Reshaping the world, in minuscule quanta

This is baby A, all 1.1 kg of her, who disguised the fact that part of her intestinal tract was missing by being a typically fragile little preemie with jaundice and an infection and spitting up feeds.  Last Monday, though, I was pretty sure this was more than just being tiny, and thankfully the Kijabe paeds team and surgeons agreed to take her in spite of her critical condition.  A few days later, Scott and I went to Kijabe to cover for a couple days and a night.  She looked much better already, alone instead of in an incubator of 3, getting total parenteral nutrition instead of plain sugar-water IV fluids, and waiting for surgery.  I think you can see the relief on her mom's face, too.  And when I went back to Naivasha yesterday, the moms of the other dozen or so preems were thrilled to see her picture and hear her report.  It's a communal effort, and a communal joy that God would provide unaffordable and inaccessible specialized care for one, demonstrating love and awareness of all.

Or consider the story of baby C.  Her pregnant mom went to work Thursday in Naivasha town, but didn't turn up on Friday.  Neighbors thought they heard a baby cry sometime Friday morning, but no one answered when they knocked, so they though she had left the room where she lived alone.  No one saw her or heard from her for over 48 hours, so when a friend from work came to check up on her Sunday they community decided to break in her room by removing a roof tile (New Testament style).  They found the mom on the floor unconscious, and the baby also on the floor still connected to her placenta.  Miraculously, they were both alive, and were rushed to our hospital which in spite of a nursing strike still keeps admitting those who have nowhere else to go.  Like kids with AIDS or meningitis, adults with TB, babies who need oxygen, pregnant women in labor, post-partum moms with bleeding or hypertension.

Such small people, such limited stories.  And in the face of so much uncertainty and frustration and injustice, strikes and closures, is it enough? 

Which is why these words on-line jumped out at me this week: 

Only the forgiven can forgive, only the healed can heal, only those who stand daily in need of mercy can offer mercy to others.  At first it sounds simplistic and even individualistic, but it is precisely such transformed people who can finally effect profound and long-lasting social change.  It has something to do with what we call quantum theology.  The cosmos is mirrored in the microcosm.  If we let the mystery happen in one small and true place, it moves from there!  It is contagious, it is shareable, it reshapes the world.  (Rohr, Hope against Darkness, 2001)

 Getting one tiny baby's bowels reconnected; warming up a starving newborn and mom stranded dying in their home, unnoticed.  These are almost invisible quanta of justice in a world that is fractured.  And they are enough, because by grace they are contagious, spreading out like ripples in the space-time pond of reality, from the cross out to the renewal of all things.  

 Being back at Kijabe was a paradox of sweet memories and head-spinning change.  This hall connects the old hospital to the new; Acacia and Jack helped lay out the river-of-life design for the floor tiles back in the day.  Now there is space, cleanliness, light, comfort.  And monitoring, good staffing, intense care.

Colleagues, smart dedicated people, multiple consultants here on a Saturday morning reviewing patients and carefully signing out the sickest ones to each other.  Trainees, of all levels.  Labs.  Function.  A lot of good happens here. 

Scott did an emergency surgery on a critically unstable woman bleeding from an ectopic pregnancy and kept watch over a busy labor and delivery; I managed the 30 or so babies on the newborn service then covered everything from a dog-bite to a new leukemia to a lung-damaged baby on a ventilator and an epidural hematoma/skull fracture in an 8-year-old hit by a motorcycle while trying to cross the road to her school bus (sounds terrible but she was awake and smiling).  It was exhausting to cross cultures back into that world again, and fun, and we're so glad we could.

The newborn unit has happy walls and a Bible verse.  I showed the resident my old habit of making a list of the critical patients on the white board and going over it with the nurses.  It felt good to be back.

For a day. But coming back to Naivasha, I have to say, felt like home.  Yes, we have a LONG way to go to reach Kijabe-level care.  But at Naivasha we provide a reasonable fraction of that care with a minimal fraction of the resources.  Now we're into our second week without our regular nursing staff (they are on strike), and with reduced patient admissions, and without assurance that the doctors won't resume their strike.  It's hard. But . . the new interns have given us a little breath of fresh air, as we teach on rounds, give lectures, answer questions.  There is good to be done, and God has so far allowed us the health and stamina to keep doing it.

