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Thursday, January 29, 2015

A re-examination of the decision-making paradigm

Does anyone remember that line from Sahara? (I know it is politically incorrect to love a movie about Africa that includes Matthew McConaughey, but it is just so GOOD).  At one point a character says something like this: " Here we are in the desert looking for an underground river that may or may not have ever existed using a map we found on a cave painting while being chased by armed soldiers . . did you every think it might be time to re-examine our decision-making paradigm?"

So, here we are today, with Scott spreading out his packing kit including things you probably always pack as well, like a thermometer and a mosquito net and eye shield glasses for the operating theatre.  And here we are, having to make sure I know things like where our health insurance cards are, how much money is in our safe, how to log into accounts and retrieve passwords, whether our rent is paid, how to re-charge the internet modem, how to use Kenyan mobile-money called MPESA.  I've had to pay attention to things I usually ignore, like why we have multiple pikis at the mechanic's and what is happening with them.  I manage to parent and doctor and survive alone a week at a time, often.  Two months looks long.

The context of the week is also far from placid.  Rotten timing, I came down with a moderately bad infection, the details of which I shall not bore you with, but it has knocked me for a loop, and made staying near a bathroom a necessity.  Jack's college application process never seems to end, and this week it was the realization that when he applied to Wheaton College, he applied to the WRONG Wheaton College.  Long story short, there are two, and the one we wanted in IL does not use the Common App, which is how he applied to a Wheaton College in MA.  Thanks to mercy he's been allowed to apply to the intended Wheaton (IL) late.  The mercy of Wheaton is in direct contrast to the NO-MERCY attitude of the Air Force.  Our cadet had a rough week, the usual of keeping up with work on six classes, plus preparing to lead a portion of an Officer's Christian Fellowship weekend and spending late nights with two friends going through life crises.  In all of that, he missed a 7:30 am meeting that was called by the research fellowship he had received for the summer (a difficult-to-get opportunity in Germany that he was thrilled about).  He realized his mistake, apologized and did not make excuses, just told the truth.  In spite of efforts to grovel and obey, the situation quickly escalated way out of proportion, and within a couple of days he found himself excluded not only from his summer program in Germany but from all research associated with his engineering department, anywhere, ever.  Basically one human mistake made from sheer exhaustion and overload, one missed meeting, turned into a branch point where his department declared him unfit for a grad school track.  What was most hurtful was that he works so hard, makes good grades, tries to always do the right thing . . . but no one in charge had anything good to say in his defense.  They immediately pounced to crush.  (Read Psalm 15 and pray for him). Oh, and two out of four kids sprained their ankles this week.  And more importantly than any of the above, one of our Christ School Bundibugyo teachers, a young man with a wife and child, one who represents the promise of the Kingdom, an orphan turned success-story graduate, died suddenly while on a 4 km training run for police work.  This was a former football-playing athlete who was 30 years old.  The kind of young man we all poured out our lives to nurture, the kind of young man who was to be the next generation of godly leadership.  Tragic.

In other words, our hearts are spread in so many directions, wrapped up in so many hard things for our own kids and other peoples', that further disintegrating our family almost takes my breath away.

So how did we get to this point?  Do we need a new paradigm?

In chapel this week at Kijabe, a visiting Kenyan TV-personality speaker said that if he spent 24 hours with a person, he could predict from their life-habits what their future would be like.  He had some valid points promoting godly discipline.  But the gist of the argument was: be a good Christian and you'll be successful, like Paul.  I didn't get the impression he was thinking of the real Paul, in prison and alone and shivering from cold and facing a death sentence.  It ran more in the direction of prosperity.  Of brilliance and income and safety and security.  Of a lot of things that seem to elude most Biblical characters.

So tonight, with a wave of nausea and a growing to-do and to-remember list, I am re-examining the series of decisions that leads to a husband flying off into a situation where 816 health care workers have been infected with ebola (including two new ones this week in Liberia) and 466 have died.

