On the Unexpected Difficulty of Volunteering to fight Ebola

For the last 21 years, we have been on the receiving end of volunteers, praying for help and appealing for colleagues, managing emails and work permits and scheduling and flights, thinking about housing and resources and correspondence and logistics.

So it has been a sobering and frustrating experience over the last five months as we have struggled on the "trying-to-go" end.

In the summer of 2014, the Ebola epidemic that had been building momentum in West Africa grabbed headlines as the rest of the world finally woke up to the gravity of the situation.  Mostly because a few Americans got sick, which was probably the most heroic thing they could have done to finally get the emergency response of the world in gear.  We were in the USA in August plugging kids into school, reading the news with pits in our stomachs.  Having lived through an Ebola epidemic in 2007-8 in Uganda (though on a much smaller, local, contained scale) our hearts were drawn to the doctors and health care workers affected, both African and missionary.

So I was not surprised in September, as we returned to Kijabe, when Scott sat me down only a few days after we got home, and said he wanted to go to Liberia to join in the fight against Ebola.

We had lost our best Ugandan friend to the disease on December 4, 2007.  Scott had treated the one other doctor in our district, who survived.  We had worked closely with MSF and other organizations at that time.  It was familiar territory. Scott is an activist, and the type of person who does not step down from danger or challenge.  He felt a strong sense of conviction that this was one of the defining crises of our lifetimes, and he should respond.  It reminded me of the time he decided to go back into Bundibugyo in the middle of a rebel insurgency.  I wasn't sure he would survive, but I knew he had to do it.

He cleared his plan with our Serge supervisors and our Kijabe Medical Director, and began sending applications to the agencies active on the front lines.  By mid-September he had applied to five organizations, and expected to deploy by the first of October.  He could work for two months in an Ebola Treatment Unit (ETU), we hoped, then have 21 days of quarantine in December before starting our Kilimanjaro climb with our kids.  They had already bought tickets, and we had booked our climb and made a deposit.  He was exploring flight options.  We were edgy, distracted, feeling the closeness of departure and the uncertainty of outcome.  Hundreds of health care workers had died.  We waited to say anything publicly, expecting any hour for plans to become concrete.

And that's where the unexpected delays began.

Incredibly, even though news reports constantly appealed for help, he could not find any organization actually treating Ebola patients that had the capacity to take him.  Some never answered calls or emails.  Others gave a polite standard form-letter response.  As a doctor with Ebola experience, two decades in Africa, ICU experience, and solid general medical and surgical skills, ready to go at the drop of a hat ... we thought he'd be exactly what was needed.  In retrospect, the treatment units took longer to construct, everyone was so overwhelmed, and probably missionaries are not assumed to be as qualified as infectious disease experts living in America.  Who knows...

October came, and he was still re-sending emails, trying to get responses.  That month a nurse friend suggested AmeriCares, and he sent in one more application.  This time he got a very welcoming response; they were ready to make him an ETU Medical Director if he could commit to six months from January to June.  We decided he would be more useful as a clinician and for a 3-month time period, since we had a major Serge regional training and retreat to run in April.  The AmeriCares group was to send an advance team in November and not begin clinical care until mid-December, so Scott agreed to deploy on Jan 2 for three months. He talked to the doctors who went in November, and kept in touch through December, getting ready to go.

But he was watching the numbers as well.  While September projections for what the epidemic might look like in January ranged from a 20,000 to a million cases, it became clear in December that the epidemic was tapering down.  GREAT news.  The response which took all Fall to mobilize was finally having an effect, contact tracing and public health messages were halting transmission chains.  The epidemic is not over, but when he talked to AmeriCares on December 29 about his departure, they told him to "hold on" for another week, as they were "reevaluating their staffing needs".  Hmm.

So another week went by, and we kept thinking and praying and discussing.  By the time the AmeriCares ETU finally opened a couple weeks ago, and the Liberia-based decision-makers finally approved Scott's deployment (they suggested Jan 16th), the area they are working in south of Monrovia was down to only a handful of cases.  The unit is functional, but mostly empty, and will soon shift gears into rebuilding the decimated health system.  The epidemic is still raging in Sierra Leone, but this organization does not work there.

