Thanks for board exam prayers...

For seven hours yesterday, I stared at a computer screen, squirmed in my chair, tried to block out the incessant clicking of neighboring keyboards - and answered medical questions at the incessant rate of one per minute.  I know a lot of medicine.  I answered questions ranging from rabies to rashes to radiology, from newborns to geriatrics, from psychiatry to sarcoidosis.  And by the end, I was spent.

But today, I want to take a moment to give thanks.
I'm thankful I was healthy, focused, rested, well-fed.
I'm thankful there is an international computerized testing center in Nairobi.
I'm thankful for the prayers of many friends.

And on the way home I saw a spectacular rainbow, reminding me of God's covenant promises, of His love and faithfulness.  And it made this little exam pale in comparison...

Ten Facts on a Tuesday

A few emails and comments have alerted me to the fact that I often fail to give follow-ups after asking for prayer.  So here are the answers to a couple questions today, and some bonus points as well:

1.  Scott lived through the strenuous and stressful exam.  He won't know if he passed for two more months.  It was exhausting.  Thanks for praying.
2.  More importantly, Dr. Travis Johnson finished all his chemo and last week he had the great news of a clear CT scan.  We are so thankful for the flood of prayers that carried his family through the last six months of nausea, weakness, and the stark reality of risk.  He is now a cancer survivor, which means for the next five years he will be closely monitored.  But all is well.
3.  Our Burundi Team finally arrived in Kibuye last weekend.  After two years working together in Kenya, meeting with WHM and deciding on Burundi, applying, raising support, packing containers, speaking, traveling, then nearly a year together in France for French study and three months in another area of Burundi for Kirundi study . . . drumroll . . . they have moved into the village where they will staff a hospital and teach medical students.  Do pray for them to establish strong relationships and healthy boundaries as they work on house construction supervision, and plan to begin full time medical work in January.  Meanwhile the Bonds are studying French and recruiting for the Bujumbura branch of this work.
4.  Caleb continues to need healing for his knee injury, but with admirable spirit plows on.  He has to pass a swimming exam today which with enough tape and pain tolerance he hopes he can do.  Luke has applications in to about a dozen or more med schools, so you can pray for God's provision and guidance in that process.
5.  Our South Sudan Team is dispersing for rest and home ministry soon, and we continue to pray that the Massos will have the support they need to return in January, and that God will raise up new leaders and new team members to bless the people of Mundri.
6.  New team members on the Bundi team have survived a disease-ridden first couple of months, and eagerly await the next influx of colleagues.  The spiritual and physical battles there never let up.  Pat in Fort Portal could not get travel visas to the US for the two young orphan girls she has guardianship of so needs prayer for wisdom and perseverance as she faithfully continues to serve without the benefit of that break.
7.  Josh and Anna Dickenson were wed, and true love is in the air elsewhere, so keep tuned for more announcements.
8.  Bethany agreed to RVA's request that she extend her counseling ministry from 3 months to 2 years, hooray.  The Maras are hosting a team of photographers to connect the church to the work of Kijabe hospital, and working through difficult issues with inadequate staff in the orthopedic department.
9.  In Nairobi, our team continues to reach out to the community accused of the Westgate attack and the community of the victims.  This team is focused on language learning right now and could use prayer for Swahili to flow.
10.  To make a complete top ten, we thank God for the spiritual hunger among students here at RVA and especially our own.  And we are thankful for fellowship and community in spite of demanding, challenging, unending work at Kijabe Hospital.

PRAYING TO PASS

Perhaps the best analogy would be the Red Sea blocking one's exit, with murderous armies behind and the Promised Land distant and inaccessible.

