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Sunday, July 31, 2011

tears in the veil

There is a veil that obscures reality, that gives us the illusion of living independently and temporally in a dependent and eternal universe.  But occasionally there are tiny tears in that veil, gaps, glimpses of the great and whole and good and true.  Perhaps most of those occur on life's edges, the beginnings and endings, transitions into and out of this visible world.  

And it is good to name, to recognize, those moments.  

Today I sat with my arm around a 16 year old young woman, C., while her baby died.  C. had delivered her first child a few days ago at another hospital, and it was a long and ugly process I'm afraid.  C. was a teen, had dropped out of school pregnant, was living with her mother, and not really ready physically.  Her baby girl, Monica, came into this world limp and blue and gasping, in severe distress.  By the time she was transferred to our hospital she was convulsing.  She had meningitis, bacterial or herpetic we weren't sure so treated both, jaundice, evidence of liver damage, and respiratory distress.  For 48 hours we gently kept her alive with fluids and antibiotics and continuous positive airway pressure with oxygen.  But as I was reviewing other infants around noon today, the nurses working on a new IV line for baby Monica called me over to see her because her oxygen saturation was falling.  It was falling because she wasn't breathing.  At all.  We used a bag and mask to blow air into her lungs numerous times over the ensuing half hour, perking her heart rate up, but as soon as we stopped she made no movements or effort on her own.  I knew our ICU beds were full, but even if they weren't, this baby's brain damage I was pretty sure was irreversible and unsurvivable.  So I called her 16-year-old mother into the nursery, placed Monica in her arms, and kept vigil with her.  Monica never really breathed, but she had little agonal gasps of movement that went on for longer than one might imagine was possible, well over an hour.   We prayed.  We called C.'s mother on my phone.  We called in our on-call chaplain to sit and pray some more.  I agonized, was this the right thing, should I have tried harder or longer to keep her alive artificially.  C. cried, and I could have but pushed the tears down, and tried to tell her over and over that she was a good mother, that she had done everything she could, that she would be reunited with her perfect healthy baby in the new heavens and new earth eternity, that this was hard and sad.  And that her baby Monica could feel her love as she lay there in her arms.

Could she?  Well, the veil tore a little at the very end of this vigil.  Finally C., exhausted and grieving, told me she wanted to put Monica down.  I had checked the baby dozens of times, she was on a monitor, I knew her heart rate was still hanging in there low and soft, and though Monica was unconscious and a deathly grey-green color, she continued to have those little convulsive gasps every minute or so that kept her body from completely dying.  Nothing had changed, but I sympathized with C.'s desire to just lay the baby back in the cot and go back to her own bed.  So I took Monica from her arms, and she walked away.  I laid the limp jaundiced little body down and arranged her blanket, and looked up at the monitor.  Flat.  The second C. let go, Monica died.  

That was a holy realization to me.  Death was hovering, but the baby seemed to know when her mother was ready, was done and gone.  After at least an hour and a half of waiting, her heart stopped the instant her mother let go.  

There is so much more to medicine and life and every equation than the concrete things we an see and control.  I'm thankful for that.  I had to break death news to another mother at 2 this morning, a neurosurgical patient who was waiting for surgery and didn't make it.  Soon after that tragic scene I went to check up on one of the evening's malnourished-vomiting-diarrhea admissions whom I had suspected had a bigger problem, a telescoping of the intestines one piece inside the other, an unusual, potentially disastrous situation.  At 3 a.m. I found that the Paediatric surgeons had whisked him to the operating theatre, and I walked in just in time to see his purplish distended twists and fans of bowel glistening outside his abdominal cavity, and hear the surgeon marvel that  in spite of the intussusception and malrotation and volvulus, everything looked salvageable.  Two moms who brought their children for care and came away bereaved.  One who came for what she thought was a simple problem, and was saved from almost certain death.

No use trying to make it all add up, and make sense.  Instead I find comfort in the details, the way Monica's heart knew her mother's touch and then quit when it stopped.  The small glimpse through the obscurity of some who live and others who die, the glimpse that says there is more happening than meets our eyes, this is a drama whose stage stretches out to eternity, and the curtain keeps us from seeing the final act.

Friday, July 29, 2011

John Stott, 1921-2011

John Stott, a giant of the Christian faith, died this week at age 90.

Time magazine called him one of the 100 Most Influential People in 2005.

I had the opportunity to speak with him over tea in the mid-90s when he was the keynote speaker at the Christian Medical Society Conference which Jennifer and I attended here in Nairobi.

