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Saturday, December 16, 2017

Christmas Prayer Letter

Merry Christmas to one and all!!

We wish you each and everyone a most joyous holiday season!

You can download our 2017 end-of-year Christmas letter (full color with photos)

Thanks to all 
for prayers and partnership.

Sunday, December 10, 2017

Between the planting and the reaping

This is where we live:  between the planting and the reaping.  In the long pause.

The entire past week, that song from Monday's advent devotion just keeps coming back to me.  The planting and reaping are never the same, but your labor is not in vain.  There is always a gap when the work seems futile and the connection between the soil and the fruit too tenuous to be real.

After remembering Dr. Jonah, ebola, the ten year anniversary, the week pummeled on with impossibilities and sorrows.  We had seven newborn deaths in six days:  six of those were babies so small that the six of them together (two sets of twins and two others) just topped 8 pounds, the size of one normal newborn.  (A seventh tiny one still struggles on. . . so many premature births, one after the other after the other).  There was a baby who was stuck in a breech position at delivery and got a broken leg.  There were moderately premature twins who should do fairly well, but their mother is very disabled by extreme burns as a child, including scarring that will make it hard for her to hold them and that will make it impossible to use both breasts to feed them.  There were brain-damage level jaundice cases, dehydrated infants, a girl with cerebral palsy starving to death, a boy with inoperable heart malformations.  There were daily calls of people unable to come to work for various reasons.  Let me just say that the week seemed to hold a lot of futility.

But I realize that part of that futility stems from our time-limited existence. We can't see ahead.  We're slogging through a week with blinders, the future turning a corner and our eyes unable to scan a bending ray of light.

Which puts the Advent season in context.  Looking backwards gives us a more linear arrangement of occurrences, so we can rise out of the time trap and see the way promises led to rescues, the way prophecies blossomed into real events.  As we put ourselves into the old stories and imagine their desperation preceding deliverance, it gives us hope that this hour's troubles will change into tomorrow's glories.  The entire season carries this double entendre, Jesus came and Jesus will come.

I think this season, then, calls for two disciplines.  One that looks back, and another that looks forward.

First, thanks. Thanks as we look back, be it 3000 years or a month, thanks as we acknowledge that good has come.  We sent some miraculously healed children home this week, and as discouraged as I get I KNOW how important it is to celebrate these.  Two little preems we'd cared for for about six weeks, with parallel stories and growth, went home the same day.  One was the sole survivor of a very premature set of triplets; her siblings died on arrival after being transported poorly from the clinic where they were born over an hour away.  Both these babies had taken tremendous attention and care over more than a month, measuring out feeds by the teaspoons, monitoring temperatures and growth, responding quickly to downturns.  Both mothers were grinning ear to ear when the time came to actually go home.  We thanked God, and our team.

The second discipline, the forward-looking version, is hope.  Hope is a choice, a recognition that the time of planting and watering may be very, very long.  The harvest will come, but not fast enough to negate the long wait.  Hope takes the backward-looking thanks and assumes that in the future we will also look back to this moment and see something worth being thankful about.

The photo at the top I snapped on the edge of a side-road near our house.  It used to be thick with thorny bushes, but over the last couple of months someone had cleared them and planted cabbages. One evening about a week before I took that photo, I had been walking the dog, and came around the corner to see the gardener at work.  Presumably he's a landless man trying to survive by cultivating the roadside "public" space, something quite common in land-strapped areas of Kenya.  There is a very large and congested urban settlement just down the hill from us.  His industry was inspiring enough, but what really moved me was the swing.  He had strung up a little rope and plank swing from that low acacia tree, and a toddler daughter happily swung as he worked.  She waved and smiled, and I waved back and greeted, and they were both delighted.  Here is someone who has to grow cabbages on the margin to survive, but he took time to make his daughter a swing.  Since that evening, I think of the pair often.  I think that the human spirit that shows, the divine spark of love, of industry, of scrappy ingenuity, of grace right along the fraying edge of a road, gave me reason to hope for this country and for us all.

