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Tuesday, January 31, 2017


New Growth Press is having a sale, 35% off!! And free shipping in North America.   Click on the link to get a copy of the Rwendigo Tales.

In a week of fear and confusion, why not respond by gaining empathy with another part of the world? Half of royalties go into a Rwendigo Fund to bless children growing up in real places with stories similar to the fictional characters in the books.

Written for ages 8-14; appropriate for all ages.

(Also available from Amazon in paperback or KINDLE, so you can read these anywhere in the world).

Duty or Destiny?

From a commentary on 1 Cor 13, our reading this morning:  The music of love, which will one day be completed, is therefore not just our duty.  It is our destiny.

In other words, the life we are living affords us opportunities to practice, to grow in, a way of life that will continue for all eternity.  Faith and hope get us through the hard brokeness of a damaged, sin-scarred world.  But love continues in an unbroken growing river right over the border into the Heavenly reality.

I confess that since listening to the sermon on work as communion with God, and reading this chapter today, I have been walking through the hours with quite limited evidence of those truths in my life.  But still, as I scurry between the Nursery and the Paeds ward, pop into the operating theatre to wait for a preem being delivered, or into the lab to check results, I do think it makes a difference to remember that these are not just duties.  They are the warm-up act for an eternity spent in intimate relationship with God and others.

And that helps, because what feels pretty stressful now is about to take a plunge for the worse tomorrow.  While the parliament delivers speeches (which included some good thoughts about bringing the governors of the counties into the negotiation, since they are supposed to be paying health care workers, or about developing a set of standards for hiring, progressing through careers, and retiring that would be country-wide even though the counties are the ones that actually employ the doctors and nurses) . . . . NOTHING IS HAPPENING.  Today the nurses checked their accounts, and still no salaries have been paid for December and January.  So tomorrow THE NURSES NATION WIDE WILL STRIKE.  A few will still come in to care for NICU and ICU patients until they are ready for discharge, but all new admissions, evaluations, normal deliveries, CS's, etc will shut down.  The little island of care our Medical Superintendent bailed out of the chaos is about to be swallowed up again.  And no one seems to have any idea of how to stop this.  Least of all me.

So as we head into the evening, we brace ourselves to imagine what love will look like tomorrow.  This week it has looked a bit like this:

  • Celebrating rescues, again.  A mom with placenta previa, meaning the placenta covers the normal baby exit causing life-threatening bleeding, instead of dying and having a dead baby, gets a safe C-section.  Baby was 34 weeks and a bit sluggish but looking good a few hours later (and note the lights were on today, the new generator is working!  Also the photo was snapped before the blood covered the floor this time . . )

  • Putting my arms around weeping mothers.  One sobbing with JOY because I told her we could discharge her baby.  A couple of years ago her first infant died on the third day of life, and then this new baby looked very jaundiced on day one and was admitted.  It was touch and go, and I'm sure she was reliving the earlier death, but by a miracle this baby improved and is now fine.  The other mom was sobbing with grief when I saw her Monday morning, because her fragile little infant whom we had snatched back from nearly inevitable death a couple weeks ago, who was getting slowly better, died unexpectedly during the night.  I was frustrated that no one called me, and extremely sad for this mom.  Nothing is more pitiful than all someone's possessions packed up in a plastic bag, bed stripped, patient missing.
  • Watching the resilience of Kenyan women.  Seriously.  The nurses feel too stretched to take vital signs, so the moms pass the thermometer around and take their own.  The young woman in the second photo was here with her daughter, admitted with severe cerebral malaria, which I'm finding is the January special because lots of people locally have relatives in a very endemic area in Western Kenya, go home for Christmas, come back with parasites, and eventually succumb.   Her 3-year-old went from convulsing pallor to smiling normalcy.  I love artesunate.  That would constitute a stressful enough week for all of us, wouldn't it?  But last night a 1-month-old was abandoned at a local supermarket.  The police dropped her at the hospital, and I found this mom with the extra baby in her bed this morning, feeding and caring for her.  

    And lastly, the message on the Dove Dark Chocolate I picked up at the women's retreat seemed prophetic for living in Kenya, for juggling patients, for dealing with a strike.  For the moment yesterday when the oxygen cylinder was empty mid-operation and the new inexperienced anesthetist literally freaked out, so Scott had to finish the case with him screaming while telling him how to simply use the ambu-bag with room air (all went well).  For today when I found a starving baby so skeletal and cold that no one could quite figure out what to do, so we stripped down mom, put the baby skin to skin, wrapped mom back up, and then managed to slip in an ng tube, give warm ORS, and eventually place and IV and draw blood, all while the infant was between the mom's breasts.  If you can't see the word well, it says, "Improvise."
Chocolate and creative making-do bring us right back to love, our duty and destiny.