At the time I was a distraught young missionary, troubled by the untold suffering of the poorest of the poor in Bundibugyo. I came to Stott with my struggles in seeing countless children dying of preventable disease, of women beaten senseless repeatedly by their drunk husbands, of relentless encounters with hunger, pain, and loss. Dr. Stott listened patiently, offered some words of consolation and pointed me to one of his most notable books, The Cross of Christ. He directed me to a specific chapter in which he addresses the issue of pain and suffering in our world. It is there that I found his words:

I could never myself believe in God if it were not for the cross. The only God I believe in is the One Nietzsche ridiculed as ‘God on the cross’. In the real world of pain, how could one worship a God who was immune to it? I have entered many Buddhist temples in different Asian countries and stood respectfully before the statue of Buddha, his legs crossed, arms folded, eyes closed, the ghost of a smile playing round his mouth, a remote look on his face, detached from the agonies of the world. But each time after awhile I have had to turn away. And in imagination, I have turned instead to that lonely, twisted, tortured figure on the cross, nails through his hands and feet, back lacerated, limbs wrenched, brow bleeding from thorn pricks, mouth dry and intolerably thirsty, plunged in God-forsaken darkness. That is the God for me! He laid aside his immunity to pain. He entered our world of flesh and blood, tears and death. He suffered for us. Our sufferings become more manageable in the light of his. There is still a question mark against human suffering, but over it we boldly stamp another mark, the cross which symbolizes divine suffering. ‘The cross of Christ … is God’s only self justification in such a world’ as ours.1 (John Stott, The Cross of Christ, pp. 335-336)

Suffering continues to be a an issue close to my heart. Other books on suffering which have been helpful to me include DA Carson's How Long O Lord, J Earekson Tada's When God Weeps, CS Lewis' The Problem of Pain, Phil Yancey's Where is God When it Hurts, and my favorite, Michael Card's Sacred Sorrow.

John Stott while not known widely outside of the church led an exceptional life of faith keeping one foot in the Scriptures and the other in the world where he was deeply committed to the salient issues of our day - justice, peace, and climate change. Extensive obituaries extolling his broad influence have appeared in the New York Times, The Guardian, and Christianity Today this week.

He will be sorely missed.

Thursday, July 28, 2011

suffer the little children

Kijabe Hospital is an outpost of the Kingdom of Heaven. One among many in Africa, where suffering little children are suffered to come unto help, shelter, love, healing.
Mercy models the latest in oxygen fashion. She sits perkily in her bed, her heart too weakened by nutritional deficiency for her to walk, her rickets-enlargened head looking heavy on her small body. But she smiles at us, after surviving a debilitating pneumonia, she is almost ready for discharge. And her oxygen prongs pointing uselessly into her eyes instead of her nose show us she's improving.
Naomi is only a couple of weeks old, but has already had neurosurgery to relieve the fluid pressure damaging her brain at birth, then struggled with infection until the drainage had to be externalized, and most recently started treatment for a nasty pathogen in her urinary tract as well. But I find her matching pink spiff outfit heartening, the love of a mother who sees her as a valued baby rather than as a severely damaged being.
Abondo was brought in by a community health worker who found her abandoned by her family. Her age and history are unknown, but she seems to be about six and also had a ventriculoperitoneal shunt at some point. She chills with fever, and can barely stand on wobbly legs as she leans on her bed. The community health worker is staying with her in the hospital as a surrogate mom, which amazes me. We're looking for the source of her fever, but mostly trying to feed her. She's hungry, and who knows what other abuses she has suffered, how many days she has spent lonely and neglected.
Most kingdoms boast of those who have explored territories, won battles, written books, passed laws, made speeches, succeeded in elections. Jesus' Kingdom stars the Mercies, Naomis, and Abondos of this world. The overlooked and neglected, the mentally and physically dependent, the fragile. And these three were just cute enough that I snapped pictures on my phone yesterday; there are many more whose appearance conjures more pity than hope. I confess that sometimes as I move from bed to bed, and see these little wasted bodies barely clinging to life, I become frustrated. I want someone with a simple defined problem that can be treated and cured. Yes, I miss malaria, odd as that sounds. On our service of thirty-some patients, few are straightforward. Many will never reach adulthood. Some will never walk, or even talk. We're excited when we can get a child weaned from oxygen, and don't expect a lot more.
So I need to remind myself, of such is the Kingdom of Heaven. It is a holy and awesome privilege to walk the halls of those welcomed by Jesus.

