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Tuesday, July 18, 2017

Earth has no sorrow . . .


This, friends, describes the heart of who we want to be.  A place to bring wounded hearts and bodies, to tell the story of all the sorrows, to find the healing of Heaven pouring down to earth.  So much of that healing comes just by gathering and telling.  And the rest comes by a dimension beyond our wildest dreams pouring, seeping, dripping, splashing over into our broken world.  

So begins another week.  The nursing strike continues.  Babies born at private clinics (private sounds ritzy, but in Naivasha generally means for-profit but not necessarily best-practice care), then bundled over to our Newborn Unit which tries to remain functional.  Four died Sunday.  Four.  Another Monday.  Coming too little, too late, too damaged.  And often passing through hands that don't recognize the dangers. Scott and I keep showing up, keep trying to give input and model compassion and a level of diligence that might make a difference.  Some days it feels futile, or like an uphill battle.  Some days we clap our hands--our 880 gram 26-weeker hit 1290 grams and 31 weeks now.  Another preem who had intractable vomiting and feeding problems for well over a month reached her due date, still tiny and vomiting . . we stopped all her medicines and just had her mom breast feed and hold her.  She's ready to go home today.  Last night on our what's app group, one CO intern got the baby in this picture a spot at our main referral hospital in Nairobi, Kenyatta, for evaluation of her heart malformations.  An off-duty CO intern volunteered to ride in the ambulance with her late at night, since there are no nurses.  Small victories, of medicine and of faith, hard to remember in the face of so many tragedies.

This is a map of Health Care Quality and Accessibility gaps, the darker red the color, the more lives could be saved by provision of health care.  Kudos to the data people, those who try and collect it, process it, publish it.  We need to tell the stories, tell the anguish so to speak, as both real-life babies with names and photos, and as aggregate numbers that put punch behind the vignettes.  This map comes from a Lancet article published last week, distilling death data and health worker availability data from around the world all into an index with a single value per country.  The good news:  health care quality and accessibility are improving world wide.  The bad news:  the gap between best and worst, richest and poorest, is widening, and here on the continent of too much red, we feel it.  Here's a graph from the next volume of the Lancet, that shows how many lives could be saved by straightforward already-discovered health care practices, right here in Kenya alone.  Tens of thousands.

So, getting to the top of those bars, requires some telling of the anguish and some healing from Heaven.  Some collaboration and education and rainfall and good governance.  Some attention and prayer.

First, pray for the upcoming elections.  The nursing strike, the general health care crisis, won't be resolved without strong leadership.  Pray for Kenya and America, to choose leaders who consider others' needs before their own power and advancement.  This was the scene in the grocery store Saturday--people stocking up on maize-flour to be sure they can make ugali, the staple starch, if the elections turn violent and it all falls apart.  We bought a bag too; along with our normal fresh food we threw in some cans.  Our neighbors reassure us that all shall be well, but then we sense the palpable disease at the hospital where people from multiple ethnic groups work together.  Many will go back to their home areas to vote, both because that's where they are registered (aka Luke 2) and because that's where they feel safe.  The elections are scheduled for August 8.  Every day there is another crisis that throws the whole process into doubt.

Second, pray for our partnership and friendship.  These two women I work with reached out to say they wanted to get to know us better.  I invited them for lunch.  It takes time to build relationship in a new place, and the strikes have made that even more challenging.  But as much as we need solid laws and security to provide the stability for development, we need solid connections with real people to build the trust and common vision for lasting changes.  And to keep our weary hearts from giving up.  Theirs too.  
Third, pray for God to move more hearts to help.  We're thankful for our overseas partners who pray, who give, and those who are moved to come.  Note the old CPAP improvised out of a cut water bottle and a lot of tape, with the re-used-forever dingy tubing on the right.  On rounds yesterday we noted once again that there wasn't enough water in the bottle to bubble; that the baby was struggling.  So we replaced it with new supplies brought by two NICU nurses.  Wala.  The spiff clean blue-topped bottle to the left in the photo, where there is a clear "fill to here" mark, and big numbers to dial the depth of the brand new clean clear tubing.  Hooray.  We need supplies, but we need people more.  People willing to be the community in Moore's quote, to move into hard places and invite their neighbors to bring their anguish, to tell their stories.  People willing to be channels of God's healing through truth, through education, through practical services like water and food and medicine.  Aren't sure where you fit?  Fill out this form and Joanna will help you, and us, figure it out.  


This is a lot to believe some days.  But it's something we stake our lives upon.  I like the double entendre of this water drop, a tear most likely representing sorrow, but like Psalm 126 the tear drop can also represent the life-giving water, healing, bearing fruit, the flow of blessing.  The last month I've been reading a commentary on Romans, and comparing it to current events and the tragic history of this continent.  Our world teaches us that to be in power is to force those "below" to serve, so that all that is desirable is pushed upwards to the few.  Jesus turns that upside down, and says Israel the ethnicity and Israel the new broader all-welcome people of God are to be conduits of blessing that flows out, floods down, serves and waters and heals the world.


