Victories, mostly

Not all of the last week has been alienating (see below).  In fact there have been some true celebrations.

First and foremost, Scott's Birthday.  Another year, another dozen roles and abilities.  His capacity for being diversely gifted and wise in doctoring, fixing, mentoring, scoring goals, cooking, creating (won the WHM Christmas photo contest too!), building, writing, organizing, fixing again, saving, listening, deciding . . . is exceeded only by his capacity for putting up with me and Africa and the whole mess of life.

Luke's Football Club of Yale University went to finals in the Ivy League tournament, won their conference, and placed respectably in regionals.  He had a great season of friendship and football, the essential outlet for Yale survival.  Caleb's Thunderbird Squadron 27 intramural team also went to finals (40 squadrons) at the US Air Force Academy.  Another essential outlet for survival.  Jack's RVA Varsity Football team also went to finals, their first defeat in a great season. So all three boys enjoyed solid season finishes in the #2 position, all as wings mostly, fast, running, defense, shots, and camaraderie.  And in the family theme, Acacia's JV basketball also finished 2nd, losing by the narrowest of margins in the finals.  And Julia's tennis team made it to semi-finals, so I guess they were 3rd or 4th in the league.  All these sports have been great fun to watch and cheer (from afar for Luke and Caleb, but field/courtside for the younger ones).  I'm grateful to coaches.  Grateful for exercise and confidence and opportunity.  And on pins and needles as the RVA three go through tryouts for the next season, I believe/help my unbelief, trying not to be the mother who asks for right-hand-seats-glory for her kids (Matt 20:21) (others seem to pray for this and then their kid scores the goal), but to trust that the teams will prove to be blessings to my own and to others.  But I can't help hoping the kid who got cut last year won't have that happen again.  So if you have more faith than I, pray for that.

And lastly, on the theme of birthdays, parenting, and victories, here is baby L on the day she was discharged, snuggling up with a very happy Mom.  The next ICU-save baby, baby F, also made it off the ventilator and back down to the nursery this week.  Thankful for life being stronger than death in these two.

Add to all that an unexpected gift of a visit from Karen, walks with friends including neighbor Sheri who had been traveling and is back, a movie with Bethany, days of sunshine and dry clothes on the line, cream cheese frosting as a rare grocery bounty in town, huevos rancheros at Java house after the alien debacle, prayer with fellow moms, and an all-hospital all-out party to celebrate the new Maternal and Child Health (now called Family Health) clinic, the new about-to-be-turned-on CT scanner, the new palliative care building, and the cornerstone-laying for the new BKKH paediatric wing . . . well it has been a celebratory week.

Thankful for the moments that give a glimpse of belonging and thriving, even if not all is victorious in this fallen world.

Rule-weary, and Confessions of Lovelessness

"If every human being had the capacity to do the right thing every minute of every day, humankind would have no need of laws.

But since all of us have the capacity for both hatred and love, we are compelled to make rules that provide our best judgment for how to live together in peace and justice. Laws alone cannot ensure our well-being, however. The stories of our very best human selves are the stories of our love for one another — the stories where laws and social norms are trumped by hearts that love and people who follow their hearts and act on that love.

Consider now how love can help us be our best selves."

This quote comes from http://www.d365.org, an on-line devotion we read as a family at breakfast in the mornings.  And I've gone back to read it several times recently.  It's been one of those rule-weary cross-cultural stretches.  A boarding school is a rule factory.  A missionary station is a diverse community, and every passing month seems to generate more rules or protocols or meetings or structures.  A foreign country has its own laws and makes it clear that we don't always fit in.  So as a missionary/doctor/mom/class sponsor/community member in Africa, there are a multitude of overlapping cultural lines that one must tread carefully.   In the last couple weeks I've showed up twice to events to which I thought I was included, only to be excluded with unintentional harshness.  And as a final straw, Kenya has declined for the time being to register us as aliens, having lost our paperwork.  The only thing more alienating than being an alien is being an alien who can't even have an alien registration card.  

So I admit, I've felt a little sorry for myself after some of these interactions, and tempted to throw in the proverbial towel.  But that very thought points out the real issue. " Towel" may be a boxing metaphor, but it is also a Gospel symbol of community.  Jesus washed feet and wiped them and called His followers to be servants not lords.  My capacity for hatred and judgement and exclusion is greater than my capacity for washing grime and tenderly wiping.  I'd like to imagine that without so many rules I'd be a sensitive neighbor and kind doctor and generous friend and sacrificing parent.  However the truth is that the same selfishness the laws are designed to protect our community from fills my own heart too.  So even as I sigh clinging (literally at one point this week) to the outside of the fence, instead of wishing it away I need to learn to live in the bounds of this community, extending grace.  