And I can re-affirm them all, from the decision to get into Scott's car for a ride to church in my first week of college . . . to the last-minute airplane-doors-closing decision to let him go back into a war zone in Uganda while I evacuated with three very small children . . . to a thousand decisions to simply keep getting up and going ahead against the odds in a remote, humid, discouraging outpost . . . to the decisions that sent kids to boarding school and then college, the decisions that took us away from the home we had built . . . to the last six months of effort and application that led to this weekend's impending separation.  These are decisions made on a few convictions:  that the power to act is a gift that grows at it is given, that grace covers a multitude of inadequacies, that loss is real but not forever, that this world is not a zero-sum cause-effect closed system, that courage trumps comfort, and that love is the most true thing of all.

(See post below for info on our new mailing list.  The fifty-some people who responded tonight have been a huge encouragement, from "you don't blog into a void" to "I'm a distant cousin", offering the gift of prayer.  THANK YOU.)


This blog is our primary means of communication with our friends, family, supporters.  But as Scott leaves for Liberia on Saturday, we have been working on (finally) developing a system of email-updating for prayer.  This enables us to quickly contact many people; to share things that we may not want to publicly post; to honor any restrictions our partnering organizations may have on media (Americares restricted fb and blog access; we are not sure of SIM's policies yet); and to push right into your inbox rather than relying on you the reader to find us on a blog.  Desperate times call for desperate measures (a favorite quote of my mom).  We may be the last missionaries in the world to finally get on this bandwagon, but better late than never (which is more of a dad proverb).

SO  . . . if you did NOT receive an email from us that looked like this yesterday:
And if you WANT to get emails from Scott in Liberia or me in Kijabe as we ask for prayer . . .

Send us an email to  (not our primary email, but my Serge email, to try and keep track of this . . ).  Again, if you got the test email pictured above, you don't need to do anything.  And if you start getting the emails and change your mind, you can easily unsubscribe.

Sunday, January 25, 2015

Just Life

This month I am the consultant for NICU service.  Which means I am often running to deliveries.  One day, a week or so ago, I was in the operating theatre for a C-section as usual.  90% of the time this is pure pleasure: I greet the mother as she gets her spinal anesthesia, flip through her chart to be aware of any potential issues, pull on my gloves as the surgery begins, watch the OB's careful incision and dissection down to the amniotic sac, await the emergence of a dusky squirming baby who gasps his first breath as the cord is cut, take him into a warm side room where the nurse and I rub him off, dry, stimulate and admire the crying newborn. 
But sometimes things are not quite so peaceful and lovely.  That morning I was just finishing such a calm case when I saw a trolley being rushed into theatre 3, with a large woman who seemed to be writhing.  The urgency and chaos suggested a trauma case, clearly out of the paeds age range, so I was staying out of the way and about to exit the hall when the theatre nurse Lydia called out "Dr. Jennifer, don't go, they're going to need you".  Curiously I followed the trolley and learned this was a pregnant woman who was obtunded after a seizure, having come to clinic for the first time that morning.  Ecclampsia, a life-threatening emergency for both mother and baby.  We had little information about whether the baby was preterm or term, or just about anything else.  I expected the worst, possibly a dead baby.  The OB team sprang to action and within minutes the infant was out:  a HUGE term baby boy, who responded quickly to our interventions and squalled.  His mom went to ICU post-op and I took him to NICU.  Three days later, we snapped the photo above.  A fully recovered mother, a normal healthy baby, and a very pleased grandmother.   

And that is what I love about NICU service.  The brink of life and death, with a balance that can so easily tip either way.  Being there at the right time, giving warmth and breath, makes all the difference.  Sweet petite preemies. Grateful mothers. Coaxing.  Trusting.  Prayer.  Sometimes tears.  Careful calculations.  Daily deliberations.  To the left, two term babies, one with meningitis and the other with unexplained severe asphyxia.  Both on CPAP, assisted breathing earlier in the week, and both amazingly improved.  That's another thing I like about NICU: even when you predict a dire prognosis, those babies and the healing power of God surprise you, and the stiff seizing little bodies slowly relax and open their eyes and start to look rather normal. They improve.  It's incredible.

The second week of January Scott and I spent in Ireland meeting with the Serge leadership.  We have semi-annual meetings to review strategies and plan and pray.  Really inspiring stuff, like seeking the poor and vulnerable, pursing diversity in leadership, developing resources, modeling spiritual formation.  Lots of prayer and friendship.  And though January in Ireland means low sun and short days, we had some brisk walks by the sea, and lots of fellowship in the evenings. 