On Tuesday, the political turmoil that is Kenya will be taunt and stretched again.  The opposition intends to inaugurate their own candidate as their own president; the supreme court justice has warned this would be treason.  In South Sudan, the militias clash and the people flee.  Our old nemesis the ADF killed more than a dozen UN peacekeepers in Beni, across the border from our old Bundibugyo home.  And perhaps the saddest thing I saw all week: our team in Burundi caring for two little boys, each with one hand amputated as retaliation for supposedly stealing avocados.  A hungry ten-year-old picks a fruit which is an abundant and renewable resource and pays with a life-long disability.  Shocking.  I can't get that one out of my mind.

But Advent insists on faith, on looking back with thanks to remember that Jesus set in motion a history-altering world-pervasive ripple of resurrection that will reach all of us.  And on looking forward with hope to remember that the ADF and the hand-hackers are a small minority; the cabbage-cultivating swing-builders will inherit the earth.  

Tuesday, December 05, 2017

Advent 2017: What we're reading

The season of Advent, an annual rhythm of longing and hope.

For an excellent overview of the season, check this post on the Serge blog.  The author begins with what I consider to be the one of the most frightening verses in the Bible:  God gave them what they asked, but sent leanness into their soul (Psalm 106:8).  When we spend this season, this life, pushing and scraping and demanding and striving for what the world tells us is necessary, for what we imagine might make us happy, God may eventually let us have it. But the cost is too high.  Every year we need seasons of re-orientation, so we long for what is truly good, long to be in God's story, and even if our Christmas is lean, our souls will be fat.

For several years, our family has reveled in Biola University's Advent and Lent projects.  You can return to the portal daily, or sign up to get an email link sent to you daily.  This site combines art, music, poetry, scripture, and a meditation for a uniquely rich Advent experience.  In yesterday's post I alluded to the Dec 4 offering, which I am still processing.  Over the last few seasons this has ushered in new poets and new artists to our awareness, a huge plus when living in isolated circumstances.

And this year, I bought on Kindle a book of daily Advent meditations by a Dean and professor in Duke's Divinity School, Luke Powery, called Rise Up Shepherd!.  We heard him speak at one of our kids' commencements and resonated with his spirituality and wisdom.  Here he takes a different traditional Spiritual, the songs of the enslaved, and juxtaposes them with Scripture, bridging the liturgical traditions of the Duke University Chapel with the reality of impoverished people of color.  If possible I search for the Spiritual on Spotify and listen as we read.  A beauty of combining the Bible readings, the Biola portal, and the book, is that patterns jump out in new ways.  For instance, the Dec 4 poem and meditation on Biola talked about God rushing in like a flood.  The Dec 4 Spiritual in Powery's book was about "the old Ship of Zion" singing "Ain't no danger in de water" . . . yet this music comes from a people for whom ships meant death, so many flung into the sea.  Taking them together, can we see that even in a flooded death there is no danger, because God is there?  Even as we long for Jesus to come, for the Shepherd to Rise, we tremble that the Day of the Lord is called great and terrible, but hold onto the faith that ultimately all shall be well?

Lastly, throughout the year our family uses the Lectionary App from the Church of England's publishing arm for daily readings.  We have found the tradition of putting the story of the Bible into the pace of the seasons of the year to be helpful to us as creatures living in bodies on earth.  Many of the readings overlap with the two other resources above, and frankly it's a bit much to try to keep up with all three, so in this season I sometimes let this last one drop a bit.

And since we just spent 24 hours in the car, here are a couple of Christmas albums.  I like my Christmas music a little bit gritty and loud and Heaven and Nature Sing, so here are two with a lot of overlap from TobyMac:
New one for 2017

Old one with other artists

If you like your Christmas music a little more "all is calm all is bright", which we also enjoy, this one was great (a recommendation from one of our kids) by Josh Garrels.

Feel free to comment with your favorites, and let's live this season fully, in community and hope.

Monday, December 04, 2017

AIDS, Ebola, and a Wedding: an unlikely weekend ushers in a decade's redemption

December 1-World AIDS Day
December 4- The tenth anniversary of the death of Dr. Jonah Kule, from Ebola Bundibugyo.

