Multicultural Celebration

(First, a thanks to the respondents regarding the blog below.  We have been pledged more than $2000 for the Needy Children's Fund, which should be very adequate for Baby A and Baby E.  Both are still quite sick, but we see some good and hopeful progress.  THANKS.)

On a different note, today is my one fully non-medical day in the week, and so I was able to attend RVA's annual Multicultural Day celebrating the diversity of countries and cultures represented in this amazing cross-roads.  Or perhaps it's not a different note at all, since Americans and other distant people are joining with a Kenyan hospital staff to assist babies in need.

I (mostly) love Multicultural Day.  Flags, costumes, music, fun.  The morning program culminates in the flags of each country represented in the student body being carried in by the kid with a passport from that place who has been at RVA the longest.  I should have counted as the alphabet of countries marched by, there must have been nearly 30, Australia, Brazil, Burundi . . . all the way to Zambia.  South Korea, USA, and Kenya have the biggest followings.  Though New Zealand and Rwanda made some spirited noise.  It's good to be reminded that a kid might sound American because of attending this school for many years, but actually be from Malaysia or Lesotho or the Netherlands or Canada.  Our team mates the Maras are an Irish/American couple, but as the first RVA students from the Republic of Ireland no flag had previously been purchased, a situation Ann will rectify by next year!

Following the ceremony and tea time (we are still quite Kenyan after all) there was a 5K One World Fun Run to raise money for AIDS orphans.  This year was professionally organized.  We had numbers.  There was a real start and finish line.  A crowd of cheerers.  Corporate sponsors that donated bottles of water.  Julia and Acacia took off on their own this year, and finished well.  They stuck together while I hung back gasping.  I appealed to the organizers for a category of "over-50 female who gave blood last week" but instead all over-18's were grouped as "adults".  Needless to say I didn't win any prizes.  A good number of people would have to go on furlough or sustain serious injuries for me to come close.  My goal was to survive, and at least I can say I did that, though I wasn't sure at some points I would.  I think I felt every inch of the 7200 foot altitude and the rocky 5 kilometer distance.

This evening there will be games (for boys, lamentably no girls) and then fireworks for all.  This day is placed to celebrate Kenya's independence, and has blossomed to include a celebration of all the nationalities at RVA.  It is the only school-day of the year that is fully a community event with activities and groups of chatting staff and food and sunshine.  It feels like a real summer-day holiday.

But for TCK-MK's, the day does have some angst.  Half my kids were born in Kenya and have lived more time here than America, but they are subtly reminded that they can not embrace a nationality that differs from their passport.  Julia wore an American cow-girl outfit for the morning and then changed into a Ugandan shirt for the afternoon.  Acacia wore Air Force garb (like me!) since Caleb is our main connection to full-fledged American patriotism . . but painted a South Sudan flag on her face. African kids at an American school need to hold onto their roots to preserve them, but that can be hard on the kids who FEEL African but LOOK American and end up on the outside of that.  

The good news is that the day ultimately celebrates the Kingdom of God, where all nations can be distinct yet united.  That paradox of belonging yet remaining individual is an essential truth of creation, of our relationship to God and each other, and one that we too often get wrong.

Lifting from the ash heap

Jesus specializes in the poor and needy.  Psalm 113 talks about lifting them from the ash heap, or basically the garbage dump.  I have two patients right now who would be essentially cast off as useless rubbish were it not for this hospital, and grace.

 Baby A has been with us for about six weeks.  He arrived severely malnourished, with a diagnosis of a cleft palate, and we thought we just had to help his mom figure out how to feed him.  But the cleft turned out to be an almost imperceptible problem, and paled in comparison to the fact that his mother has a fatal infection, plus TB. And has most likely, in spite of her best efforts to protect him, given both to him.  And has been abandoned by her husband.  And though she turned to her brothers, they aren't too excited about being responsible for her or her very sick baby.  Baby A. has a heart problem in addition to his infections and cleft palate and fatherless state.  We can't get him of oxygen, and he just coughs and coughs.  Many people, including most of Baby A's family, would not consider this a life worth struggling for.  But Jesus specializes in the impossible, and invites the discarded, the gasping, the infected and scabby, the lethargic and slow, to the feast.