Friday, July 22, 2011

pizza progress

Here's the latest on the oven, which creeps along a few bricks at a time whenever Scott has time . .the slab is done, the hearth laid, and now the dome is inching upwards. Scott decided to add a plaster layer over the bricks for increased insulation and support, which offered good opportunities for help from Caleb, Julia, Jack, and Luke. Who me throw mud? Cave art by Luke, family portraits . . We're still a long way from cooking, but there is hope!

Thursday, July 21, 2011

Ninafanya kazi hospitalini/Ninashinda nyumba

Or, a tribute to weekly schizophrenia.

MON-WED:  Ninafanya kazi hospitalini, I am working in the hospital.  And by working, I mean really working.  We're short-staffed here in the "summer" (really the winter, we're slightly south of the equator, and it's chilly at this elevation).  From 8 am Monday morning to 2 pm Weds afternoon, it's pretty non-stop.  I'm somehow responsible for a resident, 3 interns, and two clinical officers; a 15-20 baby intensive care nursery; a 20-ish bed inpatient pediatric service including consults on complicated neurosurgical patients; any pediatric patients in the ICU (one currently, usually 1 or 2); backing up the CO's and interns as they evaluate all outpatient visits to the Maternal and Child Health Clinic (another 20-30 per day) or the Casualty; resuscitations in the delivery room or the OB theatres; and evaluating all new admissions.  By the time I've rounded on all the admitted patients I can barely remember where I started, so I just pray that God gives us clarity and wisdom and makes the biggest problems clear.  The good news is that RVA is now out until the end of August, so that clinic and the daily follow-ups are at least suspended for now.  We move as a group from bed to bed, checking for low oxygen levels, listening to babies, holding xrays up to the window lights, flipping through notebooks of paper to examine medicine charts and be sure the patient is receiving what we expected.  The progress is slow, for the patients and for us, because this is a tertiary referral hospital.  No one comes here with a simple, treatable disease that gets better in a day or two.  They come with chronic intractable problems, neuro-developmental delays, pallor and weakness, poor nutrition and gasping breaths, congenital deformities and desperate social issues.  It takes patience and pondering to untangle the story; it takes days and often weeks to treat the meningitis or clotting disorder.  On Monday I was also on call, so the seven admissions (plus the three I decided should instead by treated as outpatients) all required more thought and checking and labs.  There is a review meeting to discuss the management of a baby that died, a tragic story of a mom on her 4th pregnancy with NO LIVING children, all dying in the perinatal period, and this time she loses her baby again to a cord prolapse, unthinkable suffering.  Oh, and did I mention that as the lone pediatric consultant on Tuesdays I have to come up with an hour-long teaching conference each week now too?  

Scott is also covering an extra week of the male medicine ward because of short staffing as well.  Thankfully his service is not quite as crazy (most morbidity and mortality in Africa occurs around childbirth and the first five years of life), which means that he had more home time to deal with our mysterious infestation of fleas or bedbugs or some such pest.  Julia and Caleb were the main victims, I was up at 2 am to go to the hospital and also comforting Julia who was scratching numerous bites.  We're grateful for a washing machine and doom (bug spray) but it took a lot of work for Scott just to process all the sheets and blankets and clothes . . . oh, and we've had kids staying with us again, three boys for various periods of time, the last one leaves tomorrow.  So when I do come home, it is generally straight to the kitchen to cook something for everyone, which is actually a therapeutic way to recover from the day, palpable and palatable and pracitcal.  Monday to Wednesday are just plain intense.

THURS-FRI:  But then, miracle of miracles, we reach Weds afternoon, and Mardi appears.  We discuss the service one by one, a passing of the burden.  And I walk out, free, at first bewildered.  Ninashinda nyumba, I conquer the home (I like the active Swahili rendition of being a mom at home).  Four teens on summer vacation.  A card game.  Baking, washing, listening, straightening, more baking.  A video.  An afternoon run with Julia through the adjacent forest, we pause to marvel at black-and-white colobus monkeys in low branches, to listen to the chirping of the white-bearded skittish blue monkeys, to be thankful that Star has chased baboons off the road ahead and waits between them and us.  Julia pushes the uphill pace and I try to keep up.  I go to the library which is open a few hours per week during the holiday, and fill a bag with good books, a pure pleasure.  Swahili lessons, answering emails.  And I cook.  In the last 36 hours: biscuits, an apple-strawberry pie, balsamic-citrus chicken, mashed potatoes, salads, homemade whole-wheat bread, yoghurt-making, cream of pumpkin and cream of broccoli soup, lemon-blueberry scones with boysenberry jam, lentils with carrot-rice, fresh fruit. brownies, fresh tomato sauce and pasta.  Every single one of my kids is getting skinnier in spite of the output of the kitchen, but I do try.  Sitting on Caleb's bed looking up college web sites.  Walking to the dukas.  Writing. Giving Scott a haircut (Jack got tired of waiting for me and Luke cut Jack's hair earlier in the week).  Working from home on some of the administration for the Paediatric department, and for our WHM field.

