rotating header

Monday, May 27, 2013

Spain, mostly safe and sound . . .

A quick post from our "company conference" on the Spanish coast.   Hundreds of people, hugs, name-tags, memories.  Rocking worship.  Exposition.  Seminars.  Bustle.  Meals.  Ocean breeze and freezing cold water.  The buzz of conversation, the murmur of prayer.  New babies, and honoring our founding mother Rose Marie.  Family feel.

But as with anything that has world-impact-potential, not without struggle.  The  biggest one for me is being here fragmented as a family.  It's the first time to come without LUke and Caleb.  Their absence is an ache, an off-balance unsettled missing of something.  I didn't realize how hard it would be.  And until a few hours ago, we had only Julia with us, having left Jack in Kenya for two extra days.

We let Jack stay behind for RVA's major Rugby event of the year, the Blackrock tournament.  He had a blast and scored the winning try in quarter-finals and set up the winning try of finals, so a great day for him, really fun. His JV team won the lower tier of this varsity tournament, and the Varsity team came in second in the top tier.  All well and good except that he then had to travel alone, through Dubai and Portugal to get to Spain.  And unbeknownst to us, Portugal has some stringent requirements about minors.  So when he showed up at the airport in the dark of night in Nairobi, dropped off by a taxi and all alone, the airline refused to check him in.  Thankfully he pulled out his emergency phone numbers, someone found us here in Spain, Scott emailed letters and scanned passports.  Then we checked back and he was still stuck because (surprise) the printer was down and the airline was struggling to print the documents . . but finally he was allowed through.  The rest of the trip went well.  After that stressful beginning I had planned to take the hour drive with Rachel (Matt's new wife) to meet him at the airport. 

Only at lunch, ironically a time set aside for all the medical people in WHM to eat together, I started feeling really peculiar.  Had I not been eating with a bunch of doctors including one world-famous toxicologist I might not have every known that I was having a classic food poisoning reaction to bacterial overgrowth in poorly refrigerated dark fish, called scombroid reaction.  Evidently the bacteria makes histamine.  Here is a medical text on exactly how  I felt:

"Signs and symptoms of scombroid toxicity usually begin within an hour of eating contaminated fish.  The symptoms resemble and IgE-mediated allergic reaction.  The patient may suddenly experience flushing, a sensation of warmth, and erythematous rash, palpitations, and significant tachycardia.  The rash often is especially prominent on the upper torso and face.  Headache, blurred vision, respiratory distress, and dizziness have also been described."

So after a nice slug of benadryl and ibuprofen I passed out for the afternoon, missed the airport run, and Jack had to figure out who Rachel was (which he did when he asked her for a pen to write down the number the WHM people gave him when he called again feeling slightly abandoned on arrival, and as he wrote the number they realized they were looking for each other . . ).

Still have a seminar to help teach, and lots of great conversations ahead, reunions and thought.  But all this reminds me that it's a battle.  Our speaker gave us the story of Gideon, fearful and flawed, to remind us that God uses the weak.  That's us, for sure, limping in and dependent.

Friday, May 24, 2013

There are Days . . .

 . . when I briefly consider whether I can go on.  When the stress and sadness of working on the edge of life just seems like too much, when the losses accumulate and threaten to overwhelm.  This week it was Tuesday afternoon.  I nearly missed a monthly meeting for the Bethany Kids department (Paediatric surgery and Neurosurgery), we were receiving one admission after the other, two babies who had become dangerously jaundiced and infected and dehydrated at home, another born prematurely with a spinal cord defect.  In between examining and evaluating and supervising the inerns' orders, I was shuttling between nurses and departments trying to sort our overflowing wards in such a way that the limited oxygen could reach everyone who was struggling to breathe.  I had a student sick with what looked like it could have been a serious, life-threatening illness (it wasn't, she's fine, but missionary kids are targets of spiritual attack and I carry that burden heavily).  I was on call so trying to catch up on critically ill patients for the evening, including a little girl who was deteriorating after brain surgery to remove a tumor and a baby who was being ventilated because of damage his lungs sustained at birth. Miscommunication with a surgical service had frustrated me. And never far from my mind and heart, thoughts about my own child who was stuck in a dorm room for two weeks with not much to do or look forward to after a friend canceled a planned visit.  And a foster-son who was going through a serious struggle, all over a scratchy hard-to-follow phone line.  Scott was already gone all week to WHM leadership meetings in Spain.  So all the responsibility of home was also on my shoulders, for food and homework and communication and dogs and laundry.  Oh, and of course, a minor bacterial infection just for good measure, leaving me nauseated and weary.
(Baby Bina, our tiniest preemie yet, 580 grams/25 weeks and still fighting strong at 2 weeks old.) 

On days like that I don't really look forward to the conference which starts tomorrow, the triennial all-fields meeting of World Harvest.  Sure the break from the relentless pace of work and need sounds appealing, and the location should be lovely.  But after two decades in this business, I'm supposed to be one of those senior sorts of people who will overflow grace and peace and love to others, who will fly in ready to minister.  Who will listen with wisdom and have just the right insight.  Who has this whole messy work/life/family/ministry balance in relative equilibrium, as an example and encouragement to others.

Instead of being someone who walked the short dirt path from home to hospital with tears dripping down and stomach in a knot, whose prayer disciplines have weakened, whose stretched heart keeps reaching a breaking point.

But then the Spirit reminded me:  ministry from weakness is a core value of our mission.  One of those little phrases that sounds pious and humble, but feels completely out of control in real life.  That it's OK to come to the conference worn out and wobbly, and to enter into conversations with nothing much to impart.

