Sixteen

Caleb, sixteen, and sometimes sweet (are boys allowed?). Thoughtful, affectionate, affirming. Quiet, needing down time to play guitar, to listen to music. Never quite enough sleep. Aggressive on the field, coordinated, strong, wiry, endurance. Aware. Thankful. Sometimes a loner, not one to bend to the crowd. Keeps his thoughts to himself mostly. More likely to just shut the door and do the work than to complain or ask for help. Quick wit. Sharply funny, in the right mood could be a stand-up comedian, the eye for the incongruous. Still silly.

Today Caleb turned 16, right here where he was born. All three meals a celebration, punctuating the normal work of the day. Culminating in five friends joining us for tacos, chocolate cake, and home-made ice cream (inaugurating the hand-crank freezer that took up the better part of a trunk, 10% of our luggage allowance!). Crazy noise-making horns and bubbles so the HS Juniors could revert to their true 5-year-old souls.

Birthdays wipe me out, carrying the weight of expectation through the day, to push to make it special because I want to honor the person I love. But the rest of the world turns on, punky babies are born and forget to breathe properly, children vomit, mothers are anxious, labs come back abnormal, xrays need reviewed. So the day becomes a struggle to be two things at once, creative at-home cake-baking mom and responsible in-the-NICU doctor, all accentuated by the rigid time-keeping of a boarding school where the friends who come for dinner have to be at dorm study halls at 7, though mercy was reluctantly granted for a 15 minute lateness. Add in a basketball home game for Jack, Scott and I tag-teaming on cooking and cheering and hospital calls (alone I NEVER would have made it). I suppose that tension between the worlds of work and home started back with the first giving-birth and will continue until they are all grown and launched, and beyond.

A Burundian Story

Burundi emerges in folds and ridges, green, rumpled steep, then a snaking river that twists into one of the deepest and longest lakes in the entire world. Rice paddies and dusty roads and then the tarmac of the small international airport, we are in Bujumbura. A single rusted Air Burundi jet sits neglected by the old terminal, but we taxi past to the shiny silo towers of the new one. We stumble through the French arrival forms and smile a lot. Our bags are x-rayed as we LEAVE the arrival area, which sort of fits the general tone of isolation and suspicion. It's not an easy country to get into. Being from Appalachia, I wonder at the parallels, mountainous terrain where clans cling to coves and hillsides and remain inaccessible and independent.

Background: Burundi was colonized by the Germans, but not extensively. After WW1 the European powers transferred Burundi into the hands of the Belgians, until independence in 1962 (same year that Uganda and I were born). Though all three "tribes" speak the same language, the Belgians in both Burundi and Rwanda favored the Hamitic-descended Tutsis over the Bantu-descended Hutus as chiefs and administrators, and left the forest-dwelling BaTwa (pygmies) out altogether, setting up over decades the tensions that erupted in the 70's and 90's in genocide. Central, inland, Africa was one of the last places to be reached by missionaries as well, with the first protestant missions arriving in the 1930's. The small bands of North American and European evangelicals forged schools and a few hospitals with an unusual spirit of interdenominational cooperation. But years of war, destruction, the exodus of expatriates, left these missions devastated. In the last five years the missionaries have begun to trickle back, following their Burundian colleagues, a dozen or two now resident in a country of 8 million people. A church leader who spent years in exile in Nairobi started a school while there for the Burundian refugees, and as peace was established moved it back to Bujumbura as Hope Africa University. This university has grown from a few hundred to a few thousand students, with medicine and nursing (and Bible and education and engineering, a radio station, clinic, library, computer lab, dorms, etc.). Their motto: Facing African Realities. And the founder, Bishop Ellie, prayed for 15 doctors to come and establish a clinical training hospital at Kibuye, 2 hours into the hills, right smack in the middle of the country, where students in the nursing and medicine programs could be mentored and taught, discipled and molded.

Meanwhile, a group of young men and women befriended each other during their medical school years in Michigan. Two were MK's who grew up in Africa. All were committed to giving their skills back where they were most needed. The ophthalmologist and the surgeon married their school-mate sweethearts who had become teachers, and the family medicine doctor married the obstetrician, and all three couples joined the Samaritan's Purse Post-Residency Program designed to get young doctors to Africa for two-year apprenticeships. They called themselves "The McCropders", a synthesis of all their last names, for ease of reference. They were sent to Tenwek, a mission hospital in Kenya, where they added a medicine-pediatrics and an ER doc to their number. Six doctors and two teachers; 3 couples and 2 singles; 6 babies later . . they began to ask God where He would have them serve long-term. It had to be a hard-to-reach sort of place, needy, with a focus on teaching medical students. They explored several options, including Hope Africa University (through a friend-of-a-friend who read their blog and thought they might fit).