And in between, December 1 and 2, the wedding of a young man born in the height of the AIDS epidemic, orphaned, who just finished medical school and internship on a Kule Memorial Leadership scholarship.

Uganda in the 1980's was a country devastated by AIDS even as it began to turn the corner from Idi Amin's brutal and repressive reign of the 1970's.  An entire generation of people our age was decimated, leaving behind many orphaned children, overwhelming the capacity of traditional networks of aunts, uncles, grandparents.  In 1993, we moved to Bundibugyo and Pastor Sam Kasule with his wife Zoe moved to Fort Portal, both of us working with Serge (formerly World Harvest Mission) for a holistic Kingdom vision.  We were deeply involved in screening, preventing, treating AIDS.  The Kasules were raising their own 8 children (their 8th and our first were born a day apart) as well as another 8 or more of their nieces and nephews left behind by dying parents.  So they developed a program called the Good Samaritan Project with the help of churches in Florida, and particularly Dick and Barbara Johnson.  They planted a church and established a primary school, and the Good Samaritan project helped orphans with school fees.  A few years later, a student's caretaker at Hope Primary who was sponsored by the project recommended to a neighbor that she take her son to see if he could get help there.  Katuramu Tadeo was 9, in Primary 3, an eager bright learner whose father had died while he was in the womb, leaving his mother with no support.    As Katuramu progressed through primary school, he also responded to the mentorship, teaching, example of the Kasules as well as elder and teacher Chris Mwesige.  He finished primary school with high marks and solid character, and so the Good Samaritan program decided to send him over the mountains from Fort Portal to Bundibugyo to attend Christ School.  At the time, nobody would actually WANT to do that, because the people in Tooro consider the people in Bundibugyo to be a bit backward, and the area to be known for rebels and danger.  But CSB was a good bargain, we were both working with the same mission, and Katuramu was willing to go anywhere for an education.

That was 2004, and our just-turning 11 Luke was bravely entering Senior One at CSB as the only non-Ugandan.  He and Katuramu were soon friends, top of their classes, and both slightly outsiders.  Katuramu earned the nickname "pastor" as he emerged as a spiritual leader of the class, but humbly also earned his pocket money as a cobbler of shoes.  For four years he and Luke studied and played together, and he was one of the friends drawn into our family orbit for meals, camping trips, hikes, books, soccer.  This young man had next to nothing, but never failed to bring a huge smile, and a servant's heart into any situation.  In November of 2007, they both sat for the O-level national exams.  Katuramu placed first in our district, and Luke placed second.  The Good Samaritan program decided to send him to A-levels at Nyakasura in Fort Portal, and we pondered sending Luke to RVA.

The same month they were completing exams, a mysterious disease was getting our attention.  Numerous people were plagued by high fevers and diarrhea, and we began to hear of deaths in a nearby village.  Dr. Jonah Kule had finished medical school and internship that year, and returned as the first doctor in 30 years from our district to do so.  He was our best friend, and after working with him through the mid-90's as a clinical officer, we had raised money to send him to medical school recognizing his superb clinical and community-organizing skills.  That November, we were finally realizing the dream of being colleagues, working together at the local health center, when he said he wanted to go see what was happening in that village.  I remember pushing a bottle of hand sanitizer on him, and him saying, "If I die, I die, these are my people."  We all thought it was a typhoid epidemic.  He came back puzzled and concerned, and the next week Scott and I also went to the village, and then to the central district hospital to examine patients and see what we thought.  We wore gloves, but no other protection, noting red eyes, some bleeding, lots of gastrointestinal symptoms, family clustering. We got a team from the Uganda Viral Research Institute to take samples, but the initial results were negative for viral hemorrhagic fevers including ebola.  Jonah left for Kampala as we turned the corner towards December, to pick his daughters up at school.

