Football!!

See our sidebar for the link to the Johnson's blog or try this link to see photos and read the story about the Christ School Football Teams.  We have a long history of being fans and parents of these players, and totally believe this is a life-changing experience for the kids.  Please consider supporting them.  Kevin's stand against corruption in football is similar to my post below and the reference to Jesus in the temple.  He shed blood to stand up to the violence.  And because of him, JD, Josh Trott, Nathan Elwood, Ashley Wood, other missionaries, teachers Bwampu and Immaculate and Alex . . dozens of kids have had their one and only opportunity to see the rest of their country, interact with Ugandans from different tribes, learn team work and perseverance, and taste success.  Go CSB!!!

A different kind of Saturday Rounds

About half of our Saturday mornings require rounds in the hospital.  Because sickness does not take weekend breaks . . however this Saturday our new half-time Kenyan pediatrician (YEAHH) and our kind 3-month German volunteer were covering.  Julia and Acacia had early volleyball practice, Scott had his own rounds, Jack and Caleb were wiped out in bed . . so I was free to join a small group of RVA staff and local Kenyans for a forest walk.  I thought we would be birding.  And we did hear a number of interesting bird calls, and glimpse a hornbill, batis, swallows, parrots, warblers, etc.  However the primary purpose of the walk was to be present in the forest, appreciating the beauty and diversity while patrolling for illegal loggers and charcoal burners.  This is a protected national forest, but year by year human misuse and encroachment increasingly threaten the ecosystem.



The forest canopy has been thinned so that the floor is bushier than it used to be.  And dotted with clearings, where the old trees have been cut down.  Here is a fresh one. 

The men I hiked with had decades of experience in these woods.  And they mourned their passing.  We noticed a landslide on the far hill of a ravine, just below a clearing that had been cut.  Not trees, nothing to hold the soil on the mountain.  Sad, and dangerous.

 But they didn't just mourn.  They hiked with shovels and hoes.  So that when we came upon two smoking charcoal pits, they were ready for action.  The elusive charcoal burners cut protected trees, then bury the logs under layers of sticks and dirt for a slow low-oxygen burn that will dehydrate and lighten the fuel into charcoal while still preserving some of its stored organic energy.  This is lucrative, but inefficient.  Not to mention illegal.  To discourage them our group uncovered the smoldering pits and scattered the logs far and wide.      And then called the forestry service who is supposed to be stopping this abuse of the environment.  In a poor country it is difficult for entrepreneurs to resist the pull to make some money off trees, and equally difficult for the officials to resist the pull to make some money off looking the other way. 

 I thought of Jesus in the temple, scattering the tables of the money changers.  Perhaps the next day they would all be back.  But His action demonstrated resistance to an evil.  He did more than advise, he put some muscle behind making a change.  His anger ruined some incomes, but protected the majority who were being taken advantage of by the illegal actions of a greedy few. 

Our local church, the school staff, a local NGO called Care of Creation, neighbors, police, forestry service personnel, and the press are all beginning to cooperate to save the remnant of this forest.  Not quite the same as resuscitating a baby on a Saturday morning, but in the long run the effect is similarly life-affirming and future-oriented.  A privilege to participate.

An Open Letter about Starvation

I see a lot of starving kids.  Most are slowly, quietly starving.  Kenyan toddlers, dwindling away without access to adequate nutrition.  A few are teens who suffer from eating disorders, expatriates who pass through this mission station.  This week I've been thinking about both, particularly after the death yesterday of a 4-year-old with severe cerebral palsy, seizures, skin infections, with his spastic skinny little limbs and barely-coping mother.  And praying for the children, and for our response, and pondering the causes and solutions.  Which leads me to comment on four key areas to understand, and address.

1.  Malnutrition is a physical problem.  The kids we see have been injured.  Some had inadequate oxygen during birth and are brain damaged, making it hard for them to chew and swallow or reach for food or share a bowl or hold a cup or explain their hunger.  Some were fed imbalanced or harmful diets.  Most have been made worse through acute and chronic infections.  Some in the eating disorder category are depressed, their neurotransmitters are genetically disordered, or their vitamin and mineral levels are inadequate.  It is not their fault.  

The physical problems need medical therapies, like blood tests and vitamins and high-calorie feeds, like physical therapy or hospitalization or antidepressants.  This is the part we usually think of.  But it is only the tip of the iceberg.

2.  Malnutrition is a social problem.  Injustice drives hunger.  Women who don't have safe antenatal care or skilled delivery attendants produce injured babies.  Families without land for gardens, or jobs for income, lack food.  Parents who did not attend school don't make informed decisions about nutrition.  Extreme maldistribution of wealth and medical care means the neediest can not get it.  On the other end of the starvation spectrum, the culture of physical perfection, unhealthy model-weight bodies, blatant sexual advertising, pressure to conform, bombards our teens.  