I'd like to trump rules with love.  Which does not happen by pointing out the absurdity of the rules, but by acting consistently in love, day in day out, until those who are trying to protect themselves and their community with ever-more-detailed laws relax in the fear-casting surety of love.  Which I suppose won't happen until the all-things-new of eternity.  When we finally won't be aliens any more.

Paeds Team

This is the great group of people with whom I work, at our monthly meeting.  So thankful for the wisdom and dedication of Mardi, Lillian, Mary, Erika, Ima, Bob, SarahG, Rick, and especially (not pictured due to hold-up in immigration this morning) SarahM!

Addicted to Resurrection

Jesus said, I am making all things new.

The privilege of working right down in the nitty gritty of that is pretty astonishing. The last couple of weeks I've seen it up close. Baby L, whom I've written about before, is now able to rest in her mother's arms and feed. Almost anyplace within a thousand miles she'd been born would have meant a lifespan of about one minute for her, but now she's edging towards the possibility of discharge. Her mother thanks you for your prayers, and said we could show her smile.

This week it was baby H. His mother arrived as a transfer from another hospital with a hemoglobin of 5 (that's almost too low to survive) and a blood pressure of 60/24 (that's also just a shade from demise), bleeding profusely, her life and her baby's draining out of a placenta in the wrong position. Our OB team rushed her to the theatre and our Paeds team received the baby whose heart still beat, but he was limp and blue. I found him being resuscitated, and spent the next two days and one night basically within a few yards of his cot. There is something very intimate about intubating a baby's trachea, putting an intravenous line into the umbilical vein, listening, watching, examining, calculating drips and fluids and meds, fiddling with our ancient ventilators, watching the monitors. And texting Dr. Erika our 6-month short-term neonatologist, about thirty times, because this baby was as sick as they come and way beyond my expertise. With great advice from Erika though and every medical therapy we could muster he's dramatically improved. Not out of the woods, or even out of the ICU, but not dead either and definitely trending towards recovery.

I am thankful to be a paediatrician. But that night I got a little taste of Family Medicine as I pulled for not just one ICU bed but two, to save the mother as well as the baby. As I struggled with his poor lungs and low blood pressure, I kept looking at his mom's numbers too. She's out of the ICU now and well on the way to being healed. She and her husband are small farmers with no margin for disaster. We will end up once again paying for a good portion of Baby H's care from our emergency Needy Children's Fund. Both babies were vigorous in their own ways, fighters, with little eyes that flutter open and just LOOK at you as you're trying to help them, faces that grimace in a soundless cry around the endotracheal tube, legs that kick. It's hard NOT to keep struggling for a baby that looks at you like that.

In Mel Gibson's movie about Jesus' passion, the all-things-new quote is placed on the walk to the cross. Which is an important juxtaposition, one that I tend to gloss over. Resurrection comes at a cost. For Jesus, the real maker of all things new, his life. For us, his apprentices, mere inconveniences like a bit of lost sleep, or discouragement, or mistakes, or weariness. Perhaps that is necessary, because this resurrecting business could become addictive.

Counting more thanks

THANKS for the tremendous response to the post about the needs of babies at Kijabe hospital.  Over four thousand dollars were sent by various people, and another several hundred is in the works from a family that decided to make this their Christmas presents to each other.  Besides the two babies who I had asked for help for, I expect this generosity to touch the lives of at least twenty more!

The pictures are of Baby L.  The top one is from one of her first few days of life when she was intubated on a ventilator (breathing tube and life support), had chest tubes draining fluid from both lungs.  She was delivered at Kijabe after a prenatal ultrasound showed a rare and often fatal condition called Hydrops Fetalis.  Over the last three weeks we almost lost her many times. The lower picture is from her 3-week birthday on Friday, when she was breathing on her own with a little oxygen, and being fed.  She still may not make it, but the fact she's still alive is nothing short of miraculous.  She's a first and only baby for her dedicated parents, and they have also swung between hope and despair.  I expect they will work hard to pay most of their bill, but three weeks of intensive care adds up, and we will be happy to be able to help them a bit.

