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Monday, November 13, 2017

Running with the zebras

This is the image that popped into my mind as I sit here in my laundry room/side porch/office at sunset, trying to communicate what the last week+ has been like.

We're the donkey, a hopeful but plain work-horse sort of creature, not the fastest or most glamorous, usually reliable and at times cantankerous.  But we live amongst the zebras in their spectacular wild glory and community, and we run along trying to keep up and join in.

Critical, complex medicine:

A week ago we did our monthly call at Kijabe, which is always an exhausting mixture of high-intensity medicine and deep reconnection with people we respect and admire.  It's not easy to oscillate between extremely-low-resource and moderately-low-resource, between chaotic-vague-diffuse-responsibility and emerging-organized-high-standards.  So like the little donkey, we trot along behind the Kijabe experts doing the best we can to fit in and help.  The baby above actually came from Naivasha in an ambulance as we drove over in our car, needing emergency surgery.  He survived that but sadly died later of an overwhelming infection that started at Naivasha.  We are thankful to not only contribute to Kijabe, but for the resources that we can access there for our patients.

Regional Diplomacy:

The day after finishing our two-day Kijabe work, we drove up to Chogoria hospital where we've been working for months to iron out a good Memorandum of Understanding, a sort of contract for our missionaries to serve the hospital.  Over the course of a couple of days we led six different meetings, each averaging a couple hours, with various partners.  The purpose was to bring clarity to responsibilities and allow for a peaceable and unified way forward.  This is the future of medical missions: several NGO's partnering with a completely Kenyan-led hospital, learning to flex cross-culturally with them and with each other.  Messy and good, and potentially amazing.  

Post-strike escalating care:

Back to having nurses, two per ward instead of one, shifts actually covered, people with experience.  YEAH.  But once the word went out that the strike was over, the patients flocked in.  Back to two babies in many of the cribs and most of the incubators.  Back to crazy flows of admissions and deliveries, rounding on 40-60 complicated patients.  Back to the saddest and poorest cases, families with AIDS, working women who deliver premature babies waiting for the bus, children abandoned, children abused, children malnourished, the kind of patients who were not accessing private care for the last five months but just waiting or dying at home.  This past week as the strike ended and patient numbers climbed also coincided 3/3 of my doctor co-workers being sick at some points.  And we found that it has taken a week for the returning nurses to get back mentally as well.  So it was a little crazy. 

Teaching, teaching, teaching:

We have two medical officer interns (doctors who finished med school, doing a 1-year rotating internship), five clinical officer interns (finished a PA type course, doing a 1-year rotating internship) who spend 3 months at a time on Paeds, plus students from schools around the country that show up unannounced for a week or a month at a time.  The end of the strike coincided with the 3-month slightly-staggered rotation of the interns.  My last day with some of them is pictured above.  We both spend a lot of our time teaching on rounds, and giving more formal presentations as well.  It's amazing to see them grow in their ability to give good care.  

Life tasks:
This laundry made me happy, because while I saw torrential rain during rounds after having put it out that morning before work, by the time I got home in the late afternoon the sun had dried the clothes again.  In the midst of all our patient care and teaching and administrative work and travel, there is also the challenge of renewing our work permits and having enough food and maintaining a home.  This week a HUGE HUGE sink of my time and energy went into the final points needed on my five-year cycle of staying board certified in paediatrics.  I should have put up a photo of my pulling out my hair.  Talk about a donkey among zebras, my life just does not fit their categories.  I thought a project I had done for Quality Improvement would be an ace in the hole to meet some requirements.  The American Board of Pediatrics did not agree, and I was pretty stressed out by the prospect of failing to meet the deadlines because I had waited too long.  Thanks to good ideas from others and a lot of work, I managed to jump through the final hoops and pay my massive amount of money and get my letter.  Set 'til 2022.  

Local Fellowship:

We have, over our year+ in Naivasha, been drawn more and more into our local church, the Naivasha International Fellowship.  Scott led the service this week and I play the keyboard for worship a couple times a month.  The women meet for Bible study when I'm working, so I rarely get to do the extra things, but there was a one-day retreat on "Transitions" on Saturday.  This group represents a deep treasure of life experience, and it was a privilege to join in on the trust they have built and listen to their stories of struggle and grace.  On that day I was really a stray donkey, and so thankful to have the herd welcome.

In the hospital, too, we've been trying to build relationships with our co-workers, so we took a couple hours out of our Saturday evening to attend the wedding reception of a young doctor.  It was raining.  We figured out we had to put money in the proffered envelope to go up and greet the newlyweds (the donkey/zebra effort to blend). The MC picked us out of the crowd (surprise) and announced us as guests from Scotland (Scott=Scotland I guess).  

Gold Friends:

And saving the best for last, we celebrated Scott's birthday this weekend too.  The Massos and Bethany came for a sleep-over birthday party . . a lovely dinner, gifts, cake, and the next day Scott and Michael did a bike-ride while I went to the retreat and Bethany got some work done in quiet.  It is a real gift to spend time with people whom we have loved and walked through hard valleys with for over 20 years.  On Scott's actual birthday, Sunday, we even had a true Sabbath of our favorite stroll through the local game park.  

That last photo was part of the wedding decor, but a fitting end to the week.  From posing as ICU docs or international negotiators, to balancing American board requirements and Kenyan red tape, to relaxing with dear friends and figuring out the cultural nuances of weddings, there is no donkey I'd rather trot along with amongst the zebras.

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