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Sunday, June 29, 2014

Another week, another year

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

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

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

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

My favorite celebratory group.

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

Jack made me this bowl in pottery class

And Scott made his own creations

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

How we spend cold June evenings

Birthday cheer that reminds me I have great friends.

Our lovely garden

Former neighbor Anna Rich back for a visit.  

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

My traditional bday apple pie, courtesy of Karen.

Last Caring Community.  Sniff.

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

Sunday, June 22, 2014

Occupational Hazards

My second flat-out-take-down illness in less than 3 weeks, chills and fevers over 102.  Bleaaahhh.  I think 25 years in this profession gave me the false assurance that I had developed great immunity.  But I am way less invulnerable than I think, and this weekend of shivering under blankets and coughing until I pulled a rib muscle proves that.

Scott's hazard was of a different nature, physically and technically demanding.  Friday was his fourth call for the week, the other three were mercifully reasonable to get him ready for this doozy.  Just at 5 pm a woman presented in labor with her baby transverse, meaning the baby's back (not head or bottom) was across the cervix.  It is not possible to deliver that way, and without surgery the baby and mother would die.  Even with a Cesarean it is a difficult extraction, but he was able to make an incision without rupturing the membranes and turn the baby around inside the amniotic sac for a safe entrance into the world.  He made it home for dinner and to help us set up for Senior Class night (we're still sponsors) then got called for one emergency after another, in the operating theatre from 10 pm to 6:30 am.  A lady with a ruptured ectopic pregnancy, which had to be removed to save the mother.  A lady who was bleeding to death from a cervical laceration.  A lady with a placental abruption, meaning the placenta separated from the uterus with the baby still inside, which would have led to both baby and mom bleeding to death.  A woman with previous scars who presented too far dilated to wait for morning for an elective CS.  There were some delays because the Paeds surgery team was stitching up the severed trachea of a 15 year old boy who had supposedly been attacked by a baboon in a nearby town.  The point is, he accepts the all-nighter for the satisfaction of eight lives saved (and one lost, the ectopic fetus, but that was not possible to save).  And having lived in the "bush" we know that most of those would have died most places in Africa.

In John 16, Jesus says that we endure pain as we wait for him, as we work for the Kingdom, but when we see Him we will forget all the suffering just like a mother who is in labor for a baby.  I resonate with that analogy.  The suffering is real, the scars are palpable, but the worst of it becomes a dim memory in the joy of the outcome.

And some of that joy, for us, is the privilege of living here where we can see our kids and participate in their lives.  So we close with a few photos of the weekend:
Missing Caleb.  Sigh.

Julia and Katie, baristas!

Coffee, donuts, and hot chocolate for class night (remember it is winter here below the equator at 7200 feet, chilly and damp and grey)

Julia's senior singing group leads worship this am.

"Small Group", the senior choir, performing

More World Cup with RVA kids, Germany vs. Ghana

Saturday, June 21, 2014


Kenya is a dangerous place.  Travel warnings, terrorist attacks, road traffic accidents, diseases, violence. We have made headlines recently with the latest round of death:  vans of armed men attacking World Cup viewers last Sunday on the coast, then setting fire to hotels and the police station.  Sad terrible deaths.

Which then leads the US to advise against travel, tour companies to pull out plans, embassies to relocate staff.

As I read the last travel advisory, I decided to look up some comparison numbers.

In the last 18 months there have been 83 terrorist incidents in Kenya, leading to "over 100" deaths, all Africans.  This is from a population of nearly 45 million people.

In the last 18 months there have been 63 shootings in schools in America, leading to 110 deaths.  There are about 45 million American children enrolled in schools.

So why does travel in Kenya seem so much more dangerous than going to school in America?  Is it the illusion of the foreign? Why would people not hesitate to have their child be one of 45 million in a school, yet question the safety of being one of 45 million in Kenya?

Of course I would wish that no person could take a gun into a school in America and kill children and teachers, and no person could make IED's or wield machine guns indiscriminately killing Kenyans.  The world is a dangerous place, but the Kingdom comes, slowly and quietly.

End of the Season

RVA lost to Strathmore in Rugby quarter-finals today.

They were a big, fast, expert team.  We played hard, and so did they.  Yes we made mistakes.  Too many it turns out.  We traded tries but ran out of time as they had the last score on an intercepted pass. So sad for these boys who played hard and well.  Jack had a great game, good tackles, smart strategy, a quick tackle that set up our first try and another try that was called back for unclear reasons.  He did his best.
This picture was from the last season group-play game, a victory.  I think it captures some of his intensity.

