. . . . And August is a wrap . . . but the next two months look uncertain

None too soon, this month is behind us.

As I type, the nation of Kenya sits glued to radios, waiting for the news from judges who we hear may have flown to a game park for seclusion all week, sifting through documentation to decide whether or not to call for a new election in 60 days, or uphold the results.    Television cameras follow the leader of the opposition.  But most of the nation feels tired.  Tired of being on edge, tired of being lied to, tired of rumor and unrest, tired of corruption and strikes.  Whatever the outcome today, we are praying for a just peace.  A lawful way for Kenyans to continue to sharpen their future course and competing visions, without bloodshed.

This month has taken a toll.  As evidenced by this blog being unusually dormant.  So, a glimpse of the life that flowed by in the last few weeks.  Because we stayed open at the hospital, and life went on in spite of politics.

NAIVASHA

This baby came in having lost 41% of his birthweight.  That's almost half.  I hesitated to photograph him that day, he was a skeleton.  Now he's half-way back to healing.  A year ago he would not have survived, but this Naivasha team has come a long way on treating critically ill infants.  

This woman spent the first 24 hours of her labor being turned away from 3 hospitals, traveling about 75 km on public matatus (small buses) from Nakuru, the county seat with the biggest public hospital where she was turned away because of the nursing strike, to a private hospital in that town where she was turned away because her husband's savings of 6,000 shillings ($60, a month's wages for a laborer) were a pittance compared to the thousand dollars required for a deposit, to a Catholic private hospital where they were told no room at the inn (they thought the baby by that time would need nursery care, and the newborn unit was full), to Naivasha, because her friend called my friend who contacted me.  She needed a C-section, and we really didn't think the baby would survive all that, but he did.  So the anguish turned to joy, but this picture gives a face to the reality of ordinary Kenyans this year with its strikes and shut-downs.  And shows why it is important that at least one hospital with public access (maternity care is $5) remain available.

Meanwhile many other Kenyans go to private clinics, which have criminally hiked their fees by tripling them to take advantage of the situation.  These clinics are often little more than a shopfront and beds, and ill equipped for sick babies.  So then they transfer them to us, often too late.

I've had three abuse cases this month, which has also been an emotional challenge.  Two beatings and one horrific rape of a mentally disabled 5 year old.  Perhaps the strain of this month puts children at increased risk.  You can't work long here and not believe in evil.

But you can also not work long here and not believe in hope.  In miracles of healing, in the determined love of mothers, in the resilience of families.  We have had THREE SETS OF TRIPLETS born in August, and 8/9 are surviving.  Plus numerous twins, pneumonias, TB, infected knees, brain infections, seizures, jaundice, liver failure, poisonings, etc etc.  And most have revived to go home.

And teaching continues, with interns learning to care for the kids that come in.  Rounds, lectures, practice with manikins, drills, questions, explanations.  This is what we do, day by day, in the context of real patients, building on the care these young people will provide for decades to come.

KIJABE

We also did our weekend of call and work at Kijabe, which is a juxtaposition of very complicated children who are challenging to care for and make the experience edgy, and cheerful competent colleagues who make the experience delightful.

These are again, human parents, struggling to do their best, and we work hard to partner with them.

SERGE

Another Bundi kid comes to RVA.  Pray for E, she is leaving home for boarding in 9th grade.  IT IS HARD.  Like moving the college goodbye up by 4 years, and throwing in an international border and 23 hours of driving.

Another HUGE PERK of being an Area Director, we become alternate grandparents.  What a joy to welcome baby Jacob.

We had a weekend retreat with the Kijabe team, hikes and prayer and food and reunion.  Very refreshing.

JULIA

Julia came!!!  After a summer internship working with the Royal Botanical Gardens in Jordan on biology/ecology/research/preservation, plus studying some Arabic, she finished her summer break up with us. We were stuck mostly working in Naivasha due to elections and absence of most other workers.  But we had wonderful walks, she made us a garden, went on retreat with Kijabe team at the end, watched Man U football, ate wonderful meals, talked and rested and prepared for the next term.

Her arrival.

One day we even went down to the lakeside for local fried whole tilapia.

