High's and Low's

On Thursdays, our kids come home for lunch (the only day they do that) and bring an assortment of others.  Generally we started this to touch base weekly with the kids for whom we serve as guardians, back-up parent-help.  Sometimes we have a half dozen, and sometimes we have 15 or more. One of our traditions is to go around the table (and since we usually don't fit, around the room) and listen to each person share a High and a Low from the week.  It's a way to celebrate the victories and commiserate the losses, to build a little community as we talk about what strikes us from the last few days.  I am finding it harder and harder to get a lunch break and am often late.  Today I had Abigail prepare double, thinking that since it is an exam schedule with longer breaks, attendance might be extra high.  Wrong.  But still nice to see these kids one last Thursday, and share our week together.

So in the same vein, a few highs and lows of the week.

HIGH:  'Tis alumnae season.  A quiet knock on the door as we lingered around the dinner table last night at nearly 9 pm, and then big hugs.  LOW:  Caleb can't come back for alumnae weekend (the two-year-post-grad is the main event).  HIGH:  His friends are here, which makes me feel closer to him in some way.   Titus and Aneurin had just come off a bus from Uganda, hungry.  It was like old times.  Can't wait to see more of them.  Hoping to host as many as possible.

HIGH:  Meaningful goodbye parties for the Gessners yesterday.  LOW:  You have goodbye parties because people are leaving.  HIGH:  Many got a chance to verbally express appreciation.  We had a lunch for consultants, nurses, and permanent CO staff.  Then we had a cake for the interns at our weekly teaching conference.



They will leave a huge hole in our department.
HIGH: As they leave, we welcomed Dr. Carola for five to six months, a German paediatrician who wants experience.  And for a month we have Dr. Donna and family from Georgia.  New Serge missionaries Dr. Roger and Ginny Barnette (he's an anesthesiologist) arrived for a short term stay in advance of their long-term commitment starting next year.  We've had each of these newcomers for meals this past week-plus.  Tonight we also welcomed former team mate Pamela and Serge colleague Joel here on a mission-planning trip.  'Tis the season of visitors.  It rained as we made pizza, which in Africa is a sure sign that visitors = blessing.  So I won't count the rain as a LOW.

HIGH:  Because our department is working hard on excellent and compassionate care, we are busy.  Every day more patients come.  Often the sickest, the end-of the road, the desperate.  Some of them get much much better.  We've had some fascinating diagnostic dilemmas this week.  Rare syndromes.  Hypertension that turned out to be a blood clot extending from the aorta into the kidney's blood supply.  Severe malnutrition that turned out to be TB. A massive bone infection; an infected knee.  Seizures of all sorts.  A baby referred because poor growth pointed to a congenital heart defect, but who was actually infected with HIV.  A preemie discharged who returned with pallor and shock, resuscitated and OK now (this is her great-aunt praying as I bagged her little lungs full of oxygen . . she made it).

LOW:  Not enough resources of any sort.  Not enough beds.  Not enough energy or wisdom.  Not enough money.  Every day is a marathon of juggling and survival.  Who can I move from a critical-care area to a less intense one?  Who can I send home?  How can I manage this baby without admission?  Is this one getting treatment in the hours and hours of waiting for a bed to open up?  How can I respond to calls from various areas while still seeing patients on rounds?  What can I teach our trainees as we go through the day?  One day this week this came to a head when I'd been on call, was very tired, and very frustrated.  I talked to a half-dozen people to address some issues that endangered a patients' life, and I ended up hurting some feelings.  I got reprimanded.  It was a low day.  Praying for grace to infinitely extend my patience, my diplomacy, my wisdom, and even by some miracle my joy.

HIGH:  Money raised by Mardi for a patient with spina bifida, a sweet little boy PN.  He survived pneumonia, the ICU, and now he's going home.  In fact we've been spending money on lots of kids lately.  So, LOW, our Needy Children Fund account is in deficit.  But our chaplain tells us, the more we spend the more God will send.  Testing that these days.

HIGH:  Celebrating the year.  Football and Basketball League champions for Jack, plus Rugby Blackrock winners.  Football League champions for Julia, three out of three varsity years.  She also won awards for "heart and soul" in football and most improved in tennis.  LOW:  the seasons are over. HIGH:  I got a new t-shirt.

 Literal HIGH:  the pottery class does a contest to see who can make the tallest thin vase "tower".  Jack did 12.75 inches, which evidently topped the instructor, and won him two mugs.  He has brought home lovely pieces from the pottery class.  It is the right combination of his manual dexterity and artistic bent.

