Data and Life

This week I had a lot of late nights, two on call and the rest scrambling to prepare our Nursery Audit a week early.  Every week we enter data into spreadsheet, tracking every admission, the weights, the positive cultures, the diagnoses, the need for oxygen and phototherapy.  Then once a quarter we review the data to see how we measure up, where we can improve.  At the end of the year, I try to also collate the entire year's worth of data.  And since we've been doing this for three years now, this represents the whole shebang.  My presentation ended up having 70 slides.  Everything from our goals and our team, to the proportion of males/females or the outcome of babies treated with surfactant, to tables documenting admissions and deaths by birthweight, gestational age, and place of birth for every quarter.  After the summary stats, I went through all the deaths, focusing on about 4 or 5 that I felt we could have prevented with better care.  This is how we learn, and change.  Scrutiny, data, facing real facts, being vulnerable. Naming our mistakes.  

The table above compares the survival of babies (preemies and term) at Kijabe to a brand new study of 22 Kenyan "teaching" hospitals where interns are trained.  We're the top lighter-blue line.  It was very encouraging to see that we are leading the way in what is possible.  And a challenge to bring up the stats for the smallest babies.   I love being part of a team that wants to do this.  Data and life, crunching numbers and hands-on care.  Data IS life, perhaps.

And it is very good to look at the big picture while slogging through the daily details of life in the trenches. Our 5-bed ICU has had 4 beds occupied by Paeds this week, meaning they are my responsibility.  It is rare to come through a week in the ICU without walking down the agonizing road of death with a family.  I am very grateful for your prayers, because there have been some remarkable glimmers of hope that have no other explanation.  This baby I mentioned before, baby of J who is now named "Blessing".  She had to be taken by CS two months early because her mother has severe heart disease.  She's the one whose dad asked us to please try and help her survive.  I spent a lot of the early week gingerly dialing her ventilator up and up as she got worse and worse from immature lungs.  On Wednesday she became very still, not moving or breathing on her own at all.  That evening, I told her dad that I thought we had reached the end.  I offered to pray and he held her hand as we lifted her up to God.  At that moment I thought of the dad in Mark:  Lord I believe, help my unbelief.  And I thought as I prayed, maybe this dad has faith for his daughter that I don't.  I had lost hope. So when I came in Thursday morning and she was opening her eyes and moving her arms and legs and breathing over the ventilator, I was in holy awe.  Then I did a blood gas on her and got the first decent numbers of the week.  I literally did a little dance right there in ICU.  She still has a long way to go and her lungs are beat up.  But she's still fighting, so we'll fight for her.

Most of my patients have been tiny, but on Monday evening I was called to casualty for a 15 year old girl.  She is bigger than I am I think.  She was living her normal life until Friday when she developed neck pain along with a severe headache.  By Saturday she ended up at another hospital with vomiting, and they started treatment for meningitis.  Over the weekend she became less responsive until she wasn't talking, sitting, walking, anything.  She arrived in a coma and with some worrisome neurologic signs.  After admitting her to ICU, intubating and putting on a ventilator, we asked for a head CT(only available in Nairobi over an hour away).  This is the case that got me embroiled in controversy and politics and phone calls, stepping on some toes in commandeering an ambulance meant for a private stable patient and arranging for a nurse-anesthetist to accompany her which is never popular.  However her head CT gave us invaluable information: NOT meningitis, but a mass in her brain.  Neurosurgery agreed to take her into theatre, and we all expected cancer.  Instead they found TB, a tuberculoma of the posterior fossa for the medically curious.  You may not think TB in your brain is good news, but it is much better news than cancer in your brain.  She is on treatment and already waking up and moving a bit. When the pathologist texted me the results on Thursday, it was my second rejoicing dance of the morning.

And taking another premature baby off the ventilator was my third. Whenever I talk to baby T's mom, she listens to me tell all the problems then says: "But she's going to be OK, right?"  "Yes, I think so, but she still has a long way to go."  Jack and I were reading a devotion on Naaman.  I can relate to the King of Israel, when he is sent the patient referral letter saying basically "here is my servant, heal him."  And the King says, who am I to heal anyone?  Yes!  Amen.  That's my life, referrals from hospitals that have hit their limits, parents who are desperate for hope, saying take this kid and make them well.  And lots of weeks that seems impossible, but this week we've seen some great progress.