Our old house, where our friend Abigail still works for a new family.

The garden she planted for us:  spinach, sukuma wiki, basil, and cilantro.  Plus a random two tomato plants that grew from the compost. 

The goodbye.  

And one more lovely photo.

And as a reward for making it through this post, history took a turn around an unexpected corner while I was working.  The Supreme Court announced that the Presidential election will have to be re-done.  There was enough irregularity to cast doubt on the result.  Shocking.  Hopeful, in that I believe it takes courage to rule against the inertia of the incumbency.  Unsettling, in that the strikes will not be resolved, and we don't know how the country will react.  SO KEEP PRAYING.

Eirene--Peace to you

As our church here progresses through John, we reached chapter 20, the post-resurrection appearances of Jesus.  The first words out of his mouth, repeatedly, are "Peace to you".  So I looked up the words on my handy Bible Hub app where one can find the actual greek, and links to all other uses.  48, to be exact, but what jumped out is that a significant portion fall in three times:  the angels announcing Jesus' birth (peace to all humans), the crowds rejoicing in Jesus' entry to Jerusalem (peace in heaven), and Jesus' post-resurrection reassuring greetings to the followers (peace to you).  The coming of the Messiah into human history, God says, brings peace.  Yes, I know there are other passages about judgement, a stone on which people stumble, persecution, the cross.  Those are true.   But the end-game is peace.

This, this week, is good news.  I don't know about most churches, but ours is probably similar to 1rst century Palestine in that politics, war, unrest, and injustice seep into the prayer time.  We talk about the nations.  About the elections.  We pray for peace.  We talk about floods in Houston and violence in Virginia, about threats from North Korea or riots in India too.  But mostly we pray for Kenya, which is only appropriate since that's where we all live. Tomorrow the Supreme Court is expected to rule on the validity of the Presidential election.  Schools have reopened and most people are trying to get back to life on a normal pace.  The court is unlikely to change that trajectory.  But there are still unanswered questions about ballots and numbers, and the initial confidence of the international observers has been slightly dampened by the suspicious obstructions of those in power.  So we all hold our breath a bit, waiting to see.  What will the court rule?  How will the losers react?

In this context, it is good news that Jesus brings peace, peace that is more than just an internal assurance of an otherworld escape.  The peace Jesus talks about riled up the powers that be because it has implications for the here and now.  That peace is based upon reconciliation, the breaking down of barriers, the foundation of love which allows us to rest from the scrambling conflict of self-protection and promotion.

Please pray for Kenya tomorrow, and for our world daily, that peace would permeate us all.

80 Days...

Every once in a while, I (Scott) must chime in to tell a story from the Obstetric side of our shared building.  Pull up a chair and a coffee, this will take a while.

This is a story of creeping towards and then slowly backing away from the precipice of death – many times. This is the story of Mary (not her real name).

On May 26^th, one of the medical officers on our service performed what seemed like a relatively routine Cesarean Section on Mary.  For reasons that are not clear to us, she developed a severe post-operative infection a little less than a week after her surgery.  The infection was so severe, she was taken back to the “operating theatre” for a re-exploration.  To look for anything that could have been left behind in the previous surgery (like a sponge or gauze).  Nothing was found.  The abdomen was washed out and second-line antibiotics started.

A week later, the surgical site opened up again showing more signs of severe infection.  She was taken back to theatre for another exploration.  Again, no explanation found.  Washed out.  Closed. And taken back for more post-operative care.

At Naivasha District Hospital, we don’t have the benefit of microbiologic cultures, so we could not culture any of the fluids or pus.  We had no way of knowing what bacteria was causing this infection or which antibiotic would best fight the infection.  But shortly before this event, Jennifer had sent a baby to Kijabe Hospital who was critically ill and beyond our capacity.  They did blood cultures which grew a bacteria (Klebsiella) resistant to all but two antibiotics. Based on that culture result, we began to wonder if Mary could have been infected with this resistant Klebsiella (there is a lot of traffic between the Post-Op Ward and the Newborn Unit).  At this point, I began to doubt whether Mary might survive.  She was critically ill.  She should have been in an ICU, but that was beyond our capacity and her financial resources.  And our hospital didn’t even have either of the ideal antibiotics to fight the Klebsiella.  So, I decided to go to an outside pharmacy and purchased the Meropenem out of our own pocket.  That pocket is not really my own.  We live and work in Kenya as the hands and feet of many generous churches and donors.  From their generous support, I was able to buy a full ten days’ worth of Meropenem at a cost of about $500 (which is about 9 months’ salary for the average person in our area).