Meanwhile Scott had been in touch several times over the last few months with missionary colleagues working at SIM's ELWA Hospital in Monrovia.  Their ETU had been handed over to others to run, and the hospital's general care severely scaled back.  But now that Liberia's transmission rate is rapidly falling, the ELWA hospital is resuming much-needed services.  This past week, just as we found out the AmeriCares placement would be delayed and much less urgent because of few patients and other available volunteers, he got an email from SIM asking if he could consider working there to fill a gap in surgical obstetric coverage.  Which is his favorite part of family medicine, and exactly what he does at Kijabe.

So, five months after embarking upon a path towards a trip that we thought would materialize in days, he finally has a clear(er) plan.  The first of February he plans to fly to Monrovia, Liberia, to volunteer until early March doing high-risk obstetrics at ELWA hospital, working under the Liberian leadership of Dr. Jerry Brown, relieving Ebola-survivor Dr. Rick Saccra who returns there this month to work temporarily, and giving a break to another family medicine missionary Dr. John Fankhauser who needs to see his family after a couple of months of intensive efforts.

 In our experience in Uganda, the direct Ebola deaths were the tip of the iceberg of Ebola impact.  Many more people died of preventable causes, of malaria and gastroenteritis, of labor and delivery difficulties, of birth asphyxia, because there was no functioning medical system.  We sensed God's call to serve in Liberia in this time of need, and thought it would be in order to care for Ebola patients.  Through long months of trying to get there, closed doors, and a changing situation, it looks like Scott's efforts will be redirected back towards the difficult task of rebuilding capacity for all the other things that kill the majority of people - a very real part of the war against Ebola.

This effort to volunteer has been draining, and he hasn't even gone yet.  I have to say that living for months with the expectation that one's spouse is about to deploy into a high-risk Hot Zone, but not knowing the actual dates or plans, has been hard on both of us.  It has been hard to watch a disaster unfold, to want to help, and to be paralyzed by bureaucracy.  It has made us appreciate the "administrative fee" overhead that keeps our own Serge organization running and responsive.  It has made us sympathetic to the people over the years whom we have not been able to accommodate.

Thanks for those who have been aware of this stuttering plan, and have prayed.  Please do continue to keep Scott in your prayers.  In many ways, seeing a handful of known Ebola patients in the Tyvex  HazMat suit in the controlled setting of an ETU seems safer to me than going back into one of the only functional hospitals in a devastated country and seeing all-comers without full-gear protection.   He could inadvertently be exposed to a patient with fever who has Ebola, but has not yet been diagnosed.  Obstetrics is a messy business with lots of blood and body fluids splashing all over the place.  This is exactly how Kent Brantley and Rick Saccra were infected with Ebola last summer. Scott will do the post-exposure 21-day quarantine in the month of March at his parents home in California when he leaves Liberia in order to assure that he's not infected before attending our regional retreat in Mombasa in April.   If (God forbid), he were to get infected with Ebola, being in the USA puts him within reach of the best medical care in the world - not available here in Kenya.

It has been a confusing road of obstacles and closed doors.  We trust that God honored his willingness to enter the fray earlier, but chose to close the doors in order to serve the vulnerable as well as to assist our missionary colleagues now.

Thanks for continuing to walk this uncertain road with us.  The good news is that we BOTH get to go to the Serge leadership meetings in Ireland this coming week (I thought I would be representing us all alone), and we have the rest of January together with Jack before Scott leaves.

We trust that God has been guiding our steps and prepared Scott "for such a time as this."

Christmas on Kilimanjaro

 



Mountain climbing for Christmas . . . definitely not our usual tradition.  Though being on the move, sleeping outside, being cold and far from home all are probably appropriate ways to remember the reality of the first Christmas.

Our trek started on the 22nd when we went to pick Luke up from the airport.  Of course that in itself was complicated by the random departure times and flight shuffling by Ethiopian Airlines, the nightmare of uncertainty.  He wasn't on his flight, but as we huddled with other expectant and disappointed families we took hope in the rumor that many passengers would be on the next flight only a couple of hours later.  We knew he hadn't checked any bags, so we placed bets on his ability to fly through customs.  Sure enough, he was the first passenger to emerge.

