18 and Ache-ing

Julia's 18th Birthday, a moment for milestone thankfulness and wistfulness.  Mostly thankfulness, because she is a jewel:  precious, beautiful, shining, tough.  She has plunged into her first year of American school since preschool with courage and openness, making friends and enjoying classes and braving bike transport and the newness of just about every aspect of her life.  She is practical and prayerful and loyal and true.  We love her so much.

And thankful for our friends the Harteminks (and the Barts who connected us way back when) who invited her for a birthday dinner and cake.  And Grammy who could not come but treated cousin Emma and Julia to a dinner out together the night before in absentia.  And friends who hang out late at night in the dorm and celebrated her, and a thousand other things.

But we are also wistful, because we don't get to celebrate this milestone of transition to adulthood in person.  Because it is the beginning of the rest of life, when birthdays are spent mostly apart.  When we feel deeply the chasm of the continents, the time zone gap, the challenge of knowing our growing adult kids.

 Yesterday, on her actual Birthday, as I went to early morning rounds, I felt acutely the responsibility of someone else's daughter.  Precious came to us last Monday morning, as I answered a page in the early morning to come quickly to the casualty (emergency).  Three months old, she'd had a viral-sounding cough and cold that progressed to severe gastroenteritis and then seizures.  She was convulsing and barely breathing.  Her initial pH in the blood was 6.7, which is very very bad, not many people come back from that.  With our casualty doc I intubated her and we started repleting fluids in her shocky, dehydrated body.  I was bagging breaths with one hand and holding my phone with the other making desperate calls to rearrange patients and space and call in extra nursing help to allow us to admit her to the ICU.  Now six days later she was still alive, moving a little, slightly improved, but still comatose on the ventilator.  That first morning as I rushed around casualty, I paused to explain things to her mother.  Who stood there at the end of the gurney, tears flowing.  I don't usually hug moms, but this one needed one.  I tried to be soberly realistic.  Her daughter was almost dead, and we weren't sure we could pull her back.  But also hopeful, that God brought her here in time, that we would do everything in our power.  And my own heart went into this struggle as we prayed together.  Love costs vulnerability.  I want Precious to live.  I don't claim to care as much for my patient, someone else's daughter, as my own.  But I do think the longing I felt Saturday morning to be with Julia helped me focus and pray and work for Precious.  Still hoping.

Then, up the hill to RVA, for the Sports Tournament/Senior Store Saturday.  And as I reached the top, I had the idea to take pictures of people wishing Julia happy birthday and post them to her on facebook. Liana Masso is way more artistic than I, and agreed to make a sign.  So as we watched games and stood in line for food and talked to friends, I snapped a dozen or more photos of people who knew Julia, greeting and smiling.  The edge of wistfulness was blunted by being in a place where people know Julia and care about her, where they can light up with the reminder that it is her birthday, and the opportunity to participate.

Our evening ended with dinner at our good friends' the Massos, because they are like family, and know it is hard to be away from a daughter on her birthday.  From experience.  When their daughter was with us.  Full circle now, they pulled us in for a cake and calling and passing the phone around the table to all say happy birthday to Julia.

The boys won the tournament.  Jack scored a key goal in one of their closest games (he had promised Julia to score one for her!) and assisted the second goal that won that game, as well as the overtime golden goal that won the semifinals.  He played with skill and passion.  I love seeing him use his speed and strength to battle it out, and the way he passes into the center and gives his team mates the opportunity to score.

But today the wistfulness is edging out the thankfulness.  Partly from the realization that I don't know where we will be on future birthdays, but we are unlikely to be around as many people who know our kids as we are here.  Part of what binds us to Kijabe and RVA is that it was a home for them (though never for the six of us together), that when I walk around on October 4th I run into LOTS of people who know and love Julia.  And while we have a long way to go until our HMA (furlough), part of what will make it hard to leave will be leaving behind people who share in our love and parenting.

So it's Happy 18th to Julia, and THANKS to our friends especially the Massos and Harteminks, and PLEASE PRAY to those whose daughters are also PRECIOUS that this 3-month-old would wake up, and that we would take the vulnerability of love in stride, and keep walking this path.