Including Naivasha.  And Kijabe, Nairobi, Chogoria, Litein. Fort Portal and Bundibugyo.  Nyankunde and Bunia.  Bujumbura, Kibuye. Mundri.  People we love, places we long to see healed.





Sunday, July 16, 2017

2017 Africa Reading Challenge

5 books from, or about, this continent.  That's the only rule.
Here's the site that focuses on blogging about literature and poetry from Africa, which is something we all need more of in our life.

And here are my 5 books (so far) for 2017:


Ngugi Wa Thiong'o grew up in Kiambu county, Kenya, very close to where we live.  He was born in 1938, making him a near contemporary of my own parents.  Reading the history of Kenya as an eye witness account through the eyes of a child is well worth the effort.  I prefer his novels, such as The River Between, for writing style.  However this book offers an important alternative history that contrasts with the more popular accounts of the colonists.  As an American doctor working in Kenya with a mission agency, it is important to me to acknowledge that the history of white people in Kenya is permeated with terrible injustice and tragedy, even if sprinkled with courageous health care and education.  Thiong'o recognizes the struggle of Kenyans to speak, to control, their own education and future.  Worth the read.





This read I can best describe as painful truth.  Gyasi tells the sweeping epic of hundreds of years of history by following two branches of a fictional family through generations, until they meet again.  The chapters are named for key characters in the lineage, and she uses certain images of water and fire to connect the stories.  The author is Ghanian-American woman, and a very very talented writer.  She deftly weaves West Africa with the story of enslaved people brought to America, both in the South and in Harlem.  As hard as the stories are, she draws you in with her empathetic ear for dialogue and her vivid descriptions.  The sexuality in this novel is mostly violent or tragic.  She does not gloss over the horrors of war and slavery.  This is not an easy read.  However the ending I found hopeful. My favorite genre is "dark and redemptive" and this novel fits.  Because that's the story of the world.





This book is a collection of short stories that read like a chat around the campfire.  Arensen grew up in Tanzania and Kenya and then worked in Sudan.  He draws upon a lifetime of adventures to paint life in East Africa in its beauty and drama.  This is a generally positive view of this part of the world.  Arensen can be funny, and he has a real talent for taking what seem like normal incidents of daily life and making them interesting enough to read in a book.  Some of his family still live near Naivasha, which makes this even more of a treat.











I have to admit that I ordered this book hoping for another meaty, long read by Adichie ( I did notice the price was surprisingly good, so that should have been a clue, and mine didn't have the nice red tag "short" on the cover).  I read Americanah a few years ago, and some of her other books prior, and wanted more.  Instead it is a very tiny volume that basically reprints a TED talk.  That said, I think it's worth a quick read.  Feminism from an African standpoint is survival.  It is about justice.  It is where the rubber meets the road in the Gospel stories.  She is forthright and sensible and thought provoking.   Nigerians and Indians are saving the English language in my opinion, the greatest talents are coming from those countries.  This isn't lyrical like her novels, but still a good short read to listen to another's opinion and story.




Surprise!  The last one by me.  Sincerely I have read this book about five times in the last few months of editing, so it definitely counts, even though the publication date is still just over a month away. Quality literature written in and set in Africa, about contemporary continental challenges, with African kids as heroes, needs a wider audience.  Please buy a few and send them to your local library or school, or give them to your kids or grandkids.  This is the third in the Rwendigo Tales series.  Each book relates loosely in characters and setting to the others, but can stand alone as well.  As with the others, the Read A Story, Change A Story benefit of royalties to enable real kids to write new endings still applies.  Hope you enjoy.  Available for pre-order at Amazon or New Growth Press.






You can link to the 2017 African Reading Challenge web site for more suggestions, and feel free to leave comments here on what your favorite African reads of this year might be.

Thursday, July 13, 2017

Kenya Nursing Strike, is anyone paying attention???

The public sector nurses went on strike six weeks ago.  Has anyone noticed?  The poorest once again lack health care, lack immunizations, lack labor and delivery services, lack options for ill family members, lack supervised TB therapy.  I googled and found only two news stories this week, here and here.

