Pictures from Hell's Gate

Hell's Gate, Kenya

As Americans we take the phrase "gates of hell" (Job 38, Matthew 16) comfortably symbolically, invisible and unreal.

Not so the Maasai, who noted the steam hissing and boiling from thermal vents in the Rift Valley and concluded that a spiritual underworld literally broke through the earth in this area.  

Friday Caleb left with three classmates on a cross-country trek, sleeping under the stars on the ridge of the Rift near Kijabe Hill then descending into the dusty valley. Saturday by noon we had loaded up the rest of the family and the usual camping paraphernalia (which is similar if you go for one night or one week, pans and a skillet and tents and tarps, firewood and axe and water and binoculars, food and more food and flashlights and books) and set out to catch up with the boys.  We found them waiting in the shade where the railroad track they had followed intersects the highway, and they all crammed into our car and we made our way to Naivasha for lunch.  Where we happened upon half of RVA and found out where the "under-five" crowd goes on midterm weekend, to a resort with a pool where they can pay a reasonable day rate and swim!  Thankfully the two boys who wanted to go back to RVA got a ride with them, and we proceeded on to the nearby national park with our family of five plus one senior boy (which comfortably brought us back to our family of six).

Ironically, we typed "Hell" in the GPS to find the park gate.  Probably the first and only time we've set our destination for Hell, though biblically it is "Hades" or "Death" and certainly a place where Jesus would go for a rescue raid.

This is a tiny park, and as we set up camp and watched the sunset, glows of Naivasha and Mai Mahu and Narok were discernible on the horizons of the hills all around.  But in the crater-like plain which is protected we could see, from our campsite on a ridge, zebra (MANY), impala, Thompson gazelle, eland, warthogs, giraffe, Cape buffalo.  And after dark, we heard the eerie laughing wail of hyenas.  It reminded us of Ngorongoro in TZ, a pocket of wildlife and serenity.  

Unfortunately, just at sunset, it reminded us of Ngorongoro even more.  We had seen no campers anywhere, just lots of day visitors. We were gathered around our campfire cooking Naan over the coals and spooning up a hot rich Indian chicken and vegetable curry.  We had hiked to the top of the ridge and scrambled over rocks, we had watched animals and talked.  We were content.  When suddenly a group of ten American college students arrived.  In force.  In volume.  Though there was a wide area available for camping, they pitched their tents within ten feet of us and proceeded to giggle and shout and carry on as if they were the only people in the world.  Sigh.  At nine, feeling rather old, we asked them to tone down a bit . . . I cringe to think of this group blazing their way across Africa as if they were at a frat party . . 

But besides the noisy neighbors, the park was great.  Mostly we felt that "Hell's Gate" was an unfair rap, a focus on the exception rather than the rule.  After a leisurely camp breakfast we went to the gorge to hike, and though we tried to look what we were doing we didn't find the right path until we were rescued.  We had successfully avoided the 20-ish hustlers at the park headquarters who wanted to be our guides, but when a middle-aged Maasai man in a DQ shirt, plastic sandals, and well-worn walking stick with greying hair offered we gave in.  And were glad we did.  Caleb's classmate won his friendship with his excellent Swahili, and he took us well past the end of the normal gorge hike to see the "talking water", a larger thermal vent further down a wide valley.  He painted our faces with the ochre clay in warrior patterns, and found a local plant to treat Jack's cut finger he got collecting shards of obsidian.  We ended the afternoon with a picnic at a high lookout over Lake Naivasha.  

So where are the gates of Hell?  An idyllic park with grazing animals and rough beauty, yet punctuated by steaming sulfurous vents.  A wonderful 36 hours away with the kids in the restoration of wilderness, yet the peace was broken into by obnoxious revelers.  Place is important, everywhere in Scripture.  But rather than turning the passage between earth and hell into an abstract unreality, this park reminded me that the portals of problems are concrete and frequent, reaching everywhere.  The unseen breaks into the seen, evil breaks in on love, loss bubbles up through the shell of stability.  