A small part of me is relieved that he and the team are emerging mostly intact, no horrible injuries.  But mostly it is sad to come to the end of the season.  His coach will be on furlough next year, so that will be hard too, having a new person for both football and rugby.

I think one of the primary joys of parenthood is seeing your kids try something hard, and thrive in the challenge.  I love seeing the way Jack pours himself into rugby, just as I love seeing the others in their passions.  Sometimes I'm sad that my Dad never lived to see this sport, since he was a huge American Football fan (in the simpler days when we all cheered for the Redskins because of a loyal proximity with no qualms about the implications of the name).  He would have loved watching.

So here's to the end of a great season, winning the Blackrock tournament, making it to quarter-finals in the league.  And here's to the hope that senior year will be even better!

Keeping the "World" in World Cup

I love my multicultural kids.  And having the oldest home for a week brings a lightness to life.  Yes, he's hungry and on his own schedule and opinionated and whenever he is here it is like a whirlwind that draws the rest of us into his orbit.  He's also funny and creative and I love to find him immersed in a book or fixing something or socializing.  He's just a great person to have around. And now that son two is out of his military enclave we can SKYPE which leads to leisurely conversations and sharing pictures and tales of North Africa.  Child three, the only daughter, is a month from graduation, making cookies in the afternoons, spending time with friends, and dreading final class projects which seem to pile up.  Then there's number four, who manages to do homework horizontal in front of the fire and the TV with music in his ears, and then manages to play with passion and insight on the rugby pitch, all-out scoring and tackling and kicking.

The World Cup is an interesting time for a family of TCK's.  None of the teams are from East Africa where we live.  I wondered who my kids would root for, and the list was as follows:  US because you have to root for your passport country, any African country because that's home, any team with a Manchester United player, and then whoever is the underdog.  OK, makes sense.  Football is their sport.  They watch every minute that they can stay awake for.  The last three nights we've had German neighbors over to see their team, Australians to see theirs, and Americans to cheer for the USA.  World Cup is the common topic of conversation, in the hospital as well as the family and the school.

But USA vs. Ghana was, well, complicated.  We took brief naps and got up at 1 am full of anticipation and excitement.  The US went out ahead and we cheered; Ghana equalized and we cheered again.  And as the night went on, one of the lived-in-Africa-all-his-life kids became more and more conflicted in his loyalties.  First he just wanted a good match, but the more the American friends jumped on the America bandwagon, the more he gravitated back to the Africa one.  In a crowd of Ghanaians, I suspect they would all be American.  In a crowd of Americans, they aren't quite so clear.  I watched the dynamic evolve, a little uncomfortable, wishing that friends could understand what it means to be an American by parentage and an African by experience.

The World Cup is about world talent, world football, a peculiarly unifying event in which country loyalty is heightened and yet at the same time muted.  When home is complex and not limited to one continent, when interests span borders, the World Cup becomes a showcase of world-thinking.  So we keep cheering for the US and Ghana, Cote d'Ivoire and Nigeria, Costa Rica and the Netherlands.  Places where we have friends.  

Wednesday, June 18, 2014

Dangerous Orange, sailing over love, and other tales of the day

In light of the Netherlands' victory, dangerous orange could easily refer to Dutch National Football.  Though Australia gave them a solid run, and we enjoyed watching with the loyal Steere family.

But a more dangerous orange was the one a 10-month-old previously well baby was munching on this morning.  He coughed and began to turn blue.  Within thirty minutes his parents had reached Kijabe hospital and our alert team had deduced from his wheezy breath sounds, dusky color, and collapsed lung on xray that some part of the orange had lodged in his respiratory system.  I had the privilege of watching over visiting Paeds surgeon Drew's (former MK from Nigeria I might add) shoulder as he guided a bronchoscope down this toddler's trachea and into the left bronchus.  Sure enough, there was an orange seed, which he then used remote-controlled forceps to pull out.  Pretty satisfying, and definitely not something that can happen that quickly and expertly and life-savingly in many places on this continent.