Last fun story, on Wednesday afternoon in the midst of baby Blessing looking like dying and the usual press, I had a phone call from an unknown number.  It was an Ethiopian man who had come to Kijabe a few months ago because his wife was pregnant with quadruplets (IVF) and he wanted an affordable an safe place for her to deliver.  He talked to Scott, who showed him around and helped him with cost estimates.  And perhaps gave him my phone number. . . because somehow he was calling me to say that his wife was now 27 weeks and two of the four babies had died in utero, and could they come to deliver the other two?  I quickly made sure we could open up an incubator, and said YES.  Within two hours she had arrived from Nairobi.  The OB team admitted her to prepare, and Dr. Ari and Bob received these two beautiful babies, a boy and a girl.  At 27 weeks and less than 1000 grams we know they have about a 40% chance of survival here.  So please pray for them. Their mom has clearly been through a lot to get them here.

Meanwhile in Liberia, Scott did an emergency surgery on a lady with an ectopic pregnancy, and another CS on a 15 year old girl who was seizing by the time they got her on the operating table from a condition called ecclampsia, which put her life and the baby's at risk.  Not pretty, but both survived.  It is good for him to sense the purpose in being there.  Hopefully he'll give us more of the story by email.  (contact me at jmyhre@serge.org if you're not getting those and want to, and contact Serge at info@serge.org with your mailing address if you want our new photo prayer card in the post and you don't normally get our Christmas letters).

This weekend I am off, and Jack has two friends staying with us, so I'm trading in my stethoscope for baking cookies and making dinners.  And hopefully, some sleep.

Watching out for each other

Twenty-two years ago today, in a Baltimore hospital blanketed by snow, Luke Aylestock Myhre was born.  After losing three babies by miscarriage, then spending six weeks on strict bedrest waking up every 3 hours to swallow medicine, making trips to the emergency room to get IV fluids and slow down preterm labor, simply having a live baby (even a month premature) seemed like a huge accomplishment.  Within a minute of being born he was swept of to the NICU, where he perked up and his stay was mercifully short.  Nothing was simple.  I suppose the next 22 years were harder than those months of anxious bedrest and those hours of pain, but it really doesn't seem that way.  Because the big difference in the last 22 years is that we had an actual person to love and relate to, not just a wish.  A boy who exerted his will from the get-go, hated sleep, explored anywhere and read everything, saw through any pretense, caught any faulty logic and found any loophole, somehow managed to both tease/torture and loyally love his siblings, the animator and energizer of any group, with a solid heart for good and a strong leading path. (The photo is Luke holding Jack at Kijabe in 1998).  He missed the memo on how first-borns are supposed to support the status quo and follow the rules.  The world became a much more interesting place 22 years ago today.  And as his journey unfolds, we are thankful to be watching.

But watching from a distance, sadly.  I think the last time we spent a birthday together was when Caleb and I flew out to Kijabe for his 16th.  It was his first year of boarding school, and I made cinnamon rolls for the whole dorm for breakfast, and we climbed Longonot.

That premature baby had to become a premature adult in many ways. The fracturing of the family fosters independence, which is great.  And sad.

And, in tiny ways, redemptive.  We look for slivers of redemption in our deepest pain, believing that the ache signals a place where we feel the cross, and therefore where the cross is creating the all-things-new of the Kingdom.

This year, because we are continents apart, Luke had one of his best nights in med school yet.  His friends threw a surprise party for him and another classmate with a birthday.  I am grateful for those who extended kindness to make my son loved and welcome.  And because we are continents apart, when Jack told me two of his class mates had birthdays this weekend and their plan to visit one of their families fell through, we pulled a handful of Senior boys together for a gourmet grill-out and movie night.  I am thankful to care for other people's children, in gratefulness for the way other people care for mine.

Because that is community, after all, watching out for each other.  The boys above were born in four countries on three continents, but now they are fast friends.  And though I am only a small and peripheral part of their lives and those of other senior boys, I am thankful to bake, and teach them Sunday School, and cheer at their games, and make them breakfast every Sunday morning, and open our home for dinners and games and movies.  We all long for the connection that was lost in the Garden, and these moments give us tastes of the true belonging.