Because we're there to impart Jesus.  Only.  And that's enough.

Matchmaker, matchmaker

Matchmaking, it seems to me, would be a noble profession.  Seeing need and opportunity and finding win-win mutually beneficial arrangements with the potential for long lives of blessing.

This week I felt a little thrill of matchmaking.  No, not for a marriage, though I do believe this is a love story.  Love that brings people out of their homes at dawn and into a chaotic ward full of children whose brains are being compressed by too much fluid, whose spinal cords are damaged and exposed, who often can't walk, need help to go to the bathroom, appear disproportionate and a bit unsettling.  Kijabe hospital has become a mecca for the neurologically disabled.  We had a surgeon here, Dr. Bransford, whose heart for special-needs children launched all kinds of surgical programs.  And we have one now, Dr. Albright, who with his nurse-practitioner wife has brought a lifetime of academic experience to bear in the epicenter of spina bifida and hydrocephalus.  If you build it, they will come, and the most challenging kids from all over Kenya find their way to Kijabe day by day.  Dr. Albright does more surgery here in a month than he did in the States in a year.  On my call this week I admitted three newborns with spina bifida, and heard three more were also seen.  That's one day, 6 new cases of a very complicated condition.

When I first came to Kijabe, I quickly realized how much I leaned on the excellent care of our two Clinical Officers (like PA's), Bob and Lillian.  And I noticed how busy the neurosurgical service was, and thought a CO would be a great benefit to them.  But nothing comes quickly at Kijabe, and this idea had to go through proper channels of approval.  When the 2012 CO intern class finished in November, we got the hospital to hire one for Paediatrics. Thanks to insight and advice from Dr. Erika, we chose Veronica because she had demonstrated a real heart for the babies.  It wasn't easy to pull this off.  Veronica could have made nearly double her salary elsewhere, and Kenyans experience significant family pressure to obtain a more secure and higher-paying job.  But she felt God drawing her to KH, so she signed on.  She received neonatal training in December, and then began a 4-month training and work period with us in the Nursery while our regular CO was on maternity leave, with the plan that at the end of that time we would release Veronica to work with the Neurosurgery team.

This week the Neurosurgery team confirmed that they want her to stay on long-term, and she confirmed she wants to do that.  Hooray.  I know this will bless the children.  I can be standing in nursery and watch staff go right by me to bring their issues to the CO, who is considered more approachable.  I have time after time seen Veronica find out more back story, minister to Moms spiritually, go the extra mile to ensure that needs are met.  A team needs skilled surgeons but also compassionate hands-on language-fluent primary care members.

That evening I was so happy, that Veronica might make the lives of the way-too-busy and dedicated Albrights a little better with her work, that they might teach her some specialized and excellent medicine, that mothers and babies would be cared for well, that nurses would have a better way to communicate with the surgical team.

A small joy of matchmaking that will, I hope, bear much fruit.

Sunday, May 19, 2013


Matt 4:16-"The people dwelling in darkness have seen a great light, and for those dwelling in the region and shadow of death, on them a light has dawned." (from Is 9:2)

For the last few months, we have lived in the fog and sog of a cloud here at Kijabe.  Rain, and more rain.  Deep sucking mud.  Grey skies.  Dim.  Cold.  Pounding on the roof at night, dripping into the door, washing down the hillsides.  The thing about living in gloom is that after a while it seems normal to trudge through a muted background.

Much of the last couple years has been foggy for me, too.  Too much parting.  Too much just trying to make it through another call, another rounds, another admission, another resuscitation.  Another death. This past week it was the frail baby in heart failure who no longer moved or responded.  After a tearful discussion with his parents about the reality of his impending death, I disconnected him from his monitors and dressed him and wrapped him in a blanket for his mom to hold. ( I offered to snap a photo for her memories, and a kind RVA teacher printed it for her to take home the next day.)
And when she was finished saying goodbye, she and her sister and husband handed him back to me and retreated to mourn.  His heart was still beating in spite of his lack of breathing; the nursery was bustling with work and other babies and parents.  I could not bring myself to just lay him alone in his cot, so I sat there in a sacrament of not-doing, just waiting and holding him.  Until the last flickers of life ebbed, slowly, imperceptibly, from his body.  A dark hour.

Then one day this week, the sun returned.  I looked down and saw shadow.   And it occurred to me that those rainy months did not have much shadow, because shadow is created by light and matter.  When all is dark and gloomy, you can't really tell the boundaries, there is either no shadow or all shadow.  But when light comes, the shadow is apparent.

Even the shadow of death is a shadow because of the bright reality of life.  

So here at Kijabe, where death is too-often present, I am wrestling with that shadow and looking beyond it.  The valley of the shadow of death is a part of the journey, but it is only in shadow because there is a ridge, a peak, of glory that we are ascending towards.  Glory that is dawning over gloom, until all the shadow is swallowed up in victory.

Thursday, May 09, 2013

God's fingerprint is everywhere

Read this quote today:

May I, too, celebrate the gospel wherever it rises. None of us will get all this right; better to herald the common places and extend the benefit of the doubt. God’s fingerprint is everywhere; none of us own the rights to His endorsement. If a believer on the opposite end of the ideological spectrum says something good and true, may I say without hesitation, “Amen.” I’m often afraid to identify with certain people lest I be labeled with their brand, but that is foolishness. The gospel is always beautiful, and I am not in singular possession of its power. That is so arrogant. May I bend my knee to Jesus wherever and in whomever He reigns.
(Jen Hatmaker, A Deeper Story )

Having benefited from grace, let us extend it.