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Thursday, December 13, 2018

Stay Alert for Shepherd Sightings

Yesterday, we moved.  If you can call packing all your household into a 20-foot container (actually about 3/4 of a shared 20-foot container) moving. This season has been one of uncertainty and transition and all the unsettled emotions that brings--being between, not knowing quite what is next, missing family, having life in disarray.  Which actually gives us a glimpse into Mary and Joseph's Christmas, paring life down to what can be carried on a donkey (much less than a Land Rover's capacity), leaving home, looking for the next place to stay, following the vagaries of politics and the harshness of God's call.  So after giving birth in a barn, one can only imagine they might have wondered if they made a wrong turn.  Is this really what God intended for the promised leader of Israel, the heir to the throne of David?  In the context of suffering, night, dashed expectations and physical strain, I have to think that the arrival of the shepherds provided important affirmation. 

Suddenly here are people sent just to say--we see God in you, we see that there is glory hidden here, we want to be near and be a part of all this, no matter how rough it looks.

This crossed my mind yesterday twice.  First, on the road out to the container (just before the moving truck slipped off the road into a ditch on a muddy hill, just before the tow cable broke as Scott pulled them out with our car. . .) I received my first out-of-the-blue (or out of the angels) text.  Dr. M from a distant rural Kenyan hospital had called me the week before, having been given my number by a former intern Dr. L.  They had a very sick baby with a condition that is fairly common here but poorly recognized, hypernatremic dehydration with acute kidney failure in a 1 week old.  Dr. L, however, DID recognize the problem because of her training, and she had helped with the fluids and plans, and told Dr. M to call me and confirm that they did not need to transfer the baby for dialysis. I had run through calculations with them and reassured, and yesterday Dr. M just re-contacted me to say that everything was back to normal and the baby was nearly ready to go home.  We rarely get to see that direct-line story, the way training spreads as interns are dispersed, the way a life is saved.

February 2018
December 2018
The second shepherd-text came from a paediatric surgeon at the National Referral hospital.  I had cared for his premature niece in our newborn unit at Naivasha in February.  I had not heard from him in many months, but he just wanted to share a photo and thanks and good news that the tiny baby was now a thriving 9 kg (20 pound) 10-month old.  He was just sharing the joy.

I don't get those kind of follow-up reports very often.  Mostly we are all-out for all we can do, and then people blend back into the swirl of population and I may or may not ever hear about them again.  So two reports in one day, both received in the process of going to and coming from the massive task of storing all we own, was pretty encouraging.  I think I've generally seen the story of the shepherds as lovely, as musical, as quaint, as important evidence of God reaching out to the lower levels of the social order.  But yesterday it occurred to me that the story was for Mary too.  In her confusion over the way her birth story worked out, the shepherds were sent by God to reassure her that she was in the right place at the right time. That God sees, and she was going to be OK.

Watch for shepherds this season, people who remind you that God's plans, though they wend through shadowed valleys and midnight caves and lonely losses, will bring you good, that in the end all shall be well.
(And to top the day off right or Wright . . . friends from Uganda passing through met us for dinner)

Monday, December 10, 2018

Living on the Edge this Season and Always

Bluff Edge, Whidbey Island
by Luci Shaw, in Accompanied by Angels, 2006

This is the rock-rim edge of the known world.
This is the ragged planet where Christ landed,
and we are his people, craggy and knotted and burled,
and aching and lonely.  Restless. Stranded.

These firs could well have framed his wooden manger
and his cross; I never encounter Advent without
Dark Friday.  The days in the life of this stranger
were flecked with God-graces, threaded with human doubt.

Battered by storms of loss in her loving and grieving,
all her life Mary lived on the cliff-edge of cruel foresight.
Clinging, she rode the gusts and the glory, heaving
still with the donkey rhythm, dazzled with western light.

A tribute to our Naivasha Rift Valley Escarpment walking path, our own personal bluff edge of the rock-rimmed world, our reminder of the western light and the subtle glory of God.

And like Mary, we feel the rocking, shaking, unsettling donkey-rhythm of change. In 3 days we'll be on the airplane heading to the US for a month of Christmas, family, meetings with Serge, a couple of supporter events. Tomorrow a moving truck arrives to load up all our Kenya life and re-stack it in a borrowed half of a container, for a few months as we focus back in Bundibugyo. Today we're in the throes of the final cabinets of odds and ends and food and pieces and no more trunk space and time ticking down.