In that same vein, I had the joy yesterday of introducing a miracle mother to her miracle twin girls.  Mama W had come into our maternal-and-child health clinic on Friday nearing the last month of her difficult and miraculously precious pregnancy.  But everything had gone wrong.  She was barely conscious, with severe hypertension.  By the time Scott rushed her into the operating room it was not clear if anyone, she or her babies, could be saved.  He began the surgery as another missionary anesthetist struggled expertly to revive her.  As Scott cut, he saw that she was hardly bleeding at all.  Which was because her heart had stopped beating and the team was doing CPR.  Scott said he had never done surgery during CPR before, but he got those baby girls out fast.  Our team revived them, and though they needed a big of oxygen and care they are both healthy, just a bit small.  Meanwhile the mother's heart restarted, and she went to the ICU with little hope of recovery.  We took care of the twin girls in the nursery, snuggled into our twin cot, crying and being fed by nurses.  The family was too focused on the potential loss of their mother to help much.  But by Tuesday she had moved into the High Dependency Unit, sitting up, talking, and looking 100% better.  After rounds that day Scott mentioned that she had not yet even seen the babies she nearly died for, so a nurse and I carried them up to her bed.  She named them Blessing and Favor, and together we prayed a thanksgiving prayer.  Again, this is one of the only places in Africa, let alone Kenya, where the threesome could have emerged alive.  And the effort took dozens of people doing their jobs, from the clinic to the theatre staff, anesthesia, medicine and OB, paediatrics, nursing, call coverage, biomed for equipment, and on and on.  

Which is why this place is a magnet for last-chance-efforts.  This morning I walked around maternity to check on the moms in various stages of labor:  A woman in her 4th pregnancy (all 3 previous ending in 2nd trimester deaths) who arrived threatening to lose the 4th at 29 (out of a normal 40) weeks, a woman at 26 weeks fully dilated with a baby that could pop out any second lying on strict bed rest and hoping, another at 25 weeks who seems to be quiet now, two at 34-ish weeks who were being induced to deliver after premature rupture of membranes, and a woman at 33 weeks whose baby was barely growing, stressed and small and lacking amniotic fluid.  We kept tabs on them all as we worked to care for the 20-some babies already under our care.  Each a story of potential loss, of a close shave with disaster, of coming almost-too-late, of serious malformations and infections and danger. Each hanging on by drops of fluids and carefully measured shots of medicine, by effort and prayer.

One of the 34-ish week babies emerged mid-afternoon pink and lovely, a perfect petite little girl.  And then at the very end of a long post-call day, a difficult C-section for the lady with no amniotic fluid.  Scott stepped in again to help the OB trainee who was struggling, and they pulled out a tiny little boy.  One kilogram exactly, about a month-delayed in size.  So he was improbably wailing and flailing like a more mature baby in a miniature body.  This mom had also lost 1 of her other 2 babies.  I held him up for her to kiss, and then whisked him to nursery.

A day of work and miracles and joy and risk, so let me end with this passage quoted by Eugene Peterson in Tell it Slant (chapter 17, reference to Hans Urs von Balthasar, Prayer, 1963):

 We "let ourselves be gripped by this primary truth, namely, that the whole compact mass of created being and essence and the everyday world we are so familiar with sails like a ship over the fathomless depths of a wholly different element, the only one that is absolute and determining, the boundless love of the Father."

Tuesday, June 10, 2014

The Poor Have Good News

For about 30 minutes out of this non-stop day, I sat with a cup of chai and three Kenyan colleagues for a meeting.  We talked about converting containers to housing, about chaplaincy, about funding for surgeries, about staffing changes and construction deadlines. But the highlight was listening to one, a neighbor and friend who has spent two decades in administration at Kijabe and BKKH, wax eloquent about the mission of this hospital.

We don't need to be another private hospital for Kenyans with jobs, he said.  Those people can afford the upscale institutions in the city.  Kijabe should be known instead as a place where any person, no matter how poor, can come for care.  Yes, we will talk to you and work around constraints on your resources and ours.  But no one will be turned away.  This is the way Jesus would work in our world, and this is how our world now sees Jesus.

