A Tale of Two Hospitals

In the massive, sprawling, congested city of Nairobi there are two hospitals.  There are actually many hospitals, but these are two of the most well-known, and since they host he only two paediatric residency training programs around (there is a third program in Eldoret at Moi University) they are the two that I've wanted to visit.  Since we have a visiting paediatrician in October as well as back-up from another visiting med-paeds ICU doctor, we came up with the grand plan for the three long-term Kijabe paediatricians as well as our colleague who runs the Neonatal community health program here, to take a field trip.  Together. 

So yesterday Mardi and I set out in the mist at 7:30 to drive into the city, where we met Immaculate and Mary (who live in Nairobi). It was an 11-hour eye-opening day.

Our first stop was AKU, as upscale and private as it gets in Africa.  This is a hospital where one needs a culture-shock debrief to leave the doors and re-enter the rest of the world.  It was established by a wealthy Persian hereditary prince, as part of the world-wide foundation that promotes development in the name of that particular branch of that particular religion.  We were treated royally as well:  greeted by the department chair, hosted to tea and sandwiches, invited to interact with all available faculty (all Kenyan, young to middle-aged, professionally styled, friendly), then given an extensive tour highlighting such technological wonders as the completely digital radiology department, nuclear medicine scans, well-equipped intensive care, state-of-the-art linear accelerator radiation therapy, carpeted luxurious hotel-like super-private wing where all the diplomats stay.  The Paediatric ward is new, bright, sunny, clean, creative, calm.  They have about 25 beds, with probably 20 kids.  The neonatal ventilators and monitors were state-of-the-art, and only two babies had the full-time attention of a nurse and a doctor.   The clinic has huge exam rooms, and a handful of well-dressed babies waited to see the consultant.  I felt like I could have been in any suburban high-quality American hospital.  This program takes 3 or 4 residents per year, who are paid to work there.  The only drawback for them is that the patients are all private so they are superseded by the private consultants to care for them, and the spectrum of disease can not include much that is common and poverty-related, because only the wealthiest Kenyans (or best-insured) can get in.  These residents already rotate at Kijabe for their surgical month, and we will now be on the lookout for improving their general paediatric experience while they are there as well.  We've referred a couple of patients back and forth, and it was good to find out about the wealth of subspecialty consultants there.  But few in our population would afford care at AKU.

From there we fought traffic (actually it was surprisingly not bad) across town to Kenyatta Hospital, the massive historic public institution and main teaching hospital for the University of Nairobi (medical school, nursing school, clinical officer school, public health).   Multi-storied, with dark stair wells, marginal cleanliness, obscure arrangements, a bit of a prison/institutional atmosphere, and CROWDS of patients.  The architecture was reminiscent of Mulago and Mwanza, I wonder if they were all constructed in the peri-independence colonial days of the early 60's, with open-air halls and central courtyards, unpainted grey-yellow stone stucco, formidable.  We sat in on the weekly Paediatric teaching conference, which was amazing, led by a personal hero of mine Ruth Nduati who proved that bottle-feeding HIV-affected infants was MORE DANGEROUS than exposing them to potential HIV infection through breast milk.  She is the department chair, and brilliant.  Here they take 25 or more residents per year, who sat in a steep lecture-hall with it's old furniture and peeling paint.  After the rounds we met a neonatologist (both she, the chair, and another lecturer were 50-something sorts of well-established academicians) who took us to see the newborn nursery and intensive care.  The space was brighter than I expected, and reasonably well equipped, with again the same amazing modern ventilators (only 3 of 7 functional) and monitors.  But 75 babies were crowded into what should have been space for less than half that many.  In the incubator room for the preemies, the babies were turned sideways to fit two or even three in each plastic box.  Mothers stood shoulder to shoulder with their hands through the little doors doing feedings.  Every inch of the other rooms was cluttered with cots, chairs, parents, files, etc.  Sometimes there are up to 20 students as well.  We had a good talk with the charge-nurse about the challenges she faces.  From there we toured one of the four Paediatric general wards, each with about 50 beds but bursting with a hundred or more patients.  Again the bright yellow paint, oxygen, IV tubing, etc showed a fairly functional and active system, but the place was packed, room after room with more than one patient in each bed, milling parents.  One lady ran up to me smiling and at fist I thought she was mentally a bit off, but then I realized she was the mom of a patient we referred a couple of months ago who was still languishing in a forgotten corner.  My guess is that the over-taxed residents focus on the sickest handful, and the vast majority get little attention after admission.  The consultants round only two mornings per week and then they only see 5 or 10 or 20 of the hundred inpatients.  The emergency room was lined with waiting patients, but there seemed to be an excellent triage system in place, and a very sick child was receiving oxygen by face mask with a paediatric resident attending to him.  Patients pay small fees at Kenyatta, but for EVERYTHING, from a bed to a dressing to an injection to a medicine.  Overall the costs probably end up similar to Kijabe or a bit lower.  If you have a competent aggressive parent who can advocate and navigate and has a bit of cash on hand, Kenyatta has the expertise and resources for some of the best care in Kenya.  But for the masses of the bewildered poor, it probably turns out to be a frustrating and overwhelming place, easy to slip through the cracks.

