A billion sparks

When Mary starts to understand what is happening in her body, in Luke 1, she gets a glimpse of the impossible. Life growing supernaturally.  God-with-us as a fetus.  A world-changing infant.  In her song she anticipates the scattering of the proud, and conversely the exaltation of the humble and the filling of the hungry.

The Advent message always includes this inversion, this against-the-odds outcome that blows away the categories the world assigns.

In this context, I can't help but to keep thinking of the Kenyans murdered in Mandera.  They were the poorest.  People don't live under tarps in a rock quarry on the border of an enemy land breaking rocks by hand into gravel unless they have no other options.  Advent gives hope that these people, whose earthly lives were short and bleak in many ways and ended in unspeakable horror, will be honored in Heaven.

And the Queen of Heaven just may be a mom who I also can't get off my mind.  A couple weeks ago we admitted a tiny jaundiced hungry baby.  Some responsible citizens had organized and brought the baby and his mother to the hospital.  Baby W ended up admitted to the ICU as he battled serious overwhelming bacterial infections in his blood and urine.  We actually seemed to be clearing the infections, but his liver was failing.  What made his situation so desperate was that his mother was mentally retarded, and lived with her own mentally retarded mother.  Which is why neighbors had to band together to bring them for care.  She was able to feed and hold him when told to do so, but in a better world would have been in a group home with careful supervision.  Instead she was probably raped, and became pregnant, with zero social support or capacity.  When Baby W was dying one Saturday morning as I came in for rounds, she was sitting by his bedside, seemingly unaware.  I asked the chaplain to come up and meet with us, and tried to explain the situation to her.  I suppose I expected that this was a bitter best, the kind of death that saves untold future suffering, the early end of a life that was doomed from the start.  And I did not think Mama W would comprehend the finality of his death.

Was I ever wrong.  I think her wracking sobs as she held his little lifeless body and said goodbye were perhaps the saddest thing I've ever seen.

She had next to nothing in this world, and she lost the only thing she had to love, the only love she was getting back, her baby.  Her IQ may have been quite low but her emotional intelligence was perfectly able to grasp her loss.  I didn't know what to say, or how to say it, so I just put my arms around her and shed some tears too.  Then came home and completely lost it.

Bludgeoned rock-breakers, and a broken woman in grief.  These are the people for whom Advent is more than cookies and carols.  Advent is survival, is hope, is an eternity where wrongs turn to right.  Advent brings the billions sparks of life that are the people of Africa and floods the cosmos with their light.

Glory

The lower-station families at Kijabe have started a tradition of a half-hour evening Advent activity, for as many nights in the month as there are willing hosts.  The first was at our house tonight, and our theme was the Glory of the LORD Shall be Revealed, from Isaiah 40 and the Messiah.

We read scriptures from Exodus 24 and 40, 2 Chronicles 7, Luke 2, and Revelation 21, as the kids drew a timeline with symbolic pictures for each place where God's glory was seen.  The mountaintop of Sinai, in clouds and thunder.  The tabernacle and then the temple, in bright shining dense light, overwhelming, driving out the celebrants, a presence by day and night.  The angel host startling the shepherds, announcing God's glory encased in a baby in a manger.  And then the final repository of glory, revealed to all flesh:  the City of God, the New Jerusalem, where precious gems glisten from walls and all is light.  All of these manifestations of glory were irrefutable to the observers.  Anyone present could see them, and they left no ambiguity, no doubt.

But I had the kids leave a space between the Luke 2 angel chorus and the Revelation city.

The space we live in now.

Where glory is obscure.  Hidden.  Not overwhelmingly obvious to all flesh.

Then we read one of my FAVORITE Christmas books, Papa Panov's Special Day.  In this story Leo Tolstoy tells of a humble shoemaker, and in his age and loneliness one Christmas Eve he hears a voice telling him that Jesus will visit the next day.  He looks eagerly for Jesus in all the people on the street, and in his impatience to find Him the cobbler is reluctant to invite the cold and poor street-sweeper in for soup, or the ostracized single mother begging for rent.  But as Christmas day ends, his disappointment in not seeing Jesus is transformed to peace when he realizes that Jesus exists in the "least of these".

So the glory is veiled, and to find it we have to search the highways and byways, we have to talk to the poor, invite them in, serve and love.