And while this was unfolding, they came in contact with WHM because the church they all attended in medical school had been impacted by Sonship. We arranged a lunch meeting a year ago when we were in Kenya for the CMDA conference, and kept in touch. As the Burundi option became more appealing to them, they looked for a mission agency that would be interested in sending them. As Scott moved into the role of Field Director, the evaluation of this potential new work became part of our job. Which is a lot of background story on how Burundi, the McCropders, Hope Africa University, the Myhres, and World Harvest Mission all ended up entwined this past week.

Word Pictures: Burundian drummers, tall, red-robed, springing handstands and jumps and claps, flashing sticks, chanting hymns, wild enthusiasm and rhythm. The winding smoothly paved road that snakes up from the lakeshore capital and into the hills, clay-tiled roofs, fields and villages flying past. The carefully handwritten lists of tests and patients in the laboratory, malaria, malaria, malaria. A peek into the operating theatre where a visiting short-term retired missionary doctor was amputating a young girl's severely infected arm, medical students watching, drapes and blood and a clutter of equipment. Bright kitengi-clad mothers lined up on the benches, waiting for care. Wide boulevards in the capital, cobblestone side-streets. The multi-story Hope Africa University buildings, solid and fresh, rising from the dirt, disgorging hundreds and hundreds of young people from multiple countries in Africa, with their jeans and braids and cell phones and chatter. A peek into the grocery stores, sparse goods neatly arranged, too much space. The noisy clatter of the University dining hall where we chat over lunch with professors from Congo and Canada. Fresh cement, the whine of wheelbarrows and clang of hammers, more buildings under construction. A young boy in traction for a broken leg, his x-ray hanging over his bed, so poor in quality one can hardly tell the bone from the background. The thrumming of a grain mill where the church manufactures a nutritious porridge for malnourished children. Walking down the dirt paths of Kibuye, imagining houses for the team somewhere back in the weedy perimeter. Dredging up new Swahili skills when the taxi driver kept stopping and changing direction; hearing the echos of Lubwisi in KiRundi; resurrecting college French as others spoke. Whipping wind and rain as a massive storm moved in one night, flashes of lightening, powerful, while we ate dinner under and open-walled pavilion.

Highlights: For a three-night, four-day trip, we packed a lot in. But the biggest highlight for us was our traveling companions, three of the McCropder group. After almost a year of goodbye and transition, we were looking ahead. We laughed, more than we have in a long time. Should we admit this? It was fun. And, we sensed God's presence with us. My Bible reading prior to going fell in Ezra and Nehemiah, which was amazing timing. The parallels between Burundi and Israel at that point in her history are striking: small country, over-run by war, now with exiles returning to a destroyed infrastructure, rebuilding, facing opposition and doubt, balancing prayer and practicality, depending on God while also asking for financial help, repenting and reconciling and ready to be a blessing to the larger world. Our first night we met with some Burundian Christians who said the same thing, let this nation be rebuilt to bless others, even though we are small. The passion for tackling the problems of poverty, disease, tribalism, discrimination, witchcraft, hunger . . . was infectious. It is the Burundians who are leading, and they are asking for a few outsiders to come alongside and help, to train and teach and encourage until the 6 Americans are replaced by the 15 Burundians the Bishop prays for.

The story and the Author: When we touched down at the airport, we warned the McCropders that we did not have a very good track record of being met at airports (my first trip to Africa it took me days to find the people I was supposed to serve with; our entrance to Uganda we waited hours and thought we'd been forgotten). Sure enough there was no one waiting for us . . . but they soon arrived. Bishop Ellie's daughter La'Charite, and a retired missionary couple the Vibberts. And within the first hour, we realized the way God had prepared for us. It just so happens that the Vibberts' son was a friend of ours in Uganda, working in Bundibugyo, of all places. They embraced us like long-lost family. And it just so happens that Scott and Bishop Ellie attended the same seminary at the same time, Trinity in Chicago. God delights in these details that remind us that He is the author of this whole story. We don't know how this one will end. The next chapters will unfold this year as we present the potential for the new field to the WHM Board, and as the McCropders apply to join the mission. I don't know if we will join hands, but I hope we do. Either way, I'm sure that the McCropder's story, and Burundi's, and ours, will have suspense and drama and comedy and hope, and in the end, love will prevail.

Burundi Trip

Here's a report from the blog of our travel companions, with some great pictures!  http://mccropders.blogspot.com/2011/02/back-from-burundi.html

 I would like to believe that they have a better internet connection in their remote bush hospital than we do at ours . . . but our delay is also related to coming back to clinical responsibilities and kid stuff.  Yesterday Jack traveled with the junior high (7th and 8th grade) basketball team to a Nairobi-wide tournament and won first place!  He had a blast.  We all stayed here because RVA also sponsored a high school tournament for girls' football (soccer) and boys' basketball.  Julia's JV team entered against five other varsities.  They didn't win, but they did hold both of the top two teams to scoreless draws, and played very well.  The boys' basketball was the most exciting finish.  RVA won in overtime by a last-seconds layup from a very small 9th grader, Micah N.  They were playing a team of very TALL Kenyans who had crushed every other team in the tournament, so it was an unexpected victory and the crowd went wild.  

