Home Base

in the last few weeks we've been blessed with a number of visitors. Africans always see visitors as a great blessing, and since my cooking is usually a topic of Swahili vocab and conversation with my teacher, whenever I say that we have guests he is exceedingly happy on my behalf. A family of missionaries in which the father was long-ago an RVA student coming to reconnect, kids who attend school coming a day or two early to get over jet lag, a single missionary from a remote and hard-to-live place coming for some family time, a family from a remote area of East Africa coming to investigate enrolling their child at RVA, a mom coming to check on one of her boarding kids, medical students and residents from the US coming to learn and explore and ponder their futures. Some of these have slept here, others we put up in the local guest house and just had over for meals. Many conversations, good meals, lingering, movies and games and fireside fellowship, tours and introductions, and some prayers.

I was praying with one of the long-term station women on Thursday, and we talked about this role God has given us in our lives here. The role of home base. Of safe spot to return to, to launch from. Of accessible food and medical care, of organized worship and recreation, of abundance of relationship. Kijabe and RVA are like the hub at the center of the wheel of missions in East Africa. People pass through because they have history here, or friends. Or because they're sick and need care. Or because their kids are here.

This is not always felt to be a very glorious role, particularly for the women who are mostly consumed with being moms. But I believe it is a crucial one. Because I've seen it, a good number of times, from the other side. We were once the people passing through. We first came here for safety when preterm labor threatened our baby, and stayed for a good delivery. We came here again in a time of war and upheaval and uncertainty and found a healing rhythm of work and community. We passed through other times to attend conferences and visit friends. And twice for life-saving medical care and surgery (Scott with a serious leg infection accompanying a visitor with an appendix disaster; and Jack with an incarcerated hernia). Until a year ago, Kijabe was a place whose existence allowed us to survive, and to continue living on a dangerous front line. RVA was a place which allowed our two oldest to progress further in school without having to return to America. The existence of this sprawling station with its resources was a safety net for us.

Now we are starting our second year here, appropriately, with a spurt of visitors who are using the net, touching the home base, as we once did. Now we're the people who provide the listening ear, the meals, the arrangements. It is different from the rest of our life in Africa, to be sitting on this breezy porch on a Sunday afternoon, undisturbed. To have a cold electric fridge that we just stocked with easily 15-20 different varieties of fruits and vegetables. To have a washing machine that churns out clean clothes for our travelers. To have heard a very good sermon in English with modern praise songs and American handshakes afterwards. To be able to send this post by a fast and fairly reliable internet connection.

In Genesis, Abraham and family were continually promised a land that they would use to be a blessing to others. A nation that blessed the nations. Kenya does flow, literally, with milk and honey, with dairy projects and bee hives. I still miss so much of Bundibugyo, but I do embrace the home base role, and pray that each person who passes through our life here will be strengthened and blessed for the journey.

A 24 hour life

Evil feels triumphant tonight, or at least impotence and ignorance.  

Twenty-four hours ago we were sitting around the table after dinner, serving tea.  Our friends the Wrights had just pulled in from a long day's drive from Karamoja (Uganda) to visit, and our friends the Barnes had been sucked into the party when they walked by with a young premed student delivering Birthday invites.  I had a page from the nursery to go over some labs, and was feeling pretty relaxed about the evening since things were going relatively well.  Then a few minutes later I got the "999" page that means "RUN".  I grabbed my coat and stethoscope and made quick apologies as I rushed out the door, trying to imagine which of the babies could be dying.

Into the humid warmth of the nursery, brights and steamy and slightly chlorinated, a jungly at-home feeling after rushing through the windy darkness of Kijabe.  I see our medical officer and two nurses huddled over the resuscitation table, and quickly glance around the room to see which cot or incubator is empty.  But it is a new baby, just delivered, pale and floppy and lifeless and bloody.  Very bloody.  Blood matts her hair, is caked in her ears, fills the suction catheter that vacuums her mouth.  I hear quickly that she was born dead, with no heart rate or effort to breathe.  But now a few minutes later her heart is beating strong, though nothing else seems to be happening.  No flicker of movement, no flutter of eyelids, no gasp of breath.  We dry and clean and suction and bag breaths into her lungs, over and over and over again, while her heart ticks steadily on.  I get more story that makes me suspect she may be a bit drugged from pain medicine her mother got, and after a dose of a reversal drug she does start to breathe.  In a full forty minutes though we're still floppy and in spite of lots of oxygen and help she is still blueish.  And if she was just punky from her mom's medicines, what's the explanation for all that blood?  I decide to intubate her to suction her airways better, and to try and improve her oxygen status.  I'm still not confident about many of my skills, including threading the airway of a slippery (usually squirmy, though this baby wasn't moving) phlegm-filled micro baby throat.  But by God's grace alone I get the tube in, and we suction some blood.  