After a few days of the Meropenem, Mary started to improve and I began to feel hopeful, but then I came in to change her abdominal wound bandage and found fecal material oozing from her surgical wound.  Somehow, her bowel had been injured in the second exploratory surgery and now her abdomen was filling with feces.  We called the general surgeon.  Understandably, he didn’t really want to touch her.  She’s like a hand grenade.  Nobody wants to be the last one to touch her before she dies.  But finally, he was convinced and he did yet another exploratory surgery.  Surprisingly, he couldn’t find the bowel injury.  So, he did a colostomy on the proximal part of her gut to let the lower part “rest and heal.”  This left her with a stump of intestine draining from the skin into an adhesive bag.  And the hospital didn’t have these in stock either, so we purchased those @$12 each from the outside pharmacy (who gave them to us at his cost).

After getting the colostomy and a full course of Meropenem, Mary finally turned the corner.  She began to gain strength and to eat again.  She grimaced whenever the colostomy bag had to be changed, but she improved.  She got her baby back from the nursery and began breastfeeding again.  The milk came back.  But she still had that colostomy.

The surgeon said he would reverse the colostomy after six weeks.  That put the surgery date perilously close to the Presidential Election.  But we thought it could get done.  And then the surgeon tragically died.  That is a story for another time.

So, we had no consultant surgeon to reverse the colostomy.  What to do?  There is a law that government hospitals are not supposed to refer patients to private hospitals.  This is to prevent a conflict-of-interest scenario in which a government employee refers patients to a private facility in which they have a financial interest.  But in this case, I felt like Mary’s best hope was to go to Kijabe Hospital where there are competent surgeons (who I know).  So I contacted Kijabe and the head of surgery agreed to take her.  That was contingent upon her clearing her bill at Naivasha and paying for her care at Kijabe.  The estimate for the care at Kijabe was going to be about $1000.  With the help of our donors, I thought we could handle that.  Maternity Care in Kenya is “basically free” (subsidized by the government).  Her bill at Naivasha was $5.

Mary’s experience at Kijabe was amazing.  Her colostomy reversal went smoothly and she was discharged after five days.  And while we expected to pay the bill, it turns out they had registered with the Kenya National Health Insurance plan (NHIF) which paid the entirety of her Kijabe bill.  I had given the husband $300 for the initial deposit.  That was refunded to him upon discharge and amazingly enough, he brought that back to me.  That was a true demonstration of his thankfulness and appreciation.

Unfortunately, two days after discharge from Kijabe, Mary’s wound started draining bloody fluid.  Seriously? Yes.  So she was admitted back to Naivasha Hospital – again.  We dressed the wound and Mary spent the Election week in the hospital. 

For ten days we dutifully dressed the draining wound and slowly but surely the drainage dried up.  Today the wound is dry.  And today Mary was discharged home.  80 days after she had her first baby.

It’s a tale of prayer and perseverance.  I don’t think we can necessarily step up with these resources in every complicated case, but God put Mary in my path and seemed to call us to action.  So thankful today for her great smile and her life.

Soli Deo Gloria.

(photo used with permission)

From Nairobi to Charlottesville . .

Last night the IEBC finally finished their tally of papers confirming the election results, and announced the incumbent Uhuru Kenyatta of the Jubilee party as the winner.  This was the culmination of four days of anxiety, anticipation, rumor, interviews, waiting, accusations, protest and a general sense on the part of the population that anything could happen in spite of fairly consistent updating of results electronically projecting the Uhuru win.  Many stayed close to home, many businesses remained shuttered, many essential services were suspended, as people protected themselves.  Even the announcement was incredibly drawn out as the chairman's speech was paused for important paper-signing by officials, and as he laboriously read out the votes (and percentage) for each of ten candidates in each of 47 counties.  As our friend Martha said, it was like sitting through a graduation for 470 students.  We watched on a Kenyan TV station right to the bitter end when the President gave a conciliatory and unifying speech about 10:30 pm.  Soon after we could hear wildness from town, but it was happy wildness.  Horns, music, shouts, vuvuzelas, cheers.