Though we love the feeling of associating "Christmas" and "home", Jesus' spent his Christmas in a shelter for animals, then in Egypt in exile, then in Galilee, then on the road to the cross.  So we are praying to embrace the edginess of this ragged planet as we embark upon journey again this season, shaken into chaos but never alone.

Sunday, December 09, 2018

The Gospel according to Saints and Santas

Today's Gospel Christmas Thought comes to you from a photo posted by our friends the Machogus.  Note the cutest baby in the world who looks appropriately cautious about this Santa fellow.  And don't we all?

We all know that the man in red is supposed to be benevolent.  He symbolizes a Turkish 4th century bishop of wealthy Greek ancestry who went about surreptitiously helping poor children by dropping off gifts, such as bags of gold (to save girls from being sold as prostitutes). The modern representation pales in comparison to Nicholas' wildly political origins, seeking justice, upsetting the status quo, undergoing torture, etc. However they both have in common a symbol of good will, of generosity, of safety, of kindness, of being squarely on the side of the voiceless children and willing to bless them.  And they both have in common the personification of some attributes of God.

We, like Mr. Cuteness, however, are not quite sure. Is God really good?  Will God really come through with what we need? Do we really want to be that close? Can we really trust?  Is he only going to bless the deserving, and will I make the "nice" cut? Who is this person, and should I perhaps run and hide behind some figs?

Because we have about the same relative wisdom and emotional maturity of the toddler in this photo (actually probably less, as his faith has not yet been molded by misinformation). I can talk about GRACE but rarely rise above the naughty and nice cloud. And even though I think I can plan a good win-win ending for everyone I love, I can't.  Fixing this universe beset by the ADF attacking in the midst of an Ebola epidemic, or our friend in Baltimore violently retching after the next round of chemo, or people we love going to bed lonely, is all beyond us.

So this Christmas, let's lean into Goodness.  For some of us the sound of bells may be so distant that we feel forgotten.  But let us remind each other that the real God pulls us close.  The Kingdom of Heaven has come near.  Even if we feel a little unsettled by the too-good-to-be-true truth of love, let's help each other live AS IF our lives rested on God's lap.

Saturday, December 08, 2018

Choglorious Christmas: tidings of joy for moms at the margin

The Christmas story starts with a doubting priest, a geriatric infertile woman, a small town girl going about her chores, and a carpenter saving up money for marriage. Nobody famous, nobody that would typically be in a spotlight.  

I'm not sure where we drifted from that as a community of faith, but one thing God has impressed upon us this year is that the Kingdom moves in hidden steps, small increments. Sometimes the most important event is happening right under our noses, and we don't even realize it.  Like a fetus sprouting a heart and hands.  Or like a missionary mom holding a back-yard Bible club.

We visited Chogoria Hospital this week, and saw good work.  A new curriculum for clinical officers, a newly redesigned emergency room, a packed morning report, a new medicine consultant (who was our intern at Kijabe 6 years ago and is going to be the spark and brain this place needs), new equipment for the HDU, new missionary doctors.  There is great effort being poured out on many fronts to preach the Gospel, to heal the sick, to equip a rising generation of health care providers to work with skill and compassion.

But today, in the spirit of Christmas, I want to reflect that the moms who move their families across continents, who order home-school curriculum and plan out their months, who make meals and change diapers and structure nap times, who spread out a blanket and invite the neighbors to learn about Jesus, may be the real point of all this.  I heard Lauren talk to her kids and others about theology just as deep as any Bible school.  They prayed for kids with cancer and kids needing transplants.  They talked about why this can happen in God's good world, and what it means to have faith, and about the mystery of God's goodness and our sorrows.

These conversations, with Serge kids and their friends, are the way the Kingdom draws near.  

After all, Christmas is about a mom, a baby, a family buffeted by bureaucracy and world events, a family unknown to almost everyone around them.

Whatever you're doing this Christmas season, take time to glance away from the glitter and spotlight and remember that God is possibly showing up in the young woman holding a baby.

