Spain, mostly safe and sound . . .

A quick post from our "company conference" on the Spanish coast.   Hundreds of people, hugs, name-tags, memories.  Rocking worship.  Exposition.  Seminars.  Bustle.  Meals.  Ocean breeze and freezing cold water.  The buzz of conversation, the murmur of prayer.  New babies, and honoring our founding mother Rose Marie.  Family feel.

But as with anything that has world-impact-potential, not without struggle.  The  biggest one for me is being here fragmented as a family.  It's the first time to come without LUke and Caleb.  Their absence is an ache, an off-balance unsettled missing of something.  I didn't realize how hard it would be.  And until a few hours ago, we had only Julia with us, having left Jack in Kenya for two extra days.

We let Jack stay behind for RVA's major Rugby event of the year, the Blackrock tournament.  He had a blast and scored the winning try in quarter-finals and set up the winning try of finals, so a great day for him, really fun. His JV team won the lower tier of this varsity tournament, and the Varsity team came in second in the top tier.  All well and good except that he then had to travel alone, through Dubai and Portugal to get to Spain.  And unbeknownst to us, Portugal has some stringent requirements about minors.  So when he showed up at the airport in the dark of night in Nairobi, dropped off by a taxi and all alone, the airline refused to check him in.  Thankfully he pulled out his emergency phone numbers, someone found us here in Spain, Scott emailed letters and scanned passports.  Then we checked back and he was still stuck because (surprise) the printer was down and the airline was struggling to print the documents . . but finally he was allowed through.  The rest of the trip went well.  After that stressful beginning I had planned to take the hour drive with Rachel (Matt's new wife) to meet him at the airport. 

Only at lunch, ironically a time set aside for all the medical people in WHM to eat together, I started feeling really peculiar.  Had I not been eating with a bunch of doctors including one world-famous toxicologist I might not have every known that I was having a classic food poisoning reaction to bacterial overgrowth in poorly refrigerated dark fish, called scombroid reaction.  Evidently the bacteria makes histamine.  Here is a medical text on exactly how  I felt:

"Signs and symptoms of scombroid toxicity usually begin within an hour of eating contaminated fish.  The symptoms resemble and IgE-mediated allergic reaction.  The patient may suddenly experience flushing, a sensation of warmth, and erythematous rash, palpitations, and significant tachycardia.  The rash often is especially prominent on the upper torso and face.  Headache, blurred vision, respiratory distress, and dizziness have also been described."

So after a nice slug of benadryl and ibuprofen I passed out for the afternoon, missed the airport run, and Jack had to figure out who Rachel was (which he did when he asked her for a pen to write down the number the WHM people gave him when he called again feeling slightly abandoned on arrival, and as he wrote the number they realized they were looking for each other . . ).

Still have a seminar to help teach, and lots of great conversations ahead, reunions and thought.  But all this reminds me that it's a battle.  Our speaker gave us the story of Gideon, fearful and flawed, to remind us that God uses the weak.  That's us, for sure, limping in and dependent.

There are Days . . .

 . . when I briefly consider whether I can go on.  When the stress and sadness of working on the edge of life just seems like too much, when the losses accumulate and threaten to overwhelm.  This week it was Tuesday afternoon.  I nearly missed a monthly meeting for the Bethany Kids department (Paediatric surgery and Neurosurgery), we were receiving one admission after the other, two babies who had become dangerously jaundiced and infected and dehydrated at home, another born prematurely with a spinal cord defect.  In between examining and evaluating and supervising the inerns' orders, I was shuttling between nurses and departments trying to sort our overflowing wards in such a way that the limited oxygen could reach everyone who was struggling to breathe.  I had a student sick with what looked like it could have been a serious, life-threatening illness (it wasn't, she's fine, but missionary kids are targets of spiritual attack and I carry that burden heavily).  I was on call so trying to catch up on critically ill patients for the evening, including a little girl who was deteriorating after brain surgery to remove a tumor and a baby who was being ventilated because of damage his lungs sustained at birth. Miscommunication with a surgical service had frustrated me. And never far from my mind and heart, thoughts about my own child who was stuck in a dorm room for two weeks with not much to do or look forward to after a friend canceled a planned visit.  And a foster-son who was going through a serious struggle, all over a scratchy hard-to-follow phone line.  Scott was already gone all week to WHM leadership meetings in Spain.  So all the responsibility of home was also on my shoulders, for food and homework and communication and dogs and laundry.  Oh, and of course, a minor bacterial infection just for good measure, leaving me nauseated and weary.

