What is It?

This morning my reading fell in the book of Exodus, following a historical/sequential read-through-the-Bible in one year plan.  Some background:  such dramatic stories, but we often forget the years of less glorious preparation God puts His chosen leaders through.  Joseph was a slave and a prisoner from age 17 to age 30, with no glimmer of assurance that he would ever see his family let alone freedom again.  Moses was a third-culture kid who straddled two ethnicities and then was self-exiled into a third, managing livestock in the wilderness for his father-in-law when God propelled him to leadership.  All through Genesis God upsets the normal order of the firstborn, raising up younger siblings to rule the older.  And takes those leaders through long years of wilderness, conflict, alienation.  Most of the time they had little to go on other than God's unlikely promise.  It was a conditioning by service that strengthened them for the moments of truth.

The same thing happens to the entire nation of fleeing slaves, after four centuries of oppression they go out from Egypt "with boldness".  Which lasts precisely three days.  At every obstacle (which are admittedly quite frightening obstacles, facing annihilation between an angry pursuing army and a seemingly impassible sea, facing starvation and thirst in a hostile trackless waste) they immediately panic, and blame Moses, questioning his leadership.  Why did you bring us here, you should have thought of this.  Or worse, you purposely put us in jeopardy.  Which had a slightly familiar ring to it as former remote-place leaders, when our team faced hard times.  Why didn't we prepare better, anticipate, prevent?  

And over and over Moses takes the issue straight to God, and over and over God patiently provides.  Which brings us to today's story.  

The people are hungry.  And God sends food, in the form of a seed-like dusting of flour that can be made into bread, with a flavor of honey.  When the people walk out the first morning and see this substance spread over the landscape, they say "What is it"?  Which sounds like "manna" in Hebrew I suppose, because that is how the food gets its name.  Manna is a skeptical question.  It was not immediately obvious to the wandering hungry Israelites that this was food.  It wasn't the answer to prayer that they expected.  Provision, obscured.  

I wonder how often I look at God's mercy and say, "What is it"?  How often I fail to recognize the good in what God sends?  

As we enter our second year at Kijabe there are still losses and questions that have not fully settled in my heart, and looking at this year with Caleb going one way and Luke another and balancing responsibilities, well, it looks about as appealing a gathering a seedy white ground-cover to cook with.  Today I helped a visiting family medicine resident resuscitate a tiny preemie, put in a UVC, intubated, made decisions, set up a ventilator.  I could not have done that a year ago.  Progress?  But then I returned in the evening to orient a visiting doctor with astute questions I couldn't answer, and happened upon the baby as he was deteriorating and failed to get the tube in again.  Sometimes I get tired of always feeling like I'm catching up, not quite where I should be.  Is this provision, this constant tension of more to know and do than I can manage?  We lost the baby's mother.  Is this provision, daily exposure to heartache?

For now Kijabe is my what-is-it.  To taste the honey-tinged wafers one has to go and gather.  This weekend we also spent a lot of time just being in community here.  And it was sweet.  Two couples whom we've met over the years, long-term Kijabe docs now departed to more frontier missions, were back to visit.  A medical student whom we've been working with, processing and hanging out.  Four other moms who help with class activities, baking about a thousand cupcakes and cookies for Valentine's sales, learning a little more about their lives as we poured batter and stacked cookies.  Two families who have been here more than twenty years accepting our invitation to pizza and telling us some of their story.  A friend we've made over the last year coming to us with a medical issue.  My partner dropping by with precious Starbucks coffee.  This is our community now, and I am growing in appreciation.  What at first seemed intimidating and difficult to penetrate is now beginning to look a lot like a gift.  I am thankful for these people, and the richness of our interdependence.  It doesn't look like our old team at all, so it was hard to recognize the manna in this place.  But it is here.