Though the weekend blends back a little as Mardi and I take turns on Saturday, and next weekend I'll be on call the whole time, the week is starkly spit.  And I think I like it.  It's easier to give 110% when you know there is definition to the time.  I'm less resentful of time away from my family when it is balanced with protected time together.  I suppose it is part of the way we are made, for work and for sabbath, for rhythm, for contrast.  

Sunday, July 17, 2011

Mary's New Home

This is baby Mary, about a week after her birth, in March. She was born prematurely, at 27 weeks, weighing 855 grams. By the end of the first week of her life, she was down to 740 grams, we were having trouble feeding her, her lungs required maximum levels of CPAP support. She was very sick. And her mother, who was suffering from post-partum depression, gave up. She had four other children at home, a husband who had not even come in to see the baby, a rising hospital bill, and the sorrowful conviction that her speck of a preemie would not survive. She couldn't cope. She ran away. We involved a social worker to track her down and lure her back, but when she visited she left the above letter, abandoning her baby to the hospital. She went home and told her village that the baby had died. So our dedicated nursery staff stepped in. The nurses and student nurses in particular cared for this infant, month after month, while she slowly healed and grew. And grew. By July she was 3700 grams, a thriving little baby, alert, interactive, attentive, who loved being held. She accompanied the doctors on rounds, or spent her days on all our laps as we charted. Some bought her clothes, blankets, sweaters, diapers. We all loved her, but we longed for her to be back with her family. Mr. John Karaya visited her relatives, involved the child protection officer, the police, the courts, even taking time out of his annual leave to pursue a good custody situation for her. The courts appointed the local chief to sort it out, but week passed after week, and we became concerned that developmentally it was not good for a baby to grow up in the constant light and noise and monitor-beeping of a NICU. And so on Friday, at last, Mr. Karaya obtained a court order permitting us to transfer Mary to Naomi's Village, a nearby orphanage equipped for abandoned and orphaned children. It was a bittersweet milestone, hating to see her go, but thankful for this provision for her. For the first time in her four months of life, Mary left the hospital where she had been born, accompanied by a delegation fit for a celebrity: two doctors, three nurses, a pastor, and Mr. Karaya. We all piled into the hospital ambulance and drove her over the rough road into the valley, up to the gates of Naomi's Village. This is an orphanage opened by one of the missionary doctors at Kijabe earlier this year, brand new not-yet-completed solid walls, clean and bright and organized. Dr. and Mrs. Mendonsa have a heart for creating a home to raise dozens of children with no place else to go. Mary was welcomed by their family and a team of summer volunteers, and the only other infant in the home, a little boy who is also 4 months old and will be a good brother to her. Dr. Mendonsa gave us a tour and shared their heart for the neediest children in Kenya. Mrs. Mendonsa held Mary as we toured the the baby room. And as we left, we stopped at the IDP camp across the road, a settlement that sprung up after post-election violence in 2008 and has become entrenched. Clearly the orphanage appears to be a safer and more wholesome environment. But carpeting and cribs must be accompanied by nurture and a sense of self and belonging and of God's love. Pray for Mary to find that at Naomi's Village, and for the 21 other children there to be similarly healed.