(Baby Bina, our tiniest preemie yet, 580 grams/25 weeks and still fighting strong at 2 weeks old.) 

On days like that I don't really look forward to the conference which starts tomorrow, the triennial all-fields meeting of World Harvest.  Sure the break from the relentless pace of work and need sounds appealing, and the location should be lovely.  But after two decades in this business, I'm supposed to be one of those senior sorts of people who will overflow grace and peace and love to others, who will fly in ready to minister.  Who will listen with wisdom and have just the right insight.  Who has this whole messy work/life/family/ministry balance in relative equilibrium, as an example and encouragement to others.

Instead of being someone who walked the short dirt path from home to hospital with tears dripping down and stomach in a knot, whose prayer disciplines have weakened, whose stretched heart keeps reaching a breaking point.

But then the Spirit reminded me:  ministry from weakness is a core value of our mission.  One of those little phrases that sounds pious and humble, but feels completely out of control in real life.  That it's OK to come to the conference worn out and wobbly, and to enter into conversations with nothing much to impart.

Because we're there to impart Jesus.  Only.  And that's enough.

Matchmaker, matchmaker

Matchmaking, it seems to me, would be a noble profession.  Seeing need and opportunity and finding win-win mutually beneficial arrangements with the potential for long lives of blessing.

This week I felt a little thrill of matchmaking.  No, not for a marriage, though I do believe this is a love story.  Love that brings people out of their homes at dawn and into a chaotic ward full of children whose brains are being compressed by too much fluid, whose spinal cords are damaged and exposed, who often can't walk, need help to go to the bathroom, appear disproportionate and a bit unsettling.  Kijabe hospital has become a mecca for the neurologically disabled.  We had a surgeon here, Dr. Bransford, whose heart for special-needs children launched all kinds of surgical programs.  And we have one now, Dr. Albright, who with his nurse-practitioner wife has brought a lifetime of academic experience to bear in the epicenter of spina bifida and hydrocephalus.  If you build it, they will come, and the most challenging kids from all over Kenya find their way to Kijabe day by day.  Dr. Albright does more surgery here in a month than he did in the States in a year.  On my call this week I admitted three newborns with spina bifida, and heard three more were also seen.  That's one day, 6 new cases of a very complicated condition.

When I first came to Kijabe, I quickly realized how much I leaned on the excellent care of our two Clinical Officers (like PA's), Bob and Lillian.  And I noticed how busy the neurosurgical service was, and thought a CO would be a great benefit to them.  But nothing comes quickly at Kijabe, and this idea had to go through proper channels of approval.  When the 2012 CO intern class finished in November, we got the hospital to hire one for Paediatrics. Thanks to insight and advice from Dr. Erika, we chose Veronica because she had demonstrated a real heart for the babies.  It wasn't easy to pull this off.  Veronica could have made nearly double her salary elsewhere, and Kenyans experience significant family pressure to obtain a more secure and higher-paying job.  But she felt God drawing her to KH, so she signed on.  She received neonatal training in December, and then began a 4-month training and work period with us in the Nursery while our regular CO was on maternity leave, with the plan that at the end of that time we would release Veronica to work with the Neurosurgery team.

This week the Neurosurgery team confirmed that they want her to stay on long-term, and she confirmed she wants to do that.  Hooray.  I know this will bless the children.  I can be standing in nursery and watch staff go right by me to bring their issues to the CO, who is considered more approachable.  I have time after time seen Veronica find out more back story, minister to Moms spiritually, go the extra mile to ensure that needs are met.  A team needs skilled surgeons but also compassionate hands-on language-fluent primary care members.

That evening I was so happy, that Veronica might make the lives of the way-too-busy and dedicated Albrights a little better with her work, that they might teach her some specialized and excellent medicine, that mothers and babies would be cared for well, that nurses would have a better way to communicate with the surgical team.

A small joy of matchmaking that will, I hope, bear much fruit.

Shadow

Matt 4:16-"The people dwelling in darkness have seen a great light, and for those dwelling in the region and shadow of death, on them a light has dawned." (from Is 9:2)

For the last few months, we have lived in the fog and sog of a cloud here at Kijabe.  Rain, and more rain.  Deep sucking mud.  Grey skies.  Dim.  Cold.  Pounding on the roof at night, dripping into the door, washing down the hillsides.  The thing about living in gloom is that after a while it seems normal to trudge through a muted background.

