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Sunday, July 30, 2017

And July is a wrap . . . what will August bring??

The second half of July:  a pretty solid pace of the main areas of our life.  Patient care working at Naivasha SubCounty Referral Hospital, hours of phone calls/skype/meetings with our supervisory role at Serge, and hosting current and future missionaries.  So here's a little photo wrap-up of the month, from my phone.

Clinical work: Naivasha Hospital and a touch of Kijabe
In spite of two months of a nursing strike, which now threatens to drag on just as long as the doctor strike, Naivasha tries hard to stay open.  That means hiring short term contract nurses and stretching them thin, limiting but not closing admissions, which puts everyone in a difficult position.  If a patient is told to go to "hospital of choice" they often just get sicker and come back as an emergency.  We've seen many many lives saved in this strike, as the small crew available works hard.  But Friday we had one nurse covering about 25 babies . . . no surprise that some fluids didn't get given, or medicines were delayed.  Still the interns/trainees are coming, so we teach, round, prescribe, intervene, put in a line, do a surgery, order labs, overview care.  Here's the bustling newborn unit:

Baby A has nearly doubled in size from 880 grams, 26 weeks gestation, to 1590 grams six weeks later, her entire life lived during the nursing strike.  She's a sweet little miracle that would not have survived anywhere else in Naivasha.

These three look pretty cozy . . in spite of being almost two months early (32 weeks gestation) delivered by an emergency C/S after their mother developed a severe complication of pregnancy known as ecclampsia, with seizures and failing organs.  They were a little touch-and-go blue and floppy as Scott pulled them out and handed them off to me and my two clinical officer interns, but this photo was snapped at about ten minutes of age, with everyone breathing well.

And crazy enough, they were our second set of premature triplets this week.  They joined even smaller 30-week triplets whose mom arrived in unstoppable labor and delivered them naturally on Monday.  The six of them are in two side-by-side incubators (blue lights for jaundice).

There's also the usual rush of convulsing toddlers, HIV-affected families, pneumonias, TB, sickle cell disease, severe dehydration, injuries, swallowed kerosene or pesticides, hepatitis, unexplained paralysis, difficult delayed labors, breech deliveries, overwhelming infections.  And a newborn baby found abandoned inside the muck of a pit latrine covered in maggots, who is holding on.  Naivasha is a place of last resort for the desperate, a place to take a stand against evil, and a place to encourage others who are doing the same.

And not all our patient care is at Naivasha--recognizing that the strikes put pressure on the mission hospitals, we agreed to take call at Kijabe once a month through this period.  It's a treat to reconnect with our former co-workers and to refreshingly embrace a system where labs get done and interactions are cheerful.

And kids are very sick and very complex.

Serge Area Director Work
Well, photos of meetings by phone are limited here, even though that work is important.  With ten team locations in four countries, plus a former/hopefully future 11th/5th for South Sudan, we spend a good chunk of each month communicating with team leaders, reading, writing emails, meeting virtually.  We enjoy the privilege of walking alongside people who are living for Jesus in challenging places, even when that means they also deal with discouragement, spiritual warfare, miscommunication, legal challenges, difficult partnerships, mental health setbacks, loneliness for family left in the USA, brewing insecurity.  Our hearts are scattered about in East and Central Africa.  And as God draws more people to consider joining, we find ourselves exploring new sites, hosting, dreaming, helping to develop vision.  

This past week we spent five days with this lovely family whom we hope will be returning as a nurse and nutritionist for Litein, working clinically alongside the Kenyan team and teaching in the nursing school there.  Here they are by Lake Naivasha, on a walk from our home . . . 

And at Litein hospital, which it turn out was founded by a missionary almost a hundred years ago with their SAME LAST NAME (he planted this tree) . . 

While the parents and Scott and George Mixon met with hospital leadership, toured, went on rounds . . the super trooper kids and I explored four different Kenyan schools in town, and the market.

It is no small matter to move from a life in the USA to consider a life in Kenya, so we pray for God's clarity for them and another couple who was simultaneously visiting our team who works with inner city unreached people from a neighboring country.  These visits involve a lot of good Kenyan food, so here we are sharing a lunch with the Litein staff:
Lots of car hours seeing Kenyan countryside . . . 