Thursday, July 14, 2011


We often ask "Why?" when something terrible happens. But rarely when we are spared disaster. So tonight let me remember to acknowledge that that sort of "why", the "why are we OK?" is just as mysterious.
This afternoon I was home briefly between RVA clinic and some late rounds at the hospital, and Scott had decided to work on cutting some bricks for use in the pizza oven construction. Our tools are limited, so he's been soaking bricks in water and then slicing them in half with a small hand-held circular saw type of electric power-device. It's worked quite well. Until today, when the spinning wheel disintegrated into several large projectile chunks which flew off at high speed. Right into Scott's left eye area. I heard an ominous thump and a few seconds later Scott staggered in with broken glasses. What could have been a loss-of-his-eye disaster was a temporary blow with no long-term consequences as far as we can tell. He was wearing safety goggles which were bent inward, and the force still broke the glasses UNDER the safety goggles, his skin was reddened and swollen, but his eye was protected.
It was sobering to realize how close he came to a life-altering loss. We're big believers in safety goggles at the moment.
After Luke's two motorcycle accidents, not to mention Jack and Caleb making it through an entire season of rugby, we are awed at how actively the angels have been protecting our family.
During the end of our time in Bundi, from ebola on, we did often wonder why we were still alive and even rather well when others around us suffered such loss, and death. Psalm 91:7 is sort of the story of our lives:
A thousand may fall at your side,
ten thousand at your right hand,
but it will not come near you.
So tonight we hesitatingly ponder, "why", though we don't really need to know if it is your prayers, unfinished tasks for the Kingdom, God's awareness of our vulnerability, sheer mercy, or other mysteries of providence. We are just grateful.

Wednesday, July 13, 2011

A story about Hope

I have mentioned before the story of the little girl next door, abandoned at birth, enfolded into the family of our friends, missionary dentist and wife with 25 years in Africa and plenty of biological children, who simply saw a need for foster care that grew into total commitment as parents. Because of concern for child trafficking, the legal system for international adoption has become increasingly complex to navigate.  It took the Riches 2 1/2 years with Hope in their family as their child to achieve the legal Kenyan adoption, and get her a legal Kenyan passport.  Many of us prayed for that oft-delayed and difficult-to-achieve event, until the day the Kenyan judge declared Hope theirs.  Just in time for the family's planned furlough to the USA, where their fourth child will begin University studies.  However, incredibly, the American embassy in Nairobi has denied Hope a visa for the USA.  Even though the Riches were granted custody of Hope for over two years which culminated in adoption, even though they have been her only caretakers since birth, even though she is completely part of their family, she is not yet a US citizen.  And our embassy has decided she can not enter our country with her family.  Which means the Riches can not visit their elderly parents, or help their college-age kids settle in college.  They were told that they must wait a further two years AFTER her adoption.  They had sold their car and most of their possessions, finished their jobs, given away and closed up most of their life, booked airline tickets, expecting to spend the next year in America and then return to Africa to a different mission location.  Instead they now must find a place to stay with Hope and their 9th-grade daughter indefinitely, send their graduating son on to college alone.

One of their kids made this video to explain the story, generate prayer, and encourage people to appeal to their congressional representatives.  Particularly if you are in North Carolina (the Rich's home state) please consider following the links to register your support for Hope's visa to the USA.  This is not a dangerous criminal, this is a precocious healthy loving 2 year old with a family who just wants to be together.  Watch the two-minute clip here:


Monday, July 11, 2011

Happy BDay to me, a Recycling Jubilee

After a long week and a trying emotional and spiritual stretch, recovery comes from thankfulness, as demonstrated in the Psalms by David who had his share of trials but stubbornly held on to praise. Much of what I'm thankful for is recycled, renewed, restored. . which reflects what God is doing in general down here in this world. Here are few things from the last couple of days: The Year of Jubilee, my Birthday stretches on. Tonight our friends from Uganda, the Chedesters, invited our family for a delicious dinner. In this new place I forget what it's like to just relax with people we've known for so long . . and the only people around who share the most significant chunk of our life. Above, with the roses they gave me. Renewed friendships are renewing. Scott and the kids gave me a Kitengela Glass IOU for my Birthday . . . so we went into their shop this weekend after Caleb's rugby game. I thought I'd replace some of the glasses we'd bought a couple of years ago, which are made locally here in Nairobi from recycled bottles, and which we seem to break rather often. Instead I splurged on two handcrafted chairs (with chunks of recycled glass in the back) for the counter Scott put into our kitchen. It's the new breakfast spot. These are my other Birthday present, which Luke bought me in a Maasai village, made from recycled rubber tires. Luke and Thomas this morning, off to the Loita Hills, where they will camp for a week as they visit Maasai villages for their research. The house is already too quiet. Their friendship is restorative to both of them after a year in two challenging universities. I realized that my Swahili lesson today as we chatted about the current family events contained sentences like this (which are not too reassuring): Hawaogopi fisi? (don't they fear the hyenas?) Hapana, wana visu (No, they have knives) Moe, our houseguest, who has become part of the family over the last week, we will miss her when she goes back to Japan via Rwanda. And I end with my most thankful highlight of the week, Luke and Caleb with friends after leading Praise Chapel. I miss leading worship, I'm sure that David soared not just from writing Psalms but from singing and dancing them, from playing his harp. It is a great joy to see my kids have at least a chance to do that. There are so many talented musicians here, but this week Luke and Caleb were able to step in, and I'm so glad I was able to run up the hill from the hospital and worship with them.