On Monday Scott has to sit for an all-day 8 to 5 Family Medicine recertification exam.  He'll drive into Nairobi today to stay at a hotel near the Prometrics computerized testing center.  The last one he took was ten years ago.  He is a fantastic physician, can save your life and cure your malaria, manage your ventilator and life support, treat your diabetes or hypertension, deliver your baby by Caesarean section or suture your wounds.  But he hasn't ever touched the last fifteen new variations of diabetes medicines, and he thinks in tropical medicine differentials more than in obesity and over-indulgent lifestyle differentials.  After two decades practicing medicine where most of the world's needs occur, our skills sets have diverged from the US standards.  For the last few days he's been at his desk, working through a practice test that is designed for fresh-out-of-residency young doctors, and trying to read up and prepare.  Family Medicine is a fantastically broad area of expertise, and ten years is a long time since taking this test.  The questions are intensely specific and tricky.  He is sensing the impassable sea.

Would you please pray for him in your congregations on Sunday, and as you think of it on Monday?  Pray that he would not fear defeat, that a way would open, that he would call to mind the thousands of facts that are in his brain, that he would see God's mercy leading him to pass.

Pray that God's glory would be shown in allowing him (and soon me in Paeds) to maintain licensure as we serve here in Kijabe, Kenya.

(And you can pray for us too, I'm on call today and tomorrow and working pretty intensely these days, so a ripple of single-parent-time is not without stress too.)

Thousand Dollar Baby

What would you pay to save this baby's life?  A thousand dollars sounds pretty steep in Kenya, more than the annual per capita GDP, but a drop in the bucket many places.  She was born prematurely, and survived for a couple weeks in a local hospital.  But as the days wore on she became sicker and sicker, and when her twin died, her distraught parents scooped her up and got in a taxi to Kijabe.  She arrived on death's doorstep.  I got the call in nursery as I was walking out the door that there was a baby in MCH clinic, did we have an incubator?  No, I said, we'll have to send her on to Kenyatta.  We were running at 150% or more of capacity and taking on another baby would compromise the survival of those we already had.  

But as the visiting resident who was staffing the clinic worked on carrying out the plan we had made over the phone, she called back to ask some questions about the logistics of an ambulance.  These parents had nothing with which to pay for one.  I was at the end of a stressful day and scrambling to get dinner for guests.  THANK GOD it was one of those times the Spirit just kept me unsettled.  I had no peace about the decision to send this baby on to the national hospital.  It sounded like she would die on the way.  So I called the resident back with a plan to squeeze her in without an isolette, using a crib and a heater, and hope for the best.  I can't explain the internal battle but I knew we were supposed to keep this baby. 

That weekend she became much worse, and my colleagues took her to the ICU.  I thought it was hopeless.  She was on life support for six days, battling a nearly fatal and overwhelming infection.  We fought back with the strongest antibiotics, and the kind of medicine and monitoring only available a few places in Africa.  This little twin, a deep green color of jaundice, skinny and losing her grip on life, pale and with barely the strength to keep her heart going even when we took over the breathing, teetered on the brink for a week.  But day by day her vital signs became more stable.  My team was fighting to save this one, particularly as a twin when the other had died.  They had more hope than I did.

Eventually she came back down to the nursery, and we gently helped her get to the point of feeding, and then of breathing without any oxygen.  Today she's going home, having reached normal newborn size after almost a month of life.  

She is cured.

Her parents' national insurance card payed about a third of the bill, and they were able to bring about $250 which is 3-4 months' salary for the average citizen.  That left about $1000 still to be paid.  

Thanks to several recent generous donations, our Kijabe Hospital Needy Children's Fund was able to step in and pay the bill.  Which means that baby M can go home with her mother, who was a hair's breadth away from total bereavement.  Which means that we can sustain low cost care and offer the same services to the next baby.  

Though this is only a thousandth of the million-dollar-baby story . . the themes are similar, only our story has a happier ending:  a fight against the odds, an initial reluctance, a growing wonder, the beauty of strangers growing in relationship, victories, redemption, dilemmas, and loss.  Thanks to all who helped baby M survive, and pray that we can stay in the ring for the next one and the one after that.  We get beat up pretty often.  But today we're celebrating a victory.