Baby E was delivered at another hospital, after a way-too-long labor and a too-slow rescue.  They got her heart going, but her brain had been starved for oxygen too long, and as her body convulsed for a day they decided to transfer her to us.  Her mom has hung on for the last three weeks hoping that she's about to turn a corner.  We've seen a tiny improvement in her lung function, but we've barely been able to get her to keep down feedings.  A couple nights ago her mom was sobbing, because she's financially dependent upon her own parents, and they refused to pay bills for this hopeless baby.  Baby E's mother is hopeful, loyal, dedicated, to this child of hers who does not do anything for her.

Both Baby A and Baby E will not be able to pay their hospital bills.  They have no safety net, no one at all in this world who cares, except their single mothers.  Niether has a particularly promising prognosis.  Yet both would qualify as "the least of these" to whom Jesus points us to love.

Our Kijabe "Need Children's Fund" has been depleted by patient after patient, usually by matching funds with families who can't quite cover the total cost of care, averaging fifty or a hundred dollars.  But these two babies will have hospital bills on the order of several hundred to a thousand dollars.  Less than a few hours' worth of western care, but even the bargain of Kijabe Hospital adds up over weeks and months.  Both mothers gave permission for their pictures and stories to be shared with you.  They're desperate, desperately in love with babies that no one else cares about, and desperately without any resource of their own.

If you are prompted by the Spirit to lift these two children "out of the ash heap" or provide a cushion for others like them, you could:
1. Get together some friends, make a donation to your church (for your own accountability and tax deductibility).  Then your church could write a check to us, email us drs.myhre@gmail.com and tell us, we have it deposited into our bank account in the USA (we'll give you details) and withdraw the same amount from an ATM in Kenya, take the cash and deposit it in the hospital's Needy Children's Fund (#70351) where it will 100% help Baby A and Baby E and if there's any money left after that, others like them.  We can scan the deposit slip from the hospital and email it back to you for full-circle accountability.
2.  Donate through Africa Inland Mission, to Kijabe Hospital, using this link:  Donations for KIJABE.  YOU MUST DESIGNATE "Needy Children's Fund 70351" in the comments or it will be lost in the sea of this large hospital with many projects and needs.  Still send an email (drs.myhre@gmail.com) so we can track it.  It takes about a month to be processed by AIM, and another month to be processed by Kijabe Hospital, and there is a 15% deduction for overhead.  But this is the best way to give if you need a tax deduction and don't have a church to go through.

Over the two years I've been here at Kijabe the generosity of strangers has blessed the lives of dozens and dozens of babies and children.  I'm grateful to work on a team that cares for the least of these even if they can't pay, and aware that the hospital runs on a tight margin that will crumble if hundreds and thousands of dollars of bills go unpaid.  Thanks for anything you can do.

What I Love about Medicine

Rain on the roof, a steady off-beat ticking in the darkness. Another challenging sermon from John 12, on dying, both literally, to self in community, to the familiar, to busy-ness. Another week of work, draining, but in a good way. In spite of working to make up for the time off at midterm, covering both ICU and Nursery at once, dealing with a switch in interns and the absence of both our CO's and most colleagues, as I walked away from Saturday morning rounds, I felt a sense of completeness or satisfaction or whatever it is one perceives when in a spot where the way we're created fits the job we're given.

Which led to some thoughts about just what that is. As a child I learned the catechism, and for some reason the attributes of Jesus as Prophet, Priest, and King came to my mind. Because Jesus was the epitome of what it means to be fully human, those are roles that reflect the image of God in human flesh. Mind, Heart, Will. Prophet, Priest, King. The prophet perceives, analyzes the present and looks towards the future, teaches, calls for action, warns, weighs, moves ahead guided by the Spirit. The Priest listens, prays, represents, advocates to God, sacrifices, bears the burden. The King makes decisions, directs, takes responsibility, leads, moves others. And medicine affords abundant opportunities for all of that, the environment in which one can plumb depths of being fully human, and therefore more like Christ.