Thankful to mix a week of exploratory, open-up-the-dreams travel to a needy place; intensive care for severely ill and premature newborns and AIDS-ravaged adults; and memorable time baking in the equatorial sun cheering our kids on in sports.  The fact that one can do all three from this spot of earth is God's goodness to us.

If ever a place needed . . .

So much to tell, too much for 10:45 pm after traveling from Bujumbura to Nairobi, buying groceries, catching a ride back to Kijabe in time for another JV Girls' Football victory (with another corner kick goal by Julia, which we sadly missed by about two minutes as we arrived), cooking dinner with Bethany, and being called to casualty for a girl with meningitis and a boy with a punctured (tragically, pretty much destroyed) eye.  So I will just introduce the trip with this actual quote from a 1949 autobiographical history of missions in Burundi which we read while there (But They Right Hand by John Wesley Haley), and promise more tomorrow. . . . Kibuye is the town where we would like to place a medical educational team, right smack in the center of the country.  The Free Methodists established a hospital there in the 1940's.  Prior to the arrival of the first doctor, this letter was printed in a July 1938 newsletter called Nile-Congo Notes:

"Kibuye is a beautiful place.  The view is magnificient.  There are many people here.  Sister A. has started the dispensary work, and already has from two hundred fifty to three hundred patients every day, so you see I am going to have my hands full.  I have never seen such terrible sights in my life as I have seen here.  If ever a place needed a doctor, a nurse and a hospital, Kibuye does.  Will you who read plase join us in prayer that God may send for the necessary workers?  We also need a teacher.  'More things are wrought by prayer than this world dreams of.'"

Every word is still true today, 73 years later.  Missionaries came, built, blessed, went.  War swept through, in two major waves in the 1970's and 1990's.  Hundreds of thousands died.  A tentative peace was established, and the diaspora of educated Burundians returned with vision and hope for their country.  And now the door is open, the invitation given, for us to join in the effort of healing and rebuilding.  Doctors, nurses, hospitals, teachers . . let us heed the call of the generation past, and join in prayer that God would send them.

Heading to Burundi

In the happiness of a new computer as we returned to Africa, I am just remembering the sadness of the fact that my email lists for sending prayer updates did not transfer. One of these days I need to reconstruct. But not today. We are taking a deep inhale after the Banquet week and our small role in helping Caleb's class, on top of the ongoing energy-expenditure of adjusting to Kijabe. Last night was the big event, which meant that most of the afternoon I was helping with the final arrangements, then we were photographing the set, then the boys getting ready at the dorm, then the boys picking the girls up at their dorm and walking up. The theme, which can now be revealed (!) was a Venice Masquerade, with a clever skit, musical numbers, elegant table settings, a fountain, fancy food, masks and music. I found a place in the parent serving line, arranging plates and dishing up course after course, from about 8 to 11. The party went on 'til after midnight but once we served up dessert I headed home for a few hours of sleep before early Saturday rounds . . .and this morning Scott helped deconstruct, and Caleb is still up there cleaning. So we could all use a few hours to clean and cook and recover . .

. . Before tomorrow morning, when Scott and I head to Burundi. We're accompanying three young doctors-and-spouses on an exploratory trip to Africa Hope University, a decade-old Christian University with a new medical school and a vision for transforming the country of Burundi. This is a country in which several hundred thousand people were killed between 1993-2006 in an intractable civil war sparked by Hutu-Tutsi ethnic violence similar to Rwanda's. But in the last few years there has been a return to sanity and a beginning of healing. By grace, we were privileged to be approached by a group of young American missionary doctors currently working at Tenwek Hospital in Kenya through the excellent Samaritan's Purse Post-Residency Program, who were considering their long-term calling. We met up at the CMDA conference a year ago, and in the meantime they narrowed their calling down to Burundi, and we at WHM are in the process of enfolding them. They would form a team for teaching and discipling medical students, an ideal way to bring new physical and spiritual life to a suffering country. There are 0.3 physicians/10,000 population in Burundi (25-30 in USA, 2-3 in Africa generally).

Would you pray that we would experience together a sense of God's leading and calling? That we would bond as we travel? That God would watch over all our children as we're gone? (Classically, Julia has a temp of 101 as I write). That God's love would extend to many more people in Burundi as a result of this trip?

Thanks.