Scott took this page out of our own training--teaching suturing skills on raw meat.  These interns significantly improved on their C-sections after an afternoon of training.

The quantum of care at Naivasha feels even smaller after being at Kijabe.  But in this world held together by the invisible forces of grace, it just may reshape everything.  

Strike week 25/51 . . .

As per the UW chief resident who has been working here at Naivasha in medical education for a year, that's the tally.  I should have been keeping track, but I'm sure as we move into our 9th month it's actually more than half the time.  This week it is the nurses, who came back quickly in December after their short strike when the government formed an agreement with them . . that was never signed.  Word on the street is that the doctor's agreement wasn't signed either, so they may join on Monday.  The inability to anticipate patient load or collegial help day to day gets very tiring; I am sure the inability to even access care gets MUCH MORE TIRING for the patients who must face a choice between suffering, and potentially dying at home, or calling in every favor to raise the downpayment for a private admission.  For many there isn't really a choice.  I think the sheer duration of incessant and repetitive strikes makes it clear that this is not an efficient means of progress or change.  Punishing the poor to force the hands of the powerful doesn't seem to work very well.  And in a society where political affiliation is almost purely tribal, such actions don't impact voting much.  The government can run the health sector into the ground and still be re-elected.

Meanwhile here in Naivasha, we keep plugging on at about (maybe slightly below) half-normal numbers using "contract" (non-union) nurses.  You can run for 100 days without doctors, but not even one without nurses.  We're taking emergency admissions, and continuing to care for our long-term nowhere-else-to-go patients.  We have our clinical officer interns, and our medical officer interns who just started their year after the mess of the long doctors' strike, for now (no telling what will be true come Monday).

And in spite of how we sometimes want to throw up our hands or cry, there really are remarkable things happening.

Baby E's mom came in severely dehydrated because her mom had an abscess and wasn't able to feed her well.  By severe, I mean a sodium of 192 and a creatinine upwards of 900 (that's over 10 for mg/dl).  No ICU, just weeks of fluids, antibiotics, care for the mom and baby both, using what we learned at Kijabe.  Yesterday they went home.  A miracle.

And in the NBU we have just discharged a whole preemie class of a half-dozen who grew from 1 kg to nearly 2, and the tiny ones keep coming.  Over a dozen right now who are mostly in the 880 gm-1.2 kg range, a few getting up to 1.6 or 1.7.  It is hopeful to see the team calculating fluids, knowing what antibiotics to give, watching for jaundice, paying attention to gestational age.  They have come a long way, and I am pretty sad that the CO interns must change rotations next week and the doctors might strike again.

Yes, we had one positive cholera case on the male ward, but so far our Paeds samples have been negative (though we lost two kids in the last two weeks shortly after admission, before even being reviewed by one of us, so those might have been real cases).  Meanwhile the classic cholera cots in the hall remind me of Bundi and make me happy to see them not in use.

Having the patient census at about half, but the CO and doctor team fully present, allows for more teaching.  I prepared a lecture for this morning for all the hospital trainees, giving some evidence-base about respiratory infections and teaching them to use the Kenya protocols for treatment.  We do bedside teaching every day, and enjoy it.

After the first C-sections with interns took more than triple the normal time, Scott bought $3 worth of meat and did a surgery clinic with his new interns.  They seemed pretty happy with the stitching practice.  This kind of investment in teaching is a big reason we came to Naivasha.

And lastly, just for fun, since the American president's name is in the news even here in Kenya for good or for ill . . . I finally met my first baby T.  Yes, that's right.  We had a lot of Obamas (Kenya was particularly proud) but so far only one T.  

Please pray for the many who are left without care during yet another upheaval in this health system, and pray for justice to roll down like the rains we so desperately need.