Thoughts on parenting, vaccines, sex, and the desert

We are the student health doctors and as such, we've had some emails this week about a controversial topic:  HPV (human palliomavirus) vaccines for early adolescents.  In Pediatrics they are considered routine adolescent anti-cancer vaccines (virtually all cervical cancers are caused by HPV).  For once there is a cancer that is completely preventable if a person is never infected with the HPV virus.  The rub comes when parents with very strong Christian beliefs assume that their child will never be infected, because he/she will never have a sexual encounter until their wedding day, and will marry someone who also remained celibate until that moment.  I fully believe that is healthy, and best.  And possible.

But far from a guarantee.  We live in a broken world.  Even Adam and Eve, who were created perfect and then parented directly by God and had daily intimate communication with Him, succumbed to the temptation to do the one thing they were forbidden.  Christians sin.  All of us.  Pride, gossip, laziness, cruelty.  And sometimes, being led away by passion to make a physical commitment beyond readiness for a full-life commitment.  There will be consequences emotionally and physically.  There will be grace, and healing.  But I would hope that if we could prevent one consequence, that of death by cancer in one's 30's, by a simple vaccine, we would do that.

Secondly, the broken world means that even if a particular kid is faithful and abstinent, she may be harmed by the sin of another.  Nice girls can be naive.  They can have something like valium slipped in a drink.  They can wake up to find themselves raped.  More than half of young adults in past decades ended up infected with HPV, so chances are pretty high that a rapist would transmit the disease.  Again, there is grace and healing, but in this situation we'd all opt for preventing AIDS or cancer if we could, wouldn't we?

Thirdly, even if the child walks down the wedding aisle having made perfect choices, and having been protected from all harm, there is a good chance his/her spouse will not have had the same advantages.  Some wonderful people become Christians later, after having made choices that left them with scars.  There is such beauty in that.  In fact the whole book of Hosea is about God asking one of His servants to marry, love, protect, redeem a former prostitute.  When your kid is 12, you have no idea what path God has for him/her in the decades to come. We are surrounded by a world where the Fall means that disease and death abound.

In this context I read with my team yesterday the story of Hagar and Ishmael.  Remember her weeping in the desert, thinking her son was going to die?  There she was, at the end of her resources, facing the worst thing imaginable for any of us as parents.  Helpless.  And what put her there was a mixture of her own choices (taunting Sarah), the sin of others against her (she didn't exactly choose to be a bondservant most likely, and having Abram's baby may not have been her choice either, let alone being sent into the desert), and the general brokeness of a world of deserts without water, of distance, heat, and exhaustion.  Yet at that moment, God hears, sees, comes.  He provides.  He rescues.  Even if she sinned and others sinned and the world is a mess, He still saves the boy from some of the consequences.  He does not add up and inflict upon us exactly what we deserve.  Because the deepest part of God's nature is love.  For us and for our children.  I find this extremely encouraging, that if God hears the prayerless despair of a foreign servant friendless and alone in the desert, He also knows how to provide for us and our children.

So, parents, I am opting for vaccination.  I truly hope none of my children need that extra margin of protection.  I hope they experience only true, faithful, exclusive love in their lives, and so do their spouses.  But if they, like Hagar and Ishmael, find themselves beat up by this world through their own choices, or the choices of others, I have the small comfort that cancer may not be one of the dozens of things that need healing.  And the large comfort that NOTHING can separate them from the God-who-sees.  That Love is suffusing the hot desert winds, and will provide and oasis.

Baby Hope

Just talked to R this morning, and she mentioned that she has named her baby "HOPE".  How perfect is that?  Rom 5:3-5.  Let this Hope not disappoint.

Subtlety

Friday night lacked subtlety.  Evil overplayed its hand.  In the disturbing trauma of the grabbing shadow violating my lap, the helpless confusion, the jumpy gang, Scott running . . . we called on the name of Jesus when there was nothing else to do.  We were up against darkness but also unwise in our decisions.  So many people have been kind and supportive, my sense is that the whole over-the-top nature of the situation has backfired into victory.

Most of life, the struggle is way more subtle.  Insidious loss or eroding frustrations are much harder to name, to share, to rally against.  

Pictured above is R, whose husband gave her HIV then disappeared.  She came to our hospital 3/4 of the way through her 5th pregnancy.  All four previous babies had died, either as stillbirths or within hours of delivery.  She is diabetic, malnourished, and depressed.  With vacant eyes she let her sister do the talking.  Her amniotic fluid was increasing dangerously fast; her baby had slowed in his movements, and even though she was very premature the OB team felt she had to be delivered.  We felt the chances of her baby's survival were already low and falling by the day.  So to the theatre she went.  And out came a plethoric, bloated, but crying baby boy.  He's breathing well, a bit jaundiced, and it is taking time for his blood sugar to stabilize.  But all in all we are very hopeful that R may at last take home a live child.  