LOW:  If you read the post below, it is clear that a huge portion of our week was spent in sympathy with our friends and team from Bundibugyo.  The story is on CNN and the Wall Street Journal, so anyone who wants can find out the details.  Here is President Museveni's explanation which is worth reading, and boils down to tribalism.  The four traditional Kingdoms that preceded British colonization were long suppressed, but after decades of peace allowed some ceremonial roles.  However, now many smaller groups that never had monarchies have seen the financial and political bonus of a "kingdom" and demanded that their leaders be recognized as kings. After the government allowed a Bakonjo kingdom (a fairly large language group in Western Uganda and Eastern Congo, but the minority in Bundibugyo) the Babwisi/Baamba also agitated for a king.  The groups have long had a simmering conflict (does anyone remember our baptism party fiasco?) but the establishment of the recognized kingdoms has escalated divisions.  Money, power, jealousy, fear all play a role.  Maybe even the oil discovered in the Albertine basin.  Maybe mistrust, lies, the sense that it is us or them, the drive to survive.  So one group theoretically riles up its youth and sends them on 13 coordinated attacks over three districts, armed with only pangas and spears, to steal guns from police barracks and army posts.  The army fights back with actual automatic weapons and slaughters these youth.  The newspaper reads, "In summary:  Mayhem."  Here is an alternative minority view, focusing more on the possibility of cross-border anti-government rebellion. It asks some good questions about who did that impressive coordination, and what the purpose of the whole event was.  

HIGH:  It was quickly suppressed, and the army and police are patrolling in full force.  LOW:  It is another round of uncertainty and loss in a place that has known too much.  DOUBLE LOW:  Our whole team evacuated.  TRIPLE LOW: This happened at a time when a former team mate and son were trying to visit CSB, which had to close for safety concerns.  And when other visitors were there.  HIGH:  By Tuesday we were talking to friends in the district who felt much relief.  Schools had been told to open, buses and taxis were moving, shops were reopening.  HIGH AND LOW:  So we decided to allow Luke and his room mate to drive in on Weds/Thurs.  This was a big part of his epic trek, to visit his home, and greet his old friends.  It is not something one imagines saying as a parent, yes, you can go to a place where 90 people were killed three days ago.  But we are glad we listened to the people on the ground, and let him go.  He had such a wonderful time connecting with so many people and places.  The rest of the team is going to make decisions about returning next week.  Luke is now back in Fort and on the way east to Kampala and then Kenya.  LOW:  We grieve for the deaths, the divisions, the hard task of discerning what is best, the healing of tensions and fear.  And for the same in Kenya and South Sudan.

HIGH:  Scott got interviewed this morning, live, on BBC radio. LOW: He was asked about Ebola, because we once lived through an ebola epidemic.  Still it was sort of cool, and immediately followed by an email from a German TV station requesting an interview tomorrow.  My only fame moment today was as I was walking out of the hospital at 6 pm, a random dad asked me to pose for a photo with his very cute daughter dressed in pink.  I'm pretty sure she wasn't one of my patients, but I complied.  Maybe she'll be a doctor one day and look back on that photo  . . . We have some odd life moments.

HIGH:  Caleb got to fly on a C130 to a neighboring country, and is learning and observing a lot about life on an air force base in a foreign country and in a time of war.  Another HIGH, he's been able to practice some of his Arabic.  SUPER LOW:  lots of running is making his knee hurt, so he's not really healed, and we still long for that.  He's less mobile again now.  Sigh.  HIGH:  we have been able to talk over internet a couple times.  LOW: That's two kids adjacent to war zones.  Stressful.

HIGH:  Julia signed up for classes at Duke.  LOW: that means she's really going to leave and go to Duke.  One week 'til graduation.  

Statement from the Bundibugyo Team

Dear Supporters/Family/Friends,

Over the past few days there have been many reports in the news of

conflict within western Uganda.  We would like to clarify a few things

as well as ask for prayer for the people of Uganda and our team.

We believe the series of events that began on Saturday, July 5, in the

western region was caused by tribally rooted tensions.  Even though we

never felt as though our mission (team) was a target, we made the

decision to remove ourselves from the area as the atmosphere in our

immediate area intensified.  We are thankful that God granted us the

grace to be evacuated to Fort Portal and remain safe, and we are

closely monitoring the situation in Bundibugyo.

Please pray for the local families in this western region who have

lost loved ones as a result of the fighting that has been taking

place.  Please pray against any fear in our hearts that has arisen due

to the intensity of what we have recently experienced.  Pray that we

would believe Proverbs 29:25 and put our trust in Him.  Lastly, please

pray for peace in Uganda and for wisdom for our team and organization

as we continue to assess the conditions in western Uganda at this

time.