And that sense of pulling for other-people's-kids extends deeply into my work.  I was on call Saturday here at Kijabe, watching over three critically-ill intubated ICU babies, 22 others in the NICU, and another couple dozen on the Paeds floor, two admissions in the emergency room, and a handful of consults in the outpatient department.  I grabbed a few minutes to chat with L, the girl who was wasting away, and she smiled, which I took to be a pretty amazing sign.  Still a long way to go on the path from death to life.  Most of my day was spent agonizing over baby J, whose mother was nearly dying herself, who was born too early and whose lungs just were not working.  

Her bewildered dad simply said, please, can you do everything you can?  Yes, of course.  Over the course of the day there were slight turnings in the right direction, but it will be a miracle if she survives.  It is a weighty responsibility, the holding of other people's children, being the person to interpret every piece of data, the numbers and labs, the pallor of the skin, the squeaky resistance of the lungs, the limits that can be pushed and those that can't.  This weekend I was thankful to be consulting back and forth with our newest paediatrician, Dr. Ariana Shirk, who traded off with me this morning.  

This is Ariana with a visiting resident/physical therapist couple.  One of the joys of Kijabe is that it is a point of intersection, where people with a heart for Africa come to serve and learn, and where Africans are equipped.   

Best. Feeling. Ever.  The Sunday morning return to my house, turning off the pager for the day (note that the dog was hoping I would take her running, but I had to make chocolate-chip-raspberry-pecan pancakes for Sunday School . . . ).  This life as hostess, doc-on-call, solo responsible adult in the house, Serge rep for East Africa, and communication coordinator for a family of six in four time zones . . has been more tiring, more draining, than I anticipated.

And this month our caring for other people's kids extends across the continent.  Scott is on call today in Liberia.  Last night, a baby less than a week old died of tetanus.  This is an indirect ebola casualty.  When ebola spirals out of control, maternity services disintegrate, immunization programs are suspended.  And then babies die of horrible, painful, spasmodic, tortuous diseases like tetanus which are 100% preventable.  He has done one surgery to save a mother's life who had a ruptured uterus.  And he's been straining to listen and understand, donning protective gear to admit patients with fevers that could still be ebola (they haven't been, yet), agonizing over whether to put the in the ETU (ebola treatment unit) which could unnecessarily expose them to ebola, or in an isolation room on the regular ward which could unnecessarily expose others.  This graphic from The Economist explains why he is there:

Yes, there are more than a HUNDRED TIMES as many doctors per population in the US than Liberia.  

Watching out for these sweet little ones who can't ask anyone to help them, and thankful for those who watch out for my kids.  And those who watch out for me.  

An early Lent

For 2015, I am using a nifty Lectionary app, that gives me Bible readings from Psalms, Old Testament, and New Testament, daily.  Though I was not raised in this tradition, I am appreciating the way that spirituality and season are tied together, the way that the year forms a template for redemptive history.  Monday, 2 of February, was a celebration of the Presentation of Christ in the Temple.  That made me look back into Leviticus and read the law.  40 days after birth, the mother and child bring a sacrifice, signaling the end of her post-partum period, a return to community and health.  Yes, it has been 40 days since Christmas already.  Because Joseph and Mary were poor, they did not have to buy a lamb, but used the provision for "a pair of turtle doves or two young pigeons."  This is the scene where Simeon recognizes the infant Jesus as a light for revelation for all people.  Then more ominously, he predicts that Jesus will bring division, opposition, a decision point for many, a way of revealing their hearts.  And lastly, he says to Mary, a sword will pierce your own soul too.

Is that not the way of this life, as a mother, a pilgrim, a struggler?  You see redemption coming, but a sword pierces your soul.  Because redemption is not a theoretical concept.  It is a process that is still unfolding the world over, and it involves people we love, and a piercing ache.

Scott landed last night in Monrovia, was picked up by one of the SIM ebola-survivor missionaries who is back for a month and whom he will replace this week.  He reached the ELWA hospital compound, in the dark, with the sound of the sea and the humid lingering dark heat.  Meanwhile a vaccine trial is going ahead in Liberia and Uganda, but a treatment trial of a new antiviral was suspended due to inadequate patient numbers.  Schools may reopen this month, as soon as chlorine buckets are organized.  Infection rates are slowing across the region, thank God, but as I read this morning, even one case is enough to spark a new surge of the epidemic.  Two British medical workers were evacuated after needle stick injuries.