And so the first hour ticks by, and before too long the second.  The baby is fighting a little now, moving her delicate arms.  She never really responds the way I would expect to all the efforts we make.  A fluid bolus seems to help.  We check her blood count thinking that if this is HER blood she lost, she may need a transfusion, but she doesn't.  Xray doesn't show any major lung problems, heart seems normal.  I take time to go find her mom and bring her into the nursery to see her baby, whereupon she turns and puts her arms on my shoulders and sobs.  I pray for her and stroke her back and try to sound hopeful, striking the right balance of sober and optimistic, your baby is very sick but so were all these others who are now improving.  The mom names her Victoria.  By ten pm we pack the baby into an incubator and wheel her up to the ICU to be kept on a ventilator, since she does not breathe well enough on her own to make it.  I'm home before midnight, leaving her pink and restful, opening her eyes, and I hope over the worst.  

By morning I've only had one call about her, and I am hopeful that whatever was wrong is getting better.  Then another "999" during rounds, I run up to ICU where the staff has accidentally dislodged her endotracheal breathing tube.  Not difficult to do since the margin between "in" and "out" is less than an inch.  I briefly consider keeping her off the vent, she is doing so well, but then her oxygen levels drop, and I realize she's not ready.  The medical officer tries to intubate without success and then everyone looks at me again, and I pray.  This time Victoria is actively fighting against me.  But I get the tube in again, and she's pink and as we put her back to bed, restful, looking at me.  Labs look OK, and though I'm still puzzled by just what is causing her problems, i don't really mind not knowing if she's getting better.  I order another xray to be sure the tube is back in the right place and go back to nursery.  

(Where, parenthetically, I find a surprise 32 week tiny bright pink baby boy just born . . whoops, we are out of incubators, so he has to rest on the resuscitation table while the one available incubator is fixed).

Before another hour is up though, I am back to ICU where her oxygen levels have plummeted.  I'm told the xray was OK but when I look myself I see a too-dark outline to the right lung.  Her lung has popped like a balloon, leaving a rim of air between the lung and the chest wall that compromises breathing.  And since we are pushing air into her lungs, we are making this worse minute by minute.  I call the paeds surg team to put in a chest tube, and am poised to stick a needle in myself but they arrive just in time.  

From there we never really regain our ground.  Another couple of hours pass, the chest xray with the tube in place looks great, but the baby doesn't.  Victoria is inexplicably dying.  

I usually look forward to my Wednesday afternoon sign out to Mardi.  Especially after being on call 3 of the last 4 nights.  I try my best to have everything sawa sawa and ready to go.  But today was not fun.  I hung around an extra hour but Victoria only seemed to be getting worse, and then it was time for Julia's soccer game, and I left.  Mardi messaged me not long after.  Victoria was dead.

She lived a day.  Not quite 24 hours, and I was with her a good number of those.  More than her mom was.  At first I wondered if we should even try to revive her, then I thought she would probably live and be fine, then I had no idea how to keep her alive.  

Part of my heart knows that the quote below is true. Right, temporarily defeated, is still stronger than the apparent triumph of death.  Victoria lives on, and waits for the resurrection.  Her name reminds me of 2 Cor 15--where oh death is your victory?  But I am wearied tonight by the lost battle, and though I'm thankful I was spared the final moments (thanks Mardi) it is still a sadness, hopes dashed.  Her mother will grieve this in some part of her heart throughout her life; I will probably barely remember this in a month or two, as another hundred babies pass through my hands.  

So tonight I honor one small life, a little broken body, a valiant struggle, and look forward to the place where death is no more.

