Pix from Paradise

here are a few snaps from our sanctuary of celebration in the Seychelles...

But You brought us out

We went through fire and through water;
But You brought us out to rich fulfillment.
Ps 66:12

This is the verse I read yesterday that jumped out as a summary of where we are now.  On May 9th, Scott and I reached the milestone of 25 years of marriage.  And in the midst of a post-call stupor we worked and taught and cheered and cooked and packed, and then got up at 4:30 the next morning to travel to the Seychelles.  For a week.  Of RICH FULFILLMENT.

The taxi crawled cautiously through dangerous pre-dawn fog along the escarpment, but we made it.  Sabbath is a holy principle, and the world resists it.  Like the children of Israel trying to go to the dessert to worship, it was a veritable exodus to get released from work, tasks, worries, responsibilities, good things that can consume, and break away.  But Scott wisely made these plans months ago, and our generous parents gifted us with some extra money, and our helpful team mate Karen came to look after the kids, and our Kijabe colleagues pitched in to work extra hard, and somehow we found ourselves temporarily in Paradise.

Sun, a warm ocean of clear turquoise, birds, sand, pools.  Plates of gourmet food, stars, music.  Lush jungle, a clean room.  Space and quiet and privacy and companionship.  Remembering that we were made for relationship, for Eden, and it is good and right to celebrate 25 years with a once-in-a-lifetime trip to an equatorial island.  We are healing, resting, and leaving behind the rest of life for a week.

Prayers for renewal are appreciated, as well as for Karen who is serving our family by staying with the kids.  Thanking God today for 25 years of fire and water that make this rich fulfillment all the more glorious.  There is no one else I'd rather be here with, for life.

Through fire and water

 To appreciate the next post I am about to write, just scroll through the random download of the last week's snaps from the phone.  A week of life involves a fair amount of passing through fire and water:  the fire of being handed not-breathing babies or complicated dwindling toddlers, the water of (I'm not counting but someone did) 42-plus straight days of rain, mud, damp laundry, mold and drear.

To start, the billboard on the left I just love.  A billion people live in Africa now, and that's a billion reasons for hope.

 Good thing last week:  Caleb led worship for the senior class, plus a handful of parents and staff.  A number of kids gave testimonies, including Caleb who is a true introvert but appreciated his classmates for their unique stories and exhorted them to go out into the world and tell them.  Closure is upon us. Every event like this is bittersweet.

Baby Cristobal, who arrived at 3.7 kg, 4 months old, skinny and lethargic, from an orphanage in South Sudan.  After a few weeks of nutritional rehab, he's gained almost 1.5 kg, is perky and smiling.  Love these tiny resurrections.

This 14 year old Maasai girl came in coughing blood, with a deathly looking chest xray.  TB.  The teens of course get to my heart most these days . . . after almost two weeks of anti-TB drugs she is no longer in pain, no longer coughing, no longer infectious and ready for discharge.  You have to love curable diseases and solvable problems.  

James has been in the hospital 33 days.  Something about intubating a person leads to bonding  . . I was uncomfortably on call in the ICU when he presented with meningitis and brain abscesses from a sinus infection gone awry.  He is a normal 15 year old kid.  Like mine.  Was in school.  And almost died.  His mom has stuck by his side every hour of those 33 days.  And after untold doses of antibiotics, several CT scans, days in the ICU, and a neurosurgical procedure to drain a little pus and assist diagnosis . . he is getting well enough to be bored.  I think he may emerge from this alive and well.

Last weekend we went to a wedding:  Stephen our nutritionist (who is excellent, he consults on about 80% of our admissions and always knows what is going on) married Ndinda our MO intern who had just completed her intern year.  Here are all the people from Kijabe who attended the wedding . . we're somewhere in the back row.

 Above, two of the seven interns from last year.  ALL have been posted all over Kenya, which is part of the point of what we do.  Scattering blessings.  Isaac and Fred are competent, dedicated young men.  It was a pleasure to see all of them return for the wedding.  And Scott and I enjoyed the sermon a few days before our 25th anniversary:  marriage is not a minor league, it is the CHAMPION'S LEAGUE.  You have to be fully committed for the long haul.

Below, the bride and groom after they are pronounced man and wife.  It was a meaningful ceremony full of Anglican tradition, purple dresses, bows and flowers and worship music.  The only non-traditional parts were the disco-ish easy-listening-romance music to which the bridesmaids did a swaying dance step for the processional, and the energetic praise music to which the bride and groom pretty much danced while standing up front.  It was lovely.