Acacia's Sweet 16

We've known Acacia since she was a positive pregnancy test in Bundibugyo.
And gotten to know her very very well as she's lived with us for the last two and a half years - while her parents, Michael and Karen, have carried on with the leadership of the South Sudan Team. We usually introduce her as "our daughter" when meeting new people here at Kijabe.  Nobody blinks because she blends into our family perfectly.  She's the sister that Julia never had and the "other sister" that Jack needed.

Today Acacia turns 16.
Karen sent the "Sweet 16" birthday sash and told her she "double-dog dared her to wear it."  Well, Acacia is courageous and bold, so off to school she went in the prom-like sash.  She's a sport.

Michael sent these "A" words to describe Acacia on her birthday
Artistic

Athletic

Academic

Attractive

Attentive

Affectionate

Affirming

Affable

Agreeable

Adaptable

Alegra (Spanish for happy)

Autumnal

American-

African

Adorable

Awesome

She is indeed all those things and more.

Today we thank God for Acacia and say

Amen.

Surviving the Week

No small mercy.
And in fact, our sermon this morning on Rom 12:1,2 reminded us that all our living sacrifice is in view of God's mercy.
So let's look back at the mercies new and old and daily and continuous.

Shared Parenting

Karen and Liana drove from Philadelphia to Downington to see Luke play soccer this weekend.  We had a dozen kids for lunch Thursday and another ten for "second dinner" and El Classico last night.  It is a privilege to be here with other peoples' kids, and even more to have other people bless ours.

Babies

The nursery remains packed.  Two small preemies have died this month, but so far everyone else is pulling through.  I am thankful for slowly settling jaundice, slowly plumping weights, slowly resolving leaks.  I am thankful for the doctors I work with.  For the nurses we can rely upon.  For the mothers who feed these tiny ones every two hours day and night.

Needy Children's Fund

Ten people have pledged to the fund in the last few weeks, which has moved us from a deficit to be able to help more.  We paid for three doses of surfactant for the tiny baby who ended up dying.  Anyone medical can see from this xray it was not enough.  But there is an element of comfort in knowing you did all you could for your child, without regard to funds, even if in the end the baby dies.  Maybe ESPECIALLY if in the end the baby dies.

On the other hand, Baby S is moving through his second month of recovery from esophogeal atresia and tracheoesophogeal fistula.  He's had weeks in the ICU, several surgeries, too many chest tubes, IV nutrition, and in general our highest level of care.  He's emerging but not quite out of the woods.  His mom told me her bill is almost $4000 already and will be higher, and she is hoping for some help from our fund.  She has been an inspiring stalwart of faith, comforting others throughout his stay. And she firmly believes the cost is well worth the result! I told her we would help, as will the BKKH surgical team.  

One day a couple weeks ago Baby M's family showed up with this little yellow, shriveled wisp, who was the only surviving twin born at a nearby hospital weeks before. We were out of incubator space so when the outpatient nurse called to ask if we had space for her, I said no, refer her on to Kenyatta, the national hospital.  Then I felt no peace, and after praying decided on a way we could accommodate her with a heated isolation room . . my team pulled her through a few days of septic shock and ICU care.  Now she's nearly ready to go home.  She is striking a pensive pose in the picture below.  I'm so thankful God didn't let me send her away.

Family Times

God's great mercy to us is that we live a few steps away from the activities of three kids.  This week I caught one of Acacia's Titchie (elementary) soccer games--she's the coach, many of her players are our neighbors, and it was great fun to watch them play.  Wednesday we traveled into Nairobi for games and Saturday we slipped up between patient duties to see Julia play tennis and Jack soccer (football).  Julia was the only girl in the entire tournament and played with skill, and more importantly JOY.  Jack's team did quite well; Jack scored the first goal of the tournament and set up the last with his free kick that was headed in.  The team lost in the finals, but won an exciting semi-final in penalty kicks - and finished second out of  8 teams there.  Julia's choral group led worship today; it is an honor choir for Seniors only and focuses on discipleship and service.  