Jesus, of course, is the real manna.  The real provision.  And the real "what-is-it" as He consistently defies expectations.  He wasn't recognized as God's gift when He was alive, and many of us stumble over they way he diverges from what we hoped God would do.

In 2012 I know we will be sustained by the daily freshness of God's mercies, however challenging they are to recognize.  Praying we will all taste of the goodness.

Tribute to a Cow, DMC (1997-2012)

We received news recently from Bundibugyo that our longtime dairy cow, Dairy Milk Chocolate (DMC) died.

"Where your treasure is, there will your heart be also." (Matthew 6:21)

We invested much sweat and money (for medicine, food, local labor) to keep the milk flowing from DMC's udders for the good of our children and our team over many years. Basic investment and return -- turning our money into fresh milk. But investing in a living creature has a consequences and I (Scott) have found that leaving behind my dairy cow was arguably the most difficult aspect of uprooting from our home in Bundibuygo. So, this week I traveled down memory lane revisiting the years with our friend and sustainer.

This story begins in the post-ADF war days of 1999-2000 when our mechanic (and farming consultant) in Fort Portal had some personal problems and needed to raise some cash. We had talked with him about bringing one of his dairy cows to Bundibugyo and this was an opportunity for him to make us good on our promise. So, Pat and I purchased one of his young cows for about $250. Pat chose the name based on the color of our cow which resembled Uganda's favorite milk chocolate bar. We gave him the money, but let him keep the cow since our pasture wasn't ready and the security of Bundibugyo didn't seem conducive to keeping domestic animals.

Several years passed. Our mechanic had improved his financial situation, but eventually cycled into deeper and more complex personal problems. At one point, this friend had lost everything (wife included) except his two children and DMC. It's the only thing he had to feed his two young children. At that point, I said "Keep the cow. It's my gift to help you sustain your family." Eventually, he turned his life around. His wife returned, he repented of the behaviors which led him into crisis and loss. But eventually he needed help to rebuild his business and re-buy a set of tools so he could begin to work as an auto mechanic again. So, he approached me (I had bought out Pat's shares because of her personal need for cash!) and asked me if I would be willing to buy DMC-- again!! I agreed - but decided that I wanted immediate delivery. I wanted my twice-bought redemption cow. So, we prepared: fenced the pasture, built a milking shelter, constructed a feeding trough and water trough, bought milking buckets and storage containers. No small additional investment. We took delivery of DMC in December 2005. She was giving milk at the time - for which we were so thankful. There's nothing like a bucket of warm frothy fresh milk which you've squeezed out yourself.

Things all seemed to be going well for several months, but the milk abruptly changed quality about eight to nine months after we got her. At one point it almost solidified in the bucket. About this time, Matt Alison and I undertook a bike ride over the Rwenzori mountains to Fort Portal, a blistering 100 kilometer ride. Halfway across the mountains, I called home on my cell phone. Julia answered, "Dad you won't believe it!" I'm thinking, what about me? Don't you want to ask Dear Old Dad how the brutal bike ride is going? Instead I patiently asked, "Julia, what is it? What happened?" She exclaims, "DMC PRODUCED!!" (translation: gave birth). "What!!!!" Long story short: Our mechanic had attempted artificial insemination the month before he brought DMC to Bundibugyo - but never told us! Despite her ever-widening girth, buckets full of custard-like colostrum in our milk bucket - we still never put it together -- until a calf popped out. Whoops.

We named that calf "Ghiardelli" - in honor of his dark chocolate color. We had no use for him (pasture seemed too small and I couldn't really imagine raising him for the purpose of steak) so we took him to our friend's farm in Fort Portal (after a few months of bottle feeding).