I won't tell the whole story here, but the disease turned out to be a new form of Ebola, named later Ebola Bundibugyo.  While in Kampala, Dr. Jonah became ill himself, and to protect others admitted himself to the national Mulago hospital where he was put out in a tent for treatment to keep him isolated.  At first we got good news that he was improving, but on December 4th, 2007, we got one of the worst phone calls of our lives.  He was dead.  The one other doctor in the district besides us also became ill, and Scott cared for him as we went into emergency mode, sending our kids and team away to safety not knowing if we would live or die either.  Jonah's body was returned to Bundibugyo with the scary space-suited isolation teams for burial at the hospital along with four other health workers.  We had all touched the same patients, but we were spared.  As he was buried, only his family and us came to mourn.  People were terrified.  MSF set up headquarters, the entire month became an marathon of medical care and contact tracing and isolation and fear.  In the aftermath of that crisis, we set up a fund to sponsor other young people from Bundibugyo to become doctors.  At Jonah's lonely graveside, Scott read prophetically from John 20.  The seed that falls into the ground and dies, bears fruit. ( and and other posts from 2007 tell the full story).

Katuramu became one of the young students chosen for a Kule scholarship.  He shone his way through medical school and internship, holding onto faith, ever humble and cheerful.  His mother had died in 2009 while he and Luke were still finishing secondary school, leaving him a full orphan.  He lived with his sister when on breaks, and continued to lean heavily on the spiritual guidance of the Kasules and the support of our family too.  During his internship, he cared for a young woman dying in the ICU.  Over the course of her illness, he met her family, and particularly her youngest sister Carol.  Katuramu and Carol fell in love.  She finished a university degree, and he finished his internship, and declared his desire to marry her.  Only she was the youngest of 34 children, born by 6 wives, to a pretty powerful patriarch from a different tribe all the way on the other side of the country.  She was beautiful, educated, and the last thing an 84-year-old man who had controlled a lot in his life was holding onto.  It wasn't going to be easy.

So after some difficult negotiations, many snags and trials, the whole thing hanging by an uncertain thread, this weekend, Katuramu, the kid who was as poor as they come, orphaned and alone, married Carol.  And what a production it was.  He pulled off having the traditional ceremony and the church wedding back to back on Friday and Saturday.  Friends and family contributed, the Kasules, Chris Mwesige, and we acted as his parents.  He hired a bus from Fort Portal to bring his four sisters and one brother, a handful of Hope Primary friends, and a number of the Kasule adult-children too.  We were about 30 people representing the groom's side.

Friday's "Introduction" was an all-day affair with many phases.  The groom's side and brides's side each have a mukwenda go-between, who act as masters of the ceremony, bantering back and forth.  They tell stories and joke as the bride's friends parade out in groups, each cluster in matching outfits, each bringing up some barrier or reason the marriage cannot take place, "forcing" the groom's side to bring money and gifts to solve those problems.  At last the bride comes out, brought by her paternal aunts, who then go amongst the groom's people symbolically searching for him.  They then dance with him and bring him to the bride.  There is a moment when the groom is symbolically acknowledged to have been born again into the bride's clan, making him acceptable.  Then a smaller delegation of parents goes into the bride's home with her father, and the groom and father drink from the same bottle of water to seal their unity.  The father blesses the bride and groom with a laying on of hands, and then we all shared a meal.  Finally the bride-price is paraded into the bride's compound, probably 20 baskets of food, sacks of rice, suitcases of clothes, even three cows.  The entire day is meant to establish the worth of the girl, the solidity of her family standing behind her, the fact that the groom has to work hard to earn their trust, the peace between the two families being established.  There were traditional dancers, a DJ, a cake, a hundred or so people, banners, tents.  We only began to leave when darkness fell.
Saturday, we were to report to the main Church of Uganda cathedral in town for the actual wedding.  This was a very traditional ceremony with hymns, praise songs, rings, vows, pronouncements, a sermon, a signing of the marriage certificate.  Carol was escorted down the aisle by her father and uncle, and thank God no one objected when the pastor asked, we all held our peace.  Since this is a prime season (school's out, rainy season is ending, Christmas is coming) for weddings, the cathedral is booked every two hours, so as our bride and groom exited the next group entered.  Then it was photos, and off to the reception.  Another full afternoon of people dancing their way in, some speeches, gifts, food, cake feeding, honoring parents, thanking everyone involved.  Again we went until dark.  Full of joy for the obviously ecstatic Carol and Katuramu.  Wiped out by the booming unrelenting over-powered sound system and two full days where everything except the church ceremony was in a mix of Lugwere (hers), Rutoro (his), and Luganda (major language of the country).  There was enough cross-over with the Bantu languages we get better, Lubwisi and Swahili, to help us follow a tiny bit at times, but mostly we were lost.  Amongst all the kids we have sponsored and acted as foster-parents to, this is only the second one to pursue a formal cultural introduction and a church wedding before living as husband and wife, so we aren't experts on the proper etiquette.  We just tried to follow the gracious Sam and Zoe Kasule!