I lead a Sunday School with friend and colleague Bethany Ferguson that Julia and Acacia attend as well.  These times are mercies because we love seeing our kids doing the kind of things they were created to thrive in:  sports, coaching, singing, friendships, spiritual growth.  But they are also a mercy because community is built around them.  With each passing month I am more and more thankful for the depth and breadth of relationship here.

What a WORLD

Monday was a Kenyan holiday, and RVA celebrated with "Multicultural Day" in which the nearly 30 nationalities represented in the student body are recognized. The kids have a day of games, food, and learning about the world.  Scott ran in a 5K where he more than held his own with the 20 and 30-something crowd.  The day is a reminder of God's diversity reflected in culture.

Thankful for another week survived, with moments of grace.

Wonderful Wealth

"Dear George, remember no man is a failure who has friends. Thanks for the wings, Love Clarence."

After another exhausting night, as the kids went out the door to school this morning, the dreaded 7:30 am text that one of our patients has deteriorated even more and is landing in the ICU.  As I grab my coat and stethoscope and rush to the hospital I text the group of women I would normally pray with at 8 on Tuesday mornings, saying I'm unlikely to make it.  It takes the next 1 1/2 hours to sort out the neurosurgical baby who is crashing and I don't get her intubated until my second attempt.  Meanwhile my week-old patient in another ICU bed takes a turn for the worse, and our longest-term babies in nursery all have acute flares of chronic problems.  I've had three hours of sleep max, and one mom kindly smiles at me as I give her a detailed report on the wrong baby.  My heart was till reeling from a criticism the night before, and aching from several hours of work on trying to arrange Christmas plane tickets and wrest adequate call coverage out of a very lean horizon.  not quite as desperate as George Bailey, but not exactly A-OK either.  

But today turned into a a great day, because of the kindness of friends.  One who let me vent safely, providing a filter before I said things I shouldn't elsewhere, and didn't make me feel bad about it.  Another who let me get out early and walk my dogs in the breeze and sunshine of the late afternoon.  Another who dropped off two culinary delights, and stayed to chat.  Another who just sent a text about a patient saying she is praying for me and told me not to take the burden too hard.  All of these are women I have met in the last couple years working here.  And that reminds me that though this is a community with its own issues and failings made up of sinners like me, it is a community that has a richness of kindness which flows to my soul.

It is only in the press of the struggle that we really appreciate the wealth of friendship.  So here's to a good day, and a wonderful life.

Psalm 107: An open letter to dispersed TCk's

And to us, their parents.

Because we are the redeemed, gathered from the east and the west, the north and the south.  Redeemed does not mean we are holy, yet, or special, or immune, just that we received mercy (vs. 1-3).  This is good news.

This Psalm describes the scattered people of Israel in four word-pictures or analogies.  Read along.

They wandered in the wilderness.  I sense that sometimes our college TCK's feel like they are in the wilderness, faint and distressed.  Familiar sights, sounds, foods, friends are hard to come by.  The environment can be harshly indifferent or outright hostile. Directions seem vague and circuitous.  It's easy to get lost. Or to be lonely.  My soul's been a bit faint lately, too, stretched too thin, missing familiarity and ease.  But Jesus went willingly into the wilderness, parched and starving, He faced it on our behalf, alone, worn down, and attacked by the Enemy.  Which enabled Him to be the Way, to bring us all through this journey to the City where we will finally be home, soul-satisfied, filled. (vs. 4-9).