In order to keep milk flowing, a dairy cow must keep getting pregnant. Ideally, 6-9 months after her last calving, she's bred again. With no electricity and no cows in Bundibugyo, artificial insemination was not possible so we were forced to bring a sire. Our farming consultant in Fort Portal gladly sold us a stud who we named Sir-Loin. We hoped that his loins would procreatively keep us supplied with fresh milk - but without the same emotional attachment we had for DMC. We intended to let him do his work -- and then eat him. He was a good steer. Mean as all get-out. He got out of the fence a few times and ran down to Nyahuka creating sheer pandemonium. No one had ever seen such a strong and fierce animal. Unfortunately, he developed a joint infection which killed him before we could ever eat him. His daughter (and DMC's second offspring for us), we named "Truffle", for her swirling mixture of whites and browns.

DMC's next husband, came from a local herd. I was done with ridiculous cost and headache of bringing animals from Fort Portal. In my mind, we just needed a pregnancy - not a Kentucky Derby stud. On one of my local bike rides I spotted a healthy looking guy with Texas longhorns and a wizened shepherd. I sent my negotiator. For $15, we rented the guy for a month. We called him Shadow since he never left DMC's side. Insatiable he was. And effective. Nine months later DMC gave birth to "Oreo" (named for her black and whites sandwiched together).

Shadow did come back for a repeat performance this time with both DMC and Truffle. Polygamy is common in Uganda - and it was darn convenient for us. Mother and daughter delivered after we left Bundibugyo. Truffle continues the legacy of her mother providing milk and for the entire Bundibugyo Team.

DMC. Some called her "Dr. Myhre's Cow". In Uganda, DMC is also an abbreviation for "Dangerous Mechanical Condition" ("You see that DMC truck in Nyahuka this week…man, that muffler needed replacement!").

She was as gentle a milk cow that ever trod in Uganda. She was God's provision for us and to Him I am thankful for the privilege of having her.

the rest of the week

The rest of the week, outside the NICU, music and community and sports and celebrations and just plain life. RVA choir sang this morning. Strong voices, inspiring song. You can see Caleb and Julia, but Acacia is in the front row of girls on the left that are perpendicular to our view. Caleb was asked to help lead worship for church today, with teacher/coach Ryan Dahlman and some other kids. He and we were thankful for this opportunity. I remember a little book I made the kids in poetry form: the Bundibugyo Bhana bhana (four kids) when Caleb was about 4, and described him as musical even then. He has taught himself guitar over the last few years. In the middle of the set of songs I started thinking about how much I'll miss him next year. Tears. Julia and Acacia went on a hike with me on Saturday morning, exploring a new path I'd been curious about . . .note Mount Longonot in the background. Note Acacia beneath a spectacular Acacia Tree. And by a dry river bed. The rains finally stopped in the last couple of weeks, and dry season blew in. The days are suddenly hotter, but the temperature still drops with strong winds at night. Amazing to me that we live in a place where we can walk out our front door and hike for an hour in relative wilderness. Girls' soccer season begins: two games for Julia this week, and one for Acacia. The Kijabe community's annual gathering to celebrate Dr. Ase Barnes' birthday, his 16th here at Kijabe and his 79th here on this earth. The Barnes leading Wednesday morning hospital chapel, singing in Swahili with the pathology and chaplaincy departments, accompanied by the accordion. I only hope that by the time I'm in my 8th decade I half as much fun and inspiration as they are. Ryan left this week, the little boy who almost died Christmas night, with TB and heart failure. Because his mom lives in a single room with four kids and an open fire for cooking, he could not have oxygen there, but transferred to a smaller clinic nearer his home. Pray for his lungs and heart to heal.

I've been thankful for a couple of times to pray with friends this week, to talk about life or hard things or decisions. To skype with Luke. To have pizza with our old friends the Chedesters, to create meals. To be more than a paediatrician, even though I love it, to remember there is more to the week.