Much of the last couple years has been foggy for me, too.  Too much parting.  Too much just trying to make it through another call, another rounds, another admission, another resuscitation.  Another death. This past week it was the frail baby in heart failure who no longer moved or responded.  After a tearful discussion with his parents about the reality of his impending death, I disconnected him from his monitors and dressed him and wrapped him in a blanket for his mom to hold. ( I offered to snap a photo for her memories, and a kind RVA teacher printed it for her to take home the next day.)

And when she was finished saying goodbye, she and her sister and husband handed him back to me and retreated to mourn.  His heart was still beating in spite of his lack of breathing; the nursery was bustling with work and other babies and parents.  I could not bring myself to just lay him alone in his cot, so I sat there in a sacrament of not-doing, just waiting and holding him.  Until the last flickers of life ebbed, slowly, imperceptibly, from his body.  A dark hour.

Then one day this week, the sun returned.  I looked down and saw shadow.   And it occurred to me that those rainy months did not have much shadow, because shadow is created by light and matter.  When all is dark and gloomy, you can't really tell the boundaries, there is either no shadow or all shadow.  But when light comes, the shadow is apparent.

Even the shadow of death is a shadow because of the bright reality of life.  

So here at Kijabe, where death is too-often present, I am wrestling with that shadow and looking beyond it.  The valley of the shadow of death is a part of the journey, but it is only in shadow because there is a ridge, a peak, of glory that we are ascending towards.  Glory that is dawning over gloom, until all the shadow is swallowed up in victory.

God's fingerprint is everywhere

Read this quote today:

May I, too, celebrate the gospel wherever it rises. None of us will get all this right; better to herald the common places and extend the benefit of the doubt. God’s fingerprint is everywhere; none of us own the rights to His endorsement. If a believer on the opposite end of the ideological spectrum says something good and true, may I say without hesitation, “Amen.” I’m often afraid to identify with certain people lest I be labeled with their brand, but that is foolishness. The gospel is always beautiful, and I am not in singular possession of its power. That is so arrogant. May I bend my knee to Jesus wherever and in whomever He reigns.
(Jen Hatmaker, A Deeper Story )

Having benefited from grace, let us extend it.  

Of saints, beginnings, endings, and a present help

Two friends got married on Saturday:  Agnes, one of our hospital chaplains got married here, and from the reports of friends they pulled it off well even though the Kijabe contingent was delayed half the day by the mudslides.  And Matt Allison, who showed up in Uganda in 2004 fresh from college, an intellectual historian taking a pause before his PhD to teach, preferably high school, and gamely allowed us to hand him the preschool and kindergarten.  Matt married Rachel in Philadelphia where he now works for WHM, and we are enjoying the smattering of photos starting to crop up on facebook.

Two weddings, two beginnings, four saints embarking upon lives of commitment and service and reflection of God's glory.

And one saint reaching the end of her life.  Though we missed the weddings, this afternoon we did attend a funeral.  We never met Martha Pontier in this life, but we know her siblings, niece and nephew.  A four-generation missionary family whose paths have crossed ours here and there.  Martha was my age, and as an adult had served in Africa almost the same span of time.  She was a healthy woman until a mosquito bit her in Mombasa where she worked, the same week I was there.  She came down with what was later diagnosed as dengue fever, a viral infection that 98% of the time results in a full recovery.  But in a few people, it progresses to a fulminant fatality.

We went to pay respect to a family who has laid down their lives for the good of Africa and the glory of God.  To honor a woman who loved this place and these people, whom her family and colleagues characterized as a person of generosity and dependence upon God.  To remember God's purposes and power when the worst happens.

The mudslides missed our house.  The dengue mosquito bit Martha, not me.  Cancer has struck those who paved the way in Bundibugyo (Betty) and those that followed us (Travis), not us.  Today Pat called, and we marveled again at the underserved mercy of being spared all these years the suffering that our friends quietly endure.

In worship this morning, the pastor read Psalm 46, very relevant to those of us at Kijabe where the earth gave way:
   God is our refuge and strength,
   A very present help in trouble.
   Therefore we will not fear though the earth gives way,
   Though the mountains be moved into the heart of the sea,
   Though its waters roar and foam
   Though the mountains tremble at its swelling.

Praying that for our community tonight.  The earth moved and the mountains gave way.  Our fearlessness is not based on the absence of those things happening, it is based on taking refuge in God.  Please join us in praying for the Kijabe community digging out of mud, for the Pontier family burying a daughter/sister/aunt, for the Johnsons facing chemotherapy, for our college kids swamped with papers and exams, for us turning the corner into another week of challenging patients and stretching work.