The kids went back and drew people in that 5th space, then we glued a small piece of fabric, a veil they had to lift to see that picture.

This advent, lift the veil.  Look for Jesus in those least noticed by the world.  Find glory broken up and diffused into a billion sparks.  

Longing presupposes Lack. Or Advent thoughts after the Mandera quarry massacre.

Advent season is upon us.  I revel in the decorations we have been putting up in the middle of Africa for two decades, the Messiah playing on an ipod, the cheery fire crackling as Kenya’s delayed rainy season seems to have arrived with intent to pour down two months’ worth of rain in two days.  The Advent calendars are hung, and candles lit.

But Advent is not, first and foremost, a season of ribbons and light.  It is the season of longing, waiting, expecting, preparing.  And longing implies a lack of that for which we long:

Peace on Earth, because the world is now at war.

Light, because the darkness presses. 

Reunion, because we are fractured and lonely.

All things made new, because they are so, so, broken.

In Advent we do not gloss over the chaos and darkness and evil.  They are the context of coming. 

Here in a land where terrorists attacked a bus last week and brutally shot 28 people, then attacked quarry workers in their tents shooting 32 and beheading 4 of them this morning, where we admit children spindly with malnutrition, where in the last week we lost a 4-year-old to TB and had a teenager in the ICU with previously unrecognized AIDS . .

In such a land, watching for the coming of the King is a matter of life and death.

So we begin Advent fully acknowledging the swirling sea of darkness, blood, tears.

We light a candle, a small circle of light, the beginning of victory.

Note:  Here’s what we’re reading this advent

Comfort Ye My People (Bruner) (link here)

Preparing for Christmas (Rohr) (link here) 

Following the Star, online daily devotion from d365 http://d365.org/devotions/

A desert of hope

For the last week I had the rare opportunity to travel to an area of Africa that is recovering from civil war and both witness and participate in the rebuilding of a nation.  Great stuff.  I could write volumes but if I do I won't be invited back, so I'll just give some vague and general observations.

Jesus said, "You have heard that it was said, 'You shall love your neighbor and hate your enemy.'  But I say to you, love your enemies and pray for those who persecute you, so that you may be sons of your Father who is in heaven.  For he makes his sun rise on the evil and on the good, and sends rain on the just and on the unjust. . . ."

Scene One:  Eating dinner late one evening, six chairs pulled up around a small round table, goat and rice and chips and chicken, I look around.  Four nations, all of whom have reason to distrust one another due to past injustice and acts of terrorism.  But in that moment we are humans only. We share stories, childhoods, dreams, hard work, ambitions, hunger and joy.  It is all to easy to think of any category of people as dangerous, or different.  The remedy is to meet one on one. This is what the Kingdom will be like.


Scene Two:  Straining to understand a language that seems to be English only all the consonants are pronounced differently, I listen to a Family Medicine Resident present a patient.  I am doing rounds with the only post-graduate trainees in the country, teaching about fluids and apnea and feeding and infections and all the familiar (to me) nuances of pushing down the appalling 10% infant and 10% maternal mortality in this place.


Scene Three:  Fifty 5th year medical students crowd into the classroom, and I lead them through and evidence-based approach to child survival interventions, question them on a differential diagnosis of chronic cough, draw a 4x4 table to explain the concepts of a test's positive predictive value.  The brightest is a girl seated to the side with the few female students, veiled, but whenever I meet her eyes I see she gets it.  This is the hope of the future.  These are the people who will decide policies, promote public health, perform surgeries, comfort the dying.  They are the only resource of this desert, human potential, the sheer will upon which development will build.


Scene Four:  This one was the most surreal.  After a week of solid work, we take a late afternoon off to climb (with an armed escort of course) a hill that overlooks the town.  Half-way up a little girl who is outwardly indistinguishable from the cohort of her scampering cousins sits by the side of the steep rocky path.  "You speak English?!" she pipes up in a shockingly American accent.  J is 12, back from California on a visit to her maternal relatives, a bit unnerved by the heat and dust and unfamiliarity.  She takes my hand like a lifeline and we climb together.  Welcoming, educating, loving the nations as they pour into America yields trust and makes the world a smaller place.