Unsung Heros

Today let us honor the unsung heroes of the NICU: the moms. I don't think I'd look as peaceful as Felister above if I was on my 52nd day of sleeping in a hospital ward, well, not sleeping much, because these moms get up every two hours and come into the nursery to feed their babies. Maxwell is almost ready for discharge. It has been a long push, and sometimes the last few days are the hardest! This is little Mark-Paul, who is only 3 pounds even though he was born at term. He was severely growth retarded. So his mom had to go through a FULL LENGTH pregnancy and delivery, and NOW has to stay as long as most preemie moms caring for him in the nursery. Brielle's mom is all smiles because her preemie has been a star--she's sacked out skin to skin after a feeding. This is one of the few couples where the young dad comes regularly too. I'm rooting for this little family. This baby's mom laid down her life, almost literally, to bring her into the world. Here she's being held by a nursing student, because her mom is in the ICU. This mom had such severe bleeding post-delivery that Scott got called in the middle of a not-on-call-night to help her, and he called in a general surgeon, and they called upon 15 people to emergently donate blood between about 2 and 5 am., including multiple nurses, students, security guards, one of the doctor's wives from home, and about 3 or 4 RVA staff. After two surgeries she was pulling through, but pray for Esther who is not out of the woods yet. She is a mother of four, including the cutie above. Her baby is a favorite in nursery as we don't usually have healthy term newborns whom we don't have to share with a mother, to cuddle and feed and love. Hannah Wangari is another miracle baby. This is the little girl born with gastroschisis, all of her intestines and stomach hanging out of a hole in her abdomen at birth. She is, so far, the only survivor of this condition at Kijabe and perhaps only the second or third in Kenya. Here her mom is attempting her first breast feeding after more than two weeks of tentative intravenous and slow tube feeding post-operation. Hannah's course has not been entirely smooth, and her mom seems depressed. Please pray for them. We are hopeful. This baby's mom was transferred urgently in labor to Kijabe when it was noted that he was lying sideways (not head down) in her womb, and she was in active labor a bit more than a month early. Scott did an emergency C-section that was pretty complicated, and Mardi resuscitated him back to life. Here he is in the blue glow of lights designed to bring down his levels of jaundice. His mom also had a hard time establishing feeding (not so unusual post-op). Her relief when his jaundice improved the next morning was a great joy to see. John is another cute little preemie with a bit of jaundice. His mom is reaching into his incubator to change his diaper and just touch him.George is pictured without his mom . . .because she was feeding his twin brother when I walked around snapping photos with my phone. George was the second, smaller twin, and he's had a hard week with a dangerous bowel infection. But he is greatly improved now, and his mom will have her hands full with two premature boys.

Sometimes I feel overwhelmed by coming up with three meals a day for four healthy kids who feed themselves at the table. Or unable to focus on questions about how to factor an equation or wither Iodine exists as a two-atom compound or what would be a good paper outline for the second battle of Bull Run. I am humbled to watch these women tirelessly caring for their babies around the clock, never sleeping more than an hour and a half, no privacy, wearing hospital gowns and eating from a trolley of institutional food, sharing a bathing area with 80-some patients on the ward, and with only a moderate hope that their baby can survive. Few families can afford to visit very often. These women form community amongst themselves in their shared suffering. And rejoice with each other, too.

Every morning I pray with them, that they will meet Jesus in this unlikely place.

So much of parenthood teeters on the grief of loss. This morning I read the beginning of Joseph's story in Genesis. This time Jacob jumped out at the end of chapter 37. "Thus his father wept for him." At that moment, with the torn and bloody robe in his hands, Jacob could only see tragedy and the end of his dreams. There was absolutely no evidence in this story to suggest that God would redeem Joseph's taunting pride and his father's favoritism and his brother's jealous violence and his culture's unjust slave trade to bring about the dramatic rescue of a civilization facing famine and a tribe facing extinction. Jacob had nothing to suggest any emotion other than despair. But his son was destined for greatness. I hope some of these moms have that sort of faith. And I hope I will have it too, next time my own children's paths look like they are dropping into a pit.

Here's to our nursery moms, and the painful joy of parenting.