Bloody socks, and other metrics of a week on the edge

Last night, our evening walk was abruptly interrupted by a distress call to help a visiting resident and the interns with a 40-year-old woman on her 11th pregnancy whose uterus ruptured.  Hours later as Scott wearily walked back in the door for a 9:30 pm dinner, and I was starting the laundry (thankful for a washing machine these days) to deal with the usual sweat-soaked scrubs, he sighed "the blood soaked through my socks".  That's what a surgery with 3 liters of blood loss, with a patient who's blood pressure never topped 60 until the end of the case, when you go through 80 sterile sponges, looks like. The baby was dead before the mom made it into the operating theatre, but thankfully the mom (particularly good news for her ten other kids) lived, and today is alert and recovering.  There are not many places in Kenya where that would be true.  Kenya's maternal mortality ratio is 500/100,000 (5/1000); which means given our volume of deliveries (600/month) we would expect 3 deaths/month, or 24 since we started in October.  Instead there have been 2.  That's a good metric, but the bloody socks demonstrate the reality of what it takes to get there.

Neonatal mortality is a bit more difficult for us.  Given the national ratio of 23/1000, we would expect about 14 deaths/ month just from our own labor and delivery but we also get the sickest babies born anywhere in a radius of probably 50 miles around. This year so far we're averaging about 16 deaths/month, with an average of about 150 admissions/month.  That NICU mortality rate hovering just over 10% is good on a national average, but still means we've lost over a hundred patients in the time OB lost 2. It gets pretty hard.  Still, our department is probably the most pro-active in the hospital.  We just started doing exchange transfusions for severe jaundice, the levels that cause brain damage.  Only a few places in the country will attempt this.  This week we had two babies with shockingly horrible levels due to a mismatch between their (paternal inherited) blood groups and their mothers.  Both were successfully drained of their entire blood volume twice over and replaced with donor blood in increments of a tablespoon or two at a time.  Both are doing well today.  On the prevention side, my colleague has a grant to teach "Helping Babies Breathe", the essential first-minute-of-life resuscitation skills every nurse-midwife needs.  This week she presented a quick taste of this at our hospital-wide CME, and began the first of a series of 9 weekly one-day trainings to up-skill select nurse-trainers around our catchment area.

That's how we walk in a world where your socks get bloody--first by attempting to push care boundaries to save individual lives day after day, and secondly by supporting the slow shift of education and attitude and habit and expectation that makes a long-term impact.  And thirdly, by bearing witness to the realities of injustice and brokeness, the stories that don't have such triumphal endings, but are equally important to God.

Little B came into our paeds ward at the beginning of the week, 9 months old, wasted thin limbs, an enlarged liver, a terrible cough, fevers, and a convulsion.  Her cerebral spinal fluid looked clear, but her chest x-ray showed pneumonia, and we suspected TB even before her universal admission HIV testing came back positive.  It turned out that her quiet mom was on treatment for AIDS, and as a baby B's first test after 6 weeks was negative.  But when it came time for her next test at 6 months, the family had traveled to the far western border to bury her 10-year-old brother who had been killed in a bicycle accident.  The dutiful mother had B tested there.  Positive.  Per the current international standards, she should have been started on highly-active anti-retroviral treatment (AIDS drugs) right away.  The mortality in the first year of life for infected babies, untreated, is on the order of 50%.  But the hospital there said, no, go home and get started in Naivasha.  When B's mom returned home with her many weeks later after the terrible ordeal of one child's death, she had no official record of the positive test, so the small health center in a flower-farm settlement insisted on repeating it.  These tests have about a month turn-around time, sadly.  So that meant B was 9 months old and dying and had never been treated by the time she showed up at our hospital.  We started strong antibiotics, and extra nutrition, and tested for TB, then decided to treat even though the test was negative.  But by Friday evening she was dead.  Too little too late, as is so often the case for children with AIDS.  A terrible virus, and a terrible failure of the health care system to find little B and treat her in time.

Which brings me to the end of this post.  This week in a devotion talking about the Franciscans, the author stated "Francis wanted us to live a life on the edge of the inside--not at the center or the top, but not outside throwing rocks either.  This unique position offers structural freedom and hopefully spiritual freedom too."  This phrase resonated, and I hope that's where we are, fully engaged in living and speaking truth, but on the edge willing to take risks.  We're not in a position of power at Naivasha hospital, we're plunging in but our influence is small and slow and hopefully more helpful than harmful but always a mixed bag.