From there we drove south to Amboseli National Park on the Kenya/TZ border.  Our plan was to camp in the wilderness with the views of Mt. Kilimanjaro in the distance.  In all our years in Uganda, our essential family get-away was Campsite 2 in Queen Elizabeth National Park, nothing but space and sky and scrub and animals.  The Kenya Wildlife Service is a depressing subject for another post, but suffice it to say that they refused our park card, extracted a ton of money from us, then mentioned the public campsite was "flooded", then refused to cancel our payment and let us leave . . . then we drove to the campsite which was actually NOT flooded, so we set up camp, only to be accosted by territorial Massai herders who claimed the land (which by gps and by signage was INSIDE the park) was actually theirs so our park payments didn't count and we needed to pay them . . . so we took down our tents in the gathering dusk and drove back to the gate to camp in the very non-wilderness mosquito-infested park headquarters by the gate.  It was a beautiful sunset drive through the park, with Kili's snow-capped peak peeking through the clouds and wildebeest and elephant meandering by the road, and we grilled tandoori chicken and naan and salvaged a fun evening, but the bureaucracy was draining.

The next morning Julia woke up pale and vomiting, not an auspicious beginning to what was to be a major endurance test for the week. We packed up and braved the border to TZ, the usual hassles of bringing a car across, fees for this and that, and on the TZ side the sinking realization that Julia's yellow-fever vaccination card was missing.  However it was so chaotic that no one noticed.  We finally met up with our climbing contact at the park gate in the early afternoon.  Then it turned out that the park passes for Kili had to be put into our passports, so they needed to travel with them to another gate, meaning that we could not start the climb as anticipated that day but had to camp at the gate.  It was a lovely grassy site and in the end quite helpful to give Julia some recovery time, plus it rained so we could shelter.  Plus there was an endless loop of Christmas music playing, and a lighted disco ball, and a rousing game of hearts, so we made the best of it.  We had chosen to go up the Rongai route and down the Marangu route, a less-traveled alternative from North-East to South-East.

DAY 1:  Rongai gate to Simba Camp (6,000+ to 8,400 ft)  This was a pleasant walk through pine forests, gradually climbing to a campsite by a river.  Colobus monkeys, leisurely conversations, and our guides constantly telling us to slow down before they figured out these kids don't walk slowly.  Again this day was shorter than we expected, but we didn't push to go further since Julia was still struggling with her GI bug.

The daily routine was a wake-up at dawn with ginger tea delivered to our tents (3 little 2-man tents) and warm water to wash face and hands.  Then breakfast in the mess tent, a small structure that covered a folding table and six folding stools.  We would set off while the porters took down the tents and generally arrive about the same time as them at the next campsite.  Lunch on the trail or, if the day was short, at the next site.  Lots of rest and reading time, an early dinner hunched around the table in the mess tent trying not to spill our salty soup in spite of the squeeze and slope.  At the end of the meal the three guides would slip in, hunched in the small space, and give us the briefing for the next day.  Once they realized Luke was fluent in Swahili and the rest of us passably coherent in understanding, they got a kick out of doing all this in Swahili.  Shivering into our sleeping bags shortly after sunset to read and sleep until dawn.  So many cups of hot tea, popcorn and biscuits, carbs galore. Stars.  Latrines.  Iodine pills to purify stream water.

But day one was the 24th, Christmas Eve, so I pulled the fun battery-operated string of lights out (thanks Melissa H!) and hung the kids' stockings in the mess tent, and passed out candy-canes to all our porters and guides and cook.

DAY 2: Simba to Theti (Third Cave) Camp (8,400 to 12,500 ft).  Christmas!  Before breakfast I slipped chocolate and little stuffed animals (a family tradition) into the stockings.  We read a devotion and celebrated with millet porridge before ascending through the alpine zone of scrub pine, red hot poker flowers, gladiolas and black-berry-like vines, sorrel and heather, the stark rocky beauty.  The kids hummed LOTR themes for Riders of Rohan appropriate to the territory of boulders and streams. This day was about 4 hours of hiking and an hour of rest.  Buffalo droppings and hoof prints, swooping enormous pied crows, hidden alpine chats, but mostly not much life this high.  By the time we arrived at the camp, the clouds had precipitated into a chilling misty rain, driving us to huddle in our tents.