I don't think there could be two more different hospitals in the same city offering such similar services. One is all about money, modernity, efficiency, customer satisfaction, excellence.  One is all about inclusion, the public good, stretching resources, making do, thinking nationally.  Both fill an important niche.  But you can probably tell my heart is with the latter.  It would require a strong heart to work there, because I'm certain that death is common.

Week in Review, Part 3--the Big Picture

If you've persevered through all the family happenings and medical crises of the last week, bless you for reading. The last thread of the week though was a national level meeting of the Kenya Health Task Force, convened by our American Ambassador Scott Gration, in order to cut mortality in Kenya by HALF. By the end of NEXT YEAR. Which does not sound very possible, but I have to say his opening speech was both inspiring and impressive. This ambassador grew up in Kenya with missionary parents and even went to RVA for a while, and his wife spent most of her childhood at Kijabe. They are ideally placed as Americans who know Kenya, the language, the people, the issues, the dreams, and can connect Kenya's community with both the American government (i.e. money and power and influence) and with outside charitable organizations (i.e. skills and dedication). This is the same effective triangle of action that our famous Hopkins public health professor, Carl Taylor, wrote and taught about. A cooperation between local communities, government, and NGO's, driven by actual data and need, taking advantage of the unique gifts of all three.

So in the middle of this wild week of intubating babies and baking birthday cakes, I found myself as Kijabe Hospital's Paediatrics representative to the Let's Live campaign, sitting around a table with Kenyan professors and ministers brainstorming on how to improve immunization coverage, or new ideas for training doctors, or innovations in the treatment of malnutrition. We focused a good bit on the neonatal (birth to age 1 month) mortality rate which has barely budged in the last decade (33 to 31 per thousand births) and accounts for almost half of under-five deaths. It was stimulating to sit in lectures once again, to ask questions, to meet interesting people at tea and lunch from all areas of Kenya's health system. And in a week in which one of those 31 per thousand was not a mere number but a gut-churning reality, it was also a relief to look at the big picture view of where this country is going in health, and feel encouraged that bright and ambitious and capable people are dedicating their lives to see change.

Week in Review, part 2 - Challenges

Because life is always that way. A celebratory week can not just be savored, it has to be wrested from the thorns. From the Fall, the curse meant that we could live under the vine and fig tree, but only at the cost of the sweat of the brow. We could commemorate the joy of 15 years since bringing forth a particular child, but only in the context of mourning for others.

Last weekend, the first two days of October, and by the end of them I thought I might need the rest of the month to recover. There are call days, and there are call days. This one did not start off too badly, rounds were reasonably efficient, and I ran up the hill to the school to watch the boys play soccer. At the very moment that Caleb scored the opening goal of the match, my phone rang from the ICU asking me to come for a little neurosurgical baby who had "coded" on the floor and been temporarily revived and transferred up to intensive care. And that was pretty much the last free and happy moment of the weekend, and beyond. It all runs together now, but I will tell you a few stories.