And back to Naivasha in time to welcome our Bundi Team Leaders, who in the best Bundi TL tradition are having there second child here in Kenya this month.  Pray for a save delivery!

And the rest of life . . . 
In between caring for patients, teaching trainees, recruiting new workers, and supporting teams . . . life fills the hours left.  Shopping, cooking, walking the dog, neighbors, and family phone calls.  This blog from Serge popped up again on my facebook, and expresses well one of the greatest struggles of this season of life:  
By following God’s invitation to international mission work, we extend an invitation to our adult children and parents to find more happiness in Jesus than in the comfort of family. 
That, friends, is a difficult and inconvenient truth for sure.  Our sisters, our mothers, our kids pay a high price.  So it's always a treat when we get snippets of their lives by texts, photos, phone calls.  And when they get to support each other.  C got an unexpected and sudden week of leave because his regiment is likely to deploy soon--not enough freedom to come to Kenya to see us, and we couldn't come see him, and that was SO HARD.  But his big brother pulled him into his own life for a week, a true blessing.  Plus he sent us photos.  What a good brother.

J finished her two month internship in Jordan with a party from her environmental project coworkers:

L heads into two months of intensive sub-internship rotations in orthopedic surgery in New Haven and Cleveland, starting tomorrow.  And our youngest is immersing himself in New Zealand student life, from engineering classes to backpacking.  There was a MOMENT ON FRIDAY when we were all on a Google Hangout at the SAME TIME (L not pictured but in back seat holding the phone that shows C).  Our time zones span 20 of the 24 hours in a day, so it's no small feat (aided by the fact that a certain college student is alert at 2 or 3 am in his time zone).  

Our church provides us with community, fellowship, prayerful encouragement.  I often play the keyboard, and today Scott was asked to lead the service.

So what about August???
These are three of the little lives who would like to know (Scott's photo, at a few hours of age).  Kenyan elections are set for August 8.  The entire country is sorting itself into tribal groupings, as people return to their ancestral homes to vote,  and to ensure their safety from other tribes.  Ten years ago at least a thousand people died in post-election violence stoked by politicians.  Tens of thousands were displaced.  This cycle we read of riots, youth attacking rallies, thugs taking advantage.  There is an edge of uncertainty.  ALL OF OUR FELLOW DOCTORS (consultants, medical officers (like residents), and interns) have told us they will not work the week of the elections.  Where does that leave our patients?  Particularly with the ongoing absence of nurses?  We hope at least a skeleton crew will remain of clinical officers and short term nurses, for the sake of the babies, the emergency deliveries, the poorest patients without other options.  Please do pray for peace.  Our sermon today was from John 16.  In this world you will have trouble.  But be of good cheer, I have overcome the world.  Pray for all of us here in Kenya to see that promise of Jesus pervading the country, overpowering the evil of men.

As a bonus for reading to the end, here are the 8 paintings done by the Shirk's niece, on the wall of the Paediatric Ward at Kijabe, lovely portraits that honor the patients we care about--

Tuesday, July 18, 2017

Earth has no sorrow . . .

This, friends, describes the heart of who we want to be.  A place to bring wounded hearts and bodies, to tell the story of all the sorrows, to find the healing of Heaven pouring down to earth.  So much of that healing comes just by gathering and telling.  And the rest comes by a dimension beyond our wildest dreams pouring, seeping, dripping, splashing over into our broken world.  

So begins another week.  The nursing strike continues.  Babies born at private clinics (private sounds ritzy, but in Naivasha generally means for-profit but not necessarily best-practice care), then bundled over to our Newborn Unit which tries to remain functional.  Four died Sunday.  Four.  Another Monday.  Coming too little, too late, too damaged.  And often passing through hands that don't recognize the dangers. Scott and I keep showing up, keep trying to give input and model compassion and a level of diligence that might make a difference.  Some days it feels futile, or like an uphill battle.  Some days we clap our hands--our 880 gram 26-weeker hit 1290 grams and 31 weeks now.  Another preem who had intractable vomiting and feeding problems for well over a month reached her due date, still tiny and vomiting . . we stopped all her medicines and just had her mom breast feed and hold her.  She's ready to go home today.  Last night on our what's app group, one CO intern got the baby in this picture a spot at our main referral hospital in Nairobi, Kenyatta, for evaluation of her heart malformations.  An off-duty CO intern volunteered to ride in the ambulance with her late at night, since there are no nurses.  Small victories, of medicine and of faith, hard to remember in the face of so many tragedies.