The opposition, however, had walked out of the process as the Uhuru victory became more and more inevitable, and ominously declared that this time there would be no legal option in the courts.  So while half the country cheered, about another quarter exploded in anger met with swift repression. Previous and current interns we know from opposition strongholds in Western Kenya posted on social media about tear gas being lobbed into residences, about gunfire on the streets.  The Guardian reports 24 deaths based on data gathered by Human Rights Watch.  Reuters earlier reported similarly. In contrast to all that, here in Naivasha I had an intern show back up to work, and a friend who had stayed next door out of fear moved back home confident all was fine, and people went about their business normally today.  So . . . even up close to events, it's hard to really know.  All we can tell is that multiple sources confirmed that Uhuru won a majority, and that left the areas where Odinga won 90% or more feeling defeated, disenfranchised, cheated.  Youth and poverty and desperation and hateful speech are a volatile mix.  The line between a protest and a riot is vague here, with burning tires and throwing rocks and looting shops.  And given the history, the government security reacted with deadly force, justifying that a quick few bullets would end the uprisings quickly and save lives in the end.  But at a high moral cost.  Shameful that politicians excluded from power encourage the young men to cause chaos; shameful that the politicians given power use it to kill.

Which brings us to Charlottesville, where we met on a street corner at UVA 37 years ago.  For 36 of those 37 years it would have been unthinkable that people would parade with Nazi swastika flags mixed with confederate flags, on the absurd premise that white history was under threat of being forgotten because the city wants to rename a park to recognize the Civil War resulted in the emancipation of human beings.  It would have been absurd to imagine the national guard and riot police, violent confrontations, a declared state of emergency, an unlawful assembly. Thankfully students and people of faith and people of conscience formed a counter protest.  The news is still evolving.

Kenya and Charlottesville.  Tribalism.  Fear.  Political manipulation.  Power based on inciting hate.  Identity formed in sharp contrast to the terrifying "other".  Few ideas, quick violence.

This is where we tend without an otherworldly infusion of love.  Tomorrow let us gather and pray and go back out into this mess determined to love.  It's been a hard week.  I know I've been resentful, and felt alone.  The tiny lives that have been held up this week seem a drop in the bucket.  But that's where it starts. If we can humbly do hard tasks in small places, at some cost to ourselves (it was not my ideal to work long hours alone the week Julia came to be with us), so that others can thrive . . well, that's the cross, and we're promised that changes the world.  From Nairobi to Charlottesville and beyond.

Election Anticipation Mounts: Almost Over???

Another 48 hours has gone by, and we still wait.  The IEBC constitutionally has 7 days to count the votes and announce the results.  The TV stations have hours to fill.  So we have continuous reports, rumors, accusations, occasionally suspended when the very confidence-inspiring CEO of the IEBC comes on to calmly explain what is happening next.  

The opposition claims that the official numbers are wrong, that even if the international observers testify to the integrity of the process the opposition alliance has their own vote tallies that prove their candidate leads.  Since corruption and injustice are realities in this place, people take these accusations seriously, particularly in the poorest areas of the country. The opposition candidate gave an exclusive interview to CNN last night basically saying that the electronic transmission of data was unreliable, and he can't be responsible for his supporters if their protests turn unruly. The police prepare to respond.  The international observers including John Kerry are shown intermittently giving details of the process and lending their credibility.  The IEBC calls for patience.  Now 288 of the 290 regional collected reports coming from the 40,883 polling stations have been received and verified on paper, which involves tables of people from all parties physically handling and viewing results.  The final two reports require the presence of the election officials who submitted them to answer questions, so that seems to be what we're waiting for now.  The incumbent President who per the IEBC electronic data (that we're all waiting for the paper ballots to confirm) remains 1.3 million votes ahead, and silent in the media.