"Baby of Carolyn" lived her whole life in this week I'm reviewing. I was with her at the moment of her birth Saturday, and the moment of her death at 4:40 this morning. It all started when her mom was transferred into Kijabe from a smaller clinic, bleeding and leaking amniotic fluid, with a supposed 30-week pregnancy whose fetus measured smaller than that and with a dangerously falling heart rate. Her husband did not feel he could afford an emergency C-section or intensive care that might be needed for the baby, nor did he think the baby could survive, so they refused at first to sign consents. Which left Scott, on OB call, and me, on Paeds, standing in the labor room calling our medical director and executive director for ethical advice. Within a few minutes we got permission to insist on trying to save the baby, even if the hospital would be left with the bill. And within a few minutes after that Scott was extracting the baby girl surgically and I was coaching the intern through a resuscitation of her tiny limp blue not-even-gasping form. She began to breathe with help, pinked up, moved. She weighed 840 grams. Things were going as well as one could hope with such a distressed preemie until I intubated her for the first dose of surfactant, a soapy coating that preemies lack in their lungs. I put the tube in too far (easy to do in such tiny babies) so that it lodged in her right mainstem bronchus, and the intern assisting me gave the first few breaths with nervous vigor (also easy to do in this stressful situation). I was listening for breath sounds and watching the monitor, and neither looked good, and then I looked back down at the baby and nearly died of shock and dismay when I saw that I had given her such a severe pneumothorax that air tracked up and ballooned under the skin of her neck. I called our excellent anesthesia and surgical attendings for rescue, certain that I had killed the baby. It was a terrible hour, but they were able to place a chest tube and re-intubate and stabilize. I took her to the ICU (my second newly ventilated patient of the day). It was a long weekend with her, trying to keep the tube in place, following xrays, managing her fluids and tiny initial feedings, comforting her mom. And throughout the week, I had hope. Even when I happened to be the one who found her when her tube was out, who set her up on CPAP, and who ended up with her all night the last day of the struggle, when her heart was failing, her kidneys were failing, and we ultimately failed to save her life. On Saturday we had made the difficult decision to choose to go all out to give her a chance; by early Friday morning I had to make the much more difficult decision that we had done everything, and lost this battle. She had not taken a breath, moved, opened her eyes, made a drop of urine, all day, and even intubated and pushing in the breaths we could not get her saturations over 50% (normal is 90-100%). I stopped pushing and just put her back on oxygen and within two minutes she was dead. Her mom, achingly, thanked our team for trying, and said this was God's plan. Which is on a certain level true (Job says the Lord gives and the Lord takes away, blessed be the name of the Lord) but on another level is not, the cosmic struggle of good defeating evil means that babies like Carolyn's should linger into a full earthly life as eternity reaches down into their time.

It was a week for complex patients. Another baby, Samuel, was admitted over the weekend, transferred from another hospital where he'd been treated for pneumonia and had not really healed. HIs chest xray showed a discreet pulmonary mass, which by CT was later confirmed to be a rare congenital malformation. But that did not explain his extreme cyanosis; he was BLUE, and not that uncomfortable about it. So we got an echo in Nairobi which showed complete transposition of the main blood vessels leaving his heart. The blood which should flow to his lungs for oxygen flows to his body without much, and the blood which comes from his lungs just keeps going back there, two parallel independent loops. Needless to say he can't live long like this, but we hope that he'll qualify for surgery with a visiting team in November. I snapped his photo when his mom dressed him in a shirt labeled "Special" to remind us that his anatomy is not a mistake, God can take this problem and turn it to good.