Bearing witness on the edge of the inside, and working in concretely specific as well as globally foundational ways for change, sounds a lot like Micah 6:8, the verse on our prayer card and on my Dad's funeral program.  So here's a couple of examples from the news this week that I found convicting and inspiring.  First, as the NBA finals roll on, a press conference with LeBron James after a hateful person sprayed racist graffiti on his house:

"No matter how much money you have, no matter how famous you are, no matter how many people admire you, you know being black in America is tough," James said. "And we got a long way to go, for us as a society and for us as African-Americans, until we feel equal in America."

And lastly an interview with the author of Just Mercy, Bryan Stevenson, about growing up in America and the current controversies over Confederate monuments.  He makes good points about truth leading to reconciliation (though I would argue that true repentance is healthier than shame).  This book is on my list to read in the next few months.  Here's a quote from the interview:

"For me, it's important to redefine what it is we are dealing with when we deal with poverty, and that definition begins with recognizing that the opposite of poverty isn't wealth. The opposite of poverty is justice. If we actually had been just to those communities that we removed from the land, if we had been just to the formally enslaved, if we'd been just to immigrants who came and gave great wealth, we would actually be in a very different place when it comes to dealing with structural poverty."

Fair? I do not think that word means what you think it means . . .

Last night, our President announced that the USA would join Syria (at war) and Nicaragua (who wants stricter plans) in refusing to comply with the Paris agreement on reducing destructive pollution.  Every other country in the world (195?) plans to try and save it, but our leader said the deal was not fair to America and made other nations laugh at us, so we would go ahead and do only what we think is best for us.  America first.

Every country has a right, and a duty, to protect its own citizens and interests.  But let's be realistic.  WE DON'T WANT FAIR.  We have contributed more to the degradation of the earth than any other country in history (though China by sheer volume of population will eventually catch up and surpass us).  Fair would mean that we bear the brunt of change, that we live with the consequences, that we pay for our prosperity.  Instead, the poor of the majority world will pay the highest price.  We see it already.  Fair would mean that we use earth's resources in proportion to our population, or land mass, not at our current excessive rates.  Fair would mean that we pursue renewable energy jobs for places like West Virginia, rather than pretending that a return to coal can employ enough people.  Fair would mean that we plan with a timeline of centuries, that we consider the Americans of 2050 and 3000, not just the ones making money today.

So at least we should be honest, and admit that "make America great" in this administration's view can come at the expense of the rest of the world, and the earth, and our future generations.  Which begs the question of whether "great" means what we think it means, either.

I don't know the best way to employ my friends and relatives in my home state, to provide enough energy for the world, and to best turn over to my kids and (hopefully some day) their kids a world that God gave us to care for.  But I'm pretty sure that the ocean tides, the polar ice, the clouds, the trees, the oxygen, don't respect national boundaries, and this is one issue that won't be helped by running away from the dialogue.  

In Memorial

As a mom of a soldier, I have developed a Memorial Day phobia.  This is the American holiday devoted to those who die in military service to the USA.  And, I am ever more aware, there are many.  I cringe and must force myself to read their news.  In the last 20 years, the average/year has dropped from about 2000 to about 1500.  About a third are from hostile action (what you think of in military deaths), a third from accidents (training and deploying are DANGEROUS), and the other third is split between physical and mental illness, meaning sickness or self-harm.  Except for 1983, vanishingly few are due to terrorism (terrorists target unarmed civilians, after all).  This document gives all the official stats from the Revolutionary War to now, when wars have such double-speak vague names it's hard to tell just what they refer to.  Those are stats.  But to understand them, you have to also know the stories.  Each of those deaths represents a person of courage and promise, a family of sacrifice and pride, a system that worked or failed. Unlike other risk statistics, most of the USA military dead are white males.  

But the most recent death I've read about is not, and it's one of the saddest.  2nd Lt Richard Collins III, days away from his college graduation, on a track much like Caleb's, an officer, jump qualified, and athlete, a leader.  He was standing at a campus bus stop late at night. A drunk, belligerent student who was a member of a white-supremacist online group approached him and told him to move.  He didn't, so the assailant stabbed him.  Fatally.  For nothing other than standing at a bus stop, and standing up to a bully.  For being black? Seems so. Would he have been safer in Iraq than in Maryland?