This is a map of Health Care Quality and Accessibility gaps, the darker red the color, the more lives could be saved by provision of health care.  Kudos to the data people, those who try and collect it, process it, publish it.  We need to tell the stories, tell the anguish so to speak, as both real-life babies with names and photos, and as aggregate numbers that put punch behind the vignettes.  This map comes from a Lancet article published last week, distilling death data and health worker availability data from around the world all into an index with a single value per country.  The good news:  health care quality and accessibility are improving world wide.  The bad news:  the gap between best and worst, richest and poorest, is widening, and here on the continent of too much red, we feel it.  Here's a graph from the next volume of the Lancet, that shows how many lives could be saved by straightforward already-discovered health care practices, right here in Kenya alone.  Tens of thousands.

So, getting to the top of those bars, requires some telling of the anguish and some healing from Heaven.  Some collaboration and education and rainfall and good governance.  Some attention and prayer.

First, pray for the upcoming elections.  The nursing strike, the general health care crisis, won't be resolved without strong leadership.  Pray for Kenya and America, to choose leaders who consider others' needs before their own power and advancement.  This was the scene in the grocery store Saturday--people stocking up on maize-flour to be sure they can make ugali, the staple starch, if the elections turn violent and it all falls apart.  We bought a bag too; along with our normal fresh food we threw in some cans.  Our neighbors reassure us that all shall be well, but then we sense the palpable disease at the hospital where people from multiple ethnic groups work together.  Many will go back to their home areas to vote, both because that's where they are registered (aka Luke 2) and because that's where they feel safe.  The elections are scheduled for August 8.  Every day there is another crisis that throws the whole process into doubt.

Second, pray for our partnership and friendship.  These two women I work with reached out to say they wanted to get to know us better.  I invited them for lunch.  It takes time to build relationship in a new place, and the strikes have made that even more challenging.  But as much as we need solid laws and security to provide the stability for development, we need solid connections with real people to build the trust and common vision for lasting changes.  And to keep our weary hearts from giving up.  Theirs too.  
Third, pray for God to move more hearts to help.  We're thankful for our overseas partners who pray, who give, and those who are moved to come.  Note the old CPAP improvised out of a cut water bottle and a lot of tape, with the re-used-forever dingy tubing on the right.  On rounds yesterday we noted once again that there wasn't enough water in the bottle to bubble; that the baby was struggling.  So we replaced it with new supplies brought by two NICU nurses.  Wala.  The spiff clean blue-topped bottle to the left in the photo, where there is a clear "fill to here" mark, and big numbers to dial the depth of the brand new clean clear tubing.  Hooray.  We need supplies, but we need people more.  People willing to be the community in Moore's quote, to move into hard places and invite their neighbors to bring their anguish, to tell their stories.  People willing to be channels of God's healing through truth, through education, through practical services like water and food and medicine.  Aren't sure where you fit?  Fill out this form and Joanna will help you, and us, figure it out.  

This is a lot to believe some days.  But it's something we stake our lives upon.  I like the double entendre of this water drop, a tear most likely representing sorrow, but like Psalm 126 the tear drop can also represent the life-giving water, healing, bearing fruit, the flow of blessing.  The last month I've been reading a commentary on Romans, and comparing it to current events and the tragic history of this continent.  Our world teaches us that to be in power is to force those "below" to serve, so that all that is desirable is pushed upwards to the few.  Jesus turns that upside down, and says Israel the ethnicity and Israel the new broader all-welcome people of God are to be conduits of blessing that flows out, floods down, serves and waters and heals the world.

Including Naivasha.  And Kijabe, Nairobi, Chogoria, Litein. Fort Portal and Bundibugyo.  Nyankunde and Bunia.  Bujumbura, Kibuye. Mundri.  People we love, places we long to see healed.

Sunday, July 16, 2017

2017 Africa Reading Challenge

5 books from, or about, this continent.  That's the only rule.
Here's the site that focuses on blogging about literature and poetry from Africa, which is something we all need more of in our life.

