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Sunday, April 28, 2013

Of saints, beginnings, endings, and a present help

Two friends got married on Saturday:  Agnes, one of our hospital chaplains got married here, and from the reports of friends they pulled it off well even though the Kijabe contingent was delayed half the day by the mudslides.  And Matt Allison, who showed up in Uganda in 2004 fresh from college, an intellectual historian taking a pause before his PhD to teach, preferably high school, and gamely allowed us to hand him the preschool and kindergarten.  Matt married Rachel in Philadelphia where he now works for WHM, and we are enjoying the smattering of photos starting to crop up on facebook.

Two weddings, two beginnings, four saints embarking upon lives of commitment and service and reflection of God's glory.

And one saint reaching the end of her life.  Though we missed the weddings, this afternoon we did attend a funeral.  We never met Martha Pontier in this life, but we know her siblings, niece and nephew.  A four-generation missionary family whose paths have crossed ours here and there.  Martha was my age, and as an adult had served in Africa almost the same span of time.  She was a healthy woman until a mosquito bit her in Mombasa where she worked, the same week I was there.  She came down with what was later diagnosed as dengue fever, a viral infection that 98% of the time results in a full recovery.  But in a few people, it progresses to a fulminant fatality.

We went to pay respect to a family who has laid down their lives for the good of Africa and the glory of God.  To honor a woman who loved this place and these people, whom her family and colleagues characterized as a person of generosity and dependence upon God.  To remember God's purposes and power when the worst happens.

The mudslides missed our house.  The dengue mosquito bit Martha, not me.  Cancer has struck those who paved the way in Bundibugyo (Betty) and those that followed us (Travis), not us.  Today Pat called, and we marveled again at the underserved mercy of being spared all these years the suffering that our friends quietly endure.

In worship this morning, the pastor read Psalm 46, very relevant to those of us at Kijabe where the earth gave way:
   God is our refuge and strength,
   A very present help in trouble.
   Therefore we will not fear though the earth gives way,
   Though the mountains be moved into the heart of the sea,
   Though its waters roar and foam
   Though the mountains tremble at its swelling.

Praying that for our community tonight.  The earth moved and the mountains gave way.  Our fearlessness is not based on the absence of those things happening, it is based on taking refuge in God.  Please join us in praying for the Kijabe community digging out of mud, for the Pontier family burying a daughter/sister/aunt, for the Johnsons facing chemotherapy, for our college kids swamped with papers and exams, for us turning the corner into another week of challenging patients and stretching work.

Saturday, April 27, 2013

Kijabe Mudslides April 2013

Click to see the destruction HERE

Last night, Kijabe received more that 5 inches of rain overnight. 26 inches of rain in the past month.

Add in the ongoing deforestation of the Kijabe Forest above RVA and the result was a severe MUDSLIDE.

The pictures tell the story.

The physical destruction of property will reverberate for some time...

- Severe erosion and mudslides seem to have made the road up to the main highway both impassable and possibly irreparable.  Many, many patients and hospital employees access the hospital via this road.  They will be inconvenienced and it may have considerable impact on the health of many people.

-  Water supply pipes to the Kijabe Hospital have been destroyed.  This will severely impact the functioning of the hospital almost immediately.

- RVA fences have been destroyed.

- Kijabe Boys School (a senior secondary school) experienced serious damage.

-  Many homes and business have had significant damage.

- This will seriously impact the travel of those coming for the funeral of Martha Pontier, AIM missionary who will be buried tomorrow.

There are some things for which to be thankful:

- Miraculously, RVA signed their FLOOD INSURANCE CONTRACT LAST WEEK!

     (N.B. - the Kenya newspaper The Daily Nation reported that 3 girls were killed in Kiambu County, but that did not happen in the immediate vicinity of Kijabe.  The news story is HERE ).

Let us pray for those responsible for those responsible for reconstruction and clean-up.

Wednesday, April 24, 2013


A few months ago we realized that we didn't have enough money in the Jonah Kule Memorial Leadership Fund to pay this year's tuition/fees for the Uganda medical students we are currently sponsoring through this fund.  

We currently have a 5th (last) year student (Julius Monday), two 4th year students (Baluku Morris & Amon Bwamale), a 3rd year student (Katuramu Tadeo), a 2nd year student (Birungi Fred), a first year student (Isaiah Kule) and a student finishing his MPH (Baguma Charles).  It takes over $3500 (all fees) per year per student --quite a deal compared to an American friend we know who is at the Columbia University Medical School in NYC and is paying $75,000 per year.

