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Sunday, May 13, 2018

Her name is Julia Kathleen Myhre . .

 . . .and she's now a graduate of Duke University.  About seven years ago, we first visited the Duke campus with Caleb, passing through on the LAST possible day for college tours as we were working our way down the coast.  Caleb liked Duke, but it was Julia tagging along who came away from the day saying "I want to go to school here."  When she decided to apply a couple years later, not all her high school team believed in her chances.  But one thing about Julia, when she makes up her mind, she can work and lean into the hard.  And so four years ago we were carting her belongings up three stories in a quaint but non-air-conditioned no-elevator dorm for her college adventures to begin.  She found her niche in the intersection of environmental policy, cultural anthropology, and global health.  She tested water quality in Alabama on an environmental justice research project.  She worked on the Duke Campus Farm towards a sustainable food chain, volunteered with senior citizens and church preschoolers, joined the leadership team for her Christian fellowship, catalogued rare seeds and studied the impact of grazing on indigenous plants in Jordan, studied Arabic and worked with an arts internship in Morocco, completed a comparative global health semester abroad in India, South Africa, and Brazil.  She played intramural soccer and tennis, camped out for Cameron tickets the year Duke won the national championship, made pottery, went camping and to the beach.  She baked cookies and encouraged younger students, cultivated friendships with multicultural beauty, drove hundreds of miles to be with brothers and other family.  And she wrote papers and took exams and came out with honors, in the top fifth of all Duke undergrads.

So today we wrapped up a weekend of celebrating this gift, the gift Julia has been and will be to the world, and the gift she received in this 4-year banquet of opportunities.  She grabbed them and worked hard to make the most of them, and we are so happy for her.  Person after person who had spent time as her teacher or mentor or friend smiled at us and told us stories of her impact.  She will be missed in Durham.

After a few family travels she'll start a Fellows Program in Greensboro NC, where she will be mentored in the integration of work and faith as she works part-time in her field of environmental action and food, takes theology classes, and volunteers in the Church of the Redeemer.  

We are grateful for the vast community of former teachers, team-mates, cousins and aunts and uncles and grandparents, friends from Uganda and Kenya, soccer and tennis and basketball and volleyball coaches, church leaders, supporters who have all brought us this far.  Wish you could have all breezed through this weekend with us.  Here are some highlights:
  • Julia treated her grandmothers and her mom (me!) to a lovely lunch for an early mother's day.
  • Luke was on point, with logistics and icy drinks and cheer and help throughout the long weekend, keeping the focus on what-does-Julia-want.  Plus both grandmothers, my sister Janie, most of Julia's Biggerstaff cousins.
  • We put together a party for about 40-some people with a Costco run and some decorations at a pavilion on the farm where she worked.  She invited friends and their families to come out, and the atmosphere was lovely, bees and flowers and vegetables, abundant food and drink, conversations and a setting sun.
  • Parties for other friends where we dropped in to meet people, and another party hosted by the Duke Farm managers for the 5 seniors who worked there.
  • A church service at Blacknall, where Julia attended and volunteered.  Her pastor preached powerfully to the graduates, challenging them to pursue courage over clarity.  He talked about the disciples in the storm on the boat, and how most of our plans and lives do not move in clear and predictable directions.  To follow Jesus we need courage!
  • A Baccalaureate service where the Rev. Luke Powery (Dean of the Duke Chapel) preached another powerful, relevant, bold, hopeful message on the life of Jacob.  He talked about life in America, and challenged the students with the truth that life will bring wounds and difficulty and that is where we meet God.
  • A Departmental graduation with the Environmental Science faculty, where Julia received her diploma, and we met her advisor and enjoyed seeing the educational spaces and a reception with other students and family.
  • A dinner with grandmothers and a couple of her close friends at a hip restaurant with menu items we had to google to understand.
  • And of course, the main event, the massive commencement ceremony on a 90+ degree pounding sun day in the football stadium, where Tim Cook enjoined the graduates to not accept the status quo, to keep searching for better solutions.
Duke has been a provision of grace for us.  And so has Julia.

Friday, May 04, 2018

MAY in VIRGINIA: nothing better . . .

May is a big month for Myhres, and many of those milestones happened in Virginia.  As our 31rst anniversary approaches, we have landed in Charlottesville ahead of Luke's graduation from med school and Julia's from college, and Caleb's return (we pray) at the end of the month from his deployment.  One day we were in Naivasha, knee deep in the struggle to resuscitate babies and protect moms.  Suddenly the next day we are here in the full Spring of blooming dogwood and azaleas, waking in the early morning to hear birds from our childhood.  Robins, cardinals, blue jays, red-winged blackbirds and scarlet tanagers.  Hot days and blue-ridge sunsets.