And when we're not in meetings or in the hospital, you can find us at the basketball court cheering on the Buffaloes.  Jack is on the Varsity basketball team, which came in second in the tournament last week.  Acacia is playing football.  We find the suspended time, the very-much-present focus, the friendship with fellow parents, the joy of seeing our kids thrive and strive, very renewing.  Until Jack sprained his ankle, or rather had it sprained for him Friday night when a class activity of indoor soccer resulted in a sloppy slide-tackle from a friend.  Praying for quick healing.

And this weekend, the blessing was an escape to Brackenhurst, a nearby Baptist conference center, where the AIM Women's retreat was opened to missionaries from other companies.  Our Serge group shared a room.  Sort of like summer camp for women.  Speakers, crafts, worship, small group, skits, talking late, testimonies, questions, meals.
And ever looming closer, Scott's departure on Jan 31 for Liberia.  In this context, the spiritual challenge to surrender to God's will, the encouragement of prayers and friends, was well timed.

So that is life.  Texts and phone calls and hearts going out into time zones all around the world, as we talk to our kids.  Cheering at games, reviving gasping babies, teaching interns, seeing patients, making phone calls, planning for our mission, listening and encouraging.  Making dinners and doing laundry.  Holding on through a minor virus.  Meeting with team.  Early morning runs.  Answering emails.  Walking back and forth, C-sections and rounds.  And trying not to really think that in six days life turns upside down.

Sunday, January 18, 2015

Duke and the Call to Prayer

For the last week we've been in Ireland meeting with the leadership team of Serge.  Twice a year Area Directors and the executive leadership congregate to pray and discuss, to set strategies and discern objectives.  These are "our people", comrades in the battle for two decades.  It is good to be together.  We affirmed a focus on the poor and vulnerable, a theology of the cross, a call to spiritual formation in leadership, a desire to diversify, a commitment to building infrastructure and publications and training.  These are the kinds of rallying cries that reflect Jesus shining through.  Inspiring stuff, particularly in the nitty-gritty context of praying through the hard times we experience as we move out.

And while we were there, the Paris shootings and Nigerian Boko Haram massacre were in the headlines.

Which provides the context of cross-cultural living in the 21rst century.  Terrorism.  Religious divide.  Hate.  Extreme measures.  And glimpses of heroism and unity; the African immigrant who protected Jewish victims, the outpouring of emotion as marchers and activists identified with victims.

And in the middle of all that, the announcement and retraction that Duke University would institute a weekly Muslim call-to-prayer from the chapel's bell tower.

Which, I confess, I find very confusing.  On one hand, it strikes me as ridiculously "politically correct" to suggest that a private University founded by Methodists institute a public Muslim proclamation from the iconic center of the campus.  Yes, the bell tower does chime bells.  Which carry the tunes of hymns, recognizable to those raised in that tradition, and quaint background melodies to those not aware.  They do not amplify preaching, or the name of Jesus, or a creed which is officially espoused.  The Muslim call-to-prayer, on the other hand, harkens to a history and an area of the world where religion and politics are one.  It is a declaration of a particular faith.  It is loud and universal in many countries, and carries a social pressure and assumption that all stop and participate, which is probably close to the medieval roots of bell chimes and church services.  It is a carry-over from an age before watches, and has persisted because it enforces religious control.  The idea of instituting this from a Christian chapel in the very week when the world is reeling from two terrorist attacks carried out in the name of the same religion, well, that struck me as inflammatory and peculiar.

However, in reading the responses of people, I feel compelled to remind us that Muslims are not our enemies.  We are not here to prove ourselves right.  We are not compelled to defend our territory. Giving Muslims a hospitable worship environment for one hour of the week is not equivalent to the loss of America or civilization.  Jesus didn't really spend a lot of time insisting that the government stay true to Judaism, or criticizing Roman beliefs.  He did spend a lot of time challenging us to love our neighbors.