Well, we asked and you responded.  We now have enough to send this group for another year of medical studies.  Jehovah Jireh (God will provide - Genesis 22:14).  God provided a ram in the thicket for Abraham to sacrifice in place of Isaac.  When no apparent solution is visible, God provides.

Thank you for your generosity! 

While the seed of Jonah's life was buried in Bundibugyo as he cared for his friends with Ebola, we believe that these students are the fruit of that death.   We continue to pray that all of these students will return to serve in Bundibugyo District … for the good of the people there and for God's glory.

Monday, April 22, 2013



I, for one, feel relieved that Tsarnaev the younger is being tried as a US citizen, a civilian.  Because if being photographed near disaster, and being born overseas, are enough to deem due process unnecessary for a citizen, I fear for my own children.  If found guilty, he will not be the only young American man this week that killed people, their neighbors and girlfriends.  They and Tsarnaev should be investigated, and if guilty, they should receive their consequences.  But if we skip the due process and ignore Tsarnaev's citizenship, what have we become?  Where do we draw the "alien" line?  Peculiar that he actually is caucasian, in the original sense of the word.

This past week I flew to Mombasa for meetings of the Kenya Paediatric Association, which I joined this year.  It was the biggest annual scientific meeting for doctors who care for children in East Africa, attracting hundreds of delegates from this country and her neighbors.  We debated surprising data calling into question long-held protocols on fluid administration, recommended policy changes on the treatment of sickle cell disease, called for action on unacceptably high neonatal death. We listened to lectures and case presentations, considered studies, reviewed immunization progress.  It was intellectual and stimulating and inspiring.

And it was lonely.

I delayed making hotel reservations hoping to stay with two young doctor friends, who are moms with young kids and had suggested a cheaper place, better on missionary and Kenyan budgets.  Only after I booked there, they both decided to spring for the elitely fancy and expensive official venue.  And they booked plane tickets on an alternate airline, leaving a couple hours earlier.  So I found myself alone, wandering into the swanky lobby buzzing with consultants and professors and residents, and pondering the possibility that every doctor there (except the residents) made more money than I did. Which I didn't mind, except for the barrier it put up in choosing such an expensive location to meet.  At the end of the day I walked down the beach to my better-budget hotel, and ate dinner alone.

Amongst the hundreds of Kenyans, Ugandans, Tanzanians, Sudanese . . .  there were a few white faces, but all were presenters, leaders, lecturers  important people. No ordinary learners like me. I took every opportunity to introduce myself to those Kenyan paediatricians I sat by in each session, or to try and shake hands with people in the halls.  Once I sat near my hero Dr. Ruth Nduati, who did the most important study of the last decade showing that in spite of what makes sense, breast feeding by HIV positive moms is safer than bottle feeding.  I even spoke to her.

But in three days, NOT ONE PERSON initiated speaking to me.

OK, my two friends from Kijabe were friendly as always when we bumped into each other.  But I don't think I've ever been immersed in a sea of Africans who so pointedly made me feel my alien status.  It may be because of the way the US treated Kenya leading up to elections.  It may be the nature of those meetings.  It may be the different colonial baggage of Kenya versus Uganda (once I approached a vaccine rep at her display table, and as I picked up a brochure she turned to greet me, at which point the Kenyan doctor she had been talking to bitterly accused the rep of ignoring him because he was only African.  Ouch).  It may be that I haven't lived here long enough.  Or that I'm spoiled by the camaraderie of Kijabe.

Or it may have been a good reminder from God that we are aliens and strangers, walking a path of humility and willing to be ignored.  But trying to cross the divide, establish community, live by love.

Alienation and home; a life-long paradox. Two opposite things that are true at the same time, and very tiring as humans to grasp in the right proportions.

Can't Complain

I called one of my Paeds colleagues today and when I said "how's your day" he said "Can't complain". . . upon which I thought, wow, I can ALWAYS complain.  I was checking in with him because I had some desperation texts from the outpatient clinic asking for help, as I was finishing up an admission of a kid that kind of punched my own heart, pushing my new interns in nursery to step up and get some labs and xrays done, all while trying to get home to say goodbye to the Massos who were about to leave for a month of sabbatical, and trying to not even THINK of the hundred loose end emails, people, plans, work that I should be attending do.  His day was just as bad, starting with a bloody death of a neurosurgical baby I'd watched gasp and dwindle on Saturday who took a turn for the worse on Sunday and died in a messy final hemorrhage and shock this morning.  But his reflex reflection was "can't complain."