This follows only a couple of days after two other men, one an army veteran, were stabbed on a bus in Oregon because they stood up to a man harassing women.  Women wearing muslim dress.  None of these three were technically killed in action this week as active duty US Military, but all three represent the meaning of Memorial Day, putting your body in harm's way to stop evil.

Our values of justice under the law without bias for all, of freedom to speak, assemble, worship, choose, of work and community and innovation, of opportunity . . . all of these hinge upon people of principle who stand up to bullies, who draw a line for evil and say, no further.  Sometimes on a national scale, sometimes very personal.  Sometimes the line between right and wrong is clear--I had 7 uncles in WW2, all of whom came home alive, hiding the scars of their traumas, all resilient good men who lived long lives with their families.  Most times it is not, as I think my cousins who fought in Viet Nam would attest, with their more difficult re-entries.  But in a world where hate accesses knives and bombs, it remains essential to have a counter-force answerable to the public, controlled by clear directives, and willing to pay the highest price so the rest of us don't have to.

Here in Kenya, it's just another Monday.  But if you're in America and celebrating a long weekend, picnic weather, family and friends, remember why you can.

Love and Hate, balanced on the razor blade

He wore the blue checked gingham ubiquitous in East African school uniform shirts, a sweater and primary-school shorts and scuffed shoes, standing at the corner of my colleague's desk as we chatted in English over his 8-year-old head.  His anxious father sat perched on the edge of his chair, waiting for hope.  My calm colleague meted out a few details that made my stomach churn and heart sink.  Evil had sunk its claws into this little boy in the form of an abusive older-grade-student perpetrator of humiliating violence, and his father had come to see if the physical scars would be permanent.  Just one little life in one little school in one little town, a drop in the oceanic depths of muck in Kenya let alone Africa let alone our world.

One night earlier this week I had had vivid dreams of being outside on safari, seeing lions, and sprinting with my kids for the safety of the vehicle, watching as the lion attacked and my slow motion arms were too limp to pull the door shut in time.

Evil is real.  Just ask the mom who keeps watch while her premature baby gasps her last breaths in spite of all we can do here, her third of three to die.  We bear witness, we resist, we struggle . . and we also admit that we are not immune.  The same day I dreamed of dark lions, nature red of tooth and claw, of the prowling adversary of 1 Peter 5, I had been in self-righteous conflict by What's App half the morning, trying to juggle some needed time focused on the non-clinical demands of life during an "administrative day" with the lack of the back-up I had expected on our service.  Just when I think I'm getting the swing of being calmly cross-cultural, I sink into seeing the world from the center of my own universe and being angry when it doesn't spin my way.

Today I started a book that looks like it will be excellent, and have to share this quote:  "We are sick doctors who are trying to grasp the nature and impact of a life-threatening disease that has invaded our own souls, minds, and hearts.  Whatever this disease does to our so-called patients, it has done or can do to us.  Not only that, any contact with the disease in the lives of others can make us sicker. We do not approach our subject objectively, clear-minded, and untainted.  We approach our subject mired in, clouded by, and stained by the very thing we are attempting to study.  Let the student take note. "(Diane Langberg, Suffering and the Heart of God)

It is in this context, a sick doctor fighting sickness, prophets who call out injustice but also benefit from it and enable it, that we come to the season of nine days between celebrating the Ascension and Pentecost. God likes both 40's (days of rain on Noah, of Moses on the mountain, of years in the wilderness, of years of David's reign and Solomon's too, of days of Jesus' fast) and 49's (seven times seven years to Jubilee, weeks between Passover and the Feast of First Fruits).  And by giving Jesus a meaningful but limited 40 days after his resurrection to walk with his friends, but waiting until the Feast of First-fruits to send the promised Spirit, we get this odd nine days of waiting.

Waiting, for the Spirit.  For breath, life, judgement, protection, creativity, wisdom, leadership, fire, wind, courage, justice, miracles, truth, intercession, gifts, unity, belonging, bonding, fruit (look up "spirit" in the concordance and marvel).  Waiting for that hidden dispersion of power and transformation we need to face the evil without, and within.  Waiting, lest we think we can do this on our own.  Waiting, lest we force our own vision, our own timing.

