Entering a New Culture, in many layers

Here in Kijabe, Kenya, we are entering many cultures at once. We're in a small Kenyan town clinging to the escarpment of the Rift Valley that has grown up around the AIM mission station over the last hundred years, facilitated by the famous Lunatic Express railroad, heavily Kikuyu, with small gardens and cows and forests descending into a grassy valley with pastoralist Massai and wild animals. We're about an hour west of Nairobi, a huge international congested city of contrasts with shopping malls and slums and highways and potholes. We're in an AIC-run African hospital with some 500 almost completely Kenyan staff and administration, with it's cluttered wards and spacious new operating theatres and very reasonable ICU, where my main working "team" consists of Kenyan nurses, interns, clinical officers, an Indian long-term resident, a Swiss short-term resident, and an American medical student. (In our two weeks in our new house, I estimate we've had about 15 people over for meals, among them five nationalities from four continents!). We're living on "Lower Station", the sprawling maze of small cinderblock houses, dry grassy yards, splashes of bougainvillea color, with the other missionary (and local) doctors and senior staff, blending into the largely Kenyan staff of the Bible college, dental clinic, printing press, nursing school, hotel, etc. And we're a short steep walk below the island of small-town-America that exists within the fenced compound of RVA, the missionary boarding school.

This weekend we've been immersed in the latter culture. In RVA tradition, the Junior class puts on an annual "Banquet", the main social event of the year, when the boys spiff up in suits and escort the girls in their beautiful dresses. It's the equivalent of the prom in an historically conservative fundamentalist no-dancing missionary tradition. The kids have been planning and fundraising all year, but this is the major push weekend prior to Friday's production. It is an impressive effort, with a theme kept secret from the rest of the school, but which always involves construction of an elaborate dinner-theatre type set, murals, painting, atmosphere, lighting, a drama, music, table settings, costumes, etc. All in a place that is strictly DIY: do it yourself, make it from scratch. So the parents of the Junior class are invited to come on campus while the rest of the school clears out for midterm, and WORK. Scott has been hammering and drilling and sweeping; I have been ironing and glueing and folding and cutting. And Caleb has been photoshopping on his computer while covering as DJ for music to keep the atmosphere pumped up. The class is well organized and I think the whole thing is going to be as spectacular as every other year. One of the faculty sponsors told us on the first evening: our purpose is to glorify God and to get to know each other, because those priorities last for eternity, but Banquet is only for one evening. Amen.

I'm thankful to be here for this time, to immerse and understand a little more fully this culture. It is an incredibly valuable one, a place of sacrifice and honor and idealism which has been turning out generations of well-educated and dedicated young people, from dozens of countries around the world. It is also a place that is rule-oriented and cliquish at times, and just being inside it helps me understand the places that are hard for my kids. Many of the parents I've met have amazing life stories, decades of Africa experience, long connections with the school . . . but we also clearly sense that we're now the new people, unproven and unknown, here in this cross-roads of mission stations and nationalities. I've been reading the history of the school which has been insightful as we go along, The School in the Clouds by Phil Dow. I think he gives a balanced picture of respect for the place RVA has played in the development of East Africa and even the emergence from colonialism, while being realistic about the challenges the school continues to face. I feel the same awesome respect for the century of perseverance, and yet a yearning for what could be here in the future.

Meanwhile it is good for the names I've heard from Luke and Caleb over the last few years to now take on faces and personality, good to see a class gel around the hard work and play of creating this celebration, good to interact with a wide cross-section of our missional peers, parents in their 40's and 50's who like us have taken the road less traveled, good to wear jeans and speak English. Tomorrow we'll be back to the more African culture of sick babies and tuberculous men and bright young doctors and straining to understand Swahili. And I guess that our life here will continue to be a weaving of the lower (hospital and other ministries) and upper (school) station cultures. Hoping we can find a good balance and fit in all around.