Then there was the little girl with pneumonia who got worse and worse, as her infection spread into empyema, pus in the lining of her lungs. As well as the neurosurgical patient whose wound may have been infected with tetanus, she lies in constant spasm. Or the previously normal 8 year old boy whose week of fever and headache progressed to intractable seizures, whom I found admitted to our service with classic signs that his swelling brain was about to push down through his spinal cord into his neck. Another trip to the ICU. Or the infant we had sent home from the ICU a few weeks ago who returned with a big mass in his abdomen, which turned out to be his bladder, obstructed and damaging his kidneys. Or the HIV-exposed baby who was dwindling not from the infection but from hunger. Or the Maasai boy whose bizarre symptoms Mardi linked to sampling local mushrooms. And on and on.

Somewhere in there we also had a visit from a family from Germany, whose adoption of two Haitian children led them to establish a charitable foundation to fund projects for needy children. Though we had never met we bonded quickly over the stories of these patients, and it was a privilege to connect Simone with our Paeds ward chaplain Mercy. Mercy meets with and prays with every family on the ward, and through her loving care hundreds if not thousands of people have encountered Jesus in life-changing ways. She'll be able to help identify patients who truly can not pay even the nominal fees charged by Kijabe, and connect them to Simone's group in hopes of allowing more children with anomalies to access surgery, more families being crippled by expensive bills to break out of the cycle of poverty.

And I haven't even mentioned the national meeting for health in Kenya, which will have to have a separate post.

Birthdays, grandparents, donors, visits, meetings, severely ill patients, calls in the middle of the night, tubes and blood, oxygen and labs, cooking and more cooking, travel and hosting and plans, dishes and dirt, recoveries and tragedies. And not a lot of sleep. In the context of a minor cold and just not feeling very physically well myself, I think this was one of the most challenging weeks since we arrived in Kenya. I end it tonight, tired, and sad about Baby of Carolyn, relieved to take a weekend away from the craziness, and a bit drained of optimism.

Week in Review, Part 1 - Celebrations

In the theme of thankfulness, let's start with a couple of family highlights.

First, on Monday, Grammy arrived in Africa. This is her sixth visit to the continent in the 18 years we've lived here, 3 alone and 3 with my Dad. Scott and I took a taxi ( a separate story, but due to a mishap while changing the oil, we were without a vehicle, until a servant-hearted and capable friend at RVA fixed it on Wednesday; I would mention his name but he's very humble about it, and he might get inundated with mechanical problems if we make him famous . . . ) down into the city Monday night, and waited for her flight. Which was a bit delayed, and then waiting for her handy walker to be unloaded delayed her further, until we were beginning to worry. Never fear, she had befriended multiple people on the flight and got a Kenyan airport worker to help her with her bags, talked her way through customs with two humongous pieces of luggage stuffed fully of goodies for us, and briskly made her way out into the waiting crowds in her bright pink sweater, more-slender-than-years figure, and trademark sliver-white hair. She'll be with us for the month of October.

Secondly, on Tuesday, Julia turned 15! What a lovely young lady she is, smart, capable, helpful, willing, determined, loyal, loving. She sets her own pace and has her own style, athlete and scholar, loving dogs and crochet, books and flowers and cows and bugs, friends and soccer and piano and choir. She decided to invite her JV soccer team (from 2nd term) to come for pizza, so in the less-than-two-hours between the end of Basketball practice and the mandatory study hall time for dorm girls (no exceptions for Bday parties I'm finding), we had to squeeze in 14 girls making and eating dozens of pizzas. Lots of laughter, creative toppings, hot fingers, excited conversation. We all called out our top 15 things we love about Julia as we baked and ate. As darkness fell the girls poured inside for a 4-layer cake and ice cream, then we sent them back to their dorms with bags of goodies. Julia, a blessing in our life and family that none of us deserve, yet none of us would want to live without!