By night, everyone had filtered away except Katuramu and Carol who were honeymooning their first night at the reception venue, and us, who Katuramu had also booked there.  Polite young man that he is, he kept thanking us for coming and helping, but we insisted on saying bye and leaving them alone, departing early the next morning to drive all the way back to Naivasha.  Though we had tried to garner a quorum for honoring the 10th anniversary of Dr. Jonah's death in Bundibugyo today, it just wasn't a good time for his wife and children to gather.  Meanwhile my colleague here in Naivasha went on a 6-week leave, and we discerned it best to come back and work. Today was one of those insane days, 46 babies in the NBU including 4 860-870 gram preems at 28 weeks or less. Two were twins whose mom came in and delivered abruptly, both died in spite of hours of resuscitation effort.  Scott was caught up in a C-section, and both of us ended the day thinking that slogging it out on a Naivasha Monday honored Dr. Jonah's memory as well as any memorial service.

If anyone read all this, thanks.  It's a lot to process.  Today's Advent devotion said "There is a tendency to delude ourselves into thinking that damage will never come to us, those who surely have God's favor. . . then The Advent of God comes upon us suddenly, flashing like a flood . . right now, God is here, and everything is a mess."  Amen.  AIDS and Ebola, loss and death that seemed to us futile and tragic.  But we are called to the work of repair, to a toil and a recognition of God's presence and the possibilities of redemption.  All day as I've thought about Jonah and his family, about all of our grief, about Katuramu's difficult life, about the twin preemies I laid dead into the arms of their mother this afternoon in spite of all we could do, the song from the devotion has echoed.

Your labor is not in vain.
<28 and="" anything="" as="" died="" dozens="" dr.="" effort="" far="" honors="" hours="" i="" in="" jonah="" kids="" kind="" lived="" mention="" much="" nbsp="" not="" of="" other="" out="" oxygen="" p="" probably="" resuscitating="" running="" sick="" so="" spite="" that="" thing.="" think="" to="" trying="" two="" weeks.="" would.=""> Though the ground underneath you is cursed and stained.
Your planting and reaping are never the same.
Your labor is not in vain.
For I am with you, I have called you by name,
Your labor is not in vain . . .
(Work Songs, from the Porter's Gate Worship Project).

Isaiah 25, Amos 9, the story unfolds.  Our current struggle will not be forever.  Jesus knows our names, and the flood that feels destructively frightening will clear the way for a forever-feast.  We cling to that by faith.  And this weekend we caught a glimpse of that in the wedding.  Nothing justifies the death of our friend Jonah.  Or of Jesus.  Their loss clarifies the stakes are high, the struggle is real, the consequences punishing.  But their deaths are not the end of the story.  Resurrection comes.  The doctors multiply.  An orphan marries what seems like a princess.  People from different tribes and continents came together to feast.  Hope grows.  The labor is not in vain.

Wednesday, November 29, 2017

The Lord's shining face

The founding pastor of the church in which I grew up, which is also the church to which our family holds our USA memberships, and our main supporting church, died Monday.  Larry Vail was 93, and a man of God that personified grace for me.

He had a shiny bald head, and glasses, and an ear to ear smile that made his eyes squeeze shut. He would stand under the lights and read the blessing over us "May the Lord bless you and keep you and make His face to shine upon you and give you peace."  And while he said that, his face WAS shining upon us.  Because of this, and my parent's love, I grew up with an image of God as good, as kind, as perhaps a bit stern on the rules but definitely smiling.