On Friday for instance, as a doctor-prophet, I started the day teaching on rounds. Organizing the data in the present, anticipating what might happen, asking my team to think through it, challenging them to take action. Sometimes chastising. But continuously exhorting. Why is this baby jaundiced? How should this sodium level impact our fluid management? What tests should be done in response to this fever? What plans should we make for the next few days? I like this kind of teaching, and my team grows on my heart day by day, as I see them grasp the concepts, make the effort. As a doctor-priest, I spent a large portion of Friday listening to parental concerns. Praying for them. Sacrificing lunch or rest or seeing my kids or a breath of fresh air to be available. Advocating. Making a phone call, begging a mother to consent for a certain study, holding out hope. And as a doctor-king, there was a pretty intense sequence of decisions and action in the middle of that day.

We had been warned for a couple of days that the OB team planned to deliver baby L by cesarean section, the mother had complications and the baby on ultrasound had what was described as "trivial pleural effusions" (fluid in the lung cavity) and "possible ascites" (fluid in the abdomen). Though we hoped it was much ado about nothing, I made a list of what I wanted the nursing staff to be ready with, equipment and people. I texted the paeds surgeons in case I needed them, to be on standby. I went to the operating theatre and read the mom's file while she was being prepared for surgery. And when the intern on OB pulled a lifeless slippery purple body out, with much difficulty, my heart sank. The intern kept patting the baby's back. Just cut the cord and hand her over, I told her, and whisked the baby off for care.

Faint slow pulse. No cry. No breath. Grossly swollen baby, an almost frightening froggish look to her edematous face and distended belly. Not a normal baby. I put the bag over her face to force in some air. Not much movement of the chest. So in less than 30 seconds I just decide to intubate her. Even with a tube, little air seems to move in and out, though now her heart rate picks up towards life. She moves a little. Coughs. We warm and dry, we push the air in and out, she is still dusky. We run to nursery. And there the prep pays off, I have an xray within minutes and paeds surgeons immediately after. The xray does not show any lungs. Solid or liquid, but no air. Yet I can hear some breaths as I bag. We have the portable ultrasound. Seems to be fluid, both in lungs and abdomen. Both kidneys are there. The heart is beating. There is a moment when I wonder, should I be trying to save this baby, or is she beyond hope? Her terrible swelling dehumanizes her. I can sense the hesitation from the rest of the team. She's still pretty blue. The list of conditions that can result in this picture is LONG, maybe 50 conditions, and at least 40 of them are devastating diagnoses.

But I know we have a chance, and we have to keep going until we understand the real issues, or until we fail. Our helpful paeds surgeons put tubes in her chest on both sides, the fluid compressing her lungs begins to drain, and her lungs expand more. Breathing for her becomes easier. We draw blood, do more detailed scans, I replace her tracheal tube with a slightly larger one. I push hard for an ICU bed, and in between other crises manage to get her there on a ventilator. And over the evening and then the night she improves. The teamwork of surgery and pediatrics, doctors and nurses, radiographer and lab, nursery and ICU, all has been pulled together for this one goal. I know I"m out of my depth, not an expert, just plunging ahead with courage and doing my best. I ask my partner Erika to come have a look, give me a little reassurance. That kingly responsibility can be lonely.

Teaching and thinking. Listening and loving. Directing and organizing. All these roles flowing together, and in the process a resurrection from death to life. This is what I love about medicine, the fully human-imagio-deo aspect that any day can bring. And while there are many jobs that require focused thinking, tender empathy, and decisive leadership . . .it is good to find one that combines all three, and all for a purpose beyond self or profit or dominance, instead a pouring out of one life to give life to another.

As a mom, and working at a school, I would encourage kids to look at the future through this lens of Jesus-like humanity.  Isolated mind can lead to harsh, cold, amoral, distancing intellect.  Isolated heart might lead to paralyzing sorrow.  Isolated will to bossiness and self-promotion.  But a braiding of the three carves out a tiny territory of Heavenly Kingdom for the true King, be it a thriving home, a few interns and rooms of patients in an African country, or on to more glorious responsibilities of classrooms, businesses, armies, countries.  

Snapshots of the week

Jolting along a rutted track at over 10,000 feet in the Aberdare Mountains, testing each mud-hole with a stick lest we become stuck out of the range of cell phones, having not seen another human all day. Bamboo gives way to heather, bogs, grasses, sky and more sky. Acacia spots wild dogs, rare carnivores which hunt in packs, their variegated ears round and large and effective, pointing up through the tall grass. Then we come around a curve and a large feline crosses the road, jumps up on the embankment, and turns to watch us, crouched, poised. It is a leopard, sleek, powerful, perfect. Time suspended, we ease down the windows, watch, awed. Then it saunters away.