Anne is another of our well-loved and missed interns.  And Ndinda is entering escorted by both parents, who had a prominent role in praying for and exhorting their children during the ceremony.

The next day Acacia and Julia helped me address 130 thank-yous to the supporters and teachers who have prayed another child through to graduation.  We know it is no small thing to raise a child in Africa who not only survives but thrives. 

Wednesday, the Varsity girls' volleyball team celebrated a hard-fought victory over West Nairobi School.  Acacia had the largest cheering section!  Her aunt and cousin who live nearby, her grandmother in from Athi River, and her mom in from South Sudan!

 Every day there are challenges that stretch us.  Above a baby with an occipital encephalocele.  She was born at a small hospital far from Kijabe, and it took six days for the parents to decide to come, meanwhile she was nearly dead with meningitis from the leaking fluid.  Very little brain remained in her small head.  After consultation with the surgeons and chaplains and parents, we opted to support and comfort but not attempt surgery.  Tough, tough decisions.

On the other hand, here is smiling HS, the little girl from a neighboring country who arrived in the final stages of near-death from a chronic bowel obstruction.  One Saturday morning I spent an hour begging, cajoling, insisting that the upset father NOT take her home in despair.  The next day she had surgery, and we week later she was a normal little girl sitting here in her bed, smiling and eating and growing once again.  Thankful.

 Another South Sudan orphan, who was brought for care.

 One of the triumphs of the week was getting this little girl transferred to Kenyatta National Hospital for removal of her adenoids and tonsils.  The obstruction to her airway had slowly sent her heart into worse and worse failure, until she could not get off oxygen and her survival was uncertain.  We had admitted her at Kijabe numerous times, but she always seemed to be a low priority for KNH for surgery.  Finally we transferred her directly to the ENT service, and hope that something happens!


Below a mom whose face and manner I found so beautiful.  She also has a baby with a non-survivable hydrocephalus, her ballooning head stretching her skin to the point where she can't close her eyes, and her skin is breaking down.  This is her face the day we got a translator she could understand.  Thank God for translators.  I hate practicing medicine by hand gestures.

Meet Aaron and Moses.  Twins born to a (surprise) pastor who both came in for RSV bronchiolitis.  Moses went to the ICU and could have died, but they both recovered and were on their way home when I snapped this.

 Our visiting pediatrician Dr. Christine on her birthday in the NICU with our med student, MO intern, CO intern, and nurse.  A good team, and a busy one.  We've had 20-some patients on each service most of the month, which would  be nearly impossible without help from short term volunteers like Dr. Christine.  Mid-June to early August is also short staffed . . . anyone with vacation time and interested in hard work and great experience, contact us!!

 Julia is really improving in Volleyball.  We've been to every game so far.  She's a jewel.  Acacia is the youngest and newest player and is also learning and playing quite well!

Lastly a look at wet laundry.  Seems trivial, but it isn't.  With six people getting muddy in the downpours and steep paths (the day Jack slipped and fell and lost his art project was a low) and with mold growing over our walls and ceilings, well it gets a bit depressing.

My last night of call I was up nearly the whole night.  What do you do when you are paged to a code, arrive to find a baby 8 minutes old who is likely already suffering brain damage from lack of oxygen?  I intubated and gave resusitation meds and got the baby back, but not her brain I'm afraid.  After admitting her to the ICU on a ventilator I had been back home asleep for about half an hour when the same call came again.  Same action taken.  But the second baby will likely be fine. It was a long night. 

I finished the week absolutely spent.  Tough cases, demanding calls, a teaching conference I had to pull together and lecture, pouring into our own kids by cheering and attending and going to meetings, welcoming visitors, cooking and cleaning and draping wet clothes everywhere, and with a brewing URI.  Scott ended the week recovering from a pneumonia and a sprained ankle.  We were a pretty beat pair. 

Which is the context for the next chapter . . .

Football!!

See our sidebar for the link to the Johnson's blog or try this link to see photos and read the story about the Christ School Football Teams.  We have a long history of being fans and parents of these players, and totally believe this is a life-changing experience for the kids.  Please consider supporting them.  Kevin's stand against corruption in football is similar to my post below and the reference to Jesus in the temple.  He shed blood to stand up to the violence.  And because of him, JD, Josh Trott, Nathan Elwood, Ashley Wood, other missionaries, teachers Bwampu and Immaculate and Alex . . dozens of kids have had their one and only opportunity to see the rest of their country, interact with Ugandans from different tribes, learn team work and perseverance, and taste success.  Go CSB!!!