Those who sat in darkness and in the shadow of death, bound in affliction and irons . . . Perhaps that sounds like a bit of a melodramatic description of college or a constricting job.  But there are nights of labor and semesters that seem to drag one down.  There are requirements imposed.  Sometimes failure and discouragement.  I felt the shadow of death last night too, tied by my beeper to the halls of the hospital, sitting on a rough wooden bench as a bereaved mother collapsed in my arms, as I tried to gently break the news that the last hour of trying to resuscitate her baby had failed.  Not once, but twice, I prayed over the lifeless bodies and the wailing mothers.  Jesus walked right into captivity, into more than the shadow of death, but death itself.  Which enabled Him to break those chains and become light and life in a palpable, forever-way, for us.  (vs. 10-16)

Fools, because of their transgression, and because of their iniquities, were afflicted.  This is about the need for healing.  For physical energy, for the knitting back together of torn ligaments and broken bones, the relief from nasty colds and dangerous infections. Clearly not all sickness is a result of transgression and iniquity.  But some of our weariness and illness stems from our own bad choices.  Wrong risks or relationships.  My achilles tendons are stiff knots of pain because I don't rest and stretch them enough to heal; yet the rest of my body is winded and flabby because I don't exercise enough to be strong (classic catch-22).  I slept 3 hours (not consecutively) last night, not completely my choice but partially.  Misery all around.  Perhaps it sounds harsh to even relate suffering to sin, but the fact is this makes the good news even better.  Jesus, we are told in Is 53, was wounded for our transgressions, was bruised for our iniquities.  Which enables Him to heal us even when it's our own fault that we're in the situation that needs healing or rescue.  We don't have to deserve it, we can just cry out. (vs. 17-22).

Those who go down to the sea in ships, who do business on great waters . . see a lot of chaos, danger, and challenge, and reach their wit's end, literally "their wisdom is swallowed up."  As TCK's move into the world to do business or to compete academically, they see some hard stuff.  The sea was traditionally considered the territory of hostile forces.  Our kids are getting tossed around, and their souls are in danger of melt-down.  Some days I feel like waves of crisis are pounding and throwing me from one ward to the other, and I am going to drown.  But Jesus rode out the storm on the sea, and made the waves and winds obey.  Which enables him to say "fear not" with authority.  Those aren't just pep-talk words, those are logical injunctions to remind us that He is there in the storm with the plan to calmly lead us to a safe haven when we really need it. (vs. 23-32).

The rest of the Psalm reminds us that we are living in the Kingdom of the Great Reverser.  The universe where water springs from the desert and the poor become princes; alternatively where a river can disappear and iniquity be silenced.   Where grad schools and colleges can choose you even if you know ten smarter people in your dorm alone; where the money can come through even when you're broke; where you can be visited by a dear friend or parent even if the person is ten thousand miles away; where you can meet your true love even when you feel completely alone.  Because our God works on the principles of mercy and lovingkindness, on absolute good, even when evil looks too strong.

It was hard enough to grow up as an outsider in your country of residence, then to go back to your passport country and find out you don't really belong there either.  But this life stage where we are scattered makes all of that even more difficult.  So go to Psalm 107, written for exiled hearts, and see the goodness of God for you.

Lamenting Bureaucracy, and the woes of living in a corrupt country

Julia has been rejected by the SAT.

Because we live in Kenya, and Kenya is one of the most corrupt countries in the world, it is no small feat to register for standardized tests.

Instead of the on-line registration that the rest of the world does, students in Kenya must fill out the archaic bubble forms of our youth which have to be validated by the school and sent by snail mail. And RVA students only have a few options per year for fitting in the tests.   Julia wanted to take the SAT a second time, as do most serious students, having taken it the first time way back in January and the subject tests in May (the only two options she had).  She wanted to take round two of the general SAT in November so that the schools she is applying to would see the results, especially her early decision option.

 So in early September she filled out the tedious form.  We checked it over.  The guidance office checked it over.  Probably five people looked to be sure the form was filled correctly.  32 students sent their forms in; and 31 were registered.  Not Julia, because it turns out that on the fee waiver section (because we qualify for aid) there was one bubble that was left empty.

For the sake of that one empty bubble, she can not take the SAT.

Even though any logic would confirm that she is not a fraud, that multiple adults failed to catch the missing mark, that the school totally vouches for her, that the essential info was all correct and we would much rather pay for the test and skip the fee waiver than have her disqualified, that anyone can make a mistake . . with the SAT and the fear of Kenyan con men, no second chance.