Sunday, January 29, 2017

On Loving America

Because we love America, the tarnished promise of it, the opportunity and beauty of it, even while recognizing that much of that came at the expense of the indigenous Americans and the imported slaves, we do not turn our backs.  The Constitution is a remarkable document, that contains truths which allow flawed humans to rise above their selfishness and live in community.  The land that has welcomed waves of immigrants from desperate places affords them the opportunity to innovate and thrive.  Americans are generous (we live by that), funny, smart, strong, hopeful, and kind.  We are also beset by fears at this moment, fears of the other, fear of death, fear of failure, fear of not being as wealthy as we hope, fear of getting old or ugly or fat or forgetful, fear of being left out.   Fears that leaders are playing upon, for their own agendas.

Truth, not alternative facts, will set us free.  And only love is stronger than hate.

So, in loving America from afar at this time, two pleas.

First, we are investing that which is most precious, our second son, to the protection of America and the mission of taking that constitutional idealism into the world.  Right at this moment he is beginning Ranger School.  Due to a high sense of security, we're not supposed to talk a lot about it or mention his first and last name together, on a public blog.  But if you want to keep up more closely with our family, and aren't getting our mail-chimp emails, please message me with your email address.  Here he is entering the grueling, high-fail-rate, war-simulation starving and sleeplessness program.  The first week is the worst.  Plea #1: pray for him, and for young people like him, who are the future of America and its face to the world.  Pray he would hold onto truth, hold onto love, hold onto his ideals and hopes when he is broken by the rigors of these coming months.  He needs your support.

Second, keep remembering that America and the Kingdom of God may have some great overlap, but they are not synonymous.  I like the diversity of my facebook feed. One thing I notice, the Americans who live outside the United States for a period tend to have a more tempered passion for America-first.  Everyone around Jesus wanted him to win, win, win.  But He chose to walk straight into death, to expand the good news from the national interests of Israel to the whole world.  I think it's possible, and even healthy, to love America and the good it stands for, to even bless a precious child going into the hardest echelons of the military, while holding that in tension with God's concerns which are much larger than America.  To hope for a thriving USA while still grieving over war in South Sudan and wanting to welcome her refugees.  To take the one-in-several-billion risk that a Syrian immigrant would harm us for the almost-certain reality that that same immigrant would live, and perhaps experience God's love.

We may live far away, but we are putting our treasure and our heart in the country where we were born, and trusting for an awakening of mercy.

Work as Communion, and the Humility of Sabbath: Resting during a Strike

After ten days with very little respite, I took a sabbath.  Long ago I'd signed up for a Women's Retreat to join the women on the Kijabe team for some spiritual refreshment, courtesy of AIM and a church in Iowa.  We had planned a day of silent retreat on Friday, followed by the conference from Friday late afternoon through Sunday.  But as the week wore on, with no end of the strike in sight, I was wavering.  It's difficult to walk away from a job that no one is going to do while you're gone, and a job that involved life and death situations.  I plowed on, through Friday afternoon, a bit irritable and grumpy truth be told as I thought of what I was missing.  But Scott and a trusted friend both said, GO.  (Scott in the meantime stayed to work another 12 hour Saturday day, doing 4 C-sections in the process, but he's stronger than I am . . . ) . So from Friday evening to early Sunday morning, I did.  The retreat was a gulp of fresh air (theme:  Just Breathe, with teaching from Psalm 139).  Sweet hours with friends who have stood with us for many many years, fun conversations with new ones.  Solid teaching, solid sleep.  Worship and walks.  By the time I was back in the hospital on Sunday morning, facing cerebral malaria and feverish newborns, I felt truly renewed.

But that decision had some consequences.  Two babies died.  I was on the phone many, many times throughout the day away.  Kijabe graciously accepted one of my sickest, deteriorating 3-week olds with encephalitis, a transfer arranged from the car and the edges of meetings.  I walked the Clinical Officer through resuscitating a 5-day old born in a truck-stop town with poor options for care, who came in with a nastily infected umbilical cord and succumbed.  Friday evening as I left, Scott was doing an emergency C-section on a mom who had been pushing for 3 hours and the baby was very distressed.  That one also died on Saturday.  Most likely all that would have been the same if I'd been there; these were babies with very poor options and advanced disease.  But it's hard to be sure of that.

