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Sunday, November 30, 2014

A desert of hope

For the last week I had the rare opportunity to travel to an area of Africa that is recovering from civil war and both witness and participate in the rebuilding of a nation.  Great stuff.  I could write volumes but if I do I won't be invited back, so I'll just give some vague and general observations.

Jesus said, "You have heard that it was said, 'You shall love your neighbor and hate your enemy.'  But I say to you, love your enemies and pray for those who persecute you, so that you may be sons of your Father who is in heaven.  For he makes his sun rise on the evil and on the good, and sends rain on the just and on the unjust. . . ."

Scene One:  Eating dinner late one evening, six chairs pulled up around a small round table, goat and rice and chips and chicken, I look around.  Four nations, all of whom have reason to distrust one another due to past injustice and acts of terrorism.  But in that moment we are humans only. We share stories, childhoods, dreams, hard work, ambitions, hunger and joy.  It is all to easy to think of any category of people as dangerous, or different.  The remedy is to meet one on one. This is what the Kingdom will be like.

Scene Two:  Straining to understand a language that seems to be English only all the consonants are pronounced differently, I listen to a Family Medicine Resident present a patient.  I am doing rounds with the only post-graduate trainees in the country, teaching about fluids and apnea and feeding and infections and all the familiar (to me) nuances of pushing down the appalling 10% infant and 10% maternal mortality in this place.

Scene Three:  Fifty 5th year medical students crowd into the classroom, and I lead them through and evidence-based approach to child survival interventions, question them on a differential diagnosis of chronic cough, draw a 4x4 table to explain the concepts of a test's positive predictive value.  The brightest is a girl seated to the side with the few female students, veiled, but whenever I meet her eyes I see she gets it.  This is the hope of the future.  These are the people who will decide policies, promote public health, perform surgeries, comfort the dying.  They are the only resource of this desert, human potential, the sheer will upon which development will build.

Scene Four:  This one was the most surreal.  After a week of solid work, we take a late afternoon off to climb (with an armed escort of course) a hill that overlooks the town.  Half-way up a little girl who is outwardly indistinguishable from the cohort of her scampering cousins sits by the side of the steep rocky path.  "You speak English?!" she pipes up in a shockingly American accent.  J is 12, back from California on a visit to her maternal relatives, a bit unnerved by the heat and dust and unfamiliarity.  She takes my hand like a lifeline and we climb together.  Welcoming, educating, loving the nations as they pour into America yields trust and makes the world a smaller place.

Scene Five:  A little girl whose requisite conservative dress includes a long flowing flammable polyester dress gets too close to the open cooking fire, and goes up in flames.  We don't see her until five days later when she is severely dehydrated, in respiratory distress, minimally conscious.  The polyester melts into her skin and the burns are deep.  In spite of careful dressing and a line and fluids and antibiotics and oxygen, she does not survive.  The last half hour I lean over her bed with a bag-valve-mask I found on a shelf, and keep her breaths coming and heart beating, but I know we have lost the battle.  I am frustrated that unlike Kijabe, I can't talk to the family and comfort them as I am used to.  I don't have an ICU with a ventilator and pressors.  This is a preventable, tragic death.  Someone looking for the next public health campaign:  flame-resistant fabrics in all countries where girls both have to cook and cover themselves at age 6.

This country is a paradox of rubble and hope, of harsh sun and cold night, of burgeoning new universities and extreme poverty.  I am thankful to have been the recipient of their hospitality, and to have been a tiny part of the sun rising and rain falling.

Thursday, November 27, 2014

Thanksgiving thoughts

This may have been the first time in my life I was completely away from any family and any semblance of Thanksgiving.  More on that when I get back, but for now let me reflect on thankfulness.  Everyone is thankful for their families, but never so much as when your only contact is a hasty minute or two on the phone because you're in a country where you're not sure who is listening or where/how you can get more airtime.  I am thankful that persistent friends woke one of our kids up for an early flight to the West Coast when her phone malfunctioned.  I am thankful that all three USA kids are with Scott's parents in CA, being stuffed like proverbial turkeys by Nana's amazing cooking, and riding bikes along the ocean to refresh their weary souls.  I am thankful that our Serge team in Kijabe took in Scott and Jack for a true celebration with friends from multiple countries.  I am thankful for a creative-cook of a husband who made this brick-oven turkey even though I didn't get to eat it (and who has effectively become the primary responsible adult in our household over the last couple months with my travel and work making me less and less functional).  I am thankful for my family-of-origin being together in West Virginia in spite of snowy roads.