Let us live then, in the real world, absorbing the beauty and not fearing the intermittent gates of hell that we encounter.  Let us not run away from the bubbling vents or think we can ignore or avoid them.  And let us remember that at least one portal opens in our own hearts, and the first battle is there.

Offering and Presence

"From everyone who gives it willingly with his heart you shall take my offering . . .that I may dwell among them"

Mid-Exodus, the entire chaotic nation is poised at the base of Mount Sinai for the trans-wilderness trek to the homeland.  And much of the focus seems to be on just how God will relate to them, how and WHERE.  In the beginning of chapter 25 there seems to be this principle.  Offering, sacrifice, creates the space for God's dwelling.  

A few chapters later, after the golden calf debacle, God tells them, it is time to go (chapter 33).  And He offers to send an avenging angelic presence to clear the way before them.  Which sounds like rather good news, but the people react in mourning and despair.  They realize that a distant God who makes life easy is not as good as a present God whose holiness presents a danger to their wayward hearts.  Moses pleads "let my Lord, I pray, go among us, even though we are a stiff-necked people."

In the clatter and clutter of life, I can forget that the most important thing is the Presence of God.  Not His power, His gifts, His dramatic acts of salvation and mercy going before us, driving out evil, protecting and sustaining.  Not the arrival, not a home.  But His immediate, tangible presence along the way.  And that inviting that Presence involves sacrifice. Offering.  

In the hidden losses and silent griefs of this missionary life, the thousand deaths to self, this is a redemptive view.  Those small offerings, the freewill offerings of earrings and scarlet thread, of gold and goats hair and acacia wood, brought morning by morning, have a purpose.  Those goodbyes and griefs clear the way for God's presence in our midst.

HAPPY 19

Though many in our family sport "19" shirts in honor of Manchester United's 19th Premier League championship, today we have a real 19. Luke. Who is also a champion. Of courage and perseverance, cross-cultural endurance, loyalty and humor, and the well-crafted word. Of marathon reading and outdoor survival. Of dexterity with a football (the round kind) and personable interaction with friends and strangers. Of navigating the complex world out there without us.

His birthday buddies are Anna Linhardt, missionary teacher extraordinaire, and Joshua Mutegheki, one of his best friends in Bundibugyo, a complete orphan who somehow remained sweet and seeking and hard-working as he finishes his last year of high school.

Thankful for the mercies of February 8, which was not an easy day 19 years ago . . .

CMDA KENYA 2012

Every two years a dedicated group of Christian academic doctors travels to Kenya to teach a two -week medical education conference so that missionary physicians can maintain their American medical licenses. We have gone probably six or seven times in the last 19 years. This year's conference started Monday. The first two days are generally intense day-long advanced life support classes that enable re certification in these skills. Scott took ALSO (OB emergencies) and ACLS (cardiac) and I took PALS (Pediatric) and HBB (Helping Babies Breathe, neonatal). It's no small thing to study for and pass these classes . . . We leave at 7 am and return at 7 pm, so it's a challenging schedule for keeping the family pulled together and fed and homework done and general survival. It would be IMPOSSIBLE if we didn't have a visiting pediatrician covering the NICU (thanks Scott Jones!!!) and extra help at home from our dear houseworker Abigail and her sister Nyambura. These life support courses are heavily interactive, hands-on, practical. Here Travis is preparing to resuscitate a newborn. We even received this great kit of tools for teaching the course to others. Chuck Schubert went to med school with Scott, was a missionary in Zambia, and now teaches at University of Cincinnati. He and his family have been supporters and mentors and encouragers of ours, and occasionally our professors! The HBB classroom. Dr. Dana Witmer from Congo, getting ready to do CPR. One nice thing about being around so long is connecting again with the handful of others who have stuck it out in remote places in Africa all these years too. There are many. Tina Slusher, like Chuck, is another missionary who spends most of her time in academic clinical medicine now. She's a wonderful teacher. Here she is leading our group in some case scenarios for PALS. Jim Knox from the OPC team in Karamoja (our kindred spirits on the opposite side of Uganda) and Travis are quite entertained when our large male instructor simulates being a pregnant mom . . Here Scott is at the ACLS testing station.Because CMDA does not have a facility with space for families, doctors have to leave their kids behind and be accommodated as singles, or find their own way. We did this for years, staying in some less-than-ideal spots. Though commuting is time consuming it is nice to have all our kids in school at RVA (and Yale) for the first time this year. The Johnsons, however, are a decade behind us, so they were glad to find a nearby lovely British colonial tea plantation with guest rooms where they are staying with Amy's parents who flew out to help them, as well as teacher Pamela who is continuing lessons with Lilli and Patton. It's about a twenty minute walk from the conference. And to add to our wonderful reunion time, Heidi arrived today for the conference as she joins the Sudan team, and Jessica came out of Bundibugyo with the Johnsons. Standing around the gardens at the Johnsons' tea-plantation house, as we get ready to say goodbye and drive back to Kijabe at the end of the day.

