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Monday, February 27, 2017

Kenya Doctor Strike, losing track of the weeks, but finding holy moments

And so the days go by in a blur of exhilarating craziness and dreary defeats.  The futility of pouring one's soul into one admit after another that dies.  The humbling realization that trying to hold up this service by pushing on through day after day does not guarantee better care than the mediocre chaos that preceded the strike.  Glimpses of victories.  Squeezing in the rest of life mostly between a late dinner and midnight, calls, emails, work.  Trying not to think more than a day ahead, even though that means we are no doubt very frustrating to the people we are supposed to be visiting for supervision, encouragement, and exploring opening a new team/field in March.  As in next week.  And mostly, in case you don't have time to read this ramble, realizing that the relational depth we are plumbing with God and humans is the real story, as lives come and go.
(going home tomorrow, day 51 of life, a 27-week preemie survivor)

It's hard to think back more than a few days, too much water under the bridge.  Saturday started out with my usual peek into Newborn Unit before heading to ward rounds.  Nurses seem to be doing CPR.  I walk all the way in and find a very mottled, dead baby with zero response.  As soon as I help they leave me to do the chest compressions and ventilation alone while they get the medications I ask for, and some information from the file.  Mom had just come in to feed and found the baby dead. A full term infant who aspirated meconium at delivery, but as per the file had been breast feeding and stable.  It is my first time to see this baby, and it's too late.  There is no reviving her, dead too long.  Thursday I had almost the same experience, I was examining one baby and looked over at the one sharing his bed . . who was grey and lifeless.  That one I got back with CPR and meds but not for long.  After an hour or so the responses become less and less, until there was no heartbeat at all.  Two in three days, both good sized term babies admitted the evening before, dead in the morning.  Either their critical condition and hypoxia were not recognized (since we have only 1 monitor to spot check 20-30 babies, that's understandable) or they crumbled from a rising overwhelming infection, or choked on a feeding?  It's a depressing way to start the day, comforting a grieving mother.  But there are probably 40-50 patients a day to be seen, examined, touch base with the parent, write for adjustments in treatment, draw labs or review results, discharge a half dozen and admit another half dozen.  So we go on.

But the frequent futility puts that puzzling book of Ecclesiastes into perspective.  So much seems to be in vain.  Still delving into Keller's Every Good Endeavor, trying to embrace this season and what it has to teach us.  Not just a temporary insanity to be muscled past, but an invitation to shape our work as God works.  For wholeness and newness and beauty, requiring sacrifice . . . but not necessarily demanding tangible results.

Because I want those tangible results, which in my work's case are actually lives.

Could it be that God is offering glimpses of something bigger?

A few hours later, I'm looking at a baby who has been with us all 37 days of her tiny preemie life.  Many of those days have been tenuous but on Saturday she's plunging downhill fast.  Her heart is beating at an unsustainable 225 beats a minute, and when I first check on her her lips look blue, confirmed by oxygen saturations of 77% (should be high 90's).  Her blood shows signs of another mounting infection, even though she's barely been off antibiotics more than a few days in her life.  An x-ray seems to localize the source to her gut, necrotizing enterocolitis, a dire complication.  My kind Kijabe friend what's app group responds to my enquiries with advice and rising alarm.  She may need surgery, which at this strike moment would not be available anywhere else but Kijabe.  But her mom has no money or insurance, her dad is unsteady with alcohol, and I'm afraid to put her in an ambulance looking so unstable.  Fluids and antibiotics and by mid afternoon she's marginally better, so with the gracious invitation of Kijabe's generosity we risk the ambulance ride kangaroo-style (on her mother's skin for heat).  Before she leaves, all the moms are in the unit feeding, and this baby is such a precious little long termer that I decide to ask them all to pray with me for her, explaining in my halting Swahili the problems.  We pray, I am feeling pretty emotional, then open my eyes to find her mom with tears streaming.  That, I realize, is a holy moment.  What it's all about.  The community of mothers, praying.  The teamwork of the public and mission hospitals. The mother of the sickest baby sensing God's provision, presence, support.  Running to the end of our resources, and desperately asking for survival.  And all that for something so small and fragile as a 3-pound baby.  We load her into the ambulance with our last tank of oxygen, and I hear later she's made it just in time.  The infection is indeed serious, but we have hope she will make it.

