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Friday, August 29, 2014


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

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

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

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

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

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

Wednesday, August 27, 2014

California (Paradise?)

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

And in this stage of life, we're trying to learn to be a blessing in some small way too.  Our siblings do the lion's share of this.  Both of our sisters lived near our parents most of their lives, and have made graceful gradual transitions from receiving grand-parent child-care help to providing moral support through doctor appointments and moves.  So it is a drop in the ocean, but we're glad to be a listening ear, or put up smoke detectors and fix doors for a few days.  It is also sweet for me to see this patient side of Scott, who was always charming with the older generation, shining in this role.
And to think about marriage and the resilience needed for challenges ahead.  I look at my mom and the way she has walked through the heartbreak of ALS and widowhood, and moved into a new state and neighborhood, new church and friends, new home and car.  I look at my mother-in-law and they way she's learned to use a computer, do all the driving and communicating, risen to the occasion in a hundred ways.  Good women to be following through life, even though we are too often far away.

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

Collaboration and Research

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

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

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

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

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

Wednesday, August 20, 2014

Collective genius and generosity, and thoughts on comfort

Launching has been our life this month.

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

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

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

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

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

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

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

Monday, August 11, 2014

In my father's house

 . . are many mansions.  I go to prepare a place for you, that where I am, you may be also. (John 14)

This idea of home and family and place is pretty fundamental to the human psyche.  Jesus even used the image to explain to his followers his post-death trajectory.

In a small way, that's where we are now.  Literally in my father's house, preparing a place.  And since West Virginia is called "almost Heaven" . . .well, the point is that all this preparing is so that we can have a place to be with people we love.

In 1973, my parents bought a farm up in the hills of central WV.  It was a half-mile from property where my grandfather and great-grandfather had been born in log cabins.  As the youngest of 15 himself, my dad didn't wait around to inherit any family property.  Instead he found two inexpensive, deteriorating farms.  One he fixed up as a family "camp" where we spent weekends and summers in the vicinity of our relatives. The other, this farm, he rented out to people for a small income, until it became more of a liability (like when the schoolteachers who lived here were busted for growing marijuana on site).  He added a bathroom and started some other projects to make the hundred-year-old house more liveable, but then became ill and died and the place sat unoccupied, a bit shabby and crumbling.

Last year Scott and I anticipated that with more kids in college every year, we would eventually need a place to gather when we're in the States.  Our parents have moved out of childhood homes with lots of bedrooms and space, into smaller retirement homes, which are not really available for extended stays by a family with four teen/twenty kids.  We have never owned a home.  So with my mom's blessing we decided to invest in a new roof and floors for this farmhouse, and to make it a home-away-from-Africa-home.  From a distance we contracted with a local builder.  In May Luke moved umpteen boxes of mostly photo albums and dishes, and some furniture we had inherited when my mom down-sized.  He fixed the hot-water heater, and met the neighbors, and hooked up the coffee machine.  A good start.

So this week we've been sorting, cleaning, painting, fixing, running errands, and making progress towards making the place home.  Scott put up a clothesline and I washed all the musty quilts that have been in storage 20 of the last 21 years (we lived one year in the US, in 2001).  We unpacked some dishes and pots and pans and linens that were wedding gifts 27 years ago.  We visited the local furniture store where the proprietor and his wife, in their 80's, went to high school with my dad and uncles, to order beds and mattresses.  We peeked into every box and then stacked them, filling two closets with the accumulated photos and scrapbooks and letter-jackets and souvenirs of our childhoods. We put the remnant of our books onto a shelf.  We now have an account with Southern States for propane, a fridge, and a wood-burning iron stove.  We hauled the few pieces of junk left in the house from former occupants off to the dump.  We took walks and invited our nearest neighbors over to visit.

In short, we came to prepare a place, and though it's far from a mansion it is becoming a home. We aren't leaving Africa (as far as we know) for a long time, but we are thankful to have a spot that connects our souls to a particular patch of American soil for the times we are on this side of the ocean.

And as the passage makes clear from John, the essence of the concept of home is a physical location where people who care about each other can enjoy each other's company.  It may be a tent, or a mud-brick building with no water or bathroom.  It may be a guest-house room or a rented house or a century-old handed-down farmhouse.  Our home has been all of those things.  That where Jesus and our kids are, we may also be together.