And now as midnight approaches and I think over the last few hours, I feel some satisfaction that his vision is reality.  A mom, pictured above, took home a surviving baby after losing three.  It was a long course, touch-and-go, to get this preemie to make it.  A twelve-year-old boy falls out of a tree in Somalia, and after three months of pain, transport, fear, borders, paperwork, suffering, he finally rolls into our casualty on a dark night with both legs broken and displaced.  Along with a one-month-old also from Somalia, wrapped in a thin blanket, cool, with her stoic, thin mother.  She has a neural tube defect, and will be operated on by our neurosurgeons.  Next to them, a Kenyan 2 year old with sickle cell disease and severe anemia.  Which would be enough of a hurdle to survival, only he has also suffered fractures from child abuse, and his mother murdered the abuser in front of him, so now he's in an orphanage.  The caretaker brought him along with another little boy, presumed around 1 year old, abandoned and malnourished, with rickets and a cough.  Across the aisle a 3 year old with cerebral palsy, a frazzled mother, anxious.  And I break off from these to run back to nursery and see a one-week-old who thankfully could not afford the poor care he was receiving elsewhere in Nairobi so abandoned ship and showed up in the afternoon in kidney failure, dehydrated, with fever and seizures and jaundice.  Who is only slightly sicker than an earlier admission who has a viral crud and severe respiratory distress, and oh yes by the way also has spina bifida and malnutrition.  Seven admissions this afternoon/evening, and every single one is either a refugee, an orphan, a child with a severe birth defect, or too poor to afford care in another hospital.

It is quite possible that not all these children will survive.  A little girl I admitted on my last call died over the weekend.  She had a typically lethal genetic defect in DNA repair, so that something as simple as sunlight caused her to have early skin cancer.  She was only two and came with a foul ulcer that had not been helped at other hospitals.  I have been in Africa over 20 years, but I almost fell over when I took off her hat and saw the open wound crawling with maggots that squirmed to burrow under the edges of her skin.  But I had to look, and to care, and even though her condition was probably beyond helping, I knew that we could at least give her parents accurate answers and the dignity of knowing they had tried.  The sadness of her death is tempered by the assurance she is no longer suffering.

So tonight I believe the dream of Kijabe is being realized.  The poor find their good news in caring people, in adequate medicine, in careful monitoring and affordable operations.  In open doors.  In offerings of hope, and even when hope is elusive, in the quiet support of compassion.

Monday, June 09, 2014

Crater Lake Game Sanctuary

Family, like nature, abhors a vacuum.  Julia is on Senior Safo (the senior class trip to the coast south of Mombasa), swimming in the Indian ocean and socializing with her class mates.  Luke is spending two weeks trouble-shooting and organizing after moving a storage container of hand-me-downs to a farm house in West Virginia we are fixing up as a home base, finding time for river-swims and startling a fawn in the forest in between car repairs and plumbing woes.  Caleb is in Morocco on a summer language intensive (Arabic), having just slept on a sand-dune accessed by a camel ride, and pouring over difficult script eight hours a day. Which means we are down to only Jack at home for this mid-term weekend.  We worked Friday and spent Saturday in Nairobi where he took SAT exams along with 80 other Kenyan hopefuls, the only pale-skinned kid amongst a certain elite who will end up in American universities.  But that left us the possibility of an overnight adventure, taking Sunday/Monday off.

And so we pulled together a trip to the Crater Lake reserve on the southern rim of Lake Naivasha, about a 1.5 hour drive away.  And we pulled in the Masso remnant (Michael is in South Sudan and Acacia is visiting classmates in Eldoret) of Karen, Gaby, and Liana, and a family for whom we act as guardians while they work in a stressful pioneering situation, whose boys parallel ours in age, grade, sports, interests, personality.  Which led to a very refreshing overnight get-away, Scott and I setting up the tents at the campsite with four boys while the other parents/daughter stayed in the lodge.

Kijabe friends, I'm a fan of this sanctuary.  We hiked Sunday afternoon around the crater rim, and Monday morning through the sanctuary to the lakeside.  Both were 2-plus hour hikes of 5-10 km, with spectacular views, and on-foot close-up views of buffalo, giraffe, gazelle, impala, eland, wildebeast, warthogs, zebra, birds, colobus, baboons.  I love the slower pace of walking, the engine-free sounds of the whoop of a zebra, the surprise of a startled animal jumping up through the bush.  Jack probably made our guide a little nervous when he chased giraffe and zebra on foot, but what a thrill.  From the high cliffs we could see across the lakes to Longonot.  Friendship, conversation, outdoor air, a break from routine, campfire and chai and frying bacon, books and hammocks and exercise and more sun.  The campsite I must say was very unimpressive, a fenced area with scrub brush, latrines, cold water, and too much trash.  But the lodge area (permanent tents lakeside with bathrooms) and the restaurant were lovely, and the reserve itself was crawling with wildlife and chock with views.  Expect to spend about $20/person (less for kids) for camping and entrance fees.  We ate dinner at the lodge which was just over $10.  The guide for hiking came to about $3 per person.