But for this post let me be thankful for something else, with thoughts spurred on by the great philosophical movie, Two Guns.  We watched it on our TV service, which means about 20% was blipped out, but there is a scene in the middle where the two main characters are sitting in a bar.  Mark Wahlberg gives a speech on "why we fight", and it is for the guy next to you, your colleague and comrade who is with you in the struggle.

So today I am thankful for my Paeds team at Kijabe.  As of this week, we are fully staffed for the first time ever, as Dr. Arianna began work officially on Monday. Four full-time paediatricians, augmented by one short-term and two once-a-week part-timers.  Last week was a doozy, with one person out for a death, another on leave, and several other issues pulling us in multiple directions, as is generally the case. Yet as I walked back and forth on the familiar path to the hospital, juggling critically ill intubated patients with uncertain diagnoses, talking to families who were resistant to care, making hard calls on a baby whom we had resuscitated over and over, the usual, things that could easily drag one down, I was surprisingly unfazed.  I realized with gratefulness that in all these situations and more, I am working with a great team.  We approach patients with the same level of concern and dedication, we have a compatible framework for decision-making.  We pitch in for each other.  We are friends.

This was one of our primary goals coming out of our longterm planning retreat--strengthening team relationship is the essence of staying power.

So a tribute today to the Paeds team, whom I am missing, and the beauty of community in life and work.

Saturday, November 22, 2014

There and back and there again . . .

November somehow became a month on the move.  I (Jennifer) was asked by our Serge leadership back in August to attend a first-ever "Vision Summit" for our mission, an event designed to honor and draw in donors as we clarified our vision and described our work.  A lot of work was invested in making this a professional-quality presentation.  Serge uses three pillars to explain what we do:  Renew, Reach, Restore.  Renew encompasses the Sonship course, Gospel-Centered Life, and the plethora of resources for personal discipleship and Bible study that propel our hearts to come alongside the work of Jesus in the world.  Reach incorporates the extension of this Gospel-focused transformation from the lives of believers to neighbors and friends across cultural barriers all over the world.  And Restore embraces the full-person whole-world nature of the way Jesus is making all things new, including partnering in health care, education, rescue from slavery, job provision, agriculture, training indigenous leadership.

So last week found me on the Florida coast with dozens of supporters, board members, our executive leadership, and a few other missionaries, worshiping together and giving speeches and watching videos that represented these three pillars using examples from Serge work.  I was the "Restore" speaker, and while I loved writing the speech I was pretty nervous about giving it.  I'm told it went OK.

A huge perk for me was that my mom had been invited, so we got to spend several days together at a lovely hotel, and we decided to fly Julia down for two nights so I could catch up with her too.  Julia and I took a beach walk and a bike ride in our free time, and we all enjoyed just talking and eating together.

I left here on a Monday night after work, arrived Tuesday evening in America, conference prep and rehearsal on Weds, conference Thursday to Sunday.  I flew out of America Sunday afternoon and got back this Monday night and went back to work on Tuesday, facing a week with staffing shortage, a Tues/Thurs call sequence, and a lot to do.  It was what you might call a whirlwind.  So I have to give the testimony that God gave me grace to jump into the time zone and the work both ways.  I have never traveled so easily, and been so quickly functional.  I slept and woke on the right time zone immediately both ways.  It was amazing.  I'm not recommending this but if you have to do it, miracles can happen.

Meanwhile Scott had a birthday in which he delivered four "birthday buddy" babies by C-section then went to a dinner that was hosted by our wonderful Serge team here, held down the fort, taught Sunday School and hosted the boys' football (soccer) team end-of-season pizza-fest all on his own, while working full time.  Jack got the news that he was a National Merit Scholar which I found out when I noticed a card tucked in behind a picture on the mantle . . and continues to work on college apps here and there as the deadlines loom.