About 5 pm, thinking my semi-off Saturday couldn't get much worse, my hand is literally on the exit door with Scott when a midwife runs out to ask us to come see a mom 28 weeks pregnant with triplets.  Sometimes it's so crazy you have to laugh or scream.  Really?  She's in active labor.  We recruit one more nurse to double the Newborn Unit night staff, start assembling three oxygen delivery systems (tricky since we are out of tanks completely, so it's beg and borrow enough concentrators) as the babies start coming.  Scott ferries them from the delivery room to the Newborn Unit.  The first two are identical girls, sharing a placenta, 820 and 960 grams. They are followed by a big brother.  I line them up and keep passing the bag with oxygen to inflate lungs up and down the row until the nurses can get the CPAP's bubbling.  It's after 6 when an angel of a CO pops in, this young woman has miraculous IV skills, and as I'm preparing a little surgical procedure for 3 umbilical lines she just slips in hand IVs.  Hooray.  Teamwork.  Another holy moment, three tiny lives holding on because of two nurses, a clinical officer, and me, helping each other.

Sunday . . . Scott's in at 4 am and 6 am for emergencies; I'm early to church to practice for helping with the worship team.  As soon as the service is over we head as quickly as we can to Nairobi.  The day before, our dear friends' father had been admitted to the ICU at one of the best private hospitals. Michael and Karen are there with Michael's mom waiting, while his dad goes into surgery for a triple coronary bypass after a devastating heart attack.  The senior Massos had recently retired from a 15+ year term of service teaching at a Christian University in Nairobi and founding a home for street boys on the side, but were back to sell their house and transition to more of a frequent shorter term pattern of ministry.  We sit outside the operating theatre as the risky surgery goes on, sharing some stories and memories and Psalms and prayers with the family and a handful of Kenyan adults who were once in their program.  As the hours go by, and the report is only "we're trying to get him off the heart-lung bypass machine", we all become more and more sober.  Finally about 5 pm the surgeon comes to the door of the theatre hall, and beckons Michael and his mom.  He looks tired. The setting is surreal, through a cracked door, he tells us that Mr. Masso is dead.  Sobbing tears, disbelief.  Holding onto each other.  More scripture, and prayer, and a raw sorrow balanced by the truth that this dad lived life fully and well and died in the midst of doing exactly what God called him to do.  It is dark as we finally head home with Karen, still communicating with family over the globe.  The day is unbelievably draining, but holy as well, cutting to the core of family, of love, of friendship, of faith that stands in the room with a dead body hating death and separation, yet says goodbye knowing we will be reunited.

Monday, back to the hospital, an emaciated child, another with the listless swelling of chronic malnutrition.  Two of the triplets have died but the tiniest one fights on.  Tubes of blood drawn, listening to lungs, palpating, thinking, empathizing.  Scott pushing to get emergency c-sections done, made doubly difficult sometimes by the foot-dragging of others.  Hour after hour, again the day slips away, and I walk back onto the ward one last time to deliver a lab result I've just checked, when I hear a nurse talking about intubation and see a clinical officer intern trying to do CPR.  It's a 2 year old with severe burns, and there goes another couple hours of maintaining his airway and breathing while we sort out a way to send him to the ICU at Kijabe.  Once his heart nearly stops.  He'd been treated overnight at a small private local clinic, not a good idea, since he's nearly un-save-able by the time he arrives.  And while I'm bagging his lungs with oxygen, I hear from Scott that there's a mother in labor with a premature baby with a prenatally diagnosed intestinal obstruction.  You actually couldn't make up this much crisis if you tried.

So what is bigger than a few saved lives?  Perhaps it is building trust with coworkers I used to command/ criticize, learning to value cooperation and acknowledge how much we need each other, which has the potential to save many more lives.  Perhaps it is living a small glow of light that says God is present, even on dark days of a father's death, a child's burn, a baby found without breath.  Perhaps it is faith to believe this is not all in vain, even when it looks that way.

Please do pray.  It would take a miracle to end the strike this week.  We are supposed to leave for Congo, Uganda, and Burundi on Sunday.  We feel very conflicted about walking away.  Our hearts mostly want to keep at this work. But we also have committed to other work.  Pray for wisdom.


Charles Woernle said...

Nawasalia nyinyi.

JLAkin said...

Read this post that was forwarded by a good friend and previous missionary there. My daughter and I were blessed to be able to visit them at Rift Valley and as a NICU nurse who had just recently started back nursing after the death of my husband, one of highlights was our visit and then the opportunity to help out a few days in the NICU. Tears rolled down my eyes and I prayed for you for the babies, for the families, for wisdom and for God's grace to be poured out and become evident in the midst of suffering. I will continue to be praying. Grace to you and peace from the knowledge of God and of our Lord and Savior, Jesus Christ. Jeri Akin

john smith said...

I have a tumor type thing in my spine, a srynx, the surgery was done over it brisbane