We live now in the post-Ascension day era, where we "sing the waning darkness into light" (from Malcom Guite's sonnets, Sounding the Seasons).

Whilst we ourselves become his clouds of witness 

And sing the waning darkness into light;

His light in us, and our in him concealed,

Which all creation waits to see revealed.

The light is coming.  Even though love and hate balance on the razor's edge of our divided souls, love will overcome.  Love can change this world in a moment, as my new favorite Ed Sheeran song testifies (the source of the title quote as well).  Once we climbed Mount Sinai, and hundreds of pilgrims sang in their own traditions as the sun rose.  The battle with evil has been won, but the darkness has not fully waned yet, and our voices matter.

(here is a later stanza in the Tennyson poem grappling with nature, death, and God's purposes)

This week's reading from around the Web

First for some good news, for the first time ever, an Ebola epidemic response includes not just isolation and case contact tracing, but VACCINES (read here).  Having lived through the discovery of AIDS, the devastating spread, the development of treatment . . now we get to live through watching Ebola progress from an incurable scourge to a preventable disease?  Amazing.

When we spoke in the USA on our home assignment a year ago, we often mentioned the fact that childhood deaths world wide had decreased by HALF in the nearly 25 years we've been working on the fraying edge of survival.  Much of that is due to vaccines and improved antenatal and delivery care.  The Gates Foundation's annual letter is a good read, even if you don't agree with everything they do with their money, you can see the potential impact upon JUSTICE by targeted giving.  Hooray.

Not everything in our part of the world is looking up, however.  This blog is a no-holds-barred questioning of world response to the drought and famine in Somalia, from someone who lives in a nearby country and works closely with that part of the world.  Thought-provoking, and most of it applies to all our efforts to help rather than hurt.  One of the most innovative responses involves software developed in Kenya to map hot-spots of post-election violence, this time adapted to famine and response in the horn of Africa.

This post is for the 4% of the population who struggles with their gender identity and sexual orientation, and those who love them. Meaning all of us.  It is written for the missionary community, and more balanced and kind than most things one reads.

And this one is for the many families who have chosen to enfold traumatized children, by foster care or adoption, or being counselors, teachers, neighbors, friends.  Sobering.  Our prayers are with you.

Ebola, vaccines, child survival, drought, war, mental health, love--these are big topics, important topics.  However one can not credibly get through the week without having also spent some time on the crisis-per-hour flow of news out of Washington, DC.  I always find it best to read the actual transcripts of speeches and decide what you think based on the words.  Here is Trump's speech at Liberty's graduation, more articulate than much of what is reported, and starts with some inspirational words about defending truth, swimming against the current, using your blessings to make the world better.  But the speech once again conflates the USA with the Kingdom of God in a way that leads down a well-trodden historical path of destruction, power as the way to enforce faith.  It never ends well.  At its best, justice can mitigate against our human greed and tribalistic self-preservation, but we still fall far short of love.  So we find a messy week of crisis once again, careening from press conference to press conference.  Christianity Today tries to untangle some of what Comey's movitves might have been as his faith and political service hit the wall of Trump's demands for loyalty.  And this editorial reminds us that as entertaining as the late-night-show sketches may be (where reality and satire are so close it is becoming impossible to tell the difference), the real response to a discomfort with the way America has turned is to get involved in the political process.  That's democracy.

If the week leaves you despairing about democracy, may we recommend this movie we stumbled upon on on our TV programming.  This drama follows the true story of Seretse Khama whose integrity, courage, and determination brought Botswana from the 3rd poorest country in the world to one of the most free and prosperous in Africa. Positive story out of Africa, not to be missed.

Finished another great book this week:  News of the World, by Paulette Jiles.  Because third-culture-kids are on my heart and I find poetic writing to be one of life's great pleasures, I loved this book.  Historical fiction about an old frontier soldier who ends up responsible for returning a re-captured 10 year old girl of German descent to her Texas relatives, after four years of living as a Kiowa original American tribe member.  They have no common language or experience.  The way their relationship grows as they pass through dangers, and the author's grasp of the way the dichotomy of cultures in those formative years leaves this girl stranded outside all worlds . . . well, enough said.  Read it.