Thirdly, on Wednesday, because our friend fixed the car, and because I was able to get out of a meeting an hour early, we converged upon Rosslyn (another international school in Nairobi) to cheer on the teams. It was a privilege to watch Acacia in her first-ever-in-her-life athletic competition, first team event, in her uniform, giving her all. Though her team does have a long way to go. . . Jack's team also lost Wednesday, though by a narrow margin. Julia was the only winner but her team played at a different school, so we didn't get to hear that until later (and in the week-in-review theme, her team also won a whole JV tournament last Saturday, they have really come together as a team and are doing quite well). Caleb's team was resting until Thursday when they played the Prison Guards. No, that's not a euphemistic name for a school team. It is literally the young adult men who have jobs guarding at the maximum security prison in Naivasha. His team had previously gone TO the prison and played the prisoners themselves, so I guess the guards wanted their shot. In spite of being much younger and not quite as strong or fast, the RVA boys endured and emerged victorious, 3 to 1. Caleb sent in the corner kick that resulted in one of those scores, and played hard and well the whole game. With every game we get to see I remember that it is a privilege not a right, that I never saw Luke play a high school sport, that these hours are the most focused live-in-the-moment hours of our life. When we stand and cheer, it is all about the kids and the day, the sun and the breeze, the excitement and encouragement. We're not on the way to something else, we are THERE.

Which brings us to today, when the family spun off in several directions for the long weekend. Julia's birthday wish was to take Grammy to see our favorite Kenyan spot, Sunrise Acres, near Eldama Ravine, the cozy basic camp-like cabins on a dairy farm in the highlands. Acacia went to visit her aunt, uncle, and cousins who work at a Christian University in Nairobi. Jack and Caleb flew to the coast to visit a family there whom we have been friends with over many years. This was planned long before the recent kidnappings, travel warnings and restrictions in that region, so we let them go ahead on faith, but deep down wish they were at arm's reach. And as we take a short weekend break we miss Luke all the more, this is a setting which should include him.

By any measure a full week, with the comings and goings, games and tests, celebrations and meals. But this was only half of the week, or less. On to part 2.

Parenthood, via Abraham

"Before Abraham sacrificed Isaac, he laid himself on the altar - by obeying God."

by Ferenc Visky (Ferenc Visky (July 1, 1918 - October 5, 2005) was a minister in the Hungarian Reformed Church in Transylvania and a leader of evangelical revival in Romania who spent several years in prison under the Communist rule of that country.)

"Take your son... and sacrifice him as a burnt offering."(Genesis 22:2)

 

God speaks to Abraham and requires something from him. Abraham thinks of everything, except the fact that he has a God who asks something from him.

 

Nobody is aware that God can also ask for things. People like to ask for things and they like God to give. God asked Abraham to sacrifice his own beloved son and with it, He asked everything from him.

 

When I was deported together with my seven little children, the eldest of whom was eleven years old and the youngest only two, my biggest concern was not that all our possessions had to be left behind, that the door was closed behind us and that we would not return. The one thing I worried about was the seven little ones. What would become of them? Who would feed them and look after them?

 

Abraham obeyed and laid his son on the altar, though he did not know God's purpose. He only knew God Himself, for he believed Him and loved Him. Before Abraham sacrificed Isaac, he laid himself on the altar - by obeying God. Because he sacrificed himself first, he prevented the sacrifice of Isaac.

 

I knew I had to do the same thing. I cried for my children, but I had to lay myself on the altar first. And there, in that fateful situation, I experienced a miraculous surprise. Jesus had been there before. He did His Father's will and so I found that He was there when I was prepared to sacrifice myself and it meant salvation for me and my children.

 

Don't try to find an excuse when God takes you to the altar, for it is there that He Himself is waiting for you - in His beloved Son.