Rain sweeps over the plateau, at ten thousand feet, chilling dampness. We decide to leave our remote tent site and drive to a simple shelter built for group camps, to be dry as we cook dinner. The setting sun dips below the clouds and sparkles back a vivid rainbow, a full arch across the sky as we light our charcoal. I roll out simple naan flatbread cooking each round over the coals while Scott grills the chicken, and we all eat huddled around the fires, with our fingers, ravenous and thankful.

The Norwegian blood rises to the surface as always, and everyone decides to go for a swim in the icy mountain stream, where a 100-foot waterfall pours into shady pools. Breathtaking. Painful. Alive.

Shivering into the delicious warmth of a down sleeping bag, dry and protected from the night's downpour, as a hyena barks and whines in the darkness not too far away. And awakening to a cloudless alpine vista, the night washed clean.

Sitting by the window in our Treetops hotel room, where the current Queen Elizabeth stayed on a Kenyan tour in 1952 the night her father died and she was transformed from Princess to Queen 60 years ago. Scott reads aloud from our friend Josh Trott's excellent adventure/fantasy/allegory book while I watch bushbuck, eland, buffalo, warthogs, and later and elephant all come and go from the waterhole below.

We get texts on the way back to Kijabe that a sweet couple who came to have their baby at Kijabe have indeed delivered during the night. We're sorry we missed the event, and hurry over to see them as soon as we pull in. Having had two babies here, and for other indefinable reasons, I feel a real connection with this family. So it's an honor to be asked to pose for a photo with baby Ashton.

Plunge back into the hospital: complicated patients, anxious parents. Scuffling through the corridor in a sterile gown and cap, cradling the newly delivered infant of a mother who has not one but two serious potentially (and eventually) fatal diseases herself, and has just produced a baby with hydrocephalus, a fluid-ballooned brain. The baby is not breathing, but a minute of expanding her lungs with air from the ambu bag and drying her blue wet skin and positioning her huge head, and she begins to whimper, then cry. Death to life. Never gets old.

Sitting with another couple, gently explaining that their baby's brain injury confirmed by CT scan is catastrophic. Leaving room for miracle, room for hope, but pointing to Heaven as well. Life to death, never gets comfortable.

Up to RVA for Spiritual Emphasis Week, hand-raising drum-rolling guitar-vibrating worship with complicated riffs and energetic passion, then a powerful prophetic no-hold-barred preacher who was once a Kenyan MK and RVA student himself. Messages full of Scripture and truth and challenge, radical stuff. Sitting in the back and praying, knowing that the harsh words about holiness and glory suffering and death will be hard for many to hear, the wrathful picture of God may be frightening, but also that many will be stirred and changed.

Chatting with my expat patients whom I love to see, with colds and motorcycle scrapes, then back to the ICU with a child whose intractable seizures after surgery for a brain tumor require massive intervention, then back to the premature twins huffing along with perhaps too much expenditure of energy, watching, wondering if they will turn the corner soon, and which way.

And it's only Thursday.

Sweet Sixteen

"My name is Julia Kathleen Myhre and God wants me to push that button!"  This is the girl whose confidence and spiritual awareness continue to propel her through life.  At sixteen she is friendly. Gracious.  Fun.  Unpretentious.  Seeking.  Hard-working.  Sensitive.  Sure.  More concerned about others than herself, about having fun that looking a certain way.  She's practical.  She grabs hold of a dream and sticks with it, until we all agree, hence the puppy this year.  She is careful with her homework, and spends way too many late evenings and early mornings.  For her Bday she requested coffee cake, for an early family breakfast party.  Her new Netherlands football jersey commemorates the year she first went to the Uganda National secondary schools girls' soccer tournament, and as the only white person and taller than most, the rumor went around that this 12 year old was a secret member of the Dutch National Team.  She still loves football passionately, and this year decided to take up tennis, as seen in her cake above.  She loves people and the outdoors.  After school she went on a long hike with the Koinonia team, the group of students with whom she leads a weekly fellowship.  She arrived home breathless and dirty only a few minutes before her all-girl party, escorted by a group of guys.  Then it was all silliness and laughter and pizza and cake. She received simple gifts with joy and gratitude.   Later she was the speaker for the 100-120 kids who came to the fellowship, and we saw a new side of her, Julia the preacher, capturing attention and testifying from the heart.  Julia is one of the greatest gifts of our life, someone we don't deserve and didn't earn, someone that amazes us more each year.