So, Duke, how can we actually love Muslims?  Personally I think the call-to-prayer broadcast is polarizing and political and misses the point.  It causes more divide.  But getting to know individuals, affirming them as humans, listening, welcoming, encouraging dialogue, giving voice to the moderate muslim majority, fostering respect on both sides . . these are the activities that prevent Charlie Hebdo hate.  This is, I believe, at the heart of the Duke ethos.  Connecting individuals, a few at a time, to actually know each other.  Christians coming in the name of Jesus to share their lives, to heal, to honor, to worship, to enter relationship, this is what changes the world.  Not drawing a line in the sand to restrict something that to Muslims is a part of their culture. Yes, affirm truth, but do so in love.

So it's complicated.  And in those complicated situations, let's stick to what we KNOW is right.  Love does not set up us vs. them.  Love wins, by losing.  

Friday, January 09, 2015

On the Unexpected Difficulty of Volunteering to fight Ebola

For the last 21 years, we have been on the receiving end of volunteers, praying for help and appealing for colleagues, managing emails and work permits and scheduling and flights, thinking about housing and resources and correspondence and logistics.

So it has been a sobering and frustrating experience over the last five months as we have struggled on the "trying-to-go" end.

In the summer of 2014, the Ebola epidemic that had been building momentum in West Africa grabbed headlines as the rest of the world finally woke up to the gravity of the situation.  Mostly because a few Americans got sick, which was probably the most heroic thing they could have done to finally get the emergency response of the world in gear.  We were in the USA in August plugging kids into school, reading the news with pits in our stomachs.  Having lived through an Ebola epidemic in 2007-8 in Uganda (though on a much smaller, local, contained scale) our hearts were drawn to the doctors and health care workers affected, both African and missionary.

So I was not surprised in September, as we returned to Kijabe, when Scott sat me down only a few days after we got home, and said he wanted to go to Liberia to join in the fight against Ebola.

We had lost our best Ugandan friend to the disease on December 4, 2007.  Scott had treated the one other doctor in our district, who survived.  We had worked closely with MSF and other organizations at that time.  It was familiar territory. Scott is an activist, and the type of person who does not step down from danger or challenge.  He felt a strong sense of conviction that this was one of the defining crises of our lifetimes, and he should respond.  It reminded me of the time he decided to go back into Bundibugyo in the middle of a rebel insurgency.  I wasn't sure he would survive, but I knew he had to do it.

He cleared his plan with our Serge supervisors and our Kijabe Medical Director, and began sending applications to the agencies active on the front lines.  By mid-September he had applied to five organizations, and expected to deploy by the first of October.  He could work for two months in an Ebola Treatment Unit (ETU), we hoped, then have 21 days of quarantine in December before starting our Kilimanjaro climb with our kids.  They had already bought tickets, and we had booked our climb and made a deposit.  He was exploring flight options.  We were edgy, distracted, feeling the closeness of departure and the uncertainty of outcome.  Hundreds of health care workers had died.  We waited to say anything publicly, expecting any hour for plans to become concrete.

And that's where the unexpected delays began.

Incredibly, even though news reports constantly appealed for help, he could not find any organization actually treating Ebola patients that had the capacity to take him.  Some never answered calls or emails.  Others gave a polite standard form-letter response.  As a doctor with Ebola experience, two decades in Africa, ICU experience, and solid general medical and surgical skills, ready to go at the drop of a hat ... we thought he'd be exactly what was needed.  In retrospect, the treatment units took longer to construct, everyone was so overwhelmed, and probably missionaries are not assumed to be as qualified as infectious disease experts living in America.  Who knows...

October came, and he was still re-sending emails, trying to get responses.  That month a nurse friend suggested AmeriCares, and he sent in one more application.  This time he got a very welcoming response; they were ready to make him an ETU Medical Director if he could commit to six months from January to June.  We decided he would be more useful as a clinician and for a 3-month time period, since we had a major Serge regional training and retreat to run in April.  The AmeriCares group was to send an advance team in November and not begin clinical care until mid-December, so Scott agreed to deploy on Jan 2 for three months. He talked to the doctors who went in November, and kept in touch through December, getting ready to go.