But November is not quite over, and another trip starts tonight for me.  This one is in my same time zone, but a couple countries away.  Kijabe Hospital doctors make about four trips/year into this area that is poorly served medically and difficult for outsiders to access. Most of the trips are surgical, but they asked a Pediatrician to join this one.  As this trip came together it became clear that the only one on our team who could possibly go was me.  So tonight I head towards the airport, joining two young Kenyan surgeons.  I'll be teaching all week (family medicine residents and medical students) and seeing patients in a rural hospital.  I'm not quite sure what to expect, and I have to dress extremely conservatively including head scarves, so prayers appreciated.  Renew, Reach, Restore is what we're all about here, and I'd rather do it than talk about it, but I'm nervous.  And pray for Scott and Jack, abandoned once again, with me missing Thanksgiving and the last week of the school term with exams.  Grateful for your partnership . . . Jennifer

Friday, November 07, 2014

The Inefficiency of Love

I survive on efficiency.  Multitasking, prioritizing, keeping balls spinning in multiple spheres.  Up until 4 am?  Working all day?  Dinner for 10?  Parent with a sick kid asking for help?  That's how it goes.  As in, literally, yesterday.  Which is, I suppose, a form of love.

But there is a certain inefficiency to love that interrupts, that doesn't add up, that has its own beauty.

As in, literally, the Christmas Package.

Yes, every year, our faithful friends in Cincinnati send us the Christmas Package.  There is always a puzzle and some treats.  It is not fancy.  But it has been a rare constant in a life of uncertainty and alienation and we LOVE it.  The puzzle is a family tradition in the week before Christmas, it stays on the table until it is done.

So when a clerk passed me in a basement hall of the hospital yesterday and said "Mrs. Doctor Scott?  You have a package slip!" I knew this must be our friends.  It is often the only package we get in a year, and for good reason.   This is the inefficiency of this system:

Over a month from mailing to receiving.
Postage is twice stated value of contents.
Hospital does not want to put package slip in our mail slot in case it is stolen, so it waits until someone happens to tell me the package is there.
I walk to the post office to retrieve it.
I pay then 75% duty on stated value of contents, meaning that if X is purchase price of goods, the actual cost is 3.75 x X , as in almost quadruple.
The Kenyan postal service has opened the box and unwrapped every item inside, then jumbled them back in with tape.  They even cut open with a knife slit the ranch dressing mix.  In case it was cocaine I guess.

But the truth is, this package makes us feel loved.  This friend was an MK herself.  She knows the value of tradition, of small pleasures, of being known and remembered.  
This is love.  Even if it costs four times what it should, and takes months, and arrives damaged.  I need prayer to be a loving person.  To waste time.  To not keep packing life until it is well-wrapped and cost-effective.  To focus on the people and things I care about even when pressure is on to be more efficient and do more.  
One night this week, I was rattled out of bed at 3 because a slightly premature but small stressed baby had been delivered by C-section and had no heart beat or signs of life. He was known before birth to have some congenital malformations.  Even though I got his heart started and he turned pink, I knew his brain was not going to recover.  But his mom had general anesthesia and was in the hospital alone.  I decided to keep giving him breaths until morning, when I could talk with the grandmother and mother, pray, and have them hold the baby.  My hand was cramping after a couple hours of bagging. I got the kind and handy biomed tech to jerry-rig some connections on an old ventilator finally. But morning came.  We took out the tube, and he died in his mom's arms.  That was not efficient.  But I think it was love.

Another night this week, it was a jaundiced baby.  I tried to bring the bilirubin down with lights and fluids.  I ran samples to lab myself, waiting and hovering, willing the news to be better.  It wasn't.  An exchange transfusion was indicated.  It was midnight.  My intern was a star.  We worked together, and got it done, and the baby is fine.  By 1:30 am I sent her home to rest, just as I was called to ICU.  
Another infant with a head injury and bleeding between his skull and brain was not breathing.  The next two hours I spent with him, putting in a tube, giving breaths. Suctioning, monitoring, watching.  It was one of those nights where nothing worked.  By the time we got an xray, the tube had slipped out.  But by that time, he was breathing again, and we had made it through the night.  He held on for a couple more hours then went to surgery to clear out the huge blood clot.  Now he's breast-feeding and crying and looking like he will live.  Some very inefficient hours fixing stuff, searching for stuff, repeating stuff.  But that, I believe, was love too.

As I walk back and forth to the hospital, trying to squeeze some efficiency into hours that might yield some sleep, I ask for grace.  Grace to be like my friend in Cincinnati, to be like Jesus.

Jesus sat by the well and asked for water.  He waited three days to show up at Lazarus' tomb.  He walked and wandered.  And I'm sure He would have sent Christmas packages, even if they were pillaged and costly.  In a way, He was the Christmas package, cut open and betrayed and yet a physical palpable inefficient love.