After months and years of distance (Luke left home for boarding school ten years ago at age 15), we revel in the rare privilege of a few days to run errands, pack up a house, talk, cook together, ride bikes, make coffee.  In fact it may be the most undivided parental attention he's had since Caleb was born.  After a year of a difficult surgery and recovery, the stress of the match, the culmination of a challenging medical school stretch . . . we are just delighting in this young man.

Biking to Monticello

Bike repairs at the Community Bike Shop

Sunset at the Vineyards

Meeting friends at Lampo's, Luke's favorite C'ville restaurant

Morning coffee in the yard

Blue Ridge Sunset

Tomorrow our 3 days in C'ville come to an end, and we head up to Vienna, VA.  We will speak at Sunday School at 10:15 am Sunday at Grace OPC (2381 Cedar Lane), the church in which I was raised and where we are all members, the church that has been disproportionately generous in supporting us for all these years. Our talk , "Walking through the Rift Valley:  Dark Days and a Billion Reasons to Hope" will share about our work with Serge as Area Directors and as doctors in Naivasha, Kenya. All are welcome!

The next two weeks will be immersed in celebrating the two graduations with both our moms and my sister too, moving people from Charlottesville and Durham to West Virginia and back several times, helping both Luke and Julia pack up and move on to their next phases of life.  In June we will drive all the way across the country, moving Luke into his newly rented studio apartment in Salt Lake City then welcoming Caleb back from Central Asia, visiting his home in Alaska, and returning to West Virginia in time for our Aylestock family reunion before we return to Kenya in early July.

Nothing matches the bright green of the Virginia spring, the return to a place full of memories and meaning for us.  We are grateful for this time.

Sunday, April 29, 2018

April: a sip from the deluge

April has thundered down upon us in an abundance bordering on drowning:  in rain, in work, in visitors, in emails, in tasks, in blessing, in exhaustion.  We preach pace and sabbath, but in the last few weeks we've been working long days at the hospital and long nights at home.  So many dangling loose ends, threads that have unraveled and not been tied off.  People we've failed to answer, situations we've failed to anticipate, love we've failed to show.  We are worn thin and we are sorry.

A few sips from the deluge to illustrate this month:

Patients, teaching, innovations, audits, deaths, surgeries, procedures (Our normal daily hospital work)

Mama M in the background with baby M, and their incubator-mates . . . still going improbably strong, thanks for prayers!!

Triplets whose mom had been sent here from a private hospital due to lack of space there, at 29 weeks.  The OB team held off labor for a few weeks but they were still born way too small and early.  The boy (the largest) died, but the two sisters are still struggling on.  Keep praying!

One day I just could not understand why my patient's oxygen level was so low, until I moved the bed out from the wall and saw the tangle of the improvised shared oxygen system.  We need better OXYGEN!

Every day brings struggles and joys.  One day last week Scott was on rounds and a mom who was resting on antibiotics after rupturing her membranes almost two months early showed him a green-looking cloth soaked with the fluid.  Preterm babies don't usually pass meconium (stool) so he put on a monitor (something that we can't seem to make standard due to the high volume and poor staffing) and saw a sustained stressed high heart rate.  He was able to push through an emergency caesarean quickly and called me in . . the baby's umbilical cord was not only around the neck but stretched like a sash over his shoulder and across his body and through his legs, a tight mess cutting off his blood supply.  A quick exit and some resuscitation and he did well.  Days like that we think, yes, this is what it's about, saving lives and teaching as we go.  Other days we still despair, as the docs in our county have called for another strike, and the interns are finishing their year with no replacements in sight due to a prolonged lecturer strike.  

Visitors, students, projects, donors (April is a popular month)
Cindy B spearheaded the Friends of Naivasha Hospital organization that raised money for the maternity and NBU--she visits once or twice a year with a whirlwind of innovation and energy.  This time she invited us to an evening safari at a local private reserve.

Former RVA student and friend, who are studying various medical courses in Germany and dreaming of working back in places like this.
Isaiah, a Kule Scholarship student about to graduate in Uganda, took a bus on  his vacation week to come see us in Kenya.  We walked down our hill to see the wildlife . . . 
And he spent his days with us in the hospital.

Dr. Jim O'Neill and family visited Naivasha where he had volunteered and raised funds; a leader in Paediatric Surgery, and still thinking forward at 85 on how to improve care around the world.

The University of Nebraska team donating a Pumani CPAP machine to our NBU (my new Paeds consultant partner is on the front right, Dr. Julie, by our head nurse Epharus, and my former partner who is now medical superintendent of the hospital is in the white shirt receiving the machine)

We spend a fair amount of time with University of Washington rotating residents and students too . . this is Carly who hosted Luke when he was in Seattle doing his away rotation.  Small world.