So on the day that Epiphany blends towards ordinary time, I decided to move Lent up early.  Lent is a tradition I find meaningful, a period of fasting, prayer, meditation, preparation to remember and celebrate Jesus' death and resurrection.  Giving up something(s) that is not essential to life, that is a luxury or a crutch, is a daily/hourly reminder of our weakness and dependency.  As if I needed one more, on a day with a heart-crushing death (see below), entering into the story of a Somali-Kenyan teen who is skeletally thin for unclear reasons, scrambling to prepare for guests, listening to the poignant story of a new friend mourning her brother, a 9 pm mission-related virtual meeting, a late night with frustratingly slow internet trying to help my last son on his last college app way overdue, and the sinking pit of loneliness, I think I'm pretty aware of just how helpless I am.  But the other side of the coin of desperation is deliverance.  This two-month Lent, let us be alert to the hidden work of God. To impossible situations turning out well.  To celebration and hope, to open doors and new life.  The transition from fasting to celebration is prayer.  In our weakness, we ask.

Consider a Lent this year, a season of abstaining from something good for the purpose of growing in deeper awareness of depending on God's power to resurrect us.

A sword will pierce our souls, but we pray that the holy pain will heal, that the scar will be a reminder of glory.  

mourning and singing

Sitting in the ICU, entering baby G's death into the database.  The clinical facts belie the anguish of yesterday.  10 days old.  Severe infection, acid accumulating from poor perfusion, dehydration, seizures, struggle.  Yesterday at 5 pm I was sitting on this very bench to tell G's parents that he had died in the operating theatre where we had taken him to get a central line.  Fifteen minutes earlier I had been called by the surgeon to say that they were giving up on the procedure, and as I talked I realized they were telling me that they had stopped resuscitating the child.  I rushed there to find the head anesthesiologist walking away, G's stiff cool pale body bruised and still. Failure.  His mother has two teens, but has now lost three infants in a row, at 1, 5, and 1.5 weeks of age, over the last five years.

The surgeon calmly and kindly explained what had happened in the theatre, how his heart had slowed and stopped, how they had struggled over and over to bring him back, the medicines they had given.  "Oh, Jesus, WHY?" his mother wailed.  "Why me?"  She collapsed onto the floor in agony.  Those moments are the hardest for me.  I had seen the baby that morning and recognized his condition was potentially fatal, in spite of lots of fluids and antibiotics over the 36 hours he'd been admitted in the nursery. We had brought him to ICU, increased his respiratory support, adjusted his antibiotics and fluids, added another antiviral drug, checked an arterial blood gas, arranged for a donor to give blood, and for a more reliable IV line to give it.  I honestly thought we were going to save him, because he was responding to the therapy, his kidneys starting to work.  So the surgeon's call and the mother's grief knocked the wind out of me too.  What do you say to a woman who is crying over the third infant to die in a row?

This is a point of weakness, emptiness, wordlessness.  I held her hand, rubbed her back, talked to her, prayed for her.  Then the words I had read that very morning came back to me, from Hebrews 2.  Jesus shared in our flesh and blood, that through death he might destroy the one who has the power of death, that is, the devil, and deliver all those who through fear of death were subject to lifelong slavery.  Jesus walked right here, in this situation of heartrending loss, of years of anxious fear in facing multiple deaths.  And he did it in order to destroy death itself.

 Today as I enter the codes in each column, I hear angelic singing from outside my window, the harmony of hymns in Kenyan voices.  I am near the School of Nursing, and they took exams last week, so I look out expecting a graduation.  Instead I see a funeral, clusters of people standing near the morgue, singing.

The paradox, mourning and singing, all at once.  Death conquered, death present.  Jesus near the brokenhearted, but the hearts still broken.  Eternal truth of hope and reunion and coming home, but a present ache and loss all the same.

A re-examination of the decision-making paradigm

Does anyone remember that line from Sahara? (I know it is politically incorrect to love a movie about Africa that includes Matthew McConaughey, but it is just so GOOD).  At one point a character says something like this: " Here we are in the desert looking for an underground river that may or may not have ever existed using a map we found on a cave painting while being chased by armed soldiers . . did you every think it might be time to re-examine our decision-making paradigm?"