The social problems need concerted united action, advocacy for the poor, responsible voting and laws, sacrificial generosity from churches, bold initiatives in education and health care and water engineering.  Refusal to buy our five-year-olds sexualized clothes or dolls, protecting our pre-teens from magazines and messages.

3.  Malnutrition is a spiritual problem.  Our world is broken, and the vast majority of our fellow citizens wrest their survival by the sweat of their brow.  Floods and drought wreak havoc.  Child-bearing is fraught with danger and mishap.  For those that survive, Satan whispers as he did to Even in the garden, you aren't good enough.  You won't be loved unless you look this way, control this urge.  

The spiritual problems cry out for prayer and sacrificial love.  Discipline and money alone will not solve these problems.

4.  Malnutrition is a personal problem.  We are created in the image of God, which fundamentally means we have wills and choices.  Families with injured, sick, infected children, with unemployed and under-educated parents, with oppressive spiritual issues, still make decisions.  Sometimes those decisions lead to greater harm, as family income is poured away in alcoholism, or fatalistic apathy paralyzes action.  Teens with dangerous family histories who have been poisoned by advertising and pestered by doubt, still make decisions.  Sometimes those decisions are for self-harm, or secrecy, or escape instead of healing.

This means the victims still have responsibility in their response.  Which is good news.  It means we have hope, because each family and child can make new choices, can be freed.

Malnutrition in all its forms, rickets, marasmus, kwashiorkor, anorexia, bulimia, obesity . . . is a frustrating illness to treat, but also perhaps the most satisfying to cure.  Because it is multifaceted, the analysis and solution draws upon the entire spectrum of medical, social, and spiritual insight.  The patient must be treated along with the family.  The approach requires team work.  And the long-term prevention requires big-picture thinking about politics and justice and truth.  

The Kingdom is described as a feast, a banquet, a meal.  The Fall from Grace occurred in an act of eating, and redemption comes the same way.  Jesus gives Himself to us in bread and wine.  So it is no surprise that much of the harm in our world comes through the mis-use of food.  If we could return to its holiness and wholesomeness, we would be closer to real LIFE.

A Wednesday

 By the time I got to our Paedatric noon meeting and conference, I had attended chapel,  evaluated 23 inpatients, admitted two new patients to the Intensive Care Unit (a five-month-old whose terrible diarrhea left him unconscious, with no discernible pulses and a 13 year old diabetic who was somnolent and cold in ketoacidosis), attended one death (a one-week old post-op neurosurgical baby who survived complicated surgery but then arrested twice from an abnormal heart rhythm, who was brain dead and did not move as he slowly dwindled to lifelessness in his mom's arms once we withdrew support).  Most of the kids who are brought to Kijabe are complicated, desperate, and have tried several other places first.  They are sick.  Very sick.  So it takes time to untangle the web of their histories.  I think almost 20 or the 23 suffer from malnutrition as well.  These kids don't bounce back to health very quickly.  Two make me very happy.  James, the 15 year old whose sinus infection invaded his brain, who narrowly escaped irreversible brain damage and death . . now day 21 of super-strong IV antibiotics, and finally free of fever and headache for 48 hours.  He is soft-spoken and sweet, and probably getting bored.  He could be my kid, or anyone's.  I'm so relieved he is living.  And of course HS.  Today she was sitting up.  She's hungry, for the first time in two months.  We can't understand each other at all... but when our team surrounded her bed and she stood up on her mattress agitated, the mom in me said, I think she needs to go to the bathroom, and the poor little thing let loose with urine.  Which was excellent news as we had worried over her fluid balance. The surgery saved her life but today we finally started to turn the corner towards real recovery.  A long but satisfying morning.  And a good meeting, with lunch and leadership provided by Mardi, ever-organized and visionary and helpful and cheery and committed.  We have a good team.

Meanwhile back at the ranch  . . it rained.  And rained.  And rained some more.

 Jack came home from Rugby FREEZING and wet.  He is growing like a weed in this wet weather, and in spite of being about the youngest kid trying out he was the first to the top of the "quarry" on the run today.  He works hard, like his brother Caleb who is training for Basic Cadet Training (boot camp).  Julia and Acacia are playing volleyball.  And everyone was soaked.  So rather than drip on the floor, Julia did some sort of spunky soliloquy out on the pizza table while waiting for the hot shower to open up.  We have great kids.

Lastly, end-of-the-day mail haul, Caleb's official appointment package from the Academy.  Good thing we found out by email, as the "you must reply by April 15" letter arrived on April 25.  Somehow seeing it in print makes it all the more real. 


A day of patients and meetings, rescues and death, rain and songs, the satisfaction of the moment and the reminder of the future.  A mid-week gourmet family dinner, Champions League football and a fire.  A day of full life.