Is a day of Sabbath justified in the middle of a doctor's strike?  What would Jesus do?

Interestingly, there's no formula here.  Jesus walked away from the needy at times to rest.  He didn't heal everyone.  People still died in Palestine.  People he could have saved.  There is a humility to taking a sabbath.  The work is God's, we are only a small instrument, and the restoration of all things continues when we wear out and have to sleep.

Jesus also broke the sabbath rules by healing on the prescribed day of rest.  He pointedly valued the life of a sufferer over the centuries-old rules.  The authorities didn't want him to work, but He did. The crowds didn't want him to rest, but He did.

Bethany recommended a great Greg Thompson sermon on Christ the Labourer.  on John 5 and the disabled man who sat by the pool of Bethsaida.  A healing story, so I was thinking, great, as a doctor let me learn from Jesus the healer.  But in this story, we are the man who can't walk.  We are out of options, and Jesus breaks in.  In making that connection, Jesus gave the man a trivial but impossible task:  Get up, pick up your mat, and walk.  Go write notes on 30 inpatients.  And as the man did that work, Greg says, his work became a catalyst exposing the darkness of hearts that resented his recovery, revealing the life that the new Kingdom brings.  But more than that, his work became a moment of communion.  Of joining with Jesus in the all-things-new.  An ordinary obedience that joined the bigger picture of all Jesus was doing.  They were in this together.

Would you pray for us, that our work during this strike becomes a means of communion with the Creator of the universe?  That we don't just plug away, push through, struggle on, but that we experience a true presence of the Spirit as we enter into our work?  That we depend upon Jesus just as much as the paralyzed man?

Because we're going to need those prayers.  Word on the street:  Nurses, who had briefly joined the strike at the beginning but returned, may walk out again this coming week because the government did not come through on their promised raise.  I find it hard to imagine anything worse than what we have, but a nursing strike at this point would be a worst case scenario.  The mission hospitals may be included, meaning there will be NOWHERE to go for the vast majority of Kenyans.  Even our willingness to continue will not be possible if every hospital shuts down.

Well, if you read all that, here are some photos of the babies this morning for whom a little care is making the difference between life and death.  Someone has to notice the jaundice or the fast heart rate or the labored breathing, and take some action.  Given today's sermon, that someone is Jesus and it is our privilege to happen to be handy to take part.  Hope you find some communion with God in your work this week too.

Friday, January 27, 2017

Kenyan Doctor Strike: A Refreshing Perspective

Friday, another week of hectic oscillation between panic and satisfying labor draws to a close, a full 8 weeks now of the strike.  Our maternity unit over the last two weeks since we returned, when things picked up speed, is averaging 16 deliveries a day.  That's nearly a 500/month pace.  Meaning one day this week Scott did 5 C-sections in a row, back to back, morning to evening.  Post call.  Including two cord prolapses, where the baby would have been dead within half an hour for sure.  Instead with a little resuscitation, both thrived.  (One pictured, we just couldn't get over his normality after the weakly pulsating cord, no oxygen in the theatre so the anesthetist had to take time to do a spinal, we thought he was gone for sure).  And including a mom who drove TO NAIVASHA FROM NAIROBI, a 2-3 hour trip in the reverse-referral direction, because she needed a C-section and heard that this place was functioning.

And a 500/month pace on maternity means a hopping Newborn Unit, with preemies spilling out left and right.  Some can't breathe well, some are jaundiced, some are infected.  Some can't feed.  Moms keep cycling in, every three hours.  I juggle blood draws and IV's and notes and teaching, making calculations and talking in my halting limited Swahili to moms.  Some evenings I'm called back.  The hardest part is never really handing over the responsibility.  There's no other doctors involved in Paeds.

But there are nurses and clinical officers, ward clerks and cleaners, lab personnel and secretaries.  There are dedicated people working to keep the doors open for emergencies, for the sickest, for the poorest.  And yesterday I had a refreshing conversation with a senior physician-assistant level woman, a working mom, a decade-long or more employee of the government system.  I asked her, what do you think the government should do?  What would improve health care for Kenyans?  Do you need higher salaries?  Here is a paraphrase of her answer:

The government could afford to pay the doctors more; they have so much money they are hiding or using for themselves.  But that wouldn't really help.  You could halve my salary and it would still be plenty, I mean it's almost embarrassing that I make that much more than my neighbors.  More money won't make people happy.  Don't pay me more and make me still see 70 patients a day, when I can't really do a good job on that many.  HIRE MORE people and let me see 20 or 30 patients, so I can actually help them.  Don't pay me more to prescribe medicines for people that they can't afford, and won't buy.  Buy medicine for the children, so when I see a child and write a prescription I know they will get it and get better.  Buy more equipment, hire more workers.  That's what will make our lives better, and health care better.  