Which, in some ways, is true.  Because every time I'm ready to throw up my hands and give up, I don't, because there is ALWAYS someone who is a little worse off than I, someone whom I could help if I just hold on another hour.

Last week as I came back from the US, I immediately got involved in the ICU care of a child who died.  A little boy who had been healthy, normal, running, and active the week before, who contracted an unknown infection of his brain, and though we thought we were making some progress, I was paged for a code and we could not get him back.  The brain, when pushed too hard, does not recover.  His parents were devastated.  After I told them, as we walked towards the bed, the chaplain in her Kenyan wisdom told the mother that Satan wanted to get hold of her but that she needed to be strong.  She would not let the mother flail or collapse, she told her to stand up.  So even I, who was teary and about to lose it myself, had to buck up too.  Since then I've wondered about the chaplain's approach.

I thought of it again on Saturday as I went to casualty for a very sick and dehydrated 9 month old girl, Ivy.  It wasn't until I was praying for her with her parents that the detail came out that she was a twin, but her brother Ian had died 4 days earlier on the way to another hospital of the same gastrointestinal disaster.  I could barely keep my voice from quavering too much.  These parents named their babies Ian and Ivy, so sweet, and now they had no time to grieve one as they struggled for the other.  But I thought of our chaplain, and my job, and their needs, and pressed on.

So tonight as the rain pours down, the tears stay mostly suppressed.  This culture is more stoic than our Ugandan atmosphere.  And who's to say they don't have a point.  Can't complain, it could be worse, let's move on, and work for the ones that are left, that we might help.  I've learned from my son that you can always do one more.  One more pushup perhaps for him, one more admission or treatment for me.

And lastly, complaining could be replaced by a bit of thanks:  five at the table, Julia, Jack, Acacia, Scott and me, with pasta and candlelight.  OK it was almost 8 and drizzly and there was a tarantula on the door jamb and we had all had long days, but it feels like a tiny seismic shift of RIGHTNESS to be together again.

So the week will march on, with threatening tears.  A veteran missionary our age, whose family we know, died today.  Veteran African friends, whose ministry we respect, face illness in a child.  My problems suddenly seem trivial.  Can't complain.

Wednesday, April 17, 2013

17 April

15 years ago today, my sister gave birth to her third child and second son.  We were thousands of miles away, and missed the fun.  7 years ago today, a few minutes after midnight, my Dad died.  That time we were only a few feet away.

Family is like that, full of milestones of joy and grief, events we only experience by letters and photos, and others that we agonize through in real time.  In my experience, it's harder to miss the grief milestones than the joy ones.  But both are losses that take a long slow toll over time.

12 days ago, we were in Virginia with my Mom, less than 24 hours from departure, as she turned 77.  This time we were there.  And it was fun.  We took her to a lovely French country restaurant, legendary in the area, the kind of place you only go a handful of times in your life.  She had not been in two decades.  This being our season of paring down and packing up, Julia and I had rather limited wardrobe choices for such an occasion.  So at the last minute we delved into a closet of clothes my mom was keeping for memories.  Julia wore the outfit my mom had donned to leave her own wedding reception 55 years ago.  I wore a black lace party dress she had for sorority functions around the same era.

We all miss my Dad even more in this time of transition and selling.  The home they established over four decades will officially go on the market in the next two days.  We wish he could have been the host of the 77th Birthday, and the 15th.  But tonight we remember only gratefulness for the way he lived and loved us all.

Not Quite at Home

Sitting in the domestic departure lounge at Jomo Kenyatta at 10:30 am on a rainy Wednesday morning.  A table full of Kenyans of African and Indian descent are loudly debating the merits of Ghandi and Mandela while two young Europeans in shorts share a morning beer glued to their individual iphones.  The windows are smudgy, the plastic tables are small, and the lady at the snack counter gave me THREE packets of sugar to put in my coffee.  I can see the control tower and palm trees in the misting cloudy greyness outside.  A free wireless signal tempts me to get on the molasses-slow internet.  Africa.