MLK DAY

"I believe that unarmed truth and unconditional love will have the final word in reality. This is why right, temporarily defeated, is stronger than evil triumphant." Dr. Martin Luther King

Quote for the day courtesy of our fellow-Africa-loving-Paediatrician Amy Long. Wishing I was at Luke's Gospel Choir Concert in honor of the day. Feeling a bit of temporarily-defeated-ness in the wake of a long weekend of call (Scott did 5 C sections in about an 18 hour stretch, I lost one of our NICU babies).

week in review

Julia and the Varsity Girls' Football team, with Coach Dahlman. They had their first game this week, a loss to the Swedish girls. In spite of the 1 to 0 score, our team played well. And Julia played awesomely. Highlight of the week: Miss Larissa of South Sudan has stayed with us since Wednesday. It has been delightful to have her in the house, to feel like "team" again. You can see how happy Acacia is. I am thankful for her company, ideas, service, cheer, and general presence. Brielle sports her CPAP (continuous pressure oxygen circuit) which is held in place by the little pink knit hat. Charming parents anxious but happy, unstoppable labor, an active little preemie with a reasonable weight and a good prognosis. Hoping she will fight on through. Jack, exhausted with cheering, sinks to the floor in relief when Man U pulls out a victory over Man City. It hasn't been an easy couple of weeks for avid Man U fans, and the losses have taken their toll. Caleb's last step (??) in college apps, the ROTC physical fitness test. He did 57 pushups in one minute and then ran a mile and a half around the grass field in 9 min 6 sec, which is pretty good at this altitude. Here he is smiling with Coach Davis after the run. Miracle baby Wangari. Keep her in your prayers. No baby with gastroschisis has yet survived here, though we've tried to help many. The others have been born elsewhere, languish a few days with their intestines hanging out a hole in the abdominal wall, become infected and dehydrated and can not be rescued by the time they arrive. This baby was born here, and in spite of a harrowing first few minutes when we couldn't get her to breathe . . has done well. Her intestines are now back inside, and starting to work. I taught a conference on her case this week, and reflected on Psalm 139. Rugby tryouts have started a whole term early. Because the varsity team did not do so well last year, they have to play a relegation match this term, so the coaches are training with about 40 boys daily. Rugby is THE sport at RVA . . here is Jack, with the talented Howorth brothers, coming to eat pizza covered with mud . . Some of Caleb's senior guy friends (Titus and Aneurin are our guardees, plus Joop who is just fun) join us for pizza making at the end of the week. One of our other guardees . . Anna Rich . . also joins the party. It rained for hours and then cleared just as we were ready to cook, for a very fun evening. The power has been off most nights for random blocks of time. Caleb has mastered dish washing by candlelight. Sort of nice, you can't see the mess. Fridays the students gather outside during their chapel time for flag raising. Larissa and I went up to see the choir sing the national anthem in Swahili . . I tried to post the video but no deal. It was lovely. Perhaps you can make out Julia and Acacia singing alto, and imagine Caleb singing base int he back. This weekend Scott and I are both on call. Last night I sat with a tiny preemie who was dying, praying with his mom and watching his little heart slowly tick down to nothing. We had been rescuing him with less and less success all day, and by 2 am he had signs of brain death. Meanwhile Scott was doing two C sections. We both got home at the same time, 3 am . . And were both called from church this morning for this little pumpkin, a 33-week preemie whose mom was deteriorating dangerously. Scott did a C section and I whisked her off to be revived. Only she didn't need reviving, in spite of weighing 1.4 kg she was the most active, wailing baby I've seen all week. These two cuties were surprise twins--their mom delivered the one on the left and the paeds team was taking him to nursery when lo and behold another one came out. They share a cot warmer and are twice as cute as one alone. So another week goes by: death watches and celebrations, rescues and cheering, sweat and struggle, meals and messes. Amen.

Occupational Hazards...

One of the inherent risks of doing surgery is potential exposure to patients' blood and body fluids. The Cesarean delivery is one of the bloodiest of all surgeries.

As Scott attempted to extract the placenta from HIV+ mother during a C-section this week, the cord tore and blood splashed up onto his mask and glasses.

Thankfully... -- it was cord blood which should be virus-free -- he doesn't think he got any fluid in his eyes -- the mom is on treatment so she should have very low virus in the blood.