Calm Naivasha

Police on horses . . not a common sight . . 

And Kenyans collectively hold their breath.  Babies are born, a 24-week preem delivered on the way from Suswa to Naivasha in the darkness of early morning, .  Kids cough and wheeze and need IV lines.  Nurses and nutritionists and lab techs do their jobs distractedly, clustering around radio reports on their phones or gathering in  front of the lobby TV.  Shops in Naivasha remain largely open, at least half have couches and shovels and T-shirts and mattresses stacked on the roadside.  People meander to the market, the boda motorcycles buzz, the matatus call for business.  In spite of an order that government employees had no excuse for failing to report to work, NO ONE on my team did so today.  Again.  So there is a peculiar overlay of normality, a tense undercurrent of bracing for chaos, and a wearying wait for resolution.

I think my favorite quote of the week came from an article that interviewed a woman in a shop: ""Elections are always bad news for us poor people. I have to pay bills and feed my children. I don't care who wins." 
And I'm told the youth in the slums are coining a slogan that roughly says "We won't bleed for you to lead".  Kenyans have risen up before, and found out that they paid a high price while those they supported did not suffer quite the same way.  One of my friends predicts that there will be brief violence, the police will respond with deadly force, and the collective emotional turmoil will quickly dissipate in favor of survival.

After the election, we still have to live together.  Please do pray for tonight, that there would be a clear winner with a transparent process, and that Kenyans would not die in the process of accepting the results, and that the winner would work for justice rather than personal power.  And pray for us. After a cup of coffee and a cookie, it's back to the sorrows of the world, just called for a sexually abused child, and feeling that I personally have nothing left to give, and don't like how this week pushes on my heart in bitterness.

Election Exhaustion

Polls in Kenya closed 22 hours ago.  And results have been flowing in, live.  The IEBC, the nonpartisan agency that manages the election, has a live-feed web site.  As polling stations report their data, the tallies climb.  At this moment, 39 thousand of the 40 thousand sites have reported, and the incumbent Uhuru Kenyatta is ahead with 54% of the vote.  He also must win at least 25% of the vote in 24 out of 47 counties, but the data is not geographically disaggregated so that's not clear.  Though the live feed is reassuring, the final declaration will not be official until the head of the IEBC confirms that all is in order.

Not surprisingly, a few hours ago, the main opposition candidate who has 45% of the vote went live with a nationally televised press conference.  He alleges that when the head of IT for the IEBC was murdered a week ago, the murderers got his password and then used it to alter the electronically transmitted data.  He claims the numbers we are seeing are manufactured, and that he is the real winner, and called for protest which could easily turn violent.  People are clustered around TVs and listening to phones, shaking their heads, saying we have to wait and see what will happen.

Meanwhile for the third day in a row, the hospital remains nominally open but with a limited work force.  The nurses were already on strike so we were operating at reduced capacity with temporary nurses.  I had one intern and my colleague pediatrician on Monday morning, but since mid-day Monday I've been working alone.  I thought I wouldn't mind, but it's been a rough couple days.  Monday evening I ended up back in the hospital because a child whom I suspected had been abused still had not had the scans she needed; thank God for Kijabe friends who agreed to take this little 19-month old with scratches and bite marks on her body.  I had to fight hard to get an ambulance after losing my battle to get them a head CT here.  As feared, she had evidence of bleeding inside her skull which could only have come from trauma.  Yesterday as I was struggling with an IV in an 800 gram preem who has been pricked and poked and shriveled for almost 3 weeks, the day nurse in the Newborn Unit slipped out.  There was no afternoon/evening nurse on duty it seems, and she was DONE.  I turned around to ask for help, and found I was alone in a room full of infants, with a needle in baby's neck, and no way to reach gauze or tape.  I could reach my phone and eventually someone came (who was an angel in disguise) but she left to her duties and I ended up babysitting until a nurse could be convinced to double up her post-partum ward OB duty with covering nursery.  In the meantime a mother of preemie twins had been sent home from a clinic in Mai Mahu even though the 33 week babies were less than 3 pounds each, and one died, so she came to Naivasha with the survivor wrapped in six layers of blankets.  I hadn't even had so much as a drink of water all day, so I went home around 4 only to be called back for a dehydrated infant who had been tragically, perhaps fatally (we will see) mismanaged by a private clinic in town where his mom turned for help because of the nursing strike.  He survived the night after fluids into his bone marrow, and is a little perkier today.  This morning however started tragically as I walked in and found the Paeds ward nurse doing CPR.  She hadn't had time to call, but this was the second baby to die within an hour.  Both had some form of encephalitis I think, with fevers, decreased consciousness, seizures, but both had been treated for about 5 days and seemed stable.  We think moms start to worry and want to feed the babies by mouth (though each had a tube for feeding) and then the seizing babies choke . . The first body was already wrapped up, and her mom had fainted on the floor, the second one I tried to revive for about ten minutes but she was long gone by then.  So two moms to pray with, hug, explain, listen, say sorry over and over, call relatives, fill out death forms, wring my hands, wonder what we could have done.  Even though the patients are few now, most are ICU-level sick.  It is humbling that even acting as primary intern-resident-attending-combined, I can't save them.  But I had to go on from there and see the other patients, write notes, draw blood, talk to families, order medications, and all the normal parts of the day.