In fact it is so absurd that we just have to say that this is like Elijah pouring water on the wood, or Gideon asking for the fleece to be wet one night and dry the other.  Only God can open her path to the university He wants her to attend, and He can do that with or without a second go at the SAT.

So pray for the process to be one of faith and of goodness following her all the days of her life, bubble or no bubble.

Creaky Cottage

There is a degree to which a true vacation of the soul requires a spot that reflects one’s childhood places of joy, and for this reason the Trout Tree’s Creaky Cottage is a respite for me.  Surrounded by forest and serenaded by a fast-flowing brook which curves around three sides of the property, quirky construction with logs and a porch, in the highlands of Mt. Kenya, it reminds me of West Virginia.  Scott found the advertisement on the internet and called to confirm a vacancy, and otherwise in our hectic lives we did zero preparation before noon Friday when the kids came home from school for their midterm break and we from work and we all threw clothes into bags and food into the cooler and everything into the car and set off about 2 pm.

Almost four hours of traffic and are-we-there-yet later, watching craggy snow-graced peaks of Mt Kenya in occasional partings of the high clouds, we pulled into the deserted restaurant which is the main purpose of the property.  Turns out it’s only open for lunch.  Good thing we had packed plenty of food . . . the workers on the trout farm directed us past dozens of circular ponds fed by a diversion scheme of flowing water.  At the far corner of the property we passed on foot through a little gate, and saw the cottage.  It was constructed around a tree, which still grows right up through the middle.  There is not a level surface in the whole place, and the low ceilings, brick floors, fireplace and glass-paned windows could be right out of a set for Hobbiton.  Julia and Acacia climbed a ladder to a loft with twin beds, Jack had his own double bed on the ground floor, and Scott and I had a king-sized bed at the top of rickety stairs that looked over the porch towards the stream.  We cooked dinner and soaked in the peace and soothing, quiet, background flow of the stream.

Well, mostly quiet.  The roof is intermittently stormed by troupes of Sykes monkeys or Colobus, and the tree hyraxes make shattering screams in the night or waddle around like R.O.U.S’s in the daytime. 

Two kids are in the throes of Junior Year, with multiple AP classes and sports and activities.  One is in the midst of Senior Year with College apps.  I increased my work time by about 25% when my partner-colleague followed her husband to South Africa for a year, and then by 50% again when my other colleague was pinned down to bedrest for preterm labor a couple of weeks ago.  I had worked the last two weekends and my last call had me up from 2-4 with a dying post-op patient, followed by Scott’s dying patient from 4:30-5:30.  We are both scraping for time to support teams, work on call schedules, prepare lectures.  In the last week I have also been emailing back and forth with Luke trying to help him edit umpteen essays for about a dozen med school apps.  We’ve had company, hosting residents, teaching Sunday school . . . in short, our family is exhausted.  Our kids wanted a midterm break that was RESTFUL. 

And this was just what we needed.  The first morning, as we emerged from sleep, Scott looked at his watch.  9:45.  The last time I slept that late was probably our anniversary week over a year ago.  We unplugged.  Read books.  Listened to music.  Watched “Lost”.  Cooked meals and ate by candlelight.  Basked in sunshine.  Prayed.

We did spend one of our two afternoons hiking a barely discernible train inside a little-accessed area on the slopes of Mt Kenya, which was a glorious six miles of forest and quiet.  A few worrisome buffalo and elephant signs, but no dangerous animals (though there were dangerous PLANTS).

This would not be the spot for everyone.  It’s rustic and dusty and quaint.  There is not much to “do”.  The cost is more reasonable than many options for families but not as cheap as camping; on the other hand everyone got their own bed.  You still have to plan your meals and do your dishes. 

But for us, the Creaky Cottage matched a deep chord:  erratic and unique, shady and isolated, breeze and water and sky, time to connect with each other and God.