Bloody Messes of the Curative variety

Last week, I came into the special-care nursery to find a baby on our service who had been admitted the night before with severe jaundice. Bilirubin, the toxin in the blood that makes a person turn yellow-ish, can poison the brain if the levels get too high. Normal babies stay below 10, and we worry at 20. Baby F came in with a level of 40. That's about as high as it goes, and F already had signs of brain impact. He stiffened and extended his arms and arched his neck backwards, breathing was fast and labored. It seems his blood type triggered an immune response in his mother, normally minor but in this case combined with infection and poor feeding and dehydration, nearly lethal. All this happened slowly at home (he was not born at Kijabe) until the mother-in-law showed up to visit and told the parents it was time to take the baby to the hospital. The on-call team had performed one double-volume exchange transfusion soon after admission. I suppose it's like changing oil in a car, only you can't exactly drain out all the bad blood and then replace it. Instead you have to pull out small amounts at a time, and keep replacing them with small aliquots of donor blood, and if all goes well over a couple of hours you can go through the equivalent of twice the baby's blood volume.

IF ALL GOES WELL. That's a big IF. Baby F's first exchange had brought him from 40 to 32. An improvement, but atill in the severe panic range. I knew we'd have to do it again, so I didn't wait around, and made the plan first thing in the morning, hoping to be done by noon. Ha! By noon we had just received the donor blood for exchange. I still thought, foolishly, that I could make it to the latter part of an afternoon birthday party for one of our missionary colleagues, and hopefully even a planned late afternoon walk and talk with another mom. These were to be my first really social events and I was looking forward to them. However, what followed, from 12:30 to 8:30 pm, was eight hours of a bloody mess.

The line was the main problem. Newborns have the blessing of an umbilicus, and it is usually possible to put a steady, large IV line in the umbilical vein. The peds surgery team had done so the night before, a bit more difficult since the baby had been at home for a week, but done, so we were all set. But actually, we weren't. The promising umbilical catheter behaved erratically. You have to be able to pull blood out and then push other blood in, 20 cc at a time, in and out, about 25 or 30 times, until a half-litre or more of blood is exchanged. At every 5 minutes, it should take 2 to 3 hours. After the first hour we had barely done anything as we fiddled with the line, noted air bubbles, tried to change the connections, pondered a too-dark xray for placement, consulted surgery again, held up other catheters to figure out how long F's was and where it ended in his body. In short, we struggled. Eking out a few cc's of blood here, pushing in a few cc's there, always with the tenuous feeling that our access was about to close.

Baby F, with his sickly yellow skin, his stiff spastic body, his scarily pulling ribs as he tried to breathe, his oxygen tubing and IV's, his monitors beeping, did not protest. Even when at the six-plus hour mark we gave up on the line and jabbed his groin for a second IV. The difficulty of drawing from either line led to lots of small, 1 or 2 cc aliquots. Frothing blood, a dripping, slimy mess, aching back and legs, sweat in the steamy nursery, glaring lights, the blue bili-rubin lights shining in our way too, recording amounts and times, checking the baby. Who barely whimpered and never cried. Who had nothing to eat all day either, who was basically tied down to the treatment table.

I confess, here and now, I did not have a noble attitude. I knew I had to stay until the bitter end, this was my problem on my service. I'm so thankful for the partnership of a young Indian doctor who is working at Kijabe for a few months, and for the nurses who recorded the struggle and checked the vital signs. But as the day wore on into evening and night, no lunch, no dinner, no bday party, no walk, no break, I was getting more and more frustrated. Because in my heart I was thinking: this is pointless. This baby is already devastated. Are we really doing any good?

We had hoped to get the level below 25, and the next morning as I waited for the results, I was determined NOT to go through this process again. The results: 19. Better than we had hoped, probably because the whole process took so LONG there was more equilibration and effect. Next day: 13, then 8, then 5, then 3. With no further therapy. And baby F became less stiff. Without the lines and oxygen and dripping blood, he looked, well, baby-ish. Today he was breast-feeding, noisily and hungrily. He's off all his seizure medications, and not convulsing. He is starting to look like he will survive, he will leave this nursery soon. I don't think he'll emerge unscathed. His hearing is likely affected, and he may look like a cerebral palsy kind of kid. But the newborn brain is pretty amazingly adaptable. So only God knows.

Which is the point. Only God knows. And God was listening to one of the older ladies who accompanies her doctor-husband here every year, and then spends her time praying and ministering to others. She had come by our house and found me gone that first night, and when she didn't find me and heard about baby F, she decided to pray for him. And I wondered how the bilirubin levels had continued to fall so dramatically! Baby F was PRAYED for.

The cross was a bloody, curative mess too. For people like me, who, compared to Jesus, do not seem to hold much promise. Aching hours of effort, a sanginous sacrifice. No stinginess from God, no weighing of the prognosis, no withholding of the costliest and best. Let me plunge into the bloody messy world like Jesus, and let that effort bring life.