A link to HAU's recent newsletter: http://hopeafricauniversity.org/newsletters/november-2010

A link to the blog of the doctors we are traveling with: http://mccropders.blogspot.com/

Why We're Here, Again

Today, another reminder of why we're here. It's not one simple reason, but a collection. This hospital has become the destination of choice for people from a very closed, violent, unstable, and hostile country to the North. How ironic, that the people are coming TO the missionaries rather than the other way around. The word is out: here is a place where you are cared for. So they come, and many meet Jesus. This hospital is also a refuge for the marginal, and a respite for the hurting, from nearby and every corner of Kenya.

And besides learning a lot from the experienced and competent colleagues here, and serving the sick and poor, we're here because it's a good central place to communicate with all our teams, to discuss medical problems and research issues and chat on the phone. Uganda faces potentially contentious elections on Friday. Our team is bracing. We have enjoyed catching up with our Kenya and Sudan-based colleagues. And we leave on Sunday for a three-day trip to Burundi where we will be helping a potential new team research the possibilities for service.

But tonight I'm admitting that there is another, BIG "why we're here" dynamic, that is not so holy or noble but none-the-less true and dear to our hearts. We're here where we can live with our kids, and be part of their lives for a few more years. We left work early this afternoon and drove into Nairobi's western suburbs to the International School of Kenya. And we watched Jack's Junior High Basketball team win 41-22, cheering him on. For a kid who grew up in the "bush" and never played basketball until a few weeks ago, he's holding his own and learning the game. Scott and I actually only each saw half the game, switching back and forth, because Julia's Junior Varsity girls' football (soccer) team was also beating ISK 2 to 0. Julia is the power-foot on the team, takes all the corners and goal kicks. She is one of the most valuable and steady players, starts and plays the whole game, and loves it. So instead of hearing about all this on the phone, we get to attend the games, and thank the coaches, and share the excitement. And afterwards to cook dinner for all of them, and discuss their research papers or hear about what happened in their days.

Thankful to be here. The missing piece is Luke, and he's applying for a research fellowship to come for the summer. Praying.

patient notes

I am not patient, but here are some notes of why I should be.

Today Baby F went home, with a smiling mother. Not a tinge of yellow. Feeding well, and looking relatively normal, if you don't look too hard. No seizure medicines, no medicines at all. A grueling effort now recedes into the blur of hours long gone, and a delighted young woman, whose brush with bereavement came too close, holds a baby.

Today we got a final lab back on Baby A. He had been born in late November, and went home, at last, yesterday. I was only part of the latter half of his course, but it was enough to soberly acknowledge his escape. He was born as a premature speck to an HIV-positive mother. As if that weren't enough, he had dangerously immature lungs, and developed life-threatening meningitis, growing stool organisms from his brain linings. Not good. Three weeks of strong IV antibiotics and a small intracranial bleed later, he was still twitchy and volatile. One day it occurred to me from the dark recesses of memory that his spastic movements reminded me of some babies who reflux, whose acid-laden stomach contents boil back up into their esophagus. We tried some ulcer-calming type of medicines and positioning, and it did the trick. Slowly he emerged from his oxygen-dependence, and lost tubes, and gained flesh, and one day there he was, a little boy with a face and personality. When we discharged him, his mother (whose eventually fatal disease did not keep her from investing hour by hour in the survival of this son) simply said "I have no words to thank you, may God bless you." We prayed for A and his mom, and asked her to pray for us. So it was very sweet to get the news today that his HIV test was negative. He has escaped about four commonly fatal conditions already, and he's not even five pounds yet. That is mercy.

Those two departures made room for the next struggles. Baby H and Baby N, neighbors now in suffering. Baby H was born in a refugee camp for Somalians just inside the barren, distant border of northern Kenya. Only the problem was, where she should have had an open anus for passing stool, she had a dimple of intact skin. By the second or third day of life she was vomiting everything that could not pass through, and her mother got on a bus, alone, and took the two day trip to Kijabe, where she can't speak to any of us. We gesture a lot. This woman is a refugee mother-of-8, who just survived childbirth and a punishing journey, and sits now amongst strangers with a critically ill baby, which somehow amazes me. The surgeons saved the baby's life with a temporary colostomy. She has the most beautiful face. And her room-mate Baby N, faces a surgery tomorrow that she may or may not survive. She was born without skin or skull bone over most of the top of her head, only the linings which cover her brain. With a bandaged head she looks exotic, Nefrititi-ish, but beneath those wraps the dura membranes are darkening ominously. Her syndrome includes a whoppingly worrisome heart murmur and tiny malformed fingers and toes. But she is alert and otherwise lovely and feeding well, her mom's first baby. The surgeons tomorrow will try to stretch some scalp over her defect, and perhaps transfer grafts of flaps from other areas of her tiny body, bloody and technically challenging enough without the question of her heart's capacity.