So, here we are today, with Scott spreading out his packing kit including things you probably always pack as well, like a thermometer and a mosquito net and eye shield glasses for the operating theatre.  And here we are, having to make sure I know things like where our health insurance cards are, how much money is in our safe, how to log into accounts and retrieve passwords, whether our rent is paid, how to re-charge the internet modem, how to use Kenyan mobile-money called MPESA.  I've had to pay attention to things I usually ignore, like why we have multiple pikis at the mechanic's and what is happening with them.  I manage to parent and doctor and survive alone a week at a time, often.  Two months looks long.

The context of the week is also far from placid.  Rotten timing, I came down with a moderately bad infection, the details of which I shall not bore you with, but it has knocked me for a loop, and made staying near a bathroom a necessity.  Jack's college application process never seems to end, and this week it was the realization that when he applied to Wheaton College, he applied to the WRONG Wheaton College.  Long story short, there are two, and the one we wanted in IL does not use the Common App, which is how he applied to a Wheaton College in MA.  Thanks to mercy he's been allowed to apply to the intended Wheaton (IL) late.  The mercy of Wheaton is in direct contrast to the NO-MERCY attitude of the Air Force.  Our cadet had a rough week, the usual of keeping up with work on six classes, plus preparing to lead a portion of an Officer's Christian Fellowship weekend and spending late nights with two friends going through life crises.  In all of that, he missed a 7:30 am meeting that was called by the research fellowship he had received for the summer (a difficult-to-get opportunity in Germany that he was thrilled about).  He realized his mistake, apologized and did not make excuses, just told the truth.  In spite of efforts to grovel and obey, the situation quickly escalated way out of proportion, and within a couple of days he found himself excluded not only from his summer program in Germany but from all research associated with his engineering department, anywhere, ever.  Basically one human mistake made from sheer exhaustion and overload, one missed meeting, turned into a branch point where his department declared him unfit for a grad school track.  What was most hurtful was that he works so hard, makes good grades, tries to always do the right thing . . . but no one in charge had anything good to say in his defense.  They immediately pounced to crush.  (Read Psalm 15 and pray for him). Oh, and two out of four kids sprained their ankles this week.  And more importantly than any of the above, one of our Christ School Bundibugyo teachers, a young man with a wife and child, one who represents the promise of the Kingdom, an orphan turned success-story graduate, died suddenly while on a 4 km training run for police work.  This was a former football-playing athlete who was 30 years old.  The kind of young man we all poured out our lives to nurture, the kind of young man who was to be the next generation of godly leadership.  Tragic.

In other words, our hearts are spread in so many directions, wrapped up in so many hard things for our own kids and other peoples', that further disintegrating our family almost takes my breath away.

So how did we get to this point?  Do we need a new paradigm?

In chapel this week at Kijabe, a visiting Kenyan TV-personality speaker said that if he spent 24 hours with a person, he could predict from their life-habits what their future would be like.  He had some valid points promoting godly discipline.  But the gist of the argument was: be a good Christian and you'll be successful, like Paul.  I didn't get the impression he was thinking of the real Paul, in prison and alone and shivering from cold and facing a death sentence.  It ran more in the direction of prosperity.  Of brilliance and income and safety and security.  Of a lot of things that seem to elude most Biblical characters.

So tonight, with a wave of nausea and a growing to-do and to-remember list, I am re-examining the series of decisions that leads to a husband flying off into a situation where 816 health care workers have been infected with ebola (including two new ones this week in Liberia) and 466 have died.

And I can re-affirm them all, from the decision to get into Scott's car for a ride to church in my first week of college . . . to the last-minute airplane-doors-closing decision to let him go back into a war zone in Uganda while I evacuated with three very small children . . . to a thousand decisions to simply keep getting up and going ahead against the odds in a remote, humid, discouraging outpost . . . to the decisions that sent kids to boarding school and then college, the decisions that took us away from the home we had built . . . to the last six months of effort and application that led to this weekend's impending separation.  These are decisions made on a few convictions:  that the power to act is a gift that grows at it is given, that grace covers a multitude of inadequacies, that loss is real but not forever, that this world is not a zero-sum cause-effect closed system, that courage trumps comfort, and that love is the most true thing of all.