Sunday, July 10, 2011

not my plans . . .

"Tis the season for transition, closure, goodbyes and launchings. And with that comes a certain level of disquiet, unexpected since we're still in the entry phase of life, and no one is graduating in our family. I've had a hard time putting my finger on the heartache that has settled more and more heavily upon the week . . .
For one thing, Mardi was gone, which made me realize just how much of our survival rests on the space she creates in my life at least, which of course spills over into the rest of the family in details like actually having enough food cooked . . After a month of job-sharing, going back to solo full-time-plus was harder than I thought. All the interns did their quarterly transition to new services this week too, which makes the medical care temporarily more challenging as people orient and adjust from 75 kg waling-talking patients to 1 kg fragile mysteries. At 2 am on my call night I was summoned to break the news to a mother that her baby was dead, and since it was a baby who had not previously been thought to be sick and was found cold and lifeless, it took hours of investigating just what went wrong, as well as explanation and comfort for the oddly stoic mother. Out of that sorrow came some good meetings and ideas about documentation and responsibility, so that if this was at all preventable we'll have a better shot at doing so the next time. And another afternoon just when everything seemed quite calm in nursery, a nurse came running in with something in a sheet, which turned out to be a 750 gram 26-week girl who had been delivered in the grass outside. That led to immediate action, resuscitating, warming, breathing, testing, getting her into an incubator and on support. And the whole process was complicated by a sullen quietly distressed non-communicative mother who it turned out had hidden her pregnancy from her parents, and "happened" to be hanging around the hospital because another child in the family was being seen in a clinic for another problem. Between the social complications of negotiating disclosure to the mother's father, and trying to keep the baby breathing, it was a long afternoon, and the tiny baby never really had much drive for life. So after some hours I was left with the excruciating task of deciding that we had done all we could do, gathering the medical team to discuss options, getting the mother and her father in to see the baby once, and then allowing her to die. That is the awful responsibility that I find very very draining.
There were some highlights in the nursery too, though, a much-valued only baby Shunetra who has hovered on the brink of death for two weeks with meningitis, sepsis, prematurity, feeding issues, respiratory distress, a heart lesion, you name it, gradually improved. A baby whose heroic mother did every-one-hour-feedings for weeks came back a week after discharge having gained great weight and looking so cute and normal. A malnourished baby whose intestinal obstruction was surgically corrected went home miraculously well. I had some time for teaching, both bedside and in a weekly lecture, which I enjoy. But I missed sharing the weight of responsibility.
Then there is the social craziness of this week. One day I came home and found we had four college kids from four countries for lunch--fun to hear them compare Korea, Japan, Scotland, and the USA. We have one girl from Luke's class staying with us for "alumnae weekend" and others drift in and out for movies and meals. Though we're not nearly as involved as many families here, the Netherlands and Australia have also been represented at meals this week, not to mention everyone's African countries (Rwanda, South Sudan, Kenya, Uganda). There are concerts and games and special events. The three younger kids were in exams, so that added a level of stress and a variation to the schedule too. Luke is slowly recovering from a couple of motorcycle mishaps, which have left him bruised and scraped, and rather uncomfortable and discouraged. Rugby semi-finals were yesterday too, a well-fought match against the same school that beat us badly a week ago, we came close to a tie, but disappointingly it did not happen. In the midst of band and choir and teams and returning alumnae and conversations, some of the disquiet comes from hearing kids process the school, the tension between exclusion and inclusion, the lines between who is in and who is out.
Somewhere in the middle of exams and visitors and work and patients, I totally forgot a staff meeting, and slipped even further behind in any progress on a list of things to be addressed in the newly delineated department of pediatrics (which I am supposed to be clinical director of, by virtue of being a decade older than everyone else I think). Every day I think i'll get time to make progress on details for our Africa field retreat only a month away, but another day goes by.
Besides the sapping of energy from hard decisions and lots going on . . . a large part of the crushing heart-level weariness I realize comes from a couple of specific prayers unanswered. Or at least not the answers I wanted. One prayer was for our neighbors to receive a US visa to bring their legally-adopted-Kenyan 2 1/2 year old to the States as the family completes their service in Kijabe after over 25 years, and accompanies one of their older children back to university. The US Embassy denied the visa, in spite of many appeals and letters and a reasonable legal interpretation of the statutes, and I feel their pain as they must split their family. Of all the dangers our embassy must protect American from, allowing a brilliant healthy darling loved daughter to travel with her parents does not seem to be one of them to me. Then I had prayed a couple of specific things for one of our kids, and yet watched them experience rejection, which really hurt at a deep level.
And sometimes it seems like most of the people we have gotten to know in the last six months . . are leaving within two weeks.
So today the message of Jesus in all of this unexpected unease, came through seniors giving testimony, and through the choir's excellent drama on the book of Job, the reminder once again that God's plan can not be thwarted by apparent rejection or loss. This week did not, in many seemingly important respects, go the way I hoped it would. Which is usually the context for God's work. Jesus was despised by men and acquainted with grief; He did not live a life of peace or success. He allows disappointment and injuries and goodbyes and failures for His own mysterious purposes, which we declare by faith are good, even if painful. Amen.