Celebrating Luke

18 years ago, after six weeks of preterm labor and bedrest and hospital stays and every-three-hour medication, with my OB's permission I stood up, and promptly went into labor. And so Luke came into the world, causing a bit of trouble even before he could breathe. Today I was called to emergently evaluate another 36-week preemie who, like Luke long ago, was not quite catching on to the work of life in this world, and was looking a bit sick. I doubt that punky little "Esther" will ever be 6 foot 3 inches or a freshman at Yale, but who knows. In the blink of an eye, it seems, that little being in the incubator that just ripped ones body open will be a huge being far away ripping ones heart. The in-between stages of precocious words and scrappy roughhousing and passionate soccer and reading Lord of the Rings umpteen times and mountain climbing and spotting lions and flying alone across oceans suddenly collapse into a blur, and the newborn is an official vote-capable adult. There are few people in the world I would have more confidence in, or find more interesting to be with. Which makes the little detail of seven thousand miles pretty sad.

Thanks to my mom, who braved the train alone to New Haven for a pre-Birthday visit, loaded with goodies. Thanks to Jessica and Thomas Letchford, who are friends-closer-than-a-brother(sister) in the best sense, with meals and a cake and fun. Thanks to a suite full of great guys who will probably sing and be wild. Thanks to strangers who will make this first family-less birthday for Luke a good one.

Happy 18th Birthday Luke. We love you more than the mountains are high.

good news from a far country

Cooking dinner, BBC keeping me company on our worldspace satellite radio . . and the good news.  Bashir, president of Sudan, has given a speech saying he will recognize and accept the vote of the southerners to secede.  Hugely good news.  Hopeful.

More transition at Christ School

In 2010, we realized one of our longest-standing goals at Christ School … to place a Ugandan at the helm of the school as Head Teacher. We met this goal after much effort, anguish and prayer.

As with every year, 2010 at CSB was filled with highs and lows, frustrations and celebrations. However, in addition to the ups and downs, as Travis and I did our end-of-year evaluation we saw some signs of serious problems. Nearly half of our teaching staff decided to leave in December including two of our most senior teaching staff (one of which was a Deputy Head Teacher). The signs of collapsing morale and a lack of conviction for the Vision of the school led us to decide to make a change in the leadership of the school - 10 days before students were to report for classes. We did this - by faith - not sure how it would play out. God, however, had a plan.

Some of you may remember the story of a young Ugandan who became a Christian as a result of listening to Robert Carr and Alan Lee fight during a car ride over the Rwenzoris – and then repent to each other for how they had sinned against one another. That young man was Isingoma Edward. Isingoma (his name means "the first of twins") has been a colleague and partner to WHM-Uganda missionaries for 25 years. He's got tremendous leadership gifts and the requisite Masters degree for the Head Teacher job. When we offered Isingoma the job last week, his response was this: "I am ready and willing to do anything in my power to serve World Harvest Mission and Christ School." He has a fervent passion for knowing the LORD and making Him known. He firmly grasps the Vision Statement of CSB:

An academically excellent senior secondary boarding school

producing servant leaders

for the good of Bundibugyo and God's glory.

Please continue to pray for Christ School, for Isingoma as its new Head Teacher, and for Travis and Amy as they lead the Team and the school.

Please see the blog of Travis and Amy for a more detailed re-telling of this wonderful story of God's faithfulness.

HOPE

Scott here. Being “on-call” is part of the life of a physician. Last night, at Kijabe Hospital I was “on” for Medicine. Thankfully, though, because of our age and experience Jennifer and I are never the “first call” – that burden falls to our Kenyan Medical Interns. My front line warrior last night was Issac, a quiet diligent and quite competent young doctor. He called about 10pm last night for help. He was trying to clear the Outpatient Department so he could get some sleep. A dozen or so patients who had clocked into the OPD in the midafternoon were still waiting – and their patience was wearing thin.