(See post below for info on our new mailing list.  The fifty-some people who responded tonight have been a huge encouragement, from "you don't blog into a void" to "I'm a distant cousin", offering the gift of prayer.  THANK YOU.)

Communication

This blog is our primary means of communication with our friends, family, supporters.  But as Scott leaves for Liberia on Saturday, we have been working on (finally) developing a system of email-updating for prayer.  This enables us to quickly contact many people; to share things that we may not want to publicly post; to honor any restrictions our partnering organizations may have on media (Americares restricted fb and blog access; we are not sure of SIM's policies yet); and to push right into your inbox rather than relying on you the reader to find us on a blog.  Desperate times call for desperate measures (a favorite quote of my mom).  We may be the last missionaries in the world to finally get on this bandwagon, but better late than never (which is more of a dad proverb).

SO  . . . if you did NOT receive an email from us that looked like this yesterday:

And if you WANT to get emails from Scott in Liberia or me in Kijabe as we ask for prayer . . .

Send us an email to jmyhre@serge.org  (not our primary email, but my Serge email, to try and keep track of this . . ).  Again, if you got the test email pictured above, you don't need to do anything.  And if you start getting the emails and change your mind, you can easily unsubscribe.

Just Life

This month I am the consultant for NICU service.  Which means I am often running to deliveries.  One day, a week or so ago, I was in the operating theatre for a C-section as usual.  90% of the time this is pure pleasure: I greet the mother as she gets her spinal anesthesia, flip through her chart to be aware of any potential issues, pull on my gloves as the surgery begins, watch the OB's careful incision and dissection down to the amniotic sac, await the emergence of a dusky squirming baby who gasps his first breath as the cord is cut, take him into a warm side room where the nurse and I rub him off, dry, stimulate and admire the crying newborn. 

But sometimes things are not quite so peaceful and lovely.  That morning I was just finishing such a calm case when I saw a trolley being rushed into theatre 3, with a large woman who seemed to be writhing.  The urgency and chaos suggested a trauma case, clearly out of the paeds age range, so I was staying out of the way and about to exit the hall when the theatre nurse Lydia called out "Dr. Jennifer, don't go, they're going to need you".  Curiously I followed the trolley and learned this was a pregnant woman who was obtunded after a seizure, having come to clinic for the first time that morning.  Ecclampsia, a life-threatening emergency for both mother and baby.  We had little information about whether the baby was preterm or term, or just about anything else.  I expected the worst, possibly a dead baby.  The OB team sprang to action and within minutes the infant was out:  a HUGE term baby boy, who responded quickly to our interventions and squalled.  His mom went to ICU post-op and I took him to NICU.  Three days later, we snapped the photo above.  A fully recovered mother, a normal healthy baby, and a very pleased grandmother.   

And that is what I love about NICU service.  The brink of life and death, with a balance that can so easily tip either way.  Being there at the right time, giving warmth and breath, makes all the difference.  Sweet petite preemies. Grateful mothers. Coaxing.  Trusting.  Prayer.  Sometimes tears.  Careful calculations.  Daily deliberations.  To the left, two term babies, one with meningitis and the other with unexplained severe asphyxia.  Both on CPAP, assisted breathing earlier in the week, and both amazingly improved.  That's another thing I like about NICU: even when you predict a dire prognosis, those babies and the healing power of God surprise you, and the stiff seizing little bodies slowly relax and open their eyes and start to look rather normal. They improve.  It's incredible.

The second week of January Scott and I spent in Ireland meeting with the Serge leadership.  We have semi-annual meetings to review strategies and plan and pray.  Really inspiring stuff, like seeking the poor and vulnerable, pursing diversity in leadership, developing resources, modeling spiritual formation.  Lots of prayer and friendship.  And though January in Ireland means low sun and short days, we had some brisk walks by the sea, and lots of fellowship in the evenings. 

And when we're not in meetings or in the hospital, you can find us at the basketball court cheering on the Buffaloes.  Jack is on the Varsity basketball team, which came in second in the tournament last week.  Acacia is playing football.  We find the suspended time, the very-much-present focus, the friendship with fellow parents, the joy of seeing our kids thrive and strive, very renewing.  Until Jack sprained his ankle, or rather had it sprained for him Friday night when a class activity of indoor soccer resulted in a sloppy slide-tackle from a friend.  Praying for quick healing.