DAY 3:  Theti to Kibo camp (12,500 to 15,400 ft).  The tents were crunchy with frost when we peeled back our flaps, and a clear pink sunrise shone on the crater rim to our west.  It was 29 degrees as we ate breakfast.  Today's hike took us across saddle between the eastern craggy secondary peak and the higher volcanic crater rim.  We were above the clouds, which seemed to follow but not catch us as we ascended in sunshine.  Three hours through high cold desert, wind-sculpted rocks, tiny dry everlasting flowers clinging to to the dusty ground.  The Mawenzi peak looked mysterious and intimidating, covered in jagged ice and snow to our left as we skirted around the higher peak to our right.  Our guide pointed out a plane that had crashed on a sightseeing tour a couple years ago. Paths converged towards Kibo, which was our first taste of the Kilimanjaro crowd.  Clusters of tents, the smell of various cooks, climbers in their expensive matching gear, porters laughing and greeting, strong equatorial sunshine unfiltered by much atmosphere, freezing breezes, breathless just walking around.  An early dinner and trying to sleep before darkness, knowing our "night" was over after 11 pm.

DAY 4:  SUMMIT DAY.  Kibo thru Gilman's Point to Uhuru Peak back to Kibo and down to Horombo (15,400 ->19,341->12,327 ft.).  We were awakened and given hot tea as we bundled into every layer we could possibly manage, shuffling in the dark, fitting on gloves and adjusting poles.  Our peak ascent started at 11:45 pm, aiming to be at the peak for sunrise.  We passed a couple of groups that had left earlier and were soon climbing blindly into the pitch dark, only the outline of the crater rim against the stars above us.  Winding ever upwards, back and forth across the steep scree slope.  The Kilimanjaro shuffle, a slow steady pace designed to take us up another 4 thousand feet in thin air, without dying.  Every hour or so we stopped to drink and rest, take time-lapse star photos, rub our freezing fingers together.  Our guides sang, military-like chants and Swahili songs & rap with verses including all our names.  I prayed and recited Bible verses to keep my mind occupied, focusing on Julia's steps ahead of me (I quickly abandoned my hand-held flashlight and depended on the light of her headlamp).  I am glad we couldn't see too far ahead.  Just follow the guides, stay in the line, keep walking in the few feet of light, all else a black void, on and on.  Julia was really flagging.  She was still recovering from her gastroenteritis, and had spent a semester near sea level.  The last thousand feet, Jack started pep talking in a very passable Bane (Batman) voice, then transitioned to an Obama impersonation, telling the story of a girl named Julia who inspired him in her determination to conquer the mountain.  Our guides were in stitches.  He kept up the monologue, step after step, and Julia kept going.  The last bit is a rocky boulder climb to Gilman's Point, on the crater rim.  It was nearly 5 am, so we only rested briefly then began to walk around the crater, now on deep slick snow and rock.  The sky to the east began to lighten as we worked our way up towards Uhuru Peak.  The path was mostly bare rock and scree now, but we could see the wavy jagged walls of the shrinking glaciers down the slope below us.  And then we were there.  The Peak of Africa, high in the sky, 6:06 am.  Only two other male climbers were up there at the same time as us, though we passed dozens later on our way down.  The timing was perfect.  We watched the sun rise.  Mt. Meru rose through clouds to the west.  The inside of the crater came to light, steep slopes and snow.  We were freezing. Pictures. Celebration.  Goal accomplished.  Of the thousands and thousands of hikers, only 40% reach the peak. We were so thankful that we all made it up there together.

It was too cold to stay long.  Soon we were heading back down, back around the rim of the crater, this time able to see just how steeply the snow dropped off, how intimidating the boulders below were.  Back to Gilman's point, then down the rocks to the nearly vertical scree.  Instead of carefully winding, we could bound.  Big sliding steps, like skiing, straight down the slope.  Aching muscles.  Down and down.  Beautiful clear views.  At Kibo we rested in our tents for an hour, ate "lunch", and re-packed to descend to Horombo.  Another few hours of walking, first through the desert saddle and then following streams past tussocks and senecia, improbable plants.  The afternoon clouds gathered, the peak disappeared, and soon we were being pelted with hail, tiny icy white crystals.  Mud and cold.  So so tired.  Finally, Horombo camp, our last night in tents.  Yeah.