So, braving the howling gales and pitch dark, I trudged over to Outpatient. I found a sleepy group of patients waiting for their turn to tell their stories to a doctor. None were critically ill, but obviously all felt ill enough to wait for hours to get an evaluation – and hoped for a cure. I sent a 6 year old for an elbow x-ray, admitted a 50 year woman who was scheduled for elective thyroid surgery tomorrow…and then came to W., a 55 year old woman with an “something in her stomach”. This lady stated she had a mass in her abdomen which had been moving around for the past FIVE YEARS. “Ma’am,” I said, “why have you decided to come to Kijabe Hospital TODAY – at 3pm in the afternoon – when you have been having this problem for FIVE YEARS?”

“Well, because my neighbor came to Kijabe and she got treated – and she’s better now,” she said.

“Where do you and your neighbor live?” I queried.

“Mombasa. I rode the bus from Mombasa early this morning.”

Yikes. That’s easily an 8 or 9 hour bus trip. This lady spent a considerable sum of her small savings, invested an entire day, and trekked halfway across the country, and ended up seeing me – hoping for a cure.

I’ve heard this type of complaint scores of times. “The worms are eating up my insides…the worms are moving around inside of me…there’s a stone growing up in this side of my belly…” Frankly, it’s a tough type of case to treat. Sometimes there is a diagnosis to be made; giardia, enlarged spleen from malaria, dysentery…and sometimes I can’t identify an explanation of the symptoms. In Bundibugyo, without any diagnostic tools, the latter was often the case. I began to feel a bit nervous – what if I can’t do anything for this lady? That will be horrible.

Well, I thoroughly examined her abdomen – no small challenge since there was about 6 inches of adipose tissue between my hands and her innards. I did detect a slight firmness and tenderness in her upper abdomen – so I decided to send her for an abdominal ultrasound, but that couldn’t be done until tomorrow.

“Ma’am, I want you to come back for ultrasound in the morning. Do you have anywhere to stay tonight? Do you know anyone around here?”

“No. I’ll just sleep here on this bench. I got no where to go.”

“Well…alright.”

So, I handed her a requisition for the ultrasound – and prayed that somehow she could be satisfied – with her care, with the outcome, with whatever diagnosis she ended up with.

I don’t know what happened. But I do know that I need to have that kind of hope, that surety that somehow God can make things all right – and I need to have a similar willingness to sacrifice all that I have in order to allow Him to do so.

Why we do it

A call, just before midnight. Outside, into the night, small flashlight on uneven dusty road. Dare to look away from the ruts and rocks, up at the Milky Way stretching brilliantly over Africa, undimmed, spectacular. Wind gusting in unseen trees. Then the hospital, the sleepy guard opens a gate, the empty corridors eerily quiet at last.

I bypass the nursery and ward and head straight to the newly constructed suite of operating theatres, where I change into clean clogs, mask, gown, hair-cover. There is the intern who called me, checking the warming bed and oxygen flow in the neonatal resuscitation room. I peek into the operating theatre next door, through the glass windows in the swinging doors, where the surgeon happens to be Scott. He let the on-call family physician know that one of his goals here at Kijabe is to become more proficient with C-sections, and at this moment he's well into what will be the second of three between 9 pm and 3 am. This woman, I hear, has severe pre-ecclampsia and gestational diabetes. She's been deteriorating all weekend and is now under general anesthesia in an attempt to save her life, and hopefully that of her 35-week (one month early) infant. No time to ask questions because I can see the smooth bloody purple curve of a head being pulled from her abdomen.

A few seconds later the baby is rushed into our room. I thought I heard a whimper, but when the scrub nurse deposits the infant on the warmer, I see no signs of life. He is limp. Not even a gasp of breath. The intern and I rub his back, talking to him, willing him to breathe baby breathe. We dry his slippery brown body and hold the oxygen near his face. I feel for a pulse, and feel nothing. Start bagging, I tell the intern. NOW. The intern places a mask over the baby's face attached to oxygen, and very effectively delivers breaths, a little too fast but that's to be expected in the stress of the situation. I have my stethoscope out, hear good air entry, and now the beginnings of a heartbeat. As we reach the one minute mark, we pause and dry and rub again, trying to wake him up. Apgar 5 out of 10, he's pink and has a good heart rate thanks to the initial resuscitation. Bag another half a minute. Now his arms are moving, he grimaces, and weakly cries. We change for dry cloths, blowing a little oxygen by his face as he now decides to make the transition to life. We check over his whole body now that we aren't focused on the basics of survival. He's beautiful.