This is Kijabe, a place that seems to draw in fragile, marginal, guarded-prognosis people. As Scott and I often say to each other, almost everyone we care for here would have been long dead in Bundibugyo. Instead, here, they are scooped up into the Kingdom, the mountain of the Lord that is populated by the scabby-scalped and jaundiced and spastic. Here they are treated with the honor of being important enough to warrant surgery and xrays and labs and effort. Here they encounter a few missionaries but mostly dedicated Kenyans, who are raising their own money for new projects, and providing their own administration, who are accessing the internet and pondering the possible. Bundibugyo in another fifty years? I hope so. Let us be patient.

Entering a New Culture, in many layers

Here in Kijabe, Kenya, we are entering many cultures at once. We're in a small Kenyan town clinging to the escarpment of the Rift Valley that has grown up around the AIM mission station over the last hundred years, facilitated by the famous Lunatic Express railroad, heavily Kikuyu, with small gardens and cows and forests descending into a grassy valley with pastoralist Massai and wild animals. We're about an hour west of Nairobi, a huge international congested city of contrasts with shopping malls and slums and highways and potholes. We're in an AIC-run African hospital with some 500 almost completely Kenyan staff and administration, with it's cluttered wards and spacious new operating theatres and very reasonable ICU, where my main working "team" consists of Kenyan nurses, interns, clinical officers, an Indian long-term resident, a Swiss short-term resident, and an American medical student. (In our two weeks in our new house, I estimate we've had about 15 people over for meals, among them five nationalities from four continents!). We're living on "Lower Station", the sprawling maze of small cinderblock houses, dry grassy yards, splashes of bougainvillea color, with the other missionary (and local) doctors and senior staff, blending into the largely Kenyan staff of the Bible college, dental clinic, printing press, nursing school, hotel, etc. And we're a short steep walk below the island of small-town-America that exists within the fenced compound of RVA, the missionary boarding school.

This weekend we've been immersed in the latter culture. In RVA tradition, the Junior class puts on an annual "Banquet", the main social event of the year, when the boys spiff up in suits and escort the girls in their beautiful dresses. It's the equivalent of the prom in an historically conservative fundamentalist no-dancing missionary tradition. The kids have been planning and fundraising all year, but this is the major push weekend prior to Friday's production. It is an impressive effort, with a theme kept secret from the rest of the school, but which always involves construction of an elaborate dinner-theatre type set, murals, painting, atmosphere, lighting, a drama, music, table settings, costumes, etc. All in a place that is strictly DIY: do it yourself, make it from scratch. So the parents of the Junior class are invited to come on campus while the rest of the school clears out for midterm, and WORK. Scott has been hammering and drilling and sweeping; I have been ironing and glueing and folding and cutting. And Caleb has been photoshopping on his computer while covering as DJ for music to keep the atmosphere pumped up. The class is well organized and I think the whole thing is going to be as spectacular as every other year. One of the faculty sponsors told us on the first evening: our purpose is to glorify God and to get to know each other, because those priorities last for eternity, but Banquet is only for one evening. Amen.

I'm thankful to be here for this time, to immerse and understand a little more fully this culture. It is an incredibly valuable one, a place of sacrifice and honor and idealism which has been turning out generations of well-educated and dedicated young people, from dozens of countries around the world. It is also a place that is rule-oriented and cliquish at times, and just being inside it helps me understand the places that are hard for my kids. Many of the parents I've met have amazing life stories, decades of Africa experience, long connections with the school . . . but we also clearly sense that we're now the new people, unproven and unknown, here in this cross-roads of mission stations and nationalities. I've been reading the history of the school which has been insightful as we go along, The School in the Clouds by Phil Dow. I think he gives a balanced picture of respect for the place RVA has played in the development of East Africa and even the emergence from colonialism, while being realistic about the challenges the school continues to face. I feel the same awesome respect for the century of perseverance, and yet a yearning for what could be here in the future.

Meanwhile it is good for the names I've heard from Luke and Caleb over the last few years to now take on faces and personality, good to see a class gel around the hard work and play of creating this celebration, good to interact with a wide cross-section of our missional peers, parents in their 40's and 50's who like us have taken the road less traveled, good to wear jeans and speak English. Tomorrow we'll be back to the more African culture of sick babies and tuberculous men and bright young doctors and straining to understand Swahili. And I guess that our life here will continue to be a weaving of the lower (hospital and other ministries) and upper (school) station cultures. Hoping we can find a good balance and fit in all around.