What is It?

This morning my reading fell in the book of Exodus, following a historical/sequential read-through-the-Bible in one year plan.  Some background:  such dramatic stories, but we often forget the years of less glorious preparation God puts His chosen leaders through.  Joseph was a slave and a prisoner from age 17 to age 30, with no glimmer of assurance that he would ever see his family let alone freedom again.  Moses was a third-culture kid who straddled two ethnicities and then was self-exiled into a third, managing livestock in the wilderness for his father-in-law when God propelled him to leadership.  All through Genesis God upsets the normal order of the firstborn, raising up younger siblings to rule the older.  And takes those leaders through long years of wilderness, conflict, alienation.  Most of the time they had little to go on other than God's unlikely promise.  It was a conditioning by service that strengthened them for the moments of truth.

The same thing happens to the entire nation of fleeing slaves, after four centuries of oppression they go out from Egypt "with boldness".  Which lasts precisely three days.  At every obstacle (which are admittedly quite frightening obstacles, facing annihilation between an angry pursuing army and a seemingly impassible sea, facing starvation and thirst in a hostile trackless waste) they immediately panic, and blame Moses, questioning his leadership.  Why did you bring us here, you should have thought of this.  Or worse, you purposely put us in jeopardy.  Which had a slightly familiar ring to it as former remote-place leaders, when our team faced hard times.  Why didn't we prepare better, anticipate, prevent?  

And over and over Moses takes the issue straight to God, and over and over God patiently provides.  Which brings us to today's story.  

The people are hungry.  And God sends food, in the form of a seed-like dusting of flour that can be made into bread, with a flavor of honey.  When the people walk out the first morning and see this substance spread over the landscape, they say "What is it"?  Which sounds like "manna" in Hebrew I suppose, because that is how the food gets its name.  Manna is a skeptical question.  It was not immediately obvious to the wandering hungry Israelites that this was food.  It wasn't the answer to prayer that they expected.  Provision, obscured.  

I wonder how often I look at God's mercy and say, "What is it"?  How often I fail to recognize the good in what God sends?  

As we enter our second year at Kijabe there are still losses and questions that have not fully settled in my heart, and looking at this year with Caleb going one way and Luke another and balancing responsibilities, well, it looks about as appealing a gathering a seedy white ground-cover to cook with.  Today I helped a visiting family medicine resident resuscitate a tiny preemie, put in a UVC, intubated, made decisions, set up a ventilator.  I could not have done that a year ago.  Progress?  But then I returned in the evening to orient a visiting doctor with astute questions I couldn't answer, and happened upon the baby as he was deteriorating and failed to get the tube in again.  Sometimes I get tired of always feeling like I'm catching up, not quite where I should be.  Is this provision, this constant tension of more to know and do than I can manage?  We lost the baby's mother.  Is this provision, daily exposure to heartache?