Wow.  Voice of wisdom.  

Meanwhile no one is listening.  The government gave the doctors five more days.  Now they are supposed to return the 31rst.  Not likely.  The Clinical Officers have a case in court to unionize as well, so they can agitate for more secure and better paying jobs.  That will be heard on Monday.  For-profit schools churn out minimally competent health care professionals, who need experience and supervision, a clear job track to progress, a knowledge that certain hours will lead to certain opportunities.  Instead there is a murky opacity, people are hired on short-term contracts, payments are delayed, everyone feels insecure, and the nation suffers.

Like the early believers, we say, come Lord Jesus.  Come in power and renew the world, or come quietly and change hearts one by one to let your Kingdom seep justice and life into Kenya.  Amen.

Wednesday, January 25, 2017

What would victory look like?

This question seems clinically clear some days, and murky others.  And when applied to the strike, the unions, the government, it becomes even less obvious.  Certainly sending the nation's health care force to jail does not look very victorious.  Nor does making empty promises.  Nor does bankrupting the country.  All the prophets cry out in times like this:  where is justice? What are you waiting for God?  Come and help.

And God does.  Victory does have some faces.

Like these two preemies, whose entire lives have been lived during the strike.  Thanks mostly to the diligence of some experience nurses and the grace of God, they are both going home today after more than a month of tenuous clinging to their fragile lives.  When I discharged them, the mom's were crying with joy.  I have to say that the sheer delight of a woman able to take home a live baby is no small thing, and even in my gappy Swahili I get their meaning.  

Or this cutie, who looks perfectly normal now but was on the wrong side of a true knot cutting off his blood and oxygen in the womb in the middle of Saturday night.

Or even a mid-day pause when we could both, at the same time, get lentils and chai.  Scott's job in particular is quite physically demanding.  Now that we're in the second week of being back, the 8th week of the strike, we're trying to grab more moments for rest.  Chai can really keep you going.

But while so far maternal deaths have been avoided at NCSH as services rev back up, I can't say the same for neonatal.  Women walk into clinic and pop out premature babies, or they get sent up cold and gasping from private clinics.  There was a baby with sever congenital malformations incompatible with life yesterday.  Today it was the 1.2 kg 31-week baby whose mom had life-threatening complications, and who had been very sick with necrotizing enterocolitis, a condition with a high mortality here.  I had a moment of happiness getting in a very difficult IV in her this morning, and hours of sadness when I had to use that line to attempt to bring her back to life a few hours later, without success.  As mom mourned, some more of her story spilled out, a husband who refused to pay for her transport to this hospital from Mai Mahu after her dangerous condition was detected, and whose beating triggered the bleeding that finally brought her in.  So this is what defeat looks like.  We wrested her life from the grip of the Evil One, but at the cost of her baby's life.  She's still not completely well herself, and I noticed her this afternoon just sitting, all alone.

So if the book after book of the Old Testament prophets seem repetitive or irrelevant to you, think of this woman.  Or if Jesus' words to the oppressive powers that be seem harsh to you, think of this place.  

I think we've been given a glimpse of what victory would look like:  Love defeating Evil.  Sacrifice flowing into rivers of new life.  No more tears.  All things new.  That's the long view, the one that gives us hope.  And in the more immediate time frame, a restructure of the health care in Kenya with priority to the poor, fair and reliable wages to public servants, compassionate neighbors and professionals available to all, integrity in finances, responsive government.  Please pray that tomorrow (the day non-compliant doctors are being threatened they will be jailed) does not implode even the fragile safety net we've woven here to help those we can.  Thanks.