Rain and Parties and the muddy blessings of community

 Rain respite.  Sunday evening, the incessant April deluge let up for a few hours.  Just enough time for all eight new Medical Officer Interns to join us in making pizza.  These young men and women will spend a year here at Kijabe, the transition from medical student to fully qualified physician.  Rotating through Paediatrics, OB, Surgery and Medicine.  Taking call every fourth day and night.  Admitting patients, going on rounds, churning through outpatient charts, assisting in surgeries, answering pages, reading texts.  Becoming competent.  And occasionally, having fun. 

 Kenyans have a natural knack for pizza making.  A culture that loves chapatis knows how to handle a rolling pin and dough.  Our interns are adventurous eaters, laughing, willing to try new food combinations.  They tease each other and discover the art of Italian cooking.  And we enjoy seeing them OUTSIDE the hospital.  Learning that one has seven sisters.  Another has a dad in the military and plans to serve himself.  Three are engaged, five are unattached.  In three weeks together they have sorted themselves into roles:  mom, dad, activities coordinator, pastor, cook, exercise instigator, etc.

The group at our door (my hair loves this rainy weather . . )

 Our vision statement at Kijabe Hospital:  Providing excellent and compassionate health care and spiritual ministry to the most vulnerable, extended across East Africa through training.  This night reminds us of one of our primary roles: to pour ourselves into these eight lives.  By God's grace modeling good medicine delivered with compassion in a way that points people to Jesus.  So that in the years to come, the small amount we can do is multiplied as these young doctors move out to areas more remote and needy. 

 Another night, another party.  Every Monday station families take turns hosting a dessert night for welcoming new visiting missionaries.  Problem is, Mondays can be kind of crazy. Julia came on rounds with me, her last day of break.  But then graciously came home to get a start on dessert-making.  I walked in the door at lunchtime to help her when I was paged for a 999 code (dying baby).  So much for baking. Thankfully Scott the "cake boss" rescued me, and made dinner too.  I next tried to come home at 6 pm, walked in the door, and the same page for the same baby trying to die again.  Oh well.  I finally made it home just ahead of our visitors, and my family had done everything to be ready.

 We had several new missionaries, several leaving, and a good number of long-term regulars too.  In a place with high turn-over of volunteers it can be a challenge to connect.  I'll never be the "best" friend of people who have spent a decade or more together . . but I am thankful for growing friendships as we pray and serve side by side, sharing griefs and joys.  And occasionally, cake.  Plus many of the one-to-six month doctors have a gift for quickly connecting and selflessly serving.  We will genuinely miss the young family, single woman, and retired couple all departing this week.

A stripe of sun-glow above the rain-sogged earth and below the heavy clouds, as I walked home from the second code Monday evening.  Thinking about redemption.  About the God who transforms mud into crops that sustain, who brings blessing from clouds.  Who made it clear to us two years ago that we were leaving Bundibugyo, team, neighbors, home, community, work, everything . . but who has brought us to a place with abundant opportunities for teaching, for fellowship, for people to love and serve and feed. 

Thanks for prayers

Just talked to the surgeon--he did find life-threatening intestinal problems when he operated on HS.  Thank you so much for praying.  She survived the surgery but has a long road of recovery nutritionally.  So we're not out of the woods yet.  So glad God intervened and changed her dad's mind!

Pray for this child

This little girl, HS, is wasting away.  After two months of vomiting and intractable abdominal pain she was brought by her father to Kijabe, having lost 1/3 of her body weight.  She is a refugee of sorts, her family moved across the border into Kenya from a neighboring country.  After several days in the hospital, being treated for one infection that is probably not the main problem, her father demanded to be discharged today.  I could not comply.  And so an hour of negotiation ensued.  He's from a culture that is abrupt and hostile.  I'm from a culture that believes a child should not be sent home to die with a potentially curable problem.  Even if the father says he has six other children.  Thanks to random relatives, and my MO intern, we reached a compromise that he would give us until Tuesday to find the problem.  This afternoon she returned from a CT scan with the diagnosis of intussuseption.  We suspect underlying TB.  Tomorrow she will have surgery.  In the long tense discussions this morning I sensed that HS's father has the same heart as God our father--he was standing up for his child, and he went to the trouble of getting her here.  I pray that she would be healed in a way that miraculously points to Jesus' love.  Jesus does not give up on us, and we sometimes have to stubbornly refuse to give up on others.

War Orphans

This is Christobal, who is an orphan of war from South Sudan. His parents were not shot, but rather the disabling effect of war on the entire society took them from Christobal. And almost took his life, too. And may still.