A different kind of Saturday Rounds

About half of our Saturday mornings require rounds in the hospital.  Because sickness does not take weekend breaks . . however this Saturday our new half-time Kenyan pediatrician (YEAHH) and our kind 3-month German volunteer were covering.  Julia and Acacia had early volleyball practice, Scott had his own rounds, Jack and Caleb were wiped out in bed . . so I was free to join a small group of RVA staff and local Kenyans for a forest walk.  I thought we would be birding.  And we did hear a number of interesting bird calls, and glimpse a hornbill, batis, swallows, parrots, warblers, etc.  However the primary purpose of the walk was to be present in the forest, appreciating the beauty and diversity while patrolling for illegal loggers and charcoal burners.  This is a protected national forest, but year by year human misuse and encroachment increasingly threaten the ecosystem.



The forest canopy has been thinned so that the floor is bushier than it used to be.  And dotted with clearings, where the old trees have been cut down.  Here is a fresh one. 

The men I hiked with had decades of experience in these woods.  And they mourned their passing.  We noticed a landslide on the far hill of a ravine, just below a clearing that had been cut.  Not trees, nothing to hold the soil on the mountain.  Sad, and dangerous.

 But they didn't just mourn.  They hiked with shovels and hoes.  So that when we came upon two smoking charcoal pits, they were ready for action.  The elusive charcoal burners cut protected trees, then bury the logs under layers of sticks and dirt for a slow low-oxygen burn that will dehydrate and lighten the fuel into charcoal while still preserving some of its stored organic energy.  This is lucrative, but inefficient.  Not to mention illegal.  To discourage them our group uncovered the smoldering pits and scattered the logs far and wide.      And then called the forestry service who is supposed to be stopping this abuse of the environment.  In a poor country it is difficult for entrepreneurs to resist the pull to make some money off trees, and equally difficult for the officials to resist the pull to make some money off looking the other way. 

 I thought of Jesus in the temple, scattering the tables of the money changers.  Perhaps the next day they would all be back.  But His action demonstrated resistance to an evil.  He did more than advise, he put some muscle behind making a change.  His anger ruined some incomes, but protected the majority who were being taken advantage of by the illegal actions of a greedy few. 

Our local church, the school staff, a local NGO called Care of Creation, neighbors, police, forestry service personnel, and the press are all beginning to cooperate to save the remnant of this forest.  Not quite the same as resuscitating a baby on a Saturday morning, but in the long run the effect is similarly life-affirming and future-oriented.  A privilege to participate.

An Open Letter about Starvation

I see a lot of starving kids.  Most are slowly, quietly starving.  Kenyan toddlers, dwindling away without access to adequate nutrition.  A few are teens who suffer from eating disorders, expatriates who pass through this mission station.  This week I've been thinking about both, particularly after the death yesterday of a 4-year-old with severe cerebral palsy, seizures, skin infections, with his spastic skinny little limbs and barely-coping mother.  And praying for the children, and for our response, and pondering the causes and solutions.  Which leads me to comment on four key areas to understand, and address.

1.  Malnutrition is a physical problem.  The kids we see have been injured.  Some had inadequate oxygen during birth and are brain damaged, making it hard for them to chew and swallow or reach for food or share a bowl or hold a cup or explain their hunger.  Some were fed imbalanced or harmful diets.  Most have been made worse through acute and chronic infections.  Some in the eating disorder category are depressed, their neurotransmitters are genetically disordered, or their vitamin and mineral levels are inadequate.  It is not their fault.  

The physical problems need medical therapies, like blood tests and vitamins and high-calorie feeds, like physical therapy or hospitalization or antidepressants.  This is the part we usually think of.  But it is only the tip of the iceberg.

2.  Malnutrition is a social problem.  Injustice drives hunger.  Women who don't have safe antenatal care or skilled delivery attendants produce injured babies.  Families without land for gardens, or jobs for income, lack food.  Parents who did not attend school don't make informed decisions about nutrition.  Extreme maldistribution of wealth and medical care means the neediest can not get it.  On the other end of the starvation spectrum, the culture of physical perfection, unhealthy model-weight bodies, blatant sexual advertising, pressure to conform, bombards our teens.  

The social problems need concerted united action, advocacy for the poor, responsible voting and laws, sacrificial generosity from churches, bold initiatives in education and health care and water engineering.  Refusal to buy our five-year-olds sexualized clothes or dolls, protecting our pre-teens from magazines and messages.