And an hour to spare threatens enough space for churning thoughts to clamor for attention, which allows some Dave Wilcox song lyrics to surface:

"There will always be a crazy,
With an army or a knife
To wake you from your daydream,
Put the Fear back in your life . . . "

Two bombs in Boston, hard to ignore as an American.  We read the news, watched President Obama give an excellent speech, skimmed the flood of analysis, felt the angst.  Pressure cookers with ball bearings and nails.  A mentally ill attention seeker?  Someone who is angry?  After 911, the immediate suspects are "other", foreign, but if we define a terrorist act as one designed to kill random innocent civilians to inspire terror, well, almost all other incidents on American soil including bombs and school shootings are the work of over-armed under-diagnosed suffering deluded individuals.

I am sitting in a city that has had dozens of bombings (Nairobi) headed to one that's had dozens more (Mombasa).  Which perhaps gives one a bit of a different perspective.  So here are a few thoughts:

1.  Terrorrist acts are levelers.  When someone explodes a bomb in your building, you're no more safe in Boston than in Mogadishu if you're in the wrong place at the wrong time.  Evil does not have boundaries.  All cultures have people who are bent by disease or ideology, who are deceived, who are desperate.
2.  Goodness does not have boundaries, either.  It was inspiring to hear President Obama describe the runners running on to give blood at hospitals.  I watched young men in ABU's (camo) just like Caleb's pull down the barriers to gain access to the injured.  Bostonians reacted with grace and mercy, showing that on the whole terrorism fails to cow the human spirit and instead draws out the best.

HOWEVER, it does make a difference whether you are in Boston or Mogadishu after the bomb explodes. 

3.  My news was flooded with Boston stories on Monday.  But the same day, in the hospital, caring for a Somali patient, I heard that  9 suicide bombers had strode into the High Court in Mogadishu the day before and killed 29 people, while a simultaneous car bomb took the lives of five including Turkish aid workers and innocent bystanders.  This in spite of months of security and progress in Somalia.  This is a huge blow to a struggling country.  But I had to search hard to find news stories covering this tragedy.  How much press has this garnered?  Is it a matter of fatigue that we can not muster enough outrage to mourn Afhagnis and Pakistanis killed by bombs week after week, year after year?
4.  In Boston, 170 injuries as of a few hours ago had only resulted in 3 deaths.  In Mogadishu or Nairobi, the patients with severed limbs and blunt trauma would not likely survive.  Here is a quote from an early news story that sort of slapped me in the face, reality-wise:

At least 21 of the injured were taken to Beth Israel ­Deaconess, where about 100 additional physicians, nurses, and other personnel descended on emergency rooms to help out the 25 or so typically there during a Monday afternoon.

The physician to patient ratio was more than 1:1; and THEN THE REINFORCEMENTS CAME for a 5:1 or more ratio.  Wow.  When a mass casualty rolls into Kijabe, it's just another day on the roads here, the one or two physicians on duty multiply to 5 or maybe ten.  We're a long way from Boston.

And so as I wait for my plane, in transit, I am reminded more strongly than ever of the real message behind bombs and sadness.  This world is not quite home.  Not quite what it should be.  Off balance.  Broken.  And so am I.  But the Dave Wilcox song does not end with the knife-wielding crazy.  

"It is love that set the stage here
Though it looks like we're alone.
In this season set in sorrow, like the night is here to stay . . . 
In this darkness love will find a way."

Sunday, April 14, 2013

A day in the park . . .

 When being deluged daily with over a foot of rain in the last couple weeks, and only rare glimpses of sunshine, it's time to head for the gates of hell.  Yes, Hell's Gate National Park.  This is the kids' school vacation so I was glad to get a day to take them with a few friends to our nearest national park where we rented bikes for an unusual way to view animals.

And we're off.  

Soon this was my view.  At this moment I realized the importance of choosing a park without predators when biking with five teenage varsity athletes.  Because predators pick of the stragglers.  

When we ran out of road we climbed.

And picnicked.

And enjoyed the view.

As well as the animals:  zebra, impala, gazelle, warthogs, buffalo, and a couple giraffe.  None of which I captured very well on a phone while riding a bike and huffing to keep up.  Even I can't really see the zebra that were originally in this picture.  

Mid-day we switched from the park to a nearby "heated" pool where we got a good deal to swim for the afternoon.  And miraculously, we all got sunburned through the overcast clouds, and the rain held off until the very end of our swim.

 And perhaps the greatest adventure of all was in trying to get back home as the torrents of rain beat down once again.  I was too busy driving in low-4WD to snap mud photos until we were almost up to the town.  

Yes, that's the view out my window, of the ROAD.