Bloody Messes of the Curative variety

Last week, I came into the special-care nursery to find a baby on our service who had been admitted the night before with severe jaundice. Bilirubin, the toxin in the blood that makes a person turn yellow-ish, can poison the brain if the levels get too high. Normal babies stay below 10, and we worry at 20. Baby F came in with a level of 40. That's about as high as it goes, and F already had signs of brain impact. He stiffened and extended his arms and arched his neck backwards, breathing was fast and labored. It seems his blood type triggered an immune response in his mother, normally minor but in this case combined with infection and poor feeding and dehydration, nearly lethal. All this happened slowly at home (he was not born at Kijabe) until the mother-in-law showed up to visit and told the parents it was time to take the baby to the hospital. The on-call team had performed one double-volume exchange transfusion soon after admission. I suppose it's like changing oil in a car, only you can't exactly drain out all the bad blood and then replace it. Instead you have to pull out small amounts at a time, and keep replacing them with small aliquots of donor blood, and if all goes well over a couple of hours you can go through the equivalent of twice the baby's blood volume.

IF ALL GOES WELL. That's a big IF. Baby F's first exchange had brought him from 40 to 32. An improvement, but atill in the severe panic range. I knew we'd have to do it again, so I didn't wait around, and made the plan first thing in the morning, hoping to be done by noon. Ha! By noon we had just received the donor blood for exchange. I still thought, foolishly, that I could make it to the latter part of an afternoon birthday party for one of our missionary colleagues, and hopefully even a planned late afternoon walk and talk with another mom. These were to be my first really social events and I was looking forward to them. However, what followed, from 12:30 to 8:30 pm, was eight hours of a bloody mess.

The line was the main problem. Newborns have the blessing of an umbilicus, and it is usually possible to put a steady, large IV line in the umbilical vein. The peds surgery team had done so the night before, a bit more difficult since the baby had been at home for a week, but done, so we were all set. But actually, we weren't. The promising umbilical catheter behaved erratically. You have to be able to pull blood out and then push other blood in, 20 cc at a time, in and out, about 25 or 30 times, until a half-litre or more of blood is exchanged. At every 5 minutes, it should take 2 to 3 hours. After the first hour we had barely done anything as we fiddled with the line, noted air bubbles, tried to change the connections, pondered a too-dark xray for placement, consulted surgery again, held up other catheters to figure out how long F's was and where it ended in his body. In short, we struggled. Eking out a few cc's of blood here, pushing in a few cc's there, always with the tenuous feeling that our access was about to close.

Baby F, with his sickly yellow skin, his stiff spastic body, his scarily pulling ribs as he tried to breathe, his oxygen tubing and IV's, his monitors beeping, did not protest. Even when at the six-plus hour mark we gave up on the line and jabbed his groin for a second IV. The difficulty of drawing from either line led to lots of small, 1 or 2 cc aliquots. Frothing blood, a dripping, slimy mess, aching back and legs, sweat in the steamy nursery, glaring lights, the blue bili-rubin lights shining in our way too, recording amounts and times, checking the baby. Who barely whimpered and never cried. Who had nothing to eat all day either, who was basically tied down to the treatment table.

I confess, here and now, I did not have a noble attitude. I knew I had to stay until the bitter end, this was my problem on my service. I'm so thankful for the partnership of a young Indian doctor who is working at Kijabe for a few months, and for the nurses who recorded the struggle and checked the vital signs. But as the day wore on into evening and night, no lunch, no dinner, no bday party, no walk, no break, I was getting more and more frustrated. Because in my heart I was thinking: this is pointless. This baby is already devastated. Are we really doing any good?

We had hoped to get the level below 25, and the next morning as I waited for the results, I was determined NOT to go through this process again. The results: 19. Better than we had hoped, probably because the whole process took so LONG there was more equilibration and effect. Next day: 13, then 8, then 5, then 3. With no further therapy. And baby F became less stiff. Without the lines and oxygen and dripping blood, he looked, well, baby-ish. Today he was breast-feeding, noisily and hungrily. He's off all his seizure medications, and not convulsing. He is starting to look like he will survive, he will leave this nursery soon. I don't think he'll emerge unscathed. His hearing is likely affected, and he may look like a cerebral palsy kind of kid. But the newborn brain is pretty amazingly adaptable. So only God knows.

Which is the point. Only God knows. And God was listening to one of the older ladies who accompanies her doctor-husband here every year, and then spends her time praying and ministering to others. She had come by our house and found me gone that first night, and when she didn't find me and heard about baby F, she decided to pray for him. And I wondered how the bilirubin levels had continued to fall so dramatically! Baby F was PRAYED for.

The cross was a bloody, curative mess too. For people like me, who, compared to Jesus, do not seem to hold much promise. Aching hours of effort, a sanginous sacrifice. No stinginess from God, no weighing of the prognosis, no withholding of the costliest and best. Let me plunge into the bloody messy world like Jesus, and let that effort bring life.