Home Base

in the last few weeks we've been blessed with a number of visitors. Africans always see visitors as a great blessing, and since my cooking is usually a topic of Swahili vocab and conversation with my teacher, whenever I say that we have guests he is exceedingly happy on my behalf. A family of missionaries in which the father was long-ago an RVA student coming to reconnect, kids who attend school coming a day or two early to get over jet lag, a single missionary from a remote and hard-to-live place coming for some family time, a family from a remote area of East Africa coming to investigate enrolling their child at RVA, a mom coming to check on one of her boarding kids, medical students and residents from the US coming to learn and explore and ponder their futures. Some of these have slept here, others we put up in the local guest house and just had over for meals. Many conversations, good meals, lingering, movies and games and fireside fellowship, tours and introductions, and some prayers.

I was praying with one of the long-term station women on Thursday, and we talked about this role God has given us in our lives here. The role of home base. Of safe spot to return to, to launch from. Of accessible food and medical care, of organized worship and recreation, of abundance of relationship. Kijabe and RVA are like the hub at the center of the wheel of missions in East Africa. People pass through because they have history here, or friends. Or because they're sick and need care. Or because their kids are here.

This is not always felt to be a very glorious role, particularly for the women who are mostly consumed with being moms. But I believe it is a crucial one. Because I've seen it, a good number of times, from the other side. We were once the people passing through. We first came here for safety when preterm labor threatened our baby, and stayed for a good delivery. We came here again in a time of war and upheaval and uncertainty and found a healing rhythm of work and community. We passed through other times to attend conferences and visit friends. And twice for life-saving medical care and surgery (Scott with a serious leg infection accompanying a visitor with an appendix disaster; and Jack with an incarcerated hernia). Until a year ago, Kijabe was a place whose existence allowed us to survive, and to continue living on a dangerous front line. RVA was a place which allowed our two oldest to progress further in school without having to return to America. The existence of this sprawling station with its resources was a safety net for us.

Now we are starting our second year here, appropriately, with a spurt of visitors who are using the net, touching the home base, as we once did. Now we're the people who provide the listening ear, the meals, the arrangements. It is different from the rest of our life in Africa, to be sitting on this breezy porch on a Sunday afternoon, undisturbed. To have a cold electric fridge that we just stocked with easily 15-20 different varieties of fruits and vegetables. To have a washing machine that churns out clean clothes for our travelers. To have heard a very good sermon in English with modern praise songs and American handshakes afterwards. To be able to send this post by a fast and fairly reliable internet connection.

In Genesis, Abraham and family were continually promised a land that they would use to be a blessing to others. A nation that blessed the nations. Kenya does flow, literally, with milk and honey, with dairy projects and bee hives. I still miss so much of Bundibugyo, but I do embrace the home base role, and pray that each person who passes through our life here will be strengthened and blessed for the journey.

A 24 hour life

Evil feels triumphant tonight, or at least impotence and ignorance.  

Twenty-four hours ago we were sitting around the table after dinner, serving tea.  Our friends the Wrights had just pulled in from a long day's drive from Karamoja (Uganda) to visit, and our friends the Barnes had been sucked into the party when they walked by with a young premed student delivering Birthday invites.  I had a page from the nursery to go over some labs, and was feeling pretty relaxed about the evening since things were going relatively well.  Then a few minutes later I got the "999" page that means "RUN".  I grabbed my coat and stethoscope and made quick apologies as I rushed out the door, trying to imagine which of the babies could be dying.