Pastor Vail was also a man of prayer.  Our church prays congregationally for us every week in the morning service, by name.  We had open prayer times every Sunday night.  When we left 24 years ago for Uganda he supported us financially out of his retirement pension with the OPC which had to have been a huge sacrifice, and committed to pray for us daily.  Which I am sure he did, to his dying day or at least until the last hours of palliative morphine made that impossible.  Those prayers, multiplied by the church's ongoing prayers after he left, have saved our lives over and over.

Lastly, he was a pastor of a small church on an edge where rural was transforming into suburban, but he had a heart for the world.  I grew up praying for missionaries in Japan and Eritrea and Kenya and beyond.  When he left our church, he worked for the denominational mission and outreach.  Even though in those days we had no social media or reality TV . . . we were led by Pastor Vail in having the world on our hearts.

These three things:  a smiling blessing, a disciplined prayer life, and a world-encompassing vision, have shaped my relationship with God for my whole life.  Today we thank God for his life and I am happy to think of my dad and Larry Vail meeting in Heaven, but I also feel the foundation shift for us as we lose one of the key supports of our life.

Monday, November 27, 2017

The Waiting Begins: a curled wick and an earthy investment

Though the season of Advent officially begins this coming Sunday, our church decided to start a week early.  An extra week of waiting? Hmm, not sure that sounds appealing, but the worship leader put up verses from Jeremiah 23:5-6, Lamentations 3:25-26, and Isaiah 64:4-5.  She wrote out some call and response that reminded us that God works on a timeline different from ours, so in the waiting we can choose to worry or to hope, to fret or to welcome the space of anticipation.  Advent, waiting, becomes an invitation to stop and look for God's work and presence.  Our everyday lives become an offering laid before God.

This perky little one waited a long time for today.  A full month of hospitalization to be exact, after coming in having lost a third of her weight, a dehydrated newborn who wasn't feeding, who had pneumonia and sky-high salts in her water-depleted body and failing kidneys.  She was in the hospital so long she reached her developmental milestone of smiling, which she did for me today, a sure ticket to discharge.  I think the constant presence of fragility in this hospital makes the wonder of the incarnation, the gestation of Advent, shockingly dangerously real.  

O Emmanuel, by Malcolm Guite (Sounding the Seasons)

O come, O come, and be our God-with-us,
O long-sought with-ness for a world without,
O secret seed, O hidden spring of light.
Come to us Wisdom, come unspoken Name,
Come Root, and Key, and King, and holy Flame,
O quickened little wick so tightly curled,
Be folded with us into time and place,
Unfold for us the mystery of grace
And make a womb of all this wounded world.
O heart of heaven beating in the earth,
O tiny hope within our hopelessness,
Come to be born, to bear us to our birth,
To touch a dying world with new-made hands
And make these rags of time our swaddling bands.

The wounded earth becomes a womb, what a lovely image for the seed that dies and sprouts, for the infant that barely survives yet grows, for the tiny hope that was Jesus and is all these vulnerable babies.

We also finished our Jeremiah series this week, with chapter 32.  In the middle of war, with exile impending, with political upheaval and questions and persecution all around, Jeremiah is instructed by God to BUY A FIELD.  To invest in a land that seems to be lost.  I found that strangely encouraging.  As Area Directors, almost every team teeters on the brink of some crisis, hangs by some thread.  There are thieve, bandits, rebels; there are injustices and bureaucracies and visas; there are chronic coughs and mental illnesses and dangerous parasites; there are droughts and earthquakes and careless drivers; there are coups and wars and corruption.  Yet, by God's grace, we're here buying our fields.  Working for one more term of school to be taught, living on a budget that carries us towards zeros, patiently training pastors to re-tell Bible stories, finagling chemo from far places, teaching residents to do quality-improving research projects, screening for malnutrition, inviting children to read books.

A vulnerable speck of a baby that almost didn't make it.  The reflection of God's risky plan to become Emmanuel.  The affirmation that this wounded womb of a world is a place worth investing our all, even in a season of uncertain outcomes.