This battlefront is every bit as important as thieves in the darkness, but the life-threat is to a nameless infant and much harder to see.  

R smiled when I greeted her today.  She has recovered something precious, hope.  And she welcomes your prayers for her and her child, who still face weeks of intensive care and years of struggle.  For the little boy to survive, his mother needs the kind of care that can hold her virus at bay.  A more insidious evil means she's a functional widow, and is eking by on first-level anti-retro-virals with a poor response.  She is determined to feed her baby formula to lessen his risk of AIDS, but that may mean great sacrifice for her.  Yet today she is courageous and full of plans, as she looks at a breathing child of her own who has lasted four days for the first time.

This is only one story in dozens already, as we move through day 5 back in Kijabe.  More subtle lines between good and evil, life and death:

 Surprise twins, when we thought we were getting only one preemie, they turned out to be a matching brother/sister pair.

 This is not normal.  A baby born in Dadaab refugee camp, within 36 hours is noted to have a massively swollen abdomen from blocked intestines, and makes the arduous trip to Nairobi to see our surgeons.  Because this church hospital is the preferred center of healthcare for an entire nationality and people-language-group to our northeast, even though Kenya is at war with them, even though we're smack dab between the anniversary of 9-11 and Westgate, this little girl will have her life-saving procedure tomorrow.  And probably neither she nor her family will be recruitable to the kind of terrorist cell that Uganda is trying to thwart this weekend.

This, below, is just plain sweet perfection in a tiny package.  Her mother suffers from severe pre-ecclampsia and risked dying unless she was delivered today; and she probably would not have made it much longer in that hostile inadequate environment either.  But there she is, pink and relaxed, about thirty minutes old. 

And just to keep things interesting, we landed back into a weekend on call and the first Caring Community (families have a small group of dorm kids over monthly) . . . . 

 . . . and our first-ever Senior Boys' Sunday School. 

Between the two we have the opportunity to support, feed, love, encourage, and point to Jesus a bunch of great guys from Africa, Europe, Asia, and North America.  Like most high school seniors they are concerned about college apps, sports injuries, and time management.  But they also ask prayer for elections in their unstable countries, parents who are working in dangerous places, wilderness flights and Bible translations.  

And lastly, a shout-out to friendship and teamwork.  Because the subtle borders of the Kingdom struggle demand reinforcements.  One of the greatest surprises of this return was the quick embrace of friendship.  We have a Serge team here now where we came almost 4 years ago alone.  We have meals and walks and prayer and concern.  Karen, Bethany, and Ann to the rescue.  And this month, we have Carol.  Carol L grew up in the same church I did (though decades later).  Her parents are our friends and supporters.  Once upon a time she came to Bundi as an intern and got talked into staying half the year.  Now she's in her third year of a Med-Peds residency, and brought her calm laugh, good sense, quiet can-do, smart competence right into our lives again.  She's staying with us and working with me, which is why I can be typing this on a Sunday evening on-call.

I hope that as many readers who were caught up in the drama of highway robbery will also see the more subtle moments of goodness, sacrifice, and hope in the stories of the weekend.  Moms who get years to love, boys who want to use their strength for service, babies who can breathe and grow.  Evil losing its grip on iPhones and on lives.

A no-good very-bad night and power in the Name

Some dear friends of our had a no-good, horrible, very-bad day.  Our team leaders from Burundi were flown by air ambulance from Bujumbura because a chronic disc problem in the wife's back took an acute turn for the worse.  She was unable to sit or walk and in constant pain.  Surgery that they had tried to avoid is now necessary.  They spent the night arranging the flight and the day getting here to Nairobi where they had a contact with a neurosurgeon at one of the two private hospitals in town.  A hospital that most westerners would actually recognize as such:  clean halls, spacious, lighting, curtains, wheeled gurneys that don't look like museum relics, abundance of staff, no visible blood or grunge.  By the time we got off work and went to meet them they had been settled in a small cubicle for a couple of hours waiting for a doctor to come.  We had a good visit, used our Kenyan cell phones and email, made calls to our office in America and the insurance company, interacted with the staff, prayed, and just generally tried to keep them company and help move the glacial admission process forward.  It was good to be with them and try to be helpful.  By a bit after 9 pm they encouraged us to go home, knowing we would arrive quite late already.  They were scheduled for an MRI in the morning, and hopefully surgery to follow.  Please pray for a safe and successful procedure.

