get to host potential new missionaries, people who have sensed God prodding them to consider the broader needs of the world, and take their own time and money to visit our teams.  This is pretty great on several levels.  Connecting with people walking the paths we stepped onto 25 years ago (we went through Assessment and Orientation in October of 1991) puts some meaning to a lifetime of struggles and joys and mistakes, and when we find so much in common it makes us feel less peculiar.  We rejoice in potential saving grace pouring into lives on both sides of the oceans.  And we get a great excuse to show off the beauty of Kenya on a Saturday.

The next four days we'll be with a doctor-doctor couple from Mississippi.  We've already found some amazing parallels in our stories.  Today we took them around Naivasha District Hospital, to Java House for amazing Kenyan coffee, then out to Crescent Island, a local private wildlife sanctuary.  (Extra benefit:  coffee and sunshine both cure jet lag).   Here are Scott's photos of the afternoon, to bring beauty into your day as well, to remember the creativity of God, and to prompt the next exploratory vision trip for more Sergers.