Mom is still unconscious and we're not so confident of this baby's strength, so we decide to take him back to the nursery with us. I gather him up in my arms wrapped in surgical cloths, warm and solid, and walk him through the sleeping hospital into the blue glow and steamy warmth of the NICU. Since his mom was diabetic and he's premature we have to watch his blood glucose level, and put him on IV fluids and oxygen and a monitor for a day. But today he's fine, and now I think as a mom more than a doctor and convince the nursery team (who would rather have him attached to tubes and under their eyes) to let him go back to the maternity ward and bunk with his mom, so he can start breast feeding. She's slowly improving, delivery being the cure for toxemia. In the afternoon I check back and am relieved to know he's fine.

An hour or two for the mom, a few minutes for the baby, the difference between life and death. The availability of a safe and competent C-section for her, the immediate response of warmth and a kick-start of breathing for him, and now the prospect of continued life instead of two burials. Most hours aren't so clearly beneficial to anyone, so it is something to savor, to witness pink warm life creeping into an infant body. Of course in the case of Kijabe, this all would have happened without us, there are many doctors here. It just happened to be on our watch this time.

Here is my secret: I love being on call. I like the quietness of the hospital at night, the focus of only one operation, one baby in need, one admission. The thinning of the crowd, the direct contact with one family or one intern. The friendliness of the nurses away from the pressures of the day. The slipping back out into the night when all is settled, the brisk walk back to a sleeping house. The momentary assurance, that's why we're here.

Moving . . moving . . moved

Writing, at last, from home.  Yes, we now live someplace (renters, but it feels like ours).  A house with a yard and a porch, and two bathrooms, and fresh paint, where two sacred ibis were just picking their way around the wilty dry yard as Julia and I searched for a few flowers to brighten the table.

Table?  Yes, we have a table too.  First, mid-Wednesday, we had six mattresses and a stove and fridge, and decided that was enough to justify occupation.  So we moved over from the furnished apartment to sleep on the floor that evening, a much more exhausting process than I anticipated.  Had to go back and make pancakes at the first place that night since I had nothing to cook with, though there was a stove to cook ON.  Then Thursday we carried in the dozen trunks we had stored in two families' attics here, caked with dust, filled with the fragments of our life in Bundibugyo.  Way too many books, a few pans, our favorite dishes, electronics, kitengis, games, a quilt, tools, tents, Christmas decorations and Easter baskets.  And books.  We unpacked them into stacks all over the empty floor, and slowly sorted and put what we could into the few closets here.  Then Saturday Scott went into Nairobi once again, and sent back two small chests of drawers and two chairs.  Furniture!  Then he returned with the curtains we had ordered, and Caleb and Julia painstakingly attached them to the drapery hooks at every window.  Privacy!  Color!  

Saturday evening the long-anticipated six beds and two couches came, Africa-style, on the back of a little white pick-up truck.  Not exactly what we had in mind when we paid for the transport . . . especially since the light-colored upholstery was left exposed to the dust of the road, and marred by the filthy ropes used to tie it down.  It seems that these couches are my thorn.  Because I really like them in spite of all the hassle, they look a LOT better than the fabric sample made me believe, so I have to keep being reminded not to put my heart on them too much.  Today the little truck returned with the dining table and 8 chairs.  By the end of next week we're hopeful for three simple desks (tables really) and two bookshelves.  

So there you have it. With all the creative pottery (Luke) and woodwork (Caleb) displayed on our one shelf, with our throw pillows (team via Karen as we departed), with sheets and pillows and even two blankets (it is COLD at night, the first night we were shivering and broke out the sleeping bags from our camping supplies), with places now to sit and eat, this place looks like a home at last.  

A closing story on God's provisions.  When I unpacked the trunks Thursday, I realized that though I had three pans and a skillet, I had not one utensil with which to stir.  I was seriously regretting leaving so much behind.  Then Kimberly our fellow-WHM missionary texted that she was coming to the dentist at Kijabe and offered to bring something, so I asked her to pick up a spoon, whisk, and spatula, which she graciously did.  I mentioned this Friday afternoon to one of the short-term visiting doctors from New York, and he brightened up.  Come by our place, he said, our church had a "kitchen shower" for the missionaries and we brought an entire suitcase of kitchen supplies.  Coincidence?  I think not.  I did not need to be asked twice . . within and hour I was knocking on their door.  I could have almost cried when Elaine gave me two bright aprons, brand new dish towels, measuring cups and spoons, a few more utensils, a couple sharp knives AND a sharpener, even a vegetable peeler and a pastry cutter.  Many of the things I left behind, being given back to me new and spiff and free.  It's the kind of small detail that God delights in working out, to remind us of His intricate mercies.