Into the humid warmth of the nursery, brights and steamy and slightly chlorinated, a jungly at-home feeling after rushing through the windy darkness of Kijabe.  I see our medical officer and two nurses huddled over the resuscitation table, and quickly glance around the room to see which cot or incubator is empty.  But it is a new baby, just delivered, pale and floppy and lifeless and bloody.  Very bloody.  Blood matts her hair, is caked in her ears, fills the suction catheter that vacuums her mouth.  I hear quickly that she was born dead, with no heart rate or effort to breathe.  But now a few minutes later her heart is beating strong, though nothing else seems to be happening.  No flicker of movement, no flutter of eyelids, no gasp of breath.  We dry and clean and suction and bag breaths into her lungs, over and over and over again, while her heart ticks steadily on.  I get more story that makes me suspect she may be a bit drugged from pain medicine her mother got, and after a dose of a reversal drug she does start to breathe.  In a full forty minutes though we're still floppy and in spite of lots of oxygen and help she is still blueish.  And if she was just punky from her mom's medicines, what's the explanation for all that blood?  I decide to intubate her to suction her airways better, and to try and improve her oxygen status.  I'm still not confident about many of my skills, including threading the airway of a slippery (usually squirmy, though this baby wasn't moving) phlegm-filled micro baby throat.  But by God's grace alone I get the tube in, and we suction some blood.  

And so the first hour ticks by, and before too long the second.  The baby is fighting a little now, moving her delicate arms.  She never really responds the way I would expect to all the efforts we make.  A fluid bolus seems to help.  We check her blood count thinking that if this is HER blood she lost, she may need a transfusion, but she doesn't.  Xray doesn't show any major lung problems, heart seems normal.  I take time to go find her mom and bring her into the nursery to see her baby, whereupon she turns and puts her arms on my shoulders and sobs.  I pray for her and stroke her back and try to sound hopeful, striking the right balance of sober and optimistic, your baby is very sick but so were all these others who are now improving.  The mom names her Victoria.  By ten pm we pack the baby into an incubator and wheel her up to the ICU to be kept on a ventilator, since she does not breathe well enough on her own to make it.  I'm home before midnight, leaving her pink and restful, opening her eyes, and I hope over the worst.  

By morning I've only had one call about her, and I am hopeful that whatever was wrong is getting better.  Then another "999" during rounds, I run up to ICU where the staff has accidentally dislodged her endotracheal breathing tube.  Not difficult to do since the margin between "in" and "out" is less than an inch.  I briefly consider keeping her off the vent, she is doing so well, but then her oxygen levels drop, and I realize she's not ready.  The medical officer tries to intubate without success and then everyone looks at me again, and I pray.  This time Victoria is actively fighting against me.  But I get the tube in again, and she's pink and as we put her back to bed, restful, looking at me.  Labs look OK, and though I'm still puzzled by just what is causing her problems, i don't really mind not knowing if she's getting better.  I order another xray to be sure the tube is back in the right place and go back to nursery.  

(Where, parenthetically, I find a surprise 32 week tiny bright pink baby boy just born . . whoops, we are out of incubators, so he has to rest on the resuscitation table while the one available incubator is fixed).

Before another hour is up though, I am back to ICU where her oxygen levels have plummeted.  I'm told the xray was OK but when I look myself I see a too-dark outline to the right lung.  Her lung has popped like a balloon, leaving a rim of air between the lung and the chest wall that compromises breathing.  And since we are pushing air into her lungs, we are making this worse minute by minute.  I call the paeds surg team to put in a chest tube, and am poised to stick a needle in myself but they arrive just in time.  

From there we never really regain our ground.  Another couple of hours pass, the chest xray with the tube in place looks great, but the baby doesn't.  Victoria is inexplicably dying.  

I usually look forward to my Wednesday afternoon sign out to Mardi.  Especially after being on call 3 of the last 4 nights.  I try my best to have everything sawa sawa and ready to go.  But today was not fun.  I hung around an extra hour but Victoria only seemed to be getting worse, and then it was time for Julia's soccer game, and I left.  Mardi messaged me not long after.  Victoria was dead.

She lived a day.  Not quite 24 hours, and I was with her a good number of those.  More than her mom was.  At first I wondered if we should even try to revive her, then I thought she would probably live and be fine, then I had no idea how to keep her alive.  