Tuesday, August 05, 2014

North of Carolina

The Myhres are, at this moment, all in the US of A.  And right smack in a whirlwind of transition.  We've started a month-plus of travel, 13 different stops with different beds and people and traditions.  Two kids moving into completely new school environments, one starting a new on-line class (which is proving rather complicated) in addition to his senior year of high school things, and the other re-committing to a decade of intensity of engineering, military, and stress.  I am now comfortable with Bed, Bath, and Beyond after being overwhelmed disastrously by its numbing detailed excess of choices four years ago.  We have a car Scott bought used on a trip in January, so for the first time in two decades we are driving around on our own.  Somehow we managed to fit everything two kids own (which is about two suitcases each, not much), everything the rest of us have for a month of travel, and five people into this Volvo.  
And for a brief few days, we were six.  We had planned a family biking vacation as a way to transition from the intensity of Kenya, medicine, graduation, patients, exhaustion, to the route of visits and moving.  30-40 kilometers a day of back-roads biking, scenery, picnics.  Evenings eating and talking.  A couple days into this Caleb showed up at our door one morning, having gotten away from his overseas deployment a week early (perhaps his proximity to two wars prompted the Air Force to get the students out, or just the kindness of some colonels who moved up the orders, or the gift of God to this mom).  He flew back to CO, processed paperwork in record time, got an unscheduled leave, and flew to find us as a surprise.  Glorious.  
Our real America trek began with a wedding in southern PA.  Two of Luke's classmates married each other, and he was a groomsmen.  Thomas is one of his best friends in the world, and we love both sets of parents whom we've become friends with working at Kijabe.  The RVA class of 2010 showed up en masse, about 20-30 kids.  The weekend was on a rural farm, with lots of music, dancing, hugging, stories, a pig roast, home made wine, and an atmosphere of palpable love. 
Which has been the surprise of this America journey so far.  It is the first time I have flown into the familiar Dulles airport with no parent to meet us.  When the plane was descending, I was mourning my Dad's death freshly, even though it's been 8 years.  And even though I know my mom's new home is best for her and the right decision, it gave me a sense of loneliness to know that 118 Lake Drive no longer awaited.  By the time we navigated the 14 loops of lines at immigration I was wondering what it would be like to enter America without family.  But on the other side of the airport doors two women from our main supporting church waited for us, having driven our car to meet us.  Ellen S has quietly and efficiently stepped into the gap, organizing mail, advising on finances, providing a storage and stop-off point and food and friendship and a thousand details.  Sharon B gave up her day to circle the parking area in July heat.  We stayed in Baltimore at the home of Suzanne and Dave T, who even had grilled salmon (they couldn't know it was a favorite and often our first meal at Grammy and Grampy's) and beds waiting.  The T's lived in Uganda for a year and they understand a thing or two about transition and homelessness and the need for space and a kind ear.  The wedding was a glorious abundance of relationship, at least 9 missionary families intersecting and dozens of kids.  We were able to make it to Virginia in time for church at Grace, another warm reminder of being loved and known.  And for the last two days in Charlottesville we were hosted in absentia by Lisa, Craig, and Ashely W who left us their house (and a friend, and three dogs) while they were on a family vacation.  The style, furniture, layout, everything about this home is so similar to 118 Lake Drive.  Whenever I was looking for something as I prepared dinner I just thought:  where would my mom have put that?  And there it was.  A missionary-kid who worked with us in Uganda, Tim W, appeared to help us navigate moving Luke into his apartment.  Dear friends from Uganda, Nathan and Sarah E, have moved to Charlottesville for a surgery residency.  So last night we spread a table out on the patio, grilled meat and vegetables from Sarah's job on a farm, fresh fruit and corn, candlelight and laughter as we pulled Luke's new apartment-mate Jake into the family.  (Who has been a delightful gift and surprise, seems like a solid, friendly, wise guy whom we are very thankful for Luke to live with).  Wonderful.
Which goes to demonstrate that community is fluid and re-collectable, in disparate times and places.  That the celebration of a meal and stories re-builds connection.  That what seems to be lacking can be abundantly filled by God.
And we need that faith this month.  Julia has said goodbye to all her friends, and her home, and everything she's grown up with, and is in the limbo of heading to Duke.  I don't think I was prepared for Luke's transition from college to medical school, from Yale to UVA, from north to south, to feel as weighty as the high school to college jump.  He's lived away from home in dorms for six years, after all.  He's risen to a thousand challenges, formed friendships from ground zero.  But here he is again, 21, nervous, living in an apartment for the first time, buying a used bed, thinking about groceries and health insurance, surrounded by an entirely new group of people in an entirely new place, with a very long and hard road ahead. 
So while God has given us some incredible reassurances:  Caleb's surprise arrival on vacation, a memorable wedding to celebrate with people we love, a good apartment and friend for Luke, scholarships, and entire team of supportive people to help us along the way, reminders of the constancy of community . . . it still takes time and work to walk through these transitions.  Change involves inevitable loss; resurrection has to be preceded by death.  Thanks for your prayers.