Kijabe Mudslides April 2013

Click to see the destruction HERE

Last night, Kijabe received more that 5 inches of rain overnight. 26 inches of rain in the past month.

Add in the ongoing deforestation of the Kijabe Forest above RVA and the result was a severe MUDSLIDE.

The pictures tell the story.

The physical destruction of property will reverberate for some time...

- Severe erosion and mudslides seem to have made the road up to the main highway both impassable and possibly irreparable.  Many, many patients and hospital employees access the hospital via this road.  They will be inconvenienced and it may have considerable impact on the health of many people.

-  Water supply pipes to the Kijabe Hospital have been destroyed.  This will severely impact the functioning of the hospital almost immediately.

- RVA fences have been destroyed.

- Kijabe Boys School (a senior secondary school) experienced serious damage.

-  Many homes and business have had significant damage.

- This will seriously impact the travel of those coming for the funeral of Martha Pontier, AIM missionary who will be buried tomorrow.

There are some things for which to be thankful:

- Miraculously, RVA signed their FLOOD INSURANCE CONTRACT LAST WEEK!

- NO ONE DIED OR WAS INJURED IN KIJABE
     (N.B. - the Kenya newspaper The Daily Nation reported that 3 girls were killed in Kiambu County, but that did not happen in the immediate vicinity of Kijabe.  The news story is HERE ).

Let us pray for those responsible for those responsible for reconstruction and clean-up.

Success!

A few months ago we realized that we didn't have enough money in the Jonah Kule Memorial Leadership Fund to pay this year's tuition/fees for the Uganda medical students we are currently sponsoring through this fund.  

We currently have a 5th (last) year student (Julius Monday), two 4th year students (Baluku Morris & Amon Bwamale), a 3rd year student (Katuramu Tadeo), a 2nd year student (Birungi Fred), a first year student (Isaiah Kule) and a student finishing his MPH (Baguma Charles).  It takes over $3500 (all fees) per year per student --quite a deal compared to an American friend we know who is at the Columbia University Medical School in NYC and is paying $75,000 per year.

Well, we asked and you responded.  We now have enough to send this group for another year of medical studies.  Jehovah Jireh (God will provide - Genesis 22:14).  God provided a ram in the thicket for Abraham to sacrifice in place of Isaac.  When no apparent solution is visible, God provides.

Thank you for your generosity! 

While the seed of Jonah's life was buried in Bundibugyo as he cared for his friends with Ebola, we believe that these students are the fruit of that death.   We continue to pray that all of these students will return to serve in Bundibugyo District … for the good of the people there and for God's glory.

Alienation

Alienation.

I, for one, feel relieved that Tsarnaev the younger is being tried as a US citizen, a civilian.  Because if being photographed near disaster, and being born overseas, are enough to deem due process unnecessary for a citizen, I fear for my own children.  If found guilty, he will not be the only young American man this week that killed people, their neighbors and girlfriends.  They and Tsarnaev should be investigated, and if guilty, they should receive their consequences.  But if we skip the due process and ignore Tsarnaev's citizenship, what have we become?  Where do we draw the "alien" line?  Peculiar that he actually is caucasian, in the original sense of the word.

This past week I flew to Mombasa for meetings of the Kenya Paediatric Association, which I joined this year.  It was the biggest annual scientific meeting for doctors who care for children in East Africa, attracting hundreds of delegates from this country and her neighbors.  We debated surprising data calling into question long-held protocols on fluid administration, recommended policy changes on the treatment of sickle cell disease, called for action on unacceptably high neonatal death. We listened to lectures and case presentations, considered studies, reviewed immunization progress.  It was intellectual and stimulating and inspiring.

And it was lonely.

I delayed making hotel reservations hoping to stay with two young doctor friends, who are moms with young kids and had suggested a cheaper place, better on missionary and Kenyan budgets.  Only after I booked there, they both decided to spring for the elitely fancy and expensive official venue.  And they booked plane tickets on an alternate airline, leaving a couple hours earlier.  So I found myself alone, wandering into the swanky lobby buzzing with consultants and professors and residents, and pondering the possibility that every doctor there (except the residents) made more money than I did. Which I didn't mind, except for the barrier it put up in choosing such an expensive location to meet.  At the end of the day I walked down the beach to my better-budget hotel, and ate dinner alone.