Teamwork, mentoring, bearing witness (both in the hospital, the community, and Serge)
Most unusual morning in April: Speaking to the East Africa Women's League, some really gritty and gracious women who have lived here since steam boats plied Lake Victoria, and have the stories to tell about it.  They care about Naivasha and gather to support charities.  I was super nervous but they were very kind.

Bethany shall represent the 24 people we supervise (Team Leaders, Area Specialists, and a couple of team members who are lacking Team Leaders), 22 of whom we met with this month in person or by video.  It's our annual review time to reflect on the year and set goals for the next.  Always a delight to see what God has done; but also added quite a bit of work to this month.

The April 2018 Paeds team.  The two interns here (Litole far left and Lokomol center) are amongst the hardest-working least-complaining humans I have ever met. We used to have at least 3 to 5 sharing call; these three months it was only two.  We had some UW med students, and the doc next to me is one of our two medical officers Linda.  I've been working on a core curriculum with a pre- and post-test for the rotation, and one of these women bumped her score by 30 POINTS!  They both learned a lot and were great to work with.

Scott's OB team out for lunch with a visiting University of Washington professor who was here helping set up a quality improvement study of cesarean section delays.  His partner Dr. Chege is front center.  

Serge Family celebrations, kids (both new ones and ours)

Laura Mixon (Serge teen) in the musical "In the Heights" by Lin-Manuel Miranda.  Great dancing and beats, but also a meaningful story about home, families, immigrants, prejudice, injustice, hope.  Really great job by Rosslyn students.  
The Serge crowd who came opening night, with our very own star (and Gaby front left will be in RVA's musical this Spring too).

Photo courtesy of the Kibuye team--they studied inventors and Scott wrote up a story of his dad's work on Pringles, which was fun and sweet.

Baby Jonathan safely born to the Faders at Kijabe, baby Davis' adoption was finally approved in Uganda, and baby Bennie returned with her family the Nolens this month from Home Assignment.  We've added to our Serge family this year: Keza, Davis, Julia, Jonathan, Ivy Joy, Jacob, Bennie, Salem, and if I can also claim him, Clark.  Lots of joy, though we do pray for a couple others who have lost little ones and long for parenthood.

Jack with his Duke Rugby 7's team at a tournament in Nashville (rain there too!)
And Luke got to go on vacation with great friends including Abby, and his RVA pals Thomas and Sierra.  When we are far from our kids, it does our heart wonders to see them with friends.  Julia is one paper and one exam away from finishing college, and Jack is almost done with his Junior year.  Caleb soldiers on (literally) and God willing will complete his first deployment in about a month.  One of the highlights of our month has been a few group-chats with the family.

Scientific Conference and Retreat Preparation (part of life is meetings . . .)
Sergers were strongly represented at the Kenya Paediatric Association meetings this week, doing research and presenting it.  This is part of the Kingdom, making care better for kids.  Above is Jason's project being projected . . 

And here is Caleb from Kijabe presenting one of Ari's several projects.

Scott and I rode down to Mombasa on the train to catch the last day of the conference . . 

And then accompany the Brotherton-Streets to scout out our retreat venue for August. Yes, one of the other MAJOR JOBS of this month has been working on planning a retreat with speakers, logistics, themes, child care, etc. for about 150 people in August.  

So, if you haven't heard from us in a while, perhaps you now know why. Oh, and forgot to mention the edits on the fourth Rwendigo tale due this week and working with the pictures and cover, and lots going on in lives of our Ugandan fostered young-adult kids, and taking a course on HIV, and working on finances and legal issues . . .  Sometimes it feels like our heart is in too many places.  So this quote from a devotion I found particularly encouraging today:

St Bonaventure (1221-1274) called the Trinity a "fountain fullness" of love.  God is unhindered dialogue . . an eternal waterwheel of self-emptying and outpouring love--that knows it can completely self-empty beause it will always be filled back up.  This is the very definition of divine love; all human love merely imitates, approximates, and celebrates this same pattern.  (R Rohr)

The reminder that our resources are NOT limited, that all the pouring out will be refilled, that we are merely channels of the foundational force in the universe, LOVE.  Pray for us to not be irritable and rushed, but to be kind and loving as April turns to May.