Naivasha International Fellowship begins Advent 

Talk about vulnerable . . . 43 babies, 40-ish moms (several twins), 3 doctor-interns plus 3 clinical-officer interns plus 2 graduated doctors, nursing students, and me.  Hardly even standing room, and one of the beds had not two but three babies today.

Yet a place worth investing.  Thankful that Friends of Naivasha built this space. 

Saturday, November 25, 2017

Kenya: the AFTERMATH

2017, what a year.  3+ months of doctor strike, 5+ months of nursing strike, plus two elections which each shut down the country for a week.  That's about 9/11 months of complete dysfunction (disaster number arrangement unintended).  Plus university lecturer strikes, early school closings, economic stagnation, erratic rains.  This month the nursing strike ended, and the court upheld the second election.  So are we back to normal?


A year like this has a long tail of misery.  The dictionary defines "aftermath" as
aftermath |ˈaftərˌmaTH| 
1 the consequences or aftereffects of a significant unpleasant event: food prices soared in the aftermath of the drought.

Which sounds about like Kenya right now.  It's been unpleasant, and there are come consequences.

When we returned Friday evening (a week ago) with Jack, we learned that the responsible doctor for OB had gone out of town, and hired a recently graduated intern to cover.  Not OK, as the nurses correctly surmised, so Scott ended up spending all night doing 3 emergency C-sections and then pulling a stuck breech twin out.  The rest of the weekend went from bad to worse, so that by Monday there had been 7 deaths in NBU and 5 stillbirths.  That's terrible.  Not to mention the still-alive babies with bad apgars.  To Naivasha's credit, our Med Sup called OB and Paeds into his office for a meeting.  What's going on?

Quite a few things, as it turns out, a perfect storm

  • Massive surge of demand for services after the long period of "drought".  When we sat down for our meeting, the nursing officer reported 19 normal and 8 C-section deliveries in the last 24 hours.  That's a pace of over 800/mo, which is a 30% increase from our pre-2017 average of 600/mo.  The place is a zoo.  40-50 babies in NBU, another 40 some on the floor, and that's not counting anyone who isn't significantly sick.  We're back to doubling up in the spaces.  We're running out of gloves, out of IV cannulas, routinely.  Today we were even out of charts to write on.  Infections spread in this atmosphere--we have 7 cases of suspected necrotizing enterocolitis.  
  • Rearranging coverage so that there are few with experience.  All year, there's been a sense of "we'll rotate people when this is over."  Incredibly, the hospital decided to switch the Medical Officers (like residents) at the same time that the interns were changing (every 3 months) at the same time that the Nursing director felt it would shake up the newly returned nurses to move them all around in the hospital.  So 50% of the nurses on maternity have never worked on maternity before.  It's a strictly learn-as-you-go system.  The learning curve is steep.
  • And just to make things more chaotic, a nursing and clinical officer training school that had no lecturers this month (see strikes above) decided to bring all its students on a bus and dump them on our wards for November.  So suddenly we had oodles of zero-experience young people with no supervision massing on rounds.  And if a nurse decided to teach or supervise them, that cut the patient-care ratios even further.
  • The general drag of a year of lethargy on attitudes and expectations.  After working at a lower pace level most of the year, people aren't used to being efficient or quick.  The strikes got people a few perks, though not as much as one would think for all that time.  They didn't return rested and raring to go, shall we say.  They mostly returned bitter and disillusioned.  Oh, and in spite of all those months of slow-down or absence, the strike time did not count as holiday time.  So most of the senior people have accumulated their 6 weeks of leave, and what better time to take it than mid-Nov to the end of the year for the holidays???  Truly.
  • The reality that all those months of decelerated services meant that sick people were accumulating, and now we're paying the price.  For instance in the nursing strike time, we had triplets in our NBU that we cared for for a month and sent home stable. But then there were no immunization or weight check clinics open, so they languished at home for 4 months without follow up.  One died, the two remaining ones came in and another died.  Mom had felt she had inadequate milk for the three so was buying formula but mixing it half-strength to last longer. Women coming in for delivery have had zero antenatal care.  
  • A culture of discouraging asking for help. This is something that we push back against, but it takes time to change.  
All in all, it was positive to meet for hours and hash these things out.  Some individuals were held accountable, training on specific gaps was planned, a couple of key nurses were switched back to their old jobs, ways to make the student onslaught live-able were discussed, ideas to improve efficiency for getting women to the theatre for c-sections were analyzed.

