Keeping watch over . . .

Shepherds are not an unusual sight around here, one of the perks of Christmas in Kenya.  We still get arbitrary politics, pregnant teenagers, donkeys used for transportation, people and animals sheltering together, stars so vivid you can nearly touch them.  And the joy of births, many, which we coach and struggle through and celebrate.

 Today's Advent thought, though, is about watching and community.  This week has been a fairly nonstop and intense one clinically as I jumped into covering colleagues, feeling grateful that I get two weeks of leave coming up.  After working four Christmases here, our medical director (cheers for Mardi) insisted that this year we take off. So in the run-up to that I've been trying to fill in and help my colleagues who will so graciously allow me to be gone.  On Thursday, however, my friend Dr. Sarah insisted that I leave early.  Which was excellent, because I had a quadruple recipe of Christmas cookies to roll and cut for an Advent party that night.


Only I got home, and found that our dog Star was AWOL.  She is 14, and lumpy and slow and sometimes gets confused.  I've run with her for years and years, but now she drags behind and sometimes takes wrong turns.  So I was worried she might walk off and be unable to get back home.  We called for her.  Then Scott went out on a short walk looking for her as I got started on the massive cookie project (I'm estimating I made several hundred).  No sign of Star.

On my way home I had passed three guys trimming the thorny hedge on a path near our house.  I thanked them for their pre-Christmas spiffing work.  They were not familiar faces to me, and looked on the thin and scruffy side.  Every time I went out the door they seemed to pause in their work and watch.  It made us feel a little stalked, as I took in laundry.  But I decided to tell them about the missing dog, and ask if they'd seen her.  They had, in the yard, some hours back.  Oh well.  Jack came home and we sent him out to look further afield on his piki (motorcycle).  No Star.


By this time I had accumulated cookie help so I decided to go out searching for her myself.  As I walked out the door, the young men I had talked to called to me.  They said they had seen Star.  I was having a hard time understanding where, so I just followed them.  Two houses over there is a trash pit, about 6 feet deep.  There she was, in the bottom of the pit, looking shaky and forlorn.  I ran home to get Jack (they guys were clearly a little hesitant about the dog) who climbed into the pit and lifted her out.  Rescue success.  Jack the hero.


But not the only hero.  If those guys had not been hauling off the cut branches in a wheel barrow, they would not have seen her. She was not barking.  I'm afraid in her state she might have just died down there.  Two days before Caleb and Luke get home.  That would have been so hard.  I was so thankful for the watchful help from these strangers.  I gathered up a plateful of Christmas cookies for them.

It was easy to feel a little suspicious of these laborers lingering over a job, watching our house.  Privacy is a luxury.  Need leads to community, I find.  I would not have found Star without the kindness and willingness of strangers to watch out for us, to get involved.  The Shepherds in Luke were probably the age and economic station of these three.  Perhaps a bit marginal, perhaps the kind of people who one would not want lingering around the manger.  But they were watching.  And they had the privilege of finding a real star, and the saviour. In western culture, these might not be the people we would choose to come visit our newborn.  But God chose them to watch, and to see.

Real community is like that, watching for signs, alert to the angels, ready to celebrate and to help.  I'm thankful for that today.

(A few pictures from more community, the evening Advent open houses we've been having rotating around Lower Station.  About 40 people came last night . . . a real party!)

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And to end, a CELEBRATORY PICTURE, JULIA IS HOME!!!!

Behold, the virgin shall conceive . . .

This prophecy occurs in Isaiah 7, the passage in today's lectionary.  And both Matthew and Luke make a clear connection between Mary and this passage.  But I think we've lost sight of the reason this is important, when we see Mary with the halo, as if she was uniquely worthy of motherhood, and we immediately dismiss her with an emotional distance and irrelevance.

 
Look again.  A virgin, pregnant.  Paradox, juxtaposition, the impossible possible.  Something from nothing.  Creation.  Grace.