Amongst the hundreds of Kenyans, Ugandans, Tanzanians, Sudanese . . .  there were a few white faces, but all were presenters, leaders, lecturers  important people. No ordinary learners like me. I took every opportunity to introduce myself to those Kenyan paediatricians I sat by in each session, or to try and shake hands with people in the halls.  Once I sat near my hero Dr. Ruth Nduati, who did the most important study of the last decade showing that in spite of what makes sense, breast feeding by HIV positive moms is safer than bottle feeding.  I even spoke to her.

But in three days, NOT ONE PERSON initiated speaking to me.

OK, my two friends from Kijabe were friendly as always when we bumped into each other.  But I don't think I've ever been immersed in a sea of Africans who so pointedly made me feel my alien status.  It may be because of the way the US treated Kenya leading up to elections.  It may be the nature of those meetings.  It may be the different colonial baggage of Kenya versus Uganda (once I approached a vaccine rep at her display table, and as I picked up a brochure she turned to greet me, at which point the Kenyan doctor she had been talking to bitterly accused the rep of ignoring him because he was only African.  Ouch).  It may be that I haven't lived here long enough.  Or that I'm spoiled by the camaraderie of Kijabe.

Or it may have been a good reminder from God that we are aliens and strangers, walking a path of humility and willing to be ignored.  But trying to cross the divide, establish community, live by love.

Alienation and home; a life-long paradox. Two opposite things that are true at the same time, and very tiring as humans to grasp in the right proportions.

Can't Complain

I called one of my Paeds colleagues today and when I said "how's your day" he said "Can't complain". . . upon which I thought, wow, I can ALWAYS complain.  I was checking in with him because I had some desperation texts from the outpatient clinic asking for help, as I was finishing up an admission of a kid that kind of punched my own heart, pushing my new interns in nursery to step up and get some labs and xrays done, all while trying to get home to say goodbye to the Massos who were about to leave for a month of sabbatical, and trying to not even THINK of the hundred loose end emails, people, plans, work that I should be attending do.  His day was just as bad, starting with a bloody death of a neurosurgical baby I'd watched gasp and dwindle on Saturday who took a turn for the worse on Sunday and died in a messy final hemorrhage and shock this morning.  But his reflex reflection was "can't complain."

Which, in some ways, is true.  Because every time I'm ready to throw up my hands and give up, I don't, because there is ALWAYS someone who is a little worse off than I, someone whom I could help if I just hold on another hour.

Last week as I came back from the US, I immediately got involved in the ICU care of a child who died.  A little boy who had been healthy, normal, running, and active the week before, who contracted an unknown infection of his brain, and though we thought we were making some progress, I was paged for a code and we could not get him back.  The brain, when pushed too hard, does not recover.  His parents were devastated.  After I told them, as we walked towards the bed, the chaplain in her Kenyan wisdom told the mother that Satan wanted to get hold of her but that she needed to be strong.  She would not let the mother flail or collapse, she told her to stand up.  So even I, who was teary and about to lose it myself, had to buck up too.  Since then I've wondered about the chaplain's approach.

I thought of it again on Saturday as I went to casualty for a very sick and dehydrated 9 month old girl, Ivy.  It wasn't until I was praying for her with her parents that the detail came out that she was a twin, but her brother Ian had died 4 days earlier on the way to another hospital of the same gastrointestinal disaster.  I could barely keep my voice from quavering too much.  These parents named their babies Ian and Ivy, so sweet, and now they had no time to grieve one as they struggled for the other.  But I thought of our chaplain, and my job, and their needs, and pressed on.

So tonight as the rain pours down, the tears stay mostly suppressed.  This culture is more stoic than our Ugandan atmosphere.  And who's to say they don't have a point.  Can't complain, it could be worse, let's move on, and work for the ones that are left, that we might help.  I've learned from my son that you can always do one more.  One more pushup perhaps for him, one more admission or treatment for me.

And lastly, complaining could be replaced by a bit of thanks:  five at the table, Julia, Jack, Acacia, Scott and me, with pasta and candlelight.  OK it was almost 8 and drizzly and there was a tarantula on the door jamb and we had all had long days, but it feels like a tiny seismic shift of RIGHTNESS to be together again.

So the week will march on, with threatening tears.  A veteran missionary our age, whose family we know, died today.  Veteran African friends, whose ministry we respect, face illness in a child.  My problems suddenly seem trivial.  Can't complain.