Blessings,

Serge Bundibugyo

PROJECTS COMPLETED

'Tis the season of projects, which today transitions into the season of exams.  The last week I have listened to power-point practices of presentations on the life of Orson Scott Card, the physics of forces on the Brazuka soccer ball, the calculus behind bridge designs, and the way effective nuclear charge correlates to the wavelength of light emitted by burning compounds.  Julia has been gluing popsicle sticks and Jack has been making posters.  Today the Seniors present their "End of Times" journal which is a series of essays and photos in a scrap book that tells their life stories.  I have not yet seen the 45-minute soap opera drama in Swahili that was a final project for that class, or the robot Julia and her friends made for computer science, or the lawnmower engine she rebuilt in advanced auto mechanics.  There's probably a French project of Jack's in there somewhere too.  We have a long school year.  So it seems after 200 years of habit that June means summer, and because all the AP classes have to finish their content in time for May exams, the last month of school consists of a major research/paper/art/media project in every class.

Which is a great way to learn, but also a bit stressful.  A certain child that got superb AP exam scores and nearly perfect grades begged to just quit school and drop classes as senioritis hit hard and one of these projects in particular just sapped her spirits.  But she pushed through, and as of today I think they are all done.  It is particularly hard when college things (register for classes, turn in forms) are due while high school things are still in full swing, another slight downside of our year-round schedule.

3 days of exams and then it's all parties and clean-up and alumnae games and graduation.  We're almost there.  Which gives me relief and joy for Jack, and a pit in my stomach for Julia.  She is going to be fine, but not sure we are.

Blessing and Favor

Yesterday I spent time in a sober meeting, discussing hour by hour the management of a mother who came into our hospital in labor, and delivered a very stressed and depressed baby.  The infant died about 12 hours later in spite of maximal intensive care.  We examine these cases in detail, review all the vital signs and monitor outputs, clarify what could have been done differently.  It is responsible and helpful, but frankly we aren't in control of every outcome.

So it was particularly encouraging that one of our interns sent us this picture from clinic that afternoon:

This is the mother who was getting CPR WHILE Scott performed surgery to remove her twins.  All 3 would have died 99% of places in Africa.  But the team rallied, OB and Anesthesia, Theatre and ICU, Paeds and Medicine.  And mostly, miraculous intervention by God.  When the mom finally turned the corner towards living, and woke up a couple days later, a nurse and I took her babies up to the High Dependency Unit.  She named them Blessing and Favor.  I wrote about that in a blog a few weeks ago.  Here they are for a check-up, a smiling and grateful and intact family, a dramatic story of rescue.

So much of our days are like that.  A party for Julia while we're on the phone with teams making tough decisions about evacuation.  A child who was in a coma wakes up, another who I thought was going to fully recover from a treatable infection slips into seizures and coma.

It is easy to see God's blessing, and His favor, in the dramatic healings.  It is more challenging to believe in those things during the loss and grief.  And yet we walk through the valley of the shadow of death to a richly prepared table.  Feasting and mourning, juxtaposed, throughout this life.

And Give you Peace

Juxtaposed with blessing today, chaos.  I chose Numbers 6 for the blessing for Julia:
May the LORD bless you and keep you
May the LORD make his face to shine upon you and be gracious unto you
May the LORD lift up the light of his countenance upon you
And give you peace.

This was the blessing that my pastor growing up, Pastor Vail, pronounced upon our congregation weekly.

And give you peace.

Poignant, today, because we are in a swirling epi-center of NON peace.

Here in Kenya, 29 people were killed in another round of attacks on the northern coast.  Tomorrow is "saba-saba", or 7/7 in Swahili, a day with political significance chosen for protest.  Tensions are mounting, people are being warned to stay home, the opposition (mostly from the west) versus the current administration (mostly central).  In South Sudan, our team is pondering whether to continue with plans to return at the end of the month because of newly increasing violence and tribal tensions.  In Uganda, the embassy sent out a very specific warning of an attack planned on the airport this week.  Our boarding school had a stressful exhausting week as a letter purportedly from some parents was read on the radio accusing the administration of all sorts of things, then students went on a hunger strike, rocks were thrown, police brought in.  Just as this was simmering and being sorted, in the last 24 hours five coordinated attacks in three western Ugandan districts have left over 50 people dead.  No one is quite sure what is going on, but the official line is that this is internal tribal conflict as well.  Some of the gunfire and violence took place near our team.  Visitors heading into the district were turned back by machete-wielding youth.  Our team is safe but bunkered down; our school has closed.  I talked to Melen and my heart goes out to her as she makes decisions about her school, her teachers, and her own children, all alone.  She is from the minority tribe, and if things get out of control that could be bad for her.