A Rhythm of Respite

Sunday, early church, then a flock of RVA/Kijabe station ladies headed to the tea farm in Tigoni for a lesson in Kenyan history and agriculture arranged by Kate D to raise money for forest preservation.  The farm's owner, Fiona, told stories of her grandfather who came to Kenya more than a hundred years ago, and made it his home.  We learned about tea bushes and plucking leaves and the 24-hour branch-to-tea-bag process which ensures freshness, about oxidation and sorting and politics and regional specialties and the advantages of high-altitude cool-weather slow-growth.  When we had toured the fields and a patch of indigenous forest, our hostess served us lunch in the lovely gardens complete with more tea and an amazing lemon mousse.  The fun thing is that we now have an actual WHM team:  Bethany, Anna, Ann and Jane, Acacia and me (Julia decided to stay home at the last minute because of her heavy load of commitments in the coming week).

This has been a weekend of respite in the midst of heavy work (strike still on !!!), political uncertainties (a grenade thrown into a Nairobi church again today!!), missing Luke and Caleb (deeply and frequently !!), and the slow resettling transition back to life in Africa after my summer retreat (embarrassingly drove on the right (as in not left) side of the road on a rutted empty patch today until two equally slowly moving vehicles headed right towards me and Bethany politely suggested I switch sides, never did that before !!).  The rhythm of Sabbath is a rhythm of faith. One that says another day of a bit more study, a bit more cleaning, a bit more exercise or cooking or seeing patients, is not going to make everything OK.  That even with loose ends and need, God says to pause.

So Friday evening Scott and I drove out to watch the football and tennis teams play at Greensteds and then have a real date, a fireside dinner for two and overnight in a tasteful luxurious banda overlooking Lake Elementatia.  Yesterday I made some really good special food and we had a group of kids over to watch a movie.  Today the tea.

Tomorrow it is back to preemies and clinic and ICU protocols and the stress of crowding too many patients into our limited space and hearts.

But for tonight I'm thankful for the respite this weekend has offered.

Wabuchire

Midnight. A full day. Off to a good start I can barely remember, happy dogs out for a quick morning jog, the clouded dawn suffusing Longonot and Mt. Margaret with light down in the valley. An hour of Swahili, most of which I now understand but find it extremely painful to extract any spontaneous sentences from my tongue. Rounds in the steamy nursery, constant ringing alarms, the lusty crying of the few term babies, the hot bubble of the incubators, the eerie blue glow of the bilirubin lights. I've brought some articles to read and share with Bob (we never manage), and I try to be patient with the new CO intern who is barely grasping a few basics, teaching as we go along.

Until noon, when an OB nurse bursts in to say we're needed in Labor and Delivery. A mother transferred in from another hospital seizing, her 9th pregnancy but first hospital visit, vague dates, and a decision to induce delivery to save her life. Only what she delivers turns out to be larger than expected, a viable-sized infant. Or just barely so. 700 grams, 26 weeks, a baby who would likely survive in a few places in the world, most surely die in most, and have about a 1 in 3 chance in our nursery. 1 in 3 is significant enough to try hard, but low enough to accept our limitations. And so ensues 9 hours of rising and falling hope. We resuscitate and gently stimulate breathing, provide fluids, warm, start medicine. Twice I go to tell the mother that the baby is dying (to which she says, and I quote, that's OK we don't need this one), and come back to find the baby breathing again. It is uncomfortable to invest in a baby that probably has no chance of life, but I'm not sure the chance is zero, so I go on, even though the mother professes not to care. Finally tonight, while another hopeless baby was trying to die (one with severe un-fix-able anomalies and overwhelming infection) and two new preterm twins were being born, she succumbed to her stiff unready lungs and exhausting struggle to live. A 9 hour life, and I was there from start to finish.