Celebrating Luke

18 years ago, after six weeks of preterm labor and bedrest and hospital stays and every-three-hour medication, with my OB's permission I stood up, and promptly went into labor. And so Luke came into the world, causing a bit of trouble even before he could breathe. Today I was called to emergently evaluate another 36-week preemie who, like Luke long ago, was not quite catching on to the work of life in this world, and was looking a bit sick. I doubt that punky little "Esther" will ever be 6 foot 3 inches or a freshman at Yale, but who knows. In the blink of an eye, it seems, that little being in the incubator that just ripped ones body open will be a huge being far away ripping ones heart. The in-between stages of precocious words and scrappy roughhousing and passionate soccer and reading Lord of the Rings umpteen times and mountain climbing and spotting lions and flying alone across oceans suddenly collapse into a blur, and the newborn is an official vote-capable adult. There are few people in the world I would have more confidence in, or find more interesting to be with. Which makes the little detail of seven thousand miles pretty sad.

Thanks to my mom, who braved the train alone to New Haven for a pre-Birthday visit, loaded with goodies. Thanks to Jessica and Thomas Letchford, who are friends-closer-than-a-brother(sister) in the best sense, with meals and a cake and fun. Thanks to a suite full of great guys who will probably sing and be wild. Thanks to strangers who will make this first family-less birthday for Luke a good one.

Happy 18th Birthday Luke. We love you more than the mountains are high.

good news from a far country

Cooking dinner, BBC keeping me company on our worldspace satellite radio . . and the good news.  Bashir, president of Sudan, has given a speech saying he will recognize and accept the vote of the southerners to secede.  Hugely good news.  Hopeful.

More transition at Christ School

In 2010, we realized one of our longest-standing goals at Christ School … to place a Ugandan at the helm of the school as Head Teacher. We met this goal after much effort, anguish and prayer.

As with every year, 2010 at CSB was filled with highs and lows, frustrations and celebrations. However, in addition to the ups and downs, as Travis and I did our end-of-year evaluation we saw some signs of serious problems. Nearly half of our teaching staff decided to leave in December including two of our most senior teaching staff (one of which was a Deputy Head Teacher). The signs of collapsing morale and a lack of conviction for the Vision of the school led us to decide to make a change in the leadership of the school - 10 days before students were to report for classes. We did this - by faith - not sure how it would play out. God, however, had a plan.

Some of you may remember the story of a young Ugandan who became a Christian as a result of listening to Robert Carr and Alan Lee fight during a car ride over the Rwenzoris – and then repent to each other for how they had sinned against one another. That young man was Isingoma Edward. Isingoma (his name means "the first of twins") has been a colleague and partner to WHM-Uganda missionaries for 25 years. He's got tremendous leadership gifts and the requisite Masters degree for the Head Teacher job. When we offered Isingoma the job last week, his response was this: "I am ready and willing to do anything in my power to serve World Harvest Mission and Christ School." He has a fervent passion for knowing the LORD and making Him known. He firmly grasps the Vision Statement of CSB:

An academically excellent senior secondary boarding school

producing servant leaders

for the good of Bundibugyo and God's glory.

Please continue to pray for Christ School, for Isingoma as its new Head Teacher, and for Travis and Amy as they lead the Team and the school.

Please see the blog of Travis and Amy for a more detailed re-telling of this wonderful story of God's faithfulness.

HOPE

Scott here. Being “on-call” is part of the life of a physician. Last night, at Kijabe Hospital I was “on” for Medicine. Thankfully, though, because of our age and experience Jennifer and I are never the “first call” – that burden falls to our Kenyan Medical Interns. My front line warrior last night was Issac, a quiet diligent and quite competent young doctor. He called about 10pm last night for help. He was trying to clear the Outpatient Department so he could get some sleep. A dozen or so patients who had clocked into the OPD in the midafternoon were still waiting – and their patience was wearing thin.

So, braving the howling gales and pitch dark, I trudged over to Outpatient. I found a sleepy group of patients waiting for their turn to tell their stories to a doctor. None were critically ill, but obviously all felt ill enough to wait for hours to get an evaluation – and hoped for a cure. I sent a 6 year old for an elbow x-ray, admitted a 50 year woman who was scheduled for elective thyroid surgery tomorrow…and then came to W., a 55 year old woman with an “something in her stomach”. This lady stated she had a mass in her abdomen which had been moving around for the past FIVE YEARS. “Ma’am,” I said, “why have you decided to come to Kijabe Hospital TODAY – at 3pm in the afternoon – when you have been having this problem for FIVE YEARS?”

“Well, because my neighbor came to Kijabe and she got treated – and she’s better now,” she said.

“Where do you and your neighbor live?” I queried.

“Mombasa. I rode the bus from Mombasa early this morning.”

Yikes. That’s easily an 8 or 9 hour bus trip. This lady spent a considerable sum of her small savings, invested an entire day, and trekked halfway across the country, and ended up seeing me – hoping for a cure.