That's when our no-good very-bad night really kicked in.  On our rather fast and surprisingly low-traffic ride into town we had abandoned plans to buy groceries or dinner because there was a huge jam around the shopping area, and we wanted to get there.  We had missed lunch and dinner and we asked the guard at the hospital if we could find something at 9 pm,  He directed us down the hill, where we could see a sign for a restaurant.  We turned onto another road and looked for parking.  Dark.  No street lights.  No cars.  The parking lot locked.  Confused we came to the end of the street and saw that there was a narrow curved connection to the main road that was clearly designed to bring traffic off the main road in the opposite direction, so we stopped.  Out of the darkness THREE police appeared, and demanded to see Scott's license.  You have committed a crime, they said.  This is one-way and you are driving the wrong way.  To make a painful story shorter they were lurking there for the sole purpose of extracting money.  There was no signage to indicate one-way, and we never entered the narrow connection, but they said Scott would have to go to the police station right away, pay 20,000 KSH ($250) and then return to court on Monday.  Of course they just wanted money. They produced a "boss" who had "authority" to hold court roadside and avoid the hours of delay.  I pleaded.  They were nice, then not nice, then nice again.  We finally settled on 9000 KSH (a little over $100).  Feeling discouraged, exhausted, three-days into jet lag, and hours from home, we again abandoned plans to eat and just headed towards Kijabe.

Which was fine for a few miles, except for numerous life-threatening buses running lights and barreling down on us with impunity, and no police in sight except for the ones lazing at round-abouts, stopping traffic at one point for 25 minutes straight while we sat doing nothing.  Oh well.  The night was about to get much worse.  As we headed up out of town the same traffic snarl we had seen coming in was still there, now 4-5 hours later.  We stopped.  We inched.  We crawled.  We were actually at a point where we were slowly rolling forward in our two lanes of the 4-lane divided highway when suddenly a dark long shape shot in my window.  My window was only down about 3-4 inches and I was texting my kids in America about one of them being sick.  I had my iphone held on by lap.  It took my brain a second to process what was happening.  It was frightening, this arm violating my space, reaching into my lap and grabbing my phone from my hands in a slowly moving car.  I screamed, Scott braked, I opened the door and yelled again, he ran between the lanes of cars and disappeared.  People stopped, asked what happened, looked sorry, but there was nothing to do.  It was pitch dark.

That phone is my connection to my kids.  And my number one work tool.  Scott pulled over into the median strip and got out of the car to look for the guy, but he was long gone.  He got back in and we tried to use his phone to get on the internet and wipe my account clean.  Of course, the page wouldn't load.  Then we decided to just call the phone and see if the thief was still close by and would sell it back.  He answered, Scott pleaded.  The thief was worried we were trying to trap him.  We offered just over a hundred dollars (again) because the hassle and expense of replacing the phone would be many times worse.  He said he'd come back.  Scott waited, even crossed the lanes of traffic to look for him on the other side (against my yelled protests).  Scott called him again, he kept saying he was coming, giving landmarks of where he was.  Then Scott decided to walk back in the direction we'd come from and cross the road again.  I could no longer see him.  It's after 10 pm, we're in the middle of a busy highway, but the sides are in shadow.  I have not been so scared in a long time.  In fact I could only pray over and over "Lord Jesus, have mercy.  Lord Jesus.  Lord Jesus."  It was odd, but that's all I could do, over and over and over.

For good reason, because while I was imagining an unstable, maybe violent guy, it was actually much worse.  Scott approached the person he saw who turned out to be a bystander, and while he was talking a gang of six men surrounded him.  At that moment he knew we had made a huge error in judgement.  It's only a phone.  Not worth a life.  They could have dragged him away from the road and beat him, taken the money and both phones.  But God protected him in that helpless situation.  He held out the money and talked calmly.  The thief held out the phone.  They tentatively had their hands on both for a second and then the exchange was done.  Scott backed away reassuring them over and over that he was not tricking them.  They counted the money and left, and he ran back to the car glad to be alive.

