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Thursday, October 11, 2018

Vulnerability, humility, Hagar and Naivasha

This is what a week looks like.  Tiny feet, too many of them, waving from the broken doors of four over-stuffed incubators (we have 14 preems in 4 incubators today, that's 4-4-3-3).  Moms carefully expressing milk, sitting patiently on benches, breaking into smiles when released to go home.  An HIV-infected 5 year old with TB revived by a blood transfusion and TB meds, whose mother's apathy seems to fade with each day of her survival. Abscesses drained and packed with guaze, IV cannulas inserted, oxygen tubing connected, weights charted.  Gathering interns for teaching, buying them lunch as we go step by step through the complicated fluid calculations for dehydration with kidney injury.  A departmental review of all the deaths in a month, the sorrow of each case, the obscurity of trying to discern what went wrong.  A holiday, whose celebration was unclear up until 12 hours before . . . Scott and I sense we should just bike over mid-morning to check up on things . . . and find a mother referred on a public matatu unconscious from ecclampsia (high blood pressure and convulsions associated with pregnancy) . . . Scott mobilizes the emergency cesarean staff and calls me to join as the mother shakes with seizures.  He pulls out a nearly dead, totally limp and still baby from a womb thick with meconium (stool). There is a faint heart beat but nothing else, but slowly the baby comes to life as we give breaths and oxygen and dry. Mother and baby are both in critical condition but alive and possibly will be fine.  

 A week also looks like this: for every exciting save, another sorrowful death.  Today I walked into the ward and found a mom making fun of my Swahili, loudly, with the others laughing.  I know it's not typical, but it was surprisingly humiliating. Or the antibiotics are out of stock, or the person on call was not found to help so there is a terrible outcome, or the oxygen runs out, or we get messages one after the other of absences. Or a c-section gets delayed by the reluctance of the anesthetist or someone else to step into their job, and the next day Scott checks for a fetal heart rate, and it's not there. Or we get a glimpse of how our own mothers feel our distance, or how our own kids have challenges we can't help with.
 This is what living vulnerably in the real world looks like.  We are not in control of a thousand things around us, we are just showing up and trying to do our best.  Trying to be a flickering light. Trying to bring a small measure of order, accountability, education, healing into a place where some people are eager for the mentoring and burden-sharing, and others may resent the intrusion. Trying to walk a line of faith, of praying against injustice, of seeing the best in others, of waiting for God to act . . . without feeling complicit in a system that is deeply flawed.

And as we continue, a few things happen.  First, we get a front row seat to redemption and restoration.  Baby A. above finishes 17 days of treatment today, finally with a firm lifeward direction after a severe pneumonia that required a powerful, expensive antibiotic.  Second, we find our in-this-boat-together powerlessness draws us into community with others.  Our weekly prayer time has a few new attenders.  This week we talked about Hagar, and the interns could deeply relate to feeling used, feeling without choice, feeling lost and alone and desperate.  Hagar the foreign slave tries to escape, but God sends her back.  Her path of humility leads to the dangers of childbirth (still dangerous now, imagine several thousand years ago) and the inglorious, demeaning life of a captive.  Yet Hagar gets to see, and be seen by, God.  So the third perk is just that:  this is the paradox of the Kingdom, the taking up a cross, the all loss becoming gain.  God is here. With our interns, with us, with our patients, and it is a worthwhile calling to point to that truth.
Ending with a reminder:  this is a personal forum to bear witness to our experience of God and the world.  We seek, imperfectly and haltingly, to walk into the mess, and to try to apply the logic and love of Jesus around us.  As we do that, we get a hundred things wrong every day.  Please don't think that our writing reflects any official Serge theological stance, or political either.  We love ideas, and passionately desire to reflect on what is wrong and what could help . .  and to spark others do the same.  But not everyone enjoys the process, so please forgive us for diverting into American issues the last two weeks.  Stick with us and don't hesitate to share with us your feedback and struggles too. 

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