Friday, July 08, 2011

The 9th of July

Happy Birthday to South Sudan!  We join with our team there in rejoicing over the end of decades of civil war, and the palpable sense of hope for the future.  We also grieve that some ethnic groups continue to be targeted by violent aggression, particularly on the North/South border.  Please pray that the launch of this new country would usher in a peace that allows children to survive, families to unite, villages to thrive, and a whole nation to taste a glimpse of the righteous rule of Jesus.  And remember our team, on the ground in Mundri as witnesses to this birth.

Sunday, July 03, 2011


Sitting in the front yard, wrapped in Julia's purple Maasai blanket as clouds pass over, Star at my feet the perfect company. Caleb's guitar strums from the house, it is Sunday afternoon and I hear an occasional voice as everyone putters around for a while doing their own things. Ibis squawk, poinsettias flame, a breeze moves leaves in the muted cool daylight of the southern hemisphere "winter" (60-70 degree days feel positively arctic after acclimatizing to a Bundibugyo life, and when it rains and dips to the 50's we shiver). We're back from an outdoor service at RVA where 18 young people were baptized, most of them missionary kids who have been challenged to own their own faith as teenagers apart from their parents. Eighteen stories, each a unique variation. Someone found her life was not her own but God's while she was held hostage after a carjacking. Another sensed God's love when peers sought him and pulled him out of a protective isolation. Another had to confront her emptiness when her family's move to Africa landed her at RVA without access to drugs and alcohol. Another realized even "nice" kids can be obnoxious. Another confronted his cruelty in the way his peers were damaged by his abuse. They mentioned loneliness, neglect, bitterness, bulimia, cutting, deaths of friends, feeling ugly, feeling on the outside. They also mentioned peace, scripture, caring friends, involved adults, and the compelling presence of the Lord. All took the opportunity to make public their commitment to Jesus and their desire to follow Him. And all were pulled up out of that water with spontaneous smiles.

It's good, it's faith-pushing, to remember that we're in the middle of the story. Even inside the RVA fence, protected from much that is evil, kids are in process, and many are facing life-pivotal-moments. Depression stalks, pressures abound, and yet love breaks through. When Scott and I see these kids in clinic, we want to honor their journey, remember that they will reach graduation more fully themselves than they were in the years before. When I see obnoxious attention-getting behaviour, I don't want to label that kid, but see through it to the person who might be giving next year's testimony. I am convicted today of how easily I label and box, and how crucial it is to see beyond to the glory that will be revealed.

And reminded that the current US Ambassador to Kenya attended RVA, as did his wife.

Several calls from "kids" in Uganda this week, people we care about . . . who have their own stories. Parents separating, destructive effects of alcoholism, gossip, jealousy, anxiety, and the struggle for getting needs met. Frustrating to be powerless, for them and for me. I am convicted again of the importance of believing, taking the longer view of glory.

So, how to pour into these stories in a way that peels away the crust of the Fall and reveals the wonder? Sometimes just by being present, and bearing witness.