So, a little eye-witness reporting.
This baby's brain may never recover from the strike.  His mom came to our hospital three times last weekend, having been turned towards public care after a private clinic found her with dangerously high hypertension and bleeding (and probably not enough money) . . . but all three times she was sent away because of the strike.  The fourth time, she met the requisite standard for inevitable delivery (6 cm dilated) so she got to stay, but her labor progressed so slowly and the baby's distress was so unrecognized, that he was born in critical condition.  Because our hospital is trying to keep some minimum emergency care available, our medical director has hired some non-union temporary nurses.  But partly out of solidarity with the strikers, and their concerns, the temporary nurses still follow guidelines agreed upon to make it clear that this is not a normal situation (like not admitting anyone in labor until they are 6 cm dilated).  And partly because the funds for hiring nurses are limited and they have to cover many areas with few people, the care is not as good as normal (and normal is still very far from perfect).  I suppose the politicians are supposed to notice, but in reality the babies pay the price. And the moms.  After only two maternal deaths in the 9 months we worked from October to June . . there have been two maternal deaths THIS WEEK.  



As you can see, our newborn unit still has babies, moms, student nurses.  Because in Naivasha, the private care paradoxically lags far behind this public hospital. So the sickest babies, even if born at a private clinic, find their way back.  I had one die this week who would have been born here were it not for the strike, but instead had substandard private care and arrived too late to save.


In a few months or years, who can count the cases of tetanus and measles that will spread through Kenya because the entire vaccine system has been disrupted?  Some of the private clinics are trying to make use of the otherwise-expiring public stores . . but charge 100-200 KSH (1-2 $) as a service fee for administering them.  That's a daily wage for most of our clients.  A huge barrier.



So we have our most trusted senior nurses sitting at home, frustrated, asking that the government legally sign the agreement they wrote months ago.  We have the governors saying that paying each nurse an extra $250/month will break their budget (remember the average wage here is about $60/month).  We have the central government trying to deflect any attention from this health crisis in order to focus on staying in power through the upcoming election.  We have hospital administrators trying to eke out some minimum services.  We have doctors, and those in training, trying to care for patients and learn, which is not possible without nurses on the team.  We have public health faltering in delivery of vaccines, HIV and TB drug programs, school programs, the backbone of health all run by nurses.  We have parents who agonize over the lives of their children with no ability to pay for private care.  We have half our normal load of patients, knowing that the other half aren't well, only excluded.  

And most ominously, we have the psychological discouragement of a fragile system that limps along with inadequate resources.  I read a Kenyan proverb today:  Hope is the pillar of the world.  But hope is fading, and the world is shaking.  I see it in the trainees, those who sat out the doctor strike have never quite recovered, coming later, leaving earlier, demoralized and unmotivated.  Those who wanted to dedicate their lives to public service feel unseen and unheard.  Participating in a system that feels antagonistic and uncertain leaks the life out of us all.  This week a senior surgeon in our area was found dead in his home.  The strikes take a toll on mental health of providers, too.

So once again, we ask that the world not forget Kenya.  That the government work towards a solution.  That God intervene in hearts to bring real healing and peace.  That miracles continue to fill the gap between peoples' needs and available care.  That we have wisdom to walk in this murky situation, shining a little light.  Thanks for listening.


Wednesday, July 12, 2017

In whom I am well pleased

Our youngest dropped in for a few days, between his semester-in-six-weeks studying French in Aix-en-Provence and his semester-in-four+-months studying engineering in New Zealand.  He came bearing some French goodies like local cheese and scented soap, and full of stories of his adventures in language.  We hiked our local volcano, and by the wildlife-laden lake.  We worked on visas and finances.  We hosted a few of his friends.  And we cheered in the alumni games as his class returned (40 of them!!) to RVA to touch base with each other and teachers and dorm parents after two years of dispersion.  And then, all too soon (we had about 6 days of intersection) we took him to the airport once again.


Neither Scott nor I were ever youngest children, and there are unique joys to each birth order position.  But three years ago it was just the three of us through Jack's senior year, and this visit was a bittersweet memory of that time.  The phrase that comes to mind is God's voice over His own son, affirming the PLEASURE of watching someone you love mature, thrive, speak wisely, strive passionately, hug warmly, laugh freely, run fast, and live thoughtfully.  Visits are a glimpse of a life that was, and will be.  A sip of a delicious unity.  A treat of joy in presence.  As much as we would like them to go on and on, we acknowledge he's off to the life God is giving him and we TRY to remember to just gratefully accept the days we have.

So .. enjoy a few phone photos below, and pray for our faith as we trudge on with our empty nest, until the next visit.  Nothing like being a parent to make one long for the no-more-tears of eternity.  And if you're struggling with whining babies, wild toddlers, weepy teens or anything in between, take a deep breath. They're going to turn out amazing in spite of all of us, our foibles, our dragging them into wars and diseases and our own sin.  Because this is not just our son, he's God's son, and we are all pleased as we see the glory shine through.