At least Burundi is plugging on ahead, working and building and teaching.  We just talked to Luke who passed through Kibuye on his East Africa road-trip circuit last night, and we are super-thankful for their hospitality.  No war, but he did come upon a wrecked vehicle and so showed up at the team's hospital with a bleeding child in the back seat.

You don't appreciate peace until it is, quite suddenly, not there.  The familiar pit in your stomach, the uncertainty, the rumors, the limited mobility, the hyper-alertness, the taking-nothing-for-granted view that is blocked only a few hours or days ahead.

Please pray for God's peace in East Africa.  Meaning real peace, real dealing with fear, protective reprisals, greed, hate.  Kenya, South Sudan, and Uganda all need the Gospel that breaks down dividing walls of hostility, that gives people true harmony in diversity as the many tribes reflect God's infinite complexity and yet also God's trinitarian unity.

Celebrating Julia

Today we invited all of "lower station" (hospital and Bible college staff) to an open house to celebrate our seven collective RVA soon-to-be graduates.  

Celebration and community are an essential combination in life, sharing milestones together.  Before we cut the cake, the seven stood and each set of parents spoke a blessing to their graduate and said a prayer. Raising children is a shared affair, and we are blessed by the many friends who came around today to acknowledge that reality.

And by those of you who read this blog from afar, and pray.  

Here is the letter we sent to our supporters, as we prepare to see Julia graduate:

Dear Praying Friends:                                                                                        12 May 2014

Julia is our Jewel, a precious gem of a soul, multifaceted, shining under pressure, sharp and strong.  And you have been a part of her journey from the beginning, when she was a fetus in Uganda, when she was born in Virginia, when she was an infant being carried through a war zone and evacuated by helicopter, when she was a toddler living in displacement, through all her school years growing in grace and favor with God and man.  She has been tough enough to survive Ugandan school, caring enough to draw friends into her life from many languages and cultures, smart enough to keep up with three brothers, fast and agile enough to join the first-ever girls’ football team from Bundibugyo participating in national tournaments and then to play and captain multiple varsity sports at RVA.   She was voted “Most Encouraging” in the senior class, an apt title for someone who prioritizes prayer and relationship. You would be hard-pressed to find a 17 year old girl more responsible, more independent, less influenced by fleeting opinions, more fun and adventurous, more comfortable with dairy cows and computer programing and motorcycles, or more beautiful.  And all of this rests on the prayers you have prayed, the sustenance and counsel and assistance you have given our family.  So as we approach her graduation, we want to take this opportunity to say “Thank YOU.”  To invite you to reflect on God’s mercy to all of us as you receive this announcement, to sense our gratefulness for the ways you have blessed us.

Julia will attend Duke University in Durham, NC, beginning in mid-August.  She is a gifted young woman with a heart sold out to God and we look forward to seeing what direction He will lead in her life. 

We will be in the States for the month of August as we help her get ready for college and attend orientation, as well as visiting my Mom who is recovering from serious back surgery.  Luke will also be starting medical school that month.  He graduates from Yale on May 19th with a bachelor’s degree in African Studies and a concentration in Global Health.  God has opened doors for him with scholarships and financial aid and it looks like he will head back to the very place where we met and began this journey, Charlottesville, to attend UVA’s Medical School.  Caleb is finishing a grueling second year at the US Air Force Academy, slowly recovering from his devastating knee injury, majoring in mechanical engineering.  Jack will begin his senior year at RVA in September.  These kids have survived on your prayers, and are potentially a quadrupling of sacrificial Kingdom blessing pouring back to the neediest corners of creation where their hearts remain as they study.  We continue our crazy, demanding, fantastic jobs:  working as doctors at Kijabe Hospital, teaching a new generation of Kenyan doctors and nurses, encouraging and bolstering six teams in four East African countries, caring for missionary kids at RVA.  We plan a “real” Home Ministry Assignment (year of furlough) after Jack graduates in 2015, to meet you face to face, and prayerfully seek God’s next steps for us in Africa with Serge (the new name of World Harvest Mission).

May God continue to bring Julia to your hearts to pray for her during this transition.  And for all of us, who will be grieving her absence as we press on.   