Scene Five:  A little girl whose requisite conservative dress includes a long flowing flammable polyester dress gets too close to the open cooking fire, and goes up in flames.  We don't see her until five days later when she is severely dehydrated, in respiratory distress, minimally conscious.  The polyester melts into her skin and the burns are deep.  In spite of careful dressing and a line and fluids and antibiotics and oxygen, she does not survive.  The last half hour I lean over her bed with a bag-valve-mask I found on a shelf, and keep her breaths coming and heart beating, but I know we have lost the battle.  I am frustrated that unlike Kijabe, I can't talk to the family and comfort them as I am used to.  I don't have an ICU with a ventilator and pressors.  This is a preventable, tragic death.  Someone looking for the next public health campaign:  flame-resistant fabrics in all countries where girls both have to cook and cover themselves at age 6.



This country is a paradox of rubble and hope, of harsh sun and cold night, of burgeoning new universities and extreme poverty.  I am thankful to have been the recipient of their hospitality, and to have been a tiny part of the sun rising and rain falling.

Thanksgiving thoughts

This may have been the first time in my life I was completely away from any family and any semblance of Thanksgiving.  More on that when I get back, but for now let me reflect on thankfulness.  Everyone is thankful for their families, but never so much as when your only contact is a hasty minute or two on the phone because you're in a country where you're not sure who is listening or where/how you can get more airtime.  I am thankful that persistent friends woke one of our kids up for an early flight to the West Coast when her phone malfunctioned.  I am thankful that all three USA kids are with Scott's parents in CA, being stuffed like proverbial turkeys by Nana's amazing cooking, and riding bikes along the ocean to refresh their weary souls.  I am thankful that our Serge team in Kijabe took in Scott and Jack for a true celebration with friends from multiple countries.  I am thankful for a creative-cook of a husband who made this brick-oven turkey even though I didn't get to eat it (and who has effectively become the primary responsible adult in our household over the last couple months with my travel and work making me less and less functional).  I am thankful for my family-of-origin being together in West Virginia in spite of snowy roads.

But for this post let me be thankful for something else, with thoughts spurred on by the great philosophical movie, Two Guns.  We watched it on our TV service, which means about 20% was blipped out, but there is a scene in the middle where the two main characters are sitting in a bar.  Mark Wahlberg gives a speech on "why we fight", and it is for the guy next to you, your colleague and comrade who is with you in the struggle.

So today I am thankful for my Paeds team at Kijabe.  As of this week, we are fully staffed for the first time ever, as Dr. Arianna began work officially on Monday. Four full-time paediatricians, augmented by one short-term and two once-a-week part-timers.  Last week was a doozy, with one person out for a death, another on leave, and several other issues pulling us in multiple directions, as is generally the case. Yet as I walked back and forth on the familiar path to the hospital, juggling critically ill intubated patients with uncertain diagnoses, talking to families who were resistant to care, making hard calls on a baby whom we had resuscitated over and over, the usual, things that could easily drag one down, I was surprisingly unfazed.  I realized with gratefulness that in all these situations and more, I am working with a great team.  We approach patients with the same level of concern and dedication, we have a compatible framework for decision-making.  We pitch in for each other.  We are friends.

This was one of our primary goals coming out of our longterm planning retreat--strengthening team relationship is the essence of staying power.

So a tribute today to the Paeds team, whom I am missing, and the beauty of community in life and work.

There and back and there again . . .

November somehow became a month on the move.  I (Jennifer) was asked by our Serge leadership back in August to attend a first-ever "Vision Summit" for our mission, an event designed to honor and draw in donors as we clarified our vision and described our work.  A lot of work was invested in making this a professional-quality presentation.  Serge uses three pillars to explain what we do:  Renew, Reach, Restore.  Renew encompasses the Sonship course, Gospel-Centered Life, and the plethora of resources for personal discipleship and Bible study that propel our hearts to come alongside the work of Jesus in the world.  Reach incorporates the extension of this Gospel-focused transformation from the lives of believers to neighbors and friends across cultural barriers all over the world.  And Restore embraces the full-person whole-world nature of the way Jesus is making all things new, including partnering in health care, education, rescue from slavery, job provision, agriculture, training indigenous leadership.