Wednesday, December 05, 2018

On Killer Cows and Christmas Miracles

This beast passed us relatively peacefully as we walked around Chogoria.  But that morning, at the hospital Chapel, the Chaplain had preached with some wonder about the stable.  Not the cozy stable that we see on Christmas cards, with the peaceful candlelight glow, the one-of-each animal artfully arranged in restful and reverent poses.  No, he was a farmer like most Kenyans at heart. And he waxed eloquent about the danger of cows.

Cows tend to kick the bucket.  They don't always stand still.  They can be restless or stubborn or uncooperative.  They can spill the milk pail, they can stomp on your foot.  Or your baby.

So this chaplain was reminding us, not that it was unusual for a baby to be born in a shelter, but that it was amazing for that baby to be SAFE in the midst of cows.

I love seeing and hearing the Christmas story through another culture's eyes and ears. Yes, from minute one, Jesus was in a place of risk. More, much more, would come later with Herod and soldiers and genocide. But that night, in the dark, in a cave or shack full of cows (?) and sheep and goats, the point was that animals may not respect the space of a baby, and it was dicey.

Just a stark reminder that God came into the mud and breath of humanity in the most vulnerable way. 

Sunday, December 02, 2018

A Dry Road through a Churning Sea: Advent Begins

Advent, the season of waiting.

Three friends who have longed for a child are expecting this year, and one just texted me the latest ultrasound video.  I have prayed for this baby, and rejoice, yet there is still a long way to go. Waiting, hoping, days and days accumulate to weeks and months as a baby gestates, and for much of that time the outcome remains uncertain.  How much more so for Mary and Joseph, bouncing on a donkey, stuck in a cave.

And once the baby comes, the stakes only get higher.  We can't know who will survive and for how long, or rebuild torn ligaments, or mend broken hearts, or engineer academic success or convince anyone's heart towards faith. We can't solve loneliness or shame or addictions or rejections. As Area Directors for Serge, our hearts pour out into not only our kids, and the Ugandan kids we have cared for as surrogate parents, but also the kids on all our teams. So many face really, really hard times.  How much more so for Mary and Joseph, whose child was a man of sorrows acquainted with grief.

Then there are the systemic injustices that we long to right. I wish we could just guarantee visas, or protect our teams from removals due to rebel invasions or arbitrary politics. Or how about just leveling off the Ebola epidemic in the DRC? How much more so for Mary and Joseph as Jesus confronted the corruption and oppression of his culture, entering danger.

As Advent begins today, one of the first readings came from Isaiah 51:
Awake, Awake, O arm of the LORD! 
Was it not you who dried up the sea, the waters of the great deep; 
who made the depths of the sea a way for the redeemed to cross over?

When we pray for the unborn, or for the sorrows of older kids, or for the injustices facing those we love, it feels as impossible as a dry road through a churning sea.  If our prayers are big enough, if we are really walking by faith, I suppose it should. Not a perfunctory mention of an outcome that is probable, but a desperate plea for something beyond our ability to solve.  I think we spend most of our life in the Advent of waiting.  Where the road ends into the ocean, with hostile armies approaching and no plan B route visible.  Where the only salvation road is one that only God can make. Where waiting is not a passive lethargy, but a determined view of the deep waters and a deliberate choice to actively ask that the dry road become clear.

This Advent journey begins again, year by year, a call to wait actively and expectantly. To pray with large hearts and impossible dreams, that we could cross over to joy.

Thursday, November 29, 2018

Transition, antidote to soul-stunting?

God is forever knocking people like us off balance, new languages and countries, new homes and rules.  When we came to Naivasha's public hospital after a Swahili refresher course in mid-2016, we lived in a dorm-room like very basic hostel for over a month waiting for our rental house to be available, had a major break-in where thieves stole our computers and cameras, besides the fact that we started work during the first of many doctor strikes. The last two years have been a-surprise-a-week, with constant changes in staffing, funding, medicine availability, colleague movement, etc. Now our "MOU" with the hospital has expired, and our Serge commitments mean spending the first part of 2019 based out of Uganda, largely to supervise the never-straightforward path of Christ School during the Dickenson's Home Assignment, before the arrival of the McClure's.  Yes, in many ways going to Bundibugyo for a few months is going home, and our core job of being Serge Area Directors does not alter.  We will actually spend some of that time visiting teams easier to access from Uganda, in DRC and Burundi.  Still.


It's on the horizon again, and it's already feeling unsettling.  