OK if our kids did that I would be so upset at their foolishness.  We were not using good judgement.  Blame it on jet lag and the late hour.  Or on the spiritual darkness of this evening:  A seriously ill team leader.  A bureaucratic tangle prolonging suffering while the insurance company dragged its feet.  Corrupt police.  Thieves working with impunity.  One guy against a gang.

But for reasons I can't explain, this time God protected us from ourselves.

We are still a bit shaken at midnight, and not looking forward to heading into a 48 hour call in only 7 more hours.

This night reminds me that we need, desperately, our partners in prayer to keep us and our teams in God's hands.  The reality of ebola has really hit us being back.  The tenuous nature of everything.   And the direct confrontation with palpable evil.  Thanks for praying.

Rainbows and Paradox

Rainbows require two weather extremes: rain and sun, at the same time. Not a median between them, say cloudy weather with dim sunshine, or a light pleasant mist. Rather both seemingly polar truths held together. In other words, paradox. 

Which is how GK Chesterton explains faith, and God. Mercy and Justice, the ultimate depths of each, simultaneously. Sovereignty and Choice. Life and Death. Beauty and Brokenness. We have a human tendency to mute one with the other, to seek a comfortable compromise that keeps our minds from being stretched. But truth requires us to embrace paradox. 

This weekend we headed with Caleb out to Breckenridge to spend about 40 hours on the ranch of friends (where I spent 40 days on retreat two years ago). These people are wise and generous and have blessed us with respite and space. Their ranch is a place where spiritual unseen reality breaks through. So when we got on the road in the evening after a full day of Air Force events and passed into rainy weather, it was a little disappointing at first. Then just as the sun was setting Caleb looked back and noticed this rainbow. It was even more spectacular in real life, glorious depth of color and a full double arch. We pulled off the road in awe, whipped by strong wind and bathed in golden light. The next morning we awoke to more rain with a full arch brilliant rainbow outside the window. In spite of rain we hiked all day, with alternating moments of sun and storm, and more rainbow glimpses. 

When a pattern repeats, it gets our attention. Rainbows are reminders of hope, of promise. But they are also symbols of paradox. The reason we need the hope is that we are living in the storm that looks like destruction and judgement. There is danger in the post-flood rain, but there is also God's love. 

Holding the two truths of difficulty and blessing together is our challenge this season. Two kids are facing the challenge of transition: hard schools, competition, disjointed loneliness, some disappointments.  Two others are forging into junior and senior years with responsibility and hard work. Our hearts long to be in all four places. We are heading now into a week of Serge meetings where the frontiers of the restoration are before us. New team leaders head to South Sudan in two days. Ebola is a hovering threat on our continent, and our hearts grieve. But in all of this the rainbow promises that God's love is sure and true. In fact, is the foundational truth, deeper than the storms of sorrow. 

So remember the rainbow today, and please pray we would too!

America

Today we watched Caleb march onto the parade field with 4000 other cadets, a precision spectacle of blue uniforms, white gloves, drums and flags.  All the parents and spectators rose, instructed to put our right hand over our heart as the national anthem played.  A cannon fired, bugles sounded, and a formidable number of healthy strong young men and women moved into position.

And in a surreal moment of self reflection, I wondered about how we got here. A kid born in Kenya, raised in a fluid chaotic world of dirt and sun, soldiers who wore flip flops, an army that borrowed fuel from us when rebels attacked. Whose only prior year of American school was kindergarten. Who has a healthy skepticism for dominating absolutes and an eclectic view of the spectrum of cultural beauty. Yet this morning, an indistinguishable member of a force whose purpose is to fly airplanes on the side of America. One of uncountable pale faces, short hair, uniform clothing, unified steps.

I know some of the answers. If you aren't rich (as in if you're a missionary kid) and want to learn to fly, this is he ticket. If you want a superb education emphasizing engineering science, this is the place. (We toured workshops full of machines and viewed steel under an electron microscope in one of his labs). If you are attracted to the difficult, thrive on the integration of physical and mental challenge, the military academies will provide plenty. If you believe in the brotherhood of shared danger and hard labor, the military and the mission field meld well. Bottom line in this case, if you want life to be about something more than personal comfort or gain, if you want the discipline of serving others, this is a very valid route.

But the America theme is pretty prominent, and I wonder how it will play out. In our best moments our country is about justice and equality, about the prevention of tyranny, about freedom to think and believe and pursue. In those moments, a missionary kid can feel at home. John the Baptist baptized roman soldiers and told them to go back and do their jobs fairly, to not oppress, to protect. In a world where evil sometimes takes on national violent proportions, justice needs some legitimate enforcement.