3.  Malnutrition is a spiritual problem.  Our world is broken, and the vast majority of our fellow citizens wrest their survival by the sweat of their brow.  Floods and drought wreak havoc.  Child-bearing is fraught with danger and mishap.  For those that survive, Satan whispers as he did to Even in the garden, you aren't good enough.  You won't be loved unless you look this way, control this urge.  

The spiritual problems cry out for prayer and sacrificial love.  Discipline and money alone will not solve these problems.

4.  Malnutrition is a personal problem.  We are created in the image of God, which fundamentally means we have wills and choices.  Families with injured, sick, infected children, with unemployed and under-educated parents, with oppressive spiritual issues, still make decisions.  Sometimes those decisions lead to greater harm, as family income is poured away in alcoholism, or fatalistic apathy paralyzes action.  Teens with dangerous family histories who have been poisoned by advertising and pestered by doubt, still make decisions.  Sometimes those decisions are for self-harm, or secrecy, or escape instead of healing.

This means the victims still have responsibility in their response.  Which is good news.  It means we have hope, because each family and child can make new choices, can be freed.

Malnutrition in all its forms, rickets, marasmus, kwashiorkor, anorexia, bulimia, obesity . . . is a frustrating illness to treat, but also perhaps the most satisfying to cure.  Because it is multifaceted, the analysis and solution draws upon the entire spectrum of medical, social, and spiritual insight.  The patient must be treated along with the family.  The approach requires team work.  And the long-term prevention requires big-picture thinking about politics and justice and truth.  

The Kingdom is described as a feast, a banquet, a meal.  The Fall from Grace occurred in an act of eating, and redemption comes the same way.  Jesus gives Himself to us in bread and wine.  So it is no surprise that much of the harm in our world comes through the mis-use of food.  If we could return to its holiness and wholesomeness, we would be closer to real LIFE.

A Wednesday

 By the time I got to our Paedatric noon meeting and conference, I had attended chapel,  evaluated 23 inpatients, admitted two new patients to the Intensive Care Unit (a five-month-old whose terrible diarrhea left him unconscious, with no discernible pulses and a 13 year old diabetic who was somnolent and cold in ketoacidosis), attended one death (a one-week old post-op neurosurgical baby who survived complicated surgery but then arrested twice from an abnormal heart rhythm, who was brain dead and did not move as he slowly dwindled to lifelessness in his mom's arms once we withdrew support).  Most of the kids who are brought to Kijabe are complicated, desperate, and have tried several other places first.  They are sick.  Very sick.  So it takes time to untangle the web of their histories.  I think almost 20 or the 23 suffer from malnutrition as well.  These kids don't bounce back to health very quickly.  Two make me very happy.  James, the 15 year old whose sinus infection invaded his brain, who narrowly escaped irreversible brain damage and death . . now day 21 of super-strong IV antibiotics, and finally free of fever and headache for 48 hours.  He is soft-spoken and sweet, and probably getting bored.  He could be my kid, or anyone's.  I'm so relieved he is living.  And of course HS.  Today she was sitting up.  She's hungry, for the first time in two months.  We can't understand each other at all... but when our team surrounded her bed and she stood up on her mattress agitated, the mom in me said, I think she needs to go to the bathroom, and the poor little thing let loose with urine.  Which was excellent news as we had worried over her fluid balance. The surgery saved her life but today we finally started to turn the corner towards real recovery.  A long but satisfying morning.  And a good meeting, with lunch and leadership provided by Mardi, ever-organized and visionary and helpful and cheery and committed.  We have a good team.

Meanwhile back at the ranch  . . it rained.  And rained.  And rained some more.

 Jack came home from Rugby FREEZING and wet.  He is growing like a weed in this wet weather, and in spite of being about the youngest kid trying out he was the first to the top of the "quarry" on the run today.  He works hard, like his brother Caleb who is training for Basic Cadet Training (boot camp).  Julia and Acacia are playing volleyball.  And everyone was soaked.  So rather than drip on the floor, Julia did some sort of spunky soliloquy out on the pizza table while waiting for the hot shower to open up.  We have great kids.

Lastly, end-of-the-day mail haul, Caleb's official appointment package from the Academy.  Good thing we found out by email, as the "you must reply by April 15" letter arrived on April 25.  Somehow seeing it in print makes it all the more real. 


A day of patients and meetings, rescues and death, rain and songs, the satisfaction of the moment and the reminder of the future.  A mid-week gourmet family dinner, Champions League football and a fire.  A day of full life.