These strike days are like this. The evening is dominated by a mother of twins, also a referral, in labor, bulging belly, agonizing and panting. ONly hours go by and she still hasn't delivered her 33-week twins. When the intern decides to take her for a c-section the first pops out naturally, a boy, bottom-first, with the most alarming chest-wall retractions as he struggles to breathe. By the time we have him stabilized and on CPAP the OB team has decided baby #2 is stuck transverse and they whisk the mother off for a C/S, pulling out a slippery smaller sister who also struggles slightly but revives. (Worst case scenario a la JD: a vaginal birth followed by a C/s, so the mom is sore everywhere). Once they are tucked into their snuggly shared incubator (another strike effect, we're out of space) another referred newborn arrives with her huge spongy head and open spinal defect, her paralyzed stumpy legs and blinking eyes. I work on writing up her paperwork to help the swamped MO intern.

And then one last check in ICU, where the baby with the diaphragmatic hernia rests post-op. And where a feisty toddler whose esophagus was damaged in a failed intubation attempt in Eastern Congo after an allergic reaction to malaria meds has just had a reconstruction of that vital piece of her body. Her dad with his rounded face and trace French accent feels familiar. He's sought care from Butembo, to Mbarara, to Mulago in Kampala, to Kigali, to Goma, and finally all the way to Nairobi, a medical tour of east-central Africa. For six months he's been carting this child from hospital to hospital looking for care. Until he reached Kijabe with her. We talked about familiar towns in Eastern Congo, and then I greeted him in Lukonjo. His face just lit up. I used my half-dozen Lukonjo words and made this peripatetic parent feel happily at ease. The power of a familiar word in the right tongue never ceases to amaze me. He was lonely for his home and the language reminded him he'd go back there eventually. Wabuchire, and wasinge for reading if you got this far.

Home to a last-mintue physics problem (if this ball falls and this one's thrown and the tower is 15 feet hight how many seconds before they meet . . ) and preparing to teach tomorrow. It's been a long day from intubation and writing orders and teaching and a death vigil. 4th call night in 7 days. A day redeemed by the joy of connection from a simple few words. Wasinge, I am thankful to now put it behind me (until the next call).

A new week rolls in

 Baby A is grateful for your help, though he doesn't really know it yet.  His mom agreed for his photo to be posted to thank those who contribute to Kijabe Hospital's Needy Children's Fund.  Like some of our recent visiting docs.  (If you've forgotten how email me drs.myhre@gmail.com).  Baby A was born with a cleft lip and palate, a completely fixable problem if he doesn't starve to death before he's old and big enough for surgery.  His confused and upset father took one look and abandoned him to his mother, who is dependent upon her brothers now for support.  Those uncles have been kind but are not quite able and committed to cover all his hospital costs.  He's been with us several weeks surviving a serious infection and trying to gain some weight.  We're praying he can go home soon.  He's a least-of-these speck of wrinkly skin and hunger.

The fund has also facilitated echocardiograms for some babies with severe heart problems this week, and on the weekend allowed me to help a mom get home who had spent so many days waiting to raise the last hundred dollars of her bill (the small part not covered by insurance or what her family had given) that he ran out of his seizure medicine and started to convulse again.  Kijabe hospital is the hospital-of-choice for so many Kenyans these days of strike.  We're a hundred times more functional than the rest of the public health care system, and much less expensive than the private Nairobi hospitals.  So we get referrals from both.  In many cases we give care that is just as excellent or perhaps better than our more trendy and pricey counterparts in the city.  A recent ICU patient's family told Scott (after their relative survived a situation with about a 10% chance of making it through):  we would always come here, it's not all STERILE like _______ (fill in name of "best" hospital in Kenya).  Hmm.  Not being too sterile is not always a plus, but we're glad we had these happy customers.

This weekend a similar family requested transfer from their super-duper ICU to ours, because they were out of money (cost ratio 20:1).  Super-duper ICU didn't see the diagnosis right away in this newborn's xray:  not sure I would either . . .

But if you look very very closely, there is a bubble over the left chest that should not be there.  It's bowel, which has popped up through the diaphragm.  Not a huge problem in utero where the baby doesn't need to breath or eat, but rather bothersome after birth.  In case you can't see it still, here's the gastrograffin study outlining the bowel with contrast:

(It shouldn't be up by the heart).  This baby had a good amount of lung development and with the expert care of our paediatric surgeons today we have great hopes that he will be able to survive, which is certainly not the norm in Kenya for this problem.