And this weekend, the blessing was an escape to Brackenhurst, a nearby Baptist conference center, where the AIM Women's retreat was opened to missionaries from other companies.  Our Serge group shared a room.  Sort of like summer camp for women.  Speakers, crafts, worship, small group, skits, talking late, testimonies, questions, meals.

And ever looming closer, Scott's departure on Jan 31 for Liberia.  In this context, the spiritual challenge to surrender to God's will, the encouragement of prayers and friends, was well timed.

So that is life.  Texts and phone calls and hearts going out into time zones all around the world, as we talk to our kids.  Cheering at games, reviving gasping babies, teaching interns, seeing patients, making phone calls, planning for our mission, listening and encouraging.  Making dinners and doing laundry.  Holding on through a minor virus.  Meeting with team.  Early morning runs.  Answering emails.  Walking back and forth, C-sections and rounds.  And trying not to really think that in six days life turns upside down.

Duke and the Call to Prayer

For the last week we've been in Ireland meeting with the leadership team of Serge.  Twice a year Area Directors and the executive leadership congregate to pray and discuss, to set strategies and discern objectives.  These are "our people", comrades in the battle for two decades.  It is good to be together.  We affirmed a focus on the poor and vulnerable, a theology of the cross, a call to spiritual formation in leadership, a desire to diversify, a commitment to building infrastructure and publications and training.  These are the kinds of rallying cries that reflect Jesus shining through.  Inspiring stuff, particularly in the nitty-gritty context of praying through the hard times we experience as we move out.

And while we were there, the Paris shootings and Nigerian Boko Haram massacre were in the headlines.

Which provides the context of cross-cultural living in the 21rst century.  Terrorism.  Religious divide.  Hate.  Extreme measures.  And glimpses of heroism and unity; the African immigrant who protected Jewish victims, the outpouring of emotion as marchers and activists identified with victims.

And in the middle of all that, the announcement and retraction that Duke University would institute a weekly Muslim call-to-prayer from the chapel's bell tower.

Which, I confess, I find very confusing.  On one hand, it strikes me as ridiculously "politically correct" to suggest that a private University founded by Methodists institute a public Muslim proclamation from the iconic center of the campus.  Yes, the bell tower does chime bells.  Which carry the tunes of hymns, recognizable to those raised in that tradition, and quaint background melodies to those not aware.  They do not amplify preaching, or the name of Jesus, or a creed which is officially espoused.  The Muslim call-to-prayer, on the other hand, harkens to a history and an area of the world where religion and politics are one.  It is a declaration of a particular faith.  It is loud and universal in many countries, and carries a social pressure and assumption that all stop and participate, which is probably close to the medieval roots of bell chimes and church services.  It is a carry-over from an age before watches, and has persisted because it enforces religious control.  The idea of instituting this from a Christian chapel in the very week when the world is reeling from two terrorist attacks carried out in the name of the same religion, well, that struck me as inflammatory and peculiar.

However, in reading the responses of people, I feel compelled to remind us that Muslims are not our enemies.  We are not here to prove ourselves right.  We are not compelled to defend our territory. Giving Muslims a hospitable worship environment for one hour of the week is not equivalent to the loss of America or civilization.  Jesus didn't really spend a lot of time insisting that the government stay true to Judaism, or criticizing Roman beliefs.  He did spend a lot of time challenging us to love our neighbors.

So, Duke, how can we actually love Muslims?  Personally I think the call-to-prayer broadcast is polarizing and political and misses the point.  It causes more divide.  But getting to know individuals, affirming them as humans, listening, welcoming, encouraging dialogue, giving voice to the moderate muslim majority, fostering respect on both sides . . these are the activities that prevent Charlie Hebdo hate.  This is, I believe, at the heart of the Duke ethos.  Connecting individuals, a few at a time, to actually know each other.  Christians coming in the name of Jesus to share their lives, to heal, to honor, to worship, to enter relationship, this is what changes the world.  Not drawing a line in the sand to restrict something that to Muslims is a part of their culture. Yes, affirm truth, but do so in love.

So it's complicated.  And in those complicated situations, let's stick to what we KNOW is right.  Love does not set up us vs. them.  Love wins, by losing.  

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.