 

This is one of those passages that keeps coming up as a theme in our lives, an uncomfortable one, one I'd rather skip over.  The most consistently impossible challenge of faith and missions is that of parenthood, of putting our children into situations that seem like an altar, a knife, rope, and bewilderment.  I spend a lot of energy feeling like a bit more organization, better feeding, alertness to opportunity, push for language acquisition,  more consistent family devotions, more effective prayer, will somehow shield them from the altar.  Ferenc Visky and Abraham bear testimony that by asking us to place our children at risk, we are placing our very hearts on the altar.  No wonder we balk.  But the good news is that God is there.  So for all parents of kids at boarding schools, parents of kids who feel lost and out of place, parents of kids with marginal health, parents of kids whose future feels uncertain and threatened, parents of kids who have been teased or isolated or excluded, parents of kids who are taking their own steps of sacrifice and faith . . . remember Abraham.

Walk in the manner worthy of the calling

Our chapel speaker this morning read from Ephesians 4: I therefore, as a prisoner of the Lord, urge you to walk in a manner worthy of the calling to which you have been called . . . 

And he used as an example Wangari Maathai, who died of cancer this week at age 71.  She was a called woman. Here is one paragraph about her life:

"After graduating in 1959, she won a scholarship to study in the US, as part of the "Kennedy airlift" in which 300 Kenyans – including Barack Obama's father – were chosen to study at American universities in 1960. After further study in Germany, she returned to a newly independent Kenya in 1966, and five years later become the first woman in east and central Africa to obtain a PhD from an African university. There followed a tumultuous personal and public 40 years in which she ran the University of Nairobi's veterinary department, was imprisoned several times, stood for president, became a minister and won the Nobel peace prize. . . By this time, the Green Belt was flourishing. What began as a few women planting trees became a network of 600 community groups that cared for 6,000 tree nurseries, which were often supervised by disabled and mentally ill people in the villages. By 2004, more than 30m trees had been planted, and the movement had branches in 30 countries. In Kenya, it has become an unofficial agricultural advice service, a community regeneration project and a job-creation plan all in one." (The Guardian, http://www.guardian.co.uk/world/2011/sep/26/wangari-maathai?intcmp=239)

Wangari Maathai saved some of Kenya's most important forests, because she understood the link between the environment and freedom, between environmental degradation and poverty.  She was willing to risk her life, endure beatings and hardship and loss, to stand for what she believed in.  And because she did this, an entire new generation of Africans will live better lives.

Wangari Maathai knew her calling, and lived with a passionate single-mindedness that blessed the world.  What Kenyan 3-year-olds that I'm treating will be the next Nobel Peace Prize winners?  And how can we as missionaries, parents, doctors, live with the same all-out dedication to our calling?

weekend, weekstart

It's 9 pm on Sunday, and I am very happy to be writing this from BED, the end of a long week, with another one starting too soon.  For this hour, though, the cares of Monday are still a sleep away, and I am thankful for this cozy room as the wind whistles down the Rift outside.  I confess to ending this week in a bit of a funk, physical (minor viral thing) or emotional (RVA nurse Loren Harrison's sudden death from a hemorrhaging aneurysm in his brain while on a six-month USA stay) or spiritual (allowing the demands of life to eat away at rest and reflection).  One of the many small beauties to spring from the blood-soaked soil of Loren's death was a long conversation with another teacher who had been widowed in similar circumstances a few years ago. She told me that God had prepared her heart by leading her to focus on the discipline of thankfulness.  So that even hearing about her loss and pain years later, the primary message she communicated to me was thankfulness, for her husband, for the way he died, for their life, for God's mercy.  It was very inspiring and convicting in the midst of feeling rather down myself to hear this from her. Today at Loren's service one of his friends read the verse in Proverbs "a merry heart doeth good like medicine" (which Kay Meyer cross-stitched for us years ago) and spoke of Loren's cheerful attitude as the medicine he tirelessly gave his patients.  So at this moment let me be thankful.  Thankful for life here, for cheering at games as the sun sinks glowing over the Rift Valley.  Thankful for Julia the sparkling hostess of our 10th grade Caring Community (monthly small group of students to feed and love), as we produced dozens of pizzas and engaged them in a Cranium game, and popped M and M's and chatted and prayed.  Thankful for the 30-some kids who showed up for a prayer breakfast Friday morning, sincere and open.  Thankful for the RVA community, as they came together for the memorial service, which was just the right paradox of mourning and celebration.  Thankful for teachers like Mr. Batterman volunteering to coach, and doing so in a positive way.  Thankful for Mr. Crumley and the choir singing this morning.  Thankful that Caleb finally got a chance to lead the weekly fellowship group Koinonia on guitar.  Thankful that Caleb and Jack made it through another weekend of games without being seriously injured.  Thankful for our old neighbors the Riches lingering over Sunday breakfast and talking about kids and life, thankful for the connection of relationship that goes back more than a decade.  Thankful, along those lines, for Anna and Jessica who pitched in with our group on Saturday night when I was almost too tired to stand.  Thankful for Sarah and Nathan who took a train up from NYC and spent the day with Luke, a taste of "home" as he put it.  Thankful that Caleb is another step closer to finishing his USAFA applications (and trying not to think that then we have to start the "regular" admission parade).  Thankful that I'm living with my kids, and heard 3 of the 4 sing in choir this morning.  Thankful for an evening jog/walk with Acacia, out on the lip of the valley, with scrub and birds and quiet.  Thankful that Scott washed the dishes tonight.  Thankful that we got Luke on the phone.  Thankful for my washing machine that is churning through the second installment of the weekend's accumulated mountain of dirty clothes (I do love that machine).  Thankful that a week from tomorrow we'll be collecting my mom at the Jomo Kenyatta International Airport.  Thankful for my happy dog, who gains such satisfaction from any little jog.  Thankful that God gives HIs children sleep.