In two years of being outsiders, trying to fit as missionaries into the Kenyan government system, as educators into a place where university strikes have delayed internship dates, as consultants into a place where people were used to less supervision, a few things about our Naivasha life have given us stability.  We love our simple stone-floored cottage, biking distance to work.  We love our evening walks and morning runs, our cheery mongrel dog, our community of friends through church and neighbors and history.  We love the spark that comes from empowering others.  We love the quiet spaces of living as a couple, that enable us to regroup the energy for our very cross-cultural work and our very far-flung people-filled Serge Area.  We love our proximity to several Kenya teams, and to nature reserves for camping.

Already the impact of stepping away from routines for a season starts to feel sorrowful, unmoored.

And yet, this is exactly the life we have been calling OTHER people into.  Transition, instability, where-did-I-put-that, how-do-you-say-this, why-is-it-like-that kind of days. A new family is on the way to Kijabe, having sold their two-doc house and left their richly-meaningful-extended-family-full life, and as I prayed for them this morning I could FEEL the drain of all that motion.  A couple in their 20's and a woman about to graduate from college will be at our December Assessment and Orientation, seeking to join teams in Litein and Kibuye, huge steps into the unknown.  We have families raising support, others traveling back for the holidays to support limited prognosis kinds of parental diagnoses.  Like us, most of them will wobble on through the grey zone from old-normal to new-normal.  Some of us will have to do it again, and again.

Normal is not bad, it is the background rhythm of life that lets you make breakfast knowing the groceries and fuel/power are there, lets you make phone calls knowing the numbers are in your phone, lets you focus on relationships and spiritual formation and work tasks, because you aren't drained by wondering how to get drinking water.

But God seems to frequently strip away the normal.  On my good days, I can embrace a pattern to this painful process, a method to the chaos.  Back in August, Greg Thompson told us that the wilderness was not just a place of emptiness, of stripping away.  It was a place of embrace.  That when we are made uncomfortable as our props are knocked out, God is inviting us to realize that He alone is enough.

Most days that truth remains obscured by an uneasy sense of fragility. It takes faith to want God more than a space that works, a community that knows, a job that flows.  Pray for us as we approach a season of transition.  Pray for our Sergers who live in this state of imbalance. Pray we would all choose the opportunity for embrace over the soul-stunting of comfort.

Happy moment with our neighbor-kids for dinner

The second set of triplet survivors in the last couple months, almost ready for discharge.  No small miracle.  Also this week, not pictured, a baby went from 820g (1 lb 12 oz) to 1900g (4 pounds) in her nearly 8-week hospitalization (she had been born 11 weeks early).

Scott teaching midwives about breech delivery techniques today

Monday, November 19, 2018

Thorn-scratched births and Bruised Heels and Christmas Coming

This is a 1 day old, 2.5 pound preem, estimated 32 weeks (2 months early) . . . with thorn scratch wounds on her legs.

I will greatly multiply your sorrow and your conception; in pain you shall bring forth children.
Cursed is the ground for your sake; both thorns and thistles it shall bring forth for you.

Those verse from Genesis 3 take on a gut-sinking reality when examining a newborn preem yesterday.  She had been found abandoned LITERALLY IN THE THORN BUSHES.  No glossing over the wrongness of this picture.  Something drove this mother to a level of desperation barely imaginable.  Perhaps, like another patient on Scott's service, she was a teenager whose own mother remarried, perhaps she was raped by her step father, reported to police but mother hid court papers when they were sent so she failed to testify and the man was released from jail, escaped to live with a grandmother and sister, quarreled over cooking duties, took rat poison, lived and is now awaiting the birth of the baby.  Only this preem's mom didn't make it to any kind of a caring situation, and didn't feel she had any option other than to stash the too-early baby, unexpected to live anyway, in a bush.

Those little damaged feet also, however, point to the third poetic prophetic paragraph in Genesis 3, the one that makes the sorrowful conceptions and thistly ground a graphic interlude but not the end of the story.

And I will put enmity between you and the women,
And between your seed and her seed;
He shall bruise your head,
And you shall bruise his heel.