So last week found me on the Florida coast with dozens of supporters, board members, our executive leadership, and a few other missionaries, worshiping together and giving speeches and watching videos that represented these three pillars using examples from Serge work.  I was the "Restore" speaker, and while I loved writing the speech I was pretty nervous about giving it.  I'm told it went OK.

A huge perk for me was that my mom had been invited, so we got to spend several days together at a lovely hotel, and we decided to fly Julia down for two nights so I could catch up with her too.  Julia and I took a beach walk and a bike ride in our free time, and we all enjoyed just talking and eating together.

I left here on a Monday night after work, arrived Tuesday evening in America, conference prep and rehearsal on Weds, conference Thursday to Sunday.  I flew out of America Sunday afternoon and got back this Monday night and went back to work on Tuesday, facing a week with staffing shortage, a Tues/Thurs call sequence, and a lot to do.  It was what you might call a whirlwind.  So I have to give the testimony that God gave me grace to jump into the time zone and the work both ways.  I have never traveled so easily, and been so quickly functional.  I slept and woke on the right time zone immediately both ways.  It was amazing.  I'm not recommending this but if you have to do it, miracles can happen.

Meanwhile Scott had a birthday in which he delivered four "birthday buddy" babies by C-section then went to a dinner that was hosted by our wonderful Serge team here, held down the fort, taught Sunday School and hosted the boys' football (soccer) team end-of-season pizza-fest all on his own, while working full time.  Jack got the news that he was a National Merit Scholar which I found out when I noticed a card tucked in behind a picture on the mantle . . and continues to work on college apps here and there as the deadlines loom.

But November is not quite over, and another trip starts tonight for me.  This one is in my same time zone, but a couple countries away.  Kijabe Hospital doctors make about four trips/year into this area that is poorly served medically and difficult for outsiders to access. Most of the trips are surgical, but they asked a Pediatrician to join this one.  As this trip came together it became clear that the only one on our team who could possibly go was me.  So tonight I head towards the airport, joining two young Kenyan surgeons.  I'll be teaching all week (family medicine residents and medical students) and seeing patients in a rural hospital.  I'm not quite sure what to expect, and I have to dress extremely conservatively including head scarves, so prayers appreciated.  Renew, Reach, Restore is what we're all about here, and I'd rather do it than talk about it, but I'm nervous.  And pray for Scott and Jack, abandoned once again, with me missing Thanksgiving and the last week of the school term with exams.  Grateful for your partnership . . . Jennifer

The Inefficiency of Love

I survive on efficiency.  Multitasking, prioritizing, keeping balls spinning in multiple spheres.  Up until 4 am?  Working all day?  Dinner for 10?  Parent with a sick kid asking for help?  That's how it goes.  As in, literally, yesterday.  Which is, I suppose, a form of love.

But there is a certain inefficiency to love that interrupts, that doesn't add up, that has its own beauty.

As in, literally, the Christmas Package.

Yes, every year, our faithful friends in Cincinnati send us the Christmas Package.  There is always a puzzle and some treats.  It is not fancy.  But it has been a rare constant in a life of uncertainty and alienation and we LOVE it.  The puzzle is a family tradition in the week before Christmas, it stays on the table until it is done.

So when a clerk passed me in a basement hall of the hospital yesterday and said "Mrs. Doctor Scott?  You have a package slip!" I knew this must be our friends.  It is often the only package we get in a year, and for good reason.   This is the inefficiency of this system:

Over a month from mailing to receiving.
Postage is twice stated value of contents.
Hospital does not want to put package slip in our mail slot in case it is stolen, so it waits until someone happens to tell me the package is there.
I walk to the post office to retrieve it.
I pay then 75% duty on stated value of contents, meaning that if X is purchase price of goods, the actual cost is 3.75 x X , as in almost quadruple.
The Kenyan postal service has opened the box and unwrapped every item inside, then jumbled them back in with tape.  They even cut open with a knife slit the ranch dressing mix.  In case it was cocaine I guess.

But the truth is, this package makes us feel loved.  This friend was an MK herself.  She knows the value of tradition, of small pleasures, of being known and remembered.  

This is love.  Even if it costs four times what it should, and takes months, and arrives damaged.  I need prayer to be a loving person.  To waste time.  To not keep packing life until it is well-wrapped and cost-effective.  To focus on the people and things I care about even when pressure is on to be more efficient and do more.  