DAY 5:  Horombo to Mandara (12,327 to 6,500).  The last day started with the obligatory group photo with porters, Uhuru peak just visible in the clear morning behind us.  Perhaps the low point of the trip was being informed that while we paid an all-inclusive package (which was about half the average rate so a good deal, but still expensive), everyone involved expects large tips. We had brought tips on the order of a tip not a salary.  We had what we had.  This was the only day that involved many, many people on the trail.  Porters and hikers, coming up and going down.  Most of the time our little family group moved relatively quickly and alone with our trailing guides, but occasionally we melded into and moved through larger tours.  Germans and Japanese mostly, some cheery and some gasping their "Jambo's".  The path wound around shoulders of the mountain, the peak coming in and out of visibility in the clear morning.  More and more flowers, bridges over gullies splashing with water.  Our last lunch at the Mandara camp, and then through rainforest to the gate.  Burning calves and quads, stepping down, rocky paths, on and on.  I tripped on a rock and skinned my knee, and Scott stopped to duct tape emerging blisters, but we were remarkably injury-free.  Julia brightened with each hundred feet down.  At the final gate, we were given our official certificates for reaching the peak and headed into Moshi for a night in a budget motel, tepid showers, cold drinks, Man U football on the TV, and rest before the drive back to Kenya.  I had planned an extra day to visit friends in TZ but by that time Julia's bug was affecting me, and the kids staged a we-are-ready-to-go-home coup.  So we rose early the next morning for our last Kili views and hit the road north.

This was a highly redemptive week.  Exactly two years ago, on Christmas Eve 2012, Caleb had a serious motorcycle accident that destroyed his left knee, tearing through three of the four ligaments and nearly ending his Air Force dream.  He has worked hard, both with constant physical therapy after two surgeries, and academically, to hang in there.  To be able to climb Mt. Kilimanjaro seemed like an impossible dream back then.  We are so grateful for God's healing.  The number of days the six of us spend together anymore is small, precious, limited.  We are grateful for hours of walking, meandering conversations about classes and friends and the future.  This was also the completion of a quest of sorts, as a family we have now climbed the three highest mountains in Africa (Kili, Mt. Kenya, and Mt. Stanley in the Rwenzoris).  God often calls people to the mountaintop, away from normal life into the bright thin air of glory, to get their attention.  We are listening as we enter 2015.

And we are grateful to our parents whose generous gifts to us helped us to afford this adventure.  We are blessed.

Lastly, if anyone is still reading.  We told you in our Christmas letter that Scott had signed up to go to Liberia.  This was something God laid on his heart back in September when ebola was spiraling out of control.  In the midst of crisis, it turned out to be unexpectedly difficult to organize a way to go.  In fact he went through five organizations before finding one that had the capacity to even answer emails and phone calls and hook him up with an ebola treatment unit.  He was supposed to leave Jan 2, but when we returned yesterday we found the organization asking him to be "on hold" a little longer as they re-assess the situation in light of recent declines in the infection rates.  So he may be leaving a week or so later, or the possibility exists that he may not go at all.  We don't know.  Please pray for clarity.  He still wants to go if there is need.

Merry Christmas to all of you.  We are back at Kijabe, still on leave a few more days, to celebrate the New Year and face goodbyes before school and work and life turn back to normal once more.  Hope your Christmas was equally full of memories.

Christmas Letter and Greetings

These twin girls graced my last call night, and are an appropriate Christmas image.  I was in the NICU around midnight and heard there was a mom in labor with twins.  The first time I peeked my head in it was chaotic, too many people and no babies in sight, so I went back to finish doing a lumbar puncture, then returned.  The mom was described as "mentally retarded", and I am pretty sure she was Down's.  22 years old, but mentally like an 8 or 9 year old, and terrified of the pain. She had a saint of a mother who was trying to coach her through it, but clearly everyone in the room was getting very frustrated with her.  She would promise to push, but when the contractions came she went berserk, or crossed her legs writhing, or gave little three-second push attempts.  I jumped into the fray, taking her left hand and leg while her mom coached on the right, talking, cajoling, explaining, trying to help her.  At one point even her mom walked away and she started to wail, more worried that her mom was mad at her than that she was in labor.  She was so sweet, so scared, so eager to please, but so unable to do what she needed to do.  So unfair.  The OB on call decided to take her for a C-section.  I'm the only one who was thinking, if this is Down Syndrome, she has a 50/50 chance of each twin being affected. Well, the least I could do was advocate to get her mom in the room with her, which we did.  And to give the babies the best start we could.  

And out came two little girls, looking perfectly formed, crying.  Hooray for this brave mother, who will have the joy of holding and feeding and watching these children.  Hooray for the long-suffering grandmother, who will be the primary caretaker.  Hooray that I was wrong about Down's or the odds were ever in her favor or God gave this family a major break.