That little bruised, scabbed heel reminds us of Christmas.  The one who would reverse the suffering, the rapes, the preterm births, the abandonment, the hostile ground, entered the story personally with feet not much larger than these.  In Ezekiel 16, God's people are described as a newborn, cord not cut, not washed, not wrapped, thrown out into the open field, loathed.  In this story, God takes the role of the passerby who picks the little baby up in her blood and struggle to breathe, and says live, covering and caring.  That's a beautiful picture of redemption, of love.  But the Christmas story is even more shocking.  The abandoned baby of Ezekiel 16, dressed in rich robes, adopted and loved, grows up and runs away to prostitute herself.  And the rescuing God comes to the rescue again, but not as a competent adult passing by and pitying a wailing newborn. No, this time God comes as the bruised infant.

Faith does not gloss over the thorns and blood.  They are real, they are painful, they are wrong, and they are the stuff of daily reality for the most vulnerable the world over.  But faith sees those thorns and blood on through the story to the homeless infant in a stable, to the crown of the crucified, to a fulcrum of resurrection reversal where thorns blossom to food and flower, where blood blushes in health and life.  Where babies are no longer abandoned, where mothers have the health and strength and support to enfold them in families.  And in the meantime, faith is right here in the bushes and incubators pulling for survival, one at a time.

Sunday, November 18, 2018

Four Fun Stories

Story One: A Book, a God-send, and a friendship

Meet Nanjala.  Here is how I met her:  Three years ago, my first book (A Chameleon, A Boy, and A Quest or $1.99 Kindle here)  was coming out.  A friend Elizabeth was making a video book trailer for me and requested I record my voice as an introduction, and then a reader's voice, using some high quality equipment.  We were taking Jack to orientation at Duke, and he and Julia figured out that we could use the audio lab in the university library. Both wisely refused to employ childhood accents to be the readers sounding African . . so I said, let's pray, surely there are African students at Duke who might be in this library. We prayed in the recording booth, then I walked out to look for our answer.  There was Nanjala, standing at the circulation desk wearing some Kenyan ear rings. Hoping she would not think I was a crazy person, I struck up a conversation and a friendship. Now that I know her better, I realize that her personality and courage and faith made her the perfect person to step into a recording booth with strangers.  She's a nurse from Kenya who earned a scholarship to do a Master's in Global Health.  A few months later we met again at URBANA!  Then Friday, she was passing through Naivasha and spent the night with us. Nothing is more fun than connecting with bright young people over time, hearing about life as an immigrant to America through Kenyan eyes, getting fresh perspectives on race and justice and culture from an articulate and ambitious woman.


Long-time blog readers will remember Basime, one of the young people who became like a foster son to us, whom we sponsored in school at CSB and beyond.  When Scott was doing his physical exam form for University, he checked Basime's vision and realized he had visual field loss, just before a visiting ophthalmologist arrived. Dr. Bonner diagnosed severe glaucoma and saved Basime from blindness, with herculean efforts to get him to the USA and back. Though he is significantly impaired, he finished a degree in library science, works now at CSB, got married . . . and this week Dr. Marc on our Bundibugyo team delivered Basime's second daughter by C-section at Bundibugyo Hospital. Welcome Natasha! 

Below, Isaiah Kule who graduated from CSB in Caleb's class, graduated from Medical School yesterday.  Isaiah was one of the Kule Sponsorship students, thanks to Dr Travis and Amy Johnson's advocacy.  He's been a delightful, hard-working, faith-filled young man and we look forward to the good he can do in Uganda.

Story Three: Scott's multicultural Birthday surprise

This past Monday was Scott's birthday, and as we anticipated a visit from one of our supporting church pastors, I had the idea of ordering a cake and gathering some of the people with whom we work to meet our visitors.  Well, the visitors were delayed but they still provided the perfect cover to lure Scott to the conference room at 4 pm where most of the OB team and a few others waited to surprise him!!  We had chai, mandazi's, cake, speeches, and laughter. I told the story of how we met, Nurse Mid-Wife Helen used the occasion to preach about life and the importance of marrying your friend and how all the ingredients of a cake blend to make something sweet even as two people blend to become a blessing, and even the department head Dr. Chege chimed in on theme.  It is rare to pull off a true surprise, and this afternoon tea bolstered our spirits as we saw Scott appreciated.