One night this week, I was rattled out of bed at 3 because a slightly premature but small stressed baby had been delivered by C-section and had no heart beat or signs of life. He was known before birth to have some congenital malformations.  Even though I got his heart started and he turned pink, I knew his brain was not going to recover.  But his mom had general anesthesia and was in the hospital alone.  I decided to keep giving him breaths until morning, when I could talk with the grandmother and mother, pray, and have them hold the baby.  My hand was cramping after a couple hours of bagging. I got the kind and handy biomed tech to jerry-rig some connections on an old ventilator finally. But morning came.  We took out the tube, and he died in his mom's arms.  That was not efficient.  But I think it was love.

Another night this week, it was a jaundiced baby.  I tried to bring the bilirubin down with lights and fluids.  I ran samples to lab myself, waiting and hovering, willing the news to be better.  It wasn't.  An exchange transfusion was indicated.  It was midnight.  My intern was a star.  We worked together, and got it done, and the baby is fine.  By 1:30 am I sent her home to rest, just as I was called to ICU.  

Another infant with a head injury and bleeding between his skull and brain was not breathing.  The next two hours I spent with him, putting in a tube, giving breaths. Suctioning, monitoring, watching.  It was one of those nights where nothing worked.  By the time we got an xray, the tube had slipped out.  But by that time, he was breathing again, and we had made it through the night.  He held on for a couple more hours then went to surgery to clear out the huge blood clot.  Now he's breast-feeding and crying and looking like he will live.  Some very inefficient hours fixing stuff, searching for stuff, repeating stuff.  But that, I believe, was love too.

As I walk back and forth to the hospital, trying to squeeze some efficiency into hours that might yield some sleep, I ask for grace.  Grace to be like my friend in Cincinnati, to be like Jesus.

Jesus sat by the well and asked for water.  He waited three days to show up at Lazarus' tomb.  He walked and wandered.  And I'm sure He would have sent Christmas packages, even if they were pillaged and costly.  In a way, He was the Christmas package, cut open and betrayed and yet a physical palpable inefficient love.

Four Happinesses

Prince Wesley.  Yes, that was the name of one of the babies I saw this morning.  I marveled at the mom's choice and wished him a good life, and that he would meet his own Princess Buttercup someday to whom he could say, "as you wish".  I filled in for the nursery doc who had to go to a meeting.  I have to say I think another of the babies really likes me. He was screaming his head off several times today, and as soon as I picked him up he was quiet and alert.  He was lonely.  Babies are a balm to the soul.

An A+ Pass.  In the afternoon I spent time teaching my interns about neonatal resuscitation using this low-cost baby model one fills with water, and it has lungs and a little heart you can make beat.  NeoNatalie.  I ran through scenario after scenario.  In some the baby cried, in others she didn't.  Sometimes there was meconium, sometimes not. Sometimes they had to do CPR.  They practiced giving breaths with the bag-valve-mask.  About six hours later on call, I had a "999" page which means "run someone is dead or dying".  By the time I got to nursery, I found my intern with a baby who was now crying.  He was on OB call when the nurse-midwife delivered a mom who had a difficult second stage.  The baby had a low heart rate, and nothing else-no tone, no color, no cry, no breathing.  But the intern was prepared.  He did everything right, and so by the time I got there what could have been a dead baby was instead pink and protesting.  I told him he had the real exam on what he'd learned, and he passed with an A+.

Dinner.  About 6 pm Scott called to find out if I was OK. Always nice to be missed.  By the time I got home a lovely spaghetti dinner was on the table.  All working moms need a husband who is proactive in serving, and can cook.

Amber Vinson's Hugs.  The 7th ebola survivor (out of 8 patients treated in the USA) was declared ebola-free today, the second nurse from Texas.  We watched her press conference, and the hugs which bravely showed she is no longer infectious.  Ebola is a physically but also a mentally debilitating disease.  It is hard to imagine the toll of not only risking your life, but then being treated as a plague-bearing danger, avoided, isolated, suspected, blamed.  It was so encouraging to see her alive and well and embraced.  Slowly this disease is becoming something we can treat, and change.

But God . . . .