But there is also an undercurrent of fear in America, fear of losing our wealthy advantage to the dilution of immigration or the pluralism of democracy when the majority no longer thinks like we think our founders did.  Or perhaps an undercurrent of hubris, the sense of entitlement or superiority. The same forces that drive tribalism when small language groups on one continent crowd up against each other could drive nationalism in unjust directions as America rubs shoulders with the world.

So I rejoice in the opportunity and provision of this place, and appreciate the potential for good. These kids with their values of excellence, service, and integrity are exactly who we want flying lethal aircraft and controlling dangerous weapons. And I pray for my own son's sake that being American and being African never conflict for him, that he can serve with confidence and pride a country that serves the global good. 

California (Paradise?)

With family scattered to the winds, a month of touching base means a month of serious movement.  CA is our sixth state (and CO tomorrow will be our 7th).  This is at least our tenth place to stay in August, but I may be losing count.  If West Virginia is "Almost Heaven", and we've been showered with kindness and connection throughout our visits, California needs some special mention as well.  Scott's parents moved over a decade ago to be near his sister in Half Moon Bay, south of San Francisco.  It was a good move.  They live a block off the Pacific Ocean in an agricultural, coastal community of friendly neighbors, public access to the winds and cliffs and surf, flowers and breeze.  And though they are both over 80 now, they've treated us to walks and meals and a great few days.  Ruth even treated Scott to his favorite, a triple-layer homemade carrot cake.  We feel blessed.

And in this stage of life, we're trying to learn to be a blessing in some small way too.  Our siblings do the lion's share of this.  Both of our sisters lived near our parents most of their lives, and have made graceful gradual transitions from receiving grand-parent child-care help to providing moral support through doctor appointments and moves.  So it is a drop in the ocean, but we're glad to be a listening ear, or put up smoke detectors and fix doors for a few days.  It is also sweet for me to see this patient side of Scott, who was always charming with the older generation, shining in this role.

And to think about marriage and the resilience needed for challenges ahead.  I look at my mom and the way she has walked through the heartbreak of ALS and widowhood, and moved into a new state and neighborhood, new church and friends, new home and car.  I look at my mother-in-law and they way she's learned to use a computer, do all the driving and communicating, risen to the occasion in a hundred ways.  Good women to be following through life, even though we are too often far away.

So for today we're thankful to be with parents once again, breathing in the ocean air and treated to fine home-cooked meals, with walks and projects and the grace of time together.

Collaboration and Research

This picture, from Mardi, makes me very very happy.  One of my most important goals this year as head of Paediatrics at Kijabe was to get our department to share our data and experience.  We set a goal of presenting two papers at the International Congress of Tropical Paediatrics, since it was to be held in Nairobi in 2014.  And this week, we presented three.

We, as in a very royal "we".  Everyone on our team cares for patients and collects data.  We all participate in entering it into databases on a shared google drive.  We all pour over it, and analyze it in audits and presentations.  About six months ago I selected some of our ongoing projects and wrote them up in abstract form.  When they were accepted, with the advice of a more experienced colleague and lots of googling, I created the posters.  Dr. Ima (pictured above), former intern Dr. Cathy, and long-term CO Bob, are presenting them this week.  

A brief description of the projects:  1.  We compared the survival of preemies before and after the introduction of bubble CPAP, a low-cost appropriate-technology intervention to deliver oxygen and airway pressure to newborns, and showed a significant improvement.  2.  We reported on the overall survival of newborns by weight, gestational age, and whether they were delivered at Kijabe or transferred in, which is an important benchmark to show what is possible in a low-resource African setting.  3.  We compared two strategies for the management of a particular obstetric risk to newborn infections (prolonged rupture of the amniotic membranes, colloquially "water breaking") and showed that a lower-cost algorithm was safe and effective.  

I like being part of a team that is not only caring expertly for sick kids, doing so with the compassion of Jesus, teaching others to do the same . . . but also trying to evaluate what we do scientifically and add to the body of knowledge in the world.  Most sick and dying children are not in places where most researchers want to work.  Medicine needs to be driven by evidence, not just assumptions.  So the potential to address real questions, and look for real improvements in care that matters, is great at Kijabe.

Though it is a real loss for me to miss this international meeting, I am cheering from afar as my friends and colleagues go and discuss and learn and share our experience.  Yeah team!