Meanwhile our visitors arrived, from Lawndale and Kibera, two city-areas where the poor have found homes and where God has called people to bear witness to justice and mercy.  Scott worked at Lawndale's clinic before we came to Uganda (when I was completing residency) and we worshiped with the church there during our entire five years in Chicago.  The young man second from left married the young woman who helped Scott in clinic over 25 years ago.  Pastor "Coach" Gordon is in the center.  We had a fun birthday dinner with them as we shared about our lives.

Story Four: Pre-Birthday Preaching and Party

A week ago, the day before his birthday, Scott volunteered to be the preacher on Ephesians 3.  He talked about the unmeasurable vastness of God's love and how that gives us confidence as we move through life.  He even brought a tape measure to talk about "long and wide and deep and tall" and told a story about his dad.  That evening, our neighbors joined us and Scott enjoyed all the home-made story-book cards from the Ickes kids. 

Below, the sky on the way home from church, Lake Naivasha in the background.  Hope you've enjoyed these four stories that have brought moments of gratefulness into our week.  Tell us some of yours!

Saturday, November 17, 2018

World Preemie Day!

Did you know that 1 in 10 babies in the world are born prematurely?

Or that being born prematurely is either the #1 or the #2 (sources vary) cause of death for children in the world?

Or that like all child survival, preterm infant survival is largely a matter of justice, of resources, of circumstances no child can choose about where they are born and to whom?

Or that there is a correlation between being born in a country at war and dying from prematurity?

In Kenya, neonatal causes of mortality are the top killer of children, and prematurity tops that list (the other two big issues are neonatal encephalopathy, aka birth asphyxia, caused by unattended issues during labor; and neonatal sepsis, aka infections caused by issues of hygiene, immunity, access to care, availability of antibiotics).

(Note that if you make it through the first 5 years, then death rates drop, but the top cause changes from Neonatal diseases to HIV/AIDS.)

Caring for preterm infants is a large part of my life, and has been over the 30 years that I have been a physician.  Managing mothers and extending their gestation as long as possible is a large part of Scott's life.  If anyone embodies the "least of these" then it would be a preterm infant.  Care for the most vulnerable is a measure of a society's embrace of Gospel values.  When we invest in these tiny fragile lives, we are all participating in Jesus' call to let the little children come, to give Jesus a drink and some warmth.  Literally.

The good news is that many of the interventions that enable survival are within our reach.  First, empowerment and education of girls, so that they become mothers when they are ready and have the capacity to make good decisions and seek care.  Second, reach and excellence in antenatal care.  In Kenya, pre-ecclampsia, a maternal disorder characterized by high blood pressure, multi-organ damage, and preterm delivery, requires solid consistent monitoring and options for high level care.  We suspect that much of the quality improvement in Naivasha in recent years is due to better management of this issue.  Third, safe deliveriesFourth, neonatal care including warmth, oxygen by CPAP (pressure), managed tube feeds, IV fluids, antibiotics.  Some of the solutions are fairly low-tech, like "kangaroo care" where a mother keeps her infant warm by wrapping skin to skin.  Or "bubble CPAP" which is improvisable with tubes and bottles and water.  A lot of it is just plugging through each day paying attention to the details.  I always tell my trainees, no preem raises his hand and says, "doctor, my tummy hurts" or "doctor, I feel feverish".  We have to pay attention and figure it out.

Most of the above will NOT be achieved by neonatologists.  It will be achieved by parents, teachers, school administrators, nurses, more nurses, nurse-midwives, MORE NURSE-MIDWIVES, and did I say nurses?  More NURSES?  We currently average 2 nurses per day shift, and often 1 at night, with student trainees at times to help, covering over 50 sick neonates in our Newborn Unit.  Yet much of the difference between survival and death for preems is determined by nursing care.  It's a lot of work, a high calling.  But also very tangibly rewarding.  Yes, the NBU is hot, and crowded.  There are always 2-3 babies per incubator and sometimes 4.  The cots under the phototherapy blue lights are piled with 2 and sometimes 3 babies in each one.  The moms sit shoulder to shoulder expressing their milk.  There are IV bottles in crazy clusters on poles.  You have to pull out a calculator on your phone, a lot.  It takes hours just to review 50+ sick babies each day.  

But as we celebrate World Preemie Day, here's a shout out to the moms, the nurses, and the NBU team pictured above of students and interns yesterday at the end of rounds.  Never give up, small lives depend upon it.