And here are my 5 books (so far) for 2017:

Ngugi Wa Thiong'o grew up in Kiambu county, Kenya, very close to where we live.  He was born in 1938, making him a near contemporary of my own parents.  Reading the history of Kenya as an eye witness account through the eyes of a child is well worth the effort.  I prefer his novels, such as The River Between, for writing style.  However this book offers an important alternative history that contrasts with the more popular accounts of the colonists.  As an American doctor working in Kenya with a mission agency, it is important to me to acknowledge that the history of white people in Kenya is permeated with terrible injustice and tragedy, even if sprinkled with courageous health care and education.  Thiong'o recognizes the struggle of Kenyans to speak, to control, their own education and future.  Worth the read.

This read I can best describe as painful truth.  Gyasi tells the sweeping epic of hundreds of years of history by following two branches of a fictional family through generations, until they meet again.  The chapters are named for key characters in the lineage, and she uses certain images of water and fire to connect the stories.  The author is Ghanian-American woman, and a very very talented writer.  She deftly weaves West Africa with the story of enslaved people brought to America, both in the South and in Harlem.  As hard as the stories are, she draws you in with her empathetic ear for dialogue and her vivid descriptions.  The sexuality in this novel is mostly violent or tragic.  She does not gloss over the horrors of war and slavery.  This is not an easy read.  However the ending I found hopeful. My favorite genre is "dark and redemptive" and this novel fits.  Because that's the story of the world.

This book is a collection of short stories that read like a chat around the campfire.  Arensen grew up in Tanzania and Kenya and then worked in Sudan.  He draws upon a lifetime of adventures to paint life in East Africa in its beauty and drama.  This is a generally positive view of this part of the world.  Arensen can be funny, and he has a real talent for taking what seem like normal incidents of daily life and making them interesting enough to read in a book.  Some of his family still live near Naivasha, which makes this even more of a treat.

I have to admit that I ordered this book hoping for another meaty, long read by Adichie ( I did notice the price was surprisingly good, so that should have been a clue, and mine didn't have the nice red tag "short" on the cover).  I read Americanah a few years ago, and some of her other books prior, and wanted more.  Instead it is a very tiny volume that basically reprints a TED talk.  That said, I think it's worth a quick read.  Feminism from an African standpoint is survival.  It is about justice.  It is where the rubber meets the road in the Gospel stories.  She is forthright and sensible and thought provoking.   Nigerians and Indians are saving the English language in my opinion, the greatest talents are coming from those countries.  This isn't lyrical like her novels, but still a good short read to listen to another's opinion and story.

Surprise!  The last one by me.  Sincerely I have read this book about five times in the last few months of editing, so it definitely counts, even though the publication date is still just over a month away. Quality literature written in and set in Africa, about contemporary continental challenges, with African kids as heroes, needs a wider audience.  Please buy a few and send them to your local library or school, or give them to your kids or grandkids.  This is the third in the Rwendigo Tales series.  Each book relates loosely in characters and setting to the others, but can stand alone as well.  As with the others, the Read A Story, Change A Story benefit of royalties to enable real kids to write new endings still applies.  Hope you enjoy.  Available for pre-order at Amazon or New Growth Press.

You can link to the 2017 African Reading Challenge web site for more suggestions, and feel free to leave comments here on what your favorite African reads of this year might be.

Thursday, July 13, 2017

Kenya Nursing Strike, is anyone paying attention???

The public sector nurses went on strike six weeks ago.  Has anyone noticed?  The poorest once again lack health care, lack immunizations, lack labor and delivery services, lack options for ill family members, lack supervised TB therapy.  I googled and found only two news stories this week, here and here.

So, a little eye-witness reporting.
This baby's brain may never recover from the strike.  His mom came to our hospital three times last weekend, having been turned towards public care after a private clinic found her with dangerously high hypertension and bleeding (and probably not enough money) . . . but all three times she was sent away because of the strike.  The fourth time, she met the requisite standard for inevitable delivery (6 cm dilated) so she got to stay, but her labor progressed so slowly and the baby's distress was so unrecognized, that he was born in critical condition.  Because our hospital is trying to keep some minimum emergency care available, our medical director has hired some non-union temporary nurses.  But partly out of solidarity with the strikers, and their concerns, the temporary nurses still follow guidelines agreed upon to make it clear that this is not a normal situation (like not admitting anyone in labor until they are 6 cm dilated).  And partly because the funds for hiring nurses are limited and they have to cover many areas with few people, the care is not as good as normal (and normal is still very far from perfect).  I suppose the politicians are supposed to notice, but in reality the babies pay the price. And the moms.  After only two maternal deaths in the 9 months we worked from October to June . . there have been two maternal deaths THIS WEEK.  