Part of my heart knows that the quote below is true. Right, temporarily defeated, is still stronger than the apparent triumph of death.  Victoria lives on, and waits for the resurrection.  Her name reminds me of 2 Cor 15--where oh death is your victory?  But I am wearied tonight by the lost battle, and though I'm thankful I was spared the final moments (thanks Mardi) it is still a sadness, hopes dashed.  Her mother will grieve this in some part of her heart throughout her life; I will probably barely remember this in a month or two, as another hundred babies pass through my hands.  

So tonight I honor one small life, a little broken body, a valiant struggle, and look forward to the place where death is no more.

MLK DAY

"I believe that unarmed truth and unconditional love will have the final word in reality. This is why right, temporarily defeated, is stronger than evil triumphant." Dr. Martin Luther King

Quote for the day courtesy of our fellow-Africa-loving-Paediatrician Amy Long. Wishing I was at Luke's Gospel Choir Concert in honor of the day. Feeling a bit of temporarily-defeated-ness in the wake of a long weekend of call (Scott did 5 C sections in about an 18 hour stretch, I lost one of our NICU babies).

week in review

Julia and the Varsity Girls' Football team, with Coach Dahlman. They had their first game this week, a loss to the Swedish girls. In spite of the 1 to 0 score, our team played well. And Julia played awesomely. Highlight of the week: Miss Larissa of South Sudan has stayed with us since Wednesday. It has been delightful to have her in the house, to feel like "team" again. You can see how happy Acacia is. I am thankful for her company, ideas, service, cheer, and general presence. Brielle sports her CPAP (continuous pressure oxygen circuit) which is held in place by the little pink knit hat. Charming parents anxious but happy, unstoppable labor, an active little preemie with a reasonable weight and a good prognosis. Hoping she will fight on through. Jack, exhausted with cheering, sinks to the floor in relief when Man U pulls out a victory over Man City. It hasn't been an easy couple of weeks for avid Man U fans, and the losses have taken their toll. Caleb's last step (??) in college apps, the ROTC physical fitness test. He did 57 pushups in one minute and then ran a mile and a half around the grass field in 9 min 6 sec, which is pretty good at this altitude. Here he is smiling with Coach Davis after the run. Miracle baby Wangari. Keep her in your prayers. No baby with gastroschisis has yet survived here, though we've tried to help many. The others have been born elsewhere, languish a few days with their intestines hanging out a hole in the abdominal wall, become infected and dehydrated and can not be rescued by the time they arrive. This baby was born here, and in spite of a harrowing first few minutes when we couldn't get her to breathe . . has done well. Her intestines are now back inside, and starting to work. I taught a conference on her case this week, and reflected on Psalm 139. Rugby tryouts have started a whole term early. Because the varsity team did not do so well last year, they have to play a relegation match this term, so the coaches are training with about 40 boys daily. Rugby is THE sport at RVA . . here is Jack, with the talented Howorth brothers, coming to eat pizza covered with mud . . Some of Caleb's senior guy friends (Titus and Aneurin are our guardees, plus Joop who is just fun) join us for pizza making at the end of the week. One of our other guardees . . Anna Rich . . also joins the party. It rained for hours and then cleared just as we were ready to cook, for a very fun evening. The power has been off most nights for random blocks of time. Caleb has mastered dish washing by candlelight. Sort of nice, you can't see the mess. Fridays the students gather outside during their chapel time for flag raising. Larissa and I went up to see the choir sing the national anthem in Swahili . . I tried to post the video but no deal. It was lovely. Perhaps you can make out Julia and Acacia singing alto, and imagine Caleb singing base int he back. This weekend Scott and I are both on call. Last night I sat with a tiny preemie who was dying, praying with his mom and watching his little heart slowly tick down to nothing. We had been rescuing him with less and less success all day, and by 2 am he had signs of brain death. Meanwhile Scott was doing two C sections. We both got home at the same time, 3 am . . And were both called from church this morning for this little pumpkin, a 33-week preemie whose mom was deteriorating dangerously. Scott did a C section and I whisked her off to be revived. Only she didn't need reviving, in spite of weighing 1.4 kg she was the most active, wailing baby I've seen all week. These two cuties were surprise twins--their mom delivered the one on the left and the paeds team was taking him to nursery when lo and behold another one came out. They share a cot warmer and are twice as cute as one alone. So another week goes by: death watches and celebrations, rescues and cheering, sweat and struggle, meals and messes. Amen.