However, please feel free to shoot a prayer up for his continuing HIV-free status if you think of it!

Mt. Kenya

Between Christmas and New Year's our family hiked up Mt. Kenya. We reached Pt. Lenana, 16,300 feet, one of a cluster of craggy bare-rock pinnacles. Batian is a few hundred feet higher, but not accessible to non-technical climbers like us. Our route took us from the Northwest slopes, ascending the Sirimon path through the Mackinder Valley to the central peaks, then back down the eastern side on the Chogoria route past Lake Michaelson. We spent four nights on the mountain, three in simple wooden shelters with bunk beds, and one in tents at 14,000 feet of COLD. On our summit day we woke at 2 am for tea and biscuits, then hiked too fast so we reached Pt. Lenana almost an hour BEFORE the sun rose and waited shivering in the shelter of rocky crags until the light broke. That morning the clouds were below us, and nothing but brilliant stars above.

Four nights in the wilderness refreshes the soul, five days of strenuous hiking in the thin air of equatorial altitude hones the body, a week of family togetherness completely cut off from the world (no phone, no fb, no email) builds memories and togetherness. We went with a budget outfit of Kenyan guides and porters which turned out to be perfect. We drank mugs of hot sweet tea morning, noon, and night, and sometimes in between, which seems to be how Africans handle the low temps and high altitude. We marveled at the wildflowers, jumped over boulders, teetered on the edge of precipitous panoramas (I was later thankful that we ascended the final peak in the dark so I couldn't see most of the danger until the way down), laughed at the fat unafraid rock hyraxes, fed our crumbs to the mountain chats, shivered in our sleeping bags and ended up with sunburned faces and hands. The last morning we watched an elephant drinking from a watering hole near our cabin, while monkeys chattered in the trees.

Mt. Kenya is one massive rise, not the long convoluted range of the Rwenzoris. There were few bogs, and almost no mud, long spectacular views, more dry open scrub and a lot less jungle. There were also MANY more people. In a week in the Rwenzoris we hardly had contact with any other campers, unlike the couple of dozen at each campsite on Mt. Kenya. In the evenings we read aloud from "No Picnic on Mount Kenya", the true story of an Italian POW interned in Kenya in WWII who escaped the camp to climb the mountain and then turned himself back in.

It was a lovely way to spend the holiday. God often calls people up on the mountain when He wants to meet with them, wants their undivided attention. There is something to be said for the inaccessibility, the juxtaposition of danger and beauty, the rewarding effort, the perspective on life below, that makes mountain climbing an apt metaphor for a spiritual journey as well as an appropriate real physical location for divine encounter.

As we have turned the corner of our second year at Kijabe, passing our one-year anniversary on the 1rst of January, I hope I can hold on to the memory of the stark splendor and clarity of Mt. Kenya back down here in the Rift Valley of normal life.

Thanking my faithful and generous friends

Luke stuffed his luggage on the way to Kenya with beanie babies. 162 of them, to be exact. And he brought me lots of cards from people who sent them. Vicky B, John, Susan, Ellie and Hannah P, Sarah E, Susan and Paul M, Elaine M, Sally V, Amy S, Debbie H, Dan, Erika, Daniel and Katerina C, I thank all of you. I found email addresses for some of you, but let me say thanks on this forum as well. And to whoever sent packages that Luke did not manage to keep the cards from. Yesterday we scoured craft markets for cute beaded baskets made by Maasai ladies. Tomorrow we start assembling the Valentine baskets which will encourage the students here at RVA as their parents will be able to send them, with notes. Fun stuffed animals, candy ferried by many of the doctor-visitors here, locally made African baskets, and a few fun goodies from the Nairobi grocery stores . . should be great. Thanks to the dozens of people who made this happen.

While I'm thanking, Heidi L and Julie S sent us packages (YEAH! Trader Joe's peppermint Joe's, and a puzzle!!) and Becky T sent a hand-made craft, and my mom's neighbors Victoria and Scott sent us a book and CD . . thanks so much for mailing and thinking ahead to bless us. And we had visitors from Baltimore by way of China, who brought Chinese oreos and cards and friendship and a New Year's Eve celebration. Grateful for their visit!

And I can't even begin to mention our families whose generosity made our trips to Samburu and Mt. Kenya possible.