I put Baby L up here to remind all of us that where our treasure is, there our hearts will be also.  I know the people who have partnered with Kijabe Hospital to help children are now investing prayer in their recovery.  I certainly care more about Baby L than many random Kenyan babies because I've spent hours and days and nights struggling for her survival.  Please do pray for children like her to be rescued and to recover fully, for parents to have patience and perseverance, for nurses to work with stamina and insight, for our trainees to learn as they serve, for our consultants to be alert to the correct diagnoses and to carefully direct the team's care.

For now we will close the appeal for the Needy Children's Fund, and let you know when the money you've given has been fully used.

In the meantime if others are thinking about holidays and end-of-year blessings, we have plenty of other great options. One would be the Dr. Jonah Memorial Leadership Fund, the WHM-based fund in honor of the late Dr. Jonah who laid his life down for the gospel during ebola.  We have five young men in medical school, one doing an MPH, and one recent CSB grad (friend and classmate of Caleb) applying as the direct fruit of Dr. Jonah's buried seed.  As each year goes by the tuition costs in Uganda increase.  But we believe these young people are the core of the Kingdom coming in Bundibugyo.  Each is committed to return and work there.  This is much easier since the fund is administered through World Harvest.  Just click http://www.whm.org/project/details?ID=11129  for information on donating.

As we count our blessings in November, we are very thankful for generous friends who join with us in very concrete demonstrations of the love of Jesus to those who are aching for a sign of redemption.

COUNTING

Some blessings today.

1. My mom spent the night in the basement and Luke was under curfew confined to his dorm, but neither experienced loss or injury in the wake of Hurricane Sandy.  May the spirit of community and can-do permeate the areas most affected.  My favorite radio news story this morning was of reverse-looting in NYC--a man returning scattered items from the street to a broken shop window.  
2. ACACIA.  Enough said, but I'll expound.  We've loved her since she was an embryo.  It is a privilege to stand on the sidelines in awe of a 15 year old girl growing in grace.  I love her increasing confidence as a person, a student, a basketball player, a friend, a believer.  We celebrated her birthday with gifts, meals, friends, and a nostalgic video sent from her real family in Sudan.  
3. The young men and women who come to Kijabe to train.  Today was the final day of the year for the Clinical Officer Interns.  On "T"'s final rotation in nursery he improved tremendously in his clinical skills, but I also came to appreciate his heart for patients, and his reliability.  A good guy.  We had a formal prayer/speeches/chai/goodbye for him in the nursing staff room this morning. 
4. Moments of peace in the midst of chaos.  Monday I agonized through two deaths.  Yesterday there were three very very sick babies admitted within a short period of time, each brought desperately into the nursery with minimal life.  The first was COLD (32 degrees C) and damp and listless a few hours after birth at a small clinic, the second was HOT (41.5 degrees C) and shriveled and jaundiced and not breathing a couple of days after birth, and the third was twitchy and lethargic and malformed five days after birth having gone home instead of coming here as referred.  I had to call for backup as I organized my team to administer oxygen and push fluids and draw labs and calculate meds, checking back and forth between these babies.  There was a moment in the afternoon when all had turned the corner towards life, and I sat down to feed another stable baby whose mother has been in our ICU with serious infections after her C-section elsewhere.  There are few things more therapeutic in the midst of beeping monitors and gasping babies and needles and blood and stress than holding a baby and helping him suck milk from a syringe.
5. My kids.  I shouldn't say too much about our NHS sagas, but for reasons obscure to me my oldest was not offered admission until the last month of his senior year after he already was headed to Yale, the second showed incredible persistence in applying time after time and finally was included also later in his senior year, and the third was rejected her first application too.  So when we got an email that Julia was to be inducted today we were happy for her (though the ambivalence of the "in" and "out" remains).  She's an all-around servant-hearted hard-working faith-seeking lovely person.  Also fun to see her join with Elizabeth C, after we had watched old vidoes of these girls as 3 year olds in Uganda together.
6. Swedish meat balls.  For equally obscure reasons, perhaps hearing of one of Scott's uncle's deaths this week and remembering visiting the family, I was inspired to cook from the Scandinavian roots I don't really have genetically.  Swedish meat balls, always a staple of Scott's grandmother and mom.  Lefsa.  Only my meatballs were crumbly and my lefsa amoeba-shaped and I was about to give up on the whole enterprise but Scott kept up my spirits and it actually tasted amazingly yummy.  You can't go wrong with sauteing in butter, and dipping in ketchup.
7. Football.  Jack scored a goal in the first thirty seconds of their crucial game this week, which his team went on to win 3-2.  He's been sick and so I'm very thankful for that moment of brilliance, a boost of resilience.  The night he was sickest we watched Man U together in a thrilling controversial win over Chelsea.  This morning we talked to Caleb whose intramural soccer team lost in the finals in an equally controversial match (his goal disallowed long after it was scored for suspicious reasons).  Still that makes them 2nd in the 40-squadron competition.  
8. UGANDA:  gifts from friends, pictures and stories.  All that will have to be Scott's to tell, but his weekend was worthwhile and eventful and bonding and more fun than he expected to have going to meetings!  I'm glad we're all back together.
9. Babies, and life, which just holds on and breaks through.