Occupational Hazards...

One of the inherent risks of doing surgery is potential exposure to patients' blood and body fluids. The Cesarean delivery is one of the bloodiest of all surgeries.

As Scott attempted to extract the placenta from HIV+ mother during a C-section this week, the cord tore and blood splashed up onto his mask and glasses.

Thankfully... -- it was cord blood which should be virus-free -- he doesn't think he got any fluid in his eyes -- the mom is on treatment so she should have very low virus in the blood.

However, please feel free to shoot a prayer up for his continuing HIV-free status if you think of it!

Mt. Kenya

Between Christmas and New Year's our family hiked up Mt. Kenya. We reached Pt. Lenana, 16,300 feet, one of a cluster of craggy bare-rock pinnacles. Batian is a few hundred feet higher, but not accessible to non-technical climbers like us. Our route took us from the Northwest slopes, ascending the Sirimon path through the Mackinder Valley to the central peaks, then back down the eastern side on the Chogoria route past Lake Michaelson. We spent four nights on the mountain, three in simple wooden shelters with bunk beds, and one in tents at 14,000 feet of COLD. On our summit day we woke at 2 am for tea and biscuits, then hiked too fast so we reached Pt. Lenana almost an hour BEFORE the sun rose and waited shivering in the shelter of rocky crags until the light broke. That morning the clouds were below us, and nothing but brilliant stars above.

Four nights in the wilderness refreshes the soul, five days of strenuous hiking in the thin air of equatorial altitude hones the body, a week of family togetherness completely cut off from the world (no phone, no fb, no email) builds memories and togetherness. We went with a budget outfit of Kenyan guides and porters which turned out to be perfect. We drank mugs of hot sweet tea morning, noon, and night, and sometimes in between, which seems to be how Africans handle the low temps and high altitude. We marveled at the wildflowers, jumped over boulders, teetered on the edge of precipitous panoramas (I was later thankful that we ascended the final peak in the dark so I couldn't see most of the danger until the way down), laughed at the fat unafraid rock hyraxes, fed our crumbs to the mountain chats, shivered in our sleeping bags and ended up with sunburned faces and hands. The last morning we watched an elephant drinking from a watering hole near our cabin, while monkeys chattered in the trees.

Mt. Kenya is one massive rise, not the long convoluted range of the Rwenzoris. There were few bogs, and almost no mud, long spectacular views, more dry open scrub and a lot less jungle. There were also MANY more people. In a week in the Rwenzoris we hardly had contact with any other campers, unlike the couple of dozen at each campsite on Mt. Kenya. In the evenings we read aloud from "No Picnic on Mount Kenya", the true story of an Italian POW interned in Kenya in WWII who escaped the camp to climb the mountain and then turned himself back in.

It was a lovely way to spend the holiday. God often calls people up on the mountain when He wants to meet with them, wants their undivided attention. There is something to be said for the inaccessibility, the juxtaposition of danger and beauty, the rewarding effort, the perspective on life below, that makes mountain climbing an apt metaphor for a spiritual journey as well as an appropriate real physical location for divine encounter.

As we have turned the corner of our second year at Kijabe, passing our one-year anniversary on the 1rst of January, I hope I can hold on to the memory of the stark splendor and clarity of Mt. Kenya back down here in the Rift Valley of normal life.