I thought I'd get nice cards to send back with Luke to mail. I thought I'd write out lovely notes to everyone. But the truth is I didn't, and even if I had I don't have handy addresses for most of you. So please let this serve as a heartfelt thanks.

Below is Luke at the airport yesterday. I miss him so much already. This is a hard day here at Kijabe for me, some disappointments and just the heavy sorrow of another goodbye. So I'm obeying the Psalms and being thankful, hoping it lifts my heart (and if 162 stuffed animals and pounds of chocolate can't do that, I don't know what will!).

Strangers and Aliens and the End of Gloom

There is a light. No matter how dark it might become, there is a radiance that will not be denied, that cannot be ignored. Prepare yourself for the coming of this luminous Presence. Get ready for the end of gloom. Is 42:16 http://www.d365.org/followingthestar/

If you know me you know that I love Christmas. It is a month-long tangible spirituality, anticipation and holiness, colors and tastes and music and memories. Over almost two decades we have developed a rhythm of traditions, from our families and from Bundibugyo and from Scripture and from experience. For me, at least, it was a blessing. But Christmas, the real Christmas, is a story about interrupted lives. Mary, interrupted by a turn-life-upside-down pregnancy. Joseph, interrupted by doubt and scandal. Their known world, interrupted by the chaos of a census, movement, displacement. The shepherds, interrupted from their duties by light and wonder. The wise men, interrupted by a quest, foreign intrigue, danger. Herod, interrupted by the threat of a new king. This was the theme of our sermon in church yesterday. For the first time I can remember, the Sunday School's presentation of the Christmas Pageant included soldiers marching in formation to genocide, and the main characters running out the side door, which African kids know too well. Our hearts keep trying to make order, safety, ritual, and yet the story is one of upheaval.

As newcomers to Kijabe, I felt this acutely. Trying to hold on to some of the things we "always" do, but in a new setting, with new people. A lot of that was good, and meaningful, and fun. Having advent with new colleagues, Kenyan and American and otherwise. Inviting friends for our White Dinner. Pulling out the old decorations in new arrangements. Less obligation, in some ways, brought more freedom. But in the few days before Christmas, a lot of that was hard too, and I felt the alienation of not being "home" in Bundi. In my old life our family would have taken little gifts to all the kids still admitted on the 23rd or 24th in the hospital, but here a major organized party went on the ward while I was stuck in the ICU struggling for a baby's life, and I didn't even know until I found all the balloons and stuffed animals that had been give out when I was on the ward that afternoon. In my old life we would have gone caroling as a team, but here we didn't find out about the caroling plan until a couple of hours before and it was too late as we had invited friends for dinner. In our old life we took beans and basins and practical gifts to each of a half-dozen neighbors and visited on Christmas Eve, so here I signed up to distribute Christmas gift baskets organized by RVA but our family inadvertently got dropped from the list (we could have just gone I know, but it threw us off, and it just wasn't the same as taking it to people we had known for years). All of the timing was just a little off, the services too early, the meals hard to work in. We ate our Christmas dinner with a family we had never met until that afternoon, at someone else's house. None of this is wrong or bad, people here were uniformly gracious, it is just the reality of uprooting and entering a place that has its own ways of doing things. Of moving from being the center of planning and instigating and creating, to being on the periphery of not-quite-keeping up with the established program. Compounded by working most of those days in a hospital where acutely ill children keep showing up regardless of the holiday, and being on antibiotics for a minor infection that I couldn't quite shake off.

So the words of Isaiah in the advent devotion called for faith, in a way that might not have been possible in a more comfortable setting. Get ready for the end of gloom. For a new thing God will do. For gifts He will send.

The real story is one of aliens and strangers and interrupted lives and making do. But also one of unexpected blessings, of inversion of expectations, of beauty in the strangeness.

So here are a few snapshots of Christmas, of moments that came as gifts.

Julia decided to make a wreath herself.

Christmas Eve dinner table, with the plates I found in a duka in Fort Portal once, who would have thought, all the way from China to Uganda to make an American table beautiful.

A fireplace, for the first time ever.

Best moment of Christmas: up on the soccer field at sunset, kicking a ball around, as rain swept over the valley and the dust and droplets lent a golden glow.