Thursday, April 12, 2018

Grace in the flesh

This is Mama M holding Baby M.  This is a miracle in process.  Whose outcome we do not yet see. But 11 days ago, Scott decided that M (the mama) was going to die unless she was delivered of her preterm pregnancy.  She had severe pre-ecclampsia, a complication of pregnancy that is more common in Africa (and in African-descended Americans too), characterized by high blood pressure, swelling in hands and feet and face, kidney injury, bleeding, headaches, etc.  So he took her in for an emergency C-section and removed M (the baby) who was 2 months early and weighed a kilo (2 pounds) and came out in severe respiratory distress and every complication in the book.  She's had pneumonia, very abnormal blood tests, petechiae (bleeding in the skin), bacterial and fungal infections, and a gut infection known as necrotizing enterocolitis.  In her 11 days of life up to today, she has never been stable enough to even feed.  Which kind of works out, because her mom was so sick she got transferred to a regional hospital, leaving the baby behind whom none of us (me included) expected to live this long.  This baby's premature delivery and unusually critical course we thought was the sad but inevitable cost of her mother's survival.  But day by day we look at baby M and say, she's still fighting so let's fight for her.  Tuesday we called the OB team and said, if the mom is stable, can we bring her back to Naivasha to start trying to make some milk to put in the tube for this infant?  She arrived back yesterday evening, and there she was this morning.  Very much not dead.  Very much ready to start caring for her baby.

Most of me acknowledges that baby M still has a slim chance of survival.  She's on our three strongest antibiotics and an IV anti-fungal.  She just came off the extra breathing/oxygen help of CPAP.  She is tiny and vulnerable and has been starving.  

But I can't help but hope.  This is one spunky baby.  This is one survivor of a mom.

And this is one crazy day, a day of possibility and courage.  Scott's team started the day with one of their first ever audits, a review of processes in a case where a baby's delayed C-section ended in his death. It would be easy to blame, or despair, but instead the team problem-solved the lack of surgical drape sets and arranged for more.  Progress.  After rounds I had the somewhat unusual privilege of a morning with the East Africa Women's League Naivasha branch, charming survivors themselves, with memories of pre-independence countries, steam boats and farms, and I got to tell them about the realities of medical care in Kenya now and share some testimony of why it's worth working for and how we survive and how faith impacts us.  Mid day I got off the phone wanting to cheer for one of our team leaders who had just spent two hours meeting with someone in a very sticky situation, and shown such wisdom and grace, she was amazing.  In the evening we cheered for another team leader who had spent the day in an 8 hour cross-cultural and contentious meeting, doing the right thing at high cost.  Then on to worship leading rehearsal for our church, singing about grace.  So many little ways that the universe clicked towards truth today.

Join us in praying for the M's, mom and baby, to be living miracles, testimonies of grace in the flesh.

Sunday, April 08, 2018

Survival against the Odds

Today we celebrate FIVE YEARS since our friend and colleague Dr. Travis Johnson was diagnosed with colon cancer, shockingly cutting short his family's mission service in Bundibugyo.  His tumor had spread by the time he was diagnosed, and his prognosis has never been very encouraging.  We have asked and asked for a cure, for a miracle response to surgery and chemo and radiation and now immunotherapy.  Instead, we have received survival without assurance.  Another month and another year, as Travis and Amy suffer toxic treatments, travel to the best care, eat and exercise like olympic athletes, raise prayer support, and pursue every possible avenue of help.
In fact, what we would like to see for Travis (NO TUMOR LEFT so we can hope for not just a year or five, but decades) is what we'd like to see for all those we serve.  Not just a moderate extension of survival, but a clean slate, a hopeful future. Instead, we have an incredibly unlikely gift of a 5-year struggle that finds Travis completing yesterday a 100-kilometer bike ride, with three growing kids and a meaningful job and a life that looks outward to the needs of others, without the cloud of cancer being removed. I'd like the babies in our Newborn Unit to stop getting fatal infections, but instead of 100% survival we get some dramatic rescues and too many sorrowful deaths.  I'd like to have Dr. Jonah alive, but instead we have his sweet daughters and his precious posthumous son and his hardworking wife and six medical students graduated or near-to-do-so following in his footsteps.  I'd like to have a financially and spiritually thriving school in Bundibugyo, instead we have an institution beset by riots and rumors on a regular basis that still manages to turn out the best in the district but never feels like a sure bet.  I'd like loose ends tied up, rogue cells zapped out of the body, jobs for our unemployed dear ones, and while we're at it, peace in South Sudan.

What we get, though, is the obscure uncertainty of living by faith.

Easier for me to say than for Travis and Amy, though I know they do say it.  We get to keep plugging through the next treatment or the next day.  We get to do our best, even when it feels pitifully too little, jerry-rigging oxygen tubing to share the molecules like the loaves and the fish amongst too many patients.

We get to keep walking into an uncertain day, facing absences and strikes and shortages and desperate needs.  We get to keep praying for our dear ones when beset by thieves or illness or failures or injuries.  

And on milestones like today, sometimes we get to look back and give testimony that maybe God's hard plan contains the best in some mysterious way.  Our sermon in church today talked about the times Jesus' disciples wanted what they thought was good and reasonable to ask for (help in the storm, healing for Lazarus) but in the silence of God's seeming non-response, they were set up for something unimaginable:  waves and wind stilled, resurrection.  That's what we look for for Travis and Amy, for Africa, for us.  We don't live by the odds, which is unsettling but hopeful.