He was delivered into our care at Kijabe this week by two Kenyans who work for an American-funded orphan-care NGO, and a South Sudanese nurse. His mother died in the process of giving birth to him in December, from uncontrolled bleeding. Post-partum hemorrhage should not be taking mothers' lives in 2012, but in areas where war and displacement and poverty prevent mothers from accessing reasonable care, it still does. A teenage girl in South Sudan is more likely to die in childbirth in the next decade than to finish high school. Christobal's father abandoned the family when his wife died. So the children were brought to an orphanage, where his milk-powder formula was mixed too dilute, and the caretaker was unable to adequately protect and nurture him. A few months later he was stick-thin, irritable, shrunken. His bulky sweater hides a wasted body. He's starving.

Kijabe is a long journey from South Sudan, just for food. But the Kenyans who were in charge of the project did what they would do for their own kids--brought him to a place they know and trust. Severe Acute Malnutrition is a serious illness with a very high mortality rate. We work hard to save at least 90% of kids in this condition, but in many hospitals his chance of survival is more like 75% or even less. And his recovery will be long and fraught with difficulties.

Not the least of which is that war is once again threatening between Sudan and South Sudan. Here is a clip from today's news: President Omar Hassan al-Bashir of Sudan vowed on Wednesday to “liberate” South Sudan from its governing party, a sharp escalation of rhetoric after fierce border clashes. There has been growing alarm over the worst violence since South Sudan split from Sudan to become an independent country in July under the terms of a 2005 peace settlement ending a civil war. South Sudan last week seized Heglig, a contested oil-producing region in the savanna that is known as Panthou in the south, prompting Sudan’s Parliament to brand South Sudan an “enemy” on Monday and to call its swift recapture. When world leaders can not agree on borders, sharing of resources, or mechanisms for dialogue, then the most vulnerable suffer. Babies like Christobal will lose their lives by the thousands, silently, even as dozens of combatants clash and die more publicly.

Pray for our team in Mundri, which is far from the fighting, but still in a country affected by war. And pray for Christobal, and the many caring people and organizations who are trying to build a functional country out of the ruins of decades of war. Pray that his generation would be the last to be devastated by this conflict.

April Showers . . .

 . . are drumming on the mbati roof, soothing and chilly enough for a fire in the fireplace.  Fourteen years ago today my nephew Noah was born.  Six years ago today (that year it was just after midnight of Easter Sunday) my Dad breathed his last.  Today I remembered both experiences, of happy aunt and grieving daughter.  I miss most of my real nieces' and nephews' milestones, and that is a loss that can not be ignored or minimized.  But God does give us small compensations, glimpses of family.  Today my colleague left her young kids with a babysitter and took visitors to hike Mt. Longonot.  When they were half-way up the side of the extinct volcano, her 3-year-old fell off a chair smack on his sizable head.  So I got to be aunt as well as paediatrician, holding this sweet boy who would normally have nothing to do with my lap (or with sitting still), stroking his blond curls and cleaning up his concussion-induced vomiting, while bearing the worry of whether he was going to be OK until his mom returned.  I know that doesn't sound too fun, but let me say that when you're temporarily responsible for someone you care about's kid and he gets sleepy and lethargic and punky after a head injury and you conjure up disaster scenarios, his recovery is pretty joyful.  On the other hand, I spent part of the afternoon holding a 2-week-old baby who breathed his last as my Dad did.  Whether the end of the path on this world comes at 2 weeks or 71 years, it is painful for those who watch, who are left behind.  Baby M was born with not one but five missing segments of his small intestine (jejunal atresia).  After two surgeries his poorly perfused gut fell apart, again, leaking air into his abdomen.  To make a long story short, after much prayer and consultation we explained to the parents that further therapy would cause pain with no hope of recovery.  Together we removed his tubes and handed him to his mom to hold.  But she shortly became so overwhelmed with grief, that I had to hold baby M while the father held the mother.  I felt him breath, and then slowly stop.  Another holy moment of witness, a human passing from this life to the next.  

It was a long night as Scott did an emergency C-section for a woman whose baby's umbilical cord came out ahead of the baby--a deathly situation.  In this case we were able to revive the mostly-dead baby, while Scott delivered the surprise brother.  Unexpected twins.  Other kids with rare congenital syndromes, heart disease, brain abscesses, rubella, possible TB, wasting, rickets . . . and a sister who brought her 10 year old brother with new neurological symptoms because he's the 4th of 7 siblings to begin to deteriorate this way at this age, and the other three died.  No idea what to think about that one.  A typical day at Kijabe.

The April showers drone down, drenching, the promise of life to come.

early influences

Detective Michelle Lee, a WHM teacher of our kids in Bundibugyo in the late 90s, has traced some of the early aviation influences in Caleb's life.

Seated in the cockpit in two different aircraft at age 3 on the Bundibugyo airstrip...(with co-pilot's Luke Myhre and Matt Leary)...