Yes, those are triplets. Three boys, born at 1, 1.1, and 1.4 kg at 31 weeks out of 40. At home. Then rushed into our hospital, where they stayed for 53 days, doubling in size. Yesterday they went home, about 10 days before their actual due date. Surviving in Kenya as triplets is no common occurrence. Their mom L.C. deserves a round of applause, 53 days of day and night feedings, hand-expressing milk and pouring it into their nasogastric tubes. And the nurses, who gave them antibiotics, a blood transfusion, oxygen by CPAP, cleaning septic umbilical cords, teaching skin to skin kangaroo care. And the interns who patiently recalculated daily fluids and feeds in tiny increments, who gathered vital signs and paid attention to heart murmurs. L.C. found me when she had changed out of her hospital gown and was ready to leave, for a photo. She was so happy, and even though she didn't have a smart phone or email or any way to receive the photo, she wanted to celebrate by seeing it:
That happy moment has of course been swallowed up in a mid-day mortality audit of the 30 deaths last month. Poverty, HIV, violence against women and children, desperation (one death was of a very hypothermic newborn found abandoned under a bush), malnutrition, congenital malformations, tinier prematures, overwhelming infections, complicated births leading to asphyxia and brain damage. This town can feel like a slough of despair some days. But for a moment, we clearly saw 3 reasons to be here.
About two hours after those snaps, we had a meeting with our hospital medical superintendent and our department heads as well, at our request since we passed the 2-year mark last month and wanted to listen carefully to their feedback. More on that later, but a few things stood out: they see improving care, commitment to teaching, and communication with patients as the 3 things that they consider worth the at times stressful, awkward, unclear nature of working with foreigners. They want their hospital to have better outcomes, so they were glad to have help, particularly in applying Kenyan protocols more deliberately. By having more than one consultant on the service, and by the fact that we communicate with each other and them, or came with some years of experience, they could see changes that affected outcomes for the better. Secondly, they know we are training interns and medical officers and students of all levels, so the idea of a core curriculum, regular teaching, practical skill sessions, they affirmed. Patient care and teaching, not too shocking, the core of what we do day by day, integrated together to bring healing and mentor our younger colleagues. But their third point came as a bit of a surprise. The Med Sup said she knows when Scott is in the hospital or not without leaving her office, because she sees a difference in the patient complaints that come to her desk. He takes time to talk to patients, and they gain confidence, feel heard, noticed. I think that is so much second nature to him that he never thought about it, so hearing it as a top-three feedback caught our attention. WE had 625 deliveries last month. That's a LOT of women coming through OB to talk to.
Triplets, feedback, and our prayer card verse all had me thinking about threes. Yes, we want to know, does all this make sense? Is it worth being thousands and thousands of miles away from our widowed moms and 20-something kids? Is this what God asks? Micah 6:8--what does the LORD require of you but to do justice, love mercy, and walk humbly with your God. That was the verse my sister chose for my Dad's funeral, it's the verse on our prayer card, it was the theme of the conference Julia attended last weekend, and I think that it also parallels this life--doing justice (serving in a place of poverty and need where staffing is low, investing in wave after wave of inexperienced young trainees), loving mercy (the hours, the empathy, the conversations, the prayer) require a willingness to embrace a walk of obscurity and humility. Which is probably incompatible with a blog, but I'm affirming my husband anyway. He is much better than I am about finding a way to quietly approach the chaos that is Naivasha SubCounty Hospital Maternity, without demanding a position or recognition or honor, and plug away at patient care. Day after day, examining, giving a little push here and there to get things done, talking to patients. And it makes a difference. A few years ago, we were told this hospital had 1-2 maternal deaths a month. Now it's 1-2 per year. That's many factors and God's mercy, but if you're a person who feels like you are wondering if your labor is in vain, take a deep breath. Do justice, love mercy, and walk humbly, and the tiny seeds of the kingdom will take root.
Scott has a nowhere birthday next Monday. Another year of living by Micah 6:8. He's a pretty amazing guy, and hearing the Med Sup talk about him yesterday made me thankful, and reminded me of the things that matter. In a year marked by the creation of fear and division, humbly pursuing justice and mercy can heal our divisions and bring the kingdom. Vote for whoever you find most like Scott, today?