Because the strike has packed our casualty and outpatient areas, the new Maternal and Child Health clinic building which was due to open in October had a rushed prayer-speeches-hand-over today, so that the area could begin to be used.  A few of us from the Paeds team, the engineers who did this work, the executive director and the chaplains gathered to recognize this milestone.  Looking forward to seeing patients in this bright clean new functional area rather than scrambling for a corner in the midst of the onslaught.

We can't fix all the problems, sadly.  One of our other admits in the last few days was a baby born at home with a mid-facial cleft, a huge gaping hole in his face where his nose and lip should be.  Sadly this is associated with a malformation of his brain (holoprosencephaly), probably his heart, and his kidneys and other organs.  He will not be able to survive long, but we are working to pull him through his current meningitis and jaundice to hopefully reach a point where he can be held and fed and loved and taken home.

Thankfully Kijabe has a palliative care team who will help us provide comfort and improvement and hope and support even when we can't provide a cure.  They work with the mother, us doctors, the nursing staff, the chaplains, and as a team we try to make a plan.

Lastly, there are the babies who should survive but don't due to the frustrating realities of life in Africa at this moment.  Like the 25-week preemie who was essentially dead on arrival this weekend.  If only the clinic where her mom presented Friday with labor pains had recognized them and prescribed rest and fluids instead of letting her go back to work Saturday.  If only they had made it to a hospital with a doctor in the midst of the strike on Saturday when her labor progressed.  If only there had been an ambulance available to get her to Kijabe faster.  If only she had been kept warm and breathing on the way.  I ran to the hospital when the nurses called, but even after intubating and drugs and lots of resuscitation, her little heart never picked up.  She was gone, and her parents wanted me to take photos of her and of them, looking so peaceful, for their memory.  Until they meet her again, perfect and whole, in Heaven.

Which is a good thing about this job.  I meet so many Heavenly citizens-to-be.  I look forward to eternal conversation over very good coffee from some Africa, or perhaps a whole Africa-like planetary system, with some of my current patients who are the weak and wounded and sorrowful in this life, but destined to rule and shine in the life to come.  So I'll close with a photo of the nearest-thing-on-earth cup of coffee Scott and I had on Friday.  This is one of those piled-up call weeks (tomorrow will be the 4th night in 7 days), which made that moment all the more precious as a taste of what is not-yet but promised:

Red, White, Green

Our kids' school is preparing for "Spiritual Emphasis Week" with a journal from the group "Live Dead" (live with a short i, the present tense verb), which promotes self-sacrificing team ministry to the neediest in East Africa and North Africa.  One of the entries describes the Celtic conception of martyrdom, dating back to the time of St. Patrick.

Red martyrdom, the most obvious, when blood is spilled, life lost.  Though this martyrdom is the most obvious yet most rare, many Christians around the world still face this threat for their faith, for standing against evil and getting in its way.  Dr. Jonah spilled blood because his faith led him into a path of danger.  I read that one of our current WHM missionaries is sick once again, who serves in a difficult city where forces of evil thrive on human trafficking.  Here in Kenya I talked to a local missionary whose environmental activism, which is based on his belief in God, leads him into paths of danger as he crosses the economic interests of those who destroy.  Execution, imprisonment, illness, suffering, identifying with the poor, being in the wrong place at the wrong time, these are the color red.

White martyrdom, the horizon, the desert, the withdrawal from the familiar, the sacrifice of comfort and family to serve Jesus, is a calling for more Christians.  For some it is the asceticism of fasting to pursue spiritual awakening.  For many it is the departure from an expected path, from the direction of least resistance, to move towards need.  The inconvenience of countries with flooded roads and intermittent electricity, the daily wear of misunderstanding, the grating intrusion of rodents and insects and noise and heat.  Or the more subtle sorrow of missing milestones with family, of being far away when illness or discouragement engulfs loved ones.  This is the searing white reality of missions.