Yesterday the rugby teams, Varsity and JV, traveled to a school near Thika, to play a match that had been delayed and rescheduled and confused all term, and so it felt like a last-minute addition. It was the last game of the season, coming just before exam week, and against the number one school in the league, a large well-known Kenyan institution that emphasizes rugby and trains year round, with a professionally qualified coach who works internationally. It was a school that beats us, and pretty much everyone else, decisively and repeatedly. Some of the varsity seniors chose to quit the team rather than play that last game. Plus it was over two hours away, in road-contruction-mass-confusion Nairobi outskirts traffic, to a dusty acacia-studded field, where about 500 opposing students chanted and massed on the sidelines, laughing loudly at our mistakes, taunting. At that distance, on second-to-last weekend of the school year, the supportive crowd was thin. Me and three other parents and two young siblings, to be precise. It wasn't our teams' best games, by far. JV lost 36-10, and Varsity something like 26-0. I did get to see Caleb kick a penalty for 3 points, which was a significant percentage of the total points RVA scored, but he also was frustrated with himself for a few errors, not his most heroic game. But the boys walked away satisfied, declaring that they had had fun, they had supported each other as teams, they had stuck it out to the end. The lone parent-car that went had errands to do on the way back, so I ended up on the bus packed with sweaty, scraped, dusty, thirsty kids. And I didn't hear one word of complaint. They recalled plays and tackles, they joked. (There was one kid that gave me a scare on that ride by falling into a deep sleep and slumping onto the floor, which made me worry that he'd had a head injury in the game and was now progressing to coma, but when I pried his eyes open he answered questions appropriately, and in spite of my nerves walked off the bus smiling when we got back, saying he's a solid car-sleeper . . ). They demonstrated sportsmanship and resilience.

The stories that will be told of these kids, including my own, will be long and often harrowing and intermittently hysterical, and involved scattered hard-to-reach-hard-to-love spots all over this world. Perhaps if we could see where they are heading, we'd be more willing to invest in them now.

Friday, July 01, 2011


A week ago, I entered my year of Jubilee.  Most likely my only one, unless I live to be 99, which is not very likely.  7 x 7.  I think it's supposed to be about rest, which is ironic, because I haven't even had a moment to think about it until now.  Last weekend's call blended into one of those Mondays that ran into another call on Tuesday that spilled over into a Wednesday morning when the other paediatricians all had extenuating circumstances and so I found myself with the terrible responsibility of stopping unsuccessful CPR on a 1 1/2 year old boy and then turning around and taking his soon-to-follow 1 1/2 year old room mate to the ICU where I intubated her.  I had to tell two families within 12 hours that their child had died, which is as always a holy but wrenching moment.  I also spent solid portions of both Sunday's and Tuesday's call on a punky preemie, one of those babies who just keeps teetering on the edge of existence, including sitting several hours by her bedside and ventilating her until I was about to give up and she miraculously started breathing.   Thankfully Mardi stepped into the picture on Wednesday afternoon.  Since then, RVA clinic, a long morning hospital meeting, a couple of hours tracking down xrays and an ortho consult for Luke post-accident (persistent shoulder pain and limited motion, but seems to be all muscular, which he was certain of but at least I fell better about it now), some admin work, clothes-patching, and major cooking--two dinners for young people--one night two of Luke's returning classmates, and last night two young Kijabe doctors, all delightful people.

Which brings us to Friday at last.  To quiet and journaling and reflection and prayer, to the inhale that has to be deep enough to last for through the craziness.  To the beginning of Jubilee, a week late.  To Leviticus 25.  To more thoughts to follow, but here are some initial ones.  Jubilee is good news in the middle of life.  Jubilee is course-correction.  After 49 years of divergence from perfection, Jubilee is the time when God restores the broken, recovers the lost.  Inequalities are undone.  Resources are redistributed.  Grace is real.  Jubilee calls forth faith, the faith to live on God's provision only, the faith to refrain from striving, the faith to let go of what seemed like gain, to accept what seems undeserved.  Yes, there is some rest, for the land mostly, which reminds us that it belongs to God and not to us.  But liberty is the clarion call of Jubilee.  It is an act of proclamation, which culminates in Jesus as the incarnated Jubilee, proclaiming the year of the Lord's favor, good news for the poor, healing for the brokenhearted, liberty for the captives, open prisons for the bound, comfort for those who mourn, beauty for ashes, the garment of praise for the spirit of heaviness (Is 61 fulfilled in Luke 4).  

So perhaps the first week of my Jubilee isn't so far from a true celebration.  Breath for the flagging, fluids for the parched, encouragement for the youth.  A change from the past many years, a relocation, a letting go of most of my former work and responsibility and satisfaction.  The challenge will be to live on God's provision while still living out Jesus' mission, to live in rest in the midst of a restless world.  To return to what God has given, to be without a push to do.  To celebrate Jubilee personally without letting down a community that expects so much.  To balance the rest for my soul with the proclamation of liberty for others.  I'll get it wrong, most of the time, but that's the whole point here:  God steps into the 50th year and makes it all right again.