For now Kijabe is my what-is-it.  To taste the honey-tinged wafers one has to go and gather.  This weekend we also spent a lot of time just being in community here.  And it was sweet.  Two couples whom we've met over the years, long-term Kijabe docs now departed to more frontier missions, were back to visit.  A medical student whom we've been working with, processing and hanging out.  Four other moms who help with class activities, baking about a thousand cupcakes and cookies for Valentine's sales, learning a little more about their lives as we poured batter and stacked cookies.  Two families who have been here more than twenty years accepting our invitation to pizza and telling us some of their story.  A friend we've made over the last year coming to us with a medical issue.  My partner dropping by with precious Starbucks coffee.  This is our community now, and I am growing in appreciation.  What at first seemed intimidating and difficult to penetrate is now beginning to look a lot like a gift.  I am thankful for these people, and the richness of our interdependence.  It doesn't look like our old team at all, so it was hard to recognize the manna in this place.  But it is here.

Jesus, of course, is the real manna.  The real provision.  And the real "what-is-it" as He consistently defies expectations.  He wasn't recognized as God's gift when He was alive, and many of us stumble over they way he diverges from what we hoped God would do.

In 2012 I know we will be sustained by the daily freshness of God's mercies, however challenging they are to recognize.  Praying we will all taste of the goodness.

Tribute to a Cow, DMC (1997-2012)

We received news recently from Bundibugyo that our longtime dairy cow, Dairy Milk Chocolate (DMC) died.

"Where your treasure is, there will your heart be also." (Matthew 6:21)

We invested much sweat and money (for medicine, food, local labor) to keep the milk flowing from DMC's udders for the good of our children and our team over many years. Basic investment and return -- turning our money into fresh milk. But investing in a living creature has a consequences and I (Scott) have found that leaving behind my dairy cow was arguably the most difficult aspect of uprooting from our home in Bundibuygo. So, this week I traveled down memory lane revisiting the years with our friend and sustainer.

This story begins in the post-ADF war days of 1999-2000 when our mechanic (and farming consultant) in Fort Portal had some personal problems and needed to raise some cash. We had talked with him about bringing one of his dairy cows to Bundibugyo and this was an opportunity for him to make us good on our promise. So, Pat and I purchased one of his young cows for about $250. Pat chose the name based on the color of our cow which resembled Uganda's favorite milk chocolate bar. We gave him the money, but let him keep the cow since our pasture wasn't ready and the security of Bundibugyo didn't seem conducive to keeping domestic animals.

Several years passed. Our mechanic had improved his financial situation, but eventually cycled into deeper and more complex personal problems. At one point, this friend had lost everything (wife included) except his two children and DMC. It's the only thing he had to feed his two young children. At that point, I said "Keep the cow. It's my gift to help you sustain your family." Eventually, he turned his life around. His wife returned, he repented of the behaviors which led him into crisis and loss. But eventually he needed help to rebuild his business and re-buy a set of tools so he could begin to work as an auto mechanic again. So, he approached me (I had bought out Pat's shares because of her personal need for cash!) and asked me if I would be willing to buy DMC-- again!! I agreed - but decided that I wanted immediate delivery. I wanted my twice-bought redemption cow. So, we prepared: fenced the pasture, built a milking shelter, constructed a feeding trough and water trough, bought milking buckets and storage containers. No small additional investment. We took delivery of DMC in December 2005. She was giving milk at the time - for which we were so thankful. There's nothing like a bucket of warm frothy fresh milk which you've squeezed out yourself.

Things all seemed to be going well for several months, but the milk abruptly changed quality about eight to nine months after we got her. At one point it almost solidified in the bucket. About this time, Matt Alison and I undertook a bike ride over the Rwenzori mountains to Fort Portal, a blistering 100 kilometer ride. Halfway across the mountains, I called home on my cell phone. Julia answered, "Dad you won't believe it!" I'm thinking, what about me? Don't you want to ask Dear Old Dad how the brutal bike ride is going? Instead I patiently asked, "Julia, what is it? What happened?" She exclaims, "DMC PRODUCED!!" (translation: gave birth). "What!!!!" Long story short: Our mechanic had attempted artificial insemination the month before he brought DMC to Bundibugyo - but never told us! Despite her ever-widening girth, buckets full of custard-like colostrum in our milk bucket - we still never put it together -- until a calf popped out. Whoops.

We named that calf "Ghiardelli" - in honor of his dark chocolate color. We had no use for him (pasture seemed too small and I couldn't really imagine raising him for the purpose of steak) so we took him to our friend's farm in Fort Portal (after a few months of bottle feeding).