The point is to show God's power, God's action, God's presence in the story.  To show that the rescue is coming from outside human endeavor and will, to show there is another dimension of reality that we do not control.  To show that the humble and unlikely are chosen to bear the gift of world-transforming love.

Mary should give us all hope, that any of us can be the means of grace in a world gone awry.  Her state of virginity is to make the entire story one of grace.

So it is worse than ironic that the retelling of the story somehow turns her status into a subtle, or not-so-subtle message, that God is looking for the (quote-unquote) holy and pure to deserve blessing.  It is bordering on blasphemous if her virginity becomes a message of "be like this to enter the Kingdom." One need only read the rest of the beginning of the Gospels.  There is a list of the genealogy of Jesus, and besides Mary, four other women are noted.  Not one of them was a virgin before the relationship that resulted in the all-important human lineage that led to the Messiah.  Two were widows who took initiative to pretty much seduce their male redeemer-relative in order to get pregnant.  One was a prostitute by profession, who jumped sides when the Israelites started their invasion.  And one was an adulteress.  So it would be hard to extrapolate from that data that God chooses women-who-have-kept-the-rules to be key participants in the redemption plan.

One would conclude, rather, that God likes to shake up expectations, and do the unexpected.  Hence, the virgin shall conceive.

Christmas has been coopted by rules, which is the opposite of the point.  Mary should make us catch our breath in wonder, not that she was such a perfect young woman, but that God can do anything.  Behold, I make all things new. To see the way our human bent to turn grace into law is so insidious and powerful, consider even St. Nicholas, aka Santa Claus, who started off giving gifts to poor children.  He should be a beautiful symbol of God's merciful generosity.  Instead, as our youngest pointed out listening to music playing at dinner last night, we miss the entire point with the "making a list and checking it twice, going to find out who's naughty and nice."  NO!

Christmas is grace, pure and simple.  Which is truly good news, for all of us.

Serge-Chogoria partnership: Recruiting a new team!

Scott and I have the pleasure as Area Directors of assessing new team possibilities for Serge.  We were invited to visit Chogoria Hospital, on the eastern slopes of Mt. Kenya, where a consortium of missionaries and Kabarak University are attempting to resurrect a Family Medicine Residency (master's) program.  We found a solid facility, with dedicated staff, excellent nursing, strong community support, vision, and hope.

 Almost 100 years ago, in 1922, supplies to build a house in the forest were loaded onto 70 ox-carts in Nairobi in April, and arrived at the new site in October.  Dr. Clive Irvine spent his life building not only a hospital but a nursing school and a public health system, plus primary and secondary schools, and a church.  In recent years, the supporting mission from Scotland decided that Kenya was no longer a strategic focus for their funds.  The PCEA church continued many of the programs on their own, but now they would like some help.

The dream is that Chogoria, Kijabe, and Tenwek would all be sites for training Kenyan doctors who want to be able to handle most of what comes to a District hospital.  Acute care, emergency medicine, operative OB, neonatal resuscitation, internal medicine, and some of the standard, common surgical procedures.  Young physicians who have completed a year of internship and then worked to get some experience would come to one of these three sites for a residency program, which in Kenya is called a Master's.  This fits our passion to provide excellent care to the poor, showing the

compassion of Jesus in a hands-on manner, while training a new generation of Kenyan doctors to do the same.  

The main thing lacking:  consultant physicians to be the teachers, to disciple and supervise and encourage these residents.

There are houses ready and waiting.  There is a pretty functional hospital that is sure to fill up when patients see the services return.  There are dedicated Kenyan nurses and administrators and groundskeepers and chaplains and lab technicians and interns who want some experienced doctors to come alongside and teach and help them.

The location is a gateway to Eastern Kenya, and beyond, where many unreached people groups still exist.



Perhaps even best, there is leadership in place from one of the only Family Medicine trained doctors in Kenya, and from a mature family (read, "our age") who sensed God calling them into a second career after 25 years in the Navy directing an Emergency Medicine Residency.

Interested?  Fill out a Online “Go” form :  http://www.whm.org/goform

http://www.serge.org/mission/

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