Today feels like a corner turning, the end of leaving (Bundibugyo, team, our normal life, our HMA) and the beginning of being present in this place where we've been moved.

More Redemption . . and CELEBRATION

More than three years ago a young lady came to our church at the urging of her Sunday School teacher, who happened to be one of my good friends growing up. He had urged her to apply to teach missionary kids in Uganda when she graduated from William and Mary. Little did we know that Sunday morning that Sarah would become like a member of our family. Meanwhile another young man was graduating from another William, this time without the Mary, Williams College. He applied to spend 18 months in Uganda with a possible interest in medical school. We took him on, partly because we were anticipating another young single guy whom we didn't want to be alone (who never came, ironically leaving Nathan alone most of his term). Little did we know then that Nathan would also become and integral part of our family and life. Sarah and Nathan served wholeheartedly in Bundibugyo during some rough years for the district, and for our team, and for us. They both did amazing jobs. But even more amazingly, they found God drawing their hearts towards each other. It is pretty ridiculous to even think about "dating" on a team where the singles function like siblings, where every moment and action is observed by a curious community, where there isn't a restaurant within hours, where privacy is culturally suspect. And where each of us is stretched to the limit. This is not a set-up for glamor or romance. And when Nathan and Sarah did realize their hearts moving in this direction, they bent over backwards to be sensitive and submissive. Even so, there was a cost to the other singles on the team, as well as their own cost. When Sarah finished her term Nathan remained, and they made the excruciating decisions about medical school/masters in public health options while they were 7,000 miles apart, taking some risks (waiting list) that panned out to put them in the same city.

So it is with more than the usual rejoicing that we received the news on Saturday of their engagement. Sarah and Nathan will be married this summer! I believe this is the fifth American wedding to come from Bundibugyo, two other couples who met there (Rick and Wendy, Eric and Joy) and two who met at MTI (Natalee and Wes, Rachel and Craig) . . . am I forgetting someone?? Bundibugyo is a place where marriage has fallen far from God's creative and beautiful plan in Genesis. Unions are temporary, sequential, financial, and too often end in violence or abandonment for women. It is NO SMALL THING when a marriage actually grows from this soil. It is the kind of amazing, upside-down, Kingdom-only work that God does to surprise us.

Nathan and Sarah remind me that we serve a God who is making all things new. Who prepares a celebration so wonderful, that a marriage supper is a weak analogy to help us anticipate the glorious reality. We rejoice with them, and pray for faith as they move forward in their life together, becoming a redemptive blessing to this world.

Congratulations to our dear friends!

Redemption and Rejoicing

The RVA student who has been in a coma since Saturday woke up this morning! After four days of worrisome unconsciousness as malaria parasites plugged up the small blood vessels of her brain, the prayers of the saints and the careful treatment of her medical team finally pushed her back from the edge of survival. She is quiet in that unsure sort of way, but looking us in the eye, and smiling.

Scott and I have been asked to be the first-line contact for the student health as school physicians starting in March, a sideline to our regular jobs in the hospital. We've pitched in a little this week due to crisis, not only the crisis of the young woman with cerebral malaria, but also the epidemic of 72 other students (15% of the school) out with flu and gastroenteritis. So we've felt deeply, both as parents and as doctors, the gravity of this case and the nearness of disaster. Please pray for us to have insight and caution and care with the precious burden of other peoples' children. If there is any group of kids that would be under attack, it is this one, as they represent the easiest way to remove a thousand missionaries from service.

So another small redemption occurred in student health, in the midst of the sea of flu a young man who had persistently been febrile and occasionally sprouted an impressive urticarial rash, which the excellent nurses had the foresight to photograph in case it was gone by the time we saw him (it was). Turned out he had gone rafting on the Nile and boating in Lake Victoria a few weeks ago. And we remembered the time Julia and Caleb BOTH had classic Katayama Fever, the relatively uncommon phase of acute schistosomiasis; it took us a week to figure it out a decade ago but this time we realized immediately what was going on. A little piece of suffering redeemed for someone else's good.

There is much relief and joy on campus today for the daughter that was almost lost and now is found.