Acacia is 15 today!!

Notice the birthday button!!

Welcome to the Pearl

Scott left at 4:30 this morning to get to the airport in Nairobi in time for a flight to Uganda, to meet MAF and then hopefully in the next hour land in Bundibugyo.  This trip was thrown together at the last minute:  he had better hospital coverage here in November, but the team in Bundi had set aside tomorrow for major meetings about CSB, so thanks to gracious pitching in by Drs. Letchford and Claud, off he went.  Meaning I stayed up past midnight writing 26 cards/letters to send some greetings, and we filled up a bag of Nakumatt goodies.  I apologize in advance for the hundred letters I DIDN'T write.

SO PLEASE PRAY this weekend for:

• The airstrip to be dry enough for Scott to fly in today (Friday) and out Monday.  Hard to do a quick turn-around without MAF!  And they've already had at least one plane-stuck-in-the-mud day lately.
• Jesus to be present in every interaction, the greetings, the requests, the encouragements, the reunions, the challenges.  Pray Scott would be a river of living water, overflowing to others.
• Wisdom (another name for Jesus) as the team meets tomorrow to consider what directions God is leading CSB.  This school has blessed all our kids (biological and foster) and is the foundation for lasting Kingdom change.  It is also the epicenter of attack.  Pray for Isingoma and the entire leadership team as they meet with Michael, Travis, and Scott.
• And for us here.  I left Scott for two months.  Within two hours of him leaving me there was homework crisis over a malfunctioning computer, an adult missionary with medical issues who needed him, missing puppy (she's back), and of all days, Jack's team chose to wear ties to school . . . leading to a slow-loading too-long YouTube how-to video within seconds of him running out the door late.  I don't take lone survival for granted.  Pray also for Baby Lopez to whom I have been quite committed.  She turns 2 weeks today, much of that in the ICU, and her prognosis is uncertain.  I'd love to see her prayed to life.

Thanks for partnering with us.

Happy World Spina Bifida and Hydrocephalus Day

Here from the world epicenter . . .

Our hospital has attracted top neurosurgical services, which is a good thing, because the incidence of these two problems is something like 100 times higher in East Africa than in places like America where most neurosurgeons like to live.  Yesterday in chapel our very own Dr. Okechi spoke about the causes and treatment of spina bifida (an opening of the spine exposing the nerves in the back, which happens early in fetal development and requires surgical closure shortly after birth before infection sets in, and even with good care leaves a child with some paralysis of the legs, difficulty with bladder and bowel function) and hydrocephalus (collections of fluid in and around the brain, found in about 80% of the kids with spina bifida, as well as occurring due to scar tissue after meningitis, and requiring a tube to shunt the fluid off into the abdomen).

But the real highlight of the morning was the panel of former patients.  Three had been operated on by Dr. Dick Bransford the pioneering surgeon with a heart for special-needs kids here at Kijabe back in the early 90's (making them about Luke's age or a few years older).  One now writes computer programs and works in IT, the second is in nursing school here at Kijabe, and the third has a bachelor's degree and a good job.  A fourth woman spoke who did not get surgery until later in childhood, but is now a Paralympic basketball star from Kenya.

They are pioneers themselves, showing their families and the world that they could overcome such severe challenges to reach places in life that few of their "able" bodied contemporaries manage.  Courage, vision, and a sense of grace and gratefulness permeated their speeches.

I confess I sometimes feel discouraged by the nearly daily appearance of another baby with a big spongy head, an infected brain, atrophied legs.  It was good for me to see the 20-years-later picture of hope.  And to remember that Jesus cares so much about the kind of kids that the rest of the world would hide away (or abort) that he's uprooted people like Dr. Leland and Susan Albright to come all this way to care for them, and trained people like Dr. Humphrey Okechi and Dr. Njiru and Dr. Nunthasiri and nurses like Janet and chaplains like Mercy and dozens of others to pour their lives into making a way for these children to live and grow and thrive.

The Birthday Girl

Patience.  All two months and 1400 grams of her.  See post below.