Sunday, January 22, 2017

Kenyan Doctor Strike Week 7

Saturday, about 1 pm, we've been rounding and dealing with patients and crises for about 5 hours, and are about to go buy groceries then meet a taxi bringing a visitor to us from Nairobi.  Scott gets a call from casualty—they have a woman with abdominal pain and bleeding, she's dizzy and barely awake.  I find two nurses holding IV bags while an ultrasound tech confirms an ectopic pregnancy (the fetus is not in the womb, but in one of the Fallopian tubes which then ruptures) and Scott is making phone calls to get an anesthetist to the operating theatre.  Her blood pressure is 70/30, way too unstable to transfer.  It's him, or nothing.  He's done this surgery before, but not often enough to be confident.  Let alone in the circumstances of yesterday:  no power, because the workmen are installing a back-up generator only they're not done yet.  We're out of some of the necessary sutures.  The lab can't run samples.  There's no blood in the blood bank.  I run out to pick up our visitor and by the time I'm back, Scott's in the theater, wearing his headlamp in the dim light. Blood is pouring out onto the floor, the suction isn't working.  A back-up power source was running the electrocautery, but then stops (it turns out the anesthetist tripped over the plug, but we don't realize that at the time).  I stand in the theatre and watch and pray as he works.  It turns out the ultrasound tech wrote down the wrong side, so that takes a few minutes to sort out. As if there wasn't enough else wrong with this picture.  He eventually stops the bleeding, cleans out the clots, removes the ruptured tube, sews her up.  She lost about half her blood volume.  Instead of a post-op ICU, she gets a general ward with no monitoring.  But by God's grace, she lives.
This is what a doctor's strike looks like.

Weeks one and two, before we left in December, seem quite distant now.  There was the shifting rumors, the nursing walk-out, the struggle to manage patients alone, the uncertainty of every day changing, the weight of never being fully off, the couple of days spent pitching in at Kijabe.  But in December numbers at Naivasha were still low, patients stayed home thinking the strike would be resolved any day and they'd come back, there was a collective anxious holding of breath.  When we left, we never imagined that after a month in the USA we'd return to an unresolved humanitarian crisis created by political impasse.  We missed weeks 3-6 of the strike, as mission hospitals kept shouldering larger and larger burdens as the only option for many.  Private clinics continued to rake in their unaffordable-to most fees, and the poor stayed home getting sicker or dying or recovering on their own.  Doctors and the government each retreated into their own camps, willfully refusing to see the deathly consequences of their inaction.  The government offered a 40% pay raise instead of the 300% doctors expected.  No deal.  Here in Naivasha the hospital completely closed its doors for a while, as happened in public facilities all over the country.

(the miseries of life, admissions in casualty)

Then into January, 4 women died having babies  in a shady private clinic down the road.  And the senior administrative and nursing staff at this government hospital, as well as some in the county seat of Nakuru, said enough.  Our medical superintendent worked with the county leaders to partially re-open, offering maternity and emergency care in two sites, relying heavily on nurses (who resolved their strike more quickly) and some non-union clinical officers.  We are one of those two sites.  Though he's a radiologist, he stretched back to his training and put himself and two recently-graduated interns who had not yet joined the union, on OB call.  He stopped commuting home to his family a few hours north.  As he told us, he decided, this is the time I will look back on and talk about when I'm old.  We walked into this on Wednesday just as things were really starting to pick up speed again. 

We may have missed a few weeks, but we're making up for it pretty quickly in week 7.
We've been working pretty hard, long days.  It feels like Ebola, the shutdown of services, the wild few who decide to do something about it, the stretch, the constantly shifting horizon .I found 30 babies in the Newborn Unit and 23 on the Paeds ward.  It's me and two clinical officer interns assigned from the county because they are in a different program (non-union) than all those who walked out.  Neither have any pediatric experience.  Scott is the sole OB provider daytimes, and has been on call all weekend, though he will have nights off on rotation with the medical superintendent and the two young doctors and one clinical officer.  The nursing staff is back, though that was never an adequate number.  One or two per shift in each area, including maternity where the one day he counted there were 23 deliveries.  Yes, back to the 1/hour pace.  
As Scott says, it has been alternately exhilarating and terrifying.  He's tried to refer really sick or complicated patients that are beyond his usual experience, but the only place to go is the mission hospitals and while those are reasonably priced for the middle class, we can not convince many Naivasha-poverty-level patients to go.  Besides the fact that when mission hospital beds are full they actually stop admitting, so finding space is difficult.  In fact they've been sending patients in the other direction. 

So the bleeding woman stayed.  And a woman with a life-threatening syndrome called HELLP, who he took to the operating room Friday night to save her life and her baby's, whom I admitted to our NBU.  And a woman whose baby had almost stopped moving completely days after her water broke prematurely, another NBU admission.  And many more.  And while it is satisfying to see clear and dramatic saves, it is not the full picture.  I've lost three patients in 5 days.  And we know there are more out there who aren't coming in.
In closing, a few overall strike thoughts.