By Christmas evening there were four paediatric patients in the casualty department needing admission. After working with the intern and evaluating all of them, I went to do a final check on the ward, and thought I'd pop in and say Merry Christmas to my favorite little patient, Ryan, pictured above last week when he was feeling perkier. He has TB and his heart has not kept up with the damage to his lungs. He's moved from near death to pretty much alive over the last month. Only Christmas night I found him irritable and struggling to breathe. What!?! My greeting turned into an alarmed exam, and I found his heart much worse. A review of his medicine chart showed one of his essential meds had been mistakenly canceled. I got the nurse and we gave an emergency dose. It is a Christmas highlight because I think the Spirit sent me to his room that night, and I'm so glad, I doubt he would have made it much longer.

Second favorite moment: this morning, I went out to hang the laundry early, up because of various calls from the ward. And a flock of about 30 red-fronted parrots landed in our tree! They chattered and squawked, their beaks clacking as they fed on the tiny green berries. They've been here much of the morning. Luke set up the spotting scope so we could see their bright green feathers and red faces in exquisite detail. Christmas birds.

This is the bright red pullover and the silver cross Scott brought me back from his trip to America. I love both.

The Lion and Lamb

In Samburu National Reserve, a Kenyan game sanctuary, the prophecy of Isaiah 11:6 was fulfilled about ten years ago. Jesus' reign is not complete, but in this instance a lioness adopted a young gazelle and raised it. Twice. What better place to spend a day or two before Christmas? But I get ahead of my story. What better way to really experience the anticipation of ADVENT than waiting an extra two hours for Luke to make his way off a late flight, last in line at customs from row 63 on the plane, and then talking his way through customs with a refurbished guitar in a box stuffed full of donated beanie babies? Here he is moments after arrival Monday morning: From there it was a couple of hours through snarled, agonizing, choking Nairobi traffic until we hit the open road and drove north to Samburu. All of our parents gave us generous gifts this Christmas, and this was how we spent some of it: 48 hours together, away from the rest of life, re-bonding and refreshing. Unlike our usual rough-it camping experience, we splurged on a tented camp recommended by our friends Anand and Sophia. We knew this was not a normal Myhre vacation when . . . We were following the rough trek to our camp, pausing to watch a group of elephants cross the shallow river, and around the bend we came upon a welcoming committee. Chairs, cool towels to wipe off the dust, cold drinks, all set up on the river bank where we could stop and watch the sunset before proceeding to the camp. Luke surprised us with a new safari accompaniment: the spotting scope. Binoculars on steroids. Luke can look at a distant horizon and pick out an animal, but the rest of us mere mortals need him to focus the scope to see much detail. It was a great gift! Here Julia tries it out on the veranda of the tent in the afternoon. Meanwhile Jack is cooling off in the heat of the day in a small dipping pool of COLD water. We went on the chilly early morning and late afternoon/evening drive, but mid day the temperatures soared. So each tent comes with it's on opposite-of-a-hot-tub. And our family all had good books to delve into in the heat of the afternoon. Lovely. Our final meal, breakfast this morning, on the river bank again. Any time you have four teens at a buffet you feel like you're getting your money's worth. We did actually see some beautiful views and animals, but those photos have to come from Scott. I only snapped phone shots at meals. A parting shot: Luke shows me that I can get in my own photos. We were only in the park a little over 36 hours, so we debated hiring a guide for game driving since our explore time was limited. But I realized that's not really our style. We aren't really out there to tally up the sightings. We're out there for the experience of wilderness and beauty. For the wind blowing in our faces as we ride out on top of the roof rack. For the way the sun lights up the post-rain grasses. For the spring of the spindly-legged gerenuk and the stately gaze of the oryx. For the family memories, the banter, the meals, the suspended time of being away and together. For all this I'm grateful. Tomorrow morning starts a stretch where we are "on" almost continuously 3 of the next 4 days, including 2 calls, one of which is Christmas. So this trip was a precious gift.

Christmas Prayer Letter for Downloading

Merry Christmas from the Myhres and World Harvest Mission!

Some of you will receive a hard copy of this letter in your mailboxes in the coming week...

For those of you not on our mailing list or for any who would like to see the pictures in the letter in color...

Click HERE!!

Thanks for your prayers and parternship.