Tuesday, July 04, 2017

On Just Mercy, and Creating Noise

Yesterday I was walking down the hospital sidewalk with a Kenyan friend and colleague whom I greatly respect.  She talked me off the ledge last week, and I value her wisdom.  I was lamenting that one of our discharged NICU preems was still in her cot; she has been held hostage for weeks now over inability to pay her bill, even though costs here are quite low with government subsidies.  She doesn't even look like a preemie any more as she gains and grows.  My friend said something along the lines of, well, I used to try and advocate for individual patients, but I found it just created noise.  In other words, be quiet and let the system (slowly) work, because if you call attention to the dysfunction it just generates ill will.  Focus on the places we can make an impact, like this afternoon session teaching "Helping Babies Breathe" to our interns.


She's probably right.

As God is my witness, I've generated some serious ill will lately.  The week before I had bugged social work and hospital administration repeatedly over the cases of two other kids, both with AIDS, from desperately poor families struggling with their own illnesses.  I could feel the hostility.  Then I spoke up, in what I thought was an appropriate, anonymous, and systems-improvement-oriented manner, about some gaps in our own team's care which I believe contributed to a death and could have resulted in several more.  Gossip and assumptions percolated until I got texts saying "working with you is unbearable" and "do you know everyone has a problem with you, no one wants to work with you, do not interfere with how we work."  Those are not paraphrases, they are direct quotes.  And they hurt.

I am sharing this because I've been at this for 24 years, and it is still murky.  And hard.  I still struggle with the wisdom of finding that line between cultural acceptance and passive aggression.  When does the lack of noise represent playing into an unjust system, and when does it represent humility?  Could I have been more gracious, wise, patient, and kind?  YES, always.  Should I acquiesce to systemic dysfunction because it is the delicate balance of this reality?  Maybe, sometimes.  Can my education, my otherness, my skin color and nationality, my age, my verbal tendencies, all become liabilities of power that wound?  Sadly they can.  What would Jesus do?

The answer to that I find complex, and impossible to dictate.  Jesus observed Jewish cultural norms that will not necessarily be universal or eternal: temple visits and festivals, synagogue reading of scrolls, choosing men as his closest disciples for his itinerant teaching.  Jesus also created a LOT of noise.  Healing on the sabbath, challenging the perceived righteousness of the established leaders, defining love with an enemy as the example (the "good" Samaritan), touching the unclean.  Only he knew how to do that with perfect wisdom, and with genuine love for all involved, both oppressed and the rule-blinded enforcers.  I don't.

So where does that leave me, and probably most cross-cultural workers who join the struggle for justice and healing and hope, then find that attempted change meets serious resistance and generates quite a bit of noise?

Mostly, I think, we have to embrace over and over the paradox of the prophet--speaking truth requires love.  Acting for mercy requires humility.  I so much want to make things right that I often get it wrong.  We are never perfectly able to hold both mercy and justice equally well.  So we ask for wisdom (Job 28 was this morning's reminder), for the Spirit to groan in and for us (Romans 8), so we can choose our battles, and accept God's pace.  Sometimes we encounter something worth creating noise about.  Most times a bit more patience would allow us the quiet space to be heard more gently.  There's no formula for always getting that right.  Please pray for us.

Let me end with a plug for a book about someone who seems to embody a modern-day example of getting this more right than most.  I finished Bryan Stevenson's Just Mercy last week too.  He writes the true story of his career in law, representing people on death row in Alabama (there were so many) as part of the Equal Justice Initiative, because our American court system suffers from some of the same imbalance, structural discrimination, tragic unfairness, dysfunction, and just plain sorrow, as the Kenyan health care system.  As you read, you cheer for him, but you also see his own pain and the way slamming up against racism over a lifetime has left him broken as well. And after about 280 pages he opens his heart.  He tells us that once he realizes he is fighting, not because it is necessary or important, but because he's broken too, he finds the strength in that common humanity to continue with compassion.  "I understood that even as we are caught in a web of hurt and brokenness, we're also caught in a web of healing and mercy.  I thought of the little boy who hugged me outside of church, creating reconciliation and love.  I didn't deserve reconciliation or love in that moment, but that's how mercy works.  The power of just mercy is that it belongs to the undeserving.  It's when mercy is least expected that it's most potent--strong enough to break the cycle of victimization and victimhood, retribution and suffering."

That's the Gospel.  Kenya needs it, and so do I.

Lest you think we're quitting, we're not. Yet anyway.  After absorbing a good bit of hate, I also got a good dose of encouragement from someone else.  I received mercy, whether I deserved it or not. This person, also a cultural insider, told me not to quit, and ticked off a list of changes that have happened these 9 months for the better:  doing exchange transfusions, tracking data, creating what's-app sign-out lists for communication, using second-line drugs, recognizing and treating life-threatening dehydration, organizing rounds to see the sickest patients first, increasing our level of teaching.  Change is hard, but some change is good.