Down's gets to me because of my nephew, who is equal parts handful and wonder, love and willfulness.  Imagining him trying to understand and go through this kind of pain breaks my heart.  I was texting with my kids in the US after the delivery (perks of time zones, even at 2 or 3 am I have family awake) and tried to articulate the reason this story gets to me.  I think it is the combination of innocence and pain.  Which is the Christmas story.  Mary, inexperienced sexually, young, away from home, in labor.  To have Jesus, the ultimate innocence of the Son of God combined with the ultimate pain of the cross.

May you this Christmas find the present reality of a God who took on all of that, for us, for love.

Our Christmas letter to supporters is here for download . . . 

And don't expect to hear from us for the next week or so.  Assuming Luke is truly at the airport, we are out the door in the next hour to head to climb Kilimanjaro as a family.  Off the grid, on our feet, and up to the top of Africa for the next week.  Merry Christmas.

Grace at the Fray (A Christmas Travel Story)

Living on the fraying edge, we sometimes hang on by a thread.

And no more so than when trying to gather our widely scattered children home.

First there are tickets to figure out, months ahead of time, guessing exam schedules, holding out for the best prices.  Then there are the hopeful hints to friends to pick them up from dorms and take them to the airport, something we can't do for them as distant parents.  For Caleb there is a mound of paperwork to leave the country, and to enter Kenya. Then they have to make it through a trying semester, finish classes, study, stay up into the late hours of the night, tie up projects, write papers.  And we plan ways to drive two hours to the airport on this end, to arrange for work and life to allow the gap for the 5-hour round-trip ordeal. Times three.  A few days before there are flurries of texts and phone calls about what to bring perhaps, or about what we'll do together, or packages to be received from team mates ordering American this-and-that. There are reminders (or we forget to remind) about getting cash for travel, about early checking in, about how to transfer planes in Europe.

When it finally comes time for the kids to travel, everyone has already invested quite a bit.  So when the in-the-airport texts come saying : Mom, can you please call, it's kind of a crisis here . . . My heart frays, for sure. For Julia the issue was that she was returning to Kenya on the end of a round trip ticket which began at graduation.  We know that any American traveler can pay for a tourist visa, but they were unhappy with her expired Kenyan dependents' pass and her lack of a documented return trip.  I guess they worry that Kenya will reject her and they will have to fly her back at their own expense.  I was able to quickly go home and email her one-way return-to-US in January ticket on another airline, and talk to the person on the phone.  Whew.

For Caleb, I slept through the first struggle.  It is never good to wake up and find 17 missed texts from 3 to 4 am, saying things like "Luke, can you get Mom to wake up?".  By 6 when I saw them it was all over, but the initial United Airlines person who was checking Caleb in flatly refused because the back of his well-worn passport is, literally, frayed.  It went through the wash a year or so ago.  He's been to a half dozen countries with it since, no problems.  But this guy decided it was an illegal travel document, and suggested Caleb delay three days.  As you might imagine, his semester is extremely demanding.  He hasn't been home here in a year.  Three days would make him miss our Kili climb.  He was pretty distraught.  In the end he walked away to make phone calls, looked up rules, decided the worst that could happen would be that he'd be detained along the way, and decided he would take the chance.  He went back and got a different agent who didn't blink an eye.

But his near-misses were far from over.  He flew Denver to Washington, had an 8-hour tedious wait in the airport, then Washington-Addis Ababa (13 hours) and Addis-Nairobi.  The middle, longest flight left 1 1/2 hours late.  For no clear reason.  Caleb had only an hour to make the connection in Addis, so he was pretty sure to miss that.  We were trying to call and email and get through to see if he'd be put on another flight today, no guarantee since they seats may have been full.  And the airport in Ethiopia is CHAOTIC.  Swarms of people, unruly lines, no clear monitors or gate numbers, buses taking people to planes (never sure if it's the right one).  Thankful for two things that saved us:  ALL THE FLIGHTS are so late that the connection was still possible, and Caleb didn't wait around but charged straight through, asking questions to find his way.  Otherwise he wouldn't have made it. Late, but here.

Quote of the day: "I think I just crossed the entire human spectrum of efficiency from USAFA to an African Airline."

Well, two down, and one to go.  The last is Luke, who passed the last exam of his first semester of med school and is now on the flight to Addis.  Besides a broken phone and a burned hand, we don't know of any crises yet with his travel.  But he's not here yet either.

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!)

(

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/