With love,

Jennifer, Scott, Luke, Caleb, Julia and Jack

c: +254 706 060 813  

e: drs.myhre@gmail.com                            

w: http://paradoxuganda.blogspot.com/

w: www.serge.org , www.kijabehospital.org

m: Box 20, Kijabe 00220 Kenya

                   

Another week, another year

This week began in a feverish haze of flu, shaking under a mountain of covers while my temperature edged up near 103.  In that zone, I found myself hearing the World Cup in the next room and briefly believing that the cheering was for the battle of my cells against the virus, and I remember floating over my body.  This particular pathogen eventually ripped through our whole family, with Julia also missing three days of school with chills and fever, and all of us settling into hacking productive coughs.  Thankfully we have emerged on the other side as the illness ebbs away, but we are exhausted.  I'm on call this weekend, fairly typical:  in and out of the hospital all day Saturday, evaluating multiple kids in the emergency room in the early evening, a trip in at 2:30 am, a 999 code in the early morning, two deaths, back home in time to go to Sunday school and church. That level of work this weekend, though, has left me absolutely wasted instead of just plain tired.

Physically, and emotionally.  On Thursday evening, I checked in maternity to chat with a newly admitted mom whose baby had a prenatal diagnosis of spina bifida.  When I picked up her chart though I nearly cried. Her seventh pregnancy, and all the previous six had ended in death.  Not one living child to show for time after time.  There she sat, with the paler middle-east look of the Somali-border people, wrapped in a headscarf, patient, uncomplaining.  I asked her if I could pray, and we did.  Her baby was born the next day, premature and massive-headed, pink and struggling.  Her spinal cord did not form, her brain is pressed by fluid, and she is not likely to survive long.  Which is why I gladly walked in at 2:30 am when there was a problem, to give this woman the courtesy of all my attention and explanation and communication out of respect for her suffering.  The same day she delivered, our team received a dead baby they were unable to revive.  A 13 year old school girl, too alarmed and ashamed to tell anyone she was pregnant, went out to the school shamba and delivered on her own.  The school found her and brought her with her baby, but the infant she carried in was dead.  And a preemie whom my colleague had struggled over for several weeks in ICU with ventilators and chest tubes finally gave up his tiny struggle.  This morning it was a 2-year-old whom we had admitted umpteen times for respiratory illnesses, he had severe brain damage from something previous and so a difficult time handling his swallowing and feeding, and was constantly sick.  When we admitted him he was no worse than usual, and had a good set of vital signs at 6 am but was found dead before 7.  In spite of an all-out code, we got no response.  You would never know from his well-kept well-nourished body, or from his mother's desperate cries, that this was not a perfect child.  He was loved.  I found myself supporting this woman for quite a while, reading 1 Corinthians 15 to her, and praying.  As often happens, Kijabe is a place where she spent a good portion of his two years of life, and a place where she received attention and care and hope.  Even in her tears this morning she could be thankful for that.  From there I went back to nursery where a very abnormal little baby had stopped breathing.  She had intestines protruding from the front, a heart on the wrong side, infection in her brain, lots of extra fingers and toes, a small head and deep jaundice.  We had already counseled the parents about her poor prognosis, and we stood together around her again and prayed and agreed to let her go.  No one can prepare for what he or she will be like in these life-and-death moments, so the faith of Kenyans never ceases to amaze me.  Job-like, the dad prayed in worship, and the mom affirmed thanks.  We kept a short death vigil of comfort, and then she was gone. That's four deaths and one more expected death in the last few days.  All represented the frontiers of what we can do, the margins of where we can save.  All strike home the way that evil takes its toll on the bodies of babies, in the process of birth becoming death and loss.

And in between the fevers and the losses, right in the middle of this exhausting week, I had a birthday.  I was barely moving and eating, but Scott got up to make a special breakfast of cinnamon rolls, friends brought over flowers and pie and chocolate and a necklace and a beverage.  Our quarantined family ate together and crashed by the fire and the World Cup.  I read my hundred greetings on facebook from around the world and through the years.  It was a good day.  A spot of sunshine and life-goes-on, of another year punctuating the reality that not everyone survives these flues and I am thankful for my family and this place, my work and this life.

My mom manages to get cards here on time for special occasions.

My favorite celebratory group.

The sky.  Actually saw it after weeks of cold clouds, on my birthday

Jack made me this bowl in pottery class

And Scott made his own creations

After being sick so long they were happy I emerged on my Birthday to pay a little attention to them.

How we spend cold June evenings

Birthday cheer that reminds me I have great friends.

Our lovely garden

Former neighbor Anna Rich back for a visit.  

The day Julia got out of bed, classmates came to cheer her up.

My traditional bday apple pie, courtesy of Karen.

Last Caring Community.  Sniff.

Visiting doctors on my Birthday, and it turned out the cardiologist on the right and I were actually in training together in Chicago 23 years ago.