Contrast?

Our first famine baby to reach Kijabe. Drought and war have interrupted the tenuous cycle of survival in NE Kenya and across her border in Somalia. Food prices have risen dangerously across the region, even though we are a decent distance from the most affected areas. But this week, in the wee hours of the morning, an aid agency dropped this tiny malnourished 3 month old off in our casualty department. Ayub was born in our neighboring chaotic country, 8th child in the family. Three had already died in their first months of life, so this time when his parents saw that he had a defect in his spine and was frail, they decided to trek to Dhaddab, a huge refugee-camp-tent-town on the Kenya side of the border. He was hospitalized there and then transferred to Kijabe wasted, infected, pencil-thin, and irritable, with pneumonia on top of his neurologic and nutritional issues. We stabilized him and began to uncover his underlying problems, which have affected his brain and make his prognosis very poor. But no child should die of hunger, and feeding is one thing we can do while we wait to see what God will heal in the rest of his body.

In contrast, a few meters away, five hundred bright promising multinational children study and play, learn and grow. This is Julia's class last week, and this morning about 30 of them showed up at our house for prayer and cinnamon rolls (a holy combination). They are the future of Africa, and our world, kids with hearts for the poor and with the physical and mental advantages to effect change. At first glance the gap between an RVA student and Ayub seems to be an immeasurably impossible chasm, and we walk the edge between these two worlds, back and forth, hour by hour.

And yet there is a common thread of experience which ties us all together, that of suffering. I think the strong turnout this morning was related to the tragic events of the week at RVA. One of our student health nurses, Loren Harrison, father of 8, died Thursday morning. He was in America this term for a short HMA while his 4th kid started college (3 older are fairly grown, 4 younger are students in elementary to high school). Sunday he had a headache and collapsed, and it turned out that he had massive intracranial bleeding from a cerebral aneurysm (abnormal blood vessel) that had been a dangerous silent threat and then finally burst. In spite of being near a good medical center in MN for care, in spite of being only 51, his life on this earth ended on Thursday. Loren was a man of constant good humor and cheer, who stood in as a father and strength for countless sick students as he worked here for the last decade. This is a small and close community, and such a loss reverberates throughout the students and staff.

We read Romans 8:17 this morning. As heirs of glory we are also heirs of suffering, walking the same path that Jesus did. It always comes as a surprise that godly people who serve others would suffer, even die. Yet if this was required of Jesus, how can we expect anything less?