As you can see, our newborn unit still has babies, moms, student nurses.  Because in Naivasha, the private care paradoxically lags far behind this public hospital. So the sickest babies, even if born at a private clinic, find their way back.  I had one die this week who would have been born here were it not for the strike, but instead had substandard private care and arrived too late to save.

In a few months or years, who can count the cases of tetanus and measles that will spread through Kenya because the entire vaccine system has been disrupted?  Some of the private clinics are trying to make use of the otherwise-expiring public stores . . but charge 100-200 KSH (1-2 $) as a service fee for administering them.  That's a daily wage for most of our clients.  A huge barrier.

So we have our most trusted senior nurses sitting at home, frustrated, asking that the government legally sign the agreement they wrote months ago.  We have the governors saying that paying each nurse an extra $250/month will break their budget (remember the average wage here is about $60/month).  We have the central government trying to deflect any attention from this health crisis in order to focus on staying in power through the upcoming election.  We have hospital administrators trying to eke out some minimum services.  We have doctors, and those in training, trying to care for patients and learn, which is not possible without nurses on the team.  We have public health faltering in delivery of vaccines, HIV and TB drug programs, school programs, the backbone of health all run by nurses.  We have parents who agonize over the lives of their children with no ability to pay for private care.  We have half our normal load of patients, knowing that the other half aren't well, only excluded.  

And most ominously, we have the psychological discouragement of a fragile system that limps along with inadequate resources.  I read a Kenyan proverb today:  Hope is the pillar of the world.  But hope is fading, and the world is shaking.  I see it in the trainees, those who sat out the doctor strike have never quite recovered, coming later, leaving earlier, demoralized and unmotivated.  Those who wanted to dedicate their lives to public service feel unseen and unheard.  Participating in a system that feels antagonistic and uncertain leaks the life out of us all.  This week a senior surgeon in our area was found dead in his home.  The strikes take a toll on mental health of providers, too.

So once again, we ask that the world not forget Kenya.  That the government work towards a solution.  That God intervene in hearts to bring real healing and peace.  That miracles continue to fill the gap between peoples' needs and available care.  That we have wisdom to walk in this murky situation, shining a little light.  Thanks for listening.

Wednesday, July 12, 2017

In whom I am well pleased

Our youngest dropped in for a few days, between his semester-in-six-weeks studying French in Aix-en-Provence and his semester-in-four+-months studying engineering in New Zealand.  He came bearing some French goodies like local cheese and scented soap, and full of stories of his adventures in language.  We hiked our local volcano, and by the wildlife-laden lake.  We worked on visas and finances.  We hosted a few of his friends.  And we cheered in the alumni games as his class returned (40 of them!!) to RVA to touch base with each other and teachers and dorm parents after two years of dispersion.  And then, all too soon (we had about 6 days of intersection) we took him to the airport once again.

Neither Scott nor I were ever youngest children, and there are unique joys to each birth order position.  But three years ago it was just the three of us through Jack's senior year, and this visit was a bittersweet memory of that time.  The phrase that comes to mind is God's voice over His own son, affirming the PLEASURE of watching someone you love mature, thrive, speak wisely, strive passionately, hug warmly, laugh freely, run fast, and live thoughtfully.  Visits are a glimpse of a life that was, and will be.  A sip of a delicious unity.  A treat of joy in presence.  As much as we would like them to go on and on, we acknowledge he's off to the life God is giving him and we TRY to remember to just gratefully accept the days we have.

So .. enjoy a few phone photos below, and pray for our faith as we trudge on with our empty nest, until the next visit.  Nothing like being a parent to make one long for the no-more-tears of eternity.  And if you're struggling with whining babies, wild toddlers, weepy teens or anything in between, take a deep breath. They're going to turn out amazing in spite of all of us, our foibles, our dragging them into wars and diseases and our own sin.  Because this is not just our son, he's God's son, and we are all pleased as we see the glory shine through.