Intern work . . . 

There is supposed to be a nurse in this picture

So dehydrated, cold hands, the monitor can't read

no one in this picture is listening to my call for help . . 

find the preem in the blankets . . 

Then on the way home, a stop in the police station to file an official report of the abuse case, since the social worker is gone all week (she's working as an election-official too it seems).  I found the Child Protection Officer loading his rifle with ammunition, alongside another officer, which was pretty unsettling given the uncertainty that abounds.  He was professional and kind, and I do appreciate Kenya's attempt to investigate and protect children.  After that unpleasant duty, home to more election news . . .



So the week is only half over but feels quite long.  Kenyans are collectively anxious.  Will the results be confirmed?  Is there any credibility to rumors of fraud?  Peaceful acceptance would be good if the results are legitimate; if there has been injustice then we are hoping for lawful responses involving the court, and not a call to revolt.


So . . . in short, the post-election has been quite tiring.  Living hour to hour when you don't know what will happen takes a toll.  Bumping up against raw evil in a beaten child, an abandoned baby, hungry children, without having others to share the burden with, takes a toll.  Failing patients and grieving with their families takes a toll.  Listening to the rumors, the suspicion of the electronic data (it's all made up, the same old fake news accusations that rile up America too) takes a toll.  Knowing that corruption abounds and not knowing who to believe takes a toll.  Being responsible for all the Serge families in Kenya takes a toll.

I think the prayer now needs to be for clarity--was the system compromised or not?  If so, pray for the courts to respond.  If not, pray for the citizens to accept and the rumors to be disproven.  And pray for all of us to remember that God is not surprised, that God sees the truth, that justice will win in the end.

Election Day

For today, just listen to the national anthem (or here choral) while praying for Kenya.  The melody is haunting, supposedly based on a Pokot traditional lullaby, and so unlike many of the national anthems around the continent which are pompous trumpeting of European tunes.  Here are the words:

Ee Mungu nguvu yetu Ilete baraka kwetu Haki iwe ngao na mlinzi Natukae na udugu Amani na uhuru Raha tupate na ustawi.	Oh God of all creation Bless this our land and nation Justice be our shield and defender May we dwell in unity Peace and liberty Plenty be found within our borders.
Second stanza
Amkeni ndugu zetu Tufanye sote bidii Nasi tujitoe kwa nguvu Nchi yetu ya Kenya Tunayoipenda Tuwe tayari kuilinda	Let one and all arise With hearts both strong and true Service be our earnest endeavour And our homeland of Kenya Heritage of splendour Firm may we stand to defend
Third stanza
Natujenge taifa letu Ee, ndio wajibu wetu Kenya istahili heshima Tuungane mikono Pamoja kazini Kila siku tuwe na shukrani	Let all with one accord In common bond united Build this our nation together And the glory of Kenya The fruit of our labour Fill every heart with thanksgiving.

Amen.