In order to keep milk flowing, a dairy cow must keep getting pregnant. Ideally, 6-9 months after her last calving, she's bred again. With no electricity and no cows in Bundibugyo, artificial insemination was not possible so we were forced to bring a sire. Our farming consultant in Fort Portal gladly sold us a stud who we named Sir-Loin. We hoped that his loins would procreatively keep us supplied with fresh milk - but without the same emotional attachment we had for DMC. We intended to let him do his work -- and then eat him. He was a good steer. Mean as all get-out. He got out of the fence a few times and ran down to Nyahuka creating sheer pandemonium. No one had ever seen such a strong and fierce animal. Unfortunately, he developed a joint infection which killed him before we could ever eat him. His daughter (and DMC's second offspring for us), we named "Truffle", for her swirling mixture of whites and browns.

DMC's next husband, came from a local herd. I was done with ridiculous cost and headache of bringing animals from Fort Portal. In my mind, we just needed a pregnancy - not a Kentucky Derby stud. On one of my local bike rides I spotted a healthy looking guy with Texas longhorns and a wizened shepherd. I sent my negotiator. For $15, we rented the guy for a month. We called him Shadow since he never left DMC's side. Insatiable he was. And effective. Nine months later DMC gave birth to "Oreo" (named for her black and whites sandwiched together).

Shadow did come back for a repeat performance this time with both DMC and Truffle. Polygamy is common in Uganda - and it was darn convenient for us. Mother and daughter delivered after we left Bundibugyo. Truffle continues the legacy of her mother providing milk and for the entire Bundibugyo Team.

DMC. Some called her "Dr. Myhre's Cow". In Uganda, DMC is also an abbreviation for "Dangerous Mechanical Condition" ("You see that DMC truck in Nyahuka this week…man, that muffler needed replacement!").

She was as gentle a milk cow that ever trod in Uganda. She was God's provision for us and to Him I am thankful for the privilege of having her.

the rest of the week

The rest of the week, outside the NICU, music and community and sports and celebrations and just plain life. RVA choir sang this morning. Strong voices, inspiring song. You can see Caleb and Julia, but Acacia is in the front row of girls on the left that are perpendicular to our view. Caleb was asked to help lead worship for church today, with teacher/coach Ryan Dahlman and some other kids. He and we were thankful for this opportunity. I remember a little book I made the kids in poetry form: the Bundibugyo Bhana bhana (four kids) when Caleb was about 4, and described him as musical even then. He has taught himself guitar over the last few years. In the middle of the set of songs I started thinking about how much I'll miss him next year. Tears. Julia and Acacia went on a hike with me on Saturday morning, exploring a new path I'd been curious about . . .note Mount Longonot in the background. Note Acacia beneath a spectacular Acacia Tree. And by a dry river bed. The rains finally stopped in the last couple of weeks, and dry season blew in. The days are suddenly hotter, but the temperature still drops with strong winds at night. Amazing to me that we live in a place where we can walk out our front door and hike for an hour in relative wilderness. Girls' soccer season begins: two games for Julia this week, and one for Acacia. The Kijabe community's annual gathering to celebrate Dr. Ase Barnes' birthday, his 16th here at Kijabe and his 79th here on this earth. The Barnes leading Wednesday morning hospital chapel, singing in Swahili with the pathology and chaplaincy departments, accompanied by the accordion. I only hope that by the time I'm in my 8th decade I half as much fun and inspiration as they are. Ryan left this week, the little boy who almost died Christmas night, with TB and heart failure. Because his mom lives in a single room with four kids and an open fire for cooking, he could not have oxygen there, but transferred to a smaller clinic nearer his home. Pray for his lungs and heart to heal.

I've been thankful for a couple of times to pray with friends this week, to talk about life or hard things or decisions. To skype with Luke. To have pizza with our old friends the Chedesters, to create meals. To be more than a paediatrician, even though I love it, to remember there is more to the week.

