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Friday, October 14, 2016

Like breaths of wind

The psalmist says, what are mere mortals?  They are like a breath of wind, their days pass away like a shadow. (Psalm 144).  This comes in the midst of a plea for God to act against rampant injustice. When one works amongst the poor, lives do feel like breaths of wind sometimes, unseen, passing, leaving a little ripple of joy and sadness but elusive to hold onto.

If there is one word that describes our patient population here, it might be vulnerable.  This week alone I have a 5 year old girl so malnourished her skin is breaking down, her plummeting protein levels mean that fluid leaks out of her blood vessels and puffs up her face and feet.  A teacher (hooray for alert and kind and action-taking teachers) noticed her following older siblings to school daily and begging food.  It seems her mother left the family with an unemployed alcoholic father, and she's starving.  Or a twelve year old who was caned so severely at school (for fighting with another kid), made to strip off his shirt and lie on a table for a beating that has left him shaken, refusing or unable to walk or talk.  Or babies born on matatus, a baby whose HIV-infected mother initially didn't want to keep him (she's changed her mind!), a premature baby whom I resuscitated for a day but once I left he died, a baby with a severe heart defect.  A one-year-old who seems to have become blind when severe diarrhea on top of her malnutrition left her dehydrated and in shock.  An 8-year-old who sat for days vomiting and with half her face paralyzed, until she finally got a CT scan that confirmed a dangerously located mass, probably a tumor.  A mother who came with life-threatening pre-ecclampsia (which is like an allergic rejection of the baby) and due to one thing after another ended up with delayed care, a dead baby, then severe bleeding, and in spite of two surgeries and massive effort, died herself.

One can not walk this part of the Rift Valley under the illusion that all is well.  So many broken families, struggling single parents, unnoticed sufferers.  Women working for a dollar or two a day, trying to raise children.  Or not being paid at all.  Children who are marginally looked after, who are hungry, who are injured by adults, this is hard to take.

And this is only one tiny sub-county in a large and diverse country on a large and diverse continent.  How do we grasp those fleeting breaths of wind, or how do we avoid despair for those that slip away?

First, by remembering a billion reasons to believe.  That's my favorite coca-cola advert, for Africa.  Vulnerable patients feel like so many bursts of breeze.  But in reality there are a billion such lives and together they make a powerful force.  When the senior midwife texts to make sure we're OK after a hard day, when a new acquaintance takes time to tell their story, when we try to teach and see the spark that someone is learning, when we marvel at the ingenuity, sacrifice, dedication, perseverance, vision of our African friends, then we take a deep breath of thanks and hope.  Africa is beautiful, Africa will break your heart, but the best thing about Africa is Africans.

Second, by remembering the larger story.  Psalm 144 describes mountain-smoking deliverance, last-minute rescue, and a future of full barns, no miscarriages or premature babies, thriving children.  All is not well in Naivasha, but all shall be well one day.  We are part of that story as we palpate and auscultate and treat and teach.  We are not passively caught in this tale, we are actively writing new endings, together with our partners and colleagues.  The arc of all these breaths of wind is upward to beauty and wholeness.

Third, by living in that paradox that though we are breaths of wind, our spirits call to God's spirit and we are united, known, seen.  God knows every sad story in our hospital today, and the back-stories.  God knows the challenges of the lady selling pineapples and the guard at the gate, and how they are created for good and for glory.  None of this suffering goes uncounted.  The universe is tilting towards justice on the fulcrum of the cross.  Every tear matters.

And lastly, by living with rhythms of rest.  God can absorb every sorrow and know every heart, but we can not stand unrelenting vulnerability.  An active engagement in the larger story gives us purpose.  But an active turning aside also restores our stamina to go on.  Last weekend we biked around Lake Naivasha.  We passed slums of crowded, cobbled, tin houses.  But we also passed open spaces, graceful giraffes, perky wart-hogs, whistling shepherds, and even (improbably) a herd of camels.  We thank God for the Job-like reminder that His power, creativity, scope is so far far beyond our comprehension, a lesson we always learn in the respite of nature.

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