So much of this weekend was filled with the sort of moments that make you stop and take a deep breath of thankfulness, that make you savor before you swallow.  Saturday evening we had ten Senior boys for gilled sausages wrapped with veggies and hot sauce, watching El Classico, ribbing each other, cheering.  We prayed for them, we played cards, we laughed.  The next morning another group of about a dozen came for Sunday School, which starts with mounds of pancakes and bacon, fruit slushies and hot coffee, animated talk.  Friday evening our Paeds consultants met for our first monthly social dinner, on the belief that investing in our friendships leads to staying power and better care for our patients.  Later we joined out Serge team for a discussion of justice, the first in an intended occasional series for individuals to challenge each other and engage in issues.  In short it was a weekend of significant thought, strengthening bonds, shared food, and joy.

Perhaps the peak of that was on Saturday, late morning.  Hot sun even at this altitude, the dormant volcanic craters in the distance, monkeys scampering into trees as we walked up to the school's football field.  Our boys were paying Strathmore in a friendly, a school of tall fast Kenyan boys.  It was a good contest, drawing out some of the best play I've seen perhaps this season.  While Scott roamed the sidelines taking pictures, I sat as usual with our friends the Battermans and Kendalls, whose kids are on the team with Jack, plus a few dorm dads who are fans.  This is our fifth year watching our sons on teams together.  We analyze and cheer, we gasp and hope.  As I sat in the sun and breeze, watching our boys struggle a bit at first then pull ahead, I had that sense that I should remember this day and savor it.  Senior Year.  Our last senior year.  Football, our favorite sport.  A perfect morning on a spectacular field with good friends.

Then suddenly, one of the boys went down with a yell, "my knee!".  Play stopped, and I sprinted down and arrived as the coach did.  RK was lying on his side, having planted and cut in defending.  No contact, no mistakes, nothing unusual, but he felt a pop and pain.  And since the same thing happened to his sister in the final game of her senior year, he had a pretty good idea what was happening.  "Not my senior year," he cried out.  But a few seconds later, he raised his hand and said "God I praise you no matter what this is with my knee".  

Well, it was his ACL.  This kid is one of the best athletes and nicest all-around godly good guys in the school.  A good friend.  He, along with Jack and one other boy, was one of the three Juniors playing varsity in all sports last year.  He would have been a star and probably a captain in basketball and an important force in rugby again this year.  In other words, an ACL tear with surgery and months of rehab is no small thing in his life.

For me, it was a PTSD-moment that took me back to Caleb.  I love this kid like a mom would, and my heart just broke for him.  I confess I cried, in a very un-objective un-doctorly manner.  Having watched Caleb say goodbye to some dreams, and struggle for almost two years to get back to health after his injury, I had some idea of the implications of that moment.

Later his sister wrote to him: God takes more pleasure in watching you play than even your mom and dad do.  So if He let this happen, it must be for important reasons, because He loves you.  RK's immediate response and this wisdom from his sister really are a testimony to faith.  When our story takes a turn we don't expect, when we lose something important and dear, when joy seems impossible, that's when real faith shines.  God loves the honest cry of the heart, "NO, please NO" and then the wrestling, grasping, tenacious hold on faith, "I trust you God."  Which brings me back to Sunday School today.  Joseph was the same age as all these boys when his brothers threw him in a pit and sold him into slavery.  Then he was unjustly accused and thrown into prison.  Yet decades later, he is able to look back on his own life story and all the pain and loss, and gain perspective by seeing God's fingerprints.  In Genesis 50:21 he acknowledges that his brothers meant evil, "but God meant it for good, to bring it about that many people should be kept alive, as they are today."

We may not live to see the good that is wrested from evil in every aspect of our lives, but we live on the promise that all things are being redeemed.  That God is at work for good, even in what is intended as evil. That busted knees which change life-path-directions do so in a way that will mean life to others, even if it takes years or decades to look back and see.  I would gladly give Caleb my knee, as would RK's parents (well, our old knees may not be that useful, but you get the point).  We hate to see our children injured.  We hate to see doors close on them.

But then they lead us in faith, and respond with grace, and hold onto God, and we follow them down this hard road of living.  We pray over them from  Rom 8, and wait for the all-things-made-new of redemption in their lives and knees, and ours.

Ebola...a paradoxical parody

Sometimes you just have to take a step back, take a deep breath...and smile...