Those are all workable steps, but Kenya is not yet well.  On Tuesday, the returning President will be sworn in for his second term. But the opposition candidate has already announced he will have his own ceremony to be sworn in as "the people's president".  Meaning that he's not accepting the court ruling, meaning that the half of the country who follows him will be encouraged to disrupt and not cooperate.  Meaning more violence ahead.  And also meaning that all the above issues will only become worse, because people are genuinely tired of the uncertainty and hostility and stagnation of progress.

The word aftermath, it turns out, has a second definition:  
2 Farming new grass growing after mowing or harvest.ORIGIN late 15th century ( sense 2): from after (as an adjective) + dialect math mowing, of Germanic origin; related to German Mahd .

This year, Kenya has been mowed down.  But after the mowing comes new growth. This reminds me of Psalm 126, one of my favorites.  The tears of this year can be the beginning of new life.  We've lost, but there is now space and I hope will for rebuilding.  Join us in praying that 2018 will be a year for flowering in East Africa; that Kenya will be back out in front showing the way.  Zimbabwe's example of peaceful change gives us hope.  The babies in the photo will grow up in a different world than their parents.  Let's keep on, to make it a better one.

Wednesday, November 22, 2017

Brainstorms and Symphonies: teens are the best

Last week we had the privilege of attending the opening night for Roslyn's first term theatre production.  This is an international high school in Nairobi where four Serge kids study, one of whom was amongst the 15 kids in the play.  The premise is that these 15 kids take us inside the teen brain, sharing their anxieties, struggles, creativity, plans, joys.  That would be entertaining enough, but what made the production really amazing was that the kids wrote most of the play themselves, and it was true.  They dramatized actual conflicts with their actual parents.  They talked about their actual fears.  It was a courageous act of vulnerability that I think most adults would cower away from.  

The set consisted of couches and bedrooms, external symbols of internal clutter at times.  There was humor, as each had a minute of playing their own parent.  I'm sure there were many inside jokes we missed.  My favorite scene involved the little lights you can see dangling above the screen.  A series of statements gathered from actual interviews was flashed up on the screen, and the actors pushed a button to light a bulb if that statement was true of them.  These were raw things, like "I wish I was a different color/nationality" or "I am afraid no one likes me" or "I am not sure I believe in God anymore".  A few lights, or nearly all, would flicker.  It was a powerful way to show that kids are not alone in their struggles.

Our young Serger, 9th grader Laura, was poised, smart, funny, believable.  At the very end, they all stood on the stage with a stack of large cards on which they had written messages for their parents.  I couldn't see Laura's but the kid in front of me was telling his parents he loved them and hoped they could accept him for being a quirky laid-back artistic type instead of the "type A" scientist he thought they wanted.  It was very poignant.  Evidently after the play there was a powerful time for parents and cast to interact.
(here we are with felllow Serger who came to watch)

A few nights later we attended RVA's end-of-term band and choir concert.  Gaby on the drums (grade 10) and Liana playing violin (grade 12) and Jonah running sound (grade 10) made us a proud aunt and uncle.  
(the talented Masso siblings, pre-concert)
(Jonah is back there but hard to see . . )

Candles, quiet, beat boxing, full chorus, a string ensemble, a cappella group, and the symphony.  Hymns and Beatles and Mozart and an arrangement putting Christmas Carols into a Bond-style secret spy arrangement.  It was creative and inspiring.  

Celebrating the teens in our Area, who are funny and brave and who work hard.  It's not easy to live as outsiders, to live aware of danger, to miss old lives and extended family, to prepare for the impending separation that HS graduation forces upon international families.  We have some great kids, our own and our teams'.  Looking forward to a world in which they are in charge.