1.  Necessity fosters community.  It is always good to be part of a group of people trying extraordinary things, and the Kenyans around us are working that way.  I can't see 50 patients alone, and put in their IV's and draw blood and follow up labs and talk to parents and examine and write notes and calculate fluids and make decisions.  So I'm trying to teach the two CO's (one is only part time) a crash course as we work together.  And while I'd like to be the competent senior doctor who breezes in to lead from the front, I've had a rough week of preemie IV struggles.  And I've been rescued multiple times by my juniors.  The humbling lesson that I need them just as much as they need me.  We're in it together.  This leads to some moments of genuine connection, like when a nurse told Scott, "you actually act like these are YOUR patients and not just our patients that we are calling you about."  Yes.

2.  God is present in the midst of the struggle.  The NBU mothers sing praise songs and pray over their babies at the start of each day, in this non-mission hospital.  Scott prays over his surgeries.  We are in over our heads, but patients are still getting better (at least most of them are) because God is here.  This quote was in a devotion we read by Rohr:  When prayer is authentic, it will always lead to actions of mercy; when actions of mercy are attempted at any depth, they will always drive you to prayer. 

3.  The poor depend upon the Kenyan government healthcare system.  Public health care is a beautiful thing, but the system here is broken. I guess all systems are broken.  There are good people who mean well on both sides, who feel passionately justified in their positions.  There is also corruption, despair, injustice, greed, indifference, entitlement, and all manner of evil in this situation.  So while the government and doctors' union drag on in their stalemate of no-compromise, the poor keep suffering. A few times this week, I've wanted to feel really sorry for myself.  I have a nasty cold.  We're both jet-lagged. Things don't work.  But then I admit two surviving of three triplets born on a path on the way to the hospital, to a mom with AIDS.  Or a premature baby born to a 15 year old 8th grader who got no prenatal care.  Or walk out to see a mom delivering on the floor.  Then I stop grumbling and remember the privilege of walking alongside these courageous, polite, and generally cheerful women.

4.  We can't keep this pace indefinitely.  So please do pray for resolution.  In the meantime, pray for stamina, for wisdom, for miracles of healing, for kindness towards those we work with and each other, for pockets of time to focus on the rest of our Serge job and family and life.  And pray for the mission hospitals too.  They have many more staff, but are still feeling the push of unsustainable numbers of patients (another quote from a Kenyan "the Kijabe hospital Outpatient department is like a political rally:  standing room only").  Pray for our colleagues there, and in Chogoria.  (Photo is of the Kijabe Paeds team who had a day off at a nearby hotel; I was able to run over for a half hour and greet these friends, a great group of doctors).

5.  And lastly, in the midst of the craziness of the last five days, we're grateful for our neighbors who kindly look out for us, for an old friend Scott Ickes who worked with us in Uganda and is back to visit in his role as a professor of public health at U of Washington working on a grant for important research on the outcomes for kids post-hospital-admission, for our dear friends the Massos and Bethany who made us lunch at Kijabe when we ran over to drop Scott off today.  As it says in one of my favorite movies: No man is poor as long as he has friends.

Tuesday, January 17, 2017

Still Alive, and mostly well

Christmas Day, the above photo says it all:  6 Myhres together, at the farm in West Virginia, sunshine and joy.

Otherwise, the last month has been FULL, and though we landed back in Kenya almost 24 hours ago and now have computers (thanks supporters!!), I don't think I'm ready to process the richness or face the reality of life moving on from January 17.  Between goodbyes, travel, jet lag, a full day of unpacking and settling and touching base with friends, and a cold settling in by the hour, let me just say welcome back to the blog.

Since we last posted we flew to the USA, spoke at our main supporting church, gathered our adult children to WV, baked and cooked and ate and walked and biked and kayaked and baked and ate some more, cut down a tree, decorated and celebrated Christmas, drove to North Carolina for New Year's fun in Charlotte with my mom and my sister's family including ice skating and movies, drove to Fort Benning, Georgia where Caleb is posted so we could glimpse his life, then flew to California with Jack, Julia, and Acacia to visit Scott's parents and our niece in Half Moon Bay with more biking and walking by the ocean, then flew back to Philadelphia for annual leadership meetings with Serge while the kids went back to start their new semesters.  We flew back to Kenya over the weekend via London with a side trip to Liverpool to visit Kenyan doctor friends from Kijabe who are there for further training.  Which brings us up to today, Naivasha, back to our house and growing puppy and the doctor strike.

Bearing in mind the lack of technology through most of the above, here is a small sample of photos that shall have to suffice:

Here's to 2017, and being back in communication again!!