But he was watching the numbers as well.  While September projections for what the epidemic might look like in January ranged from a 20,000 to a million cases, it became clear in December that the epidemic was tapering down.  GREAT news.  The response which took all Fall to mobilize was finally having an effect, contact tracing and public health messages were halting transmission chains.  The epidemic is not over, but when he talked to AmeriCares on December 29 about his departure, they told him to "hold on" for another week, as they were "reevaluating their staffing needs".  Hmm.

So another week went by, and we kept thinking and praying and discussing.  By the time the AmeriCares ETU finally opened a couple weeks ago, and the Liberia-based decision-makers finally approved Scott's deployment (they suggested Jan 16th), the area they are working in south of Monrovia was down to only a handful of cases.  The unit is functional, but mostly empty, and will soon shift gears into rebuilding the decimated health system.  The epidemic is still raging in Sierra Leone, but this organization does not work there.

Meanwhile Scott had been in touch several times over the last few months with missionary colleagues working at SIM's ELWA Hospital in Monrovia.  Their ETU had been handed over to others to run, and the hospital's general care severely scaled back.  But now that Liberia's transmission rate is rapidly falling, the ELWA hospital is resuming much-needed services.  This past week, just as we found out the AmeriCares placement would be delayed and much less urgent because of few patients and other available volunteers, he got an email from SIM asking if he could consider working there to fill a gap in surgical obstetric coverage.  Which is his favorite part of family medicine, and exactly what he does at Kijabe.

So, five months after embarking upon a path towards a trip that we thought would materialize in days, he finally has a clear(er) plan.  The first of February he plans to fly to Monrovia, Liberia, to volunteer until early March doing high-risk obstetrics at ELWA hospital, working under the Liberian leadership of Dr. Jerry Brown, relieving Ebola-survivor Dr. Rick Saccra who returns there this month to work temporarily, and giving a break to another family medicine missionary Dr. John Fankhauser who needs to see his family after a couple of months of intensive efforts.

 In our experience in Uganda, the direct Ebola deaths were the tip of the iceberg of Ebola impact.  Many more people died of preventable causes, of malaria and gastroenteritis, of labor and delivery difficulties, of birth asphyxia, because there was no functioning medical system.  We sensed God's call to serve in Liberia in this time of need, and thought it would be in order to care for Ebola patients.  Through long months of trying to get there, closed doors, and a changing situation, it looks like Scott's efforts will be redirected back towards the difficult task of rebuilding capacity for all the other things that kill the majority of people - a very real part of the war against Ebola.

This effort to volunteer has been draining, and he hasn't even gone yet.  I have to say that living for months with the expectation that one's spouse is about to deploy into a high-risk Hot Zone, but not knowing the actual dates or plans, has been hard on both of us.  It has been hard to watch a disaster unfold, to want to help, and to be paralyzed by bureaucracy.  It has made us appreciate the "administrative fee" overhead that keeps our own Serge organization running and responsive.  It has made us sympathetic to the people over the years whom we have not been able to accommodate.

Thanks for those who have been aware of this stuttering plan, and have prayed.  Please do continue to keep Scott in your prayers.  In many ways, seeing a handful of known Ebola patients in the Tyvex  HazMat suit in the controlled setting of an ETU seems safer to me than going back into one of the only functional hospitals in a devastated country and seeing all-comers without full-gear protection.   He could inadvertently be exposed to a patient with fever who has Ebola, but has not yet been diagnosed.  Obstetrics is a messy business with lots of blood and body fluids splashing all over the place.  This is exactly how Kent Brantley and Rick Saccra were infected with Ebola last summer. Scott will do the post-exposure 21-day quarantine in the month of March at his parents home in California when he leaves Liberia in order to assure that he's not infected before attending our regional retreat in Mombasa in April.   If (God forbid), he were to get infected with Ebola, being in the USA puts him within reach of the best medical care in the world - not available here in Kenya.

It has been a confusing road of obstacles and closed doors.  We trust that God honored his willingness to enter the fray earlier, but chose to close the doors in order to serve the vulnerable as well as to assist our missionary colleagues now.

Thanks for continuing to walk this uncertain road with us.  The good news is that we BOTH get to go to the Serge leadership meetings in Ireland this coming week (I thought I would be representing us all alone), and we have the rest of January together with Jack before Scott leaves.

We trust that God has been guiding our steps and prepared Scott "for such a time as this."