Collective genius and generosity, and thoughts on comfort

Launching has been our life this month.

First Luke to UVA med, transition and tradition all rolled up in taking the stride from being an undergraduate in a dorm to becoming a white-coated medical student in an independent apartment, already learning about diabetes and acid-base equations and ethics. We helped him assemble the bed he bought used, purchased him sheets and groceries, cleaned and organized. A week later we were back for the ceremony when the students receive their coats and give a solemn pledge of integrity and honor as doctors-to-be. There was lemonade on the Lawn, handshakes and greetings, and then a relaxing evening when our friends Stephanie (who went to UVA with us back in the day . . . ) let us invade her deck and grill steaks and relax. This is a young man who will ask hard and good questions, who will wrestle with the implications of everything he learns for the majority-world, who will foster relationship as he moves through a new cohort of colleagues. It will be a joy to watch, and we will feel the heartache too.

Then Julia to Duke, which was a multi-day process due to International as well as regular New Student Orientation, for which we are thankful. We set her up in her quaint top-floor no-AC dorm room, spreading her new comforter, putting up pictures and a bulletin board, buying hangars and cleaning supplies, hanging the Kenyan flag. We all attended lectures and tours, with helpful people explaining the ins and outs of health insurance, student advising, the history of the institution. We met couples from Singapore and India and Taiwan, all traveling to see their child off like we were. And we were well cared for by the Harteminks, friends with a long history of support for Christ School who actually came and taught in Kenya at RVA a few years ago. It all went as well as possible when you are letting go of something so precious. She met us for breakfast riding the more than 30-year-old bike I had when I was in school. In an atmosphere of nervous new students spouting off their grand plans for majors and careers, she resolutely sticks to "undecided". This is a young woman who will hold onto her core beliefs, who will watch out for others, who will have moments of intense longing for home but who will ultimately thrive.

So here are a few thoughts on this particular launching process.

First, since I grew up in Virginia, and have been living cross-culturally ever since, I was reminded of how great it is to be back in the South. UVA and Duke are southern schools at heart. I admit it may not be the same for parents from elsewhere, but for me the Duke atmosphere in particular was wonderfully friendly and hospitable. Perhaps we suspected those Duke fans were a bit into exaggeration. But no, it really is an amazing place, and I mean that in the literal sense of causing surprise and wonder. On Freshman move-in day, there is an orchestrated traffic pattern, even the police are super-friendly, and when you pull up to the dorm an army of older kids in matching t-shirts clap and cheer and descend on the car to whisk everything up to the room. The janitorial staff is there shaking peoples' hands and introducing themselves. There were multiple social events with really good food, handed out with an atmosphere of festivity and welcome. There was at every turn a helpful, informed, smiling person. Usually wearing a Duke t-shirt. These people genuinely like the school and genuinely want to share it with you. Refreshingly without pretentiousness.

Second, the Dean of Arts and Sciences today spoke about collective genius. The idea is that accomplishments are most often the result of team work. Each students stands on the shoulders of those who went before, parents who prayed and sacrificed, teachers, colleagues. An advance in science that moves health forward is still only a piece of the puzzle. Luke's curriculum is integrated and team-oriented, and Duke seems to foster collaboration in their students. Individual gifts are celebrated, each person's unique contributions valued, but not elevated. The beauty of the student body is collective, which I found to be quite biblical. Together we are the presence of Jesus making the world new. So I add to the collective genius the idea of collective generosity. We certainly would not be taking children to medical school and university without the care and support of hundreds of friends.

Lastly, President Brodhead of Duke (after 32 years at Yale) spoke today about comfort. He was warm and engaging in acknowledging the homesickness almost all the Freshmen are feeling right now, and the common suspicion that everyone else is smarter or more deserving of admission. He wanted to be comforting. But then he warned about comfort as a societal value and goal. Because other values we hold more deeply may require a good amount of discomfort to achieve. He challenged students to try hard things, new things, uncomfortable things. A good speech and again solid truth. Take up the cross, because the path to glory passes through loss. As helpful and organized as Duke and UVA are, the transitions are inevitably painful. But there is a purpose to these places, and that pain is not something to avoid.

Which leaves us, the launched-from, driving west into the dusk of a North Carolina evening, parents with only one child left under the roof. Grateful for southern hospitality. Acknowledging the collective action of achieving this moment. Decidedly uncomfortable, but trusting that it is worth it.