But the third martyrdom caught my attention, because it is not one we often recognize.  The green martyrdom represents the loss of personal autonomy, the rough sanctifying scrape of living in community.  Evidently the transformation of Ireland rested largely on the welcoming, productive, holy, inviting, stable enclaves of monasteries where believers in Jesus kept bees and transcribed Scripture.  And as anyone who has lived in close community soon learns, it's not all honey and beer and harmonious chants at sunset.   Living in community calls for a loss of privacy, a loss of choice, a loss of cushion and protection from our true selves.  In community we are called to lay down our lives over and over.  This is green, because it bears the beautiful fruit of our own Christlikeness and the drawing in of the wandering needy.

This concept really got me thinking about our mission teams.  I think we soberly count the red and white costs.  We expect discomfort and loneliness.  But then we expect our team community to be an unending source of encouragement and support.  When community itself shapes up as a form of martyrdom, we squirm or scream.  Something must be wrong.

But perhaps the Celtic believers got it right.  We are sanctified in collaboration with our fellow saints.  Even those whom we don't think we need are God's chosen instruments for our own good and His glory.

Our new community of saints at Kijabe has been a source of strength for us, of friendship and spiritual wisdom and practical help.  It is also a much more diffuse community than that of Bundibugyo, or Mundri, or soon Kibuye.  Life is easier to live (groceries, lights, water, phones, medical services, schooling, English, so many things); and the options for relationship are MANY; and therefore we are less pressured, less thrown upon each other for survival.  Which can be a relief, but is also probably a loss in spiritual terms.

But as of this weekend, we have a little WHM-Kijabe team again.  Miss Anna is teaching 6th grade this year at RVA, which was her original direction before a 3-year detour that took her to Bundibugyo.  Miss Bethany came for just one term to fill in for a counselor on HMA.  And the Mara family just arrived Thursday night, the beginning of long-term service.  Mike is an orthopedic surgeon; Ann works with justice issues and they both raise two lovely children.  Saturday night we made tacos and talked, in between calls to the hospital.  We're looking forward to the green days ahead, even if they require some sacrifice as yet unseen.

Burdens

These are some burdens I have witnessed this week:  

--A child paralyzed by a fall from a tree, now bed-ridden, admitted with pressure sores.  Hard to imagine going from a healthy active 7 year old to complete confinement in one's body.  

--A woman who brought her large-headed newborn to our hospital, the premier neurosurgical service in Africa (and possibly elsewhere as well), hoping for a surgical cure.  He arrived extremely dehydrated and dangerously close to death, and our doctors and nurses pulled him back from that brink and got him feeding and stable.  But then we did an ultrasound of that boggy bulging head and discovered nothing but water.  There was no brain above the stem.  Enough to suck and cry and make primitive motions, but not enough to see or hear or talk or sit or live.  We sat with the chaplain and prayed for her as quiet tears fell down her cheeks, facing this shocking inevitability about her son.  

--A three-year-old hit by a motorcycle, who will probably die today.

--A baby who is sleepy and twitchy, his little brain having been starved for oxygen because his umbilical cord slipped out in the birth process before he did, and his mother had to bounce from two other hospitals until he reached ours to find working doctors and an emergency C-section.

--A mother of a tiny premature baby who has braved 50 days in intensive care.  He's grown into a cute little person who is beginning to feed and squirm and hold onto life.  But she has problems at home she won't disclose, so she's begging to leave with him, even though he's not fully ready.  Putting us in a difficult position of not wanting to ruin her life, and not wanting to risk ending his.

--A lovely couple with their floppy 1 1/2 year old looking for answers, this precious boy smiles with delight but can't sit or stand alone, or talk other than grunts.  Both husband and wife in the exam room, articulate, puzzled, hoping we'll have the magic shot or pill.

--A 9 day old whose body succumbed to overwhelming infection, the powerful bacteria multiplying and growing and consuming him from the inside out.  We lost the battle slowly over a number of days.

--Then there are the burdens of our own kids and other MK's, sometimes homesick, sometimes coughing, sometimes staying up too late and getting up to early to meet expectations, sometimes struggling to know and be in a world that is complicated.

Jesus said His yoke was easy and His burden was light.  That can only be because He is the one upholding all these precious sufferers.  I certainly can't.  This world is so broken and yet so beautiful, flowers and courage and sunlight in spite of all the sorrows above.