Less poetic, but a gripping story based on real life (as was the one above).  Jodi Picoult bravely grapples with race and injustice in our society.  I almost quit after chapter one which I found unconvincing in medical details.  But I am so glad I stuck with the book.  The story is told from three voices, and the male white-supremacist one is strangely compelling.  His character is also modeled on a real-life person who came out of that world to work for justice.  If you start it, stay with it to the end.

Of waves, wind, and eye directions

In Naivasha we attend an international fellowship, a church meeting in a school, half Kenyan half expat types from a number of other countries, with the simplicity and transparency of people who know the world is not right but the Kingdom comes.  Many weeks I get to play the keyboard for worship, accompanying some very talented vocalists and guitarists.  We are a small handful in an unadorned cement upper room, plastic chairs, down to the basics of prayer and fellowship and worship and proclaiming truth.  We had come to Naivasha looking around for a very cross-cultural Swahili-only church (as if we were somehow special missionary types), only to realize we NEEDED this welcoming fellowship after our stressful weeks.  These people are the real deal.  Some operate businesses in the area, others teach, run a safe house for abused and abandoned kids, heal trauma with kindness, facilitate students learning about care of creation, creatively organize job training and discipleship.  Prayer requests grapple with tribalism in school dorms, war in South Sudan, distant kids and parents, rain and drought, the hope for peace as elections approach.  A real body of Jesus simply trying to love others and depend on God.

One of the songs our worship leader chose today is a remake of the hymn "It is well with my soul".  You should listen to it right now.  The stillness of soul is not predicated upon a well-ordered calmness of circumstances, it comes in the midst of the waves and winds of distress.  This, is faith.  One of the choruses says, through it all, through it all, my eyes are on you, which reminds me of 2 Chronicles 20:12.  When the people faced impossible odds and potential annihilation, they had no recourse but to look to God for deliverance.  This story became very meaningful to us in some hard days in Uganda.

Playing it today, our hearts went out in prayer to many windy, wavy, heartbreaking situations for people we love.  Dear friends, who were colleagues in Uganda and are now finishing graduate training in the states, found their infant son blue and lifeless yesterday morning.  After CPR and an admission to the pediatric ICU he is alive and yet the cause of his life-threatening event and his eventual outcome are still not certain.  Other supporters and childhood friends also had a baby this weekend, a difficult delivery during which mother and baby both nearly died, and this infant is also tenuously holding onto life in a neonatal ICU.  Here in Africa, one of our teams has had an inordinate burden of struggling kids and crumbling infrastructure, in what feels like a wave of spiritual oppression.  Two other teams are in areas with cholera outbreaks, a potentially deadly infection.  The rainfall in Kenya still lags behind normal (about a quarter of the expected this season).  We encounter loss, hardship, conflict, mental and physical illness, loneliness, every day.  Our oldest needs to make a pretty life-determining decision this week about his residency choice, and needs prayer for clarity that will carry him through the next decade of intense work.  The second will be jumping out of an airplane five times in the next week; we pray the weather holds for him.  Near-death days for beloved friends, chronic struggles for weary teams, life directions for our own flesh and blood.  We feel the buffeting of those storms.

Yet in that very place of shaking, of breaking, we pray for the grace to cling to the truth that all shall be well.  One who is good, fiercely so, painfully so, writes the end to this story.  

When Job struggled with the big questions of suffering, God told him to look at the hippos.  Literally, to ponder the wild beauty and independence and balance of creation.  Besides playing for worship, the highlight of the week was a visit from our great friend Bethany which prompted us to do a little walking safari Friday evening.  We can walk from our house across the highway to a small Kenya Wildlife Service preserve by the lake.  On this particular evening, we saw wildebeest, zebra, giraffe, impala, waterbuck, hippos, more zebra, fish eagles, cormorants, pelicans, storks, herons, egrets, plovers . . . and just at dusk, two black-backed jackals sauntering across the path and into the bush.  It was a holy moment of wonder, of remembering a goodness that undergirds all of us, of glimpsing a glory that has been obscured by brokenness but not erased.

Enjoy Scott's photos of the evening, and pray for those we love to know that all shall be well.