Rain and Parties and the muddy blessings of community

 Rain respite.  Sunday evening, the incessant April deluge let up for a few hours.  Just enough time for all eight new Medical Officer Interns to join us in making pizza.  These young men and women will spend a year here at Kijabe, the transition from medical student to fully qualified physician.  Rotating through Paediatrics, OB, Surgery and Medicine.  Taking call every fourth day and night.  Admitting patients, going on rounds, churning through outpatient charts, assisting in surgeries, answering pages, reading texts.  Becoming competent.  And occasionally, having fun. 

 Kenyans have a natural knack for pizza making.  A culture that loves chapatis knows how to handle a rolling pin and dough.  Our interns are adventurous eaters, laughing, willing to try new food combinations.  They tease each other and discover the art of Italian cooking.  And we enjoy seeing them OUTSIDE the hospital.  Learning that one has seven sisters.  Another has a dad in the military and plans to serve himself.  Three are engaged, five are unattached.  In three weeks together they have sorted themselves into roles:  mom, dad, activities coordinator, pastor, cook, exercise instigator, etc.

The group at our door (my hair loves this rainy weather . . )

 Our vision statement at Kijabe Hospital:  Providing excellent and compassionate health care and spiritual ministry to the most vulnerable, extended across East Africa through training.  This night reminds us of one of our primary roles: to pour ourselves into these eight lives.  By God's grace modeling good medicine delivered with compassion in a way that points people to Jesus.  So that in the years to come, the small amount we can do is multiplied as these young doctors move out to areas more remote and needy. 

 Another night, another party.  Every Monday station families take turns hosting a dessert night for welcoming new visiting missionaries.  Problem is, Mondays can be kind of crazy. Julia came on rounds with me, her last day of break.  But then graciously came home to get a start on dessert-making.  I walked in the door at lunchtime to help her when I was paged for a 999 code (dying baby).  So much for baking. Thankfully Scott the "cake boss" rescued me, and made dinner too.  I next tried to come home at 6 pm, walked in the door, and the same page for the same baby trying to die again.  Oh well.  I finally made it home just ahead of our visitors, and my family had done everything to be ready.

 We had several new missionaries, several leaving, and a good number of long-term regulars too.  In a place with high turn-over of volunteers it can be a challenge to connect.  I'll never be the "best" friend of people who have spent a decade or more together . . but I am thankful for growing friendships as we pray and serve side by side, sharing griefs and joys.  And occasionally, cake.  Plus many of the one-to-six month doctors have a gift for quickly connecting and selflessly serving.  We will genuinely miss the young family, single woman, and retired couple all departing this week.

A stripe of sun-glow above the rain-sogged earth and below the heavy clouds, as I walked home from the second code Monday evening.  Thinking about redemption.  About the God who transforms mud into crops that sustain, who brings blessing from clouds.  Who made it clear to us two years ago that we were leaving Bundibugyo, team, neighbors, home, community, work, everything . . but who has brought us to a place with abundant opportunities for teaching, for fellowship, for people to love and serve and feed. 

Thanks for prayers

Just talked to the surgeon--he did find life-threatening intestinal problems when he operated on HS.  Thank you so much for praying.  She survived the surgery but has a long road of recovery nutritionally.  So we're not out of the woods yet.  So glad God intervened and changed her dad's mind!

Pray for this child

This little girl, HS, is wasting away.  After two months of vomiting and intractable abdominal pain she was brought by her father to Kijabe, having lost 1/3 of her body weight.  She is a refugee of sorts, her family moved across the border into Kenya from a neighboring country.  After several days in the hospital, being treated for one infection that is probably not the main problem, her father demanded to be discharged today.  I could not comply.  And so an hour of negotiation ensued.  He's from a culture that is abrupt and hostile.  I'm from a culture that believes a child should not be sent home to die with a potentially curable problem.  Even if the father says he has six other children.  Thanks to random relatives, and my MO intern, we reached a compromise that he would give us until Tuesday to find the problem.  This afternoon she returned from a CT scan with the diagnosis of intussuseption.  We suspect underlying TB.  Tomorrow she will have surgery.  In the long tense discussions this morning I sensed that HS's father has the same heart as God our father--he was standing up for his child, and he went to the trouble of getting her here.  I pray that she would be healed in a way that miraculously points to Jesus' love.  Jesus does not give up on us, and we sometimes have to stubbornly refuse to give up on others.