So today as we prayed for the kids, and as I watch Ayub's mother stranded in this unfamiliar hospital days from home, surrounded by people whom she can not understand at all, I can only ask that the suffering brings us nearer to Jesus, makes us more aware of where He walked, and more complete in Him in the process.

ANNOUNCING. . .

. . . World Harvest's newest team, to go with our newest field of Burundi. Today the new team was approved as a group: John and Jessica Cropsey (ophthalmologist and teacher/administrator/mom) with children Elise, Micah, and baby-on-the-way; Eric and Rachel McLaughlin (family medicine and OB/GYN) with children Maggie and Ben; Jason and Heather Fader (general surgeon and teacher/mom) with children Anna and Abi; Alyssa Pfister (Internal Medicine/Pediatrics); and Carlan Wendler. That's 15 new family members in one day. Very sweet. We are incredibly thankful and blessed that God has intertwined our paths, for the world's good and God's glory.

They will now be in a couple of years of support raising and language study before arriving in Burundi to focus on medical care and education in 2013. Get to know them on their blog, and join us in praying for them: http://mccropders.blogspot.com/

I MISS MALARIA

Who in her right mind would miss a disease that ranks as one of the number one killers of children in the world? Me. I shouldn't, I feel guilty about it, but I confess that I do.

Malaria is deadly. But it is also quite concrete. It can be seen under the microscope. It has a known course, and a cure. A child with malaria can look like death and in a few hours look pretty normal. Malaria is an enemy one can grapple with. We aren't always successful, but we often are. Patients and parents understand it, and want the treatment. You don't have to convince or cajole. The drugs are available, relatively cheaply, and the turn-around is quick.

Which is in contrast to the average Kijabe Paediatric patient, who is complicated and for whom we seem to do little that is dramatic. When I heard that our new admission yesterday was "a 15 month old with diarrhea and dehydration" I thought, great, something we can treat. But of course he had that on top of a progressive depressing divergence from normal developmental milestones, a history of TB with a pericardial effusion, a Rickets-related cardiomyopathy, overall marginal nutrition. This morning he was barely moving, just this side of coma, and we re-checked his potassium level which had fallen from 5 to 2.2 since admission (bad) from his copious stool. The one patient on our service who may have actually come with malaria (from a distant low-lying town) was only here because he also has spina bifida, a VP shunt, a deep pressure ulcer awaiting plastic surgical repair. One of our patients was missing this morning, a darling little 4-year-old girl in a pink headscarf (already) who had come from ICU after being stabilized for new-onset insulin-dependent diabetes. Not the easiest place in the world to raise a diabetic child, but thanks to Mardi's contacts we had a donor who was willing to fund her glucometer and care. Only it seems her father and his relatives did not deem her worth the effort, because about an hour after a long conference convincing them to stay, they ran away with her, and left the bill.

Because we're a referral hospital, and because we have excellent surgeons who are game for attempting the impossible and taking on desperate cases, and because simple things can be treated more cheaply in government health centers, Kijabe is a magnet for the complicated. And often a place where we fail to substantially alter the course of a disease or disability. A place where we bump (crash) right up against our limits.

Which is my real problem, I know. I like to see cures. I like to fix, restore, redeem. It is more appealing to deal with problems we can label, to engage in battles where we can fight back.

Jesus had compassion on the poor, the blind, the lame. I suspect that most of my patients are not so different from those that thronged to Jesus. He healed many, but I don't think he "fixed" everything. The final putting-all-things right still eludes us. The people of the Kingdom are tough cases, complicated, marginal, hungry, lagging, peripheral. Being at Kijabe immersed in these very people should be a taste of Heaven. In fact it just reveals to me that I don't particularly love the needy so much as I love being able to do something about their need.

So pray for people like me, who miss the curable malaria cases, and resent the sense of ineffective futility when confronting our daily stream of those who will never be particularly healthy or smart or strong. Pray for compassion to trump frustration.