I’ve heard this type of complaint scores of times. “The worms are eating up my insides…the worms are moving around inside of me…there’s a stone growing up in this side of my belly…” Frankly, it’s a tough type of case to treat. Sometimes there is a diagnosis to be made; giardia, enlarged spleen from malaria, dysentery…and sometimes I can’t identify an explanation of the symptoms. In Bundibugyo, without any diagnostic tools, the latter was often the case. I began to feel a bit nervous – what if I can’t do anything for this lady? That will be horrible.

Well, I thoroughly examined her abdomen – no small challenge since there was about 6 inches of adipose tissue between my hands and her innards. I did detect a slight firmness and tenderness in her upper abdomen – so I decided to send her for an abdominal ultrasound, but that couldn’t be done until tomorrow.

“Ma’am, I want you to come back for ultrasound in the morning. Do you have anywhere to stay tonight? Do you know anyone around here?”

“No. I’ll just sleep here on this bench. I got no where to go.”

“Well…alright.”

So, I handed her a requisition for the ultrasound – and prayed that somehow she could be satisfied – with her care, with the outcome, with whatever diagnosis she ended up with.

I don’t know what happened. But I do know that I need to have that kind of hope, that surety that somehow God can make things all right – and I need to have a similar willingness to sacrifice all that I have in order to allow Him to do so.

Why we do it

A call, just before midnight. Outside, into the night, small flashlight on uneven dusty road. Dare to look away from the ruts and rocks, up at the Milky Way stretching brilliantly over Africa, undimmed, spectacular. Wind gusting in unseen trees. Then the hospital, the sleepy guard opens a gate, the empty corridors eerily quiet at last.

I bypass the nursery and ward and head straight to the newly constructed suite of operating theatres, where I change into clean clogs, mask, gown, hair-cover. There is the intern who called me, checking the warming bed and oxygen flow in the neonatal resuscitation room. I peek into the operating theatre next door, through the glass windows in the swinging doors, where the surgeon happens to be Scott. He let the on-call family physician know that one of his goals here at Kijabe is to become more proficient with C-sections, and at this moment he's well into what will be the second of three between 9 pm and 3 am. This woman, I hear, has severe pre-ecclampsia and gestational diabetes. She's been deteriorating all weekend and is now under general anesthesia in an attempt to save her life, and hopefully that of her 35-week (one month early) infant. No time to ask questions because I can see the smooth bloody purple curve of a head being pulled from her abdomen.

A few seconds later the baby is rushed into our room. I thought I heard a whimper, but when the scrub nurse deposits the infant on the warmer, I see no signs of life. He is limp. Not even a gasp of breath. The intern and I rub his back, talking to him, willing him to breathe baby breathe. We dry his slippery brown body and hold the oxygen near his face. I feel for a pulse, and feel nothing. Start bagging, I tell the intern. NOW. The intern places a mask over the baby's face attached to oxygen, and very effectively delivers breaths, a little too fast but that's to be expected in the stress of the situation. I have my stethoscope out, hear good air entry, and now the beginnings of a heartbeat. As we reach the one minute mark, we pause and dry and rub again, trying to wake him up. Apgar 5 out of 10, he's pink and has a good heart rate thanks to the initial resuscitation. Bag another half a minute. Now his arms are moving, he grimaces, and weakly cries. We change for dry cloths, blowing a little oxygen by his face as he now decides to make the transition to life. We check over his whole body now that we aren't focused on the basics of survival. He's beautiful.

Mom is still unconscious and we're not so confident of this baby's strength, so we decide to take him back to the nursery with us. I gather him up in my arms wrapped in surgical cloths, warm and solid, and walk him through the sleeping hospital into the blue glow and steamy warmth of the NICU. Since his mom was diabetic and he's premature we have to watch his blood glucose level, and put him on IV fluids and oxygen and a monitor for a day. But today he's fine, and now I think as a mom more than a doctor and convince the nursery team (who would rather have him attached to tubes and under their eyes) to let him go back to the maternity ward and bunk with his mom, so he can start breast feeding. She's slowly improving, delivery being the cure for toxemia. In the afternoon I check back and am relieved to know he's fine.

An hour or two for the mom, a few minutes for the baby, the difference between life and death. The availability of a safe and competent C-section for her, the immediate response of warmth and a kick-start of breathing for him, and now the prospect of continued life instead of two burials. Most hours aren't so clearly beneficial to anyone, so it is something to savor, to witness pink warm life creeping into an infant body. Of course in the case of Kijabe, this all would have happened without us, there are many doctors here. It just happened to be on our watch this time.

Here is my secret: I love being on call. I like the quietness of the hospital at night, the focus of only one operation, one baby in need, one admission. The thinning of the crowd, the direct contact with one family or one intern. The friendliness of the nurses away from the pressures of the day. The slipping back out into the night when all is settled, the brisk walk back to a sleeping house. The momentary assurance, that's why we're here.