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Tuesday, June 13, 2017

Reshaping the world, in minuscule quanta

This is baby A, all 1.1 kg of her, who disguised the fact that part of her intestinal tract was missing by being a typically fragile little preemie with jaundice and an infection and spitting up feeds.  Last Monday, though, I was pretty sure this was more than just being tiny, and thankfully the Kijabe paeds team and surgeons agreed to take her in spite of her critical condition.  A few days later, Scott and I went to Kijabe to cover for a couple days and a night.  She looked much better already, alone instead of in an incubator of 3, getting total parenteral nutrition instead of plain sugar-water IV fluids, and waiting for surgery.  I think you can see the relief on her mom's face, too.  And when I went back to Naivasha yesterday, the moms of the other dozen or so preems were thrilled to see her picture and hear her report.  It's a communal effort, and a communal joy that God would provide unaffordable and inaccessible specialized care for one, demonstrating love and awareness of all.

Or consider the story of baby C.  Her pregnant mom went to work Thursday in Naivasha town, but didn't turn up on Friday.  Neighbors thought they heard a baby cry sometime Friday morning, but no one answered when they knocked, so they though she had left the room where she lived alone.  No one saw her or heard from her for over 48 hours, so when a friend from work came to check up on her Sunday they community decided to break in her room by removing a roof tile (New Testament style).  They found the mom on the floor unconscious, and the baby also on the floor still connected to her placenta.  Miraculously, they were both alive, and were rushed to our hospital which in spite of a nursing strike still keeps admitting those who have nowhere else to go.  Like kids with AIDS or meningitis, adults with TB, babies who need oxygen, pregnant women in labor, post-partum moms with bleeding or hypertension.

Such small people, such limited stories.  And in the face of so much uncertainty and frustration and injustice, strikes and closures, is it enough? 

Which is why these words on-line jumped out at me this week: 

Only the forgiven can forgive, only the healed can heal, only those who stand daily in need of mercy can offer mercy to others.  At first it sounds simplistic and even individualistic, but it is precisely such transformed people who can finally effect profound and long-lasting social change.  It has something to do with what we call quantum theology.  The cosmos is mirrored in the microcosm.  If we let the mystery happen in one small and true place, it moves from there!  It is contagious, it is shareable, it reshapes the world.  (Rohr, Hope against Darkness, 2001)

 Getting one tiny baby's bowels reconnected; warming up a starving newborn and mom stranded dying in their home, unnoticed.  These are almost invisible quanta of justice in a world that is fractured.  And they are enough, because by grace they are contagious, spreading out like ripples in the space-time pond of reality, from the cross out to the renewal of all things.  

 Being back at Kijabe was a paradox of sweet memories and head-spinning change.  This hall connects the old hospital to the new; Acacia and Jack helped lay out the river-of-life design for the floor tiles back in the day.  Now there is space, cleanliness, light, comfort.  And monitoring, good staffing, intense care.

Colleagues, smart dedicated people, multiple consultants here on a Saturday morning reviewing patients and carefully signing out the sickest ones to each other.  Trainees, of all levels.  Labs.  Function.  A lot of good happens here. 
Scott did an emergency surgery on a critically unstable woman bleeding from an ectopic pregnancy and kept watch over a busy labor and delivery; I managed the 30 or so babies on the newborn service then covered everything from a dog-bite to a new leukemia to a lung-damaged baby on a ventilator and an epidural hematoma/skull fracture in an 8-year-old hit by a motorcycle while trying to cross the road to her school bus (sounds terrible but she was awake and smiling).  It was exhausting to cross cultures back into that world again, and fun, and we're so glad we could.
The newborn unit has happy walls and a Bible verse.  I showed the resident my old habit of making a list of the critical patients on the white board and going over it with the nurses.  It felt good to be back.

For a day. But coming back to Naivasha, I have to say, felt like home.  Yes, we have a LONG way to go to reach Kijabe-level care.  But at Naivasha we provide a reasonable fraction of that care with a minimal fraction of the resources.  Now we're into our second week without our regular nursing staff (they are on strike), and with reduced patient admissions, and without assurance that the doctors won't resume their strike.  It's hard. But . . the new interns have given us a little breath of fresh air, as we teach on rounds, give lectures, answer questions.  There is good to be done, and God has so far allowed us the health and stamina to keep doing it.

Scott took this page out of our own training--teaching suturing skills on raw meat.  These interns significantly improved on their C-sections after an afternoon of training.

The quantum of care at Naivasha feels even smaller after being at Kijabe.  But in this world held together by the invisible forces of grace, it just may reshape everything.  

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