Unsung Heros

Today let us honor the unsung heroes of the NICU: the moms. I don't think I'd look as peaceful as Felister above if I was on my 52nd day of sleeping in a hospital ward, well, not sleeping much, because these moms get up every two hours and come into the nursery to feed their babies. Maxwell is almost ready for discharge. It has been a long push, and sometimes the last few days are the hardest! This is little Mark-Paul, who is only 3 pounds even though he was born at term. He was severely growth retarded. So his mom had to go through a FULL LENGTH pregnancy and delivery, and NOW has to stay as long as most preemie moms caring for him in the nursery. Brielle's mom is all smiles because her preemie has been a star--she's sacked out skin to skin after a feeding. This is one of the few couples where the young dad comes regularly too. I'm rooting for this little family. This baby's mom laid down her life, almost literally, to bring her into the world. Here she's being held by a nursing student, because her mom is in the ICU. This mom had such severe bleeding post-delivery that Scott got called in the middle of a not-on-call-night to help her, and he called in a general surgeon, and they called upon 15 people to emergently donate blood between about 2 and 5 am., including multiple nurses, students, security guards, one of the doctor's wives from home, and about 3 or 4 RVA staff. After two surgeries she was pulling through, but pray for Esther who is not out of the woods yet. She is a mother of four, including the cutie above. Her baby is a favorite in nursery as we don't usually have healthy term newborns whom we don't have to share with a mother, to cuddle and feed and love. Hannah Wangari is another miracle baby. This is the little girl born with gastroschisis, all of her intestines and stomach hanging out of a hole in her abdomen at birth. She is, so far, the only survivor of this condition at Kijabe and perhaps only the second or third in Kenya. Here her mom is attempting her first breast feeding after more than two weeks of tentative intravenous and slow tube feeding post-operation. Hannah's course has not been entirely smooth, and her mom seems depressed. Please pray for them. We are hopeful. This baby's mom was transferred urgently in labor to Kijabe when it was noted that he was lying sideways (not head down) in her womb, and she was in active labor a bit more than a month early. Scott did an emergency C-section that was pretty complicated, and Mardi resuscitated him back to life. Here he is in the blue glow of lights designed to bring down his levels of jaundice. His mom also had a hard time establishing feeding (not so unusual post-op). Her relief when his jaundice improved the next morning was a great joy to see. John is another cute little preemie with a bit of jaundice. His mom is reaching into his incubator to change his diaper and just touch him.George is pictured without his mom . . .because she was feeding his twin brother when I walked around snapping photos with my phone. George was the second, smaller twin, and he's had a hard week with a dangerous bowel infection. But he is greatly improved now, and his mom will have her hands full with two premature boys.

Sometimes I feel overwhelmed by coming up with three meals a day for four healthy kids who feed themselves at the table. Or unable to focus on questions about how to factor an equation or wither Iodine exists as a two-atom compound or what would be a good paper outline for the second battle of Bull Run. I am humbled to watch these women tirelessly caring for their babies around the clock, never sleeping more than an hour and a half, no privacy, wearing hospital gowns and eating from a trolley of institutional food, sharing a bathing area with 80-some patients on the ward, and with only a moderate hope that their baby can survive. Few families can afford to visit very often. These women form community amongst themselves in their shared suffering. And rejoice with each other, too.

Every morning I pray with them, that they will meet Jesus in this unlikely place.

So much of parenthood teeters on the grief of loss. This morning I read the beginning of Joseph's story in Genesis. This time Jacob jumped out at the end of chapter 37. "Thus his father wept for him." At that moment, with the torn and bloody robe in his hands, Jacob could only see tragedy and the end of his dreams. There was absolutely no evidence in this story to suggest that God would redeem Joseph's taunting pride and his father's favoritism and his brother's jealous violence and his culture's unjust slave trade to bring about the dramatic rescue of a civilization facing famine and a tribe facing extinction. Jacob had nothing to suggest any emotion other than despair. But his son was destined for greatness. I hope some of these moms have that sort of faith. And I hope I will have it too, next time my own children's paths look like they are dropping into a pit.

Here's to our nursery moms, and the painful joy of parenting.