Monday, April 08, 2013

Don't Do Jet Lag

It's a famous Luke Myhre line:  "I don't do jet lag."

On the Africa to America leg, we simply jumped into life and it worked. It's a long day (extra 7 to 8 hours) going that way, and for me that is easier.

On the America to Africa leg of the journey, the jet lag issue is usually a little more intense.  We left the US Saturday afternoon, travled 20 hours snatching a little nod of sleep on the airplanes, and landed in Nairobi Sunday night, home to Kijabe about midnight.  Slept 1 am to 7 am and then it was back to reality.

Today 8 new Medical Officer interns started DAY ONE of their internship, so Scott and I had to be at their orientation at 8 am.  And I also had a new visiting doctor to help orient, rounds to do, clinic, patients. We lost my phone's SIM card in the move, so Scott was scrambling to replace it, and at one bizarre moment today I was wheeling an infant I had just intubated for respiratory failure through the halls on the way to the ICU breathing for her with a bag, and trailing an oxygen cylinder and two nurses, as he passed me to pick up the nonfunctional phone, and he said "I guess you hit the ground running".  Amen.

Hospital 8 to 5:15, Junior Class sponsor party 5:30 to 7, Kijabe Hospital greet-new-people dessert night 7-8 . . .

I know that busy-ness can be a strategy to numb grief.  And that's supposed to be a bad thing.  But for the moment I can just say it worked, I walked through this day without bursting into tears, and while being numb is not a great way to live, for now it's all we can do.

Epic Fail

Once upon a time, we took a full year sabbatical from Africa.  We enrolled in the MPH degree program at Hopkins, and rented a house in Baltimore.  And collected stuff.  Discards from relatives and friends, free stuff, hand-me-downs, a few antiques, an ikea table, chairs.  Books.  More books. Stuffed animals and toys, dishes and towels, tupperware and framed prints.  All the clutter of a life with four kids and two grandparents and community soccer and grad school. And at the end of that year only the most perishable photos made it into my parents' basement where they joined a lifetime collection of records and letters and school papers.  The rest of it was crammed in to free storage in a container at my dad's equipment yard.  Apparently we didn't have ANY time to organize and cull.  Or more likely, we were suffering from recent war and displacement and somehow believed that we were wisely preparing for the possibility of another disaster.

Instead, we provided excellent substrate for a dozen years of dust and mold.

And a mammoth task of sorting and disposal as we're losing the free storage, and now have to rent a small space for the few boxes of dishes from our wedding, photos, a table and chairs my mom doesn't want to move, less than ten percent of our books, some shelves.

What to do then with pretty much an entire household of hand-me-down stuff that we no longer have the margin to keep as an emergency stash?  And wouldn't particularly want to at this point.
Friends recommended a yard sale.  Put it on Craigs List, they said, and you'll see it all disappear. Hundreds of people scan these sales and snatch up the leftovers. Saturdays are best, so we got up very early on the day we flew out, and unloaded that container, and set our rock-botton one-dollar prices.  I was thinking of how we could put the money to good use.  We put up posters, and waited for the customers to roll in.

And waited.

And waited.

We had precisely three customers.

One lady bought two measuring cups.  One guy bought a weed wacker.  And the third looked and considered and then left.

It was an epic fail of a yard sale.  Our plane was coming in a couple hours, so we had to load it all back in and leave.

It felt like an epic fail of greater proportions.  A failure to understand the American yard sale scene, the mechanics of Craigs List (you have to repost every 24 hours), a failure to complete our task, to deal with our things, a failure to finish well.  A failure to keep this burden from falling to others. A failure to have things that anyone else values.

So tonight we remember our Good Friday sermon:  the disciples needed to understand that failure was the necessary beginning of redemption.  I don't know how this miserable yard sale failure will be redeemed, but I do know it will be, somehow, in the all-things-new of undone disappointments.

Friday, April 05, 2013

Words and Pictures: 2 weeks in review

Two weeks.  Two sons arrive, and leave.  Two trips, each two nights, one to West Virginia at the beginning to my roots, one south at the end to look at 4 colleges.  Two holidays, Easter and my mom's 77th birthday.  Too many decisions, because every hour between all that was spent sorting through boxes of every letter ever received, text books, trophies, clothes, scrapbooks.  Making decisions about furniture and mirrors and dishes and towels and tupperware.  Too much to describe, so here are a few words and phone-photos to illustrate.