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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.

Tuesday, November 21, 2017

On Spiritual Battles, Physical Rocks, and Rotten Figs

(photos above from Daily Nation) . . the rest are mine, execept the really good one from the end which is Scott's).

Friday the opposition leader in Kenya, disputed loser in both the original presidential election in August and the re-do which he boycotted in October, flew back from garnering support abroad.  He commands the loyalty of about half the country, mostly along cultural/language/tribal lines that fall to the western border with Uganda and the eastern coast on the sea, but include large numbers of people from those areas who have migrated to the central highland cities for jobs.  Those internal migrants tend to congregate in informal housing estates, crowded, poorly equipped, the kind of bleak city environments which are left to the poor.  Their hope to share in Kenya's economic growth has not always been realized.  When a charismatic and respected leader calls upon them to march, to boycott, to not cooperate, to rally . . . the anger and bitterness of feeling disenfranchised easily escalates into violence.  So, when he called for a million people to march on the airport on Friday to receive him, we knew picking Jack up from his semester abroad in New Zealand that same day was not going to be easy.

The trouble started on Thursday as his on-the-ground mobilizers began to gather, and the police responded with restrictions and arrests.  By Friday morning as we headed early into town to get our required 3-yearly work permits put into our passports (something we've been working on since July and past-due since late September; it's been a difficult year to make progress on anything administrative in the Kenyan government) we could see riot police mounted on horses preparing to resist the resistance at the city-center.  As we continued through a scheduled meeting with Sergers we supervise, Mr. Odinga landed and the warning texts were flowing in, from the US Embassy and from Kenyan friends.  Riots here.  Road closed there.  Danger.  Tear gas.  Stones thrown.  Live ammunition being used.  Mobs.  Avoid the airport.  Avoid the city. 

If there was any other reason to head to the airport, this would have been the time to turn around.  But when it's your youngest landing, there's a pretty huge heart motivation to find a way through.  We chose the route through the city about which we'd heard the least reports of trouble, hoping that in the two hours or so since Mr. Odinga arrived the frenzy might have calmed.  While he and his supporters were battling police nearer the city, we hoped to skirt around and reach the airport.

And so we drove on.  We encountered some snarled traffic at first, which is pretty normal for Nairobi, but you find yourself wondering if everyone knows something you don't.  Then the four-lane divided highway Outer Ring road (which is not very outer, it passes right through some inner city neighborhoods and trouble spots) opened up and we found ourselves driving easily, only a few other cars.  I think the ambulance with sirens heading the other direction was a bit unnerving, but I didn't really worry until we started meeting cars driving at us the wrong way on our side of the divided highway.  Soon we could see rocks in the road, melon-sized stones that had been aimed at cars before us.  Then the rising smoke from burning tires.  Then we were swerving around the smoldering heaps of rubber ourselves, windows up against the noxious fumes, flickering flames in the dark twists of cables and rubber, people crossing the road with handkerchiefs over their mouths, riot police in full gear and helmets waving us to proceed.  There were still crowds lining the roadway, but no one was actively hostile now.  All the time Scott was trying to avoid rocks on the road, to drive fast enough to not be a likely target but slow enough to not hit obstructions, dry-mounted, super-alert, wondering if we had made a really bad decision.  I was scanning news, texts, looking at the map for alternatives. 

And so we went, all the way into the airport.  By the time we made it through security, the violence had moved west into the city.  We were thankful to get Jack (!!), thankful for Kenyan friends who kept advising us on routes and even offered to have their friends who work at the airport shelter him if necessary.  Thankful for real-time prayers.  Thankful that yesterday, after a brief weekend respite with us, Jack made it back to the airport on another day where staged protests turned to death as the Supreme Court announced that they would not invalidate the election results, and the incumbent president would be sworn in for a second term.   Last night on the American news, it was reported that 31 people had been killed in clashes this weekend.  When that happens, no one wins.

Stay with me a moment, because there is a connection here with American news.  All week it's been about the Alabama senate candidate who is accused of, many years ago, approaching young teen girls (13 and 14 year olds, children) for sexual relationships when he was in his 30's.  We listened to him on TV speaking IN A CHURCH about the allegations, and he used the words "spiritual battle."  As in, if you're listening to these women and to the newspapers about me, then you're on the devil's side, because I'm God's man.  A lot goes down in America these days, but hearing someone running for public office dismissing criminal allegations involving sexuality with minors, one of the few lines still held as a reasonable limitation to indulging any appetite, as a spiritual battle AGAINST him, gave me pause.  Partly because I'm quick to attribute my problems to the spiritual battle myself.

So, are Kenyan and American stories being played out along spiritual battle lines?  Is it possible to look at the rock-wielding youths, or the tear-gas-lobbing police, and know that one is on God's side and the other not?  Is it possible to draw a line that puts one political party in the right and the other in the wrong in Kenya, or in America?  Does the endorsement of a candidate by the vocal self-proclaimed spokes-people of the evangelical movement indicate God's choice?  Does the investigative journalism of a newspaper syndicate equilibrate to religious persecution?

Interestingly, this is a question that people who love God have wrestled with for millennia.  A couple weeks ago in church as we move through the book of Jeremiah, we came to chapter 24. I'm sure I must have read it a few times, but this time the preacher drew our attention to the contrast.  In the waning days of the kingdom, it was assumed that the people captured and exiled, pillaged and enslaved, were those God wanted to punish.  The people left to rule were those God supported.  But Jeremiah has a vision of two baskets of figs, one lovely and perfect for eating, the other rotten refuse.  Surprise!  The good figs were the ones in exile, the stinky putrid figs were the ones in power.  God's purposes were bigger than political victory.  God was purifying, preserving, stripping away distractions, offering relationship.  The good/evil line was not where everyone thought. 

In 2017, in Kenya and in America, we should hesitate to claim that God is on our side and those against us are not God's people.  Yes, there is a spiritual battle, an intense one.  Read Ephesians 6.  We can't assign particular humans or groups to one side or the other, because the battle is not against flesh and blood.  There are powers, wicked ones, that induce young men to rape and rob, and police to shoot protestors, and missionaries to despise colleagues, and preachers to sanctimoniously decry sin in others, and candidates to use fear and division for votes, and average people to cheat for greedy gain, and parents to strike their kids in anger, and friends to gossip.  But when we're driving across a troubled city to get our son, we're not necessarily God's agents of goodness pitched against the Devil's evil looters.  We're humans, more frustrated with obstruction to our desire to see our kid, than empathetic with the daily lives of poverty that make people vulnerable to political manipulation, or the impossible situation of being asked to wear a uniform against fellow citizens, or the responsibility of maintaining order in a country deeply divided.  Our situation feels dramatic, but we're only a drop in the ocean of people whose lives were disrupted this weekend.  We're all dabbling in evil.  And the redeeming truth is that through even foreign invasions and coups and shady elections and daily sorrow, God still refines the underlying gold in hearts from every tribe and tongue and nation.

If you read this far, here's a bonus:  We had a fun, good-fig weekend with Jack.  Pure gratefulness for God's GRACE!

Greeting Chardonnay our old dog, at our old house at Kijabe

Hanging out with Gaby and Liana

Photography buddies

Bird and animal watching buddies

Monday, November 13, 2017

Running with the zebras

This is the image that popped into my mind as I sit here in my laundry room/side porch/office at sunset, trying to communicate what the last week+ has been like.

We're the donkey, a hopeful but plain work-horse sort of creature, not the fastest or most glamorous, usually reliable and at times cantankerous.  But we live amongst the zebras in their spectacular wild glory and community, and we run along trying to keep up and join in.

Critical, complex medicine:

A week ago we did our monthly call at Kijabe, which is always an exhausting mixture of high-intensity medicine and deep reconnection with people we respect and admire.  It's not easy to oscillate between extremely-low-resource and moderately-low-resource, between chaotic-vague-diffuse-responsibility and emerging-organized-high-standards.  So like the little donkey, we trot along behind the Kijabe experts doing the best we can to fit in and help.  The baby above actually came from Naivasha in an ambulance as we drove over in our car, needing emergency surgery.  He survived that but sadly died later of an overwhelming infection that started at Naivasha.  We are thankful to not only contribute to Kijabe, but for the resources that we can access there for our patients.

Regional Diplomacy:

The day after finishing our two-day Kijabe work, we drove up to Chogoria hospital where we've been working for months to iron out a good Memorandum of Understanding, a sort of contract for our missionaries to serve the hospital.  Over the course of a couple of days we led six different meetings, each averaging a couple hours, with various partners.  The purpose was to bring clarity to responsibilities and allow for a peaceable and unified way forward.  This is the future of medical missions: several NGO's partnering with a completely Kenyan-led hospital, learning to flex cross-culturally with them and with each other.  Messy and good, and potentially amazing.  

Post-strike escalating care:

Back to having nurses, two per ward instead of one, shifts actually covered, people with experience.  YEAH.  But once the word went out that the strike was over, the patients flocked in.  Back to two babies in many of the cribs and most of the incubators.  Back to crazy flows of admissions and deliveries, rounding on 40-60 complicated patients.  Back to the saddest and poorest cases, families with AIDS, working women who deliver premature babies waiting for the bus, children abandoned, children abused, children malnourished, the kind of patients who were not accessing private care for the last five months but just waiting or dying at home.  This past week as the strike ended and patient numbers climbed also coincided 3/3 of my doctor co-workers being sick at some points.  And we found that it has taken a week for the returning nurses to get back mentally as well.  So it was a little crazy. 

Teaching, teaching, teaching:

We have two medical officer interns (doctors who finished med school, doing a 1-year rotating internship), five clinical officer interns (finished a PA type course, doing a 1-year rotating internship) who spend 3 months at a time on Paeds, plus students from schools around the country that show up unannounced for a week or a month at a time.  The end of the strike coincided with the 3-month slightly-staggered rotation of the interns.  My last day with some of them is pictured above.  We both spend a lot of our time teaching on rounds, and giving more formal presentations as well.  It's amazing to see them grow in their ability to give good care.  

Life tasks:
This laundry made me happy, because while I saw torrential rain during rounds after having put it out that morning before work, by the time I got home in the late afternoon the sun had dried the clothes again.  In the midst of all our patient care and teaching and administrative work and travel, there is also the challenge of renewing our work permits and having enough food and maintaining a home.  This week a HUGE HUGE sink of my time and energy went into the final points needed on my five-year cycle of staying board certified in paediatrics.  I should have put up a photo of my pulling out my hair.  Talk about a donkey among zebras, my life just does not fit their categories.  I thought a project I had done for Quality Improvement would be an ace in the hole to meet some requirements.  The American Board of Pediatrics did not agree, and I was pretty stressed out by the prospect of failing to meet the deadlines because I had waited too long.  Thanks to good ideas from others and a lot of work, I managed to jump through the final hoops and pay my massive amount of money and get my letter.  Set 'til 2022.  

Local Fellowship:

We have, over our year+ in Naivasha, been drawn more and more into our local church, the Naivasha International Fellowship.  Scott led the service this week and I play the keyboard for worship a couple times a month.  The women meet for Bible study when I'm working, so I rarely get to do the extra things, but there was a one-day retreat on "Transitions" on Saturday.  This group represents a deep treasure of life experience, and it was a privilege to join in on the trust they have built and listen to their stories of struggle and grace.  On that day I was really a stray donkey, and so thankful to have the herd welcome.

In the hospital, too, we've been trying to build relationships with our co-workers, so we took a couple hours out of our Saturday evening to attend the wedding reception of a young doctor.  It was raining.  We figured out we had to put money in the proffered envelope to go up and greet the newlyweds (the donkey/zebra effort to blend). The MC picked us out of the crowd (surprise) and announced us as guests from Scotland (Scott=Scotland I guess).  

Gold Friends:

And saving the best for last, we celebrated Scott's birthday this weekend too.  The Massos and Bethany came for a sleep-over birthday party . . a lovely dinner, gifts, cake, and the next day Scott and Michael did a bike-ride while I went to the retreat and Bethany got some work done in quiet.  It is a real gift to spend time with people whom we have loved and walked through hard valleys with for over 20 years.  On Scott's actual birthday, Sunday, we even had a true Sabbath of our favorite stroll through the local game park.  

That last photo was part of the wedding decor, but a fitting end to the week.  From posing as ICU docs or international negotiators, to balancing American board requirements and Kenyan red tape, to relaxing with dear friends and figuring out